Fentanyl Absorption, Distribution, Metabolism, and Excretion: Narrative Review and Clinical Significance Related to Illicitly Manufactured Fentanyl
Journal of Addiction Medicine
This narrative review summarizes literature on pharmaceutical fentanyl's absorption, distribution, metabolism, and excretion patterns to inform research on illicitly manufactured fentanyl (IMF). It highlights research gaps due to differences in medicinal fentanyl studies and IMF use patterns, including that medicinal fentanyl studies are largely conducted with persons who were opioid-naive, anesthetized, or had severe chronic pain and that IMF use is characterized by supratherapeutic doses and frequent and sustained administration patterns, as well as adulteration with other substances and/or fentanyl analogs. In persons who use drugs, peripheral accumulation of fentanyl may be leading to prolonged exposure. More focused research on the pharmacology of fentanyl in persons using IMF is warranted.
Buprenorphine versus methadone for the treatment of opioid dependence: a systematic review and meta-analysis of randomised and observational studies 🔓
The Lancet Psychiatry
This systematic review and meta-analysis sought to compare buprenorphine vs methadone across a wide range of primary and secondary outcomes. Primary outcomes included retention in treatment up to 24 months, treatment adherence, or other prescribed/illicit opioid use. Secondary outcomes included use of other substances, withdrawal, craving, criminal activity, overdose, mental and physical health, global functioning, and suicidality. Treatment retention was better for methadone vs buprenorphine, but there was no difference in adherence to treatment between these two forms of MOUD. Evidence on the other outcomes explored demonstrated few statistically significant differences, and for the most part was based on small numbers of studies.
Changing approaches to treating opioid withdrawal in the USA
The Lancet Psychiatry
In this commentary, the authors address the poor responsiveness to the treatment of opioid withdrawal in EDs, noting without a change in approach, deaths will continue to mount. They list ways to reduce opioid deaths and emphasize that continued stigma, criminalization, and social and health inequities are factors that require attention. The authors conclude that appropriate management of OUD puts the human rights and dignity of people who use drugs upfront, helps in establishing compassionate, therapeutic relationships with patients, and improves outcomes.