Opioid analgesic prescribing for opioid‐naïve individuals prior to identification of opioid use disorder in British Columbia, Canada

Abstract Objective This study examined factors associated with prescription opioid analgesic use in the US population using data from a nationally representative sample. It focused on factors previously shown to be associated with opioid use disorder or overdose. Variations in the use of different strength opioid analgesics by demographic subgroup were also examined. Methods Data came from respondents aged 16 years and older who participated in the National Health and Nutrition Examination Survey (2011–2014). Respondents were classified as opioid users if they reported using one or more prescription opioid analgesics in the past 30 days. Results Opioid users reported poorer self-perceived health than those not currently using opioids. Compared with those not using opioids, opioid users were more likely to rate their health as being “fair” or “poor” (40.4% [95% confidence interval {CI} = 34.9%–46.2%] compared with 15.6% [95% CI = 14.3%–17.1%]), experienced more days of pain during the past 30 days (mean = 14.3 [95% CI = 12.9–15.8] days compared with 2.3 [95% CI = 2.0–2.7] days), and had depression (22.5% [95% CI = 17.3%–28.7%] compared with 7.1% [95% CI = 6.2%–8.0%]). Among those who reported using opioids during the past 30 days, 18.8% (95% CI = 14.4%–24.1%) reported using benzodiazepine medication during the same period and 5.2% (95% CI = 3.5%–7.7%) reported using an illicit drug during the past six months. When opioid strength was examined, a smaller percentage of adults aged 60 years and older used stronger-than-morphine opioids compared with adults aged 20–39 and 40–59 years. Conclusions Higher percentages of current opioid users than nonusers reported having many of the factors associated with opioid use disorder and overdose.

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Perceived risk of opioid use disorder secondary to opioid analgesic medication use by the general population in France

European Journal of Pain ◽

10.1002/ejp.1901 ◽

2021 ◽

Author(s):

Justine Lavergne ◽

Marion Debin ◽

Thierry Blanchon ◽

Vittoria Colizza ◽

Lise Dassieu ◽

...

Keyword(s):

General Population ◽

Perceived Risk ◽

Opioid Analgesic ◽

Medication Use ◽

Opioid Use Disorder ◽

Opioid Use ◽

Analgesic Medication

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The cascade of care for opioid use disorder among youth in British Columbia, 2018

Journal of Substance Abuse Treatment ◽

10.1016/j.jsat.2021.108404 ◽

2021 ◽

Vol 130 ◽

pp. 108404

Author(s):

Emanuel Krebs ◽

Jeong E. Min ◽

Haoxuan Zhou ◽

Carolyn Davison ◽

Gina McGowan ◽

...

Keyword(s):

British Columbia ◽

Opioid Use Disorder ◽

Opioid Use ◽

Cascade Of Care

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Opioid Use Disorders among Patients on Long-Term Morphine for Management of Chronic Cancer Pain: A Pilot Study from a Tertiary Palliative Care Facility

Indian Journal of Palliative Care ◽

10.25259/ijpc_358_20 ◽

2021 ◽

Vol 27 ◽

pp. 264-268

Author(s):

Nandan Choudhary ◽

Shalini Singh ◽

Puneet Rathore ◽

Atul Ambekar ◽

Sushma Bhatnagar

Keyword(s):

Cancer Pain ◽

Cancer Patients ◽

Opioid Analgesic ◽

Care Facility ◽

Opioid Use Disorder ◽

Opioid Use ◽

Chronic Cancer Pain ◽

Opioid Use Disorders ◽

Pain Patients

Objectives: Long-term opioid use can be associated with misuse and addiction. In the backdrop of increasing burden of cancer patients in India, it is important to assess the rate of opioid use disorders among those with chronic cancer pain. The objectives were to measure the rate of opioid use disorder in chronic cancer pain patients being managed with morphine and to assess its association with demographic and clinical characteristics. Materials and Methods: A cross-sectional study was conducted on chronic cancer pain patients who were prescribed morphine for ≥12 months, dosage of ≥60 mg/day. They were assessed using MINI version 7.0.0, WHO-ASSIST Hindi questionnaire, Addiction Behavior Checklist, and DSM-5 for opioid use disorder. Results: Forty patients who were treated with morphine for a total of 1479 months participated. The average morphine consumption was 159.50 ± 327.90 mg/day. Six (15%) showed possible inappropriate opioid analgesic use and none of the patients had opioid use disorder. Conclusion: This study reports the absence of opioid use disorder due to vigilant use of morphine in chronic cancer patients.

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Diagnosis of Opioid Use Disorder by Youths Assessed in Acute Care Settings in British Columbia, Canada

The Journal of Pediatrics ◽

10.1016/j.jpeds.2021.01.046 ◽

2021 ◽

Author(s):

Emanuel Krebs ◽

Charlie Zhou ◽

Jeong E. Min ◽

Connie Carter ◽

Gina McGowan ◽

...

Keyword(s):

British Columbia ◽

Acute Care ◽

Opioid Use Disorder ◽

Opioid Use ◽

Acute Care Settings

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Comparison of Post-Cesarean Section Opioid Analgesic Requirements in Women With Opioid Use Disorder Treated With Methadone or Buprenorphine

Journal of Addiction Medicine ◽

10.1097/adm.0000000000000339 ◽

2017 ◽

Vol 11 (5) ◽

pp. 397-401 ◽

Cited By ~ 15

Author(s):

Annmarie L. Vilkins ◽

Sarah M. Bagley ◽

Kristen A. Hahn ◽

Florencia Rojas-Miguez ◽

Elisha M. Wachman ◽

...

Keyword(s):

Cesarean Section ◽

Opioid Analgesic ◽

Opioid Use Disorder ◽

Opioid Use

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A Novel Precision Approach to Overcome the “Addiction Pandemic” by Incorporating Genetic Addiction Risk Severity (GARS) and Dopamine Homeostasis Restoration

Journal of Personalized Medicine ◽

10.3390/jpm11030212 ◽

2021 ◽

Vol 11 (3) ◽

pp. 212

Author(s):

Kenneth Blum ◽

Shan Kazmi ◽

Edward J. Modestino ◽

B. William Downs ◽

Debasis Bagchi ◽

...

Keyword(s):

Opioid Analgesic ◽

Deficiency Syndrome ◽

Opioid Use Disorder ◽

Testing System ◽

The Novel ◽

Opioid Use ◽

Addictive Disorders ◽

Medication Assisted Treatment ◽

Risk Alleles ◽

Addiction Risk

This article describes a unique therapeutic precision intervention, a formulation of enkephalinase inhibitors, enkephalin, and dopamine-releasing neuronutrients, to induce dopamine homeostasis for detoxification and treatment of individuals genetically predisposed to developing reward deficiency syndrome (RDS). The formulations are based on the results of the addiction risk severity (GARS) test. Based on both neurogenetic and epigenetic evidence, the test evaluates the presence of reward genes and risk alleles. Existing evidence demonstrates that the novel genetic risk testing system can successfully stratify the potential for developing opioid use disorder (OUD) related risks or before initiating opioid analgesic therapy and RDS risk for people in recovery. In the case of opioid use disorders, long-term maintenance agonist treatments like methadone and buprenorphine may create RDS, or RDS may have been in existence, but not recognized. The test will also assess the potential for benefit from medication-assisted treatment with dopamine augmentation. RDS methodology holds a strong promise for reducing the burden of addictive disorders for individuals, their families, and society as a whole by guiding the restoration of dopamine homeostasisthrough anti-reward allostatic neuroadaptations. WC 175

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The cascade of care for opioid use disorder: a retrospective study in British Columbia, Canada

Addiction ◽

10.1111/add.14947 ◽

2020 ◽

Vol 115 (8) ◽

pp. 1482-1493 ◽

Cited By ~ 4

Author(s):

Micah Piske ◽

Haoxuan Zhou ◽

Jeong E. Min ◽

Natt Hongdilokkul ◽

Lindsay A. Pearce ◽

...

Keyword(s):

British Columbia ◽

Retrospective Study ◽

Opioid Use Disorder ◽

Opioid Use ◽

Cascade Of Care

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What are the impacts when primary care providers diminish stigma for patients with opioid use disorder in British Columbia?

10.24124/2020/59087 ◽

2020 ◽

Author(s):

◽

Mary MacLellan

Keyword(s):

Primary Care ◽

Health Care ◽

British Columbia ◽

Literature Review ◽

Access To Health Care ◽

Primary Care Providers ◽

Opioid Use Disorder ◽

Opioid Overdose ◽

Care Providers ◽

Opioid Use

Stigma is a complex phenomenon with a myriad of detrimental health and social impacts that are not fully studied or understood. Persistent stigma exists towards individuals who have opioid use disorder (OUD) in British Columbia. OUD is a chronic, relapsing, clinical condition that has been identified as one of the most challenging substance use disorders. For those affected, they must also endure the consequences of stigma that promote barriers to health care, health and social inequalities, diminished quality of life as well as increased morbidity and mortality. The current unremitting opioid overdose crisis in British Columbia further emphasizes the importance of eradicating stigma towards individuals who use opioids and/or suffer from OUD, as untreated OUD is fueling this multifaceted public health emergency. For these reasons, an integrative literature review has been conducted to identify how primary care providers in British Columbia can address the intersecting stigmas for individuals suffering OUD. The results are discussed within the context of primary health care in British Columbia. Whittemore and Knafl’s approach to the integrative literature review was utilized in this study to review eleven pertinent articles. The findings suggest that stigma occurs on varying levels for individuals with OUD that serve to reinforce each other and manifest as discrimination, mistrust, social distancing, minimized advocacy, unequal access to health care and suboptimal health care. Further, the findings indicated that the role of primary care providers may be instrumental in eradicating stigma in a timely manner. Recommendations for primary care providers to dismantle the stigma associated with OUD are discussed, and specific strategies for the primary care setting are presented.

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Comparative effectiveness of buprenorphine-naloxone versus methadone for treatment of opioid use disorder: a population-based observational study protocol in British Columbia, Canada

BMJ Open ◽

10.1136/bmjopen-2019-036102 ◽

2020 ◽

Vol 10 (9) ◽

pp. e036102

Author(s):

Micah Piske ◽

Trevor Thomson ◽

Emanuel Krebs ◽

Natt Hongdilokkul ◽

Julie Bruneau ◽

...

Keyword(s):

British Columbia ◽

Comparative Effectiveness ◽

Opioid Use Disorder ◽

Retention Rates ◽

Sensitivity Analyses ◽

Administrative Databases ◽

Treatment Modalities ◽

Ethical Review ◽

Opioid Use ◽

Opioid Agonist

IntroductionDespite a recent meta-analysis including 31 randomised controlled trials comparing methadone and buprenorphine for the treatment of opioid use disorder, important knowledge gaps remain regarding the long-term effectiveness of different treatment modalities across individuals, including rigorously collected data on retention rates and other treatment outcomes. Evidence from real-world data represents a valuable opportunity to improve personalised treatment and patient-centred guidelines for vulnerable populations and inform strategies to reduce opioid-related mortality. Our objective is to determine the comparative effectiveness of methadone versus buprenorphine/naloxone, both overall and within key populations, in a setting where both medications are simultaneously available in office-based practices and specialised clinics.Methods and analysisWe propose a retrospective cohort study of all adults living in British Columbia receiving opioid agonist treatment (OAT) with methadone or buprenorphine/naloxone between 1 January 2008 and 30 September 2018. The study will draw on seven linked population-level administrative databases. The primary outcomes include retention in OAT and all-cause mortality. We will determine the effectiveness of buprenorphine/naloxone vs methadone using intention-to-treat and per-protocol analyses—the former emulating flexible-dose trials and the latter focusing on the comparison of the two medication regimens offered at the optimal dose. Sensitivity analyses will be used to assess the robustness of results to heterogeneity in the patient population and threats to internal validity.Ethics and disseminationThe protocol, cohort creation and analysis plan have been approved and classified as a quality improvement initiative exempt from ethical review (Providence Health Care Research Institute and the Simon Fraser University Office of Research Ethics). Dissemination is planned via conferences and publications, and through direct engagement and collaboration with entities that issue clinical guidelines, such as professional medical societies and public health organisations.

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