User:Jarogers0998/sandbox

I would like to change some of the language in this article on opioid use disorder. I feel like some of the language used in the article isn't as clear and concise as it should be.(IS IT BIASED? OVER or UNDER-REPRESENTATIVE OF CERTAIN VIEWPOINTS? IS IT REFERENCED CORRECTLY?) I have found a few review papers that I plan to draw from and hopefully will make this a more informative article. For example, an editor stated that tolerance and withdrawal symptoms do not occur if taken properly, when the wording should be a bit different to be clear.

If you can please revise to answer the questions assigned I will be better able to grade your evaluation.

''Choose an article, and consider some questions (but don't feel limited to these):

·        Is each fact referenced with an appropriate, reliable reference?

Most are referenced, but some items need to be updated.

·        Is everything in the article relevant to the article topic? Is there anything that distracted you?

·        Is the article neutral? Are there any claims, or frames, that appear heavily biased toward a particular position?

·        Where does the information come from? Are these neutral sources? If biased, is that bias noted?

·        Are there viewpoints that are overrepresented, or underrepresented?

·        Check a few citations. Do the links work? Is there any close paraphrasing or plagiarism in the article? There are some links that I couldn't pull up the book referenced. The ISBN wouldn't pull up anything so that will need to be changed.

·        Is any information out of date? Is anything missing that could be added? I will add to the epidemiology section of the article and add updated information.

IT LOOKS LIKE YOU GIVEN SOME CONSIDERATION TO THE SOURCES YOU PLAN TO ADD. HOW WILL YOU TACKLE THE ARTICLE AS A WHOLE ASIDE FROM THE EPIDEMIOLOGY SECTION? DO YOU THINK THAT SECTION NEEDS TO CONSIDER COUNTRIES OTHER THAN THE US?

https://www.cdc.gov/media/releases/2018/p0329-drug-overdose-deaths.html

The above link is the updated CDC deaths rates for opioid drug related deaths in the U.S. for the epidemiology section. I will need to gather information related to worldwide deaths still. (moved this to live)

https://www.networkforphl.org/_asset/qz5pvn/network-naloxone-10-4.pdf

This link is the states laws for prescribing naloxone for laypersons.

https://store.samhsa.gov/system/files/sma18-5063pt1.pdf

This book has an expanded edition of the different medications used to treat OUD. I would like to change some of the wording in relation to this section. I feel like the way some of the sentences are written is not just factual.


 * Methadone therapy has the most documentation on how it has helped opioid users. (moved this to live)

https://accessmedicine-mhmedical-com.ezproxy3.lhl.uab.edu/content.aspx?sectionid=200809266&bookid=2509&Resultclick=2#1158264814

This is chapter 50 in a medical book that describes treatment, diagnosis, and other items that will be useful to me.

The full citation is below

Edens E, Petrakis IL. Opioid Use Disorders. In: Ebert MH, Leckman JF, Petrakis IL. eds. 'Current Diagnosis & Treatment: Psychiatry, 3e' New York, NY: McGraw-Hill;. http://accessmedicine.mhmedical.com.ezproxy3.lhl.uab.edu/content.aspx?bookid=2509&sectionid=200809266. Accessed January 27, 2019.

The citation below is to update the states that allow Narcan without an individual prescription.

Naloxone Opioid Overdose Reversal Medication. (2018, January 01). Retrieved from https://cvshealth.com/thought-leadership/naloxone-opioid-overdose-reversal-medication


 * Currently, there are 48 states that allow for a pharmacist to have the authority to distribute naloxone without an individual prescription. (moved this to live)

'''I recommend at this stage you consider copying and pasting part of the article you plan to edit into your sandbox for your work. You can underline or use another marker to indicate which text you have edited.'''

The below section needs to be added to, there is a lot if info for this drug. I will start researching this section. (Buprenorphine)

Buprenorphine[edit]
Buprenorphine/naloxone tablet Buprenorphine is a partial opioid receptor agonist. Unlike methadone and other full opioid receptor agonists, buprenorphine is less likely to cause respiratory depression due to its ceiling effect. Treatment with buprenorphine may be associated with reduced mortality. Buprenorphine under the tongue is often used to manage opioid dependence. Preparations were approved for this use in the United States in 2002. Some formulations of buprenorphine incorporate the opiate antagonist naloxone during the production of the pill form to prevent people from crushing the tablets and injecting them, instead of using the sublingual (under the tongue) route of administration.

Methadone[edit]
40 mg of methadone Main article: Methadone maintenance

Methadone maintenance treatment (MMT), a form of opioid replacement therapy, reduces and/or eliminates the use of illegal opiates, the criminality associated with opiate use, and allows patients to improve their health and social productivity. Methadone has the most documentation on the benefits to opiate users. Methadone is an agonist of opioids. If initial doses during the beginning of treatment are too high or are concurrent with illicit opioid use, this may present an increased risk of death from overdose. In addition, enrollment in methadone maintenance has the potential to reduce the transmission of infectious diseases associated with opiate injection, such as hepatitis and HIV. The principal effects of methadone maintenance are to relieve narcotic craving, suppress the abstinence syndrome, and block the euphoric effects associated with opiates. Methadone maintenance has been found to be medically safe and non-sedating. It is also indicated for pregnant women addicted to opiates. For individuals who wish to completely move away from drugs, they can start a methadone reduction program. A methadone reduction program is where an individual is prescribed an amount of methadone which is increased until withdrawal symptoms subside, after a period of stability, the dose will then be gradually reduced until the individual is either free of the need for methadone or is at a level which allows a switch to a different opiate with an easier withdrawal profile, such as suboxone. Methadone toxicity has been shown to be associated with specific phenotypes of CYP2B6.

Some impairment in cognition has been demonstrated in those using methadone. Currently, 55 countries worldwide use methadone replacement therapy, while some countries such as Russia do not.

Opioid related deaths[edit]
Naloxone is used for the emergency treatment of an overdose. It can be given by many routes (e.g., intramuscular, intravenous, subcutaneous, intranasal, and inhalation) and acts quickly by displacing opioids from opioid receptors and preventing activation of these receptors by opioids. Naloxone kits are recommended for laypersons who may witness an opioid overdose, for individuals with large prescriptions for opioids, those in substance use treatment programs, or who have been recently released from incarceration. Since this is a life-saving medication, many areas of the United States have implemented standing orders for law enforcement to carry and give naloxone as needed. In addition, naloxone could be used to challenge a person's opioid abstinence status prior to starting a medication such as naltrexone, which is used in the management of opioid addiction.

Good Samaritan laws typically protect bystanders that administer naloxone. In the United States, at least 40 states have Good Samaritan laws to encourage bystanders to take action without fear of prosecution. As of 2019, there are 48 states that allow for a pharmacist to have the authority to distribute naloxone without an individual prescription.

Neuroimaging has shown functional and structural alterations in the brain. A 2017 study showed that chronic intake of opioids, such as heroin, may cause long-term effects in the orbitofrontal area (OFC), which is essential for regulating reward-related behaviors, emotional responses, and anxiety.[non-primary source needed] Moreover, neuroimaging and neuropsychological studies demonstrated dysregulation of circuits associated with emotion, stress and high impulsivity.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2246020/ This is a good, reputable source for the above statement. (It needed a non-primary source).

Adding to this section with more detailed selection.

https://www.ncbi.nlm.nih.gov/books/NBK64116/table/A85633/

Opioid intoxication[edit]
Signs and symptoms of opioid intoxication include:


 * Decreased perception of pain
 * Euphoria
 * Confusion
 * Desire to sleep
 * Nausea
 * Constipation
 * Miosis
 * Bradycardia
 * Hypotension
 * Hypothermia
 * Slurred speech
 * Slowed movement
 * Head nodding


 * Update the dates in this section to more recently (from 2010 to 2016)
 * https://www.who.int/substance_abuse/information-sheet/en/

Epidemiology[edit]
See also: Opioid crisis

Globally, the number of people with opioid dependence increased from 10.4 million in 1990 to 15.5 million in 2010. In 2016, **The World Health Organization reported there was approximately 27 million individuals who experienced opioid use disorder.** Opioid use disorders resulted in 122,000 deaths worldwide in 2015, up from 18,000 deaths in 1990. Deaths from all causes rose from 47.5 million in 1990 to 55.8 million in 2013.