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Chiappini S, Vickers-Smith R, Guirguis A, Corkery JM, Martinotti G, Harris DR, Schifano F. Pharmacovigilance Signals of the Opioid Epidemic over 10 Years: Data Mining Methods in the Analysis of Pharmacovigilance Datasets Collecting Adverse Drug Reactions (ADRs) Reported to EudraVigilance (EV) and the FDA Adverse Event Reporting System (FAERS). Pharmaceuticals (Basel) 2022; 15:ph15060675. [PMID: 35745593 PMCID: PMC9231103 DOI: 10.3390/ph15060675] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/21/2022] [Accepted: 05/24/2022] [Indexed: 01/14/2023] Open
Abstract
In the past twenty years, the consumption of opioid medications has reached significant proportions, leading to a rise in drug misuse and abuse and increased opioid dependence and related fatalities. Thus, the purpose of this study was to determine whether there are pharmacovigilance signals of abuse, misuse, and dependence and their nature for the following prescription opioids: codeine, dihydrocodeine, fentanyl, oxycodone, pentazocine, and tramadol. Both the pharmacovigilance datasets EudraVigilance (EV) and the FDA Adverse Events Reporting System (FAERS) were analyzed to identify and describe possible misuse-/abuse-/dependence-related issues. A descriptive analysis of the selected Adverse Drug Reactions (ADRs) was performed, and pharmacovigilance signal measures (i.e., reporting odds ratio, proportional reporting ratio, information component, and empirical Bayesian geometric mean) were computed for preferred terms (PTs) of abuse, misuse, dependence, and withdrawal, as well as PTs eventually related to them (e.g., aggression). From 2003 to 2018, there was an increase in ADR reports for the selected opioids in both datasets. Overall, 16,506 and 130,293 individual ADRs for the selected opioids were submitted to EV and FAERS, respectively. Compared with other opioids, abuse concerns were mostly recorded in relation to fentanyl and oxycodone, while tramadol and oxycodone were more strongly associated with drug dependence and withdrawal. Benzodiazepines, antidepressants, other opioids, antihistamines, recreational drugs (e.g., cocaine and alcohol), and several new psychoactive substances, including mitragynine and cathinones, were the most commonly reported concomitant drugs. ADRs reports in pharmacovigilance databases confirmed the availability of data on the abuse and dependence of prescription opioids and should be considered a resource for monitoring and preventing such issues. Psychiatrists and clinicians prescribing opioids should be aware of their misuse and dependence liability and effects that may accompany their use, especially together with concomitant drugs.
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Affiliation(s)
- Stefania Chiappini
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire AL10 9EU, UK; (S.C.); (J.M.C.); (G.M.); (F.S.)
| | - Rachel Vickers-Smith
- Department of Epidemiology, University of Kentucky College of Public Health, 111 Washington Avenue, Lexington, KY 40536, USA
- Correspondence:
| | - Amira Guirguis
- Department of Pharmacy, Swansea University Medical School, The Grove, Swansea University, Swansea, Wales SA2 8PP, UK;
| | - John M. Corkery
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire AL10 9EU, UK; (S.C.); (J.M.C.); (G.M.); (F.S.)
| | - Giovanni Martinotti
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire AL10 9EU, UK; (S.C.); (J.M.C.); (G.M.); (F.S.)
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D’Annunzio, 66100 Chieti-Pescara, Italy
| | - Daniel R. Harris
- Institute for Pharmaceutical Outcomes and Policy, University of Kentucky College of Pharmacy, 289 South Limestone Street, Lexington, KY 40536, USA;
- Center for Clinical and Translational Sciences, University of Kentucky, 800 Rose Street, Lexington, KY 40506, USA
| | - Fabrizio Schifano
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire AL10 9EU, UK; (S.C.); (J.M.C.); (G.M.); (F.S.)
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Mitchell M. Medicolegal Considerations in the Management of Opioid Use Disorder With Buprenorphine in the Correctional Setting. JOURNAL OF CORRECTIONAL HEALTH CARE 2021; 27:210-214. [PMID: 34388040 DOI: 10.1089/jchc.19.06.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Buprenorphine-based medication-assisted treatment is a long-term strategy for individuals with opioid use disorder (OUD), a condition observed at disproportionate rates among incarcerated populations. Individuals with OUD are also at higher risk of overdose and death upon community reentry, necessitating effective interventions and care modalities targeted at this high-risk population. As support for buprenorphine in correctional health care increases, so do concerns surrounding personal liability for prescribers. This article seeks to identify problematic events related to prescribing buprenorphine to incarcerated individuals, clarify medicolegal implications, and provide recommendations for safe prescribing and administration within this unique setting.
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Affiliation(s)
- Megann Mitchell
- Division of Emergency Medicine, UW Medicine, Harborview Medical Center, Seattle, Washington, USA
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Larney S, Jones N, Fiellin DA, Nielsen S, Hickman M, Dobbins T, Murphy T, Ali R, Degenhardt L. Data Resource Profile: The Opioid Agonist Treatment and Safety (OATS) Study, New South Wales, Australia. Int J Epidemiol 2021; 49:1774-1775. [PMID: 33063106 PMCID: PMC7825957 DOI: 10.1093/ije/dyaa125] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 06/23/2020] [Indexed: 01/27/2023] Open
Affiliation(s)
- Sarah Larney
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Nicola Jones
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - David A Fiellin
- Schools of Medicine and Public Health, Yale University, New Haven, CT, USA
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Monash University, Melbourne, Australia
| | | | - Timothy Dobbins
- School of Public Health and Community Medicine, UNSW Sydney, Sydney, Australia
| | - Thomas Murphy
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Robert Ali
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
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Cao SS, Dunham SI, Simpson SA. Prescribing Buprenorphine for Opioid Use Disorders in the ED: A Review of Best Practices, Barriers, and Future Directions. Open Access Emerg Med 2020; 12:261-274. [PMID: 33116962 PMCID: PMC7569244 DOI: 10.2147/oaem.s267416] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/18/2020] [Indexed: 01/14/2023] Open
Abstract
ED-initiated addiction treatment holds promise for enhancing access to treatment for those with opioid use disorder (OUD). We present a literature review summarizing the evidence for buprenorphine induction in the ED including best practices for dosing, follow-up care, and reducing implementation barriers. A literature search of Pubmed, PsychInfo, and Embase identified articles studying OUD treatment in the ED published after 1980. Twenty-five studies were identified including eleven scientific abstracts. Multiple studies suggest that buprenorphine induction improves engagement in substance treatment up to 30 days after ED treatment. Many different induction protocols were presented, but no particular approach was best supported as criteria for induction and initial dosing vary widely. Similarly, transition of care models focused on either a "hub and spoke" model or "warm hand-offs" model, but no studies compared these approaches. Common barriers to implementing induction programs were provider inexperience, discomfort with addiction treatment, and limited time during the ED visit. No studies described the number of EDs offering induction. While ED buprenorphine induction is safe and enhances adherence to addiction treatment, uncertainty persists in how to best identify patients needing treatment, how to initiate buprenorphine, and how to enhance follow-up after ED-initiated treatment.
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Affiliation(s)
- Scott S Cao
- University of Colorado School of Medicine Anschutz Medical Campus, Aurora, CO, USA
| | - Samuel I Dunham
- University of Colorado School of Medicine Anschutz Medical Campus, Aurora, CO, USA
| | - Scott A Simpson
- University of Colorado School of Medicine Anschutz Medical Campus, Aurora, CO, USA
- Psychiatric Emergency Services, Denver Health Medical Center, Denver, CO, USA
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Wightman RS, Perrone J, Scagos R, Krieger M, Nelson LS, Marshall BDL. Opioid Overdose Deaths with Buprenorphine Detected in Postmortem Toxicology: a Retrospective Analysis. J Med Toxicol 2020; 17:10-15. [PMID: 32648229 DOI: 10.1007/s13181-020-00795-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/14/2020] [Accepted: 06/24/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Buprenorphine is a unique μ-opioid receptor partial agonist with avid receptor binding, nominal euphoric reward, and a ceiling effect on sedation and respiratory depression. Despite a pharmacologic profile that enhances safety, cases of fatal opioid overdose with buprenorphine on postmortem toxicology are reported, but details of these cases in the literature are limited. METHODS A retrospective review of opioid-involved drug overdose fatalities in Rhode Island (RI) from 2016 to 2018 using the RI Department of Health State Unintentional Drug Overdose Reporting System (SUDORS) database. Deaths with buprenorphine on toxicology testing versus opioid-involved overdose deaths without buprenorphine were compared to assess the type and number of co-exposures. RESULTS Of 534 opioid-involved deaths, 29 (5.4%) included buprenorphine and/or norbuprenorphine on toxicology. Most frequent co-exposures are as follows: fentanyl (75.9%), norfentanyl (72.4%), cocaine (41.4%), benzoylecgonine (41.4%), cannabinoids (31.0%), ethanol (31.0%), levamisole (31.0%), and free morphine (31.0%). An average number of co-exposures for fatalities with buprenorphine were 9.24 versus 6.68 in those without buprenorphine. In one case buprenorphine was the only drug listed to cause death; all other fatalities with buprenorphine on toxicology reported additional drugs contributing to death. CONCLUSION Decedents with buprenorphine detected on toxicology testing commonly had documented polysubstance use. Although data are limited, buprenorphine may provide some risk mitigation against full agonist opioid overdose including fentanyl. Further work should explore the use of postmortem concentrations of buprenorphine, norbuprenorphine, and other opioid metabolites to determine the role of buprenorphine in fatal overdose pharmacology.
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Affiliation(s)
- Rachel S Wightman
- Department of Emergency Medicine, The Warren Alpert Medical School of Brown University, 55 Claverick St, Providence, RI, 02903, USA.
| | - Jeanmarie Perrone
- Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Ground Silverstein, Rm. 260 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Rachel Scagos
- Rhode Island Department of Health, 3 Capitol Hill, Cannon Building, Providence, RI, 02908, USA
| | - Maxwell Krieger
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St, Box G-S-121-2, Providence, RI, 02912, USA
| | - Lewis S Nelson
- Rutgers New Jersey School of Medicine, Medical Science Building, 185 South Orange Avenue, Newark, NJ, 07103, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St, Box G-S-121-2, Providence, RI, 02912, USA
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Butler SF, Oyedele NK, Dailey Govoni T, Green JL. How Motivations for Using Buprenorphine Products Differ From Using Opioid Analgesics: Evidence from an Observational Study of Internet Discussions Among Recreational Users. JMIR Public Health Surveill 2020; 6:e16038. [PMID: 32209533 PMCID: PMC7142742 DOI: 10.2196/16038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/17/2019] [Accepted: 12/16/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Opioid use disorder (OUD) poses medical and societal concerns. Although most individuals with OUD in the United States are not in drug abuse treatment, buprenorphine is considered a safe and effective OUD treatment, which reduces illicit opioid use, mortality, and other drug-related harms. However, as buprenorphine prescriptions increase, so does evidence of misused, abused, or diverted buprenorphine. Users' motivations for extratreatment use of buprenorphine (ie, misuse or abuse of one's own prescription or use of diverted medication) may be different from the motivations involved in analgesic opioid products. Previous research is based on small sample sizes and use surveys, and none directly compare the motivations for using buprenorphine products (ie, tablet or film) with other opioid products having known abuse potential. OBJECTIVE The aim of the study was to describe and compare the motivation-to-use buprenorphine products, including buprenorphine/naloxone (BNX) sublingual film and oxycodone extended-release (ER), as discussed in online forums. METHODS Web-based posts from 2012 to 2016 were collected from online forums using the Web Informed Services internet monitoring archive. A random sample of posts was coded for motivation to use. These posts were coded into the following motivation categories: (1) use to avoid withdrawal, (2) pain relief, (3) tapering from other drugs, (4) opioid addiction treatment, (5) recreational use (ie, to get high), and (6) other use. Oxycodone ER, an opioid analgesic with known abuse potential, was selected as a comparator. RESULTS Among all posts, 0.81% (30,576/3,788,922) discussed motivation to use one of the target products. The examination of query-selected posts revealed significantly greater discussion of buprenorphine products than oxycodone ER (P<.001). The posts mentioning buprenorphine products were more likely than oxycodone ER to discuss treatment for OUD, tapering down use, and/or withdrawal management (P<.001). Buprenorphine-related posts discussed recreational use (375/1020, 36.76%), although much less often than in oxycodone ER posts (425/508, 83.7%). Despite some differences, the overall pattern of motivation to use was similar for BNX sublingual film and other buprenorphine products. CONCLUSIONS An analysis of spontaneous, Web-based discussion among recreational substance users who post on online drug forums supports the contention that motivation-to-use patterns associated with buprenorphine products are different from those reported for oxycodone ER. Although the findings presented here are not expected to reflect the actual use of the target products, they may represent the interests and motivations of those posting on the online forums. Buprenorphine-related posts were more likely to discuss treatment for OUD, tapering, and withdrawal management than oxycodone ER. Although the findings are consistent with a purported link between the limited availability of medication-assisted therapies for substance use disorders and use of diverted buprenorphine products for self-treatment, recreational use was a motivation expressed in more than one-third of buprenorphine posts.
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Affiliation(s)
| | - Natasha K Oyedele
- Office of Disease Prevention, National Institutes of Health, Rockville, MD, United States
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Chen J. Therapy without a prescription: buprenorphine/naloxone diversion and the therapeutic assemblage in Taiwan. SOCIOLOGY OF HEALTH & ILLNESS 2020; 42:596-609. [PMID: 31837048 PMCID: PMC7079079 DOI: 10.1111/1467-9566.13045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Buprenorphine/naloxone (B/N) therapy is a prescription pharmacotherapy for opioid dependence. For certain health service providers, when B/N escapes supervision and diverts into the hands of people for whom it is unintended, it can pose serious risks even if it may still have therapeutic benefits. The line between therapy and diversion is thus a problematic one. By qualitatively analysing archival review and in-depth interviews, this study uses the concept of a therapeutic assemblage to understand the relationships among government, knowledge, and professionals that surround the regulation of B/N in Taiwan. The therapeutic assemblage is characterised by the partitioning of administration, the loose regulation of prescription, the exclusion of addiction treatment from National Health Insurance (NHI), and the materiality and technicality of therapies. These elements contribute to the therapeutic assemblage's different territorial modes as reflected in the substance schedules that allow for diversion. This is the first grounded work in Asia that empirically examines and theoretically explains the diversion of B/N from an assemblage perspective. It suggests establishing new associations by incorporating addiction treatment into NHI. Lastly, it addresses the analytic purchase of the assemblage approach in unveiling and problematising unintended outcomes of an intervention.
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Affiliation(s)
- Jia‐shin Chen
- Institute of Science, Technology and SocietyNational Yang‐Ming UniversityTaipeiTaiwan
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Zhao J, Kral AH, Wenger LD, Bluthenthal RN. Characteristics Associated with Nonmedical Methadone Use among People Who Inject Drugs in California. Subst Use Misuse 2019; 55:377-386. [PMID: 31608746 PMCID: PMC7002277 DOI: 10.1080/10826084.2019.1673420] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: Illicit, nonmedical use of opioid agonist medications such as methadone is an ongoing concern. Yet, few studies have examined nonmedical use of methadone by people who inject drugs (PWID). Objectives: This study describes the prevalence of nonmedical methadone use in a community sample of PWID and examines factors associated with recent use of nonmedical methadone. Methods: A cross-sectional sample of PWID (N = 777) was recruited using targeted sampling and interviewed in California (2011-2013). Descriptive, bivariate, and multivariate logistic regression analyses were used to determine characteristics associated with nonmedical methadone use in the last 30 days. To determine if nonmedical methadone use was associated with overdose in the last 6 months, a separate multivariate analysis was conducted. Results: Among PWID sampled, 21% reported nonmedical methadone use in the last 30 days. In multivariate logistic regression analysis, nonmedical methadone use was associated with recent methadone maintenance treatment (adjusted odds ratio [AOR] = 2.86; 95% confidence interval [CI] = 1.90, 4.30), recent nonmedical buprenorphine use (AOR = 3.12; 95% CI = 1.31, 7.47), higher injection frequency (referent <30 injections; 30-89 injections AOR = 1.89; 95% CI = 1.19, 3.02; 90-plus injections AOR = 2.43; 95% CI = 1.53, 3.87), schizophrenia diagnosis (AOR = 2.36; 95% CI = 1.36, 4.10), recent non-injection opioid prescription use (AOR = 2.97; 95% CI = 1.99, 4.43), and recent injection opioid prescription misuse (AOR = 2.13; 95% CI = 1.27, 3.59). Nonmedical methadone use was found not to be associated with nonfatal overdose (AOR = 0.77; 95% CI = 0.38, 1.56). Conclusion: Nonmedical methadone use identifies a vulnerable subpopulation among PWID, is not associated with elevated nonfatal overdose risk, and evidences a need to expand methadone treatment availability.
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Affiliation(s)
- Johnathan Zhao
- Keck School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033
| | - Alex H. Kral
- RTI International, 351 California Street, Suite 500, San Francisco, CA 94104
| | - Lynn D. Wenger
- RTI International, 351 California Street, Suite 500, San Francisco, CA 94104
| | - Ricky N. Bluthenthal
- Department of Preventive Medicine, Institute for Prevention Research, Keck School of Medicine, University of Southern California, 2001 N Soto St, 3rd floor, Los Angeles, CA 90033
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Buprenorphine in the United States: Motives for abuse, misuse, and diversion. J Subst Abuse Treat 2019; 104:148-157. [PMID: 31370979 DOI: 10.1016/j.jsat.2019.07.005] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 07/11/2019] [Accepted: 07/11/2019] [Indexed: 12/25/2022]
Abstract
Opioid use disorder (OUD) and its consequences are a major public health concern. The partial agonist buprenorphine is a safe and effective treatment for OUD, but concerns about abuse, misuse, and diversion of buprenorphine have been raised. This narrative review examined the rates and motives for use of illicit buprenorphine in the United States. Findings from the 17 included studies suggest the majority of study participants using illicit buprenorphine do so for reasons related to misuse (to manage opioid withdrawal symptoms or achieve or maintain abstinence from other opioids). A smaller percentage of study respondents reported using buprenorphine for reasons related to abuse (to get high). There appears to be a gap between need for buprenorphine and access to adequate treatment. Attenuation of policy-related barriers and adoption of appropriate buprenorphine use by the treatment community are critical tools in the continued effort to reduce the burdens associated with OUD.
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Bruneau J, Ahamad K, Goyer MÈ, Poulin G, Selby P, Fischer B, Wild TC, Wood E. Management of opioid use disorders: a national clinical practice guideline. CMAJ 2019; 190:E247-E257. [PMID: 29507156 DOI: 10.1503/cmaj.170958] [Citation(s) in RCA: 265] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Julie Bruneau
- Centre hospitalier de l'Université de Montréal (Bruneau), Université de Montréal; Département de médecine de famille et de médecine d'urgence (Bruneau, Goyer), Faculté de médecine, Université de Montréal, Montréal, Que.; British Columbia Centre on Substance Use (Ahamad), St. Paul's Hospital; Department of Family Medicine (Ahamad), University of British Columbia, Vancouver, BC; Centre de recherche et d'aide pour narcomanes, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal (Goyer), Montréal, Que.; Addictions Foundation of Manitoba (Poulin); Max Rady College of Medicine, Postgraduate Medical Education (Poulin), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Addictions Division (Selby), Centre for Addiction and Mental Health; Department of Family and Community Medicine, Dalla Lana School of Public Health (Selby); Department of Psychiatry (Selby, Fischer), University of Toronto, Toronto, Ont.; Institute for Mental Health Policy Research (Fischer), Centre for Addiction and Mental Health, Toronto, Ont.; School of Public Health (Wild), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta.; British Columbia Centre on Substance Use (Wood), St. Paul's Hospital; Department of Medicine (Wood), University of British Columbia, Vancouver, BC
| | - Keith Ahamad
- Centre hospitalier de l'Université de Montréal (Bruneau), Université de Montréal; Département de médecine de famille et de médecine d'urgence (Bruneau, Goyer), Faculté de médecine, Université de Montréal, Montréal, Que.; British Columbia Centre on Substance Use (Ahamad), St. Paul's Hospital; Department of Family Medicine (Ahamad), University of British Columbia, Vancouver, BC; Centre de recherche et d'aide pour narcomanes, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal (Goyer), Montréal, Que.; Addictions Foundation of Manitoba (Poulin); Max Rady College of Medicine, Postgraduate Medical Education (Poulin), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Addictions Division (Selby), Centre for Addiction and Mental Health; Department of Family and Community Medicine, Dalla Lana School of Public Health (Selby); Department of Psychiatry (Selby, Fischer), University of Toronto, Toronto, Ont.; Institute for Mental Health Policy Research (Fischer), Centre for Addiction and Mental Health, Toronto, Ont.; School of Public Health (Wild), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta.; British Columbia Centre on Substance Use (Wood), St. Paul's Hospital; Department of Medicine (Wood), University of British Columbia, Vancouver, BC
| | - Marie-Ève Goyer
- Centre hospitalier de l'Université de Montréal (Bruneau), Université de Montréal; Département de médecine de famille et de médecine d'urgence (Bruneau, Goyer), Faculté de médecine, Université de Montréal, Montréal, Que.; British Columbia Centre on Substance Use (Ahamad), St. Paul's Hospital; Department of Family Medicine (Ahamad), University of British Columbia, Vancouver, BC; Centre de recherche et d'aide pour narcomanes, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal (Goyer), Montréal, Que.; Addictions Foundation of Manitoba (Poulin); Max Rady College of Medicine, Postgraduate Medical Education (Poulin), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Addictions Division (Selby), Centre for Addiction and Mental Health; Department of Family and Community Medicine, Dalla Lana School of Public Health (Selby); Department of Psychiatry (Selby, Fischer), University of Toronto, Toronto, Ont.; Institute for Mental Health Policy Research (Fischer), Centre for Addiction and Mental Health, Toronto, Ont.; School of Public Health (Wild), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta.; British Columbia Centre on Substance Use (Wood), St. Paul's Hospital; Department of Medicine (Wood), University of British Columbia, Vancouver, BC
| | - Ginette Poulin
- Centre hospitalier de l'Université de Montréal (Bruneau), Université de Montréal; Département de médecine de famille et de médecine d'urgence (Bruneau, Goyer), Faculté de médecine, Université de Montréal, Montréal, Que.; British Columbia Centre on Substance Use (Ahamad), St. Paul's Hospital; Department of Family Medicine (Ahamad), University of British Columbia, Vancouver, BC; Centre de recherche et d'aide pour narcomanes, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal (Goyer), Montréal, Que.; Addictions Foundation of Manitoba (Poulin); Max Rady College of Medicine, Postgraduate Medical Education (Poulin), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Addictions Division (Selby), Centre for Addiction and Mental Health; Department of Family and Community Medicine, Dalla Lana School of Public Health (Selby); Department of Psychiatry (Selby, Fischer), University of Toronto, Toronto, Ont.; Institute for Mental Health Policy Research (Fischer), Centre for Addiction and Mental Health, Toronto, Ont.; School of Public Health (Wild), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta.; British Columbia Centre on Substance Use (Wood), St. Paul's Hospital; Department of Medicine (Wood), University of British Columbia, Vancouver, BC
| | - Peter Selby
- Centre hospitalier de l'Université de Montréal (Bruneau), Université de Montréal; Département de médecine de famille et de médecine d'urgence (Bruneau, Goyer), Faculté de médecine, Université de Montréal, Montréal, Que.; British Columbia Centre on Substance Use (Ahamad), St. Paul's Hospital; Department of Family Medicine (Ahamad), University of British Columbia, Vancouver, BC; Centre de recherche et d'aide pour narcomanes, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal (Goyer), Montréal, Que.; Addictions Foundation of Manitoba (Poulin); Max Rady College of Medicine, Postgraduate Medical Education (Poulin), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Addictions Division (Selby), Centre for Addiction and Mental Health; Department of Family and Community Medicine, Dalla Lana School of Public Health (Selby); Department of Psychiatry (Selby, Fischer), University of Toronto, Toronto, Ont.; Institute for Mental Health Policy Research (Fischer), Centre for Addiction and Mental Health, Toronto, Ont.; School of Public Health (Wild), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta.; British Columbia Centre on Substance Use (Wood), St. Paul's Hospital; Department of Medicine (Wood), University of British Columbia, Vancouver, BC
| | - Benedikt Fischer
- Centre hospitalier de l'Université de Montréal (Bruneau), Université de Montréal; Département de médecine de famille et de médecine d'urgence (Bruneau, Goyer), Faculté de médecine, Université de Montréal, Montréal, Que.; British Columbia Centre on Substance Use (Ahamad), St. Paul's Hospital; Department of Family Medicine (Ahamad), University of British Columbia, Vancouver, BC; Centre de recherche et d'aide pour narcomanes, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal (Goyer), Montréal, Que.; Addictions Foundation of Manitoba (Poulin); Max Rady College of Medicine, Postgraduate Medical Education (Poulin), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Addictions Division (Selby), Centre for Addiction and Mental Health; Department of Family and Community Medicine, Dalla Lana School of Public Health (Selby); Department of Psychiatry (Selby, Fischer), University of Toronto, Toronto, Ont.; Institute for Mental Health Policy Research (Fischer), Centre for Addiction and Mental Health, Toronto, Ont.; School of Public Health (Wild), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta.; British Columbia Centre on Substance Use (Wood), St. Paul's Hospital; Department of Medicine (Wood), University of British Columbia, Vancouver, BC
| | - T Cameron Wild
- Centre hospitalier de l'Université de Montréal (Bruneau), Université de Montréal; Département de médecine de famille et de médecine d'urgence (Bruneau, Goyer), Faculté de médecine, Université de Montréal, Montréal, Que.; British Columbia Centre on Substance Use (Ahamad), St. Paul's Hospital; Department of Family Medicine (Ahamad), University of British Columbia, Vancouver, BC; Centre de recherche et d'aide pour narcomanes, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal (Goyer), Montréal, Que.; Addictions Foundation of Manitoba (Poulin); Max Rady College of Medicine, Postgraduate Medical Education (Poulin), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Addictions Division (Selby), Centre for Addiction and Mental Health; Department of Family and Community Medicine, Dalla Lana School of Public Health (Selby); Department of Psychiatry (Selby, Fischer), University of Toronto, Toronto, Ont.; Institute for Mental Health Policy Research (Fischer), Centre for Addiction and Mental Health, Toronto, Ont.; School of Public Health (Wild), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta.; British Columbia Centre on Substance Use (Wood), St. Paul's Hospital; Department of Medicine (Wood), University of British Columbia, Vancouver, BC
| | - Evan Wood
- Centre hospitalier de l'Université de Montréal (Bruneau), Université de Montréal; Département de médecine de famille et de médecine d'urgence (Bruneau, Goyer), Faculté de médecine, Université de Montréal, Montréal, Que.; British Columbia Centre on Substance Use (Ahamad), St. Paul's Hospital; Department of Family Medicine (Ahamad), University of British Columbia, Vancouver, BC; Centre de recherche et d'aide pour narcomanes, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal (Goyer), Montréal, Que.; Addictions Foundation of Manitoba (Poulin); Max Rady College of Medicine, Postgraduate Medical Education (Poulin), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Addictions Division (Selby), Centre for Addiction and Mental Health; Department of Family and Community Medicine, Dalla Lana School of Public Health (Selby); Department of Psychiatry (Selby, Fischer), University of Toronto, Toronto, Ont.; Institute for Mental Health Policy Research (Fischer), Centre for Addiction and Mental Health, Toronto, Ont.; School of Public Health (Wild), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta.; British Columbia Centre on Substance Use (Wood), St. Paul's Hospital; Department of Medicine (Wood), University of British Columbia, Vancouver, BC
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11
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Doernberg M, Krawczyk N, Agus D, Fingerhood M. Demystifying buprenorphine misuse: Has fear of diversion gotten in the way of addressing the opioid crisis? Subst Abus 2019; 40:148-153. [PMID: 31008694 DOI: 10.1080/08897077.2019.1572052] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Buprenorphine is considered one of the most effective treatments for opioid use disorder and significantly reduces risk of overdose death. However, concerns about its diversion and misuse have often taken center stage in public discourse and in the design of practices and policies regarding its use. This has been to the detriment of many vulnerable patient populations, especially those involved in the criminal justice system. Policies that restrict access to buprenorphine in criminal justice and other settings due to concerns of diversion do not accurately reflect the relative risks and safety profile associated with it, creating unnecessary barriers that drive an illicit market of this much-needed medication. Although proper regulation of all controlled medications should be a priority, in most instances the benefits of buprenorphine highly outweigh its risks. In the midst of a national crisis, efforts should be focused on expanding, and not restricting, access to this lifesaving treatment.
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Affiliation(s)
- Molly Doernberg
- Yale University School of Public Health , New Haven , Connecticut , USA
| | - Noa Krawczyk
- Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA.,Behavioral Health Leadership Institute , Baltimore , Maryland , USA
| | - Deborah Agus
- Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA.,Behavioral Health Leadership Institute , Baltimore , Maryland , USA
| | - Michael Fingerhood
- Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA.,Johns Hopkins School of Medicine , Baltimore , Maryland , USA
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12
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Macintyre PE, Russell RA, Usher KAN, Gaughwin M, Huxtable CA. Pain Relief and Opioid Requirements in the First 24 Hours after Surgery in Patients Taking Buprenorphine and Methadone Opioid Substitution Therapy. Anaesth Intensive Care 2019; 41:222-30. [DOI: 10.1177/0310057x1304100212] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- P. E. Macintyre
- Department of Anaesthesia, Pain Medicine and Hyperbaric Medicine, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia 5000, Australia
- Acute Pain Service
| | - R. A. Russell
- Department of Anaesthesia, Pain Medicine and Hyperbaric Medicine, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia 5000, Australia
| | - K. A. N. Usher
- Department of Anaesthesia, Pain Medicine and Hyperbaric Medicine, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia 5000, Australia
| | - M. Gaughwin
- Department of Anaesthesia, Pain Medicine and Hyperbaric Medicine, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia 5000, Australia
- Drug and Alcohol Resource Unit, Drug and Alcohol Services South Australia
| | - C. A. Huxtable
- Department of Anaesthesia, Pain Medicine and Hyperbaric Medicine, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia 5000, Australia
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13
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Larney S, Hickman M, Fiellin DA, Dobbins T, Nielsen S, Jones NR, Mattick RP, Ali R, Degenhardt L. Using routinely collected data to understand and predict adverse outcomes in opioid agonist treatment: Protocol for the Opioid Agonist Treatment Safety (OATS) Study. BMJ Open 2018; 8:e025204. [PMID: 30082370 PMCID: PMC6078240 DOI: 10.1136/bmjopen-2018-025204] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 07/12/2018] [Accepted: 07/12/2018] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION North America is amid an opioid use epidemic. Opioid agonist treatment (OAT) effectively reduces extramedical opioid use and related harms. As with all pharmacological treatments, there are risks associated with OAT, including fatal overdose. There is a need to better understand risk for adverse outcomes during and after OAT, and for innovative approaches to identifying people at greatest risk of adverse outcomes. The Opioid Agonist Treatment and Safety study aims to address these questions so as to inform the expansion of OAT in the USA. METHODS AND ANALYSIS This is a retrospective cohort study using linked, routinely collected health data for all people seeking OAT in New South Wales, Australia, between 2001 and 2017. Linked data include hospitalisation, emergency department presentation, mental health diagnoses, incarceration and mortality. We will use standard regression techniques to model the magnitude and risk factors for adverse outcomes (eg, mortality, unplanned hospitalisation and emergency department presentation, and unplanned treatment cessation) during and after OAT, and machine learning approaches to develop a risk-prediction model. ETHICS AND DISSEMINATION This study has been approved by the Population and Health Services Research Ethics Committee (2018HRE0205). Results will be reported in accordance with the REporting of studies Conducted using Observational Routinely-collected health Data statement.
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Affiliation(s)
- Sarah Larney
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - David A Fiellin
- Schools of Medicine and Public Health, Yale University, New Haven, Connecticut, USA
| | - Timothy Dobbins
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Nicola R Jones
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Richard P Mattick
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Robert Ali
- Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
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14
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Understanding abuse of buprenorphine/naloxone film versus tablet products using data from ASI-MV® substance use disorder treatment centers and RADARS® System Poison Centers. J Subst Abuse Treat 2018; 84:42-49. [DOI: 10.1016/j.jsat.2017.10.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 10/23/2017] [Accepted: 10/25/2017] [Indexed: 11/18/2022]
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15
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A randomized clinical trial of buprenorphine for prisoners: Findings at 12-months post-release. Drug Alcohol Depend 2017; 172:34-42. [PMID: 28107680 PMCID: PMC5309171 DOI: 10.1016/j.drugalcdep.2016.11.037] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 11/22/2016] [Accepted: 11/26/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND This study examined whether starting buprenorphine treatment prior to prison and after release from prison would be associated with better drug treatment outcomes and whether males and females responded differently to the combination of in-prison treatment and post-release service setting. METHODS Study design was a 2 (In-Prison Treatment: Condition: Buprenorphine Treatment: vs. Counseling Only)×2 [Post-Release Service Setting Condition: Opioid Treatment: Program (OTP) vs. Community Health Center (CHC)]×2 (Gender) factorial design. The trial was conducted between September 2008 and July 2012. Follow-up assessments were completed in 2014. Participants were recruited from two Baltimore pre-release prisons (one for men and one for women). Adult pre-release prisoners who were heroin-dependent during the year prior to incarceration were eligible. Post-release assessments were conducted at 1, 3, 6, and 12-month following prison release. RESULTS Participants (N=211) in the in-prison treatment condition effect had a higher mean number of days of community buprenorphine treatment compared to the condition in which participants initiated medication after release (P=0.005). However, there were no statistically significant hypothesized effects for the in-prison treatment condition in terms of: days of heroin use and crime, and opioid and cocaine positive urine screening test results (all Ps>0.14) and no statistically significant hypothesized gender effects (all Ps>0.18). CONCLUSIONS Although initiating buprenorphine treatment in prison compared to after-release was associated with more days receiving buprenorphine treatment in the designated community treatment program during the 12-months post-release assessment, it was not associated with superior outcomes in terms of heroin and cocaine use and criminal behavior.
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16
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The New Kid on the Block--Incorporating Buprenorphine into a Medical Toxicology Practice. J Med Toxicol 2016; 12:64-70. [PMID: 26574020 DOI: 10.1007/s13181-015-0518-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Buprenorphine represents a safe and effective therapy for treating opioid dependence, alleviating craving and withdrawal symptoms in opioid-dependent patients. Buprenorphine has a "blocking" effect against the action of other opioids at the mu-receptor, preventing not only opioid-induced euphoria, but CNS and respiratory depressant effects as well. Buprenorphine was approved for the treatment of opioid dependence in 2002 after the passage of Drug Abuse Treatment Act 2000 (DATA 2000) which allowed clinicians to treat opioid-dependent patients with specifically named opioid agonist therapies in an office setting. Buprenorphine programs reduce the prevalence of HIV and hepatitis C and reduce criminal behaviors associated with illicit drug use. Patients stabilized on buprenorphine have increased employment, enhanced engagement with social services, and better overall health and well-being.
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17
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Analysis of the Abuse and Diversion of the Buprenorphine Transdermal Delivery System. THE JOURNAL OF PAIN 2016; 17:745-52. [DOI: 10.1016/j.jpain.2016.02.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 02/04/2016] [Accepted: 02/18/2016] [Indexed: 11/17/2022]
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18
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Delorme J, Chenaf C, Kabore JL, Pereira B, Mulliez A, Tremey A, Brousse G, Zenut M, Laporte C, Authier N. Incidence of high dosage buprenorphine and methadone shopping behavior in a retrospective cohort of opioid-maintained patients in France. Drug Alcohol Depend 2016; 162:99-106. [PMID: 27006272 DOI: 10.1016/j.drugalcdep.2016.02.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 02/09/2016] [Accepted: 02/22/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Opioid Substitution Treatment (OST) misuse and diversion have significantly increased worldwide. Obtaining OST prescriptions from multiple prescribers, known as doctor shopping, is a way in which opioids may be diverted. OBJECTIVES The aim of this study was to assess the incidence of OST (high dosage buprenorphine (HDB) and methadone (MTD)) shopping behavior and identify associated risk factors, and its impact on mortality. METHODS A retrospective cohort of patients treated by OST between April 1, 2004 and December 31, 2012 from a sample of the French Health Insurance database was established. Doctor shopping was defined as ≥1 day of overlapping prescriptions written by ≥2 different prescribers and filled in ≥3 different pharmacies. RESULTS A total of 2043 patients were enrolled, 1450HDB and 593 MTD. The one-year incidence of shopping behavior was 8.4% (95% CI: 7.0-10.1) in HDB group and 0% in MTD group, compared to 0.2% (95% CI: 0.1-0.2) for diuretics. On multivariate analysis, factors associated with HDB shopping behavior were: male gender HR: 1.74 (95% CI: 1.20-2.54); low-income status HR: 2.95 (95% CI: 2.07-4.44); mental health disorders HR: 1.43 (95% CI: 1.06-1.94); concurrent hypnotics use HR: 1.90 (95% CI: 1.39-2.61); concurrent use of weak opioids HR: 1.48 (95% CI: 1.09-1.99) and morphine HR: 1.69 (95% CI: 1.02-2.80). HDB shoppers had a higher, yet non-significant risk of death (HR: 1.56 (95% CI: 0.64-3.81)) than non HDB shoppers. CONCLUSION Shopping behavior was only found in high dosage buprenorphine patients and concerned almost one out ten patients.
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Affiliation(s)
- Jessica Delorme
- INSERM, UMR 1107 NEURO-DOL, Faculté de Médecine, Université d'Auvergne, BP38, 63001 Clermont-Ferrand, France; CHU Clermont-Ferrand, Centres Addictovigilance et Pharmacovigilance Auvergne (CEIP-CRPV), Service de Pharmacologie Médicale, BP69, 63003 Clermont-Ferrand, France.
| | - Chouki Chenaf
- INSERM, UMR 1107 NEURO-DOL, Faculté de Médecine, Université d'Auvergne, BP38, 63001 Clermont-Ferrand, France; CHU Clermont-Ferrand, Centres Addictovigilance et Pharmacovigilance Auvergne (CEIP-CRPV), Service de Pharmacologie Médicale, BP69, 63003 Clermont-Ferrand, France
| | - Jean-Luc Kabore
- INSERM, UMR 1107 NEURO-DOL, Faculté de Médecine, Université d'Auvergne, BP38, 63001 Clermont-Ferrand, France; CHU Clermont-Ferrand, Centres Addictovigilance et Pharmacovigilance Auvergne (CEIP-CRPV), Service de Pharmacologie Médicale, BP69, 63003 Clermont-Ferrand, France
| | - Bruno Pereira
- CHU Clermont-Ferrand, Délégation à la Recherche Clinique et à l'Innovation, BP69, 63003 Clermont-Ferrand, France
| | - Aurélien Mulliez
- CHU Clermont-Ferrand, Délégation à la Recherche Clinique et à l'Innovation, BP69, 63003 Clermont-Ferrand, France
| | - Aurore Tremey
- CHU Clermont-Ferrand, Service de Psychiatrie et Addictologie, CMPB, BP69, 63003 Clermont-Ferrand, France
| | - Georges Brousse
- CHU Clermont-Ferrand, Service de Psychiatrie et Addictologie, CMPB, BP69, 63003 Clermont-Ferrand, France
| | - Marie Zenut
- CHU Clermont-Ferrand, Centres Addictovigilance et Pharmacovigilance Auvergne (CEIP-CRPV), Service de Pharmacologie Médicale, BP69, 63003 Clermont-Ferrand, France; EA 4681 PEPRADE, Université d'Auvergne (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), France
| | - Catherine Laporte
- Département de Médecine Générale, Faculté de Médecine, BP38, 63001 Clermont- Ferrand, France
| | - Nicolas Authier
- INSERM, UMR 1107 NEURO-DOL, Faculté de Médecine, Université d'Auvergne, BP38, 63001 Clermont-Ferrand, France; CHU Clermont-Ferrand, Centres Addictovigilance et Pharmacovigilance Auvergne (CEIP-CRPV), Service de Pharmacologie Médicale, BP69, 63003 Clermont-Ferrand, France; CHU Clermont-Ferrand, Centre d'Evaluation et de Traitement de la Douleur (CETD), Service de Pharmacologie Médicale, BP69, 63003 Clermont-Ferrand, France; Institut Analgesia, Faculté de Médecine, BP38, 63001 Clermont-Ferrand, France
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Diversion of opioid maintenance treatment medications and predictors for diversion among Finnish maintenance treatment patients. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26:875-82. [DOI: 10.1016/j.drugpo.2015.03.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 03/20/2015] [Accepted: 03/22/2015] [Indexed: 11/22/2022]
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A review of buprenorphine diversion and misuse: the current evidence base and experiences from around the world. J Addict Med 2015; 8:315-26. [PMID: 25221984 DOI: 10.1097/adm.0000000000000045] [Citation(s) in RCA: 172] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Outpatient opioid addiction treatment with sublingual buprenorphine pharmacotherapy has rapidly expanded in the United States and abroad, and, with this increase in medication availability, there have been increasing concerns about its diversion, misuse, and related harms. This narrative review defines the behaviors of diversion and misuse, examines how the pharmacology of buprenorphine alone and in combination with naloxone influence its abuse liability, and describes the epidemiological data on buprenorphine diversion and intravenous misuse, risk factors for its intravenous misuse, and the unintended consequences of misuse and diversion. Physician practices to prevent, screen for, and therapeutically respond to these behaviors, which are a form of medication nonadherence, are discussed, and gaps in knowledge are identified. Outpatient opioid addiction treatment with sublingual buprenorphine pharmacotherapy experiences from other countries that have varied health care systems, public policies, and access to addiction treatment are shared to make clear that diversion and misuse occur across the world in various contexts, for many different reasons, and are not limited to buprenorphine. Comparisons are made with other opioids with known abuse liability and medications with no known abuse. The objective was to facilitate understanding of diversion and misuse so that all factors influencing their expression (patient and provider characteristics and public policy) can be appreciated within a framework that also recognizes the benefits of addiction treatment. With this comprehensive perspective, further careful work can help determine how to minimize these behaviors without eroding the current benefits realized through improved addiction treatment access and expansion.
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Abstract
BACKGROUND The current study aimed to identify risk factors for treatment noncompliance in a sample of veterans receiving buprenorphine/naloxone for an opioid use disorder. METHODS Records from all patients who are currently or had previously been maintained on buprenorphine in the buprenorphine maintenance treatment program at the Atlanta VA Medical Center during the years 2006 to 2013 were evaluated. Of the 209 patients treated in the clinic between 2006 and 2013, 140 were excluded from the study because they did not have a call-back done at the time of data collection. Thus, 69 patient charts were selected for review. RESULTS The multiple linear regression analysis of the predictable variables for noncompliance with the buprenorphine pill count showed that positive urine drug screen (UDS) for marijuana, benzodiazepines, and being a smoker (F = 3.08; P = 0.03) are significantly associated with noncompliance with buprenorphine pill count.Also, the multiple linear regression analysis of the predictable variables for noncompliance with the buprenorphine pill count showed that the psychiatric comorbidity independently (F = 4.88; P = 0.03) is significantly associated with noncompliance with buprenorphine pill count. CONCLUSIONS Patients found to be noncompliant were more likely to suffer from comorbid psychiatric illness. Patients who tested positive for benzodiazepines or cannabis were more likely to be noncompliant with treatment. Although the rate of noncompliance (inaccurate pill count) was high, patients were still found to be taking their prescribed buprenorphine as evidenced by positive UDS for buprenorphine/norbuprenorphine. In addition, our sample had a high rate of negative UDS screens for opioids and cocaine.
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Daniulaityte R, Carlson R, Brigham G, Cameron D, Sheth A. "Sub is a weird drug:" A web-based study of lay attitudes about use of buprenorphine to self-treat opioid withdrawal symptoms. Am J Addict 2015; 24:403-9. [PMID: 26009867 DOI: 10.1111/ajad.12213] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 02/06/2015] [Accepted: 03/12/2015] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Illicit use of buprenorphine has increased in the U.S., but our understanding of its use remains limited. This study aims to explore Web-forum discussions about the use of buprenorphine to self-treat opioid withdrawal symptoms. METHODS PREDOSE, a novel Semantic Web platform, was used to extract relevant posts from a Web-forum that allows free discussions on illicit drugs. First, we extract information about the total number of buprenorphine-related posts per year between 2005 and 2013. Second, PREDOSE was used to identify all posts that potentially contained discussions about buprenorphine and opioid withdrawal. A total number of 1,217 posts that contained these terms were extracted and entered into NVivo data base. A random sample of 404 (33%) posts was selected and content analyzed. RESULTS Buprenorphine-related posts increased over time, peaking in 2011. The posts were about equally divided between those that expressed positive and negative views about the effectiveness of buprenorphine in relieving withdrawal symptoms. Web-forum participants emphasized that buprenorphine's effectiveness may become compromised because of the "size of a person habit," and/or when users repeatedly switch back and forth between buprenorphine and other illicit opioids. Most posts reported use of significantly lower amounts of buprenorphine (≤2 mg) than doses used in standard treatment. Concomitant use of other psychoactive substances was also commonly reported, which may present significant health risks. CONCLUSIONS Our findings highlight the usefulness of Web-based data in drug abuse research and add new information about lay beliefs about buprenorphine that may help inform prevention and policy measures.
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Affiliation(s)
- Raminta Daniulaityte
- Department of Community Health, Center for Interventions, Treatment, and Addictions Research (CITAR), Boonshoft School of Medicine, Wright State University, Dayton, Ohio
| | - Robert Carlson
- Department of Community Health, Center for Interventions, Treatment, and Addictions Research (CITAR), Boonshoft School of Medicine, Wright State University, Dayton, Ohio
| | - Gregory Brigham
- Department of Psychiatry, University of Cincinnati, ADAPT, Roseburg, Oregon
| | - Delroy Cameron
- Ohio Center of Excellence in Knowledge-enabled Computing (Kno.e.sis), Wright State University, Dayton, Ohio
| | - Amit Sheth
- Ohio Center of Excellence in Knowledge-enabled Computing (Kno.e.sis), Wright State University, Dayton, Ohio
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Boucherie Q, Frauger E, Thirion X, Mallaret M, Micallef J. New methadone formulation in France: results from 5 years of utilization. Therapie 2015; 70:223-34. [PMID: 25858579 DOI: 10.2515/therapie/2015016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 02/09/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND In France, methadone has historically been less accessible than buprenorphine. In 2008, a dry formulation (capsule) was introduced into the market, aimed in particular to improve methadone accessibility. OBJECTIVE To describe the impact (prevalence of use, patient profiles and compliance with requirements) of the dry methadone formulation in France. METHOD A retrospective cohort (from 2008 to 2012) was created from the data of the French General Health Insurance System which covers 80% of the French population. For each years, all subjects affiliated to this insurance system in southeast France (about 8.5 million inhabitants) with at least two reimbursements of methadone between 1st January and 31st December were selected. RESULTS In 2012, the proportion of capsule users was almost the same as that of syrup users (40.0% versus 43.1%; p < 0.001). The rise in the number of methadone users has followed the rise in capsule users. Over the study period, the proportion of patients using benzodiazepines or antidepressants was 6-9% (p < 0.001) higher for capsule users than for syrup users. On average over the study period, 18% of subjects had at least one concurrent issue of the two forms. CONCLUSION The study has shown the rapid spread of the capsule formulation among methadone users. This may suggest that the capsule is well accepted by patients and the medical community. However, the monitoring of methadone-related deaths should continue because of the pharmacodynamic properties of methadone and the context of relaxed regulations concerning access to methadone maintenance treatement (MMT).
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Affiliation(s)
- Quentin Boucherie
- Aix Marseille Université, Institut de Neurosciences Timone, CNRS 7289, Service de Pharmacologie Clinique et Pharmacovigilance, Marseille, France - Centre d'Addictovigilance (CEIP), PACA-Corse Marseille, Marseille, France
| | - Elisabeth Frauger
- Aix Marseille Université, Institut de Neurosciences Timone, CNRS 7289, Service de Pharmacologie Clinique et Pharmacovigilance, Marseille, France - Centre d'Addictovigilance (CEIP), PACA-Corse Marseille, Marseille, France
| | - Xavier Thirion
- Aix Marseille Université, EA 3279 Laboratoire de Santé Publique, AP-HM, CEIP-Addictovigilance associé PACA-Corse, Marseille, France
| | - Michel Mallaret
- Centre d'Addictovigilance (CEIP), CHU Laboratoire de Pharmacologie, Grenoble, France
| | - Joëlle Micallef
- Aix Marseille Université, Institut de Neurosciences Timone, CNRS 7289, Service de Pharmacologie Clinique et Pharmacovigilance, Marseille, France - Centre d'Addictovigilance (CEIP), PACA-Corse Marseille, Marseille, France
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Turner L, Kruszewski SP, Alexander GC. Trends in the use of buprenorphine by office-based physicians in the United States, 2003-2013. Am J Addict 2015; 24:24-9. [DOI: 10.1111/ajad.12174] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 09/09/2014] [Accepted: 10/12/2014] [Indexed: 11/29/2022] Open
Affiliation(s)
- Lydia Turner
- Department of Epidemiology; Johns Hopkins Bloomberg School of Public Health; Baltimore Maryland
- Center for Drug Safety and Effectiveness; Johns Hopkins Bloomberg School of Public Health; Baltimore Maryland
| | - Stefan P. Kruszewski
- Stefan P. Kruszewski; MD & Associates; Harrisburg Pennsylvania
- Department of Mental Health; Johns Hopkins Bloomberg School of Public Health; Baltimore Maryland
- Center for Drug Safety and Effectiveness; Johns Hopkins Bloomberg School of Public Health; Baltimore Maryland
| | - G. Caleb Alexander
- Department of Epidemiology; Johns Hopkins Bloomberg School of Public Health; Baltimore Maryland
- Center for Drug Safety and Effectiveness; Johns Hopkins Bloomberg School of Public Health; Baltimore Maryland
- Department of Pharmacy Practice; University of Illinois at Chicago School of Pharmacy; Chicago Illinois
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Boucherie Q, Frauger E, Thirion X, Mallaret M, Micallef J. Méthadone gélule : résultats de 5 années d’utilisation en France. Therapie 2015. [DOI: 10.2515/therapie/2015015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Schmidt T, Zimam A, Nielsen A, Wakeland W. Data Sources Regarding the Nonmedical Use of Pharmaceutical Opioids in the United States. REVIEWS IN HEALTH CARE 2014; 5:33-50. [PMID: 25525498 DOI: 10.7175/rhc.v5i1.883] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Recent increases in the nonmedical use of pharmaceutical opioids and the adverse outcomes associated with them have stimulated a large amount of research and data collection on this public health problem. Systematic organization of the available data sources is needed to facilitate ongoing research, analysis, and evaluation. This work offers a systematic categorization of data sources regarding the nonmedical use of pharmaceutical opioids in the United States. METHODS A list of keywords regarding the nonmedical use of pharmaceutical opioids was used to conduct systematic searches in PubMed®. Filtration of search results generated 92 peer-reviewed academic articles, published between January 1995 and April 2012, as well as a number of primary data sources. Lists of topics were developed independently by two researchers which were later compared and consolidated. All sources were then categorized according to their relevance to each of these topics and according to their capacity for geographical and longitudinal trend analysis. RESULTS Tables cataloging data sources can be used to identify data relevant to specific topics in diversion, nonmedical use, and adverse outcomes associated with pharmaceutical opioids, and they illustrate global trends in data coverage, identifying several topics that have minimal data. A network diagram illustrates global trends in data coverage, showing variation among sources in the number of topics they cover, as well as variation among topics in the number of sources that cover them. CONCLUSIONS The categorization of data sources is hoped to facilitate ongoing research, analysis, and evaluation of this public health problem by serving as a guide for researchers, policy makers, and others who seek data regarding the nonmedical use of pharmaceutical opioids in the United States.
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Affiliation(s)
- Teresa Schmidt
- Systems Science Graduate Program Portland State University
| | - Amanuel Zimam
- Systems Science Graduate Program Portland State University
| | | | - Wayne Wakeland
- Systems Science Graduate Program Portland State University
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Cepeda MS, Fife D, Kihm MA, Mastrogiovanni G, Yuan Y. Comparison of the risks of shopping behavior and opioid abuse between tapentadol and oxycodone and association of shopping behavior and opioid abuse. Clin J Pain 2014; 30:1051-6. [PMID: 24370606 PMCID: PMC4232297 DOI: 10.1097/ajp.0000000000000067] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 12/11/2013] [Indexed: 12/03/2022]
Abstract
OBJECTIVES This study compared the risks of opioid shopping behavior and opioid abuse between tapentadol immediate release and oxycodone immediate release and, to validate the definition of shopping, examined the association between opioid shopping and opioid abuse further. MATERIALS AND METHODS This retrospective cohort study using linked dispensing and diagnosis databases followed opioid-naive patients for development of shopping behavior and/or opioid abuse during 1 year after initial exposure to tapentadol or oxycodone. Shopping was defined by having overlapping opioid prescriptions from >1 prescriber filled at ≥3 pharmacies; abuse by having International Classification of Diseases, 9th revision diagnoses reflecting opioid abuse, addiction, or dependence. To determine their association, we cross-tabulated shopping and opioid abuse and calculated odds ratios. Risks of developing each outcome were estimated using logistic regression. RESULTS Among 277,401 participants initiating opioid use with tapentadol (39,524) or oxycodone (237,877), 0.6% developed shopping behavior, 0.75% developed abuse. Higher proportions of patients in the oxycodone group developed shopping behavior and abuse than in the tapentadol group (shopping: adjusted odds ratio [95% confidence interval], 0.45 [0.36-0.55]; abuse: 0.44 [0.37-0.54]). Shopping behavior and abuse were associated; of those with shopping behavior, 6.5% had abuse. Age (18 to 64 y), sex (male), prior benzodiazepine use, paying cash, and history (mood disorders, abuse of nonopioid medications, and back pain) were risk factors for developing either outcome. DISCUSSION Shopping behavior and abuse measure complementary, but associated, constructs, which further validates the current definition of shopping. The risk of developing either is lower among patients who initiate opioid use with tapentadol than those who initiate opioid use with oxycodone.
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Affiliation(s)
| | - Daniel Fife
- Janssen Pharmaceutical Research & Development LLC, Titusville, NJ
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28
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Turner L, Kruszewski SP, Alexander GC. Trends in the use of buprenorphine by office-based physicians in the United States, 2003-2013. Am J Addict 2014. [DOI: 10.1111/j.1521-0391.2014.12174.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Lydia Turner
- Department of Epidemiology; Johns Hopkins Bloomberg School of Public Health; Baltimore Maryland
- Center for Drug Safety and Effectiveness; Johns Hopkins Bloomberg School of Public Health; Baltimore Maryland
| | - Stefan P. Kruszewski
- Stefan P. Kruszewski; MD & Associates; Harrisburg Pennsylvania
- Department of Mental Health; Johns Hopkins Bloomberg School of Public Health; Baltimore Maryland
- Center for Drug Safety and Effectiveness; Johns Hopkins Bloomberg School of Public Health; Baltimore Maryland
| | - G. Caleb Alexander
- Department of Epidemiology; Johns Hopkins Bloomberg School of Public Health; Baltimore Maryland
- Center for Drug Safety and Effectiveness; Johns Hopkins Bloomberg School of Public Health; Baltimore Maryland
- Department of Pharmacy Practice; University of Illinois at Chicago School of Pharmacy; Chicago Illinois
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29
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Secora AM, Dormitzer CM, Staffa JA, Dal Pan GJ. Measures to quantify the abuse of prescription opioids: a review of data sources and metrics. Pharmacoepidemiol Drug Saf 2014; 23:1227-37. [DOI: 10.1002/pds.3711] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 07/28/2014] [Accepted: 08/18/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Alex M. Secora
- Office of Surveillance and Epidemiology; Center for Drug Evaluation and Research, Food and Drug Administration; Silver Spring MD USA
| | - Catherine M. Dormitzer
- Office of Surveillance and Epidemiology; Center for Drug Evaluation and Research, Food and Drug Administration; Silver Spring MD USA
| | - Judy A. Staffa
- Office of Surveillance and Epidemiology; Center for Drug Evaluation and Research, Food and Drug Administration; Silver Spring MD USA
| | - Gerald J. Dal Pan
- Office of Surveillance and Epidemiology; Center for Drug Evaluation and Research, Food and Drug Administration; Silver Spring MD USA
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Gordon MS, Kinlock TW, Schwartz RP, Fitzgerald T, O’Grady KE, Vocci FJ. A randomized controlled trial of prison-initiated buprenorphine: prison outcomes and community treatment entry. Drug Alcohol Depend 2014; 142:33-40. [PMID: 24962326 PMCID: PMC4129444 DOI: 10.1016/j.drugalcdep.2014.05.011] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 05/08/2014] [Accepted: 05/09/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Buprenorphine is a promising treatment for heroin addiction. However, little is known regarding its provision to pre-release prisoners with heroin dependence histories who were not opioid-tolerant, the relative effectiveness of the post-release setting in which it is provided, and gender differences in treatment outcome in this population. METHODS This is the first randomized clinical trial of prison-initiated buprenorphine provided to male and female inmates in the US who were previously heroin-dependent prior to incarceration. A total of 211 participants with 3-9 months remaining in prison were randomized to one of four conditions formed by crossing In-Prison Treatment Condition (received buprenorphine vs. counseling only) and Post-release Service Setting (at an opioid treatment center vs. a community health center). Outcome measures were: entered prison treatment; completed prison treatment; and entered community treatment 10 days post-release. RESULTS There was a significant main effect (p=.006) for entering prison treatment favoring the In-Prison buprenorphine Treatment Condition (99.0% vs. 80.4%). Regarding completing prison treatment, the only significant effect was Gender, with women significantly (p<.001) more likely to complete than men (85.7% vs. 52.7%). There was a significant main effect (p=.012) for community treatment entry, favoring the In-Prison buprenorphine Treatment Condition (47.5% vs. 33.7%). CONCLUSIONS Buprenorphine appears feasible and acceptable to prisoners who were not opioid-tolerant and can facilitate community treatment entry. However, concerns remain with in-prison treatment termination due to attempted diversion of medication.
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Affiliation(s)
- Michael S. Gordon
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD, 21201 USA
- Stevenson University, Department of Criminal Justice, 1525 Greenspring Valley Road, Stevenson, MD 21153 USA
| | - Timothy W. Kinlock
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD, 21201 USA
- University of Baltimore, School of Criminal Justice, College of Public Affairs, 1420 N Charles Street, Baltimore, MD 21201 USA
| | - Robert P. Schwartz
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD, 21201 USA
- University of Maryland School of Medicine, Department of Psychiatry, 110 South Paca St., Baltimore, MD 21201
| | - Terrence Fitzgerald
- Glenwood Life Counseling Center, 516 Glenwood Avenue, Baltimore, MD 21212 USA
| | - Kevin E. O’Grady
- University of Maryland, College Park, 8082 Baltimore Avenue, College Park, MD 20740 USA
| | - Frank J. Vocci
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD, 21201 USA
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31
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Fox AD, Chamberlain A, Sohler NL, Frost T, Cunningham CO. Illicit buprenorphine use, interest in and access to buprenorphine treatment among syringe exchange participants. J Subst Abuse Treat 2014; 48:112-6. [PMID: 25205666 DOI: 10.1016/j.jsat.2014.07.015] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 07/19/2014] [Accepted: 07/29/2014] [Indexed: 11/28/2022]
Abstract
Poor access to buprenorphine maintenance treatment (BMT) may contribute to illicit buprenorphine use. This study investigated illicit buprenorphine use and barriers to BMT among syringe exchange participants. Computer-based interviews conducted at a New York City harm reduction agency determined: prior buprenorphine use; barriers to BMT; and interest in BMT. Of 102 opioid users, 57 had used illicit buprenorphine and 32 had used prescribed buprenorphine. When illicit buprenorphine users were compared to non-users: barriers to BMT ("did not know where to get treatment") were more common (64 vs. 36%, p<0.01); mean levels of interest in BMT were greater (3.37 ± 1.29 vs. 2.80 ± 1.34, p=0.03); and more participants reported themselves likely to initiate treatment (82 vs. 50%, p<0.01). Illicit buprenorphine users were interested in BMT but did not know where to go for treatment. Addressing barriers to BMT could reduce illicit buprenorphine use.
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Affiliation(s)
- Aaron D Fox
- Albert Einstein College of Medicine, Bronx, NY 10461, USA; Montefiore Medical Center, Bronx, NY 10467, USA.
| | | | - Nancy L Sohler
- Sophie Davis School of Biomedical Education, City College of the City University of New York, New York, NY, 10027, USA
| | - Taeko Frost
- Washington Heights CORNER Project, New York, NY, 10033, USA
| | - Chinazo O Cunningham
- Albert Einstein College of Medicine, Bronx, NY 10461, USA; Montefiore Medical Center, Bronx, NY 10467, USA
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Abstract
BACKGROUND Buprenorphine/naloxone is an effective medication used to treat opioid dependence. Patients in treatment and those using it illegally without prescriptions have discussed using buprenorphine/naloxone anonymously on Internet discussion boards. Their beliefs about self-treatment and efforts to self-treat are not well known. OBJECTIVES To identify facilitators of self-treatment by online buprenorphine/naloxone users. METHODS A qualitative, retrospective study of discussion board postings from September 2010 to November 2012 analyzed 121 threads from 13 discussion boards using grounded theory. RESULTS Facilitators of self-management themes that emerged included: (1) a ready supply of buprenorphine/naloxone from a variety of sources; (2) distrust of buprenorphine prescribers and pharmaceutical companies; (3) the declaration that buprenorphine/naloxone is a "bad-tasting" medicine; (4) the desire to adopt a different delivery method other than sublingually; and (5) a desire to become completely "substance-free." The sublingual film formulation appears to be an important facilitator in self-treatment because it can more easily be apportioned to extend the medication because of limited supply, cost, or to taper. CONCLUSIONS/IMPORTANCE: The findings indicate a range of self-management activities ranging from altering the amount taken to modifying the physical medication composition or changing the administration route; some of these behaviors constitute problematic extra-medical use. Contributors to discussion boards seem to trust each other more than they trust pharmacists and prescribing physicians. The shared knowledge and behaviors of this understudied online community are important to healthcare providers because of the previously unknown precautions and risks taken to self-treat.
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Affiliation(s)
- Shan-Estelle Brown
- Department of Internal Medicine, Section of Infectious Diseases-AIDS Program, Yale University School of Medicine , New Haven, Connecticut , USA
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Nosyk B, Anglin MD, Brissette S, Kerr T, Marsh DC, Schackman BR, Wood E, Montaner JSG. A call for evidence-based medical treatment of opioid dependence in the United States and Canada. Health Aff (Millwood) 2014; 32:1462-9. [PMID: 23918492 DOI: 10.1377/hlthaff.2012.0846] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Despite decades of experience treating heroin or prescription opioid dependence with methadone or buprenorphine--two forms of opioid substitution therapy--gaps remain between current practices and evidence-based standards in both Canada and the United States. This is largely because of regulatory constraints and pervasive suboptimal clinical practices. Fewer than 10 percent of all people dependent on opioids in the United States are receiving substitution treatment, although the proportion may increase with expanded health insurance coverage as a result of the Affordable Care Act. In light of the accumulated evidence, we recommend eliminating restrictions on office-based methadone prescribing in the United States; reducing financial barriers to treatment, such as varying levels of copayment in Canada and the United States; reducing reliance on less effective and potentially unsafe opioid detoxification; and evaluating and creating mechanisms to integrate emerging treatments. Taking these steps can greatly reduce the harms of opioid dependence by maximizing the individual and public health benefits of treatment.
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Affiliation(s)
- Bohdan Nosyk
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia.
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34
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Lavonas EJ, Severtson SG, Martinez EM, Bucher-Bartelson B, Le Lait MC, Green JL, Murrelle LE, Cicero TJ, Kurtz SP, Rosenblum A, Surratt HL, Dart RC. Abuse and diversion of buprenorphine sublingual tablets and film. J Subst Abuse Treat 2014; 47:27-34. [PMID: 24680219 DOI: 10.1016/j.jsat.2014.02.003] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 02/12/2014] [Accepted: 02/17/2014] [Indexed: 10/25/2022]
Abstract
Buprenorphine abuse is common worldwide. Rates of abuse and diversion of three sublingual buprenorphine formulations (single ingredient tablets; naloxone combination tablets and film) were compared. Data were obtained from the Researched Abuse, Diversion, and Addiction-Related Surveillance (RADARS) System Poison Center, Drug Diversion, Opioid Treatment (OTP), Survey of Key Informants' Patients (SKIP), and College Survey Programs through December 2012. To control for drug availability, event ratios (rates) were calculated quarterly, based on the number of patients filling prescriptions for each formulation ("unique recipients of a dispensed drug," URDD) and averaged and compared using negative binomial regression. Abuse rates in the OTP, SKIP, and College Survey Programs were greatest for single ingredient tablets, and abuse rates in the Poison Center Program and illicit diversion rates were greatest for the combination tablets. Combination film rates were significantly less than rates for either tablet formulation in all programs. No geographic pattern could be discerned.
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Affiliation(s)
- Eric J Lavonas
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, 777 Bannock Street, MC 0180, Denver, CO, 80204, USA.
| | - S Geoffrey Severtson
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, 777 Bannock Street, MC 0180, Denver, CO, 80204, USA.
| | - Erin M Martinez
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, 777 Bannock Street, MC 0180, Denver, CO, 80204, USA.
| | - Becki Bucher-Bartelson
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, 777 Bannock Street, MC 0180, Denver, CO, 80204, USA.
| | - Marie-Claire Le Lait
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, 777 Bannock Street, MC 0180, Denver, CO, 80204, USA.
| | - Jody L Green
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, 777 Bannock Street, MC 0180, Denver, CO, 80204, USA.
| | - Lenn E Murrelle
- Venebio Group, LLC, 7400 Beaufont Springs Drive, Suite 300, Richmond, VA 23225, USA.
| | - Theodore J Cicero
- Department of Psychiatry, Washington University in St. Louis, One Brookings Drive, Campus Box 8134, St. Louis, MO 63130 USA.
| | - Steven P Kurtz
- Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, 2 NE 40th Street, Suite 404, Miami, FL 33137 USA.
| | - Andrew Rosenblum
- Institute for Treatment and Services Research, National Development and Research Institutes, 71 West 23rd Street, 4th floor, New York, NY 10010 USA.
| | - Hilary L Surratt
- Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, 2 NE 40th Street, Suite 404, Miami, FL 33137 USA.
| | - Richard C Dart
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, 777 Bannock Street, MC 0180, Denver, CO, 80204, USA.
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Genberg BL, Gillespie M, Schuster CR, Johanson CE, Astemborski J, Kirk GD, Vlahov D, Mehta SH. Prevalence and correlates of street-obtained buprenorphine use among current and former injectors in Baltimore, Maryland. Addict Behav 2013; 38:2868-73. [PMID: 24018232 DOI: 10.1016/j.addbeh.2013.08.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 08/07/2013] [Accepted: 08/07/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES There are few systematic assessments of street-obtained buprenorphine use from community-based samples in the United States. The objective of this study was to characterize the prevalence, correlates, and reasons for street-obtained buprenorphine use among current and former injection drug users (IDUs) in Baltimore, Maryland. METHODS In 2008, participants of the ALIVE (AIDS Linked to the IntraVenous Experience) study, a community-based cohort of IDUs, were administered a survey on buprenorphine. Street-obtained buprenorphine represented self-reported use of buprenorphine obtained from the street or a friend in the prior three months. RESULTS Six hundred and two respondents were predominantly male (65%), African-American (91%), and 30% were HIV-positive. Overall, nine percent reported recent street-obtained buprenorphine use, and only 2% reported using to get high. Among active opiate users, 23% reported recent use of street-obtained buprenorphine. Use of buprenorphine prescribed by a physician, injection and non-injection drug use, use of street-obtained methadone and prescription opiates, homelessness, and opioid withdrawal symptoms were positively associated, while methadone treatment, health insurance, outpatient care, and HIV-infection were negatively associated with recent street-obtained buprenorphine use in univariate analysis. After adjustment, active injection and heroin use were positively associated with street-obtained buprenorphine use. Ninety-one percent reported using street-obtained buprenorphine to manage withdrawal symptoms. CONCLUSIONS While 9% reported recent street-obtained buprenorphine use, only a small minority reported using buprenorphine to get high, with the majority reporting use to manage withdrawal symptoms. There is limited evidence of diversion of buprenorphine in this sample and efforts to expand buprenorphine treatment should continue with further monitoring.
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Affiliation(s)
- Becky L Genberg
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, 615N. Wolfe Street, Baltimore, MD 21205 USA
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Lavonas EJ, Banner W, Bradt P, Bucher-Bartelson B, Brown KR, Rajan P, Murrelle L, Dart RC, Green JL. Root causes, clinical effects, and outcomes of unintentional exposures to buprenorphine by young children. J Pediatr 2013; 163:1377-83.e1-3. [PMID: 23993129 DOI: 10.1016/j.jpeds.2013.06.058] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 05/29/2013] [Accepted: 06/24/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To characterize the rates, root causes, and clinical effects of unintentional exposures to buprenorphine sublingual formulations among young children and to determine whether exposure characteristics differ between formulations. STUDY DESIGN Unintentional exposures to buprenorphine-containing products among children 28 days to less than 6 years old were collected from the Researched Abuse, Diversion, and Addiction-Related Surveillance System Poison Center Program and Reckitt Benckiser Pharmaceuticals' pharmacovigilance system from October 2009-March 2012. After adjustment for drug availability, negative binomial regression was used to estimate average exposure rates. Root cause assessment was conducted, and an expert clinician panel adjudicated causality and severity of moderate to severe adverse events (AEs). RESULTS A total of 2380 cases were reviewed, including 4 deaths. Exposures to buprenorphine-naloxone combination film were significantly less frequent than exposures to buprenorphine tablets (rate ratio 3.5 [95% CI, 2.7-4.5]) and buprenorphine-naloxone combination tablets (rate ratio 8.8 [7.2-10.6]). The most commonly identified root causes were medication stored in sight, accessed from a bag or purse, and not stored in the original packaging. Among 536 panel review cases, the most common AEs reported for all formulations were lethargy, respiratory depression, miosis, and vomiting. The highest level AE severity did not differ significantly by formulation. CONCLUSIONS Unintentional exposure to buprenorphine can cause central nervous system depression, respiratory depression, and death in young children. Exposure rates to film formulations are significantly less than to tablet formulations. Package and storage deficiencies contribute to unintentional exposures in young children.
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Affiliation(s)
- Eric J Lavonas
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, CO; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO.
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Sembower MA, Ertischek MD, Buchholtz C, Dasgupta N, Schnoll SH. Surveillance of diversion and nonmedical use of extended-release prescription amphetamine and oral methylphenidate in the United States. J Addict Dis 2013; 32:26-38. [PMID: 23480245 PMCID: PMC3630455 DOI: 10.1080/10550887.2012.759880] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This article examines rates of nonmedical use and diversion of extended-release amphetamine and extended-release oral methylphenidate in the United States. Prescription dispensing data were sourced from retail pharmacies. Nonmedical use data were collected from the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS) System Drug Diversion Program and Poison Center Program. Drug diversion trends nearly overlapped for extended-release amphetamine and extended-release oral methylphenidate. Calls to poison centers were generally similar; however, calls regarding extended-release amphetamine trended slightly lower than those for extended-release oral methylphenidate. Data suggest similar diversion and poison center call rates for extended-release amphetamine and extended-release oral methylphenidate.
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Lee S, Klein-Schwartz W, Welsh C, Doyon S. Medical Outcomes Associated with Nonmedical Use of Methadone and Buprenorphine. J Emerg Med 2013; 45:199-205. [DOI: 10.1016/j.jemermed.2012.11.104] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 06/18/2012] [Accepted: 11/06/2012] [Indexed: 11/26/2022]
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Pani PP, Trogu E, Maremmani I, Pacini M. QTc interval screening for cardiac risk in methadone treatment of opioid dependence. Cochrane Database Syst Rev 2013:CD008939. [PMID: 23787716 DOI: 10.1002/14651858.cd008939.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Methadone represents today the gold standard of efficacy for the pharmacological treatment of opioid dependence. Methadone, like many other medications, has been implicated in the prolongation of the rate-corrected QT (QTc) interval of the electrocardiogram (ECG), which is considered a marker for arrhythmias such as torsade de pointes (TdP). Indications on the association between methadone, even at therapeutic dosages, and TdP or sudden cardiac death have been reported. On these bases, consensus and recommendations involving QTc screening of patients receiving methadone treatment have been developed to identify patients with QTc above the thresholds considered at risk for cardiac arrhythmias, and they provide these individuals with alternative treatment (reduction of methadone dosage; provision of alternative opioid agonist treatment; treatment of associated risk factors). OBJECTIVES To evaluate the efficacy and acceptability of QTc screening for preventing cardiac-related morbidity and mortality in methadone-treated opioid dependents. SEARCH METHODS We searched MEDLINE, EMBASE, CINAHL (to April 2013), the Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Library Cochrane Drug and Alcohol Review Group Specialised Register (Issue 3, 2013), main electronic sources of ongoing trials, specific trial databases and reference lists of all relevant papers. SELECTION CRITERIA Randomised controlled trials (RCTs), controlled clinical trials (CCTs) and non-randomised studies (cohort studies, controlled before and after studies, interrupted time series studies, case control studies) examining the efficacy of QTc screening for the prevention of methadone-related mortality and morbidity in opioid addicts. DATA COLLECTION AND ANALYSIS Two review authors independently screened and extracted data from studies. MAIN RESULTS The search strategy led to the identification of 872 records. Upon full-text assessment, no study was found to meet the quality criteria used for this review. AUTHORS' CONCLUSIONS It is not possible to draw any conclusions about the effectiveness of QTc screening strategies for preventing cardiac morbidity/mortality in methadone-treated opioid addicts. Research efforts should focus on strengthening the evidence about the effectiveness of widespread implementation of such strategies and clarifying the associated benefits and harms.
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Affiliation(s)
- Pier Paolo Pani
- Social-Health Division, Health District 8 (ASL 8) Cagliari, Cagliari, Italy.
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Yang A, Arfken CL, Johanson CE. Steps Physicians Report Taking to Reduce Diversion of Buprenorphine. Am J Addict 2013; 22:184-7. [DOI: 10.1111/j.1521-0391.2012.00335.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Revised: 08/17/2011] [Accepted: 09/06/2011] [Indexed: 11/29/2022] Open
Affiliation(s)
- Amy Yang
- Department of Psychiatry and Behavioral Neurosciences; University of Chicago; Chicago, Illinois
| | - Cynthia L. Arfken
- Department of Psychiatry and Behavioral Neurosciences; Wayne State University; Detroit, Michigan
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Schuman-Olivier Z, Connery H, Griffin ML, Wyatt SA, Wartenberg AA, Borodovsky J, Renner JA, Weiss RD. Clinician beliefs and attitudes about buprenorphine/naloxone diversion. Am J Addict 2013; 22:574-80. [PMID: 24131165 DOI: 10.1111/j.1521-0391.2013.12024.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 06/20/2012] [Accepted: 10/22/2012] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Concern about diversion of buprenorphine/naloxone (B/N) in the United States may affect prescribing patterns and policy decisions. This study examines addiction treatment clinician beliefs and attitudes regarding B/N diversion. METHODS Participants (n = 369) completed a 34-item survey in 2010 during two national symposia on opioid dependence. We conducted multivariable regression, examining the relationship of perceived danger from B/N diversion with clinician characteristics and their beliefs about B/N treatment and diversion. We compared causal beliefs about diversion among clinicians with and without B/N treatment experience. RESULTS Forty percent of clinicians believed that B/N diversion is a dangerous problem. The belief that B/N diversion increases accidental overdoses in the community was strongly associated with perceived danger from B/N diversion. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Attitudes and beliefs, not education level, were associated with clinician's perceived danger from B/N diversion. Clinicians with greater B/N patient experience were more likely to believe treatment access barriers are the major cause of B/N diversion.
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Affiliation(s)
- Zev Schuman-Olivier
- Harvard Medical School, McLean Hospital, Boston, Massachusetts; Harvard/MGH Center for Addiction Medicine, Boston, Massachusetts
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Zaller N, McKenzie M, Friedmann PD, Green TC, McGowan S, Rich JD. Initiation of buprenorphine during incarceration and retention in treatment upon release. J Subst Abuse Treat 2013; 45:222-6. [PMID: 23541303 DOI: 10.1016/j.jsat.2013.02.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Revised: 02/06/2013] [Accepted: 02/13/2013] [Indexed: 11/29/2022]
Abstract
We report here on a feasibility study of initiating buprenorphine/naloxone prior to release from incarceration and linking participants to community treatment providers upon release. The study consisted of a small number of Rhode Island (RI) prisoners (N = 44) diagnosed with opioid dependence. The study design is a single arm, open-label pilot study with a 6-month follow up interview conducted in the community. However, a natural experiment arose during the study comparing pre-release initiation of buprenorphone/naloxone to initiation post-release. Time to post-release prescriber appointment (mean days) for initiation of treatment outside Rhode Island Department of Corrections (RIDOC) versus inside RIDOC was 8.8 and 3.9, respectively (p = .1). Median post release treatment duration (weeks) for outside RIDOC versus inside RIDOC was 9 and 24, respectively (p = .007). We conclude that initiating buprenorphine/naloxone prior to release from incarceration may increase engagement and retention in community-based treatment.
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Eiden C, Léglise Y, Bertomeu L, Clavel V, Faillie JL, Petit P, Peyrière H. New Formulation of Methadone for Opioid Dependence in France: Acceptability and Diversion/Misuse Liability. Therapie 2013; 68:107-11. [DOI: 10.2515/therapie/2013020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 02/15/2013] [Indexed: 11/20/2022]
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Rosenblum A, Cruciani RA, Strain EC, Cleland CM, Joseph H, Magura S, Marsch LA, McNicholas LF, Savage SR, Sundaram A, Portenoy RK. Sublingual buprenorphine/naloxone for chronic pain in at-risk patients: development and pilot test of a clinical protocol. J Opioid Manag 2013; 8:369-82. [PMID: 23264315 DOI: 10.5055/jom.2012.0137] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Revised: 09/26/2012] [Accepted: 10/29/2012] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Sublingual buprenorphine/naloxone (Bup/Nx) is approved for addiction treatment and may be useful for pain management, particularly in opioid-treated patients with pain with nonadherence behaviors. The transition of opioid-treated patients with pain to buprenorphine carries the risk of precipitated withdrawal and increased pain. This study convened pain and addiction specialists to develop and pilot a clinical protocol for safe transitioning to Bup/Nx. DESIGN The protocol was revised three times based on outside expert review and pilot study observations. The pilot was conducted with a prospective cohort of 12 patients with moderate to severe chronic pain, who were receiving long-term opioid therapy with any full m-agonist drug, and had exhibited one or more aberrant drug-related behaviors. Patients were followed up for 3-6 months with the expectation that they would experience few adverse events (AEs) and report lower pain severity. RESULTS The three patients on the highest baseline opioid dose (equivalent to 303-450 mg of oral morphine) and the three on the lowest doses (≤20 mg) had early AEs when switched to Bup/Nx and did not complete the trial. Of the remaining six, one withdrew due to AEs; one responded well, then withdrew; and four completed a 3-month trial. A mixed-effects model controlling for dropouts found that average and worst pain significantly decreased after the switch to Bup/Nx (both p < 0.01). CONCLUSION Based on this experience, the protocol recommends Bup/Nx for pain only when baseline opioid doses are within bounds that reduce AEs at transition and incorporates dose flexibility to further reduce risks. This protocol warrants further testing.
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Affiliation(s)
- Andrew Rosenblum
- Institute for Treatment and Services Research, National Development and Research Institutes, New York, NY, USA
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Zosel A, Bartelson BB, Bailey E, Lowenstein S, Dart R. Characterization of adolescent prescription drug abuse and misuse using the Researched Abuse Diversion and Addiction-related Surveillance (RADARS(®)) System. J Am Acad Child Adolesc Psychiatry 2013; 52:196-204.e2. [PMID: 23357446 PMCID: PMC3891924 DOI: 10.1016/j.jaac.2012.11.014] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 10/02/2012] [Accepted: 11/21/2012] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe the characteristics and health effects of adolescent (age 13-19 years) prescription drug abuse and misuse using the Researched Abuse Diversion and Addiction-Related Surveillance (RADARS(®)) System. METHOD Secondary analysis of data collected from RADARS System participating poison centers was performed. Data for all intentional exposures from 2007 through 2009 were used to describe adolescent prescription opioid (oxycodone, fentanyl, hydrocodone, hydromorphone, morphine, methadone, buprenorphine, and tramadol) and stimulant (methylphenidate and amphetamines) exposures. RESULTS A total of 16,209 intentional adolescent exposures to prescription drugs were identified, 68% to opioids and 32% to stimulants. The mean age was 16.6 years (SD ± 1.7 years). Slightly more than half (52.4%) of drug mentions involved females. The five most frequently misused or abused drugs were hydrocodone (32%), amphetamines (18%), oxycodone (15%), methylphenidate (14%), and tramadol (11%). Of all exposures, 38% were classified as suspected suicidal. Of adolescents who intentionally exposed themselves to prescription drugs, 30% were treated in a health care facility, 2,792 of whom were admitted to the hospital, including 1,293 to the intensive care unit. A total of 17.2% of intentional exposures were associated with no effect, 38.9% minor effects, 23.3% moderate effects, 3.6% major effects, and 0.1% were associated with death. Oxycodone and methadone were associated with the most deaths. No deaths were associated with exposures to stimulants. CONCLUSIONS Prescription drug misuse and abuse poses an important health problem and results in thousands of hospitalizations of adolescents per year. Further work is needed to develop focused interventions and educational programs to prevent prescription drug abuse and misuse by adolescents.
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Affiliation(s)
- Amy Zosel
- Rocky Mountain Poison and Drug Center, Denver Health Medical Center, Denver, CO, USA.
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Cepeda MS, Fife D, Vo L, Mastrogiovanni G, Yuan Y. Comparison of opioid doctor shopping for tapentadol and oxycodone: a cohort study. THE JOURNAL OF PAIN 2012; 14:158-64. [PMID: 23253635 DOI: 10.1016/j.jpain.2012.10.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 10/19/2012] [Accepted: 10/25/2012] [Indexed: 01/08/2023]
Abstract
UNLABELLED Obtaining opioids from multiple prescribers, known as doctor shopping, is 1 example of opioid abuse and diversion. The dual mechanism of action of tapentadol could make tapentadol less likely to be abused than other opioids. The aim of this retrospective cohort study was to compare the risk of shopping behavior between tapentadol immediate release (IR) and oxycodone IR. Subjects exposed to tapentadol or oxycodone with no recent opioid use were included and followed for 1 year. The primary outcome was the proportion of subjects who developed shopping behavior defined as subjects who had opioid prescriptions written by >1 prescriber with ≥1 day of overlap filled at ≥3 pharmacies. The opioids involved in the shopping episodes were assessed. A total of 112,821 subjects were exposed to oxycodone and 42,940 to tapentadol. Shopping behavior was seen in .8% of the subjects in the oxycodone group and in .2% of the subjects in the tapentadol group, for an adjusted odds ratio of 3.5 (95% confidence interval, 2.8 to 4.4). In the oxycodone group, 28.0% of the shopping events involved exclusively oxycodone, whereas in the tapentadol group, .6% of the shopping events involved exclusively tapentadol. Results suggest that the risk of shopping behavior is substantially lower with tapentadol than with oxycodone. PERSPECTIVE The risk of opioid doctor shopping, ie, obtaining opioid prescriptions from multiple prescribers, is lower with tapentadol than with oxycodone.
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Affiliation(s)
- M Soledad Cepeda
- Janssen Pharmaceutical Research & Development, LLC, Titusville, New Jersey 08560, USA.
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Stancliff S, Joseph H, Fong C, Furst T, Comer SD, Roux P. Opioid maintenance treatment as a harm reduction tool for opioid-dependent individuals in New York City: the need to expand access to buprenorphine/naloxone in marginalized populations. J Addict Dis 2012; 31:278-87. [PMID: 22873189 DOI: 10.1080/10550887.2012.694603] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The aim of this pilot study was to assess the effectiveness of buprenorphine/naloxone (BUP/NX) among marginalized, opioid-dependent individuals in terms of retention in and cycling into and out of a harm-reduction program. This pilot study enrolled 100 participants and followed them from November 2005 to July 2008. The overall proportion of patients retained in the program at the end of 3, 6, 9, and 12 months was 68%, 63%, 56%, and 42%, respectively. This pilot study demonstrated that BUP/NX could be successfully used to treat marginalized heroin users.
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Reisfield GM, Friedman CK. Methadone in the Chronic Pain Patient With a Substance Use Disorder. J Pain Palliat Care Pharmacother 2012; 26:368-70. [DOI: 10.3109/15360288.2012.734906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Medication assisted treatment in US drug courts: results from a nationwide survey of availability, barriers and attitudes. J Subst Abuse Treat 2012; 44:473-80. [PMID: 23217610 DOI: 10.1016/j.jsat.2012.10.004] [Citation(s) in RCA: 122] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 09/05/2012] [Accepted: 10/15/2012] [Indexed: 11/23/2022]
Abstract
Drug treatment courts are an increasingly important tool in reducing the census of those incarcerated for non-violent drug offenses; medication assisted treatment (MAT) is proven to be an effective treatment for opioid addiction. However, little is known about the availability of and barriers to MAT provision for opioid-addicted people under drug court jurisdiction. Using an online survey, we assessed availability, barriers, and need for MAT (especially agonist medication) for opioid addiction in drug courts. Ninety-eight percent reported opioid-addicted participants, and 47% offered agonist medication (56% for all MAT including naltrexone). Barriers included cost and court policy. Responses revealed significant uncertainty, especially among non-MAT providing courts. Political, judicial and administrative opposition appear to affect MAT's inconsistent use and availability in drug court settings. These data suggest that a substantial, targeted educational initiative is needed to increase awareness of the treatment and criminal justice benefits of MAT in the drug courts.
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