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Opioid substitution

Rosalind L Coleman, Susie McLean
INTRODUCTION: The offer of pre-exposure prophylaxis (PrEP) is recommended as an additional option for HIV prevention for people at substantial risk of HIV infection as part of combination HIV prevention approaches. Implementing this depends on integrating PrEP in public health programmes that address risky practices with evidence-based interventions, and that operate in an enabling legal and policy environment for the delivery of health services to those at higher risk of HIV infection...
2016: Journal of the International AIDS Society
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...
October 13, 2016: Expert Opinion on Pharmacotherapy
O Prezzavento, E Arena, C Sánchez-Fernández, R Turnaturi, C Parenti, A Marrazzo, R Catalano, E Amata, L Pasquinucci, E J Cobos
cis-N-Substituted N-normetazocine enantiomers possess peculiar pharmacological profiles. Indeed, dextro enantiomers bind with high affinity σ1 receptor while opposite enantiomers bind opioid receptors. In spite of their stereochemistry, cis-N-2-phenylethyl N-normetazocine (phenazocine) enantiomers showed mixed opioid/σ1 receptor profiles and a significant in vivo analgesia. To the best of our knowledge, there is no information available regarding the evaluation of σ1 pharmacological profile in the antinociceptive effects of (+)- and (-)-phenazocine...
September 26, 2016: European Journal of Medicinal Chemistry
Eva Charlotte Toth, Jette Tegner, Sigurd Lauridsen, Nanna Kappel
BACKGROUND: Drug consumption rooms (DCRs) have been implemented worldwide as a harm-reducing strategy. In 2012, Denmark passed legislation allowing establishment of DCRs. The aim of this study was to identify characteristics and gain knowledge of the way service users use the DCRs including bridge building to specialized health care. Associations between nationality, opioid substitution treatment (OST), drug intake method, and response to staff advice on harm-reducing education was investigated, as well as service user's reasons for using the DCRs, and their perceptions of safety and trust in the DCRs...
October 7, 2016: Harm Reduction Journal
Iain A Kaan, Geoffrey McCaughan, Tracey Jones
OBJECTIVE: To determine the likely current capacity of accredited treatment centres in treating hepatitis C (HCV) patients with Interferon free Direct Acting (DAA) Antiviral agents in Australia. METHOD: Data was collected from 22 centres before the introduction of DAA therapy - 11 sites from the Study 1 survey and an additional 11 sites from the Study 2 survey. The sites were selected based on consensus by viral hepatitis experts, in consultation with the NSW Agency for Clinical Innovation...
September 26, 2016: Internal Medicine Journal
Deborah Dowell, Kun Zhang, Rita K Noonan, Jason M Hockenberry
To address the opioid overdose epidemic in the United States, states have implemented policies to reduce inappropriate opioid prescribing. These policies could affect the coincident heroin overdose epidemic by either driving the substitution of heroin for opioids or reducing simultaneous use of both substances. We used IMS Health's National Prescription Audit and government mortality data to examine the effect of these policies on opioid prescribing and on prescription opioid and heroin overdose death rates in the United States during 2006-13...
October 1, 2016: Health Affairs
Sarah Larney, Wilson Lai, Kate Dolan, Deborah Zador
BACKGROUND AND AIMS: Opioid substitution therapy (OST) is an effective treatment for opioid dependence that is provided in many correctional settings, including New South Wales (NSW), Australia. In 2011, changes to the clinical governance of the NSW prison OST program were implemented, including a more comprehensive assessment, additional specialist nurses, and centralization of program management and planning. This study aimed to document the NSW prison OST program, and assess the impact of the enhanced clinical governance arrangements on retention in treatment until release, the provision of an OST prescription to patients at release, and presentation to a community OST clinic within 48 hours of release from custody...
November 2016: Journal of Substance Abuse Treatment
Maria E Secci, Julie A Factor, Charles W Schindler, Leigh V Panlilio
RATIONALE: The choice to seek immediate drug effects instead of more meaningful but delayed rewards is a defining feature of addiction. OBJECTIVES: To develop a rodent model of this behavior, we allowed rats to choose between immediate intravenous delivery of the prescription opioid oxycodone (50 μg/kg) and delayed delivery of palatable food pellets. RESULTS: Rats preferred food at delays up to 30 s, but they chose oxycodone and food equally at 60-s delay and preferred oxycodone over food at 120-s delay...
September 28, 2016: Psychopharmacology
Xavier Castells, Ruth Cunill, Clara Pérez-Mañá, Xavier Vidal, Dolors Capellà
BACKGROUND: Cocaine dependence is a severe disorder for which no medication has been approved. Like opioids for heroin dependence, replacement therapy with psychostimulants could be an effective therapy for treatment. OBJECTIVES: To assess the effects of psychostimulants for cocaine abuse and dependence. Specific outcomes include sustained cocaine abstinence and retention in treatment. We also studied the influence of type of drug and comorbid disorders on psychostimulant efficacy...
September 27, 2016: Cochrane Database of Systematic Reviews
Khuthala Mnika, Gift D Pule, Collet Dandara, Ambroise Wonkam
Sickle cell disease (SCD) is a blood disease caused by a single nucleotide substitution (T > A) in the beta globin gene on chromosome 11. The single point mutation (Glu6Val) promotes polymerization of hemoglobin S (HbS) and causes sickling of erythrocytes. Vaso-occlusive painful crises are associated with recurrent and long-term use of analgesics/opioids and hydroxyurea (HU) by people living with SCD. The present analysis offers a state-of-the-art expert review of the effectiveness of pharmacogenomics/genetics of pain management in SCD, with specific focus on HU and opioids...
October 2016: Omics: a Journal of Integrative Biology
Daniel Werb, Richard Garfein, Thomas Kerr, Peter Davidson, Perrine Roux, Marie Jauffret-Roustide, Marc Auriacombe, Will Small, Steffanie A Strathdee
BACKGROUND: Injection drug use remains a primary driver of HIV and HCV-related harms globally. However, there is a gap in efforts to prevent individuals from transitioning into injecting. People who inject drugs (PWID) play a key role in the transition of others into injecting, and while behavioral interventions have been developed to address this phenomenon, socio-structural approaches remain unexplored. To that end, we hypothesize that certain interventions designed to reduce injecting-related risk behaviors may also reduce the risk that PWID expose and introduce others into injecting...
2016: Harm Reduction Journal
Sara M Hall, Lindsay LeBaron, Cyf Ramos-Colon, Chaoling Qu, Jennifer Yanhua Xie, Frank Porreca, Josephine Lai, Yeon Sun Lee, Victor J Hruby
Dynorphin A (Dyn A) is a unique endogenous ligand that possesses well-known neuroinhibitory effects via opioid receptors with a preference for the kappa receptor but also neuroexcitatory effects, which cause hyperalgesia. We have shown that the neuroexcitatory effects are mediated through bradykinin (BK) receptors and that intrathecal ( administration of our lead ligand 1, [des-Arg(7)]-Dyn A-(4-11), which shows good binding affinity (IC50 = 150 nM) at the BK receptors, blocks Dyn A-induced hyperalgesia in naïve animals and reverses thermal and tactile hypersensitivities in a dose-dependent manner in nerve-injured animals...
September 27, 2016: ACS Chemical Neuroscience
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
Fabio Lugoboni, Antonio Mirijello, Chiara Resentera, Lorenzo Zamboni, Marco Faccini, Rebecca Casari, Anthony Cossari, Gessica Musi, Giorgia Bissoli, Antonio Gasbarrini, Gianluca Quaglio, Giovanni Addolorato
OBJECTIVES: To evaluate prevalence and severity of constipation and quality of life (QoL) in a cohort of opioid-addicted patients treated with opioid substitution treatments. RESEARCH DESIGN AND METHODS: Multicenter observational study. A total of 1057 heroin-dependent patients treated with methadone or buprenorphine were enrolled. Constipation was assessed by Wexner Constipation Scoring System, QoL by General Health Questionnaire (GHQ-12). RESULTS: 38...
September 7, 2016: Expert Opinion on Pharmacotherapy
Benjamin Wenz, Stine Nielsen, Martyna Gassowski, Claudia Santos-Hövener, Wei Cai, R Stefan Ross, Claus-Thomas Bock, Boris-Alexander Ratsch, Claudia Kücherer, Norbert Bannert, Viviane Bremer, Osamah Hamouda, Ulrich Marcus, Ruth Zimmermann
BACKGROUND: People who inject drugs (PWID) are at increased risk of acquiring and transmitting HIV and Hepatitis C (HCV) due to sharing injection paraphernalia and unprotected sex. To generate seroprevalence data on HIV and HCV among PWID and related data on risk behaviour, a multicentre sero- and behavioural survey using respondent driven sampling (RDS) was conducted in eight German cities between 2011 and 2014. We also evaluated the feasibility and effectiveness of RDS for recruiting PWID in the study cities...
2016: BMC Public Health
Kanna Hayashi, Evan Wood, Thomas Kerr, Huiru Dong, Paul Nguyen, Cathy M Puskas, Silvia Guillemi, Julio S G Montaner, Michael-John Milloy
BACKGROUND: Crack cocaine use is known to contribute to poor adherence to antiretroviral medications; however, little is known about facilitators of or barriers to effective HIV treatment use among HIV-infected crack cocaine users. We sought to identify correlates of optimal pharmacy refill adherence for antiretroviral medications and plasma HIV RNA viral load (pVL) suppression among this population. METHODS: Data from a prospective cohort of HIV-positive people who use illicit drugs in Vancouver, Canada, were linked to comprehensive HIV clinical monitoring and pharmacy dispensation records...
2016: BMC Infectious Diseases
Jason Grebely, Gregory J Dore, Stefan Zeuzem, Richard J Aspinall, Raymond Fox, Lingling Han, John McNally, Anu Osinusi, Diana M Brainard, G Mani Subramanian, Macky Natha, Graham R Foster, Alessandra Mangia, Mark Sulkowski, Jordan J Feld
In this analysis of the ASTRAL trials (non-opioid substitution therapy [OST], n = 984; OST, n = 51) evaluating the once-daily, pan-genotypic regimen of sofosbuvir/velpatasvir for hepatitis C virus infection, OST did not impact completion, adherence, sustained virologic response (SVR12), or safety. SVR12 was 96% (95% confidence interval, 87%, >99%) in those receiving OST.
August 23, 2016: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Jason Grebely, Stefan Mauss, Ashley Brown, Jean-Pierre Bronowicki, Massimo Puoti, David Wyles, Macky Natha, Yanni Zhu, Junming Yang, Bruce Kreter, Diana M Brainard, Chohee Yun, Val Carr, Gregory J Dore
BACKGROUND:  Interferon-based hepatitis C virus (HCV) therapy is safe and effective among people receiving opioid substitution therapy (OST), but treatment uptake remains low. Our aim was to evaluate the impact of OST and drug use during therapy on completion, adherence, sustained virologic response (SVR12), and safety of ledipasvir/sofosbuvir ± ribavirin. METHODS:  The phase 3 ION studies evaluated a fixed-dose combination of ledipasvir/sofosbuvir ± ribavirin administered for 8, 12, or 24 weeks in patients with chronic HCV genotype 1...
August 23, 2016: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Ankit Upadhyay, Vijaykumar Bodar, Mohammad Malekzadegan, Sharanjit Singh, William Frumkin, Aditya Mangla, Kaushik Doshi
Loperamide is over-the-counter antidiarrheal agent acting on peripherally located μ opioid receptors. It is gaining popularity among drug abusers as opioid substitute. We report a case of a 46-year-old male that was presented after cardiac arrest. After ruling out ischemia, cardiomyopathy, pulmonary embolism, central nervous system pathology, sepsis, and other drug toxicity, we found out that patient was using around 100 mg of Loperamide to control his chronic diarrhea presumably because of irritable bowel syndrome for last five years and consumed up to 200 mg of Loperamide daily for last two days before the cardiac arrest...
2016: Case Reports in Cardiology
Daniel O'Keefe, Nick Scott, Campbell Aitken, Paul Dietze
BACKGROUND: Coverage is used as one indicator of needle and syringe program (NSP) effectiveness. At the individual level, coverage is typically defined as an estimate of the proportion of a person who injects drugs' (PWID) injecting episodes that utilise a sterile syringe. In this paper, we explore levels of individual syringe coverage and its changes over time. METHODS: Data were extracted from 1889 interviews involving 502 participants drawn from the Melbourne drug user cohort study (MIX)...
2016: BMC Health Services Research
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