This blog explains what is meant by Type I and Type II errors in statistics (the risk of false positives and false negatives).

A beginner's guide to crossover trials, with an example and explanation of some advantages and limitation of this study design.

Opioids are widely prescribed pain relievers with multiple side effects and potential complications. They produce analgesia via G-protein-protein coupled receptors: μ-, δ-, κ-opioid and opioid receptor-like 1 receptors. Bivalent ligands targeted to the oligomerized opioid receptors might be the key to developing analgesics without undesired side effects and obtaining effective treatment for opioid addicts. In this review we will update the biological effects of μ-opioids on homo- or hetero-oligomerized μ-opioid receptor and discuss potential mechanisms through which bivalent ligands exert beneficial effects, including adenylate cyclase regulation and receptor-mediated signaling pathways.

The opioid crisis has reached epidemic proportions in the United States with rising overdose death rates. Identifying the underlying factors that contribute to addiction vulnerability may lead to more effective prevention strategies. Supply side environmental factors are a major contributing component. Psychosocial factors such as stress, trauma, and adverse childhood experiences have been linked to emotional pain leading to self-medication. Genetic and epigenetic factors associated with brain reward pathways and impulsivity are known predictors of addiction vulnerability. This review attempts to present a biopsychosocial approach that connects various social and biological theories related to the addiction crisis. The emerging role of nutrition therapy with an emphasis on gastrointestinal health in the treatment of opioid use disorder is presented. The biopsychosocial model integrates concepts from several disciplines, emphasizing multicausality rather than a reductionist approach. Potential solutions at multiple levels are presented, considering individual as well as population health. This single cohesive framework is based on the interdependency of the entire system, identifying risk and protective factors that may influence substance-seeking behavior. Nutrition should be included as one facet of a multidisciplinary approach toward improved recovery outcomes. Cross-disciplinary collaborative efforts, new ideas, and fiscal resources will be critical to address the epide...

The Clinical Manual of Addiction Psychopharmacology offers a comprehensive, meticulously detailed review of the pharmacology of addictive drugs and the medications used to treat abuse of and dependence on these addictive drugs. Though rich in detailed background, Clinical Manual of Addiction Psychopharmacology is written with a therapeutic focus, as a clinical guide for the use of pharmacotherapy in patients with substance use disorders.Twenty-four recognized experts cover all major classes of substances that are clinically important in relation to addiction, integrating the basic pharmacology of nine major groups of addictive substances, from alcohol and tobacco to club drugs, with the pharmacology of the drugs used to treat dependence on those addictive substances. The concluding chapter discusses psychosocial treatments combined with pharmacotherapy for alcohol, cocaine, and opioid use disorders.Each thoughtfully illustrated chapter covers the clinical pharmacology of the abused substance, the phenomenology and/or pharmacological treatment of the abstinence syndrome, and the pharmacological treatment for relapse prevention.An essential guide for clinical and social work, the Clinical Manual of Addiction Psychopharmacology will find a wide audience among all prescribing clinicians, psychiatric educators and their students, and other mental health practitioners.

Naltrexone implants after in-patient treatment for opioid dependence: randomised controlled trial - Volume 194 Issue 6

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When abstinence is an appropriate goal, controlled studies and systematic reviews confirm that rapid, antagonist-precipitated opiate withdrawal procedures are t...

Objective: The severity of self-reported withdrawal symptoms varies during detoxification of opioid-dependent patients. The aim of this study is to identify subgroups of withdrawal symptoms within the detoxification trajectory and to predict the severity of withdrawal symptoms on the basis of drug-related and sociodemographic characteristics. Design and setting: A prospective study carried out in an in-patient setting in four addiction treatment centres in the Netherlands. Participants: Two hundred opioid-dependent patients who participated in a randomized controlled trial and completed more than 75 percent of the administrations of the subjective opioid withdrawal scales during rapid detoxification. Intervention and main outcome measure: Main outcome measure was the severity of opioid withdrawal as measured by the subjective opioid withdrawal scale during detoxification (18 measurements). Predictor baseline data were obtained on sociodemographic background, severity of addiction, psychopathology, personality disorder, and craving. Statistics: Those variables found to be statistically significant in univariate analyses were entered into multivariate regression models to predict the severity of subjective withdrawal. Results: No distinct subgroups could be identified despite substantial individual variability throughout the detoxification trajectory. The multiple regression results showed only four variables to predict the severity of withdrawal symptoms: baseline withdrawal symptoms, intravenous heroin use in the last 30 days, anxiety, and cluster C personality disorder. The variance explained by these sociodemographic variables was low while the largest amount of variance was explained by baseline withdrawal symptoms (27 percent). Conclusions: The results of the present study provide evidence that the severity of withdrawal symptoms during detoxification treatment is moderately predicted by the baseline severity of their withdrawal symptoms and not by drug- and patient-related characteristics.

Naltrexone’s current use has been limited by compliance. Subcutaneous implants would seem to offer a solution to this problem and improve long-term outcomes. The aim of the present study was to compare groups of patients who had received oral naltrexone or a naltrexone implant after detoxification and to follow their progress. Forty-one patients received an implant, and 42 patients received oral naltrexone. They were surveyed at one, three, six, and 12 months after detoxification. Their designated support person was also contacted to confirm the self-reports of the participants. Patients were compared on gender, age, and length of time since detoxification. Implant patients showed much higher abstinence rates, while those in both groups who were abstinent showed greater compliance to naltrexone (time spent in treatment) and attended more counseling sessions. Although the participants were not randomly allocated to each treatment condition, the preliminary evidence indicates that implants can improve compliance rates and outcomes.

Naltrexone’s current use has been limited by compliance. Subcutaneous implants would seem to offer a solution to this problem and improve long-term outcomes. The aim of the present study was to compare groups of patients who had received oral naltrexone or a naltrexone implant after detoxification and to follow their progress. Forty-one patients received an implant, and 42 patients received oral naltrexone. They were surveyed at one, three, six, and 12 months after detoxification. Their designated support person was also contacted to confirm the self-reports of the participants. Patients were compared on gender, age, and length of time since detoxification. Implant patients showed much higher abstinence rates, while those in both groups who were abstinent showed greater compliance to naltrexone (time spent in treatment) and attended more counseling sessions. Although the participants were not randomly allocated to each treatment condition, the preliminary evidence indicates that implants can improve compliance rates and outcomes.

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ding socio-demographic profile and drug use pattern of the patients was collected followed by urine testing for opioids, naltrexone, and cannabis. Results The primary drug of use among the patients was found to be heroin. The duration of naltrexone use varied from 1 week to 12 months across the study sample and the mean duration of use was found to be 3.4 months. While on naltrexone, substance abuse (excluding opiates) was present in 37.4% patients. Among these patients, 26% were taking alcohol and 11.4% of the patients were consuming cannabis while on medication. The urine sample of all the subjects tested positive for naltrexone indicating good compliance on the medication. Discussion Despite the small sample size and nonhomogeneity in terms of period of being on naltrexone therapy, the study highlights 2 issues. Firstly, naltrexone seems to help patients in staying abstinent from opioid drugs and secondly a significant proportion of patients is likely to indulge in drug substitution like alcohol and/or cannabis. The latter observation raises concerns regarding the efficacy of naltrexone in managing alcohol dependence. The neurochemical basis for the finding needs to be explored in detail and the physician should be cautious about any change of drug use pattern in-patients on treatment with naltrexone....

Medscape - Indication-specific dosing for ReVia, Vivitrol, Depade (naltrexone), frequency-based adverse effects, comprehensive interactions, contraindications, pregnancy & lactation schedules, and cost information.

Introduction: Neurobiological systems engineering models are useful for treating patients. We show a model of “high opioid tone” autism and present a hypothesis about how autism is caused by administration of opioids during childbirth.Main Symptoms: Clinical diagnosis of autism in a 25 year old man was confirmed by a Social Responsiveness Scale (SRS) self-rating of 79, severe, and a Social Communications Questionnaire (SCQ-2) by the patient's father scoring 27. Cold pressor time (CPT) was 190 seconds—unusually long, consonant with the high pain tolerance of autism.Therapeutic Intervention and Outcomes: At naltrexone 50 mg/day SRS fell to 54 and SCQ-−2–9; both non-significant. CPT fell to 28, repeat 39 s. Improved relatedness was experienced ambivalently, understood as feelings never before experienced—causing pain. Non-compliance with naltrexone was followed by cutting open his palm and drinking alcoholically. Transference focused psychotherapy has helped him remain naltrexone—compliant while he works on issues of identity and relatedness.Conclusion: The model suggests studies that could be conducted to both prevent and treat this form of autism.