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Casey ER, Hetrick ML, Zwiebel SJ. Potential Application of Ketamine in Pain and Withdrawal in Patients With Opioid Use Disorder. J Acad Consult Liaison Psychiatry 2024:S2667-2960(24)00047-8. [PMID: 38636900 DOI: 10.1016/j.jaclp.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/09/2024] [Accepted: 04/13/2024] [Indexed: 04/20/2024]
Affiliation(s)
- Emily R Casey
- Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, PA.
| | - Miranda L Hetrick
- Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Samantha J Zwiebel
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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2
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Hastings LE, Frye EV, Carlson ER, Chuong V, Matthews AN, Koob GF, Vendruscolo LF, Marchette RCN. Cold nociception as a measure of hyperalgesia during spontaneous heroin withdrawal in mice. Pharmacol Biochem Behav 2024; 235:173694. [PMID: 38128767 PMCID: PMC10842911 DOI: 10.1016/j.pbb.2023.173694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023]
Abstract
Opioids are powerful analgesic drugs that are used clinically to treat pain. However, chronic opioid use causes compensatory neuroadaptations that result in greater pain sensitivity during withdrawal, known as opioid withdrawal-induced hyperalgesia (OWIH). Cold nociception tests are commonly used in humans, but preclinical studies often use mechanical and heat stimuli to measure OWIH. Thus, further characterization of cold nociception stimuli is needed in preclinical models. We assessed three cold nociception tests-thermal gradient ring (5-30 °C, 5-50 °C, 15-40 °C, and 25-50 °C), dynamic cold plate (4 °C to -1 °C at -1 °C/min, -1 °C to 4 °C at +1 °C/min), and stable cold plate (10 °C, 6 °C, and 2 °C)-to measure hyperalgesia in a mouse protocol of heroin dependence. On the thermal gradient ring, mice in the heroin withdrawal group preferred warmer temperatures, and the results depended on the ring's temperature range. On the dynamic cold plate, heroin withdrawal increased the number of nociceptive responses, with a temperature ramp from 4 °C to -1 °C yielding the largest response. On the stable cold plate, heroin withdrawal increased the number of nociceptive responses, and a plate temperature of 2 °C yielded the most significant increase in responses. Among the three tests, the stable cold plate elicited the most robust change in behavior between heroin-dependent and nondependent mice and had the highest throughput. To pharmacologically characterize the stable cold plate test, we used μ-opioid and non-opioid receptor-targeting drugs that have been previously shown to reverse OWIH in mechanical and heat nociception assays. The full μ-opioid receptor agonist methadone and μ-opioid receptor partial agonist buprenorphine decreased OWIH, whereas the preferential μ-opioid receptor antagonist naltrexone increased OWIH. Two N-methyl-d-aspartate receptor antagonists (ketamine, MK-801), a corticotropin-releasing factor 1 receptor antagonist (R121919), a β2-adrenergic receptor antagonist (butoxamine), an α2-adrenergic receptor agonist (lofexidine), and a 5-hydroxytryptamine-3 receptor antagonist (ondansetron) had no effect on OWIH. These data demonstrate that the stable cold plate at 2 °C yields a robust, reliable, and concise measure of OWIH that is sensitive to opioid agonists.
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Affiliation(s)
- Lyndsay E Hastings
- Neurobiology of Addiction Section, Integrative Neuroscience Research Branch, National Institute on Drug Abuse, Intramural Research Program, Baltimore, MD, USA
| | - Emma V Frye
- Neurobiology of Addiction Section, Integrative Neuroscience Research Branch, National Institute on Drug Abuse, Intramural Research Program, Baltimore, MD, USA
| | - Erika R Carlson
- Neurobiology of Addiction Section, Integrative Neuroscience Research Branch, National Institute on Drug Abuse, Intramural Research Program, Baltimore, MD, USA
| | - Vicky Chuong
- Neurobiology of Addiction Section, Integrative Neuroscience Research Branch, National Institute on Drug Abuse, Intramural Research Program, Baltimore, MD, USA; Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, Translational Addiction Medicine Branch, National Intitute on Drug Abuse, Intramural Research Program, and National Institute on Alcohol Abuse and Alcoholism, Division of Intramural Clinical and Biological Research, Baltimore, MD, USA
| | - Aniah N Matthews
- Neurobiology of Addiction Section, Integrative Neuroscience Research Branch, National Institute on Drug Abuse, Intramural Research Program, Baltimore, MD, USA
| | - George F Koob
- Neurobiology of Addiction Section, Integrative Neuroscience Research Branch, National Institute on Drug Abuse, Intramural Research Program, Baltimore, MD, USA
| | - Leandro F Vendruscolo
- Stress and Addiction Neuroscience Unit, Integrative Neuroscience Research Branch, National Institute on Drug Abuse, Intramural Research Program, and National Institute on Alcohol Abuse and Alcoholism, Division of Intramural Clinical and Biological Research, Baltimore, MD, USA
| | - Renata C N Marchette
- Neurobiology of Addiction Section, Integrative Neuroscience Research Branch, National Institute on Drug Abuse, Intramural Research Program, Baltimore, MD, USA.
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3
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Johnston JN, Kadriu B, Kraus C, Henter ID, Zarate CA. Ketamine in neuropsychiatric disorders: an update. Neuropsychopharmacology 2024; 49:23-40. [PMID: 37340091 PMCID: PMC10700638 DOI: 10.1038/s41386-023-01632-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/08/2023] [Accepted: 06/01/2023] [Indexed: 06/22/2023]
Abstract
The discovery of ketamine as a rapid-acting antidepressant led to a new era in the development of neuropsychiatric therapeutics, one characterized by an antidepressant response that occurred within hours or days rather than weeks or months. Considerable clinical research supports the use of-or further research with-subanesthetic-dose ketamine and its (S)-enantiomer esketamine in multiple neuropsychiatric disorders including depression, bipolar disorder, anxiety spectrum disorders, substance use disorders, and eating disorders, as well as for the management of chronic pain. In addition, ketamine often effectively targets symptom domains associated with multiple disorders, such as anxiety, anhedonia, and suicidal ideation. This manuscript: 1) reviews the literature on the pharmacology and hypothesized mechanisms of subanesthetic-dose ketamine in clinical research; 2) describes similarities and differences in the mechanism of action and antidepressant efficacy between racemic ketamine, its (S) and (R) enantiomers, and its hydroxynorketamine (HNK) metabolite; 3) discusses the day-to-day use of ketamine in the clinical setting; 4) provides an overview of ketamine use in other psychiatric disorders and depression-related comorbidities (e.g., suicidal ideation); and 5) provides insights into the mechanisms of ketamine and therapeutic response gleaned from the study of other novel therapeutics and neuroimaging modalities.
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Affiliation(s)
- Jenessa N Johnston
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.
| | - Bashkim Kadriu
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
- Translational and Experimental Medicine, Neuroscience at Jazz Pharmaceuticals, San Diego, CA, USA
| | - Christoph Kraus
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Ioline D Henter
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Carlos A Zarate
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
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4
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Levinstein MR, Michaelides M. Exploring the role of mu opioid receptors in the therapeutic potential and abuse liability of (S)-ketamine. Neuropsychopharmacology 2024; 49:315-316. [PMID: 37438422 PMCID: PMC10700302 DOI: 10.1038/s41386-023-01652-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Affiliation(s)
- Marjorie R Levinstein
- Biobehavioral Imaging and Molecular Neuropsychopharmacology Unit, National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, 21224, USA.
| | - Michael Michaelides
- Biobehavioral Imaging and Molecular Neuropsychopharmacology Unit, National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, 21224, USA.
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA.
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5
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Lynch D, Chitty L, Johnson B, Hoefnagel AL. Suspected Buprenorphine-Precipitated Opioid Withdrawal following Intercourse: A Case Report. J Pain Palliat Care Pharmacother 2023; 37:314-316. [PMID: 37640398 DOI: 10.1080/15360288.2023.2250344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/21/2023] [Accepted: 08/06/2023] [Indexed: 08/31/2023]
Abstract
Buprenorphine, a partial mu-opioid receptor agonist, is a commonly prescribed medication for opioid use disorder (OUD). There is evidence that drugs may enter the male genitourinary tract by an ion-trapping process, based on the lipid solubility and degree of ionization (1). While little is known about the pharmacokinetics of drugs in seminal fluid, pH is thought to play an integral role. Limited evidence exists surrounding cervical absorption of drugs via seminal fluid transmission. This also prompts survey of the frequency of this event and the influence on treatment within this population.
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Affiliation(s)
- Davene Lynch
- Department of Anesthesia UF Health Jacksonville, University of Florida-Jacksonville, Jacksonville, FL, USA
| | - Lyndsey Chitty
- Department of Anesthesia UF Health Jacksonville, University of Florida-Jacksonville, Jacksonville, FL, USA
| | - Brittany Johnson
- Department of Pharmacy UF Health Jacksonville, University of Florida-Jacksonville, Jacksonville, FL, USA
| | - Amie L Hoefnagel
- Department of Anesthesia UF Health Jacksonville, University of Florida-Jacksonville, Jacksonville, FL, USA
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D’Onofrio G, Perrone J, Hawk KF, Cowan E, McCormack R, Coupet E, Owens PH, Martel SH, Huntley K, Walsh SL, Lofwall MR, Herring A. Early emergency department experience with 7-day extended-release injectable buprenorphine for opioid use disorder. Acad Emerg Med 2023; 30:1264-1271. [PMID: 37501652 PMCID: PMC10822018 DOI: 10.1111/acem.14782] [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: 06/05/2023] [Revised: 07/17/2023] [Accepted: 07/25/2023] [Indexed: 07/29/2023]
Abstract
As the opioid overdose epidemic escalates, there is an urgent need for treatment innovations to address both patient and clinician barriers when initiating buprenorphine in the emergency department (ED). These include insurance status, logistical challenges such as the ability to fill a prescription and transportation, concerns regarding diversion, and availability of urgent referral sites. Extended-release buprenorphine (XR-BUP) preparations such as a new 7-day injectable could potentially solve some of these issues. We describe the pharmacokinetics of a new 7-day XR-BUP formulation and the feasibility of its use in the ED setting. We report our early experiences with this medication (investigational drug CAM2038), in the context of an ongoing clinical trial entitled Emergency Department-Initiated BUP VAlidaTION (ED INNOVATION), to inform emergency clinicians as they consider incorporating this medication into their practice. The medication was approved by the European Medicines Agency in 2018 and the U.S. Food and Drug Administration in 2023 for those 18 years or older for the treatment of moderate to severe opioid use disorder (OUD). We report our experience with approximately 800 ED patients with OUD who received the 7-day XR-BUP preparation in the ED between June 2020 and July 2023.
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Affiliation(s)
- Gail D’Onofrio
- Department of Emergency Medicine, Yale School of Medicine,
New Haven, Connecticut
- Yale School of Public Health New Haven, Connecticut
| | - Jeanmarie Perrone
- Department of Emergency Medicine Perelman School of
Medicine at the University of Pennsylvania. Philadelphia, Pennsylvania
| | - Kathryn F. Hawk
- Department of Emergency Medicine, Yale School of Medicine,
New Haven, Connecticut
- Yale School of Public Health New Haven, Connecticut
| | - Ethan Cowan
- Department of Emergency Medicine, Yale School of Medicine,
New Haven, Connecticut
- Department of Emergency Medicine Icahn School of Medicine
at Mount Sinai New York, New York
| | - Ryan McCormack
- Department of Emergency Medicine NYU Langone Medical Center
New York, New York
| | - Edouard Coupet
- Department of Emergency Medicine, Yale School of Medicine,
New Haven, Connecticut
| | - Patricia H. Owens
- Department of Emergency Medicine, Yale School of Medicine,
New Haven, Connecticut
| | - Shara H. Martel
- Department of Emergency Medicine, Yale School of Medicine,
New Haven, Connecticut
| | | | - Sharon L. Walsh
- University of Kentucky College of Medicine Center on Drug
and Alcohol Research, Lexington, Kentucky
| | - Michelle R. Lofwall
- University of Kentucky College of Medicine Center on Drug
and Alcohol Research, Lexington, Kentucky
| | - Andrew Herring
- Department of Emergency Medicine Highland Hospital Oakland,
California
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7
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Drinkuth CR, Lehane MJ, Sartor GC. The effects of (2R,6R)-hydroxynorketamine on oxycodone withdrawal and reinstatement. Drug Alcohol Depend 2023; 253:110987. [PMID: 37864957 PMCID: PMC10842506 DOI: 10.1016/j.drugalcdep.2023.110987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/13/2023] [Accepted: 09/30/2023] [Indexed: 10/23/2023]
Abstract
Despite the thousands of lives lost during the ongoing opioid crisis, a scarcity of new and effective clinical treatments for opioid use disorder (OUD) remains. To address this unmet need, some researchers have turned to dissociative and psychedelic drugs to treat multiple psychiatric conditions. In particular, low doses of ketamine have been shown to attenuate opioid withdrawal and drug use in clinical and preclinical studies. However, ketamine has misuse liability and dissociative side effects that may limit its widespread application as a treatment for OUD. More recently, (2R,6R)-hydroxynorketamine (HNK), a ketamine metabolite that lacks misuse potential, has gained attention for its effectiveness in depression and stress models. To uncover its role in OUD, we tested the time-dependent effects of (2R,6R)-HNK on oxycodone withdrawal and reinstatement of oxycodone conditioned place preference (CPP). In male and female oxycodone-dependent mice, we found that 24h pretreatment with (2R,6R)-HNK (10 or 30mg/kg, s.c.) reduced the frequency of withdrawal-like behaviors and global withdrawal scores during naloxone-precipitated withdrawal, whereas 1h pretreatment with (2R,6R)-HNK only reduced paw tremors and the sum of global withdrawal scores but not GWS Z-scores. In other experiments, both 1h and 24h pretreatment with (2R,6R)-HNK (30mg/kg, s.c.) blocked drug-induced reinstatement of oxycodone CPP. Finally, we found (2R,6R)-HNK (30mg/kg, sc) had no effect on locomotor activity and thigmotaxis. Together, these results indicate that acute (2R,6R)-HNK has efficacy in some preclinical models of OUD without producing locomotor or anxiety-like side effects.
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Affiliation(s)
- Caryssa R Drinkuth
- Department of Pharmaceutical Sciences, Connecticut Institute for the Brain and Cognitive Sciences (IBACS), University of Connecticut, Storrs, CT 06269, United States
| | - Michael J Lehane
- Department of Pharmaceutical Sciences, Connecticut Institute for the Brain and Cognitive Sciences (IBACS), University of Connecticut, Storrs, CT 06269, United States
| | - Gregory C Sartor
- Department of Pharmaceutical Sciences, Connecticut Institute for the Brain and Cognitive Sciences (IBACS), University of Connecticut, Storrs, CT 06269, United States.
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8
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Weimer MB, Herring AA, Kawasaki SS, Meyer M, Kleykamp BA, Ramsey KS. ASAM Clinical Considerations: Buprenorphine Treatment of Opioid Use Disorder for Individuals Using High-potency Synthetic Opioids. J Addict Med 2023; 17:632-639. [PMID: 37934520 DOI: 10.1097/adm.0000000000001202] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2023]
Abstract
ABSTRACT Treatment of opioid use disorder (OUD) with buprenorphine has evolved considerably in the last decade as the scale of the OUD epidemic has increased along with the emergence of high-potency synthetic opioids (HPSOs) and stimulants in the drug supply. These changes have outpaced the development of prospective research, so a clinical consideration document based on expert consensus is needed to address pressing clinical questions. This clinical considerations document is based on a narrative literature review and expert consensus and will specifically address considerations for changes to the clinical practice of treatment of OUD with buprenorphine for individuals using HPSO. An expert panel developed 6 key questions addressing buprenorphine initiation, stabilization, and long-term treatment for individuals with OUD exposed to HPSO in various treatment settings. Broadly, the clinical considerations suggest that individualized strategies for buprenorphine initiation may be needed. The experience of opioid withdrawal negatively impacts the success of buprenorphine treatment, and attention to its management before and during buprenorphine initiation should be proactively addressed. Buprenorphine dose and dosing frequency should be individualized based on patients' treatment needs, the possibility of novel components in the drug supply should be considered during OUD treatment, and all forms of opioid agonist treatment should be offered and considered for patients. Together, these clinical considerations attempt to be responsive to the challenges and opportunities experienced by frontline clinicians using buprenorphine for the treatment of OUD in patients using HPSOs and highlight areas where prospective research is urgently needed.
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Affiliation(s)
- Melissa B Weimer
- From the Yale School of Medicine, Program in Addiction Medicine, New Haven, CT (MBW); Yale School of Public Health, New Haven, CT (MBW); Division of Addiction Medicine, Highland Hospital-Alameda Health System, Oakland, CA (AAH); Department of Psychiatry and Internal Medicine, Penn State Health, Hershey, PA (SSK); University of Vermont, Burlington, VT (MM); BAK and Associates, Baltimore, MD (BAK); NYS Office of Addiction Services and Supports (OASAS), Albany, NY (KSR)
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9
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Bormann NL, Gout A, Kijewski V, Lynch A. Case Report: Buprenorphine-precipitated fentanyl withdrawal treated with high-dose buprenorphine. F1000Res 2023; 11:487. [PMID: 37767082 PMCID: PMC10521070 DOI: 10.12688/f1000research.120821.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 09/29/2023] Open
Abstract
Background: Buprenorphine, a partial agonist of the mu-opioid receptor, is an increasingly prescribed medication for maintenance treatment of opioid use disorder. When this medication is taken in the context of active opioid use, precipitated withdrawal can occur, leading to acute onset of opioid withdrawal symptoms. Fentanyl complicates use of buprenorphine, as it slowly releases from body stores and can lead to higher risk of precipitated withdrawal. Objectives: Describe the successful management of buprenorphine precipitated opioid withdrawal from fentanyl with high doses of buprenorphine. We seek to highlight how no adverse effects occurred in this patient and illustrate his stable transition to outpatient treatment. Case report: We present the case of a patient with severe opioid use disorder who presented in moderately severe opioid withdrawal after taking non-prescribed buprenorphine-naloxone which precipitated opioid withdrawal from daily fentanyl use. He was treated with high doses of buprenorphine, 148 mg over the first 48 hours, averaging 63 mg per day over four days. The patient reported rapid improvement in withdrawal symptoms without noted side effects and was able to successfully taper to 16 mg twice daily by discharge. Conclusions: This case demonstrates the safety and effectiveness of buprenorphine at high doses for treatment of precipitated withdrawal. While other options include symptomatic withdrawal management, initiating methadone or less researched options like ketamine, utilizing buprenorphine can preserve or re-establish confidence in this life-saving medication. This case also increases the previously documented upper boundary on buprenorphine dosing for withdrawal and should provide additional confidence in its use.
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Affiliation(s)
- Nicholas L. Bormann
- Psychiatry, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA
| | - Antony Gout
- Psychiatry, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA
- Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA
| | - Vicki Kijewski
- Psychiatry, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA
- Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA
| | - Alison Lynch
- Psychiatry, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA
- Family Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA
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Reed MK, Murali V, Sarpoulaki N, Zavodnick JH, Hom JK, Rising KL. Hospitalist perspectives on buprenorphine treatment for inpatients with opioid use disorder. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 5:100106. [PMID: 36844165 PMCID: PMC9948932 DOI: 10.1016/j.dadr.2022.100106] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 09/30/2022] [Accepted: 09/30/2022] [Indexed: 11/05/2022]
Abstract
Background Patients with opioid use disorder (OUD) have high hospital admission rates. Hospitalists, clinicians that work in inpatient medical settings, may have a unique opportunity to intervene on behalf of these patients, yet their experience with and attitudes towards treating patients with OUD need further exploration. Methods We conducted qualitative analysis of 22 semi-structured interviews with hospitalists between January and April 2021 in Philadelphia, PA. Participants were hospitalists in one major metropolitan university hospital and one urban community hospital in a city with a high prevalence of OUD and overdose deaths. Participants were asked about their experiences, successes, and difficulties in treating hospitalized patients with OUD. Results Twenty-two hospitalists were interviewed. Participants were majority female (14, 64%) and White (16, 73%). We identified the following common themes: lack of training/experience with OUD, a lack of community OUD treatment infrastructure, a lack of inpatient OUD/withdrawal treatment resources, the "X-waiver" as a barrier to prescribing buprenorphine, the "ideal" patient to start on buprenorphine, and the hospital as an ideal intervention setting. Conclusions Hospitalization due to acute illness or complication of drug use represents a potential intervention point to initiate treatment for patients with OUD. While hospitalists exhibit willingness to prescribe medications, provide harm reduction education, and link patients to outpatient addiction treatment, they identify training and infrastructure barriers that must first be addressed.
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Affiliation(s)
- Megan K Reed
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, 1015 Walnut Street, Curtis Building, Suite 704, Philadelphia, PA 19107, United States,Center for Connected Care, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States,College of Population Health, Thomas Jefferson University, Philadelphia, PA, United States,Corresponding author at: Thomas Jefferson University, 1015 Walnut Street, Curtis Building, Suite 704, Philadelphia, PA 19107, United States.
| | - Vignesh Murali
- Center for Connected Care, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Nazanin Sarpoulaki
- Center for Connected Care, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Jillian H. Zavodnick
- Department of Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Jeffrey K. Hom
- Division of Substance Use Prevention and Harm Reduction, Philadelphia Department of Public Health, PA, United States
| | - Kristin L Rising
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, 1015 Walnut Street, Curtis Building, Suite 704, Philadelphia, PA 19107, United States,Center for Connected Care, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States,College of Nursing, Thomas Jefferson University, Philadelphia, PA, USA
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11
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Jain L, Morrisroe K, Modesto-Lowe V. To use or not to use buprenorphine for illegally manufactured fentanyl. Fam Pract 2022; 40:428-430. [PMID: 36048969 DOI: 10.1093/fampra/cmac098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Lakshit Jain
- General Psychiatry Department, Connecticut Valley Hospital, Middletown, CT, United States.,Department of Psychiatry, University of Connecticut, Farmington, CT, United States
| | - Kathleen Morrisroe
- Department of Psychiatry, University of Connecticut, Farmington, CT, United States
| | - Vania Modesto-Lowe
- Department of Psychiatry, University of Connecticut, Farmington, CT, United States
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12
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A Neuropharmacological Model to Explain Buprenorphine Induction Challenges. Ann Emerg Med 2022; 80:509-524. [DOI: 10.1016/j.annemergmed.2022.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/25/2022] [Accepted: 05/27/2022] [Indexed: 11/17/2022]
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13
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Schoenfeld EM, Westafer LM, Beck SA, Potee BG, Vysetty S, Simon C, Tozloski JM, Girardin AL, Soares WE. "Just give them a choice": Patients' perspectives on starting medications for opioid use disorder in the ED. Acad Emerg Med 2022; 29:928-943. [PMID: 35426962 PMCID: PMC9378535 DOI: 10.1111/acem.14507] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Medications for opioid use disorder (MOUD) prescribed in the emergency department (ED) have the potential to save lives and help people start and maintain recovery. We sought to explore patient perspectives regarding the initiation of buprenorphine and methadone in the ED with the goal of improving interactions and fostering shared decision making (SDM) around these important treatment options. METHODS We conducted semistructured interviews with a purposeful sample of people with opioid use disorder (OUD) regarding ED visits and their experiences with MOUD. The interview guide was based on the Ottawa Decision Support Framework, a framework for examining decisional needs and tailoring decisional support, and the research team's experience with MOUD and SDM. Interviews were recorded, transcribed, and analyzed in an iterative process using both the Ottawa Framework and a social-ecological framework. Themes were identified and organized and implications for clinical care were noted and discussed. RESULTS Twenty-six participants were interviewed, seven in person in the ED and 19 via video conferencing software. The majority had tried both buprenorphine and methadone, and almost all had been in an ED for an issue related to opioid use. Participants reported social, pharmacological, and emotional factors that played into their decision making. Regarding buprenorphine, they noted advantages such as its efficacy and logistical ease and disadvantages such as the need to wait to start it (risk of precipitated withdrawal) and that one could not use other opioids while taking it. Additionally, participants felt that: (1) both buprenorphine and methadone should be offered; (2) because "one person's pro is another person's con," clinicians will need to understand the facets of the options; (3) clinicians will need to have these conversations without appearing judgmental; and (4) many patients may not be "ready" for MOUD, but it should still be offered. CONCLUSIONS Although participants were supportive of offering buprenorphine in the ED, many felt that methadone should also be offered. They felt that treatment should be tailored to an individual's needs and circumstances and clarified what factors might be important considerations for people with OUD.
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Affiliation(s)
- Elizabeth M. Schoenfeld
- Department of Emergency Medicine UMASS Chan Medical School–Baystate Springfield Massachusetts USA
- Department for Healthcare Delivery and Population Science UMASS Chan Medical School–Baystate Springfield Massachusetts USA
| | - Lauren M. Westafer
- Department of Emergency Medicine UMASS Chan Medical School–Baystate Springfield Massachusetts USA
- Department for Healthcare Delivery and Population Science UMASS Chan Medical School–Baystate Springfield Massachusetts USA
| | | | | | - Sravanthi Vysetty
- Lincoln Memorial University DeBusk College of Osteopathic Medicine Harrogate Tennessee USA
| | - Caty Simon
- Urban Survivors Union Greensboro North Carolina USA
- Whose Corner Is It Anyway Holyoke Massachusetts USA
| | - Jillian M. Tozloski
- Department of Emergency Medicine UMASS Chan Medical School–Baystate Springfield Massachusetts USA
| | - Abigail L. Girardin
- Department of Emergency Medicine UMASS Chan Medical School–Baystate Springfield Massachusetts USA
| | - William E. Soares
- Department of Emergency Medicine UMASS Chan Medical School–Baystate Springfield Massachusetts USA
- Department for Healthcare Delivery and Population Science UMASS Chan Medical School–Baystate Springfield Massachusetts USA
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