Journal of opioid management最新文献

Background: Opioid prescribing to post-operative patients in the acute hospital setting is well described; however, little is known about use of opioids in inpatient rehabilitation (IPR) settings. Understanding how opioids are prescribed across all inpatient settings is important to optimize opioid stewardship. The aim of this study was to determine the percentage of post-operative orthopedic patients prescribed opioids and prescribing patterns on discharge from an IPR ward.

Design: Single-center retrospective audit.

Setting: Tertiary metropolitan hospital.

Patients: Patients who underwent an orthopedic surgical procedure between January and July 2020 and were subsequently transferred to an IPR center under the same health service.

Main outcome measures: Opioid prescribing data were obtained at three time points: on admission to the acute hospital, at the time of transfer from the acute hospital to IPR, and at the time of discharge from IPR. Doses were reported in oxycodone equivalent doses.

Results: Of the 117 patients who were included in the audit (median age 84 years, median length of hospital stay 23 days), 115 (98 percent) were prescribed an opioid at the time of discharge from the acute hospital to IPR, and 69 patients (59 percent) were discharged from IPR with a prescription for an opioid.

Conclusions: A significant proportion of patients admitted to IPR were discharged with a prescription for an opioid. Further research is required to determine the appropriateness of continued opioid use in these patients, and ways to reduce the exposure of patients to opioids during and following IPR should be explored.

Opioids are known to come with some relatively benign side effects, not including their addictive potential. This review will look at some of the side effects that occur when patients, especially chronic pain patients, take opioids chronically. These side effects include both hyperalgesia and allodynia caused by opioids. Overdose and factors, including hyperalgesia and allodynia, that make a patient more likely to overdose, is the other topic that will be covered. Not much research has been done with human subjects regarding treatment of opioid induced hyperalgesia or allodynia, but some of this research will also be briefly explored throughout this review.

Objective: To evaluate the effectiveness of an outpatient, interdisciplinary pain management (IPM) program offering individualized opioid tapering as part of flexible, patient-specific care plans, in achieving the dual goals of improved management of chronic nonmalignant pain (CNMP) and substantial reduction of opioid use.

Design: A retrospective cohort study, comprising a cohort of patients who presented on opioid therapy and a cohort who did not.

Setting: Community outpatient IPM program.

Participants: Patients presenting between April 1, 2016 and September 15, 2019. From an initial pool of 402 patients, inclusion and exclusion criteria identified 300 patients for analyses.

Interventions: Engagement in a comprehensive and flexible IPM program with patient-specific care plans that included individualized opioid tapering.

Main outcome measure(s): Changes in pain intensity, pain interference, physical therapy (PT) metrics, patient retention, and follow-up of opioid use status at least 3 years after the end of each patient's study episode of care.

Results: Changes in pain intensity and interference, and PT outcomes reflected notable improvements in pain management, with no significant overall differences between cohorts. During study episodes of care, all patients in the opioid cohort reduced opioid use and two-thirds discontinued opioids; patient retention was 90.9 percent. In follow-up of over 80 percent of the opioid cohort up to an average of 4.5 years, opioid use for CNMP decreased to 15.8 percent of patients.

Conclusions: A flexible, patient-centered IPM program can improve the management of CNMP, substantially reduce opioid use, and maintain a high rate of patient retention. During follow-up, patients further reduced their use of opioids for CNMP.

Despite the contribution of the µ-agonist fentanyl to the United States's opiate overdose epidemic, no human studies specifically address the ability of extended-release preparations of the opiate antagonist naltrexone (NTX) to block fentanyl's life-threatening µ-agonist-mediated respiratory depression. This paper presents three case histories of clinically necessary opiate challenges in opiate-abusing patients implanted with extended-release NTX (ER-NTX). It also reviews the sparse literature and is the first evidence that antagonist blood levels from ER-NTX preparations can completely block the lethal µ-agonist effects of at least 1,000 mcg of intravenous fentanyl.

Objective: To report the rate of prescription opioid use rates over a 5-year period for the population of Newfoundland and Labrador (NL), Canada, and to highlight patient demographics within this cohort.

Design: This retrospective cohort design used population-based pharmacy network prescription data from the province of NL to identify patients who were prescribed opioids from June 1, 2017, to June 1, 2022.

Setting: A cohort of adult and pediatric patients who were being prescribed opioids from June 1, 2017, to June 1, 2022, in NL.

Participants: Patients who were prescribed opioids from June 1, 2017, to June 1, 2022. Prescriptions without complete data and medications taken for pain control that were not defined as opioids were excluded from the analysis. Buprenorphine, buprenorphine-naloxone, and methadone were also excluded from the analysis, as these are often prescribed as a treatment for opioid use disorder.

Results: Between 27,344 (5.2 percent of NL population) and 57,562 (11 percent of NL population) opioid pain patients in NL were identified from 2017 to 2022, with 2018 having the highest number of opioid pain patients (11 percent). During this period, patients with opioid prescriptions averaged from 55 to 58 years of age. Data also showed more female users of prescription opioids than males, and there were no significant differences between urban and rural locations. The most prevalent type of prescriber during the period of observation was general practitioners (n = 1,131), followed by pharmacists (n = 476) and dentists (n = 237).

Conclusions: In comparison to national averages in Canada, NL had lower prescription opioid use rates. This study acts as a first step to better understand opioid use and prescribing practices in NL.

Despite efforts to reduce abuse, opioids remain a societal concern. Coronavirus disease 2019 (COVID-19) brought new challenges, and research is needed to understand its impact on opioid abuse in the population. Three data sources were used to investigate trends in misuse and abuse of XTAMPZA® ER compared to extended-release (ER) and single-entity immediate-release (SE-IR) oxycodone from 2019Q3 through 2022. Changes in trends over 6-month intervals were investigated using linear spline models with a breakpoint at 2020Q3 to measure the impact of COVID-19. Poison center call rates for misuse or abuse of ER and SE-IR oxycodone showed significant changes during COVID-19 (both p < 0.001), reversing trends and significantly decreasing (201327.56 percent change and -12.91 percent change, respectively). In contrast, XTAMPZA ER trend rates showed no change during COVID-19, remaining fairly stable. The odds of abuse of ER oxycodone among those entering opioid use disorder treatment significantly changed during COVID-19 (p = 0.025), resulting in a stabilization of the trend. For SE-IR oxycodone, no change was observed in the decreasing trend (-12.88 percent change during COVID-19). XTAMPZA ER had no significant change during COVID-19 (p = 0.200) and appeared stable. Since 2021Q3, among the general adult population, the prevalence of past-year nonmedical use of XTAMPZA ER was rare (0.04 percent), as was the case for other oxycodone products (<1 percent). Overall, there is no evidence that oxycodone misuse and abuse worsened during COVID-19 in these populations, and XTAMPZA ER was consistently lower than other oxycodone products. Low rates and improving trends in oxycodone misuse and abuse may signify an ongoing reduction in prescription opioid contributions to the opioid crisis.

Aim: This study aims to assess the application of opioids for pain control in patients following a cesarean section (CS) at a tertiary referral obstetric hospital.

Methods: A retrospective cohort audit of CSs in September 2022 was conducted. Medical records were reviewed to capture patient demographics, opioid used, and discharge medications.

Results: Medical records of 46 patients were reviewed. Of those, 46 percent (n = 21) had a non-elective lower uterine CS (NELUSCS), 43 percent (n = 20) had an elective lower uterine CS (ELUSCS), and the remainder had a nonelective classical CS (NEClassicalCS). NEClassicalCS had higher total morphine equivalent opioid use with an average of 245.7 mg, compared with 92.4 mg and 60.1 mg for NELUSCS and ELUSCS, respectively. Tramadol was the most common opioid supplied on discharge (85 percent), followed by buprenorphine (17 percent) and oxycodone/naloxone (15 percent). An average discharge medication supply of 3 days was provided.

Conclusions: NEClassicalCS procedures had higher use of opioid pain medications. All patients were initiated on opioids post-CS, with 93 percent (n = 43) discharged with at least one opioid.

Objectives: To investigate post-operative opioid use, functionality, and overall survival following internal fixation for pathologic or impending fractures at 3 and 6 months.

Background: Pathologic and impending fractures commonly occur in the proximal femur, and patients may be prescribed opioids prior to surgery and often require opioids for post-operative pain relief. This study compared post-operative opiate usage and ambulatory functional status in patients with impending versus pathologic fractures in the proximal femur.

Design: This was a retrospective case-control study of patients using opioids post-operatively who underwent internal fixation for a pathologic or impending fracture between 2016 and 2022. Preoperative and post-operative opioid usage as well as ambulation status and risk factors at 3 and 6 months associated with post-operative opioid use were recorded.

Results: Twenty-four pathologic fractures and 23 impending fractures were included. Preoperative opioid daily morphine milligram equivalent was significantly higher in the pathologic fracture group, but there were no significant differences at 3 or 6 months. There was statistically significant post-operative improvement in ambulation status in the combined cohort and impending fracture cohort at 3 months and 6 months.

Conclusions: Although patients did not experience a significant post-operative change in opioid use, patients with pathologic fractures notably required higher opioid dosages preoperatively, and there was overall improvement in function following fixation. Future studies should examine post-operative opioid use with careful consideration of concurrent pain management pain therapies and tumor characteristics.

Objectives: To quantify the prevalence of opioid drug dependence and abuse in the United States between 2019 and 2020, as well as to identify which opioid molecules are associated with a higher level of dependence and abuse.

Design: National Survey on Drug Use and Health data for 2019 and 2020 was extracted. The variables related to painkillers were studied; the most important ones were selected, and several variable crosses were made. After the data were extracted, they were analyzed with Microsoft Excel® using PivotTables to calculate the relative prevalence and percentages of patients with abuse and dependence.

Results: A total of 1.2 million people were dependent on opioid pain relievers (OPRs) in 2020 versus 1.4 million people in 2018. In 2020, the last OPR used by people with dependence were hydrocodone (27 percent) and oxycodone (21 percent). In the same year, 63 percent of the people with a dependence on OPR had used it without their own prescription to relieve pain (vs 67 percent in 2017). In 2020, 2.5 million people used an OPR without a medical prescription; the main reason (42 percent) was to relieve pain (similar to 2018), followed by wanting to feel good (19 percent vs 16 percent in 2018) and to relax or relieve tension (16 percent). In 2020, 2.2 million people used an OPR differently than prescribed by the doctor; 31 percent of them had also used an OPR without a prescription; and 17 percent were dependent on an OPR in the same year. The most relevant types of abuse were the increase in frequency of use (1.4 million people), increase in the duration of treatment (1.2 million people), and increase in the quantity or dose (1.6 million people).

Conclusions: Abuse and dependence on OPRs during 2019-2020 (affecting 1.24 million people, 0.4 percent of the population over 12 years old) showed an average annual decrease of 3 percent compared to the 2017-2018 period. Similarly, the number of people using OPR without having their own prescription decreased from 5.8 million in 2019 to 4.7 million in 2020. The primary reason people use these medications without a prescription remains the relief of physical pain. The use of OPRs without having an own prescription remains a concern, as 60 percent of the people with dependence have used an OPR without their own prescription. The other major concern is the monitoring of OPR prescriptions. In 2020, over 2.2 million people used the OPRs differently than prescribed, and 28 percent of people with dependence in that year have used an OPR differently than prescribed. Oxycodone and hydrocodone continue to be the molecules more associated with abuse. Dependence associated with oxycodone is directly correlated with its use without prescription.