1,721,001 research outputs found
Abuse Liability of Controlled-release Oxycodone Formulations
Full text linkControlled-release opioid formulations may have differential abuse liability profiles related to rates of drug delivery. In this double-blind, placebo-controlled, randomized, crossover study, the abuse liability of a single 40mg intact oral dose of three controlled-release oxycodone formulations (Apo-oxycodone CR®, OxyNEO®, and OxyContin®) were compared by performing pharmacodynamic and pharmacokinetic analyses in 11 non-dependent recreational opioid users. OxyContin® was not available for 6 participants due to product expiry of discontinued product. Assessments included the primary outcomes of Drug High and Drug Liking ratings, and secondary measures of subjective effects, psychomotor performance, pupillometry and plasma oxycodone concentrations. The longer time to peak plasma concentrations of OxyNEO® versus Apo-oxycodone CR® and OxyContin® was paralleled by a reduction in the early subjective effects of Drug High post-dose. Overall, the formulations produced comparable positive and negative subjective effects suggesting that they have similar abuse liability profiles when taken intact orally.M.Sc
Influencing Factors on Methadone Pharmacology: Impact on Satisfaction with Methadone Maintenance Treatment
No full textThe methadone maintenance treatment population suffers from high rates of comorbid psychiatric and substance use disorders. Despite a more than 40-year treatment history, not all patients are satisfied with methadone treatment and more than half of the patients complain of significant inter-dose withdrawal at least some of the time. The objectives of this research were to investigate the pharmacological response to methadone under the influence of comorbid major depressive disorder and smoking; and to identify factors
other than physical withdrawal symptoms that can differentiate patients based on their
complaints of dissatisfaction with treatment. In Study 1, seven depressed methadone maintenance patients experienced more opioid withdrawal symptomatology over a 24-hour methadone-dosing interval than 10 nondepressed methadone patients. Depression
severity was significantly correlated with trough opioid withdrawal severity. This
suggests that depression or depressive symptoms are related to reported opioid
withdrawal. In Study 2, many factors other than physical opioid withdrawal symptoms
were able to differentiate patients who were satisfied with treatment (holders, n=25),
partially satisfied with treatment (partial holders, n=35), and not satisfied with treatment(nonholders, n=30). Results suggested that these patient satisfaction groups cluster differently depending on physical opioid withdrawal, mood, psychological distress, and personality. Nonholders experienced more physical withdrawal symptoms, craving for
opioids, and negative drug effects. Holders had less psychological distress and
experienced less negative mood states than the other groups. Partial holders had less
agreeable personalities compared to patients in the other groups. In Study 3, opioid and
nicotine withdrawal symptoms and effects were measured in 40 methadone-maintained
patients who were current smokers during trough and peak methadone effects, both pre and post-nicotine administration. Cigarette smoking enhanced opioid withdrawal suppression during the peak methadone condition, methadone attenuated nicotine
withdrawal, and methadone and nicotine shared many of the same main effects,
suggesting that smoking and methadone effects may be inseparable dimensions. In
summary, the results of these studies suggest that in addition to physical symptoms, mood related factors are important to opioid withdrawal perception and that the mood factors and drug interactions can impact on a patient’s perception of satisfaction with methadone treatment.Ph
Use of a cannabis clinical guide by community pharmacists providing care for people using cannabis: an exploratory feasibility study
Full text linkPharmacists are uniquely positioned to provide care to the 6.4 million Canadians using cannabis. Pharmacists’ reported lack of comfort with their cannabis-related knowledge is a barrier. To address this, we evaluated a cannabis clinical guide for pharmacists.
We aimed to describe the use of this guide by community pharmacists to provide care for patient using cannabis, in order to inform feasibility. A secondary objective was to identify pharmacists’ perspectives on use of the guide in their practice. We recruited four community pharmacists for this exploratory feasibility study who used the guide in their practice for three months, and conducted a focus group to gather their perspectives.
A global assessment of feasibility considered implementation determinants and outcomes, how the guide was used in practice, and participant feedback. It was determined that a future trial evaluating the impact and implementation of the cannabis clinical guide in community pharmacies would be feasible.M.Sc
Long-acting Opioids for Pain in Ontario: Exploring Use Patterns in an Era of Chronic Pain and Opioid Crises
No full textA need for rational opioid prescribing for chronic pain has emerged from the chronic pain and opioid crises in Canada. Three studies aimed to improve understanding of long-acting opioid use, particularly at shortened dosing intervals. The first was a retrospective chart review in people with chronic pain and opioid-related risk. A high proportion of those using long-acting opioids used them at shortened dosing intervals, associated with a higher dose compared with use at standard intervals. The second study evaluated the feasibility of an n-of-1 approach to examine the relationship amongst subjective opioid effects and the pharmacokinetics of long-acting opioids administered at shortened dosing intervals. It was not feasible at that time. A third, population-based cohort study, explored dispensing trends of long-acting opioids in Ontario (2013-2018). Overall, dispensing rates declined; geographic variability in rates persisted. This research has improved understanding related to use of long-acting opioids in people with chronic pain.M.Sc
Development and Evaluation of an Educational Program for Community Pharmacists on Opioid Stewardship in Acute Pain
Full text linkThe prescribing of excessive quantities and doses of opioids for acute pain can increase the risk of harm for patients and their families. Community pharmacists can play a role in preventing harm associated with opioids in acute pain by providing opioid stewardship activities such as dispensing smaller quantities, advising on safer daily doses and counselling on safe storage and disposal.
An educational program for community pharmacists was designed to give community pharmacists the knowledge, confidence, and motivation to provide these activities in their everyday practice. Surveys were used to evaluate the program and showed that it was well received. Survey results also suggested that the program had a positive impact on participants’ confidence, motivation, knowledge, and intention, however it is not known if this translated into a change in pharmacists’ behaviour.M.Sc
Abuse Liability of Controlled-release Oxycodone Formulations
No full textControlled-release opioid formulations may have differential abuse liability profiles related to rates of drug delivery. In this double-blind, placebo-controlled, randomized, crossover study, the abuse liability of a single 40mg intact oral dose of three controlled-release oxycodone formulations (Apo-oxycodone CR®, OxyNEO®, and OxyContin®) were compared by performing pharmacodynamic and pharmacokinetic analyses in 11 non-dependent recreational opioid users. OxyContin® was not available for 6 participants due to product expiry of discontinued product. Assessments included the primary outcomes of Drug High and Drug Liking ratings, and secondary measures of subjective effects, psychomotor performance, pupillometry and plasma oxycodone concentrations. The longer time to peak plasma concentrations of OxyNEO® versus Apo-oxycodone CR® and OxyContin® was paralleled by a reduction in the early subjective effects of Drug High post-dose. Overall, the formulations produced comparable positive and negative subjective effects suggesting that they have similar abuse liability profiles when taken intact orally.M.Sc
Influencing Factors on Methadone Pharmacology: Impact on Satisfaction with Methadone Maintenance Treatment
No full textThe methadone maintenance treatment population suffers from high rates of comorbid psychiatric and substance use disorders. Despite a more than 40-year treatment history, not all patients are satisfied with methadone treatment and more than half of the patients complain of significant inter-dose withdrawal at least some of the time. The objectives of this research were to investigate the pharmacological response to methadone under the influence of comorbid major depressive disorder and smoking; and to identify factors
other than physical withdrawal symptoms that can differentiate patients based on their
complaints of dissatisfaction with treatment. In Study 1, seven depressed methadone maintenance patients experienced more opioid withdrawal symptomatology over a 24-hour methadone-dosing interval than 10 nondepressed methadone patients. Depression
severity was significantly correlated with trough opioid withdrawal severity. This
suggests that depression or depressive symptoms are related to reported opioid
withdrawal. In Study 2, many factors other than physical opioid withdrawal symptoms
were able to differentiate patients who were satisfied with treatment (holders, n=25),
partially satisfied with treatment (partial holders, n=35), and not satisfied with treatment(nonholders, n=30). Results suggested that these patient satisfaction groups cluster differently depending on physical opioid withdrawal, mood, psychological distress, and personality. Nonholders experienced more physical withdrawal symptoms, craving for
opioids, and negative drug effects. Holders had less psychological distress and
experienced less negative mood states than the other groups. Partial holders had less
agreeable personalities compared to patients in the other groups. In Study 3, opioid and
nicotine withdrawal symptoms and effects were measured in 40 methadone-maintained
patients who were current smokers during trough and peak methadone effects, both pre and post-nicotine administration. Cigarette smoking enhanced opioid withdrawal suppression during the peak methadone condition, methadone attenuated nicotine
withdrawal, and methadone and nicotine shared many of the same main effects,
suggesting that smoking and methadone effects may be inseparable dimensions. In
summary, the results of these studies suggest that in addition to physical symptoms, mood related factors are important to opioid withdrawal perception and that the mood factors and drug interactions can impact on a patient’s perception of satisfaction with methadone treatment.Ph
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Probing Mesocorticolimbic Dopamine Function in Alcohol Dependence Using Dextroamphetamine: Behavioural and FMRI Studies
Full text linkBackground: A dysfunctional mesocorticolimbic dopamine system has been reported in alcohol dependence and major depressive disorder. Probing mesocorticolimbic dopamine function in severe depression using dextroamphetamine revealed an altered behavioural response and a disrupted mesocorticolimbic circuitry in behavioural and functional magnetic resonance imaging (fMRI) studies. The purpose of this study was to use a similar approach in alcohol dependence. Behavioural Study: to assess dextroamphetamine subjective effects in alcohol-dependent and depressed alcohol-dependent participants. FMRI Study: to assess how the mesocorticolimbic circuitry would respond to a dextroamphetamine challenge in alcohol-dependent participants exposed to alcohol cues. Methods: In both studies, a single oral 30 mg dose of dextroamphetamine was the pharmacological intervention. Behavioural Study: randomized, double-blind, placebo-controlled, between-subject study. Eighteen alcohol-dependent and 22 depressed alcohol-dependent participants were compared using validated self-report drug effect tools (e.g. Addiction Research Center Inventory). FMRI Study: single-blind, between-subject study. FMRI blood oxygen level–dependent (BOLD) activation was measured in 14 alcohol-dependent and 9 healthy control participants during an alcohol-cue exposure task pre- and post-drug. Results: Behavioural Study: DRUG (F1,40=18.6; p10; (x=10;y=-2;z=-14)). A GROUPxDRUG interaction effect was detected in the medial orbitofrontal cortex (mOFC) (F1,40=21.5; z=4.0; p10; (x=-12;y=28;z=-20). The alcohol-dependent group exhibited a negligible mOFC response across both pre- and post-drug scanning sessions. In contrast, controls exhibited attenuation of mOFC response post-drug. Conclusion: The lack of significant GROUPxDRUG interaction effects in the Behavioural Study may suggest different neurobiological mechanisms underlying alcohol dependence and depression mesocorticolimbic dysfunction. Alcohol dependence appeared to mitigate the impact of depression severity on participants’ behavioural responses to dextroamphetamine. The FMRI Study data suggest there may be ventral striatal and mOFC disruption in alcohol-dependent participants. We suggest the mOFC may be involved in the reported loss of prefrontal modulation of dopamine cell activity in alcohol dependence. This supports a key role for the mOFC in mesocorticolimbic dysfunction in alcohol dependence.Ph
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