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Opioid Withdrawal

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1. Opioid antagonists with minimal sedation for opioid withdrawal. (PubMed)

Opioid antagonists with minimal sedation for opioid withdrawal. Managed withdrawal is a necessary step prior to drug-free treatment or as the endpoint of long-term substitution treatment.To assess the effects of opioid antagonists plus minimal sedation for opioid withdrawal. Comparators were placebo as well as more established approaches to detoxification, such as tapered doses of methadone, adrenergic agonists, buprenorphine and symptomatic medications.We updated our searches of the following (...) databases to December 2016: CENTRAL, MEDLINE, Embase, PsycINFO and Web of Science. We also searched two trials registers and checked the reference lists of included studies for further references to relevant studies.We included randomised and quasi-randomised controlled clinical trials along with prospective controlled cohort studies comparing opioid antagonists plus minimal sedation versus other approaches or different opioid antagonist regimens for withdrawal in opioid-dependent participants.We used

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2017 Cochrane

4. Should Buprenorphine Be Administered to Patients With Opioid Withdrawal in the Emergency Department?

Should Buprenorphine Be Administered to Patients With Opioid Withdrawal in the Emergency Department? TAKE-HOME MESSAGE Compared with a2-adrenergic agonists (eg, clonidine), buprenorphine improves withdrawal scores and has higher rates of adherence to withdrawal regimen completion. Should Buprenorphine Be Administered to Patients With Opioid Withdrawal in the Emergency Department? EBEM Commentators Jennifer S. Love, MD Jeanmarie Perrone, MD Department of Emergency Medicine Perelman School (...) . These 14 studies demon- stratedsigni?cantvariationintheir treatment protocols, medication dosing, study design, study loca- tion, and route of medication administration. Thirteen of 14 studies compared clonidine with buprenorphine treatment. No studies occurred in the emergency Buprenorphine versus a2-adrenergic agonists for acute opioid withdrawal. Outcome Relative Effect (95% CI) No. of Participants (Studies) Mean overall withdrawal score SMD0.4 (0.6 to0.3) 902 (7) Completing withdrawal treatment RR

2018 Annals of Emergency Medicine Systematic Review Snapshots

5. Buprenorphine for managing opioid withdrawal. (PubMed)

Buprenorphine for managing opioid withdrawal. Managed withdrawal is a necessary step prior to drug-free treatment or as the endpoint of substitution treatment.To assess the effects of buprenorphine versus tapered doses of methadone, alpha2-adrenergic agonists, symptomatic medications or placebo, or different buprenorphine regimens for managing opioid withdrawal, in terms of the intensity of the withdrawal syndrome experienced, duration and completion of treatment, and adverse effects.We (...) searched the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 11, 2016), MEDLINE (1946 to December week 1, 2016), Embase (to 22 December 2016), PsycINFO (1806 to December week 3, 2016), and the Web of Science (to 22 December 2016) and handsearched the reference lists of articles.Randomised controlled trials of interventions using buprenorphine to modify the signs and symptoms of withdrawal in participants who were primarily opioid dependent. Comparison interventions involved reducing

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2017 Cochrane

6. Do ?2-Adrenergic Agonists Decrease the Symptoms Associated With Opioid Withdrawal?

Do ?2-Adrenergic Agonists Decrease the Symptoms Associated With Opioid Withdrawal? Do α2-Adrenergic Agonists Decrease the Symptoms Associated With Opioid Withdrawal? - Annals of Emergency Medicine Email/Username: Password: Remember me Search Terms Search within Search Share this page Access provided by Volume 69, Issue 6, Pages 740–742 Do α 2 -Adrenergic Agonists Decrease the Symptoms Associated With Opioid Withdrawal? x Michael Gottlieb , MD (EBEM Commentator) , x Katarzyna Gore , MD (EBEM (...) controlled clinical trials that compared the administration of an α 2 -adernergic agonist with other interventions such as placebo or methadone to reduce symptoms of opioid withdrawal. Outcomes included withdrawal signs and symptoms, adverse effects, or treatment course completion. Four review authors developed a set of inclusion and exclusion criteria by which studies were chosen. One review author assessed potential studies according to this list; however, all 4 authors confirmed these decisions. Data

2017 Annals of Emergency Medicine Systematic Review Snapshots

7. The Use of Transdermal Buprenorphine Patches in Aiding in Opioid Withdrawal: Clinical Effectiveness and Guidelines

The Use of Transdermal Buprenorphine Patches in Aiding in Opioid Withdrawal: Clinical Effectiveness and Guidelines The Use of Transdermal Buprenorphine Patches in Aiding in Opioid Withdrawal: Clinical Effectiveness and Guidelines | CADTH.ca Find the information you need The Use of Transdermal Buprenorphine Patches in Aiding in Opioid Withdrawal: Clinical Effectiveness and Guidelines The Use of Transdermal Buprenorphine Patches in Aiding in Opioid Withdrawal: Clinical Effectiveness (...) and Guidelines Published on: June 8, 2017 Project Number: RA0911-000 Product Line: Research Type: Drug Report Type: Reference List Result type: Report Question What is the clinical effectiveness regarding the use of buprenorphine patches for aiding in opioid withdrawal prior to starting a patient on buprenorphine/naloxone? What are the evidence-based guidelines regarding the use of buprenorphine patches for aiding in opioid withdrawal prior to starting a patient on buprenorphine/naloxone? Key Message One non

2017 Canadian Agency for Drugs and Technologies in Health - Rapid Review

8. Alpha₂-adrenergic agonists for the management of opioid withdrawal. (PubMed)

Alpha₂-adrenergic agonists for the management of opioid withdrawal. Withdrawal is a necessary step prior to drug-free treatment or as the endpoint of long-term substitution treatment.To assess the effectiveness of interventions involving the use of alpha2-adrenergic agonists compared with placebo, reducing doses of methadone, symptomatic medications, or an alpha2-adrenergic agonist regimen different to the experimental intervention, for the management of the acute phase of opioid withdrawal (...) ) with reducing doses of methadone, symptomatic medications or placebo, or comparing different alpha2-adrenergic agonists to modify the signs and symptoms of withdrawal in participants who were opioid dependent.We used standard methodological procedures expected by The Cochrane Collaboration.We included 26 randomised controlled trials involving 1728 participants. Six studies compared an alpha2-adrenergic agonist with placebo, 12 with reducing doses of methadone, four with symptomatic medications, and five

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2016 Cochrane

9. Do ?2-Adrenergic Agonists Decrease the Symptoms Associated With Opioid Withdrawal?

Do ?2-Adrenergic Agonists Decrease the Symptoms Associated With Opioid Withdrawal? TAKE-HOME MESSAGE a 2 -Adrenergic agonists (eg, clonidine) are associated with lower rates of severe withdrawal symptoms and higher rates of adherence; however, this must be balanced with known adverse effects such as hypotension. Doa 2 -AdrenergicAgonistsDecreasetheSymptoms Associated With Opioid Withdrawal? EBEM Commentators Michael Gottlieb, MD Katarzyna Gore, MD Department of Emergency Medicine Rush (...) such as placebo or methadone to reduce symptoms of opioid withdrawal. Outcomes included withdrawal signs and symptoms, adverse effects, or treatment course completion. Four review authors developed a set of inclusion and exclusion criteria by which studies were chosen. One review author assessed potential studies according to this list; however, all 4 authors con?rmed these decisions. DATA EXTRACTION AND SYNTHESIS One author extracted data with a standardized data extraction form, with assistance from other

2016 Annals of Emergency Medicine Systematic Review Snapshots

10. Individuals with Chronic Pain Who Misuse Prescription Opioids Report Sex-Based Differences in Pain and Opioid Withdrawal. (PubMed)

Individuals with Chronic Pain Who Misuse Prescription Opioids Report Sex-Based Differences in Pain and Opioid Withdrawal. Individuals with chronic pain who misuse prescription opioids are at high risk for developing opioid use disorder and/or succumbing to opioid overdose. The current study conducted a survey to evaluate sex-based differences in pain catastrophizing, opioid withdrawal, and current pain in persons with co-occurring chronic pain and opioid misuse. We hypothesized that women (...) with chronic pain who misused prescription opioids would self-report higher pain ratings compared with men and that the relationship between pain catastrophizing and self-reported current pain would be moderated by symptoms of opioid withdrawal in women only.Survey assessment of the relationship between pain and opioid misuse.Online via Amazon Mechanical Turk.Persons with ongoing chronic pain who also misused prescription opioids on one or more days in the last 30 days were eligible (N = 181).Participants

2019 Pain Medicine

11. Elective Naloxone-Induced Opioid Withdrawal for Rapid Initiation of Medication-Assisted Treatment of Opioid Use Disorder. (PubMed)

Elective Naloxone-Induced Opioid Withdrawal for Rapid Initiation of Medication-Assisted Treatment of Opioid Use Disorder. We present a case of elective naloxone-induced opioid withdrawal followed by buprenorphine rescue to initiate opioid use disorder treatment in the emergency department. This strategy may represent a safe alternative to prescribing buprenorphine for outpatient initiation, a method that puts the patient at risk for complications of unmonitored opioid withdrawal, including (...) relapse. After confirmation that the naloxone-induced withdrawal was adequately treated with buprenorphine, the patient was discharged with prescribed buprenorphine to follow up in an addiction medicine clinic, where he was treated 2 days later.Copyright © 2019 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

2019 Annals of Emergency Medicine

12. Lofexidine hydrochloride (Lucemyra) - For the non-opioid treatment for management of opioid withdrawal symptoms in adults

Lofexidine hydrochloride (Lucemyra) - For the non-opioid treatment for management of opioid withdrawal symptoms in adults Drug Approval Package: LUCEMYRA (lofexidine) U.S. Department of Health and Human Services Search FDA Submit search Drug Approval Package: LUCEMYRA (lofexidine) Company: US World Meds, LLC Application Number: 209229 Approval Date: 05/16/2018 Persons with disabilities having problems accessing the PDF files below may call (301) 796-3634 for assistance. FDA Approval Letter

2018 FDA - Drug Approval Package

13. Efficacy of opioids versus placebo in chronic pain: a systematic review and meta-analysis of enriched enrollment randomized withdrawal trials (PubMed)

Efficacy of opioids versus placebo in chronic pain: a systematic review and meta-analysis of enriched enrollment randomized withdrawal trials Opioids have been used for millennia for the treatment of pain. However, the long-term efficacy of opioids to treat chronic non-cancer pain continues to be debated. To evaluate opioids' efficacy in chronic non-cancer pain, we performed a meta-analysis of published clinical trials for μ-opioid receptor agonists performed for US Food and Drug Administration (...) approval.MEDLINE and Cochrane trial register were searched for enriched enrollment randomized withdrawal studies (before June 2016). Selection criteria included: adults, ≥10 subjects per arm, any chronic pain condition, double-blind treatment period lasting ≥12 weeks, and all μ-agonist opioids approved in the USA.Fifteen studies met criteria. Opioid efficacy was statistically significant (p<0.001) versus placebo for pain intensity (standardized mean difference: -0.416), ≥30% and ≥50% improvement in pain (risk

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2018 EvidenceUpdates

14. Opioids for the Management of Tramadol Withdrawal

Opioids for the Management of Tramadol Withdrawal Disclaimer: The Rapid Response Service is an information service for those involved in planning and providing health care in Canada. Rapid responses are based on a limited literature search and are not comprehensive, systematic reviews. The intent is to provide a list of sources of the best evidence on the topic that CADTH could identify using all reasonable efforts within the time allowed. Rapid responses should be considered along with other (...) not be copied, posted on a web site, redistributed by email or stored on an electronic system without the prior written permission of CADTH or applicable copyright owner. Links: This report may contain links to other information available on the websites of third parties on the Internet. CADTH does not have control over the content of such sites. Use of third party sites is governed by the owners’ own terms and conditions. TITLE: Opioids for the Management of Tramadol Withdrawal: Clinical Effectiveness DATE

2015 Canadian Agency for Drugs and Technologies in Health - Rapid Review

15. Non-pharmacological care for opioid withdrawal in newborns [Cochrane protocol]

Non-pharmacological care for opioid withdrawal in newborns [Cochrane protocol] Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites. Email

2019 PROSPERO

16. TEMPORARY REMOVAL: Managing Opioid Withdrawal in the Emergency Department With Buprenorphine. (PubMed)

TEMPORARY REMOVAL: Managing Opioid Withdrawal in the Emergency Department With Buprenorphine. 30616926 2019 01 14 1097-6760 2019 Jan 05 Annals of emergency medicine Ann Emerg Med Managing Opioid Withdrawal in the Emergency Department With Buprenorphine. S0196-0644(18)31482-3 10.1016/j.annemergmed.2018.11.032 Herring Andrew A AA Department of Emergency Medicine, Substance Use Disorder Program, Highland Hospital-Alameda Health System, University of California, San Francisco, San Francisco, CA

2019 Annals of Emergency Medicine

17. Improving Nursing Confidence and Consistency in Assessment of Opioid Withdrawal: Efficacy of Simulation and Debriefing. (PubMed)

Improving Nursing Confidence and Consistency in Assessment of Opioid Withdrawal: Efficacy of Simulation and Debriefing. The purpose of the current study was to determine if the amount of confidence in completing the Clinical Opiate Withdrawal Scale (COWS) varied among participants and whether consistency in scoring outcomes to patients occurred with COWS assessment among groups assigned to simulation and debriefing conditions. Sixty nursing staff were randomized into three groups: (a) scenario

2019 Journal of psychosocial nursing and mental health services

18. Risk of neonatal drug withdrawal after intrauterine co-exposure to opioids and psychotropic medications: cohort study. (PubMed)

Risk of neonatal drug withdrawal after intrauterine co-exposure to opioids and psychotropic medications: cohort study. Objectives To assess the impact of in utero co-exposure to psychotropic medications and opioids on the incidence and severity of neonatal drug withdrawal.Design Observational cohort study.Setting Nationwide sample of pregnancies in publicly insured women in the US, nested in the Medicaid Analytic eXtract (2000-10).Participants 201 275 pregnant women with public insurance who (...) were exposed to opioids around the time of delivery and their liveborn infants.Interventions In utero exposure to psychotropic medications, in particular antidepressants, atypical antipsychotics, benzodiazepines, gabapentin, and non-benzodiazepine hypnotics (Z drugs), with prescriptions filled within the same time window as prescriptions for opioids.Main outcome measure Diagnosis of neonatal drug withdrawal in infants exposed in utero to opioids and psychotropic medications compared with opioids

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2017 BMJ

19. Intensity of Withdrawal Symptoms During Opioid Taper in Patients with Chronic Pain-Individualized or Fixed Starting Dosage? (PubMed)

Intensity of Withdrawal Symptoms During Opioid Taper in Patients with Chronic Pain-Individualized or Fixed Starting Dosage? Controlled opioid withdrawal is recommended for patients with chronic noncancer pain (CNCP) with insufficient pain reduction or intolerable side effects while on opioid treatment. Few studies have investigated the management of opioid withdrawal (OW). Most common are protocols with an individualized starting dosage (ISD), calculated from the last opioid intake. After two (...) cases of overdose, we introduced a novel withdrawal protocol using a low fixed starting dosage (FSD) for safety reasons. The present study compares the intensity of withdrawal symptoms using the Subjective Opioid Withdrawal Scale (SOWS) and incidences of serious adverse events (SAE) and dropouts in each taper schedule in 195 CNCP patients with OW in an inpatient facility.Two protocols were compared: FSD (2014-2016): N = 68, starting dose: 90 mg morphine/d; and ISD (2010-2014): N = 127, starting dose

2019 Pain Medicine

20. Kappa opioid regulation of depressive-like behavior during acute withdrawal and protracted abstinence from ethanol. (PubMed)

Kappa opioid regulation of depressive-like behavior during acute withdrawal and protracted abstinence from ethanol. The dynorphin/kappa opioid receptor (DYN/KOR) system appears to be a key mediator of the behavioral effects of chronic exposure to alcohol. Although KOR opioid receptor antagonists have been shown to decrease stress-related behaviors in animal models during acute ethanol withdrawal, the role of the DYN/KOR system in regulating long-term behavioral changes following protracted (...) abstinence from ethanol is not well understood. The objective of the current study was to further explore the role of the DYN/KOR system in regulating stress-related behavioral changes associated with acute withdrawal and protracted abstinence from ethanol. More specifically, the present experiments sought to examine the ability of the KOR antagonist norbinaltorphimine (nor-BNI) to reverse depressive-like behavior in the forced swim test in rats exposed to chronic ethanol. In the first experiment, rats

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2018 PLoS ONE

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