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[Analgesic management of acute pain in patients receiving methadone or buprenorphine.]

Buprenorphine Research (PubMed) - Tue, 03/10/2015 - 5:00pm
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[Analgesic management of acute pain in patients receiving methadone or buprenorphine.]

Ugeskr Laeger. 2015 Mar 2;177(10)

Authors: Zinck L, Sonne NM, Madsen SL, Nikolajsen L

Abstract
In Denmark, approximately 7,600 patients receive maintenance therapy with methadone or buprenorphine because of opioid addiction. These patients have an increased risk of inadequate pain treatment during hospitalization, among others because of tolerance to opioids and poor communication with the staff. The present article describes four common misconceptions among health-care providers that underlie inadequate pain treatment and provides practical recommendations for the analgesic management of acute pain in patients receiving methadone or buprenorphine.

PMID: 25749118 [PubMed - as supplied by publisher]

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Long-term course of opioid addiction.

Buprenorphine Research (PubMed) - Tue, 03/10/2015 - 5:00pm
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Long-term course of opioid addiction.

Harv Rev Psychiatry. 2015 Mar-Apr;23(2):76-89

Authors: Hser YI, Evans E, Grella C, Ling W, Anglin D

Abstract
Opioid addiction is associated with excess mortality, morbidities, and other adverse conditions. Guided by a life-course framework, we review the literature on the long-term course of opioid addiction in terms of use trajectories, transitions, and turning points, as well as other factors that facilitate recovery from addiction. Most long-term follow-up studies are based on heroin addicts recruited from treatment settings (mostly methadone maintenance treatment), many of whom are referred by the criminal justice system. Cumulative evidence indicates that opioid addiction is a chronic disorder with frequent relapses. Longer treatment retention is associated with a greater likelihood of abstinence, whereas incarceration is negatively related to subsequent abstinence. Over the long term, the mortality rate of opioid addicts (overdose being the most common cause) is about 6 to 20 times greater than that of the general population; among those who remain alive, the prevalence of stable abstinence from opioid use is low (less than 30% after 10-30 years of observation), and many continue to use alcohol and other drugs after ceasing to use opioids. Histories of sexual or physical abuse and comorbid mental disorders are associated with the persistence of opioid use, whereas family and social support, as well as employment, facilitates recovery. Maintaining opioid abstinence for at least five years substantially increases the likelihood of future stable abstinence. Recent advances in pharmacological treatment options (buprenorphine and naltrexone) include depot formulations offering longer duration of medication; their impact on the long-term course of opioid addiction remains to be assessed.

PMID: 25747921 [PubMed - in process]

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Medication-assisted treatment of opioid use disorder: review of the evidence and future directions.

Buprenorphine Research (PubMed) - Tue, 03/10/2015 - 5:00pm
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Medication-assisted treatment of opioid use disorder: review of the evidence and future directions.

Harv Rev Psychiatry. 2015 Mar-Apr;23(2):63-75

Authors: Connery HS

Abstract
LEARNING OBJECTIVE: After participating in this activity, learners should be better able to: Evaluate the rationale for and current evidence supporting medication-assisted treatment of opioid use disorder.
ABSTRACT: Medication-assisted treatment of opioid use disorder with physiological dependence at least doubles rates of opioid-abstinence outcomes in randomized, controlled trials comparing psychosocial treatment of opioid use disorder with medication versus with placebo or no medication. This article reviews the current evidence for medication-assisted treatment of opioid use disorder and also presents clinical practice imperatives for preventing opioid overdose and the transmission of infectious disease. The evidence strongly supports the use of agonist therapies to reduce opioid use and to retain patients in treatment, with methadone maintenance remaining the gold standard of care. Combined buprenorphine/naloxone, however, also demonstrates significant efficacy and favorable safety and tolerability in multiple populations, including youth and prescription opioid-dependent individuals, as does buprenorphine monotherapy in pregnant women. The evidence for antagonist therapies is weak. Oral naltrexone demonstrates poor adherence and increased mortality rates, although the early evidence looks more favorable for extended-release naltrexone, which has the advantages that it is not subject to misuse or diversion and that it does not present a risk of overdose on its own. Two perspectives-individualized treatment and population management-are presented for selecting among the three available Food and Drug Administration-approved maintenance therapies for opioid use disorder. The currently unmet challenges in treating opioid use disorder are discussed, as are the directions for future research.

PMID: 25747920 [PubMed - in process]

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How Do I Support My Teen’s Recovery after Addiction Treatment?

Drug and Alcohol News (JoinTogether.com) - Mon, 03/09/2015 - 4:07pm

Many parents feel ill-prepared when their child has completed inpatient or outpatient drug addiction treatment. They often feel uncertain on what to expect and have many questions about how to best support their teen’s recovery.

Continuing Care, a website and guide (pdf), gives parents the tools and supports to make their families stronger and deal with the complex and challenging situations during the days, months and years after treatment.

You’ll find insights on how parents can set realistic expectations for their child’s recovery, including how to help them adapt to their new environment in sobriety, how to avoid the people, places and things that can trigger relapse and what to do if relapse occurs.

With good continuing care that is appropriately adjusted to individual needs, a teen should be able to manage his or her condition. Your child may initially need your help, but eventually he or she should be able to manage it without you, as he or she matures.

We hope this resource will help you figure out what might best support your recovery journey together.

The post How Do I Support My Teen’s Recovery after Addiction Treatment? appeared first on Partnership for Drug-Free Kids.

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Diversion of methadone and buprenorphine from opioid substitution treatment: The importance of patients' attitudes and norms.

Buprenorphine Research (PubMed) - Sat, 03/07/2015 - 8:00am
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Diversion of methadone and buprenorphine from opioid substitution treatment: The importance of patients' attitudes and norms.

J Subst Abuse Treat. 2015 Feb 18;

Authors: Johnson B, Richert T

Abstract
AIMS: Methadone and buprenorphine diversion by patients in opioid substitution treatment (OST) is a poorly understood phenomenon. We study the norms and attitudes on diversion among OST patients, including the role these norms and attitudes play as diversion risk factors. We also study whether perceived quality of care, social bonds to treatment staff, and deterrence can be associated with diversion.
METHODS: Structured interviews were conducted with 411 patients from eleven OST programs. In total, 280 interviews were done on site by the researchers, while 131 interviews were conducted through peer interviewing by specially trained patients. The data was analyzed through frequency- and averages-calculations, cross-tabulations, and logistic regression analysis.
RESULTS: Most patients consider diversion as mostly positive (83.7%), morally right (76.8%), and without any significant risk of detection (66.9%). Individual differences in norms and risk perceptions may play a role in explaining variations in diversion; patients who consider it right to share medication with friends report higher treatment-episode diversion than other patients (OR 1.455, p=0.016). Patients who perceive control measures as effective report lower diversion than other patients (OR=0.655, p=0.013). Furthermore, data indicate that patients who are satisfied with the care and service are less prone to engage in diversion. Social bonds with treatment staff seem to be less importance.
CONCLUSIONS: The norm system described by patients resemble Bourgois' 'moral economy of sharing' concept-not sharing drugs with friends in withdrawal is considered unethical. Efforts to decrease diversion may focus on lifestyle-changing interventions, and reducing black market demand for illicit medications by expanding access to treatment.

PMID: 25744650 [PubMed - as supplied by publisher]

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Effect of buprenorphine on genotoxicity evaluation of chemicals by the rat liver micronucleus test with partial hepatectomy.

Buprenorphine Research (PubMed) - Sat, 03/07/2015 - 8:00am
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Effect of buprenorphine on genotoxicity evaluation of chemicals by the rat liver micronucleus test with partial hepatectomy.

J Toxicol Sci. 2015;40(1):109-14

Authors: Itoh S, Nagata M, Hattori C, Takasaki W

Abstract
In the view of animal welfare considerations, we investigated the suitability of modifying the rat liver micronucleus test with partial hepatectomy to include administration of an analgesic drug to minimize pain and distress as much as possible. The effects of the analgesic, buprenorphine, on the genotoxicity evaluation of structural chromosome aberration inducers (cyclophosphamide, diethylnitrosamine and 1,2-dimethylhydrazine) and numerical chromosome aberration inducers (colchicine and carbendazim) were examined. The genotoxicants were given orally to 8-week-old male F344 rats a day before or after partial hepatectomy and hepatocytes were isolated 4 days after the partial hepatectomy. Buprenorphine was injected subcutaneously twice a day with at least a 6-hr interval for 2 days from just after partial hepatectomy. As results, buprenorphine caused neither change in clinical signs (except for one animal death) nor increase in the incidence of micronucleated hepatocytes of vehicle treated animals. In the case of concomitant treatment of buprenorphine and a genotoxicant, one out of 8 animals died in each group given buprenorphine with cyclophosphamide, carbendazim or colchicine (lower dose level only). Slight changes in clinical signs were noted in the group given buprenorphine with cyclophosphamide or carbendazim. A statistically significant increase in the incidence of micronucleated hepatocytes was obtained in concomitant treatment of buprenorphine and genotoxicant compared with genotoxicant alone for 1,2-dimethylhydrazine, colchicine and carbendazim. It is concluded that use of buprenorphine as an analgesic drug to minimize pain and distress for rats that are given partial hepatectomy is not appropriate under the present experimental conditions, because it could enhance the general toxicity and genotoxicity of the test chemical.

PMID: 25743750 [PubMed - in process]

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Buprenorphine-Naloxone treatment of prescription opioid abuse: does past performance predict future results?

Buprenorphine Research (PubMed) - Fri, 03/06/2015 - 9:00am
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Buprenorphine-Naloxone treatment of prescription opioid abuse: does past performance predict future results?

J Clin Psychiatry. 2015 Feb;76(2):195-197

Authors: Langleben DD

Abstract
Misuse of prescription opioids is a national public health problem: In the United States, according to the 2012 National Survey on Drug Use and Health, 4.5 million, or 1.7%, of persons aged 12 or older reported current nonmedical use of pain relievers, and 335,000 reported currently using heroin. This is an upward trend, as heroin use has more than doubled since 2002. Transition from ingesting or insufflating (ie, snorting) prescription opioids to snorting or smoking (ie, inhaling the fumes) heroin has become more common and is driven by the increasing purity and lower cost.

PMID: 25742206 [PubMed - as supplied by publisher]

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Buprenorphine-naloxone treatment in physicians and nurses with opioid dependence.

Buprenorphine Research (PubMed) - Thu, 03/05/2015 - 8:30am

Buprenorphine-naloxone treatment in physicians and nurses with opioid dependence.

Subst Abus. 2015 Mar 4;:0

Authors: Braquehais MD, Fadeuilhe C, Håkansson A, Bel MJ, Navarro MC, Roncero C, Bruguera E, Casas M

PMID: 25738533 [PubMed - as supplied by publisher]

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Feasibility of implementing share medical appointments (SMAs) for office-based opioid treatment with buprenorphine: A pilot study.

Buprenorphine Research (PubMed) - Thu, 03/05/2015 - 8:30am

Feasibility of implementing share medical appointments (SMAs) for office-based opioid treatment with buprenorphine: A pilot study.

Subst Abus. 2015 Mar 4;:0

Authors: Suzuki J, Zinser J, Klaiber B, Hannon M, Grassi H, Spinosa M, Ramirez A, Issa M, Chin Feman SP

Abstract
Background: Shared medical appointments (SMAs) are designed to improve patient satisfaction and increase access to treatment. In a typical SMA, 6-12 patients with similar diagnoses attend a group appointment with their health care providers, often lasting 60-120 minutes. All components of an individual visit are completed, and additional time is spent providing education and facilitating peer support. Our aim was to report on patient and program outcomes after implementation of a SMA-based office-based opioid treatment with buprenorphine. Methods: The study was conducted at a hospital-based outpatient psychiatric clinic that previously did not offer any office-based opioid treatment with buprenorphine. Demographic and clinical data (treatment retention, depression, anxiety, craving scores and urine toxicology results) were extracted from the medical records. Patients were recruited to complete a survey assessing their experience. Results: Ninety-three patients enrolled in the program, and 52.7% remained in treatment at 6 months. The proportion of aberrant opioid urine results, depression, anxiety and craving decreased significantly from baseline to 6 months. Twenty two patients completed the survey, who generally agreed that the SMA format allowed for more time with physicians, more support from peers, better coordination of care, and more predictable times for visits. Conclusions: Implementation of a SMA-based buprenorphine program was feasible, with treatment outcomes comparable to traditional models of care. More research is needed to explore the impact of SMA on buprenorphine treatment.

PMID: 25738320 [PubMed - as supplied by publisher]

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Comparative trial to study the effectiveness of clonidine hydrochloride and buprenorphine-naloxone in opioid withdrawal - a hospital based study.

Buprenorphine Research (PubMed) - Thu, 03/05/2015 - 8:30am

Comparative trial to study the effectiveness of clonidine hydrochloride and buprenorphine-naloxone in opioid withdrawal - a hospital based study.

J Clin Diagn Res. 2015 Jan;9(1):FC01-4

Authors: Hussain SS, Farhat S, Rather YH, Abbas Z

Abstract
OBJECTIVES: Prevalence of opioid addiction has alarmingly increased over the recent years. In South Asian region alone there are more than 10 million opioid abusers amounting to 2% of world population. Detoxification remains to be the first step for the successful treatment of opioid addiction. The present study was carried out to compare the relative efficacy and safety of buprenorphine -naloxone and clonidine hydrochloride in the detoxification of opioid-dependents.
MATERIALS AND METHODS: Present trial was conducted at De- addiction centre of Institute of Mental and Neurosciences (IMNS), GMC Srinagar. Fifty four (54) treatment seeking subjects, 15-50 years of age, fulfilling DSM-1V TR (American Psychiatric association`s Mental Disorders-1V text revision) criteria for opioid dependence were included and randomized into two groups. The groups received either clonidine hydrochloride (Group A) or buprenorphine- naloxone (Bup-Nax) (Group B) for the duration of 10 days. The efficacy of the two drugs in controlling the opioid withdrawal was evaluated by Clinical Opioid Withdrawal Scale (COWS) and their effect on the desire for the abused substance was measured by Visual Analogue Scale (VAS). The safety of the two drugs was measured by taking the side effect profile of the two compared drugs into consideration.
RESULTS: There was significant difference of COWS-score between the two groups which was evident from day 3 (14.85 ± 3.43 vs. 11.67 ± 2.40, p<0.005) and continued till day 6 (2.56 ± 1.40 vs. 0.30 ± 0.61, p<0.005), for Group A and group B respectively. The effect of two drugs in controlling the craving for the abused substance also showed significant difference from day 2 (66.30 ± 10.80 vs. 47.40 ± 12.90, p<0.005) till day 5 (7.78 ± 6.41 vs. 1.85 ± 6.22, p<0.005), for Group A and Group B respectively.
CONCLUSION: Administration of buprenorphine-naloxone was more efficient in reducing the signs and symptoms of opioid withdrawal and in controlling the craving for the abused substance during the first few days of detoxification.

PMID: 25738001 [PubMed]

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Medication assisted treatment discontinuation in pregnant and postpartum women with opioid use disorder.

Buprenorphine Research (PubMed) - Thu, 03/05/2015 - 8:30am

Medication assisted treatment discontinuation in pregnant and postpartum women with opioid use disorder.

Drug Alcohol Depend. 2015 Feb 19;

Authors: Wilder C, Lewis D, Winhusen T

Abstract
BACKGROUND: Increasing use of opioids has led to an increase in the number of pregnant and postpartum women in medication assisted treatment (MAT) for opioid use disorder.
METHODS: We (1) conducted a systematic review of published literature on MAT discontinuation (methadone and buprenorphine) in pregnant and postpartum women and (2) determined methadone discontinuation rates in a retrospective cohort (2006-2013) of pregnant and postpartum women in a university affiliated methadone clinic.
RESULTS: We found limited generalizable literature reports of discontinuation rates, with a range of prenatal discontinuation rates from 0 to 33% and rates which spanned various prenatal and postnatal periods from 26 to 64%. In our cohort of 229 women, 251 pregnancies were reported, with a prenatal methadone discontinuation rate of 11.0%. Based on a Cox proportional hazards model controlling for age, pregnancy outcome, and duration of treatment prior to delivery, the probability of methadone discontinuation at or before 6 months postpartum was 56.0%. Duration of methadone treatment prior to delivery was inversely associated with risk for postpartum discontinuation of treatment (HR=0.98, 95% CI (0.96, 0.99)).
CONCLUSIONS: We conclude that the postpartum period is a time of increased risk for discontinuation of MAT. More accurate assessment of rates of pre- and postpartum MAT discontinuation, as well as further investigation of factors affecting these rates, is warranted. Development and testing of interventions to encourage early prenatal enrollment in MAT and improve postnatal retention in MAT would benefit pregnant women and new mothers with opioid use disorder.

PMID: 25735465 [PubMed - as supplied by publisher]

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Buprenorphine ingestion in a 23-month-old boy.

Buprenorphine Research (PubMed) - Wed, 03/04/2015 - 6:30am

Buprenorphine ingestion in a 23-month-old boy.

Hosp Pediatr. 2015 Mar;5(3):164-6

Authors: Swartzentruber GS, Richardson WH, Mack EH

PMID: 25732991 [PubMed - in process]

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