Opiate Treatment Research Articles

The relationship between methamphetamine use and heterosexual behaviour: evidence from a prospective longitudinal study.

To estimate the extent to which specific sexual behaviours (being sexually active, having multiple sex partners, casual sex, condomless casual sex, anal sex and condomless anal sex) change during periods of methamphetamine use. Within-person estimates for the relationship between methamphetamine use and sexual behaviour were derived from longitudinal panel data from the Methamphetamine Treatment Evaluation Study (MATES) cohort (2006-10). Sydney and Brisbane, Australia. Participants (n=319) were recruited through treatment and other health services, self-identified as heterosexual, were aged 17-51years, 74% were male and all were dependent on methamphetamine on study entry. Days of methamphetamine use in the past month and sexual behaviour in the past month were both assessed using the Opiate Treatment Index. When using methamphetamine, participants had double the odds of being sexually active compared with when they were not using, after adjustment for demographics and other substance use [adjusted odds ratio (aOR)=1.9, P=0.010]. When participants were sexually active, they were more likely to have multiple sex partners (aOR=3.3, P=0.001), casual sex partners (aOR=3.9, P<0.001) and condomless casual sex (aOR=2.6, P=0.012) when using methamphetamine than when they were not using. During months when participants had a casual sex partner, there was no significant reduction in their likelihood of condom use when they were using methamphetamine. There was no significant change in the likelihood of having anal sex or condomless anal sex during months of methamphetamine use. Methamphetamine use is associated with an increase in being sexually active, having multiple sex partners and casual sex partners and having condomless sex with casual partners, but it is not associated with a change in condom use per se.

Methamphetamine Dependence, Psychological Well-being, Criminality and High Risk Sexual Behaviors in Female-Only Methadone Services in Tehran and Karaj, Iran

Background: Methamphetamine (MA) abuse is a health concern among drug abuse patients in Iran. Objectives: This study aimed at determining the prevalence of MA dependence among a group of female methadone users and investigating the current psychological well-being, high risk sexual and criminality behaviors, and the status of receiving MA treatment. Methods: This study was a cross-sectional survey conducted in Iran. The study was conducted at 5 central female-only methadone services in Tehran and Karaj, during years 2011 to 2013. A questionnaire was devised to collect baseline data. The general health questionnaire-28 and the Opiate Treatment Index were used to assess psychological well-being, and criminality and high-risk sexual behaviors. Results: Overall, 245 females were registered at these sites. Of them, 201 females (82%) were dependent on MA while on treatment. Duration of MA dependence was 6 years. However, only 14.3% of the participants reported lifetime MA treatment. No participant was on MA treatment. Participants reported high rates of MA-related depression (76.4%), anxiety (68.4%), social dysfunction (41.2%), and somatic symptoms (38.2%), respectively. Untreated MA dependence in methadone treatment was associated with engagement in high-risk sexual behaviors (43.8%) and criminality (28.7%). Only 10% of the participants reported receiving a lifetime matrix model. All of them reported that the Matrix model was long and it was not easily available in methadone services. Conclusions: The study showed that the high prevalence for MA dependence and its adverse health impacts while receiving MA treatment remained the same. Effective psychosocial treatments should be delivered for MA dependence among female methadone users.

Pain and Sleep Measures in Methadone and in Suboxone Patients

Background: Pain and impaired sleep are often reported by patients in opiate substitution therapy. Objectives: We compared sleep and pain ratings by patients treated with methadone to those treated with suboxone (buprenorphine/naloxone combination). Patients and Methods: Sixty-eight patients (44 men, 24 women) undergoing opiate substitution treatment were treated with methadone (mean dose = 42.2 mg, SD = 24.6) or suboxone (mean dose = 9.7 mg, SD = 5.0). Their ratings of current level of pain on a scale from 0 (no pain) to 10 (extreme pain), their sleep ratings on the Pittsburgh sleep quality index, and outcomes of their urine screening tests for cocaine, oxycodone, opiates, and benzodiazepines were recorded. Results: Sleep quality was rated as “fairly bad” by 42.0% and as “very bad” by 8.2% of our patients. Moderate to severe levels of pain (pain ratings > 3 points) were reported by 55.9% of our patients. Neither the dose of suboxone nor the dose of methadone correlated with pain and sleep ratings (rho, P > 0.05). Suboxone patients did not differ from those on methadone in their sleep and pain ratings (Mann-Whitney, P > 0.05). Conclusions: Suboxone and methadone patients did not differ in their ratings of pain and sleep.

Motivational Interviewing Can Facilitate Entry to Matrix Treatment for Methamphetamine Dependence

Background: Methamphetamine dependence on a stable methadone dose is a health problem in Iran (i.e. the most populated Persian Gulf country). However, many Iranian patients are not motivated to enter treatment. Objectives: The study aimed to assess the efficacy of motivational interviewing for entry to matrix treatment for methamphetamine dependence. Methods: A study was conducted on 275 Persian male and female methadone patients who were methamphetamine-dependent, however they reported unwillingness to receive the matrix model. The study was conducted in 20 methadone services in Karaj, Iran during 2014. Addiction severity index was used to collect data on demographics and illicit drug use. Psychological well-being and social functioning were assessed using the Persian versions of the general health questionnaire-28 and the social functioning subscale of the opiate treatment index. Results: The study indicated that 5 sessions of motivational interviewing were significantly efficacious in increasing attendance in the Matrix Model in the treatment group (P < 0.001). Attendance in motivational interviewing was significantly accompanied with increased psychological well-being (P < 0.001) and social functioning (P < 0.001). Conclusions: Motivational interviewing should be provided for those participants who are methamphetamine dependent but are not motivated for change. Conducting randomized controlled trials is suggested.

Quality of life and well-being following inpatient and partial hospitalization treatment for opioid use disorder

Treatment of opioid use disorder often begins with brief intensive inpatient or outpatient programs. Given the high relapse rates following intensive treatment, it is important to determine factors that lead to success post-discharge. Incorporating assessment during and early post-discharge may help determine such factors. The current study evaluated changes in quality of life among individuals during and after discharge from inpatient and partial hospitalization opiate treatment programs. Participants (n = 143) were recruited while in the programs and were re-assessed one month later (n = 113). Results found improvements in quality of life and reductions in rates of opiate use at follow-up. Individuals with greater improvements in Health, Substance Use, and Emotional Health domains were less likely to have relapsed. Treatment utilization post-discharge was not associated with relapse. Findings emphasize the importance of measurement-based care and suggest the need to assess indicators of treatment success beyond rates of relapse.

A pilot feasibility randomised controlled trial of an adjunct brief social network intervention in opiate substitution treatment services

BackgroundApproximately 3% of people receiving opioid substitution therapy (OST) in the UK manage to achieve abstinence from prescribed and illicit drugs within three years of commencing treatment. Involvement of families and wider social networks in supporting psychological treatment may be an effective strategy in facilitating recovery, and this pilot study aimed to evaluate the impact of a social network-focused intervention for patients receiving OST.MethodsA two-site, open feasibility trial randomised patients receiving OST for at least 12 months but still reporting illicit opiate use in the past 28 days to one of three treatments: 1) treatment as usual (TAU), 2) Brief Social Behaviour and Network Therapy (B-SBNT) + TAU, or 3) Personal Goal Setting (PGS) + TAU. The two active interventions consisted of 4 sessions. There were 3 aims: 1) test the feasibility of recruiting OST patients to a trial of B-SBNT, and following them up over 12 months; 2) test the feasibility of training clinicians to deliver B-SBNT; 3) test whether B-SBNT reduces heroin use 3 and 12 months after treatment, and to explore potential mediating factors. The primary outcome for aim 3 was number of days of heroin use in the past month, and a range of secondary outcome measures were specified in advance (level of drug dependence, mental health, social satisfaction, therapist rapport, treatment satisfaction, social network size and support).ResultsA total of 83 participants were randomised, and 70 (84%) were followed-up at 12 months. Fidelity analysis of showed that B-SBNT sessions were clearly distinguishable from PGS and TAU sessions, suggesting it was possible to train clinical staff to an adequate level of competence.No significant differences were found between the 3 intervention arms in the primary or secondary outcome measures. Attendance at psychosocial treatment intervention sessions was low across all three arms (44% overall).ConclusionsPatients receiving OST can be recruited into a trial of a social network-based intervention, but poor attendance at treatment sessions makes it uncertain whether an adequate dose of treatment was delivered. In order to achieve the benefits of psychosocial interventions, further work is needed to overcome poor engagement.Trial registrationISRCTN Trial Registration Number: ISRCTN22608399.Date of registration: 27/04/2012. Date of first randomisation: 14/08/2012.

"Real World" Factors Influencing Dropout from Opiate Treatment with Methadone and Buprenorphine

Background and objective: Comparison of retention in office-based, private-pay, outpatient opiate treatment programs with methadone or buprenorphine. Methods: Descriptive study with a prospective design comparing treatment retention in a licensed opiate treatment program (OTP) and buprenorphine program (BUP) offered in the same office-based setting. Over a period of 4.5 years, 1,372 patients were observed from program admission until six months or dropout, whichever was earlier. Results and conclusion: OTP had greater retention than BUP (36% vs. 15.8%); however, in both programs, retention was lower than reported elsewhere. Hispanic ethnicity, being married, and being unemployed correlate with significant dropout in OTP. Causes of early drop out in BUP were unclear. Percent of positive urine drug screens were significantly associated with drop out in both modalities. Significance: Results reflect the situation in a private pay outpatient program where patients are financially responsible for medications, transportation, and services. This, in addition to higher percentage of Hispanic ethnicity in study population and continuation of abuse of illicit substances, might explain overall low retention. Government supported treatment should improve retention in “real world” opiate dependence maintenance treatment.

Ibogaine as a treatment for substance misuse: Potential benefits and practical dangers.

Ibogaine is an indole alkaloid found in the root bark of the Iboga shrub native to west Africa possessing hallucinogenic properties. For centuries it has been used in religious ceremonies and to gain spiritual enlightenment. However, since the early 1960s, its apparent ability to reduce craving for psychoactive substances including alcohol, cocaine, methamphetamine, opiates, and nicotine has led to its use in detoxification treatments. In many instances, clients receive treatment in non-medical settings, with little by way of robust scientific clinical trials. This chapter provides an overview of the potential benefits that could arise from such research. This is balanced against the serious adverse effects that can occur due to undiagnosed health conditions and/or concomitant use of other drugs. A detailed update is provided of the 33 deaths known to have occurred, including 5 in the UK. Looking forward, there is a need to develop better opiate detoxification treatment against a background of increasing opioid-related fatalities. A congener of ibogaine, 18-MC, appears to be safer and is to undergo clinical trials. In the meantime, would-be consumers and treatment providers must make more careful, detailed risk-assessments before using ibogaine. Treatment outcomes, including deaths, need to be accurately recorded and published.

Treatment and Intervention for Opiate Dependence in the United Kingdom: Lessons from Triumph and Failure

The history of opiate treatment in the United Kingdom (UK) since the early 1980s is a rich source of learning about the benefits and pitfalls of drug treatment policy. We present five possible lessons to be learnt about how factors outside the clinic, including government, charities and researchers can influence treatment and outcomes. First, do not let a crisis go to waste. The philosophical shift from abstinence to harm reduction in the 1980s, in response to an HIV outbreak in injecting users, facilitated expansion in addiction services and made a harm reduction approach more acceptable. Second, studies of drug-related deaths can lead to advances in care. By elucidating the pattern of mortality, and designing interventions to address the causes, researchers have improved patient safety in certain contexts, though significant investment in Scotland has not arrested rising mortality. Third, collection of longitudinal data and its use to inform clinical guidelines, as pursued from the mid-1990s, can form an enduring evidence base and shape policy, sometimes in unintended ways. Fourth, beware of the presentation of harm reduction and recovery as in conflict. At the least, this reduces patient choice, and at worst, it has caused some services to be redesigned in a manner that jeopardises patient safety. Fifth, the relationship between the third and state sectors must be carefully nurtured. In the UK, early collaboration has been replaced by competition, driven by changes in funding, to the detriment of service provision.

Plasma Testosterone and Sexual Function in Southeast Asian Men Receiving Methadone and Buprenorphine Maintenance Treatment

BackgroundMethadone has been recognized as an effective maintenance treatment for opioid dependence. However, its use is associated with several complications, including sexual dysfunction in men. AimTo assess plasma testosterone and sexual function in Southeast Asian men on methadone maintenance treatment (MMT) or buprenorphine maintenance treatment (BMT). Methods76 sexually active men on MMT (mean age = 43.30 ± 10.32 years) and 31 men on BMT (mean age = 41.87 ± 9.76 years) from a Southeast Asian community were evaluated using plasma total testosterone (TT) and prolactin levels, body mass index, social demographics, substance use measures, and depression severity scale. OutcomesPrevalence and associated factors of TT level lower than the reference range in men on MMT or BMT. ResultsMore than 1 third of men (40.8%, n = 31) on MMT had TT levels lower than the reference range, whereas 1 fourth of men (22.6%, n = 7) on BMT did. At univariate analysis, MMT vs BMT (β = 0.298, adjusted R2 = 0.08, P = .02) and body mass index (β = −0.23, adjusted R2 = 0.12, P = .02) were associated with changes in TT after stepwise regression. There were no significant associations with age; Opiate Treatment Index Q scores for alcohol, heroin, stimulant, tobacco, or cannabis use and social functioning domain; education levels; hepatitis C status; and severity of depression. Prolactin level did not differ between the MMT and BMT groups. Clinical ImplicationsThe sex hormonal assay should be used regularly to check men on MMT. Strengths and LimitationsThis is the first study conducted in the Southeast Asian community. Our study was limited by the lack of a healthy group as the reference for serum levels of testosterone and prolactin. ConclusionsThe findings showed that plasma testosterone levels are lower in MMT than in BMT users. Hence, men who are receiving MMT should be screened for hypogonadism routinely in the clinical setting.Yee A, Loh HS, Danaee M, et al. Plasma Testosterone and Sexual Function in Southeast Asian Men Receiving Methadone and Buprenorphine Maintenance Treatment. J Sex Med 2018;15:159–166.

Long-acting intramuscular naltrexone for opioid use disorder: Utilization and association with multi-morbidity nationally in the Veterans Health Administration

BackgroundLong acting intramuscular (IM) naltrexone is an effective treatment for opioid use disorder (OUD), but rates and correlates of its use have not been studied. MethodsNational administrative from the Veterans Health Administration (VHA) from Fiscal Year 2012 identified only 16 VHA facilities that prescribed IM naltrexone to 5 or more veterans diagnosed with OUD. Data from these facilities were used to identify sociodemographic, diagnostic, and service use characteristics, including use of psychotropic medication, that were characteristic of veterans who filled prescriptions for IM naltrexone. This was in comparison to users of opiate agonist treatments (methadone or buprenorphine) or veterans with no pharmacologic treatment for OUD. Comparisons were made using both bi-variate analyses and multivariable logistic regression. ResultsOnly 179 of 16,402 veterans with OUD (1%) at these 16 facilities filled a prescription for IM naltrexone and only 256 of 99,394 (0.26%) nationally. These veterans were characterized by past homelessness, co-morbid alcohol use disorder, multiple psychiatric disorders, and a greater likelihood of psychiatric hospitalization, as well as mental health outpatient and antidepressant medication use. ConclusionsIM naltrexone is rarely used for OUD and is primarily used for patients with multiple co-morbidities, especially alcohol use disorder and serious mental illness. The use of this treatment illustrates many of the principles identified by the emerging focus on multi-morbidity as a critical feature of clinical practice.

Effects of opiate substitution treatment on mortality for opioids users: a systematic review and meta-analysis

BackgroundOpioid dependence is associated with high risk of premature death. Opiate-substitution treatment (OST) is the major treatment in community for opioid dependence worldwide. We aimed to estimate crude mortality rates (CMRs) and the effects of OST on mortality risk by meta-analysis. MethodsWe searched PubMed and Embase databases for articles that were published until Sept 30, 2016 with a combination of terms including “opiate substitution treatment”, “substitution or maintenance”, “methadone or buprenorphine”, “mortality”, and “longitudinal or cohort studies”. We restricted the search to articles written in English. We assessed the CMRs and relative risks (RR) for different OST status. We did subgroup analysis and meta-regression to determine the effect of treatment period, drug type, and drug dose on mortality. Findings29 longitudinal cohort studies involving 395 055 participants (1 611 377·8 person-years) were eligible for inclusion in the meta-analysis. From 22 studies, the pooled all-cause CMRs of opioids users were 0·90 per 100 person-years (95% CI 0·77–1·02) while receiving OST, 1·63 (1·41–1·84) after cessation of OST, and 4·91 (3·52–6·30) for an untreated period. On the basis of ten studies, the pooled overdose CMRs were 0·18 (0·16–0·20) while receiving OST, 0·76 (0·52–1·00) after cessation of OST, and 2·02 (1·30–2·74) for an untreated period. Compared with patients receiving OST, untreated participants had higher risk of all-cause mortality (RR 2·48; 95% CI 1·73–3·54) and overdose mortality (6·60; 4·73–9·21), and participants discharged from OST had a higher risk for all-cause mortality (2·27; 1·99–2·59) and a higher risk of fatal overdose (3·76; 2·24–6·30). The risk of death was greatest in the first 2 weeks after discharge from OST (all-cause CMR 4·71; 95% CI 1·69–7·73). We found evidence that buprenorphine was associated with a lower mortality risk than methadone after terminating OST (0·81; 0·70–0·93). We found no difference of mortality risk to be associated with different types and dosages of substitution medication. InterpretationOST could decrease mortality risk in opioids users, especially death from drug overdose. The findings highlight the importance of OST in the prevention of premature death among opioids users. Prevention of discharge from OST and post-treatment follow-up should be encouraged to reduce mortality. FundingThirteenth Five-Year Programme of the Chinese Ministry of Science and Technology (2016YFC0800907).

Management of Facial Trauma in the Prisoner Population

More than 10 million people are imprisoned worldwide, and the prevalence of all investigated mental disorders is higher in prisoners than in the general population. Although the extent to which prison increases the incidence of mental disorders is uncertain, considerable evidence suggests low rates of identification and treatment of psychiatric disorders. Prisoners are also at increased risk of all-cause mortality, suicide, self-harm, violence, and victimisation, and research has outlined some modifiable risk factors. Few high quality treatment trials have been done on psychiatric disorders in prisoners. Despite this lack of evidence, trial data have shown that opiate substitution treatments reduce substance misuse relapse and possibly reoffending. The mental health needs of women and older adults in prison are distinct, and national policies should be developed to meet these. In this Review, we present clinical, research, and policy recommendations to improve mental health care in prisons. National attempts to meet these recommendations should be annually surveyed.

A Call for Compassionate Care.

The Substance Abuse and Mental Health Services Administration (2014) reported that 1.1% of pregnant women used nonprescription opiates (either heroin or prescription pills) in the last 30 days. Methadone and buprenorphine are the most common treatments for opiate addiction in pregnant women. Reasons for seeking opiate maintenance treatment (OMT) include keeping custody of one's children and the hope of developing a healthy parenting relationship. Yet, healthcare organizations and professionals have mixed opinions regarding health promotion within the maternal OMT population. Proper education regarding the growing and complex opiate epidemic continues to remain a void for many healthcare professionals. It is imperative that nurses who regularly interact with women in OMT show compassion and competence. It is important to highlight the universality of the challenges and needs of caring for the OMT population. This Perspectives column will explore and describe the context of maternal nonprescription opiate use and the care mothers in OMT should receive based on established nursing ethical standards.

Src‐dependent phosphorylation of μ‐opioid receptor at Tyr336 modulates opiate withdrawal

Opiate withdrawal/negative reinforcement has been implicated as one of the mechanisms for the progression from impulsive to compulsive drug use. Increase in the intracellular cAMP level and protein kinase A (PKA) activities within the neurocircuitry of addiction has been a leading hypothesis for opiate addiction. This increase requires the phosphorylation of μ‐opioid receptor (MOR) at Tyr336 by Src after prolonged opiate treatment in vitro. Here, we report that the Src‐mediated MOR phosphorylation at Tyr336 is a prerequisite for opiate withdrawal in mice. We observed the recruitment of Src in the vicinity of MOR and an increase in phosphorylated Tyr336 (pY336) levels during naloxone‐precipitated withdrawal. The intracerebroventricular or stereotaxic injection of a Src inhibitor (AZD0530), or Src shRNA viruses attenuated pY336 levels, and several somatic withdrawal signs. This was also observed in Fyn−/− mice. The stereotaxic injection of wild‐type MOR, but not mutant (Y336F) MOR, lentiviruses into the locus coeruleus of MOR−/− mice restored somatic withdrawal jumping. Regulating pY336 levels during withdrawal might be a future target for drug development to prevent opiate addictive behaviors.

Methylphenidate: Gender trends in adult and pediatric populations over a 7 year period

Methylphenidate (MPH) is a prescription-stimulant medication which is authorized in France for two indications: attention-deficit hyperactivity disorder in children (aged≥6years) and narcolepsy in cases where modafinil is ineffective (for children and adults). MPH use has increased worldwide in the past 2 decades in children and adults. Different pharmacoepidemiological Europeans studies have described MPH patterns of use. To our knowledge, few pharmacoepidemiological studies have described MPH patterns of use in France. In this context, we have performed a study on regional reimbursement database (PACA-Corse area, covering approximately 4 millions inhabitants). The first part of the study analyzed the evolution of MPH users characteristic's yearly (grouped by age and gender) over a 7year period (2005-2011). In order to better characterize patterns of MPH use in adults, a specific analyze has been performed in the second part on MPH adult users in 2011 with a gender descriptive approach. During the 7year period, MPH dispensing grew from 0.28 to 0.68 patient per 1000. The proportion of adult patients rose from 14.8 to 25.7% (P<0.0001), with patients mainly aged 35-49years old. Gender differences in MPH users were noted between adults and children: the proportion of girls was less important in children than in adult (in 2011, 20.7% of girls among children vs 44.9% among adults). Moreover, the proportion of girls among children increased between 2005 to 2011 (15.1% of girls in 2005 versus 20.7% in 2011). Among adults, women were prescribed more antidepressants (41.5% versus 28.2%, P=0.003) and less opiate maintenance treatments (22.4% versus 31.9%, P=0.03) than men. Finally, 11% of men and 16.4% of women were over 50years old. MPH prescription greatly increased over7years, especially in adults. Moreover, in this population, patterns of MPH use differed with gender specificities. Such findings may increase clinical attention on monitoring MPH use in adults.

Effects of alkaloid-rich extract from Mitragyna speciosa (Korth.) Havil. on naloxone-precipitated morphine withdrawal symptoms and local field potential in the nucleus accumbens of mice

Ethnopharmacological relevanceMitragyna speciosa (Korth.) Havil. (M. speciosa) is among the most well-known plants used in ethnic practice of Southeast Asia. It has gained increasing attention as a plant with potential to substitute morphine in addiction treatment program. However, its action on the central nervous system is controversial. Aim of the studyThis study investigated the effects of M. speciosa alkaloid extract on naloxone-precipitated morphine withdrawal and neural signaling in the nucleus accumbens (NAc, brain reward center) of mice. Materials and methodsThe effects of M. speciosa alkaloid extract and mitragynine, a pure major constituent, on naloxone-precipitated morphine withdrawal were examined. Male Swiss Albino (ICR) mice were rendered dependent on morphine before injection with naloxone, a nonspecific opioid antagonist, to induce morphine withdrawal symptoms. The intensity of naloxone-precipitated morphine withdrawal was assessed from jumping behavior and diarrhea induced during a period of morphine withdrawal. To test possible addictive effect of M. speciosa alkaloid extract, mice were implanted with intracranial electrode into the NAc for local field potential (LFP) recording. Following M. speciosa alkaloid extract (80mg/kg) and morphine (15mg/kg) treatment, LFP power spectra and spontaneous motor activity were analyzed in comparison to control levels. ResultsOne-way ANOVA and multiple comparisons revealed that M. speciosa alkaloid extract (80 and 100mg/kg) significantly decreased the number of jumping behavior induced by morphine withdrawal whereas mitragynine did not. Additionally, M. speciosa alkaloid extract significantly decreased dry and wet fecal excretions induced by morphine withdrawal. LFP analysis revealed that morphine significantly decreased alpha (9.7–12Hz) and increased low gamma (30.3–44.9Hz) and high gamma (60.5–95.7Hz) powers in the NAc whereas M. speciosa alkaloid extract did not. Spontaneous motor activity was significantly increased by morphine but not M. speciosa alkaloid extract. ConclusionsTaken together, M. speciosa alkaloid extract, but not mitragynine, attenuated the severity of naloxone-precipitated morphine withdrawal symptoms. Neural signaling in the NAc and spontaneous motor activity were sensitive to morphine but not M. speciosa alkaloid extract. Therefore, treatment with the M. speciosa alkaloid extract may be useful for opiate addiction treatment program.

Telementoring with project ECHO: a pilot study in Europe

The Extension of Community Healthcare Outcomes (ECHO) project is a novel educational intervention designed in New Mexico to transfer subspecialty knowledge about hepatitis C virus (HCV) to primary care providers,...

Opiate Crisis and Healthcare Reform in America: A Review for Nurses

On a daily basis in the United States, patients overdosing on opioids fill our emergency rooms, intensive care units, and, sadly, our cemeteries. Overdose and subsequent death from opioid addiction has reached astonishing numbers and death rates by opioid overdoses continue to rise annually. Nurses are in front line positions to provide assessment for patients with opioid use histories and subsequently connect them to resources that save lives. All nurses face the challenges of caring for patients with addiction issues and have the opportunity to change the stigma regarding addiction. Nurse engagement can influence positive outcomes when addicted individuals are reaching out for resources and treatment. This article reviews changes in opiate usage over time; related information in the Affordable Care Act; and other changes in federal, state and local policy that affect current opiate treatment. Also discussed are considerations for nurses to effect change and potential future policy. In conclusion, with the ever increasing numbers of individuals with opioid addiction, and insufficient availability of opiate treatment programs, our nation is in a race against time to positively impact and reverse this crisis.

Opiate Analgesics as Negative Modulators of Adult Hippocampal Neurogenesis: Potential Implications in Clinical Practice.

During the past decade, studies of the mechanisms and functional implications of adult hippocampal neurogenesis (ahNG) have significantly progressed. At present, it is proposed that adult born neurons may contribute to a variety of hippocampal-related functions, including specific cognitive aspects and mood regulation. Several groups focussed on the factors that regulate proliferation and fate determination of adult neural stem/progenitor cells (NSC/NPC), including clinically relevant drugs. Opiates were the first drugs shown to negatively impact neurogenesis in the adult mammalian hippocampus. Since that initial report, a vast array of information has been collected on the effect of opiate drugs, by either modulating proliferation of stem/progenitor cells or interfering with differentiation, maturation and survival of adult born neurons. The goal of this review is to critically revise the present state of knowledge on the effect of opiate drugs on the different developmental stages of ahNG, as well as the possible underlying mechanisms. We will also highlight the potential impact of deregulated hippocampal neurogenesis on patients undergoing chronic opiate treatment. Finally, we will discuss the differences in the negative impact on ahNG among clinically relevant opiate drugs, an aspect that may be potentially taken into account to avoid long-term deregulation of neural plasticity and its associated functions in the clinical practice.