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A randomized controlled trial of prison-initiated buprenorphine: Prison outcomes and community treatment entry.

Buprenorphine Research (PubMed) - Thu, 06/26/2014 - 7:00am

A randomized controlled trial of prison-initiated buprenorphine: Prison outcomes and community treatment entry.

Drug Alcohol Depend. 2014 Jun 2;

Authors: Gordon MS, Kinlock TW, Schwartz RP, Fitzgerald TT, O'Grady KE, Vocci FJ

Abstract
BACKGROUND: Buprenorphine is a promising treatment for heroin addiction. However, little is known regarding its provision to pre-release prisoners with heroin dependence histories who were not opioid-tolerant, the relative effectiveness of the post-release setting in which it is provided, and gender differences in treatment outcome in this population.
METHODS: This is the first randomized clinical trial of prison-initiated buprenorphine provided to male and female inmates in the US who were previously heroin-dependent prior to incarceration. A total of 211 participants with 3-9 months remaining in prison were randomized to one of four conditions formed by crossing In-Prison Treatment Condition (received buprenorphine vs. counseling only) and Post-release Service Setting (at an opioid treatment center vs. a community health center). Outcome measures were: entered prison treatment; completed prison treatment; and entered community treatment 10 days post-release.
RESULTS: There was a significant main effect (p=.006) for entering prison treatment favoring the In-Prison buprenorphine Treatment Condition (99.0% vs. 80.4%). Regarding completing prison treatment, the only significant effect was Gender, with women significantly (p<.001) more likely to complete than men (85.7% vs. 52.7%). There was a significant main effect (p=.012) for community treatment entry, favoring the In-Prison buprenorphine Treatment Condition (47.5% vs. 33.7%).
CONCLUSIONS: Buprenorphine appears feasible and acceptable to prisoners who were not opioid-tolerant and can facilitate community treatment entry. However, concerns remain with in-prison treatment termination due to attempted diversion of medication.

PMID: 24962326 [PubMed - as supplied by publisher]

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Current developments in the treatment of neuropathic pain in AIDS patients.

Buprenorphine Research (PubMed) - Thu, 06/26/2014 - 7:00am
Related Articles

Current developments in the treatment of neuropathic pain in AIDS patients.

Minerva Anestesiol. 2013 Aug;79(8):835-7

Authors: Eroglu A

PMID: 23652177 [PubMed - indexed for MEDLINE]

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Evaluation of an improved sustained-release buprenorphine formulation for use in mice.

Buprenorphine Research (PubMed) - Wed, 06/25/2014 - 7:30am

Evaluation of an improved sustained-release buprenorphine formulation for use in mice.

Am J Vet Res. 2014 Jul;75(7):619-625

Authors: Healy JR, Tonkin JL, Kamarec SR, Saludes MA, Ibrahim SY, Matsumoto RR, Wimsatt JH

Abstract
Objective-To evaluate analgesic effects of an improved sustained-release buprenorphine (BUP-SR) formulation administered to mice. Animals-36 male Swiss-Webster mice. Procedures-Mice were assigned to each of 3 treatment groups (n = 12 mice/group). Treatments were administered SC (vehicle [control treatment], 1.5 mg of buprenorphine hydrochloride [BUP-HCl]/kg, and 1.5 mg of BUP-SR/kg). Mice were evaluated (total activity, gastrointestinal tract motility, respiratory rate, cataleptic behavior, and tall-flick and hot plate nociception tests) to determine behavioral and physiologic responses at 4, 24, and 48 hours after treatment administration. Body weight and respiratory rate were measured before and at each time point after treatment administration. Results-SC administration of BUP-SR resulted in significant antinociception effects for 48 hours for the hot plate and tall-flick nociception tests without substantial adverse effects. Gastrointestinal tract motility and total activity were higher at 4 hours for mice receiving BUP-SR than for mice receiving the vehicle, but values were the same between these groups at 24 and 48 hours. The BUP-SR group had a lower respiratory rate than did the control group at all times after treatment administration. Mice treated with BUP-SR had no significant changes in body weight during the study, whereas mice treated with BUP-HCl had a significant decrease in body weight at 24 and 48 hours. Conclusions and Clinical Relevance-BUP-SR administration resulted in antinociception effects for 48 hours. Results of this study indicated that the improved BUP-SR formulation could be safely administered SC and conferred superior analgesia, compared with that for BUP-HCl, in mice.

PMID: 24959727 [PubMed - as supplied by publisher]

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Maintenance treatments for opiate -dependent adolescents.

Buprenorphine Research (PubMed) - Wed, 06/25/2014 - 7:30am

Maintenance treatments for opiate -dependent adolescents.

Cochrane Database Syst Rev. 2014 Jun 24;6:CD007210

Authors: Minozzi S, Amato L, Bellisario C, Davoli M

Abstract
BACKGROUND: The scientific literature examining effective treatments for opioid-dependent adults clearly indicates that pharmacotherapy is a necessary and acceptable component. Nevertheless, no reviews have been published that systematically assess the effectiveness of pharmacological maintenance treatment in adolescents.
OBJECTIVES: To assess the effectiveness of any maintenance treatment alone or in combination with psychosocial intervention compared to no intervention, other pharmacological intervention or psychosocial interventions for retaining adolescents in treatment, reducing the use of substances and improving health and social status.
SEARCH METHODS: We searched the Cochrane Drugs and Alcohol Group's Trials Register (January 2014), the Cochrane Central Register of Controlled Trials (2014, Issue 1), PubMed (January 1966 to January 2014), EMBASE (January 1980 to January 2014), CINAHL (January 1982 to January 2014), Web of Science (1991 to January 2014) and reference lists of articles.
SELECTION CRITERIA: Randomised and controlled clinical trials of any maintenance pharmacological interventions either alone or associated with psychosocial intervention compared with no intervention, placebo, other pharmacological intervention, pharmacological detoxification or psychosocial intervention in adolescents (13 to 18 years).
DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures expected by The Cochrane Collaboration.
MAIN RESULTS: We included two trials involving 189 participants. One study, with 35 participants, compared methadone with levo-alpha-acetylmethadol (LAAM) for maintenance treatment lasting 16 weeks, after which patients were detoxified. The other study, with 154 participants, compared maintenance treatment with buprenorphine-naloxone and detoxification with buprenorphine. We did not perform meta-analysis because the two studies assessed different comparisons.In the study comparing methadone and LAAM, the authors declared that there was no difference in the use of a substance of abuse or social functioning (data not shown). The quality of the evidence was very low. No side effects, such as nausea, vomiting, constipation, weakness or fatigue, were reported by study participants.In the comparison between buprenorphine maintenance and buprenorphine detoxification, maintenance treatment appeared to be more efficacious in retaining patients in treatment (drop-out risk ratio (RR) 0.37; 95% confidence interval (CI) 0.26 to 0.54), but not in reducing the number of patients with a positive urine test at the end of the study (RR 0.97; 95% CI 0.78 to 1.22). Self reported opioid use at one-year follow-up was significantly lower in the maintenance group, even though both groups reported a high level of opioid use (RR 0.73; 95% CI 0.57 to 0.95). More patients in the maintenance group were enrolled in other addiction treatment programmes at 12-month follow-up (RR 1.33; 95% CI 0.94 to 1.88). The quality of the evidence was low. No serious side effects attributable to buprenorphine-naloxone were reported by study participants and no patients were removed from the study due to side effects. The most common side effect was headache, which was reported by 16% to 21% of patients in both groups AUTHORS' CONCLUSIONS: It is difficult to draft conclusions on the basis of only two trials. One of the possible reasons for the lack of evidence could be the difficulty of conducting trials with young people for practical and ethical reasons.There is an urgent need for further randomised controlled trials comparing maintenance treatment with detoxification treatment or psychosocial treatment alone before carrying out studies that compare different pharmacological maintenance treatments. These studies should have long follow-up and measure relapse rates after the end of treatment and social functioning (integration at school or at work, family relationships).

PMID: 24957634 [PubMed - as supplied by publisher]

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[It is both permitted and forbidden to drive after taking drugs].

Buprenorphine Research (PubMed) - Wed, 06/25/2014 - 7:30am

[It is both permitted and forbidden to drive after taking drugs].

Lakartidningen. 2014 Apr 29-May 13;111(18-19):810-1

Authors: Sjöberg C

PMID: 24855751 [PubMed - indexed for MEDLINE]

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Comparison between drug screening by immunoassay and ultra-high performance liquid chromatography/high-resolution time-of-flight mass spectrometry in post-mortem urine.

Buprenorphine Research (PubMed) - Tue, 06/24/2014 - 8:00am

Comparison between drug screening by immunoassay and ultra-high performance liquid chromatography/high-resolution time-of-flight mass spectrometry in post-mortem urine.

Drug Test Anal. 2014 Jun 20;

Authors: Sundström M, Pelander A, Ojanperä I

Abstract
Immunoassay is currently the most common approach for urine drug screening. However, the continuous emergence of new psychoactive substances (NPS) and their low urinary concentrations have challenged the scope and sensitivity of immunoassays. Consequently, specialized toxicology laboratories rely more and more on mass spectrometry (MS) based techniques. Ultra-high performance liquid chromatography/high-resolution time-of-flight mass spectrometry (UHPLC-HR-TOF-MS) is an especially attractive technique for comprehensive drug screening. The objective was to compare the performances of immunoassay and UHPLC-HR-TOF-MS in terms of scope, flexibility, sensitivity, and reliability of substance identification. A total of 279 post-mortem urine samples were analyzed using a method representative of each technique. The immunoassay method was an Emit II Plus enzyme immunoassay for the following drug groups: amphetamines, benzodiazepines, buprenorphine, cannabis, and opiates. The UHPLC-HR-TOF-MS method was a recently published method covering hundreds of drugs: conventional drugs of abuse, abused prescription drugs, and NPS of various classes. UHPLC-HR-TOF-MS produced a lower number of false positive (FP) results for the drug groups covered by immunoassay. Many of the false negative (FN, n = 40) and FP (n = 22) immunoassay results were obviously due to the higher cut-off concentrations and interfering matrix, respectively. Moreover, the wider scope of UHPLC-HR-TOF-MS allowed detection of NPS and prescription drugs. UHPLC-HR-TOF-MS gave FP results related to a few particular substances. The future option of adjusting all compound-specific reporting parameters individually would allow the method's sensitivity and specificity to be fully exploited. Copyright © 2014 John Wiley & Sons, Ltd.

PMID: 24953563 [PubMed - as supplied by publisher]

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Community pharmacy services for drug misuse: Attitudes and practices of Finnish pharmacists.

Buprenorphine Research (PubMed) - Tue, 06/24/2014 - 8:00am

Community pharmacy services for drug misuse: Attitudes and practices of Finnish pharmacists.

Int J Drug Policy. 2014 May 29;

Authors: Uosukainen H, Turunen JH, Ilomäki J, Bell JS

Abstract
BACKGROUND: Clients perceive pharmacists' attitudes as an important aspect of community pharmacy services for drug misuse. This study explored Finnish pharmacists' attitudes in relation to community pharmacy services for drug misuse.
METHODS: A cross-sectional mail survey of Finnish community pharmacies was conducted in October 2012. Wilcoxon signed rank tests were used to compare the attitudes of pharmacists who worked in pharmacies which dispensed buprenorphine-naloxone (n=77) to those of pharmacists who worked in matched comparison pharmacies which did not dispense buprenorphine-naloxone (n=236).
RESULTS: Pharmacists who worked in pharmacies which dispensed buprenorphine-naloxone were more likely to perceive that dispensing opioid substitution treatment (OST) is part of pharmacists' professional role (62% vs. 27%, p<0.001) and less likely to be concerned about safety (39% vs. 73%, p<0.001), the public image of the pharmacy as a result of dispensing OST (17% vs. 34%, p<0.001) and diversion (56% vs. 73%, p=0.011) than pharmacists who worked in comparison pharmacies.
CONCLUSIONS: Negative attitudes towards community pharmacy services for drug misuse still exist, especially among pharmacists who do not dispense buprenorphine-naloxone. Further research is needed into mechanisms to improve attitudes as provision of community pharmacy services is expanded.

PMID: 24953214 [PubMed - as supplied by publisher]

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Emerging adult age status predicts poor buprenorphine treatment retention.

Buprenorphine Research (PubMed) - Tue, 06/24/2014 - 8:00am

Emerging adult age status predicts poor buprenorphine treatment retention.

J Subst Abuse Treat. 2014 May 20;

Authors: Schuman-Olivier Z, Weiss RD, Hoeppner BB, Borodovsky J, Albanese MJ

Abstract
Emerging adults (18-25years old) are often poorly retained in substance use disorder treatment. Office-based buprenorphine often enhances treatment retention among people with opioid dependence. In this study, we examined the records of a collaborative care buprenorphine treatment program to compare the treatment retention rates of emerging adults versus older adults. Subjects were 294 adults, 71 (24%) aged 18-25, followed in treatment with buprenorphine, nurse care management, and an intensive outpatient program followed by weekly psychosocial treatment. Compared to older adults, emerging adults remained in treatment at a significantly lower rate at 3months (56% versus 78%) and 12months (17% versus 45%), and were significantly more likely to test positive for illicit opioids, relapse, or drop out of treatment. Further research into factors associated with buprenorphine treatment retention among emerging adults is needed to improve treatment and long-term outcomes in this group.

PMID: 24953168 [PubMed - as supplied by publisher]

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