scholarly journals NALTREXONE ASSOCIATED SEIZURE: A CASE REPORT

2021 ◽  
pp. 1-2
Author(s):  
Rajdip Barman ◽  
Pradipta Majumder ◽  
Varun Sharma
Keyword(s):  
Risk Factors ◽  
Case Report ◽  
Alcohol Use Disorder ◽  
Opioid Use Disorder ◽  
Opioid Antagonist ◽  
Opioid Use ◽  
Oral Naltrexone ◽  
Rare Side Effect ◽  
Gastrointestinal Side Effects ◽  
Long Acting

Naltrexone is an opioid antagonist prescribed to treat opioid use disorder and as an anti-craving medication for alcohol use disorder. Gastrointestinal side effects are considered the most common, and liver damage is a serious and rare side effect of naltrexone. In this case report, we describe a 40-year-old patient who developed a seizure after initiating treatment with naltrexone. Although the mechanism is not clear as naltrexone is not a well-known pro-convulsant medication, a few hypotheses for association with seizure have been postulated based on the studies on opioid agonists and similar opioid antagonist naloxone. Based on this case report, we strongly recommend that clinicians should thoroughly assess the risk factors for seizures in patients before using naltrexone and start long-acting injectable naltrexone only after an adequate trial of oral naltrexone to minimize the risk of seizure.

scholarly journals Successful bystander-administered intranasal naloxone reversal of opioid overdose between two veterans: A case report

2017 ◽  
Vol 7 (6) ◽  
pp. 287-289
Author(s):  
Shuang Ouyang ◽  
Troy Moore
Keyword(s):  
Case Report ◽  
Alcohol Use Disorder ◽  
White Male ◽  
Opioid Use Disorder ◽  
Opioid Overdose ◽  
Opioid Use ◽  
Stimulant Use ◽  
Pubmed Search ◽  
Abuse Treatment ◽  
Overdose Deaths

Abstract Opioid overdose–related morbidity and mortality remain one of the most pressing public health crises. Overdose education and naloxone distribution have emerged as an effective initiative for mitigating overdose deaths. This case highlights areas of patient education essential to optimizing treatment outcome when using a naloxone reversal kit. The patient is a 46-year-old white male with a past medical history significant for opioid use disorder, alcohol use disorder, stimulant use disorder, sedative-hypnotic use disorder, and posttraumatic stress disorder. The patient received an intranasal naloxone kit during residential substance abuse treatment. Five months later, the patient requested a new kit and was asked about the disposition of his previous kit. The patient recounted how he was telephoned to pick up an unconscious friend (and fellow veteran) from a nonresidential location. Upon arrival, the patient recognized opioid products near his friend and took steps to reverse the suspected opioid overdose with his 2 mg/2 mL naloxone intranasal kit. The reversal was successful, but many critical rescue response steps were omitted. This case report may guide future changes to educating patients on appropriate responses to opioid overdoses with naloxone. A PubMed search located one other case report of successful naloxone reversal of opioid overdose in the veteran population, which involved fentanyl sold as heroin. In our case report, a veteran successfully used his naloxone kit to reverse a suspected opioid overdose in another veteran, but he incompletely provided the rescue response. This experience may influence content changes for future overdose education and naloxone distribution training.

Opioids

2020 ◽  
pp. 109-148
Author(s):  
Darius A. Rastegar
Keyword(s):  
Respiratory Depression ◽  
Opioid Use Disorder ◽  
Opioid Antagonist ◽  
Opioid Use ◽  
Opioid Agonist ◽  
Level Of Consciousness ◽  
Long Acting ◽  
Self Help Groups ◽  
Prescription Pain Relievers

Opioids are a class of drugs that include heroin and prescription pain relievers that produce analgesia and euphoria. More than 2 million Americans have an opioid use disorder. Acute effects include analgesia, respiratory depression, miosis, and euphoria. Overdose is a serious complication of opioid use, characterized by depressed level of consciousness and respiratory depression. It can be treated with naloxone. Withdrawal symptoms include dysphoria, yawning, tearing, diarrhea, cramps, nausea, and piloerection. Buprenorphine, methadone, clonidine, and lofexidine can be used to ameliorate the symptoms of withdrawal. However, supervised withdrawal alone rarely leads to long-term abstinence. There are a number of psychosocial treatments, including self-help groups, outpatient therapy, and residential treatment; the data on their effectiveness are limited. Pharmacotherapy with an opioid agonist (methadone or buprenorphine) is the most effective treatment. Long-acting injectable naltrexone, an opioid antagonist, is also effective, but it is more difficult to initiate.

Personality profiles of patients with alcohol use disorder and opioid use disorder in an inpatient treatment setting

2019 ◽  
Vol 97 ◽  
pp. 91-96 ◽  
Author(s):  
Jeffrey S. Nevid ◽  
Alexander J. Gordon ◽  
Ari Barris ◽  
Jacob E. Sperber ◽  
Gregory Haggerty
Keyword(s):  
Alcohol Use ◽  
Inpatient Treatment ◽  
Alcohol Use Disorder ◽  
Opioid Use Disorder ◽  
Treatment Setting ◽  
Personality Profiles ◽  
Opioid Use

scholarly journals Buprenorphine exposure alters the development and migration of interneurons in the cortex

2020 ◽  
Author(s):  
Vanesa Nieto-Estévez ◽  
Jennifer J. Donegan ◽  
Courtney McMahon ◽  
Hannah B. Elam ◽  
Teresa A. Chavera ◽  
...  
Keyword(s):  
Human Brain ◽  
Fetal Brain ◽  
Opioid Use Disorder ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Child Bearing ◽  
Increased Risk ◽  
Adverse Neonatal Outcomes ◽  
And Migration ◽  
Long Acting

ABSTRACTThe misuse of opioids has reached epidemic proportions over the last decade, with over 2.1 million people in the U.S. suffering from substance use disorders related to prescription opioid pain relievers. This increase in opioid misuse affects all demographics of society, including women of child-bearing age, which has led to a rise in opioid use during pregnancy. Opioid use during pregnancy has been associated with increased risk of obstetric complications and adverse neonatal outcomes, including neonatal abstinence syndrome. Currently, opioid use disorder in pregnant women is treated with long-acting opioid agonists, including buprenorphine. Although buprenorphine reduces illicit opioid use during pregnancy and improves infant outcomes at birth, few long-term studies of the neurodevelopmental consequences have been conducted. The goal of the current experiments was to examine the effects of buprenorphine on the development of the cortex using fetal brain tissue, 3D brain cultures, and rodent models. First, we demonstrated that we can grow cortical and subpallial spheroids, which model the cellular diversity, connectivity, and activity of the developing human brain. Next, we show that cells in the developing human cortex express the nociceptin opioid (NOP) receptor and that buprenorphine can signal through this receptor in cortical spheroids. Using subpallial spheroids to grow inhibitory interneurons, we show that buprenorphine can alter interneuron development and migration into the cortex. Finally, using a rodent model of prenatal buprenorphine exposure, we demonstrate that alterations in interneuron distribution can persist into adulthood. Together, these results suggest that more research is needed into the long-lasting consequences of buprenorphine exposure on the developing human brain.

scholarly journals Early innovations in opioid use disorder treatment and harm reduction during the COVID-19 pandemic: a scoping review

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Noa Krawczyk ◽  
Adetayo Fawole ◽  
Jenny Yang ◽  
Babak Tofighi
Keyword(s):  
Harm Reduction ◽  
Scoping Review ◽  
English Language ◽  
Data Extraction ◽  
Home Delivery ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Policy And Practice ◽  
Patient Centered ◽  
Long Acting

Abstract Background The COVID-19 pandemic has exerted a significant toll on the lives of people who use opioids (PWUOs). At the same time, more flexible regulations around provision of opioid use disorder (OUD) services have led to new opportunities for facilitating access to services for PWUOs. In the current scoping review, we describe new services and service modifications implemented by treatment and harm reduction programs serving PWUO, and discuss implications for policy and practice. Methods Literature searches were conducted within PubMed, LitCovid, Embase, and PsycInfo for English-language studies published in 2020 that describe a particular program, service, or intervention aimed at facilitating access to OUD treatment and/or harm reduction services during the COVID-19 pandemic. Abstracts were independently screened by two reviewers. Relevant studies were reviewed in full and those that met inclusion criteria underwent final data extraction and synthesis (n = 25). We used a narrative synthesis approach to identify major themes around key service modifications and innovations implemented across programs serving PWUO. Results Reviewed OUD treatment and harm reduction services spanned five continents and a range of settings from substance use treatment to street outreach programs. Innovative service modifications to adapt to COVID-19 circumstances primarily involved expanded use of telehealth services (e.g., telemedicine visits for buprenorphine, virtual individual or group therapy sessions, provision of donated or publicly available phones), increased take-home medication allowances for methadone and buprenorphine, expanded uptake of long-acting opioid medications (e.g. extended-release buprenorphine and naltrexone), home delivery of services (e.g. MOUD, naloxone and urine drug screening), outreach and makeshift services for delivering MOUD and naloxone, and provision of a safe supply of opioids. Conclusions The COVID-19 pandemic has posed multiple challenges for PWUOs, while simultaneously accelerating innovations in policies, care models, and technologies to lower thresholds for life-saving treatment and harm reduction services. Such innovations highlight novel patient-centered and feasible approaches to mitigating OUD related harms. Further studies are needed to assess the long-term impact of these approaches and inform policies that improve access to care for PWUOs.

(372) Suboxone Therapy for Cancer Survivors with Opioid Use Disorder: A Case Report

2019 ◽  
Vol 20 (4) ◽  
pp. S67
Author(s):  
T. Su ◽  
I. Dworkin ◽  
S. Pangarkar ◽  
Q. Pham
Keyword(s):  
Case Report ◽  
Cancer Survivors ◽  
Opioid Use Disorder ◽  
Opioid Use

Management of opioid poisoning

2016 ◽  
Author(s):  
Alison L. Jones
Keyword(s):  
Respiratory Depression ◽  
Opioid Antagonist ◽  
Arterial Oxygen ◽  
Opioid Use ◽  
Analgesic Tolerance ◽  
Medication Misuse ◽  
Acute Withdrawal ◽  
Close Observation ◽  
The Central Nervous System ◽  
Long Acting

Opioids are ‘morphine like’ substances that have actions at specific opioid receptors (especially µ receptors) in the central nervous system (CNS). Tolerance of respiratory depression develops at a slower rate than analgesic tolerance, placing patients with a long history of opioid use at particular risk for respiratory depression. If chronic users abruptly stop taking opioids, they develop an acute withdrawal syndrome. Most opioid toxicity is the result of inadvertent overdosage during recreational use or in self-harm, but it can also be due to medication misuse and drug errors. It is characterized by three main clinical features (all may not be consistently present); depressed respiratory rate (the sine qua non of opioid poisoning) and respiratory volume, and reduced arterial oxygen desaturation, CNS depression, and small or pin-point pupils. Opioid-poisoned patients require early clinical assessment, appropriate administration of intravenous naloxone (competitive opioid antagonist) and meticulous respiratory supportive care, with close observation. Because of the longer half-life of opioids than naloxone, repeated doses may be needed for long-acting opioids or large doses of shorter acting opioids. If opioid antagonists are given to regular opioid users in excess, they can precipitate acute withdrawal symptoms. The need for ITU admission usually occurs as a result of a complication of the opioid toxicity.

scholarly journals Use of Oral and Implantable Naltrexone in the Management of the Opioid-Impaired Physician

2003 ◽  
Vol 31 (2) ◽  
pp. 196-201 ◽  
Author(s):  
G. K. Hulse ◽  
G. O'Neil ◽  
M. Hatton ◽  
M. J. Paech
Keyword(s):  
Previous Treatment ◽  
Opioid Antagonist ◽  
Opioid Use ◽  
Medical Board ◽  
Prescription Drug Use ◽  
Increased Risk ◽  
Oral Naltrexone ◽  
Patients At Risk ◽  
Ongoing Monitoring

Doctors are at an increased risk for prescription drug use, particularly opioids and benzodiazpines. This use can interfere with work function and has major potential negative implications for patient safety. Oral naltrexone, an opioid antagonist, has been used as part of a management strategy for opioid-dependent physicians. While some patients stabilize on oral naltrexone, others relapse to opioid use. An alternative method of naltrexone maintenance involves the injection or surgical insertion of a sustained release preparation of naltrexone. This approach dramatically improves compliance, removing the onus from the previously opioid impaired physician to use daily oral naltrexone. This article describes the cases of four opioid-impaired doctors who received naltrexone (either oral or implant) as part of their management. The authors conclude that monitoring daily oral naltrexone use and detecting early opioid relapse is difficult, placing both the opioid impaired physician and their patients at risk. In contrast, by using implantable naltrexone, compliance is assured and opioid abstinence can virtually be guaranteed for five months. It is argued that naltrexone implants offer a level of protection not achieved with any previous treatment. It is recommended that management should involve early and close collaboration between the treating doctor and the Medical Board, with initial treatment, ongoing monitoring and follow-up being a Medical Board requirement for registration.

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