1
|
Kerckhove N, Delage N, Bertin C, Kuhn E, Cantagrel N, Vigneau C, Delorme J, Lambert C, Pereira B, Chenaf C, Authier N. Cross-sectional study of the prevalence of prescription opioids misuse in French patients with chronic non-cancer pain: An update with the French version of the POMI scale. Front Pharmacol 2022; 13:947006. [PMID: 36133827 PMCID: PMC9484362 DOI: 10.3389/fphar.2022.947006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
Public health issues related to chronic pain management and the risks of opioid misuse and abuse remain a challenge for practitioners. Data on the prevalence of disorders related to the use of prescribed opioids in patients suffering from chronic pain remains rather patchy, in particular because of the absence of a gold standard for their clinical assessment. We estimated the prevalence of prescription opioid misuse (POM), using a specific and validated opioid misuse scale (POMI-5F scale), in adults with chronic non-cancer pain. Nine-hundred-fifty-one (951) patients with opioids prescription and followed-up in pain clinics and addictology centers for chronic non-cancer pain (CNCP) completed the survey interview. The results suggest that 44.4% of participants have POM, accompanied by overuse (42.5%), use of opioids for effects other than analgesia (30.9%), withdrawal syndrome (65.7%), and craving (6.9%). The motivations cited for POM, apart from pain relief, were to calm down, relax and improve mood. POM was shown to be related to male sex (OR 1.52), young age (OR 2.21) and the presence of nociplastic pain (OR 1.62) of severe intensity (OR 2.31), codeine use (OR 1.72) and co-prescription of benzodiazepines (OR 1.59). Finally, despite the presence of three subgroups of misusers, no factor was associated with the intensity of misuse, reinforcing the view that distinguishing between strong and weak opioids is not appropriate in the context of use disorder. Almost half of patients with CNCP misuse their prescribed opioid. Practitioners should be attentive of profiles of patients at risk of POM, such as young, male patients suffering from severe nociplastic pain, receiving prescription for codeine and a co-prescription for benzodiazepine. We encourage French-speaking practitioners to use the POMI-5F scale to assess the presence of POM in their patients receiving opioid-based therapy. Clinical Trial Registrationclinicaltrials.gov, identifier NCT03195374
Collapse
Affiliation(s)
- Nicolas Kerckhove
- Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre d’Evaluation et de Traitement de la Douleur, Inserm, CHU Clermont-Ferrand, Neuro-Dol, Université Clermont Auvergne, Clermont-Ferrand, France
- Institut Analgesia, Université Clermont Auvergne, Clermont-Ferrand, France
- *Correspondence: Nicolas Kerckhove,
| | - Noémie Delage
- Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre d’Evaluation et de Traitement de la Douleur, Inserm, CHU Clermont-Ferrand, Neuro-Dol, Université Clermont Auvergne, Clermont-Ferrand, France
- Institut Analgesia, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Célian Bertin
- Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre d’Evaluation et de Traitement de la Douleur, Inserm, CHU Clermont-Ferrand, Neuro-Dol, Université Clermont Auvergne, Clermont-Ferrand, France
- Institut Analgesia, Université Clermont Auvergne, Clermont-Ferrand, France
- Observatoire Français des Médicaments Antalgiques (OFMA), CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Emmanuelle Kuhn
- Centre d'évaluation et d’information sur la Pharmacodépendance—Addictovigilance, CHU Nantes, Nantes, France
| | - Nathalie Cantagrel
- Centre d’Evaluation et de Traitement de la Douleur, CHU Toulouse, Toulouse, France
| | - Caroline Vigneau
- Centre d'évaluation et d’information sur la Pharmacodépendance—Addictovigilance, CHU Nantes, Nantes, France
| | - Jessica Delorme
- Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre d’Evaluation et de Traitement de la Douleur, Inserm, CHU Clermont-Ferrand, Neuro-Dol, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Céline Lambert
- Unité de Biostatistiques, DRCI, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Bruno Pereira
- Unité de Biostatistiques, DRCI, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Chouki Chenaf
- Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre d’Evaluation et de Traitement de la Douleur, Inserm, CHU Clermont-Ferrand, Neuro-Dol, Université Clermont Auvergne, Clermont-Ferrand, France
- Institut Analgesia, Université Clermont Auvergne, Clermont-Ferrand, France
- Observatoire Français des Médicaments Antalgiques (OFMA), CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Nicolas Authier
- Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre d’Evaluation et de Traitement de la Douleur, Inserm, CHU Clermont-Ferrand, Neuro-Dol, Université Clermont Auvergne, Clermont-Ferrand, France
- Institut Analgesia, Université Clermont Auvergne, Clermont-Ferrand, France
- Observatoire Français des Médicaments Antalgiques (OFMA), CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | | |
Collapse
|
2
|
Chahin M, Matosz S, Khalel I, Day S, Keruakous A. Pain Management in Oncology Patients Amidst the Opioid Epidemic: How To Minimize Non-Medical Opioid Use. Cureus 2021; 13:e19500. [PMID: 34912639 PMCID: PMC8666098 DOI: 10.7759/cureus.19500] [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] [Accepted: 11/11/2021] [Indexed: 11/05/2022] Open
Abstract
The opioid epidemic continues to be a significant public health concern. On the surface, it appears difficult to understate the profound consequences and unnecessary loss of life at the hands of the opioid crisis throughout the 2010s. This reality should not dissuade rigorous attention toward those who have suffered unnecessarily due to an overreaching backlash toward the opioid crisis. Oncology patients have been significantly impacted on both ends of the opioid crisis. Like other populations, cancer patients were first affected during the initial surge of opioid availability, prescription, and use at the beginning of the crisis, where opioid abuse and overdose negatively impacted cancer patient populations at similar rates as the general population. Yet, cancer patients were perhaps even more heavily affected during secondary events after the initial crisis, as opioid restrictions and the stigmatization, undoubtedly beneficial in many spaces, of opioid use became prevalent across the American society. During this second period of the opioid crisis (loosely from 2013 to the present day after the Veterans Health Administration Opioid Safety Initiative started), restrictions on opioids have significantly decreased the use and access of opioids for cancer patients. Management of pain, in general, is a complex topic, and cancer pain is no exception. Cancer patients may experience pain related to the disease itself, its treatment, or other comorbidities. This review aims to clarify the impact of reducing opioid use on cancer patients over the past eight years. We summarize the challenges facing providers as they attempt to manage cancer-related pain. Additionally, we propose tools for best practices to reduce the unnecessary suffering of cancer patients and protect against the overuse and abuse of opioids.
Collapse
Affiliation(s)
- Michael Chahin
- Department of Hematology and Oncology, Georgia Cancer Center at Augusta University, Augusta, USA
| | - Sabrina Matosz
- Department of Hematology and Oncology, Georgia Cancer Center at Augusta University, Augusta, USA
| | - Irene Khalel
- Internal Medicine, University of Alexandria, Faculty of Medicine, Alexandria, EGY
| | - Silas Day
- Hematology and Medical Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Amany Keruakous
- Department of Hematology and Oncology, Georgia Cancer Center at Augusta University, Augusta, USA
| |
Collapse
|
3
|
Philip C, Roy S, Eiden C, Soler M, Georgin F, Müller A, Picot MC, Donnadieu-Rigole H, Peyriere H. Opioid misuse in community pharmacy patients with chronic non-cancer pain. Br J Clin Pharmacol 2021; 88:2306-2314. [PMID: 34859478 DOI: 10.1111/bcp.15164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 09/03/2021] [Accepted: 11/16/2021] [Indexed: 12/01/2022] Open
Abstract
AIMS Community pharmacists could contribute to identify people misusing prescription opioids, which may be associated with hospitalizations, substance use disorders and death. This study investigated prescription opioid misuse in community pharmacy patients and the factors potentially associated with high Prescription Opioid Misuse Index (POMI) scores. METHODS In this cross-sectional study, pharmacy students asked patients with opioid prescriptions to fill in a questionnaire (including the POMI) in community pharmacies in a French region, in April 2019. Eligible patients were adults with chronic non-cancer pain who consented to participate. RESULTS In total, 414 patients (62.4% women; mean age: 58.00 years ± 16.00) were included. The prescribed opioids were mainly weak opioids (73.2%; paracetamol/tramadol: 35%). Strong opioids (32.6%) included oxycodone (11.95%), fentanyl (9%) and morphine (9%). The median morphine milligram equivalent (MME) was 40 mg/day (IQR25-75 : 20-80). The POMI score (0 to 6) was ≥4 in 16% of patients who were younger (P < .01), more urban (P = .03), with higher pain visual analogue scale (VAS) score (P < .01) and MME (P < .01), and treated more frequently with strong opioids (P = .04). In multivariate analysis, age (ORfor 10y : 0.68 (95% CI: 0.56-0.82, P < .0001)), VAS (OR2units : 1.78 (95% CI: 1.26-2.40, P = .0008)), and MME (>100 mg, OR: 2.65 (95% CI: 1.14-4.41, P = .0194)) were significantly associated with POMI scores ≥4. CONCLUSIONS The high proportion of patients with high POMI scores underlines the interest of prescription opioid misuse screening in community pharmacies, in order to help these patients and refer them to pain specialists, if needed.
Collapse
Affiliation(s)
- Camille Philip
- Département de Pharmacologie Médicale et Toxicologie, Centre d'Addictovigilance, Université de Montpellier, CHU, Montpellier, France
| | - Sophie Roy
- Département de Pharmacologie Médicale et Toxicologie, Centre d'Addictovigilance, Université de Montpellier, CHU, Montpellier, France
| | - Céline Eiden
- Département de Pharmacologie Médicale et Toxicologie, Centre d'Addictovigilance, Université de Montpellier, CHU, Montpellier, France
| | - Marion Soler
- Département de l'Information médicale - Université de Montpellier, CHU, Montpellier, France
| | - François Georgin
- Département de Physiologie et Pharmacie expérimentale, Faculté de Pharmacie, Université de Montpellier, France
| | - Agnès Müller
- Département de Physiologie et Pharmacie expérimentale, Faculté de Pharmacie, Université de Montpellier, France
| | - Marie-Christine Picot
- Département de l'Information médicale - Université de Montpellier, CHU, Montpellier, France
| | - Helene Donnadieu-Rigole
- Département d'Addictologie et complications somatiques des addictions, Université de Montpellier, CHU, Montpellier, France.,Pathogenesis and Control of Chronic Infections, Université de Montpellier, INSERM, EFS, Université de Montpellier, Montpellier, France
| | - Hélène Peyriere
- Département de Pharmacologie Médicale et Toxicologie, Centre d'Addictovigilance, Université de Montpellier, CHU, Montpellier, France.,Pathogenesis and Control of Chronic Infections, Université de Montpellier, INSERM, EFS, Université de Montpellier, Montpellier, France
| |
Collapse
|
4
|
Analgesic Opioid Misuse and Opioid Use Disorder among Patients with Chronic Non-Cancer Pain and Prescribed Opioids in a Pain Centre in France. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042097. [PMID: 33670004 PMCID: PMC7926319 DOI: 10.3390/ijerph18042097] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/13/2021] [Accepted: 02/15/2021] [Indexed: 02/06/2023]
Abstract
(1) Background: Chronic non-cancer pain (CNCP) remains a public health challenge around the world. Opioids (PO) have been increasingly used in the treatment of CNCP in the last 20 years. This study aimed to assess the prevalence of opioid misuse and prescribed-opioid use disorder (p-OUD) among patients with CNCP in a pain centre in France, and to analyse risk factors for moderate or severe p-OUD. (2) Method: A cross-sectional study was conducted, including patients consulting for pain management in the pain centre of Brest University Hospital. A self-questionnaire was administered (sociodemographic data, medical data, PO misuse, and p-OUD according the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM 5) criteria). Descriptive, univariate, and multivariate analyses were conducted, together with a principal component analysis, in order to identify factors associated with p-OUD. (3) Results: In total, 115 patients were included, the majority of whom were women, with a mean age of 52 years old [18–82]; 64.3% (n = 74) had a current prescription for opioid analgesics (weak or strong). In this group, 56.7% (n = 42) had no or only mild p-OUD and 43.3% (n = 32) had current moderate or severe p-OUD. Patients with moderate or severe p-OUD were more likely to have a current antidepressant prescription, to have had psychotherapy, to currently use strong opioids and oxycodone, and to report taking more frequent doses than prescribed and feeling dependent. (4) Conclusions: We showed that the prevalence of current moderate/severe p-OUD concerned 43.3% of the patients with a CNCP seeking treatment in a pain centre. According to these results, several measures are relevant in managing p-OUD among patients with CNCP.
Collapse
|
5
|
Havens JR, Knudsen HK, Strickland JC, Young AM, Babalonis S, Lofwall MR, Walsh SL. Recent Increase in Methamphetamine Use in a Cohort of Rural People Who Use Drugs: Further Evidence for the Emergence of Twin Epidemics. Front Psychiatry 2021; 12:805002. [PMID: 35069295 PMCID: PMC8777215 DOI: 10.3389/fpsyt.2021.805002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/16/2021] [Indexed: 01/14/2023] Open
Abstract
Appalachian Kentucky was at the epicenter of the prescription opioid epidemic in the early 2000's. As we enter the third decade of the epidemic, patterns have begun to emerge as people who use drugs (PWUD) transition from use of opioids to other drugs. The purpose of this analysis was to examine longitudinal changes in methamphetamine use in an ongoing cohort of rural people who use drugs (PWUD) in Appalachian Kentucky. All but five of the cohort participants (N = 503) reported nonmedical prescription opioid use (NMPOU) at baseline and those 498 are included in this longitudinal analysis encompassing eight waves of data (2008-2020). Past 6-month use of methamphetamine was the dependent variable. Given the correlated nature of the data, mixed effects logistic regression was utilized to examine changes in methamphetamine use over time. Significant increases in methamphetamine use were observed over the past decade in this cohort of PWUD, especially in recent years (2017-2020). Prevalence of recent use at baseline and each of the follow-up visits was as follows: 9.4, 5.6, 5.0, 5.4, 8.1, 6.8, 6.9, and 33.1%, respectively (p < 0.001). On the contrary, significant reductions in NMPO and heroin use were observed in the same time period. The odds of methamphetamine use at the most recent visit were 25.8 times greater than at baseline (95% CI: 14.9, 44.6) and 52.6% of those reporting methamphetamine use reported injecting the drug. These results provide further evidence of "twin epidemics" of methamphetamine use among NMPOU. While problematic on several fronts, of particular concern is the lack of effective treatment options for methamphetamine use disorder. As policies around the opioid epidemic continue to evolve, particular attention should be paid to the surge in stimulant use in opioid-endemic areas.
Collapse
Affiliation(s)
- Jennifer R Havens
- Department of Behavioral Science, Center on Drug and Alcohol Research, University of Kentucky College of Medicine, Lexington, KY, United States
| | - Hannah K Knudsen
- Department of Behavioral Science, Center on Drug and Alcohol Research, University of Kentucky College of Medicine, Lexington, KY, United States
| | - Justin C Strickland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - April M Young
- Department of Behavioral Science, Center on Drug and Alcohol Research, University of Kentucky College of Medicine, Lexington, KY, United States.,Department of Epidemiology, University of Kentucky College of Public Health, Lexington, KY, United States
| | - Shanna Babalonis
- Department of Behavioral Science, Center on Drug and Alcohol Research, University of Kentucky College of Medicine, Lexington, KY, United States
| | - Michelle R Lofwall
- Department of Behavioral Science, Center on Drug and Alcohol Research, University of Kentucky College of Medicine, Lexington, KY, United States
| | - Sharon L Walsh
- Department of Behavioral Science, Center on Drug and Alcohol Research, University of Kentucky College of Medicine, Lexington, KY, United States
| |
Collapse
|
6
|
Miller CS, Ke C, Witty JT, Nagarajan R. Prescribing patterns of opioid analgesics in a dental setting: 2013-2018. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 130:402-410. [PMID: 32660860 DOI: 10.1016/j.oooo.2020.06.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/11/2020] [Accepted: 06/14/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Analgesic prescribing patterns are influenced by internal and external factors. Understanding these factors could help improve prescribing practices. STUDY DESIGN We conducted a retrospective analysis of electronic health records with regard to analgesic prescriptions written from 2013 through 2018 at the University of Kentucky College of Dentistry. Deidentified information (age, gender, dental procedures, analgesic drug, quantity, and refills) were recorded and studied with respect to national guidelines and recent state legislation using the χ2 test, analysis of variance, logistic regression, and multiple linear regression. RESULTS Opioids comprised 74.9% of the 17,099 analgesic prescriptions written. Extractions were most commonly associated with opioid prescriptions. Multivariate analysis showed that (1) older patients were more likely to receive an opioid prescription (P < .01) but with fewer pills (P < .01); (2) surgical extractions were associated with a lower opioid prescription rate (P < .01) but more opioid pills per prescription compared with nonsurgical extractions (P < .01); and (3) the odds of receiving an opioid prescription and the number of opioid pills prescribed decreased over year after release of the national guideline (P < .01) and after enactment of state legislation (P < .01). CONCLUSIONS Regulations and guidelines were associated with reduction in opioid prescriptions.
Collapse
Affiliation(s)
- Craig S Miller
- Division of Oral Diagnosis, Oral Medicine and Oral Radiology, University of Kentucky, College of Dentistry, Lexington, KY, USA.
| | - Chenlu Ke
- Department of Statistical Sciences and Operations Research, College of Humanities and Sciences, Virginia Commonwealth University, Richmond, Virginia
| | - Jeffrey T Witty
- Information Technology, University of Kentucky, College of Dentistry, Lexington, KY, USA
| | - Radha Nagarajan
- Center for Oral and Systemic Health, Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, WI, USA
| |
Collapse
|