Journal of opioid management最新文献_第3页

Examining the effect of a Whole Health Primary Care Pain Education and Opioid Monitoring Program (PC-POP) at preventing opioid-induced constipation. 检查整个卫生初级保健疼痛教育和阿片类药物监测计划（PC-POP）在预防阿片类药物引起的便秘中的作用。

Journal of opioid management Pub Date : 2025-03-01 DOI: 10.5055/jom.0918

Taylor Hammack, Clayton J Hamilton, Amber Martinson

{"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":"Objective: 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.Setting: This study was conducted in the Salt Lake City Veterans Affairs (VA) Medical Center's primary care setting.Subjects: 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.Results: 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).Conclusion: 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.","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}

引用次数: 0

A survey study assessing prescribers' opioid tapering instructions to patients after orthopedic surgery. 一项评估骨科手术后处方者阿片类药物逐渐减少指示的调查研究。

Journal of opioid management Pub Date : 2025-03-01 DOI: 10.5055/jom.0919

William Chan, Samuel Schuessler, Steven Magid, Seth Waldman, Roberta Stack, Alexandra Sideris

{"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":"Objective: The purpose of this institutional survey study was to assess the opioid tapering practices of prescribers responsible for writing post-discharge opioid refills.Design: A prospective, cross-sectional survey study.Setting: Urban hospital specializing in orthopedic surgery.Participants: 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.Intervention: An anonymous, voluntary eight-item survey was devised to capture information on tapering instructions from prescribers of post-discharge opioids.Main outcome measures: Survey responses categorized by role and primary service.Results: 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.Conclusions: Few prescribers provide detailed tapering instructions. Providers may not feel equipped to provide specific tapering plans.","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}

引用次数: 0

An investigation of methadone-related mortalities: A report from southeast of Iran. 美沙酮相关死亡的调查：来自伊朗东南部的报告。

Journal of opioid management Pub Date : 2025-03-01 DOI: 10.5055/jom.0897

Kasra Madani, Motahareh Soltani, Fateme Bagheri, Somayyeh Karami-Mohajeri, Omid Mehrpour, Zohreh Oghabian

{"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":"Background: 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.Methods: 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.Results: 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.Conclusion: 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.","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}

引用次数: 0

A toolkit to implement opioid quality improvement efforts in primary care: Findings from a mixed-methods study. 在初级保健中实施阿片类药物质量改进工作的工具包：一项混合方法研究的结果。

Journal of opioid management Pub Date : 2025-01-01 DOI: 10.5055/jom.0894

Ellen Childs, Holly Swan, Leigh Evans, Michael L Parchman, Brooke Ike, Laura-Mae Baldwin, Olivia Bacon, Deborah Perfetto, Eileen Hogan, Sarah J Shoemaker-Hunt

{"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":"Objective: 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.Methods: 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.Results: 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.Conclusions: 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.","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}

引用次数: 0

The potential impact of alternatives to opioids (ALTO) protocol on opioid reduction in the community emergency department. 阿片类药物替代品（ALTO）协议对社区急诊科阿片类药物减少的潜在影响。

Journal of opioid management Pub Date : 2025-01-01 DOI: 10.5055/jom.0895

Eric H Chou, Toral Bhakta, Ching-Fang Tiffany Tzeng, Andrew Shedd, Jon Wolfshohl, Alec Jessen, Yu-Lin Hsieh, Chinmay Patel, Robin K Chan, Jaydeep Shah, Dahlia Hassani

{"title":"The potential impact of alternatives to opioids (ALTO) protocol on opioid reduction in the community emergency department.","authors":"Eric H Chou, Toral Bhakta, Ching-Fang Tiffany Tzeng, Andrew Shedd, Jon Wolfshohl, Alec Jessen, Yu-Lin Hsieh, Chinmay Patel, Robin K Chan, Jaydeep Shah, Dahlia Hassani","doi":"10.5055/jom.0895","DOIUrl":"10.5055/jom.0895","url":null,"abstract":"Objective: To investigate the potential impact of implementing alternatives to opioids (ALTOs) protocol in a community emergency department (ED) in North Texas. We hypothesize that the ALTO protocol is associated with decreased opioid utilization without affecting patient satisfaction to pain control and ED flow.Design: A retrospective, single-center, cohort study.Setting: An urban ED.Participants: Adult patients (age >18 years old) who received pain medications in ED during the study timeframe were included. A total of 34,251 patients were included for final analysis.Intervention: Patients receiving pain medication after the implementation of the ALTO protocol during March to August 2019 and patients during the same period from the prior year were identified as the post-protocol group and preprotocol group, respectively.Main outcome measures: The primary outcome was the change in ED opioid administration. Secondary outcomes included patient satisfaction to pain control, left without being seen (LWOBS), door-to-doctor time, and turnaround time.Results: The total opioid administration rate decreased by 59.6 percent after the implementation of the ALTO protocol. The percentage of patients that LWOBS (p = 0.003) and the average door-to-doctor time (p < 0.001) were significantly decreased in the post-protocol group. There was no significant difference in patient satisfaction to pain control (p = 0.192) and average turnaround time (p = 0.209).Conclusions: Implementation of an ALTO protocol was associated with a significant reduction of opioid administration without a negative impact on patient satisfaction regarding pain control and ED flow.","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"21 1","pages":"77-89"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605223","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}

引用次数: 0

Urinary metabolic ratio of pain management and substance abuse treatment drugs: Drug-drug interactions. 尿代谢比疼痛管理和药物滥用治疗药物：药物-药物相互作用。

Journal of opioid management Pub Date : 2025-01-01 DOI: 10.5055/jom.0907

Agnes Cua, Eugene Wickett, Amadeo J Pesce

{"title":"Urinary metabolic ratio of pain management and substance abuse treatment drugs: Drug-drug interactions.","authors":"Agnes Cua, Eugene Wickett, Amadeo J Pesce","doi":"10.5055/jom.0907","DOIUrl":"https://doi.org/10.5055/jom.0907","url":null,"abstract":"We present data showing that the urinary metabolic ratio (MR) of metabolite to parent drug can be used to estimate the drug-drug interactions (DDIs) of pain management and substance abuse treatment medications with other coadministered drugs. We quantitatively measure 18 drugs and their phase I metabolites and monitor the effects of 14 interfering drugs on their MRs. The 18 drugs include dextromethorphan, oxycodone, hydrocodone, tramadol, morphine, buprenorphine, fentanyl, clonazepam, alprazolam, quetiapine, carisoprodol, tapentadol, ketamine, methadone, impramine, and amitriptyline. The 14 interfering drugs include fluoxetine, paroxetine, bupropion, citalopram, sertraline, venlafaxine, duloxetine, risperidone, trazodone, aripiprazole, cyclobenzaprine, amphetamine, and tetrahydrocannabinol. Some of these interfering drugs are inhibitors of either the CYP2D6, CYP3A4/5, or CYP2C19 pathways. By using the urinary MR of metabolite/parent drug, we observed patterns of inhibition and enhancement due to DDIs. Using the MR reference intervals of the 18 drug pairs established in an earlier study, and the current DDI system, we can alert providers of unusual metabolism caused by DDIs. This will help providers do better prescribing or review more closely all medications and supplements patients are taking, thus avoiding underdosing or potential medication adverse reactions.","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"21 7","pages":"41-68"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144753590","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}

引用次数: 0

Urinary metabolic ratio of pain management and substance abuse treatment drugs: Reference intervals. 尿代谢率疼痛管理和药物滥用治疗药物：参考区间。

Journal of opioid management Pub Date : 2025-01-01 DOI: 10.5055/jom.0904

Amadeo J Pesce, Agnes Cua, Eugene Wickett

引用次数: 0

Introduction of oral methadone to high-risk patients with prolonged QT interval: A retrospective study. QT间期延长的高危患者口服美沙酮的引入：一项回顾性研究。

Journal of opioid management Pub Date : 2025-01-01 DOI: 10.5055/jom.0828

Miho Takemura, Kazuyuki Niki, Yoshiaki Okamoto, Yoshinobu Matsuda, Takahito Omae, Makie Kohno, Kenji Ikeda, Mikiko Ueda

{"title":"Introduction of oral methadone to high-risk patients with prolonged QT interval: A retrospective study.","authors":"Miho Takemura, Kazuyuki Niki, Yoshiaki Okamoto, Yoshinobu Matsuda, Takahito Omae, Makie Kohno, Kenji Ikeda, Mikiko Ueda","doi":"10.5055/jom.0828","DOIUrl":"10.5055/jom.0828","url":null,"abstract":"Objective: Methadone may cause detrimental side effects such as corrected QT (QTc) prolongation. However, methadone may be desirable in patients with advanced cancer and those with heart disease who have intractable pain. Therefore, we aimed to evaluate the safety and efficacy of initiating methadone for cancer pain in patients at high risk of methadone-induced QTc prolongation.Design: A retrospective cohort study.Setting: Single center.Patients: Sixty-four patients with cancer who started oral methadone to relieve pain and underwent 12-lead electrocardiogram monitoring at baseline and 1-2 weeks after initiation of methadone therapy from January 1, 2013, to March 31, 2022, were enrolled.Main outcome measures: The primary endpoints were the change in QTc from baseline after oral methadone therapy and the difference in methadone doses between the high- and low-risk groups for methadone-induced QTc prolongation.Results: None of the patients developed clinically significant methadone-induced QTc prolongation or any adverse events attributable to cardiotoxicity, although 32 patients (50.0 percent) had heart disease or prolonged QTc before oral methadone initiation. Moreover, the high-risk group received a lower dose of opioid analgesics prior to methadone administration. For this reason, they started with a lower methadone dose than the low-risk group.Conclusions: Even in patients with heart disease or prolonged QTc at baseline, methadone may be safely administered by initiating low-dose methadone when the dose of other opioids is low and by adjusting the concomitant medications that can interact with methadone.","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"21 1","pages":"61-70"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605220","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}

引用次数: 0

Development of a standardized protocol for buprenorphine induction in a chronic pain clinic. 为慢性疼痛诊所制定丁丙诺啡诱导标准方案。

Journal of opioid management Pub Date : 2025-01-01 DOI: 10.5055/jom.0916

Jaycee A Blair, Savannah G Hansen

{"title":"Development of a standardized protocol for buprenorphine induction in a chronic pain clinic.","authors":"Jaycee A Blair, Savannah G Hansen","doi":"10.5055/jom.0916","DOIUrl":"10.5055/jom.0916","url":null,"abstract":"Objective: Create a standardized protocol document on how to convert patients from full opioid agonist to buprenorphine. Providing patients with the best possible chance of a seamless conversion resulting in decreased risk of failure of therapy with buprenorphine.Methods: A 10-question survey was distributed to better understand the different aspects the providers consider when converting a patient from full opioid agonist to buprenorphine. A medication use evaluation was completed utilizing a retrospective qualitative design to identify all patients who had a new prescription for any buprenorphine product from a chronic pain provider to establish patterns of current practice. This information, in conjunction with guidance from current literature and medication package inserts, was used to create a protocol for buprenorphine induction. Providers were educated on buprenorphine prior to guidance document implementation.Results: A five-page guidance document on how to convert patients from full opioid agonist to buprenorphine was created for providers within the chronic pain clinic. The document includes recommendations on which patients are candidates for buprenorphine versus those who are not. The document also provides a three-step process to successfully perform a conversion including which buprenorphine product and induction technique to utilize. Definitions of each induction technique along with examples are provided within the document. Recommendation for converting between buprenorphine patch and films are also listed within the document.Discussion: The five-page guidance document was successfully implemented in June 2024, supplying pain providers with all the knowledge necessary to convert patients comfortably, thus providing patients with the best possible chance of a seamless conversion and decreasing risk of failure of conversion to buprenorphine due to inadequate induction technique.","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"21 1","pages":"17-27"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605218","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}

引用次数: 0

Dispensing issues and disciplinary measures during opioid agonist treatment: A viewpoint. 阿片类激动剂治疗中的配药问题和纪律措施：一种观点。

Journal of opioid management Pub Date : 2025-01-01 DOI: 10.5055/jom.0922

Arnab Datta, Siddharth Sarkar

{"title":"Dispensing issues and disciplinary measures during opioid agonist treatment: A viewpoint.","authors":"Arnab Datta, Siddharth Sarkar","doi":"10.5055/jom.0922","DOIUrl":"10.5055/jom.0922","url":null,"abstract":"Opioid Use Disorder (OUD) poses a significant public health challenge globally, with an estimated 23 million opioid users in India. Opioid Agonist Therapy (OAT) stands as the cornerstone of treatment, offering potential reductions in morbidity, societal burdens, and improvements in patient quality of life. However, OAT coverage remains fairly low in India, with clinical guidelines lacking comprehensive information on implementation pragmatics. This viewpoint delves into the nuanced challenges faced by clinicians in the daily operations of OAT emphasizing disciplinary issues, practical responses, and the broader implications for treatment outcomes and public perception. The treatment provider's response is explored from different aspects like learning theory, attitude, psychodynamic interactions, and ethics. Understanding patient perspectives, including employment demands and perceptions of fairness, is crucial in tailoring responses and optimizing treatment engagement. While disciplinary measures are integral to maintaining treatment sanctity, their effectiveness must be balanced with patient autonomy and harm reduction goals. The discourse surrounding OAT disciplinary measures necessitates a multifaceted approach, integrating evidence-based practices, clinician experiences, patient rights, and administrative considerations to ensure equitable and effective treatment provision.","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"21 1","pages":"5-9"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605219","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}

引用次数: 0