scholarly journals The Effect of Single High-dose Buprenorphine on Opioid Craving and Relapse

2019 ◽  
Author(s):  
Jamshid Ahmadi ◽  
Mina SefidfardJahromi ◽  
Dara Ghahremani ◽  
Edythe D. London
Keyword(s):  
Statistical Significance ◽  
Opioid Use Disorder ◽  
Opioid Withdrawal ◽  
High Dose ◽  
Opioid Use ◽  
Single High Dose ◽  
High Doses ◽  
Long Acting ◽  
Drug Free

Abstract Background: Buprenorphine, a treatment for Opioid Use Disorder, has liability for diversion and abuse. Use of single high doses of buprenorphine that are supervised avoid issues with diversion that occur with unsupervised or take home doses. Such doses have the potential to act as an initial opioid detox, facilitate transition to opioid antagonists or drug free treatments, as well as to maintenance treatment. Objective: To assess effects of a single, physician-administered high dose of buprenorphine on craving and on early relapse. Method: Sixty men who used heroin, opium or prescription opioids and met DSM-5 criteria for Opioid Use Disorder received a single, sublingual dose of buprenorphine (32 mg, 64 mg or 96 mg; n’s = 20, 21, and 19) as inpatients on a psychiatric unit. Buprenorphine was administered when patients were in moderate opioid withdrawal (4-5 symptoms). Self-reports of craving were taken at baseline and daily for the next 13 days, and relapse was assessed 1 and 2 months. Findings: Craving was reduced from baseline in each of the three groups (p < 0.0005), but the doseXtime interaction did not reach statistical significance (p= 0.069). Follow-up assessments at 1- and 2-months indicated significantly lower relapse rates for the higher-dose groups than for the low-dose group (p < 0.05). Conclusions: A single high dose of buprenorphine provides rapid relief of opioid craving and positively impacts relapse rate in the initial 1- and 2-months of outpatient treatment. Further investigation of single high-dose buprenorphine for early treatment of patients with Opioid Use Disorder is warranted as an alternative when buprenorphine/naloxone or long-acting buprenorphine dosage forms are not available. Keywords: Buprenorphine; opioid dependence; opioid withdrawal; craving

scholarly journals The Effect of Single High-dose Buprenorphine on Opioid Craving and Relapse

2019 ◽  
Author(s):  
Jamshid Ahmadi ◽  
Mina SefidfardJahromi ◽  
Dara Ghahremani ◽  
Edythe D. London
Keyword(s):  
Statistical Significance ◽  
Opioid Use Disorder ◽  
High Dose ◽  
Opioid Use ◽  
Single High Dose ◽  
Treatment Objective ◽  
High Doses ◽  
Long Acting ◽  
Drug Free

Abstract Background: Buprenorphine, a treatment for Opioid Use Disorder, has liability for diversion and abuse. Use of single high doses of buprenorphine that are supervised avoid issues with diversion that occur with unsupervised or take home doses. Such doses have the potential to act as an initial opioid detox, facilitate transition to opioid antagonists or drug free treatments, as well as to maintenance treatment. Objective: To assess effects of a single, physician-administered high dose of buprenorphine on craving and on early relapse. Method: Sixty men who used heroin, opium or prescription opioids and met DSM-5 criteria for Opioid Use Disorder received a single, sublingual dose of buprenorphine (32 mg, 64 mg or 96 mg; n’s = 20, 21, and 19) as inpatients on a psychiatric unit. Buprenorphine was administered when patients were in moderate opioid withdrawal (4-5 symptoms). Self-reports of craving were taken at baseline and daily for the next 13 days, and relapse was assessed 1 and 2 months. Findings: Craving was reduced from baseline in each of the three groups (p < 0.0005), but the doseXtime interaction did not reach statistical significance (p= 0.069). Follow-up assessments at 1- and 2-months indicated significantly lower relapse rates for the higher-dose groups than for the low-dose group (p < 0.05). Conclusions: A single high dose of buprenorphine provides rapid relief of opioid craving and positively impacts relapse rate in the initial 1- and 2-months of outpatient treatment. Further investigation of single high-dose buprenorphine for early treatment of patients with Opioid Use Disorder is warranted as an alternative when buprenorphine/naloxone or long-acting buprenorphine dosage forms are not available.

scholarly journals Using Microdosing to Induct Patients Into a Long-Acting Injectable Buprenorphine Depot Medication in Low Threshold Community Settings: A Case Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Joseph Tay Wee Teck ◽  
Alexander Baldacchino ◽  
Lauren Gibson ◽  
Con Lafferty
Keyword(s):  
Methadone Treatment ◽  
Opioid Use Disorder ◽  
High Dose ◽  
Opioid Use ◽  
Access To Treatment ◽  
Medication Assisted Treatment ◽  
Low Threshold ◽  
Healthcare Innovation ◽  
Long Acting

Healthcare innovation has never been more important as it is now when the world is facing up to the unprecedented challenges brought by the COVID-19 pandemic. Within addictions services in Scotland, the priority has been to tackle our rising drug related death rate by maintaining and improving access to treatment while protecting frontline workers and managing operational challenges as a result of the pandemic. We present here a case study of five patients with opioid use disorder whose treatment represents a confluence of three important Medication Assisted Treatment (MAT) service innovations. The first was a low threshold drop in and outreach MAT service to rapidly and safely initiate opiate replacement therapy (ORT). The second was the provision of a microdosing regimen to enable same day induction to oral buprenorphine while minimizing the risk of precipitated opioid withdrawals and/or treatment disengagement. The third was rapid transitioning to an injectable long-acting buprenorphine depot which reduced unnecessary face to face patient contact and treatment non-adherence. This case study of five patients highlights the valuable role that buprenorphine microdosing can play in making induction to long-acting buprenorphine depot feasible to a broader range of patients, including those on a high dose methadone treatment regime.

End Stage Chronic Pain (ESCP): Naming Complex Suffering in the Opioid Crisis Era

2020 ◽  
pp. 104990912096962
Author(s):  
George Comerci ◽  
Lisa Marr ◽  
Esme Finlay
Keyword(s):  
Chronic Pain ◽  
Opioid Use Disorder ◽  
High Dose ◽  
Opioid Use ◽  
Opioid Crisis ◽  
Dramatic Decline ◽  
Cdc Guidelines ◽  
Severe Chronic Pain ◽  
High Doses ◽  
End Stage

The “opioid crisis” stemming from overprescribing of prescription opioids describes an iatrogenic situation which has resulted in a rise in opioid use disorder (OUD) and overdose deaths. Many of these patients suffer from chronic non-cancer pain syndromes (CNCP) who have been injudiciously treated with opioids. Some patients with CNCP are treated successfully with opioids in accordance with modern guidelines. There is a very complex, small group of patients with CNCP who require higher than recommended dosages of opioids when other modalities and treatments have failed. We describe such a patient and believe that there is a subset of patients with unremitting suffering from chronic pain which we have called end-stage chronic pain (ESCP). These patients, despite receiving expert chronic pain care, often require high doses of opioids and suffer a dramatic decline in quality of life (QOL), function and an increase in their suffering when their opioids are tapered or discontinued. We have responded to the treatment of this group of patients by critically examining our approach to the use of opioids for their pain and attempting to reconcile high dose opioids in the setting of the Center for Disease Control (CDC) guidelines. We describe a patient with severe chronic pain from congenital spinal disease who experienced increased pain and suffering when his opioids were tapered. We will discuss our approach to this patient and in doing so discuss the concept of ESCP and proposed criteria for the use of high dose opioids in such patients.

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.

Initiation of Long-Acting Opioids Following Hospital Discharge Among Medicare Beneficiaries

2021 ◽  
Author(s):  
Bhushan R Deshpande ◽  
Ellen P McCarthy ◽  
Yoojin Jung ◽  
Timothy S Anderson ◽  
Shoshana J Herzig
Keyword(s):  
Hospital Discharge ◽  
Hospice Care ◽  
Opioid Use Disorder ◽  
High Dose ◽  
Medicare Beneficiaries ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Short Acting ◽  
Long Acting

Guidelines recommend against initiating long-acting opioids during acute hospitalization, owing to higher risk of overdose and morbidity compared to short-acting opioid initiation. We investigated the incidence of long-acting opioid initiation following hospitalization in a retrospective cohort of Medicare beneficiaries with an acute care hospitalization in 2016 who were ≥65 years old, did not have cancer or hospice care, and had not filled an opioid prescription within the preceding 90 days. Among 258,193 hospitalizations, 47,945 (18.6%) were associated with a claim for a new opioid prescription in the week after hospital discharge: 817 (0.3%) with both short- and long-acting opioids, 125 (0.1%) with long-acting opioids only, and 47,003 (18.2%) with short-acting opioids only. Most long-acting opioid claims occurred in surgical patients (770 out of 942; 81.7%). Compared with beneficiaries prescribed short-acting opioids only, beneficiaries prescribed long-acting opioids were younger, had a higher prevalence of diseases of the musculoskeletal system and connective tissue, and had more known risk factors for opioid-related adverse events, including anxiety disorders, opioid use disorder, prior long-term high-dose opioid use, and benzodiazepine co-prescription. These findings may help target quality-improvement initiatives.

scholarly journals A qualitative examination of the current management of opioid use disorder and barriers to prescribing buprenorphine in a Canadian emergency department

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
David Wiercigroch ◽  
Patricia Hoyeck ◽  
Hasan Sheikh ◽  
Jennifer Hulme
Keyword(s):  
Current Knowledge ◽  
Opioid Use Disorder ◽  
Opioid Withdrawal ◽  
Barriers And Facilitators ◽  
Provider Education ◽  
Opioid Use ◽  
Structured Interviews ◽  
Addiction Medicine ◽  
Allied Health Professionals

Abstract Background Emergency departments (EDs) across Canada are increasingly prescribing buprenorphine for opioid use disorder (OUD). The objective of this study was to identify the current knowledge, attitudes, and behaviours of ED physicians on the management of OUD in the ED, including barriers and facilitators to prescribing buprenorphine. Methods We purposefully selected emergency physicians from one ED in Toronto which had recently received education on OUD management and had a new addiction medicine follow-up clinic, to participate in semi-structured interviews. We used semi-structured interviews to explore experiences with patients with OUD, conceptions of role of the ED in addressing OUD, and specifically ask about perceptions and experience on using buprenorphine for opioid withdrawal. Our analysis was informed by constructivist grounded theory to help uncover contextualized social processes and focus on what people do and why they do it. Two researchers independently coded transcripts using an iterative constant comparative and interpretative approach. Results Results fell broadly into facilitators and barriers. Generally, management of OUD in the ED varied significantly. Physician-level facilitators to treating opioid withdrawal with buprenorphine included: knowledge about OUD an7d buprenorphine, positive experiences with substitution therapy in the past, and the presence of physician champions. Systems-level facilitators included timely access to follow-up care and pre-printed order sets. Barriers included provider inexperience, lack of feedback on treatment effectiveness, limited time to counsel patients, and pressure to discharge patients quickly. Additional barriers included concerns about precipitating withdrawal, prescribing a chronic medication in acute care, and patient attitudes. Conclusion This study describes barriers and facilitators to addressing OUD and prescribing buprenorphine in a Canadian ED. These findings suggest a role for additional provider education, involvement of allied health professionals in counseling, and mentorship by physician champions in the department.

scholarly journals AB0601 RAPID AND SUSTAINED EFFICACY OF AN INDUCTION TREATMENT WITH A TRIPLE THERAPY INCLUDING HIGH-DOSE INTRAVENOUS IMMUNOGLOBULINS, METHOTREXATE AND GLUCOCORTICOIDS IN ANTI-3-HYDROXY-3-METHYLGLUTARYL-COENZYME A REDUCTASE MYOPATHY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1597.1-1597
Author(s):  
E. Treppo ◽  
M. Infantino ◽  
M. Benucci ◽  
V. Ravagnani ◽  
B. Palterer ◽  
...  
Keyword(s):  
Triple Therapy ◽  
Antibody Titer ◽  
Intravenous Immunoglobulins ◽  
High Dose ◽  
Sustained Remission ◽  
Red Rice ◽  
Gradual Improvement ◽  
High Doses ◽  
High Dose Ivig

Background:Anti-3-hydroxy-3-methylglutaryl-coenzime A reductase (HMGCR) myopathy is a new entity, which has been clearly associated to statin use, even if it can be diagnosed in patients without a history of exposure to statin or even in the childhood (1).Objectives:The aim of the study is to describe the efficacy of a triple therapy regimen consisting in high-doses of intravenous immunoglobulins (IVIG), methotrexate (MTX), and glucocorticoids (GC) in 16 patients with Anti-HMGCR myopathy enrolled in 6 specialized centres.Methods:A total of 16 patients with anti-HMGCR myopathy (7 females; 9 males) were collected. Mean (±standard deviation) age at the onset of disease was 72.4±10.3 years old. All patients were diagnosed having anti-HMGCR myopathy [anti-HMGCR antibodies were measured by chemiluminescence assay (BioFlash, Inova, CA)] (2). Median follow-up was 29.5 months (interquartile range: 15.75-60 months). Anti-HMGCR antibodies were available in the follow-up in 8/16 patients.Results:Thirteen out of 16 patients (81.3%) had been exposed to statin (1/13 to red rice), 3/16 (18.7%) were not exposed. As induction therapy, 11/16 patients have been treated with triple therapy (high-dose IVIG, MTX and GC), 2/16 with double therapy (high-dose IVIG and GC), 2/16 have been treated with GC alone, the patient exposed to red rice resolved only with red rice suspension. Clinical remission and normalization of CPK values within month +24 were obtained in all the patients. All the patients were in remission at the last follow-up. Gradual improvement started soon from the first month, and among the 13 patients treated with an aggressive immunosuppresssive therapy including IVIG (13/13), GC (13/13) and methotrexate (11/13), 9/13 normalized the CPK value within 6 months. Clinical and laboratory response was accompanied by significant decrease or normalization of the anti-HMGCR antibody titer. All the patients were either not taking GC (56.3%), or were taking low doses of GC (43.7%) at the last follow-up. Four patients had stopped GC within 6 months. No serious side effects were recorded. After persistent remission, a maintenance immunosuppressive therapy was then administered. Only 3 relapses in 3 different cases were recorded, all of them during drug-free remission in long-term follow-up. Reinduction was again effective in all.Conclusion:Anti-HMGCR myopathy is a rare and serious myopathy which usually affects older people during statin treatment. After statin suspension, a rapid and sustained remission can be achieved by induction with a triple aggressive therapy consisting in medium-to high doses of GC, high-dose IVIG, and MTX (3). GC should be tapered as soon as possible. Relapse appears infrequent during maintenance treatment. Monitoring anti-HMGCR antibody titer may be clinically relevant.References:[1]AL Mammen et al. N Engl J Med. 2016;374:664-9[2]Musset L et al. Autoimmun Rev. 2016;15:983-93.[3]Aggarwal A et al. Scand J Rheumatol. 2019; 1-7.Acknowledgments:We thank MD Francesca Grosso and MD Valentina Mecheri from the University of Florence, MD Angela Zuppa and MD Chiara De Michelis, from San Martino Hospital, Genova, for their valued collaboration in data collectionDisclosure of Interests:Elena Treppo: None declared, Maria Infantino: None declared, Maurizio Benucci: None declared, Viviana Ravagnani: None declared, Boaz Palterer: None declared, Marina Grandis: None declared, Martina Fabris: None declared, Paola Tomietto: None declared, Mariangela Manfredi: None declared, Arianna Sonaglia: None declared, Maria Grazia Giudizi: None declared, Francesca Ligobbi: None declared, Daniele Cammelli: None declared, Paola Parronchi: None declared, Salvatore De Vita Consultant of: Roche, GSK, Speakers bureau: Roche, GSK, Novartis, Luca Quartuccio Consultant of: Abbvie, Bristol, Speakers bureau: Abbvie, Pfizer

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

scholarly journals Predictors of availability of long-acting medication for opioid use disorder

2019 ◽  
Vol 204 ◽  
pp. 107586 ◽  
Author(s):  
Chelsea L. Shover ◽  
Keith Humphreys
Keyword(s):  
Opioid Use Disorder ◽  
Opioid Use ◽  
Long Acting
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