Opioid Related Disorders

Opioid-dependent patients presenting to an emergency department for other medical reasons are more likely to pursue addiction treatment if a specific therapy is initiated during their emergency care stay. What therapy are we talking about?

While opioid dependence is among the most severe and lethal of addictions, it also has the most effective medication treatments. The authors provide 2 case vignettes and a step-by-step process for clinical decision making.

There are probably few health care professionals who are unaware of the concerns about the apparent overprescription of opioids. However, we have had only limited information on how good a job physicians may actually be doing in prescribing these medications.

To combat opiate abuse and its dire consequences, drug makers have developed a number of strategies--which are detailed here.

In a world in which substance use disorders are no longer suffered in isolation, treating addiction is a challenging journey with obstacles, intermittent failures, and life-altering successes. A poem on drug withdrawal expressed through the eyes of a fellow in addiction medicine.

The elephant in the room: the problem of iatrogenic opioid use disorder is being ignored.

A guide for helping patients understand heroin, its history, and how it impacts our communities.

In the US, 38,000 drug overdose deaths occur per year, and it is estimated that 75% are opioid-related. The good news is that addiction is a treatable disease. More in this discussion of opioid addiction, the use of naloxone, and Good Samaritan laws.

What expanded roles should psychiatrists be playing in the provision of proper pain management without taking their eyes off the issue of prescription opioid misuse and abuse? Insights here.

As we are faced with a growing population of older adults, a better understanding of the issues that they confront is crucial.

SAMHSA is celebrating its 20th anniversary with a set of 8 new strategies to support and address the needs of patients with behavioral health disorders.

While regulatory controls on methadone clinics for opioid dependence resulted in treatment being physically and functionally isolated from conventional medical care, the delivery of an office-based treatment of buprenorphine and the buprenorphine/naloxone combination product over the last decade has facilitated the return of treatment to “mainstream medicine both for psychiatry and primary care."

Members of the military returning from combat operations have high rates of substance abuse. They also often exhibit a co-occurring triad of posttraumatic stress disorder (PTSD), traumatic brain injury (TBI), and pain, which complicates the problems with substance abuse.

When it comes to analgesics, many options and various factors must be weighed to make the best choice for each patient.

Apart from the lack of evidence supporting their use, is there any reason not to use patient opioid agreements and urine drug testings?

The next I heard of the Prince, my hopes that he had reshaped his consciousness in a more healthy direction were dashed. The Prince was in solitary confinement as punishment for another attempt to establish his empire.

Opioid Dependence and XR Naltrexone

Nothing can replace talking with patients. This can take substantial amounts of time, but it is the only way to obtain as clear a view as possible about whether a patient is benefiting from treatment.

The empirical basis for the effectiveness of 12-step recovery and the psychotherapeutic benefits of opioid agonist maintenance were among the topics of several symposia with introspective views of time-tested treatments at the 40th Annual Medical-Scientific Conference of the American Society of Addiction Medicine (ASAM) in New Orleans.

The number of persons in the United States who take prescription opioids for pain is growing. Sullivan and colleagues2 found that from 2000 to 2005 there was a 19% increase in the number of patients who received prescriptions for opioids to manage chronic noncancer pain conditions. Based on a survey conducted from 1998 to 2006 with more than 19,000 subjects, Parsells Kelly and associates3 reported that 2% of the US population 18 years and older legally used opioids as analgesics at least 5 days per week for 4 or more weeks-and that another 2.9% used these drugs less frequently.

The leading edge of the baby boom generation is rapidly moving into the treatment realm of geriatric psychiatry. As a cohort, baby boomers experimented more with alcohol and illicit drugs than did previous generations.

Addiction-related prevention, research, and treatment have remained important areas of concentration in the field of psychiatry.

Bulimia nervosa is a disorder with a complex cause. The disorder is most commonly seen in women, generally with onset in adolescence.

In 2006, substance dependence or abuse was diagnosed in about 22.6 million persons in the United States.1 Addiction-related morbidity and mortality pose a major burden to society, costing our economy more than $500 billion annually: about $181 billion for illicit drugs,2 $168 billion for tobacco,3 and $185 billion for alcohol.4

The therapeutic challenges presented by comorbid psychiatric and substance abuse disorders, along with strategies and initiatives to improve treatment, were the focus of a recent collection of studies and reviews in the Journal of Substance Abuse Treatment.

Recent years have witnessed exciting developments in understanding and treating addictions. For example, it seems that almost weekly we get new insights into the neurobiology underlying vulnerability to addiction. Similarly, there have never been more medications available to treat the spectrum of addictive disorders, especially alcohol, nicotine, and opioid dependence. In addition, studies continue to underscore the crucial role of psychosocial treatments in recovery from addiction.

In my last column I used the ancient metaphor from Homer's Odyssey of being caught between the two monsters of Scylla and Charybdis to describe the predicament of contemporary physicians treating chronic pain.

Although methadone (Dolophine, Methadose) is primarily thought of as treatment for opioid addiction, it is also an excellent and underused analgesic. This column discusses the issues to consider when deciding whether to prescribe methadone for pain relief.

Marijuana is the most commonly used illicit drug in the United States and worldwide. Initiation of use typically occurs during adolescence. The most recent epidemiological data indicate that in the United States, 42% of high school seniors have tried marijuana, 18% have used it in the past 30 days, and 5% use it daily.

Up to 30% of patients for whom opioids are prescribed for chronic pain show an escalating pattern of opioid abuse characterized by taking more opioids than prescribed, seeking early refills, and finding additional sources of opioids. Although many of these drug-seeking patients are addicted to opioids, some are suffering not from addiction but from inadequate pain management, according to Martha Wunsch, MD, chair of Addiction Medicine and associate professor of pediatrics at Edward Via Virginia College of Osteopathic Medicine (VCOM) in Blacksburg.