INTRODUCTION: Prolonged sedation treatment in neonatal pediatric populations is associated with opioid and benzodiazepine tolerance, dependence, and withdrawal syndrome. Despite the clinical relevance of this problem, we have limited knowledge of the long-term repercussions. Current literature focuses on premature neonates and suggests that opioid exposure may cause neurodevelopmental sequelae. The main objective of this literature review was to investigate what infant populations are at risk of developing short-term and/or long-term consequences from prolonged infantile sedation exposure. PUBLISHED STUDIES: A literature review was conducted on previous studies that focused primarily on the effects of opioids and benzodiazepines on infants and how it may affect the future development in these children. Studies show that short-term consequences include increased heart rate, increased respiratory rate, increased blood pressure, intracranial pressure fluctuations, and risk of further complications such as intraventriculat hemorrhage (IVH), periventricular leukomalacia (PVL), or even death. Long-term repercussions incluse the possibility of decreased brain volume, decreased head circumference and body weight, intelligence deficits, and social and behavioral issues. DISCUSSION: Standard pain and sedation management involves the use of opioids and benzodiazepines. Treatment duration and medication dosage depend on severity of the patient’s illness. Since prolonged sedation administration is often associated with tolerance and dependence, future research (such as long-term follow up of these infants at later neurological milestones) is necessary to determine possible short-term and long-term neurological and behavioural sequelae for infants exposed to prolonged treatment with opioids and benzodiazepines. Standardized pain and sedation management guidelines may also increase the effectiveness of treatment and drug administration.

Made available in DSpace on 2014-06-11T19:31:08Z (GMT). No. of bitstreams: 0 Previous issue date: 2006-03-09Bitstream added on 2014-06-13T19:01:29Z : No. of bitstreams: 1 conceicao_edv_dr_jabo.pdf: 517707 bytes, checksum: 5bc1ab6d19256b698bccf00abaf5611c (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Avaliaram-se os efeitos da infusão contínua de propofol em associação ao fentanil ou sufentanil sobre a hemodinâmica, eletrocardiografia e índice biespectral em cadelas submetidas à ovariosalpingo-histerectomia. Para tal, foram utilizadas 20 cadelas hígidas, induzidas à anestesia geral com 10 mg/kg de propofol. Após a intubação com sonda orotraqueal de Magill, receberam suporte ventilatório com oxigênio a 100% e fluxo de 15 mUkg/min em circuito fechado, ciciado no modo pressão controlada, mantendo-se a ventilação a pressão positiva intermitente. A manutenção anestésica foi realizada com a administração de O,4mglkglmin de propofol e foram distribuídos em dois grupos de 10 animais que receberam 5J,lglkg de fentanil (GPF) ou 1J,lg/kg de sufentanil (GPS) por via intravenosa, seguida de infusão contínua... / Possible effects of the continuous infusion of propofol associated with fentanyl or sufentanil on haemodynamic, blood gas analysis, electrocardiography and bispectral index in female dogs, submitted to the surgical procedure of ovariosalpingohysterectomy, were evaluated. Twenty healthy female dogs were used and general anesthesia was induced with 10mglkg of propofol. They received ventilatory support with 100% oxygen and a 15 mUkg/min flow in a cIosed circuit, cycled with controlled pressure. Ali animais were submitted to total intravenous anesthesia with propotol (O.4mg/kglmin) and distributed in two groups of ten animais each one. They received 5J.1glkg of fentanyl (GPF) or 1J.1g1kg of sufentanil... (Complete abstract click electronic access below)

Since the late 1990s, the abuse of prescription opioid painkillers has been constructed as a major social problem in the United States, commonly referred to in the media as the “prescription painkiller epidemic.” Stories of addiction, overdose deaths, robberies, and other tragedies related to prescription opioids have been, and continue to be, commonly featured in the media. In response to public outcry regarding the “epidemic,” government and medical institutions have enforced strict regulations on the distribution of opioids, targeting most of these regulations at the treatment of chronic pain in particular. In this dissertation, I examine the experience of chronic pain management with opioids amid this cultural environment, using the personal, cultural, and institutional levels of narrative outlined by Loseke (2007) as an organizing theme. The dissertation is comprised of four distinct but interrelated chapters that explore the topic of chronic pain management with opioids in four different ways. In the first substantive chapter, I share a personal narrative of my own experience as the daughter of a mother with chronic pain who relies on opioids, in order to provide context for the rest of the dissertation, disclose my own positionality, and show rather than tell how the stigma and regulations surrounding opioids are experienced in the lives of people with chronic pain and their families. In the following chapter, I shift away from the personal and use Loseke’s (2012) method for the empirical analysis of formula stories to examine cultural narratives about prescription opioids published in the New York Times between 2000 and 2013. I argue that the narratives contribute to an environment in which people with chronic pain who rely on opioids are made vulnerable to stigma and discrimination. I use Loseke’s method again in the third substantive chapter to examine institutional narratives about opioids told in an FDA public hearing. I argue that the narratives serve to construct moral boundaries between different types of pain patients and justify a label change that disproportionately burdens patients with chronic pain. In the final substantive chapter, I share personal narratives acquired through in-depth interviews with twelve people currently living with chronic pain. I find that the dominant cultural and institutional narratives surrounding prescription opioids translate into stigma and barriers experienced in the lives of people seeking chronic pain treatment, and serve to silence their personal narratives which are resistant and subversive. I conclude by urging for the removal of barriers to chronic pain treatment with opioids and for the wider dissemination of personal narratives of chronic pain patients at the cultural and institutional levels.

Many healthcare providers report not feeling confident when prescribing opioids, which represents an educational gap in the clinical setting that must be addressed to improve patient care and outcomes (Dowell, Haegerich, & Chou, 2016b). Healthcare providers attribute this lack of confidence in opioid prescribing to insufficient training on the tools provided to them to ensure safe prescribing habits. Thus, healthcare providers do not feel confident in managing patients’ chronic pain. A healthcare provider’s time spent with their patient is limited and therefore, needs to be utilized efficiently. In order to achieve effective time management, healthcare providers need to be experts on chronic pain management and self-assured with their practice in relation to opioids. This practice improvement project focused on increasing healthcare providers’ knowledge and confidence when prescribing opioids for chronic pain and managing chronic pain. An educational intervention with health professionals working in federally qualified health centers in North Dakota was implemented via Skype. The intervention allowed healthcare providers to be up-to-date on the most recent evidence-based literature and guidelines regarding this topic. Throughout this practice improvement project, healthcare providers were educated on the latest Centers for Disease Control (CDC) and Prevention Guideline for Prescribing Opioids for Chronic Pain, provided resources for their clinical practice, and given an opportunity to evaluate their own knowledge and confidence. The implementation of the practice improvement project was comprised of an educational session. To assess the participants’ knowledge, a pre-test was provided prior to the educational session and a post-test was given following the educational session. Furthermore, a self-confidence evaluation survey was administered, which utilized a Likert scale. Lastly, the clinic’s policies and pain agreements related to pain and opioids were reviewed and discussed. The results of the project indicated an overall increase in the participants’ knowledge and self-confidence. In addition, the project promoted awareness of the clinic’s current pain agreement and the likelihood of a future implementation of a policy regarding chronic pain management. The educational session was beneficial in promoting the use of evidence-based research and guidelines in the primary care setting.

In the United States, prescription opioids have been a major problem that contributed to the opioid crisis in the country. As dentists prescribe analgesics routinely for dental pain management, further investigation into opioid and non-opioid prescription patterns by dentists on a national level is needed. This research project aimed to examine 1) the trends in opioid and non-opioid analgesic prescriptions by dentists in the US,2) to examine the racial-ethnic disparities in receiving an opioid and non-opioid prescription from a dental professional, 3) the effect of federal Rescheduling of hydrocodone combination on opioid prescription patterns by dentists in a school setting. Data on analgesic prescriptions by dentists were obtained using medical panel survey MEPS (1996- 2015), and Boston University Henry M. Goldman School of Dental Medicine clinical repository (2010 -2019). On average about 31,206 individuals of all ages were interviewed for MEPS each year. The trend in analgesics prescription was reported weighted numbers and proportions of total and dental analgesics prescriptions were reported. Kendall tau correlation test was used to examine trends in the rate of opioid prescriptions per 100 persons over survey years. Racial differences were examined using MEPS data (2002-2015) on dental analgesic prescriptions, dental care utilization, patients’ race, and other demographic information. The outcome was analgesic prescription received. The main independent variable was the patients’ race/ethnicity. Covariates included in the analysis were gender, age, marital status, income, geographical region, and survey year. Using BUSDM data (2010-2019) we examined 12,807 patients who received an opioid prescription from a dentist. The primary outcome variables were opioid prescriptions and opioid morphine milligram equivalent (MME). The primary predictor used is the date of opioid prescription (Time before and after the intervention). To assess the effect of hydrocodone medication reclassification on the outcome variables we used an interrupted time series (ITS) analysis with a segmented regression model. Our results showed a decrease in the proportion of dental opioids out of total opioids from 9.76% in 1996 to 4.5% in 2015. Kendall tau correlation indicated an increase in prescribing rate over the years in total opioids but not in dental opioids. Racial differences were found in opioid prescriptions by dentists with whites having a lower risk of receiving an opioid analgesic compared to other racial minorities. The effect of federal rescheduling of hydrocodone combination on opioid prescription patterns by dentists showed specifically a reduction in non-hydrocodone opioids prescribing rate by morphine milligram equivalent (MME). In conclusion dentists’ contribution to the increase in prescription opioids in the United States seem to be limited compared to other health care professionals. Nevertheless, racial differences were found in whites when compared to other racial minorities. Efforts to curb the use of opioids should be encouraged even more so with evidence supporting the effectiveness of non-opioids analgesics in control of dental pain. / 2022-12-09T00:00:00Z

Release of nociceptin-like substances from the dorsal horn of rat spinal cords in situ was measured by the immobilized-antibody microprobe technique. Spinal cords removed from anesthetized 4-6 week-old rats were superfused with oxygenated Krebs solution at room temperature (21 ± 1°C). Glass microelectrodes, coated with antibodies to nociceptin, were inserted into the dorsal horn of the lumbar spinal cord (1.9 mm lateral to the midline to a depth 2.5 mm below the surface of the cord) for 15 rain periods before, during and after electrical stimulation applied to the dorsal root entry zone of the same segment. There was a basal release of immunoreactive nociceptin- like substance (irNC) from the dorsal horns during the pre-stimulation period. A significant increase in irNC release was detected during the period of electrical stimulation and this increase was maintained for at least 15 min following the cessation of electrical stimulation. These results provide the first evidence on the release of irNC, albeit non-quantitative, from the in situ rat spinal cord dorsal horn and an enhanced release upon electrical stimulation.

Dynorphin has a well-established role in feeding and gustation. Alterations in taste perception and feeding behavior are common with age. We hypothesized that proDynorphin gene expression in brain areas involved in taste and feeding declines with age. Male Sprague-Dawley rats were housed individually with ad libitum access to food and water. Brain punches of the selected regions were dissected out in groups of rats aged 4-6, 12-14 and 18-21 months. ProDynorphin mRNA (measured using a cDNA probe) decreased significantly with age in arcuate nucleus and amygdala; increased significantly with age in hippocampus; and was not significantly affected in nucleus of the solitary tract, cortex, caudate putamen or hypothalamic paraventricular nucleus. These data suggest an age-related decrease in the synthesis of dynorphin in two brain regions strongly associated with feeding behavior, and an increase in dynorphin synthesis in a brain region associated with learning and memory.

No description available.

The purpose of this study is to closely analyze opioid overdose response efforts on county, state, and federal levels in designated Appalachian regions in order to better understand program methodology standards that ensure success in combating the opioid epidemic. The study exists to answer the question: What approaches have worked best in combating the opioid epidemic and should be implemented in any future potential solutions? The research data scope involved comparison of existing data from county reports, government agencies, and response efforts to best identify program decline rates of opioid usage by the following indicators; declines in opioid overdose deaths, drug distribution per capita, deaths attributing to synthetic opioid overdose, and decline in neonatal abstinence syndrome births. All sources used are publicly available and depict de-identifiable population health information. When compiling research, important background information including how to define the opioid epidemic, root cause identification, and existing response effort methodologies were addressed. While hard to define, the opioid epidemic refers to a public health crisis by which Appalachian individuals unproportionally die at the hands of opioid overdose in comparison to the rest of the country; which is evident and alarming. This opioid crisis has many social and economic causes relating to the demographic majority of Appalachian regions, as well as occurrences that jumpstart a quick decline. The existing response effort methodologies of county, state, and federal programs are expensive and challenging to implement with only some success. There are also many facets to addressing the opioid epidemic including government initiatives, federal or state agencies, non-profit agencies, educational facilities, public health initiatives, and faith-based organizations. While the complexity of response efforts can be beneficial to have many options for addressing the issue, it can also quickly muddle the most effective methods to success. However, the most notable programs that saw a quick decline in overdose death rates included those that coordinated multiple types of entities such as schools, health departments, and correctional departments. Other successful programs reinstituted training and education both with regional providers on appropriate opioid prescriptions; and to the community on proper use, handling, and disposal of opioids. The most effective methods to reduce the health disparities relating to the opioid epidemic in Appalachian regions are extensive collaboration and re-education across the communities most deeply affected by the crisis. Any future response efforts should address these key success indicators.

Background: Methadone maintenance treatment (MMT) is a commonly prescribed therapy for patients with opioid use disorder, yet inter-individual variability in terms of treatment response is evident. Given the high prevalence of cannabis use in this population, this thesis aims to elucidate the association between cannabis use and MMT outcomes. Methods: We conducted a systematic review and meta-analysis to comprehensively evaluate the literature and quality of evidence, as well as to identify gaps in the literature to inform future research. We then conducted a cross-sectional study investigating sex differences in the association between cannabis use and illicit opioid use in MMT patients. We employed a multivariable logistic regression analysis to assess the influence of any cannabis use as well as heaviness of cannabis use within men and women. Results: The systematic review included 22 observational studies. Results revealed the low quality of available evidence as well as substantial heterogeneity among studies. We identified several limitations in the evidence base including reliance on crude measures of cannabis use and inadequate consideration of confounding variables. Our cross-sectional study included a sample of 777 patients on MMT. Consistent with previous research, we found cannabis use to be unrelated to illicit opioid use in the entire sample. However when we stratified the analysis by sex, we found cannabis use was associated with increased odds of having concurrent illicit opioid use. Conclusion: Results of this thesis suggest certain populations within MMT patients may be at higher risk of experiencing adverse effects of cannabis in terms of treatment outcomes. Future work can build on the results of these studies to identify unique risk factors for patients in order to inform the use of tailored treatment options to improve MMT effectiveness. / Thesis / Master of Science (MSc)