Prescription Drug Overdose Research Articles

Developing Mindful and Targeted Data Visualizations for Diverse Audiences

Developing Mindful and Targeted Data Visualizations for Diverse Audiences

Do-It-Yourself integration of a paper sensor in a smart lid for medication adherence

Poor adherence to prescription medications causes approximately 125 000 deaths per year while an epidemic of a prescription drug overdose has been on the rise, resulting in an alarming number of deaths, 47 055 in 2014 only in the USA. Efforts from governments to address this issue are technologically inadequate. Once a patient leaves the pharmacy with a prescription drug container, no one, besides the patient, has control over the safe use of drugs. Here, we show a Do-It-Yourself (DIY) integration strategy to monitor drug intake, using a low-cost paper sensor-based flexible electronic system integrated inside the cap of a drug container. This electronic system consists of flexible modular decal sensors connected to a central flexible decal electronic interface, using a DIY compatible integration technique using an anisotropic conductive tape. We find that our DIY integration strategy gives the flexibility to develop customized versions of the system, depending on the requirements for different applications, ranging from ambient sensors to monitor the environment inside the container to security sensors that can detect any kind of mishandling with the prescription container. The add-on system is easy to install or remove, enabling an easy implementation for practical use that will ultimately mitigate drug overuse.

Acute intoxications: markers for screening, diagnosis and therapy monitoring

Acute poisonings account for asignificant proportion of the patient population presenting to intensive care units, whereby mixed drug overdoses and prescription drug overdoses predominate. The aim of this article was to describe indications for screening, diagnosis and therapy monitoring in acute overdoses in the intensive care unit. To conduct this work, aliterature search was carried out and areview was written based on guidelines, case reports, expert opinions and scientific publications. Toxidromes are auseful tool for classification of clinical characteristics when the causative agent is initially unknown. Especially in critical care medicine, identifying and quantifying of the causative toxin by enzyme immunoassays, chromatography and mass spectrometry should be attempted. Intensive care treatment of patients with acute overdoses includes not only monitoring and support of vital functions but also methods for primary and secondary elimination of toxins. The indication for the use of extracorporeal procedures should be carefully evaluated and the method should be chosen based on protein binding and molecular size. Lipid emulsion therapy, high-dose insulin euglycaemia therapy and hyperbaric oxygenation are also increasingly used.

Are the Prescriptions of Psychiatric Patients Who Repeatedly Attempt Suicide Distinctive? A Study Based on a Survey of Prescription Drug Overdose Patients Admitted for Emergency Medical Care

Objectives: Examining the pharmacotherapy of patients who have attempted suicide by overdose could be useful in developing treatment and suicide prevention plans. We surveyed the drugs taken by psychiatric prescription overdose patients who received inpatient treatment and sought to determine the characteristics of patients who repeatedly attempt suicide. Methods: Subjects were 116 patients who attempted suicide by overdose with prescription psychiatric drugs and received inpatient treatment at the Intensive Care Unit of the Emergency and Critical Care Center of Teikyo University Hospital from August 2009 to July 2010. We retrospectively surveyed clinical characteristics, including prescriptions prior to hospitalization and psychiatric diagnosis, divided subjects into a first-admission (FA) and repeatadmission (RA) groups, and compared their clinical characteristics. Results: All subjects were prescribed benzodiazepine-receptor agonists (BZDRAs), whereas antidepressants and antipsychotics were prescribed to 58.6% and 49.1% of subjects, respectively. Emotionally unstable personality disorder, borderline-type (EUPD-B) was found to be significantly more common in the RA group. Comparing prescriptions in the FA and RA groups indicated that the prescribed dosage and prescription rate for antipsychotics were significantly higher for RA group patients. Conclusion: This study revealed that repeat-admission attempted suicide patients had a significantly higher rate of EUPD-B and were more frequently using antipsychotic prescription drugs. Further, in these patients, more frequent use of antipsychotics is believed to correspond to patient impulsivity. The excessive prescription of BZDRAs is a serious problem requiring urgent measures. Research on the prescriptions for overdose patients may lead to clinically significant findings and should be promoted in the future.

Combating Rx Drug Misuse: Incarcerated Women’s Proactive and Reactive Policy Recommendations

Given the rapid increase in prescription (Rx) drug misuse, overdose, and drug-related arrests, the purpose of this study is to identify strategies to combat Rx misuse from the perspective of former Rx drug misusers who are presently incarcerated. Using semi-structured interviews, we elicited such recommendations from 33 incarcerated women in the Midwest with histories of Rx drug misuse. The policy recommendations put forth by the women tended to be proactive rather than reactive and focused upon more vigilant surveillance and prevention efforts by medical professionals. While there was little mention of the criminal justice system or incarceration, women did also advocate for better treatment and rehabilitation options. Users affected by Rx misuse suggested more proactive approaches in dealing with Rx misuse that would ultimately shift drug control responsibilities from law enforcement to doctors.

Themes in published obituaries of people who have died of opioid overdose

This study gauged public perceptions of the opioid epidemic in online obituaries related to opioid overdose by analyzing emotional themes and tones. A thematic analysis was performed on a consecutive listing of online obituaries from the United States. Three hundred electronic obituaries of people who died due to opioid, heroin, and prescription drug overdose, identified in an online obituary platform (Legacy.com) using the keyword “overdose” were used. Tones, emotions, terms used to describe death, and types of opioids were measured using the string search function of Stata and IBM Watson Tone Analyzer. Our analysis showed that joy and sadness are the most prevalent tones in these obituaries (92% and 88%, respectively) and the most common emotion was love (79%). The two most commonly used terms to describe death due to opioid overdose were ‘accidental’ (53%) and ‘addiction’ (34%). The two types of narcotics named were ‘heroin’ (35%) and ‘prescription opioids’ (7.8%). Obituaries of people who have died due to opioid overdose contain main themes of love, joy, and sadness. The fact that stigma and shame were less prevalent themes might suggest support of the concept that addiction should be regarded as a disease rather than a criminal behavior.

Opioid Analgesics in Georgia Medicaid: Trends in Potential Inappropriate Prescribing Practices by Demographic Characteristics, 2009-2014.

There has been a dramatic rise in the number of opioid prescriptions and opioid overdose deaths in the United States over the past 15 years. Misuse and abuse of opioids is also a growing public health concern in the United States. Medicaid enrollees are more likely to be prescribed opioids and are at higher risk of prescription drug overdose compared with non-Medicaid populations. Despite rising opioid drug overdose deaths in Georgia, prevalence of indicators for potential inappropriate prescribing practices has not been examined to date. To examine trends in the general use of opioids and the prevalence of indicators for potential inappropriate opioid prescribing among the Georgia Medicaid population across various demographic characteristics over time. This study used data from the Georgia individual Medicaid pharmacy claims database from 2009 to 2014. Data sample included 3,562,227 observations (patient prescriptions) representing 401,488 individuals. Outcome measures assessed the trends in the general use of opioids and the indicators of potential inappropriate prescribing practices by providers. These outcome measures were taken from previous expert panels and clinical guidelines (e.g., overlapping prescriptions of opioids, opioids and benzodiazepines, and opioids and buprenorphine/naloxone, as well as high daily doses of opioids). Analyses were stratified by gender, type of insurance (fee-for-service and managed care), age, and race/ethnicity. The average number of opioid prescriptions, average days supply of opioids per patient, and average daily dose of opioids per patient increased over time across all demographic categories with older, fee-for-service, male, and missing race groups experiencing higher use across all 6 years compared with their counterparts. A similar pattern was observed for average number of incidences of potential inappropriate prescribing of opioids in this population from 2009 to 2014. The percentage of Medicaid enrollees with at least 1 or more indicators of potential inappropriate prescriptions slightly increased from 17.17% to 18.21% during the study time frame. Moreover, the incidence rate of indicators for potential inappropriate prescribing of opioids also increased over time across all demographic groups, with the oldest age group (55-64 years) experiencing the largest increment. The incidence rate of potential inappropriate prescribing practices per patient increased more than 58% over the 6 years. The results of this study show that potentially inappropriate prescribing practices are common and are increasing over time in the Georgia Medicaid population across all demographic categories, with individuals who are listed in the missing race category, have fee-for-service plans, and are older experiencing the largest increments. These findings indicate that patients in certain demographic groups could be at higher risk for experiencing adverse health outcomes related to inappropriate prescribing of opioids. Further research is needed to explore which policy tools or interventions might be more effective in reducing inappropriate prescribing practices in this population. This research was supported by the National Institute on Drug Abuse of the National Institutes of Health under Award Number R01DA039930 and the Georgia Department of Community Health, contract number 2015012. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Georgia Department of Community Health. The authors have nothing to disclose. A previous version of this paper was presented at the following conferences: International Health Economics Association 12th World Congress; July 8-11, 2017; Boston, MA, and Addiction Health Services Research Conference; October 18-20, 2017; Madison, WI.

Prescription Drug Policing: The Right to Protected Health Information Privacy Pre- and Post-Carpenter

This article operates at the intersection of privacy law, Fourth Amendment doctrine, and public health realities triggered by the United States drug overdose epidemic. Reputable reporting sources, public health scholars, and pundits frequently frame the ongoing American overdose crisis as a prescription drug overdose problem attributable to the overprescribing of opioid analgesics. The problem with this narrative is that it runs counter to the current epidemiological data, which indicate that the majority of American overdose deaths are now a result of illicit drug use and not prescription drug abuse. The prescription-centric frame has nonetheless sparked the rapid rise of law enforcement and regulatory surveillance of prescribers and patients in the form of state prescription drug monitoring program (PDMP) databases. State PDMPs, which maintain and analyze significant data concerning every dispensed prescription, collect a stunning amount of patient protected health information (PHI). To put things in context, Americans filled 4,063,166,658 prescriptions at retail pharmacies in 2017 alone. PDMPs are largely criminal and regulatory law enforcement tools dressed up in public health promoting rhetoric. Under the guise of rogue prescriber, pill mill, and doctor shopper crack downs, the Drug Enforcement Administration (DEA) has made it a routine practice to self-issue administrative subpoenas to conduct warrantless, dragnet-style sweeps of the swarms of sensitive protected health data stored in state PDMP databases. This widespread law enforcement prescribing surveillance tactic, which reveals highly personal health information, including, among other things, patients’ contraceptive histories, gender transition decisions, and HIV diagnoses, raises serious constitutional privacy concerns. The Supreme Court’s recent Fourth Amendment decision, Carpenter v. United States, however, may limit law enforcement’s ability to continue to access droves of electronically-stored patient prescribing-related PHI in the custody of a state regulatory agency without a court order supported by probable cause. The Court’s decision in Carpenter already has been heralded as “a landmark privacy case,” which this article uniquely applies to prescription drug monitoring and law enforcement surveillance tactics provoked by the U.S. overdose crisis and its dominant narrative. Carpenter and the Fourth Amendment doctrines central to its holding motivate this article and animate its two core contentions. First, this article maintains that pertinent pre-Carpenter precedent requires the DEA to obtain a Fourth Amendment warrant in order to conduct sweeps of state PDMP databases searching patient protected health information. It then posits that courts are even more likely to rule that warrantless DEA searches of sensitive and frequently revealing health care data run afoul of the Fourth Amendment in the post-Carpenter world. Simply stated, PDMP protected health information is entitled to Fourth Amendment warrant protection.

Linkage of VA and State Prescription Drug Monitoring Program Data to Examine Concurrent Opioid and Sedative-Hypnotic Prescriptions among Veterans.

To examine the prevalence of concurrent Veterans Health Administration (VA) and non-VA prescriptions for opioids and sedative-hypnotic medications among post-9/11 veterans in Oregon. VA health care and prescription data were probabilistically linked with Oregon Prescription Drug Monitoring Program (PDMP) data. This retrospective cohort study examined concurrent prescriptions among n=19,959 post-9/11 veterans, by year (2014-2016) and by patient demographic and clinical characteristics. Veterans were included in the cohort for years in which they received VA outpatient care; those receiving hospice or palliative care were excluded. Concurrent prescriptions were defined as ≥1days of overlap between outpatient prescriptions for opioids and/or sedative-hypnotics (categorized as benzodiazepines vs. non-benzodiazepines). Among 5,882 veterans who filled opioid or sedative-hypnotic prescriptions at VA pharmacies, 1,036 (17.6 percent) filled concurrent prescriptions from non-VA pharmacies. Within drug class, 15.1, 8.8, and 4.6 percent received concurrent VA and non-VA opioids, benzodiazepines, and non-benzodiazepines, respectively. Veteran demographics and clinical diagnoses were associated with the likelihood of concurrent prescriptions, as was enrollment in the Veterans Choice Program. A considerable proportion of post-9/11 veterans receiving VA care in Oregon filled concurrent prescriptions for opioids and sedative-hypnotics. Fragmentation of care may contribute to prescription drug overdose risk among veterans.

What happens when the insurer can say no? Assessing prior authorization as a tool to prevent high-risk prescriptions and to lower costs

Insurers are increasingly requiring physicians to obtain prior authorization before prescribing drugs that are costly or have high abuse potential. These prior authorization requirements have the potential to reduce risky prescriptions and to lower prescription drug costs, but little is known about their ability to do either. This study estimates the effect of a prior authorization requirement for certain costly and abuse-prone drugs on prescription drug use and costs for work-related injuries in Texas. The findings indicate that the prior authorization requirement reduces the likelihood that claimants receive non-preferred drugs as well as insurers' spending on non-preferred drugs. While there is some substitution to preferred drugs, I do not find evidence of large increases in spending on preferred drugs. The estimated effects on average total pharmacy spending are imprecise, though there is suggestive evidence that the prior authorization requirement reduces the likelihood that a claim has high prescription drug costs. The results provide strong evidence that the prior authorization requirement drastically reduces the likelihood that patients receive combinations of drugs that have contributed disproportionately to the rise in prescription drug overdoses. Despite the success of prior authorization in lowering spending on non-preferred drugs and in reducing high-risk prescriptions, I find little evidence that prior authorization has disproportionately large effects on the most dangerous prescription drug use and only weak, suggestive evidence that it has larger effects on prescription drug use that likely arises because physicians are not fully informed, suggesting that prior authorization requirements do not necessarily target the riskiest drug use.

Evaluating Emergency Department Opioid Prescribing Behaviors After Education About Mandated Use of the Pennsylvania Prescription Drug Monitoring Program.

Prescription drug monitoring programs (PDMPs) are among the most promising state-level interventions to improve opioid prescribing, inform clinical practice, and protect patients at risk for prescription drug misuse, overdose, and death. In 2016, Pennsylvania launched an initiative mandating all prescribers to search the PDMP for each patient when the patient is prescribed controlled substances. The primary aim of this project was to support the Pennsylvania PDMP mandate by educating emergency department (ED) providers regarding the opioid epidemic and use of the PDMP and measure opioid prescriptions posteducation. Secondary aims were to evaluate provider knowledge and identify barriers to PDMP use. This quality improvement project was conducted through a retrospective chart review of patients 18-85 years old discharged from the ED with a chief complaint of pain. A pretest and a posttest measured provider knowledge change after an education program and assessed barriers to PDMP use. Numbers of opioid prescriptions written at discharge were examined. Provider knowledge scores increased significantly (p = .000). Barriers to PDMP use focused on access and process issues. A statistically significant decrease was observed in opioid prescriptions written (p = .002) during the project. An education program increased ED providers' knowledge of the opioid epidemic and the Pennsylvania PDMP mandate and identified barriers to use. A decrease in opioid prescriptions written may have been associated with improved knowledge and suggests that providers can change prescribing behaviors. More research is needed in this area, and future projects may want to focus on prescriber attitudes toward PDMP usefulness.

Personality, High-Risk Behaviors, and Elevated Risk of Unintentional Deaths Related to Drug Poisoning Among Individuals With Spinal Cord Injury

ObjectiveTo identify risk and protective factors for unintentional death related to drug poisoning from prescription medications, including opioid-related deaths, and death due to all other causes among participants with spinal cord injury (SCI). DesignProspective cohort study. SettingLarge specialty hospital in the southeastern United States. ParticipantsTwo cohorts of SCI participants (N=3070) (>18y) with chronic (>1y) traumatic SCI. Cohort 1 was enrolled in 1997-1998 (n=1386), and cohort 2 was enrolled in 2007-2009 (n=1684). InterventionsN/A. Main Outcome MeasuresParticipants completed self-report assessments including multiple behavioral variables (alcohol, smoking, prescription medication), as well as the Zuckerman-Kuhlman Personality Questionnaire (ZKPQ). The primary outcome is unintentional death related to drug poisoning. Mortality status was determined as of December 31, 2014, using the National Death Index. The Centers for Disease Control guidelines were used for classifying participants into 3 groups: (1) unintentional death related to drug poisoning, (2) other death, and (3) alive. ResultsThere were 690 deaths (23%), including 24 unintentional deaths related to drug poisoning (11 from opioids). Binge drinking, medication usage total score, and impulsive-sensation seeking were risk factors for unintentional death related to drug poisoning, whereas the ZKPQ activity scale was protective. Risk factors for other causes of death included older age, greater injury severity, being nonambulatory, regular smoker, medication use total score, and greater neuroticism-anxiety scale scores. ConclusionsUnintentional deaths related to prescription drug overdose are associated with a set of risk factors that differs in meaningful ways from risk of death due to other causes after SCI, and these differences hold the key to prevention strategies.

A proposed SyS Case Definition for Opioid Overdose Related ED visits- an evaluation in three regions

Objective: The objective is to develop a standard opioid overdose case definition that could be generalized nationallyIntroduction: Opioid ODs have been rising globally and nationally. The death rate from ODs in the United States has increased 137% since 2000, including a 200% increase of OD deaths involving opioids1. The pilot project, a collaboration across 3 states, allowed information sharing with Syndromic surveillance (SyS) partners across jurisdictions, such as sharing a standard SyS case definition and verifying its applicability in each jurisdiction. This is a continuation of the work from an initial pilot project presented during the ISDS Opioid OD Webinar series.Methods: Three regions (Colorado North Central Region [CO-NCR]), State of Nebraska [NE], and Marion County, Indiana) participated in the development and evaluation of the opioid OD case definition. Data sources included ESSENCE and 2015 hospital discharge data (HDD) for the first two jurisdictions. Work was conducted in 3 stages. Stage I and II consisted of the development and validation of an opioid misuse definition. In stage I, the percent of completeness of admission date, chief complaint (CC), and discharge diagnosis (DD) was assessed from January 2015 to August 2016 SyS emergency department (ED) data from each of the 3 participating jurisdictions. Data selected for the time period with the best completeness among all jurisdicions was utilized to develop a case definition. Completeness of ESSENCE data submission was assessed at all jurisdicions. The threshold for best data quality was 80% of completeness. SyS ED data was analyzed for the selection of CC search terms and ICD9/ICD102 DD codes, and the reported Chief Complaint-Discharge Diagnosis (CCDD) were validated by analyzing consistency between CC and DD. In stage II, the consistency of DD reporting corresponding to the opioid case definition was assessed for CO-NCR and NE data by performing Pearson Correlation analysis to compare the weekly counts of opioid misuse cases in 2015 SyS ED data to those obtained in HDD. Stage III consisted of the development of an opioid OD case definition that meets the DD code reporting requirements of the Centers for Disease Control and Prevention (CDC), Prescription Drug Overdose Prevention for States awardees. This definition consisted of an ESSENCE query containing CC, and CCDD components. For Stage III, SyS ED data was analyzed for the August 2016 to August 2017 time period. The case definition was evaluated by assessing the consistency between the CC and DD reported for each identified opioid OD possible case. Triage notes were used for case validation.Results: Stage I: Mean percent of completeness of DD codes for CO-NCR, NE and Marion County, IN, 2015 ED SyS data was ≥ 85%. In the CO-NCR, of 963 cases detected by the CC definition, 99.4% had an opioid misuse diagnostic code in the DD, while of 1,445 cases detected by the DD, 66.2 % had an associated opioid misuse in the CC search terms. In NE, of 6 cases detected by the CC definition, 33% identified opioid misuse DD. However, of 42 cases detected by the DD definition, only 5% identified opioid misuse CC search terms. In Marion County, IN, of 95 cases detected by the CC definition, 70% identified opioid related diagnosis codes. Of 191 cases detected by the DD definition, only 20% identified opioid-related CC search terms. Stage II: Results of the Pearson correlation analysis indicate statistically significant correlations between 2015 SyS and HDD data for the DD code based opioid definition for both CO (r = 0.92, p < 0.0001), and NE (r = 0.63, p < 0.0001). Stage III: In NE, 56% of the cases detected by the CC component, identified opioid OD DD codes, and only 8% of the cases detected by the DD component identified opioid OD search terms in the CC. Triage notes were consistent with opioid OD in 55% of the cases detected by the DD component. However, for CO-NCR, of 235 cases detected by the CC component, 215 identified opioid OD DD codes. Of 465 cases detected by the DD component, 46% identified opioid OD search terms in the CC field. Triage notes values were consistent with opioid OD reported DD codes in 80% of the cases.Conclusions: Results suggest that DD codes reported in SyS ED data correlated with HDD data. Indicators of opioid OD signs and symptoms were observed in CCDD. Therefore, the SyS case definition proposed through this pilot project may be applied by other states to support real-time monitoring of opioid OD related hospital ED visits, and consequences of opioid OD. Further study includes exploring how triage notes search terms may improve the identification of opioid OD related ED visits.

State Injury Programs' Response to the Opioid Epidemic: The Role of CDC's Core Violence and Injury Prevention Program.

The Centers for Disease Control and Prevention's (CDC's) Core Violence and Injury Prevention Program (Core) supports capacity of state violence and injury prevention programs to implement evidence-based interventions. Several Core-funded states prioritized prescription drug overdose (PDO) and leveraged their systems to identify and respond to the epidemic before specific PDO prevention funding was available through CDC. This article describes activities employed by Core-funded states early in the epidemic. Four case examples illustrate states' approaches within the context of their systems and partners. While Core funding is not sufficient to support a comprehensive PDO prevention program, having Core in place at the beginning of the emerging epidemic had critical implications for identifying the problem and developing systems that were later expanded as additional resources became available. Important components included staffing support to bolster programmatic and epidemiological capacity; diverse and collaborative partnerships; and use of surveillance and evidence-informed best practices to prioritize decision-making.

Using Controlled Substance Receipt Patterns to Predict Prescription Overdose Death

Background: This study evaluates complete state data from controlled substance prescribing trends in the prescription monitoring program (PMP) database and their association with the risk of prescription drug overdose death. Summary: Maine PMP records of individuals who died of prescription overdose deaths between 2006 and 2010 were selected (n = 690). For each subject, an age, gender, and residence matched cohort of PMP users in a 50: 1 ratio was identified (n = 34,500). Key Messages: Prescription opioids contributed to 480 of 690 prescription deaths, many co-ingestions were noted, and OR for overdose death increased with milligram of morphine equivalent (MME)/day >100. The majority who were prescribed MME >100 per day received a prescription within 90 days of overdose matching the toxicology cause of death. Conclusions: Medication profiles available through state PMP can identify dosing of prescriptions associated with drug overdose death.

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Critical Analysis of White House Anti-Drug Plan.

There is no question that America is experiencing a horrific opiate/opioid epidemic whereby thousands of people are unfortunately dying, and the rate of people seeking treatment is at all -time high. One major problem can be linked to the fact that legal prescriptions for powerful opioid analgesics reached 297 million in 2016. One company that manufactures Oxycontin generated $3.1 billion in revenue in 2017. Moreover, that deaths from prescription drug overdoses have been called the “silent epidemic†for many years.

Using m-health tools to reduce the misuse of opioid pain relievers

BackgroundEmergency department (ED) patients are among the many groups at risk for prescription drug overdose. There is limited research on how best to communicate with ED patients about options for...

More States Should Regulate Pain Management Clinics to Promote Public Health.

The authors reflect on pain management clinics and the need for states to regulate them to promote public health. It states that specific regulation of pain management clinics has only been enacted by 11 states and reports the policies appeared in response to prescribing behaviors that deviated from proper clinical practices. They talk about evidence of effectiveness of these laws in reducing deaths by prescription drug overdose.

Lidocaine Infusion: A Promising Therapeutic Approach for Chronic Pain.

Opioid abuse is a national epidemic in the United States, where it is estimated that a prescription drug overdose death occurs every 19 minutes. While opioids are highly effective in acute and subacute pain control, their use for treatment of chronic pain is controversial. Chronic opioids use is associated with tolerance, dependency, hyperalgesia. Although there are new strategies and practice guidelines to reduce opioid dependence and opioid prescription drug overdose, there has been little focus on development of opioid-sparing therapeutic approaches. Lidocaine infusion has been shown to be successful in controlling pain where other agents have failed. The opioid sparing properties of lidocaine infusion added to its analgesic and antihyperalgesic properties make lidocaine infusion a viable option for pain control in opioid dependent patients. In this review, we provide an overview of the opioid abuse epidemic, and we outline current evidence supporting the potential use of lidocaine infusion as an adjuvant therapeutic approach for management of chronic pain.