Showing papers by "Jason M. White published in 2007"

Opioid maintenance: a comparative review of pharmacological strategies.

Abstract: The use of opioids outside of medical practice is a significant health problem with important social and political implications. Although treatment of opioid dependence is traditionally focused on heroin users, there is increasing recognition that a large number of people become dependent through the use of prescription opioids. The necessity for long-term treatment has also been increasingly recognised. At present, there are several pharmacotherapies available for maintenance treatment, including drugs that are full agonists at the opioid receptor (e.g., methadone, slow-release oral morphine), a partial agonist (buprenorphine) and an opioid antagonist (naltrexone). This review examines the existing strategies, highlights problems associated with their use and discusses the opportunities for new treatment approaches, particularly the use of long-acting formulations.

Opioids, pain and addiction: Cause and consequence

Abstract: Publisher Summary This chapter describes the developments in understanding of the effects of opioids on the pain response. Long-term opioid administration is associated with physiological dependence and tolerance. Opioid-maintained patients administering methadone show marked tolerance, as opioid effects are relatively small compared to what a similar methadone dose would produce in an opioid-naive person. Experimental pain models can be used to measure different aspects of pain perception. Pain can be induced by electrical, thermal, ischemic, chemical, or mechanical methods. These experimental models yield reproducible and reliable data useful for the assessment of pain sensitivity and tolerance. The research investigating the pain sensitivity of chronic pain patients managed with long-term administration of methadone or morphine shows that people in this group exhibit a similar response to experimentally induced pain when evaluated against methadone maintained patients in treatment for opioid addiction. It is found that opioid cross-tolerance and hyperalgesia are significant barriers to the provision of effective analgesia in the opioid-dependent patient. It is suggested that stabilizing patients on a maintenance agent such as methadone or buprenorphine achieves only part of the process of reversing addiction.