Bup Feeds

Opioid maintenance, weaning and detoxification techniques: where we have been, where we are now and what the future holds.

Buprenorphine Research (PubMed) - Tue, 03/25/2014 - 7:15am

Opioid maintenance, weaning and detoxification techniques: where we have been, where we are now and what the future holds.

Pain Manag. 2013 Jul;3(4):277-84

Authors: Plunkett A, Kuehn D, Lenart M, Wilkinson I

Abstract
SUMMARY Medically supervised opioid withdrawal is a complex and constantly evolving exercise in multimodal therapy that draws from the expertise of a variety of clinical specialties. Acute substitution and weaning has been performed utilizing opioid agonists, partial agonists (e.g., buprenorphine), mixed agonist/antagonists (e.g., Suboxone®), and α2 adrenergic agonists. While thousands of patients are being treated with these 'classic' opioid-withdrawal techniques, traditional treatment approaches are being challenged by the emergence of innovative techniques based on an understanding of the neurochemistry of addiction. Pharmacotherapy with controlled withdrawal is currently the most reliable method of opioid detoxification, but, as translational medicine continues to advance and genomic markers for opioid sensitivity and dependence are identified, the future shows great potential for growth and change.

PMID: 24654813 [PubMed - in process]

Categories: Bup Feeds

Buprenorphine and norbuprenorphine determination in mice plasma and brain by gas chromatography-mass spectrometry.

Buprenorphine Research (PubMed) - Sat, 03/22/2014 - 6:15am

Buprenorphine and norbuprenorphine determination in mice plasma and brain by gas chromatography-mass spectrometry.

Anal Chem Insights. 2014;9:9-16

Authors: Chiadmi F, Schlatter J

Abstract
A gas chromatography tandem mass spectrometry method for quantification of buprenorphine (BUP) and norbuprenorphine (NBUP) in brain and plasma samples from mice was developed and validated. Analytes were extracted from the brain or plasma by solid phase extraction and quantified within 20 minutes. Calibration was achieved by linear regression with a 1/x weighting factor and d4-buprenorphine internal standard. All products were linear from 1 to 2000 ng/mL with a correlation of determination >0.99. Assay accuracy and precision of back-calculated standards were within ±10%. The lower limit of quantification for both BUP and NBUP from the brain and plasma was 1 ng/mL. This sensitive and specific method can be used for the investigation of BUP mechanism of action and clinical profile.

PMID: 24653644 [PubMed]

Categories: Bup Feeds

Workplace drug testing in Italy: Findings about second-stage testing.

Buprenorphine Research (PubMed) - Sat, 03/22/2014 - 6:15am

Workplace drug testing in Italy: Findings about second-stage testing.

Drug Test Anal. 2014 Mar 20;

Authors: Vignali C, Stramesi C, Morini L, San Bartolomeo P, Groppi A

Abstract
Workplace Drug Testing (WDT) in Italy includes two levels of monitoring: a first stage concerning drug testing on urine samples and a second involving both urine and hair analysis. The second stage is performed only on workers who tested positive at the first level. We analyzed urine and hair specimens from 120 workers undergoing second-level testing between 2009 and 2012. Eighty percent of them had tested positive for cannabinoids during the first level analysis, and 15.8% for cocaine. Both urine and hair samples were analyzed in order to find the following drugs of abuse: amphetamines, buprenorphine, cannabinoids, cocaine, ecstasy, methadone, and opiates. Urine analyses were performed by immunological screening (EMIT); urine confirmatory tests and hair analyses were performed by gas chromatography-mass spectrometry (GC-MS). As regards second-stage testing on urine samples, 71.2% of workers were always negative, whereas 23.9% tested positive at least once for cannabinoids and 2.5% for cocaine. Hair analyses produced surprising results: 61.9% of hair samples tested negative, only 6.2% tested positive for cannabinoids, whereas 28.8% tested positive for cocaine. These findings confirm that second-level surveillance of WDT, which includes hair analysis, is very effective because it highlights drug intake - sometimes heavy - that cannot be revealed only through urine analyses. The employees for whom drug addiction is proved can begin rehabilitation, while keeping their job. Eventually, our results confirmed the widespread and undeclared use of cocaine in Italy. Copyright © 2014 John Wiley & Sons, Ltd.

PMID: 24652693 [PubMed - as supplied by publisher]

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Marked variability in peri-partum anesthetic management of patients on buprenorphine maintenance therapy (BMT): can there be an underlying acute opioid induced hyperalgesia precipitated by neuraxial opioids in BMT patients?

Buprenorphine Research (PubMed) - Sat, 03/22/2014 - 6:15am

Marked variability in peri-partum anesthetic management of patients on buprenorphine maintenance therapy (BMT): can there be an underlying acute opioid induced hyperalgesia precipitated by neuraxial opioids in BMT patients?

Middle East J Anesthesiol. 2013 Oct;22(3):273-81

Authors: Gupta D, Christensen C, Soskin V

Abstract
OBJECTIVES: To compare adequacy of peri-partum pain management with or without neuraxial opioids in patients on buprenorphine maintenance therapy (BMT).
METHODS: After institutional review board approval for the study protocol, retrospective peripartum anesthesia/analgesia data of BMT patients for five-year period were accessed and analyzed.
RESULTS: Out of reviewed 51 patient charts, nineteen patients were found eligible for final comparative analysis. The daily amounts of peri-partum rescue analgesics with vs without neuraxial opioids were equianalgesic doses of parenteral hydromorphone (10.7 +/- 13.8 mg vs 2.6 +/- 0.7 mg, P = 0.45 for vaginal delivery; 16.4 +/- 21.1 mg vs 5.3 +/- 3.6 mg, P = 0.42 for elective cesarean section (CS)), oral ibuprofen (1.1 +/- 0.5g vs 0.8 +/- 0.4g, P = 0.37 for vaginal delivery; 1.1 +/- 0.2g vs 1.6 +/- 0.6g, P = 0.29 for elective CS), and acetaminophen (0.2 +/- 0.4g vs 0 +/- 0g, P = 0.56 for vaginal delivery; 0.3 +/- 0.3g vs 0.2 +/- 0.2g, P = 0.81 for elective CS). In the patients who underwent emergent CS after failed labor (all had received epidural opioids), there was clinical trend for higher daily amounts ofperi-partum rescue analgesics (parenteral hydromorphone 35.6 +/- 37.5 mg; oral ibuprofen 1.2 +/- 0.4g; oral acetaminophen 1.2 +/- 0.5g), when compared with vaginal delivery patients or elective CS patients who all had received neuraxial opioids.
CONCLUSIONS: As the study was underpowered (n = 19), future adequately powered studies are required to conclude for-or-against the use ofneuraxial opioids in BMT patients; and pro-nociceptive activation by neuraxial opioids may be worth investigating to improve our understanding of peripartum pain management of BMT patients.

PMID: 24649783 [PubMed - in process]

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Pain control in horses: What do we really know?

Buprenorphine Research (PubMed) - Sat, 03/22/2014 - 6:15am
Related Articles

Pain control in horses: What do we really know?

Equine Vet J. 2014 Mar 19;

Authors: Sanchez LC, Robertson SA

Abstract
Currently, approaches to pain control in horses are a mixture of art and science. Recognition of overt pain behaviours, such as rolling, kicking at the abdomen, flank watching, lameness, or blepharospasm, may be obvious; subtle signs of pain can include changes in facial expression or head position, location in the stall, and response to palpation or human interaction. Non-steroidal anti-inflammatory drugs (i.e. phenylbutazone, flunixin meglumine, firocoxib), opioids (i.e. butorphanol, morphine, buprenorphine), and alpha-2 adrenergic agonists (i.e. xylazine, detomidine, romificine, medetomidine) comprise the most commonly used therapeutic options. Multimodal therapy utilising constant rate infusions of lidocaine, ketamine, and/or butorphanol has gained popularity for severe pain in hospitalised patients. Drugs targeting neuropathic pain, such as gabapentin, are increasingly used for conditions such as laminitis. Optimal strategies for management of pain are based upon severity and chronicity, including special considerations for use of intra-articular or epidural delivery and therapy in foals. Strategies should also aim to mitigate adverse effects associated with use of various analgesic agents are briefly discussed.

PMID: 24645799 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Lord, deliver us from pain.

Buprenorphine Research (PubMed) - Sat, 03/22/2014 - 6:15am
Related Articles

Lord, deliver us from pain.

Eur Respir J. 2013 Aug;42(2):297-8

Authors: Veyckemans F, Rodenstein D

PMID: 23904546 [PubMed - indexed for MEDLINE]

Categories: Bup Feeds

Teen Inhalant Use Decreasing: Government Report

Drug and Alcohol News (JoinTogether.com) - Thu, 03/20/2014 - 11:38am

Fewer American teens are abusing inhalants, such as spray paint, glue and gasoline, according to a new government report. The number of teens ages 12 to 17 who used inhalants dropped from 820,000 in 2011, to about 650,000 in 2012.

The Substance Abuse and Mental Health Services Administration (SAMHSA), which released the findings, defines inhalants as “liquids, sprays and gases that people sniff or inhale to get high or to make them feel good,” UPI reports.

“This downward trend of inhalant use in adolescents is very encouraging,” Pamela S. Hyde, administrator of the SAMHSA, said in a statement. “Nevertheless, we must all continue our efforts to raise awareness about the dangers and health risks of this deadly and addictive problem among our youth.”

When inhalants are breathed in through the nose or mouth in a variety of ways they are absorbed quickly through the lungs into the bloodstream and the user experiences a rapid but short-lived intoxication.

There are hundreds of household products on the market today that can be misused as inhalants. Examples of products kids abuse to get high include model airplane glue, nail polish remover, cleaning fluids, hair spray, gasoline, the propellant in aerosol whipped cream, spray paint, fabric protector, air conditioner fluid (freon), cooking spray and correction fluid.

These products are sniffed, snorted, bagged (fumes inhaled from a plastic bag), or “huffed” (inhalant-soaked rag, sock, or roll of toilet paper in the mouth) to achieve a high. Inhalants are also sniffed directly from the container.

Within seconds of inhalation, the user experiences intoxication along with other effects similar to those produced by alcohol. Alcohol-like effects may include slurred speech, an inability to coordinate movements, dizziness, confusion and delirium. Nausea and vomiting are other common side effects. In addition, users may experience lightheadedness, hallucinations, and delusions.

Compulsive use and a mild withdrawal syndrome can occur with long-term inhalant abuse. Additional symptoms exhibited by long-term inhalant abusers include weight loss, muscle weakness, disorientation, inattentiveness, lack of coordination, irritability, and depression.

Categories: Bup Feeds

Starbucks Will Add Alcohol to Evening Menu in Many Urban Locations

Drug and Alcohol News (JoinTogether.com) - Thu, 03/20/2014 - 11:38am

Starbucks announced this week it will add alcohol to its evening menu in thousands of stores around the country. The coffee chain has been testing alcohol sales in Chicago, Atlanta and Southern California.

The new menu will be rolled out over several years, Bloomberg News reports. Starbucks began testing alcohol sales in 2010 in a Seattle store. It expanded alcohol sales to other cities in 2012. About 40 stores now sell alcohol. The evening menu in Chicago includes Chardonnay, chicken skewers, truffle macaroni and cheese and chocolate fondue, the article notes.

The new menu will appear in Starbucks in urban areas, near other restaurants and theaters.

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Republicans Who Oppose Mandatory Minimum Sentences Say They’re Costly, Ineffective

Drug and Alcohol News (JoinTogether.com) - Thu, 03/20/2014 - 11:37am

Republicans, who have traditionally taken a tough approach on crime, are increasingly opposing mandatory minimum sentences, The New York Times reports. They see the sentences as ineffective, as well as too costly and punitive.

Fiscal conservatives are looking to save billions of dollars in the federal budget by closing prisons and releasing inmates who no longer appear to pose a threat to society. Religious conservatives view sentencing reform as a way to offer compassion and to reunite families.

Many Republicans and Democrats agree mandatory minimum sentences should be reduced, the newspaper notes. Attorney General Eric Holder is pushing to eliminate mandatory minimum sentences for nonviolent drug crimes. He is joining with libertarian Republicans, including Senator Rand Paul of Kentucky, in this effort.

Last week, Holder testified in favor of changing federal guidelines to reduce the average sentence for drug dealers. He told the United States Sentencing Commission the Obama Administration supports changing guidelines to reduce the average drug sentence by about one year, from 62 months to 51 months.

The proposed changes would reduce the federal prison population by about 6,550 inmates over the next five years. Currently, half of the 215,000 inmates in the federal prison system are serving time for drug crimes.

Republicans and Democrats in the Senate are discussing combining two bills on sentencing reform. One would give judges more leeway to depart from mandatory minimum sentences in lower-level drug cases, reduce mandatory sentences for other drug offenses, and make the 2010 law that reduced the disparity between cocaine and crack-cocaine sentences retroactive.

A second bill would establish a skills training and early release system for people who are incarcerated, but who are considered to be at low risk for committing another offense.

Categories: Bup Feeds

Medical Marijuana Researchers One Step Closer to Starting PTSD Study

Drug and Alcohol News (JoinTogether.com) - Thu, 03/20/2014 - 11:37am

Medical marijuana researchers are a step closer to being able to start a study on whether the drug helps treat post-traumatic stress disorder (PTSD), after the Public Health Service gave its approval to the study. The Drug Enforcement Administration (DEA) must still approve the research.

Suzanne Sisley at the University of Arizona told USA Today there is a “mountain of anecdotal evidence” that marijuana helps with PTSD. She wants to conduct a controlled trial to see how marijuana suppresses symptoms including insomnia, flashbacks and anxiety.

Sisley received approval for her study from the Food and Drug Administration in 2011, and approval from the Public Health Service on Friday. It is unclear how long the DEA will take to make a decision about the study, the article notes.

The study is designed to last 10 weeks and would include 50 veterans with moderate to severe PTSD symptoms. They would use marijuana grown at the federal government’s only sanctioned marijuana farm at the University of Mississippi. Participants would receive either a placebo or one of four different amounts of THC, the active ingredient in marijuana. The researchers would also study the differences between smoking and vaporizing marijuana.

Six states list PTSD as a qualifying condition to receive medical marijuana: Connecticut, Delaware, Maine, Nevada, New Mexico and Oregon.

The Department of Veterans Affairs estimates 11 to 20 percent of troops who served in Iraq or Afghanistan have PTSD.

Categories: Bup Feeds

A preliminary evaluation of the effects of opioids on innate and adaptive human in vitro immune function.

Buprenorphine Research (PubMed) - Thu, 03/20/2014 - 7:15am

A preliminary evaluation of the effects of opioids on innate and adaptive human in vitro immune function.

BMJ Support Palliat Care. 2013 Dec 27;

Authors: Boland JW, Foulds GA, Ahmedzai SH, Pockley AG

Abstract
BACKGROUND: Studies have demonstrated that whereas some opioids have little effect on immunity (eg, buprenorphine), others can be immunosuppressive (eg, morphine) or immunostimulatory (eg, tramadol). However, a variety of approaches have been used, especially in vitro and animal models, and the findings are variable. We hypothesised that opioids have differential effects on immunity via direct actions on neutrophils, monocytes, natural killer (NK) and T cells, and this is the first study to systematically evaluate the influence of eight opioids on neutrophil and monocyte phagocytosis and oxidative burst responses, NK cell cytotoxicity and T cell responsiveness in vitro.
METHODS: Peripheral blood was obtained from healthy volunteers, and the effects of clinically relevant concentrations of morphine, tramadol, fentanyl, buprenorphine, methadone, oxycodone, diamorphine and codeine on phagocytosis and oxidative burst responses were determined using whole blood flow cytometry. The influence of opioids on the capacity of resting and IL-2 stimulated isolated peripheral blood mononuclear cells (PBMCs) to kill NK cell-sensitive K562 cells, and the responsiveness of PBMC subpopulations to IL-2 and polyclonal stimulation were also evaluated.
RESULTS: Methadone, oxycodone and diamorphine inhibited the production of IL-6 by IL-2 stimulated PBMCs. None of the opioids consistently influenced the other measured immune parameters, although there was a trend for morphine, tramadol, fentanyl and buprenorphine to inhibit phagocytosis and oxidative burst responses to Escherichia coli.
CONCLUSIONS: Preliminary studies using standardised in vitro methodologies have demonstrated that some therapeutic opioids suppress IL-6 production. Although this might potentially suppress bacterial defence mechanisms, it would have little direct effect on anticancer immunity. These findings should be confirmed in larger in vitro and clinical studies.

PMID: 24644198 [PubMed - as supplied by publisher]

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In Vivo Profiling of Seven Common Opioids for Antinociception, Constipation and Respiratory Depression: No Two Opioids Have the Same Profile.

Buprenorphine Research (PubMed) - Thu, 03/20/2014 - 7:15am

In Vivo Profiling of Seven Common Opioids for Antinociception, Constipation and Respiratory Depression: No Two Opioids Have the Same Profile.

Br J Pharmacol. 2014 Mar 18;

Authors: Kuo A, Wyse BD, Meutermans W, Smith MT

Abstract
BACKGROUND AND PURPOSE: For patients experiencing inadequate analgesia and intolerable opioid-related side-effects on one strong opioid analgesic, pain relief with acceptable tolerability is often achieved by rotation to a second strong opioid. These observations suggest subtle between-opioid differences in their in vivo pharmacodynamic profiles. Hence this study in rats was designed to investigate between-opioid differences in their in vivo profiles.
EXPERIMENTAL APPROACH: Male Sprague Dawley rats were administered single intracerebroventricular (icv) bolus doses of morphine, morphine-6-glucuronide (M6G), fentanyl, oxycodone, buprenorphine, DPDPE or U69,593. Antinociception, constipation and respiratory depression were assessed using the warm water-tail flick test, the castor oil-induced diarrhoea test and whole body plethysmography respectively.
KEY RESULTS: The afore-mentioned opioids produced dose-dependent antinociception, constipation and respiratory depression. For antinociception, morphine, fentanyl and oxycodone were full agonists, buprenorphine and M6G were partial agonists whereas DPDPE and U69,593 had low potency. For constipation, M6G, fentanyl and buprenorphine were full agonists, oxycodone was a partial agonist, morphine produced a bell-shaped dose-response curve whereas DPDPE and U69,593 were inactive. For respiratory depression, morphine, M6G, fentanyl and buprenorphine were full agonists, oxycodone was a partial agonist whereas DPDPE and U69,593 were inactive. The respiratory depressant effects of fentanyl and oxycodone were of short duration whereas morphine, M6G and buprenorphine evoked prolonged respiratory depression.
CONCLUSION AND IMPLICATIONS: For the seven opioids assessed herein, no two have the same profile for evoking antinociception, constipation and respiratory depression suggesting that these effects are differentially regulated. Our findings likely underpin the clinical success of 'opioid rotation'.

PMID: 24641546 [PubMed - as supplied by publisher]

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