ABSTRACT
BACKGROUND: Buprenorphine is used for medication-assisted treatment of opioid dependence. PURPOSE: Monitoring of medication adherence involves testing of urine or oral fluid for the drug or its metabolite. METHODS: Quantitative results using liquid chromatography tandem mass spectrometer testing defined the excretion pattern of the drug and its metabolites. RESULTS: Frequency distribution curves of buprenorphine and norbuprenorphine describe the expected drug concentrations of patients on this medication. CONCLUSION: Urine and oral fluid drug testing can be used to monitor adherence in this population.
Subject(s)
Buprenorphine , Opioid-Related Disorders , Humans , Analgesics, Opioid/therapeutic use , Tandem Mass Spectrometry/methods , Buprenorphine/therapeutic use , Opioid-Related Disorders/drug therapy , Medication AdherenceABSTRACT
OBJECTIVE: To understand the geopolitics of the supply of fentanyl and heroin. RESULTS: In our practice, the percent of fentanyl positive drug tests increased from years 2016 to 2022, but heroin positive drug tests decreased by 80% in the same period. CONCLUSION: Fentanyl has replaced heroin as a street drug for opioid dependent drug users.
Subject(s)
Drug Overdose , Heroin Dependence , Humans , Heroin/therapeutic use , Fentanyl , Analgesics, OpioidABSTRACT
OBJECTIVE: To monitor fentanyl polydrug use over past six years. METHOD: Calculate percent of fentanyl and other drugs positive in urine drug tests. RESULTS: Percent of fentanyl positive drug tests remained unchanged, but increases in fentanyl/methamphetamine and fentanyl/marijuana were observed. CONCLUSIONS: Fentanyl laced illicit drugs remain a major substance abuse problem.
Subject(s)
Illicit Drugs , Methamphetamine , Substance-Related Disorders , Humans , Fentanyl/urine , Analgesics, Opioid/therapeutic use , Illicit Drugs/urine , Pain/drug therapy , Methamphetamine/urineABSTRACT
To dissect the antibiotic role of nanostructures from chemical moieties belligerent to both bacterial and mammalian cells, here we show the antimicrobial activity and cytotoxicity of nanoparticle-pinched polymer brushes (NPPBs) consisting of chemically inert silica nanospheres of systematically varied diameters covalently grafted with hydrophilic polymer brushes that are non-toxic and non-bactericidal. Assembly of the hydrophilic polymers into nanostructured NPPBs doesn't alter their amicability with mammalian cells, but it incurs a transformation of their antimicrobial potential against bacteria, including clinical multidrug-resistant strains, that depends critically on the nanoparticle sizes. The acquired antimicrobial potency intensifies with small nanoparticles but subsides quickly with large ones. We identify a threshold size (dsilica ~ 50 nm) only beneath which NPPBs remodel bacteria-mimicking membrane into 2D columnar phase, the epitome of membrane pore formation. This study illuminates nanoengineering as a viable approach to develop nanoantibiotics that kill bacteria upon contact yet remain nontoxic when engulfed by mammalian cells.
Subject(s)
Anti-Bacterial Agents/pharmacology , Drug Resistance, Bacterial/drug effects , Nanoparticles/chemistry , Anti-Bacterial Agents/chemical synthesis , Erythrocytes , Escherichia coli/drug effects , Escherichia coli/growth & development , Escherichia coli/ultrastructure , HEK293 Cells , Hemolysis/drug effects , Humans , Hydrophobic and Hydrophilic Interactions , Microbial Sensitivity Tests , Nanoparticles/ultrastructure , Organ Specificity , Particle Size , Staphylococcus aureus/drug effects , Staphylococcus aureus/growth & development , Staphylococcus aureus/ultrastructureABSTRACT
We examined the results of 1.3 million drug tests performed on patients being monitored for compliance with pain medications and substance abuse rehabilitation to determine if the 2016 CDC prescribing guidelines had any impact on opiate benzodiazepine use. We observed that the combination of the opiate drugs morphine, oxycodone, and hydrocodone with the benzodiazepine metabolites oxazepam, alphahydroxyalprazolam, and 7-aminoclonazepam showed many patients were on a combination of these drugs. This ranged from approximately 9 to 16%. There was considerable variability between opiate drug pairs, but there was a general trend to fewer patients on the combination of opiate-benzodiazepine over the 2016 to 2019 time frame.
Subject(s)
Drug Therapy, Combination/trends , Guideline Adherence/trends , Opioid-Related Disorders/metabolism , Benzodiazepines/adverse effects , Benzodiazepines/therapeutic use , Centers for Disease Control and Prevention, U.S. , Drug Interactions/physiology , Drug Therapy, Combination/adverse effects , Guideline Adherence/statistics & numerical data , Humans , Hydrocodone/adverse effects , Morphine/adverse effects , Opiate Alkaloids/adverse effects , Opiate Alkaloids/therapeutic use , Oxycodone/adverse effects , Pain/drug therapy , Pharmaceutical Preparations , United StatesABSTRACT
Fentanyl has been associated with many drug overdose deaths; its presence in many street drugs has been postulated to be increasing. We examined 1.3 million urine drug tests from April 2016 to April 2019 for fentanyl and other drugs. The highest relationship was observed with heroin. Approximately 30%-40% of the drug tests positive for the heroin metabolite 6-monacetylmorphine (6-MAM) were also positive for fentanyl. There was a large variance over time, but the percent positive in 2016 and 2019 were similar. In contrast, there was a definite increase in the presence of fentanyl with cocaine and methamphetamine. There was not a large increase over time associated with methadone, buprenorphine, and marijuana.
