A review of epidural and intrathecal opioids used in the management of postoperative pain.

Filed under: Methadone Clinics

J Opioid Manag. 2012 May-Jun; 8(3): 177-92
Bujedo BM, Santos SG, Azpiazu AU

Opioids are the most potent centrally acting analgesic drugs for the treatment of pain. For the past years, since the discovery of spinal opioid receptors, the use of spinal opioids has been adopted in clinical practice in the hope of producing intense segmental analgesia that was devoid of the dose-limiting side effects associated with systemic opioid administration. Experimental studies have demonstrated that after their perispinal administration, liposolubility is inversely proportional to their spinal selectivity, which is higher for the most water-soluble drug, morphine, than for other more lipophilic drugs, such as fentanyl and sufentanil. Clinical trials have shown that epidural morphine in the form of extended-release liposome injections gives good analgesia for a period of 48 hours, with no need for epidural catheterization. Conversely, fentanyl is the most appropriate opioid in ambulatory surgery and seems to have the strongest effect at the spinal cord administered epidurally as a bolus and supraspinally using continuous epidural infusion. Epidural methadone and hydromorphone are suitable alternatives for analgesia in the postoperative period, given that they have intermediate pharmacokinetic characteristics with respect to the two aforementioned groups of opioids. All opioids administered intrathecally will produce some degree of spinally mediated analgesia. The main differences are related to their duration of action, rate of clearance, and the pathways by which the drugs reach their receptors in the brain. In general, lipophilic opioids produce short-term analgesia (1-4 hours), which is very useful for immediate postoperative pain. However, morphine produces intense analgesia for up to 24 hours with doses as low as 100 ?g.
Source

Attention Deficit Hyperactivity Disorder and Obsessive-Compulsive Disorder among Former Heroin Addicts Currently in Methadone Maintenance Treatment.

Filed under: Methadone Clinics

Psychopathology. 2012 Jul 12;
Peles E, Schreiber S, Sutzman A, Adelson M

Background: The aim of this study was to evaluate the prevalence of childhood and adulthood attention deficit hyperactivity disorder (ADHD) and clinical obsessive-compulsive disorder (OCD) among adult patients in methadone maintenance treatment (MMT) and to characterize possible risk factors. Sampling and Methods: A random sample of 154 current MMT patients was studied for childhood ADHD (Wender Utah Rating Scale), current clinical OCD (Yale-Brown Obsessive Compulsive Scale), lifetime trauma history and modified Addiction Severity Index for demographics, as well as any lifetime DSM-IV-TR psychiatric diagnosis. Results: Fifty-one patients (33.1%) had childhood ADHD, and more of this group currently had clinical OCD compared to patients who did not have childhood ADHD (55.3 vs. 30.1%). The two groups did not differ with regard to gender and age of admission to MMT. Logistic regression found that the childhood ADHD group had a higher risk of having OCD [odds ratio (OR) 3.8, 95% confidence interval (CI) 1.6-8.8], more severe nicotine smoking (OR 1.4, 95% CI 1.1-1.7) and fewer years of education (OR 0.8, 95% CI 0.6-1) and were more likely to have a DSM-IV-TR axis II disorder (OR 4.3, 95% CI 1.4-13.4) and a history of falls (OR 4.3, 95% CI 1.4-12.9). Conclusions: Although ADHD is more prevalent among males in the general population, the rates in our MMT population were similar in each gender. One third of our sample had suffered from ADHD during childhood, which may have led them to self-medicate with drugs and thus to addiction. Childhood ADHD was associated with current OCD, and both conditions were highly prevalent among our MMT patients. The reason for a history of repeated falls warrants further study.
Source

Fentanyl transmucosal tablets: current status in the management of cancer-related breakthrough pain.

Filed under: Methadone Clinics

Patient Prefer Adherence. 2012; 6: 465-475
Prommer E, Ficek B

Breakthrough pain is a newly recognized pain category that was first described by Portenoy and Hagen in 1990. The term describes pain that increases in intensity to “break through” chronic pain that is being controlled by a scheduled opioid regimen. The development of fluctuations in pain intensity is challenging due to their unpredictable nature, rapid onset, and need for rapid treatment intervention. Breakthrough pain has been treated by using an extra opioid dose in addition to the scheduled opioid being used for pain. Recommendations for dose and frequency are based on expert opinion only, and have included dosing based on a percentage of the total opioid dose. Other recommendations include increasing the regularly scheduled opioid dose. Clinical trials have now focused on delivery of opioids that have both potency and a rapid onset of action. Lipophilic opioids have received a substantial amount of study due to their quick absorption and rapid onset of analgesia. Lipophilic opioids that have been studied to date include transmucosal fentanyl, sublingual fentanyl, intranasal sufentanil, and oral and sublingual methadone. Initial clinical trials have established the superiority of transmucosal fentanyl as a breakthrough analgesic when compared with immediate-release oral opioid formulations. Problems with bioavailability have led to a search for newer formulations of transmucosal delivery. Newer formulations, such as fentanyl transmucosal tablets, have been developed to ensure superior delivery for the patient suffering from breakthrough pain. The purpose of this paper is to discuss the current status of transmucosal tablet formulations for cancer breakthrough pain.
Source

An Intervention Targeting Service Providers and Clients for Methadone Maintenance Treatment in China: A Cluster-randomized Trial.

Filed under: Methadone Clinics

Addiction. 2012 Jul 13;
Li L, Wu Z, Liang LJ, Lin C, Zhang L, Guo S, Rou K, Li J

AIMS: This study examines the preliminary outcomes of an intervention targeting service providers in methadone maintenance therapy clinics in China. The intervention effects on both service providers and clients are reported. DESIGN: The MMT CARE intervention pilot was developed and implemented collaboratively with local health educators. After three group intervention sessions, trained providers in intervention clinics delivered two individual motivational interviewing sessions with their clients. SETTINGS: Six clinics in Sichuan, China, were randomized to either the MMT CARE intervention condition or a standard care condition. PARTICIPANTS: A total of 41 providers and 179 clients were sampled from the six clinics. MEASUREMENTS: At baseline and 3-, 6-, and 9-month assessments, providers completed self-administrated paper/pencil questionnaires regarding provider-client interaction, methadone maintenance therapy knowledge, perceived job-related stigma, and clinic support. Clients completed a face-to-face survey about their concurrent drug use and drug avoidance self-efficacy. Mixed-effects regression models with clinic-level random effect were used to assess the intervention effects. FINDINGS: Significant intervention effects for providers were found in improved methadone maintenance therapy knowledge, provider-client interaction, and perceived clinic support. For clients, better improvements in drug avoidance self-efficacy and reduced concurrent drug use were observed for the intervention compared to the standard care group. CONCLUSIONS: The methadone maintenance therapy CARE intervention targeting providers in methadone maintenance clinics can improve providers’ treatment knowledge and their interaction with clients. The intervention can also reduce clients’ drug using behavior through motivational interviewing sessions conducted by trained providers.
Source

Cardiovascular effects of a proprietary l-methadone/fenpipramide combination (Polamivet) alone and in addition to acepromazine in healthy Beagle dogs.

Filed under: Methadone Clinics

Vet Anaesth Analg. 2012 Jul 13;
Tünsmeyer J, Vaske B, Bösing B, Kästner SB

Objective? To determine the cardiovascular effects of a proprietary l-methadone/fenpipramide combination (Polamivet) alone and in addition to acepromazine in dogs. Study design? Prospective, randomized, experimental crossover study. Animals? Five adult healthy Beagle dogs (one male and four females, weighing 12.8-16.4?kg). Methods? Dogs were instrumented for haemodynamic measurements whilst anaesthetized with isoflurane. Three hours after recovery dogs received 0.025?mg?kg(-1) acepromazine (AP) or saline (SP) IM followed by 0.5?mg?kg(-1) L-methadone/ 0.025?mg?kg(-1) fenpipramide IV after 30?minutes. Cardiac output using thermodilution, heart rate, mean arterial pressure (MAP), central venous pressure (CVP), mean pulmonary artery pressure (MPAP), pulmonary artery occlusion pressure (PAOP), haemoglobin concentration, arterial and mixed-venous blood gas analysis were measured and sedation evaluated at baseline (BL), 30?minutes after acepromazine or saline IM (A/S), 5?minutes after L-methadone/fenpipramide IV application (35), every 15?minutes for 1?hour (50, 65, 80, 95?minutes) and every hour until baseline cardiac output was regained. Standard cardiovascular parameters were calculated. Data were analyzed by repeated measures anova and paired t-tests with p?Source

Glens Falls board: Methadone program would require review

Filed under: Methadone Clinics

GLENS FALLS — The Glens Falls Planning Board has concluded that a methadone treatment center would be an allowable use under city zoning for the 55 Elm St. property in Glens Falls where Conifer Park, a private substance abuse counseling and …
Read more on Glens Falls Post-Star

Torrington methadone clinic application filed

Filed under: Methadone Clinics

TORRINGTON — City Planner Martin Connor on Monday said a public hearing on a methadone clinic proposed for Kennedy Drive is likely to be held Sept. 12, and there will be no discussion of the application during Wednesday's meeting. The application …
Read more on Waterbury Republican American

More Methadone Clinics Information…

Comments are closed.