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Opiate withdrawal

Wojciech B Solecki, Natalia Kus, Katarzyna Gralec, Adam Klasa, Kamil Pradel, Ryszard Przewłocki
Somatic and motivational symptoms accompanying opiate withdrawal are considered one of the major reasons for relapse to opiate-seeking and opiate-taking behaviors. These symptoms are accompanied by the activation of stress-related processes including hypothalamic-pituitary-adrenal axis activity and noradrenergic (NA) signaling. In particular, the NA system plays an important role in the expression of somatic signs of opiate withdrawal, whereas glucocorticoid (GR) and mineralocorticoid receptors (MR) are activated during opiate abstinence...
November 27, 2018: Behavioural Brain Research
Neeraj Jain, B S Chavan, Ajeet Sidana, Subhash Das
Background: The need for effective and accepted method for opioid detoxification is ever increasing. Sublingual buprenorphine and oral clonidine have been effective in opioid detoxification. As often, there is a great variation in the dosage of buprenorphine and clonidine prescribed by the clinicians; hence, there is a felt need to find an effective dosage for a favorable outcome of opioid detoxification. Objective: The objective of this study was to compare the effectiveness of different doses of sublingual buprenorphine and clonidine in opioid detoxification...
July 2018: Indian Journal of Psychiatry
Pouya Azar, Mohammadali Nikoo, Isabelle Miles
BACKGROUND AND OBJECTIVES: Although buprenorphine/naloxone is widely recognized as first-line therapy for opioid use disorder, the requirement for moderate withdrawal prior to initiation in efforts to avoid precipitated withdrawal can be a barrier to its initiation. METHODS: We present a case utilizing transdermal fentanyl as a bridging treatment to eliminate withdrawal during the transition from methadone to buprenorphine/naloxone in a patient who had ongoing significant intravenous heroin use while on methadone...
November 2, 2018: American Journal on Addictions
Anlong Liu, Han Zhang, Fenfen Qin, Qisheng Wang, Qinmei Sun, Shuwu Xie, Qian Wang, Zongxiang Tang, Zhigang Lu
BACKGROUND/AIMS: Opiates are potent analgesics but their clinical use is limited by sex-associated side effects, such as drug tolerance, opioid-induced hyperalgesia and withdrawal reaction. OPRM1, as the main receptor of opioids, plays an important role in the pharmacological process of opioids in rodents and human. We have previously investigated OPRM1, the μ opioid receptor gene, which have dozens of alternatively spliced variants probably correlating with opioid-induced effects in brain regions of four inbred mouse strains and demonstrated the strain-specific expressions of these splice variants...
2018: Cellular Physiology and Biochemistry
Rahul Raghav, Raka Jain, Anju Dhawan, T S Roy, Punit Kumar
Nalbuphine is an agonist of κ-opioid receptors and a partial agonist of μ-opioid receptors, which can stimulate κ-receptors and antagonize the acute rewarding effects of morphine. It is widely used either as an analgesic or as an adjuvant with morphine. This present study aimed to compare the acute and chronic effects of nalbuphine on the naloxone-precipitated opiate-withdrawal in rats. Male adult Wistar albino rats (150-175 g, n = 160) were made physically dependent by administrating increasing dose of morphine (5-25 mg/kg; i...
December 2018: Pharmacology, Biochemistry, and Behavior
Kelly E Dunn, Elise M Weerts, Andrew S Huhn, Jennifer R Schroeder, David Andrew Tompkins, George E Bigelow, Eric C Strain
Opioid use disorder (OUD) is a public health crisis. Differences in opioid withdrawal severity that predict treatment outcome could facilitate the process of matching patients to treatments. This is a secondary analysis of a randomized controlled trial (RCT) that enrolled treatment seeking heroin-users (N = 89, males = 78) into a residential study. Participants maintained on morphine (30 mg, subcutaneous, four-times daily) underwent a naloxone (0.4 mg, IM = intramuscular) challenge session to precipitate withdrawal...
October 8, 2018: Addiction Biology
Beatrice Setnik, Kenneth W Sommerville, Glenn C Pixton, Lynn Webster
OBJECTIVE: To review the effects of naltrexone on withdrawal-related adverse events (AEs) and euphoria-related effects, and relationship between plasma naltrexone concentrations and withdrawal across EMBEDA® (MSN; extended-release morphine sulfate with sequestered naltrexone) studies. METHODS: Five studies in pain patients and a safety review summarizing AE reports during the first year following approval of MSN were assessed for withdrawal reports. Three of these studies also assessed Clinical Opiate Withdrawal Scale (COWS) scores...
October 6, 2018: Current Medical Research and Opinion
Jamshid Ahmadi, Mina Sefidfard Jahromi, Zahra Ehsaei
BACKGROUND: Buprenorphine is usually administered to treat opioid use disorder and pain syndromes. This research presents the first study regarding the effectiveness of different singly administered high doses of buprenorphine (a partial opioid agonist (of μ-opioid receptors), a potent opioid antagonist (of κ-receptors) and a partial agonist of nociception receptors) in reducing suicidal ideation in acutely depressed people with co-morbid opiate dependence. It follows small studies that suggest that ultra-low-dose buprenorphine may be useful in reducing suicidal ideation...
August 29, 2018: Trials
Rahul Lauhan, Alan Hsu, Al Alam, Kristin Beizai
BACKGROUND: Tianeptine (Stablon, Coaxil) abuse and dependence has become increasingly prominent worldwide with recent presence in the United States. OBJECTIVE: In this article, we add a case to the growing literature on tianeptine dependence, the first of which is concerning for the presence of an adulterant, and present a comprehensive literature review. METHODS: A literature search was conducted on July 2, 2018 on PubMed for articles using the keywords "tianeptine abuse" and "tianeptine dependence...
July 19, 2018: Psychosomatics
L Davidson, M Rawat, S Stojanovski, P Chandrasekharan
BACKGROUND: Mitragyna speciosa, also known as kratom, is obtained from the coffee plant family 'Rubiaceae.' Kratom is available in the form of capsules, whole, processed and powdered leaves and as liquids. Secondary to its 'natural herb' status and opioid effects, it is misconceived to be a safe alternative for the treatment of chronic pain. The use of kratom has increased by tenfold in the United States since 2010. METHODS AND RESULTS: We report a term neonate who was born to a chronic kratom user and required treatment with opiates for neonatal drug withdrawal...
August 22, 2018: Journal of Neonatal-perinatal Medicine
Jennifer R Schroeder, Karran A Phillips, David H Epstein, Michelle L Jobes, Melody A Furnari, Ashley P Kennedy, Markus Heilig, Kenzie L Preston
BACKGROUND: Preliminary evidence suggested that the PPARγ agonist pioglitazone reduces opioid-withdrawal symptoms, possibly by inhibiting increases in proinflammatory cytokines. METHODS: A randomized, placebo-controlled clinical trial was conducted utilizing two different study designs (entirely outpatient, and a combination of inpatient and outpatient) to evaluate the safety and efficacy of pioglitazone as an adjunct medication for people with opioid physical dependence undergoing a buprenorphine taper...
October 2018: Psychopharmacology
Pooja Palkar, Dipti Kothari
Loperamide is an antidiarrheal agent available as an inexpensive over-the-counter (OTC) medication. In general, it is considered to be safe, but lately, loperamide drug abuse has been reported due to its opioid properties. When used in high doses, several harmful effects including cardiotoxicity, central nervous system (CNS) and respiratory depression have been reported. This prompted the FDA to release a warning in 2016 regarding the arrhythmogenic potential of loperamide. We present a case of a 32-year-old male with a history of polysubstance abuse who presented to the emergency department (ED) requesting "detoxification" from loperamide...
May 9, 2018: Curēus
David H Malin, Mallori M Henceroth, Joanne Elayoubi, Joseph R Campbell, Andrea Anderson, Pilar Goyarzu, Jonathan Izygon, Caitlin A Madison, Christopher P Ward, Ethan S Burstein
Considerable evidence suggests the Neuropeptide FF (NPFF) and related peptides exert pro-nociceptive and anti-opiate actions, particularly at the supra-spinal level, which may contribute to opiate dependence. The FF1 receptor subtype appears to be primarily responsible for anti-opiate effects. In contrast, stimulation of the FF2 receptor primarily induces pro-opiate effects. AC-262620 is a small molecule, systemically active, selective FF1 receptor antagonist. An initial experiment showed that 10 mg/kg i...
September 25, 2018: Neuroscience Letters
Sara Soleimani Asl, Amir Roointan, Hugo Bergen, Shayan Amiri, Parastoo Mardani, Niloufar Ashtari, Ronak Shabani, Mehdi Mehdizadeh
Introduction: Genes often have multiple polymorphisms that interact with each other and the environment in different individuals. Variability in the opioid receptors can influence opiate withdrawal and dependence. In humans, A118G Single Nucleotide Polymorphisms (SNP) on μ-Opioid Receptor (MOR), 36 G>T in κ-Opioid Receptor (KOR), and T921C in the δ-Opioid Receptor (DOR) have been found to associate with substance dependence. Methods: To investigate the association between opioid receptors gene polymorphism and heroin addiction, 100 control subjects with no history of opioid use, and 100 heroin addicts (50% males and 50% females) in Tehran (capital of Iran), were evaluated...
March 2018: Basic and Clinical Neuroscience
Jessa Koch, Sarah Ward, Christopher J Thomas
Introduction: The Chillicothe Veterans Affairs Medical Center serves veterans from southern Ohio, Kentucky, and West Virginia, where the rates of non-medical opioid use are some of the highest in the nation. Prior to this project, there was not a standardized practice for the treatment of veterans undergoing opioid withdrawal at the facility. In May 2015, a symptom-triggered protocol was initiated to improve the quality of care and decrease the length of detoxification for veterans treated at the Chillicothe Veterans Affairs Medical Center...
November 2017: The mental health clinician
Scott E Hemby, Scot McIntosh, Francisco Leon, Stephen J Cutler, Christopher R McCurdy
Kratom, derived from the plant Mitragyna speciosa, is receiving increased attention as an alternative to traditional opiates and as a replacement therapy for opiate dependence. Mitragynine (MG) and 7-hydroxymitragynine (7-HMG) are major psychoactive constituents of kratom. While MG and 7-HMG share behavioral and analgesic properties with morphine, their reinforcing effects have not been examined to date. 7-HMG, but not MG, substituted for morphine self-administration in a dose-dependent manner in the rat self-administration paradigm...
June 27, 2018: Addiction Biology
Song Guo, Victoria Manning, Yi Yang, Puay Kee Koh, Edwin Chan, Nurun Nisa de Souza, Pryseley Nkouibert Assam, Rehena Sultana, Ruki Wijesinghe, Julius Pangjaya, Gomathinayagam Kandasami, Christopher Cheok, Kae Meng Lee, Kim Eng Wong
BACKGROUND: Many individuals leave costly inpatient detoxification programs prematurely because of the severity of withdrawal symptoms experienced. In the absence of opioid-assisted detoxification in Singapore, diazepam is used to manage withdrawal. However since diazepam is addictive, there is a need to explore the effectiveness of alternative medications. DESIGN AND PROCEDURES: The study aimed to examine the safety and efficacy of lofexidine, a non-opiate, non-addictive, alpha 2-adrenergic agonist in assisting opioid detoxification in Singapore, using a randomized, double-blind, investigator-initiated placebo-controlled trial comparing lofexidine against diazepam...
August 2018: Journal of Substance Abuse Treatment
Bridget Candy, Louise Jones, Victoria Vickerstaff, Philip J Larkin, Patrick Stone
BACKGROUND: Opioid-induced bowel dysfunction (OIBD) is characterised by constipation, incomplete evacuation, bloating, and gastric reflux. It is one of the major adverse events of treatment for pain in cancer and in palliative care, resulting in increased morbidity and reduced quality of life.This is an update of two Cochrane reviews. One was published in 2011, Issue 1 on laxatives and methylnaltrexone for the management of constipation in people receiving palliative care; this was updated in 2015 and excluded methylnaltrexone...
June 5, 2018: Cochrane Database of Systematic Reviews
Kate Wolitzky-Taylor, Andrea N Niles, Richard Ries, Jennifer L Krull, Richard Rawson, Peter Roy-Byrne, Michelle Craske
INTRODUCTION: Understanding for whom treatments exert their greatest effects is crucial for prescriptive recommendations that can improve overall treatment efficacy. Anxiety and substance use disorder comorbidity is prevalent and a significant public health concern. Little is known about who should receive specialized, integrated treatments to address both problems. This study aimed to examine baseline patient characteristics that predict differential outcome between typical treatment for substance use disorders (UC) compared to that treatment combined with cognitive behavioral therapy for anxiety disorders (UC + CALM ARC)...
May 17, 2018: Behaviour Research and Therapy
Thierry Lacaze-Masmonteil, Pat O'Flaherty
The incidence of infant opioid withdrawal has grown rapidly in many countries, including Canada, in the last decade, presenting significant health and early brain development concerns. Increased prenatal exposure to opioids reflects rising prescription opioid use as well as the presence of both illegal opiates and opioid-substitution therapies. Infants are at high risk for experiencing symptoms of abstinence or withdrawal that may require assessment and treatment. This practice point focuses specifically on the effect(s) of opioid withdrawal and current management strategies in the care of infants born to mothers with opioid dependency...
May 2018: Paediatrics & Child Health
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