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Factors contributing to the rise of buprenorphine misuse: 2008-2013.

Buprenorphine Research (PubMed) - Sun, 07/06/2014 - 8:00am
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Factors contributing to the rise of buprenorphine misuse: 2008-2013.

Drug Alcohol Depend. 2014 Jun 18;

Authors: Cicero TJ, Ellis MS, Surratt HL, Kurtz SP

Abstract
OBJECTIVE: The purpose of the present study was to examine the motivations underlying the use of buprenorphine outside of therapeutic channels and the factors that might account for the reported rapid increase in buprenorphine misuse in recent years.
METHODS: This study used: (1) a mixed methods approach consisting of a structured, self-administered survey (N=10,568) and reflexive, qualitative interviews (N=208) among patients entering substance abuse treatment programs for opioid dependence across the country, centered on opioid misuse patterns and related behaviors; and (2) interviews with 30 law enforcement agencies nationwide about primary diverted drugs in their jurisdictions.
RESULTS: Our results demonstrate that the misuse of buprenorphine has increased substantially in the last 5 years, particularly amongst past month heroin users. Our quantitative and qualitative data suggest that the recent increases in buprenorphine misuse are due primarily to the fact that it serves a variety of functions for the opioid-abusing population: to get high, manage withdrawal sickness, as a substitute for more preferred drugs, to treat pain, manage psychiatric issues and as a self-directed effort to wean themselves off opioids.
CONCLUSION: The non-therapeutic use of buprenorphinehas risen dramatically in the past five years, particularly in those who also use heroin. However, it appears that buprenorphine is rarely preferred for its inherent euphorigenic properties, but rather serves as a substitute for other drugs, particularly heroin, or as a drug used, preferable to methadone, to self-medicate withdrawal sickness or wean off opioids.

PMID: 24984689 [PubMed - as supplied by publisher]

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Evaluation of the perioperative analgesic efficacy of buprenorphine, compared with butorphanol, in cats.

Buprenorphine Research (PubMed) - Wed, 07/02/2014 - 7:00am

Evaluation of the perioperative analgesic efficacy of buprenorphine, compared with butorphanol, in cats.

J Am Vet Med Assoc. 2014 Jul 15;245(2):195-202

Authors: Warne LN, Beths T, Holm M, Carter JE, Bauquier SH

Abstract
Objective-To compare the analgesic effects of buprenorphine and butorphanol in domestic cats. Design-2-phase positive-controlled randomized masked clinical trial. Animals-39 healthy female cats (10 in phase 1 and 29 in phase 2). Procedures-Cats admitted for ovariohysterectomy received buprenorphine (4 in phase 1; 14 in phase 2) or butorphanol (6 in phase 1; 15 in phase 2). In phase 1, cats were premedicated with buprenorphine (0.02 mg/kg [0.009 mg/lb], IM) or butorphanol (0.4 mg/kg [0.18 mg/lb], IM), in combination with medetomidine. Anesthesia was induced with propofol (IV) and maintained with isoflurane in oxygen. After extubation, medetomidine was antagonized with atipamezole. A validated multidimensional composite scale was used to assess signs of pain after surgery starting 20 minutes after extubation and continuing for up to 360 minutes, and pain score comparisons were made between the 2 groups. Phase 2 proceeded similar to phase 1 with the following addition: during wound closure, cats from the butorphanol and buprenorphine groups received butorphanol (0.4 mg/kg, IM) or buprenorphine (0.02 mg/kg, IM), respectively. Results-Phase 1 of the study was stopped after 10 cats were ovariohysterectomized because 9 of 10 cats required rescue analgesia at the first evaluation. In phase 2, at the first pain evaluation, pain scores from the buprenorphine group were lower, and all cats from the butorphanol group required rescue analgesia. None of the cats from the buprenorphine group required rescue analgesia at any time. Conclusions and Clinical Relevance-Buprenorphine (0.02 mg/kg, IM) given before surgery and during wound closure provided adequate analgesia for 6 hours following ovariohysterectomy in cats, whereas butorphanol did not.

PMID: 24984130 [PubMed - as supplied by publisher]

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CYP2D6-Inhibiting Drugs and the Increased Risk of Fall-Related Injuries due to Newly Initiated Opioid Treatment - a Swedish, Register-based Case Cross-over Study.

Buprenorphine Research (PubMed) - Tue, 07/01/2014 - 7:30am

CYP2D6-Inhibiting Drugs and the Increased Risk of Fall-Related Injuries due to Newly Initiated Opioid Treatment - a Swedish, Register-based Case Cross-over Study.

Basic Clin Pharmacol Toxicol. 2014 Jun 30;

Authors: Möller J, Laflamme L, Löfdal KS

Abstract
It has been shown that newly initiated opioid therapy increases the risk of fall-related injuries. Yet, it remains to be determined whether drug-drug interactions can affect this negative effect, for instance with drugs inhibiting cytochrome P4502D6 (CYP2D6) that metabolizes codeine, and also has a partial effect on tramadol and oxycodone. Our aim was to investigate how CYP2D6-inhibiting drugs contribute to explaining the risk of fall-related injuries for newly initiated opioid treatments with codeine, tramadol or oxycodone. Data from a Swedish national case cross-over study were revisited. This study identified a total of 167,257 fall-related injuries leading to hospitalization that occurred between 1 May 2006 and 31 December 2009 and linked information about dispensed drugs to them. Use of newly dispensed opioids in the 28 days before fall-related injury with and without CYP2D6-inhibiting drugs was compared with an earlier control period. For codeine, there was a two-fold elevated risk with concomitant CYP2D6-inhibiting drug use (OR, 1.76; 95% CI 1.40-2.20) and a three-fold risk increase without (OR, 3.17; 95% CI 2.88-3.50). For tramadol, the risks were doubled when CYP2D6-inhibiting drugs were used (OR, 2.19; 95% CI 1.84-2.60) and tripled without their use (OR, 3.04; 95% CI 2.82-3.27). The risks were about the same for oxycodone, morphine, fentanyl and buprenorphine irrespective of CYP2D6-inhibiting drug use. In newly initiated opioid therapies, drug-drug interactions from concomitant use of CYP2D6-inhibiting drugs are associated with a lower risk of fall-related injury for codeine and tramadol that undergo metabolism via CYP2D6, but not for other opioids. This article is protected by copyright. All rights reserved.

PMID: 24975450 [PubMed - as supplied by publisher]

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A Pilot Study of a Distress Tolerance Treatment for Opiate-Dependent Patients Initiating Buprenorphine: Rationale, Methodology, and Outcomes.

Buprenorphine Research (PubMed) - Sun, 06/29/2014 - 8:00am
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A Pilot Study of a Distress Tolerance Treatment for Opiate-Dependent Patients Initiating Buprenorphine: Rationale, Methodology, and Outcomes.

Behav Modif. 2014 Jun 27;

Authors: Brown RA, Bloom EL, Hecht J, Moitra E, Herman DS, Stein MD

Abstract
Buprenorphine, an opioid that is a long-acting partial opiate agonist, is an efficacious treatment for opiate dependence that is growing in popularity. Nevertheless, evidence suggests that many patients will lapse within the first week of treatment and that lapses are often associated with withdrawal-related or emotional distress. Recent research suggests that individuals' reactions to this distress may represent an important treatment target. In the current study, we describe the development and outcomes from a preliminary pilot evaluation (N = 5) of a novel distress tolerance (DT) treatment for individuals initiating buprenorphine. This treatment incorporates exposure-based and acceptance-based treatment approaches that we have previously applied to the treatment of tobacco dependence. Results from this pilot study establish the feasibility and acceptability of this approach. We are now conducting a randomized controlled trial of this treatment that we hope will yield clinically significant findings and offer clinicians an efficacious behavioral treatment to complement the effects of buprenorphine.

PMID: 24973401 [PubMed - as supplied by publisher]

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