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1.
Nihon Yakurigaku Zasshi ; 156(3): 134-138, 2021.
Artículo en Japonés | MEDLINE | ID: mdl-33952839

RESUMEN

Many studies suggest opioid receptor (OPr) dimerization modulates the pharmacological properties of opiates. Specifically, heteromerization between OPr types has been reported to lead to changes in intracellular signaling. Thus, ligands targeting heteromers are expected to be novel therapeutic targets with reduced side effects. The heteromers of mu (MOPr) and delta (DOPr) are detected in brain regions involved in pain processing. The bivalent ligand or small molecule were identified as a MOPr-DOPr targeting ligand. These ligands exhibit antinociceptive properties similar to that of morphine with lesser antinociceptive tolerance as compared to morphine. Studies exploring the in vivo regulation of MOPr-DOPr heteromers, showed chronic morphine administration leads to an upregulation of these heteromers in select brain regions. Exploration of mechanisms underlying this phenomenon led us to the G protein-coupled receptor chaperone, RTP4, that is induced by chronic morphine and facilitates the heteromerization of MOPr and DOPr. In this review, I will introduce the simulated structure or property of MOPr-DOPr heteromer, its targeting ligands, and its intracellular regulatory mechanism that include a key molecule like RTP4 that could serve as a scaffold for the development of novel therapeutic drugs with reduced adverse effects, and hence may take place of the conventional clinical opioids.


Asunto(s)
Morfina , Receptores Opioides mu , Analgésicos Opioides , Humanos , Dolor/tratamiento farmacológico , Receptores Opioides
2.
Nihon Yakurigaku Zasshi ; 156(3): 128-133, 2021.
Artículo en Japonés | MEDLINE | ID: mdl-33952838

RESUMEN

In Japan, 14 opioids with a variety of dosage forms, such as oral preparation, injection, transdermal patch, transmucosal and suppository are clinically available as analgesics, and their use properly depends on the type and degree of pain and patient condition. Fundamentally, strong opioids are restricted to only treatment of cancer pain, while the indication of fentanyl transdermal patch and oxycodone tamper resistant tablet has been expanded for the treatment of non-cancer chronic pain. In US, the additional indication of opioids to chronic pain has led to prolongation and generalization of opioid use, which may contribute to "opioid crisis" in which opioid-related death strikingly increased due to opioid abuse and overdose-induced respiratory depression. Currently, opioid-related abuse and death have not been evident in Japan, while abuse of antitussive opioids (codeine and dihydrocodeine) are recently seen as a problem, which may suggest the sense of guilt to abuse legally-uncontrolled drugs (ex. weak opioids, antitussives or hypnotics) may be low in Japanese. In this review, I will summarize current status and issues in clinical use of opioid analgesics, and will talk about the necessity and expectation for development of novel analgesics without serious adverse reactions such as addiction and respiratory depression.


Asunto(s)
Analgésicos Opioides , Dolor Crónico , Analgésicos Opioides/efectos adversos , Dolor Crónico/tratamiento farmacológico , Humanos , Japón , Oxicodona/efectos adversos
3.
Nihon Yakurigaku Zasshi ; 156(3): 139-144, 2021.
Artículo en Japonés | MEDLINE | ID: mdl-33952840

RESUMEN

After the identification of nociceptin/orphanin FQ (N/OFQ) peptide (NOP) and its cognate receptor, the unique functional profiles of the N/OFQ-NOP receptor system have been uncovered. NOP receptors are distributed in the key regions that regulate pain and reward processing in the central nervous system. In non-human primates (NHPs), activation of the NOP receptor causes antinociception and anti-hypersensitivity via spinal and supraspinal effects. Moreover, activation of the NOP receptor attenuates dopaminergic transmission and potentiates mu-opioid peptide (MOP) receptor-mediated analgesia. Here, we highlight the functional profiles of bifunctional NOP and MOP receptor agonists based on their promising effects for the treatment of pain and drug abuse. Bifunctional NOP/MOP receptor "partial" agonists, such as AT-121, BU08028, and BU10038, exert potent analgesic effects without MOP receptor-related side effects such as abuse liability, respiratory depression, physical dependence, and itching in NHPs. These novel NOP/MOP receptor agonists reduce rewarding and the reinforcing effects of abused drugs. Furthermore, a mixed NOP/opioid receptor "full" agonist, cebranopadol, is undergoing several clinical trials, and the therapeutic advantage of the coactivation of NOP and MOP receptors has also been confirmed in humans. Therefore, this class of drugs that coactivate NOP and MOP receptors proposes a wide therapeutic range with fewer side effects, indicating a greater potential for the development of novel safer opioid analgesics.


Asunto(s)
Analgésicos Opioides , Receptores Opioides , Analgésicos , Analgésicos Opioides/efectos adversos , Animales , Péptidos Opioides/uso terapéutico , Dolor/tratamiento farmacológico
4.
London; National Institute for Health and Care Excellence; Apr. 7, 2021. 36 p.
Monografía en Inglés | BIGG - guías GRADE | ID: biblio-1179029

RESUMEN

This guideline covers assessing all chronic pain (chronic primary pain, chronic secondary pain, or both) and managing chronic primary pain in people aged 16 years and over. Chronic primary pain is pain with no clear underlying cause, or pain (or its impact) that is out of proportion to any observable injury or disease. This guideline should be used alongside NICE guidelines for other chronic pain conditions, including the NICE guidelines on headaches, low back pain and sciatica, rheumatoid arthritis, osteoarthritis, spondyloarthritis, endometriosis, neuropathic pain and irritable bowel syndrome.


Asunto(s)
Humanos , Adolescente , Dolor Crónico/clasificación , Dolor Crónico/prevención & control , Dolor Crónico/tratamiento farmacológico , Benzodiazepinas/uso terapéutico , Terapia por Acupuntura , Corticoesteroides/uso terapéutico , Marihuana Medicinal/uso terapéutico , Analgésicos Opioides/uso terapéutico , Anestésicos Locales/uso terapéutico , Anticonvulsivantes/uso terapéutico , Antidepresivos/uso terapéutico
5.
J Zoo Wildl Med ; 52(1): 287-294, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33827187

RESUMEN

This study investigated the use of a fixed-dose combination of 30 mg/ml butorphanol, 12 mg/ml azaperone, and 12 mg/ml medetomidine for the standing sedation of captive African elephants (Loxodonta africana). In total, seven females (mean age 19.6 yr; range 6-31 yr) and six males (mean age 33.5 yr; range 9-35 yr) were sedated. The estimated dose was 0.0005 ± 0.0001 ml/kg and 0.006 ± 0.001 ml/cm shoulder height, which resulted in a dose of 0.016 ± 0.002 mg/kg or 0.19 ± 0.04 mg/cm shoulder height butorphanol, 0.006 ± 0.0008 mg/ kg or 0.076 ± 0.015 mg/cm shoulder height azaperone, and 0.006 ± 0.0008 mg/kg or 0.076 ± 0.015 mg/cm medetomidine. First signs of sedation were observed within 3-10 min (mean 6 ± 2 min) after darting, and monitoring of the animals started on average at 24 ± 9 min after darting. No bradycardia was observed in any of the elephants (mean heart rate 40.0 ± 6.55 beats/min), although all the animals were mildly hypotensive (mean blood pressure 118.5/86 [94.5]). Rectal temperatures fell within acceptable ranges, and respiratory parameters were stable in all the animals throughout sedation and fell within the standard ranges reported for conscious, standing elephants. Only one elephant had clinically significant hypoxemia characterized by a partial pressure of oxygen (PaO2) < 60 mm Hg. This elephant was also hypercapnic (PaCO2 > 50 mm Hg), although pH and peripheral capillary oxygen saturation fell within acceptable ranges. None of the elephants reacted to moderately painful stimuli while sedated. The combination was reversed with intramuscular injections of naltrexone (1 mg for every 1 mg butorphanol) and atipamezole (5 mg for every 1 mg medetomidine). Recovery was smooth and calm in all the animals. Time from injection of the reversals until the first signs of recovery was 4.6 ± 2.01 min (range 1-8 min).


Asunto(s)
Azaperona/administración & dosificación , Butorfanol/administración & dosificación , Fármacos del Sistema Nervioso Central/administración & dosificación , Sedación Consciente/veterinaria , Elefantes/fisiología , Medetomidina/administración & dosificación , Analgésicos Opioides/administración & dosificación , Animales , Combinación de Medicamentos , Femenino , Hipnóticos y Sedantes/administración & dosificación , Masculino , Naltrexona/administración & dosificación , Antagonistas de Narcóticos/administración & dosificación
8.
Medicine (Baltimore) ; 100(17): e25560, 2021 Apr 30.
Artículo en Inglés | MEDLINE | ID: mdl-33907103

RESUMEN

ABSTRACT: The aim of this study was to assess the efficacy of combined opioids by comparing four regimens of patient-controlled epidural analgesia (PCEA) after cesarean section.Parturient patients who underwent elective or emergent cesarean section under combined spinal and epidural anesthesia from April 2013 to March 2016 were retrospectively analyzed. Based on PCEA, they were assigned to one of 4 groups: local anesthetic alone (LA), epidural single morphine administration during surgery followed by local anesthetic alone (M), local anesthetic combined with fentanyl 10 µg/h (F10), or local anesthetic combined with fentanyl 20 µg/h (F20). The primary outcome was the number of PCEA boluses used. Secondary outcomes included the use of rescue analgesia, postoperative nausea and vomiting, and postoperative pruritus.A total of 250 parturients were analyzed. Whereas the number of PCEA boluses in the LA group was significantly higher than in the other combined opioid groups on the day of surgery and postoperative day 1 (LA: 3 [1-6] and 7 [4-9] vs M: 2 [0-4] and 4 [0-7] vs F10: 1 [0-4] and 3 [0-6] vs F20: 1 [0-3] and 2 [0-8], P = .012 and 0.010, respectively), within the combined opioid groups, the number was not significantly different. Significantly fewer patients in the F20 group required rescue analgesia on postoperative day 1 and 2 (25 and 55%) than those in the M (66 and 81%) and F10 (62 and 66%) groups (P < .001 and P = .007, respectively). Postoperative nausea and vomiting and pruritus were significantly higher in the M group (P < .008 and P = .024, respectively).The results of the present study suggest that local anesthetic alone after a single administration of morphine, or local anesthetic combined with fentanyl 10 µg/h would generally be adequate for PCEA, whereas local anesthetic combined with fentanyl 20 µg/h would be suitable for conventional epidural analgesia.


Asunto(s)
Analgesia Epidural/métodos , Analgesia Obstétrica/métodos , Analgesia Controlada por el Paciente/métodos , Manejo del Dolor/métodos , Dolor Postoperatorio/tratamiento farmacológico , Adulto , Analgésicos Opioides/administración & dosificación , Anestésicos Locales/administración & dosificación , Cesárea/efectos adversos , Quimioterapia Combinada , Femenino , Fentanilo/administración & dosificación , Humanos , Morfina/administración & dosificación , Dimensión del Dolor , Dolor Postoperatorio/etiología , Embarazo , Estudios Retrospectivos , Autoadministración , Resultado del Tratamiento
9.
Pan Afr Med J ; 38: 74, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33889240

RESUMEN

Boerhaave's syndrome is an uncommon syndrome characterized by spontaneous rupture of the oesophagus with a high mortality rate. While excessive alcohol intake and binge-eating are the classic precipitants of this syndrome, medication-induced vomiting causing Booerhave's is quite uncommon. Traditionally managed operatively, conservative management is being increasingly reported in selected cases. We report the case of 21-year-old male with who developed sudden onset chest pain and dyspnoea after pentazocine induced vomiting. He was referred after lack of response to initial treatment for acute severe asthma. A chest CT scan showed pneumomediastinum, subcutaneous emphysema and oesophageal tear. He was managed conservatively with oxygen therapy, nil per mouth and antibiotics with improvement of symptoms and discharge after 8 days.


Asunto(s)
Perforación del Esófago/diagnóstico por imagen , Enfermedades del Mediastino/diagnóstico por imagen , Pentazocina/efectos adversos , Vómitos/complicaciones , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/efectos adversos , Antibacterianos/administración & dosificación , Asma/fisiopatología , Asma/terapia , Dolor en el Pecho/etiología , Disnea/etiología , Perforación del Esófago/etiología , Perforación del Esófago/terapia , Humanos , Masculino , Enfermedades del Mediastino/etiología , Enfermedades del Mediastino/terapia , Terapia por Inhalación de Oxígeno , Pentazocina/administración & dosificación , Tomografía Computarizada por Rayos X , Vómitos/inducido químicamente , Adulto Joven
10.
Artículo en Inglés | MEDLINE | ID: mdl-33809628

RESUMEN

There is solid evidence of an association between several psychological flexibility processes, particularly pain acceptance, and adaptation to chronic pain. However, there are relatively few studies on the relationship between pain acceptance and opioid misuse in chronic pain patients. Thus, the aim of the present study was to test a hypothetical model in which pain acceptance would regulate pain sensations and pain-related thoughts and emotions, which would be related to opioid misuse. The sample comprised 140 chronic pain patients attending two hospitals. All patients were receiving pharmacological treatment, including opioid analgesics. Structural equation modelling analyses showed a significant association between higher pain acceptance and lower pain intensity and catastrophizing, and lower levels of anxiety and depression. Only higher anxiety and depression were significantly associated with increased opioid misuse. The results suggest that levels of anxiety, depression, and pain acceptance must be assessed before opioids are prescribed. Pain acceptance implies a relationship with internal events that protects against anxiety and depression and thus against opioid misuse. Acceptance and Commitment Therapy appears to be particularly appropriate for these patients.


Asunto(s)
Terapia de Aceptación y Compromiso , Dolor Crónico , Mal Uso de Medicamentos de Venta con Receta , Analgésicos Opioides/uso terapéutico , Dolor Crónico/tratamiento farmacológico , Depresión/epidemiología , Emociones , Humanos , Prescripciones
11.
JAMA ; 325(15): 1513-1523, 2021 04 20.
Artículo en Inglés | MEDLINE | ID: mdl-33877274

RESUMEN

Importance: Although effective agents are available to prevent painful vaso-occlusive episodes of sickle cell disease (SCD), there are no disease-modifying therapies for ongoing painful vaso-occlusive episodes; treatment remains supportive. A previous phase 3 trial of poloxamer 188 reported shortened duration of painful vaso-occlusive episodes in SCD, particularly in children and participants treated with hydroxyurea. Objective: To reassess the efficacy of poloxamer 188 for vaso-occlusive episodes. Design, Setting, and Participants: Phase 3, randomized, double-blind, placebo-controlled, multicenter, international trial conducted from May 2013 to February 2016 that included 66 hospitals in 12 countries and 60 cities; 388 individuals with SCD (hemoglobin SS, SC, S-ß0 thalassemia, or S-ß+ thalassemia disease) aged 4 to 65 years with acute moderate to severe pain typical of painful vaso-occlusive episodes requiring hospitalization were included. Interventions: A 1-hour 100-mg/kg loading dose of poloxamer 188 intravenously followed by a 12-hour to 48-hour 30-mg/kg/h continuous infusion (n = 194) or placebo (n = 194). Main Outcomes and Measures: Time in hours from randomization to the last dose of parenteral opioids among all participants and among those younger than 16 years as a separate subgroup. Results: Of 437 participants assessed for eligibility, 388 were randomized (mean age, 15.2 years; 176 [45.4%] female), the primary outcome was available for 384 (99.0%), 15-day follow-up contacts were available for 357 (92.0%), and 30-day follow-up contacts were available for 368 (94.8%). There was no significant difference between the groups for the mean time to last dose of parenteral opioids (81.8 h for the poloxamer 188 group vs 77.8 h for the placebo group; difference, 4.0 h [95% CI, -7.8 to 15.7]; geometric mean ratio, 1.2 [95% CI, 1.0-1.5]; P = .09). Based on a significant interaction of age and treatment (P = .01), there was a treatment difference in time from randomization to last administration of parenteral opioids for participants younger than 16 years (88.7 h in the poloxamer 188 group vs 71.9 h in the placebo group; difference, 16.8 h [95% CI, 1.7-32.0]; geometric mean ratio, 1.4 [95% CI, 1.1-1.8]; P = .008). Adverse events that were more common in the poloxamer 188 group than the placebo group included hyperbilirubinemia (12.7% vs 5.2%); those more common in the placebo group included hypoxia (12.0% vs 5.3%). Conclusions and Relevance: Among children and adults with SCD, poloxamer 188 did not significantly shorten time to last dose of parenteral opioids during vaso-occlusive episodes. These findings do not support the use of poloxamer 188 for vaso-occlusive episodes. Trial Registration: ClinicalTrials.gov Identifier: NCT01737814.


Asunto(s)
Anemia de Células Falciformes/tratamiento farmacológico , Dolor/tratamiento farmacológico , Poloxámero/uso terapéutico , Vasodilatadores/uso terapéutico , Adolescente , Adulto , Analgésicos Opioides/uso terapéutico , Anemia de Células Falciformes/complicaciones , Niño , Método Doble Ciego , Femenino , Humanos , Masculino , Dolor/etiología , Placebos/efectos adversos , Placebos/uso terapéutico , Poloxámero/efectos adversos , Vasodilatadores/efectos adversos , Adulto Joven
12.
Semin Nephrol ; 41(1): 11-18, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33896468

RESUMEN

Opioid use and misuse in the United States has been at epidemic proportions and is predicted to increase further in the setting of the Coronavirus disease 19 pandemic. Acute kidney injury is a condition associated with significant morbidity and increased mortality. We review the literature on the effect of opioids on kidney function and critically examine the association between opioid use and acute kidney injury and identify at-risk populations in whom opioids should be used with caution. We also discuss the role of biomarkers in elucidating this condition and propose preventive measures, novel therapeutic options, and research directions.


Asunto(s)
Lesión Renal Aguda/inducido químicamente , Analgésicos Opioides/efectos adversos , Trastornos Relacionados con Opioides/complicaciones , Pandemias , Lesión Renal Aguda/epidemiología , Salud Global , Humanos , Incidencia , Trastornos Relacionados con Opioides/epidemiología
13.
Medicine (Baltimore) ; 100(15): e25531, 2021 Apr 16.
Artículo en Inglés | MEDLINE | ID: mdl-33847679

RESUMEN

INTRODUCTION: As the adjunctive anesthesia to propofol, both dezocine and fentanyl showed some potential for gastrointestinal endoscopy. This meta-analysis aimed to compare their efficacy and safety. METHODS: PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systematically searched. Randomized controlled trials (RCTs) assessing the effect of dezocine versus fentanyl for the anesthesia of patients undergoing gastrointestinal endoscopy were included. RESULTS: Five RCTs involving 677 patients were included in the meta-analysis. Overall, compared with fentanyl plus propofol for gastrointestinal endoscopy, dezocine plus propofol resulted in the reduction in propofol dose(mean difference [MD] = -11.72; 95% confidence interval [CI] = -22.83 to -0.61; P = .04), awakening time (std. MD = -1.79; 95% CI = -3.31 to -0.27; P = .02) and hypopnea (risk ratio [RR] = 0.16; 95% CI = 0.06-0.41; P = .0002), but had no remarkable effect on induction time (MD = 1.20; 95% CI = -0.98 to 3.39; P = .28), postoperative pain score (MD = -0.38; 95% CI = -1.00 to 0.24; P = .24), nausea or vomiting (RR = 0.45; 95% CI = 0.10-1.98; P = .29). CONCLUSION: Dezocine plus propofol may be better for the anesthesia of gastrointestinal endoscopy than fentanyl plus propofol.


Asunto(s)
Analgésicos Opioides/administración & dosificación , Anestésicos Intravenosos/administración & dosificación , Compuestos Bicíclicos Heterocíclicos con Puentes/administración & dosificación , Endoscopía Gastrointestinal/efectos adversos , Fentanilo/administración & dosificación , Dolor Postoperatorio/prevención & control , Propofol/administración & dosificación , Tetrahidronaftalenos/administración & dosificación , Adulto , Anciano , Quimioterapia Combinada , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del Tratamiento
14.
J Opioid Manag ; 17(2): 101-107, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33890273

RESUMEN

OBJECTIVE: This study sought to determine the rate at which nonopioid analgesics were utilized in postoperative pain management plans after pediatric ambulatory surgery in patients who were also prescribed postoperative opioids. DESIGN: Retrospective cohort analysis. PARTICIPANTS: Patients ≤ 21 years old who were prescribed opioid medications after undergoing ambulatory surgery at a tertiary-care medical center. METHODS: Postoperative day 1 (POD1) opioid prescription and use survey data along with electronic medical record data were extracted and analyzed for patients meeting inclusion criteria between April 2017 and December 2017. MAIN OUTCOME MEASURE: Recommendation to take nonopioid analgesics after discharge. RESULTS: A total of 849 (63.2 percent) patients responded to the survey and 275 (32.4 percent) of these cases were prescribed postoperative opioids. Of the 273 cases included in this study, 137 (50.2 percent) received recommendations to take at least one nonopioid analgesic as well, and 164 (60.1 percent) reported using their prescribed opioids on POD1. Opioid use did not vary significantly with nonopioid analgesic recommendations. There was significant variability in opioid and nonopioid analgesic prescribing and recommendation patterns across surgical subspecialties. CONCLUSIONS: There was limited use of nonopioid analgesics in postoperative pain management plans after pediatric ambulatory surgery. This leaves many patients with only opioid-based agents as the first-line medication for postoperative pain management. These findings highlight an opportunity to educate prescribers and patients on the importance of step-wise multimodal analgesic plans.


Asunto(s)
Analgésicos no Narcóticos , Adulto , Procedimientos Quirúrgicos Ambulatorios , Analgésicos no Narcóticos/uso terapéutico , Analgésicos Opioides/efectos adversos , Niño , Humanos , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/tratamiento farmacológico , Pautas de la Práctica en Medicina , Estudios Retrospectivos , Adulto Joven
15.
J Opioid Manag ; 17(2): 109-113, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33890274

RESUMEN

OBJECTIVE: To determine whether a pharmacistled intervention would increase the number of naloxone prescriptions and naloxone administration education in a primary care family medicine setting. DESIGN: Prospective quality improvement intervention in an academic family medicine clinic. METHODS: We surveyed providers about naloxone knowledge, prescribing habits, and prescribing barriers. We identified patients on chronic opioid therapy, through electronic health records for the year 2019. Overdose risk categories based upon morphine milligram equivalent doses and concomitant benzodiazepine use were used to determine patients who met criteria for naloxone. Pharmacists phoned qualified patients to discuss overdose risk and naloxone benefits. Patients who accepted naloxone prescriptions used their local pharmacy through a department-approved standing order set. RESULTS: From the survey results, there were 47 of 54 provider responses, and the majority noted that they do not routinely prescribe naloxone in high-risk patients. The predominant barriers were lack of time during visit and naloxone administration education. The population of patients from chart review included 93 high-risk patients with a mean age of 58 years. During the time of intervention, 71 patients remained eligible for naloxone coprescribing. Of the patients contacted, 29 (40 percent) accepted the intervention prescription, and subsequently, 22 picked up their prescription from the pharmacy. Sixteen received counseling with a support person. Twelve patients had naloxone already at home, and two received counseling with a support person. CONCLUSION: The naloxone prescribing intervention is achievable. The results of this intervention support identifying patients at increased risk of opioid overdose and offer education of a support person for naloxone in a large academic family medicine clinic.


Asunto(s)
Sobredosis de Droga , Naloxona , Analgésicos Opioides/efectos adversos , Sobredosis de Droga/tratamiento farmacológico , Sobredosis de Droga/prevención & control , Reducción del Daño , Humanos , Persona de Mediana Edad , Naloxona/uso terapéutico , Antagonistas de Narcóticos/uso terapéutico , Atención Primaria de Salud , Estudios Prospectivos
16.
J Opioid Manag ; 17(2): 115-124, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33890275

RESUMEN

INTRODUCTION: Opioid prescribing occurs within almost every healthcare setting. Implementation of safe, effective opioid stewardship programs represents a critical but daunting challenge for medical leaders. This study sought to understand the barriers and aids to the routine use of clinical guidelines for opioid prescribing among healthcare professionals and to identify areas in need of additional education for prescribing providers, pharmacists, and nurses. METHODS: Data collection and analysis in 2018-2019 employed a team of two trained facilitators who conducted 20 focus groups using a structured facilitation guide to explore operational, interpersonal, and patient care-related barriers to best practice adherence. Each professional group was interviewed separately, with similar care settings assigned together. Invitation to participate was based on a sampling methodology representing emergency, medical specialty, primary care, and surgical practice settings. RESULTS: Key concerns among all groups reflected the inadequacy of available tools for staff to appropriately assess and treat patients' pain. Tools and technology to support safe opioid prescribing were also cited as a barrier by all three professional groups. All groups noted that prescribers tend to rely upon default settings within the electronic medical record when issuing prescriptions. Both pharmacists and prescribers cited time and scheduling as a barrier to adherence. CONCLUSIONS: In spite of significant regulatory and public policy efforts to address the opioid crisis, healthcare organizations face significant challenges to improve adherence to best practice prescribing guidelines. These findings highlight several facilitators for change which could boost opioid stewardship initiatives to focus on critical systems' factors for improvement.


Asunto(s)
Analgésicos Opioides , Pautas de la Práctica en Medicina , Analgésicos Opioides/efectos adversos , Humanos , Epidemia de Opioides , Atención Primaria de Salud , Investigación Cualitativa
17.
J Opioid Manag ; 17(2): 125-133, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33890276

RESUMEN

OBJECTIVE: To estimate the annual percentage of women of reproductive age with private insurance or Medicaid who had opioid prescription claims during 2013-2017 and describe trends over time. DESIGN: A secondary analysis of insurance claims data from IBM MarketScan® Commercial and Multi-State Medicaid Databases to assess outpatient pharmacy claims for prescription opioids among women aged 15-44 years during 2013-2017. PARTICIPANTS: Annual cohorts of 3.5-3.8 million women aged 15-44 years with private insurance and 0.9-2.1 million women enrolled in Medicaid. MAIN OUTCOME MEASURE: The percentage of women aged 15-44 years with outpatient pharmacy claims for opioid prescriptions. RESULTS: During 2013-2017, the proportion of women aged 15-44 years with private insurance who had claims for opioid prescriptions decreased by 22.1 percent, and among women enrolled in Medicaid, the proportion decreased by 31.5 -percent. CONCLUSIONS: Opioid prescription claims decreased from 2013 to 2017 among insured women of reproductive age. However, opioid prescription claims remained common and were more common among women enrolled in Medicaid than those with private insurance; additional strategies to improve awareness of the risks associated with opioid prescribing may be needed.


Asunto(s)
Analgésicos Opioides , Pautas de la Práctica en Medicina , Adolescente , Adulto , Analgésicos Opioides/uso terapéutico , Bases de Datos Factuales , Prescripciones de Medicamentos , Femenino , Humanos , Medicaid , Prescripciones , Estados Unidos/epidemiología , Adulto Joven
18.
J Opioid Manag ; 17(2): 135-144, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33890277

RESUMEN

OBJECTIVES: The link between male hypogonadism and opioids is well-established, but whether there is a difference in the frequency of hypogonadism between heroin and methadone for treatment of opioid use disorder (OUD) has not been -determined. DESIGN: Cross-sectional. Setting, patients, and participants: Male drug users and nonusers matched for socioeconomic status between 18 and 65 years, recruited in Baltimore as part of the study of HIV, injection drug use, nutrition, and endocrinology (SHINE). METHODS: Hypogonadism was defined as low free testosterone <50 pg/mL. Participants were categorized into three groups based on opioid use: (1) NONE, (2) methadone use as treatment of OUD (METHADONE), and (3) Heroin use (HEROIN). This third group was further divided to mild (MH), and heavy (HH) heroin use. We used multiple logistic regression to examine the association between hypogonadism and different groups. RESULTS: The cohort consisted of 189 men, 94 percent black, average age 43 years, with high HIV (56 percent) and HCV (38 percent) prevalence. 24 percent had hypogonadism. Compared to NONE, there were higher odds of hypogonadism in METHADONE (aOR 3.46; 95 percent CI [1.34,8.93]; p = 0.01) but not in HEROIN. After dividing HEROIN into MH and HH, there were higher odds of hypogonadism in HH compared to NONE (aOR 3.27; 95 percent CI [1.12,9.53]; p = 0.03) but not in MH. CONCLUSIONS: Methadone used for treatment of OUD was associated with male hypogonadism similar to heavy heroin use. Targeted hypogonadism screening and treatment may be warranted in this population to reduce its health consequences such as sexual dysfunction, osteoporosis, and abdominal adiposity.


Asunto(s)
Analgésicos Opioides , Hipogonadismo , Adulto , Analgésicos Opioides/efectos adversos , Baltimore/epidemiología , Estudios Transversales , Humanos , Hipogonadismo/diagnóstico , Hipogonadismo/tratamiento farmacológico , Hipogonadismo/epidemiología , Masculino , Metadona , Tratamiento de Sustitución de Opiáceos
19.
J Opioid Manag ; 17(2): 155-167, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33890279

RESUMEN

OBJECTIVE: Prescription opioid misuse represents a social and economic challenge in the United States. We evaluated Schedule II opioid prescribing practices by primary care providers (PCPs), orthopedic and general surgeons, and pain management specialists. DESIGN: Prospective evaluation of prescribing practices of PCPs, orthopedic and general surgeons, and pain management specialists over 5 years (October 1, 2014-September 30, 2019) in an outpatient setting. METHODS: An analysis of Schedule II opioid prescribing following the implementation of federal and state guidelines and evidence-based standards at our institution. RESULTS: There were significantly more PCPs, orthopedic and general surgeons, and pain management specialists with a significantly increased number who prescribed Schedule II opioids, whereas there was a simultaneous significant decline in the average number of Schedule II opioid prescriptions per provider, Schedule II opioid pills prescribed per provider, and Schedule II opioid pills prescribed per patient by providers. The average number of Schedule II opioid prescriptions with a quantity >90 and Opana/Oxycontin prescriptions per PCP, orthopedic surgeon, and pain management specialist significantly decreased. The total morphine milligram equivalent (MME)/day of Schedule II opioids ordered by PCPs, orthopedic and general surgeons, and pain management specialists significantly declined. The ages of the providers remained consistent throughout the study. CONCLUSIONS: This study reports the implementation of federal and state regulations and institutional evidence-based guidelines into primary care and medical specialty practices to reduce the number of Schedule II opioids prescribed. Further research is warranted to determine alternative therapies to Schedule II opioids that may alleviate a patient's pain without initiating or exacerbating a potentially lethal opioid addiction.


Asunto(s)
Analgésicos Opioides , Cirujanos , Analgésicos Opioides/uso terapéutico , Sustancias Controladas , Prescripciones de Medicamentos , Humanos , Dolor/tratamiento farmacológico , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/tratamiento farmacológico , Pautas de la Práctica en Medicina , Atención Primaria de Salud , Estudios Prospectivos , Especialización , Estados Unidos
20.
J Opioid Manag ; 17(2): 181-183, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33890281

RESUMEN

Methadone, or in Germany levomethadone, may be used for the treatment of iatrogenic opioid withdrawal syndrome in pediatric intensive care units. The limited literature on opioid rotation in children does not provide data for the switch from methadone to another opioid. We report switching a very ill preterm baby in an unstable condition from IV levomethadone to IV fentanyl identifying a possible conversion ratio of 6.0-4.5:1 emphasizing critical steps as equipotency appropriate for neonates and dose reduction for incomplete cross-tolerance. If clinical deterioration occurs in infants on opioid tapering with levomethadone, we hope that our observations may be helpful.


Asunto(s)
Analgésicos Opioides , Fentanilo , Analgésicos Opioides/efectos adversos , Niño , Fentanilo/efectos adversos , Alemania , Humanos , Lactante , Recién Nacido , Metadona , Narcóticos
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