1/50. Opioid withdrawal during risperidone treatment.A small but significant percentage of opioid-dependent patients will require neuroleptic treatment. Several classes of drugs have been shown to affect opioid metabolism. Two patients who were hospitalized with a diagnosis of opioid dependence received concomitant treatment with opioids and risperidone. After receiving risperidone for several days, both patients exhibited symptoms of opioid withdrawal despite having no change in their opioid doses. These withdrawal symptoms resolved soon after risperidone was discontinued. This finding suggests the possibility that risperidone may precipitate opioid withdrawal in opioid-dependent patients.- - - - - - - - - - ranking = 1keywords = dependence (Clic here for more details about this article) |
2/50. Report on intrauterine drug exposure during second trimester of pregnancy in a heroin-associated death.A 17-year-old girl was found dead in a public toilet with fresh needle puncture marks. She was 18-20 weeks pregnant with a male fetus. Drug screening of her blood and urine indicated recent heroin use. Chronic drug use was confirmed by hair analysis. amniotic fluid as well as fetal and maternal tissues and body fluids were analyzed by GC/MS and HPLC. All the fetal specimens were investigated, and the following levels of drugs were found: 6-monoacetyl-morphine (blood: 152 ng/g; amniotic fluid: 128 ng/g; brain: 140 ng/g; lung: 110 ng/g; liver: 2 ng/g; kidney: 40 ng/g), morphine (blood: 1360 ng/g; amniotic fluid: 604 ng/g; brain: 710 ng/g; lung: 1030 ng/g; liver: 2060 ng/g; kidney: 1100 ng/g), codeine (blood: 70 ng/g; brain: 60 ng/g; lung: 60 ng/g; liver: 90 ng/g; kidney: 70 ng/g), and morphine-3-glucuronide (amniotic fluid: 209 ng/g; brain: 170 ng/g; lung: 325 ng/g; kidney: 231 ng/g). morphine-6-glucuronide was present in the maternal circulation but could not be detected in the fetal circulation.- - - - - - - - - - ranking = 0.63464868824471keywords = heroin (Clic here for more details about this article) |
3/50. A therapeutic use of the methadone fluvoxamine drug interaction.BACKGROUND: methadone has been effectively used in the treatment of opiate dependence. Adequate dose and blood level have correlated with success in treatment. A number of factors including the regular use of alcohol, medications, and urinary pH can influence blood level and thereby effectiveness. fluvoxamine has been shown to increase methadone blood levels. methods: Single case report. RESULTS: A patient unable to maintain an effective methadone blood level despite a dose of 200 mg per day was administered fluvoxamine with subsequent increase in her methadone blood level and reduction of opiate withdrawal symptoms. CONCLUSIONS: In patients unable to maintain an effective methadone blood level throughout the dosing interval, fluvoxamine can help increase the methadone blood level and alleviate opiate withdrawal symptoms.- - - - - - - - - - ranking = 1keywords = dependence (Clic here for more details about this article) |
4/50. methadone detoxification of tramadol dependence.tramadol hydrochloride is a centrally acting analgesic with a partial affinity for the opiate receptor (mu), having an analgesic potency estimated to be one tenth that of morphine. While preclinical investigations suggested that abuse liability associated with tramadol use is low, there are increasing numbers of cases reported to the U.S. food and Drug Administration of abuse, dependence, and withdrawal associated with tramadol use. A case of a patient with tramadol dependence requiring detoxification with methadone is presented. Acute management of significant tramadol dependence has not yet been reported in the literature. Long-term treatment issues are also discussed.- - - - - - - - - - ranking = 7keywords = dependence (Clic here for more details about this article) |
5/50. Chronic pain management: evaluating the use of opioids.A patient with chronic pain who is on multiple medications raises important questions for the case manager. Is the patient's underlying problem actually pain, or is it addiction? Has the patient been thoroughly evaluated? Does the patient have a coordinated management plan, or are several physicians independently writing prescriptions and recommending treatment? How can the case manager facilitate appropriate management?- - - - - - - - - - ranking = 1.7082308401709keywords = addiction (Clic here for more details about this article) |
6/50. A pilot study into the problematic use of opioid analgesics in chronic non-cancer pain patients.Controversy surrounds the use of strong opioid analgesic drugs for chronic non-cancer pain. Specialists have concluded that fears of problematic drug use are often unfounded. In contrast, others claim the existence of significant problems.'Problematic drug use' includes the following definitions; addiction, abuse, physiological dependence and tolerance.We present a case study and the results of a pilot, longitudinal, cohort study, via a pilot questionnaire, of 22 chronic pain clinic patients following a trial of opioid drugs.The results suggest that chronic non-cancer pain patients can be maintained on opioids with few problems, and likewise can withdraw with minimal adverse effects, other than a return of pain.- - - - - - - - - - ranking = 2.7082308401709keywords = addiction, dependence (Clic here for more details about this article) |
7/50. Complications of ultrarapid opioid detoxification with subcutaneous naltrexone pellets.Rapid and ultrarapid opioid detoxification (ROD and UROD) centers promise quick, painless, same-day detoxification treatment for patients with opioid addiction. The goal of ROD and UROD is to provide a rapid transition from opioid dependency to oral naltrexone therapy. The patient is given general anesthesia and high-dose opioid antagonists. This induces a severe withdrawal but spares the patient the experience. In theory, the process is complete within four to five hours. The patient awakens without opioid dependency and is started on oral naltrexone. Any subsequent, persistent withdrawal symptoms are treated symptomatically. A novel, unapproved approach is to compound a pellet of naltrexone and implant it in the subcutaneous tissue. In theory, this should result in continuous therapeutic levels for this drug, and avoid issues with noncompliance. CASE SERIES: This article reports six cases of complications from the same detoxification center that performed UROD with naltrexone pellet implantation, including pulmonary edema, prolonged withdrawal, drug toxicity, withdrawal from cross-addiction to alcohol and benzodiazepines, variceal rupture, aspiration pneumonia, and death. CONCLUSIONS: The risks of this procedure are great and further studies should assess its safety and the novel use of naltrexone.- - - - - - - - - - ranking = 3.4164616803418keywords = addiction (Clic here for more details about this article) |
8/50. Treatment of comorbid opiate addiction and attention-deficit hyperactivity disorder (residual type) with moclobemide: a case report.moclobemide is a specific and reversible monoamine oxidase-A (MAO-A) inhibitor. Studies show that it is an effective and well-tolerated treatment for attention-deficit hyperactivity disorder (ADHD). A number of reports suggest that ADHD may have a causal influence on the development of substance use disorders. The authors describe the use of moclobemide in a 27-year-old patient with comorbid opiate addiction and ADHD (residual type). The positive clinical response shown suggests that moclobemide may have a particular interest in the treatment of drug-dependent patients with current ADHD.- - - - - - - - - - ranking = 8.5411542008544keywords = addiction (Clic here for more details about this article) |
9/50. Ethical perspectives: opioid treatment of chronic pain in the context of addiction.The authors apply eight ethical domains of analysis to the question of treatment of chronic pain with opioids in patients with histories of substance use disorders: autonomy, nonmaleficence, beneficence, justice, medical condition, patient preference, quality of life, and consideration of specific individual or sociocultural issues. These eight domains are drawn from principle-based and case-based ethical perspectives. The domains are developed by review of available literature and through application to a specific presented case. Factors that interfere with rational, ethical decision-making regarding opioid pain management are identified. chronic pain and substance use disorders share a history of stigmatization, underdiagnosis, and undertreatment. Using the presented case as a point of departure, the authors discuss principles for prescription of opioids for treatment of chronic noncancer pain in the setting of history of substance use disorders.- - - - - - - - - - ranking = 6.8329233606835keywords = addiction (Clic here for more details about this article) |
10/50. Neonatal outcome following buprenorphine maintenance during conception and throughout pregnancy.AIMS: To assess the effects of maternal buprenorphine treatment at conception and during pregnancy on neonates in terms of birth outcomes and neonatal abstinence syndrome (NAS). DESIGN AND SETTING: Prospective, open-label, out-patient maintenance, case report study, conducted at the drug addiction out-patient clinic at the University Hospital Vienna. PARTICIPANTS: Two buprenorphine-maintained pregnant women who had conceived during buprenorphine treatment. Both patients had previously given birth to healthy neonates following induction on to buprenorphine maintenance therapy in the second trimester. MEASUREMENTS: mothers: urinalysis. Neonates: gestational age at delivery, Apgar scores, birth weight, length and NAS (Finnegan Scale). FINDINGS: Urinalyses were negative for both women for 25 and 38 months, respectively, during the pregnancy period. There were no complications during the course of the pregnancy. The newborns delivered by both women were healthy, birth outcomes were within normal ranges and there were no NAS symptoms requiring treatment. CONCLUSIONS: To our knowledge this is the first report detailing the pregnancies of women treated with buprenorphine at the time of conception and investigated in a prospective study. The NAS noted in neonates born to buprenorphine-maintained mothers appears to be less severe than the NAS observed in neonates born to methadone-maintained mothers. These preliminary data indicate that, in our patient cohort, buprenorphine maintenance at the time of conception and during pregnancy did not seem to affect birth outcome measurements such as pregnancy complications, week of delivery, birth weight, length, umbilical pH or neurodevelopmental progress. Future prospective studies with larger study populations are warranted.- - - - - - - - - - ranking = 1.7082308401709keywords = addiction (Clic here for more details about this article) |
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