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Sample records for opioid-addicted women buprenorphine

  1. Facts about Buprenorphine for Treatment of Opioid Addiction

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    ... Treatment may include medication. Medication-assisted treatment is treatment for addiction that includes the use of medication along with ... Counseling can help. Medication is one part of treatment for opioid addiction. For many people, another important part is counseling : ...

  2. Buprenorphine-containing treatments: place in the management of opioid addiction.

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    Robinson, Susan E

    2006-01-01

    Although the synthetic opioid buprenorphine has been available clinically for almost 30 years, its use has only recently become much more widespread for the treatment of opioid addiction. The pharmacodynamic and pharmacokinetic profiles of buprenorphine make it unique in the armamentarium of drugs for the treatment of opioid addiction. Buprenorphine has partial mu-opioid receptor agonist activity and is a kappa-opioid receptor antagonist; hence, it can substitute for other micro-opioid receptor agonists, yet is less apt to produce overdose reactions or dysphoria. On the other hand, buprenorphine can block the effects of opioids such as heroin (diamorphine) and morphine, and can even precipitate withdrawal in individuals physically dependent upon these drugs. Buprenorphine has significant sublingual bioavailability and a long half-life, making administration on a less than daily basis possible. Furthermore, its discontinuation is associated with only a mild withdrawal syndrome. Clinical trials have demonstrated that sublingual buprenorphine is effective in both maintenance therapy and detoxification of individuals addicted to opioids. The introduction of a sublingual formulation combining naloxone with buprenorphine further reduces the risk of diversion to illicit intravenous use. Because of its relative safety and lower risk of illegal diversion, buprenorphine has been made available in several countries for treating opioid addiction in the private office setting, greatly enhancing treatment options for this condition.

  3. Management of opioid addiction with buprenorphine: French history and current management

    Directory of Open Access Journals (Sweden)

    Poloméni P

    2014-03-01

    Full Text Available Pierre Poloméni,1 Raymund Schwan2,3 1Department of Addictology, Paris Seine Saint Denis University Hospital, AP-HP, Site René Muret Sevran, France; 2Care Center for the Treatment and Prevention of Addictions (CSAPA, Nancy University Hospital, 3General Psychiatric Division for the Greater Nancy Urban Community, Psychotherapeutic Center of Nancy, Laxou, France Abstract: The way in which opioid addiction is managed in France is unique, as it is based on the prescription of buprenorphine by general practitioners and is dispensed by retail pharmacies. This policy has had a direct, positive impact on the number of deaths caused by heroin overdose, which was reduced by four-fifths between 1994 and 2002. In addition, certain associated comorbidities, such as infection with the human immunodeficiency virus, have also been reduced; the incidence of acquired immune deficiency syndrome in intravenous drug users fell from 25% in the mid-1990s to 6% in 2010. Since the implementation of this French model of opioid management, major scientific progress has been made, leading to a better understanding of the pathophysiologic mechanisms of addiction and of the management modalities required for its treatment. However, despite notable advances in scientific knowledge and in the implementation of devices, opioid addiction remains a major public health care issue in France, with 275,000–360,000 "problem drug users" being reported in 2011. The situation is still particularly worrying due to psychoactive substance use and misuse of opioid substitution treatments. Since 2003, there has been a persistent increase in the number of deaths and comorbidities related to opioid addiction, principally hepatitis C virus infection, which affects up to 40% of intravenous drug users. In France, the direct involvement of general practitioners in the management of opioid addiction is indisputable. Nevertheless, management could be optimized through better understanding of the

  4. Buprenorphine: an analgesic with an expanding role in the treatment of opioid addiction.

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    Robinson, Susan E

    2002-01-01

    Buprenorphine, a long-acting opioid with both agonist and antagonist properties, binds to mu-opioid (OP(3)), kappa-opioid (OP(2)), delta-opioid (OP(1)), and nociceptin (ORL-1) receptors. Its actions at these receptors have not been completely characterized, although buprenorphine is generally regarded as a mu-opioid receptor partial agonist and a kappa-opioid receptor antagonist. Its pharmacology is further complicated by an active metabolite, norbuprenorphine. Although buprenorphine can be used as an analgesic agent, it is of greater importance in the treatment of opioid abuse. Because of its partial agonist activity at mu-opioid receptors and its long half-life, buprenorphine has proven to be an excellent alternative to methadone for either maintenance therapy or detoxification of the opioid addict. Although buprenorphine may ultimately prove to be superior to methadone in the maintenance of the pregnant addict, its effects on the developing fetus must be carefully evaluated.

  5. Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. Treatment Improvement Protocol (TIP) Series 40

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    Boone, Margaret; Brown, Nancy J.; Moon, Mary A.; Schuman, Deborah J.; Thomas, Josephine; Wright, Denise L.

    2004-01-01

    This Treatment Improvement Protocol (TIP) addresses the clinical use of buprenorphine in the treatment of opioid addiction. TIPs are best-practice guidelines for the treatment of substance use disorders that make the latest research in substance abuse treatment available to counselors and educators. The content was generated by a panel of experts…

  6. Buprenorphine

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    Kahan, Meldon; Srivastava, Anita; Ordean, Alice; Cirone, Sharon

    2011-01-01

    Abstract Objective To review the use of buprenorphine for opioid-addicted patients in primary care. Quality of evidence The MEDLINE database was searched for literature on buprenorphine from 1980 to 2009. Controlled trials, meta-analyses, and large observational studies were reviewed. Main message Buprenorphine is a partial opioid agonist that relieves opioid withdrawal symptoms and cravings for 24 hours or longer. Buprenorphine has a much lower risk of overdose than methadone and is preferred for patients at high risk of methadone toxicity, those who might need shorter-term maintenance therapy, and those with limited access to methadone treatment. The initial dose should be given only after the patient is in withdrawal. The therapeutic dose range for most patients is 8 to 16 mg daily. It should be dispensed daily by the pharmacist with gradual introduction of take-home doses. Take-home doses should be introduced more slowly for patients at higher risk of abuse and diversion (eg, injection drug users). Patients who fail buprenorphine treatment should be referred for methadone- or abstinence-based treatment. Conclusion Buprenorphine is an effective treatment of opioid addiction and can be safely prescribed by primary care physicians. PMID:21402963

  7. The pharmacological treatment of opioid addiction--a clinical perspective.

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    Lobmaier, Philipp; Gossop, Michael; Waal, Helge; Bramness, Jorgen

    2010-06-01

    This article reviews the main pharmacotherapies that are currently being used to treat opioid addiction. Treatments include detoxification using tapered methadone, buprenorphine, adrenergic agonists such as clonidine and lofexidine, and forms of rapid detoxification. In opioid maintenance treatment (OMT), methadone is most widely used. OMT with buprenorphine, buprenorphine-naloxone combination, or other opioid agonists is also discussed. The use of the opioid antagonists naloxone (for the treatment of intoxication and overdose) and oral and sustained-release formulations of naltrexone (for relapse prevention) is also considered. Although recent advances in the neurobiology of addictions may lead to the development of new pharmacotherapies for the treatment of addictive disorders, a major challenge lies in delivering existing treatments more effectively. Pharmacotherapy of opioid addiction alone is usually insufficient, and a complete treatment should also include effective psychosocial support or other interventions. Combining pharmacotherapies with psychosocial support strategies that are tailored to meet the patients' needs represents the best way to treat opioid addiction effectively.

  8. Quantitation of Total Buprenorphine and Norbuprenorphine in Meconium by LC-MS/MS.

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    Marin, Stephanie J; McMillin, Gwendolyn A

    2016-01-01

    Buprenorphine (Suboxone, Zubsolv, Buprenex, Butrans, etc.) is an opioid drug that has been used to treat opioid dependence on an outpatient basis, and is also prescribed for managing moderate to severe pain. Pregnant women may be prescribed buprenorphine as part of a treatment plan for opioid addiction. This chapter quantitates buprenorphine and norbuprenorphine in meconium by liquid chromatography tandem mass spectrometry (LC-MS/MS).

  9. Consumer attitudes about opioid addiction treatment: a focus group study in New York City.

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    Sohler, Nancy L; Weiss, Linda; Egan, James E; López, Carolina M; Favaro, Jamie; Cordero, Robert; Cunningham, Chinazo O

    2013-01-01

    To develop effective programs for people who are opioid dependent and to impact the opioid epidemic in New York City, it is crucial to monitor attitudes about opioid addiction treatments among opioid users who have experienced barriers to engagement and retention in addiction treatment. The authors conducted a qualitative study using focus groups. Six focus groups in three needle exchanges in New York City were audio recorded, transcribed, and systematically coded. The authors report on the main themes related to the study objectives. Participants of each needle exchange who were opioid dependent and had some knowledge of both methadone and buprenorphine were eligible. There were four main findings. Participants felt the following: 1) buprenorphine is an appropriate option for those heroin users who are motivated to stop using, 2) they have less control over their addiction treatment with methadone than they would have with buprenorphine, 3) buprenorphine treatment is not accessible to many New York City residents who would benefit from this treatment, and 4) lack of access to buprenorphine treatment is a cause of treatment-related diversion. Both methadone maintenance and buprenorphine treatment opportunities are necessary to address the diverse treatment needs of opioid-dependent people in New York City. However, the current medical model of buprenorphine treatment may be too restrictive for some opioid-dependent people and may be contributing to the use of illicit buprenorphine. New models to deliver buprenorphine treatment may address these problems.

  10. Pain volatility and prescription opioid addiction treatment outcomes in patients with chronic pain.

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    Worley, Matthew J; Heinzerling, Keith G; Shoptaw, Steven; Ling, Walter

    2015-12-01

    The combination of prescription opioid dependence and chronic pain is increasingly prevalent and hazardous to public health. Variability in pain may explain poor prescription opioid addiction treatment outcomes in persons with chronic pain. This study examined pain trajectories and pain volatility in patients with chronic pain receiving treatment for prescription opioid addiction. We conducted secondary analyses of adults with chronic pain (n = 149) who received buprenorphine/naloxone (BUP/NLX) and counseling for 12 weeks in an outpatient, multisite clinical trial. Good treatment outcome was defined as urine-verified abstinence from opioids at treatment endpoint (Week 12) and during at least 2 of the previous 3 weeks. Pain severity significantly declined over time during treatment (b = -0.36, p treatment outcome (odds ratio = 0.55, p treatment provides observational support for the analgesic effects of BUP/NLX in patients with chronic pain and opioid dependence. Patients with greater volatility in subjective pain during treatment have increased risk of returning to opioid use by the conclusion of an intensive treatment with BUP/NLX and counseling. Future research should examine underlying mechanisms of pain volatility and identify related therapeutic targets to optimize interventions for prescription opioid addiction and co-occurring chronic pain.

  11. Challenges and Opportunities for the Use of Medications to Treat Opioid Addiction in the United States and Other Nations of the World.

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    Parrino, Mark W; Maremmani, Angelo Giovanni Icro; Samuels, Paul N; Maremmani, Icro

    2015-01-01

    There has been a well documented increase in the use and abuse of prescription opioids and heroin in the United States and other parts of the world. There has also been an increasing focus to increase access to the use of medications (methadone, buprenorphine, Naltrexone/Vivitrol) for opioid addicted individuals under legal supervision. As policymakers engage in strategic initiatives to better prevent and effectively treat chronic opioid addiction, both in the United States and other countries, there are a number of unintended consequences, complicating how best to increase access to effective treatment.

  12. A Systematic Review on the Use of Psychosocial Interventions in Conjunction With Medications for the Treatment of Opioid Addiction.

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    Dugosh, Karen; Abraham, Amanda; Seymour, Brittany; McLoyd, Keli; Chalk, Mady; Festinger, David

    2016-01-01

    Opioid use and overdose rates have risen to epidemic levels in the United States during the past decade. Fortunately, there are effective medications (ie, methadone, buprenorphine, and oral and injectable naltrexone) available for the treatment of opioid addiction. Each of these medications is approved for use in conjunction with psychosocial treatment; however, there is a dearth of empirical research on the optimal psychosocial interventions to use with these medications. In this systematic review, we outline and discuss the findings of 3 prominent prior reviews and 27 recent publications of empirical studies on this topic. The most widely studied psychosocial interventions examined in conjunction with medications for opioid addiction were contingency management and cognitive behavioral therapy, with the majority focusing on methadone treatment. The results generally support the efficacy of providing psychosocial interventions in combination with medications to treat opioid addictions, although the incremental utility varied across studies, outcomes, medications, and interventions. The review highlights significant gaps in the literature and provides areas for future research. Given the enormity of the current opioid problem in the United States, it is critical to gain a better understanding of the most effective ways to deliver psychosocial treatments in conjunction with these medications to improve the health and well-being of individuals suffering from opioid addiction.

  13. Facts about Naltrexone for Treatment of Opioid Addiction

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    ... Treatment may include medication. Medication-assisted treatment is treatment for addiction that includes the use of medication along with ... Counseling can help. Medication is one part of treatment for opioid addiction. For many people, another important part is counseling : ...

  14. Investigating expectation and reward in human opioid addiction with [(11) C]raclopride PET.

    Science.gov (United States)

    Watson, Ben J; Taylor, Lindsay G; Reid, Alastair G; Wilson, Sue J; Stokes, Paul R; Brooks, David J; Myers, James F; Turkheimer, Federico E; Nutt, David J; Lingford-Hughes, Anne R

    2014-11-01

    The rewarding properties of some abused drugs are thought to reside in their ability to increase striatal dopamine levels. Similar increases have been shown in response to expectation of a positive drug effect. The actions of opioid drugs on striatal dopamine release are less well characterized. We examined whether heroin and the expectation of heroin reward increases striatal dopamine levels in human opioid addiction. Ten opioid-dependent participants maintained on either methadone or buprenorphine underwent [(11) C]raclopride positron emission tomography imaging. Opioid-dependent participants were scanned three times, receiving reward from 50-mg intravenous heroin (diamorphine; pharmaceutical heroin) during the first scan to generate expectation of the same reward at the second scan, during which they only received 0.1-mg intravenous heroin. There was no heroin injection during the third scan. Intravenous 50-mg heroin during the first scan induced pronounced effects leading to high levels of expectation at the second scan. There was no detectable increase in striatal dopamine levels to either heroin reward or expectation of reward. We believe this is the first human study to examine whether expectation of heroin reward increases striatal dopamine levels in opioid addiction. The absence of detectable increased dopamine levels to both the expectation and delivery of a heroin-related reward may have been due to the impact of substitute medication. It does however contrast with the changes seen in abstinent stimulant users, suggesting that striatal dopamine release alone may not play such a pivotal role in opioid-maintained individuals.

  15. New development of drugs against opioid addiction

    Institute of Scientific and Technical Information of China (English)

    LiJin; SuRui-bin; LuXin-qiang; LiuYin

    2004-01-01

    Opioid addiction has been a big trouble for human being for several centuries. In China, it also has become a main direct threat against national safety, society advancement, economic development and public health. Based on the national report in 2002, the number of addicts registered in due form is over 1 million, which are distributed in 2148 counties and cities in China. The real number of addicts, however, is much more than those as mentioned above. Money used for buying opioids each year in China might be over 10 billion except for other payment. Base on the statistics, 20 - 50% crimes are commited by addicts. On the other hand, drug abuse often induces contagion spread, such as tuberculosis, hepatitis and HIV disease. About 70% HIV positive subjects in China are related to drug abuse. We are very happy to see more andmore attention has been paid to the problem in our country. Recently, a program on neurobiological basis and medical biological measures of addiction has been supported by National Science and Technology Ministry as a 973 program.

  16. Prognostic factors in the development of opioid addiction

    Directory of Open Access Journals (Sweden)

    Vasila Talimbekova

    2011-04-01

    Full Text Available In 145 patients with opioid addiction were studied prognostic factors of the formation of the disease and their medical and social consequences. In the examined patients duration of the narcotization was from 1 year to 15 years. Analysis of studies showed that the most significant adverse prognostic factors, determining formation rate of medical and social consequences in opioid addiction, may include: perinatal pathology, personality deviation in the premorbid; early age of onset of drug use; hereditary load addictive and mental illness; condition of upbringing; alcohol abuse prior to narcotization; prescription of narcotization. These constitutionally-biological factors are informative indicators in the predicting the formation of opioid dependence.

  17. Buprenorphine

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    Jaroslaw Mazurek

    2014-06-01

    Full Text Available In the crystal structure of a semi-synthetic opioid drug buprenorphine, C29H41NO4 {systematic name: (2S-2-[(5R,6R,7R,14S-9α-cyclopropylmethyl-3-hydroxy-6-methoxy-4,5-epoxy-6,14-ethanomorphinan-7-yl]-3,3-dimethylbutan-2-ol}, the cyclopropylmethyl group is disordered over two sites with an occupancy factor of 0.611 (3 for the major component. One of the hydroxy groups is involved in intramolecular O—H...O hydrogen bond. The other hydroxy group acts as a proton donor in an intermolecular O—H...O interaction that connects molecules into a zigzag chain along the b axis.

  18. Buprenorphine.

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    Mazurek, Jaroslaw; Hoffmann, Marcel; Fernandez Casares, Anna; Cox, Phillip D; Minardi, Mathew D

    2014-06-01

    In the crystal structure of a semi-synthetic opioid drug buprenorphine, C29H41NO4 {systematic name: (2S)-2-[(5R,6R,7R,14S)-9α-cyclo-propyl-methyl-3-hy-droxy-6-meth-oxy-4,5-ep-oxy-6,14-ethano-morphinan-7-yl]-3,3-di-methyl-butan-2-ol}, the cyclo-propyl-methyl group is disordered over two sites with an occupancy factor of 0.611 (3) for the major component. One of the hy-droxy groups is involved in intra-molecular O-H⋯O hydrogen bond. The other hy-droxy group acts as a proton donor in an inter-molecular O-H⋯O inter-action that connects mol-ecules into a zigzag chain along the b axis.

  19. Chemical profile of counterfeit buprenorphine vials seized in Tehran, Iran.

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    Soltaninejad, Kambiz; Faryadi, Mansoor; Akhgari, Maryam; Bahmanabadi, Leila

    2007-10-25

    Buprenorphine, commonly known by the trademark Temgesic, is one of the most popular drugs of abuse among the opioid-addicted young individuals in Iran. Temgesic, Bungesic, etc. are the most popular and important illicit opioid drugs in Tehran's illicit drugs black market, and are now among the most widely abused by opioid addicts. Because of this, counterfeiting of this drug has increased in Tehran. In this study, the qualitative analysis of counterfeit buprenorphine by gas chromatography-mass spectrometry (GC-MS) and high performance liquid chromatography (HPLC) demonstrates the presence of diacetylmorphine, acetylcodeine and pheniramine, as well as the absence of buprenorphine. In conclusion, due to the absence of quality control and difficulties in differentiating counterfeit buprenorphine from genuine products, the use of counterfeit buprenorphine leads the opioid abusers to health risks.

  20. Gene May Help Guide Black Patients' Opioid Addiction Treatment

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    ... html Gene May Help Guide Black Patients' Opioid Addiction Treatment Finding suggests they may need higher doses of ... News on: African American Health Genes and Gene Therapy Opioid Abuse and Addiction Recent Health News Related MedlinePlus Health Topics African ...

  1. Mu Opioid Receptor Gene: New Point Mutations in Opioid Addicts

    OpenAIRE

    Dinarvand, Amin; Goodarzi, Ali; Vousooghi, Nasim; Hashemi, Mehrdad; Dinarvand, Rasoul; Ostadzadeh, Fahimeh; Khoshzaban, Ahad; Zarrindast, Mohammad-Reza

    2014-01-01

    Introduction Association between single-nucleotide polymorphisms (SNPs) in mu opioid receptor gene and drug addiction has been shown in various studies. Here, we have evaluated the existence of polymorphisms in exon 3 of this gene in Iranian population and investigated the possible association between these mutations and opioid addiction. Methods 79 opioid-dependent subjects (55 males, 24 females) and 134 non-addict or control individuals (74 males, 60 females) participated in the study. Geno...

  2. Substitution treatment for opioid addicts in Germany

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    Gerlach Ralf

    2007-02-01

    Full Text Available Abstract Background After a long and controversial debate methadone maintenance treatment (MMT was first introduced in Germany in 1987. The number of patients in MMT – first low because of strict admission criteria – increased considerably since the 1990s up to some 65,000 at the end of 2006. In Germany each general practitioner (GP, who has completed an additional training in addiction medicine, is allowed to prescribe substitution drugs to opioid dependent patients. Currently 2,700 GPs prescribe substitution drugs. Psychosocial care should be made available to all MMT patients. Results The results of research studies and practical experiences clearly indicate that patients benefit substantially from MMT with improvements in physical and psychological health. MMT proves successful in attaining high retention rates (65 % to 85 % in the first years, up to 50 % after more than seven years and plays a major role in accessing and maintaining ongoing medical treatment for HIV and hepatitis. MMT is also seen as a vital factor in the process of social re-integration and it contributes to the reduction of drug related harms such as mortality and morbidity and to the prevention of infectious diseases. Some 10 % of MMT patients become drug-free in the long run. Methadone is the most commonly prescribed substitution medication in Germany, although buprenorphine is attaining rising importance. Access to MMT in rural areas is very patchy and still constitutes a problem. There are only few employment opportunities for patients participating in MMT, although regular employment is considered unanimously as a positive factor of treatment success. Substitution treatment in German prisons is heterogeneous in access and treatment modalities. Access is very patchy and the number of inmates in treatment is limited. Nevertheless, substitution treatment plays a substantial part in the health care system provided to drug users in Germany. Conclusion In Germany, a

  3. Learning and generalization from reward and punishment in opioid addiction.

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    Myers, Catherine E; Rego, Janice; Haber, Paul; Morley, Kirsten; Beck, Kevin D; Hogarth, Lee; Moustafa, Ahmed A

    2017-01-15

    This study adapts a widely-used acquired equivalence paradigm to investigate how opioid-addicted individuals learn from positive and negative feedback, and how they generalize this learning. The opioid-addicted group consisted of 33 participants with a history of heroin dependency currently in a methadone maintenance program; the control group consisted of 32 healthy participants without a history of drug addiction. All participants performed a novel variant of the acquired equivalence task, where they learned to map some stimuli to correct outcomes in order to obtain reward, and to map other stimuli to correct outcomes in order to avoid punishment; some stimuli were implicitly "equivalent" in the sense of being paired with the same outcome. On the initial training phase, both groups performed similarly on learning to obtain reward, but as memory load grew, the control group outperformed the addicted group on learning to avoid punishment. On a subsequent testing phase, the addicted and control groups performed similarly on retention trials involving previously-trained stimulus-outcome pairs, as well as on generalization trials to assess acquired equivalence. Since prior work with acquired equivalence tasks has associated stimulus-outcome learning with the nigrostriatal dopamine system, and generalization with the hippocampal region, the current results are consistent with basal ganglia dysfunction in the opioid-addicted patients. Further, a selective deficit in learning from punishment could contribute to processes by which addicted individuals continue to pursue drug use even at the cost of negative consequences such as loss of income and the opportunity to engage in other life activities.

  4. Disciplining virtue: investigating the discourses of opioid addiction in nursing.

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    Kunyk, Diane; Milner, Margaret; Overend, Alissa

    2016-12-01

    Two nurses diagnosed with opioid addiction launched legal action after being found guilty of unprofessional conduct due to addiction-related behaviors. When covered by the media, their cases sparked both public and legal controversies. We are curious about the broader discursive framings that led to these strong reactions, and analyze the underlying structures of knowledge and power that shape the issue of opioid addiction in the profession of nursing through a critical discourse analysis of popular media, legal blogs and hearing tribunals. We argue that addiction in nursing is framed as personal choice, as a failure in the moral character of the nurses, as decontextualized from addiction as disease arguments, and as an individualized issue devoid of contextual factors leading to addiction. Our investigation offers a critical case study of a nursing regulatory body that upheld popular assumptions of addiction as an autonomous, rational choice replete with individual-based consequences - a framing that is inconsistent with evidence-based practice in health-care. We put forth this critical interrogation to open up possibilities for counterdiscourses that may promote more nuanced and effective responses to the issue of addiction in nursing. © 2016 John Wiley & Sons Ltd.

  5. Buprenorphine vs methadone treatment: A review of evidence in both developed and developing worlds

    Directory of Open Access Journals (Sweden)

    Paul J Whelan

    2012-01-01

    Full Text Available Heroin dependence is a major health and social problem associated with increased morbidity and mortality that adversely affects social circumstances, productivity, and healthcare and law enforcement costs. In the UK and many other Western countries, both methadone and buprenorphine are recommended by the relevant agencies for detoxification from heroin and for opioid maintenance therapy. However, despite obvious benefits due to its unique pharmacotherapy (eg, greatly reduced risk of overdose, buprenorphine has largely failed to overtake methadone in managing opioid addiction. The experience from the developing world (based on data from India is similar. In this article we compare the advantages and disadvantages of the use methadone and buprenorphine for the treatment of opioid addiction from both a developed and developing world perspective; and explore some of the reasons why buprenorphine has not fulfilled the expectations predicted by many in the addictions field.

  6. [Comorbidity of opioid addiction and alcoholism in patients of young age: clinical variants of the double diagnosis].

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    Bokhan, N A; Blagov, L N; Kurgak, D I

    2012-01-01

    A study included 115 male patients with opioid addiction, aged from 17 to 27 years. Comorbidity of opioid addiction and alcoholism in patients of young age was represented by two main variants distinguishing between primary dependence on opioid or alcohol. In the first variant, additional variants of vicarious alcoholization and replacement of addiction form were singled out. In the second case, alcoholism preceded opioid addiction that developed as a form of polyaddiction and the formation of preliminary (primary) alcoholism was considered as a protracted stage of searching narcotism with the transition from alcoholism to opioid addiction. Stages and differential criteria of the variants of double disorders are described.

  7. Shifting blame: Buprenorphine prescribers, addiction treatment, and prescription monitoring in middle-class America.

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    Mendoza, Sonia; Rivera-Cabrero, Allyssa S; Hansen, Helena

    2016-08-01

    Growing nonmedical prescription opioid analgesic use among suburban and rural Whites has changed the public's perception of the nature of opioid addiction, and of appropriate interventions. Opioid addiction has been recast as a biological disorder in which patients are victims of their neurotransmitters and opioid prescribers are irresponsible purveyors of dangerous substances requiring controls. This framing has led to a different set of policy responses than the "War on Drugs" that has focused on heroin trade in poor urban communities; in response to prescription opioid addiction, prescription drug monitoring programs and tamper-resistant opioid formulations have arisen as primary interventions in place of law enforcement. Through the analysis of preliminary findings from interviews with physicians who are certified to manage opioid addiction with the opioid pharmaceutical buprenorphine, we argue that an increase in prescriber monitoring has shifted the focus from addicted people to prescribers as a threat, paradoxically driving users to illicit markets and constricting their access to pharmaceutical treatment for opioid addiction. Prescriber monitoring is also altering clinical cultures of care, as general physicians respond to heightened surveillance and the psychosocial complexities of treating addiction with either rejection of opioid dependent patients, or with resourceful attempts to create support systems for their treatment where none exists.

  8. A Swedish Population-based Study of Adverse Birth Outcomes among Pregnant Women Treated with Buprenorphine or Methadone: Preliminary Findings

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    Wurst, Keele E.; Zedler, Barbara K.; Joyce, Andrew R.; Sasinowski, Maciek; Murrelle, E. Lenn

    2016-01-01

    BACKGROUND Untreated opioid dependence in pregnant women is associated with adverse birth outcomes. Buprenorphine and methadone are options for opioid agonist medication-assisted treatment during pregnancy. OBJECTIVE The aim of this study was to describe adverse birth outcomes observed with buprenorphine or methadone treatment compared to the general population in Sweden. METHODS Pregnant women and their corresponding births during 2005–2011 were identified in the Swedish Medical Birth Register. Data on stillbirth, neonatal/infant death, mode of delivery, gestational age at birth, Apgar score, growth outcomes, neonatal abstinence syndrome, and congenital malformations were examined. Frequencies were compared using two-sided Fisher’s exact tests. Unadjusted estimates of birth outcomes for women treated with buprenorphine or methadone were compared to the registered general population. RESULTS A total of 746,257 pregnancies among 538,178 unique women resulted in 746,485 live births. Among the 194 women treated with buprenorphine (N = 176) or methadone (N = 52), no stillbirths or neonatal/infant deaths occurred. Neonatal abstinence syndrome developed in 23.3% and 38.5% of infants born to mothers treated with buprenorphine and methadone, respectively. The frequency of the selected adverse birth outcomes assessed in women treated with buprenorphine as compared to the general population was not significantly different. However, a significantly higher frequency of preterm birth and congenital malformations was observed in women treated with methadone as compared to the general population. Compared with the general population, methadone-treated women were significantly older than buprenorphine-treated women, and both treatment groups began prenatal care later, were more likely to smoke cigarettes, and did not cohabitate with the baby’s father. CONCLUSIONS An increased frequency of the selected adverse birth outcomes was not observed with buprenorphine treatment

  9. Prescription drug monitoring program data tracking of opioid addiction treatment outcomes in integrated dual diagnosis care involving injectable naltrexone

    OpenAIRE

    Sajid, Ayesha; Whiteman, Aaron; Bell, Richard L.; Greene, Marion S.; Engleman, Eric A; Chambers, R. Andrew

    2016-01-01

    Background and Objectives Fourfold increases in opioid prescribing and dispensations over 2 decades in the U.S. has paralleled increases in opioid addictions and overdoses, requiring new preventative, diagnostic, and treatment strategies. This study examines Prescription Drug Monitoring Program (PDMP) tracking as a novel measure of opioid addiction treatment outcomes in a university‐affiliated integrated mental health‐addiction treatment clinic. Methods Repeated measure parametrics examined P...

  10. Neurophysiological mechanisms in acceptance and commitment therapy in opioid-addicted patients with chronic pain.

    Science.gov (United States)

    Smallwood, Rachel F; Potter, Jennifer S; Robin, Donald A

    2016-04-30

    Acceptance and Commitment Therapy (ACT) has been effectively utilized to treat both chronic pain and substance use disorder independently. Given these results and the vital need to treat the comorbidity of the two disorders, a pilot ACT treatment was implemented in individuals with comorbid chronic pain and opioid addiction. This pilot study supported using neurophysiology to characterize treatment effects and revealed that, following ACT, participants with this comorbidity exhibited reductions in brain activation due to painful stimulus and in connectivity at rest.

  11. Probabilistic reward- and punishment-based learning in opioid addiction: Experimental and computational data.

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    Myers, Catherine E; Sheynin, Jony; Balsdon, Tarryn; Luzardo, Andre; Beck, Kevin D; Hogarth, Lee; Haber, Paul; Moustafa, Ahmed A

    2016-01-01

    Addiction is the continuation of a habit in spite of negative consequences. A vast literature gives evidence that this poor decision-making behavior in individuals addicted to drugs also generalizes to laboratory decision making tasks, suggesting that the impairment in decision-making is not limited to decisions about taking drugs. In the current experiment, opioid-addicted individuals and matched controls with no history of illicit drug use were administered a probabilistic classification task that embeds both reward-based and punishment-based learning trials, and a computational model of decision making was applied to understand the mechanisms describing individuals' performance on the task. Although behavioral results showed that opioid-addicted individuals performed as well as controls on both reward- and punishment-based learning, the modeling results suggested subtle differences in how decisions were made between the two groups. Specifically, the opioid-addicted group showed decreased tendency to repeat prior responses, meaning that they were more likely to "chase reward" when expectancies were violated, whereas controls were more likely to stick with a previously-successful response rule, despite occasional expectancy violations. This tendency to chase short-term reward, potentially at the expense of developing rules that maximize reward over the long term, may be a contributing factor to opioid addiction. Further work is indicated to better understand whether this tendency arises as a result of brain changes in the wake of continued opioid use/abuse, or might be a pre-existing factor that may contribute to risk for addiction.

  12. Associations between personality changes and nucleus accumbens ablation in opioid addicts

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    Hai-kang ZHAO; Chong-wang CHANG; Ning GENG; Li GAO; Jing WANG; Xin WANG; Ya-rong WANG; Xue-lian WANG; Guo-dong GAO

    2012-01-01

    It has been reported that nucleus accumbens (NAc) lesions can help to prevent relapse in opioid addicts.This article aimed to investigate associations between personality changes and NAc lesions.Methods:The surgery group consisted of 78 patients who had received bilateral stereotactic lesions of the NAc to treat opioid addiction.Seventy two non-surgery opioid addicts were appropriately paired with the patients of the surgery group as the non-surgery group.All participants were interviewed in person and received urine tests,naloxone provocative tests and hair tests to determine the prevalence of relapse.Eysenck personality questionnaire (EPQ) and the health survey questionnaire (SF-36) were employed to assess personality and functional health,respectively.Results:In the surgery group,30 participants relapsed,and the non-relapse rate was 61.5% (48/78).Compared with the Chinese normative data,the neuroticism (N) and psychoticism (P) dimensions of the EPQ in the non-surgery group were significantly higher,whereas the lie (L) dimension was significantly lower.There was no significant difference in all dimensions of the EPQ between the surgery group and the Chinese normative data.The N dimension in the relapse group and the L dimension in the surgery group were significantly lower than those of the non-surgery group.The P dimension in the relapse group was significantly higher than that of the non-relapse group.The extraversion (E) dimension was relatively stable between these groups.Conclusion:Although the influence of other factors cannot be excluded,it is apparent that surgically induced NAc lesions are associated with lower P and N dimensions for opioid addicts,and a higher P dimension is associated with a tendency to relapse.

  13. Injectable and implantable sustained release naltrexone in the treatment of opioid addiction.

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    Kunøe, Nikolaj; Lobmaier, Philipp; Ngo, Hanh; Hulse, Gary

    2014-02-01

    Sustained release technologies for administering the opioid antagonist naltrexone (SRX) have the potential to assist opioid-addicted patients in their efforts to maintain abstinence from heroin and other opioid agonists. Recently, reliable SRX formulations in intramuscular or implantable polymers that release naltrexone for 1-7 months have become available for clinical use and research. This qualitative review of the literature provides an overview of the technologies currently available for SRX and their effectiveness in reducing opioid use and other relevant outcomes. The majority of studies indicate that SRX is effective in reducing heroin use, and the most frequently studied SRX formulations have acceptable adverse events profiles. Registry data indicate a protective effect of SRX on mortality and morbidity. In some studies, SRX also seems to affect other outcomes, such as concomitant substance use, vocational training attendance, needle use, and risk behaviour for blood-borne diseases such as hepatitis or human immunodeficiency virus. There is a general need for more controlled studies, in particular to compare SRX with agonist maintenance treatment, to study combinations of SRX with behavioural interventions, and to study at-risk groups such as prison inmates or opioid-addicted pregnant patients. The literature suggests that sustained release naltrexone is a feasible, safe and effective option for assisting abstinence efforts in opioid addiction. © 2012 The Authors. British Journal of Clinical Pharmacology © 2012 The British Pharmacological Society.

  14. "Demografic characteristics of opioid addiction in patients undergoing Coronary Artery Bypass Graft "

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    Abdollahi M.H

    2007-04-01

    Full Text Available Background: According to some previous reports prevalence of addiction estimated to be 3٪ in Iran. One of the most important key points about addiction is the identification of predisposing factors for starting substance use. False general believes can play important roles in this regard. This study evaluated the demographic characteristics of opioids addiction and the visions of them about the effect of opioids on their cardiac diseases. Methods: This cross-sectional analytical study intended to evaluate situation of opiate dependency among 1329 CABG patients in Yazd Afshar hospital based on criteria of the diagnostic and statistical manual of mental disorders, Fourth edition (DSM-IV.Data were collected from each subject by a self report questionnaire and structured interview and was analyzed using chi-square and ANOVA and MC nemar test. P<0.05 was determined significant. Results: The data were gathered from 1329 CABG patients (945 men and 384 women. In addition 131 patients (9.9% containing 127 men (98.9% and 4 women (1.1% were opium dependent based on DSM-IV criteria. Mean age of opium dependent group was significantly higher than non-dependent patients (58.5 ± 10.08 VS 50.7 ± 10.15 (P= 0.000. Opium was the most common used substance (96.9% and inhalation was the preferred pattern of use (52.7%. Majority of addicted patients were simple workers (44%. Based on educational levels, 57.2% of opium dependents have had primary education (under high school. Eighty two (62.5% of addicted groups believed that after starting opium, their cardiovascular function and chest pain had been improved. Although before starting opium use 58 (44.6% of them have had this belief Conclusion: The prevalence of opium addiction in CABG patients is relatively high, and the majority of addicted patients are on this belief that opiates have positive effects on improvement of their chest pain and cardiovascular function. Because the effects of opioids on chest pain are

  15. Comparison of Post-Cesarean Section Opioid Analgesic Requirements in Women With Opioid Use Disorder Treated With Methadone or Buprenorphine.

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    Vilkins, Annmarie L; Bagley, Sarah M; Hahn, Kristen A; Rojas-Miguez, Florencia; Wachman, Elisha M; Saia, Kelley; Alford, Daniel P

    2017-07-19

    Buprenorphine is a highly effective treatment for opioid use disorders, but its continuation in the perioperative setting remains controversial, unlike the accepted practice of perioperative methadone continuation. We conducted a retrospective cohort study from 2006 to 2014 comparing post-cesarean section opioid analgesic requirements of women with opioid use disorders treated with methadone or buprenorphine. Preoperative, intraoperative, and postoperative opioid requirements (morphine equivalent dose [MED]), postoperative complications, and length of stay were compared between the methadone and buprenorphine groups. During the 9-year study period, there were 185 women treated with methadone (mean dose 93.7 mg, SD 2.6) and 88 women treated with buprenorphine (mean dose 16.1 mg, SD 7.8). There were no statistically significant differences in MED requirements in the methadone versus buprenorphine groups: preoperative MED (11.4 mg [SD 31.5] vs 20.0 mg [SD 15.1]; mean difference [MD] 8.6, 95% confidence interval [CI] -1.9, 19.1), intraoperative MED (3.5 mg [SD 6.6] vs 5.2 mg [SD 13.7]; MD 1.8, 95% CI -1.1, 4.6), and postoperative MED during hospitalization (97.7 mg [SD 65.6] vs 85.1 mg [SD 73.0]; MD -12.6, 95% CI -31.1, 5.8). There were no statistically significant differences in postoperative complications or length of stay. Our study suggests that buprenorphine treatment will not interfere more than methadone with pain management after a cesarean section with no significant differences in opioid analgesic requirements, postoperative complications, or length of hospital stay. Future studies should investigate the generalizability to other surgeries.

  16. Efficacy of Acupuncture for Psychological Symptoms Associated with Opioid Addiction: A Systematic Review and Meta-Analysis

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    Zhang Boyuan

    2014-01-01

    Full Text Available This review systematically assessed the clinical evidence for and against acupuncture as a treatment for psychological symptoms associated with opioid addiction. The database was accessed from MEDLINE and China Knowledge Resource Integrated Database. We included all randomized clinical trials published in Chinese and English regardless of their controls. Meta-analysis was performed using the RevMan software, version 5.2. We conducted a literature search of 16 databases from their inception to January 2014. Four studies from Western countries did not report any clinical gains in the treatment of psychological symptoms associated with opioid addiction. 10 of 12 studies from China have reported positive findings regarding the use of acupuncture to treat the psychological symptoms associated with opioid addiction. The methodological quality of the included studies was poor. The meta-analysis indicated that there was a significant difference between the treatment group and the control group for anxiety and depression associated with opioid addiction, although groups did not differ on opioid craving. This review and meta-analysis could not confirm that acupuncture was an effective treatment for psychological symptoms associated with opioid addiction. However, considering the potential of acupuncture demonstrated in the included studies, further rigorous randomized controlled trials with long followup are warranted.

  17. Preliminary buprenorphine sublingual tablet pharmacokinetic data in plasma, oral fluid and sweat during treatment of opioid-dependent pregnant women

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    Concheiro, Marta; Jones, Hendreé E.; Johnson, Rolley E.; Choo, Robin; Huestis, Marilyn A.

    2011-01-01

    Background Buprenorphine is currently under investigation as a pharmacotherapy to treat pregnant women for opioid dependence. This research evaluates buprenorphine (BUP), norbuprenophine (NBUP), buprenorphine-glucuronide (BUP-Gluc) and norbuprenorphine-glucuronide (NBUP-Gluc) pharmacokinetics after high dose (14–20 mg) BUP sublingual tablet administration in three opioid-dependent pregnant women. Methods Oral fluid and sweat specimens were collected in addition to plasma specimens for 24 h during gestation weeks 28 or 29 and 34, and 2 months after delivery. Tmax was not affected by pregnancy; however, BUP and NBUP Cmax and AUC0–24h tended to be lower during pregnancy compared to postpartum levels. Results Statistically significant but weak positive correlations were found for BUP plasma and OF concentrations, and BUP/NBUP ratios in plasma and OF. Conclusion Statistically significant negative correlations were observed for times of specimen collection and BUP and NBUP OF/plasma ratios. BUP-Gluc and NBUP-Gluc were detected in only 5% of OF specimens. In sweat, BUP and NBUP were detected in only 4 of 25 (12 or 24 h) specimens in low concentrations (<2.4 ng/patch). These preliminary data describe BUP and metabolite pharmacokinetics in pregnant women and suggest that, like methadone, upward dose adjustments may be needed with advancing gestation. PMID:21860340

  18. Medication-Assisted Treatment For Opioid Addiction in Opioid Treatment Programs. Treatment Improvement Protocol (TIP) Series 43

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    Tinkler, Emily; Vallejos Bartlett, Catalina; Brooks, Margaret; Gilbert, Johnatnan Max; Henderson, Randi; Shuman, Deborah, J.

    2005-01-01

    TIP 43 provides best-practice guidelines for medication-assisted treatment of opioid addiction in opioid treatment programs (OTPs). The primary intended audience for this volume is substance abuse treatment providers and administrators who work in OTPs. Recommendations in the TIP are based on both an analysis of current research and determinations…

  19. Evaluation of CART peptide level in rat plasma and CSF: Possible role as a biomarker in opioid addiction.

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    Bakhtazad, Atefeh; Vousooghi, Nasim; Garmabi, Behzad; Zarrindast, Mohammad Reza

    2016-10-01

    It has been shown previously that cocaine- and amphetamine-regulated transcript (CART) peptide has a modulatory role and homeostatic regulatory effect in motivation to and reward of the drugs of abuse specially psychostimulants. Recent data also showed that in addition to psychostimulants, CART is critically involved in the different stages of opioid addiction. Here we have evaluated the fluctuations in the level of CART peptide in plasma and CSF in different phases of opioid addiction to find out whether CART can serve as a suitable marker in opioid addiction studies. Male rats were randomly distributed in groups of control, acute low-dose (10mg/kg) morphine, acute high-dose morphine (80mg/kg), chronic escalating doses of morphine, withdrawal syndrome precipitated by administration of naloxone (1mg/kg), and abstinent after long-term drug-free maintenance of addicted animals. The level of CART peptide in CSF and plasma samples was measured by enzyme immunoassay. CART peptide concentration in the CSF and plasma was significantly elevated in acute high-dose morphine and withdrawal state animals and down-regulated in addicted rats. In abstinent group, CART peptide level was up-regulated in plasma but not in CSF samples. As the observed results are in agreement with data regarding the CART mRNA and protein expression in the brain reward pathway in opioid addiction phases, it may be suggested that evaluation of CART peptide level in CSF or plasma could be a suitable marker which reflects the rises and falls of the peptide concentration in brain in the development of opioid addiction.

  20. Opioid Addiction

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  1. CART peptide and opioid addiction: Expression changes in male rat brain.

    Science.gov (United States)

    Bakhtazad, A; Vousooghi, N; Garmabi, B; Zarrindast, M R

    2016-06-14

    Previous studies have shown the prominence of cocaine- and amphetamine-regulated transcript (CART) peptide in rewarding and reinforcing effects of drugs of abuse specially psychostimulants. The data regarding the effects of different stages of opioid addiction on CART expression and the interconnection between CART and opioids are not much available. Here we have studied the changes in the expression level of CART mRNA and protein in various parts of the brain reward pathway in different stages of opioid addiction. Groups of male rats received acute low-dose (10mg/kg), acute high-dose (80mg/kg) and chronic escalating doses of morphine. In addition, withdrawal and abstinence states were evaluated after injection of naloxone (1mg/kg) and long-term maintenance of addicted animals, respectively. Expression of CART mRNA in the brain was measured by real-time PCR method. Western blotting was used to quantify the protein level. CART mRNA and protein were both up-regulated in high-dose morphine-administered animals and also in the withdrawal group in the nucleus accumbens (NAc), striatum and prefrontal cortex (PFC). In the addicted group, CART mRNA and protein were both down-regulated in NAc and striatum. In the abstinent group, CART mRNA was down-regulated in NAc. In the hippocampus, the only observed change was the up-regulation of CART mRNA in the withdrawal group. We suggest that the modulatory role of CART peptide in rewarding and reinforcing effects of opioids weakens when opioids are used for a long time and is stimulated when acute stress such as naloxone-induced withdrawal syndrome or acute high-dose administration of morphine occurs to the animal.

  2. BDNF variability in opioid addicts and response to methadone treatment: preliminary findings.

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    de Cid, R; Fonseca, F; Gratacòs, M; Gutierrez, F; Martín-Santos, R; Estivill, X; Torrens, M

    2008-07-01

    Brain-derived neurotrophic factor (BDNF) signaling pathways have been shown to be essential for opioid-induced plasticity. We conducted an exploratory study to evaluate BDNF variability in opioid addict responders and nonresponders to methadone maintenance treatment (MMT). We analyzed 21 single nucleotide polymorphisms (SNPs) across the BDNF genomic region. Responders and nonresponders were classified by means of illicit opioid consumption detected in random urinalysis. Patients were assessed by a structured interview (Psychiatric Research Interview for Substance and Mental Disorders (PRISM)-DSM-IV) and personality was evaluated by the Cloninger's Temperament and Character Inventory. No clinical, environmental and treatment characteristics were different between the groups, except for the Cooperativeness dimension (P < 0.001). Haplotype block analysis showed a low-frequency (2.7%) haplotype (13 SNPs) in block 1, which was more frequent in the nonresponder group than in the responder group (4/42 vs. 1/135; P(corrected) = 0.023). Fine mapping in block 1 allows us to identify a haplotype subset formed by only six SNPs (rs7127507, rs1967554, rs11030118, rs988748, rs2030324 and rs11030119) associated with differential response to MMT (global P sim = 0.011). Carriers of the CCGCCG haplotype had an increased risk of poorer response, even after adjusting for Cooperativeness score (OR = 20.25 95% CI 1.46-280.50, P = 0.025). These preliminary results might suggest the involvement of BDNF as a factor to be taken into account in the response to MMT independently of personality traits, environmental cues, methadone dosage and psychiatric comorbidity.

  3. Depression-like effect of prenatal buprenorphine exposure in rats.

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    Chih-Jen Hung

    Full Text Available Studies indicate that perinatal opioid exposure produces a variety of short- and long-term neurobehavioral consequences. However, the precise modes of action are incompletely understood. Buprenorphine, a mixed agonist/antagonist at the opioid receptors, is currently being used in clinical trials for managing pregnant opioid addicts. This study provides evidence of depression-like consequence following prenatal exposure to supra-therapeutic dose of buprenorphine and sheds light on potential mechanisms of action in a rat model involving administration of intraperitoneal injection to pregnant Sprague-Dawley rats starting from gestation day 7 and lasting for 14 days. Results showed that pups at postnatal day 21 but not the dams had worse parameters of depression-like neurobehaviors using a forced swimming test and tail suspension test, independent of gender. Neurobehavioral changes were accompanied by elevation of oxidative stress, reduction of plasma levels of brain-derived neurotrophic factor (BDNF and serotonin, and attenuation of tropomyosin-related kinase receptor type B (TrkB phosphorylation, extracellular signal-regulated kinase (ERK phosphorylation, protein kinase A activity, cAMP response element-binding protein (CREB phosphorylation, and CREB DNA-binding activity. Since BDNF/serotonin and CREB signaling could orchestrate a positive feedback loop, our findings suggest that the induction of oxidative stress, reduction of BDNF and serotonin expression, and attenuation of CREB signaling induced by prenatal exposure to supra-therapeutic dose of buprenorphine provide evidence of potential mechanism for the development of depression-like neurobehavior.

  4. A 20-year prospective study of mortality and causes of death among hospitalized opioid addicts in Oslo

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    Haldorsen Tor

    2008-02-01

    Full Text Available Abstract Background To study mortality rate and causes of death among all hospitalized opioid addicts treated for self-poisoning or admitted for voluntary detoxification in Oslo between 1980 and 1981, and to compare their mortality to that of the general population. Methods A prospective cohort study was conducted on 185 opioid addicts from all medical departments in Oslo who were treated for either self-poisoning (n = 93, 1980, voluntary detoxification (n = 75, 1980/1981 or both (n = 17. Their median age was 24 years; with a range from 16 to 41, and 53% were males. All deaths that had occurred by the end of 2000 were identified from the Central Population Register. Causes of death were obtained from Statistics Norway. Standardized mortality ratios (SMRs were computed for mortality, in general, and in particular, for different causes of death. Results During a period of 20 years, 70 opioid addicts died (37.8%, with a standardized mortality ratio (SMR equal to 23.6 (95% CI, 18.7–29.9. The SMR remained high during the whole period, ranging from 32.4 in the first five-year period, to 13.4 in the last five-year period. There were no significant differences in SMR between self-poisonings and those admitted for voluntarily detoxification. The registered causes of death were accidents (11.4%, suicide (7.1%, cancer (4.3%, cardiovascular disease (2.9%, other violent deaths (2.9%, other diseases (71.4%. Among the 50 deaths classified as other diseases, the category "drug dependence" was listed in the vast majority of cases (37 deaths, 52.9% of the total. SMRs increased significantly for all causes of death, with the other diseases group having the highest SMR; 65.8 (95% CI, 49.9–86.9. The SMR was 5.4 (95% CI, 1.3–21.5 for cardiovascular diseases, and 4.3 (95% CI, 1.4–13.5 for cancer. The SMR was 13.2 (95% CI, 6.6–26.4 for accidents, 10.7 (95% CI, 4.5–25.8 for suicides, and 28.6 (95% CI, 7.1–114.4 for other violent deaths. Conclusion The risk

  5. Buprenorphine kinetics.

    Science.gov (United States)

    Bullingham, R E; McQuay, H J; Moore, A; Bennett, M R

    1980-11-01

    Buprenorphine kinetics was determined in surgical patients using radioimmunoassay. Buprenorphine was measured in the plasma of 24 patients who had received 0.3 mg buprenorphine intraoperatively. After 3 hr 10 of these patients then received a further 0.3 mg buprenorphine intravenously for postoperative pain relief, and 11 patients were given 0.3 mg intramuscularly; again, plasma levels were measured for 3 hr. The data fitted closely to a triexponential decay curve. There was a very fast initial phase, with a half-life (t1/2) of 2 min. The terminal t1/2 was slow, approximately 3 hr. Comparison of the kinetics of the same patient, awake and anesthetized, showed that the clearance was significantly lower in the anesthetized state. A notable feature of the drug given intramuscularly is rapid systemic availability, so that peaks are obtained in 2 to 5 min, and in 10 min the resulting levels are the same as for the intravenous and intramuscular routes.

  6. Genetic influence on methadone treatment outcomes in patients undergoing methadone maintenance treatment for opioid addiction: a pilot study

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    Samaan Z

    2014-08-01

    Full Text Available Zainab Samaan,1–4 Monica Bawor,3,4 Brittany B Dennis,2,3 Carolyn Plater,5 Michael Varenbut,5 Jeffrey Daiter,5 Andrew Worster,5,6 David C Marsh,5,7 Charlie Tan,8 Dipika Desai,3 Lehana Thabane,2,9,10 Guillaume Pare11 1Department of Psychiatry and Behavioural Neurosciences, 2Department of Clinical Epidemiology and Biostatistics, 3Population Genomics Program, Chanchlani Research Centre, 4MiNDS Neuroscience Program, McMaster University, Hamilton, Ontario, Canada; 5Ontario Addiction Treatment Centres, Richmond Hill, Ontario, Canada; 6Department of Medicine, McMaster University, Hamilton, Ontario, Canada; 7Northern Ontario School of Medicine, Laurentian University, Sudbury, Ontario, Canada; 8Michael G. DeGroote School of Medicine, McMaster University, 9Biostatistics Unit, Centre for Evaluation of Medicine, 10System Linked Research Unit, 11Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada Introduction: Treatment of opioid addiction with methadone is effective; however, it is known to produce interindividual variability. This may be influenced in part by genetic variants, which can increase the initial risk of developing opioid addiction as well as explain differences in response to treatment. This pilot study aimed to assess the feasibility of conducting a full-scale genetic analysis to identify genes that predict methadone treatment outcomes in this population. Methods: This was a cross-sectional observational study of patients admitted to a methadone maintenance treatment program for opioid addiction. We obtained demographic and clinical characteristics in addition to blood and urine samples, for the assessment of treatment outcomes. Results: The recruitment process yielded 252 patients, representing a 20% recruitment rate. We conducted genetic testing based on a 99.6% rate of provision of DNA samples. The average retention in treatment was 3.4 years, and >50% of the participants reported psychiatric and

  7. Newborn birth-weight of pregnant women on methadone or buprenorphine maintenance treatment: A national contingency management approach trial.

    Science.gov (United States)

    Peles, Einat; Sason, Anat; Schreiber, Shaul; Adelson, Miriam

    2017-03-01

    Methadone maintenance treatment (MMT) is the gold standard for pregnant women with opioid use disorders. Still, low birth-weights were reported, in particular of mothers who became pregnant before admission to MMT. We studied whether an escalating incentive contingency-management approach may contribute to better newborn birth-weights. A nationwide controlled randomized trial among all Israeli methadone/buprenorphine maintenance treatment (MBMT), newly or already in treatment pregnant women was performed. A modified contingency-management protocol with coupons of escalating value depending upon reduction of drug use, cigarette smoking, and alcohol consumption was compared to standard care arm. Drugs in urine, smoking (Fagerstrom score), alcohol use, and depression were monitored. Thirty-five women had 46 pregnancies. In their first pregnancy, 19 from the contingency-management and 16 from the standard care arms were studied. Contingency-management group as compared to the standard care arm included more newly admitted women (36.8% vs. 6.3%, p = .05), with benzodiazepine and cannabis onset at a younger age, and higher proportion of any drug abuse while pregnant (100% vs. 68.8%, p = .01). Fifteen of the contingency-management and 14 of the control arm gave birth (78.9% vs. 87.5%, p = .3) with similar proportions of normal (>2,500 g) birth-weight (71.4% vs. 61.5%, p = .8). Newborns' birth-weight was comparable among the two study arms indicating no contribution of the contingency-management approach. Small sample and baseline differences between arms might have influenced results. Intensive intervention should be evaluated on a larger scale of participants. (Am J Addict 2017;26:167-175). © 2017 American Academy of Addiction Psychiatry.

  8. Effectiveness of social work intervention with a systematic approach to improve general health in opioid addicts in addiction treatment centers

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    Raheb G

    2016-11-01

    Full Text Available Ghoncheh Raheb,1,2 Esmat Khaleghi,1 Amir Moghanibashi-Mansourieh,1 Ali Farhoudian,2 Robab Teymouri3 1Department of Social Work, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; 2Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; 3Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran Purpose: This study takes a systematic approach to investigate the effect of social work intervention aimed at increasing general health among opioid addicts in addiction treatment centers. Patients and methods: This is an experimental plan (pretest to posttest with a control group; the study sample included 60 patients with drug dependencies undergoing treatment in addiction treatment centers. These patients were randomly assigned as case (30 and control (30 groups. The case group was subjected to intervention over ten sessions, whereas the control group received no intervention. Both groups then passed through a posttest, while a follow-up was conducted after 4 months. Data were obtained via a General Health Questionnaire. Results: A covariance analysis test and independent and dependent t-test results indicated that a social work intervention adopting systematic approach was effective in increasing the general health of drug-addicted patients under treatment. Conclusion: Thus, the nature of the presence of social workers in addiction treatment centers has been effective and can have a significant influence by reducing anxiety and insomnia and somatic symptoms, improving patients’ self-understanding and self-recognition, and enhancing social functioning. Keywords: social work, intervention, systematic approach, general health, opioid addicts

  9. Gene network analysis shows immune-signaling and ERK1/2 as novel genetic markers for multiple addiction phenotypes: alcohol, smoking and opioid addiction.

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    Reyes-Gibby, Cielito C; Yuan, Christine; Wang, Jian; Yeung, Sai-Ching J; Shete, Sanjay

    2015-06-05

    Addictions to alcohol and tobacco, known risk factors for cancer, are complex heritable disorders. Addictive behaviors have a bidirectional relationship with pain. We hypothesize that the associations between alcohol, smoking, and opioid addiction observed in cancer patients have a genetic basis. Therefore, using bioinformatics tools, we explored the underlying genetic basis and identified new candidate genes and common biological pathways for smoking, alcohol, and opioid addiction. Literature search showed 56 genes associated with alcohol, smoking and opioid addiction. Using Core Analysis function in Ingenuity Pathway Analysis software, we found that ERK1/2 was strongly interconnected across all three addiction networks. Genes involved in immune signaling pathways were shown across all three networks. Connect function from IPA My Pathway toolbox showed that DRD2 is the gene common to both the list of genetic variations associated with all three addiction phenotypes and the components of the brain neuronal signaling network involved in substance addiction. The top canonical pathways associated with the 56 genes were: 1) calcium signaling, 2) GPCR signaling, 3) cAMP-mediated signaling, 4) GABA receptor signaling, and 5) G-alpha i signaling. Cancer patients are often prescribed opioids for cancer pain thus increasing their risk for opioid abuse and addiction. Our findings provide candidate genes and biological pathways underlying addiction phenotypes, which may be future targets for treatment of addiction. Further study of the variations of the candidate genes could allow physicians to make more informed decisions when treating cancer pain with opioid analgesics.

  10. Sublingual Buprenorphine and Methadone Maintenance Treatment: A Three-Year Follow-Up of Quality of Life Assessment

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    Salvatore M. Giacomuzzi

    2005-01-01

    Full Text Available This study was conducted to compare long-term outcome effects on the quality of life (QOL of oral methadone with sublingual buprenorphine maintenance treatment. The QOL status of opioid-dependent patients was assessed using the German version (“Berlin Quality of Life Profile” of the Lancashire Quality of Life Profile. Physical symptoms were measured using the Opiate Withdrawal Scale (OWS. Urine tests were carried out randomly to detect additional consumption. In the first study period, 53 opioid-dependent subjects were enrolled and 25 could be reached after 3 years. The retention rate was 50% for methadone and 45% for buprenorphine (p = 0.786. Baseline values of the total sample (completers and noncompleters QOL and somatic complaints did not show significant differences between the two treatment groups. QOL characteristics at 6 months of treatment of the buprenorphine completer and noncompleter groups differed significantly regarding job (p = 0.013, family, and total score of physical symptoms (p = 0.002, in which the completer group showed the more favorable values. Concerning physical symptoms at 36 months, logistic regression revealed significantly less stomach cramps (p = 0.037 and fatigue and tiredness (p = 0.034 in buprenorphine compared to the methadone. Moreover, the buprenorphine-maintained group showed significantly less additional consumption of benzodiazepines (p = 0.015 compared with methadone participants. It is concluded that opioid addicts improved their QOL and health status when treated with methadone or buprenorphine. In summary, regarding QOL and health status, the present data indicate that buprenorphine is also a useful long-term alternative for maintenance treatment of opioid-dependent patients.

  11. The ABCB1, rs9282564, AG and TT Genotypes and the COMT, rs4680, AA Genotype are Less Frequent in Deceased Patients with Opioid Addiction than in Living Patients with Opioid Addiction.

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    Christoffersen, Dorte J; Damkier, Per; Feddersen, Søren; Möller, Sören; Thomsen, Jørgen L; Brasch-Andersen, Charlotte; Brøsen, Kim

    2016-10-01

    Sudden death due to acute intoxication occurs frequently in patients with opioid addiction (OA). To examine whether certain genotypes were associated with this, we examined the frequencies of 29 SNPs located in candidate genes related to opioid pharmacology: ABCB1, OPRM1, UGT2B7, CYP3A5, CYP2B6, CYP2C19, CYP2D6, COMT, KCNJ6 and SCN9A in 274 deceased patients with OA (DOA), 309 living patients with OA (LOA) and in 394 healthy volunteers (HV). The main hypothesis of the study was that subjects homozygous for the variant 3435T in ABCB1 (rs1045642) occur more frequently in DOA than in LOA and HV because morphine and methadone more readily cross the blood barrier in these subjects due to a lower efflux transporter activity of the ABCB1 (p-glycoprotein) transporter. Our results did not support this hypothesis, because no statistically significant difference (p = 0.506) in the frequency of the TT genotype of rs1045642 was observed between the DOA, LOA and HV cohorts. However, for another ABCB1 variant, rs9282564, we found that the frequencies of the AG and TT genotypes were 13, 21 and 25% in DOA, LOA and HV, respectively, and after correcting for age, sex and multiple testing, the differences between DOA and LOA were statistically significantly different (p = 0.027). The COMT rs4680 AA genotype frequencies were 25%, 35% and 31% in DOA, LOA and HV, respectively, and the difference between DOA and LOA was also statistically significant (p = 0.0028). In conclusion, this study generated two hypotheses suggesting possible associations of a reduced risk of death and carrying, respectively, the ABCB1 rs9282564 AG and TT genotypes and the COMT rs4680 AA genotype among patients with OA. These findings should be confirmed in independent cohorts, and if a causal relationship between these variants and fatal poisoning in OA is confirmed, then it may be possible at least in theory to personalize prevention of sudden death in this patient group.

  12. Cognitive impairments in young people with opioid addiction and their correction

    Directory of Open Access Journals (Sweden)

    Maria Lazarevna Chukhlovina

    2012-01-01

    Full Text Available Objective: to evaluate cognitive functions and drug correction of identified impairments in heroin users. Patients and methods. Thirty-two patients (7 women and 25 men aged 18 to 45 years who had used heroin for 1—3 years were examined using the mini-mental state examination (MMSE, the techniques of «memorizing words» and «excluding words», the tests of «information-memory-concentration», quantitative assessment of clock drawing, and the frontal assessment battery. The detected cognitive impairments were corrected with the standardized Ginkgo Biloba extract (EGb 761 ®, Tanakan ®. Results. Cognitive impairments were found in all the patients: moderate cognitive disorders in 68.8% and mild dementia in 31.2%; thinking disorders were most noticeable; decreased attention, frontal lobe dysfunction, and visual spatial impairments were detectable. After a course of therapy with tanakan (120—240 g/day according to the degree of cognitive impairments for 3 months, there was a significant improvement in MMSE scores, thought, concentration, memory; however, they failed to achieve the scores in the control group consisting of 10 apparently healthy individuals of the same age and sex.

  13. Abuse potential of intranasal buprenorphine versus buprenorphine/naloxone in buprenorphine-maintained heroin users.

    Science.gov (United States)

    Jones, Jermaine D; Sullivan, Maria A; Vosburg, Suzanne K; Manubay, Jeanne M; Mogali, Shanthi; Metz, Verena; Comer, Sandra D

    2015-07-01

    In spite of the clinical utility of buprenorphine, parenteral abuse of this medication has been reported in several laboratory investigations and in the real world. Studies have demonstrated lower abuse liability of the buprenorphine/naloxone combination relative to buprenorphine alone. However, clinical research has not yet examined the utility of the combined formulation to deter intranasal use in a buprenorphine-maintained population. Heroin-using volunteers (n = 12) lived in the hospital for 8-9 weeks and were maintained on each of three sublingual buprenorphine doses (2, 8, 24 mg). Under each maintenance dose, participants completed laboratory sessions during which the reinforcing and subjective effects of intranasal doses of buprenorphine (8, 16 mg), buprenorphine/naloxone (8/2, 8/8, 8/16, 16/4 mg) and controls (placebo, heroin 100 mg, naloxone 4 mg) were assessed. Intranasal buprenorphine alone typically produced increases in positive subjective effects and the 8 mg dose was self-administered above the level of placebo. The addition of naloxone dose dependently reduced positive subjective effects and increased aversive effects. No buprenorphine/naloxone combination dose was self-administered significantly more than placebo. These data suggest that within a buprenorphine-dependent population, intranasal buprenorphine/naloxone has reduced abuse potential in comparison to buprenorphine alone. These data strongly argue in favor of buprenorphine/naloxone rather than buprenorphine alone as the more reasonable option for managing the risk of buprenorphine misuse.

  14. Radioimmunoassay of buprenorphine

    Energy Technology Data Exchange (ETDEWEB)

    Bartlett, A.J.; Lloyd-Jones, J.G.; Rance, M.J.; Flockhart, I.R.; Dockray, G.J.; Bennett, M.R.D.

    1980-01-01

    Antisera to buprenorphine were obtained in rabbits immunised with 3-0-carboxymethylbuprenorphine and N-hemisuccinyl-norbuprenorphine conjugated to bovine serum albumin. Using the latter antiserum and tritium labelled buprenorphine a radioimmunoassay having good accuracy and precision was developed for concentrations as low as 50 picograms in 1 ml of plasma. The N-hemisuccinyl antiserum crossreacted with norbuprenorphine, and the 3-0-glucuronide conjugate with the 3-0-carboxy-methyl antiserum. Cross-reactivity of both antisera to other pharmacologically related compounds was negligible. The assay was employed to determine plasma buprenorphine concentration following its parenteral administration to dog and man.

  15. [Modified neuroleptanalgesia with buprenorphine].

    Science.gov (United States)

    Weidler, B; von Bormann, B; Seim, M; Sturm, G; Schwanen, N; Hempelmann, G

    1982-12-01

    A modification of neuroleptanalgesia by substituting fentanyl with buprenorphine is presented. Both anaesthesia techniques could be applied alternatively. We did not recognize any significant difference between the two groups concerning haemodynamics, the secretion of the so called stress hormones (antidiuretic hormone, cortisol) as well as the postoperative respiratory depression. The long lasting analgesia, which could be achieved by buprenorphine, can be advantageous in certain surgical interventions. The lack of a potent antagonist for buprenorphine in addition to its longer half-life for--not being of advantage in any anaesthesia--is discussed.

  16. Abuse Potential of Intranasal Buprenorphine versus Buprenorphine/Naloxone in Buprenorphine-Maintained Heroin Users

    OpenAIRE

    2014-01-01

    In spite of the clinical utility of buprenorphine, parenteral abuse of this medication has been reported in several laboratory investigations and in the real world. Studies have demonstrated lower abuse liability of the buprenorphine/naloxone combination relative to buprenorphine alone. However, clinical research has not yet examined the utility of the combined formulation to deter intranasal use in a buprenorphine-maintained population. Heroin-using volunteers (n = 12) lived in the hospital ...

  17. Buprenorphine and Buprenorphine/Naloxone Diversion, Misuse, and Illicit Use: An International Review

    OpenAIRE

    2011-01-01

    The diversion, misuse, and non-medically supervised use of buprenorphine and buprenorphine/naloxone by opioid users are reviewed. Buprenorphine and buprenorphine/naloxone are used globally as opioid analgesics and in the treatment of opioid dependency. Diversion of buprenorphine and buprenorphine/naloxone represents a complex medical and social issue, and has been widely documented in various geographical regions throughout the world.

  18. Buprenorphine, methadone, and morphine treatment during pregnancy: behavioral effects on the offspring in rats.

    Science.gov (United States)

    Chen, Hwei-Hsien; Chiang, Yao-Chang; Yuan, Zung Fan; Kuo, Chung-Chih; Lai, Mei-Dan; Hung, Tsai-Wei; Ho, Ing-Kang; Chen, Shao-Tsu

    2015-01-01

    Methadone and buprenorphine are widely used for treating people with opioid dependence, including pregnant women. Prenatal exposure to opioids has devastating effects on the development of human fetuses and may induce long-term physical and neurobehavioral changes during postnatal maturation. This study aimed at comparing the behavioral outcomes of young rats prenatally exposed to buprenorphine, methadone, and morphine. Pregnant Sprague-Dawley rats were administered saline, morphine, methadone, and buprenorphine during embryonic days 3-20. The cognitive function, social interaction, anxiety-like behaviors, and locomotor activity of offsprings were examined by novel object recognition test, social interaction test, light-dark transition test, elevated plus-maze, and open-field test between 6 weeks and 10 weeks of age. Prenatal exposure to methadone and buprenorphine did not affect locomotor activity, but significantly impaired novel object recognition and social interaction in both male and female offsprings in the same manner as morphine. Although prenatal exposure to methadone or buprenorphine increased anxiety-like behaviors in the light-dark transition in both male and female offsprings, the effects were less pronounced as compared to that of morphine. Methadone affected elevated plus-maze in both sex, but buprenorphine only affected the female offsprings. These findings suggest that buprenorphine and methadone maintenance therapy for pregnant women, like morphine, produced detrimental effects on cognitive function and social behaviors, whereas the offsprings of such women might have a lower risk of developing anxiety disorders.

  19. Buprenorphine During Pregnancy Reduces Neonate Distress

    Science.gov (United States)

    ... less neonatal distress. Buprenorphine, like methadone, reduces opioid craving and alleviates withdrawal symptoms without the safety and ... her first pregnancy. In each instance, the child born following buprenorphine treatment exhibited milder NAS symptoms than ...

  20. Benzodiazepines increase the reward effects of buprenorphine in a conditioned place preference test in the mouse.

    Science.gov (United States)

    Ma, Lin-Lin; Freret, Thomas; Lange, Mathilde; Bourgine, Joanna; Coquerel, Antoine; Lelong-Boulouard, Véronique

    2014-12-01

    Buprenorphine (BPN) is widely used as a substitution treatment for opioid addiction. Some cases of abuse and misuse, especially associated with various benzodiazepines (BZDs), have been described, and a previous study has shown that BZDs increase the sedative effect of BPN and decrease its anxiogenic properties. To investigate the reward effect that may lead to the abusive combination of BPN and BZD, we studied the influence of different doses of three BZDs extensively used with BPN by drug addicts on conditioned place preference behavior in mice. BPN (0.3, 1, 3 mg/kg) was injected subcutaneously into male mice alone or in combination with a BZD administered intraperitoneally: dipotassium clorazepate (CRZ; 1, 4, 16 mg/kg), diazepam (DAZ; 0.5, 1, 5 mg/kg), or bromazepam (BMZ; 0.5, 1, 3 mg/kg). Amphetamine (8 mg/kg) was used as a reference drug. Reward effects of BPN alone or in combination were measured in a conditioned place preference paradigm using an unbiased procedure. Our results showed that groups treated with BPN associated with different doses of diazepam and clorazepate, but not bromazepam, spent significantly more time in the drug-paired compartment compared to the group treated with BPN alone. Our study shows that joint consumption of diazepam and clorazepate, but not bromazepam, can increase the reward properties of BPN alone in mice. These results could help to explain the use of this type of drug combination in the drug addict population. © 2014 Société Française de Pharmacologie et de Thérapeutique.

  1. Illicit buprenorphine use, interest in and access to buprenorphine treatment among syringe exchange participants.

    Science.gov (United States)

    Fox, Aaron D; Chamberlain, Adam; Sohler, Nancy L; Frost, Taeko; Cunningham, Chinazo O

    2015-01-01

    Poor access to buprenorphine maintenance treatment (BMT) may contribute to illicit buprenorphine use. This study investigated illicit buprenorphine use and barriers to BMT among syringe exchange participants. Computer-based interviews conducted at a New York City harm reduction agency determined: prior buprenorphine use; barriers to BMT; and interest in BMT. Of 102 opioid users, 57 had used illicit buprenorphine and 32 had used prescribed buprenorphine. When illicit buprenorphine users were compared to non-users: barriers to BMT ("did not know where to get treatment") were more common (64 vs. 36%, pbuprenorphine users were interested in BMT but did not know where to go for treatment. Addressing barriers to BMT could reduce illicit buprenorphine use.

  2. Primary care management of opioid use disorders: Abstinence, methadone, or buprenorphine-naloxone?

    Science.gov (United States)

    Srivastava, Anita; Kahan, Meldon; Nader, Maya

    2017-03-01

    To advise physicians on which treatment options to recommend for specific patient populations: abstinence-based treatment, buprenorphine-naloxone maintenance, or methadone maintenance. PubMed was searched and literature was reviewed on the effectiveness, safety, and side effect profiles of abstinence-based treatment, buprenorphine-naloxone treatment, and methadone treatment. Both observational and interventional studies were included. Both methadone and buprenorphine-naloxone are substantially more effective than abstinence-based treatment. Methadone has higher treatment retention rates than buprenorphine-naloxone does, while buprenorphine-naloxone has a lower risk of overdose. For all patient groups, physicians should recommend methadone or buprenorphine-naloxone treatment over abstinence-based treatment (level I evidence). Methadone is preferred over buprenorphine-naloxone for patients at higher risk of treatment dropout, such as injection opioid users (level I evidence). Youth and pregnant women who inject opioids should also receive methadone first (level III evidence). If buprenorphine-naloxone is prescribed first, the patient should be promptly switched to methadone if withdrawal symptoms, cravings, or opioid use persist despite an optimal buprenorphine-naloxone dose (level II evidence). Buprenorphine-naloxone is recommended for socially stable prescription oral opioid users, particularly if their work or family commitments make it difficult for them to attend the pharmacy daily, if they have a medical or psychiatric condition requiring regular primary care (level IV evidence), or if their jobs require higher levels of cognitive functioning or psychomotor performance (level III evidence). Buprenorphine-naloxone is also recommended for patients at high risk of methadone toxicity, such as the elderly, those taking high doses of benzodiazepines or other sedating drugs, heavy drinkers, those with a lower level of opioid tolerance, and those at high risk of

  3. Methadone versus buprenorphine for the treatment of opioid abuse in pregnancy: science and stigma.

    Science.gov (United States)

    Holbrook, Amber M

    2015-01-01

    The past decade has seen an increase in rates of opioid abuse during pregnancy. This clinical challenge has been met with debate regarding whether or not illicit and prescription opioid-dependent individuals require different treatment approaches; whether detoxification is preferable to maintenance; and the efficacy of methadone versus buprenorphine as treatment options during pregnancy. The clinical recommendations resulting from these discussions are frequently influenced by the comparative stigma attached to heroin abuse and methadone maintenance versus prescription opioid abuse and maintenance treatment with buprenorphine. While some studies have suggested that a subset of individuals who abuse prescription opioids may have different characteristics than heroin users, there is currently no evidence to suggest that buprenorphine is better suited to treatment of prescription opioid abuse than methadone. Similarly, despite its perennial popularity, there is no evidence to recommend detoxification as an efficacious approach to treatment of opioid dependence during pregnancy. While increased access to treatment is important, particularly in rural areas, there are multiple medical and psychosocial reasons to recommend comprehensive substance abuse treatment for pregnant women suffering from substance use disorders rather than office-based provision of maintenance medication. Both methadone and buprenorphine are important treatment options for opioid abuse during pregnancy. Methadone may still remain the preferred treatment choice for some women who require higher doses for stabilization, have a higher risk of treatment discontinuation, or who have had unsuccessful treatment attempts with buprenorphine. As treatment providers, we should advocate to expand available treatment options for pregnant women in all States.

  4. Supply of buprenorphine waivered physicians: the influence of state policies.

    Science.gov (United States)

    Stein, Bradley D; Gordon, Adam J; Dick, Andrew W; Burns, Rachel M; Pacula, Rosalie Liccardo; Farmer, Carrie M; Leslie, Douglas L; Sorbero, Mark

    2015-01-01

    Buprenorphine, an effective opioid use disorder treatment, can be prescribed only by buprenorphine-waivered physicians. We calculated the number of buprenorphine-waivered physicians/100,000 county residents using 2008-11 Buprenorphine Waiver Notification System data, and used multivariate regression models to predict number of buprenorphine-waivered physicians/100,000 residents in a county as a function of county characteristics, state policies and efforts to promote buprenorphine use. In 2011, 43% of US counties had no buprenorphine-waivered physicians and 7% had 20 or more waivered physicians. Medicaid funding, opioid overdose deaths, and specific state guidance for office-based buprenorphine use were associated with more buprenorphine-waivered physicians, while encouraging methadone programs to promote buprenorphine use had no impact. Our findings provide important empirical information to individuals seeking to identify effective approaches to increase the number of physicians able to prescribe buprenorphine.

  5. 抗阿片成瘾药物研究历史与现状%History and present situation of research and development of anti-opioid addiction drugs

    Institute of Scientific and Technical Information of China (English)

    李锦; 曹丹旎; 吴宁; 李斐; 宋睿; 苏瑞斌

    2012-01-01

    Opioid addiction is a chronic and relapsing brain disorde. The clinical symptoms of opioid addiction include physical dependence, protracted 9ymptom9, psychological dependence and relapse, and the key to treatment is anti-relapse. The research of anti-relapse drug focuses on two aspects: one is targeting at opioid receptors, the other is targeting at non-opioid receptors. Opioid receptor agonist methadone and antagonist naltrexone are the representative drugs that targets at opioid receptors. Thienorphine, a new opioid receptor ligand, completely blocks morphine and other opioids-induced physical and psychological dependence, and prevents opioid relapse. Studies have shown that many non-opioid receptor systems, including dopamine receptors, excitatory amino acid receptors, gamma-aminobutyric acid receptors, acetylcholine receptors, 5-HT receptors, CB1 receptors and neurotrophic factor receptors, are involved in the modulation of opioid psychological dependence and relapse. A novel dopamine D3 receptor antagonist Y-QA14 inhibits cocaine abd heroine addiction and prevents relapse without addictive potential. I1 imidazoline receptor agonist agmatine inhibits opioid-induced physical and psychological dependence, relieves protracted symptoms and prevents relapse, the mechanism of which is due to the attenuation of the compensatory adaptations occuring on opioid receptor, dopamine and glualmate nerotransmissions. This paper reviews opium, biological basis of opioid addiction, and history, current situation as well as development tendency of anti-opioid relapse drug research.%阿片成瘾是一种慢性复发性脑疾病,临床症状包括躯体依赖、稽延症状、精神依赖和复吸,治疗的关键是防复吸.防复吸药物的研究包括以阿片受体和非阿片受体为靶标的药物.代表性药物分别为阿片受体激动剂美沙酮和受体阻断剂纳屈酮,新型阿片受体配体噻吩诺啡能够完全阻断吗啡等阿片类药物引起的躯体

  6. Survey on opioid addicts' sensitivity to related environments and influential factors%阿片类药物依赖患者对相关环境敏感程度及影响因素研究

    Institute of Scientific and Technical Information of China (English)

    冯燕; 王莹; 何倩; 王增珍

    2008-01-01

    目的 应用自行开发的敏感性量表评定阿片类药物依赖患者对其吸毒相关环境的敏感性及影响因素.方法 采用分层随机整群抽样对全国5个城市强制戒毒所1096例阿片类药物依赖患者进行敏感性调查.结果 阿片类药物依赖患者对吸毒直接相关环境和社会家庭环境比较敏感,尤其是"缺乏亲情"和"看到别人吸毒",反映强烈的分别达59.40%和59.05%.毒龄(吸毒时间)长、吸毒频率高、有亲人吸毒、消极的亲人态度是对与吸毒直接相关环境敏感性的危险因素(F=17.10,P<0.0001);女性、年龄小、毒龄长、消极的亲人态度是对社会家庭环境敏感性的危险因素(F=8.52,P<0.0001);毒龄长、吸毒频率高、消极的亲人态度是对与吸毒间接相关环境敏感性的危险因素(F=10.08.P<0.0001).结论 阿片类药物依赖患者对相关环境很敏感,其程度受性别、年龄、毒龄、吸毒频率、家人是否吸毒及亲人态度的影响.%Objective We developed a scale on opioid addicts' sensitivity to drug-related environments for assessing addicts sensitivity and influential factors, which could provide evidence for psychological interventions on detoxification. Methods The survey on opioid addicts' sensitivity was administered to 1096 opioid addicts through stratified random cluster sampling in mandatory detoxification centers from 5 cities in China. Results Patients were more sensitive to environments directly related to drug abuse, social and family environments, especially in those cases that lack of love from family or watching drug use from others, with percentages of persons having strong response reaching 59.40% and 59.05%, respectively. The risk factors of patients' sensitivity to environments directly related to drug abuse would include long period of drug use, high frequency of drug abuse, drug abuse in family members and negative family attitudes ( F = 17.10, P< 0. 0001 ). Being female, younger of

  7. Pharmacokinetics of intravenous buprenorphine in children.

    OpenAIRE

    1989-01-01

    Buprenorphine (3 micrograms kg-1) was given intravenously as premedication to small children (age 4-7 years) undergoing minor surgery. Because of the rapid decline of the plasma buprenorphine concentrations, the terminal elimination half-life could not be estimated reliably. Given this constraint, values of clearance appeared to be higher than those in adults but values of Vss were similar.

  8. Pharmacokinetics of intravenous buprenorphine in children.

    Science.gov (United States)

    Olkkola, K T; Maunuksela, E L; Korpela, R

    1989-08-01

    Buprenorphine (3 micrograms kg-1) was given intravenously as premedication to small children (age 4-7 years) undergoing minor surgery. Because of the rapid decline of the plasma buprenorphine concentrations, the terminal elimination half-life could not be estimated reliably. Given this constraint, values of clearance appeared to be higher than those in adults but values of Vss were similar.

  9. Clinical experience with fortnightly buprenorphine/naloxone versus buprenorphine in Italy: preliminary observational data in an office-based setting.

    Science.gov (United States)

    Amato, Patrizia

    2010-01-01

    Buprenorphine/naloxone is a new option for the management of opioid dependence. It has a reduced potential for abuse or misuse compared with methadone and buprenorphine alone, and has a long half-life allowing less frequent dosing. Buprenorphine/naloxone appears to be well suited for the management of opioid dependence in an office-based setting. The aim of this study was to evaluate the efficacy and safety of a buprenorphine/naloxone combination treatment in an office-based setting. Therefore, we evaluated the effect on misuse/diversion, quality of care, quality of life and service delivery. Seventy-eight patients were switched to buprenorphine/naloxone from either methadone or buprenorphine alone; the median duration of previous buprenorphine or methadone treatment was 10 years. Patients received buprenorphine/naloxone and were evaluated throughout a 1-year follow-up period. Treatment was self-administered by the patients every 2 weeks and the mean buprenorphine dosage at 1 year was 8 mg/day. Comparisons were made before and after the switch for patients who switched from buprenorphine alone to buprenorphine/naloxone. Switching to buprenorphine/naloxone was not associated with clinically relevant problems in 50% of patients studied. Buprenorphine/naloxone provided satisfactory coverage of withdrawal symptoms in 78.1% of patients, and 50% of patients were satisfied with buprenorphine/naloxone therapy. Seventy-eight per cent of patients reported improved psychosocial functioning. The majority of patients (approximately 85%) were negative for opioids during toxicological testing. A significantly higher proportion of treatment recipients were highly satisfied during buprenorphine/naloxone administration (p buprenorphine given before the switch). Other outcomes were similar during buprenorphine and buprenorphine/naloxone administration. Fortnightly self-administration of buprenorphine/naloxone appeared to be cost saving for the clinic. Buprenorphine/naloxone is an

  10. Buprenorphine, methadone, and morphine treatment during pregnancy: behavioral effects on the offspring in rats

    Directory of Open Access Journals (Sweden)

    Chen HH

    2015-03-01

    Full Text Available Hwei-Hsien Chen,1,2,* Yao-Chang Chiang,3,4,* Zung Fan Yuan,5,6 Chung-Chih Kuo,5,6 Mei-Dan Lai,2 Tsai-Wei Hung,1 Ing-kang Ho,1,3,4 Shao-Tsu Chen2,7 1Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli County, Taiwan; 2Master and PhD Program in Pharmacology and Toxicology, Tzu Chi University, Hualien, Taiwan; 3Center for Drug Abuse and Addiction, China Medical University Hospital, 4Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan; 5Master Program in Physiological and Anatomical Medicine, 6Department of Physiology, School of Medicine, Tzu Chi University, 7Department of Psychiatry, Buddhist Tzu Chi General Hospital, Hualien, Taiwan *These authors contributed equally to this work Abstract: Methadone and buprenorphine are widely used for treating people with opioid dependence, including pregnant women. Prenatal exposure to opioids has devastating effects on the development of human fetuses and may induce long-term physical and neurobehavioral changes during postnatal maturation. This study aimed at comparing the behavioral outcomes of young rats prenatally exposed to buprenorphine, methadone, and morphine. Pregnant Sprague-Dawley rats were administered saline, morphine, methadone, and buprenorphine during embryonic days 3–20. The cognitive function, social interaction, anxiety-like behaviors, and locomotor activity of offsprings were examined by novel object recognition test, social interaction test, light–dark transition test, elevated plus-maze, and open-field test between 6 weeks and 10 weeks of age. Prenatal exposure to methadone and buprenorphine did not affect locomotor activity, but significantly impaired novel object recognition and social interaction in both male and female offsprings in the same manner as morphine. Although prenatal exposure to methadone or buprenorphine increased anxiety-like behaviors in the light–dark transition in both male and female

  11. Resting State fMRI Study of Amygdala in Opioid Addiction%阿片类药物成瘾者基于杏仁核的Resting-state fMRI研究

    Institute of Scientific and Technical Information of China (English)

    吴宁; 李强; 李玮; 朱佳; 常海峰; 王玮

    2012-01-01

    Objective To discuss opioid effects on amygdala function connection by resting state (MRI. Materials and Methods Opioid addiction 12 patients and 14 healthy subjects(all men) received resting state functional MRI, the bilat-eral amygdala were used as regions of interest respectively to analyze functional connectivity, the difference between left and right side of the brain regions with opioids and the total time of drug addiction, such as average daily volume of drug were analyzed. Results Compared with the control group, connectivity of opiate addicts bilateral parahippocampal gyms, a-mygdala and bilateral cerebellar hemisphere was significantly enhanced, and connectivity of two sided precuneus, left temporal lobe and the left middle frontal gyms functional was significantly decreased, connectivity degree of the left amygdala and right precuneus was negative to average daily volume of opioid. Conclusion Opioid addicts cognitive control function of neural circuits is damaged, and rewarded, loops of learning and memory function is strengthened.%目的 通过Resting-state fMRI探讨阿片类药物对杏仁核功能连接的影响.资料与方法 阿片类药物成瘾患者12例,健康被试者14名(均为男性).采用3.0T磁共振扫描仪,对被试者分别进行静息态功能磁共振扫描,以双侧杏仁核为感兴趣区,分别进行功能连接分析,再将左右侧差异性脑区与阿片类药物成瘾组总吸毒时间、平均每日吸毒量等作相关分析.结果 与对照组比较,阿片类药物成瘾者杏仁核与双侧海马旁回及双侧小脑半球功能连接度显著增强,与双侧楔前叶,左侧颞中、下回,左侧额中回功能连接度显著下降;左侧杏仁核和右侧楔前叶的功能连接度与阿片类成瘾者每日吸入量呈负相关.结论 阿片类药物成瘾者认知控制功能的神经环路受损,而奖赏以及学习记忆环路功能出现异常强化.

  12. Buprenorphine Sublingual and Buccal (opioid dependence)

    Science.gov (United States)

    ... buprenorphine and naloxone are used to treat opioid dependence (addiction to opioid drugs, including heroin and narcotic ... as ketoconazole (Nizoral); medications for anxiety such as benzodiazepines; cyclobenzaprine (Amrix); dextromethorphan (found in many cough medications; ...

  13. 阿片类依赖者康复阶段肝功能变化分析%Analysis of changes of hepatic function in opioid addicts during rehabilitation

    Institute of Scientific and Technical Information of China (English)

    李潇潇; 梁军成; 孙莉; 郝伟; 李静; 邓艳萍

    2013-01-01

    功能可能出现异常性升高现象,随康复时间延长可逐步好转.对该类人群需持续监测肝功能指标,以便指导后续的康复及防复吸治疗.%Objective To investigate the hepatic function condition and influencing factors in opioid addicts during rehabilitation after detoxification.Methods Opioid addicts abstained from opioid in duration of rehabilitation were recruited from Shanghai,Sichuan and Henan Compulsory Isolated Detoxification Center.The subjects' demographics,drug abuse histories,and withdrawal symptoms were recorded.The protracted withdrawal symptoms scale,Hamilton Anxiety scale (HAMA),and Hamilton Depression scale (HAMD) were used to assess withdrawal symptoms.Hepatic function tests including alanine aminotransferase (ALT),aspartate aminotransferase (AST) and total bilirubin (TBil) were performed at baseline (the 15th day after detoxification),4th,12th,18th,and 24th weeks of rehabilitation.Results A total of 130 subjects were enrolled into the study,comprising 106 (81.5%)male and 24 (18.5%) female with average age of (43.8 ± 15.3) years.Their duration of drug abuse was (83.2 ± 4.9) months ranging from 1 to 242 months and average daily dose taken during the last week before abstinence was (1.02 ± 0.09) g ranging from 0.10 to 6.00 g.At the beginning of rehabilitation,the protracted withdrawal symptoms scale averaged (20.2 ± 0.9) ranging from 10 to 52,HAMD averaged (13.7 ±0.6) ranging from 4 to 41,and HADA averaged (12.3 ± 0.5) ranging from 4 to 31.The initial percentage of abnormal ALT,AST,and TBil in the subjects were 22.3% (29 cases),9.9% (8 cases),and 2.3 % (3 cases),respectively.Compared with the baseline,the percentage of cases with abnormal ALT increased to 36.8% at the 4th week of rehabilitation (P < 0.01) and then fluctuated and dropped to 16.7%at the 24th week.The change between the 4th and the 24th weeks was statistically significant (P < 0.01).The percentage of cases with abnormal AST showed a

  14. Epidural Naloxone to Prevent Buprenorphine Induced PONV

    Directory of Open Access Journals (Sweden)

    Ashok Jadon

    2008-01-01

    Full Text Available Epidural infusion of local analgesic and opioid are commonly used for postoperative pain relief. This combina-tion gives excellent anlgesia but nausea and vomiting remains a major concern. Low dose epidural naloxone prevents PONV induced by spinal opioids like morphine, fentanyl and sufentanil. However, it is not known that epidural naloxone administration prevents PONV induced by epidural buprenorphine. We have reported three cases of major abdominal operation in which lowdose epidural infusion of naloxone releived the symptom of buprenorphine induced severe PONV and improved the quality of analgesia.

  15. Pharmacokinetics of the combination tablet of buprenorphine and naloxone.

    Science.gov (United States)

    Chiang, C Nora; Hawks, Richard L

    2003-05-21

    The sublingual combination tablet formulation of buprenorphine and naloxone at a fixed dose ratio of 4:1 has been shown to be as effective as the tablet formulation containing only buprenorphine in treating opiate addiction. The addition of naloxone does not affect the efficacy of buprenorphine for two reasons: (1) naloxone is poorly absorbed sublingually relative to buprenorphine and (2) the half-life for buprenorphine is much longer than for naloxone (32 vs. 1 h for naloxone). The sublingual absorption of buprenorphine is rapid and the peak plasma concentration occurs 1 h after dosing. The plasma levels for naloxone are much lower and decline much more rapidly than those for buprenorphine. Increasing dose results in increasing plasma levels of buprenorphine, although this increase is not directly dose-proportional. There is a large inter-subject variability in plasma buprenorphine levels. Due to the large individual variability in opiate dependence level and the large variability in the pharmacokinetics (PK) of buprenorphine, the effective dose or effective plasma concentration is also quite variable. Doses must be titrated to a clinically effective level for individual patients.

  16. Recovery from opioid addiction in DATOS.

    Science.gov (United States)

    Flynn, Patrick M; Joe, George W; Broome, Kirk M; Simpson, D Dwayne; Brown, Barry S

    2003-10-01

    Patient attributions for their own long-term recovery were obtained in a 5-year followup of 432 admissions to 18 outpatient methadone treatment programs. Subjects were classified into two groups - recovering and non-recovering-strictly defined and based on both biological and self-report measures of no opioid or cocaine use, less than daily use of alcohol, and no arrests or illegal activity during the year prior to interview. The 28% who were in recovery at Year 5 reported that they had relied primarily upon personal motivation, treatment experiences, religion/spirituality, family, and their job/career. Particular value was placed on the support from family and close friends, indicating the importance of stronger efforts to develop social networks for support of drug-free functioning, especially among patients who lack these resources or need them strengthened. More information is available on the Internet at www.ibr.tcu.edu.

  17. Opioid dependence treatment, including buprenorphine/naloxone.

    Science.gov (United States)

    Raisch, Dennis W; Fye, Carol L; Boardman, Kathy D; Sather, Mike R

    2002-02-01

    To review opioid dependence (OD) and its treatment. Pharmacologic treatments, including the use of buprenorphine/naloxone, are presented. Pharmaceutical care functions for outpatient OD treatment are discussed. Primary and review articles were identified by MEDLINE and HEALTHSTAR searches (from 1966 to November 2000) and through secondary sources. Tertiary sources were also reviewed regarding general concepts of OD and its treatment. Relevant articles were reviewed after identification from published abstracts. Articles were selected based on the objectives for this article. Studies of the treatment of OD with buprenorphine were selected based on the topic (pharmacology, pharmacokinetics, adverse reactions) and study design (randomized, controlled clinical trials in patients with OD with active/placebo comparisons and/or comparisons of active OD treatments). Articles regarding pharmacists' activities in the treatment and prevention of OD were reviewed for the pharmaceutical care section. OD is considered a medical disorder with costly adverse health outcomes. Although methadone maintenance treatment (MMT) is cost-effective for OD, only about 12% of individuals with OD receive this treatment. Psychological and pharmacologic modalities are used to treat OD, but patients often relapse. Drug therapy includes alpha 2-agonists for withdrawal symptoms, detoxification regimens with or without opioids, opioid antagonists, and opioid replacement including methadone, levomethadyl acetate, and buprenorphine. The Drug Addiction Treatment Act of 1999 allows for office-based opioid replacement therapies. Sublingual buprenorphine with naloxone can be used in this milieu. Buprenorphine with naloxone is currently under new drug application review with the Food and Drug Administration. Clinical research shows buprenorphine to be equal in effectiveness to methadone, but safer in overdose due to its ceiling effect on respiratory depression. It has lower abuse potential and fewer

  18. Quantitation of Buprenorphine, Norbuprenorphine, Buprenorphine Glucuronide, Norbuprenorphine Glucuronide, and Naloxone in Urine by LC-MS/MS.

    Science.gov (United States)

    Marin, Stephanie J; McMillin, Gwendolyn A

    2016-01-01

    Buprenorphine is an opioid drug that has been used to treat opioid dependence on an outpatient basis, and is also prescribed for managing moderate to severe pain. Some formulations of buprenorphine also contain naloxone to discourage misuse. The major metabolite of buprenorphine is norbuprenorphine. Both compounds are pharmacologically active and both are extensively metabolized to their glucuronide conjugates, which are also active metabolites. Direct quantitation of the glucuronide conjugates in conjunction with free buprenorphine, norbuprenorphine, and naloxone in urine can distinguish compliance with prescribed therapy from specimen adulteration intended to mimic compliance with prescribed buprenorphine. This chapter quantitates buprenorphine, norbuprenorphine, their glucuronide conjugates and naloxone directly in urine by liquid chromatography tandem mass spectrometry (LC-MS/MS). Urine is pretreated with formic acid and undergoes solid phase extraction (SPE) prior to analysis by LC-MS/MS.

  19. Buprenorphine: clinical pharmacokinetics in the treatment of opioid dependence.

    Science.gov (United States)

    Elkader, Alexander; Sproule, Beth

    2005-01-01

    Buprenorphine is a semi-synthetic opioid derived from thebaine, a naturally occurring alkaloid of the opium poppy, Papaver somniferum. The pharmacology of buprenorphine is unique in that it is a partial agonist at the opioid mu receptor. Buprenorphine undergoes extensive first-pass metabolism and therefore has very low oral bioavailability; however, its bioavailability sublingually is extensive enough to make this a feasible route of administration for the treatment of opioid dependence. The mean time to maximum plasma concentration following sublingual administration is variable, ranging from 40 minutes to 3.5 hours. Buprenorphine has a large volume of distribution and is highly protein bound (96%). It is extensively metabolised by N-dealkylation to norbuprenorphine primarily through cytochrome P450 (CYP) 3A4. The terminal elimination half-life of buprenorphine is long and there is considerable variation in reported values (mean values ranging from 3 to 44 hours). Most of a dose of buprenorphine is eliminated in the faeces, with approximately 10-30% excreted in urine. Naloxone has been added to a sublingual formulation of buprenorphine to reduce the abuse liability of the product. The presence of naloxone does not appear to influence the pharmacokinetics of buprenorphine. Buprenorphine crosses the placenta during pregnancy and also crosses into breast milk. Buprenorphine dosage does not need to be significantly adjusted in patients with renal impairment; however, since CYP3A activity may be decreased in patients with severe chronic liver disease, it is possible that the metabolism of buprenorphine will be altered in these patients. Although there is limited evidence in the literature to date, drugs that are known to inhibit or induce CYP3A4 have the potential to diminish or enhance buprenorphine N-dealkylation. It appears that the interaction between buprenorphine and benzodiazepines is more likely to be a pharmacodynamic (additive or synergistic) than a

  20. Human pharmacokinetics of intravenous, sublingual, and buccal buprenorphine.

    Science.gov (United States)

    Kuhlman, J J; Lalani, S; Magluilo, J; Levine, B; Darwin, W D

    1996-10-01

    Buprenorphine is a potent opioid analgesic used in the treatment of moderate to severe pain. At higher doses, it has demonstrated potential for treating heroin dependence. This study was undertaken to investigate buprenorphine pharmacokinetics by different routes of administration at dosages approximating those used in opioid-dependence studies. Six healthy men who were nondependent but who had a history of heroin use were administered buprenorphine in a crossover design study by intravenous (1.2 mg), sublingual (4.0 mg), and buccal (4.0 mg) routes of administration. Plasma samples were collected up to 96 h and assayed for buprenorphine and norbuprenorphine by negative chemical ionization tandem mass spectrometry. Plasma concentrations of buprenorphine and norbuprenorphine were analyzed by nonlinear regression analysis with standard noncompartmental methods. Buprenorphine biovailability by the sublingual and buccal routes was estimated as 51.4% and 27.8%, respectively, although there was considerable interindividual variability by both routes of administration. The terminal elimination half-lives were longer for the sublingual and buccal routes than for the intravenous route. The extended elimination half-lives may be due to a shallow depot effect involving sequestration of buprenorphine in the oral mucosa. Norbuprenorphine mean peak plasma concentrations were less than 1 ng/mL and were highly variable among different routes of administration and individuals. The terminal elimination half-life of norbuprenorphine was longer than buprenorphine.

  1. A urinalysis-based study of buprenorphine and non-prescription opioid use among patients on buprenorphine maintenance

    Directory of Open Access Journals (Sweden)

    Yatan Pal Singh Balhara

    2012-01-01

    Full Text Available Objectives: To understand the pattern of use of opioid-substitution therapy (OST and opioid abuse among patients on buprenorphine maintenance using urinalysis. Materials and Methods: The study was conducted at a tertiary care de-addiction center. We reviewed the laboratory record of all consecutive urine samples sent for drug analysis over a period of 1 year. In all, 179 consecutive urine samples were included in the analysis. The chi-square test was used to compare opioid abuse among those testing positive and negative for buprenorphine on urinalysis. Additionally, in order to assess the potential impact of the prescribed induction and maximum dose of buprenorphine on the findings, we carried out the independent-samples t test. Level of statistical significance was kept at P<0.05 for all the tests. Results: Urinalysis failed to detect buprenorphine in 44.7% of the samples. Rate of detection of dextropropoxyphene was significantly higher among buprenorphine-negative samples (P<0.005. The prescribed induction dose of buprenorphine was significantly lower among those testing positive for heroin. This was found for both buprenorphine-positive (P<0.005 as well as buprenorphine-negative samples (P<0.005. Conclusions: These findings support the routine use of urine drug screening among individuals on OST.

  2. French Experience with Buprenorphine : Do Physicians Follow the Guidelines?

    Directory of Open Access Journals (Sweden)

    Morgane Guillou Landreat

    Full Text Available Opiate dependence affects about 15,479,000 people worldwide. The effectiveness of opiate substitution treatments (OST has been widely demonstrated. Buprenorphine plays a particular role in opiate dependence care provision in France. It is widely prescribed by physicians and national opiate substitution treatment guidelines have been available since 2004. In order to study the prescribing of buprenorphine, we used a questionnaire sent by email, to a large sample of physicians. These physicians were either in practice, or belonged to an addiction treatment network or a hospital. The main objective of this work was to measure the extent to which the theoretical, clinical attitude of physicians towards prescribing buprenorphine (BHD complied with the statutory guidelines. We showed that the physicians we interviewed rarely took into account the guidelines regarding buprenorphine prescription. The actual prescribing of Buprenorphine differed from the guidelines. Only 42% of independent Family Physicians (FPs, working outside the national health care system, had prescribed buprenorphine as a first-time prescription and 40% of FPs do not follow up patients on buprenorphine. In terms of compliance with the guidelines, 55% of FPs gave theoretical answers that only partially complied with the guidelines. The variations in compliance with the guidelines was noted according to different variables and took into particular account whether the physician were affiliated to a network or in training.

  3. French Experience with Buprenorphine : Do Physicians Follow the Guidelines?

    Science.gov (United States)

    Guillou Landreat, Morgane; Rozaire, Charles; Guillet, Jean Yves; Victorri Vigneau, Caroline; Le Reste, Jean Yves; Grall Bronnec, Marie

    2015-01-01

    Opiate dependence affects about 15,479,000 people worldwide. The effectiveness of opiate substitution treatments (OST) has been widely demonstrated. Buprenorphine plays a particular role in opiate dependence care provision in France. It is widely prescribed by physicians and national opiate substitution treatment guidelines have been available since 2004. In order to study the prescribing of buprenorphine, we used a questionnaire sent by email, to a large sample of physicians. These physicians were either in practice, or belonged to an addiction treatment network or a hospital. The main objective of this work was to measure the extent to which the theoretical, clinical attitude of physicians towards prescribing buprenorphine (BHD) complied with the statutory guidelines. We showed that the physicians we interviewed rarely took into account the guidelines regarding buprenorphine prescription. The actual prescribing of Buprenorphine differed from the guidelines. Only 42% of independent Family Physicians (FPs), working outside the national health care system, had prescribed buprenorphine as a first-time prescription and 40% of FPs do not follow up patients on buprenorphine. In terms of compliance with the guidelines, 55% of FPs gave theoretical answers that only partially complied with the guidelines. The variations in compliance with the guidelines was noted according to different variables and took into particular account whether the physician were affiliated to a network or in training.

  4. Steps physicians report taking to reduce diversion of buprenorphine.

    Science.gov (United States)

    Yang, Amy; Arfken, Cynthia L; Johanson, Chris-Ellyn

    2013-01-01

    Physicians are challenged to effectively treat opioid dependent patients while minimizing diversion of potentially abusable medications, such as buprenorphine. The present study was designed to obtain information on steps physicians report taking to reduce diversion of buprenorphine. National quarterly surveys from 2008 to 2009 of qualified physicians who have prescribed buprenorphine were analyzed (N = 2,330). One part of the survey queried physicians about what steps they had taken to reduce abuse and diversion of buprenorphine from a pre-specified list of 12 steps. Other parts of the survey included questions on the physicians' training and experience. Physicians reported taking a mean of 4.4 steps. Longer experience prescribing buprenorphine, more buprenorphine-related educational training, and concern about diversion as a limitation on using buprenorphine for maintenance were associated with higher number of steps taken. Physicians are currently taking multiple steps to reduce diversion. Future research needs to verify if these steps are effective or are instead reducing access to treatment. Copyright © American Academy of Addiction Psychiatry.

  5. Buprenorphine for cancer pain: is it ready for prime time?

    Science.gov (United States)

    Prommer, Eric

    2015-12-01

    Buprenorphine (BUP) is a semisynthetic derivative of the opium alkaloid thebaine found in the poppy Papaver somniferum. Its chemical structure contains the morphine structure but differs by having a cyclopropylmethyl group. Buprenorphine is a potent µ opioid agonist. Buprenorphine undergoes extensive first-pass metabolism in the liver and gut. The development of a transdermal BUP formulation in 2001 led to its evaluation in cancer pain. This article provides the practitioner with an update on the current role of BUP in cancer care. It highlights data suggesting effectiveness in various types of cancer pain. The article reviews pharmacology, routes of administration, adverse effects, drug interactions, and cost considerations.

  6. Intravenous misuse of buprenorphine: characteristics and extent among patients undergoing drug maintenance therapy.

    Science.gov (United States)

    Moratti, Enrico; Kashanpour, Hamid; Lombardelli, Tiziana; Maisto, Maria

    2010-01-01

    Sublingual buprenorphine [Subutex(R)] is used to treat opioid dependence. However, illicit intravenous (IV) injection of buprenorphine is a widespread problem. This survey investigated the IV misuse of buprenorphine among patients receiving drug replacement therapy at the Drug Addiction Centre in Udine, Italy. All patients who were receiving treatment with buprenorphine or methadone at the Drug Addiction Centre were invited to fill in a voluntary and anonymous questionnaire consisting of five questions. The questions asked if the patient had ever misused buprenorphine intravenously, when the misuse had occurred, the patient's reasons for misusing buprenorphine, the patient's perception of their experience, and the patient's perception of how widespread IV misuse of buprenorphine is. 307 patients completed the questionnaire, 93 and 214 of whom, respectively, were receiving buprenorphine and methadone. In total, 23.12% of patients admitted an IV misuse of buprenorphine, with a significantly greater prevalence among patients currently receiving buprenorphine (35.48%) than those receiving methadone (17.75%; p IV misuse was treatment of heroin addiction or withdrawal symptoms (50.71%), while only 12.67% of patients reported that their motivation was to experience pleasure or euphoria. The majority of patients who had misused buprenorphine intravenously (53.52%) had a negative experience, and methadone recipients were significantly more likely to find the experience negative than buprenorphine recipients (68.42% vs 36.36%; p = 0.007). Almost half of the patients (45.93%) thought that at least 50% of patients had taken buprenorphine by IV injection. The results of our study confirm the widespread IV misuse of buprenorphine. Misuse was most common among patients currently receiving buprenorphine treatment and younger patients. For the majority of patients, the reason for IV misuse was to treat their dependence. We believe that the prevalence of buprenorphine misuse could

  7. The pharmacokinetics and physiological effects of buprenorphine infusion in premature neonates.

    OpenAIRE

    1993-01-01

    1. The pharmacokinetics and physiological effects of buprenorphine were studied in 12 newborn premature neonates (27 to 32 weeks gestational age) who were given a loading dose of 3.0 micrograms kg-1 of buprenorphine followed by an intravenous infusion of 0.72 micrograms kg-1 h-1 of buprenorphine. Plasma concentrations of buprenorphine were measured during the infusion, at steady-state and for 24 h after the cessation of the buprenorphine infusion. 2. The mean steady-state plasma buprenorphine...

  8. Role of buprenorphine in acute postoperative pain

    Directory of Open Access Journals (Sweden)

    J. Alcázar-Castro

    2016-07-01

    Full Text Available Nowadays acute postoperative pain persists as a high prevalence symptom. The incidence, intensity and duration of postoperative pain vary considerably from one patient to another, from one surgery to another, from one hospital to another, and even from one country to another. It is important to learn about recent developments in central sensitisation, as it plays an important role in postoperative pain. Postoperative pain is mainly nociceptive somatic, in response to surgical damage. The surgical trauma and pain cause an endocrine response that increases the secretion of cortisol, catecholamines, and other stress hormones. Tachycardia, hypertension, decreased regional blood flow, impaired immune response, hyperglycaemia, lipolysis, and negative nitrogen balance also occur. All this plays an important role in morbidity and mortality in the postoperative period. Buprenorphine is a semi-synthetic opioid derived from thebaine. It has a binding affinity for the mu, kappa and delta receptors, and has a slow dissociation from these receptors. Because of its action on the mu and kappa receptors it can be used as an analgesic, as well as for maintenance therapy in patients with a history of drug abuse. This article will describe the characteristics of acute postoperative pain, the pharmacology of buprenorphine, and its interference in the management of postoperative pain.

  9. Subcutaneous Implants of Buprenorphine-Cholesterol-Triglyceride Powder in Mice

    National Research Council Canada - National Science Library

    L. DeTolla; R. Sanchez; E. Khan; B. Tyler; M. Guarnieri

    2014-01-01

    .... The present study used an US Food and Drug Administration Target Animal Safety test system to evaluate the safety of a subcutaneous implant of a cholesterol-triglyceride-buprenorphine powder in 120 BALB/c mice...

  10. Substance misuse problems during pregnancy with special emphasis on buprenorphine

    OpenAIRE

    2011-01-01

    Maternal drug abuse during pregnancy endangers the future health and wellbeing of the infant and growing child. On the other hand, via maternal abstinence, these problems would never occur; so the problems would be totally preventable. Buprenorphine is widely used in opioid maintenance treatment as a substitute medication. In Finland, during 2000 s buprenorphine misuse has steadily increased. In 2009 almost one third of clientele of substance treatment units were in treatment because of bupre...

  11. Sublingual buprenorphine used postoperatively: clinical observations and preliminary pharmacokinetic analysis.

    OpenAIRE

    Bullingham, R E; McQuay, H. J.; Dwyer, D.; Allen, M C; Moore, R A

    1981-01-01

    1 Buprenorphine is a long-acting opiate analgesic. This study was designed to investigate the pharmacokinetics of this drug when given by the sublingual route to ten postoperative patients. Plasma levels of buprenorphine were measured by a specific radioimmunoassay. 2 Plasma levels of the drug following sublingual administration of 0.4 mg showed an apparent delay in absorption and then rose slowly to reach low but significant levels by 3 h. There was considerable variation in the time at whic...

  12. Evaluation of Buprenorphine in a Postoperative Pain Model in Rats

    OpenAIRE

    Curtin, Leslie I; Grakowsky, Julie A.; Suarez, Mauricio; Thompson, Alexis C; DiPirro, Jean M.; Martin, Lisa BE; Kristal, Mark B.

    2009-01-01

    We evaluated the commonly prescribed analgesic buprenorphine in a postoperative pain model in rats, assessing acute postoperative pain relief, rebound hyperalgesia, and the long-term effects of postoperative opioid treatment on subsequent opioid exposure. Rats received surgery (paw incision under isoflurane anesthesia), sham surgery (anesthesia only), or neither and were treated postoperatively with 1 of several doses of subcutaneous buprenorphine. Pain sensitivity to noxious and nonnoxious m...

  13. Effect of telaprevir on the pharmacokinetics of buprenorphine in volunteers on stable buprenorphine/naloxone maintenance therapy.

    Science.gov (United States)

    Luo, Xia; Trevejo, Jose; van Heeswijk, Rolf P G; Smith, Frances; Garg, Varun

    2012-07-01

    This was an open-label, single-sequence trial in hepatitis C virus-negative volunteers on stable, individualized, buprenorphine maintenance therapy. Telaprevir at 750 mg every 8 h was coadministered with buprenorphine/naloxone (4:1 ratio as sublingual tablets) for 7 days with food. Pharmacokinetic profiles of buprenorphine, norbuprenorphine, and naloxone were measured over the 24-hour dosing interval on day -1 (buprenorphine/naloxone alone, reference) and day 7 of telaprevir coadministration (test). Geometric least-squares mean ratios and associated 90% confidence intervals of treatment ratios (test/reference) were calculated using log-transformed pharmacokinetic parameters. Opioid withdrawal symptoms were evaluated throughout the study (via questionnaires and pupillometry). Pharmacokinetic data were available for 14 and 13 volunteers on day -1 and day 7, respectively. The area under the concentration-time curve (AUC) for buprenorphine was unchanged and the maximum concentration of drug in serum (C(max)) for buprenorphine, C(max) and AUC for norbuprenorphine, and C(max) naxolone were modestly decreased during coadministration with telaprevir. Geometric least-squares mean ratios (90% confidence intervals) for buprenorphine were 0.80 (0.69, 0.93) for the C(max) and 0.96 (0.84, 1.10) for the AUC from 0 to 24 h (AUC(0-24)); for norbuprenorphine, values were 0.85 (0.66, 1.09) for C(max) and 0.91 (0.71, 1.16) for AUC(0-24); for naloxone, the C(max) was 0.84 (0.62, 1.13). Coadministration of telaprevir did not increase withdrawal symptom frequency, and there were no serious adverse events reported during or after completion of telaprevir coadministration. Results suggest dose adjustment may not be necessary when telaprevir and buprenorphine/naloxone are coadministered.

  14. Population pharmacokinetics of buprenorphine following a two-stage intravenous infusion in healthy volunteers

    DEFF Research Database (Denmark)

    Jensen, Mette Lykke; Foster, David J.R.; Upton, Richard N.;

    2007-01-01

    The aim of this investigation was to characterize the pharmacokinetics of buprenorphine following administration of an intravenous (i.v.) infusion. To date, the population kinetics of buprenorphine has been described for bolus administration only.......The aim of this investigation was to characterize the pharmacokinetics of buprenorphine following administration of an intravenous (i.v.) infusion. To date, the population kinetics of buprenorphine has been described for bolus administration only....

  15. 78 FR 34108 - Determination That SUBOXONE (Buprenorphine Hydrochloride and Naloxone Hydrochloride) Sublingual...

    Science.gov (United States)

    2013-06-06

    ... HUMAN SERVICES Food and Drug Administration Determination That SUBOXONE (Buprenorphine Hydrochloride and... (buprenorphine hydrochloride (HCl) and naloxone HCl) sublingual tablets, 2 milligrams (mg)/0.5 mg and 8 mg/2 mg... to approve abbreviated new drug applications (ANDAs) for buprenorphine HCl and naloxone...

  16. Serum concentrations of buprenorphine after oral and parenteral administration in male mice

    DEFF Research Database (Denmark)

    Kalliokoski, Otto; Jacobsen, Kirsten R; Hau, Jann

    2011-01-01

    Buprenorphine is the most commonly used drug for peri-operative pain relief in laboratory rodents. The systemic concentrations of buprenorphine were measured in mice following administration intravenously (IV), subcutaneously (SC), orally by gavage and by voluntary ingestion, to determine the post......-administration serum concentration of buprenorphine. Voluntarily ingested buprenorphine resulted in long-lasting high serum concentrations, as did oral gavage administration (24h serum concentration: 110ngh/mL for both routes of administration). In contrast, buprenorphine administered parenterally remained...

  17. Development, Implementation, and Evaluation of a Pilot Parenting Educational Intervention in a Pregnancy Buprenorphine Clinic.

    Science.gov (United States)

    Giles, Averie C; Ren, Dianxu; Founds, Sandra

    2016-01-01

    We developed a pilot evidence-based prenatal educational intervention to increase knowledge of neonatal abstinence syndrome (NAS) and early parenting skills for women with opiate dependency who enrolled in a pregnancy buprenorphine clinic. We developed, implemented, and tested modules regarding expectations during newborn hospitalization for observation or treatment of NAS and regarding evidence-based parenting skills in response to NAS behaviors. Testing evaluated baseline knowledge of early parenting skills with newborns at risk for NAS and change from baseline after the educational intervention. No statistically significant difference in composite knowledge scores was observed. A brief survey completed by the participants postpartum affirmed the perception of women that the educational intervention effectively prepared them for the early postpartum period while their newborns were hospitalized.

  18. Buprenorphine may not be as safe as you think: a pediatric fatality from unintentional exposure.

    Science.gov (United States)

    Kim, Hong K; Smiddy, Monica; Hoffman, Robert S; Nelson, Lewis S

    2012-12-01

    Buprenorphine is a partial μ-opioid receptor agonist that is approved for the treatment of opioid dependency. It is generally believed to be safer than methadone because of its ceiling effect on respiratory depression. As more adults in US households use buprenorphine, an increasing number of children are being exposed. We report a fatal exposure to buprenorphine in a small child that occurred after ingestion of a caretaker's buprenorphine/naloxone. Postmortem toxicology analysis showed free serum concentrations of 52 ng/mL and 39 ng/mL for buprenorphine and norbuprenorphine, respectively. No other drugs were detected. Autopsy did not find signs of injury or trauma. The theoretical safety provided by the ceiling effect in respiratory depression from buprenorphine may not apply to children, and buprenorphine may cause dose-dependent respiratory depression.

  19. Brain magnetic resonance imaging of infants exposed prenatally to buprenorphine

    Energy Technology Data Exchange (ETDEWEB)

    Kahila, H.; Kivitie-Kallio, S.; Halmesmaki, E.; Valanne, L.; Autti, T. [Dept. of Obstetrics and Gynecology, Dept. of Pediatrics, and Helsinki Medical Imaging Center, Helsinki Univ. Central Hospital (Finland)

    2007-02-15

    Purpose: To evaluate the brains of newborns exposed to buprenorphine prenatally. Material and Methods: Seven neonates followed up antenatally in connection with their mothers' buprenorphine replacement therapy underwent 1.5T magnetic resonance imaging (MRI) of the brain before the age of 2 months. The infants were born to heavy drug abusers. Four mothers were hepatitis C positive, and all were HIV negative. All mothers smoked tobacco and used benzodiazepines. All pregnancies were full term, and no perinatal asphyxia occurred. All but one neonate had abstinence syndrome and needed morphine replacement therapy. Results: Neither structural abnormalities nor abnormalities in signal intensity were recorded. Conclusion: Buprenorphine replacement therapy does not seem to cause any major structural abnormalities of the brain, and it may prevent known hypoxic-ischemic brain changes resulting from uncontrolled drug abuse. Longitudinal studies are needed to assess possible abnormalities in the brain maturation process.

  20. A novel approach in the detoxification of intravenous buprenorphine dependence

    Science.gov (United States)

    Sarkar, Sukanto; Subramaniam, Eswaran; Konthoujam, Janet

    2016-01-01

    Background: Opioid dependence remains a significant problem in India, and of late intravenous (IV) buprenorphine use has increased in India, especially in combination with antihistamines and benzodiazepines. Its usage has many serious consequences in the form of needle-transmitted hepatitis and HIV, which is showing an increasing trend. Buprenorphine is a partial agonist at μ-opioid receptors. In tablet form (and rarely as IV), it is widely used in the treatment of opioid detoxification. We assessed the safety and efficacy of transdermal patch of buprenorphine with week long duration of action in the treatment of detoxification of IV buprenorphine dependence in view of its many advantages. Materials and Methods: Six consecutive patients with International Classification of Diseases diagnosis of Opioid Dependence Syndrome (IV buprenorphine) were given a buprenorphine patch for treatment of withdrawal symptoms after receiving consent. Severity of opioid dependence was assessed by using Severity of Opioid Dependence Questionnaire on the day of presentation. Subjective and objective rating for opioid withdrawal was done by subjective opiate withdrawal scale (SOWS) and objective opiate withdrawal scale (OOWS) prepatch and postpatch 3rd and 7th day. Buprenorphine side effect checklist was applied on a daily basis. Results: The patients had a mean age of 30 years, of whom 83.3% are males. All were educated and 50% were currently employed. All of them had additional comorbid substance use as well as a comorbid psychiatric diagnosis. Each of them received a patch of varying dosage. The patch dose used initially was based on clinical considerations alone and was fairly adequate in controlling acute withdrawal symptoms. There is a significant improvement in SOWS and OOWS while comparing the baseline (prepatch) with 3rd and 7th day (postpatch) (P ≤ 0.05). None of the patients reported any side effect with the patch. Conclusion: This study shows that transdermal

  1. The pharmacokinetics and physiological effects of buprenorphine infusion in premature neonates.

    Science.gov (United States)

    Barrett, D A; Simpson, J; Rutter, N; Kurihara-Bergstrom, T; Shaw, P N; Davis, S S

    1993-09-01

    1. The pharmacokinetics and physiological effects of buprenorphine were studied in 12 newborn premature neonates (27 to 32 weeks gestational age) who were given a loading dose of 3.0 micrograms kg-1 of buprenorphine followed by an intravenous infusion of 0.72 micrograms kg-1 h-1 of buprenorphine. Plasma concentrations of buprenorphine were measured during the infusion, at steady-state and for 24 h after the cessation of the buprenorphine infusion. 2. The mean steady-state plasma buprenorphine concentration (+/- s.d.) for an infusion rate of 0.72 micrograms kg-1 h-1 was 4.3 +/- 2.6 ng ml-1. 3. Buprenorphine clearance was 0.23 +/- 0.07 l h-1 kg-1, the elimination half-life was 20 +/- 8 h and the volume of distribution was 6.2 +/- 2.11 l kg-1. 4. Small but significant falls were noted in systolic blood pressure at 6 h and heart rate at 1, 6 and 12 h after the administration of buprenorphine, but these did not appear to cause any clinical deterioration. 5. Four of the 12 subjects studied required an increase in the infusion rate of buprenorphine to achieve adequate sedation. 6. The results suggest that this dosing regimen of buprenorphine is safe but may not be as effective as other opioids in producing sedation and analgesia in premature newborns.

  2. Flunitrazepam does not alter cerebral distribution of buprenorphine in the rat.

    Science.gov (United States)

    Megarbane, Bruno; Pirnay, Stéphane; Borron, Stephen W; Trout, Hervé; Monier, Claire; Risède, Patricia; Boschi, Gabrielle; Baud, Frédéric J

    2005-07-04

    Deaths have been reported among heroin addicts related to combined buprenorphine and flunitrazepam use. The aim of this study was to determine the existence of a drug-drug interaction during the distribution phase of buprenorphine. Arterial blood gases were measured after intravenous administration of buprenorphine alone (30 mg/kg), flunitrazepam alone (40 mg/kg) or both drugs in rats. Buprenorphine kinetics was studied in plasma and in striatum using cerebral microdialysis, both alone and after rat pretreatment with flunitrazepam. In contrast to buprenorphine or flunitrazepam alone, buprenorphine in combination with flunitrazepam induced a significant, rapid and sustained respiratory depression. Arterial PCO2 was increased at 1.5 min (6.7+/-0.2 versus 5.4+/-0.3 and 5.5+/-0.3 kPa, respectively, P=0.04) (mean+/-S.E.M.), and arterial pH decreased (7.37+/-0.02 versus 7.45+/-0.02 and 7.45+/-0.01, respectively, P=0.03). Plasma buprenorphine kinetics was well described by a three-compartment linear model, with a distribution half-life of 7.4+/-2.7 min and an elimination half-life of 463.9+/-152.3 min. However, neither plasma nor striatal buprenorphine kinetics were significantly altered by pre-administration of flunitrazepam. The adverse interaction between flunitrazepam and buprenorphine cannot be explained by a pharmacokinetic drug-drug interaction during the distribution phase of buprenorphine.

  3. Voluntary ingestion of buprenorphine as a refined analgesic strategy

    DEFF Research Database (Denmark)

    Jacobsen, Kirsten Rosenmaj; Kalliokoski, Otto Henrik; Hau, Jann

    2011-01-01

    Buprenorphine is a widely used analgesic for laboratory rodents. Administration of the drug in an attractive food item for voluntary ingestion is a desirable way to administer the drug noninvasively. The method refi nes the standard analgesic procedure and has the potential to improve the welfare...

  4. Clinical pharmacology of buprenorphine in healthy, lactating goats.

    Science.gov (United States)

    Ingvast-Larsson, C; Svartberg, K; Hydbring-Sandberg, E; Bondesson, U; Olsson, K

    2007-06-01

    The pharmacokinetics and the effects of the opioid buprenorphine on behavior, cardiovascular parameters, plasma concentrations of cortisol and vasopressin were studied in the goat. After intravenous injection at a dosage of 0.02 mg/kg bw, the terminal half-life was 73.8+/-19.9 min (mean+/-SD), the apparent volume of distribution 5.22+/-1.01 L/kg, and total body clearance 79.1+/-18.5 mL/min/kg. After intramuscular administration of buprenorphine at the same dosage, bioavailability was complete and clearance was 54.7+/-16.6 mL/min/kg. Heart rate, blood pressure and concentrations of cortisol and vasopressin in plasma increased after drug administration. The goats became agitated and stopped ruminating. The effects were more pronounced the first time the animals received the drug, especially the influence on the hormone levels. The concentrations of cortisol and vasopressin in plasma remained unaffected after the second dose despite a wash-out period of 3-6 weeks. Buprenorphine may be an unsuitable drug in goats because of the profound inhibition of rumination and the agitation it causes. The short half-life of buprenorphine may limit its use if long-term analgesia is required but be advantageous if a short acting drug is desirable.

  5. Plasma concentrations of buprenorphine after epidural administration in conscious cats.

    Science.gov (United States)

    Duke-Novakovski, Tanya; Clark, Christopher R; Ambros, Barbara; Gilbert, Peter; Steagall, Paulo V M

    2011-06-01

    Buprenorphine plasma concentrations were measured after administering buprenorphine (20 μg/kg) into the lumbosacral epidural space of conscious cats chronically instrumented with an epidural catheter. Blood was collected from a jugular vein before injection and 15, 30, 45 and 60 min and 2, 3, 4, 5, 6, 8, 12 and 24 h after administration. Plasma buprenorphine concentrations were measured using ELISA. Background concentration (before injection) was 1.27 ± 0.27 ng/mL (mean ± SD). Including background concentration, the mean peak plasma concentration was obtained 15 min after injection (5.82 ± 3.75 ng/mL), and ranged from 3.79 to 2.20 ng/mL (30 min-3 h), remaining between 1.93 and 1.77 ng/mL (4-12 h), and declined to 1.40 ± 0.62 ng/mL at 24h. Elimination half-life was 58.8 ± 40.2 min and clearance 56.7 ± 21.5 mL/min. Results indicate early rapid systemic uptake of buprenorphine from epidural administration with plasma concentrations similar to using buccal or IM routes by 15 min postinjection.

  6. Opioid Abstinence Reinforcement Delays Heroin Lapse during Buprenorphine Dose Tapering

    Science.gov (United States)

    Greenwald, Mark K.

    2008-01-01

    A positive reinforcement contingency increased opioid abstinence during outpatient dose tapering (4, 2, then 0 mg/day during Weeks 1 through 3) in non-treatment-seeking heroin-dependent volunteers who had been maintained on buprenorphine (8 mg/day) during an inpatient research protocol. The control group (n = 12) received $4.00 for completing…

  7. Systemic uptake of buprenorphine by cats after oral mucosal administration.

    Science.gov (United States)

    Robertson, S A; Taylor, P M; Sear, J W

    2003-05-31

    The plasma concentration of buprenorphine was measured by radioimmunoassay in six female cats after the administration of 0.01 mg/kg (0.033 ml/kg) buprenorphine hydrochloride solution into the side of the cat's mouth. Blood samples were taken through a preplaced jugular catheter before and one, two, four, six, 10, 15, 30, 45 and 60 minutes, and two, four, six, 12 and 24 hours after the dose was administered. The buprenorphine was accepted well by all the cats and did not cause salivation or vomiting. Its median peak plasma concentration was 7.5 ng/ml and was reached after 15 minutes. The pharmacokinetic data were similar to the pharmacokinetic data obtained after the intramuscular and intravenous administration of buprenorphine to cats from the same colony, suggesting that the mucosal route of administration should be as effective as intravenous and intramuscular injections. In addition, the pH of the oral cavity of 26 cats was measured with pH paper, and 100 cat owners were asked their preferred method of administering drugs to cats. The pH of the cats' mouths was between 8 and 9, and the technique preferred by the cat owners was the use of drops placed in the mouth.

  8. The Implementation of Buprenorphine/Naloxone in College Health Practice

    Science.gov (United States)

    DeMaria, Peter A., Jr.; Patkar, Ashwin A.

    2008-01-01

    Opiate abuse and dependence have become important concerns for college healthcare providers. The passage of the Drug Addiction Treatment Act of 2000 and the approval of the combination buprenorphine/naloxone for office-based treatment of opiate dependence have increased the options available for college students and their healthcare providers. The…

  9. [Effectiveness and tolerance of tramadol in cancer pain. A comparative study with respect to buprenorphine].

    Science.gov (United States)

    Bono, A V; Cuffari, S

    1997-01-01

    and buprenorphine, 60 patients (44 men, 16 women; average age 61.4 years), all presenting with advanced tumours, were treated orally in a controlled crossover trial with randomised sequences. Patients took both drugs, each for a week, with a 24-hour washout period between treatments. Tramadol was prescribed at the daily dose of 300mg, orally, and buprenorphine at 0.6 mg/day, as a sublingual preparation. Assessments were made of Karnofsky performance status and severity of pain before and during the 4 hours after taking the 2 drugs. Each patient also completed a daily diary recording the severity of pain 1 hour after the dose, the evolution of pain during the day and its severity compared with that on the previous day. They also assessed the duration and quality of sleep. The Karnofsky index changed little with either treatment, but all other variables showed worthwhile improvement, indicating the significant analgesic effect of both drugs. Buprenorphine and tramadol had a similar analgesic effect, although the improvement with the test drug was significant within 1 hour of administration (p buprenorphine, and caused fewer and milder adverse reactions. Only 1 patient discontinued tramadol, compared with 18 using reference therapy. Tramadol, although theoretically less potent, nevertheless brought about as much pain relief as the comparator opioid. In conclusion, for this class of drug, tramadol provides an excellent balance between efficacy and tolerability, confirming preliminary studies.

  10. Morphine, pethidine and buprenorphine disposition in the cat.

    Science.gov (United States)

    Taylor, P M; Robertson, S A; Dixon, M J; Ruprah, M; Sear, J W; Lascelles, B D; Waters, C; Bloomfield, M

    2001-12-01

    Pharmacokinetics of morphine, buprenorphine and pethidine were determined in 10 cats. Six cats received morphine (0.2 mg/kg) intravenously and four intramuscularly. Five received buprenorphine (0.01 mg/kg) intravenously and six intramuscularly. Six received pethidine (5 mg/kg) intramuscularly. Jugular venous blood samples were collected at time points to 24 h, and plasma morphine concentrations were measured by high performance liquid chromatograpy (HPLC), buprenorphine by radioimmunoassay (RIA) and pethidine by gas chromatography. Our data for morphine show elimination half-life (t1/2el) 76.3 min intravenous (i.v.) and 93.6 min intramuscular (i.m.); mean residence time (MRT) 105.0 and 120.5 min; clearance (Clp) 24.1 and 13.9 mL/kg/min; and volume of distribution (V(dss)) 2.6 and 1.7 L/kg, respectively. Comparable data for buprenorphine are t1/2el 416.8 and 380.2 min; MRT 417.6 and 409.8 min; Clp 16.7 and 23.7 mL/kg/min; and V(dss) 7.1 and 8.9 L/kg. For i.m. pethidine, t1/2el 216.4 min; MRT 307.5 min; Clp 20.8 mL/kg/min and V(dss) 5.2 L/kg. For i.m. dosing, the tmax for morphine, buprenorphine and pethidine were 15, 3 and 10 min, respectively. The pharmacokinetics of the three opioids in cats are broadly comparable with those of the dog, although there is a suggestion that the cat may clear morphine more slowly.

  11. Pharmacokinetics of 2 formulations of buprenorphine in macaques (Macaca mulatta and Macaca fascicularis).

    Science.gov (United States)

    Nunamaker, Elizabeth A; Halliday, Lisa C; Moody, David E; Fang, Wenfang B; Lindeblad, Matthew; Fortman, Jeffrey D

    2013-01-01

    Buprenorphine is the cornerstone of pain management in nonhuman primates, but the pharmacokinetics of this widely used drug are unknown. The purpose of this study was to evaluate the pharmacokinetic profiles of buprenorphine (0.01 and 0.03 mg/kg IM) and sustained-release buprenorphine (0.2 mg/kg SC) in 2 macaque species (M. mulatta and M. fascicularis) by using mass spectrometry. The pharmacokinetics did not differ significantly between species, and buprenorphine was dose-proportional at the tested doses. The low and high doses of buprenorphine had elimination half-lives of 2.6 ± 0.7 and 5.3 ± 2.0 h, respectively, but the low-dose data were constrained by the sensitivity of the analytical method. Sustained-release buprenorphine had an elimination half-life of 42.6 ± 26.2 h. The AUC0-Tlast of buprenorphine were 9.1 ± 4.3 and 39.0 ± 25.1 ng × h/mL for the low and high doses, respectively, and sustained-release buprenorphine had an AUC0-Tlast of 177 ± 74 ng × h/mL. Assuming a hypothesized therapeutic buprenorphine plasma concentration threshold of 0.1 ng/mL in macaques, these results suggest that buprenorphine doses of 0.01 mg/kg IM should be administered every 6 to 8 h, whereas doses of 0.03 mg/kg IM can be administered every 12 h. These results further demonstrate that a single 0.2-mg/kg SC injection of sustained-release buprenorphine maintains plasma concentrations above 0.1 ng/mL for 5 d in macaques. These findings support a new dosing strategy using sustained-release buprenorphine to improve pain management, decrease animal stress, improve animal welfare, and simplify the postoperative management of nonhuman primates in laboratory animal and zoological settings.

  12. Prior criminal charges and outcomes among individuals initiating office-based buprenorphine treatment

    OpenAIRE

    Harris, Elizabeth E; Jacapraro, Janet S; Rastegar, Darius A

    2013-01-01

    Background There is little data on the impact of prior criminal activity on the treatment of opioid dependence with office-based buprenorphine. The goal of this study was to investigate the association between prior criminal charges and treatment outcomes in a cohort of patients initiating buprenorphine treatment in a primary care practice. Methods This was a retrospective study of 252 consecutive patients with opioid dependence who were given at least one prescription for buprenorphine in a ...

  13. Pharmacokinetics of 2 Formulations of Buprenorphine in Macaques (Macaca mulatta and Macaca fascicularis)

    OpenAIRE

    2013-01-01

    Buprenorphine is the cornerstone of pain management in nonhuman primates, but the pharmacokinetics of this widely used drug are unknown. The purpose of this study was to evaluate the pharmacokinetic profiles of buprenorphine (0.01 and 0.03 mg/kg IM) and sustained-release buprenorphine (0.2 mg/kg SC) in 2 macaque species (M. mulatta and M. fascicularis) by using mass spectrometry. The pharmacokinetics did not differ significantly between species, and buprenorphine was dose-proportional at the ...

  14. Effects of buprenorphine and meloxicam analgesia on induced cerebral ischemia in C57BL/6 male mice

    DEFF Research Database (Denmark)

    Jacobsen, Kirsten R; Fauerby, Natasha; Raida, Zindy

    2013-01-01

    investigated whether buprenorphine and meloxicam, at clinically relevant doses provided pain relief without altering infarct volume in male C57BL/6 mice. Common known side-effects of buprenorphine, including decreased food consumption, were noted after surgery in buprenorphine-treated mice, but these effects...

  15. Bridging waitlist delays with Interim Buprenorphine Treatment: Initial feasibility

    Science.gov (United States)

    Sigmon, Stacey C.; Meyer, Andrew; Hruska, Bryce; Ochalek, Taylor; Rose, Gail; Badger, Gary J.; Brooklyn, John R.; Heil, Sarah H.; Higgins, Stephen T.; Moore, Brent A.; Schwartz, Robert P.

    2015-01-01

    Despite the effectiveness of agonist maintenance for opioid dependence, individuals can remain on waitlists for months, during which they are at significant risk for morbidity and mortality. Interim dosing, consisting of daily medication without counseling, can reduce these risks. In this pilot study, we examined the initial feasibility of a novel technology-assisted interim buprenorphine treatment for waitlisted opioid-dependent adults. Following buprenorphine induction during Week 1, participants (n=10) visited the clinic at Weeks 2, 4, 6, 8, 10 and 12 to ingest their medication under staff observation, provide a urine specimen and receive their remaining doses via a computerized Med-O-Wheel Secure device. They also received daily monitoring via an Interactive Voice Response (IVR) platform, as well as random call-backs for urinalysis and medication adherence checks. The primary outcome was percent of participants negative for illicit opioids at each 2-week visit, with secondary outcomes of past-month drug use, adherence and acceptability. Participants achieved high levels of illicit opioid abstinence, with 90% abstinent at the Week 2 and 4 visits and 60% at Week 12. Significant reductions were observed in self-reported past-month illicit opioid use (p<.001), opioid withdrawal (p<.001), opioid craving (p<.001) and ASI Drug composite score (p=.008). Finally, adherence with buprenorphine administration (99%), daily IVR calls (97%) and random call-backs (82%) was high. Interim buprenorphine treatment shows promise for reducing patient and societal risks during delays to conventional treatment. A larger-scale, randomized clinical trial is underway to more rigorously examine the efficacy of this treatment approach. PMID:26256469

  16. Pharmacokinetics of intravenous and intramuscular buprenorphine in the horse.

    Science.gov (United States)

    Davis, J L; Messenger, K M; LaFevers, D H; Barlow, B M; Posner, L P

    2012-02-01

    The purpose of this study was to determine the pharmacokinetics of buprenorphine following intravenous (i.v.) and intramuscular (i.m.) administration in horses. Six horses received i.v. or i.m. buprenorphine (0.005 mg/kg) in a randomized, crossover design. Plasma samples were collected at predetermined times and horses were monitored for adverse reactions. Buprenorphine concentrations were measured using ultra-performance liquid chromatography with electrospray ionization mass spectrometry. Following i.v. administration, clearance was 7.97±5.16 mL/kg/min, and half-life (T(1/2)) was 3.58 h (harmonic mean). Volume of distribution was 3.01±1.69 L/kg. Following i.m. administration, maximum concentration (C(max)) was 1.74±0.09 ng/mL, which was significantly lower than the highest measured concentration (4.34±1.22 ng/mL) after i.v. administration (PBuprenorphine has a moderate T(1/2) in the horse and was detected at concentrations expected to be therapeutic in other species after i.v. and i.m. administration of 0.005 mg/kg. Signs of excitement and gastrointestinal stasis may be noted.

  17. SUBLINGUAL BUPRENORPHINE VS MIDAZOLAM FOR PREMEDICATION IN CHILDREN

    Directory of Open Access Journals (Sweden)

    V.A HASANI

    2000-03-01

    Full Text Available Background. Preanesthetic medication may reduce the risks of adverse psychological and physiological sequel of induction in children. Administration of premedication by sublingual route may provide the best compromise because of relatively rapid absorption without causing pain. In this study sedative and anxitolytic effects of sublingual midazolam and buprenorphine in children were compared. Methods. In a randomized, controlled, double blind clinical trial, one hundred and fifty children aged between 4 to 10 years in first or second class of ASA scheduled for adenotonsillectomy were divided in three equal groups. These groups recieved sublingual bupronorphine 3 µg/kg, midazolam 0.2 mg/kg and no premedication respectively. Cardiorespiratory variables were recorded from the time of premedication to awakening from anesthesia. Anxiety and sedation scores and patients acceptance of mask at induction were recorded using four point rating scales. Time of spontaneous eye opening and postoperative emesis occurrence were also recorded. Findings. Children recieving sublingual midazolam or buprenorphine had similar sedation, anxiety and mask acceptance scores, but different from no premedication group (P < 0.0001. None of the children experienced respiratory depression or oxygen desaturation after drug administration and during postoperative period. Time of spontaneous eye opening was longer in the midazolam group (P < 0.0001.Emetic episodes were similar in all groups. Conclusion. Midazolam is extensively studied and demonstrated that the drug is highly effective in alleviating anxiety and increasing cooperation. We concluded that sublingual buprenorphine is as effective as sublingual midazolam in providing sedation and anxitolysis for pediatric premedication.

  18. Antinociceptive effects of voluntarily ingested buprenorphine in the hot-plate test in laboratory rats

    DEFF Research Database (Denmark)

    Kristensen, Sara Hestehave; Munro, Gordon; Pedersen, Tina Brønnum

    2017-01-01

    . In addition, it is desirable to provide post-operative analgesia using methods that are minimally invasive and stressful. This study investigated the antinociceptive effects of orally administered buprenorphine ingested in Nutella® in comparison with subcutaneous buprenorphine administration. By exposing...

  19. Fulminant hepatic failure after intravenous injection of sublingual buprenorphine in a patient with hepatitis C.

    Science.gov (United States)

    French, Janine; Mujumdar, Avik; Angus, Peter; Gow, Paul

    2015-08-01

    A 20-year-old indigenous Australian male was admitted to the intensive care unit with fulminant hepatic failure secondary to intravenous use of buprenorphine, which had been prescribed sublingually for opioid dependence. Intravenous buprenorphine-induced hepatitis is well recognized, however, life-threatening fulminant hepatic failure has not previously been reported.

  20. The effect of voluntarily ingested buprenorphine on rats subjected to surgically induced global cerebral ischaemia

    DEFF Research Database (Denmark)

    Kalliokoski, Otto Henrik; Abelson, Klas; Koch, Janne;

    2010-01-01

    in buprenorphine-treated and untreated animals. A part from a slightly higher hyperthermia immediately after surgery and typical opiate-associated behaviour, the buprenorphine treatment had no apparent adverse effects on the experimental model. In contrast, the analgesic treatment improved the model by minimizing...

  1. The New Kid on the Block--Incorporating Buprenorphine into a Medical Toxicology Practice.

    Science.gov (United States)

    Wiegand, Timothy J

    2016-03-01

    Buprenorphine represents a safe and effective therapy for treating opioid dependence, alleviating craving and withdrawal symptoms in opioid-dependent patients. Buprenorphine has a "blocking" effect against the action of other opioids at the mu-receptor, preventing not only opioid-induced euphoria, but CNS and respiratory depressant effects as well. Buprenorphine was approved for the treatment of opioid dependence in 2002 after the passage of Drug Abuse Treatment Act 2000 (DATA 2000) which allowed clinicians to treat opioid-dependent patients with specifically named opioid agonist therapies in an office setting. Buprenorphine programs reduce the prevalence of HIV and hepatitis C and reduce criminal behaviors associated with illicit drug use. Patients stabilized on buprenorphine have increased employment, enhanced engagement with social services, and better overall health and well-being.

  2. Plasma concentrations of corticosterone and buprenorphine in rats subjected to jugular vein catheterization

    DEFF Research Database (Denmark)

    Goldkuhl, Renée; Jacobsen, Kirsten Rosenmaj; Kalliokoski, Otto Henrik;

    2010-01-01

    The present study investigated the postoperative plasma concentrations of corticosterone and buprenorphine in male Wistar and Sprague-Dawley rats, treated with buprenorphine administered either through subcutaneous (SC) injection or through voluntary ingestion (VI). The animals were treated...... with buprenorphine for pre-emptive analgesia prior to surgical placement of a jugular catheter, followed by automated blood sampling during 96 h. Buprenorphine was administered on a regular basis throughout the experiment, and blood was collected on selected time points. Body weight was measured before and 96 h...... after surgery. It was found that the two rat stocks responded in a similar manner to both buprenorphine treatments, with the exception of body weight change in Wistar rats, in which body weight was reduced after SC treatment. The plasma concentration of corticosterone was significantly higher in the SC...

  3. Classification and identification of opioid addiction in chronic pain patients

    DEFF Research Database (Denmark)

    Højsted, Jette; Nielsen, Per Rotbøll; Guldstrand, Sally Kendall

    2010-01-01

    Addiction is a feared consequence of long-term opioid treatment of chronic pain patients. The ICD-10 and DSM-IV diagnostic addiction criteria may not be appropriate in these patients. Therefore Portenoy's criteria (PC) were launched. The aim was to estimate the prevalence of addiction, to investi......Addiction is a feared consequence of long-term opioid treatment of chronic pain patients. The ICD-10 and DSM-IV diagnostic addiction criteria may not be appropriate in these patients. Therefore Portenoy's criteria (PC) were launched. The aim was to estimate the prevalence of addiction...... as addicted were treated with significantly higher opioid doses, drank more alcohol, smoked more tobacco, used benzodiazepines and had higher levels of depression. According to ICD-10 patients classified as addicted used higher doses of opioids, drank more alcohol and had higher scores of anxiety...... and depression. High opioid doses, concomitant use of alcohol and younger age were risk factors. The risk profile for PC was different to ICD-10 by adding risk factors as concomitant use of benzodiazepines, having depression and low educational level. PC seems to be appropriate for diagnosing addiction in opioid...

  4. Classification and identification of opioid addiction in chronic pain patients

    DEFF Research Database (Denmark)

    Højsted, Jette; Nielsen, Per Rotbøll; Guldstrand, Sally Kendall

    2010-01-01

    Addiction is a feared consequence of long-term opioid treatment of chronic pain patients. The ICD-10 and DSM-IV diagnostic addiction criteria may not be appropriate in these patients. Therefore Portenoy's criteria (PC) were launched. The aim was to estimate the prevalence of addiction......, to investigate whether PC were applicable and to compare these criteria with the ICD-10 criteria. The study was cross-sectional and included 253 patients with chronic pain at a tertiary pain centre. Patients were screened for addiction by a physician and a nurse. The addiction prevalence was 14.4% according...... to ICD-10 and 19.3% according to PC. A significant difference between the prevalence of addiction according to ICD-10 and to PC was found. The inter-rater reliability was 0.95 for ICD-10 and 0.93 for PC. The sensitivity of PC was 0.85 and the specificity was 0.96. According to PC patients classified...

  5. Comparing methadone and buprenorphine maintenance with methadone-assisted withdrawal for the treatment of opioid dependence during pregnancy: maternal and neonatal outcomes

    Directory of Open Access Journals (Sweden)

    Lund IO

    2012-02-01

    Full Text Available Ingunn O Lund1, Heather Fitzsimons2, Michelle Tuten2, Margaret S Chisolm2, Kevin E O’Grady3, Hendrée E Jones2,41SERAF-Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway; 2Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; 3Department of Psychology, University of Maryland, College Park, MD; 4Substance Abuse Treatment Evaluations and Interventions Research Program, RTI International, Research Triangle Park, NC, USAAbstract: Pregnancy can motivate opioid-dependent women to seek substance abuse treatment. Research has demonstrated that although prenatal exposure to buprenorphine results in less severe neonatal abstinence syndrome (NAS relative to prenatal methadone exposure, the maternal and other neonatal outcomes are similar for the two medications. Maternal and neonatal outcomes for opioid-dependent pregnant women receiving these medications have not been systematically compared with methadone-assisted withdrawal. The present study provides an initial assessment of the relative efficacy of both methadone and buprenorphine maintenance versus methadone-assisted withdrawal in terms of neonatal and maternal delivery outcomes. Data were derived from (1 the MOTHER (Maternal Opioid Treatment: Human Experimental Research study at the Johns Hopkins University Bayview Medical Center (JHBMC, or (2 retrospective records review of women who underwent methadone-assisted withdrawal at the JHBMC during the time period in which participants were enrolled in the MOTHER study. Compared with the methadone maintenance group, the methadone-assisted withdrawal group had a significantly lower mean NAS peak score (Means = 13.7 vs 7.0; P = 0.002, required a significantly lower mean amount of morphine to treat NAS (Means = 82.8 vs 0.2; P < 0.001, had significantly fewer days medicated for NAS (Means = 31.5 vs 3.9; P < 0.001, and remained in the hospital for a significantly fewer number of

  6. False-positive buprenorphine by CEDIA in patients prescribed amisulpride or sulpiride.

    Science.gov (United States)

    Birch, M A; Couchman, L; Pietromartire, S; Karna, T; Paton, C; McAllister, R; Marsh, A; Flanagan, R J

    2013-05-01

    Buprenorphine is a potent partial opioid agonist that is analyzed in urine to (i) monitor adherence to maintenance or detoxification therapy and (ii) detect illicit use. Buprenorphine analysis is commonly conducted on urine by immunoassay, but is subject to cross-reactivity from other drugs/drug metabolites, including morphine, codeine and dihydrocodeine. This study reports false-positive buprenorphine analysis [Thermo Fisher Scientific cloned enzyme donor immunoassay (CEDIA)] in patients who denied unauthorized buprenorphine use prior to sampling, but who had been prescribed amisulpride. In two cases, confirmatory analysis by liquid chromatography-tandem mass spectrometry was negative (sulpiride in the CEDIA buprenorphine assay is low (estimated at 0.003 and 0.002%, respectively), it remains a significant consideration given the likely high concentrations of these compounds in urine relative to the low cutoff of the buprenorphine assay. Neither amisulpride nor sulpiride was listed as potential sources of interference on the CEDIA data sheet when this work was performed. These findings highlight the importance of confirming immunoassay-positive buprenorphine results using a more selective analytical technique.

  7. Buprenorphine – an attractive opioid with underutilized potential in treatment of chronic pain

    Directory of Open Access Journals (Sweden)

    Khanna IK

    2015-12-01

    Full Text Available Ish K Khanna, Sivaram PillarisettiNeuroPn Therapeutics, Alpharetta, GA, USAAbstract: Despite proven clinical utility, buprenorphine has not been used widely for the treatment of chronic pain. Questions about “ceiling effect” or bell-shaped curve observed for analgesia in preclinical studies and potential withdrawal issues on combining with marketed µ-agonists continue to hinder progress in expanding full potential of buprenorphine in the treatment of cancer and noncancer pain. Mounting evidence from clinical studies and conclusions drawn by a panel of experts strongly support superior safety and efficacy profile of buprenorphine vs marketed opioids. No ceiling on analgesic effect has been reported in clinical studies. The receptor pharmacology and pharmacokinetics profile of buprenorphine is complex but unique and contributes to its distinct safety and efficacy. The buprenorphine pharmacology also allows it to be combined with other µ-receptor opioids for additivity in efficacy. Transdermal delivery products of buprenorphine have been preferred choices for the management of pain but new delivery options are under investigation for the treatment of both opioid dependence and chronic pain.Keywords: buprenorphine, opioids, opioid dependence, partial agonist, hyperalgesia, neuropathic pain

  8. Radioimmunoassay of buprenorphine in urine: Studies in patients and in a drug clinic

    Energy Technology Data Exchange (ETDEWEB)

    Hand, C.W.; Ryan, K.E.; Dutt, S.K.; Moore, R.A. (DPC European Research Institute, Witney (England)); O' Connor, J.; Talbot, D. (Jervis Street Hospital, Dublin (Ireland)); McQuay, H.J. (Abingdon Hospital, Oxford (England))

    A radioimmunoassay kit (DPC buprenorphine double antibody) was evaluated with clinical samples and samples from a drug clinic. Urine samples were collected over a 2-day period from 5 hospital in-patients receiving sublingual buprenorphine, 400 to 2000 {mu}g/day, for the relief of chronic pain. Samples were measured before and after enzymatic hydrolysis. Urine buprenorphine concentrations were measurable at all doses studied (minimum value 5.6 ng/mL) and were greater with larger doses. The increase in concentration after hydrolysis averaged 49% and was similar for all doses studied. The authors conclude that the method has extensive cross-reactivity with glucuronides of buprenorphine and its metabolites and that samples may be analyzed without prior hydrolysis. The prevalence of buprenorphine use in 97 patients attending a drug clinic was also studied. Sixty (62%) had measurable urinary buprenorphine concentrations of 1 ng/mL or more by direct assay. The buprenorphine users were significantly younger and reported significantly greater use of opiates than nonusers.

  9. Crushed and injected buprenorphine tablets: characteristics of princeps and generic solutions.

    Science.gov (United States)

    Bouquié, Régis; Wainstein, Laura; Pilet, Paul; Mussini, Jean-Marie; Deslandes, Guillaume; Clouet, Johann; Dailly, Eric; Jolliet, Pascale; Victorri-Vigneau, Caroline

    2014-01-01

    Self-injection of high-dose buprenorphine is responsible for well-described complications. In 2011, we have been alerted by unusual but serious cutaneous complication among injection buprenorphine users. A prospective data collection identified 30 cases of necrotic cutaneous lesions after injection of filtered buprenorphine solution, among which 25 cases occurred following injection of buprenorphine generics. The main goal of our study was to put forward particularities that could explain the cutaneous complications, by qualitatively and quantitatively confronting particles present in Subutex and generics solutions. We used the same protocol that injected-buprenorphine users: generic or subutex tablets were crushed in sterile water and filtered through 2 filters commonly used (cotton-pad and sterifilt). Solutions were analyzed by laser granulometry, flow cytometry and scanning electron microscopy. We have highlighted the wide variation of the quantity and the size of the particles present in solution between the two drugs after cotton-pad filtration. The proportion of particles solutions than with Subutex. All of the insoluble particles found in generic solutions contain silica, whereas non- organic element was to be identified in the insoluble particles of Subutex. One skin biopsy obtained from one patient who developed a necrotic lesion after intravenous injection of filtrated solution of buprenorphine generic, shows non-organic elements. Identification of particles in situ enables us to confirm the presence of silica in the biopsy. Actually the monitoring of patient receiving generic of buprenorphine must be strengthened.

  10. Recognizing Potential Buprenorphine Medication Misuse: Product Packaging Does Not Degrade With Laundering.

    Science.gov (United States)

    Gunderson, Erik W

    2015-01-01

    Expanded office-based buprenorphine opioid dependence treatment is associated with medication misuse and diversion consequences. Recurrent early refill requests may indicate misuse or diversion, although further research is needed on how to effectively recognize and address the issue in clinical practice. In the current study, patient report of damaged medication from laundering prompted evaluation of laundering on degradation of buprenorphine-containing product packages and contents. Four buprenorphine product packaging approaches were assessed: 3 buprenorphine/naloxone placebo demonstration products (Suboxone and Bunavail film in foil wrappers and Zubsolv tablet in a blister pack) and Rexam-manufactured Screw-Loc closure pill container filled with a chewable aspirin as a surrogate for generic buprenorphine and buprenorphine/naloxone products. Two experimental laundering conditions, wash machine alone (W) and washer/dryer (W+D), were compared with unlaundered control (C) condition. Standard laundering settings were based on patient presentation. Products from the 2 experimental conditions and the control condition were labeled A, B, or C with counterbalanced assignment prior to visual examination of packaging and contents by the investigator who was blinded to condition. Packaging and contents remained intact for all products across experimental conditions, with only minor cosmetic effects compared with control. The W+D Suboxone film had 1-2 mm curling of the wrapper corners. Zubsolv blister packs had slight paper label fading (W+D > W). Bunavail W+D foil had an indentation outlining the inner film. The W+D bottle tablet had a ˜1 mm nick on one edge. No other differences were noted. After implementing more structured treatment and reviewing the results with the patient, he endorsed fabricating the laundering story to get additional medication. Laundering is an unlikely cause of damaged buprenorphine-containing medication packaged in foil wrappers (Suboxone

  11. Dexmedetomidine as a novel therapeutic for postoperative pain in a patient treated with buprenorphine.

    Science.gov (United States)

    Brummett, Chad M; Trivedi, Kavita A; Dubovoy, Anna V; Berland, Daniel W

    2009-01-01

    Buprenorphine is a partial agonist/antagonist used for the outpatient management of pain and addiction. It avidly binds to the opioid receptors and has a long and varied half-life. Its effects can impair the efficacy of opioids used for postoperative pain. The authors present a case of a patient managed with buprenorphine as an outpatient who presented for revision spine surgery and had significant postoperative pain that was successfully treated with hydromorphone and dexmedetomidine. This is the first reported use of dexmedetomidine for postoperative pain in a patient treated with buprenorphine.

  12. Voluntary ingestion of nut paste for administration of buprenorphine in rats and mice.

    Science.gov (United States)

    Abelson, Klas S P; Jacobsen, Kirsten R; Sundbom, Renée; Kalliokoski, Otto; Hau, Jann

    2012-10-01

    An adequate analgesic strategy is important to improve the postoperative recovery and welfare of laboratory rats and mice. It is desirable that the method for administering the drug is non-invasive and stress-free. We have previously validated a method for administering buprenorphine in a nut paste for voluntary ingestion. This method has many advantages over parenteral administration. To use the method in a successful way, however, it is important to prepare and administer the mix correctly. The present paper describes in detail how to implement the method, by means of habituation, presentation, adequate concentrations and amounts of buprenorphine/nut paste, and dosage of buprenorphine to rats and mice.

  13. Integrating buprenorphine treatment into a public healthcare system: the San Francisco Department of Public Health's office-based Buprenorphine Pilot Program.

    Science.gov (United States)

    Hersh, David; Little, Sherri L; Gleghorn, Alice

    2011-01-01

    Despite well-documented efficacy, US physicians have been relatively slow to embrace the use of buprenorphine for the treatment of opioid dependence. In order to introduce and support the use of buprenorphine across the San Francisco Department of Public Health system of care, the Buprenorphine Pilot Program was initiated in 2003. Program treatment sites included a centralized buprenorphine induction clinic and program pharmacy, and three community-based treatment sites; two primary care clinics and a private dual diagnosis group practice. The target patient population consisted of opioid-dependent patients typically seen in an urban, public health setting, including individuals experiencing extreme poverty, homelessness/unstable housing, unemployment, polysubstance abuse/dependence, coexisting mental health disorders, and/or little psychosocial support. This program evaluation reviews patient characteristics, treatment retention, substance use over time, patient impressions, and provider practices for the 57 patients admitted between 9/1/03 and 8/31/05. At baseline, over 80% of patients were injecting heroin, over 40% were homeless, and over one-third were using cocaine. Outcomes included an overall one-year retention rate of 61%, a rapid and dramatic decline in opioid use, very positive patient impressions of the program and of buprenorphine, and significant shifts in provider practices over time.

  14. Pharmacodynamic Modelling of Placebo and Buprenorphine Effects on Event-Related Potentials in Experimental Pain

    DEFF Research Database (Denmark)

    Juul, Rasmus V; Foster, David J R; Upton, Richard N

    2014-01-01

    The purpose of the study was to investigate placebo and buprenorphine effects on event-related potentials (ERPs) in experimental pain and the potential benefit of population pharmacodynamic modelling in data analysis. Nineteen healthy volunteers received transdermal placebo and buprenorphine...... in a cross-over study. Drug plasma concentrations and ERPs after electrical stimulation at the median nerve with intensity adjusted to pain detection threshold were recorded until 144 hrs after administration. Placebo and concentration-effect models were fitted to data using non-linear mixed......-effects modelling implemented in NONMEM (V7.2.0.). Pharmacodynamic models were developed to adequately describe both placebo and buprenorphine ERP data. Models predicted significant placebo effects, but did not predict significant effects related to buprenorphine concentration. Models revealed that ERPs varied both...

  15. To Be Free and Normal: Addiction, Governance, and the Therapeutics of Buprenorphine.

    Science.gov (United States)

    Harris, Shana

    2015-12-01

    Methadone maintenance has dominated opiate addiction treatment in the United States for decades. Since 2002, opiate addiction has also been treated in general medical settings with a substance called buprenorphine. Based on interviews and participant observation conducted in northern California, this article analyzes how discourses of freedom and normalcy in patient and provider narratives reflect and affect experiences with this treatment modality. I discuss how buprenorphine treatment, in contrast to methadone maintenance, offers patients and providers a greater sense of autonomy and flexibility in how they receive and deliver treatment. It presents them with new obligations, responsibilities, and choices around care and conduct. It simultaneously perpetuates and shapes a desire to be "free" and "normal." I argue that the therapeutics of buprenorphine govern patients and providers through this desire for freedom and normalcy. Buprenorphine is thus a technology of governmentality that extends neoliberal discourses and values and produces self-governing subjects.

  16. Different profiles of buprenorphine-induced analgesia and antihyperalgesia in a human pain model.

    Science.gov (United States)

    Koppert, Wolfgang; Ihmsen, Harald; Körber, Nicole; Wehrfritz, Andreas; Sittl, Reinhard; Schmelz, Martin; Schüttler, Jürgen

    2005-11-01

    Different mechanisms were proposed for opioid-induced analgesia and antihyperalgesia, which might result in different pharmacodynamics. To address this issue, the time course of analgesic and antihyperalgesic effects of intravenous (i.v.) and sublingual (s.l.) buprenorphine was assessed in an experimental human pain model. Fifteen volunteers were enrolled in this randomized, double-blind, and placebo controlled cross-over study. The magnitude of pain and the area of secondary hyperalgesia following transcutaneous stimulation were repetitively assessed before and up to 150 min after administration of (1) 0.15 mg buprenorphine i.v. and placebo pill s.l., (2) 0.2 mg buprenorphine s.l. and saline 0.9% i.v. or (3) saline 0.9% i.v. and placebo pill s.l. as a control. The sessions were separated by 2 week wash-out periods. For both applications of buprenorphine the antihyperalgesic effects were more pronounced as compared to the analgesic effects (66+/-9 vs. 26+/-5% and 43+/-10 vs. 10+/-6%, for i.v. and s.l. application, respectively). This contrasts the pattern for the intravenous administration of pure mu-receptor agonists in the same model in which the antihyperalgesic effects are weaker. The apparent bioavailability of buprenorphine s.l. as compared to buprenorphine i.v. was 58% with a 15.8 min later onset of antinociceptive effects. The half-life of buprenorphine-induced analgesic and antihyperalgesic effects were 171 and 288 min, respectively. In contrast to pure mu-receptor agonists, buprenorphine exerts a lasting antihyperalgesic effect in our model. It will be of major clinical interest whether this difference will translate into improved treatment of pain states dominated by central sensitization.

  17. In vitro dissolution method for evaluation of buprenorphine in situ gel formulation: A technical note

    OpenAIRE

    Graves, Richard A.; Freeman, Thomas; Tarun K. Mandal

    2007-01-01

    The in situ gel formulation of buprenorphine showed sustained drug release for a prolonged period of time. The drug release from RG 502 followed a linear pattern throughout the dissolution without any significant burst release. The amount of buprenorphine released during the first 30 minutes, irrespective of the type of Resomer or dissolution medium, was less than 3%. Drug release continued over 55 days in phosphate buffer and 35 days in Tween 80. The in vitro dissolution method developed dur...

  18. Successful transition to buprenorphine in a patient with methadone-induced torsades de pointes.

    Science.gov (United States)

    Esses, Jason Levi; Rosman, Jonathan; Do, Lien Thanh; Schweitzer, Paul; Hanon, Sam

    2008-11-01

    A 56-year-old-man presented with syncope and torsades de pointes secondary to methadone-induced QT prolongation. After transition from methadone to buprenorphine, a partial mu-opiate-receptor agonist and a kappa-opiate-receptor antagonist, the QT normalized and ventricular arrhythmias resolved. Buprenorphine should be used for opiate dependence and chronic pain in patients with methadone-induced QT prolongation and as first line therapy in patients with risk factors for torsades de pointes.

  19. Randomized, Placebo-Controlled Pilot Trial of Gabapentin During an Outpatient, Buprenorphine-Assisted Detoxification Procedure1

    OpenAIRE

    Sanders, Nichole C.; Mancino, Michael J.; Gentry, W Brooks; Guise, J. Benjamin; Bickel, Warren K.; Thostenson, Jeff; Oliveto, Alison H.

    2013-01-01

    This pilot study examined the efficacy of the N-type calcium channel blocker gabapentin to improve outcomes during a brief detoxification protocol with buprenorphine. Treatment-seeking opioid-dependent individuals were enrolled in a 5-wk, double blind, placebo-controlled trial examining the effects of gabapentin during a 10-day outpatient detoxification from buprenorphine. Participants were inducted onto buprenorphine sublingual tablets during week 1, were randomized and inducted onto gabapen...

  20. Development of a radioimmunoassay for the determination of buprenorphine in biological samples

    Energy Technology Data Exchange (ETDEWEB)

    Debrabandere, L.; Boven, M. Van; Daenens, P. (Louvain Univ. (Belgium))

    1993-02-01

    The development of a specific and sensitive radioimmunoassay for the detection of buprenorphine in urine samples is described. With minor adjustments, the assay was also applied to the analysis for buprenorphine in plasma samples. The 2-diazobenzoic acid derivative of buprenorphine has been prepared as a hapten. The immunization of rabbits with the hapten-bovine serum albumin conjugate resulted in the production of antibodies, which cross-reacted with N-dealkylbuprenophine up to about the 90% level. The antibodies showed very low cross-reactivities with the 3-O-glucuronides and with the structural analogue etorphine. The assay was mainly used to prescreen for buprenorphine in urine samples of persons suspected of Temgesic misuse and to determine buprenorphine in plasma samples. A linear calibration graph for buprenorphine was obtained after logit-log regression. The spiking recovery study showed a linear regression. Intra-and inter-assay relative standard deviations were < 4.35 and < 6.36%, respectively. A comparison study of the high-performance liquid chromatographic determination (X) to the radioimmunoassay (Y) resulted in the following regression equation for the urine samples: Y = 1.44 + 1.64 X (n = 32; r 0.910) and Y = 0.007 + 1.58 X (n = 10; r = 0.930) for plasma specimens. The minimum detectable dose of the immunoassay was calculated to be 10 pg ml[sup -1] (Student's t-distribution, p 0.01, degrees of freedom = 8). (Author).

  1. Comparative pharmacokinetics of intravenous fentanyl and buprenorphine in healthy greyhound dogs.

    Science.gov (United States)

    KuKanich, B; Allen, P

    2014-12-01

    The purpose of this study was to compare the pharmacokinetics of two highly protein-bound, lipophilic opioid drugs. Fentanyl (10 μg/kg) and buprenorphine (20 μg/kg) were administered intravenously (IV) to six healthy greyhound dogs (three males and three females). The doses were based on clinically administered doses for dogs. Plasma drug concentrations were determined using liquid chromatography with mass spectrometry, and noncompartmental pharmacokinetics were estimated with computer software. The volume of distribution (area) was larger for fentanyl (7.42 L/kg) compared to buprenorphine (3.54 L/kg). The plasma clearance of fentanyl (38.6 mL·min/kg) was faster than buprenorphine (10.3 mL·min/kg). The terminal half-life of fentanyl (2.22 h) was shorter than buprenorphine (3.96 h). Despite similar physicochemical properties including octanol-water partition coefficient and pKa, the pharmacokinetics of fentanyl and buprenorphine were not similar. Both fentanyl (84%) and buprenorphine (95-98%) are considered highly protein bound, but the differences in protein binding may contribute to the lack of similarity of pharmacokinetics in healthy dogs.

  2. Pharmacokinetics of oral transmucosal and intramuscular dexmedetomidine combined with buprenorphine in cats.

    Science.gov (United States)

    Porters, N; de Rooster, H; Bosmans, T; Baert, K; Cherlet, M; Croubels, S; De Backer, P; Polis, I

    2015-04-01

    Plasma concentrations and pharmacokinetics of dexmedetomidine and buprenorphine after oral transmucosal (OTM) and intramuscular (i.m.) administration of their combination in healthy adult cats were compared. According to a crossover protocol (1-month washout), a combination of dexmedetomidine (40 μg/kg) and buprenorphine (20 μg/kg) was given OTM (buccal cavity) or i.m. (quadriceps muscle) in six female neutered cats. Plasma samples were collected through a jugular catheter during a 24-h period. Plasma dexmedetomidine and buprenorphine concentrations were determined by liquid chromatography-tandem mass spectrometry. Plasma concentration-time data were fitted to compartmental models. For dexmedetomidine and buprenorphine, the area under the plasma concentration-time curve (AUC) and the maximum plasma concentrations (Cmax ) were significantly lower following OTM than following i.m. administration. For buprenorphine, time to reach Cmax was also significantly longer after OTM administration than after i.m. injection. Data suggested that dexmedetomidine (40 μg/kg) combined with buprenorphine (20 μg/kg) is not as well absorbed from the buccal mucosa site as from the intramuscular injection site.

  3. Randomized, placebo-controlled pilot trial of gabapentin during an outpatient, buprenorphine-assisted detoxification procedure.

    Science.gov (United States)

    Sanders, Nichole C; Mancino, Michael J; Gentry, W Brooks; Guise, J Benjamin; Bickel, Warren K; Thostenson, Jeff; Oliveto, Alison H

    2013-08-01

    This pilot study examined the efficacy of the N-type calcium channel blocker gabapentin to improve outcomes during a brief detoxification protocol with buprenorphine. Treatment-seeking opioid-dependent individuals were enrolled in a 5-week, double-blind, placebo-controlled trial examining the effects of gabapentin during a 10-day outpatient detoxification from buprenorphine. Participants were inducted onto buprenorphine sublingual tablets during Week 1, were randomized and inducted onto gabapentin or placebo during Week 2, underwent a 10-day buprenorphine taper during Weeks 3 and 4, and then were tapered off gabapentin/placebo during Week 5. Assessments included thrice-weekly opioid withdrawal scales, vitals, and urine drug screens. Twenty-four individuals (13 male; 17 Caucasian, 3 African American, 4 Latino; mean age 29.7 years) participated in the detoxification portion of the study (gabapentin, n = 11; placebo, n = 13). Baseline characteristics did not differ significantly between groups. Self-reported and observer-rated opioid withdrawal ratings were relatively low and did not differ between groups during the buprenorphine taper. Urine results showed a Drug × Time interaction, such that the probability of opioid-positive urines significantly decreased over time in the gabapentin versus placebo groups during Weeks 3 and 4 (OR = 0.73, p = .004). These results suggest that gabapentin reduces opioid use during a 10-day buprenorphine detoxification procedure.

  4. Plasma buprenorphine concentrations after the application of a 70 microg/h transdermal patch in dogs. Preliminary report.

    Science.gov (United States)

    Andaluz, A; Moll, X; Ventura, R; Abellán, R; Fresno, L; García, F

    2009-10-01

    The objective of the present study was to evaluate the plasma concentrations and pharmacokinetics of buprenorphine after transdermal application in dogs (n = 4). A 70 microg/h transdermal buprenorphine patch was applied to the ventral abdomen of four healthy beagles. Blood samples were collected through a preplaced jugular catheter before and at 1, 2, 4, 8, 12, 24, 36, 48 and every 6 h until 108 h after the patch application. Plasma buprenorphine concentrations were measured using a (125)I-labelled radioimmunoassay (RIA) assay. No adverse effects were observed in any of the dogs. Concentrations of buprenorphine were detected in plasma after the application of the transdermal buprenorphine patch on the four experimental animals. Buprenorphine plasma concentrations increased during the first 36 h and then remained in the 0.7-1.0 ng/mL range during the study period. A decrease in plasma buprenorphine concentration was not observed during the study. Although analgesia could not be demonstrated the present study shows the ability of buprenorphine transdermal delivery systems developed for human use to deliver measurable concetrations of buprenorphine in dogs.

  5. Intraoperative end-tidal concentration of isoflurane in cats undergoing ovariectomy that received tramadol, buprenorphine or a combination of both.

    Science.gov (United States)

    Bellini, Luca; Mollo, Antonio; Contiero, Barbara; Busetto, Roberto

    2017-02-01

    Objectives The aim of the study was to evaluate the end-tidal concentration of isoflurane required to maintain heart and respiratory rate within ± 20% of basal measurement in cats undergoing ovariectomy that received buprenorphine, tramadol or a combination of both. Methods Thirty cats, divided into three groups, were enrolled in a simple operator-blinded, randomised study. Cats received acepromazine (0.03 mg/kg) and one of the following treatments: buprenorphine (0.02 mg/kg), tramadol (2 mg/kg) or a combination of both. Anaesthesia was induced with propofol and maintained with isoflurane titrated in order to maintain heart and respiratory rate within the target values recorded before premedication. Results Groups were similar for age, weight, dose of propofol administered, sedation and recovery scores. Cats receiving tramadol with buprenorphine were extubated earlier after isoflurane discontinuation. No statistical differences were detected in end-tidal fraction of isoflurane between buprenorphine alone or with tramadol. In cats that received tramadol or buprenorphine alone, ovarian pedicle traction caused a statistical increase in end-tidal isoflurane concentration compared with that measured during incision and suture of the skin. In cats that received the combination of tramadol plus buprenorphine no differences among surgical time points were observed. Conclusions and relevance Tramadol added to buprenorphine did not provide any advantage in decreasing the end-tidal fraction of isoflurane compared with buprenorphine alone, although it is speculated there may be an infra-additive interaction between tramadol and buprenorphine in cats.

  6. Buprenorphine in the treatment of opiate dependence: its pharmacology and social context of use in the U.S.

    Science.gov (United States)

    Wesson, Donald R

    2004-05-01

    Buprenorphine's physiological effects are produced when it attaches to specific opiate receptors that are designated mu, kappa, or delta. Buprenorphine, a partial agonist at the mu receptor and an antagonist at the kappa receptor, produces typical morphine-like effects at low doses. At higher doses, it produces opiate effects that are less than those of full opiate agonists. Knowledge of the physiological effects of opiate receptors and the way they interact with opiate agonists, partial opiate agonists, and opiate antagonists is fundamental to understanding the safety and efficacy of buprenorphine in treatment of pain and opiate addiction. Knowledge of the historical and social context of opiate agonist treatment of opiate dependence is fundamental to understanding how nonpharmacological factors may limit the clinical adoption and utility of a safe and effective medication in treatment of opiate dependence. This article reviews the pharmacology of sublingual buprenorphine and the historical context of opiate agonist therapy; delineates classes of opiate receptors and their interaction with opiate agonists, partial agonists, and antagonists; and describes the commercially available pharmaceutical formulations of buprenorphine. It focuses on sublingual buprenorphine tablets, Subutex and Suboxone, the FDA-approved formulations of buprenorphine for treatment of opiate dependence. Sublingual buprenorphine, and the combination of sublingual buprenorphine/naloxone, have unique pharmacological properties that make them a logical first-line intervention in the treatment of opioid dependence.

  7. Evaluation of medetomidine, ketamine and buprenorphine for neutering feral cats.

    Science.gov (United States)

    Harrison, Kelly A; Robertson, Sheilah A; Levy, Julie K; Isaza, Natalie M

    2011-12-01

    A combination of medetomidine (M, 100 μg/kg), ketamine (K, 10 mg/kg) and buprenorphine (B, 10 μg/kg), administered by intramuscular injection, was evaluated for spaying and castration (neutering) of feral cats (n = 101). Eleven animals (11%) required supplemental anesthesia (isoflurane by mask) to maintain an adequate plane of surgical anesthesia. Atipamezole (A, 125 μg/kg) was administered subcutaneously at the completion of surgery. All cats recovered from surgery and were released the following day. A hemoglobin saturation (SpO(2)) value of cats. This MKB combination can be used in a feral cat sterilization clinic, but isoflurane supplementation may be necessary. Further research is indicated to determine the clinical significance of the low SpO(2) values associated with this anesthetic regimen. Copyright © 2011 ISFM and AAFP. Published by Elsevier Ltd. All rights reserved.

  8. Pharmacokinetics of morphine and its surrogates. X: Analyses and pharmacokinetics of buprenorphine in dogs.

    Science.gov (United States)

    Garrett, E R; Chandran, V R

    1990-01-01

    Specific and sensitive reverse-phase HPLC assays of buprenorphine and its metabolite in biological fluids were developed with sensitivities of 2-6 ng ml-1 using fluorimetric detection. Pharmacokinetics were monitored on acute bolus administration of buprenorphine in 6 dogs within the 0.7-2.6 mg kg-1 dose range. Toxicity was circumvented when terminal plasma concentrations were increased by infusing 3.7-4.8 mg kg-1 doses of buprenorphine over 3 h in six studies in 6 dogs. The terminal rate constants of the IV infusion studies from the triexponential fits of plasma concentration-time data averaged 41.6 +/- 7.5 h with an averaged total body clearance of 191 +/- 19 ml min-1. This terminal rate constant was in contrast to the less than 100 min half-life of the second exponential fitting of the less lipophilic morphine, naloxone, and naltrexone. The apparent volumes of distribution of buprenorphine, referenced to the total plasma concentration, were 33 +/- 61 (Vc, central compartment volume) and 663 +/- 891 (Vd, total body volume), indicative of a highly bound, sequestered or lipophilic drug. Unchanged buprenorphine was insignificantly renally (less than 0.2 per cent of the dose) and biliary (less than 0.6 per cent) excreted. The major route of buprenorphine disposition was by hepatic conjugation to glucuronide which was eliminated into the bile (about 92 per cent) with only small amounts appearing in urine (less than 1 per cent as metabolite). Minor metabolites excreted in the bile accounted for about 3 per cent of the administered dose. Direct IV administration of the metabolite, buprenorphine glucuronide, gave a terminal half-life of 6 h and more than 90 per cent of the systemically circulating metabolite was excreted in bile; only 10 per cent in urine. The oral bioavailability, estimated from the areas under the buprenorphine plasma concentration-time curve following IV and oral administration of buprenorphine in the dogs, was 3-6 per cent. There were no apparent

  9. [Transdermal buprenorphine for treatment of chronic tumor and non-tumor pain].

    Science.gov (United States)

    Likar, Rudolf; Griessinger, Norbert; Sadjak, Anton; Sittl, Reinhard

    2003-01-01

    Patients with moderate to severe pain were treated with buprenorphine patches in one of 3 concentrations: 35 micrograms/h, 52.5 micrograms/h and 70 micrograms/h (= 0.8 mg/d, 1.2 mg/d and 1.6 mg/d respectively). The aim of this review was to assess the efficacy and tolerability of this transdermal system (TDS) in patients with chronic pain. A total of 445 patients were included in 3 double-blinded studies. The dosage titration with buprenorphine patches followed pretreatment with buprenorphine sublingual tablets, higher doses of weak opioids (level 2 substances), low dose morphine (level 3) or other analgesics. Patients with chronic tumour or non-tumour pain were recruited for these studies and treated with buprenorphine patches or placebo for 6 to 15 days. All patients were offered, in addition, buprenorphine sublingual tablets to be taken as required for supplementary pain relief. Pain intensity, analgesia, consumption of buprenorphine sublingual tablets and sleep duration were all assessed. All patients in the double-blinded studies were between the ages of 22 and 88. 249 patients suffered from tumour pain and 196 patients suffered from non-tumour pain. To examine long-term efficacy and tolerability of the transdermal system, treatment was expanded, if the patients were interested in participating in an open-label-study. In all 3 studies, the number of patients with moderate, severe and very severe pain increased in the placebo-patch treated group, while the patients in the buprenorphine transdermal system treated group had a greater incidence of mild or no pain. A further benefit in the buprenorphine transdermal system treated group was evidenced by a great number of patients with a daily sleep duration of more than 6 hours compared to the placebo group--an indicator of greater well-being. The systemic side-effects were typically opioid in nature and rare and usually only mild. Of particular note was the very low incidence of constipation in only 5.3% of cases

  10. Opioid partial agonist buprenorphine dampens responses to psychosocial stress in humans.

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    Bershad, Anya K; Jaffe, Jerome H; Childs, Emma; de Wit, Harriet

    2015-02-01

    Pre-clinical and clinical evidence indicates that opioid drugs have stress-dampening effects. In animal models, opioid analgesics attenuate responses to isolation distress, and in humans, opioids reduce stress related to anticipation of physical pain. The stress-reducing effects of opioid drugs may contribute to their abuse potential. Despite this evidence in laboratory animals, the effects of opioids on responses to psychosocial stress have not been determined in humans. Here we examined the effects of buprenorphine, a μ-opioid partial agonist used to treat opioid dependence and pain, on subjective and physiological responses to a stressful public speaking task in healthy adults. We hypothesized that buprenorphine would reduce subjective and physiological stress responses. Healthy adult volunteers (N=48) were randomly assigned to receive placebo, 0.2mg sublingual buprenorphine, or 0.4mg sublingual buprenorphine in a two-session study with a stressful speaking task (Trier Social Stress Test; TSST) and a non-stressful control task. During the sessions, the participants reported on their mood states, provided subjective appraisals of the task, and measures of salivary cortisol, heart rate, and blood pressure at regular intervals. Stress produced its expected effects, increasing heart rate, blood pressure, salivary cortisol, and subjective ratings of anxiety and negative mood. In line with our hypothesis, both doses of buprenorphine significantly dampened salivary cortisol responses to stress. On self-report ratings, buprenorphine reduced how threatening participants found the tasks. These results suggest that enhanced opioid signaling dampens responses to social stress in humans, as it does in laboratory animals. This stress-dampening effect of buprenorphine may contribute to the non-medical use of opioid drugs.

  11. Opioid-induced constipation: rationale for the role of norbuprenorphine in buprenorphine-treated individuals

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    Webster LR

    2016-06-01

    Full Text Available Lynn R Webster,1 Michael Camilleri,2 Andrew Finn3 1PRA Health Sciences, Salt Lake City, UT, 2Mayo Clinic Rochester, MN, 3BioDelivery Sciences, Inc., Raleigh, NC, USA Abstract: Buprenorphine and buprenorphine–naloxone fixed combinations are effective for managing patients with opioid dependence, but constipation is one of the most common side effects. Evidence indicates that the rate of constipation is lower when patients are switched from sublingual buprenorphine–naloxone tablets or films to a bilayered bioerodible mucoadhesive buccal film formulation, and while the bilayered buccal film promotes unidirectional drug flow across the buccal mucosa, the mechanism for the reduced constipation is unclear. Pharmacokinetic simulations indicate that chronic dosing of sublingually administered buprenorphine may expose patients to higher concentrations of norbuprenorphine than buprenorphine, while chronic dosing of the buccal formulation results in higher buprenorphine concentrations than norbuprenorphine. Because norbuprenorphine is a potent full agonist at mu-opioid receptors, the differences in norbuprenorphine exposure may explain the observed differences in treatment-emergent constipation between the sublingual formulation and the buccal film formulation of buprenorphine–naloxone. To facilitate the understanding and management of opioid-dependent patients at risk of developing opioid-induced constipation, the clinical profiles of these formulations of buprenorphine and buprenorphine-naloxone are summarized, and the incidence of treatment-emergent constipation in clinical trials is reviewed. These data are used to propose a potential role for exposure to norbuprenorphine, an active metabolite of buprenorphine, in the pathophysiology of opioid-induced constipation. Keywords: opioid, safety, buccal, sublingual, dependence, maintenance

  12. Effect of buprenorphine on total intravenous anesthetic requirements during spine surgery.

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    Khelemsky, Yury; Schauer, Jacob; Loo, Nathaniel

    2015-01-01

    Buprenorphine is a partial mu receptor agonist and kappa/delta antagonist commonly used for the treatment of opioid dependence or as an analgesic. It has a long plasma half-life and a high binding affinity for opioid receptors. This affinity is so high, that the effects are not easily antagonized by competitive antagonists, such as naloxone. The high affinity also prevents binding of other opioids, at commonly used clinical doses, to receptor sites - preventing their analgesic and likely minimum alveolar concentration (MAC) reducing benefits. This case report contrasts the anesthetic requirements of a patient undergoing emergency cervical spine surgery while taking buprenorphine with anesthetic requirements of the same patient undergoing a similar procedure after weaning of buprenorphine. Use of intraoperative neurophysiological monitoring prevented use of paralytics and inhalational anesthetics during both cases, therefore total intravenous anesthesia (TIVA) was maintained with propofol and remifentanil infusions. During the initial surgery, intraoperative patient movement could not be controlled with very high doses of propofol and remifentanil. The patient stopped moving in response to surgical stimulation only after the addition of a ketamine. Buprenorphine-naloxone was discontinued postoperatively. Five days later the patient underwent a similar cervical spine surgery. She had drastically reduced anesthetic requirements during this case, suggesting buprenorphine's profound effect on anesthetic dosing. This case report elegantly illustrates that discontinuation of buprenorphine is likely warranted for patients who present for major spine surgery, which necessitates the avoidance of volatile anesthetic and paralytic agents. The addition of ketamine may be necessary in patients maintained on buprenorphine in order to ensure a motionless surgical field.

  13. Diversion and abuse of buprenorphine: findings from national surveys of treatment patients and physicians.

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    Johanson, Chris-Ellyn; Arfken, Cynthia L; di Menza, Salvatore; Schuster, Charles Roberts

    2012-01-01

    Since 2003, buprenorphine has been approved for the treatment of opioid dependence in office-based practice. Diversion and abuse can be a threat to its continued approval under these conditions. As part of a national postmarketing surveillance program, applicants to substance abuse treatment and physicians certified to prescribe buprenorphine were surveyed about their perceptions of buprenorphine/naloxone diversion and abuse. These surveys were supplemented by information from national databases. Availability of buprenorphine/naloxone was measured by number of tablets dispensed. Measures of diversion and abuse of buprenorphine/naloxone increased from 2005 to 2009. The results from the applicant survey showed that the perceptions of the extent of diversion and abuse were lower than positive controls, methadone, oxycodone and heroin, but higher than the negative control, amitriptyline. By 2009, 46% of the physicians believed that buprenorphine/naloxone was diverted but 44% believed illegal use was for self-management of withdrawal and 53% believed the source of the medication was substance abuse patients. Other measures from national databases showed similar results. When adjusted for millions of tablets sold per year, slopes for measures of diversion and abuse were reduced. The increases in diversion and abuse measures indicate the need to take active attempts to curb diversion and abuse as well as continuous monitoring and surveillance of all buprenorphine products. However, these increases parallel the increased number of tablets sold. Finding a balance of risk/benefit (i.e. diversion and abuse versus expanded treatment) remains a challenge. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  14. Post-operative pain relief in children following caudal bupivacaine and buprenorphine--a comparative study.

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    Anilkumar T

    1994-04-01

    Full Text Available Eighty-five paediatric patients (age range: 6 mths-12yrs undergoing lower abdominal surgery were studied for post-operative pain relief following either caudal bupivacaine (GpI: n = 43 or buprenorphine (GpII: n = 42. Bupivacaine was administered as 0.5ml/kg body weight of 0.25% solution and buprenorphine as 4 micrograms/ml and volume of 0.5 ml/Kg body weight in normal saline. Post-operatively pain was graded on a 4-point scale and behaviour on a 5-point scale. Any post-operative complications and need for additional analgesia were also noted. Bupivacaine provided good pain relief in the early post-operative hours but buprenorphine provided pain relief lasting for 24 hrs or more post-operatively. Post-operative behaviour of 10 patients receiving buprenorphine was graded as cheerful as compared to 2 from bupivacaine group. Till the end of observation period (i.e. 8 hr post-operatively, majority of patients receiving buprenorphine remained cheerful.

  15. State policy influence on the early diffusion of buprenorphine in community treatment programs

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    Abraham Amanda J

    2008-06-01

    Full Text Available Abstract Background Buprenorphine was approved for use in the treatment of opioid dependence in 2002, but its diffusion into everyday clinical practice in community-based treatment programs has been slow. This study examines the net impact of efforts by state agencies, including provision of Medicaid coverage, on program-level adoption of buprenorphine as of 2006. Methods Interviews were conducted with key informants in 49 of the 50 state agencies with oversight responsibility for addiction treatment services. Information from these interviews was integrated with organizational data from the 2006 National Survey of Substance Abuse Treatment Services. A multivariate logistic regression model was estimated to identify the effects of state efforts to promote the use of this medication, net of a host of organizational characteristics. Results The availability of Medicaid coverage for buprenorphine was a significant predictor of its adoption by treatment organizations. Conclusion Inclusion of buprenorphine on state Medicaid formularies appears to be a key element in ensuring that patients have access to this state-of-the-art treatment option. Other potential barriers to the diffusion of buprenorphine require identification, and the value of additional state-level policies to promote its use should be evaluated.

  16. Analgesic Activity of Tramadol and Buprenorphine after Voluntary Ingestion by Rats (Rattus norvegicus).

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    Taylor, Bryan F; Ramirez, Harvey E; Battles, August H; Andrutis, Karl A; Neubert, John K

    2016-01-01

    Effective pain management for rats and mice is crucial due to the continuing increase in the use of these species in biomedical research. Here we used a recently validated operant orofacial pain assay to determine dose-response curves for buprenorphine and tramadol when mixed in nut paste and administered to male and female rats. Statistically significant analgesic doses of tramadol in nut paste included doses of 20, 30, and 40 mg/kg for female rats but only 40 mg/kg for male rats. For male rats receiving buprenorphine mixed in nut paste, a significant analgesic response was observed at 0.5 and 0.6 mg/kg. None of the doses tested produced a significant analgesic response in female rats. Our results indicate that at the doses tested, tramadol and buprenorphine produced an analgesic response in male rats. In female rats, tramadol shows a higher analgesic effect than buprenorphine. The analgesic effects observed 60 min after administration of the statistically significant oral doses of both drugs were similar to the analgesic effects of 0.03 mg/kg subcutaneous buprenorphine 30 min after administration. The method of voluntary ingestion could be effective, is easy to use, and would minimize stress to the rats during the immediate postoperative period.

  17. Buprenorphine pharmacotherapy and behavioral treatment: comparison of outcomes among prescription opioid users, heroin users and combination users.

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    Nielsen, Suzanne; Hillhouse, Maureen; Mooney, Larissa; Ang, Alfonso; Ling, Walter

    2015-01-01

    Most research examining buprenorphine has been conducted with heroin users. Few studies have examined buprenorphine pharmacotherapy for prescription opioid users. Data were from a randomized controlled trial of behavioral treatment provided for 16weeks on a platform of buprenorphine pharmacotherapy and medication management. We compared heroin (H, n=54), prescription opioid (PO, n=54) and combination heroin+prescription opioid (POH, n=71) users to test the hypothesis that PO users will have better treatment outcomes compared with heroin users. The PO group provided more opioid-negative urine drug screens over the combined treatment period (PO:70%, POH:40%, H:38%, pbuprenorphine dose between the groups. PO users appear to have better outcomes in buprenorphine pharmacotherapy compared to those reporting any heroin use, confirming that buprenorphine pharmacotherapy is effective in PO users.

  18. Visual evoked potential latencies of three-year-old children prenatally exposed to buprenorphine or methadone compared with non-opioid exposed children: The results of a longitudinal study.

    Science.gov (United States)

    Whitham, Justine N; Spurrier, Nicola J; Baghurst, Peter A; Weston, Paul; Sawyer, Michael G

    2015-01-01

    This study compared the latency of pattern reversal visual evoked potentials (VEP) of 36-month old children exposed to opioid pharmacotherapy in utero to that of a group of non-exposed children. Pregnant women were enrolled as part of an open-label non-randomised flexible dosing longitudinal study. Participants were 21 children whose mothers were treated with buprenorphine- (n=11) or methadone-pharmacotherapy (n=10) during pregnancy, and 15 children not exposed to opioids in pregnancy. One-way between groups analyses of variance (ANOVA) were conducted to test the statistical significance of differences between the mean latencies of the peak response to two different sized checkerboard patterns (48' and 69' of retinal arc). Standard multiple regression analyses were conducted to determine whether there was a significant relationship between group status and VEP latencies after adjusting for the effect of covariates. VEP latencies ranged from 98 to 112 milliseconds (ms) for checks of 48' arc, and from 95 to 113ms for checks of 69' arc. Latencies were comparable across groups. After adjusting for covariates children prenatally exposed to methadone or buprenorphine did not differ significantly from non-opioid exposed children in their responses to either check size. Nor were there any significant differences in VEP latencies between children prenatally exposed to methadone and children prenatally exposed to buprenorphine. Head circumference (HC) was significantly associated with P100 latencies for both check sizes. Data from this controlled, non-randomised study suggest that neither buprenorphine nor methadone appear to have any long-term effects on visual maturity assessed at 36months of age.

  19. Use of an Acetyl Derivative to Improve GC-MS Determination of Norbuprenorphine in the Presence of High Concentrations of Buprenorphine in Urine.

    Science.gov (United States)

    Gervais, Joel R; Hobbs, Gregory A

    2016-04-01

    Certain patients being treated with Suboxone™ or Subutex™ can exhibit very high buprenorphine and low norbuprenorphine concentrations in urine. Very high buprenorphine can interfere with buprenorphine-D4 used as an internal standard, causing errors in norbuprenorphine determination by gas chromatography-mass spectrometry (GC-MS). We used a modified method of Wu et al. to introduce norbuprenorphine-D3 as a separate internal standard for norbuprenorphine. This allowed us to accurately measure norbuprenorphine in neat urine specimens when buprenorphine is present in extremely high concentrations. Laboratories measuring buprenorphine and metabolite by GC-MS may face this problem if their clientele includes patients being treated with other medications that interfere with the cytochrome p450 CYP 3A4-mediated conversion of buprenorphine to norbuprenorphine.

  20. Prenatal buprenorphine versus methadone exposure and neonatal outcomes: systematic review and meta-analysis.

    Science.gov (United States)

    Brogly, Susan B; Saia, Kelley A; Walley, Alexander Y; Du, Haomo M; Sebastiani, Paola

    2014-10-01

    Increasing rates of maternal opioid use during pregnancy and neonatal withdrawal, termed neonatal abstinence syndrome (NAS), are public health concerns. Prenatal buprenorphine maintenance treatment (BMT) versus methadone maintenance treatment (MMT) may improve neonatal outcomes, but associations vary. To summarize evidence, we used a random-effects meta-analysis model and estimated summary measures of BMT versus MMT on several outcomes. Sensitivity analyses evaluated confounding, publication bias, and heterogeneity. Subjects were 515 neonates whose mothers received BMT and 855 neonates whose mothers received MMT and who were born from 1996 to 2012 and who were included in 12 studies. The unadjusted NAS treatment risk was lower (risk ratio=0.90, 95% confidence interval (CI): 0.81, 0.98) and mean length of hospital stay shorter (-7.23 days, 95% CI: -10.64, -3.83) in BMT-exposed versus MMT-exposed neonates. In treated neonates, NAS treatment duration was shorter (-8.46 days, 95% CI: -14.48, -2.44) and morphine dose lower (-3.60 mg, 95% CI: -7.26, 0.07) in those exposed to BMT. BMT-exposed neonates had higher mean gestational age and greater weight, length, and head circumference at birth. Fewer women treated with BMT used illicit opioids near delivery (risk ratio=0.44, 95% CI: 0.28, 0.70). Simulations suggested that confounding by indication could account for some of the observed differences. Prenatal BMT versus MMT may improve neonatal outcomes, but bias may contribute to this protective association. Further evidence is needed to guide treatment choices.

  1. Antinociceptive effects of voluntarily ingested buprenorphine in the hot-plate test in laboratory rats.

    Science.gov (United States)

    Hestehave, Sara; Munro, Gordon; Pedersen, Tina Brønnum; Abelson, Klas S P

    2016-09-27

    Researchers performing experiments on animals should always strive towards the refinement of experiments, minimization of stress and provision of better animal welfare. An adequate analgesic strategy is important to improve post-operative recovery and welfare in laboratory rats and mice. In addition, it is desirable to provide post-operative analgesia using methods that are minimally invasive and stressful. This study investigated the antinociceptive effects of orally administered buprenorphine ingested in Nutella® in comparison with subcutaneous buprenorphine administration. By exposing the animal to a thermal stimulus using a hot plate, significant antinociceptive effects of voluntarily ingested buprenorphine administered in Nutella® were demonstrated. This was evident at doses of 1.0 mg/kg 60 and 120 min post administration (P Nutella® in a 10-fold higher dose, as well as approximately 60 min earlier, than with the more commonly employed subcutaneous route of administration.

  2. Pharmacokinetic Profiles of Meloxicam and Sustained-release Buprenorphine in Prairie Dogs (Cynomys ludovicianus).

    Science.gov (United States)

    Cary, Cynthia D; Lukovsky-Akhsanov, Nicole L; Gallardo-Romero, Nadia F; Tansey, Cassandram M; Ostergaard, Sharon D; Taylor, Willie D; Morgan, Clint N; Powell, Nathaniel; Lathrop, George W; Hutson, Christina L

    2017-03-01

    In this study, we evaluated the pharmacokinetic profiles of meloxicam and sustained-release (SR) buprenorphine in prairie dogs. The 4 treatment groups were: low-dose meloxicam (0.2 mg/kg SC), high-dose meloxicam (4 mg/kg SC), low-dose buprenorphine SR (0.9 mg/kg SC), and high-dose buprenorphine SR (1.2 mg/kg SC). The highest plasma concentrations occurred within 4 h of administration for both meloxicam treatment groups. The therapeutic range of meloxicam in prairie dogs is currently unknown. However, as compared with the therapeutic range documented in other species (0.39 - 0.91 μg/mL), the mean plasma concentration of meloxicam fell below the minimal therapeutic range prior to 24 h in the low-dose group but remained above therapeutic levels for more than 72 h in the high-dose group. These findings suggest that the current meloxicam dosing guidelines may be subtherapeutic for prairie dogs. The highest mean plasma concentration for buprenorphine SR occurred at the 24-h time point (0.0098 μg/mL) in the low-dose group and at the 8-h time point (0.015 μg/mL) for the high-dose group. Both dosages of buprenorphine SR maintained likely plasma therapeutic levels (0.001 μg/mL, based on previous rodent studies) beyond 72 h. Given the small scale of the study and sample size, statistical analysis was not performed. The only adverse reactions in this study were mild erythematous reactions at injection sites for buprenorphine SR.

  3. Subcutaneous Implants of Buprenorphine-Cholesterol-Triglyceride Powder in Mice

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    L. DeTolla

    2014-01-01

    Full Text Available Subcutaneous drug implants are convenient systems for the long-term delivery of drugs in animals. Lipid carriers are logical tools because they generally allow for higher doses and low toxicity. The present study used an US Food and Drug Administration Target Animal Safety test system to evaluate the safety of a subcutaneous implant of a cholesterol-triglyceride-buprenorphine powder in 120 BALB/c mice. Mice were evaluated in 4- and 12-day trials with 1- and 5-fold doses of the intended 3 mg/kg dose of drug. One male mouse treated with three 3 mg/kg doses and surgery on days 0, 4, and 8 died on day 9. The cause of death was not determined. In the surviving 119 mice there was no evidence of skin reaction at the site of the implant. Compared to control animals treated with saline, weight measurements, clinical pathology, histopathology, and clinical observations were unremarkable. These results demonstrate that the lipid carrier is substantially safe. Cholesterol-triglyceride-drug powders may provide a valuable research tool for studies of analgesic and inflammatory drug implants in veterinary medicine.

  4. Low-dose naloxone provides an abuse-deterrent effect to buprenorphine

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    Webster LR

    2015-11-01

    Full Text Available Lynn R Webster,1 Michael D Smith,1 Cemal Unal,2 Andrew Finn3 1PRA Health Sciences, Salt Lake City, UT, USA; 2Biometrical Solutions LLC, Raleigh, NC, USA; 3BioDelivery Sciences International, Inc., Raleigh, NC, USA Abstract: In developmental research, plasma buprenorphine concentrations comparable to a 2 mg buprenorphine–naloxone (BN sublingual tablet have been achieved with a 0.75 mg dose of BN buccal film, a small, bioerodible polymer film for application to mucosal membranes. This was a randomized, double-blind, placebo-controlled, single-dose, four-period crossover study in opioid-dependent subjects with chronic pain receiving >100 mg oral morphine equivalents daily who experienced withdrawal following a naloxone challenge dose. The objective of the study was to determine if intravenous (IV naloxone doses of 0.1 and 0.2 mg would produce a withdrawal response when coadministered with a 0.75 mg IV dose of buprenorphine. Fifteen subjects receiving 90–1,260 mg oral morphine equivalents per day enrolled and completed the study. Precipitated withdrawal occurred in 13% (2/15 of placebo-treated subjects and 47% (7/15 of buprenorphine-treated subjects. When combined with the 0.75 mg dose of buprenorphine, a 0.1 mg dose of naloxone increased the incidence of precipitated withdrawal to 60%, and a 0.2 mg dose of naloxone increased the incidence to 73%. By 15 minutes postdose, the mean change in Clinical Opioid Withdrawal Scale (COWS score from predose was 3.0 for placebo, 6.9 for buprenorphine, 9.8 for BN 0.1 mg, and 12.4 for BN 0.2 mg. The mean COWS score with each active treatment was significantly greater than placebo (P<0.001, and the mean COWS score for each of the naloxone-containing treatments was significantly greater than for buprenorphine alone (P<0.001. Naloxone doses as low as 0.1 mg added an abuse-deterrent effect to a 0.75 mg IV dose of buprenorphine. Keywords: opioid dependence, withdrawal symptoms, abuse-deterrent, buprenorphine

  5. Buprenorphine-induced antinociception is mediated by mu-opioid receptors and compromised by concomitant activation of opioid receptor-like receptors.

    Science.gov (United States)

    Lutfy, Kabirullah; Eitan, Shoshana; Bryant, Camron D; Yang, Yu C; Saliminejad, Nazli; Walwyn, Wendy; Kieffer, Brigitte L; Takeshima, Hiroshi; Carroll, F Ivy; Maidment, Nigel T; Evans, Christopher J

    2003-11-12

    Buprenorphine is a mixed opioid receptor agonist-antagonist used clinically for maintenance therapy in opiate addicts and pain management. Dose-response curves for buprenorphine-induced antinociception display ceiling effects or are bell shaped, which have been attributed to the partial agonist activity of buprenorphine at opioid receptors. Recently, buprenorphine has been shown to activate opioid receptor-like (ORL-1) receptors, also known as OP4 receptors. Here we demonstrate that buprenorphine, but not morphine, activates mitogen-activated protein kinase and Akt via ORL-1 receptors. Because the ORL-1 receptor agonist orphanin FQ/nociceptin blocks opioid-induced antinociception, we tested the hypothesis that buprenorphine-induced antinociception might be compromised by concomitant activation of ORL-1 receptors. In support of this hypothesis, the antinociceptive effect of buprenorphine, but not morphine, was markedly enhanced in mice lacking ORL-1 receptors using the tail-flick assay. Additional support for a modulatory role for ORL-1 receptors in buprenorphine-induced antinociception was that coadministration of J-113397, an ORL-1 receptor antagonist, enhanced the antinociceptive efficacy of buprenorphine in wild-type mice but not in mice lacking ORL-1 receptors. The ORL-1 antagonist also eliminated the bell-shaped dose-response curve for buprenorphine-induced antinociception in wild-type mice. Although buprenorphine has been shown to interact with multiple opioid receptors, mice lacking micro-opioid receptors failed to exhibit antinociception after buprenorphine administration. Our results indicate that the antinociceptive effect of buprenorphine in mice is micro-opioid receptor-mediated yet severely compromised by concomitant activation of ORL-1 receptors.

  6. Effects of regulation on methadone and buprenorphine provision in the wake of Hurricane Sandy.

    Science.gov (United States)

    McClure, Bridget; Mendoza, Sonia; Duncan, Laura; Rotrosen, John; Hansen, Helena

    2014-10-01

    Hurricane Sandy led to the closing of many major New York City public hospitals including their substance abuse clinics and methadone programs, and the displacement or relocation of thousands of opioid-dependent patients from treatment. The disaster provided a natural experiment that revealed the relative strengths and weaknesses of methadone treatment in comparison to physician office-based buprenorphine treatment for opioid dependence, two modalities of opioid maintenance with markedly different regulatory requirements and institutional procedures. To assess these two modalities of treatment under emergency conditions, semi-structured interviews about barriers to and facilitators of continuity of care for methadone and buprenorphine patients were conducted with 50 providers of opioid maintenance treatment. Major findings included that methadone programs presented more regulatory barriers for providers, difficulty with dose verification due to impaired communication, and an over reliance on emergency room dosing leading to unsafe or suboptimal dosing. Buprenorphine treatment presented fewer regulatory barriers, but buprenorphine providers had little to no cross-coverage options compared to methadone providers, who could refer to alternate methadone programs. The findings point to the need for well-defined emergency procedures with flexibility around regulations, the need for a central registry with patient dose information, as well as stronger professional networks and cross-coverage procedures. These interventions would improve day-to-day services for opioid-maintained patients as well as services under emergency conditions.

  7. Evaluation of analgesic effect and absorption of buprenorphine after buccal administration in cats with oral disease.

    Science.gov (United States)

    Stathopoulou, Thaleia-Rengina; Kouki, Maria; Pypendop, Bruno H; Johnston, Atholl; Papadimitriou, Serafeim; Pelligand, Ludovic

    2017-09-01

    Objectives The objective of this study was to evaluate the analgesic effect and absorption of buprenorphine after buccal administration in cats with oral disease. Methods Six adult client-owned cats with chronic gingivostomatitis (weighing 5.1 ± 1.1 kg) were recruited for a randomised, prospective, blinded, saline-controlled, crossover study. Pain scores, dental examination, stomatitis score and buccal pH measurement were conducted on day 1 under sedation in all cats. On day 2, animals were randomised into two groups and administered one of the two treatments buccally (group A received buprenorphine 0.02 mg/kg and group B received 0.9% saline) and vice versa on day 3. Pain scores and food consumption were measured at 30, 90 and 360 mins after the administration of buprenorphine. Blood samples were taken at the same time and plasma buprenorphine concentration was measured by liquid chromatography-mass spectrometry. Data were statistically analysed as non-parametric and the level of significance was set as P gingivostomatitis produces an analgesic effect and low inter-individual variability in plasma concentration, and it can be incorporated in their multimodal analgesia plan.

  8. Mobile phone use patterns and preferences in safety net office-based buprenorphine patients.

    Science.gov (United States)

    Tofighi, Babak; Grossman, Ellie; Buirkle, Emily; McNeely, Jennifer; Gourevitch, Marc; Lee, Joshua D

    2015-01-01

    Integrating mobile phone technologies in addiction treatment is of increasing importance and may optimize patient engagement with their care and enhance the delivery of existing treatment strategies. Few studies have evaluated mobile phone and text message (TM) use patterns in persons enrolled in addiction treatment, and none have assessed the use in safety net, office-based buprenorphine practices. A 28-item, quantitative and qualitative semistructured survey was administered to opiate-dependent adults in an urban, publicly funded, office-based buprenorphine program. Survey domains included demographic characteristics, mobile phone and TM use patterns, and preferences pertaining to their recovery. Surveyors approached 73 of the 155 eligible subjects (47%); 71 respondents completed the survey. Nearly all participants reported mobile phone ownership (93%) and TM use (93%), and most reported "very much" or "somewhat" comfort sending TM (79%). Text message contact with 12-step group sponsors, friends, family members, and counselors was also described (32%). Nearly all preferred having their providers' mobile phone number (94%), and alerting the clinic via TM in the event of a potential relapse to receive both supportive TM and a phone call from their buprenorphine provider was also well received (62%). Mobile phone and TM use patterns and preferences among this sample of office-based buprenorphine participants highlight the potential of adopting patient-centered mobile phone-based interventions in this treatment setting.

  9. Synthesis of high-specific activity [15,16-{sup 3}H{sub 2}]buprenorphine

    Energy Technology Data Exchange (ETDEWEB)

    Oetvoes, F.; Toth, G. [Hungarian Academy of Sciences, Szeged (Hungary). Isotope Lab.; Hosztafi, S.; Simon, C. [Alkaloida Chemical Factory Ltd., Tiszavasvari (Hungary)

    1995-01-01

    Tritium labelling of buprenorphine, a mixed agonist-antagonist opioid ligand, was performed with a specific activity of 2.35 TBq/mmol (63.6 Ci/mmol) starting with 15,16-didehydrobuprenorphine. Labels at positions 15 and 16 of the morphine skeleton proved to be sufficiently stable under strong acidic or basic conditions. (Author).

  10. Developing and Implementing a New Prison-Based Buprenorphine Treatment Program

    Science.gov (United States)

    Kinlock, Timothy W.; Gordon, Michael S.; Schwartz, Robert P.; Fitzgerald, Terrence T.

    2010-01-01

    Research suggests that buprenorphine treatment may be a promising intervention for incarcerated individuals with heroin addiction histories. However, its implementation varies from corrections-based methadone because of unique challenges regarding dosing, administration, and regulation. Describing the first randomized clinical trial of…

  11. Pharmacokinetic-pharmacodynamic relationships of cognitive and psychomotor effects of intravenous buprenorphine infusion in human volunteers.

    Science.gov (United States)

    Jensen, Mette L; Sjøgren, Per; Upton, Richard N; Foster, David J R; Bonde, Peter; Graae, Christian; Skram, Ulrik; Stevner, Lene; Christrup, Lona L

    2008-07-01

    The main objective of the present study was to characterize the pharmacokinetic/pharmacodynamic (PK/PD) relationship of the effects of buprenorphine on cognitive functioning in healthy volunteers. Twenty-three male volunteers received 0.6 mg buprenorphine as an intravenous infusion over 150 min. The cognitive and psychomotor performance was evaluated before and at various times after drug administration by a test battery consisting of trail-making test for visual information processing, finger-tapping test for psychomotor speed, and continuous reaction time for attention. Non-linear mixed effect modelling was used in the analysis of the PK/PD relationships. Buprenorphine caused significant deficits in cognitive and psychomotor functioning. The time course of cognitive and psychomotor impairment was found to have a slow distribution to the biophase from plasma with PK/PD models involving an effect compartment providing the best descriptions of the time course of the data. The values for half-life of biophase equilibration were consistent between the neuropsychological tests in the range of 66.6-84.9 min. The time to onset and duration of the cognitive and psychomotor impairment of buprenorphine was determined by a slow distribution to the biophase.

  12. Management of chronic pain in the elderly: focus on transdermal buprenorphine

    Directory of Open Access Journals (Sweden)

    Nalini Vadivelu

    2008-09-01

    Full Text Available Nalini Vadivelu, Roberta L HinesDepartment of Anesthesiology, Yale University School of Medicine, New Haven, USAAbstract: Chronic pain in the elderly is a significant problem. Pharmacokinetic and metabolic changes associated with increased age makes the elderly vulnerable to side effects and overdosing associated with analgesic agents. Therefore the management of chronic cancer pain and chronic nonmalignant pain in this growing population is an ongoing challenge. New routes of administration have opened up new treatment options to meet this challenge. The transdermal buprenorphine matrix allows for slow release of buprenorphine and damage does not produce dose dumping. In addition the long-acting analgesic property and relative safety profile makes it a suitable choice for the treatment of chronic pain in the elderly. Its safe use in the presence of renal failure makes it an attractive choice for older individuals. Recent scientific studies have shown no evidence of a ceiling dose of analgesia in man but only a ceiling effect for respiratory depression, increasing its safety profile. It appears that transdermal buprenorphine can be used in clinical practice safely and efficaciously for treating chronic pain in the elderly.Keywords: transdermal buprenorphine, chronic pain, elderly

  13. Morphine- and buprenorphine-induced analgesia and antihyperalgesia in a human inflammatory pain model

    DEFF Research Database (Denmark)

    Ravn, Pernille; Secher, EL; Skram, U

    2013-01-01

    Opioid therapy is associated with the development of tolerance and paradoxically increased sensitivity to pain. It has been suggested that buprenorphine is associated with a higher antihyperalgesia/analgesia ratio than μ-opioid receptor agonists. The primary outcome of this study was therefore to...

  14. Buprenorphine pharmacokinetic parameters during coronary artery bypass graft surgery.

    Science.gov (United States)

    Amani, A; Joseph, T; Balasaraswathi, K

    1997-10-01

    The pharmacokinetic parameters of buprenorphine (BN) after a single bolus dose of 10 microg/kg i.v. was investigated in 6 male patients whose age averaged 59+/-9.8 years and body weight of 65.8+/-5.7 kg undergoing coronary artery bypass graft surgery (CABG). The unbound BN plasma concentrations were detected using ultrafiltration and high performance liquid chromatography/electro-chemical detection (HPLC/ECD) method. During cardiopulmonary bypass (CPB) there was a fall in BN plasma concentrations, observations similar to reports on fentanyl, sufentanil and alfentanil. This is probably due to haemodilution, hypothermia and hydrophobic sequestration of drug on to the CPB tubing. After CPB the concentrations rose to values higher than during CPB, though it did not attain pre CPB concentrations. These variations were not statistically significant indicating that plasma levels were adequately stable during CPB. The plasma concentration time curves were biexponential and the pharmacokinetic parameters obtained were : distribution half-life 37.24+/-6.57 min, elimination half-life 482.69+/-79 min, clearance 1221.97+/-209.42 ml/min, and volume of distribution 736.46+/-71.25 L. BN in the dose used follows the pharmacokinetic pattern of other commonly used narcotics during CABG. The mean +/- SEM plasma BN concentration during CPB was 0.51+/-0.03 ng/ml which was adequate for the maintenance of analgesia and anaesthesia, as none of our patients expressed the signs and symptoms of awareness during surgery. Further, unlike the other narcotics muscle rigidity was absent. Thus BN is a safe and good alternative to other narcotics for patients undergoing CABG.

  15. Oral self-administration of buprenorphine in the diet for analgesia in mice.

    Science.gov (United States)

    Molina-Cimadevila, M J; Segura, S; Merino, C; Ruiz-Reig, N; Andrés, B; de Madaria, E

    2014-07-01

    Postsurgical oral self-administration of analgesics in rodents is an interesting technique of providing analgesia, avoiding the negative effects of manipulation. Several strategies, using gelatin or nutella, have already been described. However, rodents require some habituation period to reach a good intake because of their neophobic behavior. The current study aimed to explore whether buprenorphine when mixed with an extruded diet offers a potential treatment option in the pain management of mice using a triple approach: by measuring the spontaneous intake in healthy animals; by using the hot-plate test; and finally by assessing the drug's ability to provide postoperative analgesia in a surgical intervention of moderate severity (intra-utero electroporation). Mice consumed during 20 hours, similar amounts of extruded diet alone, mixed with glucosaline, and mixed with buprenorphine (0.03 mg per pellet) or meloxicam (0.25 mg per pellet) both of which were diluted in glucosaline, showing that no neophobia was associated with these administrations. Relative increase from baseline latency (% maximal possible effect) in the hot-plate test at 20 h of administration was significantly higher for oral buprenorphine in diet 0.03 mg/pellet, and diet 0.15 mg/pellet, compared with placebo and no differences were found between those oral administrations and subcutaneous buprenorphine 0.1 mg/kg measured 3 h later. The treatment was also effective in attenuating the reductions in food consumption and body weight that occur after surgery. These data suggest that providing buprenorphine with the diet is a feasible and effective way of self-administration of analgesia in mice and does not cause neophobia and may easily contribute to the refinement of surgical procedures.

  16. The impact of long-term maintenance treatment with buprenorphine on complex psychomotor and cognitive function.

    Science.gov (United States)

    Shmygalev, Sergey; Damm, Martin; Weckbecker, Klaus; Berghaus, Günter; Petzke, Frank; Sabatowski, Rainer

    2011-09-01

    Despite the fact that buprenorphine is effective, well tolerated and due to its pharmacological profile a very safe drug, the impact of long-term buprenorphine substitution therapy on complex psychomotor and cognitive function predicting driving ability is not yet clear. Therefore, a prospective comparison between patients receiving sublingual buprenorphine and a control group of untreated, healthy volunteers was performed. Treated and untreated subjects were matched for age and sex, with three control subjects selected for every buprenorphine patient. Patients using unreported drugs were included in the intention-to-treat (ITT) analysis; the remaining patients were analysed as the per-protocol (PP) group. The test battery comprised the assessment of: performance during stress, visual orientation, concentration, attention, vigilance and reaction time. The primary endpoint was defined as the sum of the relevant scores of the tests after z-transformation of the individual scores. 30 patients with sublingual buprenorphine treatment (7.7±3.9 mg per day) were matched to 90 controls. 19 patients were excluded from the PP-analysis because of additional unreported drug intake. Significant non-inferiority could be demonstrated for the PP-group (pcomplex psychomotor or cognitive performance as compared to healthy controls. However intake of illicit drugs as well as the lack of social reliability are major problems in this specific patients group. Despite of the absence of a relevant impact of the drug on driving ability, those patients do not seem to be qualified for getting their driving license. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  17. The diversion and injection of a buprenorphine-naloxone soluble film formulation.

    Science.gov (United States)

    Larance, Briony; Lintzeris, Nicholas; Ali, Robert; Dietze, Paul; Mattick, Richard; Jenkinson, Rebecca; White, Nancy; Degenhardt, Louisa

    2014-03-01

    We compared the diversion and injection of a new formulation of buprenorphine, a buprenorphine-naloxone film product (BNX film), with buprenorphine-naloxone tablets (BNX tablets), mono-buprenorphine (BPN) and methadone (MET) in Australia. Surveys were conducted with people who inject drugs regularly (PWID) (2004-2012) and opioid substitution treatment (OST) clients (2012, N=543). Key outcome measures: the unsanctioned removal of supervised doses, diversion, injection, motivations, drug liking and street price. Levels of injection among PWID were adjusted for background availability of medication using sales data. Doses not taken as directed by OST clients were adjusted by total number of daily doses dispensed. Among out-of-treatment PWID, levels of injection for BNX film were comparable to those for MET and BNX tablet formulations, adjusting for background availability; BPN injecting levels were higher. Among OST clients, recent injecting of one's medication was similar among clients in all OST types; weekly or more frequent injection of prescribed doses was reported by fewer BNX film clients (3%; 95% CI: 1-6) than BPN clients (11%; 95% CI: 3-17), but at levels similar to those observed among MET and BNX tablet clients. The proportion of BNX film doses injected was lower than that for BPN and BNX tablets, and equivalent to that for MET. The majority of BNX film doses injected by OST clients were unsupervised doses, although some injection of supervised doses of BNX film did occur. The median price of all buprenorphine forms on the illicit market was the same. Non-adherence and diversion of the BNX film formulation was similar to MET and BNX tablet formulations; BPN had higher levels of all indicators of non-adherence and diversion. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  18. Cost-effectiveness of buprenorphine and naltrexone treatments for heroin dependence in Malaysia.

    Science.gov (United States)

    Ruger, Jennifer Prah; Chawarski, Marek; Mazlan, Mahmud; Ng, Nora; Schottenfeld, Richard

    2012-01-01

    To aid public health policymaking, we studied the cost-effectiveness of buprenorphine, naltrexone, and placebo interventions for heroin dependence in Malaysia. We estimated the cost-effectiveness ratios of three treatments for heroin dependence. We used a microcosting methodology to determine fixed, variable, and societal costs of each intervention. Cost data were collected from investigators, staff, and project records on the number and type of resources used and unit costs; societal costs for participants' time were estimated using Malaysia's minimum wage. Costs were estimated from a provider and societal perspective and reported in 2004 US dollars. Muar, Malaysia. 126 patients enrolled in a randomized, double-blind, placebo-controlled clinical trial in Malaysia (2003-2005) receiving counseling and buprenorphine, naltrexone, or placebo for treatment of heroin dependence. Primary outcome measures included days in treatment, maximum consecutive days of heroin abstinence, days to first heroin use, and days to heroin relapse. Secondary outcome measures included treatment retention, injection drug use, illicit opiate use, AIDS Risk Inventory total score, and drug risk and sex risk subscores. Buprenorphine was more effective and more costly than naltrexone for all primary and most secondary outcomes. Incremental cost-effectiveness ratios were below $50 for primary outcomes, mostly below $350 for secondary outcomes. Naltrexone was dominated by placebo for all secondary outcomes at almost all endpoints. Incremental treatment costs were driven mainly by medication costs, especially the price of buprenorphine. Buprenorphine appears to be a cost-effective alternative to naltrexone that might enhance economic productivity and reduce drug use over a longer term.

  19. Pharmacokinetics of buprenorphine following intravenous and buccal administration in cats, and effects on thermal threshold.

    Science.gov (United States)

    Hedges, A R; Pypendop, B H; Shilo-Benjamini, Y; Stanley, S D; Ilkiw, J E

    2014-06-01

    This study reports the pharmacokinetics of buprenorphine, following i.v. and buccal administration, and the relationship between buprenorphine concentration and its effect on thermal threshold. Buprenorphine (20 μg/kg) was administered intravenously or buccally to six cats. Thermal threshold was determined, and arterial blood sampled prior to, and at various times up to 24 h following drug administration. Plasma buprenorphine concentration was determined using liquid chromatography/mass spectrometry. Compartment models were fitted to the time-concentration data. Pharmacokinetic/pharmacodynamic models were fitted to the concentration-thermal threshold data. Thermal threshold was significantly higher than baseline 44 min after buccal administration, and 7, 24, and 104 min after i.v. administration. A two- and three-compartment model best fitted the data following buccal and i.v. administration, respectively. Following i.v. administration, mean ± SD volume of distribution at steady-state (L/kg), clearance (mL·min/kg), and terminal half-life (h) were 11.6 ± 8.5, 23.8 ± 3.5, and 9.8 ± 3.5. Following buccal administration, absorption half-life was 23.7 ± 9.1 min, and terminal half-life was 8.9 ± 4.9 h. An effect-compartment model with a simple effect maximum model best predicted the time-course of the effect of buprenorphine on thermal threshold. Median (range) ke0 and EC50 were 0.003 (0.002-0.018)/min and 0.599 (0.073-1.628) ng/mL (i.v.), and 0.017 (0.002-0.023)/min and 0.429 (0.144-0.556) ng/mL (buccal).

  20. Buprenorphine versus dihydrocodeine for opiate detoxification in primary care: a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Adams Clive E

    2007-01-01

    Full Text Available Abstract Background Many drug users present to primary care requesting detoxification from illicit opiates. There are a number of detoxification agents but no recommended drug of choice. The purpose of this study is to compare buprenorphine with dihydrocodeine for detoxification from illicit opiates in primary care. Methods Open label randomised controlled trial in NHS Primary Care (General Practices, Leeds, UK. Sixty consenting adults using illicit opiates received either daily sublingual buprenorphine or daily oral dihydrocodeine. Reducing regimens for both interventions were at the discretion of prescribing doctor within a standard regimen of not more than 15 days. Primary outcome was abstinence from illicit opiates at final prescription as indicated by a urine sample. Secondary outcomes during detoxification period and at three and six months post detoxification were recorded. Results Only 23% completed the prescribed course of detoxification medication and gave a urine sample on collection of their final prescription. Risk of non-completion of detoxification was reduced if allocated buprenorphine (68% vs 88%, RR 0.58 CI 0.35–0.96, p = 0.065. A higher proportion of people allocated to buprenorphine provided a clean urine sample compared with those who received dihydrocodeine (21% vs 3%, RR 2.06 CI 1.33–3.21, p = 0.028. People allocated to buprenorphine had fewer visits to professional carers during detoxification and more were abstinent at three months (10 vs 4, RR 1.55 CI 0.96–2.52 and six months post detoxification (7 vs 3, RR 1.45 CI 0.84–2.49. Conclusion Informative randomised trials evaluating routine care within the primary care setting are possible amongst drug using populations. This small study generates unique data on commonly used treatment regimens.

  1. Pharmacokinetics and Paw Withdrawal Pressure in Female Guinea Pigs (Cavia porcellus) Treated with Sustained-Release Buprenorphine and Buprenorphine Hydrochloride.

    Science.gov (United States)

    Smith, Brian J; Wegenast, Daniel J; Hansen, Ryan J; Hess, Ann M; Kendall, Lon V

    2016-11-01

    Providing appropriate analgesia is essential in minimizing pain and maintaining optimal animal care and welfare in laboratory animals. Guinea pigs are common animal models in biomedical research, often requiring analgesic support. Here we evaluated the pharmacokinetics and efficacy of a sustained-release formulation of buprenorphine (Bup-SR) in this species. Guinea pigs (n = 7 each group) received either Bup-HCl (0.05 mg/kg BID for 3 d) or Bup-SR (0.3 mg/kg once). Plasma collection and measurement of paw-withdrawal pressure (PWP) was conducted at 0, 1, 3, 6, 12, 26, 48, and 72 h after treatment. Plasma levels of Bup-HCl peaked at 2331 pg/mL at 1 h after administration and declined to 165 pg/mL by 12 h. Plasma concentrations of Bup-SR peaked at 1344 pg/mL at 26 h after administration and declined to 429 pg/mL by 48 h. The PWP of the Bup-HCltreated guinea pigs peaked at 674 g at 1 h and declined to 402 g at 6 h, whereas that of Bup-SRtreated guinea pigs at 1 h was 361 g, 555 g at 6 h (significantly higher than that after Bup-HCl), and peaked at 680 g at 12 h. The PWP of both treatments was similar from 24 to 72 h and ranged from 348 to 450 g. The plasma concentration and PWP showed good correlation. These results suggest that Bup-SR provides consistent analgesia equivalent to that of Bup-HCl for a prolonged period of time and that Bup-SR is an alternative method of analgesia in guinea pigs.

  2. An unusual case of death probably triggered by the association of buprenorphine at therapeutic dose with ethanol and benzodiazepines and with very low norbuprenorphine level.

    Science.gov (United States)

    Bardy, Guillaume; Cathala, Philippe; Eiden, Céline; Baccino, Eric; Petit, Pierre; Mathieu, Olivier

    2015-01-01

    Buprenorphine is largely prescribed for maintenance treatment in opioid dependence due to its safety profile. Nevertheless, fatalities at therapeutic dose have been described when associated with other central nervous system depressants, such as ethanol or benzodiazepines. Here, we report a case of death due to association of buprenorphine at therapeutic dose with benzodiazepines and ethanol. Although toxicity has been often attributed to its metabolite norbuprenorphine rather than to buprenorphine itself, in our case, norbuprenorphine was not detected in urine and bile and only in traces in blood. Moreover, the presence in blood of free buprenorphine but not of glucuronide metabolites argues for an unusual early death, at the beginning of buprenorphine metabolism. We propose that in the context of prior toxic impregnation, buprenorphine directly (and not via its metabolite norbuprenorphine) acted as a triggering factor by blocking the ventilatory response, rapidly leading to fatal respiratory depression.

  3. Effects of voluntarily-ingested buprenorphine on plasma corticosterone levels, body weight, water intake, and behaviour in permanently catheterised rats

    DEFF Research Database (Denmark)

    Goldkuhl, Renée; Hau, Jann; Abelson, Klas

    2010-01-01

    This study investigated the peri- and postoperative effect of pre-emptive analgesia through voluntary ingestion of buprenorphine in Nutella, in male Sprague-Dawley rats. An arterial catheter was inserted and the rats were connected to an automated blood sampling device (AccuSampler). Blood samples...... in the operated rats. The present study strengthens the hypothesis that pre-emptive oral buprenorphine in Nutella is suitable for treatment of postoperative pain in rats....

  4. Effect of buprenorphine on genotoxicity evaluation of chemicals by the rat liver micronucleus test with partial hepatectomy.

    Science.gov (United States)

    Itoh, Satoru; Nagata, Mayumi; Hattori, Chiharu; Takasaki, Wataru

    2015-02-01

    In the view of animal welfare considerations, we investigated the suitability of modifying the rat liver micronucleus test with partial hepatectomy to include administration of an analgesic drug to minimize pain and distress as much as possible. The effects of the analgesic, buprenorphine, on the genotoxicity evaluation of structural chromosome aberration inducers (cyclophosphamide, diethylnitrosamine and 1,2-dimethylhydrazine) and numerical chromosome aberration inducers (colchicine and carbendazim) were examined. The genotoxicants were given orally to 8-week-old male F344 rats a day before or after partial hepatectomy and hepatocytes were isolated 4 days after the partial hepatectomy. Buprenorphine was injected subcutaneously twice a day with at least a 6-hr interval for 2 days from just after partial hepatectomy. As results, buprenorphine caused neither change in clinical signs (except for one animal death) nor increase in the incidence of micronucleated hepatocytes of vehicle treated animals. In the case of concomitant treatment of buprenorphine and a genotoxicant, one out of 8 animals died in each group given buprenorphine with cyclophosphamide, carbendazim or colchicine (lower dose level only). Slight changes in clinical signs were noted in the group given buprenorphine with cyclophosphamide or carbendazim. A statistically significant increase in the incidence of micronucleated hepatocytes was obtained in concomitant treatment of buprenorphine and genotoxicant compared with genotoxicant alone for 1,2-dimethylhydrazine, colchicine and carbendazim. It is concluded that use of buprenorphine as an analgesic drug to minimize pain and distress for rats that are given partial hepatectomy is not appropriate under the present experimental conditions, because it could enhance the general toxicity and genotoxicity of the test chemical.

  5. Respiratory Rates and Arterial Blood-Gas Tensions in Healthy Rabbits Given Buprenorphine, Butorphanol, Midazolam, or Their Combinations

    Science.gov (United States)

    Schroeder, Carrie A; Smith, Lesley J

    2011-01-01

    The objective of this study was to evaluate the respiratory effects of buprenorphine, butorphanol, midazolam, and their combinations in healthy conscious rabbits. Six adult female New Zealand white rabbits were anesthetized briefly with isoflurane by mask to allow placement of a catheter into the central ear artery. After a 60-min recovery period, a baseline arterial sample was obtained. Animals then were injected intramuscularly with either 0.9% NaCl (1 mL), buprenorphine (0.03 mg/kg), butorphanol (0.3 mg/kg), midazolam (2 mg/kg), buprenorphine + midazolam (0.03 mg/kg, 2 mg/kg), or butorphanol + midazolam (0.3 mg/kg, 2 mg/kg). Arterial blood gases were evaluated at 30, 60, 90, 120, 180, 240, and 360 min after drug administration. All drug treatments caused significant decreases in respiratory rate, compared with saline. Buprenorphine and the combinations of midazolam–butorphanol and midazolam–buprenorphine resulted in statistically significant decreases in pO2. No significant changes in pCO2 pressure were recorded for any treatment. Increases in blood pH were associated with administration of butorphanol, midazolam, and the combinations of midazolam–butorphanol and midazolam–buprenorphine. In light of these results, buprenorphine and the combinations of midazolam–buprenorphine and midazolam–butorphanol result in statistically significant hypoxemia in rabbits that breathe room air. The degree of hypoxemia is of questionable clinical importance in these healthy subjects. Hypoxemia resulting from these drug combinations may be amplified in rabbits with underlying pulmonary or systemic disease. PMID:21439214

  6. Use of microdoses for induction of buprenorphine treatment with overlapping full opioid agonist use: the Bernese method

    Science.gov (United States)

    Hämmig, Robert; Kemter, Antje; Strasser, Johannes; von Bardeleben, Ulrich; Gugger, Barbara; Walter, Marc; Dürsteler, Kenneth M; Vogel, Marc

    2016-01-01

    Background Buprenorphine is a partial µ-opioid receptor agonist used for maintenance treatment of opioid dependence. Because of the partial agonism and high receptor affinity, it may precipitate withdrawal symptoms during induction in persons on full µ-opioid receptor agonists. Therefore, current guidelines and drug labels recommend leaving a sufficient time period since the last full agonist use, waiting for clear and objective withdrawal symptoms, and reducing pre-existing full agonist therapies before administering buprenorphine. However, even with these precautions, for many patients the induction of buprenorphine is a difficult experience, due to withdrawal symptoms. Furthermore, tapering of the full agonist bears the risk of relapse to illicit opioid use. Cases We present two cases of successful initiation of buprenorphine treatment with the Bernese method, ie, gradual induction overlapping with full agonist use. The first patient began buprenorphine with overlapping street heroin use after repeatedly experiencing relapse, withdrawal, and trauma reactivation symptoms during conventional induction. The second patient was maintained on high doses of diacetylmorphine (ie, pharmaceutical heroin) and methadone during induction. Both patients tolerated the induction procedure well and reported only mild withdrawal symptoms. Discussion Overlapping induction of buprenorphine maintenance treatment with full µ-opioid receptor agonist use is feasible and may be associated with better tolerability and acceptability in some patients compared to the conventional method of induction. PMID:27499655

  7. Use of microdoses for induction of buprenorphine treatment with overlapping full opioid agonist use: the Bernese method.

    Science.gov (United States)

    Hämmig, Robert; Kemter, Antje; Strasser, Johannes; von Bardeleben, Ulrich; Gugger, Barbara; Walter, Marc; Dürsteler, Kenneth M; Vogel, Marc

    2016-01-01

    Buprenorphine is a partial µ-opioid receptor agonist used for maintenance treatment of opioid dependence. Because of the partial agonism and high receptor affinity, it may precipitate withdrawal symptoms during induction in persons on full µ-opioid receptor agonists. Therefore, current guidelines and drug labels recommend leaving a sufficient time period since the last full agonist use, waiting for clear and objective withdrawal symptoms, and reducing pre-existing full agonist therapies before administering buprenorphine. However, even with these precautions, for many patients the induction of buprenorphine is a difficult experience, due to withdrawal symptoms. Furthermore, tapering of the full agonist bears the risk of relapse to illicit opioid use. We present two cases of successful initiation of buprenorphine treatment with the Bernese method, ie, gradual induction overlapping with full agonist use. The first patient began buprenorphine with overlapping street heroin use after repeatedly experiencing relapse, withdrawal, and trauma reactivation symptoms during conventional induction. The second patient was maintained on high doses of diacetylmorphine (ie, pharmaceutical heroin) and methadone during induction. Both patients tolerated the induction procedure well and reported only mild withdrawal symptoms. Overlapping induction of buprenorphine maintenance treatment with full µ-opioid receptor agonist use is feasible and may be associated with better tolerability and acceptability in some patients compared to the conventional method of induction.

  8. French general practitioners' prescribing high-dosage buprenorphine maintenance treatment: is the existing training (good) enough?

    Science.gov (United States)

    Feroni, Isabelle; Peretti-Watel, Patrick; Masut, Alain; Coudert, Christine; Paraponaris, Alain; Obadia, Yolande

    2005-01-01

    In France, since 1996, any general practitioner (GP) can prescribe high-dosage buprenorphine maintenance treatment (BMT) for opioid-dependent patients. The health authorities initially provided mandatory specific training, but since 1998, such training is only delivered by specialized networks and the pharmaceutical industry. Among a random sample of GPs from southeastern France (N=345), we found that many untrained GPs, as well as a significant minority of trained GPs, were likely to prescribe an ineffective dosage of buprenorphine or a potentially dangerous treatment (BMT+a short half-life benzodiazepine). These results highlight the necessity to edit clear guidelines, especially concerning situations of polyaddiction and psychiatric comorbidity, and to extend and improve BMT training in France with a renewed involvement of health authorities for quality control of such training. They even suggest that GPs' participation to specialized training sessions should become a mandatory prerequisite for prescribing BMT.

  9. A COMPARATIVE STUDY BETWEEN INTRATHECAL MORPHINE AND INTRATHECAL BUPRENORPHINE FOR POST - OPERATIVE ANALGESIA FOLLOWING CAESARIAN SECTION UNDER SUB ARACHNOID BLOCK

    Directory of Open Access Journals (Sweden)

    Anish M

    2015-05-01

    Full Text Available BACKGROUND: Good pain relief following caesarian section is of great importance and intrathecal opioids provide good quality postoperative analgesia for longer duration. So the following study describes a comparative study between intrathecal morphine and intrathecal buprenorphine for postoperative pain relief following caesarian section (CS under subarachnoid blockade. AIMS: The study was conducted to compare intrathecal morphine and buprenorphine for post of analgesia following CS, to achieve analgesia without seda tion for better maternal child bondage and to popularize intrathecal opioids . MATERIALS AND METHODS: 60 patients posted for CS under SAB were randomly allocated into group A and group B of 30 each, the group A received morphine 0.1 mg and buprenorphine 0 . 0 3 mg was given for group B patients along with the local anaesthetic. Subjective assessment of post - operative analgesia was done by direct questioning of the patient and by a five point pain scores. Duration of analgesia was taken as the time interval betw een the time of injection of intrathecal opiate and the time at which the patient felt pain and requested for additional analgesics. Data’s were analyzed using SPSS 16th version. OBSERVATION AND RESU LTS: The mean duration of post - operative analgesia with i ntrathecal morphine was 24.19+4 . 8 hours and that with buprenorphine was only 11.7+3.28 hours. Over weight patients reported a lower mean duration of analgesia. None of the patients in the study showed any bradycardia, hypotension, desaturation or respirato ry depression. Intrathecal opiates decreased the parenteral opiate requirements. The main side effects noticed were nausea in about 43% of patients in morphine group and 33% of patients in buprenorphine group. CONCLUSIONS: Intrathecal morphine 0 . 1 mg gives good post - operative analgesia of longer duration than buprenorphine 0 . 03mg. The quality of analgesia provided by intrathecal morphine was superior to

  10. Buprenorphine and methadone treatment for opioid dependence by income, ethnicity and race of neighborhoods in New York City

    Science.gov (United States)

    Hansen, Helena; Siegel, Carole; Wanderling, Joseph; DiRocco, Danae

    2016-01-01

    Background Geographic and demographic variation in buprenorphine and methadone treatment use in U.S. cities has not been assessed. Identifying variance in opioid maintenance is essential to improving treatment access and equity. Purpose To examine the differential uptake of buprenorphine treatment in comparison to methadone treatment between 2004 and 2013 in neighborhoods in New York City characterized by income, race and ethnicity. Methods Social area (SA) analysis of residential zip codes of methadone and buprenorphine patients in NYC, which aggregated zip codes into five social areas with similar percentages of residents below poverty, identifying as Black non-Hispanic and as Hispanic, to examine whether treatment rates differed significantly among social areas over time. For each rate, mixed model analyses of variance were run with fixed effects for social area, year and the interaction of social area by year. Results Buprenorphine treatment increased in all social areas over time with a significantly higher rate of increase in the social area with the highest income and the lowest percentage of Black, Hispanic, and low-income residents. Methadone treatment decreased slightly in all social areas until 2011 and then increased bringing rates back to 2004 levels. Treatment patterns varied by social area. Conclusions Buprenorphine treatment rates are increasing in all social areas, with slower uptake in moderate income mixed ethnicity areas. Methadone rates have remained stable over time. Targeted investments to promote public sector buprenorphine prescription may be necessary to reduce disparities in buprenorphine treatment and to realize its potential as a public health measure. PMID:27179822

  11. Buprenorphine for pain relief in mice: repeated injections vs sustained-release depot formulation.

    Science.gov (United States)

    Jirkof, P; Tourvieille, A; Cinelli, P; Arras, M

    2015-07-01

    Sustained-release formulations of analgesic drugs are promising alternatives to repeated drug injections. Here, we compared a sustained-release formulation of buprenorphine (SB, 2.2 mg/kg) with a standard protocol of three injections of buprenorphine (Temgesic, 0.1 mg/kg/8 h) in mice. Buprenorphine serum concentration and analgesic action (thermal sensitivity) were determined in healthy mice. Additionally, the pain relief properties of both protocols were assessed after laparotomy using physiological and ethological measures of pain and recovery. Serum concentrations and thermal sensitivity tests indicated duration of action of at least 4 h (but less than 8 h) with the Temgesic protocol, and 24-48 h with SB. Behavioural and clinical parameters indicated at least partial pain relief after surgery for both protocols. Observed side-effects of buprenorphine independent of the protocol were increased activity, disturbed circadian rhythm and several abnormal behaviours. A tendency for decreased food and water intake as well as body weight reduction was also seen. Body weight decreased significantly in animals that received three injections of Temgesic, regardless of whether surgery was performed or not (P = 0.015; P = 0.023), hinting at a stress response towards this repeated intervention. In conclusion, an application interval of 8 h (Temgesic) appears too long and might lead to repeated periods with insufficient analgesia in animals undergoing lasting and/or substantial pain after surgery. In comparison to the standard protocol, SB provided a long-lasting, assured analgesia without possible stressful repeated injections in a standard surgical model, with only limited and acceptable behavioural side-effects.

  12. Criminal charges prior to and after initiation of office-based buprenorphine treatment

    Directory of Open Access Journals (Sweden)

    Harris Elizabeth E

    2012-03-01

    Full Text Available Abstract Background There is little data on the impact of office-based buprenorphine therapy on criminal activity. The goal of this study was to determine the impact of primary care clinic-based buprenorphine maintenance therapy on rates of criminal charges and the factors associated with criminal charges in the 2 years after initiation of treatment. Methods We collected demographic and outcome data on 252 patients who were given at least one prescription for buprenorphine. We searched a public database of criminal charges and recorded criminal charges prior to and after enrollment. We compared the total number of criminal cases and drug cases 2 years before versus 2 years after initiation of treatment. Results There was at least one criminal charge made against 38% of the subjects in the 2 years after initiation of treatment; these subjects were more likely to have used heroin, to have injected drugs, to have had any prior criminal charges, and recent criminal charges. There was no significant difference in the number of subjects with any criminal charge or a drug charge before and after initiation of treatment. Likewise, the mean number of all cases and drug cases was not significantly different between the two periods. However, among those who were opioid-negative for 6 or more months in the first year of treatment, there was a significant decline in criminal cases. On multivariable analysis, having recent criminal charges was significantly associated with criminal charges after initiation of treatment (adjusted odds ratio 3.92; subjects who were on opioid maintenance treatment prior to enrollment were significantly less likely to have subsequent criminal charges (adjusted odds ratio 0.52. Conclusions Among subjects with prior criminal charges, initiation of office-based buprenorphine treatment did not appear to have a significant impact on subsequent criminal charges.

  13. Comparative pharmacokinetics of intravenous fentanyl and buprenorphine in healthy Greyhound dogs

    OpenAIRE

    2014-01-01

    The purpose of this study was to compare the pharmacokinetics of two highly protein bound, lipophilic opioid drugs. Fentanyl (10 μg/kg) and buprenorphine (20 μg/kg) were administered intravenously (IV) to six healthy Greyhound dogs (3 males and 3 females). The doses were based on clinically administered doses for dogs. Plasma drug concentrations were determined using liquid chromatography with mass spectrometry and noncompartmental pharmacokinetics were estimated with computer software. The v...

  14. Efficacy and safety of transdermal buprenorphine in the management of children with cancer-related pain.

    Science.gov (United States)

    Ruggiero, Antonio; Coccia, Paola; Arena, Roberta; Maurizi, Palma; Battista, Andrea; Ridola, Vita; Attinà, Giorgio; Riccardi, Riccardo

    2013-03-01

    The current study investigated the efficacy, safety, tolerability, and compliance of a transdermal buprenorphine delivery system for the management of chronic cancer pain in the pediatric population. Sixteen pediatric patients with moderate to severe cancer-related pain not satisfactorily controlled with previous non-opioid therapies were enrolled. Transdermal buprenorphine was administered following a 72 hour schedule and rescue medication (tramadol) was allowed for breakthrough pain. Pain intensity was assessed using the Wong-Baker faces pain rating scale (WBS) and other parameters related to the global quality of life were evaluated. Children's evaluations of efficacy, compliance, and tolerability were recorded using numerical scales. Adverse events were monitored during the study and the medications needed to control opioid-related nausea and constipation were recorded. Eleven patients (68.75%) responded to transdermal buprenorphine after 2 weeks of treatment. Pain intensity measured with WBS decreased from 6.25 at baseline to 1.38 at Day +60 (P alimentation, play and activity, speech, and crying) significantly improved over the 60-day study period. Children's evaluations of compliance and tolerability of the drug were always positive over the entire period of treatment. No severe adverse events were recorded. Opioid-related nausea was well controlled with medication on request, and the need for laxative therapy was greater at the end of the second month of treatment. Transdermal buprenorphine was found to represent an efficient, safe and well tolerated approach to the management of children's chronic cancer pain. Copyright © 2012 Wiley Periodicals, Inc.

  15. COMPARISON OF ANALGESIC EFFECT OF INTRA-ARTICULAR BUPRENORPHINE AND MORPHINE FOLLOWING ARTHROSCOPIC SURGERY OF KNEE

    Directory of Open Access Journals (Sweden)

    Shashidhar Gowdra Sugandarajappa

    2016-07-01

    Full Text Available BACKGROUND AND AIMS Pain after orthopaedic surgery depends on the site and extent of surgery and the preoperative use of analgesics by the patient. Arthroscopic procedures are routinely performed on outpatient basis and have spared patients large incisions and decreased morbidity compared with open incisions, but has not eliminated pain. At present several techniques are available to treat pain following arthroscopic surgeries; these include the use of opioids, local anaesthetics, NSAIDs, corticosteroids, clonidine and cryotherapy. Here, we compared the analgesic effect of intra-articular administration of morphine, buprenorphine and placebo following arthroscopic surgery of knee. METHODS A prospective, randomised, placebo-controlled double-blind comparative study conducted in 60 patients of either sex who underwent arthroscopic surgery of knee; between the age group of 18 and 65 years and of ASA class I and II physical status were included in the study. Patients were randomly assigned equally to one of the 3 groups of 20 each by a sealed envelope method. The groups were Group A - Patients receiving IA Buprenorphine 100 mcg in 20 mL normal saline. Group B - Patients receiving IA Morphine 3 mg in 20 mL normal saline. Group C - Patients receiving IA 20 mL normal saline as placebo. Parameters monitored were degree of analgesia along with haemodynamic parameters and side effects. Data were analysed using student’s t-test for continuous variables and Chi-Square test. RESULTS We found that 100 mcg buprenorphine when injected intra-articularly produced good and comparable postoperative pain control and reduced supplementary analgesic requirement when compared to other groups. CONCLUSION In summary, this study demonstrated that for eight hours postoperatively 100 mcg buprenorphine provided superior postoperative analgesia to that of 3 mg morphine

  16. Tobacco Addiction and Smoking Status in Heroin Addicts under Methadone vs. Buprenorphine Therapy

    Directory of Open Access Journals (Sweden)

    Rebecca Casari

    2012-03-01

    Full Text Available Aims of the present investigation were: (i to assess the prevalence of current smokers and relative smoking status among a large number of heroin addicts attending opioid-substitution therapy prevalence; (ii to evaluate the relationship between the type (methadone, buprenorphine and dosage of opioid substitution therapy and nicotine dependence. Three hundred and five (305 heroin addicts under opioid-substitution therapy were recruited at five Addiction Units. All participants completed a questionnaire assessing sociodemographic information, type and dose of opioid-substitution therapy, smoking history and status, Fagerström Test for Nicotine Dependence (FTND, and the Zung Self-Rating Depression scale (SDS. 298 subjects, out of 305 (97.2% were smokers, with an average of 20.5 cigarette/day and a median FTND of 6. Our data confirmed the high prevalence of smokers among heroin addicts, the highest described in the literature to date among heroin addicts under substitution therapies, without any significant difference between methadone vs. buprenorphine therapy groups. There was no correlation between dose of methadone or buprenorphine and average number of cigarettes/day. Patients in substance abuse treatment very frequently smoke cigarettes and often die of tobacco-related diseases. Substance abuse treatment programs too often ignore tobacco use. We hope that these findings will help to incorporate smoking cessation in substance abuse treatments.

  17. Effects of buprenorphine, meloxicam, and flunixin meglumine as postoperative analgesia in mice.

    Science.gov (United States)

    Tubbs, Jacquelyn T; Kissling, Grace E; Travlos, Greg S; Goulding, David R; Clark, James A; King-Herbert, Angela P; Blankenship-Paris, Terry L

    2011-03-01

    C57BL/6NCrl male mice (n = 60; age, 6 to 7 wk) underwent partial hepatectomy or no surgery and were given 1 of 3 analgesics pre- and postoperatively. Food and water consumption, body weight, running wheel activity, locomotor activity, and serum corticosterone concentrations were measured before and after surgery. Mice that were surgically manipulated weighed significantly less on days 1 through 3 after surgery than did mice not manipulated surgically. On the day of surgery, the surgery groups consumed significantly less feed (-1.5±0.35 g) than did nonsurgery groups. There were no differences in water consumption on any day between surgery and nonsurgery groups or among the 3 analgesic groups. For running wheel activity, significant decreases in the surgery groups were seen at day 1 after surgery compared with baseline. Surgery groups that received buprenorphine and meloxicam returned to baseline activity levels on day 2 after surgery. Open-field testing revealed no significant differences in locomotor activity in any groups; however, posttreatment locomotor activity in the buprenorphine nonsurgery group was increased compared with baseline, and posttreatment locomotor activity in the flunixin meglumine surgery group was decreased compared with baseline. Serum corticosterone concentrations were within normal limits regardless of treatment in all groups. Comparison of the overall results indicated that meloxicam and buprenorphine, at the dose given, appear to be suitable postoperative analgesics for partial hepatectomy in mice. Flunixin meglumine at the given dosage (2.5 mg/kg) may not provide adequate analgesia for partial hepatectomy.

  18. Determination of buprenorphine, fentanyl and LSD in whole blood by UPLC-MS-MS.

    Science.gov (United States)

    Berg, Thomas; Jørgenrud, Benedicte; Strand, Dag Helge

    2013-04-01

    A sensitive ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS-MS) method has been developed and validated for the quantification of buprenorphine, fentanyl and lysergic acid diethylamide (LSD) in whole blood. Sample preparation was performed by liquid-liquid extraction (LLE) with methyl tert-butyl ether. UPLC-MS-MS analysis was performed with a mobile phase consisting of ammonium formate (pH 10.2) and methanol. Positive electrospray ionization MS-MS detection was performed with two multiple reaction monitoring transitions for each of the analytes and the deuterium labeled internal standards. Limit of detection values of buprenorphine, fentanyl and LSD were 0.28, 0.044 and 0.0097 ng/mL and limit of quantification values were 0.94, 0.14 and 0.036 ng/mL, respectively. Most phospholipids were removed during LLE. No or only minor matrix effects were observed. The method has been routinely used at the Norwegian Institute of Public Health since September 2011 for qualitative and quantitative detections of buprenorphine, fentanyl and/or LSD in more than 400 whole blood samples with two replicates per sample.

  19. Effects of voluntarily-ingested buprenorphine on plasma corticosterone levels, body weight, water intake, and behaviour in permanently catheterised rats.

    Science.gov (United States)

    Goldkuhl, Renée; Hau, Jann; Abelson, Klas S P

    2010-01-01

    This study investigated the peri- and postoperative effect of pre-emptive analgesia through voluntary ingestion of buprenorphine in Nutella, in male Sprague-Dawley rats. An arterial catheter was inserted and the rats were connected to an automated blood sampling device (AccuSampler). Blood samples were drawn up to 18 h after surgery and the plasma concentrations of corticosterone were quantified. Postoperative changes in water intake and body weight were recorded, and the behaviour of the rats was analysed during two 30-min periods. Pre-emptive oral buprenorphine treatment reduced the plasma corticosterone levels in the postoperative period, compared to controls treated with local anaesthetics. Buprenorphine-treated rats consumed more water and maintained body weight better. Behavioural observations indicated that buprenorphine changed the behaviour in non-operated rats but there was no difference in the operated rats. The present study strengthens the hypothesis that pre-emptive oral buprenorphine in Nutella is suitable for treatment of postoperative pain in rats.

  20. Characteristics of U.S. substance abuse treatment facilities adopting buprenorphine in its initial stage of availability.

    Science.gov (United States)

    Koch, Alison L; Arfken, Cynthia L; Schuster, Charles R

    2006-07-27

    This study examined the adoption of buprenorphine for the treatment of opiate dependence among U.S. substance abuse treatment facilities and their characteristics at the time of the initial availability of the medication. Data come from a 2003 national survey of all substance abuse treatment facilities in the U.S. Out of our sample of 13,060 facilities, 5.5% of facilities reported they offered buprenorphine. Not unexpectedly, the prevalence was higher in certified opioid treatment programs (11.3%) compared to other facilities (4.6%). For opioid treatment programs, offering Naltrexone (OR=8.34, 95% CI=5.53, 12.58) and offering medically supervised withdrawal (OR=2.76, 95% CI=1.38, 5.52) were independent and robust predictors of offering buprenorphine. These same variables were independent predictors for the non-opioid treatment programs as well (Naltrexone, OR=14.32, 95% CI=7.85, 26.10; and medically supervised withdrawal services, OR=4.42, 95% CI=3.01, 6.49). Our results suggest that the adoption of buprenorphine soon after the Food and Drug Administration approved its use for treatment of opioid dependence and the shipping of the medication commenced was associated with facilities already offering pharmacotherapies such as Naltrexone and medically assisted withdrawal. These findings provide baseline data to track the adoption of buprenorphine by substance abuse treatment programs in future years.

  1. Expanding treatment capacity for opioid dependence with office-based treatment with buprenorphine: National surveys of physicians.

    Science.gov (United States)

    Arfken, Cynthia L; Johanson, Chris-Ellyn; di Menza, Salvatore; Schuster, Charles Roberts

    2010-09-01

    Office-based treatment of opioid dependence with buprenorphine has the potential to expand treatment capacity in the United States. However, nationally, little is known about the number, characteristics, and experiences of physicians certified to prescribe buprenorphine. Moreover, little is known about the impact of easing federal regulations on the number of patients a physician is allowed to treat concurrently. To address these questions, surveys of national samples of physicians certified to prescribe buprenorphine (2004-2008) were analyzed (N = 6,892). There has been a continual increase in the number of physicians certified to prescribe buprenorphine, increase in the mean number of patients treated by physicians, and decrease in patients turned away, coinciding temporally with easing of federal regulations. In addition, most physicians prescribed buprenorphine outside of traditional treatment settings. The U.S. experiment in expanding Schedule III-V medications for opioid dependence to physicians outside of formal substance abuse treatment facilities appears to have resulted in expanded capacity. Copyright 2010 Elsevier Inc. All rights reserved.

  2. Akut smertebehandling af stofbrugere i substitutionsbehandling med metadon eller buprenorfin

    DEFF Research Database (Denmark)

    Zinck, Louise; Sonne, Nan M; Madsen, Sidsel Lægdsgaard;

    2015-01-01

    In Denmark, approximately 7,600 patients receive maintenance therapy with methadone or buprenorphine because of opioid addiction. These patients have an increased risk of inadequate pain treatment during hospitalization, among others because of tolerance to opioids and poor communication with the......In Denmark, approximately 7,600 patients receive maintenance therapy with methadone or buprenorphine because of opioid addiction. These patients have an increased risk of inadequate pain treatment during hospitalization, among others because of tolerance to opioids and poor communication...... with the staff. The present article describes four common misconceptions among health-care providers that underlie inadequate pain treatment and provides practical recommendations for the analgesic management of acute pain in patients receiving methadone or buprenorphine....

  3. Deviant smooth pursuit in preschool children exposed prenatally to methadone or buprenorphine and tobacco affects integrative visuomotor capabilities.

    Science.gov (United States)

    Melinder, Annika; Konijnenberg, Carolien; Sarfi, Monica

    2013-12-01

    Although an increasing number of children are born to mothers in opioid maintenance therapy (OMT), little is known about the long-term effects of these opioids. Previous studies suggest an association between prenatal OMT exposure and difficulties in eye movement control. Also, the effects of tobacco smoking on eye movements have been reported. The present study examined the influence of eye movements, i.e. smooth pursuit, on visuomotor capabilities in children of smoking mothers in OMT. The study comprised a 2 (OMT versus contrast group) × 2 (slow versus fast smooth pursuit) between-subject factorial design. The cognitive developmental research unit at the University of Oslo, Norway. Participants were 26 4-year-old children of tobacco-smoking women in OMT and 23 non-exposed 4-year-old children, with non-smoking mothers, matched by gender and age. Eye movements and smooth pursuit were recorded using a Tobii 1750 eyetracker. Visuomotor functions were examined by Bender test. The OMT group tracked slowly moving objects with smooth pursuit in a similar manner to their non-exposed peers. When fast smooth pursuit was measured, the OMT group of children tracked the object more slowly than the contrast group, P = 0.02, ηp(2) = 0.11. A regression analysis showed that fast smooth pursuit predicted children's performance on a visuomotor task, R(2) = 0.37. Impaired eye-tracking skills in 4-year-old children exposed to methadone or buprenorphine and tobacco prenatally could inhibit the development of some cognitive functions in later life. ©2013 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of The Society for the Study of Addiction.

  4. Application of a buprenorphine transdermal patch for the perioperative analgesia in patients who underwent simple lumbar discectomy

    Science.gov (United States)

    Tang, Jian; Fan, Jin; Yao, Yilun; Cai, Weihua; Yin, Guoyong; Zhou, Wei

    2017-01-01

    Abstract This study aimed to investigate the perioperative analgesic effect of a buprenorphine transdermal patch in patients who underwent simple lumbar discectomy. In total, 96 patients were randomly divided into parecoxib intravenous injection (Group A), oral celecoxib (Group B), and buprenorphine transdermal patch groups (Group C). The pain status, degree of satisfaction, adverse effects, and condition in which the patient received tramadol hydrochloride for uncontrolled pain were recorded on the night before surgery, postoperative day 1, postoperative day 3, and postoperative day 5. The degree of patient satisfaction in Group C was higher than that in Groups A and B, with minimal adverse effects. The buprenorphine transdermal patch had a better perioperative analgesic effect in patients who underwent simple lumbar discectomy. PMID:28514299

  5. Use of microdoses for induction of buprenorphine treatment with overlapping full opioid agonist use: the “Bernese method”

    Directory of Open Access Journals (Sweden)

    Hämmig R

    2016-07-01

    Full Text Available Robert Hämmig,1 Antje Kemter,2 Johannes Strasser,2 Ulrich von Bardeleben,1 Barbara Gugger,1 Marc Walter,2 Kenneth M Dürsteler,2 Marc Vogel2 1Division of Addiction, University Psychiatric Services Bern, Bern, Switzerland; 2Division of Substance Use and Addictive Disorders, University of Basel Psychiatric Hospital, Basel, Switzerland Background: Buprenorphine is a partial µ-opioid receptor agonist used for maintenance treatment of opioid dependence. Because of the partial agonism and high receptor affinity, it may precipitate withdrawal symptoms during induction in persons on full µ-opioid receptor agonists. Therefore, current guidelines and drug labels recommend leaving a sufficient time period since the last full agonist use, waiting for clear and objective withdrawal symptoms, and reducing pre-existing full agonist therapies before administering buprenorphine. However, even with these precautions, for many patients the induction of buprenorphine is a difficult experience, due to withdrawal symptoms. Furthermore, tapering of the full agonist bears the risk of relapse to illicit opioid use.Cases: We present two cases of successful initiation of buprenorphine treatment with the ­Bernese method, ie, gradual induction overlapping with full agonist use. The first patient began buprenorphine with overlapping street heroin use after repeatedly experiencing relapse, withdrawal, and trauma reactivation symptoms during conventional induction. The second patient was maintained on high doses of diacetylmorphine (ie, pharmaceutical heroin and methadone during induction. Both patients tolerated the induction procedure well and reported only mild withdrawal symptoms.Discussion: Overlapping induction of buprenorphine maintenance treatment with full µ-opioid receptor agonist use is feasible and may be associated with better tolerability and acceptability in some patients compared to the conventional method of induction. Keywords: subutex, suboxone, heroin

  6. Tramadol and the risk of fracture in an elderly female population: a cost utility assessment with comparison to transdermal buprenorphine.

    Science.gov (United States)

    Hirst, Alexander; Knight, Chris; Hirst, Matt; Dunlop, Will; Akehurst, Ron

    2016-03-01

    Opioid treatment for chronic pain is a known risk factor for falls and/or fractures in elderly patients. The latter cause a significant cost to the National Health Service and the Personal Social Services in the UK. Tramadol has a higher risk of fractures than some other opioid analgesics used to treat moderate-to-severe pain and, in the model described here, we investigate the cost effectiveness of transdermal buprenorphine treatment compared with tramadol in a high-risk population. A model was developed to assess the cost effectiveness of tramadol compared with transdermal buprenorphine over a 1-year time horizon and a patient population of high-risk patients (female patients age 75 or older). To estimate the total cost and quality-adjusted life years (QALYs) of treatment, published odds ratios are used in combination with the published incidence rates of four types of fracture: hip, wrist, humerus and other. The model shows tramadol to be associated with 1,058 more fractures per 100,000 patients per year compared with transdermal buprenorphine, resulting in transdermal buprenorphine being cost-effective with an incremental cost-effectiveness ratio of less than £7,000 compared with tramadol. Sensitivity analysis found this result to be robust. In the UK data, there is uncertainty regarding the transdermal buprenorphine odds ratios for fractures. Odds ratios published in Danish and Swedish studies show similar point estimates but are associated with less uncertainty. Transdermal buprenorphine is cost-effective compared to tramadol at a willingness-to-pay threshold of £20,000 per QALY.

  7. Inhibition of CYP2D6-mediated tramadol O-demethylation in methadone but not buprenorphine maintenance patients

    Science.gov (United States)

    Coller, Janet K; Michalakas, Jennifer R; James, Heather M; Farquharson, Aaron L; Colvill, Joel; White, Jason M; Somogyi, Andrew A

    2012-01-01

    AIMS To compare the O- (CYP2D6 mediated) and N- (CYP3A4 mediated) demethylation metabolism of tramadol between methadone and buprenorphine maintained CYP2D6 extensive metabolizer subjects. METHODS Nine methadone and seven buprenorphine maintained subjects received a single 100 mg dose of tramadol hydrochloride. Blood was collected at 4 h and assayed for tramadol, methadone, buprenorphine and norbuprenorphine (where appropriate) and all urine over 4 h was assayed for tramadol and its M1 and M2 metabolites. RESULTS The urinary metabolic ratio [median (range)] for O-demethylation (M1) was significantly lower (P= 0.0002, probability score 1.0) in the subjects taking methadone [0.071 (0.012–0.103)] compared with those taking buprenorphine [0.192 (0.108–0.392)], but there was no significant difference (P= 0.21, probability score 0.69) in N-demethylation (M2). The percentage of dose [median (range)] recovered as M1 was significantly lower in subjects taking methadone compared with buprenorphine (0.069 (0.044–0.093) and 0.126 (0.069–0.187), respectively, P= 0.04, probability score 0.19), M2 was significantly higher in subjects taking methadone compared with buprenorphine (0.048 (0.033–0.085) and 0.033 (0.014–0.049), respectively, P= 0.04, probability score 0.81). Tramadol was similar (0.901 (0.635–1.30) and 0.685 (0.347–1.04), respectively, P= 0.35, probability score 0.65). CONCLUSIONS Methadone inhibited the CYP2D6-mediated metabolism of tramadol to M1. Hence, as the degree of opioid analgesia is largely dependent on M1 formation, methadone maintenance patients may not receive adequate analgesia from oral tramadol. PMID:22369095

  8. Pharmacokinetics of high-dose buprenorphine following single administration of sublingual tablet formulations in opioid naïve healthy male volunteers under a naltrexone block.

    Science.gov (United States)

    McAleer, Sarah D; Mills, Richard J; Polack, Torsten; Hussain, Tanweer; Rolan, Paul E; Gibbs, Alan D; Mullins, Frank G P; Hussein, Ziad

    2003-10-24

    Sublingual buprenorphine formulations have been developed as treatments for opioid dependence. In three studies, opioid naïve healthy male subjects received Subutex tablets (buprenorphine 2 and 8 mg [N=27] or 12 and 16 mg [N=27]) or Suboxone (two formulations) tablets (buprenorphine 8 mg/naloxone 2 mg [N=36]) sublingually, under a naltrexone block for assessment of buprenorphine pharmacokinetics and tablet disintegration times. Plasma buprenorphine was quantified up to 72 h post-dose using a sensitive LC-MS/MS assay. Mean Cmax values ranged from 1.6 to 6.4 ng/ml and tmax from 0.5 to 3 h. Concentrations declined bi-exponentially and fluctuations after a meal suggested enterohepatic recirculation of buprenorphine. The terminal half-life was approximately 26 h (range 9-69). Cmax and AUC appeared to increase in proportion to Subutex dose over 8-16 mg. The Suboxone formulations were bioequivalent. The least squares mean (90% CI) treatment ratio for Cmax was 1.00 (0.92-1.10) and AUC was 1.00 (0.95-1.06). Median times of disintegration were similar for all doses and formulations (range 6-12 min). Sublingual buprenorphine, up to 40 times the 400 microg analgesic dose, was well tolerated in these opioid naïve subjects, as administration of naltrexone 50-150 mg was sufficient to attenuate anticipated adverse effects in this population of subjects.

  9. Post operative analgesia after incisional infiltration of bupivacaine v/s bupivacaine with buprenorphine

    Directory of Open Access Journals (Sweden)

    Tanu R Mehta

    2011-01-01

    Full Text Available Introduction: Opioid receptors have been demonstrated in the peripheral nerve endings of afferent neurons. Blockade of these receptors with peripherally administered opioid is believed to result in analgesia. Aim: To evaluate whether buprenorphine added to bupivacaine for wound infiltration can enhance post-operative analgesia via peripheral mechanisms. Materials and Methods: Forty ASA I and II adult patients scheduled for open donor nephrectomy were enrolled in this randomized double blind prospective study. In group A ( n=20 patients, the wound was infiltrated with bupivacaine 0.5% (2 mg/kg and in group B ( n=20 with bupivacaine 0.5% (2 mg/kg and buprenorphine (2 μg/kg. All patients were given diclofenac 75 mg IM at 8 h interval. Post-operative quality of analgesia was assessed by VAS (0-10 for 24 h and when VAS > 4 rescue analgesic was administered. Total dose of rescue analgesic and side effects were noted. Results: The time of administration of first rescue analgesic was significantly higher in group B (10.52±5.54 h as compared to group A (3.275±1.8 h. Mean VAS was significantly lower in group B as compared to group A. The total dosage of rescue analgesic was more in group A as compared to group B patients. Conclusion: Addition of buprenorphine to the local anesthetic significantly prolonged the time to first rescue analgesic requirement and the total consumption of rescue analgesic in 24 h, thus providing evidence in support of the existence of peripheral opioid receptors.

  10. COMPARISON OF DEXMEDETOMIDINE, BUPRENORPHINE AND FENTANYL AS AN ADJUVANT TO BUPIVACAINE DURING SPINAL ANAESTHESIA FOR HEMIARTHROPLASTY

    Directory of Open Access Journals (Sweden)

    Pradeep R

    2016-10-01

    Full Text Available BACKGROUND Opioids such as fentanyl or buprenorphine are being added as adjuvant to local anaesthetic for spinal anaesthesia. Dexmedetomidine, a new α2 agonist is being tried as an adjuvant in the recent times. MATERIALS AND METHODS The patients were randomised into three Groups (n=30 each by closed envelope technique. Patients in Group 1 received 10 µg fentanyl with 15 mg of 0.5% hyperbaric bupivacaine, Group 2 received 15 mg of 0.5% hyperbaric bupivacaine supplemented with 30 µg of buprenorphine and Group 3 received 15 mg of 0.5% hyperbaric bupivacaine plus 5 µg dexmedetomidine intrathecally. The time to reach maximum sensory and motor level, the regression time of the same, any adverse effects were recorded. Data were analysed using chi-square test or Fisher’s exact test for categorical data and analysis of variance for continuous data. A value of P<0.05 was accepted as statistically significant. Settings and Design- The study was conducted in a prospective, randomised and double-blind manner. It included ninety American Society of Anaesthesiologists class I and II patients undergoing hemiarthroplasty under spinal anaesthesia. RESULTS In this study, the patients in dexmedetomidine group showed significantly longer duration of motor block (240±20 mins. and sensory blockade (180±22.2 mins. compared to other groups, which is statistically significant (P=0.0001 and P=0.006, respectively. The time to first request of analgesic postoperatively was also longer (260±30.2 in dexmedetomidine group when compared with other groups (P=0.0001. Haemodynamic parameters were stable and there were no complications in any group. CONCLUSIONS We concluded that intrathecal dexmedetomidine (5 µg with bupivacaine provides significantly longer duration of sensory and motor blockade and longer duration for first request of analgesia in the recovery than intrathecal buprenorphine (30 µg or fentanyl (10 µg with bupivacaine for spinal anaesthesia for

  11. Sexual Dysfunction in Heroin Dependents: A Comparison between Methadone and Buprenorphine Maintenance Treatment.

    Directory of Open Access Journals (Sweden)

    Anne Yee

    Full Text Available Methadone has long been regarded as an effective treatment for opioid dependence. However, many patients discontinue maintenance therapy because of its side effects, with one of the most common being sexual dysfunction. Buprenorphine is a proven alternative to methadone. This study aimed to investigate sexual dysfunction in opioid-dependent men on buprenorphine maintenance treatment (BMT and methadone maintenance treatment (MMT. The secondary aim was to investigate the correlation between sexual dysfunction and the quality of life in these patients.Two hundred thirty-eight men participated in this cross-sectional study. Four questionnaires were used, the Mini International Neuropsychiatric Interview, Opiate Treatment Index, Malay version of the International Index of Erectile Function 15 (Mal-IIEF-15, and World Health Organization Quality of Life-BREF Scale. Multivariate analysis of covariance was used to examine the relationship between MMT and BMT and the Mal-IIEF 15 scores while controlling for all the possible confounders.The study population consisted of 171 patients (71.8% on MMT and 67 (28.2% on BMT. Patients in the MMT group who had a sexual partner scored significantly lower in the sexual desire domain (p < 0.012 and overall satisfaction (p = 0.043 domain compared with their counterparts in the BMT group. Similarly, patients in the MMT group without a sexual partner scored significantly lower in the orgasmic function domain (p = 0.008 compared with those in the BMT group without a partner. Intercourse satisfaction (p = 0.026 and overall satisfaction (p = 0.039 were significantly associated with the social relationships domain after adjusting for significantly correlated sociodemographic variables.Sexual functioning is critical for improving the quality of life in patients in an opioid rehabilitation program. Our study showed that buprenorphine causes less sexual dysfunction than methadone. Thus, clinicians may consider the former when

  12. Psychological barriers to tobacco cessation in Indian buprenorphine-naloxone maintained patients: A pilot study

    Directory of Open Access Journals (Sweden)

    Piyali Mandal

    2015-01-01

    Full Text Available Context: The prevalence of smoking in opioid agonist treatment programmes remains high, leading to significant tobacco related health hazards and mortality. This is the first study from India addressing tobacco cessation and related barriers among recipients of buprenorphine-naloxone maintenance treatment. Aims: The purpose of the study was to investigate Indian buprenorphine-naloxone maintained patients′ willingness to quit tobacco use, to determine its possible association with demographic, agonist maintenance treatment, tobacco use related variables and personal health and risk perceptions related to health hazards associated with tobacco use. Settings and Design: The study was cross-sectional, observational. It was conducted in the out-patient department of a national level de-addiction centre in India. Materials and Methods: Fifty-five males on buprenorphine-naloxone treatment were assessed using Tobacco Use Characteristics, Fagerstrom Test for Nicotine Dependence (FTND and FTND-ST, Readiness to Change questionnaire (RCQ, Smoker′s Perceived Health Risk Evaluation (SPHERE, Importance of Intervention scale and a semi-structured questionnaire. Statistical Analysis: Descriptive statistics, Kruskal-Wallis Chi-square test, Spearman rank order correlation, paired-t test, ANOVA (STATA 9.2 statistical package. Results: Around 65.4% of the subjects were smokers, 9% were using smokeless tobacco only whereas 25.6% were using both. Mean duration of tobacco use was 20 ± 1.5 years. Only 20% had past quit attempts. Only 24% were in action phase of change. Personal health and risk perceptions were poor and only 61.62% considered intervention tobacco smoking cessation important. Conclusions: Higher severity of nicotine dependence, low perception of harm from tobacco warrant immediate attention and need for on-site treatment opportunity.

  13. Impact of a prescription monitoring program on doctor-shopping for high dosage buprenorphine.

    Science.gov (United States)

    Pradel, Vincent; Frauger, Elisabeth; Thirion, Xavier; Ronfle, Eléonore; Lapierre, Véronique; Masut, Alain; Coudert, Christine; Blin, Olivier; Micallef, Joëlle

    2009-01-01

    Doctor-shopping (simultaneous use of several physicians by a patient) is one of the most frequent ways of diversion for prescription drugs. A specific method was used to assess the evolution of doctor-shopping for High Dosage Buprenorphine (HDB) in a French region from 2000 to 2005 and the impact of a prescription monitoring program for HDB implemented in 2004. Data from eight periods (semesters of years 2000, 2002, 2004, and 2005) were extracted from a prescription database. Three quantities (the delivered, the prescribed, and the doctor-shopping quantity) were computed for each patient. The total doctor-shopping quantity and the doctor-shopping ratio (percentage of buprenorphine obtained through doctor-shopping) were used to evaluate the diversion of HDB among the population. The total prescribed quantity and the number of patients treated regularly were used as indicators of the access to treatment. The doctor-shopping ratio increased from 1st semester 2000 to 1st semester 2004 (from 14.9 to 21.7%) and then decreased to 16.9% in 2nd semester 2005. The total doctor-shopping quantity followed the same evolution. The number of patients treated remained stable from 1st semester 2000 to 2nd semester 2005. The prescribed quantity increased from 1st semester 2000 to 2nd semester 2002, decreased in 1st semester 2004 (4163 g) and then remained stable. After a four-year increase of the diversion through doctor-shopping for buprenorphine the beginning of the prescription monitoring program was concomitant with a marked decrease of doctor-shopping indicators without notable impact on the access to treatment.

  14. Simultaneous Quantification of Buprenorphine, Norbuprenorphine, Buprenorphine-Glucuronide and Norbuprenorphine-Glucuronide in Human Umbilical Cord by Liquid Chromatography Tandem Mass Spectrometry

    Science.gov (United States)

    Concheiro, Marta; Shakleya, Diaa M.; Huestis, Marilyn A.

    2009-01-01

    A LCMS method was developed and validated for the simultaneous determination of buprenorphine (BUP), norbuprenorphine (NBUP), buprenorphine glucuronide (BUP-Gluc) and norbuprenorphine glucuronide (NBUP-Gluc) in human umbilical cord. Quantification was achieved by selected ion monitoring of precursor ions m/z 468.4 for BUP; 414.3 for NBUP; 644.4 for BUP-Gluc and 590 for NBUP-Gluc. BUP and NBUP were identified by MS2, with m/z 396, 414 and 426 for BUP, and m/z 340, 364 and 382 for NBUP. Glucuronide conjugates were identified by MS3 with m/z 396 and 414 for BUP-Gluc and m/z 340 and 382 for NBUP-Gluc. The assay was linear 1–50 ng/g. Intra, inter-day and total assay imprecision (%RSD) were 66.3%, and process efficiency >73.4%. Matrix effect ranged, in absolute value, from 3.7% to 27.4% (CV<21.8%, n=8). The method was selective with no endogenous or exogenous interferences from 41 compounds evaluated. Sensitivity was high with limits of detection of 0.8 ng/g. In order to prove method applicability, an authentic umbilical cord obtained from an opioid-dependent pregnant woman receiving BUP pharmacotherapy was analyzed. Interestingly, BUP was not detected but concentrations of the other metabolites were NBUP-Gluc 13.4 ng/g, BUP-Gluc 3.5 ng/g and NBUP 1.2 ng/g. PMID:19406593

  15. Voluntary ingestion of nut paste for administration of buprenorphine in rats and mice

    DEFF Research Database (Denmark)

    Abelson, Klas S P; Jacobsen, Kirsten R; Sundbom, Renée

    2012-01-01

    An adequate analgesic strategy is important to improve the postoperative recovery and welfare of laboratory rats and mice. It is desirable that the method for administering the drug is non-invasive and stress-free. We have previously validated a method for administering buprenorphine in a nut paste...... for voluntary ingestion. This method has many advantages over parenteral administration. To use the method in a successful way, however, it is important to prepare and administer the mix correctly. The present paper describes in detail how to implement the method, by means of habituation, presentation, adequate...

  16. EFFECT OF BUPRENORPHINE ON POST OPERATIVE ANALGESI A IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK USING PERIPHE RAL NERVE LOCATOR

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    Ritesh

    2013-01-01

    Full Text Available ABSTRACT : Supraclavicular brachial plexus block is known for its simplicity, effectiveness, safety, reliability and being economical for day ca re and emergency surgery, circumventing problems of full stomach. In our randomized prospective, double blind study, t otal 60 adult ASA class I and II patients undergoing upper limb surgeri es were given supraclavicular brachial plexus block with peripheral nerve locator and studied for effect of addition of buprenorphine on post operative analgesia. 30 Patients received 0.2 5% bupivacaine 40 ml in group Bupivacaine (B and added buprenorphine 3 μgm/kg in th e other group Bupivacaine + Buprenorphine (BB. All the patients were monitored fo r onset of effect, post op analgesia, time of first analgesic drug and number of analgesic dru g require in first 24 hrs. Onset and duration of motor and sensory block were same in both groups. Post operative analgesia was significantly better in BB. Consequently, number of doses of analgesic required in first 24 hours was less in buprenorphine group (BB.

  17. Switching from high doses of pure μ-opioid agonists to transdermal buprenorphine in patients with cancer

    DEFF Research Database (Denmark)

    Lundorff, Lena; Sjøgren, Per; Hansen, Ole Bo

    2013-01-01

    with moderate-to-severe cancer pain satisfactorily controlled. SETTING: Patients were switched from the usual pure agonist to TD buprenorphine and were titrated to a stable dose. The assessments were: 1) daily self-assessment of pain intensity, numbers of rescue medications, and pain interference with sleep; 2...

  18. Comparison of Intravenous Morphine with Sublingual Buprenorphine in Management of Postoperative Pain after Closed Reduction Orthopedic Surgery

    Directory of Open Access Journals (Sweden)

    Ghasem Soltani

    2015-09-01

    Full Text Available Background: Postoperative pain is a common side effect following surgery that can significantly reduce surgical quality and patient’s satisfaction. Treatment options are morphine and buprenorphine. We aimed to compare the efficacy of a single dose of intravenous morphine with sublingual buprenorphine in postoperative pain control following closed reduction surgery. Methods: This triple blind clinical trial was conducted on 90 patients referred for closed reduction orthopedic surgery. They were older than 18 years and in classes I and II of the American Society of Anesthesiologists (ASA with an operation time of 30-90 minutes. Patients were divided into two groups of buprenorphine (4.5μg/kg sublingually and morphine (0.2mg/kg intravenously. Baseline characteristics, vital signs, pain score, level of sedation and pharmacological side effects were recorded in the recovery room (at 0 and 30 minutes, and in the ward (at 3, 6 and 12 hours. SPSS version 19 software was used for data analysis and the significance level was set at P Results: Ninety patients were studied, 60 males and 30 females with a mean age of 37.7±16.2 years. There was no significant difference between the two groups in terms of baseline characteristics.Pain score in the morphine group was significantly higher than the buprenorphine group with an average score of 2.5 (P

  19. Analgesic Effects of Tramadol, Tramadol–Gabapentin, and Buprenorphine in an Incisional Model of Pain in Rats (Rattus norvegicus)

    Science.gov (United States)

    McKeon, Gabriel P; Pacharinsak, Cholawat; Long, Charles T; Howard, Antwain M; Jampachaisri, Katechan; Yeomans, David C; Felt, Stephen A

    2011-01-01

    Postoperative pain management in laboratory animals relies heavily on a limited number of drug classes, such as opioids and nonsteroidal antiinflammatory drugs. Here we evaluated the effects of saline, tramadol, tramadol with gabapentin, and buprenorphine (n = 6 per group) in a rat model of incisional pain by examining thermal hyperalgesia and weight-bearing daily for 6 d after surgery. All drugs were administered preemptively and continued for 2 consecutive days after surgery. Rats treated with saline or with tramadol only showed thermal hyperalgesia on days 1 through 4 and 1 through 3 after surgery, respectively. In contrast, buprenorphine-treated rats showed no thermal hyperalgesia on days 1 and 2 after surgery, and rats given tramadol with gabapentin showed reduced thermal hyperalgesia on days 2 and 4. For tests of weight-bearing, rats treated with saline or with tramadol only showed significantly less ipsilateral weight-bearing on day 1 after surgery, whereas rats given either buprenorphine or tramadol with gabapentin showed no significant change in ipsilateral weight-bearing after surgery. These data suggest that tramadol alone provides insufficient analgesia in this model of incisional pain; buprenorphine and, to a lesser extent, tramadol with gabapentin provide relief of thermal hyperalgesia and normalize weight-bearing. PMID:21439212

  20. [Application of a seven-day buprenorphine transdermal patch in multimorbid patients on long-term ibuprofen or diclofenac].

    Science.gov (United States)

    Böhme, K; Heckes, B; Thomitzek, K

    2011-01-13

    The objective of this study was to evaluate the benefit of a seven-day buprenorphine transdermal patch for patients with chronic musculoskeletal pain previously receiving long-term treatment with ibuprofen or diclofenac alone. Data of a subgroup of 703 patients were analysed which were part of a multicenter observational study with 3,295 patients. These patients had previously received ibuprofen or diclofenac and were characterized by older age,the presence of gastrointestinal, cardiovascular, and renal risk factors and the existence of chronic musculoskeletal pain. The switch to the seven-day buprenorphine patch resulted in a clinically significant decrease of the mean pain intensity at rest during the day from 5.3 to 2.9, on physical effort during the day from 7.1 to 3.3, and at night from 4.9 to 1.9 at the end of the study (11-point NRS scale, ppatch proved to very tolerable. In addition, particularly multimorbid patients benefit from opioids such as buprenorphine due to the lack of cardiac, renal and gastrointestinal toxicity. Constant analgesia, improvement of daily activities and reduction of tablets were reported as important advantages of the seven-day patch. In conclusion, the seven-day buprenorphine patch is a valuable therapeutic option for patients with insufficient analgesia on long-term ibuprofen or diclofenac.

  1. [Modification of the analgetic effects (buprenorphine, pentazocine, pethidine) on respiration and haemodynamics by epidural, halothane- or neuroleptanaesthesia (author's transl)].

    Science.gov (United States)

    Wüst, H J; Moritz, K G; Sandmann, W; Richter, O

    1980-04-01

    In 38 patients buprenorphine, meperidine and pentazocine were given in a single dose for postoperative pain relief 20 hours after the end of anaesthesia. Measuring the parameters of the high- and low-pressure system as well as the metabolism the authors found that the effects of these analgetic medicaments, intravenously injected were significantly influenced by fentanyl, halothane or diazepam, given under the course of operation. Especially buprenorphine, injected after epidural anaesthesia in combination with diazepam sedation, proved to have a rather negative effect, because it caused a strong depression of respiration and circulation. On the other hand buprenorphine had, given after neuroleptanaesthesia, a neutralizing - and pentazocine and pethidine in combination with neuroleptanaesthesia a stimulating influence on the circulation. After halothane-anaesthesia the effect of the analegtics on the cardiovascular system was, when buprenorphine was given, depressing and when pentazocine was given indifferent. Similar reactions, but more pronounced, could be seen in the epidural group. With certain reservations, caused by the preliminary character of this study, the following conclusions can be drawn for the anaesthetic practice: 1 Choosing analgetic drugs for postoperative pain relief, the anaesthesist has to be aware of the interactions, possibly resulting from the medicaments, given during anaesthesia. 2. The number of medicaments, given during anaesthesia, should be kept small, considering the eventual interactions and the unintentional secondary effects.

  2. Predictors of Abstinence: National Institute of Drug Abuse Multisite Buprenorphine/Naloxone Treatment Trial in Opioid-Dependent Youth

    Science.gov (United States)

    Subramaniam, Geetha A.; Warden, Diane; Minhajuddin, Abu; Fishman, Marc J.; Stitzer, Maxine L.; Adinoff, Bryon; Trivedi, Madhukar; Weiss, Roger; Potter, Jennifer; Poole, Sabrina A.; Woody, George E.

    2011-01-01

    Objective: To examine predictors of opioid abstinence in buprenorphine/naloxone (Bup/Nal)-assisted psychosocial treatment for opioid-dependent youth. Method: Secondary analyses were performed of data from 152 youth (15-21 years old) randomly assigned to 12 weeks of extended Bup/Nal therapy or up to 2 weeks of Bup/Nal detoxification with weekly…

  3. Psychiatric comorbidity, red flag behaviors, and associated outcomes among office-based buprenorphine patients following Hurricane Sandy.

    Science.gov (United States)

    Williams, Arthur R; Tofighi, Babak; Rotrosen, John; Lee, Joshua D; Grossman, Ellie

    2014-04-01

    In October 2012, Bellevue Hospital Center (Bellevue) in New York City was temporarily closed as a result of Hurricane Sandy, the largest hurricane in US history. Bellevue's primary care office-based buprenorphine program was temporarily closed and later relocated to an affiliate public hospital. Previous research indicates that the relationships between disaster exposure, substance use patterns, psychiatric symptoms, and mental health services utilization is complex, with often conflicting findings regarding post-event outcomes (on the individual and community level) and antecedent risk factors. In general, increased use of tobacco, alcohol, and illicit drugs is associated with both greater disaster exposure and the development or exacerbation of other psychiatric symptoms and need for treatment. To date, there is limited published information regarding post-disaster outcomes among patients enrolled in office-based buprenorphine treatment, as the treatment modality has only been relatively approved recently. Patients enrolled in the buprenorphine program at the time of the storm were surveyed for self-reported buprenorphine adherence and illicit substance and alcohol use, as well as disaster-related personal consequences and psychiatric sequelae post-storm. Baseline demographic characteristics and insurance status were available from the medical record. Analysis was descriptive (counts and proportions) and qualitative, coding open-ended responses for emergent themes. There were 132 patients enrolled in the program at the time of the storm; of those, 91 were contacted and 89 completed the survey. Almost half of respondents reported disruption of their buprenorphine supply. Unexpectedly, patients with psychiatric comorbidity were no more likely to report increased use/relapse as a result. Rather, major risk factors associated with increased use or relapse post-storm were: (1) shorter length of time in treatment, (2) exposure to storm losses such as buprenorphine

  4. Urine analysis of buprenorphine/norbuprenorphine/ naloxone in drugs and driving cases

    Directory of Open Access Journals (Sweden)

    Albert A. Elian

    2015-07-01

    Full Text Available Buprenorphine is now being detected as a drug of abuse in drugs/driving cases alongside side naloxone. Being a semi synthetic opiate, it has the potential to impair motorists in a similar fashion to morphine. Many laboratories have observed that buprenorphine does not produce a positive response with typical opiate immunoassays or routine basic GC-MS drug screens. In this study, samples of urine were enzymatically hydrolyzed after which they were extracted on mixed mode solid phase (SPE columns, after which the extracted samples were analyzed by LC-MS/MS analysis in positive multiple reaction monitoring mode. The LOD/LOQ were determined to be 0.5 and 1.0 ng/mL, respectively for the analytes; linearity (10 to 1000 ng/mL and (r2>0.999. The recovery of the analytes was found to be greater than 90%. Interday/intraday analysis was found to <8% and <10%, respectively. Matrix effects were determined to be <6%.

  5. Blockade of IL-18 signaling diminished neuropathic pain and enhanced the efficacy of morphine and buprenorphine.

    Science.gov (United States)

    Pilat, Dominika; Piotrowska, Anna; Rojewska, Ewelina; Jurga, Agnieszka; Ślusarczyk, Joanna; Makuch, Wioletta; Basta-Kaim, Agnieszka; Przewlocka, Barbara; Mika, Joanna

    2016-03-01

    Currently, the low efficacy of antinociceptive drugs for the treatment of neuropathic pain is a major therapeutic problem. Here, we show the potential role of interleukin (IL)-18 signaling in this phenomenon. IL-18 is an important molecule that performs various crucial functions, including the alteration of nociceptive transmission in response to neuropathic pain. We have studied the changes in the mRNA and protein levels (qRT-PCR and Western blot analysis, respectively) of IL-18, IL-18-binding protein (IL-18BP) and the IL-18 receptor (IL-18R) over time in rats following chronic constriction injury (CCI) of the sciatic nerve. Our study demonstrated that the spinal levels of IL-18BP were slightly downregulated at days 7 and 14 in the rats subjected to CCI. In contrast, the IL-18 and IL-18R mRNA expression and protein levels were elevated in the ipsilateral spinal cord on days 2, 7 and 14. Moreover, in rats exposed to a single intrathecal administration of IL-18BP (50 and 100 ng) 7 or 14 days following CCI, symptoms of neuropathic pain were attenuated, and the analgesia pursuant to morphine and buprenorphine (0.5 and 2.5 μg) was enhanced. In summary, the restoration of the analgesic activity of morphine and buprenorphine via the blockade of IL-18 signaling suggests that increased IL-18 pathway may account for the decreased analgesic efficacy of opioids for neuropathic pain.

  6. The barriers to smoking cessation in Swiss methadone and buprenorphine-maintained patients

    Directory of Open Access Journals (Sweden)

    Stohler Rudolf

    2008-03-01

    Full Text Available Abstract Background Smoking rates in methadone-maintained patients are almost three times higher than in the general population and remain elevated and stable. Due to the various negative health effects of smoking, nicotine dependence contributes to the high mortality in this patient group. The purpose of the current study was to investigate Swiss methadone and buprenorphine-maintained patients' willingness to stop smoking and to clarify further smoking cessation procedures. Methods Substance abuse history, nicotine dependence, and readiness to stop smoking were assessed in a sample of 103 opiate-dependent patients in the metropolitan area of Zurich, Switzerland. Patients were asked to document their smoking patterns and readiness to quit. Results Only a small number of patients were willing to quit smoking cigarettes (10.7% and, even though bupropione or nicotine replacement therapy was included in the fixed daily treatment care, only one patient received nicotine replacement therapy for smoking cessation. A diagnosis of depression in patients' clinical records was associated with readiness to stop smoking. No significant associations were found between readiness to quit smoking and age, methadone treatment characteristics, and presence of co-dependencies. Conclusion The current prescription level of best medicine for nicotine dependence in Swiss methadone and buprenorphine-maintained patients is far from adequate. Possible explanations and treatment-relevant implications are discussed.

  7. Medication-Assisted Treatment for Opioid Addiction: Facts for Families and Friends

    Science.gov (United States)

    ... overcome those problems. Counseling can provide encouragement and motivation to stick to treatment. It can teach coping ... must be locked in a safe place. If children take them by mistake, they can overdose or ...

  8. Chronic Extrahepatic Bile Duct Dilatation: Sonographic Screening in the Patients with Opioid Addiction

    Energy Technology Data Exchange (ETDEWEB)

    Farahmand, H.; PourGholami, M.; Fathollah, Sheikh [Rafsanjan University of Medical Sciences, Rafsanjan (Iran, Islamic Republic of)

    2007-06-15

    One of the best known side effects of using opium is spasm of the sphincter of Oddi, which may increase the diameter of the extrahepatic bile ducts. Ultrasound is the first imaging modality used for evaluating the biliary system because it is commonly available and noninvasive. The principal objective of this study was to measure the common bile duct (CBD) diameter via ultrasonography in opium addicts and to evaluate the relation between the CBD diameter and the period of addiction. This research was an analytical-cross sectional study that was done on 110 opium addicts that were admitted to a drug treatment center. The diameter of the CBD in these cases was measured by ultrasonography and the results were analyzed with other factors like age, the period of addiction and the laboratory findings. According to the findings, there is a significant increase in the range of the CBD diameter in comparison with normal bile ducts. Also, the mean diameter of the CBD in the different age groups showed a significant difference (p < 0.0001) and there was a significant relation between the CBD diameter and the period of addiction (p < 0.001, r = 0.74); so, with the increased length of the addiction period, the mean CBD diameter increases. Opium addiction is one of the factors that causes extrahepatic bile duct dilatation, so in these cases, if no obstructing lesion was found on ultrasound examination and the serum bilirobine and alkaline phosphatase levels are normal, then further evaluation is not needed.

  9. Kids Born to Opioid-Addicted Moms Seem to Fare Poorly in School

    Science.gov (United States)

    ... of these areas. The study authors said their paper is the first to examine academic results in ... oxycodone), Vicoprofen (hydrocodone/ibuprofen), and the illegal opioid heroin are responsible for many cases of neonatal abstinence ...

  10. Opioid addiction and misuse in adult and adolescent patients with cancer.

    Science.gov (United States)

    Pinkerton, Ross; Hardy, Janet R

    2017-06-01

    In the context of a therapeutic opioid epidemic, particularly in the USA, where increasingly stringent screening for 'at risk' individuals and close monitoring of opioid prescription and use is strongly recommended, the issue of misuse within the cancer population must be addressed. Most patients with advanced cancer will have pain requiring opioid therapy at some stage during their disease course. In the majority, this will provide good pain relief with no short- or longer-term adverse sequelae. A subset will present with substance misuse issues that will influence management and prescribing practice. The potential ethical issues of limiting effective analgesia on the basis of addiction risk or history must be acknowledged. Both a judgemental or 'relaxed' approach to such patients is problematic. Ignoring the situation will not be in the patient's best interest, but an undue focus on this aspect may damage therapeutic relationships with clinicians and adversely affect a holistic approach to care. Clinical practitioners must be aware of the risk factors for opioid misuse and in patients who are not under palliative care consider screening prior to commencing opioids. Clinicians must be able to manage and monitor those identified as having an opioid misuse problem. © 2017 Royal Australasian College of Physicians.

  11. Drug-use pattern, comorbid psychosis and mortality in people with a history of opioid addiction

    DEFF Research Database (Denmark)

    Sørensen, H J; Jepsen, P W; Haastrup, S;

    2005-01-01

    OBJECTIVE: To compare the 15-year mortality of people with a history of opioid dependence that had achieved stable abstinence, with the mortality associated with continued drug use. Another objective was to study the influence of hospitalization with comorbid psychosis on the 15-year mortality. M...... at lower risk of premature death than people with continued drug use. A residual observed excess mortality in people who had apparently achieved stable abstinence from drug use is consistent with the view of drug addiction as a chronic disease....

  12. Trait Mindfulness and Progression to Injection Use in Youth With Opioid Addiction.

    Science.gov (United States)

    Wilson, J Deanna; Vo, Hoa; Matson, Pamela; Adger, Hoover; Barnett, Gabriela; Fishman, Marc

    2017-09-19

    Many youth initiate opioid misuse with prescription opioids and transition over time to more severe substance-using behaviors, including injection. Trait mindfulness is a potentially protective factor. This is a cross-sectional study characterizing a sample of opioid-using youth by level of mindfulness and examines the potential effect modification of emotion regulation on the relationship between mindfulness and progression to injection opioid use. A convenience sample of 112 youth (ages 14-24) was recruited during an episode of inpatient detoxification and residential treatment for opioid use disorders. We examined emotion regulation (Difficulties in Emotion Regulation Scale), mindfulness (Child Acceptance and Mindfulness Measure), and opioid use. We completed multivariable regressions stratified by degree of emotion regulation looking at relationship of mindfulness on time to injection use from age of first prescription opioid. Youth had difficulties in emotion regulation (m = 104.2; SD = 2.41) and low mindfulness (m = 19.1;SD = 0.59). While we found overall that mindfulness was associated with time to progression to injection opioid use, there was significant effect modification. Among youth with high levels of difficulty in emotion regulation, those with high mindfulness trait had quicker progressions to injection (-1.31 years; p =.003). In contrast, youth with normal emotion regulation and high mindfulness trait had a slower progression to injection (1.67 years; p =.041). Conclusion/Importance: Our study showed a majority of youth presenting with opioid use disorders have impairments in emotion regulation and deficits in trait mindfulness. The relationship between mindfulness and opioid use is impacted by emotion regulation capacity. More research is needed to understand the various facets of mindfulness and how they interact with emotion regulation in youth.

  13. Drug-use pattern, comorbid psychosis and mortality in people with a history of opioid addiction

    DEFF Research Database (Denmark)

    Sørensen, H J; Jepsen, P W; Haastrup, S

    2005-01-01

    OBJECTIVE: To compare the 15-year mortality of people with a history of opioid dependence that had achieved stable abstinence, with the mortality associated with continued drug use. Another objective was to study the influence of hospitalization with comorbid psychosis on the 15-year mortality. M...... at lower risk of premature death than people with continued drug use. A residual observed excess mortality in people who had apparently achieved stable abstinence from drug use is consistent with the view of drug addiction as a chronic disease....

  14. Competing neurobehavioral decision systems and the neuroeconomics of craving in opioid addiction

    Directory of Open Access Journals (Sweden)

    Sofis MJ

    2014-10-01

    Full Text Available Michael J Sofis,1 David P Jarmolowicz,1 Laura E Martin2 1University of Kansas, 2University of Kansas Medical Center, Lawrence, KS, USA Abstract: Craving is typically thought of as a classically conditioned response characterized by an elevated mesolimbic dopamine response to drug-related stimuli. Although this definition has spurred considerable research, the clinical impact of the research conducted has been less robust. The current review takes a more contemporary approach by conceptualizing craving as the breakdown of executive function and relative strengthening of the limbic system, occurring in the presence of conditioned cues, leading to a maladaptive craving response (ie, an increased likelihood of drug consumption. Working from this framework, the present review focuses on four issues in drug craving research: pivotal findings and limitations of cue-reactivity and neurocognitive tasks; two main processes of craving that include self-control and reward-based explanations; integration of neuroeconomic approaches to craving; and the theoretical implications and future directions of drug craving research. Keywords: craving, competing decision systems, executive function, loss of control, substance abuse 

  15. A non-rewarding, non-aversive buprenorphine/naltrexone combination attenuates drug-primed reinstatement to cocaine and morphine in rats in a conditioned place preference paradigm.

    Science.gov (United States)

    Cordery, Sarah F; Taverner, Alistair; Ridzwan, Irna E; Guy, Richard H; Delgado-Charro, M Begoña; Husbands, Stephen M; Bailey, Christopher P

    2014-07-01

    Concurrent use of cocaine and heroin is a major public health issue with no effective relapse prevention treatment currently available. To this purpose, a combination of buprenorphine and naltrexone, a mixed very-low efficacy mu-opioid receptor agonist/kappa-opioid receptor antagonist/nociceptin receptor agonist, was investigated. The tail-withdrawal and the conditioned place preference (CPP) assays in adult Sprague Dawley rats were used to show that naltrexone dose-dependently blocked the mu-opioid receptor agonism of buprenorphine. Furthermore, in the CPP assay, a combination of 0.3 mg/kg buprenorphine and 3.0 mg/kg naltrexone was aversive. A combination of 0.3 mg/kg buprenorphine and 1.0 mg/kg naltrexone was neither rewarding nor aversive, but still possessed mu-opioid receptor antagonist properties. In the CPP extinction and reinstatement method, a combination of 0.3 mg/kg buprenorphine and 1.0 mg/kg naltrexone completely blocked drug-primed reinstatement in cocaine-conditioned rats (conditioned with 3 mg/kg cocaine, drug prime was 3 mg/kg cocaine) and attenuated drug-primed reinstatement in morphine-conditioned rats (conditioned with 5 mg/kg morphine, drug prime was 1.25 mg/kg morphine). These data add to the growing evidence that a buprenorphine/naltrexone combination may be protective against relapse in a polydrug abuse situation.

  16. Patient perspectives on buprenorphine/naloxone: a qualitative study of retention during the starting treatment with agonist replacement therapies (START) study.

    Science.gov (United States)

    Teruya, Cheryl; Schwartz, Robert P; Mitchell, Shannon Gwin; Hasson, Albert L; Thomas, Christie; Buoncristiani, Samantha H; Hser, Yih-Ing; Wiest, Katharina; Cohen, Allan J; Glick, Naomi; Jacobs, Petra; McLaughlin, Paul; Ling, Walter

    2014-01-01

    This study examines the barriers and facilitators of retention among patients receiving buprenorphine/naloxone at eight community-based opioid treatment programs across the United States. Participants (n = 105) were recruited up to three and a half years after having participated in a randomized clinical trial comparing the effect of buprenorphine/naloxone and methadone on liver function. Semi-structured interviews were conducted with 67 patients provided with buprenorphine/naloxone who had terminated early and 38 patients who had completed at least 24 weeks of the trial. Qualitative data were analyzed using the constant comparison method. Barriers to buprenorphine/naloxone retention that emerged included factors associated with: (1) the design of the clinical trial; (2) negative medication or treatment experience; and (3) personal circumstances. The facilitators comprised: (1) positive experience with the medication; (2) personal determination and commitment to complete; and (3) staff encouragement and support. The themes drawn from interviews highlight the importance of considering patients' prior experience with buprenorphine/naloxone and methadone, medication preference, personal circumstances, and motivation to abstain from illicit use or misuse of opioids, as these may influence retention. Ongoing education of patients and staff regarding buprenorphine/naloxone, especially in comparison to methadone, and support from staff and peers are essential.

  17. Effects of multimodal analgesia with LowDose buprenorphine and meloxicam on fecal glucocorticoid metabolites after surgery in New Zealand white rabbits (Oryctolagus cuniculus).

    Science.gov (United States)

    Goldschlager, Gregg B; Gillespie, Virginia L; Palme, Rupert; Baxter, Mark G

    2013-09-01

    Despite the increasing use of rabbits as companion animals and models for biomedical research, rabbits have not been extensively studied to identify an efficacious postsurgical analgesic that does not cause systemic complications. The synergy of NSAID and systemic opioids is well-documented, and their combined use reduces the amount of either drug required for adequate analgesia. We measured fecal corticosterone metabolites (FCM) in rabbits after a minimally invasive vascular cut-down procedure. Rabbits received buprenorphine (0.03 mg/kg SC every 12 h for 3 d), meloxicam (0.2 mg/kg SC every 24 h for 3 d), buprenorphine-meloxicam (0.01 mg/kg-0.1 mg/kg SC every 24 h for 3 d), or a single dose of 0.5% bupivacaine (0.5 mL) infused locally at the incision site. By day 3 after surgery, buprenorphine, meloxicam, and bupivacaine groups showed elevated FCM levels, which continued to rise until day 7 and then gradually returned to baseline by day 28. In the buprenorphine-meloxicam group, FCM was relatively unchanged until day 3, when treatment was discontinued, and then began to rise. Rabbits in the buprenorphine-meloxicam group gained more weight over the 28-d study than did those in the other 3 treatment groups. This study shows that in rabbits low-dose buprenorphine administered with meloxicam effectively mitigates the FCM response that develops after surgery without the adverse effects associated with higher doses.

  18. Facile synthesis of ( sup 11 C)buprenorphine for positron emission tomographic studies of opioid receptors

    Energy Technology Data Exchange (ETDEWEB)

    Lever, J.R.; Dannals, R.F.; Wagner, H.N. Jr. (Johns Hopkins Univ., Baltimore, MD (USA). School of Hygiene and Public Health Johns Hopkins Univ., Baltimore, MD (USA). Dept. of Radiology); Mazza, S.M. (Johns Hopkins Univ., Baltimore, MD (USA). School of Hygiene and Public Health); Ravert, H.T.; Wilson, A.A. (Johns Hopkins Univ., Baltimore, MD (USA). Dept. of Radiology)

    1990-01-01

    We have developed a simple and rapid method for the production of buprenorphine (BPN), a potent opioid partial agonist, labelled with carbon-11 at the 6-methoxy position. The procedure uses a precursor synthesized in high yield (89%) from BPN in two steps and employs ({sup 11}C)iodomethane as the radiolabelling reagent. ({sup 11}C)BPN of 97% radiochemical purity can be prepared in high specific activity (41 GBq/{mu}mol; 1120 mCi/{mu}mol) in a radiochemical yield of 10% at end-of-synthesis (not decay corrected). The ({sup 11}C)BPN is available for use in studies of cerebral opioid receptors by positron emission tomography within 24 min from end-of-bombardment, including radiosynthesis, purification, formulation for i.v. injection and determination of specific activity. (author).

  19. The antinociceptive efficacy of buprenorphine administered through the drinking water of rats

    DEFF Research Database (Denmark)

    Jessen, L; Bjerrum, Ole Jannik; Christensen, Sten

    2007-01-01

    Postoperative pain management in laboratory animals is important for animal welfare and required under law in many countries. Frequent injection of analgesics to rodents after surgery is stressful for the animals and labour-intensive for animal care personnel. An alternative dosing scheme...... such as administration of analgesics in the drinking water would be desirable. However, the efficacy of a chronic oral analgesic treatment via this route has not yet been documented. This study investigated the antinociceptive efficacy of buprenorphine administered ad libitum via the drinking water of laboratory rats...... water may be a viable treatment option for the relief of pain in laboratory rats, but at the doses used in this study in pain-free rats it was associated with a decrease in water intake and some behavioural changes....

  20. Evaluation on drug dependence of buprenorphine%丁丙诺啡药物依赖性评价

    Institute of Scientific and Technical Information of China (English)

    刘志民; 吕宪祥; 连智; 穆悦; 郭平; 安欣

    2003-01-01

    AIM: To survey and assess the drug dependence and abuse potential liability of buprenorphine among opiate abusers. METHODS: Subjects of opiate dependence with history of buprenorphine use for 3 d at least were surveyed by interview. Physical dependence of buprenorphine was assessed using 30 items opiate withdrawal scale (OWS), which composed of 30 symptoms/signs. A 4-point scale was used to rate each symptoms/signs: zero (0), mild (1), moderate (2), and severe (3). Subjects were asked to rate their symptoms according to severity of previous experienced buprenorphine withdrawal. The estimate of the degree of subjective euphoria for buprenorphine was assessed using visual analogue scale (VAS). RESULTS: Subjects 1235 who met the research criteria cases completed this survey in multi-detoxification treatment centers. The main initial purposes of buprenorphine use were detoxification (77.4 %) and protracted abstinence treated (26.6 %) respectively. The scores of OWS of buprenorphine were between 0.2 to 1.3; The mean scores of OWS in 3 different categories of frequency of buprenorphine use on "continuous use", "un-continuous use", and "sometimes continuous, sometimes un-continuous" were 0.9±0.9, 0.4±0.5, and 0.7±0.4, respectively (F=70.846, P<0.05). The degree of subjective euphoria for buprenorphine was slight to sub-moderate (mean score of VAS was 27 mm ±24 mm). The mean scores of VAS in different routes of buprenorphine administration of sublingual and injection were (24±23) mm and (27 ±24) mm, respectively. No significant difference was found between sublingual and injection use of buprenorphine (u=1.516, P>0.05). CONCLUSION: Both physical and psychic dependence of buprenorphine were low.%目的:调查评价阿片滥用人群中丁丙诺啡(buprenorphine,Bup)的药物依赖性及滥用潜力.方法:采用询问调查方法,对戒毒机构收治的阿片依赖者进行Bup使用情况、药物依赖性及滥用潜力的调查.被调查对象为使用Bup 3天

  1. IL-1 receptor antagonist improves morphine and buprenorphine efficacy in a rat neuropathic pain model.

    Science.gov (United States)

    Pilat, Dominika; Rojewska, Ewelina; Jurga, Agnieszka M; Piotrowska, Anna; Makuch, Wioletta; Przewlocka, Barbara; Mika, Joanna

    2015-10-05

    An interesting research and therapeutic problem is the reduced beneficial efficacy of opioids in the treatment of neuropathic pain. The present study sought to investigate the potential role of IL-1 family members in this phenomenon. We studied the time course of changes in IL-1alpha, IL-1beta, IL-1 receptor type I and IL-1 receptor antagonist mRNA and protein levels experienced by rats after chronic constriction injury (CCI) of the sciatic nerve using qRT-PCR and Western blot analysis. In CCI-exposed rats, spinal levels of IL-1alpha mRNA were slightly downregulated on the 7th day, and protein levels were not changed on the 7th and 14th days. Levels of IL-1 receptor antagonist and IL-1 receptor type I were slightly upregulated in the ipsilateral part of the spinal cord on the 7th and 14th days; however, protein levels were not changed at those time points. Interestingly, we observed that IL-1beta mRNA and protein levels were strongly elevated in the ipsilateral part of the dorsal spinal cord on the 7th and 14th days following CCI. Moreover, in rats exposed to a single intrathecal administration of an IL-1 receptor antagonist (100 ng i.t.) on the 7th and 14th day following CCI, symptoms of neuropathic pain were attenuated, and the analgesic effects of morphine (2.5 µg i.t.) and buprenorphine (2.5 µg i.t.) were enhanced. In summary, restoration of the analgesic activity of morphine and buprenorphine by blockade of IL-1 signaling suggests that increased IL-1beta responses may account for the decreased analgesic efficacy of opioids observed in the treatment of neuropathy.

  2. Comparison of Interpleural and Thoracic Epidural Bupivacaine with Buprenorphine for Post-Thoracotomy Analgesia

    Directory of Open Access Journals (Sweden)

    S K Mathur

    2008-01-01

    Full Text Available The study was designed to compare the efficacy of interpleural and thoracic epidural analgesia after thorac-otomy with regard to quality of analgesia and complications. Sixty patients undergoing elective thoracotomy were randomly and equally placed into either interpleural (IP or thoracic epidural (TE group. In IP group an interpleural catheter was placed in paravertebral space under direct vision during surgery and received 0.25% bupivacaine 20 ml with buprenorphine 150 mcg. In TE group an epidural catheter was inserted in the T6-7 / T7-8 interspace and received 0.25% bupivacaine 10 ml with buprenorphine 150 mcg. Dosage were repeated in both the groups to keep a VAS score < 40 for 48 hours post-operatively. Spirometry was done preoperatively and 12, 24 and 36 hours post-opera-tively. Vital parameters were monitored for 48 hours. The mean analgesia time was 331.73±94.03 min and 567.33±127.33 min in IP and TE groups respectively. The VAS score was significantly reduced within the first 30 minutes of injection in both the groups. Post injection VAS was significantly better in TE group. Mean time taken for interpleural and epidural catheter placement was 5.0±0.0 min and 33.83±3.39 min respectively. Postoperative forced expiratory volume in 1 second(FEV1, forced vital capacity (FVC and forced expiratory ratio (FER were similar in both the groups while peak expiratory flow rate (PEFR, maximal expiratory flow (MEF and F50 were slightly better in TE group. Vital parameters showed similar changes in both the groups. The TE group had more complications. Interpleural analgesia, though of shorter duration, is a safe and effective alternative technique for post-thoracotomy analgesia and has a low complication rate.

  3. Efficacy of Sustained-Release Buprenorphine in an Experimental Laparotomy Model in Female Mice.

    Science.gov (United States)

    Kendall, Lon V; Wegenast, Daniel J; Smith, Brian J; Dorsey, Kathryn M; Kang, Sooah; Lee, Na Young; Hess, Ann M

    2016-01-01

    Mice purportedly require dosing with the opioid buprenorphine (Bup-HCl) at least every 8 to 12 h to maintain an adequate plane of analgesia. Here we used an experimental laparotomy model to determine the clinical efficacy of sustained-release formulations of buprenorphine (Bup-SR) after surgery in mice. Female CD1 mice underwent laparotomy and received either Bup-SR (0.6 mg/kg), Bup-HCl (0.1 mg/kg every 12 h), or saline (every 12 h). Pain was assessed at 1, 3, 6, 12, 24, 48, and 72 h according to the frequency of several behaviors (general activity, wheel-running activity, rearing, grooming, wound licking, orbital tightening, and percentage of integrated nest material) and daily body weight. Over time, wheel running was increased and wound licking was decreased in Bup-SR-treated mice compared with Bup-HCl- and saline-treated mice. Compared with Bup-HCl- and saline-treated mice, Bup-SR-treated mice had increased general activity and percentage of integrated nest material and decreased orbital tightening for 1 to 6 h after surgery. The Bup-HCl- and saline-treated mice had similar general activity, orbital tightening scores, and wheel running activity. Rearing activity and body weight did not differ throughout the study, and none of the observed behaviors differed between groups at 24, 48, and 72 h after surgery. These results suggest that Bup-SR at 0.6 mg/kg provides adequate analgesia after laparotomy in mice and can be used as an alternative analgesic in this context. Furthermore, Bup-HCl at 0.1 mg/kg every 12 h may be inadequate in providing analgesia for abdominal procedures in mice.

  4. [Trend in buprenorphine and methadone shopping behavior in France from 2004 to 2014].

    Science.gov (United States)

    Kernisant, Mélanie; Delorme, Jessica; Kabore, Jean-Luc; Brousse, Georges; Laporte, Catherine; Zenut, Marie; Chenaf, Chouki; Authier, Nicolas

    2016-12-01

    The opioid maintenance treatments (OMT) are widely misused and diverted in many countries. Doctor shopping represented the main way to obtain high quantities of opioids in abuse/diversion. The aim of this study was to assess the trends in the prevalence of doctor shopping for high dosage buprenorphine (HDB) and methadone (MTD) from 2004 to 2014 by using the French Health Insurance claims. This was a cross-sectional study of patients treated by OMT (High Dosage Buprenorphine or Methadone) between 2004 and 2014 from a representative sample of the French Health Insurance claims. Doctor shopping was defined as at least 1 day of overlapping prescriptions, written by at least 2 different prescribers and filled in at least 3 different pharmacies. HDB patients were more likely men (77.9 % in 2014) with a mean age ranged from 33.4±7.6 years in 2004 to 39.5±9.3 years in 2014, Pshopping for HDB decreased from 2004 to 2014 (12.6 % versus 3.9 %, Pshopping for MTD was very low during the period study (0.2 % to 0.5 %). Overall, the prevalence of doctor shopping was higher for HDB than for MTD whatever the year (Pshopping for HDB decreased significantly during the last decade while doctor shopping for MTD remained nearly inexistent even if it could be underestimated because of dispensations in specialized centers and in hospitals not comprised in the insurance claims. The low rates of doctor shopping reported in these last years could result from the guidelines for good practices in OMT use made in 2004 and the adjustments of ANSM (French National Agency for Medicines and Health Products Safety) for HDB best use made in 2011. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  5. Determination of an optimal dose of medetomidine-ketamine-buprenorphine for anaesthesia in the Cape ground squirrel (Xerus inauris

    Directory of Open Access Journals (Sweden)

    K. E. Joubert

    2011-04-01

    Full Text Available The optimal dose of medetomidine-ketamine-buprenorphine was determined in 25 Cape ground squirrels (Xerus inauris undergoing surgical implantation of a temperature logger into the abdominal cavity. At the end of anaesthesia, the squirrels were given atipamezole intramuscularly to reverse the effects of medetomidine. The mean dose of medetomidine was 67.6±9.2 μg/kg, ketamine 13.6±1.9 mg/kg and buprenorphine 0.5±0.06 μg/kg. Induction time was 3.1 ± 1.4 min. This produced surgical anaesthesia for 21± 4.2 min. Atipamezole 232±92 μg/kg produced a rapid recovery. Squirrels were sternally recumbent in 3.5 ± 2.2 min.

  6. Preparation of (/sup 11/C)buprenorphine - a potential radioligand for the study of the opiate receptor system in vivo

    Energy Technology Data Exchange (ETDEWEB)

    Luthra, S.K.; Pike, V.W.; Brady, F.; Horlock, P.L.; Prenant, C.; Crouzel, C.

    1987-01-01

    A method is described for the preparation of (/sup 11/C)buprenorphine in high specific activity, based on the reaction of N-(de-cyclopropylmethyl)buprenorphine with ''no carrier added'' (1-/sup 11/C)cyclopropanecarbonyl chloride followed by reduction with lithium aluminium hydride. The (1-/sup 11/C)cyclopropanecarbonyl chloride is itself prepared from cyclotron-produced (/sup 11/C)carbon dioxide. The overall preparation time is 57 min from the end of radionuclide production, and the radiochemical yield is ca 20%, (decay-corrected from (/sup 11/C)-carbon dioxide). (/sup 11/C)Buprenophine has potential as a radio-ligand for the study of the opiate receptor system in vivo by means of position emission tomography.

  7. Direct Injection LC-MS-MS Analysis of Opiates, Methamphetamine, Buprenorphine, Methadone and Their Metabolites in Oral Fluid from Substitution Therapy Patients.

    Science.gov (United States)

    Liu, Hsiu-Chuan; Lee, Hsi-Tzu; Hsu, Ya-Ching; Huang, Mei-Han; Liu, Ray H; Chen, Tai-Jui; Lin, Dong-Liang

    2015-01-01

    A rapid and sensitive liquid chromatography-tandem mass spectrometry (LC-MS-MS) method was developed, validated and applied to simultaneous analysis of oral fluid samples for the following 10 analytes: methadone, 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP), buprenorphine, norbuprenorphine, morphine, codeine, 6-acetylmorphine, 6-acetylcodeine, amphetamine, and methamphetamine. The oral fluid sample was briefly centrifuged and the supernatant was directly injected into the LC-MS-MS system operated under reverse-phase chromatography and electrospray ionization (ESI). Deuterated analogs of the analytes were adopted as the internal standards and found to be effective (except for buprenorphine) to compensate for potential matrix effects. Each analytical run took 0.99) established for buprenorphine and the other nine analytes were 5-100 and 1-100 ng/mL. Intra- and interday precision (% CV) ranges for the 10 analytes were 0.87-12.2% and 1.27-12.8%, while the corresponding accuracy (%) ranges were 91.8-113% and 91.9-111%. Limits of detection and quantitation established for these 10 analytes were in the ranges of 0.1-1.0 and 0.25-1.0 ng/mL (5 ng/mL for buprenorphine). The method was successfully applied to the analysis of 62 oral fluid specimens collected from patients participating in methadone and buprenorphine substitution therapy programs. Analytical results of methadone and buprenorphine were compared with data derived from GC-MS analysis and found to be compatible. Overall, the direct injection LC-MS-MS method performed well, permitting rapid analysis of oral fluid samples for simultaneous quantification of methadone, buprenorphine, opiate and amphetamine drug categories without extensive sample preparation steps.

  8. On deriving the dose–effect relation of an unknown second component: An example using buprenorphine preclinical data

    OpenAIRE

    Tallarida, Ronald J.; Cowan, Alan; Raffa, Robert B.

    2010-01-01

    Buprenorphine, like many other drugs, displays a biphasic dose–response relation (‘hormesis’), viz., its antinociceptive effect in some preclinical models increases up to some dose level (often achieving 100% effect) and decreases at high-doses. A decreasing component was evident in the tail-flick tests described here, occurring in both the mouse and the rat. While the mechanism of dose-related decline in antinociceptive effect, when observed, might be related to nociceptin/orphanin-FQ, the p...

  9. Management of moderate to severe chronic low back pain with buprenorphine buccal film using novel bioerodible mucoadhesive technology

    Directory of Open Access Journals (Sweden)

    Pergolizzi Jr JV

    2016-10-01

    Full Text Available Joseph V Pergolizzi Jr,1 Robert B Raffa,2,3 Charles Fleischer,1 Gianpietro Zampogna,1 Robert Taylor Jr1 1NEMA Research, Naples, FL, 2University of Arizona College of Pharmacy, Tucson, AZ, 3Temple University School of Pharmacy, Philadelphia, PA, USA Abstract: With a global prevalence of ~9%–12%, low back pain (LBP is a serious public health issue, associated with high costs for treatment and lost productivity. Chronic LBP (cLBP involves central sensitization, a neuropathic pain component, and may induce maladaptive coping strategies and depression. Treating cLBP is challenging, and current treatment options are not fully satisfactory. A new BioErodible MucoAdhesive (BEMA® delivery system for buprenorphine has been developed to treat cLBP. The buccal buprenorphine (BBUP film developed for this product (Belbuca™ allows for rapid delivery and titration over a greater range of doses than was previously available with transdermal buprenorphine systems. In clinical studies, BBUP was shown to effectively reduce pain associated with cLBP at 12 weeks with good tolerability. The most frequently reported side effects with the use of BBUP were nausea, constipation, and vomiting. There was no significant effect on the QT interval vs placebo. Chronic pain patients using other opioids can be successfully rotated to BBUP without risk of withdrawal symptoms or inadequate analgesia. The role of BBUP in managing cLBP remains to be determined, but it appears to be a promising new product in the analgesic arsenal in general. Keywords: buccal, transmucosal, buprenorphine, chronic low back pain, BEMA, drug delivery Belbuca

  10. Simultaneous determination of buprenorphine, norbuprenorphine and naloxone in human plasma by liquid chromatography/tandem mass spectrometry.

    Science.gov (United States)

    Liu, Yongzhen; Li, Xiaohua; Xu, Allan; Nasser, Azmi F; Heidbreder, Christian

    2016-02-20

    A simple, sensitive and rapid liquid chromatography/electrospray ionization tandem mass spectrometry (LC-ESI-MS/MS) method was developed and validated for simultaneous quantification of naloxone, buprenorphine and its metabolite norbuprenorphine in human plasma. Human plasma samples were extracted using a single step liquid-liquid extraction, and then separated on an Imtakt Unison UK-C18 column (2.1×50mm, 3μm) using alkaline mobile phases with gradient elution. All of the analytes were detected in positive ion mode using multiple reaction monitoring (MRM). The method was validated and the specificity, linearity, lower limit of quantitation, precision, accuracy, recoveries and stability were determined. The linear range was 20-10000pg/mL for buprenorphine and norbuprenorphine; and 1-500pg/mL for naloxone. The correlation coefficient (R(2)) values for all three analytes were ≥0.995. The precision and accuracy for intra-day and inter-day were 63% and matrix effects were tracked by the deuterated internal standards (IS) with the IS-normalized matrix factor ranging from 0.96 to 1.33 for all three analytes. The validated method was successfully applied in a clinical pharmacokinetic study with low dose administration of sublingual buprenorphine and naloxone.

  11. Assessment of carprofen and buprenorphine on recovery of mice after surgical removal of the mammary fat pad.

    Science.gov (United States)

    Adamson, Trinka W; Kendall, Lon V; Goss, Sherri; Grayson, Kevin; Touma, Chadi; Palme, Rupert; Chen, Jane Q; Borowsky, Alexander D

    2010-09-01

    The purpose of this study was to determine the level of pain elicited by mammary fat pad removal surgery and the effects of postoperative analgesics on recovery. Female FVB mice were anesthetized, and mammary fat pad removal was performed. After surgery, mice received carprofen, buprenorphine, a combination of carprofen and buprenorphine, or saline treatment. Additional mice received anesthesia but no surgery or treatment. Food and water intake, body weight, wheel running activity, and a visual assessment score were recorded daily for 4 d after surgery and compared with presurgical findings. Corticosterone metabolites in fecal samples were analyzed at 12 and 24 h postsurgically and compared with baseline values. All surgical groups had significantly decreased food intake at 24 h, with a return to baseline by 48 h. The combination treatment resulted in a significantly decreased water intake and body weight at 24 h. All surgical groups had significantly decreased wheel running activity at 24 h only. The visual assessment scores indicated mild pain for all surgical groups, with the buprenorphine treated mice showing the highest pain index scores, as compared with nonsurgical controls. Fecal corticosterone metabolite levels did not differ significantly between any of the groups or across time. The parameters used in this study did not indicate that administration of these analgesic regimens improved recovery as compared with that of saline-treated mice. Care should be taken when using visual assessment scores to evaluate pain in mice, given that analgesics may have side effects that inadvertently elevate the score.

  12. Primary tumour growth in an orthotopic osteosarcoma mouse model is not influenced by analgesic treatment with buprenorphine and meloxicam.

    Science.gov (United States)

    Husmann, K; Arlt, M J E; Jirkof, P; Arras, M; Born, W; Fuchs, B

    2015-10-01

    Little is known about the treatment of bone pain in animal models of bone cancer. In the present study, the orthotopic 143-B human osteosarcoma xenotransplantation model was used to address the following questions: (1) Can repetitive analgesic treatment extend the experimental period by prolonging the time to reach humane endpoints and (2) Does repetitive analgesic treatment affect bone tumour development and metastasis? The analgesics, buprenorphine and meloxicam, were either applied individually or in combination at 12 h intervals as soon as the animals began to avoid using the tumour cell injected leg. While control mice treated with NaCl showed continuous body weight loss, the major criterion previously for terminating the experiments, animals treated with analgesic substances did not. The control mice had to be sacrificed 26 days after tumour cell injection, whereas the groups of animals with the different pain treatments were euthanized after an additional eight days. Importantly, primary intratibial tumour growth was not affected in any of the experimental groups by any of the pain treatment procedures. Between days 26 and 34 after tumour cell injection an increase of about 100% of the number of lung metastases was found for the groups treated with buprenorphine alone or together with meloxicam, but not for the group treated with meloxicam alone. In summary, the results indicated that both buprenorphine and meloxicam are suitable analgesics for prolonging the experimental periods in an experimental intratibial osteosarcoma mouse model.

  13. In vitro release of clomipramine HCl and buprenorphine HCl from poly adipic anhydride (PAA) and poly trimethylene carbonate (PTMC) blends.

    Science.gov (United States)

    Dinarvand, Rassoul; Alimorad, Mohammed Massoud; Amanlou, Massoud; Akbari, Hamid

    2005-10-01

    Controlled drug-delivery technology is concerned with the systematic release of a pharmaceutical agent to maintain a therapeutic level of the drug in the body for modulated and/or prolonged periods of time. This may be achieved by incorporating the therapeutic agent into a degradable polymer vehicle, which releases the agent continuously as the matrix erodes. In this study, poly trimethylene carbonate (PTMC), an aliphatic polycarbonate, and poly adipic anhydride (PAA), an aliphatic polyanhydride, were synthesized via melt condensation and ring-opening polymerization of trimethylene carbonate and adipic acid, respectively. The release of clomipramine HCl and buprenorphine HCl from discs prepared with the use of PTMC-PAA blends in phosphate buffer (pH 7.4) are also described. Clomipramine HCl and buprenorphine HCl were both used as hydrophilic drug models. Theoretical treatment of the data with the Peppas model revealed that release of clomipramine HCl (5%) in devices containing 70% PTMC or more followed a Fickian diffusion model. However, the releases of buprenorphine HCl (5%) in the same devices were anomalous. For devices containing 50% and more PAA, surface erosion may play a significant role in the release of both molecules.

  14. Correlates of Nine-Month Retention following Interim Buprenorphine-Naloxone Treatment in Opioid Dependence: A Pilot Study

    Directory of Open Access Journals (Sweden)

    A. Håkansson

    2016-01-01

    Full Text Available Interim medication-only treatment has been suggested for the initiation of opioid maintenance treatment (OMT in opioid-dependent subjects, but this rarely has been studied using buprenorphine instead of methadone. Following a pilot trial assessing interim buprenorphine-naloxone treatment in order to facilitate transfer into OMT, we here aimed to study retention, and potential correlates of retention, in full-scale treatment. Thirty-six patients successfully referred from a waiting list through an interim treatment phase were followed for nine months in OMT. Baseline characteristics, as well as urine analyses during the interim phase and during full-scale OMT, were studied as potential correlates of retention. The nine-month retention in OMT was 83 percent (n=30. While interim-phase urine samples positive for benzodiazepines did not significantly predict dropout from full-scale OMT (p=0.09, urine samples positive for benzodiazepines within full-scale OMT were significantly associated with dropout (p<0.01, in contrast to other substances and baseline characteristics. Retention remained high through nine months in this pilot study sample of patients referred through buprenorphine-naloxone interim treatment, but use of benzodiazepines is problematic, and the present data suggest that it may be associated with treatment dropout.

  15. Comparison of prescriber evaluations and patient-directed self-reports in office-based practice for buprenorphine treatment of opiate-dependent individuals in France, 2002

    Directory of Open Access Journals (Sweden)

    Estelle Lavie

    2008-11-01

    Full Text Available Estelle Lavie1, Mélina Fatséas1, Jean-Pierre Daulouède1,2, Cécile Denis1, Jacques Dubernet1, Laurent Cattan3, Marc Auriacombe11Laboratoire de psychiatrie/EA4139, INSERM IFR-99 and Faculté de médecine Victor Pachon, University Victor Segalen Bordeaux 2, Bordeaux, France; 2Bizia, Centre de soins d’addictologie, Centre Hospitalier de la Côte Basque, Bayonne, France; 3Centre médical, Noisy-le-sec, FranceAbstract: The objective of this cross-sectional evaluation study was to compare data generated through prescriber assessments, and data generated from independent direct contact with opiate-dependent patients in office-based practice to evaluate buprenorphine treatment for modality of buprenorphine absorption, benzodiazepine use, and depressive symptoms. A group of buprenorphine office-based practice prescribers was selected to participate in this study. They were asked to screen for inclusion all their patients coming for a visit from February to August 2002. Once included by their prescribing physician, patients were given a series of self-administered questionnaires to be returned directly to the research staff, independently of their prescriber. Each prescriber was given a questionnaire to complete based on their knowledge and interview of the patient. Items assessed were history of current treatment, current substance use, buprenorphine treatment related behavior (daily frequency of intake, route of administration, benzodiazepine use and existence of a major depressive episode. Prescribers and patients’ questionnaires were compared. Concordance of both assessments was assessed by kappa statistics. The sensitivity and specificity as well as the positive and negative predictive values of prescriber collected information were compared to that of their patients’. There was an overall good correlation between both data sources on the procedures for buprenorphine use especially for intravenous use of buprenorphine. There were important

  16. The Effect of a Payer-Mandated Decrease in Buprenorphine Dose on Aberrant Drug Tests and Treatment Retention Among Patients with Opioid Dependence.

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    Accurso, Anthony J; Rastegar, Darius A

    2016-02-01

    The optimal dose for office-based buprenorphine therapy is not known. This study reports on the effect of a change in payer policy, in which the insurer of a subset of patients in an office-based practice imposed a maximum sublingual buprenorphine dose of 16 mg/day, thereby forcing those patients on higher daily doses to decrease their dose. This situation created conditions for a natural experiment, in which treatment outcomes for patients experiencing this dose decrease could be compared to patients with other insurance who were not challenged with a dose decrease. Subjects were 297 patients with opioid use disorder in a primary care practice who were prescribed buprenorphine continuously for at least 3 months. Medical records were retrospectively reviewed for urine drug test results and treatment retention. Rates of aberrant urine drug tests were calculated in the period before the dose decrease and compared to rate after it with patients serving as their own controls. Comparison groups were formed from patients with the same insurance on buprenorphine doses of 16 mg/day or lower, patients with different insurance on 16 mg/day or lower, and patients with different insurance on greater than 16 mg/day. Rates of aberrant drug tests and treatment retention of patients on 16 mg/day or less of buprenorphine were compared to that of patients on higher daily doses. The rate of aberrant urine drug tests among patients who experienced a dose decrease rose from 27.5% to 34.2% (p=0.043). No comparison group showed any significant change in aberrant drug test rates. Moreover, all groups who were prescribed buprenorphine doses greater than 16 mg/day displayed lower rates of aberrant urine drug tests than groups prescribed lower doses. Retention in treatment was also highest among those prescribed greater than 16 mg/day (100% vs. 86.8%, 90.1%, and 84.4% p=0.010). An imposed buprenorphine dose decrease was associated with an increase in aberrant drug tests. Patients in a

  17. Long-term safety and analgesic efficacy of buprenorphine buccal film in patients with moderate-to-severe chronic pain requiring around-the-clock opioids

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    Hale M

    2017-01-01

    Full Text Available Martin Hale,1 Veronica Urdaneta,2 M Todd Kirby,3 Qinfang Xiang,4 Richard Rauck5 1Gold Coast Research, LLC, Plantation, FL, USA; 2Pharmacovigilance and Risk Management, 3Clinical Development, 4Biometrics, Endo Pharmaceuticals Inc., Malvern, PA, USA; 5Carolinas Pain Institute, Wake Forest Baptist Health, Winston Salem, NC, USA Background: This open-label, single-arm study was conducted to evaluate the long-term safety and efficacy of a novel buprenorphine formulation, buprenorphine buccal film, in the treatment of moderate-to-severe chronic pain requiring around-the-clock opioids.Methods: The primary purpose of this study was to evaluate the long-term safety and tolerability of buprenorphine buccal film. Five hundred and six patients who completed previous studies with buprenorphine buccal film (n=445; rollover patients or were recruited de novo for this study (n=61 were enrolled in this study. All patients underwent a dose titration period of ≤6 weeks, during which doses of buprenorphine buccal film were adjusted to a maximum 900 µg every 12 hours, depending on tolerability and the need for rescue medication. An optimal dose was defined as the dose that the patient found satisfactory for both pain relief and tolerability, without the need for rescue medication or with ≤2 tablets of rescue medication per day. Once the optimal dose was reached, treatment was continued for ≤48 weeks. Pain intensity was measured throughout the study using a 0–10 numerical rating scale.Results: Of 435 patients achieving an optimal dose of buprenorphine buccal film who commenced long-term treatment, 158 (36.3% completed 48 weeks of treatment. Treatment-related adverse events occurred in 116 patients (22.9% during the titration phase and 61 patients (14.0% during the long-term treatment phase, and adverse events leading to discontinuation of treatment occurred in 14 (2.8% and 14 (3.2% patients, respectively. The most common adverse events were those typically

  18. Contraceptive use and pregnancy outcomes among opioid drug-using women: a retrospective cohort study.

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    Charles S Cornford

    Full Text Available The contraceptive needs of illicit opioid users differ from non-drug users but are poorly understood. The aim of this study was to describe contraceptive use and pregnancy outcomes in opioid-using women, and to examine their association with a range of risk factors.This retrospective cohort study used UK general practice records, Treatment Outcomes Profile and National Drug Treatment Monitoring System data, and a nested data validation exercise. A cohort of 376 women aged 20-61 years were in active treatment for opioid addiction in October 2010 at two specialised primary care practices in North-East England. Outcomes were age-adjusted prevalence estimates for contraceptive use and pregnancy outcomes in users of illicit opioids. The association between lifestyle-related risk factors and contraception was explored.Drug-using women made lower use of planned (non-condom contraception (24% vs 50%, p<0.001, had more frequent pregnancy terminations (0.46 vs. 0.025, p = 0.004 and higher annual incidence of chlamydia (1.1% vs. 0.33%, p<0.001, when compared with age-matched population data. Specifically, there was low use of oral contraceptives (4% vs. 25%, p<0.001, IUCD (1% vs. 6%, p<0.001, and sterilisation (7% vs. 6%, p = 0.053, but higher rates of injectable contraceptives (6% vs. 3%, p = 0.003. A total of 64% of children aged <16 years born to this group did not live with their mother. No individual risk factor (such as sex-working significantly explained the lower use or type of non-condom contraception.This is the first study to describe planned contraceptive use among drug-users, as well as the association with a range of risk factors and pregnancy outcomes. The low uptake of planned contraception, set against high rates of terminations and sexually transmitted disease demonstrates the urgent clinical need to improve contraceptive services, informed by qualitative work to explore the values and beliefs influencing low contraceptive uptake.

  19. Comparison of cerebral pharmacokinetics of buprenorphine and norbuprenorphine in an in vivo sheep model.

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    Jensen, M L; Foster, D; Upton, R; Grant, C; Martinez, A; Somogyi, A

    2007-04-01

    The pharmacokinetics and time course of blood-brain equilibration of buprenorphine (BUP) and norbuprenorphine (norBUP) in sheep were characterized. Sheep were administered 0.04 mg kg(-1) BUP or 0.6 mg kg(-1) norBUP as 4-min i.v. infusions. The cerebral kinetics were inferred from arterio-sagittal sinus concentration gradients and changes in cerebral blood flow. These data were fitted to physiologically based pharmacokinetic models. BUP cerebral kinetics were best described by a membrane-limited model with a large equilibration delay (half-life of 20 min) between brain and blood due to intermediate permeability (47 ml min(-1)) and a large cerebral distribution volume (595 ml). Significant limitation in permeability (6 ml min(-1)) characterized the cerebral kinetics of norBUP with a cerebral distribution volume (157 ml) giving a blood-brain equilibration half-life (21 min) similar to that for BUP. The logD of BUP and norBUP were 3.93 +/- 0.08 and 1.18 +/- 0.04 (mean +/- SD), respectively. Both compounds revealed slow cerebral equilibration with variations in degree of permeability and distribution volume reflecting the difference in lipophilicity. It is possible that norBUP contributes to the central effects seen after chronic BUP administration as this study demonstrated its entry into the brain.

  20. A role for the mu opioid receptor in the antidepressant effects of buprenorphine.

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    Robinson, Shivon A; Erickson, Rebecca L; Browne, Caroline A; Lucki, Irwin

    2017-02-15

    Buprenorphine (BPN), a mixed opioid drug with high affinity for mu (MOR) and kappa (KOR) opioid receptors, has been shown to produce behavioral responses in rodents that are similar to those of antidepressant and anxiolytic drugs. Although recent studies have identified KORs as a primary mediator of BPN's effects in rodent models of depressive-like behavior, the role of MORs in BPN's behavioral effects has not been as well explored. The current studies investigated the role of MORs in mediating conditioned approach behavior in the novelty-induced hypophagia (NIH) test, a behavioral measure previously shown to be sensitive to chronic treatment with antidepressant drugs. The effects of BPN were evaluated in the NIH test 24h post-administration in mice with genetic deletion of the MOR (Oprm1(-/-)) or KOR (Oprk1(-/-)), or after pharmacological blockade with the non-selective opioid receptor antagonist naltrexone and selective MOR antagonist cyprodime. We found that behavioral responses to BPN in the NIH test were blocked in Oprm1(-/-) mice, but not in Oprk1(-/-) mice. Both cyprodime and naltrexone significantly reduced approach latency at doses experimentally proven to antagonize the MOR. In contrast the selective MOR agonist morphine and the selective KOR antagonist nor-BNI were both ineffective. Moreover, antinociceptive studies revealed persistence of the MOR antagonist properties of BPN at 24h post-administration, the period of behavioral reactivity. These data support modulation of MOR activity as a key component of BPN's antidepressant-like effects in the NIH paradigm.

  1. Improved buprenorphine immunoassay performance after urine treatment with β-glucuronidase.

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    Snyder, Marion L; Darragh, Alicia; Flood, James G; Jones, Jenny; Ropar, Kaitlin; Jarolim, Petr; Melanson, Stacy E F

    2014-01-01

    Buprenorphine (BUP), a semi-synthetic opioid analgesic, is increasingly prescribed for the treatment of chronic pain and opioid dependence. Urine immunoassay screening methods are available for monitoring BUP compliance and misuse; however, these screens may have poor sensitivity or specificity. We evaluated whether the pretreatment of urine with β-glucuronidase (BG) improves the sensitivity and overall accuracy of three BUP enzyme immunoassays when compared with liquid chromatography-tandem mass spectrometry (LC-MS-MS). Urine samples sent to our laboratories for BUP testing (n = 114) were analyzed before and after BG pretreatment by cloned enzyme donor immunoassay (CEDIA), enzyme immunoassay (EIA) and homogenous EIA (HEIA) immunoassays using a common 5 ng/mL cutoff. Total BUP and norbuprenorphine (NBUP) concentrations were measured by LC-MS-MS as the reference method. Urine BG pretreatment improved EIA, HEIA and CEDIA sensitivities from 70, 82 and 94%, respectively, to 97% for each of the three methods, when compared with LC-MS-MS. While the specificity of the EIA and HEIA remained 100% after BG pretreatment, the specificity of the CEDIA decreased from 74 to 67%. Urine pretreatment with BG is recommended to improve sensitivity of the EIA and HEIA BUP screening methods. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  2. Long-term administration of high doses of transdermal buprenorphine in cancer patients with severe neuropathic pain

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    Leppert W

    2015-12-01

    Full Text Available Wojciech Leppert, Grzegorz Kowalski Chair and Department of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland Background: Buprenorphine is often administered by the transdermal route (transdermal buprenorphine [TB] in cancer patients with severe neuropathic pain. However, high doses of TB of 140 µg/h are rarely used.Patients and methods: Three cancer patients with severe neuropathic Numeric Rating Scale (NRS pain scores of 8–10 who were successfully treated with high doses of TB up to 140 µg/h along with other opioids and adjuvant analgesics.Results: TB was administered for a long period of follow-up (9 months to 4 years, including 34–261 days of treatment with the dose of 140 µg/h, which allowed achievement of satisfactory analgesia (NRS 3–5 and good treatment tolerance. In all three patients, TB dose was gradually titrated from 35 to 140 µg/h, and all patients used morphine at least for some time for breakthrough and background pain management along with adjuvant analgesics. Two patients continued the treatment with TB until the end of life, and one patient is still receiving the treatment.Conclusion: TB at doses of up to 140 µg/h in cancer patients with severe neuropathic pain seems to be effective and safe in combination with other opioids and with adjuvant analgesics, and may significantly improve patients’ quality of life. Clinical studies may explore higher than maximal 140 µg/h TB doses recommended by a manufacturer, and also in combination with other opioids and adjuvant analgesics. Keywords: adverse effects, analgesia, cancer, neuropathic pain, transdermal buprenorphine, treatment

  3. Clinical effects of buprenorphine on open field behaviour and gait symmetry in healthy and lame weaned piglets.

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    Meijer, Ellen; van Nes, Arie; Back, Willem; van der Staay, Franz Josef

    2015-12-01

    Lameness in pigs decreases animal welfare and economic profit for the farmer. An important reason for impaired welfare in lame animals is pain due to lameness. No direct measurement of pain is possible in animals, and methods to indirectly detect and quantify the amount of pain an animal is experiencing are urgently needed. In this study, two methods to assess pain associated with lameness in pigs were evaluated to determine if they were sensitive enough to detect a lameness reduction as an effect of an experimental analgesic medication. Asymmetry associated with lameness was objectively quantified using pressure mat kinetic parameters: peak vertical force (PVF), load rate (LR), vertical impulse (VI) and peak vertical pressure (PVP). Locomotor activity was assessed in an open field test. A dose of 0.04 mg/kg buprenorphine, a strong analgesic, was used to treat 10 lame pigs, while eight other lame pigs, treated with physiological saline solution, served as controls. Buprenorphine decreased lameness-associated asymmetry for pressure mat LR (P = 0.002), VI (P = 0.003) and PVP (P = 0.001) and increased activity of the lame pigs in the open field (P = 0.023), while saline-treated animals did not show any changes in asymmetry and became less active in the open field (P open field test are both sensitive enough to detect the analgesic effects of buprenorphine when used to treat moderate to severe clinical pain in a relatively small group of affected pigs. The methods used in this study may also provide promising additional tools for future research into early pain recognition and lameness treatment in pigs.

  4. COMPARATIVE STUDY BETWEEN EPIDURAL BUPIVACAINE WITH BUPRENORPHINE AND EPIDURAL BUPIVACAINE FOR POST - OPERATIVE ANALGESIA IN ABDOMINAL AND LOWER LIMB SURGERY

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    Nagesh

    2015-02-01

    Full Text Available Epidural administration of various analgesics gained increasing popularity following the discovery of opioid receptors in the spinal cord capable of producing potent analgesia. This effect seems to be greatest when epidural anaesthesia in continued in the post - operative period as epidural analgesia . It is now clear that epidural administration of opioids. Ours was a comparative study between epidural bupivacaine with buprenorphine and epidural bupivacaine for post - operative analgesia in abdominal and lower limb surgery. METHODS: 60 patients undergoing lower abdominal and lower limb surgeries of either sex with ASA grade 1 and 2 a ged between 20 and 60 years for divided into two groups. After completion of the surgery and when the effect of local anaesthetic wears of and the patients complains of pain the intended study drugs were given when visual analogue pain score touched 5 cm m ark. Group – A: Patients received 8ml of 0.25% bupivacaine + 0.15mg of buprenorphine. Group – B: patients received 0.25% of bupivacaine alone. In the post - operative period the following parameters were studied , 1. Onset of analgesia , 2. Duration of analges ia , 3. Vital parameters such as heart beat , blood pressure , respiratory rate , sedation score and visual analogue score were recorded , 4. Side effects like nausea , vomiting , hypotension , respiratory depression , and pruritus allergic reaction were looked for . RESULTS: It is observed that onset of analgesia in Group A (0.25% bupivacaine + 0.15mg buprenorphine was 7.35 min. When compared to Group B which 15.5 min , which is statically significant (P<0.05. Duration of analgesia in Group A is 17.23 hrs compared to Group B , which is 5.2 hrs , this is statically significant (P<0.05. Visual analogue scale was reduced in Group A compared to Group B CONCLUSIONS: Addition of buprenorphine to bupivacaine by epidural injection for post - operative analgesia improves the on set , The duration and the

  5. Buprenorphine for postoperative analgesia: Axillary brachial plexus block versus intramuscular administration in a placebo-controlled trial

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    Deepali Thakur

    2015-01-01

    Full Text Available Background and Aims: Peripheral administration of opioids has been suggested for prolongation of regional analgesia. This prospective, randomized, double-blind placebo-controlled study was undertaken to compare the effect of regional (axillary brachial plexus block [ABPB] versus intramuscular (IM buprenorphine (2 μg/kg in adults. Material and Methods: Seventy-five adults undergoing upper limb surgery received ABPB with local anaesthetic (15 ml 0.5% bupivacaine, 15 ml 2% lignocaine with adrenaline 1:200,000, 9 ml normal saline [NS]. In addition, regional group RB (n = 25 received buprenorphine 2 μg/kg in ABPB and 1 ml NS IM. Systemic Group SB (n = 25 received 1 ml NS in ABPB and buprenorphine 2 μg/kg IM. Group C (n = 25 received 1 ml NS in ABPB and IM. Onset, duration of sensory and motor block, hemodynamic parameters, sedation score, pain scores using visual analog scale, duration of postoperative analgesia, rescue analgesic (RA requirement, adverse events, and patient satisfaction were noted. Results: Demographics, onset and duration of sensory, motor block were similar. RB group had longest duration of analgesia (20.61 ± 1.33 h compared to SB (10.91 ± 0.90 h and control group (5.86 ± 0.57 h (P < 0.05 RB vs. SB/C and SB vs. C. RA requirement was highest in the control group and least in RB group (P = 0.000 RB vs. SB/C and SB vs. C. SB group had a maximum number of side effects (P = 0.041, SB vs. RB/C. Patient satisfaction was highest with group RB (P < 0.05 RB vs. SB/C, and P = 0.06 SB vs. C. Conclusion: Buprenorphine 2 μg/kg in axillary plexus block provides significantly prolonged analgesia with less RA requirement and greater patient satisfaction compared to IM administration. This is highly suggestive of action on peripheral opioid receptors.

  6. Investigation of cross-species translatability of pharmacological MRI in awake nonhuman primate - a buprenorphine challenge study.

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    Stephanie Seah

    Full Text Available BACKGROUND: Pharmacological MRI (phMRI is a neuroimaging technique where drug-induced hemodynamic responses can represent a pharmacodynamic biomarker to delineate underlying biological consequences of drug actions. In most preclinical studies, animals are anesthetized during image acquisition to minimize movement. However, it has been demonstrated anesthesia could attenuate basal neuronal activity, which can confound interpretation of drug-induced brain activation patterns. Significant efforts have been made to establish awake imaging in rodents and nonhuman primates (NHP. Whilst various platforms have been developed for imaging awake NHP, comparison and validation of phMRI data as translational biomarkers across species remain to be explored. METHODOLOGY: We have established an awake NHP imaging model that encompasses comprehensive acclimation procedures with a dedicated animal restrainer. Using a cerebral blood volume (CBV-based phMRI approach, we have determined differential responses of brain activation elicited by the systemic administration of buprenorphine (0.03 mg/kg i.v., a partial µ-opioid receptor agonist, in the same animal under awake and anesthetized conditions. Additionally, region-of-interest analyses were performed to determine regional drug-induced CBV time-course data and corresponding area-under-curve (AUC values from brain areas with high density of µ-opioid receptors. PRINCIPAL FINDINGS: In awake NHPs, group-level analyses revealed buprenorphine significantly activated brain regions including, thalamus, striatum, frontal and cingulate cortices (paired t-test, versus saline vehicle, p<0.05, n = 4. This observation is strikingly consistent with µ-opioid receptor distribution depicted by [6-O-[(11C]methyl]buprenorphine ([(11C]BPN positron emission tomography imaging study in baboons. Furthermore, our findings are consistent with previous buprenorphine phMRI studies in humans and conscious rats which collectively

  7. Pharmacokinetic analysis of enterohepatic circulation of buprenorphine and its active metabolite, norbuprenorphine, in rats.

    Science.gov (United States)

    Ohtani, M; Kotaki, H; Uchino, K; Sawada, Y; Iga, T

    1994-01-01

    The pharmacokinetic characteristics of buprenorphine (BN) and its active metabolite, norbuprenorphine (NBN), was investigated using rats. The elimination half-life (t1/2), total body clearance (CLtot), and steady-state volume of distribution (Vdss) of BN (0.6 mg/kg iv dose) in the intact rat were 2.8 hr, 23.3 ml/min/kg, and 4.2 liters/kg, respectively, and those of NBN (0.6 mg/kg iv dose) were 0.9 hr, 35.0 ml/min/kg, and 2.0 liters/kg. Within 24 hr after administration of BN (0.6 mg/kg dose) to the bile-fistula rat, 74.1% of dose was excreted in the bile as BN glucuronide (BN-Glu) and 18.5% as NBN glucuronide (NBN-Glu), and in urine < 3.2% as BN-Glu. After administration of NBN to the bile-fistula rat, 85.1% and 9.1% of the dose were excreted as NGN-Glu in bile and urine, respectively. The existence of the enterohepatic circulation (EHC) of BN and NBN was confirmed by using paired rats: the donor and recipient rats. Within 24 hr after administration of BN (0.6 mg/kg dose) to the donor rat, 58.8% of the dose was reexcreted as NBN-Glu in bile of the recipient and 25.1% as BN-Glu. Based on the results of in vitro metabolism, it was suggested that this increase in the proportion of NBN-Glu in bile observed after one enterohepatic cycling of BN may be due to the first-pass metabolism in the liver. BN was detected in the plasma of the recipient rat after administration of BN, to the donor rat.(ABSTRACT TRUNCATED AT 250 WORDS)

  8. Buprenorphine/naloxone treatment practices in Malaysia: Results of national surveys of physicians and patients.

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    Vicknasingam, B; Dazali, M N M; Singh, D; Schottenfeld, R S; Chawarski, M C

    2015-07-01

    Medication assisted treatment with buprenorphine/naloxone (Bup/Nx), including prescribing and dispensing practices of general practitioners (GPs) in Malaysia and their patients' experiences with this treatment have not been systematically examined. The current study surveyed GPs providing Bup/Nx treatment and patients receiving office-based Bup/Nx treatment in Malaysia. Two cross-sectional surveys of GPs (N=115) providing outpatient Bup/Nx maintenance treatment and of patients (N=253) currently receiving Bup/Nx treatment throughout peninsular Malaysia. Physicians prescribed Bup/Nx dosages in the range of 2-4mg daily for 70% of patients and conducted urine testing in the past month on approximately 16% of their patients. In the patient survey, 79% reported taking daily Bup/Nx doses of 2mg or less; 82% reported that no urine toxicology testing had been conducted on them in the past month, 36% had an opiate positive urine test at the time of the survey, 43% reported illicit opiate use, 15% reported injection of heroin and 22% reported injection of Bup/Nx in the past month. Low daily Bup/Nx doses, lack of behavioral monitoring or counseling, and high rates of continued drug use, including injection of drugs and medications during Bup/Nx treatment in Malaysia, indicate continuing problems with implementation and less than optimal treatment effectiveness. High cost of Bup/Nx in Malaysia may deter patients from seeking treatment and contribute to taking low Bup/Nx dosages. Improved training of physicians and establishing standards for Bup/Nx dosing, routine toxicology testing, and counseling may be needed to improve care and treatment response. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  9. Predictors of attrition with buprenorphine/naloxone treatment in opioid dependent youth☆

    Science.gov (United States)

    Warden, Diane; Subramaniam, Geetha A.; Carmody, Thomas; Woody, George E.; Minhajuddin, Abu; Poole, Sabrina A.; Potter, Jennifer; Fishman, Marc; Bogenschutz, Michael; Patkar, Ashwin; Trivedi, Madhukar H.

    2012-01-01

    Background In opioid dependent youth there is substantial attrition from medication-assisted treatment. If youth at risk for attrition can be identified at treatment entry or early in treatment, they can be targeted for interventions to help retain them in treatment. Methods Opioid dependent adolescents and young adults (n=152), aged 15–21, were randomized to 12 weeks (BUP, n=74) or 2 weeks of detoxification (DETOX, n=78) with buprenorphine/naloxone (Bup/Nal), both in combination with 12 weeks of psychosocial treatment. Baseline and early treatment related predictors of treatment attrition were identified in each group using bivariate and multivariate logistic regression. Results In the DETOX group 36% left between weeks 2 and 4, at the end of the dose taper, while in the BUP group only 8% left by week 4. In the BUP group, early adherence to Bup/Nal, early opioid negative urines, use of any medications in the month prior to treatment entry, and lifetime non-heroin opioid use were associated with retention while prior 30-day hallucinogen use was associated with attrition. In the DETOX group, only use of sleep medications was associated with retention although not an independent predictor. A broad range of other pre-treatment characteristics was unrelated to attrition. Conclusions Prompt attention to those with early non-adherence to medication or an early opioid positive urine, markers available in the first 2 weeks of treatment, may improve treatment retention. Extended Bup/ Nal treatment appeared effective in improving treatment retention for youth with opioid dependence across a wide range of demographics, and pre-treatment clinical characteristics. PMID:22626890

  10. On deriving the dose–effect relation of an unknown second component: An example using buprenorphine preclinical data

    Science.gov (United States)

    Tallarida, Ronald J.; Cowan, Alan; Raffa, Robert B.

    2014-01-01

    Buprenorphine, like many other drugs, displays a biphasic dose–response relation (‘hormesis’), viz., its antinociceptive effect in some preclinical models increases up to some dose level (often achieving 100% effect) and decreases at high-doses. A decreasing component was evident in the tail-flick tests described here, occurring in both the mouse and the rat. While the mechanism of dose-related decline in antinociceptive effect, when observed, might be related to nociceptin/orphanin-FQ, the precise mechanism remains unknown. Regardless of the mechanism, the values of this dose-related decline yield data that can be used to calculate the dose–effect relation of the decreasing (unknown second) component. The calculation, which uses the same concept of dose equivalence that underlies additivity in isobolographic analysis, was employed here from tail-flick data obtained in mouse and rat. The derived dose–effect curves of the second component, though differing in efficacy between mouse and rat, displayed a very notable similarity. This novel technique offers possible insight into the dual low-dose (analgesic), high-dose (addiction medication) uses of buprenorphine. PMID:20061095

  11. On deriving the dose-effect relation of an unknown second component: an example using buprenorphine preclinical data.

    Science.gov (United States)

    Tallarida, Ronald J; Cowan, Alan; Raffa, Robert B

    2010-06-01

    Buprenorphine, like many other drugs, displays a biphasic dose-response relation ('hormesis'), viz., its antinociceptive effect in some preclinical models increases up to some dose level (often achieving 100% effect) and decreases at high-doses. A decreasing component was evident in the tail-flick tests described here, occurring in both the mouse and the rat. While the mechanism of dose-related decline in antinociceptive effect, when observed, might be related to nociceptin/orphanin-FQ, the precise mechanism remains unknown. Regardless of the mechanism, the values of this dose-related decline yield data that can be used to calculate the dose-effect relation of the decreasing (unknown second) component. The calculation, which uses the same concept of dose equivalence that underlies additivity in isobolographic analysis, was employed here from tail-flick data obtained in mouse and rat. The derived dose-effect curves of the second component, though differing in efficacy between mouse and rat, displayed a very notable similarity. This novel technique offers possible insight into the dual low-dose (analgesic), high-dose (addiction medication) uses of buprenorphine.

  12. Gender and racial/ethnic differences in addiction severity, HIV risk, and quality of life among adults in opioid detoxification: results from the National Drug Abuse Treatment Clinical Trials Network

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    Bruce Burchett

    2010-12-01

    more likely than whites to use heroin and cocaine and to have more severe alcohol and employment problems.Conclusions: Women and whites show more psychopathology than men and African Americans. These results highlight the need to monitor an increased trend of opioid addiction among women and whites and to develop effective combined psychosocial and pharmacologic treatments to meet the diverse needs of the expanding opioid-abusing population. Elevated levels of HIV risk behaviors among Hispanics and whites also warrant more research to delineate mechanisms and to reduce their risky behaviors.Keywords: buprenorphine, clinical trials network, gender differences, heath disparity, HIV risk behavior, methadone, opioid dependence, rehabilitation

  13. Opioid receptor imaging and displacement studies with [6-O-[{sup 11}C]methyl]buprenorphine in baboon brain

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    Galynker, Igor; Schlyer, David J.; Dewey, Stephen L.; Fowler, Joanna S.; Logan, Jean; Gatley, S. John; MacGregor, Robert R.; Ferrieri, Richard A.; Holland, M. J.; Brodie, Jonathan; Simon, Eric; Wolf, Alfred P

    1996-04-01

    Buprenorphine (BPN) is a mixed opiate agonist-antagonist used as an analgesic and in the treatment of opiate addiction. We have used [6-O-[{sup 11}C]methyl]buprenorphine ([{sup 11}C]BPN) to measure the regional distribution in baboon brain, the test-retest stability of repeated studies in the same animal, the displacement of the labeled drug by naloxone in vivo, and the tissue distribution in mice. The regional distribution of radioactivity in baboon brain determined with PET was striatum > thalamus > cingulate gyrus > frontal cortex > parietal cortex > occipital cortex > cerebellum. This distribution corresponded to opiate receptor density and to previously published data (37). The tracer uptake in adult female baboons showed no significant variation in serial scans in the same baboon with no intervention in the same scanning session. HPLC analysis of baboon plasma showed the presence of labeled metabolites with 92% {+-} 2.2% and 43% {+-} 14.4% of the intact tracer remaining at 5 and 30 min, respectively. Naloxone, an opiate receptor antagonist, administered 30-40 min after tracer injection at a dose of 1.0 mg/kg i.v., reduced [{sup 11}C]BPN binding in thalamus, striatum, cingulate gyrus, and frontal cortex to values 0.25 to 0.60 of that with no intervention. There were minimal (< 15%) effects on cerebellum. Naloxone treatment significantly reduced the slope of the Patlak plot in receptor-containing regions. These results demonstrate that [{sup 11}C]BPN can be displaced by naloxone in vivo, and they affirm the feasibility of using this tracer and displacement methodology for short-term kinetics studies with PET. Mouse tissue distribution data were used to estimate the radiation dosimetry to humans. The critical organ was the small intestine, with a radiation dose estimate to humans of 117 nrad/mCi.

  14. Simultaneous determination of opiates, methadone, buprenorphine and metabolites in human urine by superficially porous liquid chromatography tandem mass spectrometry.

    Science.gov (United States)

    Lin, Huei-Ru; Chen, Chin-Lun; Huang, Chieh-Liang; Chen, Shao-Tsu; Lua, Ahai-Chuang

    2013-04-15

    For monitoring compliance of methadone or buprenorphine maintenance patient, a method for the simultaneous determination of methadone, 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP), buprenorphine, norbuprenorphine, opiates (morphine, codeine, 6-monoacetylmorphine) in urine by superficially porous liquid chromatography tandem mass spectrometry was developed and validated. After enzyme digestion and liquid-liquid extraction, reverse-phase separation was achieved in 5.2 min and quantification was performed by multiple reaction monitoring. Chromatographic separation was performed at 40 °C on a reversed phase Poroshell column with gradient elution. The mobile phase consisted of water and methanol, each containing 0.1% formic acid, at a flow rate of 0.32 mL/min. Intra-day and inter-day precision were less than 12.1% and accuracy was between -9.8% and 13.7%. Extraction efficiencies were more than 68%. Although ion suppression was detected, deuterated internal standards compensated for these effects. Carryover was minimal, less than 0.20%. All analytes were stable at room temperature for 16 h, 4 °C for 72 h, and after three freeze-thaw cycles. The assay also fulfilled compound identification criteria in accordance with the European Commission Decision 2002/657/EC. We analyzed 62 urine samples from patients received maintenance therapy and found that 54.8% of the patient samples tested were detected for morphine, codeine, or 6-monoacetylmorphine. This method provides a reliable and simultaneous quantification of opiates, maintenance drugs, and their metabolites in urine samples. It facilitates the routine monitoring in individuals prescribed the drug to ensure compliance and help therapeutic process.

  15. The ABCB1, rs9282564, AG and TT Genotypes and the COMT, rs4680, AA Genotype are Less Frequent in Deceased Patients with Opioid Addiction than in Living Patients with Opioid Addiction

    DEFF Research Database (Denmark)

    Christoffersen, Dorte J; Damkier, Per; Feddersen, Søren

    2016-01-01

    because morphine and methadone more readily cross the blood-barrier in these subjects due to a lower efflux transporter activity of the ABCB1 (p-glycoprotein) transporter. Our results did not support this hypothesis, since no statistically significant difference (p=0.506) in the frequency of the TT...

  16. Morphine- and buprenorphine-induced analgesia and antihyperalgesia in a human inflammatory pain model: a double-blind, randomized, placebo-controlled, five-arm crossover study

    Directory of Open Access Journals (Sweden)

    Ravn P

    2013-01-01

    Full Text Available Pernille Ravn,1 Erik L Secher,2 Ulrik Skram,3 Trine Therkildsen,1 Lona L Christrup,1 Mads U Werner41Department of Drug Design and Pharmacology, University of Copenhagen, 2Department of Anesthesiology, Juliane Marie Center, Rigshospitalet, Copenhagen University Hospitals, 3Department of Intensive Care, Gentofte Hospital, Copenhagen University Hospitals, 4Multidisciplinary Pain Center, Neuroscience Center, Rigshospitalet, Copenhagen University Hospitals, Copenhagen, DenmarkPurpose: Opioid therapy is associated with the development of tolerance and paradoxically increased sensitivity to pain. It has been suggested that buprenorphine is associated with a higher antihyperalgesia/analgesia ratio than µ-opioid receptor agonists. The primary outcome of this study was therefore to investigate relative differences in antihyperalgesia and analgesia effects between morphine and buprenorphine in an inflammatory pain model in volunteers. The secondary outcome was to examine the relationship between pain sensitivity and opioid-induced effects on analgesia, antihyperalgesia, and descending pain modulation.Subjects and methods: Twenty-eight healthy subjects were included. The study was a double-blind, randomized, placebo-controlled, five-arm crossover study with a multimodal (electrical, mechanical, and thermal stimuli testing technique. After baseline assessments, intravenous infusions of morphine (10/20 mg, buprenorphine (0.3/0.6 mg, or placebo (normal saline were administered over a 210-minute period, during which a cold pressor test, heat injury (47°C, 7 minutes, 12.5 cm2, and the first postburn assessment were done. After completion of the drug infusions, two additional postburn assessments were done. The subjects were monitored during each 8-hour session by an anesthesiologist.Results: For nearly all tested variables, significant dose-dependent analgesic effects were demonstrated. The median antihyperalgesia/analgesia ratio (secondary hyperalgesia

  17. COMPARISON OF BUTORPHANOL AND BUPRENORPHINE AS AN ADJUVANT TO LOCAL ANAESTHESIA IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK FOR POST-OPERATIVE ANALGESIA

    Directory of Open Access Journals (Sweden)

    Vinod

    2014-04-01

    Full Text Available BACKGROUND: Supraclavicular brachial plexus block provides anesthesia for surgeries around elbow, forearm and hand. With advent of opioid receptors, variety of opioid agents is used for postoperative analgesia via brachial plexus block. Butorphanol and Buprenorphine can be used along with local anesthetics to provide post op analgesia. AIMS: 1 To study the onset and extent of sensory and motor blockade. 2 To compare the duration of postoperative analgesia in two groups. METHODOLOGY: A study was carried out in 30 patients aged 18-60yr of ASA grade I & II of either sex in each group undergoing orthopedic upper limb surgeries via supraclavicular brachial plexus block. Injection Butorphanol 1mg (Group-I and Buprenorphine150µg (Group-II were added to local anesthetic mixture. Onset of sensory and motor blockade, extent of blockade and occurrence of any complications were studied in both the groups. All patients were observed for analgesia hourly until patient demanded analgesia post-operatively by VAS pain score. RESULTS: In Group II (Buprenorphine onset of sensory, motor blockade and complete blockade was delayed as compared to Group I (Butorphanol. In Group I patients, VAS score was 39.44  16.66 at the end of 5 hours while in Group II patients 50.35  25.65 VAS score at the end of 8 hours. So the duration of analgesia was upto 5-6 hours in Group I, where it was upto 8-9 hours in Group II. CONCLUSION: Both drugs are potent analgesic in brachial plexus block, but Buprenorphine is more potent and produces longer duration of postoperative analgesia than Butorphanol.

  18. Clinical application of buprenorphine and its in vitor determination%丁丙诺啡的临床应用及其体外检测

    Institute of Scientific and Technical Information of China (English)

    陈永对; 刘丽华

    2006-01-01

    丁丙诺啡(buprenorphine,Bup)是蒂巴因的衍生物,是阿片受体激动-拮抗剂.其最早是20世纪60年代由英国药物学家合成,注射液用于镇痛.80年代,丁丙诺啡作为临床手术镇痛药物,在许多国家登记注册.

  19. Can the chronic administration of the combination of buprenorphine and naloxone block dopaminergic activity causing anti-reward and relapse potential?

    Science.gov (United States)

    Blum, Kenneth; Chen, Thomas JH; Bailey, John; Bowirrat, Abdulla; Femino, John; Chen, Amanda LC; Simpatico, Thomas; Morse, Siobhan; Giordano, John; Damle, Uma; Kerner, Mallory; Braverman, Eric R.; Fornari, Frank; Downs, B.William; Rector, Cynthia; Barh, Debmayla; Oscar-Berman, Marlene

    2013-01-01

    Opiate addiction is associated with many adverse health and social harms, fatal overdose, infectious disease transmission, elevated health care costs, public disorder, and crime. Although community-based addiction treatment programs continue to reduce the harms of opiate addiction with narcotic substitution therapy such as methadone maintenance, there remains a need to find a substance that not only blocks opiate-type receptors (mu, delta, etc.) but also provides agonistic activity; hence the impetus arose for the development of a combination of narcotic antagonism and mu receptor agonist therapy. After three decades of extensive research the federal Drug Abuse Treatment Act 2000 (DATA) opened a window of opportunity for patients with addiction disorders by providing increased access to options for treatment. DATA allows physicians who complete a brief specialty-training course to become certified to prescribe buprenorphine and buprenorphine/naloxone (Subutex, Suboxone) for treatment of patients with opioid dependence. Clinical studies indicate buprenorphine maintenance is as effective as methadone maintenance in retaining patients in substance abuse treatment and in reducing illicit opioid use. With that stated, we must consider the long-term benefits or potential toxicity attributed to Subutex or Suboxone. We describe a mechanism whereby chronic blockade of opiate receptors, in spite of only partial opiate agonist action, may ultimately block dopaminergic activity causing anti-reward and relapse potential. While the direct comparison is not as yet available, toxicity to buprenorphine can be found in the scientific literature. In considering our cautionary note in this commentary, we are cognizant that to date this is what we have available, and until such a time when the real magic bullet is discovered, we will have to endure. However, more than anything else this commentary should at least encourage the development of thoughtful new strategies to target the

  20. Treatment of ischemic pain in patients suffering from peripheral vasculopathy with transdermal buprenorphine plus epidural morphine with ropivacaine vs. epidural morphine with ropivacaine.

    Science.gov (United States)

    Aurilio, Caterina; Pace, Maria Caterina; Passavanti, Maria Beatrice; Paladini, Antonella; Maisto, Massimo; Iannotti, Mario; Pota, Vincenzo; D'amora, Eleonora; Sansone, Pasquale; Barbarisi, Manlio

    2009-01-01

    This study compared the efficacy and safety of buprenorphine transdermal delivery system with peridural infusion of morphine and ropivacaine to peridural infusion alone for the control of ischemic pain in patients suffering from peripheral vasculopathy. Eighty-six patients were randomized into two groups. In the first group, a buprenorphine patch 35 microg/hour TTDS (transtec transdermal device plus ropivacaine and morphine) was applied, and a peridural infusion of ropivacaine/morphine (200 mg + 2 mg) was established. In the second group, ropivacaine and morphine analgesia was obtained using a peridural infusion and a placebo patch. The primary efficacy parameter was the visual analog scale score for pain. Secondary parameters of efficacy were the short-form McGill Pain Questionnaire scores and a score for pain interference with sleep obtained from patient diaries evaluated every week for a period of 4 weeks. Subjects in the TTDS group reported a reduction in pain, increased sleep, and a lower incidence of side effects compared with the control group. Transdermal buprenorphine use resulted in significant pain relief with excellent patient satisfaction, which may translate into improvement in mood and quality of life.

  1. Prescription Opioid Abuse, Prescription Opioid Addiction, and Heroin Abuse among Adolescents in a Recovery High School: A Pilot Study

    Science.gov (United States)

    Vosburg, Suzanne K.; Eaton, Thomas A.; Sokolowska, Marta; Osgood, Eric D.; Ashworth, Judy B.; Trudeau, Jeremiah J.; Muffett-Lipinski, Michelle; Katz, Nathaniel P.

    2016-01-01

    The progression from prescription opioid (RXO) abuse to RXO addiction is not well understood in adolescents, nor is the progression from RXO addiction to heroin abuse. The purpose of this pilot study was to characterize the development of RXO drug abuse, RXO drug addiction, and heroin abuse in a small cohort of adolescents recovering from opioid…

  2. A systematic review of the effectiveness of the community reinforcement approach in alcohol, cocaine and opioid addiction

    NARCIS (Netherlands)

    Roozen, H.G.; Boulogne, J.J.; Tulder, M.W. van; Brink, W. van den; Jong, C.A.J. de; Kerkhof, A.J.F.M.

    2004-01-01

    The community reinforcement approach (CRA) has been applied in the treatment of disorders resulting from alcohol, cocaine and opioid use. The objectives were to review the effectiveness of (1) CRA compared with usual care, and (2) CRA versus CRA plus contingency management. Studies were selected thr

  3. A systematic review of the effectiveness of the community reinforcement approach in alcohol, cocaine and opioid addiction.

    NARCIS (Netherlands)

    Roozen, H.G.; Boulogne, J.J.; Tulder, van M.; Brink, van den W.; Jong, de C.A.J.; Kerkhof, A.J.F.M.

    2004-01-01

    Abstract The community reinforcement approach (CRA) has been applied in the treatment of disorders resulting from alcohol, cocaine and opioid use. The objectives were to review the effectiveness of (1) CRA compared with usual care, and (2) CRA versus CRA plus contingency management. Studies were sel

  4. Effect of buprenorphine as an adjunct with plain local anesthetic solution in supraclavicular brachial plexus block on quality and duration of postoperative analgesia

    Directory of Open Access Journals (Sweden)

    Surekha Patil

    2015-01-01

    Full Text Available Background and Aims: Supraclavicular brachial plexus block is ideal for upper limb surgical procedures. Buprenorphine, an agonist antagonist opioid has been used as an adjunct to prolong analgesia. We aimed to evaluate the quality and duration of postoperative analgesia by addition of buprenorphine to local anesthetic solution. Material and Methods: A prospective, randomized, double-blind control study was conducted on 50 healthy patients of ASA Grade I/II of age group 20-70 years scheduled for orthopedic and reconstructive surgery of upper limb under supraclavicular brachial plexus block. Patients were allocated into two groups, 25 in each group viz.: Group B (buprenorphine group received 20 ml 0.5% bupivacaine + 15 ml 2% lignocaine with adrenaline (1:200,000 + 4 ml normal saline + 1500 units hyaluronidase + 3 μg/kg buprenorphine diluted to 1 ml normal saline. Group C (control group received 20 ml 0.5% bupivacaine + 15 ml 2% lignocaine with adrenaline (1:200,000 + 4 ml normal saline + 1500 units hyaluronidase + 1 ml normal saline. The parameters observed were onset and duration of sensory and motor block, quality and duration of analgesia and side-effects. Results: The mean duration of postoperative analgesia was significantly longer in Group B (16.04 ± 3.19 h than in Group C (6.20 ± 0.74 h. There was no difference between two groups on mean onset of sensory block. The mean duration motor block was significantly longer in Group B (4.93 ± 0.94 h than in Group C (2.25 ± 0.62 h [P < 0.05]. The mean duration of sensory block was also significantly longer in Group B (5.71 ± 0.94 h than in Group C (4.94 ± 0.70 h with P < 0.05. Conclusion: Addition of 3 μg/kg buprenorphine to 0.5% bupivacaine for supraclavicular brachial plexus block prolonged duration of postoperative analgesia and sensory blockade without an increase in side effects.

  5. Memory function in opioid-dependent patients treated with methadone or buprenorphine along with benzodiazepine: longitudinal change in comparison to healthy individuals

    Directory of Open Access Journals (Sweden)

    Rapeli Pekka

    2009-04-01

    Full Text Available Abstract Background Opioid-substitution treatment (OST for opioid dependence (OD has proven effective in retaining patients in treatment and reducing illegal opiate abuse and crime. Consequently, the World Health Organization (WHO has listed the opioid agonists methadone and buprenorphine as essential drugs for OD that should be available worldwide. In many areas of the world, OD is often associated with concomitant benzodiazepine (BZD dependence and abuse, which complicates treatment. However, possible changes in the cognitive functioning of these patients are not well-known. The present study is the first to examine longitudinal stability of memory function in OST patients with BZD use, thus providing a new tool for health policy authorities in evaluating the usefulness of OST. Methods Within the first two months (T1 and between 6–9 months (T2 after OST admission, we followed the working memory, immediate verbal memory, and memory consolidation of 13 methadone- and 15 buprenorphine- or buprenorphine/naloxone-treated patients with BZD dependence or abuse disorder. The results were compared to those of fifteen normal comparison participants. All participants also completed a self-reported memory complaint questionnaire on both occasions. Results Both patient groups performed statistically significantly worse than normal comparison participants in working memory at time points T1 and T2. In immediate verbal memory, as measured by list learning at T1, patients scored lower than normal comparison participants. Both patient groups reported significantly more subjective memory problems than normal comparison participants. Patients with more memory complaints recalled fewer items at T2 from the verbal list they had learned at T1 than those patients with fewer memory complaints. The significance of the main analyses remained nearly the same when the statistical tests were performed without buprenorphine-only patients leaving 12 patients to

  6. Women's Health

    Science.gov (United States)

    Women have unique health issues. And some of the health issues that affect both men and women can affect women differently. Unique issues ... and men also have many of the same health problems. But these problems can affect women differently. ...

  7. 美沙酮与丁丙诺啡联用治疗海洛因依赖的临床效果%Effect of Methadone Plus Buprenorphine on the Alleviation of Heroin Withdrawal Symptoms

    Institute of Scientific and Technical Information of China (English)

    家有荣

    2001-01-01

    Objective:To explore the effectiveness of methadone combined with buprenorphine on the alleviation of heroin withdrawal symptoms. Methods: One hundred and twenty patients with heroin dependence were randomly divided into two groups , namely the methadone combined buprenorphine treatment group (n=60)and the methadone alone treatment group (n=60). Rating scales were employed to assess the treatment outcomes. Results: Compared with patients in the methadone alone treatment group, patients in the combined treatment group reported fewer withdrawal symptoms, especially in first four days. They also subjectively considered the combined treatment as more acceptable. This effect was more pronounced in patients with relatively high levels of initial withdrawal symptoms. Conclusion: Methadone with buprenorphine was proved to be a favourable combination treatment in terms of reducing withdrawal symptoms, as well as improving the short-term detoxification success rate, especially in patients with severe heroin withdrawal symptoms.

  8. Longitudinal missing data strategies for substance use clinical trials using generalized estimating equations: an example with a buprenorphine trial

    Science.gov (United States)

    McPherson, Sterling; Barbosa-Leiker, Celestina; McDonell, Michael; Howell, Donelle; Roll, John

    2013-01-01

    Objective A review of substance use clinical trials indicates that sub-optimal methods are the most commonly used procedures to deal with longitudinal missing information. Methods Listwise deletion (i.e., using complete cases only), positive urine analysis (UA) imputation, and multiple imputation (MI) were used to evaluate the effect of baseline substance use and buprenorphine/naloxone tapering schedule (7 or 28 days) on the probability of a positive UA (UA+) across the 4-week treatment period. Results The listwise deletion generalized estimating equations (GEE) model demonstrated that those in the 28-day taper group were less likely to submit a UA+ for opioids during the treatment period (odds ratios (OR) = 0.57, 95% confidence interval (CI): 0.39–0.83), as did the positive UA imputation model (OR = 0.43, CI: 0.34–0.55). The MI model also demonstrated a similar effect of taper group (OR = 0.57, CI: 0.42–0.77), but the effect size was more similar to that of the listwise deletion model. Conclusions Future researchers may find utilization of the MI procedure in conjunction with the common method of GEE analysis as a helpful analytic approach when the missing at random assumption is justifiable. PMID:24014144

  9. P-glycoprotein mediates brain-to-blood efflux transport of buprenorphine across the blood-brain barrier.

    Science.gov (United States)

    Suzuki, Toyofumi; Zaima, Chika; Moriki, Yoshiaki; Fukami, Toshiro; Tomono, Kazuo

    2007-01-01

    The involvement of P-glycoprotein (P-gp) in buprenorphine (BNP) transport at the blood-brain barrier (BBB) in rats was investigated in vivo by means of both the brain uptake index technique and the brain efflux index technique. P-gp inhibitors, such as cyclosporin A, quinidine and verapamil, enhanced the apparent brain uptake of [3H]BNP by 1.5-fold. The increment of the BNP uptake by the brain suggests the involvement of a P-gp efflux mechanism of BNP transport at the BBB. [3H]BNP was eliminated with an apparent elimination half-life of 27.5 min after microinjection into the parietal cortex area 2 regions of the rat brain. The apparent efflux clearance of [3H]BNP across the BBB was 0.154 ml/min/g brain, which was calculated from the elimination rate constant (2.52 x 10- 2 min- 1) and the distribution volume in the brain (6.11 ml/g brain). The efflux transport of [3H]BNP was inhibited by range from 32 to 64% in the presence of P-gp inhibitors. The present results suggest that BNP is transported from the brain across the BBB via a P-gp-mediated efflux transport system, at least in part.

  10. Determination of buprenorphine by differential pulse voltammetry on carbon paste electrode using SDS as an enhancement factor.

    Science.gov (United States)

    Behpour, Mohsen; Valipour, Akram; Keshavarz, Mahin

    2014-09-01

    In the present study, a facile electrochemical approach is proposed for the determination of buprenorphine (BPR) in the presence of sodium dodecyl sulfate (SDS). SDS was applied for amplification of oxidation signal. Carbon paste electrode (CPE) used as working electrode and cyclic voltammetry (CV), differential pulse voltammetry (DPV) and electrochemical impedance spectroscopy (EIS) were carried out in phosphate buffer solution (pH3.0). Under optimal experimental conditions, the oxidation current increased with the addition of BPR in the sample and two dynamic ranges obtained from 4.00 nM to 0.126 μM and from 0.126 to 0.317 μM by DPV and exhibited a low detection limit (LOD) of 1.33 nM (S/N=3). This offered method has been used for the determination of BPR in the real samples and has validated with the recovery test for BPR spiked urine samples. The result demonstrated that this method is a simple, sensitive, rapid, low-cost, and stable method for BPR detection.

  11. Automated radiosyntheses of [6-0-methyl-[sup 11]C]diprenorphine and [6-0-methyl-[sup 11]C]buprenorphine from 3-0-trityl protected precursors

    Energy Technology Data Exchange (ETDEWEB)

    Luthra, S.K.; Brady, F.; Turton, D.R.; Brown, D.J.; Dowsett, K.; Waters, S.L.; Jones, A.K.P. (Hammersmith Hospital, London (United Kingdom). M.R.C. Cyclotron Unit); Matthews, R.W.; Crowder, J.C. (North London Univ., London (United Kingdom). School of Applied Chemistry)

    1994-08-01

    The antagonist [6-0-methyl-[sup 11]C]diprenorphine and the mixed agonist/antagonist [6-0-methyl-[sup 11]C]buprenorphine, radioligands for studying the opioid receptor system in vivo with positron emission tomography, were preapred by 0-methylation of (3-0-trityl, 6-desmethyl)diprenorphine and [3-0-trityl,6-desmethyl]buprenorphine, respectively, with [[sup 11]C]iodomethane. The use of the base-stable, acid labile trityl protecting group minimizes the formation of byproducts and allows reproducible radiosyntheses. (author).

  12. A comparative study of extradural anesthesia using 0.75% ropivacaine, 0.75% ropivacaine with fentanyl, and 0.75% ropivacaine with buprenorphine for cesarean section from a rural teaching hospital in India

    Directory of Open Access Journals (Sweden)

    Grace Maria George

    2014-01-01

    Full Text Available Context: The study was to compare the analgesic efficacy of three different epidural solutions - ropivacaine, ropivacaine fentanyl mixture, and ropivacaine buprenorphine mixture - for cesarean section. Materials and Methods: This was a prospective, randomized, controlled, double blind study carried out in primi parturients undergoing elective cesarean section with singleton fetus. A total of 102 parturients in the age group of 20-35 years, American Society of Anesthesiologists (ASA I or II scheduled for elective cesarean under continuous epidural anesthesia were divided into three groups using a computer-generated random number list. The test dose (3 ml 2% lignocaine with 15 μg adrenaline and 0.75% ropivacaine 12 ml were given to all parturients. In addition, normal saline 1 ml, fentanyl 50 μg, and buprenorphine 300 μg were given to Group I, II, and III respectively. Sensory block, motor block, analgesia, maternal effects, fetal outcome, and surgeons′ and parturients′ satisfaction were evaluated. Results: Onset of sensory block was faster in the fentanyl and buprenorphine groups compared to ropivacaine group (9.94 ± 0.48, 10.72 ± 0.26 versus 14.59 ± 0.34. Duration of sensory block was prolonged in buprenorphine group as compared to fentanyl and ropivacaine groups (120.41 ± 4.31 versus (95.68 ± 3.28, 98.28 ± 3.42. Duration of analgesia was prolonged in buprenorphine group compared to fentanyl and ropivacaine groups (516.38 ± 29.14 versus 327.06 ± 12.41, 285.78 ± 10.10. It proved to be safe for mother and fetus. The surgeon and the parturients were satisfied with the mode of anesthesia. Conclusion: Ropivacaine 0.75%, ropivacaine 0.75% with fentanyl 50 mg, or buprenorphine 300 mg provided safe anesthesia when given extradurally for cesarean section. Addition of both fentanyl and buprenorphine to ropivacaine hastened the onset of sensory block, while addition of buprenorphine provided prolonged excellent postoperative analgesia.

  13. Treating opioid dependence. Growing implications for primary care.

    Science.gov (United States)

    Krantz, Mori J; Mehler, Philip S

    2004-02-01

    Almost 3 million Americans have abused heroin. The most effective treatment for this concerning epidemic is opioid replacement therapy. Although, from a historical perspective, acceptance of this therapy has been slow, growing evidence supports its efficacy. There are 3 approved medications for opioid maintenance therapy: methadone hydrochloride, levomethadyl acetate, and buprenorphine hydrochloride. Each has unique characteristics that determine its suitability for an individual patient. Cardiac arrhythmias have been reported with methadone and levomethadyl, but not with buprenorphine. Due to concerns about cardiac risk, levomethadyl use has declined and the product may ultimately be discontinued. These recent safety concerns, specifics about opioid detoxification and maintenance, and new federal initiatives were studied. Opioid detoxification has a role in both preventing acute withdrawal and maintaining long-term abstinence. Although only a minority of eligible patients are engaged in treatment, opioid maintenance therapy appears to offer the greatest public health benefits. There is growing interest in expanding treatment into primary care, allowing opioid addiction to be managed like other chronic illnesses. This model has gained wide acceptance in Europe and is now being implemented in the United States. The recent Drug Addiction Treatment Act enables qualified physicians to treat opioid-dependent patients with buprenorphine in an office-based setting. Mainstreaming opioid addiction treatment has many advantages; its success will depend on resolution of ethical and delivery system issues as well as improved and expanded training of physicians in addiction medicine.

  14. Using behavioral economics to predict opioid use during prescription opioid dependence treatment.

    Science.gov (United States)

    Worley, Matthew J; Shoptaw, Steven J; Bickel, Warren K; Ling, Walter

    2015-03-01

    Research grounded in behavioral economics has previously linked addictive behavior to disrupted decision-making and reward-processing, but these principles have not been examined in prescription opioid addiction, which is currently a major public health problem. This study examined whether pre-treatment drug reinforcement value predicted opioid use during outpatient treatment of prescription opioid addiction. Secondary analyses examined participants with prescription opioid dependence who received 12 weeks of buprenorphine-naloxone and counseling in a multi-site clinical trial (N=353). Baseline measures assessed opioid source and indices of drug reinforcement value, including the total amount and proportion of income spent on drugs. Weekly urine drug screens measured opioid use. Obtaining opioids from doctors was associated with lower pre-treatment drug spending, while obtaining opioids from dealers/patients was associated with greater spending. Controlling for demographics, opioid use history, and opioid source frequency, patients who spent a greater total amount (OR=1.30, peconomic resources to drugs, reflects propensity for continued opioid use during treatment among individuals with prescription opioid addiction. Future studies should examine disrupted decision-making and reward-processing in prescription opioid users more directly and test whether reinforcer pathology can be remediated in this population. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  15. Co-relationship between sexual dysfunction and high-risk sexual behavior in patients receiving buprenorphine and naltrexone maintenance therapy for opioid dependence

    Directory of Open Access Journals (Sweden)

    Santosh Ramdurg

    2015-01-01

    Full Text Available Introduction: People suffering from substance dependence suffer from various sexual dysfunctions and are at risk for indulging in various high-risk sexual behaviors and thus are vulnerable to acquire various infections such as HIV/AIDS and other sexually transmitted infections. AIM: The aim of the study was to evaluate the correlation between sexual dysfunction and high-risk sexual behavior in opioid-dependent men receiving buprenorphine and naltrexone maintenance therapy. Materials and Methods: Semi-structured questionnaire, brief male sexual functioning inventory and HIV-risk taking behavior scale was administered to a sample of 60 sexually active men, receiving buprenorphine (n = 30 and naltrexone (n = 30 maintenance therapy for opioid dependence. Results: The main outcomes are correlation between severity of sexual dysfunction and HIV-risk taking behavior. The study results showed 83% of the men on buprenorphine and 90% on naltrexone reported at least one of the sexual dysfunction symptoms. There was a negative correlation between sexual dysfunction and HIV-risk taking behavior that suggest severe the dysfunction, higher the risk taking behavior. Significant correlation was present with overall sexual dysfunction and HIV-risk taking behavior (P = 0.028 and in naltrexone receiving group premature ejaculation versus HIV-risk taking behavior however, (P = 0.022, P < 0.05 there were no significant differences among both the groups except above findings. Conclusion: Conclusion was treatment is associated with sexual dysfunctions and HIV-risk taking behavior, which has clinical implication. Future research should explore this further using biochemical analyses.

  16. 氯诺昔康与丁丙诺啡术后镇痛效果比较%Comparison of postoperative analgesia between lornoxicam and buprenorphine

    Institute of Scientific and Technical Information of China (English)

    王秀峰

    2010-01-01

    Objective To study the efficacy arid side effects of postoperative analgesia between Lornoxicam and Buprenorphine. Methods Sixty ASA I-II patients were randomly divided into Lomoxicam group(group A) and Buprenorphine group(group B). Analgesiae were subcutaneously injected via an electronic patients controlled analgesic pump post surgeries. The visual analgesiae sacle( VAS) was used to evaluate the postoperative pain relief,and analgesic response was recorded. Result There were no significant differences between Lomoxicam and Buprenorphine about the analgesic response(P>0. 05),moreover,no stastical differences in the patients demography,analgesic and anesthetic type were associated with the analgestic outcomes. Conclusion Lomoxicam without respiratory distuber-ance was a good alternative to Buprenorphine in PCSA.%目的 比较氯诺昔康和丁丙诺啡的术后镇痛效果及不良反应.方法 60例ASA Ⅰ-Ⅱ级患者,随机分为两组:氯诺昔康A组(n=30)和丁丙诺啡B组(n=30),两组均通过电子泵经皮下给药.采用视觉模拟评分法(VAS)测定患者的术后镇痛效果,记录不良反应.结果 两组患者的性别、年龄、身高、手术类型和麻醉方法等一般情况差异无统计学意义(P>0.05).两组的术后镇痛效果和不良反应的指标均差异无统计学意义(P>0.05).结论 在术后患者自控镇痛中,氯诺昔康因其与丁丙诺啡相似的镇痛效果且无呼吸抑制的优点可以作为丁丙诺啡的替代用药.

  17. Sedative and analgesic effects of buprenorphine, combined with either acepromazine or dexmedetomidine, for premedication prior to elective surgery in cats and dogs.

    Science.gov (United States)

    Hunt, James R; Grint, Nicola J; Taylor, Polly M; Murrell, Joanna C

    2013-05-01

    To evaluate the sedative and analgesic effects of intramuscular buprenorphine with either dexmedetomidine or acepromazine, administered as premedication to cats and dogs undergoing elective surgery. Prospective, randomized, blinded clinical study. Forty dogs and 48 cats. Animals were assigned to one of four groups, according to anaesthetic premedication and induction agent: buprenorphine 20 μg kg(-1) with either dexmedetomidine (dex) 250 μg m(-2) or acepromazine (acp) 0.03 mg kg(-1), followed by alfaxalone (ALF) or propofol (PRO). Meloxicam was administered preoperatively to all animals and anaesthesia was always maintained using isoflurane. Physiological measures and assessments of pain, sedation and mechanical nociceptive threshold (MNT) were made before and after premedication, intraoperatively, and for up to 24 hours after premedication. Data were analyzed with one-way, two-way and mixed between-within subjects anova, Kruskall-Wallis analyses and Chi squared tests. Results were deemed significant if p ≤ 0.05, except where multiple comparisons were performed (p ≤ 0.005). Cats premedicated with dex were more sedated than cats premedicated with acp (p cats (1.2 ± 1.0 mg kg(-1) ) than acp cats (2.5 ± 1.9 mg kg(-1)) (p = 0.041). There were no differences in sedation in dogs however PRO doses were lower in dex dogs (1.5 ± 0.8 mg kg(-1) ) compared to acp dogs (3.3 ± 1.1 mg kg(-1) ) (p cats or dogs. Choice of dex or acp, when given with buprenorphine, caused minor, clinically detectable, differences in various characteristics of anaesthesia, but not in the level of analgesia. A combination of buprenorphine with either acp or dex, followed by either PRO or ALF, and then isoflurane, accompanied by an NSAID, was suitable for anaesthesia in dogs and cats undergoing elective surgery. Choice of sedative agent may influence dose of anaesthetic induction agent. © 2012 The Authors. Veterinary Anaesthesia and Analgesia © 2012 Association of Veterinary Anaesthetists

  18. Predisposing, enabling and need factors of heroin addicts’ using prescribed methadone or buprenorphine for a year or longer: An exploratory study of drug treatment for heroin addicts in the Swedish welfare system

    Directory of Open Access Journals (Sweden)

    Nilsson Marcus Blom

    2014-04-01

    Full Text Available AIM - This exploratory study draws on national register data for 2,638 opioid users from 2004- 2008 to examine whether or not certain predisposing, enabling and need factors are associated with taking methadone or buprenorphine continuously on doctor’s orders for one year or more. DESIGN - Chi-square analysis, one-way Anova and logistic regression methods were used to explore the association between self-reported demographic characteristics, alcohol/drug use severity, substance use disorder treatment history, criminal justice history, level of mental health symptomatology, mental health treatment history, and whether or not adult opioid users had taken methadone or buprenorphine continuously on doctor’s orders for one year or longer. RESULTS - Having a job and having had more voluntary treatment episodes were significantly associated with using methadone or buprenorphine. Those opioid users who had a job were 19 times more likely to be on methadone or buprenorphine than opiate users who did not have a job. CONCLUSIONS - In our study, individuals who were working were significantly more likely to medicate against their opioid abuse. This suggests that they may be more socially integrated than their non-medicating counterparts

  19. Retention on buprenorphine is associated with high levels of maximal viral suppression among HIV-infected opioid dependent released prisoners.

    Directory of Open Access Journals (Sweden)

    Sandra A Springer

    Full Text Available INTRODUCTION: HIV-infected prisoners lose viral suppression within the 12 weeks after release to the community. This prospective study evaluates the use of buprenorphine/naloxone (BPN/NLX as a method to reduce relapse to opioid use and sustain viral suppression among released HIV-infected prisoners meeting criteria for opioid dependence (OD. METHODS: From 2005-2010, 94 subjects meeting DSM-IV criteria for OD were recruited from a 24-week prospective trial of directly administered antiretroviral therapy (DAART for released HIV-infected prisoners; 50 (53% selected BPN/NLX and were eligible to receive it for 6 months; the remaining 44 (47% selected no BPN/NLX therapy. Maximum viral suppression (MVS, defined as HIV-1 RNA<50 copies/mL, was compared for the BPN/NLX and non-BPN/NLX (N = 44 groups. RESULTS: The two groups were similar, except the BPN/NLX group was significantly more likely to be Hispanic (56.0% v 20.4%, from Hartford (74.4% v 47.7% and have higher mean global health quality of life indicator scores (54.18 v 51.40. MVS after 24 weeks of being released was statistically correlated with 24-week retention on BPN/NLX [AOR = 5.37 (1.15, 25.1], having MVS at the time of prison-release [AOR = 10.5 (3.21, 34.1] and negatively with being Black [AOR = 0.13 (0.03, 0.68]. Receiving DAART or methadone did not correlate with MVS. CONCLUSIONS: In recognition that OD is a chronic relapsing disease, strategies that initiate and retain HIV-infected prisoners with OD on BPN/NLX is an important strategy for improving HIV treatment outcomes as a community transition strategy.

  20. Blockade of Toll-Like Receptors (TLR2, TLR4) Attenuates Pain and Potentiates Buprenorphine Analgesia in a Rat Neuropathic Pain Model.

    Science.gov (United States)

    Jurga, Agnieszka M; Rojewska, Ewelina; Piotrowska, Anna; Makuch, Wioletta; Pilat, Dominika; Przewlocka, Barbara; Mika, Joanna

    2016-01-01

    Accumulating evidence indicates that microglial TLR2 and TLR4 play a significant role in nociception. Experiments were conducted to evaluate the contribution of TLR2 and TLR4 and their adaptor molecules to neuropathy and their ability to amplify opioid effectiveness. Behavioral tests (von Frey's and cold plate) and biochemical (Western blot and qRT-PCR) analysis of spinal cord and DRG tissue were conducted after chronic constriction injury (CCI) to the sciatic nerve. Repeated intrathecal administration of LPS-RS (TLR2 and TLR4 antagonist) and LPS-RS Ultrapure (TLR4 antagonist) attenuated allodynia and hyperalgesia. Biochemical analysis revealed time-dependent upregulation of mRNA and/or protein levels of TLR2 and TLR4 and MyD88 and TRIF adaptor molecules, which was paralleled by an increase in IBA-1/CD40-positive cells under neuropathy. LPS-RS and LPS-RS Ultrapure similarly influenced opioid analgesia by enhancing the effectiveness of buprenorphine but not morphine. Summing up, in light of their upregulation over the course of pain, both TLR2 and TLR4 may indeed play a significant role in neuropathy, which could be linked to the observed activation of IBA-1/CD40-positive cells. Blockade of TLR2 and TLR4 produced analgesia and enhanced buprenorphine's effectiveness, which suggests that they may be a putative target for future pharmacological pain relief tools, especially for opioid rotation, when the effect of morphine is tolerated.

  1. Blockade of Toll-Like Receptors (TLR2, TLR4) Attenuates Pain and Potentiates Buprenorphine Analgesia in a Rat Neuropathic Pain Model

    Science.gov (United States)

    Jurga, Agnieszka M.; Rojewska, Ewelina; Makuch, Wioletta; Pilat, Dominika; Przewlocka, Barbara

    2016-01-01

    Accumulating evidence indicates that microglial TLR2 and TLR4 play a significant role in nociception. Experiments were conducted to evaluate the contribution of TLR2 and TLR4 and their adaptor molecules to neuropathy and their ability to amplify opioid effectiveness. Behavioral tests (von Frey's and cold plate) and biochemical (Western blot and qRT-PCR) analysis of spinal cord and DRG tissue were conducted after chronic constriction injury (CCI) to the sciatic nerve. Repeated intrathecal administration of LPS-RS (TLR2 and TLR4 antagonist) and LPS-RS Ultrapure (TLR4 antagonist) attenuated allodynia and hyperalgesia. Biochemical analysis revealed time-dependent upregulation of mRNA and/or protein levels of TLR2 and TLR4 and MyD88 and TRIF adaptor molecules, which was paralleled by an increase in IBA-1/CD40-positive cells under neuropathy. LPS-RS and LPS-RS Ultrapure similarly influenced opioid analgesia by enhancing the effectiveness of buprenorphine but not morphine. Summing up, in light of their upregulation over the course of pain, both TLR2 and TLR4 may indeed play a significant role in neuropathy, which could be linked to the observed activation of IBA-1/CD40-positive cells. Blockade of TLR2 and TLR4 produced analgesia and enhanced buprenorphine's effectiveness, which suggests that they may be a putative target for future pharmacological pain relief tools, especially for opioid rotation, when the effect of morphine is tolerated. PMID:26962463

  2. Opioid substitution treatment with sublingual buprenorphine in Manipur and Nagaland in Northeast India: what has been established needs to be continued and expanded

    Directory of Open Access Journals (Sweden)

    Sharma Charan

    2009-02-01

    Full Text Available Abstract Manipur and Nagaland in northeast India report an antenatal HIV prevalence of > 1% and the current HIV prevalence among injecting drug users is 24% and 4.5% respectively. Through support from DFID's Challenge Fund, Emmanuel Hospital Association (EHA established thirteen drop-in-centres across the two states to deliver opioid substitution treatment with sublingual buprenorphine for 1200 injecting drug users. Within a short span of time the treatment has been found to be attractive to the clients and currently 1248 injecting opioid users are receiving opioid substitution treatment. The project is acceptable to the drug users, the families, the communities, religious as well as the militant groups. The treatment centres operate all days of the week, have trained staff members, utilize standardized protocols and ensure a strict supervised delivery system to prevent illicit diversion of buprenorphine. The drug users receiving the substitution treatment are referred to HIV voluntary counselling and testing. As this treatment has the potential to change HIV related risk behaviours, what has been established in the two states needs to be continued and expanded with the support from the Government of India.

  3. Opioid substitution treatment with sublingual buprenorphine in Manipur and Nagaland in Northeast India: what has been established needs to be continued and expanded.

    Science.gov (United States)

    Kumar, M Suresh; Natale, Richard D; Langkham, B; Sharma, Charan; Kabi, Rachel; Mortimore, Gordon

    2009-02-26

    Manipur and Nagaland in northeast India report an antenatal HIV prevalence of > 1% and the current HIV prevalence among injecting drug users is 24% and 4.5% respectively. Through support from DFID's Challenge Fund, Emmanuel Hospital Association (EHA) established thirteen drop-in-centres across the two states to deliver opioid substitution treatment with sublingual buprenorphine for 1200 injecting drug users. Within a short span of time the treatment has been found to be attractive to the clients and currently 1248 injecting opioid users are receiving opioid substitution treatment. The project is acceptable to the drug users, the families, the communities, religious as well as the militant groups. The treatment centres operate all days of the week, have trained staff members, utilize standardized protocols and ensure a strict supervised delivery system to prevent illicit diversion of buprenorphine. The drug users receiving the substitution treatment are referred to HIV voluntary counselling and testing. As this treatment has the potential to change HIV related risk behaviours, what has been established in the two states needs to be continued and expanded with the support from the Government of India.

  4. Meloxicam and buprenorphine treatment after ovarian transplantation does not affect estrous cyclicity and follicular integrity in aged CBA/J mice.

    Directory of Open Access Journals (Sweden)

    Anna H Le

    Full Text Available Angiogenesis, the formation of new blood vessels, is important for the survival of ovarian transplants and the restoration of ovarian functions. Without angiogenesis, transplanted ovarian tissue becomes more susceptible to tissue damage and necrosis. Administration of analgesics for pain management has been shown to decrease angiogenesis, which can influence transplant success especially in aged animals. Aging and the effects of hypoxia after transplantation decrease reproductive viability of the ovarian transplant; therefore, it is important to understand the additional effects of analgesics on aged animal models. The present study investigated the effects of two analgesics, buprenorphine, an opiate, and meloxicam, a non-steroidal anti-inflammatory drug (NSAID, on the reproductive indicators related to estrous cyclicity and follicular integrity after ovarian transplantation of young ovaries into aged CBA/J mice. These aged females did not show any different reproductive responses when treated with either buprenorphine or meloxicam. No significant differences were observed in estrous cycle length, the onset of estrous cycling, the regularity of estrous cycles, and the proportion of viable follicles and total number of follicles per ovarian sample across treatment groups.

  5. Validated Method for the Quantification of Buprenorphine in Postmortem Blood Using Solid-Phase Extraction and Two-Dimensional Gas Chromatography-Mass Spectrometry.

    Science.gov (United States)

    Nahar, Limon Khatun; Andrews, Rebecca; Paterson, Sue

    2015-09-01

    A highly sensitive and fully validated method was developed for the quantification of buprenorphine in postmortem blood. After a two-step protein precipitation process using acetonitrile, buprenorphine was purified using mixed-mode (C8/cation exchange) solid-phase extraction cartridges. Endogenous water-soluble compounds and lipids were removed from the cartridges before the samples were eluted, concentrated and derivatized using N-methyl-N-trimethylsilyltrifluoroacetamide. The samples were analyzed using two-dimensional gas chromatography-mass spectrometry (2D GC-MS) in selective ion-monitoring mode. A low polarity Rxi(®)-5MS (30 m × 0.25 mm I.D. × 0.25 µm) was used as the primary column and the secondary column was a mid-polarity Rxi(®) -17Sil MS (15 m × 0.32 mm I.D. × 0.25 µm). The assay was linear from 1.0 to 50.0 ng/mL (r(2) > 0.99; n = 6). Intraday (n = 6) and interday (n = 9) imprecisions (percentage relative standard deviation, % RSD) were selective with no interference from endogenous compounds or from 62 commonly encountered drugs. To prove method applicability to forensic postmortem cases, 14 authentic postmortem blood samples were analyzed.

  6. The Leeds Evaluation of Efficacy of Detoxification Study (LEEDS prisons project pilot study: protocol for a randomised controlled trial comparing dihydrocodeine and buprenorphine for opiate detoxification

    Directory of Open Access Journals (Sweden)

    Dalton Richard

    2007-01-01

    Full Text Available Abstract Background In the United Kingdom (UK, there is an extensive market for the class 'A' drug heroin. Many heroin users spend time in prison. People addicted to heroin often require prescribed medication when attempting to cease their drug use. The most commonly used detoxification agents in UK prisons are buprenorphine, dihydrocodeine and methadone. However, national guidelines do not state a detoxification drug of choice. Indeed, there is a paucity of research evaluating the most effective treatment for opiate detoxification in prisons. This study seeks to address the paucity by evaluating routinely used interventions amongst drug using prisoners within UK prisons. Methods/Design The Leeds Evaluation of Efficacy of Detoxification Study (LEEDS Prisons Pilot Study will use randomised controlled trial methodology to compare the open use of buprenorphine and dihydrocodeine for opiate detoxification, given in the context of routine care, within HMP Leeds. Prisoners who are eligible and give informed consent will be entered into the trial. The primary outcome measure will be abstinence status at five days post detoxification, as determined by a urine test. Secondary outcomes during the detoxification and then at one, three and six months post detoxification will be recorded.

  7. The analgesic effect of plexus anesthesia with buprenorphine in patients%丁丙诺啡在臂丛麻醉患者中的镇痛作用

    Institute of Scientific and Technical Information of China (English)

    李斌; 陈学丽; 孙翠翠; 吕国义

    2011-01-01

    目的 研究对行臂神经丛阻滞的患者丁丙诺啡加入局麻药中与肌肉注射两种镇痛方式对麻醉效果、麻醉维持时间、术后镇痛等方面的作用.方法 选择2009年9月至2009年12月天津市天津医院60例拟行上肢、手部手术的患者,数字随机法分为3组.A组(局麻药中无丁丙诺啡组,n=20);B组(局麻药中加丁丙诺啡2μg/kg组,n=20);C组(麻醉前肌肉注射丁丙诺啡2 μg/kg组,n=20).用B/BRAMN-STIMMPLEX-DIG神经刺激仪引导定位行腋路臂神经丛阻滞.3组患者记录(1)麻醉起效时间;(2)麻醉维持时间;(3)手术时间;(4)术后4、8、12、24、36、48、72 h各时间点的疼痛评分;(5)恶心、呕吐的发生率;(6)观察其他副作用.结果 3组患者年龄、体重、性别、手术时间之间比较,差异无统计学意义(P>0.05);麻醉起效时间3组之间比较差异无统计学意义(P>0.05).麻醉维持时间:A、C组明显短于B组(P<0.01);疼痛评分4 h时A与B、C组之间差异无统计学意义(P>0.05);8、12、24 h时A组极显著高于B、C组(P<0.01),36、48、72 h时A组与B、C组之间差异无统计学意义(P>0.05);恶心发生率A组为10%,B组20%,C组20%.呕吐发生率A、B组为0,C组30%.结论 丁丙诺啡加入局麻药中进行臂神经丛阻滞或阻滞前肌肉注射丁丙诺啡都可以取得满意的术后镇痛效果,丁丙诺啡加入局麻药中进行臂神经丛阻滞麻醉可延长麻醉维持时间、对术后镇痛有明显疗效,且不良反应较少.%Objective To study the anesthetic effect of brachial plexus block by adding buprenorphine in local anesthetics and patients with intramuscular injection , and observe the anesthesia effects, the anesthesia maintenance time, postoperative analgesia effects. Methods 60 cases of upper limb to line, hand surgery patients from Sep. 2009 to Dec. 2009 in Tianjin Hospital were randomly divided into 3groups. A (local anesthetics without buprenorphine, n = 20); B group (plus 2

  8. 超高效液相色谱法同时测定盐酸丁丙诺啡舌下含片中丁丙诺啡和纳洛酮的含量%Simultaneous determination of buprenorphine and naloxone in buprenorphine sublingual tablets by ultrahigh performance liquid chromatography

    Institute of Scientific and Technical Information of China (English)

    郭巧珍; 杜振霞

    2011-01-01

    A simultaneous method was established for the separation and determination of buprenorphine and naloxone in buprenorphine sublingual tablets by ultra-high performance liquid chromatography. The samples were separated on a Waters Acquity BEH C18 column with gradient elution using methanol and water (containing 0. 2% formic), the two compounds were effectively separated in 3 min, and the detection was performed with an UV dector at the wavelength of 280 nm. The linear ranges of the compounds were from l to 25 μ/mL for naloxone and 2 to 50 μ/mL for buprenorphine, the correlation coefficients were 0. 9992 and 0. 9995, respectively, and the limits of detection (LOI)) of the method for the two compounds were 0. 2 μg/mL. A comparative study of two mobile phase systems methanol and acetonitrile were performed, and the response of methanol is higher than that for acetonitrile. Under optimum conditions, the actual buprenorphine sublingual tablets and spiked samples were determined. The average recoveries were 91.3% ~ 100. 1%, and RSD less than 5%.%建立了同时检测丁丙诺啡和纳洛酮的超高效液相色谱的分析方法.分析柱为Waters Acquity BEH C18超高效液相色谱柱,紫外检测波长为280 nm,流动相为甲醇-甲酸(0.2%)水,梯度洗脱,两种分析物在3 min内即可达到良好分离.纳洛酮和丁丙诺啡的线性范围分别为1~25 μg/mL,2~50 μg/mL,线性相关系数分别为0.9992,0.9995.检出限为0.2μg/mL.考察了甲醇和乙腈两种流动相体系对样品的分离效果,发现甲醇流动相体系的响应高于乙腈流动相体系.在优化条件下,对丁丙诺啡舌下含片以及加标后样品进行测定,且对其方法学进行考察,加标平均回收率在91.3%~100.1%之间,RSD小于5%.

  9. Development of a Rapid and Simultaneous Detection Method for Buprenorphine, Norbuprenorphine and Naloxone in Human Plasma Using Ultra-high Performance Liquid Chromatography- tandem Mass Spectrometer with Solid-phase Extraction%Development of a Rapid and Simultaneous Detection Method for Buprenorphine, Norbuprenorphine and Naloxone in Human Plasma Using Ultra-high Performance Liquid Chromatography- tandem Mass Spectrometer with Solid-phase Extraction

    Institute of Scientific and Technical Information of China (English)

    Guo, Qiaozhen; Du, Zhenxia

    2011-01-01

    A simultaneous method was successfully established and validated for the separation and determination of bu- prenorphine (BP), its primary metabolite, nor-buprenorphine (NBP) and a proposed co-formulate, naloxone (NLX) in human plasma. The method used buprenorphine-d4 (BP-D4), nor-buprenorphine-d3 (NBP-D3), naltrexone (NTX) as internal standards (ISs). 100 μL of plasma sample fortified with the ISs was cleaned up by solid-phase extraction (SPE), and was then separated on a Waters AcquityTM BEH C18 column with gradient elution using methanol and water (containing 0.2% formic) at a flow rate of 0.25 mL·min^-1. The mass spectrometer was used for detection and was operated in the positive electrospray ionization with multiple reaction monitoring (MRM) mode. The three compounds were effectively separated in 5 min. The linear ranges of the compounds were 0.1--25, 0.25--25 and 0.05--25 ng·mL^-1 for BP, NBP and NLX, respectively, with r≥0.9935. The method had high sensitivity (the lim- its of detection were 0.02, 0.1 and 0.01 ng.mL-1 for BP, NBP and NLX, respectively) and high recoveries (≥97.6%). The result was shown to be linear and satisfactorily met current acceptance criteria for validation of bio- analytical method: intra and inter assay precisions within the required limits of ≤25% RSD. The LOQs fulfilled the LOQ requirements: precision≤25% RSD, and was fully validated according to the State Food and Drug Administration (SFDA) regulations. The results demonstrated that ultra-high performance liquid chromatography- tandem mass spectrometer (UPLC-MS/MS) with SPE was a powerful detection tool and contributed to pharmaceutical analysis in biological matrices.

  10. The Leeds Evaluation of Efficacy of Detoxification Study (LEEDS prisons project: a randomised controlled trial comparing dihydrocodeine and buprenorphine for opiate detoxification

    Directory of Open Access Journals (Sweden)

    Li Ryan

    2009-02-01

    Full Text Available Abstract Background Many opiate users entering British prisons require prescribed medication to help them achieve abstinence. This commonly takes the form of a detoxification regime. Previously, a range of detoxification agents have been prescribed without a clear evidence base to recommend a drug of choice. There are few trials and very few in the prison setting. This study compares dihydrocodeine with buprenorphine. Methods Open label, pragmatic, randomised controlled trial in a large remand prison in the North of England. Ninety adult male prisoners requesting an opiate detoxification were randomised to receive either daily sublingual buprenorphine or daily oral dihydrocodeine, given in the context of routine care. All participants gave written, informed consent. Reducing regimens were within a standard regimen of not more than 20 days and were at the discretion of the prescribing doctor. Primary outcome was abstinence from illicit opiates as indicated by a urine test at five days post detoxification. Secondary outcomes were collected during the detoxification period and then at one, three and six months post detoxification. Analysis was undertaken using relative risk tests for categorical data and unpaired t-tests for continuous data. Results 64% of those approached took part in the study. 63 men (70% gave a urine sample at five days post detoxification. At the completion of detoxification, by intention to treat analysis, a higher proportion of people allocated to buprenorphine provided a urine sample negative for opiates (abstinent compared with those who received dihydrocodeine (57% vs 35%, RR 1.61 CI 1.02–2.56. At the 1, 3 and 6 month follow-up points, there were no significant differences for urine samples negative for opiates between the two groups. Follow up rates were low for those participants who had subsequently been released into the community. Conclusion These findings would suggest that dihydrocodeine should not be routinely

  11. A case report on the treatment of complex chronic pain and opioid dependence by a multidisciplinary transitional pain service using the ACT Matrix and buprenorphine/naloxone

    Science.gov (United States)

    Weinrib, Aliza Z; Burns, Lindsay C; Mu, Alex; Azam, Muhammad Abid; Ladak, Salima SJ; McRae, Karen; Katznelson, Rita; Azargive, Saam; Tran, Cieran; Katz, Joel; Clarke, Hance

    2017-01-01

    In an era of growing concern about opioid prescribing, the postsurgical period remains a critical window with the risk of significant opioid dose escalation, particularly in patients with a history of chronic pain and presurgical opioid use. The purpose of this case report is to describe the multidisciplinary care of a complex, postsurgical pain patient by an innovative transitional pain service (TPS). A 59-year-old male with complex chronic pain, as well as escalating long-term opioid use, presented with a bleeding duodenal ulcer requiring emergency surgery. After surgery, the TPS provided integrated pharmacological and behavioral treatment, including buprenorphine combined with naloxone and acceptance and commitment therapy (ACT) using the ACT Matrix. The result was dramatic pain reduction and improved functioning and quality of life after 40+ years of chronic pain, thus changing the pain trajectory of a chronic, complex, opioid-dependent patient.

  12. Poly-substance use and antisocial personality traits at admission predict cumulative retention in a buprenorphine programme with mandatory work and high compliance profile

    DEFF Research Database (Denmark)

    Öhlin, Leif; Hesse, Morten; Fridell, Mats

    2011-01-01

    . In this study the structure was reinforced by the addition of supervised urine samples three times a week and mandatory daily work/structured education activities as a prerequisite of inclusion in the program. Methods Of 128 patients consecutively admitted to buprenorphine maintenance treatment five patients......-IV-TR, and the Symptoms Checklist 90 (SCL-90), the Alcohol Use Disorder Identification Test (AUDIT), the Swedish universities Scales of Personality (SSP) and the Sense of Coherence Scale (SOC), all self-report measures. Some measures were repeated every third month in addition to interviews. Results Of 123 patients...... for the first 12 months with continuous abstinence and daily work. Poly-substance use before intake into treatment, high levels of conduct disorder on SCID screen and younger age at intake had a negative impact on retention and abstinence....

  13. NIDA Clinical Trials Network CTN-0051, Extended-Release Naltrexone vs. Buprenorphine for Opioid Treatment (X:BOT): Study Design and Rationale

    Science.gov (United States)

    Lee, Joshua D.; Nunes, Edward V.; Novo, Patricia; Bailey, Genie L.; Brigham, Gregory S.; Cohen, Allan J.; Fishman, Marc; Ling, Walter; Lindblad, Robert; Shmueli-Blumberg, Dikla; Stablein, Don; May, Jeanine; Salazar, Dagmar; Liu, David; Rotrosen, John

    2017-01-01

    Introduction For opioid-dependent patients in the US and elsewhere, detoxification and counseling-only aftercare are treatment mainstays. Long-term abstinence is rarely achieved; many patients relapse and overdose after detoxification. Methadone, buprenorphine-naloxone (BUP-NX) and extended-release naltrexone (XR-NTX) can prevent opioid relapse but are underutilized. This study is intended to develop an evidence-base to help patients and providers make informed choices and to foster wider adoption of relapse-prevention pharmacotherapies. Methods The National Institute on Drug Abuse's Clinical Trials Network (CTN) study CTN-0051, X:BOT, is a comparative effectiveness study of treatment for 24 weeks with XR-NTX, an opioid antagonist, versus BUP-NX, a high affinity partial opioid agonist, for opioid dependent patients initiating treatment at 8 short-term residential (detoxification) units and continuing care as outpatients. Up to 600 participants are randomized (1:1) to XR-NTX or BUP-NX. Results The primary outcome is time to opioid relapse (i.e., loss of persistent abstinence) across the 24-week treatment phase. Differences between arms in the distribution of time-to-relapse will be compared (construction of the asymptotic 95% CI for the hazard ratio of the difference between arms). Secondary outcomes include proportions retained in treatment, rates of opioid abstinence, adverse events, cigarette, alcohol, and other drug use, and HIV risk behaviors; opioid cravings, quality of life, cognitive function, genetic moderators, and cost effectiveness. Conclusions XR-NTX and BUP-NX differ considerably in their characteristics and clinical management; no studies to date have compared XR-NTX with buprenorphine maintenance. Study design choices and compromises inherent to a comparative effectiveness trial of distinct treatment regimens are reviewed. PMID:27521809

  14. Women boxers

    DEFF Research Database (Denmark)

    Gems, Gerald; Pfister, Gertrud Ursula

    2014-01-01

    This article fills a gap in the very limited literature on women's boxing by examining the gendered space in which women engaged in the sport as participants in saloons, vaudeville theatres and the prize ring. In doing so, they challenged the contemporary gender order and disputed the notion...... of women as the weak sex. Vaudeville provided women with an opportunity to present physical performances that surpassed the restrictions placed on women within the mainstream middle-class society. This article includes biographical sketches of some of the outstanding female boxers of the era by drawing...

  15. Women boxers

    DEFF Research Database (Denmark)

    Gems, Gerald; Pfister, Gertrud Ursula

    2014-01-01

    This article fills a gap in the very limited literature on women's boxing by examining the gendered space in which women engaged in the sport as participants in saloons, vaudeville theatres and the prize ring. In doing so, they challenged the contemporary gender order and disputed the notion...... of women as the weak sex. Vaudeville provided women with an opportunity to present physical performances that surpassed the restrictions placed on women within the mainstream middle-class society. This article includes biographical sketches of some of the outstanding female boxers of the era by drawing...

  16. Comparative study of the efficacy of transdermal buprenorphine patches and prolonged-release tramadol tablets for postoperative pain control after spinal fusion surgery: a prospective, randomized controlled non-inferiority trial.

    Science.gov (United States)

    Kim, Ho-Joong; Ahn, Hyo Sae; Nam, Yunjin; Chang, Bong-Soon; Lee, Choon-Ki; Yeom, Jin S

    2017-07-20

    To compare the efficacy of a transdermal buprenorphine patch (5, 10, 15, and 20 μg/h) with that of oral tramadol (150, 200, 250, and 300 mg) for postoperative pain control after single level spinal fusion surgery. The present study (ClinicalTrials.gov, number NCT02416804) was a prospective, randomized controlled non-inferiority trial designed to determine the efficacy of buprenorphine TDS for alleviating postoperative pain following patient controlled analgesia (PCA) in persons underwent a single level posterior lumbar interbody fusion surgery through 1:1 allocation. The primary outcome was the Visual Analog Pain Scale (VAS) score for postoperative back pain at 7 days after surgery. The non-inferior margin of the VAS was set at δ = 1.5 points. The VAS score (primary outcome) for postoperative back pain at 7 days after surgery in the Buprenorphine group was not inferior compared to the Tramadol group. The overall changes in VAS scores for postoperative pain during follow-up assessments over a 2-week period did not differ between both groups. However, the VAS scores for postoperative pain significantly improved with time after surgery in both groups. The patterns of changes in the VAS scores for postoperative pain during the follow-up period were not significantly different between the both groups. The efficacy of buprenorphine TDS was not inferior to that of oral tramadol medication for alleviating postoperative pain in the subacute period from 72 h after surgery, following PCA administration. In addition, adverse events were similar between both groups.

  17. Safety and efficacy of transdermal buprenorphine versus oral tramadol for the treatment of post-operative pain following surgery for fracture neck of femur: A prospective, randomised clinical study

    Directory of Open Access Journals (Sweden)

    Sameer N Desai

    2017-01-01

    Full Text Available Background: Transdermal buprenorphine, which is used in chronic pain management, has rarely been studied for use in acute pain management. The aim of this study was to compare the safety and efficacy of transdermal buprenorphine patch to oral tramadol for post-operative analgesia, following proximal femur surgeries. Methodology: Fifty adult patients undergoing surgery for hip fracture under spinal anaesthesia were included in this study. One group (Group TDB received transdermal buprenorphine 10 mcg/h patch applied a day before the surgery and other group received oral tramadol 50 mg three times a day for analgesia (Group OT. They were allowed to take diclofenac and paracetamol tablets for rescue analgesia. Pain scores at rest, on movement, rescue analgesic requirement and side effects were compared between the groups over 7 days. Chi-square and independent sample t-test were used for categorical and continuous variables, respectively. Results: Resting pain scores and pain on movement were significantly lower in TDB Group on all 7 days starting from 24 h post-operatively. Rescue analgesic requirement was significantly lower in TDB Group compared to OT Group. All the patients needed rescue analgesic in OT Group whereas 68% of the patients needed the same in TDB Group. Incidence of vomiting was less and satisfaction scores were much higher in TDB Group as compared to OT Group (79% vs. 66%, P < 0.001. Conclusion: Transdermal buprenorphine can be safely used for post-operative analgesia and is more efficacious in reducing post-operative pain after 24 hours, with fewer side effects when compared to oral tramadol.

  18. Safety and efficacy of transdermal buprenorphine versus oral tramadol for the treatment of post-operative pain following surgery for fracture neck of femur: A prospective, randomised clinical study.

    Science.gov (United States)

    Desai, Sameer N; Badiger, Santhoshi V; Tokur, Shreesha B; Naik, Prashanth A

    2017-03-01

    Transdermal buprenorphine, which is used in chronic pain management, has rarely been studied for use in acute pain management. The aim of this study was to compare the safety and efficacy of transdermal buprenorphine patch to oral tramadol for post-operative analgesia, following proximal femur surgeries. Fifty adult patients undergoing surgery for hip fracture under spinal anaesthesia were included in this study. One group (Group TDB) received transdermal buprenorphine 10 mcg/h patch applied a day before the surgery and other group received oral tramadol 50 mg three times a day for analgesia (Group OT). They were allowed to take diclofenac and paracetamol tablets for rescue analgesia. Pain scores at rest, on movement, rescue analgesic requirement and side effects were compared between the groups over 7 days. Chi-square and independent sample t-test were used for categorical and continuous variables, respectively. Resting pain scores and pain on movement were significantly lower in TDB Group on all 7 days starting from 24 h post-operatively. Rescue analgesic requirement was significantly lower in TDB Group compared to OT Group. All the patients needed rescue analgesic in OT Group whereas 68% of the patients needed the same in TDB Group. Incidence of vomiting was less and satisfaction scores were much higher in TDB Group as compared to OT Group (79% vs. 66%, P tramadol.

  19. Buprenorphine Transdermal Patch

    Science.gov (United States)

    ... any of the following symptoms: irritability, hyperactivity, abnormal sleep, high-pitched cry, uncontrollable shaking of a part ... palonosetron (Aloxi); selective serotonin-reuptake inhibitors such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, in Symbyax), ...

  20. Buprenorphine Buccal (chronic pain)

    Science.gov (United States)

    ... any of the following symptoms: irritability, hyperactivity, abnormal sleep, high-pitched cry, uncontrollable shaking of a part ... palonosetron (Aloxi); selective serotonin-reuptake inhibitors such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, in Symbyax), ...

  1. 吗啡与丁丙诺啡的蛛网膜下腔与皮下联合给药的相互作用%Interaction of combined administration of intrathecal morphine with subcutaneous morphine or buprenorphine

    Institute of Scientific and Technical Information of China (English)

    陈莲华; Alexander NEMIROVSKy; 贡沁燕

    2000-01-01

    AIM: To analyze the mode of interaction of combined administration of intrathecal morphine with subcutaneous morphine or buprenorphine. METHODS: Different groups of rats were scheduled to undergo administration of intrathecal (ith) morphine, subcutaneous (sc) morphine,sc buprenorphine, and the combinations of ith morphine with sc morphine or buprenorphine in a series of dose rarios. Nociceptive responses of hind paws of each animal were measured by means of "plantar stimulation" test.The test latency was converted to the percent of maximal possible effect ( % MPE). RESULT: Morphine ith,morphine sc, buprenorphine sc, as well as combinations in all dose ratios increased the % MPE in a dose-depen-dent manner. Isobolograms showed that the EDs0 points determined for the combinations were plotted significantly left to the theoretical additive line. CONCLUSION:The combination of morphine ith with either morphine sc or buprenorphine sc resulted in a synergistic effect. This interaction might be due to the activation of the synergistic antinociceptive mechanisms between supraspinal and spinal levels.%目的:观察大鼠吗啡与丁丙诺啡(或吗啡)的蛛网膜下腔与皮下联合给药的相互作用.方法:SD大鼠,置人蛛网膜下腔导管.辐射热诱发鼠腿撤退试验测痛阈.分别蛛网膜下腔给予吗啡、皮下注射丁丙诺啡(或吗啡)、蛛网膜下腔给予吗啡与皮下注射丁丙诺啡(或吗啡)的联合给药.结果:单独和联合给药均剂量依赖性地提高鼠痛阈.联合给药的量效曲线的斜率均显著大于吗啡单独给药的曲线斜率.等效线图显示联合给药的ED50均位于理论推测的叠加效应线的左侧.结论:吗啡与丁丙诺啡(或吗啡)的蛛网膜下腔与皮下联合给药呈协同效应.

  2. Empowering Women.

    Science.gov (United States)

    Brundtland, Gro Harlem

    1994-01-01

    An edited version of Prime Minister of Norway Gro Harlem Brundtland's keynote address to the International Conference on Population and Development in September 1994. This address focuses on the role played by women in population growth and emphasizes the urgency of economic and political rights and education for women. (LZ)

  3. Hidden Women

    NARCIS (Netherlands)

    Jolanda Bosch; René Moelker

    2008-01-01

    Discussing the visibility and cultural factors that inf luence the position of women in the armed forces is the object of the study that is presented here. The Netherlands do not have a martial tradition and are believed to have a feminine ‘soft’ culture , but nevertheless women have always been

  4. Efeitos cardiorrespiratórios da buprenorfina em cães anestesiados pelo desfluorano Cardiorespiratory effects of buprenorphine in dogs anesthetized with desflurane

    Directory of Open Access Journals (Sweden)

    Almir Pereira de Souza

    2005-12-01

    Full Text Available Objetivou-se, com este estudo, avaliar os efeitos da buprenorfina sobre variáveis cardiovasculares e respiratórias em cães durante anestesia com desfluorano. Para tanto, foram utilizados 20 cães adultos, distribuídos em dois grupos (GB e GC. A anestesia foi induzida com propofol (8mg kg-1 IV e em seguida os animais foram intubados com sonda de Magill, a qual foi conectada ao aparelho de anestesia para administração de desfluorano (1,5 CAM. Após 30 minutos, foi aplicado no GB buprenorfina (0,02mg kg-1 e no GC solução de NaCl à 0,9% (0,05ml kg-1. Avaliaram-se: freqüências cardíaca e respiratória (FC e ¦; pressões arteriais sistólica, diastólica e média (PAS, PAD e PAM; débito cardíaco (DC; pressão venosa central (PVC; e as variáveis hemogasométricas pH, PaCO2, PaO2, HCO3, SatO2 e DB. As colheitas dos dados foram feitas aos 30 minutos após o início da administração do desfluorano (MO, 15 minutos após a administração do opióide ou placebo (M15, e a cada 15 minutos após Ml5 (M30, M45, M60 e M75. A avaliação estatística dos dados foi efetuada por meio de Análise de Perfil (P¦ e o pH tiveram reduções no GB, enquanto a PaCO2 esteve aumentada. Concluiu-se que a inclusão da buprenorfina durante anestesia inalatória pelo desfluorano determina discretas alterações cardiovasculares, bem-como potencializa a hipoventilação promovida pelo desfluorano, com a manifestação de hipercapnia, o que não contra-indica o seu uso em pacientes estáveis.The aim of this study was to evaluate the effects of buprenorphine on cardiovascular and respiratory variables in dogs anesthetized with desflurane. Twenty adult healthy male and female mongrel dogs were randomly distributed in two groups of ten animals each (GB and GC. The anesthetic induction was done using propofol (8mg kg-1, IV, and immediately, the dogs were intubated and submited to desflurane anesthesia administrated at 1.5 MAC. After 30 minutes of induction, animals

  5. A comparison of oral controlled-release morphine and oxycodone with transdermal formulations of buprenorphine and fentanyl in the treatment of severe pain in cancer patients

    Directory of Open Access Journals (Sweden)

    Nosek K

    2017-08-01

    Full Text Available Krzysztof Nosek,1 Wojciech Leppert,2,3 Hanna Nosek,4 Jerzy Wordliczek,5 Dariusz Onichimowski6 1Non–public Saint Lazarius Health Care Unit, Biskupiec, 2Chair and Department of Palliative Medicine, Poznan University of Medical Sciences, Poznań, 3Department of Quality of life Research, Gdańsk Medical University, Gdańsk, 4Department of Paediatrics, Regional Children Specialized Hospital, Olsztyn, 5Department of Interdisciplinary Intensive Care, Jagiellonian University College of Medicine, Kraków, 6Department of Intensive Care, Regional Hospital, Olsztyn, Poland Aim of the study: To compare analgesia and adverse effects during oral morphine and oxycodone and transdermal fentanyl and buprenorphine administration in cancer patients with pain. Patients and methods: Cancer patients treated at home and in outpatient clinics with severe pain (numerical rating scale score 6–10 fail to respond to non-opioids and/or weak opioids. All patients were randomized to either morphine, oxycodone, fentanyl or buprenorphine and divided into subgroups with predominant neuropathic and nociceptive pain component. Doses of opioids were titrated to satisfactory analgesia and acceptable adverse effects intensity. Patients were assessed at baseline and followed for 28 days. In all patient groups, immediate-release oral morphine was the rescue analgesic and lactulose 10 mL twice daily was the prophylaxis of constipation; no antiemetics were used as prophylaxis. Results: A total of 62 patients participated and 53 patients completed the study. Good analgesia was obtained for all 4 opioids, for both nociceptive and neuropathic pain. The use of co-analgesics was greater in patients with neuropathic pain. Morphine treatment was associated with less negative impact of pain on ability to walk, work and activity (trend according to Brief Pain Inventory-Short Form scores and less consumption of rescue morphine. The most common adverse effects included nausea and drowsiness

  6. Women NGO's and Women Empowerment in

    African Journals Online (AJOL)

    FIRST LADY

    psychology, political and legal circumstances of women. Women NGO's ... directed the searchlight on a variety of issues affecting the status of women in the society. .... marginalization of women in this domain still remains. Some of the ...

  7. Tu Women

    Institute of Scientific and Technical Information of China (English)

    1998-01-01

    When honored guests visit, Tu women will block the door and invite them to show their respect by drinking three cups of wine. Only after this ritual can the guests be led indoors and shown to their seats.

  8. Women Words

    Institute of Scientific and Technical Information of China (English)

    Yuan Yuan

    2012-01-01

    Jiangyong County,a remote place in central China's Hunan Province,has been gathering more attention due to a strange-looking language passed down exclusively by women for hundreds of years. The language,which is called nushu,or women's script,is said to originate from Chinese square-block characters,but the orthography and pronunciation are quite different from all other branches of Chinese dialects.

  9. Leibniz's women.

    Science.gov (United States)

    Fara, Patricia

    2004-12-01

    Enlightenment natural philosophers were linked to one another in an extended correspondence network, but the female participants in this international Republic of Letters are rarely mentioned. Gottfried Leibniz relied on several such women not only for financial patronage, but also for intellectual stimulation. Although this hardworking and underpaid librarian at the Hanoverian Court is now one of the world's most famous mathematical philosophers, the women on whom he depended for ideas as well as support have been largely forgotten.

  10. Women and Diabetes

    Medline Plus

    Full Text Available ... Information by Audience For Women Women's Health Topics Women and Diabetes Share Tweet Linkedin Pin it More ... women during pregnancy. Diabetes and Pregnancy (CDC) Diverse Women in Clinical Trials Campaign Clinical trials can help ...

  11. Women and Diabetes

    Science.gov (United States)

    ... Information by Audience For Women Women's Health Topics Women and Diabetes Share Tweet Linkedin Pin it More ... women during pregnancy. Diabetes and Pregnancy (CDC) Diverse Women in Clinical Trials Campaign Clinical trials can help ...

  12. Women and Diabetes

    Medline Plus

    Full Text Available ... Information by Audience For Women Women's Health Topics Women and Diabetes Share Tweet Linkedin Pin it More ... women during pregnancy. Diabetes and Pregnancy (CDC) Diverse Women in Clinical Trials Campaign Clinical trials can help ...

  13. Opioid Addiction: Social Problems Associated and Implications of Both Current and Possible Future Treatments, including Polymeric Therapeutics for Giving Up the Habit of Opioid Consumption

    Directory of Open Access Journals (Sweden)

    M. Cristina Benéitez

    2017-01-01

    Full Text Available Background. Detoxification programmes seek to implement the most secure and compassionate ways of withdrawing from opiates so that the inevitable withdrawal symptoms and other complications are minimized. Once detoxification has been achieved, the next stage is to enable the patient to overcome his or her drug addiction by ensuring consumption is permanently and completely abandoned, only after which can the subject be regarded as fully recovered. Methods. A systematic search on the common databases of relevant papers published until 2016 inclusive. Results and Conclusion. Our study of the available oral treatments for opioid dependence has revealed that no current treatment can actually claim to be fully effective. These treatments require daily oral administration and, consequently, regular visits to dispensaries, which in most cases results in a lack of patient compliance, which causes fluctuations in drug plasma levels. We then reviewed alternative treatments in the available scientific literature on polymeric sustained release formulations. Research has been done not only on release systems for detoxification but also on release systems for giving up the habit of taking opioids. These efforts have obtained the recent authorization of polymeric systems for use in patients that could help them to reduce their craving for drugs.

  14. Blockade of Toll-Like Receptors (TLR2, TLR4 Attenuates Pain and Potentiates Buprenorphine Analgesia in a Rat Neuropathic Pain Model

    Directory of Open Access Journals (Sweden)

    Agnieszka M. Jurga

    2016-01-01

    Full Text Available Accumulating evidence indicates that microglial TLR2 and TLR4 play a significant role in nociception. Experiments were conducted to evaluate the contribution of TLR2 and TLR4 and their adaptor molecules to neuropathy and their ability to amplify opioid effectiveness. Behavioral tests (von Frey’s and cold plate and biochemical (Western blot and qRT-PCR analysis of spinal cord and DRG tissue were conducted after chronic constriction injury (CCI to the sciatic nerve. Repeated intrathecal administration of LPS-RS (TLR2 and TLR4 antagonist and LPS-RS Ultrapure (TLR4 antagonist attenuated allodynia and hyperalgesia. Biochemical analysis revealed time-dependent upregulation of mRNA and/or protein levels of TLR2 and TLR4 and MyD88 and TRIF adaptor molecules, which was paralleled by an increase in IBA-1/CD40-positive cells under neuropathy. LPS-RS and LPS-RS Ultrapure similarly influenced opioid analgesia by enhancing the effectiveness of buprenorphine but not morphine. Summing up, in light of their upregulation over the course of pain, both TLR2 and TLR4 may indeed play a significant role in neuropathy, which could be linked to the observed activation of IBA-1/CD40-positive cells. Blockade of TLR2 and TLR4 produced analgesia and enhanced buprenorphine’s effectiveness, which suggests that they may be a putative target for future pharmacological pain relief tools, especially for opioid rotation, when the effect of morphine is tolerated.

  15. Comparison of abuse, suspected suicidal intent, and fatalities related to the 7-day buprenorphine transdermal patch versus other opioid analgesics in the National Poison Data System.

    Science.gov (United States)

    Coplan, Paul M; Sessler, Nelson E; Harikrishnan, Venkatesh; Singh, Richa; Perkel, Charles

    2017-01-01

    Prescription opioid related abuse, suicide and death are significant public health problems. This study compares rates of poison center calls categorized as intentional abuse, suspected suicidal intent or fatality for the 7-day buprenorphine transdermal system/patch (BTDS) with other extended-release and long-acting (ER/LA) opioids indicated for chronic pain. Retrospective 24-month cohort study using National Poison Data System data from July 2012 through June 2014. BTDS was introduced in the United States in January 2011. Numbers and rates of calls of intentional abuse, suspected suicidal intent and fatalities were evaluated for BTDS, ER morphine, ER oxycodone, fentanyl patch, ER oxymorphone and methadone tablets/capsules, using prescription adjustment to account for community availability. Rate ratios (RR) and 95% confidence intervals (CI) were calculated. Absolute numbers and prescription-adjusted rates of intentional abuse and suspected suicidal intent with BTDS were significantly lower (p opioid analgesics examined. No fatalities associated with BTDS exposure were reported. This post-marketing evaluation of BTDS indicates infrequent poison center calls for intentional abuse and suspected suicidal intent events, suggesting lower rates of these risks with BTDS compared to other ER/LA opioids.

  16. A case report on the treatment of complex chronic pain and opioid dependence by a multidisciplinary transitional pain service using the ACT Matrix and buprenorphine/naloxone

    Directory of Open Access Journals (Sweden)

    Weinrib AZ

    2017-03-01

    Full Text Available Aliza Z Weinrib,1,2 Lindsay C Burns,1,2 Alex Mu,1 Muhammad Abid Azam,1,2 Salima SJ Ladak,1 Karen McRae,1,3 Rita Katznelson,1,3 Saam Azargive,1 Cieran Tran,1 Joel Katz,1–3 Hance Clarke1,3 1Pain Research Unit, Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, 2Department of Psychology, York University, 3Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada Abstract: In an era of growing concern about opioid prescribing, the postsurgical period remains a critical window with the risk of significant opioid dose escalation, particularly in patients with a history of chronic pain and presurgical opioid use. The purpose of this case report is to describe the multidisciplinary care of a complex, postsurgical pain patient by an innovative transitional pain service (TPS. A 59-year-old male with complex chronic pain, as well as escalating long-term opioid use, presented with a bleeding duodenal ulcer requiring emergency surgery. After surgery, the TPS provided integrated pharmacological and behavioral treatment, including buprenorphine combined with naloxone and acceptance and commitment therapy (ACT using the ACT Matrix. The result was dramatic pain reduction and improved functioning and quality of life after 40+ years of chronic pain, thus changing the pain trajectory of a chronic, complex, opioid-dependent patient. Keywords: transitional pain service, postsurgical pain, chronic pain, opioid dependence, opioid weaning, acceptance and commitment therapy

  17. 舒芬太尼与丁丙诺啡在术后自控镇痛中的疗效与安全性评价%Sulfentanyl versus buprenorphine for controlled intravenous analgesia on patients undergoing maxillofacial operation

    Institute of Scientific and Technical Information of China (English)

    闫俊杰; 刘伟东; 江银华; 陈慧敏

    2015-01-01

    目的:评价舒芬太尼( SF)对比丁丙诺啡( BP)在口腔颌面部手术( OMS)后自控镇静脉痛( PCIA)的临床疗效及安全性。方法79例OMS患者随机分为舒芬太尼组(41例)和丁丙诺非组(38例),舒芬太尼组术后予以舒芬太尼50μg;丁丙诺非组术后给予丁丙诺非0.6 mg,分别于术后2,8,24,48 h用视觉模拟评份量表和镇静评分量表对患者术后疼痛及镇静情况进行评定,同时记录2组患者术后48 h内生命体征及不良反应。结果舒芬太尼组与丁丙诺非组患者镇痛、镇静评分及生命体征指标差异均无统计学意义(P>0.05),但舒芬太尼组患者药物相关不良反应发生率显著低于丁丙诺非组( P<0.05)。结论舒芬太尼与丁丙诺非用于OMS术后自控镇痛、镇静效果无差异,但舒芬太尼药品不良反应低于丁丙诺非。%Objective To assess the clinical efficacy and safety of sulfentanyl versus buprenorphine for controlled intravenous analgesia on patients undergoing oral and maxillofacial surgery ( OMS) , as the patient controlled intravenous analgesia ( PCIA) way.Methods A total of 79 patients who received OMS were randomly divided into sulfentanyl group ( n=41 ) and buprenorphine group ( n =38 ).Patients in sulfentanyl group were given sulfentanyl 50 μg and patients in BP group were given buprenorphine 0.6 mg.Visual analogue scale ( VAS) and sedation scale were used to evaluate the pain control and sedation effects at the time points of 2, 8, 24 and 48 hours after operation.The vital signs and adverse events of the patients in two groups were recorded in 48 hours after operation.Results No difference was found between the two groups in the aspects of pain control, sedation effects and vital signs ( P>0.05).Adverse drug reactions were much more in buprenorphine group than those in sulfentanyl group ( P<0.05 ).Conclusion There were no differences in pain control and sedation effects

  18. 丁丙诺啡治疗海洛因依赖戒断综合征临床疗效分析%The efficacy of buprenorphine in heroin dependence withdraw-al syndrome

    Institute of Scientific and Technical Information of China (English)

    刘海波; 商田歌

    2014-01-01

    Objective To explore the efficacy of buprenorphine in heroin depend-ence withdrawal syndrome (HDWS) .Methods A total of 521 HDWS patients were randomly assigned to two groups ,research group was treated with sublingually buccal buprenorphine and intravenous drip of haloperidol+scopolamine ,and control group took orally methadone for 2 weeks .Efficacies of two groups were contrastively analyzed .Results Effective rate was respectively 95 .1% in research and 75 .1% in con-trol group ,the former significantly higher than the latter (χ2 =41 .99 ,P<0 .01) .Conclusion Sublingually buccal buprenorphine and intravenous drip of haloperidol + scopolamine have an evident effect compared with methadone replacement therapy in HAWS .%目的:探讨丁丙诺啡治疗海洛因依赖戒断综合征的临床疗效。方法将521例海洛因依赖戒断综合征患者随机分为两组,研究组舌下含服丁丙诺啡,静脉滴注氟哌啶醇+东莨菪碱治疗,对照组口服美沙酮治疗,观察2周。对两组临床疗效进行对比分析。结果研究组有效率为95.1%,对照组为75.1%,研究组有效率显著高于对照组(χ2=41.99,P<0.01)。结论舌下含服丁丙诺啡、静脉滴注氟哌啶醇+东莨菪碱治疗海洛因依赖戒断综合征疗效显著,优于美沙酮替代治疗。

  19. RP-HPLC法测定丁丙诺啡贴剂中药物的含量%Determining of Medicine Content in Buprenorphine Patches Using the RP-HPLC Method

    Institute of Scientific and Technical Information of China (English)

    曹建中

    2015-01-01

    Objective To explore significance of the RP - HPLC method for determination e medicine content of buprenorphine patches. Methods Chromatographic column and mobile phase were respectively 5 um Waters Symmetry C18 column and methanol- 0.02 mol · L-1 buf er salt solution, detection wavelength and velocity were respectively 286 nm and 1.0 ml min -1. Results 070919, 070920, 070921 batches of buprenorphine patch content levels were 0.156 mg·cm -2, 0.150 mg·cm-2, 0.149 mg·cm-2, RSD was 1.1%, 0.83%and 1.7%respectively. Conclusion RP -HPLC method for determining the content of medicine of buprenorphine patch was accurate, reliable and has high sensitivity, which is worthy of promoting.%目的:探讨RP-HPLC法测定丁丙诺啡贴剂中药物含量的意义。方法色谱柱和流动相分别为5 um的Waters Symmetry C18柱和甲醇-0.02mol•L-1的缓冲盐溶液,检测波长和流速分别为286nm和1.0ml•min-1。结果070919,070920,070921批号的丁丙诺啡贴剂的含量分别为0.156 mg•cm-2、0.150 mg•cm-2、0.149 mg•cm-2,RSD分别为1.1%、0.83%、1.7%。结论 RP-HPLC法测定丁丙诺啡贴剂中药物的含量准确可靠,具有较高的灵敏度,值得推广。

  20. Clinical observation of preventive effect of buprenorphine on shivering following Spinal anesthesia%布托啡诺预防脊髓麻醉后寒战反应的临床观察

    Institute of Scientific and Technical Information of China (English)

    郭瑶; 李妍; 黄威; 孟凌新

    2012-01-01

    目的 观察布托啡诺对脊髓麻醉后寒战反应发生的预防作用.方法 选择ASA I~Ⅱ级择期行子宫全切或次全切除患者90例,随机分为3组,每组30例.分别在脊髓麻醉后,切皮前静脉滴注2 mL布托啡诺0.5 mg(B1组)、布托啡诺0.3 mg(B2组)和生理盐水(C组).观察3组寒战反应及恶心、呕吐、嗜睡等不良反应的发生率.结果 B1、B2组和C组寒战例数分别为1、3、10例.B1组与其他两组相比,差异有统计学意义.结论 布托啡诺0.5 mg单次静脉注射,可以有效预防脊髓麻醉后的寒战反应.%Objective To observe the preventive effects of different doses of buprenorphine on shivering fol lowing spinal anesthesia. Methods 90 ASA Ⅰ ~ Ⅱ patients undergoing selective hysterectomy were allocated into 3 groups randomly,30 patients in each group. 2 mL of buprenorphine 0. 5 mg,buprenorphine 0. 3 mg and neutral saline were administered intravenously in the 3 groups after spinal anesthesia respectively. The incidence of shivering and side effects including nausea,vomiting and drowsiness were observed and recorded. Results There were 1 ,3,10 cases of shivering in group Bl, group B2 and group C respectively, with significant difference between group Bl and the other two groups. Conclusion Buprenorphine 0. 5 mg is effective to prevent shivering after spinal anesthesia.

  1. Women's Rights Unit.

    Science.gov (United States)

    Weiss, Helen; Weigel, Margaret

    Designed for use in the intermediate grades, this interdisciplinary unit helps students examine traditional and modern roles of women. Fourteen lessons focus on women's activities in colonial America, reasons for women's discontent, the women's rights movement of the 1800's, changes in the roles of women, enfranchisement of women, women's role…

  2. PREGNANT WOMEN

    African Journals Online (AJOL)

    women attending an antenatal clinic and gynaeco- logical clinic ... Other observa- tions are less specific and may be part of the gen- .... be due to the high levels of corticosteroids though there is no direct proof ... Scully C, Cawson RA. Medical ...

  3. Women's Worlds

    Science.gov (United States)

    Daniels, Arlene Kaplan

    1978-01-01

    The women's movement may show us some of the changes to come in the content and form of the social sciences. Among issues which will be increasingly addressed are those of work and the family, personal growth and social responsibility, and the emotional component in rational, objective, and scientific enterprise. (Author/GC)

  4. Smokefree Women

    Science.gov (United States)

    ... infographic that presents all the benefits to quitting smoking during pregnancy to help you have a happy, healthy birth ... of smoke… Read full story: 3 Very Real Dangers of Secondhand Smoke » share 4 Benefits of Quitting Smoking Many women are surprised by how well… Read ...

  5. Rebellious Women

    DEFF Research Database (Denmark)

    Madsen, Peter

    2010-01-01

    At the background of a short presentation of concepts of discourse (in particular in Jürgen Habermas and Michel Foucault) and of the concept of shari'a a Spanish court case against an imam in reference to his publication on Women in Islam, where sura 4 verse 34 of the Quran is a central reference...

  6. Women's worth.

    Science.gov (United States)

    Bloch, N

    1992-01-01

    Jill Conway is a feminist historian, writer, teacher, and now-emerita 1st woman president of Smith College. She claims that women today still suffer from a great deal of oppression. Women around the world are currently in a disadvantage position. In 7 countries women do not have the right to vote. In the US less that .5% of top executives are women. The wage gap in the US between 1939 and 1989 has only shrunk $.10, from $.58-$.68. Conway points out that we are all constrained by our social mores, generational attitudes, political events, and economic circumstances. Few people are able to overcome these things in the way that they live their lives. Conway questions the validity of history written from a male dominated point of view. Around the world the value of women's work is almost always lower than that of men. India is just 1 example, there 75% of women are illiterate and 1/2 the population lives in poverty based on a caste system. Female literacy tripled in the 1st 30 years of independence and by 1981 it had reached 25%. The literacy gap is actually growing in India Today with 44% of girls aged 6 to 11, who are eligible to attend school, not doing so. Rural poverty keeps them at home because their domestic work is more valuable than their education. Other cultural tradition compound the problem: arranged marriages often result in motherhood for 14 year old girls. This is done for many reasons, 1 of which is crop failure insurance. When 2 families are combined through marriage, their total land share grows and they are thus more likely to have enough to eat. Education is just 1 necessary step. Developed nations must realize the realities that exist in the countries they provide aid for. In Africa for example, 70% of continent's food is produced by women. Yet the aid programs of the past have only been designed to offer assistant to men and create jobs for men.

  7. INTRATHECAL BUPRENORPHINE, CLONIDINE AND FENTANYL AS ADJUVANTS TO 0.5% HYPERBARIC BUPIVACAINE IN LOWER ABDOMINAL AND LOWER LIMB SURGERIES: A PROSPECTIVE, RANDOMIZED AND COMPARATIVE STUDY

    Directory of Open Access Journals (Sweden)

    Rashmi

    2015-06-01

    Full Text Available BACKGROUND: Among all the spinal adjuvants, clonidine, an alpha - 2 agonist has the ability to alleviate both the somatic and visceral pain and is more potent at spinal site, favoring its neuraxial administration. OBJECTIVE: This study was done to compare the onset and duration of sensory and motor blocks, duration of analgesia, haemodynamic and adverse effects of Clonidine, buprenorhine and fentanyl used intrathecally with hyperbaric 0.5% bupuvacaine. SETTINGS & DESIGN: This prospective, randomized and comparative study included 90 ASA class 1 & 2 patients undergoing lower abdominal and lower limb surgeries under spinal anesthesia after approval from hospital ethics committee with written i nformed consent of patients. MATERIALS AND METHOD S: Patients were randomly allocated into three groups (n=30 and received 50μg of clonidine, 25μg of fentanyl and 75μg of buprenorphine respectively in group BC,BF and BB as adjuvants to 15mg of 0.5% hyperba ric bupivacaine (3.0ml. The onset time and duration of sensory and motor block, duration of analgesia, haemodynamic changes and side effects were recorded. RESULTS: The onset time of motor block and durations of sensory, motor blockade and analgesia were prolonged in - group BC as compared to group BF and BB (P.05. Group BC had lower heart rate and mean blood pressure and higher sedation score. CONCLUSION: Intr athecal Clonidine in a dose of 50μg is an effective adjuvant to local anesthetics in neuraxial blocks despite mild sedation and haemodynamic variations.

  8. Poly-substance use and antisocial personality traits at admission predict cumulative retention in a buprenorphine programme with mandatory work and high compliance profile.

    Science.gov (United States)

    Öhlin, Leif; Hesse, Morten; Fridell, Mats; Tätting, Per

    2011-05-12

    Continuous abstinence and retention in treatment for alcohol and drug use disorders are central challenges for the treatment providers. The literature has failed to show consistent, strong predictors of retention. Predictors and treatment structure may differ across treatment modalities. In this study the structure was reinforced by the addition of supervised urine samples three times a week and mandatory daily work/structured education activities as a prerequisite of inclusion in the program. Of 128 patients consecutively admitted to buprenorphine maintenance treatment five patients dropped out within the first week. Of the remaining 123 demographic data and psychiatric assessment were used to predict involuntary discharge from treatment and corresponding cumulative abstinence probability. All subjects were administered the Structured Clinical Interview for DSM-IV-TR, and the Symptom Checklist 90 (SCL-90), the Alcohol Use Disorder Identification Test (AUDIT), the Swedish universities Scales of Personality (SSP) and the Sense of Coherence Scale (SOC), all self-report measures. Some measures were repeated every third month in addition to interviews. Of 123 patients admitted, 86 (70%) remained in treatment after six months and 61 (50%) remained in treatment after 12 months. Of those discharged involuntarily, 34/62 individuals were readmitted after a suspension period of three months. Younger age at intake, poly-substance abuse at intake (number of drugs in urine), and number of conduct disorder criteria on the SCID Screen were independently associated with an increased risk of involuntary discharge. There were no significant differences between dropouts and completers on SCL-90, SSP, SOC or AUDIT. Of the patients admitted to the programme 50% stayed for the first 12 months with continuous abstinence and daily work. Poly-substance use before intake into treatment, high levels of conduct disorder on SCID screen and younger age at intake had a negative impact on

  9. A ‘Missing Not at Random’ (MNAR) and ‘Missing at Random’ (MAR) Growth Model Comparison with a Buprenorphine/Naloxone Clinical Trial

    Science.gov (United States)

    McPherson, Sterling; Barbosa-Leiker, Celestina; Mamey, Mary Rose; McDonell, Michael; Enders, Craig K.; Roll, John

    2014-01-01

    Aims To compare three missing data strategies: 1) Latent growth model that assumes the data are missing at random (MAR) model, 2) Diggle-Kenward missing not at random (MNAR) model where dropout is a function of previous/concurrent urinalysis (UA) submissions, and 3) Wu-Carroll MNAR model where dropout is a function of the growth factors. Design Secondary data analysis of a National Drug Abuse Treatment Clinical Trials Network trial that examined a 7-day versus 28-day taper (i.e., stepwise decrease in buprenorphine/naloxone) on the likelihood of submitting an opioid-positive UA during treatment. Setting 11 outpatient treatment settings in 10 US cities. Participants 516 opioid dependent participants. Measurements Opioid UAs provided across the 4-week treatment period. Findings The MAR model showed a significant effect (B=−0.45, p <0.05) of trial arm on the opioid-positive UA slope (i.e., 28-day taper participants were less likely to submit a positive UA over time) with a small effect size (d=0.20). The MNAR Diggle-Kenward model demonstrated a significant (B=−0.64, p<0.01) effect of trial arm on the slope with a large effect size (d=0.82). The MNAR Wu-Carroll model evidenced a significant (B=−0.41, p<0.05) effect of trial arm on the UA slope that was relatively small (d=0.31). Conclusions This performance comparison of three missing data strategies (latent growth model, Diggle-Kenward selection model, Wu-Carrol selection model) on sample data indicates a need for increased use of sensitivity analyses in clinical trial research. Given the potential sensitivity of the trial arm effect to missing data assumptions, it is critical for researchers to consider whether the assumptions associated with each model are defensible. PMID:25170740

  10. Poly-substance use and antisocial personality traits at admission predict cumulative retention in a buprenorphine programme with mandatory work and high compliance profile

    Directory of Open Access Journals (Sweden)

    Fridell Mats

    2011-05-01

    Full Text Available Abstract Background Continuous abstinence and retention in treatment for alcohol and drug use disorders are central challenges for the treatment providers. The literature has failed to show consistent, strong predictors of retention. Predictors and treatment structure may differ across treatment modalities. In this study the structure was reinforced by the addition of supervised urine samples three times a week and mandatory daily work/structured education activities as a prerequisite of inclusion in the program. Methods Of 128 patients consecutively admitted to buprenorphine maintenance treatment five patients dropped out within the first week. Of the remaining 123 demographic data and psychiatric assessment were used to predict involuntary discharge from treatment and corresponding cumulative abstinence probability. All subjects were administered the Structured Clinical Interview for DSM-IV-TR, and the Symptom Checklist 90 (SCL-90, the Alcohol Use Disorder Identification Test (AUDIT, the Swedish universities Scales of Personality (SSP and the Sense of Coherence Scale (SOC, all self-report measures. Some measures were repeated every third month in addition to interviews. Results Of 123 patients admitted, 86 (70% remained in treatment after six months and 61 (50% remained in treatment after 12 months. Of those discharged involuntarily, 34/62 individuals were readmitted after a suspension period of three months. Younger age at intake, poly-substance abuse at intake (number of drugs in urine, and number of conduct disorder criteria on the SCID Screen were independently associated with an increased risk of involuntary discharge. There were no significant differences between dropouts and completers on SCL-90, SSP, SOC or AUDIT. Conclusion Of the patients admitted to the programme 50% stayed for the first 12 months with continuous abstinence and daily work. Poly-substance use before intake into treatment, high levels of conduct disorder on SCID

  11. The effectiveness of buprenorphine in combination with scopolamine and promethazine on conditioned place preference in SD rats%丁丙诺啡、东莨菪碱与异丙嗪联合使用对大鼠位置偏爱的影响

    Institute of Scientific and Technical Information of China (English)

    黄劲松; 王育红; 周旭辉; 王全升; 谌红献; 王绪轶; 向小军; 郝伟

    2008-01-01

    Objective To study the potentiality of psychological dependence of the so-called "1+1" compound (the elements are buprenorphine, scopolamine and promethazine). Methods One hundred and sixty-one male Sprague-Dawley rats were randomly assigned to 9 groups: buprenorphine, scopolamine, promethazine, buprenorphine plus scopolamine, buprenorphine plus promethazine, buprenorphine plus scopolamine and promethazine, scopolamine plus promethazine, morphine and saline groups respectively. All the 9 groups were trained by using the conditioned place preference(CPP) paradigm for 10 days. Results The rats in the five groups treated with buprenorphine alone or in combination with scopolamine/promethazine and morphine developed CPP. The time change spent by the rats in the buprenorphine plus scopolamine and promethazine group are (378.6±120.8)s , apparently longer than that by the rats in the buprenorphine group (302.2±133.9)s,but compared with that by rats in the morpine group(419.8±146.4)s, there is no significant difference(F=14.3,P=0.63). Conclusion The combination use of buprenorphine plus scopolamine and promethazine may act synergistically, and scopolamine and promethazine may enhance psychological dependence of buprenorphine.%目的 通过观察丁丙诺啡、东莨菪碱与异丙嗪三药联合使用(俗称"1+1")对大鼠位置偏爱的影响,探索"1+1"对实验大鼠的精神依赖性潜力.方法 161只雄性SD大鼠随机分成9组,分别采用丁丙诺啡、丁丙诺啡+东莨菪碱、丁丙诺啡+异丙嗪、丁丙诺啡+东莨菪碱+异丙嗪、东莨菪碱、异丙嗪、东莨菪碱+异丙嗪、吗啡、以及生理盐水等进行腹腔内注射,同时进行药物匹配CPP训练,共10d,比较各组大鼠训练前后以及训练后各组大鼠之间在药物训练侧(简称伴药侧)停留时间的差异,探索各处理因素的精神依赖性潜力及其差异.结果 注射吗啡、丁丙诺啡、丁丙诺啡+东莨菪碱、丁丙诺啡+异丙嗪、丁丙

  12. Women's Club

    CERN Multimedia

    CERN Women's Club

    2012-01-01

     Coffee Morning Tuesday 7th February 2012, 9:00 – 11:00 Bldg 504 (Restaurant n°2 – DSR) 1st Floor, Club Room 3 Presentation of cheque to Terre des Hommes Those interested in helping should come along. New arrivals and all members are cordially invited.You can enrol for membership, renew membership, find out about and sign up for our activities. Visit our website: http://club-womensclub.web.cern.ch/Club-WomensClub/

  13. Women's club

    CERN Multimedia

    Club des cernoises

    2012-01-01

    Coffee MorningTuesday 9th October 2012, 9:00 – 11:00 Bldg 504 (Restaurant No 2 – DSR) 1st Floor, Club Room 3 Presentation of the charity to benefit from the Christmas Sale “Nous aussi”. Those interested in helping should come along. New arrivals and all members are cordially invited. You can enrol for membership, renew membership, find out about and sign up for our activities. Visit our website: http://cern.ch/Club-WomensClub/

  14. Women's Club

    CERN Multimedia

    Women's Club

    2014-01-01

        CERN WOMEN’S CLUB Coffee Morning Tuesday 8th Avril 2014, 9:30 – 14:00 Bldg 504 (Restaurant No 2 – DSR) Ground Floor Spring Jumble Sale   Those interested in helping should come along. New arrivals and all members are cordially invited. You can enrol for membership, renew membership, find out about and sign up for our activities. Visit our website: http://cern.ch/Club-WomensClub/

  15. Women's Club

    CERN Multimedia

    Club des Cernoises

    2012-01-01

    Coffee Morning   Tuesday 24th  April 2012, 9:00 – 14:00 Bldg 504, Ground Floor Spring Jumble Sale   Those interested in helping should come along. New arrivals and all members are cordially invited. You can enrol for membership, renew membership, find out about and sign up for our activities. Visit our website: http://club-womensclub.web.cern.ch/Club-WomensClub/

  16. Women's Club

    CERN Multimedia

    Club des Cernoises

    2012-01-01

    Coffee Morning Tuesday 13th  March 2012, 9:00 – 11:00 - Bldg 504 (Restaurant No 2 – DSR) - 1st Floor, Club Room 3. German Theme Those interested in helping should come along. New arrivals and all members are cordially invited. You can enrol for membership, renew membership, find out about and sign up for our activities. Visit our website: http://club-womensclub.web.cern.ch/Club-WomensClub/     CWC – Chinese Women's Community at CERN With an increasing number of Chinese people working at CERN, there are also surely an increasing number of Chinese women in the area, who are not always familiar with the environment, languages, or the people. In the context of the CERN Women’s Club, let's meet together and chat about integrating into the local community, available activities, commerce’s, restaurants, etc. It is also obviously a good opportunity to meet new friends. Everyone is welcome to join us to meet fo...

  17. Women's club

    CERN Multimedia

    Club des Cernoises

    2012-01-01

        CWC – Chinese Women's Community at CERN With an increasing number of Chinese people working at CERN, there are also surely an increasing number of Chinese women in the area, who are not always familiar with the environment, languages, or the people. In the context of the CERN Women’s Club, let's meet together and chat about integrating into the local community, available activities, commerce’s, restaurants, etc. It is also obviously a good opportunity to meet new friends. Everyone is welcome to join us to meet for tea, coffee, and a chat. We will meet every 3rd Tuesday of the month, starting on 20th March 2012, in building 504 (Restaurant 2) in room E-005. 20th March at 9-11am 17th April at 9-11am 22nd May at 9-11am 19th June at 9-11am For more details contact Mme Jean RODERICK, +41 (0) 76 426 61 08, jean.chow.roderick@gmail.com http://club-womensclub.web.cern.ch/Club-WomensClub/     CWC-華人茶敍 越來�...

  18. 舒芬太尼与丁丙诺啡在口腔外科术后镇痛的比较%Comparison of the postoperative analgesic efficacy between sufentanil and buprenorphine in patients undergoing oral surgeries

    Institute of Scientific and Technical Information of China (English)

    单东海; 黄旭平; 陈光娥; 王润莉; 李友安; 陶静; 方园; 郭翠

    2011-01-01

    目的 比较等效剂量丁丙诺啡与舒芬太尼在口腔外科术后镇痛的效果.方法 60例ASAⅠ或Ⅱ级口腔外科术病人依病历号奇偶数分为舒芬太尼组(S)与丁丙诺啡组(B),每组30例.两组均采用静脉自控镇痛(PCIA)给药,S组舒芬太尼50μg,B组丁丙诺啡0.6 mg,总量100 ml,首次负荷剂量4 ml.术后5、10、20及40 h行VAS疼痛与Ramsay运动评分,记录PCA有效按压次数及不良反应发生率.结果 两组VAS疼痛评分、Ramsay运动评分及PCA有效按压次数差异均无统计学意义,而不良反应发生率B组显著高于S组(P<0.05或P<0.01).结论 等效剂量舒芬太尼与丁丙诺啡用于口腔外科术后镇痛效果相当,但舒芬太尼不良反应发生率较低,更适合口腔外科术后镇痛使用.%Objective To compare the analgesic efficacy of equivalent buprenorphine and sufentanil in patients undergoing oral surgeries. Methods Sixty patients with ASA Ⅰ or Ⅱ scheduled for oral surgeries were divided into sufentanil group (S) and buprenorphine group (B) with 30 cases each according to the odd-even property of their enrollment IDs. Both groups received patient-controlled intravenous analgesia (PCIA), drugs in the group S was sufentanil 50 μg and buprenorphine 0.6 mg in the group B, total volume was 100 ml, loading bolus was 4 ml. The pain intensity was scored with visual analog scale (VAS), and motor was assessed with Ramsay scale at 5,10, 20 and 40 h after operation, and the effective PCA boluses and rate of side effects were recorded.Results No significant difference was observed between the two groups in the VAS and Ramsay scales and PCA boluses, but side effects in the group B were more than that of the group S (P<0. 05 or P<0. 01). Conclusion Equivalent sufentanil and buprenorphine produce similar analgesic efficacy,but the incidence of side effect of sufentanil is lower. So sufentanil is more suitable than buprenorphine for postoperative analgesia in oral surgeries.

  19. Outcomes of subcutaneous patient-controlled analgesia with buprenorphine combined with dezocine%丁丙诺啡复合地佐辛皮下患者自控镇痛的术后镇痛效果

    Institute of Scientific and Technical Information of China (English)

    刘玮玲; 陈海涛; 郁燕; 曹汉忠

    2016-01-01

    目的:探讨丁丙诺啡联合地佐辛皮下患者自控镇痛(PCA )的术后镇痛效果。方法择期手术患者643例实施皮下 PCA。镇痛药:S组(153例)为丁丙诺啡(0.034~0.036) mg/kg+0.75%左旋布比卡因20 m l+雷莫司琼0.6 m g ,用0.9%氯化钠稀释至150 m l;P组(490例)在上述配方中增加地佐辛10 mg。于术后1、24、48和72 h采用痛觉数字评价量表(NRS)评分和镇静程度(LOS )评分评估镇痛、镇静效果,记录相关不良反应发生情况。结果两组患者静息和活动状态下的NRS评分相仿,镇痛效果满意(P>0.05)。P组术后24 h的LOS评分低于S组(P<0.01)。P组丁丙诺啡用量少于S组[(0.027±0.007) mg/kg vs .(0.034±0.013) mg/kg](P<0.01)。S组镇痛泵夹管、恶心、呕吐、皮肤瘙痒及嗜睡发生率高于P组(P<0.05)。结论丁丙诺啡联合地佐辛皮下PCA镇痛效果满意,加用地佐辛可减少丁丙诺啡用量及其相关不良反应。%Objective To observe the efficacy of subcutaneous patient-controlled analgesia (PCA) with buprenorphine combined with dezocine .Methods Subcutaneous PCA was performed in 643 patients after elective surgeries .The analgesic solution in group S (153 cases ) consisted of buprenorphine 0.034~0.036 mg/kg ,0.75% levobupivacaine 20 ml and ramosetron 0.6 mg ,which was diluted with normal saline up to 150 ml .Dezocine 10 mg in group P(490 cases) was added into the analgesic solution of group S .The outcomes of analgesia and sedation were evaluated with numeric rating scale (NRS) and level of sedation (LOS) scoring at 1 ,24 ,48 and 72 hours during PCA .The analgesia-related adverse effects were recorded .Results The analgesia of both groups was all satisfactory and there was no significant difference in NRS scores at rest and active status between groups of P and S(P>0 .05) .The LOS score at 24 hours was significantly lower in group P than that in

  20. Opioids and the management of chronic severe pain in the elderly: consensus statement of an International Expert Panel with focus on the six clinically most often used World Health Organization Step III opioids (buprenorphine, fentanyl, hydromorphone, methadone, morphine, oxycodone).

    Science.gov (United States)

    Pergolizzi, Joseph; Böger, Rainer H; Budd, Keith; Dahan, Albert; Erdine, Serdar; Hans, Guy; Kress, Hans-Georg; Langford, Richard; Likar, Rudolf; Raffa, Robert B; Sacerdote, Paola

    2008-01-01

    SUMMARY OF CONSENSUS: 1. The use of opioids in cancer pain: The criteria for selecting analgesics for pain treatment in the elderly include, but are not limited to, overall efficacy, overall side-effect profile, onset of action, drug interactions, abuse potential, and practical issues, such as cost and availability of the drug, as well as the severity and type of pain (nociceptive, acute/chronic, etc.). At any given time, the order of choice in the decision-making process can change. This consensus is based on evidence-based literature (extended data are not included and chronic, extended-release opioids are not covered). There are various driving factors relating to prescribing medication, including availability of the compound and cost, which may, at times, be the main driving factor. The transdermal formulation of buprenorphine is available in most European countries, particularly those with high opioid usage, with the exception of France; however, the availability of the sublingual formulation of buprenorphine in Europe is limited, as it is marketed in only a few countries, including Germany and Belgium. The opioid patch is experimental at present in U.S.A. and the sublingual formulation has dispensing restrictions, therefore, its use is limited. It is evident that the population pyramid is upturned. Globally, there is going to be an older population that needs to be cared for in the future. This older population has expectations in life, in that a retiree is no longer an individual who decreases their lifestyle activities. The "baby-boomers" in their 60s and 70s are "baby zoomers"; they want to have a functional active lifestyle. They are willing to make trade-offs regarding treatment choices and understand that they may experience pain, providing that can have increased quality of life and functionality. Therefore, comorbidities--including cancer and noncancer pain, osteoarthritis, rheumatoid arthritis, and postherpetic neuralgia--and patient functional

  1. Determination of Related Substances and Content of Buprenorphine Hydrochloride Sublingual Tablet by HPLC%HPLC法测定盐酸丁丙诺啡舌下片的含量和有关物质

    Institute of Scientific and Technical Information of China (English)

    刘胜春; 赵学刚; 冯雅慧; 康海霞; 滑千里; 王乃浩

    2013-01-01

    OBJECTIVE:To establish a method for the determination of content and related substances in Buprenorphine hydrochloride sublingual tablets.METHODS:HPLC method was adopted.The determination was performed on Agilent Eclipse XDB C18 column with mobile phase consisted of 1% ammonium acetate (containing 0.1% acetic acid)-methanol (15∶85) at the flow rate of 1.0 ml/min.The column temperature was 40 ℃,and detection wavelength was 288 nm.RESULTS:Buprenorphine hydrochloride was separated with its impurities thoroughly,and its linear range were 0.004 04-0.040 4 mg/ml (r=0.999 9) with average recovery of 100.1% (RSD=0.33 %,n=9).The detection limit was 0.5 ng.CONCLUSIONS:The method is simple,sensitive and accurate.It could be applied for the determination of content and related substance in Buprenorphine hydrochloride sublingual tablets.%目的:建立同时测定盐酸丁丙诺啡舌下片含量和有关物质的方法.方法:采用高效液相色谱法.色谱柱为Agilent Eclipse XDB C18,流动相为1%醋酸铵溶液(含0.1%冰醋酸)-甲醇(15∶85),流速为1.0 ml/min,柱温为40℃,检测波长为288nm.结果:有关物质与主成分有较好的分离,盐酸丁丙诺啡检测质量浓度线性范围为0.004 04~0.040 4 mg/ml(r=0.999 9),检测限为0.5 ng,平均回收率为100.1%,RSD为0.33%(n=9).结论:本方法简便、灵敏度高、结果准确,可用于盐酸丁丙诺啡舌下片含量和有关物质测定.

  2. Rural Women Get Help from Women Students

    Institute of Scientific and Technical Information of China (English)

    JANE SHAW

    1994-01-01

    SINCE more and more rural women have become involved in commercial production, they have become more and more eager to learn about scientific technology. The Women’s Federation of Beijing had long been looking for a direct and effective way to help them. Luo Xiaolu, vicedirector of the Federation, found in her investigation of the present conditions of intellectual women in Beijing that women students were also eager to get in touch with society. Then she had an idea that women students in universities and colleges should go to the countryside. Thus, an activity developed called "women college students and rural women, hand in hand."

  3. Unsettled women.

    Science.gov (United States)

    Coleman, J

    2001-01-01

    SUMMARY Amy Bock (alias Percy Redwood) created a media sensation when "The Case of the Woman Bridegroom" hit the newspapers throughout New Zealand in 1909. She was hailed as the "queerest and most interesting character that has ever been before the New Zealand public" and "pitiable in her freakish exploits." Debates ensued as to whether her crimes were evidence of a mania, a disease, or simply due to a flawed, criminal character. This article focuses on media portrayals of women who did not conform to normative constructions of acceptable womanhood within the latter decades of the nineteenth century and the early twentieth century in New Zealand, as a means of tracing the mutable boundaries of intelligible genders. Newspaper debates and emergent discourses around the medicalisation of social de-viancy are drawn upon to demonstrate how normative constructions of gender were premised upon a defining matrix of mad/bad/woman.

  4. 右美托咪啶复合丁丙诺啡用于术后静脉自控镇痛的临床研究%Clinical study of buprenorphine be used for postoperative patient-control ed venous analgesia

    Institute of Scientific and Technical Information of China (English)

    王警卫; 张蓬勃; 蒋敢

    2013-01-01

    目的:探讨右美托咪啶复合丁丙诺啡用于术后静脉P C A的安全性及效果。方法60例择期大手术后患者随机分为右美托咪啶组和丁丙诺啡组两组(n=30),术后右美托咪啶组以右美托咪啶2μg/kg和丁丙诺啡6μg/kg加盐水至100ml行术后静脉PCA,丁丙诺啡组以丁丙诺啡12μg/kg加盐水至100ml行术后静脉PCA。观察并记录两组的镇痛效果及副作用并进行统计学分析。结果右美托咪啶组较单纯丁丙诺啡组镇痛效果更好,副作用少。结论右美托咪啶组复合丁丙诺啡用于术后静脉PCA效果确切,可减少丁丙诺啡用量和并发症。%Objective To study the security and efficacy of postoperative patient-control ed venous analgesia with dexmedetomidine al ying buprenorphine. Methods 60 patients undergoing a elective capital operation were randomly divided into tow groups: dexmedetomidine group (Group D) and buprenorphine group (Group B ) (n=30). Al the patients received either dexmedetomidine2μg/kg and buprenorphine 6μg/kg (Group D)or buprenorphine 12μg/kg (Group B) adding sodium chloride injection to 100ml used to postoperative patient-control ed venous analgesia. The effects on the pain and the side-effects were recorded to make a statistical analysis of. Results The analgesia effect in dexmedetomidine group was significant better than in buprenorphine group and the incidence of side-effects lower. Conclusion Dexmedetomidine al yingbuprenorphine can be used effectively and safely to postoperative patient-control ed venous analgesia. And it could decrease the dose of buprenorphine.

  5. Women and Industrial Education

    Science.gov (United States)

    Bjorkquist, David C.

    1973-01-01

    Deals with these three questions: (1) What is the employment status of women, (2) What do advocates of the women's rights movement want, (3) How should industrial educators respond to the women's rights movement? (SB)

  6. Competition between Women.

    Science.gov (United States)

    Joseph, R.

    1985-01-01

    Examined competition and physical attractiveness among women. Results indicated that a large number of females are highly critical of other women, particularly attractive ones, and are highly concerned about their own appearance in relation to other women. (Author/BL)

  7. Women and Diabetes

    Science.gov (United States)

    ... Audience For Women Women's Health Topics Women and Diabetes Share Tweet Linkedin Pin it More sharing options ... Diabetes How to Report Problems with Glucose Meters Diabetes Treatments Some people with diabetes need to take ...

  8. Women and Diabetes

    Medline Plus

    Full Text Available ... Audience For Women Women's Health Topics Women and Diabetes Share Tweet Linkedin Pin it More sharing options ... Diabetes How to Report Problems with Glucose Meters Diabetes Treatments Some people with diabetes need to take ...

  9. Women and HIV

    Science.gov (United States)

    ... Consumer Information by Audience For Women Women and HIV Share Tweet Linkedin Pin it More sharing options ... HIV? What should pregnant women know about HIV? HIV Quick Facts What is HIV? HIV is the ...

  10. Gallstones in Women

    Science.gov (United States)

    ... Patients Home / Digestive Health Topic / Gallstones in Women Gallstones in Women Basics Overview Did you know that women are at increased risk for gallstones? Gallstones occur in up to 20% of American ...

  11. Bleeding Disorders in Women

    Science.gov (United States)

    ... this? Submit What's this? Submit Button Past Emails Bleeding Disorders in Women Language: English Español (Spanish) Recommend ... risk for a bleeding disorder. What is excessive bleeding in women? Women with excessive bleeding may experience ...

  12. Women and Diabetes

    Medline Plus

    Full Text Available ... Audience For Women Women's Health Topics Women and Diabetes Share Tweet Linkedin Pin it More sharing options ... Diabetes How to Report Problems with Glucose Meters Diabetes Treatments Some people with diabetes need to take ...

  13. Women and Diabetes

    Medline Plus

    Full Text Available ... main page content Skip to search Skip to topics menu Skip to common links HHS U.S. Department ... Consumer Information by Audience For Women Women's Health Topics Women and Diabetes Share Tweet Linkedin Pin it ...

  14. Minority Women and Advocacy for Women's Health

    Science.gov (United States)

    Kumanyika, Shiriki K.; Morssink, Christiaan B.; Nestle, Marion

    2001-01-01

    US minority health issues involve racial/ethnic disparities that affect both women and men. However, women's health advocacy in the United States does not consistently address problems specific to minority women. The underlying evolution and political strength of the women's health and minority health movements differ profoundly. Women of color comprise only one quarter of women's health movement constituents and are, on average, socioeconomically disadvantaged. Potential alliances may be inhibited by vestiges of historical racial and social divisions that detract from feelings of commonality and mutual support. Nevertheless, insufficient attention to minority women's issues undermines the legitimacy of the women's health movement and may prevent important advances that can be achieved only when diversity is fully considered. PMID:11527764

  15. Women of ATLAS - International Women's Day 2016

    CERN Multimedia

    Biondi, Silvia

    2016-01-01

    Women play key roles in the ATLAS Experiment: from young physicists at the start of their careers to analysis group leaders and spokespersons of the collaboration. Celebrate International Women's Day by meeting a few of these inspiring ATLAS researchers.

  16. Effects of Postoperative Analgesia with Buprenorphine on Cell Immunity in Patients with Gastric Cancer%丁丙诺啡术后镇痛对胃癌患者细胞免疫的影响

    Institute of Scientific and Technical Information of China (English)

    杨少勇; 张广华; 李锦成

    2011-01-01

    Objective: Surgical stress, including pain, may induce cell immunodepression and can even affect postoperative recurrence of cancer. The influence of the postoperative analgesic buprenorphine and fentanyl on the perioperative cell immunity of gastric cancer patients was compared. Methods: A total of 40 patients umdergoing surgery for gastric cancer were randomly divided into group B ( n = 20 ) with postoperative buprenorphine 0.3 μg·kg-1·h-1 as the experiment group and group F ( n = 20 ) with fentanyl 0.3 μg·kg-1·h-1 as the controls. Blood samples were collected before the surgery and at one day and three days after the surgery. T-cell subgroups CD3+, CD4+, CD8+, CD4+/CD8+, and NK cell were analyzed by flow cytometry, and the levels of cytokines INF-γ and IL-10 were determined using ELISA. Results: The surgical procedure and analgesic effects were similar between the two groups. There were reductions in the number of T cells and NK cells, and increased immunologic derangement, such as inflammatory cytokines, after the surgery. Compared with fentany 1, buprenorphine was beneficial to the recovery of inmnume indices. Conclusion: Surgical stress can induce changes in T lymphocyte subsets, NK cells, and cytokines. Buprenorphine is more beneficial to immune recovery than fentanyl when used as a postoperative analgesic.%目的:外科手术应激(包括疼痛)可抑制细胞免疫甚至促进恶性肿瘤术后转移复发.本研究比较丁丙诺啡与芬太尼术后镇痛对胃癌手术患者围术期细胞介导免疫功能的影响.方法:选取天津医科大学附属肿瘤医院2009年3月至2010年5月间40例胃癌切除术患者,随机分为丁丙诺啡组(A组20例)和芬太尼组(B组20例).A组使用丁丙诺啡背景输注剂量为0.3μg/(kg·h)行术后镇痛,追加剂量为0.3 μg/kg;B组使用芬太尼0.3 μg/(kg·h)行术后镇痛,追加剂量0.3 μg/kg.分别在术前、术后24 h、术后72 h取血进行T细胞亚群、NK细胞

  17. 丁丙诺啡超前镇痛对围术期应激反应和术后自控镇痛的影响%Preemptive analgesia effects of buprenorphine on stress responses and postoperative pain management

    Institute of Scientific and Technical Information of China (English)

    粱琪; 金梅生

    2012-01-01

    Objective: To study the preemptive analgesia effects of buprenorphine on postoperative pain management and stress responses. Methods: 60 patients underwent spinal surgery were randomly divided into two groups with 30 cases each, patients in group P were administrated with 0. 15mg buprenorphine intravenously 30 min before operation. In group C, patients were administrated with 0. 15mg buprenorphine at the end of operation. All patients received postoperative analgesia with patient controlled intravenously analgesia(PCIA). The analgesic effect was evaluated by VAS score at 2,6,12,24 and 48 h after operation. The concentration of Cor and CRP in serum a-head of anesthesia induction (TO) and at 6h (Tl) , 12h (T2) after operation was measured. Results: VAS scores of group P were significantly lower than those in group C at the different time point (P<0. 05). The concentrations of Cor and CRP in two groups were significantly increased at Tl, T2, respectively, as compared with values at TO. Compared to group C, the concentrations of Cor and CRP were significantly lower at Tl and T2 than those in group P (P<0. 05). Conclusion;Preemptive analgesia with buprenorphine can more effectively inhibit perioperatively stress responses and have effective postoperative analgesia.%目的:观察丁丙诺啡超前镇痛对围术期患者应激反应及自控镇痛的影响.方法:60例于全身麻醉下行脊柱内固定术患者,随机分为超前镇痛(P)组,于手术开始前30min静脉缓慢注射丁丙诺啡0.15mg;术后镇痛(C)组,于手术结束时静脉缓慢注射丁丙诺啡0.15mg.两组患者术后均行静脉自控镇痛.术后不同时间点观察视觉模拟评分(VAS).并于麻醉前(T0)、术后6h(T1)、术后12h(T2)分别测定皮质醇(Cor)、C反应蛋白(CRP).结果:P组与C组均能在术后产生良好的镇痛效果,P组在术后2、6、12、24、48h VAS评分显著低于C组(P<0.05),24h内各时点PCIA有效按压次数P组明显少于C组(P<0.05),与T0

  18. 关节腔内注射丁丙诺啡对膝关节镜术后疼痛的影响%ANALGESIC EFFECT OF LOW DOSE BUPRENORPHINE INJECTED INTRA-ARTICULARLY AFTER KNEE ARTHROSCOPY

    Institute of Scientific and Technical Information of China (English)

    刘凤梅; 张忠; 谢金瑞

    2004-01-01

    目的:观察关节腔内注射丁丙诺啡(Buprenorphine)对膝关节镜术后的镇痛效果,并与注射小剂量吗啡(Morphine)进行对比分析.方法:48例腰麻下行膝关节镜手术病人,双盲法随机均分为关节腔内注射Buprenorphine(B)、Morphine(M)与生理盐水对照组(C)3组,给药后记录术后2h、4h、8h、12h与24h患者屈膝关节90°状态下的视觉模拟评分(VAS)、对镇痛效果的满意度及术后8h按需注射哌替啶的量.结果: B、M组术后8h哌替啶平均使用量分别为9.4mg与28.1mg,较C组(51.6mg)明显减少;术后4h、8h、12h、24h 患者屈膝90° VAS评分B、M组均显著低于C组,B组亦较M组低,比较统计学差异均非常显著(P<0.001);术后镇痛满意度,B、M组较C组高,组间差异非常显著(P<0.001).结论: 关节腔内注射Buprenorphine可有效缓解膝关节镜术后疼痛,效果优于吗啡.

  19. Monitoring Intravenous Abuse of Methadone or Buprenorphine in Opiate Maintenance Treatment (OMT): A Simple and Fast LC-MS-MS Method for the Detection of Disaccharides in Urine Samples.

    Science.gov (United States)

    Jungen, Hilke; Andresen-Streichert, Hilke; Müller, Alexander; Iwersen-Bergmann, Stefanie

    2017-01-01

    The detection of disaccharides in urine is under investigation to act as a marker for intravenous abuse of disaccharide formulations, like liquid methadone with syrup (sucrose), methadone tablets (lactose and sucrose), or buprenorphine tablets (lactose). As the detection time in urine has not yet been investigated and a routine method for detecting disaccharides is still lacking, a study was performed to estimate the window of detection in urine after intravenous consumption of disaccharides. Furthermore, an analytical LC-MSMS method for the quantification of sucrose and lactose in urine was validated. The method was applied to urine samples of intravenous substitute consumers, with urine being sampled before intravenous use of substitutes and approximately 30 minutes later. Twenty users provided information regarding their most recent prior intravenous consumption. Disaccharides were detectable in all 20 urine samples about 30 minutes after consumption. A cut off for both disaccharides of 40mg/L was used. Based on these conditions 81% of the persons who consumed in a time frame of 24 hours ago showed positive results for disaccharides. The study showed that the validated LC-MSMS method with an easy and fast workup is usable for daily routine in the laboratory. It might be helpful for methadone and buprenorphine prescribing physicians to check whether the opiate maintenance treatment patient takes his or her substitution medicines orally as intended, or continues with intravenous misuse by injecting substitution medicines instead of heroin. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  20. 丁丙诺啡透皮贴剂的缓释镇痛作用%Buprenorphine transdermal patches as preemptive analgesia

    Institute of Scientific and Technical Information of China (English)

    任晓凤; 任娜娜; 张爱文; 哈承志; 郑颂浩; 刘宁; 徐建

    2015-01-01

    背景:丁丙诺啡透皮贴剂具有血药浓度稳定、镇痛时间长、呼吸抑制和其他不良反应较小的特点,被广泛应用于治疗中度到重度慢性疼痛.目的:观察丁丙诺啡透皮贴剂超前镇痛对腰椎后路椎弓根螺钉内固定治疗后疼痛的抑制效果.方法:选择拟行全麻下腰椎后路减压椎间植骨融合椎弓根螺钉内固定患者80例,其中男45例,女35例,年龄42-71岁,随机均分为两组,试验组于内固定治疗前2 d使用丁丙诺啡透皮贴剂,治疗后使用帕瑞昔布钠镇痛;对照组内固定治疗前给予与丁丙诺啡透皮贴剂相似的空白贴剂,治疗后使用静脉自控镇痛泵及帕瑞昔布钠镇痛.记录患者治疗后 6,12,24,48 h的目测类比评分、术后追加盐酸曲马多及盐酸哌替啶用量和不良反应,治疗后48 h患者满意度、引流量及血常规、血沉、C-反应蛋白水平.结果与结论:两组目测类比评分、术后追加盐酸曲马多及盐酸哌替啶用量、术后引流量、白细胞总数、血沉、C-反应蛋白水平比较差异无显著性意义(P > 0.05),试验组恶心呕吐及术后谵妄的发生率低于对照组(P 0.05). Postoperative incidence of nausea, vomiting and delirium was lower in the experimental group than the control group (P < 0.05), but the patient's satisfaction in the experimental group was better than that in the control group (P< 0.05). These findings indicate that buprenorphine transdermal patches have better preemptive analgesia for posterior lumbar surgery, with less adverse effects and better patient's satisfaction.

  1. Women and Diabetes

    Medline Plus

    Full Text Available ... Diabetes Information on WebMD Order Free Women's Health Publications Women's Health Information on Twitter Information from Other ... YourDiabetesInfo.org American Diabetes Association Get Other FDA Publications for Women For Women Homepage FDA Diabetes Information ...

  2. Resources for Women's Studies.

    Science.gov (United States)

    Ridinger, Robert B.

    Over 120 bibliographies and other reference sources relevant to women's studies are identified in this annotated listing. Subjects include feminist scholarship, women in management, popular culture, autobiographies, other cultures and countries, history, lesbian women, women's education, the arts, politics, and rape. In addition to author, title,…

  3. Hypertension in postmenopausal women.

    Science.gov (United States)

    Lima, Roberta; Wofford, Marion; Reckelhoff, Jane F

    2012-06-01

    Blood pressure is typically lower in premenopausal women than in men. However, after menopause, the prevalence of hypertension in women is higher than it is in men. Hypertension is a major risk factor for cardiovascular disease in women and men, but cardiovascular disease is the leading cause of death in women. Furthermore, there is evidence that blood pressure may not be as well-controlled in women as in men, despite the fact that most women adhere better to their therapeutic regimens and medications than do men, and have their blood pressures measured more frequently than do men. This review describes possible mechanisms by which blood pressure may be increased in postmenopausal women.

  4. WOMEN AND RUSSIAN MODERNIZATION

    OpenAIRE

    KIREGIAN ELISE

    2015-01-01

    This article analyzes Russian women and their ability to embrace Western educational and business practices following the fall of the Soviet Union. As recently as the 1980s, women managers in Russia were rare. Today, a total of 42 percent of senior management posts in Russia are held by women. Unlike women in Western nations who tend to frame their emerging role in ideological terms, Russian women enrolled in academic programs that gave them valuable skills for the market economy. The paper a...

  5. Women Battle Inequality

    Institute of Scientific and Technical Information of China (English)

    1997-01-01

    WTTH women parliamentarians worldwide gathering in Beijing on 15 September 1996, China’s capital city was once again in the spotlight as women gathered to promote gender equality. One year after the Fourth World Conference on Women and the NGO Forum, and one day before the Inter-Parliamentary Union (IPU) held its 96th Conference, 150 women parliamentarians from more than 70 countries gathered in Beijing to attend the 96th Women

  6. Violence against women.

    Science.gov (United States)

    Keizire, J

    1995-01-01

    This article discusses the prevalence of violence against women in Uganda. The incidence of violence against women has been increasing despite efforts by law enforcement orders. In the broadest sense, violence against women is any violation of a woman's personhood, mental or physical integrity or freedom of movement. Violence against women is considered as an obstacle to the achievement of the objectives of equality, development and peace. Moreover, the act violates and impairs women's rights and fundamental freedoms. The low social and economic status of women can be both a cause and a consequence of violence against women. Physical, sexual and psychological violence occurring in the family, including battering, sexual abuse of female children, dowry-related violence, marital rape, female genital mutilation and other traditional practices harmful to women, limit the ability to make choices on women's lives.

  7. Analisi dei costi di buprenorfina vs metadone nella terapia dei soggetti con dipendenza da oppiacei

    Directory of Open Access Journals (Sweden)

    Giorgio L. Colombo

    2003-12-01

    Full Text Available In the last decades, methadone has virtually represented the only available option for the treatment of opioid addicts in Italy. Early in the year 2000 buprenorphine has been introduced on the market as a possible alternative to methadone. While most of the research conducted so far in our country has focused on possible differences in clinical outcomes, depending on the pharmacological differences among the two molecules, the economical aspects of the choice between the two drugs have barely been addressed. In this paper we present a pharmacoeconomical comparison between buprenorphine and methadone in the treatment of heroin dependence by the Italian health service, adopting the perspective of the Society. For this purpose, we constructed a decision analysis model comprising the possible clinical pathways a patient can go through following the inclusion in the therapeutic programs of the SerT. Two types of incremental costs have been considered in the model: direct health costs, i.e. drug acquisition and medical staff costs, and indirect cost, due to loss of working hours for the administration of the drug. The analysis was conducted with a cost-minimization approach, mandatory in the absence of reliable data on clinical differences, and with a time perspective of 12 months. Our results indicate that buprenorphine, despite its higher pharmaceutical cost, is the more convenient option for the treatment of opioid dependence in Italy, as it permits a significant saving of productivity losses. The difference in indirect costs relies on the shorter mean treatment time with buprenorphine and on the possibility of reducing dosing frequency, which allows many patients to attend health services only thrice in week, instead of the daily visits to the SerT necessary for most methadone-treated patients. The results were challenged in a series of sensibility analysis conducted on all relevant and uncertain paramenters, and in no case the option methadone

  8. Albanian women in physics

    Science.gov (United States)

    Deda, Antoneta; Alushllari, Mirela; Mico, Silvana

    2015-12-01

    In this report, presented at the 5th IUPAP International Conference on Women in Physics, we describe the status of women physicists in Albania and offer some statistical data illustrating the present situation. Undergraduate physics enrollment by girls is high and stable, more women are receiving financial support for doctoral studies, women are well represented in recent academic promotions, and recently women scientists have been appointed to several leadership positions. However, both women and men are challenged by the overall low levels of funding for research and by issues of availability and affordability of child care.

  9. Women's rights to health.

    Science.gov (United States)

    1997-08-01

    Women's rights and health are threatened by cultural, religious, and social biases against women that create barriers in women's ability to access health information, education, and services. The fact that women's basic human rights include a right to health has been incorporated in international rights covenants, but violations occur in the form of 1) direct state actions, such as coercive abortion; 2) failure of states to meet health needs; 3) discrimination that denies health care to specific groups; and 4) failure of states to protect women from violence, child marriage, female infanticide, and other forms of health- and life-threatening discrimination. In order to improve this situation, a basic set of indicators must be developed to monitor implementation of agreements to protect women. Health professionals must continue to incorporate women's rights into the ethics or charters of health practices, to improve service to women, and to increase governmental advocacy on behalf of women. Governments must acknowledge the benefits of applying a rights approach to women's health status and must develop plans to implement recommendations arising from international conferences on women's rights. Women-centered nongovernmental organizations must create a clear framework on women's rights to health and develop advocacy and networking strategies.

  10. The preemptive analgesia observation of buprenorphine hydrochloride for the lower uterine segment cesarean section%盐酸丁丙诺啡用于子宫下段剖宫产术的超前镇痛效果观察

    Institute of Scientific and Technical Information of China (English)

    刘晓燕

    2013-01-01

    Objective To observe the effect of preemptive analgesia with epidural buprenorphine on the postoperative pain for patients who were undergoing cesarean section.Methods Eighty ASA Ⅰ-Ⅱ patients underwent selective cesarean section under combined spinal epidural analgesia were randomly divided into two groups:preemptive analgesia group (group A,n =40) and control group (group B,n =40).Ten minutes before operation,the patients in group A received epidural injection of buprenorphine 0.15 mg and group B received normal saline 4 ml.The analgesia effect was assessed by visual analogue scale (VAS) at 4,8,12,24,48 hours after operation,side effects and effective pressing times of PCEA were also recorded.Results The VAS scores of group A were significantly lower than those of group B at 4,8 and 12 hours after operation(P <0.05).The incidence of side effects in the two groups was not significant(P >0.05).Conclusions Preemptive analgesia with epidural buprenorphine can provide satisfactory pain relief with no obvious side effects after lower uterine segment cesarean section.%目的 观察硬膜外腔注入盐酸丁丙诺啡用于子宫下段剖宫产术进行超前镇痛的效果.方法 将80例ASAⅠ~Ⅱ级择期子宫下段剖宫产术患者于硬-腰联合麻醉后随机分为两组:超前镇痛组(A组)40例,于手术切皮前10 min经硬膜外导管注入含盐酸丁丙诺啡0.15 mg的生理盐水4ml;对照组(B组)40例,于手术切皮前10 min经硬膜外导管注入生理盐水4ml,观察术后4、8、12、24、48h两组患者的视觉模拟评分(VAS),各时段自控硬膜外镇痛(PCEA)有效按压次数和不良反应.结果 术后4、8、12 h VAS评分A组明显低于B组(P<0.05),两组不良反应的发生率比较差异无统计学意义(P>0.05).结论 盐酸丁丙诺啡硬膜外超前镇痛能有效减轻子宫下段剖宫产术的术后疼痛.

  11. 布托啡诺复合小剂量氯氨酮用于剖宫产术后镇痛%Postoperative analgesia of cesarean section by buprenorphine hydrochloride combined with low ketamine

    Institute of Scientific and Technical Information of China (English)

    张勇; 邓燕

    2010-01-01

    目的 观察术后硬膜外持续泵入布托啡诺复合小剂量氯胺酮用于剖宫产术后镇痛的效果和对初乳及不良反应的影响. 方法选择40例Ⅰ~Ⅱ级择期或急症孕足月行剖宫产手术后的产妇,年龄23~35岁,随机分为两组.A组为观察组(n=20),用布托啡诺0.1 mg/kg+氯胺酮1 mg/kg+生理盐水至 100 ml持续泵入;B组为对照组(n=20),用0.15%罗哌卡因+0.004%芬太尼+0.1%地塞米松+生理盐水总量100 ml持续泵入.观察产妇术后各时间段的视觉模拟镇痛评分(VAS)、镇静评分、泌乳时间,并对术后产妇的总体感觉满意度进行评分.结果 A、B两组在泵药后4、12、24、48 h的VAS评分、镇静评分差异无统计学意义(P>0.05).A组产妇的总体感觉满意度高于B组(P0.05).结论 布托啡诺复合小剂量氯胺酮硬膜外持续泵入用于剖宫产术后镇痛可以提供满意的镇痛效果,而且也有利于术后产妇的恢复,并且不影响泌乳.%Objective To observe the analgesia effects of buprenorphine hydrochloride combined with low ketamine that continued to pump into epidural space,which were used to treat postoperative analgesia of cesarean section and to study their on colostrums and side reactions. Methods Forty patients were at age of 23-35 years and term pregnancy, who were 1-2 grade or emergency.These cases were randomly divided into two groups: group A(study group,n=20) and group B(control group,n=20),group A were treated with buprenorphine hydrochloride(0.1 mg/kg)+ ketamine(1 mg/kg)+NS(coming to 100 ml),which continued to pump into epidural space. Group B were treated with ropivacaine(0.15%)+febtanyl citrate(0.004%)+dexame thasone(0.1%)(coming to 100 ml), which continued to pump into epidural space.We observe postoperative parturients mimic analgesia VAS of visual sense,sedation VAS,lactigenous time and the total degree of satisfaction. Results There were no significant difference between group A and group B about mimic analgesia

  12. 舒芬太尼与丁丙诺啡对老年骨科患者术后镇痛效果比较%Comparison of postoperative analgesia effect between sufentanil and buprenorphine on elderly orthopedic patients

    Institute of Scientific and Technical Information of China (English)

    孟海; 王宁

    2014-01-01

    Objective To Compare effect of postoperative analgesia between equivalent dose of sufentanil and buprenor -phine on elderly orthopedic patients .Methods 60 cases of ASA Ⅱ-Ⅲ patients, aged 65~78 and ready for open reduction and internal fixation,were randomly divided into a sufentanil group (S) and a buprenorphine group (D),30 cases in each one.Both were treated with intravenous patient-controlled intravenous analgesia ( PCIA) administration ( group S sufentanil 100 μg;group D buprenorphine 1.2mg, total 100ml).After 5,10,20 and 40 hs respectively,VAS pain and Ramsay scores were graded .The number of effective PCA pressing and incidence of adverse reaction were accordingly recorded .Results The two groups had no significant statistic difference in terms of VAS pain score ,Ramsay score and PCA effective pressing number , but the incidence of adverse reactions in group D was significantly higher than that in group S (P<0.01).Conclusion Sufentanil and buprenorphine of equivalent dose ,if used after operation in elderly orthopedic patients ,have nearly equal analge-sia effect.But the adverse reaction rate of sufentanil is relatively lower .Thus it is more suitable for postoperative analgesia for elderly orthopedic patients .%目的:比较等效剂量舒芬太尼与丁丙诺啡对骨科老年病人患者术后镇痛的效果。方法选择60例ASAⅠ~Ⅱ级65~78岁的下肢骨折需行切开复位内固定术的患者,随机分为舒芬太尼组(S)和丁丙诺啡组(D),每组30例。2组均采用静脉自控镇痛(PCIA)给药,S组:舒芬太尼100μg,D组:丁丙诺啡1.2 mg,总量100 ml,术后5、10、20及40 h行VAS疼痛与Ramsay评分,记录PCA有效按压次数及不良反应发生率。结果2组VAS疼痛评分、Ramsay评分及PCA有效按压次数差异均无统计学意义,而不良反应发生率D组显著高于S组(P<0.01)。结论等效剂量舒芬太尼与丁丙诺啡用于骨科老年病人术后镇痛效

  13. Alternatives for Women

    Science.gov (United States)

    Alberti, Jean M.

    1975-01-01

    This article summarized the perspective of this issue by recognizing the validity of the issues being raised by the women's rights movement and also recognizing that the "liberation of women" means the liberation of men. (Author/RK)

  14. Women and schizophrenia

    National Research Council Canada - National Science Library

    Thara, R; Kamath, Shantha

    2015-01-01

    Women's mental health is closely linked to their status in society. This paper outlines the clinical features of women with schizophrenia and highlights the interpersonal and social ramifications on their lives...

  15. Women in Academic Medicine.

    Science.gov (United States)

    Thibault, George E

    2016-08-01

    More than a decade ago, women achieved parity with men in the number of matriculants to medical school, nearly one-third of the faculty of medical schools were women, and there were some women deans and department chairs. These trends were promising, but today there are still significant differences in pay, academic rank, and leadership positions for women compared with men in academic medicine. Though there has been progress in many areas, the progress is too slow to achieve previously recommended goals, such as 50% women department chairs by 2025 and 50% women deans by 2030.The author points to the findings presented in the articles from the Research Partnership on Women in Biomedical Careers in this issue, as well as research being published elsewhere, as an evidence base for the ongoing discussion of gender equity in academic medicine. More attention to culture and the working environment will be needed to achieve true parity for women in academic medical careers.

  16. Women and Diabetes

    Medline Plus

    Full Text Available ... during pregnancy. Diabetes and Pregnancy (CDC) Diverse Women in Clinical Trials Campaign Clinical trials can help doctors ... ages, races, ethnic backgrounds, and health conditions participating in clinical trials. Visit the Women in Clinical Trials ...

  17. Anorgasmia in Women

    Science.gov (United States)

    ... can decrease blood flow to the vagina and clitoris, which can delay or stop orgasm entirely. Psychological ... women need direct or indirect stimulation of the clitoris in order to orgasm, but not all women ...

  18. Women and Alcohol

    Science.gov (United States)

    ... turn JavaScript on. Feature: Rethinking Drinking Women and Alcohol Past Issues / Spring 2014 Table of Contents Women react differently than men to alcohol and face higher risks from it. Pound for ...

  19. Women's Career Development Patterns.

    Science.gov (United States)

    Schreiber, Pamela J.

    1998-01-01

    Women's career development is characterized by balance of work and family, career interruptions, and diverse career paths. Alternative work arrangements such as flexible schedules, telecommuting, and entrepreneurial opportunities may offer women more options for work. (SK)

  20. How Women Changed History

    Institute of Scientific and Technical Information of China (English)

    Vivienne; Gill; 袁爱萍

    2003-01-01

    Men sometimes say, "We are better and cleverer than women. Women never invent things. We do. " It is true that men have invented a lot of useful things: the alphabet, machines, rockets, and guns, too.

  1. Women of Jino Nationality

    Institute of Scientific and Technical Information of China (English)

    1996-01-01

    The dress of the Jino nationality differs greafiy from village to village. The upper photo shows the women of Xinyuan Village, Mengwang Township, with the photo on the right featuring women from Jiamazhai Village, Jino Township.

  2. College Women's Health

    Science.gov (United States)

    ... the College Women's Social Media Kit! College Women's Social Media Toolkit Use the Social Media Toolkit to ... International Programs News & Events Training & Continuing Education Inspections & Compliance Federal, State & Local Officials Consumers Health Professionals Science & ...

  3. Women Veteran Report

    Data.gov (United States)

    Department of Veterans Affairs — This report summarizes the history of women Veterans in the military and as Veterans. It profiles the characteristics of women Veterans in 2015, and illustrates how...

  4. Women in Information Technology

    Science.gov (United States)

    Wentling, Rose Mary; Thomas, Steven P.

    2004-01-01

    There is a major concern about the drop of young women entering Computer Science degree programs and a drop in the participation of women in these information technology occupations. In all levels of educational institutions across the nation, girls and women remain under-represented in computer and information science studies and subsequently,…

  5. Workplace Safety and Women

    Centers for Disease Control (CDC) Podcasts

    2009-05-11

    This women's health podcast focuses on four important issues for women at work: job stress, work schedules, reproductive health, and workplace violence.  Created: 5/11/2009 by Office of Women's Health (OWH) and National Institute for Occupational Safety and Health (NIOSH).   Date Released: 5/11/2009.

  6. Women in Technical Education.

    Science.gov (United States)

    Ellis, Mary L.

    Perhaps the most significant challenge of the 1970's will be the effect the women's rights movement will have on the nation's established institutions and the extent to which the nation responds to the call of women for equal opportunities. Social pressures and expectations have been, until recently, such that women simply have not opted for jobs…

  7. Longevity of Women Superintendents

    Science.gov (United States)

    Sethna, Kim C.

    2014-01-01

    Public schools are facing a leadership crisis regarding the lack of women superintendents in the United States. Although, historically, women have dominated the positions of classroom teachers and outnumbered men in receiving administrative leadership certificates, there is a disproportion in the number of men and women superintendents leading the…

  8. Women and Diabetes

    Medline Plus

    Full Text Available ... Skip to common links HHS U.S. Department of Health and Human Services U.S. Food and Drug Administration ... Consumers Consumer Information by Audience For Women Women's Health Topics Women and Diabetes Share Tweet Linkedin Pin ...

  9. Heart Disease in Women

    Science.gov (United States)

    ... United States, 1 in 4 women dies from heart disease. The most common cause of heart disease in both men and women is narrowing or ... It's the major reason people have heart attacks. Heart diseases that affect women more than men include Coronary ...

  10. Women of California.

    Science.gov (United States)

    Gray, Harry

    This publication points out the achievements of women who contributed to the development and history of California from the 16th century, when the Spanish Conquistadores moved westward into the San Francisco Bay area, to the gold rush of 1848, and during the following period when women helped stabilize society on the rugged frontier. Women not…

  11. Four Women Bank Directors

    Institute of Scientific and Technical Information of China (English)

    1995-01-01

    FOUR of the five directors of state banks in Beihai City in Guangxi Zhuang Autonomous Region are women. These women show that women are no longer only able to manage family finance, but they are able to take charge of the important responsibility for state finance. The mayor of Beihai City calls them the city’s outstanding financial affairs managers.

  12. Feminism and Black Women's Studies.

    Science.gov (United States)

    Hooks, Bell

    1989-01-01

    Women's studies programs have largely ignored Black women. Until Black women's studies courses are developed, feminist scholarship on Black women will not advance, and the contributions of Black women to women's rights movements and African American literature and scholarship may be neglected. (DM)

  13. Women in Latin American History.

    Science.gov (United States)

    Lavrin, Asuncion

    1981-01-01

    Presents a bibliography and suggests a number of topics around which a college level history course on Latin American women could be organized. Course topics include migration of women, definition of sex roles, legal status of women, women's work and society, feminism, politics, religion, women and the family, and women's education and…

  14. Women residents, women physicians and medicine's future.

    Science.gov (United States)

    Serrano, Karen

    2007-08-01

    The number of women in medicine has increased dramatically in the last few decades, and women now represent half of all incoming medical students. Yet residency training still resembles the historical model when there were few women in medicine. This article reviews the issues facing women in residency today. Data suggest that the experience of female residents is more negative than that of males. Unique challenges facing female residents include the existence of gender bias and sexual harassment, a scarcity of female mentors in leadership positions, and work/family conflicts. Further research is needed to understand the experience of female residents and to identify barriers that hinder their optimal professional and personal development. Structural and cultural changes to residency programs are needed to better accommodate the needs of female trainees.

  15. Women scientists joining Rokkasho women to sciences

    Energy Technology Data Exchange (ETDEWEB)

    Aratani, Michi [Office of Regional Collaboration, Institute for Environmental Sciences, Rokkasho, Aomori (Japan); Sasagawa, Sumiko

    1999-09-01

    Women scientists generally play a great role in the public acceptance (PA) for the national policy of atomic energy developing in Japan. The reason may be that, when a woman scientist stands in the presence of women audience, she will be ready to be accepted by them as a person with the same gender, emotion and thought to themselves. A case of interchange between the Rokkasho women and the women scientists either resident at the nuclear site of Rokkasho or staying for a short time at Rokkasho by invitation has been described from the viewpoint of PA for the national policy of atomic energy developing, and more fundamentally, for promotion of science education. (author)

  16. 丁丙诺啡、曲马多用于雷米芬太尼全麻苏醒过渡期镇痛%Analgesic effect of buprenorphine comparied with tramadol on emergence after remifentanil-based general anesthesia

    Institute of Scientific and Technical Information of China (English)

    杨金凤; 常业恬; 周志国

    2005-01-01

    目的对照观察丁丙诺啡、曲马多用于雷米芬太尼全麻苏醒过渡期镇痛的安全性和有效性.方法120例全麻开胸手术患者分为三组,术毕关胸时停静脉麻醉,同时A组静脉给予丁丙诺啡3μg/Kg,B组曲马多2 mg/Kg,C组注射用水2 mL.观察三组患者用药前(t1)、用药后10′(t2)、30′(t3)、拔管时(t4)、拔管后5′(t5)、10′(t6)各时点血流动力学、血氧饱和度、呼末CO2分压、躁动评分(RS)、Ramsay镇静评分、术后身体舒适评分(BCS)、苏醒时间、PCA按压次数、剂量及不良反应.结果A、B两组较C组在苏醒期血流动力学更稳定;给药后10′开始A、B两组RS明显低于C组(P<0.01).给药后30′开始RSS A、B两组明显高于C组(P<0.01),且拔管时开始A组明显高于B组(P<0.01);BCS A、B两组明显高于C组(P<0.01);B组出汗明显多于A组或C组(p<0.05);PCA按压次数及用药量C组>B组>A组(P<0.01,P<0.05).结论丁丙诺啡、曲马多均可安全有效应用于雷米芬太尼全麻苏醒过渡期镇痛,其中丁丙诺啡效果更好,副作用更少.%[Objective] To observe the analgesic effect of buprenorphine comparied with tramadol on emergence.after remifentanil-based general anesthesia. [Methods] 120 patients undergoing elective thoracotomy under general anesthesia were randomly divided into 3 equal groups(group A, B, C), stoped general anesthesia when starting to shut off thorax and injected buprenorphine 3 μg/kg at group A, tramadol 2 mg/kg at group B, 0.9%NS 2 mL at group C.At three groups the HR, MAP, SPO2, PETCO2, RS, RSS at every time point(t1~t6) and BCS, the waken time, PCA bolus times, PCA dosage, side reactions were observed. [Results] There were more steadily hemodynamics at group A、B than group C; Since 10' after drugs given RS of group A、B were apparently lower than group C (P <0.01).Since 30' after drugs given RSS of group A、B were obviously higher than group C (P <0.01), and there were

  17. First Mayan Women's Congress.

    Science.gov (United States)

    Teissedre, S

    1997-01-01

    In October 1997, over 200 participants attended the First Mayan Women's Congress in Mexico and called for financial assistance, capacity building, and training to help Mayan women escape poverty. The Congress was initiated by the UN Development Fund for Women in collaboration with the Small Grants Program of the UN Development Program. Traditionally, Mayan women and men have played distinct roles in society, and efforts are underway to increase gender sensitivity and achieve a new balance of power. Mayan women attending the Congress reported that they face daily challenges in gaining their husbands' approval for participation in income-generating activities outside of the home. Eventually, however, some husbands also start working in these enterprises and are learning to assume their share of domestic responsibilities. Mayan women have been forced to reevaluation their role in society by a prevailing agricultural and environmental crisis as well as a high unemployment rate. Crafts that were once produced only for household consumption are now considered for export. Because the women need funds to initiate income-generating activities, the Conference linked women's groups with development practitioners, policy-makers, and donors. The women requested financial aid for more than 30 specific projects, and Congress participants agreed to pursue innovate strategies to support the enterprises with funds, training, and technical assistance. The Congress also encouraged environmental nongovernmental organizations to include Mayan women in mainstream development activities. This successful Congress will be duplicated in other Mexican states.

  18. Women and political representation.

    Science.gov (United States)

    Rathod, P B

    1999-01-01

    A remarkable progress in women's participation in politics throughout the world was witnessed in the final decade of the 20th century. According to the Inter-Parliamentary Union report, there were only eight countries with no women in their legislatures in 1998. The number of women ministers at the cabinet level worldwide doubled in a decade, and the number of countries without any women ministers dropped from 93 to 48 during 1987-96. However, this progress is far from satisfactory. Political representation of women, minorities, and other social groups is still inadequate. This may be due to a complex combination of socioeconomic, cultural, and institutional factors. The view that women's political participation increases with social and economic development is supported by data from the Nordic countries, where there are higher proportions of women legislators than in less developed countries. While better levels of socioeconomic development, having a women-friendly political culture, and higher literacy are considered favorable factors for women's increased political representation, adopting one of the proportional representation systems (such as a party-list system, a single transferable vote system, or a mixed proportional system with multi-member constituencies) is the single factor most responsible for the higher representation of women.

  19. Chinese Women Laborers

    Institute of Scientific and Technical Information of China (English)

    1997-01-01

    FOR the last three years I have been working on two big projects about women around the world. One is Mothers of the World, and the other one is Working Women of the World. So I travel to different parts of the world to meet Women and photograph them. I knew from the start that I would be able to see China only very superficially, because there was no way I could spend more than two to three weeks there. I therefore

  20. WOMEN IN FAMILY BUSINESS

    OpenAIRE

    Anshu,

    2012-01-01

    The role of women in family businesses is explored in the paper. Although recognized as generally very important players, the role of women is often defined as invisible in business decision-making, supportive in men’s traditional business domains and only rarelyadequately recognized and rewarded. The paper explores possible differences in the views of men and women who manage small family firms. Their attitudes opposing the traditional business roles ofwomen, different views on managerial, o...

  1. Organization Champions Menopausal Women

    Institute of Scientific and Technical Information of China (English)

    JANE SHAW

    1994-01-01

    CURRENTLY, the ageing of the population has created problems for a developing China. Jiangsu is one of the provinces that has encountered these problems, where the average lifespan for women is 73. Women aged 40 to 55 who are going through menopause account for about 8 percent of Jiangsu’s total population. Whether this group is able to live a healthy life during menopause or not decides whether the women are healthy and happy and influences the rest of society.

  2. Women's empowerment: what works

    OpenAIRE

    Andrea, Cornwall

    2016-01-01

    With radical roots in the 1980s, women’s empowerment is now a mainstream development concern. Much of the narrative focuses on instrumental gains—what women can do for development rather than what development can do for women. Empowerment is treated as a destination reached through development’s equivalent of motorways: programmes rolled out over any terrain. But in the process, pathways women are travelling in their own individual or collective journeys of empowerment remain hidden. Revisiti...

  3. Chlamydia and Women

    Centers for Disease Control (CDC) Podcasts

    2009-04-02

    This women's health podcast focuses on chlamydia, its severe health consequences for women if left untreated, and the importance of annual chlamydia screening.  Created: 4/2/2009 by Office of Women’s Health (OWH) and National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP).   Date Released: 4/2/2009.

  4. Gestational Diabetes and Women

    Centers for Disease Control (CDC) Podcasts

    2009-05-12

    This women's health podcast focuses on gestational diabetes (GDM) to help educate women who may have been diagnosed with GDM now or in the past. GDM is a condition that can lead to pregnancy complications.  Created: 5/12/2009 by Office of Women’s Health (OWH) and National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 5/12/2009.

  5. Obesity and Women

    Centers for Disease Control (CDC) Podcasts

    2009-05-11

    This women's health podcast focuses on obesity in women and girls. It discusses obesity-related health risks and includes tips to help achieve and maintain a healthy weight.  Created: 5/11/2009 by Office of Women’s Health (OWH) and National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 5/11/2009.

  6. Women in Otolaryngology.

    Science.gov (United States)

    O'Connell Ferster, Ashley P; Hu, Amanda

    2017-08-01

    Advances in gender equality have been sought in the field of medicine for centuries, including the specialty of otolaryngology. Currently, about 14.5% of practicing otolaryngologists are women. Strides have been made to support equality by the American Academy of Otolaryngology-Head and Neck Surgery through the development of the Women in Otolaryngology Section in 2010, among other efforts. This article reviews the literature of women in otolaryngology, as well as current trends toward equality among otolaryngologists of all genders.

  7. Efficacy of adjuvant analgesia with buprenorphine transdermal patch in early rehabilitation after total hip replacement%丁丙诺啡透皮贴剂辅助镇痛在全髋关节置换术后早期康复锻炼中的疗效

    Institute of Scientific and Technical Information of China (English)

    孙钰; 李小磊; 颜连启; 王静成; 王强; 陈岗; 熊传芝; 胡翰生

    2015-01-01

    目的 探讨使用丁丙诺啡透皮贴剂辅助镇痛在全髋关节置换(T HR)术后早期康复锻炼中的临床疗效.方法 51例T H R患者随机分为丁丙诺啡透皮贴剂辅助镇痛组(A组 ,25例)和对照组(B组 ,26例) ,比较两组术后镇痛效果和关节功能相关指标.结果 术后A组VAS疼痛评分低于B组 ,关节活动度、直腿抬高能力和髋关节功能评分的改善均优于B组( P0 .05).结论 T HR术后使用丁丙诺啡透皮贴剂辅助镇痛能有效减少术后早期康复锻炼时的疼痛 ,保证术后康复计划的顺利进行.%Objective To investigate the clinical efficacy of adjuvant analgesia with buprenorphine transdermal patch in the early rehabilitation after total hip replacement (THR) . Methods A total of 51 patients underwent THR was randomly divided into two groups of A (treated with buprenorphine transdermal patch ,25 cases) and B(blank control ,26 cases) .Postopera-tive VAS pain score and joint function-related indicators were compared between two groups .Results Postoperative VAS pain scores were lower in group A than those in group B(P0 .05) .Conclusion Use of buprenorphine transdermal patch can effectively alleviate pain in the early rehabilitation and assure the outcomes of rehabilitation exercise in the patients after THR .

  8. Spring of women?

    Directory of Open Access Journals (Sweden)

    Mónica Castillo

    2012-12-01

    Full Text Available Terms such as “Islamic feminism” and “women’s movement” refer to those social movements of women that seek to assert their rights in Islamic societies. This brief study focuses on theses social movements of women and will presentan overview of the role and participation of women in the Arab Spring by examining news, events, press articles and opinions in order to contextualize the participation of women and feminists in the Arab Spring from a perspective of the social networking phenomenon as apparent drivers of the revolution.

  9. Women in service uniforms

    Directory of Open Access Journals (Sweden)

    Hanna Karaszewska

    2012-12-01

    Full Text Available The article discusses the problems of women who work in the uniformed services with the particular emphasis on the performing of the occupation of the prison service. It presents the legal issues relating to equal treatment of men and women in the workplace, formal factors influencing their employment, the status of women in prison, and the problems of their conducting in the professional role. The article also presents the results of research conducted in Poland and all over the world, on the functioning of women in prison and their relations with officers of the Prison Service, as well as with inmates.

  10. [Women's participation in science].

    Science.gov (United States)

    Sánchez-Guzmán, María Alejandra; Corona-Vázquez, Teresa

    2009-01-01

    The participation of women in higher education in Mexico took place in the late 19th and early 20th century. The rise of women's enrollment in universities known as the "feminization of enrollment" occurred in the last thirty years. In this review we analyze how the new conditions that facilitated better access to higher education are reflected in the inclusion of women in science. We include an overview of the issues associated with a change in the demographics of enrollment, segregation of academic areas between men and women and participation in post graduate degrees. We also review the proportion of women in science. While in higher education the ratio between male and women is almost 50-50 and in some areas the presence of women is even higher, in the field of scientific research women account for barely 30% of professionals. This is largely due to structural conditions that limit the access of women to higher positions of power that have been predominantly taken by men.

  11. Women and schizophrenia.

    Science.gov (United States)

    Seeman, M V

    2000-03-01

    Several important questions emerge from the study of gender differences in schizophrenia: Why does schizophrenia begin later in women? Why is outcome superior in women, at least in the first 15 years after onset? What causes sex differences in symptoms? What can gender differences teach us about the etiology of schizophrenia? Do men and women require substantially different treatments? What interventions during pregnancy and after childbirth ensure optimal health for the children of mothers with schizophrenia? Although complete answers may not yet be forthcoming, it is important to define the questions and keep them in mind when delivering services to women suffering from this severe, persistent mental illness.

  12. Rediscovering Women Mathematicians.

    Science.gov (United States)

    Rappaport, Karen D.

    The lives and mathematical contributions of seven famous women mathematicians are presented. They are: Hypatia, Agnesi, Sophie Germain, Mary Sommerville, Augusta Lovelace, Sofya Kovalevsky, and Emmy Noether. (MP)

  13. Health of women.

    Science.gov (United States)

    1997-01-01

    This article discusses the problems that women face in social, health, and nutritional areas in India. India's 135th ranking in the Human Development Index reflects the marginalization of women, the aged, the poor, the disabled, lower castes, and other neglected groups. The sex ratio has declined. Maternal mortality is high. 84% of rural women and 42% of urban women rely on untrained persons during childbirth. The systems of education, religion, health care, law, employment, and the mass media promote gender discrimination. Patriarchal structures resist efforts to build a gendered perspective and to provide gender sensitivity within health care and development. Women experience deficits in educational development, rest, food, recreation, and freedom of movement and action. Girls lack sufficient breast feeding and health care from a health system that is 80% private. 40% of the population is poor and needs access to affordable health services. Inadequate diets and nutrition have long term health consequences. Women's health deteriorates due to early marriage and childbearing. Adequate nutrition is exacerbated by high food prices, limits in the Public Distribution System, and the shift to non-edible cash crops. The family planning program focuses on women, despite the prevailing belief that women are not in a position to make decisions. Responsible use of modern contraception requires adequate health infrastructure, personnel, and gender sensitivity. The new emphasis on reproductive health must address the issues of unsafe abortion, reproductive tract infections, women's domestic burden, violence, and mental health.

  14. Womens Business Center

    Data.gov (United States)

    Small Business Administration — Women's Business Centers (WBCs) represent a national network of nearly 100 educational centers throughout the United States and its territories, which are designed...

  15. Health screening - women - over age 65

    Science.gov (United States)

    Health maintenance visit - women - over age 65; Physical exam - women - over age 65; Yearly exam - women - over age 65; Checkup - women - over age 65; Women's health - over age 65; Preventive care exam - women - over ...

  16. Women's lives, mothers' health.

    Science.gov (United States)

    Chauliac, M; Masse-raimbault, A M

    1985-01-01

    This document dealing with women's lives and the health of mothers identifies factors conditioning the health and nutritional status of women and girls (life expectancy at birth, maternal mortality rate, and the birthrate); considers nutritional requirements of pregnant and lactating women, weight gain during preganncy, mothers' age and number of children and interbirth interval, maternal nutritional status and breastfeeding, anemia, work and women's health, pregnancy in adolescents, abortion, the growth of small girls and its effect on future pregnancies, and sexual mutilations; and reports on actions aimed at improving the health of women as well as health problems facing rural women. The 3 key concepts of this reflection on women's lives are: women's health should be taken into account as well as children's health; the development of the whole human being should be respected, implying ongoing surveillance of the health status of women and of their children; and the overall living conditions of women within the family and society must be analyzed at the different phases of their life, so as to encourage integrated actions rather than various uncoordinated efforts. Women's health status, like the health status of everyone, depends on a multitude of socioeconomic and sanitational factors. A figure illustrates several of the many interrelations between the various factors which influence the nutritional status of all individuals. Women of childbearing age are at greater risk than other population groups, due to their reproductive function and their ability to nurse children: pregnancy, like lactation, generates metabolic changes and increases nutritional needs. Delivery itself presents a series of risks for the woman's health, and only regular surveillance of pregnancy may prevent many of these. A woman's health status and, most of all her nutritional status during pregnancy and delivery, condition her future health and ability to assume her many tasks as well as

  17. Professional Women and Marriage.

    Science.gov (United States)

    Allen, Suzanne M.; Kalish, Richard A.

    1984-01-01

    Explored the phenomenon of late marriage in 41 highly educated professional women. Compared with normative marriers, the late-marrying women had higher career goals, a more egalitarian role structure in marriage, and were more accepting of premarital sex and cohabitation. Factors associated with family backgrounds were identified. (JAC)

  18. Shattering women's glass ceiling

    OpenAIRE

    Camilleri Podesta, Marie Therese; Duca, Edward

    2013-01-01

    The role of women in academia has always greatly interested me. Several years ago, when I was asked to become Gender Issues Committee chairperson at the University of Malta, I readily accepted. http://www.um.edu.mt/think/shattering-womens-glass-ceiling/

  19. African Women Writing Resistance

    Institute of Scientific and Technical Information of China (English)

    Jennifer Browdy de Hernandez; Pauline Dongala; Omotayo; Jolaosho; Anne Serafin

    2011-01-01

    AFRICAN Women Writing Resistance is the first transnational anthology to focus on women's strategies of resistance to the challenges they face in Africa today.The anthology brings together personal narratives,testimony,interviews,short stories,poetry,performance scripts,folktales and lyrics.

  20. Women and Computer Science.

    Science.gov (United States)

    Breene, L. Anne

    1992-01-01

    Discusses issues concerning women in computer science education, and in the workplace, and sex bias in the computer science curriculum. Concludes that computing environment has not improved for women over last 20 years. Warns that, although number of white males entering college is declining, need for scientists and engineers is not. (NB)

  1. An Intergenerational Women's Group.

    Science.gov (United States)

    Fogler, Janet

    1989-01-01

    Discusses the Intergenerational Women's Group, formed to provide social support and an interchange of ideas between women of different generations. Provides a model for such a program that may be offered in geriatric medical clinics. Discusses the impact of intergenerational support for both the old and the young. (Author/BHK)

  2. Women Lead the Way

    Science.gov (United States)

    Weinstein, Margery

    2010-01-01

    Female corporate leaders are becoming more common, but that does not mean it was a snap for them to get there. Much has been said about the hard road faced by women who seek top spots in corporate America. Many point out, for instance, that women executives still often are paid less than their male counterparts, and that they face stereotypes,…

  3. Iowa Women of Achievement.

    Science.gov (United States)

    Ohrn, Deborah Gore, Ed.

    1993-01-01

    This issue of the Goldfinch highlights some of Iowa's 20th century women of achievement. These women have devoted their lives to working for human rights, education, equality, and individual rights. They come from the worlds of politics, art, music, education, sports, business, entertainment, and social work. They represent Native Americans,…

  4. Vietnamese women love physics

    Science.gov (United States)

    Anh, Kim Tran; Vu, Thi Bich; Nguyen, Ngoc Toan; Do, Tran Cat; Vo, Thach Son

    2013-03-01

    More and more females are studying physics and applying their physics knowledge in Vietnam. Women are well represented in physics in Vietnam, occupy high positions in the field, and win many national and international science awards. Overwhelmingly, women in physics in Vietnam have happy families with children who love physics.

  5. Entrepreneurs: Women and Minorities.

    Science.gov (United States)

    Akers, Lilialyce

    A program was designed to meet the needs of Kentucky women who wished to supplement their incomes by producing articles in their homes for sale. Its three-phase objective was to identify women who already had knitting skills and train them to produce a finished product; to provide basic knowledge about how to run a small business; and to provide…

  6. Oral Health and Women

    Centers for Disease Control (CDC) Podcasts

    2009-05-12

    This women's health podcast focuses on the importance of maintaining good oral health during pregnancy.  Created: 5/12/2009 by Office of Women’s Health (OWH) and National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 5/12/2009.

  7. American Women and Sport.

    Science.gov (United States)

    Curry, Jane; Bingham, Marjorie

    1992-01-01

    Presents a lesson plan dealing with women and sport in U.S. history. Discusses the themes of physical capabilities, propriety, and femininity. Describes exercises and projects that can be used to integrate the lesson into different subjects. Includes a reading list, modified rules for women's basketball, and portions of the social debate on women…

  8. Women and Advertising

    Institute of Scientific and Technical Information of China (English)

    1997-01-01

    The Platform for Action adopted at the United Nations Fourth World Conference On Women acknowledges the media’s role in eliminating sexual discrimination and promoting women’s development.It lists women and media as one of the ten fields that require strategic targeting and action.

  9. Women of Niger Delta

    African Journals Online (AJOL)

    Religion Dept

    oil multinational companies to enthrone justice, peace and development in the region. ... political autonomy of their land. Together with ... In situations of war, between ethnic group women are called ... children, and also taking care of their feeding health and training. .... “Women and Conflict Resolution: Feminism, Peace-.

  10. Women and Heart Disease

    Institute of Scientific and Technical Information of China (English)

    邹国如

    2005-01-01

    Heart disease is the leading killer of Americans. But it kills more women than men. The American Heart Association says heart disease and other cardiovascular (心血管的) disorders kill about five hundred thousand women a year. That is more than the next seven causes of death combined.

  11. Androgenetic alopecia in women.

    Science.gov (United States)

    Price, Vera H

    2003-06-01

    Androgenetic alopecia (AGA), also known in women as female pattern hair loss, is caused by androgens in genetically susceptible women and men. The thinning begins between ages 12 and 40 years, the inheritance pattern is polygenic, and the incidence is the same as in men. In susceptible hair follicles, dihydrotestosterone binds to the androgen receptor, and the hormone-receptor complex activates the genes responsible for the gradual transformation of large terminal follicles to miniaturized follicles. Both young women and young men with AGA have higher levels of 5alpha reductase and androgen receptor in frontal hair follicles compared to occipital follicles. At the same time, young women have much higher levels of cytochrome p-450 aromatase in frontal follicles than men who have minimal aromatase, and women have even higher aromatase levels in occipital follicles. The diagnosis of AGA in women is supported by early age of onset, the pattern of increased thinning over the frontal/parietal scalp with greater density over the occipital scalp, retention of the frontal hairline, and the presence of miniaturized hairs. Most women with AGA have normal menses and pregnancies. Extensive hormonal testing is usually not needed unless symptoms and signs of androgen excess are present such as hirsutism, severe unresponsive cystic acne, virilization, or galactorrhea. Topical minoxidil solution is the only drug available for promoting hair growth in women with AGA. Efficacy has been shown in double-blind studies using hair counts and hair weight.

  12. Chinese Women in Politics

    Institute of Scientific and Technical Information of China (English)

    1997-01-01

    According to international research only when the percentage of women with decision-making power reaches 30 percent can their effect on policy making be seen. In 1994, women accounted for an average of 5.7 percent of state cabinet seats throughout the world. Authoritative thinking is that in the past decade almost no progress was made in realizing the 30

  13. Women and Law

    Institute of Scientific and Technical Information of China (English)

    1997-01-01

    WOMEN’S rights concern the world over. Even though China has a different legal tradition and social system, participants from the Beijing Sino-British Women and Law Symposium discovered that both Chinese and foreign scholars could reach agreement and understanding on many issues. Enacting Laws for Women Professor Yang Dawen, from the

  14. Women's Rights Network (WRN).

    Science.gov (United States)

    Slote, K; Cuthbert, C

    1997-02-01

    The Massachusetts-based Women's Rights Network (WRN) was founded in 1995 in response to the need to develop collaborative, crosscultural, and international strategies to eliminate domestic violence. The WRN initiated meetings with local advocates to identify the most pressing issues facing the US battered women's movement and then began to contact advocates for battered women throughout the world. To date, the WRN offers a resource center documenting strategies used around the world to end domestic violence, gives workshops and presentations to increase public education and awareness about domestic violence, organizes international strategy sessions between women's advocates in Massachusetts and those in other countries, facilitates one-on-one partnerships between groups for battered women in Massachusetts and sister organizations in other countries, and participates in the annual "16 Days of Activism Against Gender Violence." The WRN also plans to publish a biannual journal.

  15. Iranian Women in Physics

    Science.gov (United States)

    Izadi, Dina; Seiedfadaei, Azita

    2009-04-01

    Women in the world have made great contributions to science. In Iran more than 60% of undergraduate university students are women, most in physics. Women's representation in postgraduate studies is lower; however, these numbers do not account for those who go to other countries to continue their studies, of which there are many. Alinoush Tarian, the oldest woman professor in Iran, the first Iranian woman professor of physics, and the founder of the first solar telescopic observatory in Iran, is one of them. There are some women physicists in Iran that are working as professors at the universities and famous institutes such as the Institute for Studies in Theoretical Physics and Mathematics. Iranians have always showed their talents and intelligence everywhere in the world, and nowadays, some of the women physics teachers in Iran are trying to teach physics with new methods to attract more students.

  16. Injuries in women's basketball.

    Science.gov (United States)

    Trojian, Thomas H; Ragle, Rosemary B

    2008-03-01

    Women's basketball has changed over time. It is a faster paced game than it was 30 years ago. Greatplayers, like Anne Meyers,who was the first, and only, woman to be signed to an NBA contract, would agree today's game is different. The game is played mostly "below the rim" but with players like Candice Parker, Sylvia Fowles and Maya Moore able to dunk the ball, the game is still changing. The one thing that remains constant in basketball, especially women's basketball, is injury. The majority of injuries in women's basketball are similar to those in men's basketball. Studies at the high school and college level show similar injury rates between women and men. ACL injuries are one exception, with female athletes having atwo to four times higher rate ofACL injuries. In this article, we review the common injuries in women's basketball. We discuss treatment issues and possible preventive measures.

  17. Venous thromboembolism in women

    DEFF Research Database (Denmark)

    Group, ESHRE Capri Workshop; Skouby, Sven Olaf

    2013-01-01

    BACKGROUND Venous thromboembolism (VTE) is a specific reproductive health risk for women. METHODS Searches were performed in Medline and other databases. The selection criteria were high-quality studies and studies relevant to clinical reproductive medicine. Summaries were presented and discussed...... is associated with an inherited thrombophilia in men and women. Changes in the coagulation system and in the risk of clinical VTE in women also occur during pregnancy, with the use of reproductive hormones and as a consequence of ovarian stimulation when hyperstimulation syndrome and conception occur together...... therapy (HRT) increases the VTE risk 2- to 4-fold. There is a synergistic effect between thrombophilia and the various reproductive risks. Prevention of VTE during pregnancy should be offered to women with specific risk factors. In women who are at high risk, CHC and HRT should be avoided. CONCLUSIONS...

  18. Vietnamese women at solidarity meeting of world women in Cuba.

    Science.gov (United States)

    1998-01-01

    This article summarizes experiences of a Vietnamese delegation at a solidarity meeting of world women during April 13-16, 1998, in Cuba. The President of the Viet Nam Women's Union headed the delegation. The advisor was the vice-chairperson of the Vietnamese National Assembly. The delegation participated in 6 forums: women and sustainable economic development; women, health, education, and social security; women, communication and the mass media; women in politics and decision-making; women, violence and discrimination; and national independence, sovereignty, peace, and women. The delegation also participated in sessions on women's issues; implementation issues; women parliamentarians; and migrant and displaced women. The delegation met with delegates from other countries and participated in a world meeting and an Asian-Pacific meeting to support Cuban women. The entire delegation presented a stage show of songs, which was well received by the 3000 participants. The delegation met with Cuban delegates to discuss the formation of women's groups and to build better relations between the women of both countries. The delegation visited a training center of women cadres and the center for gender education. Participants adopted the Havana Declaration, which states the intention of world women to eradicate poverty and war and to promote peace, progress, and happiness in all countries. The Havana Declaration condemned the US embargo against Cuba. Fidel Castro spoke and expressed gratitude for the strong support from world women, especially Vietnamese women.

  19. Do women lack ambition?

    Science.gov (United States)

    Fels, Anna

    2004-04-01

    For men, ambition is considered a necessary and desirable part of life. Most women, however, associate ambition with egotism, self-aggrandizement, or manipulation. Getting to the bottom of why this is so required study of what ambition consists of--for both sexes. In childhood, the research uncovered, girls are clear about their ambitions. Their goals are grand, and they make no apologies for them. In nearly all childhood ambitions, two distinct factors are in place: the mastery of a special skill, and recognition for it. And what's true in childhood is no less true in later life: We all want our efforts and accomplishments acknowledged. Yet there are dramatic differences in how women and men create, reconfigure, and realize (or abandon) their goals. Most women are demure when praised for their achievements. One could chalk up this behavior to women's innate modesty or see it as a passive way of highlighting their accomplishments. But the fear of recognition that many women express suggests otherwise. Research has shown that such behavior varies according to social context: Women more openly seek and compete for affirmation when they are with other women, but they behave differently when competing with men. The underlying problem has to do with cultural ideals of femininity. Women face the reality that to appear feminine, they must provide or relinquish scarce resources to others--and recognition is indeed a scarce resource. Although women have more opportunities than ever before, they still come under social scrutiny that makes hard choices--such as when and whether to start a family or advance in the workplace--even harder. There are no easy solutions, but there are ways women can hold fast to their dreams. They must band together, learn to blow their own horns, and structure their lives in a way that promotes recognition.

  20. HIV in women

    Directory of Open Access Journals (Sweden)

    Mulcahy F

    2012-11-01

    Full Text Available Globally over 50% of HIV-infected individuals are women. With the widespread use of HAART, we can expect women to have mortality rates approaching normal. Indeed, studies have shown that women may expect a slower disease progression than men following seroconversion; furthermore, it appears that female who injects drugs can live longer than their male counterparts. However, other studies from cohort analysis have reported worse outcomes in women. In essence, many studies are consistently underpowered to adequately address these questions. The proportion of women in clinical trials remains at 20 to 30%, with pregnancy potential being a major exclusion factor. Hence, many questions remain unanswered. Recent data suggest women are more likely to present late with a new AIDS diagnosis. Why this should be the case is not well understood. In addition, HIV-positive women should have the same access to reproduction health as their negative counterparts, but unfortunately many inequalities remain. Advise on contraception and fertility services are very variable across both the developed and developing world. Data are limited on the most appropriate use of contraceptives in the presence of HAART, the possible drug interactions and possible increased risk of HIV transmission. There remain significant differences in guidelines regarding prevention of mother-to-child transmission (MTCT across Europe, and implications of stopping and starting HAART for MTCT have not been adequately addressed. The mode of timing of delivery, and the effect of length of time of ruptured membranes on this decision is also contentious. Further issues relate to the desire for HIV-positive women to breastfeed in the setting of HIV viral suppression, where some guidelines now support women in this situation and others categorically would inform child protection authorities. Finally as women age it is more difficult to separate the effect of the menopause and its symptoms from the

  1. Financial Literacy Education for Women

    Science.gov (United States)

    Jarecke, Jodi; Taylor, Edward W.; Hira, Tahira K.

    2014-01-01

    Exploring the pedagogical approaches of four women's financial literacy education programs, this chapter provides an overview of trends and needs in financial education for women and offers pedagogical strategies for teaching women about finance.

  2. Women and Girls (With ADHD)

    Science.gov (United States)

    ... and Girls ADHD Medication and Pregnancy Women and Girls Knowledge of ADHD in women at this time ... Impact of ADHD in women ADHD in young girls is often overlooked, the reasons for which remain ...

  3. Alcohol: A Women's Health Issue

    Science.gov (United States)

    ... to drink than their peers. Staying Away From Alcohol. Young women under age 21 should not drink alcohol. ... talk frankly with their daughters about not drinking alcohol. Women in Young and Middle Adulthood Young women in their twenties ...

  4. Financial Literacy Education for Women

    Science.gov (United States)

    Jarecke, Jodi; Taylor, Edward W.; Hira, Tahira K.

    2014-01-01

    Exploring the pedagogical approaches of four women's financial literacy education programs, this chapter provides an overview of trends and needs in financial education for women and offers pedagogical strategies for teaching women about finance.

  5. Women's Status on the Rise

    Institute of Scientific and Technical Information of China (English)

    LIU YUNYUN

    2010-01-01

    @@ On the afternoon of March 8,Beijing's department stores and shopping malls were crowded with women on shopping sprees to celebrate International Women's Day.This year marks the 100th anniversary of the establishment of International Women's Day.

  6. Women and Diabetes -- Diabetes Medicines

    Science.gov (United States)

    ... Audience For Women Women's Health Topics Women and Diabetes - Diabetes Medicines Share Tweet Linkedin Pin it More sharing ... 1-800-332-1088 to request a form. Diabetes Medicines The different kinds of diabetes medicines are ...

  7. Management of opioid-dependent patients: comparison of the cost associated with use of buprenorphine/naloxone or methadone, and their interactions with concomitant treatments for infectious or psychiatric comorbidities.

    Science.gov (United States)

    Roncero, Carlos; Domínguez-Hernández, Raquel; Díaz, Tomás; Fernández, José Manuel; Forcada, Rafael; Martínez, José Manuel; Seijo, Pedro; Terán, Antonio; Oyagüez, Itziar

    2015-09-15

    The objective was to estimate the annual interaction management cost of agonist opioid treatment (AOT) for opioid-dependent (OD) patients with buprenorphine-naloxone (Suboxone®) (B/N) or methadone associated with concomitant treatments for infectious (HIV) or psychiatric comorbidities. A costs analysis model was developed to calculate the associated cost of AOT and interaction management. The AOT cost included pharmaceutical costs, drug preparation, distribution and dispensing, based on intake regimen (healthcare center or take-home) and type and frequency of dispensing (healthcare center or pharmacy), and medical visits. The cost of methadone also included single-dose bottles, monthly costs of custody at pharmacy, urine toxicology drug screenings and nursing visits. Potential interactions between AOT and concomitant treatments (antivirals, antibacterials/antifungals, antipsychotics, anxiolytics, antidepressant and anticonvulsants), were identified to determine the additional use of healthcare resources for each interaction management. The annual cost per patient of AOT was €1,525.97 for B/N and €1,467.29 for methadone. The average annual cost per patient of interaction management was €257.07 (infectious comorbidities), €114.03 (psychiatric comorbidities) and €185.55 (double comorbidity) with methadone and €7.90 with B/N in psychiatric comorbidities. Total annual costs of B/N were €1,525.97, €1,533.87 and €1,533.87 compared to €1,724.35, €1,581.32 and €1,652.84 for methadone per patient with infectious, psychiatric or double comorbidity respectively.Compared to methadone, the total cost per patient with OD was lower with B/N (€47.45-€198.38 per year). This is due to the differences in interaction management costs associated with the concomitant treatment of infectious and/or psychiatric comorbidities.

  8. Efeitos cardiovasculares e neuroendócrinos do butorfanol e da buprenorfina em cães anestesiados pelo desfluorano Cardiovascular and neuroendocrine effects of butorphanol and buprenorphine in dogs anesthetized with desflurane

    Directory of Open Access Journals (Sweden)

    A.P. Souza

    2007-04-01

    Full Text Available Avaliaram-se os efeitos do butorfanol e da buprenorfina sobre variáveis cardiovasculares e neuroendócrinas em cães anestesiados com desfluorano, utilizando-se 30 cães adultos, machos e fêmeas, distribuídos em três grupos denominados grupo butorfanol (GBT, grupo buprenorfina (GBP e grupo-controle (GCO. A anestesia foi induzida com propofol (8mg/kgIV e nos animais intubados administrou-se desfluorano (1,5CAM. Após 30 minutos, nos cães do GBT, aplicou-se butorfanol (0,4mg/kgIM; nos do GBP, buprenorfina (0,02mg/kgIM; e nos do GCO, solução de NaCl a 0,9% (0,05ml/kgIM. Avaliaram-se: freqüência cardíaca; pressões arteriais sistólica, diastólica e média; débito cardíaco; pressão venosa central; cortisol; hormônio adrenocorticotrópico; noradrenalina; e glicose. As colheitas dos dados foram feitas aos 30 minutos após o início da administração do desfluorano (M0, 15 minutos após a administração do opióide ou placebo (M15, e a cada 15 minutos após M15 (M30, M45, M60 e M75. Para a avaliação neuroendócrina utilizaram-se os momentos M-30 (antes da administração dos fármacos, M0, M15 e M45. Na freqüência cardíaca houve diferença entre M0 e M15 (129 e 111bat/min em GBT, e entre M0 e M30 (131 e 112bat/min em GBP. Na pressão arterial média, a diferença foi entre M0 (86mmHg e todos os momentos que se seguiram (todos os valores foram menores que 72mmHg, em GBT. A pressão arterial diastólica foi menor em todos os momentos (The effects of butorphanol and buprenorphine on cardiovascular and neuroendocrine variables in dogs anesthetized with desflurane were studied. Thirty adult healthy, males and females, mongrel dogs were distributed in three groups denominated butorphanol group (BTG, buprenorphine group (BPG and control group (COG. The anesthetic induction was done using propofol (8mg/kg, IV, and immediately, the dogs were intubated and submited to desflurane anaesthesia (1.5 MAC. After 30 minutes, the BTG animals

  9. WOMEN IN FAMILY BUSINESS

    Directory of Open Access Journals (Sweden)

    Mr Anshu

    2012-04-01

    Full Text Available The role of women in family businesses is explored in the paper. Although recognized as generally very important players, the role of women is often defined as invisible in business decision-making, supportive in men’s traditional business domains and only rarelyadequately recognized and rewarded. The paper explores possible differences in the views of men and women who manage small family firms. Their attitudes opposing the traditional business roles ofwomen, different views on managerial, ownership and transition issues and possible gender discrimination are examined. The findings support the paradigm of a different, more feminine style of management, while signs of discrimination are not clearly revealed. This paper is based on a research intended to provide acomparative analysis of the status of women entrepreneurs and men entrepreneurs in Family Business in India. It first draws demographic & psychographic profiles of women and men entrepreneurs in family business, identifies & addresses operational problems faced by women and men entrepreneurs in family business, draws theirinclination for future plans for growth and expansion and also for the furtherance of research on women entrepreneurs in India.

  10. HIV, poverty and women.

    Science.gov (United States)

    Rodrigo, Chaturaka; Rajapakse, Senaka

    2010-03-01

    This review examines the interactions of financial status and HIV and its implications for women. MEDLINE and Google scholar were searched using the keywords 'women', 'poverty' and 'HIV' in any field of the article. The search was limited to articles published in English over the last 10 years. The first section of the article tries to establish whether poverty or wealth is a risk factor for HIV. There is credible evidence for both arguments. While wealth shows an increased risk for both sexes, poverty places women at a special disadvantage. The second section explains how the financial status interacts with other 'non biological' factors to put women at increased risk. While discrimination based on these factors disadvantage women, there are some paradoxical observations that do not fit with the traditional line of explanation (e.g. paradoxical impact of wealth and education on HIV). The final section assesses the impact of HIV in driving poverty and the role of women in interventional programmes. The specific impact of poverty on females in families living with HIV is less explored. Though microfinance initiatives to empower women are a good idea in theory, the actual outcome of such a programme is less convincing.

  11. SEXUAL ASSAULT ON WOMEN

    Directory of Open Access Journals (Sweden)

    Dara Durga

    2014-05-01

    Full Text Available Our India is a vast nation with rich cultural heritage and social diversity. We have been respecting women in the highest form as Goddesses since ages. There have been several laws to protect women from many centuries in this ancient country. Yet our country is still facing difficulties in achieving women safety. And the situation is no different in the rest of the world. The prevailing situation, laws and suggestions to prevent atrocities were discussed. AIM: The current situations of women hardships around the world were mentioned. The current legal situation and recent legal changes were described. The mammoth task ahead of us to achieve the desired social objective of women safety and respect were discussed. MATERIAL & METHODS: various news articles, police journals, legal textbooks and forensic medicine text books. CONCLUSION: Many things were done to prevent sexual assaults on women, yet the true goal is still a mirage. It’s time to look into the issue from its true grass root levels, i.e., from the psycho-social view apart from legal measures, to achieve the much desired objective of prevention of sexual assaults on women.

  12. Long term Suboxone™ emotional reactivity as measured by automatic detection in speech.

    Science.gov (United States)

    Hill, Edward; Han, David; Dumouchel, Pierre; Dehak, Najim; Quatieri, Thomas; Moehs, Charles; Oscar-Berman, Marlene; Giordano, John; Simpatico, Thomas; Barh, Debmalya; Blum, Kenneth

    2013-01-01

    Addictions to illicit drugs are among the nation's most critical public health and societal problems. The current opioid prescription epidemic and the need for buprenorphine/naloxone (Suboxone®; SUBX) as an opioid maintenance substance, and its growing street diversion provided impetus to determine affective states ("true ground emotionality") in long-term SUBX patients. Toward the goal of effective monitoring, we utilized emotion-detection in speech as a measure of "true" emotionality in 36 SUBX patients compared to 44 individuals from the general population (GP) and 33 members of Alcoholics Anonymous (AA). Other less objective studies have investigated emotional reactivity of heroin, methadone and opioid abstinent patients. These studies indicate that current opioid users have abnormal emotional experience, characterized by heightened response to unpleasant stimuli and blunted response to pleasant stimuli. However, this is the first study to our knowledge to evaluate "true ground" emotionality in long-term buprenorphine/naloxone combination (Suboxone™). We found in long-term SUBX patients a significantly flat affect (p<0.01), and they had less self-awareness of being happy, sad, and anxious compared to both the GP and AA groups. We caution definitive interpretation of these seemingly important results until we compare the emotional reactivity of an opioid abstinent control using automatic detection in speech. These findings encourage continued research strategies in SUBX patients to target the specific brain regions responsible for relapse prevention of opioid addiction.

  13. Long term Suboxone™ emotional reactivity as measured by automatic detection in speech.

    Directory of Open Access Journals (Sweden)

    Edward Hill

    Full Text Available Addictions to illicit drugs are among the nation's most critical public health and societal problems. The current opioid prescription epidemic and the need for buprenorphine/naloxone (Suboxone®; SUBX as an opioid maintenance substance, and its growing street diversion provided impetus to determine affective states ("true ground emotionality" in long-term SUBX patients. Toward the goal of effective monitoring, we utilized emotion-detection in speech as a measure of "true" emotionality in 36 SUBX patients compared to 44 individuals from the general population (GP and 33 members of Alcoholics Anonymous (AA. Other less objective studies have investigated emotional reactivity of heroin, methadone and opioid abstinent patients. These studies indicate that current opioid users have abnormal emotional experience, characterized by heightened response to unpleasant stimuli and blunted response to pleasant stimuli. However, this is the first study to our knowledge to evaluate "true ground" emotionality in long-term buprenorphine/naloxone combination (Suboxone™. We found in long-term SUBX patients a significantly flat affect (p<0.01, and they had less self-awareness of being happy, sad, and anxious compared to both the GP and AA groups. We caution definitive interpretation of these seemingly important results until we compare the emotional reactivity of an opioid abstinent control using automatic detection in speech. These findings encourage continued research strategies in SUBX patients to target the specific brain regions responsible for relapse prevention of opioid addiction.

  14. Ten Outstanding Women Chosen

    Institute of Scientific and Technical Information of China (English)

    1995-01-01

    BEFORE the celebration of the 85th anniversary of International Women’s Day, the All-China Women’s Federation sponsored an activity to choose ten outstanding Chinese women, which involved the Ministries of Labor and Personnel, the General Political Department of the People’s Liberation Army, the All-China Federation of Trade Union, the Youth League of China, the China Association of Science and about a dozen Chinese news agencies. The results were recently announced, and including following women: Yue Xicui, one of the third generation of women aviators. Since she joined the air force she has accumulated 5,180 hours

  15. Women in extreme poverty.

    Science.gov (United States)

    1994-01-01

    Population is estimated to increase from 5.5 billion in 1990 to 10 billion by 2050; the poverty level is expected to increase from 1 billion to 2-3 billion people. Women in development has been promoted throughout the UN and development system, but women in poverty who perform work in the informal sector are still uncounted, and solutions are elusive. The issue of extreme poverty can not be approached as just another natural disaster with immediate emergency relief. Many people live in precarious economic circumstances throughout their lives. Recent research reveals a greater understanding of the underlying causes and the need for inclusion of poor women in sustainable development. Sanitation, water, housing, health facilities need to be improved. Women must have access to education, opportunities for trading, and loans on reasonable terms. UNESCO makes available a book on survival strategies for poor women in the informal sector. The profile shows common problems of illiteracy, broken marriages, and full time involvement in provision of subsistence level existence. Existence is a fragile balance. Jeanne Vickers' "Women and the World" offers simple, low cost interventions for aiding extremely poor women. The 1992 Commission on the Status of Women was held in Vienna. Excerpts from several speeches are provided. The emphasis is on some global responses and an analysis of solutions. The recommendation is for attention to the gender dimension of poverty. Women's dual role contributes to greater disadvantages. Women are affected differently by macroeconomic factors, and that there is intergenerational transfer of poverty. Social services should be viewed as investments and directed to easing the burdens on time and energy. Public programs must be equipped to deal with poverty and to bring about social and economic change. Programs must be aware of the different distribution of resources within households. Women must be recognized as principal economic providers within

  16. Smoking and women's health.

    Science.gov (United States)

    Seltzer, V

    2000-07-01

    Each year more than 600000 women have deaths associated with cigarette smoking. In addition, cigarette smoking is associated with a wide array of morbidities (such as osteoporosis, cardiovascular disease, and adverse pregnancy outcomes). Two hundred million women smoke worldwide, and this number appears to be rising, particularly in developing countries. Obstetrician-gynecologists can play a role in reducing morbidity and mortality from cigarette smoking by educating women about the dangers, advising them not to smoke, and assisting those who do smoke to quit.

  17. Hereditary angioedema in women

    Directory of Open Access Journals (Sweden)

    Bouillet Laurence

    2010-07-01

    Full Text Available Abstract Women with hereditary angioedema (HAE are more likely to be symptomatic that men. Hormonal factors (puberty, contraception, pregnancy,.... play a significant role in the precipitation or worsening of the condition in women. So, combined contraceptive pills are not indicated and progestogen pill must be preferred. During pregnancy, attack rate can increase (38-48% of women. C1Inhibitor concentrate and tranexamic acid can be used during pregnancy. Attenuated androgens for long term prophylaxis are effective but side effects appear more often in female patients. These side effects are dose dependant and can be attenuated by titrating the dose down the lowest effective level.

  18. Migraine in women.

    Science.gov (United States)

    Lay, Christine L; Broner, Susan W

    2009-05-01

    Of the nearly 32 million Americans with migraine, 24 million are women. It is a disorder affecting women throughout their lifetimes, from childhood and puberty through the postmenopausal years. In childhood, before puberty girls are afflicted with migraine at approximately the same rate as boys, but after puberty, there is an emerging female predominance. Estrogen plays a key role in this epidemiologic variation but is not the only factor. There are numerous times when hormonal influences have an impact on migraine and its pattern, including menarche, oral contraceptive use, pregnancy, perimenopause, and menopause. Hence practitioners treating women with migraine need to have a clear understanding of these special considerations.

  19. It's MORe exciting than mu: crosstalk between mu opioid receptors and glutamatergic transmission in the mesolimbic dopamine system.

    Science.gov (United States)

    Chartoff, Elena H; Connery, Hilary S

    2014-01-01

    Opioids selective for the G protein-coupled mu opioid receptor (MOR) produce potent analgesia and euphoria. Heroin, a synthetic opioid, is considered one of the most addictive substances, and the recent exponential rise in opioid addiction and overdose deaths has made treatment development a national public health priority. Existing medications (methadone, buprenorphine, and naltrexone), when combined with psychosocial therapies, have proven efficacy in reducing aspects of opioid addiction. Unfortunately, these medications have critical limitations including those associated with opioid agonist therapies (e.g., sustained physiological dependence and opioid withdrawal leading to high relapse rates upon discontinuation), non-adherence to daily dosing, and non-renewal of monthly injection with extended-release naltrexone. Furthermore, current medications fail to ameliorate key aspects of addiction such as powerful conditioned associations that trigger relapse (e.g., cues, stress, the drug itself). Thus, there is a need for developing novel treatments that target neural processes corrupted with chronic opioid use. This requires a basic understanding of molecular and cellular mechanisms underlying effects of opioids on synaptic transmission and plasticity within reward-related neural circuits. The focus of this review is to discuss how crosstalk between MOR-associated G protein signaling and glutamatergic neurotransmission leads to immediate and long-term effects on emotional states (e.g., euphoria, depression) and motivated behavior (e.g., drug-seeking, relapse). Our goal is to integrate findings on how opioids modulate synaptic release of glutamate and postsynaptic transmission via α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid and N-methyl-D-aspartate receptors in the nucleus accumbens and ventral tegmental area with the clinical (neurobehavioral) progression of opioid dependence, as well as to identify gaps in knowledge that can be addressed in future studies.

  20. 丁丙诺啡透皮贴剂在释放度测定中桨碟法与转筒法的差异%Difference between methods of cylinder and paddle over disk used in the release test of buprenorphine transdermal patches

    Institute of Scientific and Technical Information of China (English)

    陈华; 毛睿; 李永庆; 南楠

    2011-01-01

    Objective : To compare the difference between the methods of cylinder and paddle over disk used in the release test of transdermal drug deliver system. Method:The cylinder and paddle over disk method were used respectively to test buprenorphine transdermal patches with the release media of 900 mL of 0. 9% sodium chloride solution. Agilent column which packed TC - C18 as solid phase (250 mm ×4. 6 mm,5 μm) and the mixture of acetonitrile and 0. 05 mol · L-1 potassium dihydrogen phosphate solution( 1: 1. 3) as mobile phase were adoptd. The flow rate was 1.0 mL · min-1. The column temperature was kept at 30 ℃ and the detective wave length was 220 nm.Result : The linear correlation of buprenorphine was observed from the concentrations of 0. 4 - 24 μg · mL-1 ( r =0. 9999) . The recovery of buprenorphine was 102. 1% . There were not difference between the methods of cylinder and paddle over disk used in the release test of transdermal drug deliver system in testing 20 mg of buprenorphine transdermal patches , while there existed difference in testing 5 mg and 10 mg of buprenorphine transdermal patches.Conclusion : There will be error when testing large area patch with paddle over disk method.%目的:对透皮贴剂释放度测定中转筒法装置与中国药典桨碟法装置进行比较.方法:分别使用转筒法装置与中国药典桨碟法装置对丁丙诺啡透皮贴剂的释放曲线进行测定,释放介质为0.9%的氯化钠溶液900 mL;以TC-C18为固定相的Agilent色谱柱(250mmx4.6 mm,5μm),0.05 mol·L-1的磷酸二氢钾溶液与乙腈的混合溶液(1.3:1)为流动相,流速为1.0 mL·min-1,柱温为30℃,检测波长为220 nm.结果:丁丙诺啡在0.4~24μg·mL-1范围内线性关系良好(r=0.9999),回收率为102.1%.对于20 mg规格的透皮贴剂采用不同方法所得的丁丙诺啡释放曲线不存在差异,而对于5 mg规格和10 mg规格则存在差异.结论:中国药典桨碟法装置在测量透皮贴剂的释放度时不

  1. 脱毒后阿片类依赖者人格特征及人格障碍倾向%Personality characteristics and personality disorders inclinations of opioid addicts after detoxification

    Institute of Scientific and Technical Information of China (English)

    王赞利; 高成阁; 姚东刚; 纪术茂; 马军平

    2004-01-01

    目的:探讨脱毒后阿片类依赖者人格维度、特质层面的特点以及人格障碍的类型特征.方法:采用大五人格个性调查表(NEO-PI-R)及人格诊断问卷(PDQ+4)对52例(最后纳入分析为45例)首次住院,符合中国精神疾病分类与诊断标准第二版修订版中关于阿片类依赖的诊断标准,且阿片类戒断2周以上的阿片类依赖者的人格特征和人格障碍倾向进行评定,并与正常人(n=45)进行比较.结果:脱毒后阿片类依赖者在NEO-PI-R上呈现高神经质(103.18±21.43)和低严谨性分(115.09±14.27),与正常人比较,差异有显著性意义(F=9.931,0.126;P=0.002,0.051);在焦虑(16.47±4.93)、抑郁(19.22±5.34)、冲动性(16.49±4.25)、脆弱性(17.77±5.19)、自我肯定性(12.31±4.70)、兴奋追寻(19.69±5.75)、行动(12.91±3.00)、观念(16.31±6.39)、自律性(19.49±4.34)特质层面与正常人比较,差异有显著性意义(F=2.121~19.818,P=0.000~0.082);在PDQ+4的边缘型(4.71±1.95)、反社会型(3.20±1.69)、回避型(5.18±1.97)、被动攻击型(5.18±1.97)、抑郁型(3.76±1.81)、分裂性(3.22±1.88)人格障碍类型方面与正常人比较,差异有显著性意义(F=5.014~32.580;P=0.000~0.028);人格障碍阳性率较高的为反社会型(60%)、边缘型(53%)、回避型(47%).结论:脱毒后阿片类依赖者和正常人的特质人格模型及特质水平存在差异,反社会型及边缘型人格障碍较多见.

  2. The Right for Women--After Professions for women

    Institute of Scientific and Technical Information of China (English)

    郑文莉

    2000-01-01

    Woolfwas a flag of right fighter for women. Women fight for their rights genaration after genaration and devote themselves in different professions like men. It was proved that women can do every thing as they are willing ,women can creat many outstanding achievements in their professional life.

  3. Infertility and Women

    Science.gov (United States)

    ... with production or quality of sperm. What causes female infertility? About 25 percent of women with infertility have ... 40 percent of infertility cases are due to female infertility, but just as many cases are due to ...

  4. Women Astronomers through History

    Science.gov (United States)

    Dobrosavljevic-Grujic, Lj.

    2008-10-01

    We review the contributions of women to astronomy starting from the antique Greece and Alexandria, and mention briefly some works of nun-scientists in the Middle Ages, which are of interest only for keeping alive the spirit of inquiry during this Dark Age. We discuss in more details important contributions coming after the Scientific Revolution and Enlightenment, made by women working within their families, as assistants to their brothers or husbands. We show that by the late 19th century the role of women in astronomy becomes more independent, with more women working not only as "computers" in the great observatories, but also making important discoveries that placed them in a very high position as scientists at the dawn of 20th century.

  5. Drum Performance Tnvolues Women

    Institute of Scientific and Technical Information of China (English)

    1996-01-01

    DRUM teams from along the Yellow River are known not only in China but by many foreign friends. Recently women have formed their own teams and their performances have further increased the popularity of this ancient Chinese folk art.

  6. Women and Mice

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This is an advertisement for Dr. Pierce's "Favorite Prescription," which he developed in the 1880's to relieve women of nervous symptoms caused by disease of the...

  7. Sexual Health (Women)

    Science.gov (United States)

    ... gift today will help us get closer to curing diabetes and better treatments for those living with ... you can still get pregnant. Most birth control methods are safe for women with diabetes. Talk with ...

  8. Mostly Women and Leadership.

    Science.gov (United States)

    Barron, Daniel D.

    1996-01-01

    Discusses educational leadership and women with a focus on roles, characteristics, stereotypes, and change. Describes some sources that deal with this topic, including an article, a study, two books, and some websites. (AEF)

  9. Women and Diabetes

    Medline Plus

    Full Text Available ... How to Report Problems with Glucose Meters Diabetes Treatments Some people with diabetes need to take diabetes ... with your health care provider about your diabetes treatment. Diabetes Medicines - easy-to-read booklet for women ...

  10. Women, Men, and Machines.

    Science.gov (United States)

    Form, William; McMillen, David Byron

    1983-01-01

    Data from the first national study of technological change show that proportionately more women than men operate machines, are more exposed to machines that have alienating effects, and suffer more from the negative effects of technological change. (Author/SSH)

  11. Women and Diabetes

    Medline Plus

    Full Text Available ... Beware of Illegally Sold Diabetes Treatments Diabetes and Pregnancy Some women develop diabetes for the first time ... care provider about how to manage diabetes during pregnancy. Medicine and Pregnancy Fact Sheet Pregnancy Registries - Sign- ...

  12. Heart disease and women

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/007188.htm Heart disease and women To use the sharing features on ... please enable JavaScript. People often DO NOT consider heart disease a woman's disease. Yet cardiovascular disease is the ...

  13. Conservation among Elderly Women.

    Science.gov (United States)

    Hughston, George A.; Protinsky, Howard O.

    1979-01-01

    The majority of 63 elderly women were able to pass tests in the conservation of mass (98 percent), volume (100 percent), and surface area (65 percent). These results conflict with previous research about Piagetian abilities of elderly people. (RL)

  14. Women and Cholesterol

    Science.gov (United States)

    ... Disease Venous Thromboembolism Aortic Aneurysm More Women and Cholesterol Updated:Apr 1,2016 The female sex hormone ... 2014. Related Sites Nutrition Center My Life Check Cholesterol • Home • About Cholesterol • Why Cholesterol Matters • Understand Your ...

  15. Women and Diabetes

    Medline Plus

    Full Text Available ... Registries - Sign-up for a study to help doctors learn more about how diabetes medicines affect women ... in Clinical Trials Campaign Clinical trials can help doctors learn more about treatments for diabetes. The FDA ...

  16. Women's Health Insurance Coverage

    Science.gov (United States)

    ... adopted policies that specifically placed women at a disadvantage, either by charging them higher premiums than men ... SOURCE: Kaiser Family Foundation analysis of 2016 ASEC Supplement to the Current Population Survey, U.S. Census Bureau. ...

  17. Women and Diabetes

    Medline Plus

    Full Text Available ... Health is partnering with the NIH Office of Research on Women's Health to raise awareness about diverse ... Federal, State & Local Officials Consumers Health Professionals Science & Research Industry Scroll back to top Popular Content Home ...

  18. Sexual Dysfunction in Women

    Science.gov (United States)

    ... your sex life. Certain medicines (such as oral contraceptives and chemotherapy drugs), diseases (such as diabetes or ... have heard that taking sildenafil (Viagra) or the male hormone testosterone can help women with sexual problems. ...

  19. Women and Diabetes

    Medline Plus

    Full Text Available ... awareness about diverse women of different ages, races, ethnic backgrounds, and health conditions participating in clinical trials. ... FEAR Act Site Map Nondiscrimination Website Policies U.S. Food and Drug Administration 10903 New Hampshire Avenue Silver ...

  20. Women and Diabetes

    Medline Plus

    Full Text Available ... How to Report Problems with Glucose Meters Diabetes Treatments Some people with diabetes need to take diabetes ... with your health care provider about your diabetes treatment. Diabetes Medicines - easy-to-read booklet for women ...