Bibliographic record
Abstract
Although there are an estimated60 000–90 000 illicit opioidabusers1 in Canada, only about 25 % are currently receiving treatment.2 Methadone, a long-acting opioid ago-nist, is the treatment of choice for opi-oid dependence. However, although methadone is very effective, its use re-quires careful adherence to dosing guidelines and close monitoring be-cause its long half-life increases the risk of overdose. Buprenorphine, a rel-atively newer treatment option, may in-crease safety and treatment access for opioid-dependent patients. It also has a long half-life, but it is a partial µ-opi-oid receptor agonist and thus may carry less risk of overdose. Currently, buprenorphine is being used in several countries for the treatment of opioid dependence, and it should soon be available in Canada as an additional treatment option to methadone. Pharmacology: Buprenorphine is an opi-oid with high affinity for opioid recep-tors. It is a partial µ-receptor agonist as well as a kappa-receptor antagonist. µ-Opioid receptors mediate the common opioid effects such as analgesia, seda-tion, euphoria and respiratory depres-sion. As a partial µ-receptor agonist, buprenorphine may result in less seda-tion than full µ-opioid agonists such as methadone and morphine while still de-creasing cravings for other opioids and preventing opioid withdrawal. The clini-cal implication of the antagonist kappa receptor effect is not well understood, but it may result in buprenorphine hav-ing some mild antidepressant proper-ties. As a partial agonist, buprenorphine has a “ceiling effect”: there is a plateau to its opioid agonist effects at higher doses. Buprenorphine has a higher affinity for and lower intrinsic activity at opioid receptors than full µ-opioid agonists such as methadone, oxycodone and heroin. Hence, buprenorphine dis-places agonists from opioid receptors and may precipitate withdrawal in pa-tients physically dependent on opioids. The effect of buprenorphine peaks at 1–4 hours after the initial dose. Buprenorphine is metabolized mainly by cytochrome P4503A4 in the liver; its half-life is 24–60 hours. Although it is not yet approved for use in pregnancy, initial studies have shown that buprenoprhine is effica-cious, well tolerated and safe in preg-nancy. Neonatal withdrawal, as with other opioids, can occur. The current standard of care for opioid dependency in pregnancy is methadone treatment.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.012 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.002 | 0.004 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.431 | 0.209 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".