Journal of opioid management最新文献

Objective: To determine the influence of various opioid analgesics on the incidence of post-operative delirium (POD) by analyzing all available, relevant -literature.

Design: A database search containing keywords assessing opioids and POD was performed in Embase, Web of Science, and MEDLINE-PubMed. Retrieved studies were screened via Rayyan, and adjusted odds ratios (ORs) for associations between opioid analgesia and POD were extracted, with two-sided p-values < 0.05 being deemed significant.

Results: A total of 7,700 patients were analyzed, of which 1,703 developed POD, indicating an incidence of 22.1 percent. Random effects meta-analysis based on 95 percent confidence intervals reveals that opioid use (OR 1.15, 1.09-1.22, p < 0.001), specifically with meperidine (OR 3.36, 1.36-8.32, p < 0.009) or morphine (OR 1.42, 1.29-1.57, p < 0.001), is associated with increased incidence of POD. Furthermore, both perioperative (OR 1.10, 1.04-1.16, p < 0.001) and post-operative opioid administration (OR 1.92, 1.25-2.95, p < 0.003) were also associated with increased risk of POD.

Conclusion: Opioid analgesics were associated with higher incidences of POD. Not all opioids increased the incidence of delirium. Elderly and renally impaired patient populations were at higher risk for developing opioid-related POD. Careful selection and judicious utilization of opioid analgesics may reduce the incidence of POD and ultimately the burden on the healthcare system.

Objective: To evaluate a professional, peer-based mentorship program implemented from 2019 to 2023 to increase providers's confidence and capacity to prescribe medications for opioid use disorder (OUD).

Design: The program was evaluated using baseline, endline, and follow-up -surveys.

Setting: Arizona, United States.

Participants: Fifteen experienced medication-assisted treatment (MAT) providers were matched with 50 new MAT providers.

Interventions: Experienced and less experienced MAT providers engaged in semistructured collaborations through virtual, one-to-one consultation sessions.

Main outcome measures: Provider confidence, likelihood to prescribe buprenorphine, and long-term MAT service delivery.

Results: New providers reported a 73 percent increase in confidence in delivering MAT services and a high likelihood of starting or increasing MAT service delivery. Follow-up data indicated sustained improvements in confidence and service delivery; 57 percent of new providers reported increasing the number of patients treated with MAT.

Conclusions: Semistructured, peer-based mentorship can increase provider confidence and sustained OUD treatment provision.

Objective: To explore buprenorphine treatment characteristics and rescue medication utilization in Medicare-insured chronic low back pain (cLBP) patients prescribed buprenorphine buccal film (Belbuca®) or buprenorphine patch.

Design: A retrospective real-world analysis using Merative MarketScan® Medicare Supplemental and Coordination of Benefits claims database (from January 1, 2018, to December 31, 2021). The first Belbuca or transdermal patch prescription was considered the index date. Patients were observed 6 months pre- and post-index. Exclusion criteria were gap in insurance coverage, opioid use disorder, or cancer during the observation.

Setting: All levels of clinical care.

Patients: Patients with cLBP (at least two preindex claims with low back pain diagnosis). Propensity-score matching was performed to balance cohorts for covariates.

Interventions: Belbuca and buprenorphine transdermal patches.

Main outcome measures: Buprenorphine treatment characteristics and rescue medication utilization.

Results: There were 97 matched patients (36 Belbuca, 61 patch). Buprenorphine daily dose was higher in Belbuca (450 mcg vs 260 mcg, p = 0.001), with a wider dosing range (75-1,213 mcg vs 120-716 mcg). Comparing preindex to post-index, initiating Belbuca decreased Schedule II opioid (5.1 vs 3.6, p = 0.038) and long-acting opioid prescription counts (0.8 vs 0.1, p = 0.031), Schedule II opioid treatment duration (103 vs 77 days, p = 0.012), and daily morphine milligram equivalents (42.8 vs 30.4, p = 0.048). In the patch cohort, starting buprenorphine only decreased Schedule II opioid (2.9 vs 4.0, p = 0.014) and short-acting opioid prescription counts (3.7 vs 2.9, p = 0.044).

Conclusion: The real-world evidence suggests that elderly cLBP patients may have greater benefits from Belbuca compared to the patch by achieving higher buprenorphine daily doses and decreasing opioid rescue medication use.

Aims: To report findings from a national survey of dentists regarding their -naloxone distribution practices.

Design: Cross-sectional, national electronic survey.

Settings: United States, National Dental Practice-Based Research Network (National Dental PBRN).

Participants: A national sample of 790 dentist members of the National Dental PBRN in active clinical practice.

Main outcome measures: The Substance Use Disorders Screening (SUDS) survey assessed dentists' willingness to distribute naloxone to adult patients. SUDS survey data were merged with existing National Dental PBRN Enrollment Questionnaire data regarding practitioner's demographics and practice characteristics.

Results: A minority of dentists (8.8 percent) reported currently distributing -naloxone in their practice. Nearly half of the remaining respondents reported being either very willing (n = 121; 16.9 percent) or moderately willing (n = 235; 32.9 percent) to distribute naloxone in the future. Current distribution and future willingness were associated with younger practitioner age. Future willingness to distribute naloxone is presented as a function of additional practice and practitioner characteristics and was associated with self-reported frequency of screening, counseling, and referring for substance use disorders.

Conclusions: Younger dentists and those practicing in government settings were more likely to be current distributors of naloxone, likely a result of intentional -programing currently implemented in dental school and government practice -settings to increase naloxone education and distribution. Nearly half of the dentists not currently distributing naloxone indicated a willingness to distribute naloxone in the future, and current findings aid in the identification of opportunities to scale outreach, training, and practice supports for those dental practices willing to serve as distribution points for their patients.

Objective: To describe patients and visits with identified, probable opioid use disorder (OUD) in Los Angeles County's (LAC) safety-net system and examine rates of naloxone and buprenorphine prescribing across healthcare settings.

Design: A descriptive analysis of electronic health record data.

Setting: LAC's largest safety-net provider, the LAC Department of Health Services.

Patients: This study included 3,881 patients with 5,580 visits involving probable OUD from July 2022 to June 2023.

Main outcome measures: Visit-level analysis was performed to identify treatment settings where patients accessed care. We compared rates of buprenorphine and naloxone prescription across treatment settings using Chi-square tests and 95 percent confidence intervals.

Results: Visits with identified OUD most often occurred in outpatient settings (36 percent) compared to inpatient (31 percent), emergency (24 percent), or urgent care (8 percent) settings. Overall, 35.8 percent of visits included a naloxone prescription, and 30.4 percent included a buprenorphine prescription. Prescription rates varied significantly by treatment setting.

Conclusions: Most visits with probable OUD did not include naloxone or buprenorphine prescriptions, and prescription receipt varied by setting.

Objective: This study aims to analyze clinical features and factors related to lifetime suicidal behaviors (SBs) among outpatients with opioid use disorder (OUD).

Design: A descriptive cross-sectional study.

Setting: Outpatient center for addiction treatment.

Participants: Patients with OUD (n = 329) who were seeking a new treatment process between January 1, 2010, and December 31, 2021.

Interventions: Patients were evaluated with an ad hoc questionnaire and the European Addiction Severity Index.

Results: Lifetime suicidal ideation (SI) and suicide attempt (SA) were reported by 54.4 and 35.0 percent of participants, respectively. Lifetime SI and SA were associated with several clinical factors including any type of lifetime abuse, the number of lifetime substance use disorders, alcohol use disorder, and the number of psychiatric comorbidities.

Conclusions: The findings underscore the importance of systematic evaluation and intervention for SB among OUD patients, warranting attention in suicide prevention strategies. Further specific longitudinal studies with larger sample sizes are needed to enhance understanding of this issue.

Objective: To present the conversion ratios used for transitioning from conventional short-acting opioid (CSO) to methadone in a diverse pediatric population at methadone initiation and steady state. Oral-to-intravenous methadone conversion ratios were measured as an exploratory objective.

Design: This study is a retrospective descriptive review that spans a 13-year period from January 1, 2010, to March 31, 2023.

Setting: The study was conducted in a quaternary pediatric university healthcare center and included patients from general and specialized pediatric wards.

Patients: All patients who were initially treated with CSO and subsequently switched to methadone for pain, 3 months to 18 years old, were included. Neonates, patients treated with methadone for less than 48 hours, and patients treated with methadone for opioid use disorder were excluded.

Interventions: Switch from CSO to methadone for treatment of pain.

Outcome measures: Conversion ratios from CSO to methadone were calculated at initiation, on day 3, and on day 5 after the conversion.

Results: Sixty-five patients, aged 10.6 years, were identified, the majority of whom were treated for neuropathic or mixed-type pain. Treatment duration was 184 days on average (median 79 days). Methadone doses ranged from 0.1 to 300 mg/day (0.01-10.72 mg/kg/day). Initial conversion ratios from oral morphine equivalent doses to methadone ranged from 0.64 to 162:1.

Conclusions: Similar to the adult studies, we describe dose-dependent conversion ratios. Progressive titration of methadone was observed with high CSO doses, while low initial CSO doses had stable conversion ratios from the beginning. We have also highlighted the importance of a full 5-day switching period for patients with high CSO doses.

Objective: This study evaluated the efficacy of weekly shared medical appointments (SMAs) for opioid prescribing in addressing adherence, aberrance, and noncompliance in chronic pain patients receiving long-term opioid therapy (LTOT).

Design: A retrospective observational study.

Setting: This study was conducted as a structured intervention within a community pain specialty clinic that introduced a monitoring system over 12 months.

Participants: A total of 355 patients on LTOT were included, of whom 70 were identified as high-risk (Red status) due to noncompliance with opioid use policies.

Interventions: Patients attended monthly telemedicine shared medical opioid education appointments delivered by pain specialists that aimed to increase adherence to practice standards. A stratified risk management approach was used, with patients categorized as Green, Yellow, or Red based on adherence behavior.

Main outcome measure(s): Primary outcome measures were changes in compliance status (Red to Yellow or Green), opioid prescription changes (morphine milligram equivalent, MME), and overall patient adherence improvement.

Results: Of the 70 patients in Red status, 54 percent transitioned to Green status after weekly SMA participation. The median MME was reduced from 200 to 32. The most significant changes occurred among Red status patients, with 54 percent tapering off opioids completely. Compliance improved from 80 to 90 percent across all LTOT patients.

Conclusions: Weekly shared medical appointments significantly improved adherence and compliance among LTOT patients. The program highlights the utility of frequent touchpoints in managing high-risk patients and offers an adaptable model for other pain management clinics.

Opioid medications have become increasingly prescribed in recent decades due to their sedative and analgesic properties, making them common treatments for pain management. However, prolonged use of these opioids is associated with serious side effects, including respiratory depression, overdose, dependence, and tolerance. In response, research into safer alternatives has focused on opioid-like compounds, particularly endogenous and exogenous opioid peptides, which are produced in the body or derived from the enzymatic digestion of food proteins. These peptides function as neuromodulators, regulating various physiological processes such as pain, emotion, and attachment behavior by interacting with three major G protein-coupled receptors: µ, κ, and δ. Endogenous opioid peptides, such as endorphins, enkephalins, and dynorphins, are generated from precursor molecules through proteolytic cleavage and play key roles in pain modulation and analgesia. Opioid peptides-including both endogenous and exogenous forms from animal or plant sources, as well as synthetic analogs-exhibit complex pharmacology with diverse effects on living systems, often producing complementary or opposing physiological responses. This review highlights significant discoveries regarding the peptide sequences and structural modifications of opioid peptides, emphasizing the need for continued research to fully elucidate their roles in human behavior and their potential as safer therapeutic alternatives to traditional opioids.

Objectives: To evaluate the effectiveness of transitioning patients from methadone to buprenorphine/naloxone (BUP/NLX) using morphine milligram equivalent (MME) dosing, with a focus on treatment adherence, withdrawal management, and therapeutic response, as illustrated through two patient case studies.

Methods: Two participants (male, 33 years; female 42 years) were treated between June 2023 to January 2024 for opioid use disorder, undergoing BUP/NLX induction from methadone in an opioid treatment program. MME low-dose initiations were utilized for dosage conversion. Data collected included patient demographics, vital signs, Clinical Opiate Withdrawal Scale assessment, MME low-dose initiation calculations, adverse events, treatment adherence, and outcomes.

Results: MME dosing was based on initial methadone dosage and standard MME conversion ratios. Case 1: Sublingual BUP/NLX was started at 0.5 mg, increased to 0.5 mg twice daily by day 3, and titrated until day 17; methadone (24 mg) was tapered off by day 17. Case 2: A similar initiation and tapering process was followed; methadone (11 mg) was discontinued by day 12. Both cases achieved stabilization on BUP/NLX without severe adverse events or precipitated withdrawal symptoms.

Conclusions: MME low-dose initiations appear to be a feasible and safe method for BUP/NLX induction. Further research involving patients on higher methadone doses and larger sample sizes, along prospective designs, is necessary to validate these findings and explore the long-term effectiveness and safety of MME-guided induction protocols across various clinical settings.