[Treatment of acute pain during drug-assisted rehabilitation]. / Behandling av akutte smerter under legemiddelassistert rehabilitering.

Patients on drug-assisted rehabilitation have the same right to pain relief as others. Techniques that reduce the need for opioids should be used when possible in opioid-dependent individuals who need treatment of acute and post-operative pain. Substitution treatment should always be continued. In some situations a switch to a different opioid or route of administration is required. Higher doses of opioids than those needed in other patients may be required for analgesia. Well-designed clinical studies are lacking in this field.

Corrected QT interval during treatment with methadone and buprenorphine--relation to doses and serum concentrations.

BACKGROUND: Methadone and buprenorphine are widely used in the treatment of opioid addiction. Some study results suggest that methadone can be associated with QT interval prolongation and torsades de pointes ventricular arrhythmias, whereas no such risk has been observed for buprenorphine. The aim of this study is to determine the risk of corrected QT interval (QTc) increase among patients treated with these medications in an opioid maintenance treatment (OMT) programme, and to study possible associations between QTc changes and serum concentrations of methadone or buprenorphine. METHODS: Eighty patients enrolled in the OMT programme were followed after start of treatment with methadone (n=45) or buprenorphine (n=35). QTc interval was assessed by electrocardiography (ECG) at baseline and after 1 month (n=79) and 6 months (n=66) in the OMT programme. Blood samples were obtained for the analysis of serum concentrations of buprenorphine, (R)-methadone, (S)-methadone and total methadone. RESULTS: No patients had QTc prolongation (defined as a QTc value above 450 ms) at baseline or after 1 or 6 months. When analysed in a linear mixed effects model, QTc was not associated with the serum concentrations of buprenorphine or methadone. However, low serum potassium levels increased QTc significantly. CONCLUSIONS: These results support and extend previous findings that treatment with methadone in modest doses (i.e. below 100mg/d) is not associated with clinically significant QTc increases, and that buprenorphine in commonly used doses is a suitable alternative to methadone with regard to the risk of QTc prolongation.

Prescription of analgesics to patients in opioid maintenance therapy: a pharmacoepidemiological study.

AIMS: The primary aim of the present study is to determine the one year periodic prevalence of dispension of different analgesics to patients in long term opioid maintenance therapy (OMT). The secondary aim is to determine to which extent non-opioid analgesics are used as first line analgesics. DESIGN: The study is a pharmacoepidemiological study with cross sectional data and cohort data. Data on patients in long term OMT in Norway were obtained from the complete national Norwegian Prescription Database (NorPD). FINDINGS: The analgesics with the highest one year periodic prevalence were NSAIDs (22%), codeine-paracetamol combinations (9%), paracetamol (7%) and tramadol (2.5%). During both 2007 and 2008 a total of 12% of the study population received at least one dispension of another opioid in addition to the opioid used for OMT. In 55% of the cases where OMT patients had not received an analgesic the preceding year an NSAID was the first or only dispensed analgesic whereas paracetamol-codeine was the first or only dispensed analgesic in 29% of the cases. CONCLUSIONS: This study has documented an equally high one year periodic prevalence of opioid dispensions in OMT patients as in the general population as well as a high one year periodic prevalence of dispensions of NSAIDs. Dispension of codeine-paracetamol has a relatively high one-year prevalence and is frequently used as a first line analgesic.