Opioid-Induced Constipation: A Comprehensive Overview

2016 ◽  
Author(s):  
Trisha Patel ◽  
Hamilton Chen ◽  
John Michels ◽  
Justin Hata
Keyword(s):  
The United States ◽  
Opioid Antagonists ◽  
Submucosal Plexus ◽  
Opioid Use ◽  
Comprehensive Overview ◽  
Opioid Receptor Antagonists ◽  
Successful Resolution ◽  
Fiber Consumption ◽  
Specific Receptors ◽  
Opioid Medications

In the United States, 4.3 million adults are regularly taking opioid medications. Opioid-induced constipation (OIC) is underdiagnosed considering the prevalence of opioid use among Americans. This review is intended to clarify issues related to OIC. OIC is caused by opioids binding to specific receptors in the gastrointestinal system, resulting in various anatomic effects, including decreased gastric motility, increased sphincter tone, reduced intestinal secretions, and increased water absorption in the bowel. Various treatments include water and fiber consumption, laxatives, enemas, cessation of opioids, and central and peripheral opioid antagonists. OIC is treatable, but timely diagnosis and patient education are paramount for successful resolution. Key words: chronic pain; constipation; mu, delta, and kappa receptors; myenteric plexus; opioid; opioid-induced constipation; opioid receptor antagonists; submucosal plexus

scholarly journals Illicit Opioid Intoxication: Diagnosis and Treatment

2011 ◽  
Vol 5 ◽  
pp. SART.S7090
Author(s):  
A. Fareed ◽  
S. Stout ◽  
J. Casarella ◽  
S. Vayalapalli ◽  
J. Cox ◽  
...  
Keyword(s):  
Signs And Symptoms ◽  
The United States ◽  
Opioid Overdose ◽  
Opioid Use ◽  
Heroin Use ◽  
Treatment And Prevention ◽  
Pain Medications ◽  
Opioid Intoxication ◽  
Opioid Drugs ◽  
Opioid Medications

Opioid intoxications and overdose are associated with high rates of morbidity and mortality. Opioid overdose may occur in the setting of intravenous or intranasal heroin use, illicit use of diverted opioid medications, intentional or accidental misuse of prescription pain medications, or iatrogenic overdose. In this review, we focused on the epidemiology of illict opioid use in the United States and on the mechanism of action of opioid drugs. We also described the signs and symptoms, and diagnoses of intoxication and overdose. Lastly, we updated the reader about the most recent recommendations for treatment and prevention of opioid intoxications and overdose.

scholarly journals Discrepancies in Written Versus Calculated Durations in Opioid Prescriptions: Pre-Post Study (Preprint)

2019 ◽  
Author(s):  
Benjamin H Slovis ◽  
John Kairys ◽  
Bracken Babula ◽  
Melanie Girondo ◽  
Cara Martino ◽  
...  
Keyword(s):  
The United States ◽  
Opioid Use ◽  
Duration Of Treatment ◽  
Record System ◽  
Opioid Prescription ◽  
Increased Risk ◽  
The Us ◽  
Control And Prevention ◽  
Opioid Medications

BACKGROUND The United States is in the midst of an opioid epidemic. Long-term use of opioid medications is associated with an increased risk of dependence. The US Centers for Disease Control and Prevention makes specific recommendations regarding opioid prescribing, including that prescription quantities should not exceed the intended duration of treatment. OBJECTIVE The purpose of this study was to determine if opioid prescription quantities written at our institution exceed intended duration of treatment and whether enhancements to our electronic health record system improved any discrepancies. METHODS We examined the opioid prescriptions written at our institution for a 22-month period. We examined the duration of treatment documented in the prescription itself and calculated a duration based on the quantity of tablets and doses per day. We determined whether requiring documentation of the prescription duration affected these outcomes. RESULTS We reviewed 72,314 opioid prescriptions, of which 16.96% had a calculated duration that was greater than what was documented in the prescription. Making the duration a required field significantly reduced this discrepancy (17.95% vs 16.21%, <i>P</i>&lt;.001) but did not eliminate it. CONCLUSIONS Health information technology vendors should develop tools that, by default, accurately represent prescription durations and/or modify doses and quantities dispensed based on provider-entered durations. This would potentially reduce unintended prolonged opioid use and reduce the potential for long-term dependence.

scholarly journals A Narrative Systematic Literature Review: A Focus on Qualitative Studies on HIV and Medication-Assisted Therapy in the United States

Pharmacy ◽  
2021 ◽  
Vol 9 (1) ◽  
pp. 67
Author(s):  
Alina Cernasev ◽  
Sunitha Kodidela ◽  
Michael P. Veve ◽  
Theodore Cory ◽  
Hilary Jasmin ◽  
...  
Keyword(s):  
United States ◽  
Literature Review ◽  
Healthcare Providers ◽  
The United States ◽  
Hiv And Aids ◽  
Opioid Use ◽  
Screening Process ◽  
Persons Living With Hiv ◽  
Opioid Medications

Over the last two decades, the United States (U.S.) has experienced an opioid crisis that has had a significant negative societal and economic impact. Due to the high utilization of opioids in Persons Living with HIV and AIDS (PLWHA), there is a need for a qualitative literature review that presents opioid-use related problems in this population. This study aims to present and identify a thematic overview of the qualitative manuscripts on PLWHA who take opioid medications in the U.S., with a focus on perceptions surrounding medication assisted therapy. The systematic literature search was performed in December 2019. Four databases were searched: PubMed/MEDLINE, Scopus, Web of Science, and Cumulative Index to Nursing & Allied Health Literature (CINAHL). A total of 5348 results were exported from databases into EndNote x9, and duplicates were removed for a total of 3039 unique abstracts to screen. The records were imported into Rayyan, an online platform designed to expedite the screening process. Three authors screened titles and abstracts and determined 19 articles that would be screened in full text. On 9 April 2020, it was determined that eight articles would be included for review. The analysis of the eight manuscripts that fit the inclusion and exclusion criteria revealed barriers and facilitators to medication assisted therapy (MAT) in PLWHA. This review communicates or describes the story of PLWHA who might have delayed access to HIV healthcare providers and the commencement of antiretroviral therapy. In the literature, several studies have focused on the role of physicians in prescribing and addressing the medication regimens but none of the studies examined the role of pharmacists in access to care in this population. Therefore, further research is needed for a better understanding of the social aspects of taking opioid medications in PLWHA and the role of pharmacists within the continuum of care.

scholarly journals Discrepancies in Written Versus Calculated Durations in Opioid Prescriptions: Pre-Post Study

10.2196/16199 ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. e16199
Author(s):  
Benjamin H Slovis ◽  
John Kairys ◽  
Bracken Babula ◽  
Melanie Girondo ◽  
Cara Martino ◽  
...  
Keyword(s):  
The United States ◽  
Opioid Use ◽  
Duration Of Treatment ◽  
Record System ◽  
Opioid Prescription ◽  
Increased Risk ◽  
The Us ◽  
Control And Prevention ◽  
Opioid Medications

Background The United States is in the midst of an opioid epidemic. Long-term use of opioid medications is associated with an increased risk of dependence. The US Centers for Disease Control and Prevention makes specific recommendations regarding opioid prescribing, including that prescription quantities should not exceed the intended duration of treatment. Objective The purpose of this study was to determine if opioid prescription quantities written at our institution exceed intended duration of treatment and whether enhancements to our electronic health record system improved any discrepancies. Methods We examined the opioid prescriptions written at our institution for a 22-month period. We examined the duration of treatment documented in the prescription itself and calculated a duration based on the quantity of tablets and doses per day. We determined whether requiring documentation of the prescription duration affected these outcomes. Results We reviewed 72,314 opioid prescriptions, of which 16.96% had a calculated duration that was greater than what was documented in the prescription. Making the duration a required field significantly reduced this discrepancy (17.95% vs 16.21%, P<.001) but did not eliminate it. Conclusions Health information technology vendors should develop tools that, by default, accurately represent prescription durations and/or modify doses and quantities dispensed based on provider-entered durations. This would potentially reduce unintended prolonged opioid use and reduce the potential for long-term dependence.

scholarly journals Pharmacy Technicians, Stigma, and Compassion Fatigue: Front-Line Perspectives of Pharmacy and the US Opioid Epidemic

2021 ◽  
Vol 18 (12) ◽  
pp. 6231
Author(s):  
Alina Cernasev ◽  
Shane Desselle ◽  
Kenneth C. Hohmeier ◽  
Joanne Canedo ◽  
Britney Tran ◽  
...  
Keyword(s):  
Compassion Fatigue ◽  
Phenomenological Approach ◽  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Epidemic ◽  
Opioid Use ◽  
Pharmacy Technician ◽  
Pharmacy Technicians ◽  
Opioid Medications ◽  
Use Behavior

The opioid epidemic in the United States has led to a quadrupling of opioid overdoses since the 1990s. Stigmas exist among healthcare professionals, and it is essential to educate the next generation of pharmacy technicians regarding opioid use disorder. The main objective of this study was to characterize the phenomenon of stigma through the pharmacy technician lens when taking care of patients who are using opioid medications. Grounded in Van Manen’s phenomenological approach and the Link and Phelan stigmatization model, a qualitative study was conducted from February to June 2020 to understand pharmacy technicians’ perceptions and attitudes towards patients using opioid medications. Focus groups (n = 46) with pharmacy technicians were conducted in-person and online over five months in 2020. Thematic analysis identified three themes that characterize the stigma and the relationship between pharmacy technicians and patients taking opioid medications: (1) pharmacy technician perspectives on stigma and patients with addictive opioid-use behavior; (2) current approaches of pharmacy technicians towards patients with addictive opioid-use behavior; (3) future approaches of pharmacy technicians towards patients with addictive opioid-use behavior. The findings highlight an “ever-present” negative connotation associated with the stigma that is formed from patient interaction. It is necessary to develop proper resources and educational materials to manage the stigma that exists in pharmacies throughout the nation. These resources will facilitate how to address and prevent the stigma among pharmacy technicians in the U.S.

scholarly journals The Concurrent Initiation of Medications Is Associated with Discontinuation of Buprenorphine Treatment for Opioid Use Disorder

2020 ◽  
Author(s):  
Pengyue Zhang ◽  
Chien-Wei Chiang ◽  
Sara Quinney ◽  
Macarius Donneyong ◽  
Bo Lu ◽  
...  
Keyword(s):  
Large Scale ◽  
The United States ◽  
Opioid Use Disorder ◽  
Retention Rates ◽  
P Value ◽  
Opioid Use ◽  
Pain Medications ◽  
Real World Evidence ◽  
Opioid Medications ◽  
Buprenorphine Treatment

ABSTRACTIntroductionRetention in buprenorphine treatment for opioid use disorder (OUD) yields better opioid abstinence and reduces all-cause mortality for patients with OUD. Despite significant efforts have been made to expand the availability and use of buprenorphine in the United States, its retention rates remain on a low level. The current study examines discontinuation of buprenorphine with respect to concurrent initiation of other medications using real-world evidence.MethodsCase-crossover study was conducted to examine discontinuation of buprenorphine using a large-scale longitudinal health dataset including 148,306 commercially-insured individuals initiated on medications for opioid use disorder (MOUD). Odds ratios and Bonferroni adjusted p-values were calculated for medications and therapeutic classes of medications.ResultsClonidine was associated with increased discontinuation risk of buprenorphine both using the buprenorphine dataset alone (OR = 1.583 and adjusted p-value = 1.22 × 10−6) and using naltrexone as a comparison drug (OR = 2.706 and adjusted p-value = 4.11 × 10−5). Opioid medications (oxycodone, morphine and fentanyl) and methocarbamol were associated with increased discontinuation risk of buprenorphine using the buprenorphine dataset alone (adjusted p-value < 0.05), but not significant using naltrexone as a comparison drug. 6 drug therapeutic classes were associated with increased discontinuation risk of buprenorphine both using the buprenorphine dataset alone and using naltrexone as a comparison drug (adjusted p-value < 0.05).ConclusionConcurrent initiation of medications is associated with increased discontinuation risk of buprenorphine. Opioid medications are prescribed among patients on MOUD and associated with increased discontinuation risk of buprenorphine. Analgesics is associated with increased discontinuation risk of buprenorphine for patients without previous exposure of pain medications.

scholarly journals Investigating the Use of a Serious Game to Improve Opioid Safety Awareness Among Adolescents: A Quantitative Study (Preprint)

2021 ◽  
Author(s):  
Olufunmilola Abraham ◽  
Claire Rosenberger ◽  
Kathleen Tierney ◽  
Jen Birstler
Keyword(s):  
Self Efficacy ◽  
The United States ◽  
Negative Consequences ◽  
Opioid Use ◽  
Healthcare Settings ◽  
Safety Awareness ◽  
Nationally Representative ◽  
Opioid Medications ◽  
Safety Knowledge ◽  
Hispanic White

BACKGROUND The misuse of opioid medications among adolescents is a serious problem in the United States. Serious games (SGs) are a novel way to promote safe and responsible management of opioid medications among adolescents, thereby reducing the number of adolescent opioid misuse cases reported annually. OBJECTIVE This study aimed to examine the effect of the SG MedSMA℞T: Adventures in PharmaCity on adolescents’ opioid safety knowledge, awareness, behavioral intent, and self-efficacy. METHODS A nationally representative sample of adolescents age 12 to 18 years old were recruited online through Qualtrics panels from October to November 2020. Data collection consisted of a pre-game survey, 30 minutes of gameplay, and a post-game survey. The pre- and post-game survey included 66 items examining participants’ baseline opioid knowledge, safety, and use, and demographic information. The post-game survey had 25 additional questions regarding the MedSMA℞T game. Gameplay scenarios included five levels intended to mimic adolescents’ daily life while educating players about appropriate opioid storage and disposable practices, negative consequences of sharing opioid medications, and use of Narcan®. Survey questions were divided into 10 categories to represent key concepts and summarized into concept scores. Differences in concept scores were described by overall mean (SD) when stratified by gender, race, school, grade, and age. Differences of change in concept score were analyzed using Kruskal-Wallis and correlation tests. RESULTS A total of 117 responses were analyzed. Results showed significant improvement on all concept scores except for Narcan® knowledge (mean change = -0.04, SD = 0.29, p = 0.600) and safe storage (mean change = 0.03, SD = 0.20, p = 0.088). Female participants had greater improvement than males for safe disposal (female mean (SD) = 0.12 (0.25), male = 0.04 (0.17), p = 0.050). Male participants had higher improvement than females for misuse behavior (female mean (SD) = 0.05 (0.28) male = 0.14 (0.27), p = 0.043). Perceived knowledge for participants who were non-white or Hispanic had higher improvement than non-Hispanic white participants (non-white mean (SD) = 1.10 (1.06), white = 0.75 (0.91), p = 0.026). Older grades were associated with greater improvement in opioid knowledge (correlation coefficient -0.23 (95% CI -0.40 to -0.05), p = 0.012). There were 28 (23.9%) participants who played all 5 levels of the game and had better improvement in opioid use self-efficacy. CONCLUSIONS Findings suggest MedSMA℞T: Adventures in PharmaCity can be used as an effective tool to educate adolescents on the safe and responsible use of prescribed opioid medications. Future testing of the effectiveness of this SG should involve a randomized control trial. Additionally, the feasibility of implementing and disseminating MedSMA℞T: Adventures in PharmaCity in schools and healthcare settings, such as adolescent health or primary care clinics, emergency departments, and pharmacies, should be investigated.

Latino Catholicism

2011 ◽  
Author(s):  
Timothy Matovina
Keyword(s):  
United States ◽  
Sixteenth Century ◽  
Catholic Church ◽  
Social Life ◽  
Social Issues ◽  
The United States ◽  
Societal Impact ◽  
Comprehensive Overview ◽  
Public Debates ◽  
The U.S

Most histories of Catholicism in the United States focus on the experience of Euro-American Catholics, whose views on social issues have dominated public debates. This book provides a comprehensive overview of the Latino Catholic experience in America from the sixteenth century to today, and offers the most in-depth examination to date of the important ways the U.S. Catholic Church, its evolving Latino majority, and American culture are mutually transforming one another. This book highlights the vital contributions of Latinos to American religious and social life, demonstrating in particular how their engagement with the U.S. cultural milieu is the most significant factor behind their ecclesial and societal impact.

scholarly journals Su1597 – Increasing Inpatient Burden of Constipation and Its Relation to Opioid Use: National Trends in the United States

2019 ◽  
Vol 156 (6) ◽  
pp. S-577
Author(s):  
Eula P. Tetangco ◽  
Supannee Rassameehiran ◽  
George Tan ◽  
Humberto Sifuentes
Keyword(s):  
United States ◽  
The United States ◽  
Opioid Use ◽  
National Trends
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