Erectile Dysfunction and Methadone Maintenance Therapy

@#Erectile dysfunction is one of the most common side effects of methadone affecting more than half of methadone patient population. The problem is associated with prominent reduced quality of life. Erectile dysfunction may perpetuate greater problem if left untreated as patients may opt to use harmful self-treatment such as abusing methamphetamine. This illicit drug use to overcome the side-effects of methadone may lead to polysubstance use disorder that further compromise addiction therapy. To overcome this issue, both practitioners and patients play a major role in the management of erectile dysfunction. Patient awareness regarding erectile dysfunction and its impact as well as doctor’s active intervention to detect erectile dysfunction, are essential to improve the detection rate and management of erectile dysfunction. Frequent screening of erectile dysfunction and its risk factors will help with the identification of patients suffering from erectile dysfunction. Multiple treatments options such as bupropion, trazodone and many more are available to treat erectile dysfunction which will be further explored in this review.

Prescribing Opioids for Chronic Pain / 신경정신의학

Opioids are effective analgesics, but they are often difficult to use properly, due mainly to adverse events, such as constipation, respiratory depression, addiction, tolerance, and opioid induced hyperalgesia. In the past, the problem of opioids around the world was usually caused by drugs traded illegally, so there was no need for medical and social attention in Korea. On the other hand, with the dramatic increase in the therapeutic use of opioids, which commenced more than a decade ago, problems caused by legally prescribed drugs have emerged, and now a more serious opioid crisis is being experienced than in the days of illegal drugs. A growing number of patients are chronically prescribed opioids, and a growing number of health care providers and hospitals suffer from problems related to chronic prescription. Currently, in Korea, it is the time to pay serious attention to achieve the safe and effective use of prescribed opioids. This paper consists of the following parts. 1) A summary of the issues related to chronic pain, opioids, and problems associated with the use of opioids. 2) Some case examples the authors' experienced. 3) Simple guidelines on the use of opioids in the treatment of chronic non-cancer pain are proposed based on the author's experience and existing literature. These guidelines are by no means comprehensive, and hopefully in the future, related experts will join forces to develop better guidelines.

Effects of ultrarapid opiate detoxification during general anesthesia on plasma morphine concentration and brain ?-endorphin content in rats addicted to morphine / 中华麻醉学杂志

Objective To investigate the effects of ultrarapid opiate detoxification during general anesthesia on the plasma morphine concentration and brain ?-endorphin content in rats addicted to morphine. Methods Ninety male Wistar rats aged 12-15 weeks weighing 180-220 g were randomized into 6 groups: group I normal animal ( n = 5); group II morphine addiction ( n = 5); group III natural withdrawal ( n = 20); group IV general anesthesia ( n = 20); group V general anesthesia + naloxone ( n = 20) and group VI clonidine pretreatment ( n = 20). Morphine addiction was induced by subcutaneous injection of increasing doses of morphine sulphate for 5 days (5, 10, 20, 40 and 50 mg? kg-1 t.i.d. ? 5 days) . Morphine detoxification was started on the 6th day. General anesthesia was induced and maintained with ?-OH and midazolam i.m. supplemented with intermittent isoflurane inhalation to maintain loss of righting reflex. Spontaneous breathing was kept during general anesthesia. In group V naloxone 0.05, 0.1 and 0.2 mg was injected subcutaneously at 5, 30 and 60 min after loss of righting reflex. Successful detoxification was defined as no withdrawal symptoms after subcutaneous injection of naloxone 0.1 mg. In group VI clonidine 0.05 mg ? kg-1 was given i. v. 1 hour before induction of anesthesia. Blood samples and brain tissue were obtained before detoxification in group I (normal animal) and II (morphine addiction) while in the other 4 groups they were obtained immediately and 1,2,3 day after detoxification.Results The plasma morphine concentration was 224 ? 164 ng?ml-1 in group II (morphine addiction), significantly higher than in all the detoxification groups ( P V ) (P