Journal of opioid management最新文献

{"title":"Fentanyl dose-sparing in polyarthritic rats requires full agonism at 5-HT_1A receptors: Comparison between NLX-112, (±)8-OH-DPAT, and buspirone.","authors":"Ronan Depoortere, Laurent Bardin, Adrian Newman-Tancredi","doi":"10.5055/jom.0874","DOIUrl":"10.5055/jom.0874","url":null,"abstract":"<p><strong>Background: </strong>NLX-112 (a.k.a. F13640, befiradol) is a highly selective and fully efficacious agonist at 5-hydroxytryptamine (5-HT_1A) receptors. It has been shown to be robustly and potently active in nociceptive, neuropathic and traumatic pain models in rats and mice. In particular, NLX-112 decreases oral fentanyl self-administration (FSA) in polyarthritic rats, ie, it has opioid dose-sparing effects.</p><p><strong>Objective: </strong>To examine if the dose-sparing effects of NLX-112 in polyarthritic rats are shared by other 5-HT_1A ligands: the prototypical 5-HT_1A receptor agonist 8-HYDROXY-2-(DI-n-PROPYLAMINO)TETRALIN ((±)8-OH-DPAT), and the 5-HT_1A receptor partial agonist and weak dopamine D2 receptor blocker, -buspirone.</p><p><strong>Design: </strong>Polyarthritis was induced by inoculating rats with heat-killed Mycobacterium butyricum. They then had access to either a fentanyl (0.008 mg/mL) or a sweetened solution in their home cage. NLX-112, (±)8-OH-DPAT, or buspirone was administered via an osmotic minipump (5 µL/h) during a 2-week infusion period from day 14 to day 28 post-inoculation with Mycobacterium butyricum. Control infusions consisted of sterile 0.9 percent NaCl.</p><p><strong>Results: </strong>NLX-112 (0.63 mg/day) significantly decreased FSA by 47 percent and increased total fluid consumption (TFC) by 7 percent (vehicle-loaded minipumps as controls). Both (±)8-OH-DPAT and buspirone (0.63 and 2.5 mg/day, respectively) failed to reduce FSA; (±)8-OH-DPAT did not modify TFC, while buspirone significantly decreased it by 17 percent.</p><p><strong>Conclusions: </strong>These results suggest that oral FSA dose-sparing effect, in this rat polyarthritis pain model, requires high efficacy activation of 5-HT_1A receptors, such as that afforded by NLX-112. By contrast, the agonist efficacy of (±)8-OH-DPAT and buspirone seems insufficient for FSA dose-sparing.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"20 4","pages":"269-274"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348570","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":"Impact of an Education Module on the Knowledge and Attitudes of EM Physicians Towards Prescribing Buprenorphine/Naloxone for Opioid Use Disorder.","authors":"Amy Zosel, Jennifer Hernandez-Meier, Julie Owen","doi":"10.5055/bupe.24.rpj.1095","DOIUrl":"10.5055/bupe.24.rpj.1095","url":null,"abstract":"<p><strong>Background: </strong>Opioid overdose continues to be a major cause of morbidity and mortality. Buprenorphine is an important treatment for patients with opioid-use disorder (OUD) and initiation in the emergency department (ED) has been shown to improve outcomes for these patients.</p><p><strong>Purpose/hypothesis: </strong>Our objective was to assess the impact of a three-pronged education package on the knowledge and attitudes of emergency physicians towards using buprenorphine for treatment of OUD. Procedures/data/observations: We developed a three-pronged educational package including back- ground rationale for OUD treatment with buprenorphine, an evidence-based ED buprenorphine induction pathway and electronic medical record tools. This package was deployed to providers in an urban academic ED. A voluntary confidential pre-post survey was administered. Using a 6-point Likert Scale, participants were asked about their understanding, experience, and confidence with prescribing.</p><p><strong>Conclusions/applications: </strong>A one-hour, three-pronged educational package changed the attitudes of emergency physicians towards buprenorphine treatment and demonstrated an increase in willingness and confidence to prescribe it for patients with OUD. Our findings suggest that healthcare entities that wish to boost buprenorphine prescribing can impact willingness and confidence to prescribe with a short education package.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"20 4","pages":"B13"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348571","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":"Partial Agonist, Full Barrier: A Case-Based Discussion on Challenges with Buprenorphine in Chronic Pain Management.","authors":"Tonya S Hershman, Michelle Park","doi":"10.5055/bupe.24.rpj.1030","DOIUrl":"10.5055/bupe.24.rpj.1030","url":null,"abstract":"<p><strong>Background: </strong>More patients are on chronic opioids, as patients who were initially started on full agonist opioids for cancer-related pain are living longer. Despite doing well from the cancer stand- point, some patients have difficulty tapering off their opioids because they have been taking them for years. Given the potential complications of chronic full agonist opioids, it is important to manage these patients in a safer way. However, there are various challenges including lack of education for patients and healthcare professionals and lack of product availability. Many healthcare providers do not have much formal training on initiating, maintaining, and tapering the various buprenorphine products. These providers may not be able to effectively educate patients given the lack of education. Also, patients research these products on their own and are hesitant to try them because of misinformation. Even if patients are informed thoroughly about buprenorphine, there are barriers to obtaining them including insurance denial and lack of product availability at pharmacies. Given the above challenges, easily accessible best practices as well as avenues for healthcare professionals to educate and guide each other are needed.</p><p><strong>Purpose/hypothesis: </strong>Given the potential complications of chronic full agonist opioids, it is important to manage these patients in a safer way. However, there are various challenges including lack of education for patients and healthcare professionals and lack of product availability.</p><p><strong>Conclusions/applications: </strong>Given the above challenges, easily accessible best practices as well as avenues for healthcare professionals to educate and guide each other are needed.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"20 4","pages":"B5"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348476","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: Opioid Agonist-Antagonist for Refractory Pain of Sickle Cell Disease Patients During Hematopoietic Stem Cell Transplant, Uncontrolled By Full-Agonist Opioids.","authors":"Mayuko Sakae","doi":"10.5055/bupe.24.rpj.1065","DOIUrl":"10.5055/bupe.24.rpj.1065","url":null,"abstract":"<p><strong>Background: </strong>Bone marrow transplant (BMT) offers potential cure for cancer and a spectrum of otherwise incur- able diseases. The BMT process can cause multi-systemic pain in patients with sickle cell disease (SCD) refractory to high-dose opioid analgesics during BMT because of their pre-existing opioid-tolerance. Because of frequent pain resulting in hyperalgesia and chronic opioid use, SCD patients undergoing BMT often experience excruciating pain uncontrolled by exceedingly high-dose opioids with severe and intolerable adverse effects.</p><p><strong>Purpose/hypothesis: </strong>There is a small but growing body of literature about the successful buprenorphine effect for SCD's chronic pain management that had failed sufficient pain relief by the traditional full-agonist opioids in the outpatient setting. However, the buprenorphine use for acute inpatient pain management has not been previously researched. Pilot prospective clinical trial with buprenorphine-based pain management for acute BMT-related pain was initiated for SCD patients' pain uncontrolled by full-agonist opioids. Procedures/data/observations: Buprenorphine was started as scheduled and as-needed analgesics, supplemented by full-agonist opioids upon consultation for uncontrolled BMT-related pain of SCD patients. Patients' 24-hour opioid requirement by morphine equivalent daily doses (MEDD) were assessed at 3 time points: 1)immediately before pain escalation; 2)consultation; 3)discharge. MEDDs were compared to those of patients treated with full-agonist opioids only. Cases treated by full-agonist opioids (morphine/hydromorphone/fentanyl/methadone/oxycodone) had MEDD escalation by 1230-16300% by discharge compared to immediately before BMT-related pain escalation. Buprenorphine-supported cases had significantly smaller MEDD increase by 220-317%.</p><p><strong>Conclusions/applications: </strong>Our case series suggests superior pain control by adding Buprenorphine prior to opioid dose escalation during BMT for SCD. Buprenorphine may provide the advantageous effect for other patients with complex pain background and experiencing difficult pain management during BMT due to pre-existing hyperalgesia and high opioid-tolerance. The evidence for buprenorphine's analgesic effect is moderate but growing, and more randomized controlled trials comparing the buprenorphine and other standard opioids are needed.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"20 4","pages":"B14"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348564","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":"\"What helps your back pain?\" A qualitative analysis of pain management strategies in opioid-treated adults with chronic low back pain.","authors":"David K Woods, Evan O Nelson, Linda Denise Oakley, Fatih Kunkul, Bruce P Barrett, Nguyen Hua, Cindy A Burzinski, Robert R Edwards, Eric L Garland, Aleksandra E Zgierska","doi":"10.5055/jom.0867","DOIUrl":"10.5055/jom.0867","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this qualitative analysis was to better understand what pain management strategies adults with opioid-treated chronic low back pain (CLBP) found most helpful.</p><p><strong>Design: </strong>A subgroup of participants from a larger randomized control trial of two psychological interventions were asked: \"What helps your back pain?\" at baseline and 12 months (exit) in brief, video-recorded interviews. Videos were analyzed using qualitative thematic content analysis utilizing Transana™.</p><p><strong>Setting: </strong>Participants were recruited from the community and outpatient clinics in three United States sites.</p><p><strong>Participants: </strong>Seventy-nine adults with long-term (≥3 months) opioid-treated (≥15 mg/day morphine equivalent) CLBP.</p><p><strong>Main outcome measure(s): </strong>Participants' baseline and exit qualitative responses to the question \"What helps your back pain?\"</p><p><strong>Results: </strong>At baseline, participants identified medication (n = 63), body position (n = 59), thermal application (n = 50), physical activity (n = 49), and stretching (n = 24) as the CLBP management strategies they found helpful. At exit, the reports of medication (n = 55), physical activity (n = 41), and stretching (n = 21) were often considered helpful for CLBP and remained relatively stable, while position (n = 36) and thermal application (n = 35) strategies were mentioned less frequently and psychological strategies (n = 29) were mentioned more frequently (up from n = 5) compared to baseline.</p><p><strong>Conclusions: </strong>Over time, the reports of medication and active pain management strategies, eg, physical activity, remained stable, while the reports of some passive pain management strategies, eg, position and thermal, declined over time. Increased use of psychological strategies implies that study interventions were incorporated as useful pain self-management strategies.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"20 3","pages":"209-223"},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141627004","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":"Post-operative pain control in patients on buprenorphine or methadone for opioid use disorder.","authors":"Aurora Quaye, Tal Tsafnat, Janelle M Richard, Henry Stoddard, David J Gagnon","doi":"10.5055/jom.0823","DOIUrl":"10.5055/jom.0823","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to determine whether there is a difference in pain scores and opioid consumption after elective surgery in patients maintained on methadone or buprenorphine for opioid use disorder (OUD). Additionally, we investigated the impact of continuing or discontinuing methadone or buprenorphine on post-operative pain outcomes.</p><p><strong>Design: </strong>A single-center retrospective cohort study.</p><p><strong>Setting: </strong>Tertiary care medical center.</p><p><strong>Patients and participants: </strong>Adults aged 18 years or older with OUD maintained on buprenorphine or methadone who underwent elective surgery between January 1, 2017, and January 1, 2021.</p><p><strong>Interventions: </strong>Patients were identified through electronic medical records, and demographic and clinical data were collected.</p><p><strong>Main outcome measures: </strong>The primary outcome was opioid consumption at 24 hours post-operatively, measured in milligram morphine equivalents. The secondary outcome was opioid consumption and pain scores up to 72 hours post-operatively, assessed using a numeric rating scale.</p><p><strong>Results: </strong>This study included 366 patients (64 percent on buprenorphine and 36 percent on methadone). Opioid utilization significantly increased when buprenorphine was not administered post-operatively. Both groups exhibited comparable total opioid consumption during the post-operative period. In the buprenorphine cohort, pain scores differed significantly based on the receipt of medications for OUD post-operatively.</p><p><strong>Conclusions: </strong>This study reinforces existing evidence supporting the continuation of medications for opioid use disorder, specifically buprenorphine and methadone, during the perioperative period. Dissemination of guideline recommendations is essential to ensure optimal post-operative pain management for this patient population.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"20 3","pages":"233-241"},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11638846/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141627011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Observations on the effects of buprenorphine and methadone on illicit drug use.","authors":"Amadeo J Pesce, Keith Tran, Kevin Krock, Agnes Cua, Richard Thomas","doi":"10.5055/jom.0861","DOIUrl":"https://doi.org/10.5055/jom.0861","url":null,"abstract":"<p><strong>Objective: </strong>To determine if the agonistic effects of buprenorphine and methadone affect drug use.</p><p><strong>Method: </strong>Quantitative examination of urine drug concentrations of patients treated with buprenorphine and methadone.</p><p><strong>Results: </strong>Patients on buprenorphine had less opioid and methamphetamine drug use than those on methadone.</p><p><strong>Conclusion: </strong>Patients on buprenorphine therapy appear to use less illicit drugs.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"20 3","pages":"193-195"},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141627009","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 pilot study surveying the impact of pharmacist-led counseling on naloxone dispensing.","authors":"Angelina Vascimini, Calynn Dioses, Taylor Certain, Kevin Duane, Carl Allison, Theresa Tolle, Stacey Curtis","doi":"10.5055/jom.0855","DOIUrl":"10.5055/jom.0855","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study was to evaluate the impact of pharmacist counseling on patients purchasing naloxone and to highlight reasons for naloxone purchase refusal.</p><p><strong>Design: </strong>A multisite study that was conducted from September 15, 2022, to January 11, 2023.</p><p><strong>Setting: </strong>Independent community pharmacies.</p><p><strong>Patients/participants: </strong>Fifty patients met inclusion criteria. Data collected included demographics, preintervention knowledge assessment, post-intervention naloxone purchase, and reasons for naloxone refusal.</p><p><strong>Outcome measures: </strong>The primary outcome was naloxone purchase after pharmacist education intervention. The secondary outcome was reasons for naloxone purchase refusal.</p><p><strong>Results: </strong>The primary outcome showed that 60 percent of patients purchased naloxone after pharmacist intervention. As a secondary outcome, the number of patients who refused to purchase naloxone was 20 percent, with the majority of patients expressing that naloxone was not necessary as a reason for refusal.</p><p><strong>Conclusion: </strong>More studies are needed in order to conclude the impact of pharmacist education on the increasing purchase of naloxone.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"20 3","pages":"185-192"},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141627005","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":"Direct rotation from a fentanyl patch to a buprenorphine patch in a patient with chronic pain.","authors":"Naomi Steenhof, John Flannery, Joyce Lee","doi":"10.5055/jom.0865","DOIUrl":"10.5055/jom.0865","url":null,"abstract":"<p><p>Transitioning a patient with chronic pain from a fentanyl patch to a buprenorphine patch has not been well described in the literature. Even after a patient removes their fentanyl patch, the residual fentanyl in the skin continues to be absorbed for hours. Due to the risk of precipitated withdrawal when initiating buprenorphine, this transition is a more challenging opioid rotation to plan safely. We report a case of a patient who had been using a fentanyl patch for over 10 years and was successfully rotated directly to a buprenorphine patch.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"20 3","pages":"260-262"},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141627007","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":"First Response to Opioids Survey Tool (FROST): Pilot study of a brief screening tool to assess opioid use disorder risk.","authors":"Sara L Mills-Huffnagle, Christian Morris, Sarah Kawasaki, Grace E Waverka, Haley A Hammen, Aleksandra E Zgierska","doi":"10.5055/jom.0860","DOIUrl":"https://doi.org/10.5055/jom.0860","url":null,"abstract":"<p><strong>Objective: </strong>Early work suggests the type of subjective experiences upon first opioid use may predict opioid use disorder (OUD) risk. This study developed and pilot-tested a brief survey to evaluate the \"first response\" to opioids.</p><p><strong>Design: </strong>A cross-sectional survey research study. The survey was administered to a subsample for the second time to assess test-retest reliability.</p><p><strong>Setting: </strong>Outpatient.</p><p><strong>Participants: </strong>Convenience sample of adults treated for OUD at an opioid treatment program.</p><p><strong>Main outcome measures: </strong>A seven-question First Response to Opioids Survey Tool (FROST), developed based on the existing questionnaires and stakeholder-advisor feedback, was evaluated.</p><p><strong>Results: </strong>Participants (N = 157) were 36.8 (standard deviation [SD] = 9.4) years old, with 79.6 percent identifying as Caucasian and 56.7 percent male. They reported opioid initiation at 20.6 (SD = 8.8) years old, with a prescription-based (78.3 percent), orally administered (66.2 percent), and illicitly procured (51.0 percent) opioids. Upon opioid initiation, positive-valence, euphoria-like subjective experiences of feeling \"comfortable\" (65.0 percent), \"happy\" (61.1 percent), \"euphoria\" (58.6 percent), and \"energized\" (44.6 percent) were common, and different (p < 0.05) from other types of subjective experiences. Among 64 individuals who answered a question about \"drug-liking,\" 50 (78.1 percent) reported drug-liking. Among 31 respondents who completed the survey a second time, the test-retest consistency was 78.2 percent for subjective experience characteristics and 72 percent for drug-liking responses. Qualitative results corroborated quantitative findings.</p><p><strong>Conclusion: </strong>These results suggest that euphoria-type experiences and drug-liking upon opioid initiation are common among adults with OUD and FROST's promising psychometric properties. Future research should assess clinical utility of this brief survey, which could be applied at bedside and help identify those at risk for OUD, guide safer opioid prescribing, and reduce opioid-related harm.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"20 3","pages":"197-207"},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141627008","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}