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Buprenorphine for treating cancer pain.

Pub Med: Keyword Buprenorphine - 4 hours 23 min ago

Buprenorphine for treating cancer pain.

Cochrane Database Syst Rev. 2015 Mar 31;3:CD009596

Authors: Schmidt-Hansen M, Bromham N, Taubert M, Arnold S, Hilgart JS

Abstract
BACKGROUND: Many patients with cancer experience moderate to severe pain that requires treatment with strong analgesics. Buprenorphine, fentanyl and morphine are examples of strong opioids used for cancer pain relief. However, strong opioids are ineffective as pain treatment in all patients and are not well-tolerated by all patients. The aim of this Cochrane review is to assess whether buprenorphine is associated with superior, inferior or equal pain relief and tolerability compared to other analgesic options for patients with cancer pain.
OBJECTIVES: To assess the effectiveness and tolerability of buprenorphine for pain in adults and children with cancer.
SEARCH METHODS: We searched CENTRAL (the Cochrane Library) issue 12 or 12 2014, MEDLINE (via OVID) 1948 to 20 January 2015, EMBASE (via OVID) 1980 to 20 January 2015, ISI Web of Science (SCI-EXPANDED & CPCI-S) to 20 January 2015, ISI BIOSIS 1969 to 20 January 2015. We also searched ClinicalTrials.gov (http://clinicaltrials.gov/; metaRegister of Controlled Trials (mRCT) (http://www.controlled-trials.com/mrct/), the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal (http://apps.who.int/trialsearch/) and the Proceedings of the Congress of the European Federation of International Association for the Study of Pain (IASP; via European Journal of Pain Supplements) on 16 February 2015. We checked the bibliographic references of identified studies as well as relevant studies and systematic reviews to find additional trials not identified by the electronic searches. We contacted authors of included studies for other relevant studies.
SELECTION CRITERIA: We included randomised controlled trials, with parallel-group or crossover design, comparing buprenorphine (any formulation and any route of administration) with placebo or an active drug (including buprenorphine) for cancer background pain in adults and children.
DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data pertaining to study design, participant details (including age, cancer characteristics, previous analgesic medication and setting), interventions (including details about titration) and outcomes, and independently assessed the quality of the included studies according to standard Cochrane methodology. As it was not feasible to meta-analyse the data, we summarised the results narratively. We assessed the overall quality of the evidence for each outcome using the GRADE approach.
MAIN RESULTS: In this Cochrane review we identified 19 relevant studies including a total of 1421 patients that examined 16 different intervention comparisons.Of the studies that compared buprenorphine to another drug, 11 studies performed comparative analyses between the randomised groups, and five studies found that buprenorphine was superior to the comparison treatment. Three studies found no differences between buprenorphine and the comparison drug, while another three studies found treatment with buprenorphine to be inferior to the alternative treatment in terms of the side effects profile or patients preference/acceptability.Of the studies that compared different doses or formulations/routes of administration of buprenorphine, pain intensity ratings did not differ significantly between intramuscular buprenorphine and buprenorphine suppository. However, the average severity of dizziness, nausea, vomiting and adverse events as a total were all significantly higher in the intramuscular group relatively to the suppository group (one study).Sublingual buprenorphine was associated with faster onset of pain relief compared to subdermal buprenorphine, with similar duration analgesia and no significant differences in adverse event rates reported between the treatments (one study).In terms of transdermal buprenorphine, two studies found it superior to placebo, whereas a third study found no difference between placebo and different doses of transdermal buprenorphine.The studies that examined different doses of transdermal buprenorphine did not report a clear dose-response relationship.The quality of this evidence base was limited by under-reporting of most bias assessment items (e.g., the patient selection items), by small sample sizes in several included studies, by attrition (with data missing from 8.2% of the enrolled/randomised patients for efficacy and from 14.6% for safety) and by limited or no reporting of the expected outcomes in a number of cases. The evidence for all the outcomes was very low quality.
AUTHORS' CONCLUSIONS: Based on the available evidence, it is difficult to say where buprenorphine fits in the treatment of cancer pain with strong opioids. However, it might be considered to rank as a fourth-line option compared to the more standard therapies of morphine, oxycodone and fentanyl, and even there it would only be suitable for some patients. However, palliative care patients are often heterogeneous and complex, so having a number of analgesics available that can be given differently increases patient and prescriber choice. In particular, the sublingual and injectable routes seemed to have a more definable analgesic effect, whereas the transdermal route studies left more questions.

PMID: 25826743 [PubMed - as supplied by publisher]

Novel Buccal Film Formulation of Buprenorphine-Naloxone for the Maintenance Treatment of Opioid Dependence: A 12-Week Conversion Study.

Pub Med: Keyword Buprenorphine - 4 hours 23 min ago
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Novel Buccal Film Formulation of Buprenorphine-Naloxone for the Maintenance Treatment of Opioid Dependence: A 12-Week Conversion Study.

Clin Ther. 2015 Mar 27;

Authors: Sullivan JG, Webster L

Abstract
PURPOSE: The purpose of this study was to provide a preliminary assessment of the safety, tolerability, symptom control, and acceptability of buprenorphine-naloxone buccal film (BBN) for the maintenance treatment of opioid dependence in patients converted from buprenorphine-naloxone sublingual tablet or film (SLBN), as well as to determine the conversion ratio for switching patients from SLBN to BBN.
METHODS: This open-label study included adult opioid-dependent subjects stabilized on 8/2 to 32/8 mg/d of SLBN for a minimum of 30 days. Study subjects were converted to a bioequivalent dose of BBN and maintained for 12 weeks.
FINDINGS: A total of 249 subjects (mean age 38.7 years, 65.9% male) were converted from SLBN to a single daily dose of BBN, and 79.1% completed the 12-week study. Adverse events and withdrawal symptoms led to discontinuation in 2.4% and 2.0% of BBN-treated subjects, respectively. Rates of constipation reported at baseline declined from 41% just before the initial BBN dose and within 24 hours of the last SLBN dose to 13% after 12 weeks of BBN treatment; treatment-emergent constipation was reported by 2.8% of BBN-treated subjects. Oral mucosal abnormalities were identified in 5% and 0.6% of systematic oral examinations in SLBN- and BBN-treated subjects, respectively. A total of 34 subjects had Clinical Opiate Withdrawal Scale total scores ranging from 10 to 25 (overall mean, 13.8) within 24 hours of taking their last SLBN dose, and scores for these subjects were reduced to a range of 0 to 3 (overall mean, 0.7) at 3 hours after the initial dose of BBN. Treatment compliance was high (108%); <1% of urine samples were buprenorphine-free, and 92.4% of BBN-treated subjects did not have a urine sample that tested positive for a non-prescribed opioid. A total of 91.3% subjects rated the taste of BBN as pleasant or neutral, and 82.5% rated BBN ease of use as easy or neutral. The overall mean final dose of BBN was 8.0/1.4 mg/d, yielding a 2:1 buprenorphine conversion ratio.
IMPLICATIONS: Although these results should be considered preliminary due to the open-label design, BBN was overall safe and well tolerated, and seemed to provide adequate symptom control, in the treatment of opioid-dependent subjects previously controlled on SLBN for a minimum of 30 days. There was good adherence to study medication and favorable patient acceptance of the buccal formulation. The SLBN/BBN buprenorphine conversion ratio was 2:1. ClinicalTrials.gov identifier: NCT01666119.

PMID: 25823919 [PubMed - as supplied by publisher]

Characterizing opioid withdrawal during double-blind buprenorphine detoxification.

Pub Med: Keyword Buprenorphine - 4 hours 23 min ago
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Characterizing opioid withdrawal during double-blind buprenorphine detoxification.

Drug Alcohol Depend. 2015 Mar 12;

Authors: Dunn KE, Saulsgiver KA, Miller ME, Nuzzo PA, Sigmon SC

Abstract
BACKGROUND: Prescription opioid (PO) abuse has become an urgent public health issue in the United States. Detoxification is one important treatment option, yet relatively little is known about the time course and severity of opioid withdrawal during buprenorphine detoxification.
METHODS: This is a secondary analysis of data from a randomized, placebo-controlled, double-blind evaluation of 1, 2, and 4-week outpatient buprenorphine tapers among primary prescription opioid (PO) abusers. The aim is to characterize the time course and severity of buprenorphine withdrawal under rigorous, double-blind conditions, across multiple taper durations, and using multiple withdrawal-related measures (i.e., self-report and observer ratings, pupil diameter, ancillary medication utilization). Participants were PO-dependent adults undergoing buprenorphine detoxification and biochemically-verified to be continuously abstinent from opioids during their taper (N=28).
RESULTS: Participants randomly assigned to the 4-week taper regimen experienced a relatively mild and stable course of withdrawal, with few peaks in severity. In contrast, the 1- and 2-week taper groups experienced stark increases in withdrawal severity during the week following the last buprenorphine dose, followed by declines in withdrawal severity thereafter. The 4-week taper group also reported significantly fewer disruptions in sleep compared to the other experimental groups. When predictors of withdrawal were examined, baseline ratings of "Expected Withdrawal Severity" was the most robust predictor of withdrawal experienced during the taper.
CONCLUSION: Data from this trial may inform clinicians about the expected time course, magnitude, and pattern of buprenorphine withdrawal and aid efforts to identify patients who may need additional clinical support during outpatient buprenorphine detoxification.

PMID: 25823907 [PubMed - as supplied by publisher]

Trends in the use of buprenorphine by office-based physicians in the United States, 2003-2013.

Pub Med: Keyword Buprenorphine - 4 hours 23 min ago
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Trends in the use of buprenorphine by office-based physicians in the United States, 2003-2013.

Am J Addict. 2015 Jan;24(1):24-9

Authors: Turner L, Kruszewski SP, Alexander GC

Abstract
BACKGROUND AND OBJECTIVES: Despite buprenorphine's promise as a novel therapy for opioid dependence, little is known about its clinical adoption. We characterized trends in ambulatory use of buprenorphine in the United States.
METHODS: Cross-sectional, descriptive analyses of buprenorphine utilization from 2003 to 2013 using the IMS Health National Disease and Therapeutic Index, a nationally representative audit of ambulatory care. The primary unit of analysis was an office visit where buprenorphine was used for opioid dependence (treatment visit).
RESULTS: Between 2003 and 2013, there was significant uptake of buprenorphine in ambulatory treatment visits, from 0.16 million [M] (95% confidence interval [CI] 0.10-0.20) visits in 2003 to 2.1M (CI 1.9-2.3M) treatment visits during 2013. Approximately 90% involved the use of brand name combination buprenorphine/naloxone (Suboxone), although this percentage decreased modestly to 80% by the last quarter of 2013. Buprenorphine prescribing increased among all specialties, but the proportion accounted for by primary care physicians increased significantly from 6.0% in 2003 to 63.5% in 2013 and decreased among psychiatrists from 92.2% to 32.8% over the same time period.
CONCLUSIONS: The use of buprenorphine products to treat opioid dependence has increased significantly in the past 10 years and has shifted to greater use by primary care physicians, indicating a rapidly changing face of opioid maintenance therapy in the United States. (Am J Addict 2015;24:24-29).

PMID: 25823632 [PubMed - in process]

Initiating buprenorphine treatment for hospitalized patients with opioid dependence: A case series.

Pub Med: Keyword Buprenorphine - 4 hours 23 min ago
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Initiating buprenorphine treatment for hospitalized patients with opioid dependence: A case series.

Am J Addict. 2015 Jan;24(1):10-4

Authors: Suzuki J, DeVido J, Kalra I, Mittal L, Shah S, Zinser J, Weiss RD

Abstract
BACKGROUND AND OBJECTIVES: Opioid dependent patients are hospitalized frequently. We aimed to determine if initiation of buprenorphine treatment during hospitalization facilitates entry into treatment following discharge.
METHODS: Retrospective case series (n = 47).
RESULTS: Twenty-two (46.8%) patients successfully initiated buprenorphine treatment within 2 months of discharge. Those patients obtaining a referral to a specific program were more successful in continuing treatment, but this difference did not reach statistical significance (59.1% vs 39.1%, p = 0.18).
DISCUSSION AND CONCLUSIONS: Hospitalization may be an important opportunity to engage opioid dependent patients to initiate buprenorphine treatment.
SCIENTIFIC SIGNIFICANCE: This study provides provisional support for utilizing buprenorphine for hospitalized patients. (Am J Addict 2015;24:10-14).

PMID: 25823630 [PubMed - in process]

Translating Developmental Neuroscience to Substance Use Prevention

MedWorm Addiction Feeds - 6 hours 28 min ago
Abstract Several preventive interventions have demonstrated efficacy in reducing substance use. However, opportunities exist to further improve prevention approaches. The application of recent advances in developmental neuroscience can inform the design, implementation, and evaluation of substance use prevention programs. This paper first briefly describes the developmental integration of the prefrontal cortex with emotion and motivation centers of the brain, and the implications of this process for substance use vulnerability. Discussed next are specific examples of how developmental neuroscience can inform prevention timing, development, and evaluation. Contextual considerations are then suggested including a critical role for schools in substance misuse prevention. Finally, cur...

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Early Birds Versus Night Owls: What Your Bedtime Really Says About You

MedWorm Addiction Feeds - March 31, 2015 - 11:00pm
The tortoise and the hare. Coyote versus roadrunner. The Sharks and the Jets. There are many proverbial rivalries that have rocked this world, but perhaps none so divisive as the one between the early bird and the night owl -- two rivals who share the same world on opposing clocks. Whether you’re an early bird singing your way through morning or a night owl hooting around late at night, you can thank (or blame) your genes. The human clock follows roughly a 24-hour cycle that syncs with sequences of light and dark. What separates the night owl from the early bird is the former’s slightly longer circadian rhythm. It is not, however, just their bedtimes that distinguish these two rivals. Studies show that your sleep schedule can actually influence your personality. We partnered with G...

The association of area-level social class and tobacco use with adverse breast cancer characteristics among white and black women: evidence from Maryland, 1992¿2003

MedWorm Addiction Feeds - March 31, 2015 - 7:00pm
Conclusions: Results suggest that in one U.S. geographic area, there is a differential protection from social class for black and white women, supporting use of intersectionality theory in breast cancer disparities investigations. Area-level tobacco consumption may capture cases’ direct use and second hand smoke exposure, but also may identify neighborhoods with excess cancer-related behavioral or environmental exposures, beyond those measured by social class. Given the growing global burden of both tobacco addiction and aggressive breast cancer, similar investigations across diverse geographic areas are warranted. (Source: Epidemiologic Perspectives and Innovations)

Juvenile Sex and Non‐Sex Offenders: A Comparison of Recidivism and Risk

MedWorm Addiction Feeds - March 31, 2015 - 7:00pm
Forty male juvenile sex offenders were compared with 133 male juvenile non‐sex offenders 2 years postrelease from residential treatment to assess recidivism and factors related to recidivism. Juvenile sex offenders had significantly lower recidivism rates than juvenile non‐sex offenders. (Source: Journal of Addictions and Offender Counseling)

Pilot Testing of an Online Training for Criminal Justice Professionals on Medication‐Assisted Treatment

MedWorm Addiction Feeds - March 31, 2015 - 7:00pm
This article supports the efficacy of an online MAT training for criminal justice stakeholders. (Source: Journal of Addictions and Offender Counseling)

Career Counseling With Juvenile Offenders: Effects on Self‐Efficacy and Career Maturity

MedWorm Addiction Feeds - March 31, 2015 - 7:00pm
This study investigated the effect of career counseling on a juvenile offender population (N = 22). Results indicated the intervention produced significantly higher levels of career maturity and self‐efficacy for the treatment group compared with a control group. (Source: Journal of Addictions and Offender Counseling)

Grief and Recovery: The Prevalence of Grief and Loss in Substance Abuse Treatment

MedWorm Addiction Feeds - March 31, 2015 - 7:00pm
This study identified losses that clients encountered prior to abusing substances, losses that occurred as a result of addiction, and losses that occurred upon entering treatment. (Source: Journal of Addictions and Offender Counseling)

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Pavlovian‐to‐instrumental transfer effects in the nucleus accumbens relate to relapse in alcohol dependence

MedWorm Addiction Feeds - March 31, 2015 - 7:00pm
Abstract In detoxified alcohol‐dependent patients, alcohol‐related stimuli can promote relapse. However, to date, the mechanisms by which contextual stimuli promote relapse have not been elucidated in detail. One hypothesis is that such contextual stimuli directly stimulate the motivation to drink via associated brain regions like the ventral striatum and thus promote alcohol seeking, intake and relapse. Pavlovian‐to‐Instrumental‐Transfer (PIT) may be one of those behavioral phenomena contributing to relapse, capturing how Pavlovian conditioned (contextual) cues determine instrumental behavior (e.g. alcohol seeking and intake). We used a PIT paradigm during functional magnetic resonance imaging to examine the effects of classically conditioned Pavlovian stimuli on instrumental ch...

Alcohol‐Preferring P Rats Emit Spontaneous 22‐28 kHz Ultrasonic Vocalizations that are Altered by Acute and Chronic Alcohol Experience

MedWorm Addiction Feeds - March 31, 2015 - 7:00pm
ConclusionsOur findings demonstrate that acute and chronic effects of alcohol exposure are reflected in changes in 22‐28 and 50‐55 kHz FM USV counts and acoustic patterns. These data support the notion that initiation and maintenance of alcohol intake in P rats may be due to a unique, alcohol‐responsive emotional phenotype and further suggest that spontaneous 22‐28 kHz USVs serve as behavioral markers for excessive drinking vulnerability. (Source: Alcoholism: Clinical and Experimental Research)

Self‐Reported Risk‐Taking Behavior During Matched‐Frequency Sessions of Alcohol Versus Combined Alcohol and Energy Drinks Consumption: Does Co‐Ingestion Increase Risk‐Taking?

MedWorm Addiction Feeds - March 31, 2015 - 7:00pm
ConclusionsBivariate analyses from a matched‐frequency sample align with past research showing lower odds of risk‐taking behavior after AmED versus alcohol consumption for the same individuals. Multivariate analyses showed that risk‐taking in alcohol sessions had the strongest association with risk‐taking in AmED sessions. However, hypotheses of increased risk‐taking post‐AmED consumption were partly supported: Greater ED intake was associated with increased likelihood of specific behaviors, including drink‐driving, sexual behavior, and aggressive behaviors in the matched‐frequency sample after controlling for alcohol intake and risk‐taking in alcohol sessions. These findings highlight the need to consider both personal characteristics and beverage effects in harm reducti...

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Steady‐State Metabolism of Ethanol in Perfused Rat Livers Treated with Cyanamide: Quantitative Analysis of Acetaldehyde Effects on the Metabolic Flux Rates

MedWorm Addiction Feeds - March 31, 2015 - 7:00pm
ConclusionsOur results provide the first flux evidence that ADH and ALDH are steps influencing steady‐state metabolism of ethanol in rat livers with inactivated ALDHs. (Source: Alcoholism: Clinical and Experimental Research)

A Pilot Trial of Prazosin, an Alpha‐1 Adrenergic Antagonist, for Comorbid Alcohol Dependence and Posttraumatic Stress Disorder

MedWorm Addiction Feeds - March 31, 2015 - 7:00pm
ConclusionsConsistent with the extant research evaluating medications for comorbid PTSD/AD, the current evaluation of prazosin also found decreased alcohol consumption but no medication effect on PTSD symptomatology. (Source: Alcoholism: Clinical and Experimental Research)

Impulsive Choice Predicts Anxiety‐Like Behavior, but not Alcohol or Sucrose Consumption, in Male Long‐Evans Rats

MedWorm Addiction Feeds - March 31, 2015 - 7:00pm
ConclusionsAlthough impulsive choice and alcohol consumption appear to share some variance with anxiety‐like behavior, the present data offer no support for a relation between impulsive choice and alcohol consumption in Long‐Evans rats. Together with mixed rodent data from prior reports, these findings attenuate cross‐species comparisons to human relations between impulsive choice and alcohol use disorders. (Source: Alcoholism: Clinical and Experimental Research)

Novus Medical Detox Center Highlights Survey Findings: More Americans...

MedWorm Addiction Feeds - March 31, 2015 - 3:25pm
While many healthcare professionals continue to advocate in favor of methadone treatment for heroin addiction, a new survey reveals that half of Americans agree with Novus Medical Detox Center that...(PRWeb March 31, 2015)Read the full story at http://www.prweb.com/releases/2015/03/prweb12614654.htm (Source: PRWeb: Medical Pharmaceuticals)

Letter to the Editor

MedWorm Addiction Feeds - March 31, 2015 - 1:56pm
The homeless patient who malingers suicidality on an icy, snowy night to achieve shelter. The hallucinator who feigns auditory persecutions to achieve numbing medications. The borderline who seeks attention, of any kind, at all costs. The addict who grows desperate as his funds are dwindling and the tremors begin. (Source: The Journal for Nurse Practitioners)

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