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BMC Psychiatry Dec 2023Number of opiate users worldwide has doubled over the past decade, but not all of them are diagnosed with opioid use disorder. We aimed to identify the prevalence and...
BACKGROUND
Number of opiate users worldwide has doubled over the past decade, but not all of them are diagnosed with opioid use disorder. We aimed to identify the prevalence and risk factors for OUD after ten years of follow-up.
METHODS
Among 8,500 chronic opiate users at Golestan Cohort Study baseline (2004-2008), we recalled a random sample of 451 subjects in 2017. We used three questionnaires: a questionnaire about current opiate use including type and route of use, the drug use disorder section of the Composite International Diagnostic Interview lifetime version, and the validated Kessler10 questionnaire. We defined opioid use disorder and its severity based on the DSM-5 criteria and used a cutoff of 12 on Kessler10 questionnaire to define psychological distress.
RESULTS
Mean age was 61.2 ± 6.6 years (84.7% males) and 58% were diagnosed with opioid use disorder. Starting opiate use at an early age and living in underprivileged conditions were risk factors of opioid use disorder. Individuals with opioid use disorder were twice likely to have psychological distress (OR = 2.25; 95%CI: 1.44-3.52) than the users without it. In multivariate regression, former and current opiate dose and oral use of opiates were independently associated with opioid use disorder. Each ten gram per week increase in opiate dose during the study period almost tripled the odds of opioid use disorder (OR = 3.18; 95%CI: 1.79-5.63).
CONCLUSIONS
Chronic opiate use led to clinical opioid use disorder in more than half of the users, and this disorder was associated with psychological distress, increasing its physical and mental burden in high-risk groups.
Topics: Male; Humans; Middle Aged; Aged; Female; Opiate Alkaloids; Cohort Studies; Prevalence; Opioid-Related Disorders; Risk Factors; Analgesics, Opioid; Opiate Substitution Treatment
PubMed: 38129791
DOI: 10.1186/s12888-023-05436-x -
Journal of Affective Disorders Jun 2023From a behavioural perspective anhedonia is defined as diminished interest in the engagement of pleasurable activities. Despite its presence across a range of...
BACKGROUND
From a behavioural perspective anhedonia is defined as diminished interest in the engagement of pleasurable activities. Despite its presence across a range of psychiatric disorders, the cognitive processes that give rise to anhedonia remain unclear.
METHODS
Here we examine whether anhedonia is associated with learning from positive and negative outcomes in patients diagnosed with major depression, schizophrenia and opiate use disorder alongside a healthy control group. Responses in the Wisconsin Card Sorting Test - a task associated with healthy prefrontal cortex function - were fitted to the Attentional Learning Model (ALM) which separates learning from positive and negative feedback.
RESULTS
Learning from punishment, but not from reward, was negatively associated with anhedonia beyond other socio-demographic, cognitive and clinical variables. This impairment in punishment sensitivity was also associated with faster responses following negative feedback, independently of the degree of surprise.
LIMITATIONS
Future studies should test the longitudinal association between punishment sensitivity and anhedonia also in other clinical populations controlling for the effect of specific medications.
CONCLUSIONS
Together the results reveal that anhedonic subjects, because of their negative expectations, are less sensitive to negative feedbacks; this might lead them to persist in actions leading to negative outcomes.
Topics: Humans; Schizophrenia; Punishment; Anhedonia; Depression; Opiate Alkaloids; Reward
PubMed: 36889442
DOI: 10.1016/j.jad.2023.02.120 -
Canadian Journal of Psychiatry. Revue... Sep 2022The main objective of the present study was to develop a French-Canadian translation and adaptation of the COWS (i.e., the COWS-FC) for the assessment of opioid...
OBJECTIVE
The main objective of the present study was to develop a French-Canadian translation and adaptation of the COWS (i.e., the COWS-FC) for the assessment of opioid withdrawal symptoms in clinical and research settings.
METHODS
The French-Canadian translation and cultural adaptation of the COWS was performed following guidelines for the translation and cross-cultural adaptation of self-report measures. The steps consisted of (1) initial translation from English to French, (2) synthesis of the translation, (3) back-translation from French to English, (4) expert committee meeting, (5) test of the prefinal version among healthcare professionals and (6) review of final version by the expert committee. The expert committee considered four major areas where the French-Canadian version should achieve equivalence with the original English-version of the COWS. These areas were (1) semantic equivalence; (2) idiomatic equivalence; (3) experiential equivalence and (4) conceptual equivalence.
RESULTS
Rigorous steps based on the guidelines for the translation and cultural adaptation of assessment tools were followed, which led to a semantically equivalent version of the COWS. After a pretest among healthcare professionals, members from the expert committee agreed upon slight modifications to the French-Canadian version of the COWS to yield a final COWS-FC version.
CONCLUSIONS
A French-Canadian translation and adaptation of the COWS (i.e., the COWS-FC) was developed. The COWS-FC could be used for the assessment of opioid withdrawal symptoms in clinical and research settings.
Topics: Analgesics, Opioid; Animals; Canada; Cattle; Cross-Cultural Comparison; Humans; Opiate Alkaloids; Psychometrics; Reproducibility of Results; Substance Withdrawal Syndrome; Surveys and Questionnaires
PubMed: 35290134
DOI: 10.1177/07067437221087066 -
Molecules (Basel, Switzerland) Apr 20226,14-ethenomorphinans are semisynthetic opiate derivatives containing an ethylene bridge between positions 6 and 14 in ring-C of the morphine skeleton that imparts a... (Review)
Review
6,14-ethenomorphinans are semisynthetic opiate derivatives containing an ethylene bridge between positions 6 and 14 in ring-C of the morphine skeleton that imparts a rigid molecular structure. These compounds represent an important family of opioid receptor ligands in which the 6,14-etheno bridged structural motif originates from a [4 + 2] cycloaddition of morphinan-6,8-dienes with dienophiles. Certain 6,14-ethenomorphinans having extremely high affinity for opioid receptors are often non-selective for opioid receptor subtypes, but this view is now undergoing some revision. The agonist 20-etorphine and 20-dihydroetorphine are several thousand times more potent analgesics than morphine, whereas diprenorphine is a high-affinity non-selective antagonist. The partial agonist buprenorphine is used as an analgesic in the management of post-operative pain or in substitution therapy for opiate addiction, sometimes in combination with the non-selective antagonist naloxone. In the context of the current opioid crisis, we communicated a summary of several decades of work toward generating opioid analgesics with lesser side effects or abuse potential. Our summary placed a focus on Diels-Alder reactions of morphinan-6,8-dienes and subsequent transformations of the cycloadducts. We also summarized the pharmacological aspects of radiolabeled 6,14-ethenomorphinans used in molecular imaging of opioid receptors.
Topics: Analgesics; Analgesics, Opioid; Morphinans; Morphine; Naloxone; Receptors, Opioid; Receptors, Opioid, mu
PubMed: 35566212
DOI: 10.3390/molecules27092863 -
Drug and Alcohol Dependence Apr 2021Opiate addiction is a major health challenge with substantial societal cost. Though harm minimisation strategies have been effective, there is a growing need for new...
BACKGROUND
Opiate addiction is a major health challenge with substantial societal cost. Though harm minimisation strategies have been effective, there is a growing need for new treatments for detoxification and relapse prevention. Preclinical research has found neurokinin 1 (NK) receptors have prominent effects on opiate reward and reinforcement, and human studies have found NK antagonism led to reductions in craving and withdrawal. However, its effect on brain mechanisms in opiate addiction has not yet been examined.
METHODS
This study aims to assess the impact of NK antagonist aprepitant on heroin cue-elicited changes in blood-oxygenation level dependent (BOLD) signal in opiate dependent individuals undergoing detoxification. Participants will attend two scanning sessions and receive a single dose of aprepitant (320 mg) and a placebo in a randomised, cross-over design. During functional magnetic resonance imaging participants will undergo two runs of a cue reactivity task, which consists of passive viewing of drug cues or neutral cues in a block design fashion. We hypothesise that NK antagonism will attenuate the BOLD response to drug cues in the caudate nucleus and amygdala. Regions of interest were selected based on NK receptor density and their role in cue reactivity and craving.
Topics: Adult; Amygdala; Analgesics, Opioid; Brain; Brain Mapping; Conditioning, Psychological; Craving; Cues; Female; Heroin; Heroin Dependence; Humans; Magnetic Resonance Imaging; Male; Neurokinin-1 Receptor Antagonists; Opiate Alkaloids; Opioid-Related Disorders; Receptors, Neurokinin-1; Reward; Young Adult
PubMed: 33548897
DOI: 10.1016/j.drugalcdep.2021.108564 -
Journal of Reconstructive Microsurgery Nov 2023In the setting of the opioid crisis, managing postoperative pain without the exclusive use of opiates has become a topic of interest. Many hospitals have begun...
BACKGROUND
In the setting of the opioid crisis, managing postoperative pain without the exclusive use of opiates has become a topic of interest. Many hospitals have begun implementing enhanced recovery after surgery protocols to decrease postoperative complications, hospital costs, and opiate utilization. Ketorolac has been added to many of these protocols, but few studies have examined its effects independently.
METHODS
A retrospective chart review was performed on all patients that received autologous breast reconstruction from October 2020 to June 2022 at an academic institution. We identified patients who did and did not receive postoperative ketorolac. Use of ketorolac was based upon surgeon preference. The two groups were compared in basic demographics, reconstruction characteristics, length of stay, complications, reoperations, and morphine milligram equivalents (MMEs).
RESULTS
One-hundred ten patients were included for the analysis, with 55 receiving scheduled postoperative ketorolac and 55 who did not receive ketorolac. There were seven incidences of postoperative complications in each group (12.7%, = 1.00). The total mean postoperative MMEs were 344.7 for the nonketorolac group and 336.5 for the ketorolac group ( = 0.81). No variable was found to be independently associated with postoperative opiate use. Ketorolac was not found to contribute significantly to any postoperative complication.
CONCLUSION
In this study, the use of ketorolac did not significantly reduce opiate use in a cohort of 110 patients. Surgeons should consider whether the use of ketorolac alone is the best option to reduce postoperative opiate use following free flap breast reconstruction.
Topics: Humans; Ketorolac; Retrospective Studies; Opiate Alkaloids; Free Tissue Flaps; Pain, Postoperative; Postoperative Complications; Mammaplasty
PubMed: 37068512
DOI: 10.1055/s-0043-1768220 -
Brain Research Mar 1982Opiate alkaloid and opioid peptide actions on spontaneous neuronal activity and postsynaptic amino acid responsiveness were assessed using intracellular recording...
Opiate alkaloid and opioid peptide actions on spontaneous neuronal activity and postsynaptic amino acid responsiveness were assessed using intracellular recording techniques applied to murine spinal cord neurons in primary dissociated cell culture. Application of opiates was by superfusion and amino acids by iontophoresis. Glycine and GABA but not glutamate responses were antagonized by the opiate alkaloids. Since opiate effects on glycine and GABA responses were not naloxone-reversible, only weakly stereospecific, and not produced by the opioid peptide [D-Ala2]-Met-enkephalinamide, it is unlikely that these effects were mediated by opiate receptors. Opiate depression of glycine inhibition was correlated with the induction of paroxysmal depolarizations in cultured spinal cord neurons, suggesting that antagonism of inhibitory amino acid transmission may underlie the convulsant actions of high concentrations of the opiate alkaloids.
Topics: Animals; Cells, Cultured; Dextrorphan; Enkephalin, Methionine; Enkephalins; Evoked Potentials; Glycine; Levorphanol; Mice; Morphine; Naloxone; Narcotics; Neural Inhibition; Neurons; Seizures; Spinal Cord; Synapses; gamma-Aminobutyric Acid
PubMed: 7066678
DOI: 10.1016/0006-8993(82)90038-5 -
Substance Use & Misuse 2022Opioid use rates have dropped as North American patients gain access to medical cannabis, indicating a harm reduction role, yet health outcomes remain mostly...
Opioid use rates have dropped as North American patients gain access to medical cannabis, indicating a harm reduction role, yet health outcomes remain mostly unexplored. This study presents self-reported medical cannabis use, perceptions of health functioning, and changes in opioid pain medication use in Florida medical cannabis patients. Patients (n = 2,183) recruited from medical dispensaries across Florida completed a 66-item cross-sectional survey that included demographic, health, and medication usage items, along with items from the Medical Outcomes Survey (SF-36) to assess health functioning before and after cannabis initiation. Most participants were between the ages of 20 and 70 years of age (95%), over 54% were female, 47% were employed, and most (85%) were white. Commonly reported ailment groups were Pain and Mental Health combined (47.92%), Mental Health (28.86%) or Pain (9.07%). Health domains of bodily pain, physical functioning, and social functioning improved while limitations due to physical and emotional problems were unchanged. Most patients rated medical cannabis as being important to their quality of life. Many (60.98%) reported using pain medications prior to medical cannabis, 93.36% of these reported a change in pain medication after medical cannabis. The majority of participants (79%) reported either cessation or reduction in pain medication use following initiation of medical cannabis and 11.47% described improved functioning. The findings suggest that some medical cannabis patients decreased opioid use without harming quality of life or health functioning, soon after the legalization of medical cannabis. The public health implications of medical cannabis as an alternative pain medication are discussed.
Topics: Humans; Female; Young Adult; Adult; Middle Aged; Aged; Male; Medical Marijuana; Analgesics, Opioid; Cannabis; Opiate Alkaloids; Quality of Life; Cross-Sectional Studies; Opioid-Related Disorders; Analgesics; Hallucinogens; Pain
PubMed: 36168127
DOI: 10.1080/10826084.2022.2107673 -
Foot & Ankle International Jan 2023In response to the opioid epidemic, the use of multimodal pain management in orthopaedic surgery is increasing. Efforts to decrease opioid prescribing and opioid... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
In response to the opioid epidemic, the use of multimodal pain management in orthopaedic surgery is increasing. Efforts to decrease opioid prescribing and opioid consumption among foot and ankle surgical patients are needed. The purpose of this study was to compare the efficacy and adverse events between 2 multimodal pain management pathways for forefoot surgical patients: standard opioid-containing (OC) and opioid-free (OF).
METHODS
This is a single-center noninferior randomized controlled trial of 51 patients undergoing forefoot surgery allocated to one of 2 perioperative pain management treatments: opioid-free, multimodal (OF, n=27 patients), or traditional opioid-containing (OC, n=24 patients). Patient characteristics, creatine markers, pain (numeric rating scale [NRS]), general health (Veterans Rand 12-Item Health Survey [VR-12]), and depression were measured preoperatively. Postoperatively, pain was measured at 24-hour, 2-week, and 6-week time points. Satisfaction with pain control, complications, and general health were measured at 2 and 6 weeks.
RESULTS
The OF group is statistically noninferior to the OC group and reported lower median pain scores at 24 hours (2 [IQR 0, 3] vs 6 [IQR 3.5, 7]; p<.0001) and 2 weeks (2 [IQR 1, 4] vs 4 [IQR 0, 3]; p=.018]. By 6 weeks, pain levels were similar between groups. More than 85% of all patients reported satisfaction with pain level at 2 weeks, which increased to >90% at 6 weeks. The VR-12 scores were similar between groups across all time points. At 2 weeks, 8 patients in each group reported constipation. By 6 weeks, all but 2 OC patients reported resolution. No other adverse events of postoperative wound complications, readmissions, medication reactions, thrombosis, or persistent pain were documented.
CONCLUSION
In forefoot surgery, the opioid-free pain management protocol was statistically noninferior to the opioid-containing protocol in reducing postoperative pain.
LEVEL OF EVIDENCE
Level II, prospective cohort study.
Topics: Humans; Analgesics, Opioid; Opiate Alkaloids; Prospective Studies; Practice Patterns, Physicians'; Pain, Postoperative
PubMed: 36537761
DOI: 10.1177/10711007221140834 -
Journal of the American College of... Jan 2020
Topics: Acute Coronary Syndrome; Clopidogrel; Coronary Angiography; Humans; Morphine; Opiate Alkaloids; Prasugrel Hydrochloride
PubMed: 31976868
DOI: 10.1016/j.jacc.2019.11.023