Exploring the Lived Experience of Adults using Prescription Opioids to Manage Chronic Noncancer Pain

BACKGROUND: Chronic noncancer pain (CNCP) and prescription opioid use is a highly complex and growing health care issue in Canada. Many quantitative research studies have investigated the effectiveness of opioids for chronic pain; however, gaps remain in the literature regarding the personal experience of using opioids and their impact on those experiencing CNCP.OBJECTIVE: To explore the lived experience of adults using prescription opioids to manage CNCP, focusing on how opioid medication affected their daily lives.METHODS: In-depth qualitative interviews were conducted with nine adults between 40 and 68 years of age who were using prescription opioids daily for CNCP. Interviews were audiorecorded and transcribed, and subsequently analyzed using interpretive phenomenological analysis.RESULTS: Six major themes identified positive and negative aspects of opioid use associated with social, physical, emotional and psychological dimensions of pain management. These themes included the process of decision making, and physical and psychosocial consequences of using opioids including pharmacological side effects, feeling stigmatized, guilt, fears, ambivalence, self-protection and acceptance.CONCLUSION: Although there were many negative aspects to using opioids daily, the positive effects outweighed the negative for most participants and most of the negative aspects were socioculturally induced rather than caused by the drug itself. The present study highlighted the complexities involved in using prescription opioids daily for management of CNCP for individuals living with pain.

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Patterns and Correlates of Prescription Opioid Use in OEF/OIF Veterans with Chronic Noncancer Pain

Pain Medicine ◽

10.1111/j.1526-4637.2011.01226.x ◽

2011 ◽

Vol 12 (10) ◽

pp. 1502-1509 ◽

Cited By ~ 34

Author(s):

Tara A. Macey ◽

Benjamin J. Morasco ◽

Jonathan P. Duckart ◽

Steven K. Dobscha

Keyword(s):

Prescription Opioid ◽

Opioid Use ◽

Chronic Noncancer Pain ◽

Noncancer Pain ◽

Prescription Opioid Use

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Prescription Opioid Distribution After the Legalization of Recreational Marijuana in Colorado, 2007-2017

10.1101/702811 ◽

2019 ◽

Cited By ~ 1

Author(s):

Amalie K. Kropp ◽

Stephanie D. Nichols ◽

Daniel Y. Chung ◽

Kenneth L. McCall ◽

Brian J. Piper

Keyword(s):

United States ◽

Oral Morphine ◽

The United States ◽

Prescription Opioid ◽

Opioid Use ◽

Chronic Noncancer Pain ◽

Overdose Death ◽

Pain Medications ◽

Recreational Marijuana ◽

Noncancer Pain

AbstractImportanceOpioid related overdoses and overprescribing continue to be an ongoing issue within the United States. Further consideration of nonopioid alternatives as a substitute to treat chronic noncancer pain and in the treatment of opioid use disorders (OUD) is warranted.ObjectiveTo examine the association between the legalization of Colorado’s recreational marijuana and prescription opioid distribution trends. Two states that have not legalized recreational marijuana were selected for comparison.MethodsThe United States Drug Enforcement Administration’s Automation of Report and Consolidated Orders System (ARCOS) was used to examine nine pain medications: oxycodone, fentanyl, morphine, hydrocodone, hydromorphone, oxymorphone, tapentadol, codeine, meperidine and two OUD medications: methadone and buprenorphine from 2007-2017 in Colorado, Utah, and Maryland. The drug weights were extracted, examined, and graphed. Medications were converted to their oral morphine milligram equivalents (MME) using standard conversion factors.ResultsColorado reached a peak of pain MME weight in 2012 and had an −11.66% reduction from 2007 to 2017. During the same interval, Utah had a +9.64% increase in pain medication distribution and Maryland, a −6.02% reduction. As for medications used for OUD, Colorado, Utah, and Maryland had +19.42% increase, −31.45% reduction, and +66.56% increase, respectively. Analysis of the interval pre (2007-2009) versus post (2013-2017) marijuana legalization was completed. Statistically significant changes were observed for Colorado (P=0.033) and Maryland (P=0.007), but not Utah (P=0.659) for pain medications. Analysis of the OUD medications identified significant changes for Colorado (P=0.0003) and Maryland (P=0.0001), but not Utah (P=0.0935). Over the decade, Colorado’s opioid distribution was predominantly (72.49%) for pain with one-quarter (27.51%) for an OUD. Utah distributed 61.00% for pain and 39.00% for OUD. However, Maryland was one-third (37.89%) for pain but over-three-fifths (62.11%) for an OUD.ConclusionThere has been a significant decrease in the prescription opioid distribution after the legalization of marijuana in Colorado. This finding was particularly notable for opioids indicated predominantly for analgesia such as hydrocodone, morphine and fentanyl. Colorado had a larger decrease in opioid distribution after 2012 than Utah or Maryland. Therefore, marijuana could be considered as an alternative treatment for chronic pain and reducing use of opioids. Also, when combined with other novel research, it may also reduce the overdose death rate. Additional research with more comparison states is ongoing.

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354 Trends in the Drug-Sparing Effects for Benzodiazepines and Prescription Opioids among Insomnia Patients on Suvorexant in the US

SLEEP ◽

10.1093/sleep/zsab072.353 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A141-A141

Author(s):

Hrishikesh Kale ◽

Rezaul Khandker ◽

Ruchit Shah ◽

Marc Botteman ◽

Weilin Meng ◽

...

Keyword(s):

Interrupted Time Series ◽

Charlson Comorbidity Index Score ◽

Prescription Opioid ◽

Prescription Opioids ◽

Opioid Use ◽

Before And After ◽

Prescription Opioid Use ◽

Incident Cohort ◽

Over Time ◽

Post Period

Abstract Introduction Use of benzodiazepines to treat insomnia has been associated with serious side effects and abuse potential. Insomnia patients are at high risk of opioid abuse and better sleep patterns may help to reduce opioid use. This study examined the trend in the use of benzodiazepines and prescription opioids before and after initiation of suvorexant in insomnia patients. Methods The study analyzed 2015–2019, Optum Clinformatics Data Mart. Insomnia patients, identified using ICD-9/10 codes and prescribed suvorexant were included. The study included incident (newly diagnosed) and prevalent cohorts of insomnia patients. The proportion of patients on benzodiazepines or prescription opioids were calculated for 12 monthly intervals before (pre-period) and after initiation of suvorexant (post-period). Interrupted time series (ITS) analysis was conducted to assess trends for use of benzodiazepine or prescription opioids over time. Results A total of 5,939 patients from the incident insomnia cohort and 18,920 from the prevalent cohort were included. For the incident cohort, mean age was 64.47 (SD: 15.48), 63% were females, 71% had Medicare Advantage coverage, 59% had Charlson comorbidity index score (CCI) ≥ 1, 27% had an anxiety disorder and 16% had substance abuse disorder. Prevalent insomnia cohort was similar but had higher CCI. Results from ITS suggested that at the beginning of the pre-period, 28% of incident insomnia patients used either opioids or benzodiazepines with the rate of use in the pre-period increasing by 0.11% per month. In the post-period, the rate of use decreased by 0.33% per month. About 26% patients used benzodiazepines or opioids at 12-month after suvorexant initiation. In the absence of suvorexant, this proportion would have been 31%. Similar findings were observed for the prevalent insomnia cohort. A larger decrease was observed for opioid use than benzodiazepines. Conclusion The rate of benzodiazepines or prescription opioid use decreased over time after the initiation of suvorexant. Suvorexant has the potential to reduce the use of opioids and benzodiazepines among insomnia patients. Further research is needed to confirm these findings. Support (if any) This study was sponsored by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA.

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Opioid use in chronic noncancer pain: guidelines revisited

Current Opinion in Anaesthesiology ◽

10.1097/aco.0b013e32833c57a8 ◽

2010 ◽

Vol 23 (5) ◽

pp. 598-601 ◽

Cited By ~ 39

Author(s):

Christoph Stein ◽

Henriette Reinecke ◽

Hardo Sorgatz

Keyword(s):

Opioid Use ◽

Chronic Noncancer Pain ◽

Noncancer Pain

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Outcomes Associated with Opioid Use in the Treatment of Chronic Noncancer Pain in Older Adults: A Systematic Review and Meta-Analysis

Journal of the American Geriatrics Society ◽

10.1111/j.1532-5415.2010.02920.x ◽

2010 ◽

Vol 58 (7) ◽

pp. 1353-1369 ◽

Cited By ~ 126

Author(s):

Maria Papaleontiou ◽

Charles R. Henderson Jr ◽

Barbara J. Turner ◽

Alison A. Moore ◽

Yelena Olkhovskaya ◽

...

Keyword(s):

Systematic Review ◽

Older Adults ◽

Meta Analysis ◽

Opioid Use ◽

Chronic Noncancer Pain ◽

Noncancer Pain

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Targeting the Orexin System for Prescription Opioid Use Disorder

Brain Sciences ◽

10.3390/brainsci10040226 ◽

2020 ◽

Vol 10 (4) ◽

pp. 226 ◽

Cited By ~ 2

Author(s):

Alessandra Matzeu ◽

Rémi Martin-Fardon

Keyword(s):

Opioid Use Disorder ◽

Prescription Opioid ◽

Prescription Opioids ◽

Opioid Use ◽

Effective Strategies ◽

System A ◽

Clinical Pain ◽

Promising Target ◽

Nonmedical Use ◽

Prescription Opioid Use

Prescription opioids are potent analgesics that are used for clinical pain management. However, the nonmedical use of these medications has emerged as a major concern because of dramatic increases in abuse and overdose. Therefore, effective strategies to prevent prescription opioid use disorder are urgently needed. The orexin system has been implicated in the regulation of motivation, arousal, and stress, making this system a promising target for the treatment of substance use disorder. This review discusses recent preclinical studies that suggest that orexin receptor blockade could be beneficial for the treatment of prescription opioid use disorder.

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Accuracy of Patient Opioid Use Reporting at the Time of Medical Cannabis License Renewal

Pain Research and Management ◽

10.1155/2018/5704128 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Jacob M. Vigil ◽

Sarah S. Stith ◽

Anthony P. Reeve

Keyword(s):

Monitoring Program ◽

Prescription Opioid ◽

Prescription Opioids ◽

Medical Cannabis ◽

Opioid Use ◽

Opioid Prescription ◽

Health Functioning ◽

Patient Symptom ◽

License Renewal ◽

Pain Patients

The decision to authorize a patient for continued enrollment in a state-sanctioned medical cannabis program is difficult in part due to the uncertainty in the accuracy of patient symptom reporting and health functioning including any possible effects on other medication use. We conducted a pragmatic convenience study comparing patient reporting of previous and current prescription opioid usage to the opioid prescription records in the Prescription Monitoring Program (PMP) among 131 chronic pain patients (mean age = 54; 54% male) seeking the first annual renewal of their New Mexico Medical Cannabis Program (NMMCP) license. Seventy-six percent of the patients reported using prescription opioids prior to enrollment in the NMMCP, however, the PMP records showed that only 49% of the patients were actually prescribed opioids in the six months prior to enrollment. Of the 64 patients with verifiable opioid prescriptions prior to NMMCP enrollment, 35 (55%) patients reported having eliminated the use of prescription opioids by the time of license renewal. PMP records showed that 26 patients (63% of patients claiming to have eliminated the use of opioid prescriptions and 41% of all patients with verifiable preenrollment opioid use) showed no prescription opioid activity at their first annual NMMCP renewal visit.

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