Buprenorphine Research (PubMed)

Rate of community methadone treatment reporting at jail reentry following a methadone increased dose quality improvement effort.

Subst Abus. 2012;33(1):70-5

Authors: Harris A, Selling D, Luther C, Hershberger J, Brittain J, Dickman S, Glick A, Lee JD

Abstract
The Rikers Island Key Extended Entry Program (KEEP) has offered methadone treatment for opioid dependent inmates incarcerated in New York City's jails since 1986. In response to a trend toward low-dose methadone maintenance prescribing, a quality improvement (QI) protocol trained KEEP counselors, physicians, and pharmacists in the evidence base supporting moderate-to-high methadone maintenance doses in order to maximize therapeutic effects and rates of successful reporting to community methadone treatment programs (MTPs) post release. Discharge dose level and length of incarceration data were analyzed for 2 groups of KEEP patients discharged pre/post-QI. Among patients incarcerated for 21 or more days, the proportion of those on moderate-to-high doses of methadone increased significantly. Patients who reached a moderate-to-high methadone dose demonstrated higher rates of reporting to community MTP versus lower doses, both pre- and post-QI. Overall, a higher proportion of all patients reported to community MTP post-QI.

PMID: 22263715 [PubMed - indexed for MEDLINE]

Medication-assisted treatment in criminal justice agencies affiliated with the criminal justice-drug abuse treatment studies (CJ-DATS): availability, barriers, and intentions.

Subst Abus. 2012;33(1):9-18

Authors: Friedmann PD, Hoskinson R, Gordon M, Schwartz R, Kinlock T, Knight K, Flynn PM, Welsh WN, Stein LA, Sacks S, O'Connell DJ, Knudsen HK, Shafer MS, Hall E, Frisman LK,

Abstract
Medication-assisted treatment (MAT) is underutilized in the treatment of drug-dependent, criminal justice populations. This study surveyed criminal justice agencies affiliated with the Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) to assess use of MAT and factors influencing use of MAT. A convenience sample (N = 50) of criminal justice agency respondents (e.g., jails, prisons, parole/probation, and drug courts) completed a survey on MAT practices and attitudes. Pregnant women and individuals experiencing withdrawal were most likely to receive MAT for opiate dependence in jail or prison, whereas those reentering the community from jail or prison were the least likely to receive MAT. Factors influencing use of MAT included criminal justice preferences for drug-free treatment, limited knowledge of the benefits of MAT, security concerns, regulations prohibiting use of MAT for certain agencies, and lack of qualified medical staff. Differences across agency type in the factors influencing use and perceptions of MAT were also examined. MAT use is largely limited to detoxification and maintenance of pregnant women in criminal justice settings. Use of MAT during the community reentry period is minimal. Addressing inadequate knowledge and negative attitudes about MAT may increase its adoption, but better linkages to community pharmacotherapy during the reentry period might overcome other issues, including security, liability, staffing, and regulatory concerns. The CJ-DATS collaborative MAT implementation study to address inadequate knowledge, attitudes, and linkage will be described.

PMID: 22263709 [PubMed - indexed for MEDLINE]

Messages About Methadone and Buprenorphine in Reality Television: A Content Analysis of Celebrity Rehab With Dr. Drew.

Subst Use Misuse. 2012 May 15;

Authors: Roose R, Fuentes L, Cheema M

Abstract
Medication-assisted treatment for opioid dependence is safe and effective, yet negative perceptions about methadone and buprenorphine may discourage patients from entering treatment. One source of information that may influence viewers' perceptions is television. We performed a content analysis of a popular reality television program on addiction treatment. Although many patients had histories of opioid use, there were no positive messages about methadone or buprenorphine. The two main messages were that they (1) are primarily drugs of abuse, and (2) not acceptable treatment options. These messages reinforce negative stereotypes and may perpetuate stigma. There were multiple missed opportunities to provide evidence-based information.

PMID: 22587811 [PubMed - as supplied by publisher]

Treatment of pain in patients taking buprenorphine for opioid addiction #221.

J Palliat Med. 2012 May;15(5):613-4

Authors: Childers JW, Arnold RM

PMID: 22577788 [PubMed - in process]

Effects of a standardized anesthetic protocol on hematologic variables in healthy cats.

J Feline Med Surg. 2012 May 10;

Authors: Dhumeaux MP, Snead EC, Epp TY, Taylor SM, Carr AP, Dickinson RM, Leis ML

Abstract
This study evaluated the effects of an anesthetic protocol using intravenous ketamine and midazolam, and intramuscular buprenorphine on hematologic variables in cats. Twelve healthy adult cats had blood collected for a complete blood count before and after the induction of anesthesia. There were significant decreases in red blood cell counts, hemoglobin concentrations and hematocrits after the induction of anesthesia. On average, red blood cell counts and hematocrits decreased by 25%, and hemoglobin concentrations decreased by 24%. Based on hematocrit, 3/12 samples (25%) taken while the cats were anesthetized would have been interpreted as belonging to anemic patients while none of the cats would have been considered anemic before anesthesia. This study suggests that a complete blood count performed on blood taken under anesthesia with this anesthetic protocol should be interpreted cautiously in order to not make a false diagnosis of anemia.

PMID: 22577050 [PubMed - as supplied by publisher]

Misuse of Medicines in the European Union: A Systematic Review of the Literature.

Eur Addict Res. 2012 May 4;18(5):228-245

Authors: Casati A, Sedefov R, Pfeiffer-Gerschel T

Abstract
Background: Although awareness of the misuse of medicines is increasing, data on the extent of the problem in the European Union (EU) are lacking. Methods: In order to assess the magnitude and severity of the problem, a systematic review of the literature on the misuse of analgesics, opioid substitution medicines and sedatives/hypnotics (with the exception of benzodiazepines) was conducted using the PubMed and Web of Science databases. Relevant literature was identified between 2001 and 2011. Results: The main groups of misused medicines include opioid analgesics, methadone, buprenorphine and Z-drugs. Regional trends in medicine misuse indicate heterogeneity across the EU with respect to misused medicine types and research activities. Prevalence, high-risk populations and factors contributing to medicine misuse are discussed. Conclusion: The implications of these findings for prevention, treatment, and policy in the EU are considered.

PMID: 22572594 [PubMed - as supplied by publisher]

Comparison of pain models to detect opioid-induced hyperalgesia.

J Pain Res. 2012;5:99-106

Authors: Krishnan S, Salter A, Sullivan T, Gentgall M, White J, Rolan P

Abstract
OBJECTIVE: Chronic opioid therapy may be associated with hyperalgesia. Our objective was to determine if opioid-induced hyperalgesia detection sensitivity is dependent on the stimulus used to detect it.
METHODS: This open design study compared the detection of hyperalgesia in opioid-dependent subjects (n = 16) and healthy control subjects (n = 16) using the following pain stimuli: cold pain, electrical stimulation, mechanical pressure, and ischemic pain. The opioid-dependent subjects were maintained on either methadone (n = 8) or buprenorphine (n = 8) for at least 3 months. None of the controls was dependent on opioids or other drugs of abuse.
RESULTS: The opioid-dependent subjects were markedly more sensitive than controls to the cold pain test. Compared with the control group, the hazard ratio for ceasing the test due to intolerable pain was 7.7 (95% confidence interval [CI] 2.6-23.3) in the buprenorphine group and 4.5 (95% CI 1.7-15.6) in the methadone group, with similar data for the cold pain threshold. Of the remaining tests, there were differences only for the electrical pain threshold between treatment groups, with the geometric mean threshold in the buprenorphine group being 1.5 (95% CI 1.1-1.9)-fold higher (ie, less sensitive) than that of the controls; the geometric mean for the methadone group was 1.3 (95% CI 1.04-1.7)-fold higher than that of the controls. There were no significant differences between buprenorphine and methadone patients in test responses. Women were more sensitive to the cold pain (hazard ratio for tolerance, 3.1 [95% CI 1.4-7.3]) and ischemic tests (hazard ratio for tolerance, 2.7 [95% CI 1.2-6.1]). There were significant correlations between cold and ischemic tolerances (r = 0.50; P = 0.003) and between electrical and mechanical pain tolerances (r = 0.52; P = 0.002).
CONCLUSION: These findings indicate that cold pain is the most suitable of the methods tested to detect opioid-induced hyperalgesia. This is consistent with its sensitivity to detect opioid analgesia.

PMID: 22570562 [PubMed - in process]

Toxicological and pathological findings in a series of buprenorphine related deaths. Possible risk factors for fatal outcome.

Forensic Sci Int. 2012 May 5;

Authors: Seldén T, Ahlner J, Druid H, Kronstrand R

Abstract
Buprenorphine is considered to have little respiratory side effects at therapeutic doses and the partial agonistic properties should produce a "ceiling effect" for respiratory depression at higher doses. Still, there are several reports on buprenorphine related deaths. Most deaths involve drug users and the co-administration of other CNS depressant drugs as well as reduced tolerance have been suggested to be risk factors. The primary aims were to investigate if lack of tolerance and/or co-ingestion of other psychotropic drugs are significant risk factors in buprenorphine fatalities. From July 2005 to September 2009, all autopsy cases where buprenorphine or norbuprenorphine had been detected in femoral blood and where analysis of buprenorphine had been performed in urine were selected. Results from the postmortem examination and toxicology were compiled. Postmortem toxicology was performed using the routine methodology at the laboratory. In total, 97 subjects were included in the study. These were divided into four groups; Intoxication with buprenorphine (N=41), Possible intoxication with buprenorphine (N=24), Control cases where buprenorphine was not the cause of death (N=14), and Unclear (N=18). The metabolite to parent compound ratios in both blood and urine in the Intoxication group were significantly different from those in the Control and Unclear groups. An extensive poly-drug use was seen in all groups with several additional opioids in the Possible group (54%) and in the Unclear group (78%) and hypnotics or sedatives in more than 75% of the Intoxication, Possible, and Unclear cases. Illicit drugs were present in all groups but not to a great extent with amphetamine and tetrahydrocannabinol as the main findings. Interestingly, 4 cases in the Intoxication group presented with no other significant drugs in blood other than buprenorphine. We conclude that a lethal concentration of buprenorphine in blood cannot be defined. Instead the analysis of blood as well as urine can be an important tool to show that the drug was taken shortly before death and to rule out a continuous use of buprenorphine supporting the notion that abstinence is an important risk factor. The presence of alprazolam in more than 40% of the Intoxications and the presence of hypnotics and sedatives in 75% of the Intoxications suggests that these drugs interact with buprenorphine producing toxic effects that buprenorphine alone would not have produced. Still, in 10% of the Intoxications no other drugs were found indicating that under certain circumstances buprenorphine alone may produce respiratory depression resulting in death.

PMID: 22565115 [PubMed - as supplied by publisher]

The Effect of Telaprevir on the Pharmacokinetics of Buprenorphine in Volunteers on Stable Buprenorphine/Naloxone Maintenance Therapy.

Antimicrob Agents Chemother. 2012 May 7;

Authors: Luo X, Trevejo J, van Heeswijk RP, Smith F, Garg V

Abstract
This was an open-label, single-sequence trial in HCV-negative volunteers on stable, individualized, buprenorphine maintenance therapy. Telaprevir 750mg every 8 hours was co-administered with buprenorphine/naloxone (4:1 ratio as sublingual tablets) for 7 days with food. Pharmacokinetic profiles of buprenorphine, norbuprenorphine and naloxone were measured over the 24-hour dosing interval on Day -1 (buprenorphine/naloxone alone, reference) and Day 7 of telaprevir co-administration (test). Geometric least squares mean ratios and associated 90% confidence intervals of treatment ratios (test/reference) were calculated using log-transformed pharmacokinetic parameters. Opioid withdrawal symptoms were evaluated throughout the study (questionnaires and pupillometry). Pharmacokinetic data were available for 14 and 13 volunteers on Day -1 and Day 7, respectively. AUC for buprenorphine was unchanged, and C(max) for buprenorphine, C(max) and AUC for norbuprenorphine, and C(max) naxolone were modestly decreased, during coadministration with telaprevir. Geometric least squares mean ratios (90% confidence intervals) for buprenorphine were 0.80 [0.69, 0.93] for C(max) and 0.96 [0.84, 1.10] for AUC(0-24h); for norbuprenorphine were 0.85 [0.66, 1.09] for C(max) and 0.91 [0.71, 1.16] for AUC(0-24h); and for naloxone were 0.84 [0.62, 1.13] for C(max). Co-administration of telaprevir did not increase withdrawal symptom frequency and there were no serious adverse events reported during or after completion of telaprevir co-administration. Results suggest dose adjustment may not be necessary when telaprevir and buprenorphine/naloxone are co-administered.

PMID: 22564847 [PubMed - as supplied by publisher]

Pointers in practical pharmacology: buprenorphine: a newer drug for treating neonatal abstinence syndrome.

Neonatal Netw. 2012 May 1;31(3):178-83

Authors: Bell SG

Abstract
Neonates may be exposed to various legal and illicit substances during gestation, including cigarettes, alcohol, narcotics, benzodiazepines, antidepressants, and stimulants. Many of these substances can result in varying degrees of drug withdrawal after delivery. Polysubstance use can complicate the clinical evaluation of a newborn both in terms of assessment of withdrawal and treatment of symptoms. For the purpose of this column, the focus is on those infants with in utero narcotic exposure. The primary circumstances under which pregnant women use narcotics are illicit drug abuse, prescribed narcotic maintenance as treatment for abuse, and treatment of chronic pain conditions.

PMID: 22564314 [PubMed - in process]

Evaluation of Buprenorphine Dosage Adequacy in Opioid Receptor Agonist Substitution Therapy for Heroin Dependence: First Use of the Buprenorphine-Naloxone Dosage Adequacy Evaluation (BUDAVA) Questionnaire.

Clin Drug Investig. 2012 May 4;

Authors: D'Amore A, Romano F, Biancolillo V, Lauro G, Armenante C, Pizzirusso A, Del Tufo S, Ruoppolo C, Auriemma F, Cassese F, Oliva P, Amato P

Abstract
Background: The dosing of opioid receptor agonist medications adequately and on an individual basis is crucial in the pharmacotherapy of opioid dependence. Clinical tools that are able to measure dose appropriateness are sorely needed. The recently developed and validated Opiate Dosage Adequacy Scale (ODAS) comprehensively evaluates the main outcomes relevant for methadone dose optimization, namely relapse, cross-tolerance, objective and subjective withdrawal symptoms, craving and overdose. Based on the ODAS, we developed a new assessment tool (BUprenorphine-naloxone Dosage Adequacy eVAluation [BUDAVA]) for evaluating dosage adequacy in patients in treatment with buprenorphine-naloxone. Objective: The main goal of this observational study was to explore whether the BUDAVA questionnaire could be used to assess buprenorphine-based, long-term substitution therapy for heroin addiction. Methods: The study included heroin-dependent patients who had been in treatment with buprenorphine-naloxone for at least 3 months. Patients (n = 196) were recruited from 11 drug abuse treatment centres in Italy. Dosage adequacy was assessed with the BUDAVA questionnaire. Patients classified as inadequately treated had their dosage modified. After 1 week, they were again administered the questionnaire to assess the adequacy of the new dosage. Results: The buprenorphine-naloxone dosage was found to be inadequate in 61 of the 196 patients. In 13 patients, the treatment scored as inadequate only in the subjective withdrawal symptoms item of the questionnaire and therefore no dosage adjustment was made in the 2 weeks that have characterized this work. The remaining 48 inadequately treated patients had their dosage modified (42 dose increases and six dose decreases). After 1 week on the modified dosage, in 24 of these patients the new regimen was found by the assessment with the questionnaire to be adequate. Conclusion: These preliminary results suggest that the BUDAVA questionnaire may be useful for guiding buprenorphine-naloxone maintenance dose adjustments in heroin-dependent patients.

PMID: 22559256 [PubMed - as supplied by publisher]

Risk evaluation and mitigation strategies: Assessment of a medical center's policies and procedures.

Am J Health Syst Pharm. 2012 May 15;69(10):885-9

Authors: Childs L, Alexander E, Duong MT

Abstract
Purpose The results of a hospital's initiative to evaluate and improve compliance with federally mandated risk evaluation and mitigation strategies (REMS) are presented. Summary Food and Drug Administration approved REMS plans are required for more than 145 drugs, but clear guidance on strategies for achieving REMS compliance is lacking. As a first step toward determining the extent of REMS compliance at a large medical center, a systematic assessment was conducted to ascertain existing policies and procedures for the use of drugs subject to REMS requirements applicable in the inpatient setting. About 123 drugs with such "inpatient-applicable" REMS requirements were identified; of those, 10 had been ordered by hospital providers during a specified 18-month time frame and were included in the assessment of policies and procedures. The assessment revealed that the hospital lacked a formal REMS policy and had no REMS-compliant procedures in place for 7 evaluated drugs (ambrisentan, buprenorphine-naloxone, darbepoetin alfa, epoetin alfa, oxycodone controlled-release tablets, prasugrel, and pregabalin). Pursuant to the compliance assessment, new procedures to help ensure the safe use of those 7 drugs were developed, and REMS-focused educational programs, order-entry system enhancements, and drug storage modifications were implemented. Conclusion Quality-improvement initiatives including staff education, incorporation of REMS requirements into existing policy, development of an electronic resource, and creation of a separate storage section for drugs subject to REMS were implemented at a large academic medical center to help ensure compliance with inpatient-applicable REMS requirements.

PMID: 22555085 [PubMed - in process]

Handbook of Office-Based Buprenorphine Treatment of Opioid Treatment.

Psychiatr Serv. 2012 May 1;63(5):515

Authors: Liberto JG

PMID: 22549546 [PubMed - as supplied by publisher]

The effectiveness of opioid maintenance treatment in prison settings: a systematic review.

Addiction. 2012 Mar;107(3):501-17

Authors: Hedrich D, Alves P, Farrell M, Stöver H, Møller L, Mayet S

Abstract
AIMS: To review evidence on the effectiveness of opioid maintenance treatment (OMT) in prison and post-release.
METHODS: Systematic review of experimental and observational studies of prisoners receiving OMT regarding treatment retention, opioid use, risk behaviours, human immunodeficiency virus (HIV)/hepatitis C virus (HCV) incidence, criminality, re-incarceration and mortality. We searched electronic research databases, specialist journals and the EMCDDA library for relevant studies until January 2011. Review conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
RESULTS: Twenty-one studies were identified: six experimental and 15 observational. OMT was associated significantly with reduced heroin use, injecting and syringe-sharing in prison if doses were adequate. Pre-release OMT was associated significantly with increased treatment entry and retention after release if arrangements existed to continue treatment. For other outcomes, associations with pre-release OMT were weaker. Four of five studies found post-release reductions in heroin use. Evidence regarding crime and re-incarceration was equivocal. There was insufficient evidence concerning HIV/HCV incidence. There was limited evidence that pre-release OMT reduces post-release mortality. Disruption of OMT continuity, especially due to brief periods of imprisonment, was associated with very significant increases in HCV incidence.
CONCLUSIONS: Benefits of prison OMT are similar to those in community settings. OMT presents an opportunity to recruit problem opioid users into treatment, to reduce illicit opioid use and risk behaviours in prison and potentially minimize overdose risks on release. If liaison with community-based programmes exists, prison OMT facilitates continuity of treatment and longer-term benefits can be achieved. For prisoners in OMT before imprisonment, prison OMT provides treatment continuity.

PMID: 21955033 [PubMed - indexed for MEDLINE]

Engagement with opioid maintenance treatment and reductions in crime: a longitudinal national cohort study.

Addiction. 2012 Feb;107(2):393-9

Authors: Bukten A, Skurtveit S, Gossop M, Waal H, Stangeland P, Havnes I, Clausen T

Abstract
AIMS: This study investigates changes in criminal involvement among patients in opioid maintenance treatment (OMT) over a 7-year period prior to, during and after treatment, particularly in relation to differences in treatment engagement.
DESIGN, SETTING AND PARTICIPANTS: Treatment data on all patients who started OMT in Norway between 1997 and 2003 (n = 3221) were cross-linked with national criminal records. The period of observation was divided into four phases; pre-treatment, in-treatment, between treatments and post-treatment.
FINDINGS: During OMT, rates of criminal convictions for the cohort were reduced to fewer than half of waiting-list levels [incidence rate (IR) 0.63 versus 1.57]. Patients in continuous treatment had the fewest convictions (IR 0.47) during treatment. The highest rates were found among patients out of treatment after several treatment episodes (IR 1.52). All groups had significantly fewer criminal convictions during treatment compared to before treatment. Staying in OMT for 2 years or more was associated with significantly reduced rates of convictions during treatment. Younger age and pre-treatment criminal convictions were associated with significantly (P < 0.001) more convictions during treatment. Those who left treatment, permanently or temporarily, relapsed into high levels of convictions outside treatment.
CONCLUSIONS: Criminal activity appears to be reduced in Norway during opiate maintenance treatment. Younger age and prior history of criminal activity are important risk factors for continued criminal activity during treatment.

PMID: 21883606 [PubMed - indexed for MEDLINE]

Clinical differences between opioid abuse classes ameliorated after 1 year of buprenorphine-medication assisted treatment.

J Addict Dis. 2012 Apr;31(2):100-11

Authors: Tkacz J, Severt J, Kassed C, Ruetsch C

Abstract
This study compared the clinical and demographic profiles of three opioid-dependent user groups, and measured their response to 1 year of buprenorphine-medication assisted treatment. Opioid prescription, street, and combination (street + prescription) users completed the Addiction Severity Index multiple times over the course of one treatment year. Although groups differed on all measured demographics (P values <.05) and on six of seven Addiction Severity Index composite scores at induction (P values <.05), differences were ameliorated after 1 year. Findings highlight the disparities between the various opioid-dependent patient subpopulations and suggest that buprenorphine-medication assisted treatment is an effective treatment across user subtypes.

PMID: 22540432 [PubMed - in process]

Abstinence orientation and treatment practice: an analysis of German settings providing opioid maintenance therapy.

Subst Use Misuse. 2012 Jan;47(1):22-30

Authors: Trautmann S, Wittchen HU

Abstract
We examined whether differences in abstinence orientation are related to differences in treatment patterns by analyzing assessment data from a total of 161 German treatment settings offering opioid maintenance therapy. According to an index value, settings were divided into low (LAOs), medium (MAOs), and high abstinence-oriented settings (HAOs). Logistic, multinomial logistic, and linear regression analyses were carried out. HAOs prescribed lower maximum dosages of methadone and enforced rules for handling of concomitant drug use more rigidly than MAOs and LAOs. Patients in HAOs were more likely to undergo psychotherapeutic and psychiatric treatment than in MAOs and LAOs. Limitations, conclusions, and future research are suggested.

PMID: 22060728 [PubMed - indexed for MEDLINE]

Retention on buprenorphine treatment reduces emergency department utilization, but not hospitalization, among treatment-seeking patients with opioid dependence.

J Subst Abuse Treat. 2012 Apr 23;

Authors: Schwarz R, Zelenev A, Bruce RD, Altice FL

Abstract
Drug users are marginalized from typical primary care, often resulting in emergency department (ED) usage and hospitalization due to late-stage disease. Though data suggest methadone decreases such fragmented healthcare utilization (HCU), the impact of buprenorphine maintenance treatment (BMT) on HCU is unknown. Chart review was conducted on opioid dependent patients seeking BMT, comparing individuals (n=59) who left BMT≤7days with those retained on BMT (n=150), for ED use and hospitalization. Using negative binomial regressions, including comparison of time before BMT induction, ED utilization and hospitalization were assessed. Overall, ED utilization was 0.93 events per person year and was significantly reduced by BMT, with increasing time (retention) on BMT. BMT had no significant effect on hospitalizations or average length of stay.

PMID: 22534003 [PubMed - as supplied by publisher]

Perioperative Pain Relief by a COX-2 Inhibitor Affects Ileal Repair and Provides a Model for Anastomotic Leakage in the Intestine.

Surg Innov. 2012 Apr 24;

Authors: van der Vijver RJ, van Laarhoven CJ, de Man BM, Lomme RM, Hendriks T

Abstract
The authors examined the potential of the cyclooxygenase 2 (COX-2) inhibitor carprofen to reproducibly induce anastomotic leakage. In experiment 1, an anastomosis was constructed in both ileum and colon of 20 rats, and they were given carprofen (5 mg/kg subcutaneously every 24 hours) or buprenorphine (0.02 mg/kg subcutaneously every 12 hours). In another 20 rats an anastomosis was constructed in either ileum or colon, and all received carprofen (experiment 2). Animals were sacrificed after 3 days. In experiment 1, the ileal dehiscence rate was 60% in the carprofen group and 0% in the buprenorphine group (P = .0108). Colonic anastomoses in both groups remained patent. In experiment 2, the anastomotic leakage rate was 80% in ileum and 0% in colon. Thus, COX-2 inhibitors can severely interfere with intestinal healing, particularly in the ileum. Perioperative administration of carprofen yields a unique model for anastomotic leakage, which allows translational research on the effectiveness of perisuture line reinforcement.

PMID: 22532618 [PubMed - as supplied by publisher]

Opioid-abusing health care professionals: options for treatment and returning to work after treatment.

Mayo Clin Proc. 2012 Mar;87(3):213-5

Authors: Seppala MD, Oreskovich MR

PMID: 22386175 [PubMed - indexed for MEDLINE]