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2.
J Forensic Nurs ; 15(4): 231-241, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31764527

RESUMO

INTRODUCTION: Clients on methadone maintenance treatment (MMT) have high attrition rates that are attributed to personal and system-related factors. To develop supportive interventions for these clients, it is imperative to understand social demographic characteristics and challenges that clients in the MMT program face. OBJECTIVES: This article aims to describe (a) the sociodemographic characteristics and clinical profiles of clients in a MMT program, (b) factors that impact their positive clinical outcomes, and (c) the study's implications for practice. METHODS: A retrospective review of 101 randomly selected electronic medical records representing one third of all the records were examined for sociodemographic characteristics, clinical profiles, and outcomes. Descriptive statistics were used to analyze these variables. Interviews with 18 healthcare providers focusing on their experiences of caring for clients in the MMT program were analyzed thematically. RESULTS: The average age of clients on MMT is 35.5 years. Clients had early exposure to alcohol and drugs, and at the time of enrollment to the program, they presented with complex healthcare needs, borne from chronic use, and exposure to adverse traumatic events. Personal and systemic factors impact clients' recovery. These include poverty, homelessness, and inadequate healthcare services. Understanding sociodemographic characteristics, clinical profiles, and clients' challenges is central to the development of supportive interventions that enhance retention to care and recovery.


Assuntos
Analgésicos Opioides/uso terapêutico , Metadona/uso terapêutico , Tratamento de Substituição de Opiáceos , Centros de Tratamento de Abuso de Substâncias , Adulto , Distribuição por Idade , Canadá/epidemiologia , Feminino , Necessidades e Demandas de Serviços de Saúde , Pessoas em Situação de Rua , Humanos , Masculino , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Distribuição por Sexo , Meio Social , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Adulto Jovem
3.
J Opioid Manag ; 15(4): 275-283, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31637680

RESUMO

OBJECTIVE: Inform readers of the use of a clinical pathway that includes initiation of methadone in hospitalized patients with acute pain who have untreated opioid use disorder (OUD). DESIGN: A retrospective chart review with frequency distributions and descriptive statistics calculated to describe demo-graphic and clinical characteristics of the sample. SETTING: Urban academic hospital. PATIENTS: One hundred twenty consecutive patients with untreated OUD cared for by the Acute Pain Service (APS). INTERVENTIONS: APS leadership spearheaded development of a clinical pathway to standardize pain management and optimize outcomes. The authors outline pathway development and describe 120 patients managed using this pathway, initiated on methadone for OUD. RESULTS: The sample included patients, average age 40 years, predominantly non-Hispanic white (74.2 percent), male (61.7 percent), unemployed (88.2 percent), and on Medicaid (84.2 percent). 96.7 percent had a history of heroin use, and 52.1 percent had engaged in previous medication-assisted treatment (MAT). Methadone or other opioids were held for signs of intoxication/sedation in 10.9 percent or for prolonged corrected QT interval in 1.7 percent. The majority received at least one other analgesic agent. For those prescribed opioids upon discharge, the average maximum morphine equivalent dose was 68.2 mg/day for approximately 3 days. 68.3 percent agreed to schedule post-discharge MAT, and of these, 68 percent attended their intake appointment. A small percentage (4.7 percent) left the hospital against medical advice. CONCLUSION: This pathway provides an example of an effective and safe response to address the opioid epidemic and pro-vide quality care to patients with OUD and pain.


Assuntos
Dor Aguda , Analgésicos Opioides/uso terapêutico , Metadona/uso terapêutico , Transtornos Relacionados ao Uso de Opioides , Dor Aguda/tratamento farmacológico , Adulto , Feminino , Humanos , Masculino , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Clínicas de Dor , Estudos Retrospectivos
4.
J Opioid Manag ; 15(4): 345-348, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31637687

RESUMO

Opioid tapering may be necessary for patients on long-term opioids. Here, the authors presented a patient who had uncontrolled chronic musculoskeletal pain while on chronic methadone. Upon methadone tapering, the patient had been taking methadone for longer than six years and had severe methadone-related adverse effects. Using multidisciplinary interventions of patient education and counseling, physical interventions, and nonopioid medications, patient's methadone was discontinued after longer than one year tapering with relatively good pain control. The tapering process highlights the importance of pain management during opioid tapering using multidisciplinary interventions to prevent and treat opioid withdrawal and pain relapses.


Assuntos
Analgésicos Opioides/efeitos adversos , Metadona , Manejo da Dor/métodos , Síndrome de Abstinência a Substâncias , Humanos , Metadona/uso terapêutico , Entorpecentes , Síndrome de Abstinência a Substâncias/prevenção & controle
6.
Medicine (Baltimore) ; 98(39): e17319, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574863

RESUMO

BACKGROUND: Heroin addiction remains a significant public health problem worldwide, and relapse to heroin use following cessation of agonist maintenance treatment is common. The problems associated with use of opioid agonists mean that non-opioid therapies need to be developed to ameliorate acute and protracted opioid withdrawal syndromes. METHODS: Fifteen men with opioid use disorder on methadone maintenance treatment have been enrolled from an addiction treatment center as an experimental group in this case-controlled study. This group is receiving laser meridian massage on the back, including the Bladder meridian and Governor Vessel, 3 times weekly for 4 weeks. An age-matched control group that does not receive laser meridian massage has also been enrolled. Urinary morphine levels are being checked before and after 2 and 4 weeks of treatment. Subjects are requested to self-report their number of episodes or days of heroin use and 0 to 10-point visual analogue scale scores for heroin craving/refusal to use heroin during the previous week before and after 2 and 4 weeks of treatment. Quality of life will be reported using the Short Form-12v2 before and after 4 weeks of treatment. Pulse diagnosis will be recorded and heart rate variability calculated after one single treatment session. The baseline patient characteristics will be compared between the experimental and control groups using the independent t test and Chi-square test. Data are compared between the 2 groups using repeated-measures analysis of variance, generalized estimating equations, and the paired t test. OBJECTIVE: To investigate the effect of adjuvant laser meridian massage in men with opioid use disorder on methadone maintenance treatment. TRIAL REGISTRATION: ClinicalTrials.gov NCT04003077.


Assuntos
Lasers , Massagem , Meridianos , Metadona/uso terapêutico , Tratamento de Substituição de Opiáceos/métodos , Transtornos Relacionados ao Uso de Opioides/terapia , Pontos de Acupuntura , Adulto , Analgésicos Opioides/uso terapêutico , Estudos de Casos e Controles , Humanos , Masculino , Massagem/instrumentação , Massagem/métodos , Síndrome de Abstinência a Substâncias/terapia
7.
Mayo Clin Proc ; 94(10): 2072-2086, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31543255

RESUMO

The United States is in the midst of a national opioid epidemic. Physicians are encouraged both to prevent and treat opioid-use disorders (OUDs). Although there are 3 Food and Drug Administration-approved medications to treat OUD (methadone, buprenorphine, and naltrexone) and there is ample evidence of their efficacy, they are not used as often as they should. We provide a brief review of the 3 primary medications used in the treatment of OUD. Using data from available medical literature, we synthesize existing knowledge and provide a framework for how to determine the optimal approach for outpatient management of OUD with medication-assisted treatments.


Assuntos
Buprenorfina/uso terapêutico , Metadona/uso terapêutico , Naltrexona/uso terapêutico , Tratamento de Substituição de Opiáceos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Algoritmos , Árvores de Decisões , Humanos
8.
J Addict Nurs ; 30(3): 169-176, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31478964

RESUMO

Globally, from America to Europe and beyond, the need for the expansion of the role of nurse practitioners has been recognized within the healthcare professions. However, little emphasis has been placed on assessing the views of clients, and within the addiction services, the voice of clients can be additionally marginalized as a result of treatment philosophies, stigma, and resource constraints. The aims of this study were to establish from clients their nursing needs and to use these findings alongside an objective measurement of clients' health, to inform the development of a nurse-led treatment model.A cross-sectional survey with open-ended questions on client nursing needs was conducted in 2017 within a representative sample of six clinics in Dublin, Ireland. A convenience sample of 131 clients were interviewed. Interviews were analyzed using thematic analysis.Findings were both as expected and surprising. Clients articulated the role of the nurse in their physical care; however, unexpectedly, clients identified nurses as an essential source of psychological support and expressed the wish for the role to be expanded in terms of managing methadone treatment and accessing additional services and resources.Results contributed to the formation of the nurse-led, client mental-health-focused, Healthy Addiction Treatment Recovery Model for addiction nursing services. In terms of national policies, findings provided new evidence articulated by service users on their desire for the expansion of nurse prescribing in addiction services and an expansion of the role to more adequately address client needs.


Assuntos
Relações Enfermeiro-Paciente , Padrões de Prática em Enfermagem , Transtornos Relacionados ao Uso de Substâncias/enfermagem , Adulto , Idoso , Analgésicos Opioides/uso terapêutico , Atitude Frente a Saúde , Comunicação , Estudos Transversais , Substituição de Medicamentos , Feminino , Humanos , Assistência de Longa Duração , Masculino , Metadona/uso terapêutico , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Profissionais de Enfermagem/psicologia , Papel do Profissional de Enfermagem , Defesa do Paciente , Apoio Social , Transtornos Relacionados ao Uso de Substâncias/reabilitação
9.
Artigo em Inglês | MEDLINE | ID: mdl-31500107

RESUMO

Methadone maintenance treatment (MMT) has been scaled up significantly in recent years. This study aimed to investigate the pattern of polysubstance use in 395 MMT patients and its contextualized associated factors. A cross-sectional study was performed in three outpatient MMT clinics in Nam Dinh Province. Multivariate Poisson regression was used to identify factors associated with polysubstance use status. The mean MMT duration and the current MMT dose was 3.3 years and 69.2 mg, respectively. Among participants, 24.8% reported daily alcohol use, 68.6% smoked regularly, and 6% used illicit drugs. Peer pressure and MMT suboptimal adherence were found to associate with continual usage of drugs (47.8%). Participants who lived with a spouse/partner, were self-employed, and smoked were more likely to drink alcohol. Those who drink were also more likely to smoke, and vice versa. Recommendations for policymakers include community-based education and promotional programs aiming to decrease substance usage in the community as well as encouraging and supporting the private health sector in establishing private MMT services and clinics. Further longitudinal studies on polysubstance usage among MMT patients should also be conducted.


Assuntos
Infecções por HIV , Metadona/uso terapêutico , Tratamento de Substituição de Opiáceos , Transtornos Relacionados ao Uso de Substâncias/tratamento farmacológico , Adulto , Consumo de Bebidas Alcoólicas , Instituições de Assistência Ambulatorial , Estudos Transversais , Epidemias , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Vietnã/epidemiologia
10.
BMC Infect Dis ; 19(1): 774, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31488064

RESUMO

BACKGROUND: HCV (Hepatitis C virus) is a prevalent chronic disease with potentially deadly consequences, especially for drug users. However, there are no special HCV or HIV (human immunodeficiency virus)-related intervention programs that are tailored for drug users in China; to fill this gap, the purpose of this study was to explore HCV and HIV-related knowledge among drug users in MMT (methadone maintenance treatment) sites of China and to investigate the effectiveness of HCV and HIV-related education for improving the knowledge of IDUs (injection drug users) and their awareness of infection. METHODS: The study was a randomized cluster controlled trial that compared a usual care group to a usual care plus HCV/HIV-REP (HCV/HIV-Reduction Education Program) group with a 24-week follow-up. The self-designed questionnaires, the HCV- and HIV-related knowledge questionnaire and the HIV/HCV infection awareness questionnaire, were used to collect the data. Four MMT clinics were selected for this project; two MMT clinics were randomly assigned to the research group, with subjects receiving their usual care plus HCV/HIV-REP, and the remaining two MMT clinics were the control group, with subjects receiving their usual care over 12 weeks. Sixty patients were recruited from each MMT clinic. A total of 240 patients were recruited. Follow-up studies were conducted at the end of the 12th week and the 24th week after the intervention. RESULTS: At baseline, the mean score (out of 20 possible correct answers) for HCV knowledge among the patients in the group receiving the intervention was 6.51 (SD = 3.5), and it was 20.57 (SD = 6.54) for HIV knowledge (out of 45 correct answers) and 8.35 (SD = 2.8) for HIV/HCV infection awareness (out of 20 correct answers). At the 12-week and 24-week follow-up assessments, the research group showed a greater increase in HCV-/HIV-related knowledge (group × time effect, F = 37.444/11.281, P < 0.05) but no difference in their HIV/HCV infection awareness (group × time effect, F = 2.056, P > 0.05). CONCLUSION: An MMT-based HCV/HIV intervention program could be used to improve patient knowledge of HCV and HIV prevention, but more effort should be devoted to HIV/HCV infection awareness. TRIAL REGISTRATION: Protocols for this study were approved by institution review board (IRB) of Shanghai Mental Health Center (IRB:2009036), and registered in U.S national institutes of health (http://www.clinicaltrials.gov, NCT01647191 ). Registered 23 July 2012.


Assuntos
Usuários de Drogas/educação , Infecções por HIV/prevenção & controle , Hepatite C/prevenção & controle , Metadona/uso terapêutico , Tratamento de Substituição de Opiáceos , Educação de Pacientes como Assunto , Adulto , Conscientização , China/epidemiologia , Análise por Conglomerados , Usuários de Drogas/psicologia , Usuários de Drogas/estatística & dados numéricos , Eficiência Organizacional , Feminino , HIV/fisiologia , Infecções por HIV/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Hepacivirus/fisiologia , Hepatite C/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Tratamento de Substituição de Opiáceos/métodos , Tratamento de Substituição de Opiáceos/estatística & dados numéricos , Educação de Pacientes como Assunto/organização & administração , Educação de Pacientes como Assunto/normas , Prevalência , Inquéritos e Questionários , Resultado do Tratamento
11.
Artigo em Inglês | MEDLINE | ID: mdl-31390750

RESUMO

Around half of methadone maintenance treatment (MMT) participants choose the tapering phase, however, the guidelines on tapering differ between countries and only include the tapering rate. Physicians need more evidence to guide clinical practice. We aimed to explore a specific tapering strategy to improve heroin abstinence among MMT participants. We conducted a retrospective study from 2006 to 2017 at nine MMT clinics in Guangdong, China, involving 853 participants with 961 treatment episodes. We performed two-level hierarchical logistic regression models to identify tapering phase characteristics associated with heroin abstinence. Among all treatment episodes, 419 (43.6%) were heroin abstinent. Participants who started tapering after 52 weeks, had a taper start dose of less than 60 mg and a taper ratio of less than 5%/week, while a dose reduction in 75%-89% of the tapering weeks provided the highest odds of heroin abstinence. This study highlights the need for a more gradual taper than current guidelines recommend and strongly suggests the inclusion of other tapering phase characteristics. Those who start the tapering phase later, have a lower dose of methadone, with a more gradual rate of taper, and a dose reduction in 75%-89% of the tapering phase increased the odds of heroin abstinence.


Assuntos
Dependência de Heroína/tratamento farmacológico , Metadona/uso terapêutico , Tratamento de Substituição de Opiáceos/métodos , Adulto , China , Feminino , Humanos , Modelos Logísticos , Masculino , Metadona/administração & dosagem , Pessoa de Meia-Idade , Estudos Retrospectivos
12.
BMC Infect Dis ; 19(1): 703, 2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31395019

RESUMO

BACKGROUND: Hepatitis C virus (HCV) is a major public health problem in correctional settings. HCV treatment is often not possible in U.S. jails due to short lengths of stay. Linkage to care is crucial in these settings, but competing priorities complicate community healthcare engagement and retention after incarceration. METHODS: We conducted a single arm clinical trial of a combined transitional care coordination (TCC) and patient navigation intervention and assessed the linkage rate and factors associated with linkage to HCV care after incarceration. RESULTS: During the intervention, 84 participants returned to the community after their index incarceration. Most participants were male and Hispanic, with a history of mental illness and a mean age of 45 years. Of those who returned to the community, 26 (31%) linked to HCV care within a median of 20.5 days; 17 (20%) initiated HCV treatment, 15 (18%) completed treatment, 9 (11%) had a follow-up lab drawn to confirm sustained virologic response (SVR), and 7 (8%) had a documented SVR. Among those with follow-up labs the known SVR rate was (7/9) 78%. Expressing a preference to be linked to the participant's existing health system, being on methadone prior to incarceration, and feeling that family or a loved one were concerned about the participant's wellbeing were associated with linkage to HCV care. Reporting drinking alcohol to intoxication prior to incarceration was negatively associated with linkage to HCV care. CONCLUSION: We demonstrate that an integrated strategy with combined TCC and patient navigation may be effective in achieving timely linkage to HCV care. Additional multicomponent interventions aimed at treatment of substance use disorders and increasing social support could lead to further improvement. TRIAL REGISTRATION: Clinicaltrials.gov NCT04036760 July 30th, 2019 (retrospectively registered).


Assuntos
Continuidade da Assistência ao Paciente , Hepatite C/tratamento farmacológico , Prisioneiros/estatística & dados numéricos , Adulto , Serviços de Saúde Comunitária , Feminino , Hepatite C/virologia , Hispano-Americanos , Humanos , Masculino , Metadona/uso terapêutico , Pessoa de Meia-Idade , New York , Navegação de Pacientes , Prisões , Estudos Prospectivos , Transtornos Relacionados ao Uso de Substâncias/terapia , Resposta Viral Sustentada
13.
Rev Esp Salud Publica ; 932019 Aug 26.
Artigo em Espanhol | MEDLINE | ID: mdl-31447482

RESUMO

OBJECTIVE: People on methadone treatment have increased their life expectancy, aging prematurely with comorbidities. The objective of this study was to know the sociodemographic and clinical profile of these people in the Center for Addiction Care in the district of Latina (belonging to Madrid Salud), as well as the perception of the influence of the treatment on their aging. The Social Determinants of Health Model was used as a framework. METHODS: A mixed methodology was used in two phases: a quantitative one, to describe the sociodemographic and clinical characteristics of the study population; and another qualitative one, through semi-structured interviews to an intentional sample, to explore the history of life and the perception of future needs regarding the health of the participants. RESULTS: The results highlighted that the average age of the sample was 48.28 years, that they were mostly men (81.25%), of Spanish origin, with a low level of education and economics and with a medium stay in treatment with methadone of ± 13 years. An increase in mental pathologies was found the more years they had been in the program, as well as, at a lower age of onset in consumption, the presence of HIV and Hepatitis C virus increased. In their speeches it was found that the social determinants of Health have conditioned its vital history. CONCLUSIONS: Both consumption and methadone contribute to its stigmatization, not favoring its normalized inclusion in society and determining a high state of vulnerability. This increases as age does, not receive adequate resources to meet their future needs.


Assuntos
Envelhecimento , Metadona/uso terapêutico , Tratamento de Substituição de Opiáceos , Determinantes Sociais da Saúde , Estereotipagem , Adulto , Idade de Início , Comorbidade , Feminino , Infecções por HIV/complicações , Hepatite C/complicações , Humanos , Expectativa de Vida , Masculino , Pessoa de Meia-Idade , Espanha/epidemiologia
14.
BMC Health Serv Res ; 19(1): 440, 2019 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-31266495

RESUMO

BACKGROUND: Mortality rates and causes of death among individuals in opioid agonist treatment (OAT) vary according to several factors such as geographical region, age, gender, subpopulations, drug culture and OAT status. Patients in OAT are ageing due to effective OAT as well as demographic changes, which has implications for morbidity and mortality. Norway has one of the oldest OAT populations in Europe. Because of the varying mortality rates and causes of death in different subgroups and countries, research gaps still exist. The aims of this study were to describe the causes of death among OAT patients in Norway, to estimate all-cause and cause-specific crude mortality rates (CMRs) during OAT and to explore characteristics associated with drug-induced cause of death compared with other causes of death during OAT. METHODS: This was a national, observational register study. Data from the Norwegian Cause of Death Registry and the Norwegian Patient Registry were combined with data from medical records. We included all patients in the Norwegian OAT programme who died not more than 5 days after the last intake of OAT medication, between 1 January 2014 and 31 December 2015. RESULTS: In the 2-year observation period, 200 (1.4%) of the OAT patients died. A forensic or medical autopsy was performed in 63% of the cases. The mean age at the time of death was 48.9 years (standard deviation 8.4), and 74% were men. Somatic disease was the most common cause of death (45%), followed by drug-induced death (42%), and violent death (12%). In general, CMRs increased with age, and they were higher in men and in patients taking methadone compared with buprenorphine. Increasing somatic comorbidity, measured by the Charlson comorbidity index, reduced the odds of dying of a drug-induced cause of death compared with other causes of death. CONCLUSIONS: Both somatic and drug-induced causes of death were common during OAT. Improved treatment and follow-up of chronic diseases, especially in patients aged > 40 years, and continuous measures to reduce drug-induced deaths appear to be essential to reduce future morbidity and mortality burdens in this population.


Assuntos
Buprenorfina/uso terapêutico , Causas de Morte , Metadona/uso terapêutico , Tratamento de Substituição de Opiáceos/mortalidade , Transtornos Relacionados ao Uso de Opioides/mortalidade , Adulto , Autopsia , Causas de Morte/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros
15.
Artigo em Inglês | MEDLINE | ID: mdl-31288440

RESUMO

Methadone maintenance treatment (MMT) programs have been used worldwide to reduce the number of drug users and for HIV prevention; however, evidence of their effectiveness in mountainous areas is limited. This study aimed to identify changes in substance abuse and sexual practices among MMT patients after treatment in three Vietnamese mountainous provinces. A survey on risk behaviors was conducted among 300 drug users in six MMT clinics prior to and following one year of MMT. Cramér's effect size of changes was extrapolated to justify the magnitude of the intervention's effectiveness. A generalized estimation equation was used to find the factors associated with respondents' substance use and sexual risk behavior. While drug-related risk behaviors were significantly reduced, alcohol and sex-related behaviors remained risk factors for HIV in this group. Additionally, condom use was common among participants at both time points, but not among those having sex with sex workers. Socio-economic characteristics of ethnic, education, occupation, as well as drug use history influenced the possibility of engaging in drug use and/or sexual risk behavior following treatment. Further emphasis on managing these among MMT patients is required, potentially by providing integrated services including smoking and drinking counseling and condom use promotion in accordance with MMT.


Assuntos
Infecções por HIV/epidemiologia , Tratamento de Substituição de Opiáceos , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Adulto , Aconselhamento , Feminino , Infecções por HIV/complicações , Humanos , Masculino , Metadona/uso terapêutico , Pessoa de Meia-Idade , Fatores de Risco , Assunção de Riscos , Comportamento Sexual/estatística & dados numéricos , Inquéritos e Questionários , Vietnã/epidemiologia
16.
Phytother Res ; 33(10): 2714-2725, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31359519

RESUMO

Patients under methadone maintenance treatment (MMT) programs are susceptible to several complications including metabolic and clinical disorders. This study was designed to determine the effect of crocin supplementation on mental health parameters and metabolic profiles in subjects under MMT. The current randomized, double-blind, placebo-controlled, clinical trial was conducted among 53 patients under MMT to receive either 15 mg/day of crocin (n = 26) or placebo (n = 27) twice a day for 8 weeks. Crocin administration significantly decreased Beck Depression Inventory score (P = 0.01) and Beck Anxiety Inventory score (P = 0.008) compared with the placebo. In addition, crocin administration resulted in a significant reduction in fasting glucose (P = 0.003), insulin levels (P = 0.01), insulin resistance (P = 0.008), triglycerides (P = 0.001), very low-density lipoprotein (P = 0.001), total cholesterol levels (P = 0.03), and a significant increase in insulin sensitivity (.003) compared with the placebo. Additionally, crocin intake was associated with a significant reduction in high-sensitivity C-reactive protein (p < .001) and malondialdehyde (P = 0.001) and a significant rise in total antioxidant capacity levels (P = 0.01) compared with the placebo. The findings of this clinical trial indicate that taking crocin for 8 weeks by patients under MMT had beneficial effects on their mental health and improved their metabolic profiles.


Assuntos
Carotenoides/administração & dosagem , Metadona/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/reabilitação , Adulto , Glicemia/análise , Carotenoides/farmacologia , Suplementos Nutricionais , Método Duplo-Cego , Feminino , Humanos , Resistência à Insulina , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/metabolismo , Transtornos Relacionados ao Uso de Opioides/psicologia
17.
Am J Health Syst Pharm ; 76(15): 1097-1103, 2019 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-31361869

RESUMO

PURPOSE: The use of buprenorphine, methadone, and long-acting naltrexone for treatment of opioid use disorder (OUD) is discussed, including a review of current literature detailing treatment approaches and action steps to optimize treatment in acute care and office-based settings. SUMMARY: The U.S. epidemic of opioid-related deaths has been driven by misuse of prescription opioids and, increasingly, illicit drugs such as heroin, fentanyl, and fentanyl analogs, necessitating a refocusing of treatment efforts on expanding access to life-saving, evidence-based OUD pharmacotherapy. Inpatient treatment of opioid withdrawal includes acute symptom control through a combination of nonopioid medications and long-term pharmacotherapy to lessen opioid craving and facilitate stabilization and recovery. Methadone and buprenorphine reduce opioid craving, increase treatment retention, reduce illicit opioid use, and increase overall survival. Buprenorphine has logistical advantages over methadone, such as greater flexibility of treatment setting and less risk of adverse effects. Studies have shown the efficacy of long-acting injectable naltrexone to be comparable to that of buprenorphine if patients are detoxified prior to initiation of therapy; however, patients with active OUD are often not able to complete the week-long period of opioid abstinence needed prior to initiation of naltrexone injections. Although buprenorphine is preferred by many patients and can be prescribed in office-based settings, there remains a paucity of physicians certified to prescribe it. CONCLUSION: Buprenorphine has become the medication of choice for many patients with OUD, but its use is limited by the low number of physicians certified to prescribe the agent. Other agents studied for treatment of OUD include methadone and naltrexone.


Assuntos
Analgésicos Opioides/efeitos adversos , Medicina Baseada em Evidências/métodos , Antagonistas de Entorpecentes/uso terapêutico , Tratamento de Substituição de Opiáceos/métodos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Buprenorfina/uso terapêutico , Prescrições de Medicamentos , Humanos , Metadona/uso terapêutico , Naltrexona/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/etiologia
18.
Nurs Womens Health ; 23(4): 357-365, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31251931

RESUMO

The growing incidence of neonatal abstinence syndrome (NAS) among newborns is a public health crisis that is a sequela of the national opioid crisis. When fetuses are exposed to opioids in utero, whether through prescription pain medication, illicit substances, or supervised medication-assisted opioid treatment, neonates can experience withdrawal symptoms shortly after birth. Opioid withdrawal manifests with symptoms of central nervous system and autonomic nervous system dysfunction. Treatment of NAS begins with nonpharmacologic interventions, and if a neonate requires more intensive treatment, care will escalate to include pharmacologic treatments, including morphine, methadone, and buprenorphine. When pharmacologic therapy begins, nonpharmacologic intervention is not ceased; rather, the two are used in conjunction in an attempt to reduce the amount of medication required for successful treatment. Herein we review nonpharmacologic nursing interventions, discuss the most common pharmacologic treatments for NAS, and present practice implications for nurses who work with childbearing families.


Assuntos
Síndrome de Abstinência Neonatal/tratamento farmacológico , Tratamento de Substituição de Opiáceos/métodos , Analgésicos Opioides/uso terapêutico , Buprenorfina/uso terapêutico , Feminino , Humanos , Recém-Nascido , Masculino , Metadona/uso terapêutico , Morfina/uso terapêutico , Síndrome de Abstinência Neonatal/fisiopatologia , Tratamento de Substituição de Opiáceos/tendências , Gravidez , Complicações na Gravidez/tratamento farmacológico , Complicações na Gravidez/prevenção & controle , Resultado do Tratamento
19.
Basic Clin Pharmacol Toxicol ; 125(3): 253-258, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31188528

RESUMO

Urine tests are the commonly accepted methods to control abstinence and adherence to treatment of patients who undergo methadone maintenance treatment (MMT). Depending on various national guidelines and accessibility of techniques, only selected psychoactive substances are routinely tested in urine of MMT patients. In general, they belong to the few groups of compounds: THC, cocaine, amphetamines, opiates, PCP and benzodiazepines. It is, however, well known that patients enrolled in such replacement programmes take psychoactive substances that are not routinely detected by the toxicology laboratories, to escape unexpected tests. Here, we report semiquantitative detection of legal highs taken by the MMT patient, using high-pressure liquid chromatography coupled to the flowing atmospheric pressure afterglow ion source (LC-FAPA-MS). To demonstrate effectivity of this technique, the data were confirmed by quantitative analysis using LC-ESI-MS/MS. In the analysed sample of MMT patient, a mixture of psychoactive compounds was found, namely 3-MMC (3-methylmethcathinone), pentedrone and methcathinone and determined at the concentrations of 670; 50 and 0.2 µg/mL, respectively. Such fast analytical technique may be useful for the efficient control of substances taken intentionally by MMT patients.


Assuntos
Metadona/uso terapêutico , Tratamento de Substituição de Opiáceos/métodos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Psicotrópicos/urina , Detecção do Abuso de Substâncias/métodos , Cromatografia Líquida de Alta Pressão/métodos , Feminino , Humanos , Limite de Detecção , Metanfetamina/análogos & derivados , Metanfetamina/urina , Metilaminas/urina , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/urina , Cooperação do Paciente , Pentanonas/urina , Propiofenonas/urina , Espectrometria de Massas em Tandem/métodos
20.
Curr Pain Headache Rep ; 23(7): 49, 2019 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-31209656

RESUMO

PURPOSE OF REVIEW: Well-informed staff can help decrease risks and common misconceptions regarding opioid-tolerant patients, especially those taking methadone. RECENT FINDINGS: In 2015, opioid pain relievers were the second most used drug at 3.8 million. Overdose death was three times greater in 2015 than in 2000. Medication-assisted treatment was sought by more than 2 million individuals with substance use disorder, one of which is methadone. Chronic pain affects millions of adults in the USA. Opioid therapy is widely used among these adults. Related to the risk of abuse and dependence, guidelines suggest that opioid therapy may not be considered first-line treatment. A multidisciplinary approach, including thorough preoperative evaluation, the utilization of multimodal pain management strategies, and opioid-sparing techniques in both the intraoperative and postoperative periods will allow for the best possible outcome.


Assuntos
Analgésicos Opioides/uso terapêutico , Dor Crônica/tratamento farmacológico , Metadona/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Buprenorfina/uso terapêutico , Humanos , Metadona/efeitos adversos , Manejo da Dor/métodos
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