Research

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9 pages, 712 KiB

Open AccessArticle

Association between Initial Opioid Prescription and Patient Pain with Continued Opioid Use among Opioid-Naïve Patients Undergoing Elective Surgery in a Large American Health System

by Abass Babatunde, Lior Rennert, Kevin B. Walker, Douglas L. Furmanek, Dawn W. Blackhurst, Vito A. Cancellaro, Alain H. Litwin and Kerry A. Howard

Int. J. Environ. Res. Public Health 2023, 20(10), 5766; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph20105766 - 09 May 2023

Cited by 1 | Viewed by 1618

Abstract

There is growing concern about the over-prescription of opioids and the risks of long-term use. This study examined the relationship between initial need (pre-operative, post-operative, and discharge pain) and dosage of opioids in the first prescription after surgery with continued opioid use through [...] Read more.

There is growing concern about the over-prescription of opioids and the risks of long-term use. This study examined the relationship between initial need (pre-operative, post-operative, and discharge pain) and dosage of opioids in the first prescription after surgery with continued opioid use through opioid refills over 12 months, while considering patient-level characteristics. A total of 9262 opioid-naïve patients underwent elective surgery, 7219 of whom were prescribed opioids following surgery. The results showed that 17% of patients received at least one opioid refill within one year post-surgery. Higher initial opioid doses, measured in morphine milligram equivalent (MME), were associated with a greater likelihood of continued use. Patients receiving a dose greater than 90 MME were 1.57 times more likely to receive a refill compared to those receiving less than 90 MME (95% confidence interval: 1.30–1.90, p < 0.001). Additionally, patients who experienced pain before or after surgery were more likely to receive opioid refills. Those experiencing moderate or severe pain were 1.66 times more likely to receive a refill (95% confidence interval: 1.45–1.91, p < 0.001). The findings highlight the need to consider surgery-related factors when prescribing opioids and the importance of developing strategies to balance the optimization of pain management with the risk of opioid-related harms. Full article

(This article belongs to the Special Issue Evidence-Based Evaluation of Opioid Prescribing Practices)

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12 pages, 1003 KiB

Open AccessArticle

Annual Prevalence of Opioid Receipt by South Carolina Medicaid-Enrolled Children and Adolescents: 2000–2020

by William T. Basco, Jr., David G. Bundy, Sandra S. Garner, Myla Ebeling and Kit N. Simpson

Int. J. Environ. Res. Public Health 2023, 20(9), 5681; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph20095681 - 28 Apr 2023

Viewed by 1290

Abstract

Understanding patterns of opioid receipt by children and adolescents over time and understanding differences between age groups can help identify opportunities for future opioid stewardship. We conducted a retrospective cohort study, using South Carolina Medicaid data for children and adolescents 0–18 years old [...] Read more.

Understanding patterns of opioid receipt by children and adolescents over time and understanding differences between age groups can help identify opportunities for future opioid stewardship. We conducted a retrospective cohort study, using South Carolina Medicaid data for children and adolescents 0–18 years old between 2000–2020, calculating the annual prevalence of opioid receipt for medical diagnoses in ambulatory settings. We examined differences in prevalence by calendar year, race/ethnicity, and by age group. The annual prevalence of opioid receipt for medical diagnoses changed significantly over the years studied, from 187.5 per 1000 in 2000 to 41.9 per 1000 in 2020 (Cochran–Armitage test for trend, p < 0.0001). In all calendar years, older ages were associated with greater prevalence of opioid receipt. Adjusted analyses (logistic regression) assessed calendar year differences in opioid receipt, controlling for age group, sex, and race/ethnicity. In the adjusted analyses, calendar year was inversely associated with opioid receipt (aOR 0.927, 95% CI 0.926–0.927). Males and older ages were more likely to receive opioids, while persons of Black race and Hispanic ethnicity had lower odds of receiving opioids. While opioid receipt declined among all age groups during 2000–2020, adolescents 12–18 had persistently higher annual prevalence of opioid receipt when compared to younger age groups. Full article

(This article belongs to the Special Issue Evidence-Based Evaluation of Opioid Prescribing Practices)

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13 pages, 846 KiB

Open AccessArticle

Emergency Department Alternatives to Opioids: Adapting and Implementing Proven Therapies in Practice

by Sarah B. Floyd, Sam NcGarby, Susan Cordero Romero, Sam Garrison, Kevin Walker, William Hendry and Phillip C. Moschella

Int. J. Environ. Res. Public Health 2023, 20(2), 1206; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph20021206 - 10 Jan 2023

Viewed by 1645

Abstract

The use of opioids to treat pain can increase the risk of long-term opioid dependency and is associated with negative patient outcomes. The objective of this study was to present the initial results following the implementation of Emergency-Department Alternatives to Opioids (ED-ALTO), a [...] Read more.

The use of opioids to treat pain can increase the risk of long-term opioid dependency and is associated with negative patient outcomes. The objective of this study was to present the initial results following the implementation of Emergency-Department Alternatives to Opioids (ED-ALTO), a program that encourages the use of non-narcotic medications and procedures to treat pain in the Emergency Department (ED). We used a pre- and post-implementation study design to compare in-ED opioid utilization, as well as ED-ALTO medication and procedure use in the year before and after the program’s implementation. After ED-ALTO’s implementation, there was a decrease in opioid utilization in the ED and an increase in ED-ALTO medication use. Additionally, there was an increase in ED-ALTO procedure utilization and the complexity of conditions treated with ED-ALTO procedures, including the use of regional nerve blocks for shoulder dislocations and hip and rib fractures. In 8 of the 12 months following ED-ALTO’s implementation, a lower proportion of patients receiving ED-ALTO procedures received an opioid, and the opioid dosage was lower compared to patients with the same diagnoses who received standard care. The continued expansion of ED-ALTO programs across the US may serve as a mechanism to reduce opioid utilization and safely and successfully treat pain in ED settings. Full article

(This article belongs to the Special Issue Evidence-Based Evaluation of Opioid Prescribing Practices)

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8 pages, 555 KiB

Open AccessArticle

Impact of Impulsivity, Hyperactivity, and Inattention on Discontinuation Rate among Opioid-Dependent Patients Treated with Extended-Release Naltrexone

by Ann Tarja Karlsson, John-Kåre Vederhus, Thomas Clausen, Bente Weimand, Kristin Klemmetsby Solli and Lars Tanum

Int. J. Environ. Res. Public Health 2022, 19(18), 11435; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph191811435 - 11 Sep 2022

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Abstract

Previous studies have indicated elevated levels of impulsivity, hyperactivity, and inattention (IHI) among opioid-dependent patients seeking outpatient treatment with extended-release naltrexone (XR-NTX). This led us to hypothesize that IHI may be associated with a higher discontinuation rate for XR-NTX treatment. In a group [...] Read more.

Previous studies have indicated elevated levels of impulsivity, hyperactivity, and inattention (IHI) among opioid-dependent patients seeking outpatient treatment with extended-release naltrexone (XR-NTX). This led us to hypothesize that IHI may be associated with a higher discontinuation rate for XR-NTX treatment. In a group of 162 patients with opioid dependence, discontinuation prior to the full 24 weeks of the study period (six injections and attending the study visit at 24 weeks) occurred in 49% of the patients, primarily in the early stage of treatment. IHI above the clinical cut-off on the adult ADHD self-report scale (ASRS) was not associated with a risk of premature discontinuation. This finding was not altered when controlling for socio-demographics, substance, use and mental health severity. Conclusively, high levels of IHI per se is not contradictive for XR-NTX treatment in regard to concern for premature discontinuation. Full article

(This article belongs to the Special Issue Evidence-Based Evaluation of Opioid Prescribing Practices)

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21 pages, 479 KiB

Open AccessArticle

Assessing Opioid Use Disorder Treatments in Trials Subject to Non-Adherence via a Functional Generalized Linear Mixed-Effects Model

by Madeleine St. Ville, Andrew W. Bergen, James W. Baurley, Joe D. Bible and Christopher S. McMahan

Int. J. Environ. Res. Public Health 2022, 19(9), 5456; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19095456 - 29 Apr 2022

Viewed by 1364

Abstract

The opioid crisis in the United States poses a major threat to public health due to psychiatric and infectious disease comorbidities and death due to opioid use disorder (OUD). OUD is characterized by patterns of opioid misuse leading to persistent heavy use and [...] Read more.

The opioid crisis in the United States poses a major threat to public health due to psychiatric and infectious disease comorbidities and death due to opioid use disorder (OUD). OUD is characterized by patterns of opioid misuse leading to persistent heavy use and overdose. The standard of care for treatment of OUD is medication-assisted treatment, in combination with behavioral therapy. Medications for opioid use disorder have been shown to improve OUD outcomes, including reduction and prevention of overdose. However, understanding the effectiveness of such medications has been limited due to non-adherence to assigned dose levels by study patients. To overcome this challenge, herein we develop a model that views dose history as a time-varying covariate. Proceeding in this fashion allows the model to estimate dose effect while accounting for lapses in adherence. The proposed model is used to conduct a secondary analysis of data collected from six efficacy and safety trials of buprenorphine maintenance treatment. This analysis provides further insight into the time-dependent treatment effects of buprenorphine and how different dose adherence patterns relate to risk of opioid use. Full article

(This article belongs to the Special Issue Evidence-Based Evaluation of Opioid Prescribing Practices)

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13 pages, 422 KiB

Open AccessArticle

Effects of Buprenorphine Dose and Therapeutic Engagement on Illicit Opiate Use in Opioid Use Disorder Treatment Trials

by Andrew W. Bergen, James W. Baurley, Carolyn M. Ervin, Christopher S. McMahan, Joe Bible, Randall S. Stafford, Seshadri C. Mudumbai and Andrew J. Saxon

Int. J. Environ. Res. Public Health 2022, 19(7), 4106; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19074106 - 30 Mar 2022

Cited by 5 | Viewed by 2837

Abstract

The impact of agonist dose and of physician, staff and patient engagement on treatment have not been evaluated together in an analysis of treatment for opioid use disorder. Our hypotheses were that greater agonist dose and therapeutic engagement would be associated with reduced [...] Read more.

The impact of agonist dose and of physician, staff and patient engagement on treatment have not been evaluated together in an analysis of treatment for opioid use disorder. Our hypotheses were that greater agonist dose and therapeutic engagement would be associated with reduced illicit opiate use in a time-dependent manner. Publicly-available treatment data from six buprenorphine efficacy and safety trials from the Federally-supported Clinical Trials Network were used to derive treatment variables. Three novel predictors were constructed to capture the time weighted effects of buprenorphine dosage (mg buprenorphine per day), dosing protocol (whether physician could adjust dose), and clinic visits (whether patient attended clinic). We used time-in-trial as a predictor to account for the therapeutic benefits of treatment persistence. The outcome was illicit opiate use defined by self-report or urinalysis. Trial participants (N = 3022 patients with opioid dependence, mean age 36 years, 33% female, 14% Black, 16% Hispanic) were analyzed using a generalized linear mixed model. Treatment variables dose, Odds Ratio (OR) = 0.63 (95% Confidence Interval (95%CI) 0.59–0.67), dosing protocol, OR = 0.70 (95%CI 0.65–0.76), time-in-trial, OR = 0.75 (95%CI 0.71–0.80) and clinic visits, OR = 0.81 (95%CI 0.76–0.87) were significant (p-values < 0.001) protective factors. Treatment implications support higher doses of buprenorphine and greater engagement of patients with providers and clinic staff. Full article

(This article belongs to the Special Issue Evidence-Based Evaluation of Opioid Prescribing Practices)

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12 pages, 597 KiB

Open AccessArticle

Healthcare Professional Students’ Perspectives on Substance Use Disorders and Stigma: A Qualitative Study

by Alina Cernasev, Kiki M. Kline, Rachel Elizabeth Barenie, Kenneth C. Hohmeier, Steven Stewart and Shandra S. Forrest-Bank

Int. J. Environ. Res. Public Health 2022, 19(5), 2776; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19052776 - 27 Feb 2022

Cited by 4 | Viewed by 2636

Abstract

Background: Access to and quality of care for Substance Use Disorders (SUDs) remain a major public health issue. Stigma associated with SUDs contributes to the gap between the number of patients who need treatment and the much smaller fraction that receive it. Healthcare [...] Read more.

Background: Access to and quality of care for Substance Use Disorders (SUDs) remain a major public health issue. Stigma associated with SUDs contributes to the gap between the number of patients who need treatment and the much smaller fraction that receive it. Healthcare professional students are future care providers; an opportunity exists to characterize their collective perspectives on patients with SUDs and how that informs the care they provide. Methods: Healthcare professional students participated in online, semi-structured focus group (FGs) between March and April 2021. The FGs were conducted until thematic saturation was achieved. All verbatim transcripts were analyzed applying Thematic Analysis using Dedoose^® qualitative software. Inductive codes were grouped into categories based on similarities that facilitated the emergence of themes. Results: Thematic Analysis revealed one theme (1) Decreasing stigma among healthcare professionals by viewing substance use disorder as a disease; and two sub-themes: Subtheme 1a: Relating with the patients, “It could be me…”; Subtheme 1b: Interactions with patients, “We just don’t know exactly how to counsel these patients…” These themes describe how future healthcare professionals might perceive and approach patients with SUDs and highlight the importance of SUD training in the curriculum. Conclusion: Medical and pharmacy students are uniquely positioned to apply critical thinking from their didactic training to their real-world clinical experiences, and their collective perspectives inform gaps in training and opportunities to develop best practices for SUD care. An opportunity exists to leverage these findings in order to train future healthcare professionals to ensure access to and quality of SUD care. Full article

(This article belongs to the Special Issue Evidence-Based Evaluation of Opioid Prescribing Practices)

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Review

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11 pages, 516 KiB

Open AccessReview

The Association between Early Opioids Prescribing and the Length of Disability in Acute Lower Back Pain: A Systematic Review and Narrative Synthesis

by Ayman R. Ibrahim, Mohamed E. Elgamal, Moaz O. Moursi, Bara A. Shraim, Muath A. Shraim, Mujahed Shraim and Basem Al-Omari

Int. J. Environ. Res. Public Health 2022, 19(19), 12114; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph191912114 - 25 Sep 2022

Cited by 2 | Viewed by 1735

Abstract

Background: There is conflicting evidence with respect to whether early opioid prescribing (EOP) within the first two weeks of acute Low Back Pain (LBP) onset is associated with the length of disability (LOD). The aim of this systematic review was to examine the [...] Read more.

Background: There is conflicting evidence with respect to whether early opioid prescribing (EOP) within the first two weeks of acute Low Back Pain (LBP) onset is associated with the length of disability (LOD). The aim of this systematic review was to examine the relationship between EOP and LOD in individuals with acute LBP. Methods: A systematic search of Medline, EMBASE, and CINAHL was conducted. The Newcastle–Ottawa scale was used to assess the methodological quality of included studies. A narrative synthesis of findings was used owing to between-study heterogeneity. Results: Six cohort studies using workers’ compensation administrative data on 178,130 adults with LBP were included. Most studies were of good methodological quality. One study reported that LBP cases with EOP had higher LOD by 4 days than cases without EOP. Two studies reported that each 100 mg morphine equivalent amount (MEA) was associated with an increase in mean LOD by 0.4 day (95% confidence interval (CI): 0.3, 0.5) and 0.4 day (95% CI: 0.3, 0.4). One study showed that LBP cases with EOP had a higher hazard of continuation of time loss benefits by 1.94 (95% CI 1.86, 2.02). One study reported a dose–response relationship between MEA of EOP and LOD ranging between 5.2 days (95% CI 14.6, 25.0) for 1–140 mg MEA and 69.1 (95% CI 49.3, 89.0) for 450+ mg MEA. One study reported that LBP cases with EOP had a higher mean LOD by 3.8 days, but there was no statistically significant relationship between EOP and LOD (Hazard ratio 1.02; 95% CI 0.91, 1.13). Conclusions: The use of early opioid in the management of acute uncomplicated LBP is associated with prolonged disability duration. Further research on factors influencing inadequate adherence to evidence-based guidelines and optimal strategies to modify such factors may improve disability outcomes among patients presenting with acute LBP. Full article

(This article belongs to the Special Issue Evidence-Based Evaluation of Opioid Prescribing Practices)

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