Term Opioid Use Research Articles

Prenatal opioid exposure and subsequent risk of neuropsychiatric disorders in children: nationwide birth cohort study in South Korea

SummaryObjectiveTo investigate the potential association between prenatal opioid exposure and the risk of neuropsychiatric disorders in children.DesignNationwide birth cohort study.SettingFrom 1 January 2009 to 31 December 2020, birth cohort data...

Association between opioid utilization and patient-reported outcome measures following lumbar spine surgery

BACKGROUND CONTEXTThe patient-reported outcomes measurement information system (PROMIS), created by the National institute of Health, is a reliable and valid survey for patients with lumbar spine pathology. Preoperative opioid use has been shown to be an important predictor variable of self-reported health status in legacy patient-reported outcome measures. PURPOSETo investigate the impact of chronic preoperative opiate use on PROMIS survey scores. STUDY DESIGNRetrospective database analysis. PATIENT SAMPLEBetween March 2019 and November 2021, 227 patients underwent lumbar decompression ± ≤ 2 level fusion. Fifty-seven patients (25.11%) had chronic preoperative opioid use. OUTCOME MEASURESOswestry disability index (ODI) and PROMIS survey scores. METHODSA retrospective analysis of a prospectively maintained single center patient-reported outcome database was performed with a minimum of 2 year follow-up. PROMIS Anxiety, Depression, Fatigue, Pain Interference (PI), Physical Function (PF), Sleep disturbance (SD), and Social Roles (SR) surveys were recorded at preoperative intake with subsequent follow-up at 6, 12, and 24 months postoperatively. Patients were grouped into chronic opioid users as defined by >6-month duration of use. Differences in mean survey scores were evaluated using Welch t-tests. RESULTSTwo hundred and twenty-seven patients met our inclusion criteria of completed PROMIS surveys at the designated timepoints. A total of 57 (25.11%) were chronic opioid users (COU) prior to surgery. Analysis of patient-reported health outcomes shows that long term opioid use correlated with worse ODI and PROMIS scores at baseline compared to nonchronic users (NOU). At 1 and 2 year follow-up, the COU cohort continued to have significantly worse ODI, PROMIS Fatigue, PF, PI, SD, and SR scores. There is a statistical difference in the magnitude of change in health status between the 2 cohorts at 1 year follow-up in PROMIS Depression (-5.04±7.88 vs -2.49±8.73, p=.042), PF (6.25±7.11 vs 9.03±9.04, p=.019), and PI (-7.40±7.37 vs -10.58±9.87, p=.011) and 2 year follow-up in PROMIS PF (5.58±6.84 vs 7.99±9.64, p=.041) and PI (-6.71±8.32 vs -9.62±10.06, p=.032). Mean improvement in PROMIS scores for the COU cohort at 2 year follow-up exceeded minimal clinically important difference (MCID) in all domains except PROMIS Depression, SR and SD. CONCLUSIONPatients with chronic opioid use status have worse baseline PROMIS scores compared with patients who had nonchronic use. However, patients in the COU cohort displayed clinically significant postoperative improvement in multiple PROMIS domains. These results show that patients with chronic opioid use can benefit greatly from surgical intervention and will allow physicians to better set expectations with their patients.

Long term opioid use after burn injury: a retrospective cohort study

BackgroundPatients who have survive a burn injury might be at risk of opioid dependence after discharge. This study examined the use of opioids in patients who suffer burn injury and explored factors associated with persistent opioid use after hospital discharge. MethodsThis retrospective cohort study compared adults admitted with a burn injury from 2009 to 2019 with two matched comparison cohorts from the general population and adults with a diagnosis of acute pancreatitis. Pre-admission prescription opioid use was determined, and a multivariable negative binomial regression analysis used to explore post-discharge opioid use. ResultsA total of 7147 burn patients were matched with 6810 pancreatitis patients and with 28 184 individuals from the general population. Pre-admission opioid use was higher in the burn and pancreatitis cohorts (29% and 40%, respectively) compared with the general population (17%). Opioid use increased in both burn and pancreatitis cohorts after discharge (41% and 53%, respectively), although patients with pancreatitis were at even higher risk of increased opioid use in an adjusted analysis (incidence rate ratio 1.43). Female sex, lower socioeconomic status, ICU admission, pre-injury opioid use, and a history of excess alcohol use were all associated with an increase in opioid prescriptions after discharge. ConclusionsOpioid use is high in those admitted with a burn injury or acute pancreatitis when compared with the general population, increasing further after hospital discharge. Female sex and socioeconomic deprivation are among factors that make increased opioid use more likely, although this phenomenon seems even more pronounced in those with acute pancreatitis compared with burn injuries.

Opioid Induced Adrenal Insufficiency Complicated by Adrenal Crisis-A Case Report

Introduction: 1 in 5 people experience chronic pain that limits their ability to carry out activities of daily living. Opioid analgesics are one of the pharmaceutical interventions utilized to treat chronic pain. In fact, chronic pain is one of the most common reasons opioids are prescribed. Although many of the secondary effects of opioids are well known, a lesser-known side effect is opioid induced adrenal insufficiency (OIAI). OIAI can cause significant morbidity and has the potential to result in adrenal crisis, profound hypotension, and potential cardiovascular collapse, resulting in death. With sparse literature on OIAI, we present a case of OIAI complicated by adrenal crisis to expand awareness and discussion on the topic. Methods: The patient was a 65-year-old female on chronic opioid therapy for back pain who presented to the emergency room for syncope. On presentation, patient was hypotensive, bradycardic, and had an inadequate fluid response requiring pressors. Traditional etiologies of shock were ruled out, but interestingly morning cortisol and adrenocorticotropic hormone (ACTH) levels were low. Additionally, the cosyntropin stimulation test was suboptimal. Results suggested central hypothalamic pituitary axis suppression, which after discussion with Endocrinology indicated OIAI given the patient’s history. Results: Shortly after steroid regimen initiation the patient was weaned off pressors, and after multiple taper trials was successfully sent home on a steroid taper with Endocrinology follow up. Conclusion: Long term opioid use to treat chronic pain can decrease cortisol production via HPA axis suppression resulting in OIAI. To date, there is limited investigation into OIAI despite its increased prevalence and widespread use of opioids. The case adds to the available literature on OIAI, and sheds light on adrenal crisis as its initial presentation.

70 Burn Injury is Not a Risk Factor for Long-term Opioid Use

Abstract Introduction The United States continues to suffer from a serious epidemic of opioid use. Exposure to opioids is a known risk factor for long-term use and dependence. This is of particular importance to burn care, as opioids are frequently essential to manage the pain associated with burn injuries. The purpose of this study was to characterize opioid use among burn patients after hospitalization and to identify any risk factors for long-term dependence. Methods All patients admitted to a burn center during a single year period (2/1/2020-2/1/21) were examined. Patients who died were excluded. A controlled substance reporting system was utilized to determine opioid use over a time period from 6 months prior to injury and up to 12 months post-hospital discharge. Reporting to this database is mandated by law and therefore includes all prescriptions regardless of prescriber, insurance, location, etc. Duration of opioid use was recorded for all patients in the study. Long-term use was defined as having an active opioid prescription at 12 months post-hospital discharge. Patient demographic information, burn injury characteristics, operative interventions, and hospital course were examined to determine risk factors for long-term opioid use following burn injury. Results A total of 185 patients were included in the study. Patients were predominantly male (76.2%) and had an average age of 47.5 years old. Patients had an average TBSA burn of 9.5% and a length of stay of 6.7 days. A total of 54.7% of patients received an opioid prescription at discharge. Only 17 patients (9.7%) had persistent opioid use at 1 year. The only independent risk factor identified for long term opioid use was pre-injury use (p< 0.001). Among the 17 patients still on opioids at 1 year, 16 had filled 3 or more opioid prescriptions in the 6 months prior to injury. The solitary patient without a pre-existing opioid history had multiple readmissions and delayed operative interventions after their initial hospital course. Conclusions A majority of burn patients received opioids for pain control following hospital discharge. However, the duration of therapy was generally short among opioid naïve patients. Burn injury was not associated with long term opioid use among patients in the study. Applicability of Research to Practice When used judiciously and with caution, opioids can be safely prescribed to burn patients without fear of long-term opioid dependence.

Prolonged Opioid Use following Cervical Spine Fusion Surgeries-Incidence and Predictors of Use

Purpose: To determine the incidence and predictors of prolonged opioid use (OU) following cervical spine fusion surgery. Methods: This is a retrospective cohort study of all patients who underwent cervical arthrodesis for degenerative cervical spine disease over 7 years, between 2010 and 2016, who had at least one year of postoperative follow up at the University of Missouri hospitals. Review of medical records was done to collect data on patient's characteristics, associated pain measures (pre/postoperative VAS), ASA score, and pre/postoperative OU. The predictors of prolonged OU at 3, 6 and 12 months following surgery were identified using the logistic regression analyses. Significance was considered at p<0.05. Results: Incidences of postoperative OU were 50%, 42.5% and 30.2% at 3, 6 and 12 months respectively. After adjustment for all possible confounders, preoperative OU was a significant predictor of postoperative OU at 3 months (OR=3.06, 95% CI: 1.28-7.34, p=0.012), 6 months (OR=2.86, 95% CI: 1.01-8.14, p=0.049) and 12 months (OR=7.22, 95% CI: 2.76-18.90, p<0.001). Patients with cancer diagnosis were 23 times more likely to be prolonged opioid users for 12 months after surgery (OR= 23.13, 95% CI: 1.68-317.98, p=0.019). Conclusion: Perioperative opioid prescription for patients with cervical spine fusion is quite common. Further prospective study is necessary to minimize the effect of confounding variables such as; disease severity, and postoperative functional status on the associations between pre-and postoperative opioid use. Minimizing preoperative opioid use should be investigated as a way to mitigate long–term opioid use.

Eliminating postoperative opioid prescriptions is associated with lower long term opioid use (523)

<b>Objectives:</b> Since postoperative narcotics have been associated with the risk of long-term opioid use, they are no longer prescribed at our institution for patients undergoing robotic surgery for endometrial hyperplasia or endometrial carcinoma. This study compared postoperative narcotic use in the current cohort with a historical cohort who were prescribed postoperative opioids to assess the effect of the change in practice. <b>Methods:</b> We performed a retrospective chart review of 123 patients who underwent a robotic hysterectomy for endometrial hyperplasia or carcinoma. Group 1 patients underwent surgery between August 2017 and February 2018 and received opioid prescriptions. Group 2 underwent surgery between January and June 2020 and did not receive postoperative opioid prescriptions. We reviewed medical records and the New York State Internet System for Tracking Over-Prescribing (I-STOP), which reports all narcotic prescriptions filled in the state in the past 12 months. Narcotic use was assessed in one- month intervals for a total of 12 months after surgery. Demographic information, including diagnosis, histology, adjuvant therapy, insurance, median income based on zip code, and medical comorbid conditions, were collected. Results were analyzed using a hierarchical Bayesian ordinal regression model to determine whether Group 2 had a lower risk of opioid use and to evaluate other possible factors. The variable of interest was the time (months) from surgery to the patient filling an opiate prescription. <b>Results:</b> Group 1 had 57 patients, and Group 2 had 66 patients. There was no significant difference in age, median income, cancer stage, grade, histology, or adjuvant therapy between the groups. Group 1 had significantly more patients with private insurance (93% vs 53% p <0.0001) and fewer patients with favorable CCI scores of 1-4 (70% with vs 50%, p 0.02) compared to Group 2; however, only private insurance remained significant after Bonferroni correction. Prescriptions for opioids were filled more often by patients in Group 1 than Group 2 at immediate postop 0-1 months (79% vs 7%), 1-6 months (14% vs 6%) and 6-12 months (17% vs 6%). Opioid use was significantly higher across all measured time frames in patients who were prescribed postoperative opioids with a mean effect size of -0.99 with a 95% credible interval of -1.93 to -0.11. Lower Grade endometrial cancer was also associated with reduced opioid use with a mean effect size of -2.66 with 95% credible interval of -4.7 to -0.45 for Grade 1 and mean effect size -2.18 with 95% credible interval -4.4 to -0.16 for Grade 2. Fig. 1 <b>Conclusions:</b> Eliminating postoperative opioid prescriptions was associated with a significant decrease in both short- and long-term opioid use. While insurance type varied between the two groups, this was not an independent risk factor. The clinical relevance of the association of grade with opioid use is unclear as there was no association with stage or adjuvant therapy. Limitations of our study are the small sample size and possible confounders, including increasing awareness of the opioid crisis and a change in prescribing practices by other providers over time. This study supports avoiding prescribing opioids in the postoperative period.

Cryoablation is associated with shorter length-of-stay and reduced opioid use after the Ravitch procedure

PurposeThe use of intercostal nerve cryoablation (INC) is becoming increasingly common in patients undergoing pectus repair. This study sought to evaluate the use of INC compared to traditional use of thoracic epidural (TE) in patients undergoing the modified Ravitch procedure. MethodsA retrospective review of 37 patients undergoing the modified Ravitch repair with either INC or TE from March 2009 to July 2021 was conducted. The operations were performed by four surgeons who worked together at four different hospitals and have the same standardized practice. The primary outcome measure was hospital length of stay (LOS). Secondary variables included surgical time, total operating room time, operating room time cost, total hospital cost, inpatient opioid use, long term opioid use after discharge, and post-operative complications. ResultsLOS decreased to 2.8 days in the INC group compared to 6 days in the TE group (p<0.0001). Surgical time and total OR time was increased in the INC group. The INC group experienced significantly lower hospital costs (p<0.01). Total hospital opioid administration was significantly lower in INC group, and there was a significant decrease in long term opioid use in the INC group (p<0.0001). ConclusionsINC is a newer modality that decreases LOS, controls pain, and results in overall cost savings for patients undergoing the modified Ravitch procedure. We recommend that INC be included in the current practice for postoperative pain control in pectus disorder patients undergoing the modified Ravitch procedure.

Systematic review and meta-analysis of opioid use at 3, 6 and 12 months post-operatively by opioid naïve orthopaedic surgery patients.

There is evidence that opioid initiation post-surgery is contributing to the problem of chronic misuse and/or abuse of over the counter medications in the community, and that orthopedic patients may be particularly at risk. The aim of the systematic review with meta-analysis was to identify research that examined opioid use at 3, 6, and 12 months post-operatively by previously opioid naïve orthopedic surgery patients. Design, databases, and data treatment: A searched review with meta-analysis was undertaken. Eight databases were search. Meta-analyses conducted at all three time points (3 months, 6 months, and 12 months). The search yielded 779 records, and after screening, 13 papers were included in meta-analysis. Results provide strong evidence that post-operative opioid use amongst the opioid naïve is a real effect (7 percent at 3 months, 4 percent at 6 months, and 2 percent at 12 months). A Z-test for overall effect revealed strong evidence that this proportion was nonzero for opioid use at 3, 6, and 12 months (p < 0.001 for all time points). A small but significant proportion of opioid naïve patients who are prescribed opioids remain on these medications up to 12 months post-operatively. The nature of the studies included in the meta-analysis were varied, hence subanalyses regarding surgery type, characteristics of the patient group or other potential factors that might influence the progression to longer term opioid use after these surgeries could not be explored. Given this, further research in this area should explore such specific orthopedic subgroups.

The Predictive Value of Degree of Preference for Extended-Release Naltrexone for Treatment Adherence, Opioid Use, and Relapse

Background: Extended-release naltrexone (XR-NTX) is effective for illicit opioid abstinence as an opioid maintenance treatment. To improve treatment outcomes, patient’s preference for the modality of treatment is an important factor. Objectives: We aimed to test the relationship between baseline preference for XR-NTX and adherence to treatment, use of illicit opioids, and risk of relapse. Methods: In an open-label, Norwegian clinical trial participants with opioid use disorder were randomized to either monthly injections with XR-NTX or daily sublingual buprenorphine-naloxone (BP-NLX) for 12 weeks. Subsequently, participants could continue with their preferred medication in a 36-week follow-up and in a prolonged period of 104 weeks. Results: Of 153 participants who completed detoxification, 72% were men, with a mean age of 36 years. Preference levels were similar across the randomized groups, with no significant associations between preference and adherence to treatment, opioid use, or relapse. The BP-NLX group had a significantly higher risk of first relapse to opioids than the XR-NTX group for all levels of preference (p < 0.001) and a significantly higher number of days of illicit opioid use. In the follow-up period, the adherence rate was twice as high among participants with the highest preference compared to participants with the lowest preference, both among those who switched to XR-NTX and those who continued (hazard ratio 2.2; 1.2–4.0, p = 0.013). Opioid use was significantly higher among participants who switched to XR-NTX with the lowest preference than the medium (p = 0.003) or the highest (p = 0.001) preference. The risk of relapse to opioids, however, was significantly higher among XR-NTX continuing participants with the lowest (p = 0.002) or the medium (p = 0.043) preference than those with the highest preference. Conclusions: Individuals who matched with their preferred treatment used less illicit opioids than those who did not during short-term treatment. However, baseline preference for XR-NTX treatment primarily influenced longer term opioid use and treatment adherence.

Long-Term Opioid Use in Post-Surgical Management of Patients With Head and Neck Cancer.

This study aims to identify clinical and socioeconomic factors associated with long-term, post-surgical opioid use in the head and neck cancer population. A single center retrospective study was conducted including patients diagnosed with head and neck cancer between January 1, 2014 and July 1, 2019 who underwent primary surgical management. The primary outcome measure was continued opioid use 6 months after treatment completion. Both demographic and cancer-related variables were recorded to determine what factors were associated with prolonged opioid use. Univariate analysis was performed using chi-squared test for categorical variables and 2-sample t-test for continuous variables. Multivariate analysis was performed using logistic regression. A total of 359 patients received primary surgical management. Forty-five patients (12.53%) continued to take opioids 6 months after treatment completion. Using univariate analysis, patients less than 65 years of age (P = .0126), adjuvant chemoradiation (n = 25, P < .001), and overall length of hospital stay (8.60 ± 8.58 days, P = .0274) were significantly associated with long term opioid use. Multivariate logistic regression showed that adjuvant chemoradiation (OR = 3.446, 95% CI [1.742, 6.820], P = .0004) and overall length of hospital stay (OR = 0.949, 95% CI [0.903, 0.997], P = .0373) to be significantly associated with opioid use 6 months after head and neck cancer treatment. Long-term postoperative opioid use in head and neck cancer patients is significantly associated with adjuvant chemoradiation, and patients with longer length of hospital stay. Therefore, future research should focus on interventions to better manage opioid use during the acute treatment period to decrease long-term use.

The association of gender and persistent opioid use following an acute pain event: A retrospective population based study of renal colic

This study aims to explore gender-related differences in persistent opioid use following an acute pain episode and evaluate potential explanatory variables. This retrospective population-based study using administrative databases included all opioid-naïve patients in Ontario with renal colic between 2013 and 2017. The primary outcome was to assess any association between persistent opioid use at 3-6 months by gender. Key confounding covariates and explanatory variables examined included both care- and patient-related factors, specifically past evidence of mental health diagnoses. The dataset of 64,240 males and 37,656 females demonstrated that 8.7% of males and 9.6% of females had evidence of persistent opioid use 3-6 months after presentation (OR 1.11, 95% CI 1.05, 1.17). Females had a higher incidence of mental health services utilization [44.5% vs 29.6% (p<0.001)] and were more likely to be on a provincial disability program [5.1% vs 3.8% (p<0.001)]. Age, income quintile, mental health diagnoses and dose of opioid prescribed were associated with the primary outcome in both genders. On adjusted analysis for multiple confounding and explanatory variables, females were still more likely than males to demonstrate persistent opioid use (OR 1.07, 95% CI 1.01, 1.13) with even more pronounced associations at 1-2 years. After controlling for key covariates, females are at slightly higher risk of demonstrating long term opioid use following an episode of renal colic. Evidence of prior mental health service utilization and acute colic care did not appear to significantly explain these observations.

Practical Strategies Using Medical Cannabis to Reduce Harms Associated With Long Term Opioid Use in Chronic Pain.

Background: Chronic non-cancer pain (CNCP) is estimated to affect 20% of the adult population. Current United States and Canadian Chronic non-cancer pain guidelines recommend careful reassessment of the risk-benefit ratio for doses greater than 90 mg morphine equivalent dose (MED), due to low evidence for improved pain efficacy at higher morphine equivalent dose and a significant increase in morbidity and mortality. There are a number of human studies demonstrating cannabis opioid synergy. This preliminary evidence suggests a potential role of cannabis as an adjunctive therapy with or without opioids to optimize pain control. Methods: In 2017, the Canadian Opioid Guidelines Clinical Tool was created to encourage judicious opioid prescribing for CNCP patients and to reevaluate those who have been chronically using high MED. Mirroring this approach, we draw on our clinical experiences and available evidence to create a clinical tool to serve as a foundational clinical guideline for the initiation of medical cannabis in the management of CNCP patients using chronic opioid therapy. Findings: Following principles of harm reduction and risk minimization, we suggest cannabis be introduced in appropriately selected CNCP patients, using a stepwise approach, with the intent of pain management optimization. We use a structured approach to focus on low dose cannabis (namely, THC) initiation, slow titration, dose optimization and frequent monitoring. Conclusion: When low dose THC is introduced as an adjunctive therapy, we observe better pain control clinically with lower doses of opioids, improved pain related outcomes and reduced opioid related harm.

479 - Long Term Opioid Use in Patients with Hematologic Malignancies Undergoing Hematopoietic Stem Cell Transplantation

479 - Long Term Opioid Use in Patients with Hematologic Malignancies Undergoing Hematopoietic Stem Cell Transplantation

Stringent Control of Opioids: Sound Public Health Measures, but a Step Too Far in Palliative Care?

Opioids are the only class of drug with the proven ability to control severe pain. The introduction of stringent opioid prescribing restrictions has inevitably impacted upon the ability of those prescribing opioids for advanced life-limited disease to practice as previously and could limit the supply of adequate pain relief to patients with cancer. This review considers the evidence that symptom management of patients with advanced cancer contributes to the "opioid problem" and whether there is adequate recognition of the risks involved. The literature suggests that the risk of opioid abuse is low in the palliative care population as is the risk of legal consequences for doctors prescribing opioids at the end of life. However, as many patients with cancer are living longer or surviving with chronic pain, palliative care physicians must be cognisant not only of the risks of long term opioid use but also of the risk of opioid misuse. Adherence to evidence or consensus-based guidelines is necessary to avoid inappropriate prescribing. In palliative care, it is appropriate not only to exercise a reasonable degree of opioid control and surveillance, primarily for the good of society, but also to ensure that the ability to treat pain in patients with advanced malignant disease is not compromised.

Abstract TP452: Long Term Opioid Use in Patients With Aneurysmal Subarachnoid Hemorrhage

Background: Headache and neck pain are common in patients with aneurysmal subarachnoid hemorrhage (aSAH) throughout their course. Because pain is often a sequela, these patients are at risk for opioid dependence. Long term opioid use has not been well studied in this population. Methods: We analyzed a cohort of consecutive patients who were admitted with diagnosis of aSAH to an academic referral center from 2015 to 2018. We excluded patients who died during hospitalization or were discharged to hospice or were previously taking any opioids. The following variables were collected: demographics, any opioid use during hospitalization, short-term low-dose steroid use (mostly for headache management but some cases for immediate post craniotomy for aneurysm clipping), opioid prescription at the time of discharge and 3-month or longer opioid use verified by pharmacy and any follow up out patient records. Results: Of 200 patients with aSAH, 144 patients (72%) met our inclusion criteria. Mean age was 58 years (SD 14.8); Ninety-four patients (65%) were women; All patients received opioids at some point during hospitalization but 66% (96/144) were discharged with opioid prescription. Of these, 31% (30/96) continued to use opioids at ≥3 months. The overall rate of chronic opioid use was 20% (30/144). The rate of opioid prescription at discharge was 72% (52/72) in patients who received short course steroids and 61% (44/72) in patients who did not receive steroids. (p=0.21; OR 2.6, 95% CI 0.82-3.3). Steroids did not prevent long term opioid use. (p=0.30; OR 0.6, 95% CI 0.26-1.3) Conclusion: Opioids are regularly used as the main treatment option for pain control in patients with aSAH. A noteworthy number of patients continue to use opioids beyond their initial hospitalization. Steroid use does not prevent long term opioid use in these patients. Non-opioid pain control strategies should be explored in the future.

Diagnosis of opioid use disorder with high sensitivity and specificity by advanced computational analysis of Fourier transform infrared spectroscopy

Opioid use disorder (OUD), which is a chronic disease and widespread public health problem results in death of the patient in the early period. The consumption of opioid depending on the use disorder time, affects blood biochemical parameters. OUD diagnosis can be clinically determined from biochemical values and with the screening tools in substance abuse. However, long-term OUD causes multiple pathological and physiological changes in many organs. Opioid initiated diseases, such as changes in tissue level and molecular level can be detected with advanced diagnostic methods after a long period of usage. It is important to diagnose these changes without causing organ dysfunction. The tests for the diagnose of chronic effects of OUD are expensive and time-consuming. In this study, we used Fourier transform infrared (FTIR) spectroscopy to discriminate the whole blood samples of opioid-addicted patients (n = 20) from healthy persons (n = 14) with an average addiction period of for 8 ± 5.8 years. We purposed to compare whole blood vibrational results of OUD and HC. In order to identify absorption bands on structures of proteins, lipids and nucleic acids, their corresponding absorbance of band spectra were measured. We had chosen following bands 2959, 2931, 1646, 1550, 1453, 1400, 1314, 1243, 1080, 1079, 1542, 1045, 1467 to identify peak heights and to compare peak height ratios such as H1646 to H1550, H1079 to H1542, H2959 to H2931, H1453 to H1400, H1314 to H1243, H1045 to H1467, H1080 to H1550. Statistically, the p value of group heights were significantly different (p < 0.001). As a chemometric method, features extracted by principal component analysis (PCA) and then classified by linear discriminate analysis (LDA) and support vector machine (SVM) to determine the spectral data of disorder zones. The confidence of specificity and sensitivity and accuracy were obtained as 93.33%, 85%, 80.57% in raw data, and 100%, 100% and 100% in the second derivative respectively. Our research illustrates that whole blood analyses by FTIR, on the selected peak heights may discriminate pathological and healthy structural changes induced long term opioid use disorder.Thus, we have demonstrated that infrared spectroscopy can provide a simple and available diagnostic test for OUD patients.

Multimodal Analgesia for Perioperative Management of Patients presenting for Spinal Surgery.

Multimodal, non-opioid based analgesia has become the cornerstone of ERAS protocols for effective analgesia after spinal surgery. Opioid side effects, dependence and legislation restricting long term opioid use has led to a resurgence in interest in opioid sparing techniques. The increasing array of multimodal opioid sparing analgesics available for spinal surgery targeting novel receptors, transmitters, and altering epigenetics can help provide an optimal perioperative experience with less opioid side effects and long-term dependence. Epigenetic mechanisms of pain may enhance or suppress gene expression, without altering the genome itself. Such mechanisms are complex, dynamic and responsive to environment. Alterations that occur can affect the pathophysiology of pain management at a DNA level, modifying perceived pain relief. In this review, we provide a brief overview of epigenetics of pain, systemic local anesthetics and neuraxial techniques that continue to remain useful for spinal surgery, neuropathic agents, as well as other common and less common target receptors for a truly multimodal approach to perioperative pain management.

84. Incidence and predictors of long-term opioid use following cervical spine fusion surgery

BACKGROUND CONTEXT Over the past 10 years, opioid expenditures for spine-related pain increased dramatically in USA. Orthopedic surgery has been reported as the third highest opioid-prescribing specialty, in patients older than 40 years old. PURPOSE The aim of this study was to determine the incidence of opioid use (OU) following cervical spine fusion surgery, and to identify the predictors of prolonged opioid use at 3 months, 6 months and 12 months following surgery. STUDY DESIGN/SETTING A retrospective cohort study at University of Missouri hospitals. PATIENT SAMPLE All patients who underwent cervical arthrodesis for degenerative cervical spine disease over 7 years, between 2010 and 2016, who had at least one year of postoperative follow up at the University of Missouri hospitals. OUTCOME MEASURES Incidence of pre- and postoperative opioid prescriptions and predictors of long-term postoperative opioid use. METHODS Patients’ medical records were examined to collect data on the following: patient's characteristics (age, sex, race, monthly income, occupation, BMI, smoking behavior, comorbidities) associated pain measures (pre/postoperative VAS), ASA score, and pre/postoperative OU. Logistic regression analyses were applied to identify the predictors of prolonged OU at intervals following surgery. Significance was considered at p RESULTS Opioid use was shown in 46.9% of patients before operation, of whom 68.1%, 60.9%, and 50.7% remained on OU at 3, 6 and 12 months following surgery. Incidences of postoperative OU were 50%, 42.5% and 30.2% at 3, 6 and 12 months. Preoperative use was significantly associated with postoperative use at 3 months (X 2 =18.2, p CONCLUSIONS Perioperative opioid prescription for patients with cervical spine fusion is quite common. Minimizing preoperative opioid use should be investigated as a way to mitigate long–term OU. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Opioid-mediated Sertoli cells apoptosis is involved in testicular homeostasis and/or reproductive dysfunction.

The opioid system may exert positive direct and/or indirect effects on spermatogenesis at multiple levels including the levels of the central nervous system and at the testes/sperm levels. However, long term opioid use could be associatedwith several reproductive complications that place the users at risk of hypogonadism and even infertility. There is little available information regarding the contribution of opioids and their apoptotic effects on testis Sertoli cells. Here, the effects of DAMGO (mu opioid receptor's agonist), DPDPE (delta opioid receptor's agonist) and DYN 1-9 (kappa opioid receptor's agonist) on Sertoli cell viability and apoptosis were investigated. Cultured Sertoli cells were exposed to each agonist (0.1-100 µM, for 24 or 48 hours) and their apoptotic effects were investigated. Cell viability was decreased and apoptosis was increased in the cells exposed to DAMGO in a concentration-dependent manner, while in the cells exposed to DPDPE, no significant changes were observed. In cells exposed to DYN 1-9, the viability did not significantly change, however apoptosis increased significantly, following the exposure to the high concentration of DYN 1-9. These data suggest that mu and Kappa, but not delta receptors mediated apoptosis in Sertoli cells may be involved, at leastin part, in testicular homeostasis and/or reproductive dysfunction (Tab. 1, Fig. 3, Ref. 52).