Journal of opioid management最新文献

Objectives: To investigate post-operative opioid use following a total hip arthroplasty (THA) in metastatic bone disease (MBD) patients and identify factors associated with post-operative opioid use at 6 weeks and 90 days.

Background: MBD commonly affects the hip, and surgical intervention including THA may be indicated for pain relief or to improve function. Following THA, patients are often prescribed short courses of opioids for post-operative pain relief. No study has evaluated opiate use following THA in patients for MBD.

Methods: This was a retrospective review of patients using opioids preoperatively who underwent primary THA for MBD at two institutions between 2009 and 2022. Preoperative and post-operative opioid usages, respectively, at 6 weeks and 90 days were quantified through calculating daily morphine milligram equivalents (MMEs) and compared using the sign test. Factors associated with post-operative opioid use at 6 weeks and 90 days were compared using χ2 test or Fisher's exact test as appropriate.

Results: Nineteen THA and 11 THA with complex acetabular reconstruction were included. At 6 weeks, 26 (86.7 percent) patients were utilizing opiates, and at 90 days, 23 (76.7 percent) patients were utilizing opiates. There was a statistically significant difference between median daily preoperative MME compared to daily MME at 90 days (p < 0.001). The only statistically significant association with opioid use at 90 days was opioid use at 6 weeks.

Conclusion: To our knowledge, this is the first paper evaluating post-operative opioid use following primary THA in MBD patients. After THA in the setting of MBD, patients exhibit decreased post-operative opioid use. Future studies with larger cohorts should be conducted to characterize post-operative opioid use following joint arthroplasty in MBD patients.

Objective: This analysis seeks to understand variables within our institution that impact pain management agreement (PMA) utilization for chronic noncancer pain (CNCP).

Design: Retrospective chart review.

Setting: Public academic medical center.

Patients: Adults prescribed an opioid for CNCP between July 2020 and October 2020.

Main outcome measure: We assessed the association between patient demographics, prescription factors, and prescriber factors with the presence of a PMA. Unadjusted rates and chi-square tests were generated for each predictor. Additionally, we performed two multivariable logistic regressions: one including all variables and another utilizing a stepwise forward variable selection process to further understand the relationships between predictors and the presence of a PMA.

Results: 49.7 percent of patients who received an opioid for CNCP had a PMA on file. One significant predictor of the presence of PMA was prescriber specialty with anesthesia/pain medicine, demonstrating 88 percent compliance. Compared to anesthesia/pain medicine, patients receiving opioids from internal medicine had an odds ratio (OR) of 0.155 (95 percent confidence interval (CI), 0.109-0.220), while patients receiving opioids from family medicine had an OR of 0.122 (95 percent CI, 0.090-0.167). Additionally, patients who received schedule II opioids (as opposed to schedule III/IV opioids), patients with multiple opioid fills in 3 months, middle aged patients, and Black patients were more likely to have a PMA.

Conclusions: Compliance with PMA within our institution was only 49 percent despite an existing state law mandating use. Our analysis suggests quality improvement interventions should target patients on schedule III/IV opioids who receive their prescriptions from primary care providers.

Objective: Tapentadol is an atypical opioid analgesic thought to have dual mechanisms of action: µ-receptor agonism and inhibition of norepinephrine reuptake. Unlike other atypical opioids, tapentadol is a schedule II-controlled substance. We compared the prevalence of abuse (use to get high) of tapentadol to other atypical opioids used to treat pain (buprenor-phine and tramadol).

Design: An observational, serial cross-sectional study.

Setting: Individuals enrolling in treatment programs for opioid use disorder in 2019. Each completed a self-administered, paper questionnaire assessing prescription drug abuse and illegal drug use within 1 week of enrollment.

Main outcome measures: Indication of past month abuse of tapentadol or comparator drugs on a self-administered ques-tionnaire.

Results: There were 6,987 respondents. Unadjusted and utilization-adjusted logistic regression models were used to compare odds of endorsement of tapentadol to tramadol and buprenorphine products indicated for the management of pain. Unadjusted abuse prevalence was 0.20 percent for total tapentadol (0.03 percent for NUCYNTA® and 0.06 percent for NUCYNTA ER). Relative to total tapentadol, the odds of abuse of buprenorphine for pain was 2.9 times greater (95 percent CI: 1.6 to 5.3, p < 0.001), and for tramadol, 43.1 times greater (95 percent CI: 25.3 to 73.3, p < 0.001). Adjusting for prescriptions dispensed, differences in odds of abuse were not statistically significant (odds ratio (OR) = 1.6, 95 per-cent CI: 0.9 to 3.0, p = 0.108 for buprenorphine for pain and OR = 0.7, 95 percent CI: 0.4 to 1.2, p = 0.209 for tramadol).

Conclusions: Tapentadol use to get high is less frequent than other atypical opioids. Findings suggest tapentadol is rarely the primary drug abused by an individual.

Objective: Persons with HIV (PWH) frequently receive opioids for pain. Health literacy and trust in provider may impact patient-provider communication, and thus receipt of guideline-concordant opioid monitoring. We analyzed baseline data of HIV-positive patients on chronic opioid therapy (COT) in a trial to improve guideline-concordant COT in HIV clinics.

Design: Retrospective cohort study.

Setting: Two hospital-based safetynet HIV clinics in Boston and Atlanta.

Patients and participants: A cohort of patients who were ≥18 years, HIV-positive, had received ≥ 3 opioid prescriptions from a study site ≥21 days apart within a 6-month period during the prior year and had ≥1 visit at the HIV clinic in the prior 18 months.

Main outcome measures: Adjusted logistic regression models examined whether health literacy and trust in provider (scale scored 11-55, higher indicates more trust) were associated with: (1) ≥ 2 urine drug tests (UDTs) and (2) presence of an opioid treatment agreement.

Results: Among 166 PWH, mean trust in provider was 47.4 (SD 6.6); 117 (70 percent) had adequate health literacy. Fifty patients (30 percent) had ≥ 2 UDTs and 20 (12 percent) had a treatment agreement. The adjusted odds ratio (aOR) for a one-point increase in trust in provider was 0.97 for having ≥ 2 UDTs (95 percent CI 0.92-1.02) and 1.03 for opioid treatment agreement (95 percent CI 0.95-1.12). The aOR for adequate health literacy was 0.89 for having ≥ 2 UDTs (95 percent CI 0.42-1.88) and 1.66 for an opioid treatment agreement (95 percent CI 0.52-5.31).

Conclusions: Health literacy and trust in provider were not associated with chronic opioid therapy quality outcomes.

Introduction: Although many drugs are implicated in the crisis, opioids and concomitant sedatives are associated with increased overdose risk in both rural and urban communities. Individuals in rural areas are up to 5-fold more likely to experience adverse outcomes related to opioids. The primary objective of this study was to evaluate concomitant use of opioid and benzodiazepine prescriptions in Texas, compare metropolitan and rural differences, and use these data to inform clinicians and to help develop harm reduction strategies.

Methods: Prescribing data were extracted from the Texas Prescription Drug Monitoring Program (PDMP) public use data file, the statewide monitoring program administered by the Texas State Board of Pharmacy. An overlapping drug combination prescription day was defined as any day in which a patient had at least one of the overlapping drug types-eg, opioid + benzodiazepine, opioid + benzodiazepine + carisoprodol.

Results: In Texas, 47.4 percent of the counties with the highest number of overlapping days (per patient) bordered other states. Providers who practice in rural areas prescribe opioid and benzodiazepine medications with 8.2 more overlapping days per quarter.

Discussion: Taking both opioid and benzodiazepine prescriptions is associated with increased overdose risk. Opioid prescription data provide a distinct view into the opioid epidemic that allows all states and counties to view the trends of opioid utilization. There are only a few studies using PDMP data to compare urban and rural trends.

Conclusions: Rural patients had more benzodiazepine and opioid days overlap than urban patients. The prevalence is higher among older adults and providers who practice in rural areas (average 8.2 more days per quarter). Our findings in Texas indicate a trend downward in overlap for both rural and urban areas over the last year of measurement. However, rural areas are still significantly higher.

Objective: This study aims to assess associations between morphine-equivalent daily dose (MEDD) of opioids, clinician and patient characteristics, and prescriber adherence to guidelines for long-term opioid therapy (LTOT) in chronic noncancer pain (CNCP) and to elucidate potential relationships associated with increased-risk opioid prescribing.

Design: Retrospective cross-sectional study.

Setting: Academic health system's 33 primary care clinics.

Patients: Adults (≥18 years old) prescribed LTOT (10 + outpatient prescriptions in the past year) for CNCP.

Main outcome measure(s): Electronic health record data on prescribed opioids (for MEDD), clinician/patient characteristics, and adherence rates to LTOT guideline-concordant recommendations.

Results: A total of 2,738 patients were eligible, 61.6 percent Lower, 15.7 percent Moderate, and 22.7 percent Higher Risk MEDD (<50, 50-89, and ≥90 mg/day, respectively). Higher MEDD correlated (p < 0.001) with Medicare insurance, current cigarette smoking, higher pain intensity and interference scores, and the presence of opioid use disorder diagnoses. Male clinicians more frequently prescribed (p < 0.001) and male patients were more likely to be prescribed (p < 0.001) higher MEDD compared to their female counterparts. Higher Risk MEDD was associated with higher coprescribed benzodiazepines (p = 0.015), lower depression screening (p = 0.048), urine drug testing (p = 0.003), comparable active treatment agreement (p = 0.189), opioid misuse risk screening (p = 0.619), and prescription drug monitoring checks (p = 0.203).

Conclusions: This study documented that higher MEDD was associated with risks of worse health outcomes without improved adherence to opioid prescribing guideline recommendations. Enhanced clinician awareness of factors associated with MEDD has the potential to mitigate LTOT risks and improve overall patient care.

Objective: To review the current literature surrounding the relationship between adverse childhood experiences (ACEs) and opioid use disorder (OUD) to guide clinical identification of high-risk individuals and assess treatment implications.

Design: A PubMed search was conducted from the year 2000 to 2022 using a series of primary and secondary search terms. A total of 21,524 unique results were screened for relevancy to ACEs and OUDs. After excluding unrelated articles, a total of 48 articles were included in this systematic review.

Results: Increased frequency of ACEs was directly related to increased risk of OUD and lower onset age. ACEs were also associated with OUD severity. ACEs linked to OUD included childhood neglect, emotional abuse, physical abuse, and sexual abuse. Additionally, dysfunctional childhood home environment, female gender, and psychiatric/behavioral comorbidities increased the risk of OUD, while resilience was found to be a protective factor. Multiple biochemical markers were associated with both ACEs and OUD.

Conclusions: Children experiencing multiple ACEs should be the target of preventative intervention by medical professionals. Clinicians should include ACEs in their opioid misuse risk assessment. High incidence of co-occurring psychiatric/behavioral disorders provides multiple treatment avenues for patients with OUD. Resilience, along with being therapy target, should be fostered early in the life course. Incorporation of family members may improve opioid abuse treatment outcomes. Future research should focus on interventions interrupting the progression of ACEs to OUD along with proposed biochemical pathways.

Background: We hypothesized that chronic opioid users would likely have worse outcomes with COVID-19 infection.

Methods: A retrospective review of electronic medical records was conducted for all COVID-19 patients admitted in two large academic hospitals in New York City from March 1, 2020 to June 30, 2020 during the onset of the COVID-19 pandemic. A total of 1,361 patients (1,289 opioid naïve patients, 72 with chronic opioid use) were included. A propensity score matched analysis was used to create a dataset. A logistic regression using the generalized estimating equations method was used to evaluate oxygen requirements including bilevel positive airway pressure (BiPAP), high flow nasal cannula (HFNC), and mechanical ventilation (MV). Cox models with random match pairs were fitted for time spent until hospital discharge and in-hospital mortality.

Results: The propensity score matched analysis did not demonstrate a significant difference between the chronic opioid use group vs the opioid naïve group for the use of oxygen support (p = 0.439), BiPAP (p = 0.377), HFNC (p = 0.978), or MV (p = 0.080), and length of stay (LOS) (p = 0.950). There was also no statistically significant finding for reduced need for MV (odds ratio 0.42, 95 percent CI: 0.16-1.11, p = 0.080) and lower in-hospital mortality (hazard ratio 0.75, 95 percent CI: 0.39-1.43, p = 0.378) in the chronic opioid use group; however, future larger studies will be needed.

Conclusions: Our study did not demonstrate a significant difference in outcomes in patients with COVID-19 with preadmission chronic opioid use vs opioid naïve patients in oxygen requirements, LOS, MV, or mortality. Future studies are needed to further illustrate the impact of opioids on COVID-19 outcomes.

Objectives: (1) To explore the characteristics of patients with opioid use disorder (OUD) maintained on either methadone or buprenorphine and (2) to determine the relative acceptability of integrating Tai Chi (TC) practice into an ongoing medication-assisted treatment for opioid use disorder (MOUD) program.

Design: Survey study.

Setting: The University of Arkansas for Medical Sciences Center for Addiction Services and Treatment Program.

Patients: 97 patients receiving MOUD treatment.

Main outcomes: Drug use history, treatment status, physical limitation, mental health, pain, and whether participants were interested in using TC to improve health outcomes.

Results: At least 30.9 percent of the sample reported moderate or higher level of limitation in performing rigorous physical activities, pain intensity, and pain interference. Between 37.1 and 61.5 percent of the sample reported various psychiatric symptoms. Methadone patients reported higher levels of physical limitations, especially in rigorous activities (p = .012), climbing several flights of stairs (p = .001), and walking more than a mile (p = .011), but similar levels of pain (ps = .664-.689) and psychiatric symptoms (ps = .262-.879) relative to buprenorphine patients. At least 40.2 percent of participants expressed moderate or higher level of interest in TC for improving health outcomes, with methadone patients more interested in participating to ease mental and sleep problems (p = .005) and improve physical fitness (p = .015) compared to buprenorphine patients.

Conclusions: High prevalence of physical limitation, pain, and psychiatric comorbidities were found in OUD patients. Since patients were interested in TC to improve their health outcomes, this low-cost intervention, if proven effective, can be integrated into ongoing MOUD programs to improve health in this population.