Articles: opioid.
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Drug Alcohol Depend · Oct 2013
Differential effects of methadone and buprenorphine on the response of D2/D3 dopamine receptors in adolescent mice.
There is a lack of studies that examine the effects of opioid maintenance drugs on the developing adolescent brain, limiting the ability of physicians to conduct a science-based risk assessment on the appropriateness of these treatments for that age group. Our recent observations indicate higher potential risks in repeated exposure to morphine during adolescence, specifically to the D2/D3 dopamine receptors' signaling. Disturbances in dopaminergic signaling could have broader implications for long-term mental health. Thus, this study examined whether buprenorphine and methadone differentially alter the responses of the D2/D3 dopamine receptors in adolescents. ⋯ This study suggests that exposure to various opioids carries differential probabilities of altering the highly sensitive neurochemistry of adolescent brains. Methadone exposure disturbs the D2-like receptor's response, indicating a potential risk in administering methadone to adolescents (either for the treatment of opioid dependency/abuse or for pain management). In contrast, buprenorphine appears to have a significantly lower effect on the behavioral sensitivity of D2/D3 dopamine receptors in adolescents.
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Comparative Study
Comparison of the risks of opioid abuse or dependence between tapentadol and oxycodone: results from a cohort study.
Tapentadol may have a lower abuse risk than other opioids because it has a relatively low affinity for the mu-opioid receptor. The aim of this retrospective cohort study was to compare the risk of opioid abuse between tapentadol immediate release (IR) and oxycodone IR using 2 claims databases (Optum and MarketScan). Subjects with no recent opioid use exposed to tapentadol IR or oxycodone IR in 2010 were followed for 1 year. The outcome was the proportion of subjects who developed opioid abuse, defined as subjects with International Classification of Diseases, 9th revision, codes for opioid abuse, addiction, or dependence. The relative odds of abuse were estimated using a logistic regression model with propensity-score stratification. The estimates from the 2 databases were pooled using a random effects model. There were 13,814 subjects in Optum (11,378 exposed to oxycodone, 2,436 exposed to tapentadol) and 25,553 in MarketScan (21,728 exposed to oxycodone, 3,825 exposed to tapentadol). The risk of abuse was higher in the oxycodone group than in the tapentadol group in each database. The pooled adjusted estimate for the odds of abuse was 65% lower with tapentadol than with oxycodone (odds ratio = .35, 95% confidence interval = .21-.58). The risk of receiving an abuse diagnosis with tapentadol was lower than the risk with oxycodone. Continued monitoring is warranted because opioid desirability can change over time. ⋯ This study compared the risk of receiving an opioid abuse diagnosis between tapentadol and oxycodone in 2 U.S. claims databases. The risk of receiving an abuse diagnosis was lower with tapentadol during the year of follow-up. Opioid prescribers and patients must be aware of the risk of abuse associated with all opioids.
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Increased opioid prescribing for back pain and other chronic musculoskeletal pain conditions has been accompanied by dramatic increases in prescription-opioid addiction and fatal overdose. Opioid-related risks appear to increase with dose. ⋯ Given the lack of large, long-term randomised trials, recent epidemiologic data suggest the need for caution when considering long-term use of opioids to manage chronic musculoskeletal pain, particularly at higher dosage levels. Principles for achieving more selective and cautious use of opioids for chronic musculoskeletal pain are proposed.
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Little is known about how far opioid shoppers travel or how often they cross state lines to fill their opioid prescriptions. This retrospective cohort study evaluated these measures for opioid shoppers and nonshoppers using a large U.S. prescription database. Patients with ≥3 opioid dispensings were followed for 18 months. A subject was considered a shopper when he or she filled overlapping opioid prescriptions written by >1 prescriber at ≥3 pharmacies. A heavy shopper had ≥5 shopping episodes. Outcomes assessed were distance traveled among pharmacies and number of states visited to fill opioid prescriptions. A total of 10,910,451 subjects were included; .7% developed any shopping behavior and their prescriptions accounted for 8.6% of all opioid dispensings. Shoppers and heavy shoppers were younger than the nonshoppers. Shoppers traveled a median of 83.8 miles, heavy shoppers 199.5 miles, and nonshoppers 0 miles. Almost 20% of shoppers or heavy shoppers, but only 4% of nonshoppers, visited >1 state. Shoppers traveled greater distances and more often crossed state borders to fill opioid prescriptions than nonshoppers, and their dispensings accounted for a disproportionate number of opioid dispensings. Sharing of data among prescription-monitoring programs will likely strengthen those programs and may decrease shopping behavior. ⋯ This study shows that opioid shoppers travel greater distances and more often cross state borders to fill opioid prescriptions than nonshoppers, and their dispensings accounted for a disproportionate number of opioid dispensings. The findings support the need for data sharing among prescription-monitoring programs to deter opioid shopping behavior.
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Intrathecal drug delivery is an effective and safe option for the treatment of chronic pathology refractory to conventional pain therapies. Typical intrathecal administered drugs are opioids, baclofen, local anesthetics and adjuvant medications. Although knowledge about mechanisms of action of intrathecal drugs are every day more clear many doubt remain respect the correct location of intrathecal catheter in order to achieve the best therapeutic result. ⋯ In the second category, the variables in CSF flow, are considered that can modify the drug distribution within the CSF with special attention to the new theories of liquoral circulation. Last category try to explain inter-individual difference in baclofen response with difference that are specific for each patients such as the anatomical area to treat, patient posture or reaction to inflammatory stimulus. We conclude that a comprehensive evaluation of the patients, including imaging techniques to study the anatomy and physiology of intrathecal environment and CSF dynamics, could become essential in the future to the purpose of optimize the clinical outcome of intrathecal therapy.