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More Complex Patients
Published in Pamela E. Macintyre, Stephan A. Schug, Acute Pain Management, 2021
Pamela E. Macintyre, Stephan A. Schug
In patients with a physiological opioid dependence, withdrawal may occur as soon as four to six hours after the last dose of a short-acting opioid but will occur later if methadone or slow-release (SR) opioid preparations are ceased. Prevention of withdrawal syndrome is discussed later in this chapter.
Working with People in Contact with the Criminal Justice System and in Secure Environments
Published in James Matheson, John Patterson, Laura Neilson, Tackling Causes and Consequences of Health Inequalities, 2020
Integrated teamwork is important in the assessment and delivery of care to people coming into prison with substance misuse problems. Immediate risk and needs are identified in reception by the substance misuse nurse. If medication is required to assist withdrawal, it will be initiated in reception, in collaboration with the prison GP. Regular monitoring for withdrawal will then be undertaken during the first few days in prison for those stabilising on medication, or if there is some uncertainty about whether or not a prescription will be required to alleviate symptoms of withdrawal. In addition to clinical input, psychosocial support is an important aspect of the pathway to recovery from substance misuse. Management of opioid dependence has been referred to above. Further details of treatment for all types of substance misuse, including alcohol misuse can be found in the Drug Misuse and Dependence: UK Guidelines on Clinical Management 2017 [22]. For some substances, including cocaine, NPS and cannabis there are no specific medications recommended to alleviate withdrawal symptoms.
Diversification endangered
Published in Jane Fountain, Dirk J Korf, Drugs in Society, 2019
In Austria, 20,000 to 30,000 people are considered to be problematic drug consumers.19 Medication-assisted treatment of opioid dependence with methadone was made available in 1987, followed by the official registration for that purpose of slow-release morphine and buprenorphine in 1998. A small proportion of substituted clients also receive codeine or dihydrocodeine in a slow-release formulation. The Austrian model is different from others in Europe because of the availability of different opioids for maintenance treatment. Until the latest developments, it also differed from other maintenance models with regard to the legal regulation of the dispersion of the substances. The Austrian Substitution Act makes them available under a common set of rules and regulations, and this derives from the interpretation of the nature of the drug problem. Since heroin addiction, like all other substance dependencies, is classified as an illness in Austria, substitution treatment represents a special form of an essentially medical intervention. According to this interpretation, diversified prescribing practices in Austria are following the rules of good medical practice. If a range of effective and suitable substances is available for the treatment of an illness, prescription cannot be restricted to one substance. It has to be matched with the characteristics and needs of the individual client.
Opioids for chronic low back pain management: a Bayesian network meta-analysis
Published in Expert Review of Clinical Pharmacology, 2021
Filippo Migliorini, Nicola Maffulli, Alice Baroncini, Jörg Eschweiler, Markus Tingart, Valentin Quack
Despite being potent analgesics, the use of opiates is linked to a high rate of AEs, often involving the GI tract. While patients often develop tolerance toward nausea within a week of treatment [40], this is not the case for constipation, which usually persists despite treatment with laxative and has a substantial impact on the patients’ quality of life [41,42]. AEs can lead to discontinuation of the treatment in long-term settings [29,43], in turn causing uncontrolled pain and consequently to anxiety and depression [44]. On the other hand, opiates produce physical dependence with prolonged use: the fear of withdrawal symptoms can contribute to opioid dependence, and in some patients, these medications can also induce addiction driven by their rewarding effects [25]. Given the increasing misuse and abuse of strong opioids, these compounds have been classified as third-line treatments [29,45].
The who, the what, and the how: A description of strategies and lessons learned to expand access to medications for opioid use disorder in rural America
Published in Substance Abuse, 2021
Evan S. Cole, Ellen DiDomenico, Sherri Green, Susan K. R. Heil, Tandrea Hilliard, Sarah E. Mossburg, Andrew L. Sussman, Jack Warwick, John M. Westfall, Linda Zittleman, Julie G. Salvador
In 2017, the United States (US) Department of Health and Human Services declared addiction to prescription and illicit opioids a public health emergency.1 In that year, an average of 130 overdose deaths involving opioids occurred each day; six times the rate in 1999.2 To treat opioid use disorder (OUD), the standard of care involves the use of Food and Drug Administration (FDA)-approved medications, including opioid agonist (buprenorphine, methadone) and/or antagonist (naltrexone), combined with behavioral therapies.3 These medications are referred to as Medications for Opioid Use Disorder (MOUD). More recently the World Health Organization defined this care as Psychosocially Assisted Pharmacological Treatment of Opioid Dependence,4 which emphasizes the importance of the medications in the treatment of OUD and helps reduce perceived barriers to providing MOUD in settings with limited access to behavioral health care.
Healthcare utilization and cost burden among women with endometriosis by opioid prescription status in the first year after diagnosis: a retrospective claims database analysis
Published in Journal of Medical Economics, 2020
S. As-Sanie, A. M. Soliman, K. Evans, N. Erpelding, R. Lanier, NP Katz
Outcome variables were aggregated for 12 months following the index date for each patient and included total healthcare costs (aggregate inpatient, outpatient, and pharmacy costs), endometriosis-related healthcare costs (inpatient and outpatient costs accompanied by an ICD-9/ICD-10 code for endometriosis), total healthcare utilization (average length of stay [days], inpatient visits, outpatient visits, emergency department [ED] visits, pharmacy visits, surgery-related visits), and measures of opioid misuse (opioid abuse, opioid overdose, and opioid dependence; codes listed in Supplementary Table 1). Surgery-related visits include any inpatient, outpatient, and ED visits associated with any surgery Current Procedural Terminology (CPT) code. Of note, claims data do not provide a clear insight as to the significance of a diagnosis of “opioid dependence,” now termed “opioid use disorder” as per the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Therefore, the term opioid dependence in this analysis strictly refers to the diagnostic code in the claims database and does not necessarily reflect a single definition of opioid dependence.