Long-term naturalistic follow-up of chronic pain in adults with prescription opioid use disorder

Background: Prescription opioid misuse in Canada has become a serious public health concern and has contributed to Canada’s opioid crisis. There are thousands of Canadians who are currently receiving treatment for opioid use disorder, which is a chronic relapsing disorder with enormous impact on individuals and society. Objectives: The aim of this study was to compare the clinical and demographic differences between cohorts of patients who were introduced to opioids through a prescription and those introduced to opioids for non-medical purposes. Study Design: This was an observational, prospective cohort study. Setting: The study took place in 19 Canadian Addiction Treatment Centres across Ontario. Methods: We included a total of 976 participants who were diagnosed with Opioid Use Disorder and currently receiving methadone maintenance treatment. We excluded participants who were on any other type of prescription opioid or who were missing their 6-month follow-up urine screens. We measured the participants’ initial source of introduction to opioids along with other variables using the Maudsley Addiction Profile. We also measured illicit opioid use using urine screens at baseline and at 6-months follow-up. Results: Almost half the sample (n = 469) were initiated to opioids via prescription. Women were more likely to be initiated to opioids via a prescription (OR = 1.385, 95% CI 1.027-1.866, P = .033). Those initiated via prescription were also more likely to have post-secondary education, older age of onset of opioid use, less likely to have hepatitis C and less likely to have use cannabis. Chronic pain was significantly associated with initiation to opioids through prescription (OR = 2.720, 95% CI 1.998-3.722, P < .0001). Analyses by gender revealed that men initiated by prescription were less likely to have liver disease and less likely to use cannabis, while women initiated by prescription had a higher methadone dose. Limitations: This project was limited by its study design being observational in nature; no causal relationships can be inferred. Also, the data did not allow determination of the role that the prescribed opioids played in developing opioid use disorder. Conclusions: Our results have revealed that almost half of this methadone maintenance treatment (MMT) population has been introduced to opioids through a prescription. Given that the increasing prescribing rates of opioids has an impact on this at-risk population, alternative treatments for pain should be considered to help decrease this opioid epidemic in Canada. Key words: Opioid use disorder, chronic pain relief, methadone maintenance treatment, prescriptions, male, female

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A new OPIATE (Optimizing Positive Ibuprofen and Acetaminophen Treatment Expectations) model: A brief comment on “Concurrent and lagged associations of prescription opioid use with pain and negative affect in the daily lives of chronic pain patients” (Carpenter, Lane, Bruehl, & Trull, 2019).

Journal of Consulting and Clinical Psychology ◽

10.1037/ccp0000436 ◽

2019 ◽

Vol 87 (10) ◽

pp. 887-892

Author(s):

Jack Stevens ◽

Tarun Bhalla

Keyword(s):

Chronic Pain ◽

Negative Affect ◽

Prescription Opioid ◽

Opioid Use ◽

Treatment Expectations ◽

Daily Lives ◽

Chronic Pain Patients ◽

Prescription Opioid Use ◽

Pain Patients

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Problematic Prescription Opioid Use in a Chronic Pain Treatment Facility: The Role of Emotional Processes

Substance Use & Misuse ◽

10.1080/10826084.2018.1521426 ◽

2018 ◽

Vol 54 (3) ◽

pp. 495-505 ◽

Cited By ~ 1

Author(s):

Lindsay M. S. Oberleitner ◽

Mark A. Lumley ◽

Emily R. Grekin ◽

Kathryn M. Z. Smith ◽

Amy M. Loree ◽

...

Keyword(s):

Chronic Pain ◽

Pain Treatment ◽

Prescription Opioid ◽

Opioid Use ◽

Treatment Facility ◽

Emotional Processes ◽

Chronic Pain Treatment ◽

Prescription Opioid Use

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Opioid tapering in patients with prescription opioid use disorder: A retrospective study

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2017.09.005 ◽

2017 ◽

Vol 17 (1) ◽

pp. 167-173 ◽

Cited By ~ 1

Author(s):

Kehua Zhou ◽

Peng Jia ◽

Swati Bhargava ◽

Yong Zhang ◽

Taslima Reza ◽

...

Keyword(s):

Trigger Point ◽

Retrospective Chart Review ◽

Opioid Use Disorder ◽

Prescription Opioid ◽

Office Visits ◽

Opioid Use ◽

Clinical Practices ◽

Medication Assisted Treatment ◽

Opioid Tapering ◽

Prescription Opioid Use

AbstractBackground and aimsOpioid use disorder (OUD) refers to a maladaptive pattern of opioid use leading to clinically significant impairment or distress. OUD causes, and vice versa, misuses and abuse of opioid medications. Clinicians face daily challenges to treat patients with prescription opioid use disorder. An evidence-based management for people who are already addicted to opioids has been identified as the national priority in the US; however, options are limited in clinical practices. In this study, we aimed to explore the success rate and important adjuvant medications in the medication assisted treatment with temporary use of methadone for opioid discontinuation in patients with prescription OUD.MethodsThis is a retrospective chart review performed at a private physician office for physical medicine and rehabilitation. We reviewed all medical records dated between December 1st, 2011 and August 30th, 2016. The initial evaluation of the included patients (N =140) was completed between December 1st, 2011 and December 31st, 2014. They all have concumittant prescription OUD and chronic non-cancer pain. The patients (87 female and 53 male) were 46.7 ± 12.7 years old, and had a history of opioid use of 7.7 ±6.1 years. All patients received the comprehensive opioid taper treatments (including interventional pain management techniques, psychotherapy, acupuncture, physical modalities and exercises, and adjuvant medications) on top of the medication assisted treatment using methadone (transient use). Opioid tapering was considered successful when no opioid medication was used in the last patient visit.ResultsThe 140 patients had pain of 9.6 ± 8.4 years with 8/10 intensity before treatment which decreased after treatment in all comparisons (p < 0.001 for all). Opioids were successfully tapered off in 39 (27.9%) patients after 6.6 ±6.7 visits over 8.8 ±7.2 months; these patients maintained opioid abstinence over 14.3 ± 13.0 months with regular office visits. Among the 101 patients with unsuccessful opioid tapering, 13 patients only visited the outpatient clinic once. Significant differences were found between patients with and without successful opioid tapering in treatment duration, number of clinic visits, the use of mirtazepine, bupropion, topiramate, and trigger point injections with the univariate analyses. The use of mirtazepine (OR, 3.75; 95% CI, 1.48–9.49), topiramate (OR, 5.61; 95% CI, 1.91–16.48), or bupropion (OR, 2.5; 95% CI, 1.08–5.81) was significantly associated with successful opioid tapering. The associations remain significant for mirtazepine and topiramate (not bupropion) in different adjusted models.ConclusionsWith comprehensive treatments, 27.9% of patients had successful opioid tapering with opioid abstinence for over a year. The use of mirtazepine, topiramate, or likely bupropion was associated with successful opioid tapering in the medication assisted treatment with temporary use of methadone. Opioid tapering may be a practical option and should be considered for managing prescription OUD.ImplicationsFor patients with OUD, indefinite opioid maintenance treatment may not be necessary. Considering the ethical values of autonomy, nonmaleficence, and beneficence, clinicians should provide patients with OUD the option of opioid tapering.

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