Pain is a significant health problem. Mu opioid receptor agonists are used clinically as analgesics, but their use is constrained by high abuse liability. Intracranial self-stimulation (ICSS) is a preclinical behavioral procedure that has been used to assess abuse potential of opioids, and drug-induced facilitation of ICSS is interpreted as an abuse-related effect. ICSS can also be used as a behavioral baseline to detect affective dimensions of pain. Specifically, pain-related depression of ICSS can model pain-related depression of behavior and mood, and drug-induced blockade of pain-related ICSS depression can serve as a measure of affective analgesia. This dissertation used mu agonists that vary in efficacy at the mu receptor (methadone> fentanyl> morphine> hydrocodone> buprenorphine> nalbuphine) and compared their effects on ICSS in the absence (phase one) or presence (phase 2) of pain. Adult male Sprague-Dawley rats were equipped with intracranial electrodes targeting the medial forebrain bundle and trained to lever press for brain stimulation. Different frequencies of stimulation maintained a frequency-dependent increase in ICSS rates, and permitted detection of both rate-increasing and rate-decreasing treatment effects. During phase 1, medium- and high-efficacy mu agonists produced initial rate-decreasing effects, followed by abuse-related rate-increasing effects at later time points. Repeated morphine administration produced tolerance to its own rate-decreasing effects, cross-tolerance to rate-decreasing effects of other mu agonists, and enhanced expression of rate-increasing effects. Low efficacy mu agonists only produced rate-increasing effects, which were enhanced after repeated morphine. These results suggest that previous opioid exposure increases expression of abuse-related facilitation of ICSS by mu agonists regardless of efficacy. During phase 2, intraperitoneal administration of lactic acid (1.8%) served as a noxious stimulus to depress ICSS. All mu agonists blocked acid-induced depression of ICSS at doses similar to those that facilitated ICSS in the absence of pain. A higher intensity noxious stimulus (5.6 % acid) produced further depression of ICSS and reduced the antinociceptive potency of both methadone and nalbuphine. Morphine antinociception was resistant to tolerance in the assay of acid-depressed ICSS. Overall, these results provide a basis for comparing determinants of abuse-related opioid effects in the absence of pain with their affective analgesic effects in the presence of pain.

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Religiosity is adopting a belief system surrounding concepts of purpose, meaning, and value through an institution that has already defined these concepts prior to the individual member attending and that member’s degree of participation. Religiosity does have protective factors against negative health outcomes. This protective influence was evaluated in this study. Data from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions were examined to learn about the relationship between protective effects of religious participation on substance abuse, and whether this association weakened for individuals who have experienced higher levels of childhood abuse. A binary logistic regression was completed to examine this relationship. Religiosity does decrease the likelihood of experiencing an opioid use disorder for lower levels of childhood maltreatment, but only slightly. In extreme cases of sexual, emotional, and physical abuse, religiosity does not decrease the likelihood of experiencing an opioid use disorder.

Bakgrund: Missbruksproblematik är ett växande globalt hälsoproblem. Opioider är i dagsläget en vital del av medicineringen för en rad symtom, däribland opioidmissbruk. Opioider och opioidmissbruk är också orsaken till mycket lidande och för tidig död. Mötet med patienter med opioidmissbruk är oundvikligt i sjukvården. Vårdpersonalen känner sig inte bekväma i att vårda patientgruppen, då de ofta tycker att de saknar tillräcklig utbildning inom ämnet. Syfte: Studiens syfte var att beskriva patienter med opioidmissbruks upplevelse av bemötandet inom hälso- och sjukvården. Metod: En allmän litteraturstudie med kvalitativ ansats. Studien baseras på tolv kvalitativa vetenskapliga artiklar vilka analyserats och tematiseras med hjälp av innehållsanalys för att besvara studiens syfte. Resultat: Personer med opioidmissbruk uttrycker att de bemöts med stigmatisering, fördomsfulla attityder och bristande förståelse för missbrukets mekanismer från vårdpersonalens sida. Detta bidrar till rädsla och bristande tillit till vårdpersonalen vilket vidare kan leda till att patientgruppen undviker att uppsöka sjukvård och att personer med opioidmissbruk uppfattar att de får mindre engagerad vård än andra patienter. Slutsats: Vidareutbildning av vårdpersonal gällande opioidmissbruk och relaterade behandlingsformer kan leda till förbättrade relationer mellan patient och vårdpersonal. Opioidsubstitutionsbehandling utgör en kontaktyta mellan samhället och personer med opioidmissbruk. / Background: The misuse of drugs is a growing global health concern. Today, opioids are a vital part of the medication regimen for an assortment of symptoms, amongst which is opioid abuse. Opioids and opioid abuse also cause a lot of suffering and premature death. People with opioid abuse frequent all parts of health care. Health care professionals do not feel comfortable in caring for the patient group, as they often find that they do not have adequate education in the subject. Purpose: The purpose of the study was to describe patients with opioid abuse experiences’ of their treatment within health care. Method: A general literature study with a qualitative approach. The study is based on twelve qualitative articles that have been analyzed and thematized using content analysis in order to answer the study’s purpose. Results: People with opioid abuse express that they face stigmatization, prejudicial attitudes and lack of understanding regarding the mechanisms of abuse from healthcare professionals. This contributes to fear and lack of trust in the care staff sometimes leads to the patient group avoiding seeking medical care and the patients perceiving that they receive less committed care than other patients. Conclusion: Further education of health care personnel regarding opioid abuse and related treatment options could lead to improved patient to health care personnel relations. Opioid substitution programs constitutes a point of contact between society and people with opioid abuse. / <p>Röda Korsets sjuksköterskeförening stipendium 2020</p>

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