Background: The misuse and addiction to opioids are one of the major health and social problem that is associated with an increase in morbidity and mortality. Both Buprenorphine (BUP) and Methadone (MET) are FDA-approved treatments for opioid dependence. This longitudinal study is to determine the effects of BUP and MET on hypertension in patients with opioid dependence using a Generalized Estimating Equation(GEE) Model. Methods: The data is from National Drug Abuse Treatment Clinical TrialsNetwork (CTN) protocol CTN-0027. This is a randomized study of 1,934 opioid dependence participants seeking treatment that followed for up to 32 weeks. A total of1,284 males and 631 females participated at the Baseline (visit1) of the study. At the endof 32 weeks (10 visits), 499 males and 243 female patients completed the study. Blood pressure of all the patients was checked at every visit beginning visit 1 to visit 10. For this analysis, the dependent variable was hypertension which was defined as having asystolic blood pressure higher than 140 mmHg and/or a diastolic blood pressure higher than 90 mmHg. These participants were randomly assigned to receive BUP (n= 740) or MET (n= 529). The GEE model with exchangeable correlation was used to determine the efficacy of both the drugs on hypertension. The analysis was performed using PROCGENMOD in SAS 9.4. Results: Time increased the odds of hypertension (adjusted odds ratio (aOR): 1.04, 95% confidence interval (CI): 1.02-1.06, pConclusion: Findings suggest that BUP had a slightly less chance of causing hypertension among patients with opioid dependence comparing with MET controlling for other risk factors, but neither one of Page 54 2017 Appalachian Student Research Forum them had any significant effect on hypertension among patients with opioid dependence. Further analysis will be essential to detect gender x treatment interaction.

Opioid use during pregnancy can result in the newborn being physically dependent on the substance, thus experiencing drug withdrawal, termed neonatal abstinence syndrome (NAS). Buprenorphine and methadone are two drugs used to treat opioid withdrawal and are approved for use in pregnancy. Quantification of these compounds in umbilical cord plasma would help assess in utero exposure of neonates in cases of buprenorphine or methadone use during pregnancy. An LC-MS/MS method using solid-phase extraction sample preparation was developed and validated for the simultaneous quantification of methadone, buprenorphine, norbuprenorphine, and glucuronide metabolites in umbilical cord plasma. The average accuracy (percentage error) and precision (relative standard deviation) were

No description available.

Purpose In recent years, there has been a significant increase in opioid-related drug use among pregnant mothers, specifically Methadone, Subutex (Buprenorphine) and Suboxone (Buprenorphine and Naloxone) resulting in increased neonatal intensive care unit (NICU) admissions for treatment of neonatal abstinence syndrome (NAS). Standard tests such as urine, meconium, and cord stat blood samples have not been shown to accurately demonstrate maternal abuse of these medications or predict the clinical course of NAS. This study aims to correlate and compare clinical symptoms of NAS with cord/ placental blood concentrations of Buprenorphine, Methadone and their metabolites. Another goal is to demonstrate the ability to correctly identify maternal abuse and concentrations of these medications. Methods The design was an observational study where cord/placental blood samples were obtained from eligible subjects. In addition to the standard cord stat test done by state, samples were analyzed using liquid chromatography mass spectrometry (LC-MS/MS) to quantify the metabolites of Buprenorphine, Norbuprenorphine and Methadone. Investigators performing the LC-MS/MS were blinded. Infants were treated on attending physician’s discretion according to clinical course. All infants were followed until discharge. Demographics and clinical course, including NICU stay, were recorded. Results A total of 19 mothers were enrolled, out of which, 15 (78.9%) mothers were on Subutex, 2 (10.5%) on Suboxone and 2 (10.5%) on Methadone. Data analysis was performed only on subjects with exposure to Subutex due to low sample size for Suboxone and Methadone subjects. Cord stat performed by the state lab was negative in 33.3% of subjects; however, 100% of the cord blood samples tested by LC-/MSMS were positive. The percentage of neonates transferred to NICU for NAS was 60% of which 67% received replacement therapy. Length of stay in NICU for treatment of NAS did not have any correlation to the concentration of the metabolites in cord blood. Pearson’s correlation coefficient (r) between duration of NICU stay and Norbuprenorhine concentration was r = -0.07 (p-value = 0.40); Buprenorphine concentration was r = -0.30 (p-value = 0.14); Norbuprenorphine-glucoronate concentration was r = -0.05 (p-value = 0.43); Buprenorphine-glucoronate concentration was r = -0.31 (p-value = 0.13). No correlation was found after adding the concentrations of all the above metabolites with NICU stay r = -0.24 (p-value = 0.19). Conclusion The cord stat result is inferior to cord/placental blood levels of drug metabolites using LC-MS/MS for diagnosing maternal substance abuse in at risk infants. No correlation was found between the concentrations of metabolites and length of stay in NICU or duration of replacement therapy. This study was limited by a small sample size.

No description available.

Fatal and non-fatal opioid overdoses resulting from opioid induced respiratory depression are a significant problem throughout the world. Whilst the opioid receptor antagonist, naloxone hydrochloride, can effectively reverse opioid overdoses, its use is limited because of the adverse effects it produces. These include severe withdrawal and the reversal of analgesia produced by opioid receptor agonists. In this project, the peripherally acting opioid receptor antagonist, naloxone methiodide, was investigated for its potential to reverse opioid induced respiratory depression without altering centrally mediated effects, such as withdrawal. In the publications presented in this thesis, naloxone hydrochloride and naloxone methiodide were shown to effectively reverse the decreases in respiratory rate produced by the administration of morphine, methadone and heroin in mice. Naloxone hydrochloride and naloxone methiodide also reversed the analgesia produced by these opioid receptor agonist treatments, but only naloxone hydrochloride induced significant withdrawal. The doses of naloxone methiodide required to produce the effects described above were higher than the naloxone hydrochloride doses required. Radioligand binding techniques indicated that this was due to a difference in the affinity of naloxone hydrochloride and naloxone methiodide for µ, δ and κ opioid receptor binding sites. Radioligand binding techniques were also used to confirm that naloxone methiodide, or its metabolites, could not readily cross the blood brain barrier. Therefore, the effects of naloxone methiodide appear to be mediated outside the central nervous system. The final publication aimed to extend our knowledge of opioid induced respiratory depression by utilising new radiotelemetry technology to test the efficacy of naloxone methiodide in rats subjected to a chronic opioid administration regime. This experiment showed that circadian rhythm plays a role in the development of tolerance to the cardiorespiratory effects of continuous and chronic methadone administration, and that naloxone hydrochloride and naloxone methiodide treatment can increase respiratory rate and heart rate after this methadone administration. Therefore, naloxone methiodide can effectively antagonise the peripheral effects produced by opioid receptor agonists. Peripherally acting opioid receptor antagonists should be developed in the future to prevent or treat the adverse effects of opioid receptor agonists. / Thesis (Ph.D.)--Department of Clinical and Experimental Pharmacology, 2004.

Drug abusers in Taiwan are infected with HIV(Human Immunodeficiency Virus) seriously day by day in recent years. In view of this, since Aug.1,2005, C.D.C.(Center for Disease Control, R.O.C.(Taiwan)) has promoted Harm Reduction Program for drug abuse patients in control of spurting question of drug abuse/AIDS overflowing. We adopt the analysis frame of social marketing in this research to inspect the promotion of Harm Reduction Program at present government. Through questionnaire survey, we in death understand their contact situation and views of Harm Reduction Program from the mass population and the stakeholders(drug abusers). We visit 311 effective samples of opium-smoking prisoners(as drug group) to find out 84.9%(258) respondents has participated the declaration of health education of Harm Reduction Program during serving a sentence, 91.6%(282) has received information through newspaper, TV, broadcast, and brochure during serving a sentence, 89%(277) has got impression on C.D.C. slogans of ¡§Injecting drug, infecting AIDS¡¨, and the measure of offering needle and syringes exchange, methadone maintenance treatment, health education, and transferring/consulting service has accorded with the demand of drug abusers. In addition, we visit 289 effective samples of the public (as general group) to find out only 12.5% (36 ) respondents has participated the declaration of health education of Harm Reduction Program during in the past year, 53.5%(153) has received information through newspaper, TV, broadcast, and brochure during in the past year, and 55%(159) has got impression on C.D.C. slogans of ¡§Injecting drug, infecting AIDS¡¨. Both the public and opium-smoking prisoners have affirmed the promotion of Harm Reduction Program, and most has identified with the importance of the execution of Harm Reduction Program. We also find out 34%(99) respondents of the public has regarded famous actor as anti-drug spokesman can bring his attention and identification mostly, and moreover, 41%(128) respondents of opium-smoking prisoners has believed the declaration of acting as an example to others by the drug abstinence successfully is convincing most.

Ergebnisse einer breit angelegten Repräsentativerhebung zur Substitutionstherapie in Deutschland an 2694 Patienten zeigen, dass trotz hoher und komplexer Ko- und Multimorbidität mit psychischen Erkrankungen nur selten Psychiater an der Therapie beteiligt sind. Nur 16% der Substitutionsärzte (n=223) sind Psychiater oder Psychotherapeuten und nur 21% der substituierten Drogenabhängigen werden von Psychiatern behandelt. Die meisten substituierenden Psychiater sind in Institutsambulanzen psychiatrischer Kliniken tätig (51,3%), kaum in eigener Praxis (7,2%). Der Großteil der Substitutionsversorgung wird von Allgemein- und Hausärzten geleistet. Die relative Abstinenz psychiatrischer Kollegen bei der Substitution drogenabhängiger Patienten wird kritisch diskutiert. / Results of a nationally representative study in 2,694 patients reveal that most physicians (n=223) involved in substitution treatment of opioid-dependent patients are general practitioners, while only 16% have a psychiatric/psychotherapeutic background and only 21% of the addictive patients are treated by psychiatrists. This contrasts with the remarkably complex pattern of co- and multimorbidity with other mental disorders in such patients. Most psychiatrists engaged in substitution treatment work in specialized outpatient wards (51.3%), and few were operative in their own or private practice (7.2%). Implications of these critical findings are discussed.

Aims: To examine how patients with experience of being involuntarily discharged from medication-assisted treatment with methadone or buprenorphine have coped with the consequences following the discharge. The study also aim to examine how the patients cope with the stigma related to their abuse of heroin and how they manage to cope with the rules regarding themedication-assisted treatment. Method: Three patients with experience of involuntary discharge from medication-assisted treatment have been interviewed. All were heroin abusing men living in Stockholm. The interviewees were recruited through the Swedish Drug Users Union and through a shelter for homeless people with drug problems. Results: All the discharged patients experienced a hard time after the discharge. One went back to abuse heroin and the other two began to buy methadone or burprenorphine on the black market. All of them also experienced it difficult to cope with the stigma and considered that there were many obstacles in their life caused by the treatment rules. Conclusion: The discharge led to harsh consequences for all the patients. Heroin addicts need to deal with a lot of stigma related both to their drug abuse and the medical assisted treatment and find it difficult to manage that.

Aim and Problem statement The study aimed to investigate views on physical health amongst patients in methadone maintenance program, which is a subject little explored. Previous studies suggest that methadone patients are at risk developing illnesses related to the metabolic syndrome and an unhealthy lifestyle. Methadone also has side effects such as weight gain and irregular levels of glucose. Method This qualitive study included seven interviews with patients in the methadone maintenance program in Uppsala. Qualitive content analyses were performed Findings Content anlyses gave the theme: The view on physical health is a stuggle after normality were ambivalence of lifestyle changes and alienation causes instability in helath. Five categories were found: Health, to be normal struggle after normality, the importance of methadone, views on physical, mental and socioeconomic health. Lack of control causes deteriorating health about consequences from drug abuse and ambivalence to lifestyle changes. Motivation to live contains factors for increased/decreased motivation. Daily life habits and routines investigate attitudes and knowledge. Support and help from the healthcare more individually adjusted care and expanded support was desired. Conclusions Greater emphasis on physical health may provide patients receiving methadone treatment with increased well-being. Methods focusing on patients own resources to reach their goals should be used.