Bup Feeds

Sy37-3mental health and adaptation in 7/8 year-old children prenatally exposed to methadone and buprenorphine (omt).

Buprenorphine Research (PubMed) - Tue, 09/16/2014 - 2:30pm
Related Articles

Sy37-3mental health and adaptation in 7/8 year-old children prenatally exposed to methadone and buprenorphine (omt).

Alcohol Alcohol. 2014 Sep;49 Suppl 1:i31-i32

Authors: Sarfi M, Heiervang E

Abstract
INTRODUCTION: Children exposed to OMT prenatally are at risk of cognitive and behavior problems, particularly evident when children enter school. We here present follow-up data from a national Norwegian cohort of 32 children prenatally exposed to OMT, and 22 general population controls.
METHOD: Cognitive level was assessed with WASI, behavioral symptoms with SDQ, and diagnostic assessment was performed online with the DAWBA.
RESULTS: Full scale IQ was lower for exposed children than for controls (102 vs 113), but still within the normal range. Exposed children also had 2-3 times higher mean SDQ Total difficulties and subscale scores (except for emotional problems and parent reported impact). DSM-IV disorders were seen in 17 exposed children (53.1%); 10 ADHD, 6 oppositional, 5 emotional, 4 attachment, and 3 tic disorders. Only one control child (4.5%) met criteria for a mental disorder (within the emotional domain).
CONCLUSION: In spite of a normal mean cognitive level, exposed children had high levels of behavior symptoms, and a very high prevalence of mental disorders. Being the first study of mental disorders in children prenatally exposed to OMT, this study needs replication in larger longitudinal studies, where other contributing factors during development may be controlled for.

PMID: 25221114 [PubMed - in process]

Categories: Bup Feeds

Sy37-1lessons learned from a comparison of evidence-based research in pregnant opioid-dependent women.

Buprenorphine Research (PubMed) - Tue, 09/16/2014 - 2:30pm
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Sy37-1lessons learned from a comparison of evidence-based research in pregnant opioid-dependent women.

Alcohol Alcohol. 2014 Sep;49 Suppl 1:i31

Authors: Fischer G, Winklbaur-Hausknost B, Jagsch R, Graf-Rohrmeister K, Unger A, Baewert A, Langer M, Thau K

Abstract
OBJECTIVES: Lessons learned in research and treatment of opioid dependence demonstrate the need to include pregnant women in clinical trials.
METHODS: Two double-blind, double-dummy, randomized controlled trials comparing buprenorphine and methadone in opioid-dependent pregnant women were conducted. In both studies, participants received voucher-based incentives for attendance and completion of study assessments. In the MOTHER trial, participants additionally received escalating voucher incentives for drug-free urine samples. Neonatal abstinence syndrome was treated with oral morphine solution based on standardized modified Finnegan scores.
RESULTS: After a mean treatment period of 13.79 weeks in the Pilot study (PS, n = 18) and 20.78 weeks in the MOTHER-trial (MT, n = 41), respectively (p < 0.001), PS patients delivered at mean doses of 14.00mg buprenorphine/52.50mg methadone and MT participants at 13.44mg buprenorphine/63.68mg methadone. Nonsignificant differences regarding dropout rates were found (22% in PS versus 10% in MT), but dropout was significantly earlier in the MT (p = 0.013). Significantly higher rates of concomitant consumption of opioids and benzodiazepines occurred in the PS compared with the MT (p < 0.001), however, with no significant differences in neonatal data between both settings.
CONCLUSIONS: Early treatment enrolment combined with contingency management contributes to reduced illicit drug use throughout pregnancy, surprisingly without influencing neonatal outcome parameters.

PMID: 25221112 [PubMed - in process]

Categories: Bup Feeds

Sy15-4prescription opioids in southern europe: france.

Buprenorphine Research (PubMed) - Tue, 09/16/2014 - 2:30pm
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Sy15-4prescription opioids in southern europe: france.

Alcohol Alcohol. 2014 Sep;49 Suppl 1:i15

Authors: Touzeau D, Green JL, Maremmani I, Torrens M, Walcher S, Deruvo G, Somaini L, Martines D, Rossi P, Martinez-Riera R, Fonseca F

Abstract
BACKGROUND: Prescription opioid misuse in an increasing public health in many countries. The objective is to assess the prevalence of prescription opioid misuse in four European countries. Data from France are presented.
METHODS: Cross-sectional study. The rates of prescription drug misuse have been assessed using patient self-report at treatment program intake. Patients have been asked to self-report the use of use and injection history for European-market prescription opioids, prescription stimulants, and heroin, during the past 30-day. Also, basic demographic information, treatment history, and health care worker status have been recorded.
RESULTS: In France, a final sample of 144 subjects (77% males; 38,9years old) was recruited. The were 62,5% in treatment for heroin dependence; the rest (7) has as a main drug buprenorphine, codeine, methadone, morphine, fentanyl and tramadol. The main opioid abused drug during the last month was heroin, followed by buprenorphine, codeine, methadone and morphine. Those previously in treatment endorsed significantly less drugs, and less past 30-day use of buprenorphine. Buprenorphine is the preferred first line medication for French opioid rehabilitation patients.
CONCLUSIONS: Preliminary data show that besides heroin, there is a concomitant abuse of prescription opioids. The knowledge of drug use patterns can provide useful information to develop effective prevention and treatment.

PMID: 25221016 [PubMed - in process]

Categories: Bup Feeds

Sy15-3prescription opioids in southern europe: Spain.

Buprenorphine Research (PubMed) - Tue, 09/16/2014 - 2:30pm
Related Articles

Sy15-3prescription opioids in southern europe: Spain.

Alcohol Alcohol. 2014 Sep;49 Suppl 1:i15

Authors: Torrens M, Green J, Maremmani I, Touzeau D, Walcher S, Deruvo G, Somain L, Martinez-Sanvisens D, Rossi P, Martinez-Riera R, Fonseca F

Abstract
BACKGROUND: Prescription opioid misuse in an increasing public health in many countries. The objective is to assess the prevalence of prescription opioid misuse in four European countries: France, Germany, Italy and Spain. Data form Sapin are presented
METHODS: Cross-sectional study. The rates of prescription drug misuse have been assessed using patient self-report at treatment program intake. Patients have been asked to self-report the use of use and injection history for European-market prescription opioids, prescription stimulants, and heroin, during the past 30-day. Also, basic demographic information, treatment history, and health care worker status have been recorded.
RESULTS: In Spain, a final sample of 125 subjects (78% males; 39 + 10 years old) was recruited. The 94% were in treatment for heroin dependence; the rest (7) has as a main drug methadone, tramadol, codeine, pethidine and opium. The main opioid abused drug during the last month was heroin (63%), followed by methadone, tramadol, codeine, pethidine, fentanyl, buprenorphine, morphine and metylphenidate.
CONCLUSIONS: Preliminary data show that besides heroin, in Spain, there is a concomitant abuse of prescription opioids. The knowledge of drug use patterns can provide useful information to develop effective prevention and treatment.

PMID: 25221015 [PubMed - in process]

Categories: Bup Feeds

Sy15-2pain killers and substitution medications use in patients looking for agonist opioid treatment in northern and southern Italy, using a 18-month survey methodology.

Buprenorphine Research (PubMed) - Tue, 09/16/2014 - 2:30pm
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Sy15-2pain killers and substitution medications use in patients looking for agonist opioid treatment in northern and southern Italy, using a 18-month survey methodology.

Alcohol Alcohol. 2014 Sep;49 Suppl 1:i15

Authors: Maremmani I, Guareschi M, Deruvo G, Somain L, Maremmani AG

Abstract
BACKGROUND: This presentation reports the prevalence of the opioid primary substance of abuse in patients entering drug-addiction treatment in Italy stressing geographical differences between Northern and Southern Italy.
METHODS: This was a cross-sectional observational study. The data was collected prospectively, during the years 2012-2013. The Opioids' Survey Questionnaire was administered in a 18-month survey to all patients entering all kind of drug-addiction treatment in two National Health Drug Addiction Units, in Northern and Southern Italy.
RESULTS: Substitution medication (methadone and buprenorphine) were the most utilized primary substances of abuse when patients were looking for an Agonist Opioid Treatment. This use is higher in Northern Italy than in Southern Italy. The use of Pain Killers was less frequent. Combined use of heroin, pain killers and medication was more frequent in Northern Italy.
CONCLUSIONS: Geographical and cultural aspects may be involved in combined use of street opioids, diverted substitution medications and pain killers (prescription opioids) before entering an Opioid Agonist Treatment.

PMID: 25221014 [PubMed - in process]

Categories: Bup Feeds

Conversion from High-Dose Full-Opioid Agonists to Sublingual Buprenorphine Reduces Pain Scores and Improves Quality of Life for Chronic Pain Patients.

Buprenorphine Research (PubMed) - Tue, 09/16/2014 - 2:30pm
Related Articles

Conversion from High-Dose Full-Opioid Agonists to Sublingual Buprenorphine Reduces Pain Scores and Improves Quality of Life for Chronic Pain Patients.

Pain Med. 2014 Sep 12;

Authors: Daitch D, Daitch J, Novinson D, Frey M, Mitnick C, Pergolizzi J

Abstract
OBJECTIVE: This study aims to determine the effectiveness of converting patients from high doses of full-opioid agonists to sublingual (SL) buprenorphine.
DESIGN: An observational report of outcomes assessment.
SETTING: An interventional pain management practice setting in the United States.
SUBJECTS: Thirty-five chronic pain patients (age 24-66) were previously treated with high-dose opioid-agonist drugs and converted to SL buprenorphine. Patients' daily morphine equivalents ranged from 200 mg to 1,370 mg preconversion, with a mean daily dose of 550 mg.
METHODS: A retrospective chart analysis examined numerical pain levels and quality of life scores before and 2 months after conversion to SL buprenorphine.
RESULTS: After continuation of SL buprenorphine therapy for 2 months, the mean pain score decreased from 7.2 to 3.5 (P < 0.001), with 34 of the 35 patients examined reporting a decrease in pain. This pain score decrease was robust with regard to initial pain score and preconversion morphine equivalent dosage. Quality of life scores improved from 6.1 to 7.1 (P = 0.005).
CONCLUSION: Average pain scores decreased from 7.2 to 3.5, and quality of life scores increased from 6.1 to 7.1 for 35 patients converted from high-dose full-opioid agonists to SL buprenorphine therapy for more than 60 days. Clinicians should consider buprenorphine SL conversion for all patients on high-dose opioids, particularly patients with severe pain (7-10) unrelieved by their current opioid regimen or patients for whom the clinician does not feel comfortable prescribing high-dose opioids.

PMID: 25220043 [PubMed - as supplied by publisher]

Categories: Bup Feeds

2013 Update in addiction medicine for the generalist.

Buprenorphine Research (PubMed) - Tue, 09/16/2014 - 2:30pm
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2013 Update in addiction medicine for the generalist.

Addict Sci Clin Pract. 2013;8(1):18

Authors: Gordon AJ, Bertholet N, McNeely J, Starrels JL, Tetrault JM, Walley AY

Abstract
Increasingly, patients with unhealthy alcohol and other drug use are being seen in primary care and other non-specialty addiction settings. Primary care providers are well positioned to screen, assess, and treat patients with alcohol and other drug use because this use, and substance use disorders, may contribute to a host of medical and mental health harms. We sought to identify and examine important recent advances in addiction medicine in the medical literature that have implications for the care of patients in primary care or other generalist settings. To accomplish this aim, we selected articles in the field of addiction medicine, critically appraised and summarized the manuscripts, and highlighted their implications for generalist practice. During an initial review, we identified articles through an electronic Medline search (limited to human studies and in English) using search terms for alcohol and other drugs of abuse published from January 2010 to January 2012. After this initial review, we searched for other literature in web-based or journal resources for potential articles of interest. From the list of articles identified in these initial reviews, each of the six authors independently selected articles for more intensive review and identified the ones they found to have a potential impact on generalist practice. The identified articles were then ranked by the number of authors who selected each article. Through a consensus process over 4 meetings, the authors reached agreement on the articles with implications for practice for generalist clinicians that warranted inclusion for discussion. The authors then grouped the articles into five categories: 1) screening and brief interventions in outpatient settings, 2) identification and management of substance use among inpatients, 3) medical complications of substance use, 4) use of pharmacotherapy for addiction treatment in primary care and its complications, and 5) integration of addiction treatment and medical care. The authors discuss each selected articles' merits, limitations, conclusions, and implication to advancing addiction screening, assessment, and treatment of addiction in generalist physician practice environments.

PMID: 24499640 [PubMed - indexed for MEDLINE]

Categories: Bup Feeds

Supply of buprenorphine waivered physicians: The influence of state policies.

Buprenorphine Research (PubMed) - Mon, 09/15/2014 - 8:00am

Supply of buprenorphine waivered physicians: The influence of state policies.

J Subst Abuse Treat. 2014 Aug 2;

Authors: Stein BD, Gordon AJ, Dick AW, Burns RM, Pacula RL, Farmer CM, Leslie DL, Sorbero M

Abstract
Buprenorphine, an effective opioid use disorder treatment, can be prescribed only by buprenorphine-waivered physicians. We calculated the number of buprenorphine-waivered physicians/100,000 county residents using 2008-11 Buprenorphine Waiver Notification System data, and used multivariate regression models to predict number of buprenorphine-waivered physicians/100,000 residents in a county as a function of county characteristics, state policies and efforts to promote buprenorphine use. In 2011, 43% of US counties had no buprenorphine-waivered physicians and 7% had 20 or more waivered physicians. Medicaid funding, opioid overdose deaths, and specific state guidance for office-based buprenorphine use were associated with more buprenorphine-waivered physicians, while encouraging methadone programs to promote buprenorphine use had no impact. Our findings provide important empirical information to individuals seeking to identify effective approaches to increase the number of physicians able to prescribe buprenorphine.

PMID: 25218919 [PubMed - as supplied by publisher]

Categories: Bup Feeds

[Psychopathology of the misuse of Subutex(®): The Popeye syndrome.]

Buprenorphine Research (PubMed) - Sat, 09/13/2014 - 8:30am

[Psychopathology of the misuse of Subutex(®): The Popeye syndrome.]

Encephale. 2014 Sep 8;

Authors: Békaert J, Podevin G

Abstract
INTRODUCTION: High dose buprenorphine (HDB), commonly known as Subutex(®), is nowadays largely prescribed as a replacement therapy for major opiate dependence. Its sublingual administration allows a decrease in the withdrawal syndrome accompanying opiate abuse cessation. Over the past few decades, epidemiological data on people on replacement therapy have emphasized an increase in the misuse of Subutex(®) and more specifically intravenous injections of HDB. These growing practices pave the way to major physical consequences or even death. Several studies have highlighted the infectious, vascular, venous and arterial (pseudo-aneurysm) complications stemming from this habit. Among the possible vascular complications, we can notice the presence of abscess, venous thrombosis, phlegmons, skin necrosis, cellulite, and profound and superficial thrombophlebitis at injection sites. These can evolve into chronic edemas of the tips and subcutaneous nodules. The Popeye syndrome is one of the possible complications of this misuse. This syndrome is characterized by the swelling of both sides of the forearms and hands. These edemas tend to become persistent and to be paired with tissue changes such as skin thickening. Besides, the increase in the hands volume can occur bilaterally or sometimes in an asymmetrical way, accentuated on the hand of the non-dominant limb. This syndrome does not decrease, or just a little, after the stoppage of injections. It can have a psychological, social, psychopathological and esthetic impact.
OBJECTIVES: In this article, we will focus on the clinical case of a 43-year-old man, who is hospitalized in an addictology unit for massive injections of HDB. This patient suffers from a Popeye syndrome as well as from an alcoholic dependence.
METHOD: Following the description of psychopathological disorders, our analysis will originate from a clarification relative to the specificities of the practice of intravenous HDB injection to better sharpen the understanding of these misuses in their psychopathological and clinical aspects. We will discuss some proposals for interventions aiming at taking better care of the people suffering from a drug addiction characterized by the injection of HDB replacement therapy.
RESULTS: Adam requested an admission in an addictology ward for treatment of a self-medication by Subutex started 4 years ago. A certain awkwardness can be perceived when he lays his highly damaged and marked hands on the desk. His upper limbs, thus on display, have tripled in volume: this indicates the presence of a Popeye syndrome, consequence of repeated Subutex injections. These observations lead us to question the function and the sense of this injection behavior in the mental economy, as this repeated behavior engages the body specifically. This bruised body, marked with repeated injection holes has become a place of inscription, of representation that shows the impossibility to access other ways of expression. In this sense, taking action is becoming an act of speech. Within this speech, we can notice the existence of a profound state of uneasiness. To put up with the painful feeling of inner emptiness that is calling for a necessary filling, aiming at re-establishing a frail balance, Adam appeals to repeated injections. However, when the tortured body signifies its incapacity to receive an ultimate injection, thus showing its limits and the destruction it is undergoing, it is no longer possible to resort to Subutex injections. As a consequence, Adam came up with the idea of quitting. The withdrawal was initiated by himself and not coupled with medical care. It has led him to feel a gap, beyond the physical uneasiness. Adam has tried to fill in this unbearable feeling of empty body with tobacco, alcohol and food. The body, highly mobilized, translates the presence of a physical conflict where a massive mental anxiety is expressed in a hidden way. During the interview, Adam also addressed the repetitive familial pattern and the transgeneration effects. He seems to be fully aware of these.
DISCUSSION: Several perspectives can be addressed as part of Adam's treatment and especially cognitive-behavioral therapies as they could prove to be of a certain interest. The aim of this therapy would thus be to assess the motivation for change in order to begin a psychotherapeutic work based on personal adherence to the cessation of this misuse. This could be set up in parallel with an anxiety management work.
CONCLUSION: A better understanding and an extensive knowledge of the possible complications linked to the misuse of HDB seems necessary to sensitize and better inform people who suffer from high-risk behaviors and also to enable a more adapted care.

PMID: 25212472 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Illicit buprenorphine use, interest in and access to buprenorphine treatment among syringe exchange participants.

Buprenorphine Research (PubMed) - Thu, 09/11/2014 - 7:00am

Illicit buprenorphine use, interest in and access to buprenorphine treatment among syringe exchange participants.

J Subst Abuse Treat. 2014 Aug 7;

Authors: Fox AD, Chamberlain A, Sohler NL, Frost T, Cunningham CO

Abstract
Poor access to buprenorphine maintenance treatment (BMT) may contribute to illicit buprenorphine use. This study investigated illicit buprenorphine use and barriers to BMT among syringe exchange participants. Computer-based interviews conducted at a New York City harm reduction agency determined: prior buprenorphine use; barriers to BMT; and interest in BMT. Of 102 opioid users, 57 had used illicit buprenorphine and 32 had used prescribed buprenorphine. When illicit buprenorphine users were compared to non-users: barriers to BMT ("did not know where to get treatment") were more common (64 vs. 36%, p<0.01); mean levels of interest in BMT were greater (3.37±1.29 vs. 2.80±1.34, p=0.03); and more participants reported themselves likely to initiate treatment (82 vs. 50%, p<0.01). Illicit buprenorphine users were interested in BMT but did not know where to go for treatment. Addressing barriers to BMT could reduce illicit buprenorphine use.

PMID: 25205666 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Benefits of using intrathecal buprenorphine.

Buprenorphine Research (PubMed) - Wed, 09/10/2014 - 8:00am
Related Articles

Benefits of using intrathecal buprenorphine.

Caspian J Intern Med. 2014;5(3):143-7

Authors: Rabiee SM, Alijanpour E, Jabbari A, Rostami S

Abstract
BACKGROUND: General anesthesia draws attention to the most commonly used modalities for post cesarean delivery pain relief in systemic administration of opioids, while the administration of small dose of intrathecal opioid during spinal anesthesia can be a possible alternative. The aim of this study was to evaluate the effects of buprenorphine on cesarean section prescribed intrathecally.
METHODS: This double blind randomized clinical trial study was conducted in patients for cesarean section under spinal anesthesia. The patients were randomly divided into case and control groups. Case group (208 patients) received 65-70 mg of 5% lidocaine plus 0.2 ml of buprenorphine while the same amount of 5% lidocaine diluted with 0.2 ml of normal saline was given to 234 cases in the control group. Hemodynamic changes and neonatal APGAR scores (Appearance, Pulse, Grimace, Activity, Respiration) were recorded. Pain score was recorded according to the visual analog scale. This study was registered in the Iranian Registry of clinical Trials; IRCT2013022112552N1.
RESULTS: The mean age of case and control groups was 24.4±5.38 and 26.84±5.42 years, respectively. Systolic blood pressure was not significantly different until the 45th minute but diastolic blood pressure showed a significant difference at the 15th and the 60th minutes (P<0.001). Heart rate changes were significantly different between cases and controls at the initial 5th, 15th and after 60th minutes (P<0.001). Pain-free period was significantly different between two groups (1.25 h versus 18.73 h) (P<0.001).
CONCLUSION: The results show that prescription of intratechal buprenorphine prolongs the duration of analgesia without any significant considerable side effects.

PMID: 25202441 [PubMed]

Categories: Bup Feeds

Pharmacokinetic comparison of sustained-release and standard buprenorphine in mice.

Buprenorphine Research (PubMed) - Wed, 09/10/2014 - 8:00am
Related Articles

Pharmacokinetic comparison of sustained-release and standard buprenorphine in mice.

J Am Assoc Lab Anim Sci. 2014;53(4):387-91

Authors: Clark TS, Clark DD, Hoyt RF

Abstract
Effective pain medication is important for animal stewardship and valid research results. We compared the pharmacokinetic assessments of standard, immediate-release buprenorphine (Bup IR) and a sustained-release buprenorphine formulation (Bup SR Lab) in male C57BL/6J mice, a mouse strain commonly used in biomedical research. We postulated that the administration of Bup SR Lab would achieve a more persistent blood drug concentration (>1 ng/mL) compared with single-dose Bup IR. The study assumed a blood buprenorphine concentration of 1 ng/mL as the minimum that may result in adequate analgesia, as previously reported. The 7 experimental groups included Bup IR (0.03, 0.05, 0.1, and 2 mg/kg), Bup SR Lab (0.3 and 1.2 mg/ kg), and saline placebo (0.7 mL/100 g). Blood sampling occurred at 0.5, 1, 3, 6, 12, 24, 48, and 72 h for evaluation by using a forensic ELISA. Bup IR at 0.03 and 0.05 mg/kg and Bup SR Lab at 0.3 mg/kg failed to obtain maximal blood concentrations (Cmax ) above 1 ng/mL. All other doses (0.1 and 2 mg/kg Bup IR and 1.2 mg/kg Bup SR Lab) reached a Cmax above 1 ng/mL within 3 h after injection. In addition, 1.2 mg/kg Bup SR Lab and 2 mg/kg Bup IR provided blood concentrations above 1 ng/mL for up to 12 h, and 0.1 mg/kg Bup IR achieved this criterion for as long as 3 h. In conclusion, Bup SR Lab at 1.2 mg/kg and Bup IR at 0.1 or 2.0 mg/kg achieve or surpass the published threshold for adequate analgesia in mice.

PMID: 25199095 [PubMed - in process]

Categories: Bup Feeds

Risk reduction with buprenorphine-naloxone and methadone: patient's choice.

Buprenorphine Research (PubMed) - Wed, 09/10/2014 - 8:00am
Related Articles

Risk reduction with buprenorphine-naloxone and methadone: patient's choice.

J Acquir Immune Defic Syndr. 2014 Sep 5;

Authors: Newman RG

PMID: 25197828 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Impact of efficacy at the mu opioid receptor on antinociceptive effects of combinations of mu opioid receptor agonists and cannabinoid receptor agonists.

Buprenorphine Research (PubMed) - Sun, 09/07/2014 - 6:30am

Impact of efficacy at the mu opioid receptor on antinociceptive effects of combinations of mu opioid receptor agonists and cannabinoid receptor agonists.

J Pharmacol Exp Ther. 2014 Sep 5;

Authors: Maguire DR, France CP

Abstract
Cannabinoid receptor agonists [e.g. Δ9-tetrahydrocannabinol (Δ9-THC)] enhance the antinociceptive effects of mu opioid receptor agonists, suggesting that combining cannabinoids with opioids would improve pain treatment. Combinations with lower efficacy agonists might be preferred and could avoid adverse effects associated with large doses; however, it is unclear whether interactions between opioids and cannabinoids vary across drugs with different efficacy. The antinociceptive effects of mu opioid receptor agonists alone and in combination with cannabinoid receptor agonists were studied in rhesus monkeys (n=4) using a warm water tail withdrawal procedure. Etorphine, fentanyl, morphine, buprenorphine, nalbuphine, Δ9-THC, and CP 55,940 each increased tail withdrawal latency. Pretreatment with doses of Δ9-THC (1.0 mg/kg) or CP 55,940 (0.032 mg/kg) that were ineffective alone shifted the fentanyl dose-effect curve leftward 20.6- and 52.9- fold, respectively, and the etorphine dose-effect curve leftward 12.4- and 19.6-fold, respectively. Δ9-THC and CP 55,940 shifted the morphine dose-effect curve leftward only 3.4- and 7.9-fold, respectively, and the buprenorphine curve only 5.4- and 4.1-fold, respectively. Neither Δ9-THC nor CP 55,940 significantly altered the effects of nalbuphine. Cannabinoid receptor agonists increase the antinociceptive potency of higher efficacy opioid receptor agonists more than lower efficacy agonists; however, because much smaller doses of each drug can be administered in combinations while achieving adequate pain relief and that other (e.g., abuse-related) effects of opioids do not appear to be enhanced by cannabinoids, these results provide additional support for combining opioids with cannabinoids to treat pain.

PMID: 25194020 [PubMed - as supplied by publisher]

Categories: Bup Feeds

The applicability of a gel delivery system for self-administration of buprenorphine to laboratory mice.

Buprenorphine Research (PubMed) - Sun, 09/07/2014 - 6:30am

The applicability of a gel delivery system for self-administration of buprenorphine to laboratory mice.

Lab Anim. 2014 Sep 5;

Authors: Hovard A, Teilmann A, Hau J, Abelson K

Abstract
Oral administration of perioperative analgesia to laboratory mice is beneficial compared with administration by injection. The mice become less stressed when allowed to voluntarily ingest the drug in a palatable feed item and it results in high and long-lasting serum concentrations of the drug. We have previously demonstrated sticky nut and chocolate paste to be well-liked by mice and readily ingested in most cases. However, a disadvantage with nut and chocolate paste is its high content of fat and sugar, which may have undesirable effects in some experimental models. Alternatively, a delivery system using an aqueous gel may serve as a supplementary source of fluid post-operatively and as a vehicle for analgesic drugs. In the present study, we investigated the willingness of the mice to ingest a commercially available gel, by measuring the duration from introduction of the gel to first ingestion, as well as the amount ingested overnight. Furthermore, buprenorphine in two different concentrations (5 and 15 µg/mL) was mixed in the gel and the resulting serum concentrations of buprenorphine were investigated. The aqueous gel was ingested by the mice, but their willingness was low and did not increase over time. The serum concentrations of buprenorphine were similar to, or higher than, those following a subcutaneous injection (0.1 mg/kg body weight), but the variation was considerably higher. In conclusion, aqueous gel may serve as a relevant vehicle for the voluntary ingestion of buprenorphine in mice, but the willingness of the mice to ingest the gel needs to be improved.

PMID: 25193176 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Safety, tolerability, and clinical effect of low-dose buprenorphine for treatment-resistant depression in midlife and older adults.

Buprenorphine Research (PubMed) - Sat, 09/06/2014 - 7:00am

Safety, tolerability, and clinical effect of low-dose buprenorphine for treatment-resistant depression in midlife and older adults.

J Clin Psychiatry. 2014 Aug;75(8):e785-e793

Authors: Karp JF, Butters MA, Begley AE, Miller MD, Lenze EJ, Blumberger DM, Mulsant BH, Reynolds CF

Abstract
OBJECTIVE: To describe the clinical effect and safety of low-dose buprenorphine, a κ-opioid receptor antagonist, for treatment-resistant depression (TRD) in midlife and older adults.
METHOD: In an 8-week open-label study, buprenorphine was prescribed for 15 adults aged 50 years or older with TRD, diagnosed with the Structured Clinical Interview for DSM-IV, between June 2010 and June 2011. The titrated dose of buprenorphine ranged from 0.2-1.6 mg/d. We assessed clinical change in depression, anxiety, sleep, positive and negative affect, and quality of life. The Montgomery-Asberg Depression Rating scale (MADRS) served as the main outcome measure. Tolerability was assessed by documenting side effects and change in vital signs, weight, and cognitive function. Clinical response durability was assessed 8 weeks after discontinuation of buprenorphine.
RESULTS: The mean dose of buprenorphine was 0.4 mg/d (mean maximum dose = 0.7 mg/d). The mean depression score (MADRS) at baseline was 27.0 (SD = 7.3) and at week 8 was 9.5 (SD = 9.5). A sharp decline in depression severity occurred during the first 3 weeks of exposure (mean change = -15.0 [SD = 7.9]). Depression-specific items measuring pessimism and sadness indicated improvement during exposure, supporting a true antidepressant effect. Treatment-emergent side effects (in particular, nausea and constipation) were not sustained, vital signs and weight remained stable, and executive function and learning improved from pretreatment to posttreatment.
CONCLUSION: Low-dose buprenorphine may be a novel-mechanism medication that provides a rapid and sustained improvement for older adults with TRD. Placebo-controlled trials of longer duration are required to assess efficacy, safety, and physiologic and psychological effects of extended exposure to this medication.
TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01071538.

PMID: 25191915 [PubMed - as supplied by publisher]

Categories: Bup Feeds

The multi-site prescription opioid addiction treatment study: 18-month outcomes.

Buprenorphine Research (PubMed) - Sat, 09/06/2014 - 7:00am

The multi-site prescription opioid addiction treatment study: 18-month outcomes.

J Subst Abuse Treat. 2014 Aug 2;

Authors: Potter JS, Dreifuss JA, Marino EN, Provost SE, Dodd DR, Rice LS, Fitzmaurice GM, Griffin ML, Weiss RD

Abstract
Despite the high prevalence of prescription opioid dependence in the U.S., little is known about the course of this disorder and long-term response to treatment. We therefore examined 18-month post-randomization outcomes of participants in the Prescription Opioid Addiction Treatment Study, a multi-site, randomized controlled trial examining varying durations of buprenorphine-naloxone treatment and different intensities of counseling for prescription opioid dependence. Thus the current follow-up study provides a unique contribution to the field by reporting longer-term outcomes of a well-characterized population of treatment-seeking prescription opioid dependent patients. Participants from the treatment trial (N=252/653) completed an 18-month follow-up telephone assessment. Multivariable analyses examined associations between participant characteristics and key indicators of month-18 status: opioid abstinence, DSM-IV opioid dependence, and opioid agonist treatment. Overall, participants showed improvement from baseline to month 18: 49.6% were abstinent in the previous 30days, with only 16.3% opioid-dependent. Some participants, however, had initiated past-year heroin use (n=9) or opioid injection (n=17). Most participants (65.9%) engaged in substance use disorder treatment during the past year, most commonly opioid agonist therapy (48.8%). Of particular interest in this population, multivariable analysis showed that greater pain severity at baseline was associated with opioid dependence at 18months. In conclusion, although opioid use outcomes during the treatment trial were poor immediately following a buprenorphine-naloxone taper compared to those during 12weeks of buprenorphine-naloxone stabilization, opioid use outcomes at 18-month follow-up showed substantial improvement over baseline and were comparable to the rate of successful outcomes during buprenorphine-naloxone stabilization in the treatment trial.

PMID: 25189089 [PubMed - as supplied by publisher]

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Significant cost savings achieved by in-sourcing urine drug testing for monitoring medication compliance in pain management.

Buprenorphine Research (PubMed) - Sat, 09/06/2014 - 7:00am
Related Articles

Significant cost savings achieved by in-sourcing urine drug testing for monitoring medication compliance in pain management.

Clin Chim Acta. 2013 Jun 25;422:10-4

Authors: Melanson SE, Tanasijevic MJ, Snyder ML, Darragh A, Quade C, Jarolim P

Abstract
INTRODUCTION: Reference laboratory testing can represent a significant component of the laboratory budget. Therefore, most laboratories continually reassess the feasibility of in-sourcing various tests. We describe the transfer of urine drug testing performed for monitoring medication compliance in pain management from a reference laboratory into an academic clinical laboratory.
METHODS: The process of implementing of both screening immunoassays and confirmatory LC-MS/MS testing and the associated cost savings is outlined.
RESULTS: The initial proposal for in-sourcing this testing, which included the tests to be in-sourced, resources required, estimated cost savings and timeline for implementation, was approved in January 2009. All proposed testing was implemented by March 2011.
CONCLUSIONS: Keys to the successful implementation included budgeting adequate resources and developing a realistic timeline, incorporating the changes with the highest budget impact first. We were able to in-source testing in 27 months and save the laboratory approximately $1 million in the first 3 year.

PMID: 23545276 [PubMed - indexed for MEDLINE]

Categories: Bup Feeds

Design considerations for point-of-care clinical trials comparing methadone and buprenorphine treatment for opioid dependence in pregnancy and for neonatal abstinence syndrome.

Buprenorphine Research (PubMed) - Thu, 09/04/2014 - 8:30am

Design considerations for point-of-care clinical trials comparing methadone and buprenorphine treatment for opioid dependence in pregnancy and for neonatal abstinence syndrome.

Contemp Clin Trials. 2014 Aug 23;

Authors: Winhusen T, Wilder C, Wexelblatt SL, Theobald J, Hall ES, Lewis D, Van Hook J, Marcotte M

Abstract
The growing opioid-use epidemic in the U.S. has been associated with a significant increase in the prevalence of pregnant opioid-dependent women and of neonatal abstinence syndrome (NAS), which is caused by withdrawal from in-utero exposure to drugs. While methadone-maintenance currently is the standard of care for opioid dependence during pregnancy, recent research suggests that buprenorphine-maintenance may be associated with shorter infant hospital lengths of stay (LOS) relative to methadone-maintenance. There is no "gold standard" treatment for NAS but there is some evidence that buprenorphine, relative to morphine or methadone, treatment for NAS may reduce LOS and length of treatment. A point-of-care clinical trial (POCCT) design, which maximizes the external validity of a trial while reducing the cost and complexity associated with the classic randomized clinical trial, was selected to compare methadone to buprenorphine treatment for opioid dependence during pregnancy and for NAS. The present paper describes design considerations for the Medication-assisted treatment for Opioid-dependent expecting Mothers (MOMs; estimated N=370) and Investigation of Narcotics For Ameliorating Neonatal abstinence syndrome on Time in hospital (INFANTs; estimated N=284) POCCTs, both of which are randomized, intent-to-treat, two-group trials. All outcomes will be obtained from the participants' electronic health record (Epic) from the three participating hospitals. Another novel aspect of the trial design is that a subset of the infants in the INFANTs POCCT will be from mothers who participated in the MOMs POCCT and, thus, the potential interaction between medication treatment of the mother and the infant can be evaluated.

PMID: 25183042 [PubMed - as supplied by publisher]

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