A prescribing protocol decreases the rate of chronic opioid use in orthopaedic trauma patients

Abstract Background:Orthopaedic trauma patients face complex pain management needs and are frequently prescribed opioids, leaving them at-risk for prolonged opioid use. To date, post-trauma pain management research has placed little emphasis on individualized risk assessments for misuse and systematically implementing non-pharmacologic pain management strategies. Therefore, a community-academic partnership was formed to design a novel position in the healthcare field (Life Care Specialist (LCS)), who will educate patients on the risks of opioids, tapering usage, safe disposal practices, and harm reduction strategies. In addition, the LCS teaches patients behavior-based strategies for pain management, utilizing well-described techniques for coping and resilience. This study aims to determine the effects of LCS intervention on opioid utilization, pain control, and patient satisfaction in the aftermath of orthopaedic trauma.Methods: In total, 200 orthopaedic trauma patients will be randomized to receive an intervention (LCS) or a standard-of-care control at an urban level 1 trauma center. All patients will be assessed with comprehensive social determinants of health and substance use surveys immediately after surgery (baseline). Follow-up assessments will be performed at 2-, 6-, and 12-weeks postoperatively, and will include pain medication utilization (morphine milligram equivalents), pain scores, and other substance use. In addition, overall patient wellness will be evaluated with objective actigraphy measures and patient-reported outcomes. Finally, a survey of patient understanding of risks of opioid use and misuse will be collected, to assess the influence of LCS opioid education.Discussion: There is limited data on the role of individualized, multimodal, non-pharmacologic, behavioral-based pain management intervention in opioid related risk-mitigation in high-risk populations, including the orthopaedic trauma patients. The findings from this randomized controlled trial will provide scientific and clinical evidence on the efficacy and feasibility of the LCS intervention. Moreover, the final aim will provide early evidence into which patients benefit most from LCS intervention. Trial registration: ClinicalTrials.gov NCT04154384. Registered on 11/6/2019 (last updated on 6/10/2021). https://clinicaltrials.gov/ct2/show/NCT04154384?term=life+care+specialist&draw=2&rank=1

Download Full-text

Standardized Pain Regimen in Orthopaedic Trauma Patients Reduces Opioid Use and Length of Stay: A Prospective Pilot Study

10.26226/morressier.5cffabadf6074e97f94aad75 ◽

2019 ◽

Author(s):

Carol Alice Lin ◽

Amit Pujari

Keyword(s):

Pilot Study ◽

Length Of Stay ◽

Trauma Patients ◽

Orthopaedic Trauma ◽

Opioid Use ◽

Prospective Pilot Study

Download Full-text

Patient understanding regarding opioid use in an orthopaedic trauma surgery population: a survey study

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02881-w ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Amy L. Xu ◽

Alexandra M. Dunham ◽

Zachary O. Enumah ◽

Casey J. Humbyrd

Keyword(s):

Side Effects ◽

Trauma Surgery ◽

Withdrawal Symptoms ◽

Survey Study ◽

Trauma Patients ◽

Orthopaedic Trauma ◽

Opioid Use ◽

Personal Experiences ◽

Level Of Understanding ◽

White Patients

Abstract Background Prior studies have assessed provider knowledge and factors associated with opioid misuse; similar studies evaluating patient knowledge are lacking. The purpose of this study was to assess the degree of understanding regarding opioid use in orthopaedic trauma patients. We also sought to determine the demographic factors and clinical and personal experiences associated with level of understanding. Methods One hundred and sixty-six adult orthopaedic trauma surgery patients across two clinical sites of an academic institution participated in an internet-based survey (2352 invited, 7.1% response rate). Demographic, clinical, and personal experience variables, as well as perceptions surrounding opioid use were collected. Relationships between patient characteristics and opioid perceptions were identified using univariate and multivariable logistic regressions. Alpha = 0.05. Results Excellent recognition (> 85% correct) of common opioids, side effects, withdrawal symptoms, and disposal methods was demonstrated by 29%, 10%, 30%, and 2.4% of patients; poor recognition (< 55%) by 11%, 56%, 33%, and 52% of patients, respectively. Compared with white patients, non-white patients had 7.8 times greater odds (95% confidence interval [CI] 1.9–31) of perceiving addiction discrepancy (p = 0.004). Employed patients with higher education levels were less likely to have excellent understanding of side effects (adjusted odds ratio [aOR] 0.06, 95% CI 0.006–0.56; p = 0.01) and to understand that dependence can occur within 2 weeks (aOR 0.28, 95% CI 0.09–0.86; p = 0.03) than unemployed patients. Patients in the second least disadvantaged ADI quartile were more knowledgeable about side effects (aOR 8.8, 95% CI 1.7–46) and withdrawal symptoms (aOR 2.7, 95% CI 1.0–7.2; p = 0.046) than those in the least disadvantaged quartile. Patients who knew someone who was dependent or overdosed on opioids were less likely to perceive addiction discrepancy (aOR 0.24, 95% CI 0.07–0.76; p = 0.02) as well as more likely to have excellent knowledge of withdrawal symptoms (aOR 2.6, 95% CI 1.1–6.5, p = 0.03) and to understand that dependence can develop within 2 weeks (aOR 3.8, 95% CI 1.5–9.8, p = 0.005). Conclusions Level of understanding regarding opioid use is low among orthopaedic trauma surgery patients. Clinical and personal experiences with opioids, in addition to demographics, should be emphasized in the clinical history.

Download Full-text

rTMS for Orthopaedic Trauma Patients

Case Medical Research ◽

10.31525/ct1-nct03924024 ◽

2019 ◽

Author(s):

Keyword(s):

Trauma Patients ◽

Orthopaedic Trauma

Download Full-text

Predictors of Chronic Opioid Use: A Population-level Analysis of North Carolina Cancer Survivors Using Multi-Payer Claims

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/djab082 ◽

2021 ◽

Author(s):

Devon K Check ◽

Christopher D Bagett ◽

KyungSu Kim ◽

Andrew W Roberts ◽

Megan C Roberts ◽

...

Keyword(s):

North Carolina ◽

Substance Use ◽

Cancer Survivors ◽

Low Income ◽

Opioid Therapy ◽

Adjusted Relative Risk ◽

Opioid Use ◽

Chronic Opioid Therapy ◽

Increased Risk ◽

Chronic Opioid Use

Abstract Background No population-based studies have examined chronic opioid use among cancer survivors who are diverse with respect to diagnosis, age group, and insurance status. Methods We conducted a retrospective cohort study using North Carolina (NC) cancer registry data linked with claims from public and private insurance (2006–2016). We included adults with non-metastatic cancer who had no prior chronic opioid use (N = 38,366). We used modified Poisson regression to assess the adjusted relative risk of chronic opioid use in survivorship (>90-day continuous supply of opioids in the 13–24 months following diagnosis) associated with patient characteristics. Results Only 3.0% of cancer survivors in our cohort used opioids chronically in survivorship. Predictors included younger age (adjusted risk ratio [aRR], 50–59 vs 60–69 = 1.23, 95% confidence interval [CI] = 1.05–1.43), baseline depression (aRR = 1.22, 95% CI = 1.06–1.41) or substance use (aRR = 1.43, 95% CI = 1.15–1.78) and Medicaid (aRR vs Private = 1.93, 95% CI = 1.56–2.40). Survivors who used opioids intermittently (vs not at all) before diagnosis were twice as likely to use opioids chronically in early survivorship (aRR = 2.62, 95% CI = 2.28–3.02). Those who used opioids chronically (vs intermittently or not at all) during active treatment had a nearly 17-fold increased likelihood of chronic use in survivorship (aRR = 16.65, 95 CI = 14.30–19.40). Conclusions Younger and low-income survivors, those with baseline depression or substance use, and those who require chronic opioid therapy during treatment are at increased risk for chronic opioid use in survivorship. Our findings point to opportunities improve assessment of psychosocial histories and to engage patients in shared decision-making around long-term pain management, when chronic opioid therapy is required during treatment.

Download Full-text

Chronic opioid use modulates human enteric microbiota and intestinal barrier integrity

Gut Microbes ◽

10.1080/19490976.2021.1946368 ◽

2021 ◽

Vol 13 (1) ◽

pp. 1946368

Author(s):

Angélica Cruz-Lebrón ◽

Ramona Johnson ◽

Claire Mazahery ◽

Zach Troyer ◽

Samira Joussef-Piña ◽

...

Keyword(s):

Intestinal Barrier ◽

Opioid Use ◽

Barrier Integrity ◽

Intestinal Barrier Integrity ◽

Chronic Opioid Use

Download Full-text

Sa180 CHRONIC OPIOID USE IN OPIOID INDUCED ESOPHAGEAL DYSFUNCTION: DOSE AND GENDER EFFECTS

Gastroenterology ◽

10.1016/s0016-5085(21)01793-5 ◽

2021 ◽

Vol 160 (6) ◽

pp. S-453-S-454

Author(s):

Neil Sood ◽

Neil Nadpara ◽

Dariush Shahsavari ◽

Henry P. Parkman ◽

Zubair A. Malik

Keyword(s):

Gender Effects ◽

Opioid Use ◽

Esophageal Dysfunction ◽

Chronic Opioid Use ◽

And Gender

Download Full-text

The impact of high-risk and chronic opioid use among commercially insured endometriosis patients on health care resource utilization and costs in the United States

Women s Health ◽

10.1177/1745506520965898 ◽

2020 ◽

Vol 16 ◽

pp. 174550652096589

Author(s):

Stephanie J Estes ◽

Ahmed M Soliman ◽

Marko Zivkovic ◽

Divyan Chopra ◽

Xuelian Zhu

Keyword(s):

Health Care ◽

High Risk ◽

Resource Utilization ◽

Health Care Resource ◽

Low Risk ◽

Opioid Use ◽

Health Care Resource Utilization ◽

Outpatient Visits ◽

Chronic Opioid Use ◽

Opioid Users

Objectives: Evaluate all-cause and endometriosis-related health care resource utilization and costs among newly diagnosed endometriosis patients with high-risk versus low-risk opioid use or patients with chronic versus non-chronic opioid use. Methods: A retrospective analysis of IBM MarketScan® Commercial Claims data from 2009 to 2018 was performed for females aged 18 to 49 with newly diagnosed endometriosis (International Classification of Diseases, Ninth Edition code: 617.xx; International Classification of Diseases, Tenth Edition code: N80.xx). Two sub-cohorts were identified: high-risk (⩾1 day with ⩾90 morphine milligram equivalents per day or ⩾1-day concomitant benzodiazepine use) or chronic opioid utilization (⩾90-day supply prescribed or ⩾10 opioid prescriptions). High-risk or chronic utilization was evaluated during the 12-month assessment period after the index date. Index date was the first opioid prescription within 12 months following endometriosis diagnosis. All outcomes were assessed over 12-month post-assessment period while adjusting for demographic and clinical characteristics. Results: Out of 61,019 patients identified, 18,239 had high-risk opioid use and 5001 chronic opioid use. Health care resource utilization drivers were outpatient visits and pharmacy fills, which were higher among high-risk versus low-risk patients (outpatient visits: 17.49 vs 15.51; pharmacy fills: 19.58 vs 16.88, p < 0.0001). Chronic opioid users had a higher number of outpatient visits (19.53 vs 15.00, p < 0.0001) and pharmacy fills (23.18 vs 16.43, p < 0.0001) compared to non-chronic opioid users. High-risk opioid users had significantly higher all-cause health care costs compared to low-risk opioid users (US$16,377 vs US$13,153; p < 0.0001). Chronic opioid users also had significantly higher all-cause health care costs compared to non-chronic opioid users (US$20,930 vs US$12,272; p < 0.0001). Similar patterns were observed among endometriosis-related HCRU, except pharmacy fills among high-risk and chronic sub-cohorts. Conclusion: This analysis demonstrates significantly higher all-cause and endometriosis-related health care resource utilization and total costs for high-risk opioid users compared to low-risk opioid users among newly diagnosed endometriosis patients over 1 year. Similar trends were observed for comparing chronic opioid users with non-chronic opioid users, except for endometriosis-related pharmacy fills and associated costs.

Download Full-text