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Alías-Ferri, Maria, Manuela Pellegrini, Emilia Marchei, Roberta Pacifici, Maria Concetta Rotolo, Simona Pichini, Clara Pérez-Mañá et al. "New Psychoactive Substances Consumption in Opioid-Use Disorder Patients". Biology 11, n.º 5 (22 de abril de 2022): 645. http://dx.doi.org/10.3390/biology11050645.
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(1) Background: Since the beginning of the 21st century, the large number and wide chemical variety of new psychoactive substances (NPS) that enter the market every year has become a public health problem. Given the rapidity with which the drug market is changing, many NPS are not clinically investigated and their effects and health risks are unknown. Drug testing is a very useful tool for this purpose, but, unfortunately, it is not very widespread in individuals with opioid-use disorder under detoxification treatment. The aim of this study is to investigate the use of illicit drugs and NPS in opioid-use disorder (OUD) patients on opioid agonist treatment. (2) Methods: A multicenter, descriptive, cross-sectional study was conducted at two addiction care services in Barcelona and Badalona, Spain. Urine samples were collected from OUD individuals attending these two centers, who anonymously donated a urine sample at the time of a periodical visit. Samples were analyzed by high-sensitivity gas chromatography-mass spectrometry (GC-MS) and ultra-high-performance liquid chromatography-high –resolution mass spectrometry (UHPLC-HRMS). (3) Results: Out of the 187 collected and analyzed urine samples, 27.3% were positive for any type of NPS and 8.6% were positive for new synthetic opioids, including fentanyl and its derivatives (NSO). Other frequently detected substances were benzodiazepines in 46.0% of samples, antipsychotics in 27.8% of samples, or cocaine and cannabis in 23.5% of samples. (4) Conclusion: A wide number of NPS, including NSO, have been detected in urine samples from an OUD population. A lack of NPS detection in standard drug screening among drug users can hide the identification of a potential public health problem.
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Kavanaugh, Philip R., e Katherine McLean. "Motivations for Diverted Buprenorphine Use in a Multisite Qualitative Study". Journal of Drug Issues 50, n.º 4 (22 de julho de 2020): 550–65. http://dx.doi.org/10.1177/0022042620941796.
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Drawing on a multisite sample of 40 persons who sell, share, or use diverted buprenorphine to manage opioid use disorder, in this study we describe why individuals seek to obtain buprenorphine outside of formal treatment contexts, and between-site variation regarding their motives and means. Findings indicate that both the provision and purchase of diverted buprenorphine support user-defined risk minimization strategies to avoid withdrawal, reduce heroin use, and satiate opioid cravings in periods of lowered tolerance. We also found that a subset of the sample used buprenorphine recreationally, and that it functioned to extend or augment illicit drug use careers. Implications of the findings are discussed in light of federal and state drug control and treatment policies.
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Gedeon, Charlotte, Mikael Sandell, Inge Birkemose, Johan Kakko, Valgerður Rúnarsdóttir, Kaarlo Simojoki, Thomas Clausen, Fred Nyberg, Richard Littlewood e Hannu Alho. "Standards for opioid use disorder care: An assessment of Nordic approaches". Nordic Studies on Alcohol and Drugs 36, n.º 3 (27 de janeiro de 2019): 286–98. http://dx.doi.org/10.1177/1455072518815322.
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Aims: Outcomes in opioid use disorder (OUD) in Nordic countries have improved with integrated treatment and harm-reduction programmes. Approaches and the standard of care are different across the region. Evidence of treatment needs and current approaches are defined from evidence to inform development of a common standard. Method: Evidence of population sizes and treatment approach collected. Common standards for care (harm reduction, pharmacotherapy, psychology/social therapy) defined for each country. Results: Evidence defines number in treatment; potential population needing treatment not defined for all countries. Populations sizes, treatment access (ratio in treatment programme compared to total country population) defined: Sweden 4,000 in OUD care (access ratio 40); Finland 3,000 (55); Norway 8,000 (154); Denmark 7,500 (132). Approach to treatment similar: integrated treatment programmes standard. Care provided by specialists in outpatient clinics/primary care; secondary care/inpatient services are available. Harm reduction is limited in Sweden but available and more accessible elsewhere. Treatment entry criteria: access relatively unlimited in Norway and Denmark, more limited in Finland and Sweden. Standards of care defined: easy access to high-quality services, individual planning, care not limited by time, management of relapse, education for patients, continuous engagement, holistic approach including management of comorbidities, needle equipment programmes without limit, treatment in prisons as community. Conclusion: There are opportunities to improve OUD care in the Nordics. Policy makers and clinicians can advance OUD care and share common success factors. Collaborative work across the Nordic countries is valuable. Further research in clinical practice development can yield important results for the benefit of patients with OUD.
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Sivolap, Yury P. "Opioid crisis in the USA and Canada: how and why did this happen?" Neurology Bulletin LV, n.º 4 (15 de janeiro de 2024): 18–24. http://dx.doi.org/10.17816/nb623231.
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In the last few decades, there has been an epidemic increase in opioid use disorder and fatal opioid overdose in the United States and Canada, which allows us to state the presence of an opioid crisis. The opioid epidemic is believed to have begun due to a significantly low threshold for prescribing narcotic analgesics to treat chronic pain. This subsequent tightening of medical opioid dispensation led to the resurgence of the unlawful drug market, which included heroin and fentanyl. The review article provides data from a special commission established with the supporting of Stanford University and The Lancet Journal to understand and overcome the opioid crisis in North America, as well as analyzes other literary sources.
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Li, Zhengyi, Xiangyu Du, Xiaojing Liao, Xiaoqian Jiang e Tiffany Champagne-Langabeer. "Demystifying the Dark Web Opioid Trade: Content Analysis on Anonymous Market Listings and Forum Posts". Journal of Medical Internet Research 23, n.º 2 (17 de fevereiro de 2021): e24486. http://dx.doi.org/10.2196/24486.
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Background Opioid use disorder presents a public health issue afflicting millions across the globe. There is a pressing need to understand the opioid supply chain to gain new insights into the mitigation of opioid use and effectively combat the opioid crisis. The role of anonymous online marketplaces and forums that resemble eBay or Amazon, where anyone can post, browse, and purchase opioid commodities, has become increasingly important in opioid trading. Therefore, a greater understanding of anonymous markets and forums may enable public health officials and other stakeholders to comprehend the scope of the crisis. However, to the best of our knowledge, no large-scale study, which may cross multiple anonymous marketplaces and is cross-sectional, has been conducted to profile the opioid supply chain and unveil characteristics of opioid suppliers, commodities, and transactions. Objective We aimed to profile the opioid supply chain in anonymous markets and forums via a large-scale, longitudinal measurement study on anonymous market listings and posts. Toward this, we propose a series of techniques to collect data; identify opioid jargon terms used in the anonymous marketplaces and forums; and profile the opioid commodities, suppliers, and transactions. Methods We first conducted a whole-site crawl of anonymous online marketplaces and forums to solicit data. We then developed a suite of opioid domain–specific text mining techniques (eg, opioid jargon detection and opioid trading information retrieval) to recognize information relevant to opioid trading activities (eg, commodities, price, shipping information, and suppliers). Subsequently, we conducted a comprehensive, large-scale, longitudinal study to demystify opioid trading activities in anonymous markets and forums. Results A total of 248,359 listings from 10 anonymous online marketplaces and 1,138,961 traces (ie, threads of posts) from 6 underground forums were collected. Among them, we identified 28,106 opioid product listings and 13,508 opioid-related promotional and review forum traces from 5147 unique opioid suppliers’ IDs and 2778 unique opioid buyers’ IDs. Our study characterized opioid suppliers (eg, activeness and cross-market activities), commodities (eg, popular items and their evolution), and transactions (eg, origins and shipping destination) in anonymous marketplaces and forums, which enabled a greater understanding of the underground trading activities involved in international opioid supply and demand. Conclusions The results provide insight into opioid trading in the anonymous markets and forums and may prove an effective mitigation data point for illuminating the opioid supply chain.
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Blum, Kenneth, Abdalla Bowirrat, Eric R. Braverman, David Baron, Jean Lud Cadet, Shan Kazmi, Igor Elman et al. "Reward Deficiency Syndrome (RDS): A Cytoarchitectural Common Neurobiological Trait of All Addictions". International Journal of Environmental Research and Public Health 18, n.º 21 (2 de novembro de 2021): 11529. http://dx.doi.org/10.3390/ijerph182111529.
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Alcohol and other substance use disorders share comorbidity with other RDS disorders, i.e., a reduction in dopamine signaling within the reward pathway. RDS is a term that connects addictive, obsessive, compulsive, and impulsive behavioral disorders. An estimated 2 million individuals in the United States have opioid use disorder related to prescription opioids. It is estimated that the overall cost of the illegal and legally prescribed opioid crisis exceeds one trillion dollars. Opioid Replacement Therapy is the most common treatment for addictions and other RDS disorders. Even after repeated relapses, patients are repeatedly prescribed the same opioid replacement treatments. A recent JAMA report indicates that non-opioid treatments fare better than chronic opioid treatments. Research demonstrates that over 50 percent of all suicides are related to alcohol or other drug use. In addition to effective fellowship programs and spirituality acceptance, nutrigenomic therapies (e.g., KB220Z) optimize gene expression, rebalance neurotransmitters, and restore neurotransmitter functional connectivity. KB220Z was shown to increase functional connectivity across specific brain regions involved in dopaminergic function. KB220/Z significantly reduces RDS behavioral disorders and relapse in human DUI offenders. Taking a Genetic Addiction Risk Severity (GARS) test combined with a the KB220Z semi-customized nutrigenomic supplement effectively restores dopamine homeostasis (WC 199).
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Ahmedani, Brian K. "Policies and Events Affecting Prescription Opioid Use for Non-Cancer Pain Among an Insured Patient Population". Pain Physician 3;17, n.º 3;5 (14 de maio de 2014): 205–16. http://dx.doi.org/10.36076/ppj.2014/17/205.
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Background: Rising prescription opioid use and abuse have prompted widespread concern. However, to date there have been few rigorous investigations into the policies and events which may have contributed to these trends. Objective: This study investigates trends in opioid use and related adverse events among individuals with non-cancer pain before and after implementation of major national policies. Study Design: The study used a longitudinal prospective study design. The analysis was limited to adults (age ≥ 18 years) without a recorded cancer diagnosis. Pharmacy claims were used to assess rates of prescription opioid use, the strength of opioids dispensed, the proportion using opioids chronically, and related adverse events. Time trend analysis was used to identify changes in these rates over time. The study was Institutional Review Board approved. Setting: Study patients were members of a large, health maintenance organization in southeast Michigan, with longitudinal records of prescription opioid use. Results: The analysis comprised 523,623 individuals and 1,066,700 opioid pharmacy fills from January 1, 1997, to December 31, 2011. Contemporaneous with the implementation of health organization accreditation criteria requiring assessment and treatment of pain in all patients beginning January 2001, we observed a consistent and unabated increase in the rate of opioid fills and the proportion of chronic use. A parallel increase in the annual rate of adverse events was also observed. Similarly, we observed a continuous rise in the average strength of opioid fills following January 2001 with the exception of a single drop in December 2010, which was attributable to the withdrawal of propoxyphene from the U.S. market. Limitations: This was an observational study and not a trial. Other long-term opioid-related benefits or harms, including functional status, quality of life, and substance use disorder, were not assessed. Conclusions: This study provides temporal evidence for a rise in prescription opioid use after implementation of health organization accreditation criteria requiring standardized management of all individuals with pain. Key words: Opioid analgesics, chronic pain, chronic drug use, prescription drugs, pain management, propoxyphene, Joint Commission, adverse drug events, morphine dose equivalents, opioid epidemic
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Renfro, Mandy L., Lindsey J. Loera, Carlos F. Tirado e Lucas G. Hill. "Lofexidine for acute opioid withdrawal: A clinical case series". Mental Health Clinician 10, n.º 5 (1 de setembro de 2020): 259–63. http://dx.doi.org/10.9740/mhc.2020.09.259.
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Abstract Introduction Maintaining abstinence through the opioid withdrawal period is a substantial barrier to treatment for patients with opioid use disorder. The alpha-2 agonist lofexidine has demonstrated efficacy and safety in clinical trials, but pragmatic studies describing its use in clinical practice are lacking. This case series describes the use of lofexidine for opioid withdrawal symptoms in an inpatient addiction treatment facility. Methods Seventeen patients receiving at least 1 dose of lofexidine during inpatient treatment for opioid withdrawal were included in this study. A retrospective chart review was conducted for clinical, subjective, and objective data. Adverse events, total daily dose, clinical opioid withdrawal scale (COWS) scores, vital signs, and reasons for early discontinuation of lofexidine are reported. Results Patients treated with lofexidine experienced mild withdrawal symptoms throughout treatment. Most patients (65%) experienced a decrease in their average daily COWS scores from intake to discharge. Two patients (12%) left treatment against medical advice, and 5 patients (29%) discontinued treatment prior to day 7 due to resolution of symptoms. Average daily blood pressure readings remained stable, and daily average heart rate decreased over time. Discussion Lofexidine can be successfully incorporated into a conventional withdrawal management protocol. The cost of lofexidine and its recent introduction to the market remain barriers to accessibility in the United States. Studies evaluating patient-reported outcomes as well as direct comparisons with other alpha-2 agonists are needed to inform optimal clinical use of lofexidine.
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Trinidad, Antolin C., e Benjamin Bregman. "Pharmacotherapy of Major Depressive Disorder: Focus on Desvenlafaxine Succinate". Clinical Medicine Insights: Therapeutics 2 (janeiro de 2010): CMT.S74. http://dx.doi.org/10.4137/cmt.s74.
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The newest antidepressant, desvenlafaxine (DVS) was approved by the FDA in early 2008 and since then, has been available in the market for general use. DVS is dual acting, a serotonin-norepinepherine reuptake inhibitor (SNRI). Like its parent compound, venlafaxine (VEN), DVS inhibits the neuronal re-uptake of both serotonin and norepinepherine while having minimal affinity for muscarinic cholinergic, H1-histaminergic, alpha1-adrenergic and opioid receptors. DVS is moderately effective for MDD at doses ranging from 100–400 milligrams per day. Its possible advantage is its lower risk of drug-drug interaction. There is no extant evidence that it is especially effective over and above the other existing antidepressants. Its niche will be defined by time but one speculation, given preliminary but un-replicated proof of its efficacy in vasomotor instability in peri-menopause, is that it may have a future utility for depressed women entering menopause.
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Nakamoto, Carter H., Haiden A. Huskamp, Julie M. Donohue, Michael L. Barnett, Adam J. Gordon e Ateev Mehrotra. "Medicare Payment for Opioid Treatment Programs". JAMA Health Forum 5, n.º 7 (19 de julho de 2024): e241907. http://dx.doi.org/10.1001/jamahealthforum.2024.1907.
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ImportanceMedicare began paying for medications for opioid use disorder (MOUD) at opioid treatment programs (OTPs) that dispense methadone and other MOUD in January 2020. There has been little research describing the response to this payment change and whether it resulted in more patients receiving MOUD or just a shift in who pays for this care.ObjectiveTo describe how many and which Medicare beneficiaries receive care from OTPs and how this compares to those receiving MOUD in other settings.Design, Setting, and ParticipantsThis cross-sectional study included all patients receiving MOUD care identified in 2019-2022 100% US Medicare Parts B and D claims. Patients receiving care in an OTP who were dually insured with Medicare and Medicaid in the 2019-2020 Transformed Medicaid Statistical Information System were also included.ExposureReceiving MOUD care in an OTP.Main Outcomes and MeasuresComparisons of 2022 beneficiaries treated in OTPs vs other non-OTP settings in 2022.ResultsThe share of Medicare beneficiaries treated by OTPs rose steadily from 4 per 10 000 (14 160 beneficiaries) in January 2020 to 7 per 10 000 (25 596 beneficiaries) in August 2020, then plateaued through December 2022; of 38 870 patients (23% ≥66 years; 35% female) treated at an OTP in 2022, 96% received methadone. Patients in OTPs, compared to those receiving MOUD in other settings, were more likely be 65 years and younger (65% vs 62%; P < .001), less likely to be White (72% vs 82%; P < .001), and more likely to be an urban resident (86% vs 74%; P < .001). When Medicare OTP coverage began, there was no associated drop in the number of dually insured patients with Medicaid with an OTP claim. Of the 1854 OTPs, 1115 (60%) billed Medicare in 2022, with the share billing Medicare ranging from 13% to 100% across states.Conclusions and RelevanceThis study showed that since the initiation of Medicare OTP coverage in 2020, there has been a rapid increase in the number of Medicare beneficiaries with claims for OTP services for MOUD, and most OTPs have begun billing Medicare. Patients in OTPs were more likely to be urban residents and members of racial or ethnic minority groups than the patients receiving other forms of MOUD.
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Carlyle, Molly, Megan Rowley, Tobias Stevens, Anke Karl e Celia J. A. Morgan. "Impaired empathy and increased anger following social exclusion in non-intoxicated opioid users". Psychopharmacology 237, n.º 2 (5 de novembro de 2019): 419–30. http://dx.doi.org/10.1007/s00213-019-05378-x.
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Abstract Rationale Social functioning is modulated by the endogenous opioid system. In opioid use disorder, social functioning appears disrupted, but little research has delineated the nature of these deficits and their relationship to acute opioid use. Objectives The current study aimed to assess both emotional and cognitive empathy, along with subjective and physiological responses to social exclusion in opioid users who were either acutely intoxicated or non-intoxicated from using opioids. Methods Individuals on an opioid substitution medication (OSM) were divided into ‘intoxicated users’ (had taken their OSM the same day as testing, n = 20) and ‘non-intoxicated users’ (had taken their OSM > 12 h ago, n = 20) and compared with opioid-naïve controls (n = 24). Empathy was assessed using the multifaceted empathy test and self-report questionnaire. Participants also underwent a period of social exclusion (Cyberball Game) and completed measures of mood and physiological responses (salivary cortisol and heart rate). Results Non-intoxicated users had significantly lower emotional empathy (the ability to experience others’ emotions), as well as greater anger after social exclusion when compared with the intoxicated users and controls. Anger did not change with social exclusion in the intoxicated user group and cortisol levels were lower overall. Conclusions Reduced ability to spontaneously share the emotions of others was reported in non-intoxicated users, particularly regarding positive emotions. There was some support for the idea of hyperalgesia to social pain, but this was restricted to an enhanced anger response in non-intoxicated users. Equivalent rates of empathy between the intoxicated users and controls could indicate some remediating effects of acute opioids.
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Werner, N., e J. P. Kahn. "Suicidology and Substance abuse in Adolescence". European Psychiatry 24, S1 (janeiro de 2009): 1. http://dx.doi.org/10.1016/s0924-9338(09)70524-3.
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Adolescence is a critical period for suicidal risk. Suicide currently ranks as the second or third leading cause of mortality among adolescents in developped countries. It has been shown that a history of suicidal act, of depressive disorder and of a substance use disorder (SUD), alcohol and drugs, are the most prominent risk factors for suicidal behaviour among adolescents.Data on alcohol and drug use disorders and suicide consisted primarily of reports on alcohol use disorders and, to a lesser extent, opioid use disorder. The magnitude of the association with other drugs is still unclear.The relationships between substance use disorder and suicidal behaviour are multiple: In the long term, SUD may be associated with increases in stress and co-occuring psychopathology (poor self esteem, feeling of worthlessness, isolation).These elements may reach a level where a suicide attempt is viewed as a means to cope with perceived unsolvable difficulties. During life crises, SUD can also be responsible for inhibiting adaptative coping and desinhibiting suicidal behaviour. Finally, SUD and suicidal behaviour share common vulnerability factors: history of childhood abuse, genetically determined dimensions such as impulsivity or psychiatric disorders, particularly unipolar depressive and bipolar disorder.Given the comorbidity between SUD and suicide, it is essential for treatment and prevention that all suicidal adolescents be screened for SUD and vice versa. Ideally, adolescents who receive diagnosis of SUD and co-occuring suicidality should follow an integrated treatment protocol that addresses both conditions.
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Lemansky, Matthew G., Anna K. Martin, Judith A. Bernstein e Sabrina A. Assoumou. "Research Compensation and Enhanced Contacts in Studies With Persons Who Use Drugs: Lessons From the COVID-19 Pandemic Demand a Reset". Substance Abuse: Research and Treatment 17 (janeiro de 2023): 117822182311790. http://dx.doi.org/10.1177/11782218231179039.
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Policy changes resulting from the coronavirus 2019 (COVID-19) pandemic have had a substantial and positive impact on the clinical care of persons with opioid use disorder. These innovative paradigm shifts created a ripe environment for re-evaluating traditional approaches to recruiting and retaining persons who use drugs into research studies. For example, changes to methadone prescribing requirements and authorization of buprenorphine prescriptions via telehealth have both increased access to medications. In this commentary, we contribute to ongoing conversations about the ethics of compensation for participants in addiction-related clinical research and share methods of payment that proved successful in research performed during the pandemic. We also discuss approaches to enrollment and follow-up that were implemented during the height of COVID restrictions. These approaches may mutually benefit both participants and researchers in a post-pandemic era.
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Voss, ScD, Maren Wright, Ashley C. Yaugher, PhD, Kandice Atismé, MHA, MPH e Amy Campbell, MPH. "Opioid misuse viewed through person and place in the rural West". Journal of Opioid Management 18, n.º 2 (1 de março de 2022): 151–59. http://dx.doi.org/10.5055/jom.2022.0705.
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Objective: This article overviews the current statistics and factors related to increased rates of opioid use disorder (OUD) in rural areas, uncovering factors that may contribute to increased vulnerability to opioid overdose. We qualitatively review opinions, feelings, and thoughts surrounding this issue in rural areas of Utah, analyzing participant stories in reference to three themes through qualitative interviews, including the solitude of addiction, the beguiling strength of addiction, and one way out of addiction.Design: In 2018, three focus groups were convened with 25 individuals from the rural area. Participants either currently or formerly (self-reported substance free for 6 months or more) experienced OUD with prescription opioids and heroin, or were family members of individuals who currently and formerly experienced OUD. These focus groups addressed current issues in OUDs in a rural Utah community related to person, place, and time. Following the focus groups, six individuals were invited to participate in semi-structured interviews. In-depth, semi-structured interviews queried individual experiences through a phenomenological approach, using a moderator guide with queries focused on identified themes related to the solitude, the intensity, and the difficulty escaping substance use disorder (SUD). Methodology included training community scholars with lived experience and member-checking to ensure phenomenological emphasis.Results: Our qualitative reviews of the experience of OUD and SUD in rural Utah discussed the relevance and the nuance of the three identified themes. The interviewee statements further underscore the solitude, intensity, and difficulty of an individual's journey through SUD, the all-consuming nature of OUD, and the trouble that these factors cause in rural recovery.Conclusions: We conclude that even during difficult situations in the rural experience with the opioid crisis, hope persists. OUD support in rurality may differ from the expected urban experience and include more coordination with criminal justice workers. Rural Americans have insights to share that could help turn the tide of this crisis.
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Knopf, Alison. "FDA approves first genetic test to help identify risk for OUD". Alcoholism & Drug Abuse Weekly 36, n.º 2 (7 de janeiro de 2024): 8. http://dx.doi.org/10.1002/adaw.33990.
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On Dec. 19, 2023, the U.S. Food and Drug Administration approved the first test that uses DNA in assessing whether certain individuals may have an elevated risk of developing opioid use disorder (OUD). As part of a clinical evaluation, the AutoGenomics, Inc. AvertD test is intended to be used prior to first exposure to oral opioid pain medications in patients being considered for a 4–30‐day prescription for the treatment of acute pain, such as in patients scheduled to undergo a planned surgical procedure. “The AvertD test, a prescription‐use only genetic laboratory test for patients 18 years and older, is to be used only with patients who consent to the test and have no prior use of oral opioid analgesics,” said Jeff Shuren, M.D., J.D., director of the FDA's Center for Devices and Radiological Health. “The test is administered by a health care provider by swabbing the cheek of a patient to collect a DNA sample that will be used to determine if a patient has a combination of genetic variants that may be associated with an elevated risk of developing OUD. This information should be used as part of a complete clinical evaluation and risk assessment; it should not be used alone to make treatment decisions. The test is not intended to be used in patients being treated for chronic pain. AvertD may help patients who are concerned about being treated with an opioid for acute pain make better informed decisions.” As part of the approval order, AutoGenomic, Inc. must provide training to health care providers to help ensure appropriate use of the test and conduct a large post‐market study assessing device performance in patients, regularly reporting progress made toward completion of that study to the FDA. The primary risks associated with AvertD are false negative and false positive results.
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Solmeyer, Anna R., Aaron T. Berger, Sean L. Barton, Benjamin Nguyen, Gavin B. Bart, Brian Grahan, Heather J. Bell, Kurt M. DeVine e Weston Merrick. "Association of Project ECHO Training With Buprenorphine Prescribing by Primary Care Clinicians in Minnesota for Treating Opioid Use Disorder". JAMA Health Forum 3, n.º 11 (18 de novembro de 2022): e224149. http://dx.doi.org/10.1001/jamahealthforum.2022.4149.
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ImportanceBuprenorphine is an approved medication for opioid use disorder (MOUD); however, prescribing buprenorphine is limited by a requirement to obtain a waiver to prescribe it (hereinafter, “DATA [Drug Abuse Treatment Act]–waiver”) and a lack of knowledge of the best practices among clinicians.ObjectiveTo examine how Project ECHO (Extension for Community Healthcare Outcomes) telementoring is associated with changes in DATA-waiver attainment and buprenorphine prescribing among primary care clinicians in Minnesota.Design, Setting, and ParticipantsIn this retrospective matched-cohort study of 918 clinicians, ECHO-trained clinicians were enrolled on the date they first attended ECHO (January 3, 2018, to June 11, 2020); comparison clinicians were assigned an enrollment date from the distribution of the first ECHO sessions. The baseline period was 12 months preceding enrollment, with follow-up for 18 months or until June 30, 2020. The ECHO-trained clinicians were a population-based sample of primary care clinicians who treated Medicaid patients in Minnesota 12 months prior to the initiation of ECHO training. This analysis used propensity score matching to select comparison clinicians who were similar across demographic and clinical practice characteristics at baseline in a 2:1 ratio. Follow-up was available for 167 ECHO-trained clinicians (54.6%) and 330 comparison clinicians (53.9%) at 18 months.ExposuresECHO-trained clinicians attended at least 1 weekly, hour-long ECHO session. Comparison clinicians never participated in any ECHO sessions.Main Outcomes and MeasuresDATA-waiver attainment, any buprenorphine prescribing, and the percentage of patients with opioid use disorder (OUD) who were prescribed buprenorphine.ResultsThe final sample included 918 clinicians (ECHO-trained [306]; comparison [612]), of whom 620 (67.5%) practiced outside the metropolitan Twin Cities (Minneapolis–St Paul) region. The mean (SD) age of the ECHO-trained clinicians was 46.0 (12.1) years and that of the comparison clinicians was 45.7 (12.3) years. Relative to the changes among the matched comparison clinicians, the ECHO-trained clinicians were more likely to obtain a DATA-waiver (difference-in-differences, 22.7 percentage points; 95% CI, 15.5-29.9 percentage points; P < .001) and prescribe any buprenorphine (16.5 percentage points; 95% CI, 10.4-22.5 percentage points; P < .001) after 6 quarters of follow-up. ECHO-trained clinicians prescribed buprenorphine to a greater share of patients with OUD (a difference of 7.6 percentage points per month; 95% CI, 4.6-10.6 percentage points per month; P < .001), relative to that prescribed by the comparison clinicians.Conclusions and RelevanceAccording to the findings of this matched-cohort study, ECHO telementoring may be associated with greater prescribing of buprenorphine by primary care clinicians. These findings suggest that Project ECHO training could be a useful tool for expanding access to MOUD.
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Katz, Naomi T., Martyn Lloyd-Jones, Lucy Demediuk, Kerry McLaughlin, Megan McKechnie e Michelle Gold. "A Case Study of Pain Management at End-of-Life for a Patient on High-Dose Buprenorphine". Journal of Patient Experience 9 (janeiro de 2022): 237437352210791. http://dx.doi.org/10.1177/23743735221079141.
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In Australia, high-dose sublingual buprenorphine and long-acting injectable buprenorphine are available. High-dose buprenorphine is used predominantly in the setting of opioid use disorder and has a role in chronic pain. Palliative care specialists are increasingly involved in pain management and end-of-life care for patients on these medications, yet there is a lack of education and training about high-dose buprenorphine for palliative care specialists. We describe our experience caring for John (fictional name), a gentleman with chronic pain and a new high-grade post-transplant lymphoproliferative disorder prescribed high-dose buprenorphine. We share the challenges and experience in caring for John as he deteriorated into the terminal phase and died of his illness. We include potential management options and the rationale for our decision to rotate John from high-dose sublingual buprenorphine to subcutaneous oxycodone. We conclude with practice implications and suggestions for improved patient care and clinician experience, including increased collaboration between palliative medicine, acute pain, and addiction medicine services, increased education and training for palliative care specialists about high-dose buprenorphine, and ultimately the development of consensus high-dose buprenorphine to oral morphine equivalence guidelines.
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Waselewski, Marika Elise, Tabor Elisabeth Flickinger, Chelsea Canan, William Harrington, Taylor Franklin, Kori Nicole Otero, Jacqueline Huynh et al. "A Mobile Health App to Support Patients Receiving Medication-Assisted Treatment for Opioid Use Disorder: Development and Feasibility Study". JMIR Formative Research 5, n.º 2 (23 de fevereiro de 2021): e24561. http://dx.doi.org/10.2196/24561.
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Background Opioid use disorder (OUD) is a public health crisis with more than 2 million people living with OUD in the United States. Medication-assisted treatment (MAT) is an evidence-based approach for the treatment of OUD that relies on a combination of behavioral therapy and medication. Less than half of those living with OUD are accessing this treatment. Mobile technology can enhance the treatment of chronic diseases in readily accessible and cost-effective ways through self-monitoring and support. Objective The aim of this study is to describe the adaptation of a mobile platform for patients undergoing treatment for OUD and preliminary pilot testing results. Methods Our study was conducted with patient and provider participants at the University of Virginia MAT clinic and was approved by the institutional review board. The formative phase included semistructured interviews to understand the needs of patients with OUD, providers’ perspectives, and opportunities for MAT support via a mobile app. A second round of formative interviews used mock-ups of app features to collect feedback on feature function and desirability. Formative participants’ input from 16 interviews then informed the development of a functional smartphone app. Patient participants (n=25) and provider participants (n=3) were enrolled in a 6-month pilot study of the completed platform. Patient app use and usability interviews, including a system usability score and open-ended questions, were completed 1 month into the pilot study. Open-ended responses were analyzed for prevalent themes. Results Formative interviews resulted in the development of a mobile app, named HOPE, which includes both evidence-based and participant-suggested features. The features included daily prompts for monitoring mood, stress, treatment adherence, and substance use; patient tracking of goals, reminders, and triggering or encouraging experiences; informational resources; an anonymous community board to share support with other patients; and secure messaging for communication between patients and providers. All patient participants engaged with at least one app feature during their first month of pilot study participation, and the daily self-monitoring prompts were the most used. Patients and providers reported high levels of system usability (mean 86.9, SD 10.2 and mean 83.3, SD 12.8, respectively). Qualitative analysis of open-ended usability questions highlighted the value of self-monitoring, access to support through the app, and perceived improvement in connection to care and communication for both patient and provider participants. Conclusions The use of the HOPE program by pilot participants, high usability scoring, and positive perceptions from 1-month interviews indicate successful program development. By engaging with end users and eliciting feedback throughout the development process, we were able to create an app and a web portal that was highly usable and acceptable to study participants. Further work is needed to understand the program’s effect on clinical outcomes, patient linkage, and engagement in care.
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Melnick, Edward R., Wesley C. Holland, Osama M. Ahmed, Anthony K. Ma, Sean S. Michael, Howard S. Goldberg, Christian Lagier et al. "An integrated web application for decision support and automation of EHR workflow: a case study of current challenges to standards-based messaging and scalability from the EMBED trial". JAMIA Open 2, n.º 4 (14 de outubro de 2019): 434–39. http://dx.doi.org/10.1093/jamiaopen/ooz053.
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Abstract Computerized clinical decision support (CDS) faces challenges to interoperability and scalability. Centralized, web-based solutions offer a mechanism to share the cost of CDS development, maintenance, and implementation across practices. Data standards have emerged to facilitate interoperability and rapid integration of such third-party CDS. This case report describes the challenges to implementation and scalability of an integrated, web-based CDS intervention for EMergency department-initiated BuprenorphinE for opioid use Disorder which will soon be evaluated in a trial across 20 sites in five healthcare systems. Due to limitations of current standards, security concerns, and the need for resource-intensive local customization, barriers persist related to centralized CDS at this scale. These challenges demonstrate the need and importance for future standards to support two-way messaging (read and write) between electronic health records and web applications, thus allowing for more robust sharing across health systems and decreasing redundant, resource-intensive CDS development at individual sites.
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Roomruangwong, Chutima, Denitsa S. Simeonova, Drozdstoy S. Stoyanov, George Anderson, Andre Carvalho e Michael Maes. "Common Environmental Factors May Underpin the Comorbidity Between Generalized Anxiety Disorder and Mood Disorders Via Activated Nitrooxidative Pathways". Current Topics in Medicinal Chemistry 18, n.º 19 (21 de dezembro de 2018): 1621–40. http://dx.doi.org/10.2174/1568026618666181115101625.
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Generalized Anxiety Disorder (GAD) commonly co-occurs with mood disorders, especially Major Depressive Disorder (MDD) and bipolar disorder (BD), which are accompanied by activated neuro-immune and neuro-oxidative pathways. The aim of this narrative review is to review the phenomenological similarities and dissimilarities and the shared pathways between GAD and mood disorders. We searched PubMed, Scopus, and Google Scholar for articles published in English from 1980 to present. GAD and mood disorders, either MDD or BD, show some phenomenological overlaps and a high degree of comorbidity, especially between GAD and MDD. Both GAD and mood disorders are also frequently comorbid with other anxiety disorders, substance use disorders and medical conditions, including cardio- vascular disorder (CVD). Mood disorders have a worse prognosis when GAD is present. GAD and mood disorders are associated with female sex and may partly share genetic variants of risk. Moreover, both GAD and mood disorders frequently share similar environmental risks factors including Early Life Time Trauma (ELT) and Psychological Stressors in Adulthood (PSA). Increased nitro-oxidative stress and lipid peroxidation coupled to lowered lipid-associated antioxidant defenses are evident in GAD, MDD and type I bipolar patients. Patients with comorbid GAD and MDD show significantly higher nitro- oxidative biomarkers as compared with patients presenting with either GAD or MDD as well as patients with BD with or without co-occurring GAD. Activated immune-inflammatory processes characterized by increased levels of CRP and pro-inflammatory cytokines are other shared pathways that underpin GAD and mood disorders. Moreover, these pathways may explain comorbidities with medical disorders including CVD. Aberrations in HPA-axis, GABA and glutamate neurotransmission, NMDA and mu opioid-receptors and neuroimaging fields have yielded more inconsistent findings. In conclusion, here we propose a new model explaining GAD and the comorbidity between GAD and mood disorders. Common triggers such as ELT/PSA may underpin GAD and its comorbidity with mood disorders via activated neuro-oxidative, neuro-nitrosative and neuro-immune pathways.
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Randhawa, Privia A., Rupinder Brar e Seonaid Nolan. "Buprenorphine–naloxone “microdosing”: an alternative induction approach for the treatment of opioid use disorder in the wake of North America’s increasingly potent illicit drug market". Canadian Medical Association Journal 192, n.º 3 (19 de janeiro de 2020): E73. http://dx.doi.org/10.1503/cmaj.74018.
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Cassidy, MPH, Theresa A., Eileen Thorley, MPH, Ryan A. Black, PhD, Angela DeVeaugh-Geiss, PhD, Stephen F. Butler, PhD e Paul Coplan, ScD. "Abuse of reformulated OxyContin: Updated findings from a sentinel surveillance sample of individuals assessed for substance use disorder". Journal of Opioid Management 13, n.º 6 (7 de dezembro de 2017): 425. http://dx.doi.org/10.5055/jom.2017.0419.
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Objective: To examine abuse prevalence for OxyContin and comparator opioids over a 6-year period prior to and following market entry of reformulated OxyContin and assess consistency in abuse across treatment settings and geographic regions. Design: An observational study examining longitudinal changes using cross-sectional data from treatment centers for substance use disorder.Setting: A total of 874 facilities in 39 states in the United States within the National Addictions Vigilance Intervention and Prevention Program (NAVIPPRO®) surveillance system.Participants: Adults (72,060) assessed for drug problems using the Addiction Severity Index-Multimedia Version (ASI-MV®) from January 2009 through December 2015 who abused prescription opioids.Main outcome measure(s): Percent change in past 30-day abuse. Results: OxyContin had significantly lower abuse 5 years after reformulation compared to levels for original OxyContin. Consistency of magnitude in OxyContin abuse reductions across geographic regions, ranging from 41 to 52 percent with differences in abuse reductions in treatment setting categories occurred. Changes in geographic region and treatment settings across study years did not bias the estimate of lower OxyContin abuse through confounding.Conclusion: In the postmarket setting, limitations and methodologic challenges in abuse measurement exist and it is difficult to isolate singular impacts of any one intervention given the complexity of prescription opioid abuse. Expectations for a reasonable threshold of abuse for any one ADF product or ADF opioids as a class are still uncertain and undefined. A significant decline in abuse prevalence of reformulated OxyContin was observed 5 years after its reformulation among this treatment sample of individuals assessed for substance use disorder that was lower historically for the original formulation of this product.
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Reddy, Julia, Kristel Black, Keia Bazemore, Kiva Jordan, Jamie B. Jackson e Andrea K. Knittel. "Ethical inclusion: Risks and benefits of research from the perspective of perinatal people with opioid use disorders who have experienced incarceration". PLOS ONE 18, n.º 11 (22 de novembro de 2023): e0294604. http://dx.doi.org/10.1371/journal.pone.0294604.
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Background Research ethics guidelines and emphasis on representation in research guide the inclusion of marginalized groups, including people with perinatal opioid use disorders (OUD) and people experiencing incarceration in the United States. However, insights from participants regarding the risks and benefits of participation are not adequately considered. The aim of this study was to examine the risks and benefits of research participation from the perspective of pregnant/postpartum people with OUD who have experienced incarceration. Design We recruited people who had experience with perinatal incarceration and were either currently pregnant or postpartum, and at least 18 years old. All participants met the clinical criteria for OUD. Our study did not have exclusion criteria based on gender, race, or ethnicity. Setting Participants were either currently incarcerated at the North Carolina Correctional Institute for Women in Raleigh, North Carolina, United States or had previously experienced perinatal incarceration and were recruited from a perinatal substance use disorder treatment program located in North Carolina. Participants Between 9/2021-4/2022, we completed 12 interviews with pregnant/postpartum people with OUD, approximately half who were currently incarcerated and half with a recent history of perinatal incarceration. Intervention/measurement Interviews were conducted via Webex phone or video. The interviews followed a scripted interview guide and lasted one hour on average. Interview transcripts were analyzed using the Rigorous and Accelerated Data Reduction technique to produce an overarching thematic framework. Findings Our analysis identified benefits, including the personal advantage of self-expression, helping others and contributing to change, and financial incentives. Risks included stigma and breach of confidentiality, misunderstanding of the distinction between research and advocacy, and limited ability to share their whole experience. Conclusions Participant-identified benefits of research mirrored those from other marginalized populations, though participant-identified risks were novel and nuanced. Recruitment and consent should move beyond normative research ethics committees protocol language to consider the perspectives of participants.
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Young, April M., Kathryn E. Lancaster, Sarann Bielavitz, Miriam R. Elman, Ryan R. Cook, Gillian Leichtling, Edward Freeman et al. "Peer-based Retention Of people who Use Drugs in Rural Research (PROUD-R2): a multisite, randomised, 12-month trial to compare efficacy of standard versus peer-based approaches to retain rural people who use drugs in research". BMJ Open 12, n.º 6 (junho de 2022): e064400. http://dx.doi.org/10.1136/bmjopen-2022-064400.
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Introduction Rural communities bear a disproportionate share of the opioid and methamphetamine use disorder epidemics. Yet, rural people who use drugs (PWUD) are rarely included in trials testing new drug use prevention and treatment strategies. Numerous barriers impede rural PWUD trial engagement and advancing research methods to better retain rural PWUD in clinical trials is needed. This paper describes the Peer-based Retention Of people who Use Drugs in Rural Research (PROUD-R2) study protocol to test the effectiveness of a peer-driven intervention to improve study retention among rural PWUD. Methods and analysis The PROUD-R2study is being implemented in 21 rural counties in three states (Kentucky, Ohio and Oregon). People who are 18 years or older, reside in the study area and either used opioids or injected any drug to get high in the past 30 days are eligible for study inclusion. Participants are allocated in a 1:1 ratio to two arms, stratified by site to assure balance at each geographical location. The trial compares the effectiveness of two retention strategies. Participants randomised to the control arm provide detailed contact information and receive standard retention outreach by study staff (ie, contacts for locator information updates, appointment reminders). Participants randomised to the intervention arm are asked to recruit a ‘study buddy’ in addition to receiving standard retention outreach. Study buddies are invited to participate in a video training and instructed to remind their intervention participant of follow-up appointments and encourage retention. Assessments are completed by intervention, control and study buddy participants at 6 and 12 months after enrolment. Ethics and dissemination The protocol was approved by a central Institutional Review Board (University of Utah). Results of the study will be disseminated in academic conferences and peer-reviewed journals, online and print media, and in meetings with community stakeholders. Trial registration number NCT03885024
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Sharif, Omar, Madhusudan Basak, Tanzia Parvin, Ava Scharfstein, Alphonso Bradham, Jacob T. Borodovsky, Sarah E. Lord e Sarah M. Preum. "Characterizing Information Seeking Events in Health-Related Social Discourse". Proceedings of the AAAI Conference on Artificial Intelligence 38, n.º 20 (24 de março de 2024): 22350–58. http://dx.doi.org/10.1609/aaai.v38i20.30241.
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Social media sites have become a popular platform for individuals to seek and share health information. Despite the progress in natural language processing for social media mining, a gap remains in analyzing health-related texts on social discourse in the context of events. Event-driven analysis can offer insights into different facets of healthcare at an individual and collective level, including treatment options, misconceptions, knowledge gaps, etc. This paper presents a paradigm to characterize health-related information-seeking in social discourse through the lens of events. Events here are board categories defined with domain experts that capture the trajectory of the treatment/medication. To illustrate the value of this approach, we analyze Reddit posts regarding medications for Opioid Use Disorder (OUD), a critical global health concern. To the best of our knowledge, this is the first attempt to define event categories for characterizing information-seeking in OUD social discourse. Guided by domain experts, we develop TREAT-ISE, a novel multilabel treatment information-seeking event dataset to analyze online discourse on an event-based framework. This dataset contains Reddit posts on information-seeking events related to recovery from OUD, where each post is annotated based on the type of events. We also establish a strong performance benchmark (77.4% F1 score) for the task by employing several machine learning and deep learning classifiers. Finally, we thoroughly investigate the performance and errors of ChatGPT on this task, providing valuable insights into the LLM's capabilities and ongoing characterization efforts.
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Francis, Erica, Jennifer Kraschnewski, Ruth Hogentogler, Kimberly Buckner, Jackie Sabol e Kara Bowers. "4060 A Telehealth Approach to Improving Healthcare to Rural and Underserved Populations". Journal of Clinical and Translational Science 4, s1 (junho de 2020): 56. http://dx.doi.org/10.1017/cts.2020.199.
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OBJECTIVES/GOALS: Project Extension for Community Health Outcomes (ECHO), a telehealth model, was launched at Penn State University in 2018 to connect specialists with community providers to provide education on best clinical practices. We aim to describe clinical topics covered and relevant provider level outcomes. METHODS/STUDY POPULATION: The heart of the ECHO model is a hub-and-spoke knowledge-sharing system. The ECHO model has four core principles: 1) use technology to leverage scarce resources; 2) share best practices to reduce disparities; 3) employ case-based learning to master complexity; 4) monitor outcomes to ensure benefit. Unlike telemedicine, where outside specialists assume the care of the patient, Project ECHO is a guided learning community aimed at practice improvement: providers receive mentoring and feedback on de-identified patient cases, strengthen their skillset, and retain responsibility for their patients. RESULTS/ANTICIPATED RESULTS: Clinical topics launched include Medication Assisted Treatment for Opioid Use Disorder, Ehlers Danlos Syndrome, Polyneuropathy, and Dementia. In addition, we launched a nutrition-focused ECHO with Boy Scout summer camp leaders in 26 states, reaching 107,347 scouts. Over the past year we have reached 118 clinicians in 62 clinics within 19 counties in Pennsylvania, providing a total of 268 CME hours. These providers have treated 2,294 patients and reported increased knowledge (94%), decreased sense of professional isolation (86%), and improvement in ability to provide patient care (92%) following completion of an ECHO series. DISCUSSION/SIGNIFICANCE OF IMPACT: Project ECHO is a powerful telehealth model providing mentorship and education to clinicians, encouraging them to treat more complex cases in their primary care clinics. As a result, patients receive higher quality care when they need it, and close to home, particularly important in rural areas.
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Chorniy, Sofiia, Yaroslav Bilyk, Bohdana Pavliuk e Iryna Stechyshyn. "Analysis of the assortment structure of antidepressants on the domestic pharmaceutical market". Ukrainian Scientific Medical Youth Journal 136, n.º 1 (15 de março de 2023): 111–17. http://dx.doi.org/10.32345/usmyj.1(136).2023.111-117.
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а feature of the course of diseases, the correction of which requires the use of antidepressants, is the small number of requests for specialized help in the early stages of the development of mental disorders. This creates certain limitations for fast and effective therapy. However, given that depression is the most common mental disorder in the world, there is a certain scientific interest in researching this pathology. The purpose of the work is a comprehensive assortment analysis of the group N06A "Antidepressants" on the pharmaceutical market of Ukraine. The study of the assortment of antidepressants registered on the pharmaceutical market was carried out in accordance with the Anatomical-Therapeutic-Chemical classification and the data of the State Register of Drugs of Ukraine. The objects of research were information on drugs registered in Ukraine, which belong to category N06A "Antidepressants". According to the data of the State Register of Drugs of Ukraine, as of January 2022, taking into account drugs produced in different dosages, 149 trade names of drugs belonging to category N06A "Antidepressants" and represented by 20 international non-proprietary names were registered. Of all the antidepressants registered on the pharmaceutical market of Ukraine, 52 drugs with a limited validity period of the registration certificate should be noted. The pharmaceutical market of Ukraine for the treatment of depression is clearly dominated by foreign pharmaceutical companies, and the share of domestic companies is represented only by 18.1%, which indicates the need to expand this group of drugs, because 9 out of 20 international non-proprietary names do not have a single domestic drug. Antidepressants are imported to the Ukrainian pharmaceutical market from 19 countries. The main importing countries are: India – 18.9%, Slovenia – 12.3%, Germany – 9.0%, Poland and Turkey – 7.4% each, Hungary – 5.7%. Other countries collectively occupy 39.3% of the pharmaceutical market of imported drugs from category N06A "Antidepressants". But it is important that according to the Anatomical-Therapeutic-Chemical classification, in Ukraine this group of drugs is classified only into 3 subgroups. It should be noted that in Ukraine there are harmonized protocols, where, according to the recommendations for the treatment of depression, drugs are offered that, unfortunately, are not registered on the domestic market, which is reflected in the absence of two subgroups: N06AF and N06AG, which creates certain problems of patient access to high-quality and effective therapy recommended by the 2020 "Protocols for the diagnosis and treatment of patients with mental disorders (Finnish version)".
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Black, Joshua, Zachary R. Margolin, Gabrielle Bau, Richard Olson, Janetta L. Iwanicki e Richard C. Dart. "Web-Based Discussion and Illicit Street Sales of Tapentadol and Oxycodone in Australia: Epidemiological Surveillance Study". JMIR Public Health and Surveillance 7, n.º 12 (20 de dezembro de 2021): e29187. http://dx.doi.org/10.2196/29187.
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Background Opioid use disorder and its consequences are a persistent public health concern for Australians. Web activity has been used to understand the perception of drug safety and diversion of drugs in contexts outside of Australia. The anonymity of the internet offers several advantages for surveilling and inquiring about specific covert behaviors, such as diversion or discussion of sensitive subjects where traditional surveillance approaches might be limited. Objective This study aims to characterize the content of web posts and compare reports of illicit sales of tapentadol and oxycodone from sources originating in Australia. First, post content is evaluated to determine whether internet discussion encourages or discourages proper therapeutic use of the drugs. Second, we hypothesize that tapentadol would have lower street price and fewer illicit sales than oxycodone. Methods Web posts originating in Australia between 2017 and 2019 were collected using the Researched Abuse, Diversion, and Addiction-Related Surveillance System Web Monitoring Program. Using a manual coding process, unstructured post content from social media, blogs, and forums was categorized into topics of discussion related to the harms and behaviors that could lead to harm. Illicit sales data in a structured format were collected through a crowdsourcing website between 2016 and 2019 using the Researched Abuse, Diversion, and Addiction-Related Surveillance System StreetRx Program. In total, 2 multivariable regression models assessed the differences in illicit price and number of sales. Results A total of 4.7% (28/600) of tapentadol posts discussed an adverse event, whereas 10.27% (95% CI 9.32-11.21) of oxycodone posts discussed this topic. A total of 10% (60/600) of tapentadol posts discussed unsafe use or side effects, whereas 20.17% (95% CI 18.92-21.41) of oxycodone posts discussed unsafe use or side effects. There were 31 illicit sales reports for tapentadol (geometric mean price per milligram: Aus $0.12 [US $0.09]) and 756 illicit sales reports for oxycodone (Aus $1.28 [US $0.91]). Models detected no differences in the street price or number of sales between the drugs when covariates were included, although the potency of the pill significantly predicted the street price (P<.001) and availability predicted the number of sales (P=.03). Conclusions Australians searching the web for opinions could judge tapentadol as safer than oxycodone because of the web post content. The illicit sales market for tapentadol was smaller than that of oxycodone, and drug potency and licit availability are likely important factors influencing the illicit market.
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Khademi, Sedigh, Christine Mary Hallinan, Mike Conway e Yvonne Bonomo. "Using Social Media Data to Investigate Public Perceptions of Cannabis as a Medicine: Narrative Review". Journal of Medical Internet Research 25 (27 de fevereiro de 2023): e36667. http://dx.doi.org/10.2196/36667.
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Background The use and acceptance of medicinal cannabis is on the rise across the globe. To support the interests of public health, evidence relating to its use, effects, and safety is required to match this community demand. Web-based user-generated data are often used by researchers and public health organizations for the investigation of consumer perceptions, market forces, population behaviors, and for pharmacoepidemiology. Objective In this review, we aimed to summarize the findings of studies that have used user-generated text as a data source to study medicinal cannabis or the use of cannabis as medicine. Our objectives were to categorize the insights provided by social media research on cannabis as medicine and describe the role of social media for consumers using medicinal cannabis. Methods The inclusion criteria for this review were primary research studies and reviews that reported on the analysis of web-based user-generated content on cannabis as medicine. The MEDLINE, Scopus, Web of Science, and Embase databases were searched from January 1974 to April 2022. Results We examined 42 studies published in English and found that consumers value their ability to exchange experiences on the web and tend to rely on web-based information sources. Cannabis discussions have portrayed the substance as a safe and natural medicine to help with many health conditions including cancer, sleep disorders, chronic pain, opioid use disorders, headaches, asthma, bowel disease, anxiety, depression, and posttraumatic stress disorder. These discussions provide a rich resource for researchers to investigate medicinal cannabis–related consumer sentiment and experiences, including the opportunity to monitor cannabis effects and adverse events, given the anecdotal and often biased nature of the information is properly accounted for. Conclusions The extensive web-based presence of the cannabis industry coupled with the conversational nature of social media discourse results in rich but potentially biased information that is often not well-supported by scientific evidence. This review summarizes what social media is saying about the medicinal use of cannabis and discusses the challenges faced by health governance agencies and professionals to make use of web-based resources to both learn from medicinal cannabis users and provide factual, timely, and reliable evidence-based health information to consumers.
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Ivankiv, Ya T. "Micro- and ultrastructural organization of the uterine wall of a white laboratory rat under conditions of 4-week action of Nalbuphine". Reports of Morphology 26, n.º 1 (22 de maio de 2020): 32–36. http://dx.doi.org/10.31393/morphology-journal-2020-26(1)-05.
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The world community is facing a problem that threatens the entire population of the planet – reproductive health. This is a multifactorial problem that requires an integrated approach and effective solutions. One of the important factors that is very difficult to control and which in itself is a problem, and its prevalence can be called an epidemic without exaggeration, is drug addiction. The solution of these problems determined the purpose of our work – to establish what changes occur at the micro- and ultrastructural levels under the action of opioids on the uterus of white laboratory rats. The method of hematoxylin-eosin staining was used for histological examination, and the method of electron microscopy was used for the study at the cellular level. After 4 weeks of administration of Nalbuphine to white laboratory rats on histological sections, significant changes were observed in all layers of the uterus. The vessels of the myometrium were dilated, overflowing with erythrocytes, sometimes containing neutrophils and lymphocytes, perivasally marked the appearance of macrophages, in the cytoplasm of which was golden-brown pigment. The development of vacuolar dystrophy was also observed in the myometrium. There were necrotic changes and vacuolar dystrophy in the epithelium of the uterine mucosa, and epitheliocytes in which necrotic changes occurred exfoliated into the lumen of the uterus. The outer surface of the perimetrium was uneven due to necrotic changes of the monolayer squamous epithelium. Hyperplasia of the stratified squamous epithelium was observed in the ectocervix, in the areas of which a chaotic accumulation of low-differentiated epithelial cells was found. Electron microscopy revealed that a significant number of smooth myocytes lost their characteristic process shape, their nuclei were deformed and were in the stage of apoptosis, karyopyknosis and even karyorrhexis. The nucleoplasm contained almost no nucleoli, and heterochromatin is located on the periphery of the nucleus. The enlightened cytoplasm is filled with myofilaments, which are randomly arranged in the cell. Mitochondria acquired various shapes and sizes, mostly with destroyed cristae and areas of enlightenment. Swollen connective tissue layers between myocytes testify to circulatory disorders. The damage described in the experiment at all levels indicates the destructive effect of Nalbuphine, which causes irreversible changes that lead to significant violations of the structure and function of the uterus, which leads to the conclusion that excessive drug use has a direct negative impact on the reproductive system.
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Arnold, Louise M., Holger Brondke, Katharina Steinitz e Richard J. Kelly. "Monitoring Patient Reported Outcomes in PNH: Interim Results of a Market Research with florio ® PNH". Blood 142, Supplement 1 (28 de novembro de 2023): 7211. http://dx.doi.org/10.1182/blood-2023-185560.
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Background: Patients withparoxysmal nocturnal hemoglobinuria (PNH), an ultra-rare, acquired disorder, report various cardiovascular, gastrointestinal, neurological or hematological symptoms that can severely impact their physical functioning and health-related quality of life. Patients may require long term treatment with anti-complement therapies to alleviate PNH symptoms or complications. Whilst blood biomarkers can aid the monitoring of disease progression, patient reported outcomes (PRO) and related symptoms are also of value in assessing response to therapy, but they are not always continuously tracked by patients. Hence florio PNH, a software medical device (smartphone app), was designed to allow easy monitoring of PRO and tracking of medication by patients. It allows documentation of therapy and common symptoms as well as hemoglobin and LDH levels. florio PNH can send treatment reminders and compiles the entered data into a patient report. Patients were invited to participate in market research of florio PNH to better understand monitoring habits and expectations towards an app in this area. Methods: Twenty patients were invited to participate in market research sponsored by Florio GmbH. The participants came from the UK PNH service centre in Leeds and were selected by the coordinating clinical team at routine clinic visits. The research was submitted for ethics approval and written informed consent was provided. The market research consisted of a one hour entry interview assessing current behavior and expectations towards monitoring of outcomes, followed by an eight-week period of field-testing florio PNH app. The subsequent one hour exit interview explored the user experience with the app, and which app features were seen of value, of less value or were missing. A total of 20 patients are to be enrolled in the research, of which 17 had completed the initial interview at the time of this report. Results: The majority of participants were 50 years of age or older (59%) and described themselves as “not tech savvy”. Six participants rated the impact of PNH on their life as significant, 6 as somewhat and 5 as little to none. Fatigue was named by 10 patients unprompted as the prominent symptom affecting their social and work life. Before the research, three participants neither tracked symptoms nor reported medication, five tracked both, seven only tracked their anti-complement infusions and two only major events when they happened. Forty seven percent of participants (8 of 17) did not prepare information at all for clinical consultations in advance, as they either experienced few events or relied on their memory. All users managed to install the app, set up their account and log events without problem. The app was described as easy to use, straightforward and participants appreciated that all data was in one location and possible to summarize into a report. Sixteen (94%) patients said that they believe the app will help them track events and that they would be enthused to use it in the future. Conclusions: Monitoring applications are employed in several rare bleeding disorders and have been shown to be valuable assets for collecting patient reported outcomes, especially in the outpatient setting. Participants of this research had no experience with using disease specific apps for collecting outcomes, and usually rely on the calendar functions provided by their smartphones or paper diaries. 94% concluded that the app will help them organize their PNH data, share data with their treating clinical team, better plan their future activities and be reminded when the next treatments are due.
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Wetzel, David A., e Michael D. Tarantino. "Cost-Minimization Analysis of Anti-D Immune Globulin Versus Intravenous Immune Globulin for the Initial Treatment of Immune Thrombocytopenic Purpura." Blood 108, n.º 11 (16 de novembro de 2006): 3305. http://dx.doi.org/10.1182/blood.v108.11.3305.3305.
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Abstract Immune Thrombocytopenic Purpura (ITP) is an autoimmune disorder in which opsonized platelets are prematurely destroyed within the spleen. At this time both anti-D immune globulin (anti-D) and intravenous immune globulin (IVIG) are established treatment options for the management of ITP in children and adults. Due to the tremendous increase in demand for IVIG products in the past decade and the subsequent lack of sufficient production a national shortage has emerged. As a consequence, the direct cost and resulting burden on the healthcare payer has risen dramatically for this treatment option. We performed a cost-minimization analysis (CMA) to compare the cost of using anti-D versus IVIG for the initial treatment of non emergent ITP in appropriate patients. A CMA was employed for this economic evaluation because clinical evidence supports the supposition that the efficacies of the treatment options in question are similar. The perspective used for this study was that of the healthcare payer. The study population includes children and adults with non emergent forms of ITP who are both Rh positive and nonsplenectomized. This CMA did not include the cost to the healthcare payer for treatment administration or the incidence and cost of subsequent treatments for each product. The incidence of severe adverse events when using IVIG or anti-D are rare and therefore were not included in this CMA. In this analysis the cost for the non emergent initial treatment of ITP using [Immune Globulin Intravenous (Human)] 10% (Gammagard Liquid 10%) 1gm/kg × 2 days was compared to anti-D (WinRho® SDF Liquid) 50μg/kg × 1 day respectively. We performed a CMA using the same initial dose and duration of IVIG and anti-D dosed at 75μg/kg. And finally we performed a CMA using one day of treatment for both IVIG and anti-D dosed at 75μg/kg. An average patient weight of 75kg was used for initial dose calculations for each product. The average wholesale price (AWP) for each product was used for cost calculations. Gammagard Liquid 10% was selected as the product for IVIG therapy because this product currently holds a large portion of market share for IVIG products in the US. An example CMA calculation was; Gammagard Liquid 10% 1g/kg × 75kg × 2 days × $101.25 – WinRho® SDF 50μg/kg × 75kg × $1.10/μg. The results of these three CMAs when using anti-D versus IVIG for the initial treatment of ITP yielded a cost savings of $11,063.00, $9,000.50 and $1,406.25 respectively. When the CMA calculations were adjusted to use the actual number of vials needed to dispense the final dose of IVIG and anti-D dosed at 75μg/kg, the savings realized was $1,213.75 per dose dispensed. These CMAs have demonstrated the cost benefit of using anti-D for the initial treatment of non emergent ITP in appropriate patients.
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Dimiccoli, Mariella, e Petia Radeva. "Visual Lifelogging in the Era of Outstanding Digitization". Digital Presentation and Preservation of Cultural and Scientific Heritage 5 (30 de setembro de 2015): 59–64. http://dx.doi.org/10.55630/dipp.2015.5.4.
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In this paper, we give an overview on the emerging trend of the digitized self, focusing on visual lifelogging through wearable cameras. This is about continuously recording our life from a first-person view by wearing a camera that passively captures images. On one hand, visual lifelogging has opened the door to a large number of applications, including health. On the other, it has also boosted new challenges in the field of data analysis as well as new ethical concerns. While currently increasing efforts are being devoted to exploit lifelogging data for the improvement of personal well-being, we believe there are still many interesting applications to explore, ranging from tourism to the digitization of human behavior. 1 Introduction We are already living in the world, where digitization affects our daily lives and socio-economic models thoroughly, from education and art to the industry. In essence, digitization is about implementing new ways to put together physical and digital resources for creating more competitive models. Recently, lifelogging appeared just as another powerful manifestation of this digitization process embraced by people at different extents. Lifelogging refers to the process of automatically, passively and digitally recording our own daily experience, hence, connecting digital resource and daily life for a variety of purposes. In the last century, there has been a small number of dedicated individuals, who actively tried to log their lives. Today, thanks to the advancements in sensing technology and the significant reduction of computer storage cost, one’s personal daily life can be recorded efficiently, discretely and in hand-free fashion (see Fig. 1). The most common way of lifelogging, commonly called visual lifelogging, is through a wearable camera that captures images at a reduced framerate, ranging from 2 fpm of the Narrative Clip to 35 fps of the GoPro. The first commercially available wearable camera, called SenseCam, was presented by Microsoft in 2005 and during the last decade, it has been largely deployed in health research. As summarized in a collection of studies published in a special theme issue of the American Journal of Preventive Medicine [5], information collected by a wearable camera over long periods of time has large number of potential applications, both at individual and population level. At individual level, lifelogging can aid in contrast dementia by cognitive training based on digital memories or in improving well-being by monitoring lifestyle. At population level, lifelogging could be used as an objective tool for 60 understanding and tracking lifestyle behavior, hence enabling a better understanding of the causal relations between noncommunicable diseases and unhealthy trends and risky profiles (such as obesity, depression, etc.) Fig. 1. Evolution of wearable camera technology. From left to right: Mann (1998), GoPro (2002), SenseCam (2005), Narrative Clip (2013). However, the huge potential of these applications is currently strongly limited by technical challenges and ethical concerns. The large amount of data generated, the high variability of object appearance and the free motion of the camera, are some of the difficulties to be handled for mining information from and for managing lifelogging data. On the other hand, legality and social acceptance are the major ethical challenges to be faced. This paper discusses these issues and it is organized as follows: in the next section, we give an overview of potential applications; in section 3, we analyze technical challenges and current solutions. Section 4 is devoted to ethical issues and, finally, in section 5, we draw some conclusions. 2 Potential Applications Humans have always been interested in recording their life experiences for future reference and for storytelling purposes. Therefore, a natural application would be summarizing lifelog collections into a story that will be shared with other people, most likely through a social network. Since the end-users may have very different tastes, storytelling algorithms should incorporate some knowledge of the social context surrounding the photos, such as who the user and the target audience are. However, lifelogging technology allows capturing our entire life, not only those moments that we would like to share with others (see Fig. 2). This offers a great potential to make people aware of their lifestyle, understood as a pattern of behavioral choices that an individual makes in a period of time. This feedback could provide education and motivation to improve health trends, detecting risky profiles, with a personal trainer “in-the-loop”. Indeed, by providing a symbiosis between health professionals and wearable technology, it could be possible to design and implement individualized strategies for changing behavior. Considering that physical activity and poor diet are major risk factors for heart diseases, obesity and leading causes of premature mortality, this social impact of applications will be huge. On the other hand, lifelogging could be useful in monitoring patients affected by neurological disorders such as depression or bipolar disorder by aiding in predicting crisis. 61 Fig. 2. Images recorded by a Narrative Clip: From left to right and from the 1st to the 2nd row: in a bus, biking, attending a seminar, having lunch, in a market, in a shop, in the street, working. Finally, digital memories could be used as a tool for cognitive training for people affected by Mild Cognitive Impairment (MCI), a condition that represents a window for novel intervention tools against the Alzheimer disease. Although the emphasis nowadays is on the use of wearable cameras for health applications, its potential spreads to many other domains ranging from tourism to digitization of intangible heritage. For instance, data collected during a long trip could be used to make short and original photostreams for storytelling purposes and be shared in a network of visitors of a country. On the other hand, probably in the next century, these data would be useful for people interested in comparing how transportation and landscape have changed over time. During the last few decades, there has been an increasing interest in the use of digital media in the preservation, management, interpretation, and representation of cultural heritage. Intangible cultural heritage consists of nonphysical aspects of a particular culture, among which folklore, traditions, behavior. The intangible aspects of our cultural heritage represent a treasure of significant historical and socio-economic importance. Naturally, intangible cultural heritage is more difficult to preserve than physical objects. The digital documentation of intangible cultural heritage represents a huge market potential, which is largely unexplored. Wearable cameras could be used in this field to collect, preserve and make available digitally part of the intangible cultural heritage of the 21th century, such as human behavior. 62 3 Technical Challenges Wearing a camera over a long period of time generates a large amount of data (up to 70.000 images per month), making difficult the problem of retrieving specific information. Beside data organization, the high variability of object appearance in the real world and the free motion of the camera make state of the art object recognition algorithms to fail. In Fig. 3 are shown two sequences acquired by wearing a Narrative Clip (2fpm): one can appreciate the frequency of abrupt changes of the field of view even in temporally adjacent images that makes motion estimation unreliable and frequent occlusions that cause important drop in object recognition performances. Fig. 3. Example of photostreams captured by a Narrative CLip while (first row) biking and having a coffee (second row). As shown in [2], the interest of the computer vision community is rapidly increasing and this trend is expected to continue in the next years. Most available works have been conceived to analyze data captures by high temporal resolution wearable cameras, such as GoPro or Google Glasses and they can be broadly classified depending on the task, they try to solve in: activity-recognition [15, 11, 10, 13, 6], social interaction analysis [1, 3, 19], summarization [4, 16, 12]. Activity recognition usually relies on cues such ego-motion [15, 10], object-hand interaction [11, 10] or attention [13, 6]. Generally, the major difficult to be faced in the task of activity recognition are the large variability of objects and hands and the free motion of the camera that make it very difficult to estimate body movements and attention. Social interaction detection is based on the concept of F-formation that models orientation relationships of groups of people in space. F-formations require estimating pose and 3D-location of people, which are challenging tasks due the continuous changes of aspect ratio, scale and orientation. A common approach to summarization is to try to maximize the relevance of the selected images and minimize the redundancy. Relevancy can be captured by relying on mid-level or high-level features. Mid level features may be motion, global CNN features [4, 16], whereas high-level features may be important objects [12] or topics [18]. 63 4 Ethical Issues Lifelog technology can be considered still in its infancy and assuring that the related ethical issues receive full consideration at this moment is crucial for a responsible development of the field. In the last few years, a number of papers has tried to inquiry into the ethical aspects of lifelogs held by individuals [17, 7, 14], discussing issues to do with privacy, autonomy, and beneficence. Images captured by a wearable camera clearly impact the privacy of lifeloggers as well as of bystanders captured in such images. In [7], the authors identified various factors to make a photo sensitive and proposed to embed into the devices an algorithm that use these factors to automatically delete sensitive images. The most general meaning of autonomy is to be a law to oneself. The authors of [8] recognize that lifelogging offers a great opportunity towards autonomy, since it allows to better understand ourselves. Moreover, they provide recommendations and guidelines to meet the challenges that lifelogs poses towards autonomy. Beneficence concerns with the responsibility to do good by maximizing the benefits to an individual or to society, while minimizing harm to the individual. A critical component is informed consent that should be signed by participant to research projects or clinical projects. More general specifications for wearable camera research are provided in [9], proposing an ethical framework for health research. 5 Conclusions This paper has reviewed some of the most important aspects of visual lifelogging, focusing on the technical and ethical challenges it arises, and on its potential applications. We believe that a responsible development of the field could be highly beneficial for the society. In order to become widely used technology, a large amount of effort should be invested in the development of efficient information retrieval systems, to allow fast and easy access to lifelogging content at a semantic level. Further advances in the field of deep learning will allow filling this semantic gap. Acknowledgments This work was partially founded by TIN2012-38187-C03-01 and SGR 1219. M. Dimiccoli is supported by a Beatriu de Pinos grant (Marie-Curie COFUND action).
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Amundsen, Ellen J., Anne Line Bretteville-Jensen e Ingeborg Rossow. "Patients admitted to treatment for substance use disorder in Norway: a population-based case–control study of socio-demographic correlates and comparative analyses across substance use disorders". BMC Public Health 22, n.º 1 (20 de abril de 2022). http://dx.doi.org/10.1186/s12889-022-13199-5.
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Abstract Background Improved knowledge regarding socio-demographic correlates of people with substance use disorders (SUDs) is essential to better plan and provide adequate services for SUD patients and their families, and to improve our understanding of the complex mechanisms underlying progression into and development of various SUDs. This study aimed to: i) describe demographic, economic, and social correlates of people with SUDs in comparison with those of the general population and ii) compare these correlates across SUDs from licit versus illicit substances, as well as across specific SUDs. Methods A national population-based case–control study included all SUD patients enrolled in specialized drug treatment in Norway in 2009–2010 (N = 31 245) and a population control sample, frequency-matched on age and gender (N = 31 275). Data on education level, labour market participation, income level and sources, and family/living arrangement were obtained by linkages to national registers. Results Demographic, economic, and social correlates of SUD patients differed substantially from those of the general population, and across specific SUDs. Among SUD patients, those with illicit – as compared to licit – SUDs were younger (mean quotient = 0.72 [0.71–0.72]), more often had low education level (RR = 1.68 [1.63–1.73]), were less often in paid work (RR = 0.74 [0.72–0.76]) and had lower income (mean quotient = 0.61 [0.60–0.62]). Comparison of patients with different SUD diagnoses revealed substantial demographic differences, including the relatively low mean age among cannabis patients and the high share of females among sedatives/hypnotics patients. Opioid patients stood out by being older, and more often out of work, receiving social security benefits, and living alone. Cocaine and alcohol patients were more often better educated, included in the work force, and had a better financial situation. Conclusion Findings revealed substantial and important differences in socio-demographic correlates between SUD patients and the general population, between SUD patients with illicit and with licit substance use, and across specific SUD patient groups.
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Mendell, Ari, Chris Vannabouathong, Kim Le e Peter Dyrda. "Utilization of Opioid Agonist Therapies in Canada". Canadian Journal of Health Technologies 3, n.º 8 (15 de agosto de 2023). http://dx.doi.org/10.51731/cjht.2023.714.
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Canada continues to experience an opioid crisis that has had a devastating impact on public health, highlighting the importance of management strategies for opioid use disorder (OUD). Several opioid agonist therapies (OATs) for the management of OUD are available in Canada, including recent approvals of new brand name drugs and generic versions of widely used OATs.
Coverage criteria for OATs are comparable across public drug plans in Canada. Methadone hydrochloride (HCL) and the combination of buprenorphine HCL and naloxone HCL (buprenorphine HCL-naloxone HCL) are typically listed as regular or open benefits; generics for these 2 medications have been available since 2020 and 2013, respectively. Sublocade and Probuphine — long-acting buprenorphine preparations approved by Health Canada in 2018 — have varied coverage that is often dependent on prior therapy requirement.
The annual number of public claims for OATs decreased by 19.5% from 2018 to 2022. The market share of claims during this period was dominated by methadone HCL and buprenorphine HCL-naloxone HCL, with an increase in claims market share for buprenorphine over time (starting in 2020) and a negligible contribution by buprenorphine HCL. Additionally, in a subanalysis on the number of OAT claimants, the results did not indicate a decrease in individual beneficiaries for these medications; therefore, the decrease in OAT claims was likely driven by increased usage of OATs that require fewer claims per patient, as opposed to decreased OAT use in the population.
Despite the decrease in annual OAT claims during the analysis period, total OAT expenditures increased every year, with a 67.0% increase from 2018 to 2022 (5-year total of $307 million). The increase was initially driven by buprenorphine HCL-naloxone HCL, which increased from $27 million (58.9% of OAT expenditures) in 2018 to $39 million (67.2% of OAT expenditures) in 2019. Thereafter, expenditures for buprenorphine drove overall OAT cost increases from 2020 onward, accounting for $22 million (28.2% of OAT expenditures) in 2022. In contrast, methadone HCL accounted for a decreasing proportion of expenditures each year ($19 million or 41.1% of OAT expenditures in 2018 to $16 million or 21.0% of OAT expenditures in 2022), despite having the greatest proportion of claims throughout the study period.
The availability of new OAT formulations and generic versions of existing products, as well as other notable regulatory policy changes (e.g., Health Canada’s removal of the need for an exemption to prescribe methadone HCL) and reimbursement decisions (e.g., positive reimbursement recommendations from CADTH for the newer branded OATs, Sublocade and Probuphine), impacted the observed utilization and expenditure patterns, and will likely continue to influence decision-making, particularly where coverage has recently changed or has yet to change to reflect the evolving landscape. If the utilization of injectable buprenorphine (Sublocade) continues at the rate observed in this analysis, it will likely continue to drive increases in OAT expenditures; Sublocade has several patents and the earliest patent expiry is not until 2031, so generic versions of this formulation will likely not be available for several more years. Overall, the findings of this analysis may help to inform jurisdictions in funding decisions regarding OATs for the treatment of OUD.
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Galvez, Samy J., Frederick L. Altice, Anna Meteliuk, Roman Ivasiy, Eteri Machavariani, Scott O. Farnum, Tetiana Fomenko, Zahedul Islam e Lynn M. Madden. "High perceived stress in patients on opioid agonist therapies during rapid transitional response to the COVID-19 pandemic in Ukraine". Frontiers in Public Health 11 (30 de novembro de 2023). http://dx.doi.org/10.3389/fpubh.2023.1231581.
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BackgroundThe COVID-19 pandemic resulted in marked disruptions in healthcare delivery in Ukraine related to emergency guidance in response to treating opioid use disorder (OUD). Patients with OUD, a group with high levels of comorbid medical and psychiatric disorders, and prescribed opioid agonist therapies (OAT) were rapidly shifted to take-home dosing if they were deemed clinically stable. The impact of these shifts on patient stress and related substance use during the pandemic, however, is unknown.MethodsIn early May 2020, 269 randomly selected OAT patients in Ukraine were surveyed to assess their stress level and substance use using the validated Perceived Stress Scale and examined correlates of severe perceived stress.ResultsOverall, 195 (72.5%) met criteria for moderate to severe levels of stress, which was independently correlated with having started OAT within the past 12 months (aOR: 1.33; 95%CI: 1.15–1.55), living in a large metropolitan area (aOR: 1.31; 95%CI: 1.18–1.46), having been asked by others to share their medication (aOR: 1.13; 95%CI: 1.02–1.25), and having an increase of over 10 min in transportation time to get to treatment (aOR: 1.16; 95%CI: 1.04–1.29). Twenty seven (10%) patients felt at high risk of relapse, while 24 (8.9%) patients reported purchasing drugs.ConclusionDuring a time of great uncertainty soon after emergency guidance to the COVID-19 pandemic, there was extraordinary high levels of perceived stress reported. In response to emergency guidance, OAT patients should be screened for perceived stress and certain subgroups should be targeted for additional psychosocial support.
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Weleff, Jeremy, Julio C. Nunes, Gabriel P. A. Costa, Mehmet Sofuoglu, R. Ross MacLean e Joao P. De Aquino. "From taboo to treatment: The emergence of psychedelics in the management of pain and opioid use disorder". British Journal of Clinical Pharmacology, 16 de abril de 2024. http://dx.doi.org/10.1111/bcp.16045.
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The rise of psychedelics in contemporary medicine has sparked interest in their potential therapeutic applications. While traditionally associated with countercultural movements and recreational use, recent research has shed light on the potential benefits of psychedelics in various mental health conditions. In this review, we explore the possible role of psychedelics in the management of chronic pain and opioid use disorder (OUD), 2 critical areas in need of innovative treatment options. Pain control remains a significant clinical challenge, particularly for individuals with OUD and those who receive long‐term opioid therapy who develop marked tolerance to opioid‐induced analgesia. Despite the magnitude of this problem, there is a scarcity of controlled studies investigating pain management alternatives for these populations. Drawing from preclinical and human evidence, we highlight the potential of psychedelics to act on shared neurobiological substrates of chronic pain and OUD, potentially reversing pain‐ and opioid‐induced neuroadaptations, such as central sensitization. We elaborate on the multifaceted dimensions of the pain experience (sensory, affective and cognitive) and their intersections that overlap with opioid‐related phenomena (opioid craving and withdrawal), hypothesizing how these processes can be modulated by psychedelics. After summarizing the available clinical research, we propose mechanistic insights and methodological considerations for the design of future translational studies and clinical trials, building on a shared clinical and neurobiological understanding of chronic pain and OUD. Our intention is to provide timely perspectives that accelerate the development and exploration of novel therapeutics for chronic pain and OUD amidst the escalating opioid crisis.
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Trammel, Cassandra J., Julia Whitley e Jeannie C. Kelly. "Pharmacotherapy for opioid use disorder in pregnancy". Current Opinion in Obstetrics & Gynecology, 8 de janeiro de 2024. http://dx.doi.org/10.1097/gco.0000000000000932.
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Purpose of review Opioid use disorder (OUD) in pregnancy has significantly in the last decade, impacting 8.2 per 1000 deliveries. OUD carries significant risk of morbidity and mortality for both the birthing person and neonate, but outcomes for both are improved with opioid agonist treatment (OAT). Here, we describe the recommended forms of OAT in pregnancy, updates to the literature, and alternate OAT strategies, and share practical peripartum considerations for patients on OAT. Recent findings Recent studies comparing buprenorphine and methadone have reaffirmed previous findings that buprenorphine is associated with superior outcomes for the neonate, without clear differences in morbidity or mortality for the birthing person. Optimal initiation and dosing of OAT remains unclear, with several recent studies evaluating methods of initiation, as well as a potential role for higher and more rapid dosing in the fentanyl era. Alternative products such as buprenorphine-naloxone and extended-release buprenorphine are of significant research interest, though randomized prospective data are not yet available. Summary Buprenorphine and methadone are standard of care for treatment of OUD during pregnancy, and multiple patient factors impact the optimal choice. Insufficient data exist to recommend alternative agents as a primary strategy currently. All patients with OUD in pregnancy should be counseled regarding OAT. Video http://links.lww.com/COOG/A94
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Miller-Rosales, Chris, Susan H. Busch, Ellen R. Meara, Ashleigh King, Thomas A. D’Aunno e Carrie H. Colla. "Internal and Environmental Predictors of Physician Practice Use of Screening and Medications for Opioid Use Disorders". Medical Care Research and Review, 10 de abril de 2023, 107755872311626. http://dx.doi.org/10.1177/10775587231162681.
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Medications for opioid use disorder (MOUD) remain highly inaccessible despite demonstrated effectiveness. We examine the extent of screening for opioid use and availability of MOUD in a national cross-section of multi-physician primary care and multispecialty practices. Drawing on an existing framework to characterize the internal and environmental context, we assess socio-technical, organizational-managerial, market-based, and state-regulation factors associated with the use of opioid screening and offering of MOUD in a practice. A total of 26.2% of practices offered MOUD, while 69.4% of practices screened for opioid use. Having advanced health information technology functionality was positively associated with both screening for opioid use and offering MOUD in a practice, while access to on-site behavioral clinicians was positively associated with offering MOUD in adjusted models. These results suggest that improving access to information and expertise may enable physician practices to respond more effectively to the nation’s ongoing opioid epidemic.
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McGee, Meghan, Kellia Chiu, Rahim Moineddin e Abhimanyu Sud. "The Impact of Suboxone’s Market Exclusivity on Cost of Opioid Use Disorder Treatment". Applied Health Economics and Health Policy, 18 de janeiro de 2023. http://dx.doi.org/10.1007/s40258-022-00787-0.
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Goyal, Neera K., Erica Sood, Meghan A. Gannon, Grace Harris, Dennis J. Hand, Diane J. Abatemarco e Vanessa L. Short. "Priorities for Well Child Care of Families Affected by Parental Opioid Use Disorder". Journal of Addiction Medicine, 22 de novembro de 2023. http://dx.doi.org/10.1097/adm.0000000000001243.
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Background and Objectives Parenting women in treatment for opioid use disorder (OUD) report a lack of family centeredness and anticipatory guidance within well child care (WCC), and WCC utilization is low among affected children. We explore priorities for WCC visit content to inform primary care recommendations for this population. Methods This study is a qualitative study of parenting women from one urban, academic OUD treatment program and pediatric primary care clinicians from a nearby affiliated pediatric practice. Eligible parent participants had a child ≤2 years old and were English speaking. Semistructured interviews elicited perspectives on WCC, with questions and prompts related to visit content. Inductive thematic analysis was led by 2 investigators using open coding procedures. Results Among 30 parent participants, the majority were White (83%) and unmarried (90%). Approximately 60% reported their child received pharmacotherapy for neonatal opioid withdrawal syndrome. Of 13 participating clinicians, 9 were attending pediatricians. Five themes emerged from parental and clinician interviews: (1) improving knowledge and confidence related to child development, behavior, and nutrition; (2) mitigating safety concerns; (3) addressing complex health and subspecialty needs through care coordination; (4) acknowledging parental health and wellbeing in the pediatric encounter; and (5) supporting health education and care related to neonatal opioid withdrawal syndrome. Parents and clinicians expressed difficulty comprehensively addressing such issues due to time constraints, social determinants of health, and significant informational needs. Conclusions Parenting women in treatment for OUD and pediatric clinicians share multiple priorities for anticipatory guidance within WCC visits and barriers to addressing them comprehensively.
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Khataniar, Ripunjoi, e Bobby Hmar. "SOCIO DEMOGRAPHIC AND CLINICAL PROFILE OF INJECTABLE OPIOID ABUSERS IN A HOSPITAL BASED POPULATION". INDIAN JOURNAL OF APPLIED RESEARCH, 1 de agosto de 2022, 77–80. http://dx.doi.org/10.36106/ijar/7203108.
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Background: Substance use disorder is a highly prevalent disorder causing both social and personal burden on the individual. Opioid use disorder affects the huge population around the world. To study the socio demographic andAim: clinical prole of injectable opioid users in a hospital based population. It was a cross sectional study. The duration of the study was forMethods: 1 year from1st June 2019 to 31st May 2020.100 patients of injectable opioid users with opioid dependence from Out Patient Department and Indoor Patient Department of Psychiatry,Gauhati Medical College and Hospital who fullled the selection criteria and gave written informed consent were recruited for the study. Data were analysed using descriptive statistical method. The Mean age of theStatistical analysis: Results: study sample is 24.72 years. All the study sample were male. Majority of patients (79%) were from Hindu religion.44% of patients were self- employed.76% of study subjects were unmarried.55% of patients were from lower middle socio economic status.77% of patients were from nuclear family. Majority of patients (66%) have tattoo over their body. 59% of patients share needle with partner while taking injectable opioids. 38 % patients started injecting opioids before 18 years of age. Majority of patients (56%) had Hepatitis C Virus reactive status. Conclusion: From our study we could able to nd out different socio demographic and clinical prole of injectable opioid users. From this study it is also reected that 38% of study population started heroin injection during their adolescent period. Hence the early detection and treatment of these adolescent heroin abusers need urgent intervention.
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Jain, Aryan, Annika Dhingra e Aditya Sivakumar. "Opioids and Covid-19: Perfect Storm, or Perfect Opportunity?" Columbia University Journal of Global Health 13, n.º 1 (1 de maio de 2023). http://dx.doi.org/10.52214/cujgh.v13i1.10687.
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The opioid epidemic in the United States has been made worse by the COVID-19 pandemic, due to increased stress and isolation, reduced access to addiction treatment services, and a disruption in the supply chain for conventional opioids, resulting in more dangerous and potent drugs entering the market. This has led to a spike in overdose deaths, particularly from fentanyl and other synthetic opioids. The availability of Naloxone, the opioid overdose reversal medication, has also been affected by the pandemic, with shortages in some areas due to supply chain disruptions. Access to buprenorphine and methadone, drugs used in opioid use disorder (OUD) therapy, has also been limited due to social distancing guidelines, however government policy has gradually adapted to loosen regulations surrounding their access.
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Mijatović Jovin, Vesna, Isidora Dickov, Dragana Ratković, Aleksandra Dickov e Ana Tomas. "Synthetic cannabinoids awareness among patients with opioid use disorder in Serbia – A survey based cross-sectional pilot study". Frontiers in Psychiatry 14 (7 de março de 2023). http://dx.doi.org/10.3389/fpsyt.2023.987726.
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IntroductionThere is limited data on the awareness and use of synthetic cannabinoids (SCs) in high-risk population in Serbia, despite SCs becoming more and more common at illicit drug market.AimThis pilot study aimed to examine the awareness and prevalence of use of SCs in patients with an opioid-use disorder and to identify patient characteristics and other factors associated with SCs use.Patients and methodsThis cross-sectional study was conducted at the Clinic for Psychiatry, Clinical Center Vojvodina, Serbia, the largest tertiary health care institution in this region of the country. All patients hospitalized due to the treatment of opioid dependence during November and December 2017 were included (response rate 100%), and filled-out an anonymous questionnaire specifically developed for the purpose of this study. Differences between patients reporting SCs use and those who did not were compared using chi-square test with values of p < 0.05 were considered significant.ResultsOut of 64 patients (median age 36.37 years), one third (32.81%) reported using SCs. Socio-demographic characteristics of the subjects were not associated with SCs use. There were differences in the most common sources of information reported between the SCs users and non-users. Majority of SCs users (76.0%) were informed about SCs through friends, compared with just 26.0% of non-users (<0.001). Nearly all study participants (93.8%) were daily tobacco users. The share of respondents reporting alcohol and marihuana use was significantly higher among the SCs users (52.0% vs. 20.9%, p = 0.011 and 15.6% vs. 12.5%, p = 0.015), respectively. Higher share of SCs users used multiple psychoactive substances (38.1% vs. 16.3%), and this difference was statistically significant (p = 0.047). The most commonly reported adverse effect of SCs among users included dry mouth (81.0%), trouble thinking clearly (52.4%) and panic attacks (52.4%).ConclusionUnderstanding the awareness and use of SCs among high-risk drug users, as well as associated factors can help improve substance-use disorder treatment in our setting. Educational activities targeting public are urgently needed to raise awareness on SCs, considering that social contacts are the main sources of information on SC for this vulnerable population. Users of SCs have also reported using other psychoactive substances more often, and this calls for a holistic approach addressing multiple factors to improve substance-use treatment in our setting.
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Mariano, Vincent, e Justin Berk. "“Coke in the Dope”: The Underrecognized Complications of a Cocaine-Adulterated Fentanyl Supply". Journal of Addiction Medicine, 3 de junho de 2024. http://dx.doi.org/10.1097/adm.0000000000001319.
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Abstract The opioid crisis, particularly the “fourth wave” involving fentanyl and stimulants, has been responsible for an alarming increase in overdose deaths in the United States. Although fentanyl contamination in cocaine has gained significant attention, the converse—cocaine-adulterated fentanyl—has been largely overlooked despite its health implications. The rise in concurrent cocaine and fentanyl overdose deaths could be attributed to various factors, from intentional polysubstance use to unintentional adulterations. Cocaine-related health issues may amplify the problem. Four potential pathways for the increased risk of overdose with cocaine-adulterated opioids include enhanced drug reinforcement, potential overdose risk with switching drug samples, altered metabolism of medications used for opioid use disorder, and increased myocardial demand juxtaposed with opioid-induced respiratory depression. With these risks, the importance of drug testing becomes paramount in the unregulated drug market. As polysubstance use overdoses surge, there is an urgent need to understand how drug supplies are changing in order to effectively identify appropriate harm reduction strategies. Specifically, further research is needed evaluating complications of low-level cocaine exposure with chronic/persistent opioid use. The hazards associated with cocaine-adulterated fentanyl emphasize the significance of understanding not only fentanyl’s presence in cocaine but also cocaine’s role in the fentanyl supply.
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Hser, Yih-Ing, Allison J. Ober, Alex R. Dopp, Chunqing Lin, Katie P. Osterhage, Sarah E. Clingan, Larissa J. Mooney et al. "Is telemedicine the answer to rural expansion of medication treatment for opioid use disorder? Early experiences in the feasibility study phase of a National Drug Abuse Treatment Clinical Trials Network Trial". Addiction Science & Clinical Practice 16, n.º 1 (20 de abril de 2021). http://dx.doi.org/10.1186/s13722-021-00233-x.
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AbstractTelemedicine (TM) enabled by digital health technologies to provide medical services has been considered a key solution to increasing health care access in rural communities. With the immediate need for remote care due to the COVID-19 pandemic, many health care systems have rapidly incorporated digital technologies to support the delivery of remote care options, including medication treatment for individuals with opioid use disorder (OUD). In responding to the opioid crisis and the COVID-19 pandemic, public health officials and scientific communities strongly support and advocate for greater use of TM-based medication treatment for opioid use disorder (MOUD) to improve access to care and have suggested that broad use of TM during the pandemic should be sustained. Nevertheless, research on the implementation and effectiveness of TM-based MOUD has been limited. To address this knowledge gap, the National Drug Abuse Treatment Clinical Trials Network (CTN) funded (via the NIH HEAL Initiative) a study on Rural Expansion of Medication Treatment for Opioid Use Disorder (Rural MOUD; CTN-0102) to investigate the implementation and effectiveness of adding TM-based MOUD to rural primary care for expanding access to MOUD. In preparation for this large-scale, randomized controlled trial incorporating TM in rural primary care, a feasibility study is being conducted to develop and pilot test implementation procedures. In this commentary, we share some of our experiences, which include several challenges, during the initial two-month period of the feasibility study phase. While these challenges could be due, at least in part, to adjusting to the COVID-19 pandemic and new workflows to accommodate the study, they are notable and could have a substantial impact on the larger, planned pragmatic trial and on TM-based MOUD more broadly. Challenges include low rates of identification of risk for OUD from screening, low rates of referral to TM, digital device and internet access issues, workflow and capacity barriers, and insurance coverage. These challenges also highlight the lack of empirical guidance for best TM practice and quality remote care models. With TM expanding rapidly, understanding implementation and demonstrating what TM approaches are effective are critical for ensuring the best care for persons with OUD.
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Page, Sarah, Maria M. Mavrikaki, Tania Lintz, Daniel Puttick, Edward Roberts, Hugh Rosen, F. Ivy Carroll, William A. Carlezon e Elena H. Chartoff. "Behavioral Pharmacology of Novel Kappa Opioid Receptor Antagonists in Rats". International Journal of Neuropsychopharmacology, 15 de outubro de 2019. http://dx.doi.org/10.1093/ijnp/pyz054.
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Abstract Background New treatments for stress-related disorders including depression, anxiety, and substance use disorder are greatly needed. Kappa opioid receptors are expressed in the central nervous system, including areas implicated in analgesia and affective state. Although kappa opioid receptor agonists share the antinociceptive effects of mu opioid receptor agonists, they also tend to produce negative affective states. In contrast, selective kappa opioid receptor antagonists have antidepressant- and anxiolytic-like effects, stimulating interest in their therapeutic potential. The prototypical kappa opioid receptor antagonists (e.g., norBNI, JDTic) have an exceptionally long duration of action that complicates their use in humans, particularly in tests to establish safety. This study was designed to test dose- and time-course effects of novel kappa opioid receptor antagonists with the goal of identifying short-acting lead compounds for future medication development. Methods We screened 2 novel, highly selective kappa opioid receptor antagonists (CYM-52220 and CYM-52288) with oral efficacy in the warm water tail flick assay in rats to determine initial dose and time course effects. For comparison, we tested existing kappa opioid receptor antagonists JDTic and LY-2456302 (also known as CERC-501 or JNJ-67953964). Results In the tail flick assay, the rank order of duration of action for the antagonists was LY-2456302 < CYM-52288 < CYM-52220 << JDTic. Furthermore, LY-2456302 blocked the depressive (anhedonia-producing) effects of the kappa opioid receptor agonist U50,488 in the intracranial self-stimulation paradigm, albeit at a higher dose than that needed for analgesic blockade in the tail flick assay. Conclusions These results suggest that structurally diverse kappa opioid receptor antagonists can have short-acting effects and that LY-2456302 reduces anhedonia as measured in the intracranial self-stimulation test.
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Meiselbach, Mark K., Coleman Drake, Jane M. Zhu, Brynna Manibusan, Dylan Nagy, Mark J. Sorbero, Brendan Saloner, Bradley D. Stein e Daniel Polsky. "State Policy and the Breadth of Buprenorphine-Prescriber Networks in Medicaid Managed Care". Medical Care Research and Review, 21 de abril de 2023, 107755872311675. http://dx.doi.org/10.1177/10775587231167514.
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Provider networks in Medicaid Managed Care (MMC) play a crucial role in ensuring access to buprenorphine, a highly effective treatment for opioid use disorder. Using a difference-in-differences approach that compares network breadth across provider specialties and market segments within the same state, we investigated the association between three Medicaid policies and the breadth of MMC networks for buprenorphine prescribers: Medicaid expansion, substance use disorder (SUD) network adequacy criteria, and SUD carveouts. We found that both Medicaid expansion and SUD network adequacy criteria were associated with substantially increased breadth in buprenorphine-prescriber networks in MMC. In both cases, we found that the associations were largely driven by increases in the network breadth of primary care physician prescribers. Our findings suggest that Medicaid expansion and SUD network adequacy criteria may be effective strategies at states’ disposal to improve access to buprenorphine.
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Caulkins, Jonathan P., Anne Gould, Bryce Pardo, Peter Reuter e Bradley D. Stein. "Opioids and the Criminal Justice System: New Challenges Posed by the Modern Opioid Epidemic". Annual Review of Criminology 4, n.º 1 (21 de setembro de 2020). http://dx.doi.org/10.1146/annurev-criminol-061020-125715.
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The traditional US heroin market has transformed into a broader illegal opioid market, dominated first by prescription opioids (PO) and now also by fentanyl and other synthetic opioids (FOSO). Understanding of opioid-use disorder (OUD) has also transformed from being seen as a driver of crime to a medical condition whose sufferers deserve treatment. This creates new challenges and opportunities for the criminal justice system (CJS). Addressing inmates’ OUD is a core responsibility, including preventing overdose after release. Treatment can be supported by diversion programs (e.g., drug courts, among others) and by providing medication-assisted treatment in prison, not only as a crime-control strategy but also because of ethical and legal responsibilities to provide appropriate healthcare. The CJS also has opportunities to alter supply that were not relevant in the past, including deterring pill-mill doctors and disrupting web sites used to distribute FOSO. Expected final online publication date for the Annual Review of Criminology, Volume 4 is January 13, 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Almudaifer, Abdullateef I., Whitney Covington, JaMor Hairston, Zachary Deitch, Ankit Anand, Caleb M. Carroll, Estera Crisan et al. "Multi-task transfer learning for the prediction of entity modifiers in clinical text: application to opioid use disorder case detection". Journal of Biomedical Semantics 15, n.º 1 (7 de junho de 2024). http://dx.doi.org/10.1186/s13326-024-00311-4.
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Abstract Background The semantics of entities extracted from a clinical text can be dramatically altered by modifiers, including entity negation, uncertainty, conditionality, severity, and subject. Existing models for determining modifiers of clinical entities involve regular expression or features weights that are trained independently for each modifier. Methods We develop and evaluate a multi-task transformer architecture design where modifiers are learned and predicted jointly using the publicly available SemEval 2015 Task 14 corpus and a new Opioid Use Disorder (OUD) data set that contains modifiers shared with SemEval as well as novel modifiers specific for OUD. We evaluate the effectiveness of our multi-task learning approach versus previously published systems and assess the feasibility of transfer learning for clinical entity modifiers when only a portion of clinical modifiers are shared. Results Our approach achieved state-of-the-art results on the ShARe corpus from SemEval 2015 Task 14, showing an increase of 1.1% on weighted accuracy, 1.7% on unweighted accuracy, and 10% on micro F1 scores. Conclusions We show that learned weights from our shared model can be effectively transferred to a new partially matched data set, validating the use of transfer learning for clinical text modifiers.