Patienter med ett opioidmissbruk kan upplevas ha ett socialt avvikande beteendemönster som kan leda till en social stigmatisering. Att inom sjukvården se patienter som socialt avvikande kan leda till att de får en sämre vård och behandling än vad de har rätt till. Smärta är en subjektiv upplevelse, där patienten har en individuell uppfattning om sin smärta och kan därför inte jämföras med någon annans smärtupplevelse. Syftet med studien var att belysa sjuksköterskors attityder till smärtbehandling av patienter med opioidmissbruk. En systematisk litteraturstudie genomfördes bestående av 11 vetenskapliga artiklar. Resultatet mynnade ut i tre kategorier: Attityder gentemot patienter med opioidmissbruk, Attityder till den subjektiva smärtan och Attityder i samband med erfarenhet och bristande kunskap. Resultatet visade att sjuksköterskor har negativa attityder till patienter med opioidmissbruk. Trots att sjuksköterskorna var medvetna om att patienter med ett tidigare eller pågående opioidmissbruk, som upplevde smärta, behöver en högre dos av smärtlindring än patienter utan missbruksproblem, så upplevdes de ändå som de att ljög för att få en ökad dos opioider. Studien lyfte fram en bristande kunskap hos sjuksköterskor angående missbruk och beroende, vilket kunde leda till ett dömande av patienter med opioidmissbruk. Till vidare studier behövs det ytterligare forskning om hur patienter med opioidmissbruk upplever sjuksköterskornas attityder i det vårdande mötet. / Patients with an opioid addiction may be perceived to have a socially deviant behavior which may lead to social stigmatization. To see patients as socially deviant in healthcare can lead to that they receive worse care and treatment than what they are entitled to. Pain is a subjective experience, where the patient has an individual perception of his pain and can not be compared with another's experience of pain. The purpose of the study was to examine nurses' attitudes to pain treatment of patients with opioid addiction. A systematic literature review was conducted consisting of 11 scientific articles. The results culminated in three categories: Attitudes towards patients with opioid addiction, Attitudes to the subjective pain and attitudes associated with experience and lack of knowledge. The results showed that nurses have negative attitudes towards patients with opioid addiction. The nurses were aware that patients with a previous or current opioid addiction experienced pain needed a higher dose of pain medication, they were perceived nonetheless as they lied to get an increased dose of opioids. The study highlighted a lack of knowledge of nurses regarding addiction and dependence, which could lead to a judgment of patients with opioid addiction. For further studies there is a need to study how patients with opioid addiction experienced nurses' attitudes in the caring encounter.

Opioid abuse and addiction affects more than 2.4 million people in the United States. Medication assisted treatment (MAT), in combination with counseling, is recognized as the most effective treatment for patients with opioid dependence and abuse. Although MAT is considered the most effective treatment, previous research has found clinically significant weight gain with methadone. The purpose of this study was to determine if hedonic eating behaviors, sugar cravings, and addictive like eating was related to weight gain in opioid addicted patients receiving methadone and buprenorphine/naloxone (Suboxone™). Hedonic eating behaviors were measured using three validated surveys. Following survey collection, a chart review was completed to determine weight changes over time. One hundred twenty surveys were completed and 113 were analyzed. No differences were found between the medication groups in terms of mean age, weight at entry, BMI at entry, race, sex, and Hepatitis C status. A subset of 39 participants was analyzed for weight changes during treatment. There were no differences in food addiction scores, hedonic eating behaviors, and food cravings between the medication groups. We found significant weight gain in patients receiving methadone and no weight changes for those receiving Suboxone™. Weight gain in methadone maintenance does not appear to be related to addictive like eating, food craving, or hedonic eating. This research suggests that weight gain seen in methadone maintenance for opioid addiction treatment is related to something other than hedonic eating behaviors. Clinically significant weight gain should be considered when prescribing methadone for opioid addiction.

Prescription opioid (PO) abuse is a growing public health concern worldwide as evidenced by an increasing number of opioid-related hospital admissions with a striking lack of research examining the neural basis underlying cognitive symptomatology. Drugs of abuse, through their impact on the dopaminergic system, are thought to disrupt the cognitive network regulating impulse control and incentive salience through inhibition of goal-oriented behaviour and drug-induced attentional biases. The objective of the present study is to examine neurocognitive processes in PO abusers (vs. healthy controls) by relying on the enhanced temporal resolution (1ms) of event-related potentials (ERPs) to track information processing abnormalities associated with cognitive control. In a naturalistic clinical study, 16 patients actively using prescription opioids and 16 healthy controls (matched for age, gender, educational level and smoking status) were assessed using a Go/NoGo and cue reactivity paradigm. Analysis revealed no significant differences in N2 or P3 amplitude, measures of inhibitory control, between groups after successful NoGo trials and no significant differences in ERN or Pe amplitude, measures of error processing, between groups after unsuccessful NoGo trials. Cue reactivity analysis of attention-related ERP components in patients demonstrated significantly (p<0.005) smaller P2 amplitudes, indexing the commencement of attentional processing, for drug pictures compared to neutral and affective pictures. Furthermore, stimulus type did not significantly modulate LPP amplitudes, indexing sustained attention, in patients however arousal ratings for drug pictures were positively correlated with LPP amplitudes in patients. These ERP results of altered cognitive control and incentive salience suggest the neural mechanisms underlying these cognitions are affected by chronic opioid abuse. Investigating the cognitive abnormalities experienced by PO abusers is an important factor in understanding the neural correlates of substance abuse and in predicting successful outcomes to ensure the best chance at long-term recovery for addicted individuals.

Naloxone (NAL) is administered parenterally or intranasally for treating opioid overdose. The short duration of action of NAL calls for frequent re-dosing which may be eliminated by the development of a transdermal system. This study aimed to assess the effect of microneedles on improving the skin permeation of NAL hydrochloride. In vitro permeation of NAL across intact and microneedle-treated (Dr. Pen™ Ultima A6) porcine skin was evaluated. The effect of microneedle length and application duration, and donor concentration on NAL permeation were investigated. In-vitro in-vivo correlation of the permeation results was done to predict the plasma concentration kinetics of NAL in patients. In vitro passive permeation of NAL after 6 h was observed to be 8.25±1.06 µg/cm2. A 56- and 37-fold enhancement was observed with 500 and 250 µm needles applied for 1 min, respectively. Application of 500 µm MNs for 2 min significantly reduced the lag time to ~ 8 min and increasing the donor concentration for the same treatment group doubled the permeation (p < 0.05). Modeling simulations demonstrated the attainment of pharmacokinetic profile of NAL comparable to those obtained with the FDA-approved intramuscular and intranasal devices. Microneedle-mediated transdermal delivery holds potential for rapid and sustained NAL delivery for opioid overdose treatment.

Indiana University-Purdue University Indianapolis (IUPUI) / The aim of this research is to design a new method to identify the opioid use problems (OUP) among long-term opioid therapy patients in Indiana University Health using text mining and machine learning approaches. First, a systematic review was conducted to investigate the current variables, methods, and opioid problem definitions used in the literature. We identified 75 distinct variables in 9 models that majorly used ICD codes to identify the opioid problem (OUP). The review concluded that using ICD codes alone may not be enough to determine the real size of the opioid problem and more effort is needed to adopt other methods to understand the issue. Next, we developed a text mining approach to identify OUP and compared the results with the current conventional method of identifying OUP using ICD-9 codes. Following the institutional review board and an approval from the Regenstrief Institute, structured and unstructured data of 14,298 IUH patients were collected from the Indiana Network for Patient Care. Our text mining approach identified 127 opioid cases compared to 45 cases identified by ICD codes. We concluded that the text mining approach may be used successfully to identify OUP from patients clinical notes. Moreover, we developed a machine learning approach to identify OUP by analyzing patients’ clinical notes. Our model was able to classify positive OUP from clinical notes with a sensitivity of 88% on unseen data. We concluded that the machine learning approach may be used successfully to identify the opioid use problem from patients’ clinical notes. / 2019-06-21

America is engulfed in an opioid epidemic. Whether this is depicted through the tens of thousands of lives claimed by the number of drug overdoses each year, the unprecedentedly high and increasing rates of opiate abuse, or the broadening demographic profile of the addict, it is clear that the current issue is one that requires serious attention. As informed by the negative attitudes toward drug addiction that have prevailed since the War on Drugs was declared, it is hypothesized that much of the contemporary predicament is a result of this misinformation that did not resolve, but exacerbated the drug crisis. Despite the concurrent emergence of evidence asserting that addiction is a disease, instead, the idea that drug addiction is a failure prevails. As with many brain diseases, drug addiction displays both pathological alterations in the transmission of signals within the neural circuitries and the morphological defects associated with non-random regions of the brain. The alteration that is observed during opioid tolerance is the desensitization of mu opioid receptors to dopamine, resulting in the need of increased dosage of opiates to achieve the same high. During opioid dependence, key changes that are seen in the locus ceruleus and the mesolimbic reward system increase both the likelihood of an overdose event and withdrawal when an exogenous opioid is present or absent, respectively. There are two models that describe additional changes that occur during the transition from frequent abuse to addiction: (1) the “Changed Set Point Model” and (2) the “Cognitive Deficits Model.” All three variants of the “Changed Set Point Model” portray a shift in the physiological set points of dopamine and glutamate levels in the reward system and regions that control it. The “Cognitive Deficits Model” theorizes that the modifications localized to the prefrontal cortex are responsible for the ultimate transition. Once the abuser is thrust into the addiction cycle, additional changes in the neural networks are observed. These changes are seen in each of the three phases: (1) Binge and Intoxication, (2) Withdrawal and Negative Affect, and (3) Preoccupation and Anticipation. In the first phase, a process called drug-induced neuroplasticity occurs, resulting in the amplification of signals originating from dopaminergic neurons. Next, during Withdrawal and Negative Affect phase, among other changes, the amygdala is shown to be re-wired in such a way that the addict is more sensitive to stress. And finally in the last phase, the changes that occur, secondary to processes similar to drug-induced, are indicated in the prefrontal cortex. The current FDA-approved medication-assisted therapies include methadone, buprenorphine, and naltrexone. The single outstanding abstinence-based treatment is the 12-step program. In the evaluation of medical and non-medical interventions the relative efficacies were measured using the metrics: (1) rates of abstinence achievement, (2) rates of opioid use, and (3) retention in treatment. Individually, all therapies show moderate success when measured against each metric, which further validates the brain disease model for addiction, and also indicates that the future direction of addressing the opioid epidemic should point at combination therapies. What is most imperative now is for there to be more widespread recognition of the brain disease model for addiction.

Prevention, social work, and community awareness programs have not led to the successful reduction of opioid overdose deaths nationwide, and particularly in Ohio. This study explored social work perspectives about trauma-€informed care (TIC) for persons with opioid use disorder in Ohio. The research questions for this study examined how social workers in Ohio implemented TIC when providing outpatient treatment to opioid users and what challenges they faced when providing TIC. Using an action research methodology, data were collected through individual semistructured interviews with 5 social work professionals, selected through purposive sampling based on experience in the field of substance use in Ohio and the use of TIC. Contemporary trauma theory and TIC were chosen to frame the research project. Three themes emerged through thematic analysis of the data: appreciation for trauma-€informed opioid use disorder treatment, organizational and professional challenges to the use of trauma-€informed opioid use disorder treatment, and environmental barriers to successful trauma-€informed outpatient opioid use disorder programming. The study aligned with the social work core values of competence and principles of harm reduction. The findings from the study might bring about social change by igniting dialogue among treatment providers about how TIC interventions could support integrated treatment and holistic approaches to combatting opioid addiction in Ohio.

Today, more Americans die each year because of drug overdoses than are killed in motor vehicle accidents. In fact, in 2015, more than 33,000 individuals died due to an overdose of heroin or prescription opioids. Sadly, 40-60 % of patients on current opioid addiction treatment medications relapse. Studies have shown that the addiction/abuse liability of opioids are abolished in mu opioid receptor (MOR) knock-out mice; this indicates that the addiction and abuse liability of opioids are mainly mediated through MOR. Utilizing the “message-address concept”, the our laboratory reported a novel non-peptide, reversible MOR selective ligand 17-cyclopropylmethyl-3,14β-dihydroxy-4,5α-epoxy-6α (isoquinoline-3-carboxamido)morphinan (NAQ). Molecular modeling and mutagenesis studies revealed that the selectivity of NAQ for MOR is because of the π-π stacking of the isoquinoline ring of NAQ with W318. Therefore, other heterocyclic ring systems were explored to obtain a diverse library of compounds with similar or different molecular interactions and pharmacologic characteristics as NAQ. The newly designed compounds were indole analogs of 6α/β-naltrexamine. The compounds were synthesized and the affinity and selectivity for MOR determined using the radioligand binding assay while the functional activity at MOR was determined using the [35S]GTPγS binding assay. The indole analog of 6α-naltrexamine substituted at position 7 (compound 6) was found to be very potent and had the lowest efficacy in the [35S]GTPγS functional assay while the indole analog of 6β-naltrexamine substituted at position 2 (compound 10) was identified as a MOR agonist and had the greatest efficacy. In vivo studies were conducted using the warm-water immersion assay to find whether the synthesized compounds had antinociceptive effects and/or blocked the antinociceptive effects of morphine. Not surprisingly, compound 10 was identified as an opioid agonist while compound 6 almost completely blocked morphine’s antinociceptive effects. The opioid antagonist effect of compound 6 was found to be dose dependent with an AD50 of 2.39 mg/kg (0.46-12.47). An opioid withdrawal assay was conducted on compound 6 using morphine-pelleted mice. Compound 6 produced significantly less withdrawal symptoms at 50 mg/kg than naltrexone at 1 mg/kg. Therefore, compound 6 has the potential to be used in opioid addiction and withdrawal treatment.

Bakgrund: Opioidberoende hos personer är ett folkhälsoproblem och konsumtionen av opioider ökar konstant. Beroendet kan utvecklas efter en regelbunden användning av opioider och kännetecknas av exempelvis kognitiva samt fysiologiska tecken. En persons beroende kan utvecklas trots att konsumtionen inte överstigit den ordinerade mängd opioider, oftast utvecklas ett beroende ovetandes hos personen som använder opioider. Personer med ett beroende upplever stöd av de sjuksköterskor som lyssnar och visar medkänsla. Syfte: Syftet var att belysa hur personer som använder opioider och de personer som har utvecklat ett beroende av opioider upplever mötet med vården. Metod: Studien är en litteraturstudie. Sökningar genomfördes i två databaser och genererade nio resultatartiklar. Resultat: Tre kategorier skapades: Upplevelser av oro; Det upplevda bemötandet; Önskan på ett gott vårdmöte. Konklusion: Upplevelsen som framkallades vid en behandling av opioider var karakteriserad av risken att drabbas av ett beroende. Upplevelsen för hur livet skulle påverkas av att använda opioider och hur vårdens stigmatisering ledde till misstro av personer som använde opioider. Upplevelsen av ett fördomsfritt bemötande kunde avgöra huruvida en person valde att fortsätta få vård. / Opioid addiction is a public health problem and the consumption of opioids is constantly increasing. An addiction can develop after using opioids regularly and can be recognized by cognitive and physiological characteristics. A person's dependence can develop unknowingly despite following the opioid prescription. People with an addiction experience support from the nurses who listen to them and show compassion. Aim: The aim of this literature study was to highlight how people who use opioids and people with an opioid addiction experience the encounter with healthcare. Method: This study is a literature study. The searches were made using two databases and the searches generated nine result articles. Result: Three categories were formed: Experiences of worry; The experiences of the encounter; Desires of a good healthcare encounter. Conclusion: People’s experiences of getting treatment with opioids was characterised with concerns of becoming addicted. The effect opioid treatment had on people's lives and the stigmatization of opioid use with healthcare professionals led to distrust. People who received care from healthcare professionals who had an open mind and were non-judgmental were more likely to finish their care.

Fatal opioid overdoses in Massachusetts, U.S.A. increased by 311% from 2000 to 2019 and claim the lives of nearly 2,000 residents every year. Research suggests that the public is growing critical of traditional punitive approaches to opioid use disorder. In this study, a political feasibility study of passing non-arrest policies for opioid addiction was conducted. Semi-structured interviews with 32 experts from law enforcement, program administration, addiction treatment, policymaking, and policy advocacy were completed. The political feasibility of three policy proposals across six criteria (effect, relevance, support, opposition, enabling factors, and inhibiting factors) was examined. Media and document review augmented and affirmed interview data. Study participants reported a growth in the number of opioid-addicted young adult White residents and a concomitant shift in increased public support for treatment over incarceration. Data suggest that communities of color are disproportionately impacted by limited access to treatment. Study participants caution that strained relationships between people of color and the police could impede the positive effects of non-arrest programs among diverse populations. Results suggest that it may be politically feasible to scale non-arrest programs, but that it is not currently feasible to pass policies that decriminalize drugs or prohibit judges from requiring individuals to remain drug-free as a condition of probation. To ensure that policies benefit diverse populations, lawmakers must invest in treatment programs and pass legislation that accounts for the different relationships that Black and Hispanic residents have with the police. / 2022-09-26T00:00:00Z