Journal of addictive diseases
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Using a self-report survey methodology in a cross-sectional consecutive primary care sample (N = 238), we examined pain at 3 time points (today, past month, past year), pain catastrophizing using the Pain Catastrophizing Scale, and history of legal charges for 5 drug-related crimes as defined by the Federal Bureau of Investigation. Among the subsample of 185 participants with histories of being prescribed analgesics, 33 reported a history of legal charges for drug-related crimes. Analyses of variance among this subsample confirmed statistically significant relationships between the current level of pain and history of legal charges for drug-related crimes, as well as level of pain catastrophizing and history of legal charges for drug-related crimes.
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Interviews with fourteen opioid retail pill sellers provides an exploration into the diversion and diffusion of Suboxone to recreational ("week-end warriors") drug users. The use of social media and electronic devices enables the diffusion of Suboxone to dependent and non-dependent opiate/opioid drug abusers. ⋯ The diversion and the diffusion of Suboxone have the potential to delay entrance into drug treatment and promote the misuse of the drug by both dependent opiate/opioid drug abusers and recreational users. The dilemma posed by Suboxone maintenance treatment will not be easily addressed or mitigated in the near future.
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An increasing percentage of women are U. S. Military Veterans. ⋯ Women Veterans may have higher rates of substance misuse and comorbid psychiatric and medical disorders than male Veterans and women who are not Veterans. Studies support the AUDIT-C as a scaled marker of alcohol-related risk among female Veterans, but validated drug screening instruments are needed. We discuss evidence-based approaches in terms of treating women Veterans' substance misuse in primary and specialty care settings, along with knowledge gaps and potential research priorities to improve care in this special population.
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Randomized Controlled Trial
A preliminary study comparing methadone and buprenorphine in patients with chronic pain and coexistent opioid addiction.
Patients with opioid addiction who receive prescription opioids for treatment of nonmalignant chronic pain present a therapeutic challenge. Fifty-four participants with chronic pain and opioid addiction were randomized to receive methadone or buprenorphine/naloxone. ⋯ Other differences between the two conditions were not found. Long-term, low-dose methadone or buprenorphine/naloxone treatment produced analgesia in participants with chronic pain and opioid addiction.
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Registry data on methadone reveal that QTc-prolongation is reported more often among opioid-dependent patients than chronic pain patients. This suggests that opioid treatment programs may be an important venue for implementing arrhythmia risk-reduction strategies. An electrocardiography-based strategy in the opioid treatment program setting demonstrated a reduction in the QTc-interval among patients with marked QTc-prolongation. ⋯ Therefore, we performed qualitative interviews among opioid treatment program staff to determine the barriers and benefits of implementation. Overall, the program was well received by staff; however, a need for training and algorithms was identified. No patient was denied access to care.