Articles: opioid-analgesics.
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Methods are described for assessment of the abuse liability of opioids and analgesics. The methods developed by the USPHS Addiction Research Center for assessment of opioid abuse liability have served as the prototype for most currently used abuse liability assessment approaches. ⋯ Specific methods, including the Addiction Research Inventory, adjective- and visual analog rating scales, are described, as are methodological developments that have been introduced to improve the sensitivity of the procedures and to adapt them to modern circumstances. It is concluded that the profile-of-effects methodology has proven extremely useful and should remain a basic element in abuse liability assessments.
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Wisconsin medical journal · Dec 1991
Wisconsin physicians' knowledge and attitudes about opioid analgesic regulations.
This pilot study was designed to evaluate physician knowledge of the controlled substance regulations that govern the prescribing of opioids and whether concerns about regulatory scrutiny affect reported prescribing practices. Two hundred Wisconsin physicians were surveyed, and 90 (45%) of the questionnaires were evaluable. Approximately 50% of the responses to questions about controlled substance regulations were incorrect. ⋯ However, 54% of the respondents indicated that, due to concern of regulatory scrutiny, they will do one of the following: reduce drug dose or quantity, reduce the number of refills, or choose a drug in a lower schedule. These results indicate that many physicians have poor knowledge of controlled substances regulations and that the perceived risk of regulatory scrutiny can alter physician prescribing practice. Implications for patient care, policy and further research are discussed.
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The relationship between analgesic activity, measured as the hot plate reaction time, and respiratory depression, measured as ventilatory frequency, was investigated in mice for a variety of mu opioid receptor agonists with differing selectivities for mu receptors compared with delta receptors. There was a weak correlation between analgesia and respiratory depression for opioids with the greatest selectivity for mu opioid receptors compared with delta receptors, such as alfentanil. ⋯ Etorphine, which has almost equal affinity for mu, delta and, incidentally, kappa receptors, showed a strong correlation between analgesia and respiratory depression. We conclude that the predictability of the degree of respiratory depression produced by a given analgesic dose of an opioid appears to decrease with its selectivity for mu opioid receptors, at least in the mouse.
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Efficacy and side effects of a continuous infusion of sufentanil following epidural administration of a single dose of 30 micrograms of the opioid were studied in 28 patients undergoing laparotomy. Patients were divided into two groups treated with either 10 micrograms/h (n = 13) or 15 micrograms/h (n = 15) and compared with regard to sufentanil plasma levels, side effects and changes in blood gases. ⋯ After the injection of a bolus of 30 micrograms sufentanil, a dose chosen according to current recommendations, a quick onset of analgesia was noted, but also sedation and respiratory depression with apneic intervals lasting up to 30 s, demonstrating both the efficacy and the possibility of unwanted and even harmful side effects associated with this kind of administration. During long-term infusion, after about 20 h PaCO2 and respiratory rate were significantly different between the two groups, which could be explained by differences in sufentanil plasma levels and a somewhat higher level of postoperative pain in the group receiving 10 micrograms/h.