Opioid Use Research Articles

Challenging public stigma: the impact of a statewide social media campaign to reduce opioid use disorder stigma

Background Opioid-related stigma can affect the health and recovery of individuals with opioid use disorder (OUD). As such, campaigns to reduce stigma are needed. We evaluated Life Unites Us (LUU), a comprehensive social media campaign to reduce public stigma of opioids and those who use them, 12 months after campaign launch. Methods A cross-sectional web survey of 1,045 people was used to assess differences in public stigma by exposure to LUU. Survey items focused on public OUD stigma and were divided into three subscales: desire for social distance, treatment availability and effectiveness, and general attitudes. Results Controlling for relevant covariates (i.e. gender, political ideology, education level, race), individuals exposed to LUU endorsed less stigma in the desire for social distance and treatment subscales. There were no significant differences in stigma for the general attitudes subscale. Those who identified as more politically conservative held more stigma across all subscales than those who identified as less politically conservative. Females reported less treatment and general OUD stigma than males. Conclusions Findings suggest that comprehensive social media campaigns that foster connections, educate the public, and advocate for community-level change may positively influence public attitudes toward individuals with OUD and create a more supportive environment for recovery.

Metro/Nonmetro Migration as a Risk Factor for Opioid Use Disorder Among Older Medicare Beneficiaries: A Longitudinal Analysis of 2013-2018 Data.

Opioid use disorder (OUD) among older adults (65+) has drawn researchers' attention. Nonetheless, whether migration between a metropolitan (metro) and nonmetropolitan (nonmetro) county shapes the risk of OUD remains underexplored. The drift hypothesis argues that individuals susceptible to a certain health condition tend to move, increasing the prevalence of the health condition in the destinations. By contrast, the environmental breeder hypothesis claims that migration alters the exposures to residential environment factors, which are associated with the occurrence of health conditions. Applying fixed-effects modeling to longitudinal data of older Medicare beneficiaries moving at least once between 2013 and 2018 (N = 6,227, person-year = 28,874), this study finds that older beneficiaries moving between metro and nonmetro counties demonstrated a higher risk of OUD than those who did not move. The positive association between migration and OUD risk is particularly strong for those moving from metro to nonmetro counties and the drift hypothesis receives stronger support.

Combatting opioid misuse, overuse and abuse: a systematic review of pharmacists' services and outcomes.

Aim: To examine the range of services pharmacists provide and their impact on patient outcomes, harm reduction, and appropriate opioid use.Methods: Six databases were searched (MEDLINE, EMBASE, Scopus, PsycINFO, CENTRAL and Cochrane Methodology Register) from inception to March 2023. The protocol was registered in PROSPERO (CRD42023401895).Results: Twenty-nine studies identified five key areas of pharmacist interventions in opioid management-naloxone programs and opioid de-escalation, patient and primary healthcare providers' education and motivational interview, prescription monitoring and opioid risk screening, clinical pharmacy interventions (pharmacotherapy, medication review, prescribing, adherence monitoring), and collaborative healthcare approaches to promote optimal opioid use. Outcomes assessment indicated harm reduction, improved safety, increased non-opioid analgesic use, decreased opioid consumption, and enhanced pain management.Conclusion: This review underscores pharmacists' vital role in tackling opioid misuse, overuse and abuse, providing a foundation for evidence-based policies to minimize harm and promote optimal opioid use.

A Study on Tapentadol Misuse and Abuse among Heroin Users Attending a Deaddiction Center in Kashmir

Abstract Background: Tapentadol is a powerful opioid receptor agonist and a norepinephrine reuptake inhibitor, making it a centrally acting analgesic. In India, where the government is trying to combat an ongoing opioid crisis, the lack of scheduling of tapentadol creates an easy opportunity for its misuse. We aim to analyze the demographic and clinical characteristics of heroin users who also abuse tapentadol concurrently through our cross-sectional study done at the drug-deaddiction center situated at the community center of SMHS Hospital, Srinagar, Kashmir. Material and Methods: It was a cross-sectional study done at the Community Centre of SMHS hospital Srinagar, which houses the drug deaddiction centre run by the Psychiatry Department of GMC(Government Medical College) Srinagar. From 1st June 2023 until 30th November 2023, we gathered data for our investigation. After gaining informed consent, all the first-time heroin-dependent patients at the deaddiction facility who admitted to using tapentadol were included in the study. Patients’ age, sex, marital status, family composition, and level of education were analysed in accordance with a predefined proforma. In addition, the modified Kuppuswamy scale was used to categorise patients based on their socioeconomic status. Parameters such as the pattern of tapentadol use, the route of heroin use, and the comparison of the psychoactive effects of tapentadol and heroin were recorded using a proforma to create a clinical profile of such patients. Results: Our sample comprised 100 participants. The prevalence of tapentadol abuse among heroin users in our study came out to be 16%. The average age of our study participants was 25.11 ± 2.99 years. The vast majority of our patients were male (97%). The vast majority (58%) of our participants were from lower socioeconomic status. Ninety-eight percent of our subjects used oral tapentadol while there were 2 (2%) instances of intravenous tapentadol use. The majority of participants used the “Tapal” brand (60%). Tapentadol was mainly obtained either through a chemist’s shop (35%) (with or without a prescription) or through a friend (37%). Half of the subjects (50%) obtained tapentadol for the purpose of managing heroin withdrawal. Thirty-five percent of participants used tapentadol in a dependent manner, while the remaining 65% either misused or abused the drug. Conclusion: The continued heroin usage crisis, lenient tapentadol procurement regulations, and the use of nonevidence-based drugs for the treatment of opioid use disorder all contribute to the problem of tapentadol abuse in our region.

Effect of cannabis use history on postoperative opioid utilization in lumbar fusion patients: an American retrospective study.

A retrospective cohort study. To examine the effect of cannabis use history on postoperative opioid utilization in patients undergoing one- to three-level lumbar fusion for degenerative spine disease. Strategies to minimize dosing and chronic opioid use are needed for spine surgery given their widespread prescription for postsurgical pain management. In this database study, medical coding was used to identify patients who had undergone one- to three-level lumbar fusions between 2012 and 2021. Propensity score matching was used to create two equal cohorts with respect to cannabis use history. Opioid utilization rates (morphine milligram equivalents [MME]/day) and overuse rates at 6 months post-index procedure were assessed. All pvalues <0.05 were considered statistically significant. Following examination of 153,500 patient records, 1,216 patients were matched into cannabis user and non-cannabis user cohorts. Cannabis users had lower rates of opioid utilization compared to non-cannabis users as early as 2 months after fusion (47.7% vs. 41.1%, p <0.05), a relationship which persisted at 6 months (46.2% vs. 37.7%, p <0.01). Additionally, cannabis users had lower rates of high-dose opioid utilization (≥100 MME per day) during the initial 14-30 days following surgery (6.91% vs. 3.79%, p <0.05). Patients with a history of cannabis use were less likely to be using opioids as early as 2 months postoperatively and had lower rates of high-dose opioid utilization in the immediate postoperative period. Physicians operating on these patients should consider their cannabis use patterns to provide appropriate titration of pain medication over time.

The relations between impulsivity, opioid use, and nonmedical prescription opioid use motives: An examination within three large urban emergency departments.

Impulsivity is a transdiagnostic risk factor for multiple disorders, including opioid use disorders (OUDs). However, scant work has examined if impulsivity facets distinguish individuals reporting nonmedical opioid use from those who use opioids as prescribed, particularly in important settings such as emergency departments (EDs). Further, no studies, to our knowledge, have examined the relations between impulsivity facets and motives for nonmedical prescription opioid use (NMPOU). Using data from EDs, this study examined if impulsivity facets (assessed via the [negative] urgency, premeditation, perseverance, sensation seeking, and positive urgency) related to nonmedical opioid use and if these facets related to OUD severity among individuals reporting past-year opioid use. Among patients reporting past 3-month NMPOU, the relation between motives for use and impulsivity was examined. Results indicated all facets (except lack of perseverance) distinguished patients reporting nonmedical opioid use from individuals abstaining from opioid use and those who used opioids as prescribed, with particularly large effect sizes for positive and negative urgency. Similarly, among patients reporting past 12-month opioid use, all facets (except lack of perseverance) significantly distinguished individuals who were OUD negative from those with severe OUD, with positive and negative urgency showing the strongest relations. Multiple motives were associated with certain UPPS-P facets, particularly positive urgency, negative urgency, and sensation-seeking. Results suggest that the relation between impulsivity and opioid use characteristics varies across facets of impulsivity, with emotion-based impulsivity being the most relevant. Implications for screening and interventions are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Epidemiology and Outcomes Associated with New Persistent Opioid Use After Transabdominal Operation.

Overall, 3-12% of opioid-naïve patients develop persistent opioid use after surgery. It's still unclear whether persistent opioid use after transabdominal surgery is associated with adverse surgical outcomes. We aimed to assess if new persistent opioid use after transabdominal surgery is associated with increased long-term mortality and readmission rates. Opioid-naïve patients >18 years undergoing transabdominal surgery at Landspitali University Hospital, the only tertiary hospital in Iceland, from 2006-2018 were included. Persistent opioid use was defined as opioid use more than 3 months postoperatively. Inverse probability weighting (IPW) was used to yield balanced study groups accounting for baseline characteristics. Long-term mortality (during median follow-up of 5.2 years) was compared using propensity-weighted Cox regression and readmission within 3-6 months using propensity-weighted logistic regression. Overall, 3923 patients were included (laparoscopy-2680, laparotomy-1243). Rates of new persistent opioid use were 13.0%. Rates were higher after laparotomy than laparoscopy in the crude analysis but not in the propensity-weighted analysis. New persistent opioid use was associated with higher long-term mortality (hazard ratio 1.84, 95% CI 1.41-2.40) and readmission rates (odds ratio 3.24, 95% CI 2.25-4.76). This was consistent for both patients undergoing laparoscopy and laparotomy. Moreover, there were signs of a dose-response relationship, with patients in higher quartiles of postoperative opioid consumption having higher mortality and readmission rates. New persistent opioid use following transabdominal surgery was associated with higher rates of mortality and readmission rates. This calls for increased postoperative support for at-risk patients and increased support during transitions of care for these patients.

Socio-demographic, clinical variables and pain among Egyptian patients of opioid use disorder with and without comorbid gabapentin use

IntroductionThere is increased clinical use of gabapentin, these trends appear to chronologically align with the opioid overdose crisis and particularly with the increased restrictions on opioid prescription.ObjectivesThe study aimed to assess the clinical variables, pain quality, and severity among patients with opioid use disorder as the main substance with and without gabapentin comorbid use.MethodsThe research involved 60 patients diagnosed with substance use disorder, divided into two groups: opioid use as the main substance and opioid use with comorbid gabapentin. All participants were assessed using a semi-structured clinical addiction interview, the structured clinical interview for diagnostic and statistical manual of mental disorders, the Addiction Severity Index, urine drug test, McGill Pain Questionnaire, and Douleur Neuropathique en 4 Questionnaire, in one interview setting.ResultsThe study showed that pain relief was the main desirable effect in the gabapentin group, with 66.2% of the group experiencing it. Euphoria was the desirable effect in the opioid group, while overdose was more common in the gabapentin group. Respiratory complications were also more common in the Gabapentin group.ConclusionThe study concluded that patients with comorbid gabapentin use disorder had a higher frequency of overdose, history of pain, and significant neuropathic pain, while less abstinence.

Client and program-level factors associated with planned use of medications for opioid use disorder in specialty substance use treatment programs: Evidence from linked administrative data and survey data

BackgroundMost patients in specialty drug treatment programs that are not federally licensed Opioid Treatment Programs (OTPs) programs do not receive medications for opioid use disorder (MOUD). MethodsWe linked results from a survey of non-OTP treatment program directors in New Jersey (n = 81) to statewide administrative records of admissions for opioid use to those programs between July 2021–June 2022. Using multi-level regression, we examined the association of three types of factors with planned MOUD use: program survey responses, client-level factors, and program-level client characteristic mix. ResultsOf 9583 opioid treatment admissions in non-OTP settings, 41 % included treatment plans involving MOUD. Programs where directors reported staff concerns about buprenorphine's efficacy or diversion had a lower proportion of clients with planned MOUD, as did programs reporting too little physical space to prescribe. Being self-referred to treatment, unemployed and not looking for work, aged 30–49, heroin use (vs. prescription opioid use), and stimulant use in addition to opioids, were positively associated with planned MOUD; while non-Medicaid insurance, and Black and Hispanic race/ethnicity, were negatively associated with planned MOUD. Clients were more likely to have planned MOUD if their programs had a higher proportion of clients aged 30 or older, heroin as primary “drug of abuse,” stimulant use, and not working but actively looking for work. ConclusionFindings suggest addressing program staff attitudes toward buprenorphine could help increase planned MOUD. There is also a need to improve access for clients with non-Medicaid insurance, address within-program race and ethnic disparities, and address employment-related barriers to medication.

Enhanced Recovery After Surgery Protocols in One- or Two-Level Posterior Lumbar Fusion: Improving Postoperative Outcomes.

Background/Objectives: Enhanced recovery after surgery (ERAS) protocols optimize perioperative care and improve recovery. This study evaluated the effectiveness of ERAS in one- or two-level posterior lumbar fusion surgeries, focusing on perioperative medication use, pain management, and functional outcomes. Methods: Eighty-eight patients undergoing lumbar fusion surgery between March 2021 and February 2022 were allocated into pre-ERAS (n = 41) and post-ERAS (n = 47) groups. Outcomes included opioid and antiemetic consumption, pain scores (numerical rating scale (NRS)), functional recovery (Oswestry Disability Index (ODI) and EuroQol 5 Dimension (EQ-5D)), and complication rates. Pain was assessed daily for the first four postoperative days and at 6 months. Linear Mixed Effects Model analysis evaluated pain trajectories. Results: The post-ERAS group showed significantly lower opioid (p = 0.005) and antiemetic (p < 0.001) use. No significant differences were observed in NRS pain scores in the first 4 postoperative days. At 6 months, the post-ERAS group reported significantly lower leg pain (p = 0.002). The time:group interaction was not significant for back (p = 0.848) or leg (p = 0.503) pain. Functional outcomes at 6 months, particularly ODI and EQ-5D scores, showed significant improvement in the post-ERAS group. Complication rates were lower in the post-ERAS group (4.3% vs. 19.5%, p = 0.024), while hospital stay and fusion rates remained similar. Conclusions: The ERAS protocol significantly reduced opioid and antiemetic use, improved long-term pain management and functional recovery, and lowered complication rates in lumbar fusion patients. These findings support the implementation of ERAS protocols in spinal surgery, emphasizing their role in enhancing postoperative care.

Psilocybin reduces heroin seeking behavior and modulates inflammatory gene expression in the nucleus accumbens and prefrontal cortex of male rats.

Preclinical and human studies indicate psilocybin may reduce perseverant maladaptive behaviors, including nicotine and alcohol seeking. Such studies in the opioid field are lacking, though opioids are involved in >50% of overdose deaths. Psilocybin is an agonist at the serotonin 2A receptor (5-HT2AR), a well-documented target for modulation of drug seeking, and evidence suggests 5-HT2AR agonists may dampen motivation for opioids. We sought to investigate the therapeutic efficacy of psilocybin in mediating cessation of opioid use and maintenance of long-lasting abstinence from opioid seeking behavior in a rat model of heroin self-administration (SA). Psilocybin or 5-HT2AR antagonists ketanserin and volinanserin were administered systemically to rats prior to SA of 0.075 mg/kg/infusion of heroin, or relapse following forced abstinence. Psilocybin did not alter heroin taking, but a single exposure to 3.0 mg/kg psilocybin 4-24 h prior to a relapse test blunted cue-induced heroin seeking. Conversely, 5-HT2AR antagonists exacerbated heroin relapse. To begin to elucidate mechanisms of psilocybin, drug-naïve rats received psilocybin and/or ketanserin, and tissue was collected from the prefrontal cortex (PFC), a region critical for drug seeking and responsive to psilocybin, 24 h later for RNA-sequencing. 3.0 mg/kg psilocybin regulated ~2-fold more genes in the PFC than 1.0 mg/kg, including genes involved in the cytoskeleton and cytokine signaling. Ketanserin blocked >90% of psilocybin-regulated genes, including the IL-17a cytokine receptor, Il17ra. Psychedelic compounds have reported anti-inflammatory properties, and therefore we performed a gene expression array to measure chemokine/cytokine molecules in the PFC of animals that displayed psilocybin-mediated inhibition of heroin seeking. Psilocybin regulated 4 genes, including Il17a, and a subset of genes correlated with relapse behavior. Selective inhibition of PFC IL-17a was sufficient to reduce heroin relapse. We conclude that psilocybin reduces heroin relapse and highlight IL-17a signaling as a potential downstream pathway of psilocybin that also reduces heroin seeking.

Risk of Opioid Overdose Associated with Concomitant Use of Methadone and Statins.

Methadone has a high potential for risky drug-drug interactions that can lead to opioid overdose, yet evidence on the magnitude of this risk remains limited. Since methadone is transported via P-glycoprotein (P-gp), the use of statins that inhibit P-gp may elevate methadone plasma concentrations, potentially leading to opioid overdose. We explored this hypothesis by examining whether concomitant use of methadone and P-gp-inhibiting statins was associated with opioid overdose. Using Medicaid claims data from 2003 to 2020, we conducted a cohort study among new concomitant users of methadone and statins. We compared overdose rates among individuals exposed to P-gp-inhibiting statins (simvastatin, atorvastatin, or lovastatin) vs. those exposed to rosuvastatin (negative control), adjusting for baseline covariates. We identified 69,263 individuals newly exposed to methadone and a statin of interest; the overall incidence rate of opioid overdose was 26.0 per 1,000 person-years. Adjusted hazard ratios (HRs) for methadone + P-gp-inhibiting statins consistently showed no association, ranging from 0.76 (95% CI = 0.48-1.22) for atorvastatin to 0.78 (95% CI = 0.50-1.22) for simvastatin, compared with methadone + rosuvastatin. Similar results were observed in sensitivity analysis that treated all P-gp-inhibiting statins as a single exposure group, as well as analyses stratified by baseline diagnosis of opioid use disorder or overdose, the duration of baseline methadone use, and calendar year intervals. Our findings suggest that concomitant use of methadone with simvastatin, atorvastatin, or lovastatin is not associated with the risk of opioid overdose compared to concomitant use of methadone and rosuvastatin.

New Persistent Opioid Use After Operation: A Frequent Complication with Long-Lasting Consequences.

New Persistent Opioid Use After Operation: A Frequent Complication with Long-Lasting Consequences.

Communities That HEAL Intervention and Mortality Including Polysubstance Overdose Deaths

The HEALing Communities Study (HCS) evaluated the effectiveness of the Communities That HEAL (CTH) intervention in preventing fatal overdoses amidst the US opioid epidemic. To evaluate the impact of the CTH intervention on total drug overdose deaths and overdose deaths involving combinations of opioids with psychostimulants or benzodiazepines. This randomized clinical trial was a parallel-arm, multisite, community-randomized, open, and waitlisted controlled comparison trial of communities in 4 US states between 2020 and 2023. Eligible communities were those reporting high opioid overdose fatality rates in Kentucky, Massachusetts, New York, and Ohio. Covariate constrained randomization stratified by state allocated communities to the intervention or control group. Trial groups were balanced by urban or rural classification, 2016-2017 fatal opioid overdose rate, and community population. Data analysis was completed by December 2023. Increased overdose education and naloxone distribution, treatment with medications for opioid use disorder, safer opioid prescribing practices, and communication campaigns to mitigate stigma and drive demand for evidence-based interventions. The primary outcome was the number of drug overdose deaths among adults (aged 18 years or older), with secondary outcomes of overdose deaths involving specific opioid-involved drug combinations from death certificates. Rates of overdose deaths per 100 000 adult community residents in intervention and control communities from July 2021 to June 2022 were compared with analyses performed in 2023. In 67 participating communities (34 in the intervention group, 33 in the control group) and including 8 211 506 participants (4 251 903 female [51.8%]; 1 273 394 Black [15.5%], 603 983 Hispanic [7.4%], 5 979 602 White [72.8%], 354 527 other [4.3%]), the average rate of overdose deaths involving all substances was 57.6 per 100 000 population in the intervention group and 61.2 per 100 000 population in the control group. This was not a statistically significant difference (adjusted rate ratio [aRR], 0.92; 95% CI, 0.78-1.07; P = .26). There was a statistically significant 37% reduction (aRR, 0.63; 95% CI, 0.44-0.91; P = .02) in death rates involving an opioid and psychostimulants (other than cocaine), and nonsignificant reductions in overdose deaths for an opioid with cocaine (6%) and an opioid with benzodiazepine (1%). In this clinical trial of the CTH intervention, death rates involving an opioid and noncocaine psychostimulant were reduced; total deaths did not differ statistically. Community-focused data-driven interventions that scale up evidence-based practices with communications campaigns may effectively reduce some opioid-involved polysubstance overdose deaths. ClinicalTrials.gov Identifier: NCT04111939.

Payment and billing strategies to support methadone take-home medication: Perspectives of financial leaders of opioid treatment program organizations in New York State

IntroductionRecent federal regulatory changes governing the delivery of methadone treatment for opioid use disorder at Opioid Treatment Programs (OTPs) support continued practice changes towards greater and flexible methadone take-home medication. Existing payment models for OTPs were closely tied with onsite medication administration and thus misaligned with the need to conduct more and flexible take-homes. This study aims to understand OTP organizations' experience with the newly created OTP bundled payment model in New York State as an alternative to the pre-existing per-service payment model during 2020–2023 to inform financing strategies to support and sustain practice changes. MethodsThe study conducted semi-structured interviews with financial leaders and staff from OTP organizations in New York State. Snowball sampling supplemented purposeful sampling of OTP organizations based on their billing practices by. Qualitative data from 12 interviews (with 11 OTP organizations and 1 trade organization) were analyzed with an integrated (inductive and deductive) approach to derive themes. ResultsStudy informants recognized that the bundled payment model served to protect revenue in a time when OTPs had to pivot quickly to increase take-home medication to patients. Informants described a wide spectrum of practices to operationalize billing in the alternative payment systems, revealing confusion with the billing rules and significant logistical and technical challenges. Informants expressed concerns regarding the substantial difference between the full bundled rate, paid in weeks with one or more qualifying services, and the medication-only rate, reporting that extended (2 weeks or more) take-homes might not be sustainable under the two-tiered model with the low medication-only rate and advocating for a single bundled rate. Informants believed that increased take-home medication and federal regulatory changes had profound implications for the delivery of counseling services, the counselor workforce, and financial viability for OTPs. ConclusionsOur study of OTP organization experience in New York State provided data on OTP organization perspectives regarding the potential revenue-protecting effects of bundled payments and generated insights to inform future research and policy experimentation to support flexible take-home medication. Future implementation studies are needed to better understand the roles of financing strategies at large in supporting clinical practice changes in substance use disorder treatment.

Assessing the feasibility of the GOTT (Gabapentinoid and Opioid Tapering Toolkit) in a primary care setting in North-East England

Objective To assess the feasibility and possible impacts of implementation of systematic non-pharmacological interventions to reduce the level of prescribing of opioid and gabapentinoid analgesics for chronic non-cancer pain (CNCP), particularly high-dose prescriptions, through a proof-of-concept study in a deprived area (second lowest decile) primary care practice in North-East England. Participant Twenty-five primary care staff (clinical and non-clinical) of which 18 clinicians received the intervention. Intervention used in this study practice known as GOTT (Gabapentinoid and Opioid Toolkit) All clinicians received an educational skills programme to support patient pain self-management, tailored on the clinicians’ self-assessment of their learning needs, embedding both clinician skill learning and patient self-care resources for rapid access within consultations into a GP clinical management computer system. Outcome measures Clinical staff completed questionnaires before and after the GOTT intervention to assess levels of knowledge and confidence in their own skills to support chronic pain self-management across several domains. Prescription data were used to measure changes in opioid and gabapentinoid prescribing at the practice across the 12-month intervention and 30-month follow-up period. Results Prescribing of opioid and gabapentinoid/pregabalin decreased substantially in the practice across the intervention period (c. 90% in high-dose opioid [ p = .0118], and 15% gabapentin/pregabalin prescriptions, respectively), over a one-year period during the COVID-19 pandemic. Follow-up analysis showed 100% and c.50% reductions, respectively, in December 2022. The questionnaire data showed an increase in clinician confidence in skills to enable self-management over the intervention period, overall ( p = .044) and, specifically across three of the five domains measured: supporting behavioural change ( p = .028), supporting self-care ( p = .008), and managing difficult consultations ( p = .011). Conclusion The GOTT intervention program provided some initial evidence of a proof-of-concept for the implementation of a systematic non-pharmacological pain management skills and resources programme addressing lack of confidence in skills to introduce and support self-management and reduce use of strong opioids and gabapentinoids.

Effect of Group Motivational Enhancement Therapy in Patients with Opioid Dependence (on Maintenance Treatment): Study Protocol of a Randomized Controlled Trial

Background: Relapse and treatment dropout are key challenges in opioid use disorder that need effective intervention strategies. Motivation enhancement therapy may be effective in improving opioid use disorder treatment outcomes. Objective: To assess the effectiveness of group motivational enhancement therapy (GMET) in patients with opioid dependence. Methods: It is an open-label, two-arm, parallel-group, randomized controlled trial (RCT). Participants include patients with opioid dependence and on opioid maintenance treatment, aged between 18 and 60 years. The intervention consists of six GMET sessions, each lasting about 45 minutes. Assessments will be conducted at four time points—baseline, six weeks, four months, and six months—using the Kessler psychological distress scale (K10), Recovery and Relapse Prevention Inventory Diagnostic (RAPID), WHO Quality of Life-BREF, Harm Reduction Self-Efficacy Questionnaire and Stage of Change Readiness and Treatment Eagerness Scale for drugs (SOCRATES 8D). Conclusion: The customized GMET approach tailored to the specific needs of the local population is expected to enhance the effectiveness and feasibility of the intervention and its implementation.

Association Between Variables and Transitions Among No Opioid Use, Opioid Use, and Subsequent Dropout Among Participants on Methadone Treatment: A Retrospective Study Utilizing a Multistate Model.

Although previous studies have reported the variables that influence opioid use or dropout among participants receiving methadone treatment, limited attention has been given to the variables related to transitions among no opioid use, opioid use, and dropout. This retrospective study utilized data collected from June 2010 to June 2022 at 11 methadone treatment clinics in Guangdong Province, China. Two transient states (no opioid use and opioid use) and 1 absorbing state (dropout) were defined based on monthly urine morphine test results and daily methadone intake records. We used a multistate model to explore the variables associated with transitions among no opioid use, opioid use, and dropout among participants. Among 3136 participants, with an average treatment duration of 497 days, 1646 (52.49%) underwent at least 1 period of opioid use, resulting in 3283 transitions from no opioid use to opioid use. The transitions between no opioid use and opioid use were significantly associated with variables such as age, gender, employment status, marital status, living situation, travel time to the clinic, human immunodeficiency virus and hepatitis C virus infection statuses, average methadone dosage, and attendance rates. The variables influencing participants' dropout varied depending on their opioid use behaviors. Additionally, the probability of a specified opioid use state remaining unchanged or transitioning to a different state at a defined time point would change over time. The opioid use behaviors of participants are dynamic. Methadone providers should offer targeted interventions based on participants' opioid use behaviors to effectively decrease rates of opioid use and improve retention.

Interventions to reduce opioid use for patients with chronic non-cancer pain in primary care settings: A systematic review and meta-analysis.

This systematic review and meta-analysis aimed to assess interventions to reduce opioid use for patients with chronic non-cancer pain (CNCP) versus usual care or active controls in primary care settings. In this registered study (PROSPERO: CRD42022338458), we searched MEDLINE, Embase PsycInfo, CINAHL, and Cochrane Library from inception to December 28th 2021, and updated on Dec 14th 2023 for randomized controlled trials (RCTs) and cohort studies with no restrictions. Methodological quality was assessed using the Cochrane Risk of Bias tool for RCTs and Newcastle Ottawa Scale for cohort studies. Primary outcomes included mean reduction in morphine equivalent daily dose (reported as mean differences [MDs] mg/day; 95% confidence intervals [95%CIs]) and/or opioid cessation proportion. Secondary outcomes were mean changes in pain severity (reported as standardized mean difference [SMDs]; 95%CIs) and (serious) adverse events. Meta-analyses were performed using random-effects models. We identified 3,826 records, of which five RCTs (953 participants) and five cohort studies (901 participants) were included. Overall, opioid dosage was significantly reduced in intervention groups compared to controls (MD: -28.63 mg/day, 95%CI: -39.77 to -17.49; I2 = 31.25%; eight studies). Subgroup analyses revealed significant opioid dose reductions with mindfulness (MD: -29.36 mg/day 95%CI: -40.55 to -18.17; I2 = 0.00%; two trials) and CBT-based multimodalities (MD: -41.68 mg/day; 95%CI: -58.47 to -24.89; I2 = 0.00%; two cohort studies), respectively, compared to usual care. No significant differences were observed in opioid cessation (Odds ratio: 1.10, 95%CI: -0.48 to 2.67, I2 = 58.59%; two trials) or pain severity (SMD: -0.13, 95%CI: -0.37 to 0.11; I2 = 33.51%; three trials). Adverse events were infrequently examined, with withdrawal symptoms commonly reported. The studied interventions were effective in reducing opioid dosage for people with CNCP in primary care. They highlighted the importance of multidisciplinary collaboration. Large-scale RCTs measuring the long-term effects and cost of these interventions are needed before their implementation.

Opioid use in Latin America: Chronicle of a death foretold?

Opioid use in Latin America: Chronicle of a death foretold?