1
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Esteve R, Barrado-Moreno V, Ramírez-Maestre C, Serrano-Ibáñez ER, de la Vega R, Ruiz-Párraga GT, Sainero-Tirado G, Fernández Baena M, Jensen M, López-Martínez AE. Psychological profiles and prescription opioid misuse, craving, and withdrawal in people with chronic pain. Eur J Pain 2024; 28:943-959. [PMID: 38189159 DOI: 10.1002/ejp.2233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 12/12/2023] [Accepted: 12/12/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND The negative consequences of prescription opioid misuse and opioid use disorder make it relevant to identify factors associated with this problem in individuals with chronic pain. This cross-sectional study aimed at identifying subgroups of people with chronic pain based on their psychological profiles, prescription opioid misuse, craving, and withdrawal. METHODS The sample comprised 185 individuals with chronic pain. We performed hierarchical cluster analysis on impulsivity, anxiety sensitivity, pain acceptance, pain intensity, opioid misuse, craving, and withdrawal. RESULTS The four-cluster solution was the optimal one. Misuse, craving, and anxiety sensitivity were higher among people in the Severe-problems cluster than among people in the other three clusters. Withdrawal was the highest in the High-withdrawal cluster. Impulsivity was higher among people in the Severe-problems and High-withdrawal clusters than those in the Moderate-problems and Mild-problems clusters. Pain acceptance was higher among people in the Mild-problems cluster than among people in the other three clusters. Anxiety sensitivity and misuse were higher among people in the Moderate-problems cluster than among people in the Mild-problems cluster. CONCLUSIONS These results support that impulsivity, anxiety sensitivity, and pain acceptance are useful constructs to identify subgroups of people with chronic pain according to their level of prescription opioid misuse, craving, and withdrawal. The results of this study may help in selecting the early intervention most suitable for each of the identified profiles. SIGNIFICANCE The psychological profile of individuals with chronic pain, prescription opioid misuse, craving, and withdrawal is characterized by fearing anxiety-related symptoms due to the catastrophic interpretation of such symptoms and reacting impulsively to negative moods. In contrast, participants with high pain acceptance had less prescription opioid misuse, craving, and withdrawal. The profiles identified in this study could help clinicians select targets for intervention among profiles with similar needs and facilitate early interventions to prevent opioid misuse onset or aggravation.
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Affiliation(s)
- R Esteve
- Facultad de Psicología y Logopedia, Universidad de Málaga, Andalucía Tech, Málaga, Spain
- Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | - V Barrado-Moreno
- Facultad de Psicología y Logopedia, Universidad de Málaga, Andalucía Tech, Málaga, Spain
- Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | - C Ramírez-Maestre
- Facultad de Psicología y Logopedia, Universidad de Málaga, Andalucía Tech, Málaga, Spain
- Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | - E R Serrano-Ibáñez
- Facultad de Psicología y Logopedia, Universidad de Málaga, Andalucía Tech, Málaga, Spain
- Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | - R de la Vega
- Facultad de Psicología y Logopedia, Universidad de Málaga, Andalucía Tech, Málaga, Spain
- Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | - G T Ruiz-Párraga
- Facultad de Psicología y Logopedia, Universidad de Málaga, Andalucía Tech, Málaga, Spain
- Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | - G Sainero-Tirado
- Facultad de Psicología y Logopedia, Universidad de Málaga, Andalucía Tech, Málaga, Spain
- Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | | | - M Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - A E López-Martínez
- Facultad de Psicología y Logopedia, Universidad de Málaga, Andalucía Tech, Málaga, Spain
- Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
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2
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Petersen JK, Bager LGV, Østergaard L, Graversen PL, Iversen K, Bundgaard H, Køber L, Fosbøl EL. Patient characteristics, treatment patterns, and prognosis in drug-use-associated infective endocarditis in Denmark from 1999 to 2018. Am Heart J 2024; 273:44-52. [PMID: 38614234 DOI: 10.1016/j.ahj.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/26/2024] [Accepted: 04/09/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND While the proportion of drug-use-associated infective endocarditis (DU-IE) has been increasing during the opioid crisis in the United States, it is unknown whether this is seen in Denmark, where several preventive means have been implemented. We aimed to assess the temporal proportion of DU-IE and examine the rate of IE recurrence and mortality. METHODS This nationwide cohort study identified all patients with first-time infective endocarditis in 1999-2018. Drug use was defined using ICD-8/10 codes or prescription filling of medication for opioid use disorder. Long-term mortality was examined with a Kaplan-Meier estimator and a multivariate Cox model. The recurrence of IE was examined with the Aalen-Johansen method and a multivariate cause-specific hazard model. RESULTS We included 8,843 patients with IE: 407 with DU-IE (60.7% male, median age 43.8 years) and 8,436 with non-DU-IE (65.8% male, median age 71.5 years). The proportion of DU-IE decreased from 5.9% to 3.8% during our study period. The one-year cumulative incidence of all-cause mortality was 16.9% (CI 12.9%-20.8%) for patients with DU-IE and 17.3% (CI 16.4%-18.2%) for patients with non-DU-IE. Drug use was associated with higher one-year mortality (adjusted HR 1.64 (CI 1.23%-2.21%)). The 1-year cumulative incidence of IE recurrence was 12.8% (CI 9.3%-16.3%) in patients with DU-IE and 4.3% (CI 3.8%-4.8%) in patients with non-DU-IE. Drug use was associated with a higher 1-year recurrence of IE (adjusted HR 3.39 (CI 2.35-4.88)). CONCLUSION In Denmark, the proportion of patients with DU-IE fell by one-third from 1999 to 2018. DU-IE was associated with higher mortality and recurrence rates than non-DU-IE.
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Affiliation(s)
- Jeppe Kofoed Petersen
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
| | | | - Lauge Østergaard
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Peter Laursen Graversen
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Kasper Iversen
- Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte, Hellerup, Denmark; Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Hellerup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Emil Loldrup Fosbøl
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
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De Neve J, Elhabazi K, Gonzalez S, Herby C, Schneider S, Utard V, Fellmann-Clauss R, Petit-Demouliere N, Lecat S, Kremer M, Ces A, Daubeuf F, Martin C, Ballet S, Bihel F, Simonin F. Multitarget μ-Opioid Receptor Agonists─Neuropeptide FF Receptor Antagonists Induce Potent Antinociception with Reduced Adverse Side Effects. J Med Chem 2024. [PMID: 38687204 DOI: 10.1021/acs.jmedchem.4c00442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
The design of bifunctional compounds is a promising approach toward the development of strong analgesics with reduced side effects. We here report the optimization of the previously published lead peptide KGFF09, which contains opioid receptor agonist and neuropeptide FF receptor antagonist pharmacophores and is shown to induce potent antinociception and reduced side effects. We evaluated the novel hybrid peptides for their in vitro activity at MOP, NPFFR1, and NPFFR2 and selected four of them (DP08/14/32/50) for assessment of their acute antinociceptive activity in mice. We further selected DP32 and DP50 and observed that their antinociceptive activity is mostly peripherally mediated; they produced no respiratory depression, no hyperalgesia, significantly less tolerance, and strongly attenuated withdrawal syndrome, as compared to morphine and the recently FDA-approved TRV130. Overall, these data suggest that MOP agonist/NPFF receptor antagonist hybrids might represent an interesting strategy to develop novel analgesics with reduced side effects.
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Affiliation(s)
- Jolien De Neve
- Research Group of Organic Chemistry, Departments of Chemistry and Bioengineering Sciences, Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | - Khadija Elhabazi
- Biotechnologie et Signalisation Cellulaire, UMR 7242, Centre National de la Recherche Scientifique, Université de Strasbourg, 67400 Illkirch, France
| | - Simon Gonzalez
- Research Group of Organic Chemistry, Departments of Chemistry and Bioengineering Sciences, Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | - Claire Herby
- Laboratoire d'Innovation Thérapeutique, Faculté de Pharmacie, UMR 7200, Centre National de la Recherche Scientifique, Université de Strasbourg, 67400 Illkirch, France
| | - Séverine Schneider
- Laboratoire d'Innovation Thérapeutique, Faculté de Pharmacie, UMR 7200, Centre National de la Recherche Scientifique, Université de Strasbourg, 67400 Illkirch, France
| | - Valérie Utard
- Biotechnologie et Signalisation Cellulaire, UMR 7242, Centre National de la Recherche Scientifique, Université de Strasbourg, 67400 Illkirch, France
| | - Rosine Fellmann-Clauss
- Biotechnologie et Signalisation Cellulaire, UMR 7242, Centre National de la Recherche Scientifique, Université de Strasbourg, 67400 Illkirch, France
| | - Nathalie Petit-Demouliere
- Biotechnologie et Signalisation Cellulaire, UMR 7242, Centre National de la Recherche Scientifique, Université de Strasbourg, 67400 Illkirch, France
| | - Sandra Lecat
- Biotechnologie et Signalisation Cellulaire, UMR 7242, Centre National de la Recherche Scientifique, Université de Strasbourg, 67400 Illkirch, France
| | - Mélanie Kremer
- Centre National de la Recherche Scientifique, Université de Strasbourg, Institut des Neurosciences Cellulaires et Intégratives (INCI), 67000 Strasbourg, France
| | - Aurelia Ces
- Centre National de la Recherche Scientifique, Université de Strasbourg, Institut des Neurosciences Cellulaires et Intégratives (INCI), 67000 Strasbourg, France
| | - François Daubeuf
- Plateforme de Chimie Biologique Intégrative de Strasbourg, UAR 3286, Centre National de la Recherche Scientifique, Université de Strasbourg, 67400 Illkirch, France
| | - Charlotte Martin
- Research Group of Organic Chemistry, Departments of Chemistry and Bioengineering Sciences, Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | - Steven Ballet
- Research Group of Organic Chemistry, Departments of Chemistry and Bioengineering Sciences, Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | - Frédéric Bihel
- Laboratoire d'Innovation Thérapeutique, Faculté de Pharmacie, UMR 7200, Centre National de la Recherche Scientifique, Université de Strasbourg, 67400 Illkirch, France
| | - Frédéric Simonin
- Biotechnologie et Signalisation Cellulaire, UMR 7242, Centre National de la Recherche Scientifique, Université de Strasbourg, 67400 Illkirch, France
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4
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Cebron Lipovec N. Opioid analgesics prescribing trends 2010-2019 in Slovenia: National database study. Hum Psychopharmacol 2024; 39:e2891. [PMID: 38214662 DOI: 10.1002/hup.2891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 11/06/2023] [Accepted: 12/15/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVE Significant increases in global opioid use have been reported in recent decades. This study analyzed opioid utilization in outpatient care in Slovenia between 2010 and 2019. METHODS This retrospective cross-sectional study performed a nationwide database analysis of all outpatient opioid analgesic prescriptions based on Slovenian health insurance claims data. Prevalence was defined as the number of recipients prescribed at least one opioid per 1000 inhabitants. Opioid consumption was presented as the total number of dispensed prescriptions per 1000 inhabitants and dispensed defined daily doses (DDD) per 1000 inhabitants for each year analyzed. RESULTS The age-standardized prevalence of opioid recipients decreased by 21.5% during the study period. Total opioid consumption decreased both in the number of prescriptions (-9.2%) and DDD (-5.4%). Tramadol consumption decreased in terms of the number of prescriptions (-12.2%) and DDD (-2.7%), whereas prescriptions for strong opioids increased (10.2%) and DDDs decreased (-16.2%). The results suggest less intensive prescribing of strong opioids and more intensive prescribing for tramadol. The most frequently used strong opioids were fentanyl and oxycodone/naloxone. CONCLUSIONS The prevalence of opioid recipients and opioid consumption is decreasing in Slovenia. Further research is needed to understand whether this finding reflects safe use or underuse of these important analgesics.
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Hofer DM, Harnik M, Lehmann T, Stüber F, Baumbach P, Dreiling J, Meissner W, Stamer UM. Trajectories of pain and opioid use up to one year after surgery: analysis of a European registry. Br J Anaesth 2024; 132:588-598. [PMID: 38212183 DOI: 10.1016/j.bja.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/13/2023] [Accepted: 12/01/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Long-term opioid use after surgery is a crucial healthcare problem in North America. Data from European hospitals are scarce and differentiation of chronic pain has rarely been considered. METHODS In a mixed surgical cohort of the PAIN OUT registry, opioid use and chronic pain were evaluated before surgery, and 6 and 12 months after surgery (M6/M12). Subgroups with or without opioid medication and pre-existing chronic pain were analysed. M12-chronic pain was categorised as chronic postsurgical pain (CPSP) meeting the ICD-11 definition, chronic pain related to surgery not meeting the ICD-11 definition, and chronic pain unrelated to surgery. Primary endpoint was the rate of M12 opioid users. Variables associated with M12 opioid use and patient-reported outcomes were evaluated. RESULTS Of 2326 patients, 5.5% were preoperative opioid users; 4.4% and 3.5% took opioids at M6 and M12 (P<0.001). Chronic pain before operation and at M6/M12 was reported by 41.2%, 41.8%, and 34.7% of patients, respectively (P<0.001). The rate of M12 opioid users was highest in group unrelated (22.3%; related 8.3%, CPSP 1.5%; P<0.001). New opioid users were 1.1% (unrelated 7.1%, related 2.3%, CPSP 0.7%; P<0.001). M12 opioid users reported more pain, pain-related physical and affective interference, and needed more opioids than non-users. The predominant variable associated with M12 opioids was preoperative opioid use (estimated odds ratio [95% confidence interval]: 28.3 [14.1-56.7], P<0.001). CONCLUSIONS Opioid use was low in patients with CPSP, and more problematic in patients with chronic pain unrelated to surgery. A detailed assessment of chronic pain unrelated or related to surgery or CPSP is necessary. CLINICAL TRIAL REGISTRATION NCT02083835.
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Affiliation(s)
- Debora M Hofer
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michael Harnik
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Lehmann
- Institute of Medical Statistics, Computer and Data Sciences, University Hospital Jena, Jena, Germany
| | - Frank Stüber
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of BioMedical Research, University of Bern, Bern, Switzerland
| | - Philipp Baumbach
- Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | - Johannes Dreiling
- Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | - Winfried Meissner
- Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | - Ulrike M Stamer
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of BioMedical Research, University of Bern, Bern, Switzerland; Pain and Opioids after Surgery (PANDOS) European Society of Anaesthesiology and Intensive Care (ESAIC) Research Group, Brussels, Belgium.
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6
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List EB, Boers N, Martin E, Krijgh DD, Henk Coert J. Patient-reported outcomes after free muscle flap coverage for therapy-resistant neuropathic pain from the ulnar nerve. J Hand Surg Eur Vol 2024; 49:250-256. [PMID: 37747704 PMCID: PMC10845818 DOI: 10.1177/17531934231201930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 08/15/2023] [Accepted: 08/27/2023] [Indexed: 09/26/2023]
Abstract
Extensive microsurgical neurolysis followed by free gracilis muscle flap coverage can be performed as a last resort for patients with persistent neuropathic pain of the ulnar nerve. All patients who had this surgery between 2015 and 2021 were identified. Data were collected from the medical records of 21 patients and patient-reported outcomes were collected from 18 patients, with a minimum follow-up of 12 months. The median visual analogue pain score decreased significantly 8 months postoperatively from 8.0 to 6.0 and stabilized to 5.4 at the 3-year follow-up. Health-related quality-of-life scores remained diminished compared to normative data. In the treatment of therapy-resistant neuropathic pain of the ulnar nerve, extensive neurolysis with a subsequent free gracilis muscle flap coverage shows a promising reduction of pain that persists at long-term follow-up.Level of evidence: IV.
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Affiliation(s)
- Emile B. List
- Emile B. List, Department of Plastic and Reconstructive Surgery G04.126, University Medical Center Utrecht, Heidelberglaan 100, PO Box 85500, 3508 GA Utrecht, The Netherlands.
| | | | - Enrico Martin
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - David D. Krijgh
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J. Henk Coert
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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7
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Scholz SM, Thalmann NF, Müller D, Trippolini MA, Wertli MM. Factors influencing pain medication and opioid use in patients with musculoskeletal injuries: a retrospective insurance claims database study. Sci Rep 2024; 14:1978. [PMID: 38263185 PMCID: PMC10805862 DOI: 10.1038/s41598-024-52477-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 01/19/2024] [Indexed: 01/25/2024] Open
Abstract
Opioid use is only recommended in selected cases of musculoskeletal (MSK) injuries. We assessed factors associated with increased opioid use in MSK injuries. In a retrospective analysis of over four million workers with MSK injuries using the Swiss National Accident Insurance Fund (Suva) database, we analyzed risk factors by multivariate logistic regression. Injury severity was associated with pain medication, opioid, and strong opioid use. Whereas fractures, contusions, and ruptures had higher odds for any pain medication use, increased odds for strong opioids were observed in fractures, superficial injuries, and other injuries. Injuries of the shoulders, elbow, chest, back/spine, thorax, and pelvis/hips showed high odds for opioid use (odds ratio (OR) > 2.0). Injuries of the shoulders had higher odds for strong opioid use (OR 1.136; 95% CI 1.040-1.241). The odds for using strong opioids increased from 2008 OR 0.843 (95% confidence interval (CI) 0.798-0.891) to 2018 OR 1.503 (95% CI 1.431-1.578), compared to 2013. Injury severity, type of injury, and injured body parts influenced the use of pain medication and overall opioid use in musculoskeletal injuries. Strong opioids were more often used in fractures but also in superficial and other minor injuries, which indicates that other factors play a role when prescribing strong opioids.
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Affiliation(s)
- Stefan Markus Scholz
- Department of Statistics, Suva (Swiss National Accident Insurance Fund), Lucerne, Switzerland
| | - Nicolas Fabrice Thalmann
- Department of General Internal Medicine, University Hospital of Bern, Inselspital, Freiburgstrasse 18, 3010, Bern, Switzerland.
| | - Dominic Müller
- Department of General Internal Medicine, University Hospital of Bern, Inselspital, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Maurizio Alen Trippolini
- School of Health Professions, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland
- Institute of Physiotherapy, University Hospital of Bern, Inselspital, Freiburgstrasse 18, 3010, Bern, Switzerland
- Evidence-Based Insurance Medicine (EbIM), Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, University of Basel, Totengässlein 3, 4051, Basel, Switzerland
| | - Maria Monika Wertli
- Department of General Internal Medicine, University Hospital of Bern, Inselspital, Freiburgstrasse 18, 3010, Bern, Switzerland
- Department of Internal Medicine, Kantonsspital Baden, Baden, Switzerland
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8
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Sullivan MD, Vowles KE, Powelson EB, Patel KV, Reid MC. Prioritizing patient values for chronic pain care: a path out of the pain reduction regime? Fam Pract 2023; 40:611-614. [PMID: 36656068 DOI: 10.1093/fampra/cmad002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Mark D Sullivan
- Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Kevin E Vowles
- School of Psychology, Queens University, Belfast, United Kingdom
| | - Elisabeth B Powelson
- Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, United States
| | - Kushang V Patel
- Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, United States
| | - M Carrington Reid
- Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York City, NY, United States
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9
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Alvand S, Amin-Esmaeili M, Poustchi H, Roshandel G, Sadeghi Y, Sharifi V, Kamangar F, Dawsey SM, Freedman ND, Abnet CC, Rahimi-Movaghar A, Malekzadeh R, Etemadi A. Prevalence and determinants of opioid use disorder among long-term opiate users in Golestan Cohort Study. BMC Psychiatry 2023; 23:958. [PMID: 38129791 PMCID: PMC10734090 DOI: 10.1186/s12888-023-05436-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 12/03/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Number of opiate users worldwide has doubled over the past decade, but not all of them are diagnosed with opioid use disorder. We aimed to identify the prevalence and risk factors for OUD after ten years of follow-up. METHODS Among 8,500 chronic opiate users at Golestan Cohort Study baseline (2004-2008), we recalled a random sample of 451 subjects in 2017. We used three questionnaires: a questionnaire about current opiate use including type and route of use, the drug use disorder section of the Composite International Diagnostic Interview lifetime version, and the validated Kessler10 questionnaire. We defined opioid use disorder and its severity based on the DSM-5 criteria and used a cutoff of 12 on Kessler10 questionnaire to define psychological distress. RESULTS Mean age was 61.2 ± 6.6 years (84.7% males) and 58% were diagnosed with opioid use disorder. Starting opiate use at an early age and living in underprivileged conditions were risk factors of opioid use disorder. Individuals with opioid use disorder were twice likely to have psychological distress (OR = 2.25; 95%CI: 1.44-3.52) than the users without it. In multivariate regression, former and current opiate dose and oral use of opiates were independently associated with opioid use disorder. Each ten gram per week increase in opiate dose during the study period almost tripled the odds of opioid use disorder (OR = 3.18; 95%CI: 1.79-5.63). CONCLUSIONS Chronic opiate use led to clinical opioid use disorder in more than half of the users, and this disorder was associated with psychological distress, increasing its physical and mental burden in high-risk groups.
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Affiliation(s)
- Saba Alvand
- Liver and Pancreaticobilliary Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Amin-Esmaeili
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Poustchi
- Liver and Pancreaticobilliary Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Roshandel
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Yasaman Sadeghi
- Liver and Pancreaticobilliary Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Vandad Sharifi
- Department of Psychiatry, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farin Kamangar
- Department of Biology, School of Computer, Mathematical, and Natural Sciences, Morgan State University, Baltimore, MD, USA
| | - Sanford M Dawsey
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, 20892, USA
| | - Neal D Freedman
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, 20892, USA
| | - Christian C Abnet
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, 20892, USA
| | - Afarin Rahimi-Movaghar
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Malekzadeh
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Arash Etemadi
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, 20892, USA.
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10
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Cuomo A. Fentanyl in cancer pain management: avoiding hasty judgments and discerning its potential benefits. Drugs Context 2023; 12:2023-10-2. [PMID: 38148830 PMCID: PMC10751104 DOI: 10.7573/dic.2023-10-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/14/2023] [Indexed: 12/28/2023] Open
Abstract
Cancer pain is an important challenge in treatment and requires a rapid onset of action for its control. In particular, breakthrough cancer pain (BTcP) should be adequately controlled with a stable dose of a short-acting oral opioid. Fentanyl is a synthetic, highly selective opioid with many advantageous chemical properties, including high lipophilicity and distinct pharmacokinetic properties. It is recommended for pain management in a variety of settings, including acute pain, chronic pain and BTcP. To date, its variously designed formulations allow non-invasive administration; amongst others, sublingual fentanyl has proven useful in the management of BTcP and in improving the quality of life of patients with cancer. This review provides an update on the management of BTcP with fentanyl, with consideration of safety, as it remains an important tool in the treatment of cancer pain.
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Affiliation(s)
- Arturo Cuomo
- Istituto Nazionale dei Tumori, IRCCS Fondazione G. Pascale, Naples,
Italy
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11
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Bråthen CC, Jørgenrud BM, Bogstrand ST, Gjerde H, Rosseland LA, Kristiansen T. Prevalence of use and impairment from drugs and alcohol among trauma patients: A national prospective observational study. Injury 2023; 54:111160. [PMID: 37944451 DOI: 10.1016/j.injury.2023.111160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 10/22/2023] [Accepted: 10/23/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Being under the influence of psychoactive substances increases the risk of involvement in and dying from a traumatic event. The study is a prospective population-based observational study that aims to determine the prevalence of use and likely impairment from psychoactive substances among patients with suspected severe traumatic injury. METHOD This study was conducted at 35 of 38 Norwegian trauma hospitals from 1 March 2019 to 29 February 2020. All trauma admissions for patients aged ≥ 16 years admitted via trauma team activation during the study period were eligible for inclusion. Blood samples collected on admission were analysed for alcohol, benzodiazepines, benzodiazepine-like hypnotics (Z-drugs), opioids, stimulants, and cannabis (tetrahydrocannabinol). RESULTS Of the 4878 trauma admissions included, psychoactive substances were detected in 1714 (35 %) and in 771 (45 %) of these, a combination of two or more psychoactive substances was detected. Regarding the level of impairment, 1373 (28 %) admissions revealed a concentration of one or more psychoactive substances indicating likely impairment, and 1052 (22 %) highly impairment. Alcohol was found in 1009 (21 %) admissions, benzodiazepines and Z-drugs in 613 (13 %), opioids in 467 (10 %), cannabis in 352 (7 %), and stimulants in 371 (8 %). Men aged 27-43 years and patients with violence-related trauma had the highest prevalence of psychoactive substance use with respectively 424 (50 %) and 275 (80 %) testing positive for one or more compounds. CONCLUSION The results revealed psychoactive substances in 35 % of trauma admissions, 80 % of which were likely impaired at the time of traumatic injury. A combination of several psychoactive substances was common, and younger males and patients with violence-related injuries were most often impaired. Injury prevention strategies should focus on high-risk groups and involve the prescription of controlled substances. We should consider toxicological screening in trauma admissions and incorporation of toxicological data into trauma registries.
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Affiliation(s)
- Camilla C Bråthen
- Department of Acute Medicine, Division of Elverum-Hamar, Innlandet Hospital Trust, 2381 Brumunddal, Norway; Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway.
| | - Benedicte M Jørgenrud
- Department of Forensic Sciences, Division of Laboratory Medicine, Section of Drug Abuse Research, Oslo University Hospital, 0424 Oslo, Norway
| | - Stig Tore Bogstrand
- Department of Forensic Sciences, Division of Laboratory Medicine, Section of Drug Abuse Research, Oslo University Hospital, 0424 Oslo, Norway; Faculty of Health Sciences, Department of Nursing and Health Promotion, Acute and Critical Illness, Oslo Metropolitan University, 0130 Oslo, Norway; Department of Public Health Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway
| | - Hallvard Gjerde
- Department of Forensic Sciences, Division of Laboratory Medicine, Section of Drug Abuse Research, Oslo University Hospital, 0424 Oslo, Norway
| | - Leiv Arne Rosseland
- Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway; Department of Research & Development, Division of Emergencies and Critical Care, Oslo University Hospital, 0424 Oslo, Norway
| | - Thomas Kristiansen
- Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway; Department of Anaesthesiology, Division of Emergencies and Critical Care, Radiumhospitalet, Oslo University Hospital, 0424 Oslo, Norway
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12
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Huber TP. Rethinking leadership approaches for community-wide opioid crisis intervention: harnessing positive inquiry to unearth front-line insight. BMJ LEADER 2023:leader-2023-000862. [PMID: 37979969 DOI: 10.1136/leader-2023-000862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/26/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND/AIM The opioid crisis presents a complex and widespread health challenge for communities, necessitating a deeper exploration beyond simple solutions. To address this crisis, it is crucial to identify and disseminate best practices. In this study, we focused on positive deviance narratives from Columbus, Ohio, a community deeply affected by the opioid crisis. METHODS Employing an appreciative inquiry framework, we conducted purposive sampling to interview 47 frontline professionals and individuals grappling with opioid use disorder (OUD). RESULTS Our research revealed several key insights, highlighting successful themes through positive narratives. First, perceiving OUD as a chronic disease emerged as a critical perspective, acknowledging the long-term nature of the condition and the need for sustained care. Second, re-humanising and de-stigmatising opioid users played a vital role in facilitating their recovery and reintegration into society. Embracing inclusive care delivery was another important aspect, ensuring that individuals from diverse backgrounds receive equitable access to effective treatment. Moreover, re-energising professionals to combat burnout proved essential, emphasising the importance of supporting and motivating healthcare providers in their efforts. Finally, fostering cross-institutional relationship building and collaboration emerged as a significant factor, as it encouraged a coordinated approach to addressing the crisis. Designing adaptive organisational structures also played a crucial role, enabling healthcare institutions to respond effectively to evolving challenges. CONCLUSIONS Using a positive deviance approach to a challenging public health crisis like OUD can help us discover new and innovative care management approaches for community wide interventions.
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13
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Sommerfeld-Klatta K, Jiers W, Łukasik-Głębocka M, Tezyk A, Dolińska-Kaczmarek K, Walter K, Świderski P, Rzepczyk S, Zielińska-Psuja B, Żaba C. Severe and Fatal Fentanyl Poisonings from Transdermal Systems after On-Skin and Ingestion Application. TOXICS 2023; 11:872. [PMID: 37888722 PMCID: PMC10610823 DOI: 10.3390/toxics11100872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/12/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023]
Abstract
In recent years, the administration of fentanyl (FNTL) implicitly in transdermal drug delivery systems (TDDS) has vastly increased in chronic pain treatment. Non-medical and uncontrolled use of FNTL in TFDS (transdermal fentanyl delivery systems) may reveal toxic effects by the route of exposure, dermal or alternative, by ingestion of patches, and drug release in the stomach. The purpose of this study was to present three different cases of FNTL poisonings, two of which resulted in death due to TFDS abuse. The first case is a 66-year-old woman treated for accidental FTNL poisoning resulting in acute respiratory distress syndrome. Two remaining cases are a 31-year-old woman and a 25-year-old man who died as a result of FNTL overdose after on-skin and ingestion application of the drug patches. During the hospitalization of the 66-year-old patient, in blood samples, FNTL was confirmed at a concentration of 10.0 ng/mL. Tests run on blood taken from the corpses of 25- and 31-year-old patients exhibited FNTL presence in concentrations of 29.1 ng/mL and 38.7 ng/mL, respectively. The various routes of administration and ultimately toxic effects are important to present because, in TDDS, fentanyl can be a reason for severe to fatal poisoning, as shown by the three cases above.
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Affiliation(s)
- Karina Sommerfeld-Klatta
- Department of Toxicology, Poznań University of Medical Sciences, 30 Dojazd Street, 60-631 Poznan, Poland
| | - Wiktoria Jiers
- Department of Toxicology, Poznań University of Medical Sciences, 30 Dojazd Street, 60-631 Poznan, Poland
| | - Magdalena Łukasik-Głębocka
- Department of Emergency Medicine, Poznań University of Medical Sciences, 7 Rokietnicka Street, 60-806 Poznan, Poland
| | - Artur Tezyk
- Department of Forensic Medicine, Poznań University of Medical Sciences, 10 Rokietnicka Street, 60-806 Poznan, Poland
| | - Klaudia Dolińska-Kaczmarek
- Department of Forensic Medicine, Poznań University of Medical Sciences, 10 Rokietnicka Street, 60-806 Poznan, Poland
| | - Kamil Walter
- Department of Forensic Medicine, Poznań University of Medical Sciences, 10 Rokietnicka Street, 60-806 Poznan, Poland
| | - Paweł Świderski
- Department of Forensic Medicine, Poznań University of Medical Sciences, 10 Rokietnicka Street, 60-806 Poznan, Poland
| | - Szymon Rzepczyk
- Department of Forensic Medicine, Poznań University of Medical Sciences, 10 Rokietnicka Street, 60-806 Poznan, Poland
| | - Barbara Zielińska-Psuja
- Department of Toxicology, Poznań University of Medical Sciences, 30 Dojazd Street, 60-631 Poznan, Poland
| | - Czesław Żaba
- Department of Forensic Medicine, Poznań University of Medical Sciences, 10 Rokietnicka Street, 60-806 Poznan, Poland
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14
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Mercadante S. Houston, we have a problem of opioid crisis… and Rome? JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2023; 3:36. [PMID: 37849004 PMCID: PMC10580571 DOI: 10.1186/s44158-023-00121-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 09/09/2023] [Indexed: 10/19/2023]
Affiliation(s)
- Sebastiano Mercadante
- Main Regional Center for Pain Relief and Supportive/Palliative Care, La Maddalena Cancer Center, Via San Lorenzo 312, 90146, Palermo, Italy.
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15
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Oliva A, González de Chavez P, Dévora S, Abdala S. Opioid prescription patterns in the province of Las Palmas, Canary Islands, Spain (2016-2020): differences between urban and rural areas. Front Pharmacol 2023; 14:1184457. [PMID: 37533632 PMCID: PMC10390770 DOI: 10.3389/fphar.2023.1184457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 07/07/2023] [Indexed: 08/04/2023] Open
Abstract
Introduction: The use of opioids has increased markedly in the past decades in European countries, especially for treatment of non-cancer pain including painful chronic musculoskeletal conditions. However, there are some notable differences in the relative levels of use between geographical areas and some distinct, context-specific patterns of weak and strong opioid use. The aim of this work is to describe real world trends in dosage forms and population exposure in the prescription opioid use on isolated geographically area: The Canary Islands of Gran Canaria, Lanzarote and Fuerteventura, Spain. For this, several factors such as living in a rural or urban area, population over 65 years of age, population density or socioeconomic status were analyzed. Methods: Data were extracted from the wholesalers who supply the community pharmacies at the population level. Prescription opioid use was measured as defined daily doses (DDD) per 1,000 inhabitants per day. A model based on covariance analysis with two nested fixed factors and one co-variable was used for contrast analysis at different level. Results: The overall DDD per 1000 inhabitants per day and year variation rate in Spain was very similar to that obtained for Gran Canaria and Fuerteventura (0.967 vs. 1.006), although the levels of dispensation were different (14.75 versus 18.24 for Gran Canaria and 12.7 for Fuerteventura, respectively). Lanzarote is completely different in all issues, where the opioid consumption rate remained stable during the study period, but with a decreasing tendency. The dispensation level of strong opioids varied between islands, from 56.41% for Fuerteventura vs. 17.61% for Gran Canaria, although these values remained stable. Tramadol with acetaminophen and Tramadol in monotherapy were the most consumed forms of the weak opioids, whereas Buprenorphine was the most used strong opioid followed by Fentanyl, although demand for it varied between islands, the transdermal formulations were the most frequent pharmaceutical preparation. Conclusion: The differences in prescription opioid use are most likely explained by the opioid prescribing practices in each island, whereas factors such urbanicity level, population age, population density and status socioeconomic does not help to explain the differences in prescription opioid use across rural and urban areas.
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Affiliation(s)
- Alexis Oliva
- Departamento de Ingeniería Química y Tecnología Farmacéutica, Facultad de Farmacia, Universidad de La Laguna, Tenerife, Spain
| | - Patricia González de Chavez
- Departamento de Medicina Física y Farmacología, Facultad de Farmacia, Universidad de La Laguna, Tenerife, Spain
| | - Sandra Dévora
- Departamento de Medicina Física y Farmacología, Facultad de Farmacia, Universidad de La Laguna, Tenerife, Spain
| | - Susana Abdala
- Departamento de Medicina Física y Farmacología, Facultad de Farmacia, Universidad de La Laguna, Tenerife, Spain
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16
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Kalkman GA, Kramers C, van den Brink W, Schellekens AFA. Europe has much to do to improve the quality of and access to safe pain management - Authors' reply. Lancet 2023; 401:1651-1652. [PMID: 37210112 DOI: 10.1016/s0140-6736(23)00667-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 03/26/2023] [Indexed: 05/22/2023]
Affiliation(s)
- Gerard A Kalkman
- Department of Clinical Pharmacy, Canisius-Wilhelmina Hospital, 6532 SZ Nijmegen, Netherlands; Department of Pharmacology-Toxicology, Radboud University Medical Center, Nijmegen, Netherlands.
| | - Cornelis Kramers
- Department of Clinical Pharmacy, Canisius-Wilhelmina Hospital, 6532 SZ Nijmegen, Netherlands; Department of Pharmacology-Toxicology, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Arnt F A Schellekens
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, Netherlands; Donders Institute for Clinical Neuroscience, Radboud University Medical Center, Nijmegen, Netherlands; Nijmegen Institute for Science Practitioners in Addiction (NISPA), Nijmegen, Netherlands
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17
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Forget P, Hauser W. Europe has much to do to improve the quality of and access to safe pain management. Lancet 2023; 401:1651. [PMID: 37210113 DOI: 10.1016/s0140-6736(23)00669-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 03/26/2023] [Indexed: 05/22/2023]
Affiliation(s)
- Patrice Forget
- Institute of Applied Health Sciences, Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen AB25 2ZD, UK; Department of Anaesthesia, NHS Grampian, Aberdeen, UK; The European Society of Anaesthesiology and Intensive Care (ESAIC) Pain and Opioids after Surgery (PANDOS) Research Group, Brussels, Belgium.
| | - Winfried Hauser
- Department Internal Medicine I, Klinikum Saarbrücken, Saarbrücken, Germany; Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München, Munich, Germany; The European Society of Anaesthesiology and Intensive Care (ESAIC) Pain and Opioids after Surgery (PANDOS) Research Group, Brussels, Belgium
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18
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Alvarez-Perez B, Poras H, Maldonado R. The inhibition of enkephalin catabolism by dual enkephalinase inhibitor: A novel possible therapeutic approach for opioid use disorders. Br J Pharmacol 2023; 180:879-893. [PMID: 34378790 DOI: 10.1111/bph.15656] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 07/14/2021] [Accepted: 07/28/2021] [Indexed: 11/30/2022] Open
Abstract
Despite the increasing impact of opioid use disorders on society, there is a disturbing lack of effective medications for their clinical management. An interesting innovative strategy to treat these disorders consists in the protection of endogenous opioid peptides to activate opioid receptors, avoiding the classical opioid-like side effects. Dual enkephalinase inhibitors (DENKIs) physiologically activate the endogenous opioid system by inhibiting the enzymes responsible for the breakdown of enkephalins, protecting endogenous enkephalins and increasing their half-lives and physiological actions. The activation of opioid receptors by the increased enkephalin levels, and their well-demonstrated safety, suggests that DENKIs could represent a novel analgesic therapy and a possible effective treatment for acute opioid withdrawal, as well as a promising alternative to opioid substitution therapy minimizing side effects. This new pharmacological class of compounds could bring effective and safe medications avoiding the major limitations of exogenous opioids, representing a novel approach to overcome the problem of opioid use disorders. LINKED ARTICLES: This article is part of a themed issue on Advances in Opioid Pharmacology at the Time of the Opioid Epidemic. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v180.7/issuetoc.
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Affiliation(s)
- Beltran Alvarez-Perez
- Laboratory of Neuropharmacology, Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
| | | | - Rafael Maldonado
- Laboratory of Neuropharmacology, Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
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19
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Zajacova A, Grol-Prokopczyk H, Limani M, Schwarz C, Gilron I. Prevalence and correlates of prescription opioid use among US adults, 2019-2020. PLoS One 2023; 18:e0282536. [PMID: 36862646 PMCID: PMC9980762 DOI: 10.1371/journal.pone.0282536] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 02/16/2023] [Indexed: 03/03/2023] Open
Abstract
This study estimates the prevalence of prescription opioid use (POU) in the United States (US) in 2019-2020, both in the general population and specifically among adults with pain. It also identifies key geographic, demographic, and socioeconomic correlates of POU. Data were from the nationally-representative National Health Interview Survey 2019 and 2020 (N = 52,617). We estimated POU prevalence in the prior 12 months among all adults (18+), adults with chronic pain (CP), and adults with high-impact chronic pain (HICP). Modified Poisson regression models estimated POU patterns across covariates. We found POU prevalence of 11.9% (95% CI 11.5, 12.3) in the general population, 29.3% (95% CI 28.2, 30.4) among those with CP, and 41.2% (95% CI 39.2, 43.2) among those with HICP. Findings from fully-adjusted models include the following: In the general population, POU prevalence declined about 9% from 2019 to 2020 (PR = 0.91, 95% CI 0.85, 0.96). POU varied substantially across US geographic regions: It was significantly more common in the Midwest, West, and especially the South, where adults had 40% higher POU (PR = 1.40, 95% CI 1.26, 1.55) than in the Northeast. In contrast, there were no differences by rural/urban residence. In terms of individual characteristics, POU was lowest among immigrants and among the uninsured, and was highest among adults who were food insecure and/or not employed. These findings suggest that prescription opioid use remains high among American adults, especially those with pain. Geographic patterns suggest systemic differences in therapeutic regimes across regions but not rurality, while patterns across social characteristics highlight the complex, opposing effects of limited access to care and socioeconomic precarity. Against the backdrop of continuing debates about benefits and risks of opioid analgesics, this study identifies and invites further research about geographic regions and social groups with particularly high or low prescription opioid use.
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Affiliation(s)
- Anna Zajacova
- Department of Sociology, University of Western Ontario, London, Ontario, Canada
- * E-mail:
| | - Hanna Grol-Prokopczyk
- Department of Sociology, University at Buffalo, State University of New York, Buffalo, New York, United States of America
| | - Merita Limani
- Department of Sociology, University of Western Ontario, London, Ontario, Canada
| | - Christopher Schwarz
- Department of Politics, New York University, New York, New York, United States of America
| | - Ian Gilron
- Department of Anesthesiology and Perioperative Medicine, Queen’s University School of Medicine, Kingston, Ontario, Canada
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20
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Ing Lorenzini K, Wainstein L, Spechbach H, Sarasin F, Ramlawi M, Desmeules J, Piguet V. Opioid-related adverse drug reactions in patients visiting the emergency division of a tertiary hospital. Pharmacol Res Perspect 2022; 10:e01033. [PMID: 36404650 PMCID: PMC9676686 DOI: 10.1002/prp2.1033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/05/2022] [Indexed: 11/22/2022] Open
Abstract
Opioid use and associated morbidity and mortality have increased in several countries during the past 20 years. We performed a study whose objective was to assess the frequency and causes of opioid-related emergency division (ED) visits in an adult tertiary Swiss University Hospital over 9 weeks in 2018. We primarily assessed opioid-related adverse drug reactions (ADR), secondary overdose, misuse, abuse, and insufficient pain relief. Current opioid use was identified in 1037 (8.3%) of the 12 470 included ED visits. In 64 opioid users, an ADR was identified as a contributing cause of the ED visit, representing 6.2% of opioid users, and 0.5% of the total ED visits. Moreover, we identified an overdose in 16 opioid users, misuse or abuse in 19 opioid users, and compatible withdrawal symptoms in 7 opioid users. After pooling all these events, we conclude that the ED visits could be related to opioid use in 10.2% of opioid users. Finally, in 201 opioid users, insufficient pain relief (pain not responding to the current pharmacological treatment) was identified as a contributing cause of ED visits. In these cases, other factors than simply pharmacological nonresponse may have been involved. In the context of an ever-increasing opioid use to better control chronic pain situations, these results should reinforce emergency network epidemiological surveillance studies at a national level.
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Affiliation(s)
- Kuntheavy Ing Lorenzini
- Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Center, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency MedicineUniversity Hospitals of GenevaGenevaSwitzerland
- Faculty of MedicineUniversity of GenevaGenevaSwitzerland
| | - Laura Wainstein
- Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Center, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency MedicineUniversity Hospitals of GenevaGenevaSwitzerland
| | - Hervé Spechbach
- Faculty of MedicineUniversity of GenevaGenevaSwitzerland
- Division of Primary Care, Department of Primary Care MedicineUniversity Hospitals of GenevaGenevaSwitzerland
| | - François Sarasin
- Faculty of MedicineUniversity of GenevaGenevaSwitzerland
- Division of Emergency Medicine, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency MedicineUniversity Hospitals of GenevaGenevaSwitzerland
| | - Majd Ramlawi
- Division of Emergency MedicineLa Tour Medical GroupMeyrinSwitzerland
| | - Jules Desmeules
- Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Center, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency MedicineUniversity Hospitals of GenevaGenevaSwitzerland
- Faculty of MedicineUniversity of GenevaGenevaSwitzerland
| | - Valérie Piguet
- Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Center, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency MedicineUniversity Hospitals of GenevaGenevaSwitzerland
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21
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Hurtado I, Robles C, Peiró S, García-Sempere A, Llopis-Cardona F, Sánchez-Sáez F, Rodríguez-Bernal C, Sanfélix-Gimeno G. Real-world patterns of opioid therapy initiation in Spain, 2012-2018: A population-based, retrospective cohort study with 957,080 patients and 1,509,488 initiations. Front Pharmacol 2022; 13:1025340. [PMID: 36467078 PMCID: PMC9709437 DOI: 10.3389/fphar.2022.1025340] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/01/2022] [Indexed: 07/29/2023] Open
Abstract
Introduction: Europe has seen a steady increase in the use of prescription opioids, especially in non-cancer indications. Epidemiological data on the patterns of use of opioids is required to optimize prescription. We aim to describe the patterns of opioid therapy initiation for non-cancer pain and characteristics of patients treated in a region with five million inhabitants in the period 2012 to 2018. Methods: Population-based retrospective cohort study of all adult patients initiating opioid therapy for non-cancer pain in the region of Valencia. We described patient characteristics at baseline and the characteristics of baseline and subsequent treatment initiation. We used multinominal regression models to identify individual factors associated with initiation. Results: A total of 957,080 patients initiated 1,509,488 opioid treatments (957,080 baseline initiations, 552,408 subsequent initiations). For baseline initiations, 738,749 were with tramadol (77.19%), 157,098 with codeine (16.41%) 58,436 (6.11%) with long-acting opioids, 1,518 (0.16%) with short-acting opioids and 1,279 (0.13%) with ultrafast drugs. When compared to tramadol, patients initiating with short-acting, long-acting and ultrafast opioids were more likely to be older and had more comorbidities, whereas initiators with codeine were more prone to be healthier and younger. Treatments lasting less than 7 days accounted for 41.82% of initiations, and 11.89% lasted more than 30 days. 19.55% of initiators with ultrafast fentanyl received more than 120 daily Morphine Milligram Equivalents (MME), and 16.12% of patients initiating with long-acting opioids were prescribed more than 90 daily MME (p < 0.001). Musculoskeletal indications accounted for 65.05% of opioid use. Overlap with benzodiazepines was observed in 24.73% of initiations, overlap with gabapentinoids was present in 11.04% of initiations with long-acting opioids and 28.39% of initiators with short-acting opioids used antipsychotics concomitantly. In subsequent initiations, 55.48% of treatments included three or more prescriptions (vs. 17.60% in baseline initiations) and risk of overlap was also increased. Conclusion: Opioids are initiated for a vast array of non-oncological indications, and, despite clinical guidelines, short-acting opioids are used marginally, and a significant number of patients is exposed to potentially high-risk patterns of initiation, such as treatments lasting more than 14 days, treatments surpassing 50 daily MMEs, initiating with long-acting opioids, or hazardous overlapping with other therapies.
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Affiliation(s)
- Isabel Hurtado
- Health Services Research Unit, Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Valencia, Fisabio
- Network for Research on Chronicity Primary Care and Health Promotion (RICAPPS), Valencia, Fisabio
| | - Celia Robles
- Health Services Research Unit, Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Valencia, Fisabio
- Network for Research on Chronicity Primary Care and Health Promotion (RICAPPS), Valencia, Fisabio
| | - Salvador Peiró
- Health Services Research Unit, Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Valencia, Fisabio
- Network for Research on Chronicity Primary Care and Health Promotion (RICAPPS), Valencia, Fisabio
| | - Aníbal García-Sempere
- Health Services Research Unit, Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Valencia, Fisabio
- Network for Research on Chronicity Primary Care and Health Promotion (RICAPPS), Valencia, Fisabio
| | - Fran Llopis-Cardona
- Health Services Research Unit, Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Valencia, Fisabio
- Network for Research on Chronicity Primary Care and Health Promotion (RICAPPS), Valencia, Fisabio
| | - Francisco Sánchez-Sáez
- Health Services Research Unit, Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Valencia, Fisabio
- Network for Research on Chronicity Primary Care and Health Promotion (RICAPPS), Valencia, Fisabio
| | - Clara Rodríguez-Bernal
- Health Services Research Unit, Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Valencia, Fisabio
- Network for Research on Chronicity Primary Care and Health Promotion (RICAPPS), Valencia, Fisabio
| | - Gabriel Sanfélix-Gimeno
- Health Services Research Unit, Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Valencia, Fisabio
- Network for Research on Chronicity Primary Care and Health Promotion (RICAPPS), Valencia, Fisabio
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22
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Prescription Opioid Misuse Among School-Aged Adolescents: Gender Differences and Related Factors. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00954-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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23
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In between Opioid Crisis and the Need to Treat Pain, Where Do We Stand? J Crit Care Med (Targu Mures) 2022; 8:229-231. [DOI: 10.2478/jccm-2022-0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 10/29/2022] [Indexed: 11/13/2022] Open
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24
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Wolf A, Sant'Anna A, Vilhelmsson A. Using nudges to promote clinical decision making of healthcare professionals: A scoping review. Prev Med 2022; 164:107320. [PMID: 36283484 DOI: 10.1016/j.ypmed.2022.107320] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/25/2022] [Accepted: 10/18/2022] [Indexed: 10/31/2022]
Abstract
Nudging has been discussed in the context of policy and public health, but not so much within healthcare. This scoping review aimed to assess the empirical evidence on how nudging techniques can be used to affect the behavior of healthcare professionals (HCPs) in clinical settings. A systematic database search was conducted for the period January 2010-December 2020 using the PRISMA extension for Scoping Review checklist. Two reviewers independently screened each article for inclusion. Included articles were reviewed to extract key information about each intervention, including purpose, target behavior, measured outcomes, key findings, nudging strategies, intervention objectives and their theoretical underpinnings. Two independent dimensions, building on Kahneman's System 1 and System 2, were used to describe nudging strategies according to user action and timing of their implementation. Of the included 51 articles, 40 reported statistically significant results, six were not significant and two reported mixed results. Thirteen different nudging strategies were identified aimed at modifying four types of HPCs' behavior: prescriptions and orders, procedure, hand hygiene, and vaccination. The most common nudging strategy employed were defaults or pre-orders, followed by alerts or reminders, and active choice. Many interventions did not require any deliberate action from users, here termed passive interventions, such as automatically changing prescriptions to their generic equivalent unless indicated by the user. Passive nudges may be successful in changing the target outcome but may go unnoticed by the user. Future work should consider the broader ethical implications of passive nudges.
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Affiliation(s)
- Axel Wolf
- University of Gothenburg, Centre for Person-Centred Care (GPCC), Sweden; University of Gothenburg, Institute of Health and Care Sciences, Sahlgrenska Academy, Sweden
| | | | - Andreas Vilhelmsson
- Lund University, Department of Laboratory Medicine, Division of Occupational and Environmental Medicine, Sweden.
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25
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Bedene A, Dahan A, Rosendaal FR, van Dorp ELA. Opioid epidemic: lessons learned and updated recommendations for misuse involving prescription versus non-prescription opioids. Expert Rev Clin Pharmacol 2022; 15:1081-1094. [PMID: 36068971 DOI: 10.1080/17512433.2022.2114898] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION In the past decades, the opioid crisis has heavily impacted parts of the US society and has been followed by an increase in the use of opioids worldwide. It is of paramount importance that we explore the origins of the US opioid epidemic to develop best practices to tackle the rising tide of opioid overdoses. AREAS COVERED In this expert review, we discuss opioid (over)prescription, change in perception of pain, and false advertisement of opioid safety as the leading causes of the US opioid epidemic. Then, we review the evidence about opioid dependence and addiction potential and provide current knowledge about predictors of aberrant opioid-related behavior. Lastly, we discuss different approaches that were considered or undertaken to combat the rising tide of opioid-related deaths by regulatory bodies, pharmaceutical companies, and health-care professionals. For this expert review, we considered published articles relevant to the topic under investigation that we retrieved from Medline or Google scholar electronic database. EXPERT OPINION The opioid epidemic is a dynamic process with many underlying mechanisms. Therefore, no single approach may be best suited to combat it. In our opinion, the best way forward is to employ multiple strategies to tackle different underlying mechanisms.
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Affiliation(s)
- Ajda Bedene
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Albert Dahan
- Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Eveline L A van Dorp
- Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands
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26
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Feltmann K, Villén T, Beck O, Gripenberg J. Increasing prevalence of illicit drug use among employees at Swedish workplaces over a 25-year period. Eur J Public Health 2022; 32:760-765. [PMID: 36006016 PMCID: PMC9527979 DOI: 10.1093/eurpub/ckac105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Reports indicate that the proportion of adults using drugs of abuse has been increasing in recent years in Europe. Although there are various indicators of increased drug use in Sweden over time, few studies could demonstrate an increase in the proportion of adults using drugs. To investigate changes in drug use prevalence over time, drug testing at the workplace has been used for a 25-year period. Methods The urine samples of employees sent by occupational health services from all over Sweden during a 25-year period were analyzed. The analyzing capacity increased over time (from 3411 in 1994 to 60 315 samples analyzed in 2019), and the majority of the samples was analyzed for the following drugs: cannabis (tetrahydrocannabinol), amphetamine, opiates, cocaine, and benzodiazepines. Results There was an overall increase in the proportion of samples that tested positive for illicit drugs over a 25-year period. This increase seemed to take place step-wise, with phases of linear increases and plateaus that over time became shorter. About 1.3% of samples tested positive for drugs in 1994, whereas 5.6% tested positive in 2019. Since 2007, the rate of positive samples has increased for cannabis and decreased for benzodiazepines. Although the rate of samples tested positive for opiates had remained relatively stable over the last 20 years, this rate had increased for amphetamine and cocaine between 2013 and 2019. Conclusion The results indicate that the use of illicit drugs among employees at Swedish workplaces has increased during a 25-year period.
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Affiliation(s)
- Kristin Feltmann
- STAD (Stockholm Prevents Alcohol and Drug Problems), Stockholm, Sweden.,Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Tomas Villén
- Department of Clinical Pharmacology, Karolinska University Laboratory, Stockholm, Sweden
| | - Olof Beck
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Johanna Gripenberg
- STAD (Stockholm Prevents Alcohol and Drug Problems), Stockholm, Sweden.,Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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27
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Carrasco-Garrido P, Gallardo-Pino C, Jiménez-Trujillo I, Hernández-Barrera V, García-Gómez-Heras S, Lima Florencio L, Palacios-Ceña D. Nationwide Population-Based Study About Patterns of Prescription Opioid Use and Misuse Among Young Adults in Spain. Int J Public Health 2022; 67:1604755. [PMID: 36059585 PMCID: PMC9437214 DOI: 10.3389/ijph.2022.1604755] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 07/05/2022] [Indexed: 11/13/2022] Open
Abstract
Objective: Prescription opioid misuse has become one of the most common ways drugs are consumed among young adults. The objective of our study was to describe the prevalence and factors associated with prescription opioid use and misuse among young adults living in Spain.Methods: A nationwide, cross-sectional epidemiological study on the use and misuse of prescription opioids in Spanish Youngers. We used individualized secondary data provided by the Household Survey on Alcohol and Drugs in Spain 2017–2018.Results: Prevalence of prescription opioid use among young adults was 4.89%. Misuse among this population reached prevalence values of 13.4%, with higher values observed among women . The variables associated with a greater probability of prescription opioid use and misuse were misuse of tranquilizers, sedatives, and sleeping pills, along with using cannabis and other illicit psychoactive drugs (aOR = 2.99; 95% CI: 1.10–8.15).Conclusion: Prescription opioid use and misuse in Youngers has important implications for the Spanish public health system, because, even though not currently comparable to the situation in other countries, this drug use could be on the verge of creating similar problems.
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Affiliation(s)
- Pilar Carrasco-Garrido
- Department of Medical Specialties and Public Health, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Spain
- *Correspondence: Pilar Carrasco-Garrido,
| | - Carmen Gallardo-Pino
- Department of Medical Specialties and Public Health, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Isabel Jiménez-Trujillo
- Department of Medical Specialties and Public Health, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Valentín Hernández-Barrera
- Department of Medical Specialties and Public Health, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Soledad García-Gómez-Heras
- Department of Basic Health Sciences, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Lidiane Lima Florencio
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Domingo Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Spain
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28
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Engi Z, Benkő R, Soós G, Szok D, Csenki M, Csüllög E, Balog A, Csupor D, Viola R, Doró P, Matuz M. Trends in Opioid Utilisation in Hungary, 2006-2020: A Nationwide Retrospective Study with Multiple Metrics. Eur J Pain 2022; 26:1896-1909. [PMID: 35848717 PMCID: PMC9541344 DOI: 10.1002/ejp.2011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/01/2022] [Accepted: 07/16/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Opioid use is well-documented in several countries: some countries struggle with overuse while others have almost no access to opioids. For Europe, limited data are available. This study analysed Hungarian opioid utilisation in ambulatory care between 2006 and 2020. METHODS We obtained national drug utilization data on reimbursed opioid analgesics (ATC code: N02A) from a national health insurance database for a 15-year period. We investigated utilisation trends, using three volume-based metrics (defined daily dose per 1000 inhabitants per day (DID), oral morphine equivalent per 1000 inhabitants per day, packages dispensed per 1000 inhabitants per year). We stratified data based on administration routes, analgesic potency and reimbursement categories. RESULTS Total opioid utilisation increased during the study period according to all three metrics (74% in DID) and reached 5.31 DID by 2020. Upward trends were driven by an increase both in weak and strong opioid use (79% vs. 53%). The most commonly used opioids were fentanyl (in the strong category; 0.76 DID in 2020) and tramadol (in the weak category; 2.62 DID in 2020). Overall, tramadol was also the most commonly used opioid throughout the study period. Oral administration of opioid medications was dominant. Based on reimbursement categories, musculoskeletal pain was becoming a more frequent indication for opioid use (1552% increase in DID), while opioid use for cancer pain declined significantly during the study period (-33% in DID). CONCLUSIONS Our low utilisation numbers might indicate underuse of opioid analgesia, especially for cancer pain.
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Affiliation(s)
- Z Engi
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725, Szeged, Hungary
| | - R Benkő
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725, Szeged, Hungary.,Central Pharmacy Department, Albert Szent-Györgyi Health Center, University of Szeged, 6725, Szeged, Hungary.,Emergency Department, Albert Szent-Györgyi Health Center, University of Szeged, 6725, Szeged, Hungary
| | - G Soós
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725, Szeged, Hungary
| | - D Szok
- Department of Neurology, Albert Szent-Györgyi Health Center, University of Szeged, 6725, Szeged, Hungary
| | - M Csenki
- Department of Oncotherapy, Albert Szent-Györgyi Health Center, University of Szeged, 6725, Szeged, Hungary
| | - E Csüllög
- Department of Anesthesiology and Intensive Care, Albert Szent-Györgyi Health Center, 6725, University of Szeged, Szeged, Hungary
| | - A Balog
- Department of Rheumatology and Immunology, Albert Szent-Györgyi Health Center, University of Szeged, 6725, Szeged, Hungary
| | - D Csupor
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725, Szeged, Hungary.,Institute for Translational Medicine, Medical School, University of Pécs, 7624, Pécs, Hungary
| | - R Viola
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725, Szeged, Hungary
| | - P Doró
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725, Szeged, Hungary
| | - M Matuz
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725, Szeged, Hungary.,Central Pharmacy Department, Albert Szent-Györgyi Health Center, University of Szeged, 6725, Szeged, Hungary
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29
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Nobile B, Bonnin M, Olié E, Courtet P. Multiple suicide attempts associated with addiction to tramadol. Ann Gen Psychiatry 2022; 21:24. [PMID: 35778765 PMCID: PMC9247960 DOI: 10.1186/s12991-022-00401-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 06/22/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The opioid tramadol is used as analgesic drug, and more recently was also proposed for the management of major depressive disorder. However, growing evidence suggests a link between opioid system dysfunction and suicidal behaviors, raising the question of tramadol use in view of the high addictive and suicidal risk. Here, we present the case of a young adult woman with multiple suicide attempts related to tramadol addiction. CASE PRESENTATION A 25-year-old woman was admitted for suicide attempt by phlebotomy in the Department of Psychiatric Emergency and Acute Care, Montpellier (France), in March 2020. The suicide attempt occurred 3 days after an abrupt tramadol withdrawal. In 2018, due to spinal disc herniation, she had a first prescription of tramadol to which she became addicted. The patient described an effect on psychological pain and suicidal ideation. However, she had to increase tramadol dose to obtain the desired effects, and for several months her intake was 2 000 mg per day. When she could not obtain tramadol any longer, suicidal ideation and psychological pain increased, leading to the suicide attempt. At the time of a worldwide opioid crisis that contributes to increasing suicidal behaviors, this case raises questions about tramadol prescription (often considered to be less addictive and with lower abuse potential) to individuals at risk of suicide.
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Affiliation(s)
- Bénédicte Nobile
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital CHU Montpellier, Montpellier, France. .,IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France. .,FondaMental Foundation, Montpellier, France.
| | - Marine Bonnin
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital CHU Montpellier, Montpellier, France
| | - Emilie Olié
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital CHU Montpellier, Montpellier, France.,IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France.,FondaMental Foundation, Montpellier, France
| | - Philippe Courtet
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital CHU Montpellier, Montpellier, France.,IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France.,FondaMental Foundation, Montpellier, France
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30
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Donnelly A, Cox FJ. Raising patient and carer awareness of the risks of postoperative opioids. Br J Pain 2022; 16:260-262. [PMID: 35646338 PMCID: PMC9136994 DOI: 10.1177/20494637221103169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023] Open
Affiliation(s)
- Amy Donnelly
- Perioperative Medicine Fellow, St Vincent's University Hospital, Dublin, Ireland
| | - Felicia J Cox
- Nurse Consultant Pain Management, Royal Brompton & Harefield NHS Foundation Trust, London, UK
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31
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Chiappini S, Vickers-Smith R, Guirguis A, Corkery JM, Martinotti G, Harris DR, Schifano F. Pharmacovigilance Signals of the Opioid Epidemic over 10 Years: Data Mining Methods in the Analysis of Pharmacovigilance Datasets Collecting Adverse Drug Reactions (ADRs) Reported to EudraVigilance (EV) and the FDA Adverse Event Reporting System (FAERS). Pharmaceuticals (Basel) 2022; 15:ph15060675. [PMID: 35745593 PMCID: PMC9231103 DOI: 10.3390/ph15060675] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/21/2022] [Accepted: 05/24/2022] [Indexed: 01/14/2023] Open
Abstract
In the past twenty years, the consumption of opioid medications has reached significant proportions, leading to a rise in drug misuse and abuse and increased opioid dependence and related fatalities. Thus, the purpose of this study was to determine whether there are pharmacovigilance signals of abuse, misuse, and dependence and their nature for the following prescription opioids: codeine, dihydrocodeine, fentanyl, oxycodone, pentazocine, and tramadol. Both the pharmacovigilance datasets EudraVigilance (EV) and the FDA Adverse Events Reporting System (FAERS) were analyzed to identify and describe possible misuse-/abuse-/dependence-related issues. A descriptive analysis of the selected Adverse Drug Reactions (ADRs) was performed, and pharmacovigilance signal measures (i.e., reporting odds ratio, proportional reporting ratio, information component, and empirical Bayesian geometric mean) were computed for preferred terms (PTs) of abuse, misuse, dependence, and withdrawal, as well as PTs eventually related to them (e.g., aggression). From 2003 to 2018, there was an increase in ADR reports for the selected opioids in both datasets. Overall, 16,506 and 130,293 individual ADRs for the selected opioids were submitted to EV and FAERS, respectively. Compared with other opioids, abuse concerns were mostly recorded in relation to fentanyl and oxycodone, while tramadol and oxycodone were more strongly associated with drug dependence and withdrawal. Benzodiazepines, antidepressants, other opioids, antihistamines, recreational drugs (e.g., cocaine and alcohol), and several new psychoactive substances, including mitragynine and cathinones, were the most commonly reported concomitant drugs. ADRs reports in pharmacovigilance databases confirmed the availability of data on the abuse and dependence of prescription opioids and should be considered a resource for monitoring and preventing such issues. Psychiatrists and clinicians prescribing opioids should be aware of their misuse and dependence liability and effects that may accompany their use, especially together with concomitant drugs.
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Affiliation(s)
- Stefania Chiappini
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire AL10 9EU, UK; (S.C.); (J.M.C.); (G.M.); (F.S.)
| | - Rachel Vickers-Smith
- Department of Epidemiology, University of Kentucky College of Public Health, 111 Washington Avenue, Lexington, KY 40536, USA
- Correspondence:
| | - Amira Guirguis
- Department of Pharmacy, Swansea University Medical School, The Grove, Swansea University, Swansea, Wales SA2 8PP, UK;
| | - John M. Corkery
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire AL10 9EU, UK; (S.C.); (J.M.C.); (G.M.); (F.S.)
| | - Giovanni Martinotti
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire AL10 9EU, UK; (S.C.); (J.M.C.); (G.M.); (F.S.)
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D’Annunzio, 66100 Chieti-Pescara, Italy
| | - Daniel R. Harris
- Institute for Pharmaceutical Outcomes and Policy, University of Kentucky College of Pharmacy, 289 South Limestone Street, Lexington, KY 40536, USA;
- Center for Clinical and Translational Sciences, University of Kentucky, 800 Rose Street, Lexington, KY 40506, USA
| | - Fabrizio Schifano
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire AL10 9EU, UK; (S.C.); (J.M.C.); (G.M.); (F.S.)
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32
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Seidel MF, Hügle T, Morlion B, Koltzenburg M, Chapman V, MaassenVanDenBrink A, Lane NE, Perrot S, Zieglgänsberger W. Neurogenic inflammation as a novel treatment target for chronic pain syndromes. Exp Neurol 2022; 356:114108. [PMID: 35551902 DOI: 10.1016/j.expneurol.2022.114108] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/01/2022] [Accepted: 05/03/2022] [Indexed: 11/24/2022]
Abstract
Chronic pain syndrome is a heterogeneous group of diseases characterized by several pathological mechanisms. One in five adults in Europe may experience chronic pain. In addition to the individual burden, chronic pain has a significant societal impact because of work and school absences, loss of work, early retirement, and high social and healthcare costs. Several anti-inflammatory treatments are available for patients with inflammatory or autoimmune diseases to control their symptoms, including pain. However, patients with degenerative chronic pain conditions, some with 10-fold or more elevated incidence relative to these manageable diseases, have few long-term pharmacological treatment options, limited mainly to non-steroidal anti-inflammatory drugs or opioids. For this review, we performed multiple PubMed searches using keywords such as "pain," "neurogenic inflammation," "NGF," "substance P," "nociception," "BDNF," "inflammation," "CGRP," "osteoarthritis," and "migraine." Many treatments, most with limited scientific evidence of efficacy, are available for the management of chronic pain through a trial-and-error approach. Although basic science and pre-clinical pain research have elucidated many biomolecular mechanisms of pain and identified promising novel targets, little of this work has translated into better clinical management of these conditions. This state-of-the-art review summarizes concepts of chronic pain syndromes and describes potential novel treatment strategies.
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Affiliation(s)
- Matthias F Seidel
- Department of Rheumatology, Spitalzentrum Biel-Centre Hospitalier Bienne, 2501 Biel-Bienne, Switzerland.
| | - Thomas Hügle
- Department of Rheumatology, University Hospital Lausanne, 1011 Lausanne, Switzerland
| | - Barton Morlion
- The Leuven Center for Algology and Pain Management, University of Leuven, Leuven, Belgium
| | - Martin Koltzenburg
- Department of Clinical and Movement Neuroscience, UCL Queen Square Institute of Neurology, London, United Kingdom; Department of Clinical Neurophysiology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Victoria Chapman
- Pain Centre Versus Arthritis, School of Life Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, United Kingdom
| | - Antoinette MaassenVanDenBrink
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Nancy E Lane
- Center for Musculoskeletal Health, University of California Davis School of Medicine, Sacramento, CA, USA; Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Serge Perrot
- Unité INSERM U987, Hôpital Ambroise Paré, Paris Descartes University, Boulogne Billancourt, France; Centre d'Evaluation et Traitement de la Douleur, Hôpital Cochin, Paris Descartes University, Paris, France
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33
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van den Brink W, Pierce M, van Amsterdam J. What lessons from Europe's experience could be applied in the United States in response to the opioid addiction and overdose crisis? Addiction 2022; 117:1197-1198. [PMID: 35373491 PMCID: PMC9322582 DOI: 10.1111/add.15839] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 01/25/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Wim van den Brink
- Department of Psychiatry, Amsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - Mimi Pierce
- Department of Psychiatry, Amsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - Jan van Amsterdam
- Department of Psychiatry, Amsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
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34
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García-Sempere A, Hurtado I, Peiró S, Sánchez-Sáez F, Rodríguez-Bernal CL, Puig-Ferrer M, Escolano M, Sanfélix-Gimeno G. Impact of Three Safety Interventions Targeting Off-Label Use of Immediate-Release Fentanyl on Prescription Trends: Interrupted Time Series Analysis. Front Pharmacol 2022; 13:815719. [PMID: 35450053 PMCID: PMC9016332 DOI: 10.3389/fphar.2022.815719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background: The Spanish health authorities are concerned by the off-label use of immediate-release formulations of fentanyl (IRF) in noncancer pain and cancer pain in patients with no chronic pain therapy. Aim: To evaluate the impact of different interventions to improve appropriateness of IRF prescription on off-label prescription. Patients and methods: We used interrupted time series (ITS) to estimate immediate and trend changes of IRF prescription for noncancer pain (NCP) and breakthrough cancer pain (BCP) in patients with and without chronic cancer pain therapy associated with two medication reviews (I1 and I2) and the issue of a safety warning letter (I3) with data from a Spanish region with 5 million inhabitants, from 2015 to 2018. Results: The use of IRF for NCP in the region Valencia was reduced from about 1,800 prescriptions per week to around 1,400. The first medication review was followed by an immediate level change of -192.66 prescriptions per week (p < 0.001) and a downward trend change of -6.75 prescriptions/week (p < 0.001), resulting in a post-intervention trend of -1.99 (p < 0.001). I2 was associated with a trend change of -23.07 (p < 0.001) prescriptions/week. After I3, the trend changed markedly to 27.23 additional prescriptions/week, for a final post-intervention trend of 2.17 (p < 0.001). Controlled-ITS provided comparable results. For potentially inappropriate BCP use, the second medication review was followed by a downward, immediate level change of -10.10 prescriptions/week (p = 0.011) and a trend change of 2.31 additional prescriptions/week (p < 0.001) and the issue of the safety warning (I3) was followed by a downward trend change of -2.09 prescriptions/week (p = 0.007). Conclusion: Despite IRF prescription for NCP decreased, the interventions showed modest and temporary effect on off-label prescription. Our results call for a review of the design and implementation of safety interventions addressing inappropriate opioid use.
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Affiliation(s)
- Aníbal García-Sempere
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region, FISABIO, Valencia, Spain.,Spanish Network for Chronic Health Services Research, REDISSEC, Valencia, Spain
| | - Isabel Hurtado
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region, FISABIO, Valencia, Spain.,Spanish Network for Chronic Health Services Research, REDISSEC, Valencia, Spain
| | - Salvador Peiró
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region, FISABIO, Valencia, Spain.,Spanish Network for Chronic Health Services Research, REDISSEC, Valencia, Spain
| | - Francisco Sánchez-Sáez
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region, FISABIO, Valencia, Spain.,Spanish Network for Chronic Health Services Research, REDISSEC, Valencia, Spain
| | - Clara Liliana Rodríguez-Bernal
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region, FISABIO, Valencia, Spain.,Spanish Network for Chronic Health Services Research, REDISSEC, Valencia, Spain
| | - Magda Puig-Ferrer
- General Directorate for Pharmacy, Valencia Health System, Valencia, Spain
| | - Manuel Escolano
- General Directorate for Pharmacy, Valencia Health System, Valencia, Spain
| | - Gabriel Sanfélix-Gimeno
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region, FISABIO, Valencia, Spain.,Spanish Network for Chronic Health Services Research, REDISSEC, Valencia, Spain
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Banack A, Moore D, Rigell A. Figured Worlds of Addiction: A Content Analysis of 10 YAL Texts. CHILDREN'S LITERATURE IN EDUCATION 2022; 54:1-21. [PMID: 35600461 PMCID: PMC8976210 DOI: 10.1007/s10583-022-09485-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/11/2022] [Indexed: 06/15/2023]
Abstract
While the opioid epidemic rages on in the US, adolescent drug use and abuse is often left unaddressed in university and public-school classrooms. In an effort to support educator's conversations with youth about drug and alcohol addiction, this study draws on the theory of figured worlds to conduct a critical content analysis of 10 YAL novels to understand how adolescents with addiction are constructed within the selected texts. Our findings detail three themes that work together to construct figured worlds in which: the majority of protagonists in the texts are middle class, white, teenage girls; the protagonists' experiences around addiction are preceded by one or a series of traumatic events; and, due to their privilege, the protagonists have ready access to rehabilitation facilities and other mental health supports. We offer both implications for our findings and directions for future research.
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Affiliation(s)
- Arianna Banack
- Department of Theory and Practice in Teacher Education, University of Tennessee, Knoxville, A237 Jane & David Bailey Education Complex, 1126 Volunteer Boulevard, Knoxville, TN 37996 USA
| | - Daniel Moore
- School of Education, University of Colorado, Boulder, 249 UCB, Boulder, CO 80309-0249 USA
| | - Amanda Rigell
- Department of Theory and Practice in Teacher Education, University of Tennessee, Knoxville, A237 Jane & David Bailey Education Complex, 1126 Volunteer Boulevard, Knoxville, TN 37996 USA
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36
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Measuring Stigma Towards People with Opioid Use Problems: Exploratory and Confirmatory Factor Analysis of the Opening Minds Provider Attitudes Towards Opioid-Use Scale (OM-PATOS). Int J Ment Health Addict 2022; 20:3398-3409. [PMID: 35261572 PMCID: PMC8893056 DOI: 10.1007/s11469-022-00788-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2022] [Indexed: 12/03/2022] Open
Abstract
Many countries are experiencing an ongoing opioid crisis characterized by high rates of opioid use problems, overdose, poisoning, and death. Stigma has been identified as a central problem for seeking and receiving quality services from health providers and first respondents. The Mental Health Commission of Canada developed a scale that could be used to measure stigma in this population, as no such scale currently exists. This paper provides the results of psychometric testing of this new scale, known as the Opening Minds Provider Attitudes Towards Opioid-Use Scale (OM-PATOS), using exploratory (EFA) and confirmatory (CFA) factor analysis. EFA findings showed a 15 item 2-factor solution, with subscales of ‘attitudes’ (6 items) and ‘behaviours/motivation to help’ (9 items). The confirmatory factor analysis provided some preliminary confirmation of the factor structure suggested by the exploratory analyses, but further research with larger samples is needed to fully confirm the factor structure. Overall, results support the use of the 15-item scale with health professionals and first responders, with factors used for descriptive value rather than as calculated subscales until further research can be completed.
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37
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Kim J, Shin SJ, Yoon J, Kim HS, Lee JW, Kim YS, Kim Y, You HS, Kang HT. Recent trends in opioid consumption in Korea from 2002 to 2015, based on the Korean NHIS-NSC cohort. Epidemiol Health 2022; 44:e2022029. [PMID: 35209705 PMCID: PMC9117092 DOI: 10.4178/epih.e2022029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 02/21/2022] [Indexed: 11/09/2022] Open
Abstract
Objectives Opioids are prescribed to treat moderate-to-severe pain. We aimed to investigate the recent trends in opioid (morphine, oxycodone, fentanyl, and hydromorphone) consumption using data from the Korean National Health Insurance Service-National Sample Cohort between 2002 and 2015. Methods Morphine milligram equivalent (MME) was calculated to standardize the relative potency of the opioids. The number (cases) or amount (MME) of annual opioid prescription per 10,000 registrants was computed to analyze trends of consumption of opioids after age standardization. Joinpoint regression analysis was conducted to calculate the annual percentage change and average annual percentage change (AAPC). Results The number (cases) of prescriptions per 10,000 registrants increased from 0.07 in 2002 to 41.23 in 2015 (AAPC [95% CIs], 76.0% [61.6-91.7%]). The MME per 10,000 registrants increased from 15.06 in 2002 to 40,727.80 in 2015 (AAPC [95% CIs], 103.0% [78.2-131.3%]). The highest AAPC of prescriptions and MME per 10,000 registrants were observed in the elderly (60-69 years) and at general hospitals. Fentanyl prescription increased most rapidly among four opioids. Conclusion Consumption of opioids greatly increased in South Korea over 14 years.
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Affiliation(s)
- Joungyoun Kim
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Korea
| | - Sang-Jun Shin
- Department of Information & Statistics, Chungbuk National University, Cheongju, Korea
| | - Jihyun Yoon
- Department of Family Medicine, Yongin Severance Hospital, Yonsei University, Yongin, Korea
| | - Hyeong-Seop Kim
- Clinical Trials Center, Severance Hospital, Yonsei University Health System, Seoul, Korea
| | - Jae-Woo Lee
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Ye-Seul Kim
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Yongwhan Kim
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Hyo-Sun You
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Hee-Taik Kang
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Korea.,Chungbuk National University College of Medicine, Cheongju, Korea, Cheongju, Korea
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38
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Häuser W, Morlion B. Authors reply to the comment of Bäckryd et al. Eur J Pain 2022; 26:1176. [DOI: 10.1002/ejp.1925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Winfried Häuser
- Department Psychosomatic Medicine and Psychotherapy Technische Universitat München Munich Germany
| | - Bart Morlion
- Center for Algology & Pain Management University Hospitals Leuven Leuven Belgium
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39
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Delaney SR, Tacker DH, Snozek CLH. The North American opioid epidemic: opportunities and challenges for clinical laboratories. Crit Rev Clin Lab Sci 2022; 59:309-331. [PMID: 35166639 DOI: 10.1080/10408363.2022.2037122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Since 1999, the opioid epidemic in North America has resulted in over 1 million deaths, and it continues to escalate despite numerous efforts in various arenas to combat the upward trend. Clinical laboratories provide drug testing to support practices such as emergency medicine, substance use disorder treatment, and pain management; increasingly, these laboratories are collaborating in novel partnerships including drug-checking services (DCS) and multidisciplinary treatment teams. This review examines drug testing related to management of licit and illicit opioid use, new technologies and test strategies employed by clinical laboratories, barriers hindering laboratory response to the opioid epidemic, and areas for improvement and standardization within drug testing. Literature search terms included combinations of "opioid," "opiate," "fentanyl," "laboratory," "epidemic," "crisis," "mass spectrometry," "immunoassay," "drug screen," "drug test," "guidelines," plus review of PubMed "similar articles" and references within publications. While immunoassay (IA) and point-of-care (POC) test options for synthetic opioids are increasingly available, mass spectrometry (MS) platforms offer the greatest flexibility and sensitivity for detecting novel, potent opioids. Previously reserved as a second-tier application in most drug test algorithms, MS assays are gaining a larger role in initial screening for specific patients and DCS. However, there are substantial differences among laboratories in terms of updating test menus, algorithms, and technologies to meet changing clinical needs. While some clinical laboratories lack the resources and expertise to implement MS, many are also slow to adopt available IA and POC tests for newer opioids such as fentanyl. MS-based testing also presents challenges, including gaps in available guidance for assay validation and ongoing performance assessment that contribute to a dramatic lack of standardization among laboratories. We identify opportunities for improvement in laboratory operations, reporting, and interpretation of drug test results, including laboratorian and provider education and laboratory-focused guidelines. We also highlight the need for collaboration with providers, assay and instrument manufacturers, and national organizations to increase the effectiveness of clinical laboratory and provider efforts in preventing morbidity and mortality associated with opioid use and misuse.
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Affiliation(s)
- Sarah R Delaney
- Department of Laboratory Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Danyel H Tacker
- Department of Pathology, Anatomy, and Laboratory Medicine, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Christine L H Snozek
- Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Phoenix, AZ, USA
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40
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Bäckryd E, Heilig M, Hoffmann M. Comment on Häuser et al.: Medical use of opioids in Europe - Methodological concerns about data from the International Narcotics Control Board. Eur J Pain 2022; 26:937-938. [PMID: 35108428 PMCID: PMC9305831 DOI: 10.1002/ejp.1919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 01/23/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Emmanuel Bäckryd
- Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Markus Heilig
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences (BKV), Linköping University, Linköping, Sweden
| | - Mikael Hoffmann
- The NEPI foundation and Unit of Health Care Analysis, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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41
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Bonnet U, Specka M, Kanti AK, Scherbaum N. Differences between users' and addiction medicine experts' harm and benefit assessments of licit and illicit psychoactive drugs: Input for psychoeducation and legalization/restriction debates. Front Psychiatry 2022; 13:1041762. [PMID: 36465301 PMCID: PMC9709475 DOI: 10.3389/fpsyt.2022.1041762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 10/28/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND There is a lack of benefit/harm assessments of illicit and licit psychoactive substances performed by substance-dependent users in comparison to addiction medicine experts. METHODS We extended the analyses of substance harm/benefit assessments of German addiction medicine experts (N = 101), in parts reported recently in this journal [doi.org/10.3389/fpsyt.2020.59219], by the perspectives of substance-addicted persons. The same questionnaire as used for the abovementioned "experts-study" was handed out to inpatient detoxification or rehab treatment seeking German substance-dependent adults (N = 117) for a subsequent structured interview about harms and benefits of 33 new and traditional psychoactive substances comprising also prescription drugs. RESULTS AND DISCUSSION Both, users and experts, ranked the traditional illicit psychoactive substances heroin, cocaine and amphetamines within the top overall harm level group. Synthetic cannabinoids, alcohol and benzodiazepine were in a subordinate top-harm level position. Both cohorts also ranked methadone, nicotine and cannabis within the midrange and buprenorphine as well as psychotropic mushrooms within the lowest harm level positions. Experiences with prescription drugs (including opioidergic analgesics and gabapentinoids), cathinones, GHB, methamphetamine and methylphenidate was not prevalent in our user population. The same applied to barbiturates, propofol, kratom, ayahuasca with nearly zero assessments for each substance. The most user-experiences (>50% per assessed substance) were reported with nicotine, cannabis, alcohol, cocaine, heroin, amphetamine and methadone (core group). The user's overall harm ratings in terms of these psychoactive substances were similar to those of the experts with the exception of the methadone assessment which was rated by the experts to be significantly less harmful if compared with the users' estimation (supposed "treatment bias" of experts). The users' benefit ratings for the traditional illicit psychoactive substances, cannabis as well as for nicotine were significantly more positive in comparison to those of the experts (supposed "attraction bias" of users). Both, experts and users, ranked the harms arising from the use of alcohol or benzodiazepines (usually unregulated substances) higher than the harms caused by the use of methadone, cannabis or psychotropic mushrooms (regulated by most Western narcotic acts). Users attributed the most benefits to buprenorphine, methadone and cannabis. This might reflect a main limitation of the study as the data are from an user population comprising over 50% patients who sought detoxification-treatment of opiates where methadone and buprenorphine are usual transient medications (supposed "selection bias"). CONCLUSION This study addressed current trends of psychoactive substance abuse (e.g., synthetic cannabinoids, prescription drugs) and provides from both perspectives (that of the user and that of the addiction medicine experts) robust harm/benefit evaluations at least of a core group of psychoactive substances (traditional illicit psychoactive substances, cannabis, methadone, alcohol and nicotine). The results of this study can be valuable to the psychoeducation of substance-addicted individuals and to current restriction/legalization debates, especially in the Western-EU.
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Affiliation(s)
- Udo Bonnet
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Evangelisches Krankenhaus Castrop-Rauxel, Castrop-Rauxel, Germany - Academic Teaching Hospital of the University of Duisburg-Essen, Essen, Germany.,Department of Psychiatry and Psychotherapy, LVR-Hospital Essen, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Michael Specka
- Department of Psychiatry and Psychotherapy, LVR-Hospital Essen, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Ann-Kristin Kanti
- Department of Internal Medicine, Evangelisches Krankenhaus Castrop-Rauxel, Castrop-Rauxel, Germany - Academic Teaching Hospital of the University of Duisburg-Essen, Essen, Germany
| | - Norbert Scherbaum
- Department of Psychiatry and Psychotherapy, LVR-Hospital Essen, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
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42
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Lavergne J, Debin M, Blanchon T, Colizza V, Dassieu L, Gimenez L, Kengne-Kuetche C, Lapeyre-Mestre M, Dupouy J. Perceived risk of opioid use disorder secondary to opioid analgesic medication use by the general population in France. Eur J Pain 2021; 26:729-739. [PMID: 34958720 DOI: 10.1002/ejp.1901] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 11/15/2021] [Accepted: 12/19/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND In Europe and France, the use of opioid analgesic drugs has become widespread as an option for pain management. However, their use can lead to nonmedical use and/or opioid use disorder (OUD). This work aimed to assess the perceived risk of OUD secondary to opioid analgesic drugs use by the general population. METHODS We conducted a cross-sectional observational study using the GrippeNet web-based cohort, comprising about 10,000 French volunteers from the general population, using a self-administered questionnaire. The main outcome was the perceived risk of OUD secondary to opioid analgesic drugs use, assessed by a 4-item scale and modeled using logistic regression (backward procedure). RESULTS Among 5,046 French respondents, after adjustment, 65% believed that the use of analgesic drugs could likely or very likely lead to OUD. Factors associated with perception of a higher risk were being over 50 and having heard about opioids in the media. Previous opioid use and a high level of education decreased the perception of the risk. Among those having used opioids in the past two years (N = 1770), 71.1% reported being not at all concerned by this risk. The majority of the sample perceived the risk of OUD but those having already used opioid analgesics drugs expressed no concern about this risk for themselves. CONCLUSIONS This finding highlight the need to reinforce warning on the package insert documents, therapeutic education and collaborative care between the prescribing general practitioners and pharmacists to increase awareness of opioid medications users on the risk of OUD.
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Affiliation(s)
- Justine Lavergne
- Département Universitaire de Médecine Générale, Université de Toulouse; Faculté de Médecine, 133 route de Narbonne, 31063, Toulouse, France
| | - Marion Debin
- Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, F-75012, Paris, France
| | - Thierry Blanchon
- Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, F-75012, Paris, France
| | - Vittoria Colizza
- Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, F-75012, Paris, France
| | - Lise Dassieu
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, 850 rue Saint Denis, Montréal, QC, H2X0A9, Canada
| | - Laetitia Gimenez
- Département Universitaire de Médecine Générale, Université de Toulouse; Faculté de Médecine, 133 route de Narbonne, 31063, Toulouse, France.,CERPOP, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Charly Kengne-Kuetche
- Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, F-75012, Paris, France
| | - Maryse Lapeyre-Mestre
- CEIP-Addictovigilance, CIC 1436, Service de Pharmacologie Médicale et Clinique, Faculté de Médecine, 37 allées Jules Guesde, 31000, Toulouse, France
| | - Julie Dupouy
- Département Universitaire de Médecine Générale, Université de Toulouse; Faculté de Médecine, 133 route de Narbonne, 31063, Toulouse, France.,CERPOP, Université de Toulouse, Inserm, UPS, Toulouse, France
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43
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Mercadante S. Too much for some and too little for others. Ann Oncol 2021; 33:445. [PMID: 34958893 DOI: 10.1016/j.annonc.2021.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 11/29/2021] [Accepted: 12/21/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- S Mercadante
- Main regional center for pain relief and palliative/supportive care, La Maddalena Cancer center, Palermo, Italy.
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44
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45
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Jones W, Kaoser R, Fischer B. Patterns, trends and determinants of medical opioid utilization in Canada 2005-2020: characterizing an era of intensive rise and fall. Subst Abuse Treat Prev Policy 2021; 16:65. [PMID: 34521418 PMCID: PMC8438558 DOI: 10.1186/s13011-021-00396-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Into the 21st century, the conflation of high rates of chronic pain, systemic gaps in treatment availability and access, and the arrival of potent new opioid medications (e.g., slow-release oxycodone) facilitated strong increases in medical opioid dispensing in Canada. These persisted until post-2010 alongside rising opioid-related adverse (e.g., morbidity/mortality) outcomes. We examine patterns, trends and determinants of opioid dispensing in Canada, and specifically its 10 provinces, for the years 2005-2020. METHODS Raw data on prescription opioid dispensing were obtained from a large national community-based pharmacy database (IQVIA/Compuscript), converted into Defined-Daily-Doses/1,000 population/day for 'strong' and 'weak' opioid categories per standard methods. Dispensing by opioid category and formulations by province/year was assessed descriptively; regression analysis was applied to examine possible segmentation of over-time strong opioid dispensing. RESULTS All provinces reported starkly increasing strong opioid dispensing peaking 2011-2016, and subsequent marked declines. About half reported lower strong opioid dispensing in 2020 compared to 2005, with continuous inter-provincial differences of > 100 %; weak opioids also declined post-2011/12. Segmented regression suggests breakpoints for strong opioids in 2011/12 and 2015/16, coinciding with main interventions (e.g., selective opioid delisting, new prescribing guidelines) towards more restrictive opioid utilization control. CONCLUSIONS We characterized an era of marked rise and fall, while featuring stark inter-provincial heterogeneity in opioid dispensing in Canada. While little evidence for improvements in pain care outcomes exists, the starkly inverting opioid utilization have been associated with extensive population-level harms (e.g., misuse, morbidity, mortality) over-time. This national case study raises fundamental questions for opioid-related health policy and practice.
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Affiliation(s)
- Wayne Jones
- Centre for Applied Research in Mental Health and Addiction (CARMHA), Faculty of Health Sciences, Simon Fraser University, Suite 2400, 515 W. Hastings Street, British Columbia, Vancouver, Canada
| | - Ridhwana Kaoser
- Centre for Applied Research in Mental Health and Addiction (CARMHA), Faculty of Health Sciences, Simon Fraser University, Suite 2400, 515 W. Hastings Street, British Columbia, Vancouver, Canada
| | - Benedikt Fischer
- Centre for Applied Research in Mental Health and Addiction (CARMHA), Faculty of Health Sciences, Simon Fraser University, Suite 2400, 515 W. Hastings Street, British Columbia, Vancouver, Canada.
- Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Auckland, 1023, Grafton, New Zealand.
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, Canada.
- Department of Psychiatry, Federal University of São Paulo (UNIFESP), R. Sena Madureira, 1500 - Vila Clementino, São Paulo, Brazil.
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46
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Häuser W, Morlion B, Vowles KE, Bannister K, Buchser E, Casale R, Chenot JF, Chumbley G, Drewes AM, Dom G, Jutila L, O'Brien T, Pogatzki-Zahn E, Rakusa M, Suarez-Serrano C, Tölle T, Krčevski Škvarč N. European* clinical practice recommendations on opioids for chronic noncancer pain - Part 1: Role of opioids in the management of chronic noncancer pain. Eur J Pain 2021; 25:949-968. [PMID: 33655607 PMCID: PMC8248186 DOI: 10.1002/ejp.1736] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Opioid use for chronic non-cancer pain (CNCP) is complex. In the absence of pan-European guidance on this issue, a position paper was commissioned by the European Pain Federation (EFIC). METHODS The clinical practice recommendations were developed by eight scientific societies and one patient self-help organization under the coordination of EFIC. A systematic literature search in MEDLINE (up until January 2020) was performed. Two categories of guidance are given: Evidence-based recommendations (supported by evidence from systematic reviews of randomized controlled trials or of observational studies) and Good Clinical Practice (GCP) statements (supported either by indirect evidence or by case-series, case-control studies and clinical experience). The GRADE system was applied to move from evidence to recommendations. The recommendations and GCP statements were developed by a multiprofessional task force (including nursing, service users, physicians, physiotherapy and psychology) and formal multistep procedures to reach a set of consensus recommendations. The clinical practice recommendations were reviewed by five external reviewers from North America and Europe and were also posted for public comment. RESULTS The key clinical practice recommendations suggest: (a) first optimizing established non-pharmacological treatments and non-opioid analgesics and (b) considering opioid treatment if established non-pharmacological treatments or non-opioid analgesics are not effective and/or not tolerated and/or contraindicated. Evidence- and clinical consensus-based potential indications and contraindications for opioid treatment are presented. Eighteen GCP recommendations give guidance regarding clinical evaluation, as well as opioid treatment assessment, monitoring, continuation and discontinuation. CONCLUSIONS Opioids remain a treatment option for some selected patients with CNCP under careful surveillance. SIGNIFICANCE In chronic pain, opioids are neither a universal cure nor a universally dangerous weapon. They should only be used for some selected chronic noncancer pain syndromes if established non-pharmacological and pharmacological treatment options have failed in supervised pain patients as part of a comprehensive, multi-modal, multi-disciplinary approach to treatment. In this context alone, opioid therapy can be a useful tool in achieving and maintaining an optimal level of pain control in some patients.
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Affiliation(s)
- Winfried Häuser
- Department Internal Medicine 1, Klinikum Saarbrücken, Saarbrücken, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München, Munich, Germany
| | - Bart Morlion
- Center for Algology & Pain Management, University Hospitals Leuven, Leuven, Belgium
| | - Kevin E Vowles
- School of Psychology, Queen's University Belfast, Belfast, UK
| | - Kirsty Bannister
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Eric Buchser
- Pain Management and Neuromodulation Centre EHC Hospital, Morges, Switzerland
| | - Roberto Casale
- Neurorehabilitation Unit, Department of Rehabilitation, HABILITA, Bergamo, Italy
| | - Jean-François Chenot
- Department of General Practice, Institute for Community Medicine, University Medicine Greifswald, Germany
| | - Gillian Chumbley
- Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Asbjørn Mohr Drewes
- Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Denmark
| | - Geert Dom
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University, Antwerpen, Belgium
| | | | - Tony O'Brien
- College of Medicine & Health, University College Cork, Cork, Republic of Ireland
| | - Esther Pogatzki-Zahn
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster UKM, Munster, Germany
| | - Martin Rakusa
- Department of Neurology, University Medical Centre, Maribor, Slovenia
| | | | - Thomas Tölle
- Department of Neurology, Techhnische Universität München, München, Germany
| | - Nevenka Krčevski Škvarč
- Department of Anesthesiology, Intensive Care and Pain Treatment, Faculty of Medicine of University Maribor, Maribor, Slovenia
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