Search Results (99)

The use of opioids for cancer-related pain is essential but poses significant challenges due to the risk of misuse and the development of opioid use disorder (OUD). This review takes a multidisciplinary perspective based on the current scientific literature to analyze the pharmacological mechanisms, classification, and therapeutic roles of opioids in oncology. Key risk factors for opioid misuse—including psychiatric comorbidities, prior substance use, and insufficient clinical monitoring—are discussed in conjunction with validated tools for pain assessment and international guidelines. The review emphasizes the importance of integrating toxicological, pharmacological, physiological, and public health perspectives to promote rational opioid use. Pharmacogenetic variability is explored as a determinant of treatment response and addiction risk, underscoring the value of personalized medicine. Evidence-based strategies such as early screening, psychosocial interventions, and the use of buprenorphine-naloxone are presented as effective measures for managing OUD in cancer patients. Ultimately, this work advocates for safe, patient-centered opioid prescribing practices that ensure effective pain relief without compromising safety or quality of life. Full article

The diagnosis of opioid use disorder (OUD) is prevalent due to increased prescribing of opioids. Long-term oxycodone self-administration can lead to addiction-like behavioral responses in rats. Herein, we sought to identify molecular pathways consequent to long-term exposure to oxycodone self-administration. Towards that end, we used male Sprague Dawley rats that self-administered oxycodone for 20 days according to short-(ShA, 3 h) and long-access (LgA, 9 h) paradigms. LgA rats escalated their oxycodone intake and developed into 2 phenotypes, labeled Long-access High (LgA-H) and Long-access Low (LgA-L) rats, based on their escalation. RNA sequencing analysis revealed the LgA-H has significantly different DEGs in comparison to other groups. DAVID analysis revealed the participation of LgA-H DEGs in potassium transport. RT-PCR analysis of striatal samples validated the increased levels of potassium channels. Since these increases correlated with oxycodone intake, we believe potassium channels are potential targets for the treatment of oxycodone use disorder Full article

Background/Objectives: Opioid use disorder (OUD) remains a severe health problem globally, resulting in substantial social and economic challenges. While existing medications for managing OUD are proven to be effective, they also present certain challenges. A vaccine offers a promising therapeutic strategy to combat OUD and potentially reduce the risk of overdose death. The TT-6-AmHap heroin conjugate vaccine has effectively reduced heroin-induced pharmacological effects in behavioral assays as well as demonstrated the induction of high titer and high affinity antibody responses in mice and rats. In this GLP study conducted in rabbits, the potential local and systemic toxicity of the TT-6-AmHap heroin vaccine in combination with or without adjuvants ALF43 and Alhydrogel^® (ALFA) was investigated. Methods: Male and female New Zealand White rabbits were administered with vaccines or a saline control intramuscularly at two-week intervals over a 57-day study period. The presence, persistence or reversibility of any toxic effects of the vaccine was determined over a four-week recovery period. Results: Administration of TT-6-AmHap with or without the adjuvants induced high antibody-specific IgG in treatment groups compared to the controls. The study found no TT-6-AmHap-related effects on mortality, physical examinations, dermal Draize observations, body weights, body weight changes, food consumption, ophthalmology, clinical pathology (hematology, coagulation, clinical chemistry, and urinalysis), macroscopic pathology, or organ weights. Conclusions: Under the conditions of this study, these results demonstrate that the TT-6-AmHap vaccine with or without adjuvants was well tolerated, immunogenic, and the effects were not considered adverse in both male and female rabbits. Full article

Opioid use disorder (OUD) is a chronic disease that remains difficult to treat, even with significant improvements in available medications. While current treatments work well for some, they often do not account for the unique needs of individual patients, leading to less-than-ideal results. Precision medicine offers a new path forward by tailoring treatments to fit each person’s genetic, psychological, and social needs. This review takes a close look at medications for OUD, including methadone, buprenorphine, and naltrexone, as well as long-acting options that may improve adherence and convenience. Beyond medications, the review highlights the importance of addressing mental health co-morbidities, trauma histories, and social factors like housing or support systems to create personalized care plans. The review also explores how emerging technologies, including artificial intelligence and digital health tools, can enhance how care is delivered. By identifying research gaps and challenges in implementing precision medicine into practice, this review emphasizes the potential to transform OUD treatment. A more individualized approach could improve outcomes, reduce relapse, and establish a new standard of care focused on recovery and patient well-being. Full article

Background/Objectives: Rates of receiving opioid use disorder (OUD) treatment among adolescents and young adults (AYA) aged 16–25 are low. The current study qualitatively analyzed informants’ perspectives regarding the availability of, developmental considerations relevant to, and barriers associated with OUD treatment for AYA. Methods: Thirty key informants involved with OUD treatment in the northeastern United States completed individual, semi-structured interviews, including treatment providers (N = 11) and clinic leaders in programs that provide medication and psychosocial treatments for AYA with OUD (N = 10), as well as opioid-related policymakers (N = 6) and patient advocates (N = 3). Interviews were transcribed and independently double coded. Template-style thematic analysis methods were used and revealed seven themes. Results: The first theme highlighted limited treatment program availability for adolescents (aged < 18 years) with OUD. Four themes related to developmentally optimizing OUD treatment for AYA, describing the importance of caregiver involvement, AYA peer connections, wraparound services, and early intervention. Two themes described barriers to AYA OUD treatment, including stigma and knowledge gaps about medications for OUD as well as deficits in AYA’s access to basic resources (e.g., housing, food security) that prohibit effective participation in treatment. Conclusions: Results highlight concerns from systems-level key informants regarding gaps in OUD treatment options for youth under the age of 18 and a high need for OUD treatment that is developmentally tailored to AYA. Findings point toward potential modifications and additions to existing adult treatment programs to make OUD treatment more accessible, relevant, and engaging for AYA. Full article

Background and aims: Opioid maintenance therapy (OMT) is the first-line treatment for opioid use disorder (OUD), reducing opioid use and mortality while improving physical and mental health. However, concomitant substance use remains common, with cannabis being the most frequently used substance. This study assessed the prevalence and clinical correlates of cannabis use in OMT patients, as well as individual motivations. Methods: In this cross-sectional, single-center study, 128 OUD patients (96 male, 32 female) receiving OMT were assessed using standardized questionnaires: the Marijuana Smoking History Questionnaire (MSHQ), Cannabis Problems Questionnaire (CPQ) and the Severity of Dependence Scale (SDS). Cannabis users and non-users were compared regarding type (methadone vs. buprenorphine) and dosage of maintenance medication. Results: Cannabis use was reported by 41% of patients, 73% met criteria for cannabis dependence, 30% of the full sample. Of the patients, 85% reported cannabis-related legal issues. Common reasons for use included recreational motives (mood change, enhancement) and reduction in cravings for other substances. Cannabis dependence was significantly more common in patients receiving buprenorphine than methadone. Higher methadone doses were also associated with increased cannabis use. These results suggest a clinically relevant pattern. Conclusions: Cannabis use is highly prevalent and appears to be influenced by type and dosage of substitution medication. These findings highlight a complex interaction between opioid treatment and cannabis use, possibly involving behavioral coping or regulatory processes. Further longitudinal and placebo-controlled trials are needed to investigate the clinical and pharmacological interactions between cannabis and OMT, including effects on craving, withdrawal, and overall treatment outcomes. Full article

Opioid use disorder (OUD) and posttraumatic stress disorder (PTSD) frequently co-occur. However, there are no psychotherapy treatments intentionally designed for this comorbidity, nor designed to be augmented with medications for OUD. In this open-label pilot trial, we tested Helping Opioid Use Disorder and PTSD with Exposure (HOPE), a novel integrated, trauma-focused treatment for individuals (N = 6) with OUD/PTSD who were stabilized on medications for OUD. HOPE was delivered weekly for 10–12 sessions, and one follow-up visit was conducted ~1-month post-treatment. Primary outcomes included urine drug screens, the Timeline Followback, Desire for Drugs Questionnaire, Clinician-Administered PTSD Scale-5 (CAPS-5), and PTSD Checklist-5 (PCL-5). Boot-strapped linear mixed effect models and generalized estimating equations showed that PTSD symptoms (CAPS-5: B = −7.16, SE = 1.24, p < 0.01; PCL-5: B = −2.04, SE = 0.26, p < 0.01), desire for opioids (B = −0.56, SE = 0.15, p < 0.01), depression symptoms (B = −0.43, SE = 0.09, p < 0.01), and anxiety symptoms (B = −0.50, SE = 0.08, p < 0.01) decreased significantly over time. Client satisfaction increased throughout the study (B = 0.18, SE = 0.08, p = 0.02), and 83.3% of participants completed the therapy and follow-up visit. There were no significant changes in opioid or other substance use from baseline to follow-up. Although preliminary, results show high acceptability and feasibility of the HOPE therapy and demonstrate significant improvements in PTSD and associated symptoms with an integrated, trauma-focused treatment. Full article

This review explores pain neuroscience education (PNE) in the context of opioid dependence among Caucasian and African American populations, addressing disparities and sociocultural influences in the opioid epidemic. Von Bertalanffy’s general systems theory and Bronfenbrenner’s ecological systems theory comprise the underlying theoretical frameworks behind the review, emphasizing the importance of biopsychosocial perspectives of chronic pain and ecological systems on individual development. Within these frameworks, the study objective is to summarize relevant and contemporary literature among African American and Caucasian populations regarding opioid dependency, neuroplasticity in chronic pain, and PNE. Peer-reviewed articles published within the last 10 years were reviewed for relevance. Limitations include a lack of research on the intersection of ethnicity and PNE, a lack of studies investigating interdisciplinary input regarding PNE, and a focus on only two ethnic groups. This narrative review finds that African Americans face systemic barriers to effective treatment for pain and opioid use disorder (OUD), while Caucasians are more likely to be overprescribed with higher rates of OUD. From a systems and ecological perspective, maladaptive neuroplasticity in chronic pain (biologic subsystem) intersects with ethnic disparities in prescribing access and pain beliefs (psychosocial subsystem) to influence opioid use and the chronic pain experience. PNE shows promise as an adjunct to traditional physical therapy in reducing nociplastic pain, potentially affecting opioid dependency. Future research should incorporate readiness-to-change models, generational and ethnocultural perspectives, and neuroimaging with PNE to optimize the delivery of PNE to individuals of different backgrounds. Full article

Background: Rising rates of opioid use disorder (OUD), usually via injection, has resulted in younger patients being diagnosed with infective endocarditis (IE), with unique treatment challenges. Methods: This retrospective ecological study analyzed hospital discharge and home health records from 2016 to 2022 in South Carolina (SC). Cases of IE with concurrent coding for OUD were identified. Differences in patient demographics, hospital characteristics, length of care days, and charges by OUD status were determined using chi-square or t-tests. IE hospitalization rates by OUD status, year, and age group were calculated, and linear regression was used to determine differences by year. Results: There were 8601 acute-care hospitalization records for IE from 2016 to 2022 in the SC dataset, of which 1180 (13.7%) had concurrent OUD coding. Statistically significant differences between patients with and without OUD were identified for sex, age group, race, resident rurality, average number of comorbidities, disposition status, and year (all p < 0.01). The incidence rate of IE increased from 2.5/100,000 in 2016 to 6.9/100,000 in 2022 in patients aged 36 to 49 years with OUD (p = 0.02). Patients with IE and OUD who were discharged home had significantly longer lengths of stay in acute care hospitals (32.9 vs. 15.3 days; p < 0.01) and excessive hospital charges ($308,874 vs. $188,862) compared to those without OUD. Conclusions: Major changes have occurred in the demographics of IE in SC. The increasing incidence rate of IE in younger adults with OUD coupled with prolonged stays at acute care hospitals pose challenges to the healthcare system that require creative solutions. Full article

Insomnia is common in individuals with opioid use disorder (OUD). Biopsychosocial factors are important in sleep health, yet this intersection has yet to be fully elucidated in people on buprenorphine for OUD. The objective is to report on patient-reported biopsychosocial factors among people with and without insomnia, specifically among women and men in outpatient OUD treatment. The parent study enrolled adults stabilized on buprenorphine from February 2022–September 2023. Scores of ≥11 on the Insomnia Severity Index (ISI) indicated clinically significant insomnia. Differences were detected by the presence of insomnia, stratified by men and women, using chi-squared and Fisher’s exact tests. Of the overall participants (N = 130), most (n = 77; 59.2%) met the criteria for clinically significant insomnia. Women with insomnia were more likely to report social stressors including discrimination for substance use (p = 0.040), food insecurity (p = 0.032), and transportation difficulties accessing healthcare (p = 0.043) than women without insomnia. Men with insomnia were more likely to report financial difficulties accessing healthcare (p = 0.023) than men without insomnia. These findings provide a unique perspective to consider in the development and implementation of sleep interventions for women and men receiving medication treatment for OUD. Full article

Background: Total knee arthroplasty (TKA) is one of the most frequently performed procedures for end-stage arthritis. Effective pain control is essential for recovery, and opioids are widely used. However, patients with opioid use disorder (OUD) may be at increased risk of complications. Methods: We analyzed 2,514,099 TKA cases from the Nationwide Inpatient Sample (2016–2019), identifying 11,785 patients with OUD. After 1:1 propensity score matching, clinical and economic outcomes were compared between OUD and non-OUD patients. Results: Patients with OUD had significantly higher odds of intraoperative fracture (OR: 6.1), DVT (OR: 5.0), pneumonia (OR: 2.5), pulmonary edema (OR: 1.6), and blood transfusion (OR: 1.5) (p < 0.001). Mean hospital charges were higher (USD 68,687 vs. USD 60,984), and LOS was longer (2.8 vs. 2.5 days, p < 0.001). OUD patients were more likely to undergo revision TKA at a younger age (59.6 vs. 65.4 years, p = 0.016), with higher infection rates and greater costs. Conclusions: Patients with OUD undergoing TKA experience more complications, higher costs, and require earlier revision. Underreporting of OUD highlights the need for improved preoperative screening. Full article

Physical exercise may affect drug use by balancing neurohormonal system mechanisms. Cortisol and β-endorphin, associated with stress, mood, and pleasure feelings, can be affected by exercise and act as regulators of withdrawal symptoms associated with drug use during short-term abstinence. The present study investigated the effect of a supervised, two-month moderate-intensity aerobic exercise program on salivary cortisol and β-endorphin levels in patients with an opioid use disorder (OUD) and on a substitution treatment during a short-term, 24–36 h withdrawal phase from methadone/buprenorphine medication. Ninety opioid users (41 females) in methadone and buprenorphine substitution treatment were randomly divided into four groups: (a) buprenorphine exercise (BEX) (n = 26; age (mean ± SD): 41.9 ± 6.1 yrs), (b) buprenorphine control (BCON) (n = 25; age: 41.9 ± 5.6 yrs), (c) methadone exercise (MEX) (n = 20; age: 46.7 ± 6.6 yrs), and (d) methadone control (MCON) (n = 19; age: 46.1 ± 7.5 yrs). The exercise intervention groups (BEX and MEX) followed a training program on a treadmill for 20 min at 70% HRmax, 3 days/week for 8 weeks. The responses of cortisol and β-endorphin were measured before (t0) and immediately after an exercise session (t20) on different days (i.e., the 1st, 12th, and 24th session) corresponding to the beginning, middle, and end of the training program. A significant increase in β-endorphin levels was observed after the completion of the training intervention (24th exercise session) in both exercise groups (BEX before: 63.8 ± 33; BEX after: 185.6 ± 182.8 pg/mL; MEX before: 115 ± 211; MEX after: 262.3 ± 505.7 pg/mL), whereas β-endorphin was decreased in the control groups (BCON before: 34.7 ± 20.1; BCON after: 24.2 ± 8.8 pg/mL; MCON before: 129.7 ± 185.7; MCON after: 84.9 ± 104.3 pg/mL) (p < 0.05). Inversely, cortisol decreased in both exercise groups post-intervention (BEX before: 9.5 ± 5.9; BEX after: 2.8 ± 1.5 ng/mL; MEX before: 9.3 ± 6.6; MEX after: 3.1 ± 1.5 ng/mL) and increased in control groups (BCON before: 6.3 ± 2.5; BCON after: 10.1 ± 5.4 ng/mL; MCON before: 7.5 ± 3.2; MCON after: 12.5 ± 4.3 ng/mL) (p < 0.05). Moderate-intensity aerobic exercise can beneficially influence β-endorphin and cortisol levels in individuals undergoing treatment for OUD. By increasing endogenous opioid levels and reducing stress hormones, exercise emerges as a promising adjunctive strategy for alleviating withdrawal symptoms, enhancing emotional regulation, and potentially reducing the risk of relapse. The inverse relationship between β-endorphin and cortisol highlights the role of physical activity as a long-term modulator of neuroendocrine function in the context of substance use recovery. Future research should prioritize longitudinal studies extending beyond two months and involving larger, more diverse populations. Additionally, investigating the integration of exercise with non-pharmacological interventions—and its effects on relapse rates, mental health outcomes, and overall quality of life—would provide further insight into its therapeutic value in addiction recovery. Full article

Background: Opioid Use Disorder (OUD) has claimed the lives of many Americans, with rates of overdose steadily rising over the past decade. Despite having highly effective medications to treat this condition, many providers still hesitate to prescribe them. Psychiatric inpatient facilities have a unique opportunity to engage patients with co-occurring disorders in the treatment of OUD; however, significant barriers exist. This study describes a novel OUD–buprenorphine (BUP) consultation service that provides such care to hospitalized psychiatric patients. Methods: This IRB-approved retrospective study reviewed the medical records of 123 hospitalized psychiatric patients who received consultations from the BUP consultation service. Descriptive and comparative statistics were performed. Results: The sample was predominantly male, with significant unemployment and housing instability. Patients were hospitalized for depressive, bipolar, and schizophrenia spectrum disorders. Over 90% of patients were discharged on buprenorphine, with over 50% being connected to specialized substance use services. No increase in the length of stay was found, and no difference in outcomes was observed based on diagnosis or BUP discharge status. Discussion/Conclusions: This novel service was effective in providing OUD treatment to patients with complex co-occurring psychiatric disorders without significantly increasing their length of stay. Despite acute exacerbations in psychiatric illness, patients were able to engage in discussions regarding BUP. While the study was limited in scope, it underscores the feasibility of integrating OUD treatment in the acute psychiatric inpatient setting. Full article

Background/Objectives: Methadone maintenance treatment (MMT) is widely used in opioid use disorder (OUD). Its efficacy is influenced by its metabolism, primarily mediated by Cytochrome P450 (CYP450) enzymes in the liver. Genetic polymorphisms in CYP450 genes and other factors, such as age, sex, and concomitant treatments, contribute to interindividual variability in methadone response. This article addresses the relevance of pharmacokinetic biomarkers in methadone metabolism and its impact on treatment outcomes in European populations over the past 25 years. Methods: A systematic review was conducted using four databases (PsycINFO, PubMed, Scopus, and Web of Science) for studies published between 2000 and 2024 following the PRISMA 2020 guidelines (CRD42025641373 in PROSPERO). Two independent reviewers screened and assessed the study quality using NHLBI tools. Discrepancies were solved through consensus. Relevant data including sample size, genetic biomarkers, and key findings were extracted for each study. Data were synthesized and described in detail. Results: Fourteen studies on pharmacogenetic biomarkers influencing methadone metabolism in European populations were analyzed, encompassing a total of 3180 subjects. CYP2B6*6 was identified as a key variant associated with increased (S)-methadone plasma levels, potentially leading to cardiac complications, while the role of other pharmacokinetic genes, including ABCB1 and CYP2D6, was inconclusive. Conclusions: Genetic polymorphisms significantly influence methadone metabolism, with the CYP2B6*6 allele playing a key role in (S)-methadone metabolism and associated with cardiac risks. Pharmacogenetic studies integrating co-mediation—the principal cause of phenoconversion—as a potential variable alongside gender differences and encompassing adequate sample sizes could improve outcomes and establish the basis for personalized medicine of MMT. Full article

Background/Objectives: Adolescents and young adults (AYAs) with opioid use disorder (OUD) frequently have co-occurring psychiatric conditions and substance use disorders (SUDs). This study evaluated the association of psychiatric comorbidities and other SUDs with treatment retention and urine drug test (UDT) results in AYAs with OUD. Methods: This retrospective cohort study included AYAs enrolled in the Substance Use Treatment and Recovery clinic from 2009 to 2022. Participants were categorized into four groups: no comorbidities, only mental health disorders, only other SUDs, and both disorders. Treatment outcomes included retention time and UDT results for medication for OUD (MOUD) and illicit substances, including tetrahydrocannabinol (THC). Kruskal–Wallis tests were used to evaluate differences across groups, and regression models identified variables associated with outcomes. Statistical significance was set at p < 0.05. Results: Among 157 patients, the median retention time was 300 days. Depression (p = 0.04), post-traumatic stress disorder (p = 0.002), and alcohol use disorder (p = 0.04) were associated with prolonged retention, whereas cannabis use disorder predicted shorter retention (p = 0.02). The median proportion of positive UDTs was 0.9 for MOUD, 0.1 for illicit substances, and 0.0 for THC. Older age (p = 0.02) and the use of antidepressants and anxiolytics were associated with greater adherence to MOUD. Cannabis use disorder (p = 0.02) and male sex (p = 0.04) predicted positive UDTs for THC, while MOUD use was linked to lower THC positivity (p = 0.02). The main limitations of this study were related to its retrospective study design and single-center setting. Conclusions: Psychiatric and substance use comorbidities significantly influence retention and treatment adherence in AYAs with OUD. Integrated treatment may improve engagement and outcomes. Further research is needed to tailor interventions for AYAs with co-occurring disorders. Full article