The abuse potential of tramadol was investigated using both in vivo microdialysis measures of dopamine (DA) release within the nucleus accumbens (NAc) shell and the conditioned place preference (CPP) paradigm in rats. Tramadol (75 mg/kg, i.p.) induced a statistically significant increase (starting 80 min posttreatment) in DA release within the NAc shell, which was maintained for at least 120 min posttreatment. Tramadol (18.75, 37.5, and 75 mg/kg i.p.) produced a statistically significant CPP, with the effects of the two highest doses comparable to those induced by morphine (5 mg/kg, s.c.). The release of DA within the NAc shell may be responsible for the rewarding properties of tramadol and, together with the CPP results, provide evidence that tramadol may possess greater abuse potential than originally believed.
A business model in which health-system pharmacists provide MTM and condition care services for company employees has demonstrated successful outcomes in terms of patient satisfaction, cost savings, and clinical benefits.
LettersW e disagree with the conclusion of Drs. Fassett and Hazlet that our project was an example of human subjects research and therefore required review and approval by the institutional review board (IRB).When we approached poster presenters, we described the purpose of our project before asking whether IRB approval was sought before their research began. A simple "yes" or "no" answer was recorded without identifiers. Therefore, no additional risks of civil or criminal liability were added. Although we do not agree that the subject of our project was poster authors, we did not record information that would allow the identification of anyone volunteering information.One of the original aims of our project was to increase awareness within pharmacy of the need for appropriate oversight of human subjects research and health care improvement projects. To that end, we encourage all investigators to become familiar with and adhere to the requirements of their respective institutions' human subjects protection procedures. However, we believe that if an investigator determines that his or her study does not involve research or human subjects, no IRB submission should be necessary. Otherwise, there would be no logical stopping point for determining when an IRB submission is required. Drs. Fassett and Hazlet state that "many institutions . . . require filing 'exempt' studies with their local IRB," but they do not provide a reference for this assumption. It is our belief that policies such as this overburden IRBs with irrelevant submissions and do not measurably enhance an effective human subjects protection program.
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