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Franz B, Dhanani LY, Hall OT, Brook DL, Fenstemaker C, Simon JE, Miller WC. Buprenorphine misinformation and willingness to treat patients with opioid use disorder among primary care-aligned health care professionals. Addict Sci Clin Pract 2024; 19:7. [PMID: 38243307 PMCID: PMC10797921 DOI: 10.1186/s13722-024-00436-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 01/05/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Buprenorphine is a highly effective medication for opioid use disorder that is underused by health care professionals (HCPs). Medications for opioid use disorder (MOUD) misinformation may be an important barrier to buprenorphine access, but most implementation strategies have aimed to reduce negative attitudes towards patients with opioid use disorder (OUD) rather than misinformation specific to buprenorphine use. In this study, we assessed the degree to which HCPs endorsed misinformation related to buprenorphine, and whether this is associated with willingness to provide care to patients with OUD. METHODS In September-December of 2022, we surveyed HCPs practicing in Ohio (n = 409). Our primary outcomes included a previously validated 5-item measure of HCP willingness to treat patients with OUD, and three other measures of willingness. Our key independent variable was a study-developed 5-item measure of endorsement of misinformation related to buprenorphine, which assessed beliefs in buprenorphine's efficacy in managing withdrawal symptoms and reducing overdose deaths as well as beliefs about the role of buprenorphine in achieving remission. We computed descriptive and bivariable statistics and fit regression models predicting each outcome of interest. RESULTS On average, HCPs scored 2.34 out of 5.00 (SD = 0.80) on the composite measure of buprenorphine misinformation. 48.41% of participants endorsed at least one piece of misinformation. The most endorsed items were that buprenorphine is ineffective at reducing overdose deaths (M = 2.75, SD =0 .98), and that its use substitutes one drug for another (M = 2.41, SD = 1.25). HCP endorsement of buprenorphine misinformation significantly and negatively predicted willingness to work with patients with OUD (b = - 0.34; 95% CI - 0.46, - 0.21); intentions to increase time spent with this patient population (b = - 0.36; 95% CI - 5.86, - 1.28); receipt of an X-waiver (OR = 0.54, 95% CI 0.38, 0.77); and intention to get an X-waiver (OR: 0.56; 95% CI: 0.33-0.94). CONCLUSIONS Misinformation is common among HCPs and associated with lower willingness to treat patients with OUD. Implementation strategies to increase MOUD use among HCPs should specifically counter misinformation related to buprenorphine. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov, NCT05505227. Registered 17 August 2022, https://clinicaltrials.gov/ct2/show/NCT05505227.
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Affiliation(s)
- Berkeley Franz
- Ohio University Heritage College of Osteopathic Medicine, Department of Social Medicine, Ohio University Athens, Heritage Hall 1, Athens, OH, 45701-2979, USA.
- Appalachian Institute to Advance Health Equity Science, Athens, OH, USA.
| | - Lindsay Y Dhanani
- Rutgers University School of Management and Labor Relations, Piscataway, NJ, USA
| | - O Trent Hall
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Daniel L Brook
- Ohio State University College of Public Health, Columbus, OH, USA
| | - Cheyenne Fenstemaker
- Ohio University Heritage College of Osteopathic Medicine, Department of Social Medicine, Ohio University Athens, Heritage Hall 1, Athens, OH, 45701-2979, USA
- Appalachian Institute to Advance Health Equity Science, Athens, OH, USA
| | - Janet E Simon
- Ohio University College of Health Sciences and Professions, Athens, OH, USA
| | - William C Miller
- Gillings School of Public Health , University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
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Banner D, Cassidy D, Appleby C, Dolan S, Freeman S, Klassen-Ross T, Ghag K. Chronic scrotal content pain: the experiences of patients undergoing microsurgical spermatic cord denervation. Ther Adv Urol 2023; 15:17562872231196685. [PMID: 37767052 PMCID: PMC10521267 DOI: 10.1177/17562872231196685] [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: 12/12/2022] [Accepted: 08/03/2023] [Indexed: 09/29/2023] Open
Abstract
Background Chronic scrotal content pain, sometimes referred to as chronic orchialgia, is a common urological condition that gives rise to persistent and often severe painful stimuli to the scrotum and surrounding structures. Despite its relative commonality, accounting for over 2% of urological visits, chronic scrotal content pain is complex to manage and patients may be required to access multiple providers and undergo invasive procedures, including microsurgical spermatic cord denervation (MSCD) surgery. Objective The objective of this study was to understand the experiences and perspectives of persons with chronic scrotal content pain and accessing MSCD surgery. Design An exploratory qualitative design, guided by interpretive description and integrated knowledge translation, was adopted. Methods We conducted in-depth qualitative interviews with six patients with chronic scrotal content pain who underwent MSCD surgery in a surgical center in Western Canada. Data were analyzed thematically. Results Analysis of the study data resulted in three core themes: living with chronic scrotal content pain, quality of life, and MSCD procedure and outcomes. We highlight the debilitating nature of pain and the broad impacts upon health, quality of life, and social functioning. Participants described how MSCD surgery offered an effective solution for persistent and debilitating pain. For the participants, MSCD surgery offered hope and the chance to regain their normality. Conclusion For those with chronic scrotal content pain, access to a pain specialist, along with the adoption of a biopsychosocial approach to pain and early access to MSCD surgery, may improve patient experiences and outcomes. Considering the high prevalence of urological pain, greater interdisciplinary care is needed in order to support more effective and timely management.
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Affiliation(s)
- Davina Banner
- School of Nursing, University of Northern British Columbia, 3333 University Way, Prince George, BC V2N4Z9, Canada
| | - Darby Cassidy
- Cassidy Urology Clinic, Prince George, BC, Canada (Principal Knowledge-User)
| | - Colin Appleby
- Northern Medical Program, University of Northern British Columbia, Prince George, BC, Canada
| | - Shayna Dolan
- School of Nursing, University of Northern British Columbia, Prince George, BC, Canada
| | - Shannon Freeman
- School of Nursing, University of Northern British Columbia, Prince George, BC, Canada
| | - Tammy Klassen-Ross
- School of Health Sciences, Senior Instructor, University of Northern British Columbia, Prince George, BC, Canada
| | - Kiranpreet Ghag
- School of Nursing, University of Northern British Columbia, Prince George, BC, Canada
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Yoga & Pilates for those with chronic pain: A pilot study among women in substance use rehabilitation. J Bodyw Mov Ther 2022. [DOI: 10.1016/j.jbmt.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bulls HW, Chu E, Goodin BR, Liebschutz JM, Wozniak A, Schenker Y, Merlin JS. Framework for opioid stigma in cancer pain. Pain 2022; 163:e182-e189. [PMID: 34010940 PMCID: PMC8589872 DOI: 10.1097/j.pain.0000000000002343] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/11/2021] [Indexed: 02/03/2023]
Abstract
ABSTRACT Millions of patients with cancer pain are treated with prescription opioids each year. However, efforts to mitigate the ongoing opioid crisis result in unintended consequences with opioid pain management, including opioid stigma. Emerging research indicates that opioid stigma is problematic in patients with cancer, but few studies have examined contributors to and impacts of opioid stigma in this population. To guide future research in this area, we propose a conceptual framework-the opioid stigma framework (OSF)-with which to understand and improve opioid stigma in patients with cancer pain. Development of the OSF was guided by a literature review of stigma in health-related conditions, adaptation of the existing Health Stigma and Discrimination Framework, a topical review of challenges related to opioid cancer pain management, and author expertise in cancer, pain, and opioid prescribing. The proposed OSF highlights 5 domains: (1) contributors to opioid stigma, or factors that increase the likelihood that a patient will experience opioid stigma; (2) intersecting stigmas, or the convergence of multiple stigmatized identities within a patient; (3) stigma manifestations, or the ways opioid stigma is manifested in patients, clinicians, and the community; (4) proximal outcomes, or the immediate consequences of opioid stigma in patients; and (5) long-term impacts in patients. The OSF provides 2 main avenues to facilitate future research: (1) providing a framework to explore the mechanisms that underlie opioid stigma and its impact on cancer pain management and (2) supporting the development of targeted, tailored interventions to eliminate opioid stigma.
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Affiliation(s)
- Hailey W. Bulls
- Section of Palliative Care and Medical Ethics and
Palliative Research Center (PaRC), Division of General Internal Medicine, Department
of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Edward Chu
- Department of Medicine & Molecular Pharmacology, Albert
Einsten Cancer Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Burel R. Goodin
- Department of Psychology, University of Alabama at
Birmingham, Birmingham, AL, USA
| | - Jane M. Liebschutz
- Division of General Internal Medicine, Center for Research
on Health Care, Department of Medicine, University of Pittsburgh, Pittsburgh, PA,
USA
| | - Antoinette Wozniak
- Division of Hematology/Oncology, Department of Medicine,
University of Pittsburgh, Pittsburgh, PA, USA
| | - Yael Schenker
- Section of Palliative Care and Medical Ethics and
Palliative Research Center (PaRC), Division of General Internal Medicine, Department
of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jessica S. Merlin
- Section of Palliative Care and Medical Ethics and
Palliative Research Center (PaRC), Division of General Internal Medicine, Department
of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Adalbert JR, Ilyas AM. A focus on the future of opioid prescribing: implementation of a virtual opioid and pain management module for medical students. BMC MEDICAL EDUCATION 2022; 22:18. [PMID: 34991556 PMCID: PMC8733773 DOI: 10.1186/s12909-021-03058-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 11/26/2021] [Indexed: 05/05/2023]
Abstract
BACKGROUND The United States opioid epidemic is a devastating public health crisis fueled in part by physician prescribing. While the next generation of prescribers is crucial to the trajectory of the epidemic, medical school curricula designated to prepare students for opioid prescribing (OP) and pain management is often underdeveloped. In response to this deficit, we aimed to investigate the impact of an online opioid and pain management (OPM) educational intervention on fourth-year medical student knowledge, attitudes, and perceived competence. METHODS Graduating students completing their final year of medical education at Sidney Kimmel Medical College of Thomas Jefferson University were sent an e-mail invitation to complete a virtual OPM module. The module consisted of eight interactive patient cases that introduced topics through a case-based learning system, challenging students to make decisions and answer knowledge questions about the patient care process. An identical pre- and posttest were built into the module to measure general and case-specific learning objectives, with responses subsequently analyzed using the Wilcoxon matched-pairs signed-rank test. RESULTS Forty-three students (19% response rate) completed the module. All median posttest responses ranked significantly higher than paired median pretest responses (p < 0.05). Comparing the paired overall student baseline score to module completion, median posttest ranks (Mdn = 206, IQR = 25) were significantly higher than median pretest ranks (Mdn = 150, IQR = 24) (p < 0.001). Regarding paired median Perceived Competence Scale metrics specifically, perceived student confidence, capability, and ability in opioid management increased from "disagree" (2) to "agree" (4) (p < 0.001), and student ability to meet the challenge of opioid management increased from "neither agree nor disagree" (3) to "agree" (4) (p < 0.001). Additionally, while 77% of students reported receiving OP training in medical school, 21% reported no history of prior training. CONCLUSION Implementation of a virtual, interactive module with clinical context is an effective framework for improving the OPM knowledge, attitudes, and perceived competence of fourth-year medical students. This type of intervention may be an important method for standardizing and augmenting the education of future prescribers across multiple institutions.
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Affiliation(s)
- Jenna R Adalbert
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, USA.
- Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Asif M Ilyas
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, USA
- Rothman Orthopaedic Institute Foundation for Opioid Research & Education, Philadelphia, USA
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Bednarczyk EM, Blondell RD, Wahler RG, Fiebelkorn KD, Waghmarae R, Lu C, Rogler BA, Dunn TE. A large‐scale, online, multiprofessional opioid prescriber training program. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Edward M. Bednarczyk
- Department of Pharmacy Practice School of Pharmacy and Pharmaceutical Sciences, University at Buffalo Buffalo New York USA
| | - Richard D. Blondell
- Department of Family Medicine Jacobs School of Medicine and Biomedical Sciences, University at Buffalo Buffalo New York USA
| | - Robert G. Wahler
- Department of Pharmacy Practice School of Pharmacy and Pharmaceutical Sciences, University at Buffalo Buffalo New York USA
| | - Karl D. Fiebelkorn
- Department of Pharmacy Practice School of Pharmacy and Pharmaceutical Sciences, University at Buffalo Buffalo New York USA
| | - Romanth Waghmarae
- Department of Pharmacy Practice School of Pharmacy and Pharmaceutical Sciences, University at Buffalo Buffalo New York USA
| | - Chi‐Hua Lu
- Department of Pharmacy Practice School of Pharmacy and Pharmaceutical Sciences, University at Buffalo Buffalo New York USA
| | - Barbara A. Rogler
- Department of Pharmacy Practice School of Pharmacy and Pharmaceutical Sciences, University at Buffalo Buffalo New York USA
| | - Terry E. Dunn
- Department of Pharmacy Practice School of Pharmacy and Pharmaceutical Sciences, University at Buffalo Buffalo New York USA
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Gersch WD, Delate T, Bergquist KM, Smith K. Clinical Effectiveness of an Outpatient Multidisciplinary Chronic Pain Management Telementoring Service. Clin J Pain 2021; 37:740-746. [PMID: 34265787 DOI: 10.1097/ajp.0000000000000967] [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: 10/06/2020] [Accepted: 07/02/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to assess the effectiveness of a Pain E-Consult Program (PEP), a multidisciplinary telementoring service based on the Extension for Community Healthcare Outcomes (ECHO) model to reduce opioid use in the outpatient setting. MATERIALS AND METHODS This was a retrospective matched cohort study conducted in an integrated health care delivery system. Adult patients without cancer and with a 90-day morphine milligram equivalent (MME) ≥30 mg/d between April 1, 2016, and June 30, 2017, were included. Patients whose primary care clinician received the PEP (observation) were compared with usual care (control) patients. Observation patients were matched up to 1:5 to control patients. Outcomes included change in MME and initiation of nonopioid alternative medications. Multivariable regression analyses were performed. RESULTS A total of 665 patients were matched: 125 and 540 in the observation and control groups, respectively. Patients were primarily female, white, and Medicare beneficiaries. The observation group had a statistically significantly greater decrease in median MME/day during the 6-month (-7.4 vs. 1.5 mg, P=0.002) and 12-month (-15.1 vs. -2.8 mg, P<0.001) follow-up and rates of ≥20% decrease (6 mo: 41.6% vs. 24.6%, P=0.003; 12 mo: 48.0% vs. 32.6%, P=0.017). There were no differences in the rates of initiation of nonopioid alternative medications. CONCLUSIONS A PEP was associated with greater reductions in MME/day compared with usual care despite similar rates of nonopioid alternative medication initiation. A prospective randomized study of this program should be undertaken to confirm these findings.
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Affiliation(s)
- William D Gersch
- Veterans Affairs Northern California Health Care System, Mather, CA
| | - Thomas Delate
- Pharmacy Outcomes Research Group, Kaiser Permanente National Pharmacy
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora
| | | | - Karen Smith
- Rueckert-Hartman College for Health Professions, Regis University, Denver, CO
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Development and Initial Evaluation of Psychometric Properties of a Pain Competence Assessment Tool (PCAT). THE JOURNAL OF PAIN 2021; 23:398-410. [PMID: 34583019 DOI: 10.1016/j.jpain.2021.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/18/2021] [Accepted: 09/01/2021] [Indexed: 11/23/2022]
Abstract
Competency-based education is now considered the best approach for pain educational programs provided for pre and postgraduate healthcare providers (HCPs). To demonstrate learners' progression, an assessment tool that aligns with this educational approach and targets different HCPs is needed. A Pain Competence Assessment Tool (PCAT) was developed based on the pain management core competencies that align with the International Association for the Study of Pain interprofessional pain curriculum. The PCAT is an online competency-based assessment tool for HCPs that consists of 5 case scenarios followed by 17 key-feature questions. HCPs and trainees completed the PCAT through a series of studies to assess its psychometric properties. The preliminary evaluation suggested that the PCAT had adequate content validity. Apart from 6 questions, the PCAT questions demonstrated homogeneity and acceptable reliability, and substantial stability. No ceiling or floor effect was found. A significant difference was detected between the HCPs' and trainees' scores. The PCAT scores strongly correlated with other variables reflecting different competence levels. The PCAT scores showed significant changes in the baseline scores compared to scores after attending an educational intervention. The PCAT offers a first-of-its-kind tool for assessing HCPs' competence (ie, knowledge and its application) in managing chronic pain. Future research is needed for further validation and adaptation of the PCAT. PERSPECTIVE: The Pain Competence Assessment Tool (PCAT) offers a first-of-its-kind tool for assessing clinicians' core competencies that overlap between different professions and support the clinicians' capacity to successfully manage chronic pain in the real world focusing on the patient-centered perspective rather than the profession-specific perspective.
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Sharif-Askary B, Abdou SA, Singh T, Song DH. Are US Plastic Surgery Residents Equipped to Face the Opioid Epidemic? A National Survey. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3761. [PMID: 34476156 PMCID: PMC8382490 DOI: 10.1097/gox.0000000000003761] [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] [Received: 05/17/2021] [Accepted: 06/22/2021] [Indexed: 11/25/2022]
Abstract
The United States opioid epidemic is among this century’s most profound threats to public health and demands that all physicians consider their role in reversing its trajectory. Previous literature demonstrated that plastic surgery trainees lack vital practices that promote opioid stewardship. However, it is not understood why this practice gap exists. This is a national survey-based study evaluating the availability and effectiveness of opioid education in US plastic surgery programs. A total of 91 residents completed the survey. Our study found that there is an unmet need for practical and comprehensive training regarding safe opioid prescribing among plastic surgery trainees. “Informal training,” defined as the “learn as you go” method, was found to be more common than formal training and considerably more valuable according to trainees. Trainees cited real-world applicability of informal training and that it comes from teachers whom they know and trust as valuable attributes of this type of education. Furthermore, the severity of the opioid epidemic has not translated into improved trainee education, as there was no significant difference in knowledge on safe opioid prescribing practices between junior and senior residents. To change the course of the epidemic, plastic surgery programs need to better train younger generations who believe they are critical stakeholders. This study lays the framework for the “formalization of informal training,” and the creation of practical and efficacious educational initiatives.
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Affiliation(s)
- Banafsheh Sharif-Askary
- MedStar Georgetown University Hospital Department of Plastic and Reconstructive Surgery, Washington, D.C
| | - Salma A Abdou
- MedStar Georgetown University Hospital Department of Plastic and Reconstructive Surgery, Washington, D.C
| | - Tanvee Singh
- MedStar Georgetown University Hospital Department of Plastic and Reconstructive Surgery, Washington, D.C
| | - David H Song
- MedStar Georgetown University Hospital Department of Plastic and Reconstructive Surgery, Washington, D.C
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Delorme J, Bertin C, Delage N, Eschalier A, Ardid D, Authier N, Chenaf C. Prevalence of chronic pain in opioid-maintained patients using the capture-recapture method: a nationwide population-based study. Pain 2021; 162:195-202. [PMID: 32701648 DOI: 10.1097/j.pain.0000000000002011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Few studies all based on classical surveys have provided prevalence estimates of chronic pain (CP) in opioid-maintained patients (OMPs) but often had a limited patient sample size and a great variability in the prevalence estimates. This study sought to assess the prevalence of CP in the exhaustive population of OMPs using the capture-recapture method applied to the French nationwide health care database. Capture-recapture methods are increasingly used to estimate the prevalence of chronic conditions but have never been used in the specific context of CP in OMPs. Three large medical-administrative sources were used: the prescription drug database (A-list), the national hospital discharge database (M-list), and the pain center database (C-list). Between 2015 and 2016, 160,429 OMPs aged 15 years and older were identified and age- and sex-matched with 160,429 non-OMPs. All patients treated with analgesic drugs for ≥6 months (A-list) or diagnosed with CP (M- and C-list) were included. Capture-recapture analyses were performed to yield CP estimates with their 95% confidence intervals using log-linear models. In 2015 to 2016, 12,765 OMPs and 2938 non-OMPs with CP were captured. Most patients were male (67%) in OMPs and non-OMPs; median ages for OMPs and non-OMPs were 46 (interquartile range: 38-51) and 48 (41-53) years, respectively. The CP prevalence estimated in OMPs and non-OMPs ranged from 23.6% (14.9-46.2) to 32.1% (28.6-36.3) and from 7.28% (3.98-18.4) to 9.32% (7.42-12.1), respectively. This first study on CP in the exhaustive population of OMPs using the capture-recapture method demonstrated a high prevalence of CP in OMPs, 3- to 4-fold than in the general population.
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Affiliation(s)
- Jessica Delorme
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Clermont-Ferrand, France
- Observatoire Français des Médicaments Antalgiques (OFMA)/French Monitoring Centre for Analgesic Drugs, Université Clermont Auvergne-CHU Clermont-Ferrand, F-63001 Clermont-Ferrand, France
| | - Célian Bertin
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Clermont-Ferrand, France
- Observatoire Français des Médicaments Antalgiques (OFMA)/French Monitoring Centre for Analgesic Drugs, Université Clermont Auvergne-CHU Clermont-Ferrand, F-63001 Clermont-Ferrand, France
| | - Noémie Delage
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Clermont-Ferrand, France
| | - Alain Eschalier
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Clermont-Ferrand, France
- Observatoire Français des Médicaments Antalgiques (OFMA)/French Monitoring Centre for Analgesic Drugs, Université Clermont Auvergne-CHU Clermont-Ferrand, F-63001 Clermont-Ferrand, France
- Institut Analgesia, Faculté de Médecine, BP38, Clermont-Ferrand, France
| | - Denis Ardid
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Clermont-Ferrand, France
| | - Nicolas Authier
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Clermont-Ferrand, France
- Observatoire Français des Médicaments Antalgiques (OFMA)/French Monitoring Centre for Analgesic Drugs, Université Clermont Auvergne-CHU Clermont-Ferrand, F-63001 Clermont-Ferrand, France
- Institut Analgesia, Faculté de Médecine, BP38, Clermont-Ferrand, France
| | - Chouki Chenaf
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Clermont-Ferrand, France
- Observatoire Français des Médicaments Antalgiques (OFMA)/French Monitoring Centre for Analgesic Drugs, Université Clermont Auvergne-CHU Clermont-Ferrand, F-63001 Clermont-Ferrand, France
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Delorme J, Pennel L, Brousse G, Daulouède JP, Delile JM, Lack P, Gérard A, Dematteis M, Kabore JL, Authier N, Chenaf C. Prevalence and Characteristics of Chronic Pain in Buprenorphine and Methadone-Maintained Patients. Front Psychiatry 2021; 12:641430. [PMID: 33981257 PMCID: PMC8107279 DOI: 10.3389/fpsyt.2021.641430] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/29/2021] [Indexed: 11/13/2022] Open
Abstract
Chronic pain and substance use disorders frequently co-occur. Indeed, chronic pain is highly prevalent, affecting 23-68% of patients receiving opioid agonist treatments (OAT) worldwide. The majority of available estimates come from American studies, but data are still lacking in Europe. We aim to provide European estimates of the prevalence of chronic pain in patients receiving OAT using French data, since France is the first European country in terms of number of patients with OAT. The secondary objectives were to characterize the features and management of chronic pain, as well identify associated risk factors. We conducted a multicenter, cross-sectional study, recruiting patients treated either with buprenorphine or methadone in 19 French addiction centers, from May to July 2016. All participants had to complete a semi-directed questionnaire that collected sociodemographic and medical data, pain characteristics, and licit or illicit drug consumption. In total, 509 patients were included. The prevalence of chronic pain was estimated at 33.2% (95% CI: 29.1-37.3). Compared to non-chronic pain patients, chronic pain patients were older (38.4 vs. 36.1 years, p = 0.006), were more unemployed (66 vs. 52%, p = 0.003), had more psychiatric comorbidities (50 vs. 39%, p = 0.02), and split their OAT for pain management more frequently (24 vs. 7%, p = 0.009). Pain intensity was moderate or severe in 75% of chronic pain patients. Among patients with chronic pain, 15.4% were not prescribed, and did not self-medicate with, any analgesic drugs, 52.1% were prescribed analgesics (non-opioid analgesics, 76.3%; codeine, tramadol, opium, 27.2%; and morphine, fentanyl, oxycodone, 11.8%), and 32.5% exclusively self-medicated with analgesics. Moreover, 20.1% of patients with chronic pain also used illicit drugs for pain relief. On multivariate analysis, variables that remained significantly associated with chronic pain were age [OR = 1.03 (95% CI: 1.00-1.05], p = 0.02], anxiety [OR = 1.52 (1.15-2.02), p = 0.003], and depression [OR = 1.25 (1.00-1.55), p = 0.05]. Chronic pain is a highly prevalent condition in patients receiving OAT, and its appropriate management remains uncertain, since insufficient relief and frequent additional self-medications with analgesics or illicit drugs were reported by these patients. Increased awareness among caregivers is urgently needed regarding a systematic and careful assessment, along with an adequate management of chronic pain in patients receiving OAT.
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Affiliation(s)
- Jessica Delorme
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Service Psychiatrie-Addictologie, Clermont-Ferrand, France.,Observatoire Français des Médicaments Antalgiques (OFMA) / French monitoring centre for analgesic drugs, Université Clermont Auvergne - CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Lucie Pennel
- Service d'Addictologie, CHU Grenoble Alpes, Université Grenoble Alpes, Grenoble, France
| | - Georges Brousse
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Service Psychiatrie-Addictologie, Clermont-Ferrand, France
| | - Jean-Pierre Daulouède
- Centre de Soins et d'Accompagnement et de Prévention en Addictologie (CSAPA), BIZIA, Médecins du Monde, Centre Hospitalier de la côte Basque, Bayonne, France
| | - Jean-Michel Delile
- Centre de Soins et d'Accompagnement et de Prévention en Addictologie (CSAPA) "Maurice Serisé", Comité d'Etude et d'Information sur la Drogue (CEID), Bordeaux, France
| | - Philippe Lack
- Centre de Soins et d'Accompagnement et de Prévention en Addictologie (CSAPA), Centre Hospitalier de la Croix Rousse, Lyon, France
| | - Antoine Gérard
- Centre de Soins et d'Accompagnement et de Prévention en Addictologie (CSAPA), Centre Hospitalier Emile Roux, Le Puy-en-Velay, France
| | - Maurice Dematteis
- Service d'Addictologie, CHU Grenoble Alpes, Université Grenoble Alpes, Grenoble, France
| | - Jean-Luc Kabore
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Service Psychiatrie-Addictologie, Clermont-Ferrand, France
| | - Nicolas Authier
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Service Psychiatrie-Addictologie, Clermont-Ferrand, France.,Observatoire Français des Médicaments Antalgiques (OFMA) / French monitoring centre for analgesic drugs, Université Clermont Auvergne - CHU Clermont-Ferrand, Clermont-Ferrand, France.,Institut Analgesia, Faculté de Médecine, BP38, Clermont-Ferrand, France
| | - Chouki Chenaf
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Service Psychiatrie-Addictologie, Clermont-Ferrand, France.,Observatoire Français des Médicaments Antalgiques (OFMA) / French monitoring centre for analgesic drugs, Université Clermont Auvergne - CHU Clermont-Ferrand, Clermont-Ferrand, France
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Raheemullah A, Andruska N, Saeed M, Kumar P. Improving Residency Education on Chronic Pain and Opioid Use Disorder: Evaluation of CDC Guideline-Based Education. Subst Use Misuse 2020; 55:684-690. [PMID: 31757179 DOI: 10.1080/10826084.2019.1691600] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: National surveys show that primary care physicians feel responsible for addressing the opioid epidemic. They feel their training in managing chronic pain and addiction was insufficient, and commonly endorse the need for more residency training in these areas. However, residency training in these areas remains low, with a lack of faculty expertise and time as the most commonly cited barriers for improvement. Objective: To evaluate the feasibility of an educational program for chronic pain management and addiction that does not rely on faculty expertise or additional time, and assess resident opioid-prescribing practices and confidence in managing chronic pain after its implementation. Methods: A 16-week educational curriculum was incorporated into existing residency didactics. Internal medicine residents attended six educational sessions in 2016 over a 16-week period and implemented a protocol based on CDC Guidelines for Prescribing Opioids for Chronic Pain. Surveys were completed pre- and post-intervention. Results: Implementation of this educational intervention was feasible. Surveys showed improvement in resident confidence in detecting and managing addiction and improved prescribing practices and adherence to CDC recommendations. Conclusion: This pilot study demonstrates that increasing residency education in managing chronic pain and opioid use disorder is feasible, and no longer needs to be postponed due to lack of time or faculty expertise.
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Affiliation(s)
- Amer Raheemullah
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California, USA
| | - Neal Andruska
- Department of Internal Medicine, University of Illinois College of Medicine at Urbana-Champaign, Urbana, Illinois, USA
| | - Maryam Saeed
- Department of Internal Medicine, University of Illinois College of Medicine at Urbana-Champaign, Urbana, Illinois, USA
| | - Pardeep Kumar
- Department of Internal Medicine, University of Illinois College of Medicine at Urbana-Champaign, Urbana, Illinois, USA
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Smart MH, Monteiro AL, Saffore CD, Ruseva A, Lee TA, Fischer MA, Pickard AS. Development of an Instrument to Assess the Perceived Effectiveness of Academic Detailing. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2020; 40:235-241. [PMID: 33284174 PMCID: PMC8051138 DOI: 10.1097/ceh.0000000000000305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Academic detailing (AD) is an effective, evidence-based education outreach method of promoting clinician behavior change. Detailer feedback is important for program evaluation but is rarely systematically collected. The study's objective was to develop a measure capturing the detailer's perception of the effectiveness of an AD program. METHODS A six-item measure with a five-level scale was initially developed from the literature review and expert panel consultation. Item constructs were usefulness, acceptability, feasibility, relevance, effectiveness of communication, and readiness to change. The measure was piloted, refined, and tested during an opioid-focused AD program that included two visits. The instrument structure was evaluated using exploratory factor analysis, measure reliability was assessed using item-item correlation (rho), corrected item-total correlation, Cronbach alpha (α), and item response theory. RESULTS The initial six-item instrument demonstrated unidimensionality. The Cronbach α for the measure was 0.74 (visit 1) and 0.79 (visit 2); one item (relevance) was redundant (α = 0.73 and 0.79 when deleted) and therefore dropped. Items related to usefulness, acceptability, and readiness to change displayed high item-item correlation (rho ≥ 0.50) and contributed the most information and seemed to operate as a single scale (ie, "likelihood to change") based on item response theory analysis. Items related to feasibility and communication were slightly different constructs and should be reported separately. DISCUSSION The five-item detailer assessment of visit effectiveness (the "DAVE") instrument provides a standardized approach to assess AD. Further study of its validity and broader use in other programs and educational outreach activities is encouraged.
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Affiliation(s)
- Mary H Smart
- Dr. Smart, Ms. Monteiro, Dr. Saffore, Ms. Ruseva, Dr. Lee, Dr. Pickard: Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL; and Dr. Fischer: Division of Pharmacoepidemiology and Pharmacoeconomics, National Resource Center for Academic Detailing, Brigham and Women's Hospital, Boston, MA
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Pytell JD, Buresh ME, Graddy R. Outcomes of a novel office-based opioid treatment program in an internal medicine resident continuity practice. Addict Sci Clin Pract 2019; 14:46. [PMID: 31856915 PMCID: PMC6921403 DOI: 10.1186/s13722-019-0175-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 12/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The integration of opioid use disorder (OUD) care and competencies in graduate medical education training is needed. Previous research shows improvements in knowledge, attitudes, and practices after exposure to OUD care. Few studies report outcomes for patients with OUD in resident physician continuity practices. METHODS A novel internal office-based opioid treatment (OBOT) program was initiated in a resident continuity clinic. Surveys of resident and staff knowledge and attitudes of OBOT were administered at baseline and 4 months. A retrospective chart review of the 15-month OBOT clinic obtained patient characteristics and outcomes. RESULTS Twelve patients with OUD were seen in the OBOT clinic. Seven patients (58%) were retained in care at the end of the study period for a range of 9-15 months. Eight patients demonstrated a good clinical response. Surveys of residents and staff at 4 months were unchanged from baseline showing persistent lack of comfort in caring for patients with OUD. CONCLUSIONS OBOT can be successfully integrated into resident continuity practices with positive patient outcomes. Improvement in resident and staff attitudes toward OBOT were not observed and likely require direct and frequent exposure to OUD care to increase acceptance.
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Affiliation(s)
- Jarratt D Pytell
- Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Mason Lord Building, East Tower, 2nd Floor, Baltimore, MD, 21224, USA.
| | - Megan E Buresh
- Division of Addiction Medicine, Johns Hopkins Bayview Medical Center, 5200 Eastern Avenue, Mason Lord Building, East Tower, 2nd Floor, Baltimore, MD, 21224, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ryan Graddy
- Division of Addiction Medicine, Johns Hopkins Bayview Medical Center, 5200 Eastern Avenue, Mason Lord Building, East Tower, 2nd Floor, Baltimore, MD, 21224, USA
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Zakaria HM, Mansour TR, Telemi E, Asmaro K, Bazydlo M, Schultz L, Nerenz DR, Abdulhak M, Khalil JG, Easton R, Schwalb JM, Park P, Chang V. The Association of Preoperative Opioid Usage With Patient-Reported Outcomes, Adverse Events, and Return to Work After Lumbar Fusion: Analysis From the Michigan Spine Surgery Improvement Collaborative (MSSIC). Neurosurgery 2019; 87:142-149. [DOI: 10.1093/neuros/nyz423] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 07/31/2019] [Indexed: 11/14/2022] Open
Abstract
AbstractBACKGROUNDIt is important to delineate the relationship between opioid use and spine surgery outcomes.OBJECTIVETo determine the association between preoperative opioid usage and postoperative adverse events, patient satisfaction, return to work, and improvement in Oswestry Disability Index (ODI) in patients undergoing lumbar fusion procedures by using 2-yr data from a prospective spine registry.METHODSPreoperative opioid chronicity from 8693 lumbar fusion patients was defined as opioid-naïve (no usage), new users (<6 wk), short-term users (6 wk-3 mo), intermediate-term users (3-6 mo), and chronic users (>6 mo). Multivariate generalized estimating equation models were constructed.RESULTSAll comparisons were to opioid-naïve patients. Chronic opioid users showed less satisfaction with their procedure at 90 d (Relative Risk (RR) 0.95, P = .001), 1 yr (RR 0.89, P = .001), and 2 yr (RR 0.89, P = .005). New opioid users were more likely to show improvement in ODI at 90 d (RR 1.25, P < .001), 1 yr (RR 1.17, P < .001), and 2 yr (RR 1.19, P = .002). Short-term opioid users were more likely to show ODI improvement at 90 d (RR 1.25, P < .001). Chronic opioid users were less likely to show ODI improvement at 90 d (RR 0.90, P = .004), 1 yr (RR 0.85, P < .001), and 2 yr (RR 0.80, P = .003). Chronic opioid users were less likely to return to work at 90 d (RR 0.80, P < .001).CONCLUSIONIn lumbar fusion patients and when compared to opioid-naïve patients, new opioid users were more likely and chronic opioid users less likely to have improved ODI scores 2 yr after surgery. Chronic opioid users are less likely to be satisfied with their procedure 2 yr after surgery and less likely to return to work at 90 d. Preoperative opioid counseling is advised.
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Affiliation(s)
| | - Tarek R Mansour
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan
| | - Edvin Telemi
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan
| | - Karam Asmaro
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan
| | - Michael Bazydlo
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan
| | - Lonni Schultz
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan
| | - David R Nerenz
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan
| | | | - Jad G Khalil
- Department of Orthopedic Surgery, Beaumont Health, Royal Oak, Michigan
- Beaumont Hospital, Royal Oak, William Beaumont School of Medicine, Oakland University, Royal Oak, Michigan
| | - Richard Easton
- Orthopedic Surgery Beaumont Health, Troy, Michigan
- Beaumont Hospital, Troy, William Beaumont School of Medicine, Oakland University, Troy, Michigan
| | - Jason M Schwalb
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan
| | - Paul Park
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Victor Chang
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan
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Stephenson ED, Farzal Z, Jowza M, Hackman T, Zanation A, Du E. Postoperative Analgesic Requirement and Pain Perceptions after Nonaerodigestive Head and Neck Surgery. Otolaryngol Head Neck Surg 2019; 161:970-977. [PMID: 31476960 DOI: 10.1177/0194599819871699] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Little data exist on associations between patient factors and postoperative analgesic requirement after head and neck (H&N) surgeries. Such information is important for optimizing postoperative care considering concerns regarding opioid misuse. We analyzed factors associated with narcotic use and pain perception following H&N surgery sparing the upper aerodigestive tract. STUDY DESIGN Prospective cohort. SETTING Tertiary referral center. SUBJECTS AND METHODS From May to October 2017, data were collected for patients undergoing nonaerodigestive H&N procedures requiring hospitalization. Patients completed a preoperative survey querying chronic pain history, narcotic usage, and postoperative pain expectation. Demographics, surgical data, postoperative narcotic use defined by morphine milligram equivalents (MME), pain scores, and Overall Benefit of Analgesia Score (OBAS) were analyzed. RESULTS Seventy-six patients, 44 (57.9%) females and 32 (42.1%) males with a mean age of 54.0 years, met inclusion criteria. The most common procedures were parotidectomy (27.6%) and total thyroidectomy (19.7%). Average cumulative 24-hour postoperative MME and calculated MME per hospital day (MME/HD, cumulative MME for hospitalization divided by length of stay) were 40.5 ± 30.6 and 60.8 ± 60.1, respectively. Average pain score throughout the initial 24 hours after surgery was 3.7/10 ± 2.0. Female sex and prior chronic pain diagnosis were associated with higher OBAS after multivariate linear adjustments. CONCLUSION Postoperative narcotic requirement in nonaerodigestive H&N surgery is overall low. Female sex and prior chronic pain diagnosis may be associated with higher postoperative OBAS, a validated assessment of pain and opioid-related side effects. This study may serve as a comparison for future studies evaluating narcotic-sparing analgesia and pain perception in nonaerodigestive H&N surgery.
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Affiliation(s)
- Elizabeth D Stephenson
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Zainab Farzal
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Maryam Jowza
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Trevor Hackman
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Adam Zanation
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Eugenie Du
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Majid Z, Tanveer M, Ali Asghar S, Tahir F, Minhaj A, Khan HA, Sialvi T, Mahmood SH, Qadar LT, Imtiaz F. Opioids Use and Abuse: Prescription Practice, Attitude, and Beliefs among Doctors of Karachi. Cureus 2019; 11:e5253. [PMID: 31572638 PMCID: PMC6760877 DOI: 10.7759/cureus.5253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Opioid analgesics, also known as narcotics, are medicinal drugs used primarily for the management of pain secondary to any type of cancer, severe injury or surgery. Due to the ease of availability, opioids are commonly abused. In 2015, reported deaths exceeded 33,000 Americans from opioid overdose. A survey in 2013 revealed nearly 1.6 million Pakistanis abusing prescription opioids for non-medical needs. Although commonly prescribed by primary care physicians, most of them are diffident to stand by all the recommended strategies to reduce the incidence of opioid abuse. Methods A cross-sectional study was conducted during the period of August through October 2018. A sample size of 365 was determined using a 95% confidence interval at a degree of precision of 5%. A 22-item questionnaire was given to doctors with at least two years practicing experience either from a private or a public healthcare setup. Doctors who had never prescribed opioids were excluded from the study. Out of the eligible participants, 15 refused to take part in the survey, and the co-operation rate was recorded as 95.8%. Collected data were analyzed using statistical package for social science (SPSS) version 22 for Windows. Frequencies, percentages, mean, standard deviation, and chi-square were used to explore the variables. The statistical significance level was considered at p < 0.5. Results Opioids were reported to be used mainly for treating acute pain (40.5%), chronic pain (24.7%) and both acute and chronic (34.8%). A minority of doctors (29%) screened their patients for opioid addiction. A significant association (p = 0.000) between the frequency of opioid prescription and prior screening for depression was determined. Surprisingly, only 23.2% clinicians frequently screened their patients for depression before prescribing opioids. The rate of counselling regarding drug tapering was found to be 71.6%. A majority, i.e., 88%, of the respondents anticipated the misuse of opioids they prescribe whereas 74% also held a belief that patients self-medicate their untreated pain. Participants reported addiction (54%) as the most common reason for abuse followed by the role of pharmaceutical companies (43%) and pharmacies (41%). About 80.2% clinicians believed that patients addicted to opioids could get well and return to their daily routine. Conclusion The rising opioid epidemic is a major concern for doctors prescribing opioids. Adaptation of medical school curricula and appropriate training can equip doctors for better management of patients requiring opioids. This includes the screening of patients using standard risk assessment tools for opioid abuse leading to a more controlled opioid prescription practice. Dissemination of these tools will boost doctors' confidence and may help in reducing morbidity and mortality from opioid abuse.
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Affiliation(s)
- Zainab Majid
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Mahpara Tanveer
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | | | - Faryal Tahir
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Areeba Minhaj
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Hamza Aijaz Khan
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Tehzeeb Sialvi
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | | | - Laila Tul Qadar
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Fouzia Imtiaz
- Genetics, Dow University of Health Sciences, Karachi, PAK
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Opioid Prescribing In-Hospital: Time for Innovative Approaches to Help Combat the Opioid Crisis. CANADIAN JOURNAL OF ADDICTION 2019. [DOI: 10.1097/cxa.0000000000000054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
PURPOSE OF REVIEW The primary cause of overdose death in the United States is related to pharmaceutical opioids. A few particular populations that struggle with adverse outcomes related to opioid abuse are those in palliative care, those with chronic pain, and those receiving pain treatments secondary to cancer or chemotherapy. RECENT FINDINGS There have been massive efforts to decrease the use of opioid abuse in patient care in a gestalt manner, but palliative care provides unique challenges in applying these reduction tactics used by other specialties. SUMMARY We explore behavioral interventions, provider education, alternative pain management techniques, postmarketing surveillance, and abuse-deterrent formulas as emerging methods to counteract opioid abuse in these populations.
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Speed TJ, Parekh V, Coe W, Antoine D. Comorbid chronic pain and opioid use disorder: literature review and potential treatment innovations. Int Rev Psychiatry 2018; 30:136-146. [PMID: 30398071 DOI: 10.1080/09540261.2018.1514369] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Chronic pain (CP) and opioid use disorder (OUD) remain challenging complex public health concerns. This is an updated review on the relationship between CP and OUD and the use of stepped care models for assessment and management of this vulnerable population. A literature search was conducted from 2008 to the present in PubMed, Embase, and PsycInfo using the terms pain or chronic pain and opioid-related disorders, opiate, methadone, buprenorphine, naltrexone, opioid abuse, opioid misuse, opioid dependen*, heroin addict, heroin abuse, heroin misuse, heroin dependen*, or analgesic opioids, and stepped care, integrated services, multidisciplinary treatment, or reinforcement-based treatment. Evidenced-based data exists on the feasibility, implementation, and efficacy of stepped care models in primary care settings for the management of CP and opioid use. Although these studies did not enroll participants with OUD, they included a sub-set of patients at risk for the development of OUD. There remains a dearth of treatment options for those with comorbid CP and OUD. Future research is needed to explore the aetiology and impact of CP and OUD, and greater emphasis is needed to improve access to comprehensive pain and substance use programmes for high-risk individuals.
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Affiliation(s)
- Traci J Speed
- a Psychiatry and Behavioral Sciences , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Vinay Parekh
- a Psychiatry and Behavioral Sciences , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - William Coe
- a Psychiatry and Behavioral Sciences , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Denis Antoine
- a Psychiatry and Behavioral Sciences , Johns Hopkins University School of Medicine , Baltimore , MD , USA
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Barry DT, Marshall BD, Becker WC, Gordon AJ, Crystal S, Kerns RD, Gaither JR, Gordon KS, Justice AC, Fiellin DA, Edelman EJ. Duration of opioid prescriptions predicts incident nonmedical use of prescription opioids among U.S. veterans receiving medical care. Drug Alcohol Depend 2018; 191:348-354. [PMID: 30176548 PMCID: PMC6596307 DOI: 10.1016/j.drugalcdep.2018.07.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 07/09/2018] [Accepted: 07/09/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND/AIMS Although nonmedical use of prescription opioids (NMUPO) is a public health problem, few studies have examined the new-onset NMUPO in clinical populations. We estimated NMUPO incidence among veterans in medical care who had received prescription opioid medication and examined correlates of new-onset NMUPO. DESIGN Prospective cohort study. SETTING Veterans Health Administration primary care and infectious disease clinics in Atlanta, Baltimore, Bronx, Houston, Los Angeles, Manhattan, Pittsburgh, and Washington, DC. PARTICIPANTS Patients enrolled in the Veterans Aging Cohort Study wave 3 (2005-2007) who received prescription opioids in the previous year and without lifetime NMUPO were followed at waves 4 and 5 (2008-2011). MEASUREMENTS Cox proportional hazards regression was used to examine the relationship between duration of prescription opioid receipt and incident NMUPO, adjusting for demographics, alcohol and tobacco use, substance use disorders, psychiatric and medical diagnoses, and medication-related characteristics. FINDINGS Among eligible participants (n = 815), the median age was 52 (IQR = 47-58) and 498 (59.8%) were Black; 122 (15.0%) reported new-onset NMUPO, for an incidence rate of 5.0 per 100 person-years. In a multivariable Cox model, compared to <30 days, receipt of prescription opioids for 30-180 days (adjusted hazard ratio [AHR] = 1.65 95% CI: 1.06, 2.58) or >180 days (AHR = 1.99, 95% CI: 1.21, 3.29) was associated with incident NMUPO. CONCLUSIONS Duration of prescription opioid receipt is a risk factor for incident NMUPO among veterans receiving medical care. Providers who prescribe opioids should monitor for NMUPO, especially among those with a longer duration of opioid therapy.
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Affiliation(s)
- Declan T. Barry
- Yale School of Medicine, New Haven, CT, 06510, USA,APT Foundation Pain Treatment Services, New Haven, CT, 06519, USA,Corresponding author at: APT Pain Treatment Services, Yale School of Medicine, 495, Congress Ave, 2nd Floor, New Haven, CT 06519, USA., (D.T. Barry)
| | | | - William C. Becker
- Yale School of Medicine, New Haven, CT, 06510, USA,VA Connecticut Healthcare System, West Haven, CT, 06516, USA
| | - Adam J. Gordon
- University of Utah School of Medicine, Salt Lake City, UT, 84148, USA
| | - Stephen Crystal
- Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ, 08901, USA
| | - Robert D. Kerns
- Yale School of Medicine, New Haven, CT, 06510, USA,VA Connecticut Healthcare System, West Haven, CT, 06516, USA
| | | | - Kirsha S. Gordon
- Yale School of Medicine, New Haven, CT, 06510, USA,VA Connecticut Healthcare System, West Haven, CT, 06516, USA
| | - Amy C. Justice
- Yale School of Medicine, New Haven, CT, 06510, USA,VA Connecticut Healthcare System, West Haven, CT, 06516, USA
| | - David A. Fiellin
- Yale School of Medicine, New Haven, CT, 06510, USA,Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, 06510, USA
| | - E. Jennifer Edelman
- Yale School of Medicine, New Haven, CT, 06510, USA,Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, 06510, USA
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22
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Curran GM, Freeman PR, Martin BC, Teeter BS, Drummond KL, Bradley K, Thannisch MM, Mosley CL, Schoenberg N, Edlund M. Communication between pharmacists and primary care physicians in the midst of a U.S. opioid crisis. Res Social Adm Pharm 2018; 15:974-985. [PMID: 30170901 DOI: 10.1016/j.sapharm.2018.08.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 07/11/2018] [Accepted: 08/09/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Effective communication between prescribers of opioids and community pharmacists can contribute to maximizing appropriate pain management and reducing opioid misuse and diversion. While much of the education and training available on reducing opioid misuse and diversion stresses the importance of interprofessional communication between prescribers and pharmacists, few studies have been explored those communication patterns directly. OBJECTIVE The objectives of this manuscript are to present and explore key emergent themes from a qualitative study around the nature, frequency, and content of communication between primary care physicians (PCPs) and pharmacists focusing on opioids. METHODS Interviews were conducted with 48 PCPs and 60 community pharmacists across four states in the U.S.: Washington, Idaho, Kentucky and Arkansas. RESULTS Convergent results from both samples indicated that the content of communication usually centers on questions of dosing, timing of the prescription, and/or evidence of potential misuse/diversion. When communication was focused on relaying information about a patient and/or clarifying questions around the prescription, it appeared positive for both parties. Results also indicated that close physical proximity between PCPs and dispensing pharmacists contributed to more positive and useful communication, especially when the clinics and pharmacies were part of the same healthcare system. Many pharmacists reported hesitancy in "questioning" a physician's judgement, which appeared related to commonly held beliefs of both pharmacists and physicians about the respective roles of each in providing patient care. Pharmacists reported difficulty in reaching PCPs for discussion, while PCPs reported it was easy to reach pharmacists. CONCLUSIONS Physician and pharmacist communication around opioids can be mutually beneficial. When prescribers and pharmacists are co-located, higher levels of trust and teamwork are reported, which in turn seems to be related to more open and positive communication. Additional research is needed to identify interventions to increase mutually-valued communication that improves the quality of decision-making around opioids.
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Affiliation(s)
- Geoffrey M Curran
- University of Arkansas for Medical Sciences, 4301 West Markham St., #522-4, Little Rock, AR, 72205-7199, United States; Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, North Little Rock, AR, 72114, United States.
| | - Patricia R Freeman
- University of Kentucky, College of Pharmacy, 789 South Limestone Street, Lexington, KY, 40536, United States
| | - Bradley C Martin
- University of Arkansas for Medical Sciences, 4301 West Markham St., #522-4, Little Rock, AR, 72205-7199, United States
| | - Benjamin S Teeter
- University of Arkansas for Medical Sciences, 4301 West Markham St., #522-4, Little Rock, AR, 72205-7199, United States
| | - Karen L Drummond
- University of Arkansas for Medical Sciences, 4301 West Markham St., #522-4, Little Rock, AR, 72205-7199, United States; Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, North Little Rock, AR, 72114, United States
| | - Katharine Bradley
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101-1466, United States
| | - Mary M Thannisch
- University of Arkansas for Medical Sciences, 4301 West Markham St., #522-4, Little Rock, AR, 72205-7199, United States
| | - Cynthia L Mosley
- University of Arkansas for Medical Sciences, 4301 West Markham St., #522-4, Little Rock, AR, 72205-7199, United States
| | - Nancy Schoenberg
- University of Kentucky, College of Pharmacy, 789 South Limestone Street, Lexington, KY, 40536, United States
| | - Mark Edlund
- RTI International, 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709-2194, United States
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23
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Walker ZW, Vinson AR, Babcock D, Benjamin T, Haas DM. Determining the Initiation of Opiate Misuse Resulting in Opioid Use Disorder in Pregnant Women. J Psychoactive Drugs 2018; 50:331-338. [PMID: 30089441 DOI: 10.1080/02791072.2018.1497235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The aim of this study was to explore the "opiate misuse footprint" made by obstetrics and gynecology physicians in prescribing opioid medications for postpartum pain control that led to opioid misuse and opioid use disorder. Data were collected using intake information and anonymous surveys administered to pregnant women at local methadone clinics in Indianapolis, Indiana, in 2016-2017. Results from this study revealed that 40% of the 33 participants stated that the first drug they became addicted to was prescription opioids; 71% stated that the first opiate they became addicted to was a prescription pain medication. Prescription opioids were mainly obtained from emergency medicine physicians and friends. Reported use of opioids within the past four months was high, with the most commonly used drugs being methadone (57.6%) and heroin (42.4%). A majority of participants also endorsed a history of sexual and physical abuse, recent incarceration, and mental health disorders. As a large number of pregnant women with opioid use disorder reported their initial drug of misuse as prescription pain medications, it is important to avoid overprescribing opioids in reproductive-age women.
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Affiliation(s)
- Zachary W Walker
- a Department of OB/GYN , Indiana University School of Medicine , Indianapolis , IN, USA
| | - Abigail R Vinson
- a Department of OB/GYN , Indiana University School of Medicine , Indianapolis , IN, USA
| | - Dean Babcock
- b Department of Psychiatry , Midtown Community Mental Health Clinic, Eskenazi Health, Indianapolis, IN, USA
| | - Tara Benjamin
- a Department of OB/GYN , Indiana University School of Medicine , Indianapolis , IN, USA
| | - David M Haas
- a Department of OB/GYN , Indiana University School of Medicine , Indianapolis , IN, USA
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24
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Zhu H, Gao Y, Zhang C, Zheng X. A Prospective Evaluation of Patient-Reported Opioid Utilization After Nonoperative Treatment of Fractures and Dislocations. J Bone Joint Surg Am 2018; 100:1177-1183. [PMID: 30020123 DOI: 10.2106/jbjs.17.01475] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Prescription of opioid analgesics is currently a common practice to relieve pain for musculoskeletal injuries in many regions of the world, especially in the United States and Canada. However, overprescription may underlie opioid misuse. Details on the utilization of prescribed opioids after nonoperative treatment of fractures and dislocations and whether consumption is related to injury location are unknown. METHODS A total of 1,513 consecutive patients in China who underwent nonoperative treatment of a fracture and/or dislocation and who were prescribed opioids were studied over a 3-month period. Demographic information, alcohol consumption, smoking status, injury location, volume of prescription, and consumption patterns were recorded and were summarized. RESULTS The mean number of opioid pills prescribed was 14.7, and the mean patient-reported number of pills consumed was 7.2. Overall, 152 patients (10.0%) reported taking no prescribed opioid analgesics, and 924 patients (61.1%) ceased their prescribed opioids prior to completing the regimen. Injury location, alcohol consumption, and type of fracture or dislocation were all significantly associated with the patient-reported number of opioid pills consumed (p < 0.05). Patients with fracture and/or dislocation of the wrist or forearm (9.4 pills for 3.8 days); ankle, tibia, or fibula (9.3 pills for 3.7 days); or elbow or humerus (9.1 pills for 3.7 days) used more opioid pills compared with patients with injuries at other locations (not exceeding 6.4 pills and 3 days). When compared with patients who had no, low, or moderate daily alcohol consumption, there was more opioid use in patients with high daily alcohol consumption (8.5 pills for 3.4 days) and those with very high daily alcohol consumption (11.3 pills for 4.7 days). Patients with a dislocation and/or displaced fracture reported consuming 8.2 pills for 3.3 days, which was more than the consumption in patients with a nondisplaced fracture (6.2 pills for 2.5 days) and patients with an avulsion fracture (6.2 pills for 2.5 days). CONCLUSIONS Surgeons and patients should try to avoid opioids if possible after nonoperatively treated fractures and dislocations. If opioids are used, surgeons should prescribe the smallest dose for the shortest time after considering the injury location and type of fracture or dislocation. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Hongyi Zhu
- Department of Orthopaedic Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Yanchun Gao
- Department of Orthopaedic Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Changqing Zhang
- Department of Orthopaedic Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Xianyou Zheng
- Department of Orthopaedic Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
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25
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Lee C, Sharma M, Kantorovich S, Brenton A. A Predictive Algorithm to Detect Opioid Use Disorder: What Is the Utility in a Primary Care Setting? Health Serv Res Manag Epidemiol 2018; 5:2333392817747467. [PMID: 29383324 PMCID: PMC5784544 DOI: 10.1177/2333392817747467] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 07/17/2017] [Indexed: 11/21/2022] Open
Abstract
PURPOSE The purpose of this study was to determine the clinical utility of an algorithm-based decision tool designed to assess risk associated with opioid use in the primary care setting. METHODS A prospective, longitudinal study was conducted to assess the utility of precision medicine testing in 1822 patients across 18 family medicine/primary care clinics in the United States. Using the profile, patients were categorized into low, moderate, and high risk for opioid use. Physicians who ordered testing were asked to complete patient evaluations and document their actions, decisions, and perceptions regarding the utility of the precision medicine tests. RESULTS Approximately 47% of primary care physicians surveyed used the profile to guide clinical decision-making. These physicians rated the benefit of the profile on patient care an average of 3.6 on a 5-point scale (1 indicating no benefit and 5 indicating significant benefit). Eighty-eight percent of all clinicians surveyed felt the test exhibited some benefit to their patient care. The most frequent utilization for the profile was to guide a change in opioid prescribed. Physicians reported greater benefit of profile utilization for minority patients. Patients whose treatment was guided by the profile had pain levels that were reduced, on average, 2.7 levels on the numeric rating scale. CONCLUSIONS The profile provided primary care physicians with a useful tool to stratify the risk of opioid use disorder and was rated as beneficial for decision-making and patient improvement by the majority of physicians surveyed. Physicians reported the profile resulted in greater clinical improvement for minorities, highlighting the objective use of this profile to guide judicial use of opioids in high-risk patients. Significantly, when physicians used the profile to guide treatment decisions, patient-reported pain was greatly reduced.
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Affiliation(s)
- Chee Lee
- Proove Biosciences Inc, Irvine, CA, USA
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26
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Delorme J, Chenaf C, Bertin C, Riquelme M, Eschalier A, Ardid D, Authier N. Chronic Pain Opioid-Maintained Patients Receive Less Analgesic Opioid Prescriptions. Front Psychiatry 2018; 9:335. [PMID: 30083113 PMCID: PMC6065119 DOI: 10.3389/fpsyt.2018.00335] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/02/2018] [Indexed: 12/29/2022] Open
Abstract
Treating pain and opioid use disorder represents a clinical challenge. While most studies that have assessed opioid analgesic use in opioid substitution treatment (OST) patients primarily address opioid analgesic misuse (1, 2), only few studies focused on OST patients assessed the prescription of analgesic opioids for chronic pain. We sought to compare the prevalence of analgesic opioid prescription (AOP) in two groups of chronic non-cancer pain (CNCP) patients: OST patients vs. the general population. This was a population-based cross-sectional study based on the French national healthcare claims database SNIIRAM (Système National d'Informations Inter-Régimes de l'Assurance Maladie) covering over 66 million people (98.8% of the French population). Overall, 67,173 participants ≥15 years old undergoing continuous OST in 2015 ("OST patients" group) were included and age- and gender-matched by means of a 1:1 ratio with 67,173 patients without OST ("control" group). In each group, patients with cancer conditions were excluded and those having received opioid and non-opioid analgesics for at least 3 months were identified (CNCP patients). Compared to control patients, CNCP OST patients received less AOP (47.8 vs. 68.0%, p < 0.0001) and more often non-opioid prescription (52.2 vs. 32.0%, p < 0.0001). In multivariate analysis, CNCP OST patients were 2.7 times less likely to be prescribed analgesic opioids (adjusted odds ratio [OR] = 2.7 [2.42-3.01], p < 0.0001) than control patients. AOP correlated in CNCP OST patients with: age ≤ 40 years old, female gender, low-income status, methadone-maintained treatment, mental health disorder, hepatitis C virus (HCV) infection, and alcohol abuse disorder. Opioid analgesics were less often prescribed in CNCP OST patients. AOP prevalence was 2.7-fold lower than in the general population. Chronic pain management in OST patients needs to be reinforced through additional physician training and a multidisciplinary approach.
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Affiliation(s)
- Jessica Delorme
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Clermont-Ferrand, France.,Observatoire Français des Médicaments Antalgiques/French Monitoring Centre for Analgesic Drugs, Université Clermont Auvergne - CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Chouki Chenaf
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Clermont-Ferrand, France.,Observatoire Français des Médicaments Antalgiques/French Monitoring Centre for Analgesic Drugs, Université Clermont Auvergne - CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Celian Bertin
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Clermont-Ferrand, France.,Observatoire Français des Médicaments Antalgiques/French Monitoring Centre for Analgesic Drugs, Université Clermont Auvergne - CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Marie Riquelme
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Clermont-Ferrand, France.,Observatoire Français des Médicaments Antalgiques/French Monitoring Centre for Analgesic Drugs, Université Clermont Auvergne - CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Alain Eschalier
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Clermont-Ferrand, France.,Faculté de Médecine, Institut Analgesia, Clermont-Ferrand, France
| | - Denis Ardid
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Clermont-Ferrand, France.,Faculté de Médecine, Institut Analgesia, Clermont-Ferrand, France
| | - Nicolas Authier
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Clermont-Ferrand, France.,Observatoire Français des Médicaments Antalgiques/French Monitoring Centre for Analgesic Drugs, Université Clermont Auvergne - CHU Clermont-Ferrand, Clermont-Ferrand, France.,Faculté de Médecine, Institut Analgesia, Clermont-Ferrand, France
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27
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Zedler BK, Saunders WB, Joyce AR, Vick CC, Murrelle EL. Validation of a Screening Risk Index for Serious Prescription Opioid-Induced Respiratory Depression or Overdose in a US Commercial Health Plan Claims Database. PAIN MEDICINE (MALDEN, MASS.) 2018; 19:68-78. [PMID: 28340046 PMCID: PMC5939826 DOI: 10.1093/pm/pnx009] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective To validate a risk index that estimates the likelihood of overdose or serious opioid-induced respiratory depression (OIRD) among medical users of prescription opioids. Subjects and Methods A case-control analysis of 18,365,497 patients with an opioid prescription from 2009 to 2013 in the IMS PharMetrics Plus commercially insured health plan claims database (CIP). An OIRD event occurred in 7,234 cases. Four controls were selected per case. Validity of the Risk Index for Overdose or Serious Opioid-induced Respiratory Depression (RIOSORD), developed previously using Veterans Health Administration (VHA) patient data, was assessed. Multivariable logistic regression was used within the CIP study population to develop a slightly refined RIOSORD. The composition and performance of the CIP-based RIOSORD was evaluated and compared with VHA-based RIOSORD. Results VHA-RIOSORD performed well in discriminating OIRD events in CIP (C-statistic = 0.85). Additionally, re-estimation of logistic model coefficients in CIP yielded a 0.90 C-statistic. The resulting comorbidity and pharmacotherapy variables most highly associated with OIRD and retained in the CIP-RIOSORD were largely concordant with VHA-RIOSORD. These variables included neuropsychiatric and cardiopulmonary disorders, impaired drug excretion, opioid characteristics, and concurrent psychoactive medications. The average predicted probability of OIRD ranged from 2% to 83%, with excellent agreement between predicted and observed incidence across risk classes. Conclusions RIOSORD had excellent predictive accuracy in a large population of US medical users of prescription opioids, similar to its performance in VHA. This practical risk index is designed to support clinical decision-making for safer opioid prescribing, and its clinical utility should be evaluated prospectively.
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Affiliation(s)
| | - William B Saunders
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
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28
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Hooten WM, Brummett CM, Sullivan MD, Goesling J, Tilburt JC, Merlin JS, St Sauver JL, Wasan AD, Clauw DJ, Warner DO. A Conceptual Framework for Understanding Unintended Prolonged Opioid Use. Mayo Clin Proc 2017; 92:1822-1830. [PMID: 29108841 DOI: 10.1016/j.mayocp.2017.10.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 09/22/2017] [Accepted: 10/09/2017] [Indexed: 12/12/2022]
Abstract
An urgent need exists to better understand the transition from short-term opioid use to unintended prolonged opioid use (UPOU). The purpose of this work is to propose a conceptual framework for understanding UPOU that posits the influence of 3 principal domains that include the characteristics of (1) individual patients, (2) the practice environment, and (3) opioid prescribers. Although no standardized method exists for developing a conceptual framework, the process often involves identifying corroborative evidence, leveraging expert opinion to identify factors for inclusion in the framework, and developing a graphic depiction of the relationships between the various factors and the clinical problem of interest. Key patient characteristics potentially associated with UPOU include (1) medical and mental health conditions; (2) pain etiology; (3) individual affective, behavioral, and neurophysiologic reactions to pain and opioids; and (4) sociodemographic factors. Also, UPOU could be influenced by structural and health care policy factors: (1) the practice environment, including the roles of prescribing clinicians, adoption of relevant practice guidelines, and clinician incentives or disincentives, and (2) the regulatory environment. Finally, characteristics inherent to clinicians that could influence prescribing practices include (1) training in pain management and opioid use; (2) personal attitudes, knowledge, and beliefs regarding the risks and benefits of opioids; and (3) professionalism. As the gatekeeper to opioid access, the behavior of prescribing clinicians directly mediates UPOU, with the 3 domains interacting to determine this behavior. This proposed conceptual framework could guide future research on the topic and allow plausible hypothesis-based interventions to reduce UPOU.
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Affiliation(s)
- W Michael Hooten
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, MN.
| | - Chad M Brummett
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor
| | - Mark D Sullivan
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle
| | - Jenna Goesling
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor
| | - Jon C Tilburt
- Department of General Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN
| | - Jessica S Merlin
- Division of Infectious Diseases, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham
| | - Jennifer L St Sauver
- Division of Epidemiology, Department of Health Science Research, Mayo Clinic College of Medicine, Rochester, MN
| | - Ajay D Wasan
- Department of Anesthesiology, University of Pittsburgh, Pittsburgh, PA
| | - Daniel J Clauw
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor
| | - David O Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, MN
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30
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Dureja GP, Jain PN, Joshi M, Saxena A, Das G, Ahdal J, Narang P. Addressing the barriers related with opioid therapy for management of chronic pain in India. Pain Manag 2017; 7:311-330. [PMID: 28699380 DOI: 10.2217/pmt-2016-0064] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
India has a high prevalence of chronic disorders which may be associated with persistent pain. Despite the availability of multiple treatment options, chronic pain is largely untreated and contributes to disability and mortality. Medical consumption of opioids remains low due to various barriers that prevent access to opioids for patients and healthcare practitioners. Stringent regulatory provisions outlined in the Narcotic Drugs and Psychotropic Substances Act (1985) have been major deterrents to adequate opioid use. Although multiple amendments to the act have ensured ease of opioid access for medicinal purposes, concerns such as lack of awareness and prescribing practices and attitudes of physicians/patients still need to be addressed. This review aims to identify these barriers and suggest recommendations to overcome them.
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Affiliation(s)
| | | | | | - Ashok Saxena
- Department of Anesthesiology, Pain Clinic, University College of Medical Sciences, University of Delhi, New Delhi, India
| | - Gautam Das
- Daradia Pain Clinic, Kolkata, West Bengal, India
| | - Jaishid Ahdal
- Medical Affairs, Johnson & Johnson Pvt. Ltd., Mumbai, Maharashtra, India
| | - Prashant Narang
- Medical Affairs, Johnson & Johnson Pvt. Ltd., Mumbai, Maharashtra, India
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31
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Helmerhorst GTT, Teunis T, Janssen SJ, Ring D. An epidemic of the use, misuse and overdose of opioids and deaths due to overdose, in the United States and Canada. Bone Joint J 2017; 99-B:856-864. [DOI: 10.1302/0301-620x.99b7.bjj-2016-1350.r1] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 02/15/2017] [Indexed: 11/05/2022]
Abstract
The United States and Canada are in the midst of an epidemic of the use, misuse and overdose of opioids, and deaths related to overdose. This is the direct result of overstatement of the benefits and understatement of the risks of using opioids by advocates and pharmaceutical companies. Massive amounts of prescription opioids entered the community and were often diverted and misused. Most other parts of the world achieve comparable pain relief using fewer opioids. The misconceptions about opioids that created this epidemic are finding their way around the world. There is particular evidence of the increased prescription of strong opioids in Europe. Opioids are addictive and dangerous. Evidence is mounting that the best pain relief is obtained through resilience. Opioids are often prescribed when treatments to increase resilience would be more effective. Cite this article: Bone Joint J 2017;99-B:856–64.
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Affiliation(s)
| | - T. Teunis
- University Medical Center Utrecht, Heidelberglaan
100, 3584 CX Utrecht, The
Netherlands
| | - S. J. Janssen
- Onze Lieve Vrouwe Gasthuis, Oosterpark
9, 1091 AC Amsterdam, The
Netherlands
| | - D. Ring
- The University of Texas at Austin, 1912
Speedway, Austin, Texas, 78712, USA
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32
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Ebbert JO, Philpot LM, Clements CM, Lovely JK, Nicholson WT, Jenkins SM, Lamer TJ, Gazelka HM. Attitudes, Beliefs, Practices, and Concerns Among Clinicians Prescribing Opioids in a Large Academic Institution. PAIN MEDICINE 2017; 19:1790-1798. [DOI: 10.1093/pm/pnx140] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Jon O Ebbert
- College of Medicine
- Robert D. and Patricia E. Kern Mayo Clinic Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Lindsey M Philpot
- College of Medicine
- Robert D. and Patricia E. Kern Mayo Clinic Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
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33
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Cushman PA, Liebschutz JM, Hodgkin JG, Shanahan CW, White JL, Hardesty I, Alford DP. What do providers want to know about opioid prescribing? A qualitative analysis of their questions. Subst Abus 2017; 38:222-229. [PMID: 28394736 DOI: 10.1080/08897077.2017.1296525] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND In 2012, the US Food and Drug Administration (FDA) responded to the opioid crisis with a Risk Evaluation and Mitigation Strategy, requiring manufacturers of extended-release/long-acting opioids to fund continuing medical education based on the "FDA Blueprint for Prescriber Education." Topics in the Blueprint are "Assessing Patients for Treatment," "Initiating Therapy, Modifying Dosing, and Discontinuing Use," "Managing Therapy," "Counseling Patients and Caregivers about Safe Use," "General Drug Information," and "Specific Drug Information." Based on the FDA Blueprint, Boston University School of Medicine's "Safe and Competent Opioid Prescribing Education" (SCOPE of Pain) offers live trainings for physicians and other prescribers. During trainings, participants submit written questions about the curriculum and/or their clinical experiences. METHODS The objective was to compare themes that arose from questions asked by SCOPE of Pain participants with content of the FDA Blueprint in order to evaluate how well the Blueprint answers prescribers' concerns. The authors conducted qualitative analyses of all 1309 questions submitted by participants in 29 trainings across 16 states from May 2013 to May 2015, using conventional content analysis to code the questions. Themes that emerged from participants' questions were then compared with the Blueprint. RESULTS Most themes fell into the topic categories of the Blueprint. Five main themes diverged: Participants sought information on (1) safe alternatives to opioids, (2) overcoming barriers to safe opioid prescribing, (3) government regulations of opioid prescribing, (4) the role of marijuana in opioid prescribing, and (5) maintaining a positive provider-patient relationship while prescribing opioids. CONCLUSIONS In addition to learning the mechanics of safe opioid prescribing, providers want to understand government regulations and effective patient communication skills. Aware of the limitations of opioids in managing chronic pain, providers seek advice on alternatives therapies. Future updates to the FDA Blueprint and other educational guidelines on opioid prescribing should address providers' additional questions.
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Affiliation(s)
- Phoebe A Cushman
- a Boston University School of Medicine , Boston , Massachusetts , USA.,b Section of General Internal Medicine, Boston Medical Center , Boston , Massachusetts , USA
| | - Jane M Liebschutz
- a Boston University School of Medicine , Boston , Massachusetts , USA.,b Section of General Internal Medicine, Boston Medical Center , Boston , Massachusetts , USA
| | - Joseph G Hodgkin
- a Boston University School of Medicine , Boston , Massachusetts , USA
| | - Christopher W Shanahan
- a Boston University School of Medicine , Boston , Massachusetts , USA.,b Section of General Internal Medicine, Boston Medical Center , Boston , Massachusetts , USA
| | - Julie L White
- a Boston University School of Medicine , Boston , Massachusetts , USA
| | - Ilana Hardesty
- a Boston University School of Medicine , Boston , Massachusetts , USA
| | - Daniel P Alford
- a Boston University School of Medicine , Boston , Massachusetts , USA.,b Section of General Internal Medicine, Boston Medical Center , Boston , Massachusetts , USA
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Psychoactive substance use prior to the development of iatrogenic opioid abuse: A descriptive analysis of treatment-seeking opioid abusers. Addict Behav 2017; 65:242-244. [PMID: 27544696 DOI: 10.1016/j.addbeh.2016.08.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 07/18/2016] [Accepted: 08/13/2016] [Indexed: 11/22/2022]
Abstract
Physicians are frequently thought to be a major source of opioids diverted for non-therapeutic purposes, largely because it is so difficult for them to discern which patients might abuse them. In this study we sought to determine whether those who were first exposed to an opioid through a physician's prescription, and subsequently developed a substance use disorder, had a history of using psychoactive drugs prior to abusing opioids. Patients entering one of 125 drug treatment programs across the country for opioid abuse were asked to provide detailed histories of psychoactive drug use prior to their initial opioid exposure. Nearly half (47.1%, N=4493) indicated they were first exposed to opioids through a prescription from their physician to treat pain. Of these, 94.6% indicated experience with at least one other psychoactive substance (mean=4.55±0.05) prior to, or coincident with, their first exposure to an opioid from a physician. Alcohol (92.9%), nicotine and/or tobacco (89.5%), and marijuana (87.4%) were used by nearly all patients prior to, or coincident with, their first opioid prescription. If one excludes these drugs, 70.1% (N=2913) still reported some psychoactive drug use of licit or illicit stimulants (77.8%), benzodiazepines (59.8%) or hallucinogens (55.2%). Our results indicate that pain patients who developed a substance use disorder were rarely drug naïve prior to receiving their first opioid prescription. Rather, most have an extensive history of psychoactive drug use. As such, physicians should routinely ascertain complete licit and illicit drug histories in patients for whom they prescribe opioids.
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Chaudhary S, Compton P. Use of risk mitigation practices by family nurse practitioners prescribing opioids for the management of chronic nonmalignant pain. Subst Abus 2016; 38:95-104. [DOI: 10.1080/08897077.2016.1265038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Sahil Chaudhary
- Department of Health Systems Administration, Georgetown University, Washington, DC, USA
| | - Peggy Compton
- Department of Advanced Nursing Practice, Georgetown University, Washington, DC, USA
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Affiliation(s)
- Sunil Sirohi
- Laboratory of Endocrine and Neuropsychiatric Disorders, Division of Basic Pharmaceutical Sciences, College of Pharmacy, Xavier University of Louisiana, New Orleans, LA
| | - Amit K Tiwari
- Department of Pharmacology and Experimental Therapeutics, College of Pharmacy and Pharmaceutical Sciences, University of Toledo, Toledo, OH, USA
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Davis CS, Carr D. Physician continuing education to reduce opioid misuse, abuse, and overdose: Many opportunities, few requirements. Drug Alcohol Depend 2016; 163:100-7. [PMID: 27137406 DOI: 10.1016/j.drugalcdep.2016.04.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 04/01/2016] [Accepted: 04/03/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND The opioid overdose epidemic in the United States is driven in large part by inappropriate opioid prescribing. Although most American physicians receive little or no training during medical school regarding evidence-based prescribing, substance use disorders, and pain management, some states require continuing medical education (CME) on these topics. We report the results of a systematic legal analysis of such requirements, together with recommendations for improved physician training. METHODS To determine the presence and characteristics of CME requirements in the United States, we systematically collected, reviewed, and coded all laws that require such education as a condition of obtaining or renewing a license to practice medicine. Laws or regulations that mandate one-time or ongoing training in topics designed to reduce overdose risk were further characterized using an iterative protocol RESULTS Only five states require all or nearly all physicians to obtain CME on topics such as pain management and controlled substance prescribing, and fewer than half require any physicians to obtain such training. CONCLUSIONS While not a replacement for improved education in medical school and post-graduate clinical training, evidence-based CME can help improve provider knowledge and practice. Requiring physicians to obtain CME that accurately presents evidence regarding opioid prescribing and related topics may help reduce opioid-related morbidity and mortality. States and the federal government should also strongly consider requiring such training in medical school and residency.
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Affiliation(s)
- Corey S Davis
- Network for Public Health Law-Southeastern Region, 101 E. Weaver St. #G-7, Carrboro, NC 27510, United States.
| | - Derek Carr
- Network for Public Health Law-Southeastern Region, 101 E. Weaver St. #G-7, Carrboro, NC 27510, United States.
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Affiliation(s)
- Nora D Volkow
- From the National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD (N.D.V.); and the Treatment Research Institute, Philadelphia (A.T.M.)
| | - A Thomas McLellan
- From the National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD (N.D.V.); and the Treatment Research Institute, Philadelphia (A.T.M.)
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Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016. MMWR Recomm Rep 2016; 65:1-49. [PMID: 26987082 DOI: 10.15585/mmwr.rr6501e1] [Citation(s) in RCA: 1987] [Impact Index Per Article: 248.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
This guideline provides recommendations for primary care clinicians who are prescribing opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care. The guideline addresses 1) when to initiate or continue opioids for chronic pain; 2) opioid selection, dosage, duration, follow-up, and discontinuation; and 3) assessing risk and addressing harms of opioid use. CDC developed the guideline using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework, and recommendations are made on the basis of a systematic review of the scientific evidence while considering benefits and harms, values and preferences, and resource allocation. CDC obtained input from experts, stakeholders, the public, peer reviewers, and a federally chartered advisory committee. It is important that patients receive appropriate pain treatment with careful consideration of the benefits and risks of treatment options. This guideline is intended to improve communication between clinicians and patients about the risks and benefits of opioid therapy for chronic pain, improve the safety and effectiveness of pain treatment, and reduce the risks associated with long-term opioid therapy, including opioid use disorder, overdose, and death. CDC has provided a checklist for prescribing opioids for chronic pain (http://stacks.cdc.gov/view/cdc/38025) as well as a website (http://www.cdc.gov/drugoverdose/prescribingresources.html) with additional tools to guide clinicians in implementing the recommendations.
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Affiliation(s)
- Deborah Dowell
- Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, CDC, Atlanta, Georgia
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Pearson AC, Eldrige JS, Moeschler SM, Hooten WM. Opioids for chronic pain: a knowledge assessment of nonpain specialty providers. J Pain Res 2016; 9:129-35. [PMID: 27022300 PMCID: PMC4790520 DOI: 10.2147/jpr.s98273] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Although the majority of opioids in the US are prescribed by nonpain specialists, these providers often report inadequate training in chronic pain management and opioid prescribing. The extent of health care providers’ knowledge of opioid prescribing for chronic pain has not been well established. The purpose of this study was to assess knowledge about the use of opioids for chronic pain among health care providers seeking pain-focused continuing medical education. Materials and methods The study participants (n=131) were recruited at a pain-focused continuing medical education conference for nonpain specialists. Upon commencement of the conference, the KnowPain-50 survey was completed. The survey comprised 50 questions, and 18 questions were related to opioid management. The focus of each opioid question was further categorized as either medicolegal (n=7) or clinical (n=11). Results The majority of study participants were male physicians with a mean age of 51.8 years. The proportion of correct responses to the 50-item survey was 72%. The proportion of correct responses to the 32 nonopioid questions was 74%, and the proportion of correct responses to the 18 opioid questions was 69% (P<0.001). Similarly, the proportion of correct responses to the seven medicolegal opioid questions was 74%, and the proportion of correct responses to the eleven clinical opioid questions was 67% (P<0.001). Conclusion Health care providers demonstrated gaps in knowledge about the use of opioids for chronic pain. Lower scores on clinically based opioid questions may indicate an opportunity to provide focused educational content about this area of practice. This information could be helpful in designing future educational modules for nonpain providers.
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Affiliation(s)
- Amy Cs Pearson
- Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA
| | - Jason S Eldrige
- Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA
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Beauchamp GA, Winstanley EL, Ryan SA, Lyons MS. Moving beyond misuse and diversion: the urgent need to consider the role of iatrogenic addiction in the current opioid epidemic. Am J Public Health 2014; 104:2023-9. [PMID: 25211712 PMCID: PMC4202970 DOI: 10.2105/ajph.2014.302147] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2014] [Indexed: 11/04/2022]
Abstract
An epidemic of drug overdose deaths has led to calls for programs and policies to limit misuse and diversion of opioid medications. Any parallel call to consider the risk of iatrogenic addiction when treating pain has been muted in comparison. We have moved beyond questions of nonmedical use, abuse, and diversion to highlight the role of prescription opioids in causing addiction even when prescribed and used appropriately. Unfortunately, current evidence is insufficient, and a rapid expansion of longitudinal research is urgently needed to guide clinicians in balancing the need for opioids with the risk of adverse consequences. Meanwhile, medical education should place greater emphasis on the abuse liability of prescription opioids, and providers should endeavor to attenuate risk when possible.
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Affiliation(s)
- Gillian A Beauchamp
- Gillian A. Beauchamp, Shawn A. Ryan, and Michael S. Lyons are with the Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH. Erin L. Winstanley is with Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine and the James L. Winkle College of Pharmacy, University of Cincinnati
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Trends in Ambulatory Physician Opioid Prescription in the United States, 1997-2009. PM R 2014; 6:575-82.e4. [DOI: 10.1016/j.pmrj.2013.12.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 12/29/2013] [Accepted: 12/31/2013] [Indexed: 11/19/2022]
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Turk DC, Dansie EJ, Wilson HD, Moskovitz B, Kim M. Physicians' Beliefs and Likelihood of Prescribing Opioid Tamper-Resistant Formulations for Chronic Noncancer Pain Patients. PAIN MEDICINE 2014; 15:625-36. [DOI: 10.1111/pme.12352] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Chang YP, Compton P. Management of chronic pain with chronic opioid therapy in patients with substance use disorders. Addict Sci Clin Pract 2013; 8:21. [PMID: 24341916 PMCID: PMC3904483 DOI: 10.1186/1940-0640-8-21] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 12/05/2013] [Indexed: 01/02/2023] Open
Abstract
Substance use disorders (SUDs), whether active or in remission, are often encountered in patients with chronic nonmalignant pain. Clinicians are challenged when managing chronic pain while facing substance abuse issues during the course of chronic opioid therapy (COT). Further, the interrelated behavioral symptomatology of addiction and chronic pain suggests that if one disorder is untreated, effective treatment of the other in not possible. Incomplete understanding of the overlapping presentations of the two disorders, coupled with insufficient management of both conditions, leads to undertreated pain and premature discharge of SUD patients from pain treatment. In order to achieve pain relief and optimal functionality, both conditions need to be carefully managed. This paper reviews the prevalence of SUDs in chronic pain patents; the overlapping presentation of the two disorders; risk factors and stratification for addiction; identification of addiction in the chronic pain population; and suggestions for treating patients with COT, with an emphasis on relapse prevention. With appropriate assessment and treatment, COT for chronic pain patients with a history of SUD can be successful, leading to improved functionality and quality of life.
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Affiliation(s)
- Yu-Ping Chang
- University of Buffalo School of Nursing, Buffalo, 3435 Main Street Wende Hall 201E, Buffalo, NY 14221, USA.
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Kissin I. Long-term opioid treatment of chronic nonmalignant pain: unproven efficacy and neglected safety? J Pain Res 2013; 6:513-29. [PMID: 23874119 PMCID: PMC3712997 DOI: 10.2147/jpr.s47182] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND For the past 30 years, opioids have been used to treat chronic nonmalignant pain. This study tests the following hypotheses: (1) there is no strong evidence-based foundation for the conclusion that long-term opioid treatment of chronic nonmalignant pain is effective; and (2) the main problem associated with the safety of such treatment - assessment of the risk of addiction - has been neglected. METHODS Scientometric analysis of the articles representing clinical research in this area was performed to assess (1) the quality of presented evidence (type of study); and (2) the duration of the treatment phase. The sufficiency of representation of addiction was assessed by counting the number of articles that represent (1) editorials; (2) articles in the top specialty journals; and (3) articles with titles clearly indicating that the addiction-related safety is involved (topic-in-title articles). RESULTS Not a single randomized controlled trial with opioid treatment lasting >3 months was found. All studies with a duration of opioid treatment ≥6 months (n = 16) were conducted without a proper control group. Such studies cannot provide the consistent good-quality evidence necessary for a strong clinical recommendation. There were profound differences in the number of addiction articles related specifically to chronic nonmalignant pain patients and to opioid addiction in general. An inadequate number of chronic pain-related publications were observed with all three types of counted articles: editorials, articles in the top specialty journals, and topic-in-title articles. CONCLUSION There is no strong evidence-based foundation for the conclusion that long-term opioid treatment of chronic nonmalignant pain is effective. The above identified signs indicating neglect of addiction associated with the opioid treatment of chronic nonmalignant pain were present.
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Affiliation(s)
- Igor Kissin
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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Roux P, Sullivan MA, Cohen J, Fugon L, Jones JD, Vosburg SK, Cooper ZD, Manubay JM, Mogali S, Comer SD. Buprenorphine/naloxone as a promising therapeutic option for opioid abusing patients with chronic pain: reduction of pain, opioid withdrawal symptoms, and abuse liability of oral oxycodone. Pain 2013; 154:1442-8. [PMID: 23707283 DOI: 10.1016/j.pain.2013.05.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 04/12/2013] [Accepted: 05/01/2013] [Indexed: 11/25/2022]
Abstract
Few studies have examined abuse of prescription opioids among individuals with chronic pain under buprenorphine/naloxone (Bup/Nx) maintenance. The current 7-week inpatient study assessed oral oxycodone self-administration by patients with chronic pain who had a history of opioid abuse. Participants (n=25) were transitioned from their preadmission prescribed opioid to Bup/Nx. All of the participants were tested under each of the sublingual Bup/Nx maintenance doses (2/0.5, 8/2 or 16/4 mg) in random order. During each maintenance period, participants could self-administer oxycodone orally (0, 10, 20, 40 or 60 mg prescription opioids) or receive money during laboratory sessions. Drug choice (percentage) was the primary dependent variable. Subjective ratings of clinical pain and withdrawal symptoms also were measured. Mann-Whitney tests compared percentage of drug choice for each active oxycodone dose to placebo. Logistic regression analyses identified correlates of oxycodone preference, defined as 60% or greater choice of oxycodone compared to money. Pain was significantly reduced while participants were maintained on Bup/Nx compared to preadmission ratings. No differences in percentage drug choice were observed between the active oxycodone doses and placebo under each Bup/Nx maintenance dose. However, factors associated with oxycodone preference were lower Bup/Nx maintenance dose, more withdrawal symptoms and more pain. These data suggest that Bup/Nx was effective in reducing pain and supplemental oxycodone use. Importantly, adequate management of pain and withdrawal symptoms by Bup/Nx may reduce oxycodone preference in this population.
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Affiliation(s)
- Perrine Roux
- Division on Substance Abuse, New York State Psychiatric Institute, Department of Psychiatry, and College of Physicians and Surgeons, Columbia University, 1051 Riverside Dr, Unit 120, New York, NY 10032, USA.
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