American Society of Addiction Medicine (ASAM) National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use.

Buprenorphine Research (PubMed) - Tue, 07/12/2016 - 4:43pm
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American Society of Addiction Medicine (ASAM) National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use.

J Addict Med. 2015 Sep-Oct;9(5):358-67

Authors: Kampman K, Jarvis M

Abstract
The Centers for Disease Control have recently described opioid use and resultant deaths as an epidemic. At this point in time, treating this disease well with medication requires skill and time that are not generally available to primary care doctors in most practice models. Suboptimal treatment has likely contributed to expansion of the epidemic and concerns for unethical practices. At the same time, access to competent treatment is profoundly restricted because few physicians are willing and able to provide it. This "Practice Guideline" was developed to assist in the evaluation and treatment of opioid use disorder, and in the hope that, using this tool, more physicians will be able to provide effective treatment. Although there are existing guidelines for the treatment of opioid use disorder, none have included all of the medications used at present for its treatment. Moreover, few of the existing guidelines address the needs of special populations such as pregnant women, individuals with co-occurring psychiatric disorders, individuals with pain, adolescents, or individuals involved in the criminal justice system. This Practice Guideline was developed using the RAND Corporation (RAND)/University of California, Los Angeles (UCLA) Appropriateness Method (RAM) - a process that combines scientific evidence and clinical knowledge to determine the appropriateness of a set of clinical procedures. The RAM is a deliberate approach encompassing review of existing guidelines, literature reviews, appropriateness ratings, necessity reviews, and document development. For this project, American Society of Addiction Medicine selected an independent committee to oversee guideline development and to assist in writing. American Society of Addiction Medicine's Quality Improvement Council oversaw the selection process for the independent development committee. Recommendations included in the guideline encompass a broad range of topics, starting with the initial evaluation of the patient, the selection of medications, the use of all the approved medications for opioid use disorder, combining psychosocial treatment with medications, the treatment of special populations, and the use of naloxone for the treatment of opioid overdose. Topics needing further research were noted.

PMID: 26406300 [PubMed - indexed for MEDLINE]

Categories: Bup Feeds

Underage Drinking: What You Should Know

Drug and Alcohol News (JoinTogether.com) - Mon, 07/11/2016 - 5:15pm

Underage drinking is a serious public health problem in the United States. Alcohol is the most widely used substance of abuse among America’s young people and poses enormous health and safety risks.

During summer break with BBQs, parties and more free time, it’s an important time to talk with your teens about alcohol.

At what age do kids start drinking?

Believe it or not, the average age for a first drink is 14.

Most underage drinking is in the form of binge drinking.

People ages 12-20 drink 11 percent of all alcohol consumed in the U.S. Although young people drink less often than adults do, when they drink, they drink more. That is because young people consume more than 90 percent of their alcohol by binge drinking.

Why is alcohol attractive to teens?

As children mature, it is natural for them to assert their independence, seek new challenges and try taking risks. Many teens want to try alcohol, but often do not fully recognize its negative effects on their health and behavior (see below for why it’s dangerous). Other reasons young people drink alcohol: peer pressure/to fit in, increased independence, stress/to escape or relax, to feel grown up among peers, to rebel, to relieve boredom or out of curiosity.

Teens’ Perception of Alcohol Use

  • Almost half of teens (44 percent) do not see a “great risk” in drinking 5 or more drinks nearly every day.
  • There is low social disapproval from peers: Only 34 percent strongly disapprove of “teens your age getting drunk.”
  • It’s easy to get: 77 percent say alcohol is easily accessible. Also, 53 percent of current underage drinkers reported family and friends as their source for alcohol they consumed.

Underage Drinking is Dangerous

There is a range of risks and negative consequences. Underage drinking:

  • Causes many deaths. Each year, 4,358 young people die in alcohol-related deaths as a result of underage drinking (car crashes, homicides, alcohol poisoning, falls, burns, drowning and suicides).
  • Causes many injuries. In 2011, there were approximately 188,000 emergency room visits by people under 21 for injuries and other conditions related to alcohol.
  • Impairs judgment. Drinking can lead to poor decisions about engaging in risky behavior, including drinking and driving, sexual activity (such as unprotected sex) and aggressive or violent behavior.
  • Increases the risk of physical and sexual assault. Underage drinkers are more likely to carry out or be the victim of a physical or sexual assault after drinking than others their age who do not drink.
  • Increases the risk of alcohol problems later in life. Research shows that people who start drinking before the age of 15 are four times more likely to meet the criteria for alcohol dependence at some point in their lives.

Other Risk Factors:

  • Teen brains are more vulnerable to alcohol. Research shows that the teen brain doesn’t fully develop until 25. Alcohol can alter this development, potentially affecting brain structure and function. This may cause cognitive or learning problems and/or make the brain more prone to alcohol dependence. This is especially risky when people start drinking heavily at young ages.
  • Mixing alcohol and prescription medicine is especially dangerous. It can cause nausea and vomiting, headaches, drowsiness, fainting, loss of coordination and puts you at risk for internal bleeding, heart problems and difficulties breathing.
  • Alcohol and marijuana is also a dangerous combination, significantly impairing judgment. The level of intoxication and secondary effects experienced can be unpredictable. Learn more >

What Parents Can Do

Parents, you hold tremendous influence on whether your child decides to drink or not. Be clear to your teen that you disapprove of underage drinking. Talk often about the dangers of alcohol (see below for tips on talking). Here are other things you can do:

  • If you choose to drink, model responsible drinking behavior.
    • Sometimes we unintentionally send kids the message that we need alcohol to cope with problems or have a good time. After a long, stressful day, instead of pouring yourself a glass of wine or beer, try modeling healthy behavior like deep breathing, exercise or stretching. Find ways to celebrate without alcohol.
    • Research shows that a child with a parent who binge drinks is much more likely to binge drink than a child whose parents do not binge drink.
    • If you are struggling with a drug or alcohol problem, reach out for help.
  • Do not make alcohol available to your child.
  • Be actively involved in your child’s life and have regular conversations with your teen about what’s going on and how she/he is feeling.
  • Get to know your child’s friends – as well as their parents/caregivers.
  • Encourage your teen to participate in healthy and fun activities that do not involve alcohol. If your child seeks new challenges, guide him/her toward healthy risks.
  • Kids ages 11-14 see approximately 1,000 alcohol ads a year. Discuss what you see and help put context around the alcohol messaging your child receives from friends and the media.

Talk Often

The best thing you can do is communicate regularly with your teen. Here’s how:

  • Try to preserve a position of objectivity and openness. If you want to have a productive conversation with your teen, try to keep an open mind and remain curious and calm. That way, your child is more likely to be receptive to what you have to say.
  • Ask open-ended questions. These are questions that elicit more than just a “yes” or “no” response from your teen and will lead to a more engaging conversation.
  • Let your teen know you hear her. Use active listening and reflect back what you are hearing from your teen — either verbatim, or just the sentiment. For example, I’m hearing that you feel overwhelmed, and that you think drinking helps you relax. Is that right?”
  • Discuss the negative effects of alcohol, and what that means in terms of mental and physical health, safety and making good decisions. Talk about the long-term effects.
  • If you’re child’s interested in drinking, ask her why – and what might happen if she does. This gets your teen to think about her future, what her boundaries are around drinking – and some of the possible negative consequences (she may be late to practice, do something stupid in front of her friends, feel hungover.) It will also give you insight into what’s important to her.
  • Offer empathy and compassion. Let your child know you understand. The teen years can be tough. Acknowledge that everyone struggles sometimes, but alcohol is not a useful or healthy way to cope with problems. Let your child know that he/she can trust you.
  • Remind your child that you are there for support and guidance – and that it’s important to you that she/he is healthy and happy and makes safe choices.
  • If there is a history of addiction or alcoholism in your family, then your child has a much greater risk of developing a problem. Be aware of this elevated risk and discuss it with your child regularly, as you would with any disease. Learn more >
  • Is there a problem? Keep an eye on how your child is coping. Does he or she seem withdrawn or uninterested in the usual activities? These are signs that your child might be hiding something or need some guidance.

If You’re Throwing a Party:

  • Supervise all parties to make sure there is no alcohol – and make sure your teens know the rules ahead of time.
  • Set a start and end time for the party.
  • Make sure an adult is at home during the party and regularly checking in.

If Your Teen is Attending a Party:

  • Know where your child will be. Call the parents in advance to verify the occasion and location and that there will be supervision.
  • Indicate your expectations to your child and the parent hosting the party.
  • If the activity seems inappropriate, express concern and keep your child home.
  • Assure your child that he/she can call you to be picked up whenever needed.
  • Use this sample contract as a guide to establish rules about drugs and alcohol.

If you are worried about your child’s drinking or drug use, please call our Parent Toll-Free Helpline at 1-855-DRUGFREE (1-855-378-4373) to speak with a trained and caring specialist.

Wishing you and your family a safe and healthy summer.

Sources:

Related Links:

  • #GotYourBack helps teens identify the signs of alcohol poisoning and empowers them to take action to help a friend – and even save a life. Learn more >
  • Shelby Allen’s life was tragically cut short by alcohol poisoning after a night of binge drinking. Read her story >
  • AlcoholScreening.org helps people assess their drinking patterns to see if alcohol is harming their health. Visit alcoholscreening.org >
  • Police Chief Asks Parents to Face the Realities of Teen Drinking (The Washington Post) Learn more >
  • More Than One Million Full-Time College Students Consume Alcohol on Average Day (Join Together) Learn more >
  • Sober is the New Drunk: Why Millennials are Ditching Bar Crawls for Juice Crawls (The Guardian). Learn more >
  • Find out how to have meaningful, productive conversations with your teen about marijuana. Download our Marijuana Talk Kit >

The post Underage Drinking: What You Should Know appeared first on Partnership for Drug-Free Kids.

Categories: Bup Feeds

Methadone for the treatment of Prescription Opioids Dependence. A retrospective chart review.

Buprenorphine Research (PubMed) - Mon, 07/11/2016 - 1:13pm

Methadone for the treatment of Prescription Opioids Dependence. A retrospective chart review.

Adicciones. 2016 Jun 14;:832

Authors: Barrio P, Ezzeldin M, Bruguera P, Pérez A, Mansilla S, Fàbrega M, Lligoña A, Mondón S, Balcells M

Abstract
Prescription opioids (PO) addiction is increasing to an epidemic level. Few studies exist regarding its treatment. Although buprenorphine has been the mainstay so far, other treatment options might be considered, such as methadone. We conducted a retrospective assessment of all patients admitted to a psychiatry ward for PO detoxification using methadone between 2010 and 2013. The assessment and description was carried out during a 3-month follow-up period after their discharge. Although this is a retrospective chart review, our exploration included sociodemographic and treatment variables in addition to the abstinence rates for the whole sample. Eleven patients were included, mostly women (81.8%), with a median age of 50 years. The median duration of dependence was 8 years. Dependence on other substances and psychiatric comorbidities were high. Eight patients were monitored during three months. Of these, 7 (87.5%) were abstinent after that period. The results suggest that methadone deserves further exploration as a potentially efficacious treatment option for PO dependence.

PMID: 27391853 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Quantitative determination of Buprenorphine, Naloxone and their metabolites in rat plasma using hydrophilic interaction liquid chromatography coupled with tandem mass spectrometry.

Buprenorphine Research (PubMed) - Mon, 07/11/2016 - 1:13pm

Quantitative determination of Buprenorphine, Naloxone and their metabolites in rat plasma using hydrophilic interaction liquid chromatography coupled with tandem mass spectrometry.

Biomed Chromatogr. 2016 Jul 7;

Authors: Joshi A, Parris B, Liu Y, Heidbreder C, Gerk PM, Halquist M

Abstract
A rapid and sensitive LC-MS/MS method was developed and validated for the simultaneous determination of buprenorphine and its three metabolites (buprenorphine glucuronide, norbuprenorphine and norbuprenorphine glucuronide) as well as naloxone and its metabolite naloxone glucuronide in the rat plasma. A Hydrophilic Interaction Chromatography column and a mobile phase containing acetonitrile and ammonium formate buffer (pH 3.5) were used for the chromatographic separation. Mass spectrometric detection was achieved by an electrospray ionization source in the positive mode coupled to a triple quadrupole mass analyzer. The calibration curves for the six analytes displayed good linearity over the concentration range of 1.0 or 5.0 to 1000 ng/mL. The intra and inter-day precision (%CV) ranged from 2.68 to 16.4% and 9.02 to 14.5%, respectively. The intra and inter-day accuracy (%bias) ranged from -14.2 to 15.2% and -9.00 to 4.80%, respectively. The extraction recoveries for all the analytes ranged from 55 to 86.9%. The LC-MS/MS method was successfully applied to a pharmacokinetic study of buprenorphine-naloxone combination in rats.

PMID: 27390058 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Determinants of willingness to enroll in opioid agonist treatment among opioid dependent people who inject drugs in Ukraine.

Buprenorphine Research (PubMed) - Mon, 07/04/2016 - 1:13pm

Determinants of willingness to enroll in opioid agonist treatment among opioid dependent people who inject drugs in Ukraine.

Drug Alcohol Depend. 2016 Jun 17;

Authors: Makarenko I, Mazhnaya A, Polonsky M, Marcus R, Bojko MJ, Filippovych S, Springer S, Dvoriak S, Altice FL

Abstract
BACKGROUND: Coverage with opioid agonist treatments (OAT) that include methadone and buprenorphine is low (N=8400, 2.7%) for the 310,000 people who inject drugs (PWID) in Ukraine. In the context of widespread negative attitudes toward OAT in the region, patient-level interventions targeting the barriers and willingness to initiate OAT are urgently needed.
METHODS: A sample of 1179 PWID with opioid use disorder not currently on OAT from five regions in Ukraine was assessed using multivariable logistic regression for independent factors related to willingness to initiate OAT, stratified by their past OAT experience.
RESULTS: Overall, 421 (36%) PWID were willing to initiate OAT. Significant adjusted odds ratios (aOR) for covariates associated with the willingness to initiate OAT common for both groups included: higher injection frequency (previously on OAT: aOR=2.7; never on OAT: aOR=1.8), social and family support (previously on OAT: aOR=2.0; never on OAT: aOR=2.0), and positive attitude towards OAT (previously on OAT: aOR=1.3; never on OAT: aOR=1.4). Among participants previously on OAT, significant correlates also included: HIV-negative status (aOR=2.6) and depression (aOR=2.7). Among participants never on OAT, however, living in Kyiv (aOR=4.8) or Lviv (aOR=2.7), previous imprisonment (aOR=1.5), registration at a Narcology service (aOR=1.5) and recent overdose (aOR=2.6) were significantly correlated with willingness to initiate OAT.
CONCLUSIONS: These findings emphasize the need for developing interventions aimed to eliminate existing negative preconceptions regarding OAT among PWID with opioid use disorder in Ukraine, which should be tailored to meet the needs of specific characteristics of PWID in geographically distinct setting based upon injection frequency, prior incarceration, and psychiatric and HIV status.

PMID: 27370527 [PubMed - as supplied by publisher]

Categories: Bup Feeds

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