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Journal of Addictive Diseases 2021Qualitative analysis of Twitter posts reveals key insights about user norms, informedness, perceptions, and experiences related to opioid use disorder (OUD). This paper...
Qualitative analysis of Twitter posts reveals key insights about user norms, informedness, perceptions, and experiences related to opioid use disorder (OUD). This paper characterizes Twitter message content pertaining to medications for opioid use disorder (MOUD) and Naloxone. In-depth thematic analysis was conducted of 1,010 Twitter messages collected in June 2019. Our primary aim was to identify user perceptions and experiences related to harm reduction (e.g., Naloxone) and MOUD (e.g., sublingual and Extended-release buprenorphine, Extended-release naltrexone, Methadone). Tweets relating to OUD were most commonly authored by general Twitter users (43.8%), private residential or detoxification programs (24.6%), healthcare providers (e.g., physicians, first responders; 4.3%), PWUOs (4.7%) and their caregivers (2.9%). Naloxone was mentioned in 23.8% of posts and authored most commonly by general users (52.9%), public health experts (7.4%), and nonprofit/advocacy organizations (6.6%). Sentiment was mostly positive about Naloxone (73.6%). Commonly mentioned MOUDs in our search consisted of Buprenorphine-naloxone (13.8%), Methadone (5.7%), Extended-release naltrexone (4.1%), and Extended-release buprenorphine (0.01%). Tweets authored by PWUOs (4.7%) most commonly related to factors influencing access to MOUD or adverse events related to MOUD (70.8%), negative or positive experiences with illicit substance use (25%), policies related to expanding access to treatments for OUD (8.3%), and stigma experienced by healthcare providers (8.3%). Twitter is utilized by a diverse array of individuals, including PWUOs, and offers an innovative approach to evaluate experiences and themes related to illicit opioid use, MOUD, and harm reduction.
Topics: Analgesics, Opioid; Buprenorphine; Buprenorphine, Naloxone Drug Combination; Delayed-Action Preparations; Harm Reduction; Humans; Methadone; Naloxone; Naltrexone; Narcotic Antagonists; Opiate Substitution Treatment; Opioid-Related Disorders; Perception; Qualitative Research; Social Media; Substance Abuse Treatment Centers
PubMed: 32835641
DOI: 10.1080/10550887.2020.1811456 -
Addiction (Abingdon, England) Oct 2022Fentanyl is primarily responsible for the current phase of the overdose epidemic in North America. Despite the benefits of treatment with medications for opioid use... (Randomized Controlled Trial)
Randomized Controlled Trial
Impact of fentanyl use on initiation and discontinuation of methadone and buprenorphine/naloxone among people with prescription-type opioid use disorder: secondary analysis of a Canadian treatment trial.
BACKGROUND AND AIMS
Fentanyl is primarily responsible for the current phase of the overdose epidemic in North America. Despite the benefits of treatment with medications for opioid use disorder (MOUD), there are limited data on the association between fentanyl, MOUD type and treatment engagement. The objectives of this analysis were to measure the impact of baseline fentanyl exposure on initiation and discontinuation of MOUD among individuals with prescription-type opioid use disorder (POUD).
DESIGN, SETTING AND PARTICIPANTS
Secondary analysis of a Canadian multi-site randomized pragmatic trial conducted between 2017 and 2020. Of the 269 randomized participants, 65.4% were male, 67.3% self-identified as white and 55.4% had a positive fentanyl urine drug test (UDT) at baseline. Fentanyl-exposed participants were more likely to be younger, to self-identify as non-white, to be unemployed or homeless and to be currently using stimulants than non-fentanyl-exposed participants.
INTERVENTIONS
Flexible take-home dosing buprenorphine/naloxone or supervised methadone models of care for 24 weeks.
MEASUREMENTS
Outcomes were (1) MOUD initiation and (2) time to (a) assigned and (b) overall MOUD discontinuation. Independent variables were baseline fentanyl UDT (predictor) and assigned MOUD (effect modifier).
FINDINGS
Overall, 209 participants (77.7%) initiated MOUD. In unadjusted analyses, fentanyl exposure was associated with reduced likelihood of treatment initiation [odds ratio (OR) = 0.18, 95% confidence interval (CI) = 0.08-0.36] and shorter median times in assigned [20 versus 168 days, hazard ratio (HR) = 3.61, 95% CI = 2.52-5.17] and any MOUD (27 versus 168 days, HR = 3.32, 95% CI = 2.30-4.80). The negative effects were no longer statistically significant in adjusted models, and no interaction between fentanyl and MOUD was observed for any of the outcomes (all P > 0.05).
CONCLUSIONS
Both buprenorphine/naloxone and methadone may be appropriate treatment options for people with prescription-type opioid use disorder regardless of fentanyl exposure. Other characteristics of fentanyl-exposed individuals appear to be driving the association with poorer treatment outcomes.
Topics: Analgesics, Opioid; Buprenorphine; Buprenorphine, Naloxone Drug Combination; Canada; Female; Fentanyl; Humans; Male; Methadone; Opiate Substitution Treatment; Opioid-Related Disorders; Prescriptions
PubMed: 35712892
DOI: 10.1111/add.15954 -
Psychopharmacology Jan 2023Opioid use disorders are commonly treated by long-acting agonist opioids including methadone and buprenorphine which could affect various aspects of male reproduction...
RATIONALE
Opioid use disorders are commonly treated by long-acting agonist opioids including methadone and buprenorphine which could affect various aspects of male reproduction especially spermatogenesis.
OBJECTIVES
We aimed to determine whether detoxification with methadone or buprenorphine was associated with reproductive disorders in male mice.
METHODS
We orally induced morphine dependence in NMRI male mice, and then performed detoxification programs using either methadone or buprenorphine. Testis architecture and sperm parameters including sperm nuclear DNA integrity, mitochondrial activity, oxidative stress in seminal plasma, and routine sperm parameters were assessed to find the involved mechanisms.
RESULTS
The number of Leydig cells and the thickness of germinal epithelium reduced following morphine use and increased differently after detoxification with methadone or buprenorphine. Morphine dependence and detoxification with methadone and buprenorphine had different effects on sperm parameters. Morphine altered chromatin integrity, mitochondrial activity, and oxidative stress in sperm. Detoxification with methadone improved mitochondrial activity but worsened chromatin integrity, whereas detoxification with buprenorphine improved neither chromatin integrity nor mitochondrial activity. Seminal plasma oxidative stress was higher in the treated groups compared to control groups but was comparable among treatment groups. Our study revealed that long-term morphine use followed by detoxification with methadone or buprenorphine impairs testis structure and sperm parameters. Detoxification from morphine use with methadone and buprenorphine led to different preclinical outcomes in semen quality parameters, including chromatin integrity. Therefore, clinical detoxification protocols should be performed more cautiously, considering the desire of the individuals to reproduce.
Topics: Male; Mice; Animals; Methadone; Buprenorphine; Opiate Substitution Treatment; Morphine Dependence; Semen Analysis; Semen; Analgesics, Opioid; Morphine; Opioid-Related Disorders; Reproduction; Chromatin
PubMed: 36385208
DOI: 10.1007/s00213-022-06274-7 -
Addictive Behaviors Jul 2015Attentional bias (AB) is implicated in the development and maintenance of substance dependence and in treatment outcome. We assessed the effects of attentional bias... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Attentional bias (AB) is implicated in the development and maintenance of substance dependence and in treatment outcome. We assessed the effects of attentional bias modification (ABM), and the relationship between AB and treatment adherence in opiate dependent patients.
METHOD
An independent groups design was used to compare 23 opiate dependent patients with 21 healthy controls. Participants completed an AB task before either a control or an ABM task designed to train attention away from substance-related stimuli. Pre- and post-ABM AB and craving were assessed to determine any changes. Relationships between treatment adherence ('using on top' of prescribed opiates or not) and AB, craving and psychopathology were also examined.
RESULTS
There was no baseline difference in AB between patients and controls, and no significant effect of ABM on AB or substance craving. However, treatment adherent patients who did not use illicit opiates on top of their prescribed opiates had statistically significantly greater AB away from substance-related stimuli than both participants using on top and controls, and reported significantly lower levels of craving than non-treatment adherent patients.
CONCLUSION
Whilst we did not find any significant effects of ABM on AB or craving, patients who were treatment adherent differed from both those who were not and from controls in their attentional functioning and substance craving. These findings are the first to suggest that AB may be a within-treatment factor predictive of adherence to pharmacological treatment and potentially of recovery in opiate users.
Topics: Analysis of Variance; Attention; Buprenorphine; Craving; Female; Humans; Impulsive Behavior; Male; Medication Adherence; Methadone; Middle Aged; Narcotics; Opiate Substitution Treatment; Opioid-Related Disorders; Psychotherapy; Surveys and Questionnaires
PubMed: 25838001
DOI: 10.1016/j.addbeh.2015.03.017 -
Journal of Medical Toxicology :... Jan 2020Illicitly manufactured fentanyl (IMF) is responsible for a growing number of deaths. Some case series have suggested that IMF overdoses require significantly higher...
INTRODUCTION
Illicitly manufactured fentanyl (IMF) is responsible for a growing number of deaths. Some case series have suggested that IMF overdoses require significantly higher naloxone doses than heroin overdoses. Our objective was to determine if the naloxone dose required to treat an opioid overdose is associated with the finding of fentanyl, opiates, or both on urine drug screen (UDS).
METHODS
A retrospective chart review was conducted at a single emergency department and its affiliated emergency medical services (EMS) agency. The charts of all patients who received naloxone through this EMS from 1/1/2017 to 6/15/2018 were reviewed. The study included patients diagnosed with a non-suicidal opioid overdose whose UDS was positive for opiates, fentanyl, or both. Data collected included demographics, vital signs, initial GCS, EMS and ED naloxone administrations, response to treatment, laboratory findings, and ED disposition. The fentanyl-only and fentanyl + opiate groups were compared to the opiate-only group using the stratified (by ED provider) variant of the Mann-Whitney U test.
RESULTS
Eight hundred and thirty-seven charts were reviewed, and 121 subjects were included in the final analysis. The median age of included subjects was 38 years and 75% were male. In the naloxone dose analysis, neither the fentanyl-only (median 0.8 mg, IQR 0.4-1.6; p = 0.68) nor the fentanyl + opiate (median 0.8 mg, IQR 0.4-1.2; p = 0.56) groups differed from the opiate-only group (median 0.58 mg, IQR 0.4-1.6).
CONCLUSION
Our findings refute the notion that high potency synthetic opioids like illicitly manufactured fentanyl require increased doses of naloxone to successfully treat an overdose. There were no significant differences in the dose of naloxone required to treat opioid overdose patients with UDS evidence of exposure to fentanyl, opiates, or both. Further evaluation of naloxone stocking and dosing protocols is needed.
Topics: Adolescent; Adult; Aged; Analgesics, Opioid; Drug Dosage Calculations; Drug Overdose; Emergency Service, Hospital; Female; Fentanyl; Humans; Male; Middle Aged; Naloxone; Narcotic Antagonists; Opioid-Related Disorders; Retrospective Studies; Substance Abuse Detection; Treatment Outcome; Urinalysis; Young Adult
PubMed: 31471760
DOI: 10.1007/s13181-019-00735-w -
Non-addictive opium alkaloids selectively induce apoptosis in cancer cells compared to normal cells.Daru : Journal of Faculty of Pharmacy,... Feb 2015Cytotoxic effects of some of the members of papaveraceae family have been reported in Iranian folk medicine. Recent reports has indicated that alkaloids fraction of...
BACKGROUND
Cytotoxic effects of some of the members of papaveraceae family have been reported in Iranian folk medicine. Recent reports has indicated that alkaloids fraction of opium may be responsible for its cytotoxic effect; however, the mechanism of this effect is not fully understood. This study has been designed to investigate the selective cytotoxic, genotoxic and also apoptosis induction effects of noscapine, papaverine and narceine, three non-addictable opium alkaloids, on HT29, T47D and HT1080 cancer cell lines. Mouse NIH3T3 cell line was chosen to present non-cancerous cells and Doxorubicin was selected as the positive control.
METHODS
Cells were treated by different concentrations of Noscapine, Papaverine, Narceine and doxorubicin; viability was assessed by MTT assay. The genotoxicity and apoptosis induction were tested with comet assay and Annexin-V affinity when the concentration of each these drugs is less than its IC50. In addition, the DNA damage and caspase activity of the T47D cells were examined and the results were compared.
RESULTS
This study noted the cytotoxicity and genotoxicity of noscapine and papaverine, specifically on cancerous cell lines. Furthermore, papaverine induces apoptosis in all studied cancer cell lines and noscapine showed this effect in T47D and HT29 cells but not in NIH-3 T3 cells as noncancerous cell line. narceine also showed genototoxicity in the studied cell lines at its IC50 concentration.
CONCLUSIONS
This experiment suggests that noscapine and papaverine may be of use in cancer treatment due to their specific cytotoxicity and genotoxicity. However, further in vivo studies are needed to confirm its usefulness in cancer treatment.
Topics: Animals; Antineoplastic Agents; Apoptosis; Benzodioxoles; Cell Line, Tumor; Cell Proliferation; DNA, Neoplasm; Doxorubicin; HT29 Cells; Humans; Indole Alkaloids; Mice; NIH 3T3 Cells; Neoplasms; Noscapine; Opiate Alkaloids; Papaverine
PubMed: 25890335
DOI: 10.1186/s40199-015-0101-1 -
Journal of Addiction Medicine 2018Few studies examine how payers address the need for improved access to pharmacotherapy for opioid use disorders and the influence of environmental variables on access to...
OBJECTIVE
Few studies examine how payers address the need for improved access to pharmacotherapy for opioid use disorders and the influence of environmental variables on access to opioid agonist and antagonist medications.
METHOD
The 52 Ohio Addiction Drug Abuse and Mental Health Services (ADAMHS) Boards that disburse funds for treatment services for the uninsured and underinsured were surveyed to assess coverage for opioid agonist and antagonist treatment medications. Analyses examined public health data on regional opioid addiction patterns, characteristics of the local health insurance market, and their associations with coverage for opioid addiction pharmacotherapy.
RESULTS
Most (70%) of the 44 participating ADAMHS Boards paid for opioid treatment medications. For payment policy, all Boards required behavioral therapy to be provided in conjunction with opioid agonist or opioid antagonist therapy, and 27% of the Boards limited length of a buprenorphine therapy regimen. Higher local opioid treatment admission rates were associated with higher rates of Board funding for opioid treatment pharmacotherapy. Environmental variables (eg, overdose fatality rates or the behaviors of private insurance payers) were not associated with ADAMHS support for opioid agonist or antagonist medication.
CONCLUSIONS
The analysis highlights the policy preferences of these payers. Follow-up studies should examine the payer decision-making processes, preferences, and attitudes that affect support for pharmacotherapy for opioid dependence.
Topics: Buprenorphine; Health Care Costs; Health Services Accessibility; Humans; Mental Health Services; Narcotic Antagonists; Ohio; Opiate Substitution Treatment; Opioid-Related Disorders; Reimbursement Mechanisms
PubMed: 29176511
DOI: 10.1097/ADM.0000000000000369 -
Molecules (Basel, Switzerland) Jul 2023The 5-(3-hydroxy)phenylmorphan structural class of compounds are unlike the classical morphinans, 4,5-epoxymorphinans, and 6,7-benzomorphans, in that they have an...
The 5-(3-hydroxy)phenylmorphan structural class of compounds are unlike the classical morphinans, 4,5-epoxymorphinans, and 6,7-benzomorphans, in that they have an equatorially oriented aromatic ring rather than the axial orientation of that ring found in the classical opioids. This modified and simplified opioid-like structure has been shown to retain antinociceptive activity, depending on its stereochemistry and substituents, and some of them have been found to be much more potent than morphine. A simple C9-hydroxy-5-(3-hydroxy)phenylmorphan enantiomer was found to be about 500 times more potent than morphine in vivo. We have previously examined C9-alkenyl and hydroxyalkyl substituents in the -phenethyl-5-(3-hydroxy)phenylmorphan class of compounds. Comparable C9-alkyl (methyl through butyl) substituents, with their sets of diastereomers, have not been explored. All these compounds have now been synthesized to determine the effect chain-length and stereochemistry at the C9 position in the molecule might have on their interaction with opioid receptors. We now report the synthesis and in vitro activity of 16 compounds, the C9-methyl, ethyl, propyl, and butyl diastereomers, using the inhibition of forskolin-induced cAMP accumulation assay. Several potent (sub-nanomolar and nanomolar) MOR compounds were found to be selective agonists with varying efficacy. Of greatest interest, a selective MOR antagonist was discovered; it did not display any DOR or KOR agonist activity in vitro, was three times more potent than naltrexone, and was found to antagonize the EC90 of fentanyl at MOR to a greater extent than naltrexone.
Topics: Receptors, Opioid, mu; Naltrexone; Structure-Activity Relationship; Morphinans; Morphine; Analgesics, Opioid
PubMed: 37513283
DOI: 10.3390/molecules28145411 -
Drug and Alcohol Dependence Sep 2019Understanding mechanisms of physiological opioid withdrawal symptoms can inform treatment strategies. This secondary analysis evaluated the association between mydriasis...
BACKGROUND
Understanding mechanisms of physiological opioid withdrawal symptoms can inform treatment strategies. This secondary analysis evaluated the association between mydriasis (dilated pupils), a commonly-assessed opioid withdrawal metric, with self- and observer-rated opioid withdrawal severity.
METHOD
Ninety-five participants with opioid physical dependence were stabilized with morphine before receiving an injection of the opioid antagonist naloxone to precipitate withdrawal. Pupil diameter, the Subjective Opiate Withdrawal Scale (SOWS), and the Clinical Opiate Withdrawal Scale (COWS) were collected at baseline and in 15-minute intervals for 120 min following naloxone administration. Pearson product-moment correlations and linear regressions characterized the relationships between pupil measurements (baseline and peak naloxone-induced) and self- and observer-rated measures of withdrawal. Repeated-measures ANOVAs tested whether self and observer-rated withdrawal severity corresponded to unique patterns in pupil changes.
RESULTS
Baseline pupil diameter significantly correlated with SOWS and COWS peak scores. Peak naloxone-induced pupil diameter significantly correlated with SOWS scores only. Peak changes in pupil from baseline did not correspond to peak changes in self- and observer-rated withdrawal scales.
CONCLUSIONS
This study suggests that pupil diameter measurements were more closely associated with acute opioid withdrawal severity than changes in pupil diameter. Prospective research examining the mechanisms underlying the relationship between pupil diameter and opioid withdrawal severity are warranted.
Topics: Adult; Analgesics, Opioid; Female; Humans; Male; Morphine; Naloxone; Narcotic Antagonists; Opiate Substitution Treatment; Opioid-Related Disorders; Pupil; Substance Withdrawal Syndrome
PubMed: 31336328
DOI: 10.1016/j.drugalcdep.2019.05.010 -
Substance Abuse Treatment, Prevention,... Mar 2015Buprenorphine is under-utilized in treating opioid addiction. Payers and providers both have substantial influence over the adoption and use of this medication to...
BACKGROUND
Buprenorphine is under-utilized in treating opioid addiction. Payers and providers both have substantial influence over the adoption and use of this medication to enhance recovery. Their views could provide insights into the barriers and facilitators in buprenorphine adoption.
METHODS
We conducted individual interviews with 18 Ohio county Alcohol, Drug Addiction, and Mental Health Services (ADAMHS) Boards (payers) and 36 addiction treatment centers (providers) to examine barriers and facilitators to buprenorphine use. Transcripts were reviewed, coded, and qualitatively analyzed. First, we examined reasons that county boards supported buprenorphine use. A second analysis compared county boards and addiction treatment providers on perceived barriers and facilitators to buprenorphine use. The final analysis compared county boards with low and high use of buprenorphine to determine how facilitators and barriers differed between those settings.
RESULTS
County boards (payers) promoted buprenorphine use to improve clinical care, reduce opioid overdose deaths, and prepare providers for participation in integrated models of health care delivery with primary care clinics and hospitals. Providers and payers shared many of the same perceptions of facilitators and barriers to buprenorphine use. Common facilitators identified were knowledge of buprenorphine benefits, funds allocated to purchase buprenorphine, and support from the criminal justice system. Common barriers were negative attitudes toward use of agonist pharmacotherapy, payment environment, and physician prescribing capacity. County boards with low buprenorphine use rates cited negative attitudes toward use of agonist medication as a primary barrier. County boards with high rates of buprenorphine use dedicated funds to purchase buprenorphine in spite of concerns about limited physician prescribing capacity.
CONCLUSIONS
This qualitative analysis found that attitudes toward use of medication and medication funding environment play important roles in an organization's decision to begin buprenorphine use and that physician availability influences an organization's ability to expand buprenorphine use over time. Additional education, reimbursement support, and policy changes are needed to support buprenorphine adoption and use, along with a greater understanding of the roles payers, providers, and regulators play in the adoption of targeted practices.
Topics: Attitude of Health Personnel; Buprenorphine; Health Care Costs; Health Knowledge, Attitudes, Practice; Health Services Accessibility; Humans; Narcotic Antagonists; Ohio; Opiate Substitution Treatment; Opioid-Related Disorders
PubMed: 25884206
DOI: 10.1186/s13011-015-0009-2