Search results for: opioid addiction

Authors: Donna L. Roberts

Abstract:

Heroin has appeared on the drug scene before. Yet the current opioid crisis differs in significant ways. In order to address the grave challenges, this epidemic poses, the unique precipitating and sustaining conditions must be thoroughly examined. This research explored the various aspects of the political, economic, and social conditions that created a 'perfect storm' for the evolution and maintenance of the current opioid crisis. Specifically, the epidemiology, demographics, and progression of addiction inherent in the current crisis were compared to the patterns of past opioid use. Additionally, the role of pharmaceutical companies and prescribing physicians, the nature and pharmaceutical properties of the available substances and the changing socioeconomic climate were considered. Results indicated that the current crisis differs significantly with respect to its evolution, magnitude, prevalence, and widespread societal effects. Precipitated by a proliferation of prescription medication and sustained by the availability of cheaper, more potent street drugs, including new versions of synthetic opioids, the current crisis presents unprecedented challenges affecting a wider and more diverse segment of society. The unique aspects of this epidemic demand unique approaches to addressing the problem. Understanding these differences is a key step in working toward a practical and enduring solution.

Keywords: addiction, drug abuse, opioids, opioid crisis

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Authors: Donna L. Roberts

Abstract:

2019 marked 23 years since Purdue Pharma launched its flagship drug, OxyContin, that unleashed an unprecedented epidemic touching both celebrities and common citizens, metropolitan, suburbia and rural areas and all levels of socioeconomic status. From rural Appalachia to East LA individuals, families and communities have been devastated by a trajectory of addiction that often began with the legitimate prescription of a pain killer for anything from a tooth extraction to a sports injury to recovery from surgery or chronic arthritis. Far from being a serendipitous progression of events, the proliferation of this new breed of 'miracle drug' was instead a carefully crafted marketing program aimed at both the medical community and common citizens. This research represents and in-depth investigation of the evolution of the marketing, distribution and promotion of prescription opioids by pharmaceutical companies and its relationship to the propagation of the opioid crisis. Specifically, key components of Purdue Pharma’s aggressive marketing campaign, including its bonus system and sales incentives, were analyzed in the context of the sociopolitical environment that essential created the proverbial 'perfect storm' for the changing manner in which pain is treated in the U.S. The analyses of these series of events clearly indicate their role in first, the increase in prescription of opioids for non-terminal pain relief and subsequently, the incidence of related addiction, overdose, and death. Through this examination of the conditions that facilitated and maintained this drug crisis, perhaps we can begin to chart a course toward its resolution.

Keywords: addiction, opioid, opioid crisis, Purdue Pharma

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Authors: Adam J. Carinci

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Background: The opioid epidemic is the most pressing healthcare crisis of our time. There is increasing recognition that opioids have limited long-term efficacy and are associated with hyperalgesia, addiction, and increased morbidity and mortality. Therefore, alternative strategies to combat chronic pain are paramount. We initiated a multicenter retrospective case series to review the efficacy of DRG stimulation in facilitating opioid tapering, opioid discontinuation and as a viable alternative to chronic opioid therapy. Purpose: The dorsal root ganglion (DRG) plays a key role in the development and maintenance of pain. Recent innovations in neuromodulation, specifically, dorsal root ganglion stimulation, offers an effective alternative to opioids in the treatment of chronic pain. This retrospective case series demonstrates preliminary evidence that DRG stimulation facilitates opioid tapering, opioid discontinuation and presents a viable alternative to chronic opioid therapy. Procedure: This small multicenter retrospective case series provides preliminary evidence that DRG stimulation facilitates opioid weaning, opioid tapering and is a viable option to opioid therapy in the treatment of chronic pain. A retrospective analysis was completed. Visual analog scale pain scores and pain medication usage were collected at the baseline visit and after four weeks, 3 months and 6 months of treatment. Ten consecutive patients across two study centers were included. The pain was rated 7.38 at baseline and decreased to 1.50 at the 4-week follow-up, a reduction of 79.5%. All patients significantly decreased their opioid pain medication use with an average > 30% reduction in morphine equivalents and four were able to discontinue their medications entirely. Conclusion: This Retrospective case series demonstrates preliminary evidence that DRG stimulation facilitates opioid tapering, opioid discontinuation and presents a viable alternative to chronic opioid therapy.

Keywords: dorsal root ganglion, neuromodulation, opioid sparing, stimulation

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Authors: Daniele Zullino, Gabriel Thorens, Léonice Furtado, Federico Seragnoli, Radu Iuga, Louise Penzenstadler

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Context: Since the start of the 21st century, there has been a resurgence of interest in psychedelics, marked by a renewed focus on scientific investigations into their therapeutic potential. While psychedelic therapy has gained recognition for effectively treating depression and anxiety disorders, notable progress has been made in the clinical development of substances like psilocybin. Moreover, mounting evidence suggests promising applications of Lysergic acid diethylamide (LSD) and psilocybin in the field of addiction medicine. In Switzerland, compassionate treatment with LSD and psilocybin has been permitted since 2014 through exceptional licenses granted by the Federal Office of Public Health. This treatment approach is also available within the Geneva treatment program, extending its accessibility to patients undergoing opioid-assisted treatment involving substances like morphine and diacetylmorphine. The aim of this study is to assess the feasibility of psychedelic-assisted therapy in patients with opioid use disorder who are undergoing opioid-assisted treatment. This study addresses the question of whether psychedelic-assisted therapy can be successfully implemented in patients with opioid use disorder. It also explores the effects of psychedelic therapy on the patient's experiences and outcomes. Methodology: This is an open case series on six patients who have undergone at least one session with either LSD (100-200 micrograms) or psilocybin (20-40 mg). The patients were assessed using the Five Dimensional Altered States of Consciousness (5D-ASC)-Scale. The data were analyzed descriptively to identify patterns and trends in the patients' experiences. Results: The patients experienced substantial positive psychedelic effects during the psychedelic sessions without significant adverse effects. The patients reported positive experiences and improvements in their condition. Conclusion: The findings of this study support the feasibility and potential efficacy of psychedelic-assisted therapy in patients undergoing opioid-assisted treatment.

Keywords: psychedelics, psychedelic-assisted treatment, opioid use disorder, addiction, LSD, psilocybin

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Authors: Louise Penzenstadler, Tiphaine Robet, Radu Iuga, Daniele Zullino

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Context: The outpatient clinic of the psychiatric addiction service of Geneva University Hospital has been providing support to individuals affected by various narcotics for 30 years. However, the increasing consumption of crack cocaine in Geneva has presented a new challenge for the healthcare system. Research Aim: The aim of this research is to evaluate the impact of an outreach intervention on crack cocaine addiction in users with co-occurring opioid use disorder. Methodology: The research utilizes a combination of quantitative and qualitative retrospective data analysis to evaluate the effectiveness of the outreach intervention. Findings: The data collected from October 2023 to December 2023 show that the outreach program successfully made 1,071 contacts with drug users and led to 15 new requests for care and enrollment in treatment. Patients expressed high satisfaction with the intervention, citing easy and rapid access to treatment and social support. Theoretical Importance: This research contributes to the understanding of the challenges and specific needs of a complex group of drug users who face severe health problems. It highlights the importance of outreach interventions in establishing trust, connecting users with care, and facilitating medication-assisted treatment for opioid addiction. Data Collection: Data was collected through the outreach program's interactions with drug users, including street outreach interventions and presence at locations frequented by users. Patient satisfaction surveys were also utilized. Analysis Procedures: The collected data was analyzed using both quantitative and qualitative methods. The quantitative analysis involved examining the number of contacts made, new requests for care, and treatment enrollment. The qualitative analysis focused on patient satisfaction and their perceptions of the intervention. Questions Addressed: The research addresses the following questions: What is the impact of an outreach intervention on crack cocaine addiction in users with co-occurring opioid use disorder? How effective is the outreach program in connecting drug users with care and initiating medication-assisted treatment? Conclusion: The outreach program has proven to be an effective intervention in establishing trust with crack users, connecting them with care, and initiating medication-assisted treatment for opioid addiction. It has also highlighted the importance of addressing the specific challenges faced by this group of drug users.

Keywords: crack addiction, outreach treatment, peer intervention, polydrug use

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Authors: Shannon Rappe, Elizabeth Morse, David Phillippi

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Postpartum women with an opioid use disorder (OUD) are at high risk for treatment disengagement, leaving them vulnerable to overdose and death between seven and twelve months postpartum. Intensive case management programs have been proposed as an effective strategy to reduce barriers and increase treatment engagement among postpartum women. The purpose of this project is to determine the effects of early engagement in an intensive case management program on postpartum engagement and infant health outcomes among postpartum women with opioid use. This retrospective review of secondary data was collected on 225 infants, and 221 postpartum women enrolled in an intensive case management program in Tennessee between May 1, 2019, and May 5, 2020. Chi-squares were computed to examine the timing of engagement during pregnancy, maternal treatment outcomes, and infant health outcomes, including neonatal abstinence syndrome (NAS), birth weight, gestational age, and length of stay. The mean prenatal program engagement was 109 days (SD = 67.6); 16.7% (n = 37) enrolled during the first trimester, 37.6% (n = 83) in the second trimester, and 45.7% (n = 101) in the third trimester. Of the 221 women engaged, 45.2% (n = 100) remained engaged in the case of management at the time of data collection, and 40% (n = 89) remained engaged in MAT at the time of data collection. Twenty- five percent (n = 25) of mothers who graduated sustained engagement in MAT. Of 225 infants 28.9% (n = 65) had a positive NAS status, mean birth weight was 6.5 lbs. (SD = 19.3); mean gestational age was 38.3 weeks (SD = 19.3) and mean length of stay was 8.19 days (SD = 9.8). This study's findings identified that engaging mothers during pregnancy in a program designed to meet their unique challenges positively impacts both the mother and infant outcomes, regardless of their timing.

Keywords: intensive case management, neonatal abstinence syndrome, opioid addiction, opioid crisis, opioid use in pregnant women, postpartum addiction

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Authors: Kushal Patel, Manasa Dittakavi, Cyrus Falsafi, Gretchen Lovett

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Rural America has seen a surge in opioid addiction rates and overdose deaths in recent years, becoming a significant public health crisis. This may be due to a variety of factors, such as lack of access to healthcare or other economic and social factors that can contribute to addiction such as poverty, unemployment, and social isolation. As the opioid epidemic has disproportionately affected rural communities, pregnant women in these areas may be highly susceptible and face additional difficulties in facing the appropriate care they need. Opioid use disorder has many negative effects on prenatal infants. These include changes in their microbiome, mental health, neurodevelopment and cognition. These can affect how the child performs in various activities in life and how they interact with others. It has been demonstrated that using cognitive behavioral therapy improves not just pain-related results but also mobility, quality of life, disability, and mood outcomes. This indicates that cognitive behavioral therapy (CBT) may be a useful therapeutic strategy for enhancing general health and wellbeing in people with opioid use problems. In terms of treating psychiatric diseases, CBT carries fewer dangers than opioids. One study that illustrates the potential for CBT to promote a reduction in opioid use disorder used self-reported drug use patterns 6 months prior to and during their pregnancy. At the beginning of the study, participants reported an average of 3.78 drug or alcohol use days in the previous 28 days, which decreased to 1.63 days after treatment. The study also found a decrease in depression scores, as measured by IDS scores, from 23.9 to 17.1 at the end of treatment. These and other results show that CBT can have meaningful impacts on pregnant women in Rural America who struggle with an opioid use disorder. This project has been approved by the West Virginia School of Osteopathic Medicine- Office of Research and Sponsored Programs and deemed non-research scholarly work.

Keywords: appalachia, CBT, opiods, pregnancy

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Authors: Kyung Min Kwom, Young Joo Lee

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Purpose: Up to 90% of pancreatic cancer patient suffer from neuropathic pain. In palliative care setting, pain control in a pancreatic cancer patient is one of the major goals. Ketamine is a NMDA receptor antagonist effective in neuropathic pain. Also, there have been studies about opioid sparing effect of ketamine. This study was held in palliative care unit among pancreatic cancer patients to find out the factors related to ketamine use and the opioid sparing effect. Methods: Medical records of pancreatic cancer patients admitted to St. Mary’s hospital palliative care unit from 2013.1 to 2014.12 were reviewed. Patients were divided into two categories according to ketamine use. Also, opioid use before and after ketamine use was compared in ketamine group. Results: Compared to non ketamine use group, patients in ketamine group required a higher dose of opioid. Total opioid dose, daily opioid dose, number of daily rescue medication, daily average rescue dose were statistically significantly higher in ketamine group. Opioid requirement was increased after ketamine administration. Conclusion: In this study, ketamine group required more opioid. Ketamine is frequently considered in patients with severe pain, requiring high amount of opioid. Also, ketamine did not have an opioid sparing effect. Future studies about palliative use of ketamine in a larger number of patients are required.

Keywords: ketamine, opioid sparing, palliative care, pancreatic cancer

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Authors: Sean Hall

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Prior to COVID-19, the world was preoccupied with opioids, effectiveness versus risk, and specifically toxicity versus abuse. Historically underpinning opioid use was a concept of safety. As use over time and real-world data evolved, a pursuit for efficacy associated with non-opioid alternatives became mainstream. On January 8, 2021, the US signed back into the opioid problem, with these two fundamental questions still unresolved. The author will share the current progression of a lead non-opioid cancer bone pain candidate, NanaBis™. NanaBis™ represents two innovative factors: The active ingredients are from cannabinoids; these ingredients are in a proprietary sub-micron delivery platform, NanoCelle®. The author will offer an opinion piece, potentiating the future role of delivery platforms in medicine to increase both patient safety and compliance.

Keywords: NanaBis, nanoCelle, opioids, toxicity

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Authors: Igna Brajevic-Gizdic, Magda Pletikosa Pavić

Abstract:

Introduction: Research in opiate addiction is increasingly indicating the importance of substitution therapy in opiate addicts. Opiate addiction is a chronic relapsing disease that includes craving as a criterion. Craving has been considered a predictor of a relapse, which is defined as a strong desire with an excessive need to take a substance. The study aimed to measure the intensity of craving using the VAS (visual analog scale) in opioid addicts taking Opioid Substitution Therapy (OST). Method: The total sample compromised of 30 participants in outpatient treatment. Two groups of opiate addicts were considered: Methadone-maintenance and buprenorphine-maintenance addicts. The participants completed the survey questionnaire during the outpatient treatment. Results: The results indicated high levels of cravings in patients during the treatment of OST, which is considered an important destabilization factor in abstinence. Thus, the use of methadone/buprenorphine dose should be considered. Conclusion: These findings provided an objective measurement of methadone /buprenorphine dosage and therapy options. The underdoes of OST can put patients at high risk of relapse, resulting in high levels of craving. Thus, when determining the therapeutic dose of OST, it is crucial to consider patients' cravings. This would achieve stabilization more quickly and avoid relapse in abstinence. Subjective physician assessment and patients' statement are the main criteria to determine OST dosage. Future studies should use larger sample sizes and focus on the importance of intensity craving measurement on OST to objectify methadone /buprenorphine dosage.

Keywords: buprenorphine, craving, heroin addicts, methadone, OST

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Authors: Sue S. Feldman, Bradley Tipper, Benjamin Schooley

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Nearly every community in the US has been impacted by opioid related addictions/deaths; it is a national problem that is threatening our social and economic welfare. Most believe that tackling this problem from a prevention perspective advances can be made toward breaking the chain of addiction. One mechanism, community based participatory research, involves the community in the prevention approach. This project combines that approach with a design science approach to develop an integrated solution. Findings suggested accountable care communities, transpersonal psychology, and social exchange theory as product kernel theories. Evaluation was conducted on a prototype.

Keywords: substance use and abuse recovery, community resource centers, accountable care communities, community based participatory research

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Authors: Eui Jun Jeong, Hye Rim Lee, Ji Hye Yoo

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Recent studies have verified the significant relationship of user personality with Internet use. However, in game studies, little research has emphasized on the effects of personality traits on game addiction. This study examined whether big five personality traits affect game addiction with control of psychological, social, and demographic factors. Specifically, using data from a survey of 789 game users in Korea, we conducted a regression analysis to see the associations of psychological (loneliness/depression), social (activities with family/friends), self-efficacy (game/general), gaming (daily gaming time/perception), demographic (age/gender), and personality traits (extraversion, neuroticism conscientiousness, agreeableness, & openness) with the degree of game addiction. Results showed that neuroticism increase game addiction with no effect of extraversion on the addiction. General self-efficacy negatively affected game addiction, whereas game self-efficacy increased the degree of game addiction. Loneliness enhanced game addiction while depression showed a negative effect on the addiction. Results and implications are discussed.

Keywords: game addiction, big five personality, social activities, self-efficacy, loneliness, depression

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Authors: Igna Brajević Gizdić, Gorka Vuletić

Abstract:

Introduction: Addiction is a chronic brain relapsing disorder. Opioid Substitution Therapy (OST) using buprenorphine as a medical treatment option shows as a promising option for achieving and maintaining abstinence in opioid-addicted patients. This research aimed to determine and evaluate the quality of life (QoL) in opiate-addicted patients after five years of buprenorphine therapy. Method: The total sample included 44 buprenorphine-maintained opiate addicts in outpatient treatment. The participants were administered the QoL questionnaire (WHOQOL-BREF) at two-time points (T1 and T2) with an interval of at least five years. WHOQOL-BREF contains a total of 26 questions. The first two questions, related to overall QoL and general health status, and the remaining questions (3–26), which represented four domains—physical, psychological, social, and environmental health—were evaluated separately. Results: The results indicated no significant differences in overall self-assessed QoL nor in individual domains after five years (T2) of abstinence with OST buprenorphine- maintenance. Conclusion: These findings indicated no improvement in QoL of buprenorphine-maintenance opiate addicts in outpatient treatment. However, this might be due to the smaller sample size and participants' overall high scores in QoL at T1. This study suggests the importance of expectations when considering the QoL and general health of buprenorphine-maintenance opiate addicts in outpatient treatment.

Keywords: abstinence, addicts, buprenorphine, opioid substitution therapy, quality of life

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Authors: Mashood C., Abdul Vahid K., Ashique C. K.

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The technology is growing beyond human expectation. Internet is one of very sophisticated product of the information technology. It has various advantages like connecting the world, simplifying the difficult tasks done in past etc. Simultaneously it has demerits also; that is lack of authenticity and internet addiction. To find out the problems of internet addiction, a study conducted among the Postgraduate students of Pondicherry University and collected 454 samples. The study strictly focused to identify the internet addiction among students, influence and interdependence of personality on internet addiction among first years and second years. To evaluate this, we used two major analysis, these are Confirmatory Factor Analysis (CFA) to predict the internet addiction with the observed data and Logistic Regression to identify the difference between first years and second years in the case of internet addiction. Before applying to the core analysis, the data applied to some preliminary tests to check the model fit. The empirical findings shows that , the students of Pondicherry University are very much addicted to the internet, But there is no such huge difference between first years and second years in case of internet addiction.

Keywords: internet addiction, students, Pondicherry University, empirical study

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Authors: Brajevic-gizdic Igna, Vuletic Gorka

Abstract:

Introduction: Research in opiate addiction is increasingly indicating the importance of substitution therapy in opiate addicts. Opiate addiction is a chronic relapsing disease that includes craving as a criterion. Craving has been considered a predictor of a relapse, which is defined as a strong desire with an excessive need to take a substance. The study aimed to measure the intensity of craving using the VAS (visual analog scale) in opioid addicts taking the Opioid Substitution Therapy (OST). Method: The total sample compromised of 30 participants in outpatient treatment. Two groups of opiate addicts were considered: Methadone-maintenance and buprenorphine-maintenance addicts. The participants completed the survey questionnaire during the outpatient treatment. Results: The results indicated high levels of cravings in patients during the treatment on OST, which is considered an important destabilization factor in abstinence. Thus, the use of methadone/buprenorphine dose should be considered. Conclusion: These findings provided an objective measurement of methadone /buprenorphine dosage and therapy options. The underdoes of OST can put patients at high risk of relapse, resulting in high levels of craving. Thus, when determining the therapeutic dose of OST, it is crucial to consider patients´ craving. This would achieve stabilization more quickly and avoid relapse in abstinence. Subjective physician assessment and patient’s statement are the main criteria to determine OST dosage. Future studies should use larger sample sizes and focus on the importance of intensity craving measurement on OST to objectify methadone /buprenorphine dosage.

Keywords: abstinence, addicts, methadone, OST, quality of life

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Authors: Alireza Abdiardekani, Maryam Salimi, Shirin Sarejloo, Mehdi Bazrafshan, Amir Askarinejad, Amirhossein Salimi, Hanieh Bazrafshan, Salar Javanshir, Armin Attar, Shokoufeh Khanzadeh, Mohsen Esmaeili, Hamed Bazrafshan Drissi

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Background: Opium, after tobacco, is the most abused substance in the Middle East. The effects of opium use on coronary artery disease are indeed unclear. This study aimed to assess the association between opium use and angiographic findings in patients with acute coronary syndrome (ACS) diagnosis at Al-Zahra Heart Hospital, Shiraz, Iran. Methods: In this case-control study, 170 patients admitted for coronary angiography were enrolled from 2019 to 2020. They were categorized into two groups based on their history: "non-opium" and "opium." SPSS (Version 26) was used to investigate the correlation between opioid addiction and the severity of coronary artery disease. Results: The results of our study reveal that the mean age of the participants was 61.63±9.07. This study indicated that 49 (28.82%) patients were female, and 121 (71.17%) were male. Our findings revealed that three-vessel disease was more frequent in non-opium (40; 47.05%) and opium (45; 52.94%) groups. There was a significant correlation between the severity of the second diagonal artery(D2) and right coronary artery(RCA) involvement and opium consumption. There was a strong positive correlation between the location of the vascular lesion in the left circumflex artery and opium consumption. Conclusion: Opium, as an independent risk factor for cardiovascular diseases, can have specific effects on angiographic findings in patients with coronary artery disease. Public health officials and politicians should arrange several programs to increase the general population’s consciousness about opioid use and its consequences.

Keywords: acute coronary syndrome, opium, coronary artery disease, angiography

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Authors: Sheng-Yu Lee

Abstract:

Aim: Opioid use disorder is often characterized by repetitive drug-seeking and drug-taking behaviors with severe public health consequences. Animal model showed that opioid-induced perturbations in the gut microbiota causally relate to neuroinflammation, deficits in reward responding, and opioid tolerance, possibly due to changes in gut microbiota. Therefore, we propose that the dysbiosis of gut microbiota can be associated with pathogenesis of opioid dependence. In this current study, we explored the differences in gut microbiota between patients and normal controls and in patients before and after initiation of methadone treatment program for 12 weeks. Methods: Patients with opioid use disorder between 20 and 65 years were recruited from the methadone maintenance outpatient clinic in 2 medical centers in the Southern Taiwan. Healthy controls without any family history of major psychiatric disorders (schizophrenia, bipolar disorder and major depressive disorder) were recruited from the community. After initial screening, 15 patients with opioid use disorder joined the study for initial evaluation (Week 0), 12 of them completed the 12-week follow-up while receiving methadone treatment and ceased heroin use (Week 12). Fecal samples were collected from the patients at baseline and the end of 12th week. A one-time fecal sample was collected from the healthy controls. The microbiota of fecal samples were investigated using 16S rRNA V3V4 amplicon sequencing, followed by bioinformatics and statistical analyses. Results: We found no significant differences in species diversity in opioid dependent patients between Week 0 and Week 12, nor compared between patients at both points and controls. For beta diversity, using principal component analysis, we found no significant differences between patients at Week 0 and Week 12, however, both patient groups showed significant differences compared to control (P=0.011). Furthermore, the linear discriminant analysis effect size (LEfSe) analysis was used to identify differentially enriched bacteria between opioid use patients and healthy controls. Compared to controls, the relative abundance of Lactobacillaceae Lactobacillus (L. Lactobacillus), Megasphaera Megasphaerahexanoica (M. Megasphaerahexanoica) and Caecibacter Caecibactermassiliensis (C Caecibactermassiliensis) were increased in patients at Week 0, while Coriobacteriales Atopobiaceae (C. Atopobiaceae), Acidaminococcus Acidaminococcusintestini (A. Acidaminococcusintestini) and Tractidigestivibacter Tractidigestivibacterscatoligenes (T. Tractidigestivibacterscatoligenes) were increased in patients at Week 12. Conclusion: In conclusion, we suggest that the gut microbiome community maybe linked to opioid use disorder, such differences may not be altered even after 12-week of cessation of opioid use.

Keywords: opioid use disorder, gut microbiota, methadone treatment, follow up study

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Authors: Jared Cheves, Amanda DeChent, Joyce Pan

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Total knee replacements (TKAs) are one of the most common but painful surgical procedures performed in the United States. Currently, the gold standard for postoperative pain management is the utilization of opioids. However, in the wake of the opioid epidemic, the healthcare system is attempting to reduce opioid consumption by trialing innovative opioid sparing analgesic techniques such as continuous peripheral nerve blocks (CPNB) and continuous periarticular infiltration (CPAI). The alleviation of pain, particularly during the first 72 hours postoperatively, is of utmost importance due to its association with delayed recovery, impaired rehabilitation, immunosuppression, the development of chronic pain, the development of rebound pain, and decreased patient satisfaction. While both CPNB and CPAI are being used today, there is limited evidence comparing the two to the current standard of care or to each other. An extensive literature review was performed to explore the safety profiles and effectiveness of CPNB and CPAI in reducing reported pain scores and decreasing opioid consumption. The literature revealed the usage of CPNB contributed to lower pain scores and decreased opioid use when compared to opioid-only control groups. Additionally, CPAI did not improve pain scores or decrease opioid consumption when combined with a multimodal analgesic (MMA) regimen. When comparing CPNB and CPAI to each other, neither unanimously lowered pain scores to a greater degree, but the literature indicates that CPNB decreased opioid consumption more than CPAI. More research is needed to further cement the efficacy of CPNB and CPAI as standard components of MMA in TKA procedures. In addition, future research can also focus on novel catheter-free applications to reduce the complications of continuous catheter analgesics.

Keywords: total knee arthroplasty, continuous peripheral nerve blocks, continuous periarticular infiltration, opioid, multimodal analgesia

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Authors: Mengjia Zhi, Xingmei Wei, Xiang Gao, Shiyang Liu, Zhiran Huang, Li Yang, Jing Sun

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Background: To understand the consumption trend of opioid analgesics and the consumption adequacy of opioid analgesic treatment for moderate to severe pain in China, as well as the pain control level of China with international perspective. Importance: To author’s best knowledge, this is the first study in China to measure the adequacy of opioid analgesic treatment for moderate to severe pain considering disease pattern and with the standardized pain treatment guideline. Methods: A retrospective analysis was carried out to show the consumption frequency (daily defined doses, DDDs) of opioid analgesics and its trend in China from 2006 to 2016. Adequacy of consumption measure (ACM) was used to measure the number of needed morphine equivalents and the overall adequacy of opioid analgesic treatment of moderate to severe pain in China, and compared with international data. Results: The consumption frequency of opioid analgesics (DDDs) in China increased from 13,200,000 DDDs in 2006 to 44,200,000 DDDs in 2016, and showed an increasing trend. The growth rate was faster at first, especially in 2013, then slowed down, decreased slightly in 2015. The ACM of China increased from 0.0032 in 2006 to 0.0074 in 2016, with an overall trend of growth. The ACM level of China has been always a very poor level during 2006-2016. Conclusion: The consumption of opioid analgesics for the treatment of moderate to severe pain in China has always been inadequate. There is a huge gap between China and the international level. There are many reasons behind this problem, which lie in different aspects, including medical staff, patients and the public, health systems and social & cultural aspects. It is necessary to strengthen the training and education of medical staff and the patients, to use mass media to disseminate scientific knowledge of pain management, to encourage communications between doctors and patients, to improve regulatory system for the controlled medicines and the overall health systems, and to balance the regulatory goal for avoidance of abuse, and the social goal of meeting the increasing needs of the people for better life.

Keywords: opioid analgesics, adequate consumption measure, pain control, China

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Authors: Adil Kaval, Digdem Muge Siyez

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With the negative effects of internet use in a person's life, the use of the Internet has become an issue. This subject was mostly considered as internet addiction, and it was investigated. In literature, it is noteworthy that some theoretical models have been proposed to explain the reasons for internet addiction. In addition to these theoretical models, it may be thought that the coping style for stressing events can be a predictor of internet addiction. It was aimed to test with logistic regression the effect of high school students' coping styles on internet addiction levels. Sample of the study consisted of 770 Turkish adolescents (471 girls, 299 boys) selected from high schools in the 2017-2018 academic year in İzmir province. Internet Addiction Test, Coping Scale for Child and Adolescents and a demographic information form were used in this study. The results of the logistic regression analysis indicated that the model of coping styles predicted internet addiction provides a statistically significant prediction of internet addiction. Gender does not predict whether or not to be addicted to the internet. The active coping style is not effective on internet addiction levels, while the avoiding and negative coping style are effective on internet addiction levels. With this model, % 79.1 of internet addiction in high school is estimated. The Negelkerke pseudo R2 indicated that the model accounted for %35 of the total variance. The results of this study on Turkish adolescents are similar to the results of other studies in the literature. It can be argued that avoiding and negative coping styles are important risk factors in the development of internet addiction.

Keywords: adolescents, coping, internet addiction, regression analysis

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Authors: P. C. Li, R. H. Feng, S. J. Chen, Y. J. Yu, Y. L. Chen, X. Y. Fan

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The purpose of this study is to investigate the effect of mindfulness and wisdom comprehensive strategy intervention on addiction to the Internet of college students by engaging fourteen intensive full-day mindfulness-based wisdom retreat curriculum. Wisdom, one of the practice method from the threefold training. Internet addiction, a kind of impulse control disorder, which attract the attentions of society due to its high prevalence and harmfulness in the last decade. Therefore, the study of internet addiction intervention is urgent. Participants with internet addiction were Chinese college students and screened by internet addiction disorder diagnose questionnaire (IAD-DQ). A quasi-experimental pretest and posttest design was used as research design. The finding shows that the mindfulness-based wisdom intervention strategy appeared to be effective in reducing the Internet addiction. Moreover, semi-structure interview method was conducted and outcomes included five themes: the reduction of internet use, the increment of awareness on emotion, self-control, present concentration and better positive lifestyle, indicating that mindfulness could be an effective intervention for this group with internet addiction.

Keywords: mindfulness, internet addiction, wisdom comprehensive intervention, cognitive-behavior therapy

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Authors: Mansour Abdi, Hadi Molaei Yasavoli

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The purpose of this research is to comparison of self- efficacy and life satisfaction in normal users and users with internet addiction. The present study was descriptive and causal-comparative. Therefore, 304 students were selected random sampling method from students of Semnan University and completed questionnaires of internet addiction (young), Self-Efficacy Questionnaire and Life Satisfaction (SWIS). For data analysis was used the Multivariate Analysis of Variance (MANOVA). The results showed that internet addiction users have lower levels of self-efficacy and life satisfaction in comparison with normal users and the difference in p=0/0005 significantly. The findings showed that 78 percent of the variance in the dependent variables of self-efficacy and life satisfaction by grouping variables (internet addiction users and normal) is determined. Finally, considering that the rate of self-efficacy and life satisfaction is effective in the incidence of Internet addiction, it is proposed required measures are taken to enhance self-efficacy and life satisfaction in Internet users.

Keywords: self-efficacy, life satisfaction, users, internet addiction, normal users

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Authors: Einat E. Peles, Shaul Schreiber, Miriam Adelson

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Background: Since established more than 50 years ago, methadone maintenance treatment (MMT) is the most effective treatment for opioid addiction, a chronic relapsing brain disorder that became an epidemic in western societies. Treatment includes daily individual optimal medication methadone dose (a long acting mu opioid receptor full agonist), accompanied with psychosocial therapy. It is well established that the longer retention in treatment the better outcome and survival occur. It reduces the likelihood to infectious diseases and overdose death that associated with drug injecting, enhanced social rehabilitation and eliminate criminal activity, and lead to healthy productive life. Aim: To evaluate predictors for long term retention in treatment we analyzed our prospective follow up of a major MMT clinic affiliated to a big tertiary medical center. Population Methods: Between June 25, 1993, and June 24, 2016, all 889 patients ( ≥ 18y) who ever admitted to the clinic were prospectively followed-up until May 2017. Duration in treatment from the first admission until the patient quit treatment or until the end of follow-up (24 years) was taken for calculating cumulative retention in treatment using survival analyses (Kaplan Meier) with log-rank and Cox regression for multivariate analyses. Results: Of the 889 patients, 25.2% were females who admitted to treatment at younger age (35.0 ± 7.9 vs. 40.6 ± 9.8, p < .0005), but started opioid usage at same age (22.3 ± 6.9). In addition to opioid use, on admission to MMT 58.5% had positive urine for benzodiazepines, 25% to cocaine, 12.4% to cannabis and 6.9% to amphetamines. Hepatitis C antibody tested positive in 55%, and HIV in 7.8% of the patients and 40%. Of all patients, 75.7% stayed at least one year in treatment, and of them, 67.7% stopped opioid usage (based on urine tests), and a net reduction observed in all other substance abuse (proportion of those who stopped minus proportion of those who have started). Long term retention up to 24 years was 8.0 years (95% Confidence Interval (CI) 7.4-8.6). Predictors for longer retention in treatment (Cox regression) were being older on admission ( ≥ 30y) Odds Ratio (OR) =1.4 (CI 1.1-1.8), not abusing opioids after one year OR=1.8 (CI 1.5-2.1), not abusing benzodiazepine after one year OR=1.7 (CI 1.4-2.1) and treating with methadone dose ≥ 100mg/day OR =1.8 (CI 1.5-2.3). Conclusions: Treating and following patients over 24 years indicate success of two main outcomes, high rate of retention after one year (75.7%) and high proportion of opiate abuse cessation (67.7%). As expected, longer cumulative retention was associated with patients treated with high adequate methadone dose that successfully result in opioid cessation. Based on these findings, in order to reduce morbidity and mortality, we find the establishment of more MMT clinics within a general hospital, a most urgent necessity.

Keywords: methadone maintenance treatment, epidemic, opioids, retention

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Authors: Petr Květon, Martin Jelínek

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We try to identify the role of various aspects of parenting style in the phenomenon of videogame playing addiction. Relevant self-report questionnaires were part of a wider set of methods focused on the constructs related to videogame playing. The battery of methods was administered in school settings in paper and pencil form. The research sample consisted of 333 (166 males, 167 females) elementary and high school students at the age between 10 and 19 years (m=14.98, sd=1.77). Using stepwise regression analysis, we assessed the influence of demographic variables (gender and age) and parenting styles. Age and gender together explained 26.3% of game addiction variance (F(2,330)=58.81, p<.01). By adding four aspect of parenting styles (inconsistency, involvement, control, and warmth) another 10.2% of variance was explained (∆F(4,326)=13.09, p<.01). The significant predictor was gender of the respondent, where males scored higher on game addiction scale (B=0.70, p<.01), age (β=-0.18, p<.01), where younger children showed higher level of addiction, and parental inconsistency (β=0.30, p<.01), where the higher the inconsistency in upbringing, the more developed game playing addiction.

Keywords: gender, parenting styles, video games, addiction

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Authors: Sourav Ray, Christoph Stein, Marcus Weber

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A new class of drug candidates, initially derived from mathematical modeling of ligand-receptor interactions, activate the μ-opioid receptor (MOR) preferentially at acidic extracellular pH-levels, as present in injured tissues. This is of commercial interest because it may preclude the adverse effects of conventional MOR agonists like fentanyl, which include but are not limited to addiction, constipation, sedation, and apnea. Animal studies indicate the importance of taking the pH value of the chemical environment of MOR into account when designing new drugs. Hydrogen bonds (HBs) play a crucial role in stabilizing protein secondary structure and molecular interaction, such as ligand-protein interaction. These bonds may depend on the pH value of the chemical environment. For the MOR, antagonist naloxone and agonist [D-Ala2,N-Me-Phe4,Gly5-ol]-enkephalin (DAMGO) form HBs with ionizable residue HIS 297 at physiological pH to modulate signaling. However, such interactions were markedly reduced at acidic pH. Although fentanyl-induced signaling is also diminished at acidic pH, HBs with HIS 297 residue are not observed at either acidic or physiological pH for this strong agonist of the MOR. Molecular dynamics (MD) simulations can provide greater insight into the interaction between the ligand of interest and the HIS 297 residue. Amino acid protonation states are adjusted to the model difference in system acidity. Unbiased and unrestrained MD simulations were performed, with the ligand in the proximity of the HIS 297 residue. Ligand-receptor complexes were embedded in 1-palmitoyl-2-oleoyl-sn glycero-3-phosphatidylcholine (POPC) bilayer to mimic the membrane environment. The occurrence of HBs between the different ligands and the HIS 297 residue of MOR at acidic and physiological pH values were tracked across the various simulation trajectories. No HB formation was observed between fentanyl and HIS 297 residue at either acidic or physiological pH. Naloxone formed some HBs with HIS 297 at pH 5, but no such HBs were noted at pH 7. Interestingly, DAMGO displayed an opposite yet more pronounced HB formation trend compared to naloxone. Whereas a marginal number of HBs could be observed at even pH 5, HBs with HIS 297 were more stable and widely present at pH 7. The HB formation plays no and marginal role in the interaction of fentanyl and naloxone, respectively, with the HIS 297 residue of MOR. However, HBs play a significant role in the DAMGO and HIS 297 interaction. Post DAMGO administration, these HBs might be crucial for the remediation of opioid tolerance and restoration of opioid sensitivity. Although experimental studies concur with our observations regarding the influence of HB formation on the fentanyl and DAMGO interaction with HIS 297, the same could not be conclusively stated for naloxone. Therefore, some other supplementary interactions might be responsible for the modulation of the MOR activity by naloxone binding at pH 7 but not at pH 5. Further elucidation of the mechanism of naloxone action on the MOR could assist in the formulation of cost-effective naloxone-based treatment of opioid overdose or opioid-induced side effects.

Keywords: effect of system acidity, hydrogen bond formation, opioid action, receptor activation

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Authors: Cailyn Green

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Substance use counselors have a variety of fast-paced tasks and responsibilities. Professional resources are designed to support professionals in making their job duties easier and less stressful. The purpose of this research was to identify what types of resources would support addiction counselors in performing their job duties. Counselors often must jump in and facilitate a group counseling session with little to no time for prep. This causes stress and creates pressure to come up with a clinical group activity in little time. The researcher utilized qualitative interviews focused on identifying what types of resources would support addiction counselors in doing their jobs easier and effectively. The researcher visited 23 different addiction counseling facilities seeking participants for the interviews. Altogether 15 interviews were collected across six different substance-use counseling facilities. The interviews guided the researcher toward creating an open education resource (OER) of group activities for addiction counselors to utilize.

Keywords: addiction, counseling, resources, OER, treatment

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Authors: Kristina De Milt, Nicole Huang, Jihye Park

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Opioids have been a mainstay of the treatment of chronic pain, but their overprescription and misuse have led to an opioid epidemic. Recently, as an attempt to decrease the number of opioids prescribed, the use of cannabinoid therapy has become an increasingly popular adjunctive chronic pain management choice among providers. This review of literature investigates the effects of adjunctive cannabinoids to opioids in the management of chronic pain. The nine articles are included in the literature review range from observational studies to meta-analyses published in the year 2016 and after. A majority of the studies showed a decrease in the need for opioids after adjunctive cannabinoids were introduced and, in some instances, the cessation of opioid consumption. More high-quality evidence is needed to further support this stance and providers should weigh the benefits and risks of adjunctive cannabinoids according to the clinical picture.

Keywords: cannabis, chronic pain, opioids, pain management

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Authors: Conchita Martin de Bustamante, Christopher S. Kung, Brianne Lacy, Eunsol Park, Hien Piotrowski, Mustafa Husain, Waseem Ahmed

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Objective: To explore the comorbidity of mental health conditions (major depressive disorder, borderline personality disorder, generalized anxiety disorder, and schizophrenia) with opioid use disorder in people incarcerated at a large urban jail. Background Schizophrenia, depression, bipolar disorder, and anxiety are all serious mental health conditions that are highly prevalent amongst incarcerated patients. However, it is seldom the only disorder these patients are suffering from. According to the US Department of Justice, about half of US prisoners, both at the state and federal level, suffer from substance use disorders. Although the opioid epidemic has been studied greatly in the recent years amongst the general population, little has been explored on how the opioid crisis has affected incarcerated patients in local jails, particularly regarding which of these patients are most susceptible. Method The cohort consisted of 507 people incarcerated at a large county jail who were evaluated by mental health providers in December 2020. A retrospective review was performed to evaluate associations between mental health diagnoses, substance use disorder, and other demographic variables. Results Participants had been diagnosed with various mental health conditions, including MDD (22.6%, n = 115), GAD (33.7%, n = 171), Schizophrenia (15.2%, n = 77) and BPD (27%, n = 137). Preliminary Chi square tests were conducted for these conditions against marijuana, alcohol, cocaine, opioid, methamphetamine, benzodiazepines, and sedative use disorders. The results showed significant associations between Schizophrenia (p = 0.013), GAD (p M 0.001), and MDD (p = 0.029) with opioid use disorders. Conclusions Determining the extent of these comorbid substance use and mental health disorders within an incarcerated population can help influence treatment plans for future incarcerated patients. Many federal and state jail systems lack pharmacological substance use intervention and the prevalence of these co-morbid conditions can shed light on the importance of treating conditions concurrently upon intake.

Keywords: mental health conditions, opioids, substance use disorder, comorbidity

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Authors: Mehravar Javid, Katherine Marshall Woods, Joseph Kosowsky, Anna Missner

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In this paper, "Life and a Day" is analyzed psychoanalytically with an emphasis on the ways by which addiction is influenced by personal psychology and familial ties. It explores the influence of parenting on one's sense of self and the function of therapeutic alliances in the treatment of addiction. The analysis also observes the main characters, with a special emphasis on Somayeh, who represents the continuation of her father's role in the family and faces identity and autonomy issues in the face of familial responsibilities. In addressing addiction, the document emphasizes the significance of comprehending family dynamics and individual psychological factors, emphasizing the interaction between personal trauma, family roles, and recovery.

Keywords: addiction, autonomy, family dynamics, identity, life and a day, psychoanalytic

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Authors: Mohamad Reza Khodabakhsh

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Violence against women is a historical phenomenon; although its form and type are common in various societies and cultures, this type of violence occurs in terms of physical, psychological, financial, and sexual dimensions. This is the cause of many social deviations and endangers the center of the family as the most important institution. This research seeks to investigate the relationship between personality characteristics and the tendency to addiction to domestic violence. One hundred fifty women and one hundred fifty men were selected by the available sampling method. One hundred fifty men were admitted to drug addiction camps, and women included domestic violence cases. A questionnaire on addiction tendency, Five Personality Traits (NEO), and attitudes toward violence against women was used. Data were analyzed in descriptive and inferential statistics. The data were analyzed at the level of descriptive mean, mean, and standard deviation and analyzed using SPSS 20 software using correlation and analysis of variance at the level of inferential level. And the data were analyzed at the p≤0.05 significance level. The results showed that there is a significant relationship between personality traits and a tendency to addiction and domestic violence.

Keywords: personality, addiction, domestic violence, family

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