Journal of opioid management最新文献

The effect of chronic marijuana use on patients is unknown, including in the surgical setting. Marijuana produces many effects on the body, which should be considered when providing medical care. Chronic marijuana use may affect surgical opioid requirements. To explore this possibility, an observational study was completed by conducting a retrospective chart review of patients who underwent surgery with general anesthesia. Patients were identified in the electronic medical record via self-reporting as marijuana users (users) or nonmarijuana users (nonusers). Users and nonusers were case-matched based on age, gender, weight, and procedure. After case matching, 570 patients' charts were analyzed, and intraoperative opioid, intraoperative propofol, and post-anesthesia care unit opioid requirements were compared. Marijuana users required less intraoperative opioids (mean [standard deviation (SD)] 27.2 [20.5] morphine milligram equivalents [MMEs]) compared to those who were marijuana nonusers (31.3 [22.1] MME). These results show a statistically significant difference in the intraoperative opioid requirement between case-matched users and nonusers (p = 0.02), with p = 0.013 after statistical adjustment for racial differences between the marijuana user and nonuser cohorts. Users and nonusers required similar amounts of intraoperative propofol (242.2 [220.2] and 257.8 [250.9], respectively) and post-operative opioids (7.3 [6.0] and 8.0 [9.0], respectively). The differences in intraoperative propofol and post-operative opioid requirements were not different statistically with p-values of 0.43 and 0.31, respectively. Based on this study population, marijuana users required less intraoperative opioids when compared to case-matched marijuana nonusers, with no difference in intraoperative propofol or post-operative opioid requirements. Perspective: Typical preoperative screening includes queries about patient substance use including marijuana, but details such as frequency and length of use are infrequently asked. The addition of these details to the assessment may provide improved understanding of a patient's surgical opioid requirements.

Opioids pose significant risks of addiction due to the cyclical nature of serum opiate concentration associated with traditional dosing methods. Emerging technologies, including closed-loop feedback control systems, offer a promising solution by enabling dynamic, real-time microdosing that minimizes fluctuations in drug levels and reduces the risk of dependency. Drawing on advancements in biosensors and feedback systems used in other medical applications, these innovations could revolutionize pain management, potentially reducing opioid addiction rates by up to 87 percent compared to current oral administration methods.

Introduction: Intravenous methadone has shown an opioid-sparing effect in high-risk surgeries. It was hypothesized that intrathecal methadone might provide better effects than intravenous administration due to a direct action on the spinal cord.

Main objective: To search the currently published literature on the intraoperative use of intrathecal methadone in humans, a systematic review was conducted.

Design: Studies from PubMed, Scopus, OVID, EMBASE, LILACS, Google Scholar, ELSERVIER, REDALYC, SciELO, Europe PubMed Central, and the Cochrane Library were searched from 1980 to June 2024. Search terms included "intrathecal methadone or spinal methadone," "methadone and spinal anesthesia," "spinal anesthesia," "intraoperative period," and "perioperative period." Randomized controlled trials (RCTs) published in English and Spanish involving human participants were considered.

Main outcome: The quality of post-operative analgesia measured by the Visual Analog Scale (VAS).

Secondary outcomes: Time to first opioid analgesic rescue, post-operative daily needs of morphine equivalents, and side effects.

Results: Forty-one articles were identified. Good agreement intra- and intergroup was found. Four full-text articles met the inclusion criteria. Quality assessment showed an overall low to "some concern" risk of bias. Intrathecal methadone 5-10 mg provided post-operative pain for about 6 hours (VAS average of 2.4/10) after knee and hip replacements, urological, and gynecological surgeries showing minimal side effects. Twenty milligram of intrathecal methadone can produce remarkable side effects. Intrathecal morphine at 0.5-1.0 mg showed significantly lower VAS levels during the 24 hours post-operatively (p < 0.05) but showed more side effects. Intrathecal anesthesia with methadone as adjuvant showed a longer analgesic effect than fentanyl, and better effect than placebo, without differences in side effects (p < 0.05).

Conclusions: Due to the limited sample size and the small number of selected RCTs showing significant methodological differences, a meta-analysis could not be completed. Therefore, overall statistical significance was not established between the four studies, and there is not enough evidence to give recommendations. Further research is needed to evaluate whether the doses found in this review retain comparable efficacy and safety profiles in a broader range of patient cohorts. In the reviewed literature, no objective or conclusive evidence of neurotoxicity was found from the use of a single dose of perioperative intrathecal methadone.

Background: The World Health Organization pain ladder treatment is recognized as the gold standard for moderate and severe chronic cancer pain palliation in hospitalized patients. The third step of this treatment includes powerful opioid agents, which in our case are morphine and fentanyl.

Methods: The primary purpose of our study is to measure pain symptom relief by evaluating the pain scores after intravenous continuous infusion of these opioids in palliative care unit to ensure pain control of the patients. Our second main goal is to compare the morphine equivalent dose (MED) administered to both groups within 72 hours. Our study aimed to compare the frequency of side effects in both groups within 72 hours. The prospective observational study included 67 patients, who included inclusion and exclusion criteria. In respect of the opioid being infused, patients were distributed into Fentanyl (n = 33) and Morphine (n = 34) groups. Patients who were admitted to the palliative care unit were administered a continuous intravenous infusion of morphine or fentanyl. Continuous infusion was administered for 3 days in the hospital. An elastomeric intravenous pump was used for infusion. Taking into account the opioid agents and their doses, consumed by the patient prior to hospital admission, equal doses were calculated for both fentanyl and morphine consumers. For the management of breakthrough pain, 5-15 percent of the daily opioid dose was administered in both groups. Daily pain scores, breakthrough pain scores, basal infusion doses, breakthrough pain doses, laboratory tests, and hemodynamic parameters of the patients were recorded.

Results: Total opioid dose as well as MED and visual analogue scale/numerical rating scale (VAS/NRS) reduction was statistically lower in the fentanyl group (p: 0.000; p < 0.05). There was no significant difference in terms of adverse effects.

Conclusion: The study demonstrates that the total consumption of opioids is approximately 70 times higher in the morphine group. The total MED in the fentanyl group is seven times lower than that in the morphine group. Thus, we suggest parenteral administration of fentanyl as a more advantageous alternative to morphine, and we believe that larger, randomized prospective research studies should be conducted on this subject.

Objective: To evaluate the percentage of family medicine providers in our institution on completing the 8-hour required training on opioid and substance use disorders 14 months after introduction of the Medication Access and Training Expansion (MATE) Act and to evaluate buprenorphine prescribing attitudes.

Design/setting: An anonymized survey was electronically sent to all family medicine providers in a single institution in Minnesota, spanning five outpatient and two express care clinics. Survey was deployed for 2 weeks, August 26-September 8, 2024.

Outcome measures: Provider completion of MATE Act training and comfort level in prescribing buprenorphine for opioid use disorder (OUD).

Results: A total of 41 out of 127 providers completed the survey (31.5 percent). Although 76 percent respondents completed the training, only half felt comfortable seeing patients with OUD on buprenorphine, writing a bridge prescription, or initiating buprenorphine.

Conclusions: Findings suggest that elimination of the x-waiver and enactment of required training are insufficient to positively affect buprenorphine prescribing comfort level.

Oliceridine is the first Food and Drug Administration-approved biased opioid agonist, approved in 2020 for managing moderate to severe acute pain in adults in controlled clinical settings. The advantages of the drug are its potency and decreased opioid-related adverse effects compared to morphine. The rationale for its potency, and especially the decreased adverse effects, is its purported preferential G protein signaling over β-arrestin recruitment, favoring less opioid-related adverse effects. Further research has led to questions as to the actual mechanism of action of the drug, leading to additional questions about whether it is a genuinely biased opioid agonist. This paper examines the mechanism of action, pharmacology, adverse effects, and clinical evidence accumulated to date regarding its effectiveness as a potent analgesic.

Objective: Thoracic surgery is known to lead to post-operative opioid dependence in countries with high opioid consumption; however, there are limited reports from countries with moderate to low opioid consumption, such as Japan. This study aimed to investigate the prevalence and risk factors for persistent opioid use after thoracic surgery in Japan.

Design: A retrospective cohort study using linked medical claims data from the National Health Insurance in Ibaraki Prefecture, Japan.

Patients: Patients aged ≥18 who underwent thoracic (mediastinal or lung) surgery between October 2012 and September 2021 were included in this study.

Main outcome measures: Persistent opioid use was defined as prescription from 0 to 14 days after surgery and 91 to 180 days after surgery. We evaluated associated factors using multivariable logistic regressions.

Results: Among the 6,041 patients who underwent thoracic surgery during the study period, 3,924 were included in the final analysis. The median age was 68 years (range, 64-71 years), and 2,316 (61.0 percent) were male. Persistent opioid use was recorded in 130 (3.3 percent). Multivariable analyses identified neoadjuvant therapy (chemotherapy or radiotherapy) (odds ratio [OR], 2.02; 95 percent confidence interval [CI], 1.09-3.77; p = 0.027) and thoracotomy (vs video-assisted thoracoscopic surgery) (OR, 1.50; 95 percent CI, 1.01-2.24; p = 0.046) as independent risk factors for persistent opioid use.

Conclusions: In a prefecture of Japan, 3.3 percent of patients who underwent thoracic surgery developed persistent opioid use. Neoadjuvant therapy (chemotherapy or radiotherapy) and thoracotomy were independent factors associated with persistent opioid use. Individualized perioperative pain management strategies should be considered for high-risk patients.

Objective: The effects of opioid use disorder (OUD) are devastating and wide-ranging. Although the information in the >43,000 manuscripts on OUD are searchable, gaining a comprehensive grasp of this information is out of reach to most persons. We present a pilot study to use published data on OUD, repurpose it for rapid comprehension and distribution to the world.

Design: Data from articles on OUD were entered into a data-tree and evaluated to achieve integration of information using the least number of notes.

Setting: Literature on OUD. Experimental units: A total of 752 articles were selected from PubMed searches. Review articles, case reports, and short series with samples of less than ten were excluded.

Outcome measures: The frequency of descriptive note types, and the total number of notes used with and without note sharing.

Results: Four types of notes were found sufficient to describe extracted numeric data from an article; topic (20.1 percent), population (26.2 percent), description of numeric value (28.4 percent), and numeric value (25.3 percent). Notes were entered in parent-child relationships across hierarchical levels, descriptive analyses showed smooth expansion and reduction of notes across the database. Entry rules allowed sharing of parent notes across different numeric values, which reduced that total number of notes by 72.9 percent.

Conclusions: These results demonstrate a method of data extraction and integration that allows for readily understandable grouping of large amounts of data. This strategy yields a method to extract and make accessible all published data on OUD. We expect that common understanding will improve outcomes for patients and research objectives.