Journal of opioid management最新文献

{"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":"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":"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":"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}

{"title":"Characterizing dose changes and tapering among opioid users: A brief report on a population-level study in Alberta, Canada.","authors":"Cerina Dubois, Olivia Weaver, Ming Ye, Fizza Gilani, Salim Samanani, Ed Jess, Dean T Eurich","doi":"10.5055/jom.0880","DOIUrl":"https://doi.org/10.5055/jom.0880","url":null,"abstract":"<p><strong>Objective: </strong>Monitoring changes in oral morphine equivalents (OMEs) is an important parameter to understand how opioids are being used at the population level. However, changes in opioid doses and tapering have not been well defined.</p><p><strong>Design: </strong>We conducted a population-based exploratory data analysis (EDA) to characterize changes in opioid doses and tapering of opioids among patients in Alberta (AB). A literature review was conducted to assess opioid tapering.</p><p><strong>Setting: </strong>Using dispense data from 2020 to 2021 provided by the College of Physicians & Surgeons of Alberta (CPSA), we assessed changes in OME per day from baseline to the subsequent quarter.</p><p><strong>Patients: </strong>Patients living in AB.</p><p><strong>Interventions: </strong>N/A.</p><p><strong>Main outcome measures: </strong>The absolute and relative changes in OME per day were estimated for each assessment. Tapering was considered if an opioid user's OME per day changed from the baseline to zero in the subsequent quarter. The frequency and percentages of patients with different levels of changes in OME per day were summarized per quarter.</p><p><strong>Results: </strong>There were 13 operational definitions of opioid tapering in the literature. Comparatively, our approach at the CPSA differed in the length of the follow-up assessment period. Based on our quarterly assessment of ~390,000 patients, all four periods showed 60 percent of patients had an opioid dose decrease/tapered therapy relative to baseline. However, 21 percent were noted to be new users of opioids.</p><p><strong>Conclusions: </strong>Based on our approach at the CPSA, 60 percent of patients tapered opioids over a year. Despite no standardized definition of opioid tapering, our EDA demonstrates one approach using population-based drug dispense data to evaluate opioid use.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"20 5","pages":"383-392"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639050","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":"Repetitive transcranial magnetic stimulation in the treatment of opioid use disorder: A narrative review.","authors":"Amber N Edinoff, Saveen Sall, Sarah E Wagner, Alexa R Zahari, Mauricio J Portillo, Eric D Jackson, Danielle M Wagner, Elyse M Cornett, Kevin S Murnane, Adam M Kaye, Alan D Kaye","doi":"10.5055/jom.0876","DOIUrl":"https://doi.org/10.5055/jom.0876","url":null,"abstract":"<p><p>It is estimated that over 16 million people are living with opioid use disorder (OUD) worldwide, with 2.1 million people in the United States. Opioid addiction is theorized to be associated with strong dopaminergic response to opioid receptor stimulations that contributes to reward-seeking behaviors and individuals' experiences with opioids. Methadone and buprenorphine have been game changers; however, both come with limitations, especially in the era of fentanyl use. Naltrexone is another treatment used for OUD that blocks opioid receptors. An emerging treatment of significant interest is a neuro-interventional technique called transcranial magnetic stimulation (TMS), which is currently approved by the Food and Drug Administration for the treatment of depression and, recently, for obsessive compulsive disorder and tobacco use disorder. TMS has been seen in some studies to significantly reduce cravings for opioids with effects beyond the last administrated treatment. This manuscript is a narrative review of the potential relevance of TMS, specifically, repetitive TMS, in the future treatment of OUD.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"20 5","pages":"417-426"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639107","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":"Therapeutic experience with tramadol for opioid dependence: A prospective observational study from India.","authors":"Kirti Sharma, Prabhoo Dayal, Siddharth Sarkar, Sonali Jhanjee","doi":"10.5055/jom.0898","DOIUrl":"10.5055/jom.0898","url":null,"abstract":"<p><strong>Introduction: </strong>Opioid use disorder (OUD) is a chronic relapsing disorder with significant mortality, morbidity, and public health challenges. In India, tramadol is frequently used for the treatment and management of OUDs.</p><p><strong>Methodology: </strong>A prospective observational study was performed to evaluate 3-month outcomes in outpatients with OUD on treatment with tramadol at a tertiary care addiction treatment facility in North India. One hundred and sixty newly registered patients fulfilling the inclusion and exclusion criteria were recruited and assessed on Maudsley Addiction Profile to evaluate changes in days and the amount of substance use and associated complications at 1-, 2-, and 3-month follow-up.</p><p><strong>Results: </strong>This study also showed a treatment retention rate of 14 percent with an abstinence rate of 34 percent at the end of the third month. The mean number of days of illicit opioid use in retained population decreased from 29.3 (±3.5) days from baseline to 12.5 (±10.9) days at 1 month, 5.0 (±7.2) days at 2 months, and 4.3 (±6.8) days at 3 months. Repeated measures analyses showed significant change in the days of illicit opioid use on treatment with tramadol over 3 months (p = 0.01).</p><p><strong>Conclusion: </strong>This study leads the way in showing tramadol as an important medication for use in OUDs to provide for maintenance therapy for longer durations. This has major implications in low- and middle-income countries, especially in Asia and Africa, where tramadol is more easily available.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"20 5","pages":"365-374"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639187","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":"Patient perceptions of opioid use disorder, drug and alcohol dependence.","authors":"Heather F Thiesset, Ruthann Cunningham, Jeffrey Glenn","doi":"10.5055/jom.0877","DOIUrl":"https://doi.org/10.5055/jom.0877","url":null,"abstract":"<p><strong>Background: </strong>As the opioid epidemic continues, it behooves healthcare systems and practitioners to examine factors affecting access to care and treatment, as well as understand patient perceptions of opioid use disorder (OUD).</p><p><strong>Methods: </strong>This was a cross-sectional sample of 124 patients with an OUD diagnosis identified using International Classification of Disease codes in electronic health records. Patients responded to a qualitative survey regarding self-perceptions and history of OUD, alcohol, and substance use.</p><p><strong>Results: </strong>A total of 46 percent of the patients who had an OUD diagnosis in their medical record denied having OUD.</p><p><strong>Discussion: </strong>This showed clear differences between provider and patient perceptions, as well as potential system error. To reduce stigma as well as ensure proper pain management, providers and patients need clear and transparent individualized care plans for each patient with an OUD diagnosis, as well as a frequent review of electronic records and diagnoses.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"20 5","pages":"411-415"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639094","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}