DYNAMICS OF OPIOID SUBSTITUTION TREATMENTIN DIFFERENT INITIAL SUBSTANCE USER OPIOID DEPENDENT PATIENTS.

Pub Med: Keyword Buprenorphine - June 28, 2016 - 8:55am
Related Articles

DYNAMICS OF OPIOID SUBSTITUTION TREATMENTIN DIFFERENT INITIAL SUBSTANCE USER OPIOID DEPENDENT PATIENTS.

Georgian Med News. 2016 May;(254):56-61

Authors: Todadze K, Mosia S

Abstract
Injecting drug user size estimation studies carried out in 2009, 2012 and 2015 revealed growing trends of drug abuse in Georgia:estimated number of people who inject drugs (PWID) have been increased from 40000 and 45000 to 50000. Since Soviet period the most popular injective narcotics have been opioids: home-made opium, heroine, buprenorphine and home-made desomorphine ("Krokodile") replacing each other on the black market. Self-made desomorphine typically contains big amounts of different toxic substances and causes significant somatic disorders, especially skin, bone, blood infections, liver and kidney failure; is highly addictive, associates with frequent injections that enhance injecting-related harm, including the risk of HIV transmission, in comparison with typical opioids. The aim of the study was to determine the effectiveness of opioid substitution treatment (OST) on depression and anxiety in opioid dependent clients with history of different opioid substance use. 104 opioid drug users undergoing OST with intensive psychological counseling have been divided in 5 groups according to the principal opioid drug that was abused during past 6 months before starting treatment: heroine, desomorphine, illicit methadone injectors, illicit buprenorphine injectors, and multiple drug abusers consuming opioids as primary drugs. Level of depression (Beck Depression Inventory), anxiety (Spielberger Anxiety Inventory) as well as clinical symptoms, risky behavior, quality of life (WHO), and other data were measured before starting and after 3, 9, 15, 21 months of treatment. The illegal use of psychotropic-narcotics was checked through random urine-testing 1-2 times per patient per month. In all five groups remarkable decrease of depression and anxiety was observed in comparison with the starting data. Before inclusion desomorphine and poly-drug users had the highest scores of depression and anxiety while buprenorphine users manifested the lowest rate. Improvement of figures was observed in all groups in three month period that have been continuing during 21 month of treatment process. Study revealed normalization of scores forbothstatesin groups of heroine, desomorphine, methadone and buprenorphine users. The highest scores of depression and anxiety were observed in the group of poly-drug abusers andwhile depression rate hesitated in the range of clear "no-depression", anxiety index still remained close to the clinical important threshold after 21 month of treatment. Urine-testingon psychotropic-narcotic substances indicated remarkable decrease of illegal drug abuse in all studied groups in three month and although abuse of benzodiazepine drugs was highest in desomorphine and poly-drug abusers, the difference between groups was not statistically significant. Although some disparities have been observed in dynamics of subjects with different spectrum of initial opioid substance use, including homemade desomorphine, there is no significant difference between groups and OST effectively supports to improve depression and anxiety indices, and dramatically decreases use of illegal psychotropic-narcotic drugs during treatment. However poly-drug users seems to be the most resistant to achieve stabilization and require more treatment time and targeted interventions.

PMID: 27348169 [PubMed - as supplied by publisher]

Use and Misuse of Opioids in Maine: Results From Pharmacists, the Prescription Monitoring, and the Diversion Alert Programs.

Pub Med: Keyword Buprenorphine - June 25, 2016 - 6:55am

Use and Misuse of Opioids in Maine: Results From Pharmacists, the Prescription Monitoring, and the Diversion Alert Programs.

J Stud Alcohol Drugs. 2016 Jul;77(4):556-565

Authors: Piper BJ, Desrosiers CE, Lipovsky JW, Rodney MA, Baker RP, McCall KL, Nichols SD, Martin SL

Abstract
OBJECTIVE: Although opioids have substantial efficacy for acute pain management, escalation to opioid misuse and abuse is a persistent concern. This report assesses the current status of the opioid epidemic in Maine using three complementary data sets.
METHOD: A representative sample of pharmacists (N = 275) completed an online survey regarding the extent that opioids affected their practice. A county-level analysis of opioid prescriptions (N = 1.22 million) reported to the Maine Prescription Monitoring Program (M-PMP) in 2014 and the agents implicated in arrests as reported to the Maine Diversion Alert Program (DAP, N = 2,700) in 2014/15 also was completed.
RESULTS: A significantly greater number of pharmacists agreed that opioid misuse (85.9%), rather than diversion (76.8%) or access (54.2%), was a concern. Only half (56.2%) reported use of the M-PMP. Opioids were dispensed to 22.4% of residents (37.7% of women in their 80s). This was enough to supply everyone in Maine with a 16.1-day supply. Buprenorphine accounted for almost half of opioid prescriptions to young adults (46.3% women, 49.3% men). Arrests increased by 13.3% from 2014 to 2015, and the proportion of arrests that involved prescription opioids decreased while those involving stimulants and heroin were elevated.
CONCLUSIONS: Pharmacists are very aware of the potential for opioid misuse, but many do not consistently use the M-PMP. There continues to be substantial legitimate use, as well as criminal activity, involving oxycodone and other prescription opioids. Continued vigilance and use of tools like the PMP and DAP are necessary to minimize nonmedical use of opioids in Maine.

PMID: 27340958 [PubMed - as supplied by publisher]

Opioid Use Disorders.

Pub Med: Keyword Buprenorphine - June 25, 2016 - 6:55am

Opioid Use Disorders.

Child Adolesc Psychiatr Clin N Am. 2016 Jul;25(3):473-87

Authors: Sharma B, Bruner A, Barnett G, Fishman M

Abstract
Opioid use and addiction in adolescents and young adults is a health problem of epidemic proportions, with devastating consequences for youth and their families. Opioid overdose is a life-threatening emergency that should be treated with naloxone, and respiratory support if necessary. Overdose should always be an opportunity to initiate addiction treatment. Detoxification is often a necessary, but never sufficient, component of treatment for OUDs. Treatment for OUDs is effective but treatment capacity is alarmingly limited and under-developed. Emerging consensus supports the incorporation of relapse prevention medications such as buprenorphine and extended release naltrexone into comprehensive psychosocial treatment including counseling and family involvement.

PMID: 27338968 [PubMed - in process]

Key opioid prescription concerns in cancer patients: A nationwide study.

Pub Med: Keyword Buprenorphine - June 19, 2016 - 6:55am

Key opioid prescription concerns in cancer patients: A nationwide study.

Acta Anaesthesiol Taiwan. 2016 Jun 14;

Authors: Lin CP, Hsu CH, Fu WM, Chen HM, Lee YH, Lai MS, Shao YY

Abstract
BACKGROUND: Opioids are crucial in cancer pain management. We examined the nationwide prescription patterns of opioids in Taiwan cancer patients to find the potential concerns.
METHODS: We reviewed the claims database of the National Health Insurance of Taiwan for patients diagnosed with cancer from 2003 to 2011. The use and cost of analgesics were analyzed. Opioids were classified into recommended strong opioids (morphine and transdermal fentanyl), recommended weak opioids (tramadol, buprenorphine, and codeine), and unrecommended opioids (propoxyphene, nalbuphine, and meperidine).
RESULTS: We enrolled 1,424,048 patients with cancer, and ∼50% of them took analgesics. Among analgesic users, patients who used opioids increased from 48.2% in 2003 to 52.0% in 2010. Approximately 92% of the opioid use came from recommended opioids, either strong (51%) or weak opioids (41%). The ratio of the use of short-acting strong opioids to that of long-acting opioids increased from 0.41 in 2003 to 0.63 in 2011. Transdermal fentanyl accounted for > 50% of the use of strong opioids. Among weak opioids, the use of tramadol gradually increased to 71% in 2011. On average, opioids contributed to 0.79‰ of all medical expenditures and 2.94‰ of all medication costs.
CONCLUSION: The use of short-acting strong opioids increased during the study period. Instead of oral opioids, transdermal fentanyl was the most commonly used opioid among Taiwan cancer patients. The use of weak opioids, particularly tramadol, was high. These concerns should be the focus of pain management education.

PMID: 27317483 [PubMed - as supplied by publisher]

Satisfaction, Adherence and Health-Related Quality of Life with Transdermal Buprenorphine Compared with Oral Opioid Medications in the Usual Care of Osteoarthritis Pain.

Pub Med: Keyword Buprenorphine - June 18, 2016 - 6:55am

Satisfaction, Adherence and Health-Related Quality of Life with Transdermal Buprenorphine Compared with Oral Opioid Medications in the Usual Care of Osteoarthritis Pain.

Patient. 2016 Jun 17;

Authors: Conaghan PG, Serpell M, McSkimming P, Junor R, Dickerson S

Abstract
BACKGROUND: Osteoarthritis (OA) causes substantial pain and reduced health-related quality of life (HRQL). Although opioid analgesics are commonly used, the relative benefits of different opioids are poorly studied. Transdermal buprenorphine (TDB) offers an alternative to oral opioids for the treatment of moderate-to-severe chronic pain. This observational study of people with OA pain assessed satisfaction, HRQL and medication adherence.
METHODS: Patients in the UK with self-reported knee and/or hip OA who had been receiving one or more of TDB, co-codamol (an oral paracetamol/codeine combination) and tramadol for at least 1 month completed an online or telephone questionnaire. Medication satisfaction scores, HRQL scores (Short-Form 36 [SF-36]), medication adherence (Morisky Medication Adherence Scale [MMAS™]), adverse events and treatment discontinuations were recorded. Linear and logistic regression models were used to compare the treatment effect of TDB with co-codamol or tramadol.
RESULTS: Overall, 966 patients met the inclusion criteria; 701 were taking only one of the target medications (TDB: 85; co-codamol: 373; tramadol: 243). The largest age group was 50-59 years and 76.0 % of patients were female. The TDB group was younger, with more male patients, therefore the statistical models were adjusted for age and sex. Medication satisfaction scores were significantly higher in the TDB group than the other two groups (TDB vs. co-codamol: 3.56, 95 % confidence interval [CI] 1.90-6.68, p < 0.0001; TDB vs. tramadol: 3.22, 95 % CI 1.67-6.20, p = 0.0005). Physical Component Summary scores for HRQL and mean adherence were also higher in the TDB group, while Mental Component Summary HRQL scores were similar across the three groups.
CONCLUSIONS: Patients with knee and/or hip OA pain treated with TDB were more satisfied and more adherent with their medication, and reported higher Physical Component Summary HRQL scores than those treated with co-codamol or tramadol, although demographic differences were observed between groups.

PMID: 27314487 [PubMed - as supplied by publisher]

Transdermal Buprenorphine Relieves Neuropathic Pain: A Randomized, Double-Blind, Parallel-Group, Placebo-Controlled Trial in Diabetic Peripheral Neuropathic Pain.

Pub Med: Keyword Buprenorphine - June 18, 2016 - 6:55am

Transdermal Buprenorphine Relieves Neuropathic Pain: A Randomized, Double-Blind, Parallel-Group, Placebo-Controlled Trial in Diabetic Peripheral Neuropathic Pain.

Diabetes Care. 2016 Jun 16;

Authors: Simpson RW, Wlodarczyk JH

Abstract
OBJECTIVE: To evaluate the efficacy and safety of transdermal buprenorphine in patients with diabetic peripheral neuropathic pain (DPNP).
RESEARCH DESIGN AND METHODS: This multicenter, randomized, double-blind, placebo-controlled, parallel-group trial enrolled patients with type 1 or type 2 diabetes and stable glycemic control who had been experiencing moderate to severe DPNP for at least 6 months on maximal tolerated conventional therapy. Patients were randomly assigned to receive buprenorphine (5 μg/h) or placebo patches. The dose was titrated to effect to a maximum of 40 μg/h. Paracetamol was available as rescue analgesia. The severity of pain and other symptoms of DPNP were assessed daily in a patient diary and at clinic visits.
RESULTS: One hundred eight-six patients were enrolled, with 93 randomized to either buprenorphine or placebo. A high proportion of patients did not complete the study (buprenorphine 37 of 93, placebo 24 of 93). The main reason for premature withdrawal in the buprenorphine group was adverse events commonly due to untreated nausea and/or vomiting. Among the per-protocol population, more patients in the buprenorphine group (86.3%) experienced a 30% reduction in average versus baseline pain at week 12 than those in the placebo group (56.6%, P < 0.001). A nonsignificant trend favored the buprenorphine group within the intention-to-treat analysis of the same end point (51.7% vs. 41.3%, P = 0.175).
CONCLUSIONS: Transdermal buprenorphine, when tolerated, is an effective therapy for DPNP and provides another option to manage this challenging painful condition. Nausea and constipation need to be managed proactively to optimize treatment outcomes.

PMID: 27311495 [PubMed - as supplied by publisher]

Weighing the Risks and Benefits of Chronic Opioid Therapy.

Pub Med: Keyword Buprenorphine - June 16, 2016 - 6:55am

Weighing the Risks and Benefits of Chronic Opioid Therapy.

Am Fam Physician. 2016 Jun 15;93(12):982-990

Authors: Lembke A, Humphreys K, Newmark J

Abstract
Evidence supports the use of opioids for treating acute pain. However, the evidence is limited for the use of chronic opioid therapy for chronic pain. Furthermore, the risks of chronic therapy are significant and may outweigh any potential benefits. When considering chronic opioid therapy, physicians should weigh the risks against any possible benefits throughout the therapy, including assessing for the risks of opioid misuse, opioid use disorder, and overdose. When initiating opioid therapy, physicians should consider buprenorphine for patients at risk of opioid misuse, opioid use disorder, and overdose. If and when opioid misuse is detected, opioids do not necessarily need to be discontinued, but misuse should be noted on the problem list and interventions should be performed to change the patient's behavior. If aberrant behavior continues, opioid use disorder should be diagnosed and treated accordingly. When patients are discontinuing opioid therapy, the dosage should be decreased slowly, especially in those who have intolerable withdrawal. It is not unreasonable for discontinuation of chronic opioid therapy to take many months. Benzodiazepines should not be coprescribed during chronic opioid therapy or when tapering, because some patients may develop cross-dependence. For patients at risk of overdose, naloxone should be offered to the patient and to others who may be in a position to witness and reverse opioid overdose.

PMID: 27304767 [PubMed - as supplied by publisher]

One-Year Follow-Up of Heroin-Dependent Adolescents Treated with Buprenorfine/Naloxone for the First Time in a Substance Treatment Unit.

Pub Med: Keyword Buprenorphine - June 15, 2016 - 6:55am

One-Year Follow-Up of Heroin-Dependent Adolescents Treated with Buprenorfine/Naloxone for the First Time in a Substance Treatment Unit.

J Subst Abuse Treat. 2016 Aug;67:1-8

Authors: Mutlu C, Demirci AC, Yalcin O, Kilicoglu AG, Topal M, Karacetin G

PMID: 27296655 [PubMed - in process]

Psychometric assessment of the Neonatal Abstinence Scoring System and the MOTHER NAS Scale.

Pub Med: Keyword Buprenorphine - June 12, 2016 - 6:55am

Psychometric assessment of the Neonatal Abstinence Scoring System and the MOTHER NAS Scale.

Am J Addict. 2016 Jun 11;

Authors: Jones HE, Seashore C, Johnson E, Horton E, O'Grady KE, Andringa K, Grossman MR, Whalen B, Holmes AV

Abstract
BACKGROUND AND OBJECTIVES: The present study examined the psychometric characteristics of the Neonatal Abstinence Scoring System (NASS; "Finnegan Scale") and the MOTHER NAS Scale (MNS).
METHODS: Secondary analysis of data from 131 neonates from the Maternal Opioid Treatment: Human Experimental Research (MOTHER) study, a randomized trial in opioid-dependent pregnant women administered buprenorphine or methadone.
RESULTS: Both the NASS and MNS demonstrated poor psychometric properties, with internal consistency (Cronbach's αs) failing to exceed .62 at first administration, peak NAS score, and NAS treatment initiation.
CONCLUSIONS: Findings support the need for development of a NAS measure based on sound psychometric principles.
SCIENTIFIC SIGNIFICANCE: This study found that two frequently used measures of neonatal abstinence syndrome suffer inadequacies in regard to their basic measurement characteristics. (Am J Addict 2016;XX:1-4).

PMID: 27287965 [PubMed - as supplied by publisher]

Development, Implementation, and Evaluation of a Pilot Parenting Educational Intervention in a Pregnancy Buprenorphine Clinic.

Pub Med: Keyword Buprenorphine - June 12, 2016 - 6:55am

Development, Implementation, and Evaluation of a Pilot Parenting Educational Intervention in a Pregnancy Buprenorphine Clinic.

Nurs Womens Health. 2016 Jun-Jul;20(3):258-67

Authors: Giles AC, Ren D, Founds S

Abstract
We developed a pilot evidence-based prenatal educational intervention to increase knowledge of neonatal abstinence syndrome (NAS) and early parenting skills for women with opiate dependency who enrolled in a pregnancy buprenorphine clinic. We developed, implemented, and tested modules regarding expectations during newborn hospitalization for observation or treatment of NAS and regarding evidence-based parenting skills in response to NAS behaviors. Testing evaluated baseline knowledge of early parenting skills with newborns at risk for NAS and change from baseline after the educational intervention. No statistically significant difference in composite knowledge scores was observed. A brief survey completed by the participants postpartum affirmed the perception of women that the educational intervention effectively prepared them for the early postpartum period while their newborns were hospitalized.

PMID: 27287352 [PubMed - in process]

Intrathecal buprenorphine versus fentanyl as adjuvant to 0.75% ropivacaine in lower limb surgeries.

Pub Med: Keyword Buprenorphine - June 9, 2016 - 3:30pm

Intrathecal buprenorphine versus fentanyl as adjuvant to 0.75% ropivacaine in lower limb surgeries.

J Anaesthesiol Clin Pharmacol. 2016 Apr-Jun;32(2):229-233

Authors: Singh AP, Kaur R, Gupta R, Kumari A

Abstract
BACKGROUND AND AIMS: This study aims to compare the anesthesia characteristics between buprenorphine and fentanyl when added as an adjuvant to intrathecal ropivaciane in an attempt to prolong the duration of spinal anesthesia.
MATERIAL AND METHODS: The present prospective double-blind study was undertaken on ninety American Society of Anesthesiologist I and II patients between 18 and 60 years of age undergoing subarachnoid block for lower limb surgery. Group I (n = 30) patients were administered 3 ml of intrathecal solution (2.8 ml of 0.75% ropivacaine + 0.2 ml of isotonic sodium chloride), while Groups II and III patients (n = 30 each) received 2.8 ml 0.75% ropivacaine + 0.2 ml buprenorphine (60 μg) and 2.8 ml 0.75% ropivacaine + 0.2 ml fentanyl (10 μg), respectively. Following parameters were observed: Onset times and duration of sensory and motor block, time to first analgesic use, total dose of rescue analgesia, intra- and post-operative pain scores based on visual analog scale, sedation scores, hemodynamic parameters, and side effects if any. Data were analyzed by appropriate statistical tests and P < 0.05 were considered significant.
RESULTS: Time to onset of sensory and motor block in all the three groups was comparable. However, duration of sensory block was significantly prolonged in Groups II and III in comparison to Group I (P < 0.05) and it was the longest in Group II (P < 0.05). The duration of motor blockade was similar in all the three groups. The time to first analgesic dose was also significantly prolonged in Groups II and III as compared to Group I (P < 0.05) but was comparable between Groups II and III. Intra- and post-operative hemodynamic parameters, as well as side effects, were comparable.
CONCLUSION: Addition of buprenorphine and fentanyl as adjuvants to intrathecal 0.75% ropivacaine prolongs postoperative pain relief without causing any increase in the duration of motor blockade but buprenorphine is better as compared to fentanyl in prolonging the duration of sensory block and achieving a better outcome in terms of pain relief.

PMID: 27275055 [PubMed - as supplied by publisher]

Arrhythmia associated with buprenorphine and methadone reported to the Food and Drug Administration.

Pub Med: Keyword Buprenorphine - June 9, 2016 - 3:30pm

Arrhythmia associated with buprenorphine and methadone reported to the Food and Drug Administration.

Addiction. 2016 Jun 8;

Authors: Kao D, Haigney MC, Mehler PS, Krantz M

PMID: 27273759 [PubMed - as supplied by publisher]

Arrhythmia associated with buprenorphine and methadone reported to the Food and Drug Administration.

Pub Med: Keyword Buprenorphine - June 9, 2016 - 3:30pm

Arrhythmia associated with buprenorphine and methadone reported to the Food and Drug Administration.

Addiction. 2016 Jun 8;

Authors: Cataldo M

PMID: 27273625 [PubMed - as supplied by publisher]

Opioid agonist doses for oxycodone and morphine dependence: Findings from a retrospective case series.

Pub Med: Keyword Buprenorphine - June 9, 2016 - 3:30pm

Opioid agonist doses for oxycodone and morphine dependence: Findings from a retrospective case series.

Drug Alcohol Rev. 2016 Jun 7;

Authors: Nielsen S, Bruno R, Degenhardt L, Demirkol A, Lintzeris N

Abstract
INTRODUCTION: Use of opioid agonist treatments for prescription opioid (PO) dependence is rapidly increasing. Current guidelines are based on research with heroin users. This study aimed to examine methadone and buprenorphine dose requirements for PO-dependent people.
DESIGN AND METHODS: A retrospective case series of PO-dependent patients entering methadone and buprenorphine treatment. Daily oral morphine equivalent (OME) doses at baseline were calculated using standard dose conversion calculations. Dose conversion tables were used to estimate opioid agonist doses, based on starting dose of PO. Baseline methadone and buprenorphine dose at days 7 and 28 were examined. Linear models were fit to the data.
RESULTS: Participants (n = 44) were 67% male, mean age 41 years (SD 10 years); 69% reported a pain condition. The methadone group (n = 21) had a mean PO dose of 704.5 mg OME (SD 783.5 mg) prior to treatment, and mean methadone dose of 45.3 mg (SD 13.1 mg) at day 7 and 61.6 mg (SD 20.8 mg) at day 28. The buprenorphine group (n = 23) had a mean PO dose of 771.7 mg OME (SD 867.7 mg) prior to treatment, with a mean dose of 14.6 mg (SD 8.3 mg) at day 7 and 18.1 (SD 8.9 mg) at day 28. Linear relationships were not found between OME and opioid agonist dose.
CONCLUSIONS: Opioid agonist dosages varied substantially between individuals, and from predicted dosages based on dose conversion tables. Use of conversion tables to guide selection of opioid agonist dosage may compromise patient safety. [Nielsen S, Bruno R, Degenhardt L, Demirkol A, Lintzeris N. Opioid agonist doses for oxycodone and morphine dependence: Findings from a retrospective case series Drug Alcohol Rev 2016;00:000-00].

PMID: 27273511 [PubMed - as supplied by publisher]

Efficacy and Safety of a Sublingual Buprenorphine/Naloxone Rapidly Dissolving Tablet (BNX-RDT) for the Treatment of Adults With Opioid Dependence: A Randomized Trial.

Pub Med: Keyword Buprenorphine - June 9, 2016 - 3:30pm

Efficacy and Safety of a Sublingual Buprenorphine/Naloxone Rapidly Dissolving Tablet (BNX-RDT) for the Treatment of Adults With Opioid Dependence: A Randomized Trial.

J Addict Dis. 2016 Jun 7;:0

Authors: Webster L, Hjelmström P, Sumner M, Gunderson EW, 006 and 007 Study Investigators

Abstract
This prospective, randomized, active-controlled, non-inferiority study evaluated the efficacy and safety of a sublingual buprenorphine/naloxone rapidly dissolving tablet (Zubsolv®; BNX-RDT) versus generic buprenorphine for induction of opioid maintenance among dependent adults. The study, conducted at 13 sites from June 2013 to January 2014, included a 2-day blinded induction phase and a 27-day open-label stabilization/maintenance phase. During the blinded induction, patients received fixed doses of BNX-RDT or generic buprenorphine. During open-label stabilization/early maintenance, all patients received BNX-RDT. The primary efficacy assessment was treatment retention at day 3; BNX-RDT was considered non-inferior to generic buprenorphine if the lower limit of the 95% confidence interval (CI) for the difference between the treatments was ≥-10% in patients retained on day 3. Secondary assessments included opioid withdrawal symptoms and cravings as measured using the Clinical Opiate Withdrawal Scale (COWS), Subjective Opiate Withdrawal Scale (SOWS), and opioid cravings visual analogue scale (VAS), and safety. A total of 313 patients were randomly assigned to induction with generic buprenorphine or BNX-RDT. Mean age was 38.4 years, and mean duration of opioid dependence was 12.4 years. For the primary efficacy assessment, 235 of 256 patients (91.8%) were retained at day 3 and continued to the maintenance phase. The lower limit of the 95% CI was -13.7; thus, BNX-RDT was not non-inferior to generic buprenorphine, and significantly more patients who received induction with generic buprenorphine (122/128 [95.3%]) were retained at day 3 compared with those who received induction with BNX-RDT (113/128 [88.3%]; 95% CI: -13.7, -0.4; p = 0.040). Rates of clinical response, as measured by COWS, SOWS, and VAS, were comparable among patients regardless of induction medication. Treatment with BNX-RDT was generally safe and reduced severity of withdrawal symptoms and cravings.

PMID: 27267785 [PubMed - as supplied by publisher]

Initiation of strong prescription opioids in Australia: cohort characteristics and factors associated with the type of opioid initiated.

Pub Med: Keyword Buprenorphine - June 5, 2016 - 6:00am

Initiation of strong prescription opioids in Australia: cohort characteristics and factors associated with the type of opioid initiated.

Br J Clin Pharmacol. 2016 Jun 3;

Authors: Gisev N, Pearson SA, Blanch B, Larance B, Dobbins T, Larney S, Degenhardt L

Abstract
AIMS: To describe the characteristics of Australians initiating strong opioids and examine the factors associated with the type of opioid initiated.
METHODS: Pharmaceutical Benefits Scheme dispensing records were extracted for a 10% sample of people who initiated a strong opioid treatment episode (buprenorphine, fentanyl, hydromorphone, morphine, oxycodone) between 29 September 2009-31 December 2013, as evidenced by the absence of a strong opioid dispensing for at least 90 days. The cohort was restricted to people with complete medicines ascertainment. Socio-demographic characteristics, previous dispensing histories and index opioid use were examined. Multinomial logistic regression was used to calculate adjusted relative risk ratios (aRRRs) and 95% confidence intervals (CIs) to determine the factors associated with the type of opioid medicine initiated, relative to oxycodone.
RESULTS: The cohort consisted of 125,335 people: 58.3% were female and 63.7% were aged ≥65 years. The most commonly initiated strong opioid was oxycodone (72.8%), usually 5 mg immediate-release tablets (76.1%). Compared to people aged 18-44 years, those ≥85 years were 14.18 times as likely (95% CI 12.67-15.87) to initiate morphine than oxycodone. Compared to people without a cancer treatment history, those with a cancer treatment history were 2.34 times as likely (95% CI 2.11-2.60) to initiate morphine than oxycodone.
CONCLUSIONS: The most commonly initiated strong opioid was oxycodone, usually at lower strengths. Those who initiated oxycodone were more likely to be younger with no previous cancer treatment history. As these are high-risk characteristics for potential harms, a judicious approach when initiating strong opioids for this group is necessary.

PMID: 27260937 [PubMed - as supplied by publisher]

[Infectious and other somatic comorbidity in problem drug users - results of a cross-sectional study with medical examination].

Pub Med: Keyword Buprenorphine - June 2, 2016 - 6:30am

[Infectious and other somatic comorbidity in problem drug users - results of a cross-sectional study with medical examination].

Epidemiol Mikrobiol Imunol. 2016;65(1):56-62

Authors: Mravčík V, Florián Z, Nečas V, Štolfa J

Abstract
BACKGROUND: Problem drug use is associated with excess risk of infectious and other somatic diseases resulting mainly from injecting drug use.
MATERIAL AND METHODS: At the end of 2013, a complete medical history and physical examination was done in 40 problem drug users (30 males and 10 females), mean age 35.5 years (37.0 and 30.9, respectively), recruited in 4 low-threshold facilities in Prague. Of them, 37 were ex- or active injecting drug users, predominantly of methamphetamine (pervitin) and less often of buprenorphine.
RESULTS: The study physician rated the health status as -good or satisfactory in 35 participants and as unsatisfactory in five participants (12.5%). The most common pathologies were dental problems (36 participants, i.e. 90.0%) and skin conditions (15.0%). The most prevalent dental pathology was caries while dermatological disorders were mostly trophic skin lesions on the lower legs, including crural ulcers, and injection site infections. Gynaecological pathology was found in 2 of 10 females. The study subjects were most commonly diagnosed with chronic hepatitis C, status post hepatitis A and B, chronic caries, missing teeth, post-thrombotic swelling and trophic skin lesions on the lower legs, purulent skin lesions, and gastroduo-denal ulcer. A vast majority of the study participants were smokers. All were referred to various specialists for further examination or treatment, mostly to stomatology, hepatology, gastroenterology, and internal/general medicine departments. However, in reality the treatment participation rate is low among problem drug users due to the drug use-specific factors and needs that limit access to treatment.
CONCLUSION: The incidence of diverse somatic comorbidities requiring standard general medical care is significant among problem drug users. Infectious, dermatological, and dental pathologies are predominant. In areas with high prevalence of problem drug use, implementation of a special program should be considered to provide comprehensive medical care taking account of the special needs of this target group.

PMID: 27246646 [PubMed - in process]

Neonatal Abstinence Syndrome: Presentation and Treatment Considerations.

Pub Med: Keyword Buprenorphine - June 1, 2016 - 6:30am

Neonatal Abstinence Syndrome: Presentation and Treatment Considerations.

J Addict Med. 2016 May 27;

Authors: Jones HE, Kaltenbach K, Johnson E, Seashore C, Freeman E, Malloy E

Abstract
This clinical case conference discusses the treatment of a pregnant woman with opioid use disorder in a comprehensive care program that includes buprenorphine pharmacotherapy. The presentation summarizes common experiences that pregnant women who receive buprenorphine pharmacotherapy face, and also what their prenatally opioid-exposed children confront in the immediate postpartum period. It describes the elements of a successful comprehensive care model and corollary neonatal abstinence syndrome treatment regimen. Expert commentary is included on issues that arise in the buprenorphine induction and maintenance throughout the prenatal and postpartum periods and in the treatment of co-occurring mental health problems during both the prenatal and postpartum periods, particularly the treatment of depression. There is also expert commentary on the care of opioid-exposed neonates, with attention to the treatment for neonatal abstinence syndrome.

PMID: 27244045 [PubMed - as supplied by publisher]

Opioid dependency rehabilitation with the opioid maintenance treatment programme - a qualitative study from the clients' perspective.

Pub Med: Keyword Buprenorphine - June 1, 2016 - 6:30am
Related Articles

Opioid dependency rehabilitation with the opioid maintenance treatment programme - a qualitative study from the clients' perspective.

Subst Abuse Treat Prev Policy. 2015;10:35

Authors: Granerud A, Toft H

Abstract
BACKGROUND: Opioid maintenance treatment (OMT) is the most widely used treatment for opioid dependence. The opioid maintenance treatment (OMT) programme represents an opportunity for people who are opioid users to minimize the many negative health and societal outcomes associated with opioid use through meeting the physiological need of their bodies for opioids. The purpose of this study is to shed some light on how clients in the Norwegian OMT programme see their level of influence on their own treatment.
METHOD: It is a qualitative enquiry using semi-structured interviews of seven OMT clients living in various locations in Norway. The analysis of the material utilized a grounded theory-inspired approach.
RESULTS: This study show that the clients who were part of the OMT programme had better lives than people with untreated addictions did. However, the participants experienced having to play by the rules of the OMT programme if they wanted to have successful treatment. This resulted in varying degrees of dissatisfaction with the treatment.
CONCLUSIONS: The results indicated that the clients felt objectified and disenfranchised in the OMT programme, and points out the low level of influence on their own treatment felt by the OMT clients.

PMID: 26374128 [PubMed - indexed for MEDLINE]

Upper extremity nerve block: how can benefit, duration, and safety be improved? An update.

Pub Med: Keyword Buprenorphine - May 31, 2016 - 6:30am

Upper extremity nerve block: how can benefit, duration, and safety be improved? An update.

F1000Res. 2016;5

Authors: Brattwall M, Jildenstål P, Warrén Stomberg M, Jakobsson JG

Abstract
Upper extremity blocks are useful as both sole anaesthesia and/or a supplement to general anaesthesia and they further provide effective postoperative analgesia, reducing the need for opioid analgesics. There is without doubt a renewed interest among anaesthesiologists in the interscalene, supraclavicular, infraclavicular, and axillary plexus blocks with the increasing use of ultrasound guidance. The ultrasound-guided technique visualising the needle tip and solution injected reduces the risk of side effects, accidental intravascular injection, and possibly also trauma to surrounding tissues. The ultrasound technique has also reduced the volume needed in order to gain effective block. Still, single-shot plexus block, although it produces effective anaesthesia, has a limited duration of postoperative analgesia and a number of adjuncts have been tested in order to prolong analgesia duration. The addition of steroids, midazolam, clonidine, dexmedetomidine, and buprenorphine has been studied, all being off-label when administered by perineural injection, and the potential neurotoxicity needs further study. The use of perineural catheters is an effective option to improve and prolong the postoperative analgesic effect. Upper extremity plexus blocks have an obvious place as a sole anaesthetic technique or as a powerful complement to general anaesthesia, reducing the need for analgesics and hypnotics intraoperatively, and provide effective early postoperative pain relief. Continuous perineural infusion is an effective option to prolong the effects and improve postoperative quality.

PMID: 27239291 [PubMed]

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