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Opiate Alternative

Maura Sammon, Alveena Dawood, Scott Beaudoin, Richard A Harrigan
BACKGROUND: One of the principal tasks of an emergency physician is identifying potentially life-threatening conditions in the undifferentiated patient; cardiac dysrhythmia is an example of such a condition. A systematic approach to a patient with atypical dysrhythmia enables proper identification of such-life threatening conditions. CASE REPORT: We describe a 31-year-old man presenting to the emergency department with an undifferentiated dysrhythmia after naloxone reversal of an opiate overdose...
October 7, 2016: Journal of Emergency Medicine
Marcus Hards, Arisa Harada, Isobel Neville, Sheelagh Harwell, Mahwash Babar, Abdulsatar Ravalia, Giles Davies
STUDY OBJECTIVES: To determine the effectiveness of serratus plane block performed under direct vision on postoperative pain after mastectomy. DESIGN: We performed a retrospective study of elective breast surgery patients undergoing mastectomy over 6 months. We collected data on the outcomes for the pain score and use of analgesia in recovery, the use of analgesia and antiemetics overnight, and the pain score and mobilization status of the patient 1 day after the operation...
November 2016: Journal of Clinical Anesthesia
Lewis Mehl-Madrona, Barbara Mainguy, Julie Plummer
BACKGROUND: Opiates are no longer considered the best strategy for the long-term management of chronic pain. Yet, physicians have made many patients dependent on them, and these patients still request treatment. Complementary and alternative medicine (CAM) therapies have been shown to be effective, but are not widely available and are not often covered by insurance or available to the medically underserved. METHODS: Group medical visits (GMVs) provided education about non-pharmacological methods for pain management and taught mindfulness techniques, movement, guided imagery, relaxation training, yoga, qigong, and t'ai chi...
August 2016: Journal of Alternative and Complementary Medicine: Research on Paradigm, Practice, and Policy
Hilary Longhurst, Anette Bygum
Hereditary angioedema due to C1 inhibitor deficiency (C1-INH-HAE) is a rare disorder characterized by intermittent and unpredictable episodes of swelling which cause disfigurement, disability, pain, or, in case of laryngeal swelling, risk of death. Historical factors, including the intermittent nature of the disorder, the lack of awareness of this ultra-rare condition amongst medical personnel, lack of specialist centers, and limited treatment options have contributed to under-diagnosis and under-treatment of the condition...
October 2016: Clinical Reviews in Allergy & Immunology
María M Hurtado, Amadeo Puerto
The parabrachial complex has been related to various rewarding behavioral processes. As previously shown, electrical stimulation of the lateral parabrachial external (LPBe) subnucleus induces opiate-dependent concurrent place preference. In this study, two groups of animals (and their respective controls) were subjected to sessions of rewarding brain stimulation daily or on alternate days. The rats stimulated every other day maintained a consistent preference for the place associated with the brain stimulation...
October 1, 2016: Behavioural Brain Research
Jack L Stanley, Daniel V Mogford, Rebecca J Lawrence, Stephen M Lawrie
OBJECTIVES: Non-illicit alternatives to controlled drugs, known as novel psychoactive substances (NPS), have recently risen to prominence. They are readily available, with uncertain pharmacology and no widely available assay. Given that psychiatric patients are at risk of comorbid substance abuse, we hypothesised that NPS use would be present in the psychiatric population, and sought to determine its prevalence and investigate the characteristics of those who use these drugs with a retrospective review of discharge letters...
2016: BMJ Open
Virawudh Soontornniyomkij, Anya Umlauf, Benchawanna Soontornniyomkij, Isabella B Batki, David J Moore, Eliezer Masliah, Cristian L Achim
Methamphetamine (Meth) use is common among HIV-infected persons. It remains unclear whether Meth dependence is associated with long-lasting degenerative changes in the brain parenchyma and microvasculature of HIV-infected individuals. We examined the postmortem brains of 78 HIV-infected adults, twenty of whom were diagnosed with lifetime Meth dependence (18 past and two current at the final follow-up visit). Using logistic regression models, we analyzed associations of Meth with cerebral gliosis (immunohistochemistry for ionized calcium-binding adapter molecule-1 (Iba1) and glial fibrillary acidic protein (GFAP) in frontal, temporo-parietal, and putamen-internal capsule regions), synaptodendritic loss (confocal microscopy for synaptophysin (SYP) and microtubule-associated protein-2 (MAP2) in frontal cortex), β-amyloid plaque deposition (immunohistochemistry in frontal and temporo-parietal cortex and putamen), and arteriolosclerosis (histopathology in forebrain white matter)...
April 20, 2016: Journal of Neurovirology
Ludovica Monti, Azzurra Stefanucci, Stefano Pieretti, Francesca Marzoli, Lorenzo Fidanza, Adriano Mollica, Sako Mirzaie, Simone Carradori, Luciano De Petrocellis, Aniello Schiano Moriello, Sándor Benyhe, Ferenc Zádor, Edina Szűcs, Ferenc Ötvös, Anna I Erdei, Reza Samavati, Szabolcs Dvorácskó, Csaba Tömböly, Ettore Novellino
Fentanyl is a powerful opiate analgesic typically used for the treatment of severe and chronic pain, but its prescription is strongly limited by the well-documented side-effects. Different approaches have been applied to develop strong analgesic drugs with reduced pharmacologic side-effects. One of the most promising is the design of multitarget drugs. In this paper we report the synthesis, characterization and biological evaluation of twelve new 4-anilidopiperidine (fentanyl analogues). In vivo hot-Plate test, shows a moderate antinociceptive activity for compounds OMDM585 and OMDM586, despite the weak binding affinity on both μ and δ-opioid receptors...
December 2016: Journal of Enzyme Inhibition and Medicinal Chemistry
Deborah C Mash, Barbara Ameer, Delphine Prou, John F Howes, Emeline L Maillet
This study investigated the effects of noribogaine, the principal metabolite of the drug ibogaine, on substance-related disorders. In the first experiment, mice chronically treated with morphine were subjected to naloxone-precipitated withdrawal two hours after oral administration of noribogaine. Oral noribogaine dose dependently decreased the global opiate withdrawal score by up to 88% of vehicle control with an ED50 of 13 mg/kg. In the second experiment, blood and brain levels of noribogaine showed a high brain penetration and a brain/blood ratio of 7±1 across all doses tested...
July 2016: Journal of Psychopharmacology
Glenn Burns, Rebecca T DeRienz, Daniel D Baker, Marcel Casavant, Henry A Spiller
BACKGROUND: There has been a significant spike in fentanyl-related deaths from illicit fentanyl supplied via the heroin trade. Past fentanyl access was primarily oral or dermal via prescription fentanyl patch diversion. One factor potentially driving this increase in fatalities is the change in route of administration. Rapid intravenous (IV) fentanyl can produce chest wall rigidity. We evaluated post-mortem fentanyl and norfentanyl concentrations in a recent surge of lethal fentanyl intoxications...
June 2016: Clinical Toxicology
James G Flood, Tahira Khaliq, Kenneth A Bishop, David A Griggs
BACKGROUND: We implemented oral fluid (OF) as an alternative specimen type to urine for detection of cocaine (COC) and opiate abuse in outpatient addiction medicine clinics. METHODS: We implemented a 2-μg/L limit of quantification OF LC-MS/MS assay and compiled and reviewed all findings from a 22-month collection period for COC, benzoylecgonine (BZE), codeine (COD), 6-acetylmorphine (MAM), and morphine (MOR). We also compared the results of our clinical samples at different OF cutoffs and analytes specified in the new 2015 SAMHSA OF guidelines...
May 2016: Clinical Chemistry
Fergus D Law, Judy S Myles, Mark R C Daglish, David J Nutt
Buprenorphine is a partial μ-opioid receptor agonist that is being increasingly used in clinical practice in the treatment of opioid dependence in the UK, USA, and, elsewhere. Its unique pharmacological properties mean it is a relatively safe drug, it can be given by alternate day dispensing, and it is associated with relatively mild symptoms on withdrawal. The interpretation of the research literature on buprenorphine is however, complex, and often appears to be in conflict with how buprenorphine is used in clinical practice...
October 2004: Acta Neuropsychiatrica
Adrian P Murphy, Macartan Hughes, Siobhan Mccoy, Gloria Crispino, Abel Wakai, Ronan O'Sullivan
INTRODUCTION: Acute pain is the most common symptom in the emergency setting and its optimal management continues to challenge prehospital emergency care practitioners, particularly in the paediatric population. Difficulty in establishing vascular access and fear of opiate administration to small children are recognized reasons for oligoanalgesia. Intranasal fentanyl (INF) has been shown to be as safe and effective as intravenous morphine in the treatment of severe pain in children in the Emergency Department setting...
March 15, 2016: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
Arieh Riskin, Irit Shoris, Galina Kidalov, David Bader, Liron Borenstein-levin, Amir Kugelman
BACKGROUND: Very-low-birth-weight (VLBW) infants are occasionally treated with opiates for sedation and pain relief. OBJECTIVE: To study the short term outcomes of VLBW infants treated with opiates. METHODS: We conducted a retrospective study of all VLBW infants born during the period 2006-2010; 45 were treated with opiates (41 fentanyl continuous IV drip and 4 IV morphine prn); 114 served as controls. RESULTS: In the univariate analysis, VLBW infants treated by opiates had significantly lower Gestational Age (GA) (28...
December 2015: Harefuah
Akira Nakagawa, Eitaro Matsumura, Takashi Koyanagi, Takane Katayama, Noriaki Kawano, Kayo Yoshimatsu, Kenji Yamamoto, Hidehiko Kumagai, Fumihiko Sato, Hiromichi Minami
Opiates such as morphine and codeine are mainly obtained by extraction from opium poppies. Fermentative opiate production in microbes has also been investigated, and complete biosynthesis of opiates from a simple carbon source has recently been accomplished in yeast. Here we demonstrate that Escherichia coli serves as an efficient, robust and flexible platform for total opiate synthesis. Thebaine, the most important raw material in opioid preparations, is produced by stepwise culture of four engineered strains at yields of 2...
2016: Nature Communications
Chao Rong, Hai-Feng Jiang, Rui-Wen Zhang, Li-Juan Zhang, Jian-Chen Zhang, Jing Zhang, Xue-Shan Feng
BACKGROUND: Many countries including China are facing a serious opiate dependence problem. Anti-drug work effectiveness was affected by the high relapse rate all over the world. This study aims to analyze the factors influencing heroin addict relapse, and to provide evidence for generating relapse prevention strategies. METHODS: A community-based follow-up study was conducted in China between October 2010 and September 2012. A total of 554 heroin addicts in accordance with the inclusion criteria from 81 streets in 12 districts of Shanghai, China were divided into 4 groups: group 1--daily dosage taken orally of 60 mL of methadone or under combined with psychological counseling and social supports (n = 130); group 2--daily dosage taken orally of over 60 mL of methadone combined with psychological counseling and social supports (n = 50); group 3--JTT (Jitai tablets) combined with psychological counseling and social supports (n = 206); group 4--JTT combined with social supports (n = 168)...
February 2016: International Journal of Environmental Research and Public Health
Anne Yee, Mahmoud Danaee, Huai Seng Loh, Ahmad Hatim Sulaiman, Chong Guan Ng
INTRODUCTION: Methadone has long been regarded as an effective treatment for opioid dependence. However, many patients discontinue maintenance therapy because of its side effects, with one of the most common being sexual dysfunction. Buprenorphine is a proven alternative to methadone. This study aimed to investigate sexual dysfunction in opioid-dependent men on buprenorphine maintenance treatment (BMT) and methadone maintenance treatment (MMT). The secondary aim was to investigate the correlation between sexual dysfunction and the quality of life in these patients...
2016: PloS One
Ole Schjerning, Mary Rosenzweig, Anton Pottegård, Per Damkier, Jimmi Nielsen
BACKGROUND: Several case reports and epidemiological studies have raised concern about the abuse potential of pregabalin, the use of which has increased substantially over the last decade. Pregabalin is, in some cases, used for recreational purposes and it has incurred attention among drug abusers for causing euphoric and dissociative effects when taken in doses exceeding normal therapeutic dosages or used by alternative routes of administration, such as nasal insufflation or venous injection...
January 2016: CNS Drugs
Sara A Combs, J Pedro Teixeira, Michael J Germain
Pruritus is a common and distressing symptom in patients with chronic kidney disease. The most recent epidemiologic data have suggested that approximately 40% of patients with end-stage renal disease experience moderate to severe pruritus and that uremic pruritus (UP) has a major clinical impact, being associated strongly with poor quality of life, impaired sleep, depression, and increased mortality. The pathogenesis of UP remains largely unclear, although several theories on etiologic or contributing factors have been proposed including increased systemic inflammation; abnormal serum parathyroid hormone, calcium, and phosphorus levels; an imbalance in opiate receptors; and a neuropathic process...
July 2015: Seminars in Nephrology
Bradley D Stein, Rosalie Liccardo Pacula, Adam J Gordon, Rachel M Burns, Douglas L Leslie, Mark J Sorbero, Sebastian Bauhoff, Todd W Mandell, Andrew W Dick
POLICY POINTS: Buprenorphine is an effective opioid dependence treatment that has expanded access to care since its 2002 approval, but it can only be prescribed by physicians waivered to treat a limited number of individuals. We examined the impact of 2006 legislation that increased waivered physician patient limits from 30 to 100 on buprenorphine use, and found that 100-patient-waivered physicians were significantly associated with growth in buprenorphine use, with no such relationship for 30-patient-waivered physicians...
September 2015: Milbank Quarterly
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