Bup Feeds

Commentary on Holland et al. (2014): Opioid maintenance treatment--how much supervision is helpful?

Buprenorphine Research (PubMed) - Fri, 04/10/2015 - 8:00am
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Commentary on Holland et al. (2014): Opioid maintenance treatment--how much supervision is helpful?

Addiction. 2014 Apr;109(4):608-9

Authors: Koller G

PMID: 24605959 [PubMed - indexed for MEDLINE]

Categories: Bup Feeds

Treatment retention, drug use and social functioning outcomes in those receiving 3 months versus 1 month of supervised opioid maintenance treatment. Results from the Super C randomized controlled trial.

Buprenorphine Research (PubMed) - Fri, 04/10/2015 - 8:00am
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Treatment retention, drug use and social functioning outcomes in those receiving 3 months versus 1 month of supervised opioid maintenance treatment. Results from the Super C randomized controlled trial.

Addiction. 2014 Apr;109(4):596-607

Authors: Holland R, Maskrey V, Swift L, Notley C, Robinson A, Nagar J, Gale T, Kouimtsidis C

Abstract
AIM: Supervised consumption of opioid maintenance treatment (OMT) is standard in many drug centres reducing drug diversion, but is costly. We aimed to determine whether supervised consumption of OMT improved retention and other measures of drug use.
DESIGN: Pragmatic randomized controlled trial comparing 3 months of daily supervised consumption of OMT with 1 month or less of daily supervised OMT, then daily unsupervised consumption.
SETTING: Four community drug services in the United Kingdom.
PARTICIPANTS: A total of 293 opioid-dependent patients entering OMT.
MEASUREMENTS:
PRIMARY OUTCOME: retention in treatment at 12 weeks. Secondary: retention at 6 months; illicit drug use [Maudsley Addiction Profile (MAP)]; quality of life (SF-12 and MAP); criminality (MAP); and social functioning.
FINDINGS: No significant between-group difference was observed for the primary outcome: 69% (100 of 145) supervised and 74% (109 of 148) unsupervised were retained [odds ratio (OR) = 0.74, 95% confidence interval (CI) = 0.43-1.27]. Per protocol survival analysis suggested that supervised patients were less well retained (hazard ratio for retention = 0.71, 95% CI = 0.51-1.00). Illicit opioid use reduced in both groups and, while not statistically significant by intention-to-treat analysis, favoured unsupervised patients in per protocol analysis (odds of positive opioid screen for supervised versus unsupervised = 2.07, 95% CI = 1.05-4.06). Data on criminal activity also favoured unsupervised patients with 21% supervised patients committing crime versus 9% unsupervised (OR = 3.37, 95% CI = 1.28-8.86).
CONCLUSIONS: There was no evidence of a difference in treatment retention or opioid use rates between patients whose consumption of opioid maintenance treatment was supervised for 3 months daily (except Saturdays) compared with supervision for 1 month. There was some evidence that longer periods of supervised consumption were associated with higher levels of criminality.

PMID: 24304349 [PubMed - indexed for MEDLINE]

Categories: Bup Feeds

Embolic stroke associated with intra-carotid injection of buprenorphine.

Buprenorphine Research (PubMed) - Thu, 04/09/2015 - 8:30am
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Embolic stroke associated with intra-carotid injection of buprenorphine.

Rev Neurol (Paris). 2015 Apr 4;

Authors: Moisset X, Sia MA, Perie M, Ferrier A, Bourgois N, Moisset X, Moisset X

PMID: 25851990 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Budgetary impact of the utilization of buprenorphine/naloxone sublingual film and tablet for Medicaid in the United States.

Buprenorphine Research (PubMed) - Thu, 04/09/2015 - 8:30am
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Budgetary impact of the utilization of buprenorphine/naloxone sublingual film and tablet for Medicaid in the United States.

J Med Econ. 2015 Apr 8;:1-20

Authors: Asche CV, Clay E, Kharitonova E, Zah V, Ruby J, Aballéa S

Abstract
OBJECTIVES: The buprenorphine/naloxone combination for the treatment of opioid dependence is available in a film or tablet formulation. Recent retrospective studies demonstrated that treatment with the sublingual film formulation is associated with improved treatment retention and lower healthcare costs. In March 2013, generic buprenorphine/naloxone tablets were approved in the US. A budget impact model was built to compare health care expenditures for different market shares of sublingual film and tablet.
METHODS: A Markov model was developed to track a cohort of opioid dependent patients treated with sublingual film or tablet through the following treatment phases: initiation, maintenance, discontinuation, off-treatment and re-initiation. Transition probabilities and costs for each phase were estimated from the MarketScan® Medicaid database for the period between 1 March 2010 and 30 June 2012. The total expenditure for the plan and expenditure per plan member per month were predicted over 5 years. Two market share scenarios were considered: 1) sublingual film is progressively replaced by generic tablet (current situation) and 2) the sublingual film holds a market share of 100%.
RESULTS: Predicted total costs over 5 years were $6,400 million when the sublingual film holds a market share of 100% (as per Scenario 2) which is lower than when sublingual film is progressively replaced by generic tablet (current situation as per Scenario 1) by $64 million. These savings were mostly driven by inpatient care ($56 million saved over 5 years), followed by emergency room care ($27 million) and pharmaceutical costs ($24 million). Costs of outpatient care attenuated the difference as they were predicted to be higher by $44 million in Scenario 2. The reduction in total cost per member per month reached $0.027 in the 5th year. Results were most sensitive to price rebates and to the probability of non-psychiatric hospitalization.
CONCLUSIONS: While using the sublingual film formulation for more patients treated with buprenorphine/naloxone is predicted to increase outpatient care costs, it would generate savings in emergency care and hospitalizations. In the treatment of opioid dependence, total direct medical costs for Medicaid would be less for sublingual film treated patients, at current drug prices.

PMID: 25851505 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Commentary on Hser et al. (2014): to retain or not to retain-open questions in opioid maintenance therapy.

Buprenorphine Research (PubMed) - Thu, 04/09/2015 - 8:30am
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Commentary on Hser et al. (2014): to retain or not to retain-open questions in opioid maintenance therapy.

Addiction. 2014 Jan;109(1):88-9

Authors: Soyka M, Hillemacher T

PMID: 24438113 [PubMed - indexed for MEDLINE]

Categories: Bup Feeds

Commentary on Freelemyer et al. (2014): medication-assisted treatment in Africa-need is growing but response remains tepid.

Buprenorphine Research (PubMed) - Thu, 04/09/2015 - 8:30am
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Commentary on Freelemyer et al. (2014): medication-assisted treatment in Africa-need is growing but response remains tepid.

Addiction. 2014 Jan;109(1):33-4

Authors: Obot IS

PMID: 24438111 [PubMed - indexed for MEDLINE]

Categories: Bup Feeds

Mariujuana vs. Alcohol: What to Say to Your Teen

Drug and Alcohol News (JoinTogether.com) - Wed, 04/08/2015 - 2:21pm

When it comes to talking to your teen about marijuana (and alcohol), it’s not always easy to know what to say.

While there is no exact “script” for talking with your teen about marijuana, our new Marijuana Talk Kit explores common teen questions and arguments – and offers tips for what you can say in response.

For example, what should you say if your teen asked you, “Would you rather I drink alcohol? Weed is so much safer.”

First, instead of getting rattled by your teen’s question, try posing a question back. (This acts as a buffer while you think about your answer.) Try something like: “What is going on in your life that makes you feel like you want to do either?”

Your teen may likely mumble back, “Nothing” (or another one-word answer), but keep in mind that even the word “nothing” is an opportunity to lead to another supportive statement from you.

You can then try, “I’m glad to hear there isn’t anything going on in your life that makes you want to drink or smoke.”

Lastly, it’s a good idea to say something along these lines: “Honestly, I don’t want you to be doing anything that can harm you — whether that’s smoking pot, cigarettes, drinking or behaving recklessly. I’m interested in knowing why you think weed is safer than alcohol.”

This type of sentiment reminds your teen that you care deeply about his health and well-being, and expresses genuine curiosity about his thought process, is going to help him open up.

And that’s what it’s all about. Engaging your teen so you can have ongoing, open and positive conversations. That’s how you’ll better understand the pressures he or she may be facing. And that’s how you can express your concern and support and love. And while your teen may not admit it, deep down that’s something all teenagers want.

Learn more about what to say to your teen about marijuana. Download your free Marijuana Talk Kit >

The post Mariujuana vs. Alcohol: What to Say to Your Teen appeared first on Partnership for Drug-Free Kids.

Categories: Bup Feeds

The unsolved case of "bone-impairing analgesics": the endocrine effects of opioids on bone metabolism.

Buprenorphine Research (PubMed) - Wed, 04/08/2015 - 1:30pm

The unsolved case of "bone-impairing analgesics": the endocrine effects of opioids on bone metabolism.

Ther Clin Risk Manag. 2015;11:515-23

Authors: Coluzzi F, Pergolizzi J, Raffa RB, Mattia C

Abstract
The current literature describes the possible risks for bone fracture in chronic analgesics users. There are three main hypotheses that could explain the increased risk of fracture associated with central analgesics, such as opioids: 1) the increased risk of falls caused by central nervous system effects, including sedation and dizziness; 2) reduced bone mass density caused by the direct opioid effect on osteoblasts; and 3) chronic opioid-induced hypogonadism. The impact of opioids varies by sex and among the type of opioid used (less, for example, for tapentadol and buprenorphine). Opioid-associated androgen deficiency is correlated with an increased risk of osteoporosis; thus, despite that standards have not been established for monitoring and treating opioid-induced hypogonadism or hypoadrenalism, all patients chronically taking opioids (particularly at doses ≥100 mg morphine daily) should be monitored for the early detection of hormonal impairment and low bone mass density.

PMID: 25848298 [PubMed]

Categories: Bup Feeds

Practice Guidance for Buprenorphine for the Treatment of Opioid Use Disorders: Results of an Expert Panel Process.

Buprenorphine Research (PubMed) - Tue, 04/07/2015 - 7:00am

Practice Guidance for Buprenorphine for the Treatment of Opioid Use Disorders: Results of an Expert Panel Process.

Subst Abus. 2015 Apr 6;:0

Authors: Farmer CM, Lindsay D, Williams J, Ayers A, Schuster J, Cilia A, Flaherty MT, Mandell T, Gordon AJ, Stein BD

Abstract
BACKGROUND: Although numbers of physicians credentialed to prescribe buprenorphine has increased over time, many credentialed physicians may be reluctant to treat individuals with opioid use disorders due to discomfort with prescribing buprenorphine. Though prescribing physicians are required to complete a training course, many have questions about buprenorphine and treatment guidelines have not been updated to reflect clinical experience in recent years. We report on an expert panel process to update and expand buprenorphine guidelines.
METHODS: We identified candidate guidelines through expert opinion and a review of the literature and used a modified RAND/UCLA Appropriateness Method to assess the validity of the candidate guidelines. An expert panel completed two rounds of rating, with a meeting to discuss the guidelines between the first and second rating.
RESULTS: Through the rating process, expert panel members rated 90 candidate guideline statements across eight domains, including candidacy for buprenorphine treatment, dosing of buprenorphine, psychosocial counseling, and treatment of co-occurring depression and anxiety. A total of 65 guideline statements (72%) were rated as valid. Expert panel members had agreement in some areas, such as the treatment of co-occurring mental health problems, but disagreement in others, including the appropriate dosing of buprenorphine given patient complexities.
CONCLUSIONS: Through an expert panel process, we developed an updated and expanded set of buprenorphine treatment guidelines; this additional guidance may increase credentialed physicians' comfort with prescribing buprenorphine to patients with opioid use disorders. Future efforts should focus on appropriate dosing guidance and ensuring that guidelines can be adapted to a variety of practice settings.

PMID: 25844527 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Extended-Release Naltrexone for Alcohol and Opioid Problems in Missouri Parolees and Probationers.

Buprenorphine Research (PubMed) - Tue, 04/07/2015 - 7:00am
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Extended-Release Naltrexone for Alcohol and Opioid Problems in Missouri Parolees and Probationers.

J Subst Abuse Treat. 2015 Mar 25;

Authors: Crits-Christoph P, Lundy C, Stringer M, Gallop R, Gastfriend DR

Abstract
The purpose of this study was to compare the naturalistic outcomes of parolees and probationers with alcohol and/or opioid problems who were treated with extended-release naltrexone (XR-NTX) to those treated with other medication-assisted therapies or psychosocial treatment only. Methods consisted of using intake and discharge data collected as part of SAMHSA's Treatment Episode Data Set (TEDS) assessments, controlling for group differences using propensity scores that were based on a range of intake variables. Results showed that patients receiving XR-NTX had longer durations of care (compared to oral naltrexone and psychosocial treatment only) and were more likely to become abstinent (compared to oral naltrexone, buprenorphine/naloxone, and psychosocial treatment only). Findings were similar for the total sample and those with opioid problems. These XR-NTX results were found in the absence of significant differences in rates of self-help participation. No differences were found in employment or arrests in this relatively short time frame. This study documents the real-world effectiveness study of current FDA-approved addiction medications in parolees/probationers and encourages the use of XR-NTX in such a criminal justice population.

PMID: 25841704 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Treatment readiness, attitudes toward, and experiences with methadone and buprenorphine maintenance therapy among people who inject drugs in Malaysia.

Buprenorphine Research (PubMed) - Tue, 04/07/2015 - 7:00am
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Treatment readiness, attitudes toward, and experiences with methadone and buprenorphine maintenance therapy among people who inject drugs in Malaysia.

J Subst Abuse Treat. 2015 Feb 18;

Authors: Vijay A, Bazazi AR, Yee I, Kamarulzaman A, Altice FL

Abstract
BACKGROUND: Little is known about attitudes toward and experiences with opioid maintenance therapy (OMT) among people who inject drugs in Malaysia, a country where people who inject drugs comprise 1.3% of the adult population.
METHODS: In 2010, 460 people who inject drugs in Greater Kuala Lumpur, Malaysia were surveyed to evaluate attitudes toward and experience with OMT and treatment readiness. Attitudes towards OMT with both methadone and buprenorphine were assessed using an opinions scale. Multivariable linear regression was used to assess correlates of treatment readiness, measured with the 19-item Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES).
RESULTS: All 460 participants used opioids and nearly all (99.1%) met criteria for opioid dependence. Few had had previous experience with methadone (9.3%) or buprenorphine (12.6%) maintenance therapy, yet many had used methadone (55.2%) or buprenorphine (51.7%) outside of treatment settings. Fifteen percent had injected buprenorphine in the past month, and of the few that were currently receiving buprenorphine maintenance therapy, almost all were injecting it. The majority of subjects exhibited a moderate level of treatment readiness and a preference for methadone over buprenorphine. Those with low treatment readiness scores were more likely to have previous experience with compulsory drug detention centers (p<0.01), needle/syringe exchange programs (p<0.005), or be of Indian ethnicity (p<0.001). Past use of methadone (p<0.01), older age (p<0.001), stress symptom severity (p<0.001), and sharing of needles or syringes (p<0.05) were associated with higher treatment readiness scores.
CONCLUSION: There are suboptimal levels of OMT experience among people who inject drugs that may be improved by addressing factors that influence patient attitudes. Those individuals with moderate treatment readiness may be targeted by brief motivational and cognitive interventions in primary care, prisons or OMT clinics aimed at improving entry into and retention in treatment.

PMID: 25841703 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Ombitasvir/Paritaprevir/r and Dasabuvir Plus Ribavirin in HCV Genotype 1-Infected Patients on Methadone or Buprenorphine.

Buprenorphine Research (PubMed) - Sat, 04/04/2015 - 8:30am

Ombitasvir/Paritaprevir/r and Dasabuvir Plus Ribavirin in HCV Genotype 1-Infected Patients on Methadone or Buprenorphine.

J Hepatol. 2015 Mar 31;

Authors: Lalezari J, Sullivan JG, Varunok P, Galen E, Kowdley KV, Rustgi V, Aguilar H, Felizarta F, McGovern B, King M, Polepally AR, Cohen DE

Abstract
BACKGROUND & AIMS: HCV-infected patients with a history of injection drug use have low rates of initiation and completion of interferon-based therapies. This study evaluated efficacy, safety, and pharmacokinetics of a 12-week all-oral regimen of ombitasvir/paritaprevir/ritonavir and dasabuvir +ribavirin in HCV genotype 1-infected patients on stable opioid replacement therapy.
METHODS: This was a phase 2, multicenter, open-label, single arm study in treatment-naïve or peginterferon/ribavirin-treatment experienced HCV genotype 1-infected patients on methadone or buprenorphine +/-naloxone. Patients received 12 weeks of co-formulated ombitasvir/paritaprevir/ritonavir(25mg/150mg/100mg once daily) and dasabuvir(250mg twice daily) +weight-based ribavirin. The primary efficacy endpoint was sustained virologic response 12 weeks post-treatment.
RESULTS: Thirty-eight non-cirrhotic patients on chronic methadone(n=19) or buprenorphine(n=19) were enrolled. A total of 37 patients(97.4%) had a sustained virologic response 12 weeks post-treatment. No patient had a viral breakthrough or relapse. One patient discontinued due to serious adverse events unrelated to study drug (cerebrovascular accident and sarcoma). The most frequent adverse events were nausea, fatigue, and headache. Eight patients had on-treatment hemoglobin concentrations <10g/dL. Pharmacokinetic analyses indicated no clinically meaningful impact of methadone or buprenorphine on ombitasvir, paritaprevir, ritonavir, dasabuvir, or dasabuvir M1 metabolite exposures. No dose adjustments of methadone or buprenorphine were required CONCLUSIONS: The interferon-free regimen of ombitasvir/paritaprevir/r and dasabuvir +ribavirin for 12 weeks was well-tolerated and achieved sustained virologic response in 97.4% of patients on opioid substitution therapy in this study. This all-oral regimen may provide an effective alternative to interferon-based therapies for HCV-infected patients with a history of injection drug use.

PMID: 25839406 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Harm reduction agencies as a potential site for buprenorphine treatment.

Buprenorphine Research (PubMed) - Sat, 04/04/2015 - 8:30am

Harm reduction agencies as a potential site for buprenorphine treatment.

Subst Abus. 2015 Apr 2;:0

Authors: Fox AD, Chamberlain A, Frost T, Cunningham CO

Abstract
BACKGROUND: Harm reduction agencies complement addiction treatment by providing diverse services that improve the health of people who use drugs. Buprenorphine maintenance treatment (BMT) is an effective opioid addiction treatment that may be provided from flexible settings, potentially including harm reduction agencies. This study investigated attitudes toward different potential sites for BMT (harm reduction agencies, general medical clinics, and drug treatment programs) among harm reduction clients.
METHODS: Using computer-based interviews, participants indicated preferred potential site for BMT (harm reduction agency, drug treatment program, or general medical clinic), interest in BMT by potential site, motivation for treatment, and barriers to BMT. We used multivariable logistic regression to determine factors associated with harm reduction agency preference.
RESULTS: Of 102 opioid users, the most preferred potential site for BMT was a harm reduction agency (51%), while fewer preferred general medical clinics (13%), drug treatment programs (12%) or were not interested in BMT (25%). In multivariable analysis, experiencing ≥ 1 barrier to BMT was strongly associated with preferring harm reduction agencies (aOR = 3.39, 95% CI: 1.00 - 11.43).
CONCLUSIONS: The potential to initiate BMT at harm reduction agencies is highly favorable among harm reduction clients, especially among those experiencing barriers to BMT. Offering BMT at harm reduction agencies could improve access to treatment, but studies are needed to determine safety and efficacy of this approach.

PMID: 25837290 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Growth and developmental outcome of infants with in-utero exposure to methadone vs buprenorphine.

Buprenorphine Research (PubMed) - Sat, 04/04/2015 - 8:30am

Growth and developmental outcome of infants with in-utero exposure to methadone vs buprenorphine.

J Perinatol. 2015 Apr 2;

Authors: Bier JB, Finger AS, Bier BA, Johnson TA, Coyle MG

Abstract
OBJECTIVE: To compare early growth and developmental outcome of infants with in-utero exposure to low-dose methadone (<100 mg per  day), high-dose methadone (⩾100 mg  per day) and buprenorphine.
STUDY DESIGN: A retrospective review of infants with in-utero methadone and buprenorphine exposure who were evaluated at the Southcoast Developmental Pediatric clinic in New Bedford, MA, USA was completed. Growth data and developmental testing results during infancy were compared among the groups.
RESULT: Infants in the high-dose methadone group had lower head circumference z scores and a lower mean score on the Alberta Infant Motor Scale (AIMS). Regression results confirmed an association between methadone dose and head circumference z score and AIMS score.
CONCLUSION: Exposure to maternal methadone dose in excess of 100 mg is associated with a reduction in infant head circumference when compared with buprenorphine or lower dose methadone, and may have a negative impact on motor skill development during early infancy.Journal of Perinatology advance online publication, 2 April 2015; doi:10.1038/jp.2015.22.

PMID: 25836317 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Buprenorphine, methadone, and morphine treatment during pregnancy: behavioral effects on the offspring in rats.

Buprenorphine Research (PubMed) - Fri, 04/03/2015 - 8:30am

Buprenorphine, methadone, and morphine treatment during pregnancy: behavioral effects on the offspring in rats.

Neuropsychiatr Dis Treat. 2015;11:609-618

Authors: Chen HH, Chiang YC, Yuan ZF, Kuo CC, Lai MD, Hung TW, Ho IK, Chen ST

Abstract
Methadone and buprenorphine are widely used for treating people with opioid dependence, including pregnant women. Prenatal exposure to opioids has devastating effects on the development of human fetuses and may induce long-term physical and neurobehavioral changes during postnatal maturation. This study aimed at comparing the behavioral outcomes of young rats prenatally exposed to buprenorphine, methadone, and morphine. Pregnant Sprague-Dawley rats were administered saline, morphine, methadone, and buprenorphine during embryonic days 3-20. The cognitive function, social interaction, anxiety-like behaviors, and locomotor activity of offsprings were examined by novel object recognition test, social interaction test, light-dark transition test, elevated plus-maze, and open-field test between 6 weeks and 10 weeks of age. Prenatal exposure to methadone and buprenorphine did not affect locomotor activity, but significantly impaired novel object recognition and social interaction in both male and female offsprings in the same manner as morphine. Although prenatal exposure to methadone or buprenorphine increased anxiety-like behaviors in the light-dark transition in both male and female offsprings, the effects were less pronounced as compared to that of morphine. Methadone affected elevated plus-maze in both sex, but buprenorphine only affected the female offsprings. These findings suggest that buprenorphine and methadone maintenance therapy for pregnant women, like morphine, produced detrimental effects on cognitive function and social behaviors, whereas the offsprings of such women might have a lower risk of developing anxiety disorders.

PMID: 25834439 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Pharmacokinetics of a single subcutaneous dose of sustained release buprenorphine in northern elephant seals (Mirounga angustirostris).

Buprenorphine Research (PubMed) - Fri, 04/03/2015 - 8:30am

Pharmacokinetics of a single subcutaneous dose of sustained release buprenorphine in northern elephant seals (Mirounga angustirostris).

J Zoo Wildl Med. 2015 Mar;46(1):52-61

Authors: Molter CM, Barbosa L, Johnson S, Knych HK, Chinnadurai SK, Wack RF

Abstract
Information regarding analgesics in pinnipeds is limited. This study aimed to establish the pharmacokinetic parameters of a single subcutaneous dose of sustained release buprenorphine (Buprenorphine SR) in juvenile northern elephant seals (Mirounga angustirostris) with regard to its potential to provide long-lasting analgesia that requires infrequent dosing. Seals (n=26) were administered a single dose of sustained release buprenorphine at 0.12 mg/kg s.c. Blood samples were collected from the extradural intervertebral vein at 0 hr and at three or four of the following time points: 0.5, 1, 2, 6, 12, 24, 36, 48, 60, 96, 120, and 144 hr. Seals were examined daily for systemic and local adverse reactions. Plasma was analyzed by liquid chromatography tandem-mass spectrometry for buprenorphine and norbuprenorphine concentrations. A noncompartmental analysis for pharmacokinetic parameters was calculated using standard methods and equations. An average maximum concentration of 1.21 ng/ml (0.3-2.9 ng/ml) was detected 12 hr postadministration. Concentrations were quantifiable up to 144 hr postadministration but were below those expected to provide analgesia in some other species. No systemic adverse effects were noted in healthy seals receiving sustained release buprenorphine. Cellulitis or abscesses at the injection site were observed in 6/26 (23%) seals between 24 and 168 hr postadministration. Adverse local effects suggest that this drug should be used with caution in northern elephant seals.

PMID: 25831576 [PubMed - in process]

Categories: Bup Feeds

Marijuana: Finding the right words for your teen

Drug and Alcohol News (JoinTogether.com) - Wed, 04/01/2015 - 10:44am

At the Partnership, we’ve been talking a lot about marijuana. As you may know, we recently launched our new Marijuana Talk Kit, designed to help parents navigate the constantly evolving drug landscape and have productive conversations with their teens.

One way to set yourself up for a meaningful conversation – one during which your teen hears you and responds thoughtfully – is by knowing some words to use and avoid when talking with him about marijuana (or any issue). The Kit includes a chart of words to avoid, and helps you replace them with words to which your teen will better respond.

Take the word “but,” for example. “But” is a small word, but in using it, you risk shutting down a conversation. You might often catch yourself saying things like, “You did well on your report card, but I need you to do better.” Replacing “but” with another small word – “and” – can go a long way toward improving the outcome with your teen. “You did well on your report card, and I know you can do better.”

Why? A word like “but” can be polarizing and can have the unintended effect of negating and erasing everything that came before it. In the example, “You did well on your report card, but I need you to do better,” your teen will probably only hear “I need you to do better.” When you replace “but” with “and,” it acts as a better bridge between the two thoughts and communicates both points clearly to your teen – the praise and the areas in which you want him to improve.

The Kit is full of other examples of words to use and avoid – like “should” vs. “want”; “bad” vs. “harmful”; “disappointed” vs. “worried” and more.

Learn what words to use and avoid. Download your free Marijuana Talk Kit here >

The post Marijuana: Finding the right words for your teen appeared first on Partnership for Drug-Free Kids.

Categories: Bup Feeds

Buprenorphine for treating cancer pain.

Buprenorphine Research (PubMed) - Wed, 04/01/2015 - 9:00am

Buprenorphine for treating cancer pain.

Cochrane Database Syst Rev. 2015 Mar 31;3:CD009596

Authors: Schmidt-Hansen M, Bromham N, Taubert M, Arnold S, Hilgart JS

Abstract
BACKGROUND: Many patients with cancer experience moderate to severe pain that requires treatment with strong analgesics. Buprenorphine, fentanyl and morphine are examples of strong opioids used for cancer pain relief. However, strong opioids are ineffective as pain treatment in all patients and are not well-tolerated by all patients. The aim of this Cochrane review is to assess whether buprenorphine is associated with superior, inferior or equal pain relief and tolerability compared to other analgesic options for patients with cancer pain.
OBJECTIVES: To assess the effectiveness and tolerability of buprenorphine for pain in adults and children with cancer.
SEARCH METHODS: We searched CENTRAL (the Cochrane Library) issue 12 or 12 2014, MEDLINE (via OVID) 1948 to 20 January 2015, EMBASE (via OVID) 1980 to 20 January 2015, ISI Web of Science (SCI-EXPANDED & CPCI-S) to 20 January 2015, ISI BIOSIS 1969 to 20 January 2015. We also searched ClinicalTrials.gov (http://clinicaltrials.gov/; metaRegister of Controlled Trials (mRCT) (http://www.controlled-trials.com/mrct/), the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal (http://apps.who.int/trialsearch/) and the Proceedings of the Congress of the European Federation of International Association for the Study of Pain (IASP; via European Journal of Pain Supplements) on 16 February 2015. We checked the bibliographic references of identified studies as well as relevant studies and systematic reviews to find additional trials not identified by the electronic searches. We contacted authors of included studies for other relevant studies.
SELECTION CRITERIA: We included randomised controlled trials, with parallel-group or crossover design, comparing buprenorphine (any formulation and any route of administration) with placebo or an active drug (including buprenorphine) for cancer background pain in adults and children.
DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data pertaining to study design, participant details (including age, cancer characteristics, previous analgesic medication and setting), interventions (including details about titration) and outcomes, and independently assessed the quality of the included studies according to standard Cochrane methodology. As it was not feasible to meta-analyse the data, we summarised the results narratively. We assessed the overall quality of the evidence for each outcome using the GRADE approach.
MAIN RESULTS: In this Cochrane review we identified 19 relevant studies including a total of 1421 patients that examined 16 different intervention comparisons.Of the studies that compared buprenorphine to another drug, 11 studies performed comparative analyses between the randomised groups, and five studies found that buprenorphine was superior to the comparison treatment. Three studies found no differences between buprenorphine and the comparison drug, while another three studies found treatment with buprenorphine to be inferior to the alternative treatment in terms of the side effects profile or patients preference/acceptability.Of the studies that compared different doses or formulations/routes of administration of buprenorphine, pain intensity ratings did not differ significantly between intramuscular buprenorphine and buprenorphine suppository. However, the average severity of dizziness, nausea, vomiting and adverse events as a total were all significantly higher in the intramuscular group relatively to the suppository group (one study).Sublingual buprenorphine was associated with faster onset of pain relief compared to subdermal buprenorphine, with similar duration analgesia and no significant differences in adverse event rates reported between the treatments (one study).In terms of transdermal buprenorphine, two studies found it superior to placebo, whereas a third study found no difference between placebo and different doses of transdermal buprenorphine.The studies that examined different doses of transdermal buprenorphine did not report a clear dose-response relationship.The quality of this evidence base was limited by under-reporting of most bias assessment items (e.g., the patient selection items), by small sample sizes in several included studies, by attrition (with data missing from 8.2% of the enrolled/randomised patients for efficacy and from 14.6% for safety) and by limited or no reporting of the expected outcomes in a number of cases. The evidence for all the outcomes was very low quality.
AUTHORS' CONCLUSIONS: Based on the available evidence, it is difficult to say where buprenorphine fits in the treatment of cancer pain with strong opioids. However, it might be considered to rank as a fourth-line option compared to the more standard therapies of morphine, oxycodone and fentanyl, and even there it would only be suitable for some patients. However, palliative care patients are often heterogeneous and complex, so having a number of analgesics available that can be given differently increases patient and prescriber choice. In particular, the sublingual and injectable routes seemed to have a more definable analgesic effect, whereas the transdermal route studies left more questions.

PMID: 25826743 [PubMed - as supplied by publisher]

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Novel Buccal Film Formulation of Buprenorphine-Naloxone for the Maintenance Treatment of Opioid Dependence: A 12-Week Conversion Study.

Buprenorphine Research (PubMed) - Wed, 04/01/2015 - 9:00am
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Novel Buccal Film Formulation of Buprenorphine-Naloxone for the Maintenance Treatment of Opioid Dependence: A 12-Week Conversion Study.

Clin Ther. 2015 Mar 27;

Authors: Sullivan JG, Webster L

Abstract
PURPOSE: The purpose of this study was to provide a preliminary assessment of the safety, tolerability, symptom control, and acceptability of buprenorphine-naloxone buccal film (BBN) for the maintenance treatment of opioid dependence in patients converted from buprenorphine-naloxone sublingual tablet or film (SLBN), as well as to determine the conversion ratio for switching patients from SLBN to BBN.
METHODS: This open-label study included adult opioid-dependent subjects stabilized on 8/2 to 32/8 mg/d of SLBN for a minimum of 30 days. Study subjects were converted to a bioequivalent dose of BBN and maintained for 12 weeks.
FINDINGS: A total of 249 subjects (mean age 38.7 years, 65.9% male) were converted from SLBN to a single daily dose of BBN, and 79.1% completed the 12-week study. Adverse events and withdrawal symptoms led to discontinuation in 2.4% and 2.0% of BBN-treated subjects, respectively. Rates of constipation reported at baseline declined from 41% just before the initial BBN dose and within 24 hours of the last SLBN dose to 13% after 12 weeks of BBN treatment; treatment-emergent constipation was reported by 2.8% of BBN-treated subjects. Oral mucosal abnormalities were identified in 5% and 0.6% of systematic oral examinations in SLBN- and BBN-treated subjects, respectively. A total of 34 subjects had Clinical Opiate Withdrawal Scale total scores ranging from 10 to 25 (overall mean, 13.8) within 24 hours of taking their last SLBN dose, and scores for these subjects were reduced to a range of 0 to 3 (overall mean, 0.7) at 3 hours after the initial dose of BBN. Treatment compliance was high (108%); <1% of urine samples were buprenorphine-free, and 92.4% of BBN-treated subjects did not have a urine sample that tested positive for a non-prescribed opioid. A total of 91.3% subjects rated the taste of BBN as pleasant or neutral, and 82.5% rated BBN ease of use as easy or neutral. The overall mean final dose of BBN was 8.0/1.4 mg/d, yielding a 2:1 buprenorphine conversion ratio.
IMPLICATIONS: Although these results should be considered preliminary due to the open-label design, BBN was overall safe and well tolerated, and seemed to provide adequate symptom control, in the treatment of opioid-dependent subjects previously controlled on SLBN for a minimum of 30 days. There was good adherence to study medication and favorable patient acceptance of the buccal formulation. The SLBN/BBN buprenorphine conversion ratio was 2:1. ClinicalTrials.gov identifier: NCT01666119.

PMID: 25823919 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Characterizing opioid withdrawal during double-blind buprenorphine detoxification.

Buprenorphine Research (PubMed) - Wed, 04/01/2015 - 9:00am
Related Articles

Characterizing opioid withdrawal during double-blind buprenorphine detoxification.

Drug Alcohol Depend. 2015 Mar 12;

Authors: Dunn KE, Saulsgiver KA, Miller ME, Nuzzo PA, Sigmon SC

Abstract
BACKGROUND: Prescription opioid (PO) abuse has become an urgent public health issue in the United States. Detoxification is one important treatment option, yet relatively little is known about the time course and severity of opioid withdrawal during buprenorphine detoxification.
METHODS: This is a secondary analysis of data from a randomized, placebo-controlled, double-blind evaluation of 1, 2, and 4-week outpatient buprenorphine tapers among primary prescription opioid (PO) abusers. The aim is to characterize the time course and severity of buprenorphine withdrawal under rigorous, double-blind conditions, across multiple taper durations, and using multiple withdrawal-related measures (i.e., self-report and observer ratings, pupil diameter, ancillary medication utilization). Participants were PO-dependent adults undergoing buprenorphine detoxification and biochemically-verified to be continuously abstinent from opioids during their taper (N=28).
RESULTS: Participants randomly assigned to the 4-week taper regimen experienced a relatively mild and stable course of withdrawal, with few peaks in severity. In contrast, the 1- and 2-week taper groups experienced stark increases in withdrawal severity during the week following the last buprenorphine dose, followed by declines in withdrawal severity thereafter. The 4-week taper group also reported significantly fewer disruptions in sleep compared to the other experimental groups. When predictors of withdrawal were examined, baseline ratings of "Expected Withdrawal Severity" was the most robust predictor of withdrawal experienced during the taper.
CONCLUSION: Data from this trial may inform clinicians about the expected time course, magnitude, and pattern of buprenorphine withdrawal and aid efforts to identify patients who may need additional clinical support during outpatient buprenorphine detoxification.

PMID: 25823907 [PubMed - as supplied by publisher]

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