Opioid Dependence Disorder Research Articles

Emergency Admissions and the Prescribing of Buprenorphine, Methadone, and Psychotropic Medications in People with Sickle Cell Disease: An Analysis of National Insurance Claims

Background Although there have been efforts to address overdose risks and treatment gaps in general populations receiving opioids, there is has been little research examining potential drug-related poisoning risks in some of the highest-need and complex populations, including those with sickle cell disease (SCD). Chronic opioid medications are necessary and well-tolerated for the treatment of chronic pain, diffuse inflammation, chronic organ damage, and vaso-occlusive pain crises for people with SCD. Previous studies have found that patients with SCD are not more likely to develop addiction to opioids than the general population. However, amid the ongoing endemic of drug-related poisonings in the U.S., epidemiological data is scarce regarding the clinical characteristics of people who have SCD and physiologic opioid tolerance and dependence. There has been particularly limited work on the intersection of sociodemographic characteristics, substance use, and other mental health conditions in the SCD population. Concern has also been raised about the ongoing opioid epidemic contributing to increased stigma, and greater barriers to the management of acute and chronic pain in SCD. Studies have shown that preoccupation with opioid prescription monitoring hindered the ability of physicians to provide comprehensive SCD care. People with SCD often face more restrictive utilization management policies for opioids than peers with other forms of chronic pain (i.e., cancer-related pain). In order for us to develop better interventions for people with SCD, real-world data is urgently needed to describe the current treatment landscape and identify gaps in care for people with SCD and physiologic opioid dependence or tolerance. Using administrative claims data in the US, we aim to: 1) quantify the burden of hospitalization and emergency room admission for medication-related poisoning events, 2) describe the prevalence of opioid prescriptions, such as buprenorphine and methadone, in people with SCD and physiologic opioid dependence or misuse. Methods In this retrospective cohort study of people with physiologic opioid dependence or opioid use disorder (OUD), we analyzed ten years (1/2006-12/2016) of data from the Merative™ MarketScan® Commercial and Multi-State Medicaid Databases. The predictor variable was SCD (versus a comparator group of people with chronic pain) with diagnoses identified using ICD-9/10 codes. The outcome variables were 1) emergency admissions or hospitalization for non-fatal drug/medication-related poisoning events during enrollment, and 2) prescriptions for buprenorphine, methadone, and other opioids, identified via procedure codes and linked pharmacy records respectively. We used multivariable cox regression to estimate the relationship between SCD diagnosis and time until poisoning events. Multivariable poisson regression models were used to assess the relationship between SCD and buprenorphine, methadone, and other opioid prescriptions. Results Our overall cohort consisted of 25,448 people with ICD9-10 opioid dependence or misuse, including 313 with SCD and 25,135 with non-SCD chronic pain. In the SCD cohort, the median age was 30.8 years, and 82% were enrolled in Medicaid. Compared to the non-SCD chronic pain cohort, the SCD cohort had more hospitalizations or emergency admission for iatrogenic events (37.4% vs 9.8%, aHR=2.21[2.12-2.31]). With regards to medication receipt compared to peers with non-SCD chronic pain, the SCD cohort had a lower prevalence of buprenorphine prescriptions (8% vs 30.1%, aRR=0.20[0.18-0.21]) and a higher prevalence of methadone prescriptions for chronic pain (63.6% vs 6.8%, aRR=5.36[5.21-5.51]) and non-methadone/non-buprenorphine opioid prescriptions (80.5% vs 33.7%, aRR=2.20[2.15-2.25]). Conclusions We observed an elevated rate of emergency admission and/or hospitalization for drug/medication-related poisoning, as well as a significant burden of psychiatric comorbidity in a cohort of people with SCD and physiologic opioid dependence or OUD. The prescribing of potentially safer opioids, such as buprenorphine, was uncommon in the cohort. Further research is urgently needed to optimize opioid treatment strategies, combat stigma, and improve the comprehensive management of pain and co-occurring disorders in the SCD population.

Only 20% of People with Opioid Addiction and Dependence Disorders Receive Evidence-Based Treatments

Only 20% of People with Opioid Addiction and Dependence Disorders Receive Evidence-Based Treatments

Opioid prescription and opioid disorders in burns: A large database analysis from 1990 to 2019

BackgroundOpioids remain crucial in the management of burn pain. A comprehensive analysis of opioid use in burns and their complications has not been investigated. MethodsData were collected from TriNetX, a large multicenter database with de-identified patient information. The population included patients prescribed opioids on or following burn injury from January 1st, 1990, to December 31st, 2019. Opioid prescription use was analyzed after cohort stratification by decades: 1990–1999, 2000–2009, and 2010–2019. Outcomes for opioid-related disorders, opioid dependence, opioid abuse, intentional self-harm, and mental and behavioral disorders from psychoactive substance use were investigated. ResultsHydrocodone was the most frequently prescribed opioid in 1990–1999 and 2000–2009, with oxycodone taking the lead in 2010–2019 (p < 0.0001). During 1990–1999, patients had a decreased risk of recorded opioid-related disorders (RR=0.52), opioid dependence (RR=0.46), opioid abuse (RR=0.55), mental and behavioral disorders (RR=0.88), and intentional self-harm (RR=0.37) when compared to 2000–2009. A comparison of the 2000–2009–2010–2019 cohorts showed an increased risk of recorded opioid-related disorders (RR= 1.91), opioid dependence (RR=1.56), opioid abuse (RR=1.67), mental and behavioral disorders (RR =1.73), and intentional self-harm (RR=2.02). ConclusionsThe risk of opioid-related disorders has nearly doubled since the year 2000 warranting precautions when prescribing pain medications to burn patients.

Oxycodone prescription after inflatable penile prosthesis has risks of persistent use: a TriNetX analysis.

We sought to evaluate the impact of Oxycodone prescriptions on short-term patient outcomes and long-term Oxycodone use following inflatable penile prosthesis (IPP) placement. We queried the TriNetX research database for all adult patients undergoing IPP. Cohorts included opioid naïve patients prescribed postoperative Oxycodone against propensity score-matched patients without a prescription. We compared return visits to the emergency department (ED) within 14 and 90 days of surgery, a diagnosis of opioid abuse or dependence disorder 6 months or later after surgery and persistent Oxycodone use 9-15 months after surgery. After matching, there were 2433 patients in each group. There was an increase in 90-day ED visits based on receipt of Oxycodone (6.8% of patients vs 5.0%, risk ratio (RR) 1.4 95% confidence interval (CI) [1.1, 1.7]). Groups had similar 14-day ED visits (3.7% of patients vs 2.9%, RR 1.3, 95% CI [0.95, 1.7]). Patients prescribed Oxycodone (5.1% of patients vs 2.7%, RR 1.9, 95% CI [1.4, 2.6]) were more likely to have persistent Oxycodone use at 9-15 months. There were low instances of diagnosis of opioid dependence or abuse for both groups limiting comparison. Oxycodone prescription after IPP has risks of persistent use and withholding Oxycodone does not appear to increase postoperative healthcare utilization.

(246) Risk for Prolonged Opioid Usage after Inflatable Penile Prosthesis, A Global Analysis

Abstract Introduction Urologists are not immune from the opioid epidemic. While narcotics still have a role to play in postoperative pain management, examining individual surgeries, such as inflatable penile prosthesis placement (IPP), to identify opportunities to limit opioid use should be a priority. Objective By querying a large, global research network, we sought to evaluate the impact of a narcotic prescription on short term patient outcomes and long-term opioid use following IPP placement. Methods TriNetX is a collaborative research enterprise which collects real-time data from almost 89 million patients located in 58 healthcare organizations across the globe and analyzes patient data from 20 years back to present (2002-2022). We queried TriNetX for all adult patients undergoing IPP. The index event was surgery. Cohorts included patients prescribed oxycodone within 2 days of surgery, tramadol within 2 days of surgery, or one of many frequently prescribed oral opioids (oxycodone, hydrocodone, hydromorphone, oxymorphone or tramadol) within 2 days of surgery. The control cohorts were patients not prescribed a narcotic in the same timeframe. TrinetX identifies prescriptions using RxNorm Concept Unique Identifier, part of the Unified Medical Language System. We also compared patients taking opioids within 6 months to 1 day prior to surgery against “opioid naive” patients. Our short-term outcome was the rate of return visits to the Emergency Department (ED) within 90 days of the index event. Our long-term outcomes were a diagnosis of opioid abuse (ICD-10 F11.1) or dependence (ICD-10 F11.2) disorder 6 months or later after surgery, and we also evaluated persistent opioid use 9 to 15 months after surgery, consistent with previous literature. Propensity score matching (PSM) was performed on potential cofounders: age, race, mental and behavioral disorders, pain disorders, and prior opioid use. The analyses were performed on June 28th, 2022. Results There were 9702 patients who received an IPP (Table 1). Patients considered opioid- or oxycodone naive were less likely to have a diagnosis of opioid dependence or abuse (Relative Risk (RR)=0.51 and RR=0.42) at 6 months. Patients prescribed an opioid postoperatively, or oxycodone or tramadol specifically, were more likely have persistent opioid, oxycodone, or tramadol use (all p&amp;lt;0.05) at 9 to 15 months, except for patients prescribed postoperative tramadol for the outcome of any oral opioid prescription (p=0.75). Patients prescribed any opioid or oxycodone specifically were more likely to have an ED visit (RR=1.5 and 1.3) while patients prescribed tramadol postoperatively showed no difference in ED visits (RR=1.2). There was no significant difference in ED visits based on opioid naivety, while all patients taking preoperative opioids were more likely to continue taking an opioid at 9 to 15 months (all p&amp;lt;0.01). Conclusions The prescription of opioids after IPP has risks of long-term opioid use and prescribing opioids in general may increase healthcare utilization in the short term. Prescribing a partial agonist, such as tramadol, may reduce persistent opioid use while being non-inferior in need to return to the emergency department when compared to oxycodone; however, a non-opioid regimen is preferred to maximally reduce risk. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Coloplast

Assessing the efficacy of antidepressant treatment in opioid-dependent patients undergoing methadone maintenance treatment: A literature review

Introduction. Opioid dependence and co-occurring depressive disorders represent a significant clinical challenge within the field of psychiatry, necessitating effective interventions to improve patient outcomes. Antidepressant treatment has emerged as a potential therapeutic approach, yet its efficacy in the context of Methadone Maintenance Treatment (MMT) remains inconclusive. Methods. To address this critical knowledge gap, a comprehensive literature review was conducted. Databases including PubMed, the National Institutes of Health (NIH), Google Scholar, and Cochrane Drugs and Alcohol Reviews were meticulously searched for relevant publications from January 2010 to June 2022, using targeted keywords (“antidepressants,” “opioid addiction,” “methadone”). Results. The review uncovered a complex landscape of studies, highlighting the challenges in evaluating the efficacy of antidepressant treatment in opioid-dependent individuals receiving MMT. While some investigations have reported modest benefits in alleviating depressive symptoms, others remain inconclusive or contradictory. Desvenlafaxine, a dualaction antidepressant, demonstrated some effectiveness in this population, suggesting a potential treatment option. However, these findings necessitate further exploration through large-scale, complex studies with a focus on diverse patient populations. Discussion. The multifaceted nature of opioid dependence, comorbid depressive disorders, and the complexities of MMT underscore the challenges in ascertaining treatment outcomes definitively. Additionally, the potential for adverse effects and drug interactions, particularly in cases of relapse, complicates the therapeutic landscape. Patients often resort to self-medicating depressive symptoms with other substances, further clouding the interpretation of treatment results. Conclusion. The literature review reveals the need for continued research to elucidate the role of antidepressant treatment in opioid-dependent patients undergoing MMT. As patients’ needs vary widely, a comprehensive approach to managing affective symptoms should encompass not only pharmacotherapy but also various psychotherapeutic and social interventions. By addressing these complexities, future research may pave the way for more tailored and effective treatment strategies, ultimately enhancing the well-being of individuals grappling with the dual burdens of opioid dependence and depressive disorders within the MMT context.

Medicines prescribing for homeless persons: analysis of prescription data from specialist homelessness general practices

BackgroundSpecialist homelessness practices remain the main primary care access point for many persons experiencing homelessness. Prescribing practices are poorly understood in this population.ObjectiveThis study aims to investigate prescribing of medicines to homeless persons who present to specialist homelessness primary care practices and compares the data with the general population.SettingAnalyses of publicly available prescribing and demographics data pertaining to primary care in England.MethodsPrescribing data from 15 specialist homelessness practices in England were extracted for the period 04/2019-03/2020 and compared with data from (a) general populations, (b) the most deprived populations, and (c) the least deprived populations in England.Main outcome measurePrescribing rates, measured as the number of items/1000 population in key disease areas.ResultsData corresponding to 20,572 homeless persons was included. Marked disparity were observed in regards to prescribing rates of drugs for Central Nervous System disorders. For example, prescribing rates were 83-fold (mean (SD) 1296.7(1447.6) vs. 15.7(9.2) p = 0.033) items), and 12-fold (p = 0.018) higher amongst homeless populations for opioid dependence and psychosis disorders respectively compared to the general populations. Differences with populations in the least deprived populations were even higher. Prescribing medicines for other long-term conditions other than mental health and substance misuse was lower in the homeless than in the general population.ConclusionsMost of the prescribing activities in the homeless population relate to mental health conditions and substance misuse. It is possible that other long-term conditions that overlap with homelessness are under-diagnosed and under-managed. Wide variations in data across practices needs investigation.

26 Opioid Prescription in Burns: A Large Database Analysis from 1990 to 2021

IntroductionThe use of opioids in the medical field has contributed to the growing opioid epidemic. Nonetheless, opioids remain imperative in the treatment for pain management in burns. While some studies have addressed the use of opioids in surgery, a comprehensive analysis of the pattern of opioids use in burns has not been investigated. This study aims to identify trends of opioid use and investigate the risk of opioid related disorders in burn patients.MethodsData was obtained from TriNetX, a national research database that provides medical records of de-identified patients. The study population includes patients that were prescribed an opioid, ICD-10 code CN101, on or after any instance of burn between January 1st, 1990 and September 19th, 2021. Patient population was further stratified by the decade in which patients received opioids for pain following burn injury: 1990-1999, 2000-2009, 2010-2019, and 2020-September 19th, 2021. Five outcomes were investigated: opioid related disorders, opioid dependence, opioid abuse, intentional self-harm, and mental and behavioral disorders due to psychoactive substance use. Cohorts were matched for age at index, sex, and race. Statistical analysis used risk ratios with a 95% confidence interval, and p< 0.05 was considered significant.ResultsWe identified 8,421 patients that were prescribed an opioid between 1990-1999, 30,846 patients from 2000-2009, 169,991 patients from 2010-2019, and 30,966 patients from 2020-present. When compared to the 2000s cohorts, the 1990s patients had a 47% decrease in risk of opioid related disorders, with a 53% decrease in risk of opioid dependence, 45% decrease in risk in opioid abuse, 11% decrease in risk of mental and behavioral disorders due to psychoactive substance use, and 63% reduced risk of intentional self-harm.Comparison of the 2000-2009 to 2010-2019 cohorts showed increased risk of opioid related disorders (RR= 1.912), opioid dependence (RR=1.569), opioid abuse (RR=1.677), mental and behavioral disorders (RR =1.733), and intentional self-harm (RR=2.027). When compared to 2020-present, the 2010-2019 patient cohort had 10 times the risk of developing opioid-related disorders, with 3 times the risk for opioid dependence and behavioral disorders, and 5 times the risk for opioid abuse and intentional self-harm.ConclusionsThe risk of opioid related disorders in the 1990s was lower compared to the 2000s. Since 2000, the risk of opioid related disorders has significantly increased. Recognizing the risks of opioid prescriptions in burn patients is imperative when addressing the role of physicians in controlling the constantly growing opioid epidemic.

Indicated Opioids in Pregnancy: Guidance on Providing Comprehensive Care.

In modern obstetric practice, providers will encounter patients for whom opioid use in pregnancy is reasonable or even necessary. A "one-size-fits-all" approach to the counseling and management of such patients is misguided. Understanding indications for ongoing opioid use in pregnancy is essential to patient-centered care. Specifically, recognition of the nuanced differences between opioid dependence and opioid use disorder is crucial for appropriate diagnosis, screening for common concurrent conditions, adequately counseling about individualized maternal and perinatal risks, and accurate documentation of diagnoses and medical decision-making. In this paper, we explore the current typical scenarios in which opioid use in pregnancy may be encountered, ongoing opioid prescribing should be considered, and provide a guide for the obstetric provider to navigate the antepartum, intrapartum, and postpartum periods. KEY POINTS: · Opioid use in pregnant and postpartum individuals is not rare.. · Obstetric providers may elect to assume opioid prescribing.. · Obstetric providers are positioned to optimize outcomes for the mother-infant dyad..

Opioid dependence disorder and comorbid chronic pain: comparison of groups based on patient-attributed direction of the causal relationship between the two conditions.

Background:Chronic pain is highly prevalent in treatment-seeking opioid-dependent patients; therefore, this comorbid presentation is an important clinical consideration for both addiction and pain specialists. The objectives of the present study were to examine whether the direction of causal attribution of opioid dependence disorder and chronic pain resulted in two distinct clinical populations, and, if so, to compare treatment received during the 5-year follow-up period.Methods:Participants comprised opioid-dependent patients with chronic pain who reported a perceived causal relationship, in either direction, between the development of these two conditions (n = 252). A range of health- and addiction-related instruments were used at study inception. Treatment characteristics were obtained for the follow-up period from national health registers.Results:Those reporting that pain caused opioid dependence disorder (n = 174; 69%) were characterised by poorer pain-related health, more illicit cannabinoid use (p = 0.031), more frequent illicit use of opioid analgesics (p = 0.025) and they were in receipt of higher doses of prescribed opioid analgesics. Those reporting that opioid dependence disorder caused pain (n = 78; 31%) were characterised by poorer overall physical health (p = 0.002), more severe psychiatric symptoms and more overall drug use (p = 0.001).Conclusion:Two distinct clinical populations were identified, determined by how participants perceive the causal relationship between opioid dependence disorder and chronic pain. These two populations have differing clinical profiles and treatment requirements: those reporting that pain caused opioid dependence disorder were characterised by poorer pain-related health and more illicit use of drugs with analgesic properties; and those reporting that opioid dependence disorder caused pain were characterised by more overall use of substances, multiple substance use and more intravenous substance use and poorer general health. Identifying the causal direction, where such a relationship exists, could help addiction and pain services to develop more effective, individualised treatment strategies.

Acute Pain Management for Patients with Substance Use Disorder Receiving Buprenorphine or Methadone Compared to Patients without Opioid-Dependence Disorder

This single-center retrospective study assessed pain management between patients being treated for SUD and compared them to those without SUD who underwent orthopedic surgery. Patients with SUD could be admitted for any reason, while the control arm consisted of patients undergoing total knee arthroplasty or hip arthroplasty surgery. Primary endpoints were average pains scores and morphine milligram equivalents (MME) over the first 48h. Secondary endpoints include adjuvant pain medications and the average MME prescribed upon discharge. A total of the 60 patients were enrolled, 30 patients had history of SUD and 30 patients in the control arm. Average MME between the SUD and control was not significantly different (139.9 mg vs. 96.6 mg, p = 0.889). Average pain scores between the groups were significantly different (7.46 vs. 5.94, p = 0.002). Patients with SUD were not given a statistically different amount of MME for acute pain and experienced higher pain scores than patients without SUD. However, this study had a small population size, and further case–control studies are needed to confirm this result.

Effects of Dialectical Behavior Therapy on Emotion Regulation, Distress Tolerance, Craving, and Depression in Patients with Opioid Dependence Disorder

Methadone maintenance treatment (MMT) is a common drug treatment for opioid dependence disorder. This treatment, with positive results, has many physical and psychological complications. The purpose of this study was to evaluate the effectiveness of dialectical behavioral therapy (DBT) on emotional regulation, distress tolerance, craving, and depression in patients under MMT. The present study was a randomized controlled clinical trial with two groups of intervention (MMT with Dialect-Behavioral Therapy (DBT)) and control group (MMT). Initial evaluations were performed by clinical psychiatrist at the clinic. 50 men who referred to the methadone treatment clinic were randomly assigned to two groups of the present study. The research data were collected from demographic information form, Structured Clinical Interview for Axis I Disorders, emotion regulation questionnaire, distress tolerance questionnaire, Instant craving questionnaire, and Beck Depression Inventory in three stages: pre-test, post-test and three-month follow-up. Statistical analysis was performed using Kolmogorov–Smirnov test, Lion test, Chi-square, T-test and repeated measures. The findings showed that MMT + DBT significantly improved emotion regulation and distress tolerance in post-test and 3 months follow-up, and significantly reduced craving and depression. The simultaneous combination of MMT with DBT can be helpful in reducing the psychological problems of opiate dependent people under MMT. Given the emphasis on dialectical behavioral therapy on emotion regulation as the main mechanism of change, this therapy can be a useful treatment for other psychological disorders that are involved with emotional problems.

Global opioid agonist treatment: a review of clinical practices by country.

We assessed how opioid agonist treatment (OAT) for opioid use disorder (OUD), specifically methadone and buprenorphine, including buprenorphine-naloxone, is delivered in routine clinical practice, with a focus on factors that affect access to and delivery of these services. The aims of this review were to summarize eligibility criteria for entry to OAT, doses in routine clinical practice, access to and eligibility for unsupervised dosing and urine drug screening practices in OAT programs globally. We completed searches of PubMed, Embase, and grey literature databases for cross-sectional or observational cohort studies of OAT using either methadone or buprenorphine. Dose data extracted from eligible studies were compared with guidelines provided by WHO. We found 140 reports from 41 countries that contained data for at least one of the relevant indicators. A diagnosis of opioid dependence or opioid use disorder was the most common eligibility requirement for OAT (13 or 17 countries). Reported mean or median doses for methadone ranged from 16-131mg whereas range for buprenorphine was 2.5-19mg. Access to unsupervised dosing under some conditions was reported in 18 of 27 countries. Frequency of regular urine drug screenings (UDS) ranged from several times a week to eight times per year (methadone) or as clinically indicated. Opioid agonist treatment practices, including doses prescribed, vary greatly both within and across countries. Of particular concern is the persistence of lower dose prescribing practices, in which patients may be prescribed doses below those proven to yield significant clinical benefits.

The Adjective Rating Scale for Withdrawal: Validation of its ability to assess severity of prescription opioid misuse.

Withdrawal symptoms have been widely shown to be a useful indicator of the severity of opioid dependence. One of the most used instruments to assess them is the Adjective Rating Scale for Withdrawal (ARSW). However, there is a lack of adaptations and validations for its use with prescription opioids, even less for chronic pain patients under treatment with these analgesics. Thus, the aims of this study were to analyse the psychometric properties and invariance across gender of the ARSW in a sample of chronic noncancer pain patients. Data were collected from 208 consumers of opioid medication, chronic noncancer pain patients. Participants completed sociodemographic, ARSW, prescription opioid dependence (DSM-IV-TR) and prescription opioid-use disorder (DSM-5) measurements. Gender invariance was assessed through multigroup confirmatory factor analysis (CFA). The ARSW showed a unidimensional factor structure and high internal consistency (Cronbach's alpha=0.85). Multigroup CFA showed configural, metric, scalar and strict invariances of ARSW across gender. Predictive validity analyses indicated that ARSW has good capacity for identifying the severity of prescription opioid-use disorder, using both DSM-IV-TR and DSM-5 criteria. These findings show that the ARSW is a valid and reliable tool for use in the assessment of the withdrawal of prescription opioids in chronic pain patients under treatment with these analgesics, regardless of their gender. Findings supported the reliability and validity of the ARSW to assess withdrawal of prescription opioids in individuals with chronic noncancer pain. The instrument can be applied indistinctly in men and women. An increase in the ARSW scores could be used as an indicator of potential risk of prescription opioid-use disorder during long-term treatments.

The effectiveness of different singly administered high doses of buprenorphine in reducing suicidal ideation in acutely depressed people with co-morbid opiate dependence: a randomized, double-blind, clinical trial

BackgroundBuprenorphine is usually administered to treat opioid use disorder and pain syndromes. This research presents the first study regarding the effectiveness of different singly administered high doses of buprenorphine (a partial opioid agonist (of μ-opioid receptors), a potent opioid antagonist (of κ-receptors) and a partial agonist of nociception receptors) in reducing suicidal ideation in acutely depressed people with co-morbid opiate dependence. It follows small studies that suggest that ultra-low-dose buprenorphine may be useful in reducing suicidal ideation. The goal of this study was to describe the outcome of different doses of buprenorphine on suicidal opioid-dependent patients over a 3-day interval, by conducting a randomized clinical trial.MethodsFifty-one suicidal male inpatients who fulfilled the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for both opioid dependence and major depressive disorder were randomized to three groups (n = 17 per group) to receive a single, sublingual dose of buprenorphine (32 mg, 64 mg, or 96 mg). Out of 51 participants, there were 47 patients; 16 (34.04%) received 32 mg, 17 (36.17%) received 64 mg, and 14 (29.78%) received 96 mg of sublingual buprenorphine. They were evaluated by using psychometric assessment of the Beck Scale for Suicidal Ideation (BSSI) and interviews based on DSM-5 criteria. A placebo group was not included because of the high probability of severe withdrawal without active pharmacological treatment. The study was conducted with appropriate precautions and monitoring of respiratory and cardiovascular measures. The medication was administered while the patients were in moderate opiate withdrawal, as indicated by the presence of four to five withdrawal symptoms. A structured clinical interview was conducted, and urine toxicology testing was performed.ResultsPatients completed the 3-day trial course. The outcomes illustrated a significant reduction in BSSI scores within each of the three groups, p < 0.01., but no difference in results between the groups, p = 0.408.ConclusionsThe results suggest that a single high dose of buprenorphine could rapidly treat suicidal ideations. A single high dose of buprenorphine may be a main-mechanism medication that gives a rapid treatment for suicidal opioid-dependent patients. Placebo-controlled trials are required to measure the safety and the physiological and psychological effects of this medication.

Factors predicting opioid dependence in patients undergoing surgery for degenerative spondylolisthesis: analysis from the MarketScan databases.

OBJECTIVE The opioid crisis is identified as a national emergency and epidemic in the United States. The aim of this study was to identify risk factors associated with opioid dependence in patients undergoing surgery for degenerative spondylolisthesis (DS). METHODS The authors queried MarketScan databases to investigate the factors affecting postsurgery opioid use in patients with DS between 2000 and 2012. The outcome of interest was opioid dependence, which was defined as continued opioid use, > 10 opioid prescriptions, or diagnosis of or prescription for opioid dependence disorder in the period of 1 year before or 3-15 months after the procedure. Comparisons of outcomes were performed using nonparametric 2-group tests and generalized regression models. RESULTS A cohort of 10,708 patients was identified from the database. The median patient age was 61 years (interquartile range 54-69 years), and 65.1% were female (n = 6975). A majority of patients had decompression with fusion (n = 10,068; 94%) and underwent multilevel procedures (n = 8123; 75.9%). Of 10,708 patients, 14.85% (n = 1591) were identified as having opioid dependence within 12 months prior to the index surgical procedure and 9.90% (n = 1060) were identified as having opioid dependence within 3-15 months after the procedure. Of all the variables, prior opioid dependence (OR 16.29, 95% CI 14.10-18.81, p < 0.001) and younger age (1-year increase in age: OR 0.972, 95% CI 0.963-0.980, p < 0.001) were independent predictors of opioid dependence following surgery for DS. The use of fusion was not associated with opioid dependence following the procedure (p = 0.8396). Following surgery for DS, patients were more likely to become opioid independent than they were to become opioid dependent (8.54% vs 3.58%, p < 0.001). CONCLUSIONS The majority of patients underwent fusion for DS. Surgical decompression with fusion was not associated with increased risk of postsurgery opioid dependence in patients with DS. Overall, opioid dependence was reduced by 4.96% after surgery for DS. Prior opioid dependence is associated with increased risk and increasing age is associated with decreased risk of opioid dependence following surgery for DS.

Characterizing the Use of Telepsychiatry for Patients with Opioid Use Disorder and Cooccurring Mental Health Disorders in Ontario, Canada.

Rural patients with opioid use disorder (OUD) face a variety of barriers when accessing opioid agonist therapy (OAT) and psychiatric services, due to the limited supply of physicians and the vast geographic area. The telemedicine allows for contact between patients and their physician—regardless of physical distance. Objective. We characterize the usage of telemedicine to deliver psychiatric services to patients with OUD in Ontario, as well as traits of treatment-seeking patients with opioid dependence and concurrent psychiatric disorders. Methodology. A retrospective cohort study was conducted using an administrative database for patients who received psychiatric services via telemedicine between 2008 and 2014 and who also had OUD. Results. We identified 9,077 patients with concurrent opioid use and other mental health disorders who had received psychiatric services via telemedicine from 2008 to 2014; 7,109 (78.3%) patients lived in Southern Ontario and 1,968 (21.7%) in Northern Ontario. Telemedicine was used more frequently to provide mental health services to patients residing in Northern Ontario than Southern Ontario. Conclusion. Telemedicine is increasingly being utilized throughout Ontario for delivering mental health treatment. There is an opportunity to increase access to psychiatric services for patients with opioid dependence and concurrent psychiatric disorders through the use of the telemedicine.

Ultrarapid Influence of Buprenorphine on Major Depression in Opioid-Dependent Patients: A Double Blind, Randomized Clinical Trial

ABSTRACTObjective: To examine the impact of different doses of buprenorphine on depression symptoms in opioid dependent inpatient over a three-day interval, using a randomized clinical trial design (RCT). Design: Patients were randomized and assigned to three groups. Participants: Forty males who were admitted to an inpatient psychiatric unit and who fulfilled the DSM-5 criteria for both opioid dependence and major depressive disorder. Intervention: Patients randomly received 32 mg, 64 mg, or 96 mg of buprenorphine as a single high dose. Out of 40 patients, 11 (27.5%) received 32 mg, 14 (35%) received 64 mg and 15 (37.5%) received 96 mg of buprenorphine. We conducted medical precautional measures, including cardiovascular and respiratory monitoring. Measurements: Depression was measured by the Beck Depression Inventory (BDI). All patients completed the three-day treatment duration. The results showed a significant reduction in depression symptoms within each of the three groups (p = 0.00), although there was no significant difference in depression outcome across the groups (p = 0.90). Conclusions: The results suggest that a single high dose of buprenorphine could provide a safe, simple and speedy means of depression improvement. A single high dose of buprenorphine can be used as medication that supplies a fast and maintained treatment for major depressive disorder in patients who are opioid dependent. Placebo-controlled trials of longer periods and larger sample sizes are needed to test ability and safety, as well as the physiological and psychological impact of extended exposure to this drug.

Tailoring a NICU-Based Tobacco Treatment Program for Mothers Who Are Dependent on Opioids

ObjectiveTo collect formative information to design a tailored tobacco treatment intervention for women with newborns treated or evaluated for neonatal abstinence syndrome and to explore current tobacco use behaviors and facilitators and barriers to smoking cessation. DesignQualitative descriptive study. SettingAn academic medical center in the southern United States. ParticipantsMothers (N = 11) of newborns who were treated or evaluated for neonatal abstinence syndrome at birth within the preceding 3 months. Women recruited were older than 18 years and reported opioid dependence and smoking during pregnancy. MethodsParticipants took part in semistructured individual interviews that lasted approximately 1 hour. Interviews were professionally transcribed and analyzed in MAXQDA using content analysis. ResultsFive themes emerged from the data: Strategizing to Reduce Risk, Desire to Quit Smoking in the Future, Holding on to Smoking While Working Through Recovery, Feeling Judged by Nurses, and Feeling Supported and Empowered by Nurses. Participants reported that they to reduce risk to their newborns by avoiding second- and thirdhand smoke exposure. Participants wanted to stop smoking but reported many barriers, including multiple life stressors compounded by their newborns' extended stays in the hospital. However, most participants described overall positive experiences and the support of health care providers. ConclusionHolistic tobacco treatment programs that incorporate stress relief and social support and are led by trusted health care providers have the potential to be effective to reduce smoking in new mothers with histories of opioid dependence disorders and smoking and whose newborns are in the NICU.

Pain, Opioid Addiction Addressed Simultaneously in Special Clinic

Back to table of contents Previous article Professional NewsFull AccessPain, Opioid Addiction Addressed Simultaneously in Special ClinicAaron LevinAaron LevinSearch for more papers by this authorPublished Online:19 May 2016https://doi.org/10.1176/appi.pn.2016.5b10AbstractUniversity of Colorado addictions specialists want to integrate better care for patients and better training for colleagues into the clinic.“We need to train our way out of the opioid crisis,” said Kaylin Klie, M.D., M.A., at the American Society of Addiction Medicine’s annual conference in April in Baltimore.The use of opioid medications—most often prescribed in primary care—has risen sharply in recent years, despite a lack of evidence for their efficacy for noncancer pain, noted Klie, an instructor in psychiatry at the University of Colorado School of Medicine in Aurora. In 2014, 19,000 Americans died from overdoses of prescription opioids.Denizens of separate medical silos traditionally have had a hard time crossing professional boundaries, said Klie.“Addiction providers are uncomfortable treating pain; pain management providers are uncomfortable treating addiction; and primary care people are uncomfortable treating either,” she said.The University of Colorado has tackled that problem by establishing a Controlled Substance Clinic (CSC) within its Family Medicine primary care clinic.The CSC was set up under the direction of Patricia Pade, M.D., an assistant professor of family medicine and the program director of the University of Colorado Addiction Medicine Fellowship. Pade was formerly director of the Co-occurring Disorders Clinic at the New Mexico Veterans Administration Health Care System, and the Colorado clinic is modeled on that experience. Fellows from the Addiction Medicine Fellowship take part as well, both treating patients and working to educate their primary care colleagues.The clinic evaluates, treats, manages, and monitors comorbid pain and addiction, focusing on high-risk opioid patients, said Klie. “High-risk” includes younger patients and individuals with a family or personal history of substance use disorder or with a comorbid psychiatric disorder.“We treat both chronic pain and addiction at the same time,” she said. “We tell them that chronic opioid therapy has never been shown to be successful over a lifetime. We take an hour for the initial intake visit, but we’ve found that it’s rare to assess opioid dependence or substance use disorder in one visit. Building trust between patient and provider over time helps as they taper off opioids.” Patients worry that if they enter addiction treatment, their pain will not be addressed. So work often begins by dealing with pain to lessen the patient’s fear of losing medication. Treatment may include using drugs and behavioral therapy for pain to reduce opioid use. Patients can move in either direction between primary and addictions care. The CSC providers are available for immediate consultation from their primary care colleagues, who develop a better sense of pain and addiction as true medical conditions, lessening stigma. It also means that every patient has a primary care physician, allowing treatment of the whole patient.“Patients with co-occurring chronic pain and opioid dependence can be successfully treated in a primary care setting,” said Klie. “Buprenorphine or naloxone can be successfully used with adjunctive treatments available to primary care providers.”Following treatment, pain scores drop on average for these patients. Furthermore, about 77 percent remain in treatment, about half in primary care and the rest in the CSC.Most of the behavioral health care is provided by two psychologists on the team. Psychiatrist Laura Martin, M.D., an associate professor of psychiatry at the University of Colorado School of Medicine, is co-director of the fellowship and connects any patients with serious mental illnesses, such as personality disorders or schizophrenia, to a psychiatrist.Klie sees her clinic as a step toward future modes of expanding treatment.“The meat and potatoes of medicine come in training,” she said. “We can train ourselves, our patients, and the upcoming generation of physicians while we show that patients can be cared for without antagonizing their doctors.” ■ ISSUES NewArchived