Heroin is a highly abused opioid and incurs a significant detriment to society worldwide In an effort to expand the limited pharmacotherapy options for opioid use disorders, a heroin conjugate vaccine was developed through comprehensive evaluation of hapten structure, carrier protein, adjuvant and dosing Immunization of mice with an optimized heroin-tetanus toxoid (TT) conjugate formulated with adjuvants alum and CpG oligodeoxynucleotide (ODN) generated heroin “immunoantagonism”, reducing heroin potency by >15-fold Moreover, the vaccine effects proved to be durable, persisting for over eight months The lead vaccine was effective in rhesus monkeys, generating significant and sustained antidrug IgG titers in each subject Characterization of both mouse and monkey antiheroin antibodies by surface plasmon resonance (SPR) revealed low nanomolar antiserum affinity for the key heroin metabolite, 6-acetylmorphine (6AM), with minimal cross reactivity to clinically used opioids Following a series of heroin cha

/pdf/development-of-a-clinically-viable-heroin-vaccine-54oxmdv1g5.pdf

Development of a Clinically Viable Heroin Vaccine

Fundamento:A hipertensao arterial sistemica apresenta alta prevalencia e e um importante fator de risco para eventos cardiovasculares. O controle da pressao arterial em pacientes hipertensos cadastrados no Programa Hiperdia, um programa do Sistema Unico de Saude para acompanhamento e monitoramento dos hipertensos, permanece muito abaixo do desejavel.Objetivo:Descrever o perfil epidemiologico e avaliar o controle da pressao arterial em pacientes cadastrados no Hiperdia, em Novo Hamburgo (RS).Metodologia:Estudo transversal, com amostra probabilistica estratificada por conglomerados, incluindo 383 adultos cadastrados no Programa Hiperdia das 15 Unidades Basicas de Saude do municipio, realizado entre 2010 e 2011. A pressao arterial controlada foi definida como ≤140 mmHg × 90 mmHg. Os hipertensos foram entrevistados e a pressao arterial foi mensurada com aparelho aneroide calibrado. Na analise estatistica foram utilizados razoes de prevalencia (RP) com intervalo de confianca de 95%, teste χ2 de Wald e regressao de Poisson simples e multipla.Resultados:A media de idade foi de 63 ± 10 anos, sendo a maioria mulheres, pertencentes a classe C, com baixa escolaridade, sedentarios e com historico familiar para HAS. O diabetes melito (DM) estava presente em 31%, a adesao ao tratamento anti-hipertensivo era de 54,3%, e 33,7% estavam com pressao arterial controlada. O DM mostrou-se fortemente associado com o controle inadequado da PA, com 15,7% dos diabeticos com PA considerada controlada.Conclusao:Mesmo com o cadastro no Programa Hiperdia, o controle da PA nos hipertensos nao e satisfatoriamente alcancado e mantido, sendo os hipertensos diabeticos os que apresentam o controle mais inadequado.

/pdf/blood-pressure-control-in-hypertensive-patients-in-the-xpym4yq1bf.pdf

Blood Pressure Control in Hypertensive Patients in the "Hiperdia Program": A Territory-Based Study

BACKGROUND: In response to the growing incidence of opioid dependence, guidelines have been created, and new treatments are being developed to assist physicians in treating dependence and withdrawal of opioids. OBJECTIVE: To review treatment modalities and guidelines utilized in opioid dependence. SUMMARY: Guidelines for the treatment of opioid dependence have been developed by organizations such as the American Society of Interventional Pain Physicians (ASIPP) and the American Psychiatric Association (APA). Current guidelines recommend comprehensive treatment with pharmacological agents such as methadone, buprenorphine, or buprenorphine combined with naloxone as well as psychosocial therapy. These guidelines stress the need for an integrated approach to treatment. Office-based opioid treatment is currently being utilized to treat opioid dependent patients in a physician's office setting with buprenorphine/naloxone replacement therapy as an alternative to entering patients into a methadone clinic. These o...

https://www.jmcp.org/doi/pdf/10.18553/jmcp.2010.16.S1-B.14

Opioid dependence treatment and guidelines.

This explorative, longitudinal study evaluated the effect of the daily use of a mobile phone-based self-management support system for hypertension in reducing blood pressure (BP) among 50 primary care patients with hypertension over 8 weeks. The self-management system comprises modules for (1) self-reports of BP, pulse, lifestyle, symptoms, and well-being; (2) delivery of reminders and encouragements; and (3) graphical feedback of self-reports. Daily use of the support system significantly reduced BP (systolic BP -7 mm Hg, diastolic BP -4.9 mm Hg) between baseline and week 8, with daily improvements leveling off as the study progressed. Three homogenous subsets of patients were identified who, despite different initial BP levels, showed similar decreases in BP during the study, indicating that patients benefited irrespective of baseline BP. In showing significant reductions in BP, our results suggest that the self-management support system may be a useful tool in clinical practice to help patients self-manage their hypertension.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/jch.12682

Improved Blood Pressure Control Using an Interactive Mobile Phone Support System

BACKGROUND: Poor medication adherence among patients with chronic diseases can result in complications and increased health care expenditures. An outpatient pharmacy clinical service (OPCS) program targeted nonadherent diabetes mellitus (DM) and/or coronary artery disease (CAD) patients with hemoglobin A1c (HbA1c) and/or low-density lipoprotein cholesterol (LDL-C) outside clinical goals. Pharmacists engaged identified patients with a face-to-face B-SMART consult, a consultation methodology to identify Barriers to medication adherence, work on Solutions to identified barriers, Motivate patients, recommend Adherence tools, reinforce the pharmacist-patient Relationship, and Triage if needed, to other services such as health education to improve outcomes. OBJECTIVES: To (a) assess rates of medication adherence and clinical outcomes in the OPCS program compared with usual care in an integrated health care system and (b) estimate return-on-investment (ROI) from this intervention. METHODS: This retrospective coh...

Evaluation of an outpatient pharmacy clinical services program on adherence and clinical outcomes among patients with diabetes and/or coronary artery disease

BACKGROUND: Management of opioid dependence is associated with many challenges such as the misuse of prescribed treatment and lack of medication adherence that can affect the clinical outcome of the patient. Buprenorphine-naloxone was approved by the U.S. Food and Drug

https://www.jmcp.org/doi/pdf/10.18553/jmcp.2008.14.2.186

Opioid drug utilization and cost outcomes associated with the use of buprenorphine-naloxone in patients with a history of prescription opioid use.

OBJECTIVE To examine the impact of the coverage gap on pharmacy use, expenditures, and out-of-pocket costs for Medicare managed care beneficiaries before and after reaching the gap. STUDY DESIGN A longitudinal comparison of behaviors for beneficiaries with non-gap coverage before and after reaching the gap. METHODS Prescription drug use and expenditures were assessed for Medicare beneficiaries who reached the gap, including subsets with one of four chronic disorders (congestive heart failure (CHF), diabetes, dyslipidemia, or hypertension). Differences in pre- and post-prescription use were calculated using generalized estimating equations. Time until the end and start of the gap was estimated using a Cox proportional hazards model. Expenditure data were estimated using bootstrap methods. RESULTS Roughly a quarter (27.1 percent) of patients reached the gap in 2006, of whom 3.6 percent passed through the gap. The most prevalent disease state was hypertension (58.5 percent). Beneficiaries took an average of 8.1 months to reach the gap. Patients <65 years (HR = 1.42, 95% CI = 1.29 - 1.56) and those with diabetes (HR = 1.19, 95% CI = 1.12 - 1.27) were more likely to reach the gap sooner as compared to older beneficiaries (aged 65 to 74) and those without diabetes. These individuals were more likely to pass through the gap as well. Beneficiaries faced a 60.7 percent increase in out-of-pocket expenditures in the gap phase. Brand-name medication use decreased by 9.3 percent, while generic medication use increased by 7.4 percent. For chronic conditions, however, over 90 percent of individuals continued brand-name medication use in the gap. CONCLUSIONS Our findings suggest that, in general, beneficiaries take lower-cost generics while in the gap. However, taking brand-name medications is the predominant behavior for beneficiaries with chronic diseases. Health care reform provisions that close the gap over the next ten years may facilitate continuity of medication use while in the gap.

Comparing pre-gap and gap behaviors for Medicare beneficiaries in a Medicare managed care plan.

BACKGROUND Although hypertension is a major risk factor for cardiovascular disease, adherence to hypertensive medications is low. Previous research identifying factors influencing adherence has focused primarily on broad, population-based approaches. Identifying specific barriers for an individual is more useful in designing meaningful targeted interventions. Using customized telephonic outreach, we examined specific patient-reported barriers influencing hypertensive patients' nonadherence to medication in order to identify targeted interventions. METHODS A telephone survey of 8692 nonadherent hypertensive patients was conducted. The patient sample comprised health plan members with at least two prescriptions for antihypertensive medications in 2008. The telephone script was based on the "target" drug associated with greatest nonadherence (medication possession ratio [MPR] <80%) during the four-month period preceding the survey. RESULTS The response rate was 28.2% of the total sample, representing 63.8% of commercial members and 37.2% of Medicare members. Mean age was 63.4 years. Mean MPR was 61.0% for the target drug. Only 58.2% of Medicare respondents and 60.4% of commercial respondents reported "missing a dose of medication". The primary reason given was "forgetfulness" (61.8% Medicare, 60.8% commercial), followed by "being too busy" (2.7% Medicare, 18.5% commercial) and "other reasons" (21.9% Medicare, 8.1% commercial) including travel, hospitalization/sickness, disruption of daily events, and inability to get to the pharmacy. Prescription copay was a barrier for less than 5% of surveyed patients. CONCLUSION Our findings indicate that events interfering with daily routine had a significant impact on adherence. Medication adherence appears to be a patterned behavior established through the creation of a routine and a reminder system for taking the medication. Providers should assess patients' daily schedules and medication-taking competency to develop and promote a medication routine.

/pdf/understanding-barriers-to-medication-adherence-in-the-i4osb53idj.pdf

Understanding barriers to medication adherence in the hypertensive population by evaluating responses to a telephone survey

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Opioid drug utilization and cost outcomes associated with the use of buprenorphine-naloxone in patients with a history of prescription opioid use.

Comparing pre-gap and gap behaviors for Medicare beneficiaries in a Medicare managed care plan.

Understanding barriers to medication adherence in the hypertensive population by evaluating responses to a telephone survey