Journal articles on the topic 'Opioid use disorder (OUP)'
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Edinoff, Amber N., Catherine A. Nix, Claudia V. Orellana, Samantha M. StPierre, Erin A. Crane, Blaine T. Bulloch, Elyse M. Cornett, et al. "Naltrexone Implant for Opioid Use Disorder." Neurology International 14, no. 1 (December 30, 2021): 49–61. http://dx.doi.org/10.3390/neurolint14010004.
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The continued rise in the availability of illicit opioids and opioid-related deaths in the United States has left physicians, researchers, and lawmakers desperate for solutions to this ongoing epidemic. The research into therapeutic options for the treatment of opioid use disorder (OUD) began with the introduction of methadone in the 1960s. The approval of oral naltrexone initially showed much promise, as the drug was observed to be highly potent in antagonizing the effects of opioids while producing no opioid agonist effects of its own and having a favorable side effect profile. Patients that routinely take their naltrexone reported fewer days of heroin use and had more negative drug tests than those without treatment. Poor outcomes in OUD patients treated with naltrexone have been directly tied to short treatment time. Studies have shown that naltrexone given orally vs. as an implant at the 6-month interval showed a higher non-compliance rate among those who used oral medications at the 6-month mark and a slower return to use rate. There were concerns that naltrexone could possibly worsen negative symptoms seen in opiate use disorder related to blockade of endogenous opioids that are important for pleasurable stimuli. Studies have shown that naltrexone demonstrated no increase in levels of anxiety, depression and anhedonia in participants and another study found that those treated with naltrexone had a significant reduction in mental health-related hospitalizations. The latter study also concluded that there was no increased risk for mental health-related incidents in patients taking naltrexone via a long-acting implant. Although not yet FDA approved in the United States, naltrexone implant has shown promising results in Europe and Australia and may provide a novel treatment option for opioid addiction.
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Talmage, James B. "Rating Opioid Use Disorder for Permanent Impairment." Guides Newsletter 25, no. 1 (January 1, 2020): 3–11. http://dx.doi.org/10.1001/amaguidesnewsletters.2020.janfeb01.
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Abstract The duration of opioid therapy after surgery is the strongest known predictor of ultimate misuse, and researchers have reported that the number of days for which medication was prescribed and the total number of postoperative prescriptions each predicts long-term use. This article addresses the question of rating the impairment for an individual with no history of substance use disorder before a work injury, who is prescribed opioids for this injury, and who subsequently develops opioid use disorder (OUD). The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, should be used in conjunction with the AMA Guides to the Evaluation of Permanent Impairment, (AMA Guides), Sixth Edition. A person who is prescribed opioids is not yet at maximum medical improvement (MMI) and cannot be rated. Referral for substantiation of the diagnosis and for initiation of treatment are necessary before OUD is confirmed and the patient is at MMI. The AMA Guides is based on impairments of activities of daily living (ADL), so a patient's MMI should result in a happy outcome and no impairment, although the burden of treatment compliance may be a relevant consideration. The article concludes with an extensive literature review, including abstracts of published articles regarding OUD in various settings.
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Patel, Biren, and Thomas R. Kosten. "Keeping Up with Clinical Advances: Opioid Use Disorder." CNS Spectrums 24, S1 (July 10, 2019): 14–24. http://dx.doi.org/10.1017/s109285291900110x.
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Opioid use disorder (OUD) is a disorder that can lead to several negative outcomes, including overdose and death. A variety of opioids can be abused by individuals including both prescribed and non-prescribed opioids. Continued opioid use can be driven by negative affective states associated with opioid withdrawal. Several treatments exist in the field including medication assisted treatments such as methadone, buprenorphine, and naltrexone. Treatments such as clonidine and lofexidine can also be used to assist with decreasing withdrawal symptoms. Increasing adherence to treatment can further improve patient outcomes and promote continuation with treatment. A variety of methods to reduce relapse can also be utilized such as opioid agonists and maintenance therapy. According to the Centers for Disease Control, opioid overdoses contributed to 67.8% of overdose deaths in 2017.
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Koehl, Jennifer L., David E. Zimmerman, and Patrick J. Bridgeman. "Medications for management of opioid use disorder." American Journal of Health-System Pharmacy 76, no. 15 (July 18, 2019): 1097–103. http://dx.doi.org/10.1093/ajhp/zxz105.
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Abstract Purpose The use of buprenorphine, methadone, and long-acting naltrexone for treatment of opioid use disorder (OUD) is discussed, including a review of current literature detailing treatment approaches and action steps to optimize treatment in acute care and office-based settings. Summary The U.S. epidemic of opioid-related deaths has been driven by misuse of prescription opioids and, increasingly, illicit drugs such as heroin, fentanyl, and fentanyl analogs, necessitating a refocusing of treatment efforts on expanding access to life-saving, evidence-based OUD pharmacotherapy. Inpatient treatment of opioid withdrawal includes acute symptom control through a combination of nonopioid medications and long-term pharmacotherapy to lessen opioid craving and facilitate stabilization and recovery. Methadone and buprenorphine reduce opioid craving, increase treatment retention, reduce illicit opioid use, and increase overall survival. Buprenorphine has logistical advantages over methadone, such as greater flexibility of treatment setting and less risk of adverse effects. Studies have shown the efficacy of long-acting injectable naltrexone to be comparable to that of buprenorphine if patients are detoxified prior to initiation of therapy; however, patients with active OUD are often not able to complete the week-long period of opioid abstinence needed prior to initiation of naltrexone injections. Although buprenorphine is preferred by many patients and can be prescribed in office-based settings, there remains a paucity of physicians certified to prescribe it. Conclusion Buprenorphine has become the medication of choice for many patients with OUD, but its use is limited by the low number of physicians certified to prescribe the agent. Other agents studied for treatment of OUD include methadone and naltrexone.
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Daoust, R., J. Paquet, L. Moore, A. Cournoyer, M. Emond, S. Gosselin, G. Lavigne, A. Boulanger, J. Mac-Thiong, and J. Chauny. "LO91: Opioid poisoning and opioid use disorder in older trauma patients." CJEM 22, S1 (May 2020): S40—S41. http://dx.doi.org/10.1017/cem.2020.145.
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Introduction: Patients hospitalized following a trauma will be frequently treated with opioids during their stay and after discharge. We examined the relationship between acute phase (< 3 months) opioid use after discharge and the risk of opioid poisoning (OP) or opioid use disorder (OUD) in older trauma patients Methods: In a retrospective multicenter cohort study conducted on registry data, we included all patients aged 65 years and older admitted (hospital stay >2 days) for injury in 57 trauma centers in the province of Quebec (Canada) between 2004 and 2014. We searched for OP and OUD from ICD-9 and ICD-10 code diagnosis that resulted in a hospitalization or a medical consultation after their initial injury. Patients that filled an opioid prescription within a 3-month period after sustaining the trauma were compared to those who did not fill an opioid prescription during that period using Cox proportional hazards regressions. Results: A total of 70,314 participants were retained for analysis; median age was 82 years (IQR: 75-87), 68% were women, and 34% of the patients filled an opioid prescription within 3-months of the initial trauma. During a median follow-up of 2.6 years (IQR: 1-5), 192 participants (0.30%; 95%CI: 0.25%-0.35%) were hospitalized for OP and 73 (0.10%; 95%CI: 0.07%-0.13%) were diagnosed with OUD. Having filled an opioid prescription within 3-months of injury was associated with an increased hazard ratio of OP (2.6; 95%CI: 1.9-3.5) and OUD (4.0; 95%CI: 2.3-7.0). However, history of OP (2.7; 95%CI: 1.2-6.1), of substance use disorder (4.3; 95%CI: 2.4-7.9), or of opioid prescription filled (2.7; 95%CI: 2.1-3.5) before trauma were also related to OP or OUD. Conclusion: Opioid poisoning and opioid use disorder are rare events after hospitalization for trauma in older patients. However, opioids should be used cautiously in patients with history of substance use disorder, opioid poisoning or opioid use during the past year.
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Hall, Elizabeth A., Alina Cernasev, Umida Nasritdinova, Michael P. Veve, and Kenneth C. Hohmeier. "Stigma of Opioid Use Disorder and Its Indirect Effects on Student Pharmacists’ Perceptions and Attitudes." Pharmacy 8, no. 3 (August 14, 2020): 144. http://dx.doi.org/10.3390/pharmacy8030144.
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Objectives: Pharmacists play a vital role in serving patients during the ongoing nationwide opioid epidemic, and so it is also critical to educate the next generation of pharmacists on opioids and opioid use disorder (OUD). The primary objective of this study was to quantitatively characterize student perceptions of opioid use and the stigma associated with OUD. Secondary aims were to determine whether differences in perceptions exist based upon the student’s year in the Doctor of Pharmacy program or employment in a community pharmacy. Methods: First-, second-, third-, and fourth-year student pharmacists voluntarily completed an electronic survey regarding perceptions of opioid use and stigma associated with OUD. Results: Of the 9 survey items, students were most uncomfortable referring patients to community resources for addiction support and/or treatment (25.3% comfortable or very comfortable). Students working in a community pharmacy were significantly more comfortable talking to patients attempting to refill opioids early and providing opioid counseling as compared to their peers not working in community pharmacy. Fourth-year students reported a higher level of comfort talking to a patient attempting to refill an opioid prescription early, counseling a patient on an opioid prescription, and providing information about alternatives to opioids. Third-year students responded most favorably to the items regarding how well the curriculum has prepared them to interact with patients taking opioids and those with OUD. Conclusions: These findings reveal that students are comfortable counseling on opioids and discussing alternative options. Differences in perceptions were observed based upon the student’s year in the program and whether or not they were employed in a community pharmacy setting.
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Zhou, Kehua, Peng Jia, Swati Bhargava, Yong Zhang, Taslima Reza, Yuan Bo Peng, and Gary G. Wang. "Opioid tapering in patients with prescription opioid use disorder: A retrospective study." Scandinavian Journal of Pain 17, no. 1 (October 1, 2017): 167–73. http://dx.doi.org/10.1016/j.sjpain.2017.09.005.
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AbstractBackground and aimsOpioid use disorder (OUD) refers to a maladaptive pattern of opioid use leading to clinically significant impairment or distress. OUD causes, and vice versa, misuses and abuse of opioid medications. Clinicians face daily challenges to treat patients with prescription opioid use disorder. An evidence-based management for people who are already addicted to opioids has been identified as the national priority in the US; however, options are limited in clinical practices. In this study, we aimed to explore the success rate and important adjuvant medications in the medication assisted treatment with temporary use of methadone for opioid discontinuation in patients with prescription OUD.MethodsThis is a retrospective chart review performed at a private physician office for physical medicine and rehabilitation. We reviewed all medical records dated between December 1st, 2011 and August 30th, 2016. The initial evaluation of the included patients (N =140) was completed between December 1st, 2011 and December 31st, 2014. They all have concumittant prescription OUD and chronic non-cancer pain. The patients (87 female and 53 male) were 46.7 ± 12.7 years old, and had a history of opioid use of 7.7 ±6.1 years. All patients received the comprehensive opioid taper treatments (including interventional pain management techniques, psychotherapy, acupuncture, physical modalities and exercises, and adjuvant medications) on top of the medication assisted treatment using methadone (transient use). Opioid tapering was considered successful when no opioid medication was used in the last patient visit.ResultsThe 140 patients had pain of 9.6 ± 8.4 years with 8/10 intensity before treatment which decreased after treatment in all comparisons (p < 0.001 for all). Opioids were successfully tapered off in 39 (27.9%) patients after 6.6 ±6.7 visits over 8.8 ±7.2 months; these patients maintained opioid abstinence over 14.3 ± 13.0 months with regular office visits. Among the 101 patients with unsuccessful opioid tapering, 13 patients only visited the outpatient clinic once. Significant differences were found between patients with and without successful opioid tapering in treatment duration, number of clinic visits, the use of mirtazepine, bupropion, topiramate, and trigger point injections with the univariate analyses. The use of mirtazepine (OR, 3.75; 95% CI, 1.48–9.49), topiramate (OR, 5.61; 95% CI, 1.91–16.48), or bupropion (OR, 2.5; 95% CI, 1.08–5.81) was significantly associated with successful opioid tapering. The associations remain significant for mirtazepine and topiramate (not bupropion) in different adjusted models.ConclusionsWith comprehensive treatments, 27.9% of patients had successful opioid tapering with opioid abstinence for over a year. The use of mirtazepine, topiramate, or likely bupropion was associated with successful opioid tapering in the medication assisted treatment with temporary use of methadone. Opioid tapering may be a practical option and should be considered for managing prescription OUD.ImplicationsFor patients with OUD, indefinite opioid maintenance treatment may not be necessary. Considering the ethical values of autonomy, nonmaleficence, and beneficence, clinicians should provide patients with OUD the option of opioid tapering.
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Herrera, S., A. Riquelme, T. León, and M. Babul. "Demographic characteristics, medical and psychiatric history of patients with prescription opioid use disorder." European Psychiatry 33, S1 (March 2016): S300—S301. http://dx.doi.org/10.1016/j.eurpsy.2016.01.1025.
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IntroductionOver the past two decades the prescription of opioid analgesics has increased with a subsequent escalating in prescription opioid misuse. It is estimated that 4.5 million (2.5%) of the United States of America population abuse of pain relievers; opioids are among the most commonly.In Chile there are few reports about the prevalence of opioid use disorder.ObjectivesThe aim of this study is to describe the demographic characteristics, medical and psychiatric comorbidity of patients that suffer from opioid addiction.Patients and methodsThis transversal study examined data of 7 patients with opioid use disorder (OUD; DSM-5) that consulted at the addiction unit of “Red de Salud, Pontificia Universidad Católica de Chile”, between November 2013 and October 2015. Data included: demographics, medical and psychiatric history, laboratory and imaging tests.ResultsOf all the patients, 57% were men, 25 to 67 years of age, 43% between 35-40 years; 57% were married; 57% had completed studies at university. 43% had also alcohol use disorder, 28% marijuana, 28% cocaine and 28% benzodiazepines than in most cases began before OUD. In addition; 57% had medical comorbidity among which stand out obesity (17%), osteoarthritis (17%) and chronic low back pain (17%). Eighty-three percent require hospitalization. Twenty-eight percent had abnormal liver tests and one patient had positive hepatitis B core antibody. Opioids used were: morphine(14%), codeine (43%), tramadol (42%).ConclusionThese results emphasize on the misuse of prescription opioids analgesics, the complexity of patients with OUD and the prevalence of other substance use disorder that precedes and accompany OUD.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Nguyen, Thomas A., Jennie H. Hahn, and Stephen M. Strakowski. "Pharmacotherapies for treating opioid use disorder." CNS Spectrums 18, no. 6 (April 8, 2013): 289–95. http://dx.doi.org/10.1017/s1092852913000229.
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Opioid use disorder (OUD) is a major public health problem in the United States. It has resulted in devastating consequences for people with this condition, including psychosocial and legal problems, in addition to contraction of infectious diseases such as HIV and hepatitis B and C. Furthermore, this disease can cause fatalities from drug overdoses and drug–drug interactions. OUD shatters families and destroys relationships. Effective treatment is crucial in order to curtail the consequences of this condition. The objective of this article is to provide a review of the pharmacotherapies currently being used to treat OUD.
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Tewary, Sweta, Ariel Kidron, Naushira Pandya, Jim Howell, Marie Florent-Caree, Annisah Ishmael, and Rebecca Cherner. "Understanding Medical Students’ Knowledge of Opioid Use Disorder: A Preliminary Study." Innovation in Aging 4, Supplement_1 (December 1, 2020): 219. http://dx.doi.org/10.1093/geroni/igaa057.706.
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Abstract The rise of the opioid epidemic over the last two decades has increased the mortality rate, healthcare cost, and drug overdose deaths across the country. Practicing physicians are lacking in education regarding non-opioid alternatives to pain management, prevention, diagnosis, and treatment of opioid use disorder (OUD). Existing literature suggest a link between knowledge discrepancy and opioid use among clinicians resulting in patient’s abuse of opioids. Therefore, it is important to educate medical students at the start of their career. This preliminary study assesses the current knowledge and perceived skills of medical students regarding (OUD)/opioid misuse and related content in order to identify gaps and provide necessary education. The study used a pre-post survey method to understand the demographics, medical, and clinical knowledge about opioid use, abuse, and clinical knowledge regarding patient opioid overdose. The self-administered survey was administered to all students 18 years or older, M1- M4 enrolled in NSU-KPCOM. A total of 1164 students met these criteria. However, only 137 students participated in the Pre-survey collected from August 2019 to September 2019. Approximately 12% of the eligible students participated in the pre-survey. Data was analyzed using frequencies and percentages. Results of the pre-survey suggest a progressive increase in opioid knowledge from M1 to M4 years. Results of the study suggest investigating a relationship between medical education and knowledge of opioid usage, with a specific lens aimed at assessing the efficacy of opioid education during second and third years of medical school
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Cernasev, Alina, Michael P. Veve, Theodore J. Cory, Nathan A. Summers, Madison Miller, Sunitha Kodidela, and Santosh Kumar. "Opioid Use Disorders in People Living with HIV/AIDS: A Review of Implications for Patient Outcomes, Drug Interactions, and Neurocognitive Disorders." Pharmacy 8, no. 3 (September 11, 2020): 168. http://dx.doi.org/10.3390/pharmacy8030168.
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The opioid epidemic has had a significant, negative impact in the United States, and people living with HIV/AIDS (PLWHA) represent a vulnerable sub-population that is at risk for negative sequela from prolonged opioid use or opioid use disorder (OUD). PLWHA are known to suffer from HIV-related pain and are commonly treated with opioids, leading to subsequent addictive disorders. PLWHA and OUD are at an increased risk for attrition in the HIV care continuum, including suboptimal HIV laboratory testing, delayed entry into HIV care, and initiation or adherence to antiretroviral therapy. Barriers to OUD treatment, such as medication-assisted therapy, are also apparent for PLWHA with OUD, particularly those living in rural areas. Additionally, PLWHA and OUD are at a high risk for serious drug–drug interactions through antiretroviral-opioid metabolic pathway-related inhibition/induction, or via the human ether-a-go-go-related gene potassium ion channel pathways. HIV-associated neurocognitive disorders can also be potentiated by the off-target inflammatory effects of opioid use. PLWHA and OUD might require more intensive, individualized protocols to sustain treatment for the underlying opioid addiction, as well as to provide proactive social support to aid in improving patient outcomes. Advancements in the understanding and management of PLWHA and OUD are needed to improve patient care. This review describes the effects of prescription and non-prescription opioid use in PLWHA.
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Bender, Alexis A., Maggi N. Robert, Nathan S. Quan, Emma M. Klein, and Molly M. Perkins. "BARRIERS TO CARE FOR OLDER ADULTS IN MEDICATION-ASSISTED TREATMENT FOR OPIOID USE DISORDER." Innovation in Aging 3, Supplement_1 (November 2019): S141. http://dx.doi.org/10.1093/geroni/igz038.509.
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Abstract Over the last decade, the number of older adults (people over the age of 50) who misuse opioids doubled and continues to increase. People over the age of 50 also represent one of the fastest growing groups entering into and sustaining medication assisted treatment (MAT) (i.e., methadone and buprenorphine) for opioid use disorder (OUD). Despite increasing awareness of this growing at-risk population, significant knowledge gaps regarding their support and care needs persist. To begin to address these gaps, we conducted interviews with 20 treatment staff, focus groups with 18 patients and surveys with 100 patients over the age of 50 at eight diverse Opioid Treatment Programs (OTPs) participating in a 1-year pilot study (Bender, PI) funded by the Georgia Clinical and Translation Science Alliance supported by the National Center Advancing Translational Sciences. Patients in this study do not always disclose their use of MAT to non-OTP providers. When they do, participants reported numerous negative experiences with non-OTP providers, including perceived discrimination, stigma, and misunderstanding by providers about MAT. These negative experiences potentially contribute to an over reliance on OTP providers to manage age-related health conditions (e.g., COPD, hypertension). Providers report minimal training about aging and varied levels of confidence to manage these conditions. We present the experiences of patients and providers with suggestions for improving care coordination. We conclude with recommendations to improve communication among providers working with older adults in recovery from OUD.
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Moryl, MD, Natalie, Alexandra Filkins, Yvona Griffo, MD, Vivek Malhotra, MD, Raina H. Jain, Ethel Frierson, RN, BSN, OCN, and Charles Inturrisi, PhD. "Successful use of buprenorphine-naloxone medication-assisted program to treat concurrent pain and opioid addiction after cancer therapy." Journal of Opioid Management 16, no. 2 (March 18, 2020): 111–18. http://dx.doi.org/10.5055/jom.2020.0557.
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Cancer pain is often treated with opioids, a therapeutic regimen that can become a challenge in patients with an opioid use disorder (OUD). While use of the buprenorphine-naloxone combination is an effective medication-assisted treatment (MAT) for OUD, its use in pain patients with OUD has been controversial due to concerns that co-administration of buprenorphine can reduce or block analgesia and precipitate opioid withdrawal in those patients requiring full opioid agonists. Data on its use in cancer pain patients are lacking. In this case series, the authors explore the frequency of buprenorphine-naloxone use and its outcomes in patients in a Comprehensive Care Center (CCC) Pain Registry. OUD was deduced from an International Classification of Diseases (ICD-10) diagnostic code for opioid-related disorders recorded in the electronic medical records. Of 2,320 chronic cancer pain patients, 125 patients had ICD-10 code for opioid-related disorders, and 43 had a diagnosis of opioid abuse of whom 11 received buprenorphinenaloxone combinations. Eight patients on 18 (6-24) mg per day of buprenorphinenaloxone remained in therapy for 4 (2-7) years without opioid abuse relapse. This assessment was based on clinician's notes, the Prescription Monitoring Program, random urine drug screening, and the absence of Urgent Care Center visits for opioid withdrawal or overdose. When short-term opioids were administered for acute pain, these patients were able to taper down and stop them quickly without an opioid abuse relapse. Buprenorphine-naloxone was effective as the sole analgesic in selected patients. Given its success at the CCC, buprenorphine-naloxone should be made available and strongly considered as a treatment for patients suffering from OUD during and following cancer treatment and when cancer pain reduces or resolves.
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Kern-Goldberger, Adina R., Yongmei Huang, Melanie Polin, Zainab Siddiq, Jason D. Wright, Mary E. D'Alton, and Alexander M. Friedman. "Opioid Use Disorder during Antepartum and Postpartum Hospitalizations." American Journal of Perinatology 37, no. 14 (August 17, 2019): 1467–75. http://dx.doi.org/10.1055/s-0039-1694725.
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Objective This study aimed to evaluate temporal trends in opioid use disorder (OUD) during antepartum and postpartum hospitalizations. Study Design This repeated cross-sectional analysis analyzed data from the National (Nationwide) Inpatient Sample. Women aged 15 to 54 years admitted antepartum or postpartum were identified. The presence of OUD was determined based on a diagnosis of opioid abuse, opioid dependence, or opioid overdose. Temporal trends in OUD were evaluated using the Rao–Scott chi-square test. Temporal trends in opioid overdose were additionally evaluated. Results An estimated 7,336,562 antepartum hospitalizations and 1,063,845 postpartum readmissions were included in this analysis. The presence of an OUD diagnosis during antepartum hospitalizations increased from 0.7% of patients in 1998 to 1999 to 2.9% in 2014 (p < 0.01) and during postpartum hospitalizations increased from 0.8% of patients in 1998 to 1999 to 2.1% of patients in 2014 (p < 0.01). Risk of overdose diagnoses increased significantly for both antepartum hospitalizations, from 22.7 per 100,000 hospitalizations in 1998 to 2000 to 70.3 per 100,000 hospitalizations in 2013 to 2014 (p < 0.001), and postpartum hospitalizations, from 18.8 per 100,000 hospitalizations in 1998 to 2000 to 65.2 per 100,000 hospitalizations in 2013 to 2014 (p = 0.02). Discussion Risk of OUD diagnoses and overdoses increased over the study period for both antepartum and postpartum hospitalizations.
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Alías-Ferri, Maria, Manuela Pellegrini, Emilia Marchei, Roberta Pacifici, Maria Concetta Rotolo, Simona Pichini, Clara Pérez-Mañá, et al. "New Psychoactive Substances Consumption in Opioid-Use Disorder Patients." Biology 11, no. 5 (April 22, 2022): 645. http://dx.doi.org/10.3390/biology11050645.
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(1) Background: Since the beginning of the 21st century, the large number and wide chemical variety of new psychoactive substances (NPS) that enter the market every year has become a public health problem. Given the rapidity with which the drug market is changing, many NPS are not clinically investigated and their effects and health risks are unknown. Drug testing is a very useful tool for this purpose, but, unfortunately, it is not very widespread in individuals with opioid-use disorder under detoxification treatment. The aim of this study is to investigate the use of illicit drugs and NPS in opioid-use disorder (OUD) patients on opioid agonist treatment. (2) Methods: A multicenter, descriptive, cross-sectional study was conducted at two addiction care services in Barcelona and Badalona, Spain. Urine samples were collected from OUD individuals attending these two centers, who anonymously donated a urine sample at the time of a periodical visit. Samples were analyzed by high-sensitivity gas chromatography-mass spectrometry (GC-MS) and ultra-high-performance liquid chromatography-high –resolution mass spectrometry (UHPLC-HRMS). (3) Results: Out of the 187 collected and analyzed urine samples, 27.3% were positive for any type of NPS and 8.6% were positive for new synthetic opioids, including fentanyl and its derivatives (NSO). Other frequently detected substances were benzodiazepines in 46.0% of samples, antipsychotics in 27.8% of samples, or cocaine and cannabis in 23.5% of samples. (4) Conclusion: A wide number of NPS, including NSO, have been detected in urine samples from an OUD population. A lack of NPS detection in standard drug screening among drug users can hide the identification of a potential public health problem.
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Nawaz, Nanjiba, Michael Hester, Christiana N. Oji-Mmuo, Enrique Gomez, and Alicia M. Allen. "Risk Factors Associated with Perinatal Relapse to Opioid Use Disorder." NeoReviews 23, no. 5 (May 1, 2022): e291-e299. http://dx.doi.org/10.1542/neo.23-5-e291.
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The recent opioid epidemic in the United States has led to rising prevalence of maternal opioid use disorder (OUD). First-line treatment for maternal OUD involves the use of opioid agonist pharmacotherapy, such as methadone or buprenorphine, in addition to cognitive behavioral therapy and counseling. The management of maternal OUD can become overwhelming for both patients and clinicians, especially during the early postpartum period. Therefore, it is imperative that clinicians understand the impact of additional stressors in caring for these patients. Maternal chronic opioid dependence can lead to neonatal opioid withdrawal syndrome after birth. This multisystem condition affects neonatal neurobehavioral functioning and has significant human and socioeconomic consequences. First-line treatment for this syndrome involves intensive nonpharmacologic comforting measures, with maternal presence and involvement being central to ensuring the success of such measures. In this review, we describe the factors that place pregnant and postpartum women with OUD at risk of returning to illicit opioid use. We evaluate these multifaceted personal, social, societal, and systemic factors to inform the development of future clinical care initiatives.
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Patel, Aneesh, Jessica R. Levi, and Christopher D. Brook. "Should Excess Topical Decongestant Use Raise a Red Flag? Rhinitis Medicamentosa and Opioid Use Disorder." Annals of Otology, Rhinology & Laryngology 129, no. 2 (October 4, 2019): 164–69. http://dx.doi.org/10.1177/0003489419880576.
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Objective: The objective of this study was to determine whether patients with rhinitis medicamentosa (RM) have an increased odds of having an opioid use disorder (OUD) and which characteristics may predict this association. Methods: The authors conducted a retrospective case control study of patients 18 years and older who presented to the otolaryngology clinic at an academic medical center from January 2013 through December 2017. Cases, defined as patients who presented with excessive decongestant nasal spray usage based on history, were matched to control patients who presented with chronic rhinitis and did not report regular nasal decongestant usage. The charts were reviewed for patients that carried a problem of opioid abuse, identified using ICD-9 codes 304.XX or ICD-10 codes F11.XX. The primary outcome of this study was the odds of having an OUD. Secondary outcomes were assessed by summary statistics. Results: One hundred and thirty-one cases of RM were matched to 1871 controls of chronic rhinitis. Seven cases (5.3%) and 24 (1.3%) controls had a diagnosis of OUD, consistent with an odds ratio of 3.98 for opioid abuse in patients with RM (95% CI: 1.47-9.71). Oxymetazoline was used by 85.5% (n = 112) of patients with RM. Thirty-six patients (27.1%) with RM underwent nasal surgery following a diagnosis of RM, of which twenty patients (55.6%) were prescribed opioids following the procedure. Conclusions: RM is associated with increased odds of having an OUD.
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LaBelle, Brittanie, Alexandra M. Franklyn, Vicky PKH Nguyen, Kathleen E. Anderson, Joseph K. Eibl, and David C. Marsh. "Characterizing the Use of Telepsychiatry for Patients with Opioid Use Disorder and Cooccurring Mental Health Disorders in Ontario, Canada." International Journal of Telemedicine and Applications 2018 (2018): 1–7. http://dx.doi.org/10.1155/2018/7937610.
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Rural patients with opioid use disorder (OUD) face a variety of barriers when accessing opioid agonist therapy (OAT) and psychiatric services, due to the limited supply of physicians and the vast geographic area. The telemedicine allows for contact between patients and their physician—regardless of physical distance. Objective. We characterize the usage of telemedicine to deliver psychiatric services to patients with OUD in Ontario, as well as traits of treatment-seeking patients with opioid dependence and concurrent psychiatric disorders. Methodology. A retrospective cohort study was conducted using an administrative database for patients who received psychiatric services via telemedicine between 2008 and 2014 and who also had OUD. Results. We identified 9,077 patients with concurrent opioid use and other mental health disorders who had received psychiatric services via telemedicine from 2008 to 2014; 7,109 (78.3%) patients lived in Southern Ontario and 1,968 (21.7%) in Northern Ontario. Telemedicine was used more frequently to provide mental health services to patients residing in Northern Ontario than Southern Ontario. Conclusion. Telemedicine is increasingly being utilized throughout Ontario for delivering mental health treatment. There is an opportunity to increase access to psychiatric services for patients with opioid dependence and concurrent psychiatric disorders through the use of the telemedicine.
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Shyamala1, R., Vikas Bhatia, Vijayalakshmi Nayak, and M. Prashanth. "The Opioid Epidemic in COVID 19 Pandemic." Scientific Research Journal of Clinical and Medical Sciences 2, no. 02 (April 10, 2022): 16–22. http://dx.doi.org/10.47310/srjcms.2022.v02i02.004.
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Background: COVID 19 pandemic has caused additional challenges and insurmountable psychosocial impact for patients with opioid use disorders. The particularly challenging group include those seeking treatment with medication for OUD patients. This article discusses the bi-directional effects between opioid use disorder patients and covid 19. Method: PubMed and Google Scholar were searched with the following keywords- “COVID-19”, “opioid use disorder”, “pandemic”, “behavioural addiction”, “opioid”, “opioid agonist therapy”. Results: People with opioid use disorder are at a heightened risk of acquiring and increased severity of COVID 19 infections due to compromised immunity, homelessness or housing instability, lockdown and social distancing leading to failure of rehabilitation strategies, mucociliary dysfunction, cardiopulmonary morbidities, etc. Conclusion: COVID 19 pandemic and opioid use disorder is on the verge of the collision so every effort must be taken by the government and health care sector to prevent a big wave of opioid overdose and relapse in our community.
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Abdelaaziz, El Hadloussi, Afrikh Mohammed, Abidi Asmae, El Hamdouchi Hajar, N’joumi Younes, Aziza Bentalha, Alae El Koraichi, and Salma Es-Sherif Kettani. "Traumatic Pseudo-aneurysm of the Hepatic Artery in a 12 Year Old Child, Case Report and Literature Review." Scientific Research Journal of Clinical and Medical Sciences 2, no. 02 (April 10, 2022): 35–37. http://dx.doi.org/10.47310/srjcms.2022.v02i02.007.
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Background: COVID 19 pandemic has caused additional challenges and insurmountable psychosocial impact for patients with opioid use disorders. The particularly challenging group include those seeking treatment with medication for OUD patients. This article discusses the bi-directional effects between opioid use disorder patients and covid 19. Method: PubMed and Google Scholar were searched with the following keywords- “COVID-19”, “opioid use disorder”, “pandemic”, “behavioural addiction”, “opioid”, “opioid agonist therapy”. Results: People with opioid use disorder are at a heightened risk of acquiring and increased severity of COVID 19 infections due to compromised immunity, homelessness or housing instability, lockdown and social distancing leading to failure of rehabilitation strategies, mucociliary dysfunction, cardiopulmonary morbidities, etc. Conclusion: COVID 19 pandemic and opioid use disorder is on the verge of the collision so every effort must be taken by the government and health care sector to prevent a big wave of opioid overdose and relapse in our community..
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Sharma, Maneesh, Chee Lee, Svetlana Kantorovich, Maria Tedtaotao, Gregory A. Smith, and Ashley Brenton. "Validation Study of a Predictive Algorithm to Evaluate Opioid Use Disorder in a Primary Care Setting." Health Services Research and Managerial Epidemiology 4 (January 1, 2017): 233339281771741. http://dx.doi.org/10.1177/2333392817717411.
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Background: Opioid abuse in chronic pain patients is a major public health issue. Primary care providers are frequently the first to prescribe opioids to patients suffering from pain, yet do not always have the time or resources to adequately evaluate the risk of opioid use disorder (OUD). Purpose: This study seeks to determine the predictability of aberrant behavior to opioids using a comprehensive scoring algorithm (“profile”) incorporating phenotypic and, more uniquely, genotypic risk factors. Methods and Results: In a validation study with 452 participants diagnosed with OUD and 1237 controls, the algorithm successfully categorized patients at high and moderate risk of OUD with 91.8% sensitivity. Regardless of changes in the prevalence of OUD, sensitivity of the algorithm remained >90%. Conclusion: The algorithm correctly stratifies primary care patients into low-, moderate-, and high-risk categories to appropriately identify patients in need for additional guidance, monitoring, or treatment changes.
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James, Arul, and John Williams. "Basic Opioid Pharmacology — An Update." British Journal of Pain 14, no. 2 (March 20, 2020): 115–21. http://dx.doi.org/10.1177/2049463720911986.
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Opioids are a group of analgesic agents commonly used in clinical practice. The three classical opioid receptors are MOP, DOP and KOP. The NOP (N/OFQ) receptor is considered to be a non-opioid branch of the opioid receptor family. Opioid receptors are G-protein-coupled receptors which cause cellular hyperpolarisation when bound to opioid agonists. Opioids may be classified according to their mode of synthesis into alkaloids, semi-synthetic and synthetic compounds. Opioid use disorder (OUD) is an emerging issue and important lessons can be learnt from the United States where opioid epidemic was declared as a national emergency in 2017.
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Zhu, Vivienne J., Leslie A. Lenert, Kelly S. Barth, Kit N. Simpson, Hong Li, Michael Kopscik, and Kathleen T. Brady. "Automatically identifying opioid use disorder in non-cancer patients on chronic opioid therapy." Health Informatics Journal 28, no. 2 (January 2022): 146045822211078. http://dx.doi.org/10.1177/14604582221107808.
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Background: Using the International Classification of Diseases (ICD) codes alone to record opioid use disorder (OUD) may not completely document OUD in the electronic health record (EHR). We developed and evaluated natural language processing (NLP) approaches to identify OUD from the clinal note. We explored the concordance between ICD-coded and NLP-identified OUD. Methods: We studied EHRs from 13,654 (female: 8223; male: 5431) adult non-cancer patients who received chronic opioid therapy (COT) and had at least one clinical note between 2013 and 2018. Of eligible patients, we randomly selected 10,218 (75%) patients as the training set and the remaining 3436 patients (25%) as the test dataset for NLP approaches. Results: We generated 539 terms representing OUD mentions in clinical notes (e.g., “opioid use disorder,” “opioid abuse,” “opioid dependence,” “opioid overdose”) and 73 terms representing OUD medication treatments. By domain expert manual review for the test dataset, our NLP approach yielded high performance: 98.5% for precision, 100% for recall, and 99.2% for F-measure. The concordance of these NLP and ICD identified OUD was modest (Kappa = 0.63). Conclusions: Our NLP approach can accurately identify OUD patients from clinical notes. The combined use of ICD diagnostic code and NLP approach can improve OUD identification.
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Treitler, Peter, Stephen Crystal, and Richard Hermida. "Diagnosed Opioid Use Disorder Among Older Adults: Complex Comorbidity and Management Challenges." Innovation in Aging 4, Supplement_1 (December 1, 2020): 53. http://dx.doi.org/10.1093/geroni/igaa057.172.
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Abstract In the face of a widespread opioid epidemic and many policy changes affecting opioid access and management, it is important to understand the prevalence and characteristics of diagnosed opioid use disorder in older people and their implications for effective management of this high-risk population. We examined these issues in an ~40% random sample of Medicare beneficiaries with Part D coverage. In 2017, .8% of beneficiaries ages 65+ were diagnosed with OUD (opioid abuse or dependence diagnoses), an increase from .5% in 2015. The late-2015 transition from ICD-9 to ICD-10 may have contributed to this change, but the rate also increased post-ICD-10 by 9.1% from 2016-2017. The profile of individuals diagnosed with OUD reveals a population with complex comorbidity and multiple health challenges: 45% were diagnosed with major depression, 7% with alcohol disorders, 45% with anxiety, 8% with hepatitis C, 26% with cancer, 38% with COPD and 19% with pneumonia (risk factors for opioid overdose), 56% with diabetes and 27% with heart failure. 97% were diagnosed with pain conditions, 85% received opioid prescriptions, and 38% received benzodiazepine prescriptions. These patients represent complex and potentially competing challenges in concurrent management of pain, opioid use disorder, multi-substance use and opioid use disorder. Development of effective, integrated care models to simultaneously address these interrelated problems in this high-risk population should be informed by a closer focus on their multiple needs and monitoring of the adequacy of health system response.
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Gondré-Lewis, Marjorie C., Igor Elman, Tanya Alim, Edwin Chapman, Beverlyn Settles-Reaves, Carine Galvao, Mark S. Gold, et al. "Frequency of the Dopamine Receptor D3 (rs6280) vs. Opioid Receptor µ1 (rs1799971) Polymorphic Risk Alleles in Patients with Opioid Use Disorder: A Preponderance of Dopaminergic Mechanisms?" Biomedicines 10, no. 4 (April 7, 2022): 870. http://dx.doi.org/10.3390/biomedicines10040870.
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While opioids are a powerful class of drugs that inhibit transmission of pain signals, their use is tarnished by the current epidemic of opioid use disorder (OUD) and overdose deaths. Notwithstanding published reports, there remain gaps in our knowledge of opioid receptor mechanisms and their role in opioid seeking behavior. Thus, novel insights into molecular, neurogenetic and neuropharmacological bases of OUD are needed. We propose that an addictive endophenotype may not be entirely specific to the drug of choice but rather may be generalizable to altered brain reward circuits impacting net mesocorticolimbic dopamine release. We suggest that genetic or epigenetic alterations across dopaminergic reward systems lead to uncontrollable self-administration of opioids and other drugs. For instance, diminished availability via knockout of dopamine D3 receptor (DRD3) increases vulnerability to opioids. Building upon this concept via the use of a sophisticated polymorphic risk analysis in a human cohort of chronic opioid users, we found evidence for a higher frequency of polymorphic DRD3 risk allele (rs6280) than opioid receptor µ1 (rs1799971). In conclusion, while opioidergic mechanisms are involved in OUD, dopamine-related receptors may have primary influence on opioid-seeking behavior in African Americans. These findings suggest OUD-targeted novel and improved neuropharmacological therapies may require focus on DRD3-mediated regulation of dopaminergic homeostasis.
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Oswald, Lynn M., Kelly E. Dunn, David A. Seminowicz, and Carla L. Storr. "Early Life Stress and Risks for Opioid Misuse: Review of Data Supporting Neurobiological Underpinnings." Journal of Personalized Medicine 11, no. 4 (April 19, 2021): 315. http://dx.doi.org/10.3390/jpm11040315.
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A robust body of research has shown that traumatic experiences occurring during critical developmental periods of childhood when neuronal plasticity is high increase risks for a spectrum of physical and mental health problems in adulthood, including substance use disorders. However, until recently, relatively few studies had specifically examined the relationships between early life stress (ELS) and opioid use disorder (OUD). Associations with opioid use initiation, injection drug use, overdose, and poor treatment outcome have now been demonstrated. In rodents, ELS has also been shown to increase the euphoric and decrease antinociceptive effects of opioids, but little is known about these processes in humans or about the neurobiological mechanisms that may underlie these relationships. This review aims to establish a theoretical model that highlights the mechanisms by which ELS may alter opioid sensitivity, thereby contributing to future risks for OUD. Alterations induced by ELS in mesocorticolimbic brain circuits, and endogenous opioid and dopamine neurotransmitter systems are described. The limited but provocative evidence linking these alterations with opioid sensitivity and risks for OUD is presented. Overall, the findings suggest that better understanding of these mechanisms holds promise for reducing vulnerability, improving prevention strategies, and prescribing guidelines for high-risk individuals.
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Guillou-Landreat, Morgane, Antoine Dany, Gaëlle Challet-Bouju, Edouard Laforgue, Juliette Leboucher, Jean Benoit Hardouin, Caroline Victorri-Vigneau, and Marie Grall-Bronnec. "What Differs between Patients under Methadone and under Buprenorphine for Opioid Use Disorder (OUD) in Daily Clinical Practice in France? A Short Report." International Journal of Environmental Research and Public Health 18, no. 4 (February 3, 2021): 1425. http://dx.doi.org/10.3390/ijerph18041425.
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(1) Background: Opioid use disorder (OUD) is a complex condition that can require long-term treatment. Pharmacological therapy for OUD involves treatment with opioid agonists (OMT) tailored to individual profiles. The aim of our study in daily clinical practice was to compare the profiles of patients treated with methadone (MTD) and those using buprenorphine (BHD or BHD-naloxone-NX). (2) Methods: A cross-sectional multicentre study explored the psychological, somatic and social profiles of patients with Opioid Use Disorder (OUD) following Opioid Maintenance Treatment (BHD, BHD/NX, or MTD). Descriptive and comparative analyses were performed (3) Results: 257 patients were included, a majority were men using heroin. 68% (178) were on MTD, 32% (79) were on BHD. Patients with MTD were significantly more likely to report socio-affective damage, and more likely to be younger and not to report oral or sublingual use as the main route for heroin or non-medical opioids (4) Conclusions: In daily clinical practice, regarding OUD damage, only socio-affective damage was significantly more prevalent among patients on MTD than among those on BHD in the multivariate model. Age and route of administration also differed, and our results could raise the issue of the type of OMT prescribed in case of non-medical use of prescribed opioids. These hypothesis should be confirmed in larger studies.
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Peters-Watral, Brenda. "Opioid use disorder and chronic pain: challenges for palliative care practice." International Journal of Palliative Nursing 25, no. 9 (September 2, 2019): 453–57. http://dx.doi.org/10.12968/ijpn.2019.25.9.453.
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Along with a well-documented increase in opioid use disorder (OUD) and a rapidly escalating rate of fatal overdose in North America, inadequate management of chronic pain remains a pervasive problem. The increasing number of individuals living with OUD also experience multiple cancer risk factors, which are related to their substance use, while people with cancer diagnoses have similar risks of current or past addiction as the general population. Recent pain guidelines focus on chronic non-cancer pain and do not include recommendations for cancer pain management. Managing cancer pain at the end of life is more challenging in people with current or past substance use disorder (SUD), especially OUD. Addressing these challenges requires confronting stigmas and stereotypes, building knowledge among palliative care providers and assessing the risks and benefits of opioids for pain management on an individual basis in order to continue to provide the holistic care.
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Deyo-Svendsen, Mark, Matthew Cabrera Svendsen, James Walker, Andrea Hodges, Rachel Oldfather, and Meghna P. Mansukhani. "Medication-Assisted Treatment for Opioid Use Disorder in a Rural Family Medicine Practice." Journal of Primary Care & Community Health 11 (January 2020): 215013272093172. http://dx.doi.org/10.1177/2150132720931720.
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Opioid use disorder (OUD) is a cause of significant morbidity and mortality in the United States. Although efforts are being made to limit access to prescription opioids, the use of heroin and synthetic opioids as well as death due to opioid overdose has increased. Medication-assisted treatment (MAT) is the pairing of psychosocial intervention with a Food and Drug Administration (FDA)–approved medication (methadone, buprenorphine plus naltrexone) to treat OUD. MAT has resulted in reductions in overdose deaths, criminal activity, and infectious disease transmission. Access to MAT in rural areas is limited by shortages of addiction medicine-trained providers, lack of access to comprehensive addiction programs, transportation, and cost-related issues. Rural physicians express concern about lack of mentorship and drug diversion as reasons to avoid MAT. The prescribing of MAT with buprenorphine requires a Drug Enforcement Agency (DEA) waiver that can easily be obtained by Family Medicine providers. MAT can be incorporated into the outpatient practice, where patient follow-up rates and number needed to treat to effect change are similar to that of other chronic medical conditions. We describe a case of opioid overdose and a suggested protocol for the induction of MAT with buprenorphine/naloxone (Suboxone) for OUD in a rural family medicine outpatient practice. Treatment access is facilitated by utilizing the protocol, allowing office staff work to the extent allowed by their licensure, promoting teamwork and minimizing physician time commitment. We conclude that improved access to MAT can be accomplished in a rural family medicine outpatient clinic by staff that support and mentor one another through use of a MAT protocol.
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Countey, Haley, Claire Steinbronn, and Sarah E. Grady. "Changing student attitudes and perceptions toward opioid use disorder." Mental Health Clinician 8, no. 5 (September 1, 2018): 222–26. http://dx.doi.org/10.9740/mhc.2018.09.222.
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Abstract Introduction: With the opioid epidemic creating a group of patients with unique health care needs, pharmacists have an opportunity to be a good resource for patients recovering from opioid use disorder (OUD). To accomplish this, it is essential that pharmacists are knowledgeable and unbiased toward this patient population. Methods: Because the curriculum in place to obtain a PharmD at Drake University does not include in-depth information on substance use disorders, study investigators offered students an opportunity to receive more intensive education. Faculty members at Drake University provided didactic and panel discussion presentations on topics such as opioid pharmacology, OUD, and treatment options. The students were assessed for their perception of knowledge and stigma before and after the summit by using a 5-point Likert scale to measure their attitudes toward 10 statements. Results: Total knowledge scores showed a significant change of 3.1, indicating an increase in perceived understanding of materials presented (P < .0001). Total stigma scores also changed by 1.4, illustrating a statistically significant decrease in negative perceptions (P = .0198). Discussion: By providing more in-depth education, the summit showed that increasing pharmacy student knowledge about OUD and its treatment may decrease associated stigma.
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Hay, Kaitlyn R., Jasmyne Jardot, Andrew S. Huhn, and D. Andrew Tompkins. "Substance Use in the Performing Artist with Chronic Pain." Medical Problems of Performing Artists 37, no. 1 (March 1, 2022): 24–29. http://dx.doi.org/10.21091/mppa.2022.1003.
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OBJECTIVES: To evaluate how performing artists (PAs) with chronic pain may differ on measures of substance use compared to non-PA controls. METHODS: 157 participants reporting chronic pain (89 PAs, 68 non-PA controls) completed an online cross-sectional survey. Participants were assessed for self-reported current pain severity using the Brief Pain Inventory Short-Form, opioid misuse risk using the Screener and Opioid Assessment for Patients with Pain–Revised, opioid withdrawal using the Subjective Opiate Withdrawal Scale, and symptoms of opioid use disorder (OUD) using a modified version of the DSM-V checklist. RESULTS: PAs had lower pain severity (p<0.05, t=2.196, df=155) and lower pain interference (p<0.05, t=2.194) than non-PA controls. 24% of PAs and 13% of controls reported using opioids within the past month. Among PAs, the number of days using opioids in the past month was positively associated with hours spent practicing per week (r=0.508, p<0.05). PAs (66%) were more likely to endorse current alcohol use than controls (44.1%, t=–2.136, X2=7.72, p<0.01). Importantly, PAs (19%) were more likely than controls (3%) to endorse symptoms of at least mild OUD (X2(3)=11.3, p<0.01) and higher ratings of opioid misuse risk (t=–2.166, p<0.05). Past month opioid withdrawal was also greater in PAs than controls (t=–2.136, p<0.05), and 5.6% of PAs and 1.5% of controls reported at least one prior incidence incident of opioid overdose in their lifetime (X2=1.80, NS). CONCLUSIONS: Among persons with chronic pain, PAs may have higher risk for opioid-related consequences, including OUD, and should be screened during health care encounters.
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Han, Benjamin. "OPIOID USE DISORDER AMONG OLDER ADULTS: ADDRESSING MULTIMORBIDITY AND GERIATRIC CONDITIONS." Innovation in Aging 6, Supplement_1 (November 1, 2022): 163. http://dx.doi.org/10.1093/geroni/igac059.650.
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Abstract Dr. Han will present multidisciplinary research focused on understanding the healthcare needs of older adults with opioid use disorder. Nationally, there is a sharp increase in older adults with opioid use disorder (OUD) and the number of older adults dying of opioid-related overdoses. This lecture will first describe the prevalence of geriatric conditions and comorbidities among older adults who receive care in opioid treatment programs. Then, Dr. Han will present patterns of acute healthcare utilization among older adults with opioid use disorder. Qualitative data from patient experiences of aging with opioid use disorder and the challenges of managing chronic diseases will then be presented. The lecture will conclude with a discussion about opportunities for developing multidisciplinary models of care to best deliver geriatric-based interventions for this population.
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Pantazis, Caroline B., Luis A. Gonzalez, Brendan J. Tunstall, Stephanie A. Carmack, George F. Koob, and Leandro F. Vendruscolo. "Cues conditioned to withdrawal and negative reinforcement: Neglected but key motivational elements driving opioid addiction." Science Advances 7, no. 15 (April 2021): eabf0364. http://dx.doi.org/10.1126/sciadv.abf0364.
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Opioid use disorder (OUD) is a debilitating disorder that affects millions of people. Neutral cues can acquire motivational properties when paired with the positive emotional effects of drug intoxication to stimulate relapse. However, much less research has been devoted to cues that become conditioned to the aversive effects of opioid withdrawal. We argue that environmental stimuli promote motivation for opioids when cues are paired with withdrawal (conditioned withdrawal) and generate opioid consumption to terminate conditioned withdrawal (conditioned negative reinforcement). We review evidence that cues associated with pain drive opioid consumption, as patients with chronic pain may misuse opioids to escape physical and emotional pain. We highlight sex differences in withdrawal-induced stress reactivity and withdrawal cue processing and discuss neurocircuitry that may underlie withdrawal cue processing in dependent individuals. These studies highlight the importance of studying cues associated with withdrawal in dependent individuals and point to areas for exploration in OUD research.
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Dickson-Gomez, Julia, Antoinette Spector, Margaret Weeks, Carol Galletly, Madelyn McDonald, and Helena Danielle Green Montaque. "“You’re Not Supposed to be on it Forever”: Medications to Treat Opioid Use Disorder (MOUD) Related Stigma Among Drug Treatment Providers and People who Use Opioids." Substance Abuse: Research and Treatment 16 (January 2022): 117822182211038. http://dx.doi.org/10.1177/11782218221103859.
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Opioid use disorder (OUD) through prescription opioid misuse, heroin, and illicitly manufactured fentanyl use has increased dramatically in the past 20 years. Medications to treat opioid use disorder (MOUD) is considered the gold standard for treating opioid use disorders but uptake remains low. Recently, Madden has argued that in addition to the stigma assigned to substance use and people with SUD, MOUDs also are stigmatized, a process she labels intervention stigma to distinguish it from condition stigma (ie, stigma of SUD) . In this paper, we examine MOUD related stigma from the perspective of people who use opioids (PWUO) and key informants who play some role in providing or referring people to drug treatment. Providers and PWOU often viewed MOUD as one drug replacing another which discouraged providers from recommending and PWUO from accepting MOUD. MOUD stigma was also expressed by providers’ exaggerated fear of MOUD diversion. The extent to which MOUD was accepted as a legitimate treatment varied and influenced treatment providers’ perceptions of the goals of drug treatment and the length of time that MOUD should be used with many feeling that MOUD should only be used as a temporary tool while PWOU work on other treatment goals. This led to tapering off of MOUD after some time in treatment. Some providers also expressed mistrust of MOUD stemming from their previous experiences with the over-prescription of opioids for pain which led to the current crisis. Results from this study suggest that the proportion of PWUO on MOUD is unlikely to increase without addressing MOUD stigma among drug treatment providers and PWUO seeking treatment.
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Rieb, Launette M., Zainab Samaan, Andrea D. Furlan, Kiran Rabheru, Sid Feldman, Lillian Hung, George Budd, and Douglas Coleman. "Canadian Guidelines on Opioid Use Disorder Among Older Adults." Canadian Geriatrics Journal 23, no. 1 (March 13, 2020): 123–34. http://dx.doi.org/10.5770/cgj.23.420.
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BackgroundIn Canada, rates of hospital admission from opioid overdose are higher for older adults (≥ 65) than younger adults, and opioid use disorder (OUD) is a growing concern. In response, Health Canada commissioned the Canadian Coalition of Seniors’ Mental Health to create guidelines for the prevention, screening, assessment, and treatment of OUD in older adults.MethodsA systematic review of English language literature from 2008–2018 regarding OUD in adults was conducted. Previously published guidelines were evaluated using AGREE II, and key guidelines updated using ADAPTE method, by drawing on current literature. Recommendations were created and assessed using the GRADE method.ResultsThirty-two recommendations were created. Prevention recommendations: it is key to prioritize non-pharmacological and non-opioid strategies to treat acute and chronic noncancer pain. Assessment recommendations: a comprehensive assessment is important to help discern contributions of other medical conditions. Treatment recommendations: buprenorphine is first line for both withdrawal management and maintenance therapy, while methadone, slow-release oral morphine, or naltrexone can be used as alternatives under certain circumstances; non-pharmacological treatments should be offered as an integrated part of care.ConclusionThese guidelines provide practical and timely clinical recommendations on the prevention, assessment, and treatment of OUD in older adults within the Canadian context.
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Jordan, Colleen G., Amy L. Kennalley, Alivia L. Roberts, Kaitlyn M. Nemes, Tenzing Dolma, and Brian J. Piper. "The Potential of Methocinnamox as a Future Treatment for Opioid Use Disorder: A Narrative Review." Pharmacy 10, no. 3 (April 19, 2022): 48. http://dx.doi.org/10.3390/pharmacy10030048.
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The opioid epidemic is an ongoing public health crisis, and the United States health system is overwhelmed with increasing numbers of opioid-related overdoses. Methocinnamox (MCAM) is a novel mu opioid receptor antagonist with an extended duration of action. MCAM has potential to reduce the burden of the opioid epidemic by being used as an overdose rescue treatment and a long-term treatment for opioid use disorder (OUD). The currently available treatments for OUD include naloxone, naltrexone, and methadone. These treatments have certain limitations, which include short duration of action, patient non-compliance, and diversion. A narrative review was conducted using PubMed and Google Scholar databases covering the history of the opioid epidemic, pain receptors, current OUD treatments and the novel drug MCAM. MCAM could potentially be used as both a rescue and long-term treatment for opioid misuse. This is due to its pseudo-irreversible antagonism of the mu opioid receptor, abnormally long duration of action of nearly two weeks, and the possibility of using kappa or delta opioid receptor agonists for pain management during OUD treatment. MCAM’s novel pharmacokinetic and pharmacodynamic properties open a new avenue for treating opioid misuse.
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DeShazer, Charles, Oralia Dominic, Caesar DeLeo, and Rhonda Johnson. "Impact of a Health System's Three-Pronged Strategy to Address the Opioid Epidemic in DE, PA, and WV, 2013-2017." Open Public Health Journal 13, no. 1 (April 24, 2020): 152–60. http://dx.doi.org/10.2174/1874944502013010152.
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Background: In the past two decades, from 1999-2017, more than 700,000 people have died from a drug overdose in the United States. In 2017, more than 68% of the drug overdose deaths involved an opioid, and the opioid death rate was six times higher than in 1999. Although treatable, opioid addiction has significant health consequences; and evidence-based, data-driven models addressing these opioid-related factors remain sparse. Objectives: To help stem this epidemic, Highmark Inc., a national health plan as well as the second largest integrated delivery and financing system in America, developed, implemented and evaluated a series of quality management-focused opioid interventions utilizing a three-pronged public health approach. We focused on more effectively managing pain to reduce the need for opioids (primary prevention); when needed, prescribing opioids according to safe prescribing guidelines (secondary prevention); and for those with Opioid Use Disorder (OUD), ensuring access to effective treatment to reduce morbidity/mortality (tertiary prevention) for our members. Methods: We deployed a series of evidence-based and data-driven interventions utilizing clinical guidelines, integrated and coordinated infrastructures, and community-based participatory research frameworks within our service areas of Delaware, Pennsylvania, and West Virginia. We examined medical and pharmacy claims for combined data years 2013-2017 by age, product (commercial, diagnosis with OUD), total Opioid prescription (RX) fill rate (per 1,000 members), opioid use by dose (dosage level by Morphine Milligram Equivalents), opioid use by duration (number days of opioid use), rate per 1,000 members diagnosed with OUD, and geography. Results: Improvements in total Opioid RX fills, opioid use by dose and duration for members diagnosed with OUD. Over these years, a decrease of 19% of total Opioid RX fills; shorter durations and the majority of these members switched to 7 days or less of opioid use; and a reduction by 13 percentage point of the number of members on higher strength 20+ MMEs opioids resulted. Conclusion: These findings may help inform nationwide opioid-focused efforts and set priorities.
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Guillou-Landreat, Morgane, Bertrand Quinio, Jean Yves Le Reste, Delphine Le Goff, Jérôme Fonsecca, Marie Grall-Bronnec, and Antoine Dany. "Analgesic Opioid Misuse and Opioid Use Disorder among Patients with Chronic Non-Cancer Pain and Prescribed Opioids in a Pain Centre in France." International Journal of Environmental Research and Public Health 18, no. 4 (February 21, 2021): 2097. http://dx.doi.org/10.3390/ijerph18042097.
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(1) Background: Chronic non-cancer pain (CNCP) remains a public health challenge around the world. Opioids (PO) have been increasingly used in the treatment of CNCP in the last 20 years. This study aimed to assess the prevalence of opioid misuse and prescribed-opioid use disorder (p-OUD) among patients with CNCP in a pain centre in France, and to analyse risk factors for moderate or severe p-OUD. (2) Method: A cross-sectional study was conducted, including patients consulting for pain management in the pain centre of Brest University Hospital. A self-questionnaire was administered (sociodemographic data, medical data, PO misuse, and p-OUD according the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM 5) criteria). Descriptive, univariate, and multivariate analyses were conducted, together with a principal component analysis, in order to identify factors associated with p-OUD. (3) Results: In total, 115 patients were included, the majority of whom were women, with a mean age of 52 years old [18–82]; 64.3% (n = 74) had a current prescription for opioid analgesics (weak or strong). In this group, 56.7% (n = 42) had no or only mild p-OUD and 43.3% (n = 32) had current moderate or severe p-OUD. Patients with moderate or severe p-OUD were more likely to have a current antidepressant prescription, to have had psychotherapy, to currently use strong opioids and oxycodone, and to report taking more frequent doses than prescribed and feeling dependent. (4) Conclusions: We showed that the prevalence of current moderate/severe p-OUD concerned 43.3% of the patients with a CNCP seeking treatment in a pain centre. According to these results, several measures are relevant in managing p-OUD among patients with CNCP.
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Dong, Xinyu, Jianyuan Deng, Sina Rashidian, Kayley Abell-Hart, Wei Hou, Richard N. Rosenthal, Mary Saltz, Joel H. Saltz, and Fusheng Wang. "Identifying risk of opioid use disorder for patients taking opioid medications with deep learning." Journal of the American Medical Informatics Association 28, no. 8 (April 30, 2021): 1683–93. http://dx.doi.org/10.1093/jamia/ocab043.
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Abstract Objective The United States is experiencing an opioid epidemic. In recent years, there were more than 10 million opioid misusers aged 12 years or older annually. Identifying patients at high risk of opioid use disorder (OUD) can help to make early clinical interventions to reduce the risk of OUD. Our goal is to develop and evaluate models to predict OUD for patients on opioid medications using electronic health records and deep learning methods. The resulting models help us to better understand OUD, providing new insights on the opioid epidemic. Further, these models provide a foundation for clinical tools to predict OUD before it occurs, permitting early interventions. Methods Electronic health records of patients who have been prescribed with medications containing active opioid ingredients were extracted from Cerner’s Health Facts database for encounters between January 1, 2008, and December 31, 2017. Long short-term memory models were applied to predict OUD risk based on five recent prior encounters before the target encounter and compared with logistic regression, random forest, decision tree, and dense neural network. Prediction performance was assessed using F1 score, precision, recall, and area under the receiver-operating characteristic curve. Results The long short-term memory (LSTM) model provided promising prediction results which outperformed other methods, with an F1 score of 0.8023 (about 0.016 higher than dense neural network (DNN)) and an area under the receiver-operating characteristic curve (AUROC) of 0.9369 (about 0.145 higher than DNN). Conclusions LSTM–based sequential deep learning models can accurately predict OUD using a patient’s history of electronic health records, with minimal prior domain knowledge. This tool has the potential to improve clinical decision support for early intervention and prevention to combat the opioid epidemic.
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Owens, Rebecca, Maxine Smalling, and Joyce Fitzpatrick. "Mental health, substance use disorder, and opioid uses disorder: updates and strategies for treatment." SMAD Revista Eletrônica Saúde Mental Álcool e Drogas (Edição em Português) 17, no. 3 (October 13, 2021): 88–100. http://dx.doi.org/10.11606/issn.1806-6976.smad.2021.187412.
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Objective: to describe the main strategies to deal with gaps in the identification, treatment and training regarding substance use disorder (SUD), and opioid uses disorder (OUD). Method: this is a narrative review, based on recent articles and publications on mental health and substance use recognized internationally. Results: a prevalence of co-occurring substance use and mental health/psychiatric disorders continue to rise and are considered complex problems, with multifaceted treatment challenges including medical conditions, disabilities, homelessness, medication noncompliance, and high relapse rates. The treatment for SUD and OUD are complex. The co-occurrence of these two disorders require a multifaceted approach for the diagnosis and treatment. Conclusion: the prevalence of SUD, OUD and their co-occurrence continue to rise and nurses and other health professionals should be prepared to diagnose, treat and/or refer users to assure their adequate care and long term recovery.
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Nuamah, Joseph, Ranjana Mehta, and Farzan Sasangohar. "Technologies for Opioid Use Disorder Management: Mobile App Search and Scoping Review." JMIR mHealth and uHealth 8, no. 6 (June 5, 2020): e15752. http://dx.doi.org/10.2196/15752.
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Background Advances in technology engender the investigation of technological solutions to opioid use disorder (OUD). However, in comparison to chronic disease management, the application of mobile health (mHealth) to OUD has been limited. Objective The overarching aim of our research was to design OUD management technologies that utilize wearable sensors to provide continuous monitoring capabilities. The objectives of this study were to (1) document the currently available opioid-related mHealth apps, (2) review past and existing technology solutions that address OUD, and (3) discuss opportunities for technological withdrawal management solutions. Methods We used a two-phase parallel search approach: (1) an app search to determine the availability of opioid-related mHealth apps and (2) a scoping review of relevant literature to identify relevant technologies and mHealth apps used to address OUD. Results The app search revealed a steady rise in app development, with most apps being clinician-facing. Most of the apps were designed to aid in opioid dose conversion. Despite the availability of these apps, the scoping review found no study that investigated the efficacy of mHealth apps to address OUD. Conclusions Our findings highlight a general gap in technological solutions of OUD management and the potential for mHealth apps and wearable sensors to address OUD.
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Cox, Jiayi W., Richard M. Sherva, Kathryn L. Lunetta, Emma C. Johnson, Nicholas G. Martin, Louisa Degenhardt, Arpana Agrawal, et al. "Genome-Wide Association Study of Opioid Cessation." Journal of Clinical Medicine 9, no. 1 (January 9, 2020): 180. http://dx.doi.org/10.3390/jcm9010180.
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The United States is experiencing an epidemic of opioid use disorder (OUD) and overdose-related deaths. However, the genetic basis for the ability to discontinue opioid use has not been investigated. We performed a genome-wide association study (GWAS) of opioid cessation (defined as abstinence from illicit opioids for >1 year or <6 months before the interview date) in 1130 African American (AA) and 2919 European ancestry (EA) participants recruited for genetic studies of substance use disorders and who met lifetime Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) criteria for OUD. Association tests performed separately within each ethnic group were combined by meta-analysis with results obtained from the Comorbidity and Trauma Study. Although there were no genome-wide significant associations, we found suggestive associations with nine independent loci, including three which are biologically relevant: rs4740988 in PTPRD (pAA + EA = 2.24 × 10−6), rs36098404 in MYOM2 (pEA = 2.24 × 10−6), and rs592026 in SNAP25-AS1 (pEA = 6.53 × 10−6). Significant pathways identified in persons of European ancestry (EA) are related to vitamin D metabolism (p = 3.79 × 10−2) and fibroblast growth factor (FGF) signaling (p = 2.39 × 10−2). UK Biobank traits including smoking and drinking cessation and chronic back pain were significantly associated with opioid cessation using GWAS-derived polygenic risk scores. These results provide evidence for genetic influences on opioid cessation, suggest genetic overlap with other relevant traits, and may indicate potential novel therapeutic targets for OUD.
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Werder, Karen, Alexa Curtis, Stephanie Reynolds, and Jason Satterfield. "Addressing Bias and Stigma in the Language We Use With Persons With Opioid Use Disorder: A Narrative Review." Journal of the American Psychiatric Nurses Association 28, no. 1 (November 18, 2021): 9–22. http://dx.doi.org/10.1177/10783903211050121.
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BACKGROUND: Despite an increase in access to medications for opioid use disorder, less than 20% of individuals with opioid use disorder (OUD) receive treatment. Stigmatizing language has been identified as a potential trigger for explicit and implicit biases that may adversely affect treatment enrollment and quality of care for persons with OUD. AIMS: To conduct a narrative review of the literature on stigmatizing language and OUD, examine how treatment outcomes are affected, and present strategies to reduce bias and promote OUD treatment. METHOD: A narrative review of the literature between 2010 and 2019 was conducted using CINAHL, PubMed, and PsycINFO. Key search terms were opioid use disorder (or substance use disorder), stigma, and language. Fifty-two articles were screened for inclusion, and 17 articles were included in this review. RESULTS: The articles reviewed provide consensus that stigmatizing language toward persons with OUD fosters explicit and implicit bias and impedes engagement in treatment. Four themes emerged: (1) stigma and language, (2) stigma and language used by health care professionals, (3) stigma and language used by the general public, and (4) stigma and language used by people with OUD. CONCLUSIONS: Stigmatizing language is dehumanizing and plays a pivotal role in bias and discrimination that may contribute to unsatisfactory treatment outcomes among persons with OUD. Health care professionals, nursing in particular, must assume an intentional stance against stigma perpetuated toward persons with OUD through advocacy in education, practice, policy, and the media.
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Wipper, Benjamin, Michelle Cooke, and John Winkelman. "530 Restless Legs Syndrome Prevalence and Severity Among Patients Treated with Buprenorphine and Naloxone for Opioid Use Disorder." Sleep 44, Supplement_2 (May 1, 2021): A208—A209. http://dx.doi.org/10.1093/sleep/zsab072.528.
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Abstract Introduction Restless Legs Syndrome (RLS) is a sensory-motor neurological disorder which is associated with sleep disturbance and emotional distress. Opioid medications are effective treatments for RLS, and a high percentage of patients undergoing opioid withdrawal exhibit symptoms of RLS. Despite the known connection between RLS and opioids, there has been no assessment of RLS in patients actively treated with buprenorphine and naloxone for opioid use disorder (OUD). Methods We conducted a study to determine the prevalence of RLS among patients with OUD at an outpatient buprenorphine and naloxone clinic at Lemuel Shattuck Hospital in Jamaica Plain, Massachusetts. With the help of nurses, participants completed questionnaires which inquired about demographic information, previous opioid use, current medications, and RLS. Patients were categorized as having RLS if, according to the Cambridge-Hopkins Questionnaire, they answered positively to the four essential RLS criteria and if common mimics were not endorsed. A final determination of RLS status in those with ambiguous answers to RLS mimics was made by a trained sleep medicine physician (JWW). Results Participants (n=129) were primarily male (n=86; 66.7%), white (n=101; 78.3%), and the median age was 37.5 years. Approximately half of the sample (n=59; 45.7%) used medications for depression and/or anxiety. The median duration of buprenorphine and naloxone use was 3 years. 13.2% were judged to have RLS. RLS symptoms tended to be of moderate severity, disturb sleep to a moderate degree, and occur 5–15 days per month. There were no significant demographic or clinical differences in those with and without RLS. Of the 103 participants without suspected RLS, 15.5% (n=16) were taking a non-opioid medication known to treat RLS symptoms (e.g. gabapentin). Only 1/17 people (5.9%) with RLS were taking a treatment that would control such symptoms. Conclusion Approximately 13% of this sample currently taking buprenorphine and naloxone for OUD had RLS. RLS can greatly interfere with sleep and quality of life, and those with untreated or partially treated symptoms may be motivated to use unprescribed opioids to control them. With this in mind, clinicians treating OUD should be aware that there are effective non-opioid medications that can treat RLS. Support (if any):
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Althobaiti, Yusuf S., Maram A. Alzahrani, Norah A. Alsharif, Nawal S. Alrobaie, Hashem O. Alsaab, and Mohammad N. Uddin. "The Possible Relationship between the Abuse of Tobacco, Opioid, or Alcohol with COVID-19." Healthcare 9, no. 1 (December 22, 2020): 2. http://dx.doi.org/10.3390/healthcare9010002.
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Introduction: Substance use disorder has been frequently reported to increase the risk of infectious diseases, which might be owing to the sharing of contaminated inhalation, smoking, vaping, or injection equipment. Aim: This review analyzes the recent literature with the aim to put in light the possible relationship between the abuse of different substances (Tobacco, opioid, and Alcohol) with coronavirus disease (COVID-19). Tobacco: Multiple studies confirmed that cigarette smoking affects the respiratory system by increasing the expression of angiotensin-converting enzyme-2 (ACE2) receptors, which have a significant association with COVID-19 infection rate and disease severity. Opioid: Studies conducted regarding the association of opioid use disorder (OUD) and COVID-19 infection severity are limited; however, opioids can lead to both respiratory depression and kidney injuries, causing poor prognosis for those with COVID-19 infections. Alcohol: People with alcohol use disorders are at risk of developing acute lung injury and severe COVID-19 infection. Alcohol consumption during the COVID-19 pandemic has two possible scenarios: either increased or decreased based on situations. Conclusion: SUD has been frequently reported to have a positive relationship with COVID-19 severity Further studies are needed to understand the effects of opioids and alcohol abuse on COVID-19.
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Torrens, M. "Opioid Substitution: More than Only Methadone!" European Psychiatry 65, S1 (June 2022): S42. http://dx.doi.org/10.1192/j.eurpsy.2022.146.
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Opioid misuse and its rising rates of morbidity and associated mortality is an increasing area of concern worldwide. The licit/illicit consumption of opioids ranging from plant-based substances and pharmaceutical drugs (particularly analgesia) to the new synthetic opioids, has brought opioid use disorder (OUD) back to the public health concerns, including not only prevention but also availability of evidence-based treatments. Agonist opioids have demonstrated by long high efficacy and effectiveness for OUD treatment. Although methadone has been the more prescribed drug in most of the countries where opioid agonist treatment is available, other agonist opioids can be prescribed. We will present a start of the art of other agonist opioids available for the treatment of OUD, emphasizing in the differences among them, in line with of personalizing treatment in addiction. We will focus on morphine slow release, buprenorphine (with or without naloxone, sublingual or long-lasting) and diacetylmorphine. Disclosure MT has been consultant/advisor and/or speaker for Gilead Sciences, Merck Sharp & Dohme Corp, Servier, Adamed, Lundbeck, Camurus, Rovi and Molteni.
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Ashrafioun, Lisham, Kotwoallama R. A. Zerbo, Todd M. Bishop, and Peter C. Britton. "Opioid use disorders, psychiatric comorbidities, and risk for suicide attempts among veterans seeking pain care." Psychological Medicine 50, no. 12 (September 16, 2019): 2107–12. http://dx.doi.org/10.1017/s0033291719002307.
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AbstractBackgroundThe purpose of this study was to assess the associations of comorbid opioid use disorders and psychiatric disorders with suicide attempts among veterans seeking pain care.MethodsThe cohort (N = 226 444) was selected by identifying pain care initiation from 2012 to 2014 using national Veterans Health Administration (VHA) data. Data on opioid use disorders (OUD), psychiatric disorders, medical comorbidity, demographics at baseline, and suicide attempts in the year following the initiation of pain care were extracted from VHA databases. Relative excess risk due to interaction (RERI) was used to assess departure from additivity of effects.ResultsAdjusted models indicated that both comorbid OUD and depression (RERI = 1.07) and comorbid OUD and AUD (RERI = 1.23) were significantly associated with additive risk of suicide attempt. In adjusted multiplicative interaction models, only comorbid OUD and bipolar disorder was significantly associated with suicide attempts; however, this association was protective (HR = 0.54).ConclusionsThe current findings highlight the importance of addressing opioid use disorders and alcohol use disorders and depression together to mitigate the risk of suicidal behavior.
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Sanchez-Roige, Sandra, Pierre Fontanillas, Mariela V. Jennings, Sevim B. Bianchi, Yuye Huang, Alexander S. Hatoum, Julia Sealock, et al. "Genome-wide association study of problematic opioid prescription use in 132,113 23andMe research participants of European ancestry." Molecular Psychiatry 26, no. 11 (November 2021): 6209–17. http://dx.doi.org/10.1038/s41380-021-01335-3.
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AbstractThe growing prevalence of opioid use disorder (OUD) constitutes an urgent health crisis. Ample evidence indicates that risk for OUD is heritable. As a surrogate (or proxy) for OUD, we explored the genetic basis of using prescription opioids ‘not as prescribed’. We hypothesized that misuse of opiates might be a heritable risk factor for OUD. To test this hypothesis, we performed a genome-wide association study (GWAS) of problematic opioid use (POU) in 23andMe research participants of European ancestry (N = 132,113; 21% cases). We identified two genome-wide significant loci (rs3791033, an intronic variant of KDM4A; rs640561, an intergenic variant near LRRIQ3). POU showed positive genetic correlations with the two largest available GWAS of OUD and opioid dependence (rg = 0.64, 0.80, respectively). We also identified numerous additional genetic correlations with POU, including alcohol dependence (rg = 0.74), smoking initiation (rg = 0.63), pain relief medication intake (rg = 0.49), major depressive disorder (rg = 0.44), chronic pain (rg = 0.42), insomnia (rg = 0.39), and loneliness (rg = 0.28). Although POU was positively genetically correlated with risk-taking (rg = 0.38), conditioning POU on risk-taking did not substantially alter the magnitude or direction of these genetic correlations, suggesting that POU does not simply reflect a genetic tendency towards risky behavior. Lastly, we performed phenome- and lab-wide association analyses, which uncovered additional phenotypes that were associated with POU, including respiratory failure, insomnia, ischemic heart disease, and metabolic and blood-related biomarkers. We conclude that opioid misuse can be measured in population-based cohorts and provides a cost-effective complementary strategy for understanding the genetic basis of OUD.
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Griffin, Paul M. "Engineering Approaches for Addressing Opioid Use Disorder in the Community." Annual Review of Biomedical Engineering 22, no. 1 (June 4, 2020): 207–29. http://dx.doi.org/10.1146/annurev-bioeng-082719-040832.
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Many communities in the United States are struggling to deal with the negative consequences of illicit opioid use. Effectively addressing this epidemic requires the coordination and support of community stakeholders in a change process with common goals and objectives, continuous engagement with individuals with opioid use disorder (OUD) through their treatment and recovery journeys, application of systems engineering principles to drive process change and sustain it, and use of a formal evaluation process to support a learning community that continuously adapts. This review presents strategies to improve OUD treatment and recovery with a focus on engineering approaches grounded in systems thinking.
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Williams, K., C. Selwyn, C. Elkins, S. Young, K. Pancione, M. Baker, and Y. Getch. "An integrated addictions nursing subspecialty to expand the opioid use disorder and substance use disorder workforce." European Psychiatry 64, S1 (April 2021): S570. http://dx.doi.org/10.1192/j.eurpsy.2021.1521.
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IntroductionIn the U.S. approximately11.4 million misused prescription pain relievers; 2.1 million had an OUD in 2017. The Addictions Nursing Subspecialty was created to address this epidemic by expanding a workforce trained in OUD/SUD screening, treatment, and prevention. A curriculum was developed that included integrated/telehealth health care settings in medical and mental health provider shortage areas during their last nine months of training. Courses were developed and taught by aninterprofessional team of university faculty and informed by evidence-based guidelines/clinical competencies for effective OUD/SUD screening/prevention, assessment, treatment, and recovery. Courses were also offered as electives for nursing, clinical-counseling, social work, and other health science disciplines emphasizing an interdisciplinary approach to healthcare.ObjectivesExpand the OUD/SUD trained workforce in areas with high OUD/SUD mortality rates and high mental health provider shortages emphasizing team-based integrated care and telehealth settings.MethodsProgram curriculum was informed by evidence-based guidelines/clinical competencies for effective OUD/SUD screening/prevention, assessment, treatment, and recovery using integrated care. Competencies included: Core Competencies for Integrated Behavioral Health and Primary Care that have been set forth by the Center for Integrated Health Solutions, telehealth competencies outlined in the recommended competencies by the National Organization of Nurse Practitioner Faculties (NONPF), and Core Competencies for Addictions Medicine by the American Board of Addictions Medicine.ResultsApproximately 11 students enrolled in courses received additions integrated/telehealth health care settings. Students responded positively to evaluations regarding timely feedback, unique approach (i.e. intrative content, short videos and discussions).ConclusionsThe Addictions Nursing subspecialty will continue to be offered allowing enrollment for nurses twice a year.