Treatment Quality for Buprenorphine Care: The Pot at the End of the Rainbow.

Buprenorphine Research (PubMed) - Thu, 05/26/2016 - 8:30am
Related Articles

Treatment Quality for Buprenorphine Care: The Pot at the End of the Rainbow.

J Addict Med. 2016 May-Jun;10(3):210-211

Authors: Gordon A, Lo-Ciganic WH, Cochran G, Gellad WF, Cathers T, Donohue JM

PMID: 27223837 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Measuring Quality of Buprenorphine Care.

Buprenorphine Research (PubMed) - Thu, 05/26/2016 - 8:30am
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Measuring Quality of Buprenorphine Care.

J Addict Med. 2016 May-Jun;10(3):209-210

Authors: Sherrick RC

PMID: 27223836 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Mediation of buprenorphine analgesia by a combination of traditional and truncated mu opioid receptor splice variants.

Buprenorphine Research (PubMed) - Thu, 05/26/2016 - 8:30am
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Mediation of buprenorphine analgesia by a combination of traditional and truncated mu opioid receptor splice variants.

Synapse. 2016 May 25;

Authors: Grinnell SG, Ansonoff M, Marrone GF, Lu Z, Narayan A, Xu J, Rossi G, Majumdar S, Pan YX, Bassoni DL, Pintar J, Pasternak G

Abstract
Buprenorphine has long been classified as a mu analgesic, although its high affinity for other opioid receptor classes and the orphanin FQ/nociceptin ORL1 receptor may contribute to its other actions. The current studies confirmed a mu mechanism for buprenorphine analgesia, implicating several subsets of mu receptor splice variants. Buprenorphine analgesia depended upon the expression of both exon 1-associated traditional full length 7 transmembrane (7TM) and exon 11-associated truncated 6 transmembrane (6TM) MOR-1 variants. In genetic models, disruption of delta, kappa1 or ORL1 receptors had no impact on buprenorphine analgesia, while loss of the traditional 7TM MOR-1 variants in an exon 1 knockout (KO) mouse markedly lowered buprenorphine analgesia. Loss of the truncated 6TM variants in an exon 11 KO mouse totally eliminated buprenorphine analgesia. In distinction to analgesia, the inhibition of gastrointestinal transit and stimulation of locomotor activity were independent of truncated 6TM variants. Restoring expression of a 6TM variant with a lentivirus rescued buprenorphine analgesia in an exon 11 KO mouse that still expressed the 7TM variants. Despite a potent and robust stimulation of (35) S-GTPγS binding in MOR-1 expressing CHO cells, buprenorphine failed to recruit β-arrestin-2 binding at doses as high as 10 µM. Buprenorphine was an antagonist in DOR-1 expressing cells and an inverse agonist in KOR-1 cells. Buprenorphine analgesia is complex and requires multiple mu receptor splice variant classes, but other actions may involve alternative receptors. This article is protected by copyright. All rights reserved.

PMID: 27223691 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Buprenorphine compared with methadone to treat pregnant women with opioid use disorder: a systematic review and meta-analysis of safety in the mother, fetus and child.

Buprenorphine Research (PubMed) - Thu, 05/26/2016 - 8:30am
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Buprenorphine compared with methadone to treat pregnant women with opioid use disorder: a systematic review and meta-analysis of safety in the mother, fetus and child.

Addiction. 2016 May 25;

Authors: Zedler BK, Mann AL, Kim MM, Amick HR, Joyce AR, Murrelle EL, Jones HE

Abstract
AIMS: To assess the safety of buprenorphine compared with methadone to treat pregnant women with opioid use disorder.
METHODS: We searched PubMed, Embase and the Cochrane Library from inception through February 2015 for randomized controlled trials (RCT) and observational cohort studies (OBS) that compared buprenorphine with methadone for treating opioid-dependent pregnant women. Two reviewers independently assessed titles and abstracts of all search results and full texts of potentially eligible studies reporting original data for maternal/fetal/infant death, preterm birth, fetal growth outcomes, fetal/congenital anomalies, fetal/child neurodevelopment, and/or maternal adverse events. We ascertained each study's risk of bias using validated instruments and assessed the strength of evidence for each outcome using established methods. We computed effect sizes using random-effects models for each outcome with 2 or more studies.
RESULTS: Three RCTs (N = 223) and 15 cohort OBS (N = 1923) met inclusion criteria. In meta-analyses using unadjusted data and methadone as comparator, buprenorphine was associated with lower risk of preterm birth [RCT risk ratio (RR) 0.40 (95% CI 0.18, 0.91); OBS RR 0.67 (95% CI 0.50, 0.90)], greater birth weight [RCT weighted mean difference (WMD) 277 g (95% CI 104, 450); OBS WMD 265 g (95% CI 196, 335)] and larger head circumference [RCT WMD 0.90 cm (95% CI 0.14, 1.66); OBS WMD 0.68 cm (95% CI 0.41, 0.94)]. No treatment differences were observed for spontaneous fetal death, fetal/congenital anomalies and other fetal growth measures, although the power to detect such differences may be inadequate due to small sample sizes.
CONCLUSIONS: Moderately strong evidence indicates lower risk of preterm birth, greater birth weight and larger head circumference with buprenorphine treatment of maternal opioid use disorder during pregnancy compared with methadone treatment, and no greater harms.

PMID: 27223595 [PubMed - as supplied by publisher]

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Medication-Assisted Treatment of Opioid Use Disorder in Adolescents and Young Adults.

Buprenorphine Research (PubMed) - Thu, 05/26/2016 - 8:30am
Related Articles

Medication-Assisted Treatment of Opioid Use Disorder in Adolescents and Young Adults.

Adolesc Med State Art Rev. 2014 Aug;25(2):251-65

Authors: Cottrill CB, Matson SC

PMID: 27132312 [PubMed - indexed for MEDLINE]

Categories: Bup Feeds

Pharmacotherapy for opioid dependence in jails and prisons: research review update and future directions.

Buprenorphine Research (PubMed) - Wed, 05/25/2016 - 6:30am

Pharmacotherapy for opioid dependence in jails and prisons: research review update and future directions.

Subst Abuse Rehabil. 2016;7:27-40

Authors: Sharma A, O'Grady KE, Kelly SM, Gryczynski J, Mitchell SG, Schwartz RP

Abstract
PURPOSE: The World Health Organization recommends the initiation of opioid agonists prior to release from incarceration to prevent relapse or overdose. Many countries in the world employ these strategies. This paper considers the evidence to support these recommendations and the factors that have slowed their adoption in the US.
METHODS: We reviewed randomized controlled trials (RCTs) and longitudinal/observational studies that examine participant outcomes associated with the initiation or continuation of opioid agonists (methadone, buprenorphine) or antagonists (naltrexone) during incarceration. Papers were identified through a literature search of PubMed with an examination of their references and were included if they reported outcomes for methadone, buprenorphine, or naltrexone continued during incarceration or initiated prior to release in a correctional institution.
RESULTS: Fourteen studies were identified, including eight RCTs and six observational studies. One RCT found that patients treated with methadone who were continued on versus tapered off methadone during brief incarceration were more likely to return to treatment upon release. A second RCT found that the group starting methadone treatment in prison versus a waiting list was less likely to report using heroin and sharing syringes during incarceration. A third RCT found no differences in postrelease heroin use or reincarceration between individuals initiating treatment with methadone versus those initiating treatment with buprenorphine during relatively brief incarcerations. Findings from four additional RCTs indicate that starting opioid agonist treatment during incarceration versus after release was associated with higher rates of entry into community treatment and reduced heroin use. Finally, one pilot RCT showed that providing extended-release naltrexone prior to discharge resulted in significantly lower rates of opioid relapse compared to no medication.
CONCLUSION: Reasons why uptake of these pharmacotherapies is limited in the US and relatively widespread in Europe are discussed. Recommendations for future research are outlined.

PMID: 27217808 [PubMed]

Categories: Bup Feeds

Underage Drinking: What You Should Know

Drug and Alcohol News (JoinTogether.com) - Tue, 05/24/2016 - 5:15pm

Underage drinking is a serious public health problem in the US. Alcohol is the most widely used substance of abuse among America’s young people and poses enormous health and safety risks.

With graduation parties and Memorial Day BBQs taking place this weekend, summer is around the corner, and it’s an important time to talk with your kids about alcohol.

At what age do kids start drinking?

Believe it or not, the average age for a first drink is 14.

Most underage drinking is in the form of binge drinking.

People ages 12-20 drink 11 percent of all alcohol consumed in the US. Although young people drink less often than adults do, when they drink, they drink more. That is because young people consume more than 90 percent of their alcohol by binge drinking.

Why is alcohol attractive to teens?

As children mature, it is natural for them to assert their independence, seek new challenges and try taking risks. Many teens want to try alcohol, but often do not fully recognize its negative effects on their health and behavior (see below for why it’s dangerous). Other reasons young people drink alcohol:  Peer pressure/to fit in, increased independence, stress/to escape or relax, to feel grown up among peers, to rebel, to relieve boredom or out of curiosity.

Teens’ Perception of Alcohol Use

Almost half of teens (44 percent) do not see a “great risk” in drinking 5 or more drinks nearly every day.

There is low social disapproval from peers: Only 34 percent strongly disapprove of “teens your age getting drunk.”

It’s easy to get: 77 percent say alcohol is easily accessible. Also, 53 percent of current underage drinkers reported family and friends as their source for alcohol they consumed.

Underage Drinking is Dangerous

There is a range of risks and negative consequences. Underage drinking:

  • Causes many deaths. Each year, 4,300 young people die in alcohol-related deaths as a result of underage drinking (car crashes, homicides, alcohol poisoning, falls, burns, drowning and suicides).
  • Causes many injuries. In 2010, there were approximately 189,000 emergency room visits by people under 21 for injuries and other conditions related to alcohol.
  • Impairs judgment. Drinking can lead to poor decisions about engaging in risky behavior, including drinking and driving, sexual activity (such as unprotected sex) and aggressive or violent behavior.
  • Increases the risk of physical and sexual assault. Underage drinkers are more likely to carry out or be the victim of a physical or sexual assault after drinking than others their age who do not drink.
  • Increases the risk of alcohol problems later in life. Research shows that people who start drinking before the age of 15 are four times more likely to meet the criteria for alcohol dependence at some point in their lives.

Other Risk Factors:

  • Teen brains are more vulnerable to alcohol. Research shows that the teen brain doesn’t fully develop until 25. Alcohol can alter this development, potentially affecting brain structure and function. This may cause cognitive or learning problems and/or make the brain more prone to alcohol dependence. This is especially risky when people start drinking heavily at young ages.
  • Mixing alcohol and prescription medicine is especially dangerous. It can cause nausea and vomiting, headaches, drowsiness, fainting, loss of coordination and puts you at risk for internal bleeding, heart problems and difficulties breathing.
  • Alcohol and marijuana is also a dangerous combination, significantly impairing judgment. The level of intoxication and secondary effects experienced can be unpredictable. Learn more >

What Parents Can Do

Parents, you hold tremendous influence on whether your child decides to drink or not drink. Be clear to your teen that you disapprove of underage drinking. Talk about the dangers of drinking. Here are other things you can do:

  • If you choose to drink, model responsible drinking behavior.
    • Sometimes we unintentionally send kids the message that we need alcohol to cope with problems or have a good time. After a long, stressful day, instead of pouring yourself a glass of wine or beer, try modeling healthy behavior like deep breathing, exercise or stretching.
    • Research shows that a child with a parent who binge drinks is much more likely to binge drink than a child whose parents do not binge drink.
    • If you are struggling with a drug or alcohol problem, reach out for help.
  • Do not make alcohol available to your child.
  • Be actively involved in your child’s life and have regular conversations with your teen about what’s going on and how she/he is feeling.
  • Get to know your children’s friends – as well as their parents/caregivers.
  • Encourage your teen to participate in healthy and fun activities that do not involve alcohol. If your child seeks new challenges, guide them toward healthy risks.
  • Kids ages 11-14 see approximately 1,000 alcohol ads a year. Discuss what you see and help put context around the alcohol messaging your child receives from friends and the media.

Talk Often

The best thing you can do is communicate regularly with your teen. Here’s how:

  • Try to preserve a position of objectivity and openness. If you want to have a productive conversation with your teen, try to keep an open mind and remain curious and calm. That way, you child is more likely to be receptive to what you have to say.
  • Ask open-ended questions. These are questions that elicit more than just a “yes” or “no” response from your teen and will lead to a more engaging conversation.
  • Let your teen know you hear her. Use active listening and reflect back what you are hearing from your teen— either verbatim, or just the sentiment. For example, I’m hearing that you feel overwhelmed, and that you think drinking helps you relax. Is that right?”
  • Discuss the negative effects of alcohol, and what that means in terms of mental and physical health, safety and making good decisions. Talk about the long-term effects.
  • If you’re child’s interested in drinking, ask her why – and what might happen if she does. This gets your teen to think about her future, what her boundaries are around drinking – and some of the possible negative consequences (she may be late to practice, do something stupid in front of her friends, feel hungover.) It will also give you insight into what is important to her.
  • Off empathy and compassion. Let your child know you understand. The teen years can be tough. Acknowledge that everyone struggles sometimes, but alcohol is not a useful or healthy way to cope with problems. Let your child know that he/she can trust you.
  • Remind your child that you are there for support and guidance – and that it’s important to you that she/he is healthy and happy and to makes safe choices.
  • If there is a history of addiction or alcoholism in your family, then your child has a much greater risk of developing a problem. As a parent you need to be aware of this elevated risk and discuss it with your child regularly, as you would with any disease. Learn more >
  • Is there a problem? Keep an eye on how your child is coping. Does he or she seem withdrawn or uninterested in the usual activities. These are signs that your child might be hiding something or need some guidance. If you are concerned about your child, call our toll-free parent helpline at 1-855-DRUGFREE (1-855-378-4373) to speak with a trained and caring specialist.

If You’re Throwing a Party:

  • Supervise all parties to make sure there is no alcohol – and make sure your teens know the rules ahead of time.
  • Set a start and end time for the party.
  • Make sure an adult is at home during the party and regularly checking in.

If Your Teen is Attending a Party:

  • Know where your child will be. Call the parents in advance to verify the occasion and location.
  • Indicate your expectations to your child and the parent hosting the party.
  • If the activity seems inappropriate, express concern and keep your child home.
  • Assure your child that they can call you to be picked up whenever needed.
  • Use this sample contract as a guide to establish rules about drugs and alcohol.

If you are worried about your child’s drinking or drug use, please call our toll-free parent helpline at 1-855-DRUGFREE (1-855-378-4373) to speak with a trained and caring specialist.

Wishing you and your family a safe and healthy Memorial Day weekend and summer.

Sources:

Related links:

  • #GotYourBack helps teens identify the signs of alcohol poisoning and empowers them to take action to help a friend – and even save a life. Learn more >
  • Shelby Allen’s life was tragically cut short by alcohol poisoning after a night of binge drinking. Read her  story >
  • AlcoholScreening.org helps people assess their drinking patterns to see if alcohol is harming their health. Visit alcoholscrening.org >
  • Police Chief Asks Parents to Face the Realities of Teen Drinking (The Washington Post) Learn more >
  • Find out how to have meaningful, productive conversations with your teen about marijuana. Visit our Marijuana Talk Kit >

The post Underage Drinking: What You Should Know appeared first on Partnership for Drug-Free Kids.

Categories: Bup Feeds

Major Depressive Disorder and Kappa Opioid Receptor Antagonists.

Buprenorphine Research (PubMed) - Tue, 05/24/2016 - 8:00am
Related Articles

Major Depressive Disorder and Kappa Opioid Receptor Antagonists.

Transl Perioper Pain Med. 2016;1(2):4-16

Authors: Li W, Sun H, Chen H, Yang X, Xiao L, Liu R, Shao L, Qiu Z

Abstract
Major depressive disorder (MDD) is a common psychiatric disease worldwide. The clinical use of tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs) and selective serotonin reuptake inhibitors (SSRIs)/serotonin-norepinephrine reuptake inhibitor (SNRIs) for this condition have been widely accepted, but they were challenged by unacceptable side-effects, potential drug-drug interactions (DDIs) or slow onset/lack of efficacy. The endogenous opioid system is involved in stress and emotion regulatory processes and its role in MDD has been implicated. Although several KOR antagonists including JDTic and PF-04455242 were discontinued in early clinical trials, ALKS 5461 and CERC-501(LY-2456302) survived and entered into Phase-III and Phase-II trials, respectively. Considering the efficacy and safety of early off-label use of buprenorphine in the management of the treatment-resistant depression (TRD), it will be not surprising to predict the potential success of ALKS 5461 (a combination of buprenorphine and ALKS-33) in the near future. Moreover, CERC-501 will be expected to be available as monotherapy or adjuvant therapy with other first-line antidepressants in the treatment of TRD, if ongoing clinical trials continue to provide positive benefit-risk profiles. Emerging new researches might bring more drug candidates targeting the endogenous opioid system to clinical trials to address current challenges in MDD treatment in clinical practice.

PMID: 27213169 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Patients' Beliefs About Medications are Associated with Stated Preference for Methadone, Buprenorphine, Naltrexone, or no Medication-Assisted Therapy Following Inpatient Opioid Detoxification.

Buprenorphine Research (PubMed) - Tue, 05/24/2016 - 8:00am
Related Articles

Patients' Beliefs About Medications are Associated with Stated Preference for Methadone, Buprenorphine, Naltrexone, or no Medication-Assisted Therapy Following Inpatient Opioid Detoxification.

J Subst Abuse Treat. 2016 Jul;66:48-53

Authors: Uebelacker LA, Bailey G, Herman D, Anderson B, Stein M

Abstract
Subsequent to initial opioid detoxification, people with opioid use disorder are typically advised to engage in follow-up treatment to prevent relapse. Medication-assisted treatments (MATs) - i.e., the opioid agonist methadone (MMT) or partial agonist/antagonist, buprenorphine/naltrexone (BUP) -- are the maintenance treatment options with the best research support for positive outcomes. A third MAT, injectable extended-release naltrexone (XR-NTX), was approved by the FDA for opioid dependence in 2010 and shows promise. However, relatively few eligible patients choose to initiate one of these MATs following initial detoxification treatment. Consistent with the health belief model, we hypothesized that beliefs about 1) efficacy of each MAT; 2) safety of each MAT; and 3) perceived consistency with being drug-free would predict stated patient preferences for a particular MAT or for no MAT. We also hypothesized that perceived structural barriers (e.g., time, transportation) would decrease the likelihood of stating a preference for a given MAT. To assess these hypotheses, we surveyed 372 people undergoing inpatient opioid detoxification treatment. Results supported hypotheses for all 3 sets of patient beliefs, with the patient group stating that they preferred a particular MAT having significantly more positive beliefs about that MAT relative to other groups (p<.001). The group that preferred "no MAT" had the most negative beliefs about all MATs. Perceived structural barriers were not related to stated preferences, except that people who preferred BUP were more likely to endorse barriers to MMT than any of the other 3 groups. Notably, a relatively high proportion (32%) of participants were most interested in XR-NTX despite a lack of prior experience with this medication. These results suggest that efforts to increase MAT enrollment following detoxification might benefit from including patient beliefs as one set of factors to assess and target for change.

PMID: 27211996 [PubMed - in process]

Categories: Bup Feeds

The Future of Opioid Agonist Therapies in Ukraine: A Qualitative Assessment of Multilevel Barriers and Ways Forward to Promote Retention in Treatment.

Buprenorphine Research (PubMed) - Tue, 05/24/2016 - 8:00am
Related Articles

The Future of Opioid Agonist Therapies in Ukraine: A Qualitative Assessment of Multilevel Barriers and Ways Forward to Promote Retention in Treatment.

J Subst Abuse Treat. 2016 Jul;66:37-47

Authors: Bojko MJ, Mazhnaya A, Marcus R, Makarenko I, Islam Z, Filippovych S, Dvoriak S, Altice FL

Abstract
Opioid agonist therapies (OAT) to treat opioid addiction in people who inject drugs (PWID) began in Ukraine in 2004. Scale-up of OAT, however, has been hampered by both low enrollment and high attrition. To better understand the factors influencing OAT retention among PWID in Ukraine, qualitative data from 199 PWIDs were collected during 25 focus groups conducted in five Ukrainian cities from February to April 2013. The experiences of PWID who were currently or previously on OAT or currently trying to access OAT were analyzed to identify entry and retention barriers encountered. Transcribed data were analyzed using a grounded theory approach. Individual beliefs about OAT, particularly misaligned treatment goals between clients and providers, influenced PWID's treatment seeking behaviors. Multiple programmatic and structural issues, including inconvenient hours and treatment site locations, complicated dosing regimens, inflexible medication dispensing guidelines, and mistreatment by clinic and medical staff also strongly influenced OAT retention. Findings suggest the need for both programmatic and policy-level structural changes such as revising legal regulations covering OAT dispensing, formalizing prescription dosing policies and making OAT more available through other sites, including primary care settings as a way to improve treatment retention. Quality improvement interventions that target treatment settings could also be deployed to overcome healthcare delivery barriers. Additional patient education and medical professional development around establishing realistic treatment goals as well as community awareness campaigns that address the myths and fears associated with OAT can be leveraged to overcome individual, family and community-level barriers.

PMID: 27211995 [PubMed - in process]

Categories: Bup Feeds

Access to Addiction Pharmacotherapy in Private Health Plans.

Buprenorphine Research (PubMed) - Tue, 05/24/2016 - 8:00am
Related Articles

Access to Addiction Pharmacotherapy in Private Health Plans.

J Subst Abuse Treat. 2016 Jul;66:23-9

Authors: Reif S, Horgan CM, Hodgkin D, Matteucci AM, Creedon TB, Stewart MT

Abstract
BACKGROUND: An increasing number of medications are available to treat addictions. To understand access to addiction medications, it is essential to consider the role of private health plans. To contain medication expenditures, most U.S. health plans use cost-sharing and administrative controls, which may impact physicians' prescribing and patients' use of addiction medications. This study identified health plan approaches to manage access to and utilization of addiction medications (oral and injectable naltrexone, acamprosate, and buprenorphine).
METHODS: Data are from a nationally representative survey of private health plans in 2010 (n=385 plans, 935 products; response rate 89%), compared to the same survey in 2003. The study assessed formulary inclusion, prior authorization, step therapy, overall restrictiveness, and if and how health plans encourage pharmacotherapy.
RESULTS: Formulary exclusions were rare in 2010, with acamprosate excluded most often, by only 9% of products. Injectable naltrexone was covered by 96% of products. Prior authorization was common for injectable naltrexone (85%) and rare for acamprosate (3%). Step therapy policies were used only for injectable naltrexone (41%) and acamprosate (20%). Several medications were often on the most expensive tier. Changes since 2003 include fewer exclusions, yet increased use of other management approaches. Most health plans encourage use of addiction pharmacotherapy, and use a variety of methods to do so.
CONCLUSIONS: Management of addiction medications has increased over time but it is not ubiquitous. However, health plans now also include all medications on formularies and encourage providers to use them, indicating that they value addiction pharmacotherapy as an evidence-based practice.

PMID: 27211993 [PubMed - in process]

Categories: Bup Feeds

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