The CBHSQ Report

Buprenorphine Research (PubMed) - Fri, 09/09/2016 - 8:06am

The CBHSQ Report

Book. 2013

Authors:

Abstract
Background: Buprenorphine is a medication used to treat opioid addiction. A properly prescribed dose of buprenorphine can help opioid-addicted individuals to stop misusing opioids without experiencing withdrawal symptoms. Although buprenorphine is itself an opioid, and can thus have the same effects as other opioids (e.g., heroin, oxycodone), its maximum effects are less than those of other opioids. Therefore, with buprenorphine there is a decreased risk of abuse, addiction, and side effects compared with other opioids. Buprenorphine was approved for use in the United States for the treatment of opioid dependence in 2002. Methods: National estimates of Emergency Department (ED) visits involving buprenorphine were analyzed using data from the 2005 to 2011 Drug Abuse Warning Network (DAWN). The ED visits analyzed included nonmedical use, seeking detoxification/treatment services and adverse reactions involving buprenorphine. Results: ED visits involving buprenorphine increased substantially from an estimated 3,161 in 2005 to 30,135 visits in 2010 as availability of the drug increased. Buprenorphine-related ED visits involving nonmedical use of pharmaceuticals increased 255% from 2006 to 2010, with 4,440 visits to 15,778 visits, respectively. In 2010, 52% (15,778 visits) of buprenorphine-related ED visits were classified as nonmedical use of pharmaceuticals, 24% (7,372 visits) were by patients seeking detoxification or substance abuse treatment, and 13% (4,017 visits) were attributed to adverse reactions. In 2010, additional drugs were involved in 59% of buprenorphine-related ED visits involving nonmedical use of pharmaceuticals. Conclusion: Findings in this report show significant growth in the number of ED visits involving buprenorphine at the same time that there was an increase in its availability for treatment of opioid dependence. These data show that buprenorphine is sometimes used nonmedically, resulting in health events that require acute treatment in the ED. Buprenorphine use can be risky for individuals who are not opioid dependent because its effects are similar to other opioids (although usually more mild), leading to injuries and other health consequences. Additionally, dangerous effects can occur if buprenorphine is combined with certain other drugs, including benzodiazepines.


PMID: 27606401

Categories: Bup Feeds

High prevalence of constipation and reduced quality of life in opioid-dependent patients treated with opioid substitution treatments.

Buprenorphine Research (PubMed) - Thu, 09/08/2016 - 8:03am

High prevalence of constipation and reduced quality of life in opioid-dependent patients treated with opioid substitution treatments.

Expert Opin Pharmacother. 2016 Sep 7;

Authors: Lugoboni F, Mirijello A, Resentera C, Zamboni L, Faccini M, Casari R, Cossari A, Musi G, Bissoli G, Gasbarrini A, Quaglio G, Addolorato G, GICS

Abstract
OBJECTIVES: To evaluate prevalence and severity of constipation and quality of life (QoL) in a cohort of opioid-addicted patients treated with opioid substitution treatments.
RESEARCH DESIGN AND METHODS: Multicenter observational study. A total of 1057 heroin-dependent patients treated with methadone or buprenorphine were enrolled. Constipation was assessed by Wexner Constipation Scoring System, QoL by General Health Questionnaire (GHQ-12).
RESULTS: 38.5% patients reported mild constipation, 33.3% reported moderate constipation, 14.8% severe constipation and 5.1% very severe constipation. Mean Wexner CSS score was 6.6 ± 4.8. 44.9% patients showed a GHQ-12 score ≥14; of these 18.3% patients showed a GHQ-12 score ≥20. Mean GHQ score was 13.8 ± 6.5. Mean Wexner CSS score was significantly higher in methadone patients (p=0.004), in those taking psychoactive drugs (p=0.0001) and in female (p<0.0001) with respect to counterparts. Similarly, GHQ-12 mean scores were higher methadone group (p=0.003), in those taking psychoactive drugs (p<0.0001), and in female (p=0.039) with respect to counterparts. ANOVA and ANCOVA showed a significant influence of methadone and female gender on Wexner CSS score while psychoactive drugs significantly influenced both tests.
CONCLUSIONS: The present study shows that patients affected by opioid-dependence in OST with methadone and buprenorphine have a high prevalence of constipation and reduced QoL.

PMID: 27603712 [PubMed - as supplied by publisher]

Categories: Bup Feeds

School Stress: My Recovery From Stimulant Abuse

Drug and Alcohol News (JoinTogether.com) - Wed, 09/07/2016 - 9:15am

We are grateful to Will Hartigan, 26, for sharing his recovery story as part of our fall School Stress series, a back-to-school toolkit for parents on how to best navigate their teen’s stress and anxiety — explored in our documentary BREAKING POINTS. Here’s Will:

From a young age, I always strived for a high standard of success — getting good grades in school, participating in high-level athletics, attending a prestigious college and pursuing a career in finance. These goals permeated every aspect of my life and psyche and the pressure to succeed and the fear of failure dogged me.

Upholding my lofty goals became impossible. I discovered that drugs and alcohol served as a reprieve from the pressure. And my addictive behavior took flight.

With countless arrests and a reputation as a “wild man”, my control over people’s perceptions of me became unmanageable. My fears were compounded, stress seemed insurmountable and self-hatred blossomed.

My reaction was always the same: get back on the beam, muster all of the self-will within me and keep fighting for success. I thought that if I could temper my erratic behavior and string together a number of accomplishments, then my perception of myself, and others’ perceptions, would be mended.

My parents restricted me from getting a driver’s license until I turned 18 because I was reckless and irresponsible. When I was 18 I returned home from Cornell and obtained a license. On my first night as a driver I ran out of gas on the side of the road with a consumed case of beer in my trunk. I was arrested and held in a jail cell for the night. My drinking and using history is littered with similar incidents. At this point the knot of shame and guilt in my stomach was all consuming.

“Stress seemed insurmountable.”

I was a shell of a human, living only to prove to the people around me that I was a good person despite my failures. It felt as though everyone was disappointed — or at least in awe of my propensity for self-destruction. Determined to right my wrongs, I returned to Cornell with a newfound resolve.

It was the beginning of my second semester and I discovered unprescribed Adderall. I proceeded to get straight A’s, and had an impressive showing as a freshman on the Men’s Varsity Squash team. Naturally, I concluded that ADD had been the cause of all of my struggles to date, and that Adderall was the cure.

I used Adderall to wake up, go to class, play squash, write papers, talk to girls, make important phone calls, play video games, brush my teeth, etc. By this point I had developed the alias of “Blackout Billy” due to the long and unpredictable blackouts that I had while drinking. Adderall even prevented the blackouts! It was perfect.

But I couldn’t sleep and I found that taking painkillers at night helped with the insomnia. I discovered OxyContin during the summer between my freshman and sophomore year and fell in love. I believed that if I could sustain the feeling I got from mixing OxyContin and Adderall for the rest of my life, that the sky was the limit for my success. It relieved me of my insecurities, I was happy and relaxed, and I wasn’t tortured by my guilt and shame.

Over time, my tolerance grew and the high became less controlled. I began to withdraw from the people who loved me, I neglected school, I quit the squash team and I couldn’t sleep for more than a few hours without experiencing physical withdrawals from the opiates. I became utterly isolated and life became indescribably dark. Even the thought of a face-to-face encounter with one of my friends was enough to send me into a panic. Yet, to the very end I maintained my delusional sense of control.

My family unsuccessfully intervened many times, but in August 2010, they caught me at a desperate time. I agreed to go to 28-days inpatient treatment with a relatively open-mind. The severity of my problem began to sink in as I didn’t sleep for my first ten days due to opiate withdrawal. After 28 days I agreed to do one month in a sober house in St. Paul, Minnesota. This was a monumental shift in behavior; for the first time in my life I resisted the urge to rush back to school/squash/finance in an attempt to repair the damage as quickly as possible.

At some point in my first two months of recovery, I was struck by the revelation that my thinking was abnormal, that my ego and self-will had driven me to emotional and spiritual bankruptcy, and that if left to my own devices I would drink again, or at least struggle through life. I threw my hands up and accepted suggestions for the first time in my life. I prayed to be relieved of my bondage of self, and voraciously sought counsel from my newfound support network on how to live. I conceded that I was powerless and needed help.

I have been given a life beyond my wildest dreams and I have remained on a pink cloud since my time in Minnesota.

I returned to Cornell and started a student-run support group called SOBER with my friend, Hudson. I worked on Wall Street for three years, and experienced success in NYC. After three years, I asked myself if I wanted to look back on my life in thirty years and see a life in finance. I have never had any passion for finance, and simply pursued it because it seemed like the popular thing to do.

I left my job seven months ago and began a sober house, similar to the one I lived in for a year in Minnesota. I live in the house and am currently helping fourteen men stay sober through a daily program of action. I still follow the daily program of self-care that I developed in my sober house in Minnesota. Booze and drugs were 1% of my problem. I stay in recovery for my thinking, not for my drinking.

“Booze & drugs were 1% of my problem.”

I recently read a short story in which a man on his deathbed was asked what his greatest regret was. He said he regretted that he spent time worrying. I can worry myself sick, but I know today that it is truly pointless. If I have a daily plan, have faith that I will be taken care of and take action, I know that I will be healthy.

My addiction had to run its course, and I had to get beaten down repeatedly before I was ready to get well. Today, I am grateful for every arrest, embarrassing night, every hangover and every hour of withdrawal that I experienced. These things brought me to a point of willingness.

I still have pressure in my life but it no longer feels like a crushing burden. I am grateful for the responsibilities that life presents and thanks to recovery I am prepared to face them.

KEY TAKEAWAYS:

To Help Your Son or Daughter:

  • Try to ease the performance pressure and talk with your son or daughter about how there are many paths to success.
  • If your son or daughter is anxious, overly stressed or struggling emotionally, seek help.
  • Practice Self-Care. Take time to nurture and renew yourself so that you can respond to your son or daughter more effectively. It’s also a way to model behaviors for your child so that they see how a healthy adult manages life’s ups and downs.
  • If your child is struggling with a drug or alcohol problem, call our Toll-Free Parent’s Helpline at 1-855-DRUGFREE or visit Get Help.

Want more understanding about teen stress and pressure?
Watch the trailer for BREAKING POINTS, which explores the unhealthy ways many teens cope, including abusing Rx stimulants.

The post School Stress: My Recovery From Stimulant Abuse appeared first on Partnership for Drug-Free Kids.

Categories: Bup Feeds

Risk-factors for methadone-specific deaths in Scotland's methadone-prescription clients between 2009 and 2013.

Buprenorphine Research (PubMed) - Wed, 09/07/2016 - 7:02am

Risk-factors for methadone-specific deaths in Scotland's methadone-prescription clients between 2009 and 2013.

Drug Alcohol Depend. 2016 Aug 29;

Authors: Gao L, Dimitropoulou P, Robertson JR, McTaggart S, Bennie M, Bird SM

Abstract
AIM: To quantify gender, age-group and quantity of methadone prescribed as risk factors for drugs-related deaths (DRDs), and for methadone-specific DRDs, in Scotland's methadone-prescription clients.
DESIGN: Linkage to death-records for Scotland's methadone-clients with one or more Community Health Index (CHI)-identified methadone prescriptions during July 2009 to June 2013.
SETTING: Scotland's Prescribing Information System and National Records of Scotland.
MEASUREMENTS: Covariates defined at first CHI-identified methadone prescription, and person-years at-risk (pys) thereafter until the earlier of death-date or 31 December 2013. Methadone-specific DRDs were defined as: methadone implicated but neither heroin nor buprenorphine. Hazard ratios (HRs) were assessed using proportional hazards regression.
FINDINGS: Scotland's CHI-identified methadone-prescription cohort comprised 33,128 clients, 121,254 pys, 1,171 non-DRDs and 760 DRDs (6.3 per 1,000 pys), of which 362 were methadone-specific. Irrespective of gender, methadone-specific DRD-rate, per 1,000 pys, was higher in the 35+ age-group (4.2; 95% CI: 3.6-4.7) than for younger clients (1.9; 95% CI: 1.5-2.2). For methadone-specific DRDs, age-related HRs (e.g., 2.9 at 45+ years; 95% CI: 2.1-3.9) were steeper than for all DRDs (1.9; 95% CI: 1.5-2.4); there was no hazard-reduction for females; no gender by age-group interaction; and, unlike for all DRDs, the highest quintile for quantity of prescribed methadone at cohort-entry (>1960mg) was associated with increased HR (1.8; 95% CI: 1.3-2.5).
CONCLUSION: Higher methadone-specific DRD rates in older clients, irrespective of gender, call for better understanding of methadone's pharmaco-dynamics in older, opioid-dependent clients, many with progressive physical or mental ill-health.

PMID: 27593969 [PubMed - as supplied by publisher]

Categories: Bup Feeds

A mechanistic approach to modelling the formation of a drug reservoir in the skin.

Buprenorphine Research (PubMed) - Wed, 09/07/2016 - 7:02am
Related Articles

A mechanistic approach to modelling the formation of a drug reservoir in the skin.

Math Biosci. 2016 Aug 31;

Authors: Jones JG, White KA, Delgado-Charro MB

Abstract
It has been shown that prolonged systemic presence of a drug can cause a build up of that drug in the skin. This drug 'reservoir', if properly understood, could provide useful and important information about recent drug-taking history of the patient. In this paper we create a pair of coupled mathematical models which combine together to explore the potential for a drug reservoir to be created based on the kinetic properties of the drug. The first compartmental model is used to characterise time-dependent drug concentrations in plasma and tissue following a customisable drug regimen. Outputs from this model provide boundary conditions for the second, spatio-temporal model of drug build-up and concentration profile in the skin. We focus in particular on drugs that are highly bound as this will restrict their potential to move freely into the skin but which are lipophilic so that, in the unbound form, they would demonstrate an affinity to the outer layers of the skin (which are built around a lipid matrix). Buprenorphine, a drug used to treat opiate addiction, is one example of a drug satisfying these properties. In the discussion we highlight how our study might be used to inform future experimental design and data collection to provide relevant parameter estimates for reservoir formation and its potential to contribute to enhanced drug monitoring techniques.

PMID: 27592115 [PubMed - as supplied by publisher]

Categories: Bup Feeds

DIEP Flap for Breast Reconstruction Using Epidural Anesthesia with the Patient Awake.

Buprenorphine Research (PubMed) - Thu, 09/01/2016 - 6:41am

DIEP Flap for Breast Reconstruction Using Epidural Anesthesia with the Patient Awake.

Plast Reconstr Surg Glob Open. 2016 May;4(5):e724

Authors: de la Parra M, Camacho M, de la Garza J

Abstract
BACKGROUND: Many articles have been published about breast reconstruction using the deep inferior epigastric perforator (DIEP) flap; however, few articles have been published in plastic/reconstructive surgery journals describing the difference between anesthetic techniques and recovery in microsurgical patients.
METHODS: We analyzed 16 patients who underwent DIEP flap for breast reconstruction. Patients were divided into 2 groups: group 1: general anesthesia (n = 9); group 2: epidural block with the patient awake (n = 7). In group 2, the peridural block was done at 2 levels: thoracic (T2-T3) and lumbar (L2-L3).
RESULTS: The success rate was 100% with no partial or total loss of the flap. There was no difference between groups in regard to postoperative pain in the first 5 days (Visual Analog Scale). Analgesia used in group 1 was buprenorphine and ketorolac, and in group 2, only ketorolac without opioid derivatives. Immediate postoperative recovery was better in the peridural group than in the group administered general anesthesia (P = 0.0001).
CONCLUSIONS: DIEP flap with peridural block and the patient awake during surgery is a feasible technique with better recovery in the immediate postoperative period, achieving good analgesia level with minimal intravenous medication.

PMID: 27579248 [PubMed]

Categories: Bup Feeds

Efficacy of buprenorphine added to 2% lignocaine plus adrenaline 1:80,000 in providing postoperative analgesia after lower third molar surgery.

Buprenorphine Research (PubMed) - Thu, 09/01/2016 - 6:41am

Efficacy of buprenorphine added to 2% lignocaine plus adrenaline 1:80,000 in providing postoperative analgesia after lower third molar surgery.

Int J Oral Maxillofac Surg. 2016 Aug 28;

Authors: Chhabra N, Sharma P, Chhabra S, Gupta N

Abstract
A number of trials have examined the peripheral analgesic effect of opioids, known to have an anti-nociceptive effect at the central and/or spinal cord level. This study aimed to evaluate the efficacy of buprenorphine added to 2% lignocaine with adrenaline 1:80,000 in providing postoperative analgesia after lower third molar surgery. Sixty patients were randomized to three groups: group A received lignocaine 2% with adrenaline 1:80,000 for inferior alveolar nerve block (IANB), along with intramuscular (IM) injection of 1ml saline; group B received buprenorphine mixed with lignocaine 2% with adrenaline 1:80,000 for IANB (0.01mg buprenorphine/ml lignocaine with adrenaline), along with 1ml saline IM; group C received lignocaine 2% with adrenaline 1:80,000 for IANB, along with 0.03mg buprenorphine IM. Mean postoperative pain scores (visual analogue scale; when the patient first felt pain) were 6.0 for group A, 1.0 for group B, and 4.4 for group C. The mean duration of postoperative analgesia was 3.5h in groups A and C and 12h in group B. The mean number of postoperative analgesics consumed was 5.8 in groups A and C and 3.9 in group B. The addition of buprenorphine (0.03mg) to 2% lignocaine with adrenaline 1:80,000 significantly reduced the severity of postoperative pain and prolonged the duration of analgesia, thereby decreasing the need for postoperative analgesics.

PMID: 27576596 [PubMed - as supplied by publisher]

Categories: Bup Feeds

School Stress: 5 Myths About Stimulant Abuse

Drug and Alcohol News (JoinTogether.com) - Wed, 08/31/2016 - 9:15am

This is the second post in our weekly fall School Stress series, a back-to-school toolkit for parents on how to best navigate their teen’s stress and anxiety — explored in our documentary BREAKING POINTS.

Being a student today can be really tough, and often teens will feel tempted to “solve” their academic and social problems with prescription stimulants. While prescription stimulants are medically used for treating real diagnosed conditions such as attention deficit hyperactivity disorder (ADHD), some teens abuse them in an attempt to feel alert, focused and full of energy when they need to manage stressful schoolwork or feel as if they need to “pull an all-nighter.” The truth is that teens don’t necessarily have all of the facts.

Check out these five myths about stimulant abuse.

– 1 –

MYTH: Everybody’s doing it. FACT: While it certainly may feel like everyone’s doing it, studies show that, of teens using prescription stimulants, one in 5 take pills not prescribed to them.

– 2 –

MYTH: Stimulants will increase my GPA. FACT: Studies show that GPA is actually lower in students that take stimulants without a prescription written for them. In students that are prescribed stimulants to treat ADHD, studies show that while their ADHD symptoms improve, their GPA does not increase.

– 3 –

MYTH: It makes everyone study better. FACT: Many people that take unprescribed prescription stimulants experience anxiety, nervousness, loss of appetite and sleep deprivation—all of which interferes with studying and performance on exams.

– 4 –

MYTH: Stimulants are harmless. FACT: Data gathered from emergency room visits show that unprescribed stimulants can cause anxiety, sleep deprivation, stroke, psychosis and—perhaps most surprisingly to teens—addiction.

– 5 –

MYTH: Mixing stimulants with alcohol is safe and will help me stay awake and drink longer. FACT: Since stimulants can mask the effects of alcohol and cause the user to consume more alcohol than they normally would, mixing stimulants with alcohol puts “uppers” and “downers” at odds with each other, and thus increases the likelihood of DUI, alcohol poisoning, accidents and even death.

 

Talk with your teen to help them understand the dangers of prescription stimulant abuse and how they can better handle pressure they may feel to abuse this medicine. Be sure to:

  • Offer empathy and compassion to your teens and let them know you understand the pressure and stress they may be going through.
  • Acknowledge that everyone struggles sometimes, but taking prescription stimulants is not a useful or healthy way to cope.
  • Remind them that you are there for support and guidance – and that it’s important to you that they are healthy and happy and make safe choices.
KEY TAKEAWAYS:

To Help Your College Student Handle Stress and Anxiety:

  • Talk regularly about the dangers of drinking and using drugs, including abusing prescription drugs not prescribed to him or her.
  • Help him or her discover what healthy study methods work best. Look into time management and study techniques so he or she can be better organized and not have to cram for tests.
  • Explore study and stress management resources and programs at your child’s school and in your community.

Watch the trailer for BREAKING POINTS, our film exploring teen stress and pressure and the unhealthy ways many cope, including abusing Rx stimulants.

We thank Dr. Josh Hersh, Staff Psychiatrist at Florida Gulf Coast University, for his help in preparing this post.

The post School Stress: 5 Myths About Stimulant Abuse appeared first on Partnership for Drug-Free Kids.

Categories: Bup Feeds

First Dutch national guidelines--pharmacological care for detained opioid addicts.

Buprenorphine Research (PubMed) - Wed, 08/31/2016 - 6:37am
Related Articles

First Dutch national guidelines--pharmacological care for detained opioid addicts.

Int J Prison Health. 2009;5(4):192-200

Authors: Arends MT, De Haan HA, Van 't Hoff GI

Abstract
Heterogenic care of addicted detainees in the various prisons in The Netherlands triggered the National Agency of Correctional Institutions of the Ministry of Justice, to order the Dutch Institute for Health Care Improvement (CBO) to formulate the first national guideline titled 'Pharmacological care for detained addicts'. This article presents the content of this guideline, which mainly focuses on opioid-dependent addicts. In The Netherlands, approximately 50% of the detainees are problematic substance abusers, while again half of this group suffers from psychiatric co-morbidity. In addition, somatic co-morbidity, especially infectious diseases, is also common. Due to the moderate outcome seen with voluntary drug counselling regimes in prison, there is a policy shift to extent utilization of legally enforced approaches. Continuity of care is of great importance. In case of opioid addicts this, in general, means continuation of methadone maintenance treatment. Aftercare immediately after detention and optimalization of medical information transfer is crucial. This guideline aims to realize optimal and uniform management of addiction disorders in the Dutch prison system.

PMID: 25757520 [PubMed - in process]

Categories: Bup Feeds

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