scholarly journals What Differs between Patients under Methadone and under Buprenorphine for Opioid Use Disorder (OUD) in Daily Clinical Practice in France? A Short Report

2021 ◽  
Vol 18 (4) ◽  
pp. 1425
Author(s):  
Morgane Guillou-Landreat ◽  
Antoine Dany ◽  
Gaëlle Challet-Bouju ◽  
Edouard Laforgue ◽  
Juliette Leboucher ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Opioid Use Disorder ◽  
Term Treatment ◽  
Pharmacological Therapy ◽  
Daily Clinical Practice ◽  
Short Report ◽  
Opioid Use ◽  
Cross Sectional ◽  
Long Term Treatment ◽  
Social Profiles

(1) Background: Opioid use disorder (OUD) is a complex condition that can require long-term treatment. Pharmacological therapy for OUD involves treatment with opioid agonists (OMT) tailored to individual profiles. The aim of our study in daily clinical practice was to compare the profiles of patients treated with methadone (MTD) and those using buprenorphine (BHD or BHD-naloxone-NX). (2) Methods: A cross-sectional multicentre study explored the psychological, somatic and social profiles of patients with Opioid Use Disorder (OUD) following Opioid Maintenance Treatment (BHD, BHD/NX, or MTD). Descriptive and comparative analyses were performed (3) Results: 257 patients were included, a majority were men using heroin. 68% (178) were on MTD, 32% (79) were on BHD. Patients with MTD were significantly more likely to report socio-affective damage, and more likely to be younger and not to report oral or sublingual use as the main route for heroin or non-medical opioids (4) Conclusions: In daily clinical practice, regarding OUD damage, only socio-affective damage was significantly more prevalent among patients on MTD than among those on BHD in the multivariate model. Age and route of administration also differed, and our results could raise the issue of the type of OMT prescribed in case of non-medical use of prescribed opioids. These hypothesis should be confirmed in larger studies.

scholarly journals Long-term treatment outcomes in a First Nations high school population with opioid use disorder

2020 ◽  
Vol 66 (12) ◽  
pp. 907-912
Author(s):  
Anita Srivastava ◽  
Meldon Mayer Kahan ◽  
Mae Katt ◽  
Tammy Patriquin ◽  
Henry Becker ◽  
...  
Keyword(s):  
High School ◽  
Treatment Outcomes ◽  
First Nations ◽  
Opioid Use Disorder ◽  
Term Treatment ◽  
Opioid Use ◽  
School Population ◽  
Long Term Treatment

Methadone for Opioid Use Disorder

2020 ◽  
pp. 139-154
Author(s):  
Dennis J. Hand
Keyword(s):  
Addiction Treatment ◽  
Methadone Treatment ◽  
Opioid Use Disorder ◽  
Term Treatment ◽  
Opioid Use ◽  
Opioid Agonist ◽  
Long Term Treatment ◽  
Long Acting ◽  
Practical Factors

Methadone is a long-acting full opioid agonist that has a long history in the treatment of opioid use disorder (OUD). It was the first opioid agonist with OUD as an indication for use. Methadone was developed for OUD during a time of prohibition and criminalization of both addiction and the use of opioid agonists for addiction treatment, which resulted in methadone being heavily regulated at multiple levels. Methadone is frequently used in short-term withdrawal management (i.e., detoxification) and in long-term treatment, with the latter producing better treatment outcomes. This chapter explores the basic pharmacology of methadone and the development of methadone for OUD and its accompanying regulations, discusses the place of methadone in treatment for OUD, reviews the effectiveness of methadone treatment, and visits some practical factors related to methadone as part of treatment for OUD.

scholarly journals Development of a Web Tool to Calculate the Cumulative Dose of Glucocorticoids

2021 ◽  
Author(s):  
Nuria Montero-Pastor ◽  
Jesús Sánchez-Costa ◽  
Mercedes Guerra-Rodríguez ◽  
Clara Moriano ◽  
Javier Loricera ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Side Effects ◽  
Cumulative Dose ◽  
Web Application ◽  
Dose Calculation ◽  
Term Treatment ◽  
Daily Clinical Practice ◽  
Free Access ◽  
Average Dose ◽  
Long Term Treatment

Abstract Glucocorticoids are associated with many serious side effects, most of which are related to dosing and time of use. Correct assessment of cumulative dose, especially in patients undergoing long-term treatment, is essential to determine the risk of undesirable glucocorticoid-related events. Unfortunately, there is no standard method currently available for determining exposure to glucocorticoids in daily clinical practice. The aim of this work was to create an easy-to-use free-access web application to help clinicians and researchers calculate, in a systematic way, the cumulative dose of corticosteroids in their patients. The total cumulative dose is calculated as the sum of all periods of treatment with different doses of oral or intravenous corticosteroids, and is expressed as the equivalent dose of prednisone in mg. The doses of glucocorticoids during the periods without information are estimated by first determining the average doses between the previous and subsequent periods for which such information is available, and then multiplying that average dose by the number of days of the period. If the day on which glucocorticoids were discontinued is unknown, it is assumed to be the day before the start of the next known treatment period. For unknown start dates, the day after the end of the known prior period is used. In conclusion, this tool simplifies and, through the systematic application of assumptions when information is incomplete, standardizes the glucocorticoids cumulative dose calculation, minimizing bias in the assessment of glucocorticoid-related side effects in the context of daily clinical practice.

scholarly journals Development of an Emergency Department-Based Intervention to Expand Access to Medications for Addiction Treatment for Opioid Use Disorder in Appalachia: Protocol for Engagement and Community Collaboration (Preprint)

2020 ◽  
Author(s):  
Lauren A. Walter ◽  
LI Y. Li ◽  
Joel Rodgers ◽  
Jennifer Hess ◽  
Rachel Skains ◽  
...  
Keyword(s):  
Addiction Treatment ◽  
The United States ◽  
Opioid Use Disorder ◽  
Term Treatment ◽  
Opioid Overdose ◽  
Jefferson County ◽  
Opioid Use ◽  
Resource Limited ◽  
Long Term Treatment

BACKGROUND The opioid epidemic has disproportionately impacted the Appalachian region of the United States (US), a region characterized by higher poverty rates, healthcare access challenges, and higher opioid overdose death rates than other parts of the country. Jefferson County, Alabama, located in Southern Appalachia, has been especially affected, with overdose rates over two times greater than the statewide average (48.8 versus 19.9 overdoses per 10,000 persons). Emergency Departments (EDs) have been recognized as a major source of healthcare for persons with Opioid Use Disorder (OUD). A program to initiate medications for addiction treatment (MAT) for OUD in the ED has been shown to be effective. Likewise, continued patient engagement in a recovery or treatment program after ED discharge has been shown to be efficacious and impactful for long-term treatment success. OBJECTIVE This protocol outlines a framework for ED-initiated MAT for OUD in a resource-limited region of the US, made possible through community partnerships with referral resources for definitive OUD care. METHODS When a patient presents to the ED with symptoms of opioid withdrawal, non-fatal opioid overdose, or requesting opioid detoxification, clinicians will screen for OUD using the Diagnostic and Statistical Manual of Mental Disorders-5 diagnosis. All patients who screen positive for OUD will be further engaged and assessed for study eligibility. Recruited subjects will be evaluated for signs and symptoms of withdrawal, treated with buprenorphine/naloxone as appropriate, and given a prescription for take-home induction along with an intranasal naloxone kit. At the time of ED discharge, a peer navigator from a local substance use coordinating center will be engaged to facilitate patient referral to a regional substance abuse coordinating center for longitudinal addiction treatment. RESULTS This project is currently ongoing. It was funded in February, 2019, and approved by the University of Alabama at Birmingham IRB in June, 2019. Data collection began on July 7th, 2019 with projected end date February, 2022. Seventy-nine subjects have been enrolled to date. Results to be published in summer 2022. CONCLUSIONS ED recognition of OUD accompanied by buprenorphine/naloxone induction and referral for subsequent long-term treatment engagement have been shown to be one component of an effective strategy for addressing the ongoing opioid crisis. Establishing community and local partnerships, particularly in resource limited areas such as Appalachia, are crucial for the continuity of addiction care and rehabilitation outcomes.

scholarly journals Discovering Non-Invasive Biomarkers Predictive of Opioid Use Disorder Treatment Response

CNS Spectrums ◽  
2021 ◽  
Vol 26 (2) ◽  
pp. 173-173
Author(s):  
Amir Levine ◽  
Kelly Clemenza ◽  
Shira Weiss ◽  
Adam Bisaga ◽  
Erez Eitan ◽  
...  
Keyword(s):  
Treatment Response ◽  
Mononuclear Cells ◽  
Specific Treatment ◽  
The United States ◽  
Opioid Use Disorder ◽  
Response To Treatment ◽  
Post Translational Modification ◽  
Opioid Use ◽  
Peripheral Blood Mononuclear ◽  
Long Term Treatment

AbstractBackgroundOpioid use disorder (OUD) continues to be the driving force behind drug overdoses in the United States, killing nearly 47,000 people in 2018 alone. The increasing presence of deadlier fentanyl analogues in the heroin drug supply are putting users at a greater risk for overdose than ever before. Admissions to treatment programs for OUD have also nearly doubled since 2006, yet relapse rates remain high. In response to these alarming statistics, developing approaches to reduce overdose deaths has become an area of high priority. As it is not yet known which patients are most likely to benefit from a specific treatment, there is a dire need to utilize new molecular tools to guide precision medicine approaches and improve treatment outcomes. Here we describe a proof-of-concept study evaluating plasma-derived extracellular vesicle (EV) signatures and how they differ in patients who responded to two pharmacologically contrasting treatments for OUD: the μOR agonist methadone, and the μOR antagonist naltrexone.MethodsWe obtained blood samples from patients with OUD who remained abstinent from illicit opioids for at least 3 months during treatment with methadone (n=5) and naltrexone (n=5), as well as matched healthy controls (n=5). EVs were isolated from plasma and histones were isolated from peripheral blood mononuclear cells (PBMCs). EVs were then analyzed for lipid and histone post-translational modification (PTM) content using liquid chromatography-mass spectrometry. EV miRNA cargo was determined by RNA sequencing.ResultsWe found one lipid class and six miRNAs that differed significantly between the naltrexone group and the methadone and control groups. We also found that histone H3acK9acK14 was increasingly acetylated in PMBCs from both the methadone and naltrexone groups compared to controls.DiscussionNaltrexone, which is used in treatment of OUD and other substance use disorders as well as disorders of impulse control, was found to have multiple potential corresponding molecular signatures that can be identified after long-term treatment. It remains to be seen if these markers can also be a good predictor for treatment response. In addition, significant gender differences in EV content are found between men and women with OUD, which supports the importance of examining changes in response to treatment in a gender informed way.

scholarly journals Older Adults and Opioid Education: Lessons Learned From Experiences in Rural Arkansas

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 54-54
Author(s):  
Robin McAtee ◽  
Leah Tobey ◽  
Corey Hayes ◽  
Laura Spradley ◽  
Sajni Kumpuris
Keyword(s):  
Older Adults ◽  
Pain Management ◽  
Rural Areas ◽  
Term Treatment ◽  
Lessons Learned ◽  
Opioid Use ◽  
Farm Bureau ◽  
Department Of Health ◽  
Long Term Treatment ◽  
Agricultural Areas

Abstract Nearly one-third of all Medicare participants were prescribed an opioid by their physician in 2015 (AARP, 2017) and in 2017, Arkansas had the 2nd highest opioid prescribing rate in the nation (CDC, 2019). Approaching older adults (OA) about opioids and pain management can be a sensitive topic. Educating and altering long-term treatment with opioids is especially challenging in rural areas where literacy, especially health literacy, is suboptimal. The Arkansas Geriatric Education Collaborative (AGEC) is a HRSA Geriatric Workforce Enhancement Program with an objective to improve health outcomes including an emphasis to decrease the misuse and abuse of opioids among older Arkansans. To address this crisis, the AGEC partnered with local leaders such as the AR Drug Director, academia, Department of Health and Human Services, and multiple community based organizations to create age-tailored educational programs. Unique aspects of approaching and educating rural OA about opioids and pain management will be reviewed. Outcomes will be discussed such as their lack of knowledge about: what is an opioid, why they were prescribed, and what are viable alternatives. Also discussed will be lessons learned that resulted in more effective methods of reaching and teaching rural OA. Partnering with the AR Farm Bureau helped the AGEC reach 100’s of farmers in the extremely rural and mostly agricultural areas. Learning to not use the word opioid resulted in more participants and in a more positive attitude and outlook on attempts to change the culture of opioid use, misuse and abuse among older Arkansans.

Primary Care of Opioid use Disorder: The End of “the French Model”?

2020 ◽  
Vol 26 (6) ◽  
pp. 346-354 ◽  
Author(s):  
Julie Dupouy ◽  
Sandy Maumus-Robert ◽  
Yohann Mansiaux ◽  
Antoine Pariente ◽  
Maryse Lapeyre-Mestre
Keyword(s):  
Primary Care ◽  
Private Practice ◽  
Primary Care Providers ◽  
Opioid Use Disorder ◽  
Care Providers ◽  
Opioid Use ◽  
Access To Treatment ◽  
Cross Sectional ◽  
Number Of Patients ◽  
French Model

<b><i>Background:</i></b> In France, most patients with opioid use disorder (OUD) have been treated by buprenorphine, prescribed by general practitioners (GP) in private practice since 1996. This has contributed to building a ‘French model’ facilitating access to treatment based on the involvement of GPs in buprenorphine prescription. <b><i>Objectives:</i></b> Our study aimed to assess whether the involvement of primary care in OUD management has changed lately. <b><i>Materials and Methods:</i></b> Using data from the French National Health Insurance database, we conducted a yearly repeated cross-sectional study (2009–2015) and described proportion of opioid maintenance treatment (OMT)-prescribing GPs and OMT-dispensing community pharmacies (CP); and number of patients by GP or CP. <b><i>Results:</i></b> Whereas the number of buprenorphine-prescribing GPs in private practice remained quite stable (decrease of 3%), a substantial decrease in buprenorphine initial prescribers among private GPs was observed. In 2009, 10.3% of private GPs (6,297 from 61,301 French private GPs) prescribed buprenorphine for the initiation of a treatment, whereas they were 5.7% (<i>n</i> = 3,539 from 62,071 private GPs) in 2015 (43.8% decrease). GPs issuing initial prescriptions of buprenorphine tended to care for a higher number of patients treated by buprenorphine (14.6 ± 27.1 patients in 2009 to 16.0 ± 35.4 patients in 2015). The number of CPs dispensing buprenorphine remained quite stable (decrease of 2%), while there was a 7.5% decrease in the total number of French CPs across the study period. <b><i>Conclusions:</i></b> Our results suggest that primary care providers seem less engaged in buprenorphine initiation in OUD patients, while CPs have not modified their involvement towards these patients.

scholarly journals Hypomagnesemia Induced by Long-Term Treatment with Proton-Pump Inhibitors

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Simone Janett ◽  
Pietro Camozzi ◽  
Gabriëlla G. A. M. Peeters ◽  
Sebastiano A. G. Lava ◽  
Giacomo D. Simonetti ◽  
...  
Keyword(s):  
Receptor Antagonist ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Term Treatment ◽  
Cross Sectional ◽  
Magnesium Metabolism ◽  
Poor Renal Function ◽  
Long Term Treatment

In 2006, hypomagnesemia was first described as a complication of proton-pump inhibitors. To address this issue, we systematically reviewed the literature. Hypomagnesemia, mostly associated with hypocalcemic hypoparathyroidism and hypokalemia, was reported in 64 individuals on long-term proton-pump inhibitors. Hypomagnesemia recurred following replacement of one proton-pump inhibitor with another but not with a histamine type-2 receptor antagonist. The association between proton-pump inhibitors and magnesium metabolism was addressed in 14 case-control, cross-sectional studies. An association was found in 11 of them: 6 reports found that the use of proton-pump inhibitors is associated per se with a tendency towards hypomagnesemia, 2 found that this tendency is more pronounced in patients concurrently treated with diuretics, carboplatin, or cisplatin, and 2 found a relevant tendency to hypomagnesemia in patients with poor renal function. Finally, findings likely reflecting decreased intestinal magnesium uptake were observed on treatment with proton-pump inhibitors. Three studies did not disclose any relationship between magnesium metabolism and treatment with histamine type-2 receptor antagonists. In conclusion, proton-pump inhibitors may cause hypomagnesemia. In these cases, switching to a histamine type-2 receptor antagonist is advised.

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