Opioids

Research Update

Does Extended-Release Naltrexone Worsen Psychiatric Symptoms?

Topics: Naltrexone | Opioids | Research Update

Review of: Latif Z et al, JAMA Psychiatry 2019;76(2):127–134 Extended-release (XR) naltrexone (Vivitrol) is an injectable version of naltrexone that lasts for 4 weeks and is FDA approved for opioid use disorder (OUD). Although effective, there is some concern that XR naltrexone may cause or worsen psychiatric symptoms because of its opioid blockade

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Expert Q&A

Perioperative Management of Patients on Buprenorphine Maintenance

Topics: Addiction | Addiction Treatment | Buprenorphine | Medical Comorbidities | Medication | Opioid epidemic | Opioid Use Disorder | Opioids | Pain | Pharmacology | Suboxone | Substance Use | Substance use disorders

CATR: Can you tell us about your background? Dr. Acampora: I used to work as a cardiac anesthesiologist. Later, my interest turned to addiction medicine, and I trained in psychiatry and addiction psychiatry. I currently work in a pain clinic where I helped develop a strategy for managing buprenorphine in the perioperative period. CATR: Where does th

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Clinical Update

An Unexpected Opioid: Loperamide Misuse

Topics: Free Articles | Opioids | Over the counter medication | safety | Side Effects

Loperamide, a common antidiarrheal available at pharmacies across the country, has unexpectedly become one of the latest in a growing trend of over-the-counter medications being repurposed for recreational use. Over the past 10 years, the broader public has discovered that supratherapeutic doses of loperamide can result in opioid-like euphoric effects.

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In Brief

The Other Pandemic

Topics: Opioids | Stimulants

Predictions that overdose mortality would worsen during the COVID-19 pandemic have unfortunately proven accurate. Recent data outlined in an alert by the CDC show that rates of overdose deaths from opioids and stimulants accelerated at an alarming rate between March and May 2020, the period coinciding with widespread lockdowns (www.tinyurl.com/4ductzzx)

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Clinical Update

Perioperative Pain Management in Opioid Use Disorder

Topics: Buprenorphine | Collaborative care | Free Articles | Methadone | Opioid Use Disorder | Opioids | Pain

When your patients with opioid use disorder (OUD) develop pain due to medical illness or trauma, pain management can get tricky. When they seek pain control, they may be perceived as “drug seeking” in medical settings. Studies have shown that providing adequate pain management for these patients is a particular challenge (Department of Veterans Affa

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Clinical Update

Management of Opioid Withdrawal in the Emergency Setting

Topics: Collaborative care | Detoxification | Harm reduction | Opioid Use Disorder | Opioids | Withdrawal

Opioid withdrawal is being seen more frequently in emergency settings. From 2005 to 2014, it is estimated that the rate of US emergency department (ED) visits due to opioids doubled from 89.1 per 100,000 people to 177.7 per 100,000 (Agency for Healthcare Research and Quality, www.tinyurl.com/2xr8hp8h). For many patients, the ED is their only contact wit

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Clinical Update

Kratom: A Primer

Topics: Buprenorphine | Opioids | Pain | Withdrawal

Many mental health providers are starting to hear about kratom from their patients. Consumed in Southeast Asia (except for Malaysia, where it is banned) for centuries, it’s a plant that has opioid-like qualities but is not regulated. Kratom is a tropical tree with the scientific name Mitragyna speciosa, native to Southeast Asia. Kratom is widely av

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Expert Q&A

Supporting Patients With Pain and Addiction

Topics: Buprenorphine | Clinical practice | Opioid Use Disorder | Opioids | Pain

CATR: What kind of work do you do, Dr. Manhapra? Dr. Manhapra: I run a clinic at the Hampton VA Medical Center helping patients with treatment-resistant chronic pain and disability. We see patients who have trialed many pain management treatments including injections, procedures, surgeries, and psychological pain treatments, all of which have failed. T

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Clinical Update

Despair, Loneliness, and Substance Use Disorders

Topics: Alcohol | Alcohol use disorder | Opioid Use Disorder | Opioids | Relationships | Special populations | treatment

Despair and loneliness are underappreciated contributors to substance use disorders (SUD). Their impact can be seen particularly in rural areas hit hard by industrial restructuring and poverty. This article will explore the interplay between despair, loneliness, and SUD and will review some strategies to use in your patients. Hardship From 1999 to 2

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Clinical Update

Faith and Addiction

Topics: Alcohol | Alcohol use disorder | Connections | Opioid Use Disorder | Opioids | treatment

Discussing a patient’s spiritual life might not be something you do routinely. Conversations can be time-consuming, uncomfortable, or seemingly irrelevant to treating a substance use disorder (SUD). But studies have shown that faith can be an asset in addiction treatment. Patients may want to discuss their spiritual lives with you or have questions ab

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Expert Q&A

Gabapentin Misuse and Diversion

Topics: Deprescribing | gabapentin | Opioid epidemic | Opioid Use Disorder | Opioids | Pain

CATR: Could you start by telling us a little bit about yourself and your current work? Dr. Vickers-Smith: I am an epidemiologist, and my work has primarily been on gabapentin as an emerging drug of recreational and unhealthy use. This interest came about while I was working for Dr. Jennifer Havens on her cohort of about 500 individuals in central Appal

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Clinical Update

SAMHSA Relaxes Regulations on Methadone and Buprenorphine During COVID-19 Emergency

Topics: Buprenorphine | Coronavirus | COVID-19 | Methadone | Opioid epidemic | Opioid Use Disorder | Opioids | Outpatient | pandemic | Patient relationship

The Substance Abuse and Mental Health Services Administration (SAMHSA) has changed some prescribing rules to help minimize in-person contact while maintaining access to medications for opioid use disorder (OUD). Methadone Patients starting methadone continue to require an in-person medical evaluation at an opioid treatment program (OTP) prior to sta

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Clinical Update

Muscle Relaxants: Sedatives Often Under the Radar

Topics: Clinical practice | Deprescribing | Opioids | Pain | Pharmacology | polypharmacy | prescribing patterns | Risk Management

Muscle relaxants are a diverse group of medications with varying mechanisms of action (see Commonly Prescribed Muscle Relaxants table below). They are indicated for short-term treatment (2–3 weeks) of acute, painful muscle spasms, as well as some chronic neurologic conditions associated with spasticity. However, many patients with chronic pain are on

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Expert Q&A

Benzodiazepines: Old Medicines, New Concerns

Topics: Anxiety | Anxiety Disorder | Benzodiazepines | Deprescribing | Generalized Anxiety Disorder | Opioid epidemic | Opioid Use Disorder | Opioids | Overdose | prescribing patterns

CATR: To begin, tell us about the research and clinical work you do. Dr. Morford: I am an assistant professor at the Yale School of Medicine in the Program of Addiction Medicine. I trained as a general internist, and I see patients primarily at a large opioid treatment program and in an inpatient setting on an addiction consult service. I’m involved

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Expert Q&A

Treating Addiction in Patients Transitioning to/from Incarceration

Topics: Addiction | Addiction Treatment | Buprenorphine | Clinical practice | Incarceration | Methadone | Naltrexone | Opioid epidemic | Opioid Use Disorder | Opioids | Overdose | Prison | Substance use disorders

CATR: Could you tell us a bit about your background in working with people with addiction in the criminal justice system? Dr. Cropsey: I am a clinical psychologist and professor in the Department of Psychiatry at the University of Alabama at Birmingham. I conduct research and provide clinical care to patients with addiction within the criminal justice

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News of Note

New Generic Versions of Naloxone

Topics: Addiction | Addiction Treatment | Clinical practice | Medication | Naloxone | News of Note | Opioid epidemic | Opioid Use Disorder | Opioids | Overdose | Pharmacology

Naloxone, a rescue medication effective for reversing opioid overdoses, will soon be available in two generic forms for layperson use. Naloxone nasal spray is the generic version of branded Narcan Nasal, which currently sells for $150 for two doses. The generic version will be much cheaper. Naloxone auto-injector is the generic version of Evzio au

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News of Note

Opioid Use Disorder: Is There an App for That?

Topics: Addiction | Addiction Treatment | Clinical practice | Cognitive Behavioral Therapy | News of Note | Opioid epidemic | Opioid Use Disorder | Opioids | Technology

In December 2018, the FDA announced its approval of reSET-O, a new mobile medical app marketed by Pear Therapeutics to treat opioid use disorder (OUD). Mobile medical apps (MMAs) are a rapidly expanding class of smartphone apps intended to improve patient health and wellness. The FDA defines MMAs as software programs that run on smartphones and “trans

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Research Update

Is There a Case for Cannabis in the Treatment of Pain?

Topics: Cannabidiol | Cannabis | Marijuana | Opioids | Pain | Research | Research Update

Review of: Da Vita et al, JAMA Psychiatry 2018;75(11):1118-1127 Study Type: Meta-analysis of placebo-controlled trials In the midst of the opioid epidemic, researchers are looking for new ways to treat chronic pain. Interestingly, states that have legalized medical marijuana have fewer opioid prescriptions but no clear reduction in mortality over

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Research Update

Switching from Buprenorphine to Extended-Release Naltrexone: Does it Work?

Topics: Buprenorphine | Naltrexone | Opioids | Research Update | Substance Use

Review of: Solli KK et al, Addiction 2018;113(10):1840-1849 Extended-release naltrexone (Vivitrol) has had some good data, yet getting patients on it remains a challenge, because an opioid-free period is required before starting it. Understandably, practitioners get nervous when patients stabilized on buprenorphine ask to be transitioned to extended-

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Research Update

Is Ketamine Just Another Opiate?

Topics: Antidepressants | Depression | Ketamine | Opioids | Research Update

Review of: Williams NR et al, Am J Psychiatry 2018;175:1–11 Type of study: Double-blind, placebo-controlled, crossover study Ketamine’s rapid antidepressant effects have now been demonstrated in over two dozen double-blind, placebo-controlled trials, but how it works is less clear. For many years, NMDA receptor antagonism was thought responsib

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