Journal of opioid management最新文献

{"title":"Individualized opioid tapering in a community interdisciplinary pain management program with flexible care plans: Outcomes, patient retention, and follow-up.","authors":"Susan M Ferron, Alfred L Clavel, Georgia E Panopoulos, Grant M Kaper, Sally K Gustafson","doi":"10.5055/jom.0953","DOIUrl":"https://doi.org/10.5055/jom.0953","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the effectiveness of an outpatient, interdisciplinary pain management (IPM) program offering individualized opioid tapering as part of flexible, patient-specific care plans, in achieving the dual goals of improved management of chronic nonmalignant pain (CNMP) and substantial reduction of opioid use.</p><p><strong>Design: </strong>A retrospective cohort study, comprising a cohort of patients who presented on opioid therapy and a cohort who did not.</p><p><strong>Setting: </strong>Community outpatient IPM program.</p><p><strong>Participants: </strong>Patients presenting between April 1, 2016 and September 15, 2019. From an initial pool of 402 patients, inclusion and exclusion criteria identified 300 patients for analyses.</p><p><strong>Interventions: </strong>Engagement in a comprehensive and flexible IPM program with patient-specific care plans that included individualized opioid tapering.</p><p><strong>Main outcome measure(s): </strong>Changes in pain intensity, pain interference, physical therapy (PT) metrics, patient retention, and follow-up of opioid use status at least 3 years after the end of each patient's study episode of care.</p><p><strong>Results: </strong>Changes in pain intensity and interference, and PT outcomes reflected notable improvements in pain management, with no significant overall differences between cohorts. During study episodes of care, all patients in the opioid cohort reduced opioid use and two-thirds discontinued opioids; patient retention was 90.9 percent. In follow-up of over 80 percent of the opioid cohort up to an average of 4.5 years, opioid use for CNMP decreased to 15.8 percent of patients.</p><p><strong>Conclusions: </strong>A flexible, patient-centered IPM program can improve the management of CNMP, substantially reduce opioid use, and maintain a high rate of patient retention. During follow-up, patients further reduced their use of opioids for CNMP.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"21 4","pages":"281-302"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145000707","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":"Fentanyl-blocking effects of extended-release naltrexone in humans: Three case reports.","authors":"Colin Brewer","doi":"10.5055/jom.0949","DOIUrl":"10.5055/jom.0949","url":null,"abstract":"<p><p>Despite the contribution of the µ-agonist fentanyl to the United States's opiate overdose epidemic, no human studies specifically address the ability of extended-release preparations of the opiate antagonist naltrexone (NTX) to block fentanyl's life-threatening µ-agonist-mediated respiratory depression. This paper presents three case histories of clinically necessary opiate challenges in opiate-abusing patients implanted with extended-release NTX (ER-NTX). It also reviews the sparse literature and is the first evidence that antagonist blood levels from ER-NTX preparations can completely block the lethal µ-agonist effects of at least 1,000 mcg of intravenous fentanyl.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"21 4","pages":"355-359"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145000718","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":"Population-based prescription opioid use rate in Newfoundland and Labrador: A retrospective cohort study.","authors":"Cindy Whitten, Alison Turner, Kobe Roberts, Hui Xiong, Jeremy Harnum, Brooklyn Sparkes, Hayley Baker","doi":"10.5055/jom.0889","DOIUrl":"https://doi.org/10.5055/jom.0889","url":null,"abstract":"<p><strong>Objective: </strong>To report the rate of prescription opioid use rates over a 5-year period for the population of Newfoundland and Labrador (NL), Canada, and to highlight patient demographics within this cohort.</p><p><strong>Design: </strong>This retrospective cohort design used population-based pharmacy network prescription data from the province of NL to identify patients who were prescribed opioids from June 1, 2017, to June 1, 2022.</p><p><strong>Setting: </strong>A cohort of adult and pediatric patients who were being prescribed opioids from June 1, 2017, to June 1, 2022, in NL.</p><p><strong>Participants: </strong>Patients who were prescribed opioids from June 1, 2017, to June 1, 2022. Prescriptions without complete data and medications taken for pain control that were not defined as opioids were excluded from the analysis. Buprenorphine, buprenorphine-naloxone, and methadone were also excluded from the analysis, as these are often prescribed as a treatment for opioid use disorder.</p><p><strong>Results: </strong>Between 27,344 (5.2 percent of NL population) and 57,562 (11 percent of NL population) opioid pain patients in NL were identified from 2017 to 2022, with 2018 having the highest number of opioid pain patients (11 percent). During this period, patients with opioid prescriptions averaged from 55 to 58 years of age. Data also showed more female users of prescription opioids than males, and there were no significant differences between urban and rural locations. The most prevalent type of prescriber during the period of observation was general practitioners (n = 1,131), followed by pharmacists (n = 476) and dentists (n = 237).</p><p><strong>Conclusions: </strong>In comparison to national averages in Canada, NL had lower prescription opioid use rates. This study acts as a first step to better understand opioid use and prescribing practices in NL.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"21 4","pages":"337-348"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145000732","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":"Trends in XTAMPZA ER and other oxycodone misuse and abuse during COVID-19: A mosaic approach.","authors":"Jennifer S Jewell, Kari M Rockhill, Hannah Burkett, Joshua C Black, Matthew S Ellis, Richard Dart","doi":"10.5055/jom.0927","DOIUrl":"https://doi.org/10.5055/jom.0927","url":null,"abstract":"<p><p>Despite efforts to reduce abuse, opioids remain a societal concern. Coronavirus disease 2019 (COVID-19) brought new challenges, and research is needed to understand its impact on opioid abuse in the population. Three data sources were used to investigate trends in misuse and abuse of XTAMPZA® ER compared to extended-release (ER) and single-entity immediate-release (SE-IR) oxycodone from 2019Q3 through 2022. Changes in trends over 6-month intervals were investigated using linear spline models with a breakpoint at 2020Q3 to measure the impact of COVID-19. Poison center call rates for misuse or abuse of ER and SE-IR oxycodone showed significant changes during COVID-19 (both p < 0.001), reversing trends and significantly decreasing (201327.56 percent change and -12.91 percent change, respectively). In contrast, XTAMPZA ER trend rates showed no change during COVID-19, remaining fairly stable. The odds of abuse of ER oxycodone among those entering opioid use disorder treatment significantly changed during COVID-19 (p = 0.025), resulting in a stabilization of the trend. For SE-IR oxycodone, no change was observed in the decreasing trend (-12.88 percent change during COVID-19). XTAMPZA ER had no significant change during COVID-19 (p = 0.200) and appeared stable. Since 2021Q3, among the general adult population, the prevalence of past-year nonmedical use of XTAMPZA ER was rare (0.04 percent), as was the case for other oxycodone products (<1 percent). Overall, there is no evidence that oxycodone misuse and abuse worsened during COVID-19 in these populations, and XTAMPZA ER was consistently lower than other oxycodone products. Low rates and improving trends in oxycodone misuse and abuse may signify an ongoing reduction in prescription opioid contributions to the opioid crisis.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"21 3","pages":"249-259"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A review of opioid use within a multimodal analgesia approach to enhance post-caesarean section pain relief.","authors":"Gerrard Ferreira, Tamara Lebedevs, Stephanie Wai Khuan Teoh","doi":"10.5055/jom.0921","DOIUrl":"https://doi.org/10.5055/jom.0921","url":null,"abstract":"<p><strong>Aim: </strong>This study aims to assess the application of opioids for pain control in patients following a cesarean section (CS) at a tertiary referral obstetric hospital.</p><p><strong>Methods: </strong>A retrospective cohort audit of CSs in September 2022 was conducted. Medical records were reviewed to capture patient demographics, opioid used, and discharge medications.</p><p><strong>Results: </strong>Medical records of 46 patients were reviewed. Of those, 46 percent (n = 21) had a non-elective lower uterine CS (NELUSCS), 43 percent (n = 20) had an elective lower uterine CS (ELUSCS), and the remainder had a nonelective classical CS (NEClassicalCS). NEClassicalCS had higher total morphine equivalent opioid use with an average of 245.7 mg, compared with 92.4 mg and 60.1 mg for NELUSCS and ELUSCS, respectively. Tramadol was the most common opioid supplied on discharge (85 percent), followed by buprenorphine (17 percent) and oxycodone/naloxone (15 percent). An average discharge medication supply of 3 days was provided.</p><p><strong>Conclusions: </strong>NEClassicalCS procedures had higher use of opioid pain medications. All patients were initiated on opioids post-CS, with 93 percent (n = 43) discharged with at least one opioid.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"21 3","pages":"197-203"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992615","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 use in impending versus pathologic proximal femur fractures.","authors":"Austin Yu, Conor M Jones, Gayathri Vijayakumar, Amr Turkmani, Zachary Butler, Andre Cargill, Matthew W Colman, Steven Gitelis, Alan T Blank","doi":"10.5055/jom.0884","DOIUrl":"https://doi.org/10.5055/jom.0884","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate post-operative opioid use, functionality, and overall survival following internal fixation for pathologic or impending fractures at 3 and 6 months.</p><p><strong>Background: </strong>Pathologic and impending fractures commonly occur in the proximal femur, and patients may be prescribed opioids prior to surgery and often require opioids for post-operative pain relief. This study compared post-operative opiate usage and ambulatory functional status in patients with impending versus pathologic fractures in the proximal femur.</p><p><strong>Design: </strong>This was a retrospective case-control study of patients using opioids post-operatively who underwent internal fixation for a pathologic or impending fracture between 2016 and 2022. Preoperative and post-operative opioid usage as well as ambulation status and risk factors at 3 and 6 months associated with post-operative opioid use were recorded.</p><p><strong>Results: </strong>Twenty-four pathologic fractures and 23 impending fractures were included. Preoperative opioid daily morphine milligram equivalent was significantly higher in the pathologic fracture group, but there were no significant differences at 3 or 6 months. There was statistically significant post-operative improvement in ambulation status in the combined cohort and impending fracture cohort at 3 months and 6 months.</p><p><strong>Conclusions: </strong>Although patients did not experience a significant post-operative change in opioid use, patients with pathologic fractures notably required higher opioid dosages preoperatively, and there was overall improvement in function following fixation. Future studies should examine post-operative opioid use with careful consideration of concurrent pain management pain therapies and tumor characteristics.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"21 3","pages":"239-247"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992620","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 impact of medication adherence on health outcomes and cost reduction.","authors":"Lynn R Webster","doi":"10.5055/jom.0950","DOIUrl":"https://doi.org/10.5055/jom.0950","url":null,"abstract":"","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"21 3","pages":"193-195"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992623","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":"Update on quantification of opioid dependence and abuse prevalence in the United States of America (2019 and 2020).","authors":"Esperanza Regueras, José López Guzmán, Luis Miguel Torres, Ignacio Velázquez","doi":"10.5055/jom.0893","DOIUrl":"https://doi.org/10.5055/jom.0893","url":null,"abstract":"<p><strong>Objectives: </strong>To quantify the prevalence of opioid drug dependence and abuse in the United States between 2019 and 2020, as well as to identify which opioid molecules are associated with a higher level of dependence and abuse.</p><p><strong>Design: </strong>National Survey on Drug Use and Health data for 2019 and 2020 was extracted. The variables related to painkillers were studied; the most important ones were selected, and several variable crosses were made. After the data were extracted, they were analyzed with Microsoft Excel® using PivotTables to calculate the relative prevalence and percentages of patients with abuse and dependence.</p><p><strong>Results: </strong>A total of 1.2 million people were dependent on opioid pain relievers (OPRs) in 2020 versus 1.4 million people in 2018. In 2020, the last OPR used by people with dependence were hydrocodone (27 percent) and oxycodone (21 percent). In the same year, 63 percent of the people with a dependence on OPR had used it without their own prescription to relieve pain (vs 67 percent in 2017). In 2020, 2.5 million people used an OPR without a medical prescription; the main reason (42 percent) was to relieve pain (similar to 2018), followed by wanting to feel good (19 percent vs 16 percent in 2018) and to relax or relieve tension (16 percent). In 2020, 2.2 million people used an OPR differently than prescribed by the doctor; 31 percent of them had also used an OPR without a prescription; and 17 percent were dependent on an OPR in the same year. The most relevant types of abuse were the increase in frequency of use (1.4 million people), increase in the duration of treatment (1.2 million people), and increase in the quantity or dose (1.6 million people).</p><p><strong>Conclusions: </strong>Abuse and dependence on OPRs during 2019-2020 (affecting 1.24 million people, 0.4 percent of the population over 12 years old) showed an average annual decrease of 3 percent compared to the 2017-2018 period. Similarly, the number of people using OPR without having their own prescription decreased from 5.8 million in 2019 to 4.7 million in 2020. The primary reason people use these medications without a prescription remains the relief of physical pain. The use of OPRs without having an own prescription remains a concern, as 60 percent of the people with dependence have used an OPR without their own prescription. The other major concern is the monitoring of OPR prescriptions. In 2020, over 2.2 million people used the OPRs differently than prescribed, and 28 percent of people with dependence in that year have used an OPR differently than prescribed. Oxycodone and hydrocodone continue to be the molecules more associated with abuse. Dependence associated with oxycodone is directly correlated with its use without prescription.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"21 3","pages":"205-222"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992632","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":"Discrepancies in opioid prescription and comorbidity burden in chronic low back pain: The impact of race, ethnicity, and socioeconomic status.","authors":"Boss Povieng, Alvyn Hernandez Reyes, Yanyu Zhang, Weibin Shi, Hong Wu","doi":"10.5055/jom.0914","DOIUrl":"10.5055/jom.0914","url":null,"abstract":"<p><strong>Objective: </strong>To examine associations between race, comorbidity, opioid and nonopioid treatment burden, and socioeconomic status (SES) in patients with chronic low back pain (CLBP).</p><p><strong>Design: </strong>A case-control study.</p><p><strong>Setting: </strong>Tertiary academic system.</p><p><strong>Participants: </strong>A total of 4,193 subjects with CLBP and 4,193 age-, sex-, race-, and region-matched subjects with nonchronic low back pain participated in this study.</p><p><strong>Main outcome measure(s): </strong>The primary outcome measures were prescription frequencies of opioid and nonopioid medications as well as nonpharmaceutical interventions. Secondary measures pertained to the prevalence of comorbidities, race, and SES traits.</p><p><strong>Results: </strong>The median age of the subjects was 55.50 years, with 61.75 percent female distribution, 48.84 percent Black or African American, 30.65 percent White non-Hispanic, and 15.93 percent non-White Hispanic or Latino among the subjects. Black or African American and non-White Hispanic or Latino identity was associated with higher hardship compared to patients identifying as White non-Hispanic (Tukey-Kramer adjusted p-value < 0.0001). Opioid use was significantly higher in the CLBP group (Cochran-Armitage trend test p-value < 0.0001), and there was a significant positive trend between the number of comorbidities and opioids used. As hardship index group (HIG) increased by 1, the expected number of comorbidities increased by a factor of 1.09 (95 percent confidence interval [CI]: 1.06-1.11), and the expected number of treatments increased by a factor of 1.07 (95 percent CI: 1.04-1.09). Physical therapy and spine procedures had a significant negative relationship with hardship.</p><p><strong>Conclusions: </strong>Higher opioid prescribing behavior, particularly for morphine, hydrocodone, and tramadol, exists in patients with CLBP, especially in patients facing hardship and identifying as Black or African American and non-White Hispanic or Latino. Further prospective studies are needed to strengthen causality.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"21 3","pages":"223-237"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992648","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":"Implementation of opioid stewardship programs (OSPs) in hospitals: A narrative literature review.","authors":"Bridget S Murphy, Nicole Falls","doi":"10.5055/jom.0915","DOIUrl":"https://doi.org/10.5055/jom.0915","url":null,"abstract":"<p><p>Pain and addiction are persistent public health issues that can lead to serious and fatal consequences on individuals, families, and communities. With the continued development of the opioid epidemic and the subsequent rise in opioid use and misuse, it is important to recognize the need for intervention at a public health level. Opioid stewardship programs (OSPs) are promising public health interventions that aim to coordinate safe and effective pain management through evidence-based intervention strategies. This narrative literature review examined the current evidence for implementation of OSPs in emergency departments and acute care hospitals to identify best practices and gaps in evidence. We reviewed publications found through PubMed and Embase, and articles were selected for inclusion after being evaluated through the inclusion criteria. One hundred and ninety-six articles were first found via the database search, and a final 24 articles were included in the sample for full review. The results indicated that all but two studies were published within the last 4 years, and one study mentioned a rural location. Most of the studies were pre- and post-OSP implementation studies. On average, the studies implemented four of the 11 total OSP strategies of interest. Twenty-two studies included information on care coordination, with the most prevalent effect being a decrease in total morphine milligram equivalents being prescribed at discharge. Nine studies included data on patient safety measures, including adverse events such as return emergency room visits, need for naloxone administration, and increase in post-operative clinic visits. This narrative review provides us with a preliminary understanding of OSP implementation in hospital settings and provides evidence that they are feasible and accepted with a wide variety of implementation interventions and strategies. It also demonstrates a gap in the literature regarding implementation in rural settings and with some specific implementation strategies.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"21 3","pages":"261-275"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992601","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}