Journal of opioid management最新文献

{"title":"Why pharmacogenetic testing should be reimbursed by Medicare and commercial health insurance.","authors":"Amadeo Pesce","doi":"10.5055/jom.0870","DOIUrl":"10.5055/jom.0870","url":null,"abstract":"","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"20 4","pages":"267"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348587","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":"Emerging Trends in Perioperative Buprenorphine Management.","authors":"Amanda Engle, Jacqueline Cleary, Amanda Winans","doi":"10.5055/bupe.24.rpj.1000","DOIUrl":"10.5055/bupe.24.rpj.1000","url":null,"abstract":"<p><strong>Background: </strong>Historically, there has been limited evidence and no clear consensus suggesting best practices for perioperative buprenorphine management (PBM). Previously published PBM strategies included a wide variation in dosing, complexity, and clinical decision making points. Importantly, there are limited published algorithms reporting corresponding patient outcomes data.</p><p><strong>Purpose/hypothesis: </strong>To review the literature for newly published perioperative PBM strategies, with the aims of identifying emerging trends and assessing patient outcomes data. Procedures/data/observations: Literature review of manuscripts published from 2020 to current containing PBM strategies.</p><p><strong>Conclusions/applications: </strong>Pending completion of analysis, the authors will present findings of emerging trends and patient outcomes data in PBM.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"20 4","pages":"B3"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348569","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 the Treatment of Pain in Cancer Patients.","authors":"Marcin Chwistek, Dylan Sherry, Leigh Kinczewski","doi":"10.5055/bupe.24.rpj.1015","DOIUrl":"10.5055/bupe.24.rpj.1015","url":null,"abstract":"<p><strong>Background: </strong>Opioids remain the cornerstone for the treatment of moderate to severe cancer pain. Due to benefits over full agonist opioids (FAO), buprenorphine has emerged as an alternative treatment.</p><p><strong>Purpose/hypothesis: </strong>Buprenorphine is only approved for the treatment of pain that is chronic non-cancer. Cancer-related pain is often progressive with breakthrough pain. There is limited evidence for using short-acting FAO in combination with buprenorphine. There are concerns about withdrawal and the efficacy of pain control using buprenorphine. We hypothesize buprenorphine, in combination with short-acting FAOs, can adequately control cancer- related pain without causing withdrawal symptoms. Procedures/data/observations: Our prospective, single-arm, open-label study enrolls patients with cancer-related pain who are on buprenorphine in combination with an FAO at > 30 mg OME/day, either requiring long-acting pain relief or their pain is not controlled with an FAO alone. Our study is ongoing, with 15 patients enrolled and a target of 50. The patient's pain is self-assessed daily using a mobile application. Withdrawal is assessed regularly using a modified Clinical Opioid Withdrawal Scale (COWS) score.</p><p><strong>Conclusions/applications: </strong>Buprenorphine appears to be effective for the treatment of cancer pain without causing withdrawal in combination with short-acting FAO >30 mg/day.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"20 4","pages":"B7"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348561","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":"Clinical Pharmacist with DEA License: Efforts to Increase Access to Buprenorphine in a Veteran Population.","authors":"Shelley Stevens","doi":"10.5055/bupe.24.rpj.1010","DOIUrl":"10.5055/bupe.24.rpj.1010","url":null,"abstract":"<p><strong>Background: </strong>Opioid overdoses continue to rise in the United States. In 2021, a record 80,411 reported overdoses occurred in the US alone, nearly double that in 2017. Buprenorphine's pharmacology is ideal for management of patients with opioid use disorder (OUD) with or without chronic pain. Within the VA, clinical pharmacist practitioners (CPP) are uniquely equipped to operate with significant scope of practice to prescribe medications including controlled substances, an opportunity to vastly increase access to care for veterans suffering from OUD, complex opioid dependency or pain.</p><p><strong>Purpose/hypothesis: </strong>The purpose of this case series is to describe how DEA licensed pain CPP safely and effectively manages 1) Suboxone home inductions to increase access for OUD 2) rotations from traditional full mu opioids to chronic pain buprenorphine products and 3) off label use of Suboxone for pain. Procedures/data/observations: Cases were collected in usual workload for clinical pharmacist. High rate of tolerability and efficacy noted with buprenorphine across all products.</p><p><strong>Conclusions/applications: </strong>DEA licensed Pain CPPs can make an immediate positive impact for veterans with OUD and/or complex pain and may be more comfortable with buprenorphine than many other providers.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"20 4","pages":"B2"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348566","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 \"Micro\"cosm: Magnifying the Nuance of Low Dose Buprenorphine Inductions.","authors":"Tanya Uritsky, Emily Casey","doi":"10.5055/bupe.24.rpj.1050","DOIUrl":"10.5055/bupe.24.rpj.1050","url":null,"abstract":"<p><strong>Background: </strong>Now that the X-wavier is a thing of the past, patients with Opioid Use Disorder (OUD) who previously lacked access to buprenorphine may have access to lower barrier care and may be looking to make the transition from either methadone or illicit fentanyl to buprenorphine. This can be quite challenging and both fentanyl and methadone are hihghly potent drugs and can result in a difficult transtition to buprenorphine.</p><p><strong>Purpose/hypothesis: </strong>A transition from high potency opioids to buprenorphine is challenging and can cause discomfort or withdrawal in patients. Procedures/data/observations: Patients tend to have a difficult time when undergoing a transition from significant fentanyl use (> 1 bundle/day) or high dose methadone to buprenorphine. Over the last year, we've supported this transition for our hospitalized patients and have learned some tips and tricks to ease the transitions. Through our work we've come up with a strategy to transition patients that includes utilizing full mu agonists while initiating a low dose buprenorphine induction. We have developed an informal protocol for this transition that takes advantage of the flexibility of low dose buprenorphine induction strategies and includes the use of non-opioid adjuvant medications to control symptoms of discomfort and withdrawal.</p><p><strong>Conclusions/applications: </strong>A transition from the use of significant fentanyl or high dose methadone to buprenorphine is possible and can take place over a matter of a few days. Such a transition requires careful attention to patient symptoms, availability of as needed short acting opioids, and the judicious use of non-opioid adjuvants.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"20 4","pages":"B8"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348585","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: The Opioid that Cried 'Partial Agonist'.","authors":"Jeffrey J Bettinger, Jacqueline Cleary","doi":"10.5055/bupe.24.rpj.1040","DOIUrl":"10.5055/bupe.24.rpj.1040","url":null,"abstract":"<p><strong>Background: </strong>Although buprenorphine use has increased dramatically over the past decade, its unique pharmacologic and pharmacokinetic profile often leads to misconceptions about its overall utility and has created a drastic underrepresentation in patients with chronic non-can- cer pain. A common misnomer associated with buprenorphine is because of 'partial agonist' activity, it exhibits a plateauing of typical opioid-related side effects (including respiratory depression, constipation, euphoria, and hypogonadal axis suppression), but additionally it must exhibit a plateauing effect of overall analgesic potential. However, novel downstream molecular and cellular mechanisms offer new insights that help support the clinical potential that buprenorphine's analgesic actions may not have a ceiling, like its side effect profile. This interactive symposium will provide an enhanced review of the evolving research that helps unravel the complexity around buprenorphine's varying pharmacologic effects including actions on various opioid receptors, promiscuity to elicit varying actions on mu-opioid receptors coupled with different isoforms of G~ subunits, role in the intracellular recruitment of beta-arrestin, binding to different splice variants of mu-opioid receptors, and greater spinal versus supraspinal activity. The final half of this symposium will be designed to substantiate evidence with various human clinical trial data to further support buprenorphine's place on the analgesic ladder.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"20 4","pages":"B9"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348565","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":"Implementing a text-message-based intervention to increase access to naloxone for patients on chronic opioid therapy.","authors":"Scott G Weiner, Salah Alrakawi, Morgan Kelley, Amrita Chabria Shahani, Cheryl Silva, Andrew D McCatty, Danielle Lasden, Karthik Sivashanker","doi":"10.5055/jom.0830","DOIUrl":"10.5055/jom.0830","url":null,"abstract":"<p><strong>Objective: </strong>To implement a text-message-based intervention for primary care patients taking chronic opioid therapy to increase access to naloxone.</p><p><strong>Design: </strong>Retrospective analysis of a hospital quality improvement initiative.</p><p><strong>Setting: </strong>This study was conducted with selected primary care practices affiliated with an academic medical center between March and July 2022.</p><p><strong>Participants: </strong>Patients were eligible for receiving the intervention if they had chronic (≥90 days) opioid use of ≥50 morphine milligram equivalents/day and had not previously opted out of receiving text messages.</p><p><strong>Interventions: </strong>Text messages were sent to patients inquiring about interest in obtaining a naloxone kit, which prompted a pharmacist to contact the patient and provide the medication by mail.</p><p><strong>Main outcome measures: </strong>We examined response rates to text messages and numbers of naloxone kits dispensed.</p><p><strong>Results: </strong>There were 243 patients identified who were sent the text message. Of these, 230 (94.7 percent) had a primary language of English, 150 (61.7 percent) were White, and 57 (23.5 percent) were Black/African American. The mean age was 57.3 years. After receiving the text messages, 64 (26.3 percent) of the 243 patients responded with \"unsubscribe.\" Thirty-five (14.4 percent) patients responded to the message, and 18 patients (51.4 percent of those who responded or 7.4 percent of all included patients) wanted the medication and were contacted by a pharmacist who filled and mailed the prescription to them.</p><p><strong>Conclusions: </strong>A text-message-based program to provide naloxone to patients with chronic opioid use was feasible. However, fewer than 15 percent of patients responded to the message, and just half of those wanted the medicine.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"20 4","pages":"289-296"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348472","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":"Overcoming challenges of prescribing long-term opioid therapy in residency clinics.","authors":"Kathryn Brown, Joel Farley, Ezra Golberstein, David Satin, Peter Harper, Chrystian Pereira, Andrew H Slattengren, Kristi Van Riper, Katherine Montag Schafer","doi":"10.5055/jom.0869","DOIUrl":"10.5055/jom.0869","url":null,"abstract":"<p><strong>Objectives: </strong>To describe the impact of a standardized opioid prescribing intervention when implemented in three family medicine (FM) residency training - clinics-environments that face operational challenges including regular resident turnover.</p><p><strong>Design: </strong>We performed a retrospective cohort study to compare patterns of long-term opioid prescribing between residency and nonresidency clinics.</p><p><strong>Setting: </strong>This study took place within a large, academic, health system.</p><p><strong>Patients and participants: </strong>Three FM residency clinics were compared with three nonresidency FM clinics.</p><p><strong>Interventions: </strong>A standardized opioid prescribing process was developed and implemented within the FM residency clinics. Nonresidency clinics used an independent process and were not exposed to the intervention.</p><p><strong>Main outcome measures: </strong>Descriptive comparisons were performed for treatment and control clinics' opioid prescribing from 2015 to 2018. The primary outcome was a patient's annual opioid exposure supplied from these select clinics. We also examine coprescribing with high-risk medications that potentiate the overdose risk of opioid prescriptions. Difference-in-difference modeling was used to control for clinic-level variation in practice.</p><p><strong>Results: </strong>Statistically significant decreases were observed in both residency and nonresidency clinics for the mean number of opioid prescriptions and the mean daily morphine milligram equivalent. These decreases were comparable between the residency and nonresidency clinics.</p><p><strong>Conclusions: </strong>Residency clinics face unique challenges and require innovative solutions to keep up with best practices in opioid prescribing. Our residency clinics' implementation of a standardized intervention, including electronic health record integration, standardized processes, and metric management, suggests steps that may be valuable in achieving outcomes comparable to nonresidency clinics in large health systems.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"20 4","pages":"297-309"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348475","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":"Opioid-related clinical outcomes and associated healthcare costs following abuse/misuse of oxycodone formulations: A HEOR analysis from real-world data.","authors":"Jody L Green, Taryn Dailey-Govoni, Suzanne K Vosburg","doi":"10.5055/jom.0878","DOIUrl":"10.5055/jom.0878","url":null,"abstract":"<p><strong>Objective: </strong>The United States (US) opioid epidemic is a continued burden on the healthcare system and on the lives of individuals affected by the consequences of opioid abuse/misuse. The objective of this study was to use real-world data from intentional abuse/misuse exposures managed by US poison centers to compare clinical outcomes and quantify healthcare costs among three study cohorts: -exposures that involved Xtampza ER®, other oxycodone extended-release (ER), and oxycodone immediate-release (IR).</p><p><strong>Study design: </strong>A real-world, observational study.</p><p><strong>Main outcome measures: </strong>Descriptive statistics were used to describe patient and exposure characteristics. Drug utilization-adjusted rates of intentional abuse/misuse and clinical outcomes were used to determine relative risk. Healthcare cost estimates were calculated by extrapolating average charge per opioid-related disorder emergency department (ED) visit and per inpatient stay based upon case disposition rates, adjusted for population and drug utilization.</p><p><strong>Results: </strong>Compared to Xtampza ER, exposures that involved other oxycodone ER were 7.4 times more likely to be intentional abuse/misuse, 25.9 times more likely to result in major effect or death, 9.7 times more likely to require a visit to the ED, and 14.3 times more likely to result in hospital admission. Similar results were found for oxycodone IR when compared to Xtampza ER.</p><p><strong>Conclusions: </strong>This study is the first of its kind to synthesize clinical outcomes with opioid-related healthcare costs, suggesting that even when Xtampza ER is abused/misused, the rates of major effect/death, ED visits, and hospital admissions were significantly lower than those for other oxycodone-containing medications, resulting in relatively low downstream opioid-related healthcare costs.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"20 4","pages":"281-288"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348473","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":"Prescription opioids following herpes zoster: An observational study among insured adults, United States, 2007-2021.","authors":"Kathleen Dooling, Jessica Leung, Michele K Bohm","doi":"10.5055/jom.0845","DOIUrl":"10.5055/jom.0845","url":null,"abstract":"<p><strong>Background: </strong>The opioid overdose epidemic has resulted in hundreds of thousands of overdose deaths in the United States (US). One indication for opioids is herpes zoster (HZ)-a common painful condition with an estimated 1 million cases occurring annually in the US.</p><p><strong>Objective: </strong>We aimed to characterize prescription opioid claims and trends among patients with HZ who were previously opioid naive.</p><p><strong>Design: </strong>We used a cohort study involving three insurance claims databases in the US. We included all beneficiaries 18-64 years (commercial and Medicaid) and beneficiaries 65 years and older (Medicare) who were diagnosed with incident HZ during 2007-2021. We determined the proportion of opioid-naive patients with HZ who filled an opioid prescription within 30 days and 180 days following HZ diagnosis. We also examined trends over the study period, proportion receiving moderate, high dosages (50-89 morphine milligram equivalent [MME], and ≥90 MME per day), and long-term receipt.</p><p><strong>Results: </strong>Among all three insurance databases, 2,595,837 patients had an incident episode of HZ and were opioid naive during the prior 6 months. Within 30 days following HZ, 623,515 (24 percent) filled a prescription for an opioid. The percentage with an opioid claim declined during 2007-2021 for all groups; 65 percent for commercially insured patients, 51 percent for Medicaid-insured patients, and 60 percent for Medicare-insured patients. Approximately 8-15 percent of all beneficiaries received moderate and 2-6 percent received high dosage opioids. Long-term prescription opioid use of at least 6 months was found in 7-12 percent of the patients.</p><p><strong>Conclusions: </strong>Continuing trends in judicious opioid prescribing as well as use of recommended HZ vaccines may decrease opioid prescriptions for HZ.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"20 4","pages":"319-328"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348584","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}