#Medications for #opioid use #disorders: #clinical and pharmacological #considerations (J Clin Invest., summary)

[Source: Journal of Clinical Investigation, full page: (LINK). Summary, edited.]

Viewpoint / Free access | DOI: 10.1172/JCI134708

Medications for opioid use disorders: clinical and pharmacological considerations

Nora D. Volkow and Carlos Blanco

First published November 25, 2019

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The opioid epidemic, now in its second decade, is one of the most challenging public health crises in the US. Providing an effective response is complicated by multiple underlying causes and consequences as well as a misunderstanding of addiction and the medications used to treat it (1). Indeed, medications for opioid use disorder (MOUDs) are the most effective interventions for treating opioid addiction, but are not prescribed to many who would benefit. Here, we describe the distinction between physical dependence and addiction along with its implication for treatment, and discuss the mechanisms of action of MOUDs.

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Keywords: Opioids; Illicit drugs; Society; USA.

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#Drug #Decriminalization: A Matter of #Justice and #Equity, Not Just Health (Am J Prev Med., abstract)

[Source: American Journal of Preventive Medicine, full page: (LINK). Abstract, edited.]

Drug Decriminalization: A Matter of Justice and Equity, Not Just Health

Hakique N. Virani, MD1, Rebecca J. Haines-Saah, PhD2

DOI: https://doi.org/10.1016/j.amepre.2019.08.012

Published online: November 15, 2019

 

Abstract

Since 2016, more than 10,300 Canadians have died of an apparent opioid-related overdose, with the majority involving fentanyl or fentanyl analogs.1 This unprecedented public health crisis has decreased life expectancy at birth in the country’s most affected provinces of Alberta and British Columbia.2 Concerned by this epidemic of overdoses, Canadian advocates for drug policy reform have welcomed the recent recommendation from British Columbia’s Provincial Health Officer that drug possession for personal use be decriminalized.

© 2019 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Keywords: Opioids; Illicit drugs; Society; Canada.

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#Global #patterns of #opioid use and dependence: #harms to populations, interventions, and future action (Lancet, abstract)

[Source: The Lancet, full page: (LINK). Abstract, edited.]

Global patterns of opioid use and dependence: harms to populations, interventions, and future action

Prof Louisa Degenhardt, PhD, Prof Jason Grebely, PhD, Jack Stone, PhD, Prof Matthew Hickman, PhD, Prof Peter Vickerman, PhD, Brandon D L Marshall, PhD, Prof Julie Bruneau, MD, Prof Frederick L Altice, MD, Prof Graeme Henderson, PhD, Prof Afarin Rahimi-Movaghar, PhD, Sarah Larney, PhD

Published: October 23, 2019 / DOI: https://doi.org/10.1016/S0140-6736(19)32229-9

 

Summary

We summarise the evidence for medicinal uses of opioids, harms related to the extramedical use of, and dependence on, these drugs, and a wide range of interventions used to address these harms. The Global Burden of Diseases, Injuries, and Risk Factors Study estimated that in 2017, 40·5 million people were dependent on opioids (95% uncertainty interval 34·3–47·9 million) and 109 500 people (105 800–113 600) died from opioid overdose. Opioid agonist treatment (OAT) can be highly effective in reducing illicit opioid use and improving multiple health and social outcomes—eg, by reducing overall mortality and key causes of death, including overdose, suicide, HIV, hepatitis C virus, and other injuries. Mathematical modelling suggests that scaling up the use of OAT and retaining people in treatment, including in prison, could avert a median of 7·7% of deaths in Kentucky, 10·7% in Kiev, and 25·9% in Tehran over 20 years (compared with no OAT), with the greater effects in Tehran and Kiev being due to reductions in HIV mortality, given the higher prevalence of HIV among people who inject drugs in those settings. Other interventions have varied evidence for effectiveness and patient acceptability, and typically affect a narrower set of outcomes than OAT does. Other effective interventions focus on preventing harm related to opioids. Despite strong evidence for the effectiveness of a range of interventions to improve the health and wellbeing of people who are dependent on opioids, coverage is low, even in high-income countries. Treatment quality might be less than desirable, and considerable harm might be caused to individuals, society, and the economy by the criminalisation of extramedical opioid use and dependence. Alternative policy frameworks are recommended that adopt an approach based on human rights and public health, do not make drug use a criminal behaviour, and seek to reduce drug-related harm at the population level.

Keywords: Opioids; Public Health; Society; Psychiatry.

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#Geographic, Temporal, and #Sociodemographic #Differences in #Opioid #Poisoning (Am J Prev Med., abstract)

[Source: American Journal of Preventive Medicine, full page: (LINK). Abstract, edited.]

Geographic, Temporal, and Sociodemographic Differences in Opioid Poisoning

Elinor R. Schoenfeld, PhD1,2, George S. Leibowitz, PhD, LICSW3, Yu Wang, BE4, Xin Chen, PhD4, Wei Hou, PhD1, Sina Rashidian, BS4, Mary M. Saltz, MD2,5, Joel H. Saltz, MD, PhD2, Fusheng Wang, PhD2,4

Open Access / DOI: https://doi.org/10.1016/j.amepre.2019.03.020

 

Abstract

Introduction

Not enough is known about the epidemiology of opioid poisoning to tailor interventions to help address the growing opioid crisis in the U.S. The objective of this study is to expand the current understanding of opioid poisoning through the use of data analytics to evaluate geographic, temporal, and sociodemographic differences of opioid poisoning– related hospital visits in a region of New York State with high opioid poisoning rates.

Methods

This retrospective cohort study utilized patient-level New York State all-payer hospital data (2010–2016) combined with Census data to evaluate geographic, patient, and community factors for 9,714 Long Island residents with an opioid poisoning–related inpatient or outpatient hospital facility discharge. Temporal, 7-year opioid poisoning rates and trends were evaluated, and geographic maps were generated. Overall, significance tests and tests for linear trend were based upon logistic regression. Analyses were completed between 2017 and 2018.

Results

Since 2010, Long Island and New York State opioid poisoning hospital visit rates have increased 2.5- to 2.7-fold (p<0.001). Opioid poisoning hospital visit rates decreased for men, white patients, and self-payers (p<0.001) and increased for Medicare payers (p<0.001). Communities with high opioid poisoning rates had lower median home values, higher percentages of high school graduates, were younger, and more often white patients (p<0.01). Maps displayed geographic patterns of communities with high opioid poisoning rates overall and by age group.

Conclusions

Findings highlight the changing demographics of the opioid poisoning epidemic and utility of data analytics tools to identify regions and patient populations to focus interventions. These population identification techniques can be applied in other communities and interventions.

Keywords: Opioids; Illicit drugs; Society; USA.

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Association between #medical #cannabis #laws and #opioid #overdose #mortality has reversed over time (Proc Natl Acad Sci USA, abstract)

[Source: Proceedings of the National Academy of Sciences of the United States of America, full page: (LINK). Abstract, edited.]

Association between medical cannabis laws and opioid overdose mortality has reversed over time

Chelsea L. Shover, Corey S. Davis, Sanford C. Gordon, and Keith Humphreys

PNAS first published June 10, 2019 / DOI: https://doi.org/10.1073/pnas.1903434116

Edited by Kenneth W. Wachter, University of California, Berkeley, CA, and approved May 16, 2019 (received for review February 27, 2019)

 

Abstract

Medical cannabis has been touted as a solution to the US opioid overdose crisis since Bachhuber et al. [M. A. Bachhuber, B. Saloner, C. O. Cunningham, C. L. Barry, JAMA Intern. Med. 174, 1668–1673] found that from 1999 to 2010 states with medical cannabis laws experienced slower increases in opioid analgesic overdose mortality. That research received substantial attention in the scientific literature and popular press and served as a talking point for the cannabis industry and its advocates, despite caveats from the authors and others to exercise caution when using ecological correlations to draw causal, individual-level conclusions. In this study, we used the same methods to extend Bachhuber et al.’s analysis through 2017. Not only did findings from the original analysis not hold over the longer period, but the association between state medical cannabis laws and opioid overdose mortality reversed direction from −21% to +23% and remained positive after accounting for recreational cannabis laws. We also uncovered no evidence that either broader (recreational) or more restrictive (low-tetrahydrocannabinol) cannabis laws were associated with changes in opioid overdose mortality. We find it unlikely that medical cannabis—used by about 2.5% of the US population—has exerted large conflicting effects on opioid overdose mortality. A more plausible interpretation is that this association is spurious. Moreover, if such relationships do exist, they cannot be rigorously discerned with aggregate data. Research into therapeutic potential of cannabis should continue, but the claim that enacting medical cannabis laws will reduce opioid overdose death should be met with skepticism.

medical cannabis – opioid overdose – public policy

Keywords: Illicit drugs; Society; USA; Opioids; Cannabis.

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#Opioid–galanin #receptor heteromers differentiate the #dopaminergic effects of #morphine and #methadone (J Clin Invest., abstract)

[Source: Journal of Clinical Investigation, full page: (LINK). Abstract, edited.]

Opioid–galanin receptor heteromers differentiate the dopaminergic effects of morphine and methadone

Randal A. Serafini and Venetia Zachariou

First published May 28, 2019

 

Abstract

As the opioid addiction crisis reaches epidemic levels, the identification of opioid analgesics that lack abuse potential may provide a path to safer treatment of chronic pain. Preclinical studies have demonstrated that galanin affects physical dependence and rewarding actions associated with morphine. In the brain and periphery, galanin and opioids signal through their respective GPCRs, GalR1–3 and the μ-opioid receptor (MOR). In this issue of the JCI, Cai and collaborators reveal that heteromers between GalR1 and MOR in the rat ventral tegmental area attenuate the potency of methadone, but not other opioids, in stimulating the dopamine release that produces euphoria. These studies help us understand why some synthetic opioids, such as methadone, do not trigger the release of dopamine in the mesolimbic system but still possess strong analgesic properties.

Keywords: Opioids; Dopamine; Neurology; Psychiatry.

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Changing #Trends in #Opioid #Overdose #Deaths and #Prescription Opioid Receipt Among #Veterans (Am J Prev Med., abstract)

[Source: American Journal of Preventive Medicine, full page: (LINK). Abstract, edited.]

Changing Trends in Opioid Overdose Deaths and Prescription Opioid Receipt Among Veterans

Lewei (Allison) Lin, MD, MS1,2, Talya Peltzman, MPH3, John F. McCarthy, PhD, MPH1,2,3, Elizabeth M. Oliva, PhD4,5, Jodie A. Trafton, PhD4,5, Amy S.B. Bohnert, PhD, MHS1,2

DOI: https://doi.org/10.1016/j.amepre.2019.01.016

Published online: May 22, 2019

 

Abstract

Introduction

To inform overdose prevention, this study assessed both recent trends in opioid overdose mortality across opioid categories and receipt of prescription opioid analgesics among Veterans who died from overdose in the Veterans Health Administration.

Methods

Using Veterans Health Administration records linked to National Death Index data, annual cohorts (2010–2016) of Veterans who received Veterans Health Administration care were obtained and were examined by opioid overdose categories (natural/semisynthetic opioids, heroin, methadone, and other synthetic opioids) on (1) overdose rates and changes in rates adjusted for age, sex, and race/ethnicity; and (2) Veterans Health Administration prescription opioid receipt. Analyses were conducted in 2018.

Results

The overall rate of opioid overdose among Veterans increased from 14.47 per 100,000 person-years in 2010 to 21.08 per 100,000 person-years in 2016 (adjusted rate ratio=1.65, 95% CI=1.51, 1.81). There was a decline in methadone overdose (adjusted rate ratio=0.66, 95% CI=0.51, 0.84) and no significant change in natural/semisynthetic opioid overdose (adjusted rate ratio=1.08, 95% CI=0.94, 1.24). However, the synthetic opioid overdose rate (adjusted rate ratio=5.46, 95% CI=4.41, 6.75) and heroin overdose rate (adjusted rate ratio=4.91, 95% CI=3.92, 6.15) increased substantially. Among all opioid overdose decedents, prescription opioid receipt within 3 months before death declined from 54% in 2010 to 26% in 2016.

Conclusions

Opioid overdose rates among Veterans Health Administration Veterans increased because of increases in heroin and synthetic opioid overdose rates. Prescriptions of opioids declined among patients who died from all categories of opioid overdose; by 2016, only a minority received an opioid analgesic from Veterans Health Administration within 3 months of overdose. Future prevention efforts should extend beyond patients actively receiving opioid prescriptions.

Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine.

Keywords: Opioids; Heroin; Drugs overdose; USA; Society.

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