scholarly journals Current status of opioid addiction treatment and related preclinical research

2019 ◽  
Vol 5 (10) ◽  
pp. eaax9140 ◽  
Author(s):  
M. J. Kreek ◽  
B. Reed ◽  
E. R. Butelman
Keyword(s):  
Addiction Treatment ◽  
Prolonged Exposure ◽  
Standard Of Care ◽  
Positive Influence ◽  
Opioid Addiction ◽  
Current Status ◽  
Opioid Use ◽  
Preclinical Research ◽  
Access To Treatment ◽  
Environment Stress

Opioid use disorders (OUDs) are diseases of the brain with behavioral, psychological, neurobiological, and medical manifestations. Vulnerability to OUDs can be affected by factors such as genetic background, environment, stress, and prolonged exposure to μ-opioid agonists for analgesia. Two standard-of-care maintenance medications, methadone and buprenorphine-naloxone, have a long-term positive influence on health of persons with opioid addiction. Buprenorphine and another medication, naltrexone, have also been approved for administration as monthly depot injections. However, neither medication is used as widely as needed, due largely to stigma, insufficient medical education or training, inadequate resources, and inadequate access to treatment. Ongoing directions in the field include (i) personalized approaches leveraging genetic factors for prediction of OUD vulnerability and prognosis, or for targeted pharmacotherapy, and (ii) development of novel analgesic medicines with new neurobiological targets with reduced abuse potential, reduced toxicity, and improved effectiveness, especially for chronic pain states other than cancer pain.

scholarly journals A call for consensus in defining efficacy in clinical trials for opioid addiction: combined results from a systematic review and qualitative study in patients receiving pharmacological assisted therapy for opioid use disorder

Trials ◽  
2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Brittany B. Dennis ◽  
Nitika Sanger ◽  
Monica Bawor ◽  
Leen Naji ◽  
Carolyn Plater ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Addiction Treatment ◽  
Treatment Effectiveness ◽  
Methadone Treatment ◽  
Population Level ◽  
Opioid Addiction ◽  
Complex Nature ◽  
Opioid Use ◽  
Structured Interviews ◽  
Patient Reported

Abstract Background Given the complex nature of opioid addiction treatment and the rising number of available opioid substitution and antagonist therapies (OSAT), there is no ‘gold standard’ measure of treatment effectiveness, and each successive trial measures a different set of outcomes which reflect success in arbitrary or opportune terms. We sought to describe the variation in current outcomes employed across clinical trials for opioid addiction, as well as determine whether a discrepancy exists between the treatment targets that patients consider important and how treatment effectiveness is measured in the literature. Methods We searched nine commonly used databases (e.g., EMBASE, MEDLINE) from inception to August 1, 2015. Outcomes used across trials were extracted and categorized according to previously established domains. To evaluate patient-reported goals of treatment, semi-structured interviews were conducted with 18 adults undergoing methadone treatment. Results We identified 60 trials eligible for inclusion. Once outcomes were categorized into eight broad domains (e.g., abstinence/substance abuse), we identified 21 specific outcomes with furthermore 53 subdomains and 118 measurements. Continued opioid use and treatment retention were the most commonly reported measures (46%, n = 28). The majority of patients agreed that abstinence from opioids was a primary goal in their treatment, although they also stressed goals under-reported in clinical trials. Conclusions There is inconsistency in the measures used to evaluate the effectiveness of OSATs. Individual and population level decision making is being guided by a standard of effect considered useful to researchers yet in direct conflict with what patients deem important. Trial registration PROSPERO, CRD42013006507.

scholarly journals Introduction to the Special Issue: Opioids and the Workplace—Urgent Action Needed

2021 ◽  
pp. 104829112110484
Author(s):  
Jonathan Rosen ◽  
Jennifer R. Zelnick ◽  
Jeanette Zoeckler ◽  
Paul Landsbergis
Keyword(s):  
Addiction Treatment ◽  
Workplace Safety ◽  
Opioid Use Disorder ◽  
Special Issue ◽  
Opioid Use ◽  
Access To Treatment ◽  
Assistance Programs ◽  
Worker Training ◽  
Drug Policies ◽  
Recovery Resources

The workplace has been a neglected element in the national response to the opioid crisis. This ignores that workplace safety and health and drug policies have become important factors in opioid use disorder among workers. This results from physical or emotional pain related to workplace injuries, illnesses, and stress, and through punitive workplace drug policies, failure to address stigma, and inadequate access to treatment and recovery resources. This comprehensive New Solutions special issue encompasses timely cutting-edge research, commentaries, activism, and calls for action on primary prevention in the workplace and intervention research. It also addresses the convergence of the COVID-19 and the opioid crises, high-risk occupations and industries, health inequalities, employer and union programs, peer advocacy and member assistance programs, worker training, health parity for addiction treatment and recovery services, protection of first responders and site clean-up workers, working conditions of substance use treatment workers, and calls for necessary funding.

scholarly journals Full A Call for Consensus in Defining Efficacy in Clinical Trials for Opioid Addiction: Combined Results from a Systematic Review and Qualitative Study in Patients Receiving Pharmacological Assisted Therapy for Opioid Use Disorder

2019 ◽  
Author(s):  
Brittany B. Dennis ◽  
Nitika Sanger ◽  
Monica Bawor ◽  
Leen Naji ◽  
Andrew Worster ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Addiction Treatment ◽  
Treatment Effectiveness ◽  
Methadone Treatment ◽  
Population Level ◽  
Opioid Addiction ◽  
Complex Nature ◽  
Opioid Use ◽  
Structured Interviews ◽  
Patient Reported

Abstract Background Given the complex nature of opioid addiction treatment and the rising number of available opioid substitution and antagonist therapies (OSAT), there is no ‘gold standard’ measure of treatment effectiveness, and each successive trial measures a different set of outcomes which reflect success in arbitrary or opportune terms.We sought to describe the variation in current outcomes employed across clinical trials for opioid addiction, as well as determine whether a discrepancy exists between the treatment targets that patients consider important and how treatment effectiveness is measured in the literature. Methods We searched nine commonly used databases (e.g. EMBASE, MEDLINE) from inception to August 1, 2015. Outcomes used across trials were extracted and categorized according to previously established domains. To evaluate patient reported goals of treatment, semi-structured interviews were conducted with 18 adults undergoing methadone treatment. Results We identified 60 trials eligible for inclusion. Once outcomes were categorized into eight broad domains (e.g. abstinence/substance abuse), we identified 21 specific outcomes with furthermore 53 subdomains and 118 measurements. Continued opioid use and treatment retention were the most commonly reported measures (46%, n=28). The majority of patients agreed that abstinence from opioids was a primary goal in their treatment, however they also stressed goals under-reported in clinical trials. Conclusion There is inconsistency in the measures used to evaluate the effectiveness of OSATs. Individual and population level decision making is being guided by a standard of effect considered useful to researchers yet in direct conflict with what patients deem important. PROSPERO ID CRD42013006507

Addiction Treatment as Prison Governance: A Critical Discourse Analysis of Methadone Delivery in Kyrgyz Prisons

2021 ◽  
pp. 009145092110607 ◽  
Author(s):  
Lyu Azbel ◽  
Daniel J. Bromberg ◽  
Sergii Dvoryak ◽  
Frederick L. Altice
Keyword(s):  
Eastern Europe ◽  
Central Asia ◽  
Critical Discourse Analysis ◽  
Addiction Treatment ◽  
Methadone Treatment ◽  
Opioid Addiction ◽  
Kyrgyz Republic ◽  
Opioid Use ◽  
Informal Governance ◽  
The Government

Methadone treatment is prescribed by evidence-based medicine as the most effective tool for the treatment of opioid addiction. Its implementation into high-need prison settings worldwide has been met with challenges, particularly in Eastern Europe and Central Asia where the opioid epidemic continues to expand. To address these impasses to intervention translation, we turn to post-structural approaches to policy analysis. These approaches open space for (re)thinking the ways that translated interventions emerge locally, by treating policy texts as social practices that make interventions in specific, sometimes unexpected, ways. We leverage Carol Bacchi’s post-structuralist analytic framework to interrogate how the object of methadone is constituted in Kyrgyz prisons through an analysis of the national legislative document, the “Government Program,” which provides the legislative basis for opioid addiction treatment administration in the Kyrgyz Republic. Rather than the medicalized methadone for the treatment of opioid use disorder, contained in the distinct objectivization of methadone emerging from this policy text, is the previously unexamined assumption that methadone is a particular type of governance. We describe a methadone object tied up with the shifting social structures that govern Kyrgyz prisons, divided between formal (state-run) and informal (prisoner-run) governance. In Kyrgyz prisons, where opioid policy discourse produces a divide between formal and informal governance, methadone emerges as a tool of the formal prison administration to regain control of the prisons from the practices of prisoner subculture. Although this study takes the Kyrgyz case as an example, the enactment of methadone as formal governance is likely to resonate throughout Eastern Europe and Central Asia, where there is a strong legacy of self-governing prisons. We conclude with a call for global health policymakers to consider how opioid addiction treatment is constituted within local governing relations, in ways that may depart sharply from the evidence base.

What's in a number? Recommending practicality in the DATA 2000 patient limits

2016 ◽  
Vol 12 (4) ◽  
pp. 243
Author(s):  
Andrea G. Barthwell, MD, DFASAM ◽  
Jonathan M. Young, JD, PhD ◽  
Michael C. Barnes, JD ◽  
Shruti R. Kulkarni, JD
Keyword(s):  
Addiction Treatment ◽  
Cost Benefit ◽  
Opioid Use Disorder ◽  
Full Time ◽  
Opioid Use ◽  
Addiction Medicine ◽  
Access To Treatment ◽  
The Us ◽  
Final Rule ◽  
Receive Treatment

According to the Substance Abuse and Mental Health Services Administration, 2.4 million individuals have an opioid use disorder (OUD). Yet, nearly 80 percent of them—more than 1.9 million people—do not receive treatment. Medication-assisted treatment (MAT), specifically with buprenorphine, has proven to be effective in treating patients with OUDs while also reducing costs to the healthcare system, criminal justice system, and workforce. Despite its effectiveness, barriers to MAT continue to exist. Consequently, many individuals must wait months, if not years, to receive treatment. This article analyzes the US Department of Health and Human Services’ final rule (Final Rule) on MAT, common barriers to treatment, and the cost-benefit of treatment in light of the current opioid abuse epidemic. The article finds that while the Final Rule was a step in the right direction, it does not go far enough to adequately address the epidemic. Finally, the article proposes practical recommendations for increasing patient access to treatment for OUDs, including increasing the patient limit for highly qualified addiction treatment providers so that they can practice addiction medicine on a full-time basis and exempting buprenorphine products labeled by the US Food and Drug Administration for direct administration from the practitioner's patient limit.

scholarly journals Implementation and Outcomes of a Comprehensive Tobacco Free Workplace Program in Opioid Treatment Centers

2021 ◽  
Vol 19 (1) ◽  
pp. 239
Author(s):  
Matthew Taing ◽  
Vijay Nitturi ◽  
Tzuan A. Chen ◽  
Bryce Kyburz ◽  
Isabel Martinez Leal ◽  
...  
Keyword(s):  
Tobacco Use ◽  
Tobacco Cessation ◽  
Addiction Treatment ◽  
Opioid Use Disorder ◽  
Opioid Addiction ◽  
Evidence Based ◽  
Opioid Use ◽  
Opioid Treatment ◽  
Tobacco Education ◽  
Treatment Settings

Tobacco use is exceedingly high among individuals receiving care for opioid addiction, but not commonly addressed by clinicians in treatment settings. Taking Texas Tobacco Free (TTTF) is a comprehensive tobacco-free workplace (TFW) program that builds treatment centers’ capacity to address tobacco use with evidence-based tobacco cessation policies and practices. Here, we examine the process and outcomes of TTTF’s implementation within 7 opioid addiction centers. Program goals were structured according to the RE-AIM framework. Pre- and post-implementation data were collected from client facing and non-client facing employees to assess changes in education, training receipt, knowledge, and intervention behaviors, relative to program goals. Centers reported tobacco screenings conducted and nicotine replacement therapy (NRT) delivered through 6 months post-implementation. Overall, 64.56% of employees participated in TTTF-delivered tobacco education, with a 54.9% gain in tobacco control and treatment knowledge (p < 0.0001), and significant increases in exposure to education about tobacco use and harms among individuals with opioid use disorder (p = 0.0401). There were significant gains in clinicians’ receipt of training in 9/9 tobacco education areas (ps ≤ 0.0118). From pre- to post-implementation, there were mean increases in the use of the 5A’s (ask, advise, assess, assist, and arrange) and other evidence-based interventions for tobacco cessation, with statistically significant gains seen in NRT provision/referral (p < 0.0001). Several program goals were achieved or exceeded; however, 100% center participation in specialized clinical trainings was among notable exceptions. One program withdrew due to competing pandemic concerns; all others implemented comprehensive TFW policies. Overall, TTTF may have improved participating opioid treatment centers’ capacity to address tobacco use, although study limitations, including lower post-implementation evaluation response rates, suggest that results require replication in other opioid addiction treatment settings.

scholarly journals A Call for Consensus in Defining Efficacy in Clinical Trials for Opioid Addiction: Combined Results from a Systematic Review and Qualitative Study in Patients Receiving Pharmacological Assisted Therapy for Opioid Use Disorder

2019 ◽  
Author(s):  
Brittany B. Dennis ◽  
Nitika Sanger ◽  
Monica Bawor ◽  
Leen Naji ◽  
Andrew Worster ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Addiction Treatment ◽  
Treatment Effectiveness ◽  
Methadone Treatment ◽  
Population Level ◽  
Opioid Addiction ◽  
Complex Nature ◽  
Opioid Use ◽  
Structured Interviews ◽  
Patient Reported

Abstract Background: Given the complex nature of opioid addiction treatment and the rising number of available opioid substitution and antagonist therapies (OSAT), there is no ‘gold standard’ measure of treatment effectiveness, and each successive trial measures a different set of outcomes which reflect success in arbitrary or opportune terms. We sought to describe the variation in current outcomes employed across clinical trials for opioid addiction, as well as determine whether a discrepancy exists between the treatment targets that patients consider important and how treatment effectiveness is measured in the literature. Methods: We searched nine commonly used databases (e.g. EMBASE, MEDLINE) from inception to August 1, 2015. Outcomes used across trials were extracted and categorized according to previously established domains. To evaluate patient reported goals of treatment, semi-structured interviews were conducted with 18 adults undergoing methadone treatment. Results: We identified 60 trials eligible for inclusion. Once outcomes were categorized into eight broad domains (e.g. abstinence/substance abuse), we identified 21 specific outcomes with furthermore 53 subdomains and 118 measurements. Continued opioid use and treatment retention were the most commonly reported measures (46%, n=28). The majority of patients agreed that abstinence from opioids was a primary goal in their treatment, however they also stressed goals under-reported in clinical trials. Conclusion: There is inconsistency in the measures used to evaluate the effectiveness of OSATs. Individual and population level decision making is being guided by a standard of effect considered useful to researchers yet in direct conflict with what patients deem important. PROSPERO ID: CRD42013006507 Key Words: opioid addiction; clinical trials; efficacy; methodology; patient important outcomes; treatment effectiveness

scholarly journals A Call for Consensus in Defining Efficacy in Clinical Trials for Opioid Addiction: Combined Results from a Systematic Review and Qualitative Study in Patients Receiving Pharmacological Assisted Therapy for Opioid Use Disorder

2019 ◽  
Author(s):  
Brittany B. Dennis ◽  
Nitika Sanger ◽  
Monica Bawor ◽  
Leen Naji ◽  
Andrew Worster ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Addiction Treatment ◽  
Treatment Effectiveness ◽  
Methadone Treatment ◽  
Population Level ◽  
Opioid Addiction ◽  
Complex Nature ◽  
Opioid Use ◽  
Structured Interviews ◽  
Patient Reported

Abstract Background Given the complex nature of opioid addiction treatment and the rising number of available opioid substitution and antagonist therapies (OSAT), there is no ‘gold standard’ measure of treatment effectiveness, and each successive trial measures a different set of outcomes which reflect success in arbitrary or opportune terms.We sought to describe the variation in current outcomes employed across clinical trials for opioid addiction, as well as determine whether a discrepancy exists between the treatment targets that patients consider important and how treatment effectiveness is measured in the literature. Methods We searched nine commonly used databases (e.g. EMBASE, MEDLINE) from inception to August 1, 2015. Outcomes used across trials were extracted and categorized according to previously established domains. To evaluate patient reported goals of treatment, semi-structured interviews were conducted with 18 adults undergoing methadone treatment. Results We identified 60 trials eligible for inclusion. Once outcomes were categorized into eight broad domains (e.g. abstinence/substance abuse), we identified 21 specific outcomes with furthermore 53 subdomains and 118 measurements. Continued opioid use and treatment retention were the most commonly reported measures (46%, n=28). The majority of patients agreed that abstinence from opioids was a primary goal in their treatment, however they also stressed goals under-reported in clinical trials. Conclusion There is inconsistency in the measures used to evaluate the effectiveness of OSATs. Individual and population level decision making is being guided by a standard of effect considered useful to researchers yet in direct conflict with what patients deem important. PROSPERO ID CRD42013006507

Cannabinoids in Opioid Addiction Treatment: Pharmacological Mechanisms

2019 ◽  
Vol 07 (02) ◽  
Author(s):  
Qi K Zuo ◽  
Kelsey L Tam ◽  
Alex Bekker ◽  
Wanhong Zuo ◽  
Jiang-Hong Ye
Keyword(s):  
Addiction Treatment ◽  
Opioid Addiction

scholarly journals Polymeric Biomaterials for the Treatment of Cardiac Post-Infarction Injuries

Pharmaceutics ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 1038
Author(s):  
Sonia Trombino ◽  
Federica Curcio ◽  
Roberta Cassano ◽  
Manuela Curcio ◽  
Giuseppe Cirillo ◽  
...  
Keyword(s):  
Tissue Engineering ◽  
Cardiac Tissue ◽  
Polymeric Nanoparticles ◽  
Three Dimensional ◽  
Cardiac Regeneration ◽  
Biological Properties ◽  
Positive Influence ◽  
Regenerative Process ◽  
Current Status ◽  
Polymeric Biomaterials

Cardiac regeneration aims to reconstruct the heart contractile mass, preventing the organ from a progressive functional deterioration, by delivering pro-regenerative cells, drugs, or growth factors to the site of injury. In recent years, scientific research focused the attention on tissue engineering for the regeneration of cardiac infarct tissue, and biomaterials able to anatomically and physiologically adapt to the heart muscle have been proposed as valuable tools for this purpose, providing the cells with the stimuli necessary to initiate a complete regenerative process. An ideal biomaterial for cardiac tissue regeneration should have a positive influence on the biomechanical, biochemical, and biological properties of tissues and cells; perfectly reflect the morphology and functionality of the native myocardium; and be mechanically stable, with a suitable thickness. Among others, engineered hydrogels, three-dimensional polymeric systems made from synthetic and natural biomaterials, have attracted much interest for cardiac post-infarction therapy. In addition, biocompatible nanosystems, and polymeric nanoparticles in particular, have been explored in preclinical studies as drug delivery and tissue engineering platforms for the treatment of cardiovascular diseases. This review focused on the most employed natural and synthetic biomaterials in cardiac regeneration, paying particular attention to the contribution of Italian research groups in this field, the fabrication techniques, and the current status of the clinical trials.

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