Analgesic Activity of Tramadol and Buprenorphine after Voluntary Ingestion by Rats (Rattus norvegicus).

Buprenorphine Research (PubMed) - Fri, 01/29/2016 - 8:30am
Related Articles

Analgesic Activity of Tramadol and Buprenorphine after Voluntary Ingestion by Rats (Rattus norvegicus).

J Am Assoc Lab Anim Sci. 2016;55(1):74-82

Authors: Taylor BF, Ramirez HE, Battles AH, Andrutis KA, Neubert JK

Abstract
Effective pain management for rats and mice is crucial due to the continuing increase in the use of these species in biomedical research. Here we used a recently validated operant orofacial pain assay to determine dose-response curves for buprenorphine and tramadol when mixed in nut paste and administered to male and female rats. Statistically significant analgesic doses of tramadol in nut paste included doses of 20, 30, and 40 mg/kg for female rats but only 40 mg/kg for male rats. For male rats receiving buprenorphine mixed in nut paste, a significant analgesic response was observed at 0.5 and 0.6 mg/kg. None of the doses tested produced a significant analgesic response in female rats. Our results indicate that at the doses tested, tramadol and buprenorphine produced an analgesic response in male rats. In female rats, tramadol shows a higher analgesic effect than buprenorphine. The analgesic effects observed 60 min after administration of the statistically significant oral doses of both drugs were similar to the analgesic effects of 0.03 mg/kg subcutaneous buprenorphine 30 min after administration. The method of voluntary ingestion could be effective, is easy to use, and would minimize stress to the rats during the immediate postoperative period.

PMID: 26817983 [PubMed - in process]

Categories: Bup Feeds

Efficacy of Sustained-Release Buprenorphine in an Experimental Laparotomy Model in Female Mice.

Buprenorphine Research (PubMed) - Fri, 01/29/2016 - 8:30am
Related Articles

Efficacy of Sustained-Release Buprenorphine in an Experimental Laparotomy Model in Female Mice.

J Am Assoc Lab Anim Sci. 2016;55(1):66-73

Authors: Kendall LV, Wegenast DJ, Smith BJ, Dorsey KM, Kang S, Lee NY, Hess AM

Abstract
Mice purportedly require dosing with the opioid buprenorphine (Bup-HCl) at least every 8 to 12 h to maintain an adequate plane of analgesia. Here we used an experimental laparotomy model to determine the clinical efficacy of sustained-release formulations of buprenorphine (Bup-SR) after surgery in mice. Female CD1 mice underwent laparotomy and received either Bup-SR (0.6 mg/kg), Bup-HCl (0.1 mg/kg every 12 h), or saline (every 12 h). Pain was assessed at 1, 3, 6, 12, 24, 48, and 72 h according to the frequency of several behaviors (general activity, wheel-running activity, rearing, grooming, wound licking, orbital tightening, and percentage of integrated nest material) and daily body weight. Over time, wheel running was increased and wound licking was decreased in Bup-SR-treated mice compared with Bup-HCl- and saline-treated mice. Compared with Bup-HCl- and saline-treated mice, Bup-SR-treated mice had increased general activity and percentage of integrated nest material and decreased orbital tightening for 1 to 6 h after surgery. The Bup-HCl- and saline-treated mice had similar general activity, orbital tightening scores, and wheel running activity. Rearing activity and body weight did not differ throughout the study, and none of the observed behaviors differed between groups at 24, 48, and 72 h after surgery. These results suggest that Bup-SR at 0.6 mg/kg provides adequate analgesia after laparotomy in mice and can be used as an alternative analgesic in this context. Furthermore, Bup-HCl at 0.1 mg/kg every 12 h may be inadequate in providing analgesia for abdominal procedures in mice.

PMID: 26817982 [PubMed - in process]

Categories: Bup Feeds

Comparison between Transdermal Buprenorphine and Transdermal Fentanyl for Postoperative Pain Relief after Major Abdominal Surgeries.

Buprenorphine Research (PubMed) - Thu, 01/28/2016 - 9:00am
Related Articles

Comparison between Transdermal Buprenorphine and Transdermal Fentanyl for Postoperative Pain Relief after Major Abdominal Surgeries.

J Clin Diagn Res. 2015 Dec;9(12):UC01-UC04

Authors: Arshad Z, Prakash R, Gautam S, Kumar S

Abstract
INTRODUCTION: Opioid is generally regarded as an important part of multimodal, perioperative analgesia, especially for moderate to severe pain. Amongst the various modes of delivery transdermal route has several potential benefits over oral and parentral administration. These include noninvasive dosing, better absorption and lack of first-pass metabolism. A transdermal drug delivery system provides steady and continuous drug delivery resulting in steady plasma concentration. Bolus dosing of systemic analgesic results in supra and sub therapeutic plasma resulting in toxic and sub analgesic plasma drug concentration. It also improves patient compliance.
MATERIALS AND METHODS: Sixty patients undergoing major abdominal surgery under GA were randomly divided in two groups (n=30). Group A received buprenorphine 10 mcg/h TDS and group B received 25 mcg/h fentanyl TDS, 6 hours prior to surgery. Patients were followed for three days for postoperative pain relief and adverse effects.
RESULTS: Baseline and demographic variables are comparable in both groups. The mean level of VAS was significantly lower in group B as compared to group A at Day 1, 2 and 3. The mean level of sedation score was significantly lower in Group B than Group A. Haemodynamic variables in both groups (SBP, DBP and HR), shows comparable values in both groups and no significant difference was observed. Five out of 30 (16.7%) patients in group A required single dose of rescue analgesic while 0 out of 30 patients (0.00%) in group B required rescue analgesic. This difference in rescue analgesic requirement in not quiet statistically significant (p-value 0.0522). Twenty percent patient in fentanyl group and 16.7% patients in buprenorphine group experienced some adverse effects. Nausea and vomiting were main side effects of the drugs. The incidence of nausea and vomiting were 6.7% and 10% in buprenorphine and fentanyl group respectively.
CONCLUSION: Fentanyl and buprenorphine TDS were effective and safe in controlling postoperative pain. Fentanyl is better than buprenorphine in this respect.

PMID: 26816973 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Buprenorphine, Clonidine, Dexamethasone, and Ropivacaine for Interscalene Nerve Blockade: A Prospective, Randomized, Blinded, Ropivacaine Dose-Response Study.

Buprenorphine Research (PubMed) - Thu, 01/28/2016 - 9:00am
Related Articles

Buprenorphine, Clonidine, Dexamethasone, and Ropivacaine for Interscalene Nerve Blockade: A Prospective, Randomized, Blinded, Ropivacaine Dose-Response Study.

Pain Med. 2015 Dec 14;

Authors: YaDeau JT, Gordon MA, Goytizolo EA, Lin Y, Fields KG, Goon AK, Holck G, Miu TW, Gulotta LV, Dines DM, Craig EV

Abstract
OBJECTIVE: . This study investigated interscalene block for shoulder arthroplasty with various ropivacaine concentrations in the presence of clonidine, dexamethasone, and buprenorphine. The goal was prolonged analgesia with minimal motor blockade.
DESIGN: . Prospective, double-blind, randomized controlled trial.
SETTING: . University-affiliated orthopedic hospital.
METHODS: . Patients (20/group) received acetaminophen, ketorolac, pregabalin, opioids, and "Control"; interscalene block, 0.375% ropivacaine, intravenous additives (buprenorphine, clonidine, dexamethasone); "High Dose"; 0.375% ropivacaine, perineural additives; "Medium Dose"; 0.2% ropivacaine, perineural additives; and "Low Dose"; 0.1% ropivacaine, perineural additives.
RESULTS: . Pain with movement at 24 hours was 4.9 ± 2.5 (mean ± standard deviation [SD]) (Control), 4.5 ± 3.0 (High Dose), 3.4 ± 1.8 (Medium Dose), 4.2 ± 2.4 (Low Dose). The difference between Medium Dose and Control was -1.5 (95% CI: -2.9, -0.1) (P = 0.040). Median time until need for opioids was 16.1 hours (Control) vs 23.7 hours (High Dose); hazard ratio 0.37 [95% CI: 0.17, 0.79]. High Dose had less pain with movement the morning after surgery, vs Control; 2.9 ± 2.5 vs 4.9 ± 2.7; P = 0.027. Pain with movement in the Post-Anesthesia Care Unit was higher in Low Dose, vs Control; 0.9 ± 1.4 vs 0 ± 0, P = 0.009. Low Dose had superior hand strength in the Post-Anesthesia Care Unit (mean ± SD of pre-operative strength: 44.0 ± 20.3%) compared to Control (27.5 ± 24.5%) (P = 0.031).
CONCLUSIONS: . For maximum pain reduction, combining perineural additives with ropivacaine 0.375% or 0.2% is suggested. To minimize motor blockade, perineural additives can be combined with ropivacaine, 0.1%.

PMID: 26814246 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Use of an Acetyl Derivative to Improve GC-MS Determination of Norbuprenorphine in the Presence of High Concentrations of Buprenorphine in Urine.

Buprenorphine Research (PubMed) - Wed, 01/27/2016 - 7:00am

Use of an Acetyl Derivative to Improve GC-MS Determination of Norbuprenorphine in the Presence of High Concentrations of Buprenorphine in Urine.

J Anal Toxicol. 2016 Jan 25;

Authors: Gervais JR, Hobbs GA

Abstract
Certain patients being treated with Suboxone™ or Subutex™ can exhibit very high buprenorphine and low norbuprenorphine concentrations in urine. Very high buprenorphine can interfere with buprenorphine-D4 used as an internal standard, causing errors in norbuprenorphine determination by gas chromatography-mass spectrometry (GC-MS). We used a modified method of Wu et al. to introduce norbuprenorphine-D3 as a separate internal standard for norbuprenorphine. This allowed us to accurately measure norbuprenorphine in neat urine specimens when buprenorphine is present in extremely high concentrations. Laboratories measuring buprenorphine and metabolite by GC-MS may face this problem if their clientele includes patients being treated with other medications that interfere with the cytochrome p450 CYP 3A4-mediated conversion of buprenorphine to norbuprenorphine.

PMID: 26811236 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Response to Letter From Ruan and Bumgarner: Breakthrough Pain Associated With a Reduction in Serum Buprenorphine Concentration During Dialysis.

Buprenorphine Research (PubMed) - Wed, 01/27/2016 - 7:00am

Response to Letter From Ruan and Bumgarner: Breakthrough Pain Associated With a Reduction in Serum Buprenorphine Concentration During Dialysis.

Clin Ther. 2016 Jan 22;

Authors: Reza Salili A, Müller D, Skendaj R, Taegtmeyer AB, Jehle AW

PMID: 26811185 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Low Rates of Adoption and Implementation of Rapid HIV Testing in Substance Use Disorder Treatment Programs.

Buprenorphine Research (PubMed) - Wed, 01/27/2016 - 7:00am

Low Rates of Adoption and Implementation of Rapid HIV Testing in Substance Use Disorder Treatment Programs.

J Subst Abuse Treat. 2015 Dec 28;

Authors: Frimpong JA, D'Aunno T, Helleringer S, Metsch LR

Abstract
INTRODUCTION: Rapid HIV testing (RHT) greatly increases the proportion of clients who learn their test results. However, existing studies have not examined the adoption and implementation of RHT in programs treating persons with substance use disorders, one of the population groups at higher risk for HIV infection.
METHODS: We examined 196 opioid treatment programs (OTPs) using data from the 2011 National Drug Abuse Treatment System Survey (NDATSS). We used logistic regressions to identify client and organizational characteristics of OTPs associated with availability of on-site RHT. We then used zero-inflated negative binomial regressions to measure the association between the availability of RHT on-site and the number of clients tested for HIV.
RESULTS: Only 31.6% of OTPs offered on-site rapid HIV testing to their clients. Rapid HIV testing was more commonly available on-site in larger, publicly owned and better-staffed OTPs. On the other hand, on-site rapid HIV testing was less common in OTPs that prescribed only buprenorphine as a method of opioid dependence treatment. The availability of rapid HIV testing on-site reduced the likelihood that an OTP did not test any of its clients during the prior year. But on-site availability rapid HIV testing was not otherwise associated with an increased number of clients tested for HIV at an OTP.
CONCLUSIONS: New strategies are needed to a) promote the adoption of rapid HIV testing on-site in substance use disorder treatment programs and b) encourage substance use disorder treatment providers to offer rapid HIV testing to their clients when it is available.

PMID: 26810130 [PubMed - as supplied by publisher]

Categories: Bup Feeds

A Systematic Review on the Use of Psychosocial Interventions in Conjunction With Medications for the Treatment of Opioid Addiction.

Buprenorphine Research (PubMed) - Tue, 01/26/2016 - 7:30am

A Systematic Review on the Use of Psychosocial Interventions in Conjunction With Medications for the Treatment of Opioid Addiction.

J Addict Med. 2016 Jan 19;

Authors: Dugosh K, Abraham A, Seymour B, McLoyd K, Chalk M, Festinger D

Abstract
Opioid use and overdose rates have risen to epidemic levels in the United States during the past decade. Fortunately, there are effective medications (ie, methadone, buprenorphine, and oral and injectable naltrexone) available for the treatment of opioid addiction. Each of these medications is approved for use in conjunction with psychosocial treatment; however, there is a dearth of empirical research on the optimal psychosocial interventions to use with these medications. In this systematic review, we outline and discuss the findings of 3 prominent prior reviews and 27 recent publications of empirical studies on this topic. The most widely studied psychosocial interventions examined in conjunction with medications for opioid addiction were contingency management and cognitive behavioral therapy, with the majority focusing on methadone treatment. The results generally support the efficacy of providing psychosocial interventions in combination with medications to treat opioid addictions, although the incremental utility varied across studies, outcomes, medications, and interventions. The review highlights significant gaps in the literature and provides areas for future research. Given the enormity of the current opioid problem in the United States, it is critical to gain a better understanding of the most effective ways to deliver psychosocial treatments in conjunction with these medications to improve the health and well-being of individuals suffering from opioid addiction.

PMID: 26808307 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Characteristics of veterans receiving buprenorphine vs. methadone for opioid use disorder nationally in the Veterans Health Administration.

Buprenorphine Research (PubMed) - Tue, 01/26/2016 - 7:30am

Characteristics of veterans receiving buprenorphine vs. methadone for opioid use disorder nationally in the Veterans Health Administration.

Drug Alcohol Depend. 2016 Jan 13;

Authors: Manhapra A, Quinones L, Rosenheck R

Abstract
BACKGROUND: The advent of buprenorphine as an alternative to methadone has dramatically shifted the landscape of opioid agonist therapy (OAT) for opioid use disorder (OUD). However, there is limited US national level data describing thedifferences between patients who are prescribed these two OAT options.
METHODS: From veterans with OUD diagnosis who used Veterans Health Administration services in 2012, we identified 3 mutually exclusive groups: those who received (1) buprenorphine only (n=5,670); (2) methadone only (n=6,252); or (3) both buprenorphine and methadone in the same year (n=2513). We calculated the bi-varate effect size differences (risk ratios and Cohen's d) forcharacteristics that differentiated these groups. Logistic regression analysis was then used to identify factors independently differentiating the groups.
RESULTS: Ten year increment in age (OR 0.67; 95% CI 0.64-0.70), urban residence (OR 0.26; 95% CI 0.25-0.33), and black race (OR 0.39; 95% CI 0.35-0.43) were strongly and negatively associated with odds of receiving buprenorphine compared to methadone, while medical and psychiatric comorbidities or receipt of other psychiatric medications did not demonstrate substantial differences between groups.
CONCLUSIONS: Differences between veterans receiving buprenorphine or methadone based OAT seems to be largely shaped by demographic characteristics rather than medical or psychiatric or service use characteristics. A clearer understanding of the reasons for racial differences could be helpful in assuring that black OUD patients are not denied the opportunity to receive buprenorphine if that is their preference.

PMID: 26804898 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Evaluation of the Pharmacokinetics of Single- and Multiple-Dose Buprenorphine Buccal Film in Healthy Volunteers.

Buprenorphine Research (PubMed) - Tue, 01/26/2016 - 7:30am

Evaluation of the Pharmacokinetics of Single- and Multiple-Dose Buprenorphine Buccal Film in Healthy Volunteers.

Clin Ther. 2016 Jan 21;

Authors: Bai SA, Xiang Q, Finn A

Abstract
PURPOSE: Buprenorphine, a partial μ-receptor agonist, is approved for the management of moderate to severe pain, but it has low oral bioavailability. Two open-label studies were performed to determine the pharmacokinetic profile of buprenorphine from buccal film formulations of buprenorphine.
METHODS: Both studies enrolled healthy volunteers, aged 18 to 55 years, who received concurrent oral naltrexone to reduce adverse events (AEs); subjects with a history or evidence of substance abuse or current use of any product affecting cytochrome P450 3A4 activity were excluded. The first study (n = 25) was a 5-period crossover trial with 4 single doses (75 and 300 and 300 and 1200 μg) of 2 formulations (F14 and F24) of buccal buprenorphine (BBUP) and a 300-μg intravenous dose of buprenorphine with a 7-day washout between periods. In the second study, each subject (n = 10) received 6 doses of 4 BBUP strengths (60, 120, 180, and 240 μg BID) in a dose-escalation design. Plasma concentrations of buprenorphine and norbuprenorphine were assayed, and pharmacokinetics were summarized with descriptive statistics and analyzed by using a linear mixed effects model (single-dose study). AEs were recorded.
FINDINGS: In the single-dose study, the 2 formulations exhibited comparable bioavailability of 46% to 51% that was independent of dose, with a single buprenorphine peak concentration from each BBUP dose occurring at 2.5 to 3 hours. The mean buprenorphine Cmax across the doses ranged from 0.17 ng/mL for the 75-µg dose to 1.43 ng/mL for the 1200-µg dose. AUC0-∞, AUC0-last, and Cmax were proportional to the dose of BBUP administered. Cmax of norbuprenorphine after BBUP administration was approximately one tenth that of buprenorphine Cmax. In the multiple-dose study, steady state was reached within 3 days of BID dosing. There was a linear increase in exposure across the dose range from 60 to 240 μg BID. Treatment-emergent AEs in both studies were consistent with those reported with opiate administration to healthy volunteers.
IMPLICATIONS: The absolute bioavailability of BBUP was 46% to 51% across a 16-fold dose range, with dose-proportional increases in systemic exposure. Apparent steady-state conditions occurred within 3 days of dosing. These pharmacokinetic results suggest that therapeutic buprenorphine plasma concentrations can be obtained with BBUP across a wide dose range in a shorter time than other (eg, transdermal) dosage forms.

PMID: 26804639 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Breakthrough Pain Associated With a Reduction in Serum Buprenorphine Concentration During Dialysis.

Buprenorphine Research (PubMed) - Mon, 01/25/2016 - 8:00am

Breakthrough Pain Associated With a Reduction in Serum Buprenorphine Concentration During Dialysis.

Clin Ther. 2016 Jan 20;

Authors: Ruan X, Bumgarner GW

PMID: 26803331 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Characterization of the discriminative stimulus effects of a NOP receptor agonist Ro 64-6198 in rhesus monkeys.

Buprenorphine Research (PubMed) - Sun, 01/24/2016 - 9:00am
Related Articles

Characterization of the discriminative stimulus effects of a NOP receptor agonist Ro 64-6198 in rhesus monkeys.

J Pharmacol Exp Ther. 2016 Jan 22;

Authors: Saccone PA, Zelenock KA, Linsdey AM, Sulima A, Rice KC, Prinssen EP, Wichmann J, Woods JH

Abstract
Nociceptin/orphanin FQ receptor (NOP) agonists have been reported to produce antinociceptive effects in rhesus monkeys with comparable efficacy to μ-opioid receptor (MOP) agonists, but without their limiting side effects. There are also known to be species differences between rodents and NHPs in the behavioral effects of NOP agonists. The aims of this study were to: 1) determine if the NOP agonist Ro 64-6198 could be trained as a discriminative stimulus, 2) evaluate its pharmacological selectivity as a discriminative stimulus, and 3) establish the order of potency with which Ro 64-6198 produces discriminative stimulus effects compared with analgesic effects in NHP. Two groups of rhesus monkeys were trained to discriminate either fentanyl or Ro 64-6198 from vehicle. Four monkeys were trained in the warm-water tail-withdrawal procedure to measure antinociception. Ro 64-6198 produced discriminative stimulus effects that were blocked by the NOP antagonist J-113397 and not by naltrexone. The discriminative stimulus effects of Ro 64-6198 partially generalized to diazepam, but not to fentanyl, SNC 80, ketocyclazocine, buprenorphine, PCP, or chlorpromazine. Fentanyl produced stimulus effects that were blocked by naltrexone and not by J-113397, and Ro 64-6198 did not produce fentanyl-appropriate responding in fentanyl-trained animals. In measures of antinociception, fentanyl, but not Ro 64-6198, produced dose-dependent increases in tail-withdrawal latency. Together, these results demonstrate that Ro 64-6198 produced stimulus effects in monkeys that are distinct from other opioid receptor agonists, but may be somewhat similar to diazepam. In contrast to previous findings, Ro 64-6198 did not produce antinociception in the majority of animals tested even at doses considerably greater than those that produced discriminative stimulus effects.

PMID: 26801398 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Changes in psychological well-being among heroin-dependent adolescents during psychologically supported opiate substitution treatment.

Buprenorphine Research (PubMed) - Sun, 01/24/2016 - 9:00am
Related Articles

Changes in psychological well-being among heroin-dependent adolescents during psychologically supported opiate substitution treatment.

Early Interv Psychiatry. 2016 Jan 23;

Authors: Smyth BP, Ducray K, Cullen W

Abstract
AIM: Heroin-dependent adolescents demonstrate high rates of comorbid psychological problems. Among heroin-dependent adults, opiate substitution treatment (OST) programmes appear to reduce mental health problems. We sought to examine the impact of OST on psychological well-being in adolescents, as this is unknown.
METHODS: We conducted a prospective study examining psychological well-being in heroin dependent adolescents, aged 18 years or younger, engaged in outpatient psychologically supported OST. Patients were treated with either methadone or buprenorphine. This was complimented with individual key working, counselling (motivational interviewing and cognitive behavioral therapy) and group work focusing on life skills. The Beck Youth Inventory was used to measure psychological well-being at treatment entry and repeated after 4 months of treatment.
RESULTS: Among 55 consecutive treatment episodes, we examined the 32 episodes where the patient persisted with the OST programme. Polysubstance use was the norm at treatment entry. At follow-up, the median doses of methadone and buprenorphine were 50 mgs and 8 mgs, respectively. Only three patients were treated with antidepressant medication. There was significant improvement in the mean depression (65.0 to 57.9, P = 0.001), anxiety (61.7 to 57.0, P = 0.006) and anger (57.8 to 54.6, P = 0.009) subscale scores. The self-concept and disruptive behaviour subscale scores did not improve significantly.
CONCLUSION: In this relatively short-term follow-up, psychosocially assisted OST appears to be associated with improved psychological well-being in heroin-dependent adolescents, especially in the area of depressive and anxiety symptoms.

PMID: 26800851 [PubMed - as supplied by publisher]

Categories: Bup Feeds

How to overcome hurdles in opiate substitution treatment? A qualitative study with general practitioners in Belgium.

Buprenorphine Research (PubMed) - Sat, 01/23/2016 - 6:00am

How to overcome hurdles in opiate substitution treatment? A qualitative study with general practitioners in Belgium.

Eur J Gen Pract. 2016 Jan 22;:1-7

Authors: Fraeyman J, Symons L, Van Royen P, Van Hal G, Peremans L

Abstract
Background Opiate substitution treatment (OST) is the administration of opioids (methadone or buprenorphine) under medical supervision for opiate addiction. Several studies indicate a large unmet need for OST in general practice in Antwerp, Belgium. Some hurdles remain before GPs engage in OST prescribing. Objectives Formulate recommendations to increase engagement of GPs in OST, applicable to Belgium and beyond. Methods In 2009, an exploratory qualitative research was performed using focus group discussions and interviews with GPs. During data collection and analysis, purposive sampling, open and axial coding was applied. The script was composed around the advantages, disadvantages and conditions of engaging in OST in general practice. Results We conducted six focus groups and two interviews, with GPs experienced in prescribing OST (n = 13), inexperienced GPs (n = 13), and physicians from addiction centres (n = 5). Overall, GPs did not seem very willing to prescribe OST for opiate users. A lack of knowledge about OST and misbehaving patients creates anxiety and makes the GPs reluctant to learn more about OST. The GPs refer to a lack of collaboration with the addiction centres and a need of support (from either addiction centres or experienced GP-colleagues for advice). Important conditions for OST are acceptance of only stable opiate users and more support in emergencies. Conclusion Increasing GPs' knowledge about OST and improving collaboration with addiction centres are essential to increase the uptake of OST in general practice. Special attention could be paid to the role of more experienced colleagues who can act as advising physicians for inexperienced GPs.

PMID: 26799738 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Methadone, buprenorphine and preferences for opioid agonist treatment: A qualitative analysis.

Buprenorphine Research (PubMed) - Sat, 01/23/2016 - 6:00am

Methadone, buprenorphine and preferences for opioid agonist treatment: A qualitative analysis.

Drug Alcohol Depend. 2016 Jan 6;

Authors: Yarborough BJ, Stumbo SP, McCarty D, Mertens J, Weisner C, Green CA

Abstract
BACKGROUND: Patients and clinicians have begun to recognize the advantages and disadvantages of buprenorphine relative to methadone, but factors that influence choices between these two medications remain unclear. For example, we know little about how patients' preferences and previous experiences influence treatment decisions. Understanding these issues may enhance treatment engagement and retention.
METHODS: Adults with opioid dependence (n=283) were recruited from two integrated health systems to participate in interviews focused on prior experiences with treatment for opioid dependence, knowledge of medication options, preferences for treatment, and experiences with treatment for chronic pain in the context of problems with opioids. Interviews were audio-recorded, transcribed verbatim, and coded using Atlas.ti.
RESULTS: Our analysis revealed seven areas of consideration for opioid agonist treatment decision-making: (1) awareness of treatment options; (2) expectations and goals for duration of treatment and abstinence; (3) prior experience with buprenorphine or methadone; (4) need for accountability and structured support; (5) preference to avoid methadone clinics or associated stigma; (6) fear of continued addiction and perceived difficulty of withdrawal; and (7) pain control.
CONCLUSION: The availability of medication options increases the need for clear communication between clinicians and patients, for additional patient education about these medications, and for collaboration and patient influence over choices in treatment decision-making. Our results suggest that access to both methadone and buprenorphine will increase treatment options and patient choice and may enhance treatment adherence and outcomes.

PMID: 26796596 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Comparison of a triple-quadrupole and a quadrupole time-of-flight mass analyzer to quantify 16 opioids in human plasma.

Buprenorphine Research (PubMed) - Sat, 01/23/2016 - 6:00am

Comparison of a triple-quadrupole and a quadrupole time-of-flight mass analyzer to quantify 16 opioids in human plasma.

J Pharm Biomed Anal. 2016 Jan 3;

Authors: Viaene J, Lanckmans K, Dejaegher B, Mangelings D, Vander Heyden Y

Abstract
The aim of this work is to study whether a quadrupole time-of-flight (QToF) mass analyzer, coupled to an ultra high performance liquid chromatography (UHPLC) system, can be a valuable alternative for a triple-quadrupole (QqQ) mass analyzer, for quantitative toxicological purposes. The case study considered was the quantification of 16 opioids (6-monoacetylmorphine, buprenorphine, codeine, dihydrocodeine, ethylmorphine, fentanyl, hydrocodone, hydromorphone, morphine, norbuprenorphine, norcodeine, norfentanyl, oxycodone, oxymorphone, pholcodine and tilidine) in human plasma. Both methods were validated in parallel in terms of selectivity, matrix effects, extraction recovery, carry-over, bias, precision and sensitivity. Accuracy-profile methodology was used to determine the optimal calibration model, and to estimate bias, repeatability, intermediate precision and total error. Selectivity was demonstrated for all opioids and deuterated analogues, except for codeine-d3 on the UHPLC-QTOF. For most compounds, extraction recoveries were in the range 60 to 80% on both systems, except for the synthetic analogues, buprenorphine, fentanyl and tilidine, where large variability is observed. Carry-over was negligible on both systems. For different opioids, the optimal calibration model was different between the systems. The accuracy profiles of the majority of the opioids indicated that, over the entire tested concentration range, for more than 5% of the future measurements, total errors are expected to exceed the a priori defined 15% acceptance limit. For some exceptions, however, the measurements even suffer from total errors above 30%, which can be attributed to the solid phase extraction procedure that was applied as sample pretreatment technique. Sensitivity was generally tenfold better on the LC-QToF system, probably due to the difference in ion choice for quantification between both systems. In conclusion, the best performing system seemed to depend on the compound, on the parameter and even on the concentration. Accuracy profiles clearly provided valuable information complementary to that obtained in classical validation tests, and therefore preferably are taken into account when deciding on a method's performance.

PMID: 26795707 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Finally, Presidential Candidates are Talking about Addiction

Drug and Alcohol News (JoinTogether.com) - Fri, 01/22/2016 - 3:17pm

 

 

 

 

 

 

 

 

•   Drug overdose is the leading cause of injury death in the U.S., causing more deaths than car crashes. 

•   One in four teens has misused or abused a prescription drug at least once in his/her lifetime.

•   In the US, prescription opioid abuse costs are about $55.7 billion. This is attributed to workplace costs, healthcare costs and criminal justice costs. 

There is a heroin and prescription drug abuse epidemic in this country. And, thankfully, for the first time in a U.S. presidential election, candidates are talking about it.

They’re talking about the issue of drug abuse in an entirely new and refreshing way: one that doesn’t incriminate, shame or judge, but rather supports, destigmatizes and encourages the millions of Americans affected by addiction.

As the candidates visit key electoral states like Iowa and New Hampshire, they are hearing from constituents that drug abuse, and the opiate crisis in particular, is the main issue they care about. Parents of addicted children and those in recovery are coming out of the shadows and bravely demanding that their issue, one that is ravaging our communities, be at the center of the Presidential discussion.

Not only are candidates finally paying attention, they are even sharing their own stories. Several presidential hopefuls have experienced first-hand the devastation of losing a child to addiction. Carly Fiorina’s lost her stepdaughter, Lori, to drug addictionDonald Trump lost his brother, Freddy, to alcoholism. Chris Christie’s lost a close friend from law school to prescription drug abuse. 

Jeb Bush’s daughter’s, Noelle, has struggled with drug addiction and is now in recovery.

In addition to sharing their personal and emotional connections to the issue, both Democrat and Republican candidates are presenting comprehensive plans to address the current opiate epidemic, such as Hillary Clinton’s $10 billion plan to enhance treatment and recovery programs. Jeb Bush recently presented his strategies for combatting the opioid epidemic as well.

We cannot incarcerate our way out of this problem; but instead, we must invest in prevention and enhance our treatment resources and recovery services.

The Presidential campaign trail is bringing to light the single fact that those affected by addiction know very well: substance abuse is not a moral failing, but a public health issue. And despite crossing all social and economic boundaries, it is drastically underfunded. We have failed to discuss its devastating reach or the few resources that we have to address it…until now.

Now is the time when the 85 million Americans affected by addiction demand action and resources to properly treat and define addiction like the public health crisis that it is. And the 2016 Presidential campaign is amplifying that message and giving us the national stage to affect change.

No matter what your political beliefs, please help keep addiction and substance abuse a main topic throughout the Presidential campaign trail and election.

We urge the Presidential candidates to advocate for investment in prevention, treatment and recovery programs in order to combat this epidemic.

One easy way you can make a difference is to sign our petition to pass the Comprehensive Addiction and Recovery Act (CARA.) Please lend your support today.

Do you or a loved one need help with substance abuse or addiction? Call our Toll-Free Helpline 1-855-DRUGFREE (1-855-378-4373) to speak with a trained and caring specialist.

The post Finally, Presidential Candidates are Talking about Addiction appeared first on Partnership for Drug-Free Kids.

Categories: Bup Feeds

The extent and correlates of community-based pharmaceutical opioid utilisation in Australia.

Buprenorphine Research (PubMed) - Wed, 01/20/2016 - 8:00am

The extent and correlates of community-based pharmaceutical opioid utilisation in Australia.

Pharmacoepidemiol Drug Saf. 2016 Jan 19;

Authors: Degenhardt L, Gisev N, Cama E, Nielsen S, Larance B, Bruno R

Abstract
PURPOSE: There has been concern regarding the increasing use of opioids and related harm. We present data on opioid utilisation across Australia and consider sociodemographic factors that may affect utilisation rates.
METHODS: IMS Health national sales data for over-the-counter (codeine) and prescription opioids (buprenorphine, codeine, dextropropoxyphene, fentanyl, hydromorphone, methadone, morphine, oxycodone, tapentadol and tramadol) were used to estimate total utilisation rates in the community during 2013, mapped to Statistical Local Areas (SLAs) and Remoteness Areas. All opioid amounts were measured in pack sales and milligrammes then converted to oral morphine equivalent milligrammes (OME mg) for comparison across opioids. Data on the demographic characteristics of SLAs were obtained from the ABS (sex and age distribution, income and levels of physical labour) and other sources (number of pharmacies in SLAs) and were included in linear regression analyses.
RESULTS: In 2013, an estimated 10 747 kg (OME) of opioids were sold across Australia, equating to 481 OME mg per person. There was considerable geographic variation in opioid utilisation, with higher rates of use in rural and regional areas. Geographic areas that were less populated, had more men and older people, proportionally more low-income earning households and greater proportions in jobs requiring physical labour had higher utilisation rates.
CONCLUSIONS: Substantial geographic variation in opioid utilisation was identified, with areas outside of major cities having higher rates of utilisation of all types of opioids. Prescription monitoring and best practice interventions aimed at improving opioid use need to have a particular focus on areas outside of major cities. Copyright © 2016 John Wiley & Sons, Ltd.

PMID: 26781123 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Pharmacological effects and toxicity of Costus pulverulentus C. Presl (Costaceae).

Buprenorphine Research (PubMed) - Tue, 01/19/2016 - 8:30am
Related Articles

Pharmacological effects and toxicity of Costus pulverulentus C. Presl (Costaceae).

J Ethnopharmacol. 2016 Jan 14;

Authors: Alonso-Castro AJ, Zapata-Morales JR, González-Chávez MM, Carranza-Álvarez C, Hernández-Benavides DM, Hernández-Morales A

Abstract
ETHNOPHARMACOLOGICAL RELEVANCE: Costus pulverulentus C. Presl (Costaceae), a species endemic to Mexico, is used for the empirical treatment of cancer, pain, and inflammation.
AIM OF THE STUDY: The objective of this study was to evaluate the toxicity, as well as the cytotoxic, antinociceptive, anti-inflammatory and sedative effects of an ethanol extract from Costus pulverulentus stem (CPE).
MATERIALS AND METHODS: The chemical characterization of CPE was performed by Gas chromatography-mass spectrometry (GC-MS). The toxicity of CPE was evaluated using the comet assay (10-1000µg/ml during 5hours) and the acute toxicity test (500-5000mg/kg p.o. and i.p. during 14 days). The cytotoxic effect of CPE (1-250µg/ml) on human cancer cells was evaluated using the MTT assay. The antinociceptive effects of CPE (50-200mg/kg p.o.) were evaluated using thermal-induced nociception tests (hot plate and tail flick) and the chemical-induced nociceptive tests (acetic acid and formalin). The sedative activity of CPE (50-200mg/kg p.o.) was evaluated using the ketamine-induced sleeping time test.
RESULTS: CPE showed the presence of compounds such as campesterol, stigmasterol β-sitosterol, vanillic acid, among others. In the comet assay, CPE at 200µg/ml or higher concentrations induced DNA damage. In the acute toxicity test, the LD50 estimated for CPE was>5000mg/kg p.o. or i.p. CEP showed moderate cytotoxic effects on prostate carcinoma cells PC-3 cells (IC50= 179±23.2µg/ml). In the chemical-induced nociception models, CPE (100 and 200mg/kg p.o.) showed antinociceptive effects with similar activity to 100mg/kg naproxen. In the thermal-induced nociception tests, CPE tested at 200mg/kg showed moderate antinociceptive effects by 28% (hot plate test) and by 25% (tail flick test). In the ketamine-induced sleeping time test, CPE showed no sedative effects.
CONCLUSIONS: C. pulverulents exerts moderate cytotoxic effects in human cancer cells, moderate anti-inflammatory and antinociceptive effects. C. pulverulentus induces antinociceptive effects without inducing sedation.

PMID: 26778604 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Determination of safety margins for whole blood concentrations of alcohol and nineteen drugs in driving under the influence cases.

Buprenorphine Research (PubMed) - Sun, 01/17/2016 - 7:30am

Determination of safety margins for whole blood concentrations of alcohol and nineteen drugs in driving under the influence cases.

Forensic Sci Int. 2015 Dec 19;259:119-126

Authors: Kristoffersen L, Strand DH, Liane VH, Vindenes V, Tvete IF, Aldrin M

Abstract
Legislative limits for driving under the influence of 20 non-alcohol drugs were introduced in Norway in February 2012. Per se limits corresponding to blood alcohol concentrations (BAC) of 0.2g/kg were established for 20 psychoactive drugs, and limits for graded sanctions corresponding to BACs of 0.5 and 1.2g/kg were determined for 13 of these drugs. This new legislation made it possible for the courts to make sentences based on the analytical results, similar to the situation for alcohol. To ensure that the reported concentration is as least as high as the true concentration, with a 99% safety level, safety margins had to be calculated for each of the substances. Diazepam, tetrahydrocannabinol (THC) and alcohol were used as model substances to establish a new model for estimating the safety margins. The model was compared with a previous used model established several years ago, by a similar yet much simpler model, and they were found to be in agreement. The measurement uncertainties depend on the standard batch used, the work list and the measurements' replicate. A Bayesian modelling approach was used to determine the parameters in the model, using a dataset of 4700 diazepam positive specimens and 5400 THC positive specimens. Different safety margins were considered for low and high concentration levels of diazepam (≤2μM (0.6mg/L) and >2μM) and THC (≤0.01μM (0.003mg/L) and >0.01μM). The safety margins were for diazepam 19.5% (≤2μM) and 34% (>2μM), for THC 19.5% (≤0.01μM) and 24.9% (>0.01μM). Concentration dependent safety margins for BAC were based on a dataset of 29500 alcohol positive specimens, and were in the range 10.4% (0.1g/kg) to 4.0% (4.0g/kg) at a 99% safety level. A simplified approach was used to establish safety margins for the compounds amphetamine, MDMA, methamphetamine, alprazolam, phenazepam, flunitrazepam, clonazepam, nitrazepam, oxazepam, buprenorphine, GHB, methadone, ketamine, cocaine, morphine, zolpidem and zopiclone. The safety margins for these drugs were in the range 34-41%.

PMID: 26773222 [PubMed - as supplied by publisher]

Categories: Bup Feeds

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