Opioid Crisis Research Articles

Mitigating Medication Tampering and Diversion via Real-Time Intravenous Opioid Quantification.

Opioid tampering and diversion pose a serious problem for hospital patients with potentially life-threatening consequences. The ongoing opioid crisis has resulted in medications used for pain management and anesthesia, such as fentanyl and morphine, being stolen, substituted with a different substance, and abused. This work aims to mitigate tampering and diversion through analytical verification of the administered drug before it enters the patient. We present an electrochemical-based sensor and miniaturized wireless potentiostat that enable real-time intravenous (IV) monitoring of opioids, specifically fentanyl and morphine. The proposed system is connected to an IV drip system during surgery or post-operation recovery. Measurement results of two opioids are presented, including calibration curves and data on the sensor performance concerning pH, temperature, interference, reproducibility, and long-term stability. Finally, we demonstrate real-time fluidic measurements connected to a flow cell to simulate IV administration and a blind study classified using a machine-learning algorithm. The system achieves limits of detection (LODs) of 1.26 µg/mL and 2.75 µg/mL for fentanyl and morphine, respectively, while operating with >1-month battery lifetime due to an optimized ultra-low power 36 µA sleep mode.

Impact of opioid-related disorders on complications in patients undergoing bariatric surgery: a propensity score-matched analysis of the national inpatient sample.

The opioid crisis caused a huge health concern in the United States. Despite this, few studies haveexamined the influence of opioid-related disorders (OD) on outcomes after bariatric surgery. The major goal of this study is to determine the impact of OD on in-hospital outcomes for patients undergoing bariatric surgery. The National Inpatient Sample (NIS) database from 2016 to 2020 was used to evaluate patients with OD who underwent bariatric operations including sleeve gastrectomy, Roux-en-Y gastric bypass, and biliopancreatic diversion with duodenal switch. The non-OD comparison group was created using a propensity score match (1:1). Weighted analysis was carried out utilizing NIS-provided weights. The odds ratios were obtained using multivariate logistic regression. A total of 159,455 patients who underwent bariatric surgery were evaluated. Propensity score matching and weighted analysis were used to compare 11,025 in the OD group and 11,025 in the non-OD group. OD was an independent predictor for postoperative complications (odds ratio: 1.29, 95% confidence interval: 1.19-1.39, p < 0.001). Among complications, OD was a predictor for bleeding complications, postoperative nausea and vomiting, anastomotic leak, and mechanical ventilation. In addition, the OD group experienced significantly longer lengths of stay (LOS) and a higher total hospital charges. In patients undergoing bariatric surgery, OD is associated with a significantly higher risk of postoperative complications, as well as increased LOS and total hospital charges. These patients may benefit from further preoperative optimization, including decreasing the opioid dose and closer postoperative monitoring.

Pharmacist-Led Deprescribing of Opioids and Benzodiazepines in Older Adults: Examining Implementation and Perceptions.

Background: This study examines the implementation and perceptions of a pharmacist consultant deprescribing program aimed at reducing the risk of falls in older adults using opioids and benzodiazepines. Methods: This qualitative study conducted interviews with healthcare providers. The interviews were conducted from August to December 2021 and analyzed using inductive coding techniques. Results: Five participants, predominantly female MDs or PA-Cs from rural clinics, were interviewed. The participants adopted a pharmacist-led deprescribing program due to their heightened awareness of the opioid crisis, dedication to patient safety, and a desire for opioid deprescribing education. Initially, concerns included patient resistance and provider-driven barriers. However, over time, patient attitudes shifted toward greater openness to the program. The providers emphasized several critical needs for the success of the program: guaranteed access to pharmacists, tailored patient education, resources specific to providers, and financial support, including telehealth options. These factors were deemed essential to overcoming initial barriers and ensuring effective implementation. Conclusion: Integrating pharmacists into primary care settings shows promise for deprescribing opioids and benzodiazepines in older adults. Future research should explore telehealth options for patient-pharmacist consultations and expand the application of these findings to other healthcare settings. The study highlights the importance of awareness, patient education, access to resources (pharmacists), and provider support in addressing deprescribing among older adults.

EMS Paramedics and Law Enforcement Officers' Experiences with Joint-Response Efforts on Suspected Opioid Overdose Calls: A Qualitative Study.

In the United States, the opioid crisis remains a nationwide public health emergency. Narcan laws have increased medical collaboration between emergency medical services (EMS) paramedics and law enforcement officers (LEOs), yet research on joint opioid-response efforts with these first responders remains underexplored. Using a phenomenological approach, this study explores EMS paramedics and LEOs' experiences with joint-response efforts on suspected opioid overdose calls amidst the ongoing opioid crisis. Researchers conducted semi-structured interviews with 14 first responders (n = 8 EMS paramedics; n = 6 LEOs) from a large Central Florida emergency services district covering urban, suburban, and rural areas. Four major themes emerged: (1) facilitators to joint-response efforts; (2) barriers to joint-response efforts; (3) concerns for patient co-occurring behavioral health conditions; and (4) perceived solutions. Overall, participants described mutual respect, reliance, and communication as key facilitators, while barriers included conflicting on-scene priorities and differences in Narcan protocols. Concerns for co-occurring behavioral health (i.e., addiction and mental health) conditions among overdose patients included difficulties in assessing mental health and the availability of wraparound services, yet these concerns remained secondary to medical treatment during an opioid-related emergency. Key solutions included enhanced Narcan training for LEOs and increased availability of behavioral health services for long-term patient care. This research contributes to existing literature on opioid overdose response by specifically examining joint-response efforts between EMS paramedics and LEOs. These findings may be applicable to other partnering agencies such as mental health crisis teams and should be explored across behavioral health collaborations.

U.S. Healthcare Workers' Perspective of Outpatient Provision of Methadone: A Scoping Review.

A recent National Institute on Drug Addiction Call to Action focused on expanding methadone treatment access for individuals with opioid use disorder (OUD). One research priority identified was optimal educational and support structures, including training to provide methadone across multiple healthcare settings (e.g., primary care, opioid treatment programs [OTPs], pharmacies) and healthcare workers (HCWs) (e.g., providers, pharmacists). This scoping review sought to better understand HCWs' knowledge, attitudes, and stigma as it relates to methadone provision. Four databases (PubMed, PsycInfo, CINAHL, Web of Science) were searched for publications between 2010 and 2022 using keywords-methadone, HCW, outpatient setting, knowledge, attitudes, and stigma, focusing on HCWs in general and pharmacists specifically. A total of 2,747 articles were identified and 14 met inclusion criteria for review. Settings included OTPs (n = 4), specialty addiction treatment clinics (n = 3), community pharmacies (n = 2), and multiple settings (n = 5). All articles (n = 14) examined methadone-related attitudes. Despite approval of methadone in 1972 to treat OUD, four articles illustrated continued methadone-related stigma held by HCWs. In response to COVID-19-related policy changes allowing methadone take-home flexibility, OTP clinicians expressed a range of attitudes concerning patient risk and potential program liability around diversion and misuse. One article assessing knowledge suggested that, even when most pharmacists correctly answered knowledge questions, a significant minority had misunderstandings that could undermine effective treatment. Given the current imbalance between methadone treatment demand and availability, there is a critical need to expand outpatient methadone services. Pharmacists partnering with OTPs represent a logical but underutilized access point. We identified key areas to improve HCWs methadone-related knowledge, attitudes, and stigma. Future research should explore the impact of outpatient pharmacy-OTP and other expansion services, and systematic training, education, and evaluation of methadone-related understanding, including assessment tools to measure knowledge, attitudes, and stigma.

Mindfulness-Oriented Recovery Enhancement: Implementing an evidence-based intervention for chronic pain, opioid use, and opioid addiction in clinical settings.

The opioid crisis emerged in part due to the overprescribing of opioid analgesics for chronic pain. Although not the only source of the current epidemic of opioid use disorder (OUD), the prescription of opioids for chronic pain remains one vector for the development of opioid misuse and OUD. However, opioid tapering is not appropriate for all patients, and some patients may need to remain on opioid therapy for the long term. To reduce the risk of opioid-related harm among people with chronic pain and to treat incipient or entrenched addictive behaviours, new interventions are needed. This review discusses the clinical outcomes, biobehavioural mechanisms and implementation considerations for a novel, evidence-based intervention for chronic pain, opioid use and OUD called Mindfulness-Oriented Recovery Enhancement (MORE). MORE unites complementary aspects of mindfulness training, cognitive behavioural therapy and principles from positive psychology to simultaneously address addictive behaviour, emotion dysregulation and chronic pain by targeting brain reward and stress systems. MORE has been tested in 13 completed randomized clinical trials, including over 1300 patients, and has demonstrated efficacy against a range of active control conditions for reducing opioid dosing, opioid misuse, illicit drug use, depression, post-traumatic stress symptoms and chronic pain. Opportunities for implementing MORE include facilitating opioid tapering and promoting safe opioid use in primary care and specialty pain clinics, decreasing opioid misuse and enhancing medication-assisted treatment for OUD. Given evidence of MORE's efficacy, it is now time to consider disseminating this evidence-based treatment in the United States, the United Kingdom and worldwide.

Navigating Opioid Alternatives in Spine Surgery: A Comprehensive Review.

The opioid crisis has significantly impacted pain management practices in spine surgery, prompting a critical reassessment of traditional approaches. While opioids have historically been effective for post-operative pain relief, their widespread use has led to substantial public health challenges, including addiction and overdose. This review explores alternative strategies to opioids in spine surgery, emphasizing non-opioid pharmacological options [e.g., nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, local anesthetics] and non-pharmacological interventions (e.g., physical therapy, cognitive-behavioral therapy). These alternatives aim to mitigate opioid-related risks while optimizing patient outcomes. Key findings highlight these approaches' efficacy, safety considerations, and practical implications. Recommendations include personalized pain management plans and multidisciplinary collaboration to enhance care delivery. Future directions suggest advancing research in innovative pain management technologies and promoting evidence-based practices to mitigate opioid dependence. Ultimately, integrating these strategies into clinical practice is essential for addressing the opioid crisis and ensuring quality care in spine surgery.

The Association of Medical Cannabis Use with Pain Levels and Opioid Use in Illinois’ Opioid Alternative Pilot Program

Objective The state of Illinois’ Opioid Alternative Pilot Program (OAPP) is the first and only official harm-reduction program in the US to address the opioid crisis via facilitation of safe and legal access to medical cannabis. This study evaluates the association of medical cannabis use with pain level and frequency of opioid use in the first cohort of OAPP participants in 2019. Methods A survey was sent OAPP enrollees between February and July 2019. Cannabis users (n = 626) were compared to non-users (n = 234) to determine whether there was an association between cannabis use and self-reported (a) pain level and (b) frequency of opioid use. Backward stepwise regression models were used. Results A total of 860 participants was included in the analysis. Overall, 75% of the study sample reported pain as their primary medical symptom, and 67% of cannabis users reported having a disability. The mean difference in pain level between cannabis users and non-users was 4.5 units (on a 100-point scale) higher among cannabis users than non-users (p = 0.03); and cannabis use was statistically associated with pain level. High-frequency opioid users had lower odds of reporting cannabis use within the past year than low/no opioid users. Conclusions Although there was a statistical association between cannabis use and pain, the difference of 4.5 points in pain level between users and non-users was too small to reflect a clinically meaningful relative difference. This study may provide useful information to providers and clinicians about how the OAPP and similar programs may reduce opioid use and improve health outcomes.

The role of metaphor in the corporate political strategies of health harming industries: Comparing the concept of balance in the gambling and opioid industry discourses

Scholars have identified notable similarities between the political strategies employed by health-harming industries. This includes similarities in the narratives employed by industry actors seeking to oppose public health regulations that threaten their commercial interests. This study seeks to examine the use of a specific concept – the balance metaphor – in the policy discourses of two health-harming industries. Namely, the pharmaceutical industry implicated in the prescription opioid crisis in the US, and the UK gambling industry, whose products and practices are associated with a serious, but largely neglected, series of harms. We first review research on metaphors, demonstrating how this provides additional theoretically-informed concepts with which to understand how industry discourse circumscribes the terrain of policy debates in ways amenable to commercial interests. Building from these insights, we conducted a rhetorical analysis, examining how the concept of balance is employed by different actors in distinct contexts to shape understandings of the social and policy problems associated with gambling and opioid products and to promote industry-favourable regulatory responses to these. This brings a micro-level of analysis to supplement previous meso- and macro-level scholarship in this space. We use our findings to argue that the depoliticization of the policy process and objectivization of the policy space – in ways that obscure its contingent and political nature – through discourses of balance is itself an arch political act. Examining the metaphors used in policy debates and their functions provides important insights that can be used to inform the construction of counter-narratives to industry-favourable discourses, including the creative use of novel metaphors in the service of public health goals.

High-Dose Opioid Prescribing in Individuals with Acute Pain: Assessing the Effects of US State Opioid Policies.

How state opioid policy environments with multiple concurrent policies affect opioid prescribing to individuals with acute pain is unknown. To examine how prescription drug monitoring programs (PDMPs), pain management clinic regulations, initial prescription duration limits, and mandatory continued medical education affected total and high-dose prescribing. A county-level multiple-policy difference-in-difference event study framework. A total of 2,425,643 individuals in a large national commercial insurance deidentified claims database (aged 12-64 years) with acute pain diagnoses and opioid prescriptions from 2007 to 2019. The total number of acute pain opioid treatment episodes and number of episodes containing high-dose (> 90 morphine equivalent daily dosage (MEDD)) prescriptions. Approximately 7.5% of acute pain episodes were categorized as high-dose episodes. Prescription duration limits were associated with increases in the number of total episodes; no other policy was found to have a significant impact. Beginning five quarters after implementation, counties in states with pain management clinic regulations experienced a sustained 50% relative decline in the number of episodes containing > 90 MEDD prescriptions (95 CIs: (Q5: - 0.506, - 0.144; Q12: - 1.000, - 0.290)). Mandated continuing medical education regarding the treatment of pain was associated with a 50-75% relative increase in number of high-dose episodes following the first year-and-a-half of enactment (95 CIs: (Q7: 0.351, 0.869; Q12: 0.413, 1.107)). Initial prescription duration limits were associated with an initial relative reduction of 25% in high-dose prescribing, with the effect increasing over time (95 CI: (Q12: - 0.967, - 0.335). There was no evidence that PDMPs affected high-dose opioids dispensed to individuals with acute pain. Other high-risk prescribing indicators were explored as well; no consistent policy impacts were found. State opioid policies may have differential effects on high-dose opioid dispensing in individuals with acute pain. Policymakers should consider effectiveness of individual policies in the presence of other opioid policies to address the ongoing opioid crisis.

Opioid Administration Practice Patterns in Patients With Acute Respiratory Failure Who Undergo Invasive Mechanical Ventilation.

The opioid crisis is impacting people across the country and deserves attention to be able to curb the rise in opioid-related deaths. To evaluate practice patterns in opioid infusion administration and dosing for patients with acute respiratory failure receiving invasive mechanical ventilation. Retrospective cohort study. Patients from 21 hospitals in Kaiser Permanente Northern California and 96 hospitals in Philips electronic ICU Research Institute. We assessed whether patients received opioid infusion and the dose of said opioid infusion. We identified patients with a diagnosis of acute respiratory failure who were initiated on invasive mechanical ventilation. From each patient, we determined if opioid infusions were administered and, among those who received an opioid infusion, the median daily dose of fentanyl infusion. We used hierarchical regression models to quantify variation in opioid infusion use and the median daily dose of fentanyl equivalents across hospitals. We included 13,140 patients in the KPNC cohort and 52,033 patients in the eRI cohort. A total of 7,023 (53.4%) and 16,311 (31.1%) patients received an opioid infusion in the first 21 days of mechanical ventilation in the KPNC and eRI cohorts, respectively. After accounting for patient- and hospital-level fixed effects, the hospital that a patient was admitted to explained 7% (95% CI, 3-11%) and 39% (95% CI, 28-49%) of the variation in opioid infusion use in the KPNC and eRI cohorts, respectively. Among patients who received an opioid infusion, the median daily fentanyl equivalent dose was 692 µg (interquartile range [IQR], 129-1341 µg) in the KPNC cohort and 200 µg (IQR, 0-1050 µg) in the eRI cohort. Hospital explained 4% (95% CI, 1-7%) and 20% (95% CI, 15-26%) of the variation in median daily fentanyl equivalent dose in the KPNC and eRI cohorts, respectively. In the context of efforts to limit healthcare-associated opioid exposure, our findings highlight the considerable opioid exposure that accompanies mechanical ventilation and suggest potential under and over-treatment with analgesia. Our results facilitate benchmarking of hospitals' analgesia practices against risk-adjusted averages and can be used to inform usual care control arms of analgesia and sedation clinical trials.

S84 - Lived Experiences of Addiction Counselors: A Protocol Exploring Stigma in a Time of Regulatory Change Within Opioid Treatment Programs

S84 - Lived Experiences of Addiction Counselors: A Protocol Exploring Stigma in a Time of Regulatory Change Within Opioid Treatment Programs

S80 - Using Implementation Facilitation to Implement Interim Methadone in Opioid Treatment Programs

S80 - Using Implementation Facilitation to Implement Interim Methadone in Opioid Treatment Programs

T103 - Implementation of Virtual Contingency Management Within a Statewide Opioid Treatment Program Provider Network in Texas

T103 - Implementation of Virtual Contingency Management Within a Statewide Opioid Treatment Program Provider Network in Texas

M15 - A Digital Health App for Opioid Treatment Programs: The Sonara Health Platform for Video Observed Methadone Take-Homes

M15 - A Digital Health App for Opioid Treatment Programs: The Sonara Health Platform for Video Observed Methadone Take-Homes

M5 - Transcutaneous Auricular Neurostimulation (tAN): An Emerging Treatment Strategy to Combat the Opioid Crisis

M5 - Transcutaneous Auricular Neurostimulation (tAN): An Emerging Treatment Strategy to Combat the Opioid Crisis

Submersible voltammetric sensing probe for rapid and extended remote monitoring of opioids in community water systems

The intensifying global opioid crisis, majorly attributed to fentanyl (FT) and its analogs, has necessitated the development of rapid and ultrasensitive remote/on-site FT sensing modalities. However, current approaches for tracking FT exposure through wastewater-based epidemiology (WBE) are unadaptable, time-consuming, and require trained professionals. Toward developing an extended in situ wastewater opioid monitoring system, we have developed a screen-printed electrochemical FT sensor and integrated it with a customized submersible remote sensing probe. The sensor composition and design have been optimized to address the challenges for extended in situ FT monitoring. Specifically, ZIF-8 metal–organic framework (MOF)-derived mesoporous carbon (MPC) nanoparticles (NPs) are incorporated in the screen-printed carbon electrode (SPCE) transducer to improve FT accumulation and its electrocatalytic oxidation. A rapid (10 s) and sensitive square wave voltammetric (SWV) FT detection down to 9.9 µgL−1 is thus achieved in aqueous buffer solution. A protective mixed-matrix membrane (MMM) has been optimized as the anti-fouling sensor coating to mitigate electrode passivation by FT oxidation products and enable long-term, intermittent FT monitoring. The unique MMM, comprising an insulating polyvinyl chloride (PVC) matrix and carboxyl-functionalized multi-walled carbon nanotubes (CNT-COOH) as semiconductive fillers, yielded highly stable FT sensor operation (> 95% normalized response) up to 10 h in domestic wastewater, and up to 4 h in untreated river water. This sensing platform enables wireless data acquisition on a smartphone via Bluetooth. Such effective remote operation of submersible opioid sensing probes could enable stricter surveillance of community water systems toward timely alerts, countermeasures, and legal enforcement.Graphical abstract

Ten Priorities for Research Addressing the Intersections of Brain Injury, Mental Health and Addictions: A Stakeholder-Driven Priority-Setting Study.

The purpose of this study was to engage key stakeholders in a health research priority-setting process to identify, prioritize and produce a community-driven list of research questions addressing intersectional issues on mental health and addictions (MHA) in acquired brain injury (ABI). A multiphasic health research priority-setting process was co-designed and executed with community-based stakeholders, including researchers, health professionals, clinicians, service providers, representatives from brain injury associations, policy makers and people with lived experience of ABI and MHA, including patients and their family members. Stakeholders' ideas led to the generation of research questions, which were prioritized at a 1-day workshop. Fifty-nine stakeholders participated in the priority-setting activity during the workshop, which resulted in a rank-ordered list of the top 10 questions for research addressing the intersections of ABI and MHA. Questions identified touched on several pressing issues (e.g., opioid crisis, homelessness), encompassed multiple subtypes of ABI (e.g., hypoxic-ischaemic, mild traumatic), and involved different domains (e.g., identification, intervention) of health research. This community-driven health research priority-setting study identified and prioritized research questions addressing the intersections of ABI and MHA. Researchers and funding agencies should use this list to inform their agendas and address stakeholders' most urgent needs, fostering meaningful improvements to clinical services. An 11-person working group comprised of people with lived experience, service providers, researchers, healthcare professionals and other key stakeholders collaboratively developed and informed the scope, design, methodology and interpretation of this study. Over 50 community-based stakeholders contributed to the research priority-setting activity. One co-author is a person with lived experience.

Outpatient-Based Opioid Treatment Engagement and Attendance: A Prospective Cohort Study of Homeless-Experienced Adults.

The opioid overdose epidemic disproportionately impacts people experiencing homelessness. Outpatient-based opioid treatment (OBOT) programs have been established in homeless health care settings across the USA, but little is known about the success of these programs in engaging and retaining this highly marginalized patient population in addiction care. To evaluate predictors of initial engagement and subsequent attendance in a homeless-tailored OBOT program. Prospective cohort study with 4months of follow-up. A total of 148 homeless-experienced adults (≥18years) who newly enrolled in the Boston Healthcare for the Homeless Program (BHCHP) OBOT program over a 1-year period (1/6/2022-1/5/2023). The primary outcomes were (1) initial OBOT program engagement, defined as having ≥2 additional OBOT visits within 1month of OBOT enrollment, and (2) subsequent OBOT program attendance, measured monthly from months 2 to 4 of follow-up. The average age was 41.7years (SD 10.2); 23.6% were female, 35.8% were Hispanic, 12.8% were non-Hispanic Black, and 43.9% were non-Hispanic White. Over one-half (57.4%) were initially engaged. OBOT program attendances during months 2, 3, and 4 were 60.8%, 50.0%, and 41.2%, respectively. One-quarter (24.3%) were initially engaged and then attended the OBOT program every month during the follow-up period. Participants in housing or residential treatment programs (vs. unhoused; adjusted odds ratios (aORs) = 2.52; 95% CI = 1.17-5.44) and those who were already on or initiated a medication for opioid use disorder (OUD) (aOR = 6.53; 95% CI = 1.62-26.25) at the time of OBOT enrollment had higher odds of engagement. Older age (aOR = 1.74 per 10-year increment; 95% CI = 1.28-2.38) and initial engagement (aOR = 3.50; 95% CI = 1.86-6.59) conferred higher odds of attendance. In this study, over half initially engaged with the OBOT program, with initial engagement emerging as a strong predictor of subsequent OBOT program attendance. Interventions aimed at enhancing initial OBOT program engagement, including those focused on housing and buprenorphine initiation, may improve longer-term outcomes in this marginalized population.

Adapting the Opening Minds Stigma Scale for Healthcare Providers to Measure Opioid-Related Stigma.

The opioid crisis in Canada continues to cause a devastating number of deaths. Community-based naloxone programs have been identified as one of the solutions for combatting this crisis; however, there are disparities in which pharmacies stock and offer naloxone. Opioid-related stigma is a major barrier for limited naloxone distribution through pharmacies. Therefore, the development of anti-stigma interventions is crucial to improve naloxone distribution in Canada. However, there is no validated tool to specifically measure opioid-related stigma. The Opening Minds Stigma Scale for Healthcare Providers (OMS-HC) is a validated scale used to measure mental illness-related stigma. This study will adapt the OMS-HC by using four different opioid-related terminologies to determine which is the most stigmatizing to use in an opioid-related anti-stigma intervention. Pharmacy students completed four versions of the adapted OMS-HC. The average OMS-HC scores and Cronbach's α co-efficient were calculated for each version. The term "opioid addiction" was found to be the most stigmatizing term among participants and will be used in the adapted version of the OMS-HC in a future anti-stigma interventions.