Physical therapists should play a greater role in managing patients with opioid use and opioid misuse

2021 ◽  
pp. 1-6
Author(s):  
John Magel ◽  
David Kietrys ◽  
Eric S. Kruger ◽  
Julie M. Fritz ◽  
Adam J. Gordon
Keyword(s):  
Physical Therapists ◽  
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.

Legitimate Opioid Use and Future Risk of Adult Opioid Misuse

2016 ◽  
Vol 35 (2) ◽  
pp. 15-15
Author(s):  
R. M. Wardrop
Keyword(s):  
Opioid Misuse ◽  
Opioid Use ◽  
Future Risk

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 ELDER ABUSE AMID THE OPIOID EPIDEMIC: APS CASES IN RURAL AMERICA

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S763-S763
Author(s):  
Pamela B Teaster ◽  
Karen A Roberto ◽  
Jyoti Savla
Keyword(s):  
Older Adults ◽  
Elder Abuse ◽  
Standard Errors ◽  
Opioid Misuse ◽  
Rural America ◽  
Opioid Use ◽  
Care Needs ◽  
Community Based ◽  
Community Based Services ◽  
Physical Care

Abstract Older adults are hidden victims of the opioid crises, suffering abuse at the hands of those who seek resources to support their addiction. Using APS data from 2015-2017 provided by the Kentucky Department for Community-Based Services, we used a logistic regression model with robust standard errors to examine whether substantiated cases of elder abuse were associated with opioid misuse by perpetrators. Overall, 9% of the 462 substantiated cases over the three-year period involved perpetrators were substance users. The percentage of these cases rose from 5% in 2015 to 13% in 2016 before dropping to 7% of elder abuse cases in 2017. Opioid use was most prevalent among perpetrators of financial abuse of older adults with cognitive and/or physical care needs. The current study offers a first look at empirical linkages between opioid misuse and elder abuse and revealed consistencies across cases that call for further investigation.

The Role of Family in Youth Opioid Misuse: A Literature Review

2019 ◽  
Vol 27 (4) ◽  
pp. 429-442 ◽  
Author(s):  
Lovdeep Kaur ◽  
Eman Tadros ◽  
Rikki Patton
Keyword(s):  
Literature Review ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Treatment Development ◽  
Factors Affecting ◽  
Relative Paucity ◽  
Full Text Review ◽  
Negative Impacts ◽  
The Impact

Objective: With the opioid epidemic reaching declared a public health emergency in recent years, a synthesis of recent knowledge outlining the impact of opioid use disorders on youth and families is needed. To this aim, this exploratory literature review examined how the role of family is discussed in research on youth opioid misuse, with the goal of acting as a springboard for further research and treatment development that could mitigate the negative impacts opioids are having on families and youth. Method: Peer-reviewed journal articles between 2008 and 2018 were accessed through PsycINFO in March 2018. A total of 279 unduplicated articles were identified through the search. Upon abstract and full-text review, a total of 21 articles met criteria for inclusion in the systematic review. Findings: Overall, the role of the family in adolescent opioid misuse was not commonly discussed in the literature, with 21 of 279 (7.5%) of articles meeting inclusion criteria for the current study. In the included articles, the following major themes were identified: (1) family factors affecting adolescent opioid misuse behavior and (2) family’s role in treatment of adolescent opioid misuse. Conclusions: The review evidences there is a relative paucity of literature on relational variables and youth opioid misuse. More practice-based scholarship, as well as more rigorous clinical research, is needed to inform future steps for clinical processes, policy, and research.

Exploring the Psychometric Properties of the Current Opioid Misuse Measure Among Adults With Chronic Pain and Opioid Use

2020 ◽  
Vol 36 (8) ◽  
pp. 578-583 ◽  
Author(s):  
Andrew H. Rogers ◽  
Matthew W. Gallagher ◽  
Robert N. Jamison ◽  
Michael J. Zvolensky
Keyword(s):  
Chronic Pain ◽  
Psychometric Properties ◽  
Opioid Misuse ◽  
Opioid Use

scholarly journals Addressing the Opioid Epidemic: Recommended Solutions from Physicians

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Jessica Cataldo ◽  
Sandra Collins ◽  
Richard C Mckinnies ◽  
Jane Nichols ◽  
Thomas A Shaw
Keyword(s):  
United States ◽  
Active Role ◽  
The United States ◽  
Opioid Epidemic ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Multifaceted Approach ◽  
Improve Treatment ◽  
Opioid Crisis ◽  
A Current

The purpose of this study was to assess physicians’ accounts related to the current opioid epidemic and to identify solutions that they feel would be most successful in addressing opioid misuse and overuse. A survey was administered a group of physicians obtained from a nationwide database. Nearly all physicians surveyed believed there was a current opioid crisis in the United States and that physicians should take an active role in addressing opioid use in patients. Four key themes emerged regarding solutions to the opioid crisis: i) policy change, ii) improve treatment, iii) education, and iv) alternative treatment. The diversity of responses highlighted the need for a multifaceted approach to address opioid misuse and abuse.

Risk factors for opioid misuse in adolescents and young adults with focus on oncology setting

2016 ◽  
Vol 12 (3) ◽  
pp. 205 ◽  
Author(s):  
Kelly R. Peck, MA ◽  
Jennifer Harman Ehrentraut, PhD ◽  
Doralina L. Anghelescu, MD
Keyword(s):  
Risk Factors ◽  
Young Adults ◽  
Adolescents And Young Adults ◽  
Prescription Opioid ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Oncology Patients ◽  
Medication Misuse ◽  
Psychological Conditions ◽  
Potential Risk Factors

Prescription opioid use has increased in recent decades. Although opioids provide effective pain control, their use may be associated with the risk of misuse. Opioid misuse (OM) is prevalent among adolescents and young adults (AYAs). Opioids are necessary to treat cancer-related pain; however, oncology patients are not immune to medication misuse. Research examining OM among AYAs with cancer is scarce. This article examines the risk factors described in the general adult and adolescent medication abuse literature and aims to provide recommendations for practice in the AYA oncology population. The following risk factors should be examined in AYA oncology patients to determine their relevance: age, sex, behavioral and academic problems, psychological conditions, and a history of illicit drug use/abuse. To maintain the delicate balance of providing adequate pain relief while protecting patients from the risk of OM, clinicians must consider potential risk factors, motivating factors, and individual behaviors. Placing these challenges in perspective, this review provides clinical considerations, recommendations, and intervention strategies for OM prevention in AYA oncology patients.

Standardizing opioid prescribing practices for cancer-related pain via a novel interactive documentation template at a public hospital.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 253-253
Author(s):  
Maliha Nusrat ◽  
Amanda Marie Parkes ◽  
Bei Hu ◽  
Dalia Farhat ◽  
Alyssa G. Rieber ◽  
...  
Keyword(s):  
Palliative Care ◽  
Public Hospital ◽  
Improve Patient Safety ◽  
Cancer Center ◽  
Urine Drug Screen ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Prescribing Practices ◽  
Record System ◽  
State Regulations

253 Background: Aberrant opioid use during treatment of cancer related pain poses serious risks for patients and society. Identifying and monitoring those at risk is challenging and time consuming. We aimed to standardize the process of managing opioids at a public hospital oncology clinic in compliance with Texas (TX) state regulations to improve patient safety. Methods: We gauged the current practices of assessing and documenting opioid efficacy, toxicity and misuse via provider survey and chart review. A process flowchart was then created and streamlined in the light of: published literature, TX Administrative Code on pain management, and practices of palliative care specialists at MD Anderson Cancer Center, TX. We made an interactive documentation template (SmartPhrase) in electronic medical record system (EPIC) to implement the standardized process. Results: Pre-intervention data showedhigh inter-provider variability in opioid misuse screening, safety monitoring and documentation. Of the 22 providers surveyed, 6 (22%) had a TX PMP Aware login; 8 (36%) ever checked the website; and 19 (86%) stated the need of a standardized process for prescribing opioids. Hence, we instituted baseline screening for aberrant behavior based on substance abuse history, TX PMP Aware query and urine drug screen; increased monitoring of high risk patients; universal screening for chemical coping at each visit; and timely referral of such patients to palliative care. We created a SmartPhrase that prompts providers to risk stratify and monitor for opioid misuse as above; assess analgesic efficacy; evaluate and manage uncontrolled pain and toxicities; and specify a refill plan. This SmartPhrase allows quick selection of options pertinent to a given patient from pre-populated lists before the encounter can be closed. Conclusions: We created a systematic approach to prescribing and monitoring opioid analgesics so as to ensure safe and judicious use of opioids to treat cancer related pain. We generated an interactive SmartPhrase for efficient documentation compliant with TX state regulations. Post-implementation review of efficacy and use of this intervention is ongoing to further refine it.

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