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Australian Dental Journal Dec 2005Pain is one of the most common reasons patients seek dental treatment. It may be due to many different diseases/conditions or it may occur after treatment. Dentists must... (Review)
Review
Pain is one of the most common reasons patients seek dental treatment. It may be due to many different diseases/conditions or it may occur after treatment. Dentists must be able to diagnose the source of pain and have strategies for its management. The '3-D's' principle--diagnosis, dental treatment and drugs--should be used to manage pain. The first, and most important, step is to diagnose the condition causing the pain and identify what caused that condition. Appropriate dental treatment should then be undertaken to remove the cause of the condition as this usually provides rapid resolution of the symptoms. Drugs should only be used as an adjunct to the dental treatment. Most painful problems that require analgesics will be due to inflammation. Pain management drugs include non-narcotic analgesics (e.g., non-steroidal anti-inflammatory drugs, paracetamol, etc) or opioids (i.e., narcotics). Non-steroidal anti-inflammatory drugs (NSAIDs) provide excellent pain relief due to their anti-inflammatory and analgesic action. The most common NSAIDs are aspirin and ibuprofen. Paracetamol gives very effective analgesia but has little anti-inflammatory action. The opioids are powerful analgesics but have significant side effects and therefore they should be reserved for severe pain only. The most commonly-used opioid is codeine, usually in combination with paracetamol. Corticosteroids can also be used for managing inflammation but their use in dentistry is limited to a few very specific situations.
Topics: Acetaminophen; Adrenal Cortex Hormones; Anti-Inflammatory Agents, Non-Steroidal; Dental Care; Humans; Ibuprofen; Narcotics; Pain
PubMed: 16416713
DOI: 10.1111/j.1834-7819.2005.tb00378.x -
Pharmacologic Treatment of Opioid Use Disorder: a Review of Pharmacotherapy, Adjuncts, and Toxicity.Journal of Medical Toxicology :... Dec 2018Opioid use disorder continues to be a significant source of morbidity and mortality in the USA and the world. Pharmacologic treatment with methadone and buprenorphine... (Review)
Review
Opioid use disorder continues to be a significant source of morbidity and mortality in the USA and the world. Pharmacologic treatment with methadone and buprenorphine has been shown to be effective at retaining people in treatment programs, decreasing illicit opioid use, decreasing rates of hepatitis B, and reducing all cause and overdose mortality. Unfortunately, barriers exist in accessing these lifesaving medications: users wishing to start buprenorphine therapy require a waivered provider to prescribe the medication, while some states have no methadone clinics. As such, users looking to wean themselves from opioids or treat their opioid dependence will turn to alternative agents. These agents include using prescription medications, like clonidine or gabapentin, off-label, or over the counter drugs, like loperamide, in supratherapeutic doses. This review provides information on the pharmacology and the toxic effects of pharmacologic agents that are used to treat opioid use disorder. The xenobiotics reviewed in depth include buprenorphine, clonidine, kratom, loperamide, and methadone, with additional information provided on lofexidine, akuamma seeds, kava, and gabapentin.
Topics: Buprenorphine; Humans; Methadone; Narcotic Antagonists; Narcotics; Opiate Substitution Treatment; Opioid-Related Disorders
PubMed: 30377951
DOI: 10.1007/s13181-018-0685-1 -
The Cochrane Database of Systematic... Feb 2014Buprenorphine maintenance treatment has been evaluated in randomised controlled trials against placebo medication, and separately as an alternative to methadone for... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Buprenorphine maintenance treatment has been evaluated in randomised controlled trials against placebo medication, and separately as an alternative to methadone for management of opioid dependence.
OBJECTIVES
To evaluate buprenorphine maintenance compared to placebo and to methadone maintenance in the management of opioid dependence, including its ability to retain people in treatment, suppress illicit drug use, reduce criminal activity, and mortality.
SEARCH METHODS
We searched the following databases to January 2013: Cochrane Drugs and Alcohol Review Group Specialised Register, Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Current Contents, PsycLIT, CORK, Alcohol and Drug Council of Australia, Australian Drug Foundation, Centre for Education and Information on Drugs and Alcohol, Library of Congress, reference lists of identified studies and reviews. We sought published/unpublished randomised controlled trials (RCTs) from authors.
SELECTION CRITERIA
Randomised controlled trials of buprenorphine maintenance treatment versus placebo or methadone in management of opioid-dependent persons.
DATA COLLECTION AND ANALYSIS
We used Cochrane Collaboration methodology.
MAIN RESULTS
We include 31 trials (5430 participants), the quality of evidence varied from high to moderate quality.There is high quality of evidence that buprenorphine was superior to placebo medication in retention of participants in treatment at all doses examined. Specifically, buprenorphine retained participants better than placebo: at low doses (2 - 6 mg), 5 studies, 1131 participants, risk ratio (RR) 1.50; 95% confidence interval (CI) 1.19 to 1.88; at medium doses (7 - 15 mg), 4 studies, 887 participants, RR 1.74; 95% CI 1.06 to 2.87; and at high doses (≥ 16 mg), 5 studies, 1001 participants, RR 1.82; 95% CI 1.15 to 2.90. However, there is moderate quality of evidence that only high-dose buprenorphine (≥ 16 mg) was more effective than placebo in suppressing illicit opioid use measured by urinanalysis in the trials, 3 studies, 729 participants, standardised mean difference (SMD) -1.17; 95% CI -1.85 to -0.49, Notably, low-dose, (2 studies, 487 participants, SMD 0.10; 95% CI -0.80 to 1.01), and medium-dose, (2 studies, 463 participants, SMD -0.08; 95% CI -0.78 to 0.62) buprenorphine did not suppress illicit opioid use measured by urinanalysis better than placebo.There is high quality of evidence that buprenorphine in flexible doses adjusted to participant need,was less effective than methadone in retaining participants, 5 studies, 788 participants, RR 0.83; 95% CI 0.72 to 0.95. For those retained in treatment, no difference was observed in suppression of opioid use as measured by urinalysis, 8 studies, 1027 participants, SMD -0.11; 95% CI -0.23 to 0.02 or self report, 4 studies, 501 participants, SMD -0.11; 95% CI -0.28 to 0.07, with moderate quality of evidence.Consistent with the results in the flexible-dose studies, in low fixed-dose studies, methadone (≤ 40 mg) was more likely to retain participants than low-dose buprenorphine (2 - 6 mg), (3 studies, 253 participants, RR 0.67; 95% CI: 0.52 to 0.87). However, we found contrary results at medium dose and high dose: there was no difference between medium-dose buprenorphine (7 - 15 mg) and medium-dose methadone (40 - 85 mg) in retention, (7 studies, 780 participants, RR 0.87; 95% CI 0.69 to 1.10) or in suppression of illicit opioid use as measured by urines, (4 studies, 476 participants, SMD 0.25; 95% CI -0.08 to 0.58) or self report of illicit opioid use, (2 studies, 174 participants, SMD -0.82; 95% CI -1.83 to 0.19). Similarly, there was no difference between high-dose buprenorphine (≥ 16 mg) and high-dose methadone (≥ 85 mg) in retention (RR 0.79; 95% CI 0.20 to 3.16) or suppression of self-reported heroin use (SMD -0.73; 95% CI -1.08 to -0.37) (1 study, 134 participants).Few studies reported adverse events ; two studies compared adverse events statistically, finding no difference between methadone and buprenorphine, except for a single result indicating more sedation among those using methadone.
AUTHORS' CONCLUSIONS
Buprenorphine is an effective medication in the maintenance treatment of heroin dependence, retaining people in treatment at any dose above 2 mg, and suppressing illicit opioid use (at doses 16 mg or greater) based on placebo-controlled trials.However, compared to methadone, buprenorphine retains fewer people when doses are flexibly delivered and at low fixed doses. If fixed medium or high doses are used, buprenorphine and methadone appear no different in effectiveness (retention in treatment and suppression of illicit opioid use); however, fixed doses are rarely used in clinical practice so the flexible dose results are more relevant to patient care. Methadone is superior to buprenorphine in retaining people in treatment, and methadone equally suppresses illicit opioid use.
Topics: Buprenorphine; Humans; Maintenance Chemotherapy; Methadone; Narcotic Antagonists; Narcotics; Opioid-Related Disorders; Randomized Controlled Trials as Topic
PubMed: 24500948
DOI: 10.1002/14651858.CD002207.pub4 -
CMAJ : Canadian Medical Association... Mar 2024
Topics: Humans; Analgesics, Opioid; Narcotics; Substance Withdrawal Syndrome
PubMed: 38527744
DOI: 10.1503/cmaj.230968-f -
Revue Medicale de Liege Oct 2011Mephedrone is a designer drug recently appeared on the belgian market of the drugs of misuse. The aim of this journal paper is to provide a review on the available data...
Mephedrone is a designer drug recently appeared on the belgian market of the drugs of misuse. The aim of this journal paper is to provide a review on the available data about mephedrone and to call the attention of the first line practitioners who will have to face this emerging problem.
Topics: Amphetamine-Related Disorders; Designer Drugs; Drug Overdose; Humans; Illicit Drugs; Methamphetamine; Narcotics
PubMed: 22141261
DOI: No ID Found -
The Canadian Journal of Nursing... Dec 2022Canada is currently experiencing an opioid crisis. (Review)
Review
BACKGROUND
Canada is currently experiencing an opioid crisis.
PURPOSE
Nurses are the largest number of frontline healthcare professionals in Canada who administer narcotic pharmacotherapy, hence, they are ideally placed to improve narcotic stewardship in hospitals. Our study aims to understand the characteristics of narcotic incidents and hence recommend interventions for narcotic stewardship.
METHODS
Our study was conducted within a 442-bed academic health sciences center in Ontario. We extracted anonymized narcotic incident reports which occurred over a 3-year period from the SAFER System. Descriptive statistics were utilized to analyze narcotic incidents and their contributory factors.
RESULTS
272 narcotic incident reports were submitted to SAFER within the study period. Most incidents (51%) involved hydromorphone and morphine and were primarily categorized as Level I (n = 154) and Level II (n = 60). Incorrect narcotic dosing (44%), and narcotic count discrepancies (27%) were most commonly reported with active failures being the most commonly reported contributory factors such as failure to review medication orders prior to narcotic administration.
CONCLUSIONS
Nurses have an important role in narcotic safety as an intermediary between narcotic administration and incident reporting. Further research is needed to understand the enablers, barriers and opportunities for nurses and other healthcare professionals to improve narcotic stewardship.
Topics: Humans; Narcotics; Hydromorphone; Risk Management; Hospitals; Ontario
PubMed: 34229483
DOI: 10.1177/08445621211028709 -
Hand (New York, N.Y.) Mar 2020The goals of the study were to: (1) evaluate trends in preoperative and prolonged postoperative narcotic use in carpal tunnel release (CTR); (2) characterize risks for...
The goals of the study were to: (1) evaluate trends in preoperative and prolonged postoperative narcotic use in carpal tunnel release (CTR); (2) characterize risks for prolonged narcotic use; and (3) evaluate narcotic use as an independent risk factor for complications following CTR. A query of a large insurance database from 2007-2016 was conducted. Patients undergoing open or endoscopic CTR were included. Revision surgeries or patients undergoing median nerve repair at the forearm, upper extremity fasciotomies, or with distal radius fractures were excluded. Preoperative use was defined as narcotic use between 1 to 4 months prior to CTR. A narcotic prescription between 1 and 4 months after surgery was considered prolonged postoperative use. Demographics, comorbidities, and other risk factors for prolonged postoperative use were assessed using a regression analysis. Subgroup analysis was performed according to the number of preoperative narcotic prescriptions. Narcotic use as a risk factor for complications, including chronic regional pain syndrome (CRPS) and revision CTR, was assessed. In total, 66 077 patients were included. A decrease in prescribing of perioperative narcotics was noted. Risk factors for prolonged narcotic use included preoperative narcotic use, drug and substance use, lumbago, and depression. Preoperative narcotics were associated with increased emergency room visits, readmissions, CRPS, and infection. Prolonged postoperative narcotic use was linked to CRPS and revision surgery. Preoperative narcotic use is strongly associated with prolonged postoperative use. Both preoperative and prolonged postoperative prescriptions narcotic use correlated with increased risk of complications. Preoperative narcotic use is associated with a higher risk of postoperative CRPS.
Topics: Carpal Tunnel Syndrome; Humans; Male; Median Nerve; Narcotics; Opioid-Related Disorders; Risk Factors
PubMed: 30067126
DOI: 10.1177/1558944718792276 -
Scientific Reports Jan 2021There is an increasing challenge to prevent illicit drug smuggling across borders and seaports. However, the existing techniques in-and-of-themselves are not sufficient...
There is an increasing challenge to prevent illicit drug smuggling across borders and seaports. However, the existing techniques in-and-of-themselves are not sufficient to identify the illicit drugs rapidly and accurately. In the present study, combining nuclear resonance fluorescence (NRF) spectroscopy and the element (or isotope) ratio approach, we present a novel inspection method that can simultaneously reveal the elemental (or isotopic) composition of the illicit drugs, such as widely abused methamphetamine, cocaine, heroin, ketamine and morphine. In the NRF spectroscopy, the nuclei are excited by the induced photon beam, and measurement of the characteristic energies of the emitted [Formula: see text] rays from the distinct energy levels in the excited nuclei provides "fingerprints" of the interested elements in the illicit drugs. The element ratio approach is further used to identify drug elemental composition in principle. Monte Carlo simulations show that four NRF peaks from the nuclei [Formula: see text]C, [Formula: see text]N and [Formula: see text]O can be detected with high significance of 7-24[Formula: see text] using an induced photon beam flux of [Formula: see text]. The ratio of [Formula: see text]/[Formula: see text] and/or [Formula: see text]/[Formula: see text] for illicit drugs inspected are then extracted using the element ratio approach. It is found that the present results of simulations are in good agreement with the theoretical calculations. The feasibility to detect the illicit drugs, inside the 15-mm-thick iron shielding, or surrounded by thin benign materials, is also discussed. It is indicated that, using the state-of-the-art [Formula: see text]-ray source of high intensity and energy-tunability, the proposed method has a great potential for identifying drugs and explosives in a realistic measurement time.
Topics: Narcotics; Spectrum Analysis
PubMed: 33446676
DOI: 10.1038/s41598-020-80079-6 -
JAMA Facial Plastic Surgery Sep 2019An increase in narcotic prescription patterns has contributed to the current opioid epidemic in the United States. Opioid-sparing perioperative analgesia represents a...
IMPORTANCE
An increase in narcotic prescription patterns has contributed to the current opioid epidemic in the United States. Opioid-sparing perioperative analgesia represents a means of mitigating the risk of opioid dependence while providing superior perioperative analgesia.
OBJECTIVE
To assess whether multimodal analgesia (MMA) is associated with reduced narcotic use and improved pain control compared with traditional narcotic-based analgesics at discharge and in the immediate postoperative period after free flap reconstructive surgery.
DESIGN, SETTING, AND PARTICIPANTS
This retrospective cohort study assessed a consecutive sample of 65 patients (28 MMA, 37 controls) undergoing free flap reconstruction of a through-and-through mucosal defect within the head and neck region at a tertiary academic referral center from June 1, 2017, to November 30, 2018. Patients and physicians were not blinded to the patients' analgesic regimen. Patients' clinical courses were followed up for 30 days postoperatively.
INTERVENTIONS
Patients were administered a preoperative, intraoperative, and postoperative analgesia regimen consisting of scheduled and as-needed neuromodulating and anti-inflammatory medications, with narcotic medications reserved for refractory cases. Control patients were administered traditional narcotic-based analgesics as needed.
MAIN OUTCOMES AND MEASURES
Narcotic doses administered during the perioperative period and at discharge were converted to morphine-equivalent doses (MEDs) for comparison. Postoperative Defense and Veterans Pain Rating Scale pain scores (ranging from 0 [no pain] to 10 [worst pain imaginable]) were collected for the first 72 hours postoperatively as a patient-reported means of analyzing effectiveness of analgesia.
RESULTS
A total of 28 patients (mean [SD] age, 64.1 [12.3] years; 17 [61%] male) were included in the MMA group and 37 (mean [SD] age, 65.0 [11.0] years; 22 [59%] male) in the control group. The number of MEDs administered postoperatively was 10.0 (interquartile range [IQR], 2.7-23.1) in the MMA cohort and 89.6 (IQR, 60.0-104.5) in the control cohort (P < .001). Mean (SD) Defense and Veterans Pain Rating Scale pain scores postoperatively were 2.05 (1.41) in the MMA cohort and 3.66 (1.99) in the control cohort (P = .001). Median number of MEDs prescribed at discharge were 0 (IQR, 0-18.8) in the MMA cohort and 300.0 (IQR, 262.5-412.5) in the control cohort (P < .001).
CONCLUSIONS AND RELEVANCE
The findings suggest that after free flap reconstruction, MMA is associated with reduced narcotic use at discharge and in the immediate postoperative period and with superior analgesia as measured by patient-reported pain scores. Patients receiving MMA achieved improved pain control, and the number of narcotic prescriptions in circulation were reduced.
LEVEL OF EVIDENCE
3.
Topics: Aged; Analgesia; Female; Free Tissue Flaps; Head and Neck Neoplasms; Humans; Male; Middle Aged; Narcotics; Pain Measurement; Pain, Postoperative; Plastic Surgery Procedures; Retrospective Studies
PubMed: 31393513
DOI: 10.1001/jamafacial.2019.0612 -
Cold Spring Harbor Perspectives in... Jan 2021This review describes methods for preclinical evaluation of candidate medications to treat opioid use disorder (OUD). The review is founded on the propositions that (1)... (Review)
Review
This review describes methods for preclinical evaluation of candidate medications to treat opioid use disorder (OUD). The review is founded on the propositions that (1) drug self-administration procedures provide the most direct method for assessment of medication effectiveness, (2) procedures that assess choice between opioid and nondrug reinforcers are especially useful, and (3) states of opioid dependence and withdrawal profoundly influence both opioid reinforcement and effects of candidate medications. Effects of opioid medications and vaccines on opioid choice in nondependent and opioid-dependent subjects are reviewed. Various nonopioid medications have also been examined, but none yet have been identified that safely and reliably reduce opioid choice. Future research will focus on (1) strategies for increasing safety and/or effectiveness of opioid medications (e.g., G-protein-biased μ-opioid agonists), and (2) continued development of nonopioid medications (e.g., clonidine) that might serve as adjunctive agents to current opioid medications.
Topics: Analgesics, Opioid; Buprenorphine; Choice Behavior; Drug Development; Evidence-Based Medicine; Humans; Methadone; Naltrexone; Narcotic Antagonists; Narcotics; Opioid-Related Disorders; Receptors, Opioid, mu; Self Administration; Substance Withdrawal Syndrome; Treatment Outcome
PubMed: 31932466
DOI: 10.1101/cshperspect.a039263