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Palamim CVC, Boschiero MN, Faria AG, Valencise FE, Marson FAL. Opioids in COVID-19: Two Sides of a Coin. Front Pharmacol 2022; 12:758637. [PMID: 35069193 PMCID: PMC8770909 DOI: 10.3389/fphar.2021.758637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 11/29/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction: The treatment of most severe COVID-19 patients included the large-scale use of sedatives and analgesics-possibly in higher doses than usual-which was reported in the literature. The use of drugs that decrease mortality is necessary and opioids are important agents in procedures such as orotracheal intubation. However, these drugs seem to have been overestimated in the COVID-19 pandemic. We performed a review of the PubMed-Medline database to evaluate the use of opioids during this period. The following descriptors were used to enhance the search for papers: "Opioids", "COVID-19," "COVID-19 pandemic," "SARS-CoV-2," "Opioid use disorder," "Opioid dependence" and the names of the drugs used. We also evaluated the distribution of COVID-19 patients in Brazil and the applicability of opioids in our country during the COVID-19 pandemic. Results: Several positive points were found in the use of opioids in the COVID-19 pandemic, for instance, they can be used for analgesia in orotracheal intubation, for chronic pain management, and as coadjutant in the management of acute intensification of pain. However, high doses of opioids might exacerbate the respiratory depression found in COVID-19 patients, their chronic use can trigger opioid tolerance and the higher doses used during the pandemic might result in greater adverse effects. Unfortunately, the pandemic also affected individuals with opioid use disorder, not only those individuals are at higher risk of mortality, hospitalization and need for ventilatory support, but measures taken to decrease the SARS-CoV-2 spread such as social isolation, might negatively affect the treatment for opioid use disorder. In Brazil, only morphine, remifentanil and fentanyl are available in the basic health care system for the treatment of COVID-19 patients. Out of the 5,273,598 opioid units used in this period all over the country, morphine, fentanyl, and remifentanil, accounted for, respectively, 559,270 (10.6%), 4,624,328 (87.6%), and 90,000 (1.8%) units. Many Brazilian regions with high number of confirmed cases of COVID-19 had few units of opioids available, as the Southeast region, with a 0.23 units of opioids per confirmed COVID-19 case, and the South region, with 0.05 units. In the COVID-19 pandemic scenario, positive points related to opioids were mainly the occurrence of analgesia, to facilitate intubation and their use as coadjutants in the management of acute intensification of pain, whereas the negative points were indiscriminate use, the presence of human immunosuppressor response and increased adverse effects due to higher doses of the drug. Conclusion: The importance of rational and individualized use of analgesic hypnotics and sedative anesthetics should be considered at all times, especially in situations of high demand such as the COVID-19 pandemic.
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Affiliation(s)
- Camila Vantini Capasso Palamim
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Bragança Paulista, Brazil
- Laboratory of Human and Medical Genetics, São Francisco University, Bragança Paulista, Brazil
| | - Matheus Negri Boschiero
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Bragança Paulista, Brazil
- Laboratory of Human and Medical Genetics, São Francisco University, Bragança Paulista, Brazil
| | - Aléthea Guimarães Faria
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Bragança Paulista, Brazil
- Laboratory of Human and Medical Genetics, São Francisco University, Bragança Paulista, Brazil
| | - Felipe Eduardo Valencise
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Bragança Paulista, Brazil
- Laboratory of Human and Medical Genetics, São Francisco University, Bragança Paulista, Brazil
| | - Fernando Augusto Lima Marson
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Bragança Paulista, Brazil
- Laboratory of Human and Medical Genetics, São Francisco University, Bragança Paulista, Brazil
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Moreira de Barros GA, Calonego MAM, Mendes RF, Castro RAM, Faria JFG, Trivellato SA, Cavalcante RS, Fukushima FB, Dias A. [The use of analgesics and risk of self-medication in an urban population sample: cross-sectional study]. Rev Bras Anestesiol 2019; 69:529-536. [PMID: 31703816 DOI: 10.1016/j.bjan.2019.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 08/30/2019] [Accepted: 09/07/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES There are few data in the literature characterizing the pattern of analgesic use in Latin American countries, including Brazil. Little is known about the undertreatment of pain and its influence on the habit of self-medication with analgesics. The aim of this study is to define the pattern of analgesic use among chronic pain patients and its potential association with self-medication with analgesics. METHOD Cross-sectional observational study with an urban population sample. Chronic pain was defined as a pain lasting for at least 90 days. The study was approved by the Research Ethics Committee of the institution. RESULTS 416 subjects were included; 45.7% (n=190) had chronic pain, with females (72.3%; p=0.04) being the most affected. Self-medication with analgesics is practiced by 78.4% of patients with chronic pain. The most common current analgesic treatment consists of non-steroidal anti-inflammatory drugs (dipyrone and acetaminophen). Weak opioids are rarely used and only 2.6% of subjects with chronic pain were taking these analgesics. None of the subjects were taking potent opioids. CONCLUSIONS The practice of self-medication with analgesics is frequent among patients with chronic pain, which may be due to the underprescription of more potent analgesics, such as opioids. It can also be said that, given the data presented, there is no crisis of recreational opioid use in the studied population.
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Affiliation(s)
- Guilherme Antonio Moreira de Barros
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Departamento de Anestesiologia, Botucatu, SP, Brasil; Sociedade Brasileira de Anestesiologia, Comissão de Medicina Paliativa, Rio de Janeiro, RJ, Brasil; Sociedade Brasileira de Anestesiologia, Botucatu, SP, Brasil.
| | - Marco A Marchetti Calonego
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Departamento de Anestesiologia, Botucatu, SP, Brasil
| | - Rannier F Mendes
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Departamento de Anestesiologia, Botucatu, SP, Brasil; Sociedade Brasileira de Anestesiologia, Botucatu, SP, Brasil
| | - Raphael A M Castro
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Departamento de Anestesiologia, Botucatu, SP, Brasil
| | - João F G Faria
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Departamento de Anestesiologia, Botucatu, SP, Brasil
| | - Stella A Trivellato
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Departamento de Anestesiologia, Botucatu, SP, Brasil
| | - Rodney S Cavalcante
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Departamento de Anestesiologia, Botucatu, SP, Brasil
| | - Fernanda B Fukushima
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Departamento de Anestesiologia, Botucatu, SP, Brasil; Sociedade Brasileira de Anestesiologia, Botucatu, SP, Brasil
| | - Adriano Dias
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Departamento de Saúde Pública, Botucatu, SP, Brasil
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Moreira de Barros GA, Calonego MAM, Mendes RF, Castro RAM, Faria JFG, Trivellato SA, Cavalcante RS, Fukushima FB, Dias A. The use of analgesics and risk of self-medication in an urban population sample: cross-sectional study. Braz J Anesthesiol 2019. [PMID: 31703816 PMCID: PMC9391871 DOI: 10.1016/j.bjane.2019.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Guilherme Antonio Moreira de Barros
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Departamento de Anestesiologia, Botucatu, SP, Brasil; Sociedade Brasileira de Anestesiologia, Comissão de Medicina Paliativa, Rio de Janeiro, RJ, Brasil; Sociedade Brasileira de Anestesiologia, Botucatu, SP, Brasil.
| | - Marco A Marchetti Calonego
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Departamento de Anestesiologia, Botucatu, SP, Brasil
| | - Rannier F Mendes
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Departamento de Anestesiologia, Botucatu, SP, Brasil; Sociedade Brasileira de Anestesiologia, Botucatu, SP, Brasil
| | - Raphael A M Castro
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Departamento de Anestesiologia, Botucatu, SP, Brasil
| | - João F G Faria
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Departamento de Anestesiologia, Botucatu, SP, Brasil
| | - Stella A Trivellato
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Departamento de Anestesiologia, Botucatu, SP, Brasil
| | - Rodney S Cavalcante
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Departamento de Anestesiologia, Botucatu, SP, Brasil
| | - Fernanda B Fukushima
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Departamento de Anestesiologia, Botucatu, SP, Brasil; Sociedade Brasileira de Anestesiologia, Botucatu, SP, Brasil
| | - Adriano Dias
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Departamento de Saúde Pública, Botucatu, SP, Brasil
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Gil F, de Andrade AG, Castaldelli-Maia JM. Discussing prevalence, impacts, and treatment of substance use disorders in athletes. Int Rev Psychiatry 2016; 28:572-578. [PMID: 27534440 DOI: 10.1080/09540261.2016.1212821] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The consumption of alcohol, tobacco, and other drugs has become a concern in high-performance athletes. Professional athletes are more exposed to drugs than the general population. Although some drugs are unquestionably detrimental to performance, several studies have nevertheless shown evidence of increased consumption of these substances within this sub-population. This review aimed to elucidate alcohol, tobacco, cocaine, cannabis, and opioid use among high-performance athletes, discussing the prevalence of substance use, its impacts, and alternatives to treatment in this special population. Unfortunately, no clinical trials for the treatment of substance use disorders were carried out with this specific sub-population. Therefore, the strategies adopted for the general population should be adapted to high-performance athletes. Psychological, psychosocial, psychoeducational, cognitive-behavioural, motivational interviewing approaches can be implemented. As regards pharmacological treatment, medications used in the treatment of alcohol and tobacco dependence, such as naltrexone, disulfiram, acamprosate, varenicline, bupropion, and nicotine replacement treatment can be used without problems. However, some medications used in cocaine and opioid dependence treatment, such as moldafinil and methadone, are prohibited by doping enforcement agencies. Professionals involved with athletes should be aware of the signs and symptoms of the acute effects of substances so as to enable an early identification of substance abuse problems, especially during training periods.
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Affiliation(s)
- Felipe Gil
- a Department of Neuroscience , Medical School, Fundação ABC , Santo André , SP , Brazil
| | - Arthur Guerra de Andrade
- a Department of Neuroscience , Medical School, Fundação ABC , Santo André , SP , Brazil.,b Department of Psychiatry , Medical School, University of São Paulo , São Paulo , SP , Brazil.,c ABC Center for Mental Health Studies , Santo André , SP , Brazil
| | - João Maurício Castaldelli-Maia
- a Department of Neuroscience , Medical School, Fundação ABC , Santo André , SP , Brazil.,b Department of Psychiatry , Medical School, University of São Paulo , São Paulo , SP , Brazil.,c ABC Center for Mental Health Studies , Santo André , SP , Brazil
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Schenberg EE, de Castro Comis MA, Chaves BR, da Silveira DX. Treating drug dependence with the aid of ibogaine: a retrospective study. J Psychopharmacol 2014; 28:993-1000. [PMID: 25271214 DOI: 10.1177/0269881114552713] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Ibogaine is an alkaloid purported to be an effective drug dependence treatment. However, its efficacy has been hard to evaluate, partly because it is illegal in some countries. In such places, treatments are conducted in underground settings where fatalities have occurred. In Brazil ibogaine is unregulated and a combined approach of psychotherapy and ibogaine is being practiced to treat addiction. To evaluate the safety and efficacy of ibogaine, we conducted a retrospective analysis of data from 75 previous alcohol, cannabis, cocaine and crack users (72% poly-drug users). We observed no serious adverse reactions or fatalities, and found 61% of participants abstinent. Participants treated with ibogaine only once reported abstinence for a median of 5.5 months and those treated multiple times for a median of 8.4 months. This increase was statistically significant (p < 0.001), and both single or multiple treatments led to longer abstinence periods than before the first ibogaine session (p < 0.001). These results suggest that the use of ibogaine supervised by a physician and accompanied by psychotherapy can facilitate prolonged periods of abstinence, without the occurrence of fatalities or complications. These results suggest that ibogaine can be a safe and effective treatment for dependence on stimulant and other non-opiate drugs.
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Affiliation(s)
- Eduardo Ekman Schenberg
- Universidade Federal de São Paulo, Departamento de Psiquiatria, Instituto Plantando Consciência, São Paulo, Brazil
| | | | | | - Dartiu Xavier da Silveira
- Universidade Federal de São Paulo, Programa de Orientação e Atendimento a Dependentes (PROAD), Departamento de Psiquiatria, Instituto Plantando Consciência, São Paulo, Brazil
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Amaral RAD, Malbergier A, Andrade AGD. Manejo do paciente com transtornos relacionados ao uso de substância psicoativa na emergência psiquiátrica. BRAZILIAN JOURNAL OF PSYCHIATRY 2010; 32 Suppl 2:S104-11. [PMID: 21140070 DOI: 10.1590/s1516-44462010000600007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJETIVO: Transtornos por uso de substâncias são prevalentes em setores de emergência gerais e psiquiátricos, atingindo taxas de 28% das ocorrências em prontos-socorros gerais. Todavia, profissionais dos setores de emergência identificam menos que 50% dos casos de problemas relacionados ao álcool. Este artigo visa fornecer base fundamentada em evidências para o tratamento específico a pacientes que preencham os critérios diagnósticos de transtornos por uso de substâncias e que se apresentam ao pronto-socorro em quadros de intoxicação ou abstinência. MÉTODO: Uma revisão sobre o tema foi realizada na base de dados Medline, usando-se os descritores "intoxicação aguda", "abstinência", "álcool", "cocaína", "cannabis", "opioides", "inalantes" e "manejo", tendo o inglês como idioma. RESULTADOS E CONCLUSÃO: O cuidado de pessoas com transtornos por uso de substâncias deve conter: avaliação completa (médica geral e psiquiátrica), tratamento dos quadros diagnosticados (abstinência, intoxicação e quadros clínicos que caracterizem uma emergência), sensibilização do paciente para realizar tratamento, se for necessário, e elaboração de encaminhamento.
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