Journal of opioid management最新文献

Background: Opioids are a mainstay in treating acute post-surgical pain although there are limited data on post-discharge use.

Objectives: To assess post-operative opioid usage in children undergoing outpatient pediatric surgical procedures and provider variability in the number of doses prescribed by procedure.

Methods: This cohort study included parents of children who were prescribed opioids following outpatient pediatric surgical procedures at Texas Children's Hospital from July 2019 to July 2020. Subjects participated in an opioid takeback program with an accompanying telephone survey to determine opioid utilization. Reported opioid usage included the following: none (0 percent), some (>0 percent but <100 percent), and all (100 percent). Provider prescribing patterns were stratified by doses and surgical intervention.

Results: Parents of 423 patients received follow-up calls, of which 350 (82.7 percent) reported use of some to all opioids and 73 (17.3 percent) reported using none. In the group reporting use of all opioids (n = 140 [33.1 percent]), parents were more likely to be single, have Medicaid, and report lower education levels when compared with parents reporting some or no opioid use. The number of opioids prescribed was not associated with the amount used (p = 0.51). The number of doses varied widely within each surgical procedure: The median number of doses prescribed ranged from 6 to 15 with some patients prescribed more than twice the median given the same procedure.

Conclusion: This study suggests that opioids are indicated for acute post-surgical pain in children although select patient and parental factors are associated with the extent of usage. This study also highlights significant variability in prescribed doses for similar procedures and may indicate both overprescribing and underprescribing by physicians.

Background/objective: Opioid overdose deaths have been on the rise in the last two decades in the United States, yet the economic burden remains unclear. Although prior studies have assessed the economic impact of total overdose deaths at a regional level, there remains a paucity of information surrounding the financial burden due to specific types of opioids on a national level. This analysis aims to examine the economic burden of the opioid overdose crisis by quantifying years of potential lives lost (YPLL) due to premature mortality and the value of those statistical lives (VSL) to estimate monetary losses.

Methods: Death counts for overdose deaths due to fentanyl, hydrocodone, hydromorphone, oxycodone, and oxymorphone from 2018 to 2020 were obtained from the National Vitals Statistics System. Period life expectancy was extracted from the Social Security Administration. Resultant YPLL and VSL were then calculated.

Results: Fentanyl accounted for an overwhelming proportion of opioid-induced deaths (77 percent of deaths in 2018 and 86 percent in 2020 resulting in 2.2 million YPLL and USD 527 billion in financial losses). The largest percentage of overdose deaths from fentanyl and oxymorphone occurred in the 25-34 age range; nearly two-thirds of all fatalities were men. There was also a significant increase in the number of opioid overdose deaths in the year 2020, compared to prior years.

Conclusions: Our analysis suggests that fentanyl contributed a significant proportion of economic losses in this public health crisis. Understanding the distribution of opioid deaths by drug type and subsequent economic losses could guide targeted intervention strategies.

Objective: Monitoring changes in oral morphine equivalents (OMEs) is an important parameter to understand how opioids are being used at the population level. However, changes in opioid doses and tapering have not been well defined.

Design: We conducted a population-based exploratory data analysis (EDA) to characterize changes in opioid doses and tapering of opioids among patients in Alberta (AB). A literature review was conducted to assess opioid tapering.

Setting: Using dispense data from 2020 to 2021 provided by the College of Physicians & Surgeons of Alberta (CPSA), we assessed changes in OME per day from baseline to the subsequent quarter.

Patients: Patients living in AB.

Interventions: N/A.

Main outcome measures: The absolute and relative changes in OME per day were estimated for each assessment. Tapering was considered if an opioid user's OME per day changed from the baseline to zero in the subsequent quarter. The frequency and percentages of patients with different levels of changes in OME per day were summarized per quarter.

Results: There were 13 operational definitions of opioid tapering in the literature. Comparatively, our approach at the CPSA differed in the length of the follow-up assessment period. Based on our quarterly assessment of ~390,000 patients, all four periods showed 60 percent of patients had an opioid dose decrease/tapered therapy relative to baseline. However, 21 percent were noted to be new users of opioids.

Conclusions: Based on our approach at the CPSA, 60 percent of patients tapered opioids over a year. Despite no standardized definition of opioid tapering, our EDA demonstrates one approach using population-based drug dispense data to evaluate opioid use.

It is estimated that over 16 million people are living with opioid use disorder (OUD) worldwide, with 2.1 million people in the United States. Opioid addiction is theorized to be associated with strong dopaminergic response to opioid receptor stimulations that contributes to reward-seeking behaviors and individuals' experiences with opioids. Methadone and buprenorphine have been game changers; however, both come with limitations, especially in the era of fentanyl use. Naltrexone is another treatment used for OUD that blocks opioid receptors. An emerging treatment of significant interest is a neuro-interventional technique called transcranial magnetic stimulation (TMS), which is currently approved by the Food and Drug Administration for the treatment of depression and, recently, for obsessive compulsive disorder and tobacco use disorder. TMS has been seen in some studies to significantly reduce cravings for opioids with effects beyond the last administrated treatment. This manuscript is a narrative review of the potential relevance of TMS, specifically, repetitive TMS, in the future treatment of OUD.

Introduction: Opioid use disorder (OUD) is a chronic relapsing disorder with significant mortality, morbidity, and public health challenges. In India, tramadol is frequently used for the treatment and management of OUDs.

Methodology: A prospective observational study was performed to evaluate 3-month outcomes in outpatients with OUD on treatment with tramadol at a tertiary care addiction treatment facility in North India. One hundred and sixty newly registered patients fulfilling the inclusion and exclusion criteria were recruited and assessed on Maudsley Addiction Profile to evaluate changes in days and the amount of substance use and associated complications at 1-, 2-, and 3-month follow-up.

Results: This study also showed a treatment retention rate of 14 percent with an abstinence rate of 34 percent at the end of the third month. The mean number of days of illicit opioid use in retained population decreased from 29.3 (±3.5) days from baseline to 12.5 (±10.9) days at 1 month, 5.0 (±7.2) days at 2 months, and 4.3 (±6.8) days at 3 months. Repeated measures analyses showed significant change in the days of illicit opioid use on treatment with tramadol over 3 months (p = 0.01).

Conclusion: This study leads the way in showing tramadol as an important medication for use in OUDs to provide for maintenance therapy for longer durations. This has major implications in low- and middle-income countries, especially in Asia and Africa, where tramadol is more easily available.

Background: As the opioid epidemic continues, it behooves healthcare systems and practitioners to examine factors affecting access to care and treatment, as well as understand patient perceptions of opioid use disorder (OUD).

Methods: This was a cross-sectional sample of 124 patients with an OUD diagnosis identified using International Classification of Disease codes in electronic health records. Patients responded to a qualitative survey regarding self-perceptions and history of OUD, alcohol, and substance use.

Results: A total of 46 percent of the patients who had an OUD diagnosis in their medical record denied having OUD.

Discussion: This showed clear differences between provider and patient perceptions, as well as potential system error. To reduce stigma as well as ensure proper pain management, providers and patients need clear and transparent individualized care plans for each patient with an OUD diagnosis, as well as a frequent review of electronic records and diagnoses.

Objective: Opioid use disorder (OUD) can be effectively treated with buprenorphine maintenance. Recent changes in federal policy have removed the requirement for physicians to complete additional training to apply for a Drug Enforcement Administration (DEA) waiver to prescribe buprenorphine. At that time, few primary care providers (PCPs) had completed the training for a DEA waiver to prescribe buprenorphine. Our goal was to identify addressable barriers that may persist despite updates to federal legislation.

Design: A 42-item survey was distributed to 662 physicians and nurse practitioners at two academic medical centers with 100 respondents.

Setting: The survey was sent via email and administered anonymously through SurveyMonkey.

Patients and participants: All participants were PCPs, and all PCPs at the two academic medical centers were eligible to participate.

Interventions: PCPs responded to the survey by answering questions online.

Main outcome measures: PCPs answered questions regarding previous buprenorphine waiver training status, local OUD prevalence, the effectiveness of OUD treatment modalities, and previous barriers to training.

Results: Respondents were compared using descriptive statistics and logistic regression. Of the 100 respondents (response rate: 15 percent), 69 percent had not completed the training. Ninety-nine percent of PCPs agreed that OUD was an issue in their area, 94 percent saw patients with OUD, and 91 percent rated buprenorphine maintenance as a very effective treatment for OUD. Previously waivered and nonwaivered providers did not differ in their responses to these questions. Those who had been waivered were less likely to say they did not see enough patients with OUD to justify training (odds ratio [OR] 0.267, p = 0.005) and were less likely to express concern about allowing patients with OUD into their practice (OR 0.348, p = 0.020) than PCPs who had applied for the DEA waiver.

Conclusions: Despite nonwaivered PCPs recognizing OUD's prevalence, they were concerned about allowing patients with OUD into their practice and said there were not enough patients to justify training. This suggests that attitudinal barriers are the most appropriate target for current intervention.

Objective: To report opioid prescription patterns after pediatric anterior cruciate ligament reconstruction (ACLR) and identify if the implementation of the opioid prescribing guidelines (OPGs) modified these patterns.

Design: A retrospective chart review.

Setting: Level 1 Pediatric Trauma Center.

Patients: Pediatric patients who underwent primary ACLR at a single pediatric hospital system between the years 2016 and 2018 were included. Patients were excluded if they did not receive an opioid prescription from an orthopedic provider at the time of discharge or if they underwent an additional operative procedure within 90 days of the index surgery. Eighty-six patients met the criteria for a retrospective review.

Interventions: Opioid prescriptions were converted into morphine equivalent doses (MEDs) for standardization.

Main outcome measure: The average MED prescribed at the time of discharge and during follow-up visits for pediatric patients undergoing ACLR.

Results: Patient's age was the only independent variable that had a significant relationship with discharge MED (p = 0.002) and predicted that MED at discharge increases by 20.7 units [confidence interval = 12.3-29.1] for each increasing year in patient age. Discharge MED prescribed after implementation of the OPG was found to be significantly less than discharge MED prescribed prior to the OPG through Wilcoxon rank-sum test (p < 0.001).

Conclusions: Implementation of the OPG in Ohio led to a significant reduction in opioid doses prescribed to patients at all time points within 90 days of ACLR. However, these guidelines also led to a significant increase in the likelihood that post-OPG patients would receive an additional opioid prescription during follow-up within 90 days of surgery.

Background: About 1 in 8 children under age 17 live with a parent who has a substance use disorder. Research on treatment access identifies stigma as a significant barrier to treatment, particularly among mothers with young children. Well-meaning but punitive state policies further perpetuate stigma, which harms families and children.

Purpose/hypothesis: Explore the experiences of the stigma of addiction on mothers before, during and after treatment for substance use disorder. Procedures/data/observations: Descriptive Phenomenology was used to describe the experiences of stigma of mothers with opioid use disorder (OUD) through all stages of treatment and recovery. Mothers (n=20) participating in an outpatient treatment program interviewed. A semi-structured interview schedule was used to guide the interviews and thematic analysis was used identify themes related to stigma.

Conclusions/applications: Our analysis identified several main themes and subthemes related to internal and external sigma, including stigma against medication for opioid use dis order, stigma from the public and healthcare professionals, internalized shame, and how mothers learned to recover and heal from stigma.

Background: In this talk we will delve deep into the pharmacology of this drug and how it's receptor interactions are unique and then we will take that understanding and apply it to clinical usage to see how this drug behaves in a variety of situations.

Purpose/hypothesis: Specifically we will look at the safety profile of this drug, including it's ceiling effect on respiratory depression. Then we will look at efficacy, how well does this drug work in the treatment of pain. We will look at analgesia, tolerance and anti-hyperalgesic properties of buprenorphine. We will discus why this drug is so versatile anyhow versatility is a key asset when it comes to using buprenorphine for the treatment of pain.

Conclusions/applications: The last section of this talk will look at the specific area of preoperative use of buprenorphine and why buprenorphine should be continued throughout the pre- operative period.