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3.
Forensic Sci Int ; 307: 110137, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31927248

RESUMO

Seizures of synthetic opioids have increased since 2012, with a 45 % increase in synthetic opioid related deaths between 2016 and 2017 in US. Recently, concerns have arisen around these substances and their illicit use also in several European countries. Our aim was to develop and validate an ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method for the analysis of 16 synthetic opioids in segmented hair, including fentanyl, norfentanyl, acetylfentanyl, U-47700, AH-7921, acrylfentanyl, crotonylfentanyl, butyrylfentanyl, methoxacetylfentanyl, U-49900, valeryfentanyl, 4-fluoro-iso-butyrylfentanyl, ocfentanyl, furanylfentanyl, tetrahydrofuranylfentanyl, and alfetanyl. Sample preparation involved washing the hair in dichloromethane, water and methanol, and extraction in methanol, followed by solid phase extraction clean-up. This method was validated for linearity, limit of quantification (LLOQ), precision and bias, selectivity, stability, matrix effects, extraction efficiency of the clean up procedure, and carryover. LLOQs ranged from 0.15-1pg/mg, and the calibration ranged from the LLOQ up to 500pg/mg. Intra and inter-day precision were evaluated at low and high concentrations, with spiked QCs, during 8 days and the results were satisfactory with RSD<15 % for all the compounds except for norfentanyl (22 %) and alfentanyl (19 %). Two external certified QCs containing fentanyl at 11 and 105pg/mg were also analysed within each batch and the RSD and bias were lower than 16 % and 10 %, respectively. Matrix effects compensated by internal standard fentanyl-d5 (MEIS), were between 77-115 % (RSD<10 %) and extraction efficiency of the clean-up procedure was between 66-93 % (RSD<21 %). Processed sample stability and carryover were acceptable for all of the compounds. The method was applied to 17 authentic hair samples (body or head hair) from US fentanyl analogue users. When head hair was available, the hair strands were analysed in 1cm/segment. Concentrations ranges were as follows: fentanyl (n=16) 2->ULOQ (500) pg/mg, norfentanyl (n=14) 1-38pg/mg, acetylfentanyl (n=7) 0.6->ULOQ (250) pg/mg, furanylfentanyl (n=5) 2-123pg/mg, tetrahydrofuranylfentanyl (n=1) 0.5-63pg/mg and valerylfentanyl (n=1) 2.1->ULOQ (50) pg/mg, along the hair strands. To our knowledge, this is the first time where concentrations of tetrahydrofuranylfentanyl, and valerylfentanyl in hair are reported. The same samples were also analysed for the determination of other drugs of abuse using our routine method (also in 1cm/segment for head hair when available). The results demonstrated poly-drug use in these fentanyl-analogue users population (mean drugs: n=5): amphetamine and/or methamphetamine (n=10), buprenorphine (n=5), cocaine (n=8), methadone (n=8), 6-MAM (n=17), meperidine (n=1), oxycodone (n=11), tramadol (n=3). Evaluation of the concentrations of these drugs, together with the fentanyl analogues is discussed in the present paper. Two authentic samples from two Belgian post-mortem cases, were also analysed showing fentanyl use and in one case polydrug use. The results demonstrated multi-analyte quantitative methods, including fentanyl analogues, are becoming useful in forensic laboratories involved in hair analysis, and in particular when polydrug use is suspected.


Assuntos
Analgésicos Opioides/análise , Fentanila/análogos & derivados , Fentanila/análise , Cabelo/química , Detecção do Abuso de Substâncias/métodos , Cromatografia Líquida de Alta Pressão/métodos , Toxicologia Forense/métodos , Humanos , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Medicamentos Sintéticos/análise , Espectrometria de Massas em Tandem/métodos
4.
J Forensic Sci ; 65(1): 112-116, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31483504

RESUMO

Given the common occurrence of both opioid and cardiovascular deaths, and the concomitant use of opioids in those with cardiac disease, the present study was undertaken to see whether the old adage of using the triad of cerebral and pulmonary edema and bladder fullness to suggest an opioid death could be used to differentiate deaths due to opioid toxicity from deaths due to cardiac disease. Brain weight, lung weight, and bladder fullness were compared among opioid-related deaths, cardiac deaths, and a control population. It was found that opioid-related deaths were more likely to have heavy lungs, a heavy brain, and a full bladder, while cardiac-related deaths had smaller volumes of urine in the bladder and heavier hearts. In conjunction with a thorough investigation, these findings may be useful to forensic pathologists when determining whether a death is opioid-related, especially in the setting of concomitant cardiac disease.


Assuntos
Analgésicos Opioides/envenenamento , Doenças Cardiovasculares/diagnóstico , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Adolescente , Adulto , Distribuição por Idade , Idoso , Analgésicos Opioides/efeitos adversos , Autopsia , Encéfalo/patologia , Edema Encefálico/patologia , Estudos de Casos e Controles , Overdose de Drogas , Feminino , Patologia Legal , Humanos , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Miocárdio/patologia , Tamanho do Órgão , Edema Pulmonar/patologia , Estudos Retrospectivos , Distribuição por Sexo , Bexiga Urinária/patologia , Adulto Jovem
5.
Nurs Clin North Am ; 54(4): 495-501, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31703775

RESUMO

This article offers a brief review geared toward primary care providers of the most critical aspects of the management of opiate use disorder, including screening, brief intervention, and referral to treatment as well as medication-assisted treatment and the alarming trends and dangers of illicitly produced fentanyl.


Assuntos
Analgésicos Opioides/efeitos adversos , Overdose de Drogas/prevenção & controle , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Atenção Primária à Saúde , Overdose de Drogas/tratamento farmacológico , Fentanila/efeitos adversos , Humanos , Transtornos Relacionados ao Uso de Opioides/terapia
6.
Spine (Phila Pa 1976) ; 44(23): 1668-1675, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31730572

RESUMO

STUDY DESIGN: A retrospective cohort study performed in a nationwide insurance claims database. OBJECTIVE: This study aimed to examine duration and magnitude of postoperative opioid prescriptions following common spinal procedures. SUMMARY OF BACKGROUND DATA: Postoperative opioid prescription practices vary widely among providers and procedures and standards of care are not well-established. Previous work does not adequately quantify both duration and magnitude of opioid prescription. METHODS: Forty seven thousand eight hundred twenty three patients with record of any of four common spinal procedures in a nationwide insurance claims database were stratified by preoperative opioid use into three categories: "opioid naive," "sporadic user," or "chronic user," defined as 0, 1, or 2+ prescriptions filled in the 6 months preceding surgery. Those with record of subsequent surgery or readmission were excluded. Duration of opioid use was defined as the time between the index surgery and the last record of filling an opioid prescription. Magnitude of opioid use was defined as milligram morphine equivalents (MME) filled by 30 days post-op, converted to 5 mg oxycodone pills for interpretation. RESULTS: Opioid naive patients were less likely than chronic opioid users to fill any opioid prescription after surgery (63-68% naive vs. 91-95% chronic, P < 0.001), and when they did, their prescriptions were smaller in magnitude (76-91 pills naive vs. 127-152 pills chronic). One year after surgery, 15% to 18% of opioid naive and 50% to 64% of chronic opioid users continued filling prescriptions. CONCLUSION: Opioid naive patients use less postoperative opioids, and for a shorter period of time, than chronic users. This study serves as a normative benchmark for examining postoperative opioid use, which can assist providers in identifying patients with opioid dependence. Importantly, this work calls out the high risk of opioid exposure, as 15% to 18% of opioid naive patients continued filling opioid prescriptions 1 year after surgery. LEVEL OF EVIDENCE: 3.


Assuntos
Analgésicos Opioides/administração & dosagem , Bases de Dados Factuais/tendências , Dor Pós-Operatória/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Benchmarking/métodos , Benchmarking/tendências , Criança , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/epidemiologia , Estudos Retrospectivos , Adulto Jovem
7.
J Opioid Manag ; 15(4): 272-274, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31637679

RESUMO

OBJECTIVE: To determine the utility of the screener and opioid assessment for patients with pain-revised (SOAPP-R) for patients with cancer-related pain. DESIGN: The authors performed a retrospective analysis of cancer patients screened with the SOAPP-R. Opiate abuse was determined using a combination of urine drug screens and analysis of patients' electronic medical records. SETTING/PATIENTS: Patients who were seen at a palliative care clinic presenting with pain or needing an opioid prescription at an academic medical center with any type of cancer were screened using the SOAPP-R (N = 69). OUTCOME MEASURES: Aberrant opioid-related behavior was determined using a combination of provider notes and urine drug screens. RESULTS: A positive SOAPP-R score (⩾18) was observed in 27 participants (39.1 percent). The sensitivity and specificity of the SOAPP-R in the study population was 0.75 and 0.80, respectively. CONCLUSIONS: The SOAPP-R, in its current form, may have value in screening patients with cancer for substance abuse. Incorporation of the screening tool in palliative and oncology settings may help reduce opioid abuse in cancer patients.


Assuntos
Analgésicos Opioides , Neoplasias/complicações , Transtornos Relacionados ao Uso de Opioides , Dor/tratamento farmacológico , Inquéritos e Questionários/normas , Analgésicos Opioides/uso terapêutico , Humanos , Programas de Rastreamento/métodos , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Dor/etiologia , Manejo da Dor , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco , Sensibilidade e Especificidade
8.
J Opioid Manag ; 15(4): 285-293, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31637681

RESUMO

OBJECTIVE: To compare dependence characteristics between patients with chronic pain treated within an addiction medicine setting with those attending specialist pain clinics. SETTING AND PATIENTS: Forty patients with chronic non-cancer pain taking opioid analgesics for >1 year were recruited from university-affiliated, tertiary teaching hospital clinics; 20 from an addiction medicine clinic (addiction clinic group) and 20 from specialist pain clinics (pain clinic group). DESIGN AND MAIN OUTCOME MEASURES: Data regarding demographics, past and current substance use, pain history and current daily opioid intake were collected. Patients completed three questionnaires: the Severity of Opioid Dependence Questionnaire, Leeds Dependence Questionnaire, and Pain Disability Index. A novel "Opioid Problem Checklist score" assessing drug-related problems was also determined for each patient. RESULTS: The addiction clinic group were younger, more likely to have experienced drug overdose and had a shorter duration of chronic pain. No significant differences in dependence questionnaire scores were found between groups. However, higher Pain Disability Index scores and higher Opioid Problem Checklist scores (indicating more drug-related problems) were found for the addiction clinic group. CONCLUSIONS: Some degree of dependence was present across both addiction and pain clinic groups, supporting the notion a state of dependence can be identified among chronic pain patients taking opioids long term. Aberrant behaviors were not common in the pain clinic sample, suggesting these patients are unlikely to meet Diagnostic and Statistical Manual of Mental Disorders-V criteria for Substance Use Disorder. However, opioid dependence carries significant risks for relapse, chronicity, morbidity and mortality, warranting specific medical management. Management of such risks should be considered routine care in chronic pain patients taking opioids long term.


Assuntos
Analgésicos Opioides/efeitos adversos , Analgésicos Opioides/uso terapêutico , Comportamento Aditivo , Dor Crônica , Transtornos Relacionados ao Uso de Opioides , Dor Crônica/tratamento farmacológico , Humanos , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Clínicas de Dor , Avaliação de Sintomas
9.
West J Emerg Med ; 20(5): 804-809, 2019 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-31539338

RESUMO

INTRODUCTION: Screening of patients for opioid risk has been recommended prior to opioid prescribing. Opioids are prescribed frequently in the emergency department (ED) setting, but screening tools are often of significant length and therefore limited in their utility. We describe and evaluate three approaches to shortening a screening tool: creation of a short form; curtailment; and stochastic curtailment. METHODS: To demonstrate the various shortening techniques, this retrospective study used data from two studies of ED patients for whom the provider was considering providing an opioid prescription and who completed the Screener and Opioid Assessment for Patients with Pain-Revised, a 24-item assessment. High-risk criteria from patients' prescription drug monitoring program data were used as an endpoint. Using real-data simulation, we determined the sensitivity, specificity, and test length of each shortening technique. RESULTS: We included data from 188 ED patients. The original screener had a test length of 24 questions, a sensitivity of 44% and a specificity of 76%. The 12-question short form had a sensitivity of 41% and specificity of 75%. Curtailment and stochastic curtailment reduced the question length (mean test length ranging from 8.1-19.7 questions) with no reduction in sensitivity or specificity. CONCLUSION: In an ED population completing computer-based screening, the techniques of curtailment and stochastic curtailment markedly reduced the screening tool's length but had no effect on test characteristics. These techniques can be applied to improve efficiency of screening patients in the busy ED environment without sacrificing sensitivity or specificity.


Assuntos
Analgésicos Opioides/efeitos adversos , Serviço Hospitalar de Emergência , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Padrões de Prática Médica , Programas de Monitoramento de Prescrição de Medicamentos/organização & administração , Adulto , Feminino , Humanos , Masculino , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Inquéritos e Questionários
11.
J Consult Clin Psychol ; 87(10): 849-858, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31556662

RESUMO

OBJECTIVE: The opioid crisis has had devastating effects on individuals and communities, and it has rapidly increased in severity. However, we still lack nationally representative information on the diversity of comorbidity patterns among prescription opioid use disorder (P-OUD), other substance use disorders (SUDs), and psychopathology using the newest edition of the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013). This impedes planning for multiple aspects of intervention, including society-wide allocation of treatment resources, program design at individual treatment centers, and personalized care to individual patients. METHOD: To address this critical gap in information, we evaluated clinical profiles of American adults via latent class analysis in a large, recently collected epidemiological dataset that uses structured diagnostic assessment for DSM-5 psychopathology (National Epidemiologic Survey on Alcohol and Related Conditions-III; N = 36,309). Variables considered for profiles included lifetime diagnosis for multiple SUDs, various externalizing and internalizing conditions, and demographic variables. We then associated clinical profiles with demographic variables and functional impairment. RESULTS: Comorbid psychopathology and other SUDs were common in latent classes with elevated and very high rates of P-OUD. To illustrate, alcohol use disorder rates were greater than 45%, and posttraumatic stress disorder rates were greater than 28% in classes with higher P-OUD rates. Higher P-OUD rates were associated with White/non-Hispanic and American Indian/Alaska Native populations. Relationships between P-OUD rates and functional impairment were inconsistent. CONCLUSION: Many current treatment delivery systems are not designed to accommodate the heterogeneous profiles associated with high P-OUD rates. We provide specific suggestions for improvements to the mental health service system, individual clinical care programs, and future research approaches. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Alcoolismo/epidemiologia , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Masculino , Serviços de Saúde Mental , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/psicologia , Prevalência , Estados Unidos , Adulto Jovem
12.
J Consult Clin Psychol ; 87(10): 893-903, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31556666

RESUMO

OBJECTIVE: The prevalence of misuse of prescription opioids across adulthood and the associations of such misuse with symptoms of psychopathology and use of other substances were examined for an at-risk community sample of men. METHOD: For a longitudinal study of boys (N = 206) followed to adulthood, misuse of prescription opioids was assessed on 13 occasions from ages 20-21 years to 37-38 years. Prediction of misuse was examined from prospectively assessed risk factors in 3 models: (a) parental substance use during the men's adolescence; (b) the men's own risk behaviors in adolescence-delinquent behavior, depressive symptoms, and use of tobacco, alcohol, marijuana, and opioids; and (c) within- and between-individual effects of the men's risk behaviors during adulthood. RESULTS: Opioid misuse was reported by 29% of men. After accounting for effects of age and considered individually, parent marijuana use and all of the adolescent and adult risk factors (except adolescent depressive symptoms) were significant between-individual predictors of opioid misuse. Furthermore, within-individual prediction was significant for adult delinquency and alcohol use after accounting for increases in opioid misuse with age. When risk factors were tested simultaneously, men's adult delinquency and use of marijuana and tobacco remained significant between-individual predictors, whereas no parental or adolescent risk factors remained significant in these models. CONCLUSION: Both adolescent and adult risk factors were examined that predicted adult opioid misuse. Preventing adolescent problem behavior and using such histories to inform screening for misuse risk in adulthood may reduce the burden of the opioid crisis. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Homens , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Humanos , Estudos Longitudinais , Masculino , Fumar Maconha/epidemiologia , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Pais , Prevalência , Fatores de Risco , Adulto Jovem
13.
Toxicol Lett ; 317: 53-58, 2019 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-31560942

RESUMO

In 2017, the U.S. Department of Health and Human Services and the White House declared a public health emergency to address the opioid crisis (Hargan, 2017). On average, 192 Americans died from drug overdoses each day in 2017; 130 (67%) of those died specifically because of opioids (Scholl et al., 2019). Since 2013, there have been significant increases in overdose deaths involving synthetic opioids - particularly those involving illicitly-manufactured fentanyl. The U.S. Drug Enforcement Administration (DEA) estimates that 75% of all opioid identifications are illicit fentanyls (DEA, 2018b). Laboratories are routinely asked to confirm which fentanyl or other opioids are involved in an overdose or encountered by first responders. It is critical to identify and classify the types of drugs involved in an overdose, how often they are involved, and how that involvement may change over time. Health care providers, public health professionals, and law enforcement officers need to know which opioids are in use to treat, monitor, and investigate fatal and non-fatal overdoses. By knowing which drugs are present, appropriate prevention and response activities can be implemented. Laboratory testing is available for clinically used and widely recognized opioids. However, there has been a rapid expansion in new illicit opioids, particularly fentanyl analogs that may not be addressed by current laboratory capabilities. In order to test for these new opioids, laboratories require reference standards for the large number of possible fentanyls. To address this need, the Centers for Disease Control and Prevention (CDC) developed the Traceable Opioid Material§ Kits product line, which provides over 150 opioid reference standards, including over 100 fentanyl analogs. These kits were designed to dramatically increase laboratory capability to confirm which opioids are on the streets and causing deaths. The kits are free to U.S based laboratories in the public, private, clinical, law enforcement, research, and public health domains.


Assuntos
Analgésicos Opioides/análise , Overdose de Drogas/diagnóstico , Fentanila/análise , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Kit de Reagentes para Diagnóstico/normas , Detecção do Abuso de Substâncias/normas , Analgésicos Opioides/classificação , Calibragem , Overdose de Drogas/mortalidade , Fentanila/análogos & derivados , Fentanila/classificação , Humanos , Transtornos Relacionados ao Uso de Opioides/mortalidade , Valor Preditivo dos Testes , Padrões de Referência , Reprodutibilidade dos Testes , Estados Unidos/epidemiologia
14.
Surg Clin North Am ; 99(5): 867-883, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31446915

RESUMO

The current opioid crisis has raised awareness of the risks of misuse, addiction, and overdose with opioid prescribing for pain management in the perioperative and nonoperative care of surgical patients. Despite these risks, it is essential for surgical providers to provide safe and adequate functional pain control to enhance recovery. The purpose of this review is to outline the relevance of the US opioid crisis to surgical prescribing, describe strategies for opioid reduction using a stepwise therapy approach, and provide recommendations for improving the safety of opioid prescribing. Additional recommendations for risk assessment and naloxone coprescribing for high-risk patients are addressed.


Assuntos
Analgésicos Opioides/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Manejo da Dor/métodos , Dor Pós-Operatória/tratamento farmacológico , Analgésicos Opioides/administração & dosagem , Dor Crônica/tratamento farmacológico , Humanos , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Estados Unidos/epidemiologia
15.
Anesth Analg ; 129(3): 864-873, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31425231

RESUMO

BACKGROUND: As national opioid consumption in South Korea has soared, well-validated screening tools for opioid use disorder (OUD) have become indispensable. The aims of our study were to evaluate OUD using the Korean version of the CAGE-Adapted to Include Drugs (CAGE-AID) and the CAGE-Opioid (an alternative version of the CAGE-AID), and to investigate clinical predictors that might be useful to screen for OUD in conjunction with the CAGE-AID/Opioid questionnaires. METHODS: A single-center, prospective, observational study was performed. After linguistic validation of the Korean version of the CAGE-AID/Opioid questionnaires, we assessed OUD in patients with chronic opioid treatment. Multivariable logistic models of the CAGE-AID/Opioid questionnaires combined with relevant clinical predictors were established. Then, the receiver operating characteristic curve analysis of the multivariable CAGE-AID/Opioid models was conducted to assess diagnostic accuracy to screen for OUD. Next, we calculated predicted probability with >85% sensitivity and >50% specificity in each CAGE-AID and CAGE-Opioid model. Using the optimal value of the predicted probability, a cutoff score of the CAGE-AID/Opioid questionnaires combined with the relevant clinical factors was suggested to screen for OUD. RESULTS: Among 201 participants, 51 patients showed ≥1 OUDs. In the multivariable regression model, male sex, comorbid neuropsychiatric disorder, and current heavy drinking significantly remained as clinical variables to predict OUD combined with the scores of the Korean CAGE-AID/Opioid questionnaire. The area under the curve was 0.77 (95% confidence interval, 0.71-0.83) for the CAGE-AID model and 0.78 (95% confidence interval, 0.71-0.83) for the CAGE-Opioid model. The optimal predicted probability values to screen for OUD in the CAGE-AID/Opioid models were >0.135 (sensitivity, 0.86; specificity, 0.52) and >0.142 (sensitivity, 0.86; specificity, 0.53), respectively. When we used these predictive probabilities, the cutoff score of the CAGE-AID/Opioid questionnaires ranged from 0 to 3, which was dependent on the presence of the relevant clinical variables in each model. CONCLUSIONS: In this study, one fourth of the total participants with chronic opioid treatment showed OUD in the Korean population. The multivariable models of the CAGE-AID/Opioid with sex, comorbid neuropsychiatric disorder, and current heavy drinking are valid parameters to screen for OUD, with the cutoff scores of the CAGE-AID/Opioid questionnaires ranging from 0 to 3 depending on the presence of the clinical variables.


Assuntos
Analgésicos Opioides/efeitos adversos , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Inquéritos e Questionários/normas , Tradução , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/efeitos adversos , Manejo da Dor/normas , Valor Preditivo dos Testes , Estudos Prospectivos , República da Coreia/epidemiologia
16.
Trials ; 20(1): 412, 2019 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-31288859

RESUMO

BACKGROUND: Opioid use has risen to epidemic proportions across Canada, with increasing evidence of harms including accidental overdose and death. Policy-makers have called for effective approaches to promote opioid reduction. One promising method from deprescribing randomized trials is to empower patients through direct-to-patient education. The current trial will evaluate the effectiveness of a government-led mail-out of educational information to adult community-dwelling, chronic opioid users on the reduction of opioids compared to usual care. METHODS: This is a pragmatic, prospective, cluster randomized, parallel-arm controlled trial, comparing mailed distribution of a direct-to-patient educational brochure for chronic opioid use (intervention arm) to usual care (control arm). Eligible participants from across Manitoba, Canada, will be identified by the Provincial Drug Programs Branch within the Manitoba Health, Seniors and Active Living Department of the Manitoba Government, allocated to primary care providers, and the latter will be randomized in clusters of family medicine practices to achieve a 1:1 ratio. The primary outcome is complete cessation of opioids after 6 months assessed using Drug Program Information Network data. Secondary outcomes include ≥ 25% dose reduction in the mean morphine milligram equivalent (MME) daily dose, reduction of daily dose to < 90 mg MME, or therapeutic switch to another opioid or non-opioid medication. Data will be analyzed using intent-to-treat generalized estimating equations. DISCUSSION: This trial will test the efficacy of a population-based, wide-scale, government-led direct-to-patient educational initiative to drive reductions in chronic opioid use by community-dwelling adults across Manitoba. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT03400384 . Registered on 18 January 2018.


Assuntos
Analgésicos Opioides/administração & dosagem , Dor Crônica/tratamento farmacológico , Desprescrições , Substituição de Medicamentos , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Folhetos , Educação de Pacientes como Assunto/métodos , Analgésicos Opioides/efeitos adversos , Dor Crônica/diagnóstico , Dor Crônica/psicologia , Esquema de Medicação , Conhecimentos, Atitudes e Prática em Saúde , Política de Saúde , Humanos , Manitoba , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Transtornos Relacionados ao Uso de Opioides/psicologia , Formulação de Políticas , Serviços Postais , Ensaios Clínicos Pragmáticos como Assunto , Estudos Prospectivos , Fatores de Proteção , Medição de Risco , Fatores de Risco , Fatores de Tempo
17.
Pediatrics ; 144(2)2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31320466

RESUMO

The developmental impact of opioid use during pregnancy is a subject of ongoing debate. Short-term neonatal outcomes, such as lower birth weight and neonatal abstinence syndrome, are the most well-recognized outcomes. However, knowledge gaps exist regarding longer-term neurocognitive and mental health outcomes. In this article, we summarize an expert panel discussion that was held in April 2018 by the Substance Abuse and Mental Health Services Administration and attended by national experts in the field of perinatal opioid exposure and its impact on child development. Despite the challenges with research in this area, there is emerging literature revealing an association between neonates exposed to opioids in utero and longer-term adverse neurocognitive, behavioral, and developmental outcomes. Although adverse sequalae may not be apparent in the neonatal period, they may become more salient as children develop and reach preschool and school age. Multiple variables (genetic, environmental, and biological) result in a highly complex picture. The next steps and strategies to support families impacted by opioid use disorder are explored. Model programs are also considered, including integrated care for the child and mother, parenting supports, and augmentations to home visiting.


Assuntos
Analgésicos Opioides/efeitos adversos , Comportamento Infantil/efeitos dos fármacos , Desenvolvimento Infantil/efeitos dos fármacos , Cognição/efeitos dos fármacos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Criança , Comportamento Infantil/fisiologia , Comportamento Infantil/psicologia , Desenvolvimento Infantil/fisiologia , Cognição/fisiologia , Congressos como Assunto , Feminino , Humanos , Masculino , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Transtornos Relacionados ao Uso de Opioides/psicologia , Gravidez , Efeitos Tardios da Exposição Pré-Natal/diagnóstico , Efeitos Tardios da Exposição Pré-Natal/psicologia , Estados Unidos/epidemiologia , United States Substance Abuse and Mental Health Services Administration/tendências
18.
Forensic Sci Int ; 302: 109865, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31279278

RESUMO

Consumption of curry containing poppy seeds has raised an issue concerning the opiate content in the urine that might exceed the cut-off value (300ng/mL). The main objective of this study was to examine the morphine and codeine contents in the urine of the consumers after partaking poppy seed-enriched curry in. The volunteers were asked to partake: (a) a single meal and their urines were collected within 24h, or (b) Two meals a day for three consecutive days and their urines were collected within 72h. Two different dosages were also tested in this study: (a) low dosage: 1g/100ml curry (containing 138µg of morphine and 66µg of codeine) and (b) high dosage: 5g/100ml curry (containing 690µg of morphine and 330µg of codeine). The subjects were randomised into the groups using the method of stratified randomization with age and gender groups as covariates. A total of 6 subjects was allocated for each group and placebos were used as control. Results showed that all subjects who consumed low dosage of poppy seeds either in single meal or multiple meals experiment were found negative. However, 1 out of 6high dosage subjects was confirmed positive at a period of 3-6h after the consumption of curry in the single meal study. This outlier maybe due to the lack of water consumption after consuming the curry, thus the low volume of urine was collected and the opiate was concentrated in the urine. On the other hand, 5 out of 6high dosage subjects in the multiple meals experiment were found positive. Majority of these subjects were found positive on the second and third day of the experiment after the second curry meal was consumed. The outlier (negative) in this group might be due to the high consumption of water throughout the experiment and the subject's urine volumes and frequency of urine collection were much higher compared to other subjects. From the result of this study, it can be concluded that partaking high dosages of poppy seed in curry could give a positive response (>300ng/ml+uncertainty of measurement) in the urine, and the water consumption after partaking curry has significant influence for the opiate contents in the urine.


Assuntos
Codeína/urina , Refeições , Morfina/urina , Papaver/química , Sementes/química , Adulto , Erros de Diagnóstico/prevenção & controle , Feminino , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Malásia , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Distribuição Aleatória , Detecção do Abuso de Substâncias , Adulto Jovem
20.
BMJ Case Rep ; 12(6)2019 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-31160299

RESUMO

In developed countries, addressing the growing opioid addiction epidemic is focused on preventive measures, developing better overdose-reversal medications and designing newer strategies to treat addiction. Primary prescribers of the therapeutic use of opioids might play a definite role in the aetiology of the epidemics. Developing countries could be affected by similar issues; however, given that no updated statistics are available, it is possible that their populations undergo problems similar to those for which current data is available. Concerns have arisen regarding synthetic opioid tramadol which, given its fast and potent analgesic effects, low cost and easy availability is widely prescribed. A debate remains as to whether tramadol induces addictive effects like those of stronger analogues such as oxycodone or fentanyl. Here we present a case of tramadol dependence in an Ecuadorian patient and find that substance abuse can occur in normal individuals affected by chronic pain, otherwise treatable with standard methods.


Assuntos
Analgésicos Opioides/efeitos adversos , Transtornos de Enxaqueca/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Papel do Médico , Padrões de Prática Médica , Tramadol/efeitos adversos , Adulto , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Países em Desenvolvimento , Equador , Humanos , Injeções Intramusculares , Masculino , Tramadol/administração & dosagem , Tramadol/uso terapêutico
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