Journal of opioid management最新文献

{"title":"Attitudinal barriers to buprenorphine prescription and former waiver training.","authors":"Michael P Gannon, Monique Tello, Sarah Wakeman, Jean-Pierre Charles, Stuart Lipsitz, Lipika Samal","doi":"10.5055/jom.0827","DOIUrl":"10.5055/jom.0827","url":null,"abstract":"<p><strong>Objective: </strong>Opioid use disorder (OUD) can be effectively treated with buprenorphine maintenance. Recent changes in federal policy have removed the requirement for physicians to complete additional training to apply for a Drug Enforcement Administration (DEA) waiver to prescribe buprenorphine. At that time, few primary care providers (PCPs) had completed the training for a DEA waiver to prescribe buprenorphine. Our goal was to identify addressable barriers that may persist despite updates to federal legislation.</p><p><strong>Design: </strong>A 42-item survey was distributed to 662 physicians and nurse practitioners at two academic medical centers with 100 respondents.</p><p><strong>Setting: </strong>The survey was sent via email and administered anonymously through SurveyMonkey.</p><p><strong>Patients and participants: </strong>All participants were PCPs, and all PCPs at the two academic medical centers were eligible to participate.</p><p><strong>Interventions: </strong>PCPs responded to the survey by answering questions online.</p><p><strong>Main outcome measures: </strong>PCPs answered questions regarding previous buprenorphine waiver training status, local OUD prevalence, the effectiveness of OUD treatment modalities, and previous barriers to training.</p><p><strong>Results: </strong>Respondents were compared using descriptive statistics and logistic regression. Of the 100 respondents (response rate: 15 percent), 69 percent had not completed the training. Ninety-nine percent of PCPs agreed that OUD was an issue in their area, 94 percent saw patients with OUD, and 91 percent rated buprenorphine maintenance as a very effective treatment for OUD. Previously waivered and nonwaivered providers did not differ in their responses to these questions. Those who had been waivered were less likely to say they did not see enough patients with OUD to justify training (odds ratio [OR] 0.267, p = 0.005) and were less likely to express concern about allowing patients with OUD into their practice (OR 0.348, p = 0.020) than PCPs who had applied for the DEA waiver.</p><p><strong>Conclusions: </strong>Despite nonwaivered PCPs recognizing OUD's prevalence, they were concerned about allowing patients with OUD into their practice and said there were not enough patients to justify training. This suggests that attitudinal barriers are the most appropriate target for current intervention.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"20 4","pages":"339-346"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348548","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 influence of guidelines on opioid prescribing practices after pe-diatric anterior cruciate ligament reconstruction.","authors":"Tanner Hudson, Fehmi Berkay, Arjun Minhas, Scott Huff, Joseph Henningsen, Eric Erb, Andrew W Froehle, Michael C Albert","doi":"10.5055/jom.0856","DOIUrl":"10.5055/jom.0856","url":null,"abstract":"<p><strong>Objective: </strong>To report opioid prescription patterns after pediatric anterior cruciate ligament reconstruction (ACLR) and identify if the implementation of the opioid prescribing guidelines (OPGs) modified these patterns.</p><p><strong>Design: </strong>A retrospective chart review.</p><p><strong>Setting: </strong>Level 1 Pediatric Trauma Center.</p><p><strong>Patients: </strong>Pediatric patients who underwent primary ACLR at a single pediatric hospital system between the years 2016 and 2018 were included. Patients were excluded if they did not receive an opioid prescription from an orthopedic provider at the time of discharge or if they underwent an additional operative procedure within 90 days of the index surgery. Eighty-six patients met the criteria for a retrospective review.</p><p><strong>Interventions: </strong>Opioid prescriptions were converted into morphine equivalent doses (MEDs) for standardization.</p><p><strong>Main outcome measure: </strong>The average MED prescribed at the time of discharge and during follow-up visits for pediatric patients undergoing ACLR.</p><p><strong>Results: </strong>Patient's age was the only independent variable that had a significant relationship with discharge MED (p = 0.002) and predicted that MED at discharge increases by 20.7 units [confidence interval = 12.3-29.1] for each increasing year in patient age. Discharge MED prescribed after implementation of the OPG was found to be significantly less than discharge MED prescribed prior to the OPG through Wilcoxon rank-sum test (p < 0.001).</p><p><strong>Conclusions: </strong>Implementation of the OPG in Ohio led to a significant reduction in opioid doses prescribed to patients at all time points within 90 days of ACLR. However, these guidelines also led to a significant increase in the likelihood that post-OPG patients would receive an additional opioid prescription during follow-up within 90 days of surgery.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"20 4","pages":"311-317"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348586","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":"\"My addiction doesn't define me\": Healing from the stigma of addiction for mothers with opioid use disorder.","authors":"Christine Bakos-Block, Francine Vega, A Sarah Cohen, Tiffany Champagne-Langabeer","doi":"10.5055/bupe.24.rpj.1020","DOIUrl":"10.5055/bupe.24.rpj.1020","url":null,"abstract":"<p><strong>Background: </strong>About 1 in 8 children under age 17 live with a parent who has a substance use disorder. Research on treatment access identifies stigma as a significant barrier to treatment, particularly among mothers with young children. Well-meaning but punitive state policies further perpetuate stigma, which harms families and children.</p><p><strong>Purpose/hypothesis: </strong>Explore the experiences of the stigma of addiction on mothers before, during and after treatment for substance use disorder. Procedures/data/observations: Descriptive Phenomenology was used to describe the experiences of stigma of mothers with opioid use disorder (OUD) through all stages of treatment and recovery. Mothers (n=20) participating in an outpatient treatment program interviewed. A semi-structured interview schedule was used to guide the interviews and thematic analysis was used identify themes related to stigma.</p><p><strong>Conclusions/applications: </strong>Our analysis identified several main themes and subthemes related to internal and external sigma, including stigma against medication for opioid use dis order, stigma from the public and healthcare professionals, internalized shame, and how mothers learned to recover and heal from stigma.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"20 4","pages":"B10"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348546","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: Not Just Another Opioid - Understanding the World's Most Interesting Opioid.","authors":"Andrea Rubinstein","doi":"10.5055/bupe.24.rpj.1035","DOIUrl":"10.5055/bupe.24.rpj.1035","url":null,"abstract":"<p><strong>Background: </strong>In this talk we will delve deep into the pharmacology of this drug and how it's receptor interactions are unique and then we will take that understanding and apply it to clinical usage to see how this drug behaves in a variety of situations.</p><p><strong>Purpose/hypothesis: </strong>Specifically we will look at the safety profile of this drug, including it's ceiling effect on respiratory depression. Then we will look at efficacy, how well does this drug work in the treatment of pain. We will look at analgesia, tolerance and anti-hyperalgesic properties of buprenorphine. We will discus why this drug is so versatile anyhow versatility is a key asset when it comes to using buprenorphine for the treatment of pain.</p><p><strong>Conclusions/applications: </strong>The last section of this talk will look at the specific area of preoperative use of buprenorphine and why buprenorphine should be continued throughout the pre- operative period.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"20 4","pages":"B1"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348563","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":"Effectiveness of a discharge analgesia guideline on discharge opioid prescribing after a surgical procedure from a tertiary metropolitan hospital.","authors":"Katelyn Jauregui, Shania Liu, Asad Patanwala, David Begley, Kok Eng Khor, Bernadette Bugeja, Ian Fong, Joanne Rimington, Jonathan Penm","doi":"10.5055/jom.0863","DOIUrl":"10.5055/jom.0863","url":null,"abstract":"<p><strong>Objective: </strong>The primary objective of this study was to evaluate the effectiveness of a discharge analgesia guideline on the number of days' supply of opioid analgesics provided among surgical patients upon hospital discharge. The secondary objective was to analyze the effect of this guideline on the provision of an analgesic discharge plan.</p><p><strong>Design: </strong>A retrospective historical control cohort study.</p><p><strong>Setting: </strong>A tertiary metropolitan hospital.</p><p><strong>Interventions: </strong>A discharge analgesia guideline recommending the supply of opioid analgesics on discharge based on patient use in the 24 hours prior to discharge and the supply of an analgesic discharge plan.</p><p><strong>Main outcome measure(s): </strong>The primary outcome measure was the number of days' supply of opioids. The secondary outcome measure was the proportion of patients receiving an analgesic discharge plan.</p><p><strong>Results: </strong>There was no change in the number of days' supply of opioids provided on discharge (median, interquartile range: 5, 3-9.75 vs 6, 4-10; p = 0.107) and in the proportion of patients receiving an analgesic discharge plan (26 percent vs 22.2 percent; p = 0.604). The results of two multivariable regression models showed no change in the number of days' supply of opioids (adjusted incidence rate ratio, 95 percent confidence interval [CI]: 1.1, 0.9-1.2) and the provision of an analgesic discharge plan (adjusted odds ratio, 95 percent CI: 0.6, 0.2-1.4) after adjusting for confounding variables.</p><p><strong>Conclusion: </strong>Overall, our study found no change in the number of days' supply of opioids provided on discharge and the provision of an analgesic discharge plan after implementation of a discharge analgesia guideline, but we also found that prescribing practices already aligned with the guideline before its implementation.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"20 4","pages":"329-338"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348568","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":"Association between buprenorphine capacity rates and percentages of ethnic/racial minorities at the county level in the United States.","authors":"Saharnaz Nedjat, Marc Fleming","doi":"10.5055/jom.0858","DOIUrl":"10.5055/jom.0858","url":null,"abstract":"<p><strong>Objective: </strong>This study investigated the association between patient treatment capacity rates and the percentage of racial/ethnic minorities at the county level.</p><p><strong>Design: </strong>Ecological study at the county level.</p><p><strong>Exposure: </strong>The percentages of racial/ethnic minorities and the people living in poverty in 3,140 counties serve as the main exposure and confounder variables.</p><p><strong>Main outcome measure: </strong>\"No or low patient capacity\" was defined as a patient capacity rate less than or equal to the 40th percentile of the distribution. Patient capacity rates were calculated by adding the maximum number of patients X-waivered providers could potentially treat in each county.</p><p><strong>Result: </strong>Counties in higher racial/ethnic minority quintiles had significantly lower odds of \"no or low patient capacity\" than those in the lowest quintile in multiple logistic regression (adjusted odds ratio, 0.29; 95 percent CI, 0.14-0.61).</p><p><strong>Conclusion: </strong>Since racial/ethnic minorities continue to have limited access to buprenorphine, as shown in individual-level studies, merely increasing treatment capacity is largely insufficient.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"20 4","pages":"275-279"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348547","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 for Cancer Pain: Results from a Systematic Review.","authors":"Maria Silveira, Victoria Powell","doi":"10.5055/bupe.24.rpj.1075","DOIUrl":"10.5055/bupe.24.rpj.1075","url":null,"abstract":"<p><strong>Background: </strong>Buprenorphine may be safer and better-tolerated than full mu opioid receptor (MOR) agonists. Whether it effectively controls cancer-related pain is unclear. A prior review (Cochrane 2015) did not support prioritizing buprenorphine over full MOR agonists for cancer-associated pain.</p><p><strong>Purpose/hypothesis: </strong>We conducted an updated systematic review of buprenorphine's effect on cancer- related pain including both new studies and additional study designs. Procedures/data/observations: We searched Cochrane, OVID Medline, EMBASE, EBSCO and Web of Science for studies published in any language up to May 2023 for studies that examined buprenorphine's impact upon pain severity/intensity in patients with active cancer. Risk of bias and study quality were assessed using the Cochrane Collaboration tool for randomized controlled trials (RCTs), and the Newcastle-Ottawa Scale for cohort and casecontrol studies. Data were synthesized using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria.</p><p><strong>Conclusions/applications: </strong>2322 publications were identified and 42 studies were included (14 RCTs, 10 pre-post uncontrolled, 5 cohort, and 2 case-control studies). All had moderate-high risk of bias. One RCT showed buprenorphine was superior to placebo. 11 RCTs (12 papers) showed buprenorphine was as effective as full MOR agonists for cancer pain. 10-30 percent of cancer patients trialing buprenorphine did not achieve adequate response.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"20 4","pages":"B12"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348560","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 Use in the Military Health System (MHS).","authors":"Nicole Cornish","doi":"10.5055/bupe.24.rpj.1025","DOIUrl":"10.5055/bupe.24.rpj.1025","url":null,"abstract":"<p><strong>Background: </strong>The CPG's updated recommendation is supported by buprenorphine's lower risk of overdose and misuse.(1) In comparison to full mu-opioid agonists, buprenorphine possesses a superior safety profile with respect to respiratory depression, even in non-dependent individuals, and fatal overdose, when not combined with other sedating medications.(2-5) Purpose/hypothesis: This project identifies prescribing trends of buprenorphine for chronic pain before and after implementing two pharmacy interventions. Procedures/data/observations: Patient charts were reviewed before and after removal of a drug authorization key in the electronic health record and development of an educational presentation for providers. In the pre-intervention group, 19 patients were included and 13 patients in the post-intervention group. Prescriptions for buprenorphine decreased by 31.5% from the pre-intervention to post-intervention period, but three new prescriptions were started after interventions.</p><p><strong>Conclusions/applications: </strong>Adverse reactions were the cause of the decrease in prescriptions, most commonly nausea and vomiting. This data may be valuable to providers as they expand their knowledge about buprenorphine's analgesic use. This is a longitudinal project and identifying barriers that may limit prescribing of buprenorphine may be beneficial for future educational interventions.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"20 4","pages":"B6"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348562","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":"Conversion of CII Opioid Medications to Buprenorphine in the Chronic Pain Population - Insights and Clinical Pearls.","authors":"Amanda Zimmerman","doi":"10.5055/bupe.24.rpj.1060","DOIUrl":"10.5055/bupe.24.rpj.1060","url":null,"abstract":"<p><strong>Background: </strong>There is a great deal of confusion associated with conversion from CII opioid to buprenorphine products. The data presented supports that patients can be converted from high dose opioid medication to buprenorphine products safely and effectively. This presentation will provide a road map to help guide practitioners who are interested in applying this to their clinical practice.</p><p><strong>Purpose/hypothesis: </strong>Thepurposeoftheresearchwasnotonlytodiscoverifconversiontoapartialagonist CIII medication from full agonist CII medications would be achieveable without sacrificing analgesia, but also to provide guidance to providerswhoareinterestedinpursuingthisoptioninclinicalpractice. Procedures/data/observations: Patients who met inclusion criteria were stratified into subgroups on the basis of pre- conversion morphine milligram equivalents, whether they remained on opioids for breakthrough pain postconversion, and pre- and postconversion numerical rating scale pain scores. Outcomes of interest included the differences between pre- and postconversion numerical rating scale pain scores and daily morphine milligram equivalents for each sub-group. Of 157 patients reviewed, 87.9% were successfully converted to buprenor-phine buccal film. Overall, numericalrating scale pain scores were stable after conversion. Statistically significant reductions were demonstrated in the <90 daily morphine milligram equivalent subgroup. Postconversion daily morphine milligram equivalents decreased by 85.4% from baseline. Change in daily morphine milligram equivalents is representative of patients who remained on breakthrough pain medication.</p><p><strong>Conclusions/applications: </strong>Results demonstrate continued analgesia after conversion to buprenorphine buccal film despite reductions in daily morphine milligram equivalents. Most patients were able to convert directly from their long-acting opioid to buprenorphine buccal film and stabilized without the use of concomitant opioids for breakthrough pain. Aggressive titration strategies were associated with greater success. This data proves that conversion from full agonist CII medications is possible without sacrificing analgesia while reducing the risk of adverse events associated with full agonist CII medications.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"20 4","pages":"B11"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348567","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":"Outpatient Cross-Titration to Buprenorphine for Chronic Pain.","authors":"Katherin Peperzak","doi":"10.5055/bupe.24.rpj.1005","DOIUrl":"10.5055/bupe.24.rpj.1005","url":null,"abstract":"<p><strong>Background: </strong>Various protocols for micro-induction of buprenorphine in patients with opioid use disorder have been published. There is a paucity of literature similarly describing micro- induction in patients converting from full agonist opioids to buprenorphine for chronic pain. As the prescription opioid epidemic continues to be problematic and more patients are being converted to buprenorphine, we are working to provide more guidance on goal dosages of buprenorphine and how to safely cross-titrate to that goal.</p><p><strong>Purpose/hypothesis: </strong>As the prescription opioid epidemic continues to be problematic and more patients are being converted to buprenorphine, we are working to provide more guidance on goal dosages of buprenorphine and how to safely cross-titrate to that goal. Procedures/data/observations: Our cross-titration protocol resulted in roughly half (15/31) patients successfully converting to and continuing with buprenorphine at 4 weeks, with an average duration of induction of 29 days. Average end titration dose for patients on buprenorphine/naloxone SL films was 7.9 ± 5.7 mg/day. Patients previously taking >120 mg MEDD stabilized on 8-16 mg/day.</p><p><strong>Conclusions/applications: </strong>Clinical responses were widely variable, and many required slower taper and higher end titration buprenorphine dose than anticipated. Future work is focused on determining which factors contribute to the variation and whether adjustment to the protocol is warranted.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"20 4","pages":"B4"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348474","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}