Fentanyl withdrawal is common, but pharmacological management has largely mirrored traditional approaches to opioid withdrawal. Observations in a large urban center suggest alternative approaches, including the need for dose modification, should be considered.
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http://dx.doi.org/10.1007/s11414-020-09710-8 | DOI Listing |
J Addict Med
December 2024
From the Integrated Psychiatry, Pain, and Addiction Service, Vancouver General Hospital, Vancouver, British Columbia, Canada (PA, JSHW, JM, MN, VWL, MJI, NM); Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada (PA, MN, VWL, MJI, NM); Addictions and Concurrent Disorders Research Group, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada (JSHW, RMK); Substance Use Response and Facilitation Service, BC Children's Hospital, Provincial Health Services Authority, Vancouver, British Columbia, Canada (MJI); BC Mental Health & Substance Use Services, Provincial Health Services Authority, Vancouver, British Columbia, Canada (NM); Bridge, Public Health Institute, Oakland, CA (AAH); Department of Emergency Medicine, Highland General Hospital-Alameda Health System, Oakland, CA (AAH); Department of Emergency Medicine, University of California, San Francisco, CA (AAH); The C4 Foundation, Coronado, CA (RM); British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada (JSGM); Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (JSGM); and Pharmacokinetics Modeling and Simulation Laboratory, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada (ARM).
Buprenorphine has superior safety in opioid use disorder compared with alternatives due to its action as a partial opioid agonist, which limits its ability to cause respiratory depression. There is a risk of precipitated opioid withdrawal after buprenorphine exposure in someone using full opioid agonists. Buprenorphine induction strategies that avoid precipitated withdrawal remain a crucial component for starting buprenorphine in individuals actively using opioids.
View Article and Find Full Text PDFThe endogenous dynorphin/kappa opioid receptor (KOR) system in the brain mediates the dysphoric effects of stress, and KOR antagonists may have therapeutic potential for the treatment of drug addiction, depression, and psychosis. One class of KOR antagonists, the long-acting norBNI-like antagonists, have been suggested to act by causing KOR inactivation through a cJun-kinase mechanism rather than by competitive inhibition. In this study, we screened for other opioid ligands that might produce norBNI-like KOR inactivation and found that nalfurafine (a G-biased KOR agonist) and nalmefene (a KOR partial agonist) also produce long-lasting KOR inactivation.
View Article and Find Full Text PDFJ Gen Intern Med
January 2025
University of California, San Francisco, 1001 Potrero Avenue, Bldg 5 Rm 5H06, San Francisco, CA, 94110, USA.
Background: Fentanyl use leads to increased opioid tolerance in people with opioid use disorder, complicating management of opioid withdrawal syndrome. While accepted as gold standard, methadone and buprenorphine may be insufficient to treat acute opioid withdrawal. Short-acting full agonist opioids (SAFAO) may improve treatment in the acute care setting.
View Article and Find Full Text PDFHarm Reduct J
January 2025
Asociación Bajacaliforniana de Salud Pública A.C, Tijuana, Baja California, Mexico.
Background: Xylazine is a α2-adrenergic receptor agonist, used for sedation in veterinary contexts. Although it is increasingly found in overdose deaths across North America, the clinical management of xylazine-involved overdoses has not been extensively studied, especially in community-based harm reduction settings. Here we present a clinical series of xylazine-involved overdose and share the clinical approach and lessons learned by a community overdose response team in Tijuana, Mexico amidst the arrival of xylazine.
View Article and Find Full Text PDFBiomaterials
December 2024
Department of Pharmaceutics, Virginia Commonwealth University, Richmond, VA, 23298, USA; Department of Ophthalmology, Virginia Commonwealth University, Richmond, VA, 23298, USA; Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, 23298, USA; Center for Pharmaceutical Engineering, Center for Drug Discovery, Department of Pediatrics, and Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, 23298, USA. Electronic address:
The opioid crisis has claimed approximately one million lives in the United States since 1999, underscoring a significant public health concern. This surge in opioid use disorder (OUD) fatalities necessitates improved therapeutic options. Current OUD therapies often require daily clinical visits, leading to poor patient compliance and high costs to the health systems.
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