Journal of opioid management最新文献

Background: More patients are on chronic opioids, as patients who were initially started on full agonist opioids for cancer-related pain are living longer. Despite doing well from the cancer stand- point, some patients have difficulty tapering off their opioids because they have been taking them for years. Given the potential complications of chronic full agonist opioids, it is important to manage these patients in a safer way. However, there are various challenges including lack of education for patients and healthcare professionals and lack of product availability. Many healthcare providers do not have much formal training on initiating, maintaining, and tapering the various buprenorphine products. These providers may not be able to effectively educate patients given the lack of education. Also, patients research these products on their own and are hesitant to try them because of misinformation. Even if patients are informed thoroughly about buprenorphine, there are barriers to obtaining them including insurance denial and lack of product availability at pharmacies. Given the above challenges, easily accessible best practices as well as avenues for healthcare professionals to educate and guide each other are needed.

Purpose/hypothesis: Given the potential complications of chronic full agonist opioids, it is important to manage these patients in a safer way. However, there are various challenges including lack of education for patients and healthcare professionals and lack of product availability.

Conclusions/applications: Given the above challenges, easily accessible best practices as well as avenues for healthcare professionals to educate and guide each other are needed.

Background: Bone marrow transplant (BMT) offers potential cure for cancer and a spectrum of otherwise incur- able diseases. The BMT process can cause multi-systemic pain in patients with sickle cell disease (SCD) refractory to high-dose opioid analgesics during BMT because of their pre-existing opioid-tolerance. Because of frequent pain resulting in hyperalgesia and chronic opioid use, SCD patients undergoing BMT often experience excruciating pain uncontrolled by exceedingly high-dose opioids with severe and intolerable adverse effects.

Purpose/hypothesis: There is a small but growing body of literature about the successful buprenorphine effect for SCD's chronic pain management that had failed sufficient pain relief by the traditional full-agonist opioids in the outpatient setting. However, the buprenorphine use for acute inpatient pain management has not been previously researched. Pilot prospective clinical trial with buprenorphine-based pain management for acute BMT-related pain was initiated for SCD patients' pain uncontrolled by full-agonist opioids. Procedures/data/observations: Buprenorphine was started as scheduled and as-needed analgesics, supplemented by full-agonist opioids upon consultation for uncontrolled BMT-related pain of SCD patients. Patients' 24-hour opioid requirement by morphine equivalent daily doses (MEDD) were assessed at 3 time points: 1)immediately before pain escalation; 2)consultation; 3)discharge. MEDDs were compared to those of patients treated with full-agonist opioids only. Cases treated by full-agonist opioids (morphine/hydromorphone/fentanyl/methadone/oxycodone) had MEDD escalation by 1230-16300% by discharge compared to immediately before BMT-related pain escalation. Buprenorphine-supported cases had significantly smaller MEDD increase by 220-317%.

Conclusions/applications: Our case series suggests superior pain control by adding Buprenorphine prior to opioid dose escalation during BMT for SCD. Buprenorphine may provide the advantageous effect for other patients with complex pain background and experiencing difficult pain management during BMT due to pre-existing hyperalgesia and high opioid-tolerance. The evidence for buprenorphine's analgesic effect is moderate but growing, and more randomized controlled trials comparing the buprenorphine and other standard opioids are needed.

Objective: The purpose of this qualitative analysis was to better understand what pain management strategies adults with opioid-treated chronic low back pain (CLBP) found most helpful.

Design: A subgroup of participants from a larger randomized control trial of two psychological interventions were asked: "What helps your back pain?" at baseline and 12 months (exit) in brief, video-recorded interviews. Videos were analyzed using qualitative thematic content analysis utilizing Transana™.

Setting: Participants were recruited from the community and outpatient clinics in three United States sites.

Participants: Seventy-nine adults with long-term (≥3 months) opioid-treated (≥15 mg/day morphine equivalent) CLBP.

Main outcome measure(s): Participants' baseline and exit qualitative responses to the question "What helps your back pain?"

Results: At baseline, participants identified medication (n = 63), body position (n = 59), thermal application (n = 50), physical activity (n = 49), and stretching (n = 24) as the CLBP management strategies they found helpful. At exit, the reports of medication (n = 55), physical activity (n = 41), and stretching (n = 21) were often considered helpful for CLBP and remained relatively stable, while position (n = 36) and thermal application (n = 35) strategies were mentioned less frequently and psychological strategies (n = 29) were mentioned more frequently (up from n = 5) compared to baseline.

Conclusions: Over time, the reports of medication and active pain management strategies, eg, physical activity, remained stable, while the reports of some passive pain management strategies, eg, position and thermal, declined over time. Increased use of psychological strategies implies that study interventions were incorporated as useful pain self-management strategies.

Objective: This study aimed to determine whether there is a difference in pain scores and opioid consumption after elective surgery in patients maintained on methadone or buprenorphine for opioid use disorder (OUD). Additionally, we investigated the impact of continuing or discontinuing methadone or buprenorphine on post-operative pain outcomes.

Design: A single-center retrospective cohort study.

Setting: Tertiary care medical center.

Patients and participants: Adults aged 18 years or older with OUD maintained on buprenorphine or methadone who underwent elective surgery between January 1, 2017, and January 1, 2021.

Interventions: Patients were identified through electronic medical records, and demographic and clinical data were collected.

Main outcome measures: The primary outcome was opioid consumption at 24 hours post-operatively, measured in milligram morphine equivalents. The secondary outcome was opioid consumption and pain scores up to 72 hours post-operatively, assessed using a numeric rating scale.

Results: This study included 366 patients (64 percent on buprenorphine and 36 percent on methadone). Opioid utilization significantly increased when buprenorphine was not administered post-operatively. Both groups exhibited comparable total opioid consumption during the post-operative period. In the buprenorphine cohort, pain scores differed significantly based on the receipt of medications for OUD post-operatively.

Conclusions: This study reinforces existing evidence supporting the continuation of medications for opioid use disorder, specifically buprenorphine and methadone, during the perioperative period. Dissemination of guideline recommendations is essential to ensure optimal post-operative pain management for this patient population.

Objective: To determine if the agonistic effects of buprenorphine and methadone affect drug use.

Method: Quantitative examination of urine drug concentrations of patients treated with buprenorphine and methadone.

Results: Patients on buprenorphine had less opioid and methamphetamine drug use than those on methadone.

Conclusion: Patients on buprenorphine therapy appear to use less illicit drugs.

Objective: The purpose of this study was to evaluate the impact of pharmacist counseling on patients purchasing naloxone and to highlight reasons for naloxone purchase refusal.

Design: A multisite study that was conducted from September 15, 2022, to January 11, 2023.

Setting: Independent community pharmacies.

Patients/participants: Fifty patients met inclusion criteria. Data collected included demographics, preintervention knowledge assessment, post-intervention naloxone purchase, and reasons for naloxone refusal.

Outcome measures: The primary outcome was naloxone purchase after pharmacist education intervention. The secondary outcome was reasons for naloxone purchase refusal.

Results: The primary outcome showed that 60 percent of patients purchased naloxone after pharmacist intervention. As a secondary outcome, the number of patients who refused to purchase naloxone was 20 percent, with the majority of patients expressing that naloxone was not necessary as a reason for refusal.

Conclusion: More studies are needed in order to conclude the impact of pharmacist education on the increasing purchase of naloxone.

Transitioning a patient with chronic pain from a fentanyl patch to a buprenorphine patch has not been well described in the literature. Even after a patient removes their fentanyl patch, the residual fentanyl in the skin continues to be absorbed for hours. Due to the risk of precipitated withdrawal when initiating buprenorphine, this transition is a more challenging opioid rotation to plan safely. We report a case of a patient who had been using a fentanyl patch for over 10 years and was successfully rotated directly to a buprenorphine patch.

Objective: Early work suggests the type of subjective experiences upon first opioid use may predict opioid use disorder (OUD) risk. This study developed and pilot-tested a brief survey to evaluate the "first response" to opioids.

Design: A cross-sectional survey research study. The survey was administered to a subsample for the second time to assess test-retest reliability.

Setting: Outpatient.

Participants: Convenience sample of adults treated for OUD at an opioid treatment program.

Main outcome measures: A seven-question First Response to Opioids Survey Tool (FROST), developed based on the existing questionnaires and stakeholder-advisor feedback, was evaluated.

Results: Participants (N = 157) were 36.8 (standard deviation [SD] = 9.4) years old, with 79.6 percent identifying as Caucasian and 56.7 percent male. They reported opioid initiation at 20.6 (SD = 8.8) years old, with a prescription-based (78.3 percent), orally administered (66.2 percent), and illicitly procured (51.0 percent) opioids. Upon opioid initiation, positive-valence, euphoria-like subjective experiences of feeling "comfortable" (65.0 percent), "happy" (61.1 percent), "euphoria" (58.6 percent), and "energized" (44.6 percent) were common, and different (p < 0.05) from other types of subjective experiences. Among 64 individuals who answered a question about "drug-liking," 50 (78.1 percent) reported drug-liking. Among 31 respondents who completed the survey a second time, the test-retest consistency was 78.2 percent for subjective experience characteristics and 72 percent for drug-liking responses. Qualitative results corroborated quantitative findings.

Conclusion: These results suggest that euphoria-type experiences and drug-liking upon opioid initiation are common among adults with OUD and FROST's promising psychometric properties. Future research should assess clinical utility of this brief survey, which could be applied at bedside and help identify those at risk for OUD, guide safer opioid prescribing, and reduce opioid-related harm.

Background: The ravaging effects of the opioid epidemic have affected our communities locally and nationally and are multifaceted in their cause and treatment. It is imperative to locate multiple modalities of treatment options and care for patients with opioid use disorder (OUD) including developing healthy nutrition habits and addressing mental health concerns. Understanding patient perceptions of their personal nutrition habits and mental health status is imperative to providing holistic care in the OUD patient population.

Methods: An anonymous 31-question Likert-scale and multiple-choice survey was administered to patients with an International Classification of Disease (ICD-10) code in their electronic medical record of OUD (N = 124). χ² and Fisher's exact test where appropriate were performed to determine the demographics of survey participants who acknowledged history of OUD compared to those who did not acknowledge a history of OUD. Log-binomial models were used to generate adjusted prevalence ratios.

Results: Of the 117 patients identified using ICD-10 codes from their medical records as having OUD, only 63 patients acknowledged having a history of OUD, while 54 patients did not. A univariate analysis showed differences in marital status for patients with a self-identified history of OUD. They were also more likely to not be married (divorced or single) (p < 0.01). Patients also tended to be younger than 50 years of age (p < 0.01) and non-White (p < 0.01). There were no differences seen for patients with a history of OUD in the categories of employment (p = 0.31) status or sex (p = 0.51). Patients who acknowledged a history of OUD were significantly more likely to understand the relationship between a healthy diet and reducing the intensity of opioid cravings (p = 0.01) and more likely to consider using nutrition to help combat opioid cravings (p = 0.01). There were no significant differences in overall health or the use of supplements as a part of opioid use treatment. Significant differences were found between those acknowledging a history of OUD having higher rates of depression (p = 0.02) and anxiety (p = 0.02) treatment, despite there not being differences in condition rates for these two conditions (depression, p = 0.08; anxiety, p = 0.27) between the groups. Patients with patient-confirmed OUD were more likely to receive medication treatment (p = 0.03) than those without this acknowledgment.

Discussion: A similar disease burden of anxiety and depression existed for patients acknowledging OUD as opposed to patients denying OUD. However, significant differences existed between these groups in medication treatment, with those acknowledging OUD having higher rates of being treated for both depression and anxiety. Understanding a patient's mental health condition(s) can be impactful for the treatment of OUD. Multifaceted treatment option

Objective: Electronic prescriptions are now the standard of practice for all discharge and outpatient prescriptions. The intention is to increase patient safety, provide a more complete medication record for patients, lessen the burden on prescribers, and shorten the time it takes for medication orders to reach the pharmacy.

Design: This cross-sectional questionnaire survey study was conducted between January and August 2022 in three areas of a large urban safety net hospital.

Setting: A large single academic medical center.

Participants: Emergency department, inpatient clinicians, and procedural areas. The subjects of the study were trainees, attending physicians, and advance practice providers (APPs) Interventions: Data were collected from the participants using a self-reported questionnaire, including sociodemographic characteristics, ease of use, reliability, and preference. Additionally, the perception of the strengths and limitations associated with electronic prescribing (e-prescribing) were analyzed.

Main outcome measure: The purpose of this study was to evaluate the barriers to e-prescribing of opioids.

Results: A total of 121 prescribers completed the survey. The majority trusted that e-prescribing were transmitted successfully (62 percent), saved time (78 percent), and did not interrupt their workflow (78 percent). However, many prescribers indicated that additional improvements are needed, such as updating the patient's preferred pharmacy in the electronic medical record during each visit (52 percent) and having a 24-hour pharmacy readily available (66 percent).

Conclusion: Prescribers value the ease of use of e-prescribing and how time efficient the process can be. Nevertheless, there is a need to improve the system's service, design, and usefulness.