Bup Feeds

Buprenorphine provides better anaesthetic conditions than butorphanol for field castration in ponies: results of a randomised clinical trial.

Buprenorphine Research (PubMed) - Tue, 09/30/2014 - 6:00am
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Buprenorphine provides better anaesthetic conditions than butorphanol for field castration in ponies: results of a randomised clinical trial.

Vet Rec. 2014 Sep 26;

Authors: Rigotti C, Vries AD, Taylor PM

Abstract
A prospective, randomised, blinded, clinical trial in 47 ponies compared butorphanol and buprenorphine administered intravenously with detomidine prior to castration under anaesthesia. Detomidine 12 μg/kg intravenously was followed by butorphanol 25 μg/kg (BUT) or buprenorphine 5 μg/kg (BUP) before induction of anaesthesia with intravenous ketamine and diazepam. Quality of sedation, induction and recovery from anaesthesia, response to tactile stimulation, and surgical conditions were scored. If anaesthesia was inadequate 'rescue' was given with intravenous ketamine (maximum three doses) followed by intravenous thiopental and detomidine. Time from induction to first rescue, total ketamine dose and number of rescues were recorded. Postoperative locomotor activity was scored and abnormal behaviour noted. Simple descriptive scales were used for all scoring. Data were analysed using two-way analysis of variance, t tests, Mann-Whitney or Fisher's exact tests as appropriate; P<0.05 was considered statistically significant. Cryptorchid animals did not undergo surgery, but castration was successfully completed in 18 BUT and 20 BUP. More incremental ketamine (P=0.0310) and more rescue drugs (P=0.0165) were required in BUT and more postoperative locomotor activity occurred in BUP (P=0.0001). There were no other differences between groups. Both opioids were suitable for premedication prior to castration but buprenorphine appeared to provide better intraoperative analgesia.

PMID: 25262056 [PubMed - as supplied by publisher]

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Neonatal abstinence syndrome.

Buprenorphine Research (PubMed) - Tue, 09/30/2014 - 6:00am
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Neonatal abstinence syndrome.

Pediatrics. 2014 Aug;134(2):e547-61

Authors: Kocherlakota P

Abstract
Neonatal abstinence syndrome (NAS) is a result of the sudden discontinuation of fetal exposure to substances that were used or abused by the mother during pregnancy. Withdrawal from licit or illicit substances is becoming more common among neonates in both developed and developing countries. NAS continues to be an important clinical entity throughout much of the world. NAS leads to a constellation of signs and symptoms involving multiple systems. The pathophysiology of NAS is not completely understood. Urine or meconium confirmation may assist the diagnosis and management of NAS. The Finnegan scoring system is commonly used to assess the severity of NAS; scoring can be helpful for initiating, monitoring, and terminating treatment in neonates. Nonpharmacological care is the initial treatment option, and pharmacological treatment is required if an improvement is not observed after nonpharmacological measures or if the infant develops severe withdrawal. Morphine is the most commonly used drug in the treatment of NAS secondary to opioids. An algorithmic approach to the management of infants with NAS is suggested. Breastfeeding is not contraindicated in NAS, unless the mother is taking street drugs, is involved in polydrug abuse, or is infected with HIV. Future studies are required to assess the long-term effects of NAS on children after prenatal exposure.

PMID: 25070299 [PubMed - indexed for MEDLINE]

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[Iatrogenic dependence to meperidine in the elderly].

Buprenorphine Research (PubMed) - Tue, 09/30/2014 - 6:00am
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[Iatrogenic dependence to meperidine in the elderly].

Presse Med. 2014 Jun;43(6 Pt 1):727-9

Authors: Rolland B, Bera-Louville A, Deheul S, Roche J, Blond S, Cottencin O

PMID: 24630268 [PubMed - indexed for MEDLINE]

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Clinical Efficacy of Sustained-Release Buprenorphine with Meloxicam for Postoperative Analgesia in Beagle Dogs Undergoing Ovariohysterectomy.

Buprenorphine Research (PubMed) - Fri, 09/26/2014 - 9:00am
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Clinical Efficacy of Sustained-Release Buprenorphine with Meloxicam for Postoperative Analgesia in Beagle Dogs Undergoing Ovariohysterectomy.

J Am Assoc Lab Anim Sci. 2014;53(5):494-501

Authors: Nunamaker EA, Stolarik DF, Ma J, Wilsey AS, Jenkins GJ, Medina CL

Abstract
The goal of the current study was to compare the efficacy, adverse effects, and plasma buprenorphine concentrations of sustained-release buprenorphine (SRB) and buprenorphine after subcutaneous administration in dogs undergoing ovariohysterectomy. In a prospective, randomized, blinded design, 20 healthy adult female Beagle dogs underwent routine ovariohysterectomy and received multimodal analgesia consisting of meloxicam and one of two buprenorphine formulations. Dogs were randomly assigned to receive either SRB (0.2 mg/kg SC, once) or buprenorphine (0.02 mg/kg SC every 12 h for 3 d). Blinded observers assessed all dogs by using sedation scores, pain scores, temperature, HR, RR, and general wellbeing. Dogs were provided rescue analgesia with 0.02 mg/kg buprenorphine SC if the postoperative pain score exceeded a prede- termined threshold. Blood samples were collected, and mass spectrometry was used to determine plasma buprenorphine concentrations. Data were analyzed with a linear mixed model and Tukey-Kramer multiple comparison. Age, body weight, anesthetic duration, surgical duration, sevoflurane concentration, and cardiorespiratory variables did not differ significantly between groups. Dogs in both formulation groups had comparable postoperative sedation and pain scores. One dog from each formulation group had breakthrough pain requiring rescue analgesia. Plasma buprenorphine concentrations remained above a hypothesized therapeutic concentration of 0.6 ng/mL for 136.0 ± 11.3 and 10.67 ± 0.84 h for SRB and buprenorphine, respectively. Based on the results of this study, multimodal analgesic regimens consisting of meloxicam and either buprenorphine or SRB are equally efficacious in managing pain associated with an ovariohysterectomy and show comparable side effects.

PMID: 25255072 [PubMed - as supplied by publisher]

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Effects of Analgesic Use on Inflammation and Hematology in a Murine Model of Venous Thrombosis.

Buprenorphine Research (PubMed) - Fri, 09/26/2014 - 9:00am
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Effects of Analgesic Use on Inflammation and Hematology in a Murine Model of Venous Thrombosis.

J Am Assoc Lab Anim Sci. 2014;53(5):485-493

Authors: Hish Jr GA, Diaz JA, Hawley AE, Myers Jr DD, Lester PA

Abstract
Venous thrombosis (VT) is a significant cause of morbidity and mortality in humans. Surgical animal models are crucial in studies investigating the pathogenesis of this disease and evaluating VT therapies. Because inflammation is critical to both the development and resolution of VT, analgesic medications have the potential to adversely affect multiple parameters of interest in VT research. The objective of this study was to determine how several common analgesics affect key variables in a murine ligation model of deep vein thrombosis. Male C57BL/6 mice were randomly assigned to receive either local (bupivacaine) or systemic parenteral analgesia (buprenorphine, tramadol, or carprofen) or 0.9% NaCl (control). All mice underwent laparotomy and ligation of the inferior vena cava, and treatment was continued until euthanasia at 6 or 48 h after surgery. Analysis of harvested tissues and blood included: hematology, thrombus weight, serum and vein-wall cytokines (IL1β, IL6, IL10, TNFα), soluble P-selectin, and vein-wall leukocyte infiltration. Compared with 0.9% NaCl, all of the analgesics affected multiple parameters important to VT research. Carprofen and tramadol affected the most parameters and should not be used in murine models of VT. Although they affected fewer parameters, a single dose of bupivacaine increased thrombus weight at 6 h, and buprenorphine was associated with reduced vein wall macrophages at 48 h. Although we cannot recommend the use of any of the evaluated analgesic dosages in this mouse model of VT, buprenorphine merits additional investigation to ensure the highest level of laboratory animal care and welfare.

PMID: 25255071 [PubMed - as supplied by publisher]

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Pharmacokinetics of Sustained-Release Analgesics in Mice.

Buprenorphine Research (PubMed) - Fri, 09/26/2014 - 9:00am
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Pharmacokinetics of Sustained-Release Analgesics in Mice.

J Am Assoc Lab Anim Sci. 2014;53(5):478-484

Authors: Kendall LV, Hansen RJ, Dorsey K, Kang S, Lunghofer PJ, Gustafson DL

Abstract
Buprenorphine and carprofen, 2 of the most commonly used analgesics in mice, must be administered every 8 to 12 h to provide sustained analgesia. Sustained-release (SR) formulations of analgesics maintain plasma levels that should be sufficient to provide sustained analgesia yet require less frequent dosing and thus less handling of and stress to the animals. The pharmacokinetics of SR formulations of buprenorphine (Bup-SR), butorphanol (Butp-SR), fentanyl (Fent-SR), carprofen (Carp-SR), and meloxicam (Melox-SR) were evaluated in mice over 72 h and compared with those of traditional, nonSR formulations. Bup-SR provided plasma drug levels greater than the therapeutic level for the first 24 to 48 h after administration, but plasma levels of Bup-HCl fell below the therapeutic level by 4 h. Fent-SR maintained plasma levels greater than reported therapeutic levels for 12 h. Therapeutic levels of the remaining drugs are unknown, but Carp-SR provided plasma drug levels similar to those of Carp for the first 24 h after administration, whereas Melox-SR had greater plasma levels than did Melox for the first 8 h. Butp-SR provided detectable plasma drug levels for the first 24 h, with a dramatic decrease over the first 4 h. These results indicate that Bup-SR provides a stable plasma drug level adequate for analgesia for 24 to 48 h after administration, whereas Carp-SR, Melox-SR, Fent-SR, and Butp-SR would require additional doses to provide analgesic plasma levels beyond 24 h in mice.

PMID: 25255070 [PubMed - as supplied by publisher]

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Clinical Case Conference: Unobserved "Home" Induction Onto Buprenorphine.

Buprenorphine Research (PubMed) - Fri, 09/26/2014 - 9:00am
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Clinical Case Conference: Unobserved "Home" Induction Onto Buprenorphine.

J Addict Med. 2014 September/October;8(5):309-314

Authors: Lee JD, McNeely J, Grossman E, Vocci F, Fiellin DA

Abstract
Unobserved or "home" buprenorphine induction has become a common clinical practice. Patients take the initial and subsequent doses of buprenorphine after, rather than during, an office visit. This clinical case summarizes an unobserved induction onto buprenorphine in a typical new patient. We review the core issues surrounding patient selection, feasibility, logistics, safety, and effectiveness of unobserved buprenorphine induction. Prescribers, treatment providers, policy makers, and patients should weigh the benefits of observed induction (maximum clinical supervision) with the reduced resource burden, flexibility, and comparable safety of unobserved induction.

PMID: 25254668 [PubMed - as supplied by publisher]

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Unobserved "Home" Induction Onto Buprenorphine.

Buprenorphine Research (PubMed) - Fri, 09/26/2014 - 9:00am
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Unobserved "Home" Induction Onto Buprenorphine.

J Addict Med. 2014 September/October;8(5):299-308

Authors: Lee JD, Vocci F, Fiellin DA

Abstract
BACKGROUND:: Unobserved, or "home" buprenorphine induction is common in some clinical practices. Patients take the initial and subsequent doses of buprenorphine after, rather than during, an office visit. This review summarizes the literature on the feasibility and acceptability, safety, effectiveness, and prevalence of unobserved induction.
METHODS:: We searched the English language literature for studies describing unobserved buprenorphine induction and associated outcomes. Clinical studies were assessed by strength of design, bias, and internal and external validity. Surveys of provider practices and unobserved induction adoption were reviewed for prevalence data and key findings. We also examined previous review papers and international buprenorphine treatment guidelines.
RESULTS:: N = 10 clinical studies describing unobserved induction were identified: 1 randomized controlled trial, 3 prospective cohort studies, and 6 retrospective cohort studies. The evidence supports the feasibility of unobserved induction, particularly in office-based primary care practices. Evidence is weak to moderate in support of no differences in adverse event rates between unobserved and observed inductions. There is insufficient or weak evidence in terms of any or no differences in overall effectiveness (treatment retention, medication adherence, illicit opioid abstinence, other drug use). N = 9 provider surveys assessed unobserved induction: observed induction logistics are seen as barriers to buprenorphine prescribing; unobserved induction appears widespread in specific locations. International guidelines reviewed emphasize clinician or pharmacist observed induction (the United States, the United Kingdom, France, Australia); only one (Denmark) explicitly endorses unobserved induction.
CONCLUSIONS:: There is insufficient evidence supporting unobserved induction as more, less, or as effective as observed induction. However, the predominantly observational and naturalistic studies of unobserved induction reviewed, all of which have significant sources of bias and limited external validity, document feasibility and low rates of adverse events. Unobserved induction seems to be widely adopted in US and French regional provider surveys. Prescribers, policy makers, and patients should balance the benefits of observed induction such as maximum clinical supervision with the ease-of-use and comparable safety profile of unobserved induction.

PMID: 25254667 [PubMed - as supplied by publisher]

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Novel approaches for the treatment of psychostimulant and opioid abuse - focus on opioid receptor-based therapies.

Buprenorphine Research (PubMed) - Fri, 09/26/2014 - 9:00am
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Novel approaches for the treatment of psychostimulant and opioid abuse - focus on opioid receptor-based therapies.

Expert Opin Drug Discov. 2014 Sep 25;:1-12

Authors: Bailey CP, Husbands SM

Abstract
Introduction: Psychostimulant and opioid addiction are poorly treated. The majority of abstinent users relapse back to drug-taking within a year of abstinence, making 'anti-relapse' therapies the focus of much current research. There are two fundamental challenges to developing novel treatments for drug addiction. First, there are three key stimuli that precipitate relapse back to drug-taking: stress, presentation of drug-conditioned cue, taking a small dose of drug. The most successful novel treatment would be effective against all three stimuli. Second, a large number of drug users are poly-drug users: taking more than one drug of abuse at a time. The ideal anti-addiction treatment would, therefore, be effective against all classes of drugs of abuse. Areas covered: In this review, the authors discuss the clinical need and animal models used to uncover potential novel treatments. There is a very broad range of potential treatment approaches and targets currently being examined as potential anti-relapse therapies. These broadly fit into two categories: 'memory-based' and 'receptor-based' and the authors discuss the key targets here within. Expert opinion: Opioid receptors and ligands have been widely studied, and research into how different opioid subtypes affect behaviours related to addiction (reward, dysphoria, motivation) suggests that they are tractable targets as anti-relapse treatments. Regarding opioid ligands as novel 'anti-relapse' medication targets, research suggests that a 'non-selective' approach to targeting opioid receptors will be the most effective.

PMID: 25253272 [PubMed - as supplied by publisher]

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Prescription drug monitoring programs and buprenorphine maintenance: Clinical considerations.

Buprenorphine Research (PubMed) - Thu, 09/25/2014 - 6:00am

Prescription drug monitoring programs and buprenorphine maintenance: Clinical considerations.

Am J Addict. 2014 Sep 22;

Authors: Hoefer M, Petrakis I

PMID: 25251308 [PubMed - as supplied by publisher]

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Buprenorphine-naloxone treatment in opioid dependence and risk of liver enzyme elevation: Results from a 12-month observational study.

Buprenorphine Research (PubMed) - Thu, 09/25/2014 - 6:00am

Buprenorphine-naloxone treatment in opioid dependence and risk of liver enzyme elevation: Results from a 12-month observational study.

Am J Addict. 2014 Sep 22;

Authors: Soyka M, Backmund M, Schmidt P, Apelt S

Abstract
BACKGROUND: Some case series mention possible liver toxicity in opioid-dependent patients under buprenorphine treatment.
METHODS: This 12-month prospective observational follow-up study in opioid-dependent patients under buprenorphine-naloxone treatment assessed outcome and safety issues. At baseline, 337 eligible datasets were available; 181 patients completed the 12-month study. Liver enzymes were tested at baseline and after 12, 24, and 52 weeks' treatment.
RESULTS: One to two percent of patients showed mostly discrete elevations of liver enzymes, but no patient met the criteria for drug-induced liver injury. No serious liver-related adverse events occurred, but two non-serious cases of liver enzyme increase were recorded. No patient dropped out of treatment for liver-related disorders.
CONCLUSION: This study is in line with some recent studies and provides further evidence that buprenorphine-naloxone is relatively safe with respect to liver injury. (Am J Addict 2013;XX:1-7).

PMID: 25251050 [PubMed - as supplied by publisher]

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Medication-assisted treatment for opioid use disorders in correctional settings: An ethics review.

Buprenorphine Research (PubMed) - Thu, 09/25/2014 - 6:00am

Medication-assisted treatment for opioid use disorders in correctional settings: An ethics review.

Int J Drug Policy. 2014 Aug 30;

Authors: Ludwig AS, Peters RH

Abstract
Opioid use disorders are a pressing health concern that disproportionately impacts the United States (U.S.) correctional population. Medication-assisted treatment (MAT) is an evidence-based standard of care for opioid use disorders. Despite its availability in the community, MAT and MAT medications (buprenorphine and methadone) are largely unavailable and/or inaccessible for the treatment of opioid use disorders in U.S. prisons and jails. Given that the ethical principles have served as justification for limiting access to MAT on "moral" grounds, this article examines the implications of current correctional policies through the ethical principles of: (1) beneficence/non-maleficence; (2) distributive justice (equivalence-of-care); and (3) autonomy (informed consent). Special attention is paid to the five components of informed consent (capacity, disclosure, understanding, voluntariness, and access), as this facet has been used most often to justify policies that limit access to MAT in the past. Findings highlight that these core ethical principles support the adoption of correctional policies that include MAT. Furthermore, our findings demonstrate that autonomy is maximized during the informed consent process when MAT is available as a treatment option.

PMID: 25249444 [PubMed - as supplied by publisher]

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Datapoints: regional variation in benzodiazepine prescribing for patients on opioid agonist therapy.

Buprenorphine Research (PubMed) - Thu, 09/25/2014 - 6:00am
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Datapoints: regional variation in benzodiazepine prescribing for patients on opioid agonist therapy.

Psychiatr Serv. 2014 Jan 1;65(1):4

Authors: Park TW, Bohnert AS, Austin KL, Saitz R, Pizer SD

PMID: 24382761 [PubMed - indexed for MEDLINE]

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Tapentadol Abuse Potential: A Postmarketing Evaluation Using a Sample of Individuals Evaluated for Substance Abuse Treatment.

Buprenorphine Research (PubMed) - Tue, 09/23/2014 - 7:30am

Tapentadol Abuse Potential: A Postmarketing Evaluation Using a Sample of Individuals Evaluated for Substance Abuse Treatment.

Pain Med. 2014 Sep 22;

Authors: Butler SF, McNaughton EC, Black RA

Abstract
OBJECTIVE: Abuse of prescription opioid pain relievers continues to be a serious public health concern. In contrast to opioids such as oxycodone or morphine, tapentadol, a prescription analgesic, has two mechanisms of action: μ-opioid receptor agonism and norepinephrine reuptake inhibition. As a result of differences in its receptor pharmacology, there may be differences in its abuse profile. As an initial step toward testing this hypothesis, we present a postmarketing examination of tapentadol's abuse liability relative to comparators.
METHODS: A sentinel sample of 113,914 individuals assessed for substance abuse treatment as part of the NAVIPPRO ASI-MV(®) surveillance system at 624 facilities in 38 states from January 2011 to September 2012 was examined for prevalence and prescription-adjusted prevalence of past 30-day abuse of tapentadol as a compound and its immediate-release (IR) and extended-release (ER) formulations with oxymorphone, hydromorphone, hydrocodone, morphine, fentanyl, oxycodone, tramadol, and buprenorphine as comparators.
RESULTS: Tapentadol abuse was reported significantly less often (P < 0.001) than all comparator compounds. Tapentadol IR abuse prevalence was significantly lower than all comparators except fentanyl IR, which had the next lowest unadjusted abuse prevalence. Prevalence of tapentadol ER abuse was lower than comparators except hydromorphone ER. Low prescription-adjusted estimates were observed for tapentadol as a compound as well as its IR and ER formulations, which were among the lowest observed and the lowest of the Schedule II comparators. Prescription-adjusted risk for tapentadol ER was less than comparators except hydromorphone ER (P = 0.06).
CONCLUSIONS: Tapentadol abuse was seen infrequently in this study and, on a prescription basis, was less likely to be abused than most of the examined Schedule II analgesics.

PMID: 25243972 [PubMed - as supplied by publisher]

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HIV Risk Reduction With Buprenorphine-Naloxone or Methadone: Findings From A Randomized Trial.

Buprenorphine Research (PubMed) - Tue, 09/23/2014 - 7:30am

HIV Risk Reduction With Buprenorphine-Naloxone or Methadone: Findings From A Randomized Trial.

J Acquir Immune Defic Syndr. 2014 Sep 19;

Authors: Woody G, Bruce D, Korthuis PT, Chhatre S, Hillhouse M, Jacobs P, Sorensen J, Saxon AJ, Poole S, Metzger D, Ling W

PMID: 25243431 [PubMed - as supplied by publisher]

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Frequent use of opioids in patients with dementia and nursing home residents-A study of the entire elderly population of Denmark.

Buprenorphine Research (PubMed) - Tue, 09/23/2014 - 7:30am
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Frequent use of opioids in patients with dementia and nursing home residents-A study of the entire elderly population of Denmark.

Alzheimers Dement. 2014 Sep 16;

Authors: Jensen-Dahm C, Gasse C, Astrup A, Mortensen PB, Waldemar G

Abstract
BACKGROUND: Pain is believed to be undertreated in patients with dementia; however, no larger studies have been conducted. The aim was to investigate prevalent use of opioids in elderly with and without dementia in the entire elderly population of Denmark.
METHOD: A register-based cross-sectional study in the entire elderly (≥65 years) population in 2010 was conducted. Opioid use among elderly with dementia (N = 35,455) was compared with elderly without (N = 870,645), taking age, sex, comorbidity, and living status into account.
RESULTS: Nursing home residents (NHRs) used opioids most frequently (41%), followed by home-living patients with dementia (27.5%) and home-living patients without dementia (16.9%). Buprenorphine and fentanyl (primarily patches) were commonly used among NHRs (18.7%) and home-living patients with dementia (10.7%) but less often by home-living patients without dementia (2.4%).
CONCLUSIONS: Opioid use in the elderly Danish population was frequent but particularly in patients with dementia and NHR, which may challenge patient safety and needs further investigation.

PMID: 25239738 [PubMed - as supplied by publisher]

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The effectiveness of opioid substitution treatments for patients with opioid dependence: a systematic review and multiple treatment comparison protocol.

Buprenorphine Research (PubMed) - Tue, 09/23/2014 - 7:30am
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The effectiveness of opioid substitution treatments for patients with opioid dependence: a systematic review and multiple treatment comparison protocol.

Syst Rev. 2014 Sep 19;3(1):105

Authors: Dennis BB, Naji L, Bawor M, Bonner A, Varenbut M, Daiter J, Plater C, Pare G, Marsh DC, Worster A, Desai D, Samaan Z, Thabane L

Abstract
BACKGROUND: Opioids are psychoactive analgesic drugs prescribed for pain relief and palliative care. Due to their addictive potential, effort and vigilance in controlling prescriptions is needed to avoid misuse and dependence. Despite the effort, the prevalence of opioid use disorder continues to rise. Opioid substitution therapies are commonly used to treat opioid dependence; however, there is minimal consensus as to which therapy is most effective. Available treatments include methadone, heroin, buprenorphine, as well as naltrexone. This systematic review aims to assess and compare the effect of all available opioid substitution therapies on the treatment of opioid dependence.
METHODS: The authors will search Medline, EMBASE, PubMed, PsycINFO, Web of Science, Cochrane Library, Cochrane Clinical Trials Registry, World Health Organization International Clinical Trials Registry Platform Search Portal, and the National Institutes for Health Clinical Trials Registry. The title, abstract, and full-text screening will be completed in duplicate. When appropriate, multiple treatment comparison Bayesian meta-analytic methods will be performed to deduce summary statistics estimating the effectiveness of all opioid substitution therapies in terms of retention and response to treatment (as measured through continued opioid abuse).
DISCUSSION: Using evidence gained from this systematic review, we anticipate disseminating an objective review of the current available literature on the effectiveness of all opioid substitution therapies for the treatment of opioid use disorder. The results of this systematic review are imperative to the further enhancement of clinical practice in addiction medicine.Systematic review registration: PROSPERO CRD42013006507.

PMID: 25239213 [PubMed - as supplied by publisher]

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A pharmaceutical industry perspective on the economics of treatments for alcohol and opioid use disorders.

Buprenorphine Research (PubMed) - Tue, 09/23/2014 - 7:30am
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A pharmaceutical industry perspective on the economics of treatments for alcohol and opioid use disorders.

Ann N Y Acad Sci. 2014 Sep 18;

Authors: Gastfriend DR

Abstract
Individuals with alcohol and/or drug use disorders often fail to receive care, or evidence-based care, yet the literature shows health economic benefits. Comparative effectiveness research is emerging that examines approved approaches in terms of real, total healthcare cost/utilization. Comprehensive retrospective insurance claims analyses are few but tend to be nationally distributed and large. The emerging pattern is that, while treatment in general is cost effective, specific therapeutics can yield different health economic outcomes. Cost/utilization data consistently show greater savings with pharmacotherapies (despite their costs) versus psychosocial treatment alone. All FDA-approved addiction pharmacotherapies (oral naltrexone, extended-release naltrexone, acamprosate, disulfiram, buprenorphine, buprenorphine/naloxone, and methadone) are intended for use in conjunction with psychosocial management, not as stand-alone therapeutics; hence, pharmacotherapy costs must offer benefits in addition to abstinence alone or psychological therapy. Patient persistence is problematic, and (despite its cost) extended-release pharmacotherapy may be associated with lower or no greater total healthcare cost, mostly due to reduced hospitalization. The reviewed studies use rigorous case-mix adjustment to balance treatment cohorts but lack the randomization that clinical trials use to protect against confounding. Unlike trials, however, these studies can offer generalizability to diverse populations, providers, and payment models-and are of particular salience to payers.

PMID: 25236185 [PubMed - as supplied by publisher]

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Association of CHRNA5-A3-B4 SNP rs2036527 with smoking cessation therapy response in African-American smokers.

Buprenorphine Research (PubMed) - Tue, 09/23/2014 - 7:30am
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Association of CHRNA5-A3-B4 SNP rs2036527 with smoking cessation therapy response in African-American smokers.

Clin Pharmacol Ther. 2014 Aug;96(2):256-65

Authors: Zhu AZ, Zhou Q, Cox LS, David SP, Ahluwalia JS, Benowitz NL, Tyndale RF

Abstract
Associations between CHRNA5-A3-B4 variants and smoking behaviors exist; however, the association with smoking abstinence is less understood, particularly that among African Americans. In 1,295 African Americans enrolled in two clinical trials, we investigated the association between CHRNA5-A3-B4 and smoking abstinence. The rs2056527(A) allele was associated with lower abstinence with active pharmacotherapy (during treatment: odds ratio (OR) = 0.42, P < 0.001; end of treatment (EOT): OR = 0.55, P = 0.004), or with nicotine gum alone (during treatment: OR = 0.31, P < 0.001; EOT: OR = 0.51, P = 0.02), but not significantly with bupropion, although similar directions and magnitudes were observed (during treatment: OR = 0.54, P = 0.05; EOT: OR = 0.59, P = 0.08). In addition, the rs588765(T) allele was associated with abstinence with gum during treatment (OR = 2.31, P < 0.01). The SNP rs16969968 occurred at a low frequency and was not consistently associated with abstinence. CHRNA5-A3-B4 variants were not associated with tobacco consumption, and adjustments for smoking behaviors did not alter the associations with smoking abstinence. Together, our data suggest that among African Americans, CHRNA5-A3-B4 variants are not associated with baseline smoking but can influence smoking abstinence during active pharmacotherapy.

PMID: 24733007 [PubMed - indexed for MEDLINE]

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