Unlike hospice, long-term drug safety is an important issue in palliative medicine. Opioids may produce significant morbidity. Cannabis is a safer alternative with broad applicability for palliative care. Yet the Drug Enforcement Agency (DEA) classifies cannabis as Schedule I (dangerous, without medical uses). Dronabinol, a Schedule III prescription drug, is 100% tetrahydrocannabinol (THC), the most psychoactive ingredient in cannabis. Cannabis contains 20% THC or less but has other therapeutic cannabinoids, all working together to produce therapeutic effects. As palliative medicine grows, so does the need to reclassify cannabis. This article provides an evidence-based overview and comparison of cannabis and opioids. Using this foundation, an argument is made for reclassifying cannabis in the context of improving palliative care and reducing opioid-related morbidity.

Sleep disturbance is considered as an important symptom of acute and protracted opiate withdrawal. Current results suggest that sleep disturbance may be taken as a predictor of relapse. Appropriate sleep enhancement therapy will be in favor of the retention in treatment for opiate addicts. Our previous studies have shown that electroacupuncture (EA) is effective in suppressing morphine withdrawal syndrome. The aim of the present study is to investigate the effect of 2 and 100 Hz EA on the sleep disturbance during morphine withdrawal. Rats were made dependent on morphine by repeated morphine injections (escalating doses of 5-80 mg kg(-1), subcutaneously, twice a day) for 5 days. EA of 2 or 100 Hz was given twice a day for 3 days, starting at 48 h after the last morphine injection. Electroencephalogram and electromyogram were monitored at the end of the first and the last EA treatments, respectively. Results showed that non-rapid eye movement (NREM) sleep, REM sleep and total sleep time decreased dramatically, while the sleep latency prolonged significantly during acute morphine withdrawal. Both 2 and 100 Hz EA produced a significant increase in NREM sleep, REM sleep and total sleep time. It was suggested that EA could be a potential treatment for sleep disturbance during morphine withdrawal.

BACKGROUND:In male patients suffering from chronic pain, opioid administration induces severe hypogonadism, leading to impaired physical and psychological conditions such as fatigue, anaemia and depression. Hormone replacement therapy is rarely considered for these hypogonadic patients, notwithstanding the various pharmacological solutions available.

METHODS:To treat hypogonadism and to evaluate the consequent endocrine, physical and psychological changes in male chronic pain patients treated with morphine (epidural route), we tested the administration of testosterone via a gel formulation for one year. Hormonal (total testosterone, estradiol, free testosterone, DHT, cortisol), pain (VAS and other pain questionnaires), andrological (Ageing Males' Symptoms Scale-AMS) and psychological (POMS, CES-D and SF-36) parameters were evaluated at baseline (T0) and after 3, 6 and 12 months (T3, T6, T12 respectively).

RESULTS:The daily administration of testosterone increased total and free testosterone and DHT at T3, and the levels remained high until T12. Pain rating indexes (QUID) progressively improved from T3 to T12 while the other pain parameters (VAS, Area%) remained unchanged. The AMS sexual dimension and SF-36 Mental Index displayed a significant improvement over time.

CONCLUSIONS:In conclusion, our results suggest that a constant, long-term supply of testosterone can induce a general improvement of the male chronic pain patient's quality of life, an important clinical aspect of pain management.

BACKGROUND: Rapid Opiate Detoxification (ROD) is among the best treatments for substance abuse. Unfortunately this method is associated with severe withdrawal reaction. The effect of body acupuncture has not been clearly identified during ROD. This study was designed to evaluate the effect of acupuncture on the severity of withdrawal reaction during ROD. METHODS: Forty adult male subjects addicted to opioids and scheduled for ROD by naloxone were randomly divided into acupuncture and control groups. In the acupuncture group during three consecutive days immediately before induction of ROD, body acupuncture was performed while in the control group it was exempted. Severity of withdrawal reaction was assessed having recourse to Clinical Institute Narcotic Assessment (CINA) Score and compared between two groups. RESULTS: After induction of ROD, CINA score raised significantly during the consecutive days in both groups compared with baseline values but the rise was significantly lower in acupuncture group. CONCLUSIONS: The result of this study shows that body acupuncture reduces the severity of withdrawal symptoms associated with rapid opiate detoxification and it is recommended that this nonpharmacologic method of treatment should be included in ROD program.

BACKGROUND: Rapid Opiate Detoxification (ROD) is among the best treatments for substance abuse. Unfortunately this method is associated with severe withdrawal reaction. The effect of body acupuncture has not been clearly identified during ROD. This study was designed to evaluate the effect of acupuncture on the severity of withdrawal reaction during ROD. METHODS: Forty adult male subjects addicted to opioids and scheduled for ROD by naloxone were randomly divided into acupuncture and control groups. In the acupuncture group during three consecutive days immediately before induction of ROD, body acupuncture was performed while in the control group it was exempted. Severity of withdrawal reaction was assessed having recourse to Clinical Institute Narcotic Assessment (CINA) Score and compared between two groups. RESULTS: After induction of ROD, CINA score raised significantly during the consecutive days in both groups compared with baseline values but the rise was significantly lower in acupuncture group. CONCLUSIONS: The result of this study shows that body acupuncture reduces the severity of withdrawal symptoms associated with rapid opiate detoxification and it is recommended that this nonpharmacologic method of treatment should be included in ROD program.