Articles: opioid.
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Am J Drug Alcohol Abuse · Mar 2016
ReviewLegal regimes surrounding naloxone access: considerations for prescribers.
Since the late 1980s, opioid-related morbidity and mortality in the United States has dramatically increased. This serious epidemic requires a coordinated medical, public policy, and social response. It is becoming readily apparent that widespread provision of naloxone may help to address this problem. However, because naloxone access laws vary between states, the extent of antidote dissemination may be limited by a given provider's geographic location. ⋯ Evidence suggests that naloxone administration by laypersons, pursuant to physician prescription or standing order, is safe and effective for reversal of opioid overdose. As of July 2015, 44 states and the District of Columbia have passed naloxone access laws, offering varying degrees of protections for prescribers. Although the likelihood of naloxone-related legal action may parallel that inherent to the usual practice of medicine, providers should be mindful of potential scenarios, exercise methods to mitigate risk, and appreciate the utility of comprehensive naloxone access legislation in orchestrating a coordinated response to the opioid overdose epidemic.
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Despite advances in the treatment of cancer in paediatric patients, 15% of children die from the illness progression in Chile, and pain is the most significant symptom in advanced stages. Although the World Health Organization guidelines demonstrate that opioids are fundamental in pain management, there is still resistance to their use. The main objective of this article was to describe the experience in the use of opioids for pain management in paediatric patients with advanced cancer in palliative care (PC). ⋯ Two thirds of the patients studied required strong opioids, with which adequate pain management was achieved, with no serious complications observed. The use of opioids in this group of patients, following a protocol, is considered effective and safe.
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The incidence of obstructive sleep apnea (OSA) has reached epidemic proportions, and it is an often unrecognized cause of perioperative morbidity and mortality. Profound hypoxic injury from apnea during the postoperative period is often misdiagnosed as cardiac arrest due to other causes. Almost a quarter of patients entering a hospital for elective surgery have OSA, and >80% of these cases are undiagnosed at the time of surgery. ⋯ In the pediatric setting, a question about snoring should be part of every preoperative examination. For patients with known OSA, continuous positive airway pressure should be continued postoperatively. Continuous pulse oximetry monitoring with an alarm system can help to prevent apneic catastrophes caused by OSA in the postoperative period.
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J Pain Symptom Manage · Mar 2016
Observational StudyPatient-Controlled Therapy (PCT) of Breathlessness in Palliative Care: A New Therapeutic Concept for Opioid Application?
Breathlessness is one of the most distressing symptoms experienced by patients with advanced cancer and noncancer diagnoses alike. Often, severity of breathlessness increases quickly, calling for rapid symptom control. Oral, buccal, and parenteral routes of provider-controlled drug administration have been described. It is unclear whether patient-controlled therapy (PCT) systems would be an additional treatment option. ⋯ Opioid PCT is a feasible and acceptable therapeutic method to reduce refractory breathlessness in palliative care patients.
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Despite unknown risks, prescription opioid use (POU) for nonmalignant chronic pain has grown in the US over the last decade. The objective of this study was to examine associations between POU and coronary heart disease (CHD), stroke, and cardiovascular disease (CVD) death in a large cohort. ⋯ Female but not male POU were at higher risk of CHD and CVD death. POU was not associated with stroke in overall or sex-stratified analyses.