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Evaluation of the perioperative analgesic efficacy of buprenorphine, compared with butorphanol, in cats.

Buprenorphine Research (PubMed) - Wed, 07/02/2014 - 7:00am

Evaluation of the perioperative analgesic efficacy of buprenorphine, compared with butorphanol, in cats.

J Am Vet Med Assoc. 2014 Jul 15;245(2):195-202

Authors: Warne LN, Beths T, Holm M, Carter JE, Bauquier SH

Abstract
Objective-To compare the analgesic effects of buprenorphine and butorphanol in domestic cats. Design-2-phase positive-controlled randomized masked clinical trial. Animals-39 healthy female cats (10 in phase 1 and 29 in phase 2). Procedures-Cats admitted for ovariohysterectomy received buprenorphine (4 in phase 1; 14 in phase 2) or butorphanol (6 in phase 1; 15 in phase 2). In phase 1, cats were premedicated with buprenorphine (0.02 mg/kg [0.009 mg/lb], IM) or butorphanol (0.4 mg/kg [0.18 mg/lb], IM), in combination with medetomidine. Anesthesia was induced with propofol (IV) and maintained with isoflurane in oxygen. After extubation, medetomidine was antagonized with atipamezole. A validated multidimensional composite scale was used to assess signs of pain after surgery starting 20 minutes after extubation and continuing for up to 360 minutes, and pain score comparisons were made between the 2 groups. Phase 2 proceeded similar to phase 1 with the following addition: during wound closure, cats from the butorphanol and buprenorphine groups received butorphanol (0.4 mg/kg, IM) or buprenorphine (0.02 mg/kg, IM), respectively. Results-Phase 1 of the study was stopped after 10 cats were ovariohysterectomized because 9 of 10 cats required rescue analgesia at the first evaluation. In phase 2, at the first pain evaluation, pain scores from the buprenorphine group were lower, and all cats from the butorphanol group required rescue analgesia. None of the cats from the buprenorphine group required rescue analgesia at any time. Conclusions and Clinical Relevance-Buprenorphine (0.02 mg/kg, IM) given before surgery and during wound closure provided adequate analgesia for 6 hours following ovariohysterectomy in cats, whereas butorphanol did not.

PMID: 24984130 [PubMed - as supplied by publisher]

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CYP2D6-Inhibiting Drugs and the Increased Risk of Fall-Related Injuries due to Newly Initiated Opioid Treatment - a Swedish, Register-based Case Cross-over Study.

Buprenorphine Research (PubMed) - Tue, 07/01/2014 - 7:30am

CYP2D6-Inhibiting Drugs and the Increased Risk of Fall-Related Injuries due to Newly Initiated Opioid Treatment - a Swedish, Register-based Case Cross-over Study.

Basic Clin Pharmacol Toxicol. 2014 Jun 30;

Authors: Möller J, Laflamme L, Löfdal KS

Abstract
It has been shown that newly initiated opioid therapy increases the risk of fall-related injuries. Yet, it remains to be determined whether drug-drug interactions can affect this negative effect, for instance with drugs inhibiting cytochrome P4502D6 (CYP2D6) that metabolizes codeine, and also has a partial effect on tramadol and oxycodone. Our aim was to investigate how CYP2D6-inhibiting drugs contribute to explaining the risk of fall-related injuries for newly initiated opioid treatments with codeine, tramadol or oxycodone. Data from a Swedish national case cross-over study were revisited. This study identified a total of 167,257 fall-related injuries leading to hospitalization that occurred between 1 May 2006 and 31 December 2009 and linked information about dispensed drugs to them. Use of newly dispensed opioids in the 28 days before fall-related injury with and without CYP2D6-inhibiting drugs was compared with an earlier control period. For codeine, there was a two-fold elevated risk with concomitant CYP2D6-inhibiting drug use (OR, 1.76; 95% CI 1.40-2.20) and a three-fold risk increase without (OR, 3.17; 95% CI 2.88-3.50). For tramadol, the risks were doubled when CYP2D6-inhibiting drugs were used (OR, 2.19; 95% CI 1.84-2.60) and tripled without their use (OR, 3.04; 95% CI 2.82-3.27). The risks were about the same for oxycodone, morphine, fentanyl and buprenorphine irrespective of CYP2D6-inhibiting drug use. In newly initiated opioid therapies, drug-drug interactions from concomitant use of CYP2D6-inhibiting drugs are associated with a lower risk of fall-related injury for codeine and tramadol that undergo metabolism via CYP2D6, but not for other opioids. This article is protected by copyright. All rights reserved.

PMID: 24975450 [PubMed - as supplied by publisher]

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A Pilot Study of a Distress Tolerance Treatment for Opiate-Dependent Patients Initiating Buprenorphine: Rationale, Methodology, and Outcomes.

Buprenorphine Research (PubMed) - Sun, 06/29/2014 - 8:00am
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A Pilot Study of a Distress Tolerance Treatment for Opiate-Dependent Patients Initiating Buprenorphine: Rationale, Methodology, and Outcomes.

Behav Modif. 2014 Jun 27;

Authors: Brown RA, Bloom EL, Hecht J, Moitra E, Herman DS, Stein MD

Abstract
Buprenorphine, an opioid that is a long-acting partial opiate agonist, is an efficacious treatment for opiate dependence that is growing in popularity. Nevertheless, evidence suggests that many patients will lapse within the first week of treatment and that lapses are often associated with withdrawal-related or emotional distress. Recent research suggests that individuals' reactions to this distress may represent an important treatment target. In the current study, we describe the development and outcomes from a preliminary pilot evaluation (N = 5) of a novel distress tolerance (DT) treatment for individuals initiating buprenorphine. This treatment incorporates exposure-based and acceptance-based treatment approaches that we have previously applied to the treatment of tobacco dependence. Results from this pilot study establish the feasibility and acceptability of this approach. We are now conducting a randomized controlled trial of this treatment that we hope will yield clinically significant findings and offer clinicians an efficacious behavioral treatment to complement the effects of buprenorphine.

PMID: 24973401 [PubMed - as supplied by publisher]

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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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