Prescription opioid characteristics at initiation for non-cancer pain and risk of treated opioid use disorder: A population-based study

2021 ◽  
Vol 221 ◽  
pp. 108601
Author(s):  
Nicholas Papadomanolakis-Pakis ◽  
Kieran M. Moore ◽  
Yingwei Peng ◽  
Tara Gomes
Keyword(s):  
Cancer Pain ◽  
Population Based ◽  
Opioid Use Disorder ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Population Based Study

Association between opioid use disorder and fractures: a population‐based study

Addiction ◽  
2019 ◽  
Vol 114 (11) ◽  
pp. 2008-2015 ◽  
Author(s):  
Wen‐Yu Hsu ◽  
Cheng‐Li Lin ◽  
Chia‐Hung Kao
Keyword(s):  
Population Based ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Population Based Study

scholarly journals Chronic pain management and the development of opioid use disorder

2018 ◽  
Vol 87 (1) ◽  
pp. 55-57
Author(s):  
Lily Robinson ◽  
Richard Yu ◽  
Salonee Patel
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Cancer Pain ◽  
Medical Management ◽  
Opioid Therapy ◽  
Opioid Use Disorder ◽  
Medical Attention ◽  
Prescription Opioid ◽  
Evidence Based ◽  
Opioid Use

Chronic pain is a common condition that impacts quality of life and often precipitates the need for medical attention. Despite evidence that long-term opioid use provides limited relief, prescription opioid therapy remains a cornerstone in the medical management of chronic non-cancer pain. Presently, 13% of Canadians are prescribed opioids for pain management, and physicians play a crucial role in preventing the development of opioid use disorders. However, Canadian physicians lack knowledge of and comfort with evidence-based principles of opioid stewardship. In this article, we aim to highlight ongoing Canadian efforts to address physician discomfort and improve clinical practice. We focus on 2017 Canadian guidelines that provide clinicians with evidence-based recommendations for opioid use in chronic non-cancer pain management. In addition, we call attention to provincial efforts to implement physician accountability measures. In reviewing the existing literature, we uncovered inadequacies in pain management curricula within the Canadian undergraduate and continuing medical education (CME) systems. We consulted the educational practices of the European Pain Federation and the Centers for Disease Control and Prevention to make recommendations for improvement to current Canadian pain curricula. Based on our findings, we recommend that (1) Canadian medical institutions expand upon current core pain curricula, (2) pain management education be made compulsory, (3) academic detailing be emphasized as a means of CME, and (4) multidisciplinary non-medical management of chronic pain be featured more extensively.

Association of Medication-Assisted Treatment and Age With Treatment Completion Among Veterans Seeking Non-VA Treatment for Opioid use Disorder at Non-Veterans Health Administration Facilities

2021 ◽  
Author(s):  
Joseph G Pickard ◽  
Carissa van den Berk-Clark ◽  
Monica M Matthieu
Keyword(s):  
Positive Impact ◽  
Treatment Completion ◽  
Armed Forces ◽  
Opioid Use Disorder ◽  
Prescription Opioid ◽  
Health Administration ◽  
Opioid Use ◽  
Data Set ◽  
Medication Assisted Treatment

ABSTRACT Background Medication-assisted treatment has been shown to be effective in treating opioid use disorder among both older adults and veterans of U.S. Armed Forces. However, limited evidence exists on MAT’s differential effect on treatment completion across age groups. This study aims to ascertain the role of MAT and age in treatment completion among veterans seeking treatment in non–Department of Veterans Affairs healthcare facilities for opioid use disorder. Methods We used the Treatment Episode Data Set—Discharges (TEDS-D; 2006-2017) to examine trends in treatment and MAT usage over time and TEDS-2017 to determine the role of age and MAT in treatment completion. We examined a subset of those who self-identified as veterans and who sought treatment for an opioid use disorder. Results Veterans presented in treatment more often as heroin users than prescription opioid users, and older veterans were more likely to get MAT than younger veterans. We found that before propensity score matching, MAT initially appeared to be associated with a lower likelihood of treatment completion in inpatient ($\beta $ = −1.47, 95% CI −1.56 to −1.39) and outpatient ($\beta $ = −1.40, 95% CI −2.21 to −0.58) settings, and age (50+ years) appeared to mediate the effect of MAT on treatment completion ($\beta $ = −0.54, 95% CI −0.87 to −0.21). After matching, older veterans were more likely to complete substance use disorder treatment ($\beta $ = 0.21, 95% CI 0.01-0.42), while age no longer mediated the effect of MAT, and MAT had a significant positive impact on treatment completion in detox settings ($\beta $ = 1.36, 95% CI 1.15-1.50) and inpatient settings ($\beta $ = 1.54, 95% CI 1.37 -1.71). Conclusion The results show that age plays an important role in outpatient treatment completion, while MAT plays an important role in inpatient treatment completion. Implications for veterans are discussed.

Tapentadol is the least common opioid found in admission urine drug-test results at an intensive outpatient opioid-use disorder treatment program in Ohio: A brief report

2021 ◽  
Vol 17 (1) ◽  
pp. 13-17
Author(s):  
Adam Rzetelny, PhD ◽  
Diana Meske, PhD ◽  
Parag Patel, MD, FACOG, FASAM ◽  
Steven Passik, PhD
Keyword(s):  
Treatment Program ◽  
Opioid Use Disorder ◽  
Common Finding ◽  
Prescription Opioid ◽  
Test Results ◽  
Opioid Use ◽  
Drug Test ◽  
Urine Drug ◽  
Urine Drug Test ◽  
Dispensing Data

Background: Previous data suggest that tapentadol, an atypical opioid with a putative dual mechanism of action, has relatively low rates of abuse. A better understanding of the rates of abuse among different prescription opioids may help clinicians when considering their potential risks and benefits. The results of urine drug tests (UDTs) may provide a unique opportunity to help answer this question.Method: To investigate different rates of prescription-opioid abuse in this retrospective study, we examined urine drug test results from patients seeking treatment at four facilities of an opioid-use-disorder (OUD) treatment program in Ohio. Urine specimens were collected on admission, one from each patient, in the regular course of care. The opioids reviewed in the present study were tapentadol, hydrocodone, oxycodone, hydromorphone, oxymorphone, and tramadol. Drug dispensing data, including morphine-milligram equivalents (MME) dispensed, were examined to adjust for the relative prevalence of each opioid being examined.Results: Data from 4,162 patients were examined. Tapentadol was the least common finding in UDT results in this cohort and remained so after adjusting for drug availability. The percentage of specimens positive for a given opioid ranged from 0.12 percent (tapentadol) to 7.04 percent (oxycodone). The availability and MME adjustments resulted in a change of rank order, with tapentadol remaining the lowest but tramadol replacing oxycodone as the prescription opioid with the highest rate of abuse.Conclusions: In this sample of UDT results from patients seeking treatment at an OUD program in Ohio, tapentadol was the least frequent finding among the opioids examined, and this remained true when adjusting for dispensing data. Factors potentially contributing to this difference may include pharmacological properties unique to tapentadol. Several important limitations notwithstanding, these findings are consistent with previous real-world evidence and warrant an ongoing line of inquiry. 

Addictive behaviors related to opioid use for chronic pain: A population-based study

Pain ◽  
2013 ◽  
Vol 154 (12) ◽  
pp. 2677-2683 ◽  
Author(s):  
Jette Hjsted ◽  
Ola Ekholm ◽  
Geana Paula Kurita ◽  
Knud Juel ◽  
Per Sjgren
Keyword(s):  
Chronic Pain ◽  
Population Based ◽  
Addictive Behaviors ◽  
Opioid Use ◽  
Population Based Study

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

2017 ◽  
Vol 17 (1) ◽  
pp. 167-173 ◽  
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.

scholarly journals Buprenorphine exposure alters the development and migration of interneurons in the cortex

2020 ◽  
Author(s):  
Vanesa Nieto-Estévez ◽  
Jennifer J. Donegan ◽  
Courtney McMahon ◽  
Hannah B. Elam ◽  
Teresa A. Chavera ◽  
...  
Keyword(s):  
Human Brain ◽  
Fetal Brain ◽  
Opioid Use Disorder ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Child Bearing ◽  
Increased Risk ◽  
Adverse Neonatal Outcomes ◽  
And Migration ◽  
Long Acting

ABSTRACTThe misuse of opioids has reached epidemic proportions over the last decade, with over 2.1 million people in the U.S. suffering from substance use disorders related to prescription opioid pain relievers. This increase in opioid misuse affects all demographics of society, including women of child-bearing age, which has led to a rise in opioid use during pregnancy. Opioid use during pregnancy has been associated with increased risk of obstetric complications and adverse neonatal outcomes, including neonatal abstinence syndrome. Currently, opioid use disorder in pregnant women is treated with long-acting opioid agonists, including buprenorphine. Although buprenorphine reduces illicit opioid use during pregnancy and improves infant outcomes at birth, few long-term studies of the neurodevelopmental consequences have been conducted. The goal of the current experiments was to examine the effects of buprenorphine on the development of the cortex using fetal brain tissue, 3D brain cultures, and rodent models. First, we demonstrated that we can grow cortical and subpallial spheroids, which model the cellular diversity, connectivity, and activity of the developing human brain. Next, we show that cells in the developing human cortex express the nociceptin opioid (NOP) receptor and that buprenorphine can signal through this receptor in cortical spheroids. Using subpallial spheroids to grow inhibitory interneurons, we show that buprenorphine can alter interneuron development and migration into the cortex. Finally, using a rodent model of prenatal buprenorphine exposure, we demonstrate that alterations in interneuron distribution can persist into adulthood. Together, these results suggest that more research is needed into the long-lasting consequences of buprenorphine exposure on the developing human brain.

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