Journal of addictive diseases
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Inflated rates of opioid addiction among anesthesiologists may be caused by chronic exposure to low doses of aerosolized anesthetic/analgesic agents in the operating room. Such secondhand exposure produces neurobiological sensitization to the reinforcing effects of these substances, making later addiction more likely. This article extends findings that fentanyl and propofol are detectable in the air of the operating room and demonstrates that fentanyl is also detectable on surfaces in the operating room. ⋯ Additionally, data show that many physicians with opiate addiction have a family history of addiction, suggesting genetic vulnerability to the effects of secondhand exposure. Other new data demonstrate that the rates of marijuana and tobacco smoking are much higher among opioid-addicted physicians, suggesting that prior exposure to THC (the psychoactive component of cannabis) or nicotine might increase vulnerability to secondhand effects. Suggestions for reducing secondhand exposure in the operating room are discussed.
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Since the 1990s prescriptions for and the non-medical use of opioids have increased. This study examines associations between opioid prescribing, non-medical use, and emergency department (ED) visits. ⋯ The increased number of prescriptions written for hydrocodone and oxycodone between 1995 and 2004 was associated with similar increases in non-medical use and the number of ED visits during this time period.
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Our study showed that the perception of pain lessens with detoxification from chronic prescription opiate medications. Thus, removal of opiates resulted in less pain, and chronic administration of opiates actually increased pain perceptions. The underlying pathophysiology of increased pain sensitivity from chronic administration is not well understood. ⋯ Clinicians are advised to limit their prescribing of opiate drugs to patients on a chronic basis. Further, unresolved pain complaints, and continued complaints of pain despite escalating doses of opiate medications suggest addiction and its adverse consequences. Identification of addiction and detoxification is the proper approach to pain management in chronic opiate administration.
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Comparative Study
Buprenorphine and methadone: a comparison of patient completion rates during inpatient detoxification.
Buprenorphine and methadone are both effective for the control of the acute signs and symptoms of opiate withdrawal, but it is not known if there are differences between these two medications for other important clinical outcomes. This observational, non-randomized study evaluated completion rates of patients over a 13-month period when buprenorphine replaced methadone as the medication used for short-term inpatient opiate detoxification. ⋯ Improvement in completion rates coincided with the introduction of buprenorphine. We conclude that as compared to methadone, buprenorphine is associated with greater rates of completion of inpatient detoxification.
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To evaluate the relation between high methadone doses and methadone serum levels in MMT patients. ⋯ We extended the well-established correlation between methadone doses and serum levels in patients receiving low or moderate (60 to 120 mg/day) to high methadone doses (up to 290 mg/day).