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Opioid Dependence and Pregnancy: Minimizing Stress on the Fetal Brain.

Buprenorphine Research (PubMed) - Thu, 10/13/2016 - 6:56am
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Opioid Dependence and Pregnancy: Minimizing Stress on the Fetal Brain.

Am J Obstet Gynecol. 2016 Oct 8;:

Authors: Mccarthy JJ, Leamon MH, Finnegan LP, Fassbender C

Increase in the number of opioid dependent pregnant women delivering babies at risk for neonatal abstinence syndrome (NAS) prompted a General Accountability Office (GAO) report documenting deficits in research and provider knowledge about care of the maternal/fetal unit and the neonate. There are three general sources of dependence: untreated opioid use disorder (OUD), pain management, and medication assisted treatment with methadone or buprenorphine. A survey of methadone patients' experiences when telling a physician of their pregnancy and opioid dependence demonstrated physician confusion about proper care, frequent negative interactions with the mother, and failures to provide appropriate referral. Patients in pain management were discharged without referral when the physician was told of the pregnancy. Methadone and buprenorphine were frequently seen negatively because they 'caused' Neonatal Abstinence Syndrome (NAS). Most mothers surveyed had to find opioid treatment on their own. How dependence is managed medically is a critical determinant of the level of stress on both mother and fetus, and a therefore another determinant of neonatal health. The effects of both opioid withdrawal stress and maternal emotional stress on neonatal and developmental outcomes are reviewed. Currently, there have been efforts to criminalize maternal opioid dependence and to encourage or coerce pregnant women to undergo withdrawal. This practice poses both acute risks of fetal hypoxia and long-term risks of adverse epigenetic programming related to catecholamine and corticosteroid surges during withdrawal. Contemporary studies of the effects of withdrawal stress on the developing fetal brain are urgently needed to elucidate and quantify the risks of such practices. At birth, inconsistencies in the hospital management of neonates at risk for NAS have been observed. Neglect of the critical role of maternal comforting in NAS management is an iatrogenic and preventable cause of poor outcomes and long hospitalizations. Rooming-in allows for continuous care of the baby and maternal/neonatal attachment, often unwittingly disrupted by the NICU environment. Recommendations are made for further research into physician/patient interactions and into optimal dosing of methadone and buprenorphine to minimize maternal/fetal withdrawal.

PMID: 27729254 [PubMed - as supplied by publisher]

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Neonatal Abstinence Syndrome: Twelve Years of Experience at a Regional Referral Center.

Buprenorphine Research (PubMed) - Tue, 10/11/2016 - 6:50am

Neonatal Abstinence Syndrome: Twelve Years of Experience at a Regional Referral Center.

Klin Padiatr. 2016 Oct 10;:

Authors: Mücke S, Nagel M, Siedentopf JP, Bührer C, Hüseman D

Background: Infants exposed to opiates antenatally display withdrawal symptoms after birth referred to as neonatal abstinence syndrome (NAS). Patients: A total of 366 newborns (166 females, 10 twins) from 361 mothers were diagnosed with NAS from 2000 to 2011 at a single large metropolitan referral center. Methods: Retrospective chart review of all newborn infants exposed to opiates in utero. Results: 20% were premature (gestational age<37 weeks), 32% were small-for-gestational-age (<10(th) percentile). 70% of infants (195/278) antenatally exposed to methadone (racemic methadone or levomethadone) required pharmacological treatment for 11 (1-55) days (median; range); however, 45% of infants (28/62) exposed to buprenorphine required pharmacological treatment for a median of only 5 (1-20) days (p=0.014). Pharmacological treatment of infants with phenobarbital (n=189) took a median of 9 (1-53) days, but treatment with morphine (n=39) took 19 (3-55) days (p<0.001). The median duration of hospitalization increased from 11 days in 2000-2004 to 19 days in 2008-2011 (p<0.001). The increased durations of neonatal hospitalization were associated with similar increases in the average dosages of maternal methadone. Conclusion: Use of buprenorphine, rather than methadone, for treatment of opiate-addicted pregnant women is associated with fewer and shorter neonatal withdrawal symptoms. The duration of hospitalization and treatment for NAS has increased over time.

PMID: 27723910 [PubMed - as supplied by publisher]

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Pill-Shaped Products That Glamorize Medicine Abuse: Harmless Fun or Sugarcoating an Epidemic?

Drug and Alcohol News (JoinTogether.com) - Mon, 10/10/2016 - 3:48pm

This post was originally published in 2013 and has been updated for 2016.

In June 2013, Urban Outfitters, a national retail store popular with teens, removed a number of products from its shelves after considerable pressure from public health groups, state attorneys general, legislators and the Partnership for Drug-Free Kids. The merchandise — pint glasses, flasks and shot glasses made to look like prescription pill bottles — made light of prescription drug misuse and abuse, a dangerous behavior that is responsible for more deaths in the United States each year than heroin and cocaine combined.

In fact, the United States is in the midst of a prescription drug abuse and heroin crisis which the CDC has labeled an epidemic.

Though the removal of these items was a step in the right direction to ensure the safety of our children and teens, a further look into today’s pop culture reminds us that Urban Outfitters’ glamorization of medicine abuse was not an isolated event.

Just this week, the Moschino “Capsule” collection — with a pill-popping motif — was launched and distributed within retail and online stores. Nordstrom has already pulled the high-end Italian fashion line after Partnership parent advocates and a Minneapolis drug counselor ignited outrage that it glamorizes prescription drug abuse and heroin.

The Partnership for Drug-Free Kids is outraged by Moschino and Saks Fifth Avenue for seeking financial profit from the current opiate epidemic. Please join us in demanding that these retailers immediately remove all products from the Moschino “Capsule” collection from all of their store locations and online sites

We’ve also stumbled upon quite a few other pill-shaped products. Check out the following items and let us know what you think – harmless fun or making light of a serious epidemic?

Music Equipment

Beats, a popular company specializing in headphones and speakers, sells a pill-shaped portable speaker. Nikki Minaj, an artist with a significant number of teenage fans, has her own signature bubblegum-colored Pill. Luxury Goods: Handbags and Jewelry

You may begin to spot people wearing pills as earrings, necklaces, handbags and rings. Pills have becoming a growing trend in the fashion world, as seen in designer Jeremy Scott’s “pill bag.” and Chanel’s pill charm bracelet (no longer available). Some designers, like Cast of Vices, cross the line further, engraving specific medication names on their jewelry. High-end fashion designers have even begun to incorporate pills into their runway shows, replacing decorative jewels with pill tablets and capsules. Happy Pills

Originally from Barcelona, customers from around the world have been chasing their sugar high in the form of Happy Pills. Their online store touts “bring happy moments to people, by using a magic recipe.” Correction Tape, Pens, Clocks, Flash Drives, Pillows, Chocolates…

Pill-themed accessories like Lucite paper weights, correction tape, pens, clock radios, flash drives, pillows and chocolates have also recently appeared on the market. Their bright colors may seem innocent but they send a dangerous message to children by connecting prescription medicine with playfulness and fun.

So what do you think? Are these colorful, attractive products innocuous – or do they downplay the seriousness of prescription medicine abuse? Post a comment below and let us know.

Whether harmless or harmful, the facts remain:

  • Prescription medicines, along with marijuana, are the most commonly abused drugs among 12 to 13 year olds.
  • Every 19 minutes, a person dies from a drug overdose in the United States.
  • Drug-related deaths now outnumber traffic fatalities in the U.S., with the rise driven by an increase in prescription drug overdoses.

Educate yourself about the ways you can prevent your teen from abusing prescription drugs and over-the-counter cough medication. Inform your child about the dangers of medicine misuse and abuse. Spread the word to your local community and social networks.

Visit The Medicine Abuse Project website to learn more. Together, we can #endmedicineabuse.

Think your child is abusing drugs? Visit Get Help and call our Toll-Free Helpline at 1-855-DRUGFREE (1-855-378-4373).


The post Pill-Shaped Products That Glamorize Medicine Abuse: Harmless Fun or Sugarcoating an Epidemic? appeared first on Partnership for Drug-Free Kids.

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Trends in major opioid analgesic consumption in Taiwan, 2002-2014.

Buprenorphine Research (PubMed) - Sun, 10/09/2016 - 6:44am

Trends in major opioid analgesic consumption in Taiwan, 2002-2014.

J Formos Med Assoc. 2016 Oct 4;:

Authors: Kang KH, Kuo LF, Cheng IC, Chang CS, Tsay WI

BACKGROUND/PURPOSE: According to WHO guideline, the consumption of opioids is an important sign of national progress in cancer pain relief. However, precise data on the consumption of opioid analgesics consumption in Taiwan has not been published. We investigate opioid analgesic consumption in Taiwan between 2002 and 2014 compare the results with those in other countries to see what we could learn about other methods of pain management. To find out the different patterns between Taiwan and other country, improves the quality of pain management.
METHODS: We extracted from the Controlled Drugs Management Information System (CDMIS) database, the consumption data of morphine, fentanyl, and pethidine, three strong opioids, and of codeine and buprenorphine, two weak ones. Data were presented as defined daily doses for statistical purposes per million inhabitants per day (S-DDD/m/d). The number of inhabitants was extracted from the Taiwan Ministry of Interior Statistics population database.
RESULTS: During the thirteen studied years, the total consumption of opioids markedly increased in Taiwan. By category, the consumption of morphine, fentanyl and buprenorphine increased, but the use of pethidine and codeine decreased. Compared with the selected regions and countries, the use of opioid in Taiwan progressed in Asia, but it was still lower than in Western countries.
CONCLUSION: Opioid analgesics are probable addictive; however, they can improve a patients' quality of life if properly used. The Taiwan FDA continuously introduces new opioid analgesics and educates physicians on how to use them correctly. These measures will improve the quality of pain management in Taiwan.

PMID: 27717535 [PubMed - as supplied by publisher]

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Recent Incarceration and Buprenorphine Maintenance Treatment Outcomes Among HIV-positive Patients.

Buprenorphine Research (PubMed) - Sat, 10/08/2016 - 9:42am
Related Articles

Recent Incarceration and Buprenorphine Maintenance Treatment Outcomes Among HIV-positive Patients.

Subst Abus. 2016 Aug 11;:0

Authors: Riggins DP, Cunningham CO, Ning Y, Fox AD

BACKGROUND: Opioid use disorder is a common cause of morbidity and mortality among people living with HIV/AIDS. Buprenorphine maintenance treatment (BMT) is an effective means of therapy, but patients with recent criminal justice involvement may need more support during BMT than other patients. We hypothesized that recently incarcerated BMT patients who initiated treatment in primary care would have poorer treatment outcomes than those who were not recently incarcerated.
METHODS: We analyzed data from a multi-site cohort study of BMT integrated into HIV care. Patients were stratified by self-reported incarceration in the 30 days before initiation of BMT. The outcomes of interest were 6 and 12-month treatment retention and self-reported opioid use. We used multivariable logistic regression and hierarchical linear model, respectively, to evaluate the association between recent incarceration and these outcomes while adjusting for potential confounding variables.
RESULTS: Among 306 BMT patients living with HIV/AIDS, 39 (13%) reported recent incarceration. Patients with recent incarceration (vs. without) were more likely to be homeless, unemployed, and previously diagnosed with mental illness. Recent incarceration was not significantly associated with differences in 6-month (OR = 0.95; 95% CI = 0.46-1.98) and 12-month treatment retention (OR = 0.57; 95% CI = 0.27-1.18) or in self-reported opioid use (OR = 0.99; 95% CI = 0.51-1.92) after adjustment for potential confounding variables.
CONCLUSIONS: Those with incarceration in the 30 days prior to BMT initiation were more likely to be homeless, unemployed, and previously diagnosed with mental illness than those without recent incarceration. However, we did not detect a difference in in self-reported opioid use, 6-month or 12-month retention in treatment between those with and without recent incarceration. Future studies should confirm these findings with larger sample sizes. Encouraging formerly incarcerated individuals with opioid use disorder to initiate evidence-based treatments, including BMT, should be part of efforts to confront the opioid addiction epidemic in the United States.

PMID: 27715904 [PubMed - as supplied by publisher]

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School Stress: Modeling Healthy Behavior for Your Teen

Drug and Alcohol News (JoinTogether.com) - Thu, 10/06/2016 - 9:29am

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

Parents: You have much more influence over your sons and daughters than you think.

Even if your teens are trying their best to make you feel unimportant, don’t underestimate how much you can really impact them.

Model Healthy Coping Skills
Sixty-one percent of teens say stress and anxiety have a large impact on their lives. How we, as parents, handle stress and life’s pressures can be reflected in our children’s behavior as well. What you do and say guides your child’s behavior, attitudes and beliefs over the long term. That’s why it’s important to model the behavior you want to see in your kids.

Here are a few concrete examples of how our behavior can make an impact on our stressed-out teens and young adults:

  • When parents are stressed, kids feel it — even if they don’t show it. Acknowledge what you’re going through and talk about how you’re handling it.
  • Be aware when you automatically go to a substance to deal with a problem, whether that’s alcohol, nicotine or even aspirin.
  • When you pour a glass of wine or beer for yourself, be mindful not to say, ‘I had a really bad day’ at the same time, as this makes a connection of using a substance to manage stress or feel better.
  • Instead, pair your anxiety/stress with healthy coping strategies — and explain it out loud. Instead of saying: ‘I’m so stressed out today, I really need a drink,’ you can say ‘I had a really stressful day, so I think I’m going to go take a nice quiet walk to decompress.’ Or ‘I’m so stressed out today, I’m going to go for a run.’
  • Practicing mindfulness and meditation can be really helpful. And you can even say, ‘Who wants to meditate with me?’ Even if it sounds forced or goofy, it works — your kids are paying attention.

  • Teens can and do notice when you don’t practice what you preach. If your teen points out contradictions in your behavior (which they love to do), take responsibility and talking about how you can correct your slip-ups.
  • You should choose times and settings to model these behaviors that will increase the likelihood of your teenager paying attention and being receptive to them.
  • Positive modeling can be challenging, and does not automatically guarantee that your teen will follow the behavior you demonstrate — but it definitely improves the odds. They’ll internalize it and hopefully act on it, whether now or down the road.


  • Narrate what you’re doing — and why you’re doing it — when you’re performing behavior you’d like them to mimic or adopt.
  • Continue modeling good behavior, even if your child pushes back or seems indifferent to your actions.
  • Own your bad behavior and reflect on it — out loud in front of your kids. This is also modeling and helps them learn from your mistakes, too. It helps to show that failing and trying again builds coping skills, grit and resilience.
  • Praise your teens when you notice them demonstrating healthy coping skills on their own. Reinforcing positive behavior makes your teen feel proud, and goes far to assure the behavior continues.

Thanks to Dr. Meredith Grossman for her help in preparing this post.


The post School Stress: Modeling Healthy Behavior for Your Teen appeared first on Partnership for Drug-Free Kids.

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Ethical and clinical safety considerations in the design of an effectiveness trial: A comparison of buprenorphine versus naltrexone treatment for opioid dependence.

Buprenorphine Research (PubMed) - Sat, 10/01/2016 - 7:09am

Ethical and clinical safety considerations in the design of an effectiveness trial: A comparison of buprenorphine versus naltrexone treatment for opioid dependence.

Contemp Clin Trials. 2016 Sep 26;

Authors: Nunes EV, Lee JD, Sisti D, Segal A, Caplan A, Fishman M, Bailey G, Brigham G, Novo P, Farkas S, Rotrosen J

We examine ethical challenges encountered in the design of an effectiveness trial (CTN-0051; X:BOT), comparing sublingual buprenorphine-naloxone (BUP-NX), an established treatment for opioid dependence, to the newer extended-release injectable naltrexone (XR-NTX). Ethical issues surrounded: 1) known poor effectiveness of one possible, commonly used treatment as usual control condition-detoxification followed by counseling without medication; 2) the role of patients' preferences for treatments, given that treatments were clinically approved and available to the population; 3) differences between the optimal "usual treatment" clinical settings for different treatments making it challenging to design a fair comparison; 4) vested interest groups favoring different treatments exerting potential influence on the design process; 5) potentially vulnerable populations of substance users and prisoners; 6) potential therapeutic misconception in the implementation of safety procedures; and 7) high cost of a large trial limiting questions that could be addressed. We examine how the design features underlying these ethical issues are characteristic of effectiveness trials, which are often large trials that compare treatments with varying degrees of existing effectiveness data and familiarity to patients and clinicians, in community-based treatment settings, with minimal exclusion criteria that could involve vulnerable populations. Hence, investigators designing effectiveness trials may wish to remain alert to the possibility of similar ethical issues.

PMID: 27687743 [PubMed - as supplied by publisher]

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Dose-adjusted plasma concentrations of sublingual buprenorphine are lower during than after pregnancy.

Buprenorphine Research (PubMed) - Sat, 10/01/2016 - 7:09am

Dose-adjusted plasma concentrations of sublingual buprenorphine are lower during than after pregnancy.

Am J Obstet Gynecol. 2016 Sep 26;

Authors: Bastian JR, Chen H, Zhang H, Rothenberger S, Tarter R, English D, Venkataramanan R, Caritis SN

BACKGROUND: Buprenorphine is an FDA-approved maintenance therapy for opioid use disorders and is increasingly being used in pregnant women with opioid use disorders as an alternative to methadone. Dosing of buprenorphine in pregnant women is based on the regimen recommended for non-pregnant females and males. Limited data are available defining the pharmacokinetic (PK) properties of sublingual (SL) buprenorphine administered during pregnancy.
OBJECTIVE: This study evaluated the impact of physiological changes associated with pregnancy on the PK of sublingual buprenorphine during and after pregnancy.
STUDY DESIGN: Pregnant women (N=13), between 18 (0/7) and 37 (6/7) weeks' singleton gestation, receiving sublingual buprenorphine twice daily for opioid use disorders were studied. PK-2 studies were performed between 18-25 weeks (N=7), PK-3 studies were performed between 31-37 weeks (N=11), and PK-P was performed 4-18 weeks postpartum (N=10). On the day of study, blood was withdrawn prior to the daily morning dose of buprenorphine and at 0.25, 0.5, 0.75, 1, 1.5, 2, 4, 8 and 12h post-dose. Buprenorphine plasma concentrations were analyzed by LCMS-MS. All PK parameters were observed or estimated using Microsoft Excel. Statistical analyses were performed to identify significant changes in study participants' buprenorphine pharmacokinetic parameter estimates over the duration of the study. Univariate linear and generalized linear mixed models were employed to investigate changes in these measures over time, some of which were log transformed for normality.
RESULTS: Dose-normalized (plasma concentration/dose) buprenorphine plasma concentrations were significantly lower during pregnancy (PK-2 + PK-3) than during the postpartum period (PK-P). Specific PK parameters (and level of significance) were as follows: the area under the BUP plasma concentration-time curves (AUC0→12, p<0.003), maximum BUP concentrations (Cmax, p<0.018), average BUP concentrations (Cavg, p<0.003), BUP concentrations at 0h (C0, p<0.002) and BUP concentrations at 12h (C12, p<0.001). None of these parameters differed significantly during pregnancy (ie PK-2 vs PK-3). The time to maximum BUP concentrations (Tmax) did not differ significantly between groups.
CONCLUSION: The dose-normalized plasma concentrations during a dosing interval and the overall exposure of BUP (AUC0→12) are lower throughout pregnancy compared to the postpartum period. This indicates an increase in apparent clearance of BUP during pregnancy. These data suggest that pregnant women may need a higher dose of sublingual buprenorphine compared to postpartum individuals. The dose of buprenorphine should be assessed after delivery to maintain similar buprenorphine exposure during the postpartum period.

PMID: 27687214 [PubMed - as supplied by publisher]

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Antinociceptive effects of voluntarily ingested buprenorphine in the hot-plate test in laboratory rats.

Buprenorphine Research (PubMed) - Fri, 09/30/2016 - 7:06am

Antinociceptive effects of voluntarily ingested buprenorphine in the hot-plate test in laboratory rats.

Lab Anim. 2016 Sep 27;

Authors: Hestehave S, Munro G, Pedersen TB, Abelson KS

Researchers performing experiments on animals should always strive towards the refinement of experiments, minimization of stress and provision of better animal welfare. An adequate analgesic strategy is important to improve post-operative recovery and welfare in laboratory rats and mice. In addition, it is desirable to provide post-operative analgesia using methods that are minimally invasive and stressful. This study investigated the antinociceptive effects of orally administered buprenorphine ingested in Nutella® in comparison with subcutaneous buprenorphine administration. By exposing the animal to a thermal stimulus using a hot plate, significant antinociceptive effects of voluntarily ingested buprenorphine administered in Nutella® were demonstrated. This was evident at doses of 1.0 mg/kg 60 and 120 min post administration (P < 0.01), although antinociceptive effects were not as marked as with subcutaneous administration, and had a later onset. It is advised to administer the oral formulation of buprenorphine in Nutella® in a 10-fold higher dose, as well as approximately 60 min earlier, than with the more commonly employed subcutaneous route of administration.

PMID: 27681372 [PubMed - as supplied by publisher]

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A Swedish Population-based Study of Adverse Birth Outcomes among Pregnant Women Treated with Buprenorphine or Methadone: Preliminary Findings.

Buprenorphine Research (PubMed) - Fri, 09/30/2016 - 7:06am

A Swedish Population-based Study of Adverse Birth Outcomes among Pregnant Women Treated with Buprenorphine or Methadone: Preliminary Findings.

Subst Abuse. 2016;10:89-97

Authors: Wurst KE, Zedler BK, Joyce AR, Sasinowski M, Murrelle EL

BACKGROUND: Untreated opioid dependence in pregnant women is associated with adverse birth outcomes. Buprenorphine and methadone are options for opioid agonist medication-assisted treatment during pregnancy.
OBJECTIVE: The aim of this study was to describe adverse birth outcomes observed with buprenorphine or methadone treatment compared to the general population in Sweden.
METHODS: Pregnant women and their corresponding births during 2005-2011 were identified in the Swedish Medical Birth Register. Data on stillbirth, neonatal/infant death, mode of delivery, gestational age at birth, Apgar score, growth outcomes, neonatal abstinence syndrome, and congenital malformations were examined. Frequencies were compared using two-sided Fisher's exact tests. Unadjusted estimates of birth outcomes for women treated with buprenorphine or methadone were compared to the registered general population.
RESULTS: A total of 746,257 pregnancies among 538,178 unique women resulted in 746,485 live births. Among the 194 women treated with buprenorphine (N = 176) or methadone (N = 52), no stillbirths or neonatal/infant deaths occurred. Neonatal abstinence syndrome developed in 23.3% and 38.5% of infants born to mothers treated with buprenorphine and methadone, respectively. The frequency of the selected adverse birth outcomes assessed in women treated with buprenorphine as compared to the general population was not significantly different. However, a significantly higher frequency of preterm birth and congenital malformations was observed in women treated with methadone as compared to the general population. Compared with the general population, methadone-treated women were significantly older than buprenorphine-treated women, and both treatment groups began prenatal care later, were more likely to smoke cigarettes, and did not cohabitate with the baby's father.
CONCLUSIONS: An increased frequency of the selected adverse birth outcomes was not observed with buprenorphine treatment during pregnancy. Twofold increased frequency of preterm birth [2.21 (1.11, 4,41)] and congenital malformations [2.05 (1.08, 3.87)] was observed in the methadone group, which may be partly explained by older average maternal age and differences in other measured and unmeasured confounders.

PMID: 27679504 [PubMed]

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