Nasal Opioid Agonist Treatment in Patients with Severe Opioid Dependence: A Case Series

2021 ◽  
Vol 28 (1) ◽  
pp. 80-86
Author(s):  
Marc Vogel ◽  
Patrick Köck ◽  
Johannes Strasser ◽  
Christoph Kalbermatten ◽  
Hannes Binder ◽  
...  
Keyword(s):  
Opioid Dependence ◽  
Case Series ◽  
Rapid Onset ◽  
First Line ◽  
Opioid Agonist ◽  
Onset Of Action ◽  
Opioid Agonist Treatment ◽  
Routes Of Administration ◽  
Alternative Treatment Option ◽  
Insufficient Response

<b><i>Introduction:</i></b> Opioid agonist treatment (OAT) is the first-line treatment for opioid dependence. Currently available OAT options comprise oral (methadone and morphine) and sublingual (buprenorphine) routes of administration. In Switzerland and some other countries, severely opioid-dependent individuals with insufficient response to oral or sublingual OAT are offered heroin-assisted treatment (HAT), which involves the provision of injected or oral medical heroin (diacetylmorphine [DAM]). However, many patients on treatment with injectable DAM (i-HAT) suffer from injection-related problems such as deteriorated vein status, ulcerations, endocarditis, and abscesses. Other patients who do not respond to oral OAT do not inject but snort opioids, and are not eligible for i-HAT. For this population, there is no other short-acting OAT with rapid onset of action available unless they switch to injecting, which is associated with higher risks. Nasal DAM (n-HAT) could be an alternative treatment option suitable for both populations of patients. <b><i>Methods:</i></b> We present a case series of 3 patients on i-HAT who successfully switched to n-HAT. <b><i>Results/Conclusions:</i></b> This is the first description of the clinical use of the nasal route of administration for HAT. n-HAT may constitute an important risk-reduced rapid-onset alternative to i-HAT. In particular, it may be suited for patients with injection-related complications, or noninjecting opioid-dependent patients failing to respond to oral OAT.

scholarly journals Non-Traditional Administration of Remifentanil in an Experimental Setting

2019 ◽  
pp. S97-S103
Author(s):  
A. KURZOVÁ ◽  
J. MÁLEK ◽  
L. HESS ◽  
M. JAČEK ◽  
J. SLÍVA
Keyword(s):  
Arterial Oxygen Saturation ◽  
Pharmacokinetic Profile ◽  
Rapid Onset ◽  
Arterial Oxygen ◽  
Onset Of Action ◽  
Routes Of Administration ◽  
Arterial Blood ◽  
Pharmacokinetic Properties ◽  
Righting Reflex ◽  
Cardiovascular Functions

Remifentanil is ultrashort-acting opioid with a unique pharmacokinetic profile. It is used exclusively intravenously. While considering its rapid onset of action and other pharmacokinetic properties, we decided to assess its effects following administration via non-traditional routes. Rabbits (n=10 per each group) were randomized into six groups: remifentanil 1 μg/kg and 3 μg/kg IM, 5.0 and 10.0 μg/kg conjunctivally, and 10 μg/kg and 25.0 μg/kg intranasally. Sedating effects were assessed via a loss of the righting reflex. Secondary, mean arterial blood pressure, arterial oxygen saturation of hemoglobin, and pulse rate was monitored in all rabbits. Non-traditional routes of administration were shown to provide a rapid onset of action as well as fast recovery. Importantly, the administration of remifentanil did not result in any deterioration of cardiovascular functions.

scholarly journals Prevalence of Opioid Dependence and Opioid Agonist Treatment in the Berlin Custodial Setting: A Cross-Sectional Study

2020 ◽  
Vol 11 ◽  
Author(s):  
Kira von Bernuth ◽  
Peter Seidel ◽  
Julia Krebs ◽  
Marc Lehmann ◽  
Britta Neumann ◽  
...  
Keyword(s):  
Opioid Dependence ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Opioid Agonist ◽  
Cross Sectional ◽  
Opioid Agonist Treatment

scholarly journals Treatment of opioid dependence with buprenorphine: current update

2017 ◽  
Vol 19 (3) ◽  
pp. 299-308 ◽  
Keyword(s):  
Side Effects ◽  
Opioid Dependence ◽  
Maintenance Treatment ◽  
Partial Agonist ◽  
Opioid Antagonist ◽  
Clinical Effects ◽  
Opioid Maintenance Treatment ◽  
First Line ◽  
Opioid Agonist ◽  
Safety Issues

Opioid maintenance treatment is the first-line approach in opioid dependence. Both the full opioid agonist methadone (MET) and the partial agonist buprenorphine (BUP) are licensed for the treatment of opioid dependence. BUP differs significantly from MET in its pharmacology, side effects, and safety issues. For example, the risk of respiratory depression is lower than with MET. The risk of diversion and injection of BUP have been reduced by also making it available as a tablet containing the opioid antagonist naloxone. This review summarizes the clinical effects of BUP and examines possible factors that can support decisions regarding the use of BUP or MET in opioid-dependent people.

scholarly journals Oliceridine as a Novel Selective mu-receptor G-protein Pathway Modulator: A Narrative review

2022 ◽  
Vol 9 (3) ◽  
pp. 3-7
Author(s):  
Uma Advani ◽  
Ravi Prakash ◽  
Parmanand Swami ◽  
Neha Sharma ◽  
Charu Jain ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
G Protein ◽  
English Language ◽  
Opioid Analgesic ◽  
Rapid Onset ◽  
Repeat Dose ◽  
Opioid Agonist ◽  
Onset Of Action ◽  
Previous Response ◽  
Mu Receptor

Abstract Objective: To review the literature on equianalgesic efficacy and better safety(less respiratory depression and gastrointestinal dysfunction) of oliceridine versus opioid analgesic in moderate to severe postoperative pain. Methodology: A comprehensive literature search was conducted in PubMed (January 2021 to March 2021) using keywords as ‘oliceridine’, ‘ligand biased mu receptor agonist’, ‘acute postoperative pain’, ‘conventional opioids’ and ‘morphine’. All English language full text pre-clinical and clinical research articles were searched. In addition, other data source was from ClinicalTrial. Gov. Data Synthesis: Oliceridine is a novel selective µ (mu)-receptor G-protein pathway modulator. G protein biased mu receptor agonists are a new class of opioids exhibiting analgesic properties at par to morphine with less respiratory depressant properties. Oliceridine a first-in-class intravenous (IV) analgesic has received the US FDA approval in August 2020, for management of moderate to severe acute pain in adults. The drug can be administered in cases where the pain is severe enough to require an intravenous opioid and when alternative treatments become inadequate. Oliceridine is an opioid agonist with a rapid onset of action within two to five minutes, was administered via clinician-administered bolus dosing, patient-controlled analgesia (PCA), or a combination of the two. Bolus dosing was initiated at 1 to 2 mg, with supplemental doses of 1 to 3 mg every one to three hours, as needed, based on individual patient need and previous response to oliceridine in management of acute post-operative pain. If oliceridine was administered via PCA, the loading dose was 1.5 mg, the demand dose was 0.5 mg, and the lockout interval (repeat dose)was six minutes. The clinically relevant concentration range of 0 to 35 ng/ml. It is indicated for short-term use only & limited to hospitals or other controlled clinical settings. Oliceridine requires no dosage adjustments in patients with renal impairment as well as in patient with significant medical complications. Therefore, opioids that bias towards G-protein and away from β arrestin signaling should produce analgesia with reduced side effects.

scholarly journals Development of quality indicators for the continued and safe delivery of Opioid Agonist Treatment (OAT), throughout and beyond COVID-19, using a Delphi Consensus technique

2021 ◽  
Vol 4 ◽  
pp. 90
Author(s):  
Gráinne Cousins ◽  
Louise Durand ◽  
Fiona Boland ◽  
Norma Harnedy ◽  
Íde Delargy ◽  
...  
Keyword(s):  
Quality Indicators ◽  
Opioid Dependence ◽  
Clinical Decision Making ◽  
National Level ◽  
Healthcare Delivery ◽  
Unintended Consequences ◽  
Delphi Consensus ◽  
Opioid Agonist ◽  
Opioid Agonist Treatment ◽  
Wide Range

Opioid agonist treatment (OAT) is the most effective treatment for opioid dependence, although it relies heavily on regular face-to-face healthcare delivery. Following the emergence of COVID-19, policies were rapidly changed in Ireland to reduce the risk of contracting the virus for both clients and treatment providers. From March 2020, the Health Service Executive (HSE) National Social Inclusion Office introduced a series of national contingency guidelines, to ensure fast and uninterrupted access to OAT while balancing efforts to mitigate COVID-19 risks. The Programme for Government 2020 states they will retain many of the measures introduced during the COVID-19 pandemic to reduce waiting times in accessing treatment services and reduce overdose mortality. It is therefore essential to examine the impacts, benefits and unintended consequences of the special measures introduced during COVID-19 at a national level, thus informing which measures can and should be sustained throughout and beyond COVID-19 to support effective, safe and patient-centered care promoting the health and wellbeing of all people with opioid dependence. The aim of this project is to identify priorities for quality improvements which will inform clinical decision making throughout and beyond the pandemic. This will be achieved through a Delphi consensus study. Quality indicators will be identified by comparing the national contingency guidelines with the national 2016 Clinical Guidelines. The project steering group will review the proposed indicators, and the agreed quality indicators will be integrated into an on-line Delphi questionnaire. One hundred participants will be invited to form the Delphi consensus panel and will include a wide range of stakeholders, including people accessing OAT services, general practitioners, pharmacists and outreach workers. Evidence generated from this study will inform national policy decisions in relation to improving quality of care in OAT.

scholarly journals Effectiveness and Safety of Low-Threshold Opioid-Agonist Treatment in Hard-To-Reach Populations with Opioid Dependence

2021 ◽  
pp. 1-11
Author(s):  
Fatemeh Chalabianloo ◽  
Christian Ohldieck ◽  
Øystein A. Haaland ◽  
Lars Thore Fadnes ◽  
Kjell Arne Johansson
Keyword(s):  
Healthcare Utilization ◽  
Opioid Dependence ◽  
Treatment Retention ◽  
Retention Rates ◽  
Vulnerable Groups ◽  
Opioid Use ◽  
Opioid Agonist ◽  
Opioid Agonist Treatment ◽  
Fatal Overdose ◽  
Low Threshold

<b><i>Objectives:</i></b> Opioid-use disorder is related to premature death worldwide. Opioid-agonist treatment (OAT) is an effective treatment for opioid dependence. OAT delivery platforms may influence treatment access and outcomes, especially for the most vulnerable groups. The aim of this study was to determine the effectiveness and safety of low-threshold OAT compared to the standard treatment. <b><i>Methods:</i></b> Patients with diagnosed opioid dependence undergoing low-threshold OAT at the Bergen delivery platform in Norway were enrolled in a cohort study in 2014–2019. A national OAT cohort was the reference group. The main outcomes were treatment retention, the use of illicit opioids, non-fatal overdose, overdose death, and all-cause mortality during the first year following treatment initiation and the full treatment period. Additionally, healthcare utilization in the periods before and during OAT was investigated. <b><i>Results:</i></b> Compared to the reference cohort, the low-threshold cohort (<i>n</i> = 128, mean age: 38 years, women: 28%) showed treatment retention rates of 95% versus 92%, illicit opioid use of 7% versus 10%, non-fatal overdose of 7% versus 6%, and death at 1.0% versus 1.3%, respectively. The incident rate ratios (IRRs) for healthcare utilization increased substantially during the OAT period compared to the period before; the IRR increased by 3.3 (95% confidence interval (CI): 2.8, 3.9) and 3.4 (95% CI: 3.1, 3.9) for all in- and outpatient healthcare, respectively. <b><i>Conclusions:</i></b> Low-threshold OAT was at least as effective and safe as the standard OAT in terms of treatment retention, the use of illicit opioids, non-fatal overdose, and death. Healthcare utilization increased during the OAT compared to the period before. Lowering the threshold for OAT entrance within proper delivery platforms should be broadly considered to reduce harm and improve healthcare access among patients with opioid dependence.

scholarly journals A COMPARATIVE STUDY OF CLONIDINE AND DEXMEDETOMIDINE AS ADJUVANT IN NEURAXIAL BLOCK – A CASE SERIES

2020 ◽  
pp. 13-17
Author(s):  
Joshi Nirali K ◽  
Parasmani Parasmani ◽  
Mukesh I. Shukla
Keyword(s):  
Local Anaesthetic ◽  
Anaesthetic Agent ◽  
Case Series ◽  
Rapid Onset ◽  
Saline Group ◽  
Motor Blockade ◽  
Onset Of Action ◽  
Duration Of Action ◽  
Sensory Blockade ◽  
Neuraxial Block

BACKGROUND-Most of the lower abdominal surgeries are performed under spinal anaesthesia which is a popular technique using hyperbaric local anaesthetic solutions such as 0.5% Bupivacaine. The advantages are simplicity of technique, rapid onset of action and reliability in producing uniform sensory and motor blockade. Main disadvantage of using plain local anaesthetic agent arelimited duration of action and lack of longer postoperative analgesia.To overcome this problem, administration of different adjuvant in local anaesthetic is an excellent technique. AIMS-To compare the effect of adding Clonidine and Dexmedetomidine to Bupivacaine for neuraxial block. METHODS-This study was be conducted after the approval of institutional ethical committee. It is a prospective study in which 75 selected patients who were posted for lower abdominal surgeries were randomly allotted into three groups.Group B -Inj.0.5% Heavy Bupivacaine 3.2cc(16 mg) + Inj. Normal saline Group C -Inj.0.5% Heavy Bupivacaine 3.2cc(16 mg) + Inj.Clonidine 30 mcgGroup D -Inj.0.5% Heavy Bupivacaine 3.2cc(16 mg) + Inj.Dexmedetomidine 3 mcg, Total volume injected in all group was 3.5 ml.The end of drug injection was taken as zero time. Onset, duration of sensory blockade, duration of motor blockade was noted. RESULTS –prolonged sensory and motor blockage and superior post-operative analgesia was observed in group D. CONCLUSION- Addition of Dexmeditomidine 3 mcg is significantly more effective than plain 0.5% Bupivacaine or when Clonidine 30mcg was used as adjuvant, for prolongation of sensory and motor blockage and post-operative analgesia.

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