Articles: opioid.
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The world's global cancer burden disproportionally affects lower income countries, where 80% of patients present with late-stage disease and have limited access to palliative care and effective pain-relieving medications, such as morphine. Consequently, millions die each year with unrelieved pain. Objective. ⋯ Interventions must streamline process details of morphine procurement, work within the existing sociocultural infrastructure to ensure opioids reach patients most in need, target unexpected audiences for symptom management education, and account for role expectations of health care providers. Conclusion. Macro- and micro-level policy and practice changes are needed to improve opioid availability and cancer pain management in India.
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Phys Med Rehabil Clin N Am · May 2014
ReviewOpioid syndrome: failed opioid therapy for chronic noncancer pain.
Treatment of chronic noncancer pain (CNCP) with high-dose opioids (HDOs) has burgeoned over the past 2 decades in the United States. Characteristic domains and features of the failed CNCP management patient using long-term HDOs are described herein as the/an opioid syndrome (Schreiber AL, personal communication. 2013). Reversing or even modulating HDO use in patients with CNCP requires a paradigm shift on the part of physician, patient, and the societal "quick fix" medical culture. This review offers measures, agents, and strategies to consider in management of this pervasive, erosive medical and societal challenge.
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Clin. Exp. Pharmacol. Physiol. · May 2014
GABAA receptors are involved in the analgesic effects of morphine microinjected into the central nucleus of the amygdala.
The central nucleus of the amygdala (CeA) has an important role in pain perception and analgesia. Opioid and GABAA receptors, which are both involved in pain modulation, are found in high concentration in the CeA. The present study was designed to examine the interaction of opioidergic and GABAergic systems in the CeA during modulation of acute thermal pain. ⋯ The results revealed that microinjection of morphine into the CeA significantly increased TFL in a dose-dependent manner. Microinjection of bicuculline or muscimol in combination with morphine into the CeA increased and decreased TFL, respectively. It seems that morphine in the CeA facilitates the function of descending inhibitory systems by interacting with the activity of local GABAA receptors.
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Deaths related to opioid overdose have increased in the past decade. Community-based pharmacy practitioners have worked toward overcoming logistic and cultural barriers to make naloxone distribution for overdose prevention a standard and accepted practice. ⋯ Outpatient administration of intramuscular and intranasal naloxone represents a means of preventing opioid-related deaths. Pharmacists can play a vital role in contacting providers, provision of products, education of patients and providers, and dissemination of information throughout the community. Preventing opioid overdose-related deaths should become a major focus of the pharmacy profession.
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Int. J. Drug Policy · May 2014
Unintentional opioid overdose deaths in New York City, 2005-2010: a place-based approach to reduce risk.
Drug poisoning is the leading cause of death from injuries in the United States. In New York City (NYC), unintentional drug poisoning death is the third leading cause of premature death, and opioids are the most commonly occurring class of drugs. Opioid overdose prevention efforts aim to decrease the number of people at risk for overdose and to decrease fatality rates among those using opioids by improving overdose response. These strategies can be enhanced with a comprehensive understanding of the settings in which overdoses occur. ⋯ The sample represents a near census of unintentional opioid overdose deaths in NYC during the study period, and allows for the identification of demographic and drug-using patterns by setting of overdose. Because most opioid overdoses occur inside the home, opioid overdose response programs can most efficiently address the epidemic by both reducing the risk of overdose in the home and targeting those who may be in the home at the time of an overdose for overdose response training. Approaches include minimizing risk of misuse and diversion through safe storage and safe disposal programs, physician education on prescribing of opioid analgesics and benzodiazepines, prescription of take-home naloxone, and Good Samaritan laws.