Fred Nyberg
Uppsala University, Sweden
Title: How to deal with patients addicted to pain-relieving opioids
Biography
Biography: Fred Nyberg
Abstract
Over the past decade, the prescribing of opioids has increased dramatically in Western countries and in particular in North America. In parallel with this increase in opioid addiction, overdose, and associated deaths have been seen. A similar situation occurs in Sweden, where an about 40% increase in drug-related deaths has been documented, over the past decade, mainly due to opioids. These include synthetic drugs as methadone, buprenorphine and fentanyl and an increase has been seen in both males and females. A certain part of the increase is seen in opioid deaths combined with benzodiazepines. Although opioid addiction is effectively treated via a multidisciplinary approach including agonist opioid treatment and psychosocial intervention there are some difficulties. Misuse and diversion of pain medicines, like methadone and buprenorphine comprise a significant problem in Sweden as well as in other Nordic countries as these problems are linked to poor treatment compliance and increases in risk of blood-borne infections, crime, and mortality. To address this problem, changes in medicines used in some Nordic have already been implemented and considerations are under way in others. The new guidelines for treatment of opioid addicts in Sweden recommend combination of buprenorphine-naloxone before mono-buprenorphine. However, even if the occurrence of misuse and diversion of opioid medicine can be reduced there are other issues not always considered. Many opioid addicts in Sweden are infected by hepatitis C virus (HCV) and many of these have not been diagnosed and although we have effective medicines against HCV a great part are in lack of treatment. Another issue is that long-term opioid treatment may result in effects on the brain leading to cognitive decline. This presentation will deal with all these problems and in particular it will focus on the possibility to reverse opioid-induced damages on brain areas associated with cognitive function.