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Addiction treatment

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By Faye Kehler Family Physician and GP Anesthetist since 1987 interested in all aspects of Medicine
Traci C Green, Michael Gilbert
No abstract text is available yet for this article.
October 1, 2016: JAMA Internal Medicine
Marc A Schuckit
This article provides an overview of the current treatment of opioid-related conditions, including treatments provided by general practitioners and by specialists in substance-use disorders. The recent dramatic increase in misuse of prescription analgesics, the easy accessibility of opioids such as..
July 28, 2016: New England Journal of Medicine
Greg L Plosker
Acamprosate (Campral(®), Aotal(®), Regtect(®)) is one of a limited number of pharmacological treatment options approved as an adjunct to psychosocial interventions to facilitate the maintenance of abstinence in alcohol-dependent patients. It has been used in Europe, the USA and other countries for many years and was recently approved for this indication in Japan. In several randomized, double-blind, placebo-controlled trials (without active comparators), acamprosate in conjunction with psychosocial therapy for 3-12 months was generally significantly better than placebo plus psychosocial interventions in improving various key outcomes, including the proportion of patients who maintained complete abstinence from alcohol (complete abstinence rate), the mean cumulative abstinence duration, the percentage of alcohol-free days and the median time to first drink...
July 2015: Drugs
Kim Donoghue, Catherine Elzerbi, Rob Saunders, Craig Whittington, Stephen Pilling, Colin Drummond
AIMS: To determine the efficacy of acamprosate and naltrexone in the treatment of those who are alcohol-dependent in reducing lapse/relapse to alcohol consumption and treatment discontinuation, and to examine whether a proportion of the variance in study outcome can be explained by the country in which the trials have taken place. METHOD: A systematic review and meta-analysis of randomized controlled trials published before September 2013 was conducted. The primary outcome measures were the efficacy of acamprosate or naltrexone in reducing lapse/relapse compared to placebo in the treatment of alcohol dependence and treatment discontinuation...
June 2015: Addiction
Rainer Spanagel, Valentina Vengeliene, Bernd Jandeleit, Wolf-Nicolas Fischer, Kent Grindstaff, Xuexiang Zhang, Mark A Gallop, Elena V Krstew, Andrew J Lawrence, Falk Kiefer
Alcoholism is one of the most prevalent neuropsychiatric diseases, having an enormous health and socioeconomic impact. Along with a few other medications, acamprosate (Campral-calcium-bis (N-acetylhomotaurinate)) is clinically used in many countries for relapse prevention. Although there is accumulated evidence suggesting that acamprosate interferes with the glutamate system, the molecular mode of action still remains undefined. Here we show that acamprosate does not interact with proposed glutamate receptor mechanisms...
March 2014: Neuropsychopharmacology: Official Publication of the American College of Neuropsychopharmacology
Susumu Higuchi
OBJECTIVE: To undertake a double-blind, randomized, placebo-controlled trial to examine the efficacy of acamprosate in maintaining complete abstinence in Japanese patients with alcohol dependence. METHOD: We enrolled 327 patients with ICD-10-defined alcohol dependence and randomly assigned them to treatment with either acamprosate (1,998 mg/d orally) or placebo for 24 weeks. The primary endpoint was complete abstinence after 24 weeks of administration. The study was performed at 34 medical institutions between 2009 and 2011...
February 2015: Journal of Clinical Psychiatry
Deborah S Hasin, Bradley T Kerridge, Tulshi D Saha, Boji Huang, Roger Pickering, Sharon M Smith, Jeesun Jung, Haitao Zhang, Bridget F Grant
OBJECTIVE: Attitudes toward marijuana are changing, the prevalence of DSM-IV cannabis use disorder has increased, and DSM-5 modified the cannabis use disorder criteria. Therefore, updated information is needed on the prevalence, demographic characteristics, psychiatric comorbidity, disability, and treatment for DSM-5 cannabis use disorder. METHOD: In 2012-2013, 36,309 participants ≥18 years old were interviewed in the National Epidemiologic Survey on Alcohol and Related Conditions-III...
June 1, 2016: American Journal of Psychiatry
Nora D Volkow, James M Swanson, A Eden Evins, Lynn E DeLisi, Madeline H Meier, Raul Gonzalez, Michael A P Bloomfield, H Valerie Curran, Ruben Baler
With a political debate about the potential risks and benefits of cannabis use as a backdrop, the wave of legalization and liberalization initiatives continues to spread. Four states (Colorado, Washington, Oregon, and Alaska) and the District of Columbia have passed laws that legalized cannabis for recreational use by adults, and 23 others plus the District of Columbia now regulate cannabis use for medical purposes. These policy changes could trigger a broad range of unintended consequences, with profound and lasting implications for the health and social systems in our country...
March 2016: JAMA Psychiatry
Jane M Liebschutz, Denise Crooks, Debra Herman, Bradley Anderson, Judith Tsui, Lidia Z Meshesha, Shernaz Dossabhoy, Michael Stein
IMPORTANCE: Buprenorphine opioid agonist treatment (OAT) has established efficacy for treating opioid dependency among persons seeking addiction treatment. However, effectiveness for out-of-treatment, hospitalized patients is not known. OBJECTIVE: To determine whether buprenorphine administration during medical hospitalization and linkage to office-based buprenorphine OAT after discharge increase entry into office-based OAT, increase sustained engagement in OAT, and decrease illicit opioid use at 6 months after hospitalization...
August 2014: JAMA Internal Medicine
Kelly Yan Chen, Lucy Chen, Jianren Mao
Buprenorphine-naloxone (bup/nal in 4:1 ratio; Suboxone; Reckitt Benckiser Pharmaceuticals Incorporation, Richmond, VA) is approved by the Food and Drug Administration for outpatient office-based addiction treatment. In the past few years, bup/nal has been increasingly prescribed off-label for chronic pain management. The current data suggest that bup/nal may provide pain relief in patients with chronic pain with opioid dependence or addiction. However, the unique pharmacological profile of bup/nal confers it to be a weak analgesic that is unlikely to provide adequate pain relief for patients without opioid dependence or addiction...
May 2014: Anesthesiology
James W Finch, Jonathan B Kamien, Leslie Amass
Office-based buprenorphine-naloxone (Suboxone) treatment in the United States has significantly improved access to safe and effective opioid-dependence therapy. Little data from physicians' experiences prescribing Suboxone in private offices have been available. This retrospective chart review describes a family practitioner's first 2 years of clinical experience prescribing Suboxone for opioid dependence to 71 patients in a private office. After directly observed rapid office dose induction, Suboxone prescriptions were given monthly after evidence of continued stability...
June 2007: Journal of Addiction Medicine
Charmian D Sittambalam, Radhika Vij, Robert P Ferguson
BACKGROUND: Opioid dependence treatment traditionally involves methadone clinics, for which dispensing schedules can be cumbersome. Buprenorphine, a partial agonist of the mu receptor and antagonist of the kappa receptor, is a potential outpatient alternative to methadone. Funded by a grant from the State of Maryland's Community Health Resources Commission (CHRC), the Buprenorphine Outpatient Outcomes Project (BOOP) evaluates the outcome of Suboxone (buprenorphine/naloxone) treatment on abstinence from heroin use, rates of emergency room visits and hospitalizations, legal issues, and quality of life...
2014: Journal of Community Hospital Internal Medicine Perspectives
Corinne Canestrelli, Nicolas Marie, Florence Noble
Buprenorphine is used as a sublingual medication in the treatment of opioid dependence. However, its misuse by i.v. injection may limit its acceptability and dissemination. A buprenorphine/naloxone (ratio 4:1) combination has been developed to reduce diversion and abuse. So far, the relevance of this combination has not been investigated in the animal models traditionally used to study the reinforcing effects of drugs of abuse. The aim of this study was to compare the rewarding effects, assessed by conditioned place preference (CPP), of buprenorphine and buprenorphine/naloxone combination following i...
September 2014: International Journal of Neuropsychopharmacology
Anthony Steele, Patricia Cunningham
PURPOSE: This retrospective quality improvement study was to evaluate if Suboxone therapy reduced the risk of terminating treatment against medical advice compared with the use clonidine in men aged 18--55 years. METHODS: Data were collected through chart review for all opioid-addicted male clients admitted voluntarily to a community-based treatment center between July 1, 2009, and December 30, 2009. FINDINGS: The chi-square test of independence between treatment completion and treatment noncompletion was found to be significant at the 5% critical level (P = ...
August 2012: Archives of Psychiatric Nursing
Neil McKeganey, Christopher Russell, Lucinda Cockayne
The focus of drug policy in the UK has shifted markedly in the past 5 years to move beyond merely emphasising drug abstinence towards maximising individuals' opportunities for recovery. The UK government continues to recognise the prescribing of narcotic medications indicated for opiate dependence as a key element of these individuals' recovery journey. This article describes a small, naturalistic comparison of the efficacy of the two most commonly prescribed opiate substitute medications in the UK--methadone hydrochloride (methadone oral solution) and Suboxone (buprenorphine-naloxone sublingual tablets)--for reducing current heroin users' (n = 34) days of heroin use, and preventing short-term abstainers (n = 37) from relapsing to regular heroin use...
January 2013: Journal of Substance Abuse Treatment
Nathan Stall, Jesse Godwin, David Juurlink
No abstract text is available yet for this article.
September 16, 2014: CMAJ: Canadian Medical Association Journal, Journal de L'Association Medicale Canadienne
Nora D Volkow, Thomas R Frieden, Pamela S Hyde, Stephen S Cha
The rate of death from overdoses of prescription opioids in the United States more than quadrupled between 1999 and 2010 (see graph), far exceeding the combined death toll from cocaine and heroin overdoses. In 2010 alone, prescription opioids were involved in 16,651 overdose deaths, whereas heroin..
May 29, 2014: New England Journal of Medicine
Paola Casadio, Deanna Olivoni, Barbara Ferrari, Cecilia Pintori, Elvira Speranza, Monica Bosi, Valentina Belli, Lucia Baruzzi, Paola Pantieri, Grazia Ragazzini, Filippo Rivola, Anna Rita Atti
AIM: To evaluate the prevalence of personality disorders (PDs) in the outpatients attending an addiction service, with particular attention to the effects of PDs on social and occupational functioning and on the intensity of treatment required. DESIGN: A cross-sectional epidemiological study with the assessment of 320 outpatients, through SCID-II (Structured Clinical Interview for DSM-IV Axis II PDs), SOGS (South Oaks Gambling Screen), and questionnaire extracted from EuropASI...
2014: Substance Abuse: Research and Treatment
Christopher D Verrico, James J Mahoney, Daisy G Y Thompson-Lake, Ryan S Bennett, Thomas F Newton, Richard De La Garza
Methamphetamine use is increasing in the US. Although there are no Food and Drug Administration (FDA)-approved medications for methamphetamine dependence, preclinical and clinical studies suggest that methamphetamine users may benefit from treatments that enhance cholinergic neurotransmission. Consequently, we determined the safety and the efficacy of varenicline treatment, a partial agonist at α4β2 and a full agonist at α7 nicotinic acetylcholine receptors, to reduce positive subjective effects produced by smoked methamphetamine...
February 2014: International Journal of Neuropsychopharmacology
Edna B Foa, David A Yusko, Carmen P McLean, Michael K Suvak, Donald A Bux, David Oslin, Charles P O'Brien, Patricia Imms, David S Riggs, Joseph Volpicelli
IMPORTANCE: Alcohol dependence comorbid with posttraumatic stress disorder (PTSD) has been found to be resistant to treatment. In addition, there is a concern that prolonged exposure therapy for PTSD may exacerbate alcohol use. OBJECTIVE: To compare the efficacy of an evidence-based treatment for alcohol dependence (naltrexone) plus an evidence-based treatment for PTSD (prolonged exposure therapy), their combination, and supportive counseling. DESIGN, SETTING, AND PARTICIPANTS: A single-blind, randomized clinical trial of 165 participants with PTSD and alcohol dependence conducted at the University of Pennsylvania and the Philadelphia Veterans Administration...
August 7, 2013: JAMA: the Journal of the American Medical Association
2014-10-04 19:04:22
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