W-18
Last August, Canadian police seized 110 illegal fentanyl pills at a home in Alberta province. Yesterday, Global News reported that some of the pills have tested positive for an extremely potent opioid called W-18.
This is certainly a disturbing development, since W-18 is a μ-receptor agonist 100 times more potent than fentanyl. According to B.C. Centre for Disease Control, W-18 is one of a series of 32 synthetic opioids discovered in the 1980s at the University of Alberta. W1 thru W19 are pure μ-receptor agonists; W20 thru W32 are agonist-antagonists (as is buprenorphine.)  W-18 seems to be the most powerful agonist of the group.
The ‘W’ compounds have never been used clinically, and there has been virtually no scientific study of their actions, adverse effects, or reve…

W-18
Last August, Canadian police seized 110 illegal fentanyl pills at a home in Alberta province. Yesterday, Global News reported that some of the pills have tested positive for an extremely potent opioid called W-18.
This is certainly a disturbing development, since W-18 is a μ-receptor agonist 100 times more potent than fentanyl. According to B.C. Centre for Disease Control, W-18 is one of a series of 32 synthetic opioids discovered in the 1980s at the University of Alberta. W1 thru W19 are pure μ-receptor agonists; W20 thru W32 are agonist-antagonists (as is buprenorphine.)  W-18 seems to be the most powerful agonist of the group.
The ‘W’ compounds have never been used clinically, and there has been virtually no scientific study of their actions, adverse effects, or reve…

Objectives: The aim of the study was to evaluate buprenorphine-naloxone effects on the QTc in youth with opioid dependence. Buprenorphine is a partial agonist that is an effective treatment for opioid dependence. Compared with methadone, it has a lower risk of QTc prolongation in adults, but is less studied in the youth. It may also reduce the risk of torsades de pointes (TdP)—an uncommon variant of polymorphic ventricular tachycardia—that can result in syncope, ventricular fibrillation, and sudden death.
Methods: Secondary analysis of the electrocardiogram data from 95 individuals who participated in a multisite trial for youth with opioid dependence. The participants were randomized to a 2-week (DETOX) or a 12-week course of buprenorphine-naloxone (BUP). At baseline, 12-lead electro…

Objectives: The aim of the study was to evaluate buprenorphine-naloxone effects on the QTc in youth with opioid dependence. Buprenorphine is a partial agonist that is an effective treatment for opioid dependence. Compared with methadone, it has a lower risk of QTc prolongation in adults, but is less studied in the youth. It may also reduce the risk of torsades de pointes (TdP)—an uncommon variant of polymorphic ventricular tachycardia—that can result in syncope, ventricular fibrillation, and sudden death.
Methods: Secondary analysis of the electrocardiogram data from 95 individuals who participated in a multisite trial for youth with opioid dependence. The participants were randomized to a 2-week (DETOX) or a 12-week course of buprenorphine-naloxone (BUP). At baseline, 12-lead electro…

CONCLUSIONS: The core components of our approach-biopsychosocial assessment and multimodal treatment planning with an emphasis on promoting functional goals and safety using clear communication and a patient-centered stance-should guide providers in the management of similar clinical scenarios. More evidence is needed to definitively guide specific interventions and points of clinical equipoise.
PMID: 26818474 [PubMed – in process] (Source: Addiction Science and Clinical Practice)

CONCLUSIONS: The core components of our approach-biopsychosocial assessment and multimodal treatment planning with an emphasis on promoting functional goals and safety using clear communication and a patient-centered stance-should guide providers in the management of similar clinical scenarios. More evidence is needed to definitively guide specific interventions and points of clinical equipoise.
PMID: 26818474 [PubMed – in process] (Source: Addiction Science and Clinical Practice)

A group of researchers at Boston Medical Center recently looked at nearly 3,000 patients who had survived an opioid-related overdose between 2000 and 2012. According to their recently published study, over 90% of these patients continued to receive opioid medications from doctors — even after their overdose. Given the soaring numbers of opioid-related overdose deaths and heightened scrutiny on how these medications are being over-prescribed, the study findings are alarming and disturbing.
The researchers identified almost 3,000 patients nationwide who had had a nonfatal overdose while being treated with opioid medications for chronic pain. These patients were followed for 300 days, on average, after their overdose. During those 300 days, an additional 7% of the patients overdosed a secon…

A group of researchers at Boston Medical Center recently looked at nearly 3,000 patients who had survived an opioid-related overdose between 2000 and 2012. According to their recently published study, over 90% of these patients continued to receive opioid medications from doctors — even after their overdose. Given the soaring numbers of opioid-related overdose deaths and heightened scrutiny on how these medications are being over-prescribed, the study findings are alarming and disturbing.
The researchers identified almost 3,000 patients nationwide who had had a nonfatal overdose while being treated with opioid medications for chronic pain. These patients were followed for 300 days, on average, after their overdose. During those 300 days, an additional 7% of the patients overdosed a secon…

Preoperative narcotic use has been associated with poor outcomes following total joint arthroplasty (TJA). The purpose of this study is to compare clinical outcomes of patients undergoing elective TJA while concurrently being treated with methadone or buprenorphine/naloxone for prior heroin addiction to a matched control group. (Source: The Journal of Arthroplasty)

Preoperative narcotic use has been associated with poor outcomes after total joint arthroplasty (TJA). The purpose of this study is to compare clinical outcomes of patients undergoing elective TJA while concurrently being treated with methadone or buprenorphine/naloxone for prior heroin addiction to a matched control group. (Source: The Journal of Arthroplasty)