Buprenorphine News Feed

Buprenorphine in treatment of opioid addiction: opportunities, challenges and strategies.

Pub Med: Keyword Buprenorphine - 9 hours 42 min ago

Buprenorphine in treatment of opioid addiction: opportunities, challenges and strategies.

Expert Opin Pharmacother. 2014 Aug 29;:1-13

Authors: Li X, Shorter D, Kosten TR

Abstract
Introduction: Buprenorphine follows the success of methadone as another milestone in the history of treatment for opioid addiction. Buprenorphine can be used in an office-based setting where it is clearly effective, highly accepted by patients and has a favorable safety profile and less abuse potential. However, the adoption of buprenorphine treatment has been slow in the USA. Areas covered: This article first reviews the history of medication-assisted opioid addiction treatment and the current epidemic opioid addiction, followed by a review of the efficacy, pharmacology and clinical prescription of buprenorphine in office-based care. We then explore the possible barriers in using buprenorphine and the ways to overcome these barriers, including new formulations, educational programs and policy regulations that strike a balance between accessibility and reducing diversion. Expert opinion: Buprenorphine can align addiction treatment with treatments for other chronic medical illnesses. However, preventing diversion will require graduate and continuing medical education and integrated care models for delivery of buprenorphine to those in need.

PMID: 25171726 [PubMed - as supplied by publisher]

A 'Missing Not at Random' (MNAR) and 'Missing at Random' (MAR) Growth Model Comparison with a Buprenorphine/Naloxone Clinical Trial.

Pub Med: Keyword Buprenorphine - 9 hours 42 min ago

A 'Missing Not at Random' (MNAR) and 'Missing at Random' (MAR) Growth Model Comparison with a Buprenorphine/Naloxone Clinical Trial.

Addiction. 2014 Aug 29;

Authors: McPherson S, Barbosa-Leiker C, Mamey MR, McDonell M, Enders CK, Roll J

Abstract
AIMS: To compare three missing data strategies: 1) Latent growth model that assumes the data are missing at random (MAR) model, 2) Diggle-Kenward missing not at random (MNAR) model where dropout is a function of previous/concurrent urinalysis (UA) submissions, and 3) Wu-Carroll MNAR model where dropout is a function of the growth factors.
DESIGN: Secondary data analysis of a National Drug Abuse Treatment Clinical Trials Network trial that examined a 7-day versus 28-day taper (i.e., stepwise decrease in buprenorphine/naloxone) on the likelihood of submitting an opioid-positive UA during treatment.
SETTING: 11 outpatient treatment settings in 10 US cities.
PARTICIPANTS: 516 opioid dependent participants.
MEASUREMENTS: Opioid UAs provided across the 4-week treatment period.
FINDINGS: The MAR model showed a significant effect (B=-0.45, p <0.05) of trial arm on the opioid-positive UA slope (i.e., 28-day taper participants were less likely to submit a positive UA over time) with a small effect size (d=0.20). The MNAR Diggle-Kenward model demonstrated a significant (B=-0.64, p<0.01) effect of trial arm on the slope with a large effect size (d=0.82). The MNAR Wu-Carroll model evidenced a significant (B=-0.41, p<0.05) effect of trial arm on the UA slope that was relatively small (d=0.31).
CONCLUSIONS: This performance comparison of three missing data strategies (latent growth model, Diggle-Kenward selection model, Wu-Carrol selection model) on sample data indicates a need for increased use of sensitivity analyses in clinical trial research. Given the potential sensitivity of the trial arm effect to missing data assumptions, it is critical for researchers to consider whether the assumptions associated with each model are defensible.

PMID: 25170740 [PubMed - as supplied by publisher]

Dosing considerations with transdermal formulations of fentanyl and buprenorphine for the treatment of cancer pain.

Pub Med: Keyword Buprenorphine - 9 hours 42 min ago

Dosing considerations with transdermal formulations of fentanyl and buprenorphine for the treatment of cancer pain.

J Pain Res. 2014;7:495-503

Authors: Skaer TL

Abstract
Opioids continue to be first-line pharmacotherapy for patients suffering from cancer pain. Unfortunately, subtherapeutic dosage prescribing of pain medications remains common, and many cancer patients continue to suffer and experience diminished quality of life. A large variety of therapeutic options are available for cancer pain patients. Analgesic pharmacotherapy is based on the patient's self-report of pain intensity and should be tailored to meet the requirements of each individual. Most, if not all, cancer pain patients will ultimately require modifications in their opioid pharmacotherapy. When changes in a patient's medication regimen are needed, adequate pain control is best maintained through appropriate dosage conversion, scheduling immediate release medication for withdrawal prevention, and providing as needed dosing for breakthrough pain. Transdermal opioids are noninvasive, cause less constipation and sedation when compared to oral opioids, and may improve patient compliance. A relative potency of 100:1 is recommended when converting the patient from oral morphine to transdermal fentanyl. Based on the limited data available, there is significant interpatient variability with transdermal buprenorphine and equipotency recommendations from oral morphine of 75:1-110:1 have been suggested. Cancer patients may require larger transdermal buprenorphine doses to control their pain and may respond better to a more aggressive 75-100:1 potency ratio. This review outlines the prescribing of transdermal fentanyl and transdermal buprenorphine including how to safely and effectively convert to and use them for those with cancer pain.

PMID: 25170278 [PubMed]

Prepubertal gonadectomy in cats: different injectable anaesthetic combinations and comparison with gonadectomy at traditional age.

Pub Med: Keyword Buprenorphine - 9 hours 42 min ago

Prepubertal gonadectomy in cats: different injectable anaesthetic combinations and comparison with gonadectomy at traditional age.

J Feline Med Surg. 2014 Aug 28;

Authors: Porters N, de Rooster H, Moons CP, Duchateau L, Goethals K, Bosmans T, Polis I

Abstract
Anaesthetic and analgesic effects of three different injectable anaesthetic combinations for prepubertal gonadectomy (PPG) in cats were studied. One anaesthetic protocol was compared with a similar one for gonadectomy at traditional age (TAG). Kittens were randomly assigned to PPG or TAG. For PPG, three different protocols were compared: (1) intramuscular (IM) administration of 60 μg/kg dexmedetomidine plus 20 μg/kg buprenorphine followed by an IM injection of the anaesthetic agent (20 mg/kg ketamine) (DB-IM protocol); (2) oral transmucosal (OTM) administration of 80 μg/kg dexmedetomidine plus 20 μg/kg buprenorphine followed by an IM injection of 20 mg/kg ketamine combined with 20 µg/kg dexmedetomidine (DB-OTM protocol); (3) IM injection of a 40 μg/kg medetomidine-20 μg/kg buprenorphine-20 mg/kg ketamine combination (MBK-IM protocol). For TAG, a DB-IM protocol was used, but with different doses for dexmedetomidine (40 μg/kg) and ketamine (5 mg/kg). All cats (PPG and TAG) received a non-steroidal anti-inflammatory before surgery. Anaesthetic and analgesic effects were assessed pre- and postoperatively (until 6 h). Cumulative logit, linear and logistic regression models were used for statistical analysis. Compared with the DB-OTM protocol, the DB-IM and MBK-IM protocols provided better anaesthesia with fewer adverse effects in PPG cats. Postoperative pain was not significantly different between anaesthetic protocols. PPG and TAG cats anaesthetised with the two DB-IM protocols differed significantly only for sedation and pain scores, but sedation and pain scores were generally low. Although there were no anaesthesia-related mortalities in the present study and all anaesthetic protocols for PPG in cats provided a surgical plane of anaesthesia and analgesia up to 6 h postoperatively, our findings were in favour of the intramuscular (DB-IM and MBK-IM) protocols.

PMID: 25170033 [PubMed - as supplied by publisher]

The latest achievements in the pharmacotherapy of gambling disorder.

MedWorm Addiction Feeds - August 29, 2014 - 3:50pm
Authors: Labuzek K, Beil S, Beil-Gawełczyk J, Gabryel B, Franik G, Okopień B Abstract Gambling disorder (GD) is becoming increasingly prevalent both among adults and adolescents. Unfortunately, this disorder is largely underestimated, while it can still lead to serious social and personal consequences, including criminal behavior or suicide attempts. In the past, the only means of treating gambling were psychobehavioral therapies. Nowadays, this disorder could also respond to many drugs from different classes such as opioid antagonists, serotonin selective reuptake inhibitors, mood stabilizers, atypical antipsychotics or glutamatergic agents. This review presents current pharmacological strategies and the results of clinical trials evaluating the efficacy of pharmacotherapy for G...

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Addicted veterans get second chance

MedWorm Addiction Feeds - August 29, 2014 - 3:31pm
Veterans treatment courts are helping former warriors who struggle with drug and alcohol addiction. (Source: CNN.com - Health)

I'm Not a Self-Hating Jew, I'm a Tribe-Unexceptionalist Jew

MedWorm Addiction Feeds - August 29, 2014 - 3:21pm
Jewish hawks label my kind "Self-Hating Jews but I love myself and my tribe. I'm just not putting ourselves above all other tribes, as the hawks seem to want to do.read more (Source: Psychology Today Addiction Center)

Not a Self-Hating Jew, A Tribe-Unexceptionalist One

MedWorm Addiction Feeds - August 29, 2014 - 3:21pm
Jewish hawks label my kind "Self-Hating Jews but I love myself and my tribe. I'm just not putting ourselves above all other tribes, as the hawks seem to want to do.read more (Source: Psychology Today Personality Center)

Familial factors associated with development of alcohol and mental health comorbidity

MedWorm Addiction Feeds - August 29, 2014 - 1:45pm
ConclusionsMaternal smoking and low mother‐child warmth appear to be related to alcohol, mental health and comorbid disorders at age 21, possibly via constituent alcohol and mental health disorders. Adolescent drinking and attention/thought problems appear to be associated with comorbid disorders but not with individual alcohol and mental health disorders. (Source: Addiction)

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Cell‐type‐specific tonic GABA signaling in the rat central amygdala is selectively altered by acute and chronic ethanol

MedWorm Addiction Feeds - August 29, 2014 - 1:45pm
Abstract The central nucleus of the amygdala (CeA) is an important site for the reinforcing effects of ethanol and has been implicated in the development of alcohol dependence. The CeA GABAA receptor system is particularly vulnerable to the effects of acute and chronic ethanol exposure. Previous work in the CeA focused on ethanol and phasic GABAA receptor signaling, but tonic GABAA receptor signaling in the rat CeA remains understudied. In the present study, we found that the CeA contains two types of tonic conductance that are expressed in a cell‐type‐specific manner. Low threshold bursting (LTB) and some regular spiking (RS) neurons have an ongoing tonic conductance that is mediated by the α1‐GABAA receptor subunit and is insensitive to acute ethanol exposure. Late spiking (LS) an...

Fears of addiction keep cancer patients from getting pain relief

MedWorm Addiction Feeds - August 29, 2014 - 1:22pm
NEW YORK (Reuters Health) – Fears of opioid abuse and addiction might be keeping patients with advanced cancer from getting enough pain medicine, researchers say. (Source: Reuters: Health)

FASD is not a Diagnosis

MedWorm Addiction Feeds - August 29, 2014 - 12:53pm
Too often we hear of a child who has been "diagnosed as FASD." Since there are no diagnostic criteria for FASD, the child is being labeled without due consideration of his clinical condition. read more (Source: Psychology Today Addiction Center)

A New Understanding of Compassionate Empathy

MedWorm Addiction Feeds - August 29, 2014 - 11:57am
Sharing our deep feelings is the way out of the isolation of loneliness. It creates a doorway into the practice of what we call compassionate empathy. Compassionate empathy is the key to getting out of an irrelationship. Compassionate empathy is built on the skill of sharing honestly with another. It makes isolation difficult to maintain, it undermines self-obsession.read more (Source: Psychology Today Relationships Center)

5 Myths About Healthcare Data Privacy

MedWorm Addiction Feeds - August 29, 2014 - 10:31am
When a data breach happens at a retail store, you may have to sort out your credit card purchases. When a data breach happens in healthcare, you may have to sort out your life.read more (Source: Psychology Today Addiction Center)

Effects of Regulation on Methadone and Buprenorphine Provision in the Wake of Hurricane Sandy.

Pub Med: Keyword Buprenorphine - August 29, 2014 - 6:30am

Effects of Regulation on Methadone and Buprenorphine Provision in the Wake of Hurricane Sandy.

J Urban Health. 2014 Aug 28;

Authors: McClure B, Mendoza S, Duncan L, Rotrosen J, Hansen H

Abstract
Hurricane Sandy led to the closing of many major New York City public hospitals including their substance abuse clinics and methadone programs, and the displacement or relocation of thousands of opioid-dependent patients from treatment. The disaster provided a natural experiment that revealed the relative strengths and weaknesses of methadone treatment in comparison to physician office-based buprenorphine treatment for opioid dependence, two modalities of opioid maintenance with markedly different regulatory requirements and institutional procedures. To assess these two modalities of treatment under emergency conditions, semi-structured interviews about barriers to and facilitators of continuity of care for methadone and buprenorphine patients were conducted with 50 providers of opioid maintenance treatment. Major findings included that methadone programs presented more regulatory barriers for providers, difficulty with dose verification due to impaired communication, and an over reliance on emergency room dosing leading to unsafe or suboptimal dosing. Buprenorphine treatment presented fewer regulatory barriers, but buprenorphine providers had little to no cross-coverage options compared to methadone providers, who could refer to alternate methadone programs. The findings point to the need for well-defined emergency procedures with flexibility around regulations, the need for a central registry with patient dose information, as well as stronger professional networks and cross-coverage procedures. These interventions would improve day-to-day services for opioid-maintained patients as well as services under emergency conditions.

PMID: 25163931 [PubMed - as supplied by publisher]

Pharmacodynamic Modelling of Placebo and Buprenorphine Effects on Event-Related Potentials in Experimental Pain.

Pub Med: Keyword Buprenorphine - August 29, 2014 - 6:30am

Pharmacodynamic Modelling of Placebo and Buprenorphine Effects on Event-Related Potentials in Experimental Pain.

Basic Clin Pharmacol Toxicol. 2014 Feb 23;

Authors: Juul RV, Foster DJ, Upton RN, Andresen T, Graversen C, Drewes AM, Christrup LL, Kreilgaard M

Abstract
The purpose of the study was to investigate placebo and buprenorphine effects on event-related potentials (ERPs) in experimental pain and the potential benefit of population pharmacodynamic modelling in data analysis. Nineteen healthy volunteers received transdermal placebo and buprenorphine in a cross-over study. Drug plasma concentrations and ERPs after electrical stimulation at the median nerve with intensity adjusted to pain detection threshold were recorded until 144 hrs after administration. Placebo and concentration-effect models were fitted to data using non-linear mixed-effects modelling implemented in NONMEM (V7.2.0.). Pharmacodynamic models were developed to adequately describe both placebo and buprenorphine ERP data. Models predicted significant placebo effects, but did not predict significant effects related to buprenorphine concentration. Models revealed that ERPs varied both between subjects and between study occasions. ERPs were found to be reproducible within subjects and occasions as population variance was found to be eight times higher than the unexplained variances. Between-subject variance accounted for more than 75% of the population variance. In conclusion, pharmacodynamic modelling was successfully implemented to allow for placebo and variability correction in ERP of experimental pain. Improved outcome of ERP studies can be expected if variation between subjects and study occasions can be identified and described.

PMID: 25163749 [PubMed - as supplied by publisher]

Buprenorphine for Cancer Pain: Is It Ready for Prime Time?

Pub Med: Keyword Buprenorphine - August 29, 2014 - 6:30am

Buprenorphine for Cancer Pain: Is It Ready for Prime Time?

Am J Hosp Palliat Care. 2014 Aug 27;

Authors: Prommer E

Abstract
Buprenorphine (BUP) is a semisynthetic derivative of the opium alkaloid thebaine found in the poppy Papaver somniferum. Its chemical structure contains the morphine structure but differs by having a cyclopropylmethyl group. Buprenorphine is a potent µ opioid agonist. Buprenorphine undergoes extensive first-pass metabolism in the liver and gut. The development of a transdermal BUP formulation in 2001 led to its evaluation in cancer pain. This article provides the practitioner with an update on the current role of BUP in cancer care. It highlights data suggesting effectiveness in various types of cancer pain. The article reviews pharmacology, routes of administration, adverse effects, drug interactions, and cost considerations.

PMID: 25163678 [PubMed - as supplied by publisher]

A ‘Missing Not at Random’ (MNAR) and ‘Missing at Random’ (MAR) Growth Model Comparison with a Buprenorphine/Naloxone Clinical Trial

Med Worm: Keyword Buprenorphine - August 28, 2014 - 7:00pm
ConclusionsThis performance comparison of three missing data strategies (latent growth model, Diggle‐Kenward selection model, Wu‐Carrol selection model) on sample data indicates a need for increased use of sensitivity analyses in clinical trial research. Given the potential sensitivity of the trial arm effect to missing data assumptions, it is critical for researchers to consider whether the assumptions associated with each model are defensible. (Source: Addiction)

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A general method for handling missing binary outcome data in randomised controlled trials

MedWorm Addiction Feeds - August 28, 2014 - 7:00pm
ConclusionsA new method for undertaking sensitivity analyses when handling missing data in trials with binary outcomes allows a wide range of assumptions about the missing data to be assessed. In two smoking cessation trials the results were insensitive to all but extreme assumptions. (Source: Addiction)

Serial longitudinal magnetic resonance imaging data indicate non‐linear regional gray matter volume recovery in abstinent alcohol‐dependent individuals

MedWorm Addiction Feeds - August 28, 2014 - 7:00pm
Abstract The trajectory of regional volume changes during the first year of sustained abstinence in those recovering from an alcohol use disorder is unclear because previous research typically employed only two assessment points. To better understand the trajectory of regional brain volume recovery in treatment‐seeking alcohol‐dependent individuals (ALC), regional brain volumes were measured after 1 week, 1 month and 7.5 months of sustained abstinence via magnetic resonance imaging at 1.5 T. ALC showed significant volume increases in frontal, parietal and occipital gray matter (GM) and white matter (WM), total cortical GM and total lobar WM, thalamus and cerebellum, and decreased ventricular volume over 7.5 months of abstinence. Volume increases in regional GM were significantly grea...

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