Journal of opioid management最新文献

{"title":"Short-term healthcare resource utilization associated with receipt of CDC-informed opioid thresholds among commercially insured new chronic opioid users","authors":"Martin J. Calabrese, F. Shaya, Francis Palumbo, M. Mcpherson, Ester Villalonga-Olives, Z. Zafari, Ryan Mutter","doi":"10.5055/jom.0848","DOIUrl":"https://doi.org/10.5055/jom.0848","url":null,"abstract":"Objective: To evaluate the impact of recent changes to the Centers for Disease Control and Prevention (CDC) morphine milligram equivalent (MME)/day threshold recommendations on healthcare utilization. \u0000Design: A retrospective cohort study of new chronic opioid users (NCOUs). \u0000Setting: Commercially insured plans across the United States using IQVIA PharMetrics® Plus for Academics database with new use between January 2014 and March 2015. \u0000Patients: NCOUs with ≥60-day coverage of opioids within a 90-day period with ≥30-day opioid-free period prior to the date of the first qualifying opioid prescription. \u0000Interventions: NCOU categorized by the CDC three-tiered risk-based average MME/day thresholds: low (>0 to <50), medium (≥50 to <90), and high (≥90). \u0000Main outcome measures: Multivariable logistic regression was used to calculate adjusted odds of incurring an acute care encounter (ACE) (all-cause and opioid related) between the thresholds (adjusted odds, 95 percent confidence interval). \u0000Results: In adjusted analyses, when compared to low threshold, there was no difference in the odds of all-cause ACE across the medium (1.01, 0.94-1.28) and high (1.01, 0.84-1.22) thresholds. When compared to low threshold, a statistically insignificant increase was observed when evaluating opioid-related ACE among medium (1.86, 0.86-4.02) and high (1.51, 0.65-3.52) thresholds. \u0000Conclusions: There was no difference in odds of an all-cause or opioid-related ACE associated with the thresholds. Early-intervention programs and policies exploring reduction of MME/day among NCOUs may not result in short-term reduction in all-cause or opioid-related ACEs. Further assessment of potential long-term reduction in ACEs among this cohort may be insightful. \u0000 ","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139853175","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":"Role of opioid use in gastrointestinal obstruction and perforation: A retrospective review","authors":"Divya Bishnoi, Priyanka Sharma, A. K. Rathi","doi":"10.5055/jom.0850","DOIUrl":"https://doi.org/10.5055/jom.0850","url":null,"abstract":"Introduction: Pain is one of the most common complaints that brings a patient to a hospital. For this, usually, the patient might have already consumed various types of pain killer combinations, either prescribed or over-the-counter. In some of these cases, a patient consumes these medicines unmonitored for a long time and then comes with complications, among which gastrointestinal tract obstruction and perforation are the most life threatening. \u0000Materials and methods: Case files from the Department of Surgery were retrieved and studied. Patients were contacted telephonically for details of drug abuse history. These were then further studied in detail. \u0000Results: Forty-eight (68 percent) patients out of a total of 78 had a history of drug abuse. The most commonly abused pain killer was a combination of anti-inflammatory and other salts, which was found in 22 (46 percent) patients, followed by tramadol, NSAIDs, opium, and alcohol (23, 17, 10, and 4 percent, respectively). These groups were comparable in socio-demographic details except in the mean age, occupation, and gender distribution, and the difference was significant (p < 0.01). The most common cause for starting to use any of the above-mentioned pain killer was persistent pain. The most common site of obstruction in drug abusers was the stomach (60 percent), followed by the small intestine (38 percent) and the large intestine (2 percent). \u0000Limitations: (1) This is an observational retrospective record review. (2) Records were studied in hospital settings, so results should be generalized cautiously. (3) Risk of recall bias is present. \u0000Conclusion: Pain killers should always be prescribed with caution and for a short duration. Alternative options for pain relief should be made available, and doctors should be trained. Drug abusers tend to have a gastrointestinal complication at an early age, which means they are prone to further complications and recurrence if the problem is not addressed on time.","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":" 14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139792569","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":"Tianeptine as an opiate replacement in a patient on methadone treatment: A case report","authors":"Vivek Velagapudi, Jordan Calabrese, Roopa Sethi","doi":"10.5055/jom.0851","DOIUrl":"https://doi.org/10.5055/jom.0851","url":null,"abstract":"Tianeptine, an antidepressant and full μ-opioid receptor agonist, has increased in popularity and has been used as an over-the-counter supplement over the past decade. Due to its well-documented euphoric effects, there exists elevated risk for potential abuse. Buprenorphine–naloxone has been successfully utilized to treat opioid use disorder (OUD) in patients concurrently using tianeptine, limiting withdrawal symptoms and abstinence. However, there is limited evidence on the management of tianeptine use disorder, specifically methadone or naltrexone. The current opioid epidemic, the emerging use of tianeptine, and the lack of physician awareness have emphasized the need for further research on the role of tianeptine in medication-assisted treatment for OUD. This case report aims to demonstrate how medication-assisted therapy can be successfully utilized in a patient with opioid and severe other (tianeptine) drug use disorder.","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":" 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139792730","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":"An efficient LC-QTOF-mass spectrometry method for monitoring naltrexone compliance in urine of opioid-dependent subjects","authors":"Raka Jain, Piyali Mandal, Sachin Rana","doi":"10.5055/jom.0841","DOIUrl":"https://doi.org/10.5055/jom.0841","url":null,"abstract":"Naltrexone (NTX) is an orally effective opiate antagonist used in maintenance treatment for opiate dependence. Its utility is limited by the patient's noncompliance. The study aimed to develop an efficient method for the detection of NTX in urine by LC-QTOF-mass spectrometry (MS) and its application to NTX compliance in opioid-dependent subjects. Sample preparation included a dilution step and direct injection to LC-QTOF-MS. Chromatographic separation was achieved with a C-18 column using a mixture of mobile phase 0.1 percent formic acid in water and 0.1 percent formic acid in 95 percent methanol. The calibration curve was linear in the range 1-100 ng/mL with a correlation coefficient higher than 0.996. Precision and accuracy were acceptable, and the recovery efficiency range was 80-85 percent. The current LC-QTOF-MS method is simple, precise, sensitive, and can be used for monitoring NTX compliance among opioid-dependent subjects in a clinical setting.","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"10 18","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139851507","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":"Volume 10, Number 5","authors":"Journal of Opioid Management","doi":"10.5055/jom.2014.0227","DOIUrl":"https://doi.org/10.5055/jom.2014.0227","url":null,"abstract":"September/October 2014","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"9 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139439937","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":"Volume 19, Number 5","authors":"Geoffrey E. Hinton, R. Gartner, Jessica Bundy, Maria Jung, Tyler J King, Jane B. Sprott, Fernando Ávila, J. Briggs, Daniel Konikof, Alex Luscombe, Audrey Macklin, H. Pelvin","doi":"10.5055/jom.0820","DOIUrl":"https://doi.org/10.5055/jom.0820","url":null,"abstract":"September/October 2023","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"11 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139257421","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":"Erector spinae plane block for radiofrequency ablation of hepatic focal lesions: Randomized controlled trial.","authors":"Mona Raafat Elghamry, Mohamed Ahmed Lotfy, Kareem Mohammed Ramadan, Mohammad Ali Abduallah","doi":"10.5055/jom.0838","DOIUrl":"10.5055/jom.0838","url":null,"abstract":"<p><strong>Objective: </strong>This study evaluated the opioid sparing and pain relief effect of erector spinae plane block (ESPB) for radiofrequency ablation (RFA) of hepatic focal lesions under conscious sedation.</p><p><strong>Design: </strong>A randomized controlled trial.</p><p><strong>Setting: </strong>Tanta University Hospitals.</p><p><strong>Patients: </strong>Fifty patients aged 30-60 years old and eligible for RFA of hepatic focal lesions were included.</p><p><strong>Interventions: </strong>Patients randomized to receive either local anesthetic infiltration (group I) or ESPB (group II). Both groups received sedation by propofol infusion.</p><p><strong>Main outcome measure(s): </strong>The primary outcome was total fentanyl consumption. Secondary outcomes were nonverbal pain score (NVPS), time to first analgesic request post-procedure, radiologist's satisfaction, and complications.</p><p><strong>Results: </strong>In group I, NVPS was significantly increased at 10, 15, 25, and 30 minutes during RFA compared to group II (p = 0.008, <0.001, 0.018, and 0.001, respectively) with no significant differences on arrival to post-anesthesia care unit (PACU) and after 1 hour. Total fentanyl consumption during the procedure was significantly increased in group I compared to group II (160.9 ± 38.2 and 76 ± 21 µg, respectively; p < 0.001) with prolonged time to first analgesia request post-procedure in group II compared to group I (392.7 ± 38.8 and 101.1 ± 13.6 minutes, respectively; p < 0.001). The level of radiologist's satisfaction was significantly increased in the group II (p = 0.010). Three patients in group I and one patient in group II needed general anesthesia. Lower incidence of complications in group II occurred with statistical insignificance.</p><p><strong>Conclusions: </strong>The ESPB provided adequate analgesia and reduced opioids consumption during the hepatic RFA, with high radiologist's satisfaction.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"19 6","pages":"533-541"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139377838","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 prescription patterns in a children's hospital from 2012 to 2016.","authors":"Nicole Titze, Rishi Bhargava, Ara Jamasbi Montalvo, Gawon Shin, Campbell Belisle Haley, Soheil Saadat, Bharath Chakravarthy","doi":"10.5055/jom.0833","DOIUrl":"10.5055/jom.0833","url":null,"abstract":"<p><strong>Study objective: </strong>Pain management is a widely discussed topic, especially in the setting of the current opioid epidemic. Previous studies have shown that the use of opioids increased in the adult population. We aimed to look at the use of narcotic and non-narcotic pain medications at a large pediatric hospital to discern if patterns of pediatric pain management changed over time.</p><p><strong>Methods: </strong>58,402 analgesic prescriptions of patients 0-21 years of age were analyzed from May 2012 to November 2016. A logistic regression model was fitted to examine the association of age, sex, primary diagnosis, and the length of hospital stay with probability of opioid prescription.</p><p><strong>Results: </strong>36,560 patients aged 0-21 years (mean: 10.5, median: 11.0, and standard deviation (SD): 7.42) received analgesic pain medications. 21,847 (59.8 percent) patients were prescribed more than one analgesic. There was a male predominance in patients <15 years of age; however, in adolescents >16 years, females constituted 57.1 percent of patients. Data also showed a statistically significant reduction of opioid prescriptions from 2012 to 2016 (p < 0.001). Age and length of hospital stay were directly associated with opioid prescription (p < 0.001).</p><p><strong>Conclusion: </strong>Data show that there is a decrease in overall opioid prescriptions among pediatric patients, which may be secondary to new Food and Drug Administration regulations and increased awareness of morbidity associated with opioid use. Not surprisingly, increased hospital stay and increase in age lead to more analgesic prescriptions. Further investigation is needed to determine the differences within opioid prescription patterns.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"19 6","pages":"489-494"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139377839","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":"Patients with glenohumeral arthritis are more likely to be prescribed opioids in the emergency department or urgent care setting.","authors":"Jacob Gorbaty, Meghan K Wally, Susan Odum, Ziqing Yu, Nady Hamid, Joseph R Hsu, Michael Beuhler, Michael Bosse, Michael Gibbs, Christopher Griggs, Steven Jarrett, Madhav Karunakar, Laurence Kempton, Daniel Leas, Kevin Phelps, Tamar Roomian, Michael Runyon, Animita Saha, Stephen Sims, Brad Watling, Stephen Wyatt, Rachel Seymour","doi":"10.5055/jom.0834","DOIUrl":"10.5055/jom.0834","url":null,"abstract":"<p><strong>Objective: </strong>The objective is to quantify the rate of opioid and benzodiazepine prescribing for the diagnosis of shoulder osteoarthritis across a large healthcare system and to describe the impact of a clinical decision support intervention on prescribing patterns.</p><p><strong>Design: </strong>A prospective observational study.</p><p><strong>Setting: </strong>One large healthcare system.</p><p><strong>Patients and participants: </strong>Adult patients presenting with shoulder osteoarthritis.</p><p><strong>Interventions: </strong>A clinical decision support intervention that presents an alert to prescribers when patients meet criteria for increased risk of opioid use disorder.</p><p><strong>Main outcome measure: </strong>The percentage of patients receiving an opioid or benzodiazepine, the percentage who had at least one risk factor for misuse, and the percent of encounters in which the prescribing decision was influenced by the alert were the main outcome measures.</p><p><strong>Results: </strong>A total of 5,380 outpatient encounters with a diagnosis of shoulder osteoarthritis were included. Twenty-nine percent (n = 1,548) of these encounters resulted in an opioid or benzodiazepine prescription. One-third of those who received a prescription had at least one risk factor for prescription misuse. Patients were more likely to receive opioids from the emergency department or urgent care facilities (40 percent of encounters) compared to outpatient facilities (28 percent) (p < .0001). Forty-four percent of the opioid prescriptions were for \"potent opioids\" (morphine milliequivalent conversion factor > 1). Of the 612 encounters triggering an alert, the prescribing decision was influenced (modified or not prescribed) in 53 encounters (8.7 percent). All but four (0.65 percent) of these encounters resulted in an opioid prescription.</p><p><strong>Conclusion: </strong>Despite evidence against routine opioid use for osteoarthritis, one-third of patients with a primary diagnosis of glenohumeral osteoarthritis received an opioid prescription. Of those who received a prescription, over one-third had a risk factor for opioid misuse. An electronic clinic decision support tool influenced the prescription in less than 10 percent of encounters.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"19 6","pages":"495-505"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139377842","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":"Surgical prescription opioid trajectories among state Medicaid enrollees.","authors":"Jenna L McCauley, Ralph C Ward, David J Taber, William T Basco, Mulugeta Gebregziabher, Charles Reitman, William P Moran, Robert A Cina, Mark A Lockett, Sarah J Ball","doi":"10.5055/jom.0832","DOIUrl":"10.5055/jom.0832","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to evaluate opioid use trajectories among a sample of 10,138 Medicaid patients receiving one of six index surgeries: lumbar spine, total knee arthroplasty, cholecystectomy, appendectomy, colon resection, and tonsillectomy.</p><p><strong>Design: </strong>Retrospective cohort.</p><p><strong>Setting: </strong>Administrative claims data.</p><p><strong>Patients and participants: </strong>Patients, aged 13 years and older, with 15-month continuous Medicaid eligibility surrounding index surgery, were selected from single-state Medicaid medical and pharmacy claims data for surgeries performed between 2014 and 2017.</p><p><strong>Interventions: </strong>None.</p><p><strong>Main outcome measures: </strong>Baseline comorbidities and presurgery opioid use were assessed in the 6 months prior to admission, and patients' opioid use was followed for 9 months post-discharge. Generalized linear model with log link and Poisson distribution was used to determine risk of chronic opioid use for all risk factors. Group-based trajectory models identified groups of patients with similar opioid use trajectories over the 15-month study period.</p><p><strong>Results: </strong>More than one in three (37.7 percent) patients were post-surgery chronic opioid users, defined as the dichotomous outcome of filling an opioid prescription 90 or more days after surgery. Key variables associated with chronic post-surgery opioid use include presurgery opioid use, 30-day post-surgery opioid use, and comorbidities. Latent trajectory modeling grouped patients into six distinct opioid use trajectories. Associates of trajectory group membership are reported.</p><p><strong>Conclusions: </strong>Findings support the importance of surgeons setting realistic patient expectations for post-surgical opioid use, as well as the importance of coordination of post-surgical care among patients failing to fully taper off opioids within 1-3 months of surgery.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"19 6","pages":"465-488"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139377845","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}