scholarly journals The association between nicotine dependence and physical health among people receiving injectable diacetylmorphine or hydromorphone for the treatment of chronic opioid use disorder

2018 ◽  
Vol 7 ◽  
pp. 82-89
Author(s):  
Heather Palis ◽  
Kirsten Marchand ◽  
Mohammad Karamouzian ◽  
Scott MacDonald ◽  
Scott Harrison ◽  
...  
Keyword(s):  
Physical Health ◽  
Nicotine Dependence ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Chronic Opioid Use ◽  
Injectable Diacetylmorphine

scholarly journals Mindfulness-Oriented Recovery Enhancement remediates anhedonia in chronic opioid use by enhancing neurophysiological responses during savoring of natural rewards

2021 ◽  
pp. 1-10
Author(s):  
Eric L. Garland ◽  
Spencer T. Fix ◽  
Justin P. Hudak ◽  
Edward M. Bernat ◽  
Yoshio Nakamura ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Skin Conductance Level ◽  
Opioid Therapy ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Natural Reward ◽  
Before And After ◽  
Natural Rewards ◽  
Chronic Opioid Use ◽  
Opioid Users

Abstract Background Neuropsychopharmacologic effects of long-term opioid therapy (LTOT) in the context of chronic pain may result in subjective anhedonia coupled with decreased attention to natural rewards. Yet, there are no known efficacious treatments for anhedonia and reward deficits associated with chronic opioid use. Mindfulness-Oriented Recovery Enhancement (MORE), a novel behavioral intervention combining training in mindfulness with savoring of natural rewards, may hold promise for treating anhedonia in LTOT. Methods Veterans receiving LTOT (N = 63) for chronic pain were randomized to 8 weeks of MORE or a supportive group (SG) psychotherapy control. Before and after the 8-week treatment groups, we assessed the effects of MORE on the late positive potential (LPP) of the electroencephalogram and skin conductance level (SCL) during viewing and up-regulating responses (i.e. savoring) to natural reward cues. We then examined whether these neurophysiological effects were associated with reductions in subjective anhedonia by 4-month follow-up. Results Patients treated with MORE demonstrated significantly increased LPP and SCL to natural reward cues and greater decreases in subjective anhedonia relative to those in the SG. The effect of MORE on reducing anhedonia was statistically mediated by increases in LPP response during savoring. Conclusions MORE enhances motivated attention to natural reward cues among chronic pain patients on LTOT, as evidenced by increased electrocortical and sympathetic nervous system responses. Given neurophysiological evidence of clinical target engagement, MORE may be an efficacious treatment for anhedonia among chronic opioid users, people with chronic pain, and those at risk for opioid use disorder.

scholarly journals A double-edged sword of using opioids and COVID-19: a toxicological view

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Mahshid Ataei ◽  
Farshad M. Shirazi ◽  
Roland J. Lamarine ◽  
Samaneh Nakhaee ◽  
Omid Mehrpour
Keyword(s):  
Organ Damage ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Inflammatory Phase ◽  
Clinical Support ◽  
Increased Risk ◽  
The World ◽  
Chronic Opioid Use ◽  
High Doses ◽  
World Information

AbstractToday, COVID-19 is spreading around the world. Information about its mechanism, prognostic factors, and management is minimal. COVID-19, as a human disease, has several identifying phases. Physicians of patients with COVID-19 may be interested in knowing whether opioid use disorder may affect their patients’ course or prognosis. This information may be crucial when considering the opioid epidemic in the US and other parts of the world. Opioid use at high doses and over several months duration can mitigate the immune system’s function, which may complicate the course of COVID-19 disease. Potential suppression of parts of the immune response may be important in prevention, clinical support, and therapeutic use of medications in various phases of the COVID-19. Specifically, opioid use disorders via an inhalation route may enhance the “late hyper-inflammatory phase” or result in end-organ damage. It is well established that opioids decrease ventilation as their effect on the medullary respiratory centers increases the risk of pneumonia. This increased risk has been associated with immune-suppressive opioids. The ultimate role of opioids in COVID-19 is not clear. This paper endorses the need for clinical studies to decipher the role and impact of chronic opioid use on viral diseases such as COVID-19.

scholarly journals The Role of Quality of Education in Neurocognitive Functioning in a Diverse Sample with Chronic Opioid Use Disorder

2019 ◽  
Vol 34 (7) ◽  
pp. 1269-1269
Author(s):  
J Olsen ◽  
J Arnsten ◽  
T Scott ◽  
F Arias ◽  
C Zhang ◽  
...  
Keyword(s):  
Executive Functioning ◽  
Opioid Use Disorder ◽  
Reading Level ◽  
Quality Of Education ◽  
Opioid Use ◽  
Significant Group ◽  
Wide Range ◽  
Chronic Opioid Use

Abstract Objective Literacy is a proxy for quality of education (QoE) and mediates ethnicity-related differences in neurocognitive (NC) performance in some populations (Manly et al., 2002; Rivera Mindt et al., 2008). However, it is unknown whether this relationship exists in the context of chronic opioid use disorder (OUD). This study examined the role of ethnicity, QoE, opioid use severity, and depression in predicting NC performance in a diverse sample of persons with OUD. Participants and Method This cross-sectional study included 74 adults with OUD (Age M = 40.3 [SD = 10.5]; Education M = 11.3 [2.5]; 24% female; 68% Latinx and 32% Non-Latinx White [NLW]). All participants completed comprehensive NC testing and psychiatric/substance use questionnaires. Variables included ethnicity (Latinx vs. Non-Latinx White), years of education, QoE (Wide Range Achievement Test, Third Edition; WRAT-3 Reading Standard Scores), opioid use severity (high vs. low OAT dose), current depression (Beck Depression Inventory, Second Edition; BDI-II Total Score), and demographically-corrected NC T-scores were computed and used for average domain T-scores (e.g., learning, memory, verbal fluency, executive function). Bivariate and ANCOVA analyses were used to compare ethnic groups. Results There were no significant group differences on opioid use severity or current depression (p’s > .05). However, compared to the NLW group, the Latinx group had lower years of education (M = 10.9 [SD = 1.7] vs. M = 12.2 [SD = 3.5]; t[72)] = 2.1, p < .05), QoE (M = 83.1 [SD = 13.6] vs. M = 94.8 [SD = 9.4]; t[72] = 3.8, p < .001), executive functioning (M = 42.0 [SD = 6.5] vs. M = 45.8 [SD = 8.5]; t[72) = 2.1, p < .05), and learning (M = 32.2 [SD = 8.2] vs. M = 37.8 [SD = 8.7]; t[72)] = 2.7, p < .05), with medium to large effect sizes (Cohen’s d > .50). The overall effect of ethnicity became non-significant for executive functioning after accounting for QoE (F[2,70] = 10.0, p = .002) and years of education (F[2,70)] = 16.8, p < .001). Conclusions The current study found that accounting for years of education and QoE attenuates some differences in NC performance between Latinx and Non-Latinx participants. References Manly, J. J., Jacobs, D. M., Touradji, P., Small, S. A., & Stern, Y. (2002). Reading level attenuates differences in neuropsychological test performance between African American and White elders. Journal of the International Neuropsychological Society, 8(3), 341-348. Mindt, M. R., Arentoft, A., Germano, K. K., D’Aquila, E., Scheiner, D., Pizzirusso, M., ... & Gollan, T. H. (2008). Neuropsychological, cognitive, and theoretical considerations for evaluation of bilingual individuals. Neuropsychology review, 18(3), 255-268.

scholarly journals Adverse Events During Treatment Induction With Injectable Diacetylmorphine and Hydromorphone for Opioid Use Disorder

2019 ◽  
Vol 13 (5) ◽  
pp. 354-361 ◽  
Author(s):  
Eugenia Oviedo-Joekes ◽  
Heather Palis ◽  
Daphne Guh ◽  
David C. Marsh ◽  
Scott MacDonald ◽  
...  
Keyword(s):  
Adverse Events ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Injectable Diacetylmorphine

scholarly journals Hippocampal TNF-α Signaling Mediates Heroin Withdrawal-Enhanced Fear Learning and Withdrawal-Induced Weight Loss

2021 ◽  
Author(s):  
Shveta V. Parekh ◽  
Jacqueline E. Paniccia ◽  
Lydia O. Adams ◽  
Donald T. Lysle
Keyword(s):  
Weight Loss ◽  
Opioid Use Disorder ◽  
Fear Learning ◽  
Post Traumatic Stress ◽  
Opioid Use ◽  
Dorsal Hippocampal ◽  
Tnf Α ◽  
Post Traumatic ◽  
Chronic Opioid Use ◽  
Dependent Learning

AbstractThere is significant comorbidity of opioid use disorder (OUD) and post-traumatic stress disorder (PTSD) in clinical populations. However, the neurobiological mechanisms underlying the relationship between chronic opioid use and withdrawal and development of PTSD are poorly understood. Our previous work identified that chronic escalating heroin administration and withdrawal can produce enhanced fear learning, an animal model of hyperarousal, and is associated with an increase in dorsal hippocampal (DH) interleukin-1β (IL-1β). However, other cytokines, such as TNF-α, work synergistically with IL-1β and may have a role in the development of enhanced fear learning. Based on both translational rodent and clinical studies, TNF-α has been implicated in hyperarousal states of PTSD, and has an established role in hippocampal-dependent learning and memory. The first set of experiments tested the hypothesis that chronic heroin administration followed by withdrawal is capable of inducing alterations in DH TNF-α expression. The second set of experiments examined whether DH TNF-α expression is functionally relevant to the development of enhanced fear learning. We identified an increase of TNF-α immunoreactivity and positive cells at 0, 24, and 48 h into withdrawal in the dentate gyrus DH subregion. Interestingly, intra-DH infusions of etanercept (TNF-α inhibitor) 0, 24, and 48 h into heroin withdrawal prevented the development of enhanced fear learning and mitigated withdrawal-induced weight loss. Overall, these findings provide insight into the role of TNF-α in opioid withdrawal and the development of anxiety disorders such as PTSD.

scholarly journals Cost-Effectiveness and Guidelines for Opioid Substitution Treatment

2021 ◽  
Vol 1 (12) ◽  
Author(s):  
Kwakye Peprah ◽  
Hannah Loshak
Keyword(s):  
Cost Effectiveness ◽  
Methadone Maintenance ◽  
Oral Morphine ◽  
Cost Effective ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Opioid Substitution Treatment ◽  
Drug Treatments ◽  
Buccal Tablets ◽  
Injectable Diacetylmorphine

There was evidence indicating that in the treatment of opioid use disorder, injectable hydromorphone, or injectable methadone provided more benefit at less cost compared with injectable diacetylmorphine over a 6-month time horizon. Evidence suggests that in the treatment of opioid use disorder, both injectable hydromorphone and injectable diacetylmorphine are likely to provide more benefit at less cost than methadone maintenance treatment. Treatment with injectable hydromorphone was more cost-effective than injectable diacetylmorphine in opioid use disorder patients who do not respond to or relapse from drug treatments. The evidence is limited because observed data were collected during a short-term follow-up, and long-term cost-effectiveness outcomes were based on extrapolations beyond data from the actual studies. One guideline provided a weak recommendation, supported by low-quality evidence, for using slow-release oral morphine in older adults with adequate renal function in whom buprenorphine and methadone maintenance have been ineffective to treat opioid use disorder or could not be tolerated. Another guideline recommends using injectable hydromorphone or injectable diacetylmorphine for individuals with severe opioid use disorders who relapsed previous treatments failed. No relevant cost-effectiveness evidence or guidelines with recommendations regarding the use of oral hydromorphone, fentanyl patches, or fentanyl buccal tablets for opioid use disorder treatment were identified; therefore, no summary can be provided.

scholarly journals Treatment of Opioid Use Disorder With Buprenorphine-Naloxone at Chainama Hills College Hospital in Lusaka, Zambia: A Case Report

2020 ◽  
Vol 2 (4) ◽  
Author(s):  
Brian Maila ◽  
Anatolii Tsarkov ◽  
Petro Petlovanyi ◽  
Gaise Kweku ◽  
Evans Musonda
Keyword(s):  
Physical Dependence ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
College Hospital ◽  
The Central Nervous System ◽  
Chronic Opioid Use ◽  
Opioid Withdrawal Syndrome ◽  
Recreational Use ◽  
Chronic Use

Opioid dependence is a disorder of the central nervous system that results from chronic use of opiates. Opioids cause intense feelings of euphoria, and this is what puts opiate users at risk of recreational use of these substances. There is a desire to increase the dose in order to enhance the effect of opioids, therefore addiction arises, which is a serious medical and social problem. The more opiates come from outside, the less natural opiates are produced, and more opiates are required to create a strong feeling of euphoria, which previously could be achieved with a lower dose. The consequence of a chronic opioid use is the drug tolerance, and abrupt cessation of use causes a serious condition of opioid withdrawal syndrome, indicating the presence of physical dependence. This article describes the experience and the case study of Medication Assisted Therapy (MAT) with buprenorphine and naloxone at Chainama Hills College Hospital in Lusaka, Zambia. 

scholarly journals Outcomes of Patients with COVID-19 in the Setting of Chronic Opioid Use Disorder

2020 ◽  
Author(s):  
PhD Heather F. Thiesset ◽  
MS Michael Newman ◽  
MD Joseph E. Tonna ◽  
PhD Ray M. Merrill
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Retrospective Chart Review ◽  
Opioid Use Disorder ◽  
Hospital Inpatient ◽  
Opioid Use ◽  
Inpatient Hospitalization ◽  
Increased Risk ◽  
Chronic Opioid Use

Abstract Background: There are no known studies regarding the effects of COVID-19 in patients with a concurrent diagnosis of opioid use disorder (OUD). Due to the rapidly developing nature and consequences of this disease, it is important to identify patients at an increased risk for serious illness. The aim of this study was to understand the disease burden of COVID-19 on patients with OUD by looking at their rates of hospitalization, admission to the intensive care unit (ICU), and receipt of mechanical ventilator support.Methods: This retrospective chart review compared clinical parameters from patients with positive COVID-19 status as identified by a positive SARS-CoV-2 PCR test and diagnosed OUD at the University of Utah Health. Descriptive statistics and prevalence ratios (PRs) were generated. Log binomial models generated PRs adjusted by age, sex, race, and comorbidities of asthma, pneumonia, and diabetes.Results: COVID-19 patients with OUD were significantly more likely than patients without OUD to have asthma (p<0.01), diabetes (p<0.01), and chronic pneumonia (p<0.01), to be hospitalized (23% vs 4%; p<0.01), to be admitted to the ICU (11% vs 2%; p<0.01), and to receive mechanical ventilation (7% vs 1%; p<0.01). After adjusting for age, sex, race, asthma, pneumonia, and diabetes, patients with OUD continued to be at increased risk for inpatient hospitalization (aPR=5.65, 95% confidence interval [CI]=2.29-13.92), intensive care unit (ICU) admission (aPR=0.69, 95% CI = 0.19-2.45), and mechanical ventilation (aPR=1.25, 95% CI =0.27-5.75). Patients with OUD averaged longer stays in the hospital than those without OUD (9.53 days vs 0.70 days, p<.001).Conclusion: Patients that have a diagnosis of OUD in the presence of COVID-19 are more likely to be hospitalized, admitted to the ICU, receive mechanical ventilation and have longer hospital inpatient stays compared to patients without OUD.

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