Journal of opioid management最新文献

{"title":"Naloxone coprescribing best practice advisory for patients at high risk for opioid-related adverse events.","authors":"Holly Sheldon, Nathan Duncan, Amit Singh, Sarah Endrizzi, Ryan Conrardy, Ruta Brazauskas, William Peppard","doi":"10.5055/jom.0866","DOIUrl":"https://doi.org/10.5055/jom.0866","url":null,"abstract":"<p><strong>Objective: </strong>To implement an electronic health record best practice advisory (BPA) to promote coprescribing of naloxone to patients at high risk of serious opioid-related adverse events (ORADEs).</p><p><strong>Design: </strong>This pre-post quasi-experimental study evaluated 9 months of opioid and naloxone prescription data before and after BPA implementation.</p><p><strong>Setting: </strong>The Froedtert & the Medical College of Wisconsin enterprise is comprised of 45 ambulatory clinics and 10 hospitals, including the only adult Level 1 trauma center in eastern Wisconsin.</p><p><strong>Patients: </strong>Patients who received opioid prescriptions in the preimplementation time period (n = 106,615 prescriptions) and post-implementation time period (n = 107,352 prescriptions) were included.</p><p><strong>Interventions: </strong>BPA activation criteria included entry of a prescription with a morphine equivalent daily dose of 50 or greater with at least a 5-day supply, concomitant opioid and benzodiazepine prescription, or opioid prescription entry for a patient with a documented history of opioid overdose. The BPA defaulted to coprescribe naloxone, while also providing suppression options.</p><p><strong>Main outcome measure: </strong>The primary endpoint was the change in naloxone prescription rate for patients on chronic opioid therapy (COT) with a morphine milligram equivalent daily dose (MEDD) per day of 50 or greater.</p><p><strong>Results: </strong>The naloxone coprescription rate for COT patients with a MEDD of 50 or greater increased from 12.2 percent (95 percent confidence interval [CI] 10.4-14.4) to 34.79 percent (95 percent CI 31.8-38.2) after the BPA was implemented (odds ratio 2.85, 95 percent CI 2.37-3.42, p-value < 0.001).</p><p><strong>Conclusions: </strong>Use of BPA increased the rate of naloxone coprescribing for patients at risk of serious ORADE.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"20 6","pages":"471-486"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950360","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 pilot study to examine the opioid prescribing practices of medical residents.","authors":"Nathaniel J Leavitt, Rachel S Sundman, Matthew White, Johannie M Spaan, Belinda McCully, Glen E Kisby","doi":"10.5055/jom.0885","DOIUrl":"https://doi.org/10.5055/jom.0885","url":null,"abstract":"<p><strong>Objective: </strong>The present opioid crisis has raised concern regarding the prescribing practices of physicians. However, the training of resident physicians has not been sufficiently evaluated. The proposed objective of this study was to evaluate how residents across different specialties perceived the adequacy of their training in the prescribing of opioid-based anal-gesics.</p><p><strong>Design: </strong>Medical residents were surveyed regarding their opioid prescribing training in medical school and residency, their confidence and frequency of prescribing opioids, the indications for which they prescribed opioids, whether they utilize opioids as first-line treatment in pain management, and their perception of the effectiveness of opioids in managing a pa-tient's pain.</p><p><strong>Setting: </strong>Medical residents across multiple years and specialties at two institutions within the same state were surveyed.</p><p><strong>Results: </strong>The resident response rate was 26 percent (75), and of those residents, 56 percent (42) indicated that their medi-cal school training was insufficient and 37 percent (28) reported that their residency training was insufficient, which was independent of both year and specialty.</p><p><strong>Conclusions: </strong>These findings suggest that residents perceive a lack of adequate training on the prescribing of opioids during medical school and to a lesser degree during residency. A larger study will be required to validate these findings as well as to determine which specific aspects of a resident's medical education on opioid prescribing are lacking. More importantly, the authors hope that these findings will initiate an interest in standardizing opioid prescribing education for medical students and residents with the goal of reducing the abuse and deaths related to these medications.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"20 6","pages":"487-494"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950356","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":"Insurance coverage and consistent pricing is needed for over-the-counter naloxone.","authors":"Blake Fagan, Delesha Carpenter, Grace Marley","doi":"10.5055/jom.0892","DOIUrl":"https://doi.org/10.5055/jom.0892","url":null,"abstract":"<p><p>With the Food and Drug Administration's approval of the first over-the-counter naloxone nasal spray in 2023, it was expected that access to naloxone nasal spray would increase and that its cost would be reduced. However, the writers of this commentary found varying insurance coverage of naloxone during purchase attempts at local pharmacies. Failure to cover naloxone can reduce access and increase risk of overdose death. We suggest federal policy implementation that requires universal insurance coverage of at least one formulation of naloxone and to utilize national opioid settlement funds to pay for naloxone nasal spray to ensure equitable access to this lifesaving medication.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"20 6","pages":"439-441"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950359","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":"The effects of physician stigma and hesitancy with opioids on patient pain care in the United States: A survey study.","authors":"David W Boorman, Priyanka H Nair, Samuel B John, Joel Zivot, Sudheer Potru","doi":"10.5055/jom.0872","DOIUrl":"https://doi.org/10.5055/jom.0872","url":null,"abstract":"<p><strong>Objectives: </strong>Determine if physician stigma toward patients with chronic pain or opioid use disorder or physician hesitancy prescribing opioids adversely affects patient pain care. Explore the demographics associated with stigma and hesitancy.</p><p><strong>Design: </strong>Survey, 25 questions.</p><p><strong>Setting: </strong>Physician faculty at medical schools (80 percent), private physician Facebook® groups (15 percent), and others (5 percent), all specialties.</p><p><strong>Participants: </strong>N = 352 attending United States physicians.</p><p><strong>Main outcome measure: </strong>Physician self-reported patient pain care quality.</p><p><strong>Results: </strong>Subjectively worse patient pain care was not found to be associated with stigma but had a borderline association with hesitancy (p = 0.046). Subjectively worse pain care was associated with less knowledge and experience with opioids (odds ratio [OR] 4.1, 95 percent confidence interval [CI] 3.0-5.6), practicing in the Midwest region (OR 2.1, 95 percent CI 1.2-3.4), and specialty: emergency (OR 53, 95 percent CI 20-139), other internal (OR 15, 95 percent CI 6.6-34), and general medicine (OR 12, 95 percent CI 5.4-26) compared to pain medicine. Physician stigma was more likely to be high in males (OR 2.5, 95 percent CI 1.5-4.3) and medium in physicians over 55 (OR 2.5, 95 percent CI 1.5-4.5). Compared to medium stigma, those with low stigma (General Linear Model (GLM) 0.35, 95 percent CI 0.18-0.52) and high stigma (GLM 0.22, 95 percent CI 0.01-0.44) were both more hesitant to prescribe opioids. More hesitancy was associated with less knowledge and experience (GLM 0.14, 95 percent CI 0.05-0.22) and physicians under 55 (GLM 0.24, 95 percent CI 0.08-0.40).</p><p><strong>Conclusions: </strong>Although physician stigma was not found to affect patient pain care adversely, self-reporting bias and/or questionnaire issues may account for this. Physician specialty and knowledge and experience with opioids were important factors.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"20 6","pages":"449-470"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950392","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":"Buprenorphine: An anesthesia-centric review.","authors":"Thomas Hickey, Gregory Acampora","doi":"10.5055/jom.0901","DOIUrl":"https://doi.org/10.5055/jom.0901","url":null,"abstract":"<p><p>Buprenorphine was synthesized in the 1960s as a result of a search for a safe and effective opioid analgesic. Present formulations of buprenorphine are approved for the treatment of both acute and chronic pain. Its long duration of action, high affinity, and partial agonism at the µ-opioid receptor have established it as a mainstay treatment for opioid use disorder (OUD). Full agonist opioids (FAOs) remain a primary choice for perioperative pain in both opioid-naïve and opioid-tolerant patients despite well-known harms and new emphasis on multimodal analgesia strategies prioritizing nonopioid analgesics. We review the evidence supporting the use of buprenorphine as an effective analgesic alternative to more commonly prescribed FAOs in acute and chronic pain management. For the patient prescribed buprenorphine for OUD, prior conventionalism advised temporary discontinuation of buprenorphine preoperatively; this paradigm has shifted toward continuing buprenorphine throughout the perioperative period. Questions remain whether dose adjustments may improve patient outcomes.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"20 6","pages":"503-527"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950357","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":"Should baseline/routine ECG monitoring be performed for patients on buprenorphine-containing medications?","authors":"Kayla Boedeker, Megan Fraley, Sarah Toppins, Chris Herndon","doi":"10.5055/jom.0890","DOIUrl":"https://doi.org/10.5055/jom.0890","url":null,"abstract":"","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"20 5","pages":"351-353"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639169","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":"The opioid public health crisis in Texas: Characterizing real-world healthcare resource utilization and economic burden in different clinical settings.","authors":"Lixian Zhong, Matthew Lee Smith, Ning Lyu, Meri Davlasheridze, Joy Alonzo, Shinduk Lee, Leslie Wilson, Marcia G Ory","doi":"10.5055/jom.0899","DOIUrl":"https://doi.org/10.5055/jom.0899","url":null,"abstract":"<p><strong>Background and aims: </strong>Given the national opioid public health crisis, this study aimed to characterize the real-world healthcare resource utilization pattern and to quantify the economic burden associated with opioid misuse in Texas.</p><p><strong>Methods: </strong>A retrospective cross-sectional study was conducted using Texas state-wide Inpatient, Outpatient, and Emergency Department (ED) administrative data. International Classification of Diseases, 10th Revision (ICD-10-CM) codes related to opioid abuse, adverse effects, dependence, and poisoning identified opioid-related clinical encounters. High-sensitivity and high-specificity definition criteria were used to capture the range of opioid-related clinical encounters. Descriptive statistics were applied to evaluate the resource utilization and economic burden in different clinical settings and by different types of opioid misuse. Multivariable logistic regression models were applied to identify the association with patients' characteristics.</p><p><strong>Results: </strong>The high-sensitivity definition identified three to six times more opioid-related clinical encounters related as compared to the high-specificity definition (31,901 vs 10,423 outpatient visits and 47,021 vs 7,444 inpatient visits). A greater proportion of these patients were aged 18-44, White, non-Hispanic, living in metro areas, and uninsured as compared to all-cause visits. EDs were heavily utilized with the outpatient visits predominantly through the ED (>90 percent) and between 49 and 78 percent of inpatient hospitalizations admitted through ED. The multivariable association between patient characteristics and opioid-related clinical encounters varied with clinical settings and the two definitions. High-sensitivity opioid-related clinical encounters were generally associated with higher charges as compared to high-specificity encounters. The total healthcare charge related to opioid misuse in 2016 was estimated to be USD 0.27 billion using the high-specificity definition and USD 2.6 billion using the high-sensitivity definition.</p><p><strong>Conclusions: </strong>Findings indicate opioid-related clinical encounters impose significant clinical and economic burdens in Texas. Study findings can help healthcare policymakers, professionals, and clinicians better classify opioid use disorder as a major but underreported condition in Texas.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"20 5","pages":"393-409"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639082","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":"Assessment of attitudes of health professionals toward naloxone use.","authors":"Jonathan Lin, Helen Calmes, Heather Brooks, B Lochlann McGee, Sonia Malhotra","doi":"10.5055/jom.0879","DOIUrl":"https://doi.org/10.5055/jom.0879","url":null,"abstract":"<p><strong>Purpose: </strong>To assess the attitudes and behaviors of physicians, hospital pharmacists, registered nurses, and other healthcare professionals toward naloxone use. This survey will help the University Medical Center New Orleans Analgesic Management Stewardship team understand barriers and determine the education needed to improve the care we provide.</p><p><strong>Methods: </strong>A survey was conducted at a single center, and it contained 17 questions: two concerning provider type and practice setting, followed by 15 qualitative questions to be answered in a Likert scale format, with options ranging from strongly disagree to strongly agree. The survey was disseminated via email, in person, and at meetings. A quick-response code was used.</p><p><strong>Results: </strong>The total number of participants in the survey was 151. Physicians accounted for the majority (n = 76, 50.3 percent), followed by registered nurses (n = 36, 23.8 percent) and then pharmacists (n = 17, 11.3 percent). Respondents primarily practiced in an inpatient medicine service (n = 78, 51.7 percent). When evaluating the impact naloxone has on patients suffering from opioid use disorder (OUD), most participants acknowledged that naloxone has an important part in treatment (n = 135, 89.4 percent) and has a positive impact on these patients (n = 129, 85.4 percent). Inappropriate naloxone use was addressed. A minority of the participants (n = 13, 8.6 percent) agreed that OUD patients would not use naloxone appropriately, with 38 (25.2 percent) participants remaining neutral. Furthermore, this response more than doubled (n = 29, 19.2 percent) for those who at least agreed that naloxone would only increase opioid use and risky behavior. While a majority felt comfortable educating their patients on naloxone use (n = 103, 68.2 percent), only about half of the total respondents (n = 79, 52.3 percent) stated that they have received training on naloxone use for OUD patients. Just over half of the participants of this survey (n = 77, 51 percent) reported being aware of the standing order status of naloxone in Louisiana.</p><p><strong>Conclusions: </strong>Based on the responses, there is a consensus that naloxone is effective and an important part of treatment for OUD patients. However, barriers exist where participants may not have received training or may not be comfortable educating patients on naloxone. In addition, there is concern among participants that patients may not use naloxone appropriately.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"20 5","pages":"427-433"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639046","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":"Race and socioeconomic determinants of opioid use and disposal following pediatric surgery.","authors":"Adam C Adler, Brittany E Bryant, David Baszynski, Andrew Lee, Eduardo Medellin, Brian H Nathanson, Arvind Chandrakantan","doi":"10.5055/jom.0821","DOIUrl":"10.5055/jom.0821","url":null,"abstract":"<p><strong>Background: </strong>Opioids are a mainstay in treating acute post-surgical pain although there are limited data on post-discharge use.</p><p><strong>Objectives: </strong>To assess post-operative opioid usage in children undergoing outpatient pediatric surgical procedures and provider variability in the number of doses prescribed by procedure.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"20 5","pages":"355-364"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639101","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":"Economic losses resulting from opioid overdose deaths in the United States between 2018 and 2020: By opioid type.","authors":"Shalinie Mahadeo, Briana Lui, Elizabeth Khusid, Marissa Weber, Rohan Jotwani, Marguerite Hoyler, Robert S White","doi":"10.5055/jom.0871","DOIUrl":"10.5055/jom.0871","url":null,"abstract":"<p><strong>Background/objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"20 5","pages":"375-381"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639090","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}