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Opioid Withdrawal

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1. 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

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

Review Snapshot (SRS) series. The source for this systematic review snapshot is: Gowing L, Ali R, White JM, et al. Buprenorphine for managing opioid withdrawal. Cochrane Database Syst Rev. 2017;2:CD002025. 1. Tompkins DA, Bigelow GE, Harrison JA, et al. Concurrent validation of the Clinical Opiate Withdrawal Scale (COWS) and single-item indices against the Clinical Institute Narcotic Assessment (CINA) opioid withdrawal instrument. Drug Alcohol Depend. 2009;105:54-159. 2. Handelsman L, Cochrane KJ (...) 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

2018 Annals of Emergency Medicine Systematic Review Snapshots

5. Do ?2-Adrenergic Agonists Decrease the Symptoms Associated With Opioid Withdrawal? Full Text available with Trip Pro

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

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

-randomized study and one evidence-based guideline were identified regarding the use of buprenorphine patches for aiding in opioid withdrawal prior to starting a patient on buprenorphine/naloxone. Tags buprenorphine, transdermal patch, medical devices, Withdrawal, addiction, addictions, Opiate, Opiates, pain management, drug addiction, Chronic pain, Opioids, Opioid, dermal, skin patches, skin patch, addicts, addict Files Rapid Response Reference List Published : June 8, 2017 Related Content Follow us: © (...) 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

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

7. New directions in the treatment of opioid withdrawal. (Abstract)

New directions in the treatment of opioid withdrawal. The treatment of opioid withdrawal is an important area of clinical concern when treating patients with chronic, non-cancer pain, patients with active opioid use disorder, and patients receiving medication for opioid use disorder. Current standards of care for medically supervised withdrawal include treatment with μ-opioid receptor agonists, (eg, methadone), partial agonists (eg, buprenorphine), and α2-adrenergic receptor agonists (eg (...) , clonidine and lofexidine). Newer agents likewise exploit these pharmacological mechanisms, including tramadol (μ-opioid receptor agonism) and tizanidine (α2 agonism). Areas for future research include managing withdrawal in the context of stabilising patients with opioid use disorder to extended-release naltrexone, transitioning patients with opioid use disorder from methadone to buprenorphine, and tapering opioids in patients with chronic, non-cancer pain.Copyright © 2020 Elsevier Ltd. All rights

2020 Lancet

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

in the United States. Addict Behav. 2016;63:74-81. 4. Broers B, Giner F, Dumont P, et al. Inpatient opiate detoxi?cation in Geneva: follow-up at 1 and 6 months. Drug Alcohol Depend. 2000;58:85-92. 5. Kleber HD, Riordan CE. The treatment of narcotic withdrawal: a historical review. J Clin Psychiatry. 1982;43:30-34. 6. MojtabaiR.Useofspecialtysubstanceabuse and mentalhealthservicesin adultswith substanceusedisorders in thecommunity. DrugAlcoholDepend. 2005;78:345-354. 7. Schuckit MA. Treatment of opioid-use (...) 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

2016 Annals of Emergency Medicine Systematic Review Snapshots

9. 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

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

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

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

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

12. Wnt signaling contributes to withdrawal symptoms from opioid receptor activation induced by morphine exposure or chronic inflammation. (Abstract)

Wnt signaling contributes to withdrawal symptoms from opioid receptor activation induced by morphine exposure or chronic inflammation. Preventing and treating opioid dependence and withdrawal is a major clinical challenge, and the underlying mechanisms of opioid dependence and withdrawal remain elusive. We hypothesized that prolonged morphine exposure or chronic inflammation-induced μ-opioid receptor activity serves as a severe stress that elicits neuronal alterations and recapitulates events (...) during development. Here, we report that Wnt signaling, which is important in developmental processes of the nervous system, plays a critical role in withdrawal symptoms from opioid receptor activation in mice. Repeated exposures of morphine or peripheral inflammation produced by intraplantar injection of complete Freund's adjuvant significantly increase the expression of Wnt5b in the primary sensory neurons in dorsal root ganglion (DRG). Accumulated Wnt5b in DRG neurons quickly transmits

2020 Pain

13. Opioid Agonist Treatments for Opioid Use Disorders: A Rapid Qualitative Review

to be more useful, especially in the beginning when they were establishing a routine towards recovery. Patients also contrasted buprenorphine (and its variants such as suboxone) and methadone when describing their experiences with opioid agonist treatments. Overall, patients expressed a more positive view of buprenorphine due to lesser experienced side effects and its perceived ability to restore normalcy into their everyday living and reduce withdrawal symptoms. Patients also described more positive (...) Opioid Agonist Treatments for Opioid Use Disorders: A Rapid Qualitative Review Opioid Agonist Treatments for Opioid Use Disorders: A Rapid Qualitative Review | CADTH.ca Find the information you need Opioid Agonist Treatments for Opioid Use Disorders: A Rapid Qualitative Review Opioid Agonist Treatments for Opioid Use Disorders: A Rapid Qualitative Review Last updated: April 30, 2019 Project Number: RC1100-000 Product Line: Research Type: Drug Report Type: Summary with Critical Appraisal Result

2019 Canadian Agency for Drugs and Technologies in Health - Rapid Review

14. Opioids for the management of tramadol withdrawal: clinical effectiveness

Opioids for the management of tramadol withdrawal: clinical effectiveness Opioids for the management of tramadol withdrawal: clinical effectiveness Opioids for the management of tramadol withdrawal: clinical effectiveness CADTH Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database. Citation CADTH. Opioids for the management of tramadol withdrawal (...) : clinical effectiveness. Ottawa: Canadian Agency for Drugs and Technologies in Health (CADTH). Rapid Response. 2015 Authors' conclusions No relevant literature was identified regarding the clinical effectiveness of opioids for the management of patients experiencing tramadol withdrawal symptoms. Final publication URL Indexing Status Subject indexing assigned by CRD MeSH Substance Withdrawal Syndrome; Tramadols Language Published English Country of organisation Canada Province or state Ontario English

2015 Health Technology Assessment (HTA) Database.

15. Kappa opioid regulation of depressive-like behavior during acute withdrawal and protracted abstinence from ethanol. Full Text available with Trip Pro

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

2018 PLoS ONE

16. Alpha2-Adrenergic Agonists for the Reduction or Discontinuation of Opioids or Opioid Substitution Therapy: A Review of Clinical Effectiveness and Guidelines

are the evidence-based guidelines regarding the use of alpha2-adrenergic agonists for the treatment of patients who are reducing or discontinuing opioids or opioid substitution therapy? Key Message Alpha2-adrenergic agonists were found to be more effective than placebo for managing withdrawal, however less effective than buprenorphine and potentially similar to methadone. Hypotension was a common adverse effect with clonidine specifically. Evidence comparing alpha2-adrenergic agonists to non-medicinal support (...) Alpha2-Adrenergic Agonists for the Reduction or Discontinuation of Opioids or Opioid Substitution Therapy: A Review of Clinical Effectiveness and Guidelines Alpha2-Adrenergic Agonists for the Reduction or Discontinuation of Opioids or Opioid Substitution Therapy: A Review of Clinical Effectiveness and Guidelines | CADTH.ca Find the information you need Alpha2-Adrenergic Agonists for the Reduction or Discontinuation of Opioids or Opioid Substitution Therapy: A Review of Clinical Effectiveness

2018 Canadian Agency for Drugs and Technologies in Health - Rapid Review

17. Programs for the Reduction or Discontinuation of Opioids or Opioid Substitution Therapy: A Review of the Clinical Effectiveness

of quality of evidence and objectives. Buprenorphine, tapered doses of methadone, and alpha2-adrenergic agonists could be used in the management of opioid withdrawal. There was insufficient evidence to favor any specific pharmacological approach in the management of opium withdrawal. Among pharmacotherapy programs in opioid maintenance treatment, methadone and buprenorphine appeared to be equally effective, naltrexone implants may be offered as an alternative option, and supervised injectable heroin may (...) Programs for the Reduction or Discontinuation of Opioids or Opioid Substitution Therapy: A Review of the Clinical Effectiveness Programs for the Reduction or Discontinuation of Opioids or Opioid Substitution Therapy: A Review of the Clinical Effectiveness | CADTH.ca Find the information you need Programs for the Reduction or Discontinuation of Opioids or Opioid Substitution Therapy: A Review of the Clinical Effectiveness Programs for the Reduction or Discontinuation of Opioids or Opioid

2018 Canadian Agency for Drugs and Technologies in Health - Rapid Review

18. Telehealth-Delivered Opioid Agonist Therapy for the Treatment of Adults with Opioid Use Disorder: Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines

Telehealth-Delivered Opioid Agonist Therapy for the Treatment of Adults with Opioid Use Disorder: Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines Telehealth-Delivered Opioid Agonist Therapy for the Treatment of Adults with Opioid Use Disorder: Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines | CADTH.ca Find the information you need Telehealth-Delivered Opioid Agonist Therapy for the Treatment of Adults with Opioid Use Disorder: Review of Clinical (...) Effectiveness, Cost-Effectiveness, and Guidelines Telehealth-Delivered Opioid Agonist Therapy for the Treatment of Adults with Opioid Use Disorder: Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines Last updated: October 5, 2018 Project Number: RC1026-000 Product Line: Research Type: Devices and Systems Report Type: Summary with Critical Appraisal Result type: Report Question What is the clinical evidence regarding the use of telehealth-delivered opioid agonist therapy (alone

2018 Canadian Agency for Drugs and Technologies in Health - Rapid Review

19. Withdrawal from an opioid induces a transferable memory trace in the cerebrospinal fluid. Full Text available with Trip Pro

Withdrawal from an opioid induces a transferable memory trace in the cerebrospinal fluid. Opioids are the most powerful analgesics available to date. However, they may also induce adverse effects including paradoxical opioid-induced hyperalgesia (OIH). A mechanism that might underlie OIH is the amplification of synaptic strength at spinal C-fibre synapses after withdrawal from systemic opioids such as remifentanil ("opioid-withdrawal-LTP").Here, we show that both, the induction as well (...) as the maintenance of opioid-withdrawal-LTP were abolished by pharmacological blockade of spinal glial cells. In contrast, the blockade of TLR4 had no effect on the induction of opioid-withdrawal-LTP. D-serine, which may be released upon glial cell activation, was necessary for withdrawal-LTP. D-serine is the dominant co-agonist for neuronal NMDA-receptors, which are required for the amplification of synaptic strength upon remifentanil withdrawal.Unexpectedly, opioid-withdrawal-LTP was transferable via

2019 Pain

20. The past, present and future of opioid withdrawal assessment: a scoping review of scales and technologies. Full Text available with Trip Pro

The past, present and future of opioid withdrawal assessment: a scoping review of scales and technologies. A common challenge with all opioid use disorder treatment paths is withdrawal management. When withdrawal symptoms are not effectively monitored and managed, they lead to relapse which often leads to deadly overdose. A prerequisite for effective opioid withdrawal management is early identification and assessment of withdrawal symptoms.The objective of this research was to describe the type (...) and content of opioid withdrawal monitoring methods, including surveys, scales and technology, to identify gaps in research and practice that could inform the design and development of novel withdrawal management technologies.A scoping review of literature was conducted. PubMed, EMBASE and Google Scholar were searched using a combination of search terms.Withdrawal scales are the main method of assessing and quantifying opioid withdrawal intensity. The search yielded 18 different opioid withdrawal scales

2019 Medical Informatics and Decision Making

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