Articles: opioid.
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Review Meta Analysis
Polysubstance use and misuse or abuse of prescription opioid analgesics: A multi-level analysis of international data.
Increasing mortality and morbidity associated with opioid analgesics has led to concerns about their misuse and abuse, even when obtained through a prescription. These concerns have been most pronounced in the United States, but limited data make it difficult to determine whether it is a problem in other countries. We investigated opioid analgesic misuse and abuse in participants from the Global Drug Survey 2015 resident in the United States (N = 1334), United Kingdom (N = 1199), France (N = 1258), Germany (N = 866), and Australia (N = 1013) who had used at least 1 prescription opioid analgesic medication in the past year. ⋯ In multilevel models, country of residence accounted for less than 3% of the variance in opioid analgesic misuse or abuse. Adjusting for country of residence and sociodemographic factors, use of illicit drugs and benzodiazepines was associated with 4-fold greater odds of misuse (odds ratio 4.36, 95% confidence interval 3.29-5.93) and 6-fold greater odds of abuse compared with not using either drug (odds ratio 6.49, 95% confidence interval 4.0-10.48), although the strength of the association with abuse varied by country. Misuse and abuse by those prescribed opioid analgesics seem to be a problem that is not limited to the United States and warrant attention on an international scale.
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Randomized Controlled Trial Comparative Study
Abuse Potential Study of ALO-02 (Extended-Release Oxycodone Surrounding Sequestered Naltrexone) Compared with Immediate-Release Oxycodone Administered Orally to Nondependent Recreational Opioid Users.
To evaluate the abuse potential of ALO-02, an abuse-deterrent formulation comprising pellets of extended-release oxycodone hydrochloride surrounding sequestered naltrexone hydrochloride. ⋯ The results suggest that ALO-02 (crushed or intact) has lower abuse potential than crushed oxycodone IR when administered orally in nondependent, recreational opioid users.
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Paediatric anaesthesia · Jun 2017
Case Reports2p24.1p23.2 deletion and delayed recovery after a general anesthesia for gastrointestinal endoscopic procedure.
Interstitial 2p deletions are very rare and may include proopiomelanocortin (POMC) gene (2p23.3). Our 10-year-old patient, known to carry this genetic anomaly, underwent an endoscopic interventional procedure under general anesthesia. After a sevoflurane induction, alfentanil (8.5 μg·kg-1 ) was given. ⋯ There was an unexpected delayed recovery likely reflecting an unexpected delayed recovery likely due to opioid hypersensitivity. The deletion of POMC may cause a deficit in endorphin and may lead to an up-regulation of opioid receptors. Exogenous opioids should be used with particular caution in patients suffering a deficit of POMC.
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Opioid-induced hyperalgesia (OIH) is a key factor in the clinical management of patients experiencing pain. However, limited knowledge exists regarding the specific mechanisms involved in OIH and its treatment. ⋯ Patients who are taking opioids should receive ongoing, comprehensive assessment by a clinician. Early identification of OIH will lead to improved patient outcomes. .
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The development of G protein-biased agonists for the μ-opioid receptor (MOR) offers a clear drug discovery rationale for improved analgesia and reduced side-effects of opiate pharmacotherapy. However, our understanding of the molecular mechanisms governing ligand bias is limited, which hinders our ability to rationally design biased compounds. We have investigated the role of MOR binding site residues W320 and Y328 in controlling bias, by receptor mutagenesis. ⋯ We also observe clear uncoupling between mutation-driven changes in function and binding affinity. These findings suggest that the mutations influenced the balance of pathway activation in a ligand-specific manner, thus identifying residues in the MOR binding pocket that govern ligand bias. This increases our understanding of how ligand/receptor binding interactions can be translated into agonist-specific pathway activation.