- Shortened Taper Duration after Implementation of a Standardized Protocol for Iatrogenic Benzodiazepine and Opioid Withdrawal in Pediatric Patients: Results of a Cohort Study. [Journal Article]
- PQPediatr Qual Saf 2018 May-Jun; 3(3):e079
- CONCLUSIONS: The use of a standardized withdrawal protocol resulted in shorter taper duration for both the methadone and lorazepam groups. There was no difference in PICU or hospital length of stay.
- Emerging Evidence for Cannabis' Role in Opioid Use Disorder. [Review]
- CCCannabis Cannabinoid Res 2018; 3(1):179-189
- Introduction: The opioid epidemic has become an immense problem in North America, and despite decades of research on the most effective means to treat opioid use disorder (OUD), overdose deaths are a...
Introduction: The opioid epidemic has become an immense problem in North America, and despite decades of research on the most effective means to treat opioid use disorder (OUD), overdose deaths are at an all-time high, and relapse remains pervasive. Discussion: Although there are a number of FDA-approved opioid replacement therapies and maintenance medications to help ease the severity of opioid withdrawal symptoms and aid in relapse prevention, these medications are not risk free nor are they successful for all patients. Furthermore, there are legal and logistical bottlenecks to obtaining traditional opioid replacement therapies such as methadone or buprenorphine, and the demand for these services far outweighs the supply and access. To fill the gap between efficacious OUD treatments and the widespread prevalence of misuse, relapse, and overdose, the development of novel, alternative, or adjunct OUD treatment therapies is highly warranted. In this article, we review emerging evidence that suggests that cannabis may play a role in ameliorating the impact of OUD. Herein, we highlight knowledge gaps and discuss cannabis' potential to prevent opioid misuse (as an analgesic alternative), alleviate opioid withdrawal symptoms, and decrease the likelihood of relapse. Conclusion: The compelling nature of these data and the relative safety profile of cannabis warrant further exploration of cannabis as an adjunct or alternative treatment for OUD.
- Use of Kratom, an Opioid-like Traditional Herb, in Pregnancy. [Journal Article]
- OGObstet Gynecol 2018 Sep 07
- CONCLUSIONS: Kratom is an emerging self-treatment for opioid use disorder in the obstetric population. Obstetric care providers should be aware of kratom and consider opioid replacement for pregnant women with kratom dependence.
- ANTINOCICEPTIVE TOLERANCE TO NSAIDS PARTIALLY MEDIATED VIA ENDOCANNABINOIDS IN ANTERIOR CINGULATE CORTEX OF RATS. [Journal Article]
- GMGeorgian Med News 2018 Jul-Aug; (280-281):120-125
- Pain is characterized as a complex experience, dependent not only on the regulation of nociceptive sensory systems but also on the activation of mechanisms that control emotional processes in limbic ...
Pain is characterized as a complex experience, dependent not only on the regulation of nociceptive sensory systems but also on the activation of mechanisms that control emotional processes in limbic brain areas. Non-opioid, non-steroidal anti-inflammatory drugs (NSAIDs) are the most widely used analgesics in the treatment of not-severe pain. We have recently shown that repeated doses result in tolerance to these drugs like opioids. Here we investigated the central brain mechanisms of non-opioid induced antinociception in the non-acute pain models of rats, such as the 'formalin test' and a relation between administration of NSAIDs in the limbic brain area, - the anterior cingulated cortex (ACC), - and the endocannabinoid system. We measured nociceptive thermal paw withdrawal latencies and mechanical thresholds monolaterally in rats following microinjections of NSAIDs (diclofenac, ketoprofen, xefocam), saline or the cannabinoid receptor 1 (CB1) antagonist (AM-251) in the ACC. Five min following intraplantar formalin injection all animals showed a significant reduction in thermal paw withdrawal latency and mechanical withdrawal threshold compared to pre-baseline values. Fifteen minutes after formalin injection, diclofenac, ketoprofen, xefocam clearly showed antinociceptive effects of NSAIDs. When pretreated with AM-251 we found a significant reduction of analgesic effects of NSAIDs. The present data support the notion that endocannabinoids' CB1 receptor contributes in part to antinociceptive effects of NSAIDs and probably involved in activation of the descending opioid modulatory system of pain.
- Buprenorphine Formulations for the Treatment of Opioid Use Disorders: A Review of Comparative Clinical Effectiveness, Cost-Effectiveness and Guidelines [BOOK]
- BOOKCanadian Agency for Drugs and Technologies in Health: Ottawa (ON)
- Currently, buprenorphine formulations for the treatment of opioid use disorder (OUD) include an implant, as well as oral formulations combined with an opioid antagonist, naloxone. This combination is...
Currently, buprenorphine formulations for the treatment of opioid use disorder (OUD) include an implant, as well as oral formulations combined with an opioid antagonist, naloxone. This combination is designed to discourage abuse of buprenorphine, as naloxone can precipitate withdrawal symptoms in patients with OUD. Buprenorphine-naloxone combination formulations include a sublingual tablet, sublingual film, and high-bioavailability sublingual tablet. Only the sublingual tablet formulation of the buprenorphine-naloxone combination (Suboxone) is licensed for use in Canada. On 21 April 2017, Health Canada proposed to allow the importation and use of medications that have been authorized for sale in the United States, European Union or Switzerland, but are not yet authorized in Canada. Once this process is implemented, this medication list could potentially include newer buprenorphine formulations available in the US. The purpose of this report is to evaluate the clinical effectiveness, cost-effectiveness and evidence-based guidelines for the use of newer and unique buprenorphine formulations in patients with OUD.
- Pupillary Pain Index Changes After a Standardized Bolus of Alfentanil Under Sevoflurane Anesthesia: First Evaluation of a New Pupillometric Index to Assess the Level of Analgesia During General Anesthesia. [Journal Article]
- A&AAnesth Analg 2018 Sep 05
- CONCLUSIONS: There was a significant decrease in PPI after alfentanil administration. The results of this pilot study suggest that PPI score decreases when the level of analgesia increases. PPI measurement was not associated with a clinical or hemodynamic nociceptive response. This new index might provide useful information to individually adapt opioid administration before nociceptive stimuli under general anesthesia.
- [Illogical association nalmefene and opioids: Analysis in the French pharmacovigilance database]. [Journal Article]
- TTherapie 2018 Aug 03
- CONCLUSIONS: The effect of modifications in the SPC and the package leaflet on the use of nalmefene with ODS was real and progressive.
- PET imaging reveals lower kappa opioid receptor availability in alcoholics but no effect of age. [Journal Article]
- NNeuropsychopharmacology 2018 Sep 06
- Opioid receptors are implicated in alcoholism, other addictions, withdrawal, and depression, and are considered potential pharmacological targets for treatment. Our goal in the present study was to c...
Opioid receptors are implicated in alcoholism, other addictions, withdrawal, and depression, and are considered potential pharmacological targets for treatment. Our goal in the present study was to compare the availability of kappa opioid receptors (KOR) between an alcohol-dependent cohort (AD) and a healthy control cohort (HC). Sixty-four participants-36 AD and 28 HC-underwent PET scans with [11C]LY2795050, a selective kappa antagonist tracer. Partial-volume correction was applied to all PET data to correct for atrophy. Volume of distribution (VT) of the tracer was estimated regionally as a measure of KOR availability. VT values of AD versus HC were compared for 15 defined ROIs. Multivariate analysis showed a main effect of group on VT across these 15 ROIs. Post hoc tests showed that AD had significantly lower VT and thus a lower KOR availability than HC in amygdala and pallidum (corrected for multiple comparisons). Exploratory analysis of change in VT with age was conducted; VT was not found to vary significantly with age in any region. Our findings of lower VT in AD versus HC in multiple regions are in contrast to findings in the mu and delta opioid receptor systems of higher VT in AD versus HC. Although age-related decline in receptors has previously been observed in the mu opioid receptor system, we found that KOR availability does not change with age.
- Utilizing resources of neuropsychopharmacology to address the opioid overdose crisis. [Journal Article]
- NRNeuropsychopharmacol Rep 2018; 38(3):100-104
- CONCLUSIONS: Hopefully, this crisis will reinvigorate both basic and clinical neuropsychopharmacological research leading to the develop new and more effective options for dealing with the many and varied elements of the current opioid crisis as described in the present commentary.
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- Educational Disabilities Among Children Born With Neonatal Abstinence Syndrome. [Journal Article]
- PedPediatrics 2018; 142(3)
- CONCLUSIONS: Results of this novel analysis linking health and education data revealed that children with a history of NAS were significantly more likely to have a subsequent educational disability.