Contribution à l'étude du sevrage des opioïdes via manipulations pharmacologiques de modèles comportementaux chez le rongeur

Doctorat en sciences médicalesinfo:eu-repo/semantics/nonPublishe

Contribution à l'étude du sevrage des opioïdes via manipulations pharmacologiques de modèles comportementaux chez le rongeur

Doctorat en sciences médicalesinfo:eu-repo/semantics/nonPublishe

Psychopathologie et Neurosciences: Questions actuelles de Neurosciences Cognitives et Affectives

info:eu-repo/semantics/publishe

Implantes de naltrexona: Un avance terapéutico, tanto comportamental como farmacológico

The pioneers of naltrexone (NTX) treatment the early 1970s realized that an implant or depot injection of NTX would largely eliminate the poor compliance that undermined its potential effectiveness. Animal studies of implantable formulations appeared in the mid-1970s and human studies soon showed that effective plasma NTX levels could be maintained for several weeks using standard implant formulations. Yet only in the past few years have implants and depot injections become available for clinical use. This paper reviews their development, their rationale and the increasing number of papers describing their effectiveness for relapse-prevention in a surprisingly wide range of indications, including addicted physicians, pregnant addicts and troubled adolescents taking frequent opiate overdoses. It is clear that typical plasma levels of NTX from implants can completely block opiate effects from as much as 500 mg of pharmaceutical heroin and effective blockade can be maintained for well over six months. Even shorter-acting "first generation" implants appear to reduce considerably the high rates of early relapse that are common after opiate detoxification. Depot NTX also has potential in alcoholism treatment. However, the obviously pharmacological nature of NTX implants should not obscure the fact that they also facilitate and reinforce important psychological processes that may be crucial to the long-term success of addiction treatment. The development of long-acting blocking agents for other drugs of abuse means that the emerging principles of treatment with NTX implants may soon be applied to problems involving benzodiazepines, stimulants and cannabis. We suggest the term "Antagonist-Assisted Abstinence" for this approach but stress that maintenance treatments continue to have an important place.SCOPUS: re.jinfo:eu-repo/semantics/publishe

Long-acting naltrexone has long-acting benefits and 100% induction rates are not difficult to achieve

SCOPUS: le.jDecretOANoAutActifinfo:eu-repo/semantics/publishe

Ultra-rapid opiate detoxification: from clinical applications to basic science.

Rapid or ultra-rapid opiate detoxification has become increasingly popular in both private and public addiction centres. These techniques seem to facilitate the transfer of opiate-dependent patients from opiate agonist to opiate antagonist. Despite the probable complex neuropharmacological aspects involved in these procedures, their development over nearly three decades is notable for the almost complete absence of clinically relevant animal studies. This paper discusses the historical background of this occurrence, and reviews the small number of animal studies that have been conducted. Many discussions and arguments about the techniques seem to underscore their true purpose, which is not "simply to detoxify" opiate-addicted patients but to initiate long-term management with naltrexone. For this reason, it may be better to conceptualize these techniques not as "rapid detoxification" but as "rapid antagonist induction".Journal ArticleResearch Support, Non-U.S. Gov'tReviewSCOPUS: re.jFLWINinfo:eu-repo/semantics/publishe

Towards a comprehension concerning the clinical effects of therapy with rapid opioid detoxification.

JOURNAL ARTICLEFLWINinfo:eu-repo/semantics/publishe

Recent developments in naltrexone implants and depot injections for opiate abuse: The new kid on the block is approaching adulthood

Implants and depot injections (DI) of naltrexone (NTX) have undergone considerable development since the first commercially available implants appeared in the mid-1990s. In particular, long-acting implants that can deliver relapse-preventing serum NTX levels for around six months have now been subjected to classic randomised controlled trials that have given positive and generally significant results when compared with oral NTX and placebo implants, or with standard post-detoxification care. They also provide lower serum levels that can prevent opiate overdose for several additional months and 3-year mortality rates are similar to those of methadone maintenance treatment (MMT). At least 18 months of antagonist-assisted abstinence may be desirable to normalise new, opiatefree cognitive-behavioural habits and extinguish old, maladaptive ones. We discuss ideological antagonisms between protagonists of MMT and of NTX implants, notably in Australia, but we argue that both treatments can and should co-exist. The main obstacle to the expansion of longacting implant treatment is not the lack of an evidential or theoretical base but the lack of a licensed product. NTX appears to block all opiates if serum levels are adequate and we stress its apparent lack of clinically significant hepatotoxicity. Some patients may need above-average serum levels and occasionally, habitual injectors continue to inject opiates despite experiencing no opiate effects.SCOPUS: re.jinfo:eu-repo/semantics/publishe

Learning the language of abstinence in addiction treatment: Some similarities between relapse-prevention with disulfiram, naltrexone, and other pharmacological antagonists and intensive "Immersion" methods of foreign language teaching

Relapse-prevention (RP) is an educational process. Learning to abstain from alcohol or opiates after years of dependence involves selectively suppressing old, maladaptive habits of thought and behavior and establishing new, adaptive ones. This process resembles foreign language (FL) learning. Effective FL teaching techniques are relevant to RP. "Immersion," the most effective FL teaching method, discourages students from using their first language ab initio, requiring them to use the FL instead, however inexpertly. It resembles exposure and response-prevention for phobic or compulsive disorders. Supervised disulfiram aids RP by discouraging alcoholics from responding to real-life drinking cues in the "language" of excessive drinking, requiring them, ab initio, to practice new, alcohol-free responses. Supervised or depot naltrexone acts similarly in opiate dependence. We discuss the concept of antagonist-assisted abstinence.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Is Alcohol in Hand Sanitizers Absorbed Through the Skin or Lungs? Implications for Disulfiram Treatment

AIM: In view of the increase in the use of ethanol-containing hand sanitizers throughout the world due to the current COVID-19 pandemic, we wished to review the possible risks to patients treated with disulfiram, following a case report in which an apparent DER (disulfiram-ethanol reaction) was attributed to the cutaneous absorption of alcohol from hand sanitizers as well as by inhalation of vapour. METHOD: Simple experiments to assess the levels of absorption by each route separately. RESULTS: Our results strongly suggest that while amounts of alcohol sufficient to cause a DER may be inhaled when hand sanitizers are used in confined spaces, absorption can be avoided by dispersal of the fumes, and absorption from the skin alone does not occur in pharmacologically significant quantities. CONCLUSION: Warnings about absorption of alcohol through the skin from hand sanitizers and products such as perfumes, deodorants and after-shave (whose use is often warned against when disulfiram is prescribed) should be modified accordingly.SCOPUS: ar.jDecretOANoAutActifinfo:eu-repo/semantics/publishe