scholarly journals Primary care physicians’ perspectives on Veterans who obtain prescription opioids from multiple healthcare systems

2019 ◽  
Vol 15 (3) ◽  
pp. 183-191
Author(s):  
Felicia R. Bixler, MS ◽  
Thomas R. Radomski, MD, MS ◽  
Susan L. Zickmund, PhD ◽  
KatieLynn M. Roman, BA ◽  
Leslie R. M. Hausmann, PhD ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Healthcare Systems ◽  
Prescription Opioid ◽  
Prescription Opioids ◽  
Department Of Veterans Affairs ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Multiple Sources ◽  
Opioid Medications

Objective: To characterize primary care physicians’ (PCPs’) perceptions of the reasons patients receive opioid medications from both VA and non-VA healthcare systems.Design: Qualitative.Setting: Department of Veterans Affairs (VA).Participants: Forty-two VA PCPs who prescribed opioids to at least 15 patients and who practiced in Massachusetts, Illinois, or Pennsylvania.Methods: Thirty-minute, semistructured telephone interviews were conducted in 2016, addressing topics regarding PCPs’ experiences and perspectives on patients who use both VA and non-VA healthcare systems to obtain prescription opioids. The analysis focused on two questions: attributes that PCPs believe characterize dual-use patients and reasons that PCPs believe patients obtain opioids from both VA and non-VA sources.Results: PCPs identified multiple attributes of, and reasons for, patients obtaining opioid medications from both VA and non-VA healthcare systems, including pain issues, opioid misuse, having healthcare managed through multiple healthcare systems, and transferring care between systems. More than half of the PCPs identified addiction and diversion as key attributes and reasons why patients obtain prescription opioids from multiple sources. PCPs also identified several behavioral and psychological factors as attributes of these patients.Conclusions: PCPs within the VA have varying perceptions of patients obtaining opioid medications from multiple healthcare systems, with pain complaints and opioid misuse as the primary themes. This knowledge about PCPs’ perceptions can be incorporated into interventions to better manage pain and prescription opioid use by VA patients.

scholarly journals Identifying prescription opioid use disorder in primary care: Diagnostic characteristics of the Current Opioid Misuse Measure (COMM)

Pain ◽  
2011 ◽  
Vol 152 (2) ◽  
pp. 397-402 ◽  
Author(s):  
Ellen C. Meltzer ◽  
Denis Rybin ◽  
Richard Saitz ◽  
Jeffrey H. Samet ◽  
Sonia L. Schwartz ◽  
...  
Keyword(s):  
Primary Care ◽  
Opioid Use Disorder ◽  
Prescription Opioid ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Diagnostic Characteristics ◽  
Prescription Opioid Use

Patterns of heroin use following index prescription opioid exposure

2020 ◽  
Vol 16 (1) ◽  
pp. 49-57
Author(s):  
Scott M. Sexton, PharmD ◽  
Christopher M. Herndon, PharmD, BCACP ◽  
Jordan D. Sinclair, PharmD
Keyword(s):  
Primary Care Physicians ◽  
Outcome Measure ◽  
The United States ◽  
Prescription Opioid ◽  
Prescription Opioids ◽  
Opioid Use ◽  
Cross Sectional ◽  
Heroin Use ◽  
Chronic Pain Condition ◽  
Prescription Opioid Use

Objective: This study examined the means of obtainment, indication, and prescriber of an index opioid in self-reporting heroin users.Design: Cross-sectional, observational study.Setting: A survey was submitted by participants in the United States with current or past heroin use.Participants: Three hundred twenty-three participants greater than 18 years of age completed the survey.Main outcome measure: Participants were surveyed regarding prescription opioid use prior to heroin initiation and specifically how they were obtained. Surveys were comprehensive in nature, divulging information including which opioid(s) was/were used, how they were obtained, by which prescriber (if prescribed), and if there was a diagnosis for chronic pain.Results: Roughly 47 percent of participants reported using prescription opioids prior to heroin. The most commonly used prescription opioid prior to heroin initiation was oxycodone (92.5 percent). The most common acquisition of opioids was through the prescribing of a physician, which occurred in roughly 63 percent of cases. These prescriptions were obtained most often from primary care physicians and emergency departments. Only 34 percent of participants reported being diagnosed with a chronic pain condition prior to using heroin.Conclusions: This study further supports the role that prescription opioids play in the transition to heroin use. It suggests that oxycodone is the most common prescription opioid used prior to heroin initiation. Additionally, it reports descriptive information as to how and where prescription opioids are obtained. 

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

SLEEP ◽  
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.

scholarly journals Association of a Multimodal Educational Intervention for Primary Care Physicians With Prescriptions of Buprenorphine for Opioid Use Disorders

2019 ◽  
Vol 2 (10) ◽  
pp. e1913818 ◽  
Author(s):  
Brinton Clark ◽  
Mari Kai ◽  
Ryan Dix ◽  
Jonathan White ◽  
Yelena Rozenfeld ◽  
...  
Keyword(s):  
Primary Care ◽  
Educational Intervention ◽  
Primary Care Physicians ◽  
Opioid Use ◽  
Opioid Use Disorders

scholarly journals Targeting the Orexin System for Prescription Opioid Use Disorder

2020 ◽  
Vol 10 (4) ◽  
pp. 226 ◽  
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.

scholarly journals Communication of Recommendations for the Disposal of Unused Prescription Opioid Medications by Stakeholders in the News Media

Pain Medicine ◽  
2019 ◽  
Vol 20 (9) ◽  
pp. 1711-1716 ◽  
Author(s):  
Megan L Petrik ◽  
Patrick J McNamara ◽  
Susan M Moeschler ◽  
Benjamin D Blair
Keyword(s):  
Health Care ◽  
Law Enforcement ◽  
Health Care Providers ◽  
News Media ◽  
Prescription Opioid ◽  
Environmental Harm ◽  
Prescription Opioids ◽  
Care Providers ◽  
Take Back ◽  
Opioid Medications

Abstract Objective The opioid epidemic is a national public health emergency that requires a comprehensive approach to reduce opioid-related deaths. Proper and timely disposal of unused prescription opioids is one method to deter improper use of these medications and prevent overdose. The objective of this study was to understand how recommendations for disposing of unused prescription opioids, including both take-back programs and toilet disposal, are communicated to the public. Methods Two hundred sixty-three US newspaper articles published between January 1, 2014, and June 30, 2017, containing information on opioids and take-back programs were found using LexisNexis. Using content analysis, articles were coded for the presentation of and recommendation for opioid disposal practices, beliefs about environmental harm from toilet disposal, and additional strategies to reduce opioid supply. The entity responsible for the statement was also captured. Results Take-back programs were presented as a recommended disposal strategy for unused prescription opioids in 88.6% of coded articles. Toilet disposal was presented as a recommended disposal strategy for unused prescription opioids in 3.4% of articles and as harmful to the environment in 16.0% of articles. Individuals from health care, government, and law enforcement were primarily involved in discussing opioid disposal practices. Conclusions Although toilet disposal is recommended by the US Food and Drug Administration (FDA) for disposal of unused prescription opioids when a take-back program is not readily available, it was infrequently presented or recommended in news media articles. These results highlight the importance of improving communication of FDA guidelines for opioid disposal in the media, particularly by health care providers, government employees, and law enforcement officials.

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

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
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.

Risk factors for opioid misuse in adolescents and young adults with focus on oncology setting

2016 ◽  
Vol 12 (3) ◽  
pp. 205 ◽  
Author(s):  
Kelly R. Peck, MA ◽  
Jennifer Harman Ehrentraut, PhD ◽  
Doralina L. Anghelescu, MD
Keyword(s):  
Risk Factors ◽  
Young Adults ◽  
Adolescents And Young Adults ◽  
Prescription Opioid ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Oncology Patients ◽  
Medication Misuse ◽  
Psychological Conditions ◽  
Potential Risk Factors

Prescription opioid use has increased in recent decades. Although opioids provide effective pain control, their use may be associated with the risk of misuse. Opioid misuse (OM) is prevalent among adolescents and young adults (AYAs). Opioids are necessary to treat cancer-related pain; however, oncology patients are not immune to medication misuse. Research examining OM among AYAs with cancer is scarce. This article examines the risk factors described in the general adult and adolescent medication abuse literature and aims to provide recommendations for practice in the AYA oncology population. The following risk factors should be examined in AYA oncology patients to determine their relevance: age, sex, behavioral and academic problems, psychological conditions, and a history of illicit drug use/abuse. To maintain the delicate balance of providing adequate pain relief while protecting patients from the risk of OM, clinicians must consider potential risk factors, motivating factors, and individual behaviors. Placing these challenges in perspective, this review provides clinical considerations, recommendations, and intervention strategies for OM prevention in AYA oncology patients.

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