Journal of opioid management
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Case Reports
Codeine-associated pediatric deaths despite using recommended dosing guidelines: three case reports.
This report describes the deaths of three children ages 4-10 years due to codeine toxicity at home. All three children were overweight or obese; however, the codeine doses were within recommended dose ranges for adjusted lean weight. ⋯ Caregivers must be warned about risks associated with comorbidities including obesity and polypharmacy. Codeine should no longer be prescribed to children due to its poor analgesic effect and risk of opioid toxicity and oversedation.
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Randomized Controlled Trial
A clinical trial to determine if corelease of morphine and naltrexone from crushed extended-release capsules induces withdrawal in opioid-dependent patients: a descriptive analysis of six patients.
To evaluate whether intact or crushed doses of an extended-release formulation of morphine sulfate surrounding an inner core of sequestered naltrexone (MSN) induces signs and symptoms of withdrawal in opioid-dependent patients. ⋯ Crushing the MSN capsule may precipitate moderate-to-severe signs and symptoms of opioid withdrawal in opioid-dependent individuals. The negligible exposure to naltrexone following exposure to intact MSN supports that intact capsules may be taken safely without precipitating withdrawal in opioid-dependent individuals.
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To examine the association of risk factors, age, gender, and earlier opioid requirement with the rate of dose escalation in long-term opioid therapy. ⋯ Age, gender, and earlier dose requirement were associated with the rate of dose change in 9-year long-term opioid therapy. Patients aged 75-100 years, being female or having large dose requirement at an earlier stage of therapy may experience a slower dose escalation or even dose decline.
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Pain is a prevalent condition that often involves a neuropathic component. Hydrocodone is one of the most widely used opioids for pain but is often associated with side effects (SEs). This study sought to characterize the experience of patients taking hydrocodone for non-cancer pain. ⋯ This study demonstrates an unmet need for better therapeutic options to manage pain, including neuropathic pain. Therapies that offer improved tolerability also may increase adherence, which could affect overall satisfaction and response to pain management.
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The purpose of this study was to better quantify how urine drug monitoring (UDM) is used in clinical practice. Little is known about which patients are monitored, how often patients are monitored, which substances are important to detect, and under what circumstances clinicians modify the frequency of monitoring. ⋯ Despite a lack of agreement between guidelines informing the use of UDM, there appears to be a general consensus among practitioners that use UDM on: which patients to monitor, how often to monitor, and which substances are most important to detect.