Browsing by Subject "opioids"

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  • Lindfors, Pia (Helsingfors universitet, 2010)
    The most important part in bioanalysis is the sample cleanup process which is usually the most laborious and time consuming part of the analysis and very susceptible to errors. A functional bioanalysis has to be quick, easily automated, sensitive, selective and stable. It also needs to be suitable for high throughput analysis. Desorption atmospheric pressure photoionization (DAPPI) is a novel direct desorption/ionization technique for mass spectrometry that enables direct analysis of solids from surfaces or liquid samples from a suitable sample plate often without any sample preparation. The suitability of DAPPI-MS for biological samples was investigated by measuring the limits of detection for selected opioids and benzodiazepines and screening them from authentic urine samples. Limits of detection were measured for standard solutions and spiked urine. Opioids and benzodiazepines were analyzed from post mortem urine samples with an optimized DAPPI-MS method. Post mortem urine samples were analyzed with and without sample preparation. Sample preparation improved the sensitivity of the method remarkably. About 50 % of the analytes were detected without sample preparation and almost 100 % after sample cleanup. It is however difficult to estimate the suitability of DAPPI-MS as a screening method because not all analyte concentrations of the urine samples were known. Therefore we cannot be certain weither the results obtained without sample preparation are caused by the suppression of the urine matrix or if the concentrations of the analytes are below the limits of detection. The reliability of the method can further be improved by investigating the metabolites of the analytes and improving the system towards automation. On grounds of this research DAPPI-MS should be used cautiously as a screening method for urine samples without sample preparation and with only high enough analyte concentrations. DAPPI-MS shows promise as a screening method for opioids and benzodiazepines from urine when the sample cleanup is used before the analysis.
  • Böckerman, Petri; Haapanen, Mika; Hakulinen, Christian; Karhunen, Hannu; Maczulskij, Terhi (2021)
    Background and aims Previous studies have shown that prescription opioid use is more common in socio-economicallydisadvantaged communities in the United States. This study examined the area and individual-level determinants of pre-scription opioiduse inFinlandduring the period 1995–2016. Design Logistic regression analysisusing nation-widedataonfilled opioid-related prescriptions dispensed at Finnish pharmacies and covered by National Health Insurance. Opioidconsumption was linked, using personal identification codes, to population-based data maintained by Statistics Finland,which records individual background and area-level characteristics. Setting and participants Working-age populationaged between 15 and 64 years in Finland during the periods 1995–2007 (n= 4315409) and 2009–16 (n=4116992). Measurements Annual prescription opioid use was measured using defined daily doses (DDD) and whether people usedopioids during a year. Findings Prescription opioid use increased in Finland from 1995 to 2016 (from less than 1 to 7%),but the increase was explained by the change in the treatment of codeine-based opioids in National Health Insurance. Thearea-level unemployment rate was positively correlated with the share of opioid users at the municipal level (r=0.36;P<0.001). In comparison with being employed, being outside the labour force was associated with increased opioiduse in 1995–2007 [odds ratio (OR) = 2.22, 95% confidence interval (CI) = 2.10–2.36] and non-codeine opioid use in2009–16 (OR = 2.16, 95% CI = 2.06–2.27), but not with codeine opioid use in 2009–16. Conclusions Prescriptionopioid use in Finland appears to be more common among low socio-economic status people, similar to the UnitedStates and the United Kingdom.
  • Leamy, Zachary E. (Helsingin yliopisto, 2020)
    This thesis examines direct-to-physician pharmaceutical marketing in the United States of America. In 2013, about 78 opioid prescriptions were being written for every 100 people, and 17,000 people in the United States died from an opioid overdose. This study asks, what is the relationship, if any, between contemporary direct-to-physician pharmaceutical marketing practices and opioid mortality in the United States? Contained within an expansive piece of U.S. federal legislation, the Patient Protection and Affordable Care Act of 2010 is a provision which mandates pharmaceutical manufacturers to report marketing payments made to physicians, hospitals, and other relevant healthcare providers. By connecting marketing payments to mortality data at several geospatial levels, the study finds that there is a plausible relationship between the direct-to-physician pharmaceutical marketing and mortality.
  • Roitto, Hanna-Maria; Kautiainen, Hannu; Aalto, Ulla L.; Ohman, Hannareeta; Laurila, Jouko; Pitkala, Kaisu H. (2019)
    Objectives: The use of psychotropic drugs in long-term care (LTC) is very common, despite their known adverse effects. The prevalence of opioid use is growing among older adults. This study aimed to investigate trends in the prevalence of psychotropics, opioids, and sedative load in a LTC setting over a 14-year period. We also explored the interaction of psychotropic and opioid use according to residents' dementia status in nursing home (NH) and assisted living facility (ALF) settings. Design: Four cross-sectional studies. Setting: Institutional settings in Helsinki, Finland. Participants: Older residents in NHs in 2003 (n = 1987), 2011 (n = 1576), and 2017 (n = 791) and in ALFs in 2007 (n = 1377), 2011 (n = 1586), and 2017 (n = 1624). Measures: Comparable assessments were conducted among LTC residents at 4 time points over 14 years. The prevalence of regular psychotropics, opioids, and other sedatives and data on demographics and diagnoses were collected from medical records. Results: Disabilities and severity of dementia increased in both settings over time. The prevalence of all psychotropics decreased significantly in NHs (from 81% in 2003 to 61% in 2017), whereas in ALFs there was no similar linear trend (65% in 2007 and 64% in 2017). There was a significant increase in the prevalence of opioids in both settings (30% in NHs and 22% in AFLs in 2017). Residents with dementia used less psychotropics and opioids than those without dementia in both settings and at each time point. Conclusions/Implications: NHs show a favorable trend in psychotropic drug use, but the rates of psychotropic use remain high in both NHs and ALFs. In addition, the rates of opioid use have almost tripled, leading to a high sedative load among LTC residents. Clinicians should carefully consider the risk-to-benefit ratio when prescribing in LTC. (C) 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
  • Grotell, Milo; Abdurakhmanova, Shamsiiat; Elsilä, Lauri V.; Korpi, Esa R. (2021)
    In the brain, extrasynaptically expressed ionotropic, delta subunit-containing gamma-aminobutyric acid A-type receptors (delta-GABA(A)Rs) have been implicated in drug effects at both neuronal and behavioral levels. These alterations are supposed to be caused via drug-induced modulation of receptor ionophores affecting chloride ion-mediated inhibitory tonic currents. Often, a transgenic mouse model genetically lacking the delta-GABA(A)Rs (delta-KO) has been used to study the roles of delta-GABA(A)Rs in brain functions, because a specific antagonist of the delta-GABA(A)Rs is still lacking. We have previously observed with these delta-KO mice that activation of delta-GABA(A)Rs is needed for morphine-induced conditioning of place preference, and others have suggested that delta-GABA(A)Rs act as targets selectively for low doses of ethanol. Furthermore, activation of these receptors via drug-mediated agonism induces a robust increase in the slow-wave frequency bands of electroencephalography (EEG). Here, we tested delta-KO mice (compared to littermate wild-type controls) for the pharmaco-EEG responses of a broad spectrum of pharmacologically different drug classes, including alcohol, opioids, stimulants, and psychedelics. Gaboxadol (THIP), a known superagonist of delta-GABA(A)Rs, was included as the positive control, and as expected, delta-KO mice produced a blunted pharmaco-EEG response to 6 mg/kg THIP. Pharmaco-EEGs showed notable differences between treatments but also differences between delta-KO mice and their wild-type littermates. Interestingly mephedrone (4-MMC, 5 mg/kg), an amphetamine-like stimulant, had reduced effects in the delta-KO mice. The responses to ethanol (1 g/kg), LSD (0.2 mg/kg), and morphine (20 mg/kg) were similar in delta-KO and wild-type mice. Since stimulants are not known to act on delta-GABA(A)Rs, our findings on pharmaco-EEG effects of 4-MMC suggest that delta-GABA(A)Rs are involved in the secondary indirect regulation of the brain rhythms after 4-MMC.
  • Lahtinen, Katarina (Helsingin yliopisto, 2020)
    Yksi kivunhoidon vaihtoehdoista on kipulääkkeen itseannostelulaitteen käyttö. Kirjallisuuden mukaan itseannostelulaitetta käyttävät potilaat näyttäisivät olevan kivuttomampia ja tyytyväisempiä kivunhoitoonsa verrattuna tavanomaista hoitajan säännöstelemää kipulääkitystä saaviin potilaisiin, mutta kipulääkekulutuksen ero lääkitysmenetelmien välillä vaihtelee. Tämän tutkimuksen tarkoituksena oli verrata opioidikulutusta, mahdollisia haittavaikutuksia ja sairaalahoitoaikaa kipulääkkeen itseannostelulaitetta käyttävien ja tavanomaista kipulääkitystä saavien potilaiden välillä polven tekonivelleikkauksen jälkeen. Lisäksi selvitimme hoitavan henkilökunnan mielipiteitä itseannostelulaitteeseen liittyen. Tutkimuksessa tarkasteltiin retrospektiivisesti 166 potilasta, joille tehtiin polven tekonivelleikkaus spinaalipuudutuksessa. Potilaista 82 sai leikkauksen jälkeen oksikodonia suonensisäisesti itseannostelulaitteen kautta ja 82 kontrollipotilasta sai tavanomaisesti kipulääkitystä hoitajien annostelemana. Ensisijaisena päätemuuttujana oli opioidikulutus 24 tunnin aikana leikkauksen jälkeen. Muita tarkasteltavia muuttujia olivat pahoinvointilääkkeiden käyttö ja sairaalahoitojakson pituus. Lisäksi teetimme kyselytutkimuksen, johon vastasi 31 hoitajaa. Opioidikulutuksessa tai pahoinvointilääkkeiden käytössä 24 tunnin aikana leikkauksen jälkeen ei havaittu merkitsevää eroa ryhmien välillä. Mediaani opioidikulutus morfiiniekvivalenttina annoksena oli itseannosteluryhmässä 41.1 mg (interquartile range, IQR: 39.6 mg) ja kontrolliryhmässä 40.5 mg (IQR: 16.2 mg). Sairaalahoitoajan mediaani oli 2 päivää (IQR: 1 päivä) itseannosteluryhmässä ja 3 päivää (IQR: 1 päivä) kontrolliryhmässä (P=0.02). Kyselytutkimukseen vastanneista hoitajista valtaosa piti laitetta helppokäyttöisenä ja työaikaa säästävänä sekä käyttäisi laitetta mielellään useammilla potilailla. Tuloksien perusteella kipulääkkeen itseannostelulaitteen käyttö polven tekonivelleikkauksen jälkeen ei näyttäisi lisäävän opioidikulutusta hoitajan annostelemaan kipulääkitykseen verrattuna, mutta kipulääkekulutuksen vaihteluväli oli itseannostelulaitteella suurempi. Emme myöskään havainneet eroa haittavaikutuksissa ryhmien välillä, mutta itseannostelulaitetta käyttäneet potilaat mahdollisesti kotiutuvat aikaisemmin.
  • Oinio, Ville; Sundström, Mikko; Bäckström, Pia; Uhari-Väänänen, Johanna; Kiianmaa, Kalervo; Raasmaja, Atso; Piepponen, Timo Petteri (2021)
    Research has highlighted the association of a positive family history of alcoholism with a positive treatment response to opioid antagonists in those with a gambling disorder. However, the role of the opioidergic system in gambling behavior is not well understood, and preclinical studies are needed to clarify this. In this study, Alko Alcohol (AA) and Wistar rats went through operant lever pressing training where the task was to choose the more profitable of two options. Different sized sucrose rewards guided the lever choices, and the probability of gaining rewards changed slowly to a level where choosing the smaller reward was the most profitable option. After training, rats were administered subcutaneously with opioid agonist morphine or opioid antagonist naltrexone to study the impact of opioidergic mechanisms on cost/benefit decisions. No difference was found in the decision-making between AA rats or Wistar rats after the morphine administration, but control data revealed a minor decision enhancing effect in AA rats. Naltrexone had no impact on the decisions in AA rats but promoted unprofitable decisions in Wistar rats. Supporting behavioral data showed that in both rat strains morphine increased, and naltrexone decreased, sucrose consumption. Naltrexone also increased the time to accomplish the operant task. The results suggest that opioid agonists could improve decision-making in cost-benefit settings in rats that are naturally prone to high alcohol drinking. The naltrexone results are ambiguous but may partly explain why opioid antagonists lack a positive pharmacotherapeutic effect in some subgroups of gamblers.