Tag Archives: opioids

Most People Don’t Feel Euphoric From Opioids

Most People Don’t Actually Feel Euphoric When They Take Opioids, Study Finds | Live Science –  By Nicoletta Lanese – Oct 2019

Opioids are known to spark feelings of euphoria in users, but does everyone really share the same experience?

Opioids jump-start the brain’s reward system, provoking a burst of pleasurable feelings along with a dizzying drug-induced high. At least that’s what scientists used to think

But mounting research suggests that the average person doesn’t actually reach this euphoric state on opioids, particularly not the first time they try it. In fact, people who are not addicted to opioids may feel subjectively worse after taking the drug, according to cognitive neuroscientist Siri Leknes.    Continue reading

Long-term opioid therapy for chronic pain

Long-term opioid therapy in chronic noncancer pain. NIH – Feb 2015 – a systematic review and meta-analysis of efficacy, tolerability, and safety in open-label extension trials with a study duration of at least 26 weeks (that’s 1/2 year).

This study confirms what pain patients all know: long-term opioids are effective for long-term pain, require few increases, and only rarely result in “opioid use disorder”. 

The efficacy and safety of long-term (≥ 6 months) opioid therapy (LtOT) in chronic noncancer pain (CNCP) is under debate.A systematic review with meta-analysis of the efficacy and harms of opioids in open-label extension studies of randomized controlled trials (RCTs) has not been conducted until now.   Continue reading

Opioids Continue to Be Effective Long Term

Opioids Continue to Be Effective Long Term Medscape – Fran Lowry – October 01, 2013

This is a good review with results that ring true in my experience,

Unfortunately, it’s fatally tainted by funding from Purdue.

An extensive literature review of studies evaluating the effectiveness of long-term opioid therapy in chronic noncancer pain (CNCP) concludes that the drugs continue to provide reliable and safe analgesia for 6 months or more.

“Due to FDA regulatory guidelines, most contemporary phase 3 randomized controlled trials of opioid analgesics for CNCP are 3 months long or less.   Continue reading

Little evidence of opioid-induced hyperalgesia

Evidence of opioid-induced hyperalgesia in clinical populations after chronic opioid exposure: a systematic review and meta-analysis – Br J Anaesth. – 2019 Jun

Opioid-induced hyperalgesia (OIH) is well documented in preclinical studies…

It’s such a trendy topic that I’m sure many researchers are looking for evidence that chronic pain patients only need high doses because they are suffering from “opioid-induced hyperalgesia”, which has still NOT been proven in humans.

…but findings of clinical studies are less consistent.

This isn’t surprising to most pain patients, who know the difference between their increasing pain and hyperalgesia.  Continue reading

Drug Diversion in Hospitals

Drug Diversion: New Approaches to an Old Problem – Gregory Burger, MS, RPh, FASHP, and Maureen Burger, MSN, RN, CPHQ, CPPS, FACHE – Feb 2016

Regulations for hospitals have changed little since the Controlled Substance Act of 1970.

DEA investigators conduct scheduled investigations and unannounced visits to DEA registrants, ensuring that correct recordkeeping is being followed.

The agency has conducted several high-profile investigations in the last few years, resulting in multi-million dollar fines and organizationally significant corrective action plans.  Continue reading

Chronic opioid use and five-year survival

Trends in chronic opioid use and association with five-year survival in South Korea: a population-based cohort study. – Sep 2019

This research study came to some very interesting and highly unusual conclusions.

The Korean National Health Insurance Service (NHIS) was developed to provide population data for medical research.

The aim of this study was to estimate trends in prescription opioid use in South Korea, and to determine the association between chronic opioid use and 5-yr mortality in cancer and non-cancer patients.   Continue reading

Fentanyl: Separating Fact from Fiction

Fentanyl: Separating Fact from FictionPractical Pain ManagementLast updated on: April 12, 2019

The US Centers for Disease Control and Prevention continue to report increasing opioid-related deaths despite declining rates of opioid prescribing.

Dramatically on the rise is the role of illicit synthetic fentanyl derivatives. These potent Schedule I drugs have dwarfed deaths from prescription-opioid overdose deaths, even among those that possess prescription opioids from a nonmedical source

Part of the discrepancy is that overdose deaths are frequently reported through ICD-10 codes, based on the International Statistical Classification of Diseases and Related Health Problems, which do not allow for delineation of overdoses by

  • a legitimately prescribed opioid versus
  • an illicit opioid, versus
  • a combination of these and/or other non-opioid sedative hypnotics.

Continue reading

Novel Opioid Receptor Agonist Found Effective[?]

Novel Opioid Receptor Agonist Found Effective for Chronic Low Back Pain – Clinical Pain Advisorby Amit Akirov, MD – Aug 2019

The main appeal of this very mild opioid pain reliever is that it enters the nervous system very slowly compared to current opioids, which supposedly makes it less addictive.

NKTR-181 was found to be a safe, effective, and well tolerated treatment over the long term in patients with moderate to severe chronic low back pain (CLBP), according to results from a phase 3 trial published in Pain Medicine.

NKTR-181, a novel μ-opioid receptor agonist, has several advantages compared with conventional opioid drugs, including

  • a slower entry into the central nervous system,
  • delayed receptor binding, and [why would a delay of pain relief be desireable?]
  • long duration of effect.

Continue reading

The complexity of opioid receptor function

Untangling the complexity of opioid receptor function – by Rita J. Valentino & Nora D. Volkow – Sept 2018for science nerds

This is a technical article explaining the differences between different opioid receptors, which turn out to have further layers of complexity. Finding the molecular paths or signals that create and/or transmit pain signals, researchers hope to find new ways to interrupt that process to alleviate pain.

Evidence that opioid receptors form and can function as heteromers suggests another layer of complexity and another route for manipulating opioid receptor function

Mu opioid receptor agonists are among the most powerful analgesic medications but also among the most addictive.   Continue reading

Opioid Taper Associated with Termination of Care

Opioid Taper Is Associated with Subsequent Termination of Care: a Retrospective Cohort Study. – Pub Med – J Gen Intern Med. – Aug 2019

This study exposes the horrific aftermath of forced opioid tapers when patients are expelled from medical care because doctors have a reasonable fear of losing their livelihoods if treating pain with opioids.

BACKGROUND

Opioid tapering is increasingly utilized by providers to decrease risks of chronic opioid therapy, but it is unknown whether tapering is associated with termination of care.

Continue reading