Bup Feeds

Pharmacists' readiness to provide naloxone in community pharmacies in West Virginia.

Tue, 02/07/2017 - 8:34am
Related Articles

Pharmacists' readiness to provide naloxone in community pharmacies in West Virginia.

J Am Pharm Assoc (2003). 2017 Feb 02;:

Authors: Thornton JD, Lyvers E, Scott VG, Dwibedi N

Abstract
OBJECTIVES: The objective of this study is to assess West Virginia pharmacists' stocking and dispensing practices of opioid-related medications and to identify the educational needs relating to providing naloxone in community pharmacies.
DESIGN: A cross-sectional, anonymous, 49-item survey was created and validated to assess the educational needs of West Virginia community pharmacists.
SETTING: West Virginia.
PARTICIPANTS: The data collection instrument was administered to 266 pharmacists currently licensed in West Virginia at 6 continuing pharmacy education events throughout the state from March 1 to June 15, 2016.
OUTCOME MEASURES: Pharmacists' educational needs were determined using the Extended Parallel Process Model, which has 4 main constructs: perceived severity, perceived susceptibility, response efficacy, and self-efficacy. Pharmacists' stocking and dispensing of opioids and related medications were also assessed.
RESULTS: Pharmacists completed 157 surveys. They were mostly male (56.1%), full-time employees (67.5%), worked mostly in community pharmacies (69.4%), and had a mean age of 50.19 years (SD = 13.62). The newly adapted opioid perceived efficacy and perceived severity of opioid adverse events scales were tested for reliability and validity. Only 20.4% of the community pharmacists surveyed felt comfortable selling naloxone without a prescription. As for the other opioid-related medications, only 53.3% stocked buprenorphine and 74.8% stocked buprenorphine/naloxone.
CONCLUSIONS: As the most accessible health care providers, community pharmacists are acutely aware of how the opioid epidemic affects their communities. Some pharmacists in West Virginia are hesitant to stock and dispense opioids and opioid-dependence medications. Although this may decrease the flow of potentially abused drugs into the community, it may also restrict access to necessary therapy for patients with opioid use disorder. Furthermore, pharmacists in West Virginia are not yet comfortable stocking and dispensing naloxone. Tailored educational materials can help in controlling the pharmacists' fear and reinforce the benefits of over-the-counter naloxone use.

PMID: 28163027 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Examination of the Hepatitis C Virus care continuum among individuals with an opioid use disorder in substance use treatment.

Tue, 02/07/2017 - 8:34am
Related Articles

Examination of the Hepatitis C Virus care continuum among individuals with an opioid use disorder in substance use treatment.

J Subst Abuse Treat. 2017 Feb 02;:

Authors: Brown JL, Gause NK, Lewis D, Winhusen T

Abstract
BACKGROUND: Hepatitis C Virus (HCV) risk is elevated for individuals with an opioid use disorder (OUD). Routine HCV testing is recommended for high-risk individuals, including those with an injection drug use history. HCV antibody testing addresses the first step in the HCV treatment care cascade, with uptake and completion of HCV treatment among individuals with chronic HCV as the optimal care cascade endpoint. The aim of this study was to characterize self-reported HCV treatment cascade outcomes among individuals with an OUD in outpatient medication assisted treatment (MAT).
METHODS: Individuals receiving methadone or buprenorphine treatment (N=202, 67.8% female, M age=35.0, SD=8.4) completed a brief, anonymous paper-and-pencil survey examining self-reported history of HCV testing, diagnosis, and treatment. Descriptive statistics characterized HCV treatment cascade outcomes.
RESULTS: A majority (79.3%) endorsed a lifetime HCV testing history; 34.9% were tested for HCV during the past year. Of those with a lifetime HCV testing history, 42.7% indicated they have been told they have HCV (n=67/157), with 21% (n=14/67) of those individuals reporting that they have been told they have chronic HCV, and 71.4% (n=10/14) of those with chronic HCV reporting receipt of HCV treatment.
DISCUSSION: Results underscore gaps in the HCV care continuum among individuals with OUD in MAT. Interventions to increase uptake of HCV testing, communication of HCV diagnostic and treatment information by medical providers, linkage to HCV medical care, and uptake and adherence to HCV treatment are urgently needed, particularly among individuals with an OUD in MAT.

PMID: 28162850 [PubMed - as supplied by publisher]

Categories: Bup Feeds

(456) Factors impacting the relative bioavailability of a new formulation of buprenorphine.

Tue, 02/07/2017 - 8:34am
Related Articles

(456) Factors impacting the relative bioavailability of a new formulation of buprenorphine.

J Pain. 2016 Apr;17(4S):S88

Authors: Priestley T, Xiang S, Vasisht N, Cheruvu N

PMID: 28162703 [PubMed - in process]

Categories: Bup Feeds

7 Ways to Show Love this Valentine’s Day

Mon, 02/06/2017 - 11:43am

It’s the season of love. Here are 7 easy ways you can show love and kindness, while also supporting families who need help for a loved one struggling with substance use or addiction.

1. Send a Loving and Supportive Message
Our eCards are a terrific expression of encouragement and can show how much you support a loved one in recovery.
Send an eCard >

2. Uncover a Unique Gift
Check out India Hicks, the destination to find unique bags, accessories, jewelry and fragrance to pamper the one you love. They are hosting a charity shopping online event from now through Wednesday, February 8, 2017. Ten percent of event sales will go toward our work to help families.
Shop India Hicks >

3. Give a Heart
Read one of our Stories of Hope and leave an encouraging comment to someone in recovery. “Heart” a story to share some love – just click on the heart.
Show some love >

4. Offer Empathy and Compassion
When talking with your teen or young adult – especially about difficult topics like drug and alcohol use – try to express your understanding of how he or she may be feeling. It’s not always easy but it will help you engage better with your child and promote open and positive communication.
Set the stage for positive change >

5. Take Care of You
As parents, we often find ourselves taking care of everyone else, before we take care of ourselves. Taking care of yourself is VITAL to helping your child and the rest of the family.
Make a self-care promise >

6. Find (Almost) Any Gift at Amazon
Shop AmazonSmile and we will receive 0.5% of your total purchases from Amazon. AmazonSmile is the same Amazon you know. Just use the URL www.smile.amazon.com instead of www.amazon.com. Then enter our name – Partnership for Drug-Free Kids – as your charitable organization.
Shop AmazonSmile this Valentine’s Day >

7. Donate $14 (or more!)
Did you know that $25 trains one local professional to deliver community education on substance use? Consider making a donation to the Partnership and your dollars will immediately make a difference in the lives of families looking for support and guidance for a child’s addiction. We are grateful for whatever you can give.
Make a donation today >

Thank you for your continued support of the Partnership for Drug-Free Kids. Your generosity will help provide families with the tools they need to take effective action for their son or daughter’s substance use and addiction. We are grateful for your thoughtfulness and wish you and your family a healthy and happy Valentine’s Day.

The post 7 Ways to Show Love this Valentine’s Day appeared first on Partnership for Drug-Free Kids.

Categories: Bup Feeds

Substance use, treatment, and demographic characteristics of pregnant women entering treatment for opioid use disorder differ by United States census region.

Mon, 02/06/2017 - 8:31am
Related Articles

Substance use, treatment, and demographic characteristics of pregnant women entering treatment for opioid use disorder differ by United States census region.

J Subst Abuse Treat. 2017 Feb 01;:

Authors: Hand DJ, Short VL, Abatemarco DJ

Abstract
Opioid use disorder (OUD) among pregnant women increased substantially between 1992 and 2012 across the United States, with the greatest increases occurring in the southern states. We analyzed the 2013 Treatment Episodes Database-Admissions to determine how substances used, characteristics of treatment, and demographics of pregnant women entering treatment for opioid use disorder vary between geographical regions. Analyses were restricted to cases where women reported being pregnant at the time of admission and reported opioids as the primary substance problem leading to the treatment admission. Characteristics were compared between U.S. census regions using Chi-square tests and logistic regression with the South census region as the reference group. Compared to the South, pregnant women admitted for OUD treatment in other regions were 33-79% less likely to use benzodiazepines, twice as likely to be admitted to medication assisted treatment (MAT), 2-3 times more likely to use heroin, and up to 1.5 times more likely to inject drugs. Fewer women in the South reported having medical insurance, education beyond high school, and being married. There is a need in the southern U.S. for policies and treatment programs to target reducing concomitant opioid and benzodiazepine use, increasing access to, and utilization of, MAT, and increasing access to medical insurance.

PMID: 28161143 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Effects of Buprenorphine, Methylnaltrexone, and Their Combination on Gastrointestinal Transit in Healthy New Zealand White Rabbits.

Mon, 02/06/2017 - 8:31am
Related Articles

Effects of Buprenorphine, Methylnaltrexone, and Their Combination on Gastrointestinal Transit in Healthy New Zealand White Rabbits.

J Am Assoc Lab Anim Sci. 2017 Feb 02;:

Authors: Martin-Flores Bhupinder Singh Courtney A Walsh Elizabeth P Brooks Laci C Taylor And Lisa M Mitchell M

Abstract
Among the many analgesic agents available, buprenorphine appears to be the analgesic used most often in rabbits. Unfortunately,deleterious side effects of opioids, such as gastrointestinal stasis and anorexia, may discourage the use of these agents.Methylnaltrexone is a peripheral opioid antagonist that ameliorates opioid-induced gastrointestinal stasis in others species yet preserves the analgesic effects of buprenorphine. We evaluated whether methylnaltrexone reversed buprenorphine-inducedgastrointestinal stasis in 8 healthy male New Zealand White rabbits. To measure gastrointestinal transit time, each rabbitreceived 20 barium-filled spheres through an orogastric tube. Rabbits then received 4 treatments in random order: buprenorphine(0.05 mg/kg SC), methylnaltrexone (1 mg/kg SC), both agents combined (B+M), or normal saline (control) every 12 h for2 d. Fecal production was measured every 6 h, and water and food consumption, and body weight, were measured daily, for 5d after each treatment. The time to appearance of the first sphere was significantly longer for buprenorphine group than forcontrol and methylnaltrexone groups. Daily fecal output was lowest for buprenorphine and B+M, intermediate for control,and highest for methylnaltrexone. Water and food consumption were lower for groups buprenorphine and B+M than for control and methylnaltrexone. Body weight was not affected. In conclusion, treatment with buprenorphine 0.05 mg/kg BID for 2 d in healthy rabbits decreased food and water consumption, prolonged gastrointestinal transit time and decreased the fecal output. Coadministration of methylnaltrexone at 1 mg/kg did not alleviate these negative side effects.

PMID: 28155805 [PubMed - as supplied by publisher]

Categories: Bup Feeds

The Super Bowl Takes Courage, Perseverance and Teamwork. So Did Our Sons’ Recovery.

Fri, 02/03/2017 - 11:16am

My family lives in New England and we are huge Patriots fans – we have lots to be excited about.

I’m the father of two sons whom I love very much and am very proud of. I believe my sons work as hard as professional football players do. Every day they overcome adversity and accomplish the task at hand. The ultimate prize isn’t a Super bowl ring, though. The stakes are much higher. The opponent they faced was cunning and powerful enough to exert a deadly grip. What was the serious struggle they both tackled? Substance use.

This has impacted our entire family. At times, my sons fought with all the strength and determination they could muster from their body, mind and spirit. They had treatment and support from friends and family. We stayed in their corner, believed in them and cheered for them.

Young people struggling with substance use and those early on their path to getting well need all the help they can get. As do their parents or primary caregivers.

Do you have a son or daughter who is struggling with substance use? I hope Super Bowl Sunday presents an opportunity for you to have empathy for your child. If you watch the game together, could you lead by example? Would you need to have alcohol there? Consider offering an alcohol-free beverage and have one, too.

Save any urges to argue with your son or daughter. Scream at the game on TV instead. You don’t need to get into a heavy discussion about drugs and alcohol (despite alcohol being advertised heavily during the game.) Call a time out if you need to remind yourself about what is most important to you and your family. (I know, sometimes, easier said than done.)

An opportunity might present itself to tell your son or daughter that they can always count on you and come to you for support, guidance or just to spend time together. Try to catch your child doing something good and let him or her know it. Share a fond memory, make his or her favorite appetizer or give a simple pat on the back – or whatever connection you both need to break the ice.

If you can’t be with your child, a brief phone call can remind him or her how much you care.

My wife and I chose to advocate for our sons when they could not advocate for themselves, especially concerning treatment. We helped them navigate what’s often a broken system of care. We helped to open doors to treatment, but once inside, they did all the heavy lifting. We remained engaged by trying to encourage and motivate them to get well and feel better about themselves. We chose to look at all the good inside them and to believe in them. We may have hated the drugs, but we never stopped loving our kids. Rather than detaching, I guess we attached with love. However, we did let them suffer the negative consequences of their actions. And I certainly cleaned up more messes than I should have based on what I know now.

Today they are fine young men with integrity and wisdom beyond their years. They are my heroes. I’m proud to say they have been on a good path for a very long time. For my youngest son, who is now 29, that means almost 10 years in recovery. And for my oldest son, almost six years. I have learned so much from them and my extremely supportive wife, who has been an amazing mother throughout it all.

This Super Bowl Sunday my family has a lot to be grateful for.

The more we encourage positive change in each other, the more lives can be saved. More families can heal. More young people can get well and go on to realize their tremendous potential.

GO, all you kids out there who are still struggling! We are here for you and believe in you!
GO, all you kids who are on a healthy path of recovery!
GO, all you wonderful, supportive parents!
GOOOOOOOOOOO PATRIOTS!

Paul’s Recommended Reading and Resources:

* Learn strategies to help families deal with their child’s substance use.

* Read Beyond Addiction: How Science and Kindness Help People Change and The Parent’s 20-Minute Guide.

* If you are concerned about your child’s drug or alcohol use, visit Get Help and call the Partnership’s Toll-Free Helpline to speak with a trained and caring, master’s-level support specialist about your child’s at 1-855-DRUGFREE (1-855-378-4373).

The post The Super Bowl Takes Courage, Perseverance and Teamwork. So Did Our Sons’ Recovery. appeared first on Partnership for Drug-Free Kids.

Categories: Bup Feeds

An Open Letter to My Son or Anyone with a Drug Addiction

Thu, 02/02/2017 - 1:05am

In 2010, Ron Grover wrote an open letter to his son with a drug addiction, or anyone with a drug or alcohol addiction, that still moves us today. Writing a letter to your son or daughter who is struggling with dependence or addiction can be cathartic for both the parent and child.

It can also allow you to express the caring and emotion you feel that might be harder to communicate in person.

Read Ron’s letter below and ask yourself if letter writing might be a good option for you. Tell us: What you would write to your son or daughter?

Dear Son,

Life is not easy. It’s not easy if you have a drug addiction — or even if you don’t. It’s all about evolution. The strong survive. It’s not just about physical strength; it is more about mental strength. Do you have the will to survive? Do you have the strength to make it one more day?

As a person who has never had a drug addiction or alcoholism, I can only speak from that perspective. My insight into your world is only through observation. I do not wish to walk in your shoes. But I can tell you what it is like to walk in mine – if you are serious about recovery.

Every day I have unfulfilled wants and they are not centered on anyone else. It may seem selfish, but I believe that the center of one’s being can only revolve around oneself. I want things, I want different feelings, I want changes in others, I want, I want, I want. It really never ends. I believe that desire is no different for anyone – a person with a drug addiction and those without.

Daily there are people out there telling you, “No” – a boss, friends, parents, spouses, and significant others – that is just a part of life. Disappointment and hurt is as much a part of living as joy, happiness and love. Hurt is the same for those with an addiction as it is for those without. The difference is how we react to and cope with our emotions, whether they are good or bad. I don’t know what drugs do for a person with an addiction to help cope with disappointment. I don’t know how drugs heighten the joy of happiness. But I do know that my life would be very monochromatic without the peaks and valleys.

I have no doubt from observing you that you hated every day that you were using drugs. I can see how your life was out of control, spiraling into a pit of hurt and despair. You became so lost that the helping hands of others could not even be grasped.

I see your struggles with being clean. More pain than joy. It’s a time in your life where the scales are not balanced. You are working so hard to survive but everyone is saying, no.  There are so many frustrations. What is the use, you may wonder?

There is one place where no one will say no. There is one life that will accept you. The life of drug use that you have known for the last several years. That is the easy path to take.

But, please know that the immediate pain you feel now will eventually fade.

Just as when my father died, there was terrible pain for me. I wanted to pick up the phone and call him, but I knew I couldn’t. I wanted one last time, for old times’ sake, but I couldn’t. I flashed back to all the good times, but they were not to be any more. I believe that feeling of loss is something similar to what you are experiencing in order to live on. Your old life must die – and there is tremendous pain with that death. Each day you will want to use just one more time. Time may heal all wounds but sometimes the scars are there forever.

In time, the scales will balance and you will experience more joy than pain. But for now you must travel the difficult path and find the will to survive. You will become stronger each time you choose to steer away from that dangerous and tempting path at the fork in the road. It may be hard to see because the path to recovery is difficult. But please know you are not walking alone – hands of help are reaching out to you with your every step.

 

The post An Open Letter to My Son or Anyone with a Drug Addiction appeared first on Partnership for Drug-Free Kids.

Categories: Bup Feeds

The Opioid Epidemic: What Does it Mean for Nurses?

Tue, 01/31/2017 - 6:20am

The Opioid Epidemic: What Does it Mean for Nurses?

J Psychosoc Nurs Ment Health Serv. 2017 Jan 01;55(1):18-23

Authors: Leahy LG

Abstract
The United States is facing a major crisis with the current opioid epidemic. Tens of thousands of individuals are dying each year due to abuse and misuse of heroin and prescription opiate drugs. Nurses play an integral role in these aspects of health care and offer solutions by providing education; preventive measures; treatments, including medication-assisted treatments (MATs); and ongoing recovery options for individuals with opioid use disorders. Nurses provide education, issue prescriptions and dispense medications, and provide overall physical and mental health care to patients struggling with this "disease of the brain," and with the signing of the Comprehensive Addiction and Recovery Act, advanced practice RNs will soon be able to include MATs related to buprenorphine as part of their treatment plan. The current article explores the anatomy, physiology, and genetics of addiction and how they relate to the pharmacological MATs used to treat opioid use disorders. [Journal of Psychosocial Nursing and Mental Health Services, 55(1), 18-23.].

PMID: 28135387 [PubMed - in process]

Categories: Bup Feeds

Self-reported Sleep Improvement in Buprenorphine MAT (Medication Assisted Treatment) Population.

Tue, 01/31/2017 - 6:20am
Related Articles

Self-reported Sleep Improvement in Buprenorphine MAT (Medication Assisted Treatment) Population.

Austin J Drug Abuse Addict. 2016;3(1):

Authors: Zheng WH, Wakim RJ, Geary RC, Lander LR, Wen SJ, Xiao MC, Sullivan CR

Abstract
This is a prospective, naturalistic study to evaluate patient's report on sleep and depression in early recovery while receiving buprenorphine in Medication Assisted Treatment (MAT). 40 Subjects entering into MAT with buprenorphine/naloxonefor opioid dependence disorder were recruited. No change of concurrent treatment was made. Subjects were administered Sleep Scale from the Medical Outcomes Study (MOS-Sleep), a 5-item Supplemental Sleep Scale (SSS), and the Beck Depression Inventory II (BDI-II). The measures were administered at day 0 (baseline), 30, 60 and 90 days. The result showed that patients reported significant progressive improvements in three MOS-Sleep subscales: sleep disturbance, sleep indices I and II. The mean scores of SLPD4 (Sleep disturbance) at day 0, 30, 60, 90 were 62.4, 53.2, 53.3, and 48.4 respectively (p=0.0029). Similarly, subscores of SLP6 (Sleep Problem Index I) and SLP 9 (Sleep Problem Index II) were also significantly decreased over time (P=0.038 for SLP6 and p=0.007 for SLP9). BDI-II depression scores improved from "Moderate depression" at baseline to "Mild depression". The mean BDI score decreased from 24.2 to 17.0 after 90 days of treatment. Findings suggest that subjects reported improvement in both sleep and depression after initiating MAT with buprenorphine/naloxone.

PMID: 28133635 [PubMed - in process]

Categories: Bup Feeds

Commentary: Hypnotic Medications and Suicide: Risk, Mechanisms, Mitigation, and the FDA.

Tue, 01/31/2017 - 6:20am
Related Articles

Commentary: Hypnotic Medications and Suicide: Risk, Mechanisms, Mitigation, and the FDA.

Front Psychiatry. 2016;7:210

Authors: Ruan X, Luo JJ, Kaye AD

PMID: 28133451 [PubMed - in process]

Categories: Bup Feeds

Drug safety and adverse drug reaction reporting behavior related to outpatient opioid replacement therapy: Results from a survey among physicians.

Tue, 01/31/2017 - 6:20am
Related Articles

Drug safety and adverse drug reaction reporting behavior related to outpatient opioid replacement therapy: Results from a survey among physicians.

J Subst Abuse Treat. 2017 Mar;74:7-15

Authors: Gahr M, Eller J, Cabanis M, Hiemke C, Freudenmann RW, Connemann BJ, Lang D, Schönfeldt-Lecuona C

Abstract
To study drug safety and the reporting behavior of adverse drug reactions (ADR) related to agents used for opioid replacement therapy (ORT) we conducted a cross-sectional questionnaire-based telephone survey among physicians who provide outpatient ORT in Germany (n=176; response rate=55.7%). Most respondents (n=97/55.1%) reported that they observe ADR related to buprenorphine, (dihydro)codeine, and (levo)methdone rarely (n=38/21.6%), very rarely (n=39/22.2%) or never (n=20/11.4%). Methadone was reported to be most frequently associated with the occurrence of ADR (n=82/46.6%), followed by levomethadone (n=33/18.8%), buprenorphine (n=6/3.4%), and dihydrocodeine (n=3/1.7%). Frequently observed ADR related to these agents were gastrointestinal, nervous system/psychiatric disorders, and hyperhidrosis. Methadone and levomethadone (not buprenorphine) were frequently associated with fatigue, weight gain, and sexual dysfunction. Hundred twenty nine participants (73.3%) stated that they never report ADR related to ORT; n=19 (10.8%) did so when referring to ADR related to their complete medical practice (X(2)=141.070; df=1; p<0.001). Similar patterns of ADR related to outpatient ORT as those reported in the product information or in pain therapy were found. Motivation to report ADR related to ORT may be reduced compared to ADR related to the general medical practice.

PMID: 28132703 [PubMed - in process]

Categories: Bup Feeds

Long-term retention in Office Based Opioid Treatment with buprenorphine.

Tue, 01/31/2017 - 6:20am
Related Articles

Long-term retention in Office Based Opioid Treatment with buprenorphine.

J Subst Abuse Treat. 2017 Mar;74:65-70

Authors: Weinstein ZM, Kim HW, Cheng DM, Quinn E, Hui D, Labelle CT, Drainoni ML, Bachman SS, Samet JH

Abstract
BACKGROUND: Guidelines recommend long-term treatment for opioid use disorder with buprenorphine; however, little is known about patients in long-term treatment. The aim of this study is to examine the prevalence and patient characteristics of long-term treatment retention (≥1year) in an Office Based Opioid Treatment (OBOT) program with buprenorphine.
METHODS: This is a retrospective cohort study of adults on buprenorphine from January 2002 to February 2014 in a large urban safety-net primary care OBOT program. The primary outcome was retention in OBOT for at least one continuous year. Potential predictors included age, race, psychiatric diagnoses, hepatitis C, employment, prior buprenorphine, ever heroin use, current cocaine, benzodiazepine and alcohol use on enrollment. Factors associated with ≥1year OBOT retention were identified using generalized estimating equation logistic regression models. Patients who re-enrolled in the program contributed repeated observations.
RESULTS: There were 1605 OBOT treatment periods among 1237 patients in this study. Almost half, 45% (717/1605), of all treatment periods were ≥1year and a majority, 53.7% (664/1237), of patients had at least one ≥1year period. In adjusted analyses, female gender (Adjusted Odds Ratio [AOR] 1.55, 95% CI [1.20, 2.00]) psychiatric diagnosis (AOR 1.75 [1.35, 2.27]) and age (AOR 1.19 per 10year increase [1.05, 1.34]) were associated with greater odds of ≥1year retention. Unemployment (AOR 0.72 [0.56, 0.92]), Hepatitis C (AOR 0.59 [0.45, 0.76]), black race/ethnicity (AOR 0.53 [0.36, 0.78]) and Hispanic race/ethnicity (AOR 0.66 [0.48, 0.92]) were associated with lower odds of ≥1year retention.
CONCLUSIONS: Over half of patients who presented to Office Based Opioid Treatment with buprenorphine were ultimately successfully retained for ≥1year. However, significant disparities in one-year treatment retention were observed, including poorer retention for patients who were younger, black, Hispanic, unemployed, or with hepatitis C.

PMID: 28132702 [PubMed - in process]

Categories: Bup Feeds

Buprenorphine prescribing practice trends and attitudes among New York providers.

Tue, 01/31/2017 - 6:20am
Related Articles

Buprenorphine prescribing practice trends and attitudes among New York providers.

J Subst Abuse Treat. 2017 Mar;74:1-6

Authors: Kermack A, Flannery M, Tofighi B, McNeely J, Lee JD

Abstract
Buprenorphine office-based opioid maintenance is an increasingly common form of treatment for opioid use disorders. However, total prescribing has not kept pace with the current opioid and overdose epidemic and access remains scarce among the underserved. This study sought to assess current provider attitudes and clinical practices among a targeted sample of primarily New York City public sector buprenorphine prescribers. A cross-sectional online survey purposefully sampled buprenorphine prescribers in NYC with a focus on those serving Medicaid and uninsured patient populations. Expert review of local provider networks, snowball referrals, and in-person networking generated an email list, which received a survey link. A brief 25-question instrument queried provider and practice demographics, prescribing practices including induction approaches and attitudes regarding common hot topics (e.g., buprenorphine diversion, prescriber patient limits, insurance issues, ancillary treatments). Of 132 email invitations, N=72 respondents completed (n=64) or partially completed (n=8) the survey between January and April 2016. Most (79%) were Medicaid providers in non-psychiatric specialties (72%), working in a hospital-based or community general practice (51%), and board-certified in addiction medicine or psychiatry (58%). Practice sizes were generally 100 patients or fewer (71%); many providers (64%) individually prescribed buprenorphine <25% of total practice time to a median 23 patients (mean 31, range 0-102). Unobserved (home) induction for new patients was a common practice: 49% predominantly prescribed unobserved induction; 16% mixed unobserved and observed inductions. Adjunctive psychosocial counseling was routinely recommended (46%) or considered on a case-by-case basis (17%) versus mandated (37%). Medication prior authorization requirements were the highest rated barriers to practice, followed by inadequate clinic space, limited clinic time and/or support staff, and inadequate psychiatric services for dual diagnoses. Buprenorphine diversion was not rated as an important practice barrier. In conclusion, this targeted survey of buprenorphine prescribers in NYC treating primarily underserved populations showed a consistent pattern of part-time prescribing to modest volumes of patients, routine use of unobserved buprenorphine induction, and primarily elective referrals to psychosocial counseling. Barriers to prescribing included prior authorization requirements, lack of clinical resources (space, staff) and psychiatric services. Federal and local efforts to reduce such barriers may improve buprenorphine access among the underserved.

PMID: 28132694 [PubMed - in process]

Categories: Bup Feeds

Urine drug testing results and paired oral fluid comparison from patients enrolled in long-term medication-assisted treatment in Tennessee.

Tue, 01/31/2017 - 6:20am
Related Articles

Urine drug testing results and paired oral fluid comparison from patients enrolled in long-term medication-assisted treatment in Tennessee.

J Subst Abuse Treat. 2017 Jan 25;:

Authors: Miller KL, Puet BL, Roberts A, Hild C, Carter J, Black DL

Abstract
Urine drug testing is recommended for individuals receiving medication-assisted treatment. It provides objective information for practitioners to consider and may serve as a protective factor against drug-related mortality. The primary objective of our study was to describe urine drug testing results for patients undergoing long-term medication-assisted treatment (≥6months). The secondary objective was to provide further evidence to establish oral fluid as a reliable alternative to urine. All subjects (n=639) included in the study were enrolled in one of five treatment centers in the state of Tennessee, and all urine specimens were positive for either methadone or buprenorphine. Nicotine (87%), caffeine (70%), marijuana (15%), alcohol (14%) and gabapentin (10%) were the most prevalent substances identified through urine drug testing. The presence of non-maintenance opioids (prescription and/or heroin) may represent relapse; these drugs were present in 10% of specimens tested. Evidence of illicit drug use (cocaine, heroin, marijuana and/or methamphetamine) was detected in 19% specimens. For 126 of the 639 subjects included in the study, paired oral fluid and urine test results were compared for agreement. Of the total paired urine and oral fluid tests, approximately 7% were positive for a drug in both specimen types and 91% were negative in both, resulting in an overall agreement of 98%. The study demonstrates continued use of illicit and commercially available medications in a medication-assisted treatment population undergoing long-term treatment. The results affirm the reliability of oral fluid as an alternative specimen type for compliance testing in this population.

PMID: 28131519 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Monitoring Intravenous Abuse of Methadone or Buprenorphine in Opiate Maintenance Treatment (OMT): A Simple and Fast LC-MS-MS Method for the Detection of Disaccharides in Urine Samples.

Sun, 01/29/2017 - 6:14am
Related Articles

Monitoring Intravenous Abuse of Methadone or Buprenorphine in Opiate Maintenance Treatment (OMT): A Simple and Fast LC-MS-MS Method for the Detection of Disaccharides in Urine Samples.

J Anal Toxicol. 2017 Jan;41(1):22-31

Authors: Jungen H, Andresen-Streichert H, Müller A, Iwersen-Bergmann S

Abstract
The detection of disaccharides in urine is under investigation to act as a marker for intravenous abuse of disaccharide formulations, like liquid methadone with syrup (sucrose), methadone tablets (lactose and sucrose), or buprenorphine tablets (lactose). As the detection time in urine has not yet been investigated and a routine method for detecting disaccharides is still lacking, a study was performed to estimate the window of detection in urine after intravenous consumption of disaccharides. Furthermore, an analytical LC-MSMS method for the quantification of sucrose and lactose in urine was validated. The method was applied to urine samples of intravenous substitute consumers, with urine being sampled before intravenous use of substitutes and approximately 30 minutes later. Twenty users provided information regarding their most recent prior intravenous consumption. Disaccharides were detectable in all 20 urine samples about 30 minutes after consumption. A cut off for both disaccharides of 40mg/L was used. Based on these conditions 81% of the persons who consumed in a time frame of 24 hours ago showed positive results for disaccharides. The study showed that the validated LC-MSMS method with an easy and fast workup is usable for daily routine in the laboratory. It might be helpful for methadone and buprenorphine prescribing physicians to check whether the opiate maintenance treatment patient takes his or her substitution medicines orally as intended, or continues with intravenous misuse by injecting substitution medicines instead of heroin.

PMID: 28130543 [PubMed - in process]

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Effect of tamoxifen and brain penetrant PKC and JNK inhibitors on tolerance to opioid-induced respiratory depression in mice.

Sun, 01/29/2017 - 6:14am
Related Articles

Effect of tamoxifen and brain penetrant PKC and JNK inhibitors on tolerance to opioid-induced respiratory depression in mice.

J Pharmacol Exp Ther. 2017 Jan 27;:

Authors: Withey SL, Hill R, Lyndon A, Dewey WL, Kelly E, Henderson G

Abstract
Respiratory depression is the major cause of death in opioid overdose. We have previously shown that prolonged treatment of mice with morphine induces profound tolerance to the respiratory depressant effects of the drug (Hill et al., 2016, Neuropsychopharmacol 41:762-773). The aim of the present study was to investigate whether tolerance to opioid-induced respiratory depression is mediated by protein kinase C (PKC) and/or c-Jun N-terminal kinase (JNK). We found that whilst mice treated for up to six days with morphine developed tolerance, as measured by the reduced responsiveness to an acute challenge dose of morphine, administration of the brain-penetrant PKC inhibitors tamoxifen and calphostin C, restored the ability of acute morphine to produce respiratory depression in morphine-treated mice. Importantly reversal of opioid tolerance was dependent on the nature of the opioid ligand used to induce tolerance, as these PKC inhibitors did not reverse tolerance induced by prolonged treatment of mice with methadone nor did they reverse the protection to acute morphine-induced respiratory depression afforded by prolonged treatment with buprenorphine. We found no evidence for the involvement of JNK in morphine-induced tolerance to respiratory depression. These results indicate that PKC represents a major mechanism underlying morphine tolerance, that the mechanism of opioid tolerance to respiratory depression is ligand-dependent, and that co-administration of drugs with PKC-inhibitory activity and morphine (as well as heroin, largely metabolized to morphine in the body) may render individuals more susceptible to overdose death by reversing tolerance to the effects of morphine.

PMID: 28130265 [PubMed - as supplied by publisher]

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ANNALS EXPRESS: Do all screening immunoassay positive buprenorphine samples need to be confirmed?

Thu, 01/26/2017 - 8:07am

ANNALS EXPRESS: Do all screening immunoassay positive buprenorphine samples need to be confirmed?

Ann Clin Biochem. 2017 Jan 01;:4563216688489

Authors: Saleem M, Martin H, Tolya A, Coates P

Abstract
Background Interference from opiates in the Microgenics CEDIA(®) Buprenorphine assay is known to produce false positive buprenorphine screening immunoassay results necessitating confirmatory buprenorphine testing by chromatography/mass spectrometry methods. Method We reviewed data on falsely positive buprenorphine immunoassay screen (cut-off ≥ 5µg/L) but negative for buprenorphine by GCMS (cut-off ≥ 5µg/L) and had a positive opiate immunoassay result (cut-off ≥ 300µg/L). Results were collected over 3 months and the data were evaluated to determine whether there is an opiate immunoassay screen concentration below which a false positive buprenorphine result will not occur. Results We found that cross reactivity in the CEDIA(®) buprenorphine immunoassay by opiates at concentrations < 2000µg/L will not cause a false positive buprenorphine result. After changing our practice to not proceed with confirmatory buprenorphine GCMS assay when the opiate screening level is below an even more conservative cut-off of < 1500µg/L we estimate a potential cost saving of AU$ 17810 per year without compromising clinical care. Conclusion Samples with CEDIA(®) opiate immunoassay result <2000µg/L and a positive CEDIA(®) buprenorphine immunoassay screen do not require confirmatory testing for buprenorphine.

PMID: 28121168 [PubMed - as supplied by publisher]

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Pilot evaluation of a novel unilateral onychectomy model and efficacy of an extended release buprenorphine product.

Thu, 01/26/2017 - 8:07am
Related Articles

Pilot evaluation of a novel unilateral onychectomy model and efficacy of an extended release buprenorphine product.

BMC Vet Res. 2017 Jan 24;13(1):32

Authors: Enomoto M, Kigin PD, Bledsoe D, Slone R, Hash J, Smith CE, Lascelles BD

Abstract
BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs), transdermal fentanyl patches, and transmucosal buprenorphine are probably the most commonly used options for providing post-operative analgesia in the early at-home period. However, these require daily administration or are associated with abuse concerns. One of the significant unmet needs in veterinary surgery and pain management is for longer acting opioids for cats to effectively bridge the gap between the in-hospital and at-home recovery periods. A proof of concept study of an extended release formulation of buprenorphine HCL (ER-Bup) was conducted using objective kinetic measures and a unilateral onychectomy model. Using a blinded, randomized, two period crossover design, four cats were allocated to control (saline) or ER-Bup (0.6 mg/kg, subcutaneously [SC]) treatment groups. All animals underwent a unilateral forelimb onychectomy per period with a washout/recovery period in between. Observational pain scores and kinetic data (using a pressure sensitive walkway [PSW]) were collected prior to (baseline) and at intervals for 72 h following surgery. Symmetry indices were derived for kinetic variables (peak vertical force [PVF]; vertical impulse [VI]) of each forelimb for landing following a jump and for walking. A rescue analgesic protocol was in place. Effect of surgery and treatment were evaluated using a mixed model statistical approach.
RESULTS: No cats required rescue analgesics based on subjective pain score. ER-Bup had a positive influence on subjective pain scores during the 72 h postsurgery (p = 0.0473). PVF and VI of the operated limb were significantly decreased for both landing (p < 0.0001 and p < 0.0001) and walking (p < 0.0001 and p < 0.0001 respectively) compared to control. ER-Bup resulted in significantly decreased asymmetry in limb use during landing (PVF, p < 0.0001; VI, p < 0.0001) and walking (PVF, p = 0.0002, VI, p < 0.0001). The novel use of data collected following a jump from an elevated platform appeared to provide all desired information and was easier to collect than walking data.
CONCLUSION: This study demonstrates that SC administration of ER-Bup may be an effective analgesic for a 72 h period postoperatively. Furthermore, landing onto a PSW from an elevated perch may be a useful and efficient way to assess analgesics in cats using a unilateral model of limb pain.

PMID: 28118835 [PubMed - in process]

Categories: Bup Feeds

Si Encuentra A Su Hijo Adolescente Fumando Marihuana

Tue, 01/24/2017 - 12:17pm

Si encuentra a su hijo adolescente y a sus amigos fumando marihuana, primero que nada, no entre en pánico. Manejará la situación mejor si se mantiene calmado.

Luego, dice Phillippe Cunningham, un Ph.D. en psicología clínica y profesor asistente en el Departamento de Psiquiatría y Ciencias del Comportamiento de la Escuela de Medicina de la Universidad de South Carolina:

  • Sea bien específico y claro con su hijo al decirle que no quiere que use drogas o que se asocie con amigos que usen drogas.
  • Castigue a su hijo por asociarse con esos amigos que usan drogas quitándole sus privilegios (puede encontrar ejemplos a continuación) y recompénselo en forma positiva por asociarse con amigos que usted no crea que usen drogas u alcohol (ej., acceso a privilegios).
  • Contacte a los padres de los amigos y cuénteles que encontró a su hijo y a sus amigos (el hijo de ellos) fumando marihuana en su casa y como castigo, limitará el contacto de su hijo con el de ellos (por un mínimo de una semana, sin embargo, si los encuentra de nuevo, puede que tenga que eliminar todo contacto con ellos). El asociarse con amigos que usen drogas es el motivo principal del uso de drogas en adolescentes.
  • Contactar a los padres de los amigos de su hijo puede ayudar de varias formas: (1) le envía un mensaje claro sobre su hijo a los amigos y a sus padres de que usted habla en serio sobre no querer que su hijo use drogas, (2) a menudo, causa que otros padres castiguen a sus hijos, (3) proporciona un modelo útil para otros padres sobre qué hacer si se encontrasen en una situación parecida, (4) provoca ayuda de parte de otros al ayudar a vigilar a su hijo (en realidad “Se requiere a todo un pueblo para educar a un niño” [It Takes a Village to Raise a Child”]), y (5) puede avergonzar a su hijo, lo cual es un motivador poderoso para la mayoría de los adolescentes.
  • Si usted tiene una buena relación con su hijo adolescente, puede ser bastante poderoso el hacerle entender que él tiene que volverse a ganar su confianza a través de supervisión obligatoria. De esta manera, usted no le permitiría a su hijo estar solo en casa sin supervisión adulta (lo cual puede ser un gran inconveniente para él) y requerirle que esté siempre en casa a horas tempranas. Sin embargo, mientras su hijo le demuestre que está haciendo lo que debe de hacer de nuevo, desde tareas escolares hasta tareas en el hogar, usted puede comenzar por alargar las horas de llegada y por aumentar el tiempo en el que él esté bajo supervisión adulta (pero deberá continuar monitoreando sus andanzas y amistades).
  • Préstele atención a los esfuerzos que haga su hijo de actuar responsablemente. Ya que el uso de castigos tiene el mal efecto de debilitar la unión emocional (sin mencionar el aumento del enojo, del resentimiento y del “sigilo”) usted deberá establecer oportunidades para encontrar a su hijo portándose bien.

The post Si Encuentra A Su Hijo Adolescente Fumando Marihuana appeared first on Partnership for Drug-Free Kids.

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