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1.
R I Med J (2013) ; 104(3): 22-26, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33789404

RESUMO

Overdose deaths across the country have spiked since the onset of the COVID-19 pandemic. It is crucial now, more than ever, to address the continuing and worsening, complex and dynamic opioid and overdose epidemics. In 2018, The Center of Biomedical Research Excellence (COBRE) on Opioids and Overdose, based at Rhode Island Hospital, launched with three major goals: 1) establish a center of scientific excellence on opioids and overdose; 2) train the next generation of scientists to become independent investigators and address the opioid and overdose crises; and 3) contribute to the scientific progress and solutions to combat these epidemics. To date, we have made substantial progress. While the opioid and overdose crises continue to evolve, the COBRE on Opioid and Overdose and its team of investigators are well poised to address the daunting task of understanding and meaningfully addressing these deadly epidemics, with the ultimate goal of saving lives.


Assuntos
Analgésicos Opioides/efeitos adversos , Overdose de Drogas/epidemiologia , Educação em Saúde/organização & administração , Uso Indevido de Medicamentos sob Prescrição/estatística & dados numéricos , /epidemiologia , Overdose de Drogas/prevenção & controle , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Rhode Island/epidemiologia
2.
Arthroscopy ; 37(4): 1115-1116, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33812516

RESUMO

The creation of pain as the fifth vital sign in 2001 led to an unforeseen and dramatic increase in postoperative narcotic use. It became clear that chronic opioid use was associated with overdoses and deaths, and state medical licensing boards began to require completion of narcotic Continuing Medical Education courses to maintain licensure. Despite the overwhelming evidence of adverse effects of narcotic usage in both the pre- and postoperative periods, this continues to be a persistent problem in all areas of orthopaedic surgery. The magnitude of the problem is significant and now opioid-specific training is a mandated component of the American Board of Orthopaedic Surgery Maintenance of Certification for their Web-based Longitudinal Assessment of continuing medical education. Large database studies are helpful in identifying trends and factors that influence outcomes, potentially cut cost of care, and hopefully help us find a way out of this ongoing dilemma. This dilemma has taken a long time to create and will require a concerted disciplined effort to eliminate.


Assuntos
Transtornos Relacionados ao Uso de Opioides , Lesões do Manguito Rotador , Analgésicos Opioides/uso terapêutico , Artroscopia , Humanos , Manguito Rotador , Lesões do Manguito Rotador/tratamento farmacológico
3.
PLoS One ; 16(4): e0249453, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33793663

RESUMO

Patient access and adherence to chronic medications is critical. In this work, we evaluate whether disruptions related to Covid-19 have affected new and existing patients' access to pharmacological therapies without interruption. We do so by performing a retrospective analysis on a dataset of 9.4 billion US prescription drug claims from 252 million patients from May, 2019 through August, 2020 (about 93% of prescriptions dispensed within those months). Using fixed effect (conditional likelihood) linear models, we evaluate continuity of care, how many days of supply patients received, and the likelihood of discontinuing therapy for drugs from classes with significant population health impacts. Findings indicate that more prescriptions were filled in March 2020 than in any prior month, followed by a significant drop in monthly dispensing. Compared to the pre-Covid era, a patient's likelihood of discontinuing some medications increased after the spread of Covid: norgestrel-ethinyl estradiol (hormonal contraceptive) discontinuation increased 0.62% (95% CI: 0.59% to 0.65%, p<0.001); dexmethylphenidate HCL (ADHD stimulant treatment) discontinuation increased 2.84% (95% CI: 2.79% to 2.89%, p<0.001); escitalopram oxalate (SSRI antidepressant) discontinuation increased 0.57% (95% CI: 0.561% to 0.578%, p<0.001); and haloperidol (antipsychotic) discontinuation increased 1.49% (95% CI: 1.41% to 1.57%, p<0.001). In contrast, the likelihood of discontinuing tacrolimus (immunosuppressant) decreased 0.15% (95% CI: 0.12% to 0.19%, p<0.001). The likelihood of discontinuing buprenorphine/naloxone (opioid addiction therapy) decreased 0.59% (95% CI: 0.55% to 0.62% decrease, p<0.001). We also observe a notable decline in new patients accessing these latter two therapies. Most US patients were able to access chronic medications during the early months of Covid-19, but still were more likely to discontinue their therapies than in previous months. Further, fewer than normal new patients started taking medications that may be vital to their care. Providers would do well to inquire about adherence and provide prompt, nonjudgmental, re-initiation of medications. From a policy perspective, opioid management programs seem to demonstrate a robust ability to manage existing patients in spite of disruption.


Assuntos
/epidemiologia , Prescrições de Medicamentos/estatística & dados numéricos , Seguro de Serviços Farmacêuticos/estatística & dados numéricos , Adesão à Medicação/estatística & dados numéricos , Pandemias , Analgésicos Opioides/provisão & distribução , Antidepressivos/provisão & distribução , Antipsicóticos/provisão & distribução , Estimulantes do Sistema Nervoso Central/provisão & distribução , Contraceptivos Hormonais/provisão & distribução , Conjuntos de Dados como Assunto , Humanos , Imunossupressores/provisão & distribução , Estudos Retrospectivos , Estados Unidos/epidemiologia
4.
Psychopharmacology (Berl) ; 238(4): 1193-1211, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33655408

RESUMO

INTRODUCTION: The classical effects of exogenous opioids, such as morphine, are predominantly mediated through µ-opioid receptors. The chronic use of morphine induces anxiety-like behavior causing functional changes in the mesolimbic dopaminergic system. The mixed µ/κ-agonist, nalbuphine, used either as an analgesic or as an adjuvant with morphine, produces different and opposite effects. However, whether nalbuphine can be used to antagonize morphine-induced anxiety and dopaminergic alterations is not fully known. OBJECTIVE: This study aimed to compare acute and chronic effects of nalbuphine on morphine-induced anxiety and dopaminergic alterations in rats. METHODS: Male adult Wistar albino rats were made opioid-dependent by administering increasing doses of morphine (5-25 mg/kg; i.p.; b.i.d.). Withdrawal was induced by naloxone (1 mg/kg, i.p.), 4 h after the last morphine injection. Anxiety-like behavior was measured using Activity Monitor (Coulbourn Instruments, Inc. USA). Thereafter, the animals were sacrificed and the brain dissected out and the level of cAMP and the transcriptional and translational expression of TH was measured. Nalbuphine was co-administered with morphine, acutely and chronically, at various doses (0.1, 0.3, 1.0, 3.0 mg/kg, i.p.). RESULTS: Morphine-dependent rats showed a significant higher anxiety and cAMP levels and a significant decrease in the expression of TH. Co-administration of chronic doses of nalbuphine attenuates the higher anxiety, cAMP levels, and upregulates the TH expressions; however, the acute nalbuphine treatment does not attenuate the morphine-induced side effects. CONCLUSION: Therefore, nalbuphine might have an important role in attenuating the anxiety and the effects of the dopaminergic pathway and may have potential in the treatment of opioid addiction.


Assuntos
Analgésicos Opioides/farmacologia , Ansiedade/induzido quimicamente , Ansiedade/psicologia , Dopamina/metabolismo , Morfina/farmacologia , Nalbufina/farmacologia , Síndrome de Abstinência a Substâncias/psicologia , Animais , AMP Cíclico/metabolismo , Relação Dose-Resposta a Droga , Masculino , Atividade Motora/efeitos dos fármacos , Transtornos Relacionados com Narcóticos/psicologia , Ratos , Ratos Wistar , Tirosina 3-Mono-Oxigenase/metabolismo
7.
Toxicol Lett ; 343: 28-33, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-33652071

RESUMO

Carfentanil is an ultra-potent opioid with an analgesic potency 10,000 times that of morphine but has received little scientific investigation. In the present study, the human cytochrome P450 (CYP) isozymes catalyzing the oxidative metabolism of carfentanil were investigated. Using UHPLC-HRMS, Michaelis-Menten kinetics of formation for three major metabolites norcarfentanil (M1), pharmaceutical active metabolite 4-[(1-oxopropyl)phenylamino]-1-(2-hydroxyl-2-phenylethyl)-4-piperidinecarboxylic acid methyl ester (M11), and 4-[(1-oxopropyl)phenylamino]-1-(2-oxo-2-phenylethyl)-4-piperidinecarboxylic acid methyl ester (M15) were determined. Isozymes catalyzing the formation of the low abundant, highly active metabolite 1-[2-(2-hydroxylphenyl)ethyl]-4-[(1-oxopropyl)phenylamino]-4-piperidinecarboxylic acid methyl ester (M13) were also identified. Selective P450 inhibition studies with pooled human liver microsomes (HLMs) and recombinant CYP isozymes suggested that metabolites M1, M11, and M15 were predominantly formed by isozyme CYP3A5, followed by CYP3A4. Isozymes CYP2C8 and CYP2C9 also made contributions but to a much lesser extent. Highly potent metabolite M13 was predominantly formed by isozyme CYP2C9, followed by CYP2C8. These findings indicate that CYP3A5, CYP3A4, CYP2C8 and CYP2C9 play a major role in the transformation of carfentanil to M1 (norcarfentanil), M11, M13 and M15 through N-dealkylation of piperidine ring, hydroxylation of phenethyl group and ketone formation on phenethyl linker by human liver micrsomes.


Assuntos
Analgésicos Opioides/metabolismo , Citocromo P-450 CYP2C9/metabolismo , Citocromo P-450 CYP3A/metabolismo , Fentanila/análogos & derivados , Citocromo P-450 CYP2C9/genética , Citocromo P-450 CYP3A/genética , Fentanila/química , Fentanila/metabolismo , Regulação Enzimológica da Expressão Gênica/efeitos dos fármacos , Humanos , Estrutura Molecular , Oxirredução
9.
Subst Abuse Treat Prev Policy ; 16(1): 22, 2021 03 05.
Artigo em Inglês | MEDLINE | ID: mdl-33673847

RESUMO

BACKGROUND: In North America the opioid poisoning crisis currently faces the unprecedented challenges brought by the COVID-19 pandemic, further straining people and communities already facing structural and individual vulnerabilities. People with opioid use disorder (OUD) are facing unique challenges in response to COVID-19, such as not being able to adopt best practices (e.g., physical distancing) if they're financially insecure or living in shelters (or homeless). They also have other medical conditions that make them more likely to be immunocompromised and at risk of developing COVID-19. In response to the COVID-19 public health emergency, national and provincial regulatory bodies introduced guidance and exemptions to mitigate the spread of the virus. Among them, clinical guidance for prescribers were issued to allow take home opioid medications for opioid agonist treatment (OAT). Take Home for injectable opioid agonist treatment (iOAT) is only considered within a restrictive regulatory structure, specific to the pandemic. Nevertheless, this risk mitigation guidance allowed carries, mostly daily dispensed, to a population that would not have access to it prior to the pandemic. In this case it is presented and discussed that if a carry was possible during the pandemic, then the carry could continue post COVID-19 to address a gap in our approach to individualize care for people with OUD receiving iOAT. CASE PRESENTATION: Here we present the first case of a patient in Canada with long-term OUD that received take home injectable diacetylmorphine to self-isolate in an approved site after being diagnosed with COVID-19 during a visit to the emergency room where he was diagnosed with cellulitis and admitted to receive antibiotics. CONCLUSION: In the present case we demonstrated that it is feasible to provide iOAT outside the community clinic with no apparent negative consequences. Improving upon and making permanent these recently introduced risk mitigating guidance during COVID-19, have the potential not just to protect during the pandemic, but also to address long-overdue barriers to access evidence-based care in addiction treatment.


Assuntos
Analgésicos Opioides/uso terapêutico , Heroína/uso terapêutico , Tratamento de Substituição de Opiáceos/métodos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Administração Intravenosa , Administração Oral , Analgésicos Opioides/administração & dosagem , Heroína/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias
10.
Am Fam Physician ; 103(6): 326-328, 2021 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-33719381
11.
Oral Health Prev Dent ; 19(1): 179-188, 2021 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-33723977

RESUMO

PURPOSE: Analgesics (painkillers) are one of the most widely used medications to reduce and control pain. The objective of this study was to investigate the self-medication with analgesics (narcotic or non-narcotic) in controlling odontogenic pain in patients visiting dental offices, dental clinics, and the dental school of Kerman. MATERIALS AND METHODS: This was a descriptive-analytic study, conducted in 2018. The study sample included patients referring to dental offices, dental clinics and the dental school of Kerman. After obtaining informed consent, a questionnaire consisting of demographic data and questions regarding the consumption of different types of analgesics for relieving and controlling odontogenic pain and their impact on patients was given by the researcher to the respondents. The patients were asked to complete and return the forms. The questionnaire consisted of three categories of questions, including demographic data, pain characteristics (severity, aggravating factors, relieving factors, etc) and the drug used to relieve the pain. Pain severity was measured using a visual analogue scale (VAS). Mann-Whitney and chi-squared tests were used for statistical analysis in SPSS. RESULTS: This study included 230 males and 351 females (male:female ratio = 0.66) in the age range of 18 to 71 years old (38.21 ± 7.45). 2.6% of respondents were illiterate and 11.3% of respondents were unemployed. The mean value of pain intensity was 6.21 ± 1.11 on a scale of 1 to 10. The types of drugs used for pain relief included 71.8% analgesics, 12.1% complementary medicines and 16.1% antibiotics. The most commonly used medication was NSAIDS, followed by acetaminophen codeine. In this study, the fourth most common medication consumed by patients as an analgesic was amoxicillin. Moreover, it showed that 44.3% (257 individuals) of study participants had used analgesics as self-medication to relieve odontogenic pain, of which 46.08% were males (N = 107) and 42.68% were females (N = 150). The gender of respondents, level of education, and occupation were significantly associated with the consumption of opioid drugs (p = 0.023, p = 0.041, p = 0.011, respectively). Consumption of opioid medications was not statistically significantly correlated with pain intensity (p = 0.115). CONCLUSION: The factors affecting the appropriate use of medications are social, economic, cultural, and flaws in the health-care system of a society. This study showed that the medications used to reduce pain included analgesics, traditional drugs, and antibiotics. The rate of self-medication was higher among men and among those having a higher level of education.


Assuntos
Analgésicos , Dor , Adolescente , Adulto , Idoso , Analgésicos/uso terapêutico , Analgésicos Opioides/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Feminino , Humanos , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Dor/tratamento farmacológico , Automedicação , Adulto Jovem
12.
Artigo em Alemão | MEDLINE | ID: mdl-33725741

RESUMO

Neuroaxial procedures are among the most effective ways of relieving pain during childbirth. Especially in the late phase of vaginal delivery, surprising moments, instrumental methods or special maneuvers require quick and sufficient analgesia. This refers to situations with a sudden, often unexpected and particularly pronounced intensity of pain. Here the advantages of spinal analgesia over the gold standard of obstetric analgesia, catheter epidural analgesia, can be used. Spinal analgesia is characterized by a fast onset of pain relief, a profound blockage and simple technical feasibility and, like other neuroaxial procedures, is comparatively uncomplicated in pregnant women. However, it is only effective if the delivery situation is well assessed. There is no possibility of repetition without re-puncture, so that limited duration of action is a significant disadvantage. Applied drugs correspond to those described for combined spinal and epidural analgesia, such as a mixture of low-dose bupivacaine and sufentanil, and can be adapted to local conditions. In the future, longer acting substances could overcome the main limitation (temporary effect) of spinal analgesia and suitable adjuvants could further increase the attractiveness of the procedure.


Assuntos
Analgesia Epidural , Analgesia Obstétrica , Analgésicos Opioides , Anestésicos Locais , Bupivacaína , Parto Obstétrico , Feminino , Humanos , Dor , Gravidez
13.
JAMA ; 325(9): 865-877, 2021 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-33651094

RESUMO

Importance: The prevalence of irritable bowel syndrome (IBS) in the United States is between 7% and 16%, most common in women and young people, with annual direct costs estimated at more than $1 billion dollars in the United States. Traditionally, the diagnosis of IBS has been based on the positive identification of symptoms that correlate with several different syndromes associated with disorders such as IBS diarrhea, IBS constipation, functional diarrhea, functional constipation, chronic functional abdominal pain, or bloating. Several peripheral and central mechanisms initiate gastrointestinal motor and sensory dysfunctions leading to IBS symptoms. Those dysfunctions may require evaluation in patients whose symptoms do not respond to first-line treatments. Observations: Validation studies of consensus symptom-based criteria have identified deficiencies that favor a simpler identification of the predominant symptoms of abdominal pain, bowel dysfunction, and bloating and exclusion of alarm symptoms such as unintentional weight loss, rectal bleeding, or recent change in bowel function. Symptom-based diagnosis of IBS is enhanced with additional history for symptoms of somatoform and psychological disorders and alarm symptoms, physical examination including digital rectal examination, and screening tests to exclude organic disease (by measuring hemoglobin and C-reactive protein concentrations). The initial treatment plan should include patient education, reassurance, and first-line treatments such as fiber and osmotic laxatives for constipation, opioids for diarrhea, antispasmodics for pain and for management of associated psychological disorders. For patients who do not respond to those IBS treatments, testing for specific functional disorders may be required in a minority of patients with IBS. These disorders include rectal evacuation disorder, abnormal colonic transit, and bile acid diarrhea. Their identification is followed by individualized treatment, such as pelvic floor retraining for rectal evacuation disorders, sequestrants for bile acid diarrhea, and secretory agents for constipation, although there is only limited evidence that this individualized management approach is effective. Conclusions and Relevance: Advances in the identification of specific dysfunctions as causes of individual symptoms in the "IBS spectrum" leads to the potential to enhance the diagnosis and management of symptoms for the majority of patients for whom first-line therapies of IBS and management of comorbid psychological disorders are insufficient.


Assuntos
Síndrome do Intestino Irritável/diagnóstico , Síndrome do Intestino Irritável/terapia , Dor Abdominal/tratamento farmacológico , Analgésicos Opioides/uso terapêutico , Antidiarreicos/uso terapêutico , Diagnóstico Diferencial , Dietoterapia , Fibras na Dieta/uso terapêutico , Suplementos Nutricionais , Humanos , Laxantes/uso terapêutico , Psicoterapia
14.
Orthop Clin North Am ; 52(2): 103-110, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33752831

RESUMO

Orthopedic surgeries are associated with the prescription of more narcotics than any other surgical specialty, particularly for total knee replacement (TKR) surgery. The authors examined controlled substance prescriptions following TKR surgery in a sample of 560 TKR patients. Results indicated that of all the 5164 prescriptions documented on the controlled substance monitoring database, 64% were for opioid medications. More than half of the patients received controlled substances from both the surgery site provider and a nonsurgery site provider in the year following surgery. The authors recommend that providers consider the possibility of outside prescribing when prescribing opioid analgesic.


Assuntos
Analgésicos Opioides/administração & dosagem , Artroplastia do Joelho , Dor Pós-Operatória/tratamento farmacológico , Padrões de Prática Médica/estatística & dados numéricos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos
15.
Orthop Clin North Am ; 52(2): 149-155, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33752836

RESUMO

The field of hand surgery continues to evolve in new and exciting directions. Advances in diagnosis and management for common complaints and complex injuries allow higher-level care, while still being cognizant of the cost of health care delivery. Indications and protocols for past paradigm shifts, such as volar locked plating for distal radial fractures, continue to be honed, and the outcomes seen for modern flexor tendon repairs are impressive. Open questions remain, but promising results for scaphoid nonunion surgery and peripheral nerve reconstruction with processed allograft will continue to shed light on these unsolved problems.


Assuntos
Traumatismos da Mão/cirurgia , Procedimentos Ortopédicos/métodos , Traumatismos do Punho/cirurgia , Analgésicos Opioides/administração & dosagem , Avaliação da Deficiência , Humanos , Dor Pós-Operatória/tratamento farmacológico
19.
Biomed Khim ; 67(1): 5-16, 2021 Jan.
Artigo em Russo | MEDLINE | ID: mdl-33645518

RESUMO

This review discusses our current knowledge on the nociceptin/orphanin (N/OFQ) system regarding its role in regulation of brain functions. Nociceptin receptor (NOPr) was identified in 1994 [Bunzow et al., 1994; Mollereau et al., 1994]. In 1995 a 17 amino acid endogenous peptide was found to be the high-affinity ligand for the NOPr [Reinscheid et al., 1995]. N/OFQ has a broad spectrum of activity and can act as on opioid-like as well as an anti-opioid peptide. Considering high level of N/OFQ and NOPr mRNA expression in the limbic brain regions, the N/OFQ/NOP system is suggested to be involved in regulation of emotions, resward, pain sensitivity, stress responsibility, sexual behavior, aggression, drug abuse and addiction. However it is still not well understood whether an increased vulnerability to drugs of abuse may be associated with dysregulation of N/OFQ/NOP system. Current review further highlights a need for further research on N/OFQ/NOP system as it could have clinical utility for substance abuse, depression, and anxiety pharmacotherapy.


Assuntos
Analgésicos Opioides , Peptídeos Opioides , Ansiedade , Encéfalo/metabolismo , Peptídeos Opioides/metabolismo
20.
J Opioid Manag ; 17(1): 5-7, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33735422

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic has had harmful effects on the opioid epidemic. While a negative effect was predicted, we report on this reality in the hospital setting. We have seen a sharp rise in hospitalized patients with opioid use disorder (OUD). Our data should encourage ongoing efforts to reduce barriers in accessing medications for treatment, harm reduction interventions and additional education for trainees, primary care providers, and hospitalists alike. In the current climate, these interventions are critical to save the lives of patients with OUD.


Assuntos
Transtornos Relacionados ao Uso de Opioides , Analgésicos Opioides/efeitos adversos , Hospitalização , Humanos , Tratamento de Substituição de Opiáceos , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/epidemiologia
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