scholarly journals Examining opioid withdrawal scoring and adaptation of global scoring systems to male and female C57BL/6J mice

2021 ◽  
Author(s):  
Isabel Bravo ◽  
Maya Bluitt ◽  
Zoe McElligott
Keyword(s):  
Internal State ◽  
Scoring Systems ◽  
Therapeutic Benefit ◽  
Opioid Use Disorder ◽  
Opioid Withdrawal ◽  
Opioid Use ◽  
Male And Female ◽  
Early Withdrawal ◽  
Behavioral Adaptations ◽  
Withdrawal Behaviors

Opioid Use Disorder (OUD) is a chronic and relapsing psychiatric condition which is currently the leading cause of accidental death in the US. Symptoms of acute opioid withdrawal resemble a flu-like illness which is accompanied by a dysphoric state. Psychological comorbidities such as anxiety, depression, and disordered sleep can persist for months or years, well into the abstinence period. These symptoms are thought to drive further opioid intake in order to alleviate this unpleasant internal state. Many differences in OUD have been documented between male and female patients, with females at higher risk for relapse and overdose. This study sets out to characterize sex differences in symptoms and behavioral adaptations in mice during early withdrawal. Using our moderate dose, three-day precipitated withdrawal paradigm, we discovered significant effects of sex, time, and drug treatment on early withdrawal behaviors, locomotor activity, and gut motility in C57BL/6J mice. Here I will discuss previous methods of condensing behavioral phenotypes into one global withdrawal score, and propose a new methodology. This method increases the ability to detect nuanced effects and allows for more accurate translation across strain, sex, paradigm, and experimental context. Classification of opioid withdrawal-induced behavioral adaptations will allow for improved behavioral analysis of pharmacological manipulations, and investigations of brain circuitry involved in opioid withdrawal, as well as future screening of compounds with potential therapeutic benefit for the treatment of OUD.

scholarly journals Divergent behavioral responses in protracted opioid withdrawal in male and female C57BL/6J mice

2019 ◽  
Author(s):  
Isabel M. Bravo ◽  
Brennon R. Luster ◽  
Meghan E. Flanigan ◽  
Patric J. Perez ◽  
Elizabeth S. Cogan ◽  
...  
Keyword(s):  
Elevated Plus Maze ◽  
Behavioral Responses ◽  
Opioid Use Disorder ◽  
Opioid Withdrawal ◽  
Neural Mechanisms ◽  
Morphine Dependence ◽  
Behavioral Adaptation ◽  
Opioid Use ◽  
Male And Female ◽  
Plus Maze

AbstractPersons suffering from opioid use disorder (OUD) experience long-lasting dysphoric symptoms well into extended periods of withdrawal. This protracted withdrawal syndrome is notably characterized by heightened anxiety. Here we investigate if an exacerbated withdrawal model of acute morphine dependence results in lasting behavioral adaptation 6 weeks into forced abstinence. We found that our exacerbated morphine withdrawal paradigm produced distinct impairments in elevated-plus maze, open field, and social interaction tests in male and female mice. These findings will be relevant for future investigation examining the neural mechanisms underlying these behaviors, and will aid in uncovering physiological sex differences in response to opioid withdrawal.

Maternal opioid use disorder: Placental transcriptome analysis for neonatal opioid withdrawal syndrome

Genomics ◽  
2021 ◽  
Author(s):  
Uppala Radhakrishna ◽  
Swapan K. Nath ◽  
Sangeetha Vishweswaraiah ◽  
Lavanya V. Uppala ◽  
Ariadna Forray ◽  
...  
Keyword(s):  
Transcriptome Analysis ◽  
Withdrawal Syndrome ◽  
Opioid Use Disorder ◽  
Opioid Withdrawal ◽  
Opioid Use ◽  
Opioid Withdrawal Syndrome

Elective Naloxone-Induced Opioid Withdrawal for Rapid Initiation of Medication-Assisted Treatment of Opioid Use Disorder

2019 ◽  
Vol 74 (3) ◽  
pp. 430-432 ◽  
Author(s):  
Reid H. Phillips ◽  
Matthew Salzman ◽  
Rachel Haroz ◽  
Rachel Rafeq ◽  
Anthony J. Mazzarelli ◽  
...  
Keyword(s):  
Opioid Use Disorder ◽  
Opioid Withdrawal ◽  
Opioid Use ◽  
Medication Assisted Treatment

Psychoeducational Strategies During Outpatient Transition to Extended-Release Naltrexone for Patients With Opioid Use Disorder

2018 ◽  
Vol 25 (4) ◽  
pp. 272-279
Author(s):  
Abigail Zavod ◽  
Sarah C. Akerman ◽  
Martha M. Snow ◽  
Matt Tierney ◽  
Maria A. Sullivan
Keyword(s):  
Treatment Adherence ◽  
Extended Release ◽  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Withdrawal ◽  
Opioid Use ◽  
Major Barrier ◽  
Supportive Interventions ◽  
Outpatient Utilization ◽  
Withdrawal Management

BACKGROUND: The United States is experiencing an opioid epidemic. Better approaches to encourage outpatient utilization of Food and Drug Administration–approved medications for the treatment of opioid use disorder, including extended-release naltrexone (XR-NTX), are needed. Withdrawal management before initiation of XR-NTX is challenging for clinicians and patients and represents a major barrier to treatment. AIMS: To review psychoeducational strategies that support patients during outpatient withdrawal management and transition to XR-NTX. METHOD: We reviewed the literature on psychoeducational strategies used during opioid withdrawal management and described the role that nurses can play in facilitating transition to XR-NTX in a Phase 3, placebo-controlled, outpatient trial comparing induction regimens. RESULTS: Supportive interventions include general psychoeducation on addiction, overcoming ambivalence, treatment adherence, anticipating XR-NTX induction, managing psychological and physiological aspects of opioid withdrawal, risks of opioid use, and sources of support during recovery. CONCLUSIONS: Psychoeducational strategies led by nurses can promote treatment adherence during withdrawal management and induction onto XR-NTX.

scholarly journals Buprenorphine therapy in the setting of induced opioid withdrawal from oral naltrexone: a case report

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Laura M. Szczesniak ◽  
Vincent J. Calleo ◽  
Ross W. Sullivan
Keyword(s):  
Emergency Department ◽  
Acute Treatment ◽  
Opioid Use Disorder ◽  
Opioid Withdrawal ◽  
Opioid Use ◽  
Accidental Ingestion ◽  
Heroin Use ◽  
Case Presentation ◽  
Acute Withdrawal ◽  
Oral Naltrexone

Abstract Background Patients with opioid use disorder (OUD) frequently present to the emergency department for acute treatment of overdose and withdrawal. Case presentation A 29-year-old male presented to the emergency room after intravenous heroin use followed by accidental ingestion of naltrexone. He was treated with buprenorphine with significant improvement in his Clinical Opioid Withdrawal Score, from moderately severe to mild withdrawal symptoms within a few hours. Conclusion Buprenorphine and minimal supportive care can be used to treat acute withdrawal precipitated by oral naltrexone in patients with OUD.

scholarly journals Kratom Use Within the Context of the Evolving Opioid Crisis and the COVID-19 Pandemic in the United States

2021 ◽  
Vol 12 ◽  
Author(s):  
Walter C. Prozialeck ◽  
Peter C. Lamar ◽  
Michael Krupp ◽  
Matthew Moon ◽  
Laura E. Phelps ◽  
...  
Keyword(s):  
United States ◽  
Chronic Pain ◽  
Southeast Asia ◽  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Withdrawal ◽  
Opioid Use ◽  
Potential Harm ◽  
History Of ◽  
Chronic Pain Conditions

Kratom (Mitragyna speciosa, Korth.) is an evergreen tree that is indigenous to Southeast Asia. When ingested, kratom leaves or decoctions from the leaves have been reported to produce complex stimulant and opioid-like effects. For generations, native populations in Southeast Asia have used kratom products to stave off fatigue, improve mood, alleviate pain and manage symptoms of opioid withdrawal. Despite the long history of kratom use in Asia, it is only within the past 10–20 years that kratom has emerged as an important herbal agent in the United States, where it is being used for the self-treatment of pain, opioid withdrawal symptoms, and mood disorders. The increase in the use of kratom in the United States has coincided with the serious epidemic of opioid abuse and dependence. Since 2015, efforts to restrict access to prescription opioids have resulted in a marked increase in the use of “street” opioids such as heroin and illicit fentanyl. At the same time, many patients with chronic pain conditions or opioid use disorder have been denied access to appropriate medical help. The lack of access to care for patients with chronic pain and opioid use disorder has been magnified by the emergence of the COVID-19 pandemic. In this report, we highlight how these converging factors have led to a surge in interest in kratom as a potential harm reduction agent in the treatment of pain and opioid use disorder.

scholarly journals Novel treatment of opioid use disorder using ibogaine and iboga in two adults

2020 ◽  
Author(s):  
Claire Wilson ◽  
Trevor Millar ◽  
Zak Matieschyn
Keyword(s):  
Addiction Treatment ◽  
Case Series ◽  
Opioid Use Disorder ◽  
Opioid Withdrawal ◽  
Opioid Use ◽  
Opioid Agonist ◽  
Opioid Agonist Therapy ◽  
Safety Risks ◽  
Short Period ◽  
Multiple Treatments

AbstractIbogaine is a naturally occurring psychedelic medicine with anti-addictive properties. While research on ibogaine is limited, several observational studies have shown ibogaine can mitigate opioid withdrawal, as seen with reductions in clinical and subjective opioid withdrawal scores and reduced drug use severity (Noller, Frampton, & Yazar-Klosinski, 2018; Brown & Alper 2018). Furthermore, the psychoactive experience may help individuals to realign their values, purpose and sense of connection, as seen with post treatment reductions in depression scores (Noller et al., 2018; Mash et al., 2000).Case seriesThis case series describes two cases of individuals accessing ibogaine through private unregulated clinics in the Vancouver area to treat their opioid use disorder.ConclusionsIn case 1, the client achieved total abstinence from all opioids within 5–6 days of starting ibogaine treatment, did not experience any opioid withdrawal symptoms after ibogaine treatment and maintained abstinence from opioids for 3 years. In case 2, the patient took ibogaine/iboga in multiple treatments over a short period of time (<4 months). The patient stopped all non-medical opioids after the first iboga treatment and then used ibogaine to aid with further dose reductions of her opioid agonist therapy (OAT) and has maintained abstinence from opioids for 2 years. Ibogaine offers a unique and novel therapeutic approach to treating opioid use disorder. Further studies are needed to establish the safety, risks and potential role for ibogaine as a mainstream, evidence-based addiction treatment.

Captagon use in a patient with iatrogenic opioid use disorder

2021 ◽  
Vol 10 ◽  
Author(s):  
Mohammed Hamdan ◽  
Samer El Hayek ◽  
Maya Bizri
Keyword(s):  
Middle Eastern ◽  
Opioid Use Disorder ◽  
Opioid Withdrawal ◽  
Psychotic Symptoms ◽  
Patient Counseling ◽  
Opioid Use ◽  
Case Presentation ◽  
Recreational Use ◽  
Reducing Properties

Background: Captagon or Fenethylline is a synthetic theophylline derivative of amphetamine that is widely available for recreational use in the Middle East. It has pain-reducing properties and is known to induce restlessness, irritability, and psychotic symptoms. Case presentation: A middle-aged man with iatrogenic opioid use disorder was admitted for acute cholecystitis. A week following cholecystectomy, the patient used Captagon while hospitalized to manage opioid withdrawal pain. He experienced waxing and waning episodes of irritability, aggressiveness, disorganized behaviors, delusions, and hallucinations, all concurrent with his Captagon intake. These episodes were managed similarly to intoxication with other stimulant types. Conclusion: Careful patient counseling and close follow-up are essential when opioids are prescribed. Captagon’s pain-reducing properties make it an attractive and dangerous option for Middle Eastern patients suffering from opioid withdrawal. Captagon intoxication is currently managed similarly to other stimulant types, but more studies are needed to develop management guidelines specific to this substance.

scholarly journals Comparing Methadone and Tincture of Opium for the Management of Opioid Withdrawal among Subjects with an Opioid Use Disorder

2019 ◽  
pp. 1-11
Author(s):  
Mohammad Jamalian ◽  
Milad Nasrollahzadeh ◽  
Amir Mohammad Kazemifar ◽  
Hasan Solhi
Keyword(s):  
Opioid Use Disorder ◽  
Opioid Withdrawal ◽  
Fecal Excretion ◽  
Opiate Withdrawal ◽  
Opioid Use ◽  
Double Blind ◽  
Runny Nose ◽  
Group 2 ◽  
The Individual ◽  
Group 1

Introduction: Drug addiction is associated with complications such as mortality, monetary burden, and various socioeconomic problems at the individual to the community level. Methadone and Tincture of Opium (TOP) are the most commonly used drugs to help addicts maintain their drug withdrawal process and eventually permanent withdrawal. Desirable clinical experiences have been reported in the use of these two agents in the management of opioid withdrawal. The purpose of this study was to compare the efficacy of methadone and TOP using Khomree method for detoxification of drug abuse. Materials and Methods: This study was a randomized double-blind clinical trial among opium addicts (at least one year of use) referred to Arak University of Medical Sciences. Seventy subjects were enrolled in the study according to inclusion and exclusion criteria and then randomly divided into two groups (n = 35, treated with methadone) and group 2 (n = 35, treated with TOP). Furthermore, patients were evaluated for withdrawal symptoms on days 1, 3, 7, 14 and 28 after treatment. Finally, the results were analyzed using SPSS 18 software. Results: Severity of sweating (group 1: P = 0.0001, group 2: P =0. 005), runny nose (P = 0.001), lacrimation (P = 0.001), chord reflex (P = 001.0), fecal excretion (group 1: P = 0.001, group 2: P = 0.01, muscle twitches (P = 0.001), drooling (P = 0.001) warming sensation (P = 0.0001) and substance seeking (group 1: P = 0.0001, P = 0.008) in both groups were significantly improved during 28 days of treatment. Conclusion: Methadone and TOP detoxification are both effective in opioid withdrawal syndrome and the effect of methadone and TOP in opiate withdrawal are not preferable. However, further studies are recommended.

scholarly journals Naloxone precipitated withdrawal increases dopamine release in the dorsal striatum of opioid dependent men

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ehsan Shokri-Kojori ◽  
Gene-Jack Wang ◽  
Nora D. Volkow
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Brain Function ◽  
Dorsal Striatum ◽  
Opioid Use Disorder ◽  
Opioid Withdrawal ◽  
Opioid Antagonist ◽  
Opioid Use ◽  
Precipitated Withdrawal ◽  
Da Release

AbstractDopamine (DA) neurotransmission is critical in the neurobiology of reward and aversion, but its contribution to the aversive state of opioid withdrawal remains unknown in humans. To address this, we used updated voxelwise methods and retrospectively analyzed a [11C]raclopride-PET dataset to measure D2/3 receptor availability and relative cerebral blood flow (R1) in male opioid use disorder (OUD) participants (n = 10) during placebo and acute opioid withdrawal conditions. We found that acute withdrawal precipitated by the opioid antagonist naloxone significantly increased dorsal striatal DA release in OUD participants (pFWE < 0.05). Net changes in striatal DA were significantly correlated with a subjective index of withdrawal aversion such that greater DA increases were associated with more aversive responses (r(8) = 0.82, p < 0.005). Withdrawal also affected brain function, as indexed by increases in relative cerebral blood flow in the insula and putamen (pFWE < 0.05). Our findings are different from preclinical studies that have primarily reported decreases in ventral striatal DA during naloxone precipitated withdrawal, whereas this effect was not significant in OUD participants (p = 0.79). In sum, we provide evidence for the contribution of increases in dorsal striatal DA to the aversive state of naloxone precipitated withdrawal in humans.

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