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  1. Article: Nature-themed video intervention may improve cardiovascular safety of psilocybin-assisted therapy for alcohol use disorder.

    Heinzerling, Keith G / Sergi, Karina / Linton, Micah / Rich, Rhianna / Youssef, Brittany / Bentancourt, Inez / Bramen, Jennifer / Siddarth, Prabha / Schwartzberg, Louie / Kelly, Daniel F

    Frontiers in psychiatry

    2023  Volume 14, Page(s) 1215972

    Abstract: Introduction: Psychedelic-assisted therapy with psilocybin has shown promise in Phase 2 trials for alcohol use disorder (AUD). Set and setting, particularly factors facilitating a connection with nature, may positively influence the psychedelic ... ...

    Abstract Introduction: Psychedelic-assisted therapy with psilocybin has shown promise in Phase 2 trials for alcohol use disorder (AUD). Set and setting, particularly factors facilitating a connection with nature, may positively influence the psychedelic experience and therapeutic outcomes. But to date, randomized controlled trials of interventions to enhance set and setting for psychedelic-assisted therapy are lacking.
    Methods: This was a pilot randomized, controlled trial of Visual Healing, a nature-themed video intervention to optimize set and setting, versus Standard set and setting procedures with two open-label psilocybin 25 mg dosing sessions among 20 participants with AUD. For the first session, participants randomized to Visual Healing viewed nature-themed videos during the preparation session and the "ascent" and "descent" phases of the psilocybin dosing session while participants randomized to the Standard condition completed a meditation during the preparatory session and wore eyeshades and listened to a music playlist throughout the dosing session. For the second session 4 weeks later, participants chose either Visual Healing or Standard procedures. Primary outcomes were feasibility, safety, and tolerability of Visual Healing. Secondary and exploratory outcomes were changes in alcohol use, psychedelic effects, anxiety and stress.
    Results: Nineteen of 20 (95%) randomized participants (mean age 49 ± 11 years, 60% female) completed the 14-week study. During the first psilocybin session, participants viewed an average of 37.9 min of the 42-min video and there were no video-related adverse events. Peak increase in post-psilocybin blood pressure was significantly less for participants randomly assigned to Visual Healing compared to Standard procedures. Alcohol use decreased significantly in both Visual Healing and Standard groups and psychedelic effects, stress, and anxiety were similar between groups.
    Discussion: In this open-label pilot study, viewing Visual Healing videos during preparation and psilocybin dosing sessions was feasible, safe, and well-tolerated among participants with AUD. Preliminary findings suggest that Visual Healing has potential to reduce the cardiovascular risks of psychedelic therapy, without interfering with the psychedelic experience or alcohol-related treatment outcomes. Studies to replicate our findings as well as studies of different set and setting interventions with other psychedelic medications and indications are warranted.
    Language English
    Publishing date 2023-09-18
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2564218-2
    ISSN 1664-0640
    ISSN 1664-0640
    DOI 10.3389/fpsyt.2023.1215972
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Investigating possible syndemic relationships between structural and drug use factors, sexual HIV transmission and viral load among men of colour who have sex with men in Los Angeles County.

    Quinn, Brendan / Gorbach, Pamina M / Okafor, Chukwuemeka N / Heinzerling, Keith G / Shoptaw, Steve

    Drug and alcohol review

    2020  Volume 39, Issue 2, Page(s) 116–127

    Abstract: ... among marginalised sub-populations including MCSM, we must holistically consider systemic and structural issues (e.g ...

    Abstract Introduction and aims: Past research investigating syndemic factors and HIV-related outcomes has overlooked the impact of structural conditions on behaviours linked with HIV transmission and disease progression. Given prevalent substance use among our sample, we explored whether four structural conditions indicative of social marginalisation and previously correlated with increased risk for HIV infection demonstrated syndemic (additive/synergistic) effects on: (i) HIV viral suppression; and (ii) self-reported involvement in sexual HIV transmission behaviours among a prospective cohort mostly comprising men of colour who have sex with men (MCSM; i.e. Latino/Hispanic and African American/black men) in Los Angeles County.
    Design and methods: Data were collected between August 2014 and March 2017. The structural conditions of interest were: current unemployment, recent (≤6 months) incarceration history, 'unstable' accommodation (past month) and remote (>6 months) contact with health-care providers. Generalised estimating equations assessed possible additive effects of experiencing multiple structural conditions, and possible synergistic effects on the HIV-related outcomes.
    Results: Of 428 participants, nearly half (49%) were HIV-positive at baseline. Involvement in sexual HIV transmission risk behaviours varied over follow-up (22-30%). Reporting ≥2 structural syndemic conditions was significantly associated with reporting sexual HIV transmission risk behaviours among HIV-negative participants, and detectable viral load among HIV-positive participants. Frequent methamphetamine use was consistently associated with the HIV-related outcomes across the final multivariate models.
    Discussion and conclusions: When developing initiatives to address HIV transmission among marginalised sub-populations including MCSM, we must holistically consider systemic and structural issues (e.g. unemployment and homelessness), especially in the context of prevalent substance use.
    MeSH term(s) Adolescent ; Adult ; African Americans ; Drug Users ; HIV Infections/transmission ; HIV Infections/virology ; Hispanic Americans ; Homeless Persons ; Homosexuality, Male ; Humans ; Los Angeles ; Male ; Middle Aged ; Risk Factors ; Risk-Taking ; Sexual Behavior ; Syndemic ; Unsafe Sex ; Viral Load ; Young Adult
    Language English
    Publishing date 2020-02-04
    Publishing country Australia
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 1080442-0
    ISSN 1465-3362 ; 0959-5236
    ISSN (online) 1465-3362
    ISSN 0959-5236
    DOI 10.1111/dar.13026
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  3. Article ; Online: Corrigendum to "Ibudilast attenuates subjective effects of methamphetamine in a placebo-controlled inpatient study" [Drug Alcohol Depend. 162 (2016) 245-250].

    Worley, Matthew J / Swanson, Aimee-Noelle / Heinzerling, Keith G / Roache, Daniel J O / Shoptaw, Steven

    Drug and alcohol dependence

    2018  Volume 190, Page(s) 120

    Language English
    Publishing date 2018-07-12
    Publishing country Ireland
    Document type Published Erratum
    ZDB-ID 519918-9
    ISSN 1879-0046 ; 0376-8716
    ISSN (online) 1879-0046
    ISSN 0376-8716
    DOI 10.1016/j.drugalcdep.2018.06.002
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  4. Article ; Online: Ibudilast attenuates peripheral inflammatory effects of methamphetamine in patients with methamphetamine use disorder.

    Li, Michael J / Briones, Marisa S / Heinzerling, Keith G / Kalmin, Mariah M / Shoptaw, Steven J

    Drug and alcohol dependence

    2019  Volume 206, Page(s) 107776

    Abstract: Background: Preclinical studies suggest that the non-selective phosphodiesterase inhibitor, Ibudilast (IBUD) may contribute to the treatment of methamphetamine (METH) use disorder through the attenuation of METH-induced inflammatory markers such as ... ...

    Abstract Background: Preclinical studies suggest that the non-selective phosphodiesterase inhibitor, Ibudilast (IBUD) may contribute to the treatment of methamphetamine (METH) use disorder through the attenuation of METH-induced inflammatory markers such as adhesion molecules, sICAM-1 and sVCAM-1, and cytokines, IL-6 and TNF-α.
    Objective: The present study aimed to test whether treatment with IBUD can attenuate peripheral markers of inflammation during a METH challenge in an inpatient clinical trial of 11 patients.
    Methods: This trial followed a randomized, within-subjects crossover design where participants received a METH challenge, during which five participants were treated with placebo then with IBUD, while the remaining six participants were treated with IBUD prior to placebo. Mixed effects regression modeled changes in peripheral markers of inflammation-sICAM-1, sVCAM-1, TNF-α, IL-6, MIF, and cathepsin D-by treatment condition, with measurements at baseline, 60 min post-METH infusion, and 360 min post-METH infusion.
    Results: While on placebo, sICAM-1, sVCAM-1, and cathepsin D significantly increased by 60 min post-METH infusion, while IL-6 significantly increased 360 min post-METH infusion. Treatment with IBUD significantly reduced METH-induced levels of sICAM-1, sVCAM-1, and cathepsin D at 60 min post-METH infusion.
    Conclusions: Our findings demonstrate that IBUD attenuated acute pro-inflammatory effects of METH administration, which may have implications for treatment of METH use disorder.
    MeSH term(s) Adult ; Amphetamine-Related Disorders/blood ; Amphetamine-Related Disorders/drug therapy ; Animals ; Central Nervous System Stimulants/administration & dosage ; Central Nervous System Stimulants/adverse effects ; Cross-Over Studies ; Female ; Humans ; Inflammation Mediators/antagonists & inhibitors ; Inflammation Mediators/blood ; Infusions, Intravenous ; Male ; Methamphetamine/administration & dosage ; Methamphetamine/adverse effects ; Middle Aged ; Phosphodiesterase Inhibitors/pharmacology ; Phosphodiesterase Inhibitors/therapeutic use ; Pyridines/pharmacology ; Pyridines/therapeutic use
    Chemical Substances Central Nervous System Stimulants ; Inflammation Mediators ; Phosphodiesterase Inhibitors ; Pyridines ; Methamphetamine (44RAL3456C) ; ibudilast (M0TTH61XC5)
    Language English
    Publishing date 2019-11-26
    Publishing country Ireland
    Document type Journal Article ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural
    ZDB-ID 519918-9
    ISSN 1879-0046 ; 0376-8716
    ISSN (online) 1879-0046
    ISSN 0376-8716
    DOI 10.1016/j.drugalcdep.2019.107776
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Volatility and change in chronic pain severity predict outcomes of treatment for prescription opioid addiction.

    Worley, Matthew J / Heinzerling, Keith G / Shoptaw, Steven / Ling, Walter

    Addiction (Abingdon, England)

    2017  Volume 112, Issue 7, Page(s) 1202–1209

    Abstract: Background and aims: Buprenorphine-naloxone (BUP-NLX) can be used to manage prescription opioid addiction among persons with chronic pain, but post-treatment relapse is common and difficult to predict. This study estimated whether changes in pain over ... ...

    Abstract Background and aims: Buprenorphine-naloxone (BUP-NLX) can be used to manage prescription opioid addiction among persons with chronic pain, but post-treatment relapse is common and difficult to predict. This study estimated whether changes in pain over time and pain volatility during BUP-NLX maintenance would predict opioid use during the taper BUP-NLX taper.
    Design: Secondary analysis of a multi-site clinical trial for prescription opioid addiction, using data obtained during a 12-week BUP-NLX stabilization and 4-week BUP-NLX taper.
    Setting: Community clinics affiliated with a national clinical trials network in 10 US cities.
    Participants: Subjects with chronic pain who entered the BUP-NLX taper phase (n = 125) with enrollment occurring from June 2006 to July 2009 (52% male, 88% Caucasian, 31% married).
    Measurements: Outcomes were weekly biologically verified and self-reported opioid use from the 4-week taper phase. Predictors were estimates of baseline severity, rate of change and volatility in pain from weekly self-reports during the 12-week maintenance phase.
    Findings: Controlling for baseline pain and treatment condition, increased pain [odds ratio (OR) = 2.38, P = 0.02] and greater pain volatility (OR = 2.43, P = 0.04) predicted greater odds of positive opioid urine screen during BUP-NLX taper. Increased pain (IRR = 1.40, P = 0.04) and greater pain volatility [incidence-rate ratio (IRR) = 1.66, P = 0.009] also predicted greater frequency of self-reported opioid use.
    Conclusions: Adults with chronic pain receiving out-patient treatment with buprenorphine-naloxone (BUP-NLX) for prescription opioid addiction have an elevated risk for opioid use when tapering off maintenance treatment. Those with relative persistence in pain over time and greater volatility in pain during treatment are less likely to sustain abstinence during BUP-NLX taper.
    MeSH term(s) Adult ; Buprenorphine/therapeutic use ; Chronic Pain/physiopathology ; Drug Therapy, Combination ; Female ; Humans ; Male ; Naloxone/therapeutic use ; Narcotic Antagonists/therapeutic use ; Opiate Substitution Treatment/methods ; Opioid-Related Disorders/drug therapy ; Severity of Illness Index ; Treatment Outcome ; United States
    Chemical Substances Narcotic Antagonists ; Naloxone (36B82AMQ7N) ; Buprenorphine (40D3SCR4GZ)
    Language English
    Publishing date 2017-02-28
    Publishing country England
    Document type Journal Article ; Multicenter Study
    ZDB-ID 1141051-6
    ISSN 1360-0443 ; 0965-2140
    ISSN (online) 1360-0443
    ISSN 0965-2140
    DOI 10.1111/add.13782
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  6. Article ; Online: Gender, brain-derived neurotrophic factor Val66Met, and frequency of methamphetamine use.

    Heinzerling, Keith G / Shoptaw, Steven

    Gender medicine

    2012  Volume 9, Issue 2, Page(s) 112–120

    Abstract: Background: Frequency of pretreatment methamphetamine (MA) use is an important predictor of outcomes of treatment for MA dependence. Preclinical studies suggest females self-administer more MA than males, but few clinical studies have examined potential ...

    Abstract Background: Frequency of pretreatment methamphetamine (MA) use is an important predictor of outcomes of treatment for MA dependence. Preclinical studies suggest females self-administer more MA than males, but few clinical studies have examined potential sex differences in the frequency of MA use. Estrogen increases expression of brain-derived neurotrophic factor (BDNF), which has effects on MA-induced striatal dopamine release and protects against MA-induced neurotoxicity.
    Objective: We examined potential effects of sex, the Val66Met polymorphism in BDNF, and their interaction on frequency of MA use among 60 Caucasian MA-dependent volunteers screening for a clinical trial.
    Methods: Data was taken from 60 Caucasian MA-dependent volunteers screening for a clinical trial.
    Results: Females reported significantly more pretreatment days with MA use in the past 30 days than males. There was a significant interaction between sex and BDNF Val66Met, with the highest frequency of MA use among females with Val/Val genotype.
    Conclusions: These results, although preliminary, add to the literature documenting sexual dimorphism in response to stimulants, including MA, and suggest a potential biological mechanism involving BDNF that might contribute to these differences. Additional research characterizing the biological basis of altered response to MA among females is warranted.
    MeSH term(s) Amphetamine-Related Disorders/genetics ; Analysis of Variance ; Brain-Derived Neurotrophic Factor/genetics ; Female ; Genotyping Techniques ; Humans ; Male ; Methamphetamine ; Polymorphism, Genetic ; Sex Factors ; Substance-Related Disorders/genetics
    Chemical Substances Brain-Derived Neurotrophic Factor ; Methamphetamine (44RAL3456C)
    Language English
    Publishing date 2012-03-23
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 2171408-3
    ISSN 1878-7398 ; 1550-8579
    ISSN (online) 1878-7398
    ISSN 1550-8579
    DOI 10.1016/j.genm.2012.02.005
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  7. Article ; Online: Single nucleotide polymorphism near CREB1, rs7591784, is associated with pretreatment methamphetamine use frequency and outcome of outpatient treatment for methamphetamine use disorder.

    Heinzerling, Keith G / Demirdjian, Levon / Wu, Yingnian / Shoptaw, Steven

    Journal of psychiatric research

    2016  Volume 74, Page(s) 22–29

    Abstract: Although stimulant dependence is highly heritable, few studies have examined genetic influences on methamphetamine dependence. We performed a candidate gene study of 52 SNPs and pretreatment methamphetamine use frequency among 263 methamphetamine ... ...

    Abstract Although stimulant dependence is highly heritable, few studies have examined genetic influences on methamphetamine dependence. We performed a candidate gene study of 52 SNPs and pretreatment methamphetamine use frequency among 263 methamphetamine dependent Hispanic and Non-Hispanic White participants of several methamphetamine outpatient clinical trials in Los Angeles. One SNP, rs7591784 was significantly associated with pretreatment methamphetamine use frequency following Bonferroni correction (p < 0.001) in males but not females. We then examined rs7591784 and methamphetamine urine drug screen results during 12 weeks of outpatient treatment among males with treatment outcome data available (N = 94) and found rs7591784 was significantly associated with methamphetamine use during treatment controlling for pretreatment methamphetamine use. rs7591784 is near CREB1 and in a linkage disequilibrium block with rs2952768, previously shown to influence CREB1 expression. The CREB signaling pathway is involved in gene expression changes related to chronic use of multiple drugs of abuse including methamphetamine and these results suggest that variability in CREB signaling may influence pretreatment frequency of methamphetamine use as well as outcomes of outpatient treatment. Medications targeting the CREB pathway, including phosphodiesterase inhibitors, warrant investigation as pharmacotherapies for methamphetamine use disorders.
    MeSH term(s) Adult ; Amphetamine-Related Disorders/genetics ; California ; Central Nervous System Stimulants/pharmacology ; Cyclic AMP Response Element-Binding Protein/genetics ; European Continental Ancestry Group/genetics ; Female ; Hispanic Americans/genetics ; Humans ; Indians, North American/genetics ; Male ; Methamphetamine/pharmacology ; Polymorphism, Single Nucleotide ; Sex Factors
    Chemical Substances CREB1 protein, human ; Central Nervous System Stimulants ; Cyclic AMP Response Element-Binding Protein ; Methamphetamine (44RAL3456C)
    Language English
    Publishing date 2016-03
    Publishing country England
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S.
    ZDB-ID 3148-3
    ISSN 1879-1379 ; 0022-3956
    ISSN (online) 1879-1379
    ISSN 0022-3956
    DOI 10.1016/j.jpsychires.2015.12.008
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  8. Article ; Online: Randomized, Placebo-Controlled Trial of Targeting Neuroinflammation with Ibudilast to Treat Methamphetamine Use Disorder.

    Heinzerling, Keith G / Briones, Marisa / Thames, April D / Hinkin, Charles H / Zhu, Tianle / Wu, Ying Nian / Shoptaw, Steven J

    Journal of neuroimmune pharmacology : the official journal of the Society on NeuroImmune Pharmacology

    2019  Volume 15, Issue 2, Page(s) 238–248

    Abstract: Methamphetamine (MA) triggers neuroinflammation and medications that counteract MA-induced neuroinflammation may reduce MA-induced neurodegeneration and improve neurocognition and treatment outcomes in MA use disorder. We performed a randomized, placebo- ... ...

    Abstract Methamphetamine (MA) triggers neuroinflammation and medications that counteract MA-induced neuroinflammation may reduce MA-induced neurodegeneration and improve neurocognition and treatment outcomes in MA use disorder. We performed a randomized, placebo-controlled trial to determine the safety and efficacy of ibudilast (IBUD), a phosphodiesterase inhibitor that reduces neuroinflammation, for the treatment of MA use disorder. Treatment-seeking volunteers with MA use disorder were randomly assigned to receive 12 weeks of IBUD 50 mg twice daily (N = 64) or placebo (N = 61) with medication management counseling. Participants visited the outpatient research clinic twice weekly to provide urine specimens for drug screens and undergo study assessments. The primary outcome was end of treatment MA-abstinence (EOTA) during weeks 11 and 12 of treatment. Serum IBUID levels were measured for IBUD participants during week 3 of treatment. There was no difference in EOTA for IBUD (14%) versus placebo (16%, p > 0.05). There was no correlation between serum IBUD levels and MA use during treatment and mean IBUD levels for participants with (mean = 51.3, SD = 20.3) and without (mean = 54.7, SD = 33.0, p = 0.70) EOTA. IBUD was well tolerated. IBUD did not facilitate MA abstinence in this outpatient trial. Whether targeting neuroinflammation, either with IBUD in other subgroups of MA users or clinical trial designs, or with other anti-inflammatory medications, is an effective strategy for treating MA use disorder is not clear. Graphical Abstract The proportion of urine drug screens negative for methamphetamine (MA) during the two week lead-in period (weeks -2 and - 1) and the 12 week medication treatment period (weeks 1-12) for ibudilast versus placebo.
    MeSH term(s) Adult ; Amphetamine-Related Disorders/diagnosis ; Amphetamine-Related Disorders/drug therapy ; Amphetamine-Related Disorders/metabolism ; Central Nervous System Stimulants/adverse effects ; Double-Blind Method ; Female ; Humans ; Inflammation Mediators/antagonists & inhibitors ; Inflammation Mediators/metabolism ; Male ; Methamphetamine/adverse effects ; Middle Aged ; Phosphodiesterase Inhibitors/therapeutic use ; Pyridines/therapeutic use ; Treatment Outcome
    Chemical Substances Central Nervous System Stimulants ; Inflammation Mediators ; Phosphodiesterase Inhibitors ; Pyridines ; Methamphetamine (44RAL3456C) ; ibudilast (M0TTH61XC5)
    Language English
    Publishing date 2019-12-09
    Publishing country United States
    Document type Clinical Trial, Phase II ; Journal Article ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural
    ZDB-ID 2227405-4
    ISSN 1557-1904 ; 1557-1890
    ISSN (online) 1557-1904
    ISSN 1557-1890
    DOI 10.1007/s11481-019-09883-w
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  9. Article ; Online: Glial and neuroinflammatory targets for treating substance use disorders.

    Bachtell, Ryan K / Jones, Jermaine D / Heinzerling, Keith G / Beardsley, Patrick M / Comer, Sandra D

    Drug and alcohol dependence

    2017  Volume 180, Page(s) 156–170

    Abstract: Background: The plenary session at the 2016 Behavior, Biology and Chemistry: Translational Research in Addiction Conference focused on glia as potential players in the development, persistence and treatment of substance use disorders. Glia partake in ... ...

    Abstract Background: The plenary session at the 2016 Behavior, Biology and Chemistry: Translational Research in Addiction Conference focused on glia as potential players in the development, persistence and treatment of substance use disorders. Glia partake in various functions that are important for healthy brain activity. Drugs of abuse alter glial cell activity producing several perturbations in brain function that are thought to contribute to behavioral changes associated with substance use disorders. Consequently, drug-induced changes in glia-driven processes in the brain represent potential targets for pharmacotherapeutics treating substance use disorders.
    Methods: Four speakers presented preclinical and clinical research illustrating the effects that glial modulators have on abuse-related behavioral effects of psychostimulants and opioids. This review highlights some of these findings and expands its focus to include other research focused on drug-induced glia abnormalities and glia-focused treatment approaches in substance use disorders.
    Results: Preclinical findings show that drugs of abuse induce neuroinflammatory signals and disrupt glutamate homeostasis through their interaction with microglia and astrocytes. Preclinical and clinical studies testing the effects of glial modulators show general effectiveness in reducing behaviors associated with substance use disorders.
    Conclusions: The contribution of drug-induced glial activity continues to emerge as an intriguing target for substance use disorder treatments. Clinical investigations of glial modulators have yielded promising results on substance use measures and indicate that they are generally safe and well-tolerated. However, results have not been entirely positive and more questions remain for continued exploration in the development and testing of glial-directed treatments for substance use disorders.
    MeSH term(s) Analgesics, Opioid/pharmacology ; Analgesics, Opioid/therapeutic use ; Astrocytes/drug effects ; Behavior, Addictive/physiopathology ; Brain/drug effects ; Central Nervous System Stimulants/pharmacology ; Humans ; Microglia/drug effects ; Neuroglia ; Substance-Related Disorders/physiopathology
    Chemical Substances Analgesics, Opioid ; Central Nervous System Stimulants
    Language English
    Publishing date 2017-08-31
    Publishing country Ireland
    Document type Journal Article ; Review ; Research Support, N.I.H., Extramural
    ZDB-ID 519918-9
    ISSN 1879-0046 ; 0376-8716
    ISSN (online) 1879-0046
    ISSN 0376-8716
    DOI 10.1016/j.drugalcdep.2017.08.003
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  10. Article ; Online: Pain volatility and prescription opioid addiction treatment outcomes in patients with chronic pain.

    Worley, Matthew J / Heinzerling, Keith G / Shoptaw, Steven / Ling, Walter

    Experimental and clinical psychopharmacology

    2015  Volume 23, Issue 6, Page(s) 428–435

    Abstract: The combination of prescription opioid dependence and chronic pain is increasingly prevalent and hazardous to public health. Variability in pain may explain poor prescription opioid addiction treatment outcomes in persons with chronic pain. This study ... ...

    Abstract The combination of prescription opioid dependence and chronic pain is increasingly prevalent and hazardous to public health. Variability in pain may explain poor prescription opioid addiction treatment outcomes in persons with chronic pain. This study examined pain trajectories and pain volatility in patients with chronic pain receiving treatment for prescription opioid addiction. We conducted secondary analyses of adults with chronic pain (n = 149) who received buprenorphine/naloxone (BUP/NLX) and counseling for 12 weeks in an outpatient, multisite clinical trial. Good treatment outcome was defined as urine-verified abstinence from opioids at treatment endpoint (Week 12) and during at least 2 of the previous 3 weeks. Pain severity significantly declined over time during treatment (b = -0.36, p < .001). Patients with greater pain volatility were less likely to have a good treatment outcome (odds ratio = 0.55, p < .05), controlling for baseline pain severity and rate of change in pain over time. A 1 standard deviation increase in pain volatility was associated with a 44% reduction in the probability of endpoint abstinence. The significant reduction in subjective pain during treatment provides observational support for the analgesic effects of BUP/NLX in patients with chronic pain and opioid dependence. Patients with greater volatility in subjective pain during treatment have increased risk of returning to opioid use by the conclusion of an intensive treatment with BUP/NLX and counseling. Future research should examine underlying mechanisms of pain volatility and identify related therapeutic targets to optimize interventions for prescription opioid addiction and co-occurring chronic pain.
    MeSH term(s) Adolescent ; Adult ; Aged ; Aged, 80 and over ; Analgesics, Opioid/adverse effects ; Analgesics, Opioid/therapeutic use ; Behavior, Addictive/drug therapy ; Behavior, Addictive/psychology ; Behavior, Addictive/therapy ; Buprenorphine, Naloxone Drug Combination/therapeutic use ; Chronic Pain/drug therapy ; Chronic Pain/psychology ; Combined Modality Therapy ; Counseling ; Female ; Humans ; Male ; Middle Aged ; Opiate Substitution Treatment ; Opioid-Related Disorders/drug therapy ; Opioid-Related Disorders/psychology ; Opioid-Related Disorders/therapy ; Treatment Outcome ; Young Adult
    Chemical Substances Analgesics, Opioid ; Buprenorphine, Naloxone Drug Combination
    Language English
    Publishing date 2015-12
    Publishing country United States
    Document type Clinical Trial, Phase II ; Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural
    ZDB-ID 1209960-0
    ISSN 1936-2293 ; 1064-1297
    ISSN (online) 1936-2293
    ISSN 1064-1297
    DOI 10.1037/pha0000039
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