The Adjective Rating Scale for Withdrawal: Validation of its ability to assess severity of prescription opioid misuse

Coloma-Carmona, Ainhoa; Carballo, José Luís; Marín, Jesús Rodríguez; Hofstadt, Carlos J. van-der

doi:10.1002/ejp.1305

Cited by 9 publications

(6 citation statements)

References 47 publications

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“…Withdrawal symptoms can include patient discomfort, autonomic changes (hypertension, tachycardia), joint and muscle aches/pain, gastrointestinal cramping, lacrimation, rhinorrhea, tremors, emesis, and drug cravings. 14 Managing withdrawal symptoms is important and patients who undergo severe withdrawals are able to have their symptoms treated with an alpha 2 agonist such as clonidine or lofexidine. These agonist medications reduce NA-ergic activity by binding to alpha-2 auto-receptors on these NA neurons, leading to feedback inhibition of the NA neurons' mimicking the previous opioid-induced inhibition.…”

Section: Medication Assisted Treatmentsmentioning

confidence: 99%

Keeping Up with Clinical Advances: Opioid Use Disorder

2019

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Opioid use disorder (OUD) is a disorder that can lead to several negative outcomes, including overdose and death. A variety of opioids can be abused by individuals including both prescribed and non-prescribed opioids. Continued opioid use can be driven by negative affective states associated with opioid withdrawal. Several treatments exist in the field including medication assisted treatments such as methadone, buprenorphine, and naltrexone. Treatments such as clonidine and lofexidine can also be used to assist with decreasing withdrawal symptoms. Increasing adherence to treatment can further improve patient outcomes and promote continuation with treatment. A variety of methods to reduce relapse can also be utilized such as opioid agonists and maintenance therapy. According to the Centers for Disease Control, opioid overdoses contributed to 67.8% of overdose deaths in 2017.

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Section: Medication Assisted Treatmentsmentioning

confidence: 99%

Keeping Up with Clinical Advances: Opioid Use Disorder

2019

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“…Withdrawal symptoms appeared either in the context of discontinuation or dose reduction and were encountered in patients abusing tramadol and those with therapeutic doses. It has recently been suggested that an increase in withdrawal intensity during opioid treatment in chronic pain could be used to identify patients at risk of developing a prescription opioid use disorder 36,37 . Typical and atypical opioid signs of tramadol withdrawal have been observed 38 …”

Section: Discussionmentioning

confidence: 99%

“…This study highlights the role of tramadol use for stimulant and/or opioid psychoactive effects (well-being, euphoria, anxiolysis, hypnotic and forgetting problems) as a driving factor for primary SUD in withdrawal intensity during opioid treatment in chronic pain could be used to identify patients at risk of developing a prescription opioid use disorder. 36,37 Typical and atypical opioid signs of tramadol withdrawal have been observed. 38 Interdependence between mood, opioid tolerance/dependence, and pain plays a crucial role in the difficult reversibility of dependence on opioid pain treatment.…”

Section: Reports Of High-risk Tramadol Use To the French Addictovigil...mentioning

confidence: 99%

Increase of high‐risk tramadol use and harmful consequences in France from 2013 to 2018: Evidence from the triangulation of addictovigilance data

Roussin

Soeiro

Fouque

et al. 2022

Brit J Clinical Pharma

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The aim of this paper is to assess recent developments in non-medical tramadol use, tramadol use disorder, illegal procurement and deaths. Methods: This study used repeated cross-sectional analysis of data collected nationwide from 2013 to 2018. Analysis was conducted through multisource monitoring of the French Addictovigilance Network of: (1) validated reports of high-risk tramadol use, (2) record systems collecting information from toxicology experts investigating analgesic-related deaths (DTA) and deaths related to substance abuse (DRAMES), and pharmacists for forged prescriptions (OSIAP), and (3) survey of drug users, with investigation of patterns of use while visiting addiction-specialised institutions (OPPIDUM).Results: Despite a plateauing level of tramadol exposure in the French population, the proportion of tramadol reports increased 1.7-fold (187 cases in 2018, 3.2% (95% confidence interval [CI]: 2.74-3.63%), versus 1.9% (95% CI: 1.49-2.42% in 2013).

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“…Participants also met a minimal threshold of sleep, pain, and withdrawal symptoms as a screening requirement for the larger study. Specifically, eligibility screenings required scoring ≥4 on a 0-10 numeric pain intensity scale, having above-average (≥50) score on at least one scale for sleep disturbance and sleep-related impairment using the Patient-Reported Outcomes Measurement Information System (PROMIS; Yu et al, 2011), and reporting within "moderate" range on 25% of self-reported withdrawal signs using the Adjective Rating Scale for Withdrawal (Coloma-Carmona et al, 2019). We specifically recruited adults displaying moderate symptom burden to meet the aims of the larger study that tested an intervention to reduce withdrawal symptoms.…”

Section: Participantsmentioning

confidence: 99%

Nighttime Sleep and Respiratory Disturbances in Individuals Receiving Methadone to Treat Opioid Use Disorder

Finlay,

Erwin,

Skeiky

et al. 2023

UJAN

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Opioids are a leading cause of drug overdose deaths in the United States. Methadone used as medication for opioid use disorder (MOUD) reduces drug cravings and promotes abstinence. However, individuals in methadone-based MOUD treatment commonly report subjective sleep complaints and are at risk for respiratory depression from opioids. We investigated nighttime sleep and respiratory function in eight individuals (six women, two men; ages 31–68 years) in their first 90 days of methadone-based MOUD treatment. Participants underwent overnight cardiorespiratory polysomnography. Sleep and respiratory variables were characterized with descriptive statistics for comparison to reference data from similarly aged healthy adults. Although participants spent 8.1 ± 0.3 hours (mean ± SD) in bed, their total sleep time was only 6.8 ± 1.3 hours. They exhibited longer sleep latency and intermittent wakefulness. Sleep structure was irregular, with disrupted sleep cycles. Participants also displayed a decreased amount of N1 sleep and an increased amount of N3 sleep, compared with reference data. Participants showed respiratory depression, with an average apnea–hypopnea index of 16.5 ± 8.9 events per hour. Central sleep apneas comprised 69.1% ± 20.9% of the respiratory events. A Cheyne–Stokes-like breathing pattern, consisting of 30-second cycles of three central sleep apneas, was observed in 75% of participants. Our results suggest that individuals early in methadone-based MOUD treatment experience disordered sleep and respiratory disturbances. Such nighttime physiological changes may have serious long-term health consequences and contribute to unintended overdose rates. Identifying and treating MOUD individuals with sleep apnea could reduce risk of death.

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The Adjective Rating Scale for Withdrawal: Validation of its ability to assess severity of prescription opioid misuse

Cited by 9 publications

References 47 publications

Keeping Up with Clinical Advances: Opioid Use Disorder

Keeping Up with Clinical Advances: Opioid Use Disorder

Increase of high‐risk tramadol use and harmful consequences in France from 2013 to 2018: Evidence from the triangulation of addictovigilance data

Nighttime Sleep and Respiratory Disturbances in Individuals Receiving Methadone to Treat Opioid Use Disorder

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