Addiction Rehab: Risk Assessment and Counseling Behaviors of Healthcare Professionals Managing Patients With Chronic Pain: A National Multifaceted Assessment of Physicians, Pharmacists, and Their Patients.

Risk assessment and counseling behaviors of healthcare professionals managing patients with chronic pain: A national multifaceted assessment of physicians, pharmacists, and their patients.

Filed under: Addiction Rehab

J Opioid Manag. 2012 Sep-Oct; 8(5): 273-84
Salinas GD, Susalka D, Burton BS, Roepke N, Evanyo K, Biondi D, Nicholson S

Due to the significant and increasing problem of chronic pain in the United States, pain management is a frequent need in many healthcare settings. At the same time, there has been rising concern with the abuse/misuse and potential for addiction to opioid therapies. This study was conducted to better understand healthcare professionals’ current knowledge, perceptions, and clinical practice patterns regarding prescribing of extended-release or long-acting opioid therapy to patients with chronic pain.This study was conducted from March 2011 to May 2011; it utilized a nationally distributed case vignette survey of primary care physicians (PCPs), pain specialists, and pharmacists, along with nested chart reviews and surveys of patients with chronic pain.Many PCPs are inadequately performing opioid risk assessments and there is variability in interpreting a patient’s opioid risk, resulting in misestimated risk. Physicians underutilize urine drug screens and written opioid use agreements when initiating opioid therapy in patients. Physicians and pharmacists often omit key messages during patient counseling about safe use of opioids and safe medication storage. Among pharmacists, safety counseling is generally limited to alerting patients to potential side effects. For most PCPs, difficulty managing patients with risk factors for opioid use and uncertainty about managing first line opioid efficacy failure are significant barriers to effective management of chronic pain.Patients having chronic pain and concomitant risk factors for opioid abuse, misuse, and diversion are prevalent, yet many physicians, especially PCPs, are uncomfortable managing opioid therapy in such patients. Education on best practices for risk assessment, patient monitoring during treatment, strategies for more effective counseling, patient chart documentation, and management strategies to enhance effective treatment of chronic pain are essential to ensure that PCPs and specialists maximize effective and safe use of opioid medications. Pharmacists could be a valuable member of this interdisciplinary team and should be involved in patient counseling and monitoring for aberrant behavior.
HubMed – addiction


Nicotinic Receptors in Addiction Pathways.

Filed under: Addiction Rehab

Mol Pharmacol. 2012 Dec 17;
Leslie FM, Mojica CY, Reynaga DD

Neuronal nicotinic acetylcholine receptors (nAChRs) are ligand-gated ion channels that consist of pentameric combinations of ? and ? subunits. These receptors are widely distributed throughout the brain, and are highly expressed in addiction circuitry. The role of nAChRs in regulating neuronal activity and motivated behavior is complex, and varies both within and across brain regions. The rich diversity of central nAChRs has hampered the characterization of their structure and function using classical pharmacological techniques. However, recent molecular approaches using null mutant mice with specific regional lentiviral re-expression, in combination with neuroanatomical and electrophysiological techniques, have allowed the elucidation of the influence of different nAChR types on neuronal circuit activity and behavior. This review will address the influence of nAChRs on limbic dopamine circuitry and the medial habenula-interpeduncular nucleus complex that are critical mediators of reinforced behavior. Characterization of the mechanisms underlying regulation of addiction pathways by endogenous cholinergic transmission and by nicotine may lead to the identification of new therapeutic targets for treating tobacco dependence and other addictions.
HubMed – addiction


History of cigarette smoking is associated with higher limbic GABA(A) receptor availability.

Filed under: Addiction Rehab

Neuroimage. 2012 Dec 13;
Stokes PR, Benecke A, Myers J, Erritzoe D, Watson B, Kalk N, Barros DR, Hammers A, Nutt D, Lingford-Hughes AR

Cigarette smoking presents a significant worldwide healthcare challenge. Preclinical, genetic association and clinical trials studies provide considerable evidence for the involvement of the human ?-aminobutyric acid (GABA) system in the neurobiology of nicotine addiction. However there are few human GABA neurochemical imaging studies of nicotine addiction. We investigated limbic GABA(A) receptor availability in volunteers with a history of cigarette smoking using [(11)C]Ro15 4513 positron emission tomography (PET). Eight [(11)C]Ro15 4513 PET scans from volunteers with a history of cigarette smoking were compared to twelve scans from volunteers who were non-smokers. Total, ?1 and ?5 GABA(A) receptor subtype [(11)C]Ro15 4513 V(T) values were quantified using spectral analysis of limbic regions implicated in nicotine addiction. Spectral analysis allows quantification of the overall [(11)C]Ro15 4513 spectral frequency as well as ?1 and ?5 GABA(A) receptor subtype specific spectral frequency components. Volunteers with a history of cigarette smoking showed significantly higher total [(11)C]Ro15 4513 V(T) values in the presubgenual cingulate and parahippocampal gyrus, and at a trend level in the insula, nucleus accumbens and subgenual cingulate. In six abstinent previous smokers (‘ex-smokers’), total [(11)C]Ro15 4513 binding was significantly higher in all limbic regions studied, with higher ?5 availability in the amygdala, anterior cingulate, nucleus accumbens and presubgenual cingulate. These results suggest that limbic GABA(A) receptor availability is higher in volunteers with a history of cigarette smoking which may reflect either higher expression of GABA(A) receptors or lower endogenous GABA levels. The findings in ex-smokers suggest that higher GABA(A) receptor availability continues with abstinence indicating that this may be a trait marker for nicotine addiction or that alterations in GABA function associated with cigarette smoking persist.
HubMed – addiction



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