Use and Misuse of Opioids in Maine: Results From Pharmacists, the Prescription Monitoring, and the Diversion Alert Programs.

Buprenorphine Research (PubMed) - Mon, 06/27/2016 - 1:13pm

Use and Misuse of Opioids in Maine: Results From Pharmacists, the Prescription Monitoring, and the Diversion Alert Programs.

J Stud Alcohol Drugs. 2016 Jul;77(4):556-565

Authors: Piper BJ, Desrosiers CE, Lipovsky JW, Rodney MA, Baker RP, McCall KL, Nichols SD, Martin SL

Abstract
OBJECTIVE: Although opioids have substantial efficacy for acute pain management, escalation to opioid misuse and abuse is a persistent concern. This report assesses the current status of the opioid epidemic in Maine using three complementary data sets.
METHOD: A representative sample of pharmacists (N = 275) completed an online survey regarding the extent that opioids affected their practice. A county-level analysis of opioid prescriptions (N = 1.22 million) reported to the Maine Prescription Monitoring Program (M-PMP) in 2014 and the agents implicated in arrests as reported to the Maine Diversion Alert Program (DAP, N = 2,700) in 2014/15 also was completed.
RESULTS: A significantly greater number of pharmacists agreed that opioid misuse (85.9%), rather than diversion (76.8%) or access (54.2%), was a concern. Only half (56.2%) reported use of the M-PMP. Opioids were dispensed to 22.4% of residents (37.7% of women in their 80s). This was enough to supply everyone in Maine with a 16.1-day supply. Buprenorphine accounted for almost half of opioid prescriptions to young adults (46.3% women, 49.3% men). Arrests increased by 13.3% from 2014 to 2015, and the proportion of arrests that involved prescription opioids decreased while those involving stimulants and heroin were elevated.
CONCLUSIONS: Pharmacists are very aware of the potential for opioid misuse, but many do not consistently use the M-PMP. There continues to be substantial legitimate use, as well as criminal activity, involving oxycodone and other prescription opioids. Continued vigilance and use of tools like the PMP and DAP are necessary to minimize nonmedical use of opioids in Maine.

PMID: 27340958 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Opioid Use Disorders.

Buprenorphine Research (PubMed) - Mon, 06/27/2016 - 1:13pm

Opioid Use Disorders.

Child Adolesc Psychiatr Clin N Am. 2016 Jul;25(3):473-87

Authors: Sharma B, Bruner A, Barnett G, Fishman M

Abstract
Opioid use and addiction in adolescents and young adults is a health problem of epidemic proportions, with devastating consequences for youth and their families. Opioid overdose is a life-threatening emergency that should be treated with naloxone, and respiratory support if necessary. Overdose should always be an opportunity to initiate addiction treatment. Detoxification is often a necessary, but never sufficient, component of treatment for OUDs. Treatment for OUDs is effective but treatment capacity is alarmingly limited and under-developed. Emerging consensus supports the incorporation of relapse prevention medications such as buprenorphine and extended release naltrexone into comprehensive psychosocial treatment including counseling and family involvement.

PMID: 27338968 [PubMed - in process]

Categories: Bup Feeds

Key opioid prescription concerns in cancer patients: A nationwide study.

Buprenorphine Research (PubMed) - Mon, 06/20/2016 - 1:03pm

Key opioid prescription concerns in cancer patients: A nationwide study.

Acta Anaesthesiol Taiwan. 2016 Jun 14;

Authors: Lin CP, Hsu CH, Fu WM, Chen HM, Lee YH, Lai MS, Shao YY

Abstract
BACKGROUND: Opioids are crucial in cancer pain management. We examined the nationwide prescription patterns of opioids in Taiwan cancer patients to find the potential concerns.
METHODS: We reviewed the claims database of the National Health Insurance of Taiwan for patients diagnosed with cancer from 2003 to 2011. The use and cost of analgesics were analyzed. Opioids were classified into recommended strong opioids (morphine and transdermal fentanyl), recommended weak opioids (tramadol, buprenorphine, and codeine), and unrecommended opioids (propoxyphene, nalbuphine, and meperidine).
RESULTS: We enrolled 1,424,048 patients with cancer, and ∼50% of them took analgesics. Among analgesic users, patients who used opioids increased from 48.2% in 2003 to 52.0% in 2010. Approximately 92% of the opioid use came from recommended opioids, either strong (51%) or weak opioids (41%). The ratio of the use of short-acting strong opioids to that of long-acting opioids increased from 0.41 in 2003 to 0.63 in 2011. Transdermal fentanyl accounted for > 50% of the use of strong opioids. Among weak opioids, the use of tramadol gradually increased to 71% in 2011. On average, opioids contributed to 0.79‰ of all medical expenditures and 2.94‰ of all medication costs.
CONCLUSION: The use of short-acting strong opioids increased during the study period. Instead of oral opioids, transdermal fentanyl was the most commonly used opioid among Taiwan cancer patients. The use of weak opioids, particularly tramadol, was high. These concerns should be the focus of pain management education.

PMID: 27317483 [PubMed - as supplied by publisher]

Categories: Bup Feeds

This Father’s Day I Invite Dads to Help Fight the Heroin Epidemic

Drug and Alcohol News (JoinTogether.com) - Tue, 06/14/2016 - 4:20pm

< A recent educational workshop on “Understanding the Addicted Brain” held by Drug Crisis In Our Backyard in Putnam County, New York.

Outside New York Senator Charles Schumer’s office, May 19, 2016. The group had just met with one of the Senator’s aides asking for the senator’s support of both passage and appropriate funding for the Comprehensive Addiction and Recovery Act. >

In each photo above it’s possible to play the Sesame Street game “One of These Things is Not Like the Others.”

The answer, sadly, is “a man.” Certainly in the second picture the answer is also, “a father.”  I know.  I’m the father wearing a shirt with a picture of my son, William, who died following an accidental heroin overdose.

I’ve said this before. What I’ve come to observe as I’ve spent time reading, writing and engaging with people involved in drug education, treatment and recovery is that men are, way too often, among the missing. I’ve studied pictures and videos of rallies and marches and meetings. I pay attention to numerous postings on social media. There are plenty of women involved, mothers especially. Fathers are in noticeable short supply.    

We can speculate about why so few men are afraid or unwilling to ask for help, or to participate openly and vigorously in the battle against substance use issues. There ought to be no speculation about how our reticence to come forward and deal with addiction openly only serves to perpetuate the shame and stigma that keep the individuals afflicted, their families and the community at large from moving forward toward solutions to this epidemic.

The other day I ran across this post on Facebook:

My first reaction was, “What about me?” I lost my son. I can always use a few hugs. I’m grateful for those I’ve received, literally and figuratively. Then it occurred to me that it is possible men have fled the emotional territory surrounding addiction so completely that women are left alone, to plead for a hug on Facebook.

All of us, men and women alike, who contend with family members, especially children, suffering from substance use disorder, are haunted by loss. Whether potential or actual, loss and the change that comes with it become the moth holes in the fabric of our lives. What becomes frayed and torn, especially for men, is our ability to talk about what haunts us, to tell our stories.

This week I had the opportunity to talk with Don Downey, a father who lost his son, Kyle, only several months ago. We talked about handling grief, coping and figuring out what to do surrounding addiction issues that can enable our sons’ lives. Don wrote me an e-mail later in which he said: “I would very much like to place my feet in the…line and walk with you. Men need to start carrying some of the responsibility for issues of the heart. In truth, this epidemic is a present threat to us all and men have always stood up to threats. It should not all be on the shoulders of our brave women.”

Perhaps this Father’s Day can be a day where fathers everywhere can emulate Don. We can begin to be fathers in a fuller sense, to reach out, to share our stories, and to pass out a few hugs. Who knows? We might even get one back.      

Families concerned about a loved one using heroin or any drug of abuse can contact our toll-free Helpline at 1-855-DRUGFREE (1-855-378-4373) where they can speak with a caring and trained specialist who will listen, help develop a plan of action and identify community resources.

Help us end the heroin epidemic in our country. Please visit drugfree.org/heroin to gain an understanding of this vital issue and learn how you and others in your community can take action to affect change. ‪#‎endmedicineabuse‬‬

Read Bill’s blog post Yankee Fan Reflects on October Baseball, Loss & Ending the Silence on Addiction.

The post This Father’s Day I Invite Dads to Help Fight the Heroin Epidemic appeared first on Partnership for Drug-Free Kids.

Categories: Bup Feeds

Psychometric assessment of the Neonatal Abstinence Scoring System and the MOTHER NAS Scale.

Buprenorphine Research (PubMed) - Mon, 06/13/2016 - 3:09pm

Psychometric assessment of the Neonatal Abstinence Scoring System and the MOTHER NAS Scale.

Am J Addict. 2016 Jun 11;

Authors: Jones HE, Seashore C, Johnson E, Horton E, O'Grady KE, Andringa K, Grossman MR, Whalen B, Holmes AV

Abstract
BACKGROUND AND OBJECTIVES: The present study examined the psychometric characteristics of the Neonatal Abstinence Scoring System (NASS; "Finnegan Scale") and the MOTHER NAS Scale (MNS).
METHODS: Secondary analysis of data from 131 neonates from the Maternal Opioid Treatment: Human Experimental Research (MOTHER) study, a randomized trial in opioid-dependent pregnant women administered buprenorphine or methadone.
RESULTS: Both the NASS and MNS demonstrated poor psychometric properties, with internal consistency (Cronbach's αs) failing to exceed .62 at first administration, peak NAS score, and NAS treatment initiation.
CONCLUSIONS: Findings support the need for development of a NAS measure based on sound psychometric principles.
SCIENTIFIC SIGNIFICANCE: This study found that two frequently used measures of neonatal abstinence syndrome suffer inadequacies in regard to their basic measurement characteristics. (Am J Addict 2016;XX:1-4).

PMID: 27287965 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Development, Implementation, and Evaluation of a Pilot Parenting Educational Intervention in a Pregnancy Buprenorphine Clinic.

Buprenorphine Research (PubMed) - Mon, 06/13/2016 - 3:09pm

Development, Implementation, and Evaluation of a Pilot Parenting Educational Intervention in a Pregnancy Buprenorphine Clinic.

Nurs Womens Health. 2016 Jun-Jul;20(3):258-67

Authors: Giles AC, Ren D, Founds S

Abstract
We developed a pilot evidence-based prenatal educational intervention to increase knowledge of neonatal abstinence syndrome (NAS) and early parenting skills for women with opiate dependency who enrolled in a pregnancy buprenorphine clinic. We developed, implemented, and tested modules regarding expectations during newborn hospitalization for observation or treatment of NAS and regarding evidence-based parenting skills in response to NAS behaviors. Testing evaluated baseline knowledge of early parenting skills with newborns at risk for NAS and change from baseline after the educational intervention. No statistically significant difference in composite knowledge scores was observed. A brief survey completed by the participants postpartum affirmed the perception of women that the educational intervention effectively prepared them for the early postpartum period while their newborns were hospitalized.

PMID: 27287352 [PubMed - in process]

Categories: Bup Feeds

Heroin’s back.

Drug and Alcohol News (JoinTogether.com) - Fri, 06/10/2016 - 11:37am
We’re thrilled that USA Today /Media Planet ran our Infographic and is helping to spread awareness about the heroin epidemic.

If you’ve seen the news lately, you may have noticed that heroin is back in a big way.

Communities across the country – regardless of geographic location or economic status – are experiencing an alarming uptick in deaths related to heroin overdose. So why is this happening? Why are so many teens becoming addicted to heroin in this day and age, when it seems nearly everyone knows the dangers of this drug? It’s beginning with something you might have at home right now. Nearly half of young people who inject heroin start by abusing prescription drugs.

To help you understand how the transition happens and what you should be aware of to keep your family and community safe, we’ve developed an interactive infographic. Follow the journey of a teen; hear stories from families who have been down this road; and find the tools you need to take action – whether you’re a parent, health care provider, educator or community member.

Need help with a family member’s substance abuse problem? Call our toll-free helpline at 1-855-DRUGFREE and talk to a specialist today.

Opioid addiction is ravaging our communities. The time to take action against this epidemic is now. Learn more >

Resources like this are available free of charge because of generous donors. Please consider making a donation now so we can continue to help families every day. We appreciate your support.

The post Heroin’s back. appeared first on Partnership for Drug-Free Kids.

Categories: Bup Feeds

Intrathecal buprenorphine versus fentanyl as adjuvant to 0.75% ropivacaine in lower limb surgeries.

Buprenorphine Research (PubMed) - Thu, 06/09/2016 - 4:00pm

Intrathecal buprenorphine versus fentanyl as adjuvant to 0.75% ropivacaine in lower limb surgeries.

J Anaesthesiol Clin Pharmacol. 2016 Apr-Jun;32(2):229-233

Authors: Singh AP, Kaur R, Gupta R, Kumari A

Abstract
BACKGROUND AND AIMS: This study aims to compare the anesthesia characteristics between buprenorphine and fentanyl when added as an adjuvant to intrathecal ropivaciane in an attempt to prolong the duration of spinal anesthesia.
MATERIAL AND METHODS: The present prospective double-blind study was undertaken on ninety American Society of Anesthesiologist I and II patients between 18 and 60 years of age undergoing subarachnoid block for lower limb surgery. Group I (n = 30) patients were administered 3 ml of intrathecal solution (2.8 ml of 0.75% ropivacaine + 0.2 ml of isotonic sodium chloride), while Groups II and III patients (n = 30 each) received 2.8 ml 0.75% ropivacaine + 0.2 ml buprenorphine (60 μg) and 2.8 ml 0.75% ropivacaine + 0.2 ml fentanyl (10 μg), respectively. Following parameters were observed: Onset times and duration of sensory and motor block, time to first analgesic use, total dose of rescue analgesia, intra- and post-operative pain scores based on visual analog scale, sedation scores, hemodynamic parameters, and side effects if any. Data were analyzed by appropriate statistical tests and P < 0.05 were considered significant.
RESULTS: Time to onset of sensory and motor block in all the three groups was comparable. However, duration of sensory block was significantly prolonged in Groups II and III in comparison to Group I (P < 0.05) and it was the longest in Group II (P < 0.05). The duration of motor blockade was similar in all the three groups. The time to first analgesic dose was also significantly prolonged in Groups II and III as compared to Group I (P < 0.05) but was comparable between Groups II and III. Intra- and post-operative hemodynamic parameters, as well as side effects, were comparable.
CONCLUSION: Addition of buprenorphine and fentanyl as adjuvants to intrathecal 0.75% ropivacaine prolongs postoperative pain relief without causing any increase in the duration of motor blockade but buprenorphine is better as compared to fentanyl in prolonging the duration of sensory block and achieving a better outcome in terms of pain relief.

PMID: 27275055 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Arrhythmia associated with buprenorphine and methadone reported to the Food and Drug Administration.

Buprenorphine Research (PubMed) - Thu, 06/09/2016 - 4:00pm

Arrhythmia associated with buprenorphine and methadone reported to the Food and Drug Administration.

Addiction. 2016 Jun 8;

Authors: Kao D, Haigney MC, Mehler PS, Krantz M

PMID: 27273759 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Arrhythmia associated with buprenorphine and methadone reported to the Food and Drug Administration.

Buprenorphine Research (PubMed) - Thu, 06/09/2016 - 4:00pm

Arrhythmia associated with buprenorphine and methadone reported to the Food and Drug Administration.

Addiction. 2016 Jun 8;

Authors: Cataldo M

PMID: 27273625 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Opioid agonist doses for oxycodone and morphine dependence: Findings from a retrospective case series.

Buprenorphine Research (PubMed) - Thu, 06/09/2016 - 4:00pm

Opioid agonist doses for oxycodone and morphine dependence: Findings from a retrospective case series.

Drug Alcohol Rev. 2016 Jun 7;

Authors: Nielsen S, Bruno R, Degenhardt L, Demirkol A, Lintzeris N

Abstract
INTRODUCTION: Use of opioid agonist treatments for prescription opioid (PO) dependence is rapidly increasing. Current guidelines are based on research with heroin users. This study aimed to examine methadone and buprenorphine dose requirements for PO-dependent people.
DESIGN AND METHODS: A retrospective case series of PO-dependent patients entering methadone and buprenorphine treatment. Daily oral morphine equivalent (OME) doses at baseline were calculated using standard dose conversion calculations. Dose conversion tables were used to estimate opioid agonist doses, based on starting dose of PO. Baseline methadone and buprenorphine dose at days 7 and 28 were examined. Linear models were fit to the data.
RESULTS: Participants (n = 44) were 67% male, mean age 41 years (SD 10 years); 69% reported a pain condition. The methadone group (n = 21) had a mean PO dose of 704.5 mg OME (SD 783.5 mg) prior to treatment, and mean methadone dose of 45.3 mg (SD 13.1 mg) at day 7 and 61.6 mg (SD 20.8 mg) at day 28. The buprenorphine group (n = 23) had a mean PO dose of 771.7 mg OME (SD 867.7 mg) prior to treatment, with a mean dose of 14.6 mg (SD 8.3 mg) at day 7 and 18.1 (SD 8.9 mg) at day 28. Linear relationships were not found between OME and opioid agonist dose.
CONCLUSIONS: Opioid agonist dosages varied substantially between individuals, and from predicted dosages based on dose conversion tables. Use of conversion tables to guide selection of opioid agonist dosage may compromise patient safety. [Nielsen S, Bruno R, Degenhardt L, Demirkol A, Lintzeris N. Opioid agonist doses for oxycodone and morphine dependence: Findings from a retrospective case series Drug Alcohol Rev 2016;00:000-00].

PMID: 27273511 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Efficacy and Safety of a Sublingual Buprenorphine/Naloxone Rapidly Dissolving Tablet (BNX-RDT) for the Treatment of Adults With Opioid Dependence: A Randomized Trial.

Buprenorphine Research (PubMed) - Thu, 06/09/2016 - 4:00pm

Efficacy and Safety of a Sublingual Buprenorphine/Naloxone Rapidly Dissolving Tablet (BNX-RDT) for the Treatment of Adults With Opioid Dependence: A Randomized Trial.

J Addict Dis. 2016 Jun 7;:0

Authors: Webster L, Hjelmström P, Sumner M, Gunderson EW, 006 and 007 Study Investigators

Abstract
This prospective, randomized, active-controlled, non-inferiority study evaluated the efficacy and safety of a sublingual buprenorphine/naloxone rapidly dissolving tablet (Zubsolv®; BNX-RDT) versus generic buprenorphine for induction of opioid maintenance among dependent adults. The study, conducted at 13 sites from June 2013 to January 2014, included a 2-day blinded induction phase and a 27-day open-label stabilization/maintenance phase. During the blinded induction, patients received fixed doses of BNX-RDT or generic buprenorphine. During open-label stabilization/early maintenance, all patients received BNX-RDT. The primary efficacy assessment was treatment retention at day 3; BNX-RDT was considered non-inferior to generic buprenorphine if the lower limit of the 95% confidence interval (CI) for the difference between the treatments was ≥-10% in patients retained on day 3. Secondary assessments included opioid withdrawal symptoms and cravings as measured using the Clinical Opiate Withdrawal Scale (COWS), Subjective Opiate Withdrawal Scale (SOWS), and opioid cravings visual analogue scale (VAS), and safety. A total of 313 patients were randomly assigned to induction with generic buprenorphine or BNX-RDT. Mean age was 38.4 years, and mean duration of opioid dependence was 12.4 years. For the primary efficacy assessment, 235 of 256 patients (91.8%) were retained at day 3 and continued to the maintenance phase. The lower limit of the 95% CI was -13.7; thus, BNX-RDT was not non-inferior to generic buprenorphine, and significantly more patients who received induction with generic buprenorphine (122/128 [95.3%]) were retained at day 3 compared with those who received induction with BNX-RDT (113/128 [88.3%]; 95% CI: -13.7, -0.4; p = 0.040). Rates of clinical response, as measured by COWS, SOWS, and VAS, were comparable among patients regardless of induction medication. Treatment with BNX-RDT was generally safe and reduced severity of withdrawal symptoms and cravings.

PMID: 27267785 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Initiation of strong prescription opioids in Australia: cohort characteristics and factors associated with the type of opioid initiated.

Buprenorphine Research (PubMed) - Sun, 06/05/2016 - 9:00am
Related Articles

Initiation of strong prescription opioids in Australia: cohort characteristics and factors associated with the type of opioid initiated.

Br J Clin Pharmacol. 2016 Jun 3;

Authors: Gisev N, Pearson SA, Blanch B, Larance B, Dobbins T, Larney S, Degenhardt L

Abstract
AIMS: To describe the characteristics of Australians initiating strong opioids and examine the factors associated with the type of opioid initiated.
METHODS: Pharmaceutical Benefits Scheme dispensing records were extracted for a 10% sample of people who initiated a strong opioid treatment episode (buprenorphine, fentanyl, hydromorphone, morphine, oxycodone) between 29 September 2009-31 December 2013, as evidenced by the absence of a strong opioid dispensing for at least 90 days. The cohort was restricted to people with complete medicines ascertainment. Socio-demographic characteristics, previous dispensing histories and index opioid use were examined. Multinomial logistic regression was used to calculate adjusted relative risk ratios (aRRRs) and 95% confidence intervals (CIs) to determine the factors associated with the type of opioid medicine initiated, relative to oxycodone.
RESULTS: The cohort consisted of 125,335 people: 58.3% were female and 63.7% were aged ≥65 years. The most commonly initiated strong opioid was oxycodone (72.8%), usually 5 mg immediate-release tablets (76.1%). Compared to people aged 18-44 years, those ≥85 years were 14.18 times as likely (95% CI 12.67-15.87) to initiate morphine than oxycodone. Compared to people without a cancer treatment history, those with a cancer treatment history were 2.34 times as likely (95% CI 2.11-2.60) to initiate morphine than oxycodone.
CONCLUSIONS: The most commonly initiated strong opioid was oxycodone, usually at lower strengths. Those who initiated oxycodone were more likely to be younger with no previous cancer treatment history. As these are high-risk characteristics for potential harms, a judicious approach when initiating strong opioids for this group is necessary.

PMID: 27260937 [PubMed - as supplied by publisher]

Categories: Bup Feeds

[Infectious and other somatic comorbidity in problem drug users - results of a cross-sectional study with medical examination].

Buprenorphine Research (PubMed) - Thu, 06/02/2016 - 8:00am
Related Articles

[Infectious and other somatic comorbidity in problem drug users - results of a cross-sectional study with medical examination].

Epidemiol Mikrobiol Imunol. 2016;65(1):56-62

Authors: Mravčík V, Florián Z, Nečas V, Štolfa J

Abstract
BACKGROUND: Problem drug use is associated with excess risk of infectious and other somatic diseases resulting mainly from injecting drug use.
MATERIAL AND METHODS: At the end of 2013, a complete medical history and physical examination was done in 40 problem drug users (30 males and 10 females), mean age 35.5 years (37.0 and 30.9, respectively), recruited in 4 low-threshold facilities in Prague. Of them, 37 were ex- or active injecting drug users, predominantly of methamphetamine (pervitin) and less often of buprenorphine.
RESULTS: The study physician rated the health status as -good or satisfactory in 35 participants and as unsatisfactory in five participants (12.5%). The most common pathologies were dental problems (36 participants, i.e. 90.0%) and skin conditions (15.0%). The most prevalent dental pathology was caries while dermatological disorders were mostly trophic skin lesions on the lower legs, including crural ulcers, and injection site infections. Gynaecological pathology was found in 2 of 10 females. The study subjects were most commonly diagnosed with chronic hepatitis C, status post hepatitis A and B, chronic caries, missing teeth, post-thrombotic swelling and trophic skin lesions on the lower legs, purulent skin lesions, and gastroduo-denal ulcer. A vast majority of the study participants were smokers. All were referred to various specialists for further examination or treatment, mostly to stomatology, hepatology, gastroenterology, and internal/general medicine departments. However, in reality the treatment participation rate is low among problem drug users due to the drug use-specific factors and needs that limit access to treatment.
CONCLUSION: The incidence of diverse somatic comorbidities requiring standard general medical care is significant among problem drug users. Infectious, dermatological, and dental pathologies are predominant. In areas with high prevalence of problem drug use, implementation of a special program should be considered to provide comprehensive medical care taking account of the special needs of this target group.

PMID: 27246646 [PubMed - in process]

Categories: Bup Feeds

Neonatal Abstinence Syndrome: Presentation and Treatment Considerations.

Buprenorphine Research (PubMed) - Wed, 06/01/2016 - 8:30am
Related Articles

Neonatal Abstinence Syndrome: Presentation and Treatment Considerations.

J Addict Med. 2016 May 27;

Authors: Jones HE, Kaltenbach K, Johnson E, Seashore C, Freeman E, Malloy E

Abstract
This clinical case conference discusses the treatment of a pregnant woman with opioid use disorder in a comprehensive care program that includes buprenorphine pharmacotherapy. The presentation summarizes common experiences that pregnant women who receive buprenorphine pharmacotherapy face, and also what their prenatally opioid-exposed children confront in the immediate postpartum period. It describes the elements of a successful comprehensive care model and corollary neonatal abstinence syndrome treatment regimen. Expert commentary is included on issues that arise in the buprenorphine induction and maintenance throughout the prenatal and postpartum periods and in the treatment of co-occurring mental health problems during both the prenatal and postpartum periods, particularly the treatment of depression. There is also expert commentary on the care of opioid-exposed neonates, with attention to the treatment for neonatal abstinence syndrome.

PMID: 27244045 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Opioid dependency rehabilitation with the opioid maintenance treatment programme - a qualitative study from the clients' perspective.

Buprenorphine Research (PubMed) - Wed, 06/01/2016 - 8:30am
Related Articles

Opioid dependency rehabilitation with the opioid maintenance treatment programme - a qualitative study from the clients' perspective.

Subst Abuse Treat Prev Policy. 2015;10:35

Authors: Granerud A, Toft H

Abstract
BACKGROUND: Opioid maintenance treatment (OMT) is the most widely used treatment for opioid dependence. The opioid maintenance treatment (OMT) programme represents an opportunity for people who are opioid users to minimize the many negative health and societal outcomes associated with opioid use through meeting the physiological need of their bodies for opioids. The purpose of this study is to shed some light on how clients in the Norwegian OMT programme see their level of influence on their own treatment.
METHOD: It is a qualitative enquiry using semi-structured interviews of seven OMT clients living in various locations in Norway. The analysis of the material utilized a grounded theory-inspired approach.
RESULTS: This study show that the clients who were part of the OMT programme had better lives than people with untreated addictions did. However, the participants experienced having to play by the rules of the OMT programme if they wanted to have successful treatment. This resulted in varying degrees of dissatisfaction with the treatment.
CONCLUSIONS: The results indicated that the clients felt objectified and disenfranchised in the OMT programme, and points out the low level of influence on their own treatment felt by the OMT clients.

PMID: 26374128 [PubMed - indexed for MEDLINE]

Categories: Bup Feeds

Upper extremity nerve block: how can benefit, duration, and safety be improved? An update.

Buprenorphine Research (PubMed) - Tue, 05/31/2016 - 9:00am

Upper extremity nerve block: how can benefit, duration, and safety be improved? An update.

F1000Res. 2016;5

Authors: Brattwall M, Jildenstål P, Warrén Stomberg M, Jakobsson JG

Abstract
Upper extremity blocks are useful as both sole anaesthesia and/or a supplement to general anaesthesia and they further provide effective postoperative analgesia, reducing the need for opioid analgesics. There is without doubt a renewed interest among anaesthesiologists in the interscalene, supraclavicular, infraclavicular, and axillary plexus blocks with the increasing use of ultrasound guidance. The ultrasound-guided technique visualising the needle tip and solution injected reduces the risk of side effects, accidental intravascular injection, and possibly also trauma to surrounding tissues. The ultrasound technique has also reduced the volume needed in order to gain effective block. Still, single-shot plexus block, although it produces effective anaesthesia, has a limited duration of postoperative analgesia and a number of adjuncts have been tested in order to prolong analgesia duration. The addition of steroids, midazolam, clonidine, dexmedetomidine, and buprenorphine has been studied, all being off-label when administered by perineural injection, and the potential neurotoxicity needs further study. The use of perineural catheters is an effective option to improve and prolong the postoperative analgesic effect. Upper extremity plexus blocks have an obvious place as a sole anaesthetic technique or as a powerful complement to general anaesthesia, reducing the need for analgesics and hypnotics intraoperatively, and provide effective early postoperative pain relief. Continuous perineural infusion is an effective option to prolong the effects and improve postoperative quality.

PMID: 27239291 [PubMed]

Categories: Bup Feeds

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