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1.
J Subst Abuse Treat ; 119: 108128, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33138923

RESUMO

The COVID-19 pandemic and its containment strategies have presented unique challenges to India's healthcare infrastructure. While a national lockdown initially resulted in the closure of all licensed liquor shops, it also made healthcare facilities dedicated to the treatment of substance use disorders challenging to access. Addiction treatment services have been functioning at limited capacity with a lack of consensus on operating procedures. In this article, we present actual case scenarios where lockdown affected substance use and the treatment process, and discuss the policy implications and considerations for both.


Assuntos
Infecções por Coronavirus/epidemiologia , Assistência à Saúde/organização & administração , Transtornos Relacionados ao Uso de Opioides/reabilitação , Pneumonia Viral/epidemiologia , Centros de Tratamento de Abuso de Substâncias/organização & administração , Adulto , Acesso aos Serviços de Saúde , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias
2.
J Subst Abuse Treat ; 119: 108139, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33138924

RESUMO

The COVID-19 pandemic led government regulators to relax prescribing rules for buprenorphine and methadone, the agonist medications that effectively treat opioid use disorder, allowing for take home supplies of up to 28 days. These changes prioritized the availability of these medications over concerns about their misuse and diversion, and they provided a means for overdose prophylaxis during the highly uncertain conditions of the pandemic. In considering how to capitalize on this shift, research should determine the extent to which increased diversion has occurred as a result, and what the consequences may have been. The shifts also set the stage to consider if methadone can be safely prescribed in primary care settings, and if the monthly injectable formulation of buprenorphine is a suitable alternative to increased supplies of sublingual strips if concerns about diversion persist. The disruptions of the pandemic have caused a surge in overdose deaths, so carefully considering the prophylactic potential of agonist medications, in addition to their role as a treatment, may help us address this mortality crisis.


Assuntos
Analgésicos Opioides/administração & dosagem , Infecções por Coronavirus , Transtornos Relacionados ao Uso de Opioides/reabilitação , Pandemias , Pneumonia Viral , Padrões de Prática Médica/estatística & dados numéricos , Desvio de Medicamentos sob Prescrição/estatística & dados numéricos , Analgésicos Opioides/efeitos adversos , Buprenorfina/administração & dosagem , Overdose de Drogas/epidemiologia , Humanos , Metadona/administração & dosagem , Tratamento de Substituição de Opiáceos/métodos
3.
J Subst Abuse Treat ; 119: 108154, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33032860

RESUMO

In the context of the COVID-19 pandemic and the state of emergency that the government of Spain declared, the rapid adaptation of health services is of paramount importance to preserve access to and continuity of service delivery. This research note underscores the importance of ensuring a sufficient quantity of methadone take-home doses for patients on methadone maintenance treatment (MMT) to maximize their adherence to government-imposed lockdown restrictions and social distancing measures designed to curtail the spread of SARS-CoV-2. We evaluate the impact of COVID-19 on take-home medication (number of days provided) in a methadone clinic in Barcelona (Catalonia, Spain). This work conveys that we should consider maintaining the take-home practices that we adopted in response to the pandemic, even after the pandemic has abated.


Assuntos
Infecções por Coronavirus , Metadona/administração & dosagem , Tratamento de Substituição de Opiáceos/métodos , Transtornos Relacionados ao Uso de Opioides/reabilitação , Pandemias , Pneumonia Viral , Instituições de Assistência Ambulatorial , Acesso aos Serviços de Saúde , Humanos , Metadona/provisão & distribução , Espanha
4.
J Subst Abuse Treat ; 119: 108153, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33032862

RESUMO

The global coronavirus disease 2019 (COVID-19) will exacerbate the negative health outcomes associated with the concurrent opioid overdose crisis in North America. COVID-19 brings unique challenges for practitioners who provide opioid use disorder (OUD) care. The majority of overdose deaths in the Canadian province of British Columbia occur in housing environments. Some supportive housing environments in Vancouver, British Columbia, have on-site primary care and substance use disorder treatment clinics. Some of these housing environments also include supervised consumption services. These housing environments needed to make adjustments to their care to adhere to COVID-19 physical distancing measures. Such adjustments included a pandemic withdrawal management program to provide patients with a pharmaceutical grade alternative to the toxic illicit drug supply, which allow patients to avoid the heightened overdose risk while using illicit drugs alone or potentially exposing themselves to COVID-19 while using drugs in a group setting. Other modifications to the OUD care continuum included modified supervised injection spaces to adhere to physical distancing, the use of personal protective equipment for overdose response, virtual platforms for clinical encounters, writing longer prescriptions, and providing take-home doses to promote opioid agonist treatment retention. These strategies aim to mitigate indoor overdose risk while also addressing COVID-19 risks.


Assuntos
Analgésicos Opioides/envenenamento , Infecções por Coronavirus/prevenção & controle , Overdose de Drogas/prevenção & controle , Transtornos Relacionados ao Uso de Opioides/reabilitação , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Analgésicos Opioides/provisão & distribução , Colúmbia Britânica , Overdose de Drogas/epidemiologia , Habitação , Humanos , Drogas Ilícitas/envenenamento , Drogas Ilícitas/provisão & distribução , Programas de Troca de Agulhas , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Equipamento de Proteção Individual , Risco , Centros de Tratamento de Abuso de Substâncias/estatística & dados numéricos
5.
Tex Med ; 116(10): 32-35, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-33126270
7.
J Thorac Cardiovasc Surg ; 159(2): 691-702.e5, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-33003262

RESUMO

OBJECTIVE: We sought to identify whether chronic opioid users are at increased risk for complications or hospital readmission following lobectomy for non-small cell lung cancer. METHODS: The National Cancer Institute Surveillance, Epidemiology, and End Results-Medicare database was queried to identify patients older than age 65 years who received a lobectomy for non-small cell lung cancer. Chronic opioid users were identified through Medicare Part D records and were defined as those with >120 cumulative days of opioid supply for the year before surgery. A systematic 1:2 propensity matching was performed among chronic opioid users. RESULTS: Six thousand four hundred thirty-seven patients were identified, among whom 3627 (56%) were opioid naïve, 1866 (29%) were intermittent opioid users, and 944 (15%) were chronic opioid users. After propensity matching, 30-day mortality and 90-day mortality were nearly 2-fold higher among chronic opioid users compared with nonchronic users. In addition, length of stay and hospital charges were increased among chronic opioid users (median, 6 vs 7 days and mean increase, $12,526, respectively). Multivariable analysis revealed that intermittent opioid users and chronic opioid users were associated with an increased risk of 90-day hospital readmission compared with opioid-naïve patients (odds ratio, 1.35; 95% confidence interval, 1.07-1.71 and odds ratio, 1.72; 95% confidence interval, 1.40-2.12, respectively), predominantly burdened by infectious, renal, and pulmonary causes. CONCLUSIONS: Patients who chronically use opioids before lobectomy represent high-risk patients. The risk of 30- and 90-day mortality, length of stay, hospital charges, and 90-day readmission after lobectomy among chronic opioid users are substantially elevated.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Transtornos Relacionados ao Uso de Opioides/complicações , Pneumonectomia , Complicações Pós-Operatórias/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/complicações , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Feminino , Humanos , Pulmão/cirurgia , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/cirurgia , Masculino , Readmissão do Paciente/estatística & dados numéricos , Pneumonectomia/efeitos adversos , Pneumonectomia/mortalidade , Complicações Pós-Operatórias/mortalidade , Estudos Retrospectivos
9.
Anesth Analg ; 131(4): 1237-1248, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32925345

RESUMO

BACKGROUND: Long-term opioid use has negative health care consequences. Opioid-naïve adults are at risk for prolonged and persistent opioid use after surgery. While these outcomes have been examined in some adolescent and teenage populations, little is known about the risk of prolonged and persistent postoperative opioid use after common surgeries compared to children who do not undergo surgery and factors associated with these issues among pediatric surgical patients of all ages. METHODS: Using a national administrative claims database, we identified 175,878 surgical visits by opioid-naïve children aged ≤18 years who underwent ≥1 of the 20 most common surgeries from each of 4 age groups between December 31, 2002, and December 30, 2017, and who filled a perioperative opioid prescription 30 days before to 14 days after surgery. Prolonged opioid use after surgery (filling ≥1 opioid prescription 90-180 days after surgery) was compared to a reference sample of 1,354,909 nonsurgical patients randomly assigned a false "surgery" date. Multivariable logistic regression models were used to estimate the association of surgical procedures and 22 other variables of interest with prolonged opioid use and persistent postoperative opioid use (filling ≥60 days' supply of opioids 90-365 days after surgery) for each age group. RESULTS: Prolonged opioid use after surgery occurred in 0.77%, 0.76%, 1.00%, and 3.80% of surgical patients ages 0-<2, 2-<6, 6-<12, and 12-18, respectively. It was significantly more common in surgical patients than in nonsurgical patients (ages 0-<2: odds ratio [OR] = 4.6 [95% confidence interval (CI), 3.7-5.6]; ages 2-<6: OR = 2.5 [95% CI, 2.1-2.8]; ages 6-<12: OR = 2.1 [95% CI, 1.9-2.4]; and ages 12-18: OR = 1.8 [95% CI, 1.7-1.9]). In the multivariable models for ages 0-<12 years, few surgical procedures and none of the other variables of interest were associated with prolonged opioid use. In the models for ages 12-18 years, 10 surgical procedures and 5 other variables of interest were associated with prolonged opioid use. Persistent postoperative opioid use occurred in <0.1% of patients in all age groups. CONCLUSIONS: Some patient characteristics and surgeries are positively and negatively associated with prolonged opioid use in opioid-naïve children of all ages, but persistent opioid use is rare. Specific pediatric subpopulations (eg, older patients with a history of mood/personality disorder or chronic pain) may be at markedly higher risk.


Assuntos
Analgésicos Opioides/efeitos adversos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/etiologia , Complicações Pós-Operatórias/epidemiologia , Período Pós-Operatório , Adolescente , Fatores Etários , Analgésicos Opioides/uso terapêutico , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Masculino , Transtornos Mentais/complicações , Transtornos Mentais/epidemiologia , Transtornos Relacionados ao Uso de Opioides/psicologia , Fatores de Risco , Procedimentos Cirúrgicos Operatórios/classificação , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos
10.
Sports Health ; 12(6): 528-533, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32966157

RESUMO

INTRODUCTION: Opioid prescribing patterns play an important role in the opioid epidemic in the United States. The purpose of this study is to examine the trends and geographic variation in opioid prescribing patterns after anterior cruciate ligament (ACL) reconstruction. HYPOTHESIS: Regional differences in opioid prescribing patterns after ACL reconstruction are present. STUDY DESIGN: Descriptive epidemiology study. LEVEL OF EVIDENCE: Level 4. METHODS: The Truven Health MarketScan Commercial Claims database was used to analyze all patients with perioperative private insurance coverage who underwent ACL reconstruction from January 1, 2010, to November 31, 2017. Total number and morphine milligram equivalents per day (MMED) of opioid prescriptions were examined, and regional and statewide variation was assessed. RESULTS: A total of 90,068 ACL reconstruction patients who underwent surgery between 2010 and 2017 were included in the study. Overall, 67% received an opioid prescription within 30 days of surgery and 17% received an opioid prescription ≥90 MMED. The West (20%) had the highest proportion of patients with an opioid prescription ≥90 MMED and the Northeast had the lowest (12%), P < 0.001. The number of opioid prescriptions as well as proportion of opioid prescriptions ≥90 MMED varied significantly by state, P < 0.001. There was a significant increase in number of opioid prescriptions from 2010 to 2017 (62% in 2010 and 83% in 2017; P < 0.001). A significant change in the proportion of patients being prescribed ≥90 MMED was also present (P = 0.04; 15% in 2010, 17% in 2011, 17% 2012, 17% in 2013, 15% in 2014, 20% in 2015, 18% in 2016, and 15% in 2017). CONCLUSION: This study shows a trend of increasing opioid prescriptions and geographic variations in the amount and MMED of opioid prescriptions for patients undergoing ACL reconstruction. These data highlight several areas of improvement that state officials and national entities can use to help curb the opioid epidemic and underscore the importance of national guidelines for opioid prescribing. CLINICAL RELEVANCE: Knowledge of prescribing patterns after specific procedures may help provide more direct insight and guidance to surgeons and patients regarding postoperative pain management.


Assuntos
Analgésicos Opioides/uso terapêutico , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Prescrições de Medicamentos/estatística & dados numéricos , Dor Pós-Operatória/tratamento farmacológico , Padrões de Prática Médica , Adulto , Feminino , Humanos , Masculino , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Uso Indevido de Medicamentos sob Prescrição/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco , Estados Unidos/epidemiologia , Adulto Jovem
11.
Mol Pharmacol ; 98(4): 433-444, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32958571

RESUMO

For decades the broad role of opioids in addiction, neuropsychiatric disorders, and pain states has been somewhat well established. However, in recent years, with the rise of technological advances, not only is the existing dogma being challenged, but we are identifying new disease areas in which opioids play a critical role. This review highlights four new areas of exploration in the opioid field. The most recent addition to the opioid family, the nociceptin receptor system, shows promise as the missing link in understanding the neurocircuitry of motivation. It is well known that activation of the kappa opioid receptor system modulates negative affect and dysphoria, but recent studies now implicate the kappa opioid system in the modulation of negative affect associated with pain. Opioids are critical in pain management; however, the often-forgotten delta opioid receptor system has been identified as a novel therapeutic target for headache disorders and migraine. Lastly, changes to the gut microbiome have been shown to directly contribute to many of the symptoms of chronic opioid use and opioid related behaviors. This review summarizes the findings from each of these areas with an emphasis on identifying new therapeutic targets. SIGNIFICANCE STATEMENT: The focus of this minireview is to highlight new disease areas or new aspects of disease in which opioids have been implicated; this includes pain, motivation, migraine, and the microbiome. In some cases, this has resulted in the pursuit of a novel therapeutic target and resultant clinical trial. We believe this is very timely and will be a refreshing take on reading about opioids and disease.


Assuntos
Analgésicos Opioides/farmacologia , Transtornos de Enxaqueca/metabolismo , Transtornos Relacionados ao Uso de Opioides/microbiologia , Dor/metabolismo , Receptores Opioides/metabolismo , Analgésicos Opioides/uso terapêutico , Animais , Microbioma Gastrointestinal/efeitos dos fármacos , Humanos , Transtornos de Enxaqueca/tratamento farmacológico , Motivação , Transtornos Relacionados ao Uso de Opioides/metabolismo , Dor/tratamento farmacológico , Receptores Opioides delta/metabolismo , Receptores Opioides kappa/metabolismo , Transdução de Sinais/efeitos dos fármacos
12.
PLoS One ; 15(9): e0238285, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32925928

RESUMO

BACKGROUND: Chronic and high dose opioid use may result in adverse events. We analyzed the risk associated with chronic and high dose opioid prescription in a Swiss population. METHODS: Using insurance claims data covering one-sixth of the Swiss population, we analyzed recurrent opioid prescriptions (≥2 opioid claims with at least 1 strong opioid claim) between 2006 and 2014. We calculated the cumulative dose in milligrams morphine equivalents (MED) and treatment duration. Excluded were single opioid claims, opioid use that was cancer treatment related, and opioid use in substitution programs. We assessed the association between the duration of opioid use, prescribed opioid dose, and benzodiazepine use with emergency department (ED) visits, urogenital and pulmonary infections, acute care hospitalization, and death at the end of the episode. RESULTS: In 63,642 recurrent opioid prescription episodes (acute 38%, subacute 7%, chronic 25.8%, very chronic (>360 days) episodes 29%) 18,336 ED visits, 30,209 infections, 19,375 hospitalizations, and 9,662 deaths occurred. The maximum daily MED dose was <20 mg in 15.8%, 20-<50 mg in 16.6%, 50-<100 mg in 21.6%, and ≥100 mg in 46%. Compared to acute episodes (<90 days), episode duration was an independent predictor of ED visits (chronic OR 1.09 (95% CI 1.03-1.15), very chronic (>360 days) OR 1.76 (1.67-1.86)) for adverse effects; infections (chronic OR 1.74 (1.66-1.82), very chronic 4.16 (3.95-4.37)), and hospitalization (chronic: OR 1.22 (1.16-1.29), very chronic OR 1.82 (1.73-1.93)). The risk of death decreased over time (very chronic OR 0.46 (0.43-0.50)). A dose dependent increased risk was observed for ED visits, hospitalization, and death (≥100mg daily MED OR 1.21 (1.13-1.29), OR 1.29 (1.21-1.38), and OR 1.67, 1.50-1.85, respectively). A concomitant use of benzodiazepines increased the odds for ED visits by 46% (OR 1.46, 1.41-1.52), infections by 44% (OR 1.44, 1.41-1.52), hospitalization by 12% (OR 1.12, 1.07-1.1), and death by 45% (OR 1.45, 1.37-1.53). CONCLUSION: The length of opioid use and higher prescribed morphine equivalent dose were independently associated with an increased risk for ED visits and hospitalizations. The risk for infections, ED visits, hospitalizations, and death also increased with concomitant benzodiazepine use.


Assuntos
Analgésicos Opioides/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Hospitalização/estatística & dados numéricos , Revisão da Utilização de Seguros/estatística & dados numéricos , Transtornos Relacionados ao Uso de Opioides/etiologia , Idoso , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/patologia , Feminino , Humanos , Masculino , Transtornos Relacionados ao Uso de Opioides/patologia , Prognóstico , Fatores de Risco
14.
Sr Care Pharm ; 35(10): 413-418, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32972491

RESUMO

Substance misuse in adults 60 years of age and older is one of the fastest-growing health issues in the United States. Alcohol and prescription drugs are among the most commonly misused agents. With growing concern for opioid-overdose deaths and the use of opioids in the treatment of persistent pain in older adults, it is imperative that practitioners are aware of emerging therapies used to manage the symptoms that may result after discontinuation of opioid medications. This review highlights the first nonopioid treatment plan for the management of opioid withdrawal symptoms with a novel pharmacologic mechanism.


Assuntos
Transtornos Relacionados ao Uso de Opioides , Analgésicos Opioides/efeitos adversos , Clonidina/análogos & derivados , Clonidina/uso terapêutico , Humanos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Estados Unidos
15.
J Opioid Manag ; 16(4): 277-282, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32885835

RESUMO

The prevalence of opioid abuse has reached an epidemic level. National guidelines recommend safer opioid prescribing practices, including potentially monitoring patients with urine drug testing (UDT). There is limited research evidence sur-rounding the use of UDT in the context of chronic noncancer pain (CNCP). We evaluated the efficacy of systematic, randomized UDT to detect and manage opioid misuse among patients with CNCP in primary care. The Marathon Family Health Team (MFHT) designed and implemented a clinic-wide, randomized UDT program called the HARMS (High-yield Approach to Risk Mitigation and Safety) Program. This retrospective chart review includes 77 CNCP patients being pre-scribed opioids, who were initially stratified by their prescriber as "low-risk." Each month, 10 percent of patients were selected for a random UDT with double testing (immunoassay and liquid chromatography-mass spectrometry). The pri-mary outcome measure was UDT leading to a change in management plan. Of the 77 patients in the study, 55 (71 per-cent) completed at least one UDT during the 12-month study period. Overall, 22 patients had aberrant results. UDT led directly to changes in management in 15 of those patients. Four of those 15 patients were escalated to an addictions program, two were tapered from opioids with informed discussion, and nine were escalated to the high-risk monitoring stream. The results of this study show that in low-risk CNCP patients prescribed opioids, applying systematic UDT in a primary care setting is effective for detecting high risk behaviors and addiction, and altering management. Further re-search is needed with larger numbers using a prospective study design.


Assuntos
Analgésicos Opioides , Dor Crônica , Transtornos Relacionados ao Uso de Opioides , Dor Crônica/tratamento farmacológico , Humanos , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Padrões de Prática Médica , Atenção Primária à Saúde , Estudos Prospectivos , Estudos Retrospectivos , Urinálise
16.
J Opioid Manag ; 16(4): 291-296, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32885837

RESUMO

OBJECTIVE: Pilot study to assess psychometric indices of the screener and opioid assessment for patients with pain-revised (SOAPP-R©) with item response theory. DESIGN: Correlational. SETTING: Patients. OUTCOME MEASURES: The SOAPP-R©, the pain self-efficacy questionnaire (PSE-Q), and the patient health questionnaire-9 (PHQ-9) and a demographic -questionnaire. RESULTS: A three-dimensional model provided the best fit for the SOAPP-R© item responses, with scales entitled drug-alcohol concerns, pain medication, and emotional stress; reliabilities were 0.77, 0.71, and 0.80 for those three scales. Significant correlations were found with the PSE-Q, the PHQ-9, and the SPQ for the drug-alcohol scale but not for the two remaining scales. CONCLUSIONS: The SOAPP-R© showed invariance and support for validity, but with a three-dimensional scale structure.


Assuntos
Analgésicos Opioides , Transtornos Relacionados ao Uso de Opioides , Manejo da Dor , Humanos , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Dor , Projetos Piloto , Reprodutibilidade dos Testes , Inquéritos e Questionários
17.
J Opioid Manag ; 16(4): 283-289, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32885836

RESUMO

OBJECTIVE: Opioid use is a continuing problem for the United States. Individuals who use opioids have a high risk of misuse, especially with prescription opioids. Substances that are often used in combination with opioids include methamphetamines, sedatives, and benzodiazepines, as well as tobacco, alcohol, and marijuana, but not in a medical setting. We sought to determine (a) the relationship between various drugs (eg, methamphetamine, benzodiazepines) and opioid use, as well as (b) the relationship between polysubstance use and opioid use. DESIGN: We created a screening instrument that requested the patients seeking medical care at Federally Qualified Health Centers (FQHC) and Veterans Affairs (VA) hospitals in West Alabama self-report their substance usage. SETTING: This study took place in outpatient primary care settings (FQHCs and VA hospitals) in west Alabama. PARTICIPANTS: De-identified electronic health records for 346 adults were obtained from consenting medical facilities. Missing data were found in 33 of the records obtained. The final usable sample for this study was 311. MAIN OUTCOME MEASURE: The screening tool was comprised of five sections: demographics, tobacco use, alcohol abuse, drug use, and mental health. The primary outcome measure of this study was the number of days of opioid use in the past 30 days. RESULTS: Thirteen individuals (4.18 percent) reported opioid use in the last 30 days. While polysubstance or dual sub-stance use was not in the majority of the participant responses, the significant substances that were used in conjunction with opioids were methamphetamine, hallucinogens, and benzodiazepines. CONCLUSIONS: Individuals who are polysubstance users have a higher likelihood of opioid use. Interventions that target opioid use would serve the population stronger by including screenings and potential treatments for polysubstance use additionally.


Assuntos
Analgésicos Opioides , Alucinógenos , Transtornos Relacionados ao Uso de Opioides , Serviços de Saúde Rural , Adulto , Analgésicos Opioides/uso terapêutico , Benzodiazepinas , Humanos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Padrões de Prática Médica , Atenção Primária à Saúde , Estados Unidos
18.
J Opioid Manag ; 16(4): 297-306, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32885838

RESUMO

Tramadol is a centrally acting dual-mechanism (opioid and monoamine reuptake inhibition) analgesic that has been noted to have a lower risk of abuse compared to conventional opioids such as morphine. Oral tramadol has been ap-proved in the United States since 1995 and intravenous (IV) tramadol has been widely prescribed outside the United States (OUS); nevertheless, IV tramadol has not yet been approved for use in the United States. This paper provides a review of the pharmacokinetics (PK) of the IV tramadol dosing regimen being developed in the United States, its abuse potential as documented in the literature, and its safety record in clinical practice, and discusses how IV tramadol may become a useful option for patients in the United States with acute pain.


Assuntos
Dor Aguda , Analgésicos Opioides , Transtornos Relacionados ao Uso de Opioides , Tramadol , Dor Aguda/tratamento farmacológico , Administração Intravenosa , Analgésicos Opioides/efeitos adversos , Analgésicos Opioides/farmacocinética , Humanos , Morfina , Tramadol/efeitos adversos , Tramadol/farmacocinética
19.
PLoS One ; 15(9): e0238618, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32915834

RESUMO

INTRODUCTION: British Columbia's (BC) Take-Home Naloxone (THN) program provides naloxone to bystanders for use in cases of suspected opioid overdose. This study seeks to provide trends and analysis from the provincial BC THN program since inception in 2012 to the end of 2018. MATERIALS AND METHODS: BC THN shipment and distribution records from 2012-2018 were retrieved. Frequency distributions were used to describe characteristics of individuals accessing the program. To evaluate correlates of distribution after the addition of hundreds of pharmacy distribution sites, an analytic sample was limited to records from 2018, and multivariate logistic regression was used to evaluate correlates of collecting naloxone at a pharmacy site. RESULTS: Since program inception to the end of 2018, there were 398,167 naloxone kits shipped to distribution sites, 149,999 kits reported distributed, and 40,903 kits reported used to reverse an overdose in BC. There was a significant increasing trend in the number of naloxone kits used to reverse an overdose over time (p<0.01), and more than 90% of kits that were reported used were distributed to persons at risk of an overdose. Individuals not personally at risk of overdose had higher odds of collecting naloxone at a pharmacy site, compared to other community sites (including harm reduction supply distribution sites, peer led organizations, drop-in centers, and supportive housing sites) (Adjusted Odds Ratio (AOR): 2.69; 95% CI: 2.50-2.90). CONCLUSIONS: This study documents thousands of opioid overdose reversals facilitated through the BC THN program. While those at highest risk of overdose may preferentially access naloxone through community sites, naloxone distribution through pharmacies has allowed the BC THN program to expand dramatically, increasing naloxone availability through longer opening hours on evenings and weekends. and in rural and remote regions. A diversity of naloxone distribution sites and strategies is crucial to prevent rising opioid overdose deaths.


Assuntos
Overdose de Drogas/tratamento farmacológico , Naloxona/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Adulto , Colúmbia Britânica/epidemiologia , Overdose de Drogas/epidemiologia , Overdose de Drogas/prevenção & controle , Feminino , Redução do Dano , Humanos , Masculino , Pessoa de Meia-Idade , Naloxona/efeitos adversos , Antagonistas de Entorpecentes/efeitos adversos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Farmácias/tendências
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