Chapter 5: Medications Used to Treat Opioid Overdose and Maintenance Treatment Modalities

2018 ◽  
pp. 71-92
Keyword(s):  
Maintenance Treatment ◽  
Treatment Modalities ◽  
Opioid Overdose

Cannabis Use and Nonfatal Opioid Overdose among Patients Enrolled in Methadone Maintenance Treatment

2021 ◽  
Vol 56 (5) ◽  
pp. 697-703
Author(s):  
William C. Bryson ◽  
Benjamin J. Morasco ◽  
Brandi P. Cotton ◽  
Stephen M. Thielke
Keyword(s):  
Methadone Maintenance Treatment ◽  
Maintenance Treatment ◽  
Methadone Maintenance ◽  
Cannabis Use ◽  
Opioid Overdose

scholarly journals Fentanyl Abuse: A Literature Review

2020 ◽  
Vol 5 (1) ◽  
Keyword(s):  
Case Report ◽  
Community Acquired Pneumonia ◽  
Treatment Modalities ◽  
Opioid Overdose ◽  
Opioid Agonist ◽  
Polysubstance Use ◽  
Other Substances ◽  
Control And Prevention ◽  
Life Threatening ◽  
History Of

Background and Objectives: Fentanyl is an opioid agonist with abuse potential. The overdose can begin suddenly, progress to death rapidly, and may have an atypical presentation with body and chest wall rigidity. This article aims to review the consequences of fentanyl abuse alone or in combination with other substances along with available treatment modalities. Methods: A literature search using the keywords “opioid addiction” or “fentanyl abuse” and “fentanyl overdose” and “fentanyl treatment” was conducted on PubMed. Additional data was gathered from the Centers for Disease Control and Prevention and other websites. Finally, 32 out of 310 articles were selected for the review. Our case report highlights the consequences of fentanyl abuse in combination with other substances. Case report: A 32 years old Caucasian female with a history of polysubstance use was admitted for community-acquired pneumonia after overdosing with fentanyl, heroin, and cocaine. Results: Fentanyl is often mixed with other substances and sold as heroin to unsuspecting users. Its abuse may cause life-threatening respiratory failure from an overdose. Discussion and Conclusions: In 2016, approximately 50% who died from an opioid overdose in the US were taking fentanyl, and 57% of those who tested positive for fentanyl or its analogs were positive for other drugs such as heroin. Naloxone kits distribution has reported significant overdose reversals. Scientific Significance: Opioid crisis, declared as an emergency by the federal government, is affecting public health. Prescribers have a major role in reducing overdose deaths by prescribing the lowest, effective dose with the shortest treatment duration.

Methadone maintenance treatment modalities in relation to incidence of HIV: results of the Amsterdam cohort study

AIDS ◽  
1999 ◽  
Vol 13 (13) ◽  
pp. 1711-1716 ◽  
Author(s):  
Miranda W. Langendam ◽  
Giel H.A. van Brussel ◽  
Roel A. Coutinho ◽  
Erik J.C. van Ameijden
Keyword(s):  
Cohort Study ◽  
Methadone Maintenance Treatment ◽  
Maintenance Treatment ◽  
Methadone Maintenance ◽  
Treatment Modalities ◽  
Amsterdam Cohort Study

scholarly journals Sleep-disordered breathing in patients with opioid use disorders in long-term maintenance on buprenorphine-naloxone: A case series

2015 ◽  
Vol 11 (4) ◽  
pp. 363 ◽  
Author(s):  
Jeffrey DeVido, MD ◽  
Hilary Connery, MD, PhD ◽  
Kevin P. Hill, MD, MHS
Keyword(s):  
Daytime Sleepiness ◽  
Sleep Disordered Breathing ◽  
Maintenance Treatment ◽  
Methadone Maintenance ◽  
The United States ◽  
Opioid Overdose ◽  
Opioid Use ◽  
Opioid Agonist ◽  
Opioid Use Disorders ◽  
Disordered Breathing

Background: Rates of opioid overdose deaths are increasing in the United States, leading to intensified efforts to provide medication-assisted treatments for opioid use disorders. It is not clear what effect opioid agonist treatments (ie, the μ-opioid receptor full agonist methadone and the partial agonist buprenorphine) may have on respiratory function. However, sleep-disordered breathing has been documented in methadone maintenance pharmacotherapy, and there is emerging evidence for similar sleep-disordered breathing in buprenorphine and buprenorphine-naloxone maintenance treatment.Objective: To provide further clinical evidence of sleep-disordered breathing emerging in the context of buprenorphine-naloxone maintenance pharmacotherapy.Methods: The authors report two additional cases of sleep-disordered breathing that developed in patients with severe opioid use disorders, treated successfully as outpatients with buprenorphine-naloxone maintenance. Both patients provided written consent for their clinical information to be included in this case report, and elements of their identities have been masked to provide confidentiality.Results: Two adult female patients, who were stable in buprenorphine-naloxone maintenance treatment developed daytime sleepiness, were referred for evaluation and found to have sleep-disordered breathing. One patient's daytime sleepiness improved with reduction in both buprenorphine-naloxone and other sedating medications as well as initiation of a constant positive airway pressure (CPAP) device. However, the other patient could not tolerate decreases in buprenorphinenaloxone and/or CPAP initiation and her daytime sleepiness persisted.Conclusion: Buprenorphine-naloxone maintenance treatment can be associated with sleep-disordered breathing. It can be difficult to differentiate the cause(s) of sleep-disordered breathing among the effects of buprenorphine-naloxone treatment itself, co-occurring conditions, such as obesity and cigarette smoking or other medications, or some combination thereof. Regardless of etiology, sleep-disordered breathing and its consequences present unique challenges to the patient in recovery from an opioid use disorder and therefore warrants careful evaluation and management.

Management of thoracic aortic lesions - the future is endovascular

VASA ◽  
2012 ◽  
Vol 41 (3) ◽  
pp. 163-176 ◽  
Author(s):  
Weidenhagen ◽  
Bombien ◽  
Meimarakis ◽  
Geisler ◽  
A. Koeppel
Keyword(s):  
Thoracic Aorta ◽  
Clinical Decision Making ◽  
Treatment Options ◽  
Clinical Decision ◽  
Clinical Results ◽  
Treatment Modalities ◽  
Traumatic Rupture ◽  
Descending Thoracic Aorta ◽  
New Treatment ◽  
Aneurysm Dissection

Open surgical repair of lesions of the descending thoracic aorta, such as aneurysm, dissection and traumatic rupture, has been the “state-of-the-art” treatment for many decades. However, in specialized cardiovascular centers, thoracic endovascular aortic repair and hybrid aortic procedures have been implemented as novel treatment options. The current clinical results show that these procedures can be performed with low morbidity and mortality rates. However, due to a lack of randomized trials, the level of reliability of these new treatment modalities remains a matter of discussion. Clinical decision-making is generally based on the experience of the vascular center as well as on individual factors, such as life expectancy, comorbidity, aneurysm aetiology, aortic diameter and morphology. This article will review and discuss recent publications of open surgical, hybrid thoracic aortic (in case of aortic arch involvement) and endovascular repair in complex pathologies of the descending thoracic aorta.

Current Strategies in the Management of Spinal Metastatic Disease

Swiss Surgery ◽  
2003 ◽  
Vol 9 (2) ◽  
pp. 55-62 ◽  
Author(s):  
Bartanusz ◽  
Porchet
Keyword(s):  
Spinal Cord ◽  
Surgical Techniques ◽  
Cord Compression ◽  
Treatment Modalities ◽  
Surgical Approaches ◽  
Spinal Stabilization ◽  
Management Algorithm ◽  
Specific Manner ◽  
Extensive Surgery ◽  
Selection Of

The treatment of metastatic spinal cord compression is complex. The three treatment modalities that are currently applied (in a histologically non-specific manner) are surgery, radiotherapy and the administration of steroids. The development of new spinal instrumentations and surgical approaches considerably changed the extent of therapeutic options in this field. These new surgical techniques have made it possible to resect these tumours totally, with subsequent vertebral reconstruction and spinal stabilization. In this respect, it is important to clearly identify those patients who can benefit from such an extensive surgery. We present our management algorithm to help select patients for surgery and at the same time identifying those for whom primary non-surgical therapy would be indicated. The retrospective review of surgically treated patients in our department in the last four years reveals a meagre application of conventional guidelines for the selection of the appropriate operative approach in the surgical management of these patients. The reasons for this discrepancy are discussed.

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