Sleep-disordered breathing in patients with opioid use disorders in long-term maintenance on buprenorphine-naloxone: A case series.

Med Worm: Keyword Buprenorphine - August 28, 2015 - 6:56pm
CONCLUSION: Buprenorphine-naloxone maintenance treatment can be associated with sleep-disordered breathing. It can be difficult to differentiate the cause(s) of sleep-disordered breathing among the effects of buprenorphine-naloxone treatment itself, co-occurring conditions, such as obesity and cigarette smoking or other medications, or some combination thereof. Regardless of etiology, sleep-disordered breathing and its consequences present unique challenges to the patient in recovery from an opioid use disorder and therefore warrants careful evaluation and management. PMID: 26312963 [PubMed - as supplied by publisher] (Source: Journal of Opioid Management)

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Sleep-disordered breathing in patients with opioid use disorders in long-term maintenance on buprenorphine-naloxone: A case series.

MedWorm Addiction Feeds - August 28, 2015 - 6:56pm
CONCLUSION: Buprenorphine-naloxone maintenance treatment can be associated with sleep-disordered breathing. It can be difficult to differentiate the cause(s) of sleep-disordered breathing among the effects of buprenorphine-naloxone treatment itself, co-occurring conditions, such as obesity and cigarette smoking or other medications, or some combination thereof. Regardless of etiology, sleep-disordered breathing and its consequences present unique challenges to the patient in recovery from an opioid use disorder and therefore warrants careful evaluation and management. PMID: 26312963 [PubMed - as supplied by publisher] (Source: Journal of Opioid Management)

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Decreased responsiveness to oxycodone: A case of a pharmacokinetic drug interaction?

MedWorm Addiction Feeds - August 28, 2015 - 6:56pm
Authors: Pon D, Hwang J, Lo T, Zyl CV Abstract Concurrent administration of oxycodone and phenytoin may cause, through induction of CYP3A4 enzymes, decreased analgesic effects of oxycodone. However, no descriptions of this interaction exist. A patient who was on oxycodone for chronic back pain was admitted to the hospital. Five days after initiating fosphenytoin, the patient experienced a dramatic escalation in his pain and lack of response to oxycodone breakthrough doses. Changing oxycodone to hydromorphone resulted in significantly improved analgesia. Concurrent use of fosphenytoin and oxycodone may increase the conversion of oxycodone to inactive metabolites, resulting in decreased analgesia. This may be avoided using hydromorphone, morphine, or oxymorphone. PMID: 26312962 [...

12-Month safety and effectiveness of once-daily hydrocodone tablets formulated with abuse-deterrent properties in patients with moderate to severe chronic pain.

MedWorm Addiction Feeds - August 28, 2015 - 6:56pm
CONCLUSIONS: This long-term study demonstrated the safety and long-term maintenance of analgesic effect of HYD without continued need for dose increase. PMID: 26312961 [PubMed - as supplied by publisher] (Source: Journal of Opioid Management)

Impact of constipation on opioid therapy management among long-term opioid users, based on a patient survey.

MedWorm Addiction Feeds - August 28, 2015 - 6:56pm
CONCLUSIONS: Treating OIC effectively may help prevent inadequate pain management secondary to opioid therapy modification, help increase HRQoL, lessen OIC symptoms, decrease productivity loss, and improve adherence to opioid and OIC treatments. PMID: 26312960 [PubMed - as supplied by publisher] (Source: Journal of Opioid Management)

Triple dosing with high doses of buprenorphine: Withdrawal and plasma concentrations.

MedWorm Addiction Feeds - August 28, 2015 - 6:56pm
CONCLUSIONS: Administration of buprenorphine in three times the daily dose seems acceptable, also in the higher daily maintenance doses (here, 24 mg) used in many clinical settings. Two patients did not tolerate the regimen but, partly due to the outpatient setting, the reasons why are unclear. Further research should be of interest as high buprenorphine doses are becoming more common clinically. PMID: 26312959 [PubMed - as supplied by publisher] (Source: Journal of Opioid Management)

Opioid prescriptions before and after high-energy trauma.

MedWorm Addiction Feeds - August 28, 2015 - 6:56pm
CONCLUSIONS: The authors did not find any correlation between death by trauma and redemption of opioid prescriptions within the 6 months before the trauma. More severe traumas and especially severe traumas to the lower extremities were associated with redemption of opioid prescriptions after multitrauma. PMID: 26312958 [PubMed - as supplied by publisher] (Source: Journal of Opioid Management)

Pharmacoepidemiology of opiate use in the neonatal ICU: Increasing cumulative doses and iatrogenic opiate withdrawal.

MedWorm Addiction Feeds - August 28, 2015 - 6:56pm
Authors: Lewis T, Erfe BL, Ezell T, Gauda E Abstract OBJECTIVE: Neonatal intensive care unit (ICU) care involves use of opiates to treat postoperative, ventilated, or chronically ill infants. Opiates provide necessary analgesia and sedation, but the morbidities include prolonged neonatal abstinence syndrome (NAS) and extended length of stay for dose tapering. Our objective was to quantify trends in opiate exposure in a tertiary care NICU. The authors hypothesize that medical opiate exposure and resultant ICU-acquired NAS would increase over time. DESIGN: Retrospective cross-sectional cohort study. SETTING: Tertiary care NICU. PATIENTS: High-risk inborn infants admitted in fiscal years 2003-2004, 2007-2008, and 2010-2011. MAIN OUTCOME MEASURE: Average cumulative morp...

Duration of intrathecal morphine effect in children with idiopathic scoliosis undergoing posterior spinal fusion.

MedWorm Addiction Feeds - August 28, 2015 - 6:56pm
CONCLUSIONS: These data indicate that patients experienced improved analgesia for at least 12 hours following IT morphine. Increased use of adjuvant analgesics such as acetaminophen may reduce opioid requirements following PSF procedures. More studies are needed to investigate the combination of adjuvants and IT morphine to reduce postoperative pain in this population. PMID: 26312956 [PubMed - as supplied by publisher] (Source: Journal of Opioid Management)

Tramadol versus codeine/acetaminophen after pediatric tonsillectomy: A prospective, double-blinded, randomized controlled trial.

MedWorm Addiction Feeds - August 28, 2015 - 6:56pm
CONCLUSIONS: As part of multimodal analgesia, scheduled plus as-needed tramadol may be considered for children in the postoperative setting due to its analgesic properties, low potential for side effects, and good safety profile. PMID: 26312955 [PubMed - as supplied by publisher] (Source: Journal of Opioid Management)

Efficacy of Medications Approved for the Treatment of Alcohol Dependence and Alcohol Withdrawal Syndrome in Female Patients: A Descriptive Review

MedWorm Addiction Feeds - August 28, 2015 - 6:48pm
The aim of this study was to evaluate whether the number of women recruited for studies to establish the efficacy of medications approved for treatment of alcohol dependence (AD) and of alcohol withdrawal syndrome (AWS) is sufficient to reveal possible gender differences in the response to these medications and in suggesting the use of different doses in female patients. Our results show that the rates of women recruited for studies evaluating the efficacy of disulfiram (1%), benzodiazepines (3%), and anticonvulsants (13%) were too low to establish possible gender differences. The rates of women recruited for studies evaluating the efficacy of acamprosate (22%), naltrexone (23%), and nalmefene (30%) were higher and allowed evaluation of data obtained for female patients. Women receive medi...

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Brief in Person Interventions for Adolescents and Young Adults Following Alcohol-Related Events in Emergency Care: A Systematic Review and European Evidence Synthesis

MedWorm Addiction Feeds - August 28, 2015 - 6:48pm
Conclusion: Heterogeneity of study designs and effects limit conclusions on effectiveness of BIs for young ED patients following an alcohol-related event. However, the number of practice projects in Europe indicates a need perceived by practitioners to address this population.Eur Addict Res 2016;22:17-35 (Source: European Addiction Research)

Opioid Maintenance Treatment - A Call for a Joint European Quality Care Approach

MedWorm Addiction Feeds - August 28, 2015 - 6:48pm
Conclusion: Increasing awareness of potential shortcomings of OMT delivery systems is crucial to optimally match treatment approaches to patient needs and also to reduce the considerable economic burden of addiction to society.Eur Addict Res 2016;22:36-51 (Source: European Addiction Research)

Country Differences and Changes in Focus of Scientific Tobacco Control Publications between 2000 and 2012 in Europe

MedWorm Addiction Feeds - August 28, 2015 - 6:48pm
Conclusion: Research output had almost doubled, in line with global trends, but is still unevenly distributed across Europe. Although we observed a shift in European publications away from the harm of tobacco towards protecting smokers and changing the environment, the field is still dominated by publications on smoking and health.Eur Addict Res 2016;22:52-58 (Source: European Addiction Research)

Genetic variability of hepatitis B virus in Uruguay: D/F, A/F genotype recombinants

MedWorm Addiction Feeds - August 28, 2015 - 2:50pm
Abstract Hepatitis B virus (HBV) infection is a serious global health problem. Approximately 2 billion people worldwide have been infected, and approximately 350 million individuals currently suffer from HBV-induced chronic liver infection, which causes 600,000 deaths annually from chronic hepatitis, cirrhosis and hepatocellular carcinoma. HBV is classified in eight genotypes (A-H), and two more have been proposed (I-J). In this paper, complete genome sequences of nine Uruguayan HBV are reported. Five samples belong to genotype F1b and one to genotype A2. Three HBV recombinants were detected: A1/F1b, A2/F1b and D3/F1b. The following mutations were detected: a G1896A substitution, a 33-nucleotide deletion from position 2896 to 2928 in the Pre-S1 region involving Pre-S1 residues 3-...

Banging the drum over pay

MedWorm Addiction Feeds - August 28, 2015 - 11:51am
“Most of us are women, and lots of us are single parents, so it was a massive decision to go on strike”. It’s 8 o’clock on a Monday morning in Glasgow and Mary Docherty (pictured above) is banging a drum outside the city council chambers with around 30 of her colleagues. We’re at a rally of homelessness case workers employed by Glasgow City Council who are in their twelfth week of striking. They’re a small group outside the imposing building their employers occupy in George Square, but they’re making a lot of noise. The workers assess the housing needs of the city’s most vulnerable, supporting them to access emergency, temporary and permanent accommodation. They are striking because others employed by the council doing similar work are on a higher pay band and receive aroun...

Addiction pharmacogenetics: a systematic review of the genetic variation of the dopaminergic system

MedWorm Addiction Feeds - August 28, 2015 - 10:13am
Substance use disorders have significant personal, familial, and societal consequences. Despite the serious consequences of substance use, only a few therapies are effective in treating substance use disorders, thus highlighting a need for improved treatment practices. Substance use treatment response depends on multiple factors such as genetic, biological, and social factors. It is essential that each component is represented in treatment plans. The dopaminergic system plays a critical role in the pharmacotherapy for addictions, and an understanding of the role of variation of genes involved in this system is essential for its success. This review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement guidelines. A computerized literature search was co...

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The Mental Health and Life Satisfaction of Children of Drug Abusers in Wenzhou, China

MedWorm Addiction Feeds - August 28, 2015 - 9:05am
Abstract The spread of illegal drug use among adult caregivers of children raises many serious concerns. These concerns are intensified in situations in which drug-using adults are responsible for providing for the care, safety, and general well-being of the children under their care. The relative complexity of these situations is further compounded by the absence of rigorous scientific inquires into the mental health of children being raised in such situations. This survey utilized the Symptom Checklist-90 (SCL-90) to measure the mental health and life satisfaction of the children (aged 8 to 18 years) with at least one parent who is a drug abuser. The analysis results show that the psychological health of the children is poor and the mental health of the children affects their ...

Sleep-disordered breathing in patients with opioid use disorders in long-term maintenance on buprenorphine-naloxone: A case series.

Pub Med: Keyword Buprenorphine - August 28, 2015 - 6:55am
Related Articles

Sleep-disordered breathing in patients with opioid use disorders in long-term maintenance on buprenorphine-naloxone: A case series.

J Opioid Manag. 2015 Jul-Aug;11(4):363-366

Authors: DeVido J, Connery H, Hill KP

Abstract
BACKGROUND: Rates of opioid overdose deaths are increasing in the United States, leading to intensified efforts to provide medication-assisted treatments for opioid use disorders. It is not clear what effect opioid agonist treatments (ie, the µ-opioid receptor full agonist methadone and the partial agonist buprenorphine) may have on respiratory function. However, sleep-disordered breathing has been documented in methadone maintenance pharmacotherapy, and there is emerging evidence for similar sleep-disordered breathing in buprenorphine and buprenorphine-naloxone maintenance treatment.
OBJECTIVE: To provide further clinical evidence of sleep-disordered breathing emerging in the context of buprenorphine-naloxone maintenance pharmacotherapy.
METHODS: The authors report two additional cases of sleep-disordered breathing that developed in patients with severe opioid use disorders, treated successfully as outpatients with buprenorphine-naloxone maintenance. Both patients provided written consent for their clinical information to be included in this case report, and elements of their identities have been masked to provide confidentiality.
RESULTS: Two adult female patients, who were stable in buprenorphine-naloxone maintenance treatment developed daytime sleepiness, were referred for evaluation and found to have sleep-disordered breathing. One patient's daytime sleepiness improved with reduction in both buprenorphine-naloxone and other sedating medications as well as initiation of a constant positive airway pressure (CPAP) device. However, the other patient could not tolerate decreases in buprenorphine-naloxone and/or CPAP initiation and her daytime sleepiness persisted.
CONCLUSION: Buprenorphine-naloxone maintenance treatment can be associated with sleep-disordered breathing. It can be difficult to differentiate the cause(s) of sleep-disordered breathing among the effects of buprenorphine-naloxone treatment itself, co-occurring conditions, such as obesity and cigarette smoking or other medications, or some combination thereof. Regardless of etiology, sleep-disordered breathing and its consequences present unique challenges to the patient in recovery from an opioid use disorder and therefore warrants careful evaluation and management.

PMID: 26312963 [PubMed - as supplied by publisher]

Triple dosing with high doses of buprenorphine: Withdrawal and plasma concentrations.

Pub Med: Keyword Buprenorphine - August 28, 2015 - 6:55am
Related Articles

Triple dosing with high doses of buprenorphine: Withdrawal and plasma concentrations.

J Opioid Manag. 2015 Jul-Aug;11(4):319-324

Authors: Hvittfeldt E, Charlotte G, Fridolf I, Håkansson A

Abstract
BACKGROUND: In maintenance treatment for opiate addiction, buprenorphine can be administered less frequently than daily due to its long half-life.
OBJECTIVE: To examine the plasma concentration of buprenorphine and norbuprenorphine for 72 hours after a dose of 72 mg and to objectively and subjectively evaluate the correlations between concentrations and withdrawal levels.
METHODS: Patients in maintenance treatment with buprenorphine with a daily dose of 24 mg were given a triple dose of 72 mg (n = 9), in an outpatient setting. Blood samples were drawn, and withdrawal symptoms were evaluated objectively and subjectively every 24 hours over 72 hours. Urine and blood toxicology samples were obtained.
RESULTS: The triple dose was generally accepted well with low subjective and objective withdrawal scores. However, two patients aborted the study on day 3 and reported withdrawal symptoms. Benzodiazepine use was confirmed in one while the other likely used unauthorized buprenorphine.
CONCLUSIONS: Administration of buprenorphine in three times the daily dose seems acceptable, also in the higher daily maintenance doses (here, 24 mg) used in many clinical settings. Two patients did not tolerate the regimen but, partly due to the outpatient setting, the reasons why are unclear. Further research should be of interest as high buprenorphine doses are becoming more common clinically.

PMID: 26312959 [PubMed - as supplied by publisher]

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