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https://www.readbyqxmd.com/read/28535569/reinstituting-the-bolus-new-reasoning-for-an-existing-technique
#1
Porter W McRoberts, Jason E Pope, Catalina Apostol
Improved intrathecal (IT) pump technology is increasing the accuracy of IT opioid bolus dosing and promising advances in pain therapy. Opioid bolus dosing can be used with a minimal continuous infusion or it can function as the sole therapy. Bolus-only dosing is characterized by minimal use of opioid (often less than 1 mg of IT morphine). It achieves adequate pain control while reducing tolerance and possibly opioid-induced hyperalgesia. It may prevent receptor saturation, and provide a "washing out" of the opioid receptor that prevents the observed dose escalation resulting from continuous infusions...
May 2017: Pain Physician
https://www.readbyqxmd.com/read/28535456/effectiveness-of-treatment-for-opioid-use-disorder-a-national-five-year-prospective-observational-study-in-england
#2
Brian Eastwood, John Strang, John Marsden
BACKGROUND: This the first 5-year effectiveness study of publicly funded treatment for opioid use disorder (OUD) in England. METHODS: All adults initiating treatment in 2008/09 in all 149 local treatment systems reporting to the National Drug Treatment Monitoring System (n=54,347). Admission polydrug use sub-populations were identified by Latent Class Analysis. The treatment outcome measure was 'successful completion and no re-presentation within six months' (SCNR) analysed by multilevel, multivariable logistic regression and funnel plots to contrast outcome by treatment system...
May 16, 2017: Drug and Alcohol Dependence
https://www.readbyqxmd.com/read/28535455/the-effectiveness-of-telemedicine-delivered-opioid-agonist-therapy-in-a-supervised-clinical-setting
#3
Joseph K Eibl, Graham Gauthier, David Pellegrini, Jeffery Daiter, Michael Varenbut, John C Hogenbirk, David C Marsh
OBJECTIVE: Opioid use disorder has been declared a public health crisis across North America and opioid agonist therapy (OAT) is the standard of care for these patients. Despite the increasing adoption of telemedicine as a delivery method for OAT, its effectiveness has not yet been evaluated against traditional in-person treatment. This study compared treatment outcomes for in-person versus telemedicine-delivered OAT. METHODS: We conducted a non-randomized cohort comparison study using an administrative database for patients who commenced OAT between 2011 and 2012 across 58 clinic sites in the province of Ontario, Canada...
May 17, 2017: Drug and Alcohol Dependence
https://www.readbyqxmd.com/read/28535454/frequency-and-severity-of-non-fatal-opioid-overdoses-among-clients-attending-the-sydney-medically-supervised-injecting-centre
#4
Amanda Roxburgh, Shane Darke, Allison M Salmon, Timothy Dobbins, Marianne Jauncey
BACKGROUND: Pharmaceutical opioid overdose rates have increased in recent years. The current study aimed to compare rates per 1000 injections of non-fatal overdose after heroin or oxycodone injection, and their comparative clinical severity. METHODS: Analysis of prospectively collected data from the Sydney Medically Supervised Injecting Centre (MSIC). Severity of overdose was measured using the Glasgow Coma Scale, oxygen saturation levels, and the administration of naloxone...
May 17, 2017: Drug and Alcohol Dependence
https://www.readbyqxmd.com/read/28535130/home-manufacture-of-drugs-an-online-investigation-and-a-toxicological-reality-check-of-online-discussions-on-drug-chemistry
#5
Evelyn Hearne, Emanuele Amorim Alves, Marie Claire Van Hout, Jean-Paul C Grund
Emerging trends in market dynamics and the use of new psychoactive substances are both a public health concern and a complex regulatory issue. One novel area of investigation is the availability of homemade opioids, amphetamines and dissociatives, and the potential fueling of interest in clandestine home manufacture of drugs via the Internet. We illustrate here how online communal folk pharmacology of homemade drugs on drug website forums may actually inform home manufacture practices or contribute to the reduction of harms associated with this practice...
May 23, 2017: Journal of Psychoactive Drugs
https://www.readbyqxmd.com/read/28535115/use-of-naloxone-nasal-spray-4%C3%A2-mg-in-the-community-setting-a-survey-of-use-by-community-organizations
#6
George K Avetian, Phillip Fiuty, Silvana Mazzella, Dave Koppa, Vivian Heye, Pratibha Hebbar
OBJECTIVE: Naloxone hydrochloride, an opioid antagonist, has been approved as a concentrated 4-mg dose intranasal formulation for the emergency treatment of known or suspected opioid overdose. This new formulation is easier to use and contains a higher dose of naloxone compared with earlier, unapproved kits. A survey of first responders and community-based organizations was conducted to understand initial real-world experiences with this new formulation for opioid overdose reversal. METHODS: In August 2016, 152 US organizations known to have received units of the approved 4-mg dose/unit naloxone nasal spray (NARCAN® Nasal Spray 4 mg [NNS]; Adapt Pharma, Inc...
May 23, 2017: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/28533997/metoclopramide-for-acute-migraine-treatment-in-the-emergency-department-an-effective-alternative-to-opioids
#7
REVIEW
Mejdi Najjar, Tyler Hall, Blanca Estupinan
In light of recent warnings by the United States (US) Surgeon General and Centers for Disease Control (CDC) guidelines for recommending more prudent use of opioid narcotics, the search for a non-opioid alternative for aborting acute migraines is particularly relevant. The CDC also estimates the prevalence of opioid dependence may be as high as 26% among patients prescribed opioids for chronic pain, not due to cancer, in the primary care setting. Given such staggering data, it is imperative that we, as caretakers, not foster opioid dependence but rather continue to investigate non-opioid therapies for the management of acute migraines in the emergent care settings...
April 20, 2017: Curēus
https://www.readbyqxmd.com/read/28533693/dna-methylation-at-the-mu-1-opioid-receptor-gene-oprm1-promoter-predicts-preoperative-acute-and-chronic-postsurgical-pain-after-spine-fusion
#8
Vidya Chidambaran, Xue Zhang, Lisa J Martin, Lili Ding, Matthew T Weirauch, Kristie Geisler, Bobbie L Stubbeman, Senthilkumar Sadhasivam, Hong Ji
INTRODUCTION: The perioperative pain experience shows great interindividual variability and is difficult to predict. The mu-1 opioid receptor gene (OPRM1) is known to play an important role in opioid-pain pathways. Since deoxyribonucleic acid (DNA) methylation is a potent repressor of gene expression, DNA methylation was evaluated at the OPRM1 promoter, as a predictor of preoperative, acute, and chronic postsurgical pain (CPSP). METHODS: A prospective observational cohort study was conducted in 133 adolescents with idiopathic scoliosis undergoing spine fusion under standard protocols...
2017: Pharmacogenomics and Personalized Medicine
https://www.readbyqxmd.com/read/28533287/trv0109101-a-g-protein-biased-agonist-of-the-%C3%A2%C2%B5-opioid-receptor-does-not-promote-opioid-induced-mechanical-allodynia-following-chronic-administration
#9
Michael Koblish, Richard Carr, Edward R Siuda, David H Rominger, William Gowen-MacDonald, Conrad L Cowan, Aimee L Crombie, Jonathan D Violin, Michael W Lark
Prescription opioids are a mainstay in the treatment of acute moderate to severe pain. However, chronic use leads to a host of adverse consequences including tolerance and opioid-induced hyperalgesia (OIH), leading to more complex treatment regimens and diminished patient compliance. Patients experiencing OIH paradoxically experience exaggerated nociceptive responses instead of pain reduction after chronic opioid usage. The development of OIH and tolerance tend to occur simultaneously and, thus, present a challenge when studying the molecular mechanisms driving each phenomenon...
May 22, 2017: Journal of Pharmacology and Experimental Therapeutics
https://www.readbyqxmd.com/read/28532680/decreased-spinal-endomorphin-2-contributes-to-mechanical-allodynia-in-streptozotocin-induced-diabetic-rats
#10
Le Niu, Guang-Hai Dai, Gao-Le He, Ming Yang, Hui-Min Hu, Zhong-Kai Liu, Nian-Song Qian, Yong-Liang Chen
Diabetic neuropathic pain (DNP) plays a major role in decreased life quality of diabetes patients, however, the neural mechanisms underlying DNP remain unclear. Endomorphins are the endogenous ligands for mu-opioid receptor. There is increasing evidence implicating the involvement of spinal endomorphin-2 (EM2) in neuropathic pain. In this study, using a streptozotocin induced diabetic rat model that displayed obvious mechanical allodynia, it was found that the expression of spinal EM2 was significantly decreased in DNP rats...
May 19, 2017: Neurochemistry International
https://www.readbyqxmd.com/read/28532488/mitigating-the-heroin-crisis-in-baltimore-md-usa-a-cost-benefit-analysis-of-a-hypothetical-supervised-injection-facility
#11
Amos Irwin, Ehsan Jozaghi, Brian W Weir, Sean T Allen, Andrew Lindsay, Susan G Sherman
BACKGROUND: In Baltimore, MD, as in many cities throughout the USA, overdose rates are on the rise due to both the increase of prescription opioid abuse and that of fentanyl and other synthetic opioids in the drug market. Supervised injection facilities (SIFs) are a widely implemented public health intervention throughout the world, with 97 existing in 11 countries worldwide. Research has documented the public health, social, and economic benefits of SIFs, yet none exist in the USA. The purpose of this study is to model the health and financial costs and benefits of a hypothetical SIF in Baltimore...
May 12, 2017: Harm Reduction Journal
https://www.readbyqxmd.com/read/28532487/degree-of-dyspnoea-at-admission-and-discharge-in-patients-with-heart-failure-and-respiratory-diseases
#12
Lourdes Vicent, Juan Manuel Nuñez Olarte, Luis Puente-Maestu, Alicia Oliva, Juan Carlos López, Andrea Postigo, Irene Martín, Raquel Luna, Francisco Fernández-Avilés, Manuel Martínez-Sellés
BACKGROUND: Dyspnoea is a disabling symptom in patients admitted with heart failure (HF) and respiratory diseases (RD). The main aim of this study is to evaluate its intensity at admission and discharge and the relation with quality of life. We also describe its management, intensity, and evolution in HF and RD. METHODS: In this descriptive, cross-sectional study, we included prospectively all patients admitted with decompensated HF and chronic obstructive pulmonary disease (COPD)/pulmonary fibrosis during 4 months...
May 22, 2017: BMC Palliative Care
https://www.readbyqxmd.com/read/28531769/increases-in-prescription-opioid-injection-abuse-among-treatment-admissions-in-the-united-states-2004-2013
#13
Christopher M Jones, Aleta Christensen, R Matthew Gladden
BACKGROUND: The 2015 HIV outbreak in Indiana associated with prescription opioid injection coupled with rising rates of hepatitis C, especially in areas with long-standing opioid abuse, have raised concerns about prescription opioid injection. However, research on this topic is limited. We assessed trends in treatment admissions reporting injection, smoking, and inhalation abuse of prescription opioids and examined characteristics associated with non-oral routes of prescription opioid abuse in the U...
May 16, 2017: Drug and Alcohol Dependence
https://www.readbyqxmd.com/read/28531768/rosa-damascena-oil-improved-sexual-function-and-testosterone-in-male-patients-with-opium-use-disorder-under-methadone-maintenance-therapy-results-from-a-double-blind-randomized-placebo-controlled-clinical-trial
#14
Vahid Farnia, Faeze Tatari, Mostafa Alikhani, Jalal Shakeri, Moshen Taghizadeh, Hassan Karbasizadeh, Dena Sadeghi Bahmani, Edith Holsboer-Trachsler, Serge Brand
BACKGROUND: Some patients with opioid use disorder (OUD) are treated with methadone maintenance therapy (MMT). However, as with opioids, methadone has major side-effects; sexual dysfunction is a particularly distressing such effect. Rosa Damascena oil has been shown to reduce subjective sexual dysfunction in patients with major depressive disorders, but its influence on testosterone has not so far been tested. The aim of the present study was to investigate the influence of Rosa Damascena oil on sexual dysfunction and testosterone levels among male patients with OUD and undergoing MMT...
April 6, 2017: Drug and Alcohol Dependence
https://www.readbyqxmd.com/read/28531306/association-of-long-term-opioid-therapy-with-functional-status-adverse-outcomes-and-mortality-among-patients-with-polyneuropathy
#15
E Matthew Hoffman, James C Watson, Jennifer St Sauver, Nathan P Staff, Christopher J Klein
Importance: Polyneuropathy is one of the most common painful conditions managed within general and specialty clinics. Neuropathic pain frequently leads to decisions about using long-term opioid therapy. Understanding the association of long-term opioid use with functional status, adverse outcomes, and mortality among patients with polyneuropathy could influence disease-specific decisions about opioid treatment. Objectives: To quantify the prevalence of long-term opioid use among patients with polyneuropathy and to assess the association of long-term opioid use with functional status, adverse outcomes, and mortality...
May 22, 2017: JAMA Neurology
https://www.readbyqxmd.com/read/28531297/mechanisms-of-kappa-opioid-receptor-potentiation-of-dopamine-d2-receptor-function-in-quinpirole-induced-locomotor-sensitization-in-rats
#16
Angélica P Escobar, Marcela P González, Rodrigo C Meza, Verónica Noches, Pablo Henny, Katia Gysling, Rodrigo A España, José A Fuentealba, María E Andrés
Background: Increased locomotor activity in response to the same stimulus is an index of behavioral sensitization observed in preclinical models of drug addiction and compulsive behaviors. Repeated administration of Quinpirole (QNP), a D2/D3 dopamine agonist, induces locomotor sensitization. This effect is potentiated and accelerated by co-administration of U69593, a kappa opioid receptor agonist (KOR). The mechanism underlying KOR potentiation of QNP-induced locomotor sensitization remains to be elucidated...
May 22, 2017: International Journal of Neuropsychopharmacology
https://www.readbyqxmd.com/read/28531257/lack-of-evidence-for-benefit-from-long-term-use-of-opioid-analgesics-for-patients-with-neuropathy
#17
Nora D Volkow, Walter Koroshetz
No abstract text is available yet for this article.
May 22, 2017: JAMA Neurology
https://www.readbyqxmd.com/read/28530896/use-and-misuse-of-opioid-agonists-in-opioid-addiction
#18
REVIEW
Vania Modesto-Lowe, Katie Swiezbin, Margaret Chaplin, Gabriela Hoefer
Although methadone (an opioid agonist) and buprenorphine (a partial opioid agonist) have evidence to support their use in treating opioid use disorder, they remain misunderstood and underutilized. In this article, we outline the risks and benefits of using these drugs as maintenance therapy in opioid-dependent patients.
May 2017: Cleveland Clinic Journal of Medicine
https://www.readbyqxmd.com/read/28530891/a-rational-approach-to-opioid-use-disorder-in-primary-care
#19
EDITORIAL
Daniel G Tobin
No abstract text is available yet for this article.
May 2017: Cleveland Clinic Journal of Medicine
https://www.readbyqxmd.com/read/28530876/research-continuous-surveillance-of-sleep-apnea-patients-in-a-medical-surgical-unit
#20
Dana Supe, Leah Baron, Tom Decker, Kyle Parker, Jeanne Venella, Sarah Williams, Kari Beaton, John Zaleski
This report consists of two separate studies on the use of continuous capnography monitoring conducted in an effort to improve patient safety at Virtua Health System. The desire for improved patient safety is motivating continuous monitoring and improved surveillance in clinical areas not traditionally equipped for such monitoring. We explored the use of remote monitoring of capnography, using enterprise middleware, in patients recovering from surgery in a medical-surgical unit. Continuous monitoring traditionally has been used in higher-acuity settings, such as intensive care units...
May 2017: Biomedical Instrumentation & Technology
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