Journal of opioid management最新文献

{"title":"Investigating the relationship between the severity of oxidative stress with the severity of toxicity and clinical response in methadone-poisoned subjects.","authors":"Zohreh Oghabian, Fatemeh Barghi, Hajar Ahmadianranjbar, Ali Mandegary, Saeedeh Shojaeepour, Payam Khazaeli, Mohadeseh Soltani, Motahareh Soltani","doi":"10.5055/jom.0912","DOIUrl":"https://doi.org/10.5055/jom.0912","url":null,"abstract":"<p><strong>Background: </strong>Methadone is frequently used in opioid substitution therapies, and poisoning incidents related to its use remain a public health concern, especially in regions with high opioid dependency. In Iran, especially in the city of Kerman, there is substantial evidence regarding intentional and unintentional methadone poisoning. This raises the need for more research on the complications and treatment of methadone poisoning.</p><p><strong>Objective: </strong>Oxidative stress is involved in methadone poisoning, but so far very few studies have been done specifically in this field. The present study aims to investigate the relationship between oxidative stress, toxicity severity, and therapeutic responses.</p><p><strong>Methods: </strong>In this study, 51 patients who were poisoned with methadone and visited the Afzalipour Hospital in Kerman participated. Oxidative stress parameters, including lipid peroxidation rate, plasma antioxidant capacity, glutathione, protein carbonyl, and superoxide dismutase enzyme activity, were investigated in the mentioned population, and the results were compared with those of healthy -individuals.</p><p><strong>Results: </strong>Oxidative stress was significantly higher in methadone-poisoned subjects than in the control group.</p><p><strong>Discussion and conclusion: </strong>The use of methadone induces oxidative stress, which is correlated with the blood level of methadone.</p><p><strong>Implications: </strong>The results of this study show that reducing the oxidative stress resulting from methadone poisoning improves the treatment of methadone poisoning. In addition, monitoring the signs of oxidative stress can be an effective tool for predicting the level of toxicity and making treatment decisions. Further research in this field can suggest new therapeutic approaches considering the reduction of oxidative stress in cases of methadone poisoning. Finally, this study emphasizes that oxidative stress is an important factor in methadone poisoning and should not be overlooked by experts.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"21 2","pages":"171-180"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinician perceptions of electronic health record and email nudge interventions to prevent unsafe opioid prescribing: A qualitative study.","authors":"Mia E Lussier, Megan E Hamm, Balchandre N Kenkre, Eric A Wright, Adam J Gordon, Ajay D Wasan, Walid F Gellad, Andrew D Althouse, Gerald Cochran, Gary S Fischer, Melessa Salay, Melissa S Kern, Kevin L Kraemer","doi":"10.5055/jom.0913","DOIUrl":"https://doi.org/10.5055/jom.0913","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to understand clinician perceptions of nudge interventions designed to prevent unsafe opioid prescribing for acute pain in primary care.</p><p><strong>Design: </strong>Semistructured interviews were conducted.</p><p><strong>Setting: </strong>Forty-eight practices across three healthcare systems were included.</p><p><strong>Participants: </strong>Primary care clinicians who were exposed to nudge interventions as part of a randomized clinical trial were included.</p><p><strong>Interventions: </strong>Intervention arms included an electronic health record alert upon new opioid prescribing either alone or with one or both nudge interventions (written opioid justification and/or monthly clinician comparison emails).</p><p><strong>Main outcome measures: </strong>We used conventional content and thematic analysis to identify themes related to clinician perceptions of nudge interventions and the opioid epidemic.</p><p><strong>Results: </strong>We conducted and analyzed 77 clinician interviews. Clinicians voiced favorable impressions of both nudge interventions, but they did not feel the nudge interventions had a direct impact on their own prescribing of opioids, perhaps due to low prescribing secondary to other opioid interventions. Clinicians felt interventions should continue to assist high opioid prescribers.</p><p><strong>Conclusion: </strong>Nudge interventions are favorably perceived by physicians to be an additional option in the current landscape of interventions to prevent unsafe opioid prescribing for acute pain in the primary care setting.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"21 2","pages":"121-130"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144016254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adherence to opioid prescribing guidelines at an academic family medicine practice.","authors":"Jennifer E Roper, Brian A Gottwalt, Julienne K Kirk, Ann Hiott Barham, Keli B Jones, John G Spangler, Michelle K Keating","doi":"10.5055/jom.0931","DOIUrl":"https://doi.org/10.5055/jom.0931","url":null,"abstract":"<p><strong>Introduction: </strong>Opioid prescribing practices and guidelines are outlined by the United States Centers for Disease Control and Prevention (CDC), but limited data are currently available regarding their use in clinical practice. A primary care residency clinical site at an academic medical center attempted to improve compliance with the CDC best practices in 2022. As a quality improvement initiative, a policy was created, and education was provided to clinicians and patients. The clinical impact of these interventions was analyzed.</p><p><strong>Methods: </strong>A retrospective chart review was performed for patients on chronic opiates during 2023. Extracted electronic health record data were analyzed to collect information on the prescriber (resident/faculty/advanced practice provider), opioid type and duration, concurrent benzodiazepine use, and mental health diagnoses. The main outcomes were whether these patients had an opioid agreement and/or urine drug screen (UDS) in the past 12 months.</p><p><strong>Results: </strong>A total of 245 patients met the criteria, with 29 percent also being prescribed benzodiazepines, and 69 percent having at least one mental health diagnosis. Forty-one percent of the patients had a UDS in the electronic medical record in 2023, with the statistically significant predictors being nontramadol opioid use and a completed opioid agreement. Thirty-two percent had a completed opioid agreement, with the statistically significant predictors being a concomitant mental health diagnosis, provider type, and UDS obtained.</p><p><strong>Discussion/conclusion: </strong>Despite policy and education, compliance with our primary outcomes remained low. Residents were the most compliant. Tramadol was also uniquely identified as having lower compliance with having a UDS on file. Next steps include continued education efforts on the risk and best practices for reducing opioid-related harms and structured chart reviews.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"21 2","pages":"111-119"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144012314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying high-dose opioid prescription risks using machine learning: A focus on sociodemographic characteristics.","authors":"Olabode B Ogundele, Butros M Dahu, Praveen Rao, Xing Song, Timothy Haithcoat, Mutiyat Hameed, Douglas Burgess, Tracy Greever-Rice, Mirna Becevic","doi":"10.5055/jom.0924","DOIUrl":"https://doi.org/10.5055/jom.0924","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to leverage machine learning techniques to analyze administrative claims and socioeconomic data, with the aim of identifying and interpreting the risk factors associated with high-dose opioid prescribing.</p><p><strong>Design: </strong>We applied six machine learning algorithms to a dataset integrating Medicaid claims from Missouri (2017-2021) and 2018 United States Census Bureau data. High-dose prescribing was defined as dosages ≥120 morphine milligram equivalent/day. SHapely Additive exPlanations methods were utilized to enhance model interpretability, ensuring transparent insights into the predictors of high-dose prescription risks.</p><p><strong>Results: </strong>Our findings reveal that sociodemographic factors like age, race, and sex, along with socioeconomic variables such as percentages of veterans, disability, and primary care physicians (PCPs) per capita, have associations with high-dose prescription risks. Notably, higher percentage of veterans and PCPs per capita within counties correspond with increased high-dose prescriptions, while older age groups and patient sex also predict a greater risk.</p><p><strong>Conclusion: </strong>This analysis underscores the significant influence of sociodemographic variables on high-dose opioid prescriptions. The interplay of these factors highlights the need for multifaceted public health strategies to address the underlying complexities of the opioid crisis. The integration of machine learning methods with traditional epidemiological techniques represents a promising approach for gaining a comprehensive understanding of intricate patterns not captured in traditional statistical analysis, thereby enabling effective mitigation of the opioid crisis.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"21 2","pages":"149-162"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144018992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term opioid therapy trends in the VA: More intermittent than chronic.","authors":"Cynthia Kay, Katherine Sherman, Rodney Sparapani","doi":"10.5055/jom.0896","DOIUrl":"https://doi.org/10.5055/jom.0896","url":null,"abstract":"<p><strong>Objective: </strong>To observe patterns of opioid therapy among veterans with a focus on long-term opioid therapy (LTOT).</p><p><strong>Design: </strong>A retrospective study utilizing data from the Veterans Affairs Corporate Data Warehouse.</p><p><strong>Subjects: </strong>Veterans 18 years or older, who received at least one outpatient opioid prescription between June 1, 2008, and June 1, 2018, and had no cancer, palliative care, or hospice encounters during the study period.</p><p><strong>Main measures: </strong>For each patient, opioid prescriptions were combined into one contiguous prescription, as long as the gap (<7, <30, <90 days) between the end of supply and the receipt of the next fill met specified intervals. When gaps exceeded the threshold, a new prescription chain began. This was done to explore patterns of opioid fills.</p><p><strong>Results: </strong>There were 746,658 patients with a prescription gap <7 days who received 5,084,346 contiguous opioid scripts. For all gap lengths, 16-35 percent of contiguous scripts lasted at least 90 days, 3-14 percent lasted more than a year, and 1-8 percent lasted 2 years. While a relatively small proportion of contiguous scripts were long-lasting, a substantial proportion of patients received long-lasting opioid therapy.</p><p><strong>Conclusions: </strong>Long-term, intermittent opioid therapy was common. However, the long-term, monthly, uninterrupted opioid prescriptions expected with typical LTOT was not. It is likely that LTOT in past research was more reflective of periodic use instead of continuous, monthly prescriptions, especially for multiyear studies.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"21 2","pages":"131-140"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PCA ketamine-morphine versus PCA morphine as post-operative analgesia in colorectal surgery.","authors":"Nurul Akasya Adnan, Chian Yong Liu, Nita Salina Abdullah","doi":"10.5055/jom.0888","DOIUrl":"https://doi.org/10.5055/jom.0888","url":null,"abstract":"<p><strong>Objective: </strong>Ketamine has undergone a recent resurgence of interest as an opioid-sparing agent in pain management. The purpose of this study is to evaluate the effectiveness of patient-controlled analgesia (PCA) ketamine-morphine in comparison to conventional PCA morphine alone as post-operative analgesia in colorectal surgery patients.</p><p><strong>Design: </strong>Double-blind, randomized, controlled study.</p><p><strong>Setting: </strong>This study was conducted at a single, tertiary hospital.</p><p><strong>Patients: </strong>Sixty patients who underwent elective colorectal surgery were randomly assigned into two groups.</p><p><strong>Interventions: </strong>Group A received PCA ketamine-morphine 0.5:0.5 mg mL^-1, while Group B received PCA morphine 1 mg mL^-1 as post-operative analgesia.</p><p><strong>Main outcome measures: </strong>Patients' pain scores, total PCA demands, cumulative morphine consumption, side effects, and their overall satisfaction score were recorded and analyzed.</p><p><strong>Results: </strong>Overall, there was no significant difference in pain score in both groups, except at 24-hour intervals where Group A had significantly lower mean pain score at rest (1.10 ± 1.37 vs 2.10 ± 1.65, p = 0.017). Total PCA demands were comparable between both groups. Cumulative morphine consumptions however were significantly lower in Group A at all intervals with 24.7 ± 15.2 vs 48.9 ± 30.4 mg (p < 0.001) at 24-hour interval and 38.3 ± 22.4 vs 77.8 ± 46.3 mg (p = 0.001) at 48-hour interval. There was no significant difference in the incidence of side effects and overall satisfaction score in both groups.</p><p><strong>Conclusions: </strong>PCA ketamine-morphine was as effective as PCA morphine as post-operative analgesia in colorectal surgery, with comparable pain scores, PCA demands, side effects, and significant reduction in morphine consumption.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"21 2","pages":"141-148"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining the effect of a Whole Health Primary Care Pain Education and Opioid Monitoring Program (PC-POP) at preventing opioid-induced constipation.","authors":"Taylor Hammack, Clayton J Hamilton, Amber Martinson","doi":"10.5055/jom.0918","DOIUrl":"https://doi.org/10.5055/jom.0918","url":null,"abstract":"<p><strong>Objective: </strong>The prevention of opioid-induced constipation (OIC) in patients treated for chronic pain is important for an improved quality of life and prevention of complications. This study aims to determine whether the implementation of the Primary Care Pain Education and Opioid Monitoring Program (PC-POP) improved the management of OIC in patients receiving opioids for chronic noncancer pain. Design/measure: Pharmacy records regarding the presence of an appropriate laxative prescription, prescription fills, and laxative types were obtained. The primary outcome was the proportion of patients with an appropriate laxative prescription on file for the management of OIC.</p><p><strong>Setting: </strong>This study was conducted in the Salt Lake City Veterans Affairs (VA) Medical Center's primary care setting.</p><p><strong>Subjects: </strong>Patients aged 18 and older being treated with opioids for chronic noncancer pain >3 months who were enrolled in PC-POP and had attended at least two classes were compared to patients receiving standard primary care at a VA Medical Center.</p><p><strong>Results: </strong>Of the 698 patients included, 39.2 percent of patients enrolled in PC-POP had a laxative prescription on file compared to 20.9 percent for patients receiving standard primary care from a VA provider. Presence of appropriate laxative prescription was significantly higher for the PC-POP group (p = <0.001).</p><p><strong>Conclusion: </strong>PC-POP enrollment was associated with a significantly higher number of appropriate laxative prescription for the management of OIC. This study indicates that there is potential for improvement in prescribing practices to ensure patients receive appropriate laxatives to mitigate the impact of OIC. It also indicates that implementation of a similar program at other VA Medical Centers could improve OIC management in veterans receiving opioids for chronic noncancer pain.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"21 2","pages":"163-169"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A survey study assessing prescribers' opioid tapering instructions to patients after orthopedic surgery.","authors":"William Chan, Samuel Schuessler, Steven Magid, Seth Waldman, Roberta Stack, Alexandra Sideris","doi":"10.5055/jom.0919","DOIUrl":"https://doi.org/10.5055/jom.0919","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this institutional survey study was to assess the opioid tapering practices of prescribers responsible for writing post-discharge opioid refills.</p><p><strong>Design: </strong>A prospective, cross-sectional survey study.</p><p><strong>Setting: </strong>Urban hospital specializing in orthopedic surgery.</p><p><strong>Participants: </strong>Participants were identified from the hospital's active directory. Out of 251 questionnaires distributed, 88 were returned and evaluated; 60 percent were surgeons and 34 percent were physician assistants.</p><p><strong>Intervention: </strong>An anonymous, voluntary eight-item survey was devised to capture information on tapering instructions from prescribers of post-discharge opioids.</p><p><strong>Main outcome measures: </strong>Survey responses categorized by role and primary service.</p><p><strong>Results: </strong>All prescribers (N = 47) provide tapering instructions; 87 percent provide general, while 9 percent provide detailed plans. Most (94 percent) prescribers discuss tapering via phone calls or during office visits, and 6 percent provide written instructions.</p><p><strong>Conclusions: </strong>Few prescribers provide detailed tapering instructions. Providers may not feel equipped to provide specific tapering plans.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"21 2","pages":"103-109"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An investigation of methadone-related mortalities: A report from southeast of Iran.","authors":"Kasra Madani, Motahareh Soltani, Fateme Bagheri, Somayyeh Karami-Mohajeri, Omid Mehrpour, Zohreh Oghabian","doi":"10.5055/jom.0897","DOIUrl":"https://doi.org/10.5055/jom.0897","url":null,"abstract":"<p><strong>Background: </strong>Methadone is increasingly being used as a pharmacological agent in treating opioid use disorder (OUD). However, reports of illicit overuse of methadone have resulted in fatal consequences, mainly in those under methadone maintenance treatment (MMT). Considering the high prevalence of opioid addiction in Kerman, the present study was conducted to investigate methadone-related deaths in this province.</p><p><strong>Methods: </strong>A descriptive cross-sectional study was performed on mortality cases caused by methadone use referred to the Forensic Medicine Organization of the Kerman Province in 2020 and 2021. The demographic data as well as concurrent abused substances were extracted from records.</p><p><strong>Results: </strong>A total of 370 methadone-related deaths were registered, of which 45.7 percent were related to 2020, and 54.3 percent were related to 2021. Most cases had been referred to Kerman (65.9 percent), Sirjan (16.8 percent), Rafsanjan (6.2 percent), and Zarand (3.2 percent) forensic medicine centers. Of the deceased, 75.9 percent were men. The average age of the deceased was 33.37 ± 12.83 years, ranging from 6 days to 72 years. The majority of the cases had low levels of education. In 4.1 percent of the cases, simultaneous use of methadone and tramadol was reported, while 7.6 percent of the cases had simultaneous use of stimulants/hallucinogens, and 3.6 percent had simultaneous use of alcohol.</p><p><strong>Conclusion: </strong>Taken together, considering the high frequency of methadone-related deaths in the Kerman Province as well as the low level of socio-economic status in the deceased, designing interventions to enhance the awareness of addicts, especially those who are undergoing MMT programs, could potentially reduce the incidence of methadone poisoning.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"21 2","pages":"181-187"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A toolkit to implement opioid quality improvement efforts in primary care: Findings from a mixed-methods study.","authors":"Ellen Childs, Holly Swan, Leigh Evans, Michael L Parchman, Brooke Ike, Laura-Mae Baldwin, Olivia Bacon, Deborah Perfetto, Eileen Hogan, Sarah J Shoemaker-Hunt","doi":"10.5055/jom.0894","DOIUrl":"10.5055/jom.0894","url":null,"abstract":"<p><strong>Objective: </strong>The Six Building Blocks: A Team-Based Approach to Improving Opioid Management in Primary Care (6BBs) program provides a roadmap for improving the management of patients on opioid therapy for chronic pain. The goal of this project was to evaluate the How-to-Implement Toolkit (Toolkit) for clinics to independently implement the 6BBs without a practice facilitator.</p><p><strong>Methods: </strong>Eight healthcare organizations with 62 clinics participated in the program. We conducted interviews and surveys with clinical staff. A mixed-methods synthesis was conducted, incorporating themes from qualitative data and descriptive analysis of survey data.</p><p><strong>Results: </strong>We found that healthcare organizations appreciated the resources in the Toolkit but wanted the support of a practice facilitator. Organizations reported limited use of the Toolkit in its entirety but found individual tools useful.</p><p><strong>Conclusions: </strong>The results point to the importance of support in implementing opioid quality improvement projects in primary care. The Toolkit and other 6BBs resources are available on the Agency for Healthcare Research and Quality website.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"21 1","pages":"29-40"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}