Dissertations / Theses on the topic 'Opioid dependence'
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1
Nosyk, Bohdan. "Empirical studies in opioid dependence." Thesis, University of British Columbia, 2010. http://hdl.handle.net/2429/23718.
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Background: Opioid dependence is a chronic disease characterized by periods of relapse and remission. Methadone maintenance treatment (MMT) can be effective, though not all patients can be successfully maintained in treatment. Further, treatment entrants often use multiple illicit drugs, a fact whose motive and effect are under-studied. Rigorous evaluation at the aggregate- and patient-level is required to maximize the public health benefits of substance abuse treatment.
Objectives: (1) identify the determinants of the time to discontinuation of MMT across multiple treatment episodes; (2) determine the effect of price on drug consumption among polydrug users; (3) identify trends in compliance to MMT dosing guidelines in British Columbia, Canada from 1996-2007; (4) provide a comparative analysis of the psychometric properties of eight measures of health status for opioid users; (5) evaluate differences in trajectories of health status among opioid users following treatment enrolment.
Methods: We draw upon longitudinal data collected in administrative databases (study 1 and 3), experimental (study 4 and 5) and observational cohort studies (study 2) to shed light on the life course of treatment and relapse that opioid addicts experience, their decisions to consume addictive substances, and treatment evaluation at the aggregate- and patient-levels.
Results: This collection of studies found (1) patients experiencing multiple treatment episodes tended to stay in treatment for progressively longer periods in later episodes; (2) While heroin and crack cocaine were price inelastic polydrug users treated crack cocaine as a substitute for heroin. In terms of treatment evaluation at the aggregate-level, compliance to minimally effective dose guidelines, along with 12-month retention figures have fallen in the past 5 years in British Columbia (study 3). At the patient-level each of the health status measures assessed in the North American Opiate Medication Initiative (NAOMI) trial showed limitations (study 4), however health status can be meaningfully improved through effective, patient-centered opioid substitution treatment (study 5).
Conclusions: The results of these novel empirical studies suggest that while MMT can be an effective treatment option for opioid dependence, the individual and program-related factors that limit its effectiveness must be addressed to maximize the public health impact of this treatment.
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Edmund, Christine Hilary. "Correctional Nurses: Adult Opioid Dependence Referral Process." NSUWorks, 2017. https://nsuworks.nova.edu/hpd_con_stuetd/26.
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Background: Correctional nurses make up a large part of the corrections workforce and have increasing responsibility for making decisions about patient care in the opioid dependent incarcerated patients. The National Commission on Correctional Health Care (NCCHC) has intoxication and withdrawal standards that advocate individuals entering a correctional facility under the influence or undergoing withdrawal from opioids have their therapy continued, or a plan for appropriate referral for treatment. The NCCHC standard that incarcerated opioid dependent inmates have their therapy continued or a plan for appropriate referral for treatment is not adhered to consistently, as the current process lacks organization. Purpose: The purpose of this quality improvement project was to develop an adult opioid dependence referral for treatment tool for opioid use dependent patients to be utilized by correctional nurses and providers working in the corrections intake medical facility with posttest evaluation. Theoretical Framework: Peplau’s nurse-patient relationship theory was used. Methods: A descriptive, exploratory design was utilized. Results: A majority of the nurses acknowledged the usefulness of the Nursing Opioid Referral for Treatment Algorithm (NORTA) in facilitating the adult opioid dependence referral process. In addition, of the 20 nurses surveyed, 18 nurses agreed that the NORTA tool was relevant to the adult opioid dependence referral process. Most claimed that the NORTA facilitated the opioid dependence referral process. Conclusion: The pain management algorithm is an effective referral method for opioid users as it contributes to patient safety through safe prescription and careful assessment of patient risk regarding opioid use. The findings from this project may impact nursing practice by identification of a new organized approach to enhance the current opioid dependence referral process.
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Bilsky, Edward James 1967. "Studies on opioid delta receptor mediated antinociception, opioid antinociceptive tolerance and physical dependence." Diss., The University of Arizona, 1997. http://hdl.handle.net/10150/282311.
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The central hypothesis of this dissertation is that agonists and antagonists acting at the delta opioid receptor will have therapeutic applications in treating acute and chronic pain states and in the treatment of drug addiction. It is further hypothesized that delta compounds will have better therapeutic profiles than currently available opioids that act predominantly at the mu receptor. In advancing the central hypothesis, selective nonpeptidic delta compounds, that readily cross the blood brain barrier after systemic administration, were tested. BW373U86, a nonpeptidic ligand with moderate selectivity and activity at delta opioid receptors represented a lead compound. A structurally related molecule, SNC80, displayed an improved selectivity and activity profile compared to BW373U86. Importantly, SNC80 produced antinociception following systemic administration which was blocked by delta, but not mu, selective antagonists. The pharmacology of delta opioid receptors was further studied using antisense oligodeoxynucleotides that disrupted the synthesis of delta receptors in vivo and in vitro. The experiments provided further evidence for distinct delta receptor subtypes and demonstrated the utility of the antisense approache in studying neurochemical processes in vivo. Several studies addressed the phenomenon of opioid tolerance and physical dependence, two processes which compromise the clinical application of currently available opioid analgesics. The observation that NMDA receptor antagonists block the development of antinociceptive tolerance to repeated administrations of morphine was confirmed. The results were extended by demonstrating that NMDA antagonists did not block antinociceptive tolerance to more selective delta or mu agonists. These studies caution against the generalization that an effect seen with morphine is applicable to all opioid agonists. Further hypotheses regarding the mechanisms of opioid tolerance and physical dependence were tested using inhibitors of protein kinases and putative neutral and inverse opioid antagonists. These studies advanced the hypothesis that opioid receptor phosphorylation may play a critical role in the development of opioid antinociceptive tolerance and physical dependence. In summary, this dissertation has provided strong evidence that nonpeptidic delta selective opioid agonists and antagonists can be developed and that these compounds will have therapeutic applications in the treatment of pain and addictive disorders.
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Weich, Lize, Charles Perkel, Zyl Nicolette Van, S. T. Rataemane, and Lochan Naidoo. "Medical management of opioid dependence in South Africa." Health and Medical Publishing Group (HMPG), 2008. http://hdl.handle.net/10019.1/7055.
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The original publication is available at http://www.samj.org.zaMedical practitioners in South Africa are increasingly confronted with requests to treat patients with opioid use disorders. Many do not possess the required knowledge and skills to deal with these patients effectively. This overview of the medical treatment of opioid dependence was compiled by an elected working group of doctors working in the field of substance dependence. Recommendations are based on current best practice derived from scientific evidence and consensus of the working group, but should never replace individual clinical judgement.
Publishers' version
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Fundytus, Marian Elaine. "Contribution of metabotropic glutamate receptors to opioid dependence." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp02/NQ29938.pdf.
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Johansson, Anna. "Dependence-induced changes in opioid-receptor gene expression." Thesis, Linköpings universitet, Institutionen för fysik, kemi och biologi, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-90034.
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Using drugs such as alcohol and morphine among others can be addictive in some individuals, and progress into a substance abuse disorder. The mesolimbic dopaminergic system (MD-system) is involved in the reward process during the development of drug addiction. The MD-system is critical for survival and affects different behaviors in both man and animal. Neurochemical pathways drive for instance physical activity, food intake, love and reproduction and are part of the natural reward process involved partly in the release of dopamine (DA) into frontal lobes. Within the MD-system opioid receptors throughout the brain are affected by drug intake, and activation of these receptors modulate DA-release in brain regions involved in reward-behavior. The aim of this study was to evaluate gene expression of MOR and DOR within the endogenous opioid system (EO-system) in relation to voluntary physical activity, a natural reinforcer. Further on investigations of the drug alcohol was compared to the natural reinforcer sucrose using voluntary consumption. For both experiments qRT-PCR was used to measure mRNA levels of MOR and DOR from brain areas of interest. We found a small significant up regulation in NAc, PFC and VTA but for DOR in VTA a down regulation in gene expression of physical exercising mice. Additionally these two different genes OPRM1- and the OPRD1- gene are down regulated in VTA and NAc due to alcohol- and sugar-intake. This implicate that the natural reward system and their ORs point in the direction of earlier findings; the opioid receptors have a key role in regulate alcohol intake and the natural rewarding stimuli as food intake.
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Fundytus, Marian Elaine. "Contribution of metabotropic glutamate receptors to opioid dependence." Thesis, McGill University, 1996. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=42034.
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We investigated the role of metabotropic glutamate receptors (mGluRs), and related intracellular second messengers, in the development of morphine tolerance and dependence. The mGluRs are divided into three groups: group I mGluRs are positively coupled to phosphatidylinositol (PI) hydrolysis, while group II and III mGluRs are negatively coupled to cyclic adensoine-3$ sp prime$,5$ sp prime$-monophosphate (cAMP) production. Opioid receptors are also coupled to these same systems, and have been shown to elicit changes in these messenger systems during chronic treatment.We showed that chronic intracerebroventricular (i.c.v.) administration of selective group II and III mGluR antagonists concurrently with subcutaneous (s.c.) morphine significantly reduced the severity of precipitated withdrawal symptoms. Conversely, acute i.c.v. injection of a selective group II mGluR antagonist just prior to the precipitation of withdrawal significantly exacerbated the severity of abstinence symptoms. In addition, acute i.c.v. injection of a selective group II mGluR agonist just prior to the precipitation of withdrawal significantly reduced abstinence symptoms. From these results we hypothesized that chronic opioid treatment may induce a desensitization of group II mGluRs.
We also demonstrated that chronic i.c.v. infusion of a selective group I mGluR antagonist concurrently with s.c. morphine significantly attenuated the precipitated withdrawal syndrome. In addition, we showed that chronic i.c.v. antagonism of $ delta$-opioid receptors with a highly selective antagonist also decreased the development of morphine dependence, as well as tolerance. Since both group I mGluRs and $ delta$-opioid receptors are positively coupled to PI hydrolysis, further evidence for a role of products of PI hydrolysis in the development of morphine dependence was obtained when we showed that selective chronic inhibition of protein kinase C (PKC) activation, as well as selective chronic inhibition of intracellular Ca$ sp{2+}$ release, concurrently with morphine treatment significantly reduced the severity of abstinence symptoms. Thus, compensatory changes usually elicited by chronic opioid treatment may be counteracted by antagonizing receptors positively coupled to PI hydrolysis, as well as by inhibiting products of PI hydrolysis.
In the General Discussion, we propose a model based on the possible interaction of mGluRs and opioid receptors, via related intracellular second messengers, to explain the development of morphine dependence.
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Grivas, Konstantinos. "Analogues of buprenorphine as treatment for opioid dependence." Thesis, University of Bristol, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.294430.
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Higgins, Cassandra. "Comorbid opioid dependence and chronic pain : clinical implications." Thesis, University of Dundee, 2018. https://discovery.dundee.ac.uk/en/studentTheses/bbc038cc-562c-4e01-a617-147de73b1312.
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Context Chronic pain and opioid dependence confer substantial individual and societal burdens and are notoriously difficult to treat effectively. Their comorbid presentation further complicates effective treatment through complex physiological and environmental interactions. Objectives (1) What are the clinical characteristics and treatment outcomes associated with comorbid chronic pain in ORT patients? (2) Does the patient-attributed direction of the causal relationship in the development of opioid dependence and chronic pain identify two clinically-distinct treatment populations? (3) What is the incidence of iatrogenic opioid dependence or abuse following opioid analgesic treatment? (4) Is there evidence of opioid-induced hyperalgesia in humans? Methods Primary data Participants were 467 treatment-seeking, opioid-dependent patients. Materials comprised standardised instruments – focusing on illicit substance use and mental health characteristics – completed by medical staff at study inception, and extracts of routinely-collected clinical datasets spanning the follow-up period. Procedures involved the use of a health informatics approach. Electronic linkage of data collected at study inception with routinely-collected clinical datasets spanning the 5-year follow-up period. Secondary data Systematic searches were undertaken using six electronic research databases, supplemented by manual searches. Study quality was assessed using instruments developed by NIH. Data synthesis using random effects models (DerSimonian-Laird method) generated: (1) a pooled incidence of iatrogenic dependence or abuse following opioid analgesic treatment; and (2) a pooled effect of opioid exposure on the development of opioid-induced hyperalgesia. Additional analyses included assessment of heterogeneity in study effects, within- and between-study risk of bias and sensitivity analyses. Results A total of 246 (53%) patients reported comorbid chronic pain. This ‘comorbid’ group was associated with increased mortality, physical and mental health problems, service utilisation and illicit drug use, specifically benzodiazepines and cannabinoids. Within the ‘comorbid’ group, patients who reported a causal impact of opioid dependence on the development of pain were associated with increased illicit drug use and psychiatric morbidity. Secondary data analyses revealed a 4.7% incidence estimate of iatrogenic dependence or abuse following opioid analgesic treatment, and evidence of the development of opioid-induced hyperalgesia following therapeutic opioid exposure. Conclusions Elevated mortality, morbidity and illicit drug use in opioid-dependent patients with comorbid chronic pain reflects a patient population with substantial health burdens. The dynamic relationship between these severe and chronic conditions necessitates complex, multimodal treatment strategies and multiagency collaboration, including general psychiatric intervention. Whilst a substantial proportion reported that opioid dependence developed as a consequence of pain problems, there is evidence to suggest that the assumed risk of iatrogenic opioid dependence and abuse may be an overestimate; however, therapeutic opioids may lead to other problems that impact on treatment effectiveness, such as opioid-induced hyperalgesia.
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Cradick, Mary, Shannon DeGrote, Spencer Marsall, and Terri Warholak. "Suboxone for Medically Assisted Treatment for Opioid Dependence." The University of Arizona, 2014. http://hdl.handle.net/10150/614151.
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Class of 2014 AbstractSpecific Aims: To show that Suboxone is more effective than no MAT (Medically Assisted Treatment) in opioid dependence. Additionally, that Suboxone is as effective as methadone in MAT. Methods: This study was a retrospective chart review of probationer’s case files at The Pima County Adult Probation Office. Treatment groups included: Suboxone (n=16), methadone (n=15), and no MAT control group (n=15). The total sample size was 46 probationers. The primary dependent variables were the number of negative events and time to a negative event (i.e. missed/positive urinalysis, violation of terms of probation). The secondary outcome variables were the number of positive events and time to a positive event (i.e. finding employment, documented social/family improvement). Data analysis utilized chi-square for categorical data while t-tests were used for continuous data. Main Results: 46 probationers of Pima County with violations related to possession or use of an opioid substance were analyzed. No significant differences were found between Suboxone and placebo (no MAT) for any of the four outcomes (number of negative events p=0.82; time to first negative event p=0.41; number of positive events p=0.93; time to first positive event p=0.45). No significant differences were found between Suboxone and methadone as well (number of negative events p=0.34; time to first negative event p=0.52; number of positive events p=0.93; time to first positive event p=0.56). Conclusion: This study found no statistically significant differences between no MAT and Suboxone nor Suboxone and methadone. Differences in baseline characteristics between groups were found that could characterize the Suboxone group as being more severely ill.
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Maloney, Elizabeth Ann National Drug & Alcohol Research Centre Faculty of Medicine UNSW. "Opioid dependence: associations with suicidal behaviour and other psychiatric comorbidity." Publisher:University of New South Wales. National Drug & Alcohol Research Centre, 2008. http://handle.unsw.edu.au/1959.4/41455.
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Suicide attempts and opioid dependence are important clinical issues, as both are associated with a high degree of psychiatric morbidity and elevated risk of mortality. Research has identified a number of risk factors for suicide attempts among the general population, and to a lesser extent, among heroin users. Due to a lack of case-control studies, however, it is still not known to what extent opioid dependence per se is a risk factor for suicide attempts. This thesis comprised the first study to directly examine whether opioid dependence is a unique risk factor of suicide attempts. This thesis examined suicide attempts, associated risk factors, and related comorbidity among an opioid-dependent case group and a non-opioid-dependent control group. A structured interview was used to collect data from 726 opioid-dependent cases and 399 non-opioid-dependent controls. This thesis identified a number of important findings. Firstly, although opioid-dependent individuals were more likely to report lifetime suicide attempts compared to controls, the risk factors were largely the same for both groups. It appeared that opioid-dependent individuals were characterised by a higher likelihood of the same risk factors for suicide attempts, rather than having different risks. Cases appeared to be at increased risk of suicide attempts because of increased levels of multiple risk factors. Secondly, borderline personality disorder (BPD) and impulsivity were identified as important risk markers for suicidal behaviour, especially among opioid-dependent individuals. The study concluded that the treatment of BPD should be prioritised among this group. Third, self-mutilation was identified as a clinically significant problem in its own right, however, when combined with a history of attempted suicide, the psychological dysfunction observed was found to be very high. Fourth, non-fatal opioid overdose and suicide attempts were found to be distinct behaviours. The risk factors for each were completely different. While drug-related risks were associated with non-fatal overdose, the risk markers for suicide attempts were related to the presence of psychological disorders. This thesis has highlighted important areas of concern for clinical interventions as well as for future research to explore. Considering this is the first study of its kind, future research should focus on its replication.
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Lee, Franklin. "The Effects of Rhes on Opioid Analgesia." ScholarWorks@UNO, 2010. http://scholarworks.uno.edu/td/1254.
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Rhes (Ras homolog enriched in striatum) has been identified as a novel monomeric G-protein involved in dopaminergic and other signaling in the striatum. Given the many effects of opioids that involve striatal circuitry, genetically engineered mice that are incapable of making Rhes (rhes-/-) and their control littermates (rhes+/+) were subjected to behavioral tests to determine if any differences existed in opioid analgesia, tolerance, withdrawal, reward, and locomotion. Rhes-/- mice showed an increased opioid mediated analgesia, along with an absence of tolerance and decrease in withdrawal when compared with rhes+/+ littermates. However, no significant changes were seen in opioid induced locomotor activation or conditioned place preference. These results provide strong evidence for the implication of Rhes in opioid signaling.
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Culp, Jenna L. "Cocaine use, treatment retention and opioid abstinence at six months in a coordinated primary care and substance abuse treatment clinic among opioid-dependent patients treated with buprenorphine." Thesis, Boston University, 2012. https://hdl.handle.net/2144/12336.
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Thesis (M.A.)--Boston UniversityCocaine use among opioid dependent persons is common, with an estimated 40 to 70% of those seeking treatment for opioid dependence, also using cocaine (Sullivan et al., 2011 ). The effects of cocaine use on treatment outcomes for those seeking medication assisted treatment (MAT) for opioid dependence are not well understood. Buprenorphine, prescribed under the brand name Suboxone, has recently emerged as a convenient, effective method of MAT. The Facilitated Access to Substance Abuse Treatment with Prevention And Treatment of HIV (FAST PATH) program at Boston Medical Center, is a research study to provide substance abuse treatment along with primary care and HIV risk-reduction counseling to those afflicted with these epidemics. The objective of this study was to determine the association of cocaine use with treatment retention and opioid abstinence at six months for patients receiving buprenorphine in the FAST PATH program. A prospective cohort study was conducted on 116 patients enrolled in the FAST PATH program through 02/01/2012. Assessments were conducted at baseline and six months to evaluate the association between baseline cocaine use and treatment retention as well as opioid abstinence at six months. Baseline cocaine use was measured by either any urine toxicology screen positive for cocaine prior to study enrollment or 30 day self-reported cocaine use on the initial assessment. Of the 116 participants, 39% were positive for cocaine use at baseline and 52% were HIV positive. Baseline cocaine use had no effect significant on treatment retention or opioid abstinence at six months. Among all the participant characteristics measured, there were no significant differences between the cocaine positive (n=45) and cocaine negative (n=71) groups. In adjusted analysis, age was the only covariate which was significant at predicting the odds of treatment retention or opioid abstinence with a 1.11 (p-value = 0.0003) and 1.08 (p-value = 0.02) greater odds of each, respectively. Although cocaine use did not affect the dependent variables, integrated substance abuse and primary care clinics utilizing buprenorphine are a rich area of future research. Specifically, subsequent studies should determine how varied groups of opioid dependent persons perform within this framework, and the underlying characteristics moderating their outcomes.
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Bennett, Ryan. "Association Tests of the Opioid Receptor System and Alcohol-Related Traits." VCU Scholars Compass, 2009. http://scholarscompass.vcu.edu/etd/1993.
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The opioid receptors and their endogenous ligands have long been implicated in a variety of traits including addiction, impulsive behaviors and substance dependence. Using phenotypic measurements collected from the IASPSAD, data from a latent class analysis and data from a SNP array and additional genotyping assays, association and regression tests were performed to determine the effects of common SNPs encoded in the genes of the opioid receptors and ligands on various traits relating to alcohol dependence. Although only one SNP can be reported as significant for substance dependence within alcoholics, there were a few results approaching significance that may offer some insight into variation within alcoholism.
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Nelson, Renee. "Neurocognitive Examination of Attentional Bias and Inhibitory Control Alterations in Prescription Opioid Dependence." Thesis, Université d'Ottawa / University of Ottawa, 2018. http://hdl.handle.net/10393/37478.
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Prescription opioid (PO) abuse is a growing public health concern worldwide as evidenced by an increasing number of opioid-related hospital admissions with a striking lack of research examining the neural basis underlying cognitive symptomatology. Drugs of abuse, through their impact on the dopaminergic system, are thought to disrupt the cognitive network regulating impulse control and incentive salience through inhibition of goal-oriented behaviour and drug-induced attentional biases. The objective of the present study is to examine neurocognitive processes in PO abusers (vs. healthy controls) by relying on the enhanced temporal resolution (1ms) of event-related potentials (ERPs) to track information processing abnormalities associated with cognitive control. In a naturalistic clinical study, 16 patients actively using prescription opioids and 16 healthy controls (matched for age, gender, educational level and smoking status) were assessed using a Go/NoGo and cue reactivity paradigm. Analysis revealed no significant differences in N2 or P3 amplitude, measures of inhibitory control, between groups after successful NoGo trials and no significant differences in ERN or Pe amplitude, measures of error processing, between groups after unsuccessful NoGo trials. Cue reactivity analysis of attention-related ERP components in patients demonstrated significantly (p<0.005) smaller P2 amplitudes, indexing the commencement of attentional processing, for drug pictures compared to neutral and affective pictures. Furthermore, stimulus type did not significantly modulate LPP amplitudes, indexing sustained attention, in patients however arousal ratings for drug pictures were positively correlated with LPP amplitudes in patients. These ERP results of altered cognitive control and incentive salience suggest the neural mechanisms underlying these cognitions are affected by chronic opioid abuse. Investigating the cognitive abnormalities experienced by PO abusers is an important factor in understanding the neural correlates of substance abuse and in predicting successful outcomes to ensure the best chance at long-term recovery for addicted individuals.
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Zarnegar, Parisa. "In vitro and postmortem studies of the brain opioid system: association to opiate dependence /." Stockholm, 2006. http://diss.kib.ki.se/2006/91-7140-904-1/.
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Watson, Benjamin James. "Neurobiological mechanisms underlying the motivational process in chronic opioid and alcohol dependence." Thesis, University of Bristol, 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.633450.
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Chronic opioid and alcohol dependence are widespread problems with enormous associated individual and societal costs. The disruption of normal motivational processes is characteristic in addiction and studying the neurobiological mechanisms involved is key to helping develop treatments. This thesis has studied specific mechanisms in two different ways, firstly using neuroimaging and secondly by applying existing understanding to trial a novel treatment approach. The central role played by the mesolimbic dopaminergic system in the motivational system is well established, however compared to other drugs of abuse, it has been studied very little in opioid dependence. Two linked neuroimaging studies were conducted using llC-raclopride positron emission tomography, to better characterise the dopaminergic system. in opioid dependence. There was no detectable increase of striatal dopamine levels in opioid-dependent participants, to either expectation or delivery of a heroin related reward, and there was also no significant difference found in striatal dopamine D2/3 receptor availability compared with healthy controls. The lack of detectable changes contrasts with those seen in abstinent stimulant users. This may have been due to the impact of substitute medication and further research is needed to explore the neurobiological effects of different opioid substitutes.
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Bazov, Igor. "Epigenetic Dysregulations in the Brain of Human Alcoholics : Analysis of Opioid Genes." Doctoral thesis, Uppsala universitet, Institutionen för farmaceutisk biovetenskap, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-270321.
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Neuropeptides are special in their expression profiles restricted to neuronal subpopulations and low tissue mRNA levels. Genetic, epigenetic and transcriptional mechanisms that define spatiotemporal expression of the neuropeptide genes have utmost importance for the formation and functions of neural circuits in normal and pathological human brain. This thesis focuses on regulation of transcription of the opioid/nociceptin genes, the largest neuropeptide family, and on identification of adaptive changes in these mechanisms associated with alcoholism as model human pathology. Two epigenetic mechanisms, the common for most cells in the dorsolateral prefrontal cortex (dlPFC) and the neuron-subpopulation specific that may orchestrate prodynorphin (PDYN) transcription in the human dlPFC have been uncovered. The first, repressive mechanism may operate through control of DNA methylation/demethylation in a short, nucleosome size promoter CpG island (CGI). The second mechanism may involve USF2, the sequence–specific methylation–sensitive transcription factor which interaction with its target element in the CpG island results in USF2 and PDYN co-expression in the same neurons. The short PDYN promoter CGI may function as a chromatin element that integrates cellular and environmental signals through changes in methylation and transcription factor binding. Alterations in USF2–dependent PDYN transcription are affected by the promoter SNP (rs1997794: T>C) under transition to pathological state, i.e. in the alcoholic brain. This and two other PDYN SNPs that are most significantly associated with alcoholism represent CpG-SNPs, which are differentially methylated in the human dlPFC. The T, low risk allele of the promoter SNP forms a noncanonical AP-1–binding element. JUND and FOSB proteins, which may form homo- or heterodimers have been identified as dominant constituents of AP-1 complex. The C, non-risk variant of the PDYN 3′ UTR SNP (rs2235749 SNP: C>T) demonstrated significantly higher methylation in alcoholics compared to controls. PDYN mRNA and dynorphin levels significantly and positively correlated with methylation of the PDYN 3′ UTR CpG-SNP suggesting its involvement in PDYN regulation. A DNA–binding factor with differential binding affinity for the T allele and methylated and unmethylated C alleles of the PDYN 3′ UTR SNP (the T allele specific binding factor, Ta-BF) has been discovered, which may function as a regulator of PDYN transcription. These findings emphasize the complexity of PDYN regulation that determines its expression in specific neuronal subpopulations and suggest previously unknown integration of epigenetic, transcriptional and genetic mechanisms that orchestrate alcohol–induced molecular adaptations in the human brain. Given the important role of PDYN in addictive behavior, the findings provide a new insight into fundamental molecular mechanisms of human brain disorder. In addition to PDYN in the dlPFC, the PNOC gene in the hippocampus and OPRL1 gene in central amygdala that were downregulated in alcoholics may contribute to impairment of cognitive control over alcohol seeking and taking behaviour.
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Corder, Gregory F. "INJURY ESTABLISHES CONSTITUTIVE µ-OPIOID RECEPTOR ACTIVITY LEADING TO LASTING ENDOGENOUS ANALGESIA AND DEPENDENCE." UKnowledge, 2013. http://uknowledge.uky.edu/physiology_etds/10.
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Injury causes increased pain sensation in humans and animals but the mechanisms underlying the emergence of persistent pathological pain states, which arise in the absence of on-going physical damage, are unclear. Therefore, elucidating the physiological regulation of such intractable pain is of exceptional biomedical importance. It is well known that endogenous activation of µ-opioid receptors (MORs) provides relief from acute pain but the consequences of prolonged endogenous opioidergic signaling have not been considered. Here we test the hypothesis that the intrinsic mechanisms of MOR signaling promote pathological sensitization of pain circuits in the spinal cord. We found that tissue inflammation produces agonist-independent MOR signaling in the dorsal horn of the spinal cord, which tonically represses hyperalgesia for months, even after complete recovery from injury and re-established normal pain thresholds. Disruption of this constitutive activity with MOR inverse agonists reinstated pain and precipitated cellular, somatic and aversive signs of physical withdrawal. This phenomenon required N-methyl-D-aspartate receptor activation of calcium-sensitive adenylyl cyclase type 1. Thus, we present a novel mechanism of long-lasting opioid analgesia that regulates the transition from acute to chronic pain while, in parallel, generates physical dependence. In conclusion we propose that the prevalence of chronic pain syndromes may result from a failure in constitutive signaling of spinal MORs and a loss of endogenous analgesic control.
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Sribanditmongkol, Pongruk. "Inhibition of morphine tolerance and dependence by diazepam and its relation to opioid peptides /." The Ohio State University, 1994. http://rave.ohiolink.edu/etdc/view?acc_num=osu1487849696964501.
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Altarifi, Ahmad. "EFFECTS OF MU OPIOID RECEPTOR AGONISTS ON INTRACRANIAL SELF-STIMULATION IN THE ABSENCE AND PRESENCE OF “PAIN” IN RATS." VCU Scholars Compass, 2013. http://scholarscompass.vcu.edu/etd/518.
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Pain is a significant health problem. Mu opioid receptor agonists are used clinically as analgesics, but their use is constrained by high abuse liability. Intracranial self-stimulation (ICSS) is a preclinical behavioral procedure that has been used to assess abuse potential of opioids, and drug-induced facilitation of ICSS is interpreted as an abuse-related effect. ICSS can also be used as a behavioral baseline to detect affective dimensions of pain. Specifically, pain-related depression of ICSS can model pain-related depression of behavior and mood, and drug-induced blockade of pain-related ICSS depression can serve as a measure of affective analgesia. This dissertation used mu agonists that vary in efficacy at the mu receptor (methadone> fentanyl> morphine> hydrocodone> buprenorphine> nalbuphine) and compared their effects on ICSS in the absence (phase one) or presence (phase 2) of pain. Adult male Sprague-Dawley rats were equipped with intracranial electrodes targeting the medial forebrain bundle and trained to lever press for brain stimulation. Different frequencies of stimulation maintained a frequency-dependent increase in ICSS rates, and permitted detection of both rate-increasing and rate-decreasing treatment effects. During phase 1, medium- and high-efficacy mu agonists produced initial rate-decreasing effects, followed by abuse-related rate-increasing effects at later time points. Repeated morphine administration produced tolerance to its own rate-decreasing effects, cross-tolerance to rate-decreasing effects of other mu agonists, and enhanced expression of rate-increasing effects. Low efficacy mu agonists only produced rate-increasing effects, which were enhanced after repeated morphine. These results suggest that previous opioid exposure increases expression of abuse-related facilitation of ICSS by mu agonists regardless of efficacy. During phase 2, intraperitoneal administration of lactic acid (1.8%) served as a noxious stimulus to depress ICSS. All mu agonists blocked acid-induced depression of ICSS at doses similar to those that facilitated ICSS in the absence of pain. A higher intensity noxious stimulus (5.6 % acid) produced further depression of ICSS and reduced the antinociceptive potency of both methadone and nalbuphine. Morphine antinociception was resistant to tolerance in the assay of acid-depressed ICSS. Overall, these results provide a basis for comparing determinants of abuse-related opioid effects in the absence of pain with their affective analgesic effects in the presence of pain.
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Jali, Abdulmajeed. "DISCOVERY OF MOR SELECTIVE, REVERSIBLE OPIOID ANTAGONIST FOR POTENTIAL USE IN TREATMENT OF DRUG DEPENDENCE." VCU Scholars Compass, 2017. http://scholarscompass.vcu.edu/etd/5020.
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Abstract
DISCOVERY OF MOR SELECTIVE, REVERSIBLE OPIOID ANTAGONIST FOR POTENTIAL USE IN TREATMENT OF DRUG DEPENDENCE
Abdulmajeed M. Jali, M.S.
A thesis submitted in partial fulfillment of the requirements of Master of Science at Virginia Commonwealth University.
Virginia Commonwealth University, 2017
Director: Dana E. Selley, Ph. D., Department of Pharmacology and Toxicology
Opioid dependence/addiction is a major public health problem that is associated with multiple health and social costs. Pharmacotherapeutic treatment has been relatively effective, but the risk of relapse after treatment remains high. Naltrexone, an opioid antagonist, is FDA-approved for long-term maintenance therapy to reduce relapse risk. However, naltrexone is accompanied by side-effects that are due to lack of selectivity among opioid receptor types. Based on the message-address concept and molecular modeling studies, 18 novel compounds designed to bind selectively to the MOR based on interaction with a key aromatic residue, were synthesized by our collaborators. The purpose of this study was to identify MOR-selective antagonists from this series of compounds. Using radioligand and GTPgS binding assays in transfected cells and native tissues, two compounds were discovered with the high MOR-selectivity and low efficacy required to serves as lead ligands in future discovery efforts toward next-generation opioid antagonists.
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Gibson, Amy Elizabeth National Drug & Alcohol Research Centre Faculty of Medicine UNSW. "Mortality among the recipients of methadone, buprenorphine and naltrexone maintenance for the treatment of opioid dependence: the levels, predictors and causes of mortality." Awarded By:University of New South Wales. National Drug & Alcohol Research Centre, 2009. http://handle.unsw.edu.au/1959.4/44508.
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Opioid dependence is a complex and persistent disorder with a high mortality rate and severe impact on health and social situation. It is associated with much harm, including the transmission of blood-borne bacterial and viral infections, self-harm, traumatic injury and drug overdose. All of these harms carry a risk of death, and accordingly, mortality rates in opioid-dependent people are many times higher than those in the general population of the same age and sex. One of the more commonly used strategies for reducing the risks of opioid dependence is the provision of maintenance treatment. In Australia, available maintenance treatments include methadone, buprenorphine, oral naltrexone, and the unregistered sustained-release formulation of naltrexone, naltrexone implants. This thesis reports on a range of data collections and study designs to investigate the levels, predictors and causes of mortality in opioid-dependent persons entering methadone, buprenorphine and naltrexone maintenance treatment in Australia. The studies used data linkage to examine mortality rates and causes of death in a longitudinal cohort of the early entrants to the NSW methadone program, examined the predictors of mortality (particularly the impact of methadone and buprenorphine treatment) using survival analysis in a longitudinal cohort study, compared national mortality rates between methadone, buprenorphine and naltrexone maintenance treatments in a cross-sectional analytic study, and used a small case series of coronial cases to examine whether death from opioid overdose was possible in a recipient of a naltrexone implant. This thesis demonstrates that mortality rates as a whole and from particular causes of death are many times higher in Australian opioid-dependent subjects than the general population, exposure to methadone or buprenorphine maintenance treatment significantly reduced mortality in a sample of opioid-dependent subjects, naltrexone treatment appears to have higher mortality than both methadone and buprenorphine maintenance treatments, and fatal opioid overdose while in receipt of sustained-release naltrexone treatment is possible. These results support longer retention in and repeated access to methadone and buprenorphine maintenance treatments in order to reduce mortality in opioid-dependent people, and greater regulation of the access to and more rigorous monitoring of the mortality associated with oral and sustained-release naltrexone maintenance treatments.
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Loveday, William A. "Prescription opioid analgesic drug misuse: What can we learn from doctor-shopping behaviour." Thesis, Queensland University of Technology, 2017. https://eprints.qut.edu.au/108061/1/William_Loveday_Thesis.pdf.
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This thesis examined the phenomenon of 'doctor shopping' for prescription opioid drugs in Queensland to identify whether aspects of this behaviour could be used better identify drug misuse and to assist doctors in better treatment of patients. Findings suggest that doctor shopping is a complex and uncommon behaviour in patients receiving prescription opioid drugs and not necessarily associated with aberrant drug use. It appears that long-term high dose use of prescription opioids is a greater indicator of concern and potential risk of harm. These outcomes have relevance to the implementation of real-time reporting of prescription opioid drugs in Australia.
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Dipzinski, Aaron. "Comparison of Washington state 2010 Medicare prescription drug plan coverage of pharmacotherapies for opioid and alcohol dependence." Pullman, Wash. : Washington State University, 2010. http://www.dissertations.wsu.edu/Thesis/Spring2010/A_Dipzinski_042310.pdf.
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Thesis (M.H.P.A.)--Washington State University, May 2010.Title from PDF title page (viewed on July 22, 2010). "Department of Health Policy and Administration." Includes bibliographical references (p. 42-51).
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Nikic, Matthew James. "Factors affecting treatment outcome in opioid dependence substitution treatment : the influence of mood and withdrawal symptoms /." Title page, abstract and table of contents only, 2004. http://web4.library.adelaide.edu.au/theses/09HS/09hsn692.pdf.
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Ouzounian, Nicole Marie. "A Phenomenological Research Study on the Treatment Experience of Opioid Addicts: Exploring the Intrapersonal and Interpersonal Conflicts that Opioid Addicts Face During the Treatment Process." Diss., NSUWorks, 2018. https://nsuworks.nova.edu/shss_dcar_etd/118.
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Opioid addiction is a physical, mental, and social issue. The insidious habits and behaviors acquired while living an addictive lifestyle are more powerful than human comprehension, and the training required to release these strongholds are extreme to say the least. Capturing the lived experiences of this process is needed to increase understanding of the development that leads to transformation from active addict to addict in recovery. This phenomenological research study on the treatment experience of opioid addicts used a qualitative approach to gain understanding of this phenomenon. For this study, 15 research participants were selected. Their ages ranged from 21 to 30-years-old and they all successfully completed an adult substance abuse treatment program. All participants must have been in active recovery for a minimum of one year. The central question for this study is: what are the intrapersonal and interpersonal conflicts opioid addicts are presented with during their treatment process? By means of conducting and analyzing interview questions and utilizing the conflict resolution theories of human motivation, social identity theory, coordinated management of meaning theory, and relative deprivation theory, this study revealed that the overall essence of the treatment experience is the journey of identity transformation from active addict to addict in recovery through conflict management. The need to manage conflict in five specific areas was uncovered. They include identity formation, stigma, interpersonal relationships, group structure, and conflict styles. The participants’ shared experiences provide insight into identifying conflicts that need to be managed and resolved so recovery is achieved and sustained.
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Hussain, Muhammad Zubair. "Molecular Adaptations in the Endogenous Opioid System in Human and Rodent Brain." Doctoral thesis, Uppsala universitet, Institutionen för farmaceutisk biovetenskap, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-205133.
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The aims of the thesis were to examine i) whether the endogenous opioid system (EOS) is lateralized in human brain areas involved in processing of emotions and pain; ii) whether EOS responses to unilateral brain injury depend on side of lesion, and iii) whether in human alcoholics, this system is involved in molecular adaptations in brain areas relevant for cognitive control of addictive behavior and habit formation. The main findings were that (1) opioid peptides but not opioid receptors and classic neurotransmitters are markedly lateralized in the anterior cingulate cortex involved in processing of positive and negative emotions and affective component of pain. The region-specific lateralization of neuronal networks expressing opioid peptides may underlie in part lateralization of higher functions in the human brain including emotions and pain. (2) Analysis of the effects of traumatic brain injury (TBI) demonstrated predominant alteration of dynorphin levels in the hippocampus ipsilateral to the injury, while injury to the right hemisphere affected dynorphin levels in the striatum and frontal cortex to a greater extent than that to the left hemisphere. Thus, trauma reveals a lateralization in the mechanisms mediating the response of dynorphin expressing neuronal networks in the brain. These networks may differentially mediate effects of left or right brain injury on lateralized brain functions. (3) In human alcoholics, the enkephalin and dynorphin systems were found to be downregulated in the caudate nucleus and / or putamen that may underlie in part changes in goal directed behavior and formation of a compulsive habit in alcoholics. In contrast to downregulation in these areas, PDYN mRNA and dynorphins in dorsolateral prefrontal cortex, k-opioid receptor mRNA in orbitofrontal cortex, and dynorphins in hippocampus were upregulated in alcoholics. Activation of the k-opioid receptor by upregulated dynorphins may underlie in part neurocognitive dysfunctions relevant for addiction and disrupted inhibitory control. We conclude that the EOS exhibits region-specific lateralization in human brain and brain-area specific lateralized response after unilateral TBI in mice; and that the EOS is involved in adaptive processes associated with specific aspects of alcohol dependence.
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Klintenberg, Rebecka. "Levodopa- and Neuroleptic-Induced Dyskinesias : Studies on Pharmacological Modification and Processing of Opioid Neuropeptides." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2003. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-3331.
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Raehal, Kirsten Michele. "Opioid-Induced Side Effects in Beta-arrestin2 adn G Protein-Coupled Receptor Kinase Knockout Mice." The Ohio State University, 2009. http://rave.ohiolink.edu/etdc/view?acc_num=osu1236884585.
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Elbegdorj, Orgil. "DESIGN, SYNTHESES, AND BIOLOGICAL EVALUATION OF 14-N-SUBSTITUTED NALTREXONE DERIVATIVES AS OPIOID RECEPTOR LIGANDS." VCU Scholars Compass, 2013. http://scholarscompass.vcu.edu/etd/455.
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Opium, the dried resin obtained from the unripe seedpods of the poppy flower, has been used for medicinal and euphoric purposes since ancient times. Morphine, the main active ingredient of opium, and other clinically useful opioid analgesics all mediate their effects through activating the mu opioid receptor. Studies involving the mu opioid receptor knockout mice showed that the interaction with the mu opioid receptor is also responsible for many notorious side effects associated with these drugs including dependence and addiction. Therefore, selective antagonists for the mu opioid receptor are needed to study its function in drug abuse and addiction. Previously, based on molecular modeling studies and the “message-address” concept, a series of 14-O-substituted naltrexone derivatives were designed and synthesized. These compounds carried an ester-linked heteroaromatic substitution at the 14-position of naltrexone which was designed to interact with the putative “address” site, that was identified in the mu opioid receptor through molecular modeling studies. The lead compound of this series was determined to have a high affinity and selectivity for the mu opioid receptor. Because the 14-O-substituted naltrexone derivatives were not very stable, the ester linkage in these compounds was replaced by an amide one and a series of 14-N-substituted naltrexone derivatives were synthesized. The affinity and selectivity of these novel naltrexone derivatives were determined in a competitive radioligand binding assay. Interestingly, the 14-N-substituted naltrexone derivatives did not maintain the high selectivity of the 14-O-substituted series. It was hypothesized that the conformational constraint introduced by the amide linker was detrimental to the mu opioid receptor selectivity. Therefore, three 14-N-substituted naltrexone derivatives which carried more flexible linkages were synthesized and evaluated. The mu opioid receptor selectivity was not recovered by introducing rotational freedom into the linker. Some of these 14-N-substitued naltrexone derivatives were determined to be mu-kappa opioid receptor dual selective antagonists. Since the mu opioid receptor antagonists are effective at treating drug addiction, while growing evidence suggests that the kappa opioid receptor antagonists may be beneficial in lowering drug cravings, these novel mu-kappa opioid receptor dual selective antagonists may find unique clinical utility in the treatment of opioid dependence.
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Choski, Charvi, Kesheng Wang, Ying Liu, Olakunle Oni, Youssoufou Ouedraogo, and Shimin Zheng. "Effects of Buprenorphine and Methadone on Hypertension in Patients with Opioid Dependence: a Randomized Clinical Trial Study." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/326.
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Background: The misuse and addiction to opioids are one of the major health and social problem that is associated with an increase in morbidity and mortality. Both Buprenorphine (BUP) and Methadone (MET) are FDA-approved treatments for opioid dependence. This longitudinal study is to determine the effects of BUP and MET on hypertension in patients with opioid dependence using a Generalized Estimating Equation(GEE) Model. Methods: The data is from National Drug Abuse Treatment Clinical TrialsNetwork (CTN) protocol CTN-0027. This is a randomized study of 1,934 opioid dependence participants seeking treatment that followed for up to 32 weeks. A total of1,284 males and 631 females participated at the Baseline (visit1) of the study. At the endof 32 weeks (10 visits), 499 males and 243 female patients completed the study. Blood pressure of all the patients was checked at every visit beginning visit 1 to visit 10. For this analysis, the dependent variable was hypertension which was defined as having asystolic blood pressure higher than 140 mmHg and/or a diastolic blood pressure higher than 90 mmHg. These participants were randomly assigned to receive BUP (n= 740) or MET (n= 529). The GEE model with exchangeable correlation was used to determine the efficacy of both the drugs on hypertension. The analysis was performed using PROCGENMOD in SAS 9.4. Results: Time increased the odds of hypertension (adjusted odds ratio (aOR): 1.04, 95% confidence interval (CI): 1.02-1.06, pConclusion: Findings suggest that BUP had a slightly less chance of causing hypertension among patients with opioid dependence comparing with MET controlling for other risk factors, but neither one of Page 54 2017 Appalachian Student Research Forum them had any significant effect on hypertension among patients with opioid dependence. Further analysis will be essential to detect gender x treatment interaction.
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Soyka, Michael, Jens Strehle, Jürgen Rehm, Gerhard Bühringer, and Hans-Ulrich Wittchen. "Six-Year Outcome of Opioid Maintenance Treatment in Heroin-Dependent Patients: Results from a Naturalistic Study in a Nationally Representative Sample." Karger, 2017. https://tud.qucosa.de/id/qucosa%3A71616.
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Background: In many countries, the opioid agonists, buprenorphine and methadone, are licensed for maintenance treatment of opioid dependence. Many short-term studies have been performed, but little is known about long-term effects. Therefore, this study described over 6 years (1) mortality, retention and abstinence rates and (2) changes in concomitant drug use and somatic and mental health. Methods: A prevalence sample of n = 2,694 maintenance patients, recruited from a nationally representative sample of n = 223 substitution doctors, was evaluated in a 6-year prospectivelongitudinal naturalistic study. At 72 months, n = 1,624 patients were assessed for outcome; 1,147 had full outcome data, 346 primary outcome data and 131 had died; 660 individuals were lost to follow-up. Results: The 6-year retention rate was 76.6%; the average mortality rate was 1.1%. During follow-up, 9.4% of patients became “abstinent” and 1.9% were referred for drug-free addiction treatment. Concomitant drug use decreased and somatic health status and social parameters improved. Conclusions: The study provides further evidence for the efficacy and safety of maintenance treatment with opioid agonists. In the long term, the number of opioid-free patients is low and most patients are more or less continuously under opioid maintenance therapy. Further implications are discussed.
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Stevenson, Erin. "EXAMINING CHRONIC NON-CANCER PAIN AMONG A SAMPLE OF INDIVIDUALS IN OPIOID TREATMENT PROGRAMS." UKnowledge, 2012. http://uknowledge.uky.edu/csw_etds/2.
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National rates of chronic non-cancer pain (CNCP) are rising alongside increasing reports of prescription opioid abuse and mortality. Associations between the rise in CNCP and in opioid abuse seem logical, yet research on CNCP among individuals with opioid dependence is currently limited due to the complicated nature of comorbid conditions in research and treatment. This study aims to expand the CNCP knowledge base by responding to the question: Do individuals with CNCP participating in an opiate treatment program have better or worse treatment outcomes than individuals without CNCP?
This study used a secondary dataset including 483 adults from Kentucky’s Opiate Recovery Treatment Outcome Study. Individuals in the sample met DSM-IV-TR criteria for opioid dependence and were in treatment at a licensed opiate treatment program (OTP). Analysis compared cases with and without CNCP on national treatment outcome measures including substance use, recovery support, education, employment, mental health symptoms, and criminal justice system involvement.
Results indicated no differences at follow-up between the CNCP (n=163) and non-CNCP (n=320) individuals on substance abstinence, recovery supports, education level, or criminal justice system involvement. At baseline and follow-up there were more unemployed individuals and individuals receiving disability benefits in the CNCP group than the non-CNCP group. Reported anxiety and depression symptoms increased at follow-up, while use of prescription medicine for mental health symptoms declined for both groups (non-significant differences). The only predictors for CNCP cases in this sample were tobacco use and presence of a chronic medical condition.
Recommendations include expansion of smoking cessation programs in substance abuse treatment settings. Future research might examine integrated treatment and medical home health models to better address biopsychosocial components of clients with comorbid conditions like opioid dependence and CNCP.
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Olofsson, Anna. "Farmakologisk behandling vid opioidberoende : Finns det skillnader i effekt mellan buprenorfin- och metadonbehandling?" Thesis, Linnéuniversitetet, Institutionen för kemi och biomedicin (KOB), 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-75068.
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Bakgrund: Heroin är en opiat ursprungen från opiumvallmon och är starkt förknippad med beroende och död. När heroin och andra kortverkande opiater binder in till μ-opioidreceptorer i hjärnan sker en ökad frisättning av signalsubstansen dopamin och en stark känsla av eufori infinner sig. Vid upprepat intag sker förändringar i hjärnan; belöningseffekten minskar medan antibelöningseffekterna ökar och cravings och abstinensymptom blir allt tydligare vid frånvaro av drogen. Vid läkemedelsassisterad rehabilitering vid opiatberoende (LARO) används förutom psykosocial behandling även långverkande opioider såsom opioidagonisten metadon och den partiella opioidagonisten buprenorfin, för att återställa homeostasen och reducera cravings och abstinenssymptom som opioidberoendet har skapat. Metadon är effektivt vid beroendebehandling men dess risker begränsar dess användning. Buprenorfin har lägre överdospotential men eventuellt sämre effekt än metadon. Syfte: Syftet med denna litteraturstudie var att undersöka skillnad i effekt mellan buprenorfinpreparat och metadon vid behandling av opioidberoende. Metod: Arbetet är en litteraturstudie baserat på fem vetenskapliga studier vilka har erhållits via sökning i PubMed samt Cochrane Library. De aspekter som avhandlats är; fullföljande och retention av behandling, samtidigt sidomissbruk av opiater samt allvarliga incidenter och biverkningar. Resultat: De inkluderade studierna i denna litteraturstudie visade att metadon är bättre på att bevara patienter i behandling medan buprenorfin mer effektivt kan minska sidomissbruket av opiater. Ju högre doser som användes, desto fler deltagare stannade kvar i behandling och desto färre urinprover rapporterades positiva för sidomissbruk av opiater. Få allvarliga incidenter rapporterades från studierna. Slutsats: Både metadon och buprenorfinpreparaten har sina för- och nackdelar. Då behandling med metadon tidigare bevisats vara mer riskfyllt bör buprenorfinpreparaten utgöra förstahandsval, men vid otillräcklig effekt bör byte till metadon ske. Detta överrensstämmer med riktlinjerna i Sverige idag. Dock tycks det finnas anledning att i framtida studier undersöka dos-effekt-samband för både dessa preparat, samt också att fokusera på den initiala fasen vid behandling med buprenorfin.Background: Heroin is an opiate from the opium poppy which is strongly associated with dependence, overdose and death. When heroin and other opiates binds to the μ-opioid receptors located in the brain, dopamine is released from the ventral tegmental area and a strong feeling of euphoria arises. Continuous intake of opioids cause changes in the brain and the feeling of euphoria will be less distinct during drug intake. Instead, cravings and abstinence, will be more distinctive in absence of the drug and causes drug-abusers to continue to use the drug. The cravings and abstinence is due to an overactive HPA-axis and amygdala. This overactivity can be reduced by treatment with long lasting opioids that is used in treatment of opioid dependence. The development of opioid maintenance treatment started in the US during the early 1960s. A few years later, opioid dependent people could join the first opioid maintenance treatment program in Uppsala, Sweden. The opioid maintenance treatment involves both pharmacological and psychosocial treatment. There are two main substances available for opioid maintenance treatment in Sweden: methadone, a full μ-opioid receptor agonist and buprenorphine, a partial μ-opioid receptor agonist. Methadone has been proven to be very efficacious treating opioid dependence. However, the risk of overdose leading to respiratory depression, limits its usefulness. Buprenorphine on the other hand, has a lower risk of toxicity but may not have same efficacy as methadone. Aim: The purpose of this literature study is to examine the efficacy of buprenorphine versus methadone among patients in opioid maintenance treatment. Methods: Five different randomized, controlled trials were selected from PubMed and The Cochrane Library to be included in this literature study. To limit this degree project, four variables was selected: completion and retention in treatment, use of illicit opiates during treatment and adverse events associated with treatment medication. Results: According to the findings in the five studies, methadone can be considered as a better option than buprenorphine when it comes to retaining participants in treatment. However, buprenorphine is somewhat more effective reducing the illicit use of opiates. When both methadone and buprenorphine were used in higher doses, more participants stayed in treatment. Also, higher doses were associated with a lower portion of urine samples positive for illicit opiates. Few adverse events were documented from the studies. Conclusion: Both methadone and buprenorphine have advantages and disadvantages. Since treatment with methadone is more perilous, buprenorphine should be considered as first-line treatment. But if the clinical effect remains insufficient, a transition to methadone treatment should occur, all according to the guidelines of opioid maintenance treatment in Sweden. However, future studies should consider evaluating the relationship between dose and effect of buprenorphine and possibly also methadone. Furthermore, more focus should be added on the initiation phase of treatment with buprenorphine.
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Eriksson, Frida, and Marika Bjärgestad. "Sjuksköterskors attityder till smärtbehandling för opioidberoende patienter : en litteraturöversikt." Thesis, Sophiahemmet Högskola, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:shh:diva-3953.
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Bakgrund Smärta är en subjektiv upplevelse och smärtbehandling bör därför utformas olika beroende på individens smärtupplevelse. Att lindra lidande och smärtbehandla alla patienter där behovet finns är en del av sjuksköterskans arbetsuppgifter. Smärtbehandling hos patienter med ett samtidigt opioidberoende kan upplevas problematiskt och som ett hinder i vårdandet av denna patientgrupp. Sjuksköterskors attityder till att smärtbehandla opioidberoende patienter kan grunda sig i egna erfarenheter och personliga åsikter där attityden kan påverka mötet med patienter och vårdandet av dessa. Syfte Syftet var att belysa sjuksköterskors attityder till smärtbehandling för opioidberoende patienter. Metod Icke systematisk litteraturöversikt användes som metod för att besvara syftet med stöd av 17 vetenskapliga artiklar. Artikelsökning genomfördes i PubMed och CINAHL Complete. Resultat Genomförd litteraturöversikt visade att sjuksköterskor hade negativa attityder till att vårda och smärtbehandla opioidberoende patienter. Sjuksköterskor upplevde problematik kring tillit och partnerskap i uppbyggandet av god vårdrelation då patienten var opioidberoende och ansåg att mötet med dessa patienter kunde bli hotfullt och påverkat av manipulativt beteende. Sjuksköterskors tidigare erfarenheter och personliga inställning till missbruk påverkade vårdandet. De upplevda problemen gällande att smärtbehandla opioidberoende patienter ofta grundade sig i kunskapsbrist hos sjuksköterskor. Kunskapsbristen genererade otrygghet i beslutsfattande, bemötande och vårdande av patienter med opioidberoende och samtidig smärta. De sjuksköterskor som hade mer erfarenhet av patientgruppen tenderade uppleva mer positiva attityder och en känsla av säkerhet gällande både bemötande och smärtbehandling. Sjuksköterskor beskrev vikten av god och formell utbildning och behov av organisatoriskt stöd i vårdandet. Slutsats Litteraturöversiktens resultat tyder på att sjuksköterskor brister i sin utbildning gällande vårdandet av patienter med missbruk i samband med smärtbehandling. Sjuksköterskornas kunskap och erfarenhet ligger till grund för hur omvårdnaden och mötet med patientgruppen utformas. Framtagna riktlinjer och stödmodeller krävs på en organisatorisk nivå för vårdande av missbrukande patienter i samband med smärtbehandling.Background Pain is a subjective experience. Relieving suffering and treating all patients where the need arises is a part of the nurse's duties. Pain treatment for patients with concomitant opioid dependence can be experienced as problematic. The nurse's attitudes towards treating opioid dependent patients may be based on individual experiences and personal opinions, where their attitude can influence the meeting with patients and their care. Aim The aim was to explore nurses’ attitudes to pain treatment for opioid dependent patients. Method Non-systematic literature review was used as a method to answer the purpose with the support of 17 scientific articles. The article search was performed in PubMed and CINAHL Complete. Results The literature review showed that nurses had negative attitudes towards caring for and treating opioid dependent patients. Nurses experienced problems with trust and partnership when the patient was opioid dependent and considered that interactions with these patients could be threatening and influenced by manipulative behavior. Nurses' previous experiences and personal attitudes towards addiction affected the care. Problems regarding pain treatment of opioid dependent patients were often based on a lack of knowledge, which generated insecurity in decision making, treatment and care of the patient group. Nurses who had more experience of the patient group tended to experience more positive attitudes and a sense of security regarding both care treatment and pain treatment. Good and formal education and need for organizational support in care of the patient group were indicated. Conclusions The results indicate that there is a lack of training among nurses in the care of addicted patients in connection with pain treatment. The nurses' knowledge and experience form the basis of how the nursing and meeting with the patient group looks like. Developed guidelines are required at an organizational level for addicted patients in connection with pain treatment.
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Wittchen, Hans-Ulrich, Sabine M. Apelt, Michael Soyka, Markus Gastpar, Markus Backmund, Jörg Gölz, Michael R. Kraus, et al. "Feasibility and outcome of substitution treatment of heroin-dependent patients in specialized substitution centers and primary care facilities in Germany: A naturalistic study in 2694 patients." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2013. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-110756.
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Background: In many countries, buprenorphine and methadone are licensed for the maintenance treatment (MT) of opioid dependence. Despite many short-term studies, little is known about the long-term (12-month) effects of these treatments in different settings, i.e. primary care-based (PMC) and specialized substitution centers (SSCs).
Objectives: To describe over a period of 12 months: (1) mortality, retention and abstinence rates; (2) changes in concomitant drug use, somatic and mental health; and (3) to explore differences between different types of provider settings.
Methods: 12-Month prospective-longitudinal naturalistic study with four waves of assessment in a prevalence sample of N= 2694 maintenance patients, recruited from a nationally representative sample of N= 223 substitution physicians.
Results: The 12-month retention rate was 75%; the mortality rate 1.1%. 4.1% of patients became “abstinent” during follow-up. 7% were referred to drug-free addiction treatment. Concomitant drug use decreased and somatic health status improved. No significant improvements were observed for mental health and quality of life. When controlling for initial severity, small PMC settings revealed better retention, abstinence and concomitant drug use rates.
Conclusion: The study underlines the overall 12-month effectiveness of various forms of agonist MT. Findings reveal relatively high retention rates, low mortality rates, and improvements in most 12-month outcome domains, except for mental health and quality of life. PMC settings appear to be a good additional option to improve access to MTs.
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MacVicar, Sonya. "IBriS study : intervention supporting breastfeeding in substance dependency." Thesis, Robert Gordon University, 2016. http://hdl.handle.net/10059/2119.
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Introduction: Breastfeeding offers the substance exposed mother and child potential short and long-term health benefits, with breast milk shown to alleviate the severity of Neonatal Abstinence Syndrome. Substance dependent women, however, have limited success establishing breastfeeding with physical, psychological and institutional factors cited as barriers. This study aimed to develop and test the feasibility of an evidence informed and theory based intervention to support continued breastfeeding for this group. Methods: The research was a two-phase feasibility study. Phase 1 informed intervention development using a mixed methodology approach which included (a) a comprehensive systematic literature review of breastfeeding support for women from disadvantaged groups (b) expert advisory group recommendations and (c) ‘think aloud’ verbal protocols with opioid dependent women. Phase 2 underpinned the evidence with the theoretical constructs of behaviour change, prior to testing the acceptability and implementation fidelity of the intervention in a feasibility study with an embedded small-scale randomised controlled trial. Results: Phase 1 identified the barriers to breastfeeding continuation as low maternal self-efficacy; neonatal feeding difficulties associated with withdrawal and unsupportive healthcare practices. Evidence and theory synthesis resulted in an integrated breastfeeding support model founded on practical, informational, psychological, person-centred and environmental components. Phase 2 demonstrated that the intervention was feasible to implement and acceptable to participants. The randomised controlled trial reported higher rates of continued breastfeeding and a greater level of maternal confidence in breastfeeding ability in the intervention group compared to the control group. Breastfed infants were less likely to require pharmacological management and had corresponding shorter durations of hospitalisation than formula fed infants. Conclusion: The research provided an original contribution to the development of a complex healthcare intervention which is meaningful to both existing research and clinical practice. The findings highlighted the potential of the intervention to support breastfeeding for the substance exposed mother and baby, which has wide ranging implications for the improved health and social equalities of this group.
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Botros, Milad. "Characterization of Substance P (SP) Aminoterminal SP (1-7) Binding in Brain Regions and Spinal Cord of the Male Rat : Studies on the Interaction with Opioid Related Pathways." Doctoral thesis, Uppsala universitet, Avdelningen för biologisk beroendeforskning, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-9401.
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Binding sites for substance P(1-7), SP(1-7) have been identified and characterized for the first time in crude membrane fraction from rat CNS using tritiated ([3H]) SP(1-7) as tracer. These putative receptors were investigated in relation to their affinity for tachykinins, opioid peptides and sigma receptor ligands. [3H]-SP(1-7) specifically binds to high affinity binding sites identified as receptor targets for the heptapeptide SP (1-7). Two distinct binding sites were observed in the spinal cord. One site is recognized by high affinity for SP(1-7) with a Kd of 0.5 nM, whereas the other site showed low affinity for the heptapeptide (Kd=12 nM). In the brain, the binding of SP(1-7) fitted a single site binding model with a Kd of 4.4 nM and a Ki of 4.2 nM. Further, using the spinal cord membranes the binding of [3H]-SP (1-7) was weakly displaced by SP and other N-terminal fragments thereof and no or negligible affinity was observed for ligands of the NK-1, NK-2 and NK-3 tachykinin receptors, C-terminal SP(5-11), Tyr-w-MIF-1 or the mu-opioid receptor antagonists naloxone and naloxonazine. On the other hand it was significantly displaced by endomorphin-2, DAMGO, and Try-MIF-1 and exhibit some affinity for MIF-1, ß-casomorphin and endomorphin-1. However, only endomorphin-2, DAMGO and Tyr-MIF-1 showed affinity in the close range of the native peptide SP(1-7). The affinity of endomorphin-2 for the spinal cord site was 10 times lower than that of SP(1-7) but more than 100 times higher than the affinity recorded for endomorphin-1. Tyr-MIF-1 but not Tyr-w-MIF-1 showed similar affinity as endomorphin-2 for SP(1-7) site. All peptides exhibiting high affinity at the SP(1-7) site, have a phenylalanine or a leucine residue in their C-terminal structure. Further, synthetic analogues of SP(1-7) were tested for their affinity for the SP(1-7) receptor in the rat spinal cord. An important finding here was that the receptor-ligand-interaction was favoured by the C-terminal region of SP(1-7). Residues at positions 5-7 appeared crucial for binding to the specific SP(1-7) site. The presence of the amidated Phe7 residue was extremely critical for binding to the SP(1-7) site.The analogue Gln5-Gln6-Phe7-NH2 was almost equipotent with the parent peptide in the SP (1-7) receptor binding assay. Furthermore, the SP(1-7)-amide potently and dose dependently reduced several signs of the reaction to morphine withdrawal and was significantly attenuated by the addition of the sigma agonist SK-10047. In conclusion, the work presented in this thesis has contributed the characterization of the properties of highly selective binding sites for SP(1-7) in the rat spinal cord and VTA. These sites appear to be distinct from the µ-opioid receptor or any of the known neurokinin receptors. The study further indicates that the SP(1-7)-amide mimics the effect of the nativ heptapeptide and that the mechanisms for its action involve a sigma receptor site.
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Chamberlain, Jude M. "Development of an MMPI-2 Scale to Aid in Assessing Opioid Use Disorder." Kent State University / OhioLINK, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=kent1398255420.
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Greenwell, David Morgan. "A study of readiness to change, self efficacy and treatment entry pressures in people undertaking methadone maintenance treatment for opioid dependence." Thesis, Glasgow Caledonian University, 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.688295.
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Brooks, Billy. "Rural Opioid and Other Drug Use Disorder Diagnosis: Assessing Measurement Invariance and Latent Classification of DSM-IV Abuse and Dependence Criteria." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etd/2569.
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The rates of non-medical prescription drug use in the United States (U.S.) have increased dramatically in the last two decades, leading to a more than 300% increase in deaths from overdose, surpassing motor vehicle accidents as the leading cause of injury deaths. In rural areas, deaths from unintentional overdose have increased by more than 250% since 1999 while urban deaths have increased at a fraction of this rate. The objective of this research was to test the hypothesis that cultural, economic, and environmental factors prevalent in rural America affect the rate of substance use disorder (SUD) in that population, and that diagnosis of these disorders across rural and urban populations may not be generalizable due to these same effects. This study applies measurement invariance analysis and factor analysis techniques: item response theory (IRT), multiple indicators, multiple causes (MIMIC), and latent class analysis (LCA), to the DSM-IV abuse and dependency diagnosis instrument. The sample used for the study was a population of adult past-year illicit drug users living in a rural or urban area drawn from the 2011-2012 National Survey on Drug Use and Health data files (N = 3,369| analyses 1 and 2; N = 12,140| analysis 3). Results of the IRT and MIMIC analyses indicated no significant variance in DSM item function across rural and urban sub-groups; however, several socio-demographic variables including age, race, income, and gender were associated with bias in the instrument. Latent class structures differed across the sub-groups in quality and number, with the rural sample fitting a 3-class structure and the urban fitting 6-class model. Overall the rural class structure exhibited less diversity and lower prevalence of SUD in multiple drug categories (e.g. cocaine, hallucinogens, and stimulants). This result suggests underlying elements affecting SUD patterns in the two populations. These findings inform the development of surveillance instruments, clinical services, and public health programming tailored to specific communities.
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Wittchen, Hans-Ulrich, Sabine M. Apelt, Michael Soyka, Markus Gastpar, Markus Backmund, Jörg Gölz, Michael R. Kraus, et al. "Feasibility and outcome of substitution treatment of heroin-dependent patients in specialized substitution centers and primary care facilities in Germany: A naturalistic study in 2694 patients." Technische Universität Dresden, 2008. https://tud.qucosa.de/id/qucosa%3A26834.
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Background: In many countries, buprenorphine and methadone are licensed for the maintenance treatment (MT) of opioid dependence. Despite many short-term studies, little is known about the long-term (12-month) effects of these treatments in different settings, i.e. primary care-based (PMC) and specialized substitution centers (SSCs).
Objectives: To describe over a period of 12 months: (1) mortality, retention and abstinence rates; (2) changes in concomitant drug use, somatic and mental health; and (3) to explore differences between different types of provider settings.
Methods: 12-Month prospective-longitudinal naturalistic study with four waves of assessment in a prevalence sample of N= 2694 maintenance patients, recruited from a nationally representative sample of N= 223 substitution physicians.
Results: The 12-month retention rate was 75%; the mortality rate 1.1%. 4.1% of patients became “abstinent” during follow-up. 7% were referred to drug-free addiction treatment. Concomitant drug use decreased and somatic health status improved. No significant improvements were observed for mental health and quality of life. When controlling for initial severity, small PMC settings revealed better retention, abstinence and concomitant drug use rates.
Conclusion: The study underlines the overall 12-month effectiveness of various forms of agonist MT. Findings reveal relatively high retention rates, low mortality rates, and improvements in most 12-month outcome domains, except for mental health and quality of life. PMC settings appear to be a good additional option to improve access to MTs.
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Sheu, Ming-Jyh. "Inhibition of morphine tolerance and dependence by diazepam and its relation to cyclic AMP levels and opioid receptors in central nervous system /." The Ohio State University, 1995. http://rave.ohiolink.edu/etdc/view?acc_num=osu148786498660922.
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Hong, Pil-Sung, and Anders Kjell. "Smärtlindring av patienter med opiatberoende : En kvalitativ intervjustudie med sjuksköterskor verksamma inom beroendevård." Thesis, Röda Korsets Högskola, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:rkh:diva-538.
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Bakgrund: Internationell forskning visar på problematik kring smärtlindring av patienter med opiatberoende. Det framkommer att otillräckliga doser analgetika administreras till denna patientgrupp och att vårdpersonal saknar kunskap gällande smärtlindring av patienter med opiatberoende. Forskning visar även att vårdpersonal kan ha en negativ inställning till drogberoende patienter och ofta misstror deras motiv gällande förfrågan om analgetika. Vidare visar forskningen att denna patientgrupp upplever sig få en sämre vård än patienter utan drogberoende. Syfte: Studiens syfte var att belysa faktorer som har inverkan på smärtlindringen av patienter med opiatberoende på en beroendeavdelning. Metod: Empirisk studie med deskriptiv kvalitativ ansats baserad på strukturerade intervjuer med fyra sjuksköterskor verksamma vid en beroendeavdelning i en svensk storstad. Data analyserades genom manifest innehållsanalys. Resultat: Under analysen utkristalliserades tre kategorier och elva underkategorier, vilka beskriver faktorer som har inverkan på smärtlindringen av patienter med opiatberoende: (I) Förhållningssätt omfattar (1) Att inte döma och (2) Bemötande. (II) Förutsättningar omfattar (3) Restriktivitet, (4) Tolerans, (5) Ångest, (6) Personalbrist och (7) Kunskap. (III) Metoder omfattar (8) Smärtskattning, (9) Lindra ångest, (10) Kämpa för patienten och (11) Interprofessionalitet. Slutsats: Studiens resultat tyder på att ett respektfullt och tillmötesgående bemötande gentemot patienterna utgör en central roll i smärtbehandlingen. Vidare visar studien att sjuksköterskornas möjlighet att smärtlindra patienter i beroendevården begränsas av kunskapsluckor, restriktiva regler, resursbrist samt en patientgrupp som är svår att smärtlindra. Studiens resultat tyder på vikten av att lindra patienternas ångest samt vinsterna med ett interprofessionellt samarbete kring smärtlindring. Klinisk betydelse: Studien kan öka medvetenheten kring de hinder som identifierats för smärtlindring av patienter med opiatberoende. Sjuksköterskornas metoder i den aktuella studien skulle kunna utnyttjas i betydligt större utsträckning i beroendevården och i andra vårdkontexter vilket därigenom skulle bespara patientgruppen onödigt vårdlidande.Background: International research indicates several difficulties concerning pain relief for patients with opioid dependence. It appears that inadequate doses of analgesics are administered to patients with substance dependence and that health professionals lack knowledge regarding pain management of patients with opioid dependence. Research also shows that health professionals may have a negative attitude towards drug-dependent patients and often distrust their motives regarding request for analgesics. Furthermore, research shows that opioid dependent patients feel that they get poorer care than patients without drug addiction. Aim: The aim of the study was to examine factors that have an impact on pain relief in patients with opioid dependence from nurses’ perspective at a drug dependence treatment clinic. Method: Empirical study with descriptive qualitative approach based on structured interviews with four nurses working at a drug dependence treatment clinic in a major Swedish city. Data were analyzed with manifest content analysis. Results: During the analysis three categories and eleven subcategories emerged: (I) Attitude is comprised of (1) To not judge, and (2) Treatment. (II) Conditions is comprised of (3) Restrictivity, (4) Tolerance (5) Anxiety, (6) Staff shortage and (7) Knowledge. (III) Methods is comprised of (8) Pain assessment, (9) Relieving anxiety, (10) Fighting for the patient, and (11) Interprofessionalism. Conclusion: The study's results suggest that a respectful attitude towards patients plays a key role in pain management. Furthermore, the study shows that the nurses’ opportunity to relieve pain of patients in addiction treatment is limited by gaps in knowledge, restrictive regulations, lack of resources and patients that are difficult to pain relieve. The study's findings indicate the importance of alleviating the patients' anxiety and the benefits of interprofessional collaboration regarding pain treatment. Clinical significance: This study can increase the awareness of the barriers to pain management identified for patients with opioid dependence. Nursing practice in the current study could be used to a much greater extent in addiction services and other care contexts and thereby save the patients unnecessary suffering.
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Duah, Akwasi. "Lived Experience of Caregivers of Relatives with Alcohol and Opiate Dependence (A phenomenological study)." eScholarship@UMMS, 2017. https://escholarship.umassmed.edu/gsn_diss/50.
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Substance abuse is a relapsing chronic illness. In 2014, an estimated 27 million persons reported using illicit drugs in the United States (SAMHSA, 2014). Substance abuse negatively impacts societies, productivity, healthcare costs and families. Families play an important role in relapse prevention and sobriety. With adequate family support, substance abuse positively responds to treatment. Many individuals (about 66 million Americans) play the role as an informal caregiver for a relative with chronic illnesses such as substance abuse but few studies exist on the caregiving experiences. What we know about the family caregiving experience is restricted to data from quantitative studies which do not explain the complexities and competing challenges that exist. Different approaches are thereby needed to deepen our understanding of the family caregiver burden of living with a relative with substance abuse problems. Such studies will enable us to understand the original experience and moment of learning of a relative’s substance abuse problems, decision making and support that follows thereafter. This moment calls for major decision making and encounter with treatment services.
The purpose of this study was to explore the lived experience of caregivers of relatives with alcohol and opiate dependence. This study utilized Max van Manen’s (2014) Phenomenology of Practice. Ten participants (N=10) were recruited for this study. Van Manen’s guided existential inquiry was used in the analysis of experiential material collected through interviews. Four main themes emerged from the data: (1) Being in the moment: the extension of the self; (2) The dawn of reality: the being of acceptance; (3) Deciding in the moment: the healthcare experience; (4) Uncertainties and struggle: a lifelong process. These themes described how the participants: experienced, accepted and processed a relative’s substance abuse problem, encountered treatment services and experienced the uncertainties and struggles involved in caring for a relative with substance abuse problems. Two main findings emerged from these themes; the impact of guilt and stigma on seeking care and the need to see addiction as a disease instead of as a moral character failure. This calls for coalitions with stakeholders to decrease stigma, enhance acceptance process and increase access to treatment.
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Slatvickaja, Nelė. "Opioidinės priklausomybės pacientų lūkesčių tenkinimas slaugos procese." Master's thesis, Lithuanian Academic Libraries Network (LABT), 2013. http://vddb.laba.lt/obj/LT-eLABa-0001:E.02~2013~D_20130607_114752-92706.
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Lietuvoje asmenims, priklausomiems nuo opioidų, vis dažniau yra skiriamas gydymas stacionaruose ir farmakoterapija metadonu ar buprenorfinu. Tokiems pacientams visą parą skiriama slauga, todėl siekiant tobulinti slaugos paslaugų kokybę, svarbu žinoti, kaip slaugos veiksnius vertina patys pacientai, priklausomi nuo opioidų, ir slaugytojai, dirbantys priklausomybės ligų centruose, kokie slaugos veiksniai turi teigiamą arba neigiamą poveikį slaugos procesui ir pacientų lūkesčiams. Darbo tikslas. Išanalizuoti opioidinės priklausomybės pacientų lūkesčių tenkinimą slaugos procese.
Tyrimo metodika. Atliktas empirinis kiekybinis tyrimas. Taikyti šie metodai: anoniminė anketinė apklausa pagal standartizuotus klausimynus (juos adaptuojant), statistinis duomenų apdorojimas ir medicininės literatūros analizė. Apklausa vykdyta dviejuose priklausomybės ligų centruose. Tyrime dalyvavo 266 pacientai (priklausomi nuo opioidų), kurie gydėsi priklausomybės ligų centruose, ir 71 slaugytojas iš šių gydymo įstaigų. Tyrimas atliktas vadovaujantis etikos principais.
Tyrimo rezultatai. Nustatyta, kad labiausiai turintys įtakos pacientų lūkesčiams veiksniai yra šie: slaugytojų elgesys, jų sąžiningumas, geranoriškumas ir tolerantiškumas, aplinkos pritaikymas gydymui, informacijos apie gydymo ir slaugos svarbą ir vaistų vartojimą suteikimas, skiriamas dėmesys, bendravimas su pacientais ir jo šeimos nariais, pacientų ir jų asmeninių įpročių gerbimas. Tyrimo rezultatai parodė, kad pacientų lūkesčiams turi... [toliau žr. visą tekstą]In Lithuania, persons who have opioid dependence are more often assigned to inpatient treatment and pharmacotherapy with methadone or buprenorphine. These patients are allocated with round the clock care service, therefore in order to improve the quality of care, it is important to find out how patients with opioid dependence and carers working in addiction recovery centres rate care aspects, what factors have a positive or negative impact on the process of care and on expectations of patients. Objective of the thesis. Analyze expectations in care process of patients with opioid dependence. Methods. Empirical quantitative research has been conducted. The following methods were applied: anonymous survey using standardized (adapted) questionnaires, processing of statistical data and analysis of medical literature. The survey was carried out in two Centres of Addictive Disorders. 266 patients (addicts on opioids), who were treated in Centres of Addictive Disorders, and 71 nurses from these medical institutions have participated in the research. The study was conducted in accordance with ethical principles. Findings. It was found that factors having most influence to expectations of patients are as follows: behaviour of nurses, their honesty, kindness and tolerance, adaptation of environment to treatment, providing information about importance of treatment and care, and usage of medicines, expressing attention, communication with patients and family members, respecting patients... [to full text]
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LaForge, Karl Steven. "Preproenkephalin Gene and mRNA : Studies of Structure, Function, Cocaine Responses in an Animal Model, and Genetic Association with Human Opiate Addiction." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-4013.
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Steensland, Pia. "Anabolic Androgenic Steroids and the Brain : Studies of Neurochemical and Behavioural Changes Using an Animal Model." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2001. http://publications.uu.se/theses/91-554-5192-6/.
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Delorme, Jessica. "Évaluation de la douleur et du mésusage de la buprénorphine et de la méthadone chez les patients dépendants aux opioïdes substitués." Thesis, Université Clermont Auvergne (2017-2020), 2019. http://www.theses.fr/2019CLFAS023.
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La dépendance aux opioïdes est un problème majeur de santé publique dont la prévalence et l’incidence ne cessent d’augmenter. Sa prise en charge pharmacologique repose sur une approche substitutive basée sur la prescription des médicaments de substitution aux opioïdes (MSO), buprénorphine (BHD) et méthadone (MTD), commercialisés depuis 1995-1996 en France. Leur efficacité clinique a largement été démontrée en réduisant la consommation d’héroïne, la mortalité par overdose et en améliorant la qualité de vie des patients. Néanmoins, en parallèle, des problématiques en lien avec le mésusage des MSO ont émergé, pouvant conduire à des conséquences péjoratives pour les patients. La première partie de cette thèse a donc consisté à étudier le mésusage des MSO chez des patients dépendants aux opioïdes en France à travers l’identification d’un comportement de nomadisme médical, en exploitant les données nationales de l’EGB selon deux approches : 1/ une étude transversale répétée estimant la prévalence annuelle du mésusage des MSO entre 2004 et 2014 : la prévalence du nomadisme médical de la BHD a significativement diminué entre 2004 et 2014 (12,6 % vs 3,9 %, alors que celle de la MTD est restée faible sans évolution significative sur la période d’étude (0,2 % en 2004 à 0,5 % en 2014) ; 2/une étude de cohorte visant à estimer l’incidence du mésusage des MSO chez les patients dépendants aux opioïdes et identifier les facteurs de risque associés à ce mésusage : l'incidence à un an était de 8,4 % [IC 95 % : 7,0–10,1] dans le groupe BHD et de 0 % dans le groupe MTD, comparativement à 0,2 % [0,1-0,2] pour le groupe des diurétiques (contrôle négatif). Les facteurs associés au nomadisme médical étaient le sexe féminin (HR : 1,74 [1,20–2,54]), la précarité socio-économique (HR : 2,95 [2,07-4,44]), les comorbidités psychiatriques (HR : 1,43 [1,06–1,94]), les coprescriptions d’hypnotiques (HR : 1,90 [1,39–2,61]), d’antalgiques opioïdes faibles (HR : 1,48 [1,09–1,99]) et de morphine (HR : 1,69 [1,02–2,80]). Parmi les nombreuses motivations justifiant ce mésusage des MSO, l’existence d’une douleur mal soulagée est fréquemment retrouvée. En effet, la douleur constitue une problématique importante chez les patients dépendants aux opioïdes car elle reste encore trop souvent sous-diagnostiquée et sous-estimée, alors que sa prévalence est plus élevée qu’en population générale. Sa prise en charge adéquate est d’autant plus importante qu’elle va contribuer à une amélioration et un meilleur équilibre de la pathologie addictive. Aucune donnée française n’est disponible concernant la prévalence des phénomènes douloureux chez les patients MSO ainsi que la description des profils pharmaco-thérapeutiques antalgiques dans la vraie vie.Ces problématiques autour de la douleur ont fait l’objet des deuxièmes et troisièmes chapitres de cette thèse. La deuxième partie de ce manuscrit s’est effectivement attachée à estimer la prévalence de la douleur chez les patients dépendants aux opioïdes en France à travers une double approche : 1/ une étude de prévalence classique de terrain, incluant un échantillon représentatif de 509 patients dépendants aux opioïdes recrutés dans 12 centres de soins en addictologie : la prévalence de la douleur aiguë a été estimée à 42,0 % [37,7–46,3] et celle de la douleur chronique à 33,2 % [29,1–37,3] sans différence significative entre BHD et MTD ; 2/ une approche alternative originale, basée sur l’application de la méthode de capture-recapture aux données exhaustives du SNIIRAM : en 2015-2016, la prévalence de la douleur chronique était estimée à 31,1 % [28,0–34,9] chez les patients dépendants aux opioïdes traités par MSO vs 8,6 % [7,08–10,7] dans la population contrôle de patients non dépendants. (...)Opioid dependence is a major public health problem with increasing prevalence and incidence. Its pharmacological management is based on opioid substitution treatment (OST) (buprenorphine (HDB) and methadone (MTD)), marketed since 1995-1996 in France. Their clinical efficacy has been widely demonstrated by reducing heroin use, overdose mortality and improving patients' quality of life. Nevertheless, at the same time, problems related to the misuse of OST have emerged, which may lead to negative consequences for patients. The first part of this work consisted in studying the misuse of OST in opioid-dependent patients in France through the identification of doctor shopping, using the national EGB database according to two approaches: 1/ a repeated cross-sectional study estimating the annual prevalence of OST misuse between 2004 and 2014: the prevalence of HDB doctor shopping decreased significantly between 2004 and 2014 (12.6 % vs 3.9 %, p<0.001), while that of MTD remained low with no significant change over the study period (0.2 % in 2004 to 0.5 % in 2014); 2/a cohort study to estimate the incidence of OST misuse in opioid-dependent patients and identify the risk factors associated with this misuse: the one-year incidence was 8.4 % [95 % CI: 7.0-10.1] in the HDB group and 0 % in the MTD group, compared to 0.2 % [95 % CI: 0.1-0.2] for the diuretic group (negative control). Factors associated with doctor shopping were female gender (HR: 1.74 [1.20-2.54]), low socio-economic status (HR: 2.95 [2.07-4.44]), psychiatric comorbidities (HR : 1.43 [1.06-1.94]), coprescriptions of hypnotics (HR : 1.90 [1.39-2.61]), weak opioid analgesics (HR : 1.48 [1.09-1.99]) and morphine (HR : 1.69 [1.02-2.80]). Among the many reasons underlying this OST misuse, the existence of poorly relieved pain is frequently found. Indeed, pain is a major problem among opioid-dependent patients because it is still too often underdiagnosed and underestimated, while its prevalence is much higher than in the general population. Its adequate management is all the more important as it will contribute to an improvement and a better balance of the addictive pathology. No french data are available concerning the estimation of the prevalence of pain in OST patients and the description of associated pharmaco-therapeutic analgesic profiles in a real life setting.These issues around pain were the subject of the second and third chapters of this work. The second part of this manuscript focused on estimating the prevalence of pain among opioid-dependent patients in France using a dual approach: 1/ a traditional field prevalence study, including a representative sample of 509 opioid-dependent patients recruited from 12 addiction care centers: the prevalence of acute pain was estimated at 42.0 % [95 % CI: 37.7 - 46.3] and that of chronic pain at 33.2 % [29.1 - 37.3] with no significant difference between BHD and MTD; 2/ an original alternative approach, based on the capture-recapture method to the exhaustive SNIIRAM database: in 2015-2016, the prevalence of chronic pain was estimated at 31.1 % [28.0 - 34.9] in OST patients vs 8.6 % [7.08 - 10.7] in the control population of non-dependent patients. This method has demonstrated its major interest, given not only the speed and reliability of the estimates obtained, but also the ease of implementation and lower cost compared to studies or field surveys, while overcoming the traditional limitations of the latter in terms of representativeness and generalization of results. (...)