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2.
Anaesthesiol Intensive Ther ; 54(3): 271-278, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36062420

RESUMO

The current opioid epidemic has had a massive impact on the critical care sector. This is due to an increase in the number of acute opioid overdose-related admissions and the number of opioid-dependent and opioid-tolerant patients admitted to intensive care units (ICUs). This review discusses the challenges that intensive care physicians face when caring for patients suffering from opioid-related disorders and analyses existing solutions. Preference for non-opioid analgesics, treatment of acute pain in the ICUs to avoid chronic pain syndrome, and education of patients and caregivers are critical to preventing this pandemic.


Assuntos
Analgésicos não Narcóticos , Overdose de Drogas , Transtornos Relacionados ao Uso de Opioides , Analgésicos Opioides/efeitos adversos , Cuidados Críticos , Overdose de Drogas/tratamento farmacológico , Overdose de Drogas/epidemiologia , Humanos , Unidades de Terapia Intensiva , Epidemia de Opioides , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/prevenção & controle
3.
Expert Rev Clin Pharmacol ; 15(9): 1081-1094, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36068971

RESUMO

INTRODUCTION: In the past decades, the opioid crisis has heavily impacted parts of the US society and has been followed by an increase in the use of opioids worldwide. It is of paramount importance that we explore the origins of the US opioid epidemic to develop best practices to tackle the rising tide of opioid overdoses. AREAS COVERED: In this expert review, we discuss opioid (over)prescription, change in perception of pain, and false advertisement of opioid safety as the leading causes of the US opioid epidemic. Then, we review the evidence about opioid dependence and addiction potential and provide current knowledge about predictors of aberrant opioid-related behavior. Lastly, we discuss different approaches that were considered or undertaken to combat the rising tide of opioid-related deaths by regulatory bodies, pharmaceutical companies, and health-care professionals. For this expert review, we considered published articles relevant to the topic under investigation that we retrieved from Medline or Google scholar electronic database. EXPERT OPINION: The opioid epidemic is a dynamic process with many underlying mechanisms. Therefore, no single approach may be best suited to combat it. In our opinion, the best way forward is to employ multiple strategies to tackle different underlying mechanisms.


Assuntos
Dor Crônica , Transtornos Relacionados ao Uso de Opioides , Analgésicos Opioides/efeitos adversos , Dor Crônica/tratamento farmacológico , Humanos , Epidemia de Opioides/prevenção & controle , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Preparações Farmacêuticas
4.
Int J Palliat Nurs ; 28(9): 426-435, 2022 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-36151984

RESUMO

BACKGROUND: In the US, rising rates of opioid abuse has led to regulatory policies designed to curb opioid prescribing. While these policies generally exclude hospice and palliative care from prescribing restrictions, it is not known if these policies have had unintended consequences that affect opioid prescribing within hospice and palliative care. METHODS: A qualitative, descriptive design, guided by the Theory of Planned Behaviour, was utilised to conduct a study to answer the following two research questions: 1) How has the opioid epidemic and related policies affected opioid prescribing practises among hospice and palliative care clinicians? and 2) How do hospice and palliative care clinicians perceive patients' end-of-life care has been impacted by the opioid epidemic and related policies? FINDINGS: Ten clinicians, comprising physicians and nurse practitioners working in hospice and palliative care settings, were directly interviewed one-on-one. Data analysis revealed that the opioid epidemic and related policies have had an impact on the patient, clinician, nursing and hospice and palliative care speciality. CONCLUSIONS: As the broader medical community shifts away from opioid prescribing, care must be taken to ensure that hospice and palliative care patients still receive access to needed medications. Education is needed to assure that the relief of human suffering at end of life is prioritised.


Assuntos
Cuidados Paliativos na Terminalidade da Vida , Hospitais para Doentes Terminais , Analgésicos Opioides/uso terapêutico , Humanos , Epidemia de Opioides , Cuidados Paliativos , Padrões de Prática Médica
8.
Mo Med ; 119(3): 271-276, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36035557

RESUMO

Much of the focus on the current opioid crisis remains on how we arrived here and who is to blame. Despite having effective treatments for the management of patients with opioid use disorder (OUD), rates of overdose deaths continue to increase. As such, the focus needs to shift to increasing access to medications for OUD and better incorporation of harm reduction strategies to decrease not just the mortality but also the morbidity associated with OUD and other substance use disorders. Unfortunately, significant barriers rooted in misunderstanding and bias still limit access and prevent patients with OUD from seeking and staying in treatment. Until these are overcome and medical practice changes, both physicians and patients will continue to struggle to overcome this problem.


Assuntos
Overdose de Drogas , Transtornos Relacionados ao Uso de Opioides , Analgésicos Opioides , Humanos , Tratamento de Substituição de Opiáceos , Epidemia de Opioides
10.
Exp Clin Transplant ; 20(Suppl 4): 20-23, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-36018015

RESUMO

OBJECTIVES: The inadequate supply of transplantable organs necessitates new approaches to donor screening while avoiding transmission of infections. Donor-derived infections are well described. Multiple changes have occurred in donor management and organ utilization, including increased recognition of and therapies for viral infections, the emergence of multidrug antimicrobial-resistant organisms, and identification of some uncommon viral infections transmitted with allografts to clusters of recipients. Donor evaluation has been impacted by substance use-associated deaths and routine use of serologies and nucleic acid testing for hepatitis C virus, hepatitis B virus, and human immunodeficiency virus. Improved assays are needed to prevent infectious transmissions. MATERIALS AND METHODS: The MGH Transplant Center reviewed experience with recipients of organs from donors meeting donor risk criteria and tracked all recipients for possible exposures to hepatitis C virus, hepatitis B virus, and human immunodeficiency virus. This required development of an electronic database to document microbiologic testing data. RESULTS: Database enhancements allowed tracking of serologic testing. Among our organ recipients, no transmissions of the studied viruses were identified by nucleic acid testing or clinically. Multiple patients had positive serologic assays for tested viruses; all recipients were retested, and appropriate interventions were introduced if the test was confirmed. Some false-positive serologies resulted from recent hepatitis B virus vaccination, receipt of blood products, or transmission of donor B cells with tissues. CONCLUSIONS: Organ transplant from donors meeting donor risk criteria for disease transmission can be performed safely with appropriate informed consent and rigorous pre- and posttransplant microbiological testing. Enhanced compliance with vaccination for hepatitis B virus should be tracked. New sequencing technologies developed for investigation of undiagnosed infections and in xenotransplantation may inform future directions for donor screening. Such tools may increase the safe utilization of organs from donors who have potential risk for transmission of infection to recipients.


Assuntos
Infecções por HIV , Hepatite C , Ácidos Nucleicos , Analgésicos Opioides , Hepacivirus , Vírus da Hepatite B , Humanos , Epidemia de Opioides , Doadores de Tecidos , Resultado do Tratamento
11.
Harm Reduct J ; 19(1): 92, 2022 08 19.
Artigo em Inglês | MEDLINE | ID: mdl-35986328

RESUMO

INTRODUCTION: The majority of opioid-related deaths occur in suburban communities with people who use alone in their homes. BACKGROUND: To reach individuals who use substances alone, Grenfell Ministries, a not for profit agency in Hamilton Ontario created a phone-based supervision service to target individuals who use substances alone. METHODOLOGY: Grenfell implemented a phone line service initially as a 3-month pilot eventually operationalized to a 24/7 phoneline to determine utilization of the service and test operational feasibility. Metrics such as timing of use, number of unique clients using the service and substances used were measured. RESULTS: The line was provincially utilized. Between February 1st and December 10, 2020, the line was used 64 times. Most calls occurred in the evening, with fentanyl being the most used substance. EMS was dispatched 3 times for overdoses, of which 2 individuals were successfully resuscitated, and one individual's status being unknown. CONCLUSION: The overdose prevention line can be implemented to support individuals who use alone. The service can successfully reduce risk of death from individuals who use alone and could be a valuable tool in addressing the opioid crisis. Further study needs to be conducted to determine its efficacy and safety in supporting clients who use alone.


Assuntos
Overdose de Drogas , Transtornos Relacionados ao Uso de Opioides , Analgésicos Opioides , Overdose de Drogas/epidemiologia , Overdose de Drogas/prevenção & controle , Estudos de Viabilidade , Fentanila , Humanos , Programas de Troca de Agulhas , Epidemia de Opioides , Transtornos Relacionados ao Uso de Opioides/prevenção & controle
13.
Subst Abuse Treat Prev Policy ; 17(1): 49, 2022 07 06.
Artigo em Inglês | MEDLINE | ID: mdl-35794626

RESUMO

BACKGROUND: As Medicaid is the largest payer for opioid use disorder (OUD) treatment services in the United States, information about Medicaid provider reimbursement is critical, and Medicaid payment policies influence the structure of OUD treatment services for everyone with OUD treatment needs. METHODS: We collected Medicaid professional fees for OUD treatment and related services for the District of Columbia and fifty state Medicaid programs and the Medicare program in 2021. We create three fee indexes related to OUD treatment, with an emphasis on services related to first-line medication treatments in outpatient settings. We then create Medicaid fee indexes and Medicaid-to-Medicare fee indexes. RESULTS: Weekly Medicaid fee bundles for methadone treatment at OTPs in 2021 varied widely, more than 4-fold across states. The Medicaid-to-Medicare fee index shows that the national average Medicaid fee bundle was 56 percent of Medicare fees for regular methadone treatment at OTPs in 2021. For services related to OUD treatment, Medicaid fees varied up to 5-fold and larger across the components of each of the four services, and Medicaid fees were low relative to Medicare for almost all state services examined. The Medicaid-to-Medicare fee index was 64 percent of Medicare fees in 2021, ranging from 52 percent for evaluation & management to 76 percent for toxicology testing. CONCLUSIONS: There appears to be little justification for such large variation in Medicaid fees across states. In addition, the generally low fees in Medicaid persist despite recent efforts to increase access to opioid use disorder treatment for Medicaid enrollees, and have important implications for access to life-saving treatment during the current opioid overdose crisis.


Assuntos
Medicaid , Transtornos Relacionados ao Uso de Opioides , Idoso , Humanos , Medicare , Metadona/uso terapêutico , Epidemia de Opioides , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Estados Unidos
14.
J Bone Joint Surg Am ; 104(13): 1166-1171, 2022 07 06.
Artigo em Inglês | MEDLINE | ID: mdl-35793795

RESUMO

BACKGROUND: Opioids constitute the fastest-growing drug problem among children and adolescents in the United States. Recent heavy media coverage on the opioid prescription epidemic has garnered increased attention from prescribers and policymakers. The purpose of this study was to analyze trends in opioid prescribing for nonoperatively managed pediatric fractures and dislocations in order to examine changes in opioid-prescribing patterns across various U.S. regions. METHODS: A retrospective review of the national Pediatric Health Information System (PHIS) database comprising 42 pediatric hospitals was performed to identify pediatric fractures and dislocations presenting to the emergency department (ED) or outpatient clinics from 2004 to 2017. We included patients with the 10 most frequently encountered diagnoses who were nonoperatively managed and were discharged home the same day. To account for hospital variation, we utilized a mixed-effects logistic regression model. RESULTS: The final cohort included 134,931 patients, with a mean age (and standard deviation) of 12.57 ± 2.00 years (range, 10 to 18 years); 69.23% of patients were male. Overall, 51.69% of patients were prescribed at least 1 opioid dose during their ED or clinic visits. Of the patients receiving opioids, 72.04% were male and 54.10% were insured through a private insurance plan. When prescription trends were compared according to regions, children were more likely to be prescribed opioids in the South (71.37% more likely) and the Midwest (26.17% more likely) than in the Northeast. CONCLUSIONS: Although the opioid prescription rates in all 4 regions have decreased dramatically over the years, some regions were quicker than others in responding to the opioid epidemic. A significant interregional variability in opioid-prescribing practices still exists, but an overall downward trend in opioid prescription rates for acute pain management in conservatively treated pediatric fractures and dislocations is evidence of progress in tackling the opioid crisis. CLINICAL RELEVANCE: Opioid-related misuse is a national epidemic and reducing the use of opioids in pediatric orthopaedic procedures is critical. Although regional variability in opioid-prescribing practices still exists, an overall downward trend in opioid prescription rates for acute pain management in conservatively treated pediatric fractures and dislocations is evidence of progress in tackling the opioid crisis.


Assuntos
Fraturas Ósseas , Luxações Articulares , Transtornos Relacionados ao Uso de Opioides , Ortopedia , Adolescente , Analgésicos Opioides/uso terapêutico , Criança , Feminino , Hospitais Pediátricos , Humanos , Masculino , Epidemia de Opioides , Padrões de Prática Médica
15.
Addict Sci Clin Pract ; 17(1): 38, 2022 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-35883197

RESUMO

OBJECTIVE: To characterize and address the opioid crisis disproportionately impacting rural U.S. regions. METHODS: The Rural Opioid Initiative (ROI) is a two-phase project to collect and harmonize quantitative and qualitative data and develop tailored interventions to address rural opioid use. The baseline quantitative survey data from people who use drugs (PWUD) characterizes the current opioid epidemic (2018-2020) in eight geographically diverse regions. RESULTS: Among 3,084 PWUD, 92% reported ever injecting drugs, 86% reported using opioids (most often heroin) and 74% reported using methamphetamine to get high in the past 30 days; 53% experienced homelessness in the prior 6 months; and 49% had ever overdosed. Syringe service program use varied by region and 53% had ever received an overdose kit or naloxone prescription. Less than half (48%) ever received medication for opioid use disorder (MOUD). CONCLUSIONS: The ROI combines data across eight rural regions to better understand drug use including drivers and potential interventions in rural areas with limited resources. Baseline ROI data demonstrate extensive overlap between opioid and methamphetamine use, high homelessness rates, inadequate access to MOUD, and other unmet needs among PWUD in the rural U.S. By combining data across studies, the ROI provides much greater statistical power to address research questions and better understand the syndemic of infectious diseases and drug use in rural settings including unmet treatment needs.


Assuntos
Overdose de Drogas , Metanfetamina , Transtornos Relacionados ao Uso de Opioides , Analgésicos Opioides/uso terapêutico , Overdose de Drogas/epidemiologia , Humanos , Epidemia de Opioides , Transtornos Relacionados ao Uso de Opioides/epidemiologia
16.
JAAPA ; 35(8): 26-30, 2022 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-35881714

RESUMO

ABSTRACT: Infective endocarditis is a potentially fatal infection of the endocardium or valves that can result from IV drug abuse. This article describes a patient with infective endocarditis masked by opioid abuse withdrawal symptoms. This challenging presentation brings to the forefront the need for clinicians to be aware of and understand the changing risk factors and demographics of patients with nonspecific infective endocarditis.


Assuntos
Endocardite Bacteriana , Endocardite , Transtornos Relacionados ao Uso de Opioides , Síndrome de Abstinência a Substâncias , Endocardite/epidemiologia , Endocardite Bacteriana/diagnóstico , Humanos , Epidemia de Opioides , Transtornos Relacionados ao Uso de Opioides/complicações
17.
BMJ Open ; 12(7): e059561, 2022 07 12.
Artigo em Inglês | MEDLINE | ID: mdl-35820738

RESUMO

OBJECTIVES: Pharmaceutical industry involvement in medical education, research and clinical practice can lead to conflicts of interest. Within this context, this study examined how the 'Suboxone Education Programme', developed and delivered by a pharmaceutical company as part of a federally regulated risk management program, was presented as a solution to various kinds of risks relating to opioid use in public documents from medical institutions across Canada. SETTING: These documents were issued during the Canadian opioid crisis, a time when the involvement of industry in health policy was being widely questioned given industry's role in driving the overprescribing of opioid analgesics and contributing to population-level harms. DESIGN: A critical discourse analysis of 69 documents collected between July 2020 and May 2021 referencing the Suboxone Education Program spanning 13 years (2007-2021) from medical, nursing and pharmacy institutions sourced from every Canadian province and territory. Discursive themes were identified through iterative and duplicate analyses using a semistructured data extraction instrument. RESULTS: Documents characterised the Programme as addressing iatrogenic risks from overprescribing opioid analgesics, environmental risks from a toxic street drug supply and pharmacological risks relating to the dominant therapeutic alternative of methadone. The programme was identified as being able to address these risks by providing mechanisms to surveil healthcare professionals and to facilitate the prescribing of Suboxone. Medical institutions legitimised the Suboxone Education Programme by lending their regulatory, epidemiological and professional authority. CONCLUSIONS: Addressing risk is considered as a central, moral responsibility of contemporary healthcare services. In this case, moral imperatives to address opioid crisis-related risks overrode other ethical concerns regarding conflicts of interest between industry and public welfare. Failing to address these conflicts potentially imperils efforts of mitigating population health harms by propagating an important driving force of the opioid crisis.


Assuntos
Epidemia de Opioides , Transtornos Relacionados ao Uso de Opioides , Analgésicos Opioides/efeitos adversos , Combinação Buprenorfina e Naloxona , Canadá , Humanos , Epidemia de Opioides/prevenção & controle , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/prevenção & controle
18.
Subst Abus ; 43(1): 1322-1332, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35896005

RESUMO

Background: News coverage has both negatively and positively influenced public awareness and perceptions surrounding the opioid crisis. This study aimed to describe and analyze national network television news framing of the scope and impact of the opioid crisis in the United States. Methods: We performed a retrospective content analysis on national network television evening news segments covering the opioid crisis from 1/2000 to 8/2020, which were obtained from the Vanderbilt Television News Archive. The database was queried for: opioid epidemic, oxycontin, heroin, fentanyl, and naloxone. Two independent reviewers quantitatively coded segment characteristics, including theme, geographic location, opioids mentioned, strategies for combatting the epidemic discussed, interviews conducted, and patient demographics. Changes in segment characteristics over time were analyzed using chi-square analyses and Fisher's exact tests. Results: News segments (N = 191) most commonly provided an overview of the epidemic (55.5%) and/or conveyed personal stories (40.3%). Prescription opioids (59.7%) and heroin (62.8%) were more often referenced than fentanyl (17.8%); the focus on heroin peaked in 2011-2015 (84.8%), while references to fentanyl significantly increased over time (p = 0.021). The most frequently interviewed people included patients with opioid use disorder (OUD) (47.1%), healthcare providers (36.7%), family members/friends (31.9%), and law enforcement (30.9%). Most of the featured patients with OUD were male (63.0%), white (88.4%), and young (< 40 years) adults (77.9%). Coverage of the crisis peaked in 2016. Conclusions: Evening news segments' emphasis on personal stories, while emotionally compelling, came at the cost of thematically-framed coverage that may improve public understanding of the complexities of the epidemic. The depiction of primarily white, young adult patients with OUD revealed a need for a greater emphasis in the news on underrepresented minorities and older adults, as these populations face additional stigma and disparities in OUD treatment initiation and retention.


Assuntos
Epidemia de Opioides , Transtornos Relacionados ao Uso de Opioides , Idoso , Analgésicos Opioides/uso terapêutico , Feminino , Fentanila , Heroína , Humanos , Masculino , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Estudos Retrospectivos , Televisão , Estados Unidos/epidemiologia
19.
Front Public Health ; 10: 900733, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35903371

RESUMO

Background: The potential for digital initiatives for opioid harm reduction is boundless. Synthesized evidence on current interventions and their efficacy are emerging. This scoping review is an effort to aggregate Canadian and Australian digital health initiatives used to prevent opioid-related deaths and minimize harm, prior to and particularly during the pandemic of SARs-COVID-19, when the crisis escalated. Methods: The Joanna Briggs Institute's methodological framework for conducting scoping reviews was used. Peer reviewed and gray literature published between January 2016 to October 2021 were included. Search translation was performed across CINAHL, Cochrane, SCOPUS, MEDLINE Complete, and ProQuest Public Health with consistent use of key search terms. Citation checks were also conducted. Studies included were written in English and reported on digital technologies to prevent opioid-related harm and/or mortality in participants aged 18 years or older in Australia and Canada. Results: A total of 16 publications were included in the final analysis (Australia = 5; Canada = 11). The most frequently reported digital technologies were telehealth to support access to treatment (n = 3) and mobile applications for overdose monitoring and prevention (n = 3). Telehealth-delivered opioid replacement therapy demonstrated equal outcomes and treatment retention rates compared to in-person and mobile applications for overdose monitoring demonstrated lifesaving capability through direct linkages with emergency response services. Conclusions: Digital interventions to minimize opioid crisis related harm and overdose prevention are fast emerging in Australia and Canada. During the pandemic, the crisis escalated in both countries as a public health emergency, and different initiatives were trialed. Digital harm reduction solutions via mobile apps (or SaaS solutions) were found to have the potential to prevent accidental overdose deaths and save lives, if rendered through privacy preserved, secure and trust enabled methods that empower users. Knowledge sharing between the two countries, relating to suitable interventions, may add significant value in combatting the escalating opioid crisis in the post pandemic era.


Assuntos
COVID-19 , Overdose de Drogas , Analgésicos Opioides/uso terapêutico , Austrália/epidemiologia , COVID-19/epidemiologia , Canadá/epidemiologia , Overdose de Drogas/epidemiologia , Overdose de Drogas/prevenção & controle , Humanos , Epidemia de Opioides , Pandemias
20.
Am J Prev Med ; 63(3): 454-465, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35750550

RESUMO

The opioid epidemic has resulted in significant morbidity and mortality in the U.S. Health systems, policymakers, payers, and public health have enacted numerous strategies to reduce the harms of opioids, including opioid use disorder (OUD). Much of this implementation has occurred before the development of OUD‒related comparative effectiveness evidence, which would enable an understanding of the benefits and harms of different approaches. This article from the American College of Preventive Medicine (ACPM) uses a prevention framework to identify the current approaches and make recommendations for addressing the opioid epidemic, encompassing strategies across a primordial, primary, secondary, and tertiary prevention approach. Key primordial prevention strategies include addressing social determinants of health and reducing adverse childhood events. Key primary prevention strategies include supporting the implementation of evidence-based prescribing guidelines, expanding school-based prevention programs, and improving access to behavioral health supports. Key secondary prevention strategies include expanding access to evidence-based medications for opioid use disorder, especially for high-risk populations, including pregnant women, hospitalized patients, and people transitioning out of carceral settings. Key tertiary prevention strategies include the expansion of harm reduction services, including expanding naloxone availability and syringe exchange programs. The ACPM Opioid Workgroup also identifies opportunities for de-implementation, in which historical and current practices may be ineffective or causing harm. De-implementation strategies include reducing inappropriate opioid prescribing; avoiding mandatory one-size-fits-all policies; eliminating barriers to medications for OUD, debunking the myth of detoxification as a primary solo treatment for opioid use disorder; and destigmatizing care practices and policies to better treat people with OUD.


Assuntos
Analgésicos Opioides , Transtornos Relacionados ao Uso de Opioides , Analgésicos Opioides/efeitos adversos , Criança , Feminino , Humanos , Naloxona , Epidemia de Opioides/prevenção & controle , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Padrões de Prática Médica , Gravidez , Estados Unidos/epidemiologia
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