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Extended-release naltrexone (XR-NTX) is an opioid antagonist effective for treating opioid use disorder (OUD). However, concerns about inadequate pain management may limit its use. This study will examine changes in pain intensity in OUD patients choosing XR-NTX compared to opioid agonist treatment (OAT), identify subgroups with distinct pain intensity trajectories, and assess the effect of pain intensity on XR-NTX treatment outcomes (retention, relapse, opioid use, and cravings).
This 24-week study included OUD patients aged 18–65 years opting for XR-NTX (n = 160). Patients receiving OAT (n = 151) served as controls. Pain intensity was measured every 4 weeks for XR-NTX and at baseline and Week 24 for OAT using the numerical pain rating scale-11 (NPRS-11). Data were analyzed with linear mixed models and group-based trajectory modeling.
Between baseline and Week 24, XR-NTX participants with low to moderate pain showed a significant reduction in pain intensity, while those with high pain did not. In the OAT group, no significant reduction in pain intensity was observed (from baseline to Week 24). Pain intensity was not associated with XR-NTX treatment outcomes.
Contrary to perception, XR-NTX does not worsen pain intensity, nor did pain intensity affect XR-NTX treatment outcomes.
This study is the first to explore the association between changes in pain intensity and XR-NTX treatment outcomes in OUD patients over a 24-week period. The findings challenge the perception that XR-NTX is less suitable for treating OUD patients with pain.
Untreated opioid use disorder (OUD) in pregnancy is associated with adverse obstetrical outcomes, maternal morbidity, and maternal mortality. This article will inform clinicians about the use of monthly extended-release buprenorphine (BUP-XR, SUBLOCADE®) to treat OUD during pregnancy and postpartum.
We examined the use of monthly BUP-XR during pregnancy in patients with OUD, summarizing case studies (N = 4) from clinical practice, reviewing >5 years of pregnancy and postpartum surveillance data (quantitative [N = 322] and qualitative) and relevant literature in PubMed (N = 4).
The clinical practice case studies highlight the experience from four pregnant patients with OUD who received monthly BUP-XR. All four neonates were delivered full-term with normal birthweight, no fetal anomalies, and no medication required for neonatal opioid withdrawal syndrome. Additionally, over 300 pregnancies have been reported through postmarketing surveillance, of which 68 have known outcomes consistent with information described in the product label. Findings from literature, postmarketing surveillance, and clinical practice case studies were consistent with the established safety profile of buprenorphine.
This study addresses a lack of knowledge of treatment of pregnant individuals with OUD and draws on relevant experience from prescribers treating patients with monthly BUP-XR during pregnancy and postpartum. These data support consideration of implementing BUP-XR as part of evidence-based practice that prioritizes OUD treatment access, patient stability, and patient choice during the perinatal period. Three sources of data illustrate that the use of monthly BUP-XR during pregnancy has demonstrated no increased risk and is consistent with the established buprenorphine safety profile.
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Many cannabis laws include medical use with pain as an indication. However, it is not known the extent of cannabis use for pain, the types of pain treated, and the perceived effectiveness of cannabis for chronic pain in this region. The purpose of this study was to understand cannabis use for pain in West Virginia patients.
Ten thousand chronic pain patients were surveyed, and users and non-users of cannabis were compared.
One thousand three hundred fifty-one people responded, with 24% using cannabis. They were in pain for longer, most >10 years. They often used other medications for pain and more often had a previous opioid prescription for pain.
Patients who use cannabis have higher levels of reported pain for longer durations of time than those who do not use cannabis. More information is needed to understand the implications for cannabis use in this population.
Patients with chronic pain who use cannabis have tried multiple treatment modalities, had more types of pain, and often received an opioid prescription.
Impulsivity is a risk factor for the development and maintenance of tobacco use, especially among individuals with comorbid mental illness, but the nature of this relationship is poorly understood. We systematically examined evidence for the relationship between impulsivity and tobacco use in people with psychiatric disorders.
Following PRISMA guidelines, original peer-reviewed articles published from database inception to July 2024 were searched for using PubMed, Google Scholar, ProQuest, Ovid, and PsycINFO.
Of 1192 articles identified, 16 met the inclusion criteria. There was consistent evidence of a positive relationship between tobacco use and impulsivity in schizophrenia (SZ), major depressive disorder (MDD) and bipolar disorder (BD). However, the majority of studies were cross-sectional studies, preventing causal inferences.
Tobacco smoking is robustly associated with impulsivity in people with SZ, MDD, and BD, although causal conclusions cannot be drawn due to methodological limitations of the current literature. Future prospective and experimental studies are needed to ascertain whether impulsivity is a risk factor for smoking, how tobacco use affects impulsivity, and whether impulsivity may be a treatment target for smoking cessation.
To our knowledge, this article is the first comprehensive review of literature, specifically examining the relationship of tobacco smoking and impulsivity among individuals with psychiatric disorders. By highlighting this understudied intersection, our findings provide novel insights into the relationship between smoking behaviors and impulsivity in individuals with mental illness, contributing to more effective treatment strategies and emphasizing the need for tailored interventions to address these co-morbidities.
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