“People need them or else they’re going to take fentanyl and die”: A Qualitative Study Examining the ‘Problem’ of Prescription Opioid Diversion during an Overdose Epidemic

2021 ◽  
pp. 113986
Author(s):  
Geoff Bardwell ◽  
Will Small ◽  
Jennifer Lavalley ◽  
Ryan McNeil ◽  
Thomas Kerr
Keyword(s):  
Qualitative Study ◽  
Prescription Opioid ◽  
Opioid Diversion

The Demise of Interdisciplinary Chronic Pain Management and Its Relationship to the Scourge of Prescription Opioid Diversion and Abuse

2018 ◽  
Author(s):  
Michael E. Schatman
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Healthcare Providers ◽  
Well Being ◽  
Insurance Companies ◽  
Prescription Opioid ◽  
Pain Medicine ◽  
Opioid Crisis ◽  
Opioid Medications ◽  
Opioid Diversion

Even though the efficacy of interdisciplinary pain management programs is supported, their numbers have decreased and the vast majority of Americans with chronic pain do not have access to them. Insurance companies do not want to pay for these services, hospitals believe they are financial losers, and the opioid crisis has placed a pall over the practice of pain medicine. The demise of these programs has left pain medicine in a fragmented state. Few healthcare providers who treat chronic pain patients have the time to coordinate care by multiple professionals The opioid crisis seen in certain areas, such as Appalachia, may be related to the lack of these interdisciplinary programs. There should be concerted efforts to increase access to and funding of these programs. Although they are not a panacea for all types of chronic pain, they can improve patients’ well-being and function and reduce their need for opioid medications.

scholarly journals Multiple Determinants of Specific Modes of Prescription Opioid Diversion

2011 ◽  
Vol 41 (2) ◽  
pp. 283-304 ◽  
Author(s):  
Theodore J. Cicero ◽  
Steven P. Kurtz ◽  
Hilary L. Surratt ◽  
Gladys E. Ibanez ◽  
Matthew S. Ellis ◽  
...  
Keyword(s):  
Prescription Opioid ◽  
Opioid Diversion

scholarly journals Social context and perspectives of non-medical prescription opioid use among young adults in Rhode Island: A qualitative study

2016 ◽  
Vol 25 (8) ◽  
pp. 659-665 ◽  
Author(s):  
Jesse L. Yedinak ◽  
Elizabeth N. Kinnard ◽  
Scott E. Hadland ◽  
Traci C. Green ◽  
Melissa A. Clark ◽  
...  
Keyword(s):  
Young Adults ◽  
Social Context ◽  
Qualitative Study ◽  
Rhode Island ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Medical Prescription ◽  
Prescription Opioid Use

scholarly journals Barriers and facilitators encountered by family physicians prescribing opioids for chronic non-cancer pain: a qualitative study

2021 ◽  
Vol 41 (6) ◽  
pp. 182-189
Author(s):  
Joshua Goodwin ◽  
Susan Kirkland
Keyword(s):  
Qualitative Study ◽  
Cancer Pain ◽  
Family Physicians ◽  
Opioid Analgesics ◽  
Barriers And Facilitators ◽  
Health Concern ◽  
Prescription Opioid ◽  
Monitoring And Control ◽  
Structured Interviews ◽  
Physician Patient Relationship

Introduction Harms caused by prescription opioid analgesics (POAs) have been identified as a major international public health concern. Recent statistics show rising numbers of opioid-related deaths across Canada. However, Canadian family physicians appear to have inadequate resources to safely and effectively prescribe opioid analgesics to treat chronic non-cancer pain (CNCP). Methods We completed a qualitative study of the barriers and facilitators to safe and effective prescribing of opioid analgesics for CNCP through semi-structured interviews with eight family physicians in Nova Scotia. Thematic analysis was used to identify the barriers and facilitators. Results Family physicians identified challenges in prescribing opioid analgesics for CNCP: the complexity of CNCP management, addictions risks and prescribing tools, physician training, the physician–patient relationship, prescription monitoring and control, and systemic factors. Conclusion Family physicians described themselves as inadequately supported in their prescribing of opioid analgesics for CNCP and could benefit from an integrated and coordinated approach to prescriber support.

scholarly journals Dynamic Changes in Prescription Opioids from 2006 to 2017 in Texas

2019 ◽  
Author(s):  
Ebuwa T Ighodaro ◽  
Kenneth L McCall ◽  
Daniel Y Chung ◽  
Stephanie D Nichols ◽  
Brian J Piper
Keyword(s):  
Rural Areas ◽  
Opioid Analgesics ◽  
Opioid Use Disorder ◽  
Prescription Opioid ◽  
Prescription Opioids ◽  
Opioid Use ◽  
Study Objective ◽  
The Us ◽  
Urban And Rural Areas ◽  
Opioid Diversion

AbstractStudy ObjectiveThe US is experiencing an epidemic of opioid overdoses which may be at least partially due to an over-reliance on opioid analgesics in the treatment of chronic non-cancer pain and subsequent escalation to heroin or illicit fentanyl. As Texas was reported to be among the lowest in the US for opioid use and misuse, further examination of this state is warranted.Study DesignThis study was conducted to quantify prescription opioid use in Texas.Data SourceData was obtained from the publically available US Drug Enforcement Administration’s Automation of Reports and Consolidated Orders System (ARCOS) which monitors controlled substances transactions from manufacture to commercial distribution.Measurement and Main ResultsData for 2006-2017 from Texas for ten prescription opioids including eight primarily used to relieve pain (codeine, fentanyl, hydrocodone, hydromorphone, meperidine, morphine, oxycodone, oxymorphone) and two (buprenorphine and methadone) for the treatment of an Opioid Use Disorder (OUD) were examined. The change in Morphine Mg Equivalent (MME) of all opioids (+23.3%) was only slightly greater than the state’s population gains (21.1%). Opioids used to treat an OUD showed pronounced gains (+90.8%) which were four-fold faster than population growth. Analysis of individual agents revealed pronounced elevations in codeine (+387.5%), hydromorphone (+106.7%), and oxycodone (+43.6%) and a reduction in meperidine (−80.3%) in 2017 relative to 2006. Methadone in 2017 accounted for a greater portion (39.5%) of the total MME than hydrocodone, oxycodone, morphine, hydromorphone, oxymorphone, and meperidine, combined. There were differences between urban and rural areas in the changes in hydrocodone and buprenorphine.ConclusionsCollectively, these findings indicate that continued vigilance is needed in Texas to appropriately treat pain and an OUD while minimizing the potential for prescription opioid diversion and misuse. Texas may lead the US in a return to pre opioid crisis prescription levels.

scholarly journals Prescription Drug Monitoring Programs and Prescription Opioid–Related Outcomes in the United States

2020 ◽  
Author(s):  
Victor Puac-Polanco ◽  
Stanford Chihuri ◽  
David S Fink ◽  
Magdalena Cerdá ◽  
Katherine M Keyes ◽  
...  
Keyword(s):  
United States ◽  
Substance Use ◽  
Prescription Drug ◽  
Substance Use Disorders ◽  
Drug Monitoring ◽  
The United States ◽  
Mortality Rates ◽  
Prescription Opioid ◽  
Prescription Drug Monitoring Programs ◽  
Opioid Diversion

Abstract Prescription drug monitoring programs (PDMPs) are a crucial component of federal and state governments’ response to the opioid epidemic. Evidence about the effectiveness of PDMPs in reducing prescription opioid–related adverse outcomes is mixed. We conducted a systematic review to examine whether PDMP implementation within the United States is associated with changes in 4 prescription opioid–related outcome domains: opioid prescribing behaviors, opioid diversion and supply, opioid-related morbidity and substance-use disorders, and opioid-related deaths. We searched for eligible publications in Embase, Google Scholar, MEDLINE, and Web of Science. A total of 29 studies, published between 2009 and 2019, met the inclusion criteria. Of the 16 studies examining PDMPs and prescribing behaviors, 11 found that implementing PDMPs reduced prescribing behaviors. All 3 studies on opioid diversion and supply reported reductions in the examined outcomes. In the opioid-related morbidity and substance-use disorders domain, 7 of 8 studies found associations with prescription opioid–related outcomes. Four of 8 studies in the opioid-related deaths domain reported reduced mortality rates. Despite the mixed findings, emerging evidence supports that the implementation of state PDMPs reduces opioid prescriptions, opioid diversion and supply, and opioid-related morbidity and substance-use disorder outcomes. When PDMP characteristics were examined, mandatory access provisions were associated with reductions in prescribing behaviors, diversion outcomes, hospital admissions, substance-use disorders, and mortality rates. Inconsistencies in the evidence base across outcome domains are due to analytical approaches across studies and, to some extent, heterogeneities in PDMP policies implemented across states and over time.

Reductions in prescription opioid diversion following recent legislative interventions in Florida

2013 ◽  
Vol 23 (3) ◽  
pp. 314-320 ◽  
Author(s):  
Hilary L. Surratt ◽  
Catherine O'Grady ◽  
Steven P. Kurtz ◽  
Yamilka Stivers ◽  
Theodore J. Cicero ◽  
...  
Keyword(s):  
Prescription Opioid ◽  
Opioid Diversion

Perioperative Opioids and Public Health

2016 ◽  
Vol 124 (4) ◽  
pp. 960-965 ◽  
Author(s):  
Evan D. Kharasch ◽  
L. Michael Brunt
Keyword(s):  
Public Health ◽  
Research Agenda ◽  
Prescription Opioid ◽  
Opioid Prescribing ◽  
Opioid Diversion

Abstract Prescription opioid diversion, abuse, addiction, and overdose are epidemic. Although unclear whether postoperative opioid prescribing is contributory, or how anesthesiologists and surgeons can contribute to a solution, nonetheless awareness and a research agenda are needed.

scholarly journals Dynamic changes in prescription opioids from 2006 to 2017 in Texas

PeerJ ◽  
2019 ◽  
Vol 7 ◽  
pp. e8108 ◽  
Author(s):  
Ebuwa O. Ighodaro ◽  
Kenneth L. McCall ◽  
Daniel Y. Chung ◽  
Stephanie D. Nichols ◽  
Brian J. Piper
Keyword(s):  
Rural Areas ◽  
Opioid Analgesics ◽  
Opioid Use Disorder ◽  
Prescription Opioid ◽  
Distribution Data ◽  
Prescription Opioids ◽  
Opioid Use ◽  
The Us ◽  
Urban And Rural Areas ◽  
Opioid Diversion

Background The US is experiencing an epidemic of opioid overdoses which may be at least partially due to an over-reliance on opioid analgesics in the treatment of chronic non-cancer pain and subsequent escalation to heroin or illicit fentanyl. As Texas was reported to be among the lowest in the US for opioid use and misuse, further examination of this state is warranted. Materials and Methods This study was conducted to quantify prescription opioid use in Texas. Data was obtained from the publicly available US Drug Enforcement Administration’s Automation of Reports and Consolidated Orders System (ARCOS) which monitors controlled substances transactions from manufacture to commercial distribution. Data for 2006–2017 from Texas for ten prescription opioids including eight primarily used to relieve pain (codeine, fentanyl, hydrocodone, hydromorphone, meperidine, morphine, oxycodone, oxymorphone) and two (buprenorphine and methadone) for the treatment of an Opioid Use Disorder (OUD) were examined. Results The change in morphine mg equivalent (MME) of all opioids (+23.3%) was only slightly greater than the state’s population gains (21.1%). Opioids used to treat an OUD showed pronounced gains (+90.8%) which were four-fold faster than population growth. Analysis of individual agents revealed pronounced elevations in codeine (+387.5%), hydromorphone (+106.7%), and oxycodone (+43.6%) and a reduction in meperidine (−80.3%) in 2017 relative to 2006. Methadone in 2017 accounted for a greater portion (39.5%) of the total MME than hydrocodone, oxycodone, morphine, hydromorphone, oxymorphone, and meperidine, combined. There were differences between urban and rural areas in the changes in hydrocodone and buprenorphine. Conclusions Collectively, these findings indicate that continued vigilance is needed in Texas to appropriately treat pain and an OUD while minimizing the potential for prescription opioid diversion and misuse. Texas may lead the US in a return to pre-opioid epidemic prescription levels.

scholarly journals Doctor Shopping Behavior and the Diversion of Prescription Opioids

2017 ◽  
Vol 11 ◽  
pp. 117822181769607 ◽  
Author(s):  
Ronald Simeone
Keyword(s):  
Public Health ◽  
Drug Treatment ◽  
Shopping Behavior ◽  
Prescription Opioid ◽  
Prescription Opioids ◽  
Doctor Shopping ◽  
Health Measures ◽  
Related Drug ◽  
Opioid Diversion ◽  
Morphine Equivalent

Objectives: “Doctor shopping” as a means of prescription opioid diversion is examined. The number and percentage of prescriptions and morphine-equivalent milligrams diverted in this manner are estimated by state and molecule for the period 2008-2012. Methods: Eleven billion prescriptions with unique patient, doctor, and pharmacy identifiers were used to construct diversion “events” that involved between 1 and 6 unique doctors and between 1 and 6 unique pharmacies. Diversion thresholds were established based on the probability of each contingency. Results: A geographically widespread decline occurred between 2008 and 2012. The number of prescriptions diverted fell from approximately 4.30 million (1.75% of all prescriptions) in 2008 to approximately 3.37 million (1.27% of all prescriptions) in 2012, and the number of morphine-equivalent milligrams fell from approximately 6.55 metric tons (2.95% of total metric tons) in 2008 to approximately 4.87 metric tons (2.19% of total metric tons) in 2012. Conclusions: Diversion control efforts have likely been effective. But given increases in opioid-related deaths, opioid-related drug treatment admissions, and the more specific resurgence of heroin-related events, it is clear that additional public health measures are required.

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