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Group Medication Management for Buprenorphine/Naloxone in Opioid-Dependent Veterans.

Buprenorphine Research (PubMed) - Fri, 10/03/2014 - 7:30am

Group Medication Management for Buprenorphine/Naloxone in Opioid-Dependent Veterans.

J Addict Med. 2014 Oct 1;

Authors: Berger R, Pulido C, Lacro J, Groban S, Robinson S

Abstract
OBJECTIVE:: Substance use disorders are a key concern among US veterans. Substance use disorder pharmacotherapies with support for effectiveness are limited. Buprenorphine/naloxone (Suboxone) is an effective opioid replacement treatment option for opioid use disorder when used as part of a comprehensive treatment program. In June 2011, the Veterans Affairs San Diego Healthcare System began using a group format to prescribe buprenorphine/naloxone. This study aimed at examining outcomes of retention rates and percentage opioid negative urine samples. Results were compared for veteran patients seen in group versus individual formats.
METHODS:: This retrospective chart review included data from 32 patients who were prescribed buprenorphine/naloxone between a 3-year window (ie, January 1, 2010, and December 31, 2012).
RESULTS:: Overall results were 46% retention in treatment after 1 year, and 94% of opioid urine samples were negative. More patients seen in group were retained in treatment at 1 year compared with those seen individually (69% vs 27%, respectively; P < 0.03).
CONCLUSIONS:: This study found that veterans prescribed buprenorphine/naloxone in a group setting as part of a drug and alcohol treatment program were retained in treatment longer than veterans prescribed this medication individually. Because of inherent limitations in the study design, no causality can be determined; however, given the results found here, group medication management of buprenorphine/naloxone should be explored further.

PMID: 25275875 [PubMed - as supplied by publisher]

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Challenges and opportunities in using wastewater analysis to measure drug use in a small prison facility.

Buprenorphine Research (PubMed) - Thu, 10/02/2014 - 8:30am

Challenges and opportunities in using wastewater analysis to measure drug use in a small prison facility.

Drug Alcohol Rev. 2014 Oct 1;

Authors: van Dyken E, Lai FY, Thai PK, Ort C, Bruno R, Hall W, Kirkbride KP, Mueller JF, Prichard J

Abstract
INTRODUCTION AND AIMS: Wastewater analysis (WWA) is intended to be a direct and objective method of measuring substance use in large urban populations. It has also been used to measure prison substance use in two previous studies. The application of WWA in this context has raised questions as to how best it might be used to measure illicit drug use in prisons, and whether it can also be used to measure prescription misuse. We applied WWA to a small regional prison to measure the use of 12 licit and illicit substances. We attempted to measure the non-medical use of methadone and buprenorphine and to compare our findings with the results of the prison's mandatory drug testing (MDT).
DESIGN AND METHODS: Representative daily composite samples were collected for two periods of 12 consecutive days in May to July 2013 and analysed for 18 drug metabolites. Prescription data and MDT results were obtained from the prison and compared with the substance use estimates calculated from WWA data.
RESULTS: Daily use of methamphetamine, methadone, buprenorphine and codeine was detected, while sporadic detection of ketamine and methylone was also observed. Overall buprenorphine misuse appeared to be greater than methadone misuse.
DISCUSSION AND CONCLUSIONS: Compared with MDT, WWA provides a more comprehensive picture of prison substance use. WWA also has the potential to measure the misuse of medically prescribed substances. However, a great deal of care must be exercised in quantifying the usage of any substance in small populations, such as in prisons. [van Dyken E, Lai FY, Thai PK, Ort C, Bruno R, Hall W, Kirkbride KP, Mueller JF, Prichard J. Challenges and opportunities in using wastewater analysis to measure drug use in a small prison facility. Drug Alcohol Rev 2014].

PMID: 25272148 [PubMed - as supplied by publisher]

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Pharmacokinetics of oral transmucosal and intramuscular dexmedetomidine combined with buprenorphine in cats.

Buprenorphine Research (PubMed) - Thu, 10/02/2014 - 8:30am

Pharmacokinetics of oral transmucosal and intramuscular dexmedetomidine combined with buprenorphine in cats.

J Vet Pharmacol Ther. 2014 Oct 1;

Authors: Porters N, de Rooster H, Bosmans T, Baert K, Cherlet M, Croubels S, De Backer P, Polis I

Abstract
Plasma concentrations and pharmacokinetics of dexmedetomidine and buprenorphine after oral transmucosal (OTM) and intramuscular (i.m.) administration of their combination in healthy adult cats were compared. According to a crossover protocol (1-month washout), a combination of dexmedetomidine (40 μg/kg) and buprenorphine (20 μg/kg) was given OTM (buccal cavity) or i.m. (quadriceps muscle) in six female neutered cats. Plasma samples were collected through a jugular catheter during a 24-h period. Plasma dexmedetomidine and buprenorphine concentrations were determined by liquid chromatography-tandem mass spectrometry. Plasma concentration-time data were fitted to compartmental models. For dexmedetomidine and buprenorphine, the area under the plasma concentration-time curve (AUC) and the maximum plasma concentrations (Cmax ) were significantly lower following OTM than following i.m. administration. For buprenorphine, time to reach Cmax was also significantly longer after OTM administration than after i.m. injection. Data suggested that dexmedetomidine (40 μg/kg) combined with buprenorphine (20 μg/kg) is not as well absorbed from the buccal mucosa site as from the intramuscular injection site.

PMID: 25269566 [PubMed - as supplied by publisher]

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Is residential treatment effective for opioid use disorders? A longitudinal comparison of treatment outcomes among opioid dependent, opioid misusing, and non-opioid using emerging adults with substance use disorder.

Buprenorphine Research (PubMed) - Wed, 10/01/2014 - 6:00am

Is residential treatment effective for opioid use disorders? A longitudinal comparison of treatment outcomes among opioid dependent, opioid misusing, and non-opioid using emerging adults with substance use disorder.

Drug Alcohol Depend. 2014 Sep 18;

Authors: Schuman-Olivier Z, Claire Greene M, Bergman BG, Kelly JF

Abstract
BACKGROUND: Opioid misuse and dependence rates among emerging adults have increased substantially. While office-based opioid treatments (e.g., buprenorphine/naloxone) have shown overall efficacy, discontinuation rates among emerging adults are high. Abstinence-based residential treatment may serve as a viable alternative, but has seldom been investigated in this age group.
METHODS: Emerging adults attending 12-step-oriented residential treatment (N=292; 18-24 years, 74% male, 95% White) were classified into opioid dependent (OD; 25%), opioid misuse (OM; 20%), and no opiate use (NO; 55%) groups. Paired t-tests and ANOVAs tested baseline differences and whether groups differed in their during-treatment response. Longitudinal multilevel models tested whether groups differed on substance use outcomes and treatment utilization during the year following the index treatment episode.
RESULTS: Despite a more severe clinical profile at baseline among OD, all groups experienced similar during-treatment increases on therapeutic targets (e.g., abstinence self-efficacy), while OD showed a greater decline in psychiatric symptoms. During follow-up relative to OM, both NO and OD had significantly greater Percent Days Abstinent, and significantly less cannabis use. OD attended significantly more outpatient treatment sessions than OM or NO; 29% of OD was completely abstinent at 12-month follow-up.
CONCLUSIONS: Findings here suggest that residential treatment may be helpful for emerging adults with opioid dependence. This benefit may be less prominent, though, among non-dependent opioid misusers. Randomized trials are needed to compare more directly the relative benefits of outpatient agonist-based treatment to abstinence-based, residential care in this vulnerable age-group, and to examine the feasibility of an integrated model.

PMID: 25267606 [PubMed - as supplied by publisher]

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11 Ways to Get Your Teen Talking

Drug and Alcohol News (JoinTogether.com) - Tue, 09/30/2014 - 1:32pm

The best way to find out what is going on with your child is to, well, find out what’s going on with him. Lecturing won’t get you there. A back-and-forth conversation will. But that’s not always so easy with teens,  is it?

In order to keep the lines of communication open it’s important to know how to listen and when to talk. Here are 10 tips to help:

1. Create a safe, comfortable environment for your child to share the truth. Assure your child that he can always be honest with you – without fear of ridicule or blame. And that you love him no matter what.

2. Turn off all smartphones and other electronics and don’t allow any interruptions during your conversation.

3. Listen to your child vent. Sometimes she just needs to complain and get things off her chest. She’ll feel better afterward.

4. Rephrase your teen’s comments to show him you’ve heard what he’s saying or give nonverbal support and encouragement by nodding and smiling. You can also say, “I know what you mean” or “I understand” or “I feel that way sometimes, too.”

5. Be attentive for topics that lead into drugs or alcohol. For example, if your teen describes someone at school who is “always high” or mentions a celebrity who has gone to rehab, ask your teen what she thinks about those people or their behavior.

6. Focus completely on your child and try to see things from your child’s point of view. This will help you sympathize with his situation.

7. Be aware that your child could be hiding his true feelings out of fear, embarrassment or something else. Be careful not to just take what the child says at face value. Gently question her if things don’t seem quite right to you.

8. Listen between the words. Pay attention to body language, facial expressions, eye contact, difficulty finding the right words to use, distractions, etc.

9. Recognize and confess when you don’t have the energy to be a good listener and agree to restart the conversation (as long as it isn’t dire) at a later, better time.

10. Be positive. Everyone loves a compliment — even your teen. Show your support by using encouraging words, pointing out good behaviors and actions as well as simply saying, “I’m proud of you” — even if it’s for something small.

11. Don’t feel you have to jump in and fill every lull.  It’s okay to have long pauses and moments of silence during your conversation. In fact, it may help things sink in a bit. And you never know, you’re teen may suddenly pipe in with a brilliant insight, a profound reflection or even a juicy secret.

How do you get your teen to open up?

The post 11 Ways to Get Your Teen Talking appeared first on Partnership for Drug-Free Kids.

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Medication-assisted therapy for opioid addiction.

Buprenorphine Research (PubMed) - Tue, 09/30/2014 - 6:00am

Medication-assisted therapy for opioid addiction.

J Food Drug Anal. 2013 Dec;21(4):S13-S15

Authors: Tai B, Saxon AJ, Ling W

Abstract
The "Medication-Assisted Therapy for Opioid Addiction" session was chaired by Dr. Betty Tai and had three presenters. The presenters (and their topics) were: Dr. Andrew J. Saxon (Methadone and Buprenorphine for Treatment of Opioid Addiction and HIV Risk Reduction), Dr. Walter Ling (Opioid Antagonist Treatment for Opioid Addiction), and Dr. Betty Tai (Chronic Care Model for Substance Use Disorder).

PMID: 25264415 [PubMed - as supplied by publisher]

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Underestimation of substance abuse in psychiatric patients by conventional hospital screening.

Buprenorphine Research (PubMed) - Tue, 09/30/2014 - 6:00am
Related Articles

Underestimation of substance abuse in psychiatric patients by conventional hospital screening.

J Psychiatr Res. 2014 Sep 10;

Authors: Reidy LJ, Junquera P, Van Dijck K, Steele BW, Nemeroff CB

Abstract
Psychiatric diagnosis mainly relies on behavioral signs and symptoms. Substance abuse can mimic the clinical presentation of primary psychiatric disorders and can also complicate the management of psychiatric patients. The reliability and accuracy of urine toxicology is a vital tool in the optimal treatment of these patients. Current demographics of substance abuse suggest that in addition to the most conventional drugs of abuse (e.g. cocaine, cannabis) that are of concern to treating physicians, prescription medications and new designer drugs also should be when evaluating patients who present with symptoms of psychosis/drug addiction or altered mental status.
METHODS: Urine samples from 220 psychiatric inpatients admitted to either an acute drug and alcohol unit or acute psychiatric unit were analyzed for drugs by the standard hospital assay (KIMS) and by a more sensitive ELISA and GC-MS basic drug screening protocol.
RESULTS: The standard hospital toxicology (KIMS) was inferior to the ELISA and GC-MS methods in terms of both assay sensitivity and in detecting a broader number of drugs. The KIMS tests failed to identify opiates and amphetamine/methamphetamine in 50% of the patients. The KIMS screen did not identify zolpidem, buprenorphine and a number of synthetic drugs of abuse including cathinone and tryptamines.
CONCLUSION: In order to reliably identify substance abuse in patients with altered mental status in inpatient settings, analytical methodologies with adequate assay sensitivity and range to detect the vast majority of commonly abused illicit drugs and prescription medications are required for optimal clinical assessment and treatment.

PMID: 25262418 [PubMed - as supplied by publisher]

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Buprenorphine provides better anaesthetic conditions than butorphanol for field castration in ponies: results of a randomised clinical trial.

Buprenorphine Research (PubMed) - Tue, 09/30/2014 - 6:00am
Related Articles

Buprenorphine provides better anaesthetic conditions than butorphanol for field castration in ponies: results of a randomised clinical trial.

Vet Rec. 2014 Sep 26;

Authors: Rigotti C, Vries AD, Taylor PM

Abstract
A prospective, randomised, blinded, clinical trial in 47 ponies compared butorphanol and buprenorphine administered intravenously with detomidine prior to castration under anaesthesia. Detomidine 12 μg/kg intravenously was followed by butorphanol 25 μg/kg (BUT) or buprenorphine 5 μg/kg (BUP) before induction of anaesthesia with intravenous ketamine and diazepam. Quality of sedation, induction and recovery from anaesthesia, response to tactile stimulation, and surgical conditions were scored. If anaesthesia was inadequate 'rescue' was given with intravenous ketamine (maximum three doses) followed by intravenous thiopental and detomidine. Time from induction to first rescue, total ketamine dose and number of rescues were recorded. Postoperative locomotor activity was scored and abnormal behaviour noted. Simple descriptive scales were used for all scoring. Data were analysed using two-way analysis of variance, t tests, Mann-Whitney or Fisher's exact tests as appropriate; P<0.05 was considered statistically significant. Cryptorchid animals did not undergo surgery, but castration was successfully completed in 18 BUT and 20 BUP. More incremental ketamine (P=0.0310) and more rescue drugs (P=0.0165) were required in BUT and more postoperative locomotor activity occurred in BUP (P=0.0001). There were no other differences between groups. Both opioids were suitable for premedication prior to castration but buprenorphine appeared to provide better intraoperative analgesia.

PMID: 25262056 [PubMed - as supplied by publisher]

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Neonatal abstinence syndrome.

Buprenorphine Research (PubMed) - Tue, 09/30/2014 - 6:00am
Related Articles

Neonatal abstinence syndrome.

Pediatrics. 2014 Aug;134(2):e547-61

Authors: Kocherlakota P

Abstract
Neonatal abstinence syndrome (NAS) is a result of the sudden discontinuation of fetal exposure to substances that were used or abused by the mother during pregnancy. Withdrawal from licit or illicit substances is becoming more common among neonates in both developed and developing countries. NAS continues to be an important clinical entity throughout much of the world. NAS leads to a constellation of signs and symptoms involving multiple systems. The pathophysiology of NAS is not completely understood. Urine or meconium confirmation may assist the diagnosis and management of NAS. The Finnegan scoring system is commonly used to assess the severity of NAS; scoring can be helpful for initiating, monitoring, and terminating treatment in neonates. Nonpharmacological care is the initial treatment option, and pharmacological treatment is required if an improvement is not observed after nonpharmacological measures or if the infant develops severe withdrawal. Morphine is the most commonly used drug in the treatment of NAS secondary to opioids. An algorithmic approach to the management of infants with NAS is suggested. Breastfeeding is not contraindicated in NAS, unless the mother is taking street drugs, is involved in polydrug abuse, or is infected with HIV. Future studies are required to assess the long-term effects of NAS on children after prenatal exposure.

PMID: 25070299 [PubMed - indexed for MEDLINE]

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[Iatrogenic dependence to meperidine in the elderly].

Buprenorphine Research (PubMed) - Tue, 09/30/2014 - 6:00am
Related Articles

[Iatrogenic dependence to meperidine in the elderly].

Presse Med. 2014 Jun;43(6 Pt 1):727-9

Authors: Rolland B, Bera-Louville A, Deheul S, Roche J, Blond S, Cottencin O

PMID: 24630268 [PubMed - indexed for MEDLINE]

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