Prescription Opioid Abuse Research Articles

Electronic Real-Time Monitoring Reveals Limited Adherence to Long-Term Opioid Prescriptions in Pain Patients.

Pain management physicians are increasingly focused on limiting prescription opioid abuse, yet existing tools for monitoring adherence have limited accuracy. Medication event monitoring system (MEMS) is an emerging technology for tracking medication usage in real-time but has not been tested in chronic pain patients on long-term opioid regimens. We conducted a pilot clinical trial to investigate the utility of MEMS for monitoring opioid adherence and compared to traditional methods including self-report diaries, urine drug screen (UDS), and physicians' opinions. Opioid-maintained chronic pain patients were recruited from a pain management clinic. Participants (n=28) were randomly assigned to either receive MEMS bottles containing their opioid medication for a 90-day period or to continue using standard medication bottles. MEMS bottles were configured to record and timestamp all bottle openings and the number of pills that were removed from the bottle (via measurement of weight change). Participants who received MEMS demonstrated highly heterogenous dosing patterns, with a substantial number of patients rapidly removing excessive amounts of medication and/or "stockpiling" medication. By comparison, physicians rated all participants as either "totally compliant" or "mostly compliant". UDS results did not reveal any illicit drug use, but 25% of participants (n=7) tested negative for their prescribed opioid metabolite. MEMS data did not correlate with physician-rated adherence (P=0.24) and UDS results (P=0.77). MEMS data consistently revealed greater non-adherence than self-report data (P<0.001). These results highlight the limits in our understanding of naturalistic patterns of daily opioid use in chronic pain patients as well as support the use of MEMS for detecting potential misuse as compared to routine adherence monitoring methods. Future research directions include the need to determine how MEMS could be used to improve patient outcomes, minimize harm, and aid in clinical decision-making. This study was preregistered on ClinicalTrials.gov (NCT03752411).

Assessing Abuse-Deterrent formulations utilizing Ion-Exchange resin complexation processed via Twin-Screw granulation for improved safety and effectiveness

Opioid misuse is a public health crisis in the United States. In response, the FDA has approved drug products with abuse-deterrent features to reduce the risk of prescription opioid abuse. Abuse-deterrent formulations (ADFs) typically employ physical or chemical barriers or incorporate agonist–antagonist combinations as mechanisms to deter misuse. This study aims to assess the impact of abuse-deterrent properties, specifically ion-exchange resin complexation as a chemical barrier, on a model drug, promethazine hydrochloride (PMZ) tablets. Various formulations were developed through twin-screw wet granulation (TSWG) followed by twin-screw melt granulation (TSMG). In the TSWG process, the drug interacts with the resin through an exchange reaction, forming a drug-resin complex. Additionally, the study explored factors influencing the complex formation between the drug and resin, using the drug loading status as an indicator. DSC and ATR studies were carried out to confirm the formation of the drug-resin complex. Subsequently, hot melt granulation was employed to create a matrix tablet incorporating Kollidon® SR and Kollicoat® MAE 100P, thereby enabling sustained release properties. The drug-resin complex embedded in the matrix effectively deters abuse through methods like smoking, snorting, or parenteral injection, unless the drug can be extracted. In order to assess this, solvent extraction studies were conducted using an FDA-recommended solvents, determining the potential for abuse. Further investigations involved dissolution tests in change-over media, confirming the extended-release properties of the formulation. Results from dissolution studies comparing the ground and intact tablets provided positive evidence of the formulation's effectiveness in deterring abuse. Finally, alcohol-induced dose-dumping studies were conducted in compliance with FDA guidelines, concluding that the formulation successfully mitigates dose dumping in the presence of alcohol.

Prevention better than cure: expanding on pharmacists’ role in prescription opioid overdose and addiction management

As prescription opioid misuse and abuse increases in prevalence, pharmacists continue to be in frontlines of prevention and therapeutic management. Pharmacists as public health practitioners should be aware of new and relevant paradigms of substance abuse research and prevention and how they can further contribute to mitigation of opioid and other substance use disorders (SUDs). Screening, brief intervention, and referral to treatment (SBIRT) is a prevention tool that has been used to identify, reduce and misuse, abuse, and dependence on substances, including drugs and alcohol. The screening and brief intervention aspects of SBIRT have been shown to be adaptable across multiple health-care settings. Techniques to conduct applicable stages of SBIRT can be learned and used by pharmacists across multiple practice areas as they engage with the public. SBIRT can be used in conjunction or as a supplementary tool to other prevention and management strategies such as the use of prescription drug monitoring programs and naloxone prescription and distribution. We make a case that pharmacists, particularly those in the community setting, who act as the entry points for many patient engagement encounters, can incorporate SBIRT into their counseling and medication therapy management workflows. As pharmacists continue the move toward codifying provider status, their expertise along with expansion of services, such as the application of SBIRT called for in this article, should be continually leveraged to increase access to treatment and services for at-risk patients with SUDs.

The Upstate New York Surgical Quality Improvement Opioid Reduction Project.

Over 5 million Americans currently abuse prescription opioids. Patients' first exposure to opioids is often after surgery. Few opioid guidelines account for the challenges to health care institutions that serve wide catchment areas. We standardized postoperative opioid prescribing recommendations amongst surgical providers at our institutions and analyzed postoperative prescribing habits. The Upstate New York Surgical Quality Improvement (UNYSQI) collaborative met with surgical champions from 16 hospitals to standardize opioid prescribing for 21 surgical procedures. The guidelines were distributed to all surgical care providers at participating institutions. 581,465 pills were dispensed for 12,672 surgeries (average of 45.9 pills per procedure) before implementation. Post-implementation, 1,097,849 pills were dispensed for 28,772 surgeries (average of 38.2 pills per surgery) with over 222,000 fewer pills being prescribed. Our project suggests opioid prescribing guidelines for institutions that serve diverse communities.

Contingent administration of typical and biased kappa opioid agonists reduces cocaine and oxycodone choice in a drug vs. food choice procedure in male rhesus monkeys.

Combinations of mu and kappa-opioid receptor (KOR) agonists have been proposed as analgesic formulations with reduced abuse potential. The feasibility of this approach has been increased by the development of KOR agonists with biased signaling profiles that produce KOR-typical antinociception with fewer KOR-typical side effects. The present study determined if the biased KOR agonists, nalfurafine and triazole 1.1, could reduce choice for oxycodone in rhesus monkeys as effectively as the typical KOR agonist, salvinorin A. Adult male rhesus monkeys (N = 5) responded under a concurrent schedule of food delivery and intravenous cocaine injections (0.018mg/kg/injection). Once trained, cocaine (0.018mg/kg/injection) or oxycodone (0.0056mg/kg/injection) was tested alone or in combination with contingent injections of salvinorin A (0.1-3.2µg/kg/injection), nalfurafine (0.0032-0.1µg/kg/injection), triazole 1.1 (3.2-100.0µg/kg/injection), or vehicle. In each condition, the cocaine or oxycodone dose, as well as the food amount, was held constant across choice components, while the dose of the KOR agonist was increased across choice components. Cocaine and oxycodone were chosen over food on more than 80% of trials when administered alone or contingently with vehicle. When KOR agonists were administered contingently with either cocaine or oxycodone, drug choice decreased in a dose-dependent manner. Salvinorin A and triazole 1.1 decreased drug-reinforcer choice without altering total trials completed (i.e., choice allocation shifted to food), while nalfurafine dose dependently decreased total trials completed. These results demonstrate that salvinorin A and triazole 1.1, but not nalfurafine, selectively reduce cocaine and oxycodone self-administration independent of nonspecific effects on behavior, suggesting that G-protein bias does not appear to be a moderating factor in this outcome. Triazole 1.1 represents an important prototypical compound for developing novel KOR agonists as deterrents for prescription opioid abuse.

Public health strategies to combat opioid crisis in the United States

Abstract Background: The opioid epidemic in the United States is a national public health crisis. Driven by an increase in availability of pharmaceutical opioids and by an increase in their consumption, specifically, for pain treatment, more so in the past twenty years, it has led to an economic cost of prescription opioid abuse, overdose, and dependence in the United States estimated to be 78.5 billion USD. Methods: A thorough evaluation of the relevant extracted literature has been used to answer the question of the most effective ways to regulate health markets to decrease the opioid crisis in the United States, using keywords and phrases such as opioid epidemic in the US, prescription drug abuse, prescription medication abuse in US, medication misuse, cost-effective ways to health market regulation, drug monitoring programs, prescriber continuing education, provider continuing education, and pain management optimization. Results: Overcoming this epidemic nationwide requires improvement in patient utilization of and access to safe and effective treatment options for opioid abuse and overdose, addressing the stigma correlated with opioid use, considering appropriate use of abuse deterrent formulations (ADF) along with patient education, and improving prescribing practices via utilization of drug monitoring programs, CDC opioid prescribing guidelines and provider continuing education. Conclusion: Utilizing and implementing the aforementioned steps has shown to be a challenge. Further and repeated attempts are needed, while at the same time considering possible new steps that could help reinforce their utilization further.

Is there any Synergistic Effect of Perioperative Use of Pregabalin in Addition to Naproxen in Ankle Fractures? A Prospective, Randomized, Multicenter Study

Category: Ankle; Trauma Introduction/Purpose: Opioid-centric pain management strategies have created an epidemic of prescription opioid abuse in the United States. Multimodal opioid-sparing analgesic regimens have spotlighted as alternatives to decrease postoperative pain. However there has been little study of the synergistic effect between naproxen and pregabalin. We aimed to compare the analgesic efficacy, adverse effects, and long-term functional outcomes between perioperative uses of naproxen only and naproxen with pregabalin. Methods: This study was designed in 70 patients belonging to the 19 to 65 age group indicated for operative fixation of a rotatory ankle fracture under general anesthesia in 3 different hospitals. Group A received naproxen 500mg only, Group B received naproxen 500mg with pregabalin 75mg 2 hour before surgery and 12 hourly for 3 days thereafter. Minimal clinically important difference of visual analog scale (VAS) for pain was set 13 mm out of 100 mm. VAS for pain, opioid consumption, time for first use of escape injection, and any adverse effect were recorded at 6-, 12-, 24-, 48-, and 72-hour postoperatively. VAS for pain was checked at 2-, 6-week, 3-, and 6-month afterward and functional outcomes including Olerud and Molander score and ankle- fracture outcome of rehabilitation measure (A-FORM) were measured at 3-month and 6-month postoperatively. Results: Sixty-two patients (33 in Group A and 29 in Group B) completed follow-up until 6 months. Demographic data were similar between the 2 groups. VAS for pain scale was not significantly different between 2 groups at each time point until 6 months (P ≥ 0.520). Ninety-five percent confidential interval (CI) were within 13 mm at every time point except for at 6- and 12-hour postoperatively (95% CI -1.6 – 0.8, -1.4 – 1.0, each). There were no significant differences in opioid consumption, time for first use of escape injection, and functional outcomes between groups (P ≥ 0.163). Any adverse event at 48-hour postoperatively was significantly higher in Group B (P = 0.017). Conclusion: There was no clinically significant effect of perioperative use of pregabalin in addition to naproxen to reduce pain after operative fixation of rotatory ankle fractures. Rather it significantly raised adverse events after 48-hour postoperatively. Therefore additional use of perioperative pregabalin should be cautiously decided.

Detecting Anomalous Networks of Opioid Prescribers and Dispensers in Prescription Drug Data

The opioid overdose epidemic represents a serious public health crisis, with fatality rates rising considerably over the past several years. To help address the abuse of prescription opioids, state governments collect data on dispensed prescriptions, yet the use of these data is typically limited to manual searches. In this paper, we propose a novel graph-based framework for detecting anomalous opioid prescribing patterns in state Prescription Drug Monitoring Program (PDMP) data, which could aid governments in deterring opioid diversion and abuse. Specifically, we seek to identify connected networks of opioid prescribers and dispensers who engage in high-risk and possibly illicit activity. We develop and apply a novel extension of the Non-Parametric Heterogeneous Graph Scan (NPHGS) to two years of de-identified PDMP data from the state of Kansas, and find that NPHGS identifies subgraphs that are significantly more anomalous than those detected by other graph-based methods. NPHGS also reveals clusters of potentially illicit activity, which may strengthen state law enforcement and regulatory capabilities. Our paper is the first to demonstrate how prescription data can systematically identify anomalous opioid prescribers and dispensers, as well as illustrating the efficacy of a network-based approach. Additionally, our technical extensions to NPHGS offer both improved flexibility and graph density reduction, enabling the framework to be replicated across jurisdictions and extended to other problem domains.

An Artificial Intelligence-Based Smartphone App for Assessing the Risk of Opioid Misuse in Working Populations Using Synthetic Data: Pilot Development Study.

Opioid use disorder (OUD) is an addiction crisis in the United States. As recent as 2019, more than 10 million people have misused or abused prescription opioids, making OUD one of the leading causes of accidental death in the United States. Workforces that are physically demanding and laborious in the transportation, construction and extraction, and health care industries are prime targets for OUD due to high-risk occupational activities. Because of this high prevalence of OUD among working populations in the United States, elevated workers' compensation and health insurance costs, absenteeism, and declined productivity in workplaces have been reported. With the emergence of new smartphone technologies, health interventions can be widely used outside clinical settings via mobile health tools. The major objective of our pilot study was to develop a smartphone app that can track work-related risk factors leading to OUD with a specific focus on high-risk occupational groups. We used synthetic data analyzed by applying a machine learning algorithm to accomplish our objective. To make the OUD assessment process more convenient and to motivate potential patients with OUD, we developed a smartphone-based app through a step-by-step process. First, an extensive literature survey was conducted to list a set of critical risk assessment questions that can capture high-risk behaviors leading to OUD. Next, a review panel short-listed 15 questions after careful evaluation with specific emphasis on physically demanding workforces-9 questions had two, 5 questions had five, and 1 question had three response options. Instead of human participant data, synthetic data were used as user responses. Finally, an artificial intelligence algorithm, naive Bayes, was used to predict the OUD risk, trained with the synthetic data collected. The smartphone app we have developed is functional as tested with synthetic data. Using the naive Bayes algorithm on collected synthetic data, we successfully predicted the risk of OUD. This would eventually create a platform to test the functionality of the app further using human participant data. The use of mobile health techniques, such as our mobile app, is highly promising in predicting and offering mitigation plans for disease detection and prevention. Using a naive Bayes algorithm model along with a representational state transfer (REST) application programming interface and cloud-based data encryption storage, respondents can guarantee their privacy and accuracy in estimating their risk. Our app offers a tailored mitigation strategy for specific workforces (eg, transportation and health care workers) that are most impacted by OUD. Despite the limitations of the study, we have developed a robust methodology and believe that our app has the potential to help reduce the opioid crisis.

Sabizabulin - an unprecedented yet effective drug against COVID-19.

Madam, Opioids a group of illegal drugs such as heroin, and analgesics available legally by prescription, including morphine. Opioids are very addictive as they induce euphoria and sedation, and upon the termination of chorionic use, patients can experience opioid withdrawal symptoms. Opioid crises are usually triggered by their overprescription as analgesics which can lead to diversion and misuse. The use of prescription opioid analgesics doubled between 2001-2013, with many countries affected by epidemics of opioid misuse during this period. In this context, overprescribing OPR’s (opioid related pain relievers) for post-surgical pain has been acknowledged as a noticeable public health concern and a potential contributor to the pattern of opioid misuse but this is ignored too.[1] From 1999-2011 oxycodone consumption increased by nearly 500% and hydrocodone almost doubled. Opioid misuse needs immediate attention to prevent national epidemics such as in the USA in these past two decades above five million opioid- related deaths have been reported, more than half of which involved prescription opioids.[2]. It has been observed that physicians prescribe opioids in more than half non-surgical hospital admissions, often in high doses. Postpartum opioid prescription is another contributing factor to the issue; approximately 80% of women are prescribed opioids after C-section and about 54% of women after normal delivery, although these figures vary in different regions. The risk of chronic opioid use related to opioid prescribing after birth may not seem high (Annual risk: 0.12-0.65%), but such a large number of women being exposed to opioids and those who become chronic users out of them per year is alarming.[3] In Pakistan, after cannabis, opiates and heroin are 2nd and 3rd most commonly used drugs, respectively.[4] Due to easy availability, opioid addiction is common, a survey showed approximately 1.6 million Pakistanis abusing prescription opioids for non-medical use.[5] The majority of the primary care physicians who prescribe opioids do not follow all the recommended approaches to reduce the occurrence of opioid overuse. According to the UNODC, Pakistan is among the top 10 countries with the highest rate of opioid addiction, with or without a prescription. In our country, the general physicians play a significant role, as opioids are routinely prescribed in OPD to manage acute and chronic pain. ---Continue

Retrospective cross-sectional study of the evolution of the use of pharmacological opioids and heroin in a population group in the Barcelona area

BackgroundOpioid dependence is causing an epidemic in the US, but unlike the 1970s it seems more related to prescription opioids than heroin. ObjectivesThe objective of this study is to assess whether this new epidemic has already reached our environment and to see if there are changes in consumption and in the characteristics of consumers. Patients and methodsRetrospective cross-sectional study. 1140 patients were included between 2012 and 2019, 633 of whom were first visits to Drug Addiction Care and Monitoring Centers (CAS), 502 corresponding to emergency room visits for problems related to overdose or withdrawal of heroin or opioids with prescription, and the remaining 5 are newborns of mothers addicted to heroin. Demographic data and characteristics of the substances of abuse were analyzed, comparing between partial periods. ResultsThere was a global decrease in the first visits of patients to the CAS who reported heroin addiction (p=0.001), while those addicted to pharmacy opioids have remained stable. There has been an irregular increase in total emergency visits, overdose consultations, and withdrawal consultations, both for heroin and prescription opioids (p=0.062, p=0.166, p=0.005, respectively). Opioid-related emergencies have been less frequent than for heroin. Non-Spanish European patients have increased compared to Spanish patients. ConclusionThere has been no worrying increase in heroin or prescription opioid abuse in our setting.

The Public Health Effects of Legalizing Marijuana

Thirty-six states have legalized medical marijuana and 18 states have legalized the use of marijuana for recreational purposes. In this paper, we review the literature on the public health consequences of legalizing marijuana, focusing on studies that have appeared in economics journals as well as leading public policy, public health, and medical journals. Among the outcomes considered are: youth marijuana use, alcohol consumption, the abuse of prescription opioids, traffic fatalities, and crime. For some of these outcomes, there is a near consensus in the literature regarding the effects of medical marijuana laws (MMLs). As an example, leveraging geographic and temporal variation in MMLs, researchers have produced little credible evidence to suggest that legalization promotes marijuana use among teenagers. Likewise, there is convincing evidence that young adults consume less alcohol when medical marijuana is legalized. For other public health outcomes such as mortality involving prescription opioids, the effect of legalizing medical marijuana has proven more difficult to gauge and, as a consequence, we are less comfortable drawing firm conclusions. Finally, it is not yet clear how legalizing marijuana for recreational purposes will affect these and other important public health outcomes. We will be able to draw stronger conclusions when more posttreatment data are collected in states that have recently legalized recreational marijuana. (JEL I12, I18, K32, K42, R41)

Identification of prescription opioid misuse and abuse behaviors and risk factors in chronic pain patients using the Prescription Opioid Misuse and Abuse Questionnaire (POMAQ)

Objectives To identify patient risk factors associated with prescription opioid misuse and abuse as well as groupings of misuse and abuse behaviors as measured by the Prescription Opioid Misuse and Abuse Questionnaire (POMAQ). Methods Adults with chronic pain requiring long-term treatment with opioids completed the POMAQ and other study questionnaires. Latent class analysis (LCA) was used to examine underlying subgroups exhibiting particular risk profiles. Patient demographic and clinical characteristics were examined as covariates and the concordance between the identified latent classes at-risk classifications and the POMAQ clinical scoring algorithm was assessed. Results Analysis of data from 809 patients revealed four classes: “chronic pain, low risk” (n = 473, low to no prevalence of POMAQ behaviors), “chronic pain, comorbid condition” (n = 152, high prevalence of anti-anxiety, sleeping pill, and antihistamine use), “at risk” (n = 154, taking more opioids than prescribed and drinking alcohol with opioids more frequently than other groups), and “high risk” (n = 30, highest prevalence of each behavior). The “high risk” group was associated with being younger, less educated, and unemployed compared to other groups. When examining the LCA classes by groups defined by the original POMAQ clinical scoring algorithm, the “high risk” class had the highest proportion of participants identified with abuse behaviors (46.7%), compared to just 4.7% in the “chronic pain, low risk” group. Conclusions Findings suggest there are four distinct subgroups of patients defined by chronic opioid misuse and abuse behaviors and support the use of the POMAQ to identify risk factors associated with prescription opioid misuse and abuse.

A population-based study on the risk of prescription opioid abuse in patients with chronic opioid use and cost-effectiveness of prescription drug monitoring program using a patient simulation model in South Korea.

Concerns regarding the burden of inappropriate opioid use are growing. We examined the association between prescription opioid abuse and patient characteristics and estimated the cost-effectiveness of the prescription drug monitoring program (PDMP) implemented in South Korea, considering patient-level information. A retrospective cohort study was conducted to explore the association between opioid abuse and patient characteristics using the National Health Insurance Service-National Sample Cohort (NHIS-NSC) database. We selected non-cancer patients with chronic opioid use and investigated the incidence of opioid abuse between 2010 and 2015. The association between opioid abuse and patient characteristics was assessed using the Cox proportional hazards model. The cost-effectiveness of the PDMP was assessed using discrete event simulation (DES) with a time horizon of 30 years from a societal perspective. Time-to-event data and event costs were obtained from the NHIS-NSC database. The abuse rate was adjusted for each patient based on the baseline characteristics and history of abuse experienced in the model. Program effectiveness, program costs, and health-state utilities were obtained from the published literature. The incremental cost-utility ratio (ICUR) was estimated at a discount rate of 5% for both costs and quality-adjusted life-years (QALYs). We identified 22,524 patients with chronic opioid use in the NHIS-NSC database. Every one-year increase in age (hazard ratio: 1.002 [95% CI: 1.000-1.003]), medical aid program (1.130 [95% CI: 1.072-1.191]), high Charlson Comorbidity Index (1.054 [95% CI: 1.044-1.065]), and history of opioid abuse (1.501 [95% CI: 1.391-1.620] and 3.005 [95% CI: 2.387-3.783] for 1-2 and ≥3 abuse events, respectively) significantly increased the risk of opioid abuse. In the DES, the PDMP was cost-effective, with an estimated ICUR of $2,227/QALY, which was most affected by the program's effectiveness. Patient characteristics and history of opioid abuse affected the risk of opioid abuse. Considering patient-level information, the PDMP implemented in South Korea is likely to be cost-effective.

Oral oxycodone self-administration leads to features of opioid misuse in male and female mice.

Use of prescription opioids, particularly oxycodone, is an initiating factor driving the current opioid epidemic. There are several challenges with modelling oxycodone abuse. First, prescription opioids including oxycodone are orally self-administered and have different pharmacokinetics and dynamics than morphine or fentanyl, which have been more commonly used in rodent research. This oral route of administration determines the pharmacokinetic profile, which then influences the establishment of drug-reinforcement associations in animals. Moreover, the pattern of intake and the environment in which addictive drugs are self-administered are critical determinants of the levels of drug intake, of behavioural sensitization and of propensity to relapse behaviour. These are all important considerations when modelling prescription opioid use, which is characterized by continuous drug access in familiar environments. Thus, to model features of prescription opioid use and the transition to abuse, we designed an oral, homecage-based oxycodone self-administration paradigm. Mice voluntarily self-administer oxycodone in this paradigm without any taste modification such as sweeteners, and the majority exhibit preference for oxycodone, escalation of intake, physical signs of dependence and reinstatement of seeking after withdrawal. In addition, a subset of animals demonstrate drug taking that is resistant to aversive consequences. This model is therefore translationally relevant and useful for studying the neurobiological substrates of prescription opioid abuse.

Recreational marijuana laws and the misuse of prescription opioids: Evidence from National Survey on Drug Use and Health microdata.

Several studies have concluded that legalizing medical marijuana can reduce deaths from opioid overdoses. Drawing on micro data from the National Survey on Drug Use and Health, a survey uniquely suited to assessing patterns of substance use, we examine the relationship between recreational marijuana laws (RMLs) and the misuse of prescription opioids. Using a standard difference-in-differences (DD) regression model, we find that RML adoption reduces the likelihood of frequently misusing prescription opioids such as OxyContin, Percocet, and Vicodin. However, using a two-stage procedure designed to account for staggered treatment and dynamic effects, the DD estimate of relationship between RML adoption and the likelihood of frequently misusing prescription opioids becomes positive. Although event study estimates suggest that RML adoption leads to a decrease in the frequency of prescription opioid abuse, this effect appears to dissipate after only 2 or 3years.

A High-Throughput Ion Mobility Spectrometry-Mass Spectrometry Screening Method for Opioid Profiling.

In 2017, the United States Department of Health and Human Services declared the widespread misuse and abuse of prescription and illicit opioids an epidemic. However, this epidemic dates back to the 1990s when opioids were extensively prescribed for pain management. Currently, opioids are still recommended for pain management, and given their abuse potential, rapid screening is imperative for patient treatment. Of particular importance is assessing pain management patient compliance, where evaluating drug use is crucial for preventing opioid abuse and potential overdoses. In this work, we utilized drift tube ion mobility spectrometry coupled with mass spectrometry (DTIMS-MS) to develop a rapid screening method for 33 target opioids and opioid urinary metabolites. Collision cross section values were determined for all target molecules using a flow-injection DTIMS-MS method, and clear differentiation of 27 out of the 33 opioids without prior chromatographic separation was observed when utilizing a high resolution demultiplexing screening approach. An automated solid phase extraction (SPE) platform was then coupled to DTIMS-MS for 10 s sample-to-sample analyses. This SPE-IMS-MS approach enabled the rapid screening of urine samples for opioids and presents a major improvement in sample throughput compared to traditional chromatographic analyses coupled with MS, which routinely take several minutes per sample. Overall, this vast reduction in analysis time facilitates a faster turn-around for patient samples, providing great benefits to clinical applications.

Opioid Misuse: A Review of the Main Issues, Challenges, and Strategies.

In the United States, from 1999 to 2019, opioid overdose, either regularly prescribed or illegally acquired, was the cause of death for nearly 500,000 people. In addition to this pronounced mortality burden that has increased gradually over time, opioid overdose has significant morbidity with severe risks and side effects. As a result, opioid misuse is a cause for concern and is considered an epidemic. This article examines the trends and consequences of the opioid epidemic presented in recent international literature, reflecting on the causes of this phenomenon and the possible strategies to address it. The detailed analysis of 33 international articles highlights numerous impacts in the social, public health, economic, and political spheres. The prescription opioid epidemic is an almost exclusively North American problem. This phenomenon should be carefully evaluated from a healthcare systems perspective, for consequential risks and harms of aggressive opioid prescription practices for pain management. Appropriate policies are required to manage opioid use and prevent abuse efficiently. Examples of proper policies vary, such as the use of validated questionnaires for the early identification of patients at risk of addiction, the effective use of regional and national prescription monitoring programs, and the proper dissemination and translation of knowledge to highlight the risks of prescription opioid abuse.

Psychological variables involved in opioid abuse or misuse in patients with non-oncological chronic pain

Psychological variables can be used to predict the risk of prescription opioid abuse. The aim of the present study was to analyse the predictive value of a set of these variables. Specifically, we analysed the association between the potential abuse and misuse of opioids and self-affirming mood, neuroticism, extraversion, anxiety and/or depression symptoms, and perceived pain intensity. The sample comprised 60 patients with chronic non-oncological pain (mean age= 60 years; 77% women, 78% married). Two stepwise multiple linear regression analyses were performed. The results indicate that anxiety and/or depression symptoms were the only variables associated with the potential abuse and current misuse of prescription opioids. We suggest the need for prior psychological assessment before deciding to initiate pharmacological therapy with opioids. Any anxiety or depression symptoms in these patients should be addressed before prescribing opioids.

PLA-PCL microsphere formulation to deter abuse of prescription opioids by smoking

Opioids are commonly prescribed across the United States (US) for pain relief, despite their highly addictive nature that often leads to abuse and overdose deaths. Abuse deterrent formulations (ADFs) for prescription opioids make the non-therapeutic use of these drugs more difficult and less satisfying. Although approximately one-third of surveyed abusers in the US reported smoking opioids, to our knowledge, no commercialized ADF effectively prevents opioid smoking. Here, we report a novel approach to deter smoking of a model prescription opioid drug, thebaine (THB), by using polymer blend microspheres (MS) comprising polylactic acid (PLA) and polycaprolactone (PCL). We utilized high-performance liquid chromatography (HPLC) and thermogravimetric analysis (TGA) to test the ability of PLA-PCL MS to limit the escape of vaporized THB. Additionally, we compared the abuse-deterrent potential of PLA-PCL MS to that of activated carbon (AC) and mesoporous silica (MPS), two materials with excellent drug-adsorbing properties. Our MS formulation was effective in reducing the amount of both active drug and thermal degradation products in the vapor generated upon heating of THB. These results support that PLA-PCL microspheres can be co-formulated in a tablet with common prescription opioids to deter their abuse via the smoking route.