Tramadol for maintenance in opioid dependence: A retrospective chart revie

2017 ◽  
Vol 13 (5) ◽  
pp. 329 ◽  
Author(s):  
Siddharth Sarkar, MD, DNB ◽  
Rakesh Lal, MD ◽  
Mohit Varshney, MD ◽  
Yatan Pal Singh Balhara, MD, DNB, MNAMS
Keyword(s):  
Opioid Dependence ◽  
Maintenance Treatment ◽  
Evidence Base ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Opioid Agonist ◽  
Heroin Use ◽  
Select Group ◽  
Treatment Centre ◽  
Icd 10

Background and aims: Tramadol is an opioid agonist which can be potentially used for maintenance treatment of patients with opioid use disorders. This chart review presents the characteristics of individuals with an ICD 10 diagnosis of opioid dependence who were maintained on tramadol for a period of at least 6 months.Methods: Records of patients seeking treatment for opioid dependence from the outpatient clinic of the National Drug Dependence Treatment Centre, Ghaziabad, India were screened. One hundred consecutive patients who received tramadol for more than 6 months were included.Results: The sample comprised exclusively of males and had a mean age of 40.9 years. The median dose of tramadol at initiation and continuation was 300 mg/ day. Sixty-two patients achieved complete abstinence during the course of treatment. Greater age, longer duration of opioid use, and better follow-up adherence were associated with abstinent status. The rates of abstinence were higher among those presenting with natural opioid use as compared to others (prescription opioid use or heroin use).Conclusion: Tramadol can be an alternative medication for harm reduction in select group of patients with opioid dependence. Further research is required to strengthen the evidence base of rational use of tramadol for maintenance treatment of patients with opioid dependence.

The duration dilemma in opioid agonist therapy

2021 ◽  
Vol 17 (4) ◽  
pp. 353-358
Author(s):  
Anjali Dhanda, MD ◽  
Edwin A. Salsitz, MD, DFASAM
Keyword(s):  
Maintenance Treatment ◽  
A Priori ◽  
Opioid Use ◽  
Agonist Therapy ◽  
Short Term ◽  
Opioid Agonist ◽  
Adequate Treatment ◽  
Opioid Agonist Therapy ◽  
Optimal Outcomes

Objective: Studies dating back to 1964 consistently support the effectiveness of methadone as a maintenance treatment for opioid use disorder (OUD), and since 2003, the effectiveness of buprenorphine. Short-term detoxification has not proven to be an effective treatment, as it results in high relapse rates when compared with maintenance treatment with an opioid agonist therapy (OAT). The question about the duration of maintenance treatment for OUD has been debated with recommendations ranging from a minimum of 1 year, 2 years, to indefinitely. Other factors such as misconceptions, regulations, and insurance barriers also have an impact on the duration dilemma of OAT.Design: There were no a priori criteria for article inclusion and this is not a structured literature review. It is a review of articles of convenience from 1964 to 2018.Main outcome measure: This paper aims to address the dilemma of the ideal duration of OAT and to discuss the factors that could affect this decision.Results: Sustained OAT has had significantly better long-term outcomes than short-term detoxification or time limited maintenance. Optimal outcomes are dependent on adequate treatment duration.Conclusions: Addiction is a chronic brain disease and its treatment should be similar to the treatment of other chronic medical and psychiatric diseases. Long-term, sometimes lifetime, continuation of OAT for the treatment of OUD results in optimal outcomes when measuring morbidity and mortality. The accumulated evidence does not support any arbitrary limitation to the duration of OAT. 

scholarly journals Biased Opioid Antagonists as Modulators of Opioid Dependence: Opportunities to Improve Pain Therapy and Opioid Use Management

Molecules ◽  
2020 ◽  
Vol 25 (18) ◽  
pp. 4163 ◽  
Author(s):  
Wolfgang Sadee ◽  
John Oberdick ◽  
Zaijie Wang
Keyword(s):  
Opioid Dependence ◽  
Pain Therapy ◽  
Active Form ◽  
Opioid Analgesics ◽  
Opioid Antagonist ◽  
Opioid Antagonists ◽  
Opioid Use ◽  
Opioid Agonist ◽  
Opposing Effects

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.

Review of perioperative pain management of opioid-dependent patients

2016 ◽  
Vol 12 (4) ◽  
pp. 289 ◽  
Author(s):  
Nalini Vadivelu, MD ◽  
Sukanya Mitra, MD, MAMS ◽  
Alice M. Kai, BA ◽  
Gopal Kodumudi, MS ◽  
Karina Gritsenko, MD
Keyword(s):  
Drug Addiction ◽  
Pain Control ◽  
Opioid Dependence ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Postoperative Rehabilitation ◽  
Rehabilitation Process ◽  
Perioperative Pain Management ◽  
Prescription Opioid Use ◽  
Effective Analgesia

Opioid dependence can occur due to prescription opioid use, recreational opioid use, or as a result of opioid use for the treatment of drug addiction. Pain control in these patients is truly a challenge. It is important to understand the patient's condition such as the phenomenon of drug dependence, drug addiction, and pseudo-addiction to provide effective analgesia. This may be accomplished using appropriate multimodal therapies and by treatment of coexisting diseases such as anxiety. The goal is to provide effective analgesia, prevent cognitive and emotional problems, and produce a positive postoperative rehabilitation process. Multimodal options include pharmacological and nonpharmacological approaches, psychological support, and interventional pain procedures, all focused toward providing optimal pain control while preventing undertreatment, withdrawal symptoms, and other complications.

scholarly journals Feasibility and Outcomes of a Community-Based Taper-to-Low- Dose-Maintenance Suboxone Treatment Program for Prescription Opioid Dependence in a Remote First Nations Community in Northern Ontario

2013 ◽  
Vol 9 (1) ◽  
pp. 52
Author(s):  
Mae Katt ◽  
Claudette Chase ◽  
Andriy V. Samokhvalov ◽  
Elena Argento ◽  
Jürgen Rehm ◽  
...  
Keyword(s):  
First Nations ◽  
Opioid Dependence ◽  
Low Dose ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Community Based ◽  
Northern Ontario ◽  
Major Health Problem ◽  
Nations People ◽  
First Nations People

<p>Objective: Non-medical prescription opioid use (NMPOU) is a major health problem in North America and increasingly prevalent among First Nations people. More than 50% of many Nishnawbe Aski Nation communities in northern Ontario report NMPOU, resulting in extensive health and social problems. Opioid substitution therapy (OST) is the most effective treatment for opioid dependence yet is unavailable in remote First Nations communities. Suboxone (buprenorphine and naloxone) specifically has reasonably good treatment outcomes for prescription opioid (PO) dependence. A pilot study examining the feasibility and outcomes of a community-based Suboxone taper-to-low-dose-maintenance program for PO-dependent adults was conducted in a small NAN community as a treatment option for this particular setting.</p><p>Design: Participants (N = 22, ages 16–48 years) were gradually stabilized on and tapered off Suboxone (provided on an outpatient and directly-observed basis) over a 30-day period. Low dose maintenance was offered post-taper to patients with continued craving and relapse risk; community-based aftercare was provided to all participants. Results: Of 22 participants, 21 (95%) completed the taper phase of the program. Fifteen (88%) of 17 participants tested by urine toxicology screening had no evidence of PO use on day 30. No adverse side effects were observed. All but one of the taper completers were continued on low-dose maintenance. Conclusion: Community-based Suboxone taper-to-low-dose-maintenance is feasible and effective as an initial treatment for PO-dependence in remote First Nations populations, although abstinence is difficult to achieve and longer term maintenance may be required. More research on OST for First Nations people is needed; existing OST options, however, should be made available to First Nations communities given the acute need for treatment.</p>

scholarly journals Association of Nonmedical Prescription Opioid Use With Subsequent Heroin Use Initiation in Adolescents

2019 ◽  
Vol 173 (9) ◽  
pp. e191750 ◽  
Author(s):  
Lorraine I. Kelley-Quon ◽  
Junhan Cho ◽  
David R. Strong ◽  
Richard A. Miech ◽  
Jessica L. Barrington-Trimis ◽  
...  
Keyword(s):  
Prescription Opioid ◽  
Opioid Use ◽  
Heroin Use ◽  
Prescription Opioid Use

Nonmedical Prescription Opioid and Heroin Use Among Adolescents Who Engage in Sports and Exercise

2018 ◽  
pp. 122-132
Author(s):  
Philip Veliz ◽  
Carol J. Boyd ◽  
Sean Esteban McCabe
Keyword(s):  
Protective Factor ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Adolescent Athletes ◽  
Heroin Use ◽  
Lower Odds ◽  
The Past ◽  
Increased Risk ◽  
Monitoring The Future ◽  
Sports And Exercise

OBJECTIVES Previous research has found that adolescent athletes may be at increased risk of nonmedical prescription opioid use (NPOU) due to injuries. Although adolescent athletes are at an increased risk of engaging in NPOU, it has yet to be determined if they are also at greater risk for heroin use. The major purpose of this study was to examine both the trends in prevalence rates and patterns of initiation in lifetime NPOU and lifetime heroin use among adolescents who engage in sports and exercise. METHODS Eighteen cross-sections of eighth and 10th graders were used from the Monitoring the Future study. The sample consisted of 191 682 respondents who answered questions on past-year participation in sports and exercise, lifetime NPOU, lifetime heroin use, age of NPOU onset, and age of heroin onset. RESULTS The trends in NPOU and lifetime heroin use among adolescents who engage in sports and exercise has declined between 1997 and 2014. Logistic regression analyses found that adolescents who engage in sports and exercise had lower odds of reporting lifetime NPOU and heroin use compared with adolescents who did not engage in these activities during the past year. Analyses among lifetime heroin users found that adolescents who engage in sports and exercise had lower odds of initiating NPOU before heroin when compared with their peers who did not engage in these activities in the past year. CONCLUSIONS Daily participation in sports and exercise may serve as a protective factor with respect to NPOU and heroin use.

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