Journal articles on the topic 'Opioid habit'
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Jain, Khushboo, Akansha Singh, Poonam Singh, and Sanjana Yadav. "An Improved Supervised Classification Algorithm in Healthcare Diagnostics for Predicting Opioid Habit Disorder." International Journal of Reliable and Quality E-Healthcare 11, no. 1 (January 2022): 1–16. http://dx.doi.org/10.4018/ijrqeh.297088.
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Opioid Habit Disorder (OHD), which has become a mass health epidemic, is defined as the psychological or physical dependency on opioids. This study demonstrates how supervised machine learning procedures help us investigate and examine massive data to discover the hidden patterns in any disease to deliver adapted dealing and predict the disease in any patient. This work presents a generalized model for forecasting a disease in the healthcare sector. The proposed model was investigated and tested using a reduced feature-set of the Opioid Habit Disorder (OHD) dataset collected from the National Survey on Drug Use and Health (NSDUH) using an improved Iterative Dichotomiser 3 (pro-IDT) algorithm. The proposed healthcare model is also compared with further machine learning algorithms such as ID3, Random Forest, and Bayesian Classifier in Python programming. The performance of the proposed work and other machine-learning algorithms has estimated accuracy, precision, misclassification rate, recall, specificity, and F1 score.
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Wassum, K. M., I. C. Cely, N. T. Maidment, and B. W. Balleine. "Disruption of endogenous opioid activity during instrumental learning enhances habit acquisition." Neuroscience 163, no. 3 (October 2009): 770–80. http://dx.doi.org/10.1016/j.neuroscience.2009.06.071.
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Greiner, Rebecca S., Danielle Boselli, Jai N. Patel, Mariam Salib, Connie Edelen, and Declan Walsh. "Opioid Risk Screening in an Oncology Palliative Medicine Clinic." JCO Oncology Practice 16, no. 11 (November 2020): e1332-e1342. http://dx.doi.org/10.1200/op.20.00043.
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PURPOSE: Little information exists on factors that predict opioid misuse in oncology. We adopted the Screener and Opioid Assessment for Patients With Pain–Short Form (SOAPP-SF) and toxicology testing to assess for opioid misuse risk. The primary objective was to (1) identify characteristics associated with a high-risk SOAPP-SF score and noncompliant toxicology test, and (2) determine SOAPP-SF utility to predict noncompliant toxicology tests. METHODS: From July 1, 2017, to December 31, 2017, new patients completed the Edmonton Symptom Assessment Scale (ESAS), SOAPP-SF, and narcotic use agreement. Toxicology test results were collected at subsequent visits. RESULTS: Of 223 distinct patients, 96% completed SOAPP-SF. Mean age was 61 ± 12.7 years, 58% were female, 68% were White, and 28% were Black. Eighty-three eligible patients (38%) completed toxicology testing. Younger age, male sex, and increased ESAS depression scores were associated with high-risk SOAPP-SF scores. Smoking habit was associated with an aberrant test. An SOAPP-SF score ≥ 3 predicted a noncompliant toxicology test. CONCLUSION: Male sex, young age, and higher ESAS depression score were associated with a high SOAPP-SF score. Smoking habit was associated with an aberrant test. An SOAPP-SF of ≥ 3 (sensitivity, 0.74; specificity, 0.64), not ≥ 4, was predictive of an aberrant test; however, performance characteristics were decreased from those published by Inflexxion, for ≥ 4 (sensitivity, 0.86; specificity, 0.67). The specificity warrants caution in falsely labeling patients. The SOAPP-SF may aid in meeting National Comprehensive Cancer Network recommendations to screen oncology patients for opioid misuse.
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Nnachi, Oluomachi Charity, Chinedu Obasi Akpa, Favour Ogonna Nwani, and Oghenevwogaga Obukohwo Edenya. "Pentazocine Misuse among Sickle Cell Disease Patients and The Role of Lack of Enforcement of Opioid Dispensing Regulations by Community Pharmacies: A Descriptive Observational Study." Advances in Public Health 2022 (January 30, 2022): 1–6. http://dx.doi.org/10.1155/2022/3877882.
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Introduction. Sickle cell disease (SCD) is a chronic disease characterized by debilitating bone pains which commonly necessitate the use of analgesic drugs including opioids and psychotropic substances such as pentazocine which are controlled medicines in Nigeria. Opioid misuse including dependence and addiction is an increasing trend among SCD patients, and it has serious adverse implications on their social, economic, and physical well-being. The role of lack of implementation of existent regulation on the dispensing of opioids by pharmacies has not been adequately investigated. Objective. The primary objective of this study is to define the sociodemographic and clinical implications of pentazocine misuse among patients with SCD and to describe the contributions of lack of enforcement of opioid dispensing regulations to this menace. Materials and Methods. The study was a descriptive observational study. A 29-item pretested and prevalidated questionnaire was administered to 21 SCD patients with an established history of pentazocine misuse and addiction to establish their demographics, details of opioid use, and their clinical effects. Nine community pharmacies were interviewed to ascertain their knowledge of controlled medicines and their compliance to existent regulations on the dispensation of opioids. Results. The median (interquartile range) age of the SCD subjects was 24 years. The majority of subjects (14, 66.7%) had tertiary education. Fifteen (71.4%) of them had a history of pentazocine misuse for over two years. All subjects source pentazocine injection from local pharmacies and patent medicine shops without prescription, while 19.0% get home deliveries. Seventeen (80.9%) of the SCD subjects desired to discontinue the habit; however, inadequate medical support was reported to contribute to their inability to overcome this practice in 14 (54.3%) patients. Most of the local pharmacies/drug shop proprietors are aware of drug laws guiding controlled medicines in Nigeria. However, about 77.9% of pharmacies interviewed retail pentazocine without prescription. A lack of enforcement by the state and federal taskforce was reported to contribute to this practice. Conclusion. Pentazocine misuse is a serious problem in patients with SCD. Inadequate medical support and lack of enforcement of regulations on dispensing opioids by community pharmacies are contributors to this menace.
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Benéitez, M. Cristina, and M. Esther Gil-Alegre. "Opioid Addiction: Social Problems Associated and Implications of Both Current and Possible Future Treatments, including Polymeric Therapeutics for Giving Up the Habit of Opioid Consumption." BioMed Research International 2017 (2017): 1–7. http://dx.doi.org/10.1155/2017/7120815.
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Background. Detoxification programmes seek to implement the most secure and compassionate ways of withdrawing from opiates so that the inevitable withdrawal symptoms and other complications are minimized. Once detoxification has been achieved, the next stage is to enable the patient to overcome his or her drug addiction by ensuring consumption is permanently and completely abandoned, only after which can the subject be regarded as fully recovered. Methods. A systematic search on the common databases of relevant papers published until 2016 inclusive. Results and Conclusion. Our study of the available oral treatments for opioid dependence has revealed that no current treatment can actually claim to be fully effective. These treatments require daily oral administration and, consequently, regular visits to dispensaries, which in most cases results in a lack of patient compliance, which causes fluctuations in drug plasma levels. We then reviewed alternative treatments in the available scientific literature on polymeric sustained release formulations. Research has been done not only on release systems for detoxification but also on release systems for giving up the habit of taking opioids. These efforts have obtained the recent authorization of polymeric systems for use in patients that could help them to reduce their craving for drugs.
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Li, Yingcen, Yunliang Miao, Xufang Liang, and Shan He. "Functional Characterization and Molecular Marker Development of the Proenkephalin as Biomarker of Food Addiction in Food Habit Domestication of Mandarin Fish (Siniperca Chuatsi)." Fishes 7, no. 3 (May 27, 2022): 118. http://dx.doi.org/10.3390/fishes7030118.
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Proenkephalin (PENK), as the precursor of endogenous opioid enkephalin (ENK), is widely present in the nervous system and plays an important role in animal food addiction and rewarding behavior. In our study, we intend to study the functional characterization and molecular marker development of the penk gene related to food habit domestication of mandarin fish. We found that the penk gene of mandarin fish had three types of endogenous opioid peptide sequences. Compared with other tissues, penk mRNA was highly expressed in the whole brain. Intracerebroventricular (ICV) injection of lysine or methionine significantly increased the expression of penk mRNA. The expression of penk mRNA in the brain of mandarin fish that could be easily domesticated from eating live prey fish to artificial diets was significantly higher than those that could not. After feeding with high-carbohydrate artificial diets, the expression of penk mRNA showed no significant difference between mandarin fish with hypophagia and those that still ate normally. A total of four single nucleotide polymorphisms (SNP) loci related to easy domestication toward eating artificial diets were screened from the mandarin fish population. Additionally, the TT genotype at one of the loci was significantly correlated with the food habit domestication of mandarin fish.
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Bechara, Antoine, Kent C. Berridge, Warren K. Bickel, Jose A. Morón, Sidney B. Williams, and Jeffrey S. Stein. "A Neurobehavioral Approach to Addiction: Implications for the Opioid Epidemic and the Psychology of Addiction." Psychological Science in the Public Interest 20, no. 2 (October 2019): 96–127. http://dx.doi.org/10.1177/1529100619860513.
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Two major questions about addictive behaviors need to be explained by any worthwhile neurobiological theory. First, why do people seek drugs in the first place? Second, why do some people who use drugs seem to eventually become unable to resist drug temptation and so become “addicted”? We will review the theories of addiction that address negative-reinforcement views of drug use (i.e., taking opioids to alleviate distress or withdrawal), positive-reinforcement views (i.e., taking drugs for euphoria), habit views (i.e., growth of automatic drug-use routines), incentive-sensitization views (i.e., growth of excessive “wanting” to take drugs as a result of dopamine-related sensitization), and cognitive-dysfunction views (i.e., impaired prefrontal top-down control), including those involving competing neurobehavioral decision systems (CNDS), and the role of the insula in modulating addictive drug craving. In the special case of opioids, particular attention is paid to whether their analgesic effects overlap with their reinforcing effects and whether the perceived low risk of taking legal medicinal opioids, which are often prescribed by a health professional, could play a role in the decision to use. Specifically, we will address the issue of predisposition or vulnerability to becoming addicted to drugs (i.e., the question of why some people who experiment with drugs develop an addiction, while others do not). Finally, we review attempts to develop novel therapeutic strategies and policy ideas that could help prevent opioid and other substance abuse.
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Greiner, Rebecca, Danielle Boselli, Mariam Salib, and Jai Narendra Patel. "Examination of the Screener and Opioid Assessment for Patients with Pain-Short Form (SOAPP-SF) in an oncology palliative medicine clinic." Journal of Clinical Oncology 36, no. 34_suppl (December 1, 2018): 196. http://dx.doi.org/10.1200/jco.2018.36.34_suppl.196.
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196 Background: The National Comprehensive Cancer Network states opioids can be used to treat cancer pain and prescribers should identify patients at risk for opioid misuse; research in this area is limited. In the non-cancer population, SOAPP-SF is a validated tool to predict aberrant drug behavior; a score of ≥ 4 (out of 20) is considered high risk. We performed a retrospective observational study to determine the utility of the SOAPP in identifying opioid misuse in the oncology population as measured by a non-compliant toxicology screen. Methods: Consecutive consults seen during a 6-month period completed the 5-question SOAPP-SF and Edmonton Symptom Assessment System (ESAS) form. Toxicology screens assessed non-compliance (i.e., absence of prescribed medications and/or presence of non-prescribed or illegal substances). Logistic regression models estimated the associations of composite and individual SOAPP-SF scores and ESAS symptom scores with non-compliant screens. Threshold analysis were conducted to identify an optimal SOAPP-SF cutoff. Results: Of 192 consults, 64 patients providing SOAPP-SF score and toxicology screen were evaluable. Mean age was 59 ± 9.8 years: 56% were female, 34% and 62% were African American and Caucasian respectively. Median SOAPP-SF score was 2 (range: [0, 12]). Non-compliant screens were observed in 31% of patients. The area under the curve (AUC) was 0.65. The validated SOAPP-SF cutoff score of ≥ 4 was associated with a sensitivity and specificity of 0.43 and 0.79, respectively (p = 0.082). Sensitivity (0.76) and specificity (0.72) were maximized at a cutoff score of ≥ 3 (p < 0.001). When evaluated individually, the SOAPP-SF question about smoking habit was associated with a non-compliant screen (p = 0.020). Increased ESAS pain scores were associated with SOAPP-SF score ≥ 3 (p = 0.013). Conclusions: SOAPP-SF can identify oncology patients at risk for opioid misuse. Preliminary analyses suggest a more appropriate threshold of identification is a score of ≥ 3 not ≥ 4. Future work will increase numbers of evaluable patients and examine other factors associated with opioid misuse.
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Halepas, Steven, Cameron Christiansen, Alia Koch, Shahid R. Aziz, David M. Shafer, and Elie M. Ferneini. "Opioid-Prescribing Patterns in Connecticut and New Jersey Following Third Molar Extractions." Anesthesia Progress 69, no. 4 (December 1, 2022): 9–14. http://dx.doi.org/10.2344/anpr-69-02-12.
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Objective In recent years, opioid misuse has resulted in much scrutiny on providers' prescribing habits. The purpose of this study was to analyze prescribing habits in the context of third molar extractions as a model for promoting better postsurgical pain management. Methods This was a cross-sectional survey of oral maxillofacial surgeons in Connecticut and New Jersey. A total of 291 practitioners were contacted to complete an online survey using Qualtrics Research Services to determine prescribing habits following third molar extractions. Results The most common approach for postoperative analgesia was nonsteroidal anti-inflammatory drugs (NSAIDs) and an opioid/acetaminophen (APAP) combination as 2 separate prescriptions, reported by 36% of participants. The combination of hydrocodone/APAP was the most common opioid formulation, and an average of 10.93 ± 4.51 opioid pills were prescribed with a maximum of 20 pills reported. Most providers (79%) consistently provided patients with opioid information. Only 22% reported always checking opioid-monitoring programs; however, providers were more likely to check if prescribing more than ∼11 opioid pills (P = .0228). Most reported using dexamethasone (82%) and bupivacaine (56%) intraoperatively, while ketorolac was less common (15%). No association was found between the quantity of opioids prescribed and the use of intraoperative ketorolac, steroids, or bupivacaine (P > .05). Conclusion There remains to be a universal standard for using opioids for postoperative pain management in dentistry. Providers should be mindful when prescribing opioids and consider using NSAIDs and APAP for baseline pain plus a separate opioid prescription for breakthrough pain. Additional focus on minimizing the quantity of opioids prescribed and self-reflecting on prescribing and practice habits to further reduce opioid-related complications is warranted.
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Schinas, MSc, Anna, Shein Nanji, BSc, Kira Vorobej, MSc, Catherine Mills, MSc, Dawn Govier, BSc, and Beatrice Setnik, PhD. "Key characteristics and habits of the recreational opioid user." Journal of Opioid Management 15, no. 6 (November 1, 2019): 507–20. http://dx.doi.org/10.5055/jom.2019.0542.
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Objective: To identify key characteristics and habits of recreational opioid users.Design: The data were compiled from volunteers who participated in clinical studies at a contract research organization in Toronto, Ontario, Canada.Interventions: Data were collected from 5,018 male and female recreational opioid users via telephone and face-to-face screening interviews. Five recreational opioid users participated in a live interview broadcast on the internet.Main outcome measures: Demographic data, recreational drug use history, routes of recreational drug administration, alcohol use, and smoking status. A subset of the demographic information and recreational drug use history was summarized separately using data collected between 2013 and 2016 from 114 recreational opioid users who were not dependent on opioids. Interview excerpts were included from five recreational opioid users who described their real-world experiences with drug abuse, including the impact of abuse-deterrent opioid formulations on their drug abuse behavior.Results: The preferred route of administration of opioids was oral (52 percent), followed by intranasal (36 percent), intravenous (10 percent), and buccal (chewing on a patch; 2 percent). Other substances used included nicotine, alcohol, and non-opioid psychoactive drugs (primarily cannabis). Oxycodone was the most frequently reported opioid of abuse.Conclusions: Recreational opioid users have distinct drug-related behaviors and preferences. Monitoring current trends and examining these behaviors is an important component to understand the potential safety risks associated with recreational opioid use.
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Jarlbaek, Lene. "Opioid prescribing habits differ between Denmark, Sweden and Norway – and they change over time." Scandinavian Journal of Pain 19, no. 3 (July 26, 2019): 491–99. http://dx.doi.org/10.1515/sjpain-2018-0342.
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Abstract Background and aims The medical use of opioids in different countries is often subject to public concern and debate, frequently based on rough figures from prescription databases made for registration of consumption. However, public access to some of these databases allow for further exploration of the prescription data, which can be processed to increase knowledge and insight into national opioid prescribing-behavior. Denmark, Sweden and Norway are considered closely related with regard to health care and culture. So, this study aims to provide a more detailed picture of opioid prescribing and its changes in the three Scandinavian countries during 2006–2014, using public assessable prescription data. Methods Data on dispensed opioid prescriptions (ATC; N02A, and R05DA04) were downloaded from each country’s prescription-databases. The amounts of dispensed opioids were used as proxy for consumption or use of opioids. Potential differences between dispensed prescriptions and actual use cannot be drawn from these databases. Consumption-data were converted from defined daily doses (DDDs) to mg oral morphine equivalents (omeqs). Changes in the choice of opioid-types, consumption and number of users were presented using descriptive statistics and compared. Results Opioid users: during the whole period, Norway had the highest, and Denmark the lowest, number of opioid users/1,000 inhabitants. From 2006 to 2014 the numbers of users/1,000 inhabitants changed from 98 to 105 in Norway, from 66 to 75 in Denmark, and from 79 to 78 in Sweden. Opioid consumption/1,000 inhabitants: The results depended much on the unit of measurement. The differences between the countries in consumption/1,000 inhabitants were small when DDDs was used as unit, while using mg omeqs significant differences between the countries appeared. Denmark had a much higher consumption of omeqs per 1,000 inhabitants compared to Sweden and Norway. Opioid consumption/user: during the whole period, Norway had the lowest, and Denmark the highest consumption/user. In 2006, the annual average consumption/user was 1979, 3615, 6025 mg omeq/user in Norway, Sweden and Denmark, respectively. In 2014 the corresponding consumption was 2426, 3473, 6361 mg omeq/user. The preferred choices of opioid-types changed during the period in all three countries. The balance between use of weak or strong opioids showed more prominent changes in Norway and Sweden compared to Denmark. Conclusions This study has shown how public assessable opioid prescription data can provide insight in the doctors’ prescribing behavior, and how it might change over time. The amounts of dispensed opioids, opioid prescribing habits and changes were compared between the countries, and significant differences appeared. Within each country, the overall picture of opioid consumption appeared rather stable. Implications Studies like this can contribute to qualify the ongoing debates of use of opioids in different nations and to monitor effects of initiatives taken by health-care authorities and health-care policy-makers.
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Morgan, Jessica Kelley, Steven K. Walther, and Marian E. Lane. "Evaluation of a Mobile Application to Decrease Opioid Misuse and Habit-Forming Behaviors Following Prescription: Preliminary Results and Future Directions." Psychology 10, no. 15 (2019): 2019–25. http://dx.doi.org/10.4236/psych.2019.1015129.
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Bril, Silviu, Yoav Shoham, and Jeremy Marcus. "The ‘Mystery’ of Opioid-Induced Diarrhea." Pain Research and Management 16, no. 3 (2011): 197–99. http://dx.doi.org/10.1155/2011/309685.
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Bowel dysfunction, mainly constipation, is a well-known and anticipated side effect of opioids. The physician prescribing an opioid frequently confronts the challenge of preventing and treating bowel dysfunction. Different strategies have emerged for managing opioid-induced constipation. These strategies include physical activity, maintaining adequate fluid intake, adhering to regular daily bowel habits, using laxatives and other anticonstipation medications and, recently, using a peripheral opioid antagonist, either as a separate drug or in the form of an opioid agonist-antagonist combination pill. What options exist for the physician when a patient receiving opioids complains of diarrhea, cramps and bloating, rather than the expected constipation? The present article describes a possible cause of opioid-induced diarrhea and strategies for management.
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Thibodeaux, Anne Marie, Keith Foster, Jessica W. Skelley, and Marion Sims. "Opioid Prescribing Habits in a Family Medicine Residency Program for the Management of Non-Cancer Pain." INNOVATIONS in pharmacy 10, no. 2 (May 20, 2019): 10. http://dx.doi.org/10.24926/iip.v10i2.1149.
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Objectives: 1. List components of the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain, 2. Describe the prescribing habits of medical residents and attending physicians within a family medicine residency program, 3. Discuss the direction of future research
Methods: A report was generated for all patients with opioids listed as a medication at Christ Health Center family medicine clinic from July 2016 to June 2017. A total of 153 patients were identified with prescriptions written for chronic non-cancer pain indications. Clinical management via a retrospective chart review was completed utilizing a standardized data collection form centered around four of twelve recommendations within the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain: (1) Avoid concurrent opioid and benzodiazepine prescribing; (2) evaluate benefits and harms with patients within 1 to 4 weeks of starting opioid therapy; (3) perform urine drug testing before starting opioids and consider at least annually; and (4) offer/prescribe medication for opioid use disorder for all patients taking chronic opioids.
Results: A total of 153 prescriptions were written for chronic indications. The most common indications were chronic back pain (32.0%), unspecified chronic pain (31.4%), and osteoarthritis (9.8%). Average duration of therapy was 26.6 months. Forty-two (27.5%) patients were concurrently receiving benzodiazepine therapy. Eighteen (11.8%) patients performed a drug test before or during therapy. Twenty-two (14.4%) patients had documented discussion with their prescriber evaluating the benefits and harms of their opioid regimens. No patients were prescribed medication for opioid overdose.
Conclusion: Prescribing habits did not align with the four-guideline recommendations evaluated. The need for provider-focused education on current pain management practice guidelines was identified.
Article Type: Student Project
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Hek, Karin, Tim Boogaerts, Robert A. Verheij, Hans De Loof, Liset van Dijk, Alexander L. N. van Nuijs, Willemijn M. Meijer, and Hilde Philips. "Opioid prescribing in out-of-hours primary care in Flanders and the Netherlands: A retrospective cross-sectional study." PLOS ONE 17, no. 4 (April 7, 2022): e0265283. http://dx.doi.org/10.1371/journal.pone.0265283.
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Background Increased opioid prescribing has raised concern, as the benefits of pain relief not always outweigh the risks. Acute and chronic pain is often treated in a primary care out-of-hours (OOH) setting. This setting may be a driver of opioid use but the extent to which opioids are prescribed OOH is unknown. We aimed to investigate weak and strong opioid prescribing at OOH primary care services (PCS) in Flanders (Northern, Dutch-speaking part of Belgium) and the Netherlands between 2015 and 2019. Methods We performed a retrospective cross sectional study using data from routine electronic health records of OOH-PCSs in Flanders and the Netherlands (2015–2019). Our primary outcome was the opioid prescribing rate per 1000 OOH-contacts per year, in total and for strong (morphine, hydromorphone, oxycodone, oxycodone and naloxone, fentanyl, tapentadol, and buprenorphine and weak opioids (codeine combinations and tramadol and combinations) and type of opioids separately. Results Opioids were prescriped in approximately 2.5% of OOH-contacts in both Flanders and the Netherlands. In Flanders, OOH opioid prescribing went from 2.4% in 2015 to 2.1% in 2017 and then increased to 2.3% in 2019. In the Netherlands, opioid prescribing increased from 1.9% of OOH-contacts in 2015 to 2.4% in 2017 and slightly decreased thereafter to 2.1% of OOH-contacts. In 2019, in Flanders, strong opioids were prescribed in 8% of the OOH-contacts with an opioid prescription. In the Netherlands a strong opioid was prescribed in 57% of these OOH-contacts. Two thirds of strong opioids prescriptions in Flanders OOH were issued for patients over 75, in the Netherlands one third was prescribed to this age group. Conclusion We observed large differences in strong opioid prescribing at OOH-PCSs between Flanders and the Netherlands that are likely to be caused by differences in accessibility of secondary care, and possibly existing opioid prescribing habits. Measures to ensure judicious and evidence-based opioid prescribing need to be tailored to the organisation of the healthcare system.
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Lewis, Rachel E., Bethany R. Sappington, Andrew J. Ward, Robert E. Heidel, James M. Lewis, and James M. Mcloughlin. "Optimal Pain Control after Outpatient Surgery for Cutaneous Malignancies." American Surgeon 85, no. 9 (September 2019): 956–60. http://dx.doi.org/10.1177/000313481908500935.
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Postoperative pain managed with opioids has contributed to the opioid crisis through over-prescribing practices. We assessed opioid-prescribing habits and their use by patients undergoing surgery for cutaneous malignancies. An Institutional Review Board–approved retrospective analysis was conducted for patients who underwent skin cancer resection between January 2018 and June 2018. Data were collected from the electronic medical record, and opioid-related data were collected from patient interviews and state registries. There were 120 study participants (42 females and 78 males) with a median age of 67 years (range, 21–94 years). All received preincision local anesthetic: 64 had liposomal bupivacaine (LB) (53%) and 56 had non-LB bupivacaine (47%). Most participants (n = 88) used 0 opioids (73%), including 43 LB-anesthetic (67%) and 45 non–LB-anesthetic (80%). No significance was seen between those with a diagnosis of chronic pain, narcotic tolerance, an area of resection, and nodal sampling groups in opioid use. Four patients (3%) requested a refill. Of 105 prescriptions written for opioids, 99 had leftover opioids for an over-prescribing rate of 94 per cent. This study suggests pain after skin cancer surgery is manageable with very limited opioid requirements. Our results support prescribing no more than five opioid tablets for postoperative pain control in patients undergoing resection for skin malignancies.
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Ormsby, MD, Andrew, and Caitlin Dietsche, MD. "The effect of the COVID-19 pandemic on opioid prescribing for patients with pleuritic pain." Journal of Opioid Management 18, no. 6 (November 1, 2022): 529–35. http://dx.doi.org/10.5055/jom.2022.0748.
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Objective: We sought to understand opioid prescribing for COVID-19 positive and negative patients with pleuritic pain during the first wave of the pandemic. We hypothesized that patients without COVID-19 would be prescribed opioids more frequently intrapandemic compared to prepandemic and postulated that COVID-19 patients would be prescribed opioids more frequently and at greater quantity than their peers.Design: A retrospective observational analysis of electronic health record data.Setting: A quaternary academic hospital from February through April 2020.Participants: A total of 1,400 of 3,169 adult inpatient hospitalizations involving pleuritic pain were included.Main measures: Frequency and average daily dose of opioid prescriptions were analyzed using logistic and linear regression. Opioid prescribing habits were compared pre- and intrapandemic. Hypotheses and primary outcome measures were formulated prior to data collection.Key results: During the pandemic, COVID-19 patients were 15.77 absolute percentage points less likely to be prescribed opioids compared to patients without COVID-19 (95 percent confidence interval (CI): –8.98 to –22.56 percent). Patients without COVID-19 were equally likely to be prescribed opioids pre- and intrapandemic (95 percent CI: –9.37 to 2.42 percent). Odds ratio of opioid prescription for COVID-19 patients was 0.44 (95 percent CI: 0.08-0.80). Within those given opioids, COVID-19 patients were prescribed 3.0 percent greater morphine milligram equivalents (MMEs) (95 percent CI: 1.07-5.85 percent).Conclusion: During the first wave of the pandemic, COVID-19 patients with pleuritic pain were prescribed opioids less frequently than patients without COVID-19, while patients without COVID-19 were equally likely to be prescribed opioid pre- and intrapandemic. On the other hand, COVID-19 patients treated with opioids were given greater daily MMEs due to the greater utilization of opioid infusions.
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Nadeau, Robert, Kristopher Hasstedt, Ashley Brooke Sunstrum, Chad Wagner, and Harold Tu. "Addressing the Opioid Epidemic: Impact of Opioid Prescribing Protocol at the University of Minnesota School of Dentistry." Craniomaxillofacial Trauma & Reconstruction 11, no. 2 (June 2018): 104–10. http://dx.doi.org/10.1055/s-0038-1649498.
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Prescription opioid medications continue to be abused on an epidemic level and have been shown to be a “gateway” drug to heroin abuse. Individuals experimenting with opioids commonly fall in the 10- to 19-year age range in which dentists are the highest prescribers. To reduce the number of excess opioids, the Department of Oral and Maxillofacial Surgery, University of Minnesota, developed and implemented an evidence-based opioid prescribing policy. Data were collected via electronic health record for the previous year and compared with the year following the protocol implementation. The results showed a drastic decrease (>46%) in the number of prescriptions given over a 1-year period. All departments reported a decrease in opioid prescriptions and the average number of tablets per prescription. The concern of undertreating pain was not found to be significant, as there was no increase in after-hours calls, recall appointments, or documentable emergency room visits. The results support the efficacy of an opioid prescribing policy's ability to lower the frequency and number of opioids given to patients, while still adequately treating patients’ pain. Continued evaluation and modifications of the protocol and close monitoring of prescriber habits will enhance patients’ pain control while also limiting the number of opioids available for abuse.
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El-Amin, Nadirah, Paul Nietert, and Julie Kanter. "Opioid Prescribing Habits in Sickle Cell Disease: An International Survey of Providers." Blood 132, Supplement 1 (November 29, 2018): 2371. http://dx.doi.org/10.1182/blood-2018-99-117206.
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Abstract Introduction: Vaso-occlusive pain crisis (VOC) are the hallmark of sickle cell disease (SCD) and the primary reason for which affected individuals seek acute care (Boussard et al JAMA, 2010). Both national and international guidelines recommend aggressive IV opioids, intravenous fluids and anti-inflammatory therapy as the mainstay of treatment for acute SCD pain. In an effort to avoid acute care for VOC, many pain crises are managed at home with oral agents, including anti-inflammatory and opioid medications. However, there are no current guidelines on the use and type of medications for home pain management, likely due to lack of clinical trials comparing the efficacy and safety of oral agents for use at home. Previous studies suggest geographic differences in the use of opioids for home pain management (Kanter et al, Br J Haem, 2018). Amplifying these issues is the growing concern for opioid abuse and misuse both in the US and internationally (WHO, 2013). This study aimed to describe the opioid prescribing habits among international providers treating individuals with SCD, to better assess the different medications used for outpatient management of SCD-related pain both in the United States (US) and internationally. Methods: A thirty-question REDcap survey was disseminated electronically. Participants were recruited using a combination purposive and snowball sampling strategy. Providers were initially identified by email using databases from SCD conferences. After the initial responses were received, responding participants were asked to refer other providers who treat SCD. Results: There were 17 countries represented. Over half of the respondents were from the US (59%,75/127). Most of the respondents were Hematologist/Oncologists both pediatric-focused (43%, 54/127) and adult-focused (34%,44/127). Providers from the US were more likely to prescribe opioids than non-US physicians (95% vs 73%, p<.001) and were more likely to be "very comfortable" prescribing opioids than non-US physicians (73% vs 37%, p<.001). In exploring the rationale of physicians that do not prescribe opioids for outpatient management of pain, non-US physicians were more likely to site "outpatient opioids not being allowed" (50%) vs 25%), although this was not significant. Of those physicians who prescribe opioids, most (70%) prescribed 30 doses or less at a time. However, non-US physicians were more likely to prescribe less than 10 doses at a time (64%vs 17%, p <.001). Overall, the top 5 most commonly prescribed medications for home pain management were; acetaminophen/paracetamol (98%), ibuprofen (88%), short acting morphine (55%), tramadol (52%) and oxycodone (48%). Non US physicians were more likely to prescribe acetaminophen/paracetamol (90%vs 68%, p<.05) and tramadol (69% vs 30%, p <.05), while US providers more likely to prescribe short acting morphine (64% vs 42%, p<.05), long acting morphine (60% vs 25%, p<.001), oxycodone (70% vs 15%, p<.001), oxycontin (44% vs 10%, p<.001) and dilaudid (64% vs 6%, p<.001). The most commonly ordered acute care parenteral medications were morphine (84%), dilaudid (55%) and Toradol (54%). Parenteral dilaudid was used almost entirely in the US alone (88% vs 8%, p<.001). US physicians were more likely to be concerned that patients were abusing opioids than non-US physicians (32% vs 27%, p<.05). Discussion: Acute vaso-occlusive pain episodes are the most common reason for healthcare utilization in SCD. Although many countries use oral opioids for outpatient pain management, the majority of non-US prescribers are more likely to prescribe less potent opioids in lower quantities. Non-US physicians are more likely to use Tylenol and NSAIDS before opioids, with Tramadol being prescribed most often. As concerns have increased for opioid-induced hyerpalgesia and other complications of long term opioid use, alternative disease-modifying agents for the prevention of SCD related pain remain a huge unmet need. However, identifying optimal home pain management strategies is also necessary to improve care in SCD. Finally, as more multinational studies of novel therapeutics are undertaken in SCD, it is important to note the significant geographic differences in medication prescribing both at home and in the hospital and to work to create multinational guidelines on outpatient management of VOC's. Disclosures Kanter: bluebird bio: Membership on an entity's Board of Directors or advisory committees, Research Funding; AstraZeneca: Membership on an entity's Board of Directors or advisory committees; Novartis: Membership on an entity's Board of Directors or advisory committees, Research Funding; ASH: Membership on an entity's Board of Directors or advisory committees; Apopharma: Research Funding; Pfizer: Research Funding; NHLBI: Membership on an entity's Board of Directors or advisory committees, Research Funding; Global Blood Therapeutics: Research Funding; Sancilio: Research Funding.
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Ho, Edward, Matthew Doherty, Robert Thomas, John Attia, Christopher Oldmeadow, and Matthew Clapham. "Prescription of opioids to post-operative orthopaedic patients at time of discharge from hospital: a prospective observational study." Scandinavian Journal of Pain 18, no. 2 (April 25, 2018): 253–59. http://dx.doi.org/10.1515/sjpain-2017-0149.
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Abstract Background and aims: Excessive opioid prescribing can lead to adverse consequences including stockpiling, misuse, dependency, diversion and mortality. Increased prescriptions to post-operative inpatients as part of their discharge planning may be a significant contributor. Primary aims included comparing the amount of opioids prescribed, consumed, left unused and their relationship with pain and functionality. Methods: A total of 132 consecutive patients who underwent elective orthopaedic surgery were prospectively audited. Daily oral morphine equivalent (DME) of opioids prescribed was compared with opioids consumed and amount left unused 7–10 days after discharge. For analysis, patients were split into three groups: total knee replacement (TKR), hand surgery (Hands), and miscellaneous (Misc). Results: The mean dose of opioid prescribed per patient was 108.5 mg DME. TKR consumed 33–35% more opioids than Misc (p=0.0283) and Hands (p=0.0975). Age was a significant independent factor for opioid consumption in the 50th and 75th percentiles of Hands (p≤0.05). An average of 36 mg DME per patient was left unused with Hands having the highest median DME (37 mg) unused. In the total cohort, 26% of patients were discharged with more DME than their last 24 h as an inpatient and had at least 50% of their tablets left unused at follow-up. Conclusions: Over-prescription of opioids occurs at discharge which can increase the risk of harm. New intervention is needed to optimise prescribing practises. Implications: Changes to prescribing habits and workplace culture are required to minimise unnecessary opioid prescribing but will be challenging to implement. A multi-layered approach of electronic prescribing, opioid stewardship and targeted educational awareness programmes is recommended.
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Sadowski, MD, FHM, Richard, Emily Hillaker, DO, Michael Chavarria, MD, Fareea Khaliq, MD, and Adam Schwark, MD. "A retrospective analysis of the impact of Michigan's opioid prescribing legislation on discharge opioid prescribing at a single institution." Journal of Opioid Management 18, no. 5 (September 1, 2022): 467–74. http://dx.doi.org/10.5055/jom.2022.0740.
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This study sought to determine if there were any changes in opioid prescribing habits of providers at a single institution after the implementation of legislation to increase opioid prescribing regulations. Our study demonstrated a 39.5 percent decrease in overall morphine milligram equivalent (MME) prescribed the year after the laws took effect when compared with the year prior. It is clear that these laws have been effective in decreasing the number of opioids prescribed at discharge from Mercy Health Grand Rapids.Introduction: Opioid use disorder has become an epidemic with approximately 130 people dying every day in the United States due to prescription and illegal opioid overdoses. In December 2017, the Michigan legislature ratified a package of 10 acts to address a variety of problems through several layers of regulations including more restrictive prescribing rules, which took effect in June 2018. Objective: To evaluate the impact of legislation on the opioid prescribing habits of providers who discharged patients from a community-based academic teaching hospital.Design, setting, and participants: A retrospective cohort study was performed using data from a community-based academic teaching hospital with 303 beds, a medical ICU, labor and delivery unit, and a 42-room emergency department. All patients discharged from in-patient or observation status in the 12 months before and after June 1, 2018 were included.Main outcomes and measures: The primary outcome was MMEs of opioids prescribed at discharge before (June 1, 2017 to May 31, 2018) and after (June 1, 2018 to May 31, 2019) legislation. Medications included morphine, hydrocodone, oxycodone, fentanyl, methadone, hydromorphone, tramadol, codeine, and meperidine.Results: There were 17,227 patients discharged during the first 12-month period and 15,855 patients discharged in the second 12-month period. There were 14,064 new opioid prescriptions in total during these time periods. Total MME prescribed during the study period showed a 39.5 percent decrease from pre- (2,268,460 MME) to post-legislation (1,372,424 MME), while average MMEs/discharge significantly decreased (135.1 ± 321.2 vs. 87.6 ± 187.4; p 0.001). Total pill/patch count decreased by almost 40 percent. For patients who were prescribed opioids, average MME/discharge showed significant decline after legislation implementation (309.6 ± 427.1 vs. 212.2 ± 242.1; p 0.001). Average daily MME/patient prescribed an opioid remained similar between the time periods (52.4 ± 37.0 vs. 51.6 ± 35.0; p = 0.21). Significant reductions (p 0.05) were seen in MMEs for each individual medication with the exception of acetaminophen-codeine and methadone.Conclusions and relevance: Our results indicate that the legislation implemented in Michigan to regulate opioid prescriptions was associated with a reduction in opioids prescribed to patients discharged from a community-based academic teaching hospital.
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Thompson, Matthew M., Lucas Popp, Michael J. Foster, Hassan Malik, and R. Frank Henn. "Opioid Prescribing Habits for Common Arthroscopic Procedures in Opioid Naïve Patients." Orthopaedic Journal of Sports Medicine 9, no. 5 (May 1, 2021): 232596712110092. http://dx.doi.org/10.1177/23259671211009263.
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Background: With the opioid epidemic and the increasing number of opioid-related deaths, there is growing awareness in the medical community regarding the dangers of opioid overprescription. As a result, there is a willingness among physicians to abandon old norms and adopt new data-driven prescribing practices. Purpose: To demonstrate patient-reported consumption data of opioid medications after anterior cruciate ligament (ACL) reconstructions (ACLRs), knee arthroscopies, and rotator cuff repairs to provide data-driven guidelines for prescribing opioids after these procedures. Study Design: Case series; Level of evidence, 4. Methods: Included in the study were 168 patients who underwent an ACLR, knee arthroscopy, or arthroscopic rotator cuff repair over a 17-month period. Patients were excluded if they had an opioid allergy, had preexisting opioid use, had an acute postoperative complication requiring further surgery, required hospitalization, exhibited drug-seeking behaviors, or were lost to follow-up. Medical records were reviewed to determine the number of opioid pills prescribed and the number of pills taken postoperatively. Prescribing was standardized in that 15 hydrocodone/acetaminophen pills (5/325 mg) were prescribed for all knee arthroscopy procedures and 40 hydrocodone/acetaminophen pills were prescribed for all ACL and rotator cuff procedures. The mean number of pills consumed and percentage of prescribed pills taken were analyzed in association with specific procedures and patient demographics. Results: Overall, the mean (±SD) reported opioid consumption overall was 13.5 ± 13.0 pills, with a utilization rate of 45.6% of the prescription. The mean reported opioid consumption for ACLRs, knee arthroscopies, and rotator cuff repairs was 19.1 ± 15.4, 7.2 ± 5.4, and 17.2 ± 14.3 pills, respectively ( P < .001). This represented a utilization rate of 48%, 47%, and 41%, respectively. Conclusion: This study provides important information regarding opioid utilization after common arthroscopic procedures. For ACLRs, knee arthroscopies, and rotator cuff repairs, by respectively prescribing 20, 10, and 20 pills postoperatively, the amount of unused medications would decrease by 60%, 47%, and 64%, respectively. We recommend prescribing no more than 20, 10, and 20 hydrocodone/acetaminophen pills (5/325 mg) for ACLRs, knee arthroscopies, and arthroscopic rotator cuff repairs, respectively.
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Rivera, Alicia, Diana Suárez-Boomgaard, Cristina Miguelez, Alejandra Valderrama-Carvajal, Jérôme Baufreton, Kirill Shumilov, Anne Taupignon, Belén Gago, and M. Ángeles Real. "Dopamine D4 Receptor Is a Regulator of Morphine-Induced Plasticity in the Rat Dorsal Striatum." Cells 11, no. 1 (December 23, 2021): 31. http://dx.doi.org/10.3390/cells11010031.
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Long-term exposition to morphine elicits structural and synaptic plasticity in reward-related regions of the brain, playing a critical role in addiction. However, morphine-induced neuroadaptations in the dorsal striatum have been poorly studied despite its key function in drug-related habit learning. Here, we show that prolonged treatment with morphine triggered the retraction of the dendritic arbor and the loss of dendritic spines in the dorsal striatal projection neurons (MSNs). In an attempt to extend previous findings, we also explored whether the dopamine D4 receptor (D4R) could modulate striatal morphine-induced plasticity. The combined treatment of morphine with the D4R agonist PD168,077 produced an expansion of the MSNs dendritic arbors and restored dendritic spine density. At the electrophysiological level, PD168,077 in combination with morphine altered the electrical properties of the MSNs and decreased their excitability. Finally, results from the sustantia nigra showed that PD168,077 counteracted morphine-induced upregulation of μ opioid receptors (MOR) in striatonigral projections and downregulation of G protein-gated inward rectifier K+ channels (GIRK1 and GIRK2) in dopaminergic cells. The present results highlight the key function of D4R modulating morphine-induced plasticity in the dorsal striatum. Thus, D4R could represent a valuable pharmacological target for the safety use of morphine in pain management.
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Ramadan, Majed, Yahya Alnashri, Amjad Ilyas, Omar Batouk, Khalid A. Alsheikh, Laila Alhelabi, and Suliman Abdulah Alnashri. "Assessment of opioid administration patterns following lower extremity fracture among opioid-naïve inpatients: retrospective multicenter cohort study." Annals of Saudi Medicine 42, no. 6 (November 2022): 366–76. http://dx.doi.org/10.5144/0256-4947.2022.366.
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BACKGROUND: Prescribing habits during admission have largely contributed to the opioid epidemic. Orthopedic surgeons represent the third-highest opioid-prescribing specialty. Since more than half of body fractures in Saudi Arabia have been lower extremity fractures, it is imperative to understand opioid administration patterns and correlates among opioid-naïve inpatients. OBJECTIVES: Assess opioid administration patterns and correlates among opioid-naïve inpatients with lower extremity fractures. DESIGN AND SETTINGS: Retrospective cohort PATIENTS AND METHODS: Opioid naïve individuals aged 18 to 64 years, admitted due to lower extremity fracture from 2016 to 2020 were included. Data was collected from health records of the Ministry of National Guard Health Affairs (MNG-HA) at five different medical centers. The high-dose (≥50 MME) patients were compared with low dose (<50 MME) patients. Any association between inpatient factors and high-dose opioid use was analyzed by multiple logistic regression. MAIN OUTCOME MEASURES: Opioids taken during inpatient admission as measured by milligram morphine equivalents (MME)/per day. SAMPLE SIZE: 1520 patients RESULTS: Most of the 1520 patients (88.5%) received an opioid medication, while (20.3%) received high-dose opioids at a median daily dose of 33.7 MME/per day. The proportion of patients received naloxone (20.7%) was double among high-dose opioid inpatients. High-dose opioid patients during admission were two times more likely to receive an opioid prescription after discharge (odds ratio, 2.32; 95% confidence interval, 1.53, 3.51), and three more times likely to receive ketamine during admission (odds ratio, 3.02; 95% confidence interval, 1.64, 5.54). CONCLUSION: Notable variabilities exist in opioid administration patterns that were not explained by patient factors. Evidence-based opioid prescribing practices should be developed for orthopedic patients to prevent opioid overprescribing and potential opioid overdose among orthopedic patients. LIMITATIONS: Retrospective, unmeasurable confounders might have biased our results. Since based on National Guard employees, results may not be generalizable. CONFLICT OF INTEREST: None.
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Alexander, John C. "Evaluation of Opioid Prescribing Habits Based on Analysis of a State Prescription Drug Monitoring Program." Pain Physician 5, no. 22;5 (September 11, 2019): E425—E433. http://dx.doi.org/10.36076/ppj/2019.22.e425.
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Background: The current opioid epidemic is perhaps the greatest public health crisis in the United States. Although multiple factors led to the rise of this epidemic, it is without question associated with the rise in opioid prescribing. Objectives: Better understanding of the opioid prescribing may provide insights into populationlevel trends contributing to this epidemic, and opportunities to decrease the magnitude of opioid overdose-related death. Therefore we assessed trends in opioid prescribing habits based on analysis of the Texas Prescription Drug Monitoring Program (PDMP) and geographic, ethnic, and incomerelated data from the US Census Bureau. Study Design: Multiple linear regression analysis of Texas PDMP and US Census Bureau data were performed to assess for correlations to opioid prescribing based on geographic, ethnic, income, and time-related variables. Setting: All controlled substances prescribed in the state of Texas from April 2015 to May 2018 were analyzed. Methods: We obtained data from the Texas PDMP for all controlled substances from April 2015 to May 2018. We performed multiple linear regression analysis of these data along with US Census Bureau data to assess for correlations based on geographic, ethnic, income, and time-related variables. We hypothesized that there would be substantial variability in opioid prescribing habits based on geographic, ethnic, and economic variables. Results: Approximately 200 million pills of controlled substances were prescribed per month over the studied time frame. Overall, high geographic variability was noted, and this strongly correlated to race and ethnicity. Opioid prescribing increased along with the proportion of white residents within a county, but a similar negative correlation was noted with increasing Hispanic population proportion. This correlation was noted throughout the study period, but up until 2017, lower income levels among higher white population had even higher correlation with increased opioid prescribing. Cumulative opioid prescriptions throughout the state fell beginning in 2017. Limitations: This analysis does not include opioids obtained illicitly or from prescriptions outside the state of Texas. The specificity of geographic data are limited to the county level due to irregular entry of zip code data by prescribing pharmacies. Conclusions: In the state of Texas over the studied time period, there was strong correlation for higher rates of opioid prescribing as white population increased despite overall decreased opioid prescribing starting in 2017. Until 2017, this correlation grew stronger as low-income white population increased. Key words: Opioid, opioid epidemic, opioid utilization
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Lovecchio, Francis, Ajay Premkumar, Tyler Uppstrom, Jeffrey Stepan, Brittany Ammerman, Moira McCarthy, Beth Shubin Stein, et al. "Opioid Consumption After Arthroscopic Meniscal Procedures and Anterior Cruciate Ligament Reconstruction." Orthopaedic Journal of Sports Medicine 8, no. 4 (April 1, 2020): 232596712091354. http://dx.doi.org/10.1177/2325967120913549.
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Background: Procedure-specific opioid-prescribing guidelines have the potential to decrease the number of unused pills in the home without compromising patient satisfaction. However, there is a paucity of data on the minimum necessary quantity to prescribe for outpatient orthopaedic surgeries. Purpose: To prospectively record daily opioid use and pain levels after arthroscopic meniscal procedures and anterior cruciate ligament reconstruction (ACLR) at a single institution. Study Design: Case series; Level of evidence, 4. Methods: A total of 95 adult patients who underwent primary arthroscopic knee surgery (meniscectomy, repair, or ACLR) were enrolled. Patients with a history of opioid dependence were ineligible. Daily opioid consumption and Numeric Rating Scale pain scores were collected through an automated text-messaging platform starting on postoperative day 1 (POD1). At 6 weeks or at patient-reported cessation of opioid use, final survey questions were asked. Patients who failed to complete data collection were excluded. Opioid use was converted into “pills” (oxycodone 5-mg equivalents) to facilitate comparisons and clinical applications. Factors associated with high and low opioid use were compared. Results: Of the 95 patients enrolled, 71 (74.7%) were included in the final analysis. Of these, 40 (56.3%) underwent meniscal surgery and 31 (43.7%) underwent ACLR. After outpatient arthroscopic meniscectomy or repair, the total median postdischarge opioid use was 0.3 pills (oxycodone 5-mg equivalents), with 75% of patients consuming 3.3 or fewer pills (range, 0-19 pills). For ACLR, the median postdischarge consumption was 7 pills (75th percentile, 23.3 pills; range, 0-41 pills). Almost one-third of patients (32.3%) took no opioids after surgery (3 ACLR, 20 meniscus). All meniscus patients and 71% of ACLR patients ceased opioid consumption by postoperative day 7. Conclusion: Opioids may not be necessary in all patients, particularly after meniscal surgery and in comparison with ACLR. For patients requesting opioids for pain relief, reasonable prescription quantities are 5 oxycodone 5-mg pills after arthroscopic meniscal procedures and 20 5-mg pills after ACLR. Slowing the current opioid epidemic and preventing future crises is dependent on refining prescribing habits. Clinicians should strongly consider patient education regarding expected pain as well as pain management strategies.
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Mandava, Nikhil, Demetris Delos, Katherine Vadasdi, R. Greene, Marc Kowalsky, Francis Alberta, Paul Sethi, and Parth Kamdar. "An Evidence Driven Opioid Prescribing Guideline following Knee Arthroscopy and Anterior Cruciate Ligament Reconstruction." Orthopaedic Journal of Sports Medicine 8, no. 7_suppl6 (July 1, 2020): 2325967120S0039. http://dx.doi.org/10.1177/2325967120s00393.
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Objectives: Opioid prescriptions following knee arthroscopy vary substantially, ranging from 15 to 60 opioid pills.[1-3] Expert panel guidelines recommend up to 30 pills for knee arthroscopy and 60 pills for anterior cruciate ligament reconstruction (ACLR) using an autograft; however, these recommendations are based on consensus rather than evidence.[4] Currently, orthopaedic surgeons do not possess any evidence driven guidelines for opioid prescriptions following knee arthroscopy or ACLR. The purpose of this study was to record patients’ postoperative opioid requirement to develop evidence driven prescription guidelines for knee arthroscopy and ACLR. Tepolt FA, Bido J, Burgess S, Micheli LJ, Kocher MS. Opioid Overprescription After Knee Arthroscopy and Related Surgery in Adolescents and Young Adults. Arthroscopy. 2018;34(12):3236-3243. Gardner V, Gazzaniga D, Shepard M, et al. Monitoring Postoperative Opioid Use Following Simple Arthroscopic Meniscectomy: A Performance-Improvement Strategy for Prescribing Recommendations and Community Safety. JB JS Open Access. 2018;3(4):e0033. Wojahn RD, Bogunovic L, Brophy RH, et al. Opioid Consumption After Knee Arthroscopy. J Bone Joint Surg Am. 2018;100(19):1629-1636. Stepan JG, Lovecchio FC, Premkumar A, et al. Development of an Institutional Opioid Prescriber Education Program and Opioid-Prescribing Guidelines: Impact on Prescribing Practices. J Bone Joint Surg Am. 2019;101(1):5-13. Methods: This prospective multicenter observational study enrolled 50 subjects undergoing outpatient knee arthroscopy for meniscal repair, meniscectomy, or ACLR. Opioid prescriptions, refills, and subject demographics were recorded. All patients followed the same perioperative, multimodal analgesic regimen (Table 1). Subjects were provided a pain journal to record visual analog scale (VAS) pain scores and opioid consumption for one week postoperatively. No changes were made to existing prescribing habits, postoperative physical rehabilitation, or surgical methodology. State databases were reviewed for additional opioid prescriptions. Results: Subjects, on average, consumed 2.5 opioid pills (range 0 to 14 pills) with a median consumption of 0.5 pills after knee arthroscopy. Eighty six percent of subjects (N = 43) consumed ≤ 5 opioid pills and 50% of subjects (N = 25) chose not to consume opioids postoperatively. Ninety two percent of subjects (N = 46) discontinued opioid consumption by the 3rd postoperative day. Subjects specifically undergoing ACLR (N = 18) consumed an average of 41 OME (Figure 1). Subjects consumed only 30% of opioids leaving 2,196 OME (approximately 293 oxycodone 5mg) available for possible distribution or misuse. Conclusion: This study demonstrates that current expert panels recommend an excess of opioids following knee arthroscopy. In contrast to these expert panel guidelines, we suggest a maximum of 5 and 15 oxycodone 5mg pills for knee arthroscopy and ACLR respectively. This evidence driven guideline will greatly assist orthopaedic surgeons in their effort to combat opioid overprescription. [Table: see text][Figure: see text]
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Katz, Andrew P., Carly Misztal, Michael K. Ghiam, and Michael E. Hoffer. "Changes in Single-Specialty Postoperative Opioid Prescribing Patterns in Response to Legislation: Single-Institution Analysis Over Time." Otolaryngology–Head and Neck Surgery 164, no. 4 (February 2, 2021): 774–80. http://dx.doi.org/10.1177/0194599820986577.
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Objectives To determine changes in the prescriptions of postoperative opioids in response to Florida state legislation restricting the number of days for which these medications could be prescribed to 3 days in most circumstances or 7 days at provider discretion. Study Design A retrospective review was performed for all patients undergoing 7 common outpatient otolaryngology surgical procedures. Setting Single-institution academic center in Florida. Methods Query of the state’s online prescription drug monitoring program was used to compare prescription habits 3 months before and after the law and then again 1 year later. Results A total of 561 patients were identified meeting criteria. The number of days that opioids were prescribed decreased significantly, from 6.42 to 4.48 to 3.03 days. There was a significant decrease in the proportion of patients receiving any postoperative opioid prescription, from 0.80 to 0.52 to 0.32. The total morphine milligram equivalents prescribed decreased from 28.4 before the law to 18.4 at 1 year after. Conclusions Legislative restrictions on the length of opioid prescriptions were associated with significant decreases in the proportion of patients receiving any opioids, the number of days that opioids were prescribed, and the total morphine milligram equivalents 3 months after the law went into effect, with even more dramatic changes at the 1-year time point. We opine that these changes are due to providers learning that many procedures do not require postoperative opioids and therefore increasingly considering and utilizing nonopioid alternatives in this setting.
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Trivedi, Sunny, Kevin Shea, Whitney Chadwick, Shabnam Gaskari, Ellen Wang, and Thomas Caruso. "A QUALITY IMPROVEMENT PROJECT TO REDUCE THE USE OF COMBINATION OPIOID/ACETAMINOPHEN MEDICATIONS WITHIN A LARGE HEALTH SYSTEM." Orthopaedic Journal of Sports Medicine 8, no. 4_suppl3 (April 1, 2020): 2325967120S0025. http://dx.doi.org/10.1177/2325967120s00258.
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Background: Combination analgesics are among the most commonly prescribed pain medications in pediatric orthopedic patients. However, combined analgesics do not allow for individual medication titration, which can increase the risk of opioid misuse and hepatoxicity from acetaminophen. Increasingly, the risks of combined analgesics associated with opioid misuse and hepatotoxicity are recognized by the FDA and other organizations. Given these risks, consideration should be made for independent administration of acetaminophen and opioids. Hypothesis/Purpose: The primary aim was to alter the prescribing habits of pediatric orthopedic providers at our institution from postoperative combined opioid/acetaminophen medicines to independent opioids and acetaminophen. Methods: The study took place at a children’s hospital level one trauma center. A multidisciplinary team of health professionals utilized lean methodology to develop a project plan. Guided by a key driver diagram, (1) combination oxycodone/acetaminophen products were removed from hospital formulary, (2) a revised inpatient and outpatient electronic order set was implemented, and (3) multiple education efforts (emails, in person meetings) were conducted. Outcomes included inpatient and outpatient percent combined opioid/acetaminophen orders by surgical providers over twenty-seven months. Statistical process control charts were used to measure combination opioid prescribing practices for orthopedic and other surgical specialties. Results: Prior to intervention, inpatient combination opioid/acetaminophen products were prescribed for an average of 46% of all opioid prescriptions for orthopedic patients. After intervention and multiple educational efforts, the percent of combined opioid/acetaminophen products dropped to 31% and then to 3% by end of the investigational period. For outpatient prescriptions, the combined products accounted for 88% prior to intervention and dropped to 15% at project completion. Conclusion: By removing combined oxycodone/acetaminophen products from hospital formulary, educating the medical staff, and employing electronic order sets, the inpatient/outpatient prescribing practice of pediatric orthopedic surgeons changed from the common use of combined opioid/acetaminophen products to independent medications. This project demonstrates that changing medication prescription practice can be accomplished with 3 steps within a hospital system. Reducing the use of combination opioid/acetaminophen products may have further positive impacts on opioid misuse and hepatoxicity.
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Siva, Shivi, Chung Sang Tse, Nayantara Coelho-Prabhu, and Rajeev Jain. "AMERICAN GASTROENTEROLOGICAL ASSOCIATION’S QUALITY LEADERSHIP COUNCIL’S PRACTICE WORK GROUP: A NATIONWIDE INITIATIVE TO REDUCE THE USE OF PRESCRIPTION OPIOID AMONG PATIENTS WITH INFLAMMATORY BOWEL DISEASE AT A LOCAL LEVEL." Inflammatory Bowel Diseases 27, Supplement_1 (January 1, 2021): S48. http://dx.doi.org/10.1093/ibd/izaa347.114.
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Abstract Background and aims The use of opioids among patients with inflammatory bowel disease (IBD) in the United States is increasing and it is associated with higher mortality, re-admissions, healthcare utilization, and disability. The American Gastroenterological Association’s (AGA) Quality Leadership Council’s practice workgroup developed educational materials to educate and modify narcotic prescribing habits of providers treating IBD and change the attitudes and expectations of patients who require analgesics. Methods Council members participated in two 1-hour virtual planning meetings to develop a key driver diagram to illustrate the aims, theories to achieve the aims, and specific action items to change ideas of opioid prescribing practices. Four working groups were created to perform a literature search and create educational resources for providers and patients regarding the risks of opioid use and non-opioid alternatives for pain management. The educational resources were reviewed by the Crohn’s and Colitis Foundation prior to online publication electronic and dissemination to the AGA membership. Results We developed a key driver diagram (Figure 1) to illustrate the components of promoting non-opioid pain management in patients with IBD. Educational materials were developed to 1) Delineate the risk factors for opioid abuse among patients with IBD to prescribers of a controlled substance including; Crohn’s disease, functional gastrointestinal disorders, anxiety, depression, female sex, a history of narcotic abuse, ≥2 previous surgeries, moderate to severe pain, clinical disease activity, sexual, emotional and physical abuse, 2) Recommend alternative therapies for opioids including medications and non-pharmacological treatment alternatives (Table 1), 3) Address salient key points that patients should discuss with their provider if an opioid is prescribed including complications associated with prolonged use of narcotic medications, and 4) Illustrate alternate medical therapy and other techniques for patients including yoga and mindfulness-based techniques, cognitive behavioral therapy, and medical hypnosis. Conclusions Using quality improvement methods, we developed educational materials for patients with IBD and providers treating IBD on opioid avoidance and non-opioid alternative therapy utilizing an evidence-based approach.
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Xia, Yixue, and Patrice Forget. "Opioid and gabapentinoid prescriptions in England from 2015 to 2020." PLOS ONE 17, no. 11 (November 28, 2022): e0276867. http://dx.doi.org/10.1371/journal.pone.0276867.
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Purpose Concerns gradually arose about misuse of gabapentinoids (gabapentin and pregabalin), especially when used in combination with opioids. Because it can be a driver of usage, trends in prescribing habits may be interesting to analyse. The aim of this study is to examine the evolution of prescriptions of opioids and gabapentinoids in England from 2015 to 2020 at a regional level. Methods This study included data from April 2015 to February 2020, focusing on prescribing data, extracted the OpenPrescribing database. We described the evolution of the prescriptions of opioids and gabapentinoids and calculated their ratios for each month. We used Analyses of Variance (ANOVAs) to compare data between and within regions (over time). Results During this period, opioid prescriptions remained stable (from -3.3% to +2.2%/year) and increased for gabapentinoids generally (from +1.5% to +2.2%). The ratio between gabapentinoid to opioid prescriptions increased by more than 20% in 2020 compared to 2015, variably between regions (F(6,406) = [120.2]; P<0.001; LSD Test: P<0.001; ANOVA for repeated measures: P<0.05). In 2019, a decline in the ratio occurred in all regions, but only persisting in the London commissioning region in 2020 (-14.4% in comparison with 2018, 95%CI: -12.8 to -16.3). Conclusions Gabapentinoids are increasingly prescribed in England. The ratio of gabapentinoid to opioid prescriptions in England increased from 2015 to 2020. The reclassification of gabapentinoids as controlled drugs, in 2019, may have been associated with a significant reduction, although larger prescribers may have been less influenced.
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Arshonsky, Josh, Noa Krawczyk, Amanda M. Bunting, David Frank, Samuel R. Friedman, and Marie A. Bragg. "Informal Coping Strategies Among People Who Use Opioids During COVID-19: Thematic Analysis of Reddit Forums." JMIR Formative Research 6, no. 3 (March 3, 2022): e32871. http://dx.doi.org/10.2196/32871.
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Background The COVID-19 pandemic has transformed how people seeking to reduce opioid use access treatment services and navigate efforts to abstain from using opioids. Social distancing policies have drastically reduced access to many forms of social support, but they may have also upended some perceived barriers to reducing or abstaining from opioid use. Objective This qualitative study aims to identify informal coping strategies for reducing and abstaining from opioid use among Reddit users who have posted in opioid-related subreddits at the beginning of the COVID-19 pandemic. Methods We extracted data from 2 major opioid-related subreddits. Thematic data analysis was used to evaluate subreddit posts dated from March 5 to May 13, 2020, that referenced COVID-19 and opioid use, resulting in a final sample of 300 posts that were coded and analyzed. Results Of the 300 subreddit posts, 100 (33.3%) discussed at least 1 type of informal coping strategy. Those strategies included psychological and behavioral coping skills, adoption of healthy habits, and use of substances to manage withdrawal symptoms. In addition, 12 (4%) subreddit posts explicitly mentioned using social distancing as an opportunity for cessation of or reduction in opioid use. Conclusions Reddit discussion forums have provided a community for people to share strategies for reducing opioid use and support others during the COVID-19 pandemic. Future research needs to assess the impact of COVID-19 on opioid use behaviors, especially during periods of limited treatment access and isolation, as these can inform future efforts in curbing the opioid epidemic and other substance-related harms.
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Diasso, Pernille D. K., Per Sjøgren, Jette Højsted, Susanne D. Nielsen, Katharina M. Main, and Geana P. Kurita. "Patient reported outcomes and neuropsychological testing in patients with chronic non-cancer pain in long-term opioid therapy: a pilot study." Scandinavian Journal of Pain 19, no. 3 (July 26, 2019): 533–43. http://dx.doi.org/10.1515/sjpain-2019-0007.
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Abstract Background and aims Opioid consumption has increased dramatically in patients with chronic non-cancer pain (CNCP), but long-term consequences are still unclear. The aim of this study is to investigate the effects of long-term opioid treatment on pain, cognition, mood, sleep and quality of life in CNCP patients. Methods In this cross-sectional pilot study, two groups of patients with CNCP treated in a multidisciplinary pain center were selected: (1) opioid group: ≥30 mg morphine equivalent/day for >4 weeks, and (2) control group: no opioid consumption for >4 weeks. Socio-demographic data, alcohol consumption, smoking habits and body mass index (BMI) were registered and pain (brief pain inventory), mood (Hospital Anxiety and Depression Scale), sleep (Pittsburgh Sleep Quality Index) and quality of life (RAND 36-Item Health Survey) were assessed. Continuous Reaction Time and the Digit Span Test were used to evaluate cognitive function. Data was analyzed with a Fisher’s exact test and Wilcoxon two-sample test. Results Forty-two patients with CNCP were included (21 in each group). No differences regarding socio-demographics, smoking/alcohol habits and duration, type, or intensity of pain were found. More patients in the opioid group had significantly higher BMI (62% above BMI 25 vs. 33.3%, p = 0.042). Consequently, the subsequent data analyses were controlled for BMI. The two groups did not differ in pain, cognition, anxiety, depression, sleep or quality of life but both showed lower values than the normal standards. Further, the opioid group presented a tendency to lower ratings regarding pain and social function and performed below the normal cut off in the continuous reaction time. Conclusions No significant differences between the two groups were found regarding any of the above-mentioned variables. Interestingly, the patients assessed, regardless of taking opioids or not, could be classified with moderate pain intensity, anxiety and low quality of sleep and life compared to norm standards. Implications The findings of this pilot study suggested that long-term opioid treatment may influence pain and quality of life among CNCP patients. A larger cohort is needed to verify these findings.
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Stowe, G. Neil, Ryan B. Paulsen, Virginia A. Hill, and Michael I. Schaffer. "A Retrospective Analysis of Selected Opioids in Hair of Workplace Drug Testing Subjects." Journal of Analytical Toxicology 43, no. 7 (April 22, 2019): 553–63. http://dx.doi.org/10.1093/jat/bkz015.
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Abstract Opioids, both naturally occurring and semisynthetic, are effective pain management medications, but also possess the potential for abuse. Analyses of over 37,000 head and body hair samples containing codeine, morphine, hydrocodone, hydromorphone, oxycodone or oxymorphone provide a view of use habits of workplace-testing subjects that cannot be obtained from fluid matrices results. Testing was performed using FDA cleared immunoassays using either 2 ng morphine or oxycodone per 10 mg hair as calibrators. Non-negative screening samples were washed with an extended aqueous wash procedure followed by LC–MS-MS confirmation at a cutoff concentration of 2 ng opioid per 10 mg hair. The LC–MS-MS method measured codeine, morphine, 6-acetylmorphine, hydrocodone, hydromorphone, oxycodone and oxymorphone with an administratively established LOQ of 0.50 ng opioid per 10 mg hair. The linear range was 0.50–100 ng morphine per 10 mg hair, and 0.50–150 ng opioid per 10 mg hair for all other measured analytes. For all analytes, within run precision was ≤5.4%, and between-run precision was ≤6.4%. Analysis of samples containing metabolites found that, among codeine positive samples, 97% contained less than 10% morphine metabolite and 88% less than 20% hydrocodone metabolite, among hydrocodone positive samples, 97% contained less than 10% hydromorphone metabolite and 95% of oxycodone positive samples contained less than 10% oxymorphone metabolite. Our analysis of opioid-positive samples may provide guidelines for interpretation of hair opioid levels typically observed in workplace testing.
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VanIderstine, Carter, Michael Dunbar, and Emily Johnston. "Opioid Prescribing Habits of Orthopedic Surgeons Following Total Hip Arthroplasty and Total Knee Arthroplasty: A Pilot Study." Canadian Journal of Hospital Pharmacy 75, no. 4 (October 3, 2022): 335–39. http://dx.doi.org/10.4212/cjhp.3282.
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Background: Adequate pain management is important in patients’ recovery from total hip arthroplasty (THA) and total knee arthroplasty (TKA). Objective: To determine whether risk factors for prolonged opioid use are considered when discharge prescriptions for postoperative pain are written following THA and TKA. Methods: Opioid prescriptions written between June 14 and July 9, 2021, for patients who underwent THA or TKA were analyzed. Data were also collected on the patients’ age, sex, type of surgery, type of anesthesia (regional or general), preoperative use of opioids, and preoperative use of antidepressants. Results: Among the 59 patients included in the study, the most common prescriptions were for hydromorphone 2 mg (n = 15, 25%) and hydromorphone 1 mg (n = 15, 25%). At discharge, patients received a median of 400 morphine milligram equivalents (MMEs). There was no significant difference in the quantity of opioids (MMEs) prescribed at discharge in relation to surgery type (p = 0.63), sex (p = 0.44), preoperative antidepressant use (p = 0.22), or preoperative opioid use (p = 0.97). There also appeared to be no correlation between a patient’s age and MMEs at discharge (p = 0.21; r2 = 0.028). None of these variables could be used to predict which patients would receive more than 400 MMEs. Conclusions: Patient-specific factors appeared not to be taken into consideration when opioids were prescribed for postoperative pain among patients who underwent THA or TKA. RÉSUMÉ Contexte : Une gestion adéquate de la douleur est importante pour le rétablissement des patients après une arthroplastie totale de la hanche (ATH) et une arthroplastie totale du genou (ATG). Objectif : Déterminer si les facteurs de risque relatifs à l’utilisation prolongée d’opioïdes sont pris en compte lors de la rédaction d’ordonnances de congé pour douleurs postopératoires après une ATH et une ATG. Méthodes : Les prescriptions d’opioïdes rédigées entre le 14 juin et le 9 juillet 2021 pour les patients ayant subi une ATH ou une ATG ont été analysées. Des données ont également été recueillies sur l’âge, le sexe, le type de chirurgie, le type d’anesthésie (locale ou générale), l’utilisation préopératoire d’opioïdes et l’utilisation préopératoire d’antidépresseurs. Résultats : Parmi les 59 patients compris dans l’étude, les prescriptions les plus fréquentes étaient l’hydromorphone 2 mg (n = 15; 25 %) et l’hydromorphone 1 mg (n = 15; 25 %). Les patients recevaient une médiane de 400 équivalents milligrammes de morphine (MME) au moment du congé. Aucune différence significative quant à la quantité d’opioïdes (mesurée en MME) prescrits au moment du congé en fonction du type de chirurgie (p = 0,63), du sexe (p = 0,44), de l’utilisation préopératoire d’antidépresseurs (p = 0,22) ou de l’utilisation préopératoire d’opioïdes (p = 0,97) n’a été observée. Il ne semblait pas non plus y avoir de corrélation entre l’âge d’un patient et les MME au moment du congé (p = 0,21; r2 = 0,028). Aucune de ces variables ne pouvait être utilisée pour prédire quels patients recevraient plus de 400 MME. Conclusions : Les facteurs spécifiques au patient ne semblaient pas être pris en compte lors de la prescription d’opioïdes pour la douleur postopératoire chez les patients ayant subi une ATH ou une ATG.
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Lee, Jonathan, Ghadi Ghanem, Soheil Saadat, Justin Yanuck, Brent Yeung, Bharath Chakravarthy, Ariana Nelson, and Shalini Shah. "Positive Toxicology Results Are Not Associated with Emergency Physicians’ Opioid Prescribing Behavior." Western Journal of Emergency Medicine 22, no. 5 (August 30, 2021): 1067–75. http://dx.doi.org/10.5811/westjem.2021.5.52378.
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Introduction: Given the general lack of literature on opioid and naloxone prescribing guidelines for patients with substance use disorder, we aimed to explore how a physician’s behavior and prescribing habits are altered by knowledge of the patient’s concomitant use of psychotropic compounds as evident on urine and serum toxicology screens. Methods: We conducted a retrospective chart review study at a tertiary, academic, Level I trauma center between November 2017–October 2018 that included 358 patients who were discharged from the emergency department (ED) with a diagnosis of fracture, dislocation, or amputation and received an opioid prescription upon discharge. We extracted urine and serum toxicology results, number and amount of prescription opioids upon discharge, and the presence of a naloxone script. Results: The study population was divided into five subgroups that included the following: negative urine and serum toxicology screen; depressants; stimulants; mixed; and no toxicology screens. When comparing the 103 patients in which toxicology screens were obtained to the 255 patients without toxicology screens, we found no statistically significant differences in the total prescribed morphine milligram equivalent (75.0 and 75.0, respectively) or in the number of pills prescribed (15.0 and 13.5, respectively). Notably, none of the 103 patients who had toxicology screens were prescribed naloxone upon discharge. Conclusion: Our study found no association between positive urine toxicology results for psychotropically active substances and the rates of opioid prescribing within a single-center, academic ED. Notably, none of the 103 patients who had toxicology screens were prescribed naloxone upon discharge. More research on the associations between illicit drug use, opioids, and naloxone prescriptions is necessary to help establish guidelines for high-risk patients.
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Sheldon, Rowan R., Jessica B. Weiss, Woo S. Do, Dominic M. Forte, Preston L. Carter, Matthew J. Eckert, and Vance Y. Sohn. "Stemming the Tide of Opioid Addiction—Dramatic Reductions in Postoperative Opioid Requirements Through Preoperative Education and a Standardized Analgesic Regimen." Military Medicine 185, no. 3-4 (October 17, 2019): 436–43. http://dx.doi.org/10.1093/milmed/usz279.
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Abstract Introduction Surgery is a known gateway to opioid use that may result in long-term morbidity. Given the paucity of evidence regarding the appropriate amount of postoperative opioid analgesia and variable prescribing education, we investigated prescribing habits before and after institution of a multimodal postoperative pain management protocol. Materials and Methods Laparoscopic appendectomies, laparoscopic cholecystectomies, inguinal hernia repairs, and umbilical hernia repairs performed at a tertiary military medical center from 01 October 2016 until 30 September 2017 were examined. Prescriptions provided at discharge, oral morphine equivalents (OME), repeat prescriptions, and demographic data were obtained. A pain management regimen emphasizing nonopioid analgesics was then formulated and implemented with patient education about expected postoperative outcomes. After implementation, procedures performed from 01 November 2017 until 28 February 2018 were then examined and analyzed. Additionally, a patient satisfaction survey was provided focusing on efficacy of postoperative pain control. Results Preprotocol, 559 patients met inclusion criteria. About 97.5% were provided an opioid prescription, but prescriptions varied widely (256 OME, standard deviation [SD] 109). Acetaminophen was prescribed often (89.5%), but nonsteroidal anti-inflammatory drug (NSAID) prescriptions were rare (14.7%). About 6.1% of patients required repeat opioid prescriptions. After implementation, 181 patients met inclusion criteria. Initial opioid prescriptions decreased 69.8% (77 OME, SD 35; P < 0.001), while repeat opioid prescriptions remained statistically unchanged (2.79%; P = 0.122). Acetaminophen prescribing rose to 96.7% (P = 0.002), and NSAID utilization increased to 71.0% (P < 0.001). Postoperative survey data were obtained in 75 patients (41.9%). About 68% stated that they did not use all of the opioids prescribed and 81% endorsed excellent or good pain control throughout their postoperative course. Conclusions Appropriate preoperative counseling and utilization of nonopioid analgesics can dramatically reduce opioid use while maintaining high patient satisfaction. Patient-reported data suggest that even greater reductions may be possible.
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Drewes, Asbjørn M., Pia Munkholm, Magnus Simrén, Harald Breivik, Ulf E. Kongsgaard, Jan G. Hatlebakk, Lars Agreus, Maria Friedrichsen, and Lona L. Christrup. "Definition, diagnosis and treatment strategies for opioid-induced bowel dysfunction–Recommendations of the Nordic Working Group." Scandinavian Journal of Pain 11, no. 1 (April 1, 2016): 111–22. http://dx.doi.org/10.1016/j.sjpain.2015.12.005.
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AbstractBackground and aimsOpioid-induced bowel dysfunction (OIBD) is an increasing problem due to the common use of opioids for pain worldwide. It manifests with different symptoms, such as dry mouth, gastro-oesophageal reflux, vomiting, bloating, abdominal pain, anorexia, hard stools, constipation and incomplete evacuation. Opioid-induced constipation (OIC) is one of its many symptoms and probably the most prevalent. The current review describes the pathophysiology, clinical implications and treatment of OIBD.MethodsThe Nordic Working Group was formed to provide input for Scandinavian specialists in multiple, relevant areas. Seven main topics with associated statements were defined. The working plan provided a structured format for systematic reviews and included instructions on how to evaluate the level of evidence according to the GRADE guidelines. The quality of evidence supporting the different statements was rated as high, moderate or low. At a second meeting, the group discussed and voted on each section with recommendations (weak and strong) for the statements.ResultsThe literature review supported the fact that opioid receptors are expressed throughout the gastrointestinal tract. When blocked by exogenous opioids, there are changes in motility, secretion and absorption of fluids, and sphincter function that are reflected in clinical symptoms. The group supported a recent consensus statement for OIC, which takes into account the change in bowel habits for at least one week rather than focusing on the frequency of bowel movements. Many patients with pain receive opioid therapy and concomitant constipation is associated with increased morbidity and utilization of healthcare resources. Opioid treatment for acute postoperative pain will prolong the postoperative ileus and should also be considered in this context. There are no available tools to assess OIBD, but many rating scales have been developed to assess constipation, and a few specifically address OIC. A clinical treatment strategy for OIBD/OIC was proposed and presented in a flowchart. First-line treatment of OIC is conventional laxatives, lifestyle changes, tapering the opioid dosage and alternative analgesics. Whilst opioid rotation may also improve symptoms, these remain unalleviated in a substantial proportion of patients. Should conventional treatment fail, mechanism-based treatment with opioid antagonists should be considered, and they show advantages over laxatives. It should not be overlooked that many reasons for constipation other than OIBD exist, which should be taken into consideration in the individual patient.Conclusion and implicationsIt is the belief of this Nordic Working Group that increased awareness of adverse effects and OIBD, particularly OIC, will lead to better pain treatment in patients on opioid therapy. Subsequently, optimised therapy will improve quality of life and, from a socio-economic perspective, may also reduce costs associated with hospitalisation, sick leave and early retirement in these patients.
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Kamdar, Parth, Christopher Antonacci, Katherine Vadasdi, R. Greene, Francis Alberta, Paul Sethi, and Nicole Liddy. "Poster 223: Evidence-Based Opioid Prescribing Guidelines Following Anterior Cruciate Ligament Reconstruction (ACLR)." Orthopaedic Journal of Sports Medicine 10, no. 7_suppl5 (July 1, 2022): 2325967121S0078. http://dx.doi.org/10.1177/2325967121s00784.
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Objectives: Opioid prescriptions following anterior cruciate ligament reconstruction (ACLR) vary substantially.1-3 Expert panel guidelines recommend up to 50 pills for ACLR with many surgeons refilling 40 or more tablets.1,3 The CDC warns that a five-day supply is sufficient to develop opiate dependence.4 Current recommendations are based on consensus rather than evidence and place a vulnerable population at risk for opiate misuse.2,3 Orthopaedic surgeons do not possess evidence driven regimens for opioid prescriptions following ACLR.5,6 The purpose of this study was to develop evidence-based prescription guidelines for ACLR. We hypothesized that patients would require fewer opioids than traditional guidelines suggest with a high rate of patient satisfaction. 1. Beck, J.J., et al., Prospective Study of Acute Opioid Use After Adolescent Anterior Cruciate Ligament Reconstruction Shows No Effect From Patient- or Surgical-Related Factors. J Am Acad Orthop Surg, 2020. 28(7): p. 293-300. 2. Wyles, C.C., et al., Implementation of Procedure-Specific Opioid Guidelines: A Readily Employable Strategy to Improve Consistency and Decrease Excessive Prescribing Following Orthopaedic Surgery. JB JS Open Access, 2020. 5(1): p. e0050. 3. Stepan, J.G., et al., Development of an Institutional Opioid Prescriber Education Program and Opioid-Prescribing Guidelines: Impact on Prescribing Practices. J Bone Joint Surg Am, 2019. 101(1): p. 5-13. 4. Shah A HC, Martin BC. Characteristics of Initial Prescription Episodes and Likelihood of Long-Term Opioid Use — United States, 2006–2015. MMWR Morb Mortal Wkly Rep 2017:265-269. 5. Reider, B. Opioid Epidemic. Am J Sports Med, 2019. 44(5): p. 1039-1042. 6. Morris BJ, Mir HR. The opioid epidemic: Impact on orthopaedic surgery. J Am Acad Orthop Surg 2015;23: 267-271. Methods: This multicenter prospective study enrolled 46 patients undergoing ACLR. Subject demographics and opioid prescriptions were recorded at the time of enrollment. All patients were given instructions and education on opiate use. All patients followed the same perioperative, multimodal analgesic regimen (Table 1). Following surgery, patients were given postoperative “Pain Journals” to document visual analog scale (VAS) pain scores and to track their daily opioid consumption for the first 7 postoperative days (PODs) and on postoperative visit (POV) at 14 days. No changes were made to existing prescribing habits, postoperative physical rehabilitation, or surgical methodology. Results: 35 patients were included in this analysis. Mean subject age was 39 years old. 46% of patients were male; 54% of patients were female. Patients were prescribed a median of 15 oxycodone 5 mg pills and consumed a median of 2 pills postoperatively. Mean postoperative opioid consumption was 5 pills (range 0 to 31 pills). 42% of patients consumed 0 opioid pills; 77% of patients consumed ≤ 5 opioid pills; 73% of patients discontinued opioid use after POD 2 (Figure 1). Patients reported a mean daily VAS value of 2.5 of 10; mean satisfaction with pain management was high at 4.16/5 on a Likert satisfaction score. Overall, patients consumed a mean 28% of their opioid prescriptions, leaving 230 opioid pills not consumed. Conclusions: This study suggests that current expert panels may be recommending an unrequired volume of opioids. As the third largest prescriber of opiate medication, orthopedic surgeons are charged with reducing the risk of opiate dependence, particularly in the ACLR vulnerable population.6 Based on our findings, patients only require 15 Oxycodone 5mg tablets following ACLR. Despite this lower volume prescription, mean pain scores remained below 3/10, patient satisfaction with pain control remained high, and 72% of opiate medication prescribed was not used. [Table: see text]
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Diehl, Beau J. "Compensatory Eating Behaviors, Alcohol Consumption and Opioid Use in a Clinical Sample." International Journal of Social Science Studies 5, no. 5 (April 24, 2017): 87. http://dx.doi.org/10.11114/ijsss.v5i5.2376.
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Objectives: To estimate the prevalence of compensatory eating behaviors in relation to alcohol consumption in a clinical sample, to assess the moderating capabilities of opioid use in relation to alcohol use and compensatory behaviors, and to examine the predictive capabilities of gender-specific binge drinking in relation to compensatory behaviors.Methods: The Compensatory Eating Behaviors in Relation to Alcohol Consumption Scale (CEBRACS), an opioid use survey, and the Alcohol Use Disorders Identification Test (AUDIT) were administered to residents at an addiction treatment facility (n = 77) over a period of 6 months.Results: Morphine was the only opioid to have significant relationships with the CEBRACS alcohol effects (r = - .33), diet/exercise (r = - .38), and restrictive eating (r = - .31), subscales (all p < .001), but not with the bulimic subscale. Heroin had the strongest correlations with all other opioids. Opioid use did not have a significant moderating effect between alcohol frequency and the CEBRACS in a single moderating regression analysis (b = .84, t(73) = .43, p = .67). Men (Mdn = 27.00) and women (Mdn = 33.00) did not differ on the CEBRACS, although women ranked higher than men (U = 678.00, z = - .68, ns, r = .08). Binge drinking predicted CEBRACS scores in both males (b = .50, t(38) = 3.59, p < .001) and females (b = .60, t(35) = 4.46, p < .001).Conclusions: Individual dietary habits fluctuate throughout alcohol consumption and the goals of the individual are crucial in discerning specific substance use vs disordered eating motivations.
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Gupta, Akash, Kanupriya Kumar, Matthew M. Roberts, Austin E. Sanders, Mackenzie T. Jones, David S. Levine, Martin J. O’Malley, et al. "Pain Management After Outpatient Foot and Ankle Surgery." Foot & Ankle International 39, no. 2 (October 27, 2017): 149–54. http://dx.doi.org/10.1177/1071100717738495.
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Background: The number of opioids prescribed and used has increased precipitously over the past 2 decades for a number of reasons and has led to increases in long-term dependency, opioid-related deaths, and diversion. Most studies examining the role of prescribing habits have investigated nonoperative providers, although there is some literature describing perioperative opioid prescription and use. There are no studies looking at the number of pills consumed after outpatient foot and ankle surgeries, nor are there guidelines for how many pills providers should prescribe. The purpose of this study was to quantify the number of narcotic pills taken by opioid-naïve patients undergoing outpatient foot and ankle surgeries with regional anesthesia. Methods: Eighty-four patients underwent outpatient foot and ankle surgeries under spinal blockade and long-acting popliteal blocks. Patients were given 40 or 60 narcotic pills, a 3-day supply of ibuprofen, deep vein thrombosis prophylaxis, and antiemetics. Patients received surveys at postoperative day (POD) 3, 7, 14, and 56 documenting if they were still taking narcotics, the quantity of pills consumed, whether refills were obtained, their pain level, and their reason for stopping opioids. Results: Patients consumed a mean of 22.5 pills, with a 95% confidence interval from 18 to 27 pills. Numerical Rating Scale pain scores started at 4 on POD 3 and decreased to 1.8 by POD 56. The percentage of patients still taking narcotics decreased from 55% on POD 3 to 2.8% by POD 56. Five new prescriptions were given during the study, with 3 being due to side effects from the original medication. Conclusions: Patients receiving regional anesthesia for outpatient foot and ankle surgeries reported progressively lower pain scores with low narcotic use up to 56 days postoperatively. We suggest that providers consider prescribing 30 pills as the benchmark for this patient population. Level of Evidence: Level II, prospective comparative study.
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Priano, James, Brian Faley, Gabrielle Procopio, Kevin Hewitt, and Joseph Feldman. "Adjunct Analgesic Use for Acute Pain in the Emergency Department." Hospital Pharmacy 52, no. 2 (February 2017): 138–43. http://dx.doi.org/10.1310/hpj5202-138.
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Purpose Multimodal analgesia is common practice in the postoperative setting, but the utility of adjunctive analgesia in the emergency department (ED) is less understood. The primary objective of this study was to analyze ED prescriber ordering habits for adjunct nonopioid pain medication for opioid-naïve patients who require intravenous (IV) morphine or hydromorphone for acute pain. Secondary objectives were to assess initial and total opioid consumption in morphine equivalent units (MEU), pain scores, and ED length of stay (LOS) between groups. Methods A retrospective chart review of adult patients who presented to the ED at a large academic medical center and received IV morphine or hydromorphone for acute pain was conducted. Patients were analyzed according to initial opioid received and presence or absence of adjunct nonopioid analgesics. Results A total of 102 patient charts were analyzed. Adjunctive nonopioid analgesics were ordered on 38% of patients. Patients who received an adjunct nonopioid analgesic received a smaller mean initial opioid dose than those who did not (4.73 vs 5.48 MEU, p = .08). Initial pain score reduction on the 11-point Numeric Rating Scale (NRS) did not differ between patients who received adjunct analgesics versus those who did not (3 vs 4, p = .75). Patients who received adjunct analgesics were associated with a decreased ED LOS (294 vs 342 minutes, p = .04). Conclusion A small proportion of patients with acute pain received a nonopioid analgesic in conjunction to IV opioids. Further studies are warranted to assess the impact of adjunct analgesics for patients with acute pain.
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Ziolkowski, Natalia, Josephine D’Abbondanza, Sarah Rehou, and Shahriar Shahrohki. "110 Pain Medication Prescription Patterns and the American Burn Association 2020 Guidelines on the Management of Acute Pain in the Adult Burn Patient." Journal of Burn Care & Research 42, Supplement_1 (April 1, 2021): S74. http://dx.doi.org/10.1093/jbcr/irab032.114.
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Abstract Introduction In September 2020, the American Burn Association released new pain guidelines following a rigorous literature review and input from experts. These guidelines were last updated 14 years ago and represent a multitude of changes including increased importance for non-opioid pain medication use and non-pharmacologic adjuncts given the current opioid crisis. Specifically, the main recommendations were to use opioid medication sparingly and always with adjuncts; acetaminophen utilized in all patients; NSAID use depending on baseline comorbidities and kidney function; neuropathic pain therapy for those with such pain/refractory to standard therapy; and ketamine for procedural sedation/adjunct for opioid consumption. Further, nonpharmacologic treatments include cognitive-behavioural therapy (‘CBT’), hypnosis, and virtual reality should be considered. The objective of this study is to describe current pain medication prescription habits at one ABA-verified centre and how well they are in compliance with these new guidelines. Methods We conducted phase one of a quality improvement retrospective study of 514 patients admitted to an ABA-verified centre over a two-year period. Data included demographics and pain medication use which was compared against the new ABA American Burn Association 2020 Guidelines on the Management of Acute Pain in the Adult Burn Patient. Pain medication contraindications were defined using UpToDate Drug Information. Statistical analysis was descriptive in nature. Results 422 patients were admitted for acute burns. 65.9% were male with an average age of 46.4 (st dev 17.6,range 15–96). Flame burns were most common(n=209,49.5%) with average TBSA of 11.9%(st dev 16.5,range 0–98%) and 54 inhalation injuries(12.8%) covering an average length of stay of 15.6 days in the burn centre (st dev 16.8,range 1–146 days). A total of 3549 pain medications were prescribed: 1792 opioid(50.5%) and 1757 non-opioid(49.5%). Of those admitted, 93.8% were prescribed opioids, 72.5% NSAIDs, 87.2% acetaminophen, 74.4% nerve pain medications, and 25.3% ketamine. Opioids were not prescribed in 26 patients(6.2%) and only prescribed in 29 patients(6.9%). Regarding adjuncts, 4(0.94%) had documented contraindications to NSAIDs and 3(0.71%) to acetaminophen. No referrals were completed for CBT. Virtual reality and hypnosis are not available at this centre. Conclusions This work represents the first known study examining compliance to the new pain guidelines in an ABA-verified burn centre. There is significant room for improvement for the use of adjuncts specifically NSAIDs and acetaminophen as both were under prescribed. In addition, nonpharmacologic treatments are largely not available or not used and may be an untapped resource for better pain control.
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Ash, Nathan, Jedediah Tuten, Wayne Bohenek, and Brian Latham. "A comprehensive approach to addressing the opioid epidemic in a large health system." American Journal of Health-System Pharmacy 78, no. 4 (January 20, 2021): 320–26. http://dx.doi.org/10.1093/ajhp/zxaa388.
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Abstract Purpose To describe the implementation of a comprehensive program to address the opioid epidemic in a large health system and to assess the effect of the program on opioid prescribing. Summary Mercy Health is a nonprofit, Catholic health system that employs over 1,400 providers and operates 23 hospitals in Ohio and Kentucky, 2 states that have experienced large numbers of overdoses. As a good community partner, the health system developed a comprehensive plan to address the opioid crisis. A system-wide Opioid Steering Committee was established to implement and manage the program. The committee was chaired by a senior pharmacy executive and supported by 4 subcommittees: the data analytics, education development, outreach and assessment, and electronic health record (EHR) subcommittees. The 4 subcommittees developed and implemented several initiatives, including forming a database with prescribing data by specialty and geographical location, implementing a standardized screening approach in the emergency department, challenging hospitals to create partnerships with local schools, and creating EHR enhancements to change opioid prescribing habits. When normalized for patient volume, the prescribed opioid burden was reduced from 65.3 to 35.2 morphine milligram equivalents per unique patient from 2016 to 2019 (a 46% absolute reduction). During this same time the number of acute prescription orders with a morphine equivalent dose greater than 30 was reduced by 52% (from 37,793 to 17,822 prescriptions per year). Conclusion Mercy Health’s comprehensive approach to the opioid epidemic has successfully impacted opioid prescribing habits, screening practices, and community outreach.
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Suleiman, Zakari A., Kolawole W. Wahab, and Israel K. Kolawole. "Opioid prescribing habits of physicians in Kwara State, Nigeria." Ghana Medical Journal 50, no. 2 (July 18, 2016): 63. http://dx.doi.org/10.4314/gmj.v50i2.2.
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Sceats, Lindsay A., Nagehan Ayakta, Sylvia Bereknyei Merrell, and Cindy Kin. "Drivers, Beliefs, and Barriers Surrounding Surgical Opioid Prescribing: A Qualitative Study of Surgeons’ Opioid Prescribing Habits." Journal of Surgical Research 247 (March 2020): 86–94. http://dx.doi.org/10.1016/j.jss.2019.10.039.
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Habbouche, Joe A., Jay S. Lee, Caitlin Khalsa, Ryan Howard, Hsou Mei Hu, Michael J. Englesbe, Chad Brummett, and Jennifer F. Waljee. "Effect of Opioid Schedule Change on Prescribing Habits of Surgeons." Journal of the American College of Surgeons 225, no. 4 (October 2017): S82. http://dx.doi.org/10.1016/j.jamcollsurg.2017.07.175.
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Srinivasan, Shriya, Khalil B. Ramadi, Andrea Ippolito, and Rifat Atun. "Democratizing innovation through grass-roots entrepreneurship: lessons from efforts to address the opioid epidemic in the United States." BMJ Global Health 4, no. 6 (December 2019): e002079. http://dx.doi.org/10.1136/bmjgh-2019-002079.
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The nationwide opioid epidemic has substantially impacted economically-depressed regions in the USA. Eastern Appalachia has some of the lowest socioeconomic indicators in the USA and has suffered the highest rate of opioid-related fatality in 2016. Despite devoting considerable federal and state resources towards public health initiatives, the region continued to experience one of the highest death rates and sought alternative approaches to address the opioid crisis. Here, we describe a community-based co-creation initiative that convened diverse sectors and utilised design thinking principles to generate sustainable public health ventures towards addressing the opioid crisis. Participants of diverse backgrounds came together to attack key challenges and developed and implemented solutions, including a mobile application for naloxone delivery and exercise programs for high schools to promote healthy habits. Grassroots innovation efforts catalysed by the event strengthened community engagement and facilitated a sense of agency among participants. Through specific examples of initiatives that were launched, we provide evidence to encourage and highlight the value of healthcare innovation efforts in low-resource settings.
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Yahya, Ayesha, Christian C. Hall, Andrew Wilhelm, and Chelsea Bush. "A Prospective Evaluation of Opioid Utilization Following Ankle Fracture Surgery." Foot & Ankle Orthopaedics 7, no. 4 (October 2022): 2473011421S0101. http://dx.doi.org/10.1177/2473011421s01010.
Full textAbstract:
Category: Trauma; Ankle Introduction/Purpose: There has been significant scrutiny of physicians' opioid prescribing patterns for both operative and non- operative patients. Orthopaedic surgeons are the third highest group of opioid prescribers among physicians in the United States. The wide scope of orthopaedic procedures lends to the variability and difficulty in setting forth prescribing guidelines. Recent orthopedic literature has highlighted that orthopaedic surgeons are prescribing excess narcotic medication than is needed in common orthopaedic procedures. Ankle fractures make up about 9% of all fractures, which correlates to about 400,000 per year. The purpose of this study was to assess the amount of post-operative pain medication being prescribed and how much of that medication was being consumed in patients who underwent an open reduction internal fixation (ORIF) of an ankle fracture. Methods: We identified all patients that underwent a unilateral ORIF of a closed ankle fracture. We prospectively collected data on patients at the time of surgery. Patients were identified and enrolled in the study prior to their surgical procedure, where they were instructed to bring their pain medication bottle with them to their first post-operative visit. Patients were asked about the quantity of opioids consumed. At the twelve-week post-op, the American Orthopedic Foot and Ankle Score (AOFAS) was completed by the patient. We recorded the number, dosage, and formulation of opioid medication prescribed up to 90 days after surgery using the Pennsylvania Drug Monitoring Program (PDMP) website. Using opioid equianalgesic charts, we converted dosages of opioid to a morphine milligram equivalent (MEq) to standardize prescription amounts across all patients. Descriptive statistics were calculated and reported. Categorical data were compared using chi-square tests and quantitative data were compared using independent sample t-tests. Results: 75 patients were included in our study, 45 of which were female. The mean age of the patient was 46.7 years old with a range from 17-77 years old. On average, 400MEq were prescribed to the patient after surgery. Patients consumed an average of 258 MEq within the 2 weeks following surgery, which accounted for about 65% of the initial prescription. Thirty (13.3%) patients consumed their entire first prescription. Patients who consumed the full opioid prescription were 8.7 times more likely (95% CI 2.6, 29.3, X2(1)=14.1, p<0.001) to have other scripts filled in the PDMP. After adjusting for inequal variances, an independent samples t-test found that subjects that did not consume the full prescription also had statistically significantly higher functionality scores (82 vs. 70) than patients that consumed the full prescribed amount (p=0.001). Conclusion: We found the average patient consumes the equivalent of 34 pills of 5mg oxycodone after undergoing an open reduction internal fixation of an ankle fracture. Our providers over prescribed, on average, by 21 total pills. 9.3% of patients were still requiring narcotic pain medication ninety days post-operatively. Those patients who did not consume their first narcotic prescription were found to have statistically better functional outcome scores compared to those who did. Further studies should continue to assess patient characteristics, surgeon techniques, and prescribing habits to further improve post-operative pain control in patients undergoing open reduction internal fixation of ankle fractures.
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Aulet, Ricardo Mario, Vanessa Trieu, Gary P. Landrigan, and Donna J. Millay. "Changes in Opioid Prescribing Habits for Patients Undergoing Rhinoplasty and Septoplasty." JAMA Facial Plastic Surgery 21, no. 6 (November 1, 2019): 487–90. http://dx.doi.org/10.1001/jamafacial.2019.0937.
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