Experienced Withdrawal Symptoms Research Articles

Zolpidem-related euphoria, addiction and detoxification: A case report and review of the literature.

Zolpidem, a non-benzodiazepine sedative-hypnotic, is considered safer for the treatment of insomnia compared to benzodiazepines. However, in recent years, there have been growing reports of Zolpidem dependence, addiction, and withdrawal symptoms. We reported a case of Zolpidem addiction and successful detoxification, reviewed similar cases in the literature, and proposed a potential mechanism underlying Zolpidem addiction. The patient was a 46-year-old Tibetan woman who had been using Zolpidem intermittently to treat insomnia for at least 8 years. She was overweight, with a BMI of 28.04 kg/m², and had hypertension, diabetes, a 20-year smoking history, and several years of alcohol abuse, often seeking instant gratification. She voluntarily increased both the dosage and frequency of Zolpidem, experiencing euphoria, anxiolysis, and increased appetite at higher doses, which led her to gradually escalate her dosage to 280 mg per day in divided doses. However, upon stopping Zolpidem, she experienced withdrawal symptoms, including insomnia, tension, and palpitations. She was diagnosed with a combination of hypnotic use disorder, anxiety disorder, hypertension, and diabetes. She underwent diazepam replacement therapy, along with antianxiety medications and mindfulness-based cognitive therapy, to address Zolpidem addiction. After 13 days of inpatient treatment, the patient successfully quit Zolpidem. During a 3-month follow-up, she returned to work and remained free from Zolpidem use. We speculate that Zolpidem addiction is likely linked to the drug's euphoric effects and certain patient characteristics, such as sensation-seeking behavior. A comprehensive approach, involving both pharmacological and psychological interventions, is essential for an effective detoxification strategy for Zolpidem addiction.

Covid-19 Patients with First-Diagnosed Substance Use Disorders in Southern Thailand: A Study from a Field Hospital

Objective: This retrospective study investigated usage patterns, withdrawal symptoms, and treatments provided to COVID-19 patients with first-diagnosed substance use disorders at a field hospital in southern Thailand in 2021.Material and Methods: The medical records of all COVID-19 patients were reviewed, and descriptive statistics were calculated and reported. The process of analyzing data was carried out by utilizing Program R.Results: Of the 2116 patients, 12.9% had a history of substance and/or alcohol use without any prior diagnosis. Most patients were male (94.9%), and the mean age was 31.7 years old. Tobacco and kratom were the substances most frequently used by COVID-19 patients. Withdrawal symptoms were observed in approximately half of all patients with substance use disorders, particularly those who used kratom and opioids. The most commonly reported withdrawal symptoms were insomnia and muscle aches, and chlorpromazine and amitriptyline were the most prescribed psychotropic medications. The majority of patients with substance use disorders (93.8%) did not report any complications related to their COVID-19 infection.Conclusion: This study found that 12.9% of COVID-19 patients admitted to a field hospital in southern Thailand in 2021 had a newly diagnosed substance use disorder. The substances most commonly used by these patients were tobacco and kratom. Approximately half of the patients with substance use disorders experienced withdrawal symptoms, and kratom and opioids were the substances most frequently associated with these withdrawal symptoms.

Profile of chronic pain patients with opioid withdrawal syndrome according to psychological factors: a Latent Class Analysis.

Withdrawal syndrome stands out as the strongest risk factor for Prescription Opioid-Use Disorder (POUD) and is related to psychological and pain impairment in chronic pain population. This study aimed to identify profiles of chronic pain patients with opioid withdrawal based on psychological factors, and to explore the association between the classes and demographic, clinical, and substance use variables. This cross-sectional descriptive study involved 391 patients, 221 of them with interdose withdrawal (mean age=57.91±13.61 years; 68.3% female). Latent Class Analysis (LCA) and bivariate and logistic regression analyses were performed. Two latent classes were identified (BIC=4020.72, entropy=0.70, LRTs p<0.01): Withdrawal syndrome with No Psychological Distress (WNPD; 45.2%, n=100) and Withdrawal syndrome with Psychological Distress (WPD; 54.8%, n=121). The WPD class was more likely to experience craving, anxiety, and depression, and to report higher levels of pain intensity and interference (p<0.01). Patients in this class were younger, visited a higher number of specialists, and showed higher rates of high-dose opioid use, misuse, moderate-severe POUD, and tobacco and anxiolytics use (p<0.05). Only moderate-severe POUD (OR=2.64) and tobacco use (OR=2.28) increased the risk of WPD class membership. Although it is common for chronic pain patients to experience withdrawal symptoms during opioid treatment, more than a half of the participants reported concomitant psychological distress. Establishing differential profiles can help to improve withdrawal syndrome management during the treatment of chronic pain with opioids.

Gradually tapering off antipsychotics: lessons for practice from case studies and neurobiological principles.

There has been an increasing focus on deprescribing in psychiatry recently, particularly of antipsychotic medication, with recognition that not all patients with psychotic disorders require lifelong medication. We summarize some empirical and theoretical papers, and examine case studies to provide instruction on this topic. Recent studies have found that slower tapering (over months or longer) of antipsychotics is associated with a lower relapse rate than quicker tapering (weeks). Case studies presented suggest that the process of reduction is associated with the precipitation or exacerbation of psychotic symptoms and that a slower process of reduction may minimize this effect. This may be because faster reductions cause greater disruption of homeostatic equilibria, provoking psychotic symptoms either as direct withdrawal symptoms or consequences of nonpsychotic withdrawal symptoms (e.g. insomnia) - although not all patients will experience withdrawal symptoms. This suggests that smaller dose reductions, especially at lower doses, made very gradually, may minimize the risk of psychotic symptoms. Slower tapering of antipsychotics may provide time for adaptations made to the presence of the medications to resolve, thus reducing the disruption to homeostatic equilibrium caused by dose reduction, potentially reducing the risk of relapse. Exacerbation of psychotic symptoms on antipsychotic reduction may not represent evidence of the need for a higher dose of antipsychotic on a long-term basis but may indicate the need for more gradual reduction. Gradual reduction of antipsychotics, especially after long-term use in clinical practice is prudent.

Recent insights in the correlation between social media use, personality traits and exercise addiction: a literature review.

The excessive involvement in physical activity without stopping in between sessions despite injuries, the continuous thinking to exercise feeling insane thoughts and experiencing withdrawal symptoms are all characteristics of the Exercise Addiction (EA), an addictive behavior. While the primary exercise addiction is directly caused by compulsive exercise, many studies highlighted the relationship between Eating Disorders (ED) and EA, defining the secondary EA. The correlation between EA, social media use (SMU) and other individual traits remains a relatively underexplored domain. Therefore, this review aimed to examine the latest evidence on the relationship between EA, SMU, and some personality traits such as perfectionism and body image. Electronic databases including PubMed, Medline, PsycARTICLES, Embase, Web of Science were searched from January 2019 to October 2023, following the PRISMA guidelines. A total of 15 articles were examined and consolidated in this review. EA was found to be related to different individual traits such perfectionism, body dissatisfaction, depression, obsessive-compulsive personality disorders. While controversial results were found regarding the relationship between EA and SMU. The interaction between mental health, exercise addiction and social media use is complex. Excessive engagement in these latter may result in negative mental health consequences despite their potential benefits. Understanding individual differences and developing effective interventions is crucial to promoting healthy habits and mitigating the EA risks, ultimately enhancing mental well-being. Further research should focus on the identification of risks and protective factors with the eventual aim of developing and implementing effective prevention strategies.

Characterizing Opioid Withdrawal Experiences and Consequences Among a Community Sample of People Who Use Opioids

Background Opioid withdrawal symptoms are a highly salient and consequential health condition experienced by people who use opioids (PWUO). This study utilized qualitative interviews to explore opioid withdrawal experiences and consequences among PWUO in Los Angeles County, USA. Methods Semi-structured qualitative interviews were conducted with 22 PWUO (aged 27–63 years) between May 2021 and May 2022. Participants self-reported opioid and injection drug use in the last 30 days. We employed an inductive thematic approach to systematically code and synthesize textual interview data. Results Participants experienced withdrawal symptoms frequently, with many going to great lengths to avoid them. Withdrawal pain was described as incapacitating and interfered with PWUO’s ability to sustain regular employment and ensure stable housing. Avoiding withdrawal was described as influential in driving decisions to continue using opioids. Mechanisms for managing withdrawal included using other substances to the point of sedation. PWUO who transitioned from heroin to fentanyl use revealed more frequent, painful, and faster onset of withdrawal symptoms. Adverse withdrawal experiences and fear of precipitated withdrawal from buprenorphine were barriers to treatment initiation and continuation. Conclusion Withdrawal symptoms among PWUO increase health risk. Improved strategies to treat opioid withdrawal are urgently needed. Solutions such as safe supply and intentional opioid withdrawal interventions (educational trainings, withdrawal comfort kits) are needed to improve withdrawal management and reduce opioid-related harm.

Pregabalin use in forensic hospitals and prisons in German speaking countries-a survey study of physicians.

Pregabalin is a gamma-aminobutyric acid (GABA) analog that was approved in the EU in 2004 for the treatment of neuropathic pain, generalized anxiety disorder and epilepsy. Since its introduction, pregabalin abuse and misuse has increased significantly. In Switzerland, clinical reports suggest that pregabalin misuse is common among patients in forensic hospitals and prisons. However, data on pregabalin use is scarce, especially in these settings. Therefore, we conducted a study to explore patterns of pregabalin use among prison and forensic patients. We used a questionnaire to survey physicians working in prison and forensic medicine in German-speaking countries. A total of 131 responses were received. According to the physicians' subjective assessment, 82.5% of them had observed a recent increase in pregabalin use by their patients and 89.1% of them reported that their patients requested pregabalin without a clear medical indication. Patients misusing pregabalin in combination with other illicit substances were observed by 93.3% of the physicians surveyed. According to 73.5% of the physicians surveyed, they had already encountered patients on pregabalin doses of more than 600 mg/day (the maximum recommended daily dose); the highest dose reported was 4,200 mg/day. According to 85.0% of physicians surveyed, they have observed patients experiencing withdrawal symptoms from pregabalin, with the most commonly reported symptoms being displeasure and high aggression. Regarding the nationality of pregabalin-misusing patients, 58.3% of the interviewed physicians reported to be rather in contact with foreign patients, mainly from Northwest Africa (Maghreb). Only 45.0% of the surveyed physicians prescribe pregabalin. Among patients who developed behavioral problems while taking pregabalin, none of the physicians (0.0%) showed a tendency to continue pregabalin at the same dose; all respondents chose to reduce/substitute/discontinue. Our study has provided confirmatory evidence that the use of pregabalin presents a significant issue in forensic and prison medicine across German-speaking countries. Prescribing pregabalin in this field can compound use disorder problems and exacerbate challenges in daily life for those in forensic institutions or prisons. It is necessary that all physicians who prescribe pregabalin are clearly informed about the management (including the risks) of this drug.

Impact of Caffeine Consumption on Sleeping Hours and Stress Scale among Anesthesiologists: A Cross-Sectional Study

Background: Due to its stimulatory effects, caffeine is one of the most frequently consumed mood and behavior altering beverages. It is commonly used to improve alertness in cases of fatigue after prolonged work. Health authorities recommend not to exceed a daily intake of &lt;200 mg/day. The purpose of this study is to measure the prevalence of unsafe caffeine daily consumption (&gt;200 mg/day), detect caffeine withdrawal and intoxication symptoms, and investigate the relationship between caffeine intake and stress and sleeping hours.&#x0D; Methods: 168 anesthesiologists answered a questionnaire during the period of April to July 2022. After estimating daily consumption of caffeine, anesthesiologists were classified into either safe level group (daily consumption ≤ 200 mg/day), or unsafe level group (daily consumption &gt;200 mg/day); then, further analysis was done.&#x0D; Results: Almost 80% of the total participants were unsafe consumers. Junior doctors and registrars (group J) had a statistically higher caffeine consumption than consultants (group S) (433.9±228.7 mg versus 363.6±244.5 mg, respectively; P=0.017). Additionally, 45% of group J experienced intoxication symptoms, and 54% experienced withdrawal symptoms. These symptoms had a significantly higher prevalence in group J compared to group S (P=0.001 and P=0.004, respectively). Finally, no significant correlation was found between average daily caffeine consumption and daily sleeping hours and stress scale score (P=0.831 and P=0.324, respectively).&#x0D; Conclusion: The consumption of caffeine-containing drinks among anesthesiologists was very high. Junior anesthesiologists specifically reported higher caffeine consumption, more intoxication and withdrawal symptoms, and a higher stress score than consultants.

A study to assess the prevalence of substance abuse and its impact among medical students in a medical college

Background: Psychoactive drug is an emerging global problem. This is a disturbing matter, especially in the case of medical students, affecting their health and academic performance, which in turn affects the health outcomes of patients. The objectives of our study were to assess the prevalence and impact of substance abuse among medical students. Methods: This was cross-sectional study conducted in tertiary care center. A pretested semi structured questionnaire was used to collect the data. Medical students who were available during the study period and who were willing to participate were included in the study. A total of 301 students were interviewed. Data was entered and analysed in SPPSS version 22.0. Descriptive statistics and inferential statistics were used for the statistical analysis. Results: We had a total of 301 responders. Among them, only 70(23.3%) have been a subject to substance abuse. Alcohol was the most abused substance (19.3%). The most common reason for starting these substances was out of curiosity (15.6%). 24.6% of the students have either thought of or tried stopping, however majority of them have not. Out of these students, 10 (3.3%) have experienced withdrawal symptoms. Conclusions: The substance abuse among youngsters in medical colleges is a highly alarming situation. Proper counselling with planned policies should be implemented to root out this evil among the future doctors which will help in providing better health care services to the people.

Absconding from a Psychiatric Hospital in a Developing Country, Related Factors, and the Consequences.

This study aimed to investigate the factors related to absconding and consequences of absconding in a psychiatric hospital in a developing country within 3 years. This was a retrograde descriptive cross-sectional study from a psychiatry hospital in a developing country, Iran. The registered data of absconding between March 2018 and February 2021 were extracted. Furthermore, a retrograde follow-up by telephone on what happened after the absconding and the remembered motives was done. The obtained data were analyzed using SPSS statistical software for Windows Version 23 by descriptive statistics. The chi-square test, Fisher exact test, Student t test, or Mann-Whitney U tests were used for data analysis. P ˂ .05 was considered statistically significant. Out of 7069 admitted patients during a 36-month period, 51 (39 men and 12 women) had absconded. The total absconding rate was 0.72%. The mean ± (SD) age of the patients was 29.7 ± (10.46) years, with a range of 10 to 54 years. No statistical difference between men and women emerged in terms of age (P = 0.89). Most of the absconders were men (76%), young (mean age, 29.7 years), single (70.6%), and involuntarily hospitalized (78.4%) in an urban area (90.2%), and absconded in the evening shift (58.8%) via the route of the main gate (58.8%) in the early days of admission (5 days). In terms of psychiatric diagnosis, the highest rank belonged to bipolar disorder (33.33%) and substance-related disorders (33.33%). About one-third of absconders had a current substance-related problem and most of them had experienced withdrawal symptoms or cravings days before absconding (75%). Absconders mentioned that "no need for admission" (45.1%), "economic problems" (23.5%), and "substance craving" (13.7%) were the most common reasons for leaving the hospital. Most of the absconders were hospitalized later (70.5%). The risk for self-harm (21%) or harm to others (2%) after absconding was low. The general profile of absconders was concordant with previous studies. It was highlighted that economic problems in recent years had an evident impact on patients and it could be postulated that consideration of substance withdrawal may decrease absconding. It is advised to adhere to the policies that support community-based psychiatry and place an emphasis on early discharge and continuity of outpatient care.

RELEASE (REdressing Long-tErm Antidepressant uSE): protocol for a 3-arm pragmatic cluster randomised controlled trial effectiveness-implementation hybrid type-1 in general practice

BackgroundMany people experience withdrawal symptoms when they attempt to stop antidepressants. Withdrawal symptoms are readily misconstrued for relapse or ongoing need for medication, contributing to long-term use (> 12 months). Long-term antidepressant use is increasing internationally yet is not recommended for most people. Long-term use is associated with adverse effects including weight gain, sexual dysfunction, lethargy, emotional numbing and increased risk of falls and fractures. This study aims to determine the effectiveness of two multi-strategy interventions (RELEASE and RELEASE+) in supporting the safe cessation of long-term antidepressants, estimate cost-effectiveness, and evaluate implementation strategies.MethodsDesign3-arm pragmatic cluster randomised controlled trial effectiveness-implementation hybrid type-1. Setting: primary care general practices in southeast Queensland, Australia. Population: adults 18 years or older taking antidepressants for longer than 1 year. Practices will be randomised on a 1.5:1:1 ratio of Usual care:RELEASE:RELEASE+. Intervention: RELEASE for patients includes evidence-based information and resources and an invitation to medication review; RELEASE for GPs includes education, training and printable resources via practice management software. RELEASE+ includes additional internet support for patients and prescribing support including audit and feedback for GPs. Outcome measures: the primary outcome is antidepressant use at 12 months self-reported by patients. Cessation is defined as 0 mg antidepressant maintained for at least 2 weeks. Secondary outcomes: at 6 and 12 months are health-related quality of life, antidepressant side effects, well-being, withdrawal symptoms, emotional numbing, beliefs about antidepressants, depressive symptoms, and anxiety symptoms; and at 12 months 75% reduction in antidepressant dose; aggregated practice level antidepressant prescribing, and health service utilisation for costs. Sample size: 653 patients from 28 practices. A concurrent evaluation of implementation will be through mixed methods including interviews with up to 40 patients and primary care general practitioners, brief e-surveys, and study administrative data to assess implementation outcomes (adoption and fidelity).DiscussionThe RELEASE study will develop new knowledge applicable internationally on the effectiveness, cost-effectiveness, and implementation of two multi-strategy interventions in supporting the safe cessation of long-term antidepressants to improve primary health care and outcomes for patients.Trial registrationANZCTR, ACTRN12622001379707p. Registered on 27 October 2022.

The need for antidepressant withdrawal support services: Recommendations from 708 patients

Approximately half of the tens of millions of people currently taking antidepressants will experience withdrawal symptoms when they try to reduce or come off them. Nearly half of these describe their symptoms as severe in surveys. Many prescribing doctors seem ill-informed and unprepared to provide effective discontinuation advice and support, often misdiagnosing withdrawal as a relapse of depression or anxiety. 708 members of online support groups for people on antidepressants, from 31 countries, completed a sentence in an online survey: 'A public health service to help people come off antidepressants should include ................'. Two independent researchers categorised their responses into themes, and then reached consensus via discussion. Seven themes emerged: ‘Prescriber Role’, ‘Information’, ‘Other Supports/Services’, ‘Strong Negative Feelings re Doctors/Services etc.’, Informed Consent When Prescribed’, ‘Drug Companies’ and: ‘Public Health Campaign’. The most frequently mentioned requirements of the Prescriber Role were that prescribers be properly informed, provide small doses/liquid/tapering strips, develop a withdrawal plan and believe patients about their withdrawal experiences. The most frequently recommended other services were psychotherapy/counselling, support groups, patient led/informed services, nutrition advice, 24-hour crisis support and ‘holistic/lifestyle’ approaches. Many respondents were angry about how uninformed their doctors were and how they had been treated.

Policies Affecting Pregnant Women with Substance Use Disorder

Policies Affecting Pregnant Women with Substance Use Disorder

The experience of tobacco withdrawal symptoms among current smokers and ex-smokers in the general population: Findings from nationwide China Health Literacy Survey during 2018-19.

To clarify the extent to which smokers in the general population experience tobacco withdrawal symptoms and whether such experience differs in those who continue to smoke and those who stopped smoking. We included relevant questions in the nationally-representative China Health Literacy Survey (CHLS) conducted in 2018-2019. Among 87,028 participants, there were 22,115 ever-smokers aged 20-69 years who provided information on their smoking history and their experience of tobacco withdrawal symptoms. Multivariate logistic regressions were conducted to explore the association between withdrawal symptoms and other variables. Among ever-smokers, there were 19,643 (88.8%) current smokers and 2,472 (11.2%) ex-smokers. Among current smokers, 61.3% reported having tried to quit smoking in the past. Overall, 61.1% of current smokers reported experiencing withdrawal symptoms: 69.9% of those who tried to quit smoking in the past and 47.5% of those who did not. A lower proportion of ex-smokers experienced withdrawal symptoms (46.3%) and the difference remained significant after controlling for demographic characteristics (OR = 1.76, 95% CI 1.62-1.93, P < 0.001). The most commonly reported withdrawal symptoms in both current smokers and ex-smokers were craving, restlessness and anxiety. In the multivariable-adjusted analyses, those who experienced withdrawal symptoms when they tried to quit smoking (OR: 2.05, 95% CI: 1.86-2.27) were less likely to successfully quit. The clinical picture of the tobacco withdrawal syndrome is the same in current smokers and in ex-smokers, but ex-smokers are less likely to have experienced it. The experience of discomfort when unable to smoke is common and seems likely to be a major factor contributing to maintaining smoking behavior not just among individuals seeking help with quitting smoking, but among smokers generally.

Identifying the barriers of smoking cessation and predictors of nicotine dependence among adult Malaysian smokers: A cross-sectional study.

Proper understanding of the prevalence and determinants of nicotine dependence is crucial for developing and implementing effective tobacco control interventions. The aim of the study was to identify the intrinsic and extrinsic barriers to smoking cessation, and to assess the association between nicotine dependence with demographic variables in Malaysia. A cross-sectional survey based on the Challenges to Stopping Smoking Scale (CSS-21) and Fagerström test for nicotine dependence (FTND) was performed on smoking Malaysian citizens aged ≥18 years, from February to June 2021. A total of 1026 parents responded to the survey. As for the smoking dependence based on FTND, 39.1% suffered low-moderate dependence, while about 33.6% suffered moderate dependence. Only 1.8% suffered high dependence. Considering the barriers of quitting smoking based on CSS-21, the mean score of the intrinsic barriers domain was 5.7 ± 2.9, and for the extrinsic domain was 7.4 ± 4.0. The most common barrier reported in the intrinsic domain was the easy availability of cigarettes (69.8%), followed by experiencing withdrawal symptoms (68.5%). On the other hand, the most common barrier reported in the extrinsic domain was the belief in the capability of stopping smoking in the future (72.8%), followed by the fear of having side effects after stopping smoking (63.2%). Gender, race, education level, occupation, marital status, place of residence, and monthly income were also significantly associated with the FTND nicotine dependence category (all p<0.05). Pearson correlation analysis reported a positive association between intrinsic score (r=0.38), extrinsic score (r=0.43) and FTND score (all p<0.001). Barriers to stopping smoking should be taken into consideration in initiatives to decrease smoking-related mortality. Vulnerable populations that are susceptible to high nicotine dependence should be given particular attention.

P-031: TRANSITION FROM LONG TERM HIGH DOSE FULL AGONIST OPIOIDS TO BUPRENORPHINE IN THE INPATIENT SETTING FOR PEDIATRIC PATIENTS WITH SICKLE CELL DISEASE: A MODIFIED INDIVIDUALIZED MICRO INDUCTION APPROACH. A SINGLE CENTER EXPERIENCE

Purpose: Sickle cell disease (SCD) has a global incidence of approximately 300,000/yr. About 100000 individuals live with SCD in the US. The hallmark of SCD is anemia, recurrent acute painful Vaso occlusive episodes (VOE’s) and progressive multi-organ involvement. VOE’s begin in infancy (dactylitis) and increase in frequency with age. Prompt administration of short-term full agonist opioids, combined with Non-Steroidal Anti-Inflammatory Drugs (NSAIDS) is the mainstay of VOE treatment. However, a subset of patients will develop chronic pain (CP) beginning early in adolescence. Long term opioid therapy has been used to treat SCD CP due to a lack of available alternatives. LTOT for CP has been proven to have poor efficacy and high toxicity and is associated with reduced quality of life. Buprenorphine is a partial opioid agonist, which physiologically exerts a ‘ceiling effect’ with less opioid related toxicity and thus is a safer option for patients who experience poor efficacy and increased toxicity from LTOT. Materials and methods: From 12/2020 to 02/2022, 10 patients met program eligibility criteria: SCD diagnosis, debilitating CP, receiving >90 morphine equivalents daily, (both outpatient and inpatient totals) with poor analgesic response. Each patient underwent a comprehensive evaluation of SCD status and other comorbidities, a psychological evaluation and participated in several education sessions with their caregiver prior to enrollment. Buprenorphine was initiated using a micro induction regimen that comprised of transdermal Buprenorphine 10mcg/hour or 20 mcg/hour on day 1 and adding buccal Buprenorphine/Naloxone starting on day # 2 or 3 and titrating upwards to individualized requirements. Full opioid agonists were slowly weaned down. Symptoms of withdrawal were monitored using the clinical Opioid withdrawal scale (COWS). Results: Patient were between ages between 12-19 years, with median of 18 years. 7 were Female. All 10 patients were successfully transitioned off LTOT onto a Buprenorphine formulation and none experienced withdrawal symptoms. Of the 10 patients, 7 remain on Buprenorphine beyond 3 months post induction with reductions in both acute care utilization and inpatient hospitalization. Utilization data: 6-months pre buprenorphine: Emergency room (ER) visits ranged from 3-20 with a mean of 9 encounters. Number of inpatient admissions were from 3-10 with a mean of 5.7 and length of stay between 3-19.3 days with a mean of 8.75 days. In the 3-6 months post Buprenorphine: number of ED encounters ranges from 1-7 with a mean of 2.2; the number or admissions range from 0-5 with a mean of 1.6 and length of stay ranged between 0-15 days with a mean of 4.85 days. Conclusion: Pediatric and young patients with SCD on high dose LTOT can be transitioned successfully to buprenorphine in the inpatient setting, using a modified micro induction titration regimen. A system wide multidisciplinary approach to include nursing, emergency department, pharmacy, psychologists and psychiatrists and an education dissemination plan is needed. Both patients and parents need to be ready for an alternative in order to achieve long term success. With the increasing reports of the use of Buprenorphine for CP in SCD, large prospective multi-center clinical trials are warranted. The authors do not declare any conflict of interest

A REVIEW ON APPLICATIONS OF DEXMEDETOMIDINE (BXCL501) IN CNS DISORDERS

A drug that subdues exhilaration and produces a calming effect in the subject without necessarily inducing sleep is referred to as sedative. The main system for action of these drugs is the Central Nervous System (CNS). Sedatives are slow working drugs with a levelled dose response curve. They act by modifying nerve responses in CNS to the brain which slows down brain activity thus relaxing the body. Gamma-amino-Butyric acid (GABA) is neurotransmitter which is responsible for retarding the brain functioning and sedatives increase the activity of GABA to produce more effect on the brain activity. Mostly sedatives are used to treat sleep disorders, pain or as anaesthetics. Opioids are sedatives used to treat pain, but long-term usage of these drugs leads to dependency and addiction which may be a challenge to treat. People experience withdrawal symptoms like nausea, vomiting, anxiety, insomnia and/or irritability along with seizures and loss of consciousness in some extreme cases. BXCL501 is a formulation of Dexmedetomidine used to treat agitation and symptoms of opioid withdrawal. The drug is designed in such a manner that it reduces agitation but does not produce excessive sedation. The RELEASE clinical trial of “bioxcel therapeutics” lead to the use of this drug to treat or retard opioid withdrawal symptoms and agitations. This article is aimed at reviewing and summarising existing data concerning the synthesis, chemical taxonomy, properties, mechanism of action, pharmacokinetic-pharmacodynamic profile, side effects, interactions, toxicology of dexmedetomidine.

Special Report: Be Prepared to Address Technological Addictions in Psychiatric Practice

Special Report: Be Prepared to Address Technological Addictions in Psychiatric Practice

Management of Xylazine Withdrawal in a Hospitalized Patient: A Case Report

Xylazine is an alpha-2 adrenergic agonist commonly used as a large animal anesthetic. It is used as an adulterant in illicit opioids, and it is now well established that its synergistic effect with opioids increases lethality. The amount of xylazine adulterating illicit opioids is growing at an alarming rate, present in almost one-third of opioid overdose deaths reported in Philadelphia in 2019. Despite this, there are no reports considering the management of patients using xylazine chronically. In particular, there are no reported cases detailing the management of xylazine withdrawal or exploring the potential for ongoing treatment for those in recovery from xylazine use. We present the case of a 29 year old female with opioid use disorder and chronic xylazine use, admitted to the intensive care unit for treatment of chronic lower extremity wounds thought to be due to xylazine injection. Her xylazine withdrawal was managed with a combination of dexmedetomidine infusion, phenobarbital and tizanidine, later transitioned to clonidine. By hospital day 4 she was no longer experiencing withdrawal symptoms. She was transitioned from full-agonist opioids for pain to buprenorphine via a buprenorphine "micro-induction" and was ultimately discharged on buprenorphine, clonidine, and gabapentin on day 19 of admission. This case illustrates a potential treatment pathway that allows for safe and comfortable xylazine withdrawal in hospitalized patients. It also provides an introduction into several medical concerns affecting this patient population specifically, including xylazine-mediated soft tissue wounds.

Advances in the Study of Neural Mechanisms Associated with Exercise to Ameliorate Nicotine Addiction

Objective: The objective is to elucidate the effectiveness of exercise as smoking cessation aid by sorting out the neurotransmitter basis of nicotine addiction and combining it with the neurotransmitter modulation effect of exercise, and finally to organize and analyze the mechanisms related to exercise to ameliorate nicotine addiction. Methods: We searched the Web of Science and PubMed databases for keywords, including “nicotine addiction”, “exercise”, “sports”, “physical activity”, “smoking cessation” and “tobacco withdrawal”, and compiled and analyzed the relevant literature to explain the neurobiological mechanisms of nicotine addiction and the effects of exercise on ameliorating nicotine addiction and related mechanisms. Results: 1) long-term nicotine intake, on the one hand, binds to acetylcholine receptors to produce rewarding effects, and on the other hand, causes rewarding effects by regulating the release of various neurotransmitters and signaling, making smokers feel pleasure and experiencing withdrawal symptoms after stopping smoking; 2) exercise can effectively ameliorate nicotine addiction; 3) exercise reduces the desire to smoke by activating the reward system to cause the body to release dopamine, partially replacing the rewarding effects and reducing withdrawal symptoms. Conclusion: Exercise is effective in ameliorating nicotine addiction through the modulation of neurotransmitters and improves the health status of people who quit smoking. Therefore, physical activity and physical exercise during smoking cessation are recommended to reduce nicotine withdrawal symptoms and smoking cravings.