Category Archives: Opioids

Pain and Substance Use Can Interact in a Vicious Cycle

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PainRelief.com Interview with:

Emily L. Zale PhD Department of Psychology Syracuse University Syracuse, New York

Dr. Zale

Emily L. Zale PhD
Department of Psychology
Syracuse University
Syracuse, New York

PainRelief.com: What is the background for this study? What are the main findings?

Response: When people think of pain and substance use, it’s common for opioids to come to mind. While the opioid crisis has rightfully garnered considerable attention, our research suggests that non-opioid substances, like nicotine/tobacco, alcohol, and cannabis, are also important to consider in relation to pain. In fact, nicotine/tobacco, alcohol, and cannabis are the most commonly used substances in the US, and research into associations between pain and these non-opioid substances is continuing to increase in popularity.

Research studies usually examine either how substance use affects pain or how pain affects substance use. We looked at results from over 100 studies and put these two different types of research together to understand how pain and substance use affect each other.

On one hand, substance use can be a risk factor for chronic pain and may worsen pain over time. On the other hand, experiencing pain can motivate people to use substances and might make it harder to quit. By putting these two types of studies together, we found that pain and substance use  interact in a vicious cycle that can ultimately worsen and maintain both chronic pain and addiction.

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Study Suggest Opioids Should Not Be First Line Therapy for Chronic Non-Cancer Pain

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PainRelief.com Interview with:

Dr. Jason Busse PhD Associate Professor McMaster University

Dr. Busse


Dr. Jason Busse PhD
Associate Professor
McMaster University

PainRelief.com: What is the background for this study?  

Response: The United States prescribes more opioids per capita than any other country in the world, and opioids are associated with addiction, overdose, and death. Many individuals living with chronic noncancer pain are managed with opioid therapy; however, we have limited knowledge regarding benefits and harms. We conducted a systematic review and meta-analysis to synthesize the evidence from all RCTs that explored an opioid vs. a non-opioid comparator for patients with chronic noncancer pain, and followed participants for at least 1 month. Continue reading →

New Opioid Ligands May Provide Pain Relief Without Addiction Risk

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PainRelief.com Interview with:

Prof. Dr. Christoph Stein Direktor Institut für Experimentelle Anaesthesiologie Charité Campus Benjamin Franklin Freie Universität Berlin 

Prof. Stein

Prof. Dr. Christoph Stein
Direktor
Institut für Experimentelle Anaesthesiologie
Charité Campus Benjamin Franklin
Freie Universität Berlin 

PainRelief.com: What is the background for this study? What are the main findings? 

Response: Our group has studied the biology and pharmacology of opioid receptors on peripheral sensory neurons (i.e. outside the central or intestinal nervous system) for over 25 years. We have always aimed at finding mechanisms and opioid receptor ligands that can be developed into drugs inhibiting pain without eliciting typical adverse effects of conventional opioids such as apnoea, addiction, sedation or constipation.

From our previous work we knew that the selective activation of opioid receptors on peripheral sensory neurons can produce powerful pain relief in animals and human patients. Those analgesic effects are particularly strong in pain caused by tissue injury and inflammation (e.g. postoperative pain, arthritis). Together with mathematicians (Dr. Marcus Weber) at the Zuse Institute Berlin, we started out with computer simulations examining the interaction between opioid ligands and receptors in normal (noninflamed) and inflamed environments. These studies indicated a stronger binding of conventional opioid ligands (morphine, fentanyl) to opioid receptors at increased proton concentrations (i.e. low pH, as present in acidotic/inflamed tissue). We also knew that the protonation of a tertiary amine in the ligand is required for opioid receptor activation. Using those in silico simulations, we now designed a new ligand (NFEPP) that is only protonated (and capable of activating opioid receptors) at low pH, but not at normal pH (as in brain and intestinal wall). After synthesis of NFEPP (and similar derivatives) by a contractor we tested them in vitro and in vivo. NFEPP produced opioid receptor activation and analgesia selectively at low pH/tissue inflammation (as present in nerve injury/neuropathy and abdominal inflammation) without eliciting respiratory depression, addiction potential, sedation or constipation. 

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New Technique Can Help Pinpoint Where Heroin Batches Come From

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New method describes measuring  strontium isotopes can be used as a chemical marker for geography and geology to differentiate heroin samples from different geographic regions.

Joshua DeBord, Ali Pourmand, Sarah C. Jantzi, Sini Panicker, Jose Almirall. Profiling of heroin and assignment of provenance by 87 Sr/ 86 Sr isotope ratio analysis. Inorganica Chimica Acta, 2017; DOI: 10.1016/j.ica.2017.07.049

FDA To Require Opioid Manufacturers To Train Health Care Providers

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The FDA “notified 74 manufacturers of immediate-release opioid analgesics intended for use in the outpatient setting that their drugs will now be subject to a more stringent set of requirements under a Risk Evaluation and Mitigation Strategy (REMS).

The REMS requires that training be made available to health care providers who prescribe IR opioids, including training on safe prescribing practices and consideration of non-opioid alternatives.”

https://blogs.fda.gov/fdavoice/index.php/2017/09/fda-takes-important-steps-to-stem-the-tide-of-opioid-misuse-and-abuse/

Emergency Rooms Using Shorter, Lower Doses of Opioids

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A recent study from the Annals of Emergency Medicine founds that compared to other settings, emergency room prescriptions for opioids found more likely to be in compliance with CDC recommendations and have a lower risk of progression to long term opioid use.

CVS To Limit Opioid Prescriptions To 7 Days For New Patients

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As part of CVS’s commitment to fighting the national opioid abuse epidemic, CVS is:

  •  limiting to seven days the supply of opioids dispensed for certain acute prescriptions for patients who are new to therapy;
  • limiting the daily dosage of opioids dispensed based on the strength of the opioid; and
  • requiring the use of immediate-release formulations of opioids before extended-release opioids are dispensed.

https://cvshealth.com/newsroom/press-releases/cvs-health-fighting-national-opioid-abuse-epidemic-with-enterprise-initiatives