Article
Substance Abuse
Kristine E. Torres-Lockhart, Tiffany Y. Lu, Melissa B. Weimer, Melissa R. Stein, Chinazo O. Cunningham
Summary: Appropriate clinical management is essential for opioid withdrawal, as it reduces the risks of overdose and relapse. This narrative review provides evidence-based strategies for opioid withdrawal management, including complex cases, relapse prevention, and new developments.
Review
Pharmacology & Pharmacy
Gary B. Kaplan, Benjamin L. Thompson
Summary: Opioid use disorder is characterized by excessive use of opioids, inability to control use, withdrawal syndrome, and likelihood of relapse. The opponent process view of motivation suggests that opioid addiction involves positive affective experiences during active involvement and negative affective experiences during abstinence. These negative experiences are hypothesized to be caused by neuroadaptations in the extended amygdala, which includes the CeA, BNST, and NAc shell, as well as input from the BLA. Animal models of opioid withdrawal demonstrate the somatic, motivational, affective, and learning related aspects of withdrawal. Neuroadaptations in the extended amygdala lead to aversive and fear-related effects, hypodopaminergia, and increased vulnerability to relapse. Understanding and reversing these neuroadaptations could lead to new interventions for opioid use disorder.
FRONTIERS IN PHARMACOLOGY
(2023)
Article
Biotechnology & Applied Microbiology
Uppala Radhakrishna, Swapan K. Nath, Sangeetha Vishweswaraiah, Lavanya Uppala, Ariadna Forray, Srinivas B. Muvvala, Nitish K. Mishra, Siddesh Southekal, Chittibabu Guda, Hiranjith Govindamangalam, Derek Vargas, William G. Gardella, Richard C. Crist, Wade H. Berrettini, Raghu P. Metpally, Ray O. Bahado-Singh
Summary: Excessive prenatal opioid exposure can lead to Neonatal Opioid Withdrawal Syndrome (NOWS). RNA-seq analysis of placental tissue samples from mothers with opioid use disorder and newborns with NOWS identified 93 differentially expressed genes, with 7 genes potentially playing a key role in the etiology of NOWS. This study provides insights into the genetic mechanisms underlying the development of NOWS.
Review
Psychiatry
Justin C. Strickland, Cassandra D. Gipson, Kelly E. Dunn
Summary: The co-use of opioids and methamphetamine presents a public health challenge, and understanding the neurobiology is crucial for developing effective treatments.
FRONTIERS IN PSYCHIATRY
(2022)
Article
Biochemistry & Molecular Biology
Yongsheng Zhu, Peng Yan, Rui Wang, Jianghua Lai, Hua Tang, Xu Xiao, Rongshan Yu, Xiaorui Bao, Feng Zhu, Kena Wang, Ye Lu, Jie Dang, Chao Zhu, Rui Zhang, Wei Dang, Bao Zhang, Quanze Fu, Qian Zhang, Chongao Kang, Yujie Chen, Xiaoyu Chen, Qing Liang, Kejia Wang
Summary: Dysregulation of the immune system is a key factor in opioid addiction. The abnormal distribution of immune cells, particularly the expansion of fragile-like regulatory T cells (Tregs), is correlated with withdrawal symptoms. Opioids increase the expression of neuron-derived Ccl2, which disrupts the blood-brain barrier (BBB) integrity and allows Tregs to infiltrate the NAc, leading to synaptic instability and withdrawal symptoms mediated by IFN-y.
Article
Neurosciences
Joris C. Verster, Andrew Scholey, Thomas A. Dahl, Jacqueline M. Iversen
Summary: SJP-005 significantly reduced the incidence and duration of discontinuation-induced morphine withdrawal symptoms, with the most pronounced effects observed when treatment was initiated 2 days before morphine cessation.
PSYCHOPHARMACOLOGY
(2021)
Article
Multidisciplinary Sciences
Sarah Stevens, Shekher Mohan
Summary: With the increasing opioid use among pregnant women and the resulting rise in infants born with neonatal opioid withdrawal syndrome (NOWS), there is a need to understand the short and long-term effects of prenatal opioid exposure. The study using spiny mice as a model found that prenatal morphine exposure led to increased withdrawal behavior in early postnatal period, indicating the potential for this species as a novel preclinical model of NOWS.
Article
Pediatrics
Massroor Pourcyrous, Mohamad T. Elabiad, Divya Rana, Kan P. Gaston, Linda DeBaer, Ramasubbareddy Dhanireddy
Summary: There is a significant association between race and the development of severe neonatal opioid withdrawal syndrome (NOWS). White infants born to mothers who did not attend opioid maintenance treatment program (OMTP) had a higher rate of severe NOWS requiring pharmacological intervention compared to Black infants. Larger studies are needed to further explore the association between social and genetic factors and the development of NOWS.
PEDIATRIC RESEARCH
(2021)
Review
Toxicology
Brian A. A. Baldo
Summary: The increasing use of opioids in pregnant women has led to an alarming rise in neonates with drug-induced withdrawal symptoms, known as neonatal opioid withdrawal syndrome (NOWS). NOWS is a toxic condition with various symptoms including poor feeding, irritability, tachycardia, hypertension, respiratory defects, tremors, hyperthermia, and weight loss. Studies have shown that genetic variations and epigenetic changes in opioid-related genes play a role in the development of NOWS, and maternal opioid treatment can affect respiratory control in neonates.
ARCHIVES OF TOXICOLOGY
(2023)
Article
Medicine, General & Internal
Leslie W. Young, Songthip T. Ounpraseuth, Stephanie L. Merhar, Zhuopei Hu, Alan E. Simon, Andrew A. Bremer, Jeannette Y. Lee, Abhik Das, Margaret M. Crawford, Rachel G. Greenberg, P. Brian Smith, Brenda B. Poindexter, Rosemary D. Higgins, Michele C. Walsh, Ward Rice, David A. Paul, Jessie R. Maxwell, Sucheta Telang, Camille M. Fung, Tanner Wright, Anne Marie Reynolds, Devon W. Hahn, Julie Ross, Jennifer M. McAllister, Moira Crowley, Sophie K. Shaikh, Karen M. Puopolo, Lori Christ, Jaime Brown, Julie Riccio, Kara Wong Ramsey, Erica F. Braswell, Lauren Tucker, Karen R. McAlmon, Krishna Dummula, Julie Weiner, Jessica R. White, Meghan P. Howell, Sarah Newman, Jessica N. Snowden, Lori A. Devlin
Summary: A study conducted at 26 hospitals in the United States found that the use of the "Eat, Sleep, Console" care approach significantly reduced the time until infants with neonatal opioid withdrawal syndrome were medically ready for discharge, without increasing specified adverse outcomes.
NEW ENGLAND JOURNAL OF MEDICINE
(2023)
Article
Medicine, General & Internal
Jeanne Gripshover, Thomas Kosten
Summary: A retrospective study found that patients managed with lofexidine had a higher likelihood of successfully ceasing opioid use compared to those managed with clonidine.
CUREUS JOURNAL OF MEDICAL SCIENCE
(2022)
Article
Medicine, General & Internal
Daina B. Esposito, Krista F. Huybrechts, Martha M. Werler, Loreen Straub, Sonia Hernandez-Diaz, Helen Mogun, Brian T. Bateman
Summary: This study compared the risk of neonatal opioid withdrawal syndrome (NOWS) among neonates exposed to different types of opioids during the last 3 months of pregnancy, finding that strong agonists with long half-lives were associated with a higher risk of NOWS. This information can help healthcare providers make informed decisions when prescribing opioids for pain management in late pregnancy.
Article
Medicine, Research & Experimental
Yongsheng Zhu, Kejia Wang, Tengfei Ma, Yuanyuan Ji, Yin Lou, Xiaoyu Fu, Ye Lu, Yige Liu, Wei Dang, Qian Zhang, Fangyuan Yin, Kena Wang, Bing Yu, Hongbo Zhang, Jianghua Lai, Yunpen Wang
Summary: This study identified neural pathways involved in controlling depressive-like behaviors and acute withdrawal symptoms after morphine withdrawal. Furthermore, a new DBS treatment protocol was developed to reverse abnormal plasticity and alleviate withdrawal symptoms and depressive-like behaviors.
JOURNAL OF CLINICAL INVESTIGATION
(2023)
Review
Medicine, General & Internal
A. Zankl, J. Martin, J. G. Davey, D. A. Osborn
Summary: This study assessed the effectiveness and safety of using sedatives versus control for NAS due to opioid withdrawal. The results showed that there are different comparisons of sedatives for NAS, but some data and conclusions have low reliability.
COCHRANE DATABASE OF SYSTEMATIC REVIEWS
(2021)
Article
Emergency Medicine
Sally Mahmoud, Erik Anderson, Aidan Vosooghi, Andrew A. Herring
Summary: This study examined a cohort of patients treated with buprenorphine and phenobarbital or benzodiazepines for concurrent opioid and alcohol withdrawal in the ED. The results showed no serious adverse events related to the medications used for treatment. Further research should focus on optimizing medical therapy and transitioning patients to maintenance treatment for substance use disorders.
AMERICAN JOURNAL OF EMERGENCY MEDICINE
(2021)
Article
Immunology
Jamie L. Miller, Peter N. Johnson, Bryan P. White, Stephen B. Neely, Hala Chaaban, Netsanet Kassa, Robert C. Welliver
PEDIATRIC INFECTIOUS DISEASE JOURNAL
(2019)
Editorial Material
Pharmacology & Pharmacy
Peter N. Johnson, Jamie L. Miller
AMERICAN JOURNAL OF HEALTH-SYSTEM PHARMACY
(2019)
Article
Pharmacology & Pharmacy
Katy Stephens, Jamie L. Miller, Teresa Lewis, Stephen Neely, Peter N. Johnson
ANNALS OF PHARMACOTHERAPY
(2020)
Article
Pharmacology & Pharmacy
Maura Harkin, Brittany Powers Shaddix, Stephen B. Neely, Leigh A. Peek, Katy Stephens, Philip Barker, Lauren McMullan, Andrew Gormley, Peter N. Johnson
AMERICAN JOURNAL OF HEALTH-SYSTEM PHARMACY
(2020)
Article
Pharmacology & Pharmacy
Sin Yin Lim, Jamie L. Miller, Emilie Henry, Rebecca Heltsley, Sukyung Woo, Peter N. Johnson
Summary: Limited pharmacokinetic and pharmacodynamic data of fentanyl in mechanically ventilated children were investigated in this study. The study assessed fentanyl pharmacokinetics, sedation outcomes, and tolerance development in children receiving continuous fentanyl infusion. Different weight-based dosing rates may be needed for infants and children of various ages to achieve similar plasma concentrations. Using State Behavioral Scale scores can guide fentanyl dosing titration and patients may develop tolerance to fentanyl a day after achieving goal sedation.
Article
Pharmacology & Pharmacy
Maura Harkin, Jamie L. Miller, Sin Yin Lim, Stephen B. Neely, Christina K. Walsh, Peter N. Johnson
Summary: The study revealed that transitioning from fentanyl to hydromorphone can reduce opioid dosage in critically ill children without affecting sedative use. Further investigation is required to determine if opioid rotations with hydromorphone can decrease opioid/sedative exposure.
ANNALS OF PHARMACOTHERAPY
(2021)
Editorial Material
Pharmacology & Pharmacy
Maura Harkin, Jamie Miller, Sin Yin Lim, Stephen Neely, Christina Walsh, Peter N. Johnson
ANNALS OF PHARMACOTHERAPY
(2022)
Article
Pharmacology & Pharmacy
Rebecca A. Mayes, Peter N. Johnson, Bryan P. White, Stephen B. Neely, Hala Chaaban, Jamie L. Miller
Summary: This retrospective study found that the duration of ceftazidime use was associated with an increased risk of P aeruginosa resistance in neonatal intensive care unit patients. Further studies are needed to confirm these findings.
ANNALS OF PHARMACOTHERAPY
(2022)
Article
Pharmacology & Pharmacy
Caitlyn V. Bradford, Jamie L. Miller, Courtney D. Ranallo, Stephen B. Neely, Peter N. Johnson
Summary: The aim of this study was to determine the incidence of vasopressin-induced hyponatremia and its associated risk factors. The study found that the incidence of hyponatremia was less than 15% and that the duration of vasopressin treatment was independently associated with the development of hyponatremia.
ANNALS OF PHARMACOTHERAPY
(2023)
Article
Pharmacology & Pharmacy
Katy Stephens, Philip Barker, Erica Bergeron, Amie L. Miller, Tracy M. Hagemann, Teresa Lewis, Stephen Neely, Peter N. Johnson
Summary: This study compared clinical outcomes and medication use between obese and nonobese children in the PICU. The results showed that obesity was not associated with mortality, PICU LOS, and MV requirement, but the number of medication classes and continuous infusions were associated with these outcomes.
Article
Medicine, General & Internal
Thao T. Nguyen, Erica Bergeron, Teresa Lewis, Jamie L. Miller, Tracy M. Hagemann, Stephen Neely, Peter N. Johnson
SAGE OPEN MEDICINE
(2020)
Meeting Abstract
Critical Care Medicine
Peter Johnson, Maura Harkin, Stephen Neely, Sin Yin Lim, Christina Walsh
CRITICAL CARE MEDICINE
(2020)
Article
Education, Scientific Disciplines
Peter N. Johnson, Brooke L. Gildon, Michelle Condren, Jamie L. Miller, Tracy M. Hagemann, Teresa V. Lewis, Bob John, Kevin Farmer
CURRENTS IN PHARMACY TEACHING AND LEARNING
(2019)
Article
Pediatrics
Peter N. Johnson, Katy Stephens, Philip Barker, Erica Bergeron, Sin Yin Lim, Tracy M. Hagemann, Teresa Lewis, Stephen Neely, Jamie L. Millers
JOURNAL OF PEDIATRIC INTENSIVE CARE
(2019)
Meeting Abstract
Pharmacology & Pharmacy
S. Lim, P. Johnson, J. Miller, E. Henry, K. Standifer, C. Rathbun, R. Heltsley, S. Woo
CLINICAL PHARMACOLOGY & THERAPEUTICS
(2019)