Incidentally Identified Opioid Misuse and Opioid Use Disorder While Inpatient

2020 ◽  
pp. 495-518
Author(s):  
Ojas Mainkar ◽  
Miranda Greiner ◽  
Jonathan Avery ◽  
Neel Mehta
Keyword(s):  
Opioid Use Disorder ◽  
Opioid Misuse ◽  
Opioid Use

scholarly journals Consensus-based approach to managing opioids, including opioid misuse and opioid use disorder, in patients with serious illness: protocol for a modified Delphi process

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e045402
Author(s):  
Caroline King ◽  
Robert Arnold ◽  
Emily Dao ◽  
Jennifer Kapo ◽  
Jane Liebschutz ◽  
...  
Keyword(s):  
Palliative Care ◽  
Opioid Therapy ◽  
Opioid Use Disorder ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Serious Illness ◽  
Modified Delphi ◽  
Delphi Approach ◽  
Institutional Review ◽  
Management Guidance

IntroductionManagement of opioid misuse and opioid use disorder (OUD) among individuals with serious illness is an important yet understudied issue. Palliative care clinicians caring for individuals with serious illness, many of whom may live for months or years, describe a complex tension between weighing the benefits of opioids, which are considered a cornerstone of pain management in serious illness, and serious opioid-related harms like opioid misuse and OUD. And yet, little literature exists to inform the management of opioid misuse and OUDs among individuals with serious illness. Our objective is to provide evidence-based management guidance to clinicians caring for individuals with serious illness who develop opioid misuse or OUD.Methods and analysisWe chose a modified Delphi approach, which is appropriate when empirical evidence is lacking and expert input must be used to shape clinical guidance. We sought to recruit 60 clinicians with expertise in palliative care, addiction or both to participate in this study. We created seven patient cases that capture important management challenges in individuals with serious illness prescribed opioid therapy. We used ExpertLens, an online platform for conducting modified Delphi panels. Participants completed three rounds of data collection. In round 1, they rated and commented on the appropriateness of management choices for cases. In round 2, participants reviewed and discussed their own and other participants’ round 1 numerical responses and comments. In round 3 (currently ongoing), participants again reviewed rounds 1 and 2, and are allowed to change their final numerical responses. We used ExpertLens to automatically identify whether there is consensus, or disagreement, among responses in panels. Only round 3 responses will be used to assess final consensus and disagreement.Ethics and disseminationThis project received ethical approval from the University of Pittsburgh’s Institutional Review Board (study 19110301) and the RAND Institutional Research Board (study 2020-0142). Guidance from this work will be disseminated through national stakeholder networks to gain buy-in and endorsement. This study will also form the basis of an implementation toolkit for clinicians caring for individuals with serious illness who are at risk of opioid misuse or OUD.

scholarly journals Prevention, Diagnosis, and Management of Opioids, Opioid Misuse, and Opioid Use Disorder in Older Adults

2020 ◽  
Author(s):  
Andrew R. Zullo ◽  
Kristin J. Danko ◽  
Patience Moyo ◽  
Gaelen P. Adam ◽  
Melissa Riester ◽  
...  
Keyword(s):  
Older Adults ◽  
Opioid Use Disorder ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Diagnosis And Management

scholarly journals Opioid Use in Children

2019 ◽  
Vol 24 (1) ◽  
pp. 72-75
Author(s):  
Kelly L. Matson ◽  
Peter N. Johnson ◽  
Van Tran ◽  
Evan R. Horton ◽  
Jennifer Sterner-Allison ◽  
...  
Keyword(s):  
Young Adults ◽  
Pain Management ◽  
Pediatric Population ◽  
The United States ◽  
Opioid Use Disorder ◽  
Adolescents And Young Adults ◽  
Evidence Based ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Electronic Prescription

Limited guidance on opioid use exists in the pediatric population, causing medication safety concerns for pain management in children and adolescents. Opioid misuse and use disorder continue to greatly affect adolescents and young adults in the United States, furthering the apprehension of their use. Pediatric Pharmacy Advocacy Group (PPAG) recommends pharmacists contribute their knowledge to pain management in children, including the discussion of appropriate use of non-opioid alternatives for pain and when to recommend coprescribing of naloxone. PPAG also supports the review of electronic prescription drug–monitoring programs prior to opioid prescribing and dispensing by both prescribers and pharmacists. Education by pharmacists of children and their families regarding proper administration, storage, and disposal, as well as the awareness of opioid misuse and use disorder among adolescents and young adults, is key to prevention. If opioid use disorder is diagnosed, PPAG encourages improved access among adolescents to evidence-based medications including methadone, buprenorphine, and naltrexone. Furthermore, pharmacists should assist in screening and referral to evidence-based treatment.

Estimating costs of hospitalizations associated with opioid use disorder or opioid misuse at a large, urban safety-net hospital—Denver, Colorado, 2017

2021 ◽  
Vol 218 ◽  
pp. 108306
Author(s):  
Aziza Arifkhanova ◽  
Emily McCormick Kraus ◽  
Alia Al-Tayyib ◽  
Julie Taub ◽  
Annette Encinias ◽  
...  
Keyword(s):  
Safety Net ◽  
Opioid Use Disorder ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Safety Net Hospital ◽  
Urban Safety

scholarly journals LO42: A systematic review of short-term use of therapeutic opioids for children and future opioid use disorders

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S22-S22
Author(s):  
S. Ali ◽  
M. Afzalzada-Ahrari ◽  
M. Dyson ◽  
D. DaRosa ◽  
K. Dong ◽  
...  
Keyword(s):  
Systematic Review ◽  
Data Extraction ◽  
Opioid Use Disorder ◽  
Careful Consideration ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Short Term ◽  
Cross Sectional ◽  
The Usa ◽  
The Individual

Introduction: Despite an overall decline in opioid prescriptions in Canada, healthcare visits, hospitalizations, and deaths due to opioid-related harms continue to rise for children. Clinicians urgently require high quality synthesized evidence to inform personalized decisions regarding opioid use for children. The objective of this systematic review was to examine the association between short-term therapeutic exposure to opioids and development of opioid use disorder. Methods: A medical librarian conducted a comprehensive search of 10 databases from inception to May 2019. Two authors independently assessed studies for inclusion. Studies were eligible if they reported primary research in English or French, and study participants had short (<14 days) or non-specific duration of therapeutic exposure to opioids before age 18 years. Primary outcome was the development of an opioid use disorder; secondary outcomes included opioid addiction, dependence, misuse, and abuse. Data extraction involved two independent reviewers utilizing a standardized form. Methodological quality was assessed using the NIH tools for observational studies. Results are described narratively. Results: The search identified 4,072 unique citations; 82 were selected for review, and 17 were included (3 retrospective cohort, 4 prospective cohort, and 10 cross-sectional). All studies took place in the USA. A total of 1,562,503 participants were analyzed. Nine studies were administered in schools, 3 used administrative data. While most settings were non-specific, 1 study examined opioid use in dentistry, 1 in trauma, and 1 in organized sports. One comparative study showed an association between short-term therapeutic use and opioid misuse. Two studies showed opioid related adverse events (e.g., overdose) among cohorts exposed to short-term use. The remaining 14 studies did not specify duration of exposure; therefore, confirming whether misuse was due to short-term therapeutic exposure was not possible. Conclusion: A small number of studies in this review suggest an association between short-term opioid use and opioid misuse; however, further analysis is underway with consideration of methodological limitations of the individual studies (final results pending). Careful consideration of the risk and benefits of short-term opioid use should be undertaken prior to prescribing opioids. PROSPERO Registration Number: 122681.

scholarly journals Identifying prescription opioid use disorder in primary care: Diagnostic characteristics of the Current Opioid Misuse Measure (COMM)

Pain ◽  
2011 ◽  
Vol 152 (2) ◽  
pp. 397-402 ◽  
Author(s):  
Ellen C. Meltzer ◽  
Denis Rybin ◽  
Richard Saitz ◽  
Jeffrey H. Samet ◽  
Sonia L. Schwartz ◽  
...  
Keyword(s):  
Primary Care ◽  
Opioid Use Disorder ◽  
Prescription Opioid ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Diagnostic Characteristics ◽  
Prescription Opioid Use

Dispositional Mindfulness and Aggression Among Adults in Residential Treatment for Opioid Use Disorder: Preliminary Findings From an Applied Setting

2020 ◽  
Vol 35 (6) ◽  
pp. 828-840
Author(s):  
Meagan J. Brem ◽  
Ryan C. Shorey ◽  
Scott Anderson ◽  
Gregory L. Stuart
Keyword(s):  
Residential Treatment ◽  
Physical Aggression ◽  
Negative Relationship ◽  
Opioid Use Disorder ◽  
Hierarchical Regression ◽  
Regression Analyses ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Dispositional Mindfulness ◽  
Before And After

Individuals with opioid use disorder (OUD) evidenced high levels of aggression both before and after the onset of opioid misuse. Continued aggression after abstinence suggested that abstinence alone may be inadequate. The present study investigated dispositional mindfulness in relation to aggressive attitudes, and verbal and physical aggression, by reviewing medical records of 163 adults in residential treatment for OUD. Results of hierarchical regression analyses, controlling for age and alcohol/drug use and problems, revealed a negative relationship between dispositional mindfulness and both aggressive attitudes and verbal aggression. Although dispositional mindfulness negatively related to physical aggression at the bivariate level, only alcohol use and problems related to physical aggression in regression analyses. Mindfulness-based treatments may be a useful avenue for targeting aggression within this population.

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