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Medications to Treat Opioid Use Disorder Research Report
Research Report Revised Junio 2018 Medications to Treat Opioid Use Disorder Research Report Table of Contents Medications to Treat Opioid Use Disorder Research Report Overview How do medications to treat opioid use disorder work? How effective are medications to treat opioid use disorder? What are misconceptions about maintenance treatment? What is the treatment need versus the diversion risk for opioid use disorder treatment? What is the impact of medication for opioid use disorder treatment on HIV/HCV outcomes? How is opioid use disorder treated in the criminal justice system? Is medication to treat opioid use disorder available in the military? What treatment is available for pregnant mothers and their babies? How much does opioid treatment cost? Is naloxone accessible? References Page 1 Medications to Treat Opioid Use Disorder Research Report Discusses effective medications used to treat opioid use disorders: methadone, buprenorphine, and naltrexone. Overview An estimated 1.4 million people in the United States had a substance use disorder related to prescription opioids in 2019.1 However, only a fraction of people with prescription opioid use disorders receive tailored treatment (22 percent in 2019).1 Overdose deaths involving prescription opioids more than quadrupled from 1999 through 2016 followed by significant declines reported in both 2018 and 2019.2,3 Besides overdose, consequences of the opioid crisis include a rising incidence of infants born dependent on opioids because their mothers used these substances during pregnancy4,5 and increased spread of infectious diseases, including HIV and hepatitis C (HCV), as was seen in 2015 in southern Indiana.6 Effective prevention and treatment strategies exist for opioid misuse and use disorder but are highly underutilized across the United States. -
Opioid Overdose – Use of Naloxone
CHAPTER: 41.3.1 Page 1 of 4 NEW ORLEANS POLICE DEPARTMENT OPERATIONS MANUAL CHAPTER: 41.3.1 TITLE: OPIOID OVERDOSE – USE OF NALOXONE EFFECTIVE: 10/22/2017 REVISED: 06/24/2018 PURPOSE The purpose of this policy is to set forth guidelines with respect to the appropriate field administration of Naloxone (Narcan) kits by members of New Orleans Police Department in suspected opiate / opioid overdose incidents. POLICY STATEMENT 1. Commissioned members of the NOPD are often the first emergency responders to the scene of a medical, suspected medical and overdose incident. Recognizing this, the NOPD has adopted this Chapter with the following goals: (a) To provide a framework for training in the field use of Naloxone, (b) To provide a framework on the proper field administration of Naloxone, and (c) To facilitate life-saving intervention in suspected opiate / opioid overdose incidents where NOPD officers are the first to arrive on the scene. 2. All commissioned and/or civilian members who have been trained in the use and administration of the department’s Naloxone nasal administration kits for suspected opiate / opioid overdose incidents are authorized to carry, use and administer the kits. 3. All members responding to medical calls, including suspected opioid overdoses, shall use universal precautions. DEFINITIONS: Definitions related to this Chapter include: Administration—Nasal administration of approved Naloxone 2mg kits with atomizer; 1mg (1/2 dose) to be administered in each nostril. Naloxone—A narcotic analgesic antagonist, used in the reversal of acute narcotic analgesic respiratory depression. Naloxone is effectively an antidote to opioid overdose and may completely reverse the effects of an opioid overdose if administered in time. -
A,-, and P-Opioid Receptor Agonists on Excitatory Transmission in Lamina II Neurons of Adult Rat Spinal Cord
The Journal of Neuroscience, August 1994, 74(E): 4965-4971 Inhibitory Actions of S,-, a,-, and p-Opioid Receptor Agonists on Excitatory Transmission in Lamina II Neurons of Adult Rat Spinal Cord Steven R. Glaum,’ Richard J. Miller,’ and Donna L. Hammond* Departments of lPharmacoloaical and Phvsioloqical Sciences and ‘Anesthesia and Critical Care, The University of Chicago, Chicago, Illinois 60637 . This study examined the electrophysiological consequences tor in rat spinal cord and indicate that activation of either of selective activation of 6,-, 6,-, or r-opioid receptors using 6,- or Qopioid receptors inhibits excitatory, glutamatergic whole-cell recordings made from visually identified lamina afferent transmission in the spinal cord. This effect may me- II neurons in thin transverse slices of young adult rat lumbar diate the ability of 6, or 6, receptor agonists to produce an- spinal cord. Excitatory postsynaptic currents (EPSCs) or po- tinociception when administered intrathecally in the rat. tentials (EPSPs) were evoked electrically at the ipsilateral [Key words: DPDPE, deltorphin, spinal cord slice, EPSP, dorsal root entry zone after blocking inhibitory inputs with 6-opioid receptor, DAMGO, naltriben, 7-benzylidene- bicuculline and strychnine, and NMDA receptors with o-2- naltrexone (BNTX), naloxone] amino+phosphonopentanoic acid. Bath application of the p receptor agonist [D-Ala2, KMePhe4, Gly5-ollenkephalin (DAMGO) or the 6, receptor agonist [D-Pen2, o-PerF]en- The dorsal horn of the spinal cord is an important site for the kephalin (DPDPE) produced a log-linear, concentration-de- production of antinociception by K- and 6-opioid receptor ag- pendent reduction in the amplitude of the evoked EPSP/ onists (Yaksh, 1993). -
Naloxone FAQ What Is Naloxone?
1 Naloxone FAQ What is naloxone? An FDA approved opioid antagonist prescription medication that reverses opioid overdoses. Two of the most common ways that naloxone is administered are intranasally (nasal spray) and the auto-injector. Naloxone is available under the names of” naloxone,” an injectable that, with attachments can also be used as a nasal spray; “NARCAN,” an already assembled and easy to administer nasal spray; and, finally “EVZO,” a prefilled auto-injector. How does it work? It stops or reverses the effects of an opioid overdose and restores breathing within two (2) to eight (8) minutes. The naloxone effect lasts from 20 to 90 minutes, and can be safely readministered as indicated. Is it safe? Yes. It cannot be used to get high and it is non-addictive . Where do I find an approved training? Free in-person NARCAN administration training is available at Prevention Point Philadelphia. Where do I find an approved online training and how long does training take? www.getnaloxonenow.org https://www.pavtn.net/act-139-training http://prescribetoprevent.org/patient-education/videos/ Training takes approximately 20 minutes. Does Act 139 under Provision of Good Samaritan cover provider agencies? Yes. How do we obtain naloxone? Providers will have to purchase by prescription. Individuals may do so by prescription or by standing order issued by Pennsylvania’s Physician General, Dr. Rachel Levine. Some pharmacies keep this standing order on file. NALOXONE/NARCAN FAQ Page 1 2 Naloxone FAQ (continued) Does Medical Assistance require prior authorization for any of the naloxone products? The Evzio Auto-Injector is covered by Medical Assistance, but requires prior authorization. -
Opioid Receptorsreceptors
OPIOIDOPIOID RECEPTORSRECEPTORS defined or “classical” types of opioid receptor µ,dk and . Alistair Corbett, Sandy McKnight and Graeme Genes encoding for these receptors have been cloned.5, Henderson 6,7,8 More recently, cDNA encoding an “orphan” receptor Dr Alistair Corbett is Lecturer in the School of was identified which has a high degree of homology to Biological and Biomedical Sciences, Glasgow the “classical” opioid receptors; on structural grounds Caledonian University, Cowcaddens Road, this receptor is an opioid receptor and has been named Glasgow G4 0BA, UK. ORL (opioid receptor-like).9 As would be predicted from 1 Dr Sandy McKnight is Associate Director, Parke- their known abilities to couple through pertussis toxin- Davis Neuroscience Research Centre, sensitive G-proteins, all of the cloned opioid receptors Cambridge University Forvie Site, Robinson possess the same general structure of an extracellular Way, Cambridge CB2 2QB, UK. N-terminal region, seven transmembrane domains and Professor Graeme Henderson is Professor of intracellular C-terminal tail structure. There is Pharmacology and Head of Department, pharmacological evidence for subtypes of each Department of Pharmacology, School of Medical receptor and other types of novel, less well- Sciences, University of Bristol, University Walk, characterised opioid receptors,eliz , , , , have also been Bristol BS8 1TD, UK. postulated. Thes -receptor, however, is no longer regarded as an opioid receptor. Introduction Receptor Subtypes Preparations of the opium poppy papaver somniferum m-Receptor subtypes have been used for many hundreds of years to relieve The MOR-1 gene, encoding for one form of them - pain. In 1803, Sertürner isolated a crystalline sample of receptor, shows approximately 50-70% homology to the main constituent alkaloid, morphine, which was later shown to be almost entirely responsible for the the genes encoding for thedk -(DOR-1), -(KOR-1) and orphan (ORL ) receptors. -
Disclosures Background on Kratom
1/23/2019 Pharmacy Technician Learning Objectives • Review the history, mechanism of action, off‐label uses, and common Kratom: An side effects of kratom • Distinguish between state and federal laws for kratom and why this is Herbal relevant to patient’s use Supplement of • Identify possible treatments for kratom overdose Atomic Concern? Taylor Conklin, PharmD PGY1 Pharmacy Resident Northwestern Memorial Hospital January 22, 2019 Advisor: Robert Pecho, PharmD Clinical Pharmacist PGY1 Pharmacy Practice Coordinator Northwestern Memorial Hospital Disclosures Background on Taylor Conklin and Robert Pecho do not have any conflicts of interest to disclose regarding the subject matter Kratom Pharmacist Learning Objectives Kratom in the Media • Review the history, pharmacology, off‐label indications, and side effect profile of kratom • Distinguish current federal and state legislation regarding kratom and question how it relates to current use • Discuss historical strategies for management of kratom intoxication and outline plans to treat patients https://www.youtube.com/watch?v=P9SIjuHaiXA Image from Joe Rogan Experience (Podcast) http://podcasts.joerogan.net/. Accessed December 23, 2018. Mark Hay. “Inside Kratom, the Gas Station Drug That Could End the Opioid Crisis. https://www.vice.com/en_us/article/gyd587/kratom-opioid-crisis. Accessed December 23, 2018. Joe Rogan Podcast https://www.youtube.com/watch?v=P9SIjuHaiXA. Accessed December 23, 2018. 1 1/23/2019 Patient Case #1 Growth to Western Civilization Sally Sassafras PubMed - Articles on -
A New Data Repository for Pharmacokinetic Natural Product-Drug Interactions: From
Title Page A New Data Repository for Pharmacokinetic Natural Product-Drug Interactions: from Chemical Characterization to Clinical Studies Caroline Birer-Williams, Brandon T. Gufford, Eric Chou, Marijanel Alilio, Sidney VanAlstine, Rachael E. Morley, Jeannine S. McCune, Mary F. Paine, Richard D. Boyce CBW, EC, RDB - Department of Biomedical Informatics, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania, United States MA – School of Pharmacy, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania, United States SVA, RM – School of Pharmacy, University of Utah, Salt Lake City, Utah, United States BTG – Covance Inc., Clinical Pharmacology, Madison, Wisconsin, United States JSM – Department of Population Sciences and Department of Hematology & HCT, City of Hope Comprehensive Cancer Center, Duarte, CA, United States 1 MFP - Department of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA, United States J.S.M., M.F.P., R.D.B. – Center of Excellence for Natural Product Drug Interaction Research 2 Running Title Page: Running Title: The NaPDI Center Data Repository Corresponding author: Richard D. Boyce, PhD Suite 419, 5607 Baum Blvd Pittsburgh, PA 15206 +1 412 648 9219 [email protected] Number of text pages: Number of tables: 2 Number of figures: 5 Number of references: 60 Number of words in the Abstract: 188 Number of words in the Introduction: 564 Number of words in the Discussion: 583 List of nonstandard abbreviations: FAIR: findable, accessible, interoperable and reusable NP: natural product NPDI: NP-drug interaction NaPDI Center: Center of Excellence for Natural Product Drug Interaction Research 3 Abstract There are many gaps in scientific knowledge about the clinical significance of pharmacokinetic natural product-drug interactions (NPDIs) in which the NP is the precipitant and a conventional drug is the object. -
ASAM National Practice Guideline for the Treatment of Opioid Use Disorder: 2020 Focused Update
The ASAM NATIONAL The ASAM National Practice Guideline 2020 Focused Update Guideline 2020 Focused National Practice The ASAM PRACTICE GUIDELINE For the Treatment of Opioid Use Disorder 2020 Focused Update Adopted by the ASAM Board of Directors December 18, 2019. © Copyright 2020. American Society of Addiction Medicine, Inc. All rights reserved. Permission to make digital or hard copies of this work for personal or classroom use is granted without fee provided that copies are not made or distributed for commercial, advertising or promotional purposes, and that copies bear this notice and the full citation on the fi rst page. Republication, systematic reproduction, posting in electronic form on servers, redistribution to lists, or other uses of this material, require prior specifi c written permission or license from the Society. American Society of Addiction Medicine 11400 Rockville Pike, Suite 200 Rockville, MD 20852 Phone: (301) 656-3920 Fax (301) 656-3815 E-mail: [email protected] www.asam.org CLINICAL PRACTICE GUIDELINE The ASAM National Practice Guideline for the Treatment of Opioid Use Disorder: 2020 Focused Update 2020 Focused Update Guideline Committee members Kyle Kampman, MD, Chair (alpha order): Daniel Langleben, MD Chinazo Cunningham, MD, MS, FASAM Ben Nordstrom, MD, PhD Mark J. Edlund, MD, PhD David Oslin, MD Marc Fishman, MD, DFASAM George Woody, MD Adam J. Gordon, MD, MPH, FACP, DFASAM Tricia Wright, MD, MS Hendre´e E. Jones, PhD Stephen Wyatt, DO Kyle M. Kampman, MD, FASAM, Chair 2015 ASAM Quality Improvement Council (alpha order): Daniel Langleben, MD John Femino, MD, FASAM Marjorie Meyer, MD Margaret Jarvis, MD, FASAM, Chair Sandra Springer, MD, FASAM Margaret Kotz, DO, FASAM George Woody, MD Sandrine Pirard, MD, MPH, PhD Tricia E. -
Biochemical Benefits, Diagnosis, and Clinical Risks Evaluation of Kratom
REVIEW published: 24 April 2017 doi: 10.3389/fpsyt.2017.00062 Biochemical Benefits, Diagnosis, and Clinical Risks Evaluation of Kratom Dimy Fluyau1* and Neelambika Revadigar2 1 Brain Health, Emory University, Atlanta, GA, USA, 2 Columbia University, New York, NY, USA Background: Kratom (Mitragyna speciosa) is a tropical tree with a long history of tradi- tional use in parts of Africa and Southeast Asia. Kratom is also known as Thom, Thang, and Biak. Its leaves and the teas brewed from them have long been used by people in that region to manage pain and opioid withdrawal and to stave off fatigue. Kratom is actually consumed throughout the world for its stimulant effects and as an opioid substi- tute (in form of tea, chewed, smoked, or ingested in capsules). Some case reports have associated kratom exposure with psychosis, seizures, intrahepatic cholestasis, other medical conditions, and deaths. The clinical manifestations of kratom effects are not well defined and the clinical studies are limited. Data research suggest that both stimulant and sedative dose-dependent effects do exist, in addition to antinociceptive, antide- pressant activity, anxiolytic-like effects, and anorectic effects, but a growing concern for the drug’s effects and safety of use has resulted in national and international attention primarily due to an increase in hospital visits and deaths in several countries that are Edited by: believed to have been caused by extracts of the plant. There is a dearth of double blind Angelo G. I. Maremmani, controlled studies. In this study, we aim to use existing literature to clarify both benefits North-Western Tuscany Region, Italy and risks of kratom as well as its diagnosis evaluation as kratom misuse is an emerging Reviewed by: trend in the Western world. -
Brain Magnetic Resonance Imaging of Regular Kratom (Mitragyna Speciosa Korth.) Users: a Preliminary Study
Malaysian Journal of Medicine and Health Sciences (eISSN 2636-9346) ORIGINAL ARTICLE Brain Magnetic Resonance Imaging of Regular Kratom (Mitragyna speciosa Korth.) Users: A Preliminary Study Darshan Singh1, Yann Chye2, Chao Suo2, Murat Yücel2, Oliver Grundmann3, Muhamad Zabidi Ahmad4, Eric Tatt Wei Ho5, Sharif Mahsufi Mansor1, Siti Rafidah Yusof1, Christopher R. McCurdy3, Christian Mϋller6, Edward W. Boyer7, Balasingam Vicknasingam1 1 Centre for Drug Research, Universiti Sains Malaysia. 11800 Minden, Penang. Malaysia. 2 Brain & Mental Health Research Hub, Monash Institute of Cognitive and Clinical Neuroscience, School of Psychological Sciences, Monash University. 3 Department of Medicinal Chemistry, College of Pharmacy, University of Florida, 1345 Center Drive, Gainesville, FL 32610, USA. 4 Oncological and Radiological Sciences Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Bertam, 13200 Kepala Batas, Pulau Pinang, Malaysia 5 Center for Intelligent Signal & Imaging Research, Universiti Teknologi PETRONAS, Perak, Malaysia. 6 Department of Psychiatry and Psychotherapy, University Clinic, Friedrich-Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany. 7 Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA. ABSTRACT Introduction: Mitragyna speciosa (Korth.) or kratom is a native medicinal plant of Southeast Asia. Commonly used by hard labours in harsh working environment, the ingestion of brewed kratom decoction is reported to produce dose-dependent stimulant and opioid-like effects. Kratom is also regularly consumed as a pain killer and as tradi- tional cure for common maladies such as fever and cough. However, it remains unknown whether regular consump- tion of kratom decoction is associated with brain abnormalities in regular users in traditional settings. -
(Mitragyna Speciosa) Use Among Ketum Leaf Users in Malysia
View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Repository@USM MEASURING DEPENDENCE SEVERITY OF KETUM (MITRAGYNA SPECIOSA) USE AMONG KETUM LEAF USERS IN MALYSIA by DARSHAN SINGH A/L MAHINDER SINGH Thesis submitted in fulfilment of the requirements for the degree of Doctor of Philosophy April 2013 ACKNOWLEDGEMENT I would like to express my appreciation and gratitude to my principal supervisor Associate Professor Dr.B.Vicknasingam Kasinather, for all his indispensible support and valuable guidance during my study at the Centre for Drug Research, Universiti Sains Malaysia. I am also grateful to my co-supervisor the Director of Centre for Drug Research Professor Sharif Mahsufi Mansor, for all his excellent guidance and moral support. I would also thank Mr. Firdaus Bin Ramli from the Centre for Drug Research, for dedicating his precious time in helping me with my data collection. My special thanks to Miss Vemala Devi from the Centre for Drug Research, who obsequiously helped to edit my thesis. I also extent my sincere appreciation to Professor Suresh Narayanan from the School of Social Sciences, for guiding me in my statistical analysis work. I would also like to thank the Ministry of Sains and Technology (MOSTI) for financially supporting my research work. Last but not least, I thank Almighty for blessing me to excel in my studies. Finally I want to also thank both my loving parents the Late Mr. Mahinder Singh and Madam Jagjit Kaur who always encouraged me to do well in all my endeavours. ii TABLES OF CONTENTS Acknowledgement.......................................................................................... -
Heterodimerization of Μ and Δ Opioid Receptors: a Role in Opiate Synergy
The Journal of Neuroscience, 2000, Vol. 20 RC110 1of5 Heterodimerization of and ␦ Opioid Receptors: A Role in Opiate Synergy I. Gomes, B. A. Jordan, A. Gupta, N. Trapaidze, V. Nagy, and L. A. Devi Departments of Pharmacology and Anesthesiology, New York University School of Medicine, New York, New York 10016 Opiate analgesics are widely used in the treatment of severe -selective ligands results in a significant increase in the bind- pain. Because of their importance in therapy, different strate- ing of a ␦ receptor agonist. This robust increase is also seen in gies have been considered for making opiates more effective SKNSH cells that endogenously express both and ␦ recep- while curbing their liability to be abused. Although most opiates tors. Furthermore, we find that a ␦ receptor antagonist en- exert their analgesic effects primarily via opioid receptors, a hances both the potency and efficacy of the receptor signal- number of studies have shown that ␦ receptor-selective drugs ing; likewise a antagonist enhances the potency and efficacy can enhance their potency. The molecular basis for these find- of the ␦ receptor signaling. A combination of agonists ( and ␦ ings has not been elucidated previously. In the present study, receptor selective) also synergistically binds and potentiates we examined whether heterodimerization of and ␦ receptors signaling by activating the –␦ heterodimer. Taken together, could account for the cross-modulation previously observed these studies show that heterodimers exhibit distinct ligand between these two receptors. We find that co-expression of binding and signaling characteristics. These findings have im- and ␦ receptors in heterologous cells followed by selective portant clinical ramifications and may provide new foundations immunoprecipitation results in the isolation of –␦ het- for more effective therapies.