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Medication assisted treatment for opioid

Jennifer J Carroll
In 2014, Russian authorities in occupied Crimea shut down all medication-assisted treatment (MAT) programs for patients with opioid use disorder. These closures dramatically enacted a new political order. As the sovereign occupiers in Crimea advanced new constellations of citizenship and statehood, so the very concept of "right to health" was re-tooled. Social imaginations of drug use helped single out MAT patients as a population whose "right to health," protected by the state, would be artificially restricted...
November 27, 2018: Medical Anthropology
Melissa Medina, Shannon R Foiles, Matilde Francois, Carl V Asche, Jinma Ren, Dale K Mueller, Richard C Anderson
BACKGROUND: Thoracic Epidural has long been the most recommended treatment for postoperative pain management in general thoracic surgery. This study compares liposomal bupivacaine (LB) as an alternative method for pain control and compares it to the standard. METHODS: LB was compared to thoracic epidural bupivacaine hydrochloride (TE BH) in 387 patients who underwent video-assisted thoracoscopic pulmonary resection (VATS-R) at our institution. Patients received either continuous TE BH or intraoperative LB at a predetermined dose...
October 17, 2018: American Journal of Surgery
Joshua A Rash, Norman Buckley, Jason W Busse, Tavis S Campbell, Kim Corace, Lynn Cooper, David Flusk, Alfonso Iorio, Kim L Lavoie, Patricia A Poulin, B Skidmore
BACKGROUND: Evidence from diverse areas of medicine (e.g., cardiovascular disease, diabetes) indicates that healthcare providers (HCPs) often do not adhere to clinical practice guidelines (CPGs) despite a clear indication to implement recommendations-a phenomenon commonly termed clinical inertia. There are a variety of reasons for clinical inertia, but HCP-related factors (e.g., knowledge, motivation, agreement with guidelines) are the most salient and amenable to intervention aimed to improve adherence...
November 13, 2018: Systematic Reviews
Emma M Nellhaus, Sara Murray, Zachary Hansen, Sean Loudin, Todd H Davies
Neonatal abstinence syndrome (NAS) is a withdrawal syndrome observed in neonates exposed to drugs in utero, typically opioids, which is associated with symptoms affecting the central and autonomic nervous systems and the gastrointestinal system. West Virginia, particularly the southeastern region of the state, has remarkably higher rates of NAS than similar communities. Our facility is increasingly faced with complex cases of NAS caused by in utero exposure to multiple substances. We present a case report of a neonate born to a 25-year-old mother enrolled in a medication-assisted treatment program for substance use disorder who was noncompliant in prenatal care, using multiple substances throughout the pregnancy, including gabapentin and fentanyl...
November 8, 2018: Journal of Pediatric Health Care
Alicia A Jacobs, Michelle Cangiano
Opioid addiction rates are at a national high, with significant morbidity and mortality. In women, rates have been steadily increasing to be at par with addiction rates in men. Women tend to have quicker addiction and shorter duration to adverse outcomes. Treatment of women has the best outcomes when it is gender-specific, trauma-informed, connected with access to psychiatric services, and integrated into the medical home. Improved outcomes can be achieved with coordinated systems of care based on the harm-reduction model, with integration of medication-assisted therapy in a patient-centered medical home...
December 2018: Primary Care
Robert West, Charles Mikel, Doriane Hofilena, Maria Guevara
BACKGROUND: Drug testing is recommended as part of comprehensive monitoring for medication-assisted treatment. Alternative matrices including oral fluid offer a number of advantages when compared with conventional urine testing but are not as well characterized. This study aims to compare positivity rates of drugs and drug classes in oral fluid and urine as a measure of the clinical utility of oral fluid in the evaluation and treatment of patients with opioid use disorders. METHODS: A retrospective review of paired oral fluid and urine test results from Millennium Health's laboratory database was performed for 2746 patients with reported prescriptions for buprenorphine products used in the treatment of opioid dependence...
December 1, 2018: Drug and Alcohol Dependence
Roman Shrestha, Frederick L Altice, Michael M Copenhaver
BACKGROUND: Opioid agonist therapies with methadone are associated with higher levels of adherence to antiretroviral therapy (ART), yet no studies have explored factors associated with optimal ART levels in HIV-positive patients on methadone maintenance treatment (MMT), including explanatory pathways using mediation analysis. SETTING: Participants included 121 HIV-positive, methadone-maintained patients who reported HIV-risk behaviors and were taking ART. METHODS: Participants were assessed using an audio-computer assisted self-interview (ACASI)...
October 23, 2018: Journal of Acquired Immune Deficiency Syndromes: JAIDS
David R Axon, Mira J Patel, Jennifer R Martin, Marion K Slack
Background and aims Multidomain strategies (i.e. two or more strategies) for managing chronic pain are recommended to avoid excessive use of opioids while producing the best outcomes possible. The aims of this systematic review were to: 1) determine if patient-reported pain management is consistent with the use of multidomain strategies; and 2) identify the role of opioids and non-steroidal anti-inflammatory drugs (NSAIDs) in patient-reported pain management. Methods Bibliographic databases, websites, and reference lists of included studies were searched to identify published articles reporting community-based surveys of pain self-management from January 1989 to June 2017 using controlled vocabulary (and synonyms): pain; self-care; self-management; self-treatment; and adult...
October 30, 2018: Scandinavian Journal of Pain
David H Cisewski, Cynthia Santos, Alex Koyfman, Brit Long
INTRODUCTION: Opioid use disorder (OUD) is increasing in prevalence throughout the world, with approximately three million individuals in the United States affected. Buprenorphine is a medication designed, researched, and effectively used to assist in OUD recovery. OBJECTIVE: This narrative review discusses an approach to initiating buprenorphine in the emergency department (ED) for opioid-abuse recovery. DISCUSSION: Buprenorphine is a partial mu-opioid receptor agonist with high affinity and low intrinsic activity...
October 11, 2018: American Journal of Emergency Medicine
C Holly A Andrilla, Tessa E Moore, Davis G Patterson
PURPOSE: The United States is in the midst of a severe opioid use disorder epidemic. Buprenorphine is an effective office-based treatment that can be prescribed by physicians, nurse practitioners, and physician assistants with a Drug Enforcement Administration (DEA) waiver. However, many providers report barriers that keep them from either getting a DEA waiver or fully using it. The study team interviewed rural physicians successfully prescribing buprenorphine to identify strategies for overcoming commonly cited barriers for providing this service...
October 19, 2018: Journal of Rural Health
Caterina Magnani, Diana Giannarelli, Alice Calvieri, Ana Dardeli, Giovanni Eusepi, Maria Rosa Restuccia, Chiara Mastroianni, Giuseppe Casale
BACKGROUND: Various options for the pharmacological treatment of breakthrough cancer pain (BTcP) are available. International guidelines on BTcP treatment are not univocal. A tailored treatment should be based on the assessment of different variables such as BTcP characteristics, oral mucositis, chronic rhinitis and a patient's ability to take medication. OBJECTIVE: The goal of this study is to assess the relationship between these variables and the medication treatment for BTcP in a sample of patients with terminal cancer...
October 2018: Postgraduate Medical Journal
Peter Barglow
BACKGROUND AND OBJECTIVES: Outcome intervention data from Medicare, veteran, prison, and United States' public populations can identify best practices to decrease opioid misuse. Prescription policies for treating pain in the United States and other countries are relevant to preventing overdose. METHODS: Three strategies are considered: (1) Demand Reduction counsels and educates patients and current or potential opioid users about risks and treatment options to reduce motivation to consume opioids...
October 12, 2018: American Journal on Addictions
Naoko A Ronquest, Tina M Willson, Leslie B Montejano, Vijay R Nadipelli, Bernd A Wollschlaeger
Background: Treatment for opioid use disorder is important because of the negative health, societal and economic consequences of illicit opioid use, but treatment adherence can be a challenge. This study assessed the association between buprenorphine medication-assisted treatment (MAT) adherence and relapse, health care utilization and costs. Patients and methods: Patients with opioid use disorder who were newly initiating a buprenorphine MAT regimen were identified in the 2008-2014 MarketScan® Commercial and Medicaid Databases and followed for 12 months after their earliest outpatient pharmacy claim for buprenorphine...
2018: Substance Abuse and Rehabilitation
Hestia Moningka, Sarah Lichenstein, Patrick D Worhunsky, Elise E DeVito, Dustin Scheinost, Sarah W Yip
The current opioid epidemic is an urgent public health problem, with enormous individual, societal, and healthcare costs. Despite effective, evidence-based treatments, there is significant individual variability in treatment responses and relapse rates are high. In addition, the neurobiology of opioid-use disorder (OUD) and its treatment is not well understood. This review synthesizes published fMRI literature relevant to OUD, with an emphasis on findings related to opioid medications and treatment, and proposes areas for further research...
October 3, 2018: Neuropsychopharmacology: Official Publication of the American College of Neuropsychopharmacology
Eric Weintraub, Aaron David Greenblatt, Joy Chang, Seth Himelhoch, Christopher Welsh
BACKGROUND AND OBJECTIVES: The opioid epidemic in the United States has resulted in a public health emergency. Medication-assisted treatment (MAT) with methadone and buprenorphine are evidence-based treatments for opioid use disorder. However, numerous barriers hinder access to treatment in rural areas. The use of telemedicine to deliver psychiatric services is demonstrated to be safe and effective; however, limited data exist on the novel application of telemedicine in the delivery of MAT...
September 28, 2018: American Journal on Addictions
Jessica L Coker, David Catlin, Shona Ray-Griffith, Bettina Knight, Zachary N Stowe
BACKGROUND: The treatment of pregnant women with opioid use disorder is challenging due to the myriad of physical, mental, and social complications. Factors influencing adherence to buprenorphine during pregnancy have not been identified. MATERIALS AND METHODS: Pregnant women with opioid use disorder followed in a tertiary clinic were included in a retrospective chart review from buprenorphine induction through delivery. All women who had been evaluated and treated with buprenorphine from January 1, 2014, to September 31, 2016, were included...
September 15, 2018: Drug and Alcohol Dependence
Erich J Dietrich, Todd Leroux, Carla F Santiago, Melvin D Helgeson, Patrick Richard, Tracey P Koehlmoos
BACKGROUND: Acute low back pain is one of the most common reasons for individuals to seek medical care in the United States. The US Military Health System provides medical care to approximately 9.4 million beneficiaries annually. These patients also routinely suffer from acute low back pain. Within this health system, patients can receive care and treatment from physicians, or physician extenders including physician assistants and nurse practitioners. Given the diversity of provider types and their respective training programs, it would be informative to evaluate variation in care delivery, adherence to clinical guidelines, and differences within the MHS among a complex mix of provider types...
September 17, 2018: BMC Health Services Research
Michael E Herce, Monde Muyoyeta, Stephanie M Topp, German Henostroza, Stewart E Reid
PURPOSE OF REVIEW: To advance a re-conceptualized prevention, treatment, and care continuum (PTCC) for HIV-associated tuberculosis (TB) in prisons, and to make recommendations for strengthening prison health systems and reducing HIV-associated TB morbidity and mortality throughout the cycle of pretrial detention, incarceration, and release. RECENT FINDINGS: Despite evidence of increased HIV-associated TB burden in prisons compared to the general population, prisoners face entrenched barriers to accessing anti-TB therapy, antiretroviral therapy, and evidence-based HIV and TB prevention...
November 2018: Current Opinion in HIV and AIDS
Kathleen Broglio, Marianne Matzo
: Medication-assisted treatment for opioid use disorder (OUD), which incorporates methadone, buprenorphine, or naltrexone, has been shown to reduce all-cause mortality rates in patients with this disease-and the numbers of patients receiving such treatment is substantial. In 2016, among U.S. patients with OUD, nearly 350,000 were treated with methadone, more than 60,000 were treated with buprenorphine, and more than 10,000 were treated with naltrexone. Managing acute pain in patients receiving this treatment can be a significant nursing challenge...
October 2018: American Journal of Nursing
Carlos Nordt, Marc Vogel, Michelle Dey, Andreas Moldovanyi, Thilo Beck, Toni Berthel, Marc Walter, Erich Seifritz, Kenneth M D├╝rsteler, Marcus Herdener
BACKGROUND AND AIMS: Opioid agonist treatment (OAT) is currently the most effective treatment for people with opioid dependence. In most countries, however, access to the whole range of effective medications is restricted. This study aims to model the distribution of different OAT medications within a naturalistic and relatively unrestricted treatment setting (Zurich, Switzerland) over time, and to identify patient characteristics associated with each medication. METHODS: We used generalized estimating equation analysis with data from the OAT register of Zurich and the Swiss register for heroin-assisted treatment (HAT) to model and forecast the annual proportion of opioids applying exponential distributions until 2018 and patient characteristics between 1992 and 2015...
September 12, 2018: Addiction
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