Innovative Approaches to Educating Future Clinicians about Opioids, Pain, Addiction and Health Policy

A Comprehensive Collection of Pain and Opioid Use Disorder Compounds for High-Throughput Screening and Artificial Intelligence-Driven Drug Discovery

As part of the NIH Helping to End Addiction Long-term (HEAL) Initiative, the National Center for Advancing Translational Sciences is dedicated to the development of new pharmacological tools and investigational drugs for managing and treating pain as well as the prevention and treatment of opioid misuse and addiction. In line with these objectives, we created a comprehensive, annotated small molecule library including drugs, probes, and tool compounds that act on published pain- and addiction-relevant targets. Nearly 3000 small molecules associated with approximately 200 known and hypothesized HEAL targets have been assembled, curated, and annotated in one collection. Physical samples of the library compounds have been acquired and plated in 1536-well format, enabling a rapid and efficient high-throughput screen against a wide range of assays. The creation of the HEAL Targets and Compounds Library, coupled with an integrated computational platform for AI-driven machine learning, structural modeling, and virtual screening, provides a valuable source for strategic drug repurposing, innovative profiling, and hypothesis testing of novel targets related to pain and opioid use disorder (OUD). The library is available to investigators for screening pain and OUD-relevant phenotypes.

Assessing pain in persons with opioid use disorder: Approaches, techniques and special considerations

Pain and opioid use disorder (OUD) are inextricably linked, as the former can be a risk factor for the development of the latter, and over a third of persons with OUD suffer concomitant chronic pain. Assessing pain among people with OUD is challenging, because ongoing opioid use brings changes in pain responses and most pain assessment tools have not been validated for this population. In this narrative review, we discuss the fundamentals of pain assessment for populations with OUD. First, we describe the biological, psychological and social aspects of the pain experience among people with OUD, as well as how opioid-related phenomena may contribute to the pain experience in this population. We then review methods to assess pain, including (1) traditional self-reported methods, such visual analogue scales and structured questionnaires; (2) behavioural observations and physiological indicators; (3) and laboratory-based approaches, such as quantitative sensory testing. These methods are considered from a perspective that encompasses both pain and OUD. Finally, we discuss strategies for improving pain assessment in persons with OUD and implications for future research, including educational strategies for multidisciplinary teams. We highlight the substantial gaps that persist in this literature, particularly regarding the applicability of current pain assessment methods to persons with OUD, as well as the generalizability of the existing results from adjacent populations on chronic opioid therapy but without OUD. As research linking pain and OUD evolves, considering the needs of diverse populations with complex psychosocial backgrounds, clinicians will be better equipped to reduce these gaps.

Substance Use Disorder and Suicidal Ideation in Rural Maryland

Background

Rural areas in the United States have been disproportionately burdened with high rates of substance use, mental health challenges, chronic stress, and suicide behaviors. Factors such as a lack of mental health services, decreased accessibility to public health resources, and social isolation contribute to these disparities. The current study explores risk factors to suicidal ideation, using emergency room discharge data from Maryland.

Methods

The current study used data from the Healthcare Cost and Utilization Project (HCUP) State Emergency Department Databases (SEDD) from the State of Maryland. Logistic regression was used to assess the association between ICD-10 coded opioid use disorder, alcohol use disorder, cannabis use disorder, major depressive disorder, and the outcome variable of suicidal ideation discharge. We controlled for income, race, age, and gender.

Results

Lifetime major depressive disorder diagnosis (odds ration [OR] = 79.30; 95% confidence interval [CI] 51.91-121.15), alcohol use disorder (OR = 6.87; 95% CI 4.97-9.51), opioid use disorder (OR = 5.39; 95% CI 3.63-7.99), and cannabis use disorder (OR = 2.67; 95% CI 1.37-5.18) were all positively associated with suicidal ideation.

Conclusions

The study highlights the strong link between prior substance use disorder, depression, and suicidal ideation visit to the emergency room, indicating the need for prevention and intervention, particularly among those in rural areas where the burden of suicidal ideation and chronic stress are high. As health disparities between rural and urban areas further widened during the COVID-19 pandemic, there is an urgent need to address these issues.

Influences on advance practice nursing education to prescribe medications for opioid use disorder

BACKGROUND

Opioid misuse is a major public health concern in the United States. Opioid agonist medications are evidence-based treatments for opioid use disorders (OUD) that can be prescribed by advance practice registered nurses (APRNs) with prescriptive authority and appropriate training.

PURPOSE

Article examines factors influencing preparation to provide medications for opioid use disorder (MOUD) in APRN education.

METHODS

Data from semi-structured interviews addressing the role of education in preparing APRNs to provide MOUD were grouped into key themes using thematic analysis. Data were collected in a mixed methods study in four states with high opioid overdose deaths whose main findings were previously published.

FINDINGS

Two overarching themes emerged: "addressing attitudes" and "curriculum change." Sub-themes include affective barriers to providing OUD treatment; motivation to respond to the OUD crisis; and attitude change through experience with MOUD.

DISCUSSION AND CONCLUSION

APRNs can play a key role in reducing the harms caused by OUD. Attention to attitudinal issues, such as stigma, toward people using opioids is important in educating APRNs about providing MOUD.

Healthcare Utilization of Patients with Opioid Use Disorder in US Hospitals from 2016 to 2019: Focusing on Racial and Regional Variances

BACKGROUND

There is a lack of US population-based research on healthcare utilization differences caused by opioid misuse.

OBJECTIVE

The aim of this study was to explore disparities in healthcare utilization by type of opioid use disorder, race, region, and other patient factors for a more targeted prevention and treatment program.

METHODS

The National Inpatient Sample of the United States was used to identify patients with opioid use disorder (n = 101,231, weighted n = 506,155) from 2016 to 2019. Type of opioid use disorder was defined as opioid dependence/unspecified use, adverse effects of opioids, opioid misuse, and opioid poisoning (also known as overdose). We examined the sample characteristics and the association between type of disorder, racial and regional variables, and healthcare utilization, measured by hospital charges and length of stay. The multivariate survey linear regression model was used.

RESULTS

Among 506,155 patients, most were categorized as opioid dependence/unspecified use (56.3%) and opioid poisoning (42.7%). The number of opioid use disorder patients during the study decreased; however, overall total charges and length of stay continuously increased. Survey linear results showed that opioid poisoning, adverse effects, and abuse were associated with higher hospital charges than opioid dependence; however, length of stay was significantly lower for these groups. White patients compared with minorities, and West, Northeast, and South regions were associated with higher hospital charges and length of stay.

CONCLUSION

Significant differences in healthcare utilization exist between type of disorder, race, and region. Such findings illustrate that tailored treatment regimens are required to bridge the gaps in care and combat the opioid crisis. Minorities with opioid use disorder utilize healthcare the least, possibly because of affordability, and need culturally sensitive and financially feasible treatment options.

A Cross-Sectional Survey Exploring Nursing Students' Knowledge and Attitudes Regarding Opioids and the Opioid Epidemic

BACKGROUND

The opioid epidemic continues to be a serious public health crisis in the United States. One way to address this issue is to effectively educate future healthcare providers, especially nurses, who play a key role in managing pain and improving opioid-related outcomes.

METHODS

A 34-item electronic survey was administered to traditional baccalaureate student nurses at a large, public University School of Nursing. The survey was used to assess participant demographics, general knowledge, and attitudes regarding opioids and the opioid epidemic, and relevant personal and professional experiences. Quantitative responses were analyzed using descriptive statistics, ANOVAs, and logistic regression; free-text responses were categorized by frequency of keywords.

RESULTS

In all, 134 students (response rate 42.3%) completed the survey. Increases in student opioid knowledge and confidence scores over the 4 years were statistically significant (p< .001). General opioid attitudes were primarily negative (n = 70; 52.5%) or neutral (n = 54; 40.3%), and few students (n = 12; 9.0%) reported positive experiences caring for patients with substance use disorders. Free-text responses revealed that nursing students are eager to contribute to the conversation regarding how to address this critical public health issue and recognize they have a key role to play in safely supporting patients coping with pain.

CONCLUSIONS

Although opioid knowledge and confidence scores were higher for 4th year compared with 1st year nursing students, there is room for continued improvement. Curricula and clinical experiences must thoughtfully integrate opioid and pain management content longitudinally across all years of a nursing program to optimize care for both patients in pain and those coping with substance use disorders.