Prevention and Treatment of Opioid Overdose and Opioid-Use Disorders

Background: Rates of opioid overdose deaths are increasing in the United States, leading to intensified efforts to provide medication-assisted treatments for opioid use disorders. It is not clear what effect opioid agonist treatments (ie, the μ-opioid receptor full agonist methadone and the partial agonist buprenorphine) may have on respiratory function. However, sleep-disordered breathing has been documented in methadone maintenance pharmacotherapy, and there is emerging evidence for similar sleep-disordered breathing in buprenorphine and buprenorphine-naloxone maintenance treatment.Objective: To provide further clinical evidence of sleep-disordered breathing emerging in the context of buprenorphine-naloxone maintenance pharmacotherapy.Methods: The authors report two additional cases of sleep-disordered breathing that developed in patients with severe opioid use disorders, treated successfully as outpatients with buprenorphine-naloxone maintenance. Both patients provided written consent for their clinical information to be included in this case report, and elements of their identities have been masked to provide confidentiality.Results: Two adult female patients, who were stable in buprenorphine-naloxone maintenance treatment developed daytime sleepiness, were referred for evaluation and found to have sleep-disordered breathing. One patient's daytime sleepiness improved with reduction in both buprenorphine-naloxone and other sedating medications as well as initiation of a constant positive airway pressure (CPAP) device. However, the other patient could not tolerate decreases in buprenorphinenaloxone and/or CPAP initiation and her daytime sleepiness persisted.Conclusion: Buprenorphine-naloxone maintenance treatment can be associated with sleep-disordered breathing. It can be difficult to differentiate the cause(s) of sleep-disordered breathing among the effects of buprenorphine-naloxone treatment itself, co-occurring conditions, such as obesity and cigarette smoking or other medications, or some combination thereof. Regardless of etiology, sleep-disordered breathing and its consequences present unique challenges to the patient in recovery from an opioid use disorder and therefore warrants careful evaluation and management.

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Answering a Call to Action on American Workplace and Community Opioid Concerns

NEW SOLUTIONS A Journal of Environmental and Occupational Health Policy ◽

10.1177/10482911211037573 ◽

2021 ◽

pp. 104829112110375

Author(s):

Peter Harnett ◽

John Hindman ◽

Melissa Duenas ◽

Michael Coogan ◽

Heather Misicko

Keyword(s):

Mental Health ◽

Community Outreach ◽

Well Being ◽

Opioid Overdose ◽

Opioid Use ◽

Call To Action ◽

Worker Health ◽

Opioid Use Disorders ◽

Health And Well Being ◽

Total Worker Health

Leidos, Inc. is a large government science and technology company. When a Leidos employee lost his son to an opioid overdose, he wrote an impassioned email to the CEO, asking him to take action related to the growing societal problem of opioid use disorders. The CEO understood and accepted this important call to action. Leidos’ subsequent efforts included supporting employees and families, as well as community outreach, eventually broadening to include mental health and well-being. This paper outlines the company’s efforts to combat opioid use disorders, understanding that they sit within a larger total worker health umbrella inclusive of mental health and well-being. The hope is that this ongoing journey and its exemplars are helpful for other organizations seeking to make an impact for their employees and society.

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Confronting the new epidemic: Integrated care for opioid use disorders.

Families Systems & Health ◽

10.1037/fsh0000279 ◽

2017 ◽

Vol 35 (2) ◽

pp. 248-250

Author(s):

Christine N. Runyan ◽

Amber L. Hewitt ◽

Stephen A. Martin ◽

Daniel Mullin

Keyword(s):

Integrated Care ◽

Opioid Use ◽

Opioid Use Disorders

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Viral vector-mediated gene therapy for opioid use disorders

Experimental Neurology ◽

10.1016/j.expneurol.2021.113710 ◽

2021 ◽

pp. 113710

Author(s):

Tao Wang ◽

Xun Zhu ◽

Hyun Yi ◽

Jun Gu ◽

Shue Liu ◽

...

Keyword(s):

Gene Therapy ◽

Viral Vector ◽

Opioid Use ◽

Opioid Use Disorders

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Suicide Risk and Addiction: The Impact of Alcohol and Opioid Use Disorders

Current Addiction Reports ◽

10.1007/s40429-021-00361-z ◽

2021 ◽

Author(s):

Mina M. Rizk ◽

Sarah Herzog ◽

Sanjana Dugad ◽

Barbara Stanley

Keyword(s):

Suicide Risk ◽

Opioid Use ◽

Opioid Use Disorders ◽

The Impact

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Assessing the Relationships Between COVID-19 Stay-at-Home Orders and Opioid Overdoses in the State of Pennsylvania

Journal of Drug Issues ◽

10.1177/00220426211006362 ◽

2021 ◽

pp. 002204262110063

Author(s):

Brian King ◽

Ruchi Patel ◽

Andrea Rishworth

Keyword(s):

Age Groups ◽

The United States ◽

Opioid Use Disorder ◽

Opioid Overdose ◽

Policy Recommendations ◽

Opioid Use ◽

Fentanyl Analogs ◽

Measure Change ◽

Using Data ◽

At Home

COVID-19 is compounding opioid use disorder throughout the United States. While recent commentaries provide useful policy recommendations, few studies examine the intersection of COVID-19 policy responses and patterns of opioid overdose. We examine opioid overdoses prior to and following the Pennsylvania stay-at-home order implemented on April 1, 2020. Using data from the Pennsylvania Overdose Information Network, we measure change in monthly incidents of opioid-related overdose pre- versus post-April 1, and the significance of change by gender, age, race, drug class, and naloxone doses administered. Findings demonstrate statistically significant increases in overdose incidents among both men and women, White and Black groups, and several age groups, most notably the 30–39 and 40–49 ranges, following April 1. Significant increases were observed for overdoses involving heroin, fentanyl, fentanyl analogs or other synthetic opioids, pharmaceutical opioids, and carfentanil. The study emphasizes the need for opioid use to be addressed alongside efforts to mitigate and manage COVID-19 infection.

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