Opioid antagonists with minimal sedation for opioid withdrawal

Gowing, Linda; Ali, Robert; White, Jason M.

doi:10.1002/14651858.cd002021.pub4

Cited by 28 publications

(8 citation statements)

References 86 publications

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“…Lofexidine provides substantially more symptom relief than placebo; however, the comparative efficacy of lofexidine in combination with long-acting opioid agonists or opioid antagonists is still being characterized. 71 , 98–100 …”

Section: Cannabis During Acute Opioid Withdrawalmentioning

confidence: 99%

Emerging Evidence for Cannabis' Role in Opioid Use Disorder

Wiese

Wilson-Poe

2018

Cannabis and Cannabinoid Research

127

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Introduction: The opioid epidemic has become an immense problem in North America, and despite decades of research on the most effective means to treat opioid use disorder (OUD), overdose deaths are at an all-time high, and relapse remains pervasive.Discussion: Although there are a number of FDA-approved opioid replacement therapies and maintenance medications to help ease the severity of opioid withdrawal symptoms and aid in relapse prevention, these medications are not risk free nor are they successful for all patients. Furthermore, there are legal and logistical bottlenecks to obtaining traditional opioid replacement therapies such as methadone or buprenorphine, and the demand for these services far outweighs the supply and access. To fill the gap between efficacious OUD treatments and the widespread prevalence of misuse, relapse, and overdose, the development of novel, alternative, or adjunct OUD treatment therapies is highly warranted. In this article, we review emerging evidence that suggests that cannabis may play a role in ameliorating the impact of OUD. Herein, we highlight knowledge gaps and discuss cannabis' potential to prevent opioid misuse (as an analgesic alternative), alleviate opioid withdrawal symptoms, and decrease the likelihood of relapse.Conclusion: The compelling nature of these data and the relative safety profile of cannabis warrant further exploration of cannabis as an adjunct or alternative treatment for OUD.

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Section: Cannabis During Acute Opioid Withdrawalmentioning

confidence: 99%

Emerging Evidence for Cannabis' Role in Opioid Use Disorder

Wiese

Wilson-Poe

2018

Cannabis and Cannabinoid Research

127

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“…The efficacy of methadone or buprenorphine is comparable with low rates of adverse effects. 43,44 An important consideration when prescribing buprenorphine is the potential for precipitated withdrawal, a syndrome of worsening withdrawal symptoms when buprenorphine, a partial opioid agonist with high affinity for the opioid receptor, is administered when a full opioid agonist is also systemically present. To avoid this, buprenorphine should not be administered until at least 12 hours after the last dose of a short-acting opioid and up to 48 hours after the last dose of a long-acting opioid.…”

Section: The Addiction Consultmentioning

confidence: 99%

Inpatient Addiction Consult Service

Weinstein

Wakeman

Nolan

2018

Medical Clinics of North America

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Substance use disorders are highly prevalent and are a large driver of costly inpatient medical care; however, historically the substance use disorder has gone unaddressed during an inpatient stay. Inpatient addiction consult services are an important intervention to use the reachable moment of hospitalization to engage patients and initiate addiction treatment. Addiction consultation involves taking an addiction-specific history, motivational interviewing, withdrawal symptom management, and initiation of long-term pharmacotherapy. Addiction consult services have the potential to decrease readmissions and utilization costs for medical systems and improve substance-related outcomes for patients.

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“…In situations when methadone is not available, the conversion of methadone to any opioid can be performed; however, the conversion calculations may not be bidirectional due to the long half-life of methadone ( 21 ). A multimodal approach ( 16 , 27 ) including the perioperative infusion of ketamine ( 28 , 29 , 30 ), clonidine ( 31 ), and the use of regional anesthesia ( 32 ) should be considered. In a retrospective cohort study performed by Macintyre et al ( 26 ), methadone opioid substitution therapy was continued and it showed the efficacy and safety of PCA opioids for the management of postoperative pain ( 26 ).…”

Section: Summary Of Evidencementioning

confidence: 99%

Perioperative Management of Patients on Buprenorphine and Methadone: A Narrative Review

Sritapan¹,

Clifford²,

Bautista³

2020

Balkan Med J

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The opioid epidemic has emerged as a major health and social problem over the last few decades. An increasing number of patients with opioid use disorder are presenting for perioperative management. These patients are either on buprenorphine or methadone for the maintenance and treatment of opioid addiction or chronic pain. In the settings of acute pain, the optimal management of patients with opioid use disorder is challenging, and recovery can be jeopardized secondary to the unique pharmacology of these agents. The purpose of this narrative review is to summarize the existing studies on the perioperative management of patients who are using buprenorphine and methadone and provide guidance for the management of patients with opioid use disorder during the perioperative period.

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Opioid antagonists with minimal sedation for opioid withdrawal

Cited by 28 publications

References 86 publications

Emerging Evidence for Cannabis' Role in Opioid Use Disorder

Emerging Evidence for Cannabis' Role in Opioid Use Disorder

Inpatient Addiction Consult Service

Perioperative Management of Patients on Buprenorphine and Methadone: A Narrative Review

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