Journal of Opioid Management

Tianeptine, an antidepressant and full µ-opioid receptor agonist, has increased in popularity and has been used as an over-the-counter supplement over the past decade. Due to its well-documented euphoric effects, there exists elevated risk for potential abuse. Buprenorphine-naloxone has been successfully utilized to treat opioid use disorder (OUD) in patients concurrently using tianeptine, limiting withdrawal symptoms and abstinence. However, there is limited evidence on the management of tianeptine use disorder, specifically methadone or naltrexone...

INTRODUCTION: Orthopedic surgical procedures are expected to increase annually, making it imperative to understand the correlations between patient genetic makeup and post-operative pain levels. METHODS: We performed a systematic literature review using PubMed and Cochrane databases in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 299 articles were initially selected, 20 articles remained after title and abstract review, and nine articles were selected for inclusion upon full text review...

OBJECTIVE: To examine recent literature and determine common clinical risk factors between antecedent traumatic brain injury (TBI) and the following development of opioid misuse and provide a framework for clinical identification of at-risk subjects and evaluate potential treatment implications within this association. DESIGN: A comprehensive systematic literature search of PubMed was conducted for articles between 2000 and December 2022. Studies were included if the human participant had any head trauma exposure and any chronic opioid use or dependence...

INTRODUCTION: Pain is one of the most common complaints that brings a patient to a hospital. For this, usually, the patient might have already consumed various types of pain killer combinations, either prescribed or over-the-counter. In some of these cases, a patient consumes these medicines unmonitored for a long time and then comes with complications, among which gastrointestinal tract obstruction and perforation are the most life threatening. MATERIALS AND METHODS: Case files from the Department of Surgery were retrieved and studied...

We report a 30-case series from the Pain Management Center at the Massachusetts General Hospital where we have applied a guideline to convert chronic treatment for pain from full agonist opioids (FAO) to buprenorphine (BUP). Of the patients, 24 (80 percent) elected to continue BUP over FAO. Five conversions were stopped for side effects (fatigue) and/or lack of sufficient pain reduction. One patient elected not to participate on the day that the conversion was to begin. There were no major adverse events. We conclude that conversion to BUP should be considered as an alternative to treat patients on chronic opioids for pain...

OBJECTIVE: To evaluate the impact of recent changes to the Centers for Disease Control and Prevention (CDC) morphine milligram equivalent (MME)/day threshold recommendations on healthcare utilization. DESIGN: A retrospective cohort study of new chronic opioid users (NCOUs). SETTING: Commercially insured plans across the United States using IQVIA PharMetrics® Plus for Academics database with new use between January 2014 and March 2015...

OBJECTIVE: The objective of this study is to examine rural hospitals' status in implementing opioid stewardship program (OSP) elements and assess differences in implementation in emergency department (ED) and acute inpatient departments. DESIGN: Health administrator survey to identify the number and type of OSP elements that each hospital has implemented. SETTING: Arizona critical access hospitals (CAHs). PARTICIPANTS: ED and acute inpatient department heads at 17 Arizona CAHs (total of 34 assessments)...

BACKGROUND: Buprenorphine is used for medication-assisted treatment of opioid dependence. PURPOSE: Monitoring of medication adherence involves testing of urine or oral fluid for the drug or its metabolite. METHODS: Quantitative results using liquid chromatography tandem mass spectrometer testing defined the excretion pattern of the drug and its metabolites. RESULTS: Frequency distribution curves of buprenorphine and norbuprenorphine describe the expected drug concentrations of patients on this medication...

OBJECTIVE: To evaluate patterns of opioid handling as well as their associated -variables. DESIGN: A transversal study. SETTING: Institutional care. PARTICIPANTS: One hundred cancer pain patients aged 18 and above at diagnosis. INTERVENTIONS: Open and dichotomous questions related to opioid handling and a depression-anxiety scale. MAIN OUTCOME MEASURE(S): The percentage of patients who properly handled opioids...

Naltrexone (NTX) is an orally effective opiate antagonist used in maintenance treatment for opiate dependence. Its utility is limited by the patient's noncompliance. The study aimed to develop an efficient method for the detection of NTX in urine by LC-QTOF-mass spectrometry (MS) and its application to NTX compliance in opioid-dependent subjects. Sample preparation included a dilution step and direct injection to LC-QTOF-MS. Chromatographic separation was achieved with a C-18 column using a mixture of mobile phase 0...

OBJECTIVE: To determine the effectiveness and safety of the University of Washington's buprenorphine cross-titration protocol for chronic pain in the outpatient setting. METHODS: Retrospective chart review was performed on 150 patients transitioned from full µ-opioid agonist therapy to buprenorphine using the University of Washington Medical Center Pain Clinic's cross-titration protocol between September 1, 2020, and December 31, 2021, in an outpatient setting...

OBJECTIVE: This study evaluated the opioid sparing and pain relief effect of erector spinae plane block (ESPB) for radiofrequency ablation (RFA) of hepatic focal lesions under conscious sedation. DESIGN: A randomized controlled trial. SETTING: Tanta University Hospitals. PATIENTS: Fifty patients aged 30-60 years old and eligible for RFA of hepatic focal lesions were included. INTERVENTIONS: Patients randomized to receive either local anesthetic infiltration (group I) or ESPB (group II)...

OBJECTIVE: The primary objective of this study is to assess factors that influence opioid prescribing by dentists and the role of these factors in the practice of dental pain control. DESIGN: A 25-question survey instrument was distributed to the study population for anonymous responses, covering dentist and practice demographics and opioid prescribing characteristics. SETTING: Private solo and group practice settings, including general practitioners and dental specialists...

BACKGROUND: The epidemic of opioid misuse and abuse is rampant in the United States. A large percentage of patients who go on to misuse or abuse opioids were initially legally prescribed an opioid medication by their physician. One of the most common reasons patients of reproductive age seek medical care is for pregnancy and delivery. These patients are frequently prescribed opioids. Greater than one in 10 Medicaid-enrolled women fill an opioid prescription after vaginal delivery. OBJECTIVE: To assess the opioid prescribing patterns of obstetric providers following vaginal deliveries...

OBJECTIVES: (1) To evaluate the effectiveness of a curriculum on physician assistant (PA) students' knowledge about opioid use disorder (OUD) treatment and management and (2) present student satisfaction with the curriculum. METHODS: Three cohorts of PA students completed pre- and post-intervention questionnaires about their knowledge of motivational interviewing (MI) for OUD. One cohort of students completed the 11-item questionnaire without exposure to the intervention (control group)...

OBJECTIVE: The objective is to quantify the rate of opioid and benzodiazepine prescribing for the diagnosis of shoulder osteoarthritis across a large healthcare system and to describe the impact of a clinical decision support intervention on prescribing patterns. DESIGN: A prospective observational study. SETTING: One large healthcare system. PATIENTS AND PARTICIPANTS: Adult patients presenting with shoulder osteoarthritis...

STUDY OBJECTIVE: Pain management is a widely discussed topic, especially in the setting of the current opioid epidemic. Previous studies have shown that the use of opioids increased in the adult population. We aimed to look at the use of narcotic and non-narcotic pain medications at a large pediatric hospital to discern if patterns of pediatric pain management changed over time. METHODS: 58,402 analgesic prescriptions of patients 0-21 years of age were analyzed from May 2012 to November 2016...

OBJECTIVE: The objective of this study was to evaluate opioid use trajectories among a sample of 10,138 Medicaid patients receiving one of six index surgeries: lumbar spine, total knee arthroplasty, cholecystectomy, appendectomy, colon resection, and tonsillectomy. DESIGN: Retrospective cohort. SETTING: Administrative claims data. PATIENTS AND PARTICIPANTS: Patients, aged 13 years and older, with 15-month continuous Medicaid eligibility surrounding index surgery, were selected from single-state Medicaid medical and pharmacy claims data for surgeries performed between 2014 and 2017...

Buprenorphine, a partial opioid agonist, is a Food and Drug Administration-approved medication for the treatment of opioid use disorder (OUD). However, due to its high binding affinity, precipitated withdrawal may occur if initiated in the presence of other opioids. The growing literature demonstrates promise for alternative induction model of low-dose initiation of buprenorphine for the treatment of OUD, specifically targeting patients averse to withdrawal or using fentanyl. In this case series, we present four clinical cases of outpatient inductions, in which three out of four successfully transitioned from fentanyl to buprenorphine, and one patient transitioned from methadone to buprenorphine using a low-dose induction method...

OBJECTIVE: Tapentadol is an atypical opioid analgesic thought to have dual mechanisms of action: µ-receptor agonism and inhibition of norepinephrine reuptake. Unlike other atypical opioids, tapentadol is a schedule II-controlled substance. We compared the prevalence of abuse (use to get high) of tapentadol to other atypical opioids used to treat pain (buprenor-phine and tramadol). DESIGN: An observational, serial cross-sectional study. SETTING: Individuals enrolling in treatment programs for opioid use disorder in 2019...