<?xml version='1.0' encoding='ISO-8859-1' ?><rss version='2.0'>	<channel><title>Coretext</title><link>http://coretext.org</link><description>the Reckitt-Benckiser buprenorphine bibliography</description><item><title><![CDATA[( BUPP09035 - 14 July 2008) Long-term opioid management for chronic noncancer pain.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09035</link><pubDate></pubDate><description><![CDATA[This is the protocol for a review and there is no abstract. The objectives
are as follows:

To determine the effectiveness of long-term opioid therapy for chronic
noncancer pain;
to identify the adverse effects of long-term opioid therapy for chronic
noncancer pain; and
to assess withdrawal rates from treatment by reasons for withdrawal based
on patient statements.

Cochrane Database of Systematic Reviews 2008 Issue 2 (Status: Unchanged)
This version first published online: 18 July 2007 in Issue 3, 2007.


]]></description></item><item><title><![CDATA[( BUPP09034 - 14 July 2008) Test  strip  handling in screening for drugs of abuse in the clinical toxicological setting.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09034</link><pubDate></pubDate><description><![CDATA[Test  strips  are commonly used in rapid screening for drugs of abuse in
clinical  applications  and forensic situations, but the operator does
not   necessarily   have   a   toxicological   qualification.
Pharmacological   and   toxicological   knowledge  is  necessary  for
interpretation  of the results and for technical understanding of the
test  system (e.g., cutoff values, cross-reactivity). Possible false-
negative  results  have  to  be  considered  and  strategies  for the
detection  of  sample  manipulation  should  be  established. Quality
controls  are  indispensable  in  ensuring  results are authentic and
reproducible,  and  proper  documentation  is  mandatory  to  achieve
traceability.   Analysis  using  chromatographic  methods  should  be
included   to  confirm  positive  test-strip  results.  National  and
international   regulations   for  decision  limits  should  also  be
considered.


]]></description></item><item><title><![CDATA[( BUPP09033 - 14 July 2008) Enhancing capacities: Right or wrong?]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09033</link><pubDate></pubDate><description><![CDATA[As far as human characteristics or capacities are concerned, much of the
debate concerning all methods of enhancement turns on the question: what
is normal? Do we take normal to be represented by statistical averages,
such as average height? If so, normal height would be markedly greater in
some countries, such as Finland or the Netherlands, than in many other
European countries and even more so when compared with countries around
the world. Whatever value or range is chosen there will always be outliers
unless the range is set so wide as to be meaningless.


]]></description></item><item><title><![CDATA[( BUPP09032 - 14 July 2008) Harm  reduction  and equity of access to care for French prisoners: A review.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09032</link><pubDate></pubDate><description><![CDATA[Background:  Despite  France  being  regarded as a model of efficient
harm  reduction  policy  and  equity of access to care in the general
community,  the health of French inmates is a critical issue, as harm
reduction   measures   are  either  inaccessible  or  only  partially
implemented  in  French prisons. Method: Using specific inclusion and
exclusion criteria, information was collected and analyzed about HIV, HBV
and  HCV  prevalence,  risk practices, mortality, access to harm
reduction  measures and care for French prison inmates. Results: Data
about  the  occurrence of bloodborne diseases, drug use and access to
care  in  prisons  remain  limited  and  need urgent updating. Needle
exchange  programs  are  not yet available in French prisons and harm
reduction  interventions  and  access  to  OST  remain limited or are
heterogeneous  across prisons. The continuity of care at prison entry and
after release remains problematic and should be among the primary public
health priorities for French prisoners. Conclusion: Preventive and harm
reduction measures should be urgently introduced at least as pilot
programs.  The  implementation  of  such  measures,  not  yet available
in  French  prisons,  is not only a human right for prison inmates but can
also provide important public health benefits for the general population.


]]></description></item><item><title><![CDATA[( BUPP09031 - 14 July 2008) Temporary services for patients in need of chronic care.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09031</link><pubDate></pubDate><description><![CDATA[Background: A project is a temporary endeavour undertaken to create a
product  or service. Projects are frequently used for the testing and
development  of  new  approaches in social work. Projects can receive
grants  from  central,  often national or international institutions, and
allow  for more experimentation than work placed within existing
institutions.  Discussion:  For socially marginalized groups who need
continuing  support  and care, receiving help in a project means that the
clients  will  have to be transferred to other services when the project
ends.  There  is  also a risk that clients will experience a decline  in
services,  as  staff members have to seek new employment towards  the
end  of  the  project,  or  begin  to focus more on the evaluation  than
the  services.  This  raises  some  ethical  issues concerning the use of
human subjects in projects. Conclusion: Project managers  should
consider  ethical  issues relating to continuity of services  when serving
vulnerable patients with a need for continuing care.


]]></description></item><item><title><![CDATA[( BUPP09030 - 14 July 2008) Diagnostics and therapy of chronic pancreatitis.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09030</link><pubDate></pubDate><description><![CDATA[Chronic  pancreatitis  (CP)  is characterized by progressive, chronic
inflammation  of  the  pancreas,  resulting  in  loss of exocrine and
endocrine  function  and chronic abdominal pain. In most cases, CP is
induced  by  long-term alcoholism. The second most frequent diagnosis is
idiopathic CP, in the absence of known causes of CP. However, the
identification  of  genetic  and  immunological  causes  continuously
reduces  the  number  of cases classified as idiopathic pancreatitis.
Common  symptoms of CP comprise abdominal pain radiating to the back,
diarrhea,  steatorrhea and the development of diabetes. The diagnosis is
mainly based on clinical features, typical morphological findings such  as
pancreatic calcifications, duct stenoses and dilatations, as well  as
pathologic  pancreatic  function  tests.  Treatment  of  CP includes
watch   and  wait  strategies  in  asymptomatic  patients, symptomatic
treatment of the clinical features such as pain, exocrine and  endocrine
insufficiency,  as well as interventional or surgical therapy   of
complications  such  as  pseudocysts,  pancreatic  duct stenosis,  stones
or  biliary  obstruction.


]]></description></item><item><title><![CDATA[( BUPP09029 - 14 July 2008) Variable  response to opioid treatment: Any genetic predictors within sight?]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09029</link><pubDate></pubDate><description><![CDATA[The  aim  of  this  literature review is to summarize and discuss the
available  evidence for a relationship between polymorphisms in human
genes  and  variability  in  opioid  analgesia and side effects among
patients treated for moderate or severe pain. The evidence supporting a
role  of certain alleles, genotypes or haplotypes in modulation of opioid
analgesia  is  derived  from  a  limited number of studies, a limited
number  of  genes  and a limited number of opioids. Although several
interesting  candidates have emerged as potentially relevant factors,
only  for one polymorphism, the prevalent 118A>G of the mu- opioid
receptor, the accumulated evidence is sufficient to suggest a clinically
relevant effect for an opioid used for moderate or severe pain.  Still the
data are valid only at the group level and cannot be used  to predict
treatment outcome in individual patients. Only a few of  the  symptoms
often seen as opioid adverse effects in palliative care,  such as nausea,
vomiting, constipation and sedation, have been associated  with  genetic
variants in various genes, but the results have been based on case
reports, healthy volunteers or post-operative patients. So far, there is
no clear evidence that genetic markers can be  used  to predict opioid
efficacy or adverse effects in palliative care patients. This reflects the
general lack of studies performed in the  context  of  palliative  care,
the  lack of sufficiently scaled studies and the lack of international
standards for the assessment of subjective symptoms.


]]></description></item><item><title><![CDATA[( BUPP09028 - 14 July 2008) Receptor functions.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09028</link><pubDate></pubDate><description><![CDATA[Prescribers  should  have  some  understanding of receptor mechanisms
because many drugs commonly used in modern practice act on receptors,
safe  drug  usage  requires an understanding of receptor pharmacology and
future  advances  in pharmacology and therapeutics are likely to develop
from  the  discovery  of  further  receptors  and  molecular modelling
of  drugs to interact with them. This article covers basic concepts  such
as  receptors  and ligands, agonists and antagonists, dose-response
curves, efficacy, potency, selectivity and affinity. It illustrates  the
different ways that ligand-receptor interactions can be  coupled  to
responses (e.g. channel-linked receptors, G-protein- coupled  receptors,
kinase-linked receptors and receptors regulating gene transcription). The
potential for agonists, partial agonists and antagonists  to  interact
with each other is examined. The importance of  understanding  the
dose-response curve, and its influence on the likelihood  of  achieving
clinical  efficacy without causing adverse effects, is emphasized.


]]></description></item><item><title><![CDATA[( BUPP09027 - 14 July 2008) Thoracic  epidural  catheterization  leading  to  delayed  transient neurological symptoms with normal imaging findings.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09027</link><pubDate></pubDate><description><![CDATA[Paraparesis  after  epidural  catheterization  is  rare  but  may  be
multifactorial.  We  report  a case of temporary paraparesis in a 32-
year-old  female  patient  after  thoracic  epidural  catheterization
performed  analgesia.  A  16  G epidural needle was introduced at the
T-7-T-8  interspace but as frank blood came through, it was withdrawn and
was  reinserted  at  the  T-8-T-9  interspace.  An 18 G epidural catheter
was  introduced  and  10  ml  of  0.125%  bupivacaine  with buprenorphine
150 mcg was given. Further top-ups were given for 48 h on complain of
pain. There was an episode of hypotension after giving the  epidural drug
but later on the patient remained haemodynamically stable.  On  the
fourth  post-operative  day,  the  patient reported paraparesis  with
heaviness  and  tingling  sensation  in both lower extremities.   MRI
was  normal  with  no  evidence  of  spinal  cord compression,  oedema,
haematoma  or  abscess.  The  patient improved gradually  within  a period
of 3 days. The possible causes of delayed onset of neurological symptoms
are discussed.


]]></description></item><item><title><![CDATA[( BUPP09026 - 14 July 2008) Long-term  treatment  with  buprenorphine/naloxone  in  primary care: results at 2-5 years.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09026</link><pubDate></pubDate><description><![CDATA[To   examine   long-term  outcomes  with  primary  care  office-based
buprenorphine/naloxone  treatment,  we  followed  53 opioid-dependent
patients  who  had  already  demonstrated  six  months  of documented
clinical  stability  for  2-5 years. Primary outcomes were retention,
illicit  drug  use,  dose,  satisfaction,  serum  transaminases,  and
adverse  events.  Thirty-eight  percent  of  enrolled  subjects  were
retained  for  two  years. Ninety-one percent of urine samples had no
evidence  of  opioid  use,  and  patient satisfaction was high. Serum
transaminases  remained  stable  from  baseline.  No  serious adverse
events related to treatment occurred. We conclude that select opioid-
dependent  patients  exhibit  moderate levels of retention in primary care
office-based treatment.


]]></description></item><item><title><![CDATA[( BUPP09025 - 14 July 2008) Suicidality in opioid-dependent subjects.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09025</link><pubDate></pubDate><description><![CDATA[We determined suicide attempt characteristics in 160 opioid-dependent
subjects.  Three aspects of suicide vulnerability were also examined:
familial  aggregation  of  suicidal  behaviors,  degree of aggression
/impulsivity,  and  smoking.  Forty-eight  percent  of subjects had a
personal  history  of  suicide attempt. A personal history of suicide
attempt  was  associated  with  an early onset of heroin use, but not
with   gender   differences.  A  family  history  of  suicide  was  a
progressive risk factor for suicide attempt. Subjects with a personal
history  of  suicide  attempt  had  a  higher  degree  of  aggression
/impulsivity  and  smoked  more  cigarettes.  In  conclusion, opioid-
dependent  subjects who attempt suicide show familial aggregation and
clinical expressions of suicidal liability similar to those described in
other psychiatric groups.


]]></description></item><item><title><![CDATA[( BUPP09024 - 14 July 2008) Oral substitution treatments for opioid dependence (Comments)]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09024</link><pubDate></pubDate><description><![CDATA[Illicit opioid dependence, once largely a problem in developed countries,
has become an increasingly important public-health concern over the past
few decades in countries such as China, India, Indonesia, Iran, Malaysia,
Pakistan, and Russia.1 In 2003, its health effects were estimated to
account for 0·7% of global disease burden.
Many developing countries have prohibited the use of pharmacological
treatments for opioid dependence that are used in developed countries (and
in WHO's Model List of Essential Medicines) - ie, oral agonist maintenance
treatment with methadone and buprenorphine.  The preferred forms of
so-called treatment in these countries have often been imprisonment,
enforced opioid withdrawal, and a coerced form of drug-free rehabilitation
in prison-like settings.
Also see BUPP08985 "Maintenance treatment with buprenorphine and
naltrexone for heroin dependence in Malaysia: a randomised, double-blind,
placebo-controlled trial"  Schottenfeld R S, Chawarski M, Mazlan M. Lancet
2008, 371, 2192-2200.


]]></description></item><item><title><![CDATA[( BUPP09046 - 21 July 2008) Local  infiltration  analgesia:  A technique for the control of acute postoperative  pain  following knee and hip surgery - A case study of 325 patients.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09046</link><pubDate></pubDate><description><![CDATA[Background:  We have developed a multimodal technique for the control of
pain  following  knee and hip surgery, called "local infiltration
analgesia" (LIA). It is based on systematic infiltration of a mixture of
ropiva-caine,  ketorolac,  and adrenaline into the tissues around the
surgical  field to achieve satisfactory pain control with little
physiological  disturbance.  The technique allows virtually immediate
mobilization  and  earlier  discharge  from  hospital.  Patients  and
methods:  In  this  open,  nonrandomized  case series, we used LIA to
manage  postoperative  pain  in  all  325  patients presenting to our
service  from Jan 1, 2005 to Dec 31,2006 for elective hip resurfacing
(HRA),  primary  total  hip  replacement (THR), or primary total knee
replacement arthroplasty (TKR). We recorded pain scores, mobilization
times, and morphine usage for the entire group. Results: Pain control was
generally  satisfactory (numerical rating scale pain score range 0-3). No
morphine was required for postoperative pain control in two- thirds  of
the  patients.  Most  patients  were  able  to  walk with assistance
between  5 and 6 h after surgery and independent mobility was  achieved
13-22 h after surgery. Orthostatic hypotension, nausea, and vomiting were
occasionally associated with standing for the first time,  but other side
effects were unremarkable. 230 (71%) of the 325 patients  were discharged
directly home after a single overnight stay in  hospital. Interpretation:
Local infiltration analgesia is simple, practical, safe, and effective for
pain management after knee and hip surgery.


]]></description></item><item><title><![CDATA[( BUPP09045 - 21 July 2008) Gender issues and the pharmacotherapy of substance abuse.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09045</link><pubDate></pubDate><description><![CDATA[In  the last 25 years, the different disciplines and professions that are
involved in managing the issue of substance abuse have recognized that
gender-linked factors influence patterns of substance abuse and response
to  treatment.  In  2007, the US National Institute on Drug Abuse  (NIDA)
concluded  that  studies  of  substance  abuse  should routinely  address
gender  issues. In the field of drug development, gender  issues
historically have not been an issue of high priority. By outlining the
types of evidence that underpin the view of the NIDA and  providing
evidence of the widespread existence of gender-linked effects   from
pharmacotherapies  (both  those  marketed  and  under development),  this
feature  review  proposes  that  drug developers should embrace the
opinion of the NIDA regarding gender and substance abuse.  To avoid false
conclusions, the issue of gender should become a  higher  priority
during  the  collection  and analysis of data on pharmacotherapies.  Some
gender  differences will have more clinical significance  than  others,
but any difference related to gender has the  potential to complicate
clinical trials and other studies.


]]></description></item><item><title><![CDATA[( BUPP09044 - 21 July 2008) Prescription of opiates in medical practice.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09044</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09043 - 21 July 2008) Attitudes and knowledge of substance misusers regarding buprenorphine and methadone maintenance therapy.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09043</link><pubDate></pubDate><description><![CDATA[Aims:  To  assess  substance  users' beliefs and the sources of these
beliefs regarding methadone and buprenorphine and to examine how they
choose  between  them.  Design:  Forty-two  opiate-dependent patients
seeking treatment chose between open label buprenorphine or methadone
maintenance  treatment. Prior to treatment patients completed a semi-
structured  interview  or  a  self-completed questionnaire. Findings:
Beliefs   were   based   primarily  on  their  own  or  other  users'
experiences.  All  patients  chose  their treatment. There was little
difference  between  those  choosing  MMT  and  BMT in terms of their
beliefs about the drugs, although the BMT group viewed methadone more
negatively  and  buprenorphine  more  positively  than the MMT group.
Those  choosing  MMT  appeared  to  do so on the basis of familiarity
whereas  those choosing BMT appeared to be attracted by their beliefs
that  it  would  block  heroin more effectively, reduce craving, give
less  intoxication  and be easier to stop taking. Conclusions: Opiate
users  rapidly  become  well  informed  about a new treatment when it
becomes  available.  They  rely  more  on  their own and other users'
experience  than  the  information given by agencies. Choices between
treatments  are  based more on individual perceived requirements than
different beliefs.


]]></description></item><item><title><![CDATA[( BUPP09042 - 21 July 2008) Opioids and the control of respiration.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09042</link><pubDate></pubDate><description><![CDATA[Respiratory  depression  limits the use of opioid analgesia. Although
well  described  clinically, the specific mechanisms of opioid action on
respiratory  control  centres  in the brain have, until recently, been
less  well  understood.  This article reviews the mechanisms of
opioid-induced  respiratory  depression,  from  the  cellular  to the
systems level, to highlight gaps in our current understanding, and to
suggest  avenues  for further research. The ultimate aim of combating
opioid-induced  respiratory depression would benefit patients in pain and
potentially  reduce  deaths from opioid overdose. By integrating recent
findings  from animal studies with those from human volunteer and clinical
studies, further avenues for investigation are proposed, which  may
eventually lead to safer opioid analgesia.


]]></description></item><item><title><![CDATA[( BUPP09041 - 21 July 2008) Simultaneous   screening   of  buprenorphine,  ketamine,  LSD,  MDMA, methaqualone,  fentanyl,  oxycodone,  hydromorphone, propoxyphene and the  dilution marker creatinine in urine using Evidence biochip array technology.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09041</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09040 - 21 July 2008) The buprenorphine Assay* on the Olympus (R) analyzers.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09040</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09039 - 21 July 2008) Comparison  of  two  Buprenorphine  immunoassays and their ability to determine Buprenorphine prevalence, compliance, diversion and abuse.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09039</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09038 - 21 July 2008) Buprenophine enzyme immunoassay on Synchron systems.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09038</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09037 - 21 July 2008) Method for reducing pain.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09037</link><pubDate></pubDate><description><![CDATA[Anonymous, Inventor(s): The present invention is direct to a method of
producing analgesia in a mammalian subject. The method includes
administering to the subject an  omega  conopeptide, preferably
ziconotide, in combination with an analgesic selected from the group
consisting  of  morphine, bupivicaine,    clonidine, hydromorphone,
baclofen,   fentanyil, buprenorphine,  and  sufentanil,  or  its
pharmaceutically acceptable salts  thereof, wherein the omega-conopeptide
retains its potency and is  physically and chemically compatible with the
analgesic compound. A  preferred  route  of administration is intrathecal
administration, particularly  continuous  intrathecal infusion. The
present invention is  also directed to a pharmaceutical formulation
comprising an omega conopeptide,  preferably ziconotide, in combination
with an analgesic selected   from   the  group  consisting  of  morphine,
bupivicaine, clonidine,  hydromorphone,  baclofen,  fentanyl,
buprenorphine,  and sufentanil.


]]></description></item><item><title><![CDATA[( BUPP09036 - 21 July 2008) Driving  ability  under  opioids:  current  assessment  of published studies.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09036</link><pubDate></pubDate><description><![CDATA[Opioids  are  more  frequently  used in the treatment of chronic non-
cancer  pain.  The aim is not only to reduce pain intensity, but also the
patients' reintegration into their social environment, including the
possibility  of  driving  their  own  car.  Various studies have
investigated  the  impact  of opioids on driving ability. Two studies
showed that a group of patients with chronic pain receiving sustained
treatment   with  transdermal  fentanyl  or  buprenorphine  performed
significantly  better  in  tests  than  healthy  persons with legally
relevant 0,05% concentration of blood alcohol. These results indicate
that  stable  opioid  treatment  does  not necessarily impair driving
ability  of  patients  in  chronic  pain.  However,  so far published
studies  do  not  provide  clear  evidence for saying that persons on
sustained  opioid  treatment can drive a car without any problem. Nor do
they indicate that such persons should not drive.


]]></description></item><item><title><![CDATA[( BUPP09059 - 28 July 2008) Case series of buprenorphine injectors in Kuala Lumpur, Malaysia.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09059</link><pubDate></pubDate><description><![CDATA[Diversion of buprenorphine has been described in settings where it is
legally  prescribed and has become an increasing concern in Malaysia; it
resulted   in   banning  of  buprenorphine  in  Singapore  where
unsubstantiated  case  reports suggested that buprenorphine injection
was   associated   with  particularly  poor  outcomes.  We  therefore
conducted  a case series of qualitative interviews with buprenorphine
injectors  in  Kuala  Lumpur,  Malaysia to examine further the issues
surrounding buprenorphine injection as well as the abuse of midazolam in
combination  with  buprenorphine.  Interviews  with 19 men do not suggest
significant  adverse  health consequences from buprenorphine injection
alone and injectors have adapted diverted buprenorphine as a  treatment
modality. A subset of these injectors, however, combined buprenorphine
and  midazolam  for  euphoric  effects  with resultant symptoms  of  a
possible  pharmacological  interaction.  Prospective cohort  studies,
rather than hospital-derived samples, are needed to better  understand the
safety of buprenorphine injection. Reapply


]]></description></item><item><title><![CDATA[( BUPP09058 - 28 July 2008) Pharmacogenetic treatments for drug addiction: Alcohol and opiates.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09058</link><pubDate></pubDate><description><![CDATA[Aims:  Psychiatric pharmacogenetics involves the use of genetic tests
that  can  predict  the  effectiveness  of  treatments for individual
patients  with  mental  illness  such as drug dependence. This review
aims  to  cover  these developments in the pharmacotherapy of alcohol and
opiates,  two  addictive drugs for which we have the majority of our
FDA   approved   pharmacotherapies.  Methods:  We  conducted  a
literature  review using Medline searching terms related to these two
drugs  and  their  pharmacotherapies  crossed  with  related  genetic
studies.  Results: Alcohol's physiological and subjective effects are
associated with enhanced beta-endorphin release. Naltrexone increases
baseline  beta-endorphin release blocking further release by alcohol.
Naltrexone's action as an alcohol pharmacotherapy is facilitated by a
putative  functional  single  nucleotide  polymorphism  (SNP)  in the
opioid  mu  receptor  gene  (Al18G)  which  alters receptor function.
Patients  with  this  SNP  have  significantly lower relapse rates to
alcoholism  when  treated  with  naltrexone.  Caucasians with various
forms  of the CYP2D6 enzyme results in a 'poor metabolizer' phenotype and
appear to be protected from developing opioid dependence. Others with  a
"ultra-rapid  metabolizer"  phenotype do poorly on methadone maintenance
and have frequent withdrawal symptoms. These patients can do   well
using  buprenorphine  because  it  is  not  significantly metabolized
by  CYP2D6.  Conclusions:  Pharmacogenetics  has  great potential  for
improving  treatment  outcome  as  we  identify  gene variants  that
affect  pharmacodynamic  and pharmacokinetic factors. These  mutations
guide  pharmacotherapeutic agent choice for optimum treatment  of  alcohol
and  opiate  abuse  and  subsequent  relapse.


]]></description></item><item><title><![CDATA[( BUPP09057 - 28 July 2008) Assessment  of  differential  doses  of  buprenorphine  for long term pharmacotherapy among opiate dependent subjects.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09057</link><pubDate></pubDate><description><![CDATA[The  aim of the present study was to evaluate, two different doses of
sublingual   buprenorphine   (2  mg  and  4  mg)  among  patients  on
maintenance  treatment and to assess the relationship of steady state
plasma level with craving. Twenty three male opioid dependent (ICD-10
DCR)  subjects,  were  assigned to double blind randomized controlled
trial  of  2  and  4  mg/day  doses  of buprenorphine in an inpatient
setting.  They  were  evaluated  thrice  (2nd, 7th and 14th day) in 2
weeks  for  withdrawal  symptoms  (acute  and  protracted), sedation,
euphoria,  craving, side effects, global rating of well being and for
measurement  of  plasma levels of buprenorphine. The data showed that
there  were  no  significant  difference  in  scores  of euphoria and
sedation,  protracted  withdrawal  symptoms and side effects, craving and
overall  well  being and plasma level of buprenorphine among the
subjects.  However,  both  the  groups  had significant difference in
score  on  almost  all  the  measurements  on  final  observation  in
comparison to initial observation. Both 2 mg/day and 4 mg/day dose of
buprenorphine  were  effective in long term pharmacotherapy of opioid
dependence  without  significant  difference as compared by different
measures used in the study. On waiting list


]]></description></item><item><title><![CDATA[( BUPP09056 - 28 July 2008) Call for feedback on managing chronic pain and opioid addiction.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09056</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09055 - 28 July 2008) Prescription opioid abuse and dependence among physicians: Hypotheses and treatment.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09055</link><pubDate></pubDate><description><![CDATA[Physician  impairment  is  a  serious  public  health issue affecting
physicians  as  well  as  their  families,  colleagues, and patients.
Though  physicians generally display healthier habits than members of the
general population, overall rates of impairment are similar among both
groups,  and  prescription  drug  abuse (including prescription opioids)
is  particularly  problematic among physicians. The current review
focuses  mainly  on  prescription opioid abuse and dependence among
physicians.  It  includes  a  brief history of early physician
experiences  with  anesthetic  and  analgesic  agents,  and  explores
several  hypotheses  regarding  the  etiology  of prescription opioid
abuse and dependence among physicians. Barriers to identification and to
treatment  entry  among  physicians  are  discussed. In addition,
methods   of  assessment  and  successful  treatment  in  specialized
impaired  physician  programs are described. Medical and psychosocial
interventions,  12-step involvement, and extensive use of evaluations are
highlighted.  Attention is paid to typical follow-up contracting and
monitoring  strategies,  as  well  as strategies for prevention. Given
the  extremely  positive  outcomes demonstrated by specialized programs
for treating impaired professionals, it is recommended that their
methods  be disseminated and utilized in treatment centers for the general
public.


]]></description></item><item><title><![CDATA[( BUPP09054 - 28 July 2008) Prediction  of  pharmacokinetic  drug-drug  interactions  using human hepatocyte  suspension in plasma and cytochrome P450 phenotypic data. II. in vitro-in vivo correlation with ketoconazole.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09054</link><pubDate></pubDate><description><![CDATA[Traditional  cytochrome P450 (P450) based drug-drug interaction (DDI)
predictions  are  based  on the ratio of an inhibitor's physiological
concentration (I) and its inhibition constant K /sub i/ . Determining (I)
at the enzymatic site, although critical for predicting clinical DDIs,
remains  a technical challenge. In our previous study, a novel approach
using  cryopreserved  human  hepatocytes suspended in human plasma  was
investigated  to  mimic  the  in  vivo  concentration of ketoconazole  at
the  enzymatic  site (Lu et al., 2007), effectively eliminating  the
estimation of the elusive (I) value. P450 inhibition in  this system
appears to model that in vivo. Using the ketoconazole inhibition
information  in  a  human  hepatocyte-plasma  suspension together   with
quantitative   P450   phenotypic   information,  we successfully
predicted  the  pharmacokinetic DDIs for a small set of drugs,  such  as
theophylline, tolbutamide, omeprazole, desipramine, midazolam,
loratadine,  cyclosporine,  and alprazolam, as well as an investigational
compound.  For  the applicability of this model on a wider  scale  the  in
vitro-in vivo correlation data set needed to be expanded.  However,  for
most  drugs  in the literature there is not enough  quantitative
information  on  the  involvement of individual P450s  to  predict  DDIs
retrospectively. To facilitate that, in this study  we determined
quantitative P450 phenotyping for seven marketed drugs:  budesonide,
buprenorphine, loratadine, sirolimus, tacrolimus, docetaxel,  and
methylprednisolone. Augmentation of the new data set with  the  one
generated previously produced broader a database that provided further
support for the wider applicability of this approach using  ketoconazole
as a potent CYP3A inhibitor. This application is predicted to be equally
effective with other P450 inhibitors that are not  substrates  of  efflux
pumps.


]]></description></item><item><title><![CDATA[( BUPP09053 - 28 July 2008) An   emerging  trend  of  buprenorphine  abuse  resulting  in  severe neurologic deficits.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09053</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09052 - 28 July 2008) Combined spinal-epidural anesthesia for renal transplantation.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09052</link><pubDate></pubDate><description><![CDATA[Introduction.  A  patient  undergoing  renal transplantation presents
unique  problems  to  the anesthetist, as almost every body system is
affected.  The  combined spinal-epidural technique has become popular in
lower abdominal surgeries because it offers the advantages of both spinal
and epidural techniques. We review our experience of combined
spinal-epidural    technique    in    patients    undergoing    renal
transplantation   with   respect   to   demographics,  intraoperative
anesthesia,   hemodynamics,  postoperative  analgesia,  and  untoward
adverse  events.Materials  and  method.  Fifty  consecutive  patients
scheduled  for  elective  renal  transplantation  over  a period of 4
months  who  consented  for  combined spinal-epidural anesthesia were
enrolled  in  the  study.  Combined  spinal-epidural  anaesthesia was
performed  using  a  double-space  technique  in  the  right  lateral
position.  Intraoperative  monitoring  included  electrocardiography,
pulse  oximetry, noninvasive blood pressure, central venous pressure, and
urinary output after clamp release. Intravenous fluids, colloids, and
blood  products  were  infused  so as to keep the central venous pressure
between  12  and  15  mm  Hg.  Postoperative  analgesia was provided
with  buprenorphine  via  an  epidural  catheter.  We noted
intraoperative  and  postoperative  complications.Results.  Neuraxial
blockade  was  satisfactory  in  all  but  four patients who required
supplementation with general anesthesia for unduly prolonged surgery.
There  were  no  significant  intraoperative hemodynamic changes. The
total intravenous fluid used during surgery was 64.24 +/- 12.3 mL/kg.
During  the postoperative period, all patients had good postoperative
pain  relief  with  no  incidence  of  epidural  hematoma.Conclusion.
Combined  spinal-epidural  anesthesia  proved to be a useful regional
anesthetic  technique,  combining the reliability of spinal block and
versatility of epidural block for renal transplantation.


]]></description></item><item><title><![CDATA[( BUPP09051 - 28 July 2008) A 50-year-old woman addicted to heroin: review of treatment of heroin addiction.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09051</link><pubDate></pubDate><description><![CDATA[Heroin addiction is a complicated medical and psychiatric issue, with
well-established  as well as newer modes of treatment. The case of Ms W,
a  50-year-old  woman with a long history of opiate addiction who has
been treated successfully with methadone for 9 years and who now would
like  to  consider newer alternatives, illustrates the complex issues  of
heroin  addiction. The treatment of heroin addiction as a chronic  disease
is reviewed, including social, medical, and cultural issues  and
pharmacologic  treatment  with  methadone  and  the more experimental
medication options of buprenorphine and naltrexone.


]]></description></item><item><title><![CDATA[( BUPP09050 - 28 July 2008) Stepping into the wide world.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09050</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09049 - 28 July 2008) Community treatment programs take up buprenorphine.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09049</link><pubDate></pubDate><description><![CDATA[Clinicians  have  been  working out ways to incorporate buprenorphine
into  their  treatment  models.  Representatives  of  three addiction
treatment  programs - a Veterans Affairs methadone clinic, a group of
outpatient  mental  health  centers, and a nationwide organization of
therapeutic communities - talk about their plans and experiences.


]]></description></item><item><title><![CDATA[( BUPP09048 - 28 July 2008) Response: integrating buprenorphine therapy into clinical practice.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09048</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09047 - 24 July 2008) A retrospective evaluation of patients switched from buprenorphine (subutex) to the buprenorphine / naloxone combination (suboxone)]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09047</link><pubDate></pubDate><description><![CDATA[A complete electronic version of this article can be found online at
http://www.substanceabusepolicy.com/content/3/1/16 - This is an Open
Access article  distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/2.0), which
permits unrestricted use, distribution, and reproduction in any medium,
provided the original work is properly cited.
Background
In Finland, buprenorphine (Subutex) is the most abused opioid. In order to
curb this problem, many treatment centres transferred ("forced transfer")
their buprenorphine patients to the buprenorphine plus naloxone (Suboxone)
combination product in late 2003.
Methods
Data from a retrospective study involving five different treatment
centers, examining the effects of switching patients to Suboxone, were
gathered from 64 opioid-dependent patients who had undergone the
medication transfer.
Results
Most patients (90.6%) switched to Suboxone at the same dose of
buprenorphine that they had been receiving as Subutex (average 22 mg). The
majority of these patients (71.9%) were maintained at the same dose of
Suboxone throughout the 4-week study period. During the first 4 weeks, 50%
of the patients reported adverse events and at the four month time point,
26.6% reported adverse events. However, due to adverse events one patient
only discontinued treatment with Suboxone during the 4-week study period,
and five during the four month follow-up period. Of the 26 patients in the
follow-up period, Suboxone was misused intravenously once each by 4
patients and twice by 1 patient. These 5 patients all reported that
injecting Suboxone was like injecting "nothing" with any euphoria, or that
it was a bad experience.
Conclusion
We conclude that when patients are transferred from high doses (> 22 mg)
of buprenorphine to the combination product, dose adjustments may be
necessary especially in the later phase of the treatment. We recommend
that a transfer from Subutex to Suboxone should be carefully discussed and
planned in advance with the patients and after the transfer adverse events
should be regularly monitored. With regard of buprenorphine IV abuse, the
combination product seems to have a less abuse potential than
buprenorphine alone.


]]></description></item><item><title><![CDATA[( BUPP09082 - 11 August 2008) Endogenous   Candida  endophthalmitis  in  drug  misusers  injecting intravenous buprenorphine.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09082</link><pubDate></pubDate><description><![CDATA[PURPOSE:  To analyze patients presenting ocular candidiasis caused by
intravenous drug addiction to buprenorphine. PATIENTS AND METHODS: We
have  listed  all  the  cases  of  endogenous  fungal endophthalmitis
hospitalized between 1996 and 2005 in the ophthalmology department of
the   university-affiliated  hospital  of  Rouen,  France.  Posterior
vitrectomy  was  performed  for each patient, with direct examination and
bacterial and fungal cultures. The treatment was begun both with an
intravitreal  injection  of  amphotericin B and oral fluconazole,
modified  in  the  event  of  resistance.  RESULTS:  Seven  men, drug
addicts,  all using intravenous buprenorphine users, were included in the
study.  The  vitreal  culture  revealed  four  cases  of Candida
albicans  candidiasis and one case of Candida tropicalis candidiasis. In
two  cases,  oral  fluconazole  had  to  be  replaced  with  oral
voriconazole.  Of  the  seven  patients,  three  evolved  unfavorably
despite  treatment. DISCUSSION: Intravenous drug use is known to be a
risk  factor  for ocular candidiasis. However, buprenorphine does not seem
to be related to endogenous endophthalmitis, since this was also observed
among patients using methadone or heroine. Salivary contact during the
preparation of the syringe being used for the injection of the
substitute  appears  to  be  the source of the candidemia in our
series  and  in the literature. CONCLUSION: Inappropriate intravenous use
of oral buprenorphine in drug users is a significant risk factor of
endogenous   fungal   endophthalmitis.   Visual   monitoring  by
pharmacists  of  the oral intake of buprenorphine seems essential. We
underline   the   advantages  of  removing  the  vitreous  in  ocular
candidiasis.


]]></description></item><item><title><![CDATA[( BUPP09081 - 11 August 2008) Pharmacokinetic-pharmacodynamic   relationships   of   cognitive  and psychomotor  effects  of  intravenous buprenorphine infusion in human volunteers.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09081</link><pubDate></pubDate><description><![CDATA[The  main  objective  of  the  present  study was to characterize the
pharmacokinetic/pharmacodynamic  (PK/PD)  relationship of the effects of
buprenorphine  on  cognitive  functioning  in healthy volunteers.
Twenty-three  male  volunteers  received  0.6  mg buprenorphine as an
intravenous  infusion  over  150  min.  The cognitive and psychomotor
performance  was  evaluated  before  and  at various times after drug
administration  by a test battery consisting of trail-making test for
visual  information  processing,  finger-tapping test for psychomotor
speed,  and  continuous reaction time for attention. Non-linear mixed
effect modelling was used in the analysis of the PK/PD relationships.
Buprenorphine   caused   significant   deficits   in   cognitive  and
psychomotor functioning. The time course of cognitive and psychomotor
impairment was found to have a slow distribution to the biophase from
plasma  with  PK/PD  models involving an effect compartment providing the
best descriptions of the time course of the data. The values for
half-life  of  biophase  equilibration  were  consistent  between the
neuropsychological  tests  in the range of 66.6-84.9 min. The time to
onset  and  duration  of  the cognitive and psychomotor impairment of
buprenorphine  was determined by a slow distribution to the biophase.


]]></description></item><item><title><![CDATA[( BUPP09080 - 11 August 2008) Therapy  goals, evaluation and health-economic aspects of the therapy of drug-dependent.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09080</link><pubDate></pubDate><description><![CDATA[Changes regarding the goal paradigms in the therapy of drug-dependent have
substantial influence on the evaluation of the effectiveness and cost
effectiveness  of  such interventions. This overview represents the
connection between therapy goals and clinical and health-economic
evaluation concepts. In addition, the state of research is summarized
concerning  the  effectiveness  and  cost-effectiveness  of different
therapy  strategies on the basis by reviews.


]]></description></item><item><title><![CDATA[( BUPP09079 - 11 August 2008) Transdermal drug delivery systems.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09079</link><pubDate></pubDate><description><![CDATA[20th August 2008: British Library cannot find a copy of this paper.


]]></description></item><item><title><![CDATA[( BUPP09078 - 11 August 2008) Addressing Canine and Feline Aggression in the Veterinary Clinic.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09078</link><pubDate></pubDate><description><![CDATA[Handling  aggressive  dogs  and  cats in the veterinary clinic can be
frustrating,  time  consuming,  and  injurious  for both employee and
animal. This article discusses the etiology of the aggressive dog and cat
patient  and  how  best  to  approach  these cases. A variety of handling
techniques, safety products, and drug therapy are reviewed.


]]></description></item><item><title><![CDATA[( BUPP09077 - 11 August 2008) Neuropathic  pain  -  The  view  of  combined therapy with the use of opioids.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09077</link><pubDate></pubDate><description><![CDATA[The  effective  management  of chronic pain is a fundamental goal for all
clinicians and algesiologists. Potent opioids - such as morphine and  the
newer-generation agents (fentanyl, buprenorphine, oxycodone and
hydromorphone)  play  an important role in management of pain in patients
with chronic pain. The three-step analgesic ladder developed by  the World
Health Organisation (WHO) outlines these opioids in the management  of
cancer pain, and these widely accepted and extensively validated
guidelines have also been influential in the application of opioid
therapy for the treatment of chronic, non-malignant pain. The use  of
opioids  for  treatment in neuropathic pain remains somewhat
controversial, since early studies indicated that neuropathic pain is
generally less responsive to pure mu-opioid analgesia. A growing body of
evidence now suggests that different opioids affect different pain
pathways, and that opioids are effective under peripheral and central
neuropathic  pain  conditions.  Recently  emerging  data  support the
possibility  of  a  role  for  oxycodone  and  buprenorphine  in  the
management  of  neuropathic pain. In the article on the use different
opioid  therapy, the author focuses on the treatment of chronic,
non-malignant  pain over the course of one year. In the first part of the
article,  the  author  describes  the  separation  of the patients in
relation  to  diagnosis  and the use of opioid therapy with different
opioids.  The  group  comprised  47  patients, whose reactions to the
treatment  were studied over the course of one year. Neuropathic pain was
treated  with oxycodone in 53.2% (27 patients), TTS fentanyl was used  by
27.6%  (13 patients), TDS buprenorphine in 17% (8 patients) and
hydromorphone  was  prescribed for 2.2% (1 patient). In the next part  of
the  article  is discussed the efficacy and tolerability of
oxycodone in neuropathic pain and greater improvements in the quality of
life  score.  The  author  emphasizes  the  preference  of  using
oxycodone in the treatment of neuropathic pain and points to the good
analgesic  efficacy  when  using  low  doses of oxycodone. The author
concludes  the  article  by  focusing  on new clinical studies, which
point to the good analgesic effect of using TDS buprenorphine.


]]></description></item><item><title><![CDATA[( BUPP09076 - 11 August 2008) Opioids  and  the  management  of chronic severe pain in the elderly: Consensus  statement  of  an international expert panel with focus on the six clinically most often used world health organization step III opioids (Buprenorphine, Fentanyl, Hydromorphone, Methadone, Morphine, Oxycodone)]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09076</link><pubDate></pubDate><description><![CDATA[1.  The  use  of  opioids  in cancer pain: The criteria for selecting
analgesics  for  pain  treatment  in the elderly include, but are not
limited  to,  overall efficacy, overall side-effect profile, onset of
action,  drug  interactions,  abuse  potential, and practical issues,
such  as  cost  and availability of the drug, as well as the severity and
type  of  pain  (nociceptive, acute/chronic, etc.). At any given time,
the order of choice in the decision-making process can change. This
consensus  is based on evidence-based literature (extended data are  not
included  and  chronic,  extended-release  opioids  are not covered).
There  are various driving factors relating to prescribing medication,
including  availability  of the compound and cost, which may,   at
times,  be  the  main  driving  factor.  The  transdermal formulation of
buprenorphine is available in most European countries, particularly
those  with  high  opioid  usage, with the exception of
France;  however,  the  availability of the sublingual formulation of
buprenorphine  in  Europe is limited, as it is marketed in only a few
countries,  including  Germany  and  Belgium.  The  opioid  patch  is
experimental  at present in U.S.A. and the sublingual formulation has
dispensing restrictions, therefore, its use is limited. It is evident
that  the population pyramid is upturned. Globally, there is going to be
an older population that needs to be cared for in the future. This
older  population  has  expectations in life, in that a retiree is no
longer  an  individual  who decreases their lifestyle activities. The
"baby-boomers"  in  their 60s and 70s are "baby zoomers" they want to
have  a  functional active lifestyle. They are willing to make trade-offs
regarding  treatment  choices  and  understand  that  they  may
experience  pain,  providing  that can have increased quality of life and
functionality.  Therefore,  comorbidities-including  cancer  and
noncancer    pain,    osteoarthritis,   rheumatoid   arthritis,   and
postherpetic neuralgia-and patient functional status need to be taken
carefully  into  account  when  addressing pain in the elderly. World
Health  Organization  step  III  opioids  are  the  mainstay  of pain
treatment for cancer patients and morphine has been the most commonly
used  for  decades.  In general, high level evidence data (Ib or IIb)
exist,  although  many studies have included only few patients. Based on
these studies, all opioids are considered effective in cancer pain
management  (although  parts of cancer pain are not or only partially
opioid  sensitive),  but  no  well-designed  specific  studies in the
elderly  cancer  patient  are  available.  Of  the 2 opioids that are
available  in  transdermal  formulation-fentanyl  and
buprenorphine-fentanyl  is  the  most investigated, but based on the
published data both  seem  to  be effective, with low toxicity and good
tolerability profiles,  especially  at  low  doses.  2.  The  use  of
opioids  in noncancer-related   pain:   Evidence  is  growing  that
opioids  are
efficacious in noncancer pain (treatment data mostly level Ib or IIb)  ,
but  need  individual  dose  titration  and  consideration  of the
respective  tolerability  profiles.  Again no specific studies in the
elderly  have  been  performed,  but it can be concluded that opioids have
shown efficacy in noncancer pain, which is often due to diseases typical
for  an elderly population. When it is not clear which drugs and  which
regimes  are  superior  in terms of maintaining analgesic
efficacy,  the  appropriate drug should be chosen based on safety and
tolerability  considerations. Evidence-based medicine, which has been
incorporated  into best clinical practice guidelines, should serve as a
foundation  for  the  decision-making  processes  in patient care;
however,  in  practice,  the  art  of  medicine  is  realized when we
individualize care to the patient. This strikes a balance between the
evidence-based    medicine    and   anecdotal   experience.   Factual
recommendations  and  expert  opinion both have a value when applying
guidelines in clinical practice. 3. The use of opioids in neuropathic
pain:  The  role of opioids in neuropathic pain has been under debate in
the  past but is nowadays more and more accepted; however, higher opioid
doses  are  often  needed  for  neuropathic  pain  than  for nociceptive
pain. Most of the treatment data are level II or III, and suggest that
incorporation of opioids earlier on might be beneficial. Buprenorphine
shows a distinct benefit in improving neuropathic pain symptoms,   which
is   considered   a   result   of   its  specific  pharmacological
profile.  4.  The use of opioids in elderly patients with  impaired
hepatic  and renal function: Functional impairment of excretory organs is
common in the elderly, especially with respect to renal  function.  For
all opioids except buprenorphine, half-life of the  active  drug  and
metabolites is increased in the elderly and in patients  with renal
dysfunction. It is, therefore, recommended that-except  for
buprenorphine-doses be reduced, a longer time interval be used  between
doses,  and  creatinine  clearance be monitored. Thus, buprenorphine
appears to be the top-line choice for opioid treatment
in  the  elderly.  5. Opioids and respiratory depression: Respiratory
depression  is  a significant threat for opioid-treated patients with
underlying  pulmonary  condition  or  receiving  concomitant  central
nervous  system  (CNS) drugs associated with hypoventilation. Not all
opioids  show  equal effects on respiratory depression: buprenorphine is
the only opioid demonstrating a ceiling for respiratory depression when
used  without  other CNS depressants. The different features of opioids
regarding  respiratory  effects  should  be  considered when treating
patients at risk for respiratory problems, therefore careful dosing  must
be maintained. 6. Opioids and immunosuppression: Age is related  to a
gradual decline in the immune system: immunosenescence, which  is
associated  with  increased  morbidity  and mortality from infectious
diseases,  autoimmune diseases, and cancer, and decreased efficacy   of
immunotherapy,  such  as  vaccination.  The  clinical relevance  of the
immunosuppressant effects of opioids in the elderly is   not   fully
understood,   and   pain  itself  may  also  cause
immunosuppression.  Providing  adequate  analgesia  can  be  achieved
without    significant   adverse   events,   opioids   with   minimal
immunosuppressive  characteristics should be used in the elderly. The
immunosuppressive  effects  of  most opioids are poorly described and
this  is  one  of the problems in assessing true effect of the opioid
spectrum,  but  there is some indication that higher doses of opioids
correlate  with  increased  immunosuppressant  effects.  Taking  into
consideration   all   the   very   limited  available  evidence  from
preclinical  and  clinical  work,  buprenorphine  can be recommended,
while  morphine  and  fentanyl  cannot.  7.  Safety  and tolerability
profile  of opioids: The adverse event profile varies greatly between
opioids.  As the consequences of adverse events in the elderly can be
serious,  agents should be used that have a good tolerability profile
(especially  regarding CNS and gastrointestinal effects) and that are as
safe  as  possible  in  overdose  especially regarding effects on
respiration.  Slow  dose  titration  helps to reduce the incidence of
typical initial adverse events such as nausea and vomiting. Sustained
release  preparations,  including  transdermal formulations, increase
patient compliance.


]]></description></item><item><title><![CDATA[( BUPP09075 - 11 August 2008) On  drug treatment and social control: Russian narcology's great leap backwards.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09075</link><pubDate></pubDate><description><![CDATA[The  medical  discipline  of narcology in Russia is a subspecialty of
psychiatry  from the Soviet era and it is given warrant to define the
scope of health activities with regard to alcohol and other drug use,
drug  users,  and  related problems. Narcological practice is in turn
constrained  by  the  State.  The  emergence  of widespread injection
opiate  use and associated HIV morbidities and mortalities during the
first  decade  following the collapse of the Soviet Union has brought the
contradictions  in  Russian  narcological  discourse  into  high relief.
Narcology   officials   in   the  Russian  Federation  have
consistently  opposed  substitution treatment for opiate dependence - the
replacement  of  a  short-acting illegal substance with a longer acting
prescribed drug with similar pharmacological action but lower degree   of
risk.  Thus,  despite  the  addition  of  methadone  and buprenorphine
to  WHO's  list  of  essential  medicines  in 2005 and multiple position
papers  by  international  experts  calling  for substitution  treatment
as a critical element in the response to HIV (IOM, 2006; UNODC, UNAIDS,
and WHO, 2005), methadone or buprenorphine remain  prohibited  by  law
in  Russia.  The  authors detail Russian    opposition  to  the
prescription  of  methadone  and  buprenorphine, describing  four
phenomena: (1) the dominance of law enforcement and drug  control  policy
over public health and medical ethics; (2) the conflation  of  Soviet
era  alcoholism  treatment with treatment for opiate   dependence;   (3)
the  near  universal  representation  of detoxification  from  drugs  as
treatment  for dependence; and (4) a framework for judging treatment
efficacy that is restricted to "cure" versus  "failure  to  cure, " and
does not admit its poor outcomes or recognize  alternative  frameworks
for  gauging  treatment of opiate dependence.   In   keeping  with  this
position,  Russian  narcology officials  have taken an implacable
ideological stance toward illicit drug  use, the people who use drugs, and
their treatment. By adopting policies and practices totally unsupported by
scientific evidence and inquiry,  officials  in  Russia  have rendered
narcology (and medical practice)  insensitive  to the alarming rates and
continued spread of HIV,  with  its  dire  morbidity  and  mortality rates
in the Russian Federation,  turning  their  backs  on  all the other
health problems posed  by  opiate  use  and  dependence  itself.


]]></description></item><item><title><![CDATA[( BUPP09074 - 11 August 2008) Controversies in translational research: Drug self-administration]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09074</link><pubDate></pubDate><description><![CDATA[Rationale:   Laboratory   animal  and  human  models  of  drug
self-administration  are  used to evaluate potential pharmacotherapies for
drug  abuse, yet the utility of these models in predicting clinically
useful  medications  is  variable.  Objective:  The objective of this
study  was  to  track  how  antagonist,  agonist, and partial agonist
medication    approaches   influence   heroin   and   cocaine
self-administration  by  rodents,  non-human  primates,  and humans and to
compare  these results to clinical outcomes. Results: Across species,
heroin  self-administration  was  decreased  by  all three medication
approaches,  paralleling  their  demonstrated  clinical  utility. The
heroin  data  emphasize  the  importance  of assessing a medication's
abuse   liability  preclinically  to  predict  medication  abuse  and
compliance  and  of considering subject characteristics (e.g., opioid
dependence)  when  interpreting  medication effects. For cocaine, the
effects  of  ecopipam, modafinil, and aripiprazole were consistent in the
laboratory  and  clinic,  provided  that  the  medications  were
administered    repeatedly   before   self-administration   sessions.
Modafinil  attenuated  cocaine's  reinforcing  effects  in  the human
laboratory   and  improved  treatment  outcome,  while  ecopipam  and
aripiprazole  increased the reinforcing effects of cocaine and do not
appear  promising in the clinic. Conclusions: The self-administration
model has reliably identified medications to treat opioid dependence, and
the recent data with modafinil suggest that the human laboratory model
also identifies medications to treat cocaine dependence. There have  been
numerous  false positives when subjective effects are the primary
outcome  measure,  but  not  when self-administration is the outcome.
Factors  relevant  to  the  predictive  validity  of  self-administration
procedures  include  medication  maintenance  and the concurrent
assessment  of  a  range  of behaviors to determine abuse liability and
the specificity of effect.


]]></description></item><item><title><![CDATA[( BUPP09073 - 11 August 2008) Mucositis postradiotherapy]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09073</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09072 - 11 August 2008) Comparison of anesthetic induction in cats by use of isoflurane in an anesthetic  chamber  with  a  conventional  vapor or liquid injection technique.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09072</link><pubDate></pubDate><description><![CDATA[Objective-To  compare  2  techniques  for induction of cats by use of
isoflurane  in  an  anesthetic chamber.Design-Prospective, randomized
study.Animals-51 healthy cats.Procedures-Cats were randomly allocated to
2  induction techniques. Cats were premedicated with acepromazine (0.1
mg/kg  (0.045 mg/lb), SC) and buprenorphine (0.01 mg/kg (0.0045 mg/lb),
SC)  30 minutes before induction. Cats were then placed into an
induction  chamber,  and  anesthetic induction was initiated. One
technique  involved  a  conventional flow-through system that used an
oxygen  flowmeter and an isoflurane vaporizer to flow vapors into the
induction chamber. Alternatively, liquid isoflurane was injected into a
vaporization  tray that was mounted to the interior surface of the
chamber  lid. Inductions were videotaped for analysis. Five variables
(head  bobbing,  head  swinging  side to side, paddling, rotating 180
degrees  to 360 degrees, and rolling over or flipping) were scored to
assess  induction  quality.  Time variables recorded during induction
corresponded  to  the  interval  until  onset  of  excitatory motion,
duration   of  excitatory  motion,  interval  until  recumbency,  and
interval   until   complete   induction.Results-Compared   with  cats
anesthetized  by  use of a conventional vapor chamber technique, cats
anesthetized   by  use  of  the  liquid  injection  technique  had  a
significantly  shorter  interval  until recumbency and interval until
complete  induction  and  lower  scores  for  quality  of  induction,
indicating  a  smoother induction.Conclusions and Clinical Relevance-
Anesthetic  induction  in cats by use of a liquid injection technique was
more  rapid and provided a better quality of induction, compared
with  results  for  cats  induced  by  use  of  a  conventional vapor
technique.


]]></description></item><item><title><![CDATA[( BUPP09083 - 15 August 2008) Sublingual Buprenorphine for Treatment of Neonatal Adstinence Syndrome: A Randomized Trial]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09083</link><pubDate></pubDate><description><![CDATA[Pediatrics published online 11 Aug 2008. Online version of this article,
along with updated information and services, is located on the World Wide
Web at : http://www.pediatrics.org/cgi/content/full/peds.2008-057v1
OBJECTIVE. In utero exposure to drugs of abuse can lead to neonatal
abstinence syndrome, a condition that is associated with prolonged
hospitalization. Buprenorphine is a partial u-opioid agonist used for
treatment of adult detoxification and maintenance but has never been
administered to neonates with opioid abstinence syndrome. The primary
objective of this study was to demonstrate the feasibility and, to the
extent possible in this size of study, the safety of sublingual
buprenorphine in the treatment of neonatal abstinence syndrome. Secondary
goals were to evaluate efficacy relative to standard therapy and to
characterize buprenorphine pharmacokinetics when sublingually administered.
METHODS.We conducted a randomized, open-label, active-control study of
sublingual buprenorphine for the treatment of opiate withdrawal. Thirteen
term infants were allocated to receive sublingual buprenorphine 13.2 to
39.0 ug/kg per day administered in 3 divided doses and 13 to receive
standard-of-care oral neonatal opium solution. Dose decisions were made by
using a modified Finnegan scoring system.
RESULTS. Sublingual buprenorphine was largely effective in controlling
neonatal abstinence syndrome. Greater than 98% of plasma concentrations
ranged from undetectable to ~0.60 ng/mL, which is less than needed to
control abstinence symptoms in adults. The ratio of buprenorphine to
norbuprenorphine was larger than that seen in adults, suggesting a
relative impairment of N-dealkylation. Three infants who received
buprenorphine and 1 infant who received standard of care reached
protocol-specified maximum doses and required adjuvant therapy with
phenobarbital. The mean length of treatment for those in the
neonatal-opium-solution group was 32 compared with 22 days for the
buprenorphine group. The mean length of stay for the
neonatal-opium-solution group was 38 days compared with 27 days for those
in the buprenorphine group. Treatment with buprenorphine was well
tolerated.
CONCLUSIONS. Buprenorphine administered via the sublingual route is
feasible and apparently safe and may represent a novel treatment for
neonatal abstinence syndrome. Pediatrics 2008;122:e601–e607
www.pediatrics.org/cgi/doi/10.1542/
This trial has been registered at www. clinicaltrials.gov (identi.er
NCT00521248). Dr Ehrlich’s current af.liation is Departments of Pediatrics
and Neurology, Mt
Sinai School of Medicine, New York, New York.
Accepted for publication May 13, 2008 Address correspondence to Walter K.
Kraft, MD, 132 S 10th St, 1170 Main Building, Jefferson Medical College,
Philadelphia, PA 19107. E-mail: walter.kraft@jefferson.edu PEDIATRICS
(ISSN Numbers: Print, 0031-4005; Online, 1098-4275). Copyright©2008 by the
American Academy of Pediatrics


]]></description></item><item><title><![CDATA[( BUPP09084 - 15 August 2008) Treating Pregnant women dependent on opioids is not the same as treating pregnancy and opioid dependence: a knowledge synthesis for better treatment for women and neonates.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09084</link><pubDate></pubDate><description><![CDATA[Aims: Through a novel synthesis of the literature and our own clinical
experience, we have derived a set of evidence based recommendations for
consideration as guidance in the management of opioid-dependent pregnant
women and infants.
Methods: PubMed literature searches were carried out to identify recent
key publications in the areas of pregnancy and opioid dependence, neonatal
abstinence syndrome (NAS) prevention and treatment, multiple substance
abuse and psychiatric comorbidity.
Results: Pregnant women dependent on opioids require careful treatment to
minimize harm to the fetus and neonate and improve maternal health.
Applying multi-disicpinary treatment as early as possible, allowing
medication maintenance and regular monitoring, benefits mother and child
both in the short and the long term. However, there is a need for
randomized clinical trials with sufficient sample sizes.
Recommendations: Opioid maintenance therapy is the recommended treatment
approach during pregnancy. Treatment decisions must encompass the full
clinical picture, with respect to frequent complications approaches to
pregnancy, equivalent attention must be given to the treatment of NAS,
which occurs frequently after opioid medication.
Conclusion: Methodological flaws and inconsistencies confound
interpretation to today's literature. Based on this synthesis of available
evidence and our clinical experience, we propose recommendations for
further discussion.


]]></description></item><item><title><![CDATA[( BUPP09085 - 18 August 2008) The neurobiology of opioid dependence: implications for treatment.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09085</link><pubDate></pubDate><description><![CDATA[Opioid tolerance, dependence, and addiction are all manifestations of
brain  changes  resulting  from  chronic  opioid  abuse.  The  opioid
abuser's  struggle  for  recovery  is  in  great  part  a struggle to
overcome the effects of these changes. Medications such as methadone,
LAAM,  buprenorphine, and naltrexone act on the same brain structures and
processes as addictive opioids,  but  with  protective  or normalizing
effects.  Despite the effectiveness of medications, they must be used in
conjunction with appropriate psychosocial treatments.
http://www.nida.nih.gov/PDF/Perspectives/vol1no1/03Perspectives-Neurobio.pd
f


]]></description></item><item><title><![CDATA[( BUPP09086 - 18 August 2008) Comparison of characteristics of opioid-using pregnant women in rural and urban settings.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09086</link><pubDate></pubDate><description><![CDATA[Historically, research on opioid use during pregnancy has occurred in
urban  settings  and  it  is  unclear how urban and rural populations
compare. We examined socio-demographic and other variables in opioid using
pregnant women seeking treatment and screened for participation in  a
multi-site randomized controlled trial. Women screened in rural
Burlington,  Vermont  (n  =  54),  were compared to those screened in
urban  Baltimore,  Maryland  (n  =  305). Rural opioid-using pregnant
women  appear  to  have  some  characteristics associated with better
treatment  outcomes (e.g., less severe drug use, greater employment).
However,  they  may  face  additional barriers in accessing treatment
(e.g., greater distance from treatment clinic).
Grant ID: R01DA015764, Acronym: DA, Agency: United States NIDA
Grant ID: R01DA018410, Acronym: DA, Agency: United States NIDA.


]]></description></item><item><title><![CDATA[( BUPP09087 - 18 August 2008) State  policy  influence  on  the early diffusion of buprenorphine in community treatment programs.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09087</link><pubDate></pubDate><description><![CDATA[BACKGROUND:  Buprenorphine  was  approved for use in the treatment of
opioid  dependence  in 2002, but its diffusion into everyday clinical
practice  in  community-based  treatment programs has been slow. This
study examines the net impact of efforts by state agencies, including
provision   of   Medicaid  coverage,  on  program-level  adoption  of
buprenorphine as of 2006. METHODS: Interviews were conducted with key
informants in 49 of the  50  state  agencies  with  oversight
responsibility  for  addiction  treatment  services. Information from
these  interviews  was  integrated  with organizational data from the
2006  National  Survey  of  Substance  Abuse  Treatment  Services.  A
multivariate  logistic regression model was estimated to identify the
effects of state efforts to promote the use of this medication, net of a
host of organizational characteristics.  RESULTS:  The availability of
Medicaid coverage for buprenorphine was a significant predictor  of  its
adoption  by treatment organizations. CONCLUSION: Inclusion  of
buprenorphine on state Medicaid formularies appears to be a key element in
ensuring that patients have access to this state-of-the-art   treatment
option.  Other  potential  barriers  to  the
diffusion  of  buprenorphine require identification, and the value of
additional state-level  policies  to  promote  its  use  should  be
evaluated.


]]></description></item><item><title><![CDATA[( BUPP09088 - 18 August 2008) Addiction: a chronic medical condition.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09088</link><pubDate></pubDate><description><![CDATA[More hapless drug users have paid with their lives, figuratively and
literally, as  investigators demonstrate yet again that opiate addiction
is a treatable but not curable medical condition (1). Thirty-eight of 75
patients given buprenorphine completed the 9 month detoxification
protocol, with completion defined as missing less than 2 consecutive weeks
of treatment. Completers also included dropouts who returned to agonist
maintenance treatment within 30 days. Three patients died during the 9
month detoxification regimen, another died within 12 months of completing
treatment and yet one more died 18 months after dropping out, All told,
nine of the 75 starting subjects were abstinent at 24 month follow up, and
of these an unknown number were incarcerated or in residential care at the
time of assessment. Among the authors conclusions: 'Outcomes...do not
support the assumption that buprenorphine is a more appropriate agent than
methadone in abstinence oriented replacement therapies - an assumption
that they attribute to the proposedly mild withdrawal syndrome associated
with discontinuation that they attribute to the proposedly mild withdrawal
syndrome associated with discontinuation of buprenorphine therapy...' In
fact, the problem is not the medication employed, but the nature of this
chronic, notoriously relapsing, treatable but (as yet) incurable patients
must pay the ultimate price to confirm that which is based so solidly on
empirical evidence and common sense.


]]></description></item><item><title><![CDATA[( BUPP09089 - 18 August 2008) Buprenorphine use by the smoking route in gaols in NSW.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09089</link><pubDate></pubDate><description><![CDATA[A recent paper in the Journal of Addictive Diseases by Smith and
colleagues (1) reports on the abuse of buprenorphine in the United States.
The authors cite the unfortunate absence of data  regarding the route of
administration in assisting then in interpreting their study results. They
seem to have focused primarily on the potential for buprenorphine to be
injected and the additional aversive potential of the
buprenorphine-naloxone combination (Suboxone) in this regard. I wish to
raise the issue of smoking as a potential route for misuse and the use of
buprenorphine within correctional facilities.


]]></description></item><item><title><![CDATA[( BUPP09090 - 18 August 2008) Patients' help-seeking behaviours for health problems associated with methadone and buprenorphine treatment.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09090</link><pubDate></pubDate><description><![CDATA[INTRODUCTION  AND  AIMS: Clients in opioid substitution therapy often have
considerable unmet health-care needs. The current study aimed to explore
health problems related to opioid substitution therapy among clients on
methadone and buprenorphine treatment. DESIGN AND METHODS: A
self-complete, cross-sectional survey conducted among 508 patients
receiving   methadone   and   buprenorphine  treatment  at  community
pharmacies  in  New  South  Wales (NSW), Australia. RESULTS: The most
common  problems  for  which  participants  had ever sought help were
dental  (29.9%),  constipation (25.0%) and headache (24.0%). The most
common problems for which participants would currently like help were
dental (41.1%), sweating (26.4%) and reduced sexual enjoyment (24.2%).
There  were  no significant differences between those currently on
methadone  and those currently on buprenorphine for any of the health
problems  explored, nor differences for gender or treatment duration.
Participants on methadone  doses 100 mg or above were significantly more
likely  to  want  help  currently  for sedation. DISCUSSION AND
CONCLUSIONS:  The considerable   unmet  health  care  needs  among
participants  in  this  study suggest that treatment providers should
consider  improving  the  detection  and  response  to  common health
problems related to opioid substitution therapy.


]]></description></item><item><title><![CDATA[( BUPP09091 - 18 August 2008) The  safety  of  disulfiram  for the treatment of alcohol and cocaine dependence  in  randomized  clinical  trials:  Guidance  for clinical practice.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09091</link><pubDate></pubDate><description><![CDATA[Background:  Disulfiram  has  demonstrated efficacy in six randomized
clinical  trials  for  the  treatment  of  cocaine dependence, but is
rarely used  in  clinical  settings  because  of  safety  concerns.
Objective: What are the common and serious side effects of disulfiram in
cocaine-dependent individuals with and without alcohol dependence in
randomized  clinical  trials?  Methods: We located Phase I and II
randomized  trials  that  discussed the safety of disulfiram.
Results/conclusions:  In randomized clinical trials that eliminated
subjects with  serious cardiovascular, hepatic, and psychiatric disorders,
the most frequent side effects of disulfiram over placebo or index groups
include  headaches, fatigue, sleepiness, and anxiety. Disulfiram in a
dose  of  250 mg/day led to only mild interactions with alcohol. When
patients  are screened for medical and psychiatric stability, and are
evaluated  for  drug interactions, disulfiram has an acceptable
side-effect  profile  for  the  treatment  of  cocaine  dependence with or
without alcohol dependence.


]]></description></item><item><title><![CDATA[( BUPP09092 - 18 August 2008) Transdermal  buprenorphine  (Transtec®)  for  the treatment of severe chronic pain]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09092</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09093 - 18 August 2008) Epidemiology of opioid pharmacy claims in the United States]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09093</link><pubDate></pubDate><description><![CDATA[Objective:  To describe opioid pharmacy claims patterns in the United
States  among an insured population. Design: Information was obtained
from the US insurance claims database, IMS Lifelink TM , between 1997 and
2002.  Descriptive  statistics  of  opioid  claims patterns were
described  with  stratification  by  gender,  age,  and  year of use.
Results: The  prevalence  of  insured  people  with  opioid  claims
increased  from  17.1  percent in 1997 to 18.4 percent in 2002. Among
people  with  an  opioid claim, 24 percent had 30 days and 10 percent had
90  days  of  days  supplied  based  on  the  insurance  claims.
Prevalence  varied  by  type  of  opioid; 56 percent of people with a
claim  received propoxyphene, 43 percent received codeine, 23 percent
received  oxycodone,  and 17 percent received hydrocodone.
Sustained-release  opioids  were  found  among 6 percent of those with a
claim. With respect to the dose of opioids in the pharmacy claims
(expressed as morphine  equivalent total daily dose), 71 percent had
claims for <50 mg, 55 percent had claims for 50-99 mg, and 24 percent had
claims for  100  mg.  Women, individuals with cancer, and older patients
had significantly more pharmacy claims as well as claims for higher doses
of  opioids  (p  <  0.05).  Internal  medicine  and  family  practice
specialists were responsible for 22.4 percent and 20.9 percent of all
opioid claims. Conclusions: Opioid pharmacy claims increased slightly over
time. Older patients, women and patients with a cancer diagnosis had
significantly more opioid claims and claims for higher doses than the
younger patients, men, and those without cancer.


]]></description></item><item><title><![CDATA[( BUPP09094 - 18 August 2008) Opioid-induced    hyperalgesia: Pathophysiology and clinical implications.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09094</link><pubDate></pubDate><description><![CDATA[Background:  Opioid-induced hyperalgesia (OIH) refers to a phenomenon
whereby opioid   administration  results  in  a  lowering  of  pain
threshold,   clinically   manifest   as  apparent  opioid  tolerance,
worsening  pain  despite accelerating opioid doses, and abnormal pain
symptoms  such as allodynia. Aim: The current review, while providing a
clinically oriented updated overview on the pathophysiology of OIH,
focuses  predominantly  on  evidence-based  clinical  and  management
aspects  of  this  important  and  often baffling phenomenon. Method:
Online  and  manual  search  using  key  words such as opioid-induced
hyperalgesia, opioid-induced abnormal  pain  sensitivity,  opioid
hyperalgesia,  opioid-induced  paradoxical  pain,  or  opioid-induced
abnormal  pain,  followed  by  full-text  access  and  further
cross-referencing.   Results:   The   underlying  pathophysiology  of
this phenomenon,  although  still  unclear,  appears  to  be related to an
opioid-induced  imbalance  between  the  internal antinociceptive and
pronociceptive  systems.  Clinical  differentiation  of  an  apparent
opioid  tolerance state includes OIH. Once diagnosed or provisionally
considered, treatment strategies could include opioid dose reduction,
opioid  rotation,  use of agents with NMBA receptor antagonism, and a
properly  timed  coxib.  Conclusion:  Despite  initial skepticism and
reservations,  the  phenomenon  of  OIH  in  humans is now accepted a
clinical reality and  a  challenge  faced  by  anesthesiologists,
intensivists,  pain specialists, and other workers in a diverse range of
settings from perioperative care to palliative care medicine.


]]></description></item><item><title><![CDATA[( BUPP09095 - 18 August 2008) A  patient-based  national survey on postoperative pain management in France reveals significant achievements and persistent challenges.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09095</link><pubDate></pubDate><description><![CDATA[We  carried  out  a  national  survey  on  postoperative  pain  (POP)
management  in a representative sample (public/private,
teaching/non-teaching,  size)  of  76 surgical centers in France. Based on
medical records  and  questionnaires,  we evaluated adult patients 24 h
after surgery,   concerning   information:   pre  and  postoperative
pain, evaluation,  treatment  and side effects. A local consultant
provided information  about  POP management. Data were recorded for 1900
adult patients,  69.3%  of  whom remembered information on POP.
Information was mainly delivered orally (90.3%) and rarely noted on the
patient's chart  (18.2%).  Written evaluations of POP were frequent on the
ward (93.7%)  with appropriate intervals (4.1 (4.0) h), but not frequently
prescribed  (32.7%).  Pain  evaluations  were  based on visual analog
scale  (21.1%), numerical scale (41.2%), verbal scale (13.8%) or
non-numerical  tool  (24%). Pain was rarely a criterion for recovery room
discharge  (19.8%).  Reported  POP  was  mild  at  rest  (2.7 (1.3)),
moderate during movement (4.9 (1.9)) and intense at its maximal level
(6.4  (2.0)).  Incidence  of  side  effects  was similar according to
patient  (26.4%) or medical chart (25.1%) including mostly nausea and
vomiting   (83.3%).   Analgesia   was   frequently  initiated  during
anesthesia  (63.6%).  Patient-controlled  analgesia  (21.4%) was used less
frequently than subcutaneous morphine (35.1%) whose prescription
frequently  did  not  follow  guidelines.  Non-opioid analgesics used
included paracetamol (90.3%), ketoprofen (48.5%) and nefopam (21.4%).
Epidural  (1.5%)  and peripheral (4.7%) nerve blocks were under used.
Evaluation  (63.4%) or treatment (74.1%) protocols were not available
for  all  patients. This national, prospective, patient-based, survey
reveals  both progress and persistent challenges in POP management


]]></description></item><item><title><![CDATA[( BUPP09096 - 18 August 2008) Normative data of multifrequency tympanometry in rabbits.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09096</link><pubDate></pubDate><description><![CDATA[In an experimental study, we evaluated acoustic immittance in rabbits in
order  to  use  these  data  as  normative  values  for  further
experimental  investigations.  This  study  is the first experimental
evaluation of both conventional   226   Hz  and  multifrequency
tympanometry  (MFT)  in  rabbits.  For  the investigation, we used 33
female New Zealand rabbits weighing 3.2 - 4.4 kg and aged six months.
Bilateral  measurements  using  conventional  226  Hz  and  MFT  were
performed  under  general  anaesthetic.  A  226  Hz  tympanogram  was
recorded  for  all  animals  by conducting an air pressure sweep from
+200  to  -400  daPa  at a rate of 50 daPa/s. Subsequent tympanograms
were  recorded  over  a wide frequency range from 250 to 2000 Hz. The
acoustic  impedance  device  used in this study provided reproducible and
evaluable  tympanograms.  The  applied  tone frequency of 226 Hz proved
to   be  especially  suitable  for  determining  compliance. Normative
data obtained from our study reveal the resonance frequency to  be
1368±205  standard  deviation  (SD)  for  the  right side and 1413±216  SD
for the left side. The values for physiological acoustic immittance of the
middle ear in the rabbit obtained here can serve as normative   data   in
subsequent  experimental  animal  studies.


]]></description></item><item><title><![CDATA[( BUPP09097 - 18 August 2008) Pharmacogenetic testing for uridine diphosphate glucuronosyltransferase 1A1 polymorphisms: Are we there yet?]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09097</link><pubDate></pubDate><description><![CDATA[Recent   changes   to  the  labels  of  three  prescription  drugs -
irinotecan,  6-mercaptopurine, and warfarin - include recommendations for
pharmacogenetic  testing in patients. Thus, clinicians are faced with
determining  the  utility  and  practicality of pharmacogenetic testing in
clinical practice. We illustrate the clinical implications that  this
testing  may have using irinotecan, an agent approved for the  treatment
of  metastatic  colorectal  cancer,  as an example. A
clinical   association  between  the  drug's  active  metabolite  and
toxicity has been found. By performing  uridine  diphosphate
lucuronosyltransferase  (UGT) 1A1 genetic testing, some studies have been
able  to  predict  which  patients  receiving  irinotecan  will
experience  the  toxicity.  Thus,  irinotecan's  package  insert  was
revised  to  include  a recommendation for such testing. In addition, the
United  States  Food and Drug Administration approved a clinical test for
the  UGT1A1*28  allele.  These  events  demonstrate  that pharmacogenetics
has entered the realm of clinical practice. However, the  transition
from  bench  to  bedside of these tests has distinct challenges  such as
population differences, test sensitivity, and the role  of  other
genetic  and  nongenetic factors that influence drug toxicity.   In
addition,   ethical  and  logistic  implications  of pharmacogenetic
testing exist.


]]></description></item><item><title><![CDATA[( BUPP09098 - 18 August 2008) Palliative  medicine:  Pain management according to time and step-by-step plan.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09098</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09099 - 18 August 2008) A clinical snapshot of transdermal buprenorphine in pain management.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09099</link><pubDate></pubDate><description><![CDATA[New and effective analgesics for the treatment of pain are essential.
Buprenorphine,  a partial mu receptor agonist, offers unique
physico-chemical  and  pharmacological  qualities,  making  it  an
attractive first-choice  opioid  for  the  treatment  of acute and chronic
pain. Several  delivery  formulations  are  available  including
parental, sublingual  tablet, sublingual solution and transdermal. The
parental formulation  has  been  administered  intravenously,
intramuscularly, epidurally  and  intrathecally. Transdermal patches allow
the drug to be continuously  absorbed  through  the  skin  and into the
systemic
circulation.  This  approach has been shown to have clinical benefit,
along  with high-level patient acceptability, compliance and improved
quality  of  life.  However, further randomised controlled trials are
needed  to  focus  on  defining  dose  requirements in different pain
states and the appropriateness and utilisation of adjuvant analgesics
when  required.


]]></description></item><item><title><![CDATA[( BUPP09100 - 18 August 2008) Basic pharmacology of buprenorphine.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09100</link><pubDate></pubDate><description><![CDATA[Buprenorphine  is a derivative of the morphine alkaloid thebaine. The
plasma  elimination  half-life of buprenorphine is three times longer
than  that  of  the active metabolite, norbuprenorphine. Although the
elimination of norbuprenorphine from the body is more rapid than that of
buprenorphine,  the  plasma concentration of norbuprenorphine was
observed  to exceed that of buprenorphine with chronic administration of
buprenorphine.  This plasma level of norbuprenorphine is based on the
proportional  increase  in norbuprenorphine-glucuronide observed after
one  enterohepatic  circulation  of  buprenorphine  due to the first-pass
metabolism.  When buprenorphine and norbuprenorphine were administered
intraventricularly, the analgesic effect of norbuprenorphine  was
approximately one-fourth that of buprenorphine. After intravenous
administration of buprenorphine or norbuprenorphine in rats, the analgesic
effect of norbuprenorphine was approximately 1/50th  that of
buprenorphine. The remarkably weak analgesic effect of norbuprenorphine
after  intravenous administration may be due to the low permeability of
norbuprenorphine into the brain. Therefore, the plasma  concentration of
norbuprenorphine with chronic administration of buprenorphine has little
analgesic effect. The most dangerous side effect  of  opioid therapy is
respiratory depression. In our study of the   respiratory   effects
after  intravenous  infusion  in  rats, norbuprenorphine  was  ten  times
more  potent than the parent drug. However,  it  is  possible that the
plasma levels of norbuprenorphine with chronic  administration  of
buprenorphine are not sufficiently high  to  depress  respiratory
function. Overall, buprenorphine is a safe  and  highly  effective
analgesic  opioid  for the treatment of chronic   pain.


]]></description></item><item><title><![CDATA[( BUPP09101 - 18 August 2008) Cancer pain management modalities and positioning of oxycodone.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09101</link><pubDate></pubDate><description><![CDATA[Cancer  pain  management  is  centered on opioid therapy. In Japan, 3
types  of  strong opioid are available for treatment; therefore it is
important  to  use them according to the characteristics of each drug and
dosage  form.  Particularly, oxycodone is suitable as first-line choice of
opioid, which can also be employed as opioid switching when symptoms  of
the  central nervous system is manifested following the use  of  oral
morphine. Furthermore, opioid responsiveness should be taken  into account
when opioid therapy is carried out; assessment of the analgesic effect is
particularly important. Recently, we tried to select suitable treatment
modalities by speculating on the pathologic conditions of pain relative to
the responsiveness to morphine and causes of pain. In the case of pain
with low response to morphine, it was  possible  to attain good pain
control not only by opioid therapy but  also by a combination of opioid
therapy and nerve block therapy. In cancer pain treatment,  appropriate
assessment  of  pathologic conditions of pain and selection of adequate
and accurate treatment modalities  are  essential  for  improvement  of
the  effect of pain relief.


]]></description></item><item><title><![CDATA[( BUPP09102 - 18 August 2008) Predicting pain and pain responses to opioids.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09102</link><pubDate></pubDate><description><![CDATA[The  mechanisms  behind  the  wide  individual  variability  in  pain
experience  and  relief  are  an  area  of intense research activity.
Predicting   individual  clinical  pain  and  the  responsiveness  to
analgesics should increase the efficacy and tolerability of analgesic
treatments,  and  improve  the  overall  treatment  outcome.  Several
factors  have  shown  validity  in  the prediction of pain, with most
studies  having  been  performed in postoperative pain. These factors
include younger age,  female   gender,   multiple   psychosocial
contributors  (e.g.  negative  affect, somatisation, depressive mood,
expectations, anxiety), pre-existing physical comorbidities and pain,
information  provided  by  carers, and the nature of the pain insult.
Recent  studies  have  shown  quantitiative  sensory  testing at high
stimulus  intensity  (e.g.  pain  thresholds),  as  well  as specific
genetic  factors  and  the  functional testing of the endogenous pain
modulatory  pathways  as  emerging  useful  tools  in  the  study  of
individual  pain  variability.  Many  of  the  above factors are also
relevant   in   the   prediction  of  analgesic  responsiveness.  The
predominant  pain  characteristics,  pain chronicity and neuroplastic
changes,  opioid-related  genetic  factors  and psychological factors
(including  placebo  response  components)  are major determinants of
analgesic   efficacy.  Prediction  of  analgesia  using  quantitative
sensory  tests  has been studied with some success. Better prediction of
individual  pain and analgesic responsiveness promises to improve  pain
control and general treatment outcome, and reduce adverse events as  well
as costs. Further prospective studies with interdisciplinary input
validating  the  usefulness  of  predictive  variables  within algorithms
are  encouraged in large patient cohorts.


]]></description></item><item><title><![CDATA[( BUPP09103 - 18 August 2008) The  3rd Asia Pacific Symposium on Pain Control, Singapore, September 1-3, 2006: Introduction and Overview]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09103</link><pubDate></pubDate><description><![CDATA[The first Asia Pacific Symposium on Pain Control (APSPC) was held in 1991
in Sydney Australia, with the intention of providing the Asia Pacific
region with an international platform for discussing emerging concepts in
cancer pain management with special regard to oral controlled release
morphine. The Proceedings were published in the Postgraduate Medical
Journal, Vol 67 S2, 1991.
Ten years later followed the 2nd APSPC, also in Sydney and equally
successful, with a timely update on further developments in chronic pain
management, and with the newly introduced controlled release oxycodone
tablets as a novelty in the armamentarium of strong oral opioid
analgesics. Proceedings were published in the European Journal of Pain,
Vol 5 SA,2001


]]></description></item><item><title><![CDATA[( BUPP09104 - 18 August 2008) Family  1  uridine-5'-diphosphate  glucuronosyltransferases  (UGT1A): From Gilbert's syndrome to genetic organization and variability.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09104</link><pubDate></pubDate><description><![CDATA[The  human  UDP-glucuronosyltransferase 1A gene locus is organized to
generate  enzymes,  which  share  a  carboxyterminal  portion and are
unique  at their aminoterminal variable region. Expression is
tissue-specific  and  overlapping  substrate  specificities  include a
broad spectrum  of  endogenous  and  xenobiotic  compounds  as well as
many therapeutic  drugs  targeted  for  detoxification  and elimination by
glucuronidation.  The  absence  of  glucuronidation  leads  to  fatal
hyperbilirubinemia.  A remarkable interindividual variability of
UDP-glucuronosyltransferases  is evidenced by over 100 identified genetic
variants   leading   to   alterations   of   catalytic  activites  or
transcription levels. Variant alleles with  lower  carcinogen
detoxification activity have been associated with cancer risk such as
colorectal  cancer and hepatocellular carcinoma. Genetic variants and
haplotypes  have  been  identified  as risk factors for unwanted drug
effects of the anticancer  drug  irinotecan  and  the  antiviral
proteinase  inhibitor atazanavir. Glucuronidation and its variability are
likely  to represent an important factor for individualized drug therapy
and  risk  prediction  impacting  the  drug  development and licensing
processes


]]></description></item><item><title><![CDATA[( BUPP09105 - 18 August 2008) Pharmacogenetics of Gilbert's syndrome.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09105</link><pubDate></pubDate><description><![CDATA[The  pharamcogenetics  of  Gilbert's  syndrome  is  reviewed.  Topics
discussed  are:  the  uridine  diphosphate-5'-glucuronosyltransferase
(UGT)  1A  gene  locus;  genetic  variation  at the UGT1A gene locus;
bilirubin  metabolism  and  UGT  genes;  the  UGT1A1  gene; Gilbert's
syndrome  variants and specific pharmacogenetic risks; disposition to
drug  toxicity;  irinotecan  toxicity;  and  jaundice  in  proteinase
inhibitor  therapy  (atazanavir).  The  analysis  of  transcriptional
regulation   of   the  UGT1A  genes  will  offer  the  potential  for
therapeutic intervention by identifying druggable inducers that could be
co-administered with potentially side effect prone drugs.


]]></description></item><item><title><![CDATA[( BUPP09106 - 18 August 2008) Monitored   anaesthesia   care   in  the  elderly  -  Guidelines  and recommendations.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09106</link><pubDate></pubDate><description><![CDATA[Monitored anesthesia care in the elderly is reviewed with respect to:
age-related physiological changes   in   the   elderly;   patient
preparation;  patient-specific monitoring; assessment of the level of
sedation;  specific  agents,  doses and related risks for medications
used  for  monitored  anesthesia  care; specific procedures performed
under monitored  anesthesia care; potential complications associated with
monitored  anesthesia  care  in the elderly; postoperative pain control in
the elderly after monitored anesthesia care; and discharge criteria  for
the elderly after monitored anesthesia care. Anesthetic    dosing  should
be  in  smaller  increments  in  the elderly, boluses reduced  by  half
and  infusions  reduced  by as much as two-thirds. Caution  must be
exercised through full monitoring of intra-operative and postoperative
mental status, oxygenation and perfusion states.


]]></description></item><item><title><![CDATA[( BUPP09107 - 18 August 2008) Comparable   analgesic   efficacy  of  transdermal  buprenorphine  in patients over and under 65 years of age.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09107</link><pubDate></pubDate><description><![CDATA[This  prospective  age-controlled,  open  clinical trial compared the
efficacy and tolerability of transdermal and sublingual buprenorphine
(Transtec  patches,  Grunenthal  GmbH)  in  82  elderly  patients and
younger  populations with moderate-to-severe chronic pain. Daily mean pain
intensities were even lower in elderly patients vs. younger age-groups.
Sleep  duration incidences above 6 hr improved from 34% to a plateau
above 50% for patients terminating the study as planned. The need for
rescue medication was lowest in elderly patients. The opioid typical
adverse  event  profile (predominantly dizziness and nausea)
and  local  skin  tolerability  were  both comparable for younger and
elderly patients.   Treatment  of  chronic  pain  with  transdermal
buprenorphine  in elderly patients above the age of 65 yr is at least as
effective,  tolerable,  and safe as in patients studied in 2 age-groups
below that age.


]]></description></item><item><title><![CDATA[( BUPP09108 - 18 August 2008) Is  hepatitis  C  prevalence decreasing among opiate-substituted drug users attending an addiction outpatient unit in France?]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09108</link><pubDate></pubDate><description><![CDATA[Background and Aims: A previous study conducted in our area in 2003 has
shown that HCV prevalence in drug users attending an addiction out patient
unit was 66%. The aim of our prospective study is to know if this
prevalence has changed in 2007.
Methods: A screening for Hepatitis B and C virus, HIV, ALT was offered by
the addiction physician to each Opiate Maintenance Treatment (OMT)
patient. Samples of venous or capillary blood were collected in the unit.
Results: Among the 239 consecutive DU (81 with methadone (MM)- and 158
with buprenorphine (BM)- maintenance), 183 (77%) have been screened
without difference according to the type of substitution. 76% were male;
mean age was 31.3 years (34.4 vs 29.7 in MM and BM patients respectively,
p<0.05). Twenty percent of the samples were performed on capillary blood
(41% in MM patients vs 9% in BM patients; p<0.05). While the prevalence of
HCV antibodies was 66% in 2003 in this same unit, it was only 19.0% in
2007 (n=35) (37.9% in MM patients vs 8.5% in BM patients; p<0.05). HCV RNA
was found in 88.6% of those patients. ALT was higher than the upper limit
of normal in 15 out of 26 patients. Daily excessive alcohol intake was
observed more frequently in the DU with HCV antibodies (52.9% vs 22.1%;
p<0.05) or with MM treatment (44.4% vs 22.8% in BM patients; p=0.03).
All patients were antigen HBs-negative and 4 patients were co-infected
with HIV-HCV.
Conclusion: This study highlights a clear decrease if the hepatitis C
prevalence in DU with opiate maintenance treatment in our centre. It can
reflect the effectiveness of sanitary guidelines proposed by French
authorities in the middle of the 90's and/or a modification of patients'
course in the health-care system with a management of highest HVD risk DU
apart from our unit. These data underline the need for an extension of
systematic screening in other addiction of our town to confirm these
results.


]]></description></item><item><title><![CDATA[( BUPP09109 - 18 August 2008) Relapse  rate  and outcome after liver transplantation (LT) in former intravenous drug (IVD) abusers.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09109</link><pubDate></pubDate><description><![CDATA[Background and Aims: Former IVD abusers and patients on methadone of
buprenorphine maintenance therapy are accepted in many LT programs. The
risks of IVD relapse and the effects on long term survival, however, have
been seldom investigated. The aims of the present study wee to address
these issues across more transplantation centers in different countries.
Methods: Patients with a past history of IVD abuse were identified from
the liver transplantation listing protocols from the University Hospitals
of Geneva (Switzerland), Grenoble and Lyon (France). Pertinent demographic
information and data on survival and relapse were collected and analyzed.
Results: Of 1486 liver transplanted patients in these centers between 1985
and 2006, we identified 59 (4.0%) patients with a past history if
intravenous drug use. The mean age of transplantation was 46.7 years
(range 22-58) and the majority of patients were men (84.7%). The
indications for LT were HCV (61%), HBV +HCV (14%), HBV (6.8%), HCV+HIV
(3.4%), HBV+HCV+HIV (1.7%), alcohol (5.1%). The mean length of IVD
abstinence at the time of listing was 132 months and patients had a mean
duration of IVD use before transplantation of 54 months (dependence mode
43%, abuse 15, and occasional use 42%). A substitution therapy with
methadone or buprenorphine was administered in 16.9% of patients before
transplantation and 6.8% continued after LT. The mean follow up duration
was 50 months (range 5 to 168). Post transplant relapse into IVD use was
observed in 2 patients (3.4%). Overall survival was 84%, 66% and 61% at 1,
5 and 10 year transplantation, respectively. In 3/17 cases the cause of
death was related to a lack of compliance to medication leading to organ
loss.
Conclusion: Data from the largest cohort of patients with former IVD abuse
show a relapse rate of 3.4% after LT. The use of non-IV illicit drugs is
not affected by LT. The overall outcome is similar to survival in the
general population after LT, but is negatively affected by a major lack of
compliance, responsible for the death in 18% of patients.


]]></description></item><item><title><![CDATA[( BUPP09110 - 26 August 2008) Management of cancer pain: ESMO Clinical Recommendations.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09110</link><pubDate></pubDate><description><![CDATA[The  ESMO  clinical  recommendations on the management of cancer pain are
reviewed.  The  following topics are discussed: the incidence of cancer
pain;  the  assessment  and  management  of  cancer pain; the treatment of
mild, moderate, and severe cancer pain (WHO level I, II, and   III,
respectively);  the  scheduling  and  titration  of  drug treatments;
the  management  of  opioid  side-effects; radiotherapy, surgery,  and
other  interventions;  the  treatment of resistant and neuropathic pain;
and coanalgesic medication. The drugs discussed are paracetamol,
acetylsalicylic acid, ibuprofen, ketoprofen, diclofenac, mefenamic acid,
naproxen, dihydrocodeine, tramadol, morphine sulfate, oxycodone,
hydromorphone,   fentanyl,   buprenorphine,   methadone,  nicomorphine,
amitriptyline, clomipramine, nortriptyline, fluoxetine, haloperidol,
chlorpromazine,    carbamazepine, gabapentin, and pregabalin.


]]></description></item><item><title><![CDATA[( BUPP09111 - 26 August 2008) Formation   of  the  N-methylpyridinium  derivative  to  improve  the detection of buprenorphine by liquid chromatography-mass spectrometry.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09111</link><pubDate></pubDate><description><![CDATA[The  legally  defensible  identification  of  the narcotic, analgesic
buprenorphine,   in   biological   specimen   requires   considerable
sensitivity  due  to  its  low  therapeutic dosages and corresponding
target   concentrations.   Application   of   liquid
chromatography-electrospray  ionisation-mass  spectrometry, which became
the default method for buprenorphine detection, is impeded by the
disadvantageous fragmentation  of  the  stable  precursor  ion  producing
unspecific product  ions of comparatively low abundance. A chemical
modification to  form  the N-methylpyridinium ether derivative of
buprenorphine is    presented to improve the selectivity and sensitivity
of its detection by  liquid  chromatography-mass spectrometry (LC-MS). The
reaction of buprenorphine  with
2-fluoro-1-methyl-pyridinium-p-toluene-sulfonate and  triethylamine as
catalyst was accomplished in acetonitrile at an ambient temperature
yielding   a  chemically  stable  derivative. Fragmentation  of  the
permanently charged precursor ion (m/z = 559) leads to the formation of
diagnostic and abundant fragments (e.g. m/z =  443  and  450)
representing  all  parts  of  the  molecule.  The application  of  the
technique to the identification of buprenorphine in  hair  samples
demonstrates  a  high specificity, availability of sufficient  qualifier
ions  and a significant (approximately 8-fold) improvement   of
detection   limits   with  respect  to  comparable experiments based on
underivatised buprenorphine.


]]></description></item><item><title><![CDATA[( BUPP09112 - 26 August 2008) Methadone  and buprenorphine treatment during pregnancy: what are the effects on infants?]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09112</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09113 - 26 August 2008) Drug-induced dementia:  A case/non-case study  in  the  French pharmacovigilance database.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09113</link><pubDate></pubDate><description><![CDATA[The  increased  incidence  of  dementia on the aging population makes
this  disease  a  major  public health problem. Among known causes of
dementia,  drug  etiology  is  under  considered. We investigated the
relationship  between  exposure  to  drug therapy and dementia with a
case/non-case  study  using  reports  of the French Pharmacovigilance
database.  Among  263  962  adverse effects recorded between 1985 and
2005,  79  (0.03%) are dementia. Median age is 66 (range 3-91). There was
41 women and 37 men. The therapeutic drug class associated with dementia
were  anticonvulsants,  antiparkinsonians, antidepressants, anxiolytics,
hypnotics, antipsychotics and morphinics. An association between
reporting  of  dementia  and non neurotropic drugs were also    found,
i.e. interferon alfa-2B, vancomycin and allopurinol. The term "Dementia"
is only mentioned in the summary of the characteristics of valproate, but
it may concern other drugs. Drug etiology for dementia is a reality  but
is not necessarily attributed as a cause in aging population, in
particular.


]]></description></item><item><title><![CDATA[( BUPP09114 - 26 August 2008) Pharmacokinetic approaches to treatment of drug addiction.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09114</link><pubDate></pubDate><description><![CDATA[The  pharmacokinetic approach to treatment targets the drug molecules
themselves,  aiming  to  reduce  their  concentration  at the site of
action,  thereby  reducing  or preventing any pharmacodynamic effect. This
approach might be useful in the treatment of acute drug toxicity/overdose
and in the long-term treatment of addiction. Early clinical trials with
anticocaine and antinicotine vaccines have shown reduced drug  use  and
good  tolerability.  Also  showing  promise in animal studies  are
monoclonal  antibodies against cocaine, methamphetamine and
phencyclidine,  as  well as the enhancment of cocaine metabolism with
genetic  variants  of  human  butyrylcholinesterase,  using  a bacterial
esterase or catalytic monoclonal antibodies. Pharmacokinetic  treatments
offer  potential  advantages in terms of patient  compliance,  absence  of
medication interactions and benefit for  patients  who  cannot  take
standard medications.


]]></description></item><item><title><![CDATA[( BUPP09115 - 26 August 2008) First, Remove the Offending Agent]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09115</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09116 - 26 August 2008) Efficacy and clinical management of buprenorphine.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09116</link><pubDate></pubDate><description><![CDATA[Objectives.  To describe both, the clinical efficacy of buprenorphine in
the  maintenance  treatment  of  opioid  dependence  and the most
relevants  aspects  of  the  clinical use. Material and methods. This
review  describes  the  most relevant studies that have evaluated the
efficacy of  burprenorphine  as  maintenance  treatment  of  opioid
dependence,  compared  to  placebo and other opiate treatments. Other
indication  for  which  buprenorphine has been studied are described.
Results. Buprenorphine is an opiate that has demonstrated efficacy in the
maintenance treatment of opiate dependent patients when compared to
placebo as well as to other opiate treatments (methadone,
L-alpha-acetyl-methadol (LAAM), morphine and heroin). Buprenorphine is a
safe   and  well  tolerated drug and can be used as fixed or flexible
doses, which  means  that  is  easy  to start the treatment and carry on
it. Conclusions.  Buprenorphine  is  effective in the treatment of opiate
addiction,  in  maintenance  or detoxification programs, specially in
patients with affective disorders comorbidity.


]]></description></item><item><title><![CDATA[( BUPP09117 - 26 August 2008) Interactions  between  antiretroviral  therapy (ART) and substitution medications in HIV-infected drug users.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09117</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09118 - 26 August 2008) Immunotherapies for drug addictions.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09118</link><pubDate></pubDate><description><![CDATA[Immunotherapies  in  the  form  of  vaccines (active immunization) or
monoclonal  antibodies  (passive  immunization)  appear  safe  and  a
promising  treatment approaches for some substance-related disorders. The
mechanism of action of the antibody therapy is by preventing the rapid
entry  of  drugs  of abuse into the central nervous system. In theory,
immunotherapies  could  have  several clinical applications. Monoclonal
antibodies  may  be  useful  to  treat drug overdoses and prevent  the
neurotoxic  effects  of drugs by blocking the access of drugs  to  the
brain. Vaccines may help to prevent the development of addiction,
initiate  drug  abstinence  in  those already addicted to drugs,  or
prevent  drug use relapse by reducing the pharmacological effects  and
rewarding properties of the drugs of abuse on the brain. Passive
immunization with monoclonal antibodies has been investigated for
cocaine,  methamphetamine,  nicotine,  and  phencyclidine (PCP). Active
immunization  with  vaccines  has  been  studied for cocaine, heroin,
methamphetamine,  and  nicotine.  These immunotherapies seem promising
therapeutic  tools  and  are  at different stages in their development
before  they  can be approved by regulatory agencies for the treatment
of  substance-related  disorders. The purpose of this article  is  to
review  the  current  immunotherapy  approaches with emphasis  on  the
risks  and  benefits  for  the  treatment of these disorders.


]]></description></item><item><title><![CDATA[( BUPP09119 - 26 August 2008) Hysteresis in drug response.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09119</link><pubDate></pubDate><description><![CDATA[Hysteresis may be defined as 'the retardation or lagging of an effect
behind  the  cause  of  the effect'. The two main reasons for the lag
phase  are limited access to the site of drug action or slow receptor
kinetics.   Both of these characteristics would produce  an anticlockwise
hysteresis,  in  which time moves anticlockwise in the change  in the
relationship between plasma concentration and observed effect  with time.
An alternative definition would be 'failure of one of  two  related
phenomena  to  keep pace with the other', and would include  any
situation in which the value of one variable depends on whether   the
other  variable  is  increasing  or  decreasing.  This definition  would
take in clockwise hysteresis, which is seen in drug tolerance.


]]></description></item><item><title><![CDATA[( BUPP09120 - 26 August 2008) Addiction and substance misuse.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09120</link><pubDate></pubDate><description><![CDATA[Alcohol  and  psychoactive  substance misuse has far-reaching social,
psychological  and  physical  consequences.  The numbers of women and
young  people  exposed  to  the  harmful  effects  of substances have
increased.  Substance use, misuse and addiction incur immense cost to the
individual  and to society. It is paramount to adequately assess
substances misuse,  and  recognize  the  effects  of  intoxication,
withdrawal  and  chronic  effects.  It  is also important to diagnose
associated  disorders  to  treat  promptly and adequately these often
life-threatening conditions. Focus should be put on management of the
misuse  itself,  using  appropriate  pharmacotherapy as an adjunct to
psychosocial  approaches,  but  also remember to address any physical and
psychiatric sequelae.


]]></description></item><item><title><![CDATA[( BUPP09121 - 26 August 2008) Characteristics of alcohol-dependent male inmates]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09121</link><pubDate></pubDate><description><![CDATA[Objective:  The  objective  of  this  study was to compare social and
penal  characteristics  and consumption of psychoactive substances by
alcohol-dependent  and  non-dependent inmates of the Lyon's prison in
2004.  Methods:  The  study  was  carried  out among 2033 male adults
incarcerated   between   January  1st  and  December  31st  2004.  An
administered  questionnaire  was proposed during the arrival visit to
record social, administrative and penal data. Use of tobacco, alcohol and
illicit drugs was quantified. Results:  In all,  1898 questionnaires were
analysed. Comparison between alcohol-dependent (n = 356) versus non
alcohol-dependent inmates (n = 1542), revealed that the alcohol-dependent
population  was older, mean age (34 years old versus  30 years, p <
0.001), and had a higher unemployment rate (50% versus  39.4%,  p  <
0.001). Alcohol addicts were more often repeated    offenders (62% versus
50.7%, p = 0.001), had a higher rate of Subutex mixture  (11%  versus
3.2%,  p  <  0.001) and presented more psychic suffering   (21%   versus
6%,  p  <  0.001).  Multivariate  analysis identified  use  of  psychotop
drugs, use of psychoactive substances, age and  familial  situation  as
significantly  and  independently associated  with the abusise alcohol
consumption. Conclusion: Because of an elevated  prevalence  of  alcohol
dependence  among arriving penitentiary  inmates,  effective  screening
is  needed  to  prevent withdrawal syndrome and propose care adapted to
the specific features of this dependent population: social insecurity and
polydrug abuse.


]]></description></item><item><title><![CDATA[( BUPP09122 - 26 August 2008) The  nociceptin/orphanin FQ receptor: A target with broad therapeutic potential.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09122</link><pubDate></pubDate><description><![CDATA[Identification  of  the  enigmatic  nociceptin/orphanin FQ peptide
(N/OFQ)  in  1995  represented  the  first  successful  use  of reverse
pharmacology  and led to deorphanization of the N/OFQ receptor (NOP).
Subsequently,  the  N/OFQ-NOP  system  has  been implicated in a wide
range   of   biological   functions,   including  pain,  drug  abuse,
cardiovascular control   and   immunity.  Although  this  could  be
considered  a hurdle for the development of pharmaceuticals selective for
a  specific  disease  indication,  NOP  represents a viable drug target.
This  article  describes  potential clinical indications and highlights
the current status of the very limited number of clinical trials.


]]></description></item><item><title><![CDATA[( BUPP09123 - 01 September 2008) ADR  news:  Buprenorphine  abuse.  Cerebral  embolism  (first report) following parenteral administration: case report. Serious.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09123</link><pubDate></pubDate><description><![CDATA[A  woman in her mid-forties (exact age not stated) developed cerebral
embolisms while abusing buprenorphine (Subutex) parenterally. The  woman
had a history of opioid abuse and dependence since age 17 years.  She  was
prescribed sublingual buprenorphine by her physician in  2003  (dosage
and  indication  not stated). However, she quickly began  abusing
buprenorphine  intravenously  to  achieve a high. She reported  crushing
1-3  buprenorphine  tablets, mixing the resulting powder  in  hot  water
and injecting it. When venous access became a problem  she  started using
her left radial artery. She then reported having  a  friend  inject
buprenorphine  into  her  jugular vein and carotid  artery,  on at least
10 occasions starting 2 months prior to presentation.  The  most  recent
occurrence was just days before she presented with blurred vision that
waxed and waned (duration of abuse not  stated).  At  time  of
presentation  she had subacute bacterial endocarditis.  Ophthalmologic
examination revealed no abnormalities. She  experienced  symptoms  of
cravings and opioid withdrawal, with a psychiatric  interview confirming
opioid dependence. She scored 25/30 on  the  Mini-Mental  State
Examination.  Her  score on the Montreal    Cognitive  Assessment
(24/30)  was  consistent  with  mild cognitive impairment,  and
suggested  involvement  of the visuospatial system. Several  foci of T2
and FLAIR hyperintensity were evident upon MRI in the right  frontal lobe
and bilaterally in the temporal and parietal lobes.  Corresponding
hyperintensity  of these foci were seen during diffusion weighted imaging,
suggestive of multiple embolic infarcts. The  woman's  blurred  vision
resolved during hospitalisation and she was  discharged.  Follow  up  was
planned  with  substance abuse and neuropsychiatry services. Author
Comment:  "It  would  not  always  be possible to distinguish whether
the  embolic phenomenon is caused by or associated with this patient's
subacute  endocarditis  or the parenteral buprenorphine or both, which, in
our view, is most likely the case." Editorial  Comment: A search of
AdisBase, Medline, Embase and The WHO Adverse  Drug  Reactions  database
did  not reveal any previous case reports of cerebral embolism associated
with buprenorphine.


]]></description></item><item><title><![CDATA[( BUPP09124 - 01 September 2008) A  comparative  study  of  the  ventilatory  effects  of four opioids administered at toxic doses in the rat.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09124</link><pubDate></pubDate><description><![CDATA[The  Authors  performed an experimental study in Sprague-Dawley rats, to
compare  the  respiratory  effects  of  the i.p. methadone (MET),
buprenorphine (BUP), morphine (MOR), and fentanyl (FEN). MET, MOR and FEN
except  BUP  induced  respiratory  depression characterized by a increase
of  inspiratory time (TI) and decrease in respiratory rate, without  any
modification  of  tidal  volume.  MET and FEN increased expiratory  time
(TE) and decreased minute ventilation. Mechanisms of respiratory
depression  in  relation  with opioid toxic doses is not uniform,
depending  on  the  molecule.  These  results  suggest,  a different
control  pattern  of  inspiratory  and expiratory times by opioid
receptors.


]]></description></item><item><title><![CDATA[( BUPP09125 - 01 September 2008) Neonatal  outcome  of 58 infants exposed to maternal buprenorphine in utero.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09125</link><pubDate></pubDate><description><![CDATA[This  prospective  study  examined the neonatal outcome of 58 infants
exposed  to  buprenorphine (BH) in utero. All infants had BH in their
urine.  A  total  of 38 infants required 20 days of morphine HCl (MH)
treatment  for  neonatal  abstinence syndrome. The length of hospital stay
for all infants was 25 days. The infants' highest urinary nor-BH
concentrations  across  their  1st 3 days of life correlated with the
length  of hospital stay and duration of MH treatment. The mean birth
weight  and  mean  head  circumference were below average. 11 Infants
were  discharged  home,  19  were  placed  in  foster  care,  28 were
discharged  with  their mothers to Mother and Child homes or to other
institutions  and 1 infant followed her mother to prison. Maternal BH use
at  the  time  of  birth may cause neonatal abstinence syndrome, requiring
long-term hospitalization.


]]></description></item><item><title><![CDATA[( BUPP09126 - 01 September 2008) Monitoring  of  the  misuse  of  prescription  drugs  by  clients  of outpatient addiction treatment centres (PHAR-MON, formerly: ebis-med) - Monitoring of medication misuse.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09126</link><pubDate></pubDate><description><![CDATA[Objectives:  The  monitoring  system  PHAR-MON  (formerly:  ebis-med)
documents  the  misuse  of  pharmaceuticals  in  addiction counseling
centres  as  an early warning system. It is described as a diagnostic
instrument  according  to  its  aims  and  tasks,  implementation and
assessing  procedures  and is evaluated according to the main quality
criteria of diagnostic instruments. In addition, selected results are
reported  about  the misuse of medicaments in the year 2004. Methods: In
analogy  to  diagnostic  instruments,  the  main quality criteria
objectivity,  reliability  and validity are applied to evaluate PHAR-MON,
they  are  extended,  however, by the validity of the sample of reference
outpatient centers. Statistical methods for proving results are applied
and discussed concerning their appropriateness for cross-sectional  and
longitudinal  analyses of PHAR-MON data. The selected results  are  based
on  the  survey  data  for 2004 of 32 counseling centers with 629
medicaments   abused   by   500  clients.  The representativity  was
checked  by  comparison  with  the  outpatient   addiction  statistics.
Results:  The sample of counseling centers is representative  for  all
addiction counseling centers in Germany. The dominant  influence  factor
on  the abuse of medicaments is the main diagnosis  of  the  clients.
Therefore, the analysis is separated for the  main diagnoses as to
alcohol, illegal drugs and medicaments. The statistical  methods  of
confidence  intervals and other statistical procedures  are  useful  in
proving  data  for  cross-sectional  and longitudinal  analyses.  In
2004  there  was  an  increase of abused buprenorphine  by  5.7%
compared  to  the previous year. The rate of misuse   of   hypnotics,
which  is  the  largest  group  of  abused medicaments,  only  slightly
increased  by  2.4%.  Conclusions:  The monitoring system PHAR-MON is a
sensitive and valid monitoring system for  the  abuse  of  medicaments  in
addiction counseling centres. By documenting  individual  criteria  of
abuse in the new version of the documentation  sheet, the results of
medicament abuse can be analyzed in  a  more  valid  way. To improve the
PHAR-MON system a study about reliability  is  planned. Because of the
health risks associated with the abuse of medicaments, continuous
information for physicians about the  risks  of  medicament  abuse  is
helpful  to  prevent  negative consequences.


]]></description></item><item><title><![CDATA[( BUPP09127 - 01 September 2008) Health  care  utilization and morbidity associated with methadone and buprenorphine treatment.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09127</link><pubDate></pubDate><description><![CDATA[Background:  Methadone  and  buprenorphine  treatment reduce the high
mortality  associated  with  heroin addiction, but even in-treatment,
Standardised  Mortality  Rates are high. Aim: This study investigates the
nature  of morbidity associated with methadone and buprenorphine
treatment,  and  investigates  predictors  of health care utilization
among  people  in a variety of treatment settings. Methods: Collation of
data  from earlier studies, and from published reports. Findings: In  a
recent study of an entry cohort, the SMR was 5.52 (4.62, 5.65); suicide
and overdose accounted for 2/3 of the mortality, but allowing for  this,
mortality rates remain elevated. Cancer, heart disease and respiratory
disease  were the three major contributors to mortality. Taken  in
conjunction  with  a recent study of medical co-morbidity, this suggests
that alcohol, tobacco and other drug use represent the major  factors
contributing  to  serious  illness  in treated opioid addicts.  In
addition,  side-effects  of  treatment  may  themselves contribute  to
some morbidity. Lack of access to health care does not appear  to  be a
contributing factor, as opioid users consult doctors (other  than  their
methadone  doctors) at rates far higher than the general population.
Predictors of doctor attendance "outside" doctors were  psychological
distress,  and benzodiazepine use. Adjusting for these  factors, we found
evidence that quality of methadone treatment was  a  significant
predictor  of  doctor  attendance,  with  better clinical  care  being
associated with less outside doctor attendance.
Conclusion:  There  is  a  paradox;  heroin  users  have  significant
physical  illness,  but  their attendance for health care tends to be
driven  by  psychological  distress, and can be improved by good care
within treatment programs. The priority in addressing health problems of
stabilised  heroin  users  is  dealing  with  alcohol and tobacco
problems.


]]></description></item><item><title><![CDATA[( BUPP09128 - 01 September 2008) Effects  of  epidurally administered morphine or buprenorphine on the thermal threshold in cats.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09128</link><pubDate></pubDate><description><![CDATA[Objective  -  To  determine  the  antinociceptive effects of epidural
administration  of  morphine  or  buprenorphine  in  cats by use of a
thermal threshold model. Animals - 6 healthy adult cats. Procedures -
Baseline  thermal  threshold  was  determined in duplicate. Cats were
anesthetized  with isoflurane in oxygen. Morphine (100 mug/kg diluted
with  saline  (0.9%  NaCl) solution to a total volume of 0.3 mL/ kg),
buprenorphine  (12.5  mug/kg  diluted with saline solution to a total
volume of 0.3 mL/kg), or saline solution (0.3 mL/kg) was administered
into  the  epidural space according to a Latin square design. Thermal
threshold  was  determined  at  various  times  up  to 24 hours after
epidural  injection.  Results  -  Epidural  administration  of saline
solution  did  not  affect  thermal  threshold. Thermal threshold was
significantly  higher  after  epidural administration of morphine and
buprenorphine, compared with the effect of saline solution, from 1 to 16
hours   and  1  to  10  hours,  respectively.  Maximum  (cutout)
temperature  was  reached  without  the cat reacting in 0, 74, and 11
occasions in the saline solution, morphine, and buprenorphine groups,
respectively.   Conclusions   and   Clinical   Relevance  -  Epidural
administration   of   morphine   and  buprenorphine  induced  thermal
antinociception  in cats. At the doses used in this study, the effect of
morphine  lasted  longer  and  was  more  intense  than  that  of
buprenorphine.


]]></description></item><item><title><![CDATA[( BUPP09129 - 01 September 2008) Addiction  and  addiction  medicine:  Exploring opportunities for the general practitioner.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09129</link><pubDate></pubDate><description><![CDATA[Addiction  medicine  deals  with  problems  arising  from  the use of
psychoactive  substances,  and encompasses the disciplines of general
practice and primary care, psychiatry, psychology, internal medicine,
public  health,  pharmacology  and sociology. Addiction is a chronic,
relapsing illness that is difficult to cure. There are now effective,
evidence-based  interventions  for  the  prevention  and treatment of
substance  misuse disorders. Harm minimisation and treatment are more
cost-effective than policing and supply-reduction  methods  of responding
to substance misuse.


]]></description></item><item><title><![CDATA[( BUPP09130 - 01 September 2008) Pain in the elderley]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09130</link><pubDate></pubDate><description><![CDATA[05/09/08 Message from the BL: Placed on a waiting list


]]></description></item><item><title><![CDATA[( BUPP09131 - 01 September 2008) Intravenous   regional   anesthesia   -  First  century  (1908-2008). Beggining, development, and current status.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09131</link><pubDate></pubDate><description><![CDATA[BACKGROUND  AND OBJECTIVES: Intravenous regional block is celebrating its
100  /sup  th/  anniversary in 2008. Since this is a widely used
technique,  this  milestone  should be recorded, the date celebrated,
Brazilian  anesthesiologists  should  be  remembered of its evolutive
process, especially in the last 40 years, and we should pay homage to the
individual  who  started  it: August Karl Gustav Bier. CONTENTS: This
report  describes  the  beginning of locoregional anesthesia in general
and  regional  intravenous  block  in  particular, since the introduction
of  garroting  of  the extremities to the discovery and improvement   of
needles,  syringes,  and  local  anesthetics.  The technical  details used
initially by Bier, and the pathophysiological and clinical concepts
enounced by him at the beginning of the 20 /sup th/  Century  are
described.  It describes the initial evolution and that  of  the
following decades of intravenous regional block, lists national  and
international  pioneers,  explains the reasons for the relatively  late
scientific  studies on the technique, and describes the main contributions
that made it an effective and safe technique. Finally,  it  describes
the  current  state  of  the  main knowledge   acquired  over the years,
such as the mechanism and site of action of the  anesthetic and ischemia,
the use of modern anesthetic solutions, improvement    of
postoperative   analgesia   and   motor   block, pharmacokinetic   and
pathophysiological  concepts,  and  the  best  interpretation  of
possible  complications. CONCLUSIONS: Intravenous regional  block  is the
anesthetic technique created by A. K. G. Bier  exactly  100 years ago. In
the first half of the 20 /sup th/ Century,  it  evolved  little and
slowly, but in the last several years, it has seen  an  accentuated
improvement,  thanks  to  countless technical,  pathophysiological,
pharmacological,  pharmacokinetic,  and clinical developments,  for
which  Brazilian  Anesthesiology  has contributed considerably. Since it
is celebrating its 100 /sup th/ anniversary in 2008, intravenous regional
block deserves to have its story told, and the  date  should  not  go
unnoticed,  but  should be remembered and celebrated


]]></description></item><item><title><![CDATA[( BUPP09132 - 01 September 2008) Early   behavioral   and  histological  outcomes  following  a  novel traumatic partial nerve lesion.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09132</link><pubDate></pubDate><description><![CDATA[A  new  partial nerve lesion (PNL) model is needed to better simulate
traumatic lesions seen clinically that result in both dysfunction and
neuropathic  pain.  We  assessed  surgical  variability  and  several
outcome  measures  including histology during the acute postoperative
period.  A  surgical  lesion  was  created in the rat tibial nerve by
removing  a  segment,  later  confirmed  by  myelinated  axon counts.
Variability  in  the  model  was assessed with four different outcome
measures during  the  first  postoperative  week  (n  =  24),  with
additional  histological outcomes at 7 days (n = 13) and pain testing at
21  days  (n = 9). At 7 days postoperative, the PNL resulted in a tibial
functional index (TFI) of -41.3% distinct from a percent motor deficit
(PMD) of -76.3%. However, the respective deficits from 2 to 7 days  were
similar.  Either  test  could  detect  outliers,  but PMD measurements
had a lower coefficient of variation and were easier to perform  and
analyze.  The  deleted  segment  contained  26%  of the myelinated  axons
and resulted in distal degeneration that was either 46% based on axon
counts or 54% based on area. Replicated experiments confirmed the PMD,
muscle atrophy, and formation of neuropathic pain. In  conclusion,  our
partial lesion histologically progresses twofold during the first
postoperative week with profound behavioral deficits involving  both
motor  and  sensory  loss.  These  results  based on sensitive and
correlative outcome measures support the application of this  novel
model  in  experimental  nerve  lesion  studies.


]]></description></item><item><title><![CDATA[( BUPP09133 - 01 September 2008) Buprenorphine  treatment  in an urban community health center: What to expect.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09133</link><pubDate></pubDate><description><![CDATA[Background:   Despite   new  opportunities  to  expand  buprenorphine
treatment  for  opioid dependence, use of this treatment modality has
been  limited.  Physicians may question their ability to successfully
treat  opioid-dependent patients with buprenorphine in a primary care
setting.  We describe a buprenorphine treatment program and treatment
outcomes  in  an urban community health center. Methods: We conducted
retrospective chart reviews on the first 41 opioid-dependent patients
treated  with  buprenorphine/naloxone. The primary outcome was 90-day
retention  in  treatment.  Results:  Patients' mean age was 46 years,
70.7%  were  male, 58.8% Hispanic, 31.7% black, 57.5% unemployed, and
70.0%  used  heroin  prior to treatment. Twenty-nine (70.7%) patients were
retained in treatment at day 90. Compared to those not retained, patients
retained  in treatment were more likely to have used street   methadone
(0%  versus  37.9%)  and  less  likely to have used opioid analgesics
(54.6%  versus  20.7%)  and  alcohol (50.0% versus 13.8%) prior  to
treatment. Of the 25 patients with urine toxicology tests, 24% tested
positive for opioids. Conclusions: Buprenorphine treatment for opioid
dependence in an urban community health center resulted in a  90-day
retention  rate  of  70.7%. Type of substance use prior to treatment
appeared  to  be associated with retention. These findings can help guide
program development.


]]></description></item><item><title><![CDATA[( BUPP09134 - 01 September 2008) Preliminary study of buprenorphine and bupropion for opioid-dependent smokers.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09134</link><pubDate></pubDate><description><![CDATA[In this double-blind, placebo-controlled trial, bupropion (BUPRO, 300
mg/day) was compared to placebo (PBO) for the concurrent treatment of
opioid   and   tobacco   addiction  in  40  opioid-dependent  smokers
stabilized on buprenorphine (BUPRE, 24 mg/day). Participants received
contingent,  monetary  reinforcement  for  abstinence  from  smoking,
illicit  opioids,  and  cocaine. Significant differences in treatment
retention  were  observed  (BUPRE+BUPRO,  58%; BUPRE+PBO, 90%). BUPRO
treatment  was  not  more  effective than placebo for abstinence from
tobacco,  opioids,  or  cocaine  in  BUPRE-stabilized patients. These
preliminary  findings  do  not  support  the  efficacy  of  BUPRO, in
combination  with  BUPRE,  for the concurrent treatment of opioid and
tobacco addiction.


]]></description></item><item><title><![CDATA[( BUPP09135 - 01 September 2008) Key findings from the WHO collaborative study on substitution therapy for opioid dependence and HIV / AIDS]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09135</link><pubDate></pubDate><description><![CDATA[Aims: Opioid substitution treatment has been studied extensively in
industrialized countries, but there are relatively few studies in
developing / transitional countries.  The aim of this study was to examine
the effectiveness of opioid substitution treatment (OST) in less resourced
countries. Design: Longitudinal cohort study. Setting: Purposively
selected OST sites in Asia (China, Indonesia, Thailand). Eastern Europe
(Lithuania, Poland, Ukraine), the Middle East (Iran) and Australia.
Participants. Seven hundred and twenty-six OST entrants. Measurements.
Participants were interviewed at treatment entry, 3 and 6 months.
Standardized instruments assessed drug use, treatment history, physical
and psychological health, quality of life, criminal involvement,
blood-borne virus (BBV) risk behaviours and prevalence of human
immunodeficiency virus (HIV) and hepatitis C.  Findings. Participants were
predominantly male, aged in their early 30s and had attained similar
levels of education. Seroprevalence rates for HIV were highest in Thailand
(52%), followed by Indonesia (28%) and Iran (26%), and lowest in Australia
(2.6%).  Treatment retention at 6 months was uniformly high, averaging
approximately 70%.  All countries demonstrated significant and marked
reductions in reported heroin and other illicit opioid use; HIV (and other
BBV) exposure risk behaviours associated with injection drug users (IDU)
and criminal activity, and demonstrated substantial improvement in their
physical and mental health and general wellbeing over the course of the
study.  Conclusions. OST can similar outcomes consistently in a culturally
diverse range of settings in low- and middle-income countries to those
reported widely in nigh-income countries. It is associated with a
substantial reduction in HIV exposure risk associated with IDU across
nearly all the countries. results support the expansion of opioid
substitution treatment.


]]></description></item><item><title><![CDATA[( BUPP09136 - 09 September 2008) ADR   news:   Buprenorphine.  Somnolence  and  visual  hallucinations following  transdermal  administration  in  an  elderly patient: case report.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09136</link><pubDate></pubDate><description><![CDATA[An  81-year-old  man  with  oncological  neuropathic pain experienced
somnolence  after treatment with a buprenorphine patch (Transtec). He
subsequently  experienced  visual  hallucinations  while  receiving a
reduced  buprenorphine  dose;  when the dose was further reduced, the ADR
resolved. The  man,  who  had  weakness  and  progressive pain in his
legs, and tumor-like  injury  in  the medullary cone, had received
radiotherapy with resolution of the tumor. He continued to experience
moderate-to-intense  pain  and  numbness  in  his  legs,  and the pain had
proved difficult  to  control  during  the previous 3 years; he had
received various   NSAIDs,   antiepileptic   drugs,   opioid   analgesics
and amitriptyline,   and   had   experienced   adverse   events.  He
was   subsequently treated with 1/2 a buprenorphine 35 microg/h (20
mg/25cm sup(2))  patch applied every 3.5 days. His pain resolved, however,
he experienced  great  somnolence (duration of therapy to reaction onset
not stated). Treatment  was  reduced  to  1/4  of  a  buprenorphine patch.
The man remained  wide  awake  but  experienced visual hallucinations and
the dose  was  further  reduced  to  1/5  of  a  buprenorphine  patch. He
continued  to  use  1/5  of  a buprenorphine patch and, at subsequent
follow-up, remained free from somnolence and visual hallucinations.
Author   Comment:   "This  case  reminds  us  of  the  importance  of
individualized  treatment  of  pain  and shows that some patients can
respond to low doses of opioids."


]]></description></item><item><title><![CDATA[( BUPP09137 - 09 September 2008) Pharmacogenetics  of  analgesics:  toward  the  individualization  of prescription.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09137</link><pubDate></pubDate><description><![CDATA[Individual  responses  to  drugs  are  influenced by a combination of
pharmacokinetic  and  pharmacodynamic  factors  that can sometimes be
regulated  by  genetic factors. Available data on the pharmacokinetic and
pharmacodynamic  consequences  of  known  polymorphisms of
drug-metabolizing  enzymes,  drug  transporters,  drug  targets, and other
nonopioid biological systems on central and peripheral analgesics are
reviewed.  Agents  mentioned  include  morphine, methadone, fentanyl,
tramadol,  codeine,  hydrocodone,  oxycodone,  dextromethorphan, M3G,
M6G,  levomethadone,  alfentanil,  NSAID  in  general, diclofenac,
R-ibuprofen,    S-ibuprofen,   flurbiprofen,   celecoxib,   lornoxicam,
tenoxicam,    piroxicam,    aspirin,   acetaminophen   (paracetamol),
aceclofenac,  buprenorphine,  dihydrocodeine, felbamate, indometacin,
mefenamic acid, meloxicam, naproxen, phenylbutazone, and sulfentanil.


]]></description></item><item><title><![CDATA[( BUPP09138 - 09 September 2008) Recommendations for treatment of neuropathic pain.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09138</link><pubDate></pubDate><description><![CDATA[Tricyclic    antidepressants    (TCAs),   selective   serotonin   and
norepinephrine  reuptake  inibitors (SSNRIs), calcium channel alpha2-
delta  ligands  and topical lidocaine are recommended as a first-line
treatment  for  patients  with neuropathic pain. In patients who have
failed  to  respond  to  these  first-line  medications alone or in
combination,  opioid  analgetics or tramadol can be used as a second-line
treatment  alone  or  in combination with one of the first-line
medications.  In  some  specific  situations,  opioid  analgetics  or
tramadol can also be considered for first-line use.


]]></description></item><item><title><![CDATA[( BUPP09139 - 09 September 2008) The management of neuropathic pain in cancer.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09139</link><pubDate></pubDate><description><![CDATA[Neuropathic  pain is a common problem amongst cancer patients, yet it can
be challenging to diagnose and treat successfully. The diagnosis of
neuropathic  pain has been helped by the identification of common
descriptors and symptoms often used by patients and several screening
tools  now  exist to identify neuropathic features. The management of
neuropathic  pain in cancer is a balance of pharmacological, physical and
psychological  interventions used skilfully in patients that are often
frail and with cognitive, hepatic or renal impairment. Commonly used
drugs  for  the  treatment of neuropathic pain include opioids,
antidepressants  and anti-epileptics, although the evidence for their use
in  the  cancer  population is often poor. Other drugs that have shown
to  be  of benefit include NMDA receptor antagonists and local
anaesthetic  agents,  although  side  effects  often limit their use.
Physical  interventions include intrathecal drug delivery, neurolytic
sympathetic  plexus  blockade  and  spinal  cord  stimulation.  These
therapies  should  be considered in patients who have refractory pain or
intolerable side effects to systemically administered analgesics. New
intrathecal  drugs,  such  as the N-type calcium channel blocker
ziconotide  have  shown  promise in managing neuropathic pain.


]]></description></item><item><title><![CDATA[( BUPP09140 - 09 September 2008) Effects   of   indomethacin   and   buprenorphine  analgesia  on  the postoperative recovery of mice.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09140</link><pubDate></pubDate><description><![CDATA[Buprenorphine  (Bup) is the most commonly used analgesic in mice, yet few
objective  assessments  address its superiority for postsurgical recovery.
In mice, IP implantation of a radiotelemetry device induces decreases  in
body weight (BW), food and water intake (FI, WI), core temperature  (T),
and activity levels that persist approximately 14 d in the absence of
analgesia. To compare the efficacy of Bup with that of  the  nonsteroidal
antiinflammatory  drug indomethacin (Indo) for postsurgical  recovery,
male C57BL/6J mice were treated on the day of radiotelemetry  implantation
with Bup (0.3 mg/kg SC) or Indo (1 mg/kg SC)  followed  by  treatment
with  Indo (1 mg/kg PO) on the next day (Bup-Indo   versus   Indo-Indo).
Responses  were  compared  between treatments  in  mice implanted with a
radiotelemetry device and those that  did not undergo surgery. Changes in
BW, FI, WI, T, and activity were  examined  throughout  14  d  of
recovery.  Indo-Indo  was more efficacious  in  inhibiting  postsurgical
BW, FI, and WI reductions, compared  with Bup-Indo. Bup also reduced BW
and FI in the absence of surgery,  indicating  a  nonspecific  effect  of
this  drug on these variables.  Indo-Indo  treatment  was associated with
higher activity levels  during  lights-on-to-lights-off  transition
periods compared with that observed with Bup-Indo. According to 5
objective measures of surgical  recovery,  our data suggest that Indo-Indo
treatment is more efficacious  than  is  Bup-Indo  for  postsurgical
recovery of radiotelemetry-implanted   mice.   Copyright  2008  by  the
American Association for Laboratory Animal Science.


]]></description></item><item><title><![CDATA[( BUPP09141 - 09 September 2008) Harm reduction and control of HIV in IDUs in France.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09141</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09142 - 09 September 2008) Pain therapy in children and adolescents.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09142</link><pubDate></pubDate><description><![CDATA[Introduction:  In  children,  acute  pain occurs predominantly during
infectious  illnesses  or  after  surgery.  Chronic  pain, especially
headache  and  abdominal  pain, is becoming increasingly common among
children  and adolescents. Methods: Selective literature review, also
including  evidence-based  guidelines  and  recommendations. Results:
Simple  self-reporting  and behavioral pain scales are easy to use to
assess  the intensity of acute pain. To evaluate chronic pain, on the
other  hand,  more  complicated,  multi-dimensional  instruments  are
necessary  (e.g., semi-structured interviews). The most commonly used
analgesics   are  ibuprofen  and  paracetamol  (acetaminophen).  When
paracetamol  is used, its narrow therapeutic window should be kept in
mind.  Perioperative  pain  should be treated with balanced analgesia
involving  a combination of non-pharmacological treatment strategies,
non-opioid  drugs,  opioids, and regional anesthesia. Chronic pain in
children  can  only  be  treated successfully over the long term with
multidisciplinary  team  intervention  based  on this biopsychosocial
model.  Discussion: Pain not only causes children momentary suffering but
also  threatens  to  impair their normal development. Therefore, every
effort  should  be  made  to  prevent  pain  and  to  treat it effectively
once it arises.


]]></description></item><item><title><![CDATA[( BUPP09143 - 09 September 2008) Oxycodone: A pharmacological and clinical review.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09143</link><pubDate></pubDate><description><![CDATA[Oxycodone  is a semi-synthetic opioid with an agonist activity on mu,
kappa  and  delta  receptors.  Equivalence with regard to morphine is 1:2.
Its effect commences one hour after administration and lasts for 12 h in
the controlled-release formulation. Plasma half-life is 3-5 h (half  that
of morphine) and stable plasma levels are reached within 24  h (2-7 days
for morphine). Oral bioavailability ranges from 60 to 87%,  and  plasma
protein  binding  is  45%.  Most  of  the  drug is metabolised  in  the
liver, while the rest is excreted by the kidney along  with its
metabolites. The two main metabolites are oxymorphone -  which  is  also a
very potent analgesic - and noroxycodone, a weak analgesic.  Oxycodone
metabolism  is  more  predictable than that of morphine,  and  therefore
titration is easier. Oxycodone has the same mechanism  of  action  as
other  opioids:  binding  to  a  receptor, inhibition  of adenylyl-cyclase
and hyperpolarisation of neurons, and decreased  excitability.  These
mechanisms  also  play a part in the onset of dependence and tolerance.
The clinical efficacy of oxycodone is similar  to  that  of  morphine,
with a ratio of 1/1.5-2 for the treatment  of cancer pain. Long-term
administration may be associated
with  less  toxicity in comparison with morphine. In the future, both
opioids could be used simultaneously at low doses to reduce toxicity. It
does  not appear that there are any differences between immediate and
slow-release  oxycodone, except their half-life is 3-4 h, and 12 h,
respectively. In Spain, controlled-release oxycodone (OxyContin®) is
marketed   as   10-,   20-,   40-or  80-mg  tablets  for  b.i.d.
administration.  Tablets  must be taken whole and must not be broken,
chewed or crushed. There is no food interference. The initial dose is 10
mg  b.i.d.  for new treatments and no dose reduction is needed in the
elderly  or  in  cases  of  moderate  hepatic  or renal failure.
Immediate-release  oxycodone (OxyNorm®) is also available in capsules and
oral  solution. Side effects are those common to opioids: mainly nausea,
constipation and drowsiness. Vomiting, pruritus and dizziness are less
common. The  intensity  of  these  side  effects tends to decrease  over
the  course  of  time. Oxycodone causes somewhat less nausea,
hallucinations and pruritus than morphine.


]]></description></item><item><title><![CDATA[( BUPP09144 - 09 September 2008) QTc interval prolongation and opioid addiction therapy.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09144</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09145 - 09 September 2008) (Commentary) maintenance treatments across countries.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09145</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09146 - 09 September 2008) Cetuximab  with  hepatic  arterial  infusion  of chemotherapy for the treatment of colorectal cancer liver metastases.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09146</link><pubDate></pubDate><description><![CDATA[Background:  Both hepatic arterial infusion (HAI) of chemotherapy and
cetuximab  (CET)  have  interesting  activity  for  the  treatment of
colorectal  cancer  liver  metastases (CRC-LM). Patients and Methods:
Intravenous  CET  with HAI oxaliplatin (OXA) or i.v. Irinotecan (IRI)
followed by HAI of infusion of folic acid modulated 5-fluorouracil
5-FU/l-FA was administered to patients (pts) with CRC-LM who had failed
at  least one line of prior chemotherapy. Results: Eight pts received i.v.
CET with HAI-OXA (5 pts) and i.v.-IRI (3 pts) and HAI-S-FU/I-FA. Adverse
events: repeated grade 3 skin toxicity (1 pt), abdominal pain with
elevated  liver enzymes and asthenia (2 pts), duodenal ulcer (2 pts)
with  catheter  migration  and  intestinal  bleeding  (1  pt), reversible
interstitial  pneumonitis  (1  pt),  and cystic bile duct dilatation  (2
pts)  with  arteriobiliary  fistulisation  (1  pt). A partial  response
was  documented in 5 pts (62%). The median time to
progression  was  8.7  months  (95% confidence interval 8-14 months).
Conclusion: Intravenous administration of CET with HAI of chemotherapy is
feasible and has promising activity but is associated with specific
toxicity.


]]></description></item><item><title><![CDATA[( BUPP09147 - 09 September 2008) First   meeting   of   the   French  CEIP  (centres  d'evaluation  et d'information sur la pharmacodependance). Assessment of the abuse and pharmacodependence potential during drug development.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09147</link><pubDate></pubDate><description><![CDATA[The  French system for the evaluation of abuse and dependence created in
1990  was definitely implemented in 1999 with the decree n°99-249 making
in particular mandatory the reporting of all serious cases of abuse  or
dependence  to  psychoactive  drugs.  This decree was also important  to
define  the  role  of each party (regulatory agencies, pharmaceutical
companies, health professionals and the network of the regional Centres
for Evaluation and Information    of Pharmacodependence)  for  all
marketed psychoactive drugs in France. The first meeting on
pharmacodependence was organized during the last annual congress of the
French Society of Therapeutic Pharmacology and Physiology  (P2T)  held
in  Toulouse  in April 2007. The aim of this meeting  was that the role of
the French system for the evaluation of abuse  and dependence during the
different steps of drug approval and after  marketing  in  the context of
real life would be better known. The   French   approach   includes
classical   data  obtained  from experimental  and  clinical trials, but
also and mainly data obtained
from  the  specific tools installed since the creation of the CEIP


]]></description></item><item><title><![CDATA[( BUPP09148 - 09 September 2008) Efficacy  and  Safety  of  Transdermal  Buprenorphine:  A Randomized, Placebo-Controlled Trial in 289 Patients with Severe Cancer Pain.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09148</link><pubDate></pubDate><description><![CDATA[Strong opioids are recommended for treating severe cancer pain in the
advanced stages of the disease. Few data are available concerning the
efficacy  of  buprenorphine  in  cancer pain. We compared transdermal
buprenorphine  70  mug/h  (BUP  TDS) to placebo in an enriched design
study.  Opioid-tolerant  patients  with  cancer pain requiring strong
opioids  in  the  dose range of 90-150 mg/d oral morphine equivalents
entered  a two-week run-in phase, during which they were converted to BUP
TDS. Patients who could be stabilized on BUP TDS were randomized to BUP
TDS or placebo patch for a two-week maintenance phase. Rescue medication
(buprenorphine  sublingual tablets 0.2 mg) was allowed as required.
Response  was defined as a mean pain intensity of <5 (0-10 scale)  and  a
mean daily buprenorphine sublingual tablet intake of 2 tablets during the
maintenance phase. Of 289 patients who entered the run-in  phase,  100
discontinued treatment due to lack of efficacy or adverse  events;  189
patients continued treatment in the maintenance phase  (94 BUP TDS, 95
placebo), of whom 31 discontinued treatment (7 BUP  TDS,  24  placebo).
A  significant  difference in the number of treatment  responders was
observed: 70 BUP TDS (74.5%, 65.7-83.3) vs. 47  placebo  (50%, 39.9-60.1)
(P = 0.0003). This result was supported by  a  lower  daily  pain
intensity,  lower  intake of buprenorphine sublingual  tablets  and
fewer  dropouts  in  the BUP TDS group. The incidence  of  adverse
events  was  slightly  higher for BUP TDS. In conclusion, BUP TDS 70 mug/h
is an efficacious and safe treatment for patients  with  severe  cancer
pain.  © 2008 U.S. Cancer Pain Relief Committee.


]]></description></item><item><title><![CDATA[( BUPP09149 - 09 September 2008) (Commentary) modern treatment for prisoners.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09149</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09150 - 09 September 2008) Precipitated  withdrawal  during  maintenance  opioid  blockade  with extended release naltrexone]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09150</link><pubDate></pubDate><description><![CDATA[Background: There has been increasing interest in the use of extended
release injectable naltrexone for the treatment of opioid dependence.
Case  description:  We  report a case of precipitated withdrawal in a
17-year-old  adolescent  female receiving extended release naltrexone
(Vivitrol)  for opioid dependence, following her third serial monthly
dose  of the medication, several days after using oxycodone with mild
intoxication.   Conclusions:   This   case  suggests  that,  in  some
circumstances,  the  opioid  blockade may be overcome when naltrexone
levels  drop  towards  the  end  of  the  dosing  interval, producing
vulnerability  to  subsequent naltrexone-induced withdrawal. This may
provide  cautionary  guidance  for  clinical  management  and  dosing
strategies.


]]></description></item><item><title><![CDATA[( BUPP09151 - 09 September 2008) Opioid  switching  from  transdermal  buprenorphine  to  oxicodone in delirium: A case report.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09151</link><pubDate></pubDate><description><![CDATA[The  prescription  of transdermal buprenorphine for treating moderate to
severe  chronic  pain  has  shown  an  important increment in the primary
health care of the sanitary region of Lleida being, on 2005, the  second
strong opioid in Defined Daily Dose (DDD) prescribed (1). Oxycodone  is
a  pure  agonist  opioid  that  presents  an excellent bioavailability
and  less  adverse  effects  than morphine. For that reason can be
considered a safe alternative when intolerance, adverse effects  or  lack
of analgesia is present (2). Delirium results from the interaction of
certain conditions of the patient, leading them to a more vulnerable
state, and of some precipiting factors, that can be related  to  some
disease or drug use (3). We present a case of a 75 years  old  lady
diagnosed  of  epidermoid  carcinoma of vagina with regional  spreading.
While  she was treated at home with transdermal buprenorphine,   she
presented  with  a  cognitive  and  functional impairment  due  to  the
increasing analgesic doses due to incomplete pain relief.


]]></description></item><item><title><![CDATA[( BUPP09152 - 09 September 2008) Health  Care  Use  in  Patients  With  Chronic Intestinal Dysmotility Before and After Introducing a Specialized Day-Care Unit.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09152</link><pubDate></pubDate><description><![CDATA[Background & Aims: Patients with chronic intestinal dysmotility (CID)
have  a  lifelong  disease,  and  no curative treatment is available.
Interventions  are  needed  to  improve  the  care and support of the
patients.   The   aim  of  this  study  was  to  measure  health-care
consumption   in  adult  patients  with  CID  before  and  after  the
introduction  of  a specialized day-care unit. Methods: Retrospective
analysis  was  made  of  medical and nursing records from 3 different
health-care delivery systems: period I, traditional care (1987-1996);
period II, outpatient clinic (1997-1999); and period III, specialized
day-care  unit  (2000-2002). There were 54 patients (44 women) with a
median  age  of  47 years (range, 22-80 years). Results: The need for
admissions to hospital care decreased from 80% to 35% of the patients
after  the  introduction of the specialized day-care unit (P < .002).
Also,  the  mean number of days in hospital care per patient and year was
reduced  from  39.4 to 3.3 days. The number of outpatient visits remained
unaltered. The average cost per patient-year decreased from $32,698
during  traditional  health-care  services  to  $9,681 after introducing
the specialized day-care unit (P < .002). Irrespective of the  form of
care delivery, the majority of patients (67%-77%) needed daily  treatment
with  analgesics,  and  81%-84%  needed nutritional support  on  a regular
basis. Conclusions: Individually tailored care at a specialized day-care
unit leads to substantially decreased needs for  hospital  stays and lower
costs in patients with CID.


]]></description></item><item><title><![CDATA[( BUPP09153 - 09 September 2008) The postoperative analgesia procedures in children.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09153</link><pubDate></pubDate><description><![CDATA[The  postoperative  analgesia  technique  which  was  performed  with
general  anesthesia has gained lot of interest in pediatric patients. Most
of regional analgesia techniques which were valid for adults are also
valid for the pediatric population. During postoperative period regional
analgesia  produces  considerable  amount  of analgesia and prevents
postoperative complications.
23rd Sept 08 - Message from the British Library - This paper is placed on
a waiting list.


]]></description></item><item><title><![CDATA[( BUPP09154 - 16 September 2008) ADR  news:  Buprenorphine/naloxone  abuse.  First report of serotonin syndrome: case report. Serious.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09154</link><pubDate></pubDate><description><![CDATA[A  54-year-old  man  developed severe serotonin syndrome after taking
unprescribed  buprenorphine/naloxone (Suboxone) in order to achieve a
euphoric   high.  He  had  been  taking  doxepin,  amitriptyline  and
methadone. The  man,  who  had a history of intravenous drug use,
presented with jaw spasm 1.5 hours after consuming a friend's
buprenorphine/naloxone (dosage  not stated). On presentation, he had been
unable to open his mouth  for an hour. He was extremely anxious and unable
to sit still. Tests  revealed the following: rectal temperature 100.4 deg
F; HR 130 beats/min;  respiratory  rate  30 breaths/min; BP 210/93mm Hg.
He was responsive  to questions and commands but exhibited episodes where
he spoke   nonsensically.   Examination   showed   masseter  spasm  with
accompanying  trismus,  spontaneous  jerking of his upper extremities and
clonus in his lower extremities. He was unable to co-operate with
a  detailed neurological examination. He continued to be agitated and
confused. The  man  was  hydrated  with  normal  saline and received
lorazepam,   midazolam,  diphenhydramine  and  benzatropine.  He  also
received IV hydromorphone  for  possible  acute  opioid analgesic
withdrawal. His condition  did  not  change. He was intubated and
underwent a CT scan and   lumbar  puncture.  He  also  received
treatment  for  possible meningitis.  Blood  tests  revealed  a calcium
level of 7 mg/dL and a creatine  kinase level of 1006 U/L. An ECG revealed
sinus tachycardia with nonspecific ST segment changes. A urine drug screen
was positive for methadone  and tricyclic antidepressants. Serotonin
syndrome was suspected   due   to  the  possible  effects  of  multiple
tricyclic
antidepressants  combined with buprenorphine/naloxone. He was started on
cyproheptadine and his mental status improved. On day 3, he self-extubated
and was oriented, alert and co-operative. He reported chest pain  but was
discharged home on day 4 in a stable condition and with baseline  mental
status.  He  had  not experienced any sequela at 6-months' follow-up.
Author  Comment:  "(T)he  temporal  relationship between the time the
patient  took  the  buprenorphine/naloxone  and the onset of symptoms
suggests  that  this  medication  was  the  cause  of  the (serotonin
syndrome)." Editorial  Comment:  A search of AdisBase, Medline and Embase
did not reveal  any  previous  case  reports of serotonin syndrome
associated with  buprenorphine  or  naloxone.  The  WHO  Adverse  Drug
Reactions database  did  not  contain  any  reports  of serotonin syndrome
with buprenorphine/naloxone  or  naloxone,  but  did  contain 3 reports of
serotonin syndrome associated with buprenorphine.


]]></description></item><item><title><![CDATA[( BUPP09155 - 16 September 2008) Implementation  of  chronic  care  management  for  alcohol  and drug dependence: Prescription of addiction and psychiatric medications.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09155</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09156 - 16 September 2008) Charateristics   of  individals  utilizing  12  step  programs  while participating in buprenorphine-naloxone outpatient treatment.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09156</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09157 - 16 September 2008) Buprenorphine-induced  respiratory depression reversed by naloxone in a 2-year-old.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09157</link><pubDate></pubDate><description><![CDATA[The  Authors  reported  a  pediatric  case  of  buprenorphine-induced
respiratory  depression  successfully  reversed  by  i.v. naloxone. A
continuous   infusion  of  naloxone  appeared  to  prevent  recurrent
respiratory depression. In conclusion, while buprenorphine is thought to
demonstrate  slow dissociation from the mu receptor, naloxone was shown to
be effective in reversing the respiratory depression in this patient.
(conference  abstract: Annual Meeting of the North American
Congress  of  Clinical Toxicology, Toronto, ON, Canada,
11/09/2008-16/09/2008).


]]></description></item><item><title><![CDATA[( BUPP09158 - 16 September 2008) Drug treatment of opiate dependence in primary care - An update.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09158</link><pubDate></pubDate><description><![CDATA[Opioid  dependence  is a chronic, relapsing condition associated with
significant  harms  for  patients  and  the  wider  community. In the
broadest  sense,  the  aims  of  treatment  are to reduce the health,
social  and  economic  harms  that  are associated with the misuse of
opiates.  The available evidence indicates that treatment can lead to
substantial improvements in a number of outcomes for many individuals and
society. These improvements rely on a multidisciplinary approach using
appropriate drugs at sufficient doses to retain patients within treatment
programmes,  supported  by a range of ongoing psychosocial interventions.
It is important that all drug misusers are provided with  information
and  advice  about harm reduction, both at routine contacts   and
opportunistically.  Drug  treatment  should  only  be considered  if
there is evidence of dependence and tolerance, and at least  one
positive  opiate  test. Maintenance treatment is the best option  for
many individuals in the short, medium and often the long term. Coerced or
enforced detoxification is not effective as it leads to relapse,  a
return to the use of street drugs and the associated risks of overdose,
blood-bome  viruses, etc. Maintenance treatment Methadone and
buprenorphine, using flexible dosing regimens, are both recommended  as
options for maintenance therapy in the management of opioid  dependence.
Evidence  suggests  that  methadone  maintenance therapy  (MMT) is more
effective at maintaining patients in treatment than buprenorphine
maintenance  therapy  (BMT).  There  is  little evidence to support the
routine use of BMT instead of MMT in terms of other   outcome  measures
such  as  illicit  opiate  use  whilst  on treatment. However, it is
generally agreed that there is less risk of opioid  overdose  associated
with the use of buprenorphine than with oral  methadone.  The decision
about which drug to use should be made on  a  case-by-case  basis.  If
both  drugs  are  equally  suitable, methadone  should  be  prescribed
as  the  first  choice. Injectable diamorphine  and  injectable  methadone
should only be considered for the  minority  of  patients  who  are
genuinely  unresponsive  to an optimised  oral  maintenance treatment
approach. Close monitoring and regular  clinical  review  are  required
throughout  treatment,  and especially  during  the  early  stages  of
treatment  and periods of instability. Daily installment prescribing and
supervised consumption are  useful  for  ensuring  that  patients  take
their  treatment as intended   and  for  reducing  the  diversion  of
prescribed  drugs. Detoxification It is not clear if there is any
difference in efficacy between methadone and buprenorphine for opioid
detoxification. Either may  be  offered as the first-line treatment. Risks
of drug treatment Methadone  carries  a  risk  of QT-interval
prolongation, so patients with risk factors  (e.g.  heart  or  liver
disease,  electrolyte abnormalities)  and  those  taking doses over 100mg
per day should be carefully  monitored.  When  buprenorphine  is
initiated, withdrawal symptoms  may  arise  if  patients  still have
opioid drug present in their  system.  This occurs because buprenorphine
has a high affinity for  opioid  receptors and displaces other opioids,
such as heroin or methadone.  This gives a rapid reduction in opiate
effects because it has  less  opioid  activity.  The  first  dose  should
therefore  be administered  when  the patient is exhibiting signs of
withdrawal, or at  least  6-12  hours  after  the last use of heroin and
24-48 hours after the last use of methadone. Patients should be fully
informed of the risks  of overdose with the use of prescribed and illicit
drugs, They  also  need to be aware that their previous tolerance to
illicit
opioids  may  be  lost during detoxification treatment and relapse to
illicit drugs may increase their risk of overdose.


]]></description></item><item><title><![CDATA[( BUPP09159 - 16 September 2008) Evidence  of the efficacy of major and minor opioids in the treatment of osteoarticular pain.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09159</link><pubDate></pubDate><description><![CDATA[Although  in  normal  clinical  practice specialists in the locomotor
apparatus  frequently use opioids for the treatment of osteoarticular
pain, there is a lack of scientific evidence regarding their specific
recommendation.  The  purpose  of  this  review  is  to  consider the
scientific evidence in the literature regarding the efficacy of major and
minor  opioids in the treatment of osteoarticular pain, limiting the
references as closely as possible to specific rheumatic diseases.
The  method  established  to comply with these objectives includes: -
Search  for evidence. - Analysis of the search. - Results. The search for
evidence  included:  1) search strategy: random and quasi-random studies
in different databases from 1990 to April 2005; 2) inclusion criteria:
clinical trials and/or studies of cohorts of more than 100 patients with
acute (<   6   weeks)  or  chronic  (>  6  weeks) musculoskeletal pain, of
all ages and sexes, and under treatment with
major  or minor opioids irrespective of the duration of the treatment or
route of administration. Control: placebo or any other analgesic, and  3)
search  criteria:  reduction  of  pain  (through  the use of qualitative
or continuous measures) and improvement of the quality of life.  Major
opiates  resulted in a significantly greater percentage improvement  of
the pain compared to placebo in patients with chronic pain,  with an
acceptable evidence level. Major opiates by oral route also resulted  in
improvement  of  the WOMAC pain index compared to placebo  in patients
with osteoarthritis, with an acceptable evidence
level.  Major  opiates  by  intraarticular route showed a significant
improvement  in  the severity of pain compared to placebo in patients
with  peripheral  osteoarthritis or rheumatoid arthritis, with a good
evidence  level.  Major  opiates  by  intravenous  route  in  general
resulted  in  a  higher  percentage  response  compared to placebo in
patients  with fibromyalgia and radiculopathy, with a slight evidence
level. Major opiates by transdermal route resulted in a significantly
higher percentage of patients with at least good improvement of the pain,
a higher percentage response, and a greater number of patients with  more
than  6  h  of uninterrupted sleep compared to placebo in patients  with
chronic  pain  secondary  to  cancer, musculoskeletal diseases  or  other
situations  that cause chronic pain, with a good evidence level. The
evidence level is insufficient in regard to major opiates
significantly   improving   pain  when  compared  to  anti-inflammatory
drugs  in  patients  with chronic lumbago or peripheral osteoarthritis.
Tramadol  is  an  efficient  treatment for acute and
chronic musculoskeletal pain.
23rd Sept 08 - message from the British Library - This paper is placed on
a waiting list.


]]></description></item><item><title><![CDATA[( BUPP09160 - 16 September 2008) Pharmacology of opioids.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09160</link><pubDate></pubDate><description><![CDATA[Opium comes from the Greek word opos, which means "juice". This juice is
also called  "latex"  and  is  extracted  from the seed pod of a
solanaceous  plant,  commonly  known  as  the  opium  poppy,  Papaver
somniferum  or "sleep-bringing poppy". Between 10-100 mg of opium, in the
form of a milky exudate can be extracted from each seed pod of an opium
poppy. It is extracted by carefully cutting the surface of the seed  pod
capsule  without  touching  the  seeds. This juice is then allowed to dry
until  becoming  a rubbery substance from which the opium  is  later
extracted using several chemical processes. Although the  word  opiate
and  opioid are often used as synonyms, there is a difference  between
both terms: - Opiate. This term is applied to all substances  derived
from  opium,  with  or  without  a morphine-like activity. - Opioid.  This
is a much wider term used to refer to any endogenous  (opioid  peptides)
or  exogenous  substance (natural and semi-synthetic  opium derivatives,
as well as synthetic opioids) with a capacity  to interact with opioid
receptors, either as an agonist,
antagonist,  partial  agonist  or  agonist-antagonist,  and  of being
displaced  by the antagonist drug naloxone. Initially, three families of
endogenous  opioid  peptides  have  been identified: enkephalins,
endorphins  and  dynorphins,  which include approximately 20 peptides
with  opioid  activity  originating from inactive precursor molecules
(pro-enkephalin, pro-opiomelanocortin and pro-dynorphin). Each of the
families  is derived from a different polypeptide precursor and has a
characteristic  anatomic  distribution.  Opioid  peptides  share  the
common  amino-terminal  sequence, which is called "opioid motif". The
same  precursor  may  be  the  origin of different endogenous opioids
depending  on the tissue where it is found and the stimulus received.
Recently,  three  new  endogenous opioid peptides have been isolated:
nociceptin/orphanin  FQ (N/OFQ) and endomorphins 1 and 2. It has been
suggested  that  endomorphins are selective endogenous ligands of the mu
receptor because of their high affinity for this receptor in spite of
their  structural  differences  compared  to all other endogenous
peptides.  The  antinociceptive  effects  of  opioids are mediated by
binding  to specific membrane proteins called opioid receptors. There are
four  known  types  of  opioid  receptors  called mu (mu), kappa (kappa),
delta (delta), and the recently discovered and cloned N/OFQ or opioid
receptor like ORL /sub 1/ , which have the peculiarity that no binding
takes place with conventional opioids, but which do accept binding  with
endogenous ligands such as nociceptin/orphanin FQ. The ORL  /sub  1/
receptor  has  been  associated with the appearance of hyperalgesia  and
anti-opioid  effects on a supra-spinal level, even though it produces
analgesia   at   spinal   level.   Different classifications  are  used
to  group opioid drugs according to their function  and  clinical  use.
They are classified according to their origin  in  natural  opium
alkaloids,  semi-synthetic derivatives of opium   alkaloids  and
synthetic  opioids.  They  are  then  divided according  to  their
analgesic  power into weak or minor opioids and powerful  or  major
opioids. Oral administration is simple and safe,
but  has  the inconvenience that there is a hepatic first pass effect
that  considerable  reduces  bioavailability. Sustained release forms are
now available to improve analgesia levels and patient compliance.
Transdermal  administration has recently acquired great importance in
modern pain treatment.
23rd Sept 08 - message from the British Library - This paper is placed on
a waiting list.


]]></description></item><item><title><![CDATA[( BUPP09161 - 16 September 2008) Rapamycin,  mycophenolate  mofetil, methylprednisolone, and cytotoxic T-lymphocyte-associated  antigen 4 immunoglobulin-based conditioning regimen  to  induce partial tolerance to hind limb allografts without cytoreductive conditioning.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09161</link><pubDate></pubDate><description><![CDATA[BACKGROUND:  Composite tissue allograft transplantation may represent the
next  frontier  in the field of reconstructive surgery. However, the
main  obstacles  precluding  the routine use of composite tissue
allotransplants  are rejection and toxicity associated with life-long
immunosuppressive  therapy. In this study, we investigated a nontoxic
immunosuppressant  and  cytotoxic  T-lymphocyte-associated  antigen 4
immunoglobulin  (CTLA4-Ig)-based  protocol  to  induce donor-specific
tolerance to hind limb allografts in rats. METHODS: Fully mismatched, 4-
to  10-week-old Brown Norway (BN, RT1n) and Lewis (RT1) rats were used
as  cell/organ  donors and recipients, respectively. Recipients were
treated  with  CTLA4-Ig (2 mg/kg/d) on days -30, -28, -26, -24, and  -22,
rapamycin,  mycophenolate  mofetil, and methylprednisolone (RAPA/MMF/MP)
combined  therapy (from days -30 to day 100), a single dose  of
anti-lymphocyte  serum  (10 mg, on day -30), and donor bone marrow  (10
x  10(7) T-cell-depleted cells) transplantation (BMT, on day  -30). Thirty
days after BMT, chimeric animals received hind limb allotransplantations
(on day 0). The RAPA/MMF/MP combined therapy was changed  to
Cyclosporine  (CsA, 8 mg/kg/d) on day 100 and maintained thereafter  at
this level. RESULTS: Hematopoietic chimerism of 17.6 + /-  9.5%  at  day
0, was stable (15.2 +/- 5.6%) at 230 days post-BMT; there  was  no sign of
graft-versus-host disease. Chimeric recipients (Lewis) permanently
accepted (>200 days) donor (BN)-specific (RT11, n
=  6)  hind  limbs,  yet rapidly rejected (20 +/- 2 days) third-party hind
limbs (Wistar Furth (WF)). Lymphocytes of graft-tolerant animals
demonstrated  hyporesponsiveness  in  mixed  lymphocyte cultures in a
donor-specific  manner.  Tolerant  graft histology showed no signs of
acute  and  chronic rejection. CONCLUSIONS: The immunosuppressant and
CTLA4-Ig-based  conditioning  regimen  with  donor BMT produced mixed
chimerism  and  induced partial donor-specific tolerance to hind limb
allografts.


]]></description></item><item><title><![CDATA[( BUPP09162 - 16 September 2008) (Drug therapy of opioid withdrawal).]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09162</link><pubDate></pubDate><description><![CDATA[Although  the  opiate dependence is of low frequency in our midst, it is
important  to  know  its  management  because it requires medical
treatment  in most cases. At present, in our country, we may classify the
different patient populations able to submit an opioid withdrawal
syndrome  in  patients  undergoing  chronic  treatment  with opioids,
patients  in  intensive care units, neonatal mother addicted patients and
addicts  from  the  general  population  or linked to the health system.
Detoxification programs are typically characterized by a low rate  of
completion  of  treatment  and  a high rate of relapse. The opioid
withdrawal syndrome is objectively and subjectively severe and moderate
and  the  goals  of  the therapy for the Opiates Withdrawal Syndrome
are:  to  prevent  or  reduce  the objective and subjective symptoms  of
abstinence;  to  prevent  or  treat  its  most  serious complications;
to   treat  preexisting  or  concurrent  psychiatric disorders;  to
reduce  the  frequency or severity of relapses and to rehabilitate in the
long term.
30th September 2008 - British Library cannot find this paper at present.


]]></description></item><item><title><![CDATA[( BUPP09163 - 22 September 2008) Epidural analgesia during brachytherapy for cervical cancer patients.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09163</link><pubDate></pubDate><description><![CDATA[Aims:  To  find  out  the efficacy of epidural analgesia in providing
continuous  pain  relief  for  patients  undergoing brachytherapy for
cervical  cancer.  Settings: Teaching Hospital. Design: Retrospective
Study.  Materials  and  Methods:  A total of 152 patients of cervical
cancer  received  epidural  analgesia during 18 to 21 hours of pelvic
brachytherapy.  Epidural  top  up  was  given  using  60-100  mug  of
buprenorphine   every  08-10  hrs.  Additional  top  up  or  systemic
analgesics  were  given  for  breakthrough pain. Results: Majority of
patients  119  out of 152 received epidural top up twice during their
stay  in the brachytherapy ward. Only 20 out of 152 needed additional
analgesics.  Conclusions:  Epidural  analgesia  is  safe and provides
satisfactory  pain  relief  during  brachytherapy and makes patient's stay
more comfortable.
30th September 2008 - British Library are unable to get hold of this paper
at present.


]]></description></item><item><title><![CDATA[( BUPP09164 - 22 September 2008) Fentanyl  transdermal  matrix  patch  (Durotep®  MT patch; Durogesic® DTrans®; Durogesic® SMAT): In adults with cancer-related pain.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09164</link><pubDate></pubDate><description><![CDATA[The  fentanyl  transdermal  matrix patch is approved in Japan for the
management  of  moderate  to  severe  cancer-related  pain in adults.
Bioequivalence,  in  terms  of  exposure  and the maximum and minimum
serum concentrations,  has  been  established  between  the fentanyl
transdermal  matrix  patch  16.8  mg  (100  mug/h)  and  the fentanyl
transdermal  reservoir  patch  10  mg  (100  mug/h)  after single and
multiple  applications. The fentanyl transdermal matrix patch 2.1-8.4 mg
(12.5-50 mug/h) effectively managed chronic cancer-related pain in adults
in  a  noncomparative,  multicentre, phase II study; 89.4% of   recipients
rated their global assessment of pain as 'very satisfied', 'satisfied'
or  'neither  satisfied  nor  dissatisfied'. Adults with cancer-or
non-cancer-related  chronic  pain  were  switched  from fentanyl
transdermal  reservoir patch to fentanyl transdermal matrix patch
therapy  without compromising efficacy; no differences in pain intensity
or  sleep  interference  scores  were seen between the two formulations
in  an  nonblind,  multicentre,  switching pilot study. Given  the
nature  of  the  therapy, the tolerability profile of the fentanyl
transdermal  matrix patch was generally acceptable. Topical adverse
events  included  erythema,  application-site irritation and pruritus.  In
general, patients and physicians preferred the fentanyl transdermal
matrix  patch  over  the  fentanyl transdermal reservoir  patch in the
pilot study.


]]></description></item><item><title><![CDATA[( BUPP09165 - 22 September 2008) Current recommondations on the evaluation of the impact of opioids on driving ability.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09165</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09166 - 22 September 2008) Candidate  gene  polymorphisms  predicting  individual sensitivity to opioids]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09166</link><pubDate></pubDate><description><![CDATA[Significant  interindividual  differences  in  opioid sensitivity can
hamper  effective  pain treatment and increase the risk for substance
abuse.   Elucidation  of  the  genetic  mechanisms  involved  in  the
interindividual   differences   in   opioid  sensitivity  would  help
establish  personalized  pain management. Studies using gene knockout mice
have revealed that genes encoding some metabolic enzymes, opioid
transporters,  and opioid system signal transduction mediators may be
candidate genes to predict appropriate kinds and doses of opioids for
individuals.   Recently,   various databases on knockout  mice,
pharmacogenetics,   and   gene   polymorphisms   have   been  rapidly
consolidated. Such information should aid in developing and improving the
methods  of  predicting  interindividual  differences  in opioid
sensitivity.  In  the near future, it will be possible to predict the
appropriate  kinds  and doses of opioids for individuals by analyzing
genetic variations  contributing  to  opioid  sensitivity.


]]></description></item><item><title><![CDATA[( BUPP09167 - 22 September 2008) Opioid  addiction  and pregnancy: Perinatal exposure to buprenorphine affects myelination in the developing brain.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09167</link><pubDate></pubDate><description><![CDATA[Buprenorphine  is  a  mu-opioid  receptor  partial agonist and
kappa-opioid  receptor antagonist currently on trials for the management
of pregnant opioid-dependent addicts. However, little is known about the
effects of  buprenorphine  on  brain  development.  Oligodendrocytes
express  opioid  receptors  in a developmentally regulated manner and
thus,  it  is  logical  to  hypothesize  that  perinatal  exposure to
buprenorphine   could   affect   myelination.   To  investigate  this
possibility,  pregnant  rats were implanted with minipumps to deliver
buprenorphine  at  0.3  or  1  mg/kg/day.  Analysis  of their pups at
different  postnatal  ages  indicated  that exposure to 0.3 mg/kg/day
buprenorphine  caused  an accelerated and significant increase in the
brain expression of all myelin basic protein (MBP) splicing isoforms. In
contrast,  treatment  with the higher dose caused a developmental delay in
MBP expression. Examination of corpus callosum at 26-days of age
indicated  that  both  buprenorphine  doses  cause a significant increase
in the caliber of the myelinated axons. Surprisingly, these axons  have
a  disproportionately  thinner myelin sheath, suggesting alterations  at
the  level  of  axonglial  interactions. Analysis of myelin  associated
glycoprotein  (MAG)  expression and glycosylation indicated  that  this
molecule  may play a crucial role in mediating these effects.
o-immunoprecipitation  studies  also  suggested  a mechanism  involving
a  NUG-dependent  activation  of the Src-family tyrosine  kinase  Fyn.
These  results  support  the idea that opioid signaling  plays  an
important role in regulating myelination in vivo and  stress  the  need
for  further  studies investigating potential
effects  of  perinatal buprenorphine exposure on brain development.


]]></description></item><item><title><![CDATA[( BUPP09168 - 22 September 2008) Dividing transdermal plaster is not tolerable.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09168</link><pubDate></pubDate><description><![CDATA[Publisher Hans Marseille Verlag GmbH, PO Box 22 13 41, Munchen, 80503,
Germany.


]]></description></item><item><title><![CDATA[( BUPP09169 - 22 September 2008) Oral versus transdermal treatment of cancer pain.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09169</link><pubDate></pubDate><description><![CDATA[The  treatment  of  cancer  pain  can still be improved. Recently new
preparations  and ways of administration have become available. Still the
oral  administration remains first choice for the great majority of
patients.  The  oral administration allows indeed an optimal dose
titration  and  adaptation  to the varying needs of patients. Finally and
compared to the application of transdermal preparations, the intoxication
risk is considerably reduced.


]]></description></item><item><title><![CDATA[( BUPP09170 - 22 September 2008) Late  morbidity  after  duodenum-preserving pancreatic head resection with bile duct reinsertion into the resection cavity.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09170</link><pubDate></pubDate><description><![CDATA[Background: Reinsertion of the distal common bile duct (CBD) into the
pancreatic  resection  cavity  during  duodenum-preserving pancreatic
head  excision  (DPPHE)  may  be  an  alternative  option  to Whipple
resection  or  bilioenteric  anastomosis when chronic pancreatitis is
associated  with  CBD  stenosis. Methods: Outcome in 82 patients with
chronic  pancreatitis  who  underwent  DPPHE with CBD reinsertion was
compared  with  that  in 432 who had DPPHE without reinsertion and 50 who
had  a  Whipple  procedure or pylorus-preserving pancreatoduodenectomy
(PPPD).  Results:  There  were no deaths after
DPPHE  with  CBD reinsertion, compared with four (0.9 per cent) after
DPPHE  without  reinsertion  and  three  (6 per cent) after classical
resection.  Overall  morbidity  rates  were  30, 28.9 and 36 per cent
respectively.  Fifteen  patients (18 per cent) who had DPPHE with CBD
reinsertion  developed  a stricture at the reinsertion site, compared
with  a long-term stricture rate of 2.3 per cent (ten patients) after
DPPHE  without  CBD  reinsertion  and 4 per cent (two patients) after
PPPD/Whipple  resection.  Conclusion: Although associated with a high
incidence of anastomotic stricture, reinsertion of the CBD into the
resection  cavity  as  part of DPPHE can be used to preserve duodenal
passage  and  offers an alternative to extended resection for chronic
pancreatitis


]]></description></item><item><title><![CDATA[( BUPP09171 - 22 September 2008) Treatment of chronic osteoarthritis pain: Effectivity and safety of a 7 day matrix patch with a lowdose buprenorphine.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09171</link><pubDate></pubDate><description><![CDATA[Patients  with osteoarthritis often suffer from chronic pain. If pain
treatment  with NSAIDS and coxibes is no longer indicated, a constant and
user  friendly  opioid  analgesia can be achieved with a lowdose
buprenorphine patch being applicated using an interval of 7 days. The use
of this matrix patch was evaluated in a multicenter observational study on
4263  patients  in  clinical  practice. During treatment a significant
decrease of mean pain intensity on a 11-point scale could be observed
from 6.9 points before using the patch to 2.9 points at the end of
observation. Further effects were a decrease of additional
analgetic  medication  and an improvement of aspects of life quality, e.
g.  mobility  and  quality of sleep. Only in 4.5% of the patients adverse
effects  were  observed,  reflecting  the  expected range of adverse
effects  of  opioids. Thus it could be demonstrated that the use of the
transdermal patch is an effective, user friendly and safe way of chronic
pain relief for osteoarthritis patients.


]]></description></item><item><title><![CDATA[( BUPP09172 - 22 September 2008) Placebo Response: Relevance to the Rheumatic Diseases.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09172</link><pubDate></pubDate><description><![CDATA[Recent interest in the neurobiology of the placebo effect has brought
about  a  new  awareness  of  its  potential exploitation for patient
benefit,  framing  it  as a positive context effect with the power to
influence  therapy  outcome.  Among  the  different  placebo  effects
described  in  clinical conditions and experimental settings, placebo
analgesia  is  of particular relevance to the rheumatologist. Placebo
analgesia is the field that has most contributed to our understanding
of  the  multiple mechanisms underlying this phenomenon. The possible
clinical  applications  of  placebo  studies range from the design of
clinical trials incorporating specific recommendations and minimizing the
use of placebo arms  to  the  optimization  of  the  context surrounding
the  patient  so  that  the  placebo  component  in  any treatment is
maximized


]]></description></item><item><title><![CDATA[( BUPP09173 - 22 September 2008) The Pharmacotherapy of Chronic Pain]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09173</link><pubDate></pubDate><description><![CDATA[Most  patients  with  rheumatic diseases experience difficulties with
chronic  pain. To assist clinicians in directly addressing this pain, this
article  presents  a  treatment approach and algorithm based on best
evidence.  The  usual  approach for mild to moderate pain is to start
with  a  nonopioid  analgesic. If this is inadequate or poorly tolerated,
and  if  there  is  an  element of sleep loss, it is then reasonable to
add an antidepressant  with analgesic qualities. If there  is  a
component  of  neuropathic pain or fibromyalgia, then a trial of one of
the gabapentinoids is appropriate. If these steps are inadequate,  then
an  opioid analgesic may be added. For moderate to severe  pain,  one
would initiate a trial of chronic opioid earlier. Cannabinoids and
topicals may also be appropriate as single agents or in combination.


]]></description></item><item><title><![CDATA[( BUPP09174 - 22 September 2008) Regional haemodynamic responses to adenosine receptor activation vary across time following lipopolysaccharide treatment in conscious rats.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09174</link><pubDate></pubDate><description><![CDATA[Background  and purpose: Studies using adenosine receptor antagonists have
shown that adenosine-mediated vasodilatations play an important role  in
the maintenance of regional perfusion during sepsis, but it is unclear
whether  vascular  sensitivity to adenosine is affected. Here,  we
assessed  regional  haemodynamic  responses  to  adenosine agonists  and
antagonists  in  normal  and lipopolysaccharide (LPS)-treated  rats  to
investigate  a  possible role for adenosine in the haemodynamic  sequelae.
Experimental  approach:  Male Sprague-Dawley rats were chronically
instrumented with pulsed Doppler flow probes to measure  regional
haemodynamic   responses  to  adenosine-receptor agonists   (adenosine,
2-choloro-N  /sup  6/  -cyclopentyladenosine    (CCPA))    and
antagonists    (8-phenyltheophylline   (8-PT),   8-
cyclopentyl-1,3-dipropylxanthine (DPCPX)), at selected time points in
control and LPS-treated rats. Key results: The responses to 8-PT were
consistent  with  endogenous adenosine causing bradycardia, and renal and
hindquarters  vasodilatation  in  control  rats, whereas in LPS-treated
rats,  there  was  evidence for endogenous adenosine causing renal  (at
1.5  h)  and  hindquarters  (at 6 h) vasoconstriction. In control
animals, exogenous adenosine caused hypotension, tachycardia and
widespread  vasodilatation,  whereas  in  LPS-treated  rats, the
adenosine-induced  renal  (at  1.5  h)  and  hindquarters  (at  6  h)
vasodilatations  were  abolished.  As  enhanced  A  /sub 1/
receptor-mediated  vasoconstriction  could  explain the results in
LPS-treated rats,  vascular  responsiveness  to  a  selective A /sub 1/
-receptor agonist  (CCPA)  or  antagonist  (DPCPX)  was  assessed. There
was no evidence  for enhanced vasoconstrictor responsiveness to CCPA in
LPS-treated  rats, but DPCPX caused renal vasodilatation, consistent with
endogenous  adenosine  mediating  renal  vasoconstriction under these
conditions. Conclusions and implications: The results show changes in
adenosine  receptor-mediated  cardiovascular  effects in endotoxaemia
that  may  have implications for the use of adenosine-based therapies in
sepsis


]]></description></item><item><title><![CDATA[( BUPP09175 - 22 September 2008) Use   of  buprenorphine  for  addiction  treatment:  Perspectives  of addiction specialists and general psychiatrists.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09175</link><pubDate></pubDate><description><![CDATA[Objective:  In  2002 buprenorphine (Suboxone or Subutex) was approved by
the  U.S. Food and Drug Administration for office-based treatment of
opioid  addiction. The goal of office-based pharmacotherapy is to bring
more  opiate-dependent  people into treatment and to have more physicians
address  this  problem.  This  study examined prescribing practices for
buprenorphine, including facilitators and barriers, and the
organizational  settings  that facilitate its being incorporated into
treatment.  Methods:   Addiction   specialists  and  other psychiatrists
in four market areas were surveyed by mail and Internet in  fall  2005
to  examine  prescribing practices for buprenorphine. Respondents
included  271  addiction specialists (72% response rate) and  224
psychiatrists  who were not listed as addiction specialists but  who had
patients with addictions in their practice (57% response rate).  Results:
Three  years  after  approval  of buprenorphine for office-based addiction
treatment, nearly 90% of addiction specialists had  been  approved  to
prescribe it and two-thirds treated patients
with   buprenorphine.   However,  fewer  than  10%  of  non-addiction
specialist  psychiatrists  prescribed it. Regression-adjusted factors
predicting  prescribing of buprenorphine included support of training and
use of  buprenorphine  by  the  physician's  main  affiliated
organization,   less   time   in  general  psychiatry  compared  with
addictions  treatment,  more time in group practice rather than solo, ten
or more opiate-dependent patients, belief that drugs play a large
role in addiction treatment, and patient demand. Conclusions:
Office-based  pharmacotherapy  offers a promising path to improved access
to addictions  treatment, but prescribing has expanded little beyond the
addiction specialist community.


]]></description></item><item><title><![CDATA[( BUPP09176 - 23 September 2008) Further investigation of the N-demethylation of tertiary amine alkaloids using the non-classical Polonovski reaction.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09176</link><pubDate></pubDate><description><![CDATA[Abstract - The iron salt-medicated Polonovski reaction efficiently
N-demethylates certain opiate alkaloids. In this process, the use of the
hydrochloride salt of the tertiary N-methy amine oxide was reported to
give better yields of the desired N-demethylated product. Herein, we
report further investigation into the use of N-oxide salts in the iron
salt-mediated Polonovski reaction. An efficient approach for the removal
of iron salts that greatly facilitates isolation and purification of the
N-nor product is also described.


]]></description></item><item><title><![CDATA[( BUPP09177 - 29 September 2008) Serotonin syndrome triggered by a single dose of suboxone.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09177</link><pubDate></pubDate><description><![CDATA[Suboxone  (buprenorphine/naloxone) is an oral medication used for the
treatment of opiate dependence. Because of its mixed properties at the
opiate  receptors,  buprenorphine  has a ceiling on its euphoric effects.
We  report  the  first case of serotonin syndrome caused by buprenorphine
and  review  other medications implicated in serotonin syndrome.  A
54-year-old  man  on  tricyclic antidepressants took an unprescribed
dose  of  buprenorphine/naloxone.  He  presented to the emergency
department  with  signs  and  symptoms of severe serotonin syndrome
including clonus, agitation, and altered mental status. His
agitation  was not controlled with benzodiazepines and was electively
intubated. At the recommendation of the toxicology service,
cyproheptadine,  a  serotonin  receptor  antagonist, was administered with
improvement  in  the  patient's  symptoms. Emergency physicians  should be
aware of the potential of buprenorphine/naloxone to trigger serotonin
syndrome.


]]></description></item><item><title><![CDATA[( BUPP09178 - 29 September 2008) Pharmacokinetics  of  buprenorphine  following  intravenous  and oral transmucosal administration in dogs.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09178</link><pubDate></pubDate><description><![CDATA[Pharmacokinetic analysis of buprenorphine administered to six healthy
dogs  via  the  oral  transmucosal (OTM) route at doses of 20 and 120
microg/kg  was  conducted  using  liquid  chromatography-electrospray
ionization-tandem  mass  spectroscopy (LC-ESI-MS/MS). Bioavailability was
38% plus or minus 12% for the 20 microg/kg dose and 47%+/-16% for the 120
microg/kg  dose. Maximum plasma concentrations were similar for
buprenorphine  doses  of  20 microg/kg IV and 120 microg/kg OTM. Sedation
and salivation were common side effects, but no bradycardia, apnea,  or
cardiorespiratory  depressive effects were seen. When the two  OTM  dosing
rates were normalized to dose, LC-ESI-MS/MS analysis of buprenorphine
and  its  metabolites  detected  no  significant difference  (P>.05),
indicating dose proportionality. The results of this  study  suggest that
OTM buprenorphine may be an alternative for pain management in dogs.


]]></description></item><item><title><![CDATA[( BUPP09179 - 29 September 2008) How do you treat fibromyalgia in your practice?]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09179</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09180 - 29 September 2008) 'Topping up' methadone: An analysis of patterns of heroin use among a treatment sample of Scottish drug users.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09180</link><pubDate></pubDate><description><![CDATA[Objectives:   To  determine:  (a)  whether  Scottish  drug  users  on
methadone  maintenance  use  heroin  less frequently than their peers
following other forms of drug treatment; and (b) to what extent those on
methadone maintenance 'top up' with heroin. Design: A cohort study
followed-up  for  33  months from 2001 to 2004. Methods: Four hundred and
ten  interviewees  who  responded  at all four interview sweeps,
recruited  as  new treatment entrants from 28 drug treatment agencies
across  Scotland.  Results:  Sixty-eight  of the 401 interviewees had
commenced  an episode of methadone-maintenance treatment at the start of
the  study.  There  was  no  significant  difference  between the
methadone-maintained  sample  and  the  other  interviewees  in their
propensity  to  abstain from heroin use, nor was there any difference
between the two groups in the mean reduction over time in their
self-reported dependence on drugs. However, if the outcome measure used is
the change  (between  baseline  and 33 months) in the number of days that
the  interviewee  reported having used heroin in the previous 3 months,
the reduction in the number of days that heroin was used was
significantly  greater  (52  days)  in the methadone-maintained group
than  in  the rest of the sample (36.4 days). This fall in the number of
days  of  heroin  use  was  greater  still  if the comparison was
restricted  to  those  who  had  continued  on  methadone-maintenance
treatment, although 67.4% of those still on methadone maintenance had
topped  up'  with  heroin at some point in the 3 months prior to
33-month   follow-up.   Those  on  higher  maintenance  doses  were  not
significantly more likely to have reduced the number of days on which
they  used heroin compared with those on lower doses, and those still on
methadone  maintenance were not more likely to have reduced their
criminality  (measured  by the number of days on which they committed
acquisitive  crimes  in the previous 3 months) compared with the rest of
the  sample. Conclusions: Methadone-maintained drug users are not more
likely  to  achieve  abstinence than drug users receiving other forms of
treatment, but they are significantly more likely to achieve a reduction
in the frequency of their illicit drug use; they 'top up' on  methadone,
but  the  frequency of their illicit drug use is less than  that  of
drug  users in other treatment modalities. These data confirm  the  value
of  methadone-maintenance  services as part of a 'mixed economy' of
services for the treatment of drug use.


]]></description></item><item><title><![CDATA[( BUPP09181 - 29 September 2008) Urinary   buprenorphine   concentrations  in  patients  treated  with Suboxone®  as  determined  by liquid chromatography-mass spectrometry and CEDIA immunoassay.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09181</link><pubDate></pubDate><description><![CDATA[We  report  on  the  utility  of  urine  total  buprenorphine,  total
norbuprenorphine,  and  creatinine concentrations in patients treated with
Suboxone® (a formulation containing buprenorphine and naloxone), used
increasingly  for the maintenance or detoxification of patients dependent
on  opiates such as heroin or oxycodone. Patients received 8-24  mg/day
buprenorphine. Two-hundred sixteen urine samples from 70 patients  were
analyzed  for  both  total  buprenorphine  and  total norbuprenorphine  by
liquid chromatography-mass spectrometry (LC-MS-MS).  Buprenorphine
concentrations  in  all 176 samples judged to be unadulterated  averaged
164 ng/mL, with a standard deviation (SD) of 198  ng/mL.  Nine  samples
(4.2%) had metabolite-parent drug ratios <    0.02,  and 33 (15.3%) had no
detectable buprenorphine. The metabolite/parent  drug  ratio  in 166
samples had a range of 0.07-23.0 (mean = 4.52;  SD  = 3.97). Fifteen of 96
available urine samples (16.7%) had creatinine less than 20 mg/dL. We also
found sample adulteration in 7 (7.3%) available samples. Using a 5 ng/mL
urine buprenorphine cutoff, the sensitivity and specificity of the
Microgenics homogeneous enzyme immunoassay  versus LC-MS-MS were 100% and
87.5%, respectively. The 5 ng/mL  cutoff  Microgenics  CEDIA
buprenorphine assay results agreed analytically with LC-MS-MS in 97.9% of
samples.


]]></description></item><item><title><![CDATA[( BUPP09182 - 29 September 2008) Chronic pain and opioidis dependence syndrome.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09182</link><pubDate></pubDate><description><![CDATA[Pain  is  one  of  the  most common complaints among patients seeking
medical  attention.  Chronic  pain  can present an enormous burden to
medical  services, and its management has been elusive to clinicians,
particularly  when one considers the diversity of pain disorders that lack
identifiable etiologies. Frequently, the adequate pain treatment is not
carried  out,  because  doctors may not aware of the several
psychological  and organic factors associated with painful syndromes.
Pain  management  has  received  increased attention from the medical
community  as  a  result  of  societal demands for more effective and
comprehensive treatment.  Besides,  pain  management  has  received
greater  legal  attention.  This paper aims to review some aspects of the
use  of  opioids in the treatment for the chronic pain, and some forensic
issues pertaining to these problems.


]]></description></item><item><title><![CDATA[( BUPP09183 - 29 September 2008) Studies  on  the  analgesic and anti-inflammatory properties of crude extracts of sting ray, Dasyatis zugei (Muller and Henle 1841).]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09183</link><pubDate></pubDate><description><![CDATA[Dasyatis zugei (Muller and Henle (1841), the pale-deged sting ray its
traditionally  used  by  freshermen  community  of Puducherry for the
treatment  of various body ailments. Presently an attempt was made to
examine  the  analgesic  and  anti-inflammatory  properties  of crude
extract  of  commonly  available ray fish, Dasyatis zugei using mouse
assay.  The  statistically  tested data from this experimental study,
revealed that the crude petroleum ether and ether extracts of the ray
fish  exhibited significant pharmacological activities further it was
also  noticed that, of the extracts ether extract showed higher level of
analgesic  and  anti-inflammatory  property  in  comparison  with standard
drugs.


]]></description></item><item><title><![CDATA[( BUPP09184 - 29 September 2008) Pain   and  U-shaped  dose  responses:  Occurrence,  mechanisms,  and clinical implications.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09184</link><pubDate></pubDate><description><![CDATA[This article assesses pain within the context of the dose response. A
substantial  number  of  studies  indicate that the dose response for
pain-related endpoints is commonly biphasic, being independent of the type
of biological  model  employed,  endpoint  measured,  or agent tested.
The  quantitative  features  of  the  dose response are also remarkably
consistent  regardless  of  the  receptor  pathway  that mediates  the
nociceptive  response,  indicating a likely downstream
message  convergence.  These findings have important implications for
drug  discovery,  development,  and  clinical evaluation.


]]></description></item><item><title><![CDATA[( BUPP09185 - 29 September 2008) Effects of various combinations of benzodiazepines with buprenorphine on arterial blood gases in rats.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09185</link><pubDate></pubDate><description><![CDATA[Fatalities   have   been  attributed  to  combinations  of  high-dose
buprenorphine  with benzodiazepines. In rats, high-dose buprenorphine
combined  with  midazolam  was  shown to induce sustained respiratory
acidosis,  while buprenorphine alone did not. However, the effects of
buprenorphine  combined with pharmacological doses of benzodiazepines
remain  unknown.  Our  objective  was to compare the acute effects of
four  selected benzodiazepines used intravenously at equi-efficacious
doses  in  rats,  alone  and  in  combination  with  buprenorphine on
sedation,  respiratory  rate  and arterial blood gases. Buprenorphine (30
mg/kg) did not significantly modify sedation level or respiratory rate,
but  induced mild and transient effects on pH and PaCO /sub 2/(P < 0.05).
Similarly, despite having no effects on respiratory rate, nordiazepam  (10
mg/kg), bromazepam (1 mg/kg) and oxazepam (12 mg/kg) mildly  and
transiently  altered  pH  and  PaCO  /sub 2/ (P < 0.05), whereas
clonazepam  (5  mg/kg)  did not. Buprenorphine combined with each
benzodiazepine  induced  no  significant effects on respiratory rate or
blood gases, in comparison with buprenorphine alone. However, combinations
of oxazepam or nordiazepam with  buprenorphine significantly  deepened
sedation.  While  both  combinations reduced respiratory  rate,
buprenorphine + 30 mg/kg clonazepam significantly
increased  PaCO  /sub  2/  and  buprenorphine  + 30 mg/kg nordiazepam
decreased PaO /sub 2/ . In conclusion, not all benzodiazepines induce
significant  respiratory  depression  at  therapeutic  doses. We were
unable   to   demonstrate  significant  effects  on  rat  ventilatory
parameters of buprenorphine   combined   with   equi-efficacious
pharmacological   doses   of   benzodiazepines   in  comparison  with
buprenorphine  alone.  Our  results may suggest that effects of these
combinations  are  rather  mild.  Respiratory  failure  may, however,
result  from  the association of buprenorphine with elevated doses of
benzodiazepines.


]]></description></item><item><title><![CDATA[( BUPP09186 - 29 September 2008) Murine renal ischaemia-reperfusion injury.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09186</link><pubDate></pubDate><description><![CDATA[Ischaemia/reperfusion  is  a  major  cause  of acute kidney injury in
native  and  transplant  kidneys  and  is associated with significant
morbidity and mortality. Murine models of renal ischaemia/reperfusion
injury have great  potential  to  improve  understanding  of  the
underlying  processes  and are an important focus of ongoing research into
therapeutic and preventative strategies. Like all experimental models,
murine  models  of  renal ischaemia/reperfusion are prone to significant
variability and results may be influenced by a number of technical  and
design factors. In this article we review the factors that  may
influence  experimental  results  and  provide  a guide to conducting
reproducible   experiments  in  murine  renal  ischaemia/reperfusion


]]></description></item><item><title><![CDATA[( BUPP09187 - 29 September 2008) Office-based  management  of  opioid  dependence  with buprenorphine: Clinical practices and barriers.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09187</link><pubDate></pubDate><description><![CDATA[BACKGROUND:  Buprenorphine  is  a  safe,  effective and underutilized
treatment  for opioid dependence that requires special credentialing,
known  as  a waiver, to prescribe in the United States. OBJECTIVE: To
describe  buprenorphine clinical practices and barriers among
office-based  physicians.  DESIGN: Cross-sectional survey. PARTICIPANTS:
Two hundred  thirty-five  office-based  physicians  waivered to prescribe
buprenorphine  in  Massachusetts. MEASUREMENTS: Questionnaires mailed to
all  waivered physicians in Massachusetts in October and November 2005
included  questions  on  medical  specialty,  practice setting, clinical
practices, and barriers to prescribing. Logistic regression analyses
were  used to identify factors associated with prescribing. RESULTS:
Prescribers  were  66%  of  respondents and prescribed to a median of
ten  patients.  Clinical  practices  included  mandatory    counseling
(79%),  drug  screening  (82%), observed induction (57%), linkage  to
methadone  maintenance  (40%), and storing buprenorphine notes separate
from other medical records (33%). Most non-prescribers (54%) reported they
would prescribe if barriers were reduced. Being a primary care physician
compared to a psychiatrist (AOR: 3.02; 95% CI: 1.48-6.18)  and  solo
practice only compared to group practice (AOR: 3.01;  95%  CI:
1.23-7.35)  were  associated with prescribing, while reporting  low
patient  demand  (AOR: 0.043, 95% CI: 0.009-0.21) and insufficient
institutional  support  (AOR:  0.37; 95% CI: 0.15-0.89) were  associated
with  not  prescribing.  CONCLUSIONS:  Capacity for increased
buprenorphine prescribing exists among physicians who have
already  obtained  a  waiver  to prescribe. Increased efforts to link
waivered physicians with opioid-dependent patients and initiatives to
improve  institutional support may mitigate barriers to buprenorphine
treatment. Several  guideline-driven  practices  have  been  widely
adopted,  such  as adjunctive counseling and monitoring patients with drug
screening


]]></description></item><item><title><![CDATA[( BUPP09188 - 29 September 2008) Effectiveness  of  non-steroidal anti-inflammatory drugs and epidural anaesthesia  in  reducing the pain and stress responses to a surgical husbandry procedure (mulesing) in sheep.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09188</link><pubDate></pubDate><description><![CDATA[In  this study, we examined the potential of several widely used
non-steroidal  anti-inflammatory  drugs ( NSAIDs) and other analgesics to
reduce  pain  and  stress  in  sheep  after surgery. Because mulesing
involves  a  greater  degree  of  tissue  trauma  than other surgical
husbandry  procedures such as castration or tail-docking, it provides a
more rigorous and conservative test to identify potentially useful
analgesic  strategies  in  sheep.  Merino lambs (5 weeks of age) were
randomised  into eight treatment groups: (1) carprofen; (2) flunixin; (3)
ketoprofen;  (4)  buprenorphine;  (5)  xylazine;  (6) lignocaine
epidural;  (7)  saline  control;  (8)  sham  control. The NSAIDs were
administered 1.5 h before mulesing, buprenorphine 0.75 h and xylazine and
lignocaine  0.25 h before mulesing. Pain- and discomfort-related
behaviours were recorded for 12 h after mulesing, and plasma cortisol
concentrations  were  measured before mulesing and 0.5, 6, 12, 24 and 48
h  after mulesing. The results indicated that no single analgesic
treatment  provided  satisfactory  analgesia during both the surgical
mulesing procedure and the ensuing period of pain associated with the
inflammatory  phase.  However, there were indications that two NSAIDs
(carprofen  and  flunixin) showed good potential as analgesics during the
inflammatory  phase.  A  combination  of  short- and long-acting
analgesics  may  be  needed  to provide more complete pain relief. In
conclusion,  the  administration  of some NSAIDs offers the potential for
good analgesia in sheep for the inflammatory phase following the tissue
trauma  of  surgical  husbandry  procedures.  Other analgesic options
need  to  be  considered if the acute stress response to the   procedure
is to be reduced.


]]></description></item><item><title><![CDATA[( BUPP09189 - 06 October 2008) High  cervical  epidural  neurostimulation for cluster headache: Case report and review of the literature.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09189</link><pubDate></pubDate><description><![CDATA[Cluster headache belongs to the trigeminal autonomic cephalgias.
Clinically, it is characterized by attacks of severe pain localized
orbitally, supraorbitally or temporally, lasting for 15-180 min and
occuring from once every other day to eight times a day. The attacks are
associated with one or more of the following: conjunctival injection,
lacrimation, nasal congestion, rhinorrhoea, forehead and facial sweating,
miosis, ptosis and eyelid oedema (1). Attacks occur in series (so called
cluster periods or bouts) that are usually separated by remission periods
lasting for months or years. In chronic cluster headache (CCH) substantial
remission periods are lacking. Mean age at onset is 20-40 years and, for
unknown reasons, 80% of patients are male.
Treatment usually consists of drug therapy. Agents used for acute therapy
are inhalation of high flow oxygen, sumatriptan subcutaneous injection or
nasal spray and zolmitriptan nasal spray. For transitional or short term
prophylaxis, corticosteroids and ergotamine derivatives are used. The
cornerstone of maintenance prophylaxis is verapamil, but lithium and
methysergide may also be used. Some patients respond to melatonin or
topiramate (2).
Nevertheless, there are a significant percentage of patients with CCH that
do not experience satisfactory pain relief with drug therapy alone. In the
last yeas new invasive techniques have emerged, and operational criteria
have been proposed to define pharmacologically intractable headache (3)


]]></description></item><item><title><![CDATA[( BUPP09190 - 06 October 2008) The  optimal temperature of first aid treatment for partial thickness burn injuries.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09190</link><pubDate></pubDate><description><![CDATA[Using our porcine model of deep dermal partial thickness burn injury,
various  cooling techniques (15 °C running water, 2 °C running water, ice)
of first aid were applied for 20 minutes compared with a control (ambient
temperature).  The  subdermal  temperatures  were monitored during  the
treatment and wounds observed and photographed weekly for 6 weeks,
observing  reepithelialization,  wound  surface  area  and cosmetic
appearance. Tissue histology and scar tensile strength were examined  6
weeks  after burn. The 2 °C and ice treatments decreased the subdermal
temperature the fastest and lowest, however, generally the 15  and  2  °C
treated  wounds  had better outcomes in terms of reepithelialization,
scar  histology,  and  scar  appearance.  These findings provide evidence
to support the current first aid guidelines of  cold  tap  water
(approximately  15  °C) for 20 minutes as being beneficial in helping to
heal the burn wound. Colder water at 2 °C is also  beneficial. Ice should
not be used.


]]></description></item><item><title><![CDATA[( BUPP09191 - 06 October 2008) Overdose   training   and   take-home   naloxone  for  opiate  users: Prospective  cohort  study  of  impact on knowledge and attitudes and subsequent management of overdoses.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09191</link><pubDate></pubDate><description><![CDATA[Aim:  To  examine  the  impact of training in overdose management and
naloxone  provision on the knowledge and confidence of current opiate
users;  and  to  record subsequent management of overdoses that occur
during  a  3-month follow-up period. Design: Repeated-measures design to
examine  changes  in  knowledge  and confidence immediately after
overdose  management  training; retention of knowledge and confidence at
3  months; and prospective cohort study design to document actual
interventions applied at post-training overdose situations. Method: A
total  of  239  opiate  users  in  treatment completed a pre-training
questionnaire  on overdose management and naloxone administration and
were  re-assessed immediately post-training, at which point they were
provided  with  the  take-home  emergency  supply  of naloxone. Three
months later they   were   re-interviewed.  Results:  Significant
improvements   were   seen   in   knowledge  of  risks  of  overdose,
characteristics  of overdose and appropriate actions to be taken; and  in
confidence in the administration of naloxone. A 78% follow-up rate  was
achieved (186 of 239) among whom knowledge of both the risks and
physical/behavioural   characteristics   of   overdose  and  also  of
recommended  management actions was well retained. Eighteen overdoses
(either  experienced  or  witnessed) had occurred during the 3 months
between  the  training  and  the  follow-up.  Naloxone was used on 12
occasions  (a trained client's own supply on 10 occasions). One death
occurred  in  one  of  the six overdoses where naloxone was not used.
Where  naloxone  was  used,  all  12 resulted in successful reversal.
Conclusions:  With  overdose management training, opiate users can be
trained  to  execute  appropriate  actions  to  assist the successful
reversal  of  potentially  fatal overdose. Wider provision may reduce
drug-related  deaths  further.  Future studies should examine whether
public  policy  of  wider  overdose  management training and naloxone
provision  could  reduce  the  extent  of opiate overdose fatalities,
particularly  at  times  of  recognized  increased  risk.


]]></description></item><item><title><![CDATA[( BUPP09192 - 06 October 2008) Motor  cortex  rTMS  in  chronic  neuropathic  pain:  Pain  relief is associated with thermal sensory perception improvement.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09192</link><pubDate></pubDate><description><![CDATA[Background:  Improvement in sensory detection thresholds was found to be
associated with neuropathic pain relief produced by epidural motor
cortex  stimulation  with surgically implanted electrodes. Objective: To
determine   the  ability  of  repetitive  transcranial  magnetic
stimulation  (rTMS)  of  the  motor cortex to produce similar sensory
changes.  Methods:  In  46  patients with chronic neuropathic pain of
various origins, first-perception thresholds for thermal (cold, warm) and
mechanical  (vibration,  pressure) sensations were quantified in the
painful  zone  and  in  the  painless  homologue  contralateral territory,
before and after rTMS of the motor cortex corresponding to the painful
side. Ongoing pain level was also scored before and after rTMS.  Three
types of rTMS session, performed at 1 Hz or 10 Hz using an active  coil,
or  at 10 Hz using a sham coil, were compared. The relationships  between
rTMS-induced changes in sensory thresholds and in pain scores were
studied. Results: Subthreshold rTMS applied at 10 Hz  significantly
lowered pain scores and thermal sensory thresholds in the painful zone but
did not lower mechanical sensory thresholds. Pain  relief  correlated
with  post-rTMS improvement of warm sensory    thresholds  in  the painful
zone. Conclusions: Thermal sensory relays are  potentially dysfunctioning
in chronic neuropathic pain secondary to sensitisation or
deafferentation-induced disinhibition. By acting on these structures,
motor cortex stimulation could relieve pain and concomitantly improve
innocuous thermal sensory discrimination.
10th October 2008 - Message from the British Library - They are not
allowed to take a copy of this paper so this will not be supplied to us.


]]></description></item><item><title><![CDATA[( BUPP09193 - 06 October 2008) Coming to terms with complexity: a call to action for HIV prevention.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09193</link><pubDate></pubDate><description><![CDATA[A  quarter  of a century of AIDS responses has created a huge body of
knowledge  about  HIV  transmission  and how to prevent it, yet every
day,  around  the  world, nearly 7000 people become infected with the
virus.  Although  HIV  prevention  is  complex,  it  ought  not to be
mystifying.  Local  and national achievements in curbing the epidemic
have  been  myriad,  and  have  created a body of evidence about what
works,  but  these  successful  approaches  have  not  yet been fully
applied.  Essential  programmes  and services have not had sufficient
coverage;  they  have  often  lacked  the  funding to be applied with
sufficient  quality  and  intensity.  Action  and  funding  have  not
necessarily  been directed to where the epidemic is or to what drives it.
Few  programmes  address  vulnerability  to  HIV  and structural
determinants  of the epidemic. A prevention constituency has not been
adequately  mobilised  to  stimulate  the  demand for HIV prevention.
Confident  and  unified  leadership has not emerged to assert what is
needed   in  HIV  prevention  and  how  to  overcome  the  political,
sociocultural, and logistic barriers in getting there. We discuss the
combination of solutions  which  are  needed  to  intensify  HIV
prevention,  using the existing body of evidence and the lessons from our
successes  and  failures in HIV prevention.


]]></description></item><item><title><![CDATA[( BUPP09194 - 06 October 2008) Drug  withdrawal  in  newborns  -  Clinical  data  of 49 infants with intrauterine drug exposure: What should be done?]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09194</link><pubDate></pubDate><description><![CDATA[Background:  Infants  of  drug  abusing  mothers  are at high risk to
suffer from neonatal abstinence syndrome (NAS). Depending on the drug
signs  of neonatal withdrawal vary but mainly include central nervous
system  irritability.  NAS  causes  long  duration  of hospital stay.
Severe  withdrawal  signs  are  seen in infants exposed to methadone,
infants  exposed  to  other opioids like heroin or buprenorphine have
been  shown  to  be less symptomatic. Between the years 1997 and 2003
following  the  border  opening there was a dramatic increase in drug
exposed newborns seen in the area of Leipzig (East Germany). Methods: In
a  retrospective  study  maternal  and  infant  characteristics, severity
of  symptoms,  duration  of  withdrawal  and hospital stay, duration and
kind of treatment as well as modalities for release from hospital  were
analyzed.  Results: From 1997 to 2003 49 drug exposed newborns  were
admitted  to  our  neonatal  care  unit. There was an increase  of  the
number of affected infants within these years (Fig. 1A).  Maternal drug
abuse (n=48) included mainly methadone (n=33), in second  line heroine and
benzodiazepines, in a few cases also cocaine and  cannabinoides.  3
mothers  received  substitution  therapy with buprenorphine.  Additional
drug use to substitution therapy was seen in 15 mothers. Drugs of abuse
were detected in infant urine specimen (36/48).35  of exposed newborns
showed signs of NAS (incidence of NAS 71%).  For  evaluation  of
withdrawal signs and conduction of therapy the  Finnegan score was used.
As first line pharmacological treatment phenobarbitone  was  administered
(n=42), secondary morphine was used (n=14,  treatment failure 33%). Mean
duration of hospital stay was 21 days.  Mean  duration  of
pharmacological treatment was 14 days with longer  duration  for
methadone  exposed  infants  vs. non-methadone exposed  infants  (16 vs.
10 days). Hospital stay was longer for non-methadone  exposed  infants.
Maternal  intake  of  more  than  20 mg
methadone  per  day vs. up to 20 mg per day caused longer duration of
hospital stay (28 vs. 20 days, p=0,015). Conclusion: Long duration of
hospital  stay  and  pharmacological  treatment  call  for  optimised
principal  guide lines for diagnosis, treatment and long term follow-up.
The  results also underline the need for further research for an effective
pharmacological  treatment.


]]></description></item><item><title><![CDATA[( BUPP09195 - 06 October 2008) Pain therapy Part III. Opioid analgetic drugs.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09195</link><pubDate></pubDate><description><![CDATA[Opioid  are  natural  or  synthetic analgetic drugs. They are divided
into  two  groups: opiates - natural analgesics received from opium -
codeine,  morphine,  heroine;  opioids  -  alfentanil, buprenorphine,
fentanyl,    methadone,    pentazocine,    pethidine,   remifentanil,
sufentanil,  tramadol.  Opioid  receptors  are located in the central
nervous  system  and peripheral tissues. There are four main types of the
receptors:  mu  (mi),  kappa  (kappa),  delta  (delta) and sigma
(sigma), with several subtypes. The mechanism of opioid action can be
explained  as:  presynaptic  inhibition  due  to  potassium  channels
opening  and/or  calcium channels closing; postsynaptic inhibition as an
effect  of  polarization  of the dorsal corns of the spinal cord;
influence on the enkephalinergic and GABAergic complexes. Opioids are
indicated  in  the  therapy of: acute posttraumatic and postoperative
pain;  severe  pain  in  certain diseases, e.g. myocardial ischaemia;
moderate  and strong cancer pain; chronic non-neoplasmatic pain; pain
syndromes  partly  of  inflammatory  origin;  neuropathic  pain. Side
effects  of  the  opioid  therapy:  nausea  and vomiting; somnolence;
dizziness;    mood   changes   (euphoria,   dysphoria);   respiratory
depression;  decrease  in  arterial and venous pressure; obstipation;
increased tension of smooth muscles (biliary ducts); urine retention;
histamine  release.  Wide  range  of the opioid analgetic drugs makes
possible  to  use  them  according  to cause, character, severity and
persistence of pain. The knowledge of the undesirable side effects is of
crucial  value  considering  safety  of  the  treated patients.


]]></description></item><item><title><![CDATA[( BUPP09196 - 06 October 2008) Attitudes  toward  buprenorphine and methadone among opioid-dependent individuals.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09196</link><pubDate></pubDate><description><![CDATA[Attitudes and beliefs about drug abuse treatment have long been known to
shape  response  to  that  treatment.  Two  major pharmacological
alternatives  are  available  for opioid dependence: methadone, which has
been  available  for  the  past  40  years, and buprenorphine, a recently
introduced medication. This mixed-methods study examined the attitudes of
opioid-dependent  individuals  toward  methadone  and buprenorphine.  A
total  of  195  participants  (n  =  140  who were enrolling  in one of
six Baltimore area methadone programs and n = 55 who  were
out-of-treatment)  were  administered the Attitudes toward
Methadone  and  toward  Buprenorphine  Scales,  and a subset (n = 46)
received  an  ethnographic  interview.  The  in-treatment  group  had
significantly  more  positive attitudes toward methadone than did the
out-of-treatment  group (p <.001), while they did not differ in their
attitudes  toward  buprenorphine.  Both groups had significantly more
positive  attitudes  toward  buprenorphine than methadone. Addressing
these attitudes may increase treatment entry and retention.


]]></description></item><item><title><![CDATA[( BUPP09197 - 06 October 2008) From yeast to alkaloids.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09197</link><pubDate></pubDate><description><![CDATA[Alkaloids,  which include caffeine and morphine, are a large class of
pharmacologically  active plant compounds that are often difficult to
chemically  synthesize.  Incorporation of benzylisoquinoline alkaloid
pathways  in yeast will facilitate the production of natural and
non-natural alkaloids.


]]></description></item><item><title><![CDATA[( BUPP09198 - 06 October 2008) beta-Endorphin and drug-induced reward and reinforcement.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09198</link><pubDate></pubDate><description><![CDATA[Although  drugs  of  abuse have different acute mechanisms of action,
their brain pathways of reward exhibit common functional effects upon
both  acute  and chronic administration. Long known for its analgesic
effect,  the  opioid  beta-endorphin is now shown to induce euphoria, and
to have rewarding and reinforcing properties. In this review, we will
summarize  the present neurobiological and behavioral evidences that
support involvement of beta-endorphin in drug-induced reward and
reinforcement.  Currently,  evidence  supports  a  prominent role for
beta-endorphin  in  the  reward  pathways of cocaine and alcohol. The
existing  information  indicating  the  importance  of beta-endorphin
neurotransmission  in  mediating  the reward pathways of nicotine and
THC,  is  thus  far  circumstantial.  The  studies  described  herein
employed  diverse  techniques,  such  as  biochemical measurements of
beta-endorphin  in  various  brain  sites  and plasma, and behavioral
measurements,  conducted following elimination (via administration of
anti-beta-endorphin  antibodies or using mutant mice) or augmentation (by
intracerebral administration) of beta-endorphin. We suggest that the
reward  pathways  for  different  addictive  drugs converge to a
common pathway in which beta-endorphin is a modulating element.
beta-Endorphin is involved also with distress. However, reviewing the data
collected  so  far  implies  a discrete role, beyond that of a stress
response,  for  beta-endorphin  in  mediating  the substance of abuse
reward  pathway.  This  may occur via interacting with the mesolimbic
dopaminergic  system  and also by its interesting effects on learning and
memory.  The functional meaning of beta-endorphin in the process of
drug-seeking  behavior  is  discussed.


]]></description></item><item><title><![CDATA[( BUPP09199 - 06 October 2008) Pain and medical treatment for pain in gynecology.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09199</link><pubDate></pubDate><description><![CDATA[Pain is encountered in gynecology in both acute and chronic forms. In
addition  to  causal  treatment,  appropriate  pain therapy should be
initiated early for managing acute pain. Chronic pain, including that not
caused  by  tumors,  is  treated  according  to  WHO guidelines, important
components of which include medication according to a fixed schedule,
individualized  dosage  regimens, and prophylaxis for side effects  of
adjunct  medications.  Laxatives  are  indicated for the obstipation
frequently accompanying opioid  administration.  If adequate  pain relief
cannot be achieved despite oral and transdermal    analgetic  agents,
intravenous morphine should be considered as well as invasive  methods
such  as  central  or  peripheral nerve block. Coanalgetic  agents  such
as  corticosteroids,  antidepressants, and neuroleptics  can help lower
the analgetic dosage needed. Acupuncture is  possibly useful in certain
forms of chronic pain.


]]></description></item><item><title><![CDATA[( BUPP09200 - 06 October 2008) The  role  of  the  opioid  receptor-like  (ORL1)  receptor  in motor stimulatory and rewarding actions of buprenorphine and morphine.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09200</link><pubDate></pubDate><description><![CDATA[We  have  previously  shown  that  the  ability  of  buprenorphine to
activate  the  opioid  receptor-like  (ORL1) receptor compromises its
antinociceptive effect. Furthermore, morphine has been shown to alter the
level of orphanin FQ/nociceptin (OFQ/N), the endogenous ligand of the
ORL1 receptor, raising the possibility that the endogenous OFQ/N/ORL1
receptor  system  may  be  involved  in  the  actions of these opioids.
Thus,  using mice lacking the ORL1 receptor and their wild-type
littermates,  the  present  study assessed the role of the ORL1 receptor
in   psychomotor   stimulant   and  rewarding  actions  of
buprenorphine  and  morphine. Morphine (5, 10 mg/kg) dose-dependently
increased  motor  activity  and induced conditioned place preference.
However, the magnitude of each response was comparable for the mutant
mice  and  their wild-type littermates. In contrast, buprenorphine
(1mg/kg)  induced  greater  motor stimulation in ORL1 receptor knockout
mice as  compared  with their wild-type littermates. Further, single
conditioning with buprenorphine (3 mg/kg) induced place preference in
mutant  mice  but  not in their wild-type littermates. The results of
binding  assay  showed  that  buprenorphine concentration-dependently
(0-1000 nM) displaced specific binding of ( /sup 3/ H)-OFQ/N in brain
membrane  of  wild-type  mice.  Together, the present results suggest
that  the ability of buprenorphine to interact with the ORL1 receptor
modulates  its  acute motor stimulatory and rewarding effects.


]]></description></item><item><title><![CDATA[( BUPP09201 - 06 October 2008) The  direct  comparison  of  health  and  ulcerated stomach tissue: A multiple probe microdialysis sampling approach.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09201</link><pubDate></pubDate><description><![CDATA[The  ability to directly compare gastric ulcerated and healthy tissue
would  aid  in  the  understanding  of  the physiological differences
between  these tissue types. Presently, these comparisons can only be
drawn  by  the  use  of  separate  animal  groups,  which  results in
increased  study  variability.  The  focus  of  this  research was to
develop  a  four-probe  microdialysis  sampling  approach to directly
compare  ulcerated  and  healthy  tissue  in  the  same animal. After
controlled  chemical  ulcer  induction,  probes were implanted in the
ulcerated  and  healthy  stomach  submucosa, stomach lumen and in the
blood.  To  assess  the significance of this multiple probe approach,
drug  concentrations  in  each  probe  location  were monitored after
selected  compounds were dosed to the ligated stomach by oral gavage.
Analysis  of  the  dialysate  samples  was  performed  by HPLC-UV and
concentration-time  curves and pharmacokinetics analyses were used to
determine  differences  between  these  tissue types.


]]></description></item><item><title><![CDATA[( BUPP09202 - 06 October 2008) Transdermal buprenorphine in clinical daily practice: Effectiveness and tolerability in patients suffering fom chronic musculoskeletal pain.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09202</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09203 - 07 October 2008) Commentary on Letter Entitled, "Buprenorphine Comes of Age".]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09203</link><pubDate></pubDate><description><![CDATA[We appreciate the interest that Drs. heit and Gourlay have in our case
conference on treating opioid dependence with buprenorphine. we share
their hope that increasing numbers of patients will have access to this
life-saving treatment. We would like to address their comments of our case
discussion. We agree that the limits of toxicology testing for
benzodiazepines is a very important clinical issue for addiction
physicians to consider in their daily work. in our case discussion, the
patient had given a remote history of episodic clonazepam use to
self-medicate anxiety and insomnia. There was no mention of her being
clonazepam-dependent (prescribed or illicit) and, therefore, the
discussants made no assumptions about which benzodiazepine she had used
during her relapse during the second month of treatment.


]]></description></item><item><title><![CDATA[( BUPP09204 - 07 October 2008) The Case for Chronic Disease Management for Addiction]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09204</link><pubDate></pubDate><description><![CDATA[Abstract: chronic disease (care) management (CDM) is a patient-centered
model of care that involves longitudinal care delivery; integrated and
coordinated primary medical and speciality care; patient and clinician
education; explicit evidence-based care plans; and expert care
availability. The model, incorporating mental health and speciality
addiction care, holds promise for improving care for patients with
substance dependence who often receive no care or fragmented ineffective
care. We describe a CDM model for substance dependence and discuss a
conceptual framework, the extensive current evidence for component
elements, and a promising strategy to recognize primary and speciality
health care to facilitate access for people with substance dependence. The
CDM model goes beyond integrated case management by a professional,
colocation of services, and integrated medical and addiction care -
elements that individually can improve outcomes. Supporting evidence is
presented that: 1) substance dependence is a chronic disease requiring
longitudinal care, although most patients with addictions receive no
treatment (eg, detoxification only) or short term interventions, and 2)
for other chronic diseases requiring longitudinal care (eg, diabetes,
congestive heart failure), CDM has been proven effective.


]]></description></item><item><title><![CDATA[( BUPP09205 - 13 October 2008) Assessment  of lung inflammation in a mouse model of smoke inhalation and burn injury: Strain-specific differences.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09205</link><pubDate></pubDate><description><![CDATA[To  test  concepts  developed in our ovine model of acute respiratory
distress  syndrome, specifically the roles of neuropeptides and other
peptide  mediators,  a  recently  developed  murine model of combined
smoke  inhalation  and  burn  (SB)  injury  was  extended by applying
methods  for  quantitative  assessment  of  acute inflammation in the
lung.  Mice  received  SB  injury per protocol, n = 5 to 7 per group.
Mice  were  anesthetized  with i.p. ketamine/xylazine, endotracheally
intubated, and exposed to cooled cotton smoke (4 x 30 sec for Balb/C, 2
x  30  sec for C57BL/6). After s.c. injection of 1 mL 0.9% saline, each
received  a  40%  total  body  surface  area (TBSA) flame burn.
Buprenorphine (0.1 mg/kg) was given i.p. for postoperative analgesia;
0.9%  saline was given i.p. at 4 mL/kg per %TBSA burn. Evans Blue dye
(EB)  was  injected i.v. 15 min before sacrifice. Lung wet/dry weight
ratio  was  measured. In other animals, after vascular perfusion with
buffered  saline, lungs were sampled and analyzed for myeloperoxidase
(MPO), using an EIA kit, and for their content of EB dye. There was a
significant  (p  <  0.05)  increase in EB dye content, wet/dry weight
ratio,  and  MPO  24 h after injury in Balb/C mice. Similar increases were
seen in C57BL/6 mice 48 h after SB injury, but not at 24 h. C57 mice
tolerated  less  smoke  inhalation  than  Balb/C  mice,  due to
postexposure  apnea,  and required 48 h to show significant increases in
these variables. Direct comparison between animals injured by 40% TBSA
burn  and  2  x 30 sec smoke exposure and sacrificed after 48 h showed
significantly  greater  abnormality  in the C57BL/6 mice. The mouse
model  can be used effectively to assess acute inflammation in the lung.


]]></description></item><item><title><![CDATA[( BUPP09206 - 13 October 2008) Opioid-induced  hyperalgesia  may  be  more  frequent than previously thought]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09206</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP0207 - 13 October 2008) Pain  treatment  with  high-dose,  controlled-release  oxycodone:  An Italian perspective.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP0207</link><pubDate></pubDate><description><![CDATA[Objective: To investigate the possible role and tolerability of high-dose
(>160  mg/day)  oxycodone  controlled  release  (CR)  for  the treatment
of  cancer  and non-cancer pain. Design: 227 patients with cancer  or
non-cancer  pain  were  enrolled in an open-label, multi-center,  Italian
study  in  order  to  assess  the adequacy of their existing  pain
management (using a numerical rating scale (NRS)) and the  possible
benefit  high-dose  oxycodone  CR  may  offer patients experiencing
uncontrolled  pain. Results: Pain was poorly controlled at  baseline,
with  only  18.1%  of patients reporting adequate pain relief  (NRS  <
3.5). All other patients reported uncontrolled pain, with  an  average
NRS  of  7.81.  At  baseline assessment, 47.89% of patients  had been in
pain for up to 3 months, 32.82% for 3-6 months, and  19.19%  for  more
than  6  months.  After  baseline assessment, patients were switched to
oxycodone CR monotherapy. The starting dose was individualized to each
patient and titrated up over a 3- to 4-day period  until  effective  pain
management was achieved. Treatment was
continued for an average of 37.24 days during the study. Pain control
(final  mean  NRS  of  2.85)  was  attained  with  an average dose of
oxycodone  CR  221.84  mg/day.  Standard  adverse  events  (including
constipations,  nausea,  and  vomiting)  were  recorded  in 39.64% of
patients  receiving  high-dose oxycodone CR monotherapy. Side-effects
tended  to  subside  after  the initial week of treatment and did not
result  in  any participants leaving the study. Conclusion: Higb-dose
oxycodone  CR  can achieve rapid and effective management of moderate to
severe  cancer  and  non-cancer pain with minimum side-effects.


]]></description></item><item><title><![CDATA[( BUPP09208 - 13 October 2008) Efficacy  of pethidine and buprenorphine for prevention and treatment of postanesthetic shivering.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09208</link><pubDate></pubDate><description><![CDATA[Background:  Postanesthetic  shivering is a distressing postoperative
complication.  Pharmacological  control  is  an  effective method for
treatment   and  prevention  of  postoperative  shivering.  Pethidine
prevents  or manages shivering far better than equianalgesic doses of
other  opioids.  However,  buprenorphine  is an opioid with a similar
structure  to  morphine  but approximately 33 times more potent. This
study aimed to assess and compare the effects of these two opioids in
preventing  post-anesthetic  shivering.  Materials  and Methods: This
randomized  double-  blind clinical trial was designed to compare the
efficacy of buprenorphine  and  pethidine  in  prevention  of  post
anesthetic  shivering.  Sixty  ASA  grade  I-II  patients  undergoing
general  anesthesia  for elective Cesarean section entered the study.
Patients  received  either  bupranorphine 3mug/kg (n=30) or pethidine 0.5
mg/kg  (n=30)  intravenously  30  min before the end of surgery. Heart
rate  and  blood  pressure  were  measured  15  min  after the injection.
Occurrence of shivering was evaluated for one hour in the recovery  room.
Also,  pain intensity was assessed by using a visual analog scale (VAS;
0-5). Results: Shivering was significantly reduced in the pethidine group
(5 of 30 versus 13 of 30, p<0.05). Visual pain scores  were  similar in
both groups. There was no difference between the two groups ragarding
hemodynamics. Conclusion: Despite similar in pain  control,  pethidine
is  more  effective  than buprenorphine in prevention  of  post
anesthetic  shivering.


]]></description></item><item><title><![CDATA[( BUPP09209 - 13 October 2008) A new pathway]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09209</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09210 - 13 October 2008) Oxycodone/paracetamol:  A  guide  to  its  use  in  the  treatment of moderate to severe musculoskeletal pain.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09210</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09211 - 13 October 2008) Therapeutic  strategies  for persons addicted to opiates: The role of substitution treatment.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09211</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09212 - 13 October 2008) A  comprehensive  review  on  the  mode  of  action  and  the  use of analgesics in different clinical pain states]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09212</link><pubDate></pubDate><description><![CDATA[Opioids in Medicine Book purchased by Chris Chapleo BBG.


]]></description></item><item><title><![CDATA[( BUPP09207 - 13 October 2008) Pain  treatment  with  high-dose,  controlled-release  oxycodone:  An Italian perspective.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09207</link><pubDate></pubDate><description><![CDATA[Objective: To investigate the possible role and tolerability of
high-dose   (>160  mg/day)  oxycodone  controlled  release  (CR)  for  the
treatment  of  cancer  and non-cancer pain. Design: 227 patients with
cancer  or  non-cancer  pain  were  enrolled in an open-label,
multi-center,  Italian  study  in  order  to  assess  the adequacy of
their existing  pain  management (using a numerical rating scale (NRS))
and the  possible  benefit  high-dose  oxycodone  CR  may  offer patients
experiencing  uncontrolled  pain. Results: Pain was poorly controlled at
baseline,  with  only  18.1%  of patients reporting adequate pain relief
(NRS  <  3.5). All other patients reported uncontrolled pain, with  an
average  NRS  of  7.81.  At  baseline assessment, 47.89% of patients  had
been in pain for up to 3 months, 32.82% for 3-6 months, and  19.19%  for
more  than  6  months.  After  baseline assessment, patients were switched
to oxycodone CR monotherapy. The starting dose was individualized to each
patient and titrated up over a 3- to 4-day period  until  effective  pain
management was achieved. Treatment was
continued for an average of 37.24 days during the study. Pain control
(final  mean  NRS  of  2.85)  was  attained  with  an average dose of
oxycodone  CR  221.84  mg/day.  Standard  adverse  events  (including
constipations,  nausea,  and  vomiting)  were  recorded  in 39.64% of
patients  receiving  high-dose oxycodone CR monotherapy. Side-effects
tended  to  subside  after  the initial week of treatment and did not
result  in  any participants leaving the study. Conclusion: Higb-dose
oxycodone  CR  can achieve rapid and effective management of moderate to
severe  cancer  and  non-cancer pain with minimum side-effects


]]></description></item><item><title><![CDATA[( BUPP09213 - 27 October 2008) Substitution treatment in Malaysia]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09213</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09214 - 27 October 2008) Accelerating   harm  reduction  interventions  to  confront  the  HIV epidemic in the Western Pacific and Asia: The role of WHO (WPRO).]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09214</link><pubDate></pubDate><description><![CDATA[The epidemic of HIV/AIDS linked to injecting drug usage is one of the
most  explosive  in  recent  years.  After  a historical epicentre in
Europe,  South  and  North America, at present it is clearly the main
cause of dissemination of the epidemic in Eastern Europe and some key
Asian  countries.  Recently, 10 African countries reported the spread of
HIV  through  people who inject drugs (PWID), breaking one of the final
geographical  barriers to the globalization of the epidemic of HIV  among
and  from PWID. Several countries of the Asia and Pacific Region  have
HIV  epidemics that are driven by injecting drug usage.    Harm  reduction
interventions have been implemented in many countries and  potential
barriers  to  implementation are being overcome. Harm reduction is no
longer a marginal approach in the Region; instead, it is the core tool for
responding to the HIV/AIDS epidemic among PWID. The  development  of  a
comprehensive response in the Region has been remarkable,  including
scaling  up  of needle and syringe programmes (NSPs),  methadone
maintenance treatment (MMT), and care, support and treatment  for  PWID.
This development is being followed up by strong ongoing  changes  in
policies and legislations. The main issue now is to enhance interventions
to a level that can impact the epidemic. The World  Health  Organization
(WHO)  is one of the leading UN agencies promoting  harm  reduction.
Since  the  establishment  of the Global Programme on AIDS, WHO has been
working towards an effective response    to the HIV epidemic among PWID.
WHO's work is organized into a number of components:  establishing an
evidence base; advocacy; development of  normative  standards,  tools  and
guidelines; providing technical support   to  countries;  ensuring
access  to  essential  medicines, diagnostics and commodities; and
mobilizing resources. In this paper, we trace the course of development of
the HIV/AIDS epidemic among and from  PWID  in  the Western Pacific and
Asia Region (WPRO) as well as WHO's  role  in supporting the response in
some of the key countries: Cambodia,  China,  Lao PDR, Malaysia, the
Philippines and Viet Nam.


]]></description></item><item><title><![CDATA[( BUPP09215 - 27 October 2008) A short review of pharmacy practice in England.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09215</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09216 - 27 October 2008) Effects  of  chronic  buprenorphine  treatment  on  levels of nucleus accumbens glutamate   and  on  the  expression  of  cocaine-induced behavioral sensitization in rats.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09216</link><pubDate></pubDate><description><![CDATA[Rationale:  Chronic  treatment  with  the mu-opioid receptor agonist,
buprenorphine,  reduces  cocaine-induced  behaviors  in  rats  with a
history  of  cocaine  self-administration.  The mechanisms underlying
these  actions  of  buprenorphine  remain  unclear.  Objectives:  The
objective  of  this  study  is  to investigate the effects of chronic
buprenorphine  treatment  on  cocaine-induced  activity and levels of
glutamate  and  dopamine  (DA) in the nucleus accumbens (NAc) in rats that
were preexposed to cocaine or drug-naive. Materials and methods: In
experiment 1, basal levels of NAc glutamate were assessed using in vivo
microdialysis   in   cocaine-naive   rats  that  were  treated
chronically  with  buprenorphine  (3.0  mg/kg  per  day)  via osmotic
minipumps  or that underwent sham surgery. In experiment 2, rats were
preexposed  to  seven  daily injections of cocaine or saline. After a
12-16-day drug-free period, extracellular levels of NAc glutamate and DA
and  locomotor  activity were assessed simultaneously, before and after
an  acute injection of cocaine (15 mg/kg, intraperitoneal), in
rats  under  sham  and  chronic  buprenorphine  (3.0  mg/kg  per day)
treatment.  Results:  Chronic buprenorphine treatment increased basal
levels  of  glutamate  in  drug-naive  and  cocaine-preexposed  rats,
blocked  the  expression  of  locomotor sensitization to cocaine, and
potentiated  the  NAc  DA  response  to  acute  cocaine  in
cocaine-preexposed   rats.   Conclusions:   These   findings   suggest
that buprenorphine  may  block the expression of cocaine sensitization and
other cocaine-related  behaviors  by  increasing  basal  levels  of
glutamate in the NAc, which would serve to decrease the effectiveness of
cocaine or cocaine-associated cues.


]]></description></item><item><title><![CDATA[( BUPP09217 - 27 October 2008) Quantitative   analysis  of  cocaine  in  human  hair  by  HPLC  with fluorescence detection.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09217</link><pubDate></pubDate><description><![CDATA[Cocaine  is  currently  one of the most widespread abuse drugs in the
world.  Since  hair  cocaine  concentrations are a reliable marker of
exposition to the drug, an original liquid chromatographic method has
been  developed  for  the determination of cocaine in human hair. The
chromatographic  analysis  was  carried out on a Hydro-RP C18 column,
using  a  mobile  phase  containing  a  phosphate  buffer  (pH  3.0)-
acetonitrile-methanol  (75:15:10, v/v/v). Native cocaine fluorescence was
monitored  at  315  nm while exciting at 230 nm. Mirtazapine was used  as
the internal standard. Sample pre-treatment was carried out by
incubative  extraction  with  0.1  M  HCl followed by solid-phase
extraction  with  C2  cartridges.  Good linearity was obtained over a
working  range  of  0.3-100.0 ng/mg. Both extraction yield (>89%) and
precision values (R.S.D. < 6.2%) were highly satisfactory. The method was
successfully  applied  to  hair  samples  collected from cocaine users.
Thus,  the method is suitable for the long-term monitoring of cocaine use
by means of hair testing.


]]></description></item><item><title><![CDATA[( BUPP09218 - 27 October 2008) Prevention  of Herpes Zoster infections in the elderly and management of post-herpetic neuralgia.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09218</link><pubDate></pubDate><description><![CDATA[30th October 2008 - Word from the British Library - Been asked to reapply
for paper in 3 weeks.


]]></description></item><item><title><![CDATA[( BUPP09219 - 27 October 2008) Development  and validation of a stability indicating HPLC method for the determination of buprenorphine in transdermal patch.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09219</link><pubDate></pubDate><description><![CDATA[A  rapid  and  sensitive  stability  indicating  HPLC method has been
developed  and validated for the determination of buprenorphine (BPN) in
transdermal   patch.  Chromatographic  separation  was  achieved
isocratically  on  an  XBridge  (TM) Shield RP18 column with a mobile
phase  of acetonitrile / 0.063 M ammonium bicarbonate buffer (pH 9.5)
(58:42,  v/v)  at  the  flow  rate  of  1.5 mL/min with UV absorbance
monitoring  at  230  nm. The system performance was evaluated and the
result  showed  that  BPN  and  degradation  products were separated.
Buprenorphine  was  subjected to neutral, acidic and basic hydrolysis as
well  as  chemical  oxidation  to  evaluate  the specificity. The
calibration  curve  of buprenorphine was linear in the range of 30-70 mu
g/mL (r = 0.9999, n =: 5). The values of RSD (%) for the intra-day and
inter-day  precision ranged from 0.04 to 0.22 and 0.65 to 0.88%,
respectively.  The  average  of  the  recovery percentage ranged from
98.86 to 99.36%. The detection limit (DL) and quantitation limit (QL) for
buprenorphine  were  0.008  and  0.024  mu g/mL, separately. The
robustness of this  method  was  also  evaluated  oil  the  small
fluctuations of pH  in the  mobile  phase,  the  mobile  phase
compositions,  and  the  flow  rate. The results of stability studies
showed  the  hydrolysis reaction of buprenorphine followed zero-order
kinetics  model  in  acidic and basic environment and followed
first-order  kinetics  model  in  the  presence  of hydrogen peroxide.
This analytical  method  was  successfully applied to the determination of
buprenorphine  in  transdermal  patch  and  call  be used for routine
quality control work.


]]></description></item><item><title><![CDATA[( BUPP09220 - 27 October 2008) Imaging of opioid receptors in the central nervous system.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09220</link><pubDate></pubDate><description><![CDATA[In  vivo  functional imaging by means of positron emission tomography
(PET)  is the sole method for providing a quantitative measurement of
mu-,  kappa  and  delta-opioid  receptor-mediated  signalling  in the
central  nervous system. During the last two decades, measurements of
changes  to  the  regional  brain  opioidergic  neuronal activation -
mediated  by  endogenously  produced  opioid peptides, or exogenously
administered  opioid  drugs - have been conducted in numerous chronic
pain   conditions,   in  epilepsy,  as  well  as  by  stimulant-  and
opioidergic  drugs.  Although  several  PET-tracers  have  been  used
clinically  for  depiction and quantification of the opioid receptors
changes,  the  underlying mechanisms for regulation of changes to the
availability   of   opioid  receptors  are  still  unclear.  After  a
presentation  of  the  general  signalling  mechanisms  of the opioid
receptor   system   relevant  for  PET,  a  critical  survey  of  the
pharmacological properties of some currently available PET-tracers is
presented.  Clinical studies performed with different PET ligands are
also  reviewed and the compound-dependent findings are summarized. An
outlook  is given concluding with the tailoring of tracer properties, in
order to facilitate for a selective addressment of dynamic changes to
the  availability  of  a  single subclass, in combination with an
optimization  of  the  quantification  framework  are  essentials for
further  progress  in the field of in vivo opioid receptor imaging.


]]></description></item><item><title><![CDATA[( BUPP09221 - 27 October 2008) Differential  therapeutic  aspects  of analgesia with oral sustained-release   strong   opioids:  Application  intervals,  metabolism  and    immunosuppression.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09221</link><pubDate></pubDate><description><![CDATA[The  oral  "around-the  clock"  administration  of  sustained-release
strong  opioids  has  been recommended for the long-term treatment of
patients suffering from chronic severe pain. At present a plethora of
products  are  available  in  Germany. Modern galenics even allow for only
once-daily oral application without clinically relevant negative
chronobiological interference. This application scheme has been shown to
improve  compliance  and  sleep  quality,  factors that influence
treatment outcome. Randomized controlled studies revealed no relevant
differences  between  the  different  strong  opioids with respect to
efficacy  and  tolerability.  However,  hydromorphone  and  oxycodone
appear to be advantageous  over  morphine  due  to  a  lack  of
immunosuppression.  Hydromorphone  has  the  additional  benefit of a
lower  risk  of intoxication by accumulation of active metabolites in
patients  with  decreased  renal  function.  As  a  result,  although
morphine  has  been  regarded  as  the  standard for the treatment of
chronic  severe  pain,  hydromorphone and oxycodone may be better and
safer  alternatives  for  certain  patient  groups  (e.g.  older age,
multimorbidity, cancer).


]]></description></item><item><title><![CDATA[( BUPP09222 - 27 October 2008) Topical  application  of morphine and buprenorphine gel has no effect in the sunburn model.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09222</link><pubDate></pubDate><description><![CDATA[Background.  The aim of this placebo-controlled double-blinded cross-over
study was to investigate the antihyperalgesic effect of topical morphine
and  buprenorphine  in the sunburn pain model. Material and methods. The
study was designed as a double-blind, placebo-controlled cross-over
trial, separated into 2 parts each with 16 volunteers. In part A morphine
dissolved  in  Ultrabas-ultrasic  ointment  at  3 concentrations  (0.1,
0.2, 0.4%) and placebo ointment were applied to 4  UVB-induced  erythemas
on the thighs. In part B buprenorphine at 3 concentrations  (0.01,  0.02
and 0.1%) and placebo dissolved in a gel
for  transcutaneous  application,  was  applied to 4 erythemas on the
thighs.  Thermal  and  mechanical  hyperalgesia  were assessed in the
respective  erythema by standardized quantitative sensory testing and
opioids  were  compared to the placebo. Results. Neither morphine nor
buprenorphine  showed  any  significant  reduction of hyperalgesia in
comparison  to  the  placebo.  Conclusion. The topical application of
opioids  in this form has no effect on inflamed skin.


]]></description></item><item><title><![CDATA[( BUPP09223 - 27 October 2008) /sup 153/ Sm:  Its use in multiple myeloma and report of a clinical    experience.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09223</link><pubDate></pubDate><description><![CDATA[Background:  In  the  past years the bone seeking radiopharmaceutical
samarium  lexidronam ( /sup 153/ Sm-EDTMP) has been increasingly used
alone  or in conjunction with chemotherapy and/or bisphosphonates for the
treatment of painful bone metastasis. Objective: Its use has been
explored  in  different  solid tumours. In this report we explore its
interesting  characteristics  and describe our experience in multiple
myeloma  (MM).  Methods:  /sup 153/ Sm-EDTMP has an affinity for bone and
concentrates  in  areas  of  bone  turnover.  It  decays  as  a
therapeutic  beta-emission  and at the same time as gamma-photon that
can  be  used  for tracking its concentration with bone scan imaging. Ten
patients  with  symptomatic  MM  were  treated  to  achieve pain control.
Results:  Encouraging results were obtained in MM patients. The  use  of
this  radioisotope  could  be  largely improved.
30th October 2008 - Message from the Brirtish Library. They are not
allowed to copy this piece from the jounral so canot supply.


]]></description></item><item><title><![CDATA[( BUPP09224 - 27 October 2008) Neuropathic pain - The case for opioid therapy.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09224</link><pubDate></pubDate><description><![CDATA[For  many patients, neuropathic pain (NeP) is arguably more difficult to
control  than nociceptive or 'normal' pain. We also now recognise the
great  burden  that NeP has on the lives of patients - it is not only  a
matter of treating pain in isolation, but managing all of the issues
that  affect  the patient's quality of life. Until relatively recently
we  have  had  little  understanding of the pathophysiology causing NeP
and have relied on the secondary effects of non-analgesic
drugs  as  the  mainstays  of treatment. Greater understanding of the
pathophysiology  of  NeP  has  led to more appropriate therapy and an
increased  use  of  multiple  drug therapy - 'rational polypharmacy'.
Traditional  opinions  concerning  the  treatment  of  NeP  have been
challenged  and  it is because of this that the use of opioids in NeP
has   been   re-evaluated.   Opioids  will  never  replace  tricyclic
antidepressants and anti-epileptic drugs as first-line therapy for Ne
P.  However,  they  are now fully established as effective and useful
second-  or  third-line  drugs.  Many  patients in the past have been
potentially  undertreated  as a result of our inertia to use opioids. The
case  for  opioid  therapy  in  NeP has been firmly established.


]]></description></item><item><title><![CDATA[( BUPP09225 - 27 October 2008) Pharmacotherapeutic guideline for pain management.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09225</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09226 - 27 October 2008) Illicit  drug  use  and liver transplantation: Is there a problem and what is the solution?]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09226</link><pubDate></pubDate><description><![CDATA[Liver  transplantation  is  indicated  in carefully selected patients
with  alcohol-induced  liver  disease.  There has been less debate to date
on the issues surrounding assessment of patients with an illicit drug
history  and  outcome  post-transplantation.  UK  guidelines on
assessment  and  selection  have  been agreed. Careful assessment and
access to treatment should be considered.


]]></description></item><item><title><![CDATA[( BUPP09227 - 27 October 2008) A survey of cancer pain status in Shanghai]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09227</link><pubDate></pubDate><description><![CDATA[This   is  a  multicenter  investigational  survey  conducted  in  76
hospitals in Shanghai between July and August 2004. The objective was to
investigate the cancer pain status and physicians' pain management
capabilities  in Shanghai. A total of 923 cancer patients involved in the
investigation  completed  a questionnaire which included general
condition,  self-assessment  of  pain  and  questions of pain control
knowledge.  The  study  results  were analyzed concerning: reason for
cancer  pain,  type  and intensity of cancer pain, treatment methods,
patients'  understanding  of  addiction,  patients'  request for pain
treatment,  and patients' and physicians' viewpoint on current cancer pain
treatment.


]]></description></item><item><title><![CDATA[( BUPP09228 - 27 October 2008) The selection and use of essential medicines]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09228</link><pubDate></pubDate><description><![CDATA[This  report presents the recommendations of the WHO Expert Committee
responsible  for  updating the WHO Model List of Essential Medicines. The
first  part contains a summary of the Committee's considerations and
justifications  for  additions  and  changes  to the Model List, including
its recommendations. Annexes to the main report include the revised
version  of  the  WHO Model List of Essential Medicines (the 14th)  and  a
list of all items on the Model List sorted according to their  5-level
Anatomical  Therapeutic Chemical (ATC) classification codes.


]]></description></item><item><title><![CDATA[( BUPP09229 - 27 October 2008) High  dose  transdermal  buprenorphine for moderate to severe pain in Spanish  pain  centres  -  A  retrospective  multicenter  safety  and efficacy study.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09229</link><pubDate></pubDate><description><![CDATA[Obectives:  To  assess the effectiveness of transdermal buprenorphine in
patients  suffering  from  moderate  to  severe  pain.  Secondary
objectives  included  gathering information about the causes of pain,
management  of  episodic  pain,  and  the  safety  profile.  Methods:
Retrospective  data  were collected from 1,465 patients with moderate to
severe pain, ie, 50 mm on a 0 to 100 mm visual analog scale (VAS), that
were switched to transdermal buprenorphine, and received a dose 52.5
mug/hour  for  at  least 14 days during the previous 12 months. Pain
could have any etiology. Most patients (72.1%) were on tramadol and/or
paracetamol  (40.7%) before switching to buprenorphine. Using case  report
forms, efficacy was determined from changes in VAS score compared  with
24 hours prior to the first patch application. Safety was evaluated  by
retrieving  information  about  the  nature  and incidence  of  adverse
events (AE), whether they were related to the study compound, and the
percentage considered being serious. Results: An  absolute  reduction  of
25.1 points in VAS score was seen over a median period of 3.7 months
treatment. In addition, the VAS score was reduced  by  at  least  10% in
88.4% of patients and the incidence of episodic  pain  fell
significantly. Treatment was rated as "Good" or "Very  Good"  by  82.5%
of  patients.  Out  of 1,465 patients, 50.2% experienced  an  AE;  this
was  related  to  the  drug in 48.8%, and considered  serious  in  4.0%.
Conclusions: Transdermal buprenorphine was  an  effective  and
considerably safe drug for relieving chronic moderate to severe pain.


]]></description></item><item><title><![CDATA[( BUPP09230 - 03 November 2008) Opiate  treatment  in  depression  refractory  to antidepressants and electroconvulsive therapy.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09230</link><pubDate></pubDate><description><![CDATA[This  open-label  study examined efficacy of sublingual buprenorphine in
6  patients  with  nonpsychotic  major  depressive  episode.  All
depressive patients improved under buprenorphine treatment over 1 wk.
This  rapid  improvement  was  observed  after  long-term  depressive
episodes  that  had been treated without success with antidepressants and
electroconvulsive therapy. Several questions need to be addressed to in
further  studies  (effectiveness in patients with and without treatment
resistance, biological or psychopathological predictors for a response  to
buprenorphine treatment, proper dosage, and treatment
duration).


]]></description></item><item><title><![CDATA[( BUPP09231 - 03 November 2008) Comparison  of  consumption  of  opioid  analgesics  and  analgesics-antipyretics in Slovakia and in Finland.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09231</link><pubDate></pubDate><description><![CDATA[We  can classify analgesics according to affinity to opioid receptors into
nonopioid   and   opioid   analgesics.  We  analyse  wholesale
consumption  of  analgesics  in  the  ATC group N02 in Slovak medical
practice  in the years 1996-2007. Obtained results were compared with
data  based  annual health statistics in Finland during 2003-2007. We
noticed  a  significant  increase  in consumption of metamizol, while
consumption  of  acetylsalicylic  acid  is  decreasing.  Fentanyl and
buprenorfme  consumption  significantly  increased.  These  trends in
consumption showed a well known accent on effective pain treatment in
Scandinavian countries.


]]></description></item><item><title><![CDATA[( BUPP09232 - 03 November 2008) Effect  of  selenium  compound  (selol)  on  the  opioid  activity in vincristine induced hyperalgesia.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09232</link><pubDate></pubDate><description><![CDATA[Purpose:    Effect    of    organoselenium   compound   (selol),   on
antinociceptive  action of opioid agonists in vincristine neuropathic
pain  model was investigated. Methods: The changes in pain thresholds
were  determined  using  mechanical stimuli - the modification of the
classic  paw  withdrawal  test described by Randall-Selitto. Results:
Daily administration of VIN (70 mug/kg, iv) resulted in progressive
decrease of pain threshold. Neither  morphine,  fentanyl nor
buprenorphine  administered alone in 5 consecutives days modified the
vincristine-induced  hyperalgesia,  whereas  selol slightly increased
the  nociceptive  threshold.  Co-administration of selol with opioids
markedly  enhanced  the  analgesic activity of all three investigated
compounds.   Conclusions:  Therefore,  concomitant  of  selenium  and
opioids  may  be  beneficial  in  terminal  neoplastic states.


]]></description></item><item><title><![CDATA[( BUPP09233 - 03 November 2008) Interventional pain treatments for cancer pain.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09233</link><pubDate></pubDate><description><![CDATA[Cancer  pain  is prevalent and often multifactorial. For a segment of the
cancer  pain population, pain control remains inadequate despite full
compliance  with  the WHO analgesic guidelines including use of
co-analgesics.  The  failure  to  obtain  acceptable  pain or symptom
relief  prompted  the inclusion of a fourth step to the WHO analgesic
ladder,  which  includes  advanced  interventional   approaches.
Interventional  pain-relieving  therapies can be indispensable allies in
the quest for pain reduction among cancer patients suffering from
refractory   pain.   There  are  a  variety  of  techniques  used  by
interventional  pain  physicians,  which  may be grossly divided into
modalities  affecting the spinal canal (e.g., intrathecal or epidural
space),  called neuraxial techniques and those that target individual
nerves  or  nerve  bundles, termed neurolytic techniques. An array of
intrathecal  medications  are infused into the cerebrospinal fluid in an
attempt  to  relieve  refractory  cancer  pain,  reduce disabling adverse
effects of systemic analgesics, and promote a higher quality of life.
These  intrathecal  medications  include  opioids,  local anesthetics,
clonidine,  and  ziconotide.  Intrathecal  and epidural infusions  can
serve  as  useful  methods  of  delivering analgesics quickly and
safely.  Spinal  delivery of drugs for the treatment of chronic  pain  by
means of an implantable drug delivery system (IDDS)
began  in  the 1980s. Both intrathecal and epidural neurolysis can be
effective  in  managing  intractable  cancer-related  pain. There are
several  sites  for  neurolytic  blockade  of the sympathetic nervous
system  for  the  treatment  of  cancer  pain.  The more common sites
include  the celiac plexus, superior hypogastric plexus, and ganglion
impar.  Today,  interventional  pain-relieving  approaches  should be
considered a critical component of a multifaceted therapeutic program of
cancer pain relief.


]]></description></item><item><title><![CDATA[( BUPP09234 - 03 November 2008) Cancer pain and analgesia.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09234</link><pubDate></pubDate><description><![CDATA[Pain  ranges  in  prevalence  from  14-100% among cancer patients and
occurs in 50-70% of those in active treatment. Cancer pain may result
from  direct  invasion  of  tumor  into  nerves,  bones, soft tissue,
ligaments, and fascia,  and  may  induce  visceral  pain  through
distension  and  obstruction. Cancer pain is multifaceted. Clinicians may
describe  cancer  pain as acute, chronic, nociceptive (somatic), visceral,
or neuropathic. Despite  implementation  of  the  WHO
guidelines,  reports  of  undertreatment  of  cancer  pain persist in
various  clinical  settings and in spite of decades of work to reduce
unnecessary discomfort. Substantial obstacles to adequate pain relief
with  opioids include specific concerns of patients themselves, their
family  members,  physicians,  nurses, and the healthcare system. The WHO
analgesic  ladder  serves  as  the mainstay of treatment for the relief of
cancer  pain  in  concert  with  tumoricidal,  surgical,
interventional,  radiotherapeutic,  psychological, and rehabilitative
modalities.   This  multidimensional  approach  offers  the  greatest
potential  for  maximizing  analgesia and minimizing adverse effects.
Primary  therapies  are directed at the source of the cancer pain and may
enhance  a  patient's function, longevity, and comfort. Adjuvant therapies
include nonopioids that confer analgesic effects in certain medical
conditions but primarily treat conditions that do not involve
pain.  Nonopioid  medications (over-the-counter agents) are useful in the
management  of  mild  to  moderate  pain, and their continuation through
step 3 of the WHO ladder is an option after weighing a drug's risks  and
benefits in individual patients. Symptomatic treatment of severe  cancer
pain  should  begin with an opioid, regardless of the mechanism  of  the
pain. They are very effective analgesics, titrate easily, and offer a
favorable risk/benefit ratio. Cancer pain remains inadequately  controlled
despite the diagnostic and therapeutic means of ensuring  that  patients
feel  comfortable during their illness. Therefore,  all  practitioners
need to make control of cancer pain a professional duty, even if they can
only use the most basic and least expensive  analgesic  medications,
such  as  morphine,  codeine, and acetaminophen,  to reduce human
suffering.


]]></description></item><item><title><![CDATA[( BUPP09235 - 03 November 2008) Sublingual drug delivery.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09235</link><pubDate></pubDate><description><![CDATA[The  sublingual route is one of the early modes of administration for
systemic  drug  delivery. This route avoids first-pass metabolism and
affords quick drug entry into the systemic circulation. Attempts have been
made to deliver various pharmacologically active agents, such as
cardiovascular drugs, analgesics, and peptides, across the sublingual
mucosa.  In  this  review,  the  anatomical  structure, blood supply,
biochemical  composition,  transport pathways, permeation enhancement
strategies,  in  vitro  / in vivo models, and clinical investigations for
the  sublingual  route  of drug delivery is discussed.


]]></description></item><item><title><![CDATA[( BUPP09237 - 03 November 2008) Neuropsychological   functioning   of  opiate-dependent  patients:  A nonrandomized  comparison of patients preferring either buprenorphine or methadone maintenance treatment]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09237</link><pubDate></pubDate><description><![CDATA[Objectives:   In   the   present   study,   we  investigated  whether
buprenorphine  as a partial mu -opioid receptor agonist is associated with
less cognitive   impairment than methadone. Methods: Neuropsychological
functioning of opioid-dependent  patients, previously assigned to
methadone (MMP, n = 30) or buprenorphine (BMP, n = 26) maintenance
treatment according to their own preference, was compared  and  dose
effects  were investigated. Results: MMP and BMP performed equally   well
on  all  measures  of  neuropsychological functioning including   the
trail  making  test,  the  continuous performance test, and a vigilance
task. However, patients receiving a higher dose  of  methadone  were
impaired  in  a  vigilance  task. Conclusions:   In   a  free-choice
administration  of  methadone  or buprenorphine,   there   seems  to  be
no  difference  in  cognitive functioning. Possible explanations are
discussed.


]]></description></item><item><title><![CDATA[( BUPP09238 - 03 November 2008) "Narcotics  helped, I thought." Recurrent traumatization and recovery from drug dependence.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09238</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09239 - 03 November 2008) Office-based  treatment  in  opioid  dependence: A critical survey of prescription   practices   for  opioid  maintenance  medications  and concomitant benzodiazepines in Vienna, Austria.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09239</link><pubDate></pubDate><description><![CDATA[Background:   The   success   of  maintenance  treatment  for  opioid
dependence  in  office-based  settings is influenced by the extent of
treatment coverage, the availability of effective medications and the
capacity  of  general  practitioners to prescribe opioids in adequate
doses  with  a  minimum  of concomitant benzodiazepine prescriptions.
Methods: This study compares prescriptions for opioid maintenance and
concomitant  benzodiazepine from Viennese physicians in 2002 and 2005
using  health  insurance  prescription records (n = 30,309). Results:
Between 2002 and 2005, the number of patients prescribed opioids more than
doubled  (ratio  1:2.3),  slow-release  oral  morphine replaced methadone
as  the  most  frequently  prescribed medication (57.1 vs. 23.4%;
buprenorphine  19.5%),  and  the  ratio  of benzodiazepine to opioid
prescriptions significantly declined (0.76:1 vs. 0.42:1). Many patients
were  prescribed concomitant benzodiazepines (27%), in some cases  from  a
secondary physician. Conclusion: Increased utilization of opioid
medications in office-based settings will facilitate better treatment
coverage. However, safeguards are necessary to ensure that general
practitioners have sufficient training and support to safely and
appropriately  provide  treatment,  including  the  reduction in
concomitant benzodiazepine use.


]]></description></item><item><title><![CDATA[( BUPP09240 - 03 November 2008) Post-treatment  outcomes of buprenorphine detoxification in community settings: A systematic review.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09240</link><pubDate></pubDate><description><![CDATA[A   systematic   review   was   undertaken   to  examine  studies  of
buprenorphine detoxification   that   has  included  post-treatment
outcomes  as well as more immediate aspects of progress. Studies were
required  to  report  details  of buprenorphine withdrawal regime and
post-treatment outcomes including abstinence rates. Only five studies met
these  criteria,  with  buprenorphine  regimes lasting 3 days to several
weeks, and with variable follow-up. Detoxification completion rates were
65-100%, but relatively few treatment completers were then drug free at
their follow-up appointments. In subsequent prescribing, more  patients
had returned to opioid maintenance than complied with naltrexone. Our
preliminary review indicates that buprenorphine is a suitable medication
for the process of opiate detoxification but that this newer treatment
option has not led to higher rates of abstinence following withdrawal.
Further studies are  required  to  more substantially examine abstinence
outcomes, as well as characteristics which predict success.


]]></description></item><item><title><![CDATA[( 09241 - 03 November 2008) Retention in substitution programmes with buprenorphine.]]></title><link>http://coretext.org/bupp_detail.asp?recno=09241</link><pubDate></pubDate><description><![CDATA[International and national experiences with substitution programme on
buprenorphine  are  presented.  As  an  advantage,  the  extension of
availability  of  this  treatment modality outside specialized opiate
maintenance centres is underlined. Increasing  presence of buprenorphine
on black market and its misuse are seen as factors that may create  a
barrier  for wider implementation of the programme by general
practitioners.  Involvement  in the programme is crucial for
the  treatment  outcome,  therefore  specific  attention  is  paid to
factors that influence retention.


]]></description></item><item><title><![CDATA[( BUPP09241 - 03 November 2008) Retention in substitution programmes with buprenorphine.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09241</link><pubDate></pubDate><description><![CDATA[International and national experiences with substitution programme on
buprenorphine  are  presented.  As  an  advantage,  the  extension of
availability  of  this  treatment modality outside specialized opiate
maintenance centres is underlined.  Increasing  presence  of buprenorphine
on black market and its misuse are seen as factors that may  create  a
barrier  for wider implementation of the programme by general
practitioners.  Involvement  in the programme is crucial for
the  treatment  outcome,  therefore  specific  attention  is  paid to
factors that influence retention.


]]></description></item><item><title><![CDATA[( BUPP09242 - 03 November 2008) Methadone   versus   buprenorphine   for   inpatient   detoxification treatment.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09242</link><pubDate></pubDate><description><![CDATA[Aim:  The  effects  of methadone and buprenorphine on withdrawal from
opiates  were compared with each other on a drug detoxification unit.
Method:  10  female  and  50 male patients were randomly assigned; 30
patients  received methadone-racemate, and 30 received buprenorphine.
Withdrawal  symptoms  and  craving  were  assessed  with standardised
measures on Days 1, 2, 3, 7, 14, and 21. Results: During the first 14
days,  patients  receiving  buprenorphine  reported  fewer withdrawal
symptoms,  and from Day 7 onward, they reported less craving. The two
groups  of  patients  did  not  differ  noticeably  in their need for
additional  medication  or  in  the  rate  at which they successfully
completed  the trial. Conclusions: The results show an overall better
effect for buprenorphine compared to methadone on withdrawal symptoms and
craving.


]]></description></item><item><title><![CDATA[( BUPP09243 - 03 November 2008) Hair  analysis  for  psychoactive  substances  in comparison to urine analysis.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09243</link><pubDate></pubDate><description><![CDATA[Background: Like urine analysis, hair analysis for psychoactive drugs is
often regarded  as  a  procedure  that  is  easily performed and
interpreted. However, various aspects of either kind of analysis must be
considered in order to obtain meaningful results. Variables: Both urine
and  hair vary widely in their composition. Damage to the hair resulting
from  weathering or cosmetic treatment is accompanied by a reduction  in
the concentration of the addictive substance. Urine and hair have quite
different  analytic  patterns  that  have  to  be considered during sample
preparation and analysis. The interpretation
of  results  from  a  hair analysis is hampered by the fact that drug
incorporation routes  are  still  not  known  with  certainty.  The
assumption  that hair grows at a rate of about 1 cm per month is only a
ough  estimate.  Prospects:  The  suggestion  that  hair analysis results
be  adjusted according to the melanin content of hair should be examined
further.  Enzyme polymorphisms could partly explain the variability  in
hair analysis results. There is evidence from several studies  that  hair
analysis is more accurate than urine analysis at identifying  drug
users.  Conclusion: Which kind of analysis is used depends  on  which
kind of specimen is available and on the question that  is posed; urine
and hair analyses complement each other because of their different
detection windows.


]]></description></item><item><title><![CDATA[( BUPP09244 - 03 November 2008) A  national  survey  of  postoperative  pain  management  in  France: Influence of type of surgical centres.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09244</link><pubDate></pubDate><description><![CDATA[Background:  The French Society of Anaesthesia and Intensive Care has
supported a national survey of postoperative pain (POP) management in
various  type of surgical centres. Methodology: The survey was
cross-checking data on information, evaluation, treatment concerning POP
of adult  patient within 24 h after surgery in surgical centres randomly
selected  according to teaching status, public or private funding and
size. A  local anaesthetist  referent  provided  information  on
management  of  POP.  Results:  One  thousand  and nine hundred adult
patients  were  audited.  Information on POP was better understood in
private  centres.  Rarely  prescribed,  written evaluation of POP was
frequent  on the ward (> 90%) without any difference between centres. In
all  centres,  POP  evaluation tool were by decreasing frequency,
numerical  scale,  nonspecific  tool,  visual analog scale and verbal
scale.  In all institutions, pain was rarely a criterion for recovery room
discharge.  Reported POP was mild at rest, moderate when moving and
intense  for  maximal  pain  with no difference between centres.
Incidence  of  side-effects  was  similar in all centres according to
patient  or  chart,  with mainly nausea and vomiting. Analgesics were
frequently  started  during anaesthesia. Patient-controlled analgesia was
used less frequently than subcutaneous morphine  whose prescription
frequently did not follow guidelines especially in small hospital.  Non
opioid  analgesic  included  paracetamol,  ketoprofen mainly   in
private  structure  and  nefopam  mainly  in  university hospital.
Epidural   or  peripheral  nerve  blocks  were  underused similarly in all
centres. Evaluation or treatment protocols were less frequent   in
university   hospital.   Conclusion:  This  national, prospective,
patient-based,  observational  survey  reveals  similar achievements  in
different surgical centres but also some differences and persistent
challenges for POP management.


]]></description></item><item><title><![CDATA[( BUPP09245 - 03 November 2008) Conscious  and  anesthetized  non-human  primate  safety pharmacology models: Hemodynamic sensitivity comparison.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09245</link><pubDate></pubDate><description><![CDATA[Introduction:   Drug-induced  cardiovascular  effects  identified  in
conscious  cynomolgus  monkeys equipped with tethers and prepared for
radiotelemetry were compared with results from anesthetized non-human
primate  (cynomolgus  and  rhesus) models. Methods: Remifentanil (4.0
mug/kg,  bolus),  esmolol (2.0 mg/kg, bolus) and dopamine (0.05 mg/kg
/min,  30  min  infusion)  were  given  intravenously  to all models.
Results:  Remifentanil  decreased heart rate (HR), systolic, mean and
diastolic  systemic  arterial pressures (SAP) in anesthetized animals
while  conscious  monkeys presented an increase in HR, systolic, mean and
diastolic  SAP,  as  seen  in humans for the respective state of
consciousness  (conscious  and  anesthetized).  Esmolol decreased HR,
systolic,  mean  and diastolic SAP in anesthetized monkeys while only HR,
systolic  and  mean  SAP  achieved  a  statistically significant decrease
in  the conscious model. The amplitude of SAP reduction was greater  in
anesthetized models, while the amplitude of HR reduction was  greater in
the conscious and anesthetized cynomolgus models than in  the
anesthetized  rhesus  model.  Dopamine induced a significant increase  in
HR,  systolic,  mean  and diastolic SAP in anesthetized models  without
any statistically significant effect on HR and SAP in the  conscious
model.  Discussion:  The amplitude of hemodynamic and chronotropic
alterations  induced  by  positive  control  drugs  was generally
greater  in  anesthetized  than  in  conscious  models and statistical
significance   was   achieved   more   often  with  the anesthetized
models. These results suggest that an anesthetized model may be valuable
as part  of  a  drug  screening  program  for cardiovascular safety
evaluations in addition to a conscious model


]]></description></item><item><title><![CDATA[( BUPP09246 - 10 November 2008) Correlations  of  maternal  buprenorphine  dose,  buprenorphine,  and metabolite concentrations in meconium with neonatal outcomes.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09246</link><pubDate></pubDate><description><![CDATA[For  the first time, relationships among maternal buprenorphine dose,
meconium  buprenorphine  and  metabolite concentrations, and neonatal
outcomes   are   reported.   Free   and   total   buprenorphine   and
norbuprenorphine,  nicotine,  opiates,  cocaine, benzodiazepines, and
metabolites were quantified in meconium from 10 infants born to women who
had  received buprenorphine during pregnancy. Neither cumulative nor
total  third-trimester  maternal  buprenorphine  dose  predicted meconium
concentrations  or  neonatal  outcomes. Total buprenorphine meconium
concentrations  and  buprenorphine/norbuprenorphine  ratios were
significantly  related  to  neonatal  abstinence syndrome (NAS) scores
>4.  As  free buprenorphine concentration and percentage free
buprenorphine  increased, head circumference decreased. Thrice-weekly
urine  tests  for  opiates,  cocaine,  and  benzodiazepines and
self-reported  smoking  data  from the mother were compared with data from
analysis  of the meconium to estimate in utero exposure. Time of last
drug  use  and  frequency  of  use  during  the  third trimester were
important  factors  associated with drug-positive meconium specimens. The
results suggest that buprenorphine and metabolite concentrations in the
meconium may predict the onset and frequency of NAS.


]]></description></item><item><title><![CDATA[( BUPP09247 - 10 November 2008) Management  of  chronic  pain  in  the  elderly: Focus on transdermal buprenorphine.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09247</link><pubDate></pubDate><description><![CDATA[Chronic pain in the elderly is a significant problem. Pharmacokinetic and
metabolic changes associated with increased age makes the elderly
vulnerable  to  side effects and overdosing associated with analgesic
agents.  Therefore  the management of chronic cancer pain and chronic
nonmalignant pain in this growing population is an ongoing challenge. New
routes of administration have opened up new treatment options to meet
this challenge. The transdermal buprenorphine matrix allows for slow
release  of  buprenorphine  and  damage  does  not produce dose dumping.
In addition the long-acting analgesic property and relative safety
profile  makes  it  a  suitable  choice  for the treatment of chronic
pain  in  the elderly. Its safe use in the presence of renal failure
makes  it an attractive choice for older individuals. Recent scientific
studies  have  shown  no  evidence  of  a ceiling dose of analgesia   in
man  but  only  a  ceiling  effect  for  respiratory depression,
increasing   its   safety   profile.  It  appears  that transdermal
buprenorphine can be used in clinical practice safely and efficaciously
for  treating chronic pain in the elderly.


]]></description></item><item><title><![CDATA[( BUPP09248 - 10 November 2008) Potent  analgesic  effect  of  tissue-engineered  skin  in a terminal patient with severe leg ulcer pain.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09248</link><pubDate></pubDate><description><![CDATA[We present herein an elderly and terminal patient suffering from an
unusual, extremely severe and disabling pain associated with chronic leg
ulcers. This pain, first unresponsive to conventional analgesic
treatments, was promptly and totally resolved by applying bilayered
low-cost, self-made, noncommercial, allogeneic tissue-engineered skin
entirely designed and produced in our hospital.
This prototype is based on human plasma as the main component of there
dermal layer. keratinocytes and fibroblasts are obtained from skin
biopsies from organ donors. After mechanical fragmentation and double
enzymatic digestion, we obtain the cells for the primary cultures.Cells
coming from trypsin-EDTA (ethylene-diaminetetraacetic acid) digestion are
cultured in the presence of lethally irradiated 3T3 cells to generate
keratinocytes. Cells coming from collagenase digestion are cultivated
without 3T3 to produce cultured fibroblasts. To obtain our skin
equivalent, fibroblasts are diluted in human plasma and clot is caused in
a culture flask by adding calcium chloride. The resulting dermis is then
seeded with previously cultivated keratinocytes. Once keratinocytes have
reached confluence, the skin prototype is detached from the flask, fixed
to a gauze, and then grafted on the wound bed. The estimated cost of 30
cm2 of this self-made noncommercial artificial skin is approximately $50.
Tissue engineered skin is being increasingly used for treating leg ulcers.
we report the success of a unique inexpensive bioengineered skin
equivalent in controlling pain in the ulcers of a terminally ill patient.


]]></description></item><item><title><![CDATA[( BUPP09249 - 10 November 2008) The Disease of Addiction: Origins, Treatment, and Recovery.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09249</link><pubDate></pubDate><description><![CDATA[Addiction can be defined as the continued use of mood-altering addicting
substances or behaviors (e.g. gambling, compulsive sexual behaviors)
despite adverse consequences. We have learned that alcoholism is a
primary, chronic disease with genetic, psychsocial, and environmental
factors influencing its development and manifestations. It is
characterized by continuous or periodic impaired control over drinking,
preoccupation with the alcohol, use of alcohol despite adverse
consequences, and distortions in thinking, most notably denial. This is a
definition forwarded in JAMA in 1992, and includes the thinking of the
American Society of Addiction Medicine and the National Council of
Alcoholism and Drug Dependencies. Since that time, continued exploration
of the nature if addiction includes other mood-altering substances aside
from alcohol, as well as a number of highly reinforcing behaviors.
The common pathways in reward circuitry that affect memory and learning,
motivation, control and decision making are also involved in the addictive
process. With the more global understanding of addiction come more
treatment strategies, such as meditation and mindfulness training,
psychosocial  interventions, and pharmacologic approaches. Interestingly,
our growing understanding of addiction as a disease has not diminished the
value of the spiritually driven approaches, such as 12-step-oriented
treatments, that are outlined in this article. An understanding of the
disease of chemical dependency, and the multiple approaches to treatment,
can assist the primary care physician (PCP) in the extended treatment team
and at the forefront of patient care.
Substance abuse negatively impacts public safety, reduces workers
productivity, and contributed to higher healthcare costs, premature
deaths, and disability for millions of Americans. Despite this massive
health problem, only a fraction of affected people get the help they need.
A report released in September 2007, by the Substance Abuse and Mental
Health Services Administration (SAMHSA), shows that, in 2006, 23.6
milllion persons aged 12 or older (9.6% of the population) required
treatment for alcohol or drug problems with only 2.5 million receiving the
help. The PCP is often the first (and sometimes only) clinician to
interface with the active addict. This article supplements June 2008
Disease a month, "Substance related disorders in adults" by Jerold B
Leiken MD, in which he outlines a practical approach by addressing various
clinical presentations of substance abuse, including withdrawal states,
potential toxicities, and pharmacologic management stratergies. Hos
overview assists the PCP with substance abusing patients in an office,
hospital, or medical setting. This article targets the addict in a mental
health setting, such as an addiction treatment program.


]]></description></item><item><title><![CDATA[( BUPP09250 - 10 November 2008) The  impact  of  methadone  or  buprenorphine  treatment  and ongoing injection  on highly active antiretroviral therapy (HAART) adherence: Evidence from the MANIF2000 cohort study.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09250</link><pubDate></pubDate><description><![CDATA[Aims: To date, no data exist assessing the impact of either methadone or
buprenorphine on adherence to highly active antiretroviral therapy
(HAART)  in  the  long  term.  This  study  was conducted in order to
evaluate  whether receiving take-home methadone and buprenorphine may
ensure  better  adherence to HAART in individuals infected with human
immunodeficiency  virus  (HIV)  through  injection  drug  use  (IDU).
Design: Longitudinal data on adherence, opioid substitution treatment
(OST) and  patient  behaviours  starting  from  their  first  HAART
prescription  were collected for 276 individuals HIV-infected through
drug  use  (n  = 1558 visits). Setting: Out-patient hospital services
delivering  HIV  care in Marseilles, Avignon, Nice and Ile de France.
Measurements:  At  any  given  visit,  patients  were classified both
according to the type of OST received and ongoing injection. Patients who
reported no injection and no OST over the whole study period were
considered  as  'abstinent' and used as a reference category. A logit
model  based  on  generalized  estimation equations (GEE) was used to
identify  predictors of non-adherence. Findings: After adjustment for
alcohol  consumption,  depression  and  self-reported  side  effects,
patients   ceasing   injection  during  OST  and  abstinent  patients
exhibited  comparable adherence. Patients reporting injection, on OST or
not,  had  a  twofold  and  threefold risk, respectively, of
non-adherence  compared  with abstinent patients (P < 0.01 linear trend).
Duration  on  OST without injecting was associated significantly with
virological success. Conclusions: Both access to and effectiveness of OST
contribute to sustaining adherence to HAART in HIV-infected IDUs. These
results  advocate  strongly  the  need  of wider use of OST in countries
scaling-up  HAART  where HIV is driven by IDUs.


]]></description></item><item><title><![CDATA[( BUPP09251 - 10 November 2008) Life-threatening wound treatment.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09251</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09252 - 10 November 2008) Effect  of  subcutaneous  injection  and  oral voluntary ingestion of buprenorphine  on  post-operative serum corticosterone levels in male rats.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09252</link><pubDate></pubDate><description><![CDATA[Background:   Adequate  peri-operative  analgesia  may  reduce
post-operative stress response and improve recovery in laboratory animals.
We  have  established  a  method  involving  repeated automated blood
sampling,  allowing  quantification of serum corticosterone levels in
rats  for  stress  assessment  without  stress-inducing  handling  or
restraint.  In  the  present  study, the effects of the commonly used
route of buprenorphine administration (0.05   mg/kg  injected
subcutaneously)  were  compared  with  oral administration (0.4 mg/kg
mixed  with  Nutella® and orally administered by voluntary ingestion) in
male  Sprague-Dawley  rats. Methods: A catheter was placed in the jugular
vein  and  attached  to  an Accusampler® for automated blood sampling.
During 96 h after surgery, blood was collected at specified time points.
Pre-  and  post-operative  body  weights  and  water consumption  were
registered.  Results:  Buprenorphine significantly suppressed  levels  of
circulating corticosterone after the oral but not  after  the subcutaneous
treatment. Both buprenorphine treatments had  a  positive  impact  on
maintenance  of  body  weight and water consumption,   compared   to  the
control  group  that  received  no   buprenorphine.  Conclusion:  The
present investigation suggests that oral voluntary ingestion ad libitum is
an efficacious, convenient and non-invasive  way  of  administering
peri-operative buprenorphine to rats, as judged by corticosteroid response
and effects on body weight and water consumption.


]]></description></item><item><title><![CDATA[( BUPP09253 - 10 November 2008) Treatment of opioid dependence via home-based telepsychiatry.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09253</link><pubDate></pubDate><description><![CDATA[To the Editor: The Food and Drug Administration's approval of the drug
buprenorphine in 2002 changed the landscape in terms of our ability to
manage opioid dependence. Yet because of the relatively small number of
buprenorphine certified physicians and sluggish efforts at public
education, a majority of patients with opioid dependence, particularly in
rural areas, go without this definitive treatment.
Simultaneously, we have seen personal use of broadband Internet expand
from 10% of the population in 2002 to its current rate of 55% (1), as well
as the release of numerous versions of consumer video conferencing
software, such as iChat with secure encryption for the Macintosh and Skype
or SightSpeed for both PC and Mac platforms. When combined with broadband
Internet and a midrange Webcam, these software packages offer home based
telepsychiatry.
Over the past two years i have treated approximately 40 opioid dependent
patients from communities throughout Colorado, all of whom were seen
exclusively via telepsychiatry from their own homes or offices. Many of
these patients are affluent professionals seeking treatment for convert
addiction to narcotic analgesics, who were relieved to find an option
providing both convenience and confidentiality. Few have chronic mental
illness other than addiction.
The standard of care of general outpatient psychiatry is maintained. After
a routine intake, a prescription for buprenorphine is arranged when
clinically appropriate by telephone with the patients local pharmacy.
Induction is achieved at home, in some cases with intermittent on-camera
contact, and follow-up occurs at appropriate intervals. Patients are
required to contact their primary care physicians for laboratory tests and
physical examinations as indicated. Many are required to participate in
ancillary psychosocial treatments, such as Narcotics Anonymous, or in
local random urine screening programs. In many cases, the patients spouse
or family member appeared on camera to participate and collaborate in
treatment.


]]></description></item><item><title><![CDATA[( BUPP09254 - 10 November 2008) Continuous   and   intermittent  nicotine  treatment  reduces  L-3,4-dihydroxyphenylalanine (L-DOPA)-induced dyskinesias in a rat model of Parkinson's disease.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09254</link><pubDate></pubDate><description><![CDATA[The   development   of   abnormal  involuntary  movements  (AIMs)  or
dyskinesias is a serious complication of L-DOPA   (L-3,4-
dihydroxyphenylalanine) therapy for Parkinson's disease. Our previous
work  had  shown  that  intermittent  nicotine dosing reduced L-DOPA-
induced  dyskinetic-like  movements  in  nonhuman primates. A readily
available  nicotine formulation is the nicotine patch, which provides a
constant   source   of   nicotine.   However,  constant  nicotine
administration  more  readily  desensitizes  nicotinic  receptors, to
possibly   yield   alternate   behavioral   outcomes.  Therefore,  we
investigated whether constant nicotine administration reduced L-DOPA-
induced  AIMs in a rat parkinsonian model, with results compared with
those  with  intermittent  nicotine dosing. Rats with a unilateral
6-hydroxydopamine  (6-OHDA)  lesion were exposed to either intermittent
(drinking water) or constant (minipump) nicotine for 2 weeks at doses
that  yielded  plasma  levels  of  the  nicotine  metabolite cotinine
similar  to  those in smokers. The rats were next treated with L-DOPA
/benserazide  (8  or  12 mg/kg/15 mg/kg) for 3 weeks to allow for the
development of AIMs, with nicotine treatment continued. Both modes of
nicotine administration  resulted  in  50% decline in L-DOPA-induced
AIMs.  Nicotine  treatment also significantly reduced AIMs in L-DOPA-
primed rats using either dosing regimen, whereas nicotine removal led to
an increase in AIMs. There was no effect of nicotine on various measures
of motor  performance in 6-OHDA-lesioned rats. In summary, nicotine
provided  either via the drinking water or minipump reduced
L-DOPA-induced  AIMs  in  a  rat  model of Parkinson's disease. These
results suggest  that  either  intermittent  or  constant  nicotine
treatment   may   be   useful  in  the  treatment  of  L-DOPA-induced
dyskinesias in patients with Parkinson's disease.


]]></description></item><item><title><![CDATA[( BUPP09255 - 10 November 2008) The  JNK  inhibitor XG-102 protects from ischemic damage with delayed  intravenous administration also in the presence of recombinant tissue plasminogen activator.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09255</link><pubDate></pubDate><description><![CDATA[Background:  XG-102  (formerly  D-JNKI1),  a  TAT-coupled  dextrogyre
peptide  which selectively inhibits the c-Jun N-terminal kinase, is a
powerful  neuroprotectant  in  mouse models of middle cerebral artery
occlusion  (MCAo)  with delayed intracerebroventricular injection. We
aimed  to  determine  whether  this  neuroprotection  could  also  be
achieved by intravenous injection of XG-102, which is a more feasible
approach  for  future  use  in  stroke  patients.  We also tested the
compatibility  of  the  compound  with recombinant tissue plasminogen
activator  (rtPA),  commonly  used  for  intravenous thrombolysis and
known to enhance  excitotoxicity.  Methods:  Male ICR-CD1 mice were
subjected  to a 30-min-suture MCAo. XG-102 was injected intravenously in a
single dose, 6 h after ischemia. Hippocampal slice cultures were
subjected  to  oxygen (5%) and glucose (1 mM) deprivation for 30 min.
rtPA  was added after ischemia and before XG-102 administration, both in
vitro and in vivo. Results: The lowest intravenous dose achieving
neuroprotection  was  0.0003  mg/kg, which reduced the infarct volume
after  48  h from 62 ± 19 mm /sup 3/ (n = 18) for the vehicle-treated
group  to 18 ± 9 mm /sup 3/ (n = 5, p < 0.01). The behavioral outcome was
also significantly improved at two doses. Addition of rtPA after ischemia
enhanced the ischemic damage both in vitro and in vivo, but XG-102  was
still  able  to  induce  a  significant neuroprotection. Conclusions:  A
single  intravenous administration of XG-102 several hours  after
ischemia  induces  a  powerful  neuroprotection. XG-102 protects from
ischemic  damage  in  the  presence  of  rtPA. The feasibility of systemic
administration of this promising compound and its compatibility  with rtPA
are important steps for its development as  a  drug  candidate in ischemic
stroke.


]]></description></item><item><title><![CDATA[( BUPP09256 - 10 November 2008) Extended vs Short-term Buprenorphine-Naloxone for Treatment of opioid-Addicted Youth - A Randomized Trial]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09256</link><pubDate></pubDate><description><![CDATA[Context  The usual treatment for opioid-addicted youth is detoxification
and counseling. Extended medication-assisted therapy may be more helpful.
Objective  To evaluate the efficacy of continuing buprenorphine-naloxone
for 12 weeks vs detoxification for opioid-addicted youth.
Design, Setting, and Patients  Clinical trial at 6 community programs from
July 2003 to December 2006 including 152 patients aged 15 to 21 years who
were randomized to 12 weeks of buprenorphine-naloxone or a 14-day taper
(detox).
Interventions  Patients in the 12-week buprenorphine-naloxone group were
prescribed up to 24 mg per day for 9 weeks and then tapered to week 12;
patients in the detox group were prescribed up to 14 mg per day and then
tapered to day 14. All were offered weekly individual and group
counseling.
Main Outcome Measure  Opioid-positive urine test result at weeks 4, 8, and
12.
Results  The number of patients younger than 18 years was too small to
analyze separately, but overall, patients in the detox group had higher
proportions of opioid-positive urine test results at weeks 4 and 8 but not
at week 12 (22 = 4.93, P = .09). At week 4, 59 detox patients had positive
results (61%; 95% confidence interval [CI] = 47%-75%) vs 58 12-week
buprenorphine-naloxone patients (26%; 95% CI = 14%-38%). At week 8, 53
detox patients had positive results (54%; 95% CI = 38%-70%) vs 52 12-week
buprenorphine-naloxone patients (23%; 95% CI = 11%-35%). At week 12, 53
detox patients had positive results (51%; 95% CI = 35%-67%) vs 49 12-week
buprenorphine-naloxone patients (43%; 95% CI = 29%-57%). By week 12, 16 of
78 detox patients (20.5%) remained in treatment vs 52 of 74 12-week
buprenorphine-naloxone patients (70%; 21 = 32.90, P < .001). During weeks
1 through 12, patients in the 12-week buprenorphine-naloxone group
reported less opioid use (21 = 18.45, P < .001), less injecting (21 =
6.00, P = .01), and less nonstudy addiction treatment (21 = 25.82, P <
.001). High levels of opioid use occurred in both groups at follow-up.
Four of 83 patients who tested negative for hepatitis C at baseline were
positive for hepatitis C at week 12.
Conclusions  Continuing treatment with buprenorphine-naloxone improved
outcome compared with short-term detoxification. Further research is
necessary to assess the efficacy and safety of longer-term treatment with
buprenorphine for young individuals with opioid dependence.
Trial Registration  clinicaltrials.gov Identifier: NCT00078130


]]></description></item><item><title><![CDATA[( BUPP09257 - 17 November 2008) Buprenorphine alters desmethylflunitrazepam disposition and flunitrazepam toxicity in rats.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09257</link><pubDate></pubDate><description><![CDATA[High-dosage   buprenorphine   (BUP)   consumed   concomitantly   with
benzodiazepines  (BZD)  including  flunitrazepam (FZ) may cause
life-threatening  respiratory  depression despite a BUP ceiling effect and
BZD'  limited  effects  on  ventilation.  This  study  determined the
respiratory  effects  of  i.v.  BUP  (Schering-Plough)/FZ (Roche) and
investigated  BUP  effects  on the kinetics of FZ and its main active
metabolites,  desmethylflunitrazepam (DMFZ), and 7-aminoflunitrazepam
(7-AFZ,  both  Radian  Inc.)  in catheterized rats. BUP did not alter
plasma  FZ,  7-AFZ, and DMFZ kinetics, but increased the AUC of DMFZ. BUP
or  BUP/FZ  increased  PaCO2,  while  BUP/FZ  decreased Pa02. FZ
increased  PaCO2,  while  DMFZ  decreased  PaO2. Thus, combined high-
dosage  BUP  and FZ is responsible for increased respiratory toxicity in
which  BUP-mediated  alteration  in  DMFZ  disposition may play a
significant role.


]]></description></item><item><title><![CDATA[( BUPP09258 - 17 November 2008) Magnesium  ions and opioid agonist activity in streptozotocin-induced hyperalgesia.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09258</link><pubDate></pubDate><description><![CDATA[Streptozotocin-induced   hyperglycemia   accompanied   by  a  chronic
decrease in the nociceptive threshold is considered a useful model of
experimental  hyperalgesia.  We examined (1) the effect of the opioid
receptor  agonists and (2) the effect of the magnesium ions (Mg2+) on the
antinociceptive   action  of  opioid  agonists  in  a  diabetic
neuropathic pain model. When administered alone, opioid agonists like
morphine  (5 mg/kg i.p.) and fentanyl (0.0625 mg/kg i.p.), as well as the
partial  agonist  buprenorphine  (0.075  mg/kg)  had only little effect
on streptozotocin-induced hyperalgesia. However, pretreatment
with  Mg2+  at  a  dose  of  40 mg magnesium sulfate/kg i.p. markedly
enhanced  the  analgesic  activity of all three investigated opioids.
Practical  aspects  of  co-administration of magnesium and opioids in
diabetic  neuropathy  are discussed.


]]></description></item><item><title><![CDATA[( BUPP09259 - 17 November 2008) Propoxyphene: A drug with unfavorable risk-benefit characteristics.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09259</link><pubDate></pubDate><description><![CDATA[Background: Proxyphene is an opioid analgesic (OA) used to treat mild to
moderate pain and approximately equivalent to ibuprofen or acetaminophen
in efficacy. Exposures to propoxyphene can result in a major medical
outcome or death due to cardiac dysrhythmia. It has been withdrawn from
the market in the United Kingdom.
Methods: The study aim was to assess the safety of propoxyphene in adults
and children by examining the proportions of associated death relative to
other known medical outcomes (KMOs) after exposure to propoxythene and
compare them to those of other schedule 2 and 3 OAs, using National Poison
Data System (NPDS) data 2002-2006. Number of deaths and other KMOs,
including no effect, minor, moderate and major effects were abstracted
from NPDS database for propoxyphene and other OAs (buprenorphine,
hydrocodone, hydromorphone, methadone, morphine and oxycodone).
Chi-squared two tail analysis  was performed  using VassarStats statistics
software.
Results: Among the schedule 2 and 3 opioids, methadone had the highest
proportion of deaths and hydrocodone the lowest. Proxythene had a higher
proportion of deaths than hydrocodone.
Discussion: Propoxyphene had fewer deaths relative to other KMOs compared
to oxycodone, hydromorphone, morphine and methadone which are all schedule
2 controlled substances but more deathsrelative to hydrocodone, which is
schedule 3.
Conclusion: Because propoxyphene has similar efficacy in the treatment of
acute pain relative to non-opioid analgesics such as ibuprofen and
acetaminophen the risk of severe adverse outcomes seems unwarranted.


]]></description></item><item><title><![CDATA[( BUPP09260 - 17 November 2008) Office-based   opioid   addiction   treatment,   and   the   rise  in unintentional   pediatric  buprenorphine  ingestions  reported  to  a    regional poison center - A new challenge for poison educators.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09260</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09261 - 17 November 2008) Changes  in  caller  type for drug identification calls reported to a regional poison center over time.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09261</link><pubDate></pubDate><description><![CDATA[Background: Drug identification (ID) calls to poison centres are common.
The purpose of this study was to evaluate the distribution of caller types
for several commonly identified substances to the Maryland Poison Center
(MPC) between 2005 and 2007.
Methods: Calls to the MPC in 2005 to 2007 coded as being drug IDs were
reviewed. Substances identified by imprint codes as amphetamines,
buprenorphine, or oxycodone were tabulated by caller type by year (total
and percentage). Caller types were coded to Health Professional, Law
Enforcement, Public or Other.
Results: There was variability in there percentage of callers who self
identified as low enforcement callers. Calls that were self identified as
being from law enforcement increased for all drugs over the study period.
Discussion: Drug ID calls to the MPC increased during the study period.
The caller type has changed over time with a greater percentage of calls
from law enforcement varies by substance. While the overall numbers for
buprenorphine calls to the MPC were low, they overwhelmingly came from law
enforcement.
Conclusion: The caller type for drug ID calls to the MPC changed between
2005 and  2007. We have documented increasing numbers of calls from law
enforcement personnel.


]]></description></item><item><title><![CDATA[( BUPP09262 - 17 November 2008) Persistent toxicity after suboxone ingestion in a toddler.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09262</link><pubDate></pubDate><description><![CDATA[Background: Suboxone (Buprenorphine/Naloxone) has been approved by the FDA
for treatment of opioid addiction. Its advantage over methadone is a
thrice weekly dosing and proposed ceiling effect on respiratory
depression. We report ingestion in a toddler requiring prolonged
supportive care for hyperventilation and persistent sedation.
Case Report: A 2 to (14kg) male with a history remarkable only for asthma
was witnessed by his mother to ingest a single suboxone (8mg/2mg) tablet.
Presentation to the ED 1 hour post-ingestion revealed him to be obtunded
with pinpoint pupils. Vital signs were: 37.0C, HE 126 bpm, RR 18/minute,
96%on RA. His O2 saturation then dropped to 91%. He was initially given
1.4mg of naloxone IV and woke slightly but quickly became somnolent again.
After being given a total of 7 mg of naloxone he became awake and
appropriate. He was then transported by EMS to the nearest PICU after
being placed on a naloxone drip. On arrival to the PICU he was awake and
interactive with normal vital signs. Initial urine drug screen was
negative. Multiple attempts to stop the naloxone drip over the next 48
hours resulted in obtundation and apneic episodes even requiring
intubation for respiratory acidosis for 7 hours. A confirmatory urine
immunoassay for buprenorphine was confirmed positive. The naloxone drip
continued for additional 44 hours. Ninety-six hours post-ingestion the
drip was discontinued and he remained asymptomatic.
Case Discussion: This is the highest reported dose and duration of
naloxone use in a toddler to reverse both somnolence and respiratory
depression. His presentation was consistent with an opioid toxidrome, with
no other ingestion confirmed by history or urine drug screen. Consistent
with other previous reports of toddler ingestion, higher doses of naloxone
may be required rather than the recommended 0.1 mg/kg dose.
Conclusion: We report an ingestion of suboxone in a toddler requiring
prolonged supportive care than had previously been reported. As this
medication is becoming more commonly prescribed, clinicians should be
aware of the possibility of persistent respiratory depression and
somnolence.


]]></description></item><item><title><![CDATA[( BUPP09263 - 17 November 2008) A  retrospective  review  of  unintentional  pediatric  buprenorphine ingestions reported to a regional poison center.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09263</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09264 - 17 November 2008) Treatment of adolescent opioid dependence: no quick fix.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09264</link><pubDate></pubDate><description><![CDATA[The prevalence of adolescent opioid use and dependent is increasing. The
epidemiology of opioid use among youth in the 21st century raises concern
over the potential far-reaching impact of prescription opioid and heroin
use on the current generation of adolescents. In 2007, 232,000 adolescents
reported misuse of just one of the many forms of prescription opioids,
sustained-release oxycodone. During the same year, heroin, the opioid that
is most often associated with illicit use was used by 24,000 adolescents.
The prevalence of hydrocodone use is reported to be 3% among 8th graders,
7% in 10th graders, and 10% in 12th graders. Most adolescent users report
chewing, swallowing, or insufflating (snorting) opioids, although
injection use is reported by 45% of users.


]]></description></item><item><title><![CDATA[( BUPP09265 - 17 November 2008) Analgesics and palliative care.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09265</link><pubDate></pubDate><description><![CDATA[Pain  is  an  important  and  often  under-treated  symptom  of
life-threatening illness. A complete evaluation of pain facilitate optimal
treatment.   Correct  use  of  analgesic  medication,  following  the
guidelines  of the W.H.O. step ladder, with attention to detail, with
addition  of  adjuvant analgesics, should control the pain in most of the
cases. The  use  of  weak  and  strong opioid analgesics, their
tolerance,  the  breakthrough doses, principle of opioid rotation and the
place of adjuvant drugs are discussed. Proper pain management in
end-of-life  is  never  easy and require to become more familiar with the
use  of  these  analgesics  and to surround oneself with a
multidisciplinary team.


]]></description></item><item><title><![CDATA[( BUPP09266 - 17 November 2008) Perioperative Pain Management in Veterinary Patients.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09266</link><pubDate></pubDate><description><![CDATA[Pain  exists;  however,  we  can prevent it, and we can treat it. The
fallacy that pain is protective and must be allowed to avoid risk for
damage  after  surgery  needs  to  be  eradicated.  Preoperative  and
postoperative  analgesia  is  directed  at aching pain, whereas sharp pain
associated  with  inappropriate  movements  persists. Analgesia provides
much  more  benefit  than  concern.  This  article provides suggestions
for  development  of an analgesic plan from the point of admission to
discharge. These guidelines  can  then  be  adjusted according to the
patient's needs and responses.


]]></description></item><item><title><![CDATA[( BUPP09267 - 17 November 2008) Analgesia for the Critically Ill Dog or Cat: An Update.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09267</link><pubDate></pubDate><description><![CDATA[Acute  pain  reliably accompanies severe illness and injury, and when
sufficiently severe, it can complicate the recovery of critically ill
patients.  Because  acute  pain  is  closely  tied  to the neurologic
process of nociception, pharmacologic therapy is often essential and
effective.  This update focuses on two methods of treatment of acute
pain-local anesthetic infusion and continuous intravenous infusion of
multimodal  agents-that  can  be layered on top of standard care with
other drugs


]]></description></item><item><title><![CDATA[( BUPP09268 - 17 November 2008) Pain   Management  for  the  Pregnant,  Lactating,  and  Neonatal  to Pediatric Cat and Dog.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09268</link><pubDate></pubDate><description><![CDATA[Little information on the approach to analgesia in pregnant, nursing, or
extremely young animals is available in the veterinary literature.
Various  analgesics  and  analgesic  modalities  are  discussed, with
emphasis  placed on preference and caution for each group. Management of
pain  is extremely important in all animals but especially in the
extremely  young,  in which a permanent hyperalgesic response to pain may
exist with inadequate therapy. Inappropriate analgesic selection in
pregnant and nursing mothers may  result  in  congenital abnormalities
of  the  fetus  or  neonate.  Inadequate  analgesia in nursing  mothers
may  cause  aggressive  behavior  toward the young. Review  of  the
human  and  veterinary  literature  on  the  various analgesics  available
for use in this group of patients is discussed.


]]></description></item><item><title><![CDATA[( BUPP09269 - 17 November 2008) Managing Pain in Feline Patients]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09269</link><pubDate></pubDate><description><![CDATA[This article reviews the current knowledge of pain assessment in cats
and  the  most effective methods for its alleviation. Excellent acute
pain  management is achievable in cats by using opioids, nonsteroidal
anti-inflammatory  drugs (NSAIDs), alpha /sub 2/ -agonists, and local
anesthetics. A  multimodal  approach  using  agents  that  work  at
different  places  in the pain pathway is encouraged because this can
have  added  benefits.  Management  of  chronic  pain  in cats can be
challenging, but there is now an approved NSAID for long-term use. As we
gain experience  with  less  traditional  analgesics,  such  as
gabapentin,  and  critically  evaluate  complimentary  therapies, our
ability to provide comfort to this population of cats should improve.


]]></description></item><item><title><![CDATA[( BUPP09270 - 17 November 2008) Control of Cancer Pain in Veterinary Patients.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09270</link><pubDate></pubDate><description><![CDATA[Control   of   cancer   pain  is  within  the  capabilities  of  most
veterinarians  and  is  achievable  in most animal patients that have
cancer   with   techniques   that   are  currently  available.  Great
satisfaction  can  be derived from not only treating the pet's cancer but
its pain. Incorporating pain management into oncology practice is good
for  the  well-being  of  the  pet,  the  owner, the staff, the
veterinarians,  and  the  practice.


]]></description></item><item><title><![CDATA[( BUPP09271 - 17 November 2008) Epidural Analgesia and Anesthesia in Dogs and Cats.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09271</link><pubDate></pubDate><description><![CDATA[Current  knowledge  of  drugs  administered epidurally has allowed an
effective way of providing analgesia for a wide variety of conditions in
veterinary  patients.  Proper  selection of drugs and dosages can result
in  analgesia  of  specific  segments of the spinal cord with minimal
side  effects.  Epidural  anesthesia  is  an  alternative to general
anesthesia with inhalation  anesthetics,  although  the combination  of
both techniques is more common and allows for reduced doses of drugs
used  with  each technique. Epidural anesthesia and intravenous
anesthetics can also be used  without  inhalation anesthetics  in
surgical  procedures caudal to the diaphragm.


]]></description></item><item><title><![CDATA[( BUPP09272 - 17 November 2008) Adjunctive Analgesic Therapy in Veterinary Medicine]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09272</link><pubDate></pubDate><description><![CDATA[Adjunctive  analgesic  therapies  are  interventions  for  pain  that
involve  agents  or  techniques other than the traditional analgesics
(opioids, nonsteroidal    anti-inflammatory   drugs,   and   local
anesthetics). Adjunctive   therapies   may   be   pharmacologic  or
nonpharmacologic   in  nature.  The  focus  of  this  article  is  on
pharmacologic  interventions  with  potential  utility  as adjunctive
analgesics  in  veterinary medicine. Pharmacology of selected agents,
including  medetomidine,  ketamine,  amantadine, gabapentin, systemic
lidocaine,  and pamidronate, is discussed in addition to evidence for
their  safety and efficacy and guidelines for their use in veterinary
patients


]]></description></item><item><title><![CDATA[( BUPP09273 - 17 November 2008) Pharmacological treatment of schizophrenia and co-occurring substance use disorders.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09273</link><pubDate></pubDate><description><![CDATA[Substance abuse among individuals with schizophrenia is common and is
often associated   with   poor  clinical  outcomes.  Comprehensive,
integrated  pharmacological  and  psychosocial  treatments  have been
shown  to  improve  these outcomes. While a growing number of studies
suggest  that  second-generation  antipsychotic  medications may have
beneficial  effects  on  the  treatment of co-occurring substance use
disorders,  this  review suggests that the literature is still in its
infancy. Few existing well controlled trials support greater efficacy of
second-generation  antipsychotics  compared with first-generation
antipsychotics  or  any  particular  second-generation antipsychotic. This
article focuses on and reviews studies involving US FDA-approved
medications   for   co-occurring   substance   abuse  problems  among
individuals with schizophrenia.   Comprehensive   treatment   for
individuals   with   schizophrenia  and  co-occurring  substance  use
disorders   must   include   specialized,   integrated   psychosocial
intervention.  Most  approaches  use  some  combination of
cognitive-behavioural  therapy,  motivational enhancement therapy and
assertive case management.   The   research   on   antipsychotic   and
other pharmacological  treatments is also reviewed, as well as
psychosocial treatments   for  individuals  with  schizophrenia  and
co-occurring substance  use  disorders,  and  clinical recommendations to
optimize care  for  this  population are offered.


]]></description></item><item><title><![CDATA[( BUPP09274 - 17 November 2008) An  interventional  study  to improve the quality of analgesia in the emergency department.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09274</link><pubDate></pubDate><description><![CDATA[Objective:   We  sought  to  document  the  adequacy  of  acute  pain
management in a high-volume urban emergency department and the impact of
a  structured  intervention. Methods: We conducted a prospective,
single-blind,   pre-  and  postintervention  study  on  patients  who
suffered  minor-to-moderate  trauma.  The  intervention  consisted of
structured  training  sessions on emergency department (ED) analgesia
practice  and  the  implementation of a voluntary analgesic protocol.
Results:  Preintervention  data showed that only 340 of 1000 patients
(34%)  received  analgesia.  Postintervention data showed that 693 of 700
patients  (99%)  received analgesia, an absolute increase of 65% (95%  CI
61%-68%),  and  that delay to analgesia administration fell from  69
(standard deviation (SD) 54) minutes to 35 (SD 43) minutes. Analgesics
led  to  similar  reductions  in visual analog pain scale ratings  during
the pre- and postintervention phases (4,5 cm, SD 2.0 cm,   and   4.3
cm,  SD  3.0  cm,  respectively).  Conclusion:  Our multifaceted  ED pain
management intervention was highly effective in improving  quality  of
analgesia,  timeliness  of  care  and patient satisfaction.  This
protocol  or  similar ones have the potential to   substantially improve
pain management in diverse ED settings.


]]></description></item><item><title><![CDATA[( BUPP09275 - 17 November 2008) Guidelines  of  the German Society for Addiction Medicine (DGS e.V.), the  German  AIDS  Society  (DAIG)  and  the  German  association of physicians in private practice treating HIV-infected persons (DAGNAe) : HIV infection in intravenous drug addicts (IVDA).]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09275</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09276 - 17 November 2008) Addiction and cognitive functions.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09276</link><pubDate></pubDate><description><![CDATA[Drug  addiction  is  a compulsive behavioral abnormality. In spite of
pharmacologic and psychosocial treatments to reduce or eliminate drug
taking,  addiction  tends to persist over time. Preclinical and human
observations have converged  on  the  hypothesis  that  addiction
represents  the  pathologic  deterioration  of  neural processes that
normally serve  affective  and  cognitive  functioning.  The  major
elements  of  persistent  compulsive  drug use are hypothesized to be
molecular and cellular mechanisms that underlie enduring changes in a
number  of  forebrain  circuits  (involving  the ventral striatum and
prefrontal  cortex) that receive input from midbrain dopamine neurons and
are involved in affective and cognitive mechanisms, respectively. Here
we  review  progress  in identifying crucial elements useful in
understanding   the   pathophysiology   of   the   disease   and  its
pharmacologic   treatment.   Pharmacologic   targeting   of  K-opiate
receptors,  with  their discrete distribution within the dopaminergic
system(s),  and  thus different actions on dopaminoceptive areas, may
provide  beneficial  effects  at the affective and cognitive level.


]]></description></item><item><title><![CDATA[( BUPP09277 - 17 November 2008) Step-by-step plan for pain management.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09277</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09278 - 17 November 2008) Organisation of acute pain therapy.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09278</link><pubDate></pubDate><description><![CDATA[Orthopaedic  and  traumatized  patients often suffer from severe pain
after surgery or trauma.  Their  early recovery also depends on an
efficient  acute  pain  relief  based  on  a  combination of systemic
medication, local drug application and physical therapy. In 2007, new
guidelines for the treatment of perioperative and traumatic pain were
published.  Based  on  these guidelines standard operating procedures for
each  hospital  should  be developed and implemented. Courses on
analgesic  concepts  should  be  offered  regularly  for the involved
staff.  It  is  helpful  to establish an acute pain service for daily
rounds  and  documentation. The individual patient should be informed
about  his  specific  acute  pain  therapy before the operation. Pain
scores  should  be  frequently  documented  by  the  patient.


]]></description></item><item><title><![CDATA[( BUPP09279 - 17 November 2008) New and evidence-based aspects of postoperative pain therapy.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09279</link><pubDate></pubDate><description><![CDATA[Poorly  managed  postoperative  pain  has  been  recognised  to delay
patient  recovery and hospital discharge. Recent metaanalyses support a
multimodal approach with combinations of analgesics from different
classes.  The  pharmacological  options  of  commonly  used  opioids,
nonsteroidal  anti-inflammatory drugs, and other nonopioid analgesics in
combination  have been shown to provide effective pain relief and to
reduce  opioid consumption. Local, intraarticular, epidural, and, more
importantly,  modern peripheral regional techniques can be used
successfully   to   enhance   perioperative  analgesia.  The  use  of
continuous  perineural techniques with local anaesthetic infusion has been
extended beyond hospital discharge in many European countries.


]]></description></item><item><title><![CDATA[( BUPP09280 - 17 November 2008) Treatment  of  opioid-dependent pregnant women: Clinical and research issues.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09280</link><pubDate></pubDate><description><![CDATA[his  article  addresses  common  questions that clinicians face when
treating  pregnant  women  with opioid dependence. Guidance, based on
both  research evidence and the collective clinical experience of the
authors,   which   include   investigators  in  the  Maternal  Opioid
Treatment:  Human Experimental Research (MOTHER) project, is provided to
aid  clinical  decision  making.  The MOTHER project is a double-blind,
double-dummy,  flexible-dosing, parallel-group clinical trial examining
the  comparative  safety  and  efficacy  of  methadone and buprenorphine
for  the  treatment  of  opioid dependence in pregnant women  and  their
neonates.  The article begins with a discussion of appropriate
assessment  during pregnancy and then addresses clinical    management
stages   including   maintenance  medication  selection, induction,  and
stabilization;  opioid agonist medication management before,  during, and
after delivery; pain management; breast-feeding; and  transfer  to
aftercare. Lastly, other important clinical issues including  managing
co-occurring psychiatric disorders and medication interactions are
discussed.


]]></description></item><item><title><![CDATA[( BUPP09281 - 24 November 2008) Ketamine-based   total   intravenous   anesthesia  versus  isoflurane anesthesia in a swine model of hemorrhagic shock.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09281</link><pubDate></pubDate><description><![CDATA[BACKGROUND:  Inhalational  anesthetics can cause profound hemodynamic
effects including  decreases  in  systemic  vascular  resistance and
cardiac  inotropy.  Although  widely used in uncontrolled hemorrhagic
shock  (UHS),  their  consequences  compared  with  other  anesthetic
regimens  are  not  well-studied.  Ketamine-based  total  intravenous
anesthesia (TIVA)   may   produce   less   profound  cardiovascular
depression,  and  has  been  used  during elective surgery but rarely
during traumatic shock. The purpose of this study was to compare the
effects  of  isoflurane  (ISO)  and  TIVA regimens in a swine grade V
liver injury  model.  We hypothesized that TIVA would result in less
hypotension and dysfunctional inflammation than ISO. METHODS: Twenty swine
were  randomized  blindly  to  receive either 1% to 3% ISO, or
intravenous  ketamine,  midazolam, and buprenorphine for maintenance
anesthesia.  Six  animals  acted  as  controls.  After sedation  and
intubation,  randomized  anesthesia was initiated and monitored by an
independent animal technician. Invasive lines were placed followed by
celiotomy  and splenectomy. Baseline mean arterial pressure (MAP) was
documented  and  a  grade V liver injury created. After 30 minutes of
UHS,  animals  were  resuscitated  with  8 mL of Ringer's lactate per
milliliter blood loss at 165 mL/min. MAP and tissue oxygen saturation
(StO2)  were  continuously  recorded. The animals were sacrificed 120
minutes  after  injury and lung tissue was harvested. Serum cytokines
(interleukin-6  (IL-6),  IL-8,  and tumor necrosis factor-alpha
(TNF-alpha))  were quantified with enzyme-linked immunosorbent assay. Lung
cytokine   mRNA   levels  were  quantified with real time reverse
transcriptase  polymerase  chain  reaction.  RESULTS:  Animal weight,
liver  injury pattern, and blood loss were similar (p > 0.1). The ISO
group had a lower MAP at baseline (p = 0.02), at injury (p = 0.004), and
study completion (p = 0.001). After resuscitation, MAP decreased in  the
ISO  group  but  remained stable in the TIVA group. StO2 was significantly
higher in the TIVA group immediately after injury (p =  0.004),  but
similar  between groups throughout the remainder of the study.  Animals
who  received  TIVA  trended toward higher levels of lactate  and  lower
pH throughout the study, reaching significance at 30 minutes postinjury
(p = 0.037 and 0.043). Inflammatory cytokine (IL-6, IL-8, and TNF-alpha)
production did not differ between groups, however TNF-alpha mRNA
production was significantly lower in the TIVA group  (p  = 0.04).
CONCLUSION: Although a TIVA regimen produced less pronounced  hypotension
in  a  swine model of UHS than did ISO, end-organ  perfusion  with  TIVA
appeared to be equivalent or inferior to    ISO. In circumstances of
limited resources, such as those experienced by forward Army surgical
teams, a ketamine-based TIVA regimen may be an option for use in UHS.


]]></description></item><item><title><![CDATA[( BUPP09282 - 24 November 2008) Opioid-induced immunosuppression.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09282</link><pubDate></pubDate><description><![CDATA[PURPOSE   OF   REVIEW:  This  review  provides  an  overview  of  the
immunological  effects  of  commonly used analgesic opioid drugs with
particular emphasis on human studies, with the final aim to highlight
their potential clinical relevance.   RECENT   FINDINGS:  The
immunomodulatory  effects  of  morphine  have  been  characterized in
animal  and  human  studies.  Morphine decreases the effectiveness of
several  functions of both natural and acquired immunity, interfering with
important intracellular pathways involved in immune regulation. Mainly
from  animal  studies,  however,  it has emerged that not all    opioids
induce the same immunosuppressive effects and evaluating each opioid's
profile  is  important for appropriate analgesic selection. The  potent
opioid fentanyl also exerts a relevant immunosuppression, while  the
partial  agonist  buprenorphine  appears  to  have a more favourable
immune  profile. The impact of the opioid-mediated immune effects could
be  particularly  dangerous  in  selective vulnerable populations,  such
as  the  elderly  or  immunocompromised patients. SUMMARY: The impact of
opioid drug treatment on immunity may be a new safety  concern  for  the
physician. Although many advances have been made in understanding  the
effects  of  opioid  drugs  on  immune responses,  their  relevance  is
not completely clear. The scientific
community  must  be  aware  that  it  is  about  time to perform well
designed  clinical  studies  in  order  to  assess  the importance of
opioid-induced immune suppression.


]]></description></item><item><title><![CDATA[( BUPP09283 - 24 November 2008) Methadone  and   buprenorphine related   ambulance  attendances:  A population-based indicator of adverse events.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09283</link><pubDate></pubDate><description><![CDATA[This   study  examined  the  nature  and  extent  of  methadone- and
buprenorphine-related  morbidity  through a retrospective analysis of
ambulance service records (N = 243) in Melbourne, Australia. Cases in
which  methadone and  buprenorphine  were  implicated  are examined.
Demographic  and  presenting characteristics, transport outcomes, and
other substance  use  were  explored.  There  were 84
buprenorphine-related attendances and 159 methadone-related attendances
recorded on the database  over  the 4-year period. Presenting signs
(respiratory rate and Glasgow  Coma  Scale  score)  were lower in the
methadone-related attendances. Most of the attendances resulted in
transport to hospital.  Most  presentations  did  not involve traditional
signs of opioid overdose, a finding that warrants further investigation.
This is the  first  article to describe characteristics of methadone and
buprenorphine-related  ambulance attendances, with results suggesting
this  may  be  a  useful  way  to monitor harms associated with these
medications in the future.


]]></description></item><item><title><![CDATA[( BUPP09284 - 24 November 2008) Abuse-deterrent opioid formulations: Are they a pipe dream?]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09284</link><pubDate></pubDate><description><![CDATA[The  continued  need  for opioids to treat pain and their unavoidable
link  to  abuse  and  addiction  create  a  need  for risk mitigation
approaches  that  optimize  their risk-benefit ratio. Abuse-deterrent
formulations  (ADFs)  have  emerged  as a means for supporting opioid
access while  limiting abuse and its consequences. Several different types
of ADFs have emerged including physical barriers to tampering,
agonist-antagonist  formulations, aversion, prodrugs, and alternative
methods of administration. Each of these types has the potential to
reduce  specific  forms  of  prescription opioid abuse. ADFs have the
potential  to  reduce the public health burden of prescription opioid
abuse, but  they  will  require  not  only  technically  successful
formulations,  but also appropriate scientific assessment, widespread
market  penetration,  and  rational  expectations  of their benefits.


]]></description></item><item><title><![CDATA[( BUPP09285 - 24 November 2008) Steps of practical management.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09285</link><pubDate></pubDate><description><![CDATA[In  a  more practical than didactic purpose, we are going to describe the
successive steps of the management of a leg ulcer. The purpose is to
reproduce the stages of the first consultation. Firstly it will be
necessary  to  push aside diagnostic traps (positive and differential
diagnosis),  then  to  place  the  wound  in  its  context (etiologic
diagnosis),  to grade it (diagnosis of gravity) and finally to build up a
plan  of  treatment according to the various general and local therapeutic
means at disposal


]]></description></item><item><title><![CDATA[( BUPP09286 - 24 November 2008) Analgesia and renal failure.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09286</link><pubDate></pubDate><description><![CDATA[Chronic  kidney  disease  (CKD)  prevalence increases with population
aging and makes drugs prescription more difficult. Only a few studies
have  reported  drug  dosing  adjustment in CKD patients, even in the
important  field of pain management. We propose an algorithm based on the
current  literature  that  helps  in  selecting  right analgesic
according  to  the degree of renal failure. Drug dosing adjustment of the
most  usually used analgesics (acetaminophen, nonsteroidal anti
inflammatory drugs and opioids) is discussed.


]]></description></item><item><title><![CDATA[( BUPP09287 - 24 November 2008) Managing  acute  pain  in patients with an opioid abuse or dependence disorder.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09287</link><pubDate></pubDate><description><![CDATA[Assessing  and  managing patients with acute pain who are addicted to
opioids  is  often  challenging.  Treatment  may  be  complicated  by
pharmacological  therapies,  including  methadone,  buprenorphine and
naltrexone.  There  is  limited  evidence  to guide the management of
acute  pain  in  these  patients  as  they  are usually excluded from
analgesic studies.   Principles   of  management  include  thorough
assessment  of both the pain and the addictive disorder, consultation and
referral  as  appropriate, maximisation of non-opioid analgesics and
non-pharmacological therapies, and use of opioids when indicated.


]]></description></item><item><title><![CDATA[( BUPP09288 - 24 November 2008) Occurrence  of  ethanol  and other drugs in blood and urine specimens from female victims of alleged sexual assault.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09288</link><pubDate></pubDate><description><![CDATA[Results  of  toxicological analysis of blood and urine specimens from
1806  female  victims  of  alleged non-consensual sexual activity are
reported.  After  making  contact  with  the  police authorities, the
victims  were  examined  by  a  physician for injuries and biological
specimens were taken for forensic toxicology and other purposes (e.g.
DNA).  Urine  if  available or otherwise on an aliquot of blood after
protein  precipitation  was  screened  for  the  presence of drugs by
enzyme  immunoassay  methods  (EMIT/CEDIA). All positive results from
screening  were  verified by more specific methods, involving isotope
dilution  gas  chromatography-mass  spectrometry  (GC-MS) for illicit
drugs. A large number of prescription drugs were analyzed in blood by
capillary column gas chromatography with a nitrogen-phosphorous (N-P)
detector.  Ethanol was determined in blood and urine by headspace gas
chromatography  and concentrations less than 0.1 g/L were reported as
negative. The number of reported cases of alleged sexual assault was
highest  during  the warmer summer months and the mean age of victims was
24  years  (median  20  years), with 60% being between 15 and 25 years.
In  559  cases  (31%) ethanol and drugs were negative. In 772 cases (43%
of total) ethanol was the only drug identified in blood or urine. In 215
cases (12%) ethanol occurred together with at least one
other drug. The mean, median and highest concentrations of ethanol in
blood  (N  =  806) were 1.24 g/L, 1.19 g/L and 3.7 g/L, respectively. The
age  of victims and their blood-alcohol concentration (BAC) were
positively  correlated  (r = 0.365, p < 0.001). Because BAC decreases at a
rate of 0.10-0.25 g/(L h), owing to metabolism the concentration in  blood
at time of sampling is often appreciably less than when the crime  was
committed  several  hours earlier. Licit or illicit drugs were identified
in blood or urine in N = 262 cases (15%). Amphetamine and
tetrahydrocannabinol  were the most common illicit drugs at mean (median)
concentrations  in blood of 0.22 mg/L (0.1 mg/L) and 0.0012 mg/L (0.0006
mg/L), respectively. Among prescription drugs, sedative- hypnotics  such
as diazepam and zopiclone were common findings along with SSRI
antidepressants and various opiate analgesics. Interpreting the
analytical  results  in  terms  of  voluntary  vs. surreptitious
administration  of  drugs  and  the  degree  of incapacitation in the
victim  as  well  as  ability  to  give  informed  consent for sexual
activity  is  fraught with difficulties.


]]></description></item><item><title><![CDATA[( BUPP09289 - 24 November 2008) Successful  transition  to buprenorphine in a patient with methadone induced torsades de pointes.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09289</link><pubDate></pubDate><description><![CDATA[A  56-year-old-man  presented  with  syncope  and torsades de pointes
secondary to methadone-induced QT prolongation. After transition from
methadone  to buprenorphine, a partial mu-opiate-receptor agonist and a
kappa-opiate- receptor   antagonist,   the  QT  normalized  and
ventricular  arrhythmias  resolved.  Buprenorphine should be used for
opiate dependence and chronic pain in patients with methadone-induced QT
prolongation  and  as  first  line  therapy in patients with risk factors
for  torsades  de  pointes.


]]></description></item><item><title><![CDATA[( BUPP09290 - 24 November 2008) Ins and outs of neurologic therapy for chronic pain.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09290</link><pubDate></pubDate><description><![CDATA[Although  chronic pain is common, especially in elderly patients, its
treatment  often  remains inadequate. One of many reasons for this is
that  insufficient  therapy  of acute pain carries the risk of making the
pain chronic.  Sooner  or  later  most  patients suffering from chronic
pain   will   consult   a  neurologist.  However, in most neurological
departments, pain treatment is neither one of the common medical
activities  nor  a subject in medical education. In Germany,
only  specialised centres have associated pain outpatient clinics, so it
is almost  impossible  for neurologist trainees to improve their
knowledge  in  pain  treatment.  This  review  provides a synopsis of
procedures  regarding  chronic pain treatments, with particular focus on
the  most  frequent pain disorders. The treatment recommendations follow
the  current guidelines of the German Society of Neurology


]]></description></item><item><title><![CDATA[( BUPP09291 - 24 November 2008) Detecting signs of opioid abuse and treating the addiction.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09291</link><pubDate></pubDate><description><![CDATA[Opioid dependence is an epidemic that has no prejudice or limits. The
number of non-medical users of narcotics has increased steadily over the
years, making opioids one of the highest drug classes abused, second only
to marijuana. By 2006, the number of users of nonmedical pain relievers
was greater than cocaine and heroin users combined (5.2 million vs 2.4
million and 0.6 million, respectively). Pharmacists need to be informed
and educate on opioid dependence, so they are able to recognise, confront,
and recommend appropriate programs. Classified as an addiction, opioid
abuse is recognized in the Diagnostic and Statistical Manual of Mental
Disorders, fourth Edition, as a medical disorder with an etiology,
pathogenesis, clinical presentation, diagnosis, and treatment options.
Understanding the alteration of neurobiology in the brain, as well as the
social dispositions that put opioid users at risk, encourages clinical
diagnosis and treatment, rather than turning away a "drug seeker", who is
judged to have arrived voluntarily at his or her condition.


]]></description></item><item><title><![CDATA[( BUPP09292 - 01 December 2008) Immune-mediated   neuropathies   in  myeloma  patients  treated  with bortezomib.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09292</link><pubDate></pubDate><description><![CDATA[Objective:  Bortezomib  is  a new chemotherapeutic drug available for the
treatment of  lymphoid  disorders,  including multiple myeloma. Although
its  primary  mechanism of action is proteasome inhibition, other
mechanisms can contribute to the therapeutic effects, including
modulation  of inflammatory cytokines and immune response. One of the
main  toxic  effects  of bortezomib is peripheral neuropathy, usually
occurring  in  the  form of a painful, sensory axonal neuropathy. The
mechanisms  of peripheral damage, however, are still unclear. We here
report  a series of patients treated with bortezomib, who developed a
peripheral  damage  possibly  related to immuno-mediated, rather than
toxic,  mechanisms. Methods: Five patients who developed a peripheral
neuropathy  with  severe motor involvement under bortezomib treatment
underwent CSF,   electrophysiological,   and   spinal   cord   MRI
examinations.   Results:  Peripheral  damage  was  characterized  by:
demyelinating or mixed axonal-demyelinating   neuropathy,  with prominent
motor involvement; albumin-cytological dissociation; lumbar root
enhancement  on  MRI in 2/5 patients; favourable outcome in 4/5 patients
after  immune  treatments,  either steroids (2 patients) or IVIg  (2
patients).  Conclusions:  In some instances, the peripheral damage
associated  with  bortezomib  may  recognize  immuno-mediated
mechanisms.   Significance:   This   form   of  bortezomib-associated
neuropathy  needs  to be recognized as treatable condition, as it may
respond  to  immune  therapies. Unexplained worsening of neurological
dysfunction  despite bortezomib discontinuation, with prominent motor
involvement  and  CSF signs of inflammation, may be the clues to this
complication.


]]></description></item><item><title><![CDATA[( BUPP09293 - 01 December 2008) Pain  and  the  pharmacogenetics  at  the  fuzzy  border between pain physiopathology and pain treatment.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09293</link><pubDate></pubDate><description><![CDATA[Nociceptive pain is time limited and severe nociceptive pain normally
responds well to treatment with opioids, On the contrary, neuropatic pain
is frequently chronic, and tends to have a less robust response to
treatment with opioids. The unsolved problem of insufficient pain
treatment  at clinical level, including both wanted analgesic effects and
unwanted  side effects, is a stimulus to expand the knowledge on the
physiophatology of pain and on the involved molecular mechanisms. In
particular,  it  is  important  not only to better understand the
molecular mechanisms  associated  to  drugs  effects  but  also  to
characterize  the  genetic traits underlying pharmacokinetic (PK) and
pharmacodynamic (PD) mechanisms related to drugs. Literature analysis
reveals  that  there  are  interesting genetic polymorphisms that are
associated  either  to  the sensitivity to pain and to PD response to
drugs,  or  to the metabolic and excretion pathways.
Pharmacogenetics/pharmacogenomics  holds  the  promise  that  drugs might
in the next future  be  tailor-made  for individuals and adapted to each
person's own genetic  background.  Collected  information, allowing to
design combined therapies and to dissect analgesic from addictive
properties
of  opioids  within a given patient, will also contribute to contrast the
persisting  opiophobia in medical practice.


]]></description></item><item><title><![CDATA[( BUPP09294 - 01 December 2008) Showing-off muscles: Be aware of doping signs.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09294</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09295 - 01 December 2008) Buccoadhensive  drug  delivery  systems  - Extensive review on recent patents.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09295</link><pubDate></pubDate><description><![CDATA[Peroral  administration  of  drugs,  although  most preferred by both
clinicians and  patients  has  several disadvantages such as hepatic
first  pass metabolism and enzymatic degradation within the GI tract,
that  prohibit  oral  administration  of  certain  classes  of  drugs
especially  peptides  and  proteins.  Consequently,  other absorptive
mucosae are considered as potential sites for administration of these
drugs.  Among  the  various  transmucosal  routes  studied the buccal
mucosa  offers  several  advantages  for controlled drug delivery for
extended  period  of  time.  The  mucosa  is  well supplied with both
vascular  and  lymphatic  drainage  and  first-pass metabolism in the
liver and  pre-systemic elimination in the gastrointestinal tract is
avoided.  The  area is well suited for a retentive device and appears to
be acceptable to the patient. With the right dosage form, design and
formulation,  the  permeability and the local environment of the mucosa
can be controlled and manipulated in order to accommodate drug
permeation.  Buccal  drug  delivery  is  thus  a  promising  area for
continued  research  with  the  aim of systemic and local delivery of
orally inefficient drugs  as  well  as  feasible  and  attractive
alternative  for  non-invasive delivery of potent protein and peptide
drug  molecules.  Extensive  review  pertaining  specifically  to the
patents  relating  to  buccal  drug  delivery is currently available.
However,  many  patents  e.g.  US patents 6, 585,997; US20030059376A1 etc.
have been mentioned in few articles. It is the objective of this article
to extensively review buccal drug delivery by discussing the recent
patents  available. Buccal dosage forms will also be reviewed
with  an  emphasis on bioadhesive polymeric based delivery systems.


]]></description></item><item><title><![CDATA[( BUPP09296 - 01 December 2008) Drug addiction in China.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09296</link><pubDate></pubDate><description><![CDATA[Drug addiction in China began with the importation of Indian opium by the
British in the 16th century and brought severe social and health
problems.  While  drug  abuse  abated  following the establishment of
People's  Republic  of China, modernization and Westernization in the
1980s  led  to  the  reemergence of this problem. Drug abuse in China
became epidemic,  facilitating  the  spread of HIV/AIDS. The Chinese
government has made great efforts to address these problems, focusing
both  on treatments of drug addiction and on harm-reduction programs.
Although  the new trends of drug addiction in China pose great public
health  challenges,  these  government  interventions  are  likely to
successfully stem the problem of drug abuse in the future.


]]></description></item><item><title><![CDATA[( BUPP09297 - 01 December 2008) A  French prospective observational study of the treatment of chronic hepatitis C in drug abusers.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09297</link><pubDate></pubDate><description><![CDATA[The  objective  of this prospective, multicenter, observational study was
to evaluate healthcare for hepatitis C virus (HCV)-infected drug abusers
in France  and  to  determine  predictors of successful therapeutic
intervention.  A  total of 170 drug users were recruited from  40  French
centers.  Three  centers  recruited 66 participants (38.8%),  and  one to
eight patients each were enrolled from 37 other centers  (n  =  104). A
sustained viral response (SVR) was seen in 65 (38.2%)  patients.  SVR
rates were significantly higher in compliant than  in  non-compliant
patients (43.5% versus 23.9%; P = 0.019), in patients  from high- rather
than low-recruiting centers (54.5% versus 27.9%;  P  <  0.001)  and in
patients receiving Buprenorphine /sup ®/ rather  than  methadone (48.1%
versus 21.8%; P = 0.001). In patients, who completed both the treatment
and follow-up (n = 94), SVR rate was 57.4%.  Buprenorphine /sup ®/
substitution therapy and genotypes 2 or 3  HCV  infection  were associated
with significantly higher rates of SVR  (P < 0.01, for both comparisons).
In conclusion, successful care of  hepatitis  requires  an  active
treatment policy of every center toward  drug  addicts.  Additional
studies are needed to explore the difference  in  SVR  with  methadone
versus  Buprenorphine  /sup  ®/ therapy.


]]></description></item><item><title><![CDATA[( BUPP09298 - 01 December 2008) Substance Abuse and Withdrawal in the Critical Care Setting.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09298</link><pubDate></pubDate><description><![CDATA[Substance  use  is  common among individuals admitted to the critical care
setting and may complicate treatment of underlying disorders. It is
imperative  for  the  critical  care team to have a high index of
suspicion  for  substance  intoxication  and withdrawal. This article
reviews  the epidemiology of substance use in this population and the
treatment  of common withdrawal  syndromes.  General  principles
regarding  the  management  of substance withdrawal syndromes include
general  resuscitative measures, use of a symptom-triggered approach, and
substitution of a long-acting replacement for the abused drug in gradual
tapering dose. The authors stress the importance of long-term planning
as  part of the overall treatment protocol beyond the acute presentation.


]]></description></item><item><title><![CDATA[( BUPP09299 - 01 December 2008) Transdermal buprenorphine to treat pain in sickle cell crisis.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09299</link><pubDate></pubDate><description><![CDATA[A  specific dosage regimen of buprenorphine achieves pain relief from
painful  episodes  due  to  sickle  cell  disease. The dosage regimen
comprises  administering  to  a  patient  in need of pain relief from
sickle cell disease   at   least   one  BTDS  transdermal  patch.
Alternatively,  the  dosing  regimen  comprises  administering to the
patient  (1) a first buprenorphine-containing transdermal dosage form for
a first dosing period; (2) administering to the patient a second
buprenorphine-containing  transdermal dosage form for a second dosing
period,  where  the  second  dosage form comprises the same dosage of
buprenorphine  as,  or  a  greater  dosage of buprenorphine than, the
first dosage  form;  and  (3)  administering  to the patient a third
buprenorphine-containing   Inventor(s): Reidenberg Bruce E, Spyker Daniel
A.transdermal  dosage form for a third dosing period,  where  the  third
dosage form comprises a greater dosage of buprenorphine than the second
dosage form.


]]></description></item><item><title><![CDATA[( BUPP09300 - 01 December 2008) Implementation of Drug Substitution Therapy in Georgia]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09300</link><pubDate></pubDate><description><![CDATA[The  geopolitical uniqueness of the regional, socioeconomic situation and
the existence of territories outside the control of the national
government  have  facilitated  the  spread  of drug use in Georgia. A
special  problem  is  injection  of opiates, in particular heroin and
Subutex   (buprenorphine).   It   has  been  established  that  among
registered HIV infected individuals the main route of transmission is
injecting  drug  use.  Although  the  prevalence  of  HIV  among IDUs
(injecting  drug user) is only 1-3%, the high number of IDUs, and the
high  prevalence  of hepatitis C in this population creates high risk of
dramatic  spread of HIV in Georgia. Beginning at the end of 2005, the
GFATM  (Global  Fund against HIV/AIDS, Tuberculosis and Malaria)
supported  methadone  substitution programmes in Georgia. At present,
three  programmes are functioning. At the same time, they involve 230
patients altogether.  The  studies  carried  out  by  the  Research
Institute on Addiction, with the aim to control the efficacy of pilot
programmes  have  revealed  a  dramatic improvement of psychophysical
state  of  patients,  with  very  high  rate  of  resocialization and
decriminalization,  significant  diminishment  of  drug-related risky
behaviour.  Obtained  results  indicate  high efficiency of methadone
substitution  programmes  in  Georgia,  as an important tool both for
treatment of opioid dependence and harm reduction. In order to obtain a
more  significant  impact  on  public  health substitution therapy
programmes have to be further expanded.


]]></description></item><item><title><![CDATA[( BUPP09301 - 01 December 2008) Development  and  validation  of  a liquid chromatography-tandem mass spectrometry   assay   for   the   simultaneous   quantification   of buprenorphine, norbuprenorphine, and metabolites in human urine.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09301</link><pubDate></pubDate><description><![CDATA[A  liquid  chromatography-tandem  mass  spectrometry  method  for the
simultaneous  quantification of buprenorphine (BUP), norbuprenorphine
(NBUP),  buprenorphine  glucuronide  (BUP-Gluc), and norbuprenorphine
glucuronide  (NBUP-Gluc)  in  human  urine  was  developed  and fully
validated.  Extensive  endogenous  and  exogenous  interferences were
evaluated  and  limits of quantification were identified empirically.
Analytical  ranges  were  5-1,000  ng/mL  for  BUP  and  BUP-Gluc and
25-1,000  ng/mL  for  NBUP  and NBUP-Gluc. Intra-assay and interassay
imprecision  were  less  than  17% and recovery was 93-116%. Analytes
were  stable  at  room  temperature,  at  4  degrees C, and for three
freeze-thaw  cycles.  This  accurate and precise assay has sufficient
sensitivity and specificity for urine analysis of specimens collected from
individuals treated with BUP for opioid dependence.


]]></description></item><item><title><![CDATA[( BUPP09302 - 01 December 2008) Electrocardiographic abnormalities in opiate addicts]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09302</link><pubDate></pubDate><description><![CDATA[Aims: To determine in a cross-sectional study the prevalence of
electocardiographic (ECG) abnormalities in opiate addicts who were
therapy-seeking and its association with demographic, clinical and
drug-specific parameters.
Methods: In consecutive therapy-seeking opiate addicts, a 12-lead ECG was
registered within 24 hours after admission and evaluated according to a
pre-set protocol between October 2004 and August 2006. Additionally,
demographic, clinical and drug-specified parameters were recorded.
Results: Included were 511 opiate addicts, 25% female, with a mean age of
29 years (range 17-59 years). One or more ECG abnormalities were found in
314 patients (61%). In the 511 patients were found most commonly St
abnormalities (19%). Qtc prolongation (13%), tall R-and/or S waves (11%)
and missing R Progression (10%). ECG abnormalities were more common in
males than in females (64 versus 54%, P<0.05), and in patients with
positive than negative urine findings for cannabis more often (68 versus
57%, P<0.05). Patients with ST abnormalities were more often males than
females (21 versus 11%, P<0.05), had a history of seizures less often (16
versus 27%, P<0.05), had positive urine findings for cannabis more often
(26 versus 15%, P<0.01) and had negative than positive urine findings for
methadone more often (21 versus 11%, P<0.05). QTc prolongation was more
frequent in patients with high dosages of maintenance drugs than in
patients with medium or low dosages (27 versus 12 versus 10%, P<0.05) and
in patients whose urine findings were positive than negative for methadone
(23 versus 11%, P<0.001) as well as for benzodiazepines (17 versus 9%,
P<0.05). Limitations of the data are that in most cases other risk factors
for the cardiac abnormalities were not known.
Conclusion: ECG abnormalities are frequent in opiate addicts. The most
frequent ECG abnormalities are ST abnormalities. QTc prolongation and tall
R- and/or S-waves. ST abnormalities are associated with cannabis, and
QTcprolongation with methadone and benzodiazepines.


]]></description></item><item><title><![CDATA[( BUPP09303 - 01 December 2008) Opioids and Cardiogram Abnormalities: Providing treatment based on understanding the risks and benefits.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09303</link><pubDate></pubDate><description><![CDATA[Wallner and colleagues present new and interesting findings on the range
of electrocardiographic abnormalities in a sample of opioid-dependent
patients receiving a variety of opioid therapies. This paper is especially
timely because of increasing concerns over the effect of methadone on
cardiac function, specifically cardiac rhythm and possible lengthening of
cardiac QT interval. While they report QTc prolongation to occur more
frequently with methadone in a dose-dependent fashion, ST abnormalities
occurred at greatest frequency in this sample, followed by QTc
prolongation, tall R or S waves, and pathologic Q waves, all of which
occurred at higher frequencies than fir the general population. However,
other abnormalities were observed at rates that do not appear to be
substantially greater or were lower than those reported for the general
population. Importantly,the association of electrocardiographic
abnormalities with illicit substance use by those who are opioid
maintained was demonstrated.


]]></description></item><item><title><![CDATA[( BUPP09304 - 01 December 2008) Letter to the Editor: The use of sublingual Buprenorphine-Naloxone for reversing heroin overdose: A high risk strategy that should not be recommended.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09304</link><pubDate></pubDate><description><![CDATA[We write with great concern regarding the recent report published in
addiction by Welsh and colleagues, and their suggestion that buprenorphine
(alone or in combination with naloxone) may be a useful strategy in
overdose reversal. While the details surrounding this case are consistent
with a buprenorphine-precipitated reversal of heroin effects, there are a
number of reasons why buprenorphine should not be recommended for overdose
reversal and why such action may, in fact, contribute to increased
overdose mortality.


]]></description></item><item><title><![CDATA[( BUPP09305 - 01 December 2008) Letter to the Editor: The use of Buprenorphine to reverse opioid overdose deserves further evaluation.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09305</link><pubDate></pubDate><description><![CDATA[Nielsen and Lintzeris express concern over the reported use of
Buprenorphine/Naloxone in the reversal of a presumed overdose in A case of
heroin overdose reversed by sublingually administered
buprenorphine/naloxone (Suboxone). Certainly, their concerns are valid and
important to consider. They very correctly point out that one anecdotal
report should be treated with extreme caution. The primary purpose of
reporting the case was to alert the addiction treatment and public health
communities to a practice that is apparently occurring. Since writing the
initial case report, i have heard of similar cases in several other
American cities as well as other countries.


]]></description></item><item><title><![CDATA[( BUPP09306 - 01 December 2008) When a New Drug Promotes the Integration of Treatment Modalities: Suboxone and Harm Reduction]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09306</link><pubDate></pubDate><description><![CDATA[In medicine, the introduction of a new drug is often associated with an
overall enhanced understanding of the clinical issues that originally
stimulated its own development. Sometimes newer drugs must be introduced
to counter the improper use of existing drugs. In this paper, we discuss
some concepts regarding the pharmacotherapy of heroin addiction (regarding
blocking dosages and stabilization dosages), the advantages and
disadvantages of opioid agonists in the pharmacotherapy of heroin
addiction, the role of motivation for harm reduction strategies, the
difficulties of methadone, buprenorphine, naltrexone and naloxone use in
harm reduction strategies, and the possible use of buprenorphine-naloxone
combination in harm reduction strategies. A buprenorphine-naloxone
combination is not only a clinical improvement over pre-existing
treatments, but it also represents a good example of a drug designed to
limit the misuse of another resulting in the integration of difficult
modalities of intervention, previously believed to be in opposition.


]]></description></item><item><title><![CDATA[( BUPP09307 - 01 December 2008) The Under-Treatment of Pain: A Global Problem. An Educational Approach]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09307</link><pubDate></pubDate><description><![CDATA[In order to undertake comprehensive pain treatment, acute and chronic, all
prescribers are required to understand opioid medication, and to
appreciate the phenomenon of addiction. Throughout the world there is a
major concern with under treatment of pain. This paper aims to assist
health professionals in their effort to treat patients pain effectively.
It also outlines medications available for use, typical patient situations
and strategies for intervention to relieve pain. Barriers to pain
treatment are reviewed, in both developed and developing nations.


]]></description></item><item><title><![CDATA[( BUPP09308 - 01 December 2008) Finnish Experience With Buprenorphine-Naloxone Combination (Suboxone): Survey Evaluations With Intravenous Drug Users]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09308</link><pubDate></pubDate><description><![CDATA[Finland, with a population of around 5.5 million, has four years of
prescribing a buprenorphine-naloxone combination product (bup/nx) under
its belt, and it already has the most bup/nx experience within Europe. Our
data show that the decision to transfer patients from buprenorphine to
bup/nx more than halved the street value of an 8mg tablet, in a country
where buprenorphine had previously been the most widely
intravenously-abused drug. Patients are now maintained on an average daily
dose of 16mg bup/nx and, reassuringly, buprenorphine misuse is decreasing.
Most importantly, the pre-buprenorphine heroin mortality figures have all
but vanished: from 63 deaths in 2000, in the last few years Finland has
seen heroin claim just 0-4 lives per annum.


]]></description></item><item><title><![CDATA[( BUPP09309 - 01 December 2008) Letter to the editor: Fifteen Years of Office Based Prescribing in Croatia. Attitudes, Obstacles and Outcomes.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09309</link><pubDate></pubDate><description><![CDATA[To the Editor: Like many other European countries, Croatia had to face a
heroin addiction epidemic in the early 1990s. However, unlike many of
those countries, Croatia gave a prompt medical response to its new public
health problem. Methadone for outpatient treatment was introduced in 1991,
and by 1995 there were over 1500 patients on methadone. Currently, more
than 50% of 2400 GPs in Croatia have patients on maintenance treatment;
buprenorphine was introduced in 2004, and by now about 25% of all
maintenance patients take buprenorphine.


]]></description></item><item><title><![CDATA[( BUPP09310 - 05 December 2008) Opiate agonist tretament for addiction (Correspondence letter)]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09310</link><pubDate></pubDate><description><![CDATA[Richard Schottenfeld and colleagues' clinical trial involving maintenance
treatment with buprenorphine and naltrexone for heroin dependence (Lancet
28 June 2008. p 2192 - BUPP08985) raises several questions, starting with
why it was done in the first place.  Enrolment began after buprenorphine
(with and without naloxone) had been approved for widespread use by
communitybased practitioners in the USA, and at a time whne well over
80,000 patients were receiving buprenorphine maintenance treatment in
France.


]]></description></item><item><title><![CDATA[( BUPP09311 - 08 December 2008) Comparison  of  sevoflurane  and isoflurane in dogs anaesthetised for clinical surgical or diagnostic procedures.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09311</link><pubDate></pubDate><description><![CDATA[OBJECTIVES:  To assess attributes of sevoflurane for routine clinical
anaesthesia  in  dogs  by  comparison  with  the established volatile
anaesthetic  isoflurane.METHODS: One hundred and eight dogs requiring
anaesthesia  for  elective  surgery  or  diagnostic  procedures  were
studied. The majority   was   premedicated with  0.03  mg/kg  of
acepromazine  and  0.01  mg/kg  of  buprenorphine  or  0.3  mg/kg  of
methadone  before  induction  of  anaesthesia  with  2  to 4 mg/kg of
propofol  and  0.5  mg/kg of diazepam. They were randomly assigned to
receive  either sevoflurane (group S, n=50) or isoflurane (group I, n=58)
in  oxygen  and  nitrous  oxide for maintenance of anaesthesia. Heart
rate,  respiratory  rate,  indirect  arterial  blood pressure,
haemoglobin  saturation, vaporiser settings, end-tidal carbon dioxide and
anaesthetic  concentration  and  oesophageal  temperature  were measured.
Recovery  was  timed. Data were analysed using analysis of variance  and
non-parametric  tests.RESULTS:  Heart  rate (85 to 140/minute),
respiratory  rate (six to 27/minute) and systolic arterial blood  pressure
(80 to 150 mmHg) were similar in the two groups. End- tidal  carbon
dioxide  between 30 and 60 minutes (group S 6.4 to 6.6 and  group  I  5.8
to 5.9 per cent) and vaporiser settings throughout (group  S  2.1 to 2.9
and group I 1.5 to 1.5 per cent) were higher in group  S.  There  was  no
difference in time to head lift (18 +/- 16 minutes),  sternal recumbency
(28 +/- 22 minutes) or standing (48 +/-32   minutes).  No  adverse
events  occurred.CLINICAL  SIGNIFICANCE: Sevoflurane  appeared  to  be  a
suitable  volatile  anaesthetic for maintenance of routine clinical
anaesthesia in dogs.


]]></description></item><item><title><![CDATA[( BUPP09312 - 08 December 2008) Sublingual bioavailability of buprenorphine in newborns with neonatal abstinence syndrome - a case study an physiological and developmental changes using SIMCYP.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09312</link><pubDate></pubDate><description><![CDATA[Background: 60-80% of infants born to opioid dependent mothers require
pharmacologic treatment for neonatal abstinence syndrome (NAS).
Buprenorphine (BUP) is used as a maintenance agent for adult opioid
dependence. There is no data regarding the use of sublingual BUP below the
age of 4 years, including in term infants with NAS.
Objectives: Characterize pharmacokinetics (PK) of BUP and its metabolite,
norbuprenorphine (NBUP), in neonates; Evaluate the developmental changes
in neonates to assist dose optimization in ongoing clinical studies.
Methods: In silico prediction of PK behaviour and physiological
development in neonates were evaluated using SIMCYP. Intravenous clearance
was predicted through physiologically based simulation method in SIMCYP.
Based on sublingual clearance obtained from a one compartmental model
developed previously using NONMEM, individual changes of sublingual
bioavailability were evaluated with physiological development in the first
two months during the neonatal period.
Results: Intrinsic clearance of BUP in neonates was incorporated as 30%
and 20% of adult values for CYP3A4 and CYP2C8, respectively. Sublingual
bioavailability for individual neonates was evaluated with bioavailability
time profiles, and was estimated at 10-30% of adult levels.
Conclusion: Developmental considerations for the PK of BUP in neonates are
important for the charectirazation of the dose-exposure relationship. We
have evaluated this from "bottom up" and "top down" approaches with SIMCYP
and NONMEM respectively and found these approaches to be complimentary and
valuable for clinical trial design and routine clinical care. Presumably
these data will also facilitate rational decision making in pediatric drug
development.


]]></description></item><item><title><![CDATA[( BUPP09313 - 08 December 2008) Population  pharmacokinetic  investigation  of ribavirin in pediatric subjects infected with hepatitis C virus]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09313</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09314 - 08 December 2008) Psychotherapeutic benefits of opioid agonist therapy.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09314</link><pubDate></pubDate><description><![CDATA[Opioids   have  been  used  for  centuries  to  treat  a  variety  of
psychiatric  conditions with much success. The so-called "opium cure"
lost  popularity  in  the  early  1950s  with the development of
non-addictive tricyclic antidepressants and monoamine oxidase inhibitors.
Nonetheless, recent literature supports the potent role of methadone,
buprenorphine,  tramadol,  morphine,  and other opioids as effective,
durable,  and  rapid  therapeutic  agents for anxiety and depression.
This  article  reviews  the  medical  literature  on the treatment of
psychiatric disorders with  opioids   (notably,   methadone  and
buprenorphine) in both the non-opioid-dependent population and in the
opioid-dependent  methadone  maintenance  population. The most recent
neurotransmitter  theories  on  the  origin of depression and anxiety
will  be  reviewed,  including  current  information  on  the role of
serotonin,  N-Methyl d-Aspartate, glutamate, cortisol, catecholamine, and
dopamine in psychiatric disorders. The observation that methadone
maintenance  patients  with  co-existing  psychiatric  morbidity  (so
called   dual   diagnosis   patients)  require  substantially  higher
methadone  dosages  by  between  20%  and  50%  will  be explored and
qualified.  The  role  of  methadone  and other opioids as beneficial
psychiatric  medications  that  are  independent  of their drug abuse
mitigating  properties  will  be  discussed.  The mechanisms by which
methadone and other opioids   can   favorably   modulate   the
neurotransmitter systems controlling mood will also be discussed.


]]></description></item><item><title><![CDATA[( BUPP09315 - 08 December 2008) Electrocardiogram  characteristics  of  methadone  and  buprenorphine maintained subjects.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09315</link><pubDate></pubDate><description><![CDATA[There has been recent concern about the association between high dose
methadone  and  prolongation  of QTc in the electrocardiogram. QTc is the
time  from  the beginning of the QRS complex to the end of the T have  as
measured  on  an  electrocardiogram and corrected for heart rate.  To
date,  no  association has been made between methadone and buprenorphine
in commonly used  doses and prolonged  QTc. Electrocardiograms  were
performed  on  groups of methadone (n = 35, mean  daily  dose standard
deviation, 69 +/- 29 mg) and buprenorphine (n  = 19, mean daily dose 11 5
mg) subjects and a group of non-opioid dependent  controls  (n  =  17).
Mean  QTc did not differ (p = 0.45) between  methadone,  buprenorphine,
or  controls. Methadone subjects
were  significantly  (odds  ratio of 7.8) more likely to have U waves
than  buprenorphine  and controls combined. Methadone subjects with U
waves  were maintained on higher (p = 0.004) doses (89 +/- 29 mg/day) than
methadone subjects without U waves (60 +/- 24 mg/day). Methadone subjects
taking 60 mg and above had higher (p = 0.02) QTc (405 +/- 29
milliseconds)  than methadone subjects taking less than 60 mg per day
(381  +/-  27  milliseconds).  Although  an association is thought to
exist  between  high methadone doses and elongated QTc, methadone and
buprenorphine,  at  commonly used daily doses, remain safe agents for
opioid substitution therapy.


]]></description></item><item><title><![CDATA[( BUPP09316 - 08 December 2008) Mood  and neuroendocrine response to a chemical stressor, metyrapone, in buprenorphine-maintained heroin dependence]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09316</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09317 - 08 December 2008) Addiction  to  Prescription  Opioids: Characteristics of the Emerging Epidemic and Treatment With Buprenorphine.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09317</link><pubDate></pubDate><description><![CDATA[Dependence  on  and abuse of prescription opioid drugs is now a major
health problem, with initiation of prescription  opioid  abuse exceeding
cocaine  in young people. Coincident with the emergence of abuse  and
dependence  on  prescription  opioids,  there has been an  increased
emphasis  on  the treatment of pain. Pain is now the "5th vital sign"
and  physicians face disciplinary action for failure to adequately
relieve  pain. Thus, physicians are whipsawed between the imperative  to
treat  pain  with  opioids  and the fear of producing addiction in some
patients. In this article, the authors characterize the  emerging
epidemic  of  prescription  opioid  abuse, discuss the utility of
buprenorphine in the  treatment  of  addiction  to prescription  opioids,
and  present  illustrative  case histories of successful treatment  with
buprenorphine.


]]></description></item><item><title><![CDATA[( BUPP09318 - 08 December 2008) Opioids  and  the  Treatment  of Chronic Pain: Controversies, Current Status, and Future Directions]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09318</link><pubDate></pubDate><description><![CDATA[Opioids  have been regarded for millennia as among the most effective
drugs for the treatment of pain. Their use in the management of acute
severe  pain  and chronic pain related to advanced medical illness is
considered  the  standard  of care in most of the world. In contrast, the
long-term  administration  of  an  opioid  for  the treatment of chronic
noncancer  pain  continues  to  be  controversial.  Concerns related  to
effectiveness,  safety, and abuse liability have evolved over decades,
sometimes  driving a more restrictive perspective and sometimes leading to
a greater willingness to endorse this treatment. The past several decades
in the United States have been characterized by attitudes that have
shifted repeatedly in response to clinical and epidemiological
observations, and events in the legal and regulatory communities.  The
interface  between  the  legitimate medical use of opioids  to provide
analgesia and the phenomena associated with abuse and addiction continues
to challenge the clinical community, leading to uncertainly  about  the
appropriate  role  of these drugs in the treatment of pain.  This
narrative  review  briefly  describes the neurobiology  of  opioids  and
then focuses on the complex issues at
this  interface  between  analgesia and abuse, including terminology,
clinical  challenges,  and  the  potential  for  new  agents, such as
buprenorphine,  to  influence practice.


]]></description></item><item><title><![CDATA[( BUPP09319 - 08 December 2008) Sex   Differences  in  Analgesic,  Reinforcing,  Discriminative,  and Motoric Effects of Opioids.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09319</link><pubDate></pubDate><description><![CDATA[This  review  summarizes  evidence  for sex differences in behavioral
effects  of opioids, primarily in rats. Whereas mu agonists have been
found  to  be  more  potent  and  in  some  cases more efficacious in
producing  analgesia  and sedation in males than females, females are
more  sensitive  than  males  to  reinforcing and locomotor stimulant
effects of opioids. Sex differences in motoric effects of opioids may
contribute to sex differences in other behavioral effects of opioids; for
example,  sex  differences  in  rats'  ability  to  discriminate morphine
from saline can be attributed entirely to greater morphine-induced
sedation   in  males.  Chronic  estradiol  blunts  females' sensitivity to
morphine's  analgesic  and  sedative  effects,  but enhances  females'
sensitivity  to  the  reinforcing  and  locomotor stimulant  effects  of
mu opioids. The neurobiological basis for sex differences  in  and
estradiol  modulation  of behavioral effects of opioids  includes brain
opioid receptor density (greater in males and under low-estradiol
conditions in females) and dopaminergic function (greater  in  females and
under high-estradiol conditions). Given the significant and growing use of
opioids by women, both medicinally and recreationally, understanding how
female biology influences analgesic and other effects of  opioids  is
crucial.


]]></description></item><item><title><![CDATA[( BUPP09320 - 08 December 2008) Comparison   between  continuous  propofol  infusion  &  conventional balanced anaesthesia in neurosurgical patients.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09320</link><pubDate></pubDate><description><![CDATA[Background:   Thiopentone   induction   and   maintenance   with   an
inhalational  agent  is  widely  used  anaesthetic  regimen  in  most
operations including neurosurgeries. Propofol has a favourable effect on
neurophysiology and its use during neurosurgeries is advantageous in
terms  of  stable  intraoperative  vitals  and excellent recovery
profile.  Our  study aimed at comparing the conventional technique of
thiopentone-isoflurane   anaesthesia  with  propofol  anaesthesia  in
neurosurgeries.  Patients  &  Methods: One hundred twenty ASA grade I and
II patients were randomly divided into two groups of sixty each.
Group   I   (conventional  )  patients  were  induced  with  5  mg/kg
thiopentone  and  vecuronium  bromide and maintained on isoflurane in
oxygen  and  nitrous  oxide.  Group II (propofol group) patients were
induced  with  titrated  dose  of  propofol (until the loss of verbal
commands)   and  vecuronium  bromide  and  maintained  on  continuous
propofol  infusion,  oxygen  and nitrous oxide. Pulse rates, arterial
pressures,  recovery  profile  and  postoperative  complications were
observed.  Results:  Propofol  preserved preoperative pulse rates and
provided  easily  controllable  and reversible lowering effect on the
mean  arterial  pressure.  Extubation  time, sedation scores and PONV
were  all  lesser in the propofol group. Conclusion: We conclude that
propofol  is  good  drug  for  induction  &  maintenance  of  general
anaesthesia in neurosurgical patients.


]]></description></item><item><title><![CDATA[( BUPP09321 - 08 December 2008) Pain  therapy  -  Dosing  recommendations  at  beginning  and  end of treatment]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09321</link><pubDate></pubDate><description><![CDATA[Pain therapy is one of the basic tasks of a clinician. Good knowlegde of
the active profile of prescribed analgesics as well as their side effects
will  facilitate  their  use and decrease undesired effects. This article
discusses  currently used analgesics, their indication and   practical
application  with  special  consideration  of  dose requirements  at the
beginning and end of treatment


]]></description></item><item><title><![CDATA[( BUPP09322 - 16 December 2008) Guidelines:  Control  of  pain in adults with cancer: Summary of SIGN guidelines.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09322</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09323 - 16 December 2008) Effects of cocaine in the human beings.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09323</link><pubDate></pubDate><description><![CDATA[Objective.  Cocaine  abuse  still  remains  a healthy problem in many
developed  societies.  Despite  the  research  efforts  of  the  last
decades,  the  goal of an effective pharmacological cocaine treatment has
not  been  yet  achieved.  Therefore, it is clear that we should pursue in
the search of the psychobiologycal mechanisms that maintain cocaine
dependence. New contributions on this particular subject are published
every  year  in  scientific  journals.  A summary of the conclusions  of
some of these journals may help to other researchers and experience-ded
personnel in the field of drug addiction. Material and  methods.  The
availability  of behavioral animal models of drug dependence  such as
self-administration, conditioned place preferente drug  discrimination
and locomotor sensitization, as well as that of neurobiological
methodologies such as intracerebral drug administration,  microdialysis,
binding  and  quantitative  receptor autoradiography,  in  situ
hibridization,  and electrophysiology has increased  our  knowledge  of
the neural bases of cocaine dependence. Moreover,  recent neuroimage
studies in cocaine abusers are providing new  insights  on  the genetic,
psychological and social factors that
participate  in  acquisition  and  maintenance  of cocaine addiction.
Results.  In  the  last years, several reports have demonstrated that
cocaine acts in the brain altering the neurotransmission of different
compounds, and specially that of dopamine,  serotonine  and noradrenaline
in cerebral areas related to the reinforcing properties of natural
rewards. The anatomical and functional connections between these brain
regions constitue a neural circuit, the mesocorticolimbic dopaminergic
system,  that it is also regulated by psychological and social  factors
besides  the  drug. Chronic cocaine abuse change the
adequate  function  of  this  rewarding system resulting in increased
alterations of brain neurotransmission and damage in other corporal
tissues.   Conclusions.   Although   cocaine   alter   the  chemicals
connections of different  neurotransmitters,  it  seems that of the
dopamine  is  mainly  involved  in the reinforcing properties of this
drug.  The  psychostimulant  feelings  induced  by this drug are also
dependent on the  subject  expectancies  and  a  chronic  cocaine
consumption   may   result   in   neuroadaptive  changes  of  several
neurotransmitter  sytems  that  are maintained even in absence of the
drug.  It is thought  that  these  neuroadaptive  changes  could
participate  too  in  cocaine relapse. Besides to the nervous tissue,
chronic  cocaine  abuse  cause adverse effects on many other corporal
tissues, specially in the brain and heart vascular system.


]]></description></item><item><title><![CDATA[( BUPP09324 - 16 December 2008) Fifteen  years  of  office-based  prescribing  in Croatia. Attitudes, obstacles and outcomes.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09324</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09325 - 16 December 2008) The  use of buprenorphine to reverse opioid overdose deserves further evaluation.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09325</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09326 - 16 December 2008) Ciprofloxacin-induced  torsades  de  pointes in a methadone-dependent patient.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09326</link><pubDate></pubDate><description><![CDATA[Background:  Methadone  has  been associated with QT prolongation and
Torsades de pointes. Ciprofloxacin may prolong QT interval and induce
Torsades  de  pointes  when  other  risk  factors  are  present. Case
description:  A  case  is  described  in  which  a  patient receiving
methadone  treatment  developed  Torsades  de  pointes  following the
addition of ciprofloxacin. Conclusion: Ciprofloxacin should be used with
caution in patients receiving methadone.


]]></description></item><item><title><![CDATA[( BUPP09327 - 16 December 2008) The  use  of  sublingual  buprenorphine-naloxone for reversing heroin overdose: A high-risk strategy that should not be recommended.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09327</link><pubDate></pubDate><description><![CDATA[We write with great concern regarding the recent report published in
Addiction y Welsh and colleagues, and their suggestion that buprenorphine
(alone or in combination with naloxone) may be a useful strategy in
overdose reversal. While the details surrounding this case are consistent
with a buprenorphine-precipitated reversal of heroin effects, there are a
number of reasons why buprenorphine should not be recommended for overdose
reversal and why such action may, in fact, contribute to increased
overdose mortality. This is exemplified by a previous case in the
literature of a person being administered intravenous buprenorphine in an
attempt (unsuccessfully) to reverse a heroin overdose. The authors of this
paper note that this action may delay the initiation of proper life-saving
actions, and we could concur that this is a grave concern. Welsh and
colleagues are incorrect in suggesting that there are no published cases
of oral or sublingual buprenorphine related overdoses. There is at least
one published fatality following oral buprenorphine and intravenous use of
buprenorphine is  not suspected in all fatalities.


]]></description></item><item><title><![CDATA[( BUPP09328 - 16 December 2008) The  use  of  depot  naltrexone  under  legal  coercion: The case for caution.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09328</link><pubDate></pubDate><description><![CDATA[In many developed countries over the past century there have been periodic
enthusiasms for legally coerced treatment of addiction: that is, addiction
treatment that is offered as an alternative to imprisonment. Between the
1930s and early 1970s, for example, the United States established two
Federal public health hospitals where opioid addicts were treated
compulsorily for 6 months or over. Enthusiasm for the coerced treatment of
addiction has been renewed recently (in the absence of compelling evidence
of its efficacy). In the case of heroin addiction, the renewed interest
has been stimulated by the development of depot forms of the opioid
antagonist, naltrexone, which promises to be more effective in ensuring
abstinence from opioids than psychosocial treatment or oral naltrexone.
For example, Caplan has argued recently that it would be ethically
acceptable to coerce heroin addicts legally into receiving naltrexone
implants because heroin addicts are, by definition, incapable of making
self-determining autonomous choices about whether or not to use heroin.
Naltrexone, he argues, restores heroin addicts autonomy by removing their
cravings for heroin and by blocking the euphoric effects of heroin if they
succumb to temptation. Caplan also asserts that naltrexone has been used
safely and effectively to treat heroin addiction for more than 30 years,
so implantable forms of the drug do not present any special ethical
issues.


]]></description></item><item><title><![CDATA[( BUPP09329 - 16 December 2008) Unplanned  admissions to two Sydney public hospitals after naltrexone implants.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09329</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09330 - 16 December 2008) Prevalence of diversion and injection of methadone and buprenorphine among clients opioid treatment at community pharmacies in New South Wales, Australia.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09330</link><pubDate></pubDate><description><![CDATA[Background: This study aimed to investigate the prevalence of diversion
and injection of methadone and buprenorphine among clients receiving
opioid pharmacotherapy treatment at community pharmacies in New South
Wales (NSW), Australia.
Methods: A multi-site cross-sectional survey design was utilised using a
self-complete questionnaire. Participants were 508 clients receiving
supervised methadone (n=442) and buprenorphine (n=66) at 50 community
pharmacies. Participants were surveyed about whether they had diverted
their currently prescribed pharmacotherapy, whether they had injected
methadone or buprenorphine, the frequency, desirability and duration of
action of injecting, and the ease of availability of street-purchased
pharmacotherapies.
Results: The prevalence of recent diversion was more than 10 times higher
among those receiving buprenorphine compared to methadone, with 23.8% of
buprenorphine-maintained participants reporting diverting their dose in
the preceding 12 months. Seventeen percent of methadone clients had
injected methadone on the preceding 12 months compared with 9.1% of
buprenorphine clients over the same period.
Conclusion: The higher prevalence of buprenorphine diversion compared to
methadone diversion is likely to be due to its sublingual tablet
formulation and difficulty associated with supervising its consumption
compared to that of an oral liquid. Methadone diversion is also less
prevalent likely due to high levels of methadone takeaway provision, which
also helps to explain the higher levels of recent methadone injecting
compared to buprenorphine injecting. A clearer understanding of the
motivations for diversion and injection of opioid pharmacotherapies, and
the relationship between them is required.


]]></description></item><item><title><![CDATA[( BUPP09331 - 16 December 2008) Obstiless reports impact of opioid-induced side-effects.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09331</link><pubDate></pubDate><description><![CDATA[Opioids are widely used to provide analgesia in advanced cancer patients
and increasingly being used to treat chronic, non-malignant pain. However,
constipation is a major side effect of opioids and can impact
significantly on patients quality of life. Constipation is the most
adverse effect of long term opioid therapy. Opioid agents mediate their
effects through three distinct classes of membrane bound opioid receptors
which are expressed throughout the central nervous system, but also in
peripheral areas.


]]></description></item><item><title><![CDATA[( BUPP09332 - 17 December 2008) Opioid maintenance therapy suppresses alcohol intake in heroin addicts with alcohol dependence: Preliminary results of an open randomized study .]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09332</link><pubDate></pubDate><description><![CDATA[Abstract : An open randomized study lasting 12 months was performed to
evaluate the efficacy of methadone or buprenorphine to suppress alcohol
use in two hundred and eighteen heroin addicts with alcohol dependence.
Daily maintenance doses of methadone were 80, 120, 160, and 200 mg/day,
while doses of buprenorphine were 8, 16, 24, and 32 mg/day.
As expected, both treatments were able to reduce both heroin use and
addiction severity (measured with ASI interview). However, although both
medications were able to suppress alcohol use, the highest dose of
buprenorphine was better than the highest dose of methadone, in reducing
alcohol craving, ethanol intake (measured as daily number of drinks), and
the ASI subscale of alcohol use.
The mechanism underlying the effects of the opioid maintenance therapy on
the reduction of alcohol intake is still unclear.
The results of the present study may represent the first clinical evidence
of the potential effective use of the highest doses of buprenorphine for
the suppression of ethanol intake in heroin addicts with alcohol
dependence.


]]></description></item><item><title><![CDATA[( BUPP09333 - 22 December 2008) Cognitive  Functioning  During  Methadone and Buprenorphine Treatment Results of a Randomized Clinical Trial.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09333</link><pubDate></pubDate><description><![CDATA[Cognitive  impairment  in drug-dependent patients receiving methadone
(MMP) maintenance treatment has been reported previously. We assessed
cognitive  functioning  after at least 14 days of stable substitution
treatment  with  buprenorphine (BUP) or MIMP and after 8 to 10 weeks. We
performed  a  randomized,  nonblinded  clinical trial in 59 drug dependent
patients receiving either BUP or NIMP maintenance treatment and  healthy
normal  controls  (n  =  24)  matched for sex, age, and educational
level. Thirteen patients dropped out of the study before the second
testing  was  performed  (BUP  n  = 22; MNIP, n = 24). A
neuropsychological test  battery  was  used  to  measure  selective
attention, verbal  memory,  motor/cognitive  speed,  and  cognitive
flexibility.  In  addition,  subjective perceived stress was assessed with
a questionnaire.  Patients  in both treatment groups performed equally
well in all of the cognitive domains tested. Both BUP and MMP patients
showed  significantly  improved concentration and executive functions
after  8 to 10 weeks of stable substitution treatment. The control  group
achieved better results than the BUP and MMP groups in most  cognitive
domains,  indicating  cognitive  impairment  in  the
patients.  Perceived stress did not show any significant change after 8 to
10  weeks of treatment, and no major differences were detected between
the  3  groups.  No effects of perceived stress on cognitive function
were  found. Our results indicate a cognitive impairment in patients
receiving  maintenance  treatment  with BUP or MMP compared with  healthy
controls. Selective attention improved in both patient groups during
treatment. We propose that the improvement of attention may facilitate
rehabilitation of drug-dependent patients.


]]></description></item><item><title><![CDATA[( BUPP09334 - 22 December 2008) Urine buprenorphine - A pilot study]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09334</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09335 - 22 December 2008) A  simple  gas  chromatography-mass  spectrometry  procedure  for the simultaneous  determination  of buprenorphine and norbuprenorphine in human urine.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09335</link><pubDate></pubDate><description><![CDATA[With  the  increasing  use  of  buprenorphine  in treatment of opiate
addiction  and  pain management, it is important that laboratories be able
to assess patient compliance. The presented procedure is simple,
efficient,  and  employs gas chromatography-mass spectrometry (GC-MS)
technology available to most laboratories. The specimen is hydrolyzed
with  beta-glucuronidase prior to liquid-liquid extraction at a basic pH.
The evaporated extract is derivatized to form the
tertiary-butyl-dimethyl-silyl  derivatives  of  buprenorphine  and
norbuprenorphine prior  to analysis by GC-MS in the electron impact mode.
Confirmation
of the analytes is based on comparing the ion abundance ratios of the
analytes  to  those  of  a  contemporaneously  analyzed standard. The
qualitative  ion  abundance  ratios  are required to be within 20% of
those  of the standard for acceptance. Quantification is based on the ion
ratios of the analytes to those of their corresponding deuterated
analogues. Linearity was obtained for buprenorphine in the range of 1 to
2000 mug/L with a correlation coefficient (R) exceeding 0.999 and or
norbuprenorphine  from  1  to 1000 mug/L with R exceeding 0.997. Percent
recoveries  for  the buprenorphine and norbuprenorphine were 71%  and
75%,  respectively.  It  was  found  that  the  recovery of
norbuprenorphine  could be enhanced to 100% by a simple "salting-out"
modification to the procedure.


]]></description></item><item><title><![CDATA[( BUPP09336 - 22 December 2008) Urinary detection times and metabolite/parent compound ratios after a single dose of buprenorphine.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09336</link><pubDate></pubDate><description><![CDATA[The  objective  was  to  estimate  the detection times and
metabolite/parent compound   ratios   in   urine   after  a  single  dose
of buprenorphine.  Eighteen healthy volunteers received a single dose of
0.4 mg buprenorphine sublingually. Urine samples were collected prior to
dosing  and at 2, 4, 6, 8 12, 24, 48, 72, and 96 h post-dose. The samples
were  screened using cloned enzyme donor immunoassay (CEDIA) reagent  and
quantitation  was performed with liquid chromatography- tandem  mass
spectrometry (LC-MS-MS) with a cut-off of 0.5 ng/mL for buprenorphine
and  norbuprenorphine.  The  mean  time  of continuous positive results
was 9 h (range 4 to 24 h) with CEDIA, whereas for an LC-MS-MS  method  it
was 76 h (range 23-96 h) for buprenorphine, and
for norbuprenorphine all samples were positive at 96 h. Some subjects had
positive  CEDIA  results  after  a  negative  sample,  owing  to
differences  in  creatinine  concentration.  The  time when the ratio
norbuprenorphine/buprenorphine  exceeded  1 was estimated at 7 h. The
metabolite/parent  ratio  may  be used to estimate the time of intake
even  though  the individual ratios showed an increased variation the
more  distant  the collection time. We believe that using this ratio,
rather  than  the actual concentrations, it is possible to compensate for
urine dilution and different doses, and to  improve interpretation.


]]></description></item><item><title><![CDATA[( BUPP09337 - 22 December 2008) Outbreak   of   exogenous   Cushing's   syndrome  due  to  unlicensed medications.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09337</link><pubDate></pubDate><description><![CDATA[Objective:  Despite  the  widespread  medical use of glucocorticoids,
reports of factitious administration  of  these hormones have been
uncommon.  We  herein  report  an  outbreak  of Cushing's syndrome in
Tehran among the addicts using Tamgesic (a brand of Buprenorphine) to help
them through the narcotic withdrawal stage, without knowledge of the
glucocorticoid  content  of  the  black-market  drug. Design and
measurements: Case histories of 19 patients with a final diagnosis of
iatrogenic  Cushing's  syndrome  were reviewed. Liquid chromatography/mass
spectrometry (LC-Mass) method  was used to evaluate    glucocorticoid
existence  in  the  brand.  High  performance  liquid chromatography  was
used  to  determine  plasma dexamethasone level. Results:  No
buprenorphine  was  present in the vials. Each Tamgesic vial contained 0.4
mg of Dexamethasone disodium phosphate; Heroin was also  found  in  them.
The duration of injection abuse and the total dexamethasone  intake  was
4.5 (1-18) months and 2.6 (0.8-8) mg/day, respectively.  Median plasma
dexamethasone concentration was 5.8 nmol/l,  with  a  range of 5-8.7.
Physical findings of the cases were not different from those of the
classic endogenous Cushing's syndrome but their  serum  cortisol  and
urinary  free  cortisol were suppressed. Severe  life-threatening
complications  were  demonstrated  in  five cases.   Conclusion:
Surreptitious  use  of  steroids  resulting  in Cushing's syndrome may be
more common in opium addicts; a high degree of  suspicion  is  needed to
uncover this disorder. Whenever facing a cushingoid  appearance  in
addicts,  the  possibility of using black market  drugs  with
corticosteroid contents should be kept in mind.


]]></description></item><item><title><![CDATA[( BUPP09338 - 22 December 2008) Transdermal drug delivery has ideal properties in the elderly.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09338</link><pubDate></pubDate><description><![CDATA[The transdermal route of drug delivery has many advantages over other
routes;  some  of these advantages are particularly applicable to the
elderly  population.


]]></description></item><item><title><![CDATA[( BUPP09339 - 22 December 2008) Pain   therapy   in   case   of   renal  disease  and  chronic  renal insufficiency.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09339</link><pubDate></pubDate><description><![CDATA[Chronic  pain  patients  constitute  a  problem  clientele  in  every
practice. It is decisive to avoid or to break chronification. In case of
concomitant  renal  disease,  impaired renal function or patients after
renal  transplantation,  some  special  precautions have to be taken
into  account. The following summary shows the current data on therapy
recommendations.


]]></description></item><item><title><![CDATA[( BUPP09340 - 22 December 2008) Transdermal buprenorphine intoxication.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09340</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09341 - 22 December 2008) Muscle   injury,   vimentin   expression,   and   nonsteroidal  anti-inflammatory  drugs  predispose  to  cryptic  group  A  streptococcal    necrotizing infection.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09341</link><pubDate></pubDate><description><![CDATA[Background.  Myonecrosis  due  to  group  A  streptococci (GAS) often
develops  at  sites of nonpenetrating muscle injury, and nonsteroidal
anti-inflammatory  drugs  (NSAIDs) may increase the severity of these
cryptic  infections.  We  have  previously  shown  that  GAS  bind to
vimentin  on  injured  skeletal  muscles  in vitro. The present study
investigated  whether  vimentin  up-regulation  in injured muscles in vivo
is associated with homing of circulating GAS to the injured site and
whether  NSAIDs  facilitate  this process. Methods. M type 3 GAS were
delivered  intravenously 48 h after eccentric contraction (EC)- induced
injury of murine hind-limb muscles. Vimentin gene expression and  homing
of  GAS  were followed by real-time reversetranscriptase polymerase
chain  reaction  and  quantitative bacteriology of muscle homogenates,
respectively.   In separate  experiments,  ketorolac tromethamine
(Toradol)  was  given 1 h before GAS infusion. Results. Vimentin  was
up-regulated  8-fold 48 h after EC. Significantly more GAS  were  found
in  moderately  injured  muscles than in noninjured
controls.  NSAIDs  greatly  augmented  the  number  of GAS in injured
muscles.  Conclusions. Vimentin may tether circulating GAS to injured
muscle,  and  NSAIDs  enhance  this process. Strategies targeting the
vimentin-GAS  interaction  may  prevent or attenuate GAS myonecrosis. Use
of  NSAIDs should increase suspicion of cryptic GAS infection in patients
with  increasing  pain  at  sites  of nonpenetrating muscle injury.


]]></description></item><item><title><![CDATA[( BUPP09342 - 22 December 2008) Prenatal  buprenorphine  exposure:  Effects on biochemical markers of hypoxia and early neonatal outcome.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09342</link><pubDate></pubDate><description><![CDATA[Objective.  To  evaluate  the  possible  association between prenatal
buprenorphine exposure and compromised early neonatal outcome in view of
markers  of  perinatal  hypoxia.  Design, setting and sample. The study
group   consisted   of   27  full-term  neonates  exposed  to
buprenorphine  prenatally  and prospectively followed up at a special
tertiary  outpatient  clinic  for  pregnant  drug abusers. Serving as
controls  were  27  full-term  neonates exposed prenatally to illicit
substances other  than  opioids  and  38  full-term  neonates  from
uncomplicated  pregnancies  of  healthy parturients. Methods and main
outcome  measures.  Apgar  scores,  cord  pH  and  base  excess  were
recorded.  Cord serum samples were collected at birth for analysis of
biochemical  markers  of  fetal  hypoxic stress: erythropoietin (EPO;
chronic  hypoxia),  cardiac troponin T (cardiac involvement) and S100
(neural  damage).  Results.  All  infants were born in good condition
according  to  Apgar  scores  and  pH of cord blood. No statistically
significant  differences  were found between the three groups in cord
serum concentrations of EPO (33.0 median, range: 9.0-476.0 U/L in the
buprenorphine-exposed   group   vs   27.0,   range:  8.0-114.0U/L  in
substance-abusing  controls  vs 28.1, range: 11.6-260.0U/L in healthy
controls)  or  S100  (0.47,  range:  0.25-0.91mug/L  vs  0.40, range:
0.12-1.22mug/L   vs  0.47,  range:  0.20-2.15mug/L).  No  significant
differences existed in cardiac TnT levels (0.017, range: 0.010-0.072U/L
vs 0.010, range: 0.010-0.075U/L vs 0.024, range: 0.010-0.075U/L).
Conclusions.  While  no  significant  differences in asphyxia markers
were  observed  between  the  three groups, a tendency towards higher
levels  of  EPO  emerged  in  the buprenorphine-exposed group.


]]></description></item><item><title><![CDATA[( BUPP09343 - 05 January 2009) Analysis of a range of narcotic and psychotropic substances.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09343</link><pubDate></pubDate><description><![CDATA[The registered narcotic and psychotropic drugs has recently tended to
reduce in numer. Out of 19 INN registered narcotic and psychotropic
agents,  buprenorphine,  morphine,  promedol, prosidol, fentanyl, and
sodium oxybate are distinguished  by  the maximum completeness and depth
of their assortment.


]]></description></item><item><title><![CDATA[( BUPP09344 - 05 January 2009) The prevalence of borderline personality among  buprenorphine patients.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09344</link><pubDate></pubDate><description><![CDATA[OBJECTIVE:  In  this  study, we examined the prevalence of borderline
personality disorder (BPD) in a sample of patients seeking outpatient
treatment  with buprenorphine for opioid addiction. METHOD: To assess for
BPD,  we  used  three self-report surveys in a consecutive study sample.
RESULTS:  Of  the  111  participants who completed all three measures of
BPD, 49 (44.1%) exceeded the cut-off score indicative of BPD.
CONCLUSIONS:  Among individuals who are addicted to opioids and seeking
treatment  with  buprenorphine,  the  prevalence  of BPD, as mutually
confirmed by three self-report measures, is quite high.


]]></description></item><item><title><![CDATA[( BUPP09345 - 05 January 2009) Treating opioid dependency and coexistent chronic nonmalignant pain.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09345</link><pubDate></pubDate><description><![CDATA[As pointed out by Jackman and colleagues in this issue of American Family
Physician, opioids are commonly used for the treatment of chronic
non-malignant pain (i.e., pain unrelated to cancer that persists beyond
the usual course of disease or injury). Although most patients with
chronic non-malignant pain may be successfully treated with long-term
opioids, there is a risk of drug misuse, abuse, and addiction. One of the
most common pain conditions seen in primary care is chronic low back pain.
In one systematic review, 5 to 24 percent of patients who were prescribed
long-term opioids had aberrant drug-taking behaviour. The review authors
noted that, although clinical trials suggest that opioids are effective
for the short-term (less than 16 weeks), the effectiveness of long-term
opioids (16 weeks or more) for pain relief and improved physical function
is less clear. Less is known about the use of long term opioids for
another common chronic pain conditions. Recommendations are based on
expert opioids for other common chronic pain conditions. Recommendations
are based on expert opinion and uncontrolled studies; however, several
adverse effects are known to be associated with prolonged treatment with
opioids. One study showed that the unintended consequences include
accident proneness, impaired judgement and cognitive function, a decline
in occupational and social function, and strained family relationships.
Physicians should monitor patients for adverse effects. The patients
medical history may provide important clues. For example, if the patient
is taking unusually large quantities if opioids and still complains of
insufficient pain relief, there may be aberrant drug-taking behaviour or
drug diversion. This should not be confused with pseudoaddiction, in which
patients appear to have drug-seeking behaviour that is actually caused by
inadequate pain control.


]]></description></item><item><title><![CDATA[( BUPP09346 - 05 January 2009) New guidelines against unfair treatment of narcotic addicts necessary]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09346</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09347 - 05 January 2009) Outcomes  of  DATA  2000 certification trainings for the provision of buprenorphine treatment in the veterans health administration.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09347</link><pubDate></pubDate><description><![CDATA[Despite  the  high  numbers  of  veterans with opioid dependence, few
receive  pharmacologic  treatment  for this disorder. The adoption of
buprenorphine  treatment  within  the  Veterans Health Administration
(VHA)  has been slow. To expand capacity for buprenorphine treatment, the
VHA  sponsored two eight-hour credentialing courses for the Drug
Addiction  Treatment  Act of 2000. We sought to describe the outcomes of
such  training.  Following the training sessions, 29 participants (18
physicians)  were  highly  satisfied  with  course  content  and affirmed
their intention to prescribe buprenorphine; after nine-month follow-up,
two   physicians  were  prescribing.  We  conclude  that providing
credentialing  courses,  while  popular,  did not markedly promote  the
prescription  of  buprenorphine.


]]></description></item><item><title><![CDATA[( BUPP09348 - 05 January 2009) Variability and function of family 1 uridine-5'-diphosphate glucuronosyltransferases (UGT1A).]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09348</link><pubDate></pubDate><description><![CDATA[The   substrate  spectrum  of  human  UDP-glucuronosyltransferase  1A
(UGT1A)  proteins includes the glucuronidation of non-steroidal
anti-inflammatory   drugs,   anticonvulsants,  chemotherapeutics,  steroid
hormones,  bile acids, and bilirubin. The unique genetic organization of
the human  UGT1A  gene  locus,  and  an  increasing  number of
functionally  relevant  genetic variants define tissue specificity as well
as a   broad   range  of  interindividual  variabilities  of
glucuronidation.   Genetic   UGT1A  variability  has  been  conserved
throughout  the protein's evolution and shows ethnic diversity. It is the
biochemical  and  genetic  basis for clinical phenotypes such as
Gilbert's  syndrome  and  Crigler-Najjar's disease as well as for the
potential   for  severe,  unwanted  drug  side  effects  such  as  in
irinotecan  treatment. UGT1A variants influence the metabolic effects of
xenobiotic exposure and therefore have been linked to cancer risk.
Detailed    knowledge    of    the    organization,   function,   and
pharmacogenetics   of  the  human  UGT1A  gene  locus  is  likely  to
significantly  contribute  to  the  improvement  of  drug  safety and
efficacy  as  well  as  to  the provision of steps toward the goal of
individualized  drug therapy and disease risk prediction.


]]></description></item><item><title><![CDATA[( BUPP09349 - 05 January 2009) Post  marketing  surveillance  study  with an analgesic (transdermal buprenorphine  patch  in  patients  with  moderate to severe chronic pain).]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09349</link><pubDate></pubDate><description><![CDATA[AIM:   To  obtain  information  on  the  efficacy,  tolerability  and
safetyofa  transdermal buprenorphine patch (Transtec PRO) in patients
with  moderate  to  severe  chronic  pain.  In  addition it should be
evaluated  to what extent the two fixed patch change days per weekare
simplifyingthe  therapy.  METHODS:  In  this prospective multi-center
post  marketing  surveillance  study patients with chronic cancer and
non-cancer pain were treated with transdermal buprenorphine for up to
eight  weeks. The evaluation included pain intensity, the dosage of the
applied  analgesics and additional therapies, the renal function
(by serum creatinine) and adverse events. RESULTS: 3654 patients were
treated  for  a  mean  of  50.4  days. Using the NRS-11 the mean pain
intensity  decreased from 6.3 at the time when patients were switched to
the  transdermal buprenorphine patch to 2.6 at the last treatment
evaluation.  The  matrix  patch  was  safe and well tolerated also in
patients  with  advanced  renal  insufficiency.  Adverse  events were
reported  in  6.7% of the patients. 89.3% of the physicians quoted to
prefer transdermal buprenorphine with the two fixed patch change days per
week  compared to the   pre-treatment.   CONCLUSION:   The
buprenorphine-containing   matrix   patch   was  effective  and  well
tolerated  in  patients  with  moderate  to severe chronic cancer and
noncancer  pain.  From the physicians view the two fixed patch change
days  per  week  facilitate the guidance of therapy. In patients with
advanced renal insufficiency a dose adjustment is not necessary.


]]></description></item><item><title><![CDATA[( BUPP09350 - 05 January 2009) Transdermal Buprenorphine in Children With Cancer-Related Pain.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09350</link><pubDate></pubDate><description><![CDATA[We  present three cases of children (aged 3-5 years) in which cancer
related  pain was adequately controlled by Transdermal Buprenorphine. The
endpoints  for  evaluating  analgesic  efficacy consisted of the
assessment  of  pain  using  a  visual  scale  and the possibility of
reducing other  pain  treatment.  improvement  of  pain  level  was
demonstrated  by  the  decrease  in  pain scores, by reduction of the
overall amount of medications, especially opioids, and by improvement of
uninterrupted sleep. Only limited data is available on the use of
Transdermal Buprenorphine in children. In Our experience, Transdermal
Buprenorphine allowed good analgesia without significant side effects in
these three children  with  cancer-related  pain.


]]></description></item><item><title><![CDATA[( BUPP09351 - 05 January 2009) Update in Addiction Medicine for the Primary Care Clinician.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09351</link><pubDate></pubDate><description><![CDATA[The United States Preventive Services Task Force recommends that primary
care clinicians assume a major role in screening, identification,
treatment, and referral to treatment of unhealthy alcohol and other drugs
(AOD) use-the spectrum from use that risks health consequences to AOD
disorders (abuse and dependence)-in generalist settings. In the United
States, nicotine dependence, alcohol use, and drug use are the first,
third and ninth leading causes, respectively, of preventable deaths.
Despite the harmful effects of addiction and improved options for office
based treatments and referral, not all primary care clinicians routinely
address AOD use in their patients. The objectives of this paper are to
identify and examine important recent advances in addiction medicine that
have implications for primary care clinicians and that emphasize primary
care clinicians role in the identification, treatment and/or referral of
patients with addictions. We conducted and electronic database (PubMed)
search to systematically identify recent (June 1, 2006 to January 1, 2008)
human subject, English language, peer-reviewed, research publications that
are relevant to generalist care for patients with addiction disorders. We
also surveyed the publications that were reviewed by a NIH-funded
newsletter that, in an attempt to identify articles that address the
health impact of alcohol and drugs, systematically reviews the core
general medical, infectious disease, public health, and additional
subspecialty journals. Similar to our prior review, authors (A.G., D.F.,
R.S.) were provided a title listing of articles with addiction-related key
words within the reference time frame, and then secondary searches and
consensus deliberations were used to identify articles that may impact the
care provided by primary care clinicians in the categories of 1) alcohol
use and disorders and 2) opioid use and dependence. Articles were
categorized as impacting primary care clinicians if they studied primary
care settings or could impact such settings and had practice changing
findings or implications.


]]></description></item><item><title><![CDATA[( BUPP09352 - 05 January 2009) Allergic contact dermatitis from transdermal buprenorphine.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09352</link><pubDate></pubDate><description><![CDATA[Buprenorphine   is   a   low-molecular-weight,   lipophilic,   opioid
analgesic.  The  transdermal  delivery system (TDS) containing it has
skin  irritation potential, but at least two cases of contact allergy to
the  active  principal  have been described previously. To confirm
allergic  contact  dermatitis from transdermal buprenorphine (TDB) in
five  older  patients  suffering  from chronic pain and who developed
persistent,  pruritic erythematous plaques at the contact sites, with
two  of them also presenting with a generalized skin eruption.Besides the
baseline  patch  test series, all five patients were tested with the
TDB,  four of whom were also tested with the placebo transdermal delivery
system as provided by the manufacturer; one patient was also tested  with
other preparations containing buprenorphine.All reacted to the TDB
containing  the  active  principal,  the  placebo being negative  in  the
four  patients tested. The patient tested with the other  buprenorphine
preparations  did  react  positively to them as well.  Tests  with TDB in
28 healthy controls were negative.We report five  cases of delayed
hypersensitivity reactions to a TDS containing buprenorphine.  Such
adverse  reactions  might  be under-reported. A fentanyl-containing TDS is
a good alternative in these cases.


]]></description></item><item><title><![CDATA[( BUPP09353 - 05 January 2009) Challenges  in  providing  drug  user  treatment  services in Russia: Providers' views.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09353</link><pubDate></pubDate><description><![CDATA[The  estimated  number  of  opiate  users  in Russia is 2,000,000 and
heroin  consumption is continuing to increase. The Russian government is
discussing the initiation of compulsory treatment to bring illegal drug
users  to the treatment services. At the same time, there is no access
to  the evidence-based treatment for opiate addiction such as methadone
and buprenorphine maintenance  programs.  Qualitative interviews  were
conducted with drug user treatment service providers (N  =  35)  in
Barnaul,  Volgograd,  and  Yekaterinburg,  Russia, in 2003-2004  to
examine their views on drug user treatment services in
Russia.  The  framework  approach  was  used  in  data collection and
analysis.  Study  participants identified major challenges in service
provision  for  drug  using  population, including lack of resources,
rehabilitation programs,  and  social  support.  It  also  depicted
ambivalent   attitudes   toward  compulsory  treatment  and  clients'
registration. The  Russian  drug  user  treatment system desperately
needs  resources  allocation to provide quality care and diversify in its
services  in order to achieve long-term recovery. At this stage, it seems
unreasonable  to  initiate  compulsory  treatment  as  is advocated  by
some  government  officials.


]]></description></item><item><title><![CDATA[( BUPP09354 - 05 January 2009) Long-term   recovery  from  heroin  use  among  female  ex-offenders: Marisol's story.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09354</link><pubDate></pubDate><description><![CDATA[Ex-offenders   experience   various   difficulties   in  successfully
reentering  communities  post-incarceration. For those with a history of
opioid  misuse, despite various interventions, long-term recovery rates
are relatively low. Additionally, the difficulties ex-offenders experience
reintegrating  with  their  families  and communities are further
compounded  by  the  stigma and structural barriers posed by prior
criminal and drug use histories. This qualitative study, using
in-depth  interviews  conducted during an 18-month period between mid
2004  and  late 2005 examines the process of creating and maintaining
abstinence  among  25  former heroin users, mostly Latino and African
American  New York City ex-offenders who have remained abstinent from
heroin  use for a period of 5 yr or longer. Focusing primarily on the
story  of  one  female respondent and in participants' own words, the
factors  that  they  found  to  be  most  salient  in enhancing their
recovery   efforts   (positive   peer  support,  motivational  tools,
exercise,  meditation,  skills  enhancement)  are examined. The study
findings  suggest  that  reentry  programs  and policies can help
ex-offenders  sustain  long-term  abstinence and prosocial lifestyles by
supporting  the various coping strategies that they identify as being
particularly valuable.


]]></description></item><item><title><![CDATA[( BUPP09355 - 05 January 2009) Substance Use & Misuse: Editorial.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09355</link><pubDate></pubDate><description><![CDATA[Use of the term "recovery" when it comes to addiction has a long history.
Its use remains virtually invisible in the scientific literature however.
The bulk of what we know about addiction processes emanates from research
conducted in the United States and other "developed" nations; most of the
work adopts a Western perspective and tends to focus on symptoms and the
effectiveness of professional treatment at reducing symptoms. This
literature as been useful in guiding policy and funding decisions and
service development as well as refining theory that contributes to
innovations in treatment. However, there are critical gaps in the
addiction knowledge base, chiefly the pervasive under representation of
research on the wellness perspective and on recovery. To date, addiction
researchers, treatment providers, and public and private funders of
services have emphasized the absence of symptom (i.e., abstinence from
drugs and alcohol in the United States). Wellness goes beyond absence of
illness (Breslow, 2006; World Health Organization, 1985). Recovery goes
beyond not using drugs or alcohol. A participant in one of our studies
defined recovery thus: My definition of recovery is life. Cause i didn't
have no life before i got into recovery. Ultimately, recovery is about
quality of life.


]]></description></item><item><title><![CDATA[( BUPP09356 - 05 January 2009) Views  and models about addiction: Differences between treatments for alcohol-dependent people and for illicit drug consumers in Italy.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09356</link><pubDate></pubDate><description><![CDATA[Treatment  of people who are alcohol-dependent and treatment of users of
illicit drugs  differ  remarkably  in Italy, in keeping with the
perception of the general public that drinking alcoholic beverages is a
time-honored  behavior,  while  consumption  of illicit drugs is a
deviant  behavior.  From  a  clinical  perspective, the treatment for
alcoholism  essentially  stands  on  the  principle  of  free choice,
motivation  to  change, and a family approach, while the treatment of
people  who  are  illicit  drug  users  is  characterized by control,
pharmacotherapy,  and  individual  therapy  approaches. From a
socio-political  viewpoint  both  were established in the 1970s, the
former being  a "bottom-up" movement that started as "spontaneous"
responses that mutual help groups and a few clinicians and institutions
gave to alcoholics  and  their  families; while the latter was provided
"top-down"  as  a  political  response  of  the Government confronting the
increase of illegal  drug consumption among youngsters.


]]></description></item><item><title><![CDATA[( BUPP09357 - 05 January 2009) Endogenous opiates and behavior: 2007.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09357</link><pubDate></pubDate><description><![CDATA[This  paper  is  the  thirtieth consecutive installment of the annual
review  of  research  concerning  the  endogenous  opioid  system. It
summarizes  papers  published during 2007 that studied the behavioral
effects  of  molecular,  pharmacological  and genetic manipulation of
opioid   peptides,  opioid  receptors,  opioid  agonists  and  opioid
antagonists. The  particular  topics  that  continue  to  be covered
include   the   molecular-biochemical   effects   and   neurochemical
localization  studies  of  endogenous  opioids  and  their  receptors
related  to  behavior,  and  the  roles  of these opioid peptides and
receptors  in pain and analgesia; stress and social status; tolerance and
dependence; learning and memory; eating and drinking; alcohol and drugs
of abuse; sexual activity and hormones, pregnancy, development and
endocrinology;  mental illness and mood; seizures and neurologic
disorders;  electrical-related  activity and neurophysiology; general
activity   and   locomotion;   gastrointestinal,  renal  and  hepatic
functions; cardiovascular responses; respiration and
thermoregulation;  and  immunological responses.


]]></description></item><item><title><![CDATA[( BUPP09359 - 12 January 2009) Hospital morbidity associated with the natural history of heroin use.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09359</link><pubDate></pubDate><description><![CDATA[Objective:  To  assess  changes in hospital morbidity associated with
heroin  use  from  pre-initiation, recreational to dependent use, and
changes  following  treatment. Design: Analysis of hospital admission
data  assessed  over  six,  6-month  periods (before and after heroin
initiation; two dependent heroin use periods; and post-oral and
post-sustained  release  naltrexone treatment). Participants: A sequential
cohort of 139 patients for whom date of initial heroin use, regular
heroin  use, and two periods of heroin dependence (prior to treatment with
oral and implant naltrexone) were known. Outcome Measures: The West
Australian  Data  Linkage  System was used to assemble hospital admission
data.  Admissions  were  analyzed  as follows: "all cause" admissions
and  then  subgrouped as "mental health (MH) other, " "MH opioid
related,  "  "MH  non-opioid  drug  related,  "  and  "opioid overdoses."
Results: The database identified 130 (94 percent) of the participants with
76 (59  percent) being male. The mean length of follow-up  from  first
heroin use was 9.4 (SD 4.9) years. Significant increases  in  morbidity
were not found in the periods pre-first and post-first  heroin  use,  but
were  found  from  pre-heroin use to dependent  use  for  "all  cause, "
"MH opioid related, " and "opioid over-dose"  admissions.  A  significant
decline in these measures was observed  from the first dependent period to
the post-implant period. "MH  opioid related" admissions declined from the
first to the second period  of  dependent  heroin use. Conclusions:
Findings suggest that the movement to dependent heroin use increases
hospital morbidity; that  morbidity  in  the  presence  of treatment does
not necessarily
increase;  and the treatment with a sustained release preparation may be
more effective than oral naltrexone in arresting morbidity.


]]></description></item><item><title><![CDATA[( BUPP09360 - 12 January 2009) Intrathecal  drug  delivery  for  management  of cancer and noncancer pain.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09360</link><pubDate></pubDate><description><![CDATA[Intrathecal   drug  delivery  (ITDD)  has  been  an  option  for  the
management  of  persistent  pain  since  the  1980s. The discovery of
opioid  receptors  in  the central nervous system was the impetus for
early attempts to deliver opioids intraspinally. Approximately, 10-20
percent  patients  with  cancer  pain  get  inadequate analgesia from
conventional  medical management; this group particularly may benefit
from  ITDD.  However, there is also some evidence for the use of ITDD in
those with noncancer pain. This review presents options for ITDD,
available   drugs,  evidence  for  efficacy,  principles of patient
selection, and problems with the intrathecal route.


]]></description></item><item><title><![CDATA[( BUPP09361 - 12 January 2009) Opiate agonist treatment for addiction - Authors' reply.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09361</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09362 - 12 January 2009) Multiple  bone  lesions resembling a metastatic origin. An unexpected diagnosis.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09362</link><pubDate></pubDate><description><![CDATA[Lytic  and blastic lesions have been associated to malignant tumours, such
as solid cancer (breast cancer, renal cancer, prostate cancer, malignant
melanoma or thyroid tumours). Although a mixed pattern with lytic  and
blastic  lesions is due to metastatic tumour, this is not the only
possible origin. The following case shows a systematic. This case report
shows  the  number  of tests that were made in order to discover  the
origin of osteolytic and osteoblastic lesions and it is
notable  that  there  is not an occult neoplasia on every occasion.


]]></description></item><item><title><![CDATA[( BUPP09363 - 12 January 2009) Oral or transdermal opioids for osteoarthritis of the knee or hip.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09363</link><pubDate></pubDate><description><![CDATA[Osteoarthritis is a degenerative joint disease characterized by pain and
inflammation and primarily involves degeneration of the articular
cartilage. Oral paracetamol and non-sterodial anti-inflammatory drugs
(NSAIDS) are far the most common pharmacological treatment of pain in
patients with osteoarthritis of the knee or hip. However, paracetamol is
often inadequate to treat osteoarthritis pain on a daily basis and more
chronic NSAID use may cause serious gastrointestinal and may be associated
with cardiovascular adverse events. Therefore, opioids may often be a
reasonable alternative for patients suffering from severe pain or for
which other analgesics are contraindicated. Opioids are potent analgesics
that work by targeting opioid receptors. Cellular studies have shown that
there are opioid receptors in inflamed osteoarthritis synovial tissue. The
American College of Rheumatology guidelines on management of
osteoarthritis, updated in 2000, suggest that opioids can be used as a
last resort. Guidelines from the UK also propose opioids as an
alternative, if inadequate pain relief is achieved with ibuprofen and
paracetamol, However, the use of strong opioids for the treatment of
non-cancer pain remains controversial. Concerns about long-term use of
opioids for chronic non-cancer pain have been expressed mainly due to the
risks of dependence and addiction to opioids. Additionally, evidence on
the long-term effects of the use of opioids in patients with knee or hip
osteoarthritis is still lacking. he objective of this review is to
systematically look at the effectiveness of pain reduction and improvement
of physical function, and at the safety of opioid therapy for
osteoarthritis.


]]></description></item><item><title><![CDATA[( BUPP09364 - 12 January 2009) Maintenance treatments for opiate dependent adolescent.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09364</link><pubDate></pubDate><description><![CDATA[Several studies have been demonstrated that the adolescent (less than 18
years old) substance abuse is a serious and growing problem. In Europe,
estimate of cumulative use of drugs by young people under eighteen vary
greatly by Countries, ranging from 3% to 20%. School survey of adolescents
in seven countries of Latin America, found an estimate 5% of the youths in
this region have tried drugs. In the USA, recent household survey data
indicate that drugs are used on estimate 9% of 12-17 years old. The most
common drugs used by young people worldwide are cannabis and inhalants.
The prevalence of use of heroin and other opioid among adolescents has
markedly increased in the last decade, reaching levels not observed since
the 1960s. The percentage of young people aged between 13 to 18 years who
have used heroin doubled from 0.4% in the early 1990s to 1.0%-1.6% in the
recent years.


]]></description></item><item><title><![CDATA[( BUPP09365 - 12 January 2009) Consumer  satisfaction  with  opioid  treatment services at community pharmacies in Australia.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09365</link><pubDate></pubDate><description><![CDATA[Objective: To explore consumer satisfaction with, and experiences of, a
range of issues associated with the delivery of opioid substitution
treatment  at  community  pharmacies  in  New South Wales, Australia.
Setting: 50  community  pharmacies  providing  opioid  substitution
treatment in New  South  Wales.  Method:  Self-completion  survey
completed  by  508  clients  during  supervised  dosing. Main outcome
measure:  Satisfaction with opioid substitution treatment delivery at
community  pharmacies.  Results:  Sixty-one  percent  of participants
reported being satisfied with their treatment programme. Participants
expressed  a  high  level of satisfaction with most aspects of opioid
substitution  treatment  delivery at their pharmacy (aggregate mean =
8.1/10;  10  =  excellent). However, participants were less satisfied
with  the  level  of  privacy  afforded  at the pharmacy. Thirty-four
percent  reported  that  they  were  made  to  wait longer than other
customers,  and  25%  reported  that the pharmacy staff did not treat
them  the  same  as  other customers. However, 87% reported that they felt
welcomed by the pharmacy staff. Twenty-three percent of clients were
currently  in debt to the pharmacy for nonpayment of dispensing fees.
The  mean  amount  of  current  debt was $71.75, equivalent to
approximately  2  weeks  of  pharmacy  dispensing  fees.  Conclusion:
Community  pharmacies  providing opioid substitution treatment in New
South Wales  appear  to  be  providing  a  level  of service that is
satisfactory   to  the  clients  of  those  services.  However,  many
participants were concerned about a lack of privacy, the high cost of
treatment,  and  being treated differently to other customers.


]]></description></item><item><title><![CDATA[( BUPP09366 - 12 January 2009) Comparison   of   nonhydrolysis   and   hydrolysis  methods  for  the determination of buprenorphine  metabolites  in  urine  by  liquid    chromatography-tandem mass spectrometry.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09366</link><pubDate></pubDate><description><![CDATA[A  highly sensitive and selective method for the direct determination of
buprenorphine  (BUP),  norbuprenorphine  (NBUB),
buprenorphine-3-glucuronide,   and   norbuprenorphine-3-glucuronide   in
urine  was developed  and  validated.  Analytes  of  interest  were
extracted by solid-phase   extraction   on  Bond  Elut  C18,  followed
by  liquid chromatography-electrospray   ionization   tandem  mass
spectrometry analysis  using a Synergy Polar RP column. Gradient elution
was based on a mobile phase consisting of 10 mM ammonium formate adjusted
to pH 3 and acetonitrile. Acceptance criteria for linearity, precision,
and recovery  were  achieved  for  all  analytes.  Intraday  and interday
precisions  were  better  than 12% and 14%, respectively. Calibration
curves were linear for BUP and its metabolites over the concentration
range of 5-250 ng/mL, and correlation coefficients (R(2)) were better
than  0.999.  Limits  of detection and lower limits of quantification
were  0.2-0.4 and 0.7-1.2 ng/mL, respectively. Recoveries were in the
range  of  76-96%.  No  interference  was  detected with other common
drugs. The described method was compared with an in-house hydrolysis
method  using  21 real urine case samples. BUP and NBUP were detected
using  both  methods,  with  higher concentrations obtained using the
direct method. Both methods were linear with correlation coefficients of
0.994  and  0.986 for total BUP and total NBUP, respectively. The
comparison between the direct detection of BUP and its metabolites with
the  analysis  of total BUP and total NBUP using the hydrolysis method is
reported for the first time in this work.


]]></description></item><item><title><![CDATA[( BUPP09380 - 26 January 2009) Effects of transdermal buprenorphine in cancer patients. Results from the Cancer Pain Outcome Research (CPOR) Study Group.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09380</link><pubDate></pubDate><description><![CDATA[Pain  still  afflicts  most cancer patients, mainly in the metastatic
phases, and undertreatment is well documented. Transdermal delivery
systems  (TDS)  could  potentially  have  advantages  over  oral  and
parental  routes, but evidence from comparative trials are scanty. In the
framework  of  a wider initiative, an Outcome Research Study was carried
out  in  Italy  in  2006  to evaluate the effects of various analgesic
options,  particularly  TDS  Buprenorphine.  Despite  the limitations
due  to  the observational design, these findings may be useful  to
clinicians  to  better  judge the value of the drug under evaluation  and
to  help  researchers  to design further comparative studies.


]]></description></item><item><title><![CDATA[( BUPP09381 - 26 January 2009) Opioid  dependent  patients'  experiences  of  and  attitudes towards having their injecting sites examined.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09381</link><pubDate></pubDate><description><![CDATA[Background: This study explored the attitude towards, and experiences of,
injection  site examination among injecting drug users in opioid
treatment  and  the  potential  impact of this routine examination on
information  disclosure  and  future  injection practices. Methods: A
self-complete, anonymous, cross-sectional questionnaire was used with 153
patients recruited  from  three  public  clinics  in  Sydney, Australia.
Results:  The  vast  majority  (97%) had ever injected in
their  upper  limb,  19%  in  their leg, 16% in their neck, and 7% in
their  groin. The majority were 'happy to have their sites inspected'
(78%),  and  felt it was an 'appropriate part of routine examination'
(72%).  Seventy-seven  percent  said  they would be more honest about
recent  injecting,  and 25% would inject in other sites if upper limb
inspection  occurred  at  every  clinical  review.  Conclusions:  The
examination  of  injecting  sites can provide useful corroboration of
self-reported  injecting  drug  use  and an opportunity to offer harm
reduction advice. The inspection of injecting sites was acceptable to most
patients and should form part of routine clinical reviews.


]]></description></item><item><title><![CDATA[( BUPP09382 - 26 January 2009) An  enhanced  method for the review of CD prescribing, based on ePACT data]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09382</link><pubDate></pubDate><description><![CDATA[Following the murders committed by Harold Shopman over a period of 23
years, there have been recommendations and legislation of tighten the
management and monitoring of Controlled Drug prescriptions to prevent such
a tragedy recurring. The recommendations in the Fourth Report of the
Shipman Inquiry were wide ranging and the Government responded by issuing
the command paper "Safer management of Controlled Drugs". Stakeholders
went on to develop safer methods of monitoring and handling of CDs and the
role of the "accountable officer" was developed. Legislation was passed by
Parliament in July 2006 and January 2007 that enacted these changes. Their
arms were: to ensure patients have timely access to the drugs prescribed
for them: to promote the safe and effective use management of CDs; to
limit the opportunities for CDs to be abused or diverted, causing possible
harm to patients; and to share good practice and pick up poor performance
quickly.


]]></description></item><item><title><![CDATA[( BUPP09383 - 26 January 2009) Interventions  to  reduce  HIV transmission related to injecting drug use in prison.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09383</link><pubDate></pubDate><description><![CDATA[The  high  prevalence  of  HIV  infection  and  drug dependence among
prisoners,  combined  with  the  sharing of injecting drug equipment,
make  prisons  a  high-risk  environment for the transmission of HIV.
Ultimately,  this  contributes to HIV epidemics in the communities to
which   prisoners   return   on   their   release.  We  reviewed  the
effectiveness  of  interventions  to  reduce  injecting drug use risk
behaviours  and,  consequently,  HIV  transmission  in  prisons. Many
studies  reported  high  levels of injecting drug use in prisons, and HIV
transmission has been documented. There is increasing evidence of what
prison  systems  can  do to prevent HIV transmission related to injecting
drug use. In particular, needle and syringe programmes and opioid
substitution  therapies have proven effective at reducing HIV risk
behaviours  in  a  wide  range  of prison environments, without resulting
in negative consequences for the health of prison staff or prisoners. The
introduction of these programmes in countries with an existing  or
emergent epidemic of HIV infection among injecting drug
users  is therefore warranted, as part of comprehensive programmes to
address HIV in prisons.


]]></description></item><item><title><![CDATA[( BUPP09384 - 26 January 2009) Medications   for   Stimulant  Abuse:  Agonist-Based  Strategies  and Preclinical  Evaluation  of  the  Mixed-Action  D(2)  Partial Agonist    Aripiprazole (Abilify(R)).]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09384</link><pubDate></pubDate><description><![CDATA[Agonist-based  strategies  and  preclinical  evaluation of the
mixed-action  D2  partial agonist aripiprazole (Abilify) as medications
for stimulant abuse are   reviewed.   Topics   discussed   include:
pharmacological strategies for medications development; monoaminergic
psychomotor stimulants (cocaine and methamphetamine) as agonist-based
strategies   for   medications   development;  partial  agonist-based
strategies  for  medications  development;  preclinical evaluation of
aripiprazole  in  nonhuman  primates; and aripiprazole and D2 partial
agonist-based   strategies   for  medications  development.  Findings
indicate  that  agonist  and  antagonist  effects of aripiprazole are
evident  under  different  experimental  conditions and that, like D2
full  agonists,  aripiprazole  may  have  limited  value for treating
monoaminergic stimulant abuse and addiction.


]]></description></item><item><title><![CDATA[( BUPP09385 - 26 January 2009) Local  Inhibition  of  Rho  Signaling  by  Cell-Permeable Recombinant Protein  BA-210  Prevents  Secondary  Damage  and Promotes Functional Recovery following Acute Spinal Cord Injury.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09385</link><pubDate></pubDate><description><![CDATA[Spinal cord injury (SCI) leads to robust Rho activation at the lesion
site.  Here,  we  demonstrate  that  BA-210,  a cell-permeable fusion
protein derived from C3 transferase, formulated in fibrin sealant and
delivered  topically  onto  the dura matter, diffuses into the spinal
cord  and  inactivates Rho in a dose-dependent manner. Treatment with
BA-210  in  rats with thoracic spinal cord contusion increased tissue
sparing  around the lesion area and led to significant improvement of
locomotor  function. In mice, BA-210 improved functional outcome when
treatment  was  either applied at the time of injury or delayed by 24 h.
In  both rats and mice, treatment with BA-210 was well tolerated. Rats
gained body weight normally, and BA-210 treatment had no impact on  the
development of allodynia. Inactivating Rho with BA-210 holds promise for
treating patients with SCI.


]]></description></item><item><title><![CDATA[( BUPP09386 - 26 January 2009) Neonatal  outcome  following  buprenorphine  maintenance  for  opiate dependency.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09386</link><pubDate></pubDate><description><![CDATA[Methadone  substitution  improves  maternal  and  neonatal  outcomes.
However  methadone  induced  neonatal  abstinence  syndrome  (NAS) is
common. Buprenorphine-exposed neonates may be at a lower risk of NAS.
Currently  in  the Republic of Ireland, buprenorphine does not have a
special  licence  for  use in pregnancy. We describe here the history and
neonatal  outcomes  of  the  first  Irish  woman  maintained  on
buprenorphine  during two pregnancies.Supervised urinanalysis on this
mother  between  and  throughout  both pregnancies did not reveal any
illicit  drug use. She delivered two post-term babies of normal birth
weight and length. The second infant required treatment for NAS for 21
days with morphine sulphate. Although the use of buprenorphine in
pregnancy  does  not remove the possibility of NAS, neonatal outcomes of
buprenorphine-maintained  women compares favourably to methadone. As  the
use of buprenorphine becomes more established in Ireland, the management
of buprenorphine-exposed neonates will become more common.


]]></description></item><item><title><![CDATA[( BUPP09387 - 26 January 2009) Pegylated interferon alfa-2a (peg-2a) plus ribavirin (rbv) for patients with chronic Hepatitis C virus (HCV) on opioid pharmacotherapy: virological outcomes, psychological impact and safety.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09387</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09388 - 26 January 2009) High rates of sustained virological response in HCV-infected injection drug users receiving directly observed therapy  with peginterferon alfa-2a and once daily ribavirin.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09388</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09389 - 26 January 2009) Prediction  of  Drug Clearance by Glucuronidation from in Vitro Data: Use  of  Combined  Cytochrome  P450  and  UDP-Glucuronosyltransferase Cofactors in Alamethicin-Activated Human Liver Microsomes.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09389</link><pubDate></pubDate><description><![CDATA[Glucuronidation   via   UDP-glucuronosyltransferase   (UGT)   is   an
increasingly  important  clearance  pathway.  In this study intrinsic
clearance  (CLint)  values  for  buprenorphine,  carvedilol, codeine,
diclofenac, gemfibrozil, ketoprofen, midazolam, naloxone, raloxifene, and
zidovudine were determined in pooled human liver microsomes using the
substrate  depletion  approach.  The  in  vitro  clearance  data
indicated  a varying contribution of glucuronidation to the clearance of
the  compounds  studied,  ranging from 6 to 79% for midazolam and
gemfibrozil,  respectively.  The  CLint  was  obtained  using  either
individual  or  combined cofactors for cytochrome P450 (P450) and UGT
enzymes  with  alamethicin activation and in the presence and absence of
2%  bovine  serum albumin (BSA). In the presence of combined P450 and
UGT  cofactors,  CLint  ranged  from  2.8 to 688 mu l/min/mg for
zidovudine   and   buprenorphine,  respectively;  the  clearance  was
approximately  equal  to  the sum of the CLint values obtained in the
presence  of  individual  cofactors.  The unbound intrinsic clearance
(CLint, u) was scaled to provide an in vivo predicted CLint; the data
obtained  in  the  presence  of combined cofactors resulted in 5-fold
underprediction on average. Addition of 2% BSA to the incubation with
both  P450  and  UGT  cofactors  reduced  the  bias  in the clearance
prediction, with 8 of 10 compounds predicted within 2-fold of in vivo
values  with the exception of raloxifene and gemfibrozil. The current
study  indicates the applicability of combined cofactor conditions in the
assessment  of  clearance  for  compounds  with  a  differential
contribution  of  P450  and  UGT  enzymes  to  their  elimination. In
addition,  improved  predictability of microsomal data is observed in the
presence of BSA, in particular for UGT2B7 substrates.


]]></description></item><item><title><![CDATA[( BUPP09390 - 26 January 2009) Buprenorphine   transdermal   system   in   chronic   pain   due   to osteoarthritis.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09390</link><pubDate></pubDate><description><![CDATA[Objective: Evaluate the safety and efficacy of the Buprenorphine
Transdermal System (BTDS) compared to placebo in subjects with chronic
pain due to osteoarthritis of the hip/knee. Methods: Randomized,
double-blind, placebo-controlled, maintenance-of-analgesia design study
consisting of 3 phases: open-label run-in (21 days), double-blind
evaluation (28 days), open-label extension (6 months), During the
open-label run-in period, subjects were titrated to a dose of BTDS (5mg,
10mg or 20mg) that provided adequate analgesia with acceptable
tolerability. The subjects meeting protocol-specified criteria for
"adequate analgesia" were randomized to BDTS or placebo in the
double-blind phase. The subjects continued taking their pre-study chronic,
stable non-opioid analgesics, discontinued all intermittent analgesics,
and were provided acetaminophen for breakthrough pain. The primary
efficacy parameter was time to development of inadequate analgesia. Pain
relief was also assessed with mean daily maximum pain right now' scores
over last 7 days of study drug treatment. Results: 326 subjects age 36-76
with OA for 1 year, currently treated with stable doses of non-opioid
analgesics or intermittent doses of opioid and non-opioid analgesics were
randomized and analyzed for efficacy and safety. Subjects reported
moderate to severe pain during the 14 days prior to enrollment. the median
time to inadequate analgesia was 7 days in placebo versus 21 days in
BTDS-treated subjects (p=0.0026,Cox regression). In total, 66% of placebo
and 51% of BTDS-treated subjects met the protoc-specified criteria for
inadequate analgesia. Mean daily maximum 'pain right now' scores were
lower in BDTS (3.2 +0.14) compared to placebo-treated subjects (3.8 +
0.15; P = 0.0066). Adverse events reported were those typically observed
with other opioids, No clinically important changes in labs, ECGs or
vitals were noted. Conclusion: BTDS treatment in this study showed greater
efficacy than placebo and was generally well tolerated in patients with
chronic pain die to OA of the hip/knee.



]]></description></item><item><title><![CDATA[( BUPP09391 - 03 February 2009) Pharmacokinetics  of  buprenorphine  after  single-dose  subcutaneous administration in red-eared sliders (Trachemys scripta elegans).]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09391</link><pubDate></pubDate><description><![CDATA[Buprenorphine,  a  mu  opioid  receptor  agonist, is expected to be a
suitable analgesic drug for use in reptiles. However, to date, dosage
recommendations have been based on anecdotal observations. The aim of
this  study was to provide baseline pharmacokinetic data in red-eared
sliders  (Trachemys scripta elegans) targeting a plasma level of 1 ng /ml
reported effective for analgesia in humans. Serial blood samples were
taken after subcutaneous injection of buprenorphine, and plasma
buprenorphine    levels    were    measured    by   radioimmunoassay.
Pharmacokinetic parameters of a lower dose (0.02 mg/kg) injected into the
forelimb  were compared with a higher dose (0.05 mg/kg) given in the
same  forelimb as well as a lower dose (0.02 mg/kg) given in the hind
limb  of  the  same  animals  with  2 wk between studies. After
administration  of  0.05  mg/kg  in  the  front  limb, 85% of animals
maintained  the  minimum effective plasma level for 24 hr, while only 43%
of  animals  maintained  this level after 0.02 mg/kg. After hind limb
injection at 0.02 mg/kg, maximum plasma concentrations and areas under
the  buprenorphine concentration-time curve were less than 20% and 70%,
respectively, of values after forelimb injection, consistent with
substantial  first pass extraction by the liver. Furthermore, a secondary
rise in the buprenorphine level was found after having only a  hind  limb
injection, probably from enterohepatic recirculation of glucuronidated
drug. In conclusion, buprenorphine dosages of at least 0.075  mg/kg s.i.d.
should be appropriate for evaluation of analgesia efficacy,  and  front
limb  administration may be preferable to hind limb administration for
optimal drug exposure.


]]></description></item><item><title><![CDATA[( BUPP09392 - 03 February 2009) DOTS in drug addicts with TB : Delhi experience.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09392</link><pubDate></pubDate><description><![CDATA[BACKGROUND:  Drug  abuse  is  on  the rise. Drug addiction lowers the
general  immunity of the body. Tuberculosis is known to be one of the
major  infectious  diseases with a high incidence among drug addicts.
Treatment  of drug addicts suffering from tuberculosis is a challenge to
the  treating  physician.  METHODS: An interventional prospective study
which  involved  free  de-addiction drugs and motivation along with  free
anti tubercular drugs under Revised National Tuberculosis Programme  was
undertaken  among  drug  addicts.  Sixty drug addicts suffering  from
tuberculosis,  registered under RNTCP in SPM marg TB Clinic  (Pili
Kothi)  between 2002-2007 and treated under DOTS along with de-addiction
treatment  by  an  NGO  (Sharan) formed the study sample.  OBJECTIVES:
Objectives  of  the study were: a) To study the profile of drug addicts
with tuberculosis, b) To assess the success results  of  DOTS  in  drug
addicts with tuberculosis (along with de-addiction treatment). RESULTS:
Extensive counselling for de-addiction and  motivation  of  the  study
patients along with nutritional food supplements  improved  the compliance
and adherence to treatment with equal  success  rates  as  in  non-addict
tuberculosis patients. The overall  success  rate in drug addicts was
83.3%. The default rate of 3.3% and failure rate of just 1.7% among study
group were also within the  permissible  range  of RNTCP (< 4%).
CONCLUSION: DOTS along with supplementary intervention was observed to be
quite effective in drug addicts with TB.


]]></description></item><item><title><![CDATA[( BUPP09393 - 03 February 2009) Integration   of  viral  hepatitis  services  into  opioid  treatment programs.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09393</link><pubDate></pubDate><description><![CDATA[Opioid treatment programs (OTPs) dispense methadone and buprenorphine
under  specific  federal  regulations  to  individuals diagnosed with
opioid  dependence.  OTPs  can  provide  a  comprehensive therapeutic
milieu, often including   primary   medical   care,  psychosocial
counseling,    vocational    rehabilitation,    ongoing   performance
monitoring,  and other vital services. Because of the high prevalence of
infectious  diseases,  particularly  hepatitis C virus infection, model
OTPs  are developing comprehensive care and treatment programs that
integrate general medical and infectious disease-related medical care
with  substance  abuse  and mental health services. Integrating hepatitis
care  services  in  the substance abuse treatment settings fosters access
to care for patients with multiple comorbidities, many who otherwise would
not receive needed care. Improving health related outcomes  for  this
patient population with complex medical problems requires  an  advanced
integrated model of care for OTPs that can be exemplified   through
establishing   resources  needed  to  prevent hepatitis  infection as
standard of care. Outcomes management becomes possible  through enhancing
current capability of existing dispensing programs. This  may  serve  as
a  national  model  for highly cost-efficient  healthcare  that  has  a
measurable  outcome  of improved
health.


]]></description></item><item><title><![CDATA[( BUPP09394 - 03 February 2009) Adverse reactions to drug withdrawal.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09394</link><pubDate></pubDate><description><![CDATA[Withdrawal  from  a  wide  range  of  drugs  may precipitate clinical
syndromes  in  susceptible  individuals. We review recent advances in the
understanding of the pathophysiology of some of these reactions, the
clinical features and consider the available treatment options.


]]></description></item><item><title><![CDATA[( BUPP09395 - 03 February 2009) Low-dose strong opioid (LDSO) - Treatment of pain in osteoarthritis.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09395</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09396 - 03 February 2009) Medications, drugs and alcohol in road traffic.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09396</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09397 - 03 February 2009) "Maintenance"  treatment  of  addiction:  To whose credit, and why it matters.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09397</link><pubDate></pubDate><description><![CDATA[It has been stated that credit for introducing methadone "maintenance"
treatment of opiate dependence does not belong to Drs. Vincent Dole and
Marie Nyswander, but rather to a Canadian.  Dr. Robert Halliday.  One
writer put it this way: "Halliday began methadone treatment for heroin
addiction in Vancouver, British Columbia, in the late 1950s and introduced
a methadone maintenance program in 1963" (Bayes, 2007).  Can and should
he, in fact, be credited with first introducing the concept and practice
of "maintenance" treatment of addiction?  The answer seems to be "no".


]]></description></item><item><title><![CDATA[( BUPP09398 - 09 February 2009) Treatment of opioid withdrawal]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09398</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09399 - 09 February 2009) General  practitioner  views on drug-assisted rehabilitation and the    Norwegian substance abuse reform]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09399</link><pubDate></pubDate><description><![CDATA[Due  to  increased  use of injected heroin in Norway the official  policy
has  shifted  from an ideal drug-free position to a
more  realistic  harm  reduction,  where  one element is substitution
therapy.  This  implies controlled distribution of opiates, methadone and
buprenorfine to selected individuals, combined with close follow-up  and
social rehabilitation. After the "substance abuse reform" was implemented
in  2004,  a  number  of  treatment facilities have been included  in
the  ordinary  specialist  health  care system, and the clients  who can
document their right to <<necessary health support>> have  obtained
ordinary  patient  rights  according  to the Patients Rights  Act.
General  practitioners  are supposed to follow up these patients,  by
prescribing opiates to those eligible for substitution therapy,  and by
participating in local <<responsibility groups>>. We wanted  to
investigate  how  general  practitioners'  perceive their
involvement in substitution therapy, and to see whether this view had
changed   from   2000   to   2006.   MATERIAL   AND  METHODS:  Postal
questionnaires  were  sent to 1606 doctors in 2000 and to 1400 of the
same  doctors  in 2006. Of the 1318 (82 %) who responded in 2000, 227 were
general practitioners and 78 were municipal medical officers; of the  966
(69  %)  who  responded  in  2006, 227 were regular general
practitioners.  208  of  these had also responded in 2000. In 2006 we
also  asked  the  doctors  about  the  recent substance abuse reform.
RESULTS:  53  %  of  the  general  practitioners  were  in  favour of
substitution  therapy  with methadone or buprenorfine; 50 % said they
might  prescribe  the drugs themselves and 77 % were positive towards
participating  in  "responsibility  groups".  Two  thirds  felt  that
transferral  of  responsibility  for  patients  with  substance abuse
problems  to  the specialist health care service, was a necessary and
useful  reform.  The  fraction  of  doctors  with a positive attitude
towards  substitution  therapy  increased slightly from 2000 to 2006, but
individual  viewpoints varied largely. INTERPRETATION: Political and
cultural rather than medical arguments seem to dominate doctors' views on
these issues.


]]></description></item><item><title><![CDATA[( BUPP09400 - 09 February 2009) Tolerance to the antinociceptive effects of peripherally administered    opioids. Expression of beta-arrestins]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09400</link><pubDate></pubDate><description><![CDATA[Tolerance  to  peripheral  antinociception  after chronic exposure to
systemic morphine was assessed in mice with chronic CFA-inflammation;
cross-tolerance  to  locally  administered mu, delta and kappa-opioid
agonists  and  levels of beta-arrestins in the injured paw, were also
evaluated.  Tolerance was induced by the subcutaneous implantation of a
75  mg  morphine-pellet,  and  antinociception  evaluated with the
Randall-Selitto  test,  5  min  after  the  subplantar  injection  of
morphine,   fentanyl,   buprenorphine,   DPDPE,   U-50488H   or  CRF.
Experiments  were  performed  in  the  absence  and  presence of
CFA-inflammation, in animals implanted with a morphine or placebo pellet.
Beta-arrestin protein levels were determined by western blot. In mice
without    inflammation,    subplantar   opioids   did   not   induce
antinociception,  while  during CFA-inflammation, all drugs generated
dose-response  curves with an order of potency of: U-50488H < DPDPE <
morphine  <  buprenorphine < fentanyl << CRF. During CFA-inflammation
plus  morphine-pellet,  the potency of fentanyl decreased 1.25 times,
while  that  of  DPDPE,  U-50488H  and  CRF  diminished approximately
2.5-4.3  times.  For  each  drug,  the  ratio between the ED(50)'s in
tolerant  and  naive animals, was significantly higher than 1 (except
for   buprenorphine   and  fentanyl),  demonstrating  partial
cross-tolerance  to  systemic  morphine.  Inflammation  induced  a
twofold increase   in  beta-arrestin  expression  (p<0.01),  and  the
levels decreased  after  acute morphine exposure (p<0.05). Tolerance did
not alter beta-arrestins, but partially prevented the increase induced by
inflammation.  The  results  suggest  that  peripheral beta-arrestins
could   facilitate   peripheral   OR-desensitization   and  tolerance
development. Clinically, the experiments could be useful to establish the
effectiveness  of  local  opioid administration in patients with
musculoskeletal pain, chronically receiving morphine analgesia.


]]></description></item><item><title><![CDATA[( BUPP09401 - 09 February 2009) Impact  of  a  prescription monitoring program on doctor-shopping for    high dosage buprenorphine]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09401</link><pubDate></pubDate><description><![CDATA[Doctor-shopping (simultaneous use of several physicians by a patient)
is  one  of  the  most  frequent  ways  of  diversion  for prescription
drugs.  A  specific  method  was  used  to  assess  the evolution of
doctor-shopping for High Dosage Buprenorphine (HDB) in a French  region
from  2000  to  2005 and the impact of a prescription monitoring  program
for  HDB implemented in 2004. METHODS: Data from eight  periods
(semesters  of years 2000, 2002, 2004, and 2005) were extracted   from  a
prescription  database.  Three  quantities  (the delivered,  the
prescribed,  and  the doctor-shopping quantity) were computed for each
patient. The total doctor-shopping quantity and the doctor-shopping
ratio  (percentage of buprenorphine obtained through doctor-shopping) were
used to evaluate the diversion of HDB among the population.  The total
prescribed quantity and the number of patients treated regularly were used
as indicators of the access to treatment.  RESULTS:  The  doctor-shopping
ratio increased from 1st semester 2000 to 1st semester 2004 (from 14.9 to
21.7%) and then decreased to 16.9% in 2nd semester 2005. The total
doctor-shopping quantity followed the same  evolution.  The number of
patients treated remained stable from 1st  semester  2000  to  2nd
semester  2005. The prescribed quantity increased  from  1st semester 2000
to 2nd semester 2002, decreased in 1st  semester  2004  (4163  g) and then
remained stable. CONCLUSIONS:  After  a  four-year increase of the
diversion through doctor-shopping for  buprenorphine  the  beginning  of
the  prescription  monitoring program  was  concomitant  with  a marked
decrease of doctor-shopping indicators without notable impact on the
access to treatment.



]]></description></item><item><title><![CDATA[( BUPP09402 - 09 February 2009) Methicillin-Susceptible  Staphyloccocus  aureus (MSSA) Bacteremias in    Intravenous  Buprenorphine  Abusers:  An  Emerging Pathogen in Highly    Regulated Singapore]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09402</link><pubDate></pubDate><description><![CDATA[Buprenorphine was licensed in Singapore in 2002 for treatment of opiate
addiction.  MSSA bacteremia has occurred in intravenous drug addicts
(IVDAs) in Singapore who crush and inject buprenorphine intended for
sublingual use.  We attempted to quantify this phenomenon in our 900 bed
teaching hospital.  Method:  All cases of community acquired MSSA
bacteremias in 2005 were retrospectively reviewed to identity patients who
abused buprenorphine.  Overall hospitalizations for substance abuse at our
hospital based on International Classification of Disease-9 (ICD-9) coding
of discharge diagnoses was accessed.  Results:  12/99 (12.1%) of our
community based MSSA bacteremias were patients using iv buprenorphine.
They were young (32.9 + 8.8years) and 11/12 males.  11 patients had
endocarditis, 9 had septic pulmonary emboli.  6 had musculoskeletal
complications (pyomyositis, epidural abscess, septic arthritis).  4 deaths
(33%) ensued.  Since 2002 there is a rise in substance abuse
hospitalizations (Fig 1).  this is reasonably explained by this spate of
buprenorphine misuse cases.  Discussions:  Though therapy of opiate
dependence is critical, unsupervised use of buprenorphine can be
associated with considerable infections complications.  Hence the need for
strict control measures including supervised dispensing of buprenorphine
and meticulous post marketing surveillance.


]]></description></item><item><title><![CDATA[( BUPP09403 - 09 February 2009) Novel medications to treat addictive disorders]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09403</link><pubDate></pubDate><description><![CDATA[Recent  discoveries  about the effects of drugs of abuse on the brain
and  the  mechanisms  of  their  addictions;  new chemical compounds,
including  immunotherapies;  and new actions of available medications are
offering many opportunities for the discovery and development of novel
medications   to   treat  addictive  disorders.  Furthermore,
advancements in the understanding of the genetic and epigenetic basis of
drug  addiction  and  the  pharmacogenetics  of the safety and/or
efficacy  of  the  medications  are  providing opportunities for more
individualized    pharmacotherapy   approaches.   Although   multiple
medications  have  been  investigated for treating addictions, only a
handful have shown acceptable safety and efficacy and are approved by the
US Food and Drug Administration. This article reviews the current
medications  that are medically safe and have shown promising results
for   treating   opioid,   cocaine,   methamphetamine,  and  cannabis
addictions.



]]></description></item><item><title><![CDATA[( BUPP09404 - 09 February 2009) A  French prospective observational study of the treatment of chronic    hepatitis C in drug abusers: A commentary.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09404</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09405 - 09 February 2009) Potential use of dopamine partial agonists in cocaine addiction]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09405</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09424 - 16 February 2009) Buprenorphine tapering schedule and illicit opioid use]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09424</link><pubDate></pubDate><description><![CDATA[To  compare  the  effects  of  a  short  or long taper schedule after
buprenorphine  stabilization  on  participant outcomes as measured by
opioid-free  urine  tests at the end of each taper period.This multi-site
study sponsored by Clinical Trials Network (CTN, a branch of the US
National Institute on Drug Abuse) was conducted from 2003 to 2005 to
compare  two  taper  conditions  (7  days and 28 days). Data were
collected  at  weekly  clinic visits to the end of the taper periods, and
at  1-month  and 3-month post-taper follow-up visits.Eleven out-patient
treatment  programs  in 10 US cities.Non-blinded dosing with Suboxone  (R)
during the 1-month stabilization phase included 3 weeks of flexible dosing
as determined appropriate by the study physicians.   A  fixed  dose  was
required for the final week before beginning the    taper  phase.The
percentage  of  participants  in  each  taper group providing  urine
samples  free  of illicit opioids at the end of the taper  and  at
follow-up.At  the  end of the taper, 44% of the 7-day taper  group  (n =
255) provided opioid-free urine specimens compared to 30% of the 28-day
taper group (n = 261; P = 0.0007). There were no differences  at  the
1-month and 3-month follow-ups (7-day = 18% and 12%;  28-day  =  18% and
13%, 1 month and 3 months, respectively).For individuals  terminating
buprenorphine  pharmacotherapy  for  opioid dependence,  there  appears
to  be  no  advantage  in prolonging the duration of taper.


]]></description></item><item><title><![CDATA[( BUPP09423 - 16 February 2009) Comparison  of  Side Effects between Buprenorphine and Meloxicam Used   Postoperatively in Dutch Belted Rabbits (Oryctolagus cuniculus)]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09423</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09422 - 16 February 2009) Model  for  Clinical  Evaluation  of  Perioperative  Analgesia in the Rabbit]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09422</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09421 - 16 February 2009) Castration  Eliminates  Conspecific  Aggression  in Group-housed Male Surveillance Mice]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09421</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09419 - 16 February 2009) Evaluation  of  Perioperative  Analgesia  on  Behavioral Tests in the Chronic Constriction Injury Neuropathic Pain Model]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09419</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09418 - 16 February 2009) In Vitro Skin Permeation of Buprenorphine Transdermal Patch.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09418</link><pubDate></pubDate><description><![CDATA[This  study  was  aimed to develop the new transdermal formulation to
improve  the  permeability  of  buprenorphine. The apparent partition
coefficients  of  buprenorphine were measured using the buffers at pH 1.2
to  10.0  as  aqueous phase. The solubility of buprenorphine was 12.97 mu
g/mL in the 0.1 M phosphate buffer at pH 6.8. The influences of  vehicles
at different pH, adhesives, and permeation enhancers on the  penetration
of  buprenorphine  through  nude  mouse  skin  were investigated  using
the static Franz diffusion cells. The permeation parameter  J(ss)  of
buprenorphine increased along with the reduction of  the  pH  of receptor
fluid, and the vehicle at pH 6.8 was used in the   following  skin
permeation  studies.  The  pressure  sensitive adhesives  (PSA)  including
polyisobutylene (PIB), polystyrene-block-
polyisoprene-block-polystyrene  (SIS),  and  acrylic  adhesives  were
evaluated. The permeability of buprenorphine was higher in the PIB or SIS
adhesives than that in the acrylic adhesives under the condition without
enhancer.  When combined the enhancers with propylene glycol (PG)  to
improve  the  penetration of buprenorphine, the permeation-   enhancing
effects  of  enhancers were in the following order: lauric acid >
linolenic acid > menthol > oleic acid > N-methyl-2-pyrrolidone (NMP)  >
laurocapram > glabridin. Finally, a matrix-type transdermal delivery
system  for  buprenorphine  was  formulated  using  acrylic adhesive,  PG,
and lauric acid. The J(ss) parameter was 2.68 +/- 0.20 mu  g/cm(2)/h  and
buprenorphine permeated across the nude mouse skin was 31.68%.


]]></description></item><item><title><![CDATA[( BUPP09417 - 16 February 2009) The  dynorphin/kappa  opioid  receptor  system:  a new target for the  treatment of addiction and affective disorders?]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09417</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09415 - 16 February 2009) Mucositis in the treatment of haematological malignancies.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09415</link><pubDate></pubDate><description><![CDATA[Mucositis in the treatment of hematological malignancies is reviewed.
Topics   discussed   include   epidemiology,  pathobiology,  clinical
features  and  diagnostic  tools,  and  therapeutic approach. Mucosal
response to cytotoxic insults appears to be controlled by both global
factors  and  tissue-specific  factors.  Interactions  between  these
elements,  coupled  with  underlying  genetic influences, most likely
govern  the  risk,  course,  and  severity of regimen-related mucosal
injury.  Thus  far,  there  is  no  predictive  model  of the risk of
mucositis,  at  the  beginning  of  therapy.  However,  by exploiting
molecular  diagnostic methods, pharmacogenomics will eventually allow
routine determination of a patient's genotype, enabling the physician to
tailor the drug and dosage to every patient.


]]></description></item><item><title><![CDATA[( BUPP09414 - 16 February 2009) The  clinical  content  of  preconception care: alcohol, tobacco, and illicit drug exposures.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09414</link><pubDate></pubDate><description><![CDATA[Substance  abuse  poses significant health risks to childbearing-aged
women  in  the  United  States and, for those who become pregnant, to
their  children.  Alcohol is the most prevalent substance consumed by
childbearing-aged  women,  followed  by  tobacco,  and  a  variety of
illicit  drugs.  Substance  use  in the preconception period predicts
substance  use during the prenatal period. Evidence-based methods for
screening  and  intervening  on harmful consumption patterns of these
substances have been developed and are recommended for use in primary care
settings for women who are pregnant, planning a pregnancy, or at risk
for  becoming  pregnant.  This  report  describes  the scope of  substance
abuse in the target population and provides recommendations from  the
Clinical Working Group of the Select Panel on Preconception Care,
Centers  for  Disease  Control  and Prevention, for addressing alcohol,
tobacco, and illicit drug use among childbearing-aged women.


]]></description></item><item><title><![CDATA[( BUPP09413 - 16 February 2009) Introduction  to a Symposium on Recent Advances in the Development of  Medications  for  Drug Abuse Treatment in Honor of Jack H. Mendelson,  MD.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09413</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09411 - 16 February 2009) Treating  drug  abuse  and  addiction in the criminal justice system:  Improving public health and safety.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09411</link><pubDate></pubDate><description><![CDATA[Despite  increasing evidence that addiction is a treatable disease of the
brain, most individuals do not receive treatment. Involvement in the
criminal  justice system often results from illegal drug-seeking behavior
and  participation  in  illegal activities that reflect, in part,
disrupted  behavior  ensuing  from  brain changes triggered by repeated
drug use. Treating drug-involved offenders provides a unique opportunity
to  decrease  substance  abuse  and  reduce  associated criminal
behavior.  Emerging  neuroscience  has  the  potential  to transform
traditional  sanction-oriented public safety approaches by providing  new
therapeutic strategies against addiction that could be used   in   the
criminal  justice  system.  We  summarize  relevant neuroscientific
findings  and evidence-based principles of addiction    treatment  that,
if implemented in the criminal justice system, could help  improve
public  heath  and  reduce  criminal  behavior.


]]></description></item><item><title><![CDATA[( BUPP09410 - 16 February 2009) Delayed-onset  neutropenia  associated  with divalproex sodium; Acute psychosis  induced  by  clarithromycin;  Acute  phase  reaction  with ibandronate;  Duloxetine-associated  tachycardia; Hepatotoxicity with valerian;  Serotonin  syndrome  with  a  single dose of buprenorphine  /naloxone.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09410</link><pubDate></pubDate><description><![CDATA[Publisher: Facts and Comparisons, 111 W. Port Plaza, Ste. 300, St. Louis,
MO 6314603098.


]]></description></item><item><title><![CDATA[( BUPP09409 - 16 February 2009) Short- and intermediate-term efficacy of buprenorphine TDS in chronic painful neuropathies: Research report.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09409</link><pubDate></pubDate><description><![CDATA[Buprenorphine  is a potent opioid available as a transdermal delivery
system  (TDS)  formulation.  This  open-label  study investigated its
safety,  tolerability,  and  efficacy  in  30  patients  with chronic
painful neuropathy. Subjects with visual analogue scale (VAS) score 5
under stable analgesic treatment were entered. The starting dosage of 35
mug/h  was  increased  up to 70.0 mug/h in case of unsatisfactory pain
control as assessed by fortnightly visits. The primary endpoint was  the
number of patients achieving at least 30% pain relief at day 42  visit.
Treatment  was  safe over the study period. Nine patients dropped  out
for  side  effects, mostly nausea and daily sleepiness.  Buprenorphine
TDS  was  well  tolerated  in  21  patients.  Thirteen patients  achieved
>30% of pain relief at day 42 visit. Five patients needed  to  increase
the dosage to 52.5 mug/h. Eight patients did not meet  the  primary
outcome, but none allowed increasing the dosage to 70  mug/h,  and  four
patients withdrew consent to continue the study before  day 42 visit
because of a 'fear to become addicted,' although 40%  had  obtained  VAS
reduction.  In  our study, which needs to be confirmed by a controlled
trial, buprenorphine TDS induced clinically meaningful  pain relief in
about 40% of patients with chronic painful   neuropathy,  suggesting  its
use  as  a third-line treatment.


]]></description></item><item><title><![CDATA[( BUPP09408 - 16 February 2009) Inhibition  of  inducible  nitric  oxide  synthase  reduces  an acute  peripheral  motor  neuropathy produced by dermal burn injury in mice:   Research report.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09408</link><pubDate></pubDate><description><![CDATA[The  systemic  inflammatory  response  produced  by  a full-thickness
dermal  burn injury is associated with a peripheral motor neuropathy.  We
previously  reported  that  a  20%  body surface area (BSA)
full-thickness   dermal  burn  in  C57BL6  mice  produced  structural  and
functional  deficits in motor axons at a distance from the burn site.
The  etiology  of the neuropathy, however, is not well characterized.
Burn  injury  leads  to  an  increase  in  production  of a number of
proinflammatory mediators, including nitric oxide (NO). We tested the
hypothesis  that  dermal burn-induced motor neuropathy is mediated by
increased  production of NO. NO synthase (NOS) activity was inhibited
following  a 20% BSA full-thickness burn by injection of non-specific NOS
inhibitor, nitro-l-arginine methyl ester or inducible NOS (iNOS)
inhibitors,   l-N6-(1-iminoethyl)  lysine,  and  aminoguanidine.  NOS
inhibitors  also  prevented  the reduction in ventral roots mean axon
caliber  and  the decrease in a motor nerve conduction velocity (MCV)
following  burn.  iNOS  knockout  mice  prevented MCV decrease in the
first  3  days  post-burn,  but  iNOS  knockout MCV was significantly
reduced  at  7-14  days  post-burn.  These  results  suggest  that an
increase in NO production generated by systemic inflammatory response
pathways   after  burn  injury  contributes  to  the  development  of
structural  and functional deficits in peripheral motor axons.


]]></description></item><item><title><![CDATA[( BUPP09407 - 16 February 2009) Substance-related  problems and treatment among men who have sex with men in comparison to other men in Chicago.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09407</link><pubDate></pubDate><description><![CDATA[This study compares a sample of urban men who have sex with men (MSM)
with  a  general  population  sample of men in the same city on
self-reported  problems  with  substance  use indicative of dependence and
history  of  substance  use  treatment.  Both  samples  were randomly
selected  using  multistage  probability  methods.  All  participants
completed    audio   computer-assisted   self-interviews,   including
questions  on  substance  use,  problems  related  to  substance  use
experienced  in  the past 12 months, and substance treatment. Problem use
of  alcohol,  marijuana,  and  cocaine  did  not  differ between samples.
Compared  to men in the general population sample, MSM were significantly
more  likely to experience problems related to the use of  sedatives,
tranquilizers,  or prescription pain relievers. Among MSM,  history  of
substance treatment was associated with a positive HIV  test,  and
treatment usually preceded HIV diagnosis. Research is needed  on
effective  methods for integrating HIV prevention for MSM   into
substance  treatment settings, including physician-administered
buprenorphine  treatment  for  opiate addiction.


]]></description></item><item><title><![CDATA[( BUPP09420 - 16 February 2009) Effect of Buprenorphine Analgesia on Growth in Neonatal Mice]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09420</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09416 - 16 February 2009) (<< Puffy hands >> syndrome)]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09416</link><pubDate></pubDate><description><![CDATA[]]></description></item><item><title><![CDATA[( BUPP09412 - 16 February 2009) Reinforcing   Effects   of   Stimulants  in  Humans:  Sensitivity  of    Progressive-Ratio Schedules.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09412</link><pubDate></pubDate><description><![CDATA[Drug self-administration methodologies have been developed for use in
humans  to  model naturalistic stimulant drug-taking behaviors. These
methodologies  use  a number of schedules of reinforcement, including
progressive-ratio  schedules.  As the name implies, in a progressive-ratio
schedule, the response requirement for each subsequent delivery of  drug
increases,  and  the  primary outcome variable is often the break  point
(i.e.,  the  last  ratio  completed  to  receive a drug delivery).  These
schedules  have  been  used  in  a number of human laboratory  studies
evaluating the reinforcing effects of stimulants.  The results of these
studies have demonstrated that progressive-ratio schedules   are
sensitive  to  manipulation  of  a  pharmacological variable,  dose,  and
to nonpharmacological variables contributing to stimulant  drug effects.
In addition, findings with progressive-ratio schedules  are  largely
concordant with clinical findings, suggesting that  drug
self-administration  under these schedules has predictive validity  in
terms  of drug abuse and dependence. Future research is necessary,
however, to understand better how pharmacological factors like  route  of
administration,  onset  of effects, and pretreatment influence  the
reinforcing  effects of stimulants under progressive-ratio schedules.


]]></description></item><item><title><![CDATA[( BUPP09406 - 16 February 2009) Home buprenorphine/naloxone induction in primary care]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09406</link><pubDate></pubDate><description><![CDATA[Buprenorphine  can  be used for the treatment of opioid dependence in
primary   care   settings.  National  guidelines  recommend  directly
observed  initial dosing followed by multiple in-clinic visits during the
induction  week.  We offered buprenorphine treatment at a public hospital
primary  care  clinic  using  a  home, unobserved induction protocol.
Participants  were  opioid-dependent  adults  eligible for office-based
buprenorphine  treatment.  The  initial physician visit included
assessment,   education,   induction   telephone   support instructions,
an  illustrated  home induction pamphlet, and a 1-week
buprenorphine/naloxone  prescription.  Patients initiated dosing off-site
at  a  later  time.  Follow-up  with  urine  toxicology testing occurred
at  day  7  and  thereafter  at  varying intervals. Primary outcomes
were  treatment  status  at  week  1  and induction-related events:
severe precipitated withdrawal, other  buprenorphine-prompted withdrawal
symptoms,  prolonged  unrelieved  withdrawal, and serious adverse  events
(SAEs). Patients (N = 103) were predominantly heroin users   (68%),  but
also  prescription  opioid  misusers  (18%)  and    methadone  maintenance
patients (14%). At the end of week 1, 73% were retained,  17%  provided
induction  data  but  did not return to the clinic,  and  11%  were  lost
to  follow-up  with  no induction data available.  No  cases  of  severe
precipitated withdrawal and no SAEs were  observed.  Five  cases  (5%) of
mild-to-moderate buprenorphine-prompted   withdrawal   and   eight  cases
of  prolonged  unrelieved withdrawal  symptoms  (8%  overall, 21% of
methadone-to-buprenorphine inductions)  were  reported.
Buprenorphine-prompted  withdrawal  and prolonged  unrelieved  withdrawal
symptoms  were not associated with treatment status at week 1. Home
buprenorphine induction was feasible and appeared safe. Induction
complications occurred at expected rates and  were  not  associated with
short-term treatment drop-out.


]]></description></item><item><title><![CDATA[( BUPP09367 - 15 January 2009) Cost analysis of clinic and office-basaed treatment of opioid dependence: Results with methadone and buprenorphine in clinically stable patients.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09367</link><pubDate></pubDate><description><![CDATA[The cost of providing and receiving treatment for opioid dependence can
determine its adoption. To compare the cost of clinic-based methadone (MC,
n=23), office-based methadone (MO, n=21), and office-based buprenorphine
(BO, n=34) we performed an analysis of treatment and patient costs over 6
months of maintenance in patients who had previously been stabilized for
at least 1 year. We performed statistical comparisons using ANOVA and
chi-square tests and performed a sensitivity analysis varying cost
estimates and intensity of clinical contact. The cost of providing 1 month
of treatment per patient was $147 (MC), $220 (MO) and $336 (BO) (p<0.001).
Mean monthly medication cost was $93 (MC), $86 (MO) and $257 (BO)
(p<0.001). The cost to patients was $92 (MC), $63 (MO) and $38 (BO)
(p=0.102). Sensitivity analyses, varying cost estimates and clinical
contact, result in total monthly costs of $117 to $183 (MC), $149 to $279
(MO), $292 to $499 (BO). Monthly patient costs were $84 to $133 (MC), $55
to $105 (MO) and $34 to $65 (BO). We conclude that providing clinic-based
methadone is least expensive. The piece of buprenorphine accounts for a
major portion of the difference in costs. For patients, office-based
treatment may be less expensive.


]]></description></item><item><title><![CDATA[( BUPP09368 - 15 January 2009) Predictors of outcome for short-term medically supervised opioid withdrawal during a randomized, multicenter trial of buprenorphine-naloxone and clonidine in the NIDA clinical trials network drug and alcohol dependence.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09368</link><pubDate></pubDate><description><![CDATA[This article was received in December 06, but has been revised in June
2008.
Few studies in community settings have evaluated predictors, meditators,
and moderators of treatment success for medically supervised opioid
withdrawal treatment. This report presents new findings about these
factors from a study of 344 opioid-dependent men and women prospectively
randomized to either buprenorphine-naloxone or clonidine in an open-label
13 day medically supervised withdrawal study. Subjects were either
in-patient or outpatient in community treatment settings; however not
randomized by treatment setting. Medication type (buprenorphine-naloxone
versus clonidine) was the single best predictor of treatment retention and
treatment success, regardless of treatment setting. Compared to the
outpatient setting, the in-patient setting was associated with higher
abstinence but similar retention rates when adjusting for medication type.
Early opioid withdrawal severity medicated the relationship between
medication type and treatment outcome with buprenorphine-naloxone being
superior to clondine at relieving early withdrawal symptoms. In-patient
subjects on clonidine with lower withdrawal scores at baseline than those
with lower withdrawal scores. No relationship was found between treatment
outcome and age, gender, race, education, employment, marital status,
legal problems, baseline depression, or length/severity of drug use.
Tobacco use was associated with worse opioid treatment outcomes. Severe
baseline anxiety symptoms doubled treatment success. Medication type
(buprenorphine-naloxone) was the most important predictor of positive
outcome; however the paper also considers other clinical and policy
implications of other results, including that in-patient setting predicted
better outcomes and moderate medication outcomes.


]]></description></item><item><title><![CDATA[( BUPP09369 - 16 January 2009) Buprenorphine and methadone maintenance in jail and post-release: A randomized clinical trial.]]></title><link>http://coretext.org/bupp_detail.asp?recno=BUPP09369</link><pubDate></pubDate><description><![CDATA[Buprenorphine has rarely been administered as an opioid agonist
maintenance therapy in a correctional setting. This study introduced
buprenorphine maintenance in a large urban jail, Rikers Island in New York
City. Heroin-dependent men not enrolled in community methadone treatment
and sentenced to 10-90 days i
