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Latest & greatest articles for opioid
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Initial Opioid Prescriptions among U.S. Commercially Insured Patients, 2012-2017. The United States is undergoing a crippling opioid epidemic, spurred in part by overuse of prescription opioids by adults 25 to 64 years of age. Of concern are long-duration and high-dose initial prescriptions, which place the patients and their friends and relatives at heightened risk for long-term opioid use, misuse, overdose, and death.We estimated the incidence of initial opioid prescriptions in each month (...) between July 2012 and December 2017 using administrative-claims data from across the United States (accessed through Blue Cross-Blue Shield [BCBS] Axis); monthly incidence was estimated as the percentage of enrollees who received an initial opioid prescription among those who had not used opioids (i.e., no opioid prescription or a diagnosis of opioid use disorder in the 6 months before a given month). We then estimated the percentage of enrollees initiating opioid therapy who received a long-duration
Dual Receipt of Prescription Opioids From the Department of Veterans Affairs and Medicare Part D and Prescription Opioid Overdose Death Among Veterans: A Nested Case-Control Study. More than half of enrollees in the U.S. Department of Veterans Affairs (VA) are also covered by Medicare and can choose to receive their prescriptions from VA or from Medicare-participating providers. Such dual-system care may lead to unsafe opioid use if providers in these 2 systems do not coordinate care (...) or if prescription use is not tracked between systems.To evaluate the association between dual-system opioid prescribing and death from prescription opioid overdose.Nested case-control study.VA and Medicare Part D.Case and control patients were identified from all veterans enrolled in both VA and Part D who filled at least 1 opioid prescription from either system. The 215 case patients who died of a prescription opioid overdose in 2012 or 2013 were matched (up to 1:4) with 833 living control patients
Efficacy and safety of a monthly buprenorphine depot injection for opioid use disorder: a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial. RBP-6000, referred to as BUP-XR (extended-release buprenorphine), is a subcutaneously injected, monthly buprenorphine treatment for opioid use disorder. BUP-XR provides sustained buprenorphine plasma concentrations to block drug-liking of abused opioids over the entire monthly dosing period, while controlling withdrawal and craving (...) symptoms. Administration of BUP-XR in a health-care setting also mitigates abuse, misuse, diversion, and unintentional exposure. We aimed to investigate the efficacy of different BUP-XR dosing regimens in participants with opioid use disorder.This randomised, double-blind, placebo-controlled, phase 3 trial was done at 36 treatment centres in the USA. Treatment-seeking adults aged 18-65 years who had moderate or severe opioid use disorder (as defined by the fifth edition of the Diagnostic
Quick guide: National clinical guideline on opioid treatment of chronic non-malignant pain National clinical guideline on opioid treatment of chronic non-malignant pain. Published by the Danish Health Authority, December 2018 NATIONAL CLINICAL GUIDELINE ON OPIOID TREATMENT OF CHRONIC NON-MALIGNANT PAIN Quick guide 1 Optimise non-pharmacological and pharmacological non-opioid treatment rather a trial of opioids in patients with chronic non-malignant pain conditions. Strong recommendation (...) For some patients with neuropathic pain, the possible pharmacological treatment options apart from opioids are tricyclic antidepressants and anticonvulsants. For patients with nociceptive pain, in specific instances NSAIDs can be used at the lowest possible dose for the shortest possible time and in accordance with the recommendations of the Danish Health Authority’s National Recommendations List for treatment of chronic nociceptive pain with NSAIDs. The evidence profile for paracetamol has not been
Opioid Prescription Patterns for Children Following Laparoscopic Appendectomy To describe variability in and consequences of opioid prescriptions following pediatric laparoscopic appendectomy.Postoperative opioid prescribing patterns may contribute to persistent opioid use in both adults and children.We included children <18 years enrolled as dependents in the Military Health System Data Repository who underwent uncomplicated laparoscopic appendectomy (2006-2014). For the primary outcome (...) of days of opioids prescribed, we evaluated associations with discharging service, standardized to the distribution of baseline covariates. Secondary outcomes included refill, Emergency Department (ED) visit for constipation, and ED visit for pain.Among 6732 children, 68% were prescribed opioids (range = 1-65 d, median = 4 d, IQR = 3-5 d). Patients discharged by general surgery services were prescribed 1.23 (95% CI = 1.06-1.42) excess days of opioids, compared with those discharged by pediatric
Does Opioid Tapering in Chronic Pain Patients Result in Improved Pain or Same Pain vs Increased Pain at Taper Completion? A Structured Evidence-Based Systematic Review To support or refute the hypothesis that opioid tapering in chronic pain patients (CPPs) improves pain or maintains the same pain level by taper completion but does not increase pain.Of 364 references, 20 fulfilled inclusion/exclusion criteria. These studies were type 3 and 4 (not controlled) but reported pre/post-taper pain (...) completion. One study reported that by taper completion, 97% of the CPPs had improved or the same pain, but CPPs had worse pain in 3%. As such, 100% of the studies supported the hypothesis. Applying the Agency for Health Care Policy and Research Levels of Evidence Guidelines to this result produced an A consistency rating.There is consistent type 3 and 4 study evidence that opioid tapering in CPPs reduces pain or maintains the same level of pain. However, these studies represented lower levels
Association of Prescribed Opioids With Increased Risk of Community-Acquired Pneumonia Among Patients With and Without HIV Some opioids are known immunosuppressants; however, the association of prescribed opioids with clinically relevant immune-related outcomes is understudied, especially among people living with HIV.To assess the association of prescribed opioids with community-acquired pneumonia (CAP) by opioid properties and HIV status.This nested case-control study used data from patients (...) .Prescribed opioid exposure during the 12 months before the index date was characterized by a composite variable based on timing (none, past, or current); low (<20 mg), medium (20-50 mg), or high (>50 mg) median morphine equivalent daily dose; and opioid immunosuppressive properties (yes vs unknown or no).CAP requiring hospitalization based on VA and Centers for Medicare & Medicaid data.Among the 25 392 VACS participants (98.9% male; mean [SD] age, 55  years), current medium doses of opioids
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 (...) in this population.This retrospective cohort study examined outpatient opioid prescriptions for patients aged 16 to 25 years in the Optum Research Database in 2015. Prescriptions were linked by National Provider Identifier number to a clinician category.Individuals were included in the index dental opioid (opioid-exposed) cohort if they filled an opioid prescription from a dental clinician in 2015, had continuous health plan coverage and no record of opioid prescriptions for 12 months before receiving
Opioid drugs are no better than standard painkillers for long-term back and joint pain Opioid drugs are no better than standard painkillers for long-term back and joint pain Discover Portal Discover Portal Opioid drugs are no better than standard painkillers for long-term back and joint pain Published on 3 July 2018 doi: People with long-term back pain, or osteoarthritis of their hips or knees, do not get better pain relief from opioid drugs and are more likely to get side effects than those (...) who take paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs), like naproxen or ibuprofen. A US study assigned 240 patients to either opioid or non-opioid pain relief drugs and measured their pain over 12 months. Those who were assigned opioid drugs had less relief of their pain and also were more likely to have side-effects related to their medication. The findings may surprise some doctors and patients with long-term pain, because of the widely held belief that opioids have a stronger
Opioid use disorder Opioid use disorder - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Opioid use disorder Last reviewed: February 2019 Last updated: January 2019 Summary Heroin and prescription opioid misuse is a major health concern. From a diagnostic perspective, it is imperative that the physician understands the criteria for opioid use disorder. Comorbid medical and psychiatric illnesses, as well as other (...) substance use disorders, should be assessed. Physicians should be aware of methods for screening and detection of opioid use in clinical settings. Evidence-based treatments include detoxification, maintenance therapy, and psychosocial and supportive therapies. Treatment requires a multidisciplinary approach, is long term, and involves modifying deeply ingrained behaviours through the use of medications and psychosocial treatments. Definition An opioid is a synthetic or natural agent that stimulates
Opioid overdose Opioid overdose - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Opioid overdose Last reviewed: February 2019 Last updated: January 2019 Summary The patient's history from bystanders/friends/family can assist diagnosis. Signs include central nervous system and respiratory depression, miosis, and apnoea. Initial treatment consists of ensuring adequate ventilation followed by administration of the opioid (...) antagonist naloxone. Monitor patients for re-sedation and repeat antidote dose if necessary. Definition An opioid is any synthetic or natural agent that stimulates opioid receptors and produces opium-like effects. Opiates are opioids naturally derived from the opium poppy, Papaver somniferum , and include morphine and codeine. Opioids are used in the treatment of pain but are often sold illicitly and abused for their euphoric effects. An overdose occurs when larger quantities than physically tolerated
Side Effect Rates of Opioids in Equianalgesic Doses Via Intravenous Patient-Controlled Analgesia: A Systematic Review and Network Meta-analysis Side effects of opioids used for the treatment of acute pain frequently limit their analgesic quality. Many studies have compared opioid side effects in patient-controlled analgesia (PCA), but it remains unclear whether there are specific side effect profiles that can be exploited when choosing an opioid for a patient. In this review, we wanted (...) to determine the risk ratios (RRs) for the most common side effects when using different opioids for intravenous PCA in equianalgesic doses and rank the substances accordingly.A search of MEDLINE, EMBASE, the Cochrane Library (CENTRAL), and Web of Science identified 63 randomized controlled trials comparing opioids under equianalgesic conditions. Inclusion criteria were comparable pain stimulus between groups, equal coanalgesic treatment, and comparable resulting pain scores. Quality of studies
Effect of Age on Opioid Prescribing, Overdose, and Mortality in Massachusetts, 2011 to 2015 To examine the effect of age on the likelihood of PIP of opioids and the effect of PIP on adverse outcomes.Retrospective cohort study.Data from multiple state agencies in Massachusetts from 2011 to 2015.Adult Massachusetts residents (N=3,078,163) who received at least one prescription opioid during the study period; approximately half (1,589,365) aged 50 and older.We measured exposure to 5 types of PIP (...) : high-dose opioids, coprescription with benzodiazepines, multiple opioid prescribers, multiple opioid pharmacies, and continuous opioid therapy without a pain diagnosis. We examined 3 adverse outcomes: nonfatal opioid overdose, fatal opioid overdose, and all-cause mortality.The rate of any PIP increased with age, from 2% of individuals age 18 to 29 to 14% of those aged 50 and older. Older adults also had higher rates of exposure to 2 or more different types of PIP (40-49, 2.5%; 50-69, 5%; ≥70, 4
Safety of benzodiazepines and opioids in interstitial lung disease: a national prospective study Safety concerns are a barrier to prescribing benzodiazepines (BDZs) and opioids in interstitial lung disease (ILD). We therefore examined the association of BDZs and opioids on risk of admission to hospital and death.We conducted a population-based longitudinal cohort study of fibrotic ILD patients starting long-term oxygen therapy in Sweden between October 2005 and December 2014. Effects of BDZs (...) and opioids on rates of admission to hospital and mortality were analysed using Fine-Gray and Cox regression while adjusting for potential confounders.We included 1603 patients (61% females). BDZs were used by 196 (12%) patients and opioids were used by 254 (15%) patients. There was no association between BDZs and increased admission. Treatment with high- versus low-dose BDZs was associated with increased mortality (subdistribution hazard ratio (SHR) 1.46, 95% CI 1.08-1.98 versus 1.13, 95% CI 0.92-1.38
Cost-Effectiveness of Buprenorphine-Naloxone Versus Extended-Release Naltrexone to Prevent Opioid Relapse. Not enough evidence exists to compare buprenorphine-naloxone with extended-release naltrexone for treating opioid use disorder.To evaluate the cost-effectiveness of buprenorphine-naloxone versus extended-release naltrexone.Cost-effectiveness analysis alongside a previously reported randomized clinical trial of 570 adults in 8 U.S. inpatient or residential treatment programs.Study (...) instruments.Adults with opioid use disorder.24-week intervention with an additional 12 weeks of observation.Health care sector and societal.Buprenorphine-naloxone and extended-release naltrexone.Incremental costs combined with incremental quality-adjusted life-years (QALYs) and incremental time abstinent from opioids.Use of the health care sector perspective and a willingness-to-pay threshold of $100 000 per QALY showed buprenorphine-naloxone to be preferable to extended-release naltrexone in 97% of bootstrap
Opioids for Chronic Noncancer Pain: A Systematic Review and Meta-analysis. Harms and benefits of opioids for chronic noncancer pain remain unclear.To systematically review randomized clinical trials (RCTs) of opioids for chronic noncancer pain.The databases of CENTRAL, CINAHL, EMBASE, MEDLINE, AMED, and PsycINFO were searched from inception to April 2018 for RCTs of opioids for chronic noncancer pain vs any nonopioid control.Paired reviewers independently extracted data. The analyses used (...) including 26 169 participants (61% female; median age, 58 years [interquartile range, 51-61 years]) were included. Of the included studies, there were 25 trials of neuropathic pain, 32 trials of nociceptive pain, 33 trials of central sensitization (pain present in the absence of tissue damage), and 6 trials of mixed types of pain. Compared with placebo, opioid use was associated with reduced pain (weighted mean difference [WMD], -0.69 cm [95% CI, -0.82 to -0.56 cm] on a 10-cm visual analog scale
Pre-emptive and preventive opioids for postoperative pain in adults undergoing all types of surgery. Postoperative pain is a common consequence of surgery and can have deleterious effects. It has been suggested that the administration of opioid analgesia before a painful stimulus may improve pain control. This can be done in two ways. We defined 'preventive opioids' as opioids administered before incision and continued postoperatively, and 'pre-emptive opioids' as opioids given before incision (...) but not continued postoperatively. Both pre-emptive and preventive analgesia involve the initiation of an analgesic agent prior to surgical incision with the aim of reducing intraoperative nociception and therefore postoperative pain.To assess the efficacy of preventive and pre-emptive opioids for reducing postoperative pain in adults undergoing all types of surgery.We searched the following electronic databases: CENTRAL, MEDLINE, Embase, AMED, and CINAHL (up to 18 March 2018). In addition, we searched
Nerve-ous About Opioids? Treatment of neuropathic pain with opioids Tools for Practice is proudly sponsored by the Alberta College of Family Physicians (ACFP). ACFP is a provincial, professional voluntary organization, representing more than 4,800 family physicians, family medicine residents, and medical students in Alberta. Established over sixty years ago, the ACFP strives for excellence in family practice through advocacy, continuing medical education and primary care research. www.acfp.ca (...) June 18, 2018 Nerve-ous About Opioids? Treatment of neuropathic pain with opioids Clinical Question: What are the risks and benefits of opioids for neuropathic pain? Bottom Line: Compared to placebo, high-dose opioids moderately (at least 30%) reduce pain for an additional 1 in every 5-8 people over 4-12 weeks. Opioid-related adverse events lead to discontinuation for 1 in every 11-12 people over placebo. Other medications (like tricyclic antidepressants, gabapentin/pregabalin, and duloxetine
Location, Location, Location: Treating patients with opioid use disorder in primary care Tools for Practice is proudly sponsored by the Alberta College of Family Physicians (ACFP). ACFP is a provincial, professional voluntary organization, representing more than 4,800 family physicians, family medicine residents, and medical students in Alberta. Established over sixty years ago, the ACFP strives for excellence in family practice through advocacy, continuing medical education and primary care (...) research. www.acfp.ca October 9, 2018 Location, Location, Location: Treating patients with opioid use disorder in primary care Clinical Question: How well is opioid agonist therapy managed in primary care? Bottom Line: For opioid-dependent patients, receiving opioid agonist therapy (OAT) in a primary care setting versus a specialized opioid treatment program results in an additional 1 in 6 patients retained in treatment and abstinent from street opioids at 42 weeks. Additionally, twice as many patients
Does this patient taking prescription opioids have opioid use disorder? Tools for Practice is proudly sponsored by the Alberta College of Family Physicians (ACFP). ACFP is a provincial, professional voluntary organization, representing more than 4,800 family physicians, family medicine residents, and medical students in Alberta. Established over sixty years ago, the ACFP strives for excellence in family practice through advocacy, continuing medical education and primary care research (...) . www.acfp.ca October 22, 2018 Does this patient taking prescription opioids have opioid use disorder? Clinical Question: What is the best tool to help identify patients with prescription opioid use disorder? Bottom Line: Despite over 50 studies in the literature, only two have compared case-finding tools to the Diagnostic and Screening Manual for Mental Disorders (DSM), the most commonly used diagnostic criteria for patients with opioid use disorder (OUD). A single, small study demonstrates