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Journal of Pharmacy Practice Jun 2021Methadone is frequently used to prevent withdrawal symptoms secondary to intended therapeutic opiate exposure. Absence of a standardized dose weaning strategy...
Methadone is frequently used to prevent withdrawal symptoms secondary to intended therapeutic opiate exposure. Absence of a standardized dose weaning strategy potentially results in increased exposure to narcotics and/or withdrawal symptoms. We sought to quantify the effect of implementing a standardized methadone weaning protocol and withdrawal assessment tool on methadone exposure and opiate withdrawal in pediatric patients receiving 5 or more days of continuous morphine or fentanyl infusions. The preintervention phase included patients weaned off of opiate infusions before implementation of a standardized weaning protocol and withdrawal symptom scoring tool. Patients in the postintervention phase were started on a standardized methadone wean based on total duration and dose of continuous opiate infusion exposure in the 24 hours preceding methadone initiation. Patients received either a 5- or 10-day wean, with the total daily methadone dose reduced by 20% daily or every other day, respectively. Patients in the postintervention phase were monitored for withdrawal using the withdrawal assessment tool (WAT-1). Postintervention patients were compared to preintervention patients treated with methadone. Total methadone duration decreased significantly from a median of 17 (13-22 interquartile range [IQR]) to 5 (5-10 IQR) days ( = .00001) after implementation of the methadone weaning protocol. Number of morphine boluses administered increased from a median of 3 (0-6 IQR) to 4 (0-5 IQR) doses per patient ( = .45). Demographic data were similar between both groups. Patients in the postintervention phase had significant reductions in methadone exposure after implementation of a standardized methadone weaning protocol and assessment tool.
Topics: Analgesics, Opioid; Child; Humans; Iatrogenic Disease; Methadone; Opiate Alkaloids; Substance Withdrawal Syndrome
PubMed: 31530073
DOI: 10.1177/0897190019875613 -
Revue Medicale Suisse Jan 2024
Topics: Humans; Opiate Alkaloids; Pain Management
PubMed: 38268354
DOI: 10.53738/REVMED.2024.20.858.130 -
The Journal of Clinical Investigation Jan 2024Converging studies demonstrate the dysfunction of the dopaminergic neurons following chronic opioid administration. However, the therapeutic strategies targeting...
Converging studies demonstrate the dysfunction of the dopaminergic neurons following chronic opioid administration. However, the therapeutic strategies targeting opioid-responsive dopaminergic ensembles that contribute to the development of opioid withdrawal remain to be elucidated. Here, we used the neuronal activity-dependent Tet-Off system to label dopaminergic ensembles in response to initial morphine exposure (Mor-Ens) in the ventral tegmental area (VTA). Fiber optic photometry recording and transcriptome analysis revealed downregulated spontaneous activity and dysregulated mitochondrial respiratory, ultrastructure, and oxidoreductase signal pathways after chronic morphine administration in these dopaminergic ensembles. Mitochondrial fragmentation and the decreased mitochondrial fusion gene mitofusin 1 (Mfn1) were found in these ensembles after prolonged opioid withdrawal. Restoration of Mfn1 in the dopaminergic Mor-Ens attenuated excessive oxidative stress and the development of opioid withdrawal. Administration of Mdivi-1, a mitochondrial fission inhibitor, ameliorated the mitochondrial fragmentation and maladaptation of the neuronal plasticity in these Mor-Ens, accompanied by attenuated development of opioid withdrawal after chronic morphine administration, without affecting the analgesic effect of morphine. These findings highlighted the plastic architecture of mitochondria as a potential therapeutic target for opioid analgesic-induced substance use disorders.
Topics: Humans; Opiate Alkaloids; Morphine; Mitochondrial Dynamics; Analgesics, Opioid; Dopaminergic Neurons; Dopamine; Substance Withdrawal Syndrome
PubMed: 38236644
DOI: 10.1172/JCI171995 -
The Primary Care Companion For CNS... Mar 2023
Topics: Humans; Adolescent; Nicotine; Opiate Alkaloids; Social Stigma; Physicians
PubMed: 36946564
DOI: 10.4088/PCC.22br03358 -
HPB : the Official Journal of the... Jul 2022Multimodal analgesia and regional anesthetic blocks, such as transversus abdominis plane (TAP) block, decrease postoperative opiate consumption but their effect on...
BACKGROUND
Multimodal analgesia and regional anesthetic blocks, such as transversus abdominis plane (TAP) block, decrease postoperative opiate consumption but their effect on intraoperative opiates is unknown.
METHODS
This was a retrospective review of patients undergoing pancreatoduodenectomy between June 2018 and February 2021, in which perioperative data, operative times, and medication administration data were collected. Intraoperative opiate use was calculated in total morphine equivalent doses (MED) for each patient and adjusted for operative time. Univariate analysis and multivariate linear regression were performed to determine factors affecting intraoperative opiate requirements.
RESULTS
Of the 169 patients in the study, 51 (30.2%) received pre-surgical TAP blocks and 118 (69.8%) did not. There were no statistically significant differences in intraoperative opiate use with preoperative acetaminophen (p = 0.527), celecoxib (p = 0.553), gabapentin (p = 0.308), intraoperative ketorolac (p = 0.698) or epidural placement (p = 0.086). Minimally invasive surgery had lower intraoperative opiate use compared to open (p = 0.011), as well as pre-surgical TAP block compared to no pre-surgical block (5.24 vs 7.27 MED/hour, p < 0.001). On multivariate linear regression, pre-surgical TAP block (p = 0.001) was independently associated with decreased intraoperative opiate use.
CONCLUSION
Preoperative TAP blocks were associated with decreased intraoperative opiate use during pancreatoduodenectomy and should be considered for routine use.
Topics: Abdominal Muscles; Analgesics, Opioid; Humans; Morphine; Nerve Block; Opiate Alkaloids; Pain, Postoperative; Pancreaticoduodenectomy
PubMed: 35012875
DOI: 10.1016/j.hpb.2021.12.008 -
Neurology Oct 2022Physician prescribing habits for opiates and headache therapies have not been previously evaluated in a large, matched cohort study in idiopathic intracranial...
BACKGROUND AND OBJECTIVES
Physician prescribing habits for opiates and headache therapies have not been previously evaluated in a large, matched cohort study in idiopathic intracranial hypertension (IIH). Our objective was to evaluate opiate and headache medication prescribing habits in women with IIH compared with matched women with migraine and population controls. We also investigated the occurrence of new onset headache in IIH compared with population controls.
METHODS
We performed a population-based matched, retrospective cohort study to explore headache outcomes. Cross-sectional analyses were used to describe medication prescribing patterns. We used data from IQVIA Medical Research Data, an anonymized, nationally representative primary care electronic medical record database in the United Kingdom, from January 1, 1995, to September 25, 2019. Women aged 16 years and older were eligible for inclusion. Women with IIH (exposure) were matched by age and body mass index with up to 10 control women without IIH but with migraine (migraine controls), and without IIH or migraine (population controls).
RESULTS
A total of 3,411 women with IIH, 13,966 migraine controls, and 33,495 population controls were included. The adjusted hazard ratio for new onset headache in IIH compared with population controls was 3.09 (95% CI 2.78-3.43). In the first year after diagnosis, 58% of women with IIH were prescribed acetazolamide and 20% topiramate. In total, 20% of women with IIH were prescribed opiates within the first year of their diagnosis, reducing to 17% after 6 years, compared with 8% and 11% among those with migraine, respectively. Twice as many women with IIH were prescribed opiates compared with migraine controls, and 3 times as many women with IIH were prescribed opiates compared with population controls. Women with IIH were also prescribed more headache preventative medications compared with migraine controls.
DISCUSSION
Women with IIH were more likely to be prescribed opiate and simple analgesics compared with both migraine and population controls. Women with IIH trialed more preventative medications over their disease course suggesting that headaches in IIH may be more refractory to treatment.
Topics: Humans; Female; Pseudotumor Cerebri; Retrospective Studies; Cohort Studies; Opiate Alkaloids; Cross-Sectional Studies; Headache; Migraine Disorders; Intracranial Hypertension
PubMed: 35985824
DOI: 10.1212/WNL.0000000000201064 -
Journal of Perinatology : Official... Jul 2020This study examined acute findings and long-term outcome trajectories between birth and adolescence in children with prenatal opiate exposure.
OBJECTIVE
This study examined acute findings and long-term outcome trajectories between birth and adolescence in children with prenatal opiate exposure.
STUDY DESIGN
Ninety children (45 opiate-exposed, 45 non-exposed) completed assessments between 1 month and 15 years of age. Outcome variables (medical, anthropomorphic, developmental, and behavioral) were analyzed at individual time points and using longitudinal statistical modeling.
RESULTS
Opiate-exposed infants displayed transient neurologic findings, but no substantial signs or symptoms long term. There were no group differences in growth, cognitive functioning, or behavior at individual time periods; however, the trajectories of outcomes using longitudinal analyses adjusting for variables known to impact outcome demonstrated increased deficits among opiate-exposed children over time with regards to weight, head circumference, cognitive functioning, and behavior.
CONCLUSIONS
Findings support concerns that maternal opiate use during pregnancy may negatively impact a child's developmental trajectory, which in turn may impose concerns to society (e.g., increased need for social, medical, and/or educational services).
Topics: Adolescent; Child; Cognition; Female; Humans; Infant; Longitudinal Studies; Models, Statistical; Opiate Alkaloids; Pregnancy; Prenatal Exposure Delayed Effects
PubMed: 32444681
DOI: 10.1038/s41372-020-0692-3 -
Science (New York, N.Y.) Mar 2017
Topics: Centers for Disease Control and Prevention, U.S.; China; Crime; Drug Overdose; Federal Government; Female; Fentanyl; Heroin; Humans; Illicit Drugs; Male; Ohio; Opiate Alkaloids; Opioid-Related Disorders; United States
PubMed: 28360278
DOI: 10.1126/science.355.6332.1364 -
The New Zealand Medical Journal Feb 2024Excessive opiate analgesia in relation to orthopaedic surgery is associated with morbidity and mortality. Pre-operative use of opiates is associated with higher...
AIMS
Excessive opiate analgesia in relation to orthopaedic surgery is associated with morbidity and mortality. Pre-operative use of opiates is associated with higher post-operative use. There is little information about opiate prescribing practices in relation to elective total joint arthroplasty (TJA) in New Zealand rural centres. The aims of this study were to describe opiate use before, immediately after and 1 year after TJA, and to compare prescribing practices with local guidelines.
METHODS
A retrospective cohort study of elective primary hip and knee arthroplasties was conducted between January 2018 and April 2019. Opiate use was evaluated from clinical records and from electronic prescribing records and described in morphine milligram equivalents (MME) with a particular focus on pre-operative and post-operative periods, and use after 1 year.
RESULTS
In the study period, 199 patients underwent 203 joint arthroplasties. Of these, data from 157 patients were analysed. Patient data were not analysed because of unavailable files (N=20), non-elective procedures (N=11), bilateral arthroplasties (N=4), deaths (N=4) and incomplete information (N=3). Pre-operative opiates were used by 92 (59%) patients, of whom 70 (76%) were not using opiates after 1 year. There were 126 (80%) patients who were discharged with opiate prescriptions and the vast majority, 121 (96%), did not receive discharge prescriptions that conformed to local guidelines.
CONCLUSION
Despite undergoing joint arthroplasty, about one quarter of patients who had been prescribed opiates before the operation were still receiving opiates after 1 year. There was poor compliance with local guidelines.
Topics: Humans; Arthroplasty, Replacement, Knee; Opiate Alkaloids; Retrospective Studies; Analgesics, Opioid; New Zealand; Prescriptions; Arthroplasty, Replacement, Hip; Pain, Postoperative; Practice Patterns, Physicians'
PubMed: 38301201
DOI: 10.26635/6965.6327 -
Spine Sep 2019
Topics: Analgesics, Opioid; Humans; Lower Extremity; Medicine; Opiate Alkaloids; Pain
PubMed: 31479040
DOI: 10.1097/BRS.0000000000003143