Journal articles on the topic 'Opioid dependence'
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Lazcano, A. I. López, L. Ortega, A. Fauli, C. Busquets, and A. Lligoña. "Prescription opioid abuse, addiction and psychopathology in a pain clinic." European Psychiatry 41, S1 (April 2017): s869. http://dx.doi.org/10.1016/j.eurpsy.2017.01.1744.
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IntroductionThere has been an escalation of therapeutic use and abuse of opioids. Aberrant drug related behaviors (ADRB) have prevalence between 2.8% and 62.2% in chronic pain patients treated with opioids and dependence is estimated around 3.27%.ObjectivesTo estimate the prevalence of dependence, ADRB, risk of opioid abuse, and co-occurring disorders in patients with chronic pain in our environment.MethodsA total of 115 (n = 115) patients attending our pain clinic were screened to evaluate the risk of opioid abuse and presence of dependence including a clinical interview, hamilton depression scale (HAD), opioid risk tool (ORT), diagnostic criteria for substance abuse and dependence (DSM IV-TR) and a checklist of ADRB.ResultsAmong the patients, 78.26% were taking opioids, aberrant opioid related behaviors were detected in 20% and 8.9% met criteria for abuse or dependence; 11.3% had high risk and 20% moderate risk of opioid abuse (ORT). The most prevalent substance use disorders were sedative (11.3%) and alcohol (5.2%). There was a significant difference in means (t = -3.20 P < 0.005) in ORT scores between patients with current opiod dependence (x = 7.70 [s.d. = 3.07]) and without it (x = 2.88 [s.d = 3.58]); 30.4% had anxiety, 20% depression and 3.5% adjustment disorders; 57.5% and 48.3% had a score > 10 on anxiety and depression respectively on the HAD.ConclusionsA systematic screening of risk of opioid abuse and of dependence as well as psychotherapy to treat comorbid psychopathology should be part of the treatment protocol.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Daoust, R., J. Paquet, J. Morris, A. Cournoyer, E. Piette, J. Lessard, V. Castonguay, S. Gosselin, and J. Chauny. "P026: Opioid use and dependence three months after an emergency department visit for acute pain." CJEM 20, S1 (May 2018): S66. http://dx.doi.org/10.1017/cem.2018.224.
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Introduction: Most studies evaluating prescription opioid dependence or misuse are retrospective and are based on prescription filling rates from pharmaceutical databases. These studies cannot evaluate if opioids are really consumed nor differentiate if used for a new pain, chronic pain, or for misuse/dependence. The aim of this study was to assess the opioid consumption in emergency department (ED) patients three months after discharge with an opioid prescription. Methods: This prospective cohort study was conducted in the ED of a tertiary care centre with a convenience sample of patients aged 18 years and older, recruited 24/7, who consulted and were discharged for an acute pain condition ( 2 weeks). We excluded patients who: did not speak French or English, were using opioid medication prior to their ED visit, with an ED stay > 48 hours, or suffering from cancer or chronic pain. Three months post-ED visit, participants were contacted by phone for a structured interview on their past two-week opioid use, their reasons for consuming them, and also answered the Rapid Opioid Dependence Screen (RODS) questionnaire. Results: In the 524 participants interviewed at three months (mean age ± SD: 51±16 years, 47% women), 44 (8.4%) patients consumed opioids in the previous two weeks. Among those, 72% consumed opioids for their initial pain, 19% for a new unrelated pain, and 9% for another reason. In this entire cohort, only five patients (1%) tested positive to opioid dependence from the RODS test. The low dependence incidence could be affected by a social desirability bias. Conclusion: This study suggests that opioid use at 3-month, for patients initially treated for acute pain, is associated with opioid dependency in 1% or possible misuse in only 9%. Additional prospective studies using multiple methods to measure opioids consumption, misuse, and dependence are needed.
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Colson, James. "Office-Based Opioid Dependence Treatment." July 2012 3S;15, no. 3S;7 (July 14, 2012): ES231—ES236. http://dx.doi.org/10.36076/ppj.2012/15/es231.
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Background: Opioid misuse and abuse occurring in association with the treatment of chronic non-cancer pain are not new phenomena, but their increasing prevalence in recent years is unprecedented. Advancements in pharmaceutical technologies have provided opioid-related drugs, which lack the pure mu agonist activity characteristic of the typical opioid congeners. This absent or altered mu receptor activity imparts an opioid receptor antagonistic or partial agonistic pharmacologic action, which serves to modulate the development of opioid-induced tolerance and physical dependence and facilitate detoxification and withdrawal from opioids. Opioid antagonists and partial agonists are being used in abuse deterrent strategy regimens to prevent opioid tolerance and the development of dependence, as well as in the management of opioid detoxification and treatment of withdrawal. The specific opioid antagonists and partial agonists used in these various therapeutic modalities will be the focus of this review. Objectives: Evaluate the comparative therapeutic utility of opioid antagonists and partial agonists in preventing the development of opioid tolerance and treating opioid dependence, detoxification, and withdrawal. A primary focus is the use of opioid antagonists and partial agonists within an office-based practice. Methods: A narrative review of the current literature involving the therapeutic use of opioid antagonists and partial agonists in the management of opioid tolerance, dependence, detoxification, and withdrawal. A computerized literature search in the PubMed, EMBASE, BioMed, and Cochrane Library review databases from 2008 through 2010 was performed. This search included systematic and narrative reviews, prospective and retrospective studies, as well as cross-references from bibliographies of notable primary and review articles and abstracts from scientific meetings. US Food and Drug Administration records and pharmaceutical manufacturers’ product literature were also used in the search. Conclusion: Opioid dependency, whether it results from the misuse or abuse of prescription or street drugs, continues to be a significant public health issue. Passage of DATA 2000 and US Food and Drug Administration approval of buprenorphine and buprenorphine/ naloxone has revolutionized opioid dependence therapy. The traditional addiction medicine therapy regimen of methadone maintenance, with its inherent legal limitations and restrictions, has been challenged by an office-based dependence practice with buprenorphine serving as a prominent therapeutic tool. Key words: opioid antagonist, opioid partial agonist, tolerance, dependence, detoxification, withdrawal, hyperalgesia, buprenorphine, suboxone, naloxone, naltrexone, methylnaltrexone, nalmefene, tramadol, butorphanol, nalbupine, pentazocine.
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Levin, Marc, Michael G. Roskies, and Jamil Asaria. "Perspectives of Facial Plastic Surgeons on Opioid Dependence in Rhinoplasty Patients." Facial Plastic Surgery 35, no. 05 (July 10, 2019): 540–45. http://dx.doi.org/10.1055/s-0039-1693133.
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AbstractUnderstanding the perspectives and opinions of facial plastic surgeons on opioid dependence is critical in a national epidemic of opioid overuse. Findings may encourage surgeon education so that facial plastic surgeons may be able to judiciously prescribe opioids, improving patient outcomes and reducing healthcare opioid-related spending. The objective of this study is to understand facial plastic surgeons' perspectives on opioid dependence in rhinoplasty patients. A key secondary objective was to quantify facial plastic surgeons' opioid prescribing patterns. This was a prospective survey study. A nine-question survey was sent to all members of the American Academy of Facial Plastic and Reconstructive Surgery in July of 2018, and analysis of the data was completed in August of 2018. The primary study outcome measurement was surgeon perspectives on opioid dependence. This was measured by an online survey. A total of 164 facial plastic surgeons responded to the survey (response rate: 6.6%). The majority were experienced surgeons in practice for more than 10 years (61.96%) who perform less than five rhinoplasties per week (84.15%). Of the facial plastic surgeons, 89.51% prescribe some variation of opioids following rhinoplasty. Most surgeons believe that opioid dependence is not a problem in rhinoplasty patients (86.96%), but that it is a problem among surgical patients in general (61.11%). The majority (52.45%) of surgeons prescribe between 11 and 25 tablets of opioids following rhinoplasty, with 25.17% of surgeons prescribing > 25 tablets of opioids. Facial plastic surgeons do not believe opioid dependence to be a problem among rhinoplasty patients. Resultantly, many facial plastic surgeons can prescribe more than 25 tables of opioids following rhinoplasty. The findings suggest that facial plastic surgeons may require further education and complete more research regarding opioid dependence among the rhinoplasty population. Additionally, the findings are important for health policy in that they encourage the creation of rhinoplasty specific opioid prescription guidelines.
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Owais Kareem, Muhammad Asif, Sohaib Hassan, Muqaddas Abaid, Muhammad Ashrib, and Muhammad Arqam Arshad. "Severity of opioid dependence and its relation with psychosocial factors of users." Professional Medical Journal 28, no. 11 (October 31, 2021): 1604–10. http://dx.doi.org/10.29309/tpmj/2021.28.11.6638.
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Objectives: To determine the relationship between severe opioid dependence and psychosocial factors of users Study Design: Descriptive Cross Sectional study. Setting: Department of Psychiatry Nishtar Hospital Multan. Period: Nov 2018 to May 2020. Material & Methods: 196 participants were enrolled through non probability purposive sampling technique. Pearson chi square test was applied to identify significant relationship between severe opioid dependence and psychosocial factors. Result: Mean age of study cases was 30.86 ± 1.66. The frequency of severe opioid dependence was noted in 159 (81.1%) of study participants. Statistical significant relation of severe opioid dependence was noted with age, literacy status, literacy level, marital status, monthly income, route of opioid use, frequency of opioid use per day, previous detoxification treatment and encounters with law enforcement agencies Conclusion: The severity of opioid dependence was high in patients admitted for treatment of opioid use. Severe opioid dependence was related with certain psychosocial factors such as user’s age, literacy status, literacy level, marital status, monthly income, route of opiod use, frequency of opioid use, previous detoxification treatment for opioid use and encounters with law enforcement agencies. This suggests that optimal treatment of severe opioid dependence should include interventions based on individual’s psychosocial needs.
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Williams, John T., MacDonald J. Christie, and Olivier Manzoni. "Cellular and Synaptic Adaptations Mediating Opioid Dependence." Physiological Reviews 81, no. 1 (January 1, 2001): 299–343. http://dx.doi.org/10.1152/physrev.2001.81.1.299.
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Although opioids are highly effective for the treatment of pain, they are also known to be intensely addictive. There has been a massive research investment in the development of opioid analgesics, resulting in a plethora of compounds with varying affinity and efficacy at all the known opioid receptor subtypes. Although compounds of extremely high potency have been produced, the problem of tolerance to and dependence on these agonists persists. This review centers on the adaptive changes in cellular and synaptic function induced by chronic morphine treatment. The initial steps of opioid action are mediated through the activation of G protein-linked receptors. As is true for all G protein-linked receptors, opioid receptors activate and regulate multiple second messenger pathways associated with effector coupling, receptor trafficking, and nuclear signaling. These events are critical for understanding the early events leading to nonassociative tolerance and dependence. Equally important are associative and network changes that affect neurons that do not have opioid receptors but that are indirectly altered by opioid-sensitive cells. Finally, opioids and other drugs of abuse have some common cellular and anatomical pathways. The characterization of common pathways affected by different drugs, particularly after repeated treatment, is important in the understanding of drug abuse.
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&NA;. "Opioid dependence." Inpharma Weekly &NA;, no. 1168 (December 1998): 4. http://dx.doi.org/10.2165/00128413-199811680-00004.
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Benich, Joseph J. "Opioid Dependence." Primary Care: Clinics in Office Practice 38, no. 1 (March 2011): 59–70. http://dx.doi.org/10.1016/j.pop.2010.11.005.
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Burks, T. F., C. C. Bihm, G. C. Rosenfeid, and C. L. Williams. "Opioid Dependence." Japanese Journal of Pharmacology 82 (2000): 38. http://dx.doi.org/10.1016/s0021-5198(19)47632-4.
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Perimbeti, Stuthi Pavani, Kevin Ye Hou, Sabarina Ramanathan, Adonas Woodard, Daniel Kyung, Priyadarshini Pathak, Rishi Shrivastav, Kristine Ward, and Michael Styler. "Opioid Dependency Significantly Increases Complications and Mortality in Sickle Cell Disease." Blood 132, Supplement 1 (November 29, 2018): 4701. http://dx.doi.org/10.1182/blood-2018-99-120012.
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Abstract Introduction: According to the National Center for Health Statistics, there was a twenty-one percent increase in deaths from drug overdose in the USA, with opioids contributing to about two-thirds of these deaths. Despite nationwide efforts to reduce opioid use, narcotic pain medications are still the most frequently used method of pain control in patients with sickle cell disease (SCD). We sought to examine the burden and complications of opioid dependence in patients with SCD. Methods: The National Inpatient Sample (NIS) for the years 1999 to 2014 was queried to yield adult admissions with a primary diagnosis of sickle cell disease (ICD-9 codes: 2826, 28260, 28261, 28262, 28263, 28264, 28268, 28269) and the admissions were stratified based on the presence of opioid dependence (ICD-9 codes: 30400-30403, 30470-30473, 30550-30553). Univariate and bivariate analyses were performed using the Chi square test. Cox proportional hazard regression was used to control for multiple confounders in calculating the hazard ratios of occurrence of complications and mortality. Results A total of 216,438 (Weighted N=1,066,536) admissions were identified between 1999 and 2014, out of which 1.6% (N=3603) had opioid dependence. The median age of patients with opioid dependence was 26 years, compared to 31 years in patients without opioid dependence. Average cost and length of hospitalization for patients with and without opioid dependence was $29,883 & $20,638 and 6.4 days & 5.1 days, respectively. The rates of various complications and Hazard Ratio (HR) of event occurrence among patients with and without opioid dependence are depicted in Table 1. After adjusting for demographics, hospital characteristics (region, bed size, location), and baseline comorbidities, SCD patients with opioid dependence had a 50% increased risk of in-hospital mortality (H.R 1.5, 95% C.I. 1.2-1.6, p<0.001) compared to those without. Conclusions: There is a correlation between opioid dependence and SCD complications among patients hospitalized with a diagnosis of SCD. Perhaps, patients predisposed to vaso-occlusive events require more frequent use of narcotics and become opioid dependent. Alternatively, the dependence on opioids may increase the incidence of complications from sickle cell disease. Regardless, patients with opioid dependence have significantly higher in-hospital mortality. The main limitation of this study is the use of ICD codes for identifying opioid dependence. In our opinion, the abnormally low incidence of opioid dependence in our data is a poor representation of the actual population. Opioid abuse is a serious concern that has heavy financial, social and public health implications on the welfare of the community, particularly those with SCD. This study highlights the need for more effective disease modifying agents for the treatment of this chronic and debilitating disorder. Disclosures No relevant conflicts of interest to declare.
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Villarreal, Elvia L., Steven E. Wolf, George Golovko, Kendall Wermine, Sunny Gotewal, Lyndon G. Huang, Kassandra K. Corona, et al. "26 Opioid Prescription in Burns: A Large Database Analysis from 1990 to 2021." Journal of Burn Care & Research 43, Supplement_1 (March 23, 2022): S19—S20. http://dx.doi.org/10.1093/jbcr/irac012.029.
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Abstract Introduction The use of opioids in the medical field has contributed to the growing opioid epidemic. Nonetheless, opioids remain imperative in the treatment for pain management in burns. While some studies have addressed the use of opioids in surgery, a comprehensive analysis of the pattern of opioids use in burns has not been investigated. This study aims to identify trends of opioid use and investigate the risk of opioid related disorders in burn patients. Methods Data was obtained from TriNetX, a national research database that provides medical records of de-identified patients. The study population includes patients that were prescribed an opioid, ICD-10 code CN101, on or after any instance of burn between January 1st, 1990 and September 19th, 2021. Patient population was further stratified by the decade in which patients received opioids for pain following burn injury: 1990-1999, 2000-2009, 2010-2019, and 2020-September 19th, 2021. Five outcomes were investigated: opioid related disorders, opioid dependence, opioid abuse, intentional self-harm, and mental and behavioral disorders due to psychoactive substance use. Cohorts were matched for age at index, sex, and race. Statistical analysis used risk ratios with a 95% confidence interval, and p< 0.05 was considered significant. Results We identified 8,421 patients that were prescribed an opioid between 1990-1999, 30,846 patients from 2000-2009, 169,991 patients from 2010-2019, and 30,966 patients from 2020-present. When compared to the 2000s cohorts, the 1990s patients had a 47% decrease in risk of opioid related disorders, with a 53% decrease in risk of opioid dependence, 45% decrease in risk in opioid abuse, 11% decrease in risk of mental and behavioral disorders due to psychoactive substance use, and 63% reduced risk of intentional self-harm. Comparison of the 2000-2009 to 2010-2019 cohorts showed increased risk of opioid related disorders (RR= 1.912), opioid dependence (RR=1.569), opioid abuse (RR=1.677), mental and behavioral disorders (RR =1.733), and intentional self-harm (RR=2.027). When compared to 2020-present, the 2010-2019 patient cohort had 10 times the risk of developing opioid-related disorders, with 3 times the risk for opioid dependence and behavioral disorders, and 5 times the risk for opioid abuse and intentional self-harm. Conclusions The risk of opioid related disorders in the 1990s was lower compared to the 2000s. Since 2000, the risk of opioid related disorders has significantly increased. Recognizing the risks of opioid prescriptions in burn patients is imperative when addressing the role of physicians in controlling the constantly growing opioid epidemic.
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Mourad, Mirella, Ruth Landau, Jason D. Wright, Zainab Siddiq, Cassandra R. Duffy, Adina R. Kern-Goldberger, Mary E. D'Alton, and Alexander M. Friedman. "Oral Opioid Use during Vaginal Delivery Hospitalizations." American Journal of Perinatology 37, no. 04 (February 12, 2019): 390–97. http://dx.doi.org/10.1055/s-0039-1678566.
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Objective This study aimed to determine the receipt of short-acting opioid medications during vaginal delivery hospitalizations. Study Design The Perspective database was analyzed to evaluate patterns of short-acting oral opioid use during vaginal delivery hospitalizations from January 2006 to March 2015. Unadjusted and adjusted models evaluating the role of demographic and hospital factors were created evaluating use of opioids. Hospital-level rates of opioid use were evaluated. Opioid receipt among women with opioid abuse or dependence was evaluated based on overall hospital rates of opioid use. Results Of 3,785,396 vaginal delivery hospitalizations from 2006 to 2015, 1,720,899 (45.5%) women received an oral opioid for pain relief. Opioid use varied significantly among the 458 hospitals included in the analysis, with one-third of hospitals providing opioids to <38% of patients, one-third to 38 to <59% of patients, and one-third to ≥59% of patients. When hospitals were stratified by overall opioid administration rates, women with opioid abuse or dependence were less likely to be given opioids in hospitals with low overall opioid rates. Discussion The use of opioid pain medications during vaginal delivery hospitalizations varied significantly among hospitals, suggesting that standardization of pain management practices could reduce opioid use.
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Eichmeyer, Sarah, and Jonathan Zhang. "Pathways into Opioid Dependence: Evidence from Practice Variation in Emergency Departments." American Economic Journal: Applied Economics 14, no. 4 (October 1, 2022): 271–300. http://dx.doi.org/10.1257/app.20210048.
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We use practice variation across physicians to uncover the role of medical care in causing opioid dependence. Using health records of 2 million US veterans with emergency department visits, we find that quasi-random assignment to a top (versus bottom) decile prescribing provider significantly increases subsequent opioid use and misuse rates. Instrumental variable results show that opioid prescription receipt leads to a 20 percent increase in the probability of long-term prescription opioid use and sizable increases in the development of opioid use disorder and opioid overdose mortality. We find suggestive evidence of transition into illicit opioids due to prescription opioid exposure. (JEL I11, I12, I18)
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Ouyang, Handong, Shue Liu, Weian Zeng, Roy C. Levitt, Keith A. Candiotti, and Shuanglin Hao. "An Emerging New Paradigm in Opioid Withdrawal: A Critical Role for Glia-Neuron Signaling in the Periaqueductal Gray." Scientific World Journal 2012 (2012): 1–9. http://dx.doi.org/10.1100/2012/940613.
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The chronic use of opiates (i.e., narcotics such as the natural derivatives of opium including morphine or codeine) or opioids (i.e., semisynthetic derivatives of opium and other molecules that activate opioid receptors) induces dependence, which is associated with various specific behavioral and somatic signs after their withdrawal or after the administration of an opioid antagonist. Among the brain regions implicated in opiate dependence and withdrawal, the periaqueductal gray area (PAG) appears to be critical in regulating the complex signs and symptoms of opioid withdrawal. Numerous neurochemical mechanisms in the PAG have been identified that may contribute to the opioid withdrawal syndrome. Accumulating evidence suggests that glial activation leading to the release of proinflammatory molecules acting on neurons is important in the complex syndrome of opioid dependence and withdrawal. This paper focuses on the recent advances in our understanding of the vital role that glia-neuron interactions play in opioid dependence and withdrawal within the PAG. We summarize those neurochemical mechanisms associated with opioid withdrawal including the recently defined importance of TNFαrelease from activated glial cells that communicate with TNF receptors on PAG neurons.
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Leung, Janni, Gary C. K. Chan, Samuel X. Tan, Caitlin McClure-Thomas, Louisa Degenhardt, and Wayne Hall. "State-Level Prevalence and Associates of Opioid Dependence in the USA." International Journal of Environmental Research and Public Health 19, no. 7 (March 23, 2022): 3825. http://dx.doi.org/10.3390/ijerph19073825.
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Traditionally, opioid-related disease burden was primarily due to heroin use. However, increases in extra-medical (or non-medicinal use of prescription opioids; NMPOs) use has precipitated the current overdose epidemic in North America. We aim to examine the state-level prevalence of heroin and NMPO dependence and their associations with opioid-related mortality and state-level socio-demographic profiles. Data were pooled from the 2005–2014 National Survey on Drug Use and Health (NSDUH). We examine opioid-related mortality from CDC WONDER (Cause of Death database) by the past year prevalence of DSM-IV heroin and NMPO dependence, by age and sex, and their associations with state-level socio-demographic characteristics from census data. State-level rates of heroin dependence were associated with opioid-related death rates in young and mid-aged adults, while rates of NMPO dependence were associated with opioid-related death rates across all ages. The prevalence of heroin dependence was positively associated with state-level GDP/capita and urbanity. State-level NMPO dependence prevalence was associated with higher unemployment, lower GDP/capita, and a lower high-school completion rate. The prevalence of heroin and NMPO dependence are associated with a broad range of geographical and socio-demographic groups. Taking a wider view of populations affected by the opioid epidemic, inclusive interventions for all are needed to reduce opioid-related disease burden.
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McDonough, MBBS, Mike, Jacinta L. Johnson, PhD, Jason M. White, PhD, and Femke T. A. Buisman-Pijlman, PhD. "Measuring opioid dependence in chronic pain patients: A comparison between addiction clinic and pain clinic patient populations." Journal of Opioid Management 15, no. 4 (July 1, 2019): 285–93. http://dx.doi.org/10.5055/jom.2019.0514.
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Objective: To compare dependence characteristics between patients with chronic pain treated within an addiction medicine setting with those attending specialist pain clinics.Setting and patients: Forty patients with chronic non-cancer pain taking opioid analgesics for 1 year were recruited from university-affiliated, tertiary teaching hospital clinics; 20 from an addiction medicine clinic (addiction clinic group) and 20 from specialist pain clinics (pain clinic group).Design and main outcome measures: Data regarding demographics, past and current substance use, pain history and current daily opioid intake were collected. Patients completed three questionnaires: the Severity of Opioid Dependence Questionnaire, Leeds Dependence Questionnaire, and Pain Disability Index. A novel “Opioid Problem Checklist score” assessing drug-related problems was also determined for each patient.Results: The addiction clinic group were younger, more likely to have experienced drug overdose and had a shorter duration of chronic pain. No significant differences in dependence questionnaire scores were found between groups. However, higher Pain Disability Index scores and higher Opioid Problem Checklist scores (indicating more drug-related problems) were found for the addiction clinic group.Conclusions: Some degree of dependence was present across both addiction and pain clinic groups, supporting the notion a state of dependence can be identified among chronic pain patients taking opioids long term. Aberrant behaviors were not common in the pain clinic sample, suggesting these patients are unlikely to meet Diagnostic and Statistical Manual of Mental Disorders-V criteria for Substance Use Disorder. However, opioid dependence carries significant risks for relapse, chronicity, morbidity and mortality, warranting specific medical management. Management of such risks should be considered routine care in chronic pain patients taking opioids long term.
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Angst, Martin S., and J. David Clark. "Opioid-induced Hyperalgesia." Anesthesiology 104, no. 3 (March 1, 2006): 570–87. http://dx.doi.org/10.1097/00000542-200603000-00025.
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Opioids are the cornerstone therapy for the treatment of moderate to severe pain. Although common concerns regarding the use of opioids include the potential for detrimental side effects, physical dependence, and addiction, accumulating evidence suggests that opioids may yet cause another problem, often referred to as opioid-induced hyperalgesia. Somewhat paradoxically, opioid therapy aiming at alleviating pain may render patients more sensitive to pain and potentially may aggravate their preexisting pain. This review provides a comprehensive summary of basic and clinical research concerning opioid-induced hyperalgesia, suggests a framework for organizing pertinent information, delineates the status quo of our knowledge, identifies potential clinical implications, and discusses future research directions.
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Fink, Brandi C., Olivier Uyttebrouck, and Richard S. Larson. "An Effective Intervention: Limiting Opioid Prescribing as a Means of Reducing Opioid Analgesic Misuse, and Overdose Deaths." Journal of Law, Medicine & Ethics 48, no. 2 (2020): 249–58. http://dx.doi.org/10.1177/1073110520935336.
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Overdose deaths involving prescription opioids killed more than 17,000 Americans in 2017, marking a five-fold increase since 1999. High prescribing rates of opioid analgesics have been a substantial contributor to prescription opioid misuse, dependence, overdose and heroin use. There was recognition approximately ten years ago that opioid prescribing patterns were contributing to this startling increase in negative opioid-related outcomes, and federal actions, including Medicare reimbursement reform and regulatory actions, were initiated to restrict opioid prescribing. The current manuscript is a description of those actions, the effect of those actions on opioid prescribing and related patient outcomes. We also describe our proposal of methods of expanding these efforts as an important piece to further reduce opioid-related misuse, dependence, and overdose death.
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Kjome, Kimberly L., and F. Gerard Moeller. "Long-Acting Injectable naltrexone for the Management of patients with Opioid Dependence." Substance Abuse: Research and Treatment 5 (January 2011): SART.S5452. http://dx.doi.org/10.4137/sart.s5452.
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Opioid dependence is a condition with serious clinical ramifications. Treatment has focused on detoxification, agonist therapy with methadone or buprenorphine, or remission maintenance with the opioid antagonist, naltrexone. Treatment with oral naltrexone has been limited by poor treatment adherence and relapse. Studies with long-acting formulations have shown increased treatment adherence. Extended-release injectable naltrexone has been used for the treatment of alcohol dependence, and has recently received an indication for treatment of opioid dependence from the US Food and Drug Administration. Dosing occurs once monthly and existing data with long-acting naltrexone supports efficacy of treatment for opioid dependence; however published data is sparse. Treatment with long-acting naltrexone should be monitored for hepatotoxicity, and patients should be made aware of increased risk of overdose with administration of opioids during and immediately after discontinuation of long-acting naltrexone.
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Sarkar, Siddharth, Mohit Varshney, Vaibhav Patil, and Rakesh Lal. "Maintainence Treatment of Opioid Dependence with Tramadol." Journal of Neurosciences in Rural Practice 08, S 01 (August 2017): S098—S101. http://dx.doi.org/10.4103/jnrp.jnrp_422_16.
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ABSTRACT Background: Although tramadol has been used in the management of acute withdrawal in patients with opioid dependence, its use for maintenance treatment as a harm reduction approach has not been assessed systematically. This case series describes patients with opioid dependence who were treated with tramadol for long-term maintenance. Methods: Patients with opioid dependence who received treatment at the National Drug Dependence Treatment Centre of All India Institute of Medical Sciences, New Delhi, were included in the study. Patients who received at least 6 months of tramadol and had follow-up adherence of more than 80% were included in the case series. Results: A total of 25 cases were included, all of whom were males. The types of opioids being taken at the time of initiation of tramadol were natural opiates (poppy husk and raw opium), followed by heroin. The median dose of tramadol at initiation and maintenance was 300 mg/day. Nineteen patients were able to achieve complete abstinence to other opiates on tramadol. Conclusion: Tramadol may be an effective option in the long-term management of patients with opioid dependence. Further studies are required for establishing the efficacy of tramadol for agonist management of patients with opioid dependence.
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Vitzthum, Lucas K., Paul Riviere, Paige Sheridan, Vinit Nalawade, Rishi Deka, Timothy Furnish, Loren K. Mell, Brent Rose, Mark Wallace, and James D. Murphy. "Predicting Persistent Opioid Use, Abuse, and Toxicity Among Cancer Survivors." JNCI: Journal of the National Cancer Institute 112, no. 7 (November 20, 2019): 720–27. http://dx.doi.org/10.1093/jnci/djz200.
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Abstract Background Although opioids play a critical role in the management of cancer pain, the ongoing opioid epidemic has raised concerns regarding their persistent use and abuse. We lack data-driven tools in oncology to understand the risk of adverse opioid-related outcomes. This project seeks to identify clinical risk factors and create a risk score to help identify patients at risk of persistent opioid use and abuse. Methods Within a cohort of 106 732 military veteran cancer survivors diagnosed between 2000 and 2015, we determined rates of persistent posttreatment opioid use, diagnoses of opioid abuse or dependence, and admissions for opioid toxicity. A multivariable logistic regression model was used to identify patient, cancer, and treatment risk factors associated with adverse opioid-related outcomes. Predictive risk models were developed and validated using a least absolute shrinkage and selection operator regression technique. Results The rate of persistent opioid use in cancer survivors was 8.3% (95% CI = 8.1% to 8.4%); the rate of opioid abuse or dependence was 2.9% (95% CI = 2.8% to 3.0%); and the rate of opioid-related admissions was 2.1% (95% CI = 2.0% to 2.2%). On multivariable analysis, several patient, demographic, and cancer and treatment factors were associated with risk of persistent opioid use. Predictive models showed a high level of discrimination when identifying individuals at risk of adverse opioid-related outcomes including persistent opioid use (area under the curve [AUC] = 0.85), future diagnoses of opioid abuse or dependence (AUC = 0.87), and admission for opioid abuse or toxicity (AUC = 0.78). Conclusion This study demonstrates the potential to predict adverse opioid-related outcomes among cancer survivors. With further validation, personalized risk-stratification approaches could guide management when prescribing opioids in cancer patients.
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Gupta, Atul, Junaid Nizamuddin, Dalia Elmofty, Sarah L. Nizamuddin, Avery Tung, Mohammed Minhaj, Ariel Mueller, Jeffrey Apfelbaum, and Sajid Shahul. "Opioid Abuse or Dependence Increases 30-day Readmission Rates after Major Operating Room Procedures." Anesthesiology 128, no. 5 (May 1, 2018): 880–90. http://dx.doi.org/10.1097/aln.0000000000002136.
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Abstract Background Although opioids remain the standard therapy for the treatment of postoperative pain, the prevalence of opioid misuse is rising. The extent to which opioid abuse or dependence affects readmission rates and healthcare utilization is not fully understood. It was hypothesized that surgical patients with a history of opioid abuse or dependence would have higher readmission rates and healthcare utilization. Methods A retrospective cohort analysis was performed of patients undergoing major operating room procedures in 2013 and 2014 using the National Readmission Database. Patients with opioid abuse or dependence were identified using International Classification of Diseases codes. The primary outcome was 30-day hospital readmission rate. Secondary outcomes included hospital length of stay and estimated hospital costs. Results Among the 16,016,842 patients who had a major operating room procedure whose death status was known, 94,903 (0.6%) had diagnoses of opioid abuse or dependence. After adjustment for potential confounders, patients with opioid abuse or dependence had higher 30-day readmission rates (11.1% vs. 9.1%; odds ratio 1.26; 95% CI, 1.22 to 1.30), longer mean hospital length of stay at initial admission (6 vs. 4 days; P < 0.0001), and higher estimated hospital costs during initial admission ($18,528 vs. $16,617; P < 0.0001). Length of stay was also higher at readmission (6 days vs. 5 days; P < 0.0001). Readmissions for infection (27.0% vs. 18.9%; P < 0.0001), opioid overdose (1.0% vs. 0.1%; P < 0.0001), and acute pain (1.0% vs. 0.5%; P < 0.0001) were more common in patients with opioid abuse or dependence. Conclusions Opioid abuse and dependence are associated with increased readmission rates and healthcare utilization after surgery.
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Evans, Christopher J., and Catherine M. Cahill. "Neurobiology of opioid dependence in creating addiction vulnerability." F1000Research 5 (July 19, 2016): 1748. http://dx.doi.org/10.12688/f1000research.8369.1.
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Opioid drugs are potent modulators of many physiological and psychological processes. When given acutely, they can elicit the signature responses of euphoria and analgesia that societies have coveted for centuries. Repeated, or chronic, use of opioids induces adaptive or allostatic changes that modify neuronal circuitry and create an altered normality — the “drug-dependent” state. This state, at least that exhibited by those maintained continuously on long-acting opioid drugs such as methadone or buprenorphine, is generally indistinguishable from the drug-naïve state for most overt behaviors. The consequences of the allostatic changes (cellular, circuit, and system adaptations) that accompany the drug-dependent state are revealed during drug withdrawal. Drug cessation triggers a temporally orchestrated allostatic re-establishment of neuronal systems, which is manifested as opposing physiological and psychological effects to those exhibited by acute drug intoxication. Some withdrawal symptoms, such as physical symptoms (sweating, shaking, and diarrhea) resolve within days, whilst others, such as dysphoria, insomnia, and anxiety, can linger for months, and some adaptations, such as learned associations, may be established for life. We will briefly discuss the cellular mechanisms and neural circuitry that contribute to the opioid drug-dependent state, inferring an emerging role for neuroinflammation. We will argue that opioid addictive behaviors result from a learned relationship between opioids and relief from an existing or withdrawal-induced anxiogenic and/or dysphoric state. Furthermore, a future stressful life event can recall the memory that opioid drugs alleviate negative affect (despair, sadness, and anxiety) and thereby precipitate craving, resulting in relapse. A learned association of relief of aversive states would fuel drug craving in vulnerable people living in an increasingly stressful society. We suggest that this route to addiction is contributive to the current opioid epidemic in the USA.
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Bohl, Daniel D., Emily Hejna, Nasima Mehraban, Johnny L. Lin, George B. Holmes, Simon Lee, and Kamran S. Hamid. "Postoperative Opioid Dependence following Orthopaedic Foot and Ankle Surgery: A Cohort Study of 448 Patients." Foot & Ankle Orthopaedics 5, no. 4 (October 1, 2020): 2473011420S0013. http://dx.doi.org/10.1177/2473011420s00138.
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Category: Other Introduction/Purpose: Surgeon prescription of narcotic medications has been identified as a contributor to the nation’s devastating opioid epidemic. The purpose of this study is to identify risk factors for postoperative opioid dependence following orthopaedic foot and ankle surgery. Methods: Four hundred and forty-eight patients undergoing orthopaedic foot and ankle surgery at a single institution over a 6- month period were identified. The Illinois Prescription Monitoring Program was used to track opioid prescriptions filled in the preoperative, perioperative, and postoperative periods. Preoperative use was defined as the filling of a prescription during the six months prior to the procedure, excluding the 30 days prior to the procedure. Postoperative dependence was defined as the filling of opioid prescriptions beyond the initial postoperative prescription. Baseline characteristics, including preoperative opioid use, were tested for association with opioid dependence. Results: The rate of preoperative opioid use was 20.5%. The rate of postoperative opioid dependence was 31.3%. Patients who used opioids during the preoperative period had the highest risk for postoperative opioid dependence, at 59.6% (RR=2.5, 95% confidence interval = 1.9-3.2, p<0.001; Table 1). Other baseline characteristics associated with postoperative opioid dependence included antiepileptic use (RR=1.8, p=0.001), recreational drug use (RR=1.7, p=0.022), Charlson comorbidity index >= 2 (RR=1.6, p=0.002), benzodiazepine use (RR=1.5, p=0.010), current smoker status (RR=1.5, p<0.001), age >=60 years (RR=1.4, p=0.022), body mass index >= 30 kg/m2 (RR=1.4, p=0.027), antidepressant use (RR=1.4, p=0.050), and <1 drink per week (RR=1.3 p=0.045). Conclusion: The single strongest predictor of postoperative opioid dependence was preoperative opioid use, which was associated with more than a doubling in risk. Of note, the chronicity of the foot or ankle condition did not predict postoperative opioid dependence. Preoperative discussion of opiate treatment duration, multimodal pain management strategies and judicious prescription of narcotics should be considered in patients with the above-noted risk factors in an effort to avoid dependence on this potentially addictive and harmful class of medications. [Table: see text]
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Subramanian, Prabavathy, and Jayasri Jayamoorthy. "Opioid-dependence Syndrome." Pondicherry Journal of Nursing 12, no. 1 (2019): 13–14. http://dx.doi.org/10.5005/jp-journals-10084-12110.
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JAMES, DOMINIKA LIPOWSKA, and MARYAM JOWZA. "Treating Opioid Dependence." Clinical Obstetrics and Gynecology 62, no. 1 (March 2019): 87–97. http://dx.doi.org/10.1097/grf.0000000000000422.
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Galderisi, S. "In opioid dependence." European Psychiatry 17 (May 2002): 220. http://dx.doi.org/10.1016/s0924-9338(02)80941-5.
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Newman, Robert G. "Prescription Opioid Dependence." JAMA Psychiatry 71, no. 3 (March 1, 2014): 338. http://dx.doi.org/10.1001/jamapsychiatry.2013.4530.
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Krantz, Mori J., and Philip S. Mehler. "Treating Opioid Dependence." Archives of Internal Medicine 164, no. 3 (February 9, 2004): 277. http://dx.doi.org/10.1001/archinte.164.3.277.
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Weekes, Danielle G., Jenna A. Feldman, Richard E. Campbell, Michael DeFrance, Fotios P. Tjoumakaris, and Luke Austin. "The Incidence of Chronic Opioid Use Following Arthroscopic Rotator Cuff Repair and Patient Opioid Education." Orthopaedic Journal of Sports Medicine 7, no. 7_suppl5 (July 2019): 2325967119S0025. http://dx.doi.org/10.1177/2325967119s00258.
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Objectives: Opioids are commonly prescribed for pain management following Arthroscopic Rotator Cuff Repair (ARCR). While their efficacy outweighs their risks in the short term, chronic opioid use is associated with significant adverse effects, such as dependence, endocrine imbalance or respiratory depression. The rate of chronic opioid use and dependence following ARCR is unknown. The purpose of this study is to determine the rate of chronic opioid use following ARCR and establish the effect of preoperative opioid education on reducing chronic consumption. A secondary aim is to determine if any correlation exists between chronic opioid use and shoulder functionality. Methods: A prospective, randomized study of 140 patients undergoing ARCR was performed with a minimum follow-up of 24 months. Patients were randomized to receive preoperative opioid education (risks of abuse, dependence, etc.) or no education. State registry database opioid prescription data monitoring software were utilized to search for all opioid prescriptions following ARCR in our patient population and this was compared to our electronic medical database for accuracy/discrepancy. The total number of opioid prescriptions and number of tablets was determined as well as time from surgery to most recent prescription. Patients were contacted to determine a shoulder Single Assessment Numeric Evaluation (SANE) score and Visual Analog Scale (VAS) pain score. Categorical data was analyzed via chi-squared tests as appropriate. Numeric data was analyzed using t-tests as appropriate. Results: Forty-five patients (32%) continued to fill opioid prescriptions chronically following ARCR. Seventeen (38%) of these patents received pre-operative opioid educated, whereas twenty-eight (62%) did not (p=0.05). Sixty percent of patients with a history of pre-operative opioid use continued to take opioids, while 23% of opioid naive patients continued (p< 0.01). There was no significant difference in SANE (p= 0.53) or VAS (p= 0.65) scores between the education and control group. Patients taking opioids prior to surgery had worse SANE scores (71.28) than the non-users (86.28), p< 0.01. Conclusion: Almost a third of patients will chronically use opioids following ARCR, including 23% of opioid naive patients. Preoperative opioid use is strongly associated with chronic opioid utilization, as well as decreased shoulder function 2 years after ARCR. Preoperative opioid education significantly decreased the rate of chronic opioid use; however, there is no effect on long-term shoulder function. [Table: see text]
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Fowler, Megan, Samina Ali, Serge Gouin, Amy Drendel, Naveen Poonai, Esther Jun, Mithra Sivakumar, and Kathryn Dong. "Knowledge, attitudes, and practices regarding opioid use in the pediatric emergency department." Paediatrics & Child Health 23, suppl_1 (May 18, 2018): e10-e10. http://dx.doi.org/10.1093/pch/pxy054.026.
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Abstract BACKGROUND Inadequate pain management in children is ubiquitous in the emergency department (ED). Inadequate pain management in children can have both short and long term detrimental effects. As the current national opioid crisis has highlighted, physicians are caught between balancing pain management and the risk of long term opioid dependence. OBJECTIVES This study aimed to describe paediatric emergency physicians’ (PEPs) willingness to prescribe opioids to children in the ED and at discharge, perceived knowledge regarding common fears and myths about opioid use, management approach to hypothetical scenarios of varying musculoskeletal injury (MSK-I) pain in children, and perceived facilitators and barriers to prescribing opioids. DESIGN/METHODS A unique survey tool was created using published methodology guidelines. Information regarding practices, knowledge, attitudes, perceived barriers, facilitators and demographics were collected. The survey was distributed to all physician members of Pediatric Emergency Research Canada (PERC), using a modified Dillman’s Tailored Design method, from October to December 2017. RESULTS The response rate was 49.7% (124/242); 53% (57/107) were female, mean age was 43.6 years (+/- 8.7), and 58% (72/124) had paediatric emergency subspecialty training. The most common first line pain medication in the ED was ibuprofen for mild, moderate and severe MSK-I related pain (94.4% (117/124), 89.5% (111/124), and 62.9% (78/124), respectively). For moderate and severe MSK-I pain, intranasal fentanyl was the most common opioid for first (35.5% (44/124) and 61.3% (76/124), respectively) and second line pain management (41.1% (51/124) and 20.2% (25/124), respectively). 74.8% (89/119) of PEPs reported that an opioid protocol would be helpful, specifically for morphine, fentanyl, and hydromorphone. Using a 0–100 scale, physicians minimally worried about physical dependence (13.3 +/-19.3), addiction (16.6 +/-19.8), and diversion of opioids (32.8+/-26.4) when prescribing short-term opioids to children. They reported that the current opioid crisis minimally influenced their willingness to prescribe opioids (30.0 +/-26.2). Physicians reported rarely (36%; 45/125) or never (28%; 35/125) completing a screening risk assessment prior to prescribing opioids. CONCLUSION Intranasal fentanyl was the top opioid for all MSK-I pain intensities. PEPs are minimally concerned regarding dependence, addiction, and the current opioid crisis when prescribing short-term opioids to children. There is an urgent need for evidence regarding the dependence and addiction risk for children receiving short term opioids in order to create knowledge translation tools for ED physicians. Opioid specific protocols in the ED would likely improve physician comfort in responsible and adequate pain management for children.
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Fowler, M. A., S. Ali, N. Poonai, K. Dong, S. Gouin, A. Drendel, E. Jun, and M. Sivakumar. "LO85: Knowledge, attitudes, and practices regarding opioid use in the pediatric emergency department." CJEM 20, S1 (May 2018): S37. http://dx.doi.org/10.1017/cem.2018.147.
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Introduction: Inadequate pain management in children is ubiquitous in the emergency department (ED). As the current national opioid crisis has highlighted, physicians are caught between balancing pain management and the risk of long term opioid dependence. This study aimed to describe pediatric emergency physicians (PEPs) willingness to prescribe opioids to children in the ED and at discharge. Methods: A unique survey tool was created using published methodology guidelines. Information regarding practices, knowledge, attitudes, perceived barriers, facilitators and demographics were collected. The survey was distributed to all physician members of Pediatric Emergency Research Canada (PERC), using a modified Dillmans Tailored Design method, from October to December 2017. Results: The response rate was 49.7% (124/242); 53% (57/107) were female, mean age was 43.6 years (+/− 8.7), and 58% (72/124) had pediatric emergency subspecialty training. The most common first line ED pain medication was ibuprofen for mild, moderate and severe musculoskeletal injury (MSK-I)-related pain (94.4% (117/124), 89.5% (111/124), and 62.9% (78/124), respectively). For moderate and severe MSK-I, intranasal fentanyl was the most common opioid for first (35.5% (44/124) and 61.3% (76/124), respectively) and second line pain management (41.1% (51/124) and 20.2% (25/124), respectively). 74.8% (89/119) of PEPs reported that an opioid protocol would be helpful, specifically for morphine, fentanyl, and hydromorphone. Using a 0-100 scale, physicians minimally worried about physical dependence (13.3 +/−19.3), addiction (16.6 +/−19.8), and diversion of opioids (32.8+/−26.4) when prescribing short-term opioids to children. They reported that the current opioid crisis minimally influenced their willingness to prescribe opioids (30.0 +/−26.2). Physicians reported rarely (36%; 45/125) or never (28%; 35/125) completing a screening risk assessment prior to prescribing opioids. Conclusion: Ibuprofen remains the most common medication recommended for MSK-I pain in the ED and at discharge. Intranasal fentanyl was the top opioid for all pain intensities. PEPs are minimally concerned regarding dependence, addiction, and the current opioid crisis when prescribing short-term opioids to children. There is an urgent need for robust evidence regarding the dependence and addiction risk for children receiving short term opioids in order to create knowledge translation tools for ED physicians. Opioid specific protocols for both in the ED and at discharge would likely improve physician comfort in responsible and adequate pain management for children.
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Ahmed, Sagir G., Umma A. Ibrahim, and Modu B. Kagu. "Opioid dependence among people with haemophilia in a low-resource tropical setting: prevalence and risk factors in northern Nigeria." Journal of Haemophilia Practice 6, no. 1 (January 1, 2019): 19–28. http://dx.doi.org/10.17225/jhp00132.
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Abstract Background: In tropical countries such as Nigeria, where factor VIII (FVIII) is scarce, severe pain due to musculoskeletal bleeding complications, leading to frequent opioid prescription, is not uncommon in poorly managed people with haemophilia (PWH). The relationship between opioid use and dependence is intensively studied in other painful diseases, such as cancer and rheumatoid arthritis, but surprisingly little is known about opioid dependence in haemophilia. We hypothesise that the risk of opioid dependence among PWH in tropical countries like Nigeria is multi-factorial, encompassing demographic (age), clinical (haemophilia severity and chronic arthropathy) and biological (ABO blood groups and haemoglobin (Hb) phenotypes) factors that may directly or indirectly increase incidence of bleeding and/or pain. Aims: To determine the prevalence of opioid dependence and relative risks (RR) associated with age, haemophilia severity, chronic arthropathy, ABO blood groups and Hb phenotypes, and to elucidate the pathophysiological roles of each risk factor in the development of opioid dependence among haemophilia-A patients in five hospitals in northern Nigeria. Methodology: A retrospective review of the medical records of 88 PWH seen between 1996 and 2012 was used to collate data on age, sex, haemophilia severity, painful chronic haemophilic arthropathy, ABO blood group, haemoglobin phenotypes, presence or absence of opioid dependence, and the types of opioids on which the patients were dependent. The prevalence of opioid dependence among the cohort was expressed as a percentage. The frequency of each putative risk factor for opioid dependence in patients with and without opioid dependence were compared using Fisher’s exact test; RR associated with each risk factor was determined by regression analysis. P<0.05 was taken as significant. Results: Of the 88 PWH studied,15 (17%) were shown to be opioid-dependent. Compared with PWH who were not opioid-dependent, this group had higher frequencies of severe haemophilia (86.7% vs. 49.3%: RR= 5.2, p=0.02), survival to adulthood (73.3% vs. 12.3%: RR= 9.5, p=0.0001), chronic arthropathy in one or more joints (86.7% vs. 21.9%: RR= 13.2, p=0.0004), blood group-O (80% vs. 49.3%: RR= 3.3, p=0.04), and HbAA phenotype (86.7% vs. 54.8%: RR= 4.3, p=0.04). Conclusion: Prevalence of opioid dependence among PWH treated at five hospitals in northern Nigeria was 17% during the study period. Significant risk factors were directly or indirectly associated with increased rates of bleeding and/or pain, which can only be prevented or treated through optimal application of FVIII. There is a need for the Nigerian government to establish standard haemophilia care centres with adequate FVIII for optimal prophylaxis and treatment in order to minimise painful complications, thereby helping to prevent undue opioid use and dependence.
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Eken Sander, MD, Stephanie C., and Lon R. Hays, MD, MBA. "Prescription opioid dependence and treatment with methadone in pregnancy." Journal of Opioid Management 1, no. 2 (May 1, 2005): 91. http://dx.doi.org/10.5055/jom.2005.0022.
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Prescription opioids are used medically to treat pain, but their diversion and abuse continues to escalate in the United States.1 Abuse of OxyContin (Purdue Pharma LP, Stamford, CT), a timed-release form of oxycodone, is a major focus of public health and law enforcement agencies. 2 The rise in opioid abuse may lead to an increase in opioid dependence in pregnancy, which was a focus of this study. Our retrospective chart review examined the demographics and patterns of opioid addiction of pregnant women admitted to an inpatient psychiatric unit in an academic medical center in central Kentucky. Charts of 94 women admitted from January 2001 to May 2004 were reviewed. Information obtained included demographics and details of their opioid use, including the specific opioid( s) used, route of administration, and duration of use. Treatment information included length of hospital stay, stabilizing dose of methadone, comorbid drug use, and concomitant Axis I diagnoses. Most women were in their mid-twenties and in the second trimester of pregnancy when they sought treatment. Benzodiazepines were the most common comorbid drugs of abuse and the most frequent medical complication of their drug use was hepatitis C, newly diagnosed in 11 patients. This study demonstrates the need for further research in prescription opioid dependency in pregnancy, methadone maintenance therapy, the safety of detoxification, and neonatal outcomes.
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Dietz, Nicholas, Mayur Sharma, Ahmad Alhourani, Beatrice Ugiliweneza, Miriam Nuno, Doniel Drazin, Dengzhi Wang, and Maxwell Boakye. "Preoperative and Postoperative Opioid Dependence in Patients Undergoing Anterior Cervical Diskectomy and Fusion for Degenerative Spinal Disorders." Journal of Neurological Surgery Part A: Central European Neurosurgery 82, no. 03 (February 4, 2021): 232–40. http://dx.doi.org/10.1055/s-0040-1718759.
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Abstract Background Anterior cervical diskectomy and fusion (ACDF) is a procedure for effectively relieving radiculopathy. Opioids are commonly overprescribed in postsurgical settings and prescriptions vary widely among providers. We identify trends in opioid dependence before and after ACDF. Methods We used the Truven Health MarketScan data to identify adult patients undergoing ACDF for degenerative cervical spine conditions between 2009 and 2015. Patients were segregated in four cohorts of preoperative and postoperative opioid nondependence (ND) or dependence (D) with 15 months of postoperative follow-up. Results A total of 25,403 patients with median age of 52 years (18–92) who underwent ACDF met the inclusion criteria. Breakdown of the four cohorts was as follows: prior nondependent who remain nondependent (NDND): 62.76% (n = 15,944); prior nondependent who become dependent (NDD): 4.6% (n = 1,168); prior dependent who become nondependent (DND): 14.03% (n = 3,564); and prior dependent who remain dependent (DD): 18.61% (n = 4,727). Opioid dependence decreased 9.43% postoperatively. Overall payments and 30-day readmissions increased 1.96 and 1.79 times for opioid dependent versus nondependent cohorts, respectively. Adjusted payments at 3 to 15 months were significantly increased for dependent cohorts with 3.56-fold increase for the DD cohort when compared with the NDND cohort. Length of stay, complications, medication refills, outpatient measures, and hospital admissions were also higher in those groups with postoperative opioid dependence when compared with those who were not opioid dependent. Conclusions Opioid dependence after ACDF is associated with increased hospital readmissions, complication rates at 30 days, and payments within 3 months and 3 to 15 months postdischarge. Overall opioid dependence was decreased after ACDF procedure, however, a smaller number of opioid-dependent and opioid-naive patients became dependent postoperatively and should be followed carefully.
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Suzuki, MD, Joji, Michele L. Matthews, PharmD, David Brick, BA, Minh-Thuy Nguyen, Robert N. N. Jamison, PhD, Andrew L. Ellner, MD, MSc, Lori W. Tishler, MD, and Roger D. Weiss, MD. "Implementation of a collaborative care management program with buprenorphine in primary care: A comparison between opioid-dependent patients and patients with chronic pain using opioids nonmedically." Journal of Opioid Management 10, no. 3 (May 1, 2014): 159. http://dx.doi.org/10.5055/jom.2014.0204.
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Objective: To implement a collaborative care management program with buprenorphine in a primary care clinic.Design: Prospective observational study.Setting: A busy urban academic primary care clinic affiliated with a tertiary care hospital.Participants: Opioid-dependent patients or patients with chronic pain using opioids nonmedically were recruited for the study. A total of 45 participants enrolled.Interventions: Patients were treated with buprenorphine and managed by a supervising psychiatrist, pharmacist care manager, and health coaches. The care manager conducted buprenorphine inductions and all follow-up visits. Health coaches offered telephonic support. The psychiatrist supervised both the care manager and health coaches.Main outcome measures: Primary outcomes were treatment retention at 6 months, and change in the proportion of aberrant toxicology results and opioid craving scores from baseline to 6 months. After data collection, clinical outcomes were compared between opioid-dependent patients and patients with chronic pain using opioids nonmedically. Overall, 55.0 percent of participants (25/45) remained in treatment at 6 months. Primary care physicians (PCPs)' attitudes about opioid dependence treatment were surveyed at baseline and at 18 months.Results: Forty-three patients (95.6 percent) accepted treatment and 25 (55.0 percent) remained in treatment at 6 months. The proportion of aberrant urine toxicology results decreased significantly from baseline to 6 months (p < 0.01). Craving scores significantly decreased from baseline to 6 months (p < 0.01). Opioid-dependent patients, as opposed to patients with chronic pain using opioids nonmedically, were significantly more likely to complete 6 months of treatment (p < 0.05). PCPs' confidence in treating opioid dependence in primary care increased significantly from baseline to 18 months postimplementation (p < 0.01).Conclusion: Collaborative care management for opioid dependence with buprenorphine may be feasible in a primary care clinic. More research is needed to understand the role of buprenorphine in managing patients with chronic pain using opioids nonmedically.
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Berger, Reisel. "Buprenorphine for opioid dependence." Mental Health Clinician 3, no. 6 (December 1, 2013): 286–89. http://dx.doi.org/10.9740/mhc.n183350.
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Opioid use disorder is a growing problem in the United States that can have devastating consequences on affected individuals. Buprenorphine is a partial mu-opioid agonist that can be used in the treatment of opioid dependence. In this article, the pharmacology of buprenorphine is discussed as is the dosing strategy. Formulations and product availability are mentioned and assessed. Several studies comparing the use of buprenorphine to methadone for opioid dependence are briefly reviewed.
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Kissin, M. Ya, N. B. Khalezova, E. A. Gibitova, A. V. Tarnorutskaya, and A. N. Ivanov. "Pregabalin use in HIV-infected patients with opioid dependence syndrome." V.M. BEKHTEREV REVIEW OF PSYCHIATRY AND MEDICAL PSYCHOLOGY, no. 2 (November 11, 2018): 70–79. http://dx.doi.org/10.31363/2313-7053-2018-2-70-79.
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Te purpose of the current study was to identify an abuse potential of pregabalin in HIVinfected patients with opioid use disorder long time using pregabaline. A cross-sectional study was performed at the St. Petersburg Center for the prevention and control of HIV and infectious diseases. A cohort of 572 HIV-infected patients with opioid use disorder was examined. 96 patients (16,8% of the entire cohort) used pregabalin. 34 of them agreed to participate in the study. Te pregabalin addiction was diagnosed in 23 of 34 observed HIV-infected patients with opioid dependence. People with opioid dependence and presence of organic brain damage of various genesis (toxic exposure, neurological consequences of trauma or infection) are at risk of development of pregabalin dependence. Te use of pregabalin with for self-medication of opiod withdrawal was registered in 11 patients.
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Hakimian, Joshua K., Tien S. Dong, Jorge A. Barahona, Venu Lagishetty, Suchi Tiwari, Darien Azani, Matthew Barrera, et al. "Dietary Supplementation with Omega-3 Polyunsaturated Fatty Acids Reduces Opioid-Seeking Behaviors and Alters the Gut Microbiome." Nutrients 11, no. 8 (August 14, 2019): 1900. http://dx.doi.org/10.3390/nu11081900.
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Opioids are highly addictive substances with a relapse rate of over 90%. While preclinical models of chronic opioid exposure exist for studying opioid dependence, none recapitulate the relapses observed in human opioid addiction. The mechanisms associated with opioid dependence, the accompanying withdrawal symptoms, and the relapses that are often observed months or years after opioid dependence are poorly understood. Therefore, we developed a novel model of chronic opioid exposure whereby the level of administration is self-directed with periods of behavior acquisition, maintenance, and then extinction alternating with reinstatement. This profile arguably mirrors that seen in humans, with initial opioid use followed by alternating periods of abstinence and relapse. Recent evidence suggests that dietary interventions that reduce inflammation, including omega-3 polyunsaturated fatty acids (n-3 PUFAs), may reduce substance misuse liability. Using the self-directed intake model, we characterize the observed profile of opioid use and demonstrate that an n-3-PUFA-enriched diet ameliorates oxycodone-seeking behaviors in the absence of drug availability and reduces anxiety. Guided by the major role gut microbiota have on brain function, neuropathology, and anxiety, we profile the microbiome composition and the effects of chronic opioid exposure and n-3 PUFA supplementation. We demonstrate that the withdrawal of opioids led to a significant depletion in specific microbiota genera, whereas n-3 PUFA supplementation increased microbial richness, phylogenetic diversity, and evenness. Lastly, we examined the activation state of microglia in the striatum and found that n-3 PUFA supplementation reduced the basal activation state of microglia. These preclinical data suggest that a diet enriched in n-3 PUFAs could be used as a treatment to alleviate anxiety induced opioid-seeking behavior and relapse in human opioid addiction.
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Roberts, D. M., and M. Meyer-Witting. "High-dose Buprenorphine: Perioperative Precautions and Management Strategies." Anaesthesia and Intensive Care 33, no. 1 (February 2005): 17–25. http://dx.doi.org/10.1177/0310057x0503300104.
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Buprenorphine has been in clinical use in anaesthesia for several decades. Recently, the high-dose sublingual formulation (Subutex®, Reckitt Benckiser, Slough, U.K.) has been increasingly used as maintenance therapy in opioid dependence, as an alternative to methadone and other pharmacological therapies. Buprenorphine has unique pharmacological properties making it well suited for use as a maintenance therapy in opioid dependence. However, these same properties may cause difficulty in the perioperative management of pain. Buprenorphine is a partial opioid agonist, attenuating the effects of supplemental illicit or therapeutic opioid agonists. As a result of its high receptor affinity, supplemental opioids do not readily displace buprenorphine from the opioid receptor in standard doses. High-dose buprenorphine has an extended duration of action that prolongs both of these effects. The perioperative management of patients stabilized on high-dose buprenorphine and undergoing surgery requires consideration of the likely analgesic requirements. Where possible the buprenorphine should be continued. Pain management should focus on maximizing non-opioid analgesia, local anaesthesia and non-pharmacological techniques. Where pain may not be adequately relieved by these methods, the addition of a full opioid agonist such as fentanyl or morphine at appropriate doses should be considered, accompanied by close monitoring in a high dependency unit. In situations where this regimen is unlikely to be effective, preoperative conversion to morphine or methadone may be an option. Where available, liaison with a hospital-based alcohol and drug service should always be considered.
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Shah, S., I. Okunev, E. Tranby, J. Frantsve‐Hawley, M. Monopoli, and F. Shaya. "Opioid Dependence Subsequent to Exposure to Prescription Opioids." Health Services Research 55, S1 (August 2020): 132–33. http://dx.doi.org/10.1111/1475-6773.13521.
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Medvedev, M. A., and I. V. Roudin. "The role of opioid peptides in the regulation of secretin-stimulated bile secretion." Bulletin of Siberian Medicine 5, no. 3 (September 30, 2006): 37–41. http://dx.doi.org/10.20538/1682-0363-2006-3-37-41.
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Influence of intraperitoneal dalargin (dand m-opioid agonist), DADLE (d-opioid agonist), DAGO (m-opioid agonist) and U50488 (k-opioid agonist) on bile secretion which is stimulated by secretin was studied in sharp experiments on white rats. All opioids studied is demonstrated to suppress secretory response of liver upon secretin in different extent. We suppose that opioidergic regulation system has different effect on bile secretion in dependence of baseline level of physiologic secretion.
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Rath, Jessica M., Siobhan N. Perks, Donna M. Vallone, Alexis A. Barton, Daniel K. Stephens, Bethany Simard, and Elizabeth C. Hair. "Educating Young Adults about Opioid Misuse: Evidence from a Mass Media Intervention." International Journal of Environmental Research and Public Health 19, no. 1 (December 21, 2021): 22. http://dx.doi.org/10.3390/ijerph19010022.
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The US opioid epidemic is a serious public health problem. Rates of opioid misuse and dependence are highest for young adults ages 18–25. Prevention strategies that reduce prescription opioid misuse while decreasing stigma around dependence and treatment are critical components of addressing the epidemic. The Truth About Opioids, a mass media public education campaign, was designed to prevent opioid misuse and dependence among young adults. This study examined the intervention’s effectiveness to shift opioid-related knowledge, attitudes, and beliefs within targeted designated market areas (DMAs) over time. A sample of young adults (N = 1434) in DMAs with varying levels of media exposure was surveyed at baseline (June–September 2019) and post-intervention (July–August 2020). Logistic regression assessed associations between campaign awareness and campaign-targeted knowledge and attitudes, controlling for baseline variables. Those with any awareness had significantly higher odds of campaign-targeted opioid-related knowledge (versus no awareness) (low awareness OR = 1.52 (95% CI: 1.04, 2.24); high awareness OR = 2.47 (95% CI: 1.58, 3.87)). Those with campaign awareness were also more likely to report lower levels of opioid-related stigma and higher intentions to share information and talk to a friend about the epidemic. Mass media public education campaigns can help influence young adults’ opioid-related knowledge and attitudes.
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Gisev, Natasa, Sallie-Anne Pearson, Timothy Dobbins, David C. Currow, Fiona Blyth, Sarah Larney, Adrian Dunlop, Richard P. Mattick, Andrew Wilson, and Louisa Degenhardt. "Combating escalating harms associated with pharmaceutical opioid use in Australia: the POPPY II study protocol." BMJ Open 8, no. 12 (December 2018): e025840. http://dx.doi.org/10.1136/bmjopen-2018-025840.
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IntroductionOpioid prescribing has increased 15-fold in Australia in the past two decades, alongside increases in a range of opioid-related harms such as opioid dependence and overdose. However, despite concerns about increasing opioid use, extramedical use and harms, there is a lack of population-level evidence about the drivers of long-term prescribed opioid use, dependence, overdose and other harms.Methods and analysisWe will form a cohort of all adult residents in New South Wales (NSW), Australia, who initiated prescribed opioids from 2002 using Pharmaceutical Benefits Scheme dispensing records. This cohort will be linked to a wide range of other datasets containing information on sociodemographic and clinical characteristics, health service use and adverse outcomes (eg, opioid dependence and non-fatal and fatal overdose). Analyses will initially examine patterns and predictors of prescribed opioid use and then apply regression and survival analysis to quantify the risks and risk factors of adverse outcomes associated with prescribed opioid use.Ethics and disseminationThis study has received full ethical approval from the Australian Institute of Health and Welfare Ethics Committee, the NSW Population and Health Services Research Committee and the ACT Health Human Research Ethics Committee. This will be the largest postmarketing surveillance study of prescribed opioids undertaken in Australia, linking exposure and outcomes and examining risk factors for adverse outcomes of prescribed opioids. As such, this work has important translational promise, with direct relevance to regulatory authorities and agencies worldwide. Project findings will be disseminated at scientific conferences and in peer-reviewed journals. We will also conduct targeted dissemination with policy makers, professional bodies and peak bodies in the pain, medicine and addiction fields through stakeholder workshops and advisory groups. Results will be reported in accordance with the REporting of studies Conducted using Observational Routinely collected Data (RECORD) Statement.
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Regmi, B., S. Limbu, and S. Nepal. "Is There Possibility Of Withdrawal Seizure In Opioid Dependence Syndrome? A Case Report." Journal of Psychiatrists' Association of Nepal 9, no. 2 (December 31, 2020): 82–84. http://dx.doi.org/10.3126/jpan.v9i2.36290.
Full textAbstract:
Opioids are commonly used and abused substance worldwide. Opioid withdrawal may manifest as severe muscle cramps, diarrhea, rhinorrhea, lacrimation, piloerection, yawning, and fever. Here, we report a 32 year old man with heroin dependence, presented with new onset generalized tonic-clonic seizure following heroin withdrawal. Seizure is a life-threating condition and rare phenomenon in opioid withdrawal therefore, reporting of this case is important. It may help clinician to be aware and consider seizure as a part of opioid withdrawal.
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Caldera, Franklin E. "Medical cannibus as an alternative for opioids for chronic pain: A case report." SAGE Open Medical Case Reports 8 (January 2020): 2050313X2090701. http://dx.doi.org/10.1177/2050313x20907015.
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Opioid medication–related deaths have increased to epidemic proportions in the last decade. This report describes a case of 43-year-old female with a traumatic brain injury who developed chronic pain and opioid dependence. The patient expressed concerns and wanted weaning off opioids. Recent legalization of medical marijuana in Pennsylvania allows us to try it as an alternative to opioids for chronic pain. Medical cannibus has risks associated with administration but is safer than opioids. Our patient was successfully weaned off her opioid medications with the help of medical cannibus and pain remained well controlled. More studies need to be done on using medical cannibus as an alternative to opioids.
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Franke, Petra, Birgit Wendel, Michael Knapp, Sibylle G. Schwab, Daniela Neef, Wolfgang Maier, Dieter B. Wildenauer, and Margret R. Hoehe. "Introducing a new recruitment approach to sample collection for genetic association studies in opioid dependence." European Psychiatry 18, no. 1 (February 2003): 18–22. http://dx.doi.org/10.1016/s0924-9338(02)00005-6.
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AbstractObjective. –In a modified case–control association study we tested the assumption that two polymorphisms (A118G in exon 1 and IVS2+31 in intron 2) of the human μ-opioid receptor gene (OPRM1) confer susceptibility to opioid dependence.Methods. –In contrast to classical case–control studies both groups, opioid dependent cases and non-opioid dependent controls were recruited from individuals who have had access to drugs including opioids and who had been sentenced for violation of the “Dangerous Drugs Act” in Germany.Results. –For the two allelic variants of OPRM1 under study we did not find evidence for association with opioid dependence.Conclusions. –Despite absence of association we think that this recruitment approach introduced here, is useful since it putatively offers a more adequate matching for case–control association studies of opioid dependent individuals.
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Hutchinson, Mark R., Sondra T. Bland, Kirk W. Johnson, Kenner C. Rice, Steven F. Maier, and Linda R. Watkins. "Opioid-Induced Glial Activation: Mechanisms of Activation and Implications for Opioid Analgesia, Dependence, and Reward." Scientific World JOURNAL 7 (2007): 98–111. http://dx.doi.org/10.1100/tsw.2007.230.
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This review will introduce the concept of toll-like receptor (TLR)–mediated glial activation as central to all of the following: neuropathic pain, compromised acute opioid analgesia, and unwanted opioid side effects (tolerance, dependence, and reward). Attenuation of glial activation has previously been demonstrated both to alleviate exaggerated pain states induced by experimental pain models and to reduce the development of opioid tolerance. Here we demonstrate that selective acute antagonism of TLR4 results in reversal of neuropathic pain as well as potentiation of opioid analgesia. Attenuating central nervous system glial activation was also found to reduce the development of opioid dependence, and opioid reward at a behavioral (conditioned place preference) and neurochemical (nucleus accumbens microdialysis of morphine-induced elevations in dopamine) level of analysis. Moreover, a novel antagonism of TLR4 by (+)- and (˗)-isomer opioid antagonists has now been characterized, and both antiallodynic and morphine analgesia potentiating activity shown. Opioid agonists were found to also possess TLR4 agonistic activity, predictive of glial activation. Targeting glial activation is a novel and as yet clinically unexploited method for treatment of neuropathic pain. Moreover, these data indicate that attenuation of glial activation, by general or selective TLR antagonistic mechanisms, may also be a clinical method for separating the beneficial (analgesia) and unwanted (tolerance, dependence, and reward) actions of opioids, thereby improving the safety and efficacy of their use.
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Boretsky, Karen, and Keira Mason. "In the Arms of Morpheus without Morphia; Mitigating the United States Opioid Epidemic by Decreasing the Surgical Use of Opioids." Journal of Clinical Medicine 10, no. 7 (April 2, 2021): 1472. http://dx.doi.org/10.3390/jcm10071472.
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The opioid epidemic is a major public health issue in the United States. Exposure of opioid naïve-patients to opioids in the perioperative period is a well-documented source of continued use with one in 20 opioid-naïve surgical patients continuing to use opioids beyond 90 days. There is no association with magnitude of surgery, major versus minor, and the strongest predictor of continued use is surgical exposure. Causal factors include over reliance on opioids for intraoperative and postoperative analgesia and excessive ambulatory opioid prescribing. Opioid-induced hyperalgesia can paradoxically result from intraoperative (anesthesia controlled) opioid administration. Increasing size of initial prescription is a strong predictor of continued use necessitating procedure specific supplies limited to under 3-days. Alternative multimodal pain management (non-opioid medications and regional anesthesia) that limit opioid use must be a high priority with opioids reserved for severe breakthrough pain. Barriers to implementation of opioid-sparing pathways include reluctance to adopt protocols and apprehension about opioid elimination. Considering the number of surgeries performed annually in the United States, perioperative physicians must aggressively address modifiable factors in surgical patients. Patient care pathways need to be constructed collaboratively by surgeons and anesthesiologists with continuing feedback to optimize patient outcomes including iatrogenic opioid dependence.
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Christian, Thomas, Ian Breunig, Joan Teno, Pedro Gozalo, and Michael Plotzke. "Rates of Diagnoses Indicating Opioid Dependence After Hospice Live Discharge: A National Study." Innovation in Aging 4, Supplement_1 (December 1, 2020): 17–18. http://dx.doi.org/10.1093/geroni/igaa057.057.
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Abstract Opioids are an important tool for managing Medicare Hospice beneficiaries’ pain and symptoms. Little is known about the prevalence of opioid dependence among patients discharged alive from hospice. Using 100% Medicare hospice, acute inpatient, and Part B claims from Federal Fiscal Years (FY) 2017-2018, we identified hospice beneficiaries that were discharged alive during FY2017-2018 and associated with diagnosis codes in subsequent health care incidents indicating opioid dependence. We used a crosswalk from the Agency for Healthcare Research and Quality to determine which codes represented opioid dependence. We characterized beneficiaries and their hospice providers using information from the Medicare Enrollment Database and Provider of Services file. There were 468,204 live hospice discharges during FY2017-2018, among which 9,282 (2.0%) were associated with subsequent health care events including a diagnosis code signifying opioid dependence. Post-hospice opioid diagnoses were more frequent among beneficiaries who were younger (for ages <65 relative to 85-89; Adjusted Odds Ratio [AOR]=6.23, 95% Confidence Intervals [CI] 5.73-6.77); dual-eligible (AOR=1.40, 95% CI 1.34-1.47); and relative to cancer, diagnosed with lung (AOR=1.83, 95% CI 1.72-1.95), heart (AOR=1.23, 95% CI 1.14-1.34), or liver diseases (AOR=1.25, 95% CI 1.10-1.42). Beneficiaries with opioid incidents tended to have survived much longer after hospice (150.9 days with opioid incidents vs. 13.6 days no opioid-related incidents). The states with the highest rates of post-hospice opioid-incidents per 10,000 live discharges were Kentucky (435.2), Wyoming (386.0), Tennessee (359.3), Washington (345.6), and Idaho (342.9). Further monitoring can ensure that hospice beneficiaries receive appropriate care during and after hospice enrollment.