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Opiate withdrawal

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...
October 9, 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...
August 6, 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
Juhwan Kim, Sueun Lee, Sohi Kang, Tae-Il Jeon, Man-Jong Kang, Tae-Hoon Lee, Yong Sik Kim, Key-Sun Kim, Heh-In Im, Changjong Moon
Crosstalk between G-protein signaling and glutamatergic transmission within the brain reward circuits is critical for long-term emotional effects (depression and anxiety), cravings, and negative withdrawal symptoms associated with opioid addiction. A previous study showed that Regulator of G-protein signaling 4 (RGS4) may be implicated in opiate action in the nucleus accumbens (NAc). However, the mechanism of the NAc-specific RGS4 actions that induce the behavioral responses to opiates remains largely unknown...
May 31, 2018: Molecules and Cells
Deborah Corrigan, Richard L Mix, Glen A Palmer, Stephen A Olson
The purpose of the current study was to determine if the amount of confidence in completing the Clinical Opiate Withdrawal Scale (COWS) varied among participants and whether consistency in scoring outcomes to patients occurred with COWS assessment among groups assigned to simulation and debriefing conditions. Sixty nursing staff were randomized into three groups: (a) scenario; (b) scenario and simulation; and (c) scenario, simulation, and debriefing. Staff were administered a questionnaire to assess their confidence before (i...
October 1, 2018: Journal of Psychosocial Nursing and Mental Health Services
Haining Dai, Dana M Tilley, Greici Mercedes, Chris Doherty, Amitabh Gulati, Neel Mehta, Amer Khalil, Katrin Holzhaus, Francis M Reynolds
INTRODUCTION: Opioids remain a mainstay in the treatment of acute and chronic pain, despite numerous and potentially dangerous side effects. There is a great unmet medical need for alternative treatments for patients suffering from pain that do not result in addiction or adverse side effects. Anticonvulsants have been shown to be effective in managing pain, though high systemic levels and subsequent side effects limit their widespread usage. Our goal was to determine if the incorporation of an anticonvulsant, carbamazepine, into a biodegradable microparticle for local sustained perineural release would be an efficacious analgesic following a peripheral injury...
May 3, 2018: Pain Practice: the Official Journal of World Institute of Pain
Simona Guerzoni, Lanfranco Pellesi, Luigi Alberto Pini, Fabio Caputo
Drug interactions are one of the most common causes of side effects in polypharmacy. Alcoholics are a category of patients at high risk of pharmacological interactions, due to the presence of comorbidities, the concomitant intake of several medications and the pharmacokinetic and pharmacodynamic interferences of ethanol. However, the data available on this issue are limited. These reasons often frighten clinicians when prescribing appropriate pharmacological therapies for alcohol use disorder (AUD), where less than 15% of patients receive an appropriate treatment in the most severe forms...
July 2018: Pharmacological Research: the Official Journal of the Italian Pharmacological Society
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