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1.
J Addict Nurs ; 32(3): 205-210, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34473450

RESUMO

BACKGROUND: Opioid use disorder (OUD) continues to be a growing and major public health issue in the United States. In an effort to increase OUD treatment access, medication-assisted treatment with buprenorphine via telehealth is emerging as the leading treatment option. OBJECTIVE: This study sought to describe the experiences of adults with OUD receiving medication-assisted treatment buprenorphine in a nurse-practitioner-facilitated telehealth program. METHODS: Using a descriptive qualitative design, convenience sampling was used to recruit participants who were currently receiving OUD treatment in one telehealth program with locations in California and Michigan. Participants were invited to participate in the study via an email flyer sent to all clients of the telehealth program. Participants completed demographic data and took part in individual, semistructured interviews that were conducted online. RESULTS: The study sample included 15 largely White, married, college-educated men (n = 8, 53%) and women (n = 7, 47%). Qualitative content analysis of interview data revealed three overall themes and associated subthemes: (a) improved access to care, (b) isolation, and (c) feeling normal on buprenorphine. CONCLUSION: Our findings support a nurse-practitioner-facilitated telehealth treatment program for OUD. However, in a program that offers patient-centered care that does not have a one-size-fits-all approach to service, goals of care must be reevaluated throughout treatment. Moreover, given the increased risk of patients feeling isolated with telehealth appointments and the lack of physical face-to-face interactions, healthcare providers should explore ways to engage patients in meaningful support resources and reduce stigma.


Assuntos
Buprenorfina , Transtornos Relacionados ao Uso de Opioides , Telemedicina , Adulto , Buprenorfina/uso terapêutico , Feminino , Pessoal de Saúde , Humanos , Masculino , Tratamento de Substituição de Opiáceos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Estados Unidos
3.
J Opioid Manag ; 17(7): 15-20, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34520022

RESUMO

Opioids, the frontline drugs for postsurgical analgesia, have been linked to diversion and abuse with lethal consequences. The search for safe analgesics with less harm potential has been decades long. However, clinical trials for safe opioid and nonopioid analgesics have relied on subjective pain reports, which are biased by placebo effects that increase the complexity of trials to develop new therapies to manage pain. Research in opioid naïve animals and humans demonstrates that blood concentrations of opioids that effectively saturate the morphine opioid receptor are tightly linked with patient reports and quantitative sensory tests for analgesia. Opioid drug concentrations can predict clinical responses. This report reviews preclinical and clinical evidence correlating buprenorphine pharmacokinetics with analgesia. More than 30 years of data confirm buprenorphine blood concentrations can be an objective biomarker of analgesia for moderate to severe acute postoperative pain.


Assuntos
Analgesia , Buprenorfina , Analgésicos Opioides/efeitos adversos , Biomarcadores , Buprenorfina/efeitos adversos , Humanos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/tratamento farmacológico
4.
J Opioid Manag ; 17(7): 21-31, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34520023

RESUMO

Buprenorphine's unique pharmacologic mechanisms of action lend itself to a higher level of complexity than its typical characterization as a partial agonist at µ-opioid receptors. It is well-documented that its additional activity at Δ- and κ-opioid receptors, and opioid receptor ligand 1 may be associated with varying degrees of analgesia and usual opioid-related adverse effects. However, novel downstream molecular and cellular mechanisms from µ-opioid receptor activation contain potential new insights into its overall unique effects. These include buprenorphine's peculiar ability to induce analgesia at escalating doses, while exhibiting a plateaued effect on respiratory depression, euphoria, gastrointestinal (GI) motility, depression, anxiety, and addictive potential. Thus, this review aims to discuss several of these emerging mechanisms to gain a better understanding of these curious actions, as well as support much of this in vitro evidence with various human clinical trial data to further support buprenorphine's place on the analgesic ladder.


Assuntos
Analgesia , Buprenorfina , Analgésicos Opioides/efeitos adversos , Buprenorfina/efeitos adversos , Humanos , Dor/tratamento farmacológico , Receptores Opioides
5.
J Opioid Manag ; 17(7): 43-50, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34520025

RESUMO

Opioid abuse represents a public health crisis that has significant associated morbidity and mortality. Since beginning in the early 1990's, the opioid abuse epidemic has been difficult to control due to regulatory, economic, and psychosocial factors that have perpetuated its existence. This era of opioid abuse has been punctuated by three distinct rises in mortality, precipitated by unique public health problems that needed to be addressed. Patients affected by opioid abuse have been historically treated with either methadone or naltrexone. While these agents have clinical utility supported by robust literature, we the authors posit that buprenorphine is a superior therapy for both opioid use disorder (OUD) as well as pain. This primacy is due to the pharmacological properties of buprenorphine which render it unique among other opioid medications. One such property is buprenorphine's ceiling effect of respiratory depression, a common side effect and complicating factor in the administration of many classical opioid medications. This profile renders buprenorphine safer, while simultaneously retaining therapeutic utility in the medical practitioner's pharmacopeia for the treatment of opioid use disorder and pain.


Assuntos
Buprenorfina , Transtornos Relacionados ao Uso de Opioides , Analgésicos Opioides/efeitos adversos , Buprenorfina/efeitos adversos , Humanos , Metadona/uso terapêutico , Naltrexona/uso terapêutico , 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 , Dor/diagnóstico , Dor/tratamento farmacológico
6.
J Opioid Manag ; 17(7): 33-41, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34520024

RESUMO

OBJECTIVE: This study compared opioid utilization and clinical outcomes in surgical patients receiving maintenance buprenorphine therapy who discontinued versus those who continued buprenorphine treatment perioperatively. Lack of high-quality evidence, conflicting results in previous studies, and the possible need for reinduction after discontinuing therapy present clinicians with the complicated dilemma of choosing the best strategy to control post-operative pain in patients receiving buprenorphine. DESIGN: A multicenter, retrospective cohort study. PARTICIPANTS: Hospitalized patients between January 1, 2017 and December 12, 2019 who underwent any type of surgery, had a documentation of an outpatient buprenorphine prescription or inpatient order, and received buprenorphine for 5 or more days prior to the procedure were included. MAIN OUTCOME MEASURE(S): The primary objective was to compare mean 24-hour morphine milligram equivalent (MME) utilization post-operatively between patients who discontinued buprenorphine preoperatively versus those who continued therapy throughout the perioperative period. RESULTS: Fifty-one patients met the inclusion criteria for this study. Of these, 42 patients were continued on buprenorphine through surgery, while nine patients had a documentation of discontinuation preoperatively. The 24-hour post-operative MME utilization (interquartile range) was 58.8 (18-100.8) in patients who continued therapy through surgery versus 152.6 (114.5-236) in patients who discontinued therapy preoperatively (p = 0.005). There were no significant differences in post-operative pain scores or length of stay between groups. CONCLUSION: Post-operative opioid use was significantly lower in patients who continued buprenorphine compared with those who discontinued buprenorphine preoperatively.


Assuntos
Buprenorfina , Transtornos Relacionados ao Uso de Opioides , Analgésicos Opioides/efeitos adversos , Buprenorfina/efeitos adversos , Humanos , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Manejo da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/tratamento farmacológico , Estudos Retrospectivos
7.
J Opioid Manag ; 17(7): 59-67, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34520027

RESUMO

OBJECTIVE: To examine syringe services program (SSP) participants' interest in long-acting injectable buprenorphine. DESIGN: SSP participants completed a 136-item questionnaire by phone. Items assessed quantitative ratings of interest in sublingual and injectable buprenorphine, preference for sublingual versus injectable buprenorphine, and reasons for preferences. SETTING: Two large urban SSPs. PARTICIPANTS: SSP participants ≥18 years of age with current or lifetime opioid use disorder (OUD). MAIN OUTCOME MEASURE(S): (1) Interest in sublingual and injectable buprenorphine, respectively, on a scale from 0 to 10 (0 = no interest and 10 = high interest); and (2) preference for sublingual buprenorphine versus injectable buprenorphine. Participants were also asked whether they agreed with statements that presented potential reasons for preferring each formulation. RESULTS: A total of 104 unique participants were interviewed, of which 72 (69 percent) were currently receiving or considering buprenorphine treatment. Among these 72 participants, the median level of interest in starting or continuing sublingual buprenorphine was 8 out of 10 (interquartile range [IQR]: 6-10) and in starting injectable buprenorphine was 5 out of 10 (IQR: 1-9). Thirty-six (50 percent) preferred sublingual, 27 (38 percent) preferred injectable, and 9 (13 percent) preferred neither or declined to answer. Participants who preferred injectable buprenorphine most commonly agreed that the convenience of the monthly injection was the reason for their preference. CONCLUSIONS: Among SSP participants with OUD, we found moderate interest in injectable buprenorphine. Introducing this new form of buprenorphine treatment at SSPs could help meet the needs of individuals who are not well-served by standard OUD treatment models.


Assuntos
Buprenorfina , Transtornos Relacionados ao Uso de Opioides , Analgésicos Opioides/uso terapêutico , Buprenorfina/uso terapêutico , Humanos , Tratamento de Substituição de Opiáceos , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Inquéritos e Questionários , Seringas
8.
J Opioid Manag ; 17(7): 69-76, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34520028

RESUMO

INTRODUCTION: Urine drug screens (UDS) assist in clinical planning and assessment of adherence in opioid agonist treatment (OAT). Urine drug screens may also be used in criminal justice and child protection settings. Buprenorphine (BPN) UDS testing is complex. Immunoassay often does not detect BPN and gas chromatography-mass spectrometry (GC-MS) is needed. A limited understanding of testing can negatively influence UDS interpretation and clinical decision making. OBJECTIVES: The primary aim was to determine detection rates of BPN in UDS in participants on BPN or buprenorphine/naloxone (BNX) treatment. The secondary aim was to identify if comorbidities, sex, co-prescribed medications, or dosing site and observation were associated with BPN detection. SETTING: Public outpatient clinic in a specialist addiction treatment service. DESIGN/PARTICIPANTS: In this retrospective observational study, records of clients on supervised BPN/BNX treatment between September 2017 and 2018 were reviewed. MEASURES: Data extracted included UDS results, age, sex, indication for BPN, frequency of observed doses, dose of BPN, dosing site, comorbid medical conditions, and medications. RESULTS: One hundred and sixty-one medical records were reviewed. Ninety-seven (60 percent) underwent screening urine immunoassay. Of these 97, 51 (53 percent) had further GC-MS testing for BPN of which 22 (43 percent) did not detect BPN despite directly observed OAT. Co-prescription of medications known to interact with cytochrome P450 3A4 was associated with nondetection of BPN (p < 0.05). No significant association between median dose, dosing site, and observed dosing and BPN detection was identified. CONCLUSION: Urine drug testing for BPN is complex. Failure to detect BPN does not betoken nonadherence to treatment and is associated with co-prescription of drugs interacting with cytochrome P450 3A4.


Assuntos
Buprenorfina , Transtornos Relacionados ao Uso de Opioides , Analgésicos Opioides/efeitos adversos , Buprenorfina/uso terapêutico , Combinação Buprenorfina e Naloxona/uso terapêutico , Criança , Avaliação Pré-Clínica de Medicamentos , Humanos , Naloxona/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/epidemiologia
9.
J Opioid Manag ; 17(7): 77-86, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34520029

RESUMO

INTRODUCTION: Pharmacy-level challenges that exist for patients when seeking to fill buprenorphine prescriptions at traditional retail pharmacies can result in a less than optimal treatment experience. High patient satisfaction with treatment for opioid use disorder (OUD), which for oral buprenorphine treatment includes the necessary step of obtaining medication after being prescribed, is associated with positive health outcomes and, therefore, is of great clinical interest. The objective of this study was to examine patient satisfaction when participating in a pharmacy program that coordinated buprenorphine delivery and provision to patients at office visits instead of requiring patients to fill their prescriptions at local pharmacies. METHODS: We conducted a voluntary and anonymous survey to assess patient satisfaction when the need to seek a retail pharmacy to fill buprenorphine prescriptions was alleviated. The survey was completed by 714 patients prescribed buprenorphine for OUD treated at 15 office-based opioid treatment clinics that integrated the clinic-based pharmacy program as an extension of their treatment services. The survey consisted of 16 questions evaluating satisfaction with the pharmacy program and prior retail pharmacy experience. RESULTS: Majority of patient respondents reported high levels of satisfaction with the pharmacy program. Specifically, 97.6 percent (n = 697) of respondents noted feeling respected and/or that the pharmacy staff cares about their wellbeing, 91.7 percent (n = 655) of respondents reported that they are more likely to make their treatment appointments and/or stick to their treatment plan when the physical need to seek a pharmacy to fill their prescription was alleviated. The survey resulted in an 83.8 Net Promoter Score, further supporting a high patient satisfaction. Patient responses regarding how the program impacted their recovery illustrated common themes of more convenient, more private, judgment free, quicker, and stress free. The survey responses also validated previously reported pharmacy-level barriers for patients with OUD that the program sought to alleviate. Transportation challenges and/or undue time spent obtaining medication were indicated by 77.6 percent (n = 529) of respondents, feelings of stigma and shame at retail pharmacies was experienced by 56.8 percent (n = 386) of respondents, and pharmacies not reliably stocking their medication was noted by 37.1 percent (n = 252) of respondents. CONCLUSIONS: The survey findings demonstrate that patients were highly satisfied with the provision of pharmacy-dispensed buprenorphine at their treatment visit in place of having to seek to fill prescriptions at retail pharmacies. Responses indicated the pharmacy program may also be a motivating factor for patients to attend treatment appointments. Continuing to develop and research strategies that alleviate physical barriers to buprenorphine access and result in high patient satisfaction, like this clinic-based pharmacy program studied, have meaningful implications for both patients and treatment providers.


Assuntos
Buprenorfina , Farmácias , Farmácia , Analgésicos Opioides/uso terapêutico , Buprenorfina/uso terapêutico , Humanos , Satisfação do Paciente
10.
J Opioid Manag ; 17(7): 87-100, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34520030

RESUMO

OBJECTIVE: To demonstrate the prevalence of opioid use disorder (OUD) in the military health system (MHS), geographically map OUD patients and providers, and offer policy recommendations to help increase buprenorphine waiver prescribing. DESIGN: This study was a retrospective review of data from the MHS records. Deidentified records of MHS OUD patients receiving buprenorphine were utilized. Secondary data with nonpersonally identifiable information (PII) were used for pulling records of buprenorphine prescribing providers within the direct care system (MHS providers) and providers from the purchased care system (civilian facilities accepting TRICARE beneficiaries). SETTING: This study reviewed records of individuals within the MHS, in the United States, and its territories. PATIENTS AND PARTICIPANTS: Patients within the MHS system with a diagnosis of OUD. Providers, within the MHS or purchased care, who had prescribed buprenorphine were selected. MAIN OUTCOME MEASURED: The number of OUD patients in the MHS and providers caring for these OUD patients. In addition, geographical maps illustrating the dispersion of OUD patients, and prescribers were created. RESULTS: The vast majority of MHS OUD patients receive their care from purchased care. Between 2015 and 2018, there has been a shift in the number OUD diagnosed patients by region, and the number of OUD prescribers. CONCLUSION: The MHS population, particularly active duty, is a transient population. As such, it is not a surprise that the population of OUD patients or prescribers varied by region during that time period. Furthermore, results demonstrate that there is a need to increase the number of buprenorphine-waivered prescribers within the MHS. Changes in policy may encourage more providers to obtain the waiver or increase patient load.


Assuntos
Buprenorfina , Serviços de Saúde Militar , Transtornos Relacionados ao Uso de Opioides , Analgésicos Opioides/efeitos adversos , Buprenorfina/uso terapêutico , 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 , Estudos Retrospectivos , Estados Unidos/epidemiologia
11.
J Opioid Manag ; 17(7): 101-107, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34520031

RESUMO

There is limited evidence and no clear consensus suggesting best practices for perioperative buprenorphine management in patients with opioid use disorder. As such, we aimed to develop a standardized perioperative management approach with the goals of (1) optimizing perioperative analgesia, (2) minimizing relapse risk, (3) setting expectations for patients and clinicians, (4) achieving prescribing consistency and mitigating risk among clinicians not familiar with perioperative buprenorphine management, and (5) maintaining continuity throughout care transitions. An interprofessional expert focus group convened to develop a consensus algorithm based upon buprenorphine's unique pharmacologic features and published perioperative management recommendations. The resulting consensus algorithm continues the patient's home buprenorphine dose in order to minimize relapse risk, but utilizes a divided dose approach starting the day of surgery if moderate to severe post-operative pain is expected. This strategy leverages the analgesic effects of buprenorphine while allowing for additional opioid binding to optimize analgesia. A patient-centered multimodal perioperative approach including local and/or regional anesthetics and nonopioid adjuncts is employed. Post-operative care is optimized by preoperative planning, including standardized patient assessment, perioperative communication with the buprenorphine prescriber, and education for patients and clinicians. Overall, integrating an understanding of pharmacology and clinical impact through the use of a readily adaptable algorithm such as the divided dose approach is key to optimizing patient care in this high-risk population.


Assuntos
Buprenorfina , Transtornos Relacionados ao Uso de Opioides , Analgésicos Opioides/efeitos adversos , Buprenorfina/efeitos adversos , Humanos , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Manejo da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle
12.
J Opioid Manag ; 17(7): 109-118, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34520032

RESUMO

Opioids are an important tool in the treatment of pain, but opioid overdose has become a serious health issue. Most opioid-related deaths are caused by respiratory depression, and the risk of respiratory depression is compounded because of the risks of abuse and diversion, which makes the need for safer opioids even more urgent. However, the atypical opioids (buprenorphine, tramadol, and tapentadol), with mechanisms of action not purely driven by µ-opioid receptor agonism, may be safer than conventional opioids, eg, morphine, oxycodone, and fentanyl. The purpose of this narrative review is to describe the clinical and experimental evidence regarding opioid-induced respiratory depression in the context of the mechanisms of action of the atypical opioids. Among the atypical opioids, tramadol has an advantage of being a Schedule IV drug, and thus having a relatively low abuse potential-but its effects, including its effect on respiratory drive, are dependent on cytochrome P450 2D6 metabolizer status. Tapentadol appears to affect respiratory drive, but this has not been well investigated. Buprenorphine is a Schedule III drug, thus having less abuse potential than the majority of opioids. Experimentally, a ceiling effect on the respiratory depression has been reported with intravenous buprenorphine. In addition, experimental hypercapnic stress in healthy volunteers demonstrated no respiratory depression following the administration of a single dose of the buccal film formulation of buprenorphine when compared with placebo. Overall, the data suggest that atypical opioids may be a safer option than conventional opioids for the treatment of pain.


Assuntos
Analgésicos Opioides , Buprenorfina , Analgésicos Opioides/efeitos adversos , Fentanila , Humanos , Morfina , Oxicodona
13.
J Opioid Manag ; 17(7): 119-131, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34520033

RESUMO

BACKGROUND: Availability and access to opioid agonist treatment (OAT) are limited despite its evidence of effectiveness in treating opioid use disorders (OUDs). COVID-19 pandemic has inadvertently exacerbated the problems of restricted access to OAT and, at the same time, has increased odds of harm due to opioid use. OBJECTIVES: We examined (a) adaptations conceived or implemented in the buprenorphine (BPN)-based OAT service delivery at the national, regional, or local level during the COVID-19 pandemic and (b) the impact of such transformations on the quantitative and qualitative aspects of service delivery. We focused exclusively on BPN-based OAT. METHODS: We carried out a systematic electronic database search in PubMed and Google Scholar. We included all types of articles. Additionally, we looked up relevant websites of international and national government agencies working in the field of drug abuse. RESULTS: We included 21 articles from 10 countries in the review and summarized the results in a narrative format. The majority of literature was from developed countries. We observed changes in the BPN initiation, dosing, and dispensing protocols, and particular emphasis on telemedicine. There was limited literature on service provisions for the vulnerable population. The changing modes of service delivery have possibly increased the number of new patients and reduced the risk of exposure owing to limited in-person contact. CONCLUSION: Newer adaptations to meet with the challenges of COVID-19 pandemic in the BPN-based OAT delivery tend to be innovative, flexible, and patient centered. Although it is too early to comment on these newer adaptations' impact, the outcome's directions appear to be positive.


Assuntos
Buprenorfina , COVID-19 , Transtornos Relacionados ao Uso de Opioides , Analgésicos Opioides/efeitos adversos , Buprenorfina/efeitos adversos , Humanos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Pandemias , SARS-CoV-2
14.
J Opioid Manag ; 17(7): 133-139, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34520034

RESUMO

PROBLEM: Drug addiction and misuse is a medical and societal problem that has exacted a heavy toll on the United States, and, indeed, the world. In the United States, opioids are currently the main driver of drug overdose deaths. Despite the proven safety and efficacy of medically assisted therapy (MAT) using buprenorphine for the treatment of opioid use disorder (OUD), as well as the fact that its use is regulated by US Federal Law, many states have enacted separate and often burdensome regulations that restrict the prescribing of buprenorphine beyond those required by the US Drug Enforcement Agency (DEA) under the provisions of the DATA 2000 Act, and unnecessarily reduce the availability of effective treatment of OUD in those states. PURPOSE: The purpose of this article is to review the pharmacology of both buprenorphine (and naloxone as an additive) and the risks associated with the misuse of buprenorphine products and to consider if such additional state oversight and restrictions improves or is deleterious to public safety in the face of this national epidemic. CONCLUSION: We conclude that the placing of unnecessary and unscientific restraints on the treatment of patients with OUD is inconsistent with the principles of harm reduction, and such restraints should be removed unless/until they can be supported by real evidence.


Assuntos
Buprenorfina , Transtornos Relacionados ao Uso de Opioides , Analgésicos Opioides/efeitos adversos , Buprenorfina/efeitos adversos , Humanos , Naloxona/efeitos adversos , Tratamento de Substituição de Opiáceos , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Estados Unidos
15.
J Opioid Manag ; 17(7): 141-152, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34520035

RESUMO

Opioid use disorder is a major public health problem, and opioid replacement therapy with buprenorphine (BPN) is a clinically effective and evidence-based treatment for it. To deter misuse of the tablet through the injecting route, BPN coformulated with naloxone (BNX) in 4:1 ratio is available in many countries. Despite this, significant diversion and injecting use of the BNX combination has been reported from across the world. In this article, the pharmacological properties of BPN and BNX and the evidence for their diversion are reviewed. Also, a critical examination is made of the evidence supporting the role of naloxone in reducing the agonist effects of BPN when used through the injecting route. Based on this evidence, a hypothesis explaining the continued diversion of BNX has been proposed.


Assuntos
Buprenorfina , Transtornos Relacionados ao Uso de Opioides , Analgésicos Opioides/efeitos adversos , Buprenorfina/efeitos adversos , Combinação Buprenorfina e Naloxona/uso terapêutico , Humanos , Naloxona/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Comprimidos/uso terapêutico
16.
J Opioid Manag ; 17(7): 153-158, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34520036

RESUMO

We report a case in which sublingual buprenorphine was used to help transition a patient off intravenous (IV) opioid analgesics medications post-multiple abdominal procedures. Intravenous opioids are commonly used in inpatient surgical pain management for patients with severe pain who are unable to take oral medications. Typically, a short course of IV analgesics is used, followed by transition to oral analgesic regimen. However, in patients with poor gastrointestinal absorption, pain control can be challenging. We present this case to highlight how sublingual buprenorphine can be a useful agent for acute pain management, especially when conventional strategies provide suboptimal responses.


Assuntos
Analgésicos Opioides , Buprenorfina , Analgésicos Opioides/efeitos adversos , Buprenorfina/efeitos adversos , Combinação Buprenorfina e Naloxona , Humanos , Dor , Manejo da Dor
17.
J Opioid Manag ; 17(7): 167-170, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34520038

RESUMO

Buprenorphine (BPN), FDA approved for opioid use disorder (OUD), requires an induction protocol for the patient in mild to moderate withdrawal. This can be problematic in outpatient practice due to complicated medical management. An emerging technique in literature uses a novel approach, called microinduction. In this method, escalating microdoses of BPN are administered, without requiring the patient to stop the opioid agonist. Our addiction treatment center used a microdosing technique to transit patients from methadone to BPN, without requiring opioid abstinence. Our case series is novel as it was outpatient microinduction from methadone to BPN in 7 days or less.


Assuntos
Buprenorfina , Transtornos Relacionados ao Uso de Opioides , Analgésicos Opioides/efeitos adversos , Buprenorfina/uso terapêutico , Humanos , Metadona/uso terapêutico , Tratamento de Substituição de Opiáceos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Pacientes Ambulatoriais
18.
J Opioid Manag ; 17(7): 171-177, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34520039

RESUMO

OBJECTIVE: Pain management following spine surgery can be challenging as patients routinely suffer from chronic pain and opioid tolerance. The increasing popularity of buprenorphine use for pain management in this population may further complicate perioperative pain management due to the limited efficacy of other opioids in the presence of buprenorphine. This study describes perioperative management and outcomes in patients on chronic buprenorphine who underwent elective inpatient spine surgery. DESIGN: The authors performed a retrospective chart review of all patients >18 years of age taking chronic buprenorphine for any indication who had elective inpatient spine surgery at a single institution. Perioperative pain management data were analyzed for all patients who underwent spine surgery and were maintained on buprenorphine during their hospital stay. SETTING: The study was performed at a single tertiary academic medical center. MAIN OUTCOME MEASURES: The primary outcome measures were post-operative pain scores and analgesic medication requirements. RESULTS: Twelve patients on buprenorphine underwent inpatient spine surgery. Acceptable pain control was achieved in all cases. Management included preoperative dose limitation of buprenorphine when indicated and the extensive use of multimodal analgesia. CONCLUSION: The question whether patients presenting for painful, elective surgery should continue using buprenorphine perioperatively is an area of controversy, and the present manuscript provides more evidence for the concept of therapy continuation with buprenorphine.


Assuntos
Buprenorfina , Dor Crônica , Analgésicos Opioides/efeitos adversos , Buprenorfina/efeitos adversos , Dor Crônica/diagnóstico , Dor Crônica/tratamento farmacológico , Tolerância a Medicamentos , Humanos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Estudos Retrospectivos
19.
J Opioid Manag ; 17(7): 179-182, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34520040

RESUMO

This case report demonstrates using buprenorphine 32 mg to achieve adequate pain control after a total knee replacement. The patient stopped buprenorphine 48 hours before surgery. He was prescribed 150 tablets of oxycodone 5 mg. After finishing oxycodone, he experienced significant pain that was relieved by 32 mg of buprenorphine daily. Urine drug screens were negative perioperatively. Patients with opioid use disorder require careful discharge planning to avoid opioid relapses or misuses of pain medications. Buprenorphine offers many unique advantages in acute pain control, including lower risk of respiratory depression, abuse potential, and lower risk of nephrotoxicity.


Assuntos
Artroplastia do Joelho , Buprenorfina , Analgésicos Opioides/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Buprenorfina/efeitos adversos , Humanos , Masculino , Oxicodona/efeitos adversos , Dor
20.
J Opioid Manag ; 17(7): 159-166, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34520037

RESUMO

Buprenorphine/naloxone (BPN/NX) is a first-line treatment for opioid use disorder. Conventional treatment guidelines recommend a period of opioid abstinence and the presence of moderate withdrawal before initiation to avoid precipitated withdrawal. A newer approach of "microdosing" removes this requirement and has potential benefits. We present two cases of successful induction of BPN/NX using a microdosing regimen in an inpatient withdrawal unit. Both cases did not result in precipitated withdrawal and did not necessitate prior cessation of other opioids. This case report highlights how the use of microdosing to induct BPN/NX treatment can reduce potential barriers and complications with treatment initiation.


Assuntos
Buprenorfina , Transtornos Relacionados ao Uso de Opioides , Analgésicos Opioides/efeitos adversos , Buprenorfina/uso terapêutico , Combinação Buprenorfina e Naloxona/uso terapêutico , Humanos , Naloxona/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico
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