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Infante AF, Elmes AT, Gimbar RP, Messmer SE, Neeb C, Jarrett JB. Stronger, longer, better opioid antagonists? Nalmefene is NOT a naloxone replacement. Int J Drug Policy 2024; 124:104323. [PMID: 38232438 DOI: 10.1016/j.drugpo.2024.104323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/21/2023] [Accepted: 01/03/2024] [Indexed: 01/19/2024]
Abstract
The fatal overdose crisis claims nearly 200 lives daily in the United States (U.S). Evolutions in the illicit drug supply, such as the addition of sedative adulterants and a shift to synthetic opioids such as fentanyl, have driven increasing rates of both fatal and non-fatal overdose. Specifically, synthetic opioid usage of fentanyl was implicated in 68 % of the U.S. drug overdose deaths in 2022 alone. This has placed tremendous burden on communities, emergency medical services, and healthcare systems, and contributed to tragedy and grief both in the U.S. and worldwide. Despite the availability of effective opioid antagonist medications and standards of care, there has been increased interest in research and development of alternative opioid overdose reversal agents by the National Institutes of Health (NIH) in partnership with pharmaceutical manufacturers over the last decade. The U.S. Food and Drug Administration (FDA) recently approved nalmefene (Opvee) a mu-opioid receptor antagonist that boasts an extended half-life and stronger mu-receptor affinity compared to the standard of care use of naloxone for opioid reversal. In this article, we explore the medical need and ramifications of the introduction of longer-acting opioid antagonists in the current opioid overdose landscape. Existing data highlight the effectiveness of already available naloxone products as a safe and effective standard of care. These data support the notion that stronger, longer-acting agents may be unnecessary, and their existence may cause undue harm, such as more severe and/or prolonged withdrawal symptoms, lead to challenging patient interactions, and complicate the initiation of medications for opioid use disorder. More evidence is needed before healthcare professionals should implement the use of stronger, longer-acting opioid antagonists for reversing opioid overdose over evidence-based, cost-effective naloxone.
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Affiliation(s)
- Alexander F Infante
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois Chicago, 833 South Wood St (MC 886), Chicago, IL 60612, United States.
| | - Abigail T Elmes
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois Chicago, 833 South Wood St (MC 886), Chicago, IL 60612, United States
| | - Renee Petzel Gimbar
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois Chicago, 833 South Wood St (MC 886), Chicago, IL 60612, United States
| | - Sarah E Messmer
- Department of Medicine, College of Medicine, University of Illinois Chicago, Westside Research Office Building, 1747W Roosevelt Rd, Rm 256, Chicago, IL 60608, United States
| | - Christine Neeb
- Division of Internal Medicine, School of Medicine, University of Colorado, Academic Office Building 1, 12631 E 17th Ave, Aurora, CO 80045, United States
| | - Jennie B Jarrett
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois Chicago, 833 South Wood St (MC 886), Chicago, IL 60612, United States
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Posen A, Keller E, Elmes AT, Messmer S, Gastala N, Neeb C, Jarrett JB. Medication-assisted recovery for opioid use disorder: A guide. J Fam Pract 2023; 72:164-171. [PMID: 37224548 DOI: 10.12788/jfp.0591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Considering offering medical intervention for OUD to reduce mortality? It's essential to understand the clinical benefits, limitations, and regulation of available agents.
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Affiliation(s)
- Andrew Posen
- Department of Pharmacy Practice, College of Pharmacy (Drs. Posen, Keller, Elmes, and Jarrett) and Department of Academic Internal Medicine (Dr. Messmer) and Department of Family and Community Medicine (Drs. Gastala and Neeb), College of Medicine, University of Illinois Chicago
| | - Eden Keller
- Department of Pharmacy Practice, College of Pharmacy (Drs. Posen, Keller, Elmes, and Jarrett) and Department of Academic Internal Medicine (Dr. Messmer) and Department of Family and Community Medicine (Drs. Gastala and Neeb), College of Medicine, University of Illinois Chicago
| | - Abigail T Elmes
- Department of Pharmacy Practice, College of Pharmacy (Drs. Posen, Keller, Elmes, and Jarrett) and Department of Academic Internal Medicine (Dr. Messmer) and Department of Family and Community Medicine (Drs. Gastala and Neeb), College of Medicine, University of Illinois Chicago
| | - Sarah Messmer
- Department of Pharmacy Practice, College of Pharmacy (Drs. Posen, Keller, Elmes, and Jarrett) and Department of Academic Internal Medicine (Dr. Messmer) and Department of Family and Community Medicine (Drs. Gastala and Neeb), College of Medicine, University of Illinois Chicago
| | - Nicole Gastala
- Department of Pharmacy Practice, College of Pharmacy (Drs. Posen, Keller, Elmes, and Jarrett) and Department of Academic Internal Medicine (Dr. Messmer) and Department of Family and Community Medicine (Drs. Gastala and Neeb), College of Medicine, University of Illinois Chicago
| | - Christine Neeb
- Department of Pharmacy Practice, College of Pharmacy (Drs. Posen, Keller, Elmes, and Jarrett) and Department of Academic Internal Medicine (Dr. Messmer) and Department of Family and Community Medicine (Drs. Gastala and Neeb), College of Medicine, University of Illinois Chicago
| | - Jennie B Jarrett
- Department of Pharmacy Practice, College of Pharmacy (Drs. Posen, Keller, Elmes, and Jarrett) and Department of Academic Internal Medicine (Dr. Messmer) and Department of Family and Community Medicine (Drs. Gastala and Neeb), College of Medicine, University of Illinois Chicago
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Hamlish T, Pasquinelli M, Gastala N, Huber M, Manst D, Andersen K, Jarrett JB, Neeb C, Tuite J, Maes P, Sung C, Fleurimont J, Feldman L. A team-based approach to effective management of pain and opioid use disorder in patients with cancer: Case report. Current Problems in Cancer: Case Reports 2022. [DOI: 10.1016/j.cpccr.2022.100196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Leo P, Gastala N, Fleurimont J, Messmer S, Maes P, Richardson J, Neeb C, Stackhouse N, Koruba S, Watson DP. A Community Partnership to Improve Access to Buprenorphine in a Homeless Population. Ann Fam Med 2021; 19:85. [PMID: 33431401 PMCID: PMC7800747 DOI: 10.1370/afm.2636] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/01/2020] [Accepted: 08/05/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- Paul Leo
- Corresponding author Paul A. Leo, MD, 1919 W. Taylor Street M/C 663, Chicago, IL 60612,
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Armbrust R, Neeb C, Thuss-Patience P, Lüftner D, Pietzner K, Riess H, Oskay-Öczelik G, Richter R, Keller M, Sehouli J. Patients' perspectives towards malignant ascites: results of a prospective observational trial regarding expectations, characteristics and quality of life-a study of the North-Eastern-German Society of Gynecological Oncology. Arch Gynecol Obstet 2019; 299:1385-1389. [PMID: 30834969 DOI: 10.1007/s00404-019-05071-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 01/28/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Malignant ascites (MA) is a frequent and common symptom in (gyneco-) oncological patients. The present trial evaluated and assessed patients' characteristics, clinical features and the possible influence of MA on QoL measurements. METHODS A prospective observational trial was conducted from Oct 2013 until Nov 2016. Therefore an interdisciplinary questionnaire was developed. Overall 250 patients with histological confirmed MA were included with different cancer entities (gynecological, gastrointestinal). The correlation of MA caused symptoms and QoL measurements was assessed using Kendall's tau b. Multivariable logistic regression models were applied to analyze the risks of symptoms or severe limitation in daily activities. RESULTS 125 questionnaires could be analyzed. The majority of patients with MA had diagnosis of ovarian cancer (68.8%) and were under current cancer treatment (57.6%), mostly chemotherapy. Over 50% reported abdominal tension as major symptom, around 56% of the patients had MA when cancer was firstly diagnosed. Regression analysis showed that patients with MA above 2l were significantly more likely to be harmed in everyday activities. However, the age, gender, type of malignancy and the current treatment (chemotherapy vs. no chemotherapy) had no significant influence. CONCLUSION MA has a significantly impact on QoL measurements in cancer patients and might influence everyday activities including basic needs like eating, walking and body care. There is a high need for more information and education of patients with MA.
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Affiliation(s)
- Robert Armbrust
- Department of Gynecology With Center for Oncological Surgery, Charité European Competence Center for Ovarian Cancer, University Hospital Charité Berlin, Augustenburger Platz 1, 13353, Berlin, Germany. .,North-Eastern German Society of Gynecological Oncology (NOGGO), Augustenburger Platz 1, 13353, Berlin, Germany.
| | - C Neeb
- Department of Gynecology With Center for Oncological Surgery, Charité European Competence Center for Ovarian Cancer, University Hospital Charité Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - P Thuss-Patience
- Department of Hematology, Oncology and Tumor Immunology, University Hospital Charité Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - D Lüftner
- Department of Hematology, Oncology and Tumor Immunology, University Hospital Charité Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - K Pietzner
- Department of Gynecology With Center for Oncological Surgery, Charité European Competence Center for Ovarian Cancer, University Hospital Charité Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,North-Eastern German Society of Gynecological Oncology (NOGGO), Augustenburger Platz 1, 13353, Berlin, Germany
| | - H Riess
- Department of Hematology, Oncology and Tumor Immunology, University Hospital Charité Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - G Oskay-Öczelik
- Department of Gynecology With Center for Oncological Surgery, Charité European Competence Center for Ovarian Cancer, University Hospital Charité Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,North-Eastern German Society of Gynecological Oncology (NOGGO), Augustenburger Platz 1, 13353, Berlin, Germany
| | - R Richter
- Department of Gynecology With Center for Oncological Surgery, Charité European Competence Center for Ovarian Cancer, University Hospital Charité Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - M Keller
- North-Eastern German Society of Gynecological Oncology (NOGGO), Augustenburger Platz 1, 13353, Berlin, Germany
| | - J Sehouli
- Department of Gynecology With Center for Oncological Surgery, Charité European Competence Center for Ovarian Cancer, University Hospital Charité Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,North-Eastern German Society of Gynecological Oncology (NOGGO), Augustenburger Platz 1, 13353, Berlin, Germany
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Hülsdünker T, Mierau A, Neeb C, Kleinöder H, Strüder HK. Cortical processes associated with continuous balance control as revealed by EEG spectral power. Neurosci Lett 2015; 592:1-5. [PMID: 25724275 DOI: 10.1016/j.neulet.2015.02.049] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 02/08/2015] [Accepted: 02/19/2015] [Indexed: 01/08/2023]
Abstract
Balance is a crucial component in numerous every day activities such as locomotion. Previous research has reported distinct changes in cortical theta activity during transient balance instability. However, there remains little understanding of the neural mechanisms underlying continuous balance control. This study aimed to investigate cortical theta activity during varying difficulties of continuous balance tasks, as well as examining the relationship between theta activity and balance performance. 37 subjects completed nine balance tasks with different levels of surface stability and base of support. Throughout the balancing task, electroencephalogram (EEG) was recorded from 32 scalp locations. ICA-based artifact rejection was applied and spectral power was analyzed in the theta frequency band. Theta power increased in the frontal, central, and parietal regions of the cortex when balance tasks became more challenging. In addition, fronto-central and centro-parietal theta power correlated with balance performance. This study demonstrates the involvement of the cerebral cortex in maintaining upright posture during continuous balance tasks. Specifically, the results emphasize the important role of frontal and parietal theta oscillations in balance control.
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Affiliation(s)
- T Hülsdünker
- Institute of Movement and Neurosciences, German Sport University Cologne, Cologne, Germany
| | - A Mierau
- Institute of Movement and Neurosciences, German Sport University Cologne, Cologne, Germany.
| | - C Neeb
- Institute of Movement and Neurosciences, German Sport University Cologne, Cologne, Germany
| | - H Kleinöder
- Institute of Training Science and Sport Informatics, German Sport University Cologne, Cologne, Germany
| | - H K Strüder
- Institute of Movement and Neurosciences, German Sport University Cologne, Cologne, Germany
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Stevens H, Betstadt S, Neeb C, Pensak M, Maguire M. The PIP study: improving rates of postpartum IUD placement with prescheduled appointments. Contraception 2012. [DOI: 10.1016/j.contraception.2012.05.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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