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https://www.readbyqxmd.com/read/29049469/the-effectiveness-of-injectable-extended-release-naltrexone-vs-daily-buprenorphine-naloxone-for-opioid-dependence-a-randomized-clinical-noninferiority-trial
#1
Lars Tanum, Kristin Klemmetsby Solli, Zill-E-Huma Latif, Jurate Šaltyte Benth, Arild Opheim, Kamni Sharma-Haase, Peter Krajci, Nikolaj Kunøe
Importance: To date, extended-release naltrexone hydrochloride has not previously been compared directly with opioid medication treatment (OMT), currently the most commonly prescribed treatment for opioid dependence. Objective: To determine whether treatment with extended-release naltrexone will be as effective as daily buprenorphine hydrochloride with naloxone hydrochloride in maintaining abstinence from heroin and other illicit substances in newly detoxified individuals...
October 18, 2017: JAMA Psychiatry
https://www.readbyqxmd.com/read/29049282/behavioral-intervention-to-reduce-opioid-overdose-among-high-risk-persons-with-opioid-use-disorder-a-pilot-randomized-controlled-trial
#2
Phillip Oliver Coffin, Glenn-Milo Santos, Tim Matheson, Emily Behar, Chris Rowe, Talia Rubin, Janelle Silvis, Eric Vittinghoff
OBJECTIVE: The United States is amidst an opioid epidemic, including synthetic opioids that may result in rapid death, leaving minimal opportunity for bystander rescue. We pilot tested a behavioral intervention to reduce the occurrence of opioid overdose among opioid dependent persons at high-risk for subsequent overdose. MATERIALS AND METHODS: We conducted a single-blinded randomized-controlled trial of a repeated dose motivational interviewing intervention (REBOOT) to reduce overdose versus treatment as usual, defined as information and referrals, over 16 months at the San Francisco Department of Public Health from 2014-2016...
2017: PloS One
https://www.readbyqxmd.com/read/29049278/illicit-drug-use-illicit-drug-use-disorders-and-drug-overdose-deaths-in-metropolitan-and-nonmetropolitan-areas-united-states
#3
Karin A Mack, Christopher M Jones, Michael F Ballesteros
PROBLEM/CONDITION: Drug overdoses are a leading cause of injury death in the United States, resulting in approximately 52,000 deaths in 2015. Understanding differences in illicit drug use, illicit drug use disorders, and overall drug overdose deaths in metropolitan and nonmetropolitan areas is important for informing public health programs, interventions, and policies. REPORTING PERIOD: Illicit drug use and drug use disorders during 2003-2014, and drug overdose deaths during 1999-2015...
October 20, 2017: MMWR. Surveillance Summaries: Morbidity and Mortality Weekly Report. Surveillance Summaries
https://www.readbyqxmd.com/read/29049113/the-us-opioid-crisis-current-federal-and-state-legal-issues
#4
Cobin D Soelberg, Raeford E Brown, Derick Du Vivier, John E Meyer, Banu K Ramachandran
The United States is in the midst of a devastating opioid misuse epidemic leading to over 33,000 deaths per year from both prescription and illegal opioids. Roughly half of these deaths are attributable to prescription opioids. Federal and state governments have only recently begun to grasp the magnitude of this public health crisis. In 2016, the Centers for Disease Control and Prevention released their Guidelines for Prescribing Opioids for Chronic Pain. While not comprehensive in scope, these guidelines attempt to control and regulate opioid prescribing...
November 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29046888/imaging-sex-differences-in-regional-brain-metabolism-during-acute-opioid-withdrawal
#5
Giovanni C Santoro, Joseph Carrion, Stephen L Dewey
The rate of opioid overdose continues to rise, necessitating improved treatment options. Current therapeutic approaches rely on administration of either a blocking agent, such as naloxone, or chronic treatment with replacement drugs, including methadone and/or buprenorphine. Recent findings suggest that males and females respond to these treatments uniquely. In an effort to better understand this sex-specific variation in treatment efficacy, we investigated the effects of acute opioid withdrawal in male and female rats using 18FDG and microPET...
April 2017: Journal of Alcoholism and Drug Dependence
https://www.readbyqxmd.com/read/29045991/naloxone-counseling-for-harm-reduction-and-patient-engagement
#6
Jonathan K Han, Lucas G Hill, Marianne E Koenig, Niladri Das
BACKGROUND AND OBJECTIVES: The United States is experiencing an epidemic of opioid-related deaths. Naloxone, the drug of choice for reversing acute opioid overdose, is not routinely prescribed for outpatient use. The aims of this project were to improve naloxone awareness, increase naloxone prescribing, and prevent opioid overdoses. METHODS: A naloxone counseling intervention was implemented in three family health centers by an interprofessional team of providers including family medicine physicians, clinical pharmacists, and social workers...
October 2017: Family Medicine
https://www.readbyqxmd.com/read/29045696/group-visits-for-overdose-education-and-naloxone-distribution-in-primary-care-a-pilot-quality-improvement-initiative
#7
Juliette F Spelman, Stephanie Peglow, Amy R Schwartz, Lucille Burgo-Black, Katelyn McNamara, William C Becker
Objective: Opioid prescribing for chronic pain significantly contributes to opioid overdose deaths in the United States. Naloxone as a take-home antidote to opioid overdose is underutilized and has not been evaluated in the high-risk chronic pain population. The objective was to increase overdose education and naloxone distribution (OEND) to high-risk patients on long-term opioid therapy for pain by utilizing group visits in primary care. Design: Quality improvement intervention among two primary care clinics...
October 16, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/29044528/endomorphins-potentiate-asic-currents-and-enhance-the-lactic-acid-mediated-increase-in-arterial-blood-pressure-effects-amplified-in-hindlimb-ischemia
#8
Mohamed Farrag, Julie K Drobish, Henry L Puhl, Joyce S Kim, Paul B Herold, Marc P Kaufman, Victor Ruiz-Velasco
Chronic muscle ischemia leads to accumulation of lactic acid and other inflammatory mediators with a subsequent drop in interstitial pH. Acid-sensing ion channels (ASICs), expressed in thin muscle afferents, sense the decrease in pH and evoke a pressor reflex known to increase mean arterial pressure. The naturally occurring endomorphins are also released by primary afferents under ischemic conditions. We examined whether high affinity mu opioid receptor (MOR) agonists, endomorphin-1 (E-1) and -2 (E-2), modulate ASIC currents and the lactic acid-mediated pressor reflex...
October 16, 2017: Journal of Physiology
https://www.readbyqxmd.com/read/29043922/barriers-and-facilitators-to-dispensing-of-intranasal-naloxone-by-pharmacists
#9
Ludmila N Bakhireva, Adriana Bautista, Sandra Cano, Shikhar Shrestha, Amy M Bachyrycz, Theresa H Cruz
BACKGROUND: While misuse of prescription opioids has reached epidemic proportions, pharmacy-based preventive services to combat this epidemic are limited. The aims of this study were to identify barriers and facilitators to the dispensing of intranasal naloxone (INN) by pharmacists in New Mexico. METHODS: For this mixed methods study, a qualitative component (focus group) informed the development of a quantitative component (electronic survey) distributed to all pharmacists registered with the New Mexico Board of Pharmacy and practicing in the state...
October 18, 2017: Substance Abuse
https://www.readbyqxmd.com/read/29042317/fentanyl-fentanyl-analogs-and-novel-synthetic-opioids-a-comprehensive-review
#10
REVIEW
Patil Armenian, Kathy T Vo, Jill Barr-Walker, Kara L Lynch
Deaths from opioid use are increasing in the US, with a growing proportion due to synthetic opioids. Until 2013, sporadic outbreaks of fentanyl and fentanyl analogs contaminating the heroin supply caused some deaths in heroin users. Since then, fentanyl has caused deaths in every state and fentanyl and its analogs have completely infiltrated the North American heroin supply. In 2014, the first illicit pills containing fentanyl, fentanyl analogs, and other novel synthetic opioids such as U-47700 were detected...
October 14, 2017: Neuropharmacology
https://www.readbyqxmd.com/read/29035918/dopaminergic-mechanisms-in-periaqueductal-gray-mediated-antinociception
#11
Glaucia Tobaldini, Rafael A Reis, Natalia F Sardi, Mayla K Lazzarim, Dabna H Tomim, Marcelo M S Lima, Luana Fischer
As important as perceiving pain is the ability to modulate this perception in some contextual salient situations. The periaqueductal gray (PAG) is perhaps the most important site of endogenous pain modulation; however, little is known about dopaminergic mechanisms underlying PAG-mediated antinociception. In this study, we used a pharmacological approach to evaluate this subject. We found that µ-opioid receptor-induced antinociception (DAMGO, 0.3 μg) from PAG was blocked by the coadministration of either D1-like or D2-like dopaminergic antagonists (SCH23390, 2, 4, and 6 μg or raclopride, 2 and 4 μg, respectively) both in the tail-flick and in the mechanical paw-withdrawal test...
October 13, 2017: Behavioural Pharmacology
https://www.readbyqxmd.com/read/29031874/an-update-on-the-physiopathology-and-therapeutic-management-of-cholestatic-pruritus-in-children
#12
A Thébaut, D Debray, E Gonzales
Pruritus is a disabling symptom accompanying chronic cholestasis. In extreme cases, the refractory nature of pruritus can result in a need for invasive therapies including liver transplantation. The pathogenesis of pruritus in cholestatic disease is poorly understood. It may involve a specific neural pathway (similar to that associated with pain) regulated by several pruritogenic substances such as bile acids, opioids, serotonin, and the more recently identified lysophosphatidic acid. While the therapeutic management of cholestatic pruritus is well established in adults, there is no consensus in children, in light of the difficulty of conducting controlled clinical studies...
October 11, 2017: Clinics and Research in Hepatology and Gastroenterology
https://www.readbyqxmd.com/read/29029049/intraoperative-naloxone-reduces-remifentanil-induced-postoperative-hyperalgesia-but-not-pain-a-randomized-controlled-trial
#13
C-H Koo, S Yoon, B-R Kim, Y J Cho, T K Kim, Y Jeon, J-H Seo
Background: Intraoperative use of a high-dose remifentanil may induce postoperative hyperalgesia. Low-dose naloxone can selectively reverse some adverse effects of opioids without compromising analgesia. We thus hypothesized that the intraoperative use of a high-dose remifentanil combined with a low-dose naloxone infusion reduces postoperative hyperalgesia compared with the use of remifentanil alone. Methods: Patients undergoing elective thyroid surgery were randomly assigned into one of three groups, depending on the intraoperative effect-site concentration of remifentanil, with or without a continuous infusion of naloxone: 4 ng ml-1 remifentanil with 0...
October 3, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29024092/pharmaceutical-opioid-use-and-harm-in-australia-the-need-for-proactive-and-preventative-responses
#14
Briony Larance, Louisa Degenhardt, Amy Peacock, Natasa Gisev, Richard Mattick, Samantha Colledge, Gabrielle Campbell
There are parallels between the North American experience of escalating pharmaceutical opioid utilisation and harm and the trends being observed in Australia. In Australia, opioid utilisation has increased dramatically over the past two decades. There have been significant shifts away from the predominant prescribing of 'weak' and short-acting opioids, to 'strong' and long-acting opioids, for an increasing range of chronic pain indications. In concordance with escalating use, Australia is experiencing increases in opioid-related hospital admissions and overdose, as well as opioid dependence and treatment seeking...
October 12, 2017: Drug and Alcohol Review
https://www.readbyqxmd.com/read/29023172/basic-and-advanced-ems-providers-are-equally-effective-in-naloxone-administration-for-opioid-overdose-in-northern-new-england
#15
Nazey Gulec, Joseph Lahey, James C Suozzi, Matthew Sholl, Charles D MacLean, Daniel L Wolfson
OBJECTIVE: Overdose mortality from illicit and prescription opioids has reached epidemic proportions in the United States, especially in rural areas. Naloxone is a safe and effective agent that has been shown to successfully reverse the effects of opioid overdose in the prehospital setting. The National EMS Scope of Practice Model currently only recommends advanced life support (ALS) providers to administer naloxone; however, some individual states have expanded this scope of practice to include intranasal (IN) administration of naloxone by basic life support (BLS) providers, including the Northern New England states...
October 12, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/29017806/implementation-of-a-bundled-protocol-significantly-reduces-risk-of-spinal-cord-ischemia-after-branched-or-fenestrated-endovascular-aortic-repair
#16
Salvatore T Scali, Moses Kim, Paul Kubilis, Robert J Feezor, Kristina A Giles, Brittney Miller, Javairiah Fatima, Thomas S Huber, Scott A Berceli, Martin Back, Adam W Beck
OBJECTIVE: Spinal cord ischemia (SCI) is a devastating complication after branched or fenestrated endovascular aortic repair (B/FEVAR) for thoracoabdominal aortic disease. The purpose of this analysis was to describe the impact of a bundled clinical care protocol designed to reduce the risk of SCI in this population of patients. METHODS: A bundled SCI prevention protocol including cerebrospinal fluid drainage, blood pressure parameters, transfusion goals, and pharmacologic adjuncts (steroids, naloxone) was initiated in May 2015...
October 7, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28992869/valproic-acid-overdose-review-of-a-case-with-electrocardiographic-changes
#17
Antonio E Muñiz
BACKGROUND: Valproic acid (VPA) is increasingly used to treat a variety of medical disorders, such as seizures, psychiatric disorders, and headaches. Therefore, accidental and intentional ingestions with valproic acid are increasing. OBJECTIVES: A case is presented in an adolescent with ischemic electrocardiographic changes after an acute overdose with VPA. DISCUSSION: Major features of a valproic acid overdose include respiratory depression, progressive coma, hepatotoxicity, thrombocytopenia, and hemodynamic instability...
September 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28986667/prolonged-release-oxycodone-naloxone-improves-anal-sphincter-relaxation-compared-to-oxycodone-plus-macrogol-3350
#18
Jakob Lykke Poulsen, Christina Brock, Debbie Grønlund, Donghua Liao, Hans Gregersen, Klaus Krogh, Asbjørn Mohr Drewes
BACKGROUND: Opioid analgesics inhibit anal sphincter function and contribute to opioid-induced bowel dysfunction (OIBD). However, it is unknown whether the inhibition can be reduced by opioid antagonism with prolonged-release (PR) naloxone and how this compares to laxative treatment. AIMS: To compare the effects of combined PR oxycodone/naloxone or PR oxycodone plus macrogol 3350 on anal sphincter function and gastrointestinal symptoms. METHODS: A randomized, double-blind, crossover trial was conducted in 20 healthy men...
October 6, 2017: Digestive Diseases and Sciences
https://www.readbyqxmd.com/read/28983963/beyond-rescue-implementation-and-evaluation-of-revised-naloxone-training-for-law-enforcement-officers
#19
Chin Hwa Gina Dahlem, Lisa King, Glynis Anderson, Ashton Marr, Jonathon Eric Waddell, Marci Scalera
OBJECTIVE: This study describes the implementation and evaluation of revised opioid overdose prevention and education of naloxone training for law enforcement officers (LEOs) that added: (1) a recovery testimony and (2) the process for deputy-initiated referrals postnaloxone administration. DESIGN AND SAMPLE: Evaluation regarding the naloxone training included a pre- and postopioid overdose knowledge surveys (N = 114) and subsequent 1-year postnaloxone training outcomes...
October 6, 2017: Public Health Nursing
https://www.readbyqxmd.com/read/28977468/opioid-crisis-at-the-jersey-shore-special-report
#20
Larissa S Dudley, Dorothy Konomos, Vince Robbins, Linda Qiu, Robert Bauter, Mark A Merlin
The USA is experiencing an epidemic of drug overdoses and deaths with a 200% increase in overdose deaths involving opioids including heroin. Legislation since 2013 has created paths to reduce opioid overdose deaths and since, basic life support (BLS) and police agencies have been administering naloxone to patients with suspected opioid overdoses as part of standard treatment protocols. Charts were reviewed from 1 January 2016 to 15 April 2016 on the de-identified electronic medical records of patients in a two-county system comprising the 'Jersey Shore' who received naloxone to determine the number of naloxone administrations and heroin overdoses...
August 31, 2017: Journal of Public Health
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