scholarly journals Describing long-term opioid use utilizing Nordic Prescription Registers – A Norwegian example

2021 ◽  
Author(s):  
Aleksi Hamina ◽  
Vidar Hjellvik ◽  
Marte Handal ◽  
Ingvild Odsbu ◽  
Thomas Clausen ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
Outcome Research ◽  
Opioid Use ◽  
Short Term ◽  
Clinical Applicability ◽  
Prescription Register ◽  
Continued Use ◽  
Opioid Users

Abstract Previous studies have defined long-term opioid use in varying ways, decreasing comparability, reproducibility and clinical applicability of the research. Based on recent systematic reviews, we aimed to estimate long-term opioid use defined as use persisting more than three months using one of the Nordic prescription registers. We used the Norwegian Prescription Register (NorPD) to extract data on all opioid dispensations between January 1st 2004 and October 31st 2019. New users of opioids (washout 365 days) were defined as long-term users if they filled two criteria: 1) they had ≥2 dispensations of opioids, 91-180 days apart; 2) days 0-90 included ≥90 dispensed administration units (e.g., tablets) of opioids. Overall, there were 2,543,224 new users of opioids during the study period. Of these, 354,666 (13.9%) filled the criteria for long-term opioid use at least once. Compared to those who did not fill the criteria (short-term users), long-term users were older, more likely women, and used tramadol, oxycodone, and buprenorphine more frequently as their first opioid. In conclusion, we found that 1/7 of opioid users continued use longer than 3 months. Future outcome research should identify the clinically most important dose requirements for long-term opioid use criteria.

scholarly journals Describing long-term opioid use utilizing Nordic Prescription Registers – A Norwegian example

2021 ◽  
Author(s):  
Aleksi Hamina ◽  
Vidar Hjellvik ◽  
Marte Handal ◽  
Ingvild Odsbu ◽  
Svetlana Skurtveit
Keyword(s):  
Systematic Reviews ◽  
Outcome Research ◽  
Opioid Use ◽  
Short Term ◽  
Clinical Applicability ◽  
Prescription Register ◽  
Continued Use ◽  
Opioid Users

Abstract Previous studies have defined long-term opioid use in varying ways, decreasing comparability, reproducibility and clinical applicability of the research. Based on recent systematic reviews, we aimed to estimate long-term opioid use defined as use persisting more than three months using one of the Nordic prescription registers. We used the Norwegian Prescription Register (NorPD) to extract data on all opioid dispensations between January 1st 2004 and October 31st 2019. New users of opioids (washout 365 days) were defined as long-term users if they filled two criteria: 1) they had ≥2 dispensations of opioids, 91-180 days apart; 2) days 0-90 included ≥90 dispensed administration units (e.g., tablets) of opioids. Overall, there were 2,543,224 new users of opioids during the study period. Of these, 354,666 (13.9%) filled the criteria for long-term opioid use at least once. Compared to those who did not fill the criteria (short-term users), long-term users were older, more likely women, and used tramadol, oxycodone, and buprenorphine more frequently as their first opioid. In conclusion, we found that 1/7 of opioid users continued use longer than 3 months. Future outcome research should identify the clinically most important dose requirements for long-term opioid use criteria.

scholarly journals Patterns of initial opioid prescription and its association with short-term and long-term use among opioid-naïve patients in Malaysia: a retrospective cohort study

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e027203 ◽  
Author(s):  
Che Suraya Zin ◽  
Nor Ilyani Nazar ◽  
Norny Syafinaz Abdul Rahman ◽  
Wan Rohaidah Ahmad ◽  
Nurul Sahida Rani ◽  
...  
Keyword(s):  
Cohort Study ◽  
Outcome Measures ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Opioid Use ◽  
Short Term ◽  
Opioid Prescription ◽  
Long Acting ◽  
Opioid Users

ObjectiveThis study examined opioid prescription initiation patterns and their association with short-term and long-term opioid use among opioid-naïve patients.DesignThis study was designed as a retrospective cohort study.Setting and participantsIn this study, we analysed the prescription databases of tertiary hospitals in Malaysia. This study included patients aged ≥18 years with at least one opioid prescription (buprenorphine, morphine, oxycodone, fentanyl, dihydrocodeine or tramadol) between 1 January 2011 and 31 December 2016. These patients had no opioid prescriptions in the 365 days prior, and were followed up for 365 days after the initial opioid prescription.Main outcome measuresThe main outcome measures were the number of short-term (<90 days) and long-term opioid users (≥90 days), initial opioid prescription period and daily dose.ResultsThere were 33 752 opioid-naïve patients who received opioid prescriptions (n=43 432 prescriptions) during the study period. Of these, 29 824 (88.36%) were short-term opioid users and 3928 (11.64%) were long-term opioid users. The majority of these short-term (99.09%) and long-term users (96.18%) received an initial daily opioid dose of <50 mg/day with a short-acting opioid formulation. Short-term opioid users were predominantly prescribed opioids for 3–7 days (59.06%) by the emergency department (ED, 60.56%), while long-term opioid users were primarily prescribed opioids for ≥7 days (91.85%) by non-ED hospital departments (91.8%). The adjusted model showed that the following were associated with long-term opioid use: increasing opioid daily doses, prescription period ≥7 days and long-acting opioids initiated by non-EDs.ConclusionsThe majority of opioid-naïve patients in tertiary hospital settings in Malaysia were prescribed opioids for short-term use. The progression to long-term use among opioid-naïve patients was attributed to the prescription of higher opioid doses for a longer duration as well as long-acting opioids initiated by non-ED hospital departments.

scholarly journals The association between initial opioid type and long-term opioid use after hip fracture surgery in elderly opioid-naïve patients

2020 ◽  
Vol 20 (4) ◽  
pp. 755-764
Author(s):  
Amalie H. Simoni ◽  
Lone Nikolajsen ◽  
Anne E. Olesen ◽  
Christian F. Christiansen ◽  
Søren P. Johnsen ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Pain Treatment ◽  
Population Based ◽  
Opioid Use ◽  
Calendar Time ◽  
Opioid Prescription ◽  
Hip Fracture Surgery ◽  
Opioid Users ◽  
Fracture Surgery

AbstractObjectivesLong-term opioid use after hip fracture surgery has been demonstrated in previously opioid-naïve elderly patients. It is unknown if the opioid type redeemed after hip surgery is associated with long-term opioid use. The aim of this study was to examine the association between the opioid type redeemed within the first three months after hip fracture surgery and opioid use 3–12 months after the surgery.MethodsA nationwide population-based cohort study was conducted using data from Danish health registries (2005–2015). Previously opioid-naïve patients registered in the Danish Multidisciplinary Hip Fracture Registry, aged ≥65 years, who redeemed ≥1 opioid prescription within three months after the surgery, were included. Long-term opioid use was defined as ≥1 redeemed prescription within each of three three-month periods within the year after hip fracture surgery. The proportion with long-term opioid use after surgery, conditioned on nine-month survival, was calculated according to opioid types within three months after surgery. Adjusted odds ratios (aOR) for different opioid types were computed by logistic regression analyses with 95% confidence intervals (CI) using morphine as reference. Subgroup analyses were performed according to age, comorbidity and calendar time before and after 2010.ResultsThe study included 26,790 elderly, opioid-naïve patients with opioid use within three months after hip fracture surgery. Of these patients, 21% died within nine months after the surgery. Among the 21,255 patients alive nine months after surgery, 15% became long-term opioid users. Certain opioid types used within the first three months after surgery were associated with long-term opioid use compared to morphine (9%), including oxycodone (14%, aOR; 1.76, 95% CI 1.52–2.03), fentanyl (29%, aOR; 4.37, 95% CI 3.12–6.12), codeine (13%, aOR; 1.55, 95% CI 1.14–2.09), tramadol (13%, aOR; 1.56, 95% CI 1.35–1.80), buprenorphine (33%, aOR; 5.37, 95% CI 4.14–6.94), and >1 opioid type (27%, aOR; 3.83, 95% CI 3.31–4.44). The proportion of long-term opioid users decreased from 18% before 2010 to 13% after 2010.ConclusionsThe findings suggest that use of certain opioid types after hip fracture surgery is more associated with long-term opioid use than morphine and the proportion initiating long-term opioid use decreased after 2010. The findings suggest that some elderly, opioid-naïve patients appear to be presented with untreated pain conditions when seen in the hospital for a hip fracture surgery. Decisions regarding the opioid type prescribed after hospitalization for hip fracture surgery may be linked to different indication for pain treatment, emphasizing the likelihood of careful and conscientious opioid prescribing behavior.

Can the use of physical modalities for pain control be rationalized by the research evidence?

1991 ◽  
Vol 69 (5) ◽  
pp. 704-712 ◽  
Author(s):  
C. Elaine Chapman
Keyword(s):  
Musculoskeletal Pain ◽  
Pain Control ◽  
Research Evidence ◽  
Power Laser ◽  
Short Term ◽  
Analgesic Effects ◽  
Short And Long Term ◽  
Continued Use ◽  
Physical Modalities

Physical modalities, including cold and heat, are widely used in the conservative management of pain associated with musculoskeletal disorders. This review has critically appraised the literature supporting the use of these modalities in the treatment of musculoskeletal pain. It was concluded that, apart from a few exceptions and in a few types of disorders, existing evidence does not support the use of these modalities in long-term pain control. There was, however, evidence that several modalities, specifically cold and a form of deep heat (shortwave diathermy), do have short-lived analgesic effects and so may contribute to more painfree function in the short term. Further research is clearly warranted to define the short- and long-term therapeutic efficacy of physical modalities in the treatment of musculoskeletal pain to justify their continued use in clinical practice.Key words: pain control, cold, heat, ultrasound, low-power laser.

The duration dilemma in opioid agonist therapy

2021 ◽  
Vol 17 (4) ◽  
pp. 353-358
Author(s):  
Anjali Dhanda, MD ◽  
Edwin A. Salsitz, MD, DFASAM
Keyword(s):  
Maintenance Treatment ◽  
A Priori ◽  
Opioid Use ◽  
Agonist Therapy ◽  
Short Term ◽  
Opioid Agonist ◽  
Adequate Treatment ◽  
Opioid Agonist Therapy ◽  
Optimal Outcomes

Objective: Studies dating back to 1964 consistently support the effectiveness of methadone as a maintenance treatment for opioid use disorder (OUD), and since 2003, the effectiveness of buprenorphine. Short-term detoxification has not proven to be an effective treatment, as it results in high relapse rates when compared with maintenance treatment with an opioid agonist therapy (OAT). The question about the duration of maintenance treatment for OUD has been debated with recommendations ranging from a minimum of 1 year, 2 years, to indefinitely. Other factors such as misconceptions, regulations, and insurance barriers also have an impact on the duration dilemma of OAT.Design: There were no a priori criteria for article inclusion and this is not a structured literature review. It is a review of articles of convenience from 1964 to 2018.Main outcome measure: This paper aims to address the dilemma of the ideal duration of OAT and to discuss the factors that could affect this decision.Results: Sustained OAT has had significantly better long-term outcomes than short-term detoxification or time limited maintenance. Optimal outcomes are dependent on adequate treatment duration.Conclusions: Addiction is a chronic brain disease and its treatment should be similar to the treatment of other chronic medical and psychiatric diseases. Long-term, sometimes lifetime, continuation of OAT for the treatment of OUD results in optimal outcomes when measuring morbidity and mortality. The accumulated evidence does not support any arbitrary limitation to the duration of OAT. 

scholarly journals The impact of long-term opioid use on the risk and severity of COVID-19

2020 ◽  
Vol 16 (6) ◽  
pp. 401-404
Author(s):  
Rahul Shah, BS ◽  
Yong-Fang Kuo, PhD ◽  
Jacques Baillargeon, PhD ◽  
Mukaila A. Raji, MD
Keyword(s):  
Prescription Opioids ◽  
Immune Functions ◽  
Emerging Infections ◽  
Opioid Use ◽  
Public Health Importance ◽  
The Us ◽  
Prolonged Icu Stay ◽  
Opioid Users ◽  
The Impact

Based on evidence of the immunosuppressive effects of chronic opioids, long-term users of prescription and illicit opioids comprise an unrecognized but growing population of Americans with compromised immune function and respiratory depression who may be at high risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease 19 (COVID-19)-related hospitalization, prolonged ICU stay, adverse events, and death. This perspective is of broad clinical and public health importance because the US has the highest population of long-term users of prescription opioids, a sequel of a decade-long practice of opioid overprescribing in the US. For long-term opioid users who are hospitalized for COVID-19, clinicians face clinical challenges arising from the suppressive effects of opioids on the respiratory and immune functions, as well as the potential for adverse drug-drug interaction when opioids have to be continued in long-term users. More research is needed to further understand the association of long-term opioid use and susceptibility to COVID-19 and other emerging infections.

scholarly journals Effect of preoperative long-term opioid therapy on patient outcomes after total knee arthroplasty: an analysis of multicentre population-based administrative data

2021 ◽  
Vol 64 (2) ◽  
Author(s):  
C. Michael Goplen ◽  
Sung Hyun Kang ◽  
Jason R. Randell ◽  
Allyson Jones ◽  
Donald C. Voaklander ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Physical Function ◽  
Knee Arthroplasty ◽  
Population Based ◽  
Womac Pain ◽  
Opioid Use ◽  
Before And After ◽  
Total Knee ◽  
Opioid Users

Background: Up to 40% of patients are receiving opioids at the time of total knee arthroplasty (TKA) in the United States despite evidence suggesting opioids are ineffective for pain associated with arthritis and have substantial risks. Our primary objective was to determine whether preoperative opioid users had worse knee pain and physical function outcomes 12 months after TKA than patients who were opioidnaive preoperatively; our secondary objective was to determine the prevalence of opioid use before and after TKA in Alberta, Canada. Methods: In this retrospective analysis of population-based data, we identified adult patients who underwent TKA between 2013 and 2015 in Alberta. We used multivariable linear regression to examine the association between preoperative opioid use and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and physical function scores 12 months after TKA, adjusting for potentially confounding variables. Results: Of the 1907 patients, 592 (31.0%) had at least 1 opioid dispensed before TKA, and 124 (6.5%) were classified as long-term opioid users. Long-term opioid users had worse adjusted WOMAC pain and physical function scores 12 months after TKA than patients who were opioid-naive preoperatively (pain score β = 7.7, 95% confidence interval [CI] 4.0 to 11.6; physical function score β = 7.8, 95% CI 4.0 to 11.6; p < 0.001 for both). The majority (89 ([71.8%]) of patients who were long-term opioid users preoperatively were dispensed opioids 180–360 days after TKA, compared to 158 (12.0%) patients who were opioid-naive preoperatively. Conclusion: A substantial number of patients were dispensed opioids before and after TKA, and patients who received opioids preoperatively had worse adjusted pain and functional outcome scores 12 months after TKA than patients who were opioidnaive preoperatively. These results suggest that patients prescribed opioids preoperatively should be counselled judiciously regarding expected outcomes after TKA.

Civil commitment for opioid misuse: do short-term benefits outweigh long-term harms?

2021 ◽  
pp. medethics-2020-107160
Author(s):  
John C Messinger ◽  
Daniel J Ikeda ◽  
Ameet Sarpatwari
Keyword(s):  
Civil Commitment ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Short Term ◽  
Community Based ◽  
Loss Of Life ◽  
Severe Withdrawal ◽  
The Usa ◽  
Overdose Deaths

In response to a sharp rise in opioid-involved overdose deaths in the USA, states have deployed increasingly aggressive strategies to limit the loss of life, including civil commitment—the forcible detention of individuals whose opioid use presents a clear and convincing danger to themselves or others. While civil commitment often succeeds in providing short-term protection from overdose, emerging evidence suggests that it may be associated with long-term harms, including heightened risk of severe withdrawal, relapse and opioid-involved mortality. To better assess and mitigate these harms, states should collect more robust data on long-term health outcomes, decriminalise proceedings and stays, provide access to medications for opioid use disorder and strengthen post-release coordination of community-based treatment.

A Stress and Pain Self-management m-Health App for Adult Outpatients with Sickle Cell Disease (RADIANCE Study): Protocol for a Randomized Controlled Study (Preprint)

2021 ◽  
Author(s):  
Miriam O. Ezenwa ◽  
Yingwei Yao ◽  
Molly W. Mandernach ◽  
David A. Fedele ◽  
Robert J. Lucero ◽  
...  
Keyword(s):  
Pain Intensity ◽  
Sickle Cell ◽  
Controlled Trial ◽  
Data Entry ◽  
Self Management ◽  
Opioid Use ◽  
Short Term ◽  
Self Monitoring ◽  
Randomized Controlled

BACKGROUND The purpose of this article is to describe the research protocol for a randomized controlled trial of a self-management intervention for adults diagnosed with sickle cell disease (SCD). People living with SCD suffer with lifelong recurrent episodes of acute and chronic pain, both of which are exacerbated by stress. OBJECTIVE The aims of this study are to decrease stress and improve SCD pain control with reduced opioid use through an intervention with self-management relaxation/distraction exercises (RDE), named You Cope, We Support (YCWS). Building on our prior findings of formative studies, this study is designed to test the efficacy of YCWS on stress intensity, pain intensity, and opioid use in adults with SCD. METHODS A randomized controlled trial of the short-term (8 weeks) and long-term (6 months) effects of YCWS on stress, pain, and opioid use will be conducted with 170 adults with SCD. Patients will be randomized based on a 1:1 ratio (stratified on pain intensity [<=5; >5]) to be either in the experimental (Self-monitoring of outcomes + alerts/reminders + use of YCWS [RDE + Support]) or control (Self-monitoring of outcomes + alerts/reminders) group. Patients will be asked to report outcomes daily. During weeks 1-8, patients in both groups will receive system-generated alerts/reminders via phone call, text, or email to facilitate data entry (both groups) and intervention use support (experimental). If the participant does not enter data after 24 hours, the study support staff will contact him/her for data entry troubleshooting (both groups) and YCWS use (experimental). We will time stamp and track patients' online activities to understand the study context and conduct exit interviews on the acceptability of system-generated and staff support. RESULTS The study was funded by the National Institute of Nursing Research of the National Institutes of Health in 2020. Our Institutional Review Board approved this study. Currently in the recruitment phase, the study began in March 2021 and will be concluded in June 2025. As of September 2021, we have enrolled 40 patients. We will analyze the data using the mixed-effects regression models (short-term, long-term) to account for the repeated measurements over time and utilize machine-learning to construct and evaluate prediction models. Due to the COVID-19 pandemic, the study was modified to allow for a mail-in consent process and a virtual consent process via email or Zoom video conference. CONCLUSIONS We expect that the intervention group will report reductions in pain intensity (primary outcome, 0-10 scale) and in stress intensity (0-10 scale) and opioid use, which are secondary outcomes. Our study will contribute to advancing the use of non-opioid therapy such as guided relaxation/distraction techniques for managing sickle cell pain. CLINICALTRIAL ClinicalTrials.gov NCT04484272

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