Patterns Of Opioid Use Research Articles

Impact of Opioid Use on Duration of Time Loss After Work-Related Lower Limb Injury

Purpose This study sought to determine patterns of opioid use among workers with a compensated lower limb injury, factors associated with opioid use, and how opioid use is associated with time loss duration. Methods Claims and medication data were provided by the workers’ compensation regulator of Victoria, Australia, for claims lodged 2008–2018 from workers aged 15+ years with a lower limb injury. Descriptive statistics showed the number and prevalence of each opioid type (weak/strong) by demographic, claim and injury predictors. Binary and multinomial logistic regression determined the likelihood of any opioid use, and use of strong, weak or a combination of strong and weak opioids by predictors. Cox regression determined the effect of each opioid type on duration of time loss, controlling for predictors. Results There were 51,334 claims and of these 23.6% were dispensed opioids (9.2% for strong opioids only, 6.6% for weak opioids only and 7.8% for a combination). Weak opioids, on average, were dispensed 15 days earlier than strong opioids. Time loss claims and workers with fractures or hip injuries were most likely to be dispensed opioids. All opioids were associated with increased duration of time loss, with those dispensed both weak and strong opioids having the longest duration of time loss. Conclusions Any opioid use was associated with longer time loss duration, with increasing opioid strength having a greater effect. Review of pain management methods should be undertaken to reduce opioid use, which may have a positive impact on duration of time loss and long-term function.

Patterns of Opioid Use in Commercially Insured Patients With Cancer

In an era of heightened opioid prescribing scrutiny, ensuring safe and adequate pain management is challenging. Understanding opioid use in patients with cancer can facilitate effective pain management regimens while minimizing safety concerns. This study characterized patterns of and factors associated with opioid use following a new cancer diagnosis. Retrospective cohort study. Our study included patients with a new cancer diagnosis aged 18 to 64 years in IQVIA PharMetrics Plus 2007-2013 who were continuously enrolled 12 months before receiving their cancer diagnosis and 24 months after. Study outcomes included opioid prevalence and measures of potentially high-risk opioid use (total days supplied, number of prescriptions, and morphine equivalent daily dose [MEDD]). Descriptive analyses and logistic regression were implemented. Of 191,616 eligible individuals, 93,739 (48.9%) received opioid prescriptions; of these, 56,025 (59.8%) were new opioid users. Opioid users received 4.6 prescriptions on average, covering 65 total days with a mean MEDD of 31.8 mg. Only 2387 (2.5%) patients received higher than recommended (≥ 90 mg) MEDD. Predictors of opioid use post cancer included prior opioid use, select comorbidities, use of nonopioid pain treatment adjuvants (muscle relaxants, sedative/hypnotics, anticonvulsants, antidepressants, and steroids), cancer site, and metastatic cancer. Fewer than half of patients received opioids in the 2 years following cancer onset. Among users, we found a relatively small proportion of potentially problematic opioid use. Further research is warranted to assess the adequacy of cancer pain treatment and determinants of high-risk opioid use.

Incarceration exposure and prescription opioid use during pregnancy

BackgroundPrior research demonstrates a high prevalence of substance use, including opioid use, among those who have had personal or vicarious contact with the correctional system. Relatedly, alongside patterns of rising opioid use in general, opioid use during pregnancy is becoming a growing public health concern. Still, risk factors for prescription opioid use during pregnancy remain understudied. This study is the first to assess the connection between a women’s personal or vicarious exposure to incarceration in the 12 months prior to birth and patterns of prenatal opioid use. MethodsData are from the Pregnancy Risk Assessment Monitoring System (PRAMS) in 2019 (N = 17,551 mothers). Logistic and multinomial logistic regression are used to assess the association between incarceration exposure and patterns of opioid use during pregnancy. ResultsIncarceration-exposed women were more likely to use all eight types of prescription opioids assessed in this study (Hydrocodone, Codeine, Oxycodone, Tramadol, Hydromorphone/Meperidine, Oxymorphone, Morphine, and Fentanyl). After adjustment for control variables, incarceration-exposed women were significantly more likely to report any prescription opioid use during pregnancy (OR = 1.745, 95% CI = 1.194, 2.554). Furthermore, relative to no opioid use, incarceration exposure was also associated with illicit prescription opioid use (RRR = 2.979, 1.533, 5.791). ConclusionsIncarceration exposure in the year prior to birth is associated with higher odds of prescription opioid use. These findings add to the burgeoning literature that details a women’s exposure to incarceration is a risk marker for substance use and engagement in health risk behaviors that can jeopardize maternal and infant wellbeing.

Opioid use and associated factors among pancreatic cancer patients diagnosed between 2007 and 2015.

BackgroundOpioid therapy provides essential pain relief for cancer patients. We used the population‐based Surveillance Epidemiology and End Results (SEER) linked with Medicare database to identify the patterns of opioid use and associated factors in pancreatic adenocarcinoma cancer patients 66 years or older.Patients and MethodsWe assessed opioid types, dispensed days, opioid uptake rates, and factors associated with opioid use after pancreatic adenocarcinoma cancer diagnosis in Medicare beneficiaries between 2007 and 2015 from the SEER‐Medicare data. Multivariable regression analysis was used to adjust for a variety of patient‐related factors.ResultsWe identified a cohort of 10,745 pancreatic cancer patients with a median age of 76 years old and median survival of 7 months; 75% of patients‐initiated opioids after cancer diagnosis. African Americans had the lowest rate of opioid use of 69.1% compared with all other race/ethnicity groups at around 75%. No significant yearly trend of prescribing opioids was detected. Hydrocodone was the most frequently prescribed opioid type. Regression analysis revealed that age ≤80 years, residing in Southern or Western SEER registries, residing in urban/less urban versus big metro areas, having stage IV cancer at diagnosis, longer survival time, and undertaking cancer‐directed treatment or using palliative care were positively associated with opioid initiation, more prescribed opioid types, and higher opioid doses.DiscussionWhile a range of sociodemographic variables were associated with opioid use in unadjusted analysis, the associations between race/ethnicity, gender, and socioeconomic status with opioid initiation disappeared when sociodemographic factors, tumor characteristics, and cancer treatment were adjusted.ConclusionHealth care professionals' opioid prescription pattern for pancreatic cancer patients does not parallel the U.S. opioid epidemic. Racial/ethnic disparities in opioid treatment were not identified.

Temporal Trends and Predictors of Opioid Use Among Older Patients With Cancer.

While opioids represent a cornerstone of cancer pain management, the timing and patterns of opioid use in the cancer population have not been well studied. This study sought to explore longitudinal trends in opioid use among Medicare beneficiaries with nonmetastatic cancer. Within a cohort of 16,072 Medicare beneficiaries ≥66 years old diagnosed with nonmetastatic cancer between 2007 and 2013, we determined the likelihood of receiving a short-term (0 to 6 mo postdiagnosis), intermediate-term (6 to 12 mo postdiagnosis), long-term (1 to 2 y postdiagnosis), and high-risk (morphine equivalent dose ≥90 mg/day) opioid prescription after cancer diagnosis. Multivariable logistic regression models were used to identify patient and cancer risk factors associated with these opioid use endpoints. During the study period, 74.6% of patients received an opioid prescription, while only 2.66% of patients received a high-risk prescription. Factors associated with use varied somewhat between short-term, intermediate-term, and long-term use, though in general, patients at higher risk of receiving an opioid prescription after their cancer diagnosis were younger, had higher stage disease, lived in regions of higher poverty, and had a history of prior opioid use. Prescriptions for high-risk opioids were associated with individuals living in regions with lower poverty. Temporal trends in opioid use in cancer patients depend on patient, demographic, and tumor characteristics. Overall, understanding these correlations may help physicians better identify patient-specific risks of opioid use and could help better inform future evidence-based, cancer-specific opioid prescription guidelines.

Impact of COVID-19 pandemic on treatment seeking in opioid users: A retrospective comparative study

Background: The planet has been hit by the novel coronavirus since December 2019, which has not only affected the day-to-day activities but has also affected the health-seeking approach of the general population. The reports from the National Institute on Drug Abuse survey hint toward a rise in opioid use in the states. Even in India, the utilization of health services, especially the outpatient department (OPD) and opioid substitution clinics have been affected due to the impact of COVID-19 and subsequent national and regional lockdowns. The Indian studies reflect upon the experience and measures to continue the treatment facilities in substance users, yet none are available to reflect upon the impact of COVID-19 on the pattern of opioid use or functionality of OPD services. Objective: The objective of this study is to study the impact of COVID-19 pandemic on treatment seeking among opioid users from OPD-based opioid treatment centers: a retrospective study. Methodology: A retrospective study was done in an OPD-based opioid treatment center of a tertiary care hospital to analyze the impact of COVID-19 on treatment-seeking opioid users by comparing the data of pre-COVID-19 (April 2019–March 2020) and during COVID-19 (April 2020–March 2021) OPD visits by opioid users. The OPD visits data were collected, including the number of visits, the total number of buprenorphine tablets dispensed, and the dose of buprenorphine consumed per month. The data collected were further analyzed for the descriptive and analytic statistics using the SPSS software version 23.0. Results: During the pre-COVID-19 (April 2019–March 2020) duration, there were a total of 1104 (average 92/month) OPD visits and 4818 (Average 401/month) buprenorphine tablets were dispensed; whereas during the COVID-19 year (April 2020–March 2021), it was 980 (average 81.66/month) visits and 5174 (431/month) tablets. The results were further compared using the paired t-test, which was found to be statistically significant for the number of tablets dispensed, whereas not statistically significant for the number of OPD visits and doses. Conclusion: Although the COVID-19 pandemic has affected the feasibility to seek treatment in opioid users, it has not significantly affected OPD visits for opioid treatment at our center. Although the policy changes such as Indian Psychiatry Society (IPS) interim guidelines for opioid substitution therapy have been beneficial to facilitate the harm reduction and treatment-seeking attitude and have not affected the treatment seeking as expected due to lockdown and transportation which have been a hurdle. Further regulations on opioid treatment OPD, Tele-consultation services and mobile mental health services may be helpful to ensure continuity of treatment and harm reduction among the opioid users.

Opioid Use Among Orthopaedic Patients and Comparison of Opioid Prescribing Patterns Among Spine Surgeons and Other Orthopaedic Subspecialists in the United States

Background/Introduction: The US opioid epidemic has received particular attention with 33091 reported deaths from narcotic overdose in 2015. A recent survey comparing US and Japanese opioid prescribing patterns from the AOA-JOA traveling fellows included 76 US orthopedic surgeons representing 8 subspecialties. We used this data to compare opioid prescribing patterns among US spine surgeons to other orthopaedic subspecialties. Materials/Methods: The survey included data based on surgeon demographics (gender, age, years in practice), patient baseline opioid use (pre/post-operative opioid use, types of opioid agents, duration of opioid use), perioperative pain management (procedure/institution factors, multimodal analgesic therapy), and responses to questions regarding opioid use attitudes. Survey responses were recorded as either categorical or semi-continuous variables. Statistical analysis was performed using chi-squared analysis for categorical responses and Kolmogorov-Smirnov testing to a statistical significance level of p < 0.05. Parameters that trended toward significance to p < 0.10 were also recorded. Statistical analysis was performed using Stata statistical analysis software [StataCorp, College Station, Texas]. Results: Spine patients were more likely using opioid medications prior to evaluation by spine surgeons compared to non-spine patients(p=0.029). Patients with spine pathologies treated non-operatively were also more likely to be prescribed opioids(p=0.006). Post-operatively, spine patients were less likely to stop opioid prescriptions on the intended time (p=0.046). Peri-operatively, spine patients were more likely to be given muscle relaxant medications, and less likely to receive local/regional anesthesia(p=0.0025). Additionally, spine patients showed a trend toward association for requesting additional opioids beyond their initial prescription(p=0.057). Spine surgeons showed a trend toward association for choice of opioid agent prescribed–spine patients were less likely to receive codeine/tramadol analogs(p=0.062). When surveyed on opinions regarding opioid use, US spine surgeons did not show significantly different opinions regarding opioid use compared to surgeons in other subspecialties. Discussion/Conclusion: Spine patients did demonstrate statistically significant patterns of opioid use, particularly regarding opioid use prior to evaluation by orthopedic surgeon and use of opioids for nonoperative pathologies. They were also less likely to stop opioid prescriptions on time. Surgeon prescription patterns and perceptions of opioid use were not significantly different for spine surgeons compared to other subspecialties.

Prevalence of chronic opioid use in patients with peripheral arterial disease undergoing revascularization.

Opiate use, dependence, and the associated morbidity and mortality are major current public health problems in the United States. Little is known about patterns of opioid use in patients with peripheral arterial disease (PAD). The purpose of this study was to identify the prevalence of chronic preoperative and postoperative prescription opioid use in patients with PAD. A secondary aim was to determine the demographic, comorbid conditions, and operative characteristics associated with chronic opioid use. Using a single-institution database of patients with PAD undergoing open or endovascular lower extremity intervention from 2013 to 2014, data regarding opiate use and associated conditions were abstracted for analysis. Patients were excluded if they did not live in North Carolina or surgery was not for PAD. Preoperative (PreCOU) and postoperative chronic opioid use (PostCOU) were defined as consistent opioid prescription filling in the 3months before and after the index procedure, respectively. Opioid prescription filling was assessed using the North Carolina Controlled Substance Reporting System. Demographics, comorbid conditions, other adjunct pain medication data, and operative characteristics were abstracted from our institutional electronic medical record. Associations with PreCOU were evaluated using the t test, Wilcoxon test, or two-sample median test (continuous), or the χ2 or Fisher exact tests (categorical). A total of 202 patients undergoing open (108; 53.5%) or endovascular (94; 46.5%) revascularization for claudication or critical limb ischemia were identified for analysis. The mean age was 64.6years, and 36% were female. Claudication was the indication for revascularization in 26.7% of patients, and critical limb ischemia was the indication in 73.3% of patients. The median preoperative ankle-brachial index (ABI) was 0.50. Sixty-eight patients (34%) met the definition for PreCOU. PreCOU was associated with female gender, history of chronic musculoskeletal pain, benzodiazepine use, and self-reported illicit drug use. Less than 50% of patients reported use of non-opiate adjunct pain medications. No association was observed between PreCOU and pre- or postoperative ABI, or number of prior lower extremity interventions. Following revascularization, the median ABI was 0.88. PreCOU was not associated with significant differences in postoperative complications, length of stay, or mortality. Overall, 71 patients (35%) met the definition for PostCOU, 14 of whom had no history of preoperative chronic opiate use. Ten patients with PreCOU did not demonstrate PostCOU. Chronic opiate use was common in patients with PAD with a prevalence of approximately 35%, both prior to and following revascularization. Revascularization was associated with a termination of chronic opiate use in less than 15% of patients with PreCOU. Additionally, 10% of patients who did not use opiates chronically before their revascularization did so afterwards. Patients with PAD requiring intervention represent a high-risk group with regards to chronic opiate use. Increased diligence in identifying opioid use among patients with PAD and optimizing the use of non-narcotic adjunct pain medications may result in a lower prevalence of chronic opiate use and its attendant adverse effects.

Persistent use of prescription opioids following lumbar spine surgery: Observational study with prospectively collected data from two Norwegian nationwide registries

Study design Prospective pharmacoepidemiological study. Objective To investigate the use of prescription opioids two years following degenerative lumbar spine surgery. Summary of background data There are limited data providing details to evaluate patterns of opioid use. The number of patients is often limited and data on opioid use following some of the most common surgical procedures are lacking. Methods Data from the Norwegian Registry for Spine Surgery and the Norwegian Prescription Database were linked on an individual level. The primary outcome measure was persistent opioid use the second year after surgery. Functional disability was measured with the Oswestry disability index (ODI). Study participants were operated between 2007 and 2017. Results Among 32886 study participants, 2754 (8.4%) met criteria for persistent opioid use the second year after surgery. Among persistent opioid users in the second year after surgery, 64% met the criteria for persistent opioid use the year preceding surgery. Persistent opioid use the year preceding surgery (OR 31.10, 95% CI 26.9-36.0, P = .001), use of high doses of benzodiazepines (OR 1.62, 95% CI 1.30-2.04, P = .001), and use of high doses of z-hypnotics (OR 1.90, 95% CI 1.58-2.22, P = .001) the year before surgery were associated with increased risk of persistent opioid use the second year after surgery. A higher ODI score at one year was observed in persistent opioid users compared to non-persistent users (41.5 vs 18.8 points) and there was a significant difference in ODI change (-13.7 points). Patients with persistent opioid use in the year preceding surgery were less likely to achieve a minimal clinically important ODI change at one year compared to non-persistent users (37.7% vs 52.6%, P = .001). Conclusion Patients with or at risk of developing persistent opioid should be identified and provided counseling and support to taper off opioid treatment.Level of Evidence: 2.

The Incidence of Opioid Use in Patients Undergoing Orthopaedic Oncology Surgery

Objective: Primary or metastatic cancer can cause debilitating pain. Despite societal concerns regarding opioid use and abuse, opioid utilization patterns in orthopaedic oncology patients is not well-described. The purpose of this study is to determine patterns of opioid use in orthopaedic oncology patients and to identify factors associated with chronic use postoperatively.

Patterns of opioid use after endoscopic sinus surgery among patients with anxiety and depression.

International Forum of Allergy & RhinologyEarly View RESEARCH NOTE Patterns of opioid use after endoscopic sinus surgery among patients with anxiety and depression Vivek C. Pandrangi MD, Vivek C. Pandrangi MD Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, ORSearch for more papers by this authorBrian L. Scott MD, Brian L. Scott MD Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, ORSearch for more papers by this authorJasmina Pailet MD, Jasmina Pailet MD Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, ORSearch for more papers by this authorJess C. Mace MPH, Jess C. Mace MPH Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, ORSearch for more papers by this authorNyssa F. Farrell MD, Nyssa F. Farrell MD Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis, St. Louis, MOSearch for more papers by this authorMathew Geltzeiler MD, Mathew Geltzeiler MD Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, ORSearch for more papers by this authorTimothy L. Smith MD, MPH, Timothy L. Smith MD, MPH Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, ORSearch for more papers by this authorKara Y. Detwiller MD, Corresponding Author Kara Y. Detwiller MD detwille@ohsu.edu Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, OR Correspondence Kara Y. Detwiller, MD, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, 3303 South Bond Avenue, Portland, OR 97239. Email: detwille@ohsu.eduSearch for more papers by this author Vivek C. Pandrangi MD, Vivek C. Pandrangi MD Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, ORSearch for more papers by this authorBrian L. Scott MD, Brian L. Scott MD Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, ORSearch for more papers by this authorJasmina Pailet MD, Jasmina Pailet MD Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, ORSearch for more papers by this authorJess C. Mace MPH, Jess C. Mace MPH Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, ORSearch for more papers by this authorNyssa F. Farrell MD, Nyssa F. Farrell MD Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis, St. Louis, MOSearch for more papers by this authorMathew Geltzeiler MD, Mathew Geltzeiler MD Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, ORSearch for more papers by this authorTimothy L. Smith MD, MPH, Timothy L. Smith MD, MPH Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, ORSearch for more papers by this authorKara Y. Detwiller MD, Corresponding Author Kara Y. Detwiller MD detwille@ohsu.edu Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, OR Correspondence Kara Y. Detwiller, MD, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, 3303 South Bond Avenue, Portland, OR 97239. Email: detwille@ohsu.eduSearch for more papers by this author First published: 28 October 2021 https://doi.org/10.1002/alr.22919 Presented as a poster at the annual meeting (virtual) of the American Rhinologic Society, September 2020. Potential conflict of interest: M.G.: Stryker and Intersect ENT, consultant. View this article online at wileyonlinelibrary.com. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Early ViewOnline Version of Record before inclusion in an issue RelatedInformation

Persistent Use of Prescription Opioids Following Lumbar Spine Surgery: Observational Study with Prospectively Collected Data From Two Norwegian Nationwide Registries.

Prospective pharmacoepidemiological study. To investigate the use of prescription opioids 2 years following degenerative lumbar spine surgery. There are limited data providing details to evaluate patterns of opioid use. The number of patients is often limited and data on opioid use following some of the most common surgical procedures are lacking. Data from the Norwegian Registry for Spine Surgery and the Norwegian Prescription Database were linked on an individual level. The primary outcome measure was persistent opioid use the second year after surgery. Functional disabilitywas measured with the Oswestry disability index (ODI). Study participants were operated between 2007 and 2017. Among 32,886 study participants, 2754 (8.4%) met criteria for persistent opioid use the second year after surgery. Among persistent opioid users in the second year after surgery, 64% met the criteria for persistent opioid use the year preceding surgery. Persistent opioid use the year preceding surgery (odds ratio [OR] 31.10, 95% confidence interval [CI] 26.9-36.0, P = 0.001), use of high doses of benzodiazepines (OR 1.62, 95% CI 1.30-2.04, P = 0.001), and use of high doses of z-hypnotics (OR 1.90, 95% CI 1.58-2.22, P = 0.001) the year before surgery were associated with increased risk of persistent opioid use the second year after surgery. A higher ODI score at 1 year was observed in persistent opioid users compared with non-persistent users (41.5 vs. 18.8 points) and there was a significant difference in ODI change (-13.7 points). Patients with persistent opioid use in the year preceding surgery were less likely to achieve a minimal clinically important ODI change at 1 year compared with non-persistent users (37.7% vs. 52.6%, P = 0.001). Patients with or at risk of developing persistent opioid should be identified and provided counseling and support to taper off opioid treatment.Level of Evidence: 2.

New Persistent Opioid Use After Surgery: A Risk Factor for Opioid Use Disorder?

New Persistent Opioid Use After Surgery: A Risk Factor for Opioid Use Disorder?

Preoperative and Postoperative Opioid Prescription Rates in the Total Hip Replacement Surgical Patient.

The United States is facing an opioid epidemic that has only worsened with the COVID-19 pandemic. There is little evidence regarding patterns of opioid use among patients with total hip replacement (THR). Although the Centers for Disease Control and Prevention has put forward guidelines for prescribing opioids, it does not include guidance specifically for THR patients suffering from presurgical and postsurgical pain. The purpose of this study was to (1) compare presurgical and postsurgical opioid rates, (2) compare presurgical and postsurgical morphine milligram equivalents (MME), and (3) determine whether having a presurgical opioid prescription predicts the receipt of postsurgical opioid prescriptions among patients undergoing THR surgery. Retrospective cohort analysis of 4,405 patients undergoing THR at a major academic medical center in the United States from April 30, 2015, to April 30, 2018, was done. Patient characteristics, opioid rates, and average MME/day/person were described. Logistic regression was used to determine whether presurgical opioid prescription and opioid risk level predicted postsurgical opioid prescribing. Median age was 64 years (range = 18-85 years); patients were primarily Caucasian/White (78.8%) and female (54.7%). Opioid prescription rates in this sample for the 12-month presurgical and postsurgical periods were 66.1% and 95.6%, respectively. Oxycodone was the most common opioid prescribed in both periods. Among those prescribed an opioid, moderate/high risk for overdose and/or death was 6.3% presurgery and 19.8% postsurgery. Patients with a comorbidity were two times more likely to receive an opioid prescription in the postsurgical period. The median average MME/day/person was 26.5 (range = 0.3-180.0) for patients with an opioid prescribed during the presurgery period and 40.4 (range = 1.5-270.0) during the postsurgery period. Opioid use, regardless of strength, in the presurgical period as well as having one or more comorbidities predicted opioid use in the postsurgical period.

The Headache in Emergency Departments study: Opioid prescribing in patients presenting with headache. A multicenter, cross-sectional, observational study.

To describe the patterns of opioid use in patients presenting to the emergency department (ED) with nontraumatic headache by severity and geography. International guidelines recognize opioids are ineffective in treating primary headache disorders. Globally, many countries are experiencing an opioid crisis. The ED can be a point of initial exposure leading to tolerance for patients. More geographically diverse data are required to inform practice. This was a planned, multicenter, cross-sectional, observational substudy of the international Headache in Emergency Departments (HEAD) study. Participants were prospectively identified throughout March 2019 from 67hospitals in Europe, Asia, Australia, and New Zealand. Adult patients with nontraumatic headache were included as identified by the local site investigator. Overall, 4536 patients were enrolled in the HEAD study. Opioids were administered in 1072/4536 (23.6%) patients in the ED, and 386/3792 (10.2%) of discharged patients. High opioid use occurred prehospital in Australia (190/1777, 10.7%) and New Zealand (55/593, 9.3%). Opioid use in the ED was highest in these countries (Australia: 586/1777, 33.0%; New Zealand: 221/593, 37.3%). Opioid prescription on discharge was highest in Singapore (125/442, 28.3%) and Hong Kong (12/49, 24.5%). Independent predictors of ED opioid administration included the following: severe headache (OR 4.2, 95% CI 3.1-5.5), pre-ED opioid use (OR 1.42, 95% CI 1.11-1.82), and long-term opioid use (OR 1.80, 95% CI 1.26-2.58). ED opioid administration independently predicted opioid prescription at discharge (OR 8.4, 95% CI 6.3-11.0). Opioid prescription for nontraumatic headache in the ED and on discharge varies internationally. Severe headache, prehospital opioid use, and long-term opioid use predicted ED opioid administration. ED opioid administration was a strong predictor of opioid prescription at discharge. These findings support education around policy and guidelines to ensure adherence to evidence-based interventions for headache.

Author Response: Characterizing Opioid Use in a US Population With Migraine: Results From the CaMEO Study.

We thank Dr. Gupta for his comments on our article.1 We agree that patterns of opioid use vary by region of the world and acknowledge that opioid treatment of migraine may be particularly problematic in the United States.2 We also agree that metoclopramide given intravenously is an important option in the emergency department, where opioids are often used.2–4 There are also a number of other acute treatment options—including neuromodulation—and oral treatments, such as nonsteroidal anti-inflammatory drugs, triptans, gepants, and ditans.5

Post-Operative Pain Management in Lung Transplant Recipients: A Focus on Opioid Use

Purpose Effective management of post-operative pain in lung transplant recipients (LTR) can be challenging. LTR are highly vulnerable to opioid related adverse effects such as sedation, respiratory depression and gastrointestinal side effects. While systemic opioids have traditionally been used as the mainstay of post-operative pain management, there is now heightened awareness of their harmful effects. Internationally, increasing opioid prescriptions has corresponded with an increase in opioid abuse, adverse events and hospital admissions. In addition, the Australian and New Zealand College of Anaesthetists recently released a position statement recommending against the use of slow-release opioids in the management of patients with acute pain. The patterns of opioid use following lung transplantation (LT) have not been well described in the literature. This study examined the prescribing patterns at our centre including the type of opioid and non-opioid analgesia used, the length of opioid use and rates of opioid associated adverse events following LT. Methods We undertook a single center retrospective analysis of 56 patients undergoing LT from 2016 to 2019. Post-operative pain relief regimens were examined including opioid and non-opioid modalities used in the ICU, at hospital discharge, at 6 weeks, 3 months and 6 months following LT. The incidence of opioid related adverse events was examined. Results There was a large variation in analgesic modalities used in the immediate post-operative period. Thoracic epidural analgesia was used in 37.5% and extra-pleural catheters were used in 3.6%. The use of opioid analgesia was 100% in the ICU, 66.1% at discharge from hospital, 46.4% at 6 weeks, 8.9% at 3 months and 1.8% at 6 months. Opioid related adverse effects occurred in 17.9%. LTR who were prescribed long acting opioids in the ICU had a higher incidence of opioid-related adverse events (RR 3.27, 95% CI 1.05 - 10.21). Conclusion The majority of LTR have ceased opioid medication use by 3 months. The high incidence of early opioid related adverse events highlights the need to reduce early systemic opioid use. The development of a standardized approach to pain management could be considered and increased use of regional modalities could be used. Long acting opioids were linked to greater harm and their use should be minimized.

Prenatal methadone exposure disrupts behavioral development and alters motor neuron intrinsic properties and local circuitry.

Despite the rising prevalence of methadone treatment in pregnant women with opioid use disorder, the effects of methadone on neurobehavioral development remain unclear. We developed a translational mouse model of prenatal methadone exposure (PME) that resembles the typical pattern of opioid use by pregnant women who first use oxycodone then switch to methadone maintenance pharmacotherapy, and subsequently become pregnant while maintained on methadone. We investigated the effects of PME on physical development, sensorimotor behavior, and motor neuron properties using a multidisciplinary approach of physical, biochemical, and behavioral assessments along with brain slice electrophysiology and in vivo magnetic resonance imaging. Methadone accumulated in the placenta and fetal brain, but methadone levels in offspring dropped rapidly at birth which was associated with symptoms and behaviors consistent with neonatal opioid withdrawal. PME produced substantial impairments in offspring physical growth, activity in an open field, and sensorimotor milestone acquisition. Furthermore, these behavioral alterations were associated with reduced neuronal density in the motor cortex and a disruption in motor neuron intrinsic properties and local circuit connectivity. The present study adds to the limited body of work examining PME by providing a comprehensive, translationally relevant characterization of how PME disrupts offspring physical and neurobehavioral development.

Patterns of Inpatient Opioid Use and Related Adverse Events Among Patients With Cirrhosis: A Propensity-Matched Analysis.

Pain is common among patients with cirrhosis, yet managing pain in this population is challenging. Opioid analgesics are thought to be particularly high risk in patients with cirrhosis, and their use has been discouraged. We sought to understand patterns of opioid use among inpatients with cirrhosis and the risks of serious opioid‐related adverse events in this population. We used the Vizient Clinical Database/Resource Manager, which includes clinical and billing data from hospitalizations at more than 500 academic medical centers. We identified all nonsurgical patients with cirrhosis hospitalized in 2017‐2018 as well as a propensity score‐matched cohort of patients without cirrhosis. Inpatient prescription records defined patterns of inpatient opioid use. Conditional logistic regression compared rates of use and serious opioid‐related adverse events between patients with and without cirrhosis. Of 116,146 nonsurgical inpatients with cirrhosis, 62% received at least one dose of opioids and 34% had regular inpatient opioid use (more than half of hospital days), rates that were significantly higher than in patients without cirrhosis (adjusted odds ratio [AOR] for any use, 1.17; 95% confidence interval [CI], 1.13‐1.21; P < 0.001; AOR for regular use, 1.07; 95% CI, 1.02‐1.11; P = 0.002). Compared with patients without cirrhosis, patients with cirrhosis more often received tramadol (P < 0.001) and less commonly received opioid/acetaminophen combinations (P < 0.001). Rates of serious opioid‐related adverse events were similar in patients with and without cirrhosis (1.6% vs. 1.9%; AOR, 0.96; P = 0.63). Conclusion: Over half of patients with cirrhosis have pain managed with opioids during hospitalization. Patterns of opioid use differ in patients with cirrhosis compared with patients without cirrhosis, although rates of serious adverse events are similar. Future studies should further explore the safety and efficacy of opioids in patients with cirrhosis, with the goal of improving pain management and quality of life in this population.

The complex relationships among race/ethnicity, social determinants, and opioid utilization.

To examine individual- and community-level factors associated with racial/ethnic differences in individuals' opioid prescription use. Outpatient opioid prescription utilization and demographic, socioeconomic, and health characteristics from a nationally representative sample of the US noninstitutionalized civilian population obtained from 2013-2016 Medical Expenditure Panel Survey (MEPS) data and combined with 2012-2016 American Community Survey data and 2015 Health Area Resources File data. We use the Oaxaca-Blinder decomposition method to disaggregate racial/ethnic differences in prescription opioid utilization into differences explained by underlying predisposing, enabling and need characteristics, and unexplained differences. We use restricted-use geographic identifiers to supplement the MEPS data with information on community characteristics and local health care resources. The average annual rate of any outpatient opioid prescription use was higher for non-Hispanic whites (15.8%; standard errors [SE]: 0.3) than for non-Hispanic blacks and Hispanics by 1.4 percentage points (SE: 0.5) and 6.2 percentage points (SE: 0.4), respectively. The smaller difference between non-Hispanic blacks and whites is not explained by the differences in the risk factors, while almost all the difference between Hispanics and non-Hispanic whites can be explained by the differences in the means of the risk factors. The differences in the prevalence of pain, the rate of being United States-born, and the racial/ethnic composition of the community explain 2.4 (SE: 0.2), 1.4 (SE: 0.3), and 1.9 (SE: 0.4) percentage-point differences, respectively. Pain prevalence explains the difference regardless of opioid potency, while foreign-born status and community racial/ethnic composition explain the difference in higher-potency opioid utilization only. This study underscores the importance of accounting for both individual and community characteristics when investigating patterns in opioid use. Our results could assist policy makers in tailoring strategies to promote safer and more effective pain management based on individual and community characteristics.