Articles: opioid.
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J Pain Symptom Manage · Oct 2014
Multicenter StudyCross-sectional pilot study to monitor the availability, dispensed prices, and affordability of opioids around the globe.
Opioids are essential medicines. The World Health Organization and Health Action International monitor the price of essential medicines. However, their surveys do not include opioids, and there is no information on their affordability. ⋯ Patients in LMIC and LIC have limited access to opioids, and there are subsidies in place for more expensive medications and formulations in all GNI levels, but not for morphine oral solid IR. Additional research is necessary to identify the reasons behind these findings.
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Journal of critical care · Oct 2014
Enteral naloxone for the treatment of opioid-induced constipation in the medical intensive care unit.
To determine the safety and efficacy of enteral naloxone for the treatment of opioid-induced constipation in the medical intensive care unit (MICU). ⋯ Enteral naloxone appears safe for the treatment of opioid-induced constipation in the MICU. Enteral naloxone may be effective in treating opioid-induced constipation; however, further studies are warranted.
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Roughly 25 years ago, the United States National Institute on Drug Abuse (US NIDA) initiated the creation of public use datasets for its National Household Survey on Drug Abuse, since re-named the National Survey on Drug Use and Health (NSDUH). The Substance Abuse and Mental Health Services Administration (SAMHSA), which assumed responsibility for the survey in 1992, has continued and expanded this effort to make the survey data available to researchers. During 2012, SAMHSA created a "Restricted-Use Data Analysis System" (R-DAS) to provide researchers with the capability to create tabulations using restricted NSDUH variables not otherwise available on the public-use files. ⋯ The R-DAS makes it possible to derive state-level estimates of male-female and age-related differences in incidence of extra-medical prescription pain reliever (EMPPR) use, not previously reported in peer-reviewed articles, and not available without research approaches described here.
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Neurogastroenterol. Motil. · Oct 2014
ReviewSite and mechanism of morphine tolerance in the gastrointestinal tract.
Opioid-induced constipation is a major clinical problem. The effects of morphine, and other narcotics, on the gastrointestinal tract persist over long-term use thus limiting the clinical benefit of these excellent pain relievers. The effects of opioids in the gut, including morphine, are largely mediated by the μ-opioid receptors at the soma and nerve terminals of enteric neurons. ⋯ Here, we review the mechanisms by which tolerance develops in the small but not the large intestine. The regional differences lie in the signaling and regulation of the μ-opioid receptor in the various segments of the gastrointestinal tract. The differential role of β-arrestin2 in tolerance development between central and enteric neurons defines the potential for therapeutic approaches in developing ligands with analgesic properties and minimal constipating effects.
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The Opioid Risk Tool (ORT) is a screening instrument for assessing the risk of opioid-related aberrant behavior in chronic noncancer pain (CNCP) patients. ⋯ Significant differences existed between this study population and the patient sample from which the ORT was derived. Limitations of this study are discussed. We concur with the authors of the original study that the ORT may not be applicable in different pain populations and settings. Based on our findings, we encourage caution in interpreting the ORT in general CNCP settings until further studies are performed.