Interaction between Mu and Delta Opioid Receptor Agonists in an Assay of Capsaicin-Induced Thermal Allodynia in Rhesus Monkeys.

Filed under: Methadone Clinics

Pain Res Treat. 2012; 2012: 867067
Negus SS, Morrissey EM, Folk JE, Rice KC

Delta opioid agonists enhance antinociceptive effects of mu-opioid agonists in many preclinical assays of acute nociception, but delta/mu interactions in preclinical models of inflammation-associated pain have not been examined. This study examined interactions between the delta agonist SNC80 [(+)-4-[(?R)-?-((2S,5R)-4-allyl-2,5-dimethyl-1-piperazinyl)-3-methoxybenzyl]-N,N-diethylbenzamide] and the mu agonist analgesics methadone, morphine, and nalbuphine in an assay of capsaicin-induced thermal allodynia in rhesus monkeys. Thermal allodynia was produced by topical application of capsaicin to the tail. Antiallodynic effects of methadone, morphine, and nalbuphine were evaluated alone or in combination with fixed proportions of SNC80 identical to proportions previously shown to enhance acute thermal antinociceptive effects of these mu agonists in rhesus monkeys (0.9?:?1 SNC80/methadone; 0.29?:?1 SNC80/morphine; 3.6?:?1 SNC80/nalbuphine). Methadone, morphine, and nalbuphine each produced dose-dependent antiallodynia. SNC80 produced partial antiallodynia up to the highest dose tested (5.6?mg/kg). SNC80 produced a modest, enantioselective, and naltrindole-reversible enhancement of methadone-induced antiallodynia. However, SNC80 did not enhance morphine antiallodynia and only weakly enhanced nalbuphine antiallodynia. Overall, SNC80 produced modest or no enhancement of the antiallodynic effects of the three mu agonists evaluated. These results suggest that delta agonist-induced enhancement of mu agonist antiallodynia may be weaker and less reliable than previously demonstrated enhancement of mu agonist acute thermal nociception.
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[Pharmacological correction of hypoxia in patients with severe carbon monoxide poisoning].

Filed under: Methadone Clinics

Georgian Med News. 2012 Apr; 31-8
Shilov V, Andrianov A, Vasilyev S, Batotsyrenov B, Loladze A

The article deals with the materials, which have been received in the process of the examination and treatment of 44 patients with acute severe methadone poisonings. It has been revealed, that gravity of these patients’ condition depends on the intensity of hypoxia due to breath deficiency because of methadone. The development of hypoxia, in its turn, causes violations of antiradical protection system and intensification of processes of peroxide lipid oxidation. It has been registered that the including of reamberin into the complex program of the intensive therapy of acute severe methadone poisonings leads to a more rapid restoration of antiradical protection system and to a decrease of activity of processes of peroxide lipid oxidation. The correction of hypoxia and free-radical violations led to the improvement of the acute poisonings clinics, what was characterized by a decrease of coma-period duration, duration of treatment with artificial lung ventilation, a decrease of secondary lung complications and a decrease of lethality.
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Subsidising patient dispensing fees: The cost of injecting equity into the opioid pharmacotherapy maintenance system.

Filed under: Methadone Clinics

Drug Alcohol Rev. 2012 May 25;
Chalmers J, Ritter A

Introduction and Aims. Australian pharmacotherapy maintenance programs incur costs to patients. These dispensing fees represent a financial burden to patients and are inconsistent with Australian health-care principles. No previous work has examined the current costs nor the future predicted costs if government subsidised dispensing fees. Design and Methods. A system dynamics model, which simulated the flow of patients into and out of methadone maintenance treatment, was developed. Costs were imputed from existing research data. The approach enabled simulation of possible behavioural responses to a fee subsidy (such as higher retention) and new estimates of costs were derived under such scenarios. Results. Current modelled costs (AUS$ 11.73m per month) were largely borne by state/territory government (43%), with patients bearing one-third (33%) of the total costs and the Commonwealth one-quarter (24%). Assuming no behavioural changes associated with fee subsidies, the cost of subsidising the dispensing fees of Australian methadone patients would be $ 3.9m per month. If retention were improved as a result of fee subsidy, treatment numbers would increase and the model estimates an additional cost of $ 0.8m per month. If this was coupled with greater numbers entering treatment, the costs would increase by a further $ 0.4m per month. In total, full fee subsidy with modelled behavioural changes would increase per annum government expenditure by $ 81.8m to $ 175.8m. Discussion and Conclusions. If government provided dispensing fee relief for methadone maintenance patients, it would be a costly exercise. However, these additional costs are offset by the social and health gains achieved from the methadone maintenance program.[Chalmers J, Ritter A. Subsidising patient dispensing fees: The cost of injecting equity into the opioid pharmacotherapy maintenance system. Drug Alcohol Rev 2012].
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[Differences in depression severity and frequency of relapses in opiate addicts treated with methadone or opiate blocker after detoxification].

Filed under: Methadone Clinics

Vojnosanit Pregl. 2012 Apr; 69(4): 326-32
Jovanovi? T, Lazarevi? D, Nikoli? G

Relapse of opiate dependence is a common occurrence after detoxification and introduction of opiate addicts in abstinence from opiates. Clinical evaluation showed that over 90% of opiate addicts exhibit depressive manifestations during detoxification, or develop post-detoxification depression. The aim of this study was to determine differences in the frequency of relapses, severity and course of depression during a of 6-month period, and previous patterns of use of opioids in the two groups of opiate addicts treated by two different therapeutic modalities.The results of the two groups of opiate addicts were compared: the patients on substitution methadone treatment (M) and the patients treated with opiate blocker naltrexone (B). In all the patients, clinical and instrumental evaluations confirmed depressive syndrome. Opioid relapses were diagnosed by the panel test for rapid detection of metabolites of opiates in urine. Then they were brought in connection with scores of depression and addiction variables. The Hamilton Depression Scale (HAMD) and Zunge Depression Scale were the applied instruments for measuring the level of depression. All the subjects completed a questionnaire Pompidou (short version). Psychological measurements were carried out during a 6-month follow-up on three occasions. The presence of opiate metabolites in urine was controlled every two weeks.Both groups of patients (M and B) had high scores on HAMD during the study. The group on methadone had a strong depression in all three measurements. There was a drop in the level of depression in both experimental groups over time, which was accompanied by a decrease in the incidence of recurrence. In both tested groups the frequency of relapses was positively correlated with earlier addiction variables – intravenous application of opioids, the experience of overdose, the absence of immunization against hepatitis C and hepatitis C virus carriers.The opioid relapse behavior is associated with a marked depression in post-detoxification period. The tested group M had a more expressed depression which is consistent with the literature data. In both tested groups the frequency of relapses was positively correlated with individual addiction variables associated with latent suicidal behavior. Diagnosing and monitoring depression of opiate addicts as well as timely remediation of post-detoxification depression symtoms, could help in prevention of opiate relapse.
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Drug addicts need a clean break

Filed under: Methadone Clinics

In the year to March 2011, 153733 addicts were given methadone and other replacement drugs, while only 9273 went to a rehab clinic. This is one of Somers's main gripes: that people aren't getting the chance to try abstinence. "To me, methadone was free …
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