Bup Feeds

Randomised Comparison of a Novel Buprenorphine Oral Lyophilisate versus Existing Buprenorphine Sublingual Tablets in Opioid-Dependent Patients: A First-in-Patient Phase II Randomised Open Label Safety Study.

Wed, 03/08/2017 - 6:10am

Randomised Comparison of a Novel Buprenorphine Oral Lyophilisate versus Existing Buprenorphine Sublingual Tablets in Opioid-Dependent Patients: A First-in-Patient Phase II Randomised Open Label Safety Study.

Eur Addict Res. 2017 Mar 08;23(2):61-70

Authors: Strang J, Reed K, Bogdanowicz K, Bell J, van der Waal R, Keen J, Beavan P, Baillie S, Knight A

Abstract
AIMS: To test the safety of new buprenorphine oral lyophilisate wafer ("bup-lyo") versus standard sub-lingual buprenorphine ("bup-SL").
DESIGN: Randomised (2:1) open-label study; opioid-dependent subjects; subsequent partial cross-over.
SETTINGS: Specialised clinical trials facility and addictions treatment facility.
PARTICIPANTS: Opioid-dependent subjects (n = 36) commencing buprenorphine maintenance (personalised dose-titration) including patients co-using alcohol, cocaine and benzodiazepines (below thresholds).
MEASUREMENTS: Respiratory function (respiratory rate, pulse-oximetry); medication hold and dose adequacy; opiate withdrawal signs and symptoms; tablet disintegration times; treatment retention. Pharmacokinetics (PK) for plasma buprenorphine and norbuprenorphine (n = 11).
FINDINGS: Oral lyophilised buprenorphine ("bup-lyo") completely dissolved within 2 min for 58 vs. 5% for "bup-SL." Dose titration resulted in similar maintenance dosing (10.8 vs. 9.6 mg). There were no significant between-group differences in opiate-withdrawal phenomena, craving, adequacy of "hold," respiratory function. No serious adverse events (AEs), nor "severe" AEs, although more AEs and Treatment-Emergent AEs with "bup-lyo" (mostly "mild"). PK found greater bioavailability of buprenorphine with "bup-lyo" (but not norbuprenorphine).
CONCLUSIONS: Orally disintegrating buprenorphine oral lyophilisate wafer disintegrated rapidly. No increased respiratory depression was found and clinically no difference between medications was observed. PK found substantially increased bioavailability of buprenorphine (but not of nor-buprenorphine) with "bup-lyo" relative to "bup-SL." In supervised dosing contexts, rapidly disintegrating formulations may enable wider buprenorphine prescribing.

PMID: 28268215 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Buprenorphine-related complications in elderly hospitalised patients: a case series.

Wed, 03/08/2017 - 6:10am

Buprenorphine-related complications in elderly hospitalised patients: a case series.

Anaesth Intensive Care. 2017 Mar;45(2):256-261

Authors: Richards S, Torre L, Lawther B

Abstract
We report a case series of buprenorphine-related respiratory and neurological depression in opioid-naïve elderly hospitalised patients who received buprenorphine for acute pain management at our institution over a 24-month period. All six patients had risk factors for respiratory depression such as advanced age, concurrent comorbidities, or the ingestion of other potential central nervous system depressants. All patients required escalation of management with additional monitoring, with some transferred to a high dependency or intensive care unit. Five patients had attempted naloxone reversal with varying results. Our cases highlight the fact that while buprenorphine has been demonstrated to have a ceiling effect in relation to respiratory depression in healthy volunteers, it remains an important side-effect and may result in significant respiratory depression in patients with reduced respiratory or neurological reserve. Difficulties with buprenorphine's reversal using naloxone are described. We recommend additional caution when considering buprenorphine for acute pain management in elderly opioid-naïve patients, especially if they have comorbidities or are taking other central nervous system depressants. When buprenorphine is used in patients with risk factors, we recommend additional monitoring and education about potential adverse respiratory effects and their management.

PMID: 28267949 [PubMed - in process]

Categories: Bup Feeds

Buprenorphine for the management of acute pain.

Wed, 03/08/2017 - 6:10am

Buprenorphine for the management of acute pain.

Anaesth Intensive Care. 2017 Mar;45(2):143-146

Authors: Macintyre PE, Huxtable CA

PMID: 28267934 [PubMed - in process]

Categories: Bup Feeds

Opioid Agonist Treatment for Patients With Dependence on Prescription Opioids.

Wed, 03/08/2017 - 6:10am

Opioid Agonist Treatment for Patients With Dependence on Prescription Opioids.

JAMA. 2017 Mar 07;317(9):967-968

Authors: Nielsen S, Larance B, Lintzeris N

Abstract
Clinical Question: Are different opioid agonist treatments (eg, methadone vs buprenorphine) associated with differences in efficacy for treating prescription opioid dependence, and is long-term maintenance of opioid agonist treatment associated with differences in efficacy compared with opioid taper or psychological treatments alone?
Bottom Line: For patients who are dependent on prescription opioids, long-term maintenance of opioid agonists is associated with less prescription opioid use and better adherence to medication and psychological therapies for opioid dependence compared with opioid taper or psychological treatments alone. Methadone maintenance was not associated with differences in therapeutic efficacy compared with buprenorphine maintenance treatment. Evidence quality was low to moderate.

PMID: 28267837 [PubMed - in process]

Categories: Bup Feeds

Identifying Drug-Drug Interactions by Data Mining: A Pilot Study of Warfarin-Associated Drug Interactions.

Tue, 03/07/2017 - 8:22am
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Identifying Drug-Drug Interactions by Data Mining: A Pilot Study of Warfarin-Associated Drug Interactions.

Circ Cardiovasc Qual Outcomes. 2016 Nov;9(6):621-628

Authors: Hansen PW, Clemmensen L, Sehested TS, Fosbøl EL, Torp-Pedersen C, Køber L, Gislason GH, Andersson C

Abstract
BACKGROUND: Knowledge about drug-drug interactions commonly arises from preclinical trials, from adverse drug reports, or based on knowledge of mechanisms of action. Our aim was to investigate whether drug-drug interactions were discoverable without prior hypotheses using data mining. We focused on warfarin-drug interactions as the prototype.
METHODS AND RESULTS: We analyzed altered prothrombin time (measured as international normalized ratio [INR]) after initiation of a novel prescription in previously INR-stable warfarin-treated patients with nonvalvular atrial fibrillation. Data sets were retrieved from clinical work. Random forest (a machine-learning method) was set up to predict altered INR levels after novel prescriptions. The most important drug groups from the analysis were further investigated using logistic regression in a new data set. Two hundred and twenty drug groups were analyzed in 61 190 novel prescriptions. We rediscovered 2 drug groups having known interactions (β-lactamase-resistant penicillins [dicloxacillin] and carboxamide derivatives) and 3 antithrombotic/anticoagulant agents (platelet aggregation inhibitors excluding heparin, direct thrombin inhibitors [dabigatran etexilate], and heparins) causing decreasing INR. Six drug groups with known interactions were rediscovered causing increasing INR (antiarrhythmics class III [amiodarone], other opioids [tramadol], glucocorticoids, triazole derivatives, and combinations of penicillins, including β-lactamase inhibitors) and two had a known interaction in a closely related drug group (oripavine derivatives [buprenorphine] and natural opium alkaloids). Antipropulsives had an unknown signal of increasing INR.
CONCLUSIONS: We were able to identify known warfarin-drug interactions without a prior hypothesis using clinical registries. Additionally, we discovered a few potentially novel interactions. This opens up for the use of data mining to discover unknown drug-drug interactions in cardiovascular medicine.

PMID: 28263937 [PubMed - in process]

Categories: Bup Feeds

Pharmacokinetic Considerations for Combining Antiretroviral Therapy, Direct-Acting Antiviral Agents for Hepatitis C Virus, and Addiction Treatment Medications.

Tue, 03/07/2017 - 8:22am
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Pharmacokinetic Considerations for Combining Antiretroviral Therapy, Direct-Acting Antiviral Agents for Hepatitis C Virus, and Addiction Treatment Medications.

Clin Pharmacol Drug Dev. 2017 Mar;6(2):135-139

Authors: Bednasz CJ, Venuto CS, Ma Q, Morse GD

Abstract
There are many factors that can affect the pharmacokinetics (PK) of drugs. Pathophysiological changes from disease states can alter the mechanisms that control the PK of antiretrovirals (ARVs), direct-acting antivirals (DAAs), and addiction treatment medications. Drug-drug interaction pathways of certain ARVs and DAAs can be very complex, with agents being substrates, inhibitors, or inducers of multiple metabolic and transporter pathways. Buprenorphine and methadone may be used in HIV- and hepatitis C virus (HCV)-infected patients and may also be affected by drug interactions. Current research is focused on novel PK analyses, which aim to describe the PK of agents within organs that host the infection of interest, such as within hepatocytes during treatment for HCV. Modeling techniques allow for the prediction of drug PK in specific organs and the plasma compartment. This review will provide a summary of these areas while exploring PK considerations for ARVs, DAAs, and addiction treatment medications.

PMID: 28263465 [PubMed - in process]

Categories: Bup Feeds

Ombitasvir/Paritaprevir/Ritonavir and Dasabuvir: Drug Interactions With Antiretroviral Agents and Drugs forSubstance Abuse.

Tue, 03/07/2017 - 8:22am
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Ombitasvir/Paritaprevir/Ritonavir and Dasabuvir: Drug Interactions With Antiretroviral Agents and Drugs forSubstance Abuse.

Clin Pharmacol Drug Dev. 2017 Mar;6(2):201-205

Authors: King JR, Menon RM

Abstract
AbbVie's 3 direct-acting antiviral (3D) regimen containing ombitasvir, paritaprevir, ritonavir, and dasabuvir with and without ribavirin is approved for the treatment of chronic hepatitis C virus (HCV) genotype 1 infection. Safe and efficacious antiviral regimens resulting in minimal to no drug-drug interactions (DDIs) with antiretrovirals are needed to ensure that patients coinfected with HCV and the human immunodeficiency virus (HIV) achieve 12-week sustained virologic response rates similar to HCV-monoinfected patients. Also, the prevalence of injection drug use history is high in both monoinfected and HIV/HCV-coinfected patients. This review summarizes results from phase 1 DDI studies of the 3D regimen and antiretrovirals or drugs to treat substance abuse. Data suggest the 3D regimen is a viable option for HIV/HCV-coinfected patients on antiretroviral therapy containing tenofovir/emtricitabine, abacavir/lamivudine, dolutegravir, raltegravir, or atazanavir. HCV-infected patients receiving medications for substance abuse, particularly methadone or buprenorphine/naloxone, can also be treated with the 3D regimen.

PMID: 28263457 [PubMed - in process]

Categories: Bup Feeds

Changes in substance use in patients receiving opioid substitution therapy and resulting clinical challenges: a 17-year treatment case register analysis.

Sun, 03/05/2017 - 9:42am
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Changes in substance use in patients receiving opioid substitution therapy and resulting clinical challenges: a 17-year treatment case register analysis.

Lancet Psychiatry. 2017 Feb 28;:

Authors: Herdener M, Dürsteler KM, Seifritz E, Nordt C

Abstract
BACKGROUND: Although the beneficial effects of opioid substitution for the reduction of heroin use are well established, its effect on other substance use is unclear. We aimed to evaluate short-term and long-term changes in substance use in opioid-dependent patients on opioid substitution therapy. We focused on frequent use of heroin, cocaine, benzodiazepines, and alcohol under naturalistic conditions (ie, with non-selected patients and clinical practice as usual) over 17 years.
METHODS: This was a treatment case register analysis. Data were obtained from the treatment case register of the canton of Zurich, Switzerland, which included information for 8962 patients (122 399 case report forms) who received substitution therapy with methadone or buprenorphine between 1998 and 2014. The main focus of our study was to evaluate long-term changes in frequent substance use of patients on opioid substitution therapy, together with the associations between individual, treatment, and environmental factors and substance use, including short-term changes at first treatment entry. Data were analysed using a generalised estimating equation that accounted for individual, treatment, and environmental factors. Frequent use was defined as substance use on at least 5 days per week.
FINDINGS: The most frequent use of heroin (odds ratio [OR] 5·30, 95% CI 4·63-6·08; p<0·0001), cocaine (2·30, 1·95-2·71; p<0·0001) and, to a lesser extent, benzodiazepines (1·34, 1·17-1·54; p<0·0001) and alcohol (1·21, 1·08-1·35; p=0·0007), was found in previously untreated individuals compared with patients already receiving treatment 6 months after starting opioid substitution therapy, corroborating a strong effect of initiating substitution therapy. Frequency of substance use was associated with the year of evaluation: frequent use of heroin (OR per decade 0·56, 0·52-0·60; p<0·0001) and cocaine (0·63, 0·58-0·68; p<0·0001) significantly decreased between 1998 and 2014, while frequent alcohol use increased (1·15, 1·08-1·23; p<0·0001). In 2014, frequent alcohol use was observed in 990 (22·5%) of 4400 patients on opioid substitution therapy.
INTERPRETATION: Frequent use of alcohol during opioid substitution therapy significantly increased during the observation period, whereas there was a decline in frequent use of heroin and cocaine. Given the high infection rates with hepatotoxic viruses and the increasing liver-related mortality rates in patients on opioid substitution therapy, these findings suggest that frequent alcohol use increasingly constitutes a therapeutic challenge in opioid substitution therapy.
FUNDING: None.

PMID: 28258833 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Medication-Assisted Treatment for Adolescents in Specialty Treatment for Opioid Use Disorder.

Sun, 03/05/2017 - 9:42am
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Medication-Assisted Treatment for Adolescents in Specialty Treatment for Opioid Use Disorder.

J Adolesc Health. 2017 Feb 28;:

Authors: Feder KA, Krawczyk N, Saloner B

Abstract
PURPOSE: The American Academy of Pediatrics recently recommended that pediatricians consider medication-assisted treatment (MAT) for adolescents with severe opioid use disorders. Little is known about adolescents' current use of MAT.
METHODS: We use data on episodes of specialty treatment for heroin or opioid use (n = 139,092) from a database of publicly funded treatment programs in the U.S. We compare the proportions of adolescents and adults who received MAT, first using unadjusted comparison of proportions, then using logistic regression to adjust for potential confounders.
RESULTS: Only 2.4% (95% confidence interval [CI], 1.4%-3.7%) of adolescents in treatment for heroin received MAT, as compared to 26.3% (95% CI, 26.0%-26.6%) of adults. Only .4% (95% CI, .2%-.7%) of adolescents in treatment for prescription opioids received MAT, as compared to 12.0% (95% CI, 11.7%-12.2%) of adults. Regression-adjusted results were qualitatively similar.
CONCLUSIONS: Regulatory changes and expansions of Medicaid/CHIP coverage for MAT may be needed to improve MAT access.

PMID: 28258807 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Nurse Practitioner Prescriptive Authority for Buprenorphine: From DATA 2000 to CARA 2016.

Fri, 03/03/2017 - 8:09am
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Nurse Practitioner Prescriptive Authority for Buprenorphine: From DATA 2000 to CARA 2016.

J Addict Nurs. 2017 Jan/Mar;28(1):43-48

Authors: Fornili KS, Fogger SA

Abstract
The aim of this Policy Watch column is to provide an update on a much anticipated legislation, enacted in 2016, which enabled office-based opioid treatment (OBOT) with buprenorphine prescribing for the treatment of opioid addiction by nurse practitioners (as well as physician assistants). First, an overview of the Drug Addiction Treatment Act of 2000, which only permitted OBOT prescribing by physicians, will be described. It will be followed by a summary of the Recovery Enhancement for Addiction Treatment Act of 2015-2016. Finally, a review of the Comprehensive Addiction Recovery Act of 2016 will be provided, which includes information about important changes to OBOT regulations that enable NP prescribing of buprenorphine for the treatment of opioid addiction.

PMID: 28252511 [PubMed - in process]

Categories: Bup Feeds

The CBHSQ Report

Fri, 03/03/2017 - 8:09am
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The CBHSQ Report

Book. 2013

Authors:

Abstract
Background: Opioid dependence during pregnancy is associated with increased risk of low birthweight, neonatal mortality, and maternal complications. Methadone or buprenorphine maintenance therapy can prevent the effects of repeated withdrawals on the fetus and improve outcomes for infants and mothers. Method: This report uses the combined 2007 to 2012 National Surveys on Drug Use and Health (NSDUHs), the 2012 Treatment Episode Data Set (TEDS), and the 2012 National Survey of Substance Abuse Treatment Services (N-SSATS) to examine opioid misuse and treatment among women of childbearing age (aged 15 to 44). Results: An annual average of 21,000 pregnant women aged 15 to 44 misused opioids in the past month. Among pregnant women aged 15 to 44, those who were younger and those living below the federal poverty level were more likely than other pregnant women to be past month opioid misusers. Of the pregnant female treatment admissions, 22.9 percent reported heroin use and 28.1 percent reported nonheroin opioid misuse. About half of pregnant female admissions with heroin use had methadone or buprenorphine as a part of their treatment plan compared with less than one-quarter of nonpregnant female admissions with heroin use. For female admissions aged 15 to 44 reporting nonheroin opioid misuse, rates for having methadone or buprenorphine as a part of their treatment plan were comparatively lower. About 13 percent of outpatient-only substance use treatment facilities and residential treatment facilities offered a special program or group for pregnant/postpartum women. Between 61 and 79 percent of facilities that offered specialized programs or groups to pregnant or postpartum women accepted Medicaid as a form of payment. Conclusion: The findings suggest that outreach and educational resources targeting younger pregnant women and women living below the federal poverty level about the dangers of misusing prescription pain relievers may be especially beneficial. The health insurance gap among pregnant treatment admissions suggests that these women may need assistance in navigating the health insurance and health service opportunities provided by the Affordable Care Act to ensure critical access to the health care system.


PMID: 28252898

Categories: Bup Feeds

Public sector low threshold office-based buprenorphine treatment: outcomes at year 7.

Thu, 03/02/2017 - 7:30am
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Public sector low threshold office-based buprenorphine treatment: outcomes at year 7.

Addict Sci Clin Pract. 2017 Feb 28;12(1):7

Authors: Bhatraju EP, Grossman E, Tofighi B, McNeely J, DiRocco D, Flannery M, Garment A, Goldfeld K, Gourevitch MN, Lee JD

Abstract
BACKGROUND: Buprenorphine maintenance for opioid dependence remains of limited availability among underserved populations, despite increases in US opioid misuse and overdose deaths. Low threshold primary care treatment models including the use of unobserved, "home," buprenorphine induction may simplify initiation of care and improve access. Unobserved induction and long-term treatment outcomes have not been reported recently among large, naturalistic cohorts treated in low threshold safety net primary care settings.
METHODS: This prospective clinical registry cohort design estimated rates of induction-related adverse events, treatment retention, and urine opioid results for opioid dependent adults offered buprenorphine maintenance in a New York City public hospital primary care office-based practice from 2006 to 2013. This clinic relied on typical ambulatory care individual provider-patient visits, prescribed unobserved induction exclusively, saw patients no more than weekly, and did not require additional psychosocial treatment. Unobserved induction consisted of an in-person screening and diagnostic visit followed by a 1-week buprenorphine written prescription, with pamphlet, and telephone support. Primary outcomes analyzed were rates of induction-related adverse events (AE), week 1 drop-out, and long-term treatment retention. Factors associated with treatment retention were examined using a Cox proportional hazard model among inductions and all patients. Secondary outcomes included overall clinic retention, buprenorphine dosages, and urine sample results.
RESULTS: Of the 485 total patients in our registry, 306 were inducted, and 179 were transfers already on buprenorphine. Post-induction (n = 306), week 1 drop-out was 17%. Rates of any induction-related AE were 12%; serious adverse events, 0%; precipitated withdrawal, 3%; prolonged withdrawal, 4%. Treatment retention was a median 38 weeks (range 0-320) for inductions, compared to 110 (0-354) weeks for transfers and 57 for the entire clinic population. Older age, later years of first clinic visit (vs. 2006-2007), and baseline heroin abstinence were associated with increased treatment retention overall.
CONCLUSIONS: Unobserved "home" buprenorphine induction in a public sector primary care setting appeared a feasible and safe clinical practice. Post-induction treatment retention of a median 38 weeks was in line with previous naturalistic studies of real-world office-based opioid treatment. Low threshold treatment protocols, as compared to national guidelines, may compliment recently increased prescriber patient limits and expand access to buprenorphine among public sector opioid use disorder patients.

PMID: 28245872 [PubMed - in process]

Categories: Bup Feeds

Capsule Commentary on D&#039;Onofrio et al., Emergency Department-Initiated Buprenorphine for Opioid Dependence with Continuation in Primary Care: Outcomes During and After Intervention.

Wed, 03/01/2017 - 6:38am
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Capsule Commentary on D'Onofrio et al., Emergency Department-Initiated Buprenorphine for Opioid Dependence with Continuation in Primary Care: Outcomes During and After Intervention.

J Gen Intern Med. 2017 Feb 27;:

Authors: Murimi IB

PMID: 28243878 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Primary healthcare-based integrated care with opioid agonist treatment: First experience from Ukraine.

Wed, 03/01/2017 - 6:38am
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Primary healthcare-based integrated care with opioid agonist treatment: First experience from Ukraine.

Drug Alcohol Depend. 2017 Feb 21;173:132-138

Authors: Morozova O, Dvoriak S, Pykalo I, Altice FL

Abstract
BACKGROUND: Ukraine's HIV epidemic is concentrated among people who inject drugs (PWID), however, coverage with opioid agonist therapies (OATs) available mostly at specialty addiction clinics is extremely low. OAT integrated into primary healthcare clinics (PHCs) provides an opportunity for integrating comprehensive healthcare services and scaling up OAT.
METHODS: A pilot study of PHC-based integrated care for drug users conducted in two Ukrainian cities between 2014 and 2016 included three sub-studies: 1) cross-sectional treatment site preference assessment among current OAT patients (N=755); 2) observational cohort of 107 PWID who continued the standard of care versus transition of stabilized and newly enrolled PWID into PHC-based integrated care; and 3) pre/post analysis of attitudes toward PWID and HIV patients by PHC staff (N=26).
RESULTS: Among 755 OAT patients, 53.5% preferred receiving OAT at PHCs, which was independently correlated with convenience, trust in physician, and treatment with methadone (vs. buprenorphine). In 107 PWID observed over 6 months, retention in treatment was high: 89% in PWID continuing OAT in specialty addiction treatment settings (standard of care) vs 94% in PWID transitioning to PHCs; and 80% among PWID newly initiating OAT in PHCs. Overall, satisfaction with treatment, subjective self-perception of well-being, and trust in physician significantly increased in patients prescribed OAT in PHCs. Among PHC staff, attitudes towards PWID and HIV patients significantly improved over time.
CONCLUSIONS: OAT can be successfully integrated into primary care in low and middle-income countries and improves outcomes in both patients and clinicians while potentially scaling-up OAT for PWID.

PMID: 28242537 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Thermal antinociception following oral administration of tapentadol in conscious cats.

Wed, 03/01/2017 - 6:38am
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Thermal antinociception following oral administration of tapentadol in conscious cats.

Vet Anaesth Analg. 2017 Jan 07;:

Authors: Doodnaught GM, Evangelista MC, Steagall PV

Abstract
OBJECTIVE: To evaluate the onset, magnitude and duration of thermal antinociception after oral administration of two doses of tapentadol in cats.
STUDY DESIGN: Prospective, randomized, blinded, experimental study.
ANIMALS: Six healthy adult cats weighing 4.4 ± 0.4 kg.
METHODS: Skin temperature (ST) and thermal threshold (TT) were evaluated using a wireless TT device up to 12 hours after treatment. Treatments included placebo (PBO, 50 mg dextrose anhydrase orally), buprenorphine (BUP, 0.02 mg kg(-1)) administered intramuscularly, low-dose tapentadol (LowTAP, 25 mg orally; mean 5.7 mg kg(-)(1)) and high-dose tapentadol (HighTAP, 50 mg orally; mean 11.4 mg kg(-)(1)) in a blinded crossover design with 7 day intervals. Statistical analysis was performed using anova with appropriate post hoc test (p ≤ 0.05).
RESULTS: Salivation was observed immediately following 11 out of 12 treatments with tapentadol. The ST was significantly increased at various time points in the opioid treatments. Hyperthermia (≥ 39.5 °C) was not observed. Baseline TT was 45.4 ± 1.4 °C for all treatments. Maximum TT values were 48.8 ± 4.8 °C at 1 hour in LowTAP, 48.5 ± 3.0 °C at 2 hours in HighTAP and 50.2 ± 5.3 °C at 1 hour in BUP. TT significantly increased after LowTAP at 1 hour, after HighTAP at 1-2 hours, and after BUP at 1-2 hours compared with baseline values. TTs were significantly increased in BUP at 1-2 hours compared with PBO.
CONCLUSION AND CLINICAL RELEVANCE: Oral administration of tapentadol increased ST and TT in cats. The durations of thermal antinociception were similar between HighTAP and BUP, both of which were twice as long as that in LowTAP. Studies of different formulations may be necessary before tapentadol can be accepted into feline practice.

PMID: 28242230 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Changes over time in prescription practices of pain medications in Switzerland between 2006 and 2013: an analysis of insurance claims.

Wed, 03/01/2017 - 6:38am
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Changes over time in prescription practices of pain medications in Switzerland between 2006 and 2013: an analysis of insurance claims.

BMC Health Serv Res. 2017 Feb 27;17(1):167

Authors: Wertli MM, Reich O, Signorell A, Burgstaller JM, Steurer J, Held U

Abstract
BACKGROUND: In Europe, scant information is available about prescription practices for pain medications. The aim of this research was to assess changes in prescription rates of non-opioid, weak opioid, and strong opioid medications between 2006 and 2013 in the Swiss population.
METHODS: Using insurance claims data covering one-sixth of the Swiss population, we analyzed the numbers of reimbursed pain medications, the number of reimbursements per persons, and the cumulative dose in milligrams. For opioids, the morphine equivalent dose and treatment days were calculated. Data were extrapolated to the dose per day per 100'000 population stratified by age, gender, and canton.
RESULTS: In total, 4'746'942 paracetamol, 2'156'620 NSAIDs or Coxibs, 931'129 metamizole, 1'322'272 weak opioid, and 807'835 strong opioid claims were analyzed. Between 2006 and 2013, the increase in claims per 100'000 persons was 32% for paracetamol, 242% for metamizole, 107% for NSAIDS, 86% for Coxibs, 13% for weak opioids, and 121% for strong opioids. For strong opioids the total MED in mg /100'000 increased by 117%, the treatment days /100'000 by 101%. For strong opioids, fentanyl was most frequently used (increase between 2006 and 2013 by 91% for MED/100'000 persons and 94% treatment days / 100'000) followed by buprenorphine and oxycodone. The highest proportional increase in MED / 100'000 was observed for methadone (+1414%) and oxycodone (+313%). Marked geographical variation was detected in the use of metamizole, paracetamole, and strong opioids in different cantons.
CONCLUSION: The analysis of insurance claims data provides evidence that the prescription rates for pain medications increased in Switzerland within the last ten years, in particular for metamizole and strong opioids. Furthermore, the prescription rates for metamizole, paracetamol, and strong opioids varied substantially between different cantons in Switzerland.

PMID: 28241764 [PubMed - in process]

Categories: Bup Feeds

Pharmacokinetics and pharmacodynamics of buprenorphine and sustained-release buprenorphine after administration to adult alpacas.

Tue, 02/28/2017 - 6:29am

Pharmacokinetics and pharmacodynamics of buprenorphine and sustained-release buprenorphine after administration to adult alpacas.

Am J Vet Res. 2017 Mar;78(3):321-329

Authors: Dooley SB, Aarnes TK, Lakritz J, Lerche P, Bednarski RM, Hubbell JA

Abstract
OBJECTIVE To determine pharmacokinetics and pharmacodynamics of buprenorphine after IV and SC administration and of sustained-release (SR) buprenorphine after SC administration to adult alpacas. ANIMALS 6 alpacas. PROCEDURES Buprenorphine (0.02 mg/kg, IV and SC) and SR buprenorphine (0.12 mg/kg, SC) were administered to each alpaca, with a 14-day washout period between administrations. Twenty-one venous blood samples were collected over 96 hours and used to determine plasma concentrations of buprenorphine. Pharmacokinetic parameters were calculated by use of noncompartmental analysis. Pharmacodynamic parameters were assessed via sedation, heart and respiratory rates, and thermal and mechanical antinociception indices. RESULTS Mean ± SD maximum concentration after IV and SC administration of buprenorphine were 11.60 ± 4.50 ng/mL and 1.95 ± 0.80 ng/mL, respectively. Mean clearance was 3.00 ± 0.33 L/h/kg, and steady-state volume of distribution after IV administration was 3.8 ± l.0 L/kg. Terminal elimination half-life was 1.0 ± 0.2 hours and 2.7 ± 2.8 hours after IV and SC administration, respectively. Mean residence time was 1.3 ± 0.3 hours and 3.6 ± 3.7 hours after IV and SC administration, respectively. Bioavailability was 64 ± 28%. Plasma concentrations after SC administration of SR buprenorphine were below the LLOQ in samples from 4 alpacas. There were no significant changes in pharmacodynamic parameters after buprenorphine administration. Alpacas exhibited mild behavioral changes after all treatments. CONCLUSIONS AND CLINICAL RELEVANCE Buprenorphine administration to healthy alpacas resulted in moderate bioavailability, rapid clearance, and a short half-life. Plasma concentrations were detectable in only 2 alpacas after SC administration of SR buprenorphine.

PMID: 28240955 [PubMed - in process]

Categories: Bup Feeds

Intravenous Buprenorphine: A Substitute for Naloxone in Methadone-Overdosed Patients?

Mon, 02/27/2017 - 8:46am

Intravenous Buprenorphine: A Substitute for Naloxone in Methadone-Overdosed Patients?

Ann Emerg Med. 2017 Feb 23;:

Authors: Zamani N, Hassanian-Moghaddam H

Abstract
Administration of naloxone is a common treatment for opioid-dependent patients who present with respiratory depression. Although safe in opioid-naive patients, naloxone may cause severe and even life-threatening complications in opioid-dependent patients, including acute respiratory distress syndrome and myocardial infarction. It has been suggested that administration of buprenorphine, a partial μ-opioid receptor agonist, to an opioid-intoxicated patient may result in reversal of respiratory depression with less severe withdrawal signs and symptoms. In addition, the longer half-life of buprenorphine compared with naloxone may reduce the need for repetitive administration of antidote. We present a 20-year-old morphine-addicted man who presented with methadone-induced respiratory depression and responded safely and effectively to intravenous administration of buprenorphine. Buprenorphine may be a useful alternative opioid reversal agent for opioid-dependent patients.

PMID: 28237362 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Retention in buprenorphine treatment is associated with improved HCV care outcomes.

Mon, 02/27/2017 - 8:46am

Retention in buprenorphine treatment is associated with improved HCV care outcomes.

J Subst Abuse Treat. 2017 Apr;75:38-42

Authors: Norton BL, Beitin A, Glenn M, DeLuca J, Litwin AH, Cunningham CO

Abstract
Persons who inject drugs, most of whom are opioid dependent, comprise the majority of the HCV infected in the United States. As the national opioid epidemic unfolds, increasing numbers of people are entering the medical system to access treatment for opioid use disorder, specifically with buprenorphine. Yet little is known about HCV care in patients accessing buprenorphine-based opioid treatment. We sought to determine the HCV prevalence, cascade of care, and the association between patient characteristics and completion of HCV cascade of care milestones for patients initiating buprenorphine treatment. We reviewed electronic health records of all patients who initiated buprenorphine treatment at a primary-care clinic in the Bronx, NY between January 2009 and January 2014. Of the 390 patients who initiated buprenorphine treatment, 123 were confirmed to have chronic HCV infection. The only patient characteristic associated with achieving HCV care milestones was retention in opioid treatment. Patients retained (vs. not retained) in buprenorphine treatment were more likely to be referred for HCV specialty care (63.1% vs. 34.0%, p<0.01), achieve an HCV-specific evaluation (40.8% vs. 21.3%, p<0.05), be offered HCV treatment (22.4% vs. 8.5%, p<0.05), and initiate HCV treatment (9.2% vs. 6.4%, p=0.6). Given the current opioid epidemic in the US and the growing number of people receiving buprenorphine treatment, there is an unprecedented opportunity to access and treat persons with HCV, reducing HCV transmission, morbidity and mortality. Retention in opioid treatment may improve linkage and retention in HCV care; innovative models of care that integrate opioid drug treatment with HCV treatment are essential.

PMID: 28237052 [PubMed - in process]

Categories: Bup Feeds

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