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Zhao J, Green C, Markham C, Fujimoto K, Nyitray AG, Hwang LY. Association between non-injection drug use and hepatitis C infection among HIV-negative men who have sex with men. BMC Infect Dis 2024; 24:985. [PMID: 39285350 PMCID: PMC11406739 DOI: 10.1186/s12879-024-09685-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 07/29/2024] [Indexed: 09/19/2024] Open
Abstract
BACKGROUND Prior research predominantly examined the association between HIV-positive men who have sex with men (MSM) or those using injection drugs and hepatitis C virus (HCV) infection. However, limited attention has been given to understanding the association among HIV-negative MSM who do not inject drugs. This gap leaves apportion of the population unexamined, potentially overlooking important factor that may contribute to the transmission and prevalence of HCV. This study aims to investigate the relationship between non-injection drug use and HCV infection in this population. METHODS In this cross-sectional study, we analyzed data on 118 MSM who reported use of non-injection drugs. The participants were recruited from two inner-city communities in Houston, TX, between 2004 and 2007 and were negative for both HIV and hepatitis B virus infection. Latent class analysis (LCA) was used to identify drug use latent classes. Multinomial logistic regression analysis was used to evaluate the association between drug use latent class and HCV infection. RESULTS Four distinct latent classes of drug use were identified: class 1, persons ≥ 42 years of age who used only crack cocaine; class 2, persons approximately 42 years of age who used > 2 drugs; class 3, persons < 42 years of age who used > 5 drugs; and class 4, persons ≥ 42 years of age who used > 6 drugs. Class 4 was significantly associated with HCV infection. The odds of HCV infection in members of class 4 was 17 times higher than in class 2 members (adjusted odds ratio [aOR] = 16.9, 95% confidence interval [CI]: 1.4-205.4) and almost 22 times higher than in class 3 members (aOR = 21.8, 95% CI: 1.5-322.8). CONCLUSIONS Among MSM with non-injection drug use, the subgroup of individuals who were ≥ 42 years of age and used multiple drugs (including heroin, speedball, methamphetamine, crack cocaine, and marijuana) had a high probability of HCV infection. Public health and education programs, as well as drug treatment and rehabilitation programs, should be developed for this high-risk subgroup of individuals to prevent HCV acquisition and transmission.
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Affiliation(s)
- Jing Zhao
- Department of Epidemiology, MD Anderson Cancer Center, Houston, TX, USA.
| | - Charles Green
- Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Christine Markham
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Kayo Fujimoto
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Alan G Nyitray
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Lu-Yu Hwang
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
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Urhan M, Gezmen Karadağ M. Diet quality, nutritional status and taste recognition are impaired in men with substance use disorder. NUTR BULL 2024; 49:40-51. [PMID: 38115211 DOI: 10.1111/nbu.12654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/22/2023] [Accepted: 11/27/2023] [Indexed: 12/21/2023]
Abstract
This study aimed to (1) evaluate the nutritional status, prevalence of malnutrition and dietary habits in individuals using substances and (2) examine the possible effects of substance use on the perception of five basic tastes. Ninety male individuals with substance use disorder (SUD) (heroin = 78, cocaine = 12) and 32 non-users participated in the study conducted at Manisa Alcohol and Substance Addiction Treatment Center (AMATEM), Turkey. To determine the quality of the diet, the mean nutrient adequacy ratio (MAR) was calculated based on 24-h recall food consumption records of the individuals. Subjective Global Assessment (SGA) was employed to determine nutritional status, and anthropometric measurements were also taken from the individuals. The taste detection and recognition thresholds were determined with solutions with different concentrations for bitter, sour, sweet, umami and salty tastes and scored, with higher scores indicating lower thresholds. Mild-moderate malnutrition was determined in 50% of the individuals with SUD based on SGA. The body mass index (BMI) of individuals with SUD was found to be 21.2 ± 1.88 kg/m2 , and 24.1 ± 1.64 kg/m2 for non-users (p < 0.001). Diet quality, evaluated by MAR, was lower in individuals with SUD (54.7 ± 18.9%) than in non-users (93.5 ± 9.0%) (p < 0.001). The taste detection and taste recognition thresholds of individuals with SUD were impaired, and the threshold scores for sour, salty, sweet and umami taste recognition were significantly lower compared with non-users, with the lowest substance user threshold scores observed for the sweet recognition threshold. Standardised nutritional and behavioural interventions designed by dietitians should be provided for drug users in treatment centres and integrated with medical treatment practices.
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Affiliation(s)
- Murat Urhan
- Department of Nutrition and Dietetics, Faculty of Health Science, Ege University, Karşıyaka, İzmir, Turkey
| | - Makbule Gezmen Karadağ
- Department of Nutrition Dietetics, Gazi University Faculty of Health Science, Çankaya, Ankara, Turkey
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Lee-Cheong S, Ludgate SA, Epp TCM, Schütz CG. The effectiveness of oxytocin in the treatment of stimulant use disorders: a systematic review. Behav Pharmacol 2023; 34:381-392. [PMID: 37462158 DOI: 10.1097/fbp.0000000000000744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
OBJECTIVES The purpose of this review is to examine human study evidence on the effectiveness of oxytocin in this patient population. Despite stimulant use disorder being a major public health concern, there are no validated pharmacological treatments. Psychosocial interventions show limited effectiveness especially in the more severe cases of stimulant use disorder, whereas animal models suggest that oxytocin may be a useful treatment. METHODS A literature search using Medline, Embase, and PsychInfo was undertaken. Search results were subsequently imported into Covidence to identify relevant studies. RESULTS Six studies were included in this review, two of which were pilot studies. Although oxytocin was well tolerated across studies, no study showed a statistically significant reduction in reported cocaine use or cravings. One study suggested oxytocin increased the desire to use cocaine, although the population of participants should be taken into consideration. In contrast, one study showed a trend towards reduced self-reported cocaine use. CONCLUSION Available research does not support the use of oxytocin in the management of stimulant use disorder; however, included studies are small in sample size and limited in number. There were several noteworthy findings unrelated to this review's primary and secondary outcomes, which are of interest and warrant further research. We provide suggestions for future studies in this area of research. Considering the limited data available at this time, further studies are required before any definitive conclusions can be made regarding the use of oxytocin in stimulant use disorder management.
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Affiliation(s)
- Stephen Lee-Cheong
- Department of Psychiatry, University of British Columbia, Vancouver, BC
- Department of Psychiatry, University of Saskatchewan, Saskatoon, SK, Canada
- Department of Public Health, King's College London, Strand, London, UK
| | - Sacha A Ludgate
- Department of Psychiatry, University of British Columbia, Vancouver, BC
| | - Tanisse C M Epp
- Department of Psychiatry, University of British Columbia, Vancouver, BC
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Ortega-Hidalgo BD, Monge K, Pérez V, Villanueva-Vilchis MDC, Gaitán-Cepeda LA. Non-neoplasic and non-syndromic palatal perforations. Presentation of 5 cases and systematic review of the literature. J Clin Exp Dent 2021; 13:e961-e968. [PMID: 34603627 PMCID: PMC8464392 DOI: 10.4317/jced.58714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 06/28/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Palatal perforations not associated with syndromes or neoplasms are rare lesions whose frequency has increased recently. However, their clinical and demographic characteristics have not been fully described. Therefore, this report aimed to establish the demographic and clinical characteristics of patients with non-syndromic and non-neoplastic palatal perforations. MATERIAL AND METHODS The file of an oral medicine teaching clinic from January 2004 to December 2018 was reviewed to identify and isolate all cases with a diagnosis of palatal perforation. Cases with a diagnosis of palatal perforation related to congenital alteration, syndrome, or neoplasia were excluded. Age, sex, medical history, and diagnosis were obtained from the clinical history. In addition, a systematic review of the literature was performed using a PICO strategy. MEDLINE electronic databases from January 1990 to December 2018 were systematically reviewed using the combination of keywords with Boolean terms "OR" (palatal perforation, destruction of the palate) and "AND" (drugs, cocaine, mycosis, syphilis, mucormycosis, tuberculosis, trauma). The PRISMA guide was used to identify the different results of the literature search and article selection process. Case reports and case series were included. RESULTS Five cases of non-syndromic, non-neoplastic palatal perforations were identified. All cases were male with a mean age of 42 years. Two cases were related to cocaine use, 2 cases were caused by mucormycosis, and one case by trauma. As for the systematic literature review, 51 non-neoplastic and non-syndromic cases were collected. The cases showed a male predominance, with a mean age of 41 years. The most frequent etiology was chronic cocaine use followed by mucormycosis. CONCLUSIONS Since cocaine use and type II Diabetes Mellitus, risk factors related to non-syndromic and non-neoplastic palatal perforations, have shown a worldwide increase, the clinician should be alert to make an early diagnosis and initiate appropriate treatment. Key words:Palatal perforation, cocaine-induced, mucormycosis, mycotic infection, drug users.
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Affiliation(s)
| | - Karen Monge
- Dental student, Dental School, University of Sonora, Hermosillo, Sonora, México
| | - Vania Pérez
- Dental student, Dental School, University of Sonora, Hermosillo, Sonora, México
| | | | - Luis-Alberto Gaitán-Cepeda
- Full time Professor of Department of Oral Pathology and Oral Medicine, Graduate and Research Division, Dental School, National Autonomous University of Mexico. Mexico City, Mexico
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Puri A, Frempong D, Mishra D, Dogra P. Microneedle-mediated transdermal delivery of naloxone hydrochloride for treatment of opioid overdose. Int J Pharm 2021; 604:120739. [PMID: 34048932 DOI: 10.1016/j.ijpharm.2021.120739] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/11/2021] [Accepted: 05/23/2021] [Indexed: 02/03/2023]
Abstract
Naloxone (NAL) is administered parenterally or intranasally for treating opioid overdose. The short duration of action of NAL calls for frequent re-dosing which may be eliminated by the development of a transdermal system. This study aimed to assess the effect of microneedles on improving the skin permeation of NAL hydrochloride. In vitro permeation of NAL across intact and microneedle-treated (Dr. Pen™ Ultima A6) porcine skin was evaluated. The effect of microneedle length and application duration, and donor concentration on NAL permeation were investigated. In-vitro in-vivo correlation of the permeation results was done to predict the plasma concentration kinetics of NAL in patients. In vitro passive permeation of NAL after 6 h was observed to be 8.25±1.06 µg/cm2. A 56- and 37-fold enhancement was observed with 500 and 250 µm needles applied for 1 min, respectively. Application of 500 µm MNs for 2 min significantly reduced the lag time to ~ 8 min and increasing the donor concentration for the same treatment group doubled the permeation (p < 0.05). Modeling simulations demonstrated the attainment of pharmacokinetic profile of NAL comparable to those obtained with the FDA-approved intramuscular and intranasal devices. Microneedle-mediated transdermal delivery holds potential for rapid and sustained NAL delivery for opioid overdose treatment.
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Affiliation(s)
- Ashana Puri
- Department of Pharmaceutical Sciences, Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, TN, USA.
| | - Dorcas Frempong
- Department of Pharmaceutical Sciences, Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, TN, USA
| | - Dhruv Mishra
- Department of Biological Sciences, Northern Arizona University, Flagstaff, AZ, USA
| | - Prashant Dogra
- Mathematics in Medicine Program, Houston Methodist Research Institute, Houston, TX, USA
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Martin H, Bursztejn A, Albuisson E, Leguern A, Mahe E, Villemur B, Blaise S, Perceau G, Goujon E, Lok C, Modiano P, Debure C, Guillot B, Maillard H, Say M, Carvalho-Lallement P, Dompmartin A, Journet-Tollhupp J, Schmutz JL, Senet P, Schoeffler A. Caractéristiques des plaies chroniques chez les toxicomanes : étude rétrospective de 58 patients. Ann Dermatol Venereol 2019; 146:793-800. [DOI: 10.1016/j.annder.2019.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 07/07/2019] [Accepted: 09/03/2019] [Indexed: 12/21/2022]
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Slawek DE, Lu TY, Hayes B, Fox AD. Caring for Patients With Opioid Use Disorder: What Clinicians Should Know About Comorbid Medical Conditions. PSYCHIATRIC RESEARCH AND CLINICAL PRACTICE 2018. [PMCID: PMC9175890 DOI: 10.1176/appi.prcp.20180005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Opioid use disorder (OUD) is a growing problem, with opioid‐involved overdose deaths quadrupling since 1999 in the United States. This article reviews comorbid medical conditions related to OUD, starting with complications of behaviors associated with opioid use (e.g., injection drug use), followed by conditions stemming from the direct effects of opioids (e.g., hypogonadism). HIV and hepatitis C virus (HCV) are common infections in people with OUD, and treatment for these conditions can be safely provided regardless of ongoing substance use. Complications of drug injection, such as HIV, HCV, skin and soft tissue infections, and infective endocarditis, may be prevented through provision of sterile syringes and supervised injection facilities. Rare, life‐threatening bacterial infections may present with signs and symptoms that mimic intoxication, such as malaise or stupor, and should be assessed in patients with fever or positive blood cultures. In addition, chronic opioid exposure can lead to hypogonadism, opioid‐induced hyperalgesia, sleep‐disordered breathing, and potentially increased risk of cardiovascular disease and neurocognitive impairment. Pharmacotherapies for OUD (buprenorphine, methadone, and naltrexone) are safe and effective and their adverse opioid effects can be managed in clinical practice. Awareness of OUD‐associated medical conditions and their treatments is an important step in improving the health and wellness of people with OUD.
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Affiliation(s)
| | - Tiffany Y. Lu
- Department of MedicineAlbert Einstein College of MedicineBronxNY
| | - Benjamin Hayes
- Department of MedicineAlbert Einstein College of MedicineBronxNY
| | - Aaron D. Fox
- Department of MedicineAlbert Einstein College of MedicineBronxNY
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McDonald R, Lorch U, Woodward J, Bosse B, Dooner H, Mundin G, Smith K, Strang J. Pharmacokinetics of concentrated naloxone nasal spray for opioid overdose reversal: Phase I healthy volunteer study. Addiction 2018; 113:484-493. [PMID: 29143400 PMCID: PMC5836974 DOI: 10.1111/add.14033] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 07/12/2017] [Accepted: 09/10/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND AIMS Take-home naloxone can prevent death from heroin/opioid overdose, but pre-provision is difficult because naloxone is usually given by injection. Non-injectable alternatives, including naloxone nasal sprays, are currently being developed. To be effective, the intranasal (i.n.) spray dose must be adequate but not excessive, and early absorption must be comparable to intramuscular (i.m.) injection. We report on the pharmacokinetics (PK) of a specially produced concentrated novel nasal spray. The specific aims were to: (1) estimate PK profiles of i.n. naloxone, (2) compare early systemic exposure with i.n. versus i.m. naloxone and (3) estimate i.n. bioavailability. DESIGN Open-label, randomized, five-way cross-over PK study. SETTING Clinical trials facility (Croydon, UK). PARTICIPANTS Thirty-eight healthy volunteers (age 20-54 years; 11 female). INTERVENTION AND COMPARATOR Three doses of i.n. (1 mg/0.1 ml, 2 mg/0.1 ml, 4 mg/0.2 ml) versus 0.4 mg i.m. (reference) and 0.4 mg intravenous (i.v.) naloxone. MEASUREMENTS Regular blood samples were taken, with high-frequency sampling during the first 15 minutes to capture early systemic exposure. PK parameters were determined from plasma naloxone concentrations. Exploratory analyses involved simulation of repeat administration. FINDINGS Mean peak concentration (Cmax ) values for 1 mg (1.51 ng/ml), 2 mg (2.87 ng/ml) and 4 mg (6.02 ng/ml) i.n. exceeded 0.4 mg i.m. (1.27 ng/ml) naloxone. All three i.n. doses rapidly achieved plasma levels > 50% of peak concentrations (T50%) by 10 minutes, peaking at 15-30 minutes (Tmax ). For comparison, the i.m. reference reached Tmax at 10 minutes. Mean bioavailability was 47-51% for i.n. relative to i.m. naloxone. Simulation of repeat dosing (2 × 2 mg i.n. versus 5 × 0.4 mg i.m. doses) at 3-minute intervals showed that comparable plasma naloxone concentrations would be anticipated. CONCLUSIONS Concentrated 2 mg intranasal naloxone is well-absorbed and provides early exposure comparable to 0.4 mg intramuscular naloxone, following the 0.4 mg intramuscular curve closely in the first 10 minutes post-dosing and maintaining blood levels above twice the intramuscular reference for the next 2 hours.
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Affiliation(s)
- Rebecca McDonald
- National Addiction Centre, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Ulrike Lorch
- Richmond Pharmacology LtdCroydon University Hospital (Woodcroft Wing)CroydonUK
| | - Jo Woodward
- Mundipharma Research LtdCambridge Science ParkCambridgeshireUK
| | - Björn Bosse
- Mundipharma Research GmbH and Co. KGLimburgGermany
| | - Helen Dooner
- Mundipharma Research LtdCambridge Science ParkCambridgeshireUK
| | - Gill Mundin
- Mundipharma Research LtdCambridge Science ParkCambridgeshireUK
| | - Kevin Smith
- Mundipharma Research LtdCambridge Science ParkCambridgeshireUK
| | - John Strang
- National Addiction Centre, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
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Daveluy A, Géniaux H, Baumevieille M, Létinier L, Matta MN, Lazès-Charmetant A, Haramburu F, Guéroult P. Parachuting psychoactive substances: Pharmacokinetic clues for harm reduction. Addict Behav 2018; 78:173-177. [PMID: 29175294 DOI: 10.1016/j.addbeh.2017.11.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 11/10/2017] [Accepted: 11/12/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Parachuting, also called bombing, is a way to ingest psychoactive substances wrapped into cigarette paper, toilet paper, etc. There is little data describing parachuting in terms of substances use, context of use and, most importantly, the motivations for using such wrappers, although some authors hypothesized that parachute could be used for pharmacokinetic reason. However, inconsistently, some authors report that parachutes are used for sustained-release whereas others report that users are looking for an immediate effect. RESEARCH DESIGN AND METHODS Considering parachute as a "home-made" dosage form, we have applied the dissolution testing to characterize the dissolution performance of a substance wrapped into a parachute and to characterize whether a parachute represents an immediate-release form or not. RESULTS This in-vitro study provides the first pharmacokinetic data for drugs wrapped in parachutes. It shows that parachute acts as sustained-release form when made with a cigarette paper wrapper, but as immediate release form in the presence of alcohol or if wrapped with toilet paper. CONCLUSIONS An important message to harm reduction is that users must be aware that a parachute can have unexpected pharmacokinetics and have to avoid taking another parachute in the absence of an immediate-effect to avoid overdose.
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Affiliation(s)
- Amélie Daveluy
- Centre d'addictovigilance, Service de pharmacologie médicale, CHU Bordeaux, F-33000 Bordeaux, France; Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Team, Pharmacoepidemiology, UMR 1219, F-33000 Bordeaux, France.
| | - Hélène Géniaux
- Centre d'addictovigilance, Service de pharmacologie médicale, CHU Bordeaux, F-33000 Bordeaux, France
| | - Marie Baumevieille
- Centre d'addictovigilance, Service de pharmacologie médicale, CHU Bordeaux, F-33000 Bordeaux, France; Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Team, Pharmacoepidemiology, UMR 1219, F-33000 Bordeaux, France; Laboratoire de droit et économie pharmaceutiques, Univ. Bordeaux, F-33000 Bordeaux, France
| | - Louis Létinier
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Team, Pharmacoepidemiology, UMR 1219, F-33000 Bordeaux, France
| | - Marie-Noëlle Matta
- Laboratoire de technologies pharmaceutiques industrielles (LTPIB), Univ. Bordeaux, F-33000 Bordeaux, France
| | - Aurélie Lazès-Charmetant
- Comité d'étude et d'information sur la drogue et les addictions (CEID-Addictions), F-33000 Bordeaux, France
| | - Françoise Haramburu
- Centre d'addictovigilance, Service de pharmacologie médicale, CHU Bordeaux, F-33000 Bordeaux, France; Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Team, Pharmacoepidemiology, UMR 1219, F-33000 Bordeaux, France
| | - Pascale Guéroult
- Laboratoire de technologies pharmaceutiques industrielles (LTPIB), Univ. Bordeaux, F-33000 Bordeaux, France
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Zhang D, Patel KB, Cass LM, Foster AE, Guntupalli L, Brunworth JD. Heroin-induced nasal necrosis and septal perforation. ACTA OTO-LARYNGOLOGICA CASE REPORTS 2017. [DOI: 10.1080/23772484.2017.1379354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Donald Zhang
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Saint Louis University, Saint Louis, MO, USA
| | - Kunjan B. Patel
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Saint Louis University, Saint Louis, MO, USA
| | - Lauren M. Cass
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Saint Louis University, Saint Louis, MO, USA
| | | | - Lohitha Guntupalli
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Saint Louis University, Saint Louis, MO, USA
| | - Joseph D. Brunworth
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Saint Louis University, Saint Louis, MO, USA
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Peyrière H, Eiden C, Mallaret M, Victorri-Vigneau C. Medical complications of psychoactive substances with abuse risks: Detection and assessment by the network of French addictovigilance centres. Therapie 2016; 71:563-573. [PMID: 27499243 DOI: 10.1016/j.therap.2016.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 06/06/2016] [Indexed: 12/16/2022]
Abstract
The use of psychoactive substances, whether occasional or regular, can induce a large number of clinical and/or biological complications. These complications may be related to the effects of the active substance itself and/or adulterants, but also to the modalities for use (administrations route, contexts of use). The detection and evaluation of these potentially severe complications are a public health issue. Beyond the assessment of the potential for abuse of and dependence on psychoactive substances, the collection and evaluation of complications related to the use of the substances are one of the roles of addictovigilance centres. In this article, the expertise of the French addictovigilance centres in the detection and assessment of medical complications related to psychoactive substances, adulterants or route of administration of substances is advanced through a few recent examples.
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Affiliation(s)
- Hélène Peyrière
- Département de pharmacologie médicale et toxicologie, centre hospitalier universitaire, 191, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France.
| | - Céline Eiden
- Département de pharmacologie médicale et toxicologie, centre hospitalier universitaire, 191, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - Michel Mallaret
- Centre d'addictovigilance, centre hospitalier universitaire, 38043 Grenoble, France
| | - Caroline Victorri-Vigneau
- Département de pharmacologie clinique, centre d'addictovigilance, centre hospitalier universitaire, 44093 Nantes, France
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13
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Strang J, McDonald R, Alqurshi A, Royall P, Taylor D, Forbes B. Naloxone without the needle - systematic review of candidate routes for non-injectable naloxone for opioid overdose reversal. Drug Alcohol Depend 2016; 163:16-23. [PMID: 26996745 DOI: 10.1016/j.drugalcdep.2016.02.042] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 02/24/2016] [Accepted: 02/28/2016] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Deaths from opioid overdose can be prevented through administration of the antagonist naloxone, which has been licensed for injection since the 1970s. To support wider availability of naloxone in community settings, novel non-injectable naloxone formulations are being developed, suitable for emergency use by non-medical personnel. OBJECTIVES 1) Identify candidate routes of injection-free naloxone administration potentially suitable for emergency overdose reversal; 2) consider pathways for developing and evaluating novel naloxone formulations. METHODS A three-stage analysis of candidate routes of administration was conducted: 1) assessment of all 112 routes of administration identified by FDA against exclusion criteria. 2) Scrutiny of empirical data for identified candidate routes, searching PubMed and WHO International Clinical Trials Registry Platform using search terms "naloxone AND [route of administration]". 3) Examination of routes for feasibility and against the inclusion criteria. RESULTS Only three routes of administration met inclusion criteria: nasal, sublingual and buccal. Products are currently in development and being studied. Pharmacokinetic data exist only for nasal naloxone, for which product development is more advanced, and one concentrated nasal spray was granted licence in the US in 2015. However, buccal naloxone may also be viable and may have different characteristics. CONCLUSION After 40 years of injection-based naloxone treatment, non-injectable routes are finally being developed. Nasal naloxone has recently been approved and will soon be field-tested, buccal naloxone holds promise, and it is unclear what sublingual naloxone will contribute. Development and approval of reliable non-injectable formulations will facilitate wider naloxone provision across the community internationally.
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Affiliation(s)
- John Strang
- National Addiction Centre, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, 4 Windsor Walk, Denmark Hill, London SE5 8BB, UK.
| | - Rebecca McDonald
- National Addiction Centre, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, 4 Windsor Walk, Denmark Hill, London SE5 8BB, UK.
| | - Abdulmalik Alqurshi
- Institute of Pharmaceutical Science, King's College London, 150 Stamford Street, London SE1 9NH, UK.
| | - Paul Royall
- Institute of Pharmaceutical Science, King's College London, 150 Stamford Street, London SE1 9NH, UK.
| | - David Taylor
- Institute of Pharmaceutical Science, King's College London, 150 Stamford Street, London SE1 9NH, UK; Pharmacy Department, South London and Maudsley NHS Foundation Trust (SLaM), Maudsley Hospital, Denmark Hill, London SE5 8AZ, UK.
| | - Ben Forbes
- Institute of Pharmaceutical Science, King's College London, 150 Stamford Street, London SE1 9NH, UK.
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Strang J, McDonald R, Tas B, Day E. Clinical provision of improvised nasal naloxone without experimental testing and without regulatory approval: imaginative shortcut or dangerous bypass of essential safety procedures? Addiction 2016; 111:574-82. [PMID: 26840916 DOI: 10.1111/add.13209] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 08/06/2015] [Accepted: 10/12/2015] [Indexed: 10/22/2022]
Abstract
CONTEXT Take-home naloxone is increasingly provided to prevent heroin overdose deaths. Naloxone 0.4-2.0 mg is licensed for use by injection. Some clinicians supply improvised nasal naloxone kits (outside licensed approval). Is this acceptable? AIMS (1) To consider provision of improvised nasal naloxone in clinical practice and (2) to search for evidence for pharmacokinetics and effectiveness (versus injection). METHODS (1) To document existing nasal naloxone schemes and published evidence of pharmacokinetics (systematic search of the CINAHL, Cochrane, EMBASE and MEDLINE databases and 18 records included in narrative synthesis). (2) To analyse ongoing studies investigating nasal naloxone (WHO International Clinical Trials Registry Platform and US NIH RePORT databases). FINDINGS (1) Multiple studies report overdose reversals following administration of improvised intranasal naloxone. (2) Overdose reversal after nasal naloxone is frequent but may not always occur. (3) Until late 2015, the only commercially available naloxone concentrations were 0.4 mg/ml and 2 mg/2 ml. Nasal medications are typically 0.05-0.25 ml of fluid per nostril. The only published study of pharmacokinetics and bioavailability finds that nasal naloxone has poor bioavailability. QUESTIONS FOR DEBATE: (1) Why are pharmacokinetics and bioavailability data for nasal naloxone not available before incorporation into standard clinical practice? (2) Does nasal naloxone have the potential to become a reliable clinical formulation? (3) What pre-clinical and clinical studies should precede utilization of novel naloxone formulations as standard emergency medications? CONCLUSIONS The addictions treatment field has rushed prematurely into the use of improvised nasal naloxone kits. Evidence of adequate bioavailability and acceptable pharmacokinetic curves are vital preliminary steps, especially when effective approved formulations exist.
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Affiliation(s)
- John Strang
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Rebecca McDonald
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Basak Tas
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ed Day
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Vosler PS, Ferguson BJ, Contreras JI, Wang EW, Schaitkin BM, Lee S. Clinical and pathologic characteristics of intranasal abuse of combined opioid-acetaminophen medications. Int Forum Allergy Rhinol 2014; 4:839-44. [PMID: 25137346 DOI: 10.1002/alr.21355] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 04/22/2014] [Accepted: 04/29/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND The nonmedical abuse of prescription opioids via intranasal administration is a growing problem. The objective of this study is to investigate of the typical presentation of intranasal opioid-acetaminophen abuse and outline optimal therapy. METHODS This study was a retrospective chart review. Patients with intranasal pathology from inhalation of combined opioid-acetaminophen medications (COAMs) from 3 academic otolaryngology practices in western Pennsylvania from January 2012 to October 2012 were included in the review. RESULTS Seven adults ranging in age from 23 to 46 years were identified with nasal complaints from the intranasal inhalation of COAMs. All patients presented with nasal pain and were found to have fibrinous necrotic nasal mucosa involving the posterior nasal cavity and nasopharynx. Of the 7 patients, 6 (85.7%) presented with a septal perforation. Pathology and culture revealed fungus in 85.7% of the patients; however, no invasive fungal disease was noted in any of the specimens. Patients did not improve with either systemic or topical antifungal therapy. Polarizable material characteristic of talc used as a tablet binder was present in the histopathology of 4 of 7 (57.1%) patients. Patients who abstained from intranasal drug use along with serial debridement demonstrated the greatest improvement. CONCLUSION Intranasal COAM abuse causes nasal pain, tissue necrosis with potential septal and palatal perforation, and noninvasive fungal colonization. Antifungal therapy was of no benefit in the current series of patients. Current therapy should focus on recognition of the etiology of patients' pathology and encourage abstinence from intranasal use of these drugs along with serial debridements.
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Affiliation(s)
- Peter S Vosler
- Division of Sinonasal Disorders and Allergy, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA
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