Population Pharmacokinetic Model of Sublingual Buprenorphine in Neonatal Abstinence Syndrome.

Buprenorphine Research (PubMed) - Wed, 07/15/2015 - 7:00am

Population Pharmacokinetic Model of Sublingual Buprenorphine in Neonatal Abstinence Syndrome.

Pharmacotherapy. 2015 Jul 14;

Authors: Ng CM, Dombrowsky E, Lin H, Erlich ME, Moody DE, Barrett JS, Kraft WK

Abstract
OBJECTIVE: Neonatal abstinence syndrome (NAS)-a clinical entity of infants from in utero exposure to psychoactive xenobiotic and buprenorphine-has been successfully used to treat NAS. However, nothing is known about the pharmacokinetics (PK) of buprenorphine in neonates with NAS. To our knowledge, this is the first study to investigate the population pharmacokinetic of sublingual buprenorphine in neonates with NAS.
DESIGN: A retrospective population PK analysis of: (1) neonates with NAS treated with sublingual buprenorphine in randomized, double blinded clinical study and (2) data from healthy adults from a previously published pharmacokinetic study.
SETTING: Neonatal intensive care unit and general clinical research unit.
PATIENTS: Twenty-four neonates with NAS and five healthy adults.
INTERVENTIONS: All participants received sublingual buprenorphine per study protocol.
MEASUREMENTS AND MAIN RESULTS: A total of 303 PK data from 29 neonates and adults were used for model development. A population pharmacokinetic analysis was conducted using a first order conditional estimation with interaction in the NONMEM software program. A two-compartment linear PK model with first-order absorption process best described the pharmacokinetics of sublingual buprenorphine in neonates. The apparent clearance (CL) of buprenorphine was linearly related to body weight and matured with increasing age via two distinct saturated pathways. A typical neonate with NAS (body weight, 2.9 kg; postnatal age; 5.4 days) had a CL of 3.5 L/kg/hour and elimination half-life of 11 hours. Phenobarbital did not affect the clearance of buprenorphine compared to neonates of similar age and weight.
CONCLUSIONS: This is the first study to investigate the population PK of sublingual buprenorphine in neonatal NAS. To our knowledge, this is also the first report to describe the age-dependent changes of buprenorphine PK in this patient population. No buprenorphine dose adjustment is needed for neonates with NAS treated with buprenorphine and concurrent phenobarbital.

PMID: 26172282 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Ethanol Reversal of Tolerance to the Respiratory Depressant Effects of Morphine.

Buprenorphine Research (PubMed) - Wed, 07/15/2015 - 7:00am

Ethanol Reversal of Tolerance to the Respiratory Depressant Effects of Morphine.

Neuropsychopharmacology. 2015 Jul 14;

Authors: Hill R, Lyndon A, Withey S, Roberts J, Kershaw Y, MacLachlan J, Lingford-Hughes A, Kelly E, Bailey C, Hickman M, Henderson G

Abstract
Opioids are the most common drugs associated with unintentional drug overdose. Death results from respiratory depression. Prolonged use of opioids results in the development of tolerance but the degree of tolerance is thought to vary between different effects of the drugs. Many opioid addicts regularly consume alcohol (ethanol) and post-mortem analyses of opioid overdose deaths have revealed an inverse correlation between blood morphine and ethanol levels. In the present study we determined whether ethanol reduced tolerance to the respiratory depressant effects of opioids. Mice were treated with opioids (morphine, methadone or buprenorphine) for up to 6 days. Respiration was measured in freely moving animals breathing 5% CO2 in air in plethysmograph chambers. Antinociception (analgesia) was measured as the latency to remove the tail from a thermal stimulus. Opioid tolerance was assessed by measuring the response to a challenge dose of morphine (10 mg/kg i.p.). Tolerance developed to the respiratory depressant effect of morphine but at a slower rate than tolerance to its antinociceptive effect. A low dose of ethanol (0.3 mg/kg) alone did not depress respiration but in prolonged morphine treated animals respiratory depression was observed when ethanol was co-administered with the morphine challenge. Ethanol did not alter the brain levels of morphine. In contrast, in methadone or buprenorphine treated animals no respiratory depression was observed when ethanol was co-administered along with the morphine challenge. As heroin is converted to morphine in man selective reversal of morphine tolerance by ethanol may be a contributory factor in heroin overdose deaths.Neuropsychopharmacology accepted article preview online, 14 July 2015. doi:10.1038/npp.2015.201.

PMID: 26171718 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Effectiveness of yogic breathing intervention on quality of life of opioid dependent users.

Buprenorphine Research (PubMed) - Wed, 07/15/2015 - 7:00am
Related Articles

Effectiveness of yogic breathing intervention on quality of life of opioid dependent users.

Int J Yoga. 2015 Jul-Dec;8(2):144-7

Authors: Dhawan A, Chopra A, Jain R, Yadav D, Vedamurthachar

Abstract
INTRODUCTION: The quality of life (QOL) of substance users is known to be impaired. Sudarshan Kriya Yoga (SKY), a yogic breathing program has potential to improve QOL and needs evaluation in an Indian setting.
AIMS: Study aimed to assess changes in QOL in treatment seeking male opioid dependent users following practice of SKY program.
SETTINGS AND DESIGN: Users were randomized into study (n = 55) and control group (n = 29). Study group besides standard treatment (long term pharmacotherapy with buprenorphine in flexible dosing schedule) underwent a 3 days, 12 h SKY program while control group received standard treatment alone.
MATERIALS AND METHODS: World Health Organization QOL-brief scale was used to measure QOL and urine tested to assess recent drug use. Assessments were made at baseline and at 3 and 6 months.
STATISTICAL ANALYSIS: Data were analyzed using generalized estimation equation to assess within group change with time and the overall difference between groups for changes at assessment points.
RESULTS: Overtime within study group, all four QOL domain scores were significantly higher at 6 months. Between group comparison showed significant increase in physical (P < 0.05); psychological (P < 0.001) and environment domains (P < 0.001) for study group while control group showed significant changes in social relationship domain only. Urine screening results were negative for study group indicating no drug use at 6 months.
CONCLUSION: SKY as a complementary therapy was found beneficial in improving QOL for group practicing it and is recommended for use as low cost and low-risk adjunct in substance treatment settings in India.

PMID: 26170596 [PubMed]

Categories: Bup Feeds

Counselor Training and Attitudes Toward Pharmacotherapies for Opioid Use Disorder.

Buprenorphine Research (PubMed) - Wed, 07/15/2015 - 7:00am
Related Articles

Counselor Training and Attitudes Toward Pharmacotherapies for Opioid Use Disorder.

Subst Abus. 2015 Jul 13;:0

Authors: Aletraris L, Edmond MB, Paino M, Fields D, Roman PM

Abstract
BACKGROUND: Methadone and buprenorphine have been demonstrated to be effective in the treatment of opioid use disorder (OUD), especially when combined with psychosocial treatment. Despite buprenorphine's association with fewer withdrawal symptoms and lessened risk of abuse, compared to methadone, its adoption remains limited. Given the vital role that counselors may play in its successful implementation, their knowledge and perceptions of opioid agonist therapy may be facilitators or barriers to its acceptance.
METHODS: Informed by diffusion theory, the current study examined perceptions of buprenorphine and methadone acceptability among 725 counselors employed in a nationally representative sample of substance use disorder treatment centers. First, we provided descriptive statistics about medication diffusion, extent of training received about the medications, and perceptions of acceptability of each medication. Then, we compared acceptability of opioid agonists with other treatment approaches for OUD. Finally, we conducted two ordinary least squares regressions to examine counselor acceptability of buprenorphine and of methadone.
RESULTS: Descriptive statistics suggested that diffusion of information about buprenorphine and methadone was not complete, and training was not extensive for either medication. Counselors reported greater acceptability and training of buprenorphine compared to methadone. Methadone was rated as the least acceptable among all other treatment approaches. Multivariate analyses indicated regional differences, and that medication-specific training, adaptability, and educational attainment were positively related with perceptions of acceptability of either medication, even after controlling for organizational characteristics. Adherence to a 12-step orientation was negatively associated with acceptability.
CONCLUSIONS: Dissemination of information about opioid agonist therapy is occurring. Nevertheless, the fact that 20% of counselors admitted not knowing enough about either buprenorphine's or methadone's effectiveness is surprising in light of the extensive literature documenting their effectiveness. Future research should focus upon different types of training that can inform physicians, counselors and patients about the use of opioid agonist therapy.

PMID: 26168816 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Is periconceptional opioid use safe?

Buprenorphine Research (PubMed) - Wed, 07/15/2015 - 7:00am
Related Articles

Is periconceptional opioid use safe?

Can Fam Physician. 2015 May;61(5):431-3

Authors: Chan F, Koren G

Abstract
QUESTION: A patient in my practice who takes buprenorphine for chronic pain would like to conceive. Is it safe for her to continue taking her medication?
ANSWER: The literature regarding periconceptional opioid use is conflicted as to whether opioids pose an elevated risk of birth defects. Confounding factors such as socioeconomic status, stress, and alcohol consumption might play a role. The first trimester of pregnancy is the critical period of development for many organ systems in the embryo. A chemical or environmental insult is more likely to produce major congenital malformations such as neural tube defects or mental retardation if it occurs within this window. Medical practitioners should judiciously consider a risk-benefit analysis before making their decisions.

PMID: 26167561 [PubMed - in process]

Categories: Bup Feeds

Outcomes from the Malaysian Arm of The International Survey Informing Greater Insights in Opioid Dependence Treatment (INSIGHT) Project.

Buprenorphine Research (PubMed) - Wed, 07/15/2015 - 7:00am
Related Articles

Outcomes from the Malaysian Arm of The International Survey Informing Greater Insights in Opioid Dependence Treatment (INSIGHT) Project.

Med J Malaysia. 2015 Apr;70(2):117-24

Authors: George P

Abstract
BACKGROUND: Opioid dependence (OD) is a chronic, relapsing condition representing a significant societal burden in Asia. Opioid maintenance treatment (OMT) in combination with psychosocial treatment is considered to be the most effective strategy to treat opioid dependence. In Malaysia, about 52,000 patients reported receiving OMT in December 2012.
OBJECTIVE: The International Survey Informing Greater Insights in Opioid Dependence Treatment (INSIGHT) project aimed to assess aspects of OMT access and quality of care by surveying patients and users with opioid dependence, and healthcare professionals treating opioid-dependent patients.
MATERIALS AND METHODS: Using a structured questionnaire, 50 patients who were currently receiving OMT (or had received OMT in the past 3 months) and 77 physicians were surveyed in Malaysia regarding the provision and quality of OMT.
RESULTS: Patients were predominately male and in their thirties. Nearly all patients (98%) reported currently receiving methadone liquid; almost half (48%) reported ever having received psychosocial counselling and only 14% had ever received buprenorphine-naloxone in the past. Most physicians reported they were treating their patients with OMT (77% on methadone and 15% on buprenorphine-naloxone), and 3% used psychosocial counselling alone. Although methadone maintenance doses were close to levels recommended by WHO guidelines, induction doses of methadone, and both induction and maintenance doses of buprenorphine were well below these levels in Malaysia.
CONCLUSIONS: The findings suggest that OMT implementation in Malaysia can be improved by providing patients with more education on treatment options, better access to available treatments, including abuse-deterrent formulations, and psychosocial support.

PMID: 26162395 [PubMed - in process]

Categories: Bup Feeds

Evaluation of an inpatient medical withdrawal program in rural Ontario: a 1-year prospective study.

Buprenorphine Research (PubMed) - Sat, 07/11/2015 - 6:00am

Evaluation of an inpatient medical withdrawal program in rural Ontario: a 1-year prospective study.

Can J Rural Med. 2015;20(3):92-7

Authors: Kiepek N, Groom B, Toppozini D, Kakekagumick K, Muileboom J, Kelly L

Abstract
INTRODUCTION: We present a 1-year program evaluation of the Medical Withdrawal Support Service (MWSS) provided at the Sioux Lookout Meno Ya Win Health Centre. The centre's service area includes 4 rural municipalities and 28 First Nations communities. The program involves inpatient detoxification for opioid dependence with the use of buprenorphine-naloxone.
METHODS: Data were collected from preadmission interviews (i.e., medical history, substance use history, previous counselling, social history, previous addiction treatment and screening tools used during the interview); discharge forms (i.e., length of stay, maximum dose of prescribed buprenorphine-naloxone and client goals); and postdischarge interviews.
RESULTS: Overall, 81% of the clients successfully completed the program. Two weeks after discharge, 48% of clients reported continued abstinence. At 3-month follow-up, 32% were abstinent, and at 6 months, 30% were abstinent.
CONCLUSION: The MWSS shows positive outcomes for many clients, their families and communities. Clients returned to work and school, became more engaged in healthy meal preparation and exercise, spent more time with family and were more involved as leaders in their communities.

PMID: 26160514 [PubMed - in process]

Categories: Bup Feeds

Methadone versus buprenorphine for the treatment of opioid abuse in pregnancy: science and stigma.

Buprenorphine Research (PubMed) - Sat, 07/11/2015 - 6:00am

Methadone versus buprenorphine for the treatment of opioid abuse in pregnancy: science and stigma.

Am J Drug Alcohol Abuse. 2015 Jul 8;:1-3

Authors: Holbrook AM

Abstract
The past decade has seen an increase in rates of opioid abuse during pregnancy. This clinical challenge has been met with debate regarding whether or not illicit and prescription opioid-dependent individuals require different treatment approaches; whether detoxification is preferable to maintenance; and the efficacy of methadone versus buprenorphine as treatment options during pregnancy. The clinical recommendations resulting from these discussions are frequently influenced by the comparative stigma attached to heroin abuse and methadone maintenance versus prescription opioid abuse and maintenance treatment with buprenorphine. While some studies have suggested that a subset of individuals who abuse prescription opioids may have different characteristics than heroin users, there is currently no evidence to suggest that buprenorphine is better suited to treatment of prescription opioid abuse than methadone. Similarly, despite its perennial popularity, there is no evidence to recommend detoxification as an efficacious approach to treatment of opioid dependence during pregnancy. While increased access to treatment is important, particularly in rural areas, there are multiple medical and psychosocial reasons to recommend comprehensive substance abuse treatment for pregnant women suffering from substance use disorders rather than office-based provision of maintenance medication. Both methadone and buprenorphine are important treatment options for opioid abuse during pregnancy. Methadone may still remain the preferred treatment choice for some women who require higher doses for stabilization, have a higher risk of treatment discontinuation, or who have had unsuccessful treatment attempts with buprenorphine. As treatment providers, we should advocate to expand available treatment options for pregnant women in all States.

PMID: 26154531 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Buprenorphine-elicited alteration of adenylate cyclase activity in human embryonic kidney 293 cells coexpressing κ-, μ-opioid and nociceptin receptors.

Buprenorphine Research (PubMed) - Sat, 07/11/2015 - 6:00am

Buprenorphine-elicited alteration of adenylate cyclase activity in human embryonic kidney 293 cells coexpressing κ-, μ-opioid and nociceptin receptors.

J Cell Mol Med. 2015 Jul 8;

Authors: Wang PC, Ho IK, Lee CW

Abstract
Buprenorphine, a maintenance drug for heroin addicts, exerts its pharmacological function via κ- (KOP), μ-opioid (MOP) and nociceptin/opioid receptor-like 1 (NOP) receptors. Previously, we investigated its effects in an in vitro model expressing human MOP and NOP receptors individually or simultaneously (MOP, NOP, and MOP+NOP) in human embryonic kidney 293 cells. Here, we expanded this cell model by expressing human KOP, MOP and NOP receptors individually or simultaneously (KOP, KOP+MOP, KOP+NOP and KOP+MOP+NOP). Radioligand binding with tritium-labelled diprenorphine confirmed the expression of KOP receptors. Immunoblotting and immunocytochemistry indicated that the expressed KOP, MOP and NOP receptors are N-linked glycoproteins and colocalized in cytoplasmic compartments. Acute application of the opioid receptor agonists- U-69593, DAMGO and nociceptin- inhibited adenylate cyclase (AC) activity in cells expressing KOP, MOP and NOP receptors respectively. Buprenorphine, when applied acutely, inhibited AC activity to ~90% in cells expressing KOP+MOP+NOP receptors. Chronic exposure to buprenorphine induced concentration-dependent AC superactivation in cells expressing KOP+NOP receptors, and the level of this superactivation was even higher in KOP+MOP+NOP-expressing cells. Our study demonstrated that MOP receptor could enhance AC regulation in the presence of coexpressed KOP and NOP receptors, and NOP receptor is essential for concentration-dependent AC superactivation elicited by chronic buprenorphine exposure.

PMID: 26153065 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Response.

Buprenorphine Research (PubMed) - Sat, 07/11/2015 - 6:00am
Related Articles

Response.

Can Fam Physician. 2014 Nov;60(11):986

Authors: Koren G

PMID: 25392437 [PubMed - indexed for MEDLINE]

Categories: Bup Feeds

Not antagonist treatment.

Buprenorphine Research (PubMed) - Sat, 07/11/2015 - 6:00am
Related Articles

Not antagonist treatment.

Can Fam Physician. 2014 Nov;60(11):986

Authors: Newman R, Gevertz S

PMID: 25392436 [PubMed - indexed for MEDLINE]

Categories: Bup Feeds

What DO I do with those extra meds? A few simple steps.

Drug and Alcohol News (JoinTogether.com) - Wed, 07/08/2015 - 4:13pm

Teen medicine abuse is an epidemic. That’s not our declaration; it’s that of the CDC, who doesn’t throw the term “epidemic” around loosely.  It’s no secret that this behavior is a problem (and a devastating one); what is sometimes confusing, though, is what you can do in your own home to prevent the behavior and protect your family.

At the Partnership, we know that kids and adults who intend to abuse are not only accessing medicine from their own homes, but they seek it at the homes of their friends’ parents; their grandparents; and others. Safeguarding and properly disposing of the medicine you keep at home is an action that everyone should take – regardless of whether or not you believe your teen or family is at risk.

So, how do you deal with those unwanted, expired or unused medicines in your home? Here are some simple steps to help clear up the confusion.

  1. The best and safest way to dispose of unwanted medicine is by finding a take-back location near you. The American Medicine Chest Challenge features a national directory of permanent prescription collection sites in every state across the country, so you can learn where to take your meds year round. The DEA also hosts national take-back days a few times per year. Either of these options are ideal ways of disposing of your medicine.
  2. If you can’t get to a take-back location and must dispose of your meds at home, it is best to crush them up and mix them with an undesirable substance – like coffee grounds or kitty litter – and throw the mixture in the trash. This makes pills less appealing and less recognizable to anyone who can see your trash – including your teens. Note: flushing your medicine is not advised and is dangerous, as it contaminates water and causes an environmental hazard.

Of course, many people have medicine at home that they are actively using, or need to keep at home for future use. If this is the case, be vigilant about counting your pills and safeguarding this medicine.

Finally, but perhaps most importantly, talk to your kids and family about the dangers of abusing medicine. For more information on how you can help #EndMedicineAbuse at home and in your community, visit our Medicine Abuse Project website.

The post What DO I do with those extra meds? A few simple steps. appeared first on Partnership for Drug-Free Kids.

Categories: Bup Feeds

Endovascular treatment of infected brachial pseudoaneurysm in an intravenous drug abuser: a case report.

Buprenorphine Research (PubMed) - Mon, 07/06/2015 - 6:30am

Endovascular treatment of infected brachial pseudoaneurysm in an intravenous drug abuser: a case report.

Ann Vasc Surg. 2015 Jul 1;

Authors: Raluca B, Georg Y, Ramlugun D, Martinot M, Camin A, Matysiak L, Kretz B

Abstract
We report the case of a 36-year old male, admitted in the emergency room with a non ruptured brachial pseudoaneurysm after Buprenorphine injection, with no signs of distal acute ischemia. After endovascular treatment with a nitinol covered stent associated with adapted antibiotherapy and 35 days of hospitalizations, the patient was discharged with good short results but stent need to be removed at 6 months for thrombosis and partial exposure through the wound.

PMID: 26142880 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Pages

Subscribe to BupPractice aggregator - Bup Feeds