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J Opioid Manag ; 17(1): 9-12, 2021.
Artículo en Inglés | MEDLINE | ID: covidwho-1140759


The limited access to opioids remains a reality in developing countries. Recent evidence suggests that opioid epidemics are getting worse with the COVID-19 crisis. The increase in opioid abuse could be attributed to the extended lockdowns and the social distancing recommendations, hindering chronic pain patients' access to regular office visits and monitoring in addition to limited access to behavioral services like group therapies and other pain management interventions. Use of telemedicine as an alternative to in-person follow-up visits has faced many limitations due to technological challenges and cost. Chronic pain patients living in developing countries face extra burden during the pandemic. Limited access to outpatient clinics and hesitance to visit hospitals due to COVID-19 pandemic, in addition to reduction in supply of opioids, are some of the limiting factors. Unfortunately, the low-income class with limited financial capabilities faces further barriers to access the chronic pain services and treatments like opioid prescriptions. Medical entities involved in care of chronic pain patients have adopted different strategies to overcome these challenges. In addition to expanding on educational programs to medical staff and patients, modifying the strict opioid pre-scribing and dispensing regulations has been successful. Another positive trend has been the growing use of opioid sparing interventions, such as multimodal analgesia, regional blocks, and interventional pain procedures.

Pandemias , Analgésicos Opioides/efectos adversos , Control de Enfermedades Transmisibles , Humanos , Epidemia de Opioides
J Opioid Manag ; 17(1): 5-7, 2021.
Artículo en Inglés | MEDLINE | ID: covidwho-1140758


The coronavirus disease 2019 (COVID-19) pandemic has had harmful effects on the opioid epidemic. While a negative effect was predicted, we report on this reality in the hospital setting. We have seen a sharp rise in hospitalized patients with opioid use disorder (OUD). Our data should encourage ongoing efforts to reduce barriers in accessing medications for treatment, harm reduction interventions and additional education for trainees, primary care providers, and hospitalists alike. In the current climate, these interventions are critical to save the lives of patients with OUD.

Trastornos Relacionados con Opioides , Analgésicos Opioides/efectos adversos , Hospitalización , Humanos , Tratamiento de Sustitución de Opiáceos , Trastornos Relacionados con Opioides/diagnóstico , Trastornos Relacionados con Opioides/tratamiento farmacológico , Trastornos Relacionados con Opioides/epidemiología
J Opioid Manag ; 16(6): 401-404, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-1022155


Based on evidence of the immunosuppressive effects of chronic opioids, long-term users of prescription and illicit opioids comprise an unrecognized but growing population of Americans with compromised immune function and respiratory depression who may be at high risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease 19 (COVID-19)-related hospitalization, prolonged ICU stay, adverse events, and death. This perspective is of broad clinical and public health importance because the US has the highest population of long-term users of prescription opioids, a sequel of a decade-long practice of opioid overprescribing in the US. For long-term opioid users who are hospitalized for COVID-19, clinicians face clinical challenges arising from the suppressive effects of opioids on the respiratory and immune functions, as well as the potential for adverse drug-drug interaction when opioids have to be continued in long-term users. More research is needed to further understand the association of long-term opioid use and susceptibility to COVID-19 and other emerging infections.

Analgésicos Opioides/efectos adversos , Trastornos Relacionados con Opioides/complicaciones , Humanos , Huésped Inmunocomprometido , Insuficiencia Respiratoria , Estados Unidos/epidemiología
Eur Rev Med Pharmacol Sci ; 24(24): 13062-13064, 2020 12.
Artículo en Inglés | MEDLINE | ID: covidwho-1000852


Cytokine storm in COVID-19 is linked to disease severity and mortality. 40% of patients with severe COVID-19 require mechanical ventilation. Analgesia and sedation are used for treatment of pain, facilitation of mechanical ventilation, or management of acute agitation. Herein, we present the immunomodulating actions of morphine that may either improve or worsen the clinical course of COVID-19 once cytokine storm develops. A literature search was performed to find articles on potential immunomodulatory effects of morphine. Taken together, the results of in vitro and in vivo models in non-COVID-19 conditions suggest that morphine could have a beneficial effect by mitigating the cytokine storm in the early stages of severe COVID-19. In contrast, it could be potentially harmful in late stages of severe COVID-19, especially in the presence of septic shock.

Analgésicos Opioides/efectos adversos , Síndrome de Liberación de Citoquinas/inmunología , Inmunomodulación , Morfina/efectos adversos , Analgésicos Opioides/uso terapéutico , Citocinas/inmunología , Humanos , Morfina/uso terapéutico , Respiración Artificial , Choque Séptico/inmunología
J Subst Abuse Treat ; 119: 108139, 2020 12.
Artículo en Inglés | MEDLINE | ID: covidwho-808920


The COVID-19 pandemic led government regulators to relax prescribing rules for buprenorphine and methadone, the agonist medications that effectively treat opioid use disorder, allowing for take home supplies of up to 28 days. These changes prioritized the availability of these medications over concerns about their misuse and diversion, and they provided a means for overdose prophylaxis during the highly uncertain conditions of the pandemic. In considering how to capitalize on this shift, research should determine the extent to which increased diversion has occurred as a result, and what the consequences may have been. The shifts also set the stage to consider if methadone can be safely prescribed in primary care settings, and if the monthly injectable formulation of buprenorphine is a suitable alternative to increased supplies of sublingual strips if concerns about diversion persist. The disruptions of the pandemic have caused a surge in overdose deaths, so carefully considering the prophylactic potential of agonist medications, in addition to their role as a treatment, may help us address this mortality crisis.

Analgésicos Opioides/administración & dosificación , Infecciones por Coronavirus , Trastornos Relacionados con Opioides/rehabilitación , Pandemias , Neumonía Viral , Pautas de la Práctica en Medicina/estadística & datos numéricos , Desvío de Medicamentos bajo Prescripción/estadística & datos numéricos , Analgésicos Opioides/efectos adversos , Buprenorfina/administración & dosificación , Sobredosis de Droga/epidemiología , Humanos , Metadona/administración & dosificación , Tratamiento de Sustitución de Opiáceos/métodos
Subst Use Misuse ; 55(11): 1900-1901, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-643514


BACKGROUND: Alarms have been raised that COVID-19 may disproportionately affect certain populations with substance use disorders, particularly Opioid Use Disorder (OUD), however warnings have largely focused on social risks such as reduced availability of services. Objectives: This commentary highlights three plausible biological mechanisms for potentially worsened outcomes in patients with OUD who contract COVID-19. Results: Opioid-related respiratory depression may amplify risks of hypoxemia from COVID-19 viral pneumonia. Complex opioid immune modulation may impact host response to COVID-19, though the effect direction and clinical significance are unclear. Drug-drug interactions may affect individuals with OUD who are co-administered medications for OUD and medications for COVID-19, particularly due to cardiac adverse effects. Conclusions/Importance: There are plausible biological mechanisms for potentially worsened outcomes in patients with OUD who contract COVID-19; these mechanisms require further study, and should be considered in individuals with OUD.

Analgésicos Opioides/efectos adversos , Arritmias Cardíacas/inducido químicamente , Infecciones por Coronavirus/complicaciones , Huésped Inmunocomprometido/inmunología , Trastornos Relacionados con Opioides/complicaciones , Neumonía Viral/complicaciones , Insuficiencia Respiratoria/inducido químicamente , Inmunidad Adaptativa/inmunología , Analgésicos Opioides/uso terapéutico , Betacoronavirus , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/inmunología , Infecciones por Coronavirus/fisiopatología , Interacciones Farmacológicas , Humanos , Inmunidad Innata/inmunología , Metadona/efectos adversos , Trastornos Relacionados con Opioides/tratamiento farmacológico , Trastornos Relacionados con Opioides/inmunología , Pandemias , Neumonía Viral/tratamiento farmacológico , Neumonía Viral/inmunología , Neumonía Viral/fisiopatología , Pronóstico , Insuficiencia Respiratoria/fisiopatología
Psychosomatics ; 61(5): 544-550, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-616923

Agonistas de Receptores Adrenérgicos alfa 2/uso terapéutico , Antipsicóticos/uso terapéutico , Infecciones por Coronavirus/terapia , Delirio/tratamiento farmacológico , Hipnóticos y Sedantes/efectos adversos , Neumonía Viral/terapia , Agitación Psicomotora/tratamiento farmacológico , Fármacos Inductores del Sueño/uso terapéutico , Anciano , Analgésicos Opioides/efectos adversos , Azepinas/uso terapéutico , Betacoronavirus , Depresores del Sistema Nervioso Central/uso terapéutico , Clordiazepóxido/efectos adversos , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/psicología , Delirio/etiología , Delirio/fisiopatología , Delirio/psicología , Dexmedetomidina/efectos adversos , Femenino , Guanfacina/uso terapéutico , Haloperidol/uso terapéutico , Humanos , Hidromorfona/efectos adversos , Unidades de Cuidados Intensivos , Ketamina/efectos adversos , Melatonina/uso terapéutico , Midazolam/efectos adversos , Oxicodona/efectos adversos , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/fisiopatología , Neumonía Viral/psicología , Propofol/efectos adversos , Agitación Psicomotora/etiología , Agitación Psicomotora/fisiopatología , Agitación Psicomotora/psicología , Respiración Artificial , Trastornos del Sueño del Ritmo Circadiano/tratamiento farmacológico , Trastornos del Sueño del Ritmo Circadiano/etiología , Trastornos del Sueño del Ritmo Circadiano/fisiopatología , Traqueostomía , Triazoles/uso terapéutico , Ácido Valproico/uso terapéutico
Anaesth Crit Care Pain Med ; 39(3): 341-343, 2020 06.
Artículo en Inglés | MEDLINE | ID: covidwho-141692