| 1. |
- Alho, Hannu, et al.
(author)
-
Misuse and diversion of agonist opioid treatment medicines : assessment of the scale of the problem and review of the changing environment for care in the Nordic countries
- 2015
-
In: Heroin Addiction and Related Clinical Problems. - 1592-1638. ; 17:5, s. 43-49
-
Research review (peer-reviewed)abstract
- Background: Opioid addiction is effectively treated via a multidisciplinary approach including agonist opioid treatment (AOT) and psychosocial intervention. Misuse and diversion of AOT medicines such as methadone and mono-buprenorphine comprise a significant problem occurring in the Nordic countries with some of the highest frequencies in Europe. Misuse and diversion are associated with poor treatment compliance and increases in risk of blood-borne infections, crime, and mortality. Regulations and guidelines for provision of AOT medication vary among the Nordic countries. Aim: The extent and impact of misuse and diversion in the Nordic countries has not been documented in the literature. This review of local sources summarizes the extent and impact of misuse and diversion of AOT medication to provide a basis for improving outcomes in opioid addiction care. Methods: PubMed was searched using the terms "methadone" or "buprenorphine" and "misuse" or "diversion". Titles and abstracts of search results were inspected for location and relevance. Government sources and mainstream media were also searched for relevant reports. Results: Misuse and diversion of AOT medicines is a significant issue in the Nordic countries; these opioids are available outside of treatment and are misused, including by young addicts. To address this problem, changes in medicines used in treatment in Finland and Iceland have already been implemented and considerations are under way in Norway and Sweden. Conclusions: All persons involved in AOT should take action to better understand AOT medication misuse and diversion as this can lead to a step change improvement in outcomes.
|
|
| 2. |
- Gedeon, Charlotte, et al.
(author)
-
Standards for opioid use disorder care : An assessment of Nordic approaches
- 2019
-
In: Nordic Studies on Alcohol and Drugs. - : Sage Publications. - 1455-0725 .- 1458-6126. ; 36:3, s. 286-298
-
Journal article (peer-reviewed)abstract
- Aims: Outcomes in opioid use disorder (OUD) in Nordic countries have improved with integrated treatment and harm-reduction programmes. Approaches and the standard of care are different across the region. Evidence of treatment needs and current approaches are defined from evidence to inform development of a common standard.Method: Evidence of population sizes and treatment approach collected. Common standards for care (harm reduction, pharmacotherapy, psychology/social therapy) defined for each country.Results: Evidence defines number in treatment; potential population needing treatment not defined for all countries. Populations sizes, treatment access (ratio in treatment programme compared to total country population) defined: Sweden 4,000 in OUD care (access ratio 40); Finland 3,000 (55); Norway 8,000 (154); Denmark 7,500 (132). Approach to treatment similar: integrated treatment programmes standard. Care provided by specialists in outpatient clinics/primary care; secondary care/inpatient services are available. Harm reduction is limited in Sweden but available and more accessible elsewhere. Treatment entry criteria: access relatively unlimited in Norway and Denmark, more limited in Finland and Sweden. Standards of care defined: easy access to high-quality services, individual planning, care not limited by time, management of relapse, education for patients, continuous engagement, holistic approach including management of comorbidities, needle equipment programmes without limit, treatment in prisons as community.Conclusion: There are opportunities to improve OUD care in the Nordics. Policy makers and clinicians can advance OUD care and share common success factors. Collaborative work across the Nordic countries is valuable. Further research in clinical practice development can yield important results for the benefit of patients with OUD.
|
|
| 3. |
- Johansson, Jarkko, et al.
(author)
-
Intranasal naloxone rapidly occupies brain mu-opioid receptors in human subjects
- 2019
-
In: Neuropsychopharmacology. - : Nature Publishing Group. - 0893-133X .- 1740-634X. ; 44:9, s. 1667-1673
-
Journal article (peer-reviewed)abstract
- Nasal spray formulations of naloxone, a mu-opioid receptor (MOR) antagonist, are currently used for the treatment of opioid overdose. They may have additional therapeutic utility also in the absence of opioid agonist drugs, but the onset and duration of action at brain MORs have been inadequately characterized to allow such projections. This study provides initial characterization of brain MOR availability at high temporal resolution following intranasal (IN) naloxone administration to healthy volunteers in the absence of a competing opioid agonist. Fourteen participants were scanned twice using positron emission tomography (PET) and [11C]carfentanil, a selective MOR agonist radioligand. Concentrations of naloxone in plasma and MOR availability (relative to placebo) were monitored from 0 to 60 min and at 300–360 min post naloxone. Naloxone plasma concentrations peaked at ~20 min post naloxone, associated with slightly delayed development of brain MOR occupancy (half of peak occupancy reached at ~10 min). Estimated peak occupancies were 67 and 85% following 2 and 4 mg IN doses, respectively. The estimated half-life of occupancy disappearance was ~100 min. The rapid onset of brain MOR occupancy by IN naloxone, evidenced by the rapid onset of its action in opioid overdose victims, was directly documented in humans for the first time. The employed high temporal-resolution PET method establishes a model that can be used to predict brain MOR occupancy from plasma naloxone concentrations. IN naloxone may have therapeutic utility in various addictions where brain opioid receptors are implicated, such as gambling disorder and alcohol use disorder.
|
|
| 4. |
- Jones, Owen R., et al.
(author)
-
Senescence rates are determined by ranking on the fast-slow life-history continuum
- 2008
-
In: Ecology Letters. - : Wiley. - 1461-023X .- 1461-0248. ; 11:7, s. 664-673
-
Journal article (peer-reviewed)abstract
- Comparative analyses of survival senescence by using life tables have identified generalizations including the observation that mammals senesce faster than similar-sized birds. These generalizations have been challenged because of limitations of life-table approaches and the growing appreciation that senescence is more than an increasing probability of death. Without using life tables, we examine senescence rates in annual individual fitness using 20 individual-based data sets of terrestrial vertebrates with contrasting life histories and body size. We find that senescence is widespread in the wild and equally likely to occur in survival and reproduction. Additionally, mammals senesce faster than birds because they have a faster life history for a given body size. By allowing us to disentangle the effects of two major fitness components our methods allow an assessment of the robustness of the prevalent life-table approach. Focusing on one aspect of life history - survival or recruitment - can provide reliable information on overall senescence.
|
|
| 5. |
- Kakko, Johan, et al.
(author)
-
Craving in Opioid Use Disorder : From Neurobiology to Clinical Practice
- 2019
-
In: Frontiers in Psychiatry. - : Frontiers Media S.A.. - 1664-0640. ; 10
-
Research review (peer-reviewed)abstract
- Opioid use disorder (OUD) is a major public health issue that has reached epidemic levels in some parts of the world. It is a chronic and complex neurobiological disease associated with frequent relapse to drug taking. Craving, defined as an overwhelmingly strong desire or need to use a drug, is a central component of OUD and other substance use disorders. In this review, we describe the neurobiological and neuroendocrine pathways that underpin craving in OUD and also focus on the importance of assessing and treating craving in clinical practice. Craving is strongly associated with patients returning to opioid misuse and is therefore an important treatment target to reduce the risk of relapse and improve patients' quality of life. Opioid agonist therapies (OAT), such as buprenorphine and methadone, can significantly reduce craving and relapse risk, and it is essential that patients are treated optimally with these therapies. There is also evidence to support the benefits of non-pharmacological approaches, such as cognitive behavioral therapy and mindfulness-based interventions, as supplementary treatments to opioid agonist therapies. However, despite the positive impact of these treatments on craving, many OUD patients continue to suffer with negative affect and dysphoria. There is a clear need for further studies to progress our understanding of the neurobiological basis of craving and addiction and to identify novel therapeutic strategies as well as to optimize the use of existing treatments to improve outcomes for the growing numbers of patients affected by OUD.
|
|
| 6. |
- Kakko, Johan, et al.
(author)
-
Principles for managing OUD related to chronic pain in the Nordic countries based on a structured assessment of current practice
- 2018
-
In: Substance Abuse Treatment, Prevention, and Policy. - : BioMed Central. - 1747-597X. ; 13
-
Research review (peer-reviewed)abstract
- Background: Long-term use of opioid analgesics (OA) for chronic pain may result in opioid use disorder (OUD). This is associated with adverse outcomes for individuals, families and society. Treatment needs of people with OUD related to chronic pain are different compared to dependence related to use, and also injection, of illicit opioids. In Nordic countries, day-to-day practical advice to assist clinical decision-making is insufficient.Aim: To develop principles based on expert clinical insights for treatment of OUD related to the long-term use of OA in the context of chronic pain.Methods: Current status including an assessment of barriers to effective treatment in Finland, Denmark, Iceland, Norway, Sweden was defined using a patient pathway model. Evidence to describe best practice was identified from published literature, clinical guidelines and expert recommendations from practice experience.Results: Availability of national treatment guidelines for OUD related to chronic pain is limited across the Nordics. Important barriers to effective care identified: patients unlikely to present for help, healthcare system set up limits success, diagnosis tools not used, referral pathways unclear and treatment choices not elucidated. Principles include the development of a specific treatment pathway, awareness/education programs for teams in primary care, guidance on use of diagnostic tools and a flexible treatment plan to encourage best practice in referral, treatment assessment, choice and ongoing management via an integrated care pathway. Healthcare systems and registries in Nordic countries offer an opportunity to further research and identify population risks and solutions.Conclusions: There is an opportunity to improve outcomes for patients with OUD related to chronic pain by developing and introducing care pathways tailored to specific needs of the population.
|
|
