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Opioid Abuse [keywords]
- Drug-poisoning Deaths Involving Opioid Analgesics: United States, 1999-2011. [Journal Article]
- NCHS Data Brief 2014 Sep; (166):1-8.
Data from the National Vital Statistics System, Mortality File. The age-adjusted rate for opioid-analgesic poisoning deaths nearly quadrupled from 1.4 per 100,000 in 1999 to 5.4 per 100,000 in 2011. Although the opioid-analgesic poisoning death rates increased each year from 1999 through 2011, the rate of increase has slowed since 2006. Natural and semisynthetic opioid analgesics, such as hydrocodone, morphine, and oxycodone, were involved in 11,693 drug-poisoning deaths in 2011, up from 2,749 deaths in 1999. Benzodiazepines were involved in 31% of the opioid-analgesic poisoning deaths in 2011, up from 13% of the opioid-analgesic poisoning deaths in 1999. During the past decade, adults aged 55-64 and non-Hispanic white persons experienced the greatest increase in the rates of opioid-analgesic poisoning deaths. Poisoning is the leading cause of injury death in the United States (1). Drugs-both illicit and pharmaceutical-are the major cause of poisoning deaths, accounting for 90% of poisoning deaths in 2011. Misuse or abuse of prescription drugs, including opioid-analgesic pain relievers, is responsible for much of the recent increase in drug-poisoning deaths (2). This report highlights trends in drug-poisoning deaths involving opioid analgesics (referred to as opioid-analgesic poisoning deaths) and updates previous Data Briefs on this topic.
- Opioid Misuse Behaviors in Adolescents and Young Adults in a Hematology/Oncology Setting. [JOURNAL ARTICLE]
- J Pediatr Psychol 2014 Sep 14.
To describe the occurrence and psychosocial correlates of aberrant opioid-associated behavior (AOB) in adolescent and young adult (AYA) hematology and oncology patients prescribed opioid therapy. METHODS: Structured retrospective chart reviews were conducted for AYA patients (N = 398) accepted for active treatment at a large pediatric hematology/oncology institution over a 17-month period. Opioid therapy was documented in the records of 94 out of the 398 patients. The records of those 94 patients were further reviewed to identify documented AOB and documented correlates of AOB. RESULTS: Of the 94 patients prescribed opioid therapy, 11.7% exhibited AOB. At least one psychosocial risk factor was identified in 90.9% of patients with AOB. Concurrent use of multiple opioids was significantly associated with AOB (p = .003). CONCLUSIONS: Hematology/oncology AYA patients may exhibit AOB despite a legitimate clinical indication for opioid therapy. Clinicians should consider young patients' psychosocial risk factors when using opioid therapy.
- Buprenorphine Diversion and Misuse in Outpatient Practice. [JOURNAL ARTICLE]
- J Addict Med 2014 Sep 11.
This case is an amalgamation of several real patients in office-based treatment for prescription opioid dependence synthesized into a single theoretical case. The case illustrates the various ways in which medication diversion and misuse may be encountered in clinical practice and therapeutic responses designed to maximize positive treatment outcomes. It is followed by discussions from several expert addiction medicine providers from 3 different countries, giving their perspectives on the salient aspects of this case. This case conference should be of particular interest to clinicians working with opioid-dependent patients in an outpatient setting.
- A Review of Buprenorphine Diversion and Misuse: The Current Evidence Base and Experiences From Around the World. [JOURNAL ARTICLE]
- J Addict Med 2014 Sep 11.
Outpatient opioid addiction treatment with sublingual buprenorphine pharmacotherapy has rapidly expanded in the United States and abroad, and, with this increase in medication availability, there have been increasing concerns about its diversion, misuse, and related harms. This narrative review defines the behaviors of diversion and misuse, examines how the pharmacology of buprenorphine alone and in combination with naloxone influence its abuse liability, and describes the epidemiological data on buprenorphine diversion and intravenous misuse, risk factors for its intravenous misuse, and the unintended consequences of misuse and diversion. Physician practices to prevent, screen for, and therapeutically respond to these behaviors, which are a form of medication nonadherence, are discussed, and gaps in knowledge are identified. Outpatient opioid addiction treatment with sublingual buprenorphine pharmacotherapy experiences from other countries that have varied health care systems, public policies, and access to addiction treatment are shared to make clear that diversion and misuse occur across the world in various contexts, for many different reasons, and are not limited to buprenorphine. Comparisons are made with other opioids with known abuse liability and medications with no known abuse. The objective was to facilitate understanding of diversion and misuse so that all factors influencing their expression (patient and provider characteristics and public policy) can be appreciated within a framework that also recognizes the benefits of addiction treatment. With this comprehensive perspective, further careful work can help determine how to minimize these behaviors without eroding the current benefits realized through improved addiction treatment access and expansion.
- Sy07-3medications for treatment of alcoholism that derive from the dark side of addiction. [Journal Article]
- Alcohol Alcohol 2014 Sep.:i9.
Drug addiction is a disorder characterized by compulsive drug intake, loss of control over intake and emergence of a negative emotional state during withdrawal. Addiction involves elements of impulsivity and compulsivity which when combined form an addiction cycle that provides heuristic framework with which to identify the neurobiological and neuroadaptive mechanisms involved in addiction, and as a result treatments for addiction. Based on this framework 3 stages of the addiction cycle have been identified that are relevant to alcoholism. These three stages: Binge-intoxication, withdrawal-negative affect and preoccupation-anticipation ("craving") are reflected in key neuroadaptations that drive and maintain addiction. The binge-intoxication stage includes enhanced habit (stimulus- response) activity in the dorsal striatum. The withdrawal-negative affect stage reflects reward deficits in the ventral striatum (nucleus accumbens) such as dopamine and opioid peptides, but also stress surfeit in the amygdala such as recruitment of the brain stress systems including corticotropin releasing factor, dynorphin and norepinephrine. The preoccupation-anticipation stage reflects impairments in self-regulation mediated by dysregulation of executive function in the frontal cortex. Each of these stages provides a heuristic framework for treatment and can be targeted by existing and novel pharmaceuticals. Both naltrexone and acamprosate are effective medications for the treatment of alcoholism and are approved by the Food and Drug Administration of the USA. Naltrexone acts on the binge-intoxication state to block endogenous opioids and acamprosate acts on the preoccupation-anticipation stage to block glutamatergic activation. Future medications that focus on the withdrawal-afffect stage and preoccupation- anticipation stage to restore the stress surfeit dysregulation characterizing these stages of the addiction cycle may have high potential as novel approaches to medications development for alcoholism.
- P-65substance abuse in psychiatric patients attending out patient department. [Journal Article]
- Alcohol Alcohol 2014 Sep.:i66.
Present study has been carried out at Mental Hospital Indore associated with Department of Psychiatry M. G. M. Medical College Indore, (M. P.), India. This is 155 bedded teaching hospital having all required facilities for treating mentally ill. About 115 to 275 patients attends outpatient department (O PD)daily. All patients attending O PD from November 2013 to April 2014 have been included in the study. A semi structured proforma was designed to record drug abuse history along with biodata, etiology, types of substances, cost of substance used per day etc. Substances abused in studied population were -alcohol (32.20%). opioid (3.38%), cannabis (8.47%), tobacco (52.54%). Alcohol was more commonly abused in patients with mood disorder and cannabis and tobacco in psychotic disorders. Various psychosocial factor, per day cost, family factors, complications of substances abused and other related issues have been discussed.
- P-59in- prison outcomes of buprenorphine maintainence for prisoners: results from a pilot intervention in tihar prisons, India. [Journal Article]
- Alcohol Alcohol 2014 Sep.:i64-i65.
A pilot study was done to test the feasibility and effectiveness of buprenorphine as maintenance treatment for opioid dependent prisoners in Tihar prisons, India. This was the first such intervention in a South Asian prison.The study had a pre-post test design with quantitative, qualitative and biochemical assessments at baseline and at three, six, nine and twelve months after initiation of treatment with buprenorphine. Psychosocial intervention was provided in both, group and individual sessions. A total of 133 opioid dependent inmates fulfilling the eligibility criteria of the study were recruited in the study from November, 2008-March, 2012.The study sample mostly comprised pretrial remand prisoners (95.3%) and most(94.3%) were repeat offenders. For most patients(95.3%), heroin was the primary drug of abuse. 50.3% were currently Injecting Drug Users (IDUs). Among the IDUs, sharing of syringe/needle was reported by 70% and paraphernalia by 49% in their drug using careers. Treatment was initiated with buprenorphine and the mean dose (in mg) of buprenorphine was 4.3± 2.0, 4.6± 1.9, 4.3 ±1.4, 4.3 ±1.5 given on 3,6,9&12 months respectively. Retention in the prison arm was excellent (98%) and compliance among those retained in prison was 100%. In the prison, during the course of the study, 10, 3, 1 prisoners reported injecting drug use at 3, 6, 9 months respectively. No reporting of injecting drug use was obtained at 12 months and thereafter. No other illicit drug use was reported at follow up. This was corroborated by results of urine screening suggestive of minimal or no drug use at follow up during imprisonment. A statistically significant reduction was found in severity of dependence, craving for drugs and withdrawal symptoms at follow up. Recognition of co-morbid health problems and appropriate treatment of the same was provided to the prisoners on OST. In qualitative assessments, most prisoners expressed satisfaction with treatment and reported experiencing OST treatment as their first ray of hope in their lives.Buprenorphine maintenance for opioid dependent prisoners was found to be feasible and effective in Tihar prisons. An upscale of this intervention in prisons in the region both as a drug treatment and harm reduction strategy is advisable.United Nations Office of Drugs and crime(UNODC- ROSA) under Project RAS H/71 IMPLEMENTED IN: Tihar Prisons, Delhi, India ACNOWLEDGEMENT: Ms. Christina Albertin, Regional representative, UNODC- ROSA; Prof. Rajat Ray(retd): ex HOD Psychiatry and Chief NDDTC.
- P-44involvement of mu- and delta-opioid receptor function in the rewarding effect of pentazocine. [Journal Article]
- Alcohol Alcohol 2014 Sep.:i61-i62.
Most opioid receptor agonists have abuse potential, and the rewarding effects of opioids can be reduced in the presence of pain. Pentazocine has been used clinically for the treatment of pain. However, little information is available regarding whether the pentazocine-induced rewarding effects can be suppressed under pain. Therefore, the present study was performed to investigate the effects of pain on the acquisition of the rewarding effects of pentazocine, and to examine the mechanism of the rewarding effects of pentazocine using the conditioned place preference paradigm. Pentazocine produced significant rewarding effects. Even though the rewarding effects induced by pentazocine were significantly suppressed under pain induced by formalin, accompanied by increase of preprodynorphin mRNA levels in the nucleus accumbens, a high dose of pentazocine produced significant rewarding effects under pain. In the normal condition, pentazocine-induced rewarding effects were blocked by a low dose of naloxone, whereas the rewarding effects induced by high doses of pentazocine under pain were suppressed by naltrindole (a delta-opioid receptor antagonist). These findings suggest that the rewarding effects of pentazocine is mediated by activation of mu- as well as delta-opioid receptors. We also found that neural adaptations can reduce the abuse potential of pentazocine under pain.
- P-11sex differences in the effects of chronic social isolation on alcohol consumption in mu-opioid receptor knockout mice. [Journal Article]
- Alcohol Alcohol 2014 Sep.:i55.
Early social experience has been consistently shown increase alcohol consumption, perhaps by influencing stress systems. However, the connection between these effects and alcohol consumption is complex and poorly understood. This experiment was based on the hypothesis that the effects of chronic social isolation on alcohol consumption would be influenced by both sex and the functioning of Mu-opioid receptor (MOP) systems.The present study assessed the effects of isolation-rearing on later ethanol intake using a two-bottle home-cage consumption (ethanol 8% vs. water) paradigm in wild-type and MOP gene knockout (KO) mice. A total of 97 male and female mice were used in this study.Isolation rearing had no effects upon ethanol consumption in WT mice under the conditions used in the present experiments; however, isolation rearing did have effects in both male and female MOP KO mice, but these effects were in the opposite direction, increasing ethanol consumption in male mice, but decreasing ethanol consumption in female mice.These results indicate that MOP influences ethanol consumption, but does so in quite different ways depending on sex and previous social experience during adolescent development.
- Or11-4long term outpatient detoxification treatment of opioid dependence by buprenorphine suppository: case report. [Journal Article]
- Alcohol Alcohol 2014 Sep.:i48-i49.
There are very few cases of opioid abuse and dependence in Japan and use of opioid in the opioid dependence treatment is prohibited by the old-fashioned Japanese narcotics control law. There are few options of medical treatment for opioid dependence available in Japan. Although we used low dosage buprenorphine injection on inpatient detoxification treatment for heroin dependence for ten years, we have not prescribed opioid agonist and antagonist for outpatient treatment of opioid dependence. The relapse rete was high. A patient was referred from U.S. addiction treatment agency last year. He had three years opioid abuse history. He was treated by buprenorphine film for three months. After the patient arrived in Japan, he used buprenorphine film he brought from U.S. and buprenorphine suppository. In the first 3 weeks, the patient use buprenorphine film and tapered buprenorphine from 1.0 mg/day to 0.25 mg /day. In the next 7 weeks, he used buprenorphine suppository 0.2mg/day. In the last 3 days of tenth week, he withdrew from buprenorphine. He returned to US in the 13th week. His drug use was monitored by frequent urinary test and he kept clean in Japan. Buprenorphine suppository was effective substitute of sublingual buprenorphine, in small dosage.