Buprenorphine News Feed

Medicaid Tied to Better Addiction Treatment in Pregnancy

November 24, 2017 - 9:18am
Source: HealthDay Related MedlinePlus Pages: Medicaid, Opioid Abuse and Addiction, Pregnancy and Substance Abuse (Source: MedlinePlus Health News)

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6 Questions You MUST Ask Before Checking into Rehab: An Interview with VH1 Addiction Counselor Bob Forrest

November 24, 2017 - 9:00am
The gentleman on the other end of the telephone line has seen the best and worst of humanity and has soared and stumbled, struggled and survived. He emerged from the throes of addiction to claim a new identity; Rehab Bob. According to his website, “Bob Forrest lived a drug-fueled life in the L.A. indie rock scene of the ’80s and ’90s as the frontman for Thelonious Monster. He was known as one of the worst junkies in Hollywood at the time. But after 24 stints in rehab, he finally got sober in 1996. Since then he has dedicated his life to becoming a drug counselor who specializes in reaching the unreachable. He’s helped addicts from all walks of life, often employing methods that are very much at odds with the “traditional rehab approach.” Now living a 180-degree ...

Why Tobacco Companies Are Paying to Tell You Smoking Kills

November 24, 2017 - 4:00am
Court-ordered ads, which will start appearing on Sunday, are “ corrective statements ” about the health risks and addictive nature of smoking. (Source: NYT Health)

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Is there a reasonable excuse for not providing post-operative analgesia when using animal models of peripheral neuropathic pain for research purposes?

November 23, 2017 - 6:24am

Is there a reasonable excuse for not providing post-operative analgesia when using animal models of peripheral neuropathic pain for research purposes?

PLoS One. 2017;12(11):e0188113

Authors: Hestehave S, Munro G, Christensen R, Brønnum Pedersen T, Arvastson L, Hougaard P, Abelson KSP

Abstract
INTRODUCTION: The induction of neuropathic pain-like behaviors in rodents often requires surgical intervention. This engages acute nociceptive signaling events that contribute to pain and stress post-operatively that from a welfare perspective demands peri-operative analgesic treatment. However, a large number of researchers avoid providing such care based largely on anecdotal opinions that it might interfere with model pathophysiology in the longer term.
OBJECTIVES: To investigate effects of various peri-operative analgesic regimens encapsulating different mechanisms and duration of action, on the development of post-operative stress/welfare and pain-like behaviors in the Spared Nerve Injury (SNI)-model of neuropathic pain.
METHODS: Starting on the day of surgery, male Sprague-Dawley rats were administered either vehicle (s.c.), carprofen (5.0mg/kg, s.c.), buprenorphine (0.1mg/kg s.c. or 1.0mg/kg p.o. in Nutella®), lidocaine/bupivacaine mixture (local irrigation) or a combination of all analgesics, with coverage from a single administration, and up to 72 hours. Post-operative stress and recovery were assessed using welfare parameters, bodyweight, food-consumption, and fecal corticosterone, and hindpaw mechanical allodynia was tested for assessing development of neuropathic pain for 28 days.
RESULTS: None of the analgesic regimes compromised the development of mechanical allodynia. Unexpectedly, the combined treatment with 0.1mg/kg s.c. buprenorphine and carprofen for 72 hours and local irrigation with lidocaine/bupivacaine, caused severe adverse effects with peritonitis. This was not observed when the combination included a lower dose of buprenorphine (0.05mg/kg, s.c.), or when buprenorphine was administered alone (0.1mg/kg s.c. or 1.0mg/kg p.o.) for 72 hours. An elevated rate of wound dehiscence was observed especially in the combined treatment groups, underlining the need for balanced analgesia. Repeated buprenorphine injections had positive effects on body weight the first day after surgery, but depressive effects on food intake and body weight later during the first week.
CONCLUSION: Post-operative analgesia does not appear to affect established neuropathic hypersensitivity outcome in the SNI model.

PMID: 29166664 [PubMed - in process]

Join us December 14 for a Twitter Chat about Women and Alcohol

November 22, 2017 - 12:36pm
Why are drinking guidelines different for women than men? How do the health effects of heavy drinking differ? Where can women turn for help if they have an alcohol problem?     The National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the National Council on Alcoholism and Drug Dependence (NCADD) are partnering for a Twitter Chat on women and alcohol. Bring your questions for NIAAA and NCADD experts as we discuss what women need to know about alcohol and their health.  (Source: NIAAA News)

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Weekly Postings

November 22, 2017 - 10:56am
See something of interest? Please share our postings with colleagues in your institutions! Spotlight Funding available! The National Network of Libraries of Medicine, Middle Atlantic Region, is accepting applications for health information outreach, health literacy initiatives, emergency preparedness partnerships and health sciences library projects. Applications will be due by COB on December 1. See a recent blog post from Executive Director, Kate Flewelling for details, or review our funding opportunities and start your application today! Check out the Fall 2017 issue of the MAReport! This quarter, Elaina Vitale is “Highlighting Community Outreach within the Middle Atlantic Region” – read more about her involvement with two symposiums in New Jersey, and our partnership ...

Medicaid Tied to Better Addiction Treatment in Pregnancy

November 22, 2017 - 10:11am
WEDNESDAY, Nov. 22, 2017 -- Pregnancy and opioid addiction are an all-too-common problem in the United States. And where you live may affect your treatment. Addicted moms-to-be are more likely to receive recommended therapy if they live in states... (Source: Drugs.com - Daily MedNews)

At the Expense of a Life: Race, Class, and the Meaning of Buprenorphine in Pharmaceuticalized "Care".

November 22, 2017 - 6:39am

At the Expense of a Life: Race, Class, and the Meaning of Buprenorphine in Pharmaceuticalized "Care".

Subst Use Misuse. 2017 Nov 21;:1-10

Authors: Hatcher AE, Mendoza S, Hansen H

Abstract
BACKGROUND/OBJECTIVE: Office-based buprenorphine maintenance has been legalized and promoted as a treatment approach that not only expands access to care, but also reduces the stigma of addiction treatment by placing it in a mainstream clinical setting. At the same time, there are differences in buprenorphine treatment utilization by race, ethnicity, and socioeconomic status.
METHODS: This article draws on qualitative data from interviews with 77 diverse patients receiving buprenorphine in a primary care clinic and two outpatient substance dependence clinics to examine differences in patients' experiences of stigma in relation their need for psychosocial supports and services.
RESULTS: Management of stigma and perception of social needs varied significantly by ethnicity, race and SES, with white educated patients best able to capitalize on the medical focus and confidentiality of office-based buprenorphine, given that they have other sources of support outside of the clinic, and Black or Latino/a low income patients experiencing office-based buprenorphine treatment as isolating.
CONCLUSION: Drawing on Agamben's theory of "bare life," and on the theory of intersectionality, the article argues that without attention to the multiple oppressions and survival needs of addiction patients who are further stigmatized by race and class, buprenorphine treatment can become a form of clinical abandonment.

PMID: 29161171 [PubMed - as supplied by publisher]

Pregnancy Increases Norbuprenorphine Clearance in Mice by Induction of Hepatic Glucuronidation.

November 22, 2017 - 6:39am

Pregnancy Increases Norbuprenorphine Clearance in Mice by Induction of Hepatic Glucuronidation.

Drug Metab Dispos. 2017 Nov 20;:

Authors: Liao MZ, Gao C, Phillips BR, Neradugomma NK, Han LW, Bhatt DK, Prasad B, Shen DD, Mao Q

Abstract
Norbuprenorphine (NBUP) is the major active metabolite of buprenorphine (BUP) which is commonly used to treat opiate addiction during pregnancy; it possesses 25% of BUP's analgesic activity and 10 times BUP's respiratory depression effect. To optimize BUP's dosing regimen during pregnancy with better efficacy and safety, it is important to understand how pregnancy affects NBUP disposition. In this study, we examined the pharmacokinetics of NBUP in pregnant and non-pregnant mice by administering the same amount of NBUP through retro-orbital injection. We demonstrated that the systemic clearance (CL) of NBUP in pregnant mice increased ~2.5-fold compared with non-pregnant mice. Intrinsic CL of NBUP by glucuronidation in mouse liver microsomes from pregnant mice was ~2 times greater than that from non-pregnant mice. Targeted LC-MS/MS proteomics quantification revealed that hepatic Ugt1a1 and Ugt2b1 protein levels in the same amount of total liver membrane proteins were significantly increased by ~50% in pregnant mice versus non-pregnant mice. After scaling to the whole liver with consideration of the increase in liver protein content and liver weight, we found that the amounts of Ugt1a1, Ugt1a10, Ugt2b1, and Ugt2b35 protein in the whole liver of pregnant mice were significantly increased ~2-fold compared to non-pregnant mice. These data suggest that the increased systemic CL of NBUP in pregnant mice is likely caused by an induction of hepatic Ugt expression and activity. The data provide a basis for further mechanistic analysis of pregnancy-induced changes in the disposition of NBUP and drugs that are predominately and extensively metabolized by Ugts.

PMID: 29158248 [PubMed - as supplied by publisher]

FDA, DEA running massive conspiracy to criminalize Kratom in order to protect Big Pharma's obscene opioid profits

November 22, 2017 - 4:34am
(Natural News) Federal agencies who have declared a national emergency over the burgeoning opioid epidemic are simultaneously continuing to criminalized kratom, which is a non-addictive, natural plant that has allowed scores of Americans to be weaned off their opioid addictions. The Drug Enforcement Agency (DEA) announced plans to place the substance on the government’s list... (Source: NaturalNews.com)

Medical News Today: Wine or beer? The differing effects of alcohol on mood

November 22, 2017 - 2:00am
How do wine, beer, and spirits impact our mood? New research suggests that different types of alcohol may be tied to distinct emotions. (Source: Health News from Medical News Today)

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Certain popular cigars deliver more nicotine than cigarettes

November 21, 2017 - 11:00pm
(Penn State) Cigars may have a reputation for being safer than cigarettes, but they may be just as harmful and addictive, according to Penn State researchers, who add that small cigars have just as much if not more nicotine than cigarettes. (Source: EurekAlert! - Medicine and Health)

Alo House Recovery Centers Named Best Addiction Treatment Center in...

November 21, 2017 - 6:00pm
Alo House Recovery Centers, a state-licensed, Joint Commission accredited, residential treatment center based in Malibu, with locations in Los Angeles, CA, was recently named the best addiction...(PRWeb November 22, 2017)Read the full story at http://www.prweb.com/releases/2017/11/prweb14941102.htm (Source: PRWeb: Medical Pharmaceuticals)

Opioid Crisis Hitting Boomers, Millennials Hardest

November 21, 2017 - 3:00pm
Source: HealthDay Related MedlinePlus Pages: Health Disparities, Heroin, Opioid Abuse and Addiction (Source: MedlinePlus Health News)

Neonatal Outcomes in a Medicaid Population With Opioid Dependence.

November 21, 2017 - 6:39am

Neonatal Outcomes in a Medicaid Population With Opioid Dependence.

Am J Epidemiol. 2017 Nov 16;:

Authors: Brogly SB, Hernández-Diaz S, Regan E, Fadli E, Hahn KA, Werler MM

Abstract
Confounding may account for the apparent improved infant outcomes after prenatal exposure to buprenorphine versus methadone. We used Massachusetts Medicaid Analytic eXtract (MAX) data to identify a cohort of opioid dependent mother-infant pairs (2006-2011) supplemented with confounder data from an external Boston cohort (2015-2016). Associations between prenatal buprenorphine versus methadone exposure and infant outcomes in the MAX Cohort were adjusted for measured MAX confounders, and unmeasured confounders with bias analysis using External Cohort data. 477 women in MAX were treated with methadone and 543 with buprenorphine. More buprenorphine users were white and used psychotropic medications. Adjusting for MAX confounders, risk ratios in buprenorphine versus methadone exposed infants were: preterm birth (0.45, 95% CI: 0.34, 0.61) and low birth weight for gestational age (0.75, 95% CI: 0.51, 1.11). The mean difference in infant hospitalization was -7.35 days (95% CI: -9.16, -5.55). After further adjustment with bias analysis estimates were: preterm birth (0.53, 95% CI: 0.39, 0.71), low birth weight for gestational age (1.14, 95% CI: 0.77, 1.69), and hospitalization (-3.66 days, 95% CI: -5.46, -1.87). External confounder data can be used to adjust for unmeasured confounding in studies of prenatal outcomes in women on opioid agonist therapy based on administrative databases.

PMID: 29155919 [PubMed - as supplied by publisher]

A novel strategy to address unmeasured confounding when comparing opioid agonist therapies in pregnancy.

November 21, 2017 - 6:39am

A novel strategy to address unmeasured confounding when comparing opioid agonist therapies in pregnancy.

Am J Epidemiol. 2017 Nov 16;:

Authors: Lemon LS

Abstract
Opioid addiction in pregnancy is a growing concern that has recently received a lot of attention. When comparing recommended opioid agonist therapies, many currently published studies guiding practice may be impacted by unmeasured confounding by indication. Populations of women who receive methadone are generally different from those treated with buprenorphine. Women treated with methadone frequently have more severe and uncontrolled addiction compared with buprenorphine treated patients; however, these factors are typically unmeasured or unavailable in large observational data sets. Consequently, findings of superior perinatal outcomes with buprenorphine may in truth be a result of an overall healthier profile of women taking this medication. In this issue of the American Journal of Epidemiology, Brogly et al. describes an approach utilizing detailed data from an External Cohort (n = 113) to account for confounding by indication in a larger Medicaid population (n = 1,020) to more accurately compare opioid agonist therapies in pregnancy. Authors found that the decreased risk of preterm birth and infant length of hospitalization associated with buprenorphine compared with methadone were attenuated after accounting for the additional confounding. These authors should be commended for providing a novel method to address this bias in future studies.

PMID: 29155916 [PubMed - as supplied by publisher]

For opiate addiction, study finds drug-assisted treatment is more effective than detox

November 20, 2017 - 7:00pm
Say you ’re a publicly-insured Californian with an addiction to heroin, fentanyl or prescription narcotics, and you want to quit.New research suggests you can do it the way most treatment-seeking addicts in the state do — by undergoing a medically-supervised “detoxification” that’s difficult, expensive... (Source: Los Angeles Times - Science)

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Substituting methadone for opioids could save billions

November 20, 2017 - 4:08pm
(Reuters Health) - Policymakers and insurers have been pushing people addicted to opioids into abstinence-based detox programs, but a new study concludes that methadone and similar drug-maintenance treatments save lives and money. (Source: Reuters: Health)

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New Analysis Estimates Cost of the Opioid Epidemic Tops $500 billion

November 20, 2017 - 10:09am
WASHINGTON (AP) — The White House says the true cost of the opioid drug epidemic in 2015 was $504 billion, or roughly half a trillion dollars. In an analysis to be released Monday, the Council of Economic Advisers says the figure is more than six times larger than the most recent estimate. The council said a 2016 private study estimated that prescription opioid overdoes, abuse and dependence in the U.S. in 2013 cost $78.5 billion. Most of that was attributed to health care and criminal justice spending, along with lost productivity. The council said its estimate is significantly larger because the epidemic has worsened, with overdose deaths doubling in the past decade, and that some previous studies didn't reflect the number of fatalities blamed on opioids, a powerful but addictive categ...

Opioids haunt users' recovery: 'It never really leaves you'

November 20, 2017 - 10:00am
In the worst opioid epidemic in U.S. history, addiction recovery may be toughest for pain patients who must find safer ways to manage their conditions (Source: ABC News: Health)

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