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Opioid Detoxification

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https://www.readbyqxmd.com/read/28199203/neurogenetics-of-acute-and-chronic-opiate-opioid-abstinence-treating-symptoms-and-the-cause
#1
Kenneth Blum, Mark S Gold, William Jacobs, William Vaughn McCall, Marcelo Febo, David Baron, Kristina Dushaj, Zsolt Demetrovics, Rajendra D Badgaiyan
This review begins with a comprehensive history of opioid dependence and treatment in the United States. The focus is an evidence-based treatment model for opioid/opiate dependent individuals. The role of reward genetic polymorphisms and the epigenetic modifications that lead to vulnerability to use and misuse of opiates/opioid to treat pain are reviewed. The neurochemical mechanisms of acute opiate withdrawal and opiate/opioid reward mechanisms are explored with a goal of identifying specific treatment targets...
March 1, 2017: Frontiers in Bioscience (Landmark Edition)
https://www.readbyqxmd.com/read/28138205/opium-withdrawal-delirium-two-case-reports
#2
Ravi C Sharma, Ramesh Kumar, Dinesh Dutt Sharma, Pankaj Kanwar
Two patients with opium dependence developed delirium during abstinence. The delirium resolved completely within 48-58 hours of appropriate treatment. Caution needs to be exercised during opioid detoxification in timely detecting and treating potentially life-threatening condition like delirium.
January 26, 2017: Psychopharmacology Bulletin
https://www.readbyqxmd.com/read/28108941/factors-associated-with-emergency-department-useamong-veteran-psychiatric-patients
#3
Daniel M Blonigen, Kathryn S Macia, Xiaoyu Bi, Paola Suarez, Luisa Manfredi, Todd H Wagner
Frequent utilization of emergency department (ED) services contributes substantially to the cost of healthcare nationally and is often driven by psychiatric factors. Using national-level data from the Veterans Health Administration (VHA), the present study examined patient-level factors associated with ED use among veteran psychiatric patients. Veterans who had at least one ED visit with a psychiatric diagnosis in fiscal years 2011-2012 (n = 226,122) were identified in VHA administrative records. Andersen's behavioral model of healthcare utilization was used to identify need, enabling, and predisposing factors associated with frequency of ED use (primary outcome) in multivariate regression models...
January 21, 2017: Psychiatric Quarterly
https://www.readbyqxmd.com/read/28079573/medically-assisted-withdrawal-detoxification-considering-the-mother-infant-dyad
#4
Hendrée E Jones, Mishka Terplan, Marjorie Meyer
Recommendations for opioid agonist pharmacotherapy and against medically assisted withdrawal were based upon early reports that associated withdrawal with maternal relapse and fetal demise. Data from recent case series have called these recommendations into question. Although these data do not support an association between medically assisted withdrawal and fetal demise, relapse remains a significant clinical concern with reported rates ranging from 17% to 96% (average 48%). Given the high loss to follow-up in these studies, the actual relapse rate is likely even greater...
January 11, 2017: Journal of Addiction Medicine
https://www.readbyqxmd.com/read/28068780/long-acting-injectable-naltrexone-induction-a-randomized-trial-of-outpatient-opioid-detoxification-with-naltrexone-versus-buprenorphine
#5
Maria Sullivan, Adam Bisaga, Martina Pavlicova, C Jean Choi, Kaitlyn Mishlen, Kenneth M Carpenter, Frances R Levin, Elias Dakwar, John J Mariani, Edward V Nunes
OBJECTIVE: At present there is no established optimal approach for transitioning opioid-dependent adults to extended-release injection naltrexone (XR-naltrexone) while preventing relapse. The authors conducted a trial examining the efficacy of two methods of outpatient opioid detoxification for induction to XR-naltrexone. METHOD: Participants were 150 opioid-dependent adults randomly assigned 2:1 to one of two outpatient detoxification regimens, naltrexone-assisted detoxification or buprenorphine-assisted detoxification, followed by an injection of XR-naltrexone...
January 10, 2017: American Journal of Psychiatry
https://www.readbyqxmd.com/read/28059434/assessment-of-abuse-liability-of-tramadol-among-experienced-drug-users-double-blind-crossover-randomized-controlled-trial
#6
Mrinmay Das, Raka Jain, Anju Dhawan, Amandeep Kaur
BACKGROUND: Tramadol is a widely used opioid analgesic. Different preclinical, clinical, and postmarketing surveillance studies show conflicting results regarding abuse potential of this drug. METHODS: A randomized double-blind complete crossover study was conducted at National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi. Total subjects were 10, comprising total 120 observations (each subject assessed at baseline, 5, 45, and 240 minutes)...
November 2016: Journal of Opioid Management
https://www.readbyqxmd.com/read/28051842/the-use-of-auricular-acupuncture-in-opioid-use-disorder-a-systematic-literature-review
#7
REVIEW
Tanya E Baker, Grace Chang
BACKGROUND AND OBJECTIVES: Opioid use disorder (OUD) is a chronic disease with significant personal, societal, and public health consequences. Even for the minority who receive the most effective evidence-based treatments, morbidity, and mortality remain significant. These facts, along with the recovery movement calling for individualized, holistic, culturally sensitive care, have led to the exploration of adjunctive interventions including acupuncture. Despite hundreds of international trials, however, there is a lack of consensus regarding its efficacy in OUD due in large part to methodological issues of trials to date...
December 2016: American Journal on Addictions
https://www.readbyqxmd.com/read/28027027/estimating-state-transitions-for-opioid-use-disorders
#8
Emanuel Krebs, Jeong E Min, Elizabeth Evans, Libo Li, Lei Liu, David Huang, Darren Urada, Thomas Kerr, Yih-Ing Hser, Bohdan Nosyk
AIM: The aim was to estimate transitions between periods in and out of treatment, incarceration, and legal supervision, for prescription opioid (PO) and heroin users. METHODS: We captured all individuals admitted for the first time for publicly funded treatment for opioid use disorder (OUD) in California (2006 to 2010) with linked mortality and criminal justice data. We used Cox proportional hazards and competing risks models to assess the effect of primary PO use (v...
December 1, 2016: Medical Decision Making: An International Journal of the Society for Medical Decision Making
https://www.readbyqxmd.com/read/28017182/prevalence-of-restless-legs-syndrome-during-detoxification-from-alcohol-and-opioids
#9
Susan E Mackie, R Kathryn McHugh, Katherine McDermott, Margaret L Griffin, John W Winkelman, Roger D Weiss
BACKGROUND AND AIMS: Restless legs syndrome (RLS) is a movement disorder associated with adverse health outcomes and decreased quality of life. Small case series suggest that symptoms of RLS occur during opioid withdrawal. However, the prevalence is unknown. METHODS: We conducted an observational study to determine the prevalence of RLS among inpatients patients receiving buprenorphine detoxification from opioids. To assess the specificity of RLS to opioid detoxification, we also evaluated patients receiving detoxification from alcohol as a comparison group...
February 2017: Journal of Substance Abuse Treatment
https://www.readbyqxmd.com/read/27981691/the-costs-of-crime-during-and-after-publicly-funded-treatment-for-opioid-use-disorders-a-population-level-study-for-the-state-of-california
#10
Emanuel Krebs, Darren Urada, Elizabeth Evans, David Huang, Yih-Ing Hser, Bohdan Nosyk
BACKGROUND AND AIMS: Treatment for opioid use disorders (OUD) reduces the risk of mortality and infectious disease transmission; however, opportunities to quantify the potential economic benefits of associated decreases in drug-related crime are scarce. This paper aimed to estimate the costs of crime during and after periods of engagement in publicly-funded treatment for OUD to compare total costs of crime over a hypothetical 6-month period following initiation of opioid agonist treatment (OAT) versus detoxification...
December 15, 2016: Addiction
https://www.readbyqxmd.com/read/27776678/cognitive-behavioral-therapy-improves-treatment-outcomes-for-prescription-opioid-users-in-primary-care-buprenorphine-treatment
#11
Brent A Moore, David A Fiellin, Christopher J Cutter, Frank D Buono, Declan T Barry, Lynn E Fiellin, Patrick G O'Connor, Richard S Schottenfeld
To determine whether treatment outcomes differed for prescription opioid and heroin use disorder patients, we conducted a secondary analysis of a 24-week (N=140) randomized trial of physician management (PM) or PM plus cognitive behavioral therapy (CBT) in primary care buprenorphine/naloxone treatment. Self-reported opioid use and urine toxicology analyses were obtained weekly. We examined baseline demographic differences between primary prescription opioid use patients (n=49) and primary heroin use patients (n=91) and evaluated whether treatment response differed by assigned condition...
December 2016: Journal of Substance Abuse Treatment
https://www.readbyqxmd.com/read/27740713/tincture-of-opium-for-treating-opioid-dependence-a-systematic-review-of-safety-and-efficacy
#12
REVIEW
Mohammadali Nikoo, Nooshin Nikoo, Sanam Javid Anbardan, Afshar Amiri, Marc Vogel, Fiona Choi, Amir Ali Sepehry, Amir Hooshang Bagheri Valoojerdi, Kerry Jang, Christian Schütz, Shahin Akhondzadeh, Michael Krausz
BACKGROUND AND AIMS: Recently, there has been a growing interest in using opium tincture (OT) for treating opioid dependence in certain regions. We aimed to assess the evidence on its safety and efficacy for this indication. METHODS: We searched several databases (CENTRAL, Medline, EMBASE, Web of Science, PsychINFO, ProQuest Dissertation and Theses Database, Iran Medex, clinicaltrials.gov and who.int/trialsearch) with no language or publication date limitations...
October 14, 2016: Addiction
https://www.readbyqxmd.com/read/27739172/progressive-white-matter-impairment-as-a-predictor-of-outcome-in-a-cohort-of-opioid-dependent-patient-s-post-detoxification
#13
Jo-Hanna Ivers, Jacqueline Fitzgerald, Christopher Whelan, Brion Sweeney, Eamon Keenan, Andrew Fagan, Jason McMarrow, Jim Meany, Joe Barry, Thomas Frodl
White matter impairment is associated with opioid dependence. However, the specific neuropathology related to opioid dependence is still not fully understood. The main aims of this study were to: (1) assess the association between white matter impairment and duration of dependence; (2) examine whether this impairment correlates with treatment outcome measures in opioid-dependent patients post-detoxification. Fifty-eight opioid-dependent patients participated, 20 females and 38 males, across three groups: less than 10 years use (n = 18), 10-15 years use (n = 26) and 16-25+ years use (n = 14)...
October 13, 2016: Addiction Biology
https://www.readbyqxmd.com/read/27734745/update-on-pharmacotherapy-for-treatment-of-opioid-use-disorder
#14
Daniel Ayanga, Daryl Shorter, Thomas R Kosten
Opioid Use Disorder (OUD) is a significant public health concern, negatively impacting the medical, psychological, and social domains of an individual's life as well as creating substantial burdens for society. Effective treatment interventions are necessary for reduction of OUD and its consequences. Pharmacotherapy represents a central component of management. Areas covered: This review focuses on pharmacologic strategies for OUD treatment, discussing both primary as well as adjunctive therapy modalities. We will discuss both medications used during detoxification to treat withdrawal, as well as those used as maintenance therapy...
December 2016: Expert Opinion on Pharmacotherapy
https://www.readbyqxmd.com/read/27722007/predictors-of-relapse-after-inpatient-opioid-detoxification-during-1-year-follow-up
#15
Harsh Chalana, Tanu Kundal, Varun Gupta, Amandeep Singh Malhari
Introduction. Relapse rate after opioid detoxification is very high. We studied the possibility that predetoxification patient characteristics might predict relapse at follow-up and thus conducted this 1-year follow-up study to assess the predictors of relapse after inpatient opioid detoxification. Materials and Methods. We conducted this study in our tertiary care institute in India over two-year time period (1 Jan 2014 to 31 Dec 2015). Out of 581 patients admitted, 466 patients were considered for study. Results and Discussion...
2016: Journal of Addiction
https://www.readbyqxmd.com/read/27692193/non-prescribed-buprenorphine-in-new-york-city-motivations-for-use-practices-of-diversion-and-experiences-of-stigma
#16
Bennett Allen, Alex Harocopos
Non-medical use of opioid analgesics (OAs) has increased in the United States over the past decade. Concurrently, access to opioid agonist therapies (OATs) such as buprenorphine has expanded. However, there has been little in-depth qualitative exploration into circumstances surrounding buprenorphine diversion and non-prescribed use. This study reports on qualitative data from in-depth interviews conducted with persons in New York City reporting non-medical OA use in the past 12 months. Participants (n=42) were aged between 18 and 49 years...
November 2016: Journal of Substance Abuse Treatment
https://www.readbyqxmd.com/read/27692182/community-based-methadone-maintenance-in-a-large-detention-center-is-associated-with-decreases-in-inmate-recidivism
#17
Verner S Westerberg, Barbara S McCrady, Mandy Owens, Paul Guerin
Because it is not common in the U.S. for jails to allow inmates to continue opioid medications that have been started in the community, we aimed to assess whether inmates maintained on methadone showed different rates of recidivism, lengths of incarceration, and types of offenses than other incarcerated groups. We also analyzed rates of return to home clinics after release. In order to answer these questions this study used extant data from 960 adult inmates in a large metropolitan detention center who were in 1 of 4 groups: general population with no known substance use disorders, alcohol detoxification, methadone maintenance (MMT), and opioid detoxification...
November 2016: Journal of Substance Abuse Treatment
https://www.readbyqxmd.com/read/27687743/ethical-and-clinical-safety-considerations-in-the-design-of-an-effectiveness-trial-a-comparison-of-buprenorphine-versus-naltrexone-treatment-for-opioid-dependence
#18
Edward V Nunes, Joshua D Lee, Dominic Sisti, Andrea Segal, Arthur Caplan, Marc Fishman, Genie Bailey, Gregory Brigham, Patricia Novo, Sarah Farkas, John Rotrosen
We examine ethical challenges encountered in the design of an effectiveness trial (CTN-0051; X:BOT), comparing sublingual buprenorphine-naloxone (BUP-NX), an established treatment for opioid dependence, to the newer extended-release injectable naltrexone (XR-NTX). Ethical issues surrounded: 1) known poor effectiveness of one possible, commonly used treatment as usual control condition-detoxification followed by counseling without medication; 2) the role of patients' preferences for treatments, given that treatments were clinically approved and available to the population; 3) differences between the optimal "usual treatment" clinical settings for different treatments making it challenging to design a fair comparison; 4) vested interest groups favoring different treatments exerting potential influence on the design process; 5) potentially vulnerable populations of substance users and prisoners; 6) potential therapeutic misconception in the implementation of safety procedures; and 7) high cost of a large trial limiting questions that could be addressed...
November 2016: Contemporary Clinical Trials
https://www.readbyqxmd.com/read/27615418/medication-overuse-headache-risk-factors-pathophysiology-and-management
#19
REVIEW
Hans-Christoph Diener, Dagny Holle, Kasja Solbach, Charly Gaul
Medication-overuse headache (MOH) is defined by the International Classification of Headache Disorders as a headache in patients with a pre-existing primary headache disorder that occurs on ≥15 days per month for >3 months, and is caused by overuse of medication intended for acute or symptomatic headache treatment. The prevalence of MOH in the general population is around 1%, but the condition is much more common in people with headache, in particular chronic migraine. The phenotype of the headache in MOH depends on the initial primary headache and the type of overused acute medication...
October 2016: Nature Reviews. Neurology
https://www.readbyqxmd.com/read/27613150/acceptability-of-extended-release-naltrexone-by-heroin-dependent-patients-and-addiction-treatment-providers-in-the-netherlands
#20
Eline R Zaaijer, Anna E Goudriaan, Maarten W J Koeter, Jan Booij, Wim van den Brink
BACKGROUND: Extended-release naltrexone (XRNT) was developed to overcome poor treatment compliance with oral naltrexone in alcohol and opioid-dependent patients. XRNT injections are registered in the United States and Russia, but not in The Netherlands. However, XRNT can be obtained for individual patients, but it is expensive and not reimbursed by the health insurance. OBJECTIVES: This study evaluates the support for abstinence oriented treatment among heroin-dependent patients and the acceptability of XRNT injections by heroin-dependent patients and treatment providers in The Netherlands...
December 5, 2016: Substance Use & Misuse
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