What is known and objective
Opioid use in the United States has reached unprecedented—some would even say crisis—levels. Although many individuals use opioid drugs as part of legitimate pain ...management plans, a significant number misuse prescription or illicit opioids. With regular opioid use, individuals develop tolerance and physical dependence; both are predictable, physiologic responses to repeated opioid exposure. However, a substantial number of individuals who misuse opioids will develop opioid use disorder (OUD), a complex, primary, chronic, neurobiological disease rooted in genetic, environmental and psychosocial factors. This article discusses OUD, opioid receptor physiology, and opioid withdrawal symptomatology and pathophysiology, as well as current treatment options available to reduce opioid withdrawal symptoms in individuals with physical dependence and/or OUD.
Methods
The research articles regarding OUD and its management have been reviewed thoroughly based on a PubMed literature search using keywords related to opioid dependence, its pathophysiology and current treatment strategies.
Results and discussion
Tolerance/physical dependence and the behavioural characteristics associated with OUD reflect complex neurobiologic adaptations in several major systems of the brain, including the locus ceruleus and mesolimbic systems. Physical dependence is responsible for the distressing withdrawal symptoms individuals experience upon abrupt cessation or rapid dose reduction of exogenous opioids. Opioid withdrawal symptoms are a key driver behind continued opioid use, and a barrier to opioid discontinuation. Several opioid‐based medications are available to treat patients with OUD; these treatments can diminish opioid withdrawal symptoms and cravings as well as block opioid effects in the event of relapse. Additionally, non‐opioid drugs may be used during acute detoxification to help alleviate opioid withdrawal symptoms.
What is new and conclusion
The opioid crisis has produced many challenges for physicians, one being the need to determine which patients would benefit most from maintenance therapy and which may be candidates for opioid discontinuation. In addition to summarizing current understanding of OUD, we provide a new algorithm for determining the need for continued opioid use as well as examples of situations where management of opioid withdrawal symptoms is indicated.
Opioid abuse has reached epidemic levels and includes many chronic pain patients. This review discusses opioid receptor physiology and opioid withdrawal symptomatology and pathophysiology, as well as current treatment options available to assist in the withdrawal process in individuals with physical dependence and/or opioid use disorder.
•Health warnings with graphic images perceived as more effective than text-only health warnings.•Negatively framed warnings perceived as more effective than positively framed warnings.•Negatively ...framed warnings produced stronger negative emotions than positively framed warnings.•Positive message framing improved motivation to be healthy more than negative framing.
Food product health warnings may be a valuable intervention strategy for helping reduce obesity rates and the negative health outcomes associated with consuming an unhealthy diet. Research into the efficacy of food product health warnings has shown promising effects on consumers’ beliefs and behaviour, but existing research has typically featured a single or limited number of simple, text-only warnings. Two studies are presented that tested the influence of text-only and text-and-graphic, positively and negatively framed health warnings on perceived efficacy, negative affect and motivation to change behaviour. Using a between-subjects design, Study 1 found that negatively framed health warnings and text-and-graphic health warnings produced more negative emotional responses than positively framed and text-only health warnings. Study 2 then featured the highest rated message topics from Study 1. Using a within-subjects design, Study 2 found that participants rated text-and-graphic health warnings as more effective than text-only warnings, and negatively framed warnings as more effective than positively framed warnings, though all warning groups scored above the scale mid-point on perceived efficacy. Negatively framed warnings produced stronger negative emotional responses, while positively framed warnings produced stronger feelings of motivation to change behaviour. Results indicate that food product health warnings were perceived as capable of effectively promoting behavioural change. While negatively framed warnings were seen as most effective, positively framed warnings may also be effective, possibly through a different persuasive pathway.
Food product health warnings have been proposed as a potential obesity prevention strategy. This study examined the effects of text-only and text-and-graphic, negatively and positively framed health ...warnings on dietary choice behavior. In a 2 × 5 mixed experimental design, 96 participants completed a dietary self-control task. After providing health and taste ratings of snack foods, participants completed a baseline measure of dietary self-control, operationalized as participants' frequency of choosing healthy but not tasty items and rejecting unhealthy yet tasty items to consume at the end of the experiment. Participants were then randomly assigned to one of five health warning groups and presented with 10 health warnings of a given form: text-based, negative framing; graphic, negative framing; text, positive framing; graphic, positive framing; or a no warning control. Participants then completed a second dietary decision making session to determine whether health warnings influenced dietary self-control. Linear mixed effects modeling revealed a significant interaction between health warning group and decision stage (pre- and post-health warning presentation) on dietary self-control. Negatively framed graphic health warnings promoted greater dietary self-control than other health warnings. Negatively framed text health warnings and positively framed graphic health warnings promoted greater dietary self-control than positively framed text health warnings and control images, which did not increase dietary self-control. Overall, HWs primed healthier dietary decision making behavior, with negatively framed graphic HWs being most effective. Health warnings have potential to become an important element of obesity prevention.
Modern societies are replete with palatable food cues. A growing body of evidence suggests that food cue exposure activates conditioned appetitive physiological and psychological responses that may ...override current metabolic needs and existing eating goals, such as the desire to maintain a healthy diet. This conditioned response results in unhealthy dietary choices and is a contributing factor in the current obesity epidemic. Prime based obesity prevention measures such as health warnings at point-of-sale or on product packaging may have the potential to counteract the influence of the obesogenic environment at the crucial moment when people make food purchasing or consumption decisions. Existing research into the efficacy of these intervention strategies has predominantly employed self-report and population level measures, and little evidence exists to support the contention that these measures counteract food cue reactivity at the time of decision making. Using a dietary self-control priming paradigm, we demonstrated that brief exposure to food product health warnings enhanced dietary self-control. Further, we analysed electroencephalographic correlates of selective attention and food cue evoked craving (N1, P3, LPP) to show that health warning exposure reduced the automatic appetitive response towards palatable food cues. These findings contribute to existing evidence that exogenous information can successfully prime latent goals, and substantiate the notion that food product health warnings may provide a new avenue through which to curb excessive energy intake and reduce rising obesity rates.
•Food product health warnings successfully promote dietary self-control.•ERP components P3 and LPP sensitive to food characteristics and health warnings•LPP amplitudes also directly predict dietary self-control.•Health warnings useful to reduce appetitive food responses in obesity prevention
The ligand for CD40 (CD40L) is a membrane glycoprotein on activated T cells that induces B cell proliferation and immunoglobulin secretion. Abnormalities in the CD40L gene were associated with an ...X-linked immunodeficiency in humans hyper-IgM (immunoglobulin M) syndrome. This disease is characterized by elevated concentrations of serum IgM and decreased amounts of all other isotypes. CD40L complementary DNAs from three of four patients with this syndrome contained distinct point mutations. Recombinant expression of two of the mutant CD40L complementary DNAs resulted in proteins incapable of binding to CD40 and unable to induce proliferation or IgE secretion from normal B cells. Activated T cells from the four affected patients failed to express wild-type CD40L, although their B cells responded normally to wild-type CD40L. Thus, these CD40L defects lead to a T cell abnormality that results in the failure of patient B cells to undergo immunoglobulin class switching.
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