Use Of Opioid Pain Relievers Research Articles

Evaluating preferences for medication formulation and treatment model among people who use opioids non-medically: A web-based cross-sectional study

IntroductionOver the past decade, treatment for opioid use disorder has expanded to include long-acting injectable and implantable formulations of medication for opioid use disorder (MOUD), and integrated treatment models systematically addressing both behavioral and physical health. Patient preference for these treatment options has been underexplored. Gathering data on OUD treatment preferences is critical to guide the development of patient-centered treatment for OUD. This cross-sectional study assessed preferences for long-acting MOUD and integrated treatment using an online survey. MethodsAn online Qualtrics survey assessed preferences for MOUD formulation and integrated treatment models. The study recruited participants (n = 851) in October and November 2019 through advertisements or posts on Facebook, Google AdWords, Reddit, and Amazon Mechanical Turk (mTurk). Eligible participants scored a two or higher on the opioid pain reliever or heroin scales of the Tobacco, Alcohol Prescription Medication and other Substance Use (TAPS) Tool. Structured survey items obtained patient preference for MOUD formulation and treatment model. Using stated preference methods, the study assessed preference via comparison of preferred options for MOUD and treatment model. ResultsIn the past year, 824 (96.8 %) participants reported non-prescribed use of opioid pain relievers (mean TAPS score = 2.72, SD = 0.46) and 552 (64.9 %) reported heroin or fentanyl use (mean TAPS score = 2.73, SD = 0.51). Seventy-four percent of participants (n = 631) reported currently or previously receiving OUD treatment, with 407 (48.4 %) receiving MOUD. When asked about preferences for type of MOUD formulation, 452 (53.1 %) preferred a daily oral formulation, 115 (13.5 %) preferred an implant, 114 (13.4 %) preferred a monthly injection and 95 (11.2 %) preferred a weekly injection. Approximately 8.8 % (n = 75) would not consider MOUD regardless of formulation. The majority of participants (65.2 %, n = 555) preferred receiving treatment in a specialized substance use treatment program distinct from their medical care, compared with receiving care in an integrated model (n = 296, 34.8 %). ConclusionsThough most participants expressed willingness to try long-acting MOUD formulations, the majority preferred short-acting formulations. Likewise, the majority preferred non-integrated treatment in specialty substance use settings. Reasons for these preferences provide insight on developing effective educational tools for patients and suggesting targets for intervention to develop a more acceptable treatment system.

Association between pain and e-cigarette use stratified by cigarette smoking status: Results from National Health Interview Survey (NHIS) 2019–2020

IntroductionPrevious studies have shown frequent co-morbidities between pain and tobacco use. However, the investigation in use of e-cigarettes, a relatively new tobacco product, at the intersection of pain and cigarette smoking is still lacking. This study used a US national dataset to examine associations between pain experience (pain lasting 3 months) and e-cigarette use, stratified by cigarette smoking status. MethodsThis study used a pooled dataset of the 2019 and 2020 National Health Interview Survey (NHIS) (N = 63,565). We estimated multivariable binomial logistic regressions predicting current e-cigarette use by pain experience, after controlling for survey year, age, sex, race/ethnicity, sexual orientation, education level, health insurance status, other tobacco use, diagnosis of anxiety and depression, use of pain management methods (e.g., physical therapy, behavioral therapy), and prescribed opioid pain reliever use among the overall population, and stratified by cigarette smoking status – never, former, and current cigarette smoking. ResultsAfter controlling for covariates, past-3-month pain experience was associated with current e-cigarette use (aOR = 1.26; 95 % CI = 1.08, 1.46) in the overall population. When stratified by current cigarette smoking, pain experience was associated with current e-cigarette use among current combustible cigarette smokers (aOR = 1.62, 95 % CI = 1.20, 2.18). However, there was no significant difference in e-cigarette use by pain experience among non-current cigarette smokers (p = 0.103). ConclusionsWe observed a higher likelihood of e-cigarette use among US adults experiencing pain. Future studies are needed to investigate mechanisms linking pain and e-cigarette use to inform smoking/vaping prevention and cessation interventions.

Evaluation of drug-drug interactions in hospitalized patients at Sociedad Española de Beneficencia

Background: drug-drug interactions are a frequent cause of adverse drug reactions, the use of more than 5 drugs is significantly related to serious interactions. Comorbidities in patients have precipitated the frequency of polypharmacy, which produces an enhanced incidence of morbidity and mortality, hospital stay and costs. Materials and methods: 50 records of hospitalized patients were analyzed in the period from May to July 2019, a search for drug interactions was carried out with the help of Medscape Drug-Interactions Checker and the Drugs Interactions Checker. Results: 68% of the records presented at least one pharmacological interaction, the majority associated with musculoskeletal pathology and abdominal pain syndrome (45 and 29%, respectively). On the other hand, 48% of the interactions were related to the use of non-steroidal anti-inflammatory drugs and the use of opioid pain relievers combined with sedatives or anesthetics. Conclusions: there is a significant incidence in drug interactions, most of them related to poor pain management, however, it is essential to know the pathophysiology of each patient's disease, and to understand that the benefit must be greater than the risk when indicating the best therapy for the patient.

The North American Opioid Epidemic.

The culmination of the widespread overprescription of opioids, a resurgence of heroin use, and increased accessibility and use of illicit synthetic opioids is commonly referred to as the opioid epidemic in North America. This article is not intended to provide a comprehensive systematic literature review, but rather summarized recent publications and online governmental reports and datasets for English-written literature primarily published between January 1, 2015 and July 1, 2020. In both the United States and Canada, opioids represent one of the most widely prescribed classes of medications. According to the US Centers for Disease Control and Prevention (CDC), an unprecedented increase in the use of opioid pain relievers has led to one of the worst drug overdose epidemics in US history and continues to be an ongoing major public health crisis based on recent Centers for Disease Control and Prevention mortality data, where almost two-thirds of all overdose deaths still involve opioids, including heroin and illicit opioids. In addition to the high mortality rates in both the United States and Canada, there has also been an increase in emergency department visits for nonmedical use of opioid pain relievers, along with additional individuals seeking treatment for opioid addiction, and a rise in neonatal abstinence syndrome. This article highlights the history, underlying issues, ongoing national regulatory efforts, and future strategies and therapies to help mitigate the opioid crisis in North America.

Vital Signs: Prescription Opioid Pain Reliever Use During Pregnancy — 34 U.S. Jurisdictions, 2019

Prescription opioid use during pregnancy has been associated with poor outcomes for mothers and infants. Studies using administrative data have estimated that 14%-22% of women filled a prescription for opioids during pregnancy; however, data on self-reported prescription opioid use during pregnancy are limited. CDC analyzed 2019 data from the Pregnancy Risk Assessment Monitoring System (PRAMS) survey in 32 jurisdictions and maternal and infant health surveys in two additional jurisdictions not participating in PRAMS to estimate self-reported prescription opioid pain reliever (prescription opioid) use during pregnancy overall and by maternal characteristics among women with a recent live birth. This study describes source of prescription opioids, reasons for use, want or need to cut down or stop use, and receipt of health care provider counseling on how use during pregnancy can affect an infant. An estimated 6.6% of respondents reported prescription opioid use during pregnancy. Among these women, 21.2% reported misuse (a source other than a health care provider or a reason for use other than pain), 27.1% indicated wanting or needing to cut down or stop using, and 68.1% received counseling from a provider on how prescription opioid use during pregnancy could affect an infant. Among respondents reporting opioid use during pregnancy, most indicated receiving prescription opioids from a health care provider and using for pain reasons; however, answers from one in five women indicated misuse. Improved screening for opioid misuse and treatment of opioid use disorder in pregnant patients might prevent adverse outcomes. Implementation of public health strategies (e.g., improving state prescription drug monitoring program use and enhancing provider training) can support delivery of evidence-based care for pregnant women.

Illicit opioid use following changes in opioids prescribed for chronic non-cancer pain

BackgroundAfter decades of increased opioid pain reliever prescribing, providers are rapidly reducing prescribing. We hypothesized that reduced access to prescribed opioid pain relievers among patients previously reliant upon opioid pain relievers would result in increased illicit opioid use.Methods and findingsWe conducted a retrospective cohort study among 602 publicly insured primary care patients who had been prescribed opioids for chronic non-cancer pain for at least three consecutive months in San Francisco, recruited through convenience sampling. We conducted a historical reconstruction interview and medical chart abstraction focused on illicit substance use and opioid pain reliever prescriptions, respectively, from 2012 through the interview date in 2017–2018. We used a nested-cohort design, in which patients were classified, based on opioid pain reliever dose change, into a series of nested cohorts starting with each follow-up quarter. Using continuation-ratio models, we estimated associations between opioid prescription discontinuation or 30% increase or decrease in dose, relative to no change, and subsequent frequency of heroin and non-prescribed opioid pain reliever use, separately. Models controlled for demographics, clinical and behavioral characteristics, and past use of heroin or non-prescribed opioid pain relievers. A total of 56,372 and 56,484 participant-quarter observations were included from the 597 and 598 participants available for analyses of heroin and non-prescribed opioid pain reliever outcomes, respectively. Participants discontinued from prescribed opioids were more likely to use heroin (Adjusted Odds Ratio (AOR) = 1.57, 95% CI: 1.25–1.97) and non-prescribed opioid pain relievers (AOR = 1.75, 1.45–2.11) more frequently in subsequent quarters compared to participants with unchanged opioid prescriptions. Participants whose opioid pain reliever dose increased were more likely to use heroin more frequently (AOR = 1.67, 1.32–2.12). Results held throughout sensitivity analyses. The main limitations were the observational nature of results and limited generalizability beyond safety-net settings.ConclusionsDiscontinuation of prescribed opioid pain relievers was associated with more frequent non-prescribed opioid pain reliever and heroin use; increased dose was also associated with more frequent heroin use. Clinicians should be aware of these risks in determining pain management approaches.

Use and Misuse of Opioid Pain Medications by Pregnant and Nonpregnant Women

BackgroundThe use and misuse of opioid pain medication is a public health problem that has extended to pregnant women. Assessing both the use and misuse of opioid pain medication had been limited. AimsThe aim of the present study was to disseminate data from a national sample of pregnant and nonpregnant women, tracking the rate and predictors of opioid use and misuse. MethodsIn 2015 the National Survey on Drug Use and Health expanded the assessment of opioid pain reliever use and misuse. Here, a secondary analysis of 2 years of National Survey on Drug Use and Health expanded data assesses the use and misuse of opioids in pregnant and nonpregnant women ranging in age from 18 to 44 years (N = 46,229). ResultsOpioid medication use was reported by 31.89% of pregnant women and 38.87% of nonpregnant women. Race and pregnancy status were associated with risk, with pregnancy being protective and White women having significantly higher risk. ConclusionsThe high rates of use and misuse of opioids in pregnant women underscores a critical need for screening for opioid use and misuse, particularly among White women. Pregnancy provides a unique window of opportunity to educate, screen, and provide treatment.

MP05-07 PROSPECTIVE IMPLEMENTATION OF A NON-OPIOID (NOP) PROTOCOL FOR PATIENTS UNDERGOING ROBOT-ASSISTED RADICAL CYSTECTOMY

INTRODUCTION AND OBJECTIVES:Drug overdose have become the leading cause of death in Americans under 50 years old, and the use of opioid pain relievers accounts for approximately half of opioid-over...

Trends in insurance coverage and treatment among persons with opioid use disorders following the Affordable Care Act

PurposeThis short communication examines the impact of the Patient Protection and Affordable Care Act (PPACA) on insurance coverage and substance use treatment access among persons with opioid use disorders. MethodsData came from the 2010–2015 National Surveys on Drug Use and Health. Among persons with heroin and opioid pain-reliever use disorders, measures of insurance coverage and treatment access were compared before and after the implementation of major PPACA provisions that expanded access to insurance in 2014. ResultsThe prevalence of uninsured persons among those with heroin use disorders declined dramatically following PPACA implementation (OR 0.59, 95% CI 0.39–0.89), largely due to an increase in the prevalence of Medicaid coverage (OR 1.96, 95% CI 1.21–3.18). There was no evidence of an increase in the prevalence of treatment, but among persons who received treatment, there was an increase in the proportion whose treatment was paid for by insurance (OR 3.75, 95% CI 2.13–3.18). By contrast, there was no evidence the uninsured rate declined among persons with pain-reliever use disorders. ConclusionsThe PPACA Medicaid expansion increased insurance coverage among persons with heroin use disorders, and likely plays an essential role in protecting the health and financial security of this high-risk group. More research is needed on the relationship between insurance acquisition and utilization of substance use treatment.

A New Option for Management of Neonatal Abstinence Syndrome

In the U.S., the use of opioid pain relievers during pregnancy continues to rise. This has contributed to an increased incidence of neonatal abstinence

The Biopsychosocial Model of Low Back Pain and Patient-Centered Outcomes Following Lumbar Fusion.

Lumbar fusion is a surgical procedure performed to eliminate painful motion in a spinal segment by joining, or fusing, two or more vertebrae. Although the surgery has a high rate of producing radiographic fusion, many patients report pain, functional disability, an inability to return to work, and prolonged opioid pain reliever use following the procedure. Using the biopsychosocial model of low back pain as a framework, this review of the literature describes the biological, psychological, and social factors that have been associated with these negative outcomes. The findings suggest that at least some of the variability in postoperative outcomes may be due to preoperative patient characteristics, and evidence the theorized relationship between biopsychosocial factors and low back disability. The review also highlights a gap in the literature regarding biopsychosocial predictors of prolonged opioid use following lumbar fusion.

Safe Storage of Opioid Pain Relievers Among Adults Living in Households With Children.

To describe safe storage practices and beliefs among adults who have used a prescription opioid pain reliever (OPR) in the past year; to compare practices and beliefs among those living with younger (<7 years) versus older children (7-17 years). A survey was administered to a nationally representative sample of adults reporting OPR use in the previous 12 months and who had children <18 years old living with them. We used Health Belief Model-derived items to measure beliefs. Safe storage was defined as locked or latched for younger children and as locked for older children. Regression models examined the association between beliefs and safe storage practices. Among 681 adults who completed our survey and reported having children in their home, safe storage was reported by 32.6% (95% confidence interval [CI], 21.4-43.8) of those with only young children, 11.7% (95% CI, 7.2-16.2) among those with only older children, and 29.0% (95% CI, 18.3-39.8) among those with children in both age groups. Among those asked to answer survey questions thinking about only their oldest child, the odds of reporting safe storage decreased by half as perceived barriers increased (0.505; 95% CI, 0.369-0.692), increased twofold as efficacy increased (2.112; 95% CI, 1.390-3.210), and increased (1.728; 95% CI, 1.374-2.174) as worry increased. OPRs are stored unsafely in many households with children. Educational messages should address perceived barriers related to safe storage while emphasizing how it may reduce OPR access among children.

Who's to Blame for the Opiod Overdose Epidemic?

The use of opioid pain relievers was much lower before the withdrawal of Vioxx and Bextra from the market by Merck and Pfizer respectively. Numerous studies showed that the pain relief provided by these drugs was equal or superior to opiate medications for many conditions from sprain/strains to post-operative pain. From a surgical prospective, the cyclo-oxygenase-2 inhibitors offer a unique option to relieve pain and have no increased risk of bleeding due to lack of platelet inhibition characteristic of other NSAID's. Their addictive potential is zero. The Cox-2 drugs are still available in Celebrex and Arcoxia (the later not available in the US but in sixty other countries), but circumstances of fear generated from the market withdrawal of the first two medications noted above has greatly decreased their use as pain and anti-inflammatory drugs.

Nonmedical Opioid Pain Relievers and All-Cause Mortality: A 27-Year Follow-Up From the Epidemiologic Catchment Area Study.

We investigated whether nonmedical opioid pain reliever use is associated with higher mortality in the general US population. We assessed the history of nonmedical opioid pain reliever use among 9985 people interviewed at baseline of the Epidemiologic Catchment Area Program initiated in 1981 to 1983 in Baltimore, Maryland; St. Louis, Missouri; and Durham, North Carolina. We linked the data with the National Death Index through 2007. Nonmedical opioid pain reliever use was 1.4%. Compared with no nonmedical drug use, mortality was increased for nonmedical opioid pain reliever use (hazard ratio [HR] = 1.60; 95% confidence interval [CI] = 1.01, 2.53) or nonmedical use of other drugs (HR = 1.31; 95% CI = 1.07, 1.62). Mortality was also higher for males and for those beginning nonmedical opioid pain reliever use before aged 15 years. A history of nonmedical opioid pain reliever use was associated with increased mortality, in particular for males and early onset users.

Understanding Americans' views on opioid pain reliever abuse.

Opioid pain reliever abuse rates have increased sharply in the United States. This study examines Americans' personal experience with opioid pain reliever use and abuse, and views about the seriousness of the problem, factors causing it, responsibility for addressing it and support for policies to resolve it. Public opinion survey. A nationally representative US adult sample (n = 1111). Experiences with opioid pain relievers and views about the seriousness, causes of and responsibility for addressing the problem, and support for policies to reduce opioid pain reliever abuse. 28.2 per cent of Americans reported using opioid pain relievers in the last 12 months, 69.5% have used them in their life-time and 17.3% reported using these medications when not prescribed to them. Fifty-eight per cent ranked the problem as serious, on a par with other major health concerns. Individual-orientated factors, including a lack of understanding about how easy it is to become addicted (80.0%) and improper storage (65.1%) and disposal (64.1%), ranked highest as causes, and those abusing opioid pain relievers (83.8%) and their physicians (78.0%) were viewed as most responsible for solving the problem. Of the policies recommended to curb the epidemic, 14 of 16 were supported by a majority of Americans. Americans view the problem of opioid pain reliever abuse as serious, and support nearly all the policies recommended by medical, law enforcement, disease control and public health experts to curb the epidemic.

The Prescription Opioid and Heroin Crisis: A Public Health Approach to an Epidemic of Addiction

Public health authorities have described, with growing alarm, an unprecedented increase in morbidity and mortality associated with use of opioid pain relievers (OPRs). Efforts to address the opioid crisis have focused mainly on reducing nonmedical OPR use. Too often overlooked, however, is the need for preventing and treating opioid addiction, which occurs in both medical and nonmedical OPR users. Overprescribing of OPRs has led to a sharp increase in the prevalence of opioid addiction, which in turn has been associated with a rise in overdose deaths and heroin use. A multifaceted public health approach that utilizes primary, secondary, and tertiary opioid addiction prevention strategies is required to effectively reduce opioid-related morbidity and mortality. We describe the scope of this public health crisis, its historical context, contributing factors, and lines of evidence indicating the role of addiction in exacerbating morbidity and mortality, and we provide a framework for interventions to address the epidemic of opioid addiction.

Polysubstance Abuse: Alcohol, Opioids and Benzodiazepines Require Coordinated Engagement by Society, Patients, and Physicians

The Centers for Disease Control and Prevention (CDC) has published significant data trends related to substance abuse involving opioid pain relievers (OPR), benzodiazepines and alcohol in the United States. The CDC describes opioid misuse and abuse as an epidemic, with the use of OPR surpassing that of illicit drugs. Alcohol has also been a persistent problem and is associated with a number of emergency department visits and deaths independent of other substances. The use of these drugs in combination creates an additive effect with increased central nervous system suppression and a heightened risk of an overdose. We present a summary of the findings from the Morbidity and Mortality Weekly Report (MMWR) with commentary on strategies to combat prescription drug and alcohol abuse.

Heroin use and heroin use risk behaviors among nonmedical users of prescription opioid pain relievers – United States, 2002–2004 and 2008–2010

BackgroundHeroin use and overdose deaths have increased in recent years. Emerging information suggests this is the result of increases in nonmedical use of opioid pain relievers and nonmedical users transitioning to heroin use. Understanding this relationship is critically important for the development of public health interventions. MethodsCombined data from the 2002–2004 National Surveys on Drug Use and Health were compared to the 2008–2010 surveys to examine patterns of heroin use and risk behaviors among past year nonmedical users of opioid pain relievers. ResultsBetween 2002–2004 and 2008–2010, past year heroin use increased among people reporting past year nonmedical use (PYNMU) of opioid pain relievers (p<0.01), but not among those reporting no PYNMU. Frequent nonmedical users – people reporting 100–365 days of PYNMU – had the highest rate of past year heroin use and were at increased risk for ever injecting heroin (aOR 4.3, 95% CI 2.5–7.3) and past year heroin abuse or dependence (aOR 7.8, 95% CI 4.7–12.8) compared to infrequent nonmedical users (1–29 days of PYNMU). In 2008–2010, 82.6% of frequent nonmedical users who used heroin in the past year reported nonmedical use of opioid pain relievers prior to heroin initiation compared to 64.1% in 2002–2004. ConclusionsHeroin use among nonmedical users of opioid pain relievers increased between 2002–2004 and 2008–2010, with most reporting nonmedical use of opioid pain relievers before initiating heroin. Interventions to prevent nonmedical use of these drugs are needed and should focus on high-risk groups such as frequent nonmedical users of opioids.

States Should Take More Responsibility for Reining In Painkiller Abuse

Back to table of contents Previous article Next article Professional NewsFull AccessStates Should Take More Responsibility for Reining In Painkiller AbuseLeslie SinclairLeslie SinclairSearch for more papers by this authorPublished Online:20 Jan 2012https://doi.org/10.1176/pn.47.2.psychnews_47_2_5-bAbstractThe epidemic of prescription painkiller overdose deaths in the United States grew more severe over the last decade, and—as of 2008—was fast approaching the number of deaths from motor-vehicle crashes, the nation’s leading cause of injury death. That’s according to a recent analysis by the Centers for Disease Control and Prevention (CDC), published in the November 4, 2011, Morbidity and Mortality Weekly.The CDC analyzed rates of fatal opioid painkiller overdoses, nonmedical use of the medications, sales, and treatment admissions for the period 1999 to 2008. Rates of nonmedical opioid pain reliever use in the past year by state were obtained from the 2008 to 2009 National Survey on Drug Use and Health (NSDUH). The CDC found that those opioid-related deaths had increased to the point of exceeding deaths involving heroin and cocaine combined. And, they said, the wide variation among states in the nonmedical use of opioid pain relievers and overdose rates they found cannot be explained by underlying demographic differences in state populations. Rather, wide variations in prescribing patterns are more likely to blame.“The proliferation of high-volume prescribers can have a large impact on state use of opioid pain relievers and overdose death rates,” said CDC researchers, who pointed to a spate of illegitimate pain clinics that provide medication to large volumes of patients without adequate evaluation of follow-up (so called “pill mills”) as one contributor to disparities in numbers between states. “Large increases in overdoses involving the types of drugs sold by illegitimate pain clinics have been reported in Florida and Texas,” they said.“Public-health interventions to reduce prescription drug overdose must strike a balance between reducing misuse and abuse and safeguarding legitimate access to treatment, the CDC emphasized, noting that health care providers should only use opioid pain relievers in carefully screened and monitored patients when nonopioid pain treatments have not been sufficient to treat pain, as recommended in published evidence-based guidelines.The CDC tasked states with achieving some level of control over opioid pain prescriptions, saying that state agencies, as regulators of health-care practice, have the responsibility and authority to monitor and correct inappropriate and illegal prescribing.“All interventions need to be evaluated further, and new interventions developed,” said the CDC. “Concerted attempts to address this problem, especially in states with high rates of opioid pain reliever sales, nonmedical use, or overdose mortality, might help control the epidemic.”“Vital Signs: Overdoses of Prescription Opioid Pain Relievers, United States, 1999-2008” is posted at www.cdc.gov/mmwr/preview/mmwrhtml/mm6043a4.htm?s_cid=mm6043a4_w. ISSUES NewArchived