Opiate Dependence Research Articles

Protective factors against relapse for practicing nurse anesthetists in recovery from anesthetic opiate dependency.

This qualitative inquiry explored factors that protect recovering anesthetic opioid-dependent nurse anesthetists from relapse after their return to anesthesia practice. Practicing nurse anesthetists in recovery from potent opioids were recruited through online advertising and individually interviewed over the telephone. The interview consisted of open-ended questions that aided description of personal experience of individual factors. Content analysis of the interviews revealed an overarching theme of a commitment to the recovery process, which provided the foundational protective element against relapse. Within this context, two major thematic factors emerged: personal factors and external factors. Personal factors came from within the individual and included such features as removing the obsession to use, self-realization, inner strength, and seeing the future. External factors were external to the individual and described as time away from practice, state regulatory agency involvement, and talking with significant others. Although the Twelve-Step process was not a factor per se, it was credited by all participants as the structure on which their recovery was built. This process provided mechanisms for developing the motivation and learning the tools necessary to maintain their sobriety.

Using a drug-word Stroop task to differentiate recreational from dependent drug use

Distinguishing dependent from recreational drug use can be a surprisingly difficult task, and the current means for identifying substance abuse can be inadequate or even misleading. In subjective self-reports, those who are most at risk may down play their consumption, not admitting to the full extent of their habit, and measures purely of quantity of use rarely capture the true nature of an individual's relationship to the drug, such as a psychological dependence on the substance. This trend is particularly true for heavy stimulant use, which is absent of the physical withdrawal symptoms that can help identify opiate or alcohol dependence. As such, a simple objective measure to help identify substance abuse, particularly in individuals who might not otherwise raise suspicion, would be a valuable tool in both clinical and experimental settings. We propose that the drug-word Stroop task, an objective assessment of attentional bias and distraction to salient drug-related stimuli, would be a valuable tool in helping to make these categorizations. This measure has been shown to correlate with drug craving, as well as to successfully distinguish dependent from recreational stimulant users and to help to predict outcomes in treatment-seeking individuals. Here, we survey prior literature on the drug-word Stroop task and provide a perspective on using the assessment as a potential diagnostic for drug use severity.

Psychiatrist-Anthropologist Studies Drug Addiction and Recovery

Psychiatrist-Anthropologist Studies Drug Addiction and Recovery

In Search of Normal Controls: A Methodological Complication When Conducting Adolescent Opiate Dependence Research

The objective of this study was to describe the complexities surrounding the selection of an appropriate comparative control group for research with opiate dependent adolescents and young adults.

Hypothalamic Pathophysiology in the Neuroimmune,Dysmetabolic and Longevity Complications of Chronic Opiate Dependency

Hypothalamic Pathophysiology in the Neuroimmune,Dysmetabolic and Longevity Complications of Chronic Opiate Dependency New conceptual and therapeutic advances in our understanding of various important pathophysiological states have remarkable relevance to current practices in the area of the treatment of opiate dependence. Major breakthroughs have recently occurred in our understanding of: The central mediation of the hypertensive-obesity-metabolic syndrome and particularly its association with the hypothalamic regulation of longevity; The ability of addictive chemical species to induce local inflammation of many parts of the CNS including the hypothalamus; The interactions between the host and the resident gut microbial flora and its implications for systemic organismal health and disease. These breakthroughs have occurred on the backdrop of detailed quantified pathophysiological and mortality surveys of opiate dependence from several continents and in the context of exciting new pharmacological developments including suppressors of central neuroinflammation such as ibudilast, non-habituating newer generation opiates such as PTI-609, and depot-implantable forms of the opiate antagonist naltrexone. Opiates induce electrical silencing of POMC neurons resulting in hyperphagic obesity and dysmetabolic syndrome, mimicking senescence. Hence POMC neuronal pathophysiology becomes amplified organism-wide in a feed-forward loop. Together these factors suggest that we are on the very threshold of new insights which have the potential to overhaul both our conceptual understandings and our clinical treatments. The purpose of this review is to bring together findings from widely disparate areas and to elucidate their relevance and overlap with research on the effects of long-term opiate dependence. Whilst opiate dependence is the primary focus these observations likely also pertain to other chemical dependencies.

Illicit and Prescription Opiate Dependence: The Impact of Axis II Psychiatric Comorbidity on Detoxification Outcome

Objective: The current study examined the predictors of inpatient detoxification failure among illicit and prescription opiate dependent patients. Outcomes for the treatment of opiate dependence were compared to those with sedativehypnotic dependence. Methods: Data from 203 consecutive detoxification admissions included results of urine toxicology screens, length of stay, and outcomes. All detoxification protocols were designed to manage withdrawal throughout the tapering process and medical/psychiatric monitoring was provided daily. Results: Opiate-dependent patients were significantly less likely to complete detoxification and more likely to dropout against medical advice or to be discharged for non-compliance compared to sedative-hypnotic dependent patients. Those with opiate dependence were also more likely to be polysubstance abusers, and to report that they suffered some form of chronic pain syndrome (e.g. fibromyalgia) compared to the non-opiate group. Additionally, a large percentage of the sample was diagnosed with a personality disorder (PD), primarily Cluster B PD. There was considerable overlapping comorbidity between PD, pain syndromes and opiate abuse; 31.6% of the opiate-dependent patients suffered from both a chronic pain condition and a PD compared to 4.0% of the non-opiate patients. A hierarchical logistic regression revealed that treatment failure was predicted by three significant variables – younger age, opiate dependence and the presence of a Cluster B personality disorder. Illicit opiate (IO) users differed significantly from prescription opiate (PO) users in that they were significantly younger at first use of opiates and at the time of detoxification. Time between first use and detoxification admission did not significantly differ between the groups and rates of detoxification completion were comparable. Conclusions: Overall, these findings suggest a complex interaction between opiate dependence, pain syndromes, and affective dysregulation, which may lead to early termination from treatment.Further understanding of treatment failure may lead to specific, targeted interventions for thisdifficult to treat population.

EPA-1757 – Globus pallidus abnormalities in opiate dependent patients receiving methadone maintenance therapy

Introduction Preclinical studies have suggested that continuous, long-term opiate exposure may be neurotoxic. There is accumulating evidence for neural and neuropsychological abnormalities in diverse human drug addiction populations. However, the structural and behavioural correlates of human opiate dependency have been less studied than other drugs. Aims We investigated brain structure and neuropsychological functioning in opiate dependent, treatment-seeking patients receiving Methadone Maintenance Treatment, to test hypotheses of regional grey matter reductions correlating with methadone exposure and neuropsychological measures. Methods Cambridge Gambling Task (CGT) data were acquired from 47 patients receiving MMT and 51 controls. T1 weighted Magnetic Resonance Images were acquired from a representative subset of these volunteers. Results MMT patients exhibited grey matter reductions in the orbito-medial prefrontal cortex and basal ganglia. Additionally, patients exhibited significant abnormalities on CGT behavioural measures; risk adjustment, risk taking and impulsivity. Both the initial titration dose of methadone at the commencement of MMT following protocolised tolerance testing, and methadone dose at the time of scanning, correlated with grey matter reductions in the globus pallidus. Abnormal risk adjustment behaviour correlated with reductions in globus pallidus grey matter, increased risk taking with orbitofrontal grey matter reductions, and increased impulsivity with cingulate cortex reductions. Conclusions These findings support an interpretation of heightened risk taking and impulsivity in patients receiving MMT. However, the anatomically restricted correlates with indices of methadone exposure suggest that most structural brain abnormalities are not opiate linked, with the possible exception of the globus pallidus.

Alexithymia, Physiological Reactivity and Cognitive Appraisals of Emotional Stimuli in Opiate Dependents: A Pilot Study.

Objective: The aim of this study was to investigate psychophysiological reactivity to daily-life stimuli in opiate dependents and associations with alexithymia. Methods: The sample (n=72) was composed of a heroin addicts group treated with methadone and a healthy group, studied in several variables. Participants completed the Portuguese versions of the Toronto Alexithymia Scale-20 items, the Hospital Anxiety and Depression Scale and the Mini-Mental State Examination. They were also exposed to images from The International Affective Pictures System (IAPS) and physiological parameters and ratings of valence and arousal were collected. Results: Opiate dependents showed more alexithymia than controls and higher autonomic reactivity to stimuli. Higher levels of alexithymia seems to moderate an inverse association between heart rate and cognitive appraisals of unpleasant stimuli in this sample. Conclusion: A dysregulated brain-peripheral integration increased by the long term-use of drugs and damage in prefrontal regions are discussed as potential etiological factors supporting the presence of emotional deficits in these populations.

EPA-0298 – Pregabalin abuse among opiate addicted patients

Introduction Pregabalin is a novel GABA-analogue approved for the treatment of partial onset seizures, neuropathic pain, and general anxiety disorder. Pregabalin has been classified as a Schedule V drug with a low risk of inflicting abuse or addiction. However, some publications have indicated that pregabalin may have a potential for abuse among patients with past or current opiate addiction. Aims We hypothesized that pregabalin might be abused my patients who were undergoing an opiate replacement therapy and never had an indication for taking pregabalin on medical grounds. Methods Urine specimens from 124 patients with opiate dependency syndrome and from 111 patients with other addiction disorders (alcohol, benzodiazepines, cannabis, amphetamines) were screened for pregabalin by means of a mass spectrometer analysis. Results We found 12.1% of all urine specimens from patients with opiate addiction to be positive for pregabalin. None of the patients concerned had a medical indication for using pregabalin. In the control group, 2.7% of the patients were tested positively for pregabalin, due to their taking it regularly for chronic pain or general anxiety. Conclusions Our data suggest that pregabalin is liable to be abused among patients with opiate dependency syndrome. Thus, vigilance and caution are called for when patients with a past or current opiate dependency are exposed to treatment with pregabalin.

Legal Aspects of End-of-Life Care in Severe Anorexia Nervosa

Anorexia nervosa has the highest mortality rate of any psychiatric illness. Its management can be complicated as people with the condition can resist efforts to enable them to eat and drink. Ethical, medico-legal and psychological issues need careful exploration when considering compulsory treatment. This article summarises the judgment from the High Court case of a 32-year-old woman, ‘E’, with severe anorexia nervosa, emotionally unstable personality disorder, alcohol and opiate dependence and physical complications of malnutrition. Her death was imminent and she was placed on an end-of-life care pathway. Despite two advance directives refusing life-sustaining treatment, and her parents’ skepticism about further intervention, the judge declared that it was lawful and in her best interests for her to be fed, forcibly if necessary. This unique and complex case was heavily dependent on the detailed application of the Mental Capacity Act 2005. Respect for personal independence was balanced against the right to life to make a decision about E’s best interests. Conflicts of interest: none

Opiate Dependence in Schizophrenia: Case Presentation and Literature Review

In the past decade opioid pain reliever misuse among the U.S. population has increased to epidemic proportions. While the U.S. has only 4% of the world's population, Americans consume 86% of the world's opioids. In 2011, approximately 13 million people (5% of the U.S. population) reported nonmedical use of prescription opioids, which are now the second most commonly abused class of drug behind cannabis. There has been little in the way of formal study examining the association between mental illness and prescription opiate abuse, but preliminary evidence suggests a strong association. Neurobiological processes involved in psychosis and opiate abuse may partially explain this association. Despite compelling evidence of the growth in opiate misuse and the potential relationship with mental illness, patients with mental disorders and/or substance abuse are routinely excluded from randomized trials, making it impossible to better understand these phenomena. Treatment guidelines, especially regarding opioid agonists such as methadone and buprenorphine for people with mental illness, are woefully inadequate. We present the case of a young man with schizoaffective disorder who sustained an injury and developed chronic back pain. Opioids were prescribed and he quickly progressed to abusing increasing doses of opioids, which eventually led to daily heroin use. The young man struggled with repeated relapses, serious use-related consequences and suicide attempts. This case highlights the role of chronic pain and opioid prescribing, the segue from prescribed use to abuse and dependence, and the transition to heroin use. It demonstrates the difficulty patients may have in obtaining adequate treatment for co-occurring mental illness and substance abuse and how outcomes are improved when treatment is integrated to address both disorders. Comprehensive treatment must involve a combination of case management and medical management, including possible opioid replacement therapy.

Smoking Cessation Outcomes and Predictors Among Individuals With Co-occurring Substance Use and/or Psychiatric Disorders

Objective: Individuals with substance use and psychiatric disorders have a high prevalence of tobacco use disorders and are disproportionately affected by tobacco-related morbidity and mortality. However, it is unclear how having co-occurring disorders affects tobacco cessation. Our aim was to examine smoking cessation outcomes and relevant predictors of smoking cessation among smokers with substance use and/or psychiatric disorders. Methods: Data from medical records of 674 participants in a tobacco treatment program within mental health and addictions services in Vancouver, Canada, were analyzed. The 26-week treatment program included an 8-week structured behavioral counseling group, an 18-week support group, and 26 weeks of no-cost pharmacotherapy. Information on demographics, tobacco use and history, type of pharmacotherapy received, nicotine dependence, importance of and confidence in quitting smoking, expired carbon monoxide level, substance use and psychiatric disorder history, and total program visits were gathered. Results: Approximately 67% (n = 449) of participants had co-occurring substance use and psychiatric disorders, while 20% (n = 136) had substance use disorder only, 10% (n = 67) had psychiatric disorder only, and 3% (n = 22) had tobacco dependence only. Rates of tobacco cessation (i.e., 7-day point prevalence of abstinence verified by expired carbon monoxide of ≤8 ppm) by group in the 522 people who completed treatment were as follows: 38.2% for those with co-occurring disorders, 47.1% for those with tobacco dependence only, 47.1% for those with substance use disorder only, and 41.8% for those with psychiatric disorder only. Length of treatment was a significant predictor of smoking cessation for those with co-occurring disorders and substance use disorder only. In the final stratified multivariate analysis, for individuals with co-occurring disorders, having an opiate use disorder (as compared to an alcohol use disorder) and higher nicotine dependence scores at baseline were predictive of poor cessation outcomes, while greater length of treatment was predictive of successful smoking cessation. Conclusions: Tobacco cessation treatment for individuals with co-occurring substance use and psychiatric disorders is likely to be as effective as for smokers with either disorder alone. Treatment duration predicts success among these smokers so strategies to enhance engagement and retention are needed.

Long-term Suboxone Treatment and its Benefit on Long-Term Remission for Opiate Dependence

Aims: To review the current professional literature and describe factors related to Suboxone treatment that contributes to sustained opioid detoxification, as well as the characteristics of patients who are likely to benefit from long-term Suboxone treatment.

EPA-0904 – Integrative complex personalized treatment of dual diagnoses of opiate drug addict person who is treated with maintenance substitution opiate therapy with buprenorphine/naloxone (suboxone)- case report

Opiate addiction is very often complicated with different clinical problems which are not visible because of complex clinical problems because of opiate dependency. We present a male drug addict aged of 31 year, married, he is a father of two kids, unemployed who has a complex history of trauma exposure during the war in Bosnia-Herzegovina. He survived several life threatened dangerous events with age of twelve. He started to misuse marijuana with 15 years; he started with heroin addiction with 20 years when he worked in Croatia. As intravenous drug user he became hepatitis C infected. He returned from Croatia and started to live in small village in Bosnia-Herzegovina in very difficult conditions. After induced in maintenance substitution opiate therapy with Buprenorphine/Naloxone (Suboxone), he appeared with symtoms of posttraumatic stress disorder (PTSD), he had seizures Grand mal, so we did complex clinical investigation. We found both side brain cortex reduction, and EEG positive finding. With Suboxone we introduced and Sodium-Valproate, SSRI and Clozapine because of heavy night mares. Despite complex psychopharmacotherapy his recovery was questionable. We introduced him in the Interferon treatment of Hepatitis C infection, but because of lack of money he quitted it after incomplete treatment three month after beginning. Because of increased chronic insomnia he was hospitalized for integrative complex personalized treatment. After working through of his trauma experiences in individual EMDR psychotherapy and after telling his severe trauma experiences in the group therapy of war veterans he recovered and dismissed to continue treatment as an outpatient.

A Novel Community-Based Buprenorphine Program

The aims of this retrospective, descriptive study were to describe clients served by a buprenorphine program in a community-based recovery center and to present initial treatment outcomes. A record review was conducted for clients treated from July 2010 to August 2011. Client demographic, health, substance use, and treatment history data were abstracted from the records of the first 78 clients served. Buprenorphine and opiate use data were collected via urine toxicology reports, collected weekly among clients who remained enrolled in treatment. The average percentages of weeks spent opiate free and buprenorphine compliant were 83% (SD = 26%) and 95% (SD = 13%), respectively. When positive heroin toxicology and negative buprenorphine toxicology were replaced for the missing/unknown data, the average percentages of opiate-abstinent weeks and buprenorphine compliance were 60% (SD = 34%) and 74% (SD = 28%), respectively. Roughly half of all clients (49%) were successfully transitioned to continue treatment with buprenorphine in a primary care setting. Findings from this study demonstrate that buprenorphine treatment for opiate dependence can be incorporated into a community-based recovery center with high rates of opiate abstinence and treatment adherence.

Long-term Suboxone Treatment and its Benefit on Long-Term Remission for Opiate Dependence

Long-term Suboxone Treatment and its Benefit on Long-Term Remission for Opiate Dependence

Biogenic Amine Neurotransmitter Response to Morphine in the Anterior Cingulate Cortex Predicts Propensity for Acquiring Self-Administration and the Intensity of the Withdrawal Syndrome

Individual differences in behavioral characteristics or initial responses to abused drugs had been recently demonstrated to have predictive value in the propensity of later abuse. The research described here was initiated to determine the initial response of rats to administration of morphine if the physiological response has predictive value for the propensity of the animals to later self-administration. The initial response of extracellular fluid levels of the biogenic monoamine neurotransmitters in the anterior cingulate cortex (aCC) was assessed in drug rats with in vivo microdialysis following administration of morphine. Rats that did not acquire morphine self-administration (NSA) had higher baseline levels of aCC extracellular fluid levels of dopamine (DA) and 3,4-dihydroxyphenylacetic acid (DOPAC) than animals that developed stable morphine self-administration (SA). However, the response independent administration of morphine resulted in a dramatic increase in (DA) in aCC in the SA group, while the morphine injection in the NSA rats increased extracellular fluid levels of noradrenaline (NA). It is possible that these differences might be related to the development of physical dependence. Therefore, the development of physical dependence was observed in these animals. There was no relationship between the propensity to self-administration morphine and the development of physical dependence. Rats that showed the highest withdrawal scores had lower extracellular fluid levels of serotonin (5-HT) compared to rats showing low withdrawal scores. Thus, monoamine neuronal innervations of the aCC respond to an initial dose of morphine that is predictive of the later propensity to self-administration and the resistance and predisposition to the formation of opiate dependence, but there is no relationship between these two indices in individual animals. These data add to a growing body of evidence for the involvement of neuronal systems in the aCC in the actions of opiates.

Clinical efficacy of acupuncture as an adjunct to methadone treatment services for heroin addicts: a randomized controlled trial.

Scant scientific evidence supports the efficacy of acupuncture in the treatment of opiate dependence. The purpose of this study was to examine the effectiveness of acupuncture for heroin addicts on methadone maintenance by measuring the daily consumption of methadone, variations in the 36-item Short Form Health Survey-36 (SF-36) and Pittsburgh Sleep Quality Index (PSQI) scores, and heroin craving. Sixty heroin addicts were randomly assigned to true acupuncture (electroacupuncture at the Hegu [LI4] and Zusanli [ST36] acupoints, as well as acupuncture at the Ear Shenmen) or sham acupuncture (minimal acupuncture at the Hegu and Zusanli acupoints without electrical stimulation and superficial acupuncture at the Ear Shenmen), twice weekly for 4 weeks. From week 2 onwards, the daily dose of methadone was reduced by a significantly greater amount with true acupuncture compared with sham acupuncture. True acupuncture was also associated with a greater improvement in sleep latency at follow-up. All adverse events were mild in severity. Acupuncture appears to be a useful adjunct to methadone maintenance therapy (MMT) in heroin addiction.

КЛИНИЧЕСКОЕ ТЕЧЕНИЕ ВОСПАЛИТЕЛЬНЫХ ЗАБОЛЕВАНИЙ ПОЛОСТИ РТА У БОЛЬНЫХ ОПИЙНОЙ НАРКОМАНИЕЙ В ЗАВИСИМОСТИ ОТ СТАЖА УПОТРЕБЛЕНИЯ ПСИХОТРОПНЫХ ВЕЩЕСТВ. Литературный обзор

<p>The review of the data of domestic and foreign literature on the impact of opiate dependence on the development of inflammatory diseases of the oral cavity. Shows the prevalence of various pathologies of the oral cavity in patients with drug dependence and the severity of the duration of use of psychotropic substances; marked characteristics of the disease in this group of patients.</p>

Duration of opiate exposure as a determinant of arterial stiffness and vascular age in male opiate dependence: a longitudinal study

Despite intriguing initial and associational studies, there remains little research on opiate-related arterial dysfunction and no longitudinal studies. As opiates act potently via P16INK4A/CDKN2A identified on GWAS screens, and as arterial ageing is a surrogate for organismal ageing, this area is of general concern. Thirty-eight male controls compared with 198 opiate-dependent male patients were studied longitudinally using SphygmoCor pulse wave analysis. Healthy male controls and opiate-dependent male patients were studied on 125 and 625 occasions, respectively. The mean (±SEM) chronological age (CA) was 42·32±2·22 for controls and 35·04±0·61 for opiate dependent (P=0·0029). 94·4% and 13·2% smoked tobacco (P<0·0001). Controlling for BMI and CA, there was a significant time: addictive status interaction for vascular age (P=0·0127) and central augmentation pressure and index (both P<0·02). Central systolic and diastolic pressures were also worse over time by addictive status (P<0·005). At repeated measures multiple regression adjusted for classical risk factors, opiate dose and duration of opiate use remained significant. The dose-duration effect was significant in 8 terms and by time. A similar model quadratic in opiate duration was more powerfully predictive, suggesting the salience of the duration of opiate treatment (AIC 191·6898 and 191·5966, P=0·0116). Data suggest that increased length of opiate dependence is associated with advanced vascular stiffness and ageing and are therefore consistent with accelerated ageing organismally. The superiority of power functions of the opiate duration of exposure underscores the significance of the duration of treatment and of putative senescence induction.