Search results for "Opioid"
showing 10 items of 320 documents
Impact of a physician-targeted letter on opioid prescribing.
2020
We study the effect of a physician-targeted nudge letter on opioid prescribing. In May 2017, the Social Insurance Institution of Finland sent a personal information letter to all physicians who had issued a prescription containing at least 100 tablets of paracetamol-codeine combination to a new patient. The aim of the letter was to draw the physicians’ attention to their prescribing practices and to decrease the size of the first codeine prescription. Using individual level register data and a difference-in-differences strategy, we estimate that the letter decreased the average number of tablets purchased by new patients by 12.5 percent and the probability of a first purchase being at least…
Brain Opioid Activity and Oxidative Injury: Different Molecular Scenarios Connecting Celiac Disease and Autistic Spectrum Disorder
2020
Celiac Disease (CD) is an immune-mediated disease triggered by the ingestion of wheat gliadin and related prolamins from other cereals, such as barley and rye. Immunity against these cereal-derived proteins is mediated by pro-inflammatory cytokines produced by both innate and adaptive system response in individuals unable to adequately digest them. Peptides generated in this condition are absorbed across the gut barrier, which in these patients is characterized by the deregulation of its permeability. Here, we discuss a possible correlation between CD and Autistic Spectrum Disorder (ASD) pathogenesis. ASD can be induced by an excessive and inappropriate brain opioid activity during the neon…
Intrauterine and Neonatal Exposure to Opioids: Toxicological, Clinical, and Medico-Legal Issues
2023
Opioids have a rapid transplacental passage (i.e., less than 60 min); furthermore, symptoms characterize the maternal and fetal withdrawal syndrome. Opioid withdrawal significantly impacts the fetus, inducing worse outcomes and a risk of mortality. Moreover, neonatal abstinence syndrome (NAS) follows the delivery, lasts up to 10 weeks, and requires intensive management. Therefore, the prevention and adequate management of NAS are relevant public health issues. This review aims to summarize the most updated evidence in the literature regarding toxicological, clinical, and forensic issues of intrauterine exposure to opioids to provide a multidisciplinary, evidence-based approach for managing …
Opioid-induced hyperalgesia after rapid titration with intravenous morphine: Switching and re-titration to intravenous methadone.
2012
Rapid titration with intravenous morphine (IV-MO) provides fast and efficient pain relief in cancer patients with severe-excruciating pain. However, some patients, after an initially favourable response, can develop an hyperexcitated state unrelieved or worsened by further dose increments.Eighty-one patients admitted on emergency basis titrated with IV-MO were assessed.12 patients were unsuccessfully titrated with IV-MO. Switching to intravenous methadone (IV-ME) and titrating the doses proved to be successfully.In escalating opioid doses rapidly a recognition of the development of hyperalgesia should be suspected. Increasing doses of opioids may stimulate rather than inhibiting the central…
Are benzodiazepines and opioids really safe in patients with severe COPD?
2015
Breathlessness is a key symptom in chronic obstructive pulmonary disease (COPD) with prognostic implications on health status and survival. Since most conditions underlying chronic refractory breathlessness in COPD are not modifiable, the use of opioids and benzodiazepines has been proposed to relieve it. However, respiratory depression is a known adverse event of these drugs, and concerns have been raised on their use in patients with chronic respiratory failure. Despite safety-related concerns, benzodiazepines are frequently prescribed for a variety of reasons, including treatment of insomnia, depression and anxiety, as well as to relieve refractory dyspnea in patients with COPD. The key …
Dolor y recaída en el alcoholismo: alteraciones en la función moduladora del sistema opioide endógeno sobre el sistema dopaminérgico mesocorticolímbi…
2020
Durant els últims anys, múltiples estudis clínics i epidemiològics han revelat que la presència de dolor crònic està estretament relacionada amb el trastorn per consum d'alcohol (AUD). De fet, el dolor crònic sembla augmentar el risc de patir AUD i predir el consum excessiu d'alcohol i la recaiguda en aquells pacients amb antecedents d'abús d'alcohol. A més, s'ha informat que el dolor té un impacte negatiu en el processament motivacional i de recompensa, ja que altera la funció de sistema mesocorticolímbic (MCLS). Els receptors opioides mu (MOR) són components clau del MCLS i són essencials per al processament de recompenses tant d'estímuls naturals com de drogues d'abús, inclòs l'alcohol. …
Determinants of Prescription Opioid Use : Population‐Based Evidence from Finland
2021
Background and aims Previous studies have shown that prescription opioid use is more common in the socioeconomically disadvantaged communities in the US. This study examined the area and individual‐level determinants of prescription opioid use in Finland during the period 1995‐2016. Design Logistic regression analysis using nationwide data on filled opioid‐related prescriptions dispensed at Finnish pharmacies and covered by the National Health Insurance. Opioid consumption was linked, using personal identification codes, to population‐based data maintained by Statistics Finland, which records individual background and area‐level characteristics. Setting and participants Working‐age populati…
The barriers dentists face to communicate cancer diagnosis:self-assessment based on SPIKES protocol
2022
This study aimed to characterize the barriers faced by Brazilian dentists to deliver bad news (DBN) about oral and oropharyngeal cancer diagnoses to patients by using a questionnaire based on the guidelines of the SPIKES protocol. This was an observational cross-sectional study. The questionnaire contained 27 questions based on the SPIKES protocol, which were answered in the SurveyMonkey platform. A total of 186/249 dentists answered the questionnaire. The main specialties reported were 36.02% oral medicine, 21.5% oral pathology, and 9.13% oral and maxillofacial surgery. A total of 44.6% expressed concern about the patient?s emotional reactions, and 46.24% of respondents had never participa…
Synthesis and Structure-Affinity Relationships of Spirocyclic Benzopyrans with Exocyclic Amino Moiety
2019
σ1 and/or σ2 receptors play a crucial role in pathological conditions such as pain, neurodegenerative disorders, and cancer. A set of spirocyclic cyclohexanes with diverse O-heterocycles and amino moieties (general structure III) was prepared and pharmacologically evaluated. In structure-activity relationships studies, the σ1 receptor affinity and σ1:σ2 selectivity were correlated with the stereochemistry, the kind and substitution pattern of the O-heterocycle, and the substituents at the exocyclic amino moiety. cis-configured 2-benzopyran cis-11b bearing a methoxy group and a tertiary cyclohexylmethylamino moiety showed the highest σ1 affinity ( Ki = 1.9 nM) of this series of compounds. In…
Prescription opioid use and employment : A nationwide Finnish register study
2021
Background: The secular decline in labor market participation and the concurrent increase in opioid use in many developed countries have sparked a policy debate on the possible connection between these two trends. We examined whether the use of prescription opioids was connected to labor market outcomes relating to participation, employment and unemployment among the Finnish population. Methods: The working-age population (aged 19–64 years) living in Finland during the period 1995–2016 was used in the analyses (consisting of 67 903 701 person-year observations). Lagged values of prescription opioid use per capita were used as the exposure. Instrumental variables (IV) estimation method was u…