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American Journal of Surgery Oct 2023
Topics: Humans; Opium; Opiate Alkaloids; Opioid-Related Disorders
PubMed: 37336710
DOI: 10.1016/j.amjsurg.2023.06.007 -
Current Pain and Headache Reports Dec 2023The aim of this review is to educate healthcare professionals regarding buprenorphine for the use of opioid use disorder (OUD) as well as for chronic pain management.... (Review)
Review
PURPOSE OF REVIEW
The aim of this review is to educate healthcare professionals regarding buprenorphine for the use of opioid use disorder (OUD) as well as for chronic pain management. This review provides physicians and practitioners with updated information regarding the distinct characteristics and intricacies of prescribing buprenorphine.
RECENT FINDINGS
Buprenorphine is approved by the US Food and Drug Administration (FDA) for acute pain, chronic pain, opioid use disorder (OUD), and opioid dependence. When compared to most other opioids, buprenorphine offers superior patient tolerability, an excellent half-life, and minimal respiratory depression. Buprenorphine does have notable side effects as well as pharmacokinetic properties that require special attention, especially if patients require future surgical interventions. Many physicians are not trained to initiate or manage patients on buprenorphine. However, buprenorphine offers a potentially safer alternative for medication management for patients who require chronic opioid therapy for pain or have OUD. This review provides updated information on buprenorphine for both chronic pain and OUD.
Topics: Humans; Buprenorphine; Chronic Pain; Analgesics, Opioid; Opioid-Related Disorders; Acute Pain; Opiate Substitution Treatment
PubMed: 37897592
DOI: 10.1007/s11916-023-01185-4 -
Frontiers in Public Health 2023Opioid use disorder (OUD) is a major public health threat, contributing to morbidity and mortality from addiction, overdose, and related medical conditions. Despite our... (Review)
Review
Opioid use disorder (OUD) is a major public health threat, contributing to morbidity and mortality from addiction, overdose, and related medical conditions. Despite our increasing knowledge about the pathophysiology and existing medical treatments of OUD, it has remained a relapsing and remitting disorder for decades, with rising deaths from overdoses, rather than declining. The COVID-19 pandemic has accelerated the increase in overall substance use and interrupted access to treatment. If increased naloxone access, more buprenorphine prescribers, greater access to treatment, enhanced reimbursement, less stigma and various harm reduction strategies were effective for OUD, overdose deaths would not be at an all-time high. Different prevention and treatment approaches are needed to reverse the concerning trend in OUD. This article will review the recent trends and limitations on existing medications for OUD and briefly review novel approaches to treatment that have the potential to be more durable and effective than existing medications. The focus will be on promising interventional treatments, psychedelics, neuroimmune, neutraceutical, and electromagnetic therapies. At different phases of investigation and FDA approval, these novel approaches have the potential to not just reduce overdoses and deaths, but attenuate OUD, as well as address existing comorbid disorders.
Topics: Humans; Pandemics; Opiate Substitution Treatment; Opioid-Related Disorders; Buprenorphine; Naloxone; Drug Overdose
PubMed: 38332941
DOI: 10.3389/fpubh.2023.1274719 -
Assessment of the potential of novel and classical opioids to induce respiratory depression in mice.British Journal of Pharmacology Dec 2023Opioid-induced respiratory depression limits the use of μ-opioid receptor agonists in clinical settings and is the main cause of opioid overdose fatalities. The...
BACKGROUND AND PURPOSE
Opioid-induced respiratory depression limits the use of μ-opioid receptor agonists in clinical settings and is the main cause of opioid overdose fatalities. The relative potential of different opioid agonists to induce respiratory depression at doses exceeding those producing analgesia is understudied despite its relevance to assessments of opioid safety. Here we evaluated the respiratory depressant and anti-nociceptive effects of three novel opioids and relate these measurements to their in vitro efficacy.
EXPERIMENTAL APPROACH
Respiration was measured in awake, freely moving male CD-1 mice using whole body plethysmography. Anti-nociception was measured using the hot plate test. Morphine, oliceridine and tianeptine were administered intraperitoneally, whereas methadone, oxycodone and SR-17018 were administered orally. Receptor activation and arrestin-3 recruitment were measured in HEK293 cells using BRET assays.
KEY RESULTS
Across the dose ranges examined, all opioids studied depressed respiration in a dose-dependent manner, with similar effects at the highest doses, and with tianeptine and oliceridine showing reduced duration of effect, when compared with morphine, oxycodone, methadone and SR-17018. When administered at doses that induced similar respiratory depression, all opioids induced similar anti-nociception, with tianeptine and oliceridine again showing reduced duration of effect. These data were consistent with the in vitro agonist activity of the tested compounds.
CONCLUSION AND IMPLICATIONS
In addition to providing effective anti-nociception, the novel opioids, oliceridine, tianeptine and SR-17018 depress respiration in male mice. However, the different potencies and kinetics of effect between these novel opioids may be relevant to their therapeutic application in different clinical settings.
Topics: Male; Humans; Animals; Mice; Analgesics, Opioid; Oxycodone; HEK293 Cells; Morphine; Respiratory Insufficiency; Methadone
PubMed: 37489013
DOI: 10.1111/bph.16199 -
Drugs in R&D Dec 2023Buprenorphine has become an important medication in the context of the ongoing opioid epidemic. However, complex pharmacologic properties and varying government... (Review)
Review
Buprenorphine has become an important medication in the context of the ongoing opioid epidemic. However, complex pharmacologic properties and varying government regulations create barriers to its use. This narrative review is intended to facilitate buprenorphine use-including non-traditional initiation methods-by providers ranging from primary care providers to addiction specialists. This article briefly discusses the opioid epidemic and the diagnosis and treatment of opioid use disorder (OUD). We then describe the basic and complex pharmacologic properties of buprenorphine, linking these properties to their clinical implications. We guide readers through the process of initiating buprenorphine in patients using full agonist opioids. As there is no single recommended approach for buprenorphine initiation, we discuss the details, advantages, and disadvantages of the standard, low-dose, bridging-strategy, and naloxone-facilitated initiation techniques. We consider the pharmacology of, and evidence base for, buprenorphine in the treatment of pain, in both OUD and non-OUD patients. Throughout, we address the use of buprenorphine in children and adolescent patients, and we finish with considerations related to the settings of pregnancy and breastfeeding.
Topics: Pregnancy; Female; Adolescent; Child; Humans; Buprenorphine; Narcotic Antagonists; Opiate Substitution Treatment; Opioid-Related Disorders; Analgesics, Opioid
PubMed: 37938531
DOI: 10.1007/s40268-023-00443-5 -
Biomedicine & Pharmacotherapy =... Nov 2023Corydalis yanhusuo W. T. Wang, also known as yanhusuo, yuanhu, yanhu and xuanhu, is one of the herb components of many Chinese Traditional Medicine prescriptions such as... (Review)
Review
Corydalis yanhusuo W. T. Wang, also known as yanhusuo, yuanhu, yanhu and xuanhu, is one of the herb components of many Chinese Traditional Medicine prescriptions such as Jin Ling Zi San and Yuanhu-Zhitong priscription. C. yanhusuo was traditionally used to relieve pain and motivate blood and Qi circulation. Now there has been growing interest in pharmacological effects of alkaloids, the main bioactive components of C. yanhusuo. Eighty-four alkaloids isolated from C. yanhusuo are its important bioactive components and can be characterized into protoberberine alkaloids, aporphine alkaloids, opiate alkaloids and others and proper extraction or co-administration methods modulate their contents and efficacy. Alkaloids from C. yanhusuo have various pharmacological effects on the nervous system, cardiovascular system, cancer and others through multiple molecular mechanisms such as modulating neurotransmitters, ion channels, gut microbiota, HPA axis and signaling pathways and are potential treatments for many diseases. Plenty of novel drug delivery methods such as autologous red blood cells, self-microemulsifying drug delivery systems, nanoparticles and others have also been investigated to better exert the effects of alkaloids from C. yanhusuo. This review summarized the alkaloid components of C. yanhusuo, their pharmacological effects and mechanisms, and methods of drug delivery to lay a foundation for future investigations.
PubMed: 37729733
DOI: 10.1016/j.biopha.2023.115511 -
Revue Medicale Suisse Jan 2024
Topics: Humans; Palliative Care; Family Practice; Morphine Derivatives
PubMed: 38268379
DOI: 10.53738/REVMED.2024.20.858.185 -
Phytomedicine : International Journal... Dec 2023Sinomenine (SIN) is the main pharmacologically active component of Sinomenii Caulis and protects against rheumatoid arthritis (RA). In recent years, many studies have... (Review)
Review
BACKGROUND
Sinomenine (SIN) is the main pharmacologically active component of Sinomenii Caulis and protects against rheumatoid arthritis (RA). In recent years, many studies have been conducted to elucidate the pharmacological mechanisms of SIN in the treatment of RA. However, the molecular mechanism of SIN in RA has not been fully elucidated.
PURPOSE
To summarize the pharmacological effects and molecular mechanisms of SIN in RA and clarify the most valuable regulatory mechanisms of SIN to provide clues and a basis for basic research and clinical applications.
METHODS
We systematically searched SciFinder, Web of Science, PubMed, China National Knowledge Internet (CNKI), the Wanfang Databases, and the Chinese Scientific Journal Database (VIP). We organized our work based on the PRISMA statement and selected studies for review based on predefined selection criteria.
OUTCOME
After screening, we identified 201 relevant studies, including 88 clinical trials and 113 in vivo and in vitro studies on molecular mechanisms. Among these studies, we selected key results for reporting and analysis.
CONCLUSIONS
We found that most of the known pharmacological mechanisms of SIN are indirect effects on certain signaling pathways or proteins. SIN was manifested to reduce the release of inflammatory cytokines such as Tumor necrosis factor-α (TNF-α), Interleukin-6 (IL-6), and IL-1β, thereby reducing the inflammatory response, and apparently blocking the destruction of bone and cartilage. The regulatory effects on inflammation and bone destruction make SIN a promising drug to treat RA. More notably, we believe that the modulation of α7nAChR and the regulation of methylation levels at specific GCG sites in the mPGES-1 promoter by SIN, and its mechanism of directly targeting GBP5, certainly enriches the possibilities and the underlying rationale for SIN in the treatment of inflammatory immune-related diseases.
Topics: Humans; Arthritis, Rheumatoid; Anti-Inflammatory Agents; Morphinans; Signal Transduction
PubMed: 37816287
DOI: 10.1016/j.phymed.2023.155114 -
Indian Journal of Pharmacology 2023
Topics: Ketamine; Morphine; Analgesics, Opioid
PubMed: 38174540
DOI: 10.4103/ijp.ijp_230_23 -
Revista Espanola de Sanidad... 2023To evaluate the effectiveness of opioid maintenance programs in treating opioid dependence in Spanish prisons. (Review)
Review
OBJECTIVES
To evaluate the effectiveness of opioid maintenance programs in treating opioid dependence in Spanish prisons.
MATERIAL AND METHOD
A narrative bibliographic review was carried out on the following databases: PubMed; Cochrane; IBECS; LILACS; HealthCare. All clinical trials were chosen as a preference, along with systematic review articles and some articles that were considered relevant for their content. The time period was limited to between January 2011 and November 2021. The languages chosen were English, Spanish and Catalan. Repeated articles and those that were not related to the objectives were rejected. The search criteria were: "methadone AND prisons"; "opiate substitution treatment AND prisons"; "methadone AND buprenorphine"; "methadone OR buprenorphine"; "prisons AND Methadone AND buprenorphine".
RESULTS
20 articles were selected out of 647 items consulted after applying the corresponding filters and after discarding duplicates.
DISCUSSION
There was a slightly greater effectiveness of buprenorphine versus methadone. The high prevalence of the program was highlighted, as well as the variety of adverse effects of methadone. Usefulness with regard to inmates' behavior showed a range of opinions. The possibility of new treatment alternatives with better pharmacological control is mentioned.
Topics: Humans; Analgesics, Opioid; Buprenorphine; Methadone; Narcotics; Opiate Substitution Treatment; Opioid-Related Disorders; Prisons
PubMed: 38289166
DOI: 10.18176/resp.00077