Opioid use in gynecologic oncology in the age of the opioid epidemic: Part I - Effective opioid use across clinical settings, a society of gynecologic oncology evidence-based review

Objectives Hospitals are on the front lines of the opioid epidemic, seeing patients who overdose or have complicated infections, but the extent of services offered or whether services are evidence-based is not known. The objective of our study was to assess the extent to which nonprofit hospitals are addressing opioid abuse, a critical public health issue, through their community benefit work and to identify which evidence-based strategies they adopt. Methods We reviewed community benefit documents from January 1, 2015, through December 31, 2018, for a sample (N = 446) of all nonprofit hospitals in the United States. We classified hospital opioid-related strategies into 9 categories. Using logistic regression, we predicted the likelihood of hospitals adopting various strategies to address opioid abuse. Results Of the 446 nonprofit hospitals in our sample, 49.1% (n = 219) adopted ≥1 clinical strategy to address opioid use disorder in their community. Approximately one-quarter (26.5%; n = 118) of hospitals adopted a strategy related to treatment services for substance use disorder; 28.2% (n = 126) had ≥1 program focused on connecting patients to a primary care medical home, and 14.6% (n = 65) focused on caring for patients with opioid-related overdoses in the emergency department. We also identified factors that predicted involvement in programs that were less common than clinical strategies, but potentially effective, such as harm reduction and prescriber initiatives (both 6.3% of hospitals). Conclusions Evidence-based prevention and treatment require strong collaboration between health care and community institutions at all levels. Effective policy interventions may exist to encourage various types and sizes of nonprofit hospitals to adopt evidence-based interventions to address opioid abuse in their communities.

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Forgotten but Not Gone: The Impact of the Opioid Epidemic and Other Substance Use Disorders on Families and Children

Commonwealth ◽

10.15367/com.v20i2-3.189 ◽

2018 ◽

Vol 20 (2-3) ◽

Cited By ~ 7

Author(s):

Dennis C. Daley ◽

Erin Smith ◽

Daniel Balogh ◽

Jodi Toscaloni

Keyword(s):

Substance Use ◽

Substance Use Disorders ◽

Health And Safety ◽

Clinical Settings ◽

Opioid Epidemic ◽

Sources Of Information ◽

Opioid Use ◽

Current Trends ◽

The Impact ◽

Public Health And Safety

This article discusses the impact of the opioid epidemic and other substance use disorders (SUDs) on families and their members, including children. We review factors contributing to this major public health and safety problem, current trends in opioid and other substance use and misuse, prevalence of opioid use disorders (OUDs) and other SUDs, and interventions to help families. Sources of information for this article include research, clinical and recovery literature, government reports, experiences of the two senior authors in clinical settings, and interviews and surveys of family members affected by a loved one’s SUD.

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Evidence-Based Treatment for Opioid Use Disorder

PsycEXTRA Dataset ◽

10.1037/e503952019-001 ◽

2018 ◽

Keyword(s):

Opioid Use Disorder ◽

Evidence Based ◽

Opioid Use ◽

Evidence Based Treatment

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Championing Change to Save Lives: A Call to Action to Implement Reforms to Increase Use of Medications to Treat Opioid Use Disorder in Correctional Settings

Criminal Justice Review ◽

10.1177/0734016820981629 ◽

2020 ◽

pp. 073401682098162

Author(s):

Sonia L. Canzater ◽

Regina M. LaBelle

Keyword(s):

Standard Of Care ◽

Opioid Use Disorder ◽

Correctional Facilities ◽

Evidence Based ◽

Opioid Use ◽

Call To Action ◽

Evidence Based Treatment ◽

High Prevalence ◽

Correctional Settings ◽

Overdose Deaths

The disproportional rates of opioid use disorder (OUD) in U.S. correctional facilities make them prime intervention points to treat OUD utilizing medication to treat opioid use disorder (MOUD), the evidence-based clinical standard of care. MOUD has been shown to be effective to support recovery and reduce recurrence of OUD, overdose deaths, and recidivism for justice-involved persons both while incarcerated and once they reenter their communities. Despite the high prevalence, most jails and prisons do not offer MOUD. Litigation has spurred expanded access in more facilities, but widespread MOUD access can only become a reality through a comprehensive effort of corrections officials, medical experts, advocates, legislators, and other champions to raise awareness and affect ideological and policy change. It is a legal and ethical imperative that the lives of justice-involved persons not be jeopardized by the lack of evidence-based treatment for OUD in correctional settings.

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One Shot to Control Pain: Decreasing Postoperative Opioid Use in Gynecologic Oncology Patients with Intrathecal Opioid Injection

Gynecologic Oncology Reports ◽

10.1016/j.gore.2021.100858 ◽

2021 ◽

pp. 100858

Author(s):

Yevgeniya Ioffe ◽

Ruofan Yao ◽

Eileen Hou ◽

Michelle Wheeler ◽

Mohammed Nour ◽

...

Keyword(s):

Gynecologic Oncology ◽

Opioid Use ◽

Oncology Patients ◽

Control Pain

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A review of the evidence to explain pharmacological basis of injection (ab)use of buprenorphine–naloxone tablets

Journal of Opioid Management ◽

10.5055/jom.2021.0651 ◽

2021 ◽

Vol 17 (7) ◽

pp. 141-152

Author(s):

Tamoud Modak, MD, DM ◽

Siddharth Sarkar, MD, MRCPsych ◽

Yatan Pal Singh Balhara, MD

Keyword(s):

Public Health Problem ◽

Opioid Use Disorder ◽

Critical Examination ◽

Evidence Based ◽

Major Public Health Problem ◽

Opioid Use ◽

Evidence Based Treatment ◽

Opioid Replacement Therapy ◽

Pharmacological Basis

Opioid use disorder is a major public health problem, and opioid replacement therapy with buprenorphine (BPN) is a clinically effective and evidence-based treatment for it. To deter misuse of the tablet through the injecting route, BPN coformulated with naloxone (BNX) in 4:1 ratio is available in many countries. Despite this, significant diversion and injecting use of the BNX combination has been reported from across the world. In this article, the pharmacological properties of BPN and BNX and the evidence for their diversion are reviewed. Also, a critical examination is made of the evidence supporting the role of naloxone in reducing the agonist effects of BPN when used through the injecting route. Based on this evidence, a hypothesis explaining the continued diversion of BNX has been proposed.

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Reduction in opioid use with perioperative non-pharmacologic analgesia in total knee arthroplasty and ACL reconstruction: a systematic review

SICOT-J ◽

10.1051/sicotj/2021063 ◽

2021 ◽

Vol 7 ◽

pp. 63

Author(s):

Ryan B Juncker ◽

Faisal M Mirza ◽

Joel J Gagnier

Keyword(s):

Systematic Review ◽

Total Knee Arthroplasty ◽

Acl Reconstruction ◽

Knee Arthroplasty ◽

Cruciate Ligament ◽

Future Research ◽

Opioid Epidemic ◽

Clinical Implementation ◽

Opioid Use ◽

Total Knee

Introduction: The world’s opioid epidemic has gotten increasingly severe over the last several decades and projects to continue worsening. Orthopedic surgery is the largest contributor to this epidemic, accounting for 8.8% of postoperative opioid dependence cases. Total knee arthroplasty (TKA) and anterior cruciate ligament (ACL) reconstruction are commonly performed orthopedic operations heavily reliant on opioids as the primary analgesic in the peri- and immediate postoperative period. These downfalls highlight the pressing need for an alternate, non-pharmacologic analgesic to reduce postoperative opioid use in orthopedic patients. The presented systematic review aimed to analyze and compare the most promising non-pharmacologic analgesic interventions in the available literature to guide future research in such a novel field. Methods: A systematic search of PubMed, MEDLINE, Embase, Cochrane, and Web of Science was performed for studies published before July 2020 based on the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines, and the obtained manuscripts were evaluated for inclusion or exclusion against strict, pre-determined criteria. Risk-of-bias and GRADE (grades of recommendation, assessment, development, and evaluation) assessments were then performed on all included studies. Results: Six studies were deemed fit for inclusion, investigating three non-pharmacologic analgesics: percutaneous peripheral nerve stimulation, cryoneurolysis, and auricular acupressure. All three successfully reduced postoperative opioid use while simultaneously maintaining the safety and efficacy of the procedure. Discussion: The results indicate that all three presented non-pharmacologic analgesic interventions are viable and warrant future research. That said, because of its slight advantages in postoperative pain control and operational outcomes, cryoneurolysis seems to be the most promising. Further research and eventual clinical implementation of these analgesics is not only warranted but should be a priority because of their vast potential to reduce orthopedics surgeries’ contribution to the opioid epidemic.

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Surveying Dentists’ Perceptions of Caregiver Refusal of Topical Fluoride

JDR Clinical & Translational Research ◽

10.1177/2380084418761846 ◽

2018 ◽

Vol 3 (3) ◽

pp. 314-320 ◽

Cited By ~ 3

Author(s):

D.L. Chi ◽

A.A. Basson

Keyword(s):

Interdisciplinary Research ◽

Public Health Problem ◽

Preventive Therapy ◽

Clinical Settings ◽

Evidence Based ◽

The West ◽

Geographic Differences ◽

Us West ◽

Perceived Reasons ◽

Topical Fluoride

The objective of this study was to assess dentists’ perceptions of caregiver topical fluoride refusal behaviors. We administered an 8-item survey in 2015 and 2016 ( N = 582) and asked dentists about the extent to which fluoride refusal is a problem, refusal trends, comfort talking to caregivers who refuse, and perceived reasons why caregivers refuse. To examine geographic variation, we ran χ2 tests between dentists’ location (US West vs. non-West) and the first 3 perception measures (α = 0.05). Nearly 80% of dentists believed fluoride refusal was a problem, and 42.3% believed it was a growing problem. A significantly larger proportion of dentists who saw fluoride refusal as a problem also believed refusal was a growing problem compared to those who thought refusal was not a problem (89.6% and 41.2%, respectively; P < 0.0001). Caregiver characteristics perceived to be associated with fluoride refusal included immunization refusal (41.3%), White race (37.6%), and high income (33.7%). Thirty-seven percent of surveyed dentists were uncomfortable talking to caregivers who refused. There were no geographic differences in perceptions of fluoride refusal as a problem ( P = 0.52). A significantly larger proportion of non-West dentists believed fluoride refusal has gotten worse (non-West: 65.5%, West: 41.2%; P < 0.0001), but more dentists from the West were uncomfortable talking to caregivers who refused (West: 86%, non-West: 67.4%; P < 0.0001). Caregiver refusal of topical fluoride may be a growing problem, and many dentists are uncomfortable talking to caregivers who refuse. Additional interdisciplinary research is needed to identify the reasons why caregivers refuse fluoride, which is an important next step in developing chairside interventions that address fluoride refusal behaviors. Knowledge Transfer Statement: The results of this study can be used by researchers to develop chairside strategies to help dentists identify and manage fluoride refusal behaviors in clinical settings. This could help preserve topical fluoride as an evidence-based preventive therapy and address a growing public health problem.

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Less is more: Implementing the ‘Minimal Intervention Needed for Change (MINC)’ approach to increase contextual fit of speech-language interventions

10.31234/osf.io/pu6sa ◽

2021 ◽

Author(s):

Maura Curran ◽

Rouzana Komesidou ◽

Tiffany P. Hogan

Keyword(s):

Clinical Settings ◽

Evidence Based ◽

Evidence Based Practices ◽

Minimal Intervention ◽

Less Is More ◽

Resource Limitations ◽

Practice Method ◽

Core Components ◽

Contextual Fit ◽

Clinically Significant

AbstractPurpose: Speech-Language Pathologists (SLPs) and researchers face difficulties in moving evidence-based practices from clinical research into widespread practice, in part due to a mismatch between the design of typical intervention research studies and the realities of clinical settings. SLPs must adapt interventions from the literature or established programs to fit the needs of specific clients and settings. Researchers must design studies that better reflect clinical practice. Method: Here, we provide an overview of the Minimal Intervention Needed for Change (MINC) approach; a systematic approach to developing and adapting interventions that focuses on achieving meaningful outcomes within specific contexts. We outline the principles of MINC, and illustrate this process through use of a case study.Results: MINC can support systematic development and adaptation of interventions in clinical and research settings, particularly settings with resource limitations. Conclusions: Researchers should work to align research intervention work with typical clinical settings. This involves both targeting outcomes that are functional and clinically significant and acknowledging resource limitations. SLPs should adapt evidence-based interventions systematically and carefully to meet the needs of clients and settings while retaining the core components of intervention that result in meaningful change for clients.

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