Many Opioid Overdoses Linked to Lower Prescribed Doses, Intermittent Use Wolters Kluwer Health Overdoses of opioid pain medications frequently occur in people who aren't chronic users with high prescribed opioid doses--the groups targeted by current opioid prescribing guidelines, reports a study in the August issue of Medical Care. The article indicates a far higher correlation with concurrent sedative use, and encourages a shift in targeted populational interventions.
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FROM JOURNAL OF ADDICTION MEDICINE
Opioid Use in Pregnant Women and the Increase in Neonatal Abstinence Syndrome: What Is the Cost? Journal of Addiction Medicine (free ASAM member resource) Retrospective chart review, N = 160, span 3 years. The costs associated with treating newborns with Neonatal Abstinence Syndrome (NAS) are exponentially higher than the costs associated with newborns not affected with NAS, and are detailed in the article. The societal costs associated with treatment of newborns with NAS, as well as infant symptomatology experienced with NAS, can be reduced by screening for drug/alcohol use, engagement in family planning, and encouragement of substance use disorder treatment.
Tapering Long-term Opioid Therapy in Chronic Noncancer Pain Mayo Clinic Proceedings This is an extensive and readable overview of the management of opioid withdrawal, deriving from current research into the role of opioids in nociceptive physiology. On completion of this article, readers should be able to (1) appropriately identify circumstances when tapering chronic opioid therapy (COT) in patients with chronic noncancer pain should be considered; (2) recognize withdrawal symptoms during a COT taper, classify them for severity, and choose an adequate treatment; (3) apply strategies for medico-legal risk management during a COT taper, including using an opioid taper agreement.
Temporary Placement of Acetyl Fentanyl into Schedule I Federal Register Superficially appearing to be a notice reclassifying a hazardous opioid, this piece provides a good discussion of what data the DEA uses and audits, and of its processes for drug classification. The Administrator of the Drug Enforcement Administration is issuing this final order to temporarily schedule the synthetic opioid, N-(1-phenethylpiperidin-4-yl)-N-phenylacetamide (acetyl fentanyl) into schedule I.
Methadone Continuation Versus Forced Withdrawal on Incarceration in a Combined US Prison and Jail The Lancet Methadone is an effective treatment for opioid dependence. When people who are receiving methadone maintenance treatment for opioid dependence are incarcerated in prison or jail, most US correctional facilities discontinue their methadone treatment, either gradually, or more often, abruptly. This discontinuation can cause uncomfortable symptoms of withdrawal and renders prisoners susceptible to relapse and overdose on release. This study examined the outcomes for continued methadone vs. discontinuation of methadone, in assuring resumption of methadone maintenance on release. However the variance between the two populations (96% vs. 78%) may also reflect in part the unwillingness of the maintained population to go abruptly without opioids upon prison release.
Benzodiazepine Prescribing Patterns and Deaths from Drug Overdose Among US Veterans Receiving Opioid Analgesics The British Medical Journal This is a major contribution to the field, and to patient safety, reflecting a study with uncommonly large power. Deaths from drug overdose, particularly involving opioid analgesics, have increased steadily over the past two decades and are now one of the leading causes of mortality from injury in the United States. Of the deaths from overdose related to pharmaceuticals, which constituted 58% of total deaths from drug overdose in 2010, 75% involved opioid analgesics. Thirty percent of overdose deaths related to opioid analgesics involved benzodiazepines, drugs commonly prescribed concurrently for patients who receive opioid analgesics. The authors are appropriately cautious in their conclusions;
but a clear inference is the need to consider whether co-prescription of an opioid and a benzodiazepine is truly essential to the patient’s treatment.
Dose-Response Relationship Between Methadone Dose and Adherence to Antiretroviral Therapy Among HIV-Positive Persons Who Use Illicit Opioids Addiction For HIV-positive individuals who use illicit opioids, engagement in methadone maintenance therapy (MMT) can contribute to improved HIV treatment outcomes. With an N of 297, this study yielded a robust correlation, that among HIV-positive individuals in methadone maintenance therapy, those receiving higher doses of methadone (≥ 100 mg/day) are more likely to achieve ≥ 95% adherence to antiretroviral therapy than those receiving lower doses.
Research Uncovers Disconnect In Pain-Related Communications Between Prescribers of Pain Medications and Patients The Partnership for Drug-Free Kids Research released by the Partnership for Drug-Free Kids confirms several “disconnects” in the pain-related communication between healthcare prescribers of prescription opiates (Rx painkillers) and their patients. The new data was fielded by the Partnership for Drug-Free Kids to gain a better understanding of the interactions between opiate-prescribing healthcare providers and patients.
NIH Begins Clinical Trial of New Medication for Alcohol Use Disorder NIH News A clinical trial investigating a potential treatment for alcohol use disorder (AUD) was announced by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). The study will assess the safety and efficacy of gabapentin enacarbil (HORIZANT) in extended-release tablets for treating moderate to severe AUD. With a projected population of 346, the study will span a half-year with outcome assessments in the final month. This is promising and potentially valuable, and obviously any positive signal will be welcome; it raises a recurrent issue, however, of study duration in a population whose illness chronicity invites longer trials.
Chronic Medical Care for Chronic Medical Illnesses: Addiction Should Not Be an Exception ASAM Magazine Dr. Lou Baxter handsomely articulates a concern argued by many of us, that success in treatment requires fidelity to a chronic disease model. The “failure” rate in addiction treatment is a self-fulfilling prophecy, the outcome of interruption of continuous care. Its analogy in the setting of 12-step recovery would be being told that one had fully recovered and need no longer go to meetings. Worse, it is recognized by the patients as hypocritical, that they are advised that they have a chronic illness yet are treated as if it is acute and self-limited.
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