Journal of opioid management
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Comparative Study
Weaning of opioids and benzodiazepines at home after critical illness in infants: a cost-effective approach.
To evaluate the feasibility of infants' weaning of opioids and sedatives at home. ⋯ The results indicate that home weaning reduced the length of hospital stay by a median of 107 days for the five infants in this study, and thereby considerably reduced healthcare costs. Parents need to be informed clearly about possible withdrawal symptoms and should consent in this strategy. The strategy of final weaning with the aid of weekly telephone consultations with a consultant pediatric intensivist was feasible for these parents.
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Chemotherapy-induced and radiation-induced mucositis is a debilitating and often painful condition resulting in an inability to swallow, and thus inability to maintain adequate quality of life and overall functioning. To date, attempts on palliation of mucositis-related pain have primarily used topical anesthetic solutions and intravenous opioids; these approaches have achieved only limited success, particularly in oncology patients. ⋯ Sublingual methadone is an alternative to standard treatment options for mucositis-related pain and has unique pharmacokinetic and pharmacodynamic properties that make methadone a suitable agent for this pathology. These properties are addressed and discussed, as is the need for additional study to better understand the potential benefits, burdens, and risks that may be associated with this formulation of methadone when treating chemotherapy-induced and/or radiation therapy-induced mucositis in patients with cancer.
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Case Reports
Intranasal abuse of prescription hydrocodone/acetaminophen results in oronasal fistula: a case report.
Opioids are becoming more common in the treatment of chronic nonmalignant pain. With increased availability of opioids for chronic pain we may expect an increased misuse of these as analgesics as well. ⋯ This case report highlights the need for vigilance on the part of the physician for any aberrant drug-related behaviors. Any unusual symptoms or signs such as hypernasal speech, chronic nasal infection, or unexplained foreign body sensation in the nose should be thoroughly investigated.
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Historically and anecdotally cannabinoids have been used as analgesic agents. In recent years, there has been an escalating interest in developing cannabis-derived medications to treat severe pain. This review provides an overview of the history of cannabis use in medicine, cannabinoid signaling pathways, and current data from preclinical as well as clinical studies on using cannabinoids as potential analgesic agents. ⋯ As opioids are the only therapy for severe pain, analgesic ability of cannabinoids may provide a much-needed alternative to opioids. Moreover, cannabinoids act synergistically with opioids and act as opioid sparing agents, allowing lower doses and fewer side effects from chronic opioid therapy. Thus, rational use of cannabis-based medications deserves serious consideration to alleviate the suffering of patients due to severe pain.