A case report of satisfactory post-left knee replacement pain control after switching from oxycodone to buprenorphine

2021 ◽  
Vol 17 (7) ◽  
pp. 179-182
Author(s):  
Shuo Qiu, MD ◽  
Sachinder Vasudeva, MD
Keyword(s):  
Case Report ◽  
Knee Replacement ◽  
Pain Control ◽  
Lower Risk ◽  
Discharge Planning ◽  
Opioid Use Disorder ◽  
Left Knee ◽  
Opioid Use ◽  
Pain Medications ◽  
Daily Urine

This case report demonstrates using buprenorphine 32 mg to achieve adequate pain control after a total knee replacement. The patient stopped buprenorphine 48 hours before surgery. He was prescribed 150 tablets of oxycodone 5 mg. After finishing oxycodone, he experienced significant pain that was relieved by 32 mg of buprenorphine daily. Urine drug screens were negative perioperatively. Patients with opioid use disorder require careful discharge planning to avoid opioid relapses or misuses of pain medications. Buprenorphine offers many unique advantages in acute pain control, including lower risk of respiratory depression, abuse potential, and lower risk of nephrotoxicity.

scholarly journals Factors that affect opioid use for postpartum pain control in women with opioid use disorder

2022 ◽  
Vol 226 (1) ◽  
pp. S133-S134
Author(s):  
Omar Abuzeid ◽  
Cassandra Heiselman ◽  
Anna Fuchs ◽  
Lama R. Noureddine ◽  
Mia A. Heiligenstein ◽  
...  
Keyword(s):  
Pain Control ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Postpartum Pain

(372) Suboxone Therapy for Cancer Survivors with Opioid Use Disorder: A Case Report

2019 ◽  
Vol 20 (4) ◽  
pp. S67
Author(s):  
T. Su ◽  
I. Dworkin ◽  
S. Pangarkar ◽  
Q. Pham
Keyword(s):  
Case Report ◽  
Cancer Survivors ◽  
Opioid Use Disorder ◽  
Opioid Use

scholarly journals Hospital Care of Opioid-Exposed Newborns: Clinical and Psychosocial Challenges

2020 ◽  
Vol 15 (10) ◽  
pp. 613-618
Author(s):  
Neera K Goyal ◽  
Jennifer McAllister
Keyword(s):  
Pregnant Women ◽  
Neonatal Intensive Care ◽  
Discharge Planning ◽  
Hospital Costs ◽  
Opioid Use Disorder ◽  
Care Utilization ◽  
Opioid Use ◽  
Maternal Experience ◽  
Medication Assisted Treatment ◽  
Experience Of Care

In the past two decades, the incidence of neonatal abstinence syndrome (NAS) has risen fivefold, mirroring the rise of opioid use disorder (OUD) among pregnant women. The resulting increases in length of stay and neonatal intensive care utilization are associated with higher hospital costs, particularly among Medicaid-financed deliveries. Pregnant women with OUD require comprehensive medical and psychosocial evaluation and management; this combined with medication-assisted treatment is critical to optimize maternal and newborn outcomes. Multidisciplinary collaboration and standardized approaches to screening for intrauterine opioid exposure, evaluation and treatment of NAS, and discharge planning are important for clinical outcomes and may improve maternal experience of care.

scholarly journals A Case Report of Cardiogenic Syncope Due to Loperamide Abuse: Acute Presentation and Novel Use of Buprenorphine

2021 ◽  
Vol 2 (5) ◽  
pp. 214-217
Author(s):  
David Betting ◽  
James Chenoweth ◽  
Angela Jarman
Keyword(s):  
Case Report ◽  
Sodium Bicarbonate ◽  
Alternative Treatment ◽  
Opioid Dependence ◽  
Intestinal Tract ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Acute Presentation ◽  
Cardiogenic Syncope ◽  
High Doses

Introduction: Loperamide is a non-prescription anti-diarrheal agent targeting µ-opioid receptors in the intestinal tract. At high doses it crosses the blood-brain barrier, where µ-opioid agonism can cause euphoric effects. Misuse has been increasing for both the euphoric effects and as an alternative treatment for opioid dependence and withdrawal. Case Report: Here we report the case of a 30-year-old woman presenting with syncope, who was found to have severe myocardial conduction delays in the setting of chronic loperamide abuse. Conclusion: Treatment with sodium bicarbonate and hypertonic sodium resulted in improvement of her conduction abnormalities. Prior to discharge she was initiated on buprenorphine for her opioid use disorder.

Rapid Micro-induction of Buprenorphine/Naloxone for Opioid Use Disorder in a Critically ill Intubated Patient: A Case Report

2020 ◽  
Vol 14 (6) ◽  
pp. 514-517 ◽  
Author(s):  
Basia Hamata ◽  
Donald Griesdale ◽  
Jessica Hann ◽  
Pouya Rezazadeh-Azar
Keyword(s):  
Case Report ◽  
Critically Ill ◽  
Opioid Use Disorder ◽  
Opioid Use

scholarly journals Perioperative Management of a Patient Taking Suboxone® at the Time of Ambulatory Surgery

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Shawn H. Malan ◽  
Christopher H. Bailey ◽  
Narjeet Khurmi
Keyword(s):  
Postoperative Pain ◽  
Minimally Invasive ◽  
Pain Control ◽  
Perioperative Management ◽  
Ambulatory Surgery ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Postoperative Pain Control ◽  
Recovery Unit ◽  
Postanesthesia Recovery

In 2016, more than 11 million people reported misuse of opioids in the previous year. In an effort to combat opioid use disorder (OUD), the use of agonist/antagonist is becoming increasingly common, with more than 2.2 million patients reporting use of a buprenorphine containing medication such as Suboxone®. Buprenorphine is a unique opioid which acts as a partial μ agonist and ĸ antagonist. These properties make it an effective tool in treating OUD and abuse. However, despite its advantages in treating OUD and abuse, buprenorphine can make it difficult to control acute perioperative pain. We present a case in which the Mayo Clinic Arizona protocol for patients undergoing minimally invasive ambulatory surgery while taking Suboxone® is successfully executed, resulting in adequate postoperative pain control and timely discharge from the postanesthesia recovery unit.

Prior Authorization for Opioid Use Disorder Versus Pain Medications: Lessons Learned for Parity Enforcement

2021 ◽  
Vol 82 (2) ◽  
pp. 214-218
Author(s):  
Tami L. Mark ◽  
William J. Parish ◽  
Ellen M. Weber ◽  
Gary A. Zarkin
Keyword(s):  
Opioid Use Disorder ◽  
Lessons Learned ◽  
Prior Authorization ◽  
Opioid Use ◽  
Pain Medications

Punitive discontinuation of opioid agonist therapy during incarceration

2020 ◽  
Vol 16 (4) ◽  
pp. 337-342
Author(s):  
Allison Marmel ◽  
Nikki Bozinoff
Keyword(s):  
Case Report ◽  
Significant Risk ◽  
Opioid Use Disorder ◽  
Considerable Proportion ◽  
Opioid Use ◽  
Agonist Therapy ◽  
Opioid Agonist ◽  
Content Type ◽  
Opioid Agonist Therapy ◽  
Increased Risk

Purpose The prevalence of substance use disorders among incarcerated individuals in Canada is substantially higher than in the general population. Many incarcerated individuals with opioid use disorder remain untreated due to inadequate access to opioid agonist therapy (OAT). A considerable proportion of overdose-related deaths in the province of Ontario are individuals who have recently been released from prison. The purpose of this paper is to highlight that discontinuation of OAT as a disciplinary measure remains an active concern within prisons in Canada and places individuals with opioid use disorder at increased risk of relapse and resultant overdose death. Design/methodology/approach This case report describes an incarcerated client with opioid use disorder who was initially stable on OAT, but was forcibly tapered off OAT as a disciplinary measure and subsequently relapsed to illicit opioid use while in custody. Findings This case calls attention to concerns regarding treatment of opioid use disorder during incarceration, as forcible detoxification from OAT as a disciplinary measure is a highly dangerous practice. The authors discuss concerns regarding diversion and ways in which prison-based OAT programs can be improved to increase their safety and acceptability among correctional staff. Ongoing advocacy is required on the part of health-care workers and policymakers to ensure that individuals are able to appropriately access this life-saving therapy while incarcerated. Originality/value To the best of the authors’ knowledge, this is the first case report to describe forcible tapering of OAT as a disciplinary measure during incarceration. Despite existing evidence emphasizing the significant risk of overdose associated with detoxification from opioids, this case highlights the need for further research into the causes and prevalence of this practice.

scholarly journals Adapting inpatient addiction medicine consult services during the COVID-19 pandemic

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Miriam T. H. Harris ◽  
Alyssa Peterkin ◽  
Paxton Bach ◽  
Honora Englander ◽  
Emily Lapidus ◽  
...  
Keyword(s):  
Substance Use ◽  
Discharge Planning ◽  
Medical Center ◽  
Health Care Systems ◽  
Opioid Use Disorder ◽  
Substance Use Treatment ◽  
New Haven ◽  
Opioid Use ◽  
Addiction Medicine ◽  
The Impact

Abstract Background We describe addiction consult services (ACS) adaptations implemented during the Novel Coronavirus Disease 2019 (COVID-19) pandemic across four different North American sites: St. Paul’s Hospital in Vancouver, British Columbia; Oregon Health & Sciences University in Portland, Oregon; Boston Medical Center in Boston, Massachusetts; and Yale New Haven Hospital in New Haven, Connecticut. Experiences ACS made system, treatment, harm reduction, and discharge planning adaptations. System changes included patient visits shifting to primarily telephone-based consultations and ACS leading regional COVID-19 emergency response efforts such as substance use treatment care coordination for people experiencing homelessness in COVID-19 isolation units and regional substance use treatment initiatives. Treatment adaptations included providing longer buprenorphine bridge prescriptions at discharge with telemedicine follow-up appointments and completing benzodiazepine tapers or benzodiazepine alternatives for people with alcohol use disorder who could safely detoxify in outpatient settings. We believe that regulatory changes to buprenorphine, and in Vancouver other medications for opioid use disorder, helped increase engagement for hospitalized patients, as many of the barriers preventing them from accessing care on an ongoing basis were reduced. COVID-19 specific harm reductions recommendations were adopted and disseminated to inpatients. Discharge planning changes included peer mentors and social workers increasing hospital in-reach and discharge outreach for high-risk patients, in some cases providing prepaid cell phones for patients without phones. Recommendations for the future We believe that ACS were essential to hospitals’ readiness to support patients that have been systematically marginilized during the pandemic. We suggest that hospitals invest in telehealth infrastructure within the hospital, and consider cellphone donations for people without cellphones, to help maintain access to care for vulnerable patients. In addition, we recommend hospital systems evaluate the impact of such interventions. As the economic strain on the healthcare system from COVID-19 threatens the very existence of ACS, overdose deaths continue rising across North America, highlighting the essential nature of these services. We believe it is imperative that health care systems continue investing in hospital-based ACS during public health crises.

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