Poster 388 Improvement in Pain Control in Complex Regional Pain Syndrome Treated with Buprenorphine Patch and Topical Compounding Cream Containing Ketamine and Clonidine: A Case Series.

Pub Med: Keyword Buprenorphine - 5 hours 11 min ago

Poster 388 Improvement in Pain Control in Complex Regional Pain Syndrome Treated with Buprenorphine Patch and Topical Compounding Cream Containing Ketamine and Clonidine: A Case Series.

PM R. 2016 Sep;8(9S):S287

Authors: Kent RE, Kent Z, Hannah JQ, Ksaibati T

PMID: 27673139 [PubMed - as supplied by publisher]

Corrigendum to "A randomized trial of intensive outpatient (IOP) vs. standard outpatient (OP) buprenorphine treatment for African Americans" [Drug Alcohol Depend. 128 (2013) 222-229].

Pub Med: Keyword Buprenorphine - September 27, 2016 - 6:03am

Corrigendum to "A randomized trial of intensive outpatient (IOP) vs. standard outpatient (OP) buprenorphine treatment for African Americans" [Drug Alcohol Depend. 128 (2013) 222-229].

Drug Alcohol Depend. 2016 Sep 22;

Authors: Mitchell SG, Gryczynski J, Schwartz RP, O'Grady KE, Olsen YK, Jaffe JH

PMID: 27665675 [PubMed - as supplied by publisher]

Evaluation of buprenorphine hydrochloride Pluronic(®) gel formulation in male C57BL/6NCrl mice.

Pub Med: Keyword Buprenorphine - September 23, 2016 - 6:44am
Related Articles

Evaluation of buprenorphine hydrochloride Pluronic(®) gel formulation in male C57BL/6NCrl mice.

Lab Anim (NY). 2016 Sep 21;45(10):370-9

Authors: Blankenship-Paris TL, Dutton JW, Goulding DR, McGee CA, Kissling GE, Myers PH

Abstract
Providing adequate analgesia while minimizing handling and stress post-surgery can be challenging. Recently, there have been commercial products made available for providing long acting analgesia in rodents. However, we find there are limitations for use in mice due to the viscosity of the product and the small dosing volumes needed. This project evaluated an in-house compounded formulation of buprenorphine easily made in the laboratory using pharmaceutical grade products. The release of buprenorphine was evaluated when compounded with two types of hydrogels (Pluronic(®) F-127 and F-68). Mice given buprenorphine in hydrogel (BP) demonstrated higher serum levels of buprenorphine for a longer period of time compared to mice given standard buprenorphine (Bup). However, the rate of decline in serum levels between the groups was similar; thus, it is more likely that the higher buprenorphine concentration seen in the BP group is due to the higher dose of buprenorphine given, rather than a slower release of product. Feed consumption was decreased in both groups one day after dosing; however, there was no difference in body weights. Increased activity in the open field was observed with both buprenorphine formulations, and lipemia was observed in mice given BP which persisted to at least 96 h. Based on our results, we conclude that this formulation did not sustain the release of buprenorphine or eliminate the increased activity commonly seen in mice given buprenorphine. In addition, the lipemia may confound research parameters, especially in cardiac studies and lipid metabolism studies. Therefore, we cannot recommend this formulation for use.

PMID: 27654688 [PubMed - in process]

Physician Capacity to Treat Opioid Use Disorder With Buprenorphine-Assisted Treatment.

Pub Med: Keyword Buprenorphine - September 23, 2016 - 6:44am
Related Articles

Physician Capacity to Treat Opioid Use Disorder With Buprenorphine-Assisted Treatment.

JAMA. 2016 Sep 20;316(11):1211-1212

Authors: Stein BD, Sorbero M, Dick AW, Pacula RL, Burns RM, Gordon AJ

PMID: 27654608 [PubMed - as supplied by publisher]

Buprenorphine/Naloxone Versus Methadone for the Treatment of Opioid Dependence: A Review of Comparative Clinical Effectiveness, Cost-Effectiveness and Guidelines

Pub Med: Keyword Buprenorphine - September 23, 2016 - 6:44am
Related Articles

Buprenorphine/Naloxone Versus Methadone for the Treatment of Opioid Dependence: A Review of Comparative Clinical Effectiveness, Cost-Effectiveness and Guidelines

Book. 2016 09 02

Authors:

Abstract
In 2013, Suboxone (buprenorphine/naloxone) became available as a generic and its direct cost, and cost differential with methadone, decreased. Buprenorphine/naloxone has several advantages compared with methadone. Methadone is a full agonist; there is no ceiling to respiratory depression or sedation effects and an overdose can be fatal. Buprenorphine also has a long half-life but because it is a partial agonist, it has a ceiling effect (effect plateaus at higher doses) and thus the risk of overdose is decreased. Other advantages of buprenorphine/naloxone include its long duration of action which allows for every second day dosing if needed; its administration as a sublingual tablet; its lack of requirements of an exemption to be prescribed; and its formulation with less potential for abuse. Given the foregoing, an assessment is required to assist decision-makers and prescribers in selecting between the two treatments. Hence, the purpose of this review is to provide evidence on the comparative clinical effectiveness and cost-effectiveness of buprenorphine/naloxone compared with methadone, for the treatment of patients with opioid use disorder. Clinical practice guidelines will also be examined.


PMID: 27656728

No evidence of potentiation of buprenorphine by milnacipran in healthy subjects using a nociceptive test battery.

Pub Med: Keyword Buprenorphine - September 22, 2016 - 6:42am

No evidence of potentiation of buprenorphine by milnacipran in healthy subjects using a nociceptive test battery.

Eur J Pain. 2016 Sep 21;

Authors: Okkerse P, Alvarez-Jimenez R, Hay JL, Tehim A, Kumar R, de Kam ML, Groeneveld GJ

Abstract
BACKGROUND: Serotonin-norepinephrine reuptake inhibitors inhibit the reuptake of serotonin and noradrenalin and are used in the treatment of neuropathic pain. Animal studies suggest that milnacipran co-administered with opioids may potentiate the analgesic effect of μ-opioid receptor agonists. This study hypothesized that co-administration of milnacipran and buprenorphine would have a synergistic effect in evoked pain models in healthy subjects.
METHODS: This was a randomized double-blinded, placebo-controlled, four-way cross-over, multiple dose clinical trial to investigate the analgesic effects of buprenorphine (placebo, 0.5, 1 and 3 μg/kg) in combination with milnacipran (placebo, 25 and 50 mg) in healthy subjects.
RESULTS: 11 healthy men were enrolled in the study. Buprenorphine alone showed a dose-response relationship indicative of anti-nociception in the pain tests. Following milnacipran administration, no changes were seen in the pharmacodynamic measurements for pain, psychomotor function, body stability or eye movements. For the electrical tests, cold pressor test and pressure pain test, buprenorphine alone was superior when compared with buprenorphine plus milnacipran. No differences in pharmacodynamic variables, besides an increase in pupil/iris ratio, were observed after repeated administration of milnacipran 50 mg. Single and multiple doses of 25 or 50 mg milnacipran did not further potentiate the anti-nociceptive effects of buprenorphine.
CONCLUSIONS: Buprenorphine showed dose-dependent effects consistent with its pharmacological profile. Milnacipran alone did not affect any of the pain variables. The combination of both buprenorphine and milnacipran did not potentiate or show a synergistic effect on the pain models used in this study.
SIGNIFICANCE: Buprenorphine is known to be a potent opioid agonist. Animal studies suggest that milnacipran co-administered with opioids may potentiate the analgesic effect of μ-opioid receptor agonists. Here, we found that buprenorphine showed a dose-dependent analgesic effect, but that no potentiation or synergy on a battery of evoked pain tasks could be observed after co-administration of both milnacipran and buprenorphine.

PMID: 27651026 [PubMed - as supplied by publisher]

Pharmacokinetics of liposomal encapsulated buprenorphine suspension following subcutaneous administration to cats.

Pub Med: Keyword Buprenorphine - September 21, 2016 - 6:36am

Pharmacokinetics of liposomal encapsulated buprenorphine suspension following subcutaneous administration to cats.

J Vet Pharmacol Ther. 2016 Sep 20;

Authors: Johnson RJ, Kerr CL, Enouri SS, Modi P, Lascelles BD, Del Castillo JR

Abstract
We investigated the effects of liposome encapsulation at prolonging the systemic exposure of buprenorphine following subcutaneous administration in cats. Seven healthy male cats were dosed intravenously with 0.02 mg/kg buprenorphine solution (STD-BUP), followed 14 days later by a subcutaneous injection of 0.2 mg/kg buprenorphine as a liposomal suspension (SUS-BUP) containing drug molecules both in liposomes and the suspending vehicle. Buprenorphine time plasma concentration data for both dosing routes were analyzed simultaneously with four compartmental models. Goodness of fit was assessed both graphically and with the Akaike information criterion. The time-course of intravenous STD-BUP was biphasic, with a 4.39 h average terminal half-life. The subcutaneous SUS-BUP produced plasma buprenorphine concentrations above 0.5 μg/L for more than 96 h, with three distinct peaks in the first 15 h. The model with best fit comprised a central and a peripheral compartment, plus three subcutaneous absorption compartments: one of dissolved drug molecules that were absorbed through a first-order process, and two of liposome-encapsulated drug molecules that were transferred to the solution compartment through separate zero-order processes. Liposomes effectively prolonged the systemic exposure of buprenorphine in cats.

PMID: 27647259 [PubMed - as supplied by publisher]

Too much or never enough: a response to Treatment of opioid disorders in Canada: looking at the 'other epidemic'.

Pub Med: Keyword Buprenorphine - September 21, 2016 - 6:36am

Too much or never enough: a response to Treatment of opioid disorders in Canada: looking at the 'other epidemic'.

Subst Abuse Treat Prev Policy. 2016;11(1):33

Authors: Eibl JK, Morin-Taus KA, Marsh DC

Abstract
Prescription opioid (PO) misuse is a major health concern across North America, and it is the primary cause of preventable death for the 18-35 year old demographic. Medication assisted therapy including methadone and buprenorphine, is the standard of care for patients with opioid-dependence. Moreover, both of these medications are recognized as essential medicines by World Health Organization. In Ontario Canada, the availability of medication assisted therapy has expanded substantially, with almost a ten-fold increase number of patients accessing methadone in Ontario in the past decade. In their manuscript, Fischer et. al. (2016), present a view that expansion of opioid maintenance therapy (OMT) has outpaced true patient need and alternate strategies should be considered as first-line treatments. Here, we present a countering perspective-that medication assisted therapy, along with other harm reduction strategies, should be widely available to all opioid-dependent people as first-line treatments.

PMID: 27646674 [PubMed - as supplied by publisher]

Pharmacotherapy for Neonatal Abstinence Syndrome: Choosing the Right Opioid or No Opioid at All.

Pub Med: Keyword Buprenorphine - September 17, 2016 - 6:32am

Pharmacotherapy for Neonatal Abstinence Syndrome: Choosing the Right Opioid or No Opioid at All.

Neonatal Netw. 2016;35(5):314-320

Authors: McPherson C

Abstract
Neonatal abstinence syndrome (NAS) from in utero opioid exposure has reached epidemic levels in the United States. Although nonpharmacologic therapies form the foundation of care, many neonates require pharmacotherapy. Morphine represents the most widely used first-line agent and effectively treats the symptoms of withdrawal. However, methadone or buprenorphine may facilitate earlier discharge. Although phenobarbital is traditionally used when opioids fail, clonidine may be a more appropriate adjunctive agent to minimize negative neurodevelopmental impact. Consideration of the available data allows hospitals to generate effective pharmacologic strategies to manage NAS while further research continues.

PMID: 27636696 [PubMed - as supplied by publisher]

Impact of early childhood trauma on retention and phase advancement in an outpatient buprenorphine treatment program.

Pub Med: Keyword Buprenorphine - September 16, 2016 - 6:53am

Impact of early childhood trauma on retention and phase advancement in an outpatient buprenorphine treatment program.

Am J Addict. 2016 Sep 15;

Authors: Kumar N, Stowe ZN, Han X, Mancino MJ

Abstract
BACKGROUND: Early adverse life events such as childhood trauma have been linked to development of substance use disorders. The prevalence and impact on treatment of early childhood trauma in opioid-dependent individuals has received limited research attention. The present study examined reported childhood trauma and its relation to retention and adherence in an outpatient buprenorphine treatment program.
METHODS: Medical records of individuals who completed childhood trauma questionnaire (CTQ) were reviewed to extract baseline data and demographics (N = 113). Total and subscale CTQ scores were dichotomized to low versus moderate-severe levels of trauma. Treatment course evaluation was based on successful phase advancement and retention in treatment during the first 90 days. Logistic regression models were used to examine associations between CTQ subscales and total score and the two outcomes adjusting for covariates.
RESULTS: Moderate-severe trauma defined by total CTQ score was present in 16% of participants. Logistic regression models showed significant associations between physical and emotional neglect and drop out after adjusting for covariates. Individuals who had never married and those with positive admission urine drug screen for opiates associated significantly with drop out.
CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: The results from a convenience sample participating in a university-based buprenorphine treatment program demonstrated significant association between self-reported early childhood trauma and retention during the first 90 days. These findings suggest that addressing early trauma could potentially improve adherence rates leading to reduced disease burden. This study extends the knowledge base on potential predictive factors associated with successful participation in outpatient buprenorphine treatment. (Am J Addict 2016;XX:1-7).

PMID: 27629823 [PubMed - as supplied by publisher]

Intranasal opioid administration in rhesus monkeys: PET imaging and antinociception.

Pub Med: Keyword Buprenorphine - September 15, 2016 - 6:47am

Intranasal opioid administration in rhesus monkeys: PET imaging and antinociception.

J Pharmacol Exp Ther. 2016 Sep 13;

Authors: Saccone PA, Lindsey AM, Koeppe RA, Zelenock KA, Shao X, Sherman P, Quesada CA, Woods JH, Scott PJ

Abstract
The goal of this study was to evaluate the effects of intransally administered opioids in rhesus monkeys using the tail-withdrawal assay, and to correlate these effects with measures of receptor occupancy using positron emission tomography (PET) imaging. Initial experiments characterized the antinociceptive effects of intranasal (IN) fentanyl and buprenorphine relative to intramuscular (IM) injection. Fentanyl (0.010- 0.032 mg/kg) and buprenorphine (0.1-1.0 mg/kg) produced dose-dependent increases in tail-withdrawal latency that did not differ between routes of delivery. The second experiment compared the ability of IN and intravenous (IV) naloxone (NLX) to block the antinociceptive effects IV fentanyl, and to measure receptor occupancy at equipotent doses of NLX using PET imaging. IN and IV NLX (0.0032- 0.032 mg/kg) produced dose-dependent decreases in fentanyl-induced antinociception. Again, there was no difference observed in overall potency between routes. PET imaging showed that IV and IN NLX produced similar decreases in receptor occupancy as measured by [11C]carfentanil blocking, although there was a trend for IV NLX produce marginally greater occupancy changes. This study validated the first procedures to evaluate the IN effects of opioids in rhesus monkeys.

PMID: 27625351 [PubMed - as supplied by publisher]

Curious crosses: injection-induced lesions.

Pub Med: Keyword Buprenorphine - September 14, 2016 - 6:37am

Curious crosses: injection-induced lesions.

Am J Med. 2016 Sep 9;

Authors: Bhatt AS, Perkins S, McKinnon E, Perfect JR

PMID: 27619355 [PubMed - as supplied by publisher]

Correlates of Skin and Soft Tissue Infections in Injection Drug Users in a Syringe-Exchange Program in Malmö, Sweden.

Pub Med: Keyword Buprenorphine - September 14, 2016 - 6:37am
Related Articles

Correlates of Skin and Soft Tissue Infections in Injection Drug Users in a Syringe-Exchange Program in Malmö, Sweden.

Subst Use Misuse. 2015;50(12):1529-35

Authors: Dahlman D, Håkansson A, Björkman P, Blomé MA, Kral AH

Abstract
BACKGROUND: Injection drug users (IDUs) are at increased risk of various medical conditions, including bacterial skin and soft tissue infections (SSTIs). SSTIs, which are painful and can lead to life-threatening complications, are common but scarcely studied.
OBJECTIVES: To investigate life time, past 12 month and past 30-day prevalence for SSTI related to injection drug use, in IDUs at Malmö syringe exchange program (Malmö SEP). To investigate factors associated with having ever had an SSTI.
METHODS: IDUs were recruited from Malmö SEP (N = 80). They participated in a survey with questions about demographics, drug use, and experience of SSTIs. Factors independently associated with self-reported SSTI ever were assessed using logistic regression analysis.
RESULTS: The lifetime reported prevalence of SSTI was 58%, past 12 months 30%, and past 30 days 14%. Factors independently associated with SSTI ever were age (adjusted odds ratio [AOR] = 1.09; 95% confidence interval [CI] = 1.01-1.18), female sex (AOR = 6.75; 95% CI = 1.40-32.47), having ever injected prescribed drugs (AOR = 52.15; 95% CI = 5.17-525.67), and having ever injected in the neck (AOR = 8.08; 95% CI = 1.16-56.08).
CONCLUSIONS/IMPORTANCE: SSTI is common among IDUs in Malmö. Women and those injecting in the neck or injecting prescribed drugs (crushed tablets/liquids), are more likely to have had an SSTI.

PMID: 26583450 [PubMed - indexed for MEDLINE]

Three Complementary Approaches to Characterize Buprenorphine Misuse.

Pub Med: Keyword Buprenorphine - September 13, 2016 - 6:32am

Three Complementary Approaches to Characterize Buprenorphine Misuse.

Subst Use Misuse. 2016 Sep 12;:1-8

Authors: Eiden C, Nogue E, Diot C, Frauger E, Jouanjus E, Léglise Y, Picot MC, Peyriere H

Abstract
BACKGROUND: In France, buprenorphine has been available for opioid maintenance therapy since 1996 and since then its misuse has been continuously evaluated by the French health authorities.
OBJECTIVES: To characterize buprenorphine misuse in Languedoc-Roussillon (LR) region, using three different approaches.
METHODS: Three different data sources were analyzed : (i) spontaneous reports (NotS) of buprenorphine misuse or dependence, (ii) a specific periodic survey from specialized care centers (OPPIDUM) over 11 years (2002-2012) and (iii) a drug reimbursement database (DRB).
RESULTS: A total of 209 spontaneous reports were collected. The main type of buprenorphine misuse was use by an unintended route of administration. The main complications notified were directly related to the injection of buprenorphine. NotS enabled the collection of data about severe clinical complications or new diversion phenomenon. The OPPIDUM LR survey revealed a decrease in the buprenorphine misuse indicator through the study period. The DRB analysis identified one subgroup of patients with a buprenorphine deviant behavior, characterized by a significantly greater number of dispensing episodes, pharmacies, prescribers, daily dose and switch between buprenorphine forms (princeps and generic). The DRB analysis provides data on buprenorphine diversion in the context of outpatients care.
CONCLUSION: The three complementary approaches allowed us to characterize buprenorphine misuse in LR area. The three approaches are complementary because each data source provides different types of information.

PMID: 27617799 [PubMed - as supplied by publisher]

Mother-child interaction and cognitive development in children prenatally exposed to methadone or buprenorphine.

Pub Med: Keyword Buprenorphine - September 11, 2016 - 6:20am

Mother-child interaction and cognitive development in children prenatally exposed to methadone or buprenorphine.

Early Hum Dev. 2016 Sep 7;101:91-97

Authors: Konijnenberg C, Sarfi M, Melinder A

Abstract
OBJECTIVE: To assess the influence of mother-child interaction on children's cognitive development in a group of children prenatally exposed to methadone or buprenorphine.
STUDY DESIGN: The study is part of a prospective longitudinal project investigating the development of children born to women in opioid maintenance therapy (OMT). The sample includes 67 children born between 2005 and 2007, 35 of which prenatally exposed to either methadone or buprenorphine and 32 non-exposed comparison children.
RESULTS: Both groups scored within the normal range of development. However, the OMT group scored significantly lower on measures of cognitive development and mother-child interaction compared to the comparison group. Cognitive development was found to be affected by both group status, F(1,54)=5.65, p=0.02, η(2)=0.10 and mother-child interaction F(1,54)=5.26, p=0.03, η(2)=0.09. Behavioral inhibition (statue), sensorimotor function (imitating hand positions), and short-term memory (sentences) was influenced by group status while narrative memory and vocabulary were found to be more influenced by mother-child interaction.
CONCLUSIONS: Different risk factors may influence different cognitive functions in children of women in OMT. Specifically, language-related cognitive skills may be more related to mother-child interaction while performance in higher cognitive functions requiring precise control over sensorimotor responses may be more sensitive to other factors such as prenatal OMT exposure, genetics, and/or prenatal exposure to other substances.

PMID: 27614330 [PubMed - as supplied by publisher]

Evaluating the impact of a national naloxone programme on ambulance attendance at overdose incidents: a controlled time series analysis.

Pub Med: Keyword Buprenorphine - September 11, 2016 - 6:20am

Evaluating the impact of a national naloxone programme on ambulance attendance at overdose incidents: a controlled time series analysis.

Addiction. 2016 Sep 10;

Authors: McAuley A, Bouttell J, Barnsdale L, Mackay D, Lewsey J, Hunter C, Robinson M

Abstract
BACKGROUND AND AIMS: It has been suggested that distributing naloxone to people who inject drugs (PWID) will lead to fewer attendances by emergency medical services at opioid-related overdose incidents if peer administration of naloxone was perceived to have successfully resuscitated the overdose victim. This study evaluated the impact of a National Naloxone Programme (NNP) on ambulance attendance at opioid-related overdose incidents throughout Scotland. Specifically, we aimed to answer the following research questions: is there evidence of an association between ambulance callouts to opioid-related overdose incidents and the cumulative number of 'take-home naloxone' (THN) kits in issue?; is there evidence of an association between ambulance callouts to opioid-related overdose incidents in early adopter (pilot) or later adopting (non-pilot) regions and the cumulative number of THN kits issued in those areas?
DESIGN: Controlled time series analysis.
SETTING: Scotland, UK, 2008-2015.
PARTICIPANTS: Pre-NNP implementation period for the evaluation was defined as 1 April 2008 to 31 March 2011 and post-implementation period as 1 April 2011 to 31 March 2015. In total, 3721 ambulance attendances at opioid-related overdose were recorded for the pre-NNP implementation period across 158 weeks (mean 23.6 attendances per week) and 5258 attendances across 212 weeks in the post-implementation period (mean 24.8 attendances per week).
INTERVENTION: Scotland's NNP; formally implemented on 1 April 2011.
MEASUREMENTS: Primary outcome measure was weekly incidence (counts) of callouts to opioid-related overdoses at national and regional Health Board level. Data were acquired from the Scottish Ambulance Service (SAS). Models were adjusted for opioid replacement therapy using data acquired from Information Services Division on monthly sums of all dispensed methadone and buprenorphine in the study period. Models were further adjusted for a control group: weekly incidence (counts) of callouts to heroin-related overdose in the London Borough area acquired from London Ambulance Service.
FINDINGS: There was no significant association between SAS callouts to opioid-related overdose incidents and THN kits in issue for Scotland as a whole (coefficient 0.009, 95% Confidence Intervals (CIs): -0.01, 0.03, p = 0.39). In addition, the magnitude of association between THN kits and SAS callouts did not differ significantly between pilot and non-pilot regions (interaction test, p = 0.62).
CONCLUSIONS: The supply of take-home naloxone kits through a National Naloxone Programme in Scotland was not clearly associated with a decrease in ambulance attendance at opioid-related overdose incidents in the 4-year period after it was implemented in April 2011. This article is protected by copyright. All rights reserved.

PMID: 27614084 [PubMed - as supplied by publisher]

The CBHSQ Report

Pub Med: Keyword Buprenorphine - September 9, 2016 - 6:07am

The CBHSQ Report

Book. 2013

Authors:

Abstract
Background: Trend data between 2002 and 2012 show that the number of persons meeting the criteria for heroin dependence or abuse in 2012 was more than double that in 2002 (467,000 vs. 214,000), and the number of persons with pain reliever dependence or abuse rose from 1.4 million to 2.1 million between 2004 and 2012. Methadone, in use since 1964 for opioid dependence, may be dispensed only in federally approved opioid treatment programs (OTPs). Buprenorphine may be prescribed by physicians who obtain specialized training. Although OTPs are distinguished from other treatment programs because they offer medication-assisted therapy in general and methadone in particular, it is important to note that they also provide a wide variety of nonpharmacotherapies as well. Methods: The purpose of this report is to examine the similarities and differences in the types and range of services offered among outpatient-only facilities that operated OTPs and those that did not operate OTPs (non-OTP facilities). Outpatient-only facilities were selected because they account for the majority of treatment modalities overall and because outpatient-only treatment was provided by 88 percent of OTP facilities in 2012. Results: Of the 10,144 outpatient-only substance abuse treatment facilities in 2012, 10 percent (1,026 facilities) were OTPs. Compared with non-OTP facilities, OTP facilities provided fewer mental health disorder screenings (49 vs. 73%) and comprehensive mental health assessments (22 vs. 52%). Medications for psychiatric disorders were used by a smaller proportion of OTPs than non-OTPs (21 vs. 34%). OTPs had more than quadruple the percentages of testing services compared to non-OTPs for hepatitis C (61 vs. 13%) and hepatitis B (55 vs. 12%), and more than triple the percentage for HIV testing (59 vs. 16%). Conclusion: A larger proportion of OTP than non-OTP facilities offered opiate detoxification and discharge planning. Although screenings for mental health disorders, mental health assessments, and medications for psychiatric disorders were provided by a smaller proportion of OTP than non-OTP facilities, OTPs provided more educational and testing services for communicable diseases compared to non-OTPs. Over 90% of outpatient-only facilities used substance abuse counseling, and the majority of both types of facility also used relapse prevention. Over half of OTP facilities used motivational interviewing and cognitive behavioral therapy always or often, over a third used brief intervention, and over a quarter used contingency management and 12-step facilitation always or often.


PMID: 27606408

The CBHSQ Report

Pub Med: Keyword Buprenorphine - September 9, 2016 - 6:07am

The CBHSQ Report

Book. 2013

Authors:

Abstract
Background: An estimated 2 million people in the United States are dependent upon or abuse opioids, including heroin and prescription opioids such as oxycodone and hydrocodone. An effective treatment for opioid dependence and addiction includes medication-assisted treatment with the opioid medications methadone or buprenorphine, the only two opioids federally approved for the treatment of these conditions. Methods: Data from the 2011 National Survey of Substance Abuse Treatment Services (N-SSATS), an annual survey of all known substance abuse treatment (SAT) facilities, both public and private in the U.S., was analyzed. This report examines the trends in the use of methadone and buprenorphine in the treatment of opioid dependence at SAT; it includes data from Opioid Treatment Programs (OTPs) as well as facilities that did not have OTPs. It does not include data from private physicians who are not affiliated with a SAT program or facility. Results: The number of facilities with OTPs has remained constant at around 1,100 to 1,200 since 2003 (8 to 9% of all SAT facilities), the number of clients receiving methadone on the survey reference date March 31, 2011 increased from about 227,000 in 2003 to over 306,000 in 2011. The percentage of OTPs offering buprenorphine increased from 11% in 2003 to 51% in 2011; the percentage of facilities without OTPs offering buprenorphine increased from 5% in 2003 to 17% in 2011. The numbers of clients receiving buprenorphine increased between 2004 and 2011: at OTPs, from 727 clients in 2004 to 7,020 clients in 2011, and at facilities without OTPs, from 1,670 clients in 2004 to 25,656 clients in 2011. Conclusion: Methadone and buprenorphine are medications that permit addicted individuals to function normally within their families, jobs, and communities. While treatment with methadone is more established, it requires daily visits to an OTP. Not all individuals who could benefit from methadone treatment live within easy travelling distance of an OTP; the requirement for daily visits can interfere with jobs and other important activities. The introduction of buprenorphine for the treatment of opioid dependence has provided an alternative to methadone treatment for some opioid dependent persons. The dramatic increase in the number of clients receiving buprenorphine through SAT is an indication of the demand for safe and effective medications for the treatment of opioid addiction in the context of a broader treatment program.


PMID: 27606405

The CBHSQ Report

Pub Med: Keyword Buprenorphine - September 9, 2016 - 6:07am

The CBHSQ Report

Book. 2013

Authors:

Abstract
Background: Buprenorphine is a medication used to treat opioid addiction. A properly prescribed dose of buprenorphine can help opioid-addicted individuals to stop misusing opioids without experiencing withdrawal symptoms. Although buprenorphine is itself an opioid, and can thus have the same effects as other opioids (e.g., heroin, oxycodone), its maximum effects are less than those of other opioids. Therefore, with buprenorphine there is a decreased risk of abuse, addiction, and side effects compared with other opioids. Buprenorphine was approved for use in the United States for the treatment of opioid dependence in 2002. Methods: National estimates of Emergency Department (ED) visits involving buprenorphine were analyzed using data from the 2005 to 2011 Drug Abuse Warning Network (DAWN). The ED visits analyzed included nonmedical use, seeking detoxification/treatment services and adverse reactions involving buprenorphine. Results: ED visits involving buprenorphine increased substantially from an estimated 3,161 in 2005 to 30,135 visits in 2010 as availability of the drug increased. Buprenorphine-related ED visits involving nonmedical use of pharmaceuticals increased 255% from 2006 to 2010, with 4,440 visits to 15,778 visits, respectively. In 2010, 52% (15,778 visits) of buprenorphine-related ED visits were classified as nonmedical use of pharmaceuticals, 24% (7,372 visits) were by patients seeking detoxification or substance abuse treatment, and 13% (4,017 visits) were attributed to adverse reactions. In 2010, additional drugs were involved in 59% of buprenorphine-related ED visits involving nonmedical use of pharmaceuticals. Conclusion: Findings in this report show significant growth in the number of ED visits involving buprenorphine at the same time that there was an increase in its availability for treatment of opioid dependence. These data show that buprenorphine is sometimes used nonmedically, resulting in health events that require acute treatment in the ED. Buprenorphine use can be risky for individuals who are not opioid dependent because its effects are similar to other opioids (although usually more mild), leading to injuries and other health consequences. Additionally, dangerous effects can occur if buprenorphine is combined with certain other drugs, including benzodiazepines.


PMID: 27606401

High prevalence of constipation and reduced quality of life in opioid-dependent patients treated with opioid substitution treatments.

Pub Med: Keyword Buprenorphine - September 8, 2016 - 7:01am

High prevalence of constipation and reduced quality of life in opioid-dependent patients treated with opioid substitution treatments.

Expert Opin Pharmacother. 2016 Sep 7;

Authors: Lugoboni F, Mirijello A, Resentera C, Zamboni L, Faccini M, Casari R, Cossari A, Musi G, Bissoli G, Gasbarrini A, Quaglio G, Addolorato G, GICS

Abstract
OBJECTIVES: To evaluate prevalence and severity of constipation and quality of life (QoL) in a cohort of opioid-addicted patients treated with opioid substitution treatments.
RESEARCH DESIGN AND METHODS: Multicenter observational study. A total of 1057 heroin-dependent patients treated with methadone or buprenorphine were enrolled. Constipation was assessed by Wexner Constipation Scoring System, QoL by General Health Questionnaire (GHQ-12).
RESULTS: 38.5% patients reported mild constipation, 33.3% reported moderate constipation, 14.8% severe constipation and 5.1% very severe constipation. Mean Wexner CSS score was 6.6 ± 4.8. 44.9% patients showed a GHQ-12 score ≥14; of these 18.3% patients showed a GHQ-12 score ≥20. Mean GHQ score was 13.8 ± 6.5. Mean Wexner CSS score was significantly higher in methadone patients (p=0.004), in those taking psychoactive drugs (p=0.0001) and in female (p<0.0001) with respect to counterparts. Similarly, GHQ-12 mean scores were higher methadone group (p=0.003), in those taking psychoactive drugs (p<0.0001), and in female (p=0.039) with respect to counterparts. ANOVA and ANCOVA showed a significant influence of methadone and female gender on Wexner CSS score while psychoactive drugs significantly influenced both tests.
CONCLUSIONS: The present study shows that patients affected by opioid-dependence in OST with methadone and buprenorphine have a high prevalence of constipation and reduced QoL.

PMID: 27603712 [PubMed - as supplied by publisher]

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