Bup Feeds

Association of CHRNA5-A3-B4 SNP rs2036527 with smoking cessation therapy response in African-American smokers.

Buprenorphine Research (PubMed) - Tue, 09/23/2014 - 7:30am
Related Articles

Association of CHRNA5-A3-B4 SNP rs2036527 with smoking cessation therapy response in African-American smokers.

Clin Pharmacol Ther. 2014 Aug;96(2):256-65

Authors: Zhu AZ, Zhou Q, Cox LS, David SP, Ahluwalia JS, Benowitz NL, Tyndale RF

Abstract
Associations between CHRNA5-A3-B4 variants and smoking behaviors exist; however, the association with smoking abstinence is less understood, particularly that among African Americans. In 1,295 African Americans enrolled in two clinical trials, we investigated the association between CHRNA5-A3-B4 and smoking abstinence. The rs2056527(A) allele was associated with lower abstinence with active pharmacotherapy (during treatment: odds ratio (OR) = 0.42, P < 0.001; end of treatment (EOT): OR = 0.55, P = 0.004), or with nicotine gum alone (during treatment: OR = 0.31, P < 0.001; EOT: OR = 0.51, P = 0.02), but not significantly with bupropion, although similar directions and magnitudes were observed (during treatment: OR = 0.54, P = 0.05; EOT: OR = 0.59, P = 0.08). In addition, the rs588765(T) allele was associated with abstinence with gum during treatment (OR = 2.31, P < 0.01). The SNP rs16969968 occurred at a low frequency and was not consistently associated with abstinence. CHRNA5-A3-B4 variants were not associated with tobacco consumption, and adjustments for smoking behaviors did not alter the associations with smoking abstinence. Together, our data suggest that among African Americans, CHRNA5-A3-B4 variants are not associated with baseline smoking but can influence smoking abstinence during active pharmacotherapy.

PMID: 24733007 [PubMed - indexed for MEDLINE]

Categories: Bup Feeds

Oral or transdermal opioids for osteoarthritis of the knee or hip.

Buprenorphine Research (PubMed) - Thu, 09/18/2014 - 7:00am

Oral or transdermal opioids for osteoarthritis of the knee or hip.

Cochrane Database Syst Rev. 2014 Sep 17;9:CD003115

Authors: da Costa BR, Nüesch E, Kasteler R, Husni E, Welch V, Rutjes AW, Jüni P

Abstract
BACKGROUND: Osteoarthritis is the most common form of joint disease and the leading cause of pain and physical disability in older people. Opioids may be a viable treatment option if people have severe pain or if other analgesics are contraindicated. However, the evidence about their effectiveness and safety is contradictory. This is an update of a Cochrane review first published in 2009.
OBJECTIVES: To determine the effects on pain, function, safety, and addiction of oral or transdermal opioids compared with placebo or no intervention in people with knee or hip osteoarthritis.
SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and CINAHL (up to 28 July 2008, with an update performed on 15 August 2012), checked conference proceedings, reference lists, and contacted authors.
SELECTION CRITERIA: We included randomised or quasi-randomised controlled trials that compared oral or transdermal opioids with placebo or no treatment in people with knee or hip osteoarthritis. We excluded studies of tramadol. We applied no language restrictions.
DATA COLLECTION AND ANALYSIS: We extracted data in duplicate. We calculated standardised mean differences (SMDs) and 95% confidence intervals (CI) for pain and function, and risk ratios for safety outcomes. We combined trials using an inverse-variance random-effects meta-analysis.
MAIN RESULTS: We identified 12 additional trials and included 22 trials with 8275 participants in this update. Oral oxycodone was studied in 10 trials, transdermal buprenorphine and oral tapentadol in four, oral codeine in three, oral morphine and oral oxymorphone in two, and transdermal fentanyl and oral hydromorphone in one trial each. All trials were described as double-blind, but the risk of bias for other domains was unclear in several trials due to incomplete reporting. Opioids were more beneficial in pain reduction than control interventions (SMD -0.28, 95% CI -0.35 to -0.20), which corresponds to a difference in pain scores of 0.7 cm on a 10-cm visual analogue scale (VAS) between opioids and placebo. This corresponds to a difference in improvement of 12% (95% CI 9% to 15%) between opioids (41% mean improvement from baseline) and placebo (29% mean improvement from baseline), which translates into a number needed to treat (NNTB) to cause one additional treatment response on pain of 10 (95% CI 8 to 14). Improvement of function was larger in opioid-treated participants compared with control groups (SMD -0.26, 95% CI -0.35 to -0.17), which corresponds to a difference in function scores of 0.6 units between opioids and placebo on a standardised Western Ontario and McMaster Universities Arthritis Index (WOMAC) disability scale ranging from 0 to 10. This corresponds to a difference in improvement of 11% (95% CI 7% to 14%) between opioids (32% mean improvement from baseline) and placebo (21% mean improvement from baseline), which translates into an NNTB to cause one additional treatment response on function of 11 (95% CI 7 to 14). We did not find substantial differences in effects according to type of opioid, analgesic potency, route of administration, daily dose, methodological quality of trials, and type of funding. Trials with treatment durations of four weeks or less showed larger pain relief than trials with longer treatment duration (P value for interaction = 0.001) and there was evidence for funnel plot asymmetry (P value = 0.054 for pain and P value = 0.011 for function). Adverse events were more frequent in participants receiving opioids compared with control. The pooled risk ratio was 1.49 (95% CI 1.35 to 1.63) for any adverse event (9 trials; 22% of participants in opioid and 15% of participants in control treatment experienced side effects), 3.76 (95% CI 2.93 to 4.82) for drop-outs due to adverse events (19 trials; 6.4% of participants in opioid and 1.7% of participants in control treatment dropped out due to adverse events), and 3.35 (95% CI 0.83 to 13.56) for serious adverse events (2 trials; 1.3% of participants in opioid and 0.4% of participants in control treatment experienced serious adverse events). Withdrawal symptoms occurred more often in opioid compared with control treatment (odds ratio (OR) 2.76, 95% CI 2.02 to 3.77; 3 trials; 2.4% of participants in opioid and 0.9% of participants control treatment experienced withdrawal symptoms).
AUTHORS' CONCLUSIONS: The small mean benefit of non-tramadol opioids are contrasted by significant increases in the risk of adverse events. For the pain outcome in particular, observed effects were of questionable clinical relevance since the 95% CI did not include the minimal clinically important difference of 0.37 SMDs, which corresponds to 0.9 cm on a 10-cm VAS.

PMID: 25229835 [PubMed - as supplied by publisher]

Categories: Bup Feeds

The current status of opioid maintenance treatment in France: a survey of physicians, patients, and out-of-treatment opioid users.

Buprenorphine Research (PubMed) - Thu, 09/18/2014 - 7:00am

The current status of opioid maintenance treatment in France: a survey of physicians, patients, and out-of-treatment opioid users.

Int J Gen Med. 2014;7:449-57

Authors: Benyamina A

Abstract
AIM: Project Access France was a national survey designed to provide real-world observations on the status of opioid dependence treatment in France.
METHODS: The views of physicians (n=100), patients (n=130), and out-of-treatment opioid users (n=33) were collected via interviews and questionnaires.
RESULTS: Physicians reported being moderately satisfied with treatment programs in their area (rating 6.9 out of 10). Most physicians (82%) reported being concerned about misuse and diversion of medication-assisted treatment (MAT) medications and 50% identified psychosocial/behavioral counseling as the key change that would most improve patient care. Among patients, the mean number of previous MAT episodes was low (1.5); 78% reported that it was easy to access a doctor to undergo MAT; 14% reported regularly or sometimes using heroin; misuse and diversion were reported in 15% and 39% of patients, respectively; and 57% of patients were not receiving psychosocial help. Out-of-treatment opioid users reported using drugs on a regular basis (42% regularly used heroin) and cited 'not wanting to give up drugs completely' as the most frequent reason for staying out of MAT.
CONCLUSION: This survey highlights a number of positive features of the open-access, GP-based treatment model for opioid dependence in France. Challenges remain with regard to continued misuse/diversion of MAT medications and limited patient access to psychosocial support.

PMID: 25228817 [PubMed]

Categories: Bup Feeds

Emergency Hospitalizations for Unsupervised Prescription Medication Ingestions by Young Children.

Buprenorphine Research (PubMed) - Wed, 09/17/2014 - 7:30am

Emergency Hospitalizations for Unsupervised Prescription Medication Ingestions by Young Children.

Pediatrics. 2014 Sep 15;

Authors: Lovegrove MC, Mathew J, Hampp C, Governale L, Wysowski DK, Budnitz DS

Abstract
BACKGROUND: Emergency department visits and subsequent hospitalizations of young children after unsupervised ingestions of prescription medications are increasing despite widespread use of child-resistant packaging and caregiver education efforts. Data on the medications implicated in ingestions are limited but could help identify prevention priorities and intervention strategies.
METHODS: We used nationally representative adverse drug event data from the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project and national retail pharmacy prescription data from IMS Health to estimate the frequency and rates of emergency hospitalizations for unsupervised prescription medication ingestions by young children (2007-2011).
RESULTS: On the basis of 1513 surveillance cases, 9490 estimated emergency hospitalizations (95% confidence interval: 6420-12 560) occurred annually in the United States for unsupervised prescription medication ingestions among children aged <6 years from 2007 through 2011; 75.4% involved 1- or 2-year old children. Opioids (17.6%) and benzodiazepines (10.1%) were the most commonly implicated medication classes. The most commonly implicated active ingredients were buprenorphine (7.7%) and clonidine (7.4%). The top 12 active ingredients, alone or in combination with others, were implicated in nearly half (45.0%) of hospitalizations. Accounting for the number of unique patients who received dispensed prescriptions, the hospitalization rate for unsupervised ingestion of buprenorphine products was significantly higher than rates for all other commonly implicated medications and 97-fold higher than the rate for oxycodone products (200.1 vs 2.1 hospitalizations per 100 000 unique patients).
CONCLUSIONS: Focusing unsupervised ingestion prevention efforts on medications with the highest hospitalization rates may efficiently achieve large public health impact.

PMID: 25225137 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Buprenorphine Diversion and Misuse in Outpatient Practice.

Buprenorphine Research (PubMed) - Tue, 09/16/2014 - 2:30pm
Related Articles

Buprenorphine Diversion and Misuse in Outpatient Practice.

J Addict Med. 2014 Sep 11;

Authors: Lofwall MR, Martin J, Tierney M, Fatséas M, Auriacombe M, Lintzeris N

Abstract
This case is an amalgamation of several real patients in office-based treatment for prescription opioid dependence synthesized into a single theoretical case. The case illustrates the various ways in which medication diversion and misuse may be encountered in clinical practice and therapeutic responses designed to maximize positive treatment outcomes. It is followed by discussions from several expert addiction medicine providers from 3 different countries, giving their perspectives on the salient aspects of this case. This case conference should be of particular interest to clinicians working with opioid-dependent patients in an outpatient setting.

PMID: 25221985 [PubMed - as supplied by publisher]

Categories: Bup Feeds

A Review of Buprenorphine Diversion and Misuse: The Current Evidence Base and Experiences From Around the World.

Buprenorphine Research (PubMed) - Tue, 09/16/2014 - 2:30pm
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A Review of Buprenorphine Diversion and Misuse: The Current Evidence Base and Experiences From Around the World.

J Addict Med. 2014 Sep 11;

Authors: Lofwall MR, Walsh SL

Abstract
Outpatient opioid addiction treatment with sublingual buprenorphine pharmacotherapy has rapidly expanded in the United States and abroad, and, with this increase in medication availability, there have been increasing concerns about its diversion, misuse, and related harms. This narrative review defines the behaviors of diversion and misuse, examines how the pharmacology of buprenorphine alone and in combination with naloxone influence its abuse liability, and describes the epidemiological data on buprenorphine diversion and intravenous misuse, risk factors for its intravenous misuse, and the unintended consequences of misuse and diversion. Physician practices to prevent, screen for, and therapeutically respond to these behaviors, which are a form of medication nonadherence, are discussed, and gaps in knowledge are identified. Outpatient opioid addiction treatment with sublingual buprenorphine pharmacotherapy experiences from other countries that have varied health care systems, public policies, and access to addiction treatment are shared to make clear that diversion and misuse occur across the world in various contexts, for many different reasons, and are not limited to buprenorphine. Comparisons are made with other opioids with known abuse liability and medications with no known abuse. The objective was to facilitate understanding of diversion and misuse so that all factors influencing their expression (patient and provider characteristics and public policy) can be appreciated within a framework that also recognizes the benefits of addiction treatment. With this comprehensive perspective, further careful work can help determine how to minimize these behaviors without eroding the current benefits realized through improved addiction treatment access and expansion.

PMID: 25221984 [PubMed - as supplied by publisher]

Categories: Bup Feeds

P-59in- prison outcomes of buprenorphine maintainence for prisoners: results from a pilot intervention in tihar prisons, India.

Buprenorphine Research (PubMed) - Tue, 09/16/2014 - 2:30pm
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P-59in- prison outcomes of buprenorphine maintainence for prisoners: results from a pilot intervention in tihar prisons, India.

Alcohol Alcohol. 2014 Sep;49 Suppl 1:i64-i65

Authors: Jhanjee S, Pant S, Girdhar N, Gunasekhar R, Jain R, Sethi H

Abstract
INTRODUCTION: A pilot study was done to test the feasibility and effectiveness of buprenorphine as maintenance treatment for opioid dependent prisoners in Tihar prisons, India. This was the first such intervention in a South Asian prison.
METHODS: The study had a pre-post test design with quantitative, qualitative and biochemical assessments at baseline and at three, six, nine and twelve months after initiation of treatment with buprenorphine. Psychosocial intervention was provided in both, group and individual sessions. A total of 133 opioid dependent inmates fulfilling the eligibility criteria of the study were recruited in the study from November, 2008-March, 2012.
RESULTS: The study sample mostly comprised pretrial remand prisoners (95.3%) and most(94.3%) were repeat offenders. For most patients(95.3%), heroin was the primary drug of abuse. 50.3% were currently Injecting Drug Users (IDUs). Among the IDUs, sharing of syringe/needle was reported by 70% and paraphernalia by 49% in their drug using careers. Treatment was initiated with buprenorphine and the mean dose (in mg) of buprenorphine was 4.3± 2.0, 4.6± 1.9, 4.3 ±1.4, 4.3 ±1.5 given on 3,6,9&12 months respectively. Retention in the prison arm was excellent (98%) and compliance among those retained in prison was 100%. In the prison, during the course of the study, 10, 3, 1 prisoners reported injecting drug use at 3, 6, 9 months respectively. No reporting of injecting drug use was obtained at 12 months and thereafter. No other illicit drug use was reported at follow up. This was corroborated by results of urine screening suggestive of minimal or no drug use at follow up during imprisonment. A statistically significant reduction was found in severity of dependence, craving for drugs and withdrawal symptoms at follow up. Recognition of co-morbid health problems and appropriate treatment of the same was provided to the prisoners on OST. In qualitative assessments, most prisoners expressed satisfaction with treatment and reported experiencing OST treatment as their first ray of hope in their lives.
CONCLUSION: Buprenorphine maintenance for opioid dependent prisoners was found to be feasible and effective in Tihar prisons. An upscale of this intervention in prisons in the region both as a drug treatment and harm reduction strategy is advisable.
FUNDED AND SUPPORTED BY: United Nations Office of Drugs and crime(UNODC- ROSA) under Project RAS H/71 IMPLEMENTED IN: Tihar Prisons, Delhi, India ACNOWLEDGEMENT: Ms. Christina Albertin, Regional representative, UNODC- ROSA; Prof. Rajat Ray(retd): ex HOD Psychiatry and Chief NDDTC.

PMID: 25221294 [PubMed - in process]

Categories: Bup Feeds

P-56efficacy of buprenorphine/naloxone combination in reducing intravenous misuse in opioid-dependent patients (rime study).

Buprenorphine Research (PubMed) - Tue, 09/16/2014 - 2:30pm
Related Articles

P-56efficacy of buprenorphine/naloxone combination in reducing intravenous misuse in opioid-dependent patients (rime study).

Alcohol Alcohol. 2014 Sep;49 Suppl 1:i64

Authors: Touzeau D

Abstract
AIMS: this study assesses the effectiveness of buprenorphine/naloxone combination in reducing intravenous (IV) misuse of buprenorphine in opioid-dependent patients.
METHODS: 158 patients >= 18 years, who misused buprenorphine intravenously >= 4 times/week and treated for opioid dependency with buprenorphine ( >= 2 mg/day dose) for >= 3 months were included in a multicenter, open-label, randomized controlled trial. They were required to report IV misuse in a daily diary. Randomization was 1:1 (buprenorphine/naloxone, n = 79: buprenorphine, n = 79). The trial was including a 3-month randomized treatment period with a follow-up optional 9-month treatment period for those who chose to continue receiving buprenorphine/naloxone.
RESULTS: the primary outcome was the percentage of patients achieving >= 30% reduction in the mean number of weekly study drug injections throughout the randomized treatment period compared with baseline: 89.6% (n = 67) and 45.8% (n = 59) (p <0.0001) of patients in the buprenorphine/naloxone and buprenorphine groups, respectively. In the buprenorphine/naloxone group, 74.2% of patients stopped injecting the study drug compared to 15.9% in the buprenorphine group (p < 0.0001). Of those patients injecting the study drug, patients misusing buprenorphine/naloxone (n = 44) reported significantly less disagreeable side effects than the buprenorphine group (n = 71) (p < 0.0001). Buprenorphine/naloxone combination is significantly effective in reducing IV misuse of buprenorphine in opioid-dependent patients.

PMID: 25221291 [PubMed - in process]

Categories: Bup Feeds

P-52slow-release oral morphine (srom) as further medication in opioid subtitution treatment (ost): results from a registration study.

Buprenorphine Research (PubMed) - Tue, 09/16/2014 - 2:30pm
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P-52slow-release oral morphine (srom) as further medication in opioid subtitution treatment (ost): results from a registration study.

Alcohol Alcohol. 2014 Sep;49 Suppl 1:i63

Authors: Haemmig R

Abstract
Since 50 years oral methadone is the gold standard in OST. However, some of the heroin dependent patients refrain from this kind of treatment due to different reasons (e.g. no injections, limited well-being, excessive sweating). Additionally the prolongation of the QTc poses a clinical problem in double diagnosed patients as many medications that are necessary in the treatment of these patients, add to the QTc prolongation. Unconfirmed reports from different countries suggested that SROM could be a useful addition to the in Switzerland already registered substitution medications methadone, diamorphine, and buprenorphine. In order to test this assumption we conducted a prospective, multi-dose, open label, non-inferiority, cross-over study in a bi-national, multicentre setting over 11 weeks, in which methadone and SROM were compared (ITT population n = 276). Beyond this time-point, the participants were observed another 25 weeks. Main results were: The proportion of heroin-positive urine samples and retention rates under SROM was equal to the ones under methadone. The mean QTc-interval under methadone was significantly longer than that under SROM. Higher treatment satisfaction, fewer cravings for heroin, and lower mental stress were reported by patients under SROM. More Details will be presented. SROM is now registered in Switzerland as an OST medication.

PMID: 25221287 [PubMed - in process]

Categories: Bup Feeds

Sy03-2-4who-isam fellowship barriers of tobacco cessation among Indian buprenorphine-naloxone maintained patients.

Buprenorphine Research (PubMed) - Tue, 09/16/2014 - 2:30pm
Related Articles

Sy03-2-4who-isam fellowship barriers of tobacco cessation among Indian buprenorphine-naloxone maintained patients.

Alcohol Alcohol. 2014 Sep;49 Suppl 1:i6

Authors: Mandal P, Jain R, Jhanjee S, Sreenivas V

Abstract
INTRODUCTION: Prevalence of smoking in opioid agonist treatment programme, leading to significant health hazards and high mortality. This study aims to examine the readiness to quit, perceived personal health and risk susceptibility associated with tobacco use and importance of intervention, among patients on opioid agonist treatment with buprenorphine-naloxone.
METHODS: Fifty-five males on buprenorphine-naloxone treatment at National Drug Dependence Treatment Centre, India, were assessed using Tobacco Use Characteristics, Fagerstrom test for nicotine dependence (smoker and smokeless tobacco user), Readiness to Change questionnaire (RCQ), Smoker's Perceived Health Risk Evaluation (SPHERE), Importance of Intervention scale and a semi-structured questionnaire.
RESULTS: 65.4% of the subjects were smokers, 9% were using smokeless tobacco only whereas 25.6% were using both. Mean FTND score of 5 ± 1.70 among smokers, denotes medium dependence. Only one-fifth of them reported prior quit attempts for tobacco. None of the attempts involved any assistance. 38.8% did not plan to quit in next 6 month. Perceived personal health and risk were poor. Only 61.62% considered intervention for smoking cessation important. Most common choice of intervention was advice and guidance only (49%).
CONCLUSIONS: Higher severity of nicotine dependence, Poor willingness to quit highlights the need for on-site motivational treatment.

PMID: 25221267 [PubMed - in process]

Categories: Bup Feeds

Or14-5medical board policies in the United States on buprenorphine maintenance therapy for the recovering opioid dependent physician seeking a return to clinical practice.

Buprenorphine Research (PubMed) - Tue, 09/16/2014 - 2:30pm
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Or14-5medical board policies in the United States on buprenorphine maintenance therapy for the recovering opioid dependent physician seeking a return to clinical practice.

Alcohol Alcohol. 2014 Sep;49 Suppl 1:i52

Authors: Brown CL, Adelman CL, Lydon JF, Lyon ME, Parran TV

Abstract
SUMMARY: Buprenorphine maintenance therapy for recovering opioid dependent physicians returning to practice is controversial, with concerns regarding neurocognition, despite treatment efficacy. This study's objective was to survey state medical board policies regarding physicians on buprenorphine maintenance therapy seeking a return to clinical practice.
METHODS: Fifty state medical boards were surveyed by phone and email to determine their policies regarding buprenorphine maintenance therapy for recovering physicians returning to practice.
RESULTS: Sixteen state boards would not allow a physician on buprenorphine maintenance therapy to practice. Eight state boards have policies allowing the treatment. Still fifteen other state boards consider the issue on a case by case basis, but have no specific policy. Ten state boards have not responded to multiple requests for information, and state law precludes one board from interpreting statutes without formal rulemaking process.
CONCLUSIONS: Many state medical boards have a defined policy addressing buprenorphine maintenance therapy for physicians in recovery from opioid dependence. A number of boards allow physicians on buprenorphine maintenance therapy to practice, but a greater number preclude it. Many consider the issue on an individual basis. Further research on the safety and efficacy of buprenorphine maintenance therapy may broaden treatment policies for physicians with opioid dependence.

PMID: 25221226 [PubMed - in process]

Categories: Bup Feeds

Sy03-1-5isam fellowship follow up rates in opioid dependence syndrome: a case control study from India.

Buprenorphine Research (PubMed) - Tue, 09/16/2014 - 2:30pm
Related Articles

Sy03-1-5isam fellowship follow up rates in opioid dependence syndrome: a case control study from India.

Alcohol Alcohol. 2014 Sep;49 Suppl 1:i5

Authors: Bandawar MS, Kandasamy A, Chand P, Murthy P, Benegal V

Abstract
BACKGROUND: Buprenorphine Maintenance therapy (BMT) is effective in improving follow-up rate in patients with Opioid Dependence Syndrome (ODS). However, there is very limited published literature regarding this from the Indian sub-continent.
AIM: To compare follow-up rate in patients with opioid dependence syndrome who were on BMT with patients who were not on BMT.
METHOD: Case files of patients (n = 248) registered at a tertiary care Psychiatric hospital from southern India with ODS, between 2005 to 2012, were reviewed. Basic demographic and management data of patients were noted. Details regarding follow up rate for a minimum of one-year after the initiation of the treatment was collected. R commander was used for analyzing the data.
RESULT: 57 patients received BMT of which followup rate was 77% at 1month, 68% at 6months and 1year after initiation of treatment. 191 patients were not on BMT of which followup rate was 55% at 1month, 44% at 6months and 34% at 1year. There was significantly greater follow-up among patients of opioid dependence given BMT than patients who are not on BMT.
CONCLUSION: BMT improves long term follow up rates in patients with ODS.

PMID: 25221213 [PubMed - in process]

Categories: Bup Feeds

Or11-4long term outpatient detoxification treatment of opioid dependence by buprenorphine suppository: case report.

Buprenorphine Research (PubMed) - Tue, 09/16/2014 - 2:30pm
Related Articles

Or11-4long term outpatient detoxification treatment of opioid dependence by buprenorphine suppository: case report.

Alcohol Alcohol. 2014 Sep;49 Suppl 1:i48-i49

Authors: Aso K

Abstract
There are very few cases of opioid abuse and dependence in Japan and use of opioid in the opioid dependence treatment is prohibited by the old-fashioned Japanese narcotics control law. There are few options of medical treatment for opioid dependence available in Japan. Although we used low dosage buprenorphine injection on inpatient detoxification treatment for heroin dependence for ten years, we have not prescribed opioid agonist and antagonist for outpatient treatment of opioid dependence. The relapse rete was high. A patient was referred from U.S. addiction treatment agency last year. He had three years opioid abuse history. He was treated by buprenorphine film for three months. After the patient arrived in Japan, he used buprenorphine film he brought from U.S. and buprenorphine suppository. In the first 3 weeks, the patient use buprenorphine film and tapered buprenorphine from 1.0 mg/day to 0.25 mg /day. In the next 7 weeks, he used buprenorphine suppository 0.2mg/day. In the last 3 days of tenth week, he withdrew from buprenorphine. He returned to US in the 13th week. His drug use was monitored by frequent urinary test and he kept clean in Japan. Buprenorphine suppository was effective substitute of sublingual buprenorphine, in small dosage.

PMID: 25221205 [PubMed - in process]

Categories: Bup Feeds

Or10-5drug use characteristics of opioid and amphetamine-type stimulants (coats) dependent individuals in kota bahru, malaysia.

Buprenorphine Research (PubMed) - Tue, 09/16/2014 - 2:30pm
Related Articles

Or10-5drug use characteristics of opioid and amphetamine-type stimulants (coats) dependent individuals in kota bahru, malaysia.

Alcohol Alcohol. 2014 Sep;49 Suppl 1:i48

Authors: Yasin MA, Tink CW, Ahmad I, Jaapar SZ, Zaharim NM, Balasingam V

Abstract
INTRODUCTION: More than 60% of opioid IDUs in many regions in Malaysia use amphetamine type stimulants (ATS) and 29% of opioid IDUs inject ATS. In Kota Bharu, approximately 65% of patients entering buprenorphine or methadone maintenance treatment have current ATS abuse or dependence at treatment. The objective of this study is to describe the drug use characteristics of COATS individuals.
METHODS: A survey was conducted among n = 88 COATS dependent individuals who were interested to enter and undergo treatment in Hospital Universiti Sains Malaysia in Kota Bharu.
RESULTS: Their mean (SD) age was 35.3 (8) years, 80% had between 7 to 9 years of education, 14.1% reported to be HIV positive while 30% have never been tested. 35.2% reported heroin use of less than 10 years; 25.7%, 11 to 15 years; 12.2%, 16 to 20 years and 15.1%, 21 to 25 years. While for ATS use, 48% reported using less than 10 years; 33.3%, 11 to 15 years; 12%, 16 to 20 years. 74% and 35% of them injected heroin and ATS. 35.5% reported to use ATS daily.
CONCLUSION: Individuals in this sample have a relatively long history of drug use and they also report high rates of injection drug use.

PMID: 25221201 [PubMed - in process]

Categories: Bup Feeds

Or10-1pharmacological treatment of opioid dependence - beliefs and their implications: a study from tertiary care centre in northern India.

Buprenorphine Research (PubMed) - Tue, 09/16/2014 - 2:30pm
Related Articles

Or10-1pharmacological treatment of opioid dependence - beliefs and their implications: a study from tertiary care centre in northern India.

Alcohol Alcohol. 2014 Sep;49 Suppl 1:i47

Authors: Prakash S, Balhara YP

Abstract
INTRODUCTION: The present study aims to identify the beliefs related to treatment with buprenorphine/naloxone combination, buprenorphine and naltrexone among patients diagnosed with opioid dependence; and to explore for relationship between underlying beliefs and treatment choice, adherence and abstinence.
METHODS: It was a cross-sectional, observational study held at the inpatient department of a tertiary care teaching centre in northern India. 85 opioid dependent patients completed the Drug Abuse Monitoring System proforma and, a questionnaire to elicit beliefs, developed for the purposes of this study.
RESULTS: The patients described a variety of beliefs in relation to each of these drugs, both positive and negative. The beliefs seemed to influence the choice of drugs. While patients believing that buprenorphine or naltrexone were harmful quoted necessary durations of treatment that were much shorter than those who did not so believe, there was no statistically significant difference in the actual durations and periods of abstinence (p = 0.34; p = 0.62). Sociodemographic profile, beliefs related to dosing, nature of medication, expectations from treatment and duration of illness are also described.
CONCLUSIONS: Beliefs may affect choice of treatment which in turn can have potentially important effects on outcome. Effect of beliefs on duration of treatment and abstinence needs further exploration.

PMID: 25221197 [PubMed - in process]

Categories: Bup Feeds

Or09-3protocols for detox of high dose methadone patients off methadone in 14 days in an outpatients program.

Buprenorphine Research (PubMed) - Tue, 09/16/2014 - 2:30pm
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Or09-3protocols for detox of high dose methadone patients off methadone in 14 days in an outpatients program.

Alcohol Alcohol. 2014 Sep;49 Suppl 1:i46

Authors: O'Neil GA

Abstract
It has been reported that the average overdose mortality rate for patients detoxing from methadone in the UK, is 46pt/1000py in the first month following detox (Cornish et al, 2010). This highlights the need to provide safe and effective detox services alongside the provision and high quality sustained release naltrexone treatment for those seeking to detox from methadone programs. The development of protocols for assisting high dose methadone patients to detox from methadone in 14 days, using a combination of Buprenorphine and long acting naltrexone implants, will be discussed. At an outpatient clinic in Perth, Australia, a large number of patients on doses of methadone of 100mg/d and above, present with requests for assistance in stopping their methadone treatment. The patient is initially transferred from their high dose methadone onto buprenorphine over a 4 day period. Patients are then detoxed from their buprenorphine and treated with naltrexone implants. No major complications or deaths in the months immediately post detox have occurred. The provision of naltrexone implants has been associated with an overdose mortality of 0.67pt/1000py in the first four months after ceasing opiates. Therefore, the method developed is fast, efficient and provides protections from overdose mortality following methadone detox.

PMID: 25221194 [PubMed - in process]

Categories: Bup Feeds

Sy42-4outcomes of aripirazole versus risperidone among methamphetamine dependence individuals seeking treatment in malaysia.

Buprenorphine Research (PubMed) - Tue, 09/16/2014 - 2:30pm
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Sy42-4outcomes of aripirazole versus risperidone among methamphetamine dependence individuals seeking treatment in malaysia.

Alcohol Alcohol. 2014 Sep;49 Suppl 1:i36

Authors: Rashid RA, Habil MH, Sulaiman AH, Zahari MM, Hanif MA, Seghatoleslam T

Abstract
INTRODUCTION: There is increasing numbers of methamphetamine users in Malaysia. Evidence of changing pattern of substance use from traditional illicit substance to designer drugs. Multiple complications were associated with methamphetamine use, yet no effective pharmacotherapy options available up to now. There is an urgent needs for anticraving agents to treat those methamphetamine dependents.
METHODS: Twelve weeks randomised controlled trials comparing outcomes of apiprazole, a partial dopamine agonist and risperidone, an antagonist of dopamine D2 receptors. The inclusion criteria are Methamphetamine dependents that fulfilled DSM IV criteria, 18 years and above, with informed written consent and no history of allergy to both of the medicine were randomised to receive either ariprazole or risperidone. Baseline outcomes measure include Amphetamine Withdrawal Scales (AWS), Positive and Negative Syndrome Scales (PANSS), WHO Quality of Life (WHOQoL) and retention rate in treatment. Weekly urine rapid drug test and Extrapyramidal symptoms were also measured using Simpson Angus Scale (SAS) and BARS.
EXPECTED RESULTS: Fifteen were enrolled into each arm so far. We expect that there are sigficance difference of outcome measures between the two groups.
CONCLUSION: Aripiprazole may have potential role for reducing craving and harm related to methamphetamine use similarly like buprenorphine treament for heroin dependents.

PMID: 25221136 [PubMed - in process]

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Sy37-4tapering of methadone or buprenorphine medication dose in pregnancy. How many succeed and what are the neonatal outcomes?

Buprenorphine Research (PubMed) - Tue, 09/16/2014 - 2:30pm
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Sy37-4tapering of methadone or buprenorphine medication dose in pregnancy. How many succeed and what are the neonatal outcomes?

Alcohol Alcohol. 2014 Sep;49 Suppl 1:i32

Authors: Welle-Strand GK, Ravndal E

Abstract
BACKGROUND: Opioid maintenance treatment (OMT) with methadone or buprenorphine is the treatment of choice for opioid dependent pregnant women. Many women want to lower their OMT-medication dose during pregnancy, thinking this will lead to less neonatal abstinence syndrome (NAS) for their neonates. Many professionals also try to influence women to lower their dose of methadone or buprenorphine during pregnancy.
METHODS: A mixed prospective/retrospective cohort of 123 women were issued a questionnaire, also focusing on tapering of the OMT-medication dose during pregnancy. The medical information was confirmed by records from health professionals and from the hospitals.
RESULTS: 63% of the women tried tapering their medication dose during pregnancy. The degree of tapering and the characteristics of the women who managed to taper their OMT-medication dose substantially during pregnancy will be presented, as well as the neonatal outcomes (growth parameters and NAS parameters) for the neonates of the women who tapered versus the neonates of the women who did not taper.
CONCLUSION: Some women manage to taper their OMT-medication dose substantially during pregnancy, but the impact on the neonatal outcomes is limited.

PMID: 25221115 [PubMed - in process]

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Sy37-3mental health and adaptation in 7/8 year-old children prenatally exposed to methadone and buprenorphine (omt).

Buprenorphine Research (PubMed) - Tue, 09/16/2014 - 2:30pm
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Sy37-3mental health and adaptation in 7/8 year-old children prenatally exposed to methadone and buprenorphine (omt).

Alcohol Alcohol. 2014 Sep;49 Suppl 1:i31-i32

Authors: Sarfi M, Heiervang E

Abstract
INTRODUCTION: Children exposed to OMT prenatally are at risk of cognitive and behavior problems, particularly evident when children enter school. We here present follow-up data from a national Norwegian cohort of 32 children prenatally exposed to OMT, and 22 general population controls.
METHOD: Cognitive level was assessed with WASI, behavioral symptoms with SDQ, and diagnostic assessment was performed online with the DAWBA.
RESULTS: Full scale IQ was lower for exposed children than for controls (102 vs 113), but still within the normal range. Exposed children also had 2-3 times higher mean SDQ Total difficulties and subscale scores (except for emotional problems and parent reported impact). DSM-IV disorders were seen in 17 exposed children (53.1%); 10 ADHD, 6 oppositional, 5 emotional, 4 attachment, and 3 tic disorders. Only one control child (4.5%) met criteria for a mental disorder (within the emotional domain).
CONCLUSION: In spite of a normal mean cognitive level, exposed children had high levels of behavior symptoms, and a very high prevalence of mental disorders. Being the first study of mental disorders in children prenatally exposed to OMT, this study needs replication in larger longitudinal studies, where other contributing factors during development may be controlled for.

PMID: 25221114 [PubMed - in process]

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Sy37-1lessons learned from a comparison of evidence-based research in pregnant opioid-dependent women.

Buprenorphine Research (PubMed) - Tue, 09/16/2014 - 2:30pm
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Sy37-1lessons learned from a comparison of evidence-based research in pregnant opioid-dependent women.

Alcohol Alcohol. 2014 Sep;49 Suppl 1:i31

Authors: Fischer G, Winklbaur-Hausknost B, Jagsch R, Graf-Rohrmeister K, Unger A, Baewert A, Langer M, Thau K

Abstract
OBJECTIVES: Lessons learned in research and treatment of opioid dependence demonstrate the need to include pregnant women in clinical trials.
METHODS: Two double-blind, double-dummy, randomized controlled trials comparing buprenorphine and methadone in opioid-dependent pregnant women were conducted. In both studies, participants received voucher-based incentives for attendance and completion of study assessments. In the MOTHER trial, participants additionally received escalating voucher incentives for drug-free urine samples. Neonatal abstinence syndrome was treated with oral morphine solution based on standardized modified Finnegan scores.
RESULTS: After a mean treatment period of 13.79 weeks in the Pilot study (PS, n = 18) and 20.78 weeks in the MOTHER-trial (MT, n = 41), respectively (p < 0.001), PS patients delivered at mean doses of 14.00mg buprenorphine/52.50mg methadone and MT participants at 13.44mg buprenorphine/63.68mg methadone. Nonsignificant differences regarding dropout rates were found (22% in PS versus 10% in MT), but dropout was significantly earlier in the MT (p = 0.013). Significantly higher rates of concomitant consumption of opioids and benzodiazepines occurred in the PS compared with the MT (p < 0.001), however, with no significant differences in neonatal data between both settings.
CONCLUSIONS: Early treatment enrolment combined with contingency management contributes to reduced illicit drug use throughout pregnancy, surprisingly without influencing neonatal outcome parameters.

PMID: 25221112 [PubMed - in process]

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