strong opioids
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Author(s):  
Samira Choufi ◽  
Simon Mounier ◽  
Etienne Merlin ◽  
Emmanuelle Rochette ◽  
Jessica Delorme ◽  
...  

Codeine use was restricted in 2013 and is currently contraindicated for children below the age of 12 years. We examined how the prescription of opioid analgesics in children in France evolved between 2012 and 2018. Our population-based study from the SNIIRAM database (National System of Health Insurance Inter-Regime Information) was designed to determine trends in opioid prescription from 2012 to 2018 in all French children. The number of children who received at least one opioid prescription gradually declined from 452,665 in 2012 (347.5 children per 10,000) to 169,338 in 2018 (130.3 children per 10,000). This decrease was especially marked for codeine (36 children per 10,000 in 2018 vs. 308.5 children per 10,000 in 2012), whereas the number of tramadol prescriptions increased by 171% in 2018 (94.6 children per 10,000). Despite the increase, strong opioids still formed only a small proportion of prescriptions (2.6 children per 10,000 given opioids in 2018). Overall opioid prescriptions in French children dramatically decreased between 2012 and 2018, probably owing to restrictions on the use of codeine. Codeine has been partly replaced by tramadol. Morphine is still probably underused. This suggests that opioids are being used less often for pain management in children.


Author(s):  
Alexis Oliva ◽  
Néstor Armas ◽  
Sandra Dévora ◽  
Susana Abdala

Abstract This study is an evaluation of prescription opioid use on the island of La Gomera, a mainly rural area, during the period 2016–2019 at various levels. Data were extracted from the wholesalers who supply the community pharmacies at the population level. Prescription opioid use was measured as defined daily doses per 1,000 inhabitants/day (DID) and by the number of units sold per 1,000 inhabitants and year (units sold). This provided an island total of La Gomera’s overall prescription of opioids and its rate of change, as well as differences in prescribing at the municipal and health area level. Tramadol with acetaminophen and tramadol in monotherapy were the most consumed by “units sold” parameter, which accounted for 69.48% and 18.59% of the total. The situation was similar for DID, although with lower percentages, but a significant increase was observed in the use of fentanyl and buprenorphine, around 15% in each case. The balance between the uses of weak or strong opioids was different in La Gomera compared to that of Spain as a whole. In Spain, almost 70% of the prescriptions were for weak opioids compared to 58.67% in La Gomera. Fentanyl was the most used strong opioid (16.10%) followed by tapentadol and buprenorphine, around 5% each, whereas in La Gomera, buprenorphine was the most consumed (15.75%) followed by fentanyl (14.87%) and tapentadol (5.82%). These differences in prescription opioid use are most likely explained by prescriber characteristics, whereas the population age, socioeconomic status, or living in rural/urban area are not decisive determinants.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jin-Ping Zhao ◽  
Christelle Berthod ◽  
Odile Sheehy ◽  
Behrouz Kassaï ◽  
Jessica Gorgui ◽  
...  

Abstract Background Recent studies show a rapid growth among pregnant women using high potency opioids for common pain management during their pregnancy. No study has examined the duration of treatment among strong opioid users and weak opioid users during pregnancy. We aimed to investigate the prevalence of prescribed opioid use during pregnancy, in Quebec; and to compare the duration of opioid treatment between strong opioid users and weak opioid users. Methods Using the Quebec Pregnancy Cohort (1998–2015), we included all pregnancies covered by the Quebec Public Prescription Drug Insurance Program. Opioid exposure was defined as filled at least one prescription for any opioid during pregnancy or before pregnancy but with a duration that overlapped the beginning of pregnancy. Prevalence of opioids use was calculated for all pregnancies, according to pregnancy outcome, trimester of exposure, and individual opioids. The duration of opioid use during pregnancy was analyzed according to 8 categories based on cumulative duration (< 90 days vs. ≥90 days), duration of action (short-acting vs. long-acting) and strength of the opioid (weak vs. strong). Results Of 442,079 eligible pregnancies, 20,921 (4.7%) were exposed to opioids. Among pregnancies ending with deliveries (n = 249,234), 5.4% were exposed to opioids; the prevalence increased by 40.3% from 3.9% in 1998 to 5.5% in 2015, more specifically a significant increase in the second and third trimesters of pregnancy. Weak opioid, codeine was the most commonly dispensed opioid (70% of all dispensed opioids), followed by strong opioid, hydromorphone (11%), morphine (10%), and oxycodone (5%). The prevalence of codeine use decreased by 47% from 4.3% in 2005 to 2.3% in 2015, accompanied by an increased use of strong opioid, morphine (0.029 to 1.41%), hydromorphone (0.115 to 1.08%) and oxycodone (0.022 to 0.44%), from 1998 to 2015. The average durations of opioid exposure were significantly longer among pregnancies exposed to strong opioid as compared to weak opioid regardless of the cumulative duration or duration of action (P < 0.05). Conclusions Given the differences in the safety profile between strong opioids and the major weak opioid codeine, the increased use of strong opioids during pregnancy with longer treatment duration raises public health concerns.


Author(s):  
L. Brullot ◽  
G. Hans ◽  
P.J. Germonpré ◽  
D. Mesotten ◽  
T. Vanneste ◽  
...  

Retrospective practice analysis of tapentadol prolonged release in patients with chronic pain refractory to strong opioids Tapentadol is a strong opioid with mixed antinociceptive analgesia and inhibition of the descending pain pathway, tested for the management of different types of chronic refractory pain. In daily practice, tapentadol prolonged release (tapentadol PR) is reserved for patients who already received strong opioids with unsatisfactory pain control or severe side effects, or patients who experienced opioid-induced hyperalgesia. The data of patients treated with tapentadol PR in 3 pain centers in Flanders (Belgium) were analyzed. The primary endpoint was the number of patients who continued the tapentadol PR treatment 6 weeks after it started. The secondary endpoints were pain reduction, global perceived effect (GPE) and side effects. Six weeks after the start of the treatment, 83% of the patients continued the therapy. The median reduction in pain score was 2 points on a numeric scale from 0-10. The GPE showed an improvement of 25% to 30% in 52% of the patients. The mean duration of the tapentadol PR treatment was 6.5 months. Only 24% of the patients stopped the treatment because of side effects and 34% due to an unsatisfactory result. Tapentadol PR is a possible addition in the therapeutic arsenal for the treatment of patients with severe chronic pain.


2021 ◽  
Vol 17 (6) ◽  
pp. 465-479
Author(s):  
Ben Hunter, MBChB, BSc (Hons) ◽  
Shiva Tripathi, MBBS, FRCA, CCT

Introduction: Current data suggest that the chronic use of strong opioids in low back pain (LBP) is increasing. There is evidence for the use of opioids in the initial management of LBP, but the efficacy in the long term is unknown. This article intends to examine the use of opioids in patients with chronic LBP over a period of three doctor-led clinics.Methods: Single-center retrospective cohort study following 200 patients through the pain clinic at a UK teaching hospital for more than two clinic visits, up to a maximum of three. Data concerning demographics, pain scores, medication changes, and clinic outcome.Results: Data collected showed that there was a significant correlation between baseline morphine equivalent amount (MEA) and final clinic MEA; initial pain scores and final clinic MEA; cause of LBP and final clinic LBP; and traumatic LBP and absolute change in MEA. There was no association between number of physical interventions and MEA. The sample also showed an average absolute change in MEA by 2.93 ± 57.86 mg. The proportion of patients with a MEA of 50 mg/d increased from 24 to 29 percent. The proportion of patients on opioids at least one opioid increased by 10 percent.Conclusions: Significant predictors of final clinic MEA were initial pain scores, baseline MEA, and the cause of LBP. Duration of pain was a poor predictor of MEA. There was no association between MEA and number of interventions. In this cohort, the trend seems to be increasing the number and dose of opioids in patients with LBP.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mathilde Ruel ◽  
Bastien Boussat ◽  
Mehdi Boudissa ◽  
Virginie Garnier ◽  
Catherine Bioteau ◽  
...  

Abstract Background Patients with cognitive deficits are 3 times more likely to suffer a hip fracture than geriatric patients of the same age group without cognitive deficits. The persistence of perioperative pain following hip fracture is a risk factor for the occurrence of delirium, poor functional prognosis, and the development of secondary chronic pain. Patients with cognitive deficits receive 20 to 60% less analgesics than those without cognitive deficits. Our retrospective descriptive monocentric study was performed in an orthogeriatric unit on a cohort of elderly patients hospitalized for hip fracture. The aim of the study was to compare the quantity of strong opioids delivered in a morphine sulfate equivalent daily during the preoperative period after a hip fracture between cognitively intact patients and those with cognitive deficits. Results Our total population of 69 patients had a median age of 90 years old, and 46% of these patients had moderate or severe cognitive deficits. During the preoperative period, the same quantity of strong opioids was administered to both groups of patients (13.1 mg/d versus 10.8 mg/d (p = 0.38)). Patients with moderate to severe cognitive deficits more often experienced delirium during their hospitalization (p < 0.01) and received more psychotropic drugs in the first 3 postoperative days (p = 0.025). Conclusions We reported that with standardized pain management in an orthogeriatric unit, patients aged 75 years and older received the same daily average quantity of strong opioids during the preoperative period regardless of the presence of cognitive deficits.


Author(s):  
Ilari Rautalin ◽  
Miia Kallio ◽  
Miikka Korja

Abstract Background Postoperative opioid use plays an important role in the global opioid crisis, but little is known about in-hospital opioid use trends of large surgical units. We investigated whether postoperative in-hospital opioid consumption changed in a large academic neurosurgical unit between 2007 and 2018. Methods We extracted the data of consumed opioids in the neurosurgical intensive care unit and two bed wards between 2007 and 2018. Besides overall consumption, we analyzed the trends for weak (tramadol and codeine), strong, and the most commonly used opioids. The use of various opioids was standardized using the defined daily doses (DDDs) of each opioid agent. A linear regression analysis was performed to estimate annual treatment day-adjusted changes with 95% confidence intervals. Results Overall, 121 361 opioid DDDs were consumed during the 196 199 treatment days. Oxycodone was the most commonly used postoperative opioid (49% of all used opioids) in neurosurgery. In the bed wards, the use of oral oxycodone increased 375% (on average 13% (9–17%) per year), and the use of transdermal buprenorphine 930% (on average 26% (9–45%) per year) over the 12-year period. Despite the increased use of strong opioids in the bed wards (on average 3% (1–4%) per year), overall opioid use decreased 39% (on average 6% (4–7%) per year) between 2007 and 2018. Conclusions Due to the increase of strong opioid use in the surgical bed wards, we encourage other large teaching hospitals and surgical units to investigate whether their opioid use trends are similarly worrisome and whether the opioid consumption changes in the hospital setting are transferred to opioid use patterns or opioid-related harms after discharge.


PLoS Medicine ◽  
2021 ◽  
Vol 18 (10) ◽  
pp. e1003796
Author(s):  
Sarah L. Alderson ◽  
Tracey M. Farragher ◽  
Thomas A. Willis ◽  
Paul Carder ◽  
Stella Johnson ◽  
...  

Background The rise in opioid prescribing in primary care represents a significant international public health challenge, associated with increased psychosocial problems, hospitalisations, and mortality. We evaluated the effects of a comparative feedback intervention with persuasive messaging and action planning on opioid prescribing in primary care. Methods and findings A quasi-experimental controlled interrupted time series analysis used anonymised, aggregated practice data from electronic health records and prescribing data from publicly available sources. The study included 316 intervention and 130 control primary care practices in the Yorkshire and Humber region, UK, serving 2.2 million and 1 million residents, respectively. We observed the number of adult patients prescribed opioid medication by practice between July 2013 and December 2017. We excluded adults with coded cancer or drug dependency. The intervention, the Campaign to Reduce Opioid Prescribing (CROP), entailed bimonthly, comparative, and practice-individualised feedback reports to practices, with persuasive messaging and suggested actions over 1 year. Outcomes comprised the number of adults per 1,000 adults per month prescribed any opioid (main outcome), prescribed strong opioids, prescribed opioids in high-risk groups, prescribed other analgesics, and referred to musculoskeletal services. The number of adults prescribed any opioid rose pre-intervention in both intervention and control practices, by 0.18 (95% CI 0.11, 0.25) and 0.36 (95% CI 0.27, 0.46) per 1,000 adults per month, respectively. During the intervention period, prescribing per 1,000 adults fell in intervention practices (change −0.11; 95% CI −0.30, −0.08) and continued rising in control practices (change 0.54; 95% CI 0.29, 0.78), with a difference of −0.65 per 1,000 patients (95% CI −0.96, −0.34), corresponding to 15,000 fewer patients prescribed opioids. These trends continued post-intervention, although at slower rates. Prescribing of strong opioids, total opioid prescriptions, and prescribing in high-risk patient groups also generally fell. Prescribing of other analgesics fell whilst musculoskeletal referrals did not rise. Effects were attenuated after feedback ceased. Study limitations include being limited to 1 region in the UK, possible coding errors in routine data, being unable to fully account for concurrent interventions, and uncertainties over how general practices actually used the feedback reports and whether reductions in prescribing were always clinically appropriate. Conclusions Repeated comparative feedback offers a promising and relatively efficient population-level approach to reduce opioid prescribing in primary care, including prescribing of strong opioids and prescribing in high-risk patient groups. Such feedback may also prompt clinicians to reconsider prescribing other medicines associated with chronic pain, without causing a rise in referrals to musculoskeletal clinics. Feedback may need to be sustained for maximum effect.


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