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    ABSTRACT: Many Australians are prescribed drugs such as naltrexone, methadone and buprenorphine to assist with abstinence from illicit drug abuse and alcoholism. Abstinence therapies influence the efficacy of standard opioid analgesics. Non-opioid alternatives can often provide effective analgesia. In some situations the use of opioids is unavoidable. The acute pain management of two patients using naltrexone is described, followed by a review of acute pain management options for patients receiving abstinence therapies.
    Acute Pain 12/2006; 8(4):186-186. DOI:10.1016/j.acpain.2006.09.005
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    ABSTRACT: The prescription drugs or drug classes that are most frequently associated with death in the US might be identifiable from death certificate data. To identify the drugs/drug classes associated with the greatest numbers of deaths in the US that might be considered as possible targets for prevention. US vital statistics data were accessed in order to identify International Classification of Diseases (10th Revision) [ICD-10] codes indicating that prescription drugs had caused or contributed to death and diseases with significant drug-related mortality. ICD-10 codes for primarily prescription drugs that were listed as the underlying cause or as 'total mentions' on death certificates and were implicated in >or=1000 deaths in any one year were selected. The annual number of deaths by ICD-10 code was obtained from the Division of Vital Statistics, National Center for Health Statistics. Codes for diseases with significant drug-related aetiologies and involvement in >or=1000 deaths in any one year were also identified and analysed separately. For the selected ICD-10 codes, a total of 25 031 deaths were listed as having a prescription drug as the underlying cause in 2003, compared with 16 135 in 1999, a 55% increase. Total mentions of these codes increased from 46 523 in 1999 to 72 080 in 2003, also a 55% increase. Most codes involved 'poisonings' (overdose or the wrong substance given or taken in error that is accidental, intentional or with undetermined intent). Drugs associated with poisoning deaths had central nervous system effects. Among the codes associated with specified drug classes, poisonings and accidental poisonings involving narcotics, hallucinogens, psychoactive substances and opioids (other than opium and heroin) were associated with the largest numbers of deaths. Drug-related codes associated with the largest percentage increases in deaths between 1999 and 2003 included poisoning due to methadone (275%); poisoning by other and unspecified antidepressants (primarily selective serotonin reuptake inhibitors) [130%]; and poisoning by psychostimulants with potential for abuse (amfetamines and drugs for attention deficit hyperactivity disorder) [117%]. Anticoagulants were associated with the largest numbers of deaths with codes involving "adverse effects in therapeutic use". Among diseases with significant drug-related aetiologies, Clostridium difficile enterocolitis (associated primarily with antibacterials) had the largest percentage increase in total mentions, with a 203% rise between 1999 and 2003. Deaths due to overdoses are the most prominent cause of drug-related mortality in death certificate data. Certain drugs and drug classes, especially the opioids (e.g. narcotics, methadone), psychoactive drugs (e.g. antidepressants, amfetamines), anticoagulants and antibacterials (which cause or contribute to C. difficile enterocolitis) are associated with large and increasing numbers of deaths and preventive strategies should be considered.
    Drug Safety 01/2007; 30(6):533-40. DOI:10.2165/00002018-200730060-00007 · 2.62 Impact Factor
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    ABSTRACT: While opioid dependence has more treatment agents available than other abused drugs, none are curative. They can, however, markedly diminish withdrawal symptoms and craving, and block opioid effects due to lapses. The most effective withdrawal method is substituting and tapering methadone or buprenorphine, α-2 Adrenergic agents can ameliorate untreated symptoms or substitute for agonists if not available. Shortening withdrawal by precipitating it with narcotic antagonists has been studied, but the methods are plagued by safety issues or persisting symptoms. Neither the withdrawal agents nor the methods are associated with better long-term outcome, which appears mostly related to post-detoxification treatment. Excluding those with short-term habits, the best outcome occurs with long-term maintenance on methadone or buprenorphine accompanied by appropriate psychosocial interventions. Those with strong external motivation may do well on the antagonist naltrexone. Currently, optimum duration of maintenance on either is unclear. Better agents are needed to impact the brain changes related to addiction.
    Dialogues in clinical neuroscience 02/2007; 9(4):455-70.
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