scholarly journals Opioid Epidemic: Diagnosed, Started on Treatment?

2021 ◽  
Vol 15 (2) ◽  
pp. 97-100
Author(s):  
Alexei M. Ovechkin

In the March 2021 issue of the journal Pharmacoepidemiology Drug Safety, an article by K. Bykov et al. was published, which contains an analysis of the use of opioid and non-opioid analgesics in US clinics in the period 20072017. According to the authors, the frequency of use of drugs in this group does not tend to decrease, despite the previously announced opioid epidemic in the USA. In Russia, the problem of the emergence of opioid dependence due to the perioperative use of drugs of this group is of little relevance. The existing legal restrictions on the prescription of opioid analgesics minimize this risk. But these same limitations make the idea of opioid-free analgesia very attractive in our country.

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Emmanuel Bäckryd ◽  
Markus Heilig ◽  
Mikael Hoffmann

Abstract Objectives Opioid analgesics are essential in clinical practice, but their excessive use is associated with addiction risk. Increases in opioid prescription rates have fuelled an epidemic of opioid addiction in the USA, making statistics on medical opioid use a critical warning signal. A dramatic 150% increase in Swedish opioid access 2001–2013 was recently reported based on data from the International Narcotics Control Board (INCB; Berterame et al. 2016) in conflict with other studies of opioid use in the Nordic countries. This article aims to analyse to what degree published INCB statistics on opioids in Scandinavia (Denmark, Norway and Sweden) reflect actual medical use and study the methodological reasons for putative discrepancies. Methods Data on aggregated total national sales of opioids for the whole population, including hospitals, were collected from the Swedish e-Health Authority. Total sales data for Denmark and drugs dispensed at pharmacies in Norway are publicly available through the relevant authorities’ websites. Results INCB opioid statistics during the period 2001–2013 were markedly inconsistent with sales data from Scandinavia, calling the reliability of INCB data into question. INCB-data were flawed by (a) over-representing the volume of fentanyl, (b) under-reporting of codeine, and (c) by not including tramadol. Conclusions Opioid availability, as expressed by INCB statistics, does not reflect medical opioid use. It is crucial to underline that INCB statistics are based on the manual compilation of national production, import and export data from manufacturers and drug companies. This is not the same amount that is prescribed and consumed within the health care system. Moreover, there are methodological problems in the INCB reports, in particular concerning fentanyl, codeine and tramadol. We suggest that INCB should carefully review the quality of their data on medical opioids.


Molecules ◽  
2020 ◽  
Vol 25 (18) ◽  
pp. 4163 ◽  
Author(s):  
Wolfgang Sadee ◽  
John Oberdick ◽  
Zaijie Wang

Opioid analgesics are effective pain therapeutics but they cause various adverse effects and addiction. For safer pain therapy, biased opioid agonists selectively target distinct μ opioid receptor (MOR) conformations, while the potential of biased opioid antagonists has been neglected. Agonists convert a dormant receptor form (MOR-μ) to a ligand-free active form (MOR-μ*), which mediates MOR signaling. Moreover, MOR-μ converts spontaneously to MOR-μ* (basal signaling). Persistent upregulation of MOR-μ* has been invoked as a hallmark of opioid dependence. Contrasting interactions with both MOR-μ and MOR-μ* can account for distinct pharmacological characteristics of inverse agonists (naltrexone), neutral antagonists (6β-naltrexol), and mixed opioid agonist-antagonists (buprenorphine). Upon binding to MOR-μ*, naltrexone but not 6β-naltrexol suppresses MOR-μ*signaling. Naltrexone blocks opioid analgesia non-competitively at MOR-μ*with high potency, whereas 6β-naltrexol must compete with agonists at MOR-μ, accounting for ~100-fold lower in vivo potency. Buprenorphine’s bell-shaped dose–response curve may also result from opposing effects on MOR-μ and MOR-μ*. In contrast, we find that 6β-naltrexol potently prevents dependence, below doses affecting analgesia or causing withdrawal, possibly binding to MOR conformations relevant to opioid dependence. We propose that 6β-naltrexol is a biased opioid antagonist modulating opioid dependence at low doses, opening novel avenues for opioid pain therapy and use management.


2019 ◽  
Vol 4 (6) ◽  
pp. e002079
Author(s):  
Shriya Srinivasan ◽  
Khalil B. Ramadi ◽  
Andrea Ippolito ◽  
Rifat Atun

The nationwide opioid epidemic has substantially impacted economically-depressed regions in the USA. Eastern Appalachia has some of the lowest socioeconomic indicators in the USA and has suffered the highest rate of opioid-related fatality in 2016. Despite devoting considerable federal and state resources towards public health initiatives, the region continued to experience one of the highest death rates and sought alternative approaches to address the opioid crisis. Here, we describe a community-based co-creation initiative that convened diverse sectors and utilised design thinking principles to generate sustainable public health ventures towards addressing the opioid crisis. Participants of diverse backgrounds came together to attack key challenges and developed and implemented solutions, including a mobile application for naloxone delivery and exercise programs for high schools to promote healthy habits. Grassroots innovation efforts catalysed by the event strengthened community engagement and facilitated a sense of agency among participants. Through specific examples of initiatives that were launched, we provide evidence to encourage and highlight the value of healthcare innovation efforts in low-resource settings.


2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Svetlana Madjunkova ◽  
Caroline Maltepe ◽  
Gideon Koren

Background. Nausea and vomiting of pregnancy (NVP) is the most common medical condition of pregnancy, affecting up to 85% of expecting mothers. In the USA, there is no FDA-approved medication for the treatment of NVP.Objective. To identify the primary concerns of American women leading them to contact the Motherisk NVP Helpline and to characterize the severity of their symptoms and therapy offered in order to develop improved and customized counseling for them.Methods. We reviewed the intake forms of the American women who called the NVP Helpline from 2008 to 2012. We extracted their state of residence, demographic data, severity of NVP symptoms, and other available clinical characteristics.Results. A total of 195 forms were reviewed. Of these, 86% called for information on management of NVP with/without questions about fetal drug safety, while 14% called solely about drug safety during pregnancy/breastfeeding. The majority of women were Caucasian, in their thirties, educated, employed, married and in their second pregnancy. Of them 95% were suffering from moderate-to-severe condition with 13% having hyperemesis gravidarum.Conclusion. American women need more information on the management of NVP and on a variety of its aspects in addition to the safety and effectiveness of antiemetic medications. Their leading concern was the use of doxylamine and vitamin B6 combination for NVP treatment followed by the use of ondansetron.


2017 ◽  
Vol 8 (3) ◽  
pp. 320-342 ◽  
Author(s):  
Jean-Marc Dewaele

Abstract The present exploratory study focuses on the effect of living outside the USA on the understanding of the meaning, the perceived offensiveness and the self-reported frequency of use of four English emotion-laden words of British origin and four English emotion-laden words of American origin among 556 first (L1) users of American English. Statistical analyses revealed that the scores of the Americans living in the UK or in non-English-speaking countries differed significantly from those of compatriots living in the USA. Positive relationships emerged between multilingualism and scores on the dependent variables for the four British words, but no link emerged between languages known and the dependent variables for the American words. This is interpreted as an indication that semantic representations of emotion-laden words originating from another variety of the L1 are relatively weaker and are more likely to shift as a result of exposure to their use in other varieties, and the knowledge of other languages.


2012 ◽  
Vol 3S;15 (3S;7) ◽  
pp. ES157-ES168 ◽  
Author(s):  
Daniel Krashin

Background: Human Immunodeficiency Virus (HIV) patients have an increased rate of chronic pain, particularly peripheral neuropathy. This disease burden causes considerable disability and negatively affects quality of life. Pain is undertreated and more complex to manage in these patients for a number of reasons, including complex anti-retroviral drug regimens, higher risks of side effects, and higher rates of comorbid psychiatric illness and substance abuse. Pain management must take these factors into account and use all available modalities, including nonopioid pain relievers, adjuvant medications, and psychosocial therapies in addition to opioid analgesics. Here we review recent recommendations regarding acute and chronic opioid treatment of pain and the treatment of opioid dependence in HIV-infected patients, and provide suggestions regarding aberrant behavior in pain treatment. Objectives: The objective of this comprehensive review is to assess and summarize the complicating factors involved in treating HIV patients’ pain with opioid analgesics. Study Design: This is a narrative review without a systematic quality assessment of the literature discussion. Methods: A comprehensive review of the literature relating to pain and pain treatment in HIV patients. The literature was collected from electronic databases, textbooks, and other sources. The scientific literature reviewed includes randomized trials, observational studies, systematic reviews, guidelines, and government reports. Results: This patient population is heterogeneous and diverse in their medical issues and comorbidities, but a systematic, stepwise approach to assessing and managing pain in HIV patients is described. Chronic opioid treatment has proven to be problematic and considerations and alternatives to this treatment are described. Management of pain in patients with opioid addiction, a frequent comorbidity of HIV infection, requires special awareness and different prescribing practices. Screening and identifying patients who are at special risk for developing medical or behavior complications of pain treatment is essential, and approaches to this, and common forms of aberrant behavior, are described. Limitations: The scientific literature on opioid treatment in this population is limited. The population of HIV patients is heterogeneous and differs in significant ways based on ethnicity, national origin, and mode of transmission, making it difficult to generalize about pain treatment in such a diverse group. Conclusions: Pain management in HIV patients must take these factors into account and use all available modalities for treatment, including nonopioid analgesics, adjuvant medications, and psychosocial therapies. Opioid analgesics should be prescribed with caution in accordance with current guidelines and after careful risk assessment. Key words: HIV, Human Immunodeficiency Virus, acute pain, chronic pain, psychiatric comorbidity, opioid dependence, opioids, chronic opioid therapy, substance abuse.


1988 ◽  
Vol 7 (5) ◽  
pp. 465-467 ◽  
Author(s):  
P.N. Bennett

1 Present attitudes to drug safety have been shaped largely by a series of disasters. 2 In 1937 about 107 people in the USA died of poisoning by diethylene glycol used as a vehicle for sulphanilamide which led to the requirement that all formulations must be licensed by the FDA before marketing. 3 Up to 1960 the rate of production of new drugs outstripped the ability to introduce them safely. In Germany, thalidomide, an effective sedative, had been introduced in 1956 but it was not until 1961, when an estimated 10 000 babies worldwide had been born with birth deformities, that the teratogenicity of this compound was recognized. 4 Further legislation soon followed, both reducing the number and lengthening the time required to introduce a new drug onto the market. However, problems were encountered with practolol in the 1970s and with benoxaprofen in the 1980s, the latter highlighting the need to make special provision for drug use in the elderly. 5 As to the future, more attention will be paid to the special needs of children and to the possible effects of genetic differences in metabolism.


Anaesthesia ◽  
2013 ◽  
Vol 68 (12) ◽  
pp. 1215-1219 ◽  
Author(s):  
D. Weisberg ◽  
C. Stannard

2021 ◽  
Vol 14 (10) ◽  
pp. 1034
Author(s):  
Lamees Alhassen ◽  
Khawla Nuseir ◽  
Allyssa Ha ◽  
Warren Phan ◽  
Ilias Marmouzi ◽  
...  

The opioid epidemic was triggered by an overprescription of opioid analgesics. In the treatment of chronic pain, repeated opioid administrations are required which ultimately lead to tolerance, physical dependence, and addiction. A possible way to overcome this conundrum consists of a co-medication that maintains the analgesic benefits of opioids while preventing their adverse liabilities. YHS, the extract of the plant Corydalis yanhusuo, has been used as analgesic in traditional Chinese medicine for centuries. More recently, it has been shown to promote analgesia in animal models of acute, inflammatory, and neuropathic pain. It acts, at least in part, by inhibiting the dopamine D2 receptor, suggesting that it may be advantageous to manage addiction. We first show that, in animals, YHS can increase the efficacy of morphine antinociceptive and, as such, decrease the need of the opioid. We then show that YHS, when coadministered with morphine, inhibits morphine tolerance, dependence, and addiction. Finally, we show that, in animals treated for several days with morphine, YHS can reverse morphine dependence and addiction. Together, these data indicate that YHS may be useful as a co-medication in morphine therapies to limit adverse morphine effects. Because YHS is readily available and safe, it may have an immediate positive impact to curb the opioid epidemic.


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