Bup Feeds

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Buprenorphine Prescribing: To Expand or Not to Expand.

Buprenorphine Research (PubMed) - Fri, 04/29/2016 - 7:00am

Buprenorphine Prescribing: To Expand or Not to Expand.

J Psychiatr Pract. 2016 May;22(3):183-192

Authors: Li X, Shorter D, Kosten TR

Abstract
As a result of the prescription opioid epidemic in the United States, there has been an increasing need for effective treatment interventions, both pharmacological and nonpharmacological. Buprenorphine has emerged as a critical component of the treatment of opioid use disorder, yet its adoption has not been without some concerns. This article first reviews the pharmacology, clinical use, and US legislative action related to buprenorphine, followed by a discussion of the misuse and diversion of buprenorphine in the United States as well as internationally. We then explore the impact of buprenorphine abuse as well as discussing strategies for its reduction, including changes in policy, prescription and pharmacy monitoring, and continuing medical education for guiding and improving clinical practice.

PMID: 27123798 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Design of a randomized controlled trial of extended-release naltrexone versus daily buprenorphine-naloxone for opioid dependence in Norway (NTX-SBX).

Buprenorphine Research (PubMed) - Fri, 04/29/2016 - 7:00am

Design of a randomized controlled trial of extended-release naltrexone versus daily buprenorphine-naloxone for opioid dependence in Norway (NTX-SBX).

BMC Pharmacol Toxicol. 2016;17(1):18

Authors: Kunøe N, Opheim A, Solli KK, Gaulen Z, Sharma-Haase K, Latif ZE, Tanum L

Abstract
BACKGROUND: Current guidelines for opioid dependence recommend daily maintenance of physical dependence with methadone or buprenorphine, and discourage abstinence due to the high risk of relapse and overdose. Extended-release formulations of the opioid antagonist naltrexone (XR-NTX) block heroin and other opioid agonists competitively for around 4 weeks per administration. XR-NTX thus enables opioid users to experience abstinence from opioid agonists with greatly reduced risk of overdose compared to medication-free abstinence. While XR-NTX has shown promise compared to placebo and daily naltrexone tablets, there is limited information on long-term safety and its performance compared to daily maintenance treatment.
METHODS/DESIGN: In this five-hospital RCT with long-term follow-up, we aim to recruit n = 180 patients in treatment for opioid dependence and allocate them in an open, randomized manner (1:1) to receive either 4-week XR-NTX or daily buprenorphine-naloxone (BP-NLX) for the duration of 12 weeks. Allocation is open-label due to the risk of overdose during attempts to self-unmask allocation using heroin. Urine drug tests are scheduled every week with follow-up visits & assessment every 4 weeks. Primary outcomes are abstinence from illicit opioids in urine drug tests and self-report, as well as retention in treatment. Secondary outcomes include other substance use, injecting behavior, drug craving, mental health, quality of life, treatment satisfaction, abstinence motivation, opioid agonist effect rating, insomnia, and pain. Observation is continued for another 36 weeks in order to assess longer-term safety, adherence and effectiveness. The study is an investigator-initiated trial, funded by public grants and approved by an Independent Ethical Committee (the Regional Ethical Committee for Research South-East B # 2011/1320) and the Norwegian Medicines Agency.
DISCUSSION: Despite minor implementation problems, the protocol appears sufficiently robust to generate results of high interest to patients, clinicians and policy makers.
TRIAL REGISTRATION: Clinicaltrials.gov # NCT01717963 , first registered: Oct 28, 2012. Protocol version # 3C, June 12th 2012.

PMID: 27121539 [PubMed - in process]

Categories: Bup Feeds

Implementing opioid substitution in Lebanon: Inception and challenges.

Buprenorphine Research (PubMed) - Wed, 04/27/2016 - 8:30am
Related Articles

Implementing opioid substitution in Lebanon: Inception and challenges.

Int J Drug Policy. 2016 Feb 23;

Authors: El-Khoury J, Abbas Z, Nakhle PE, Matar MT

Abstract
Opioid Substitution Treatment (OST) is a firmly established method of treating and managing dependence to opioids in Europe, the US and rest of the developed world. It has a solid evidence base and a positive safety track record. Dissemination of its practice, in parallel to the acceptance of harm reduction as an effective approach, is still timid in low and middle Income countries. After years of advocacy on the parts of clinicians and the voluntary sector, the government of Lebanon launched a national opioid substitution program in 2011 using buprenorphine as the substance of substitution. Lebanon is one of the first countries in the MENA region to establish such a program despite a difficult socio-political context. This paper provides the background of harm reduction efforts in the region and presents the outline of the program from inception to present date. Challenges and recommendations for the future are also discussed. The Lebanese experience with opioid substitution is encouraging so far and can be used as a template for others in the region who might be contemplating broadening the range of services available to tackle addiction to heroin and related substances.

PMID: 27114000 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Perceptions Related to Pharmacological Treatment of Opioid Dependence Among Individuals Seeking Treatment at a Tertiary Care Center in Northern India: A Descriptive Study.

Buprenorphine Research (PubMed) - Fri, 04/22/2016 - 8:30am
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Perceptions Related to Pharmacological Treatment of Opioid Dependence Among Individuals Seeking Treatment at a Tertiary Care Center in Northern India: A Descriptive Study.

Subst Use Misuse. 2016 Apr 21;:1-9

Authors: Prakash S, Balhara Y

Abstract
BACKGROUND: Perceptions of individuals with opioid dependence regarding medications used for long-term management of the condition have been explored only by a handful of studies. Interestingly, no study had compared the perceptions regarding buprenorphine, buprenorphine-naloxone, and oral naltrexone in the opioid-dependent subjects from the same setting.
OBJECTIVES: The present study aimed to examine the perceptions related to treatment of opioid dependence with buprenorphine, buprenorphine-naloxone, and oral naltrexone among individuals seeking help at a tertiary care center.
METHODS: This was a cross-sectional, observational study with consecutive sampling. Sociodemographic data, Drug Abuse Monitoring System questionnaire, perceptions questionnaire, clinical interview to elicit drug use history, treatment history and details of prior abstinence attempts were completed.
RESULTS: Eighty-five subjects were recruited in the study. Fear of becoming dependent (35.3%) was the most common harm reported while withdrawal control (82.4%) was the most common benefit reported with buprenorphine preparations. Precipitated withdrawals (21.2%) were the most common harm reported and prevention of relapse (53%) was the most common benefit reported with oral naltrexone. While patients who believed that buprenorphine or naltrexone were harmful reported durations of treatment that were much shorter than those who did not so believe, there was no statistically significant difference in the actual duration and period of abstinence (p = .34; p = .62). Sociodemographic profile, perceptions related to dosing, nature of medication, expectations from treatment, and duration of illness were also described.

PMID: 27100203 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Criminal Charges Prior to and After Enrollment in Opioid Agonist Treatment: A Comparison of Methadone Maintenance and Office-based Buprenorphine.

Buprenorphine Research (PubMed) - Thu, 04/21/2016 - 8:30am
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Criminal Charges Prior to and After Enrollment in Opioid Agonist Treatment: A Comparison of Methadone Maintenance and Office-based Buprenorphine.

Subst Use Misuse. 2016 Apr 20;:1-9

Authors: Rastegar DA, Sharfstein Kawasaki S, King VL, Harris EE, Brooner RK

Abstract
BACKGROUND: Entry into methadone maintenance is associated with a reduction in criminal activity; less is known about the effects of office-based buprenorphine.
OBJECTIVE: To compare criminal charges before and after enrollment in methadone maintenance or office-based buprenorphine.
METHODS: Subjects were opioid-dependent adults who initiated either methadone maintenance (n = 252) or office-based buprenorphine (n = 252) between 2003 and 2007. Medical records were reviewed to gather demographic data and a state-maintained web-based database to collect data on criminal charges. Overall charges and drug charges in the 2 years prior to and after treatment enrollment were compared. Multivariable analysis was used to examine risk factors for charges after treatment enrollment.
RESULTS: In the 2 years after enrolling in treatment, subjects receiving methadone had a significant decline in the proportion of subjects with any charges (49.6% vs. 32.5%, p < .001) or drug charges (25.0% vs. 17.5%, p = .015), as well as the mean number of cases (0.97 vs. 0.63, p = .002) and drug cases (0.38 vs. 0.23, p = .008), while those who initiated buprenorphine did not have significant changes in any of these measures. On multivariable analysis, the strongest predictor of criminal charges in the 2 years after treatment enrollment was prior charges (adjusted odds ratio 3.35, 95% confidence interval, 2.24-5.01).
CONCLUSIONS: Enrollment in office-based buprenorphine treatment did not appear to have the same beneficial effect on subsequent criminal charges as methadone maintenance. If this observation is replicated in other settings, it may have implications for matching individuals to these treatment options.

PMID: 27097276 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Use of Psychotropic Drug Urine Test Strips in Opiate Maintenance Therapy: A Clinical Assessment of Its Advantages.

Buprenorphine Research (PubMed) - Wed, 04/20/2016 - 9:00am
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Use of Psychotropic Drug Urine Test Strips in Opiate Maintenance Therapy: A Clinical Assessment of Its Advantages.

Subst Abus. 2016 Apr 19;:0

Authors: Victorri-Vigneau C, Rousselet M, Grall-Bronnec M, Bouquié R, Belliot E, Guerlais M, Guillet JY, Jolliet P

Abstract
BACKGROUND: Methadone and buprenorphine are the two opiate maintenance treatments (OMT) available in France. According to the good clinical practices, a full clinical and biological assessment is required before deciding to initiate or renew an OMT. For methadone, this assessment includes psychoactive drug consumption investigation, through an initial interview completed by a systematic urine test mandatory before starting methadone treatment. In case of buprenorphine prescription, the situation is less clear and the urine test was not systematically performed. This work aims at evaluating changes in the therapeutic strategy brought by the systematic use of urine strips for detecting drug consumptions.
METHODS: During one month, for each case of OMT renewal, physicians belonging to the 3 types of prescribing structures in France (general medicine, specialised centers for drug addict patients, specialised centers for drug addict patients in prison) had to complete a specific questionnaire about prescription renewal. This questionnaire contained two parts. The first part was completed by the physicians before the urine test strip realisation. The second part was completed by the same physicians at the end of the consultation, after he had obtained results from the urine test strip. A change between part 1 and 2 of the questionnaire concerning OMT prescription, dialogue with the patient, associated psychotropic drug prescription and orientation was considered as a change in therapeutic strategy.
RESULTS: A total of 429 questionnaires have been collected. Among them 315 showed at least one change in therapeutic strategy (73.4%).
CONCLUSIONS: This study highlighted the important benefits brought by the urine test strip in managing patients under opiate maintenance treatment. Urine test strips provided an immediate answer which allowed physicians to optimize his therapeutic strategy. However, regulatory evolutions would be necessary to ease their implantation.

PMID: 27093305 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Simultaneous quantification of buprenorphine, naloxone and phase I and II metabolites in plasma and breastmilk by liquid chromatography-tandem mass spectrometry.

Buprenorphine Research (PubMed) - Sun, 04/17/2016 - 8:00am
Related Articles

Simultaneous quantification of buprenorphine, naloxone and phase I and II metabolites in plasma and breastmilk by liquid chromatography-tandem mass spectrometry.

J Chromatogr A. 2016 Mar 31;

Authors: Swortwood MJ, Scheidweiler KB, Barnes AJ, Jansson LM, Huestis MA

Abstract
Opioid abuse during pregnancy is associated with fetal growth restriction, placental abruption, preterm labor, fetal death, and Neonatal Abstinence Syndrome. Current guidelines for medication-assisted opioid addiction treatment during pregnancy are methadone or buprenorphine monotherapy. Buprenorphine/naloxone combination therapy (Suboxone(®)) has not been thoroughly evaluated during pregnancy and insufficient naloxone safety data exist. While methadone- and buprenorphine-treated mothers are encouraged to breastfeed, no studies to date investigated naloxone concentrations during breastfeeding following Suboxone administration. For this reason, we developed and fully validated a liquid chromatography-tandem mass spectrometry method for the simultaneous quantification of buprenorphine, buprenorphine-glucuronide, norbuprenorphine, norbuprenorphine-glucuronide, naloxone, naloxone-glucuronide and naloxone-N-oxide in 100μL human plasma and breastmilk in a single injection following protein precipitation and solid-phase extraction. Lowest limits of quantification were 0.1-2μg/L with 20-100μg/L upper limits of linearity. Bias and imprecision were <±16%. Matrix effects ranged from -57.9 to 11.2 and -84.6 to 29.3% in plasma and breastmilk, respectively. All analytes were stable (within ±20% change from baseline) under all tested conditions (24h room temperature, 72h at 4°C, 3 freeze/thaw cycles at -20°C, and in the autosampler for 72h at 4°C). For proof of concept, buprenorphine and its metabolites were successfully quantified in authentic positive maternal and infant plasma and paired breastmilk specimens. This comprehensive, highly sensitive and specific method detects multiple buprenorphine markers in a small specimen volume.

PMID: 27083254 [PubMed - as supplied by publisher]

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Impact of Opioid and Nonopioid Drugs on Postsurgical Pain Management in the Rat.

Buprenorphine Research (PubMed) - Thu, 04/14/2016 - 6:30am
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Impact of Opioid and Nonopioid Drugs on Postsurgical Pain Management in the Rat.

Pain Res Treat. 2016;2016:8364762

Authors: Wilson NM, Ripsch MS, White FA

Abstract
Aim. Nonsteroidal anti-inflammatory drugs or opioids are commonly used to control surgical pain following veterinary and clinical procedures. This study evaluated the efficacy of postoperative ketorolac or buprenorphine following abdominal surgery. Main Methods. Mean arterial pressure (MAP), heart rate, animal activity, corticosterone levels, and a nociceptive sensitivity assay were used to evaluate 18 adult male Sprague-Dawley rats which underwent aortic artery occlusion for implantation of a radiotelemetry device. The animals were treated postoperatively with intraperitoneal injections of vehicle, ketorolac (10 mg/kg), or buprenorphine (0.06 mg/kg) every 8 hours for 3 days. Key Findings. There were no consistent significant changes in any of the telemetry parameters after treatment with ketorolac compared with no saline treatment with the exception of increased MAP in the buprenorphine group during the first 48 hours when compared with other treatment groups. There was a sustained increase in fecal corticosterone levels from baseline on days 2-7 with buprenorphine compared with vehicle- or ketorolac-treated animals. All treatment conditions displayed reduced paw withdrawal thresholds (PWTs) from day 1 to day 21 following surgery. Compared with the vehicle treatment group, buprenorphine-treated animals exhibited significantly lower PWT levels from day 4 to 14 days. Significance. Given the prolonged increase in fecal corticosterone levels and pronounced changes in tactile hyperalgesia behavior in rodents subjected to buprenorphine treatment, these data suggest that ketorolac may be superior to buprenorphine for the treatment of postprocedure pain behavior in rodents.

PMID: 27069684 [PubMed]

Categories: Bup Feeds

Factors associated with non-adherence and misuse of opioid maintenance treatment medications and intoxicating drugs among Finnish maintenance treatment patients.

Buprenorphine Research (PubMed) - Thu, 04/14/2016 - 6:30am
Related Articles

Factors associated with non-adherence and misuse of opioid maintenance treatment medications and intoxicating drugs among Finnish maintenance treatment patients.

Drug Alcohol Depend. 2016 Mar 28;

Authors: Launonen E, Wallace I, Kotovirta E, Alho H, Simojoki K

Abstract
BACKGROUND: The intravenous (IV) use of opioid maintenance treatment (OMT) medications and other intoxicating drugs among OMT patients is a challenge for many OMT units and affects treatment outcomes. The aim of this study is to examine factors associated with IV use of OMT medications and other intoxicating drugs among Finnish OMT patients.
METHODS: A cross-sectional study was conducted among all Finnish OMT patients of whom 60% (n=1508) participated. The data were collected by anonymous questionnaire. Binominal regression analysis with unadjusted and adjusted ORs was conducted to evaluate predictors for IV use.
FINDINGS: Factors associated with the injection of a patient's own OMT medication were: being treated with buprenorphine-naloxone (BNX) (OR 2.60, p=0.005) with a low dose (<9.0mg/day; OR 5.70, p<0.001) and being treated in a health-care centre (OR 2.03, p=0.029). Factors associated with the injection of illicit OMT medications were: being treated with BNX (OR 5.25, p<0.001) with a low dose (<9.0mg/day; OR 2.89, p=0.017), lack of psychosocial support (OR 2.62, p<0.001) and concurrent use of psychotropic medications from illicit sources (OR 4.28, p<0.001). Associated factors for the injection of other intoxicating drugs were: concurrent use of illicit drugs (OR 1.72, p=0.015), psychotropic medications from illicit sources (OR 4.78, p<0.001) and from a doctor (OR 1.93, p=0.004).
CONCLUSIONS: More effort should be made to reduce concurrent injecting use during OMT. This may be done by addressing concurrent substance use orders more effectively, by ensuring that patients receive an optimal BNX dose and by providing more psychosocial support.

PMID: 27068849 [PubMed - as supplied by publisher]

Categories: Bup Feeds

It’s Been a Year Since We Launched Our Marijuana Talk Kit

Drug and Alcohol News (JoinTogether.com) - Wed, 04/13/2016 - 2:54pm

With the changing marijuana landscape in our country – new policies like legalization and new products like edibles – parents were (and still are) struggling with how to talk to their kids about marijuana. So we created a Marijuana Talk Kit and other supportive materials to help parents set the stage for an open dialogue with their teens and equip them with the tools to respond to some tough questions. Look what we were able to do:

March 2015: We launched our free Marijuana Talk Kit: What you need to know to talk with your teen about marijuana. Nearly 11,000 parents have downloaded the Marijuana Talk Kit so far.

April 2015: We hosted a live Facebook Chat on teen marijuana use.

May 2015: We hosted an expert panel discussion at Harvard Medical School, “What You Need to Know to Talk With Your Kids About Marijuana.”

March-May 2015: We launched a Marijuana Talk Kit blog series:

July 2015: We launched our Marijuana Talk Kit YouTube video series designed to give parents quick and simple tips and skills to help answer tough questions and respond to push-back from teens. Topics include:

Be the first to know when we upload new videos – subscribe to our YouTube channel.

August 2015: Family Circle covered our Marijuana Talk Kit in a piece called “The Pot Talk.”

October 2015: Halloween blog post: Which Candy Is Which? Tricks, Treats and Talking about Marijuana

Coming Soon: Spanish version of our Marijuana Talk Kit. Check back soon!

If you haven’t already, download our free Marijuana Talk Kit and start talking with your teen today.

Need help with your child’s drug use or drinking? Call our Parents Toll-Free Helpline – 1-855-DRUGFREE to speak with one of our trained and caring specialists.

 

Categories: Bup Feeds

Alcohol and other substance use, mental health treatment use, and perceived unmet treatment need: Comparison between baby boomers and older adults.

Buprenorphine Research (PubMed) - Tue, 04/12/2016 - 7:00am
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Alcohol and other substance use, mental health treatment use, and perceived unmet treatment need: Comparison between baby boomers and older adults.

Am J Addict. 2015 Jun;24(4):299-307

Authors: Choi NG, DiNitto DM, Marti CN

Abstract
BACKGROUND AND OBJECTIVE: As the baby boomers age, the number of older adults with comorbid substance use and mental disorders is projected to grow. Little research has examined the potential impact of substance use on older adults' mental health treatment use and unmet treatment need. This study examined these associations among the rapidly growing population of baby boomers and their older counterparts.
METHODS: Data are from the 2008 to 2012 National Survey on Drug Use and Health (NSDUH) (N = 18,443 respondents aged 50-64 and 11,191 aged 65 +). Age-combined and age-stratified logistic regression analyses were used to examine relationships between alcohol, illicit drug, and tobacco use and mental health problems, treatment use, and perceived unmet treatment need, with sociodemographic characteristics and health status as covariates.
RESULTS: Heavy alcohol, illicit drug, and tobacco use increased the odds of having a mental health problem in both age groups. Compared to those who used alcohol on 1-99 days during the preceding year, lifetime abstainers had significantly lower odds of having received mental health treatment in both age groups. Poorer self-rated health and past-year mental health treatment use increased the odds of perceived unmet treatment need in both age groups, while lifetime abstention in the boomers decreased the odds.
CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: This study's key finding is the lower likelihood of mental health treatment use among lifetime abstainers in both age groups. Further research may identify barriers to treatment use and ways to promote use among both age groups.

PMID: 25923291 [PubMed - indexed for MEDLINE]

Categories: Bup Feeds

Baseline characteristics of patients predicting suitability for rapid naltrexone induction.

Buprenorphine Research (PubMed) - Tue, 04/12/2016 - 7:00am
Related Articles

Baseline characteristics of patients predicting suitability for rapid naltrexone induction.

Am J Addict. 2015 Apr;24(3):258-64

Authors: Mogali S, Khan NA, Drill ES, Pavlicova M, Sullivan MA, Nunes E, Bisaga A

Abstract
BACKGROUND AND OBJECTIVES: Extended-release (XR) injection naltrexone has proved promising in the treatment of opioid dependence. Induction onto naltrexone is often accomplished with a procedure known as rapid naltrexone induction. The purpose of this study was to evaluate pre-treatment patient characteristics as predictors of successful completion of a rapid naltrexone induction procedure prior to XR naltrexone treatment.
METHODS: A chart review of 150 consecutive research participants (N = 84 completers and N = 66 non-completers) undergoing a rapid naltrexone induction with the buprenorphone-clonidine procedure were compared on a number of baseline demographic, clinical and psychosocial factors. Logistic regression was used to identify client characteristics that may predict successful initiation of naltrexone after a rapid induction-detoxification.
RESULTS: Patients who failed to successfully initiate naltrexone were younger (AOR: 1.040, CI: 1.006, 1.075), and using 10 or more bags of heroin (or equivalent) per day (AOR: 0.881, CI: 0.820, 0.946). Drug use other than opioids was also predictive of failure to initiate naltrexone in simple bivariate analyses, but was no longer significant when controlling for age and opioid use level.
CONCLUSIONS: Younger age, and indicators of greater substance dependence severity (more current opioid use, other substance use) predict difficulty completing a rapid naltrexone induction procedure. Such patients might require a longer period of stabilization and/or more gradual detoxification prior to initiating naltrexone.
SCIENTIFIC SIGNIFICANCE: Our study findings identify specific characteristics of patients who responded positively to rapid naltrexone induction.

PMID: 25907815 [PubMed - indexed for MEDLINE]

Categories: Bup Feeds

Antinociceptive interactions between the imidazoline I2 receptor agonist 2-BFI and opioids in rats: role of efficacy at the μ opioid receptor.

Buprenorphine Research (PubMed) - Sat, 04/09/2016 - 8:30am

Antinociceptive interactions between the imidazoline I2 receptor agonist 2-BFI and opioids in rats: role of efficacy at the μ opioid receptor.

J Pharmacol Exp Ther. 2016 Apr 7;

Authors: Siemian JN, Obeng S, Zhang Y, Zhang Y, Li JX

Abstract
While μ-opioids have been reported to interact favorably with imidazoline I2 receptor (I2R) ligands in animal models of chronic pain, the dependence on the efficacy of the μ-opioid receptor ligand on these interactions had not been previously investigated. This study systematically examined the interactions between the selective I2 receptor ligand 2-BFI and three μ-opioid receptor ligands of varying efficacies: fentanyl (high efficacy), buprenorphine (medium-low efficacy), and NAQ (very low efficacy). The von Frey test of mechanical nociception and Hargreaves test of thermal nociception were used to examine the antihyperalgesic effects of drug combinations in complete Freund's adjuvant (CFA)-induced inflammatory pain in rats. Food-reinforced schedule-controlled responding was used to examine the rate-suppressing effects of each drug combination. Dose-addition and isobolographical analyses were used to characterize the nature of drug-drug interactions in each assay. 2-BFI and fentanyl fully reversed both mechanical and thermal nociception, whereas buprenorphine significantly reversed thermal but only slightly reversed mechanical nociception. NAQ was ineffective in both nociception assays. When studied in combination with fentanyl, NAQ acted as a competitive antagonist (apparent pA2 value: 6.19). 2-BFI/fentanyl mixtures produced additive to infra-additive analgesic interactions, 2-BFI/buprenorphine mixtures produced supra-additive to infra-additive interactions, and 2-BFI/NAQ mixtures produced supra-additive to additive interactions in the nociception assays. The effects of all combinations on schedule-controlled responding were generally additive. Results consistent with these were found in experiments using female rats. These findings indicate that lower efficacy μ-opioid receptor agonists may interact more favorably with I2R ligands than high efficacy μ opioid receptor agonists. .

PMID: 27056847 [PubMed - as supplied by publisher]

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Breastfeeding among Mothers on Opioid Maintenance Treatment: A Literature Review.

Buprenorphine Research (PubMed) - Fri, 04/08/2016 - 9:00am

Breastfeeding among Mothers on Opioid Maintenance Treatment: A Literature Review.

J Hum Lact. 2016 Apr 6;

Authors: Tsai LC, Doan TJ

Abstract
Although there is an abundance of interventional studies to increase breastfeeding rates, little is known about how to support and promote breastfeeding among mothers on opioid maintenance treatment (OMT). The studies on maternal OMT mainly focus on medication excreted in breast milk and breastfeeding benefits for infants with neonatal abstinence syndrome (NAS). We aim to review interventions to improve breastfeeding outcomes among mothers on OMT to make recommendations for practice and future research. We searched CINAHL, PubMed, PsycINFO, and the Cochrane Database of Systematic Reviews for articles, preferably experimental/quasi-experimental studies published within the past 10 years, that examined interventions to increase rates of breastfeeding initiation and duration among mothers on OMT. Nine studies met our inclusion criteria, comprising 5 categories: 4 combined obstetric and addiction care, 1 rooming-in, 1 Baby-Friendly hospital, 2 inpatient/outpatient NAS treatment, and 1 divided methadone dose. Breastfeeding rates were relatively higher for divided methadone dose (81% initiated any breastfeeding) and rooming-in (62% initiated any breastfeeding); lower in Baby-Friendly hospital (24%) and inpatient/outpatient NAS treatment (45% and 24%, respectively); and mixed in combined obstetric and addiction care programs (2 studies reported 70% and 76%; 2 studies reported 17% and 28%). Studies that included both methadone and buprenorphine did not specify breastfeeding results by medication. We recommend future research to differentiate breastfeeding types and duration by OMT medication. Qualitative studies are needed to explore maternal view on breastfeeding regarding need, barrier, and motivating factors in order to develop effective interventions to promote breastfeeding among mothers on OMT.

PMID: 27053175 [PubMed - as supplied by publisher]

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Buprenorphine buccal film (Belbuca) for chronic pain.

Buprenorphine Research (PubMed) - Thu, 04/07/2016 - 1:00pm

Buprenorphine buccal film (Belbuca) for chronic pain.

Med Lett Drugs Ther. 2016 Apr 11;58(1492):47-48

Authors:

PMID: 27049508 [PubMed - as supplied by publisher]

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Pregnancy: morphine, or sometimes buprenorphine, when paracetamol is ineffective.

Buprenorphine Research (PubMed) - Tue, 04/05/2016 - 11:30am
Related Articles

Pregnancy: morphine, or sometimes buprenorphine, when paracetamol is ineffective.

Prescrire Int. 2016 Feb;25(168):49

Authors:

PMID: 27042734 [PubMed - in process]

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"Weak" opioid analgesics. Codeine, dihydrocodeine and tramadol: no less risky than morphine.

Buprenorphine Research (PubMed) - Tue, 04/05/2016 - 11:30am
Related Articles

"Weak" opioid analgesics. Codeine, dihydrocodeine and tramadol: no less risky than morphine.

Prescrire Int. 2016 Feb;25(168):45-50

Authors:

Abstract
So-called weak opioid analgesics are often used to treat severe pain, or when paracetamol or a nonsteroidal anti-inflammatory drug (NSAID) proves inadequate. But are weak opioids any more effective than paracetamol or NSAIDs on nociceptive pain, and are they better tolerated than morphine? To answer these questions, we conducted a review of literature using the standard Prescrire methodology. The potency of codeine and tramadol is strongly influenced by the cytochrome P450 isoenzyme CYP2D6 genotype, which varies widely from one person to another. This explains reports of overdosing or underdosing after administration of standard doses of the two drugs. The potency of morphine and that of buprenorphine, an opioid receptor agonist-antagonist, appears to be independent of CYP2D6 activity. All "weak" opioids can have the same dose-dependent adverse effects as morphine. There is no evidence that, at equivalent analgesic efficacy, weak opioids carry a lower risk of addiction than low-dose morphine. Respiratory depression can occur in ultrarapid metabolisers after brief exposure to standard doses of codeine or tramadol. Similar cases have been reported with dihydrocodeine in patients with renal failure. In addition, tramadol can cause a serotonin syndrome, hypoglycaemia, hyponatraemia and seizures. Several trials have compared different weak opioids in patients with post-operative pain. A single dose of a weak opioid, possibly combined with paracetamol, has greater analgesic efficacy than paracetamol alone but is not more effective than an NSAID alone. There is a dearth of evidence on weak opioids in patients with chronic pain. Available trials fail to show that a weak opioid has markedly superior analgesic efficacy to paracetamol or an NSAID. Sublingual buprenorphine at analgesic doses appears less likely to cause respiratory depression, but it seems to have weak analgesic efficacy. In practice, when opioid therapy is needed, there is no evidence that codeine, dihydrocodeine or tramadol is less risky than morphine at its lowest effective dose. Compared to morphine, the efficacy of these drugs varies more from one patient to another, and their multiple pharmacokinetic interactions can be difficult to manage. There is also a sometimes unpredictable risk of serious over-dose. Tramadol has additional adverse effects unrelated to its opioid effects. Weak opioids require at least as much vigilance as morphine, despite the major differences in their reputation and regulation.

PMID: 27042732 [PubMed - in process]

Categories: Bup Feeds

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