Bup Feeds

Buprenorphine/Naloxone Dose and Pain Intensity Among Individuals Initiating Treatment for Opioid Use Disorder.

Buprenorphine Research (PubMed) - Wed, 10/15/2014 - 8:00am

Buprenorphine/Naloxone Dose and Pain Intensity Among Individuals Initiating Treatment for Opioid Use Disorder.

J Subst Abuse Treat. 2014 Sep 26;

Authors: Becker WC, Ganoczy D, Fiellin DA, Bohnert AS

Abstract
BACKGROUND: Opioid use disorder and pain often co-occur, complicating the treatment of each condition. Owing to its partial agonist properties, buprenorphine/naloxone (BUP/NX) may confer advantages over full agonist opioids for treatment of both conditions. The optimal dose of BUP/NX for comorbid pain is not known. We examined dose and other factors associated with pain intensity among patients initiating BUP/NX for opioid use disorder.
METHODS: We studied 1106 patients initiating BUP/NX treatment for opioid use disorder from 2003 to 2010. Information on pain level, diagnoses, and treatment were extracted from medical records. Eligible patients had at least one self-reported pain intensity numerical rating score (NRS) within 30days before BUP/NX initiation (baseline) and at least one between 15 and 90days after BUP/NX initiation (during treatment). The primary outcome was NRS decrease (2 or greater) from baseline to during treatment. We used generalized estimating equations to model odds of the primary outcome with BUP/NX dose as the independent variable of interest in the subset of patients with a baseline NRS≥2.
RESULTS: The sample was 94% male and 73% White. Mean age was 50. Psychiatric and non-opioid substance use comorbidities were common. The following demographic and clinical correlates were associated with a decrease in pain intensity: age 18-29 (compared to 30-39 and 40-49); absence of PTSD diagnosis and absence of a chronic pain diagnosis. BUP/NX dose was not associated with decreased pain intensity in bivariate or multivariable analysis.
CONCLUSIONS: BUP/NX maintenance treatment was generally consistent with improvements in pain intensity; however, factors other than BUP/NX dose contribute to improved pain intensity among those initiating the medication.

PMID: 25312475 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Neonatal abstinence syndrome: essentials for the practitioner.

Buprenorphine Research (PubMed) - Tue, 10/14/2014 - 9:00am

Neonatal abstinence syndrome: essentials for the practitioner.

J Pediatr Pharmacol Ther. 2014 Jul;19(3):147-55

Authors: Siu A, Robinson CA

Abstract
The incidence of neonatal abstinence syndrome (NAS) has increased dramatically during the past 15 years, likely due to an increase in antepartum maternal opiate use. Optimal care of these patients is still controversial because of the available published literature lacking sufficient sample size, placebo control, and comparative pharmacologic trials. Primary treatment for NAS consists of opioid replacement therapy with either morphine or methadone. Paregoric and tincture of opium have been abandoned because of relative safety concerns. Buprenorphine is emerging as a treatment option with promising initial experience. Adjunctive agents should be considered for infants failing treatment with opioid monotherapy. Traditionally, phenobarbital has been used as adjunctive therapy; however, results of clonidine as adjunctive therapy for NAS appear to be beneficial. Future directions for research in NAS should include validating a simplified scoring tool, conducting comparative studies, exploring home management options, and optimizing management through pharmacogenomics.

PMID: 25309144 [PubMed]

Categories: Bup Feeds

Comparative prices of diverted buprenorphine/naloxone and buprenorphine in a UK prison setting: A cross-sectional survey of drug using prisoners.

Buprenorphine Research (PubMed) - Mon, 10/13/2014 - 6:00am

Comparative prices of diverted buprenorphine/naloxone and buprenorphine in a UK prison setting: A cross-sectional survey of drug using prisoners.

Drug Alcohol Depend. 2014 Sep 30;

Authors: Wright NM, Mohammed Z, Hughes GJ

Abstract
BACKGROUND: There is evidence regarding the abuse potential of buprenorphine in prison settings. There is also emerging evidence from community settings that buprenorphine/naloxone is less amenable to abuse than the single preparation buprenorphine hydrochloride as evidenced by cost-differentials of diverted medication. This study sought to explore cost-differentials within a prison setting of diverted buprenorphine/naloxone medication relative to either single preparation buprenorphine hydrochloride or methadone.
METHODS: Cross-sectional survey in one remand prison.
RESULTS: A total of 85 prisoners participated in the survey. Prisoners estimated buprenorphine to have a significantly (p<0.001) higher cost than buprenorphine/naloxone both inside and outside of prison. This finding was supported when the analysis was restricted to both the prisoners with a longer-term experience of taking opioid substitution drugs during their current prison stay and those with a longer-term experience prior to reception.
CONCLUSIONS: Consideration should be given to the recommendation that buprenorphine/naloxone medication is the prescribed buprenorphine preparation of choice for clinicians offering opiate substitution therapy to prisoners, pending developments of buprenorphine preparations that have less abuse potential than sublingual preparations.

PMID: 25305714 [PubMed - as supplied by publisher]

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Safety studies of post-surgical buprenorphine therapy for mice.

Buprenorphine Research (PubMed) - Sun, 10/12/2014 - 7:00am

Safety studies of post-surgical buprenorphine therapy for mice.

Lab Anim. 2014 Oct 10;

Authors: Traul KA, Romero JB, Brayton C, DeTolla L, Forbes-McBean N, Halquist MS, Karnes HT, Sarabia-Estrada R, Tomlinson MJ, Tyler BM, Ye X, Zadnik P, Guarnieri M

Abstract
The use of appropriate analgesia in laboratory mice may be suboptimal because of concerns about adverse events (AE). Target Animal Safety trials were conducted to determine the safety of an extended-release suspension of buprenorphine. Drug or control suspensions were injected subcutaneously in surgically-treated BALB/c mice anesthetized with ketamine-xylazine to mimic post-operative conditions in which the compound might commonly be administered. Single and repeat five-fold (5×) excesses of the 3.25 mg/kg intended dose were used to provoke potential AE. Trials included prospective measurements of weight changes, blood chemistry, hematology, and histopathology. Clinical and histopathology findings were similar in drug-treated and control mice in a four-day trial using a single 16.25 mg/kg, 5× overdose of the drug. In a 12-day trial, which used a total buprenorphine dose of 48.75 mg/kg, clinical and histopathology values were also similar in control and drug-treated female mice. In the male arm of the repeat-overdose trial, two of eight mice died on the morning of day 12, three days following the third 16.25 mg/kg overdose administration. Histopathology did not reveal a cause of death. In a 14-month trial using a single 3.25 mg/kg dose of the drug, no significant findings identified potential AE. These findings indicate a high tolerance to an extended-release buprenorphine suspension administered post-operatively in mice with appropriate husbandry.

PMID: 25305141 [PubMed - as supplied by publisher]

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Geographic variability in HIV and injection drug use in Ukraine: Implications for integration and expansion of drug treatment and HIV care.

Buprenorphine Research (PubMed) - Sun, 10/12/2014 - 7:00am

Geographic variability in HIV and injection drug use in Ukraine: Implications for integration and expansion of drug treatment and HIV care.

Int J Drug Policy. 2014 Sep 16;

Authors: Zaller N, Mazhnaya A, Larney S, Islam Z, Shost A, Prokhorova T, Rybak N, Flanigan T

Abstract
BACKGROUND: Ukraine has the highest HIV burden of any European country with much of the current HIV epidemic concentrated among people who inject drugs (PWIDs) and their sexual partners. Opiate substitution therapy (OST) is limited in Ukraine and expansion of OST is urgently needed to help stem the tide of the HIV epidemic.
METHODS: We accessed publicly available data in Ukraine in order to explore geographic variability with respect to prevalence of HIV, PWIDs and OST programmes.
RESULTS: The regions of Ukraine with the largest number of opioid dependent persons (the south and eastern portions of the country) correspond to the regions with the highest HIV prevalence and HIV incidence. The number of opioid PWIDs per 100,000 population as well as the number of all OST treatment slots per 100,000 varied significantly across the three HIV prevalence categories. Overall, the proportion of individuals receiving either methadone maintenance therapy (MMT) or buprenorphine maintenance therapy (BMT) was quite low: average across categories: 7.3% and 0.4%, respectively. Additionally, less than half of OST patients receiving MMT or BMT were HIV positive patients.
CONCLUSION: There is significant geographic variability in both numbers of HIV positive individuals and numbers of PWIDs across Ukraine, however, there may be a more concentrated epidemic among PWIDs in many regions of the country. Scale up of addiction treatment for PWID, especially OST, can have a significant impact on preventing injection related morbidity, such as HIV and HCV infection. Ukraine can learn from the mistakes other nations have made in denying critical treatment opportunities to PWID.

PMID: 25304049 [PubMed - as supplied by publisher]

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A high-quality RCT documents that elderly with dementia, the most neglected pain patients, have effective and safe pain relief from paracetamol alone or with buprenorphine patch.

Buprenorphine Research (PubMed) - Sat, 10/11/2014 - 7:30am

A high-quality RCT documents that elderly with dementia, the most neglected pain patients, have effective and safe pain relief from paracetamol alone or with buprenorphine patch.

Eur J Pain. 2014 Nov;18(10):1363-1364

Authors: Breivik H

PMID: 25303611 [PubMed - as supplied by publisher]

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Type of opioids injected: Does it matter? A multicentric cross-sectional study of people who inject drugs.

Buprenorphine Research (PubMed) - Sat, 10/11/2014 - 7:30am

Type of opioids injected: Does it matter? A multicentric cross-sectional study of people who inject drugs.

Drug Alcohol Rev. 2014 Oct 10;

Authors: Ambekar A, Rao R, Mishra AK, Agrawal A

Abstract
INTRODUCTION AND AIMS: Injecting pharmaceutical opioids for non-medical purposes is a major concern globally. Though pharmaceutical opioids injection is reported in India, the exact proportion of people who inject drugs (PWID) using pharmaceutical opioids is unknown. The objectives of this study were to describe the various types of drugs that are injected by people in India and to analyse the differences between the commonly injected drugs.
DESIGN AND METHODS: A cross-sectional, multicentric study covering 22 harm-reduction sites from different regions of the country was conducted. First 50 subjects, chosen randomly from a list of PWIDs accessing services from each site and fulfilling study criteria, were interviewed using a structured questionnaire. Data from 902 male subjects are presented here.
RESULTS: Pharmaceutical opioid injectors (POI) accounted for 65% of PWIDs (buprenorphine: 30.8%, pentazocine: 21.8% and dextropropoxyphene: 11.9%). Heroin, injected by 34.3%, was prevalent in most states surveyed. Buprenorphine and pentazocine were not injected in the north-east region, whereas dextropropoxyphene was injected in the north-east alone. Univariate and multivariate logistic regression showed that, compared with heroin injectors, the POI group was more likely to consume alcohol and pharmaceutical opioids orally, inject frequently, share needle/syringes and develop injection-site complications. Among individual POIs, buprenorphine injectors had significantly higher proportion of subjects injecting frequently, sharing needle/syringes and developing local complications. Irrespective of the opioid type, majority of subjects were opioid dependent.
DISCUSSION AND CONCLUSIONS: Pharmaceutical opioids are the most common drugs injected in India currently and have greater injection-related risks and complications. Significant differences exist between different pharmaceutical opioids, which would be important considerations for interventions. [Ambekar A, Rao R, Mishra AK, Agrawal A. Type of opioids injected: Does it matter? A multicentric cross-sectional study of people who inject drugs. Drug Alcohol Rev 2014].

PMID: 25302827 [PubMed - as supplied by publisher]

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How to Solve a Problem (Including Your Child’s Substance Use)

Drug and Alcohol News (JoinTogether.com) - Thu, 10/09/2014 - 5:13pm

Here is a general strategy for approaching ANY problem. Whether it’s your child’s substance use – or any of the related problems – communication, behavior, friend choices, school performance and emotional development (you name it!)

Here are seven steps for solving problems based on CRAFT (Community Reinforcement and Family Training) among other behavioral approaches. This approach will take you beyond painful avoidance strategies and unreliable quick fixes, to help you work through problems thoroughly and systematically. As you practice with these steps, try to apply (and give yourself credit for) what you already do well, and take the time you need to learn what would be useful that you don’t already know.

  1. Define the problem as narrowly as you can.
 Often what people take as “the problem” is actually many smaller problems lumped together. No wonder they feel overwhelmed. When you describe a problem, be on the lookout for multiple problems embedded within your description, and tease them apart. The idea is to tackle one relatively discrete problem at a time. Solutions are more manageable with a series of smaller problems and you’ll feel more accomplished and optimistic as you get through each one.
  1. Brainstorm possible solutions.
 In this step, your task is to write down as many solutions as you can think of, to foster a sense of possibility and give yourself some choice. Brainstorming is an open, free-for-all process of allowing every idea in the door as they come, to be sorted and refined later. Your inner critic will tend to dismiss ideas out of habit or fear; but some of these could be viable options if you gave them a chance. List without judging. Try not to rule out anything before you’ve written down every conceivable solution to your problem.
  1. Eliminate unwanted suggestions. 
Now that you have an exhaustive list of potential solutions, you can examine them more closely and cross out any that are unappealing. Eliminate options that you can’t actually imagine ever doing, have too many downsides, or seem unrealistic. If you end up crossing off every idea, then return to step 2 and brainstorm again.
  1. Select one potential solution or goal.
 Pick one solution that seems doable to you, that you can see yourself trying this week. Hint: a doable goal is put in brief, simple, and positive terms (what you will do, not what you won’t do or haven’t been doing), is specific and measurable, reasonable and achievable, in your control, and involves skills you already have or are learning. (For a detailed discussion of goal setting, see chapter 8 of our book, Beyond Addiction.)
  1. Identify possible obstacles.
 Next, identify potential obstacles that could get in the way of completing your task. By anticipating problems you can plan strategies for dealing with them. This can include specific, predictable obstacles as well as a more general awareness that unforeseen challenges may arise, which can lend you some emotional resilience in dealing with them.
  1. Address each obstacle.
 Design specific strategies to cope with each obstacle. Not just, “I’m sure I can deal with it,” but exactly how you will get past it and move forward.
  1. See how things go.
 After you’ve carried out your plan, evaluate the process … How did it go? Look at what went well and what was more challenging in the implementation. Did your strategies for dealing with obstacles work well? Did obstacles come up that you hadn’t predicted? Is there anything you would do differently next time? This is how you figure out what works and what doesn’t work for you.
From from the Parents 20-Minute Guide by Center for Motivation and Change. Used with permission.

[Adapted from pp.187-190 in: Smith, J., & Myers, R. (2004). Motivating substance abusers to enter treatment: working with family members. New York: Guilford Press.]

The post How to Solve a Problem (Including Your Child’s Substance Use) appeared first on Partnership for Drug-Free Kids.

Categories: Bup Feeds

Effects of Buprenorphine and Estrous Cycle in a Murine Model of Cecal Ligation and Puncture.

Buprenorphine Research (PubMed) - Thu, 10/09/2014 - 6:30am

Effects of Buprenorphine and Estrous Cycle in a Murine Model of Cecal Ligation and Puncture.

Comp Med. 2014;64(4):270-282

Authors: Kennedy LH, Hwang H, Wolfe AM, Hauptman J, Nemzek-Hamlin JA

Abstract
The effect of opioids on the immunopathology of sepsis models in mice has been controversial. In previous work, we showed that mortality and various inflammatory parameters did not differ between female mice given saline or buprenorphine after cecal ligation and puncture. To investigate further, we hypothesized that buprenorphine would not affect outcomes of sepsis at any stage of estrous. Female mice were allocated into 4 groups (n = 20 per group) according to stage of estrous. Mice then underwent cecal ligation and puncture and received either buprenorphine or saline. In 3-wk survival studies, overall survival did not differ between buprenorphine- and saline-treated mice. When mice were stratified according to stage of estrous, survival did not vary among saline-treated groups but was lower in buprenorphine-treated mice in metestrus compared with proestrus. To investigate inflammation as a potential mechanism for survival, we measured cell counts and cytokine levels in the peripheral blood and peritoneal lavage fluid at 12 and 24 h after cecal ligation and puncture. At 24 h, buprenorphine-treated mice in proestrus had more circulating neutrophils and monocytes than did saline-treated mice in proestrus and more circulating WBC than did mice in any other stage with or without buprenorphine. Our current results suggest that the effects of buprenorphine on a 50% survival model of sepsis in BALB/c female mice are minimal overall but that the stage of estrous has various effects in this model. Investigators should consider the effects of buprenorphine and estrous cycle when using female mice in sepsis research.

PMID: 25296014 [PubMed - as supplied by publisher]

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Analysis of buprenorphine/naloxone dosing impact on treatment duration, resource use and costs in the treatment of opioid-dependent adults: a retrospective study of US public and private health care claims.

Buprenorphine Research (PubMed) - Thu, 10/09/2014 - 6:30am

Analysis of buprenorphine/naloxone dosing impact on treatment duration, resource use and costs in the treatment of opioid-dependent adults: a retrospective study of US public and private health care claims.

Postgrad Med. 2014 Sep;126(5):113-120

Authors: Khemiri A, Kharitonova E, Zah V, Ruby J, Toumi M

Abstract
Objectives: The buprenorphine/naloxone combination is used to treat the chronic relapsing disorder of opioid dependence. Adequate dosing levels are important to control cravings, prevent withdrawal syndrome, and maintain patients in treatment. The objective of this study was to estimate the impact of dosing on treatment persistence, resource utilization, and total direct health care costs. Methods: A retrospective cohort analysis was performed using administrative claims extracted from the MarketScan and Clinformatics databases from January 2007 to June and November 2012. Patients initiating treatment with buprenorphine/naloxone were classified into 2 groups based on the prescribed average dose over the entire treatment period and matched by multiple criteria. The threshold for differentiating the dosing groups was set at 15 and 15.7 mg/day for publicly and privately insured patients, respectively. Resource utilization and related costs were calculated over the 12-month period after the treatment initiation. Results: Patient characteristics at baseline were considerably different between the privately and publicly insured patients. Publicly insured patients were slightly younger (33.1 vs 34.3 years old for privately insured) and had a higher prevalence of mental disorders (70.9% vs 64.9%). In both groups, patients treated with higher doses (> 15 mg and > 15.7 mg per day for publicly and privately insured patients, respectively) had lower risk of discontinuation (public: 11% lower; private: 9% lower) and lower probability of a psychiatric hospitalization than patients treated with lower doses (public: 17% lower; private: 41% lower). Total costs were comparable between the 2 groups (public: $14 600; private: $21 000) despite the expected higher cost of pharmacy in the higher-dose group. Conclusions: Treatment with higher doses of buprenorphine/naloxone was associated with a longer time to treatment discontinuation, less resource use, and lower total medical costs despite higher pharmacy acquisition cost.

PMID: 25295655 [PubMed - as supplied by publisher]

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Opioid withdrawal, craving, and use during and after outpatient buprenorphine stabilization and taper: A discrete survival and growth mixture model.

Buprenorphine Research (PubMed) - Mon, 10/06/2014 - 8:00am

Opioid withdrawal, craving, and use during and after outpatient buprenorphine stabilization and taper: A discrete survival and growth mixture model.

Addict Behav. 2014 Sep 28;41C:20-28

Authors: Northrup TF, Stotts AL, Green C, Potter JS, Marino EN, Walker R, Weiss RD, Trivedi M

Abstract
INTRODUCTION: Most patients relapse to opioids within one month of opioid agonist detoxification, making the antecedents and parallel processes of first use critical for investigation. Craving and withdrawal are often studied in relationship to opioid outcomes, and a novel analytic strategy applied to these two phenomena may indicate targeted intervention strategies.
METHODS: Specifically, this secondary data analysis of the Prescription Opioid Addiction Treatment Study used a discrete-time mixture analysis with time-to-first opioid use (survival) simultaneously predicted by craving and withdrawal growth trajectories. This analysis characterized heterogeneity among prescription opioid-dependent individuals (N=653) into latent classes (i.e., latent class analysis [LCA]) during and after buprenorphine/naloxone stabilization and taper.
RESULTS: A 4-latent class solution was selected for overall model fit and clinical parsimony. In order of shortest to longest time-to-first use, the 4 classes were characterized as 1) high craving and withdrawal, 2) intermediate craving and withdrawal, 3) high initial craving with low craving and withdrawal trajectories and 4) a low initial craving with low craving and withdrawal trajectories. Odds ratio calculations showed statistically significant differences in time-to-first use across classes.
CONCLUSIONS: Generally, participants with lower baseline levels and greater decreases in craving and withdrawal during stabilization combined with slower craving and withdrawal rebound during buprenorphine taper remained opioid-free longer. This exploratory work expanded on the importance of monitoring craving and withdrawal during buprenorphine induction, stabilization, and taper. Future research may allow individually tailored and timely interventions to be developed to extend time-to-first opioid use.

PMID: 25282598 [PubMed - as supplied by publisher]

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Group Medication Management for Buprenorphine/Naloxone in Opioid-Dependent Veterans.

Buprenorphine Research (PubMed) - Fri, 10/03/2014 - 7:30am

Group Medication Management for Buprenorphine/Naloxone in Opioid-Dependent Veterans.

J Addict Med. 2014 Oct 1;

Authors: Berger R, Pulido C, Lacro J, Groban S, Robinson S

Abstract
OBJECTIVE:: Substance use disorders are a key concern among US veterans. Substance use disorder pharmacotherapies with support for effectiveness are limited. Buprenorphine/naloxone (Suboxone) is an effective opioid replacement treatment option for opioid use disorder when used as part of a comprehensive treatment program. In June 2011, the Veterans Affairs San Diego Healthcare System began using a group format to prescribe buprenorphine/naloxone. This study aimed at examining outcomes of retention rates and percentage opioid negative urine samples. Results were compared for veteran patients seen in group versus individual formats.
METHODS:: This retrospective chart review included data from 32 patients who were prescribed buprenorphine/naloxone between a 3-year window (ie, January 1, 2010, and December 31, 2012).
RESULTS:: Overall results were 46% retention in treatment after 1 year, and 94% of opioid urine samples were negative. More patients seen in group were retained in treatment at 1 year compared with those seen individually (69% vs 27%, respectively; P < 0.03).
CONCLUSIONS:: This study found that veterans prescribed buprenorphine/naloxone in a group setting as part of a drug and alcohol treatment program were retained in treatment longer than veterans prescribed this medication individually. Because of inherent limitations in the study design, no causality can be determined; however, given the results found here, group medication management of buprenorphine/naloxone should be explored further.

PMID: 25275875 [PubMed - as supplied by publisher]

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