Conclusions. There is enough high quality data to formulate evidence-based guidelines for the treatment of opioid abuse and dependence. This task force report provides evidence for the efficacy of a number of medications to treat opioid abuse and dependence, particularly the opioid agonists methadone or buprenorphine. These medications have great relevance for clinical practice.
PMID: 21486104 [PubMed – in process] (Source: The World Journal of Biological Psychiatry)

Buprenorphine is an effective treatment for opiate dependence. Prisoners with histories of opiate dependence who are inducted on buprenorphine prior to release are at decreased risk of post-release relapse and overdose, yet many clinicians are unaware of the risks related to buprenorphine induction for non-opiate tolerant patients, especially those on other psychotropic medications. The authors report a case of probable non-lethal overdose during dose induction of a non-tolerant prisoner and discuss appropriate dosing under similar circumstances.
(C) 2011 Lippincott Williams & Wilkins, Inc. (Source: Addictive Disorders and Their Treatment)

Conclusions and Scientific Significance: This study further elucidates the effects of TPV/r on glucuronidation. The current evaluation of glucuronide metabolites of BUP and norBUP are suggestive of combined inhibition of Uridine diphosphate (UDP)-glucuronosyltransferase of the 1A family and cytochrome P450 3A4 that spares UGT2B7 leading to a shunting of BUP away from production of norBUP and toward BUP-3G as seen by a statistically significant increase in the AUC of BUP-3G.
PMID: 21438849 [PubMed – as supplied by publisher] (Source: The American Journal of Drug and Alcohol Abuse)

Conclusion  Collaborative care with nurse care managers in an urban primary care practice is an alternative and successful treatment method for most patients with opioid addiction that makes effective use of time for physicians who prescribe buprenorphine. (Source: Archives of Internal Medicine)

Conclusions.  It is difficult to determine if observed differences in abuse potential between intranasal buprenorphine and buprenorphine/naloxone are clinically relevant at the doses tested. Greater bioavailability and faster onset of pharmacodynamic effects compared to sublingual administration suggests a motivation for intranasal misuse in non�dependent opioid abusers. However, significant naloxone absorption from intranasal buprenorphine/naloxone administration may deter the likelihood of intranasal misuse of buprenorphine/naloxone, but not buprenorphine, in opioid dependent individuals. (Source: Addiction)

Administering a benzodiazepine depressant to patients taking buprenorphine/naloxone can be life-threatening. Unfortunately, many ED health care providers are unaware of this potentially lethal combination. The following case study illustrates how these medications, when administered together, can adversely affect patient outcome. (Source: Journal of Emergency Nursing: JEN)

About three years ago, I was attending a national conference on public health (American Public Health Association) and presenting my posters on the relationship between drug use and violence, and sexually transmitted infections and injecting drugs. As I walked the aisles I ran into a woman who runs a Florida addiction “treatment” facility. We talked for a bit about my work, her facility, and then we shared some of our personal stories. Mine included meth addiction, jail, recovery, and now graduate school studying addictions. Everything was great until I mentioned that I now drink alcohol socially… “We’ll save a seat for you” she told me as she handed me her business card. Idiot. Recovery bullies and addiction treatmentAs soon as my version of recovery from addiction didn’t match her expe…

This study compared the ability of buprenorphine (B) and B/N films to suppress spontaneous withdrawal in opioid-dependent volunteers. Participants were maintained on morphine and underwent challenge sessions to confirm sensitivity to naloxone-induced opioid withdrawal. Subjects were randomized to receive either B (16 mg, n = 18) or B/N (16/4 mg, n = 16) soluble films for 5 days. The primary outcome measure was the Clinical Opiate Withdrawal Scale (COWS) score. Thirty-four subjects completed induction onto soluble films. There was a significant decrease in COWS scores but no significant differences between the groups. The results support the use of B and B/N soluble films as safe and effective delivery methods for opioid induction.
PMID: 21270789 [PubMed – as supplied by publisher] (S…

On the Web site of the American Society of Health System Pharmacists (ASHP), the list goes on for pages: atracurium, bumetanide, buprenorphine, clindamycin, cisatracurium, epinephrine, fentanyl, furosemide, lipid emulsion, lidocaine, metronidazole, naloxone, propofol, rocuronium, succinylcholine, sulfamethoxazole-trimethoprim, torsemide, vancomycin hydrochloride, vecuronium. They are all sterile injectable drugs that an emergency physician might use every day, and they and dozens of other drugs—more than 140 in late November—are on the list because they are either unavailable or in extremely short supply. There is a similar though less complete list, bearing 50 names in late November, on the Web site of the Food and Drug Administration (FDA). (Source: Annals of Emergency Medicine)

Conclusions.Australian prescribers perceive most patients adhere with OST, although they may underestimate the levels of diversion. Prescribers’ beliefs about patients’ behaviours are important and influence decisions to prescribe, medication choice and suitability for unsupervised dosing. The uncertainties in assessing and responding to diversion/injection may be a factor deterring prescribers’ participation in OST.[Larance B, Degenhardt L, O’Brien S, Lintzeris N, Winstock A, Mattick RP, Bell J, Ali R. Prescribers’ perceptions of the diversion and injection of medication by opioid substitution treatment patients. Drug Alcohol Rev 2011] (Source: Drug and Alcohol Review)