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Opioid Abuse

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2. Association of Opioid Prescriptions From Dental Clinicians for US Adolescents and Young Adults With Subsequent Opioid Use and Abuse

Association of Opioid Prescriptions From Dental Clinicians for US Adolescents and Young Adults With Subsequent Opioid Use and Abuse Through prescription writing, dental clinicians are a potential source of initial opioid exposure and subsequent abuse for adolescents and young adults.To examine the association between index dental opioid prescriptions from dental clinicians for opioid-naive adolescents and young adults in 2015 and new persistent use and subsequent diagnoses of abuse (...) the prescription, and had 12 months of health plan coverage after receiving the prescription. Two age- and sex-matched opioid-nonexposed control individuals were selected for each opioid-exposed individual and were assigned a corresponding phantom prescription date.Receipt of an opioid prescription within 90 to 365 days, a health care encounter diagnosis associated with opioid abuse within 365 days, and all-cause mortality within 365 days of the index opioid or phantom prescription date.Among 754 002

2019 EvidenceUpdates

3. Abuse-Deterrent Formulations of Opioids: Effectiveness and Value

Abuse-Deterrent Formulations of Opioids: Effectiveness and Value ©Institute for Clinical and Economic Review, 2017 Abuse-Deterrent Formulations of Opioids: Effectiveness and Value Evidence Report June 28, 2017 Prepared for: ©Institute for Clinical and Economic Review, 2017 Page i Evidence Report—Abuse-deterrent Formulations of Opioids: Effectiveness and Value ICER Staff/Consultants Reiner Banken, MD, MSc Senior Fellow Institute for Clinical and Economic Review Foluso Agboola, MBBS, MPH Research (...) Daniel A. Ollendorf, PhD Chief Scientific Officer Institute for Clinical and Economic Review Steven D. Pearson, MD, MSc President Institute for Clinical and Economic Review DATE OF PUBLICATION: June 28, 2017 We would also like to thank Anne Loos, Noah Mwandha, Erin Lawler and Jerry Berger for their contributions to this report.©Institute for Clinical and Economic Review, 2017 Page ii Evidence Report—Abuse-deterrent Formulations of Opioids: Effectiveness and Value About ICER The Institute for Clinical

2017 California Technology Assessment Forum

4. Assessment of potentially abuse-related events in two phase 3 studies of NKTR-181, a novel opioid analgesic, using the MADDERS® system (Misuse, Abuse, and Diversion Drug Event Reporting System). (PubMed)

Assessment of potentially abuse-related events in two phase 3 studies of NKTR-181, a novel opioid analgesic, using the MADDERS® system (Misuse, Abuse, and Diversion Drug Event Reporting System). To prospectively evaluate the abuse potential of NKTR-181, a novel opioid analgesic, in two phase 3 clinical trials using a newly developed reporting system: the Misuse, Abuse, and Diversion Drug Event Reporting System (MADDERS®).SUMMIT-07 was an enriched enrollment randomized withdrawal study (...) that examined the safety and efficacy of NKTR-181 across 12 weeks in opioid-naïve subjects with chronic low back pain. SUMMIT-LTS was a 52 week open-label study in opioid-naïve and experienced subjects with chronic low back pain or noncancer pain rolled over from SUMMIT-07 or enrolled de novo. System evaluations were triggered by adverse events of interest and drug accountability discrepancies signaling potentially abuse-related events. Each event was assigned a primary classification and supplementary

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2019 Current medical research and opinion

5. Human abuse potential studies of abuse-deterrent opioids: lessons from oral and intranasal studies with morphine abuse-deterrent, extended-release, injection-molded tablets. (PubMed)

Human abuse potential studies of abuse-deterrent opioids: lessons from oral and intranasal studies with morphine abuse-deterrent, extended-release, injection-molded tablets. The development and use of abuse-deterrent (AD) opioids is part of a multifaceted strategy to reduce misuse, abuse, and diversion, while maintaining access for patients with severe pain who may benefit from their analgesic efficacy. Morphine AD, extended-release (ER), injection-molded tablets (morphine-ADER-IMT; ARYMO ER (...) ; Egalet US Inc., Wayne, PA) is approved by the FDA as an AD opioid. As part of the characterization of AD opioids, assessments of their human abuse potential (HAP) are required. Evidence from HAP studies can guide clinicians on the use of AD opioids in clinical practice. Herein, we describe HAP study design, and how specific AD features can impact the conduct of a study and interpretation of its results.To review the design features and results of the oral and intranasal HAP studies with morphine-ADER

2018 Current medical research and opinion

6. Prescription-Opioid Abuse and Heroin Abuse

Prescription-Opioid Abuse and Heroin Abuse Rotation Prep | NEJM Resident 360 Social Login Email Login Log in via Email Create Your Account We will not share your email with anyone. Password must be at least 8 characters. Show or Hide the password you are typing. Request to Join has invited you to join this group Your browser does not support video tags Welcome! NEJM Resident 360 helps you prepare for your next rotation quickly and efficiently, provides support for coping with the pressures

2016 Now@NEJM

7. Mitigation of IV Abuse Through the Use of Abuse-Deterrent Opioid Formulations: An Overview of Current Technologies. (PubMed)

Mitigation of IV Abuse Through the Use of Abuse-Deterrent Opioid Formulations: An Overview of Current Technologies. Providers who treat patients with chronic pain face a dual challenge: providing adequate access to opioid therapies for appropriate pain management while adopting strategies to minimize the risk for abuse. Commonly prescribed opioids have substantial abuse potential when administered intravenously, and extended-release (ER)/long-acting (LA) opioids may be targeted for IV abuse (...) because of the higher per-dose medication level. The consequences of IV opioid abuse are severe and increase the risks for adverse outcomes, including mortality due to acute health events, serious infections, and deep vein thrombosis, to name a few. To reduce the potential for abuse of prescription opioids by both recreational and experienced drug abusers, abuse-deterrent formulations (ADFs) of opioid medications employ either physical/chemical barriers or agonist-antagonist combinations. Here we

2018 Pain Practice

8. Intranasal abuse potential of an abuse-deterrent oxycodone formulation compared to oxycodone immediate release and placebo in nondependent, recreational opioid users. (PubMed)

Intranasal abuse potential of an abuse-deterrent oxycodone formulation compared to oxycodone immediate release and placebo in nondependent, recreational opioid users. To assess the intranasal (IN) human abuse potential of ELI-200, a novel immediate-release (IR) oxycodone formulation containing sequestered naltrexone.Randomized, double-blind, double-dummy, active and placebo-controlled, five-way crossover study. Pharmacodynamics, safety, and pharmacokinetics (PKs) were evaluated for up to 36 (...) hours postdose.Single site in Canada (INC Research Toronto).Healthy male and female nondependent recreational opioid users underwent a naloxone challenge and drug discrimination qualification test.Single IN dose of ground ELI-200 (30-mg oxycodone hydrochloride [HCl]/3-mg naltrexone HCl), crushed 30-mg oxycodone HCl IR (Roxicodone®), placebo, fixed placebo, and single oral dose of intact ELI-200 (30mg/3mg).Peak effect (Emax) for bipolar Drug Liking (0-100 point visual analog scale).Of the 44

2018 Journal of opioid management

9. Incidence of iatrogenic opioid dependence or abuse in patients with pain who were exposed to opioid analgesic therapy: a systematic review and meta-analysis. (PubMed)

Incidence of iatrogenic opioid dependence or abuse in patients with pain who were exposed to opioid analgesic therapy: a systematic review and meta-analysis. The prevalence and incidence of chronic conditions, such as pain and opioid dependence, have implications for policy development, resource allocation, and healthcare delivery. The primary objective of the current review was to estimate the incidence of iatrogenic opioid dependence or abuse after treatment with opioid analgesics.Systematic (...) (DerSimonian-Laird method) generated a pooled incidence of opioid dependence or abuse of 4.7%. There was little within-study risk of bias and no significant publication bias; however, substantial heterogeneity was found among study effects (99.78%). Sensitivity analyses indicated that the diagnostic criteria selected for identifying opioid dependence or abuse (Diagnostic Statistical Manual (DSM-IV) vs International Classification of Diseases (ICD-9)) accounted for 20% and duration of exposure to opioid

2018 British Journal of Anaesthesia

10. Blocking interleukin-4 enhances efficacy of vaccines for treatment of opioid abuse and prevention of opioid overdose (PubMed)

Blocking interleukin-4 enhances efficacy of vaccines for treatment of opioid abuse and prevention of opioid overdose Vaccines offer an option to treat heroin and prescription opioid abuse and prevent fatal overdoses. Opioid vaccines elicit antibodies that block opioid distribution to the brain and reduce opioid-induced behavioral effects and toxicity. The major limitation to the translation of addiction vaccines is that efficacy is observed only in subjects achieving optimal drug-specific serum (...) antibody levels. This study tested whether efficacy of a vaccine against oxycodone is increased by immunomodulators targeting key cytokine signaling pathways involved in B and T cell lymphocyte activation. Blockage of IL-4 signaling increased vaccine efficacy in blocking oxycodone distribution to the brain and protection against opioid-induced behavior and toxicity in mice. This strategy generalized to a peptide-protein conjugate immunogen, and a tetanus-diphtheria-pertussis vaccine. These data

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2018 Scientific reports

11. Effect of opioid dependence or abuse on opioid utilization after shoulder arthroplasty (PubMed)

Effect of opioid dependence or abuse on opioid utilization after shoulder arthroplasty To examine whether opioid dependence or abuse has an effect on opioid utilization after anatomic or reverse total shoulder arthroplasty (TSA).All anatomic TSA (ICD-9 81.80) and reverse shoulder arthroplasty (RSA) (ICD-9 81.88) procedures from 2007 to 2015 were queried from within the Humana claims database utilizing the PearlDiver supercomputer (Colorado Springs, CO). Study groups were formed based (...) on the presence or absence of a previous history of opioid dependence (ICD-9 304.00 and 304.03) or abuse (ICD-9 305.50 and 305.53). Opioid utilization among the groups was tracked monthly up to 1 year post-operatively utilizing National Drug Codes. A secondary analysis was performed to determine risk factors for pre-operative opioid dependence or abuse.Two percent of TSA (157 out of 7838) and 3% of RSA (206 out of 6920) patients had a history of opioid dependence or abuse. For both TSA and RSA, opioid

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2018 World journal of orthopedics

12. Are abuse-deterrent opioids the solution to the opioid crisis?

Are abuse-deterrent opioids the solution to the opioid crisis? Are abuse-deterrent opioids the solution to the opioid crisis? Are abuse-deterrent opioids the solution to the opioid crisis? | | July 17, 2018 7 Shares As a primary care doctor who cares for many patients with opioid-use disorder, I am invested in timely and effective strategies to curb our nation’s opioid epidemic. Because so many instances of opioid addiction and overdoses begin with or involve commonly prescribed opioids, we (...) need multiple strategies that address the significant harms associated with prescription opioids. I am skeptical of one strategy, however: The and the Food and Drug Administration are promoting development of abuse-deterrent prescription opioids as the solution to our opioid problem. These technologies target common methods of opioid abuse, such as crushing, snorting, dissolving or injecting prescription opioids. Currently, ten are available. Many of these new and expensive formulations incorporate

2018 KevinMD blog

13. The Opioid Abuse Risk Screener predicts aberrant same-day urine drug tests and 1-year controlled substance database checks: A brief report (PubMed)

The Opioid Abuse Risk Screener predicts aberrant same-day urine drug tests and 1-year controlled substance database checks: A brief report The Opioid Abuse Risk Screener was developed to support well-informed decision-making in opioid analgesic prescribing by extending the breadth of psychiatric risk factors evaluated relative to other non-clinician-administered measures. We examined the preliminary predictive validity of the Opioid Abuse Risk Screener relative to the widely used Screener (...) and Opioid Assessment for Patients with Pain-Revised in predicting aberrant urine drug tests and controlled substance database checks. The Opioid Abuse Risk Screener is significantly different from the Screener and Opioid Assessment for Patients with Pain-Revised in predicting aberrant same-day urine drug tests (Z = 2.912, p = 0.0036) and controlled substance database checks within 1 year of assessment (Z = 3.731, p = 0.0002). Promising preliminary analyses using machine learning methods are also

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2017 Health psychology open

14. Impact of Abuse Deterrent Formulations of Opioids in Patients With Chronic Pain in the United States: A Cost-Effectiveness Model. (PubMed)

Impact of Abuse Deterrent Formulations of Opioids in Patients With Chronic Pain in the United States: A Cost-Effectiveness Model. Opioid abuse is a significant public health problem in the United States. We evaluate the clinical effectiveness and economic impact of abuse-deterrent formulations (ADF) of opioids relative to non-ADF opioids in preventing abuse.We developed a cost-effectiveness model simulating 2 cohorts of 100 000 noncancer, chronic-pain patients newly prescribed either ADF or non (...) -ADF extended-release (ER) opioids and followed them over 5 years, tracking new events of opioid abuse and opioid-related overdose deaths in addition to tracking 5-year cumulative costs of therapeutic use and abuse of ADF and non-ADF opioids. Patients in each cohort entered the model for therapeutic opioid use from where they could continue in that pathway, discontinue opioid use, or abuse opioids or die of opioid overdose-related or unrelated causes. In addition, one-way sensitivity and scenario

2019 Value in Health

15. Opioid Abuse Prevention and Treatment: Lessons From South Carolina. (PubMed)

Opioid Abuse Prevention and Treatment: Lessons From South Carolina. Opioid-related overdoses in the United States have increased by 33% over the past 5 years. America's opioid crisis is increasing across demographic groups and spreading geographically. South Carolina is one of the states in the southern region of the United States that experiences an unusually high rate of opioid-related deaths. In 2016, 616 deaths occurred in South Carolina from drug overdoses from prescription opioid drugs (...) , up 9% from 2015. South Carolina residents filled nearly 4.5 million opioid prescriptions in 2015, which is greater than 1.5 times the national average.In 2017, the governor of South Carolina declared a statewide public health emergency in response to the growing opioid crisis. In response, a committee of the South Carolina House of Representatives released a report in January 2018 on its opioid abuse prevention study and made recommendations on ways to reduce the number of opioid-related

2019 Journal of Public Health Management and Practice

16. Abuse Potential with Oral Route of Administration of a Hydrocodone Extended-Release Tablet Formulated with Abuse-Deterrence Technology in Nondependent, Recreational Opioid Users. (PubMed)

Abuse Potential with Oral Route of Administration of a Hydrocodone Extended-Release Tablet Formulated with Abuse-Deterrence Technology in Nondependent, Recreational Opioid Users. To compare the oral abuse potential of hydrocodone extended-release (ER) tablet developed with CIMA ® Abuse-Deterrence Technology with that of hydrocodone immediate release (IR).Randomized, double-blind, placebo-controlled, crossover study.One study site in the United States; adult nondependent, recreational opioid (...) IR. The 72-hour plasma concentration-time profile for each treatment mimicked its respective "at the moment" drug-liking-over-time profile. Incidence of adverse events was lower with intact hydrocodone ER (53%) vs. hydrocodone IR (79%) and finely crushed hydrocodone ER (73%).The oral abuse potential of hydrocodone ER (intact and finely crushed) was significantly lower than hydrocodone IR in healthy, nondependent, recreational opioid users. Hydrocodone ER was generally well tolerated.© 2016

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2017 Pain medicine (Malden, Mass.)

17. Evaluation of the Relative Intranasal Abuse Potential of a Hydrocodone Extended-Release Tablet Formulated with Abuse-Deterrence Technology in Nondependent, Recreational Opioid Users. (PubMed)

Evaluation of the Relative Intranasal Abuse Potential of a Hydrocodone Extended-Release Tablet Formulated with Abuse-Deterrence Technology in Nondependent, Recreational Opioid Users. To assess the intranasal abuse potential of hydrocodone extended-release (ER) tablets developed with CIMA Abuse-Deterrence Technology compared with hydrocodone powder and hydrocodone bitartrate ER capsules (Zohydro ER, original formulation [HYD-OF]).Single-dose, randomized, double-blind, quadruple-dummy, active (...) points indicate a lower intranasal abuse potential with hydrocodone ER in healthy, nondependent, recreational opioid users.

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2017 Pain Medicine

18. The Effects of Kentucky's Comprehensive Opioid Legislation on Patients Presenting with Prescription Opioid or Heroin Abuse to One Urban Emergency Department. (PubMed)

The Effects of Kentucky's Comprehensive Opioid Legislation on Patients Presenting with Prescription Opioid or Heroin Abuse to One Urban Emergency Department. Prescription opioid abuse has increased to epidemic proportions in the United States. Kentucky, along with other states, passed comprehensive legislation to monitor and curb opioid prescribing.This paper characterizes patients who presented to the emergency department (ED) after abusing prescription opioids and heroin prior to and after (...) the passage of House Bill 1 (HB1) in April 2012.Based on a retrospective review of ED visits from 2009-2014 in one urban adult facility, patients were included if the chief complaint or diagnosis was directly related to prescription opioid or heroin abuse. The primary outcome is the number and type of substance abused by each ED patient.From 2009-2014, 2945 patients presented to the ED after prescription opioid or heroin abuse. The number of prescription opioid patients decreased from 215 (of 276 patients

2017 Journal of Emergency Medicine

19. Attitudes Toward Opioids and Risk of Misuse/Abuse in Patients with Chronic Noncancer Pain Receiving Long-term Opioid Therapy. (PubMed)

Attitudes Toward Opioids and Risk of Misuse/Abuse in Patients with Chronic Noncancer Pain Receiving Long-term Opioid Therapy. To determine the attitudes of patients toward long-term opioid therapy (LtOT) and the potential risk of misuse/abuse in patients with chronic noncancer pain (CNCP).Prospective, descriptive epidemiological study.Multidisciplinary tertiary care pain center within the Montreal University Health Center.Patients who had had at least one visit at least one year prior (...) , and the median dose per day in morphine equivalents was 48.21 mg. The DAI-M showed that 32.16% had a positive attitude toward opioids, 39.73% had a negative attitude, and 22.16% had a neutral attitude. The ORT questionnaire demonstrated that 86.2% of the patients were at low risk of abuse/misuse, 13.2% were at moderate risk, and only 0.54% were at high risk. The STAR questionnaire showed that 4.2% had a low risk of abuse/misuse.Despite public opinion, patients treated with LtOT for CNCP and followed

2017 Pain Medicine

20. The opioid epidemic: a central role for the blood brain barrier in opioid analgesia and abuse (PubMed)

The opioid epidemic: a central role for the blood brain barrier in opioid analgesia and abuse Opioids are currently the primary treatment method used to manage both acute and chronic pain. In the past two to three decades, there has been a surge in the use, abuse and misuse of opioids. The mechanism by which opioids relieve pain and induce euphoria is dependent on the drug crossing the blood-brain barrier and accessing the central nervous system. This suggests the blood brain barrier plays (...) a central role in both the benefits and risks of opioid use. The complex physiological responses to opioids that provide the benefits and drive the abuse also needs to be considered in the resolution of the opioid epidemic.

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2017 Fluids and barriers of the CNS

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