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Nonopioid medications for managing opioid withdrawal in acute care settings: A scoping review.
Am J Health Syst Pharm
December 2024
Banner - University Medical Center, Tucson, AZ, USA.
Purpose: There are hospitalized patients with chronic opioid use who will experience signs and symptoms of opioid withdrawal who were not on medications for opioid use disorder (OUD) prior to admission, do not want to start or are unable to start medications for OUD during admission, and want to limit or avoid the use of opioids. The purpose of this scoping review was to assess the potential effectiveness and safety of using non-opioid agents for managing acute opioid withdrawal in acute care settings.
Methods: PubMed (inception to 2024), Embase (inception to 2024), and Cochrane Library (inception to 2024) were the databases evaluated for the literature search.
The Mitragyna speciosa (kratom) alkaloid mitragynine: Analysis of adrenergic α receptor activity in vitro and in vivo.
Eur J Pharmacol
October 2024
Department of Pharmacodynamics, College of Pharmacy, University of Florida, Gainesville, FL, 32610, USA. Electronic address:
Mitragynine, an alkaloid present in the leaves of Mitragyna speciosa (kratom), has a complex pharmacology that includes low efficacy agonism at μ-opioid receptors (MORs). This study examined the activity of mitragynine at adrenergic α receptors (AαRs) in vitro and in vivo. Mitragynine displaced a radiolabeled AαR antagonist ([H]RX821002) from human AαRs in vitro with lower affinity (K = 1260 nM) than the agonists (-)-epinephrine (K = 263 nM) or lofexidine (K = 7.
View Article and Find Full Text PDFManaging Opioid Withdrawal Symptoms During the Fentanyl Crisis: A Review.
Subst Abuse Rehabil
April 2024
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
Illicitly manufactured fentanyl (IMF) is a significant contributor to the increasing rates of overdose-related deaths. Its high potency and lipophilicity can complicate opioid withdrawal syndromes (OWS) and the subsequent management of opioid use disorder (OUD). This scoping review aimed to collate the current OWS management of study populations seeking treatment for OWS and/or OUD directly from an unregulated opioid supply, such as IMF.
View Article and Find Full Text PDFLow dose lofexidine for medically directed outpatient opioid tapering in adults with chronic pain: a prospective case series.
J Med Case Rep
January 2024
Department of Anesthesiology and Perioperative Medicine, Mayo School of Graduate Education, Mayo Clinic, 200 First St SW, Charlton 1-145, Rochester, MN, 55905, USA.
Background: In adults with chronic pain, mild-to-moderate withdrawal symptoms during medically directed opioid tapering in the outpatient setting may not be accompanied by hypertension or tachycardia. This clinical scenario could limit the use of lofexidine at dosages reported in clinical trials of opioid withdrawal precipitated by abrupt opioid discontinuation. Thus, the primary aim of this prospective case series is to describe the use of low dose lofexidine for opioid withdrawal in patients with chronic pain undergoing medically directed opioid tapering in an outpatient setting.
View Article and Find Full Text PDFCold nociception as a measure of hyperalgesia during spontaneous heroin withdrawal in mice.
Pharmacol Biochem Behav
February 2024
Neurobiology of Addiction Section, Integrative Neuroscience Research Branch, National Institute on Drug Abuse, Intramural Research Program, Baltimore, MD, USA. Electronic address:
Opioids are powerful analgesic drugs that are used clinically to treat pain. However, chronic opioid use causes compensatory neuroadaptations that result in greater pain sensitivity during withdrawal, known as opioid withdrawal-induced hyperalgesia (OWIH). Cold nociception tests are commonly used in humans, but preclinical studies often use mechanical and heat stimuli to measure OWIH.
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