Prescription Pain Medication Dependence

Dodrill, Carrie L.; Helmer, Drew A.; Kosten, Thomas R.

doi:10.1176/appi.ajp.2010.10020260

Cited by 26 publications

(18 citation statements)

References 40 publications

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“…Managing addiction with combined buprenorphine and naloxone offers opportunities for pain management based on the mechanism of action of the medication [77]. With agonism at the mu opioid receptor, moderate pain relief can be achieved.…”

Section: Ptsd Chronic Pain and Addictionmentioning

confidence: 99%

Review of posttraumatic stress disorder and chronic pain: The path to integrated care

Gibson¹

2012

JRRD

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Abstract-With the large number of Veterans experiencing posttraumatic stress disorder (PTSD) and chronic pain, the purpose of this article is to review the prevalence of PTSD and chronic pain, the theoretical models that explain the maintenance of both conditions, and the challenges faced by providers and families who care for these patients. The Department of Veterans Affairs (VA)/Department of Defense (DOD) VA/DOD Clinical Practice Guideline for Management of Post-Traumatic Stress with special attention to chronic pain is presented. Limited scientific evidence supports specific care and treatment of PTSD and chronic pain, and this challenges providers to investigate and research potential treatment options. Integrated care models designed for working with these patients are reviewed, including a focus on the techniques and strategies to address not only PTSD and chronic pain, but other conditions, including substance dependence and depression. A specific focus on headaches, back pain, and neuropathic pain follows, including treatment recommendations such as pharmacological, psychotherapeutic, and complementary approaches, given the high rates of these pain complaints for Veterans in PTSD clinical programs. Integrated care is presented as a viable solution and approach that challenges clinicians and researchers to develop innovative, scientifically based therapeutics and treatments to enhance the recovery and quality of life for Veterans with PTSD and chronic pain.

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Section: Ptsd Chronic Pain and Addictionmentioning

confidence: 99%

Review of posttraumatic stress disorder and chronic pain: The path to integrated care

Gibson¹

2012

JRRD

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“…Intravenous drug use is also a known vehicle for blood-borne pathogens, including HIV (11). Despite the high prevalence of opiate abuse, only a few medications exist (12; 13). Also, no treatments are approved for cocaine and methamphetamine dependence, supporting the need for new therapies (14).…”

Section: Introductionmentioning

confidence: 99%

The Frequency of Naive and Early-Activated Hapten-Specific B Cell Subsets Dictates the Efficacy of a Therapeutic Vaccine against Prescription Opioid Abuse

Laudenbach

Baruffaldi

Vervacke

et al. 2015

The Journal of Immunology

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Translation of therapeutic vaccines for addiction, cancer or other chronic non-communicable diseases has been slow because only a small subset of immunized subjects achieved effective antibody levels. We hypothesize that individual variability in the number of naïve and early-activated hapten-specific B cells determines post-vaccination serum antibody levels and vaccine efficacy. Using a model vaccine against the highly abused prescription opioid oxycodone, the polyclonal B cell population specific for an oxycodone-based hapten (6OXY) was analyzed by flow cytometry paired with antigen-based magnetic enrichment. A higher frequency of 6OXY-specific B cells in either spleen biopsies or blood, before and after immunization, correlated to subsequent greater oxycodone-specific serum antibody titers and their efficacy in blocking oxycodone distribution to the brain and oxycodone-induced behavior in mice. The magnitude of 6OXY-specific B cell activation and vaccine efficacy was tightly correlated to the size of the CD4+ T cell population. The frequency of enriched 6OXY-specific B cells was consistent across various mouse tissues. These data provide novel evidence that variations in the frequency of naïve or early-activated vaccine-specific B and T cells can account for individual responses to vaccines and may predict the clinical efficacy of a therapeutic vaccine.

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“…Many prescription opioid abusers do not fit this profile because their opioid use is oral rather than intravenous and may be sporadic, yet they still run the risk of overdose, social disruption, and transition to intravenous drug use and addiction. Additional treatment options for prescription opioid abuse are needed (Stotts et al, 2009;Dodrill et al, 2011;Maxwell, 2011).…”

Section: Introductionmentioning

confidence: 99%

An Oxycodone Conjugate Vaccine Elicits Drug-Specific Antibodies that Reduce Oxycodone Distribution to Brain and Hot-Plate Analgesia

Pravetoni

Naour²,

Harmon

et al. 2012

J Pharmacol Exp Ther

123

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Opioid conjugate vaccines have shown promise in attenuating the behavioral effects of heroin or morphine in animals. The goal of this study was to extend this approach to oxycodone (OXY), a commonly abused prescription opioid. Haptens were generated by adding tetraglycine (Gly) 4 or hemisuccinate (HS) linkers at the 6-position of OXY. Immunization of rats with OXY(Gly) 4 conjugated to the carrier proteins bovine serum albumin (BSA) or keyhole limpet hemocyanin (KLH) produced high-titer antibodies to OXY and its metabolite oxymorphone with substantially lower affinities for other structurally related opioid agonists and antagonists. There was no measurable binding of antibody by the (Gly) 4 linker alone or off-target opioids methadone and buprenorphine. OXY(HS) conjugates were less immunogenic despite achieving protein haptenation ratios comparable to OXY(Gly) 4 -BSA. In rats given a single intravenous dose of OXY, immunization with OXY(Gly) 4 -KLH increased OXY protein binding and retention in serum while decreasing its unbound (free) concentration in plasma and distribution to brain. Vaccine efficacy correlated with serum antibody titers, and it was greatest in rats given the lowest OXY dose (0.05 mg/kg) but was significant even after a larger OXY dose (0.5 mg/kg), equivalent to the high end of the therapeutic range in humans. These effects of OXY(Gly) 4 -KLH on drug disposition were comparable to those of nicotine or cocaine vaccines that are in clinical trials as addiction treatments. Immunization with OXY(Gly) 4 -KLH also reduced OXY analgesia in a thermal nociception test. These data support further study of vaccination with the OXY(Gly) 4 -KLH immunogen as a potential treatment option for OXY abuse or addiction.

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Prescription Pain Medication Dependence

Cited by 26 publications

References 40 publications

Review of posttraumatic stress disorder and chronic pain: The path to integrated care

Review of posttraumatic stress disorder and chronic pain: The path to integrated care

The Frequency of Naive and Early-Activated Hapten-Specific B Cell Subsets Dictates the Efficacy of a Therapeutic Vaccine against Prescription Opioid Abuse

An Oxycodone Conjugate Vaccine Elicits Drug-Specific Antibodies that Reduce Oxycodone Distribution to Brain and Hot-Plate Analgesia

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