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1.
J Opioid Manag ; 17(2): 145-154, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33890278

RESUMO

OBJECTIVES: Recently, opioid abuse and related overdoses have increased warranting the need for research directed against the opioid epidemic. Previous studies identified that patients on opioid therapy may become zinc deficient and that zinc, in a murine model, may antagonistically affect the opioid receptor.13 Further understanding the relationship between opioid use and zinc deficiency may mitigate the opioid epidemic. METHODS: A retrospective study was conducted to identify zinc (Zn2+) deficiencies among post-operative total hip arthroplasty (THA) patients. On post-operative day one, patients had routine blood tests, including Zn2+ plasma levels. Patients were considered Zn2+-deficient if their Zn2+ plasma was < 56 µg/dL (Reference: 56-134 µg/dL). Upon discharge from the hospital, the patients' inpatient opioid medication consumption per day was determined by dividing total morphine milligram equivalents (MMEs) by length of stay. A Student's t-test was performed to compare the total MMEs for Zn2+-deficient patients versus Zn2+-normal patients. A univariate analysis followed by multiple linear regression was performed to identify demographic or surgical predictors of MMEs/day. RESULTS: For Zn2+-deficient patients, the total MMEs/day was 33.62 ( ± 27.06), as compared to Zn2+-normal patients who consumed 16.22 ( ±16.01) MMEs/day (p = 0.031). The univariate analysis and multiple linear regression showed that patients' Zn2+ status had a significant contribution toward predicting MMEs/day, with p = 0.022 and p = 0.04, re-spectively. CONCLUSION: The results of this study suggest that Zn2+ deficiency may potentiate opioid consumption. Thus, Zn2+ sup-plementation may be a simple approach to reducing opioid addiction and dependence.


Assuntos
Artroplastia de Quadril , Transtornos Relacionados ao Uso de Opioides , Analgésicos Opioides/efeitos adversos , Artroplastia de Quadril/efeitos adversos , Humanos , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/tratamento farmacológico , Estudos Retrospectivos , Zinco
2.
J Opioid Manag ; 17(1): 5-7, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33735422

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic has had harmful effects on the opioid epidemic. While a negative effect was predicted, we report on this reality in the hospital setting. We have seen a sharp rise in hospitalized patients with opioid use disorder (OUD). Our data should encourage ongoing efforts to reduce barriers in accessing medications for treatment, harm reduction interventions and additional education for trainees, primary care providers, and hospitalists alike. In the current climate, these interventions are critical to save the lives of patients with OUD.


Assuntos
Transtornos Relacionados ao Uso de Opioides , Analgésicos Opioides/efeitos adversos , Hospitalização , Humanos , Tratamento de Substituição de Opiáceos , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/epidemiologia
3.
J Opioid Manag ; 17(1): 13-17, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33735424

RESUMO

BACKGROUND: Previous data suggest that tapentadol, an atypical opioid with a putative dual mechanism of action, has relatively low rates of abuse. A better understanding of the rates of abuse among different prescription opioids may help clinicians when considering their potential risks and benefits. The results of urine drug tests (UDTs) may provide a unique opportunity to help answer this question. METHOD: To investigate different rates of prescription-opioid abuse in this retrospective study, we examined urine drug test results from patients seeking treatment at four facilities of an opioid-use-disorder (OUD) treatment program in Ohio. Urine specimens were collected on admission, one from each patient, in the regular course of care. The opioids reviewed in the present study were tapentadol, hydrocodone, oxycodone, hydromorphone, oxymorphone, and tramadol. Drug dispensing data, including morphine-milligram equivalents (MME) dispensed, were examined to adjust for the relative prevalence of each opioid being examined. RESULTS: Data from 4,162 patients were examined. Tapentadol was the least common finding in UDT results in this cohort and remained so after adjusting for drug availability. The percentage of specimens positive for a given opioid ranged from 0.12 percent (tapentadol) to 7.04 percent (oxycodone). The availability and MME adjustments resulted in a change of rank order, with tapentadol remaining the lowest but tramadol replacing oxycodone as the prescription opioid with the highest rate of abuse. CONCLUSIONS: In this sample of UDT results from patients seeking treatment at an OUD program in Ohio, tapentadol was the least frequent finding among the opioids examined, and this remained true when adjusting for dispensing data. Factors potentially contributing to this difference may include pharmacological properties unique to tapentadol. Several important limitations notwithstanding, these findings are consistent with previous real-world evidence and warrant an ongoing line of inquiry.


Assuntos
Transtornos Relacionados ao Uso de Opioides , Preparações Farmacêuticas , Analgésicos Opioides/efeitos adversos , Humanos , Ohio/epidemiologia , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Pacientes Ambulatoriais , Estudos Retrospectivos , Tapentadol
4.
JMIR Mhealth Uhealth ; 9(2): e23080, 2021 02 22.
Artigo em Inglês | MEDLINE | ID: mdl-33616545

RESUMO

BACKGROUND: The growing epidemic of opioid use disorder (OUD) and associated injection drug use has resulted in a surge of new hepatitis C virus (HCV) infections. Approximately half of the people with HCV infection are unaware of their HCV status. Improving HCV awareness and increasing screening among people with OUD are critical. Addiction-Comprehensive Health Enhancement Support System (A-CHESS) is an evidence-based, smartphone-delivered relapse prevention system that has been implemented among people with OUD who are receiving medications for addiction treatment (MAT) to improve long-term recovery. OBJECTIVE: We incorporated HCV-related content and functionality into A-CHESS to characterize the HCV care continuum among people in early remission and receiving MAT for OUD and to determine whether incorporating such content and functionality into A-CHESS increases HCV testing. METHODS: HCV intervention content, including dissemination of educational information, private messages tailored to individuals' stage of HCV care, and a public discussion forum, was implemented into the A-CHESS platform. Between April 2016 and April 2020, 416 participants with OUD were enrolled in this study. Participants were randomly assigned to receive MAT alone (control arm) or MAT+A-CHESS (experimental arm). Quarterly telephone interviews were conducted from baseline to month 24 to assess risk behaviors and HCV testing history. Cox proportional hazards regression was used to assess whether participants who used A-CHESS were tested for HCV (either antibody [Ab] or RNA testing) at a higher rate than those in the control arm. To assess the effect of A-CHESS on subsets of participants at the highest risk for HCV, additional analyses were performed to examine the effect of the intervention among participants who injected drugs and shared injection equipment. RESULTS: Overall, 44.2% (184/416) of the study participants were HCV Ab positive, 30.3% (126/416) were HCV Ab negative, and 25.5% (106/416) were considered untested at baseline. At month 24, there was no overall difference in HCV testing uptake between the intervention and control participants. However, among the subset of 109 participants who engaged in injection drug use, there was a slight trend toward increased HCV testing uptake among those who used A-CHESS (89% vs 85%; hazard ratio: 1.34; 95% CI 0.87-2.05; P=.18), and a stronger trend was observed when focusing on the subset of 32 participants who reported sharing injection equipment (87% vs 56%; hazard ratio: 2.92; 95% CI 0.959-8.86; P=.06). CONCLUSIONS: Incorporating HCV prevention and care information into A-CHESS may increase the uptake of HCV testing while preventing opioid relapse when implemented among populations who engage in high-risk behaviors such as sharing contaminated injection equipment. However, more studies that are powered to detect differences in HCV testing among high-risk groups are needed. TRIAL REGISTRATION: ClinicalTrials.gov NCT02712034; https://clinicaltrials.gov/ct2/show/NCT02712034. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/12620.


Assuntos
Hepatite C , Transtornos Relacionados ao Uso de Opioides , Abuso de Substâncias por Via Intravenosa , Telemedicina , Analgésicos Opioides , Hepatite C/diagnóstico , Hepatite C/tratamento farmacológico , Hepatite C/epidemiologia , Humanos , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Abuso de Substâncias por Via Intravenosa/epidemiologia
5.
Int J Drug Policy ; 90: 103088, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33385974

RESUMO

BACKGROUND: Amid the opioid crisis, the health care system is restructuring to prevent and treat COVID-19. Individuals in opioid agonist treatment (OAT) are uniquely challenged because of disruption to treatment, medication diversion, and isolation during the pandemic. METHODS: Between January and September 2020, we utilized the electronic medical record from a chain of 67 opioid agonist treatment clinics in Ontario, Canada, to examine routinely collected urine drug screen results of patients in opioid agonist treatment by Public Health Units. RESULTS: We present evidence of a 108% increase in the percentage of fentanyl positive urine drug screens from April to September (p< 0.001). During the same period, health regions in northern and southwestern Ontario, areas with a high concentration of rural communities, have seen the most notable increase in the percent of fentanyl positive urine drug screen results. CONCLUSION: The use of fentanyl increased by 108% among OAT patients in Ontario during the COVID 19 pandemic. We argue that the persistent increase of fentanyl exposure over time, specifically in the OAT population, suggests that reduced monitoring may decrease OAT's effectiveness and negatively impact patient outcomes.


Assuntos
Analgésicos Opioides/uso terapêutico , Analgésicos Opioides/urina , Fentanila/urina , Tratamento de Substituição de Opiáceos , Epidemia de Opioides , Transtornos Relacionados ao Uso de Opioides/reabilitação , Detecção do Abuso de Substâncias , Centros de Tratamento de Abuso de Substâncias , Humanos , Ontário , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Transtornos Relacionados ao Uso de Opioides/urina , Valor Preditivo dos Testes , Urinálise
6.
Trials ; 22(1): 102, 2021 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-33509278

RESUMO

BACKGROUND: A lack of consensus on the optimal outcome measures to assess the efficacy and effectiveness of interventions for the treatment of opioid use disorder (OUD) has hampered the pooling of research data for evidence synthesis and clinical guidelines. A core outcome set (COS) is a minimum set of outcome measures that are recommended for all studies of a particular condition. The National Drug Abuse Treatment Clinical Trials Network (CTN) Core Outcome Set for OUD (COS-OUD) is a development study to identify core constructs, meaningful outcomes, and their optimal measurement for all efficacy and effectiveness studies of OUD treatment and service delivery. METHODS/DESIGN: Overseen by an expert workgroup, a modified, stepwise, e-Delphi methodology will be used to gain consensus among a panel of clinical practitioners and researchers involved in the treatment of OUD, who are members of the CTN. Sequential rounds of anonymous, online questionnaires will be used to identify, rate the importance of, and refine a core outcome set. A consensus threshold will be achieved if at least 70% of the panel rate the measure as critical for inclusion in the COS-OUD. Where consensus is not reached or there are suggestions for new measures, these will be brought forward to a further round of review prior to a consensus meeting. Products from this study will be communicated via peer-reviewed scientific journals and conferences. DISCUSSION: This initiative will develop a COS for OUD intervention trials, treatment studies, and service delivery and will support the pooling of research and clinical practice data and efforts to develop measurement-based care within the OUD treatment cascade. TRIAL REGISTRATION: http://www.comet-initiative.org/Studies/Details/1579.


Assuntos
Consenso , Técnica Delfos , National Institute on Drug Abuse (U.S.)/normas , Transtornos Relacionados ao Uso de Opioides/terapia , Projetos de Pesquisa/normas , Adolescente , Adulto , Idoso , Determinação de Ponto Final/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Resultado do Tratamento , Estados Unidos , Adulto Jovem
7.
J Subst Abuse Treat ; 120: 108155, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33298297

RESUMO

The COVID-19 pandemic and the move to telemedicine for office-based opioid treatment have made the practice of routine urine drug tests (UDT) obsolete. In this commentary we discuss how COVID-19 has demonstrated the limited usefulness and possible harms of routine UDT. We propose that practitioners should stop using routine UDT and instead use targeted UDT, paired with clinical reasoning, as part of a patient-centered approach to care.


Assuntos
Transtornos Relacionados ao Uso de Opioides/diagnóstico , Detecção do Abuso de Substâncias/métodos , Humanos , Transtornos Relacionados ao Uso de Opioides/urina , Assistência Centrada no Paciente/métodos , Telemedicina
9.
J Subst Abuse Treat ; 123: 108258, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33358617

RESUMO

The COVID-19 pandemic has led to abrupt changes in the delivery of substance use treatment, notably the adoption of telehealth services and a departure from mandatory urine drug screens (UDS). Amid current circumstances, the UDS, which had evolved to signal a "successful" recovery, no longer seems feasible, safe, or necessary. Even prior to the pandemic, the UDS had notable drawbacks, including sending a message of mistrust and hierarchy, potentially causing psychological trauma, and incentivizing falsification. Nonetheless, certain patients may state that they depend on the UDS for motivation or structure while some providers may rely on it to discover which patients are struggling. While a combination of self-report and UDS is generally regarded as the strongest measure of substance use among patients, our experiences caring for patients without the results of the UDS during the COVID-19 pandemic have forced us to examine the use of other measures to define a successful recovery. Complete abstinence may not be the goal for all patients and those who achieve abstinence may have additional goals worth supporting. While the UDS will likely be incorporated back into our treatment plans, we suggest unseating it as the centerpiece of substance use care and discovering additional methods of measuring our patients' outcomes in less traumatizing and more patient-centered ways.


Assuntos
Transtornos Relacionados ao Uso de Opioides/diagnóstico , Autorrelato , Detecção do Abuso de Substâncias , Urinálise , Humanos , Pandemias , Estados Unidos
10.
J Opioid Manag ; 16(4): 277-282, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32885835

RESUMO

The prevalence of opioid abuse has reached an epidemic level. National guidelines recommend safer opioid prescribing practices, including potentially monitoring patients with urine drug testing (UDT). There is limited research evidence sur-rounding the use of UDT in the context of chronic noncancer pain (CNCP). We evaluated the efficacy of systematic, randomized UDT to detect and manage opioid misuse among patients with CNCP in primary care. The Marathon Family Health Team (MFHT) designed and implemented a clinic-wide, randomized UDT program called the HARMS (High-yield Approach to Risk Mitigation and Safety) Program. This retrospective chart review includes 77 CNCP patients being pre-scribed opioids, who were initially stratified by their prescriber as "low-risk." Each month, 10 percent of patients were selected for a random UDT with double testing (immunoassay and liquid chromatography-mass spectrometry). The pri-mary outcome measure was UDT leading to a change in management plan. Of the 77 patients in the study, 55 (71 per-cent) completed at least one UDT during the 12-month study period. Overall, 22 patients had aberrant results. UDT led directly to changes in management in 15 of those patients. Four of those 15 patients were escalated to an addictions program, two were tapered from opioids with informed discussion, and nine were escalated to the high-risk monitoring stream. The results of this study show that in low-risk CNCP patients prescribed opioids, applying systematic UDT in a primary care setting is effective for detecting high risk behaviors and addiction, and altering management. Further re-search is needed with larger numbers using a prospective study design.


Assuntos
Analgésicos Opioides , Dor Crônica , Transtornos Relacionados ao Uso de Opioides , Dor Crônica/tratamento farmacológico , Humanos , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Padrões de Prática Médica , Atenção Primária à Saúde , Estudos Prospectivos , Estudos Retrospectivos , Urinálise
11.
J Opioid Manag ; 16(4): 291-296, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32885837

RESUMO

OBJECTIVE: Pilot study to assess psychometric indices of the screener and opioid assessment for patients with pain-revised (SOAPP-R©) with item response theory. DESIGN: Correlational. SETTING: Patients. OUTCOME MEASURES: The SOAPP-R©, the pain self-efficacy questionnaire (PSE-Q), and the patient health questionnaire-9 (PHQ-9) and a demographic -questionnaire. RESULTS: A three-dimensional model provided the best fit for the SOAPP-R© item responses, with scales entitled drug-alcohol concerns, pain medication, and emotional stress; reliabilities were 0.77, 0.71, and 0.80 for those three scales. Significant correlations were found with the PSE-Q, the PHQ-9, and the SPQ for the drug-alcohol scale but not for the two remaining scales. CONCLUSIONS: The SOAPP-R© showed invariance and support for validity, but with a three-dimensional scale structure.


Assuntos
Analgésicos Opioides , Transtornos Relacionados ao Uso de Opioides , Manejo da Dor , Humanos , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Dor , Projetos Piloto , Reprodutibilidade dos Testes , Inquéritos e Questionários
12.
Rev. Soc. Esp. Dolor ; 27(4): 278-280, jul.-ago. 2020.
Artigo em Espanhol | IBECS | ID: ibc-196845

RESUMO

Los pacientes con patología dual son especialmente complejos y realizar un buen diagnóstico diferencial es fundamental. En este caso, un cuadro de "dolor crónico" enmascara la sintomatología psiquiátrica y adictiva desde el inicio


Patients with dual diagnosis are particularly complex and do a good differential diagnosis is critical. In this case, a diagnosis of "chronic pain" masks addictive and psychiatric symptoms from the beginning


Assuntos
Humanos , Masculino , Adulto , Diagnóstico Duplo (Psiquiatria)/estatística & dados numéricos , Analgésicos Opioides/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Dor Lombar/tratamento farmacológico , Esquizofrenia/complicações , Diagnóstico Diferencial , Tratamento de Substituição de Opiáceos/métodos , Dor Crônica/tratamento farmacológico
13.
PLoS One ; 15(7): e0235981, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32678860

RESUMO

OBJECTIVE: To develop and validate a machine-learning algorithm to improve prediction of incident OUD diagnosis among Medicare beneficiaries with ≥1 opioid prescriptions. METHODS: This prognostic study included 361,527 fee-for-service Medicare beneficiaries, without cancer, filling ≥1 opioid prescriptions from 2011-2016. We randomly divided beneficiaries into training, testing, and validation samples. We measured 269 potential predictors including socio-demographics, health status, patterns of opioid use, and provider-level and regional-level factors in 3-month periods, starting from three months before initiating opioids until development of OUD, loss of follow-up or end of 2016. The primary outcome was a recorded OUD diagnosis or initiating methadone or buprenorphine for OUD as proxy of incident OUD. We applied elastic net, random forests, gradient boosting machine, and deep neural network to predict OUD in the subsequent three months. We assessed prediction performance using C-statistics and other metrics (e.g., number needed to evaluate to identify an individual with OUD [NNE]). Beneficiaries were stratified into subgroups by risk-score decile. RESULTS: The training (n = 120,474), testing (n = 120,556), and validation (n = 120,497) samples had similar characteristics (age ≥65 years = 81.1%; female = 61.3%; white = 83.5%; with disability eligibility = 25.5%; 1.5% had incident OUD). In the validation sample, the four approaches had similar prediction performances (C-statistic ranged from 0.874 to 0.882); elastic net required the fewest predictors (n = 48). Using the elastic net algorithm, individuals in the top decile of risk (15.8% [n = 19,047] of validation cohort) had a positive predictive value of 0.96%, negative predictive value of 99.7%, and NNE of 104. Nearly 70% of individuals with incident OUD were in the top two deciles (n = 37,078), having highest incident OUD (36 to 301 per 10,000 beneficiaries). Individuals in the bottom eight deciles (n = 83,419) had minimal incident OUD (3 to 28 per 10,000). CONCLUSIONS: Machine-learning algorithms improve risk prediction and risk stratification of incident OUD in Medicare beneficiaries.


Assuntos
Biologia Computacional/métodos , Planos de Pagamento por Serviço Prestado/estatística & dados numéricos , Aprendizado de Máquina , Medicare/estatística & dados numéricos , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Medição de Risco/métodos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/complicações , Prognóstico , Estados Unidos
14.
Spine (Phila Pa 1976) ; 45(15): 1062-1066, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32675613

RESUMO

STUDY DESIGN: Retrospective cross-sectional study. OBJECTIVES: The aim of this study was to examine whether there are racial and ethnic disparities in opioid use for back pain treatment. In addition, we examine whether physical therapy reduces opioid use. SUMMARY OF BACKGROUND DATA: Back pain is a common health problem that affects most adults in their lifetime. Opioid and physical therapy are commonly used to treat back pain. While evidence indicates that there are substantial disparities in the receipt of opioids by race and ethnicity in opioid use in the United States, it remains unclear whether these disparities in opioid use exist in the treatment of back pain. METHODS: Cross-sectional analysis of the 2010-2012 Medical Expenditures Panel Survey and logistic regression of a sample of about 4000 adults with back pain. RESULTS: Logistic regression models showed statistically significant differences in opioids receipt by race among adult patients with back pain. Compared to White patients, Asian and Hispanic patients are less likely to be prescribed opioids. On the other hand, Black patients and patients of other race are more likely to receive an opioid prescription to treat their back pain even after accounting for socioeconomic status, health insurance status, and general health status. Additionally, patients who receive physical therapy treatment are less likely to be prescribed opioids. CONCLUSION: These findings suggest that there are racial disparities in the use of opioids and physical therapy may reduce opioid prescription use to treat back pain. These disparities may be contributing to disparities in back pain recovery and long-term health disparities in general. LEVEL OF EVIDENCE: 2.


Assuntos
Analgésicos Opioides/uso terapêutico , Dor nas Costas/tratamento farmacológico , Dor nas Costas/etnologia , Grupos de Populações Continentais/etnologia , Grupos Étnicos , Disparidades em Assistência à Saúde/etnologia , Adulto , Analgésicos Opioides/efeitos adversos , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Transtornos Relacionados ao Uso de Opioides/etnologia , Manejo da Dor/métodos , Estudos Retrospectivos , Classe Social , Estados Unidos/etnologia
15.
Clin Interv Aging ; 15: 763-770, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32546994

RESUMO

Background: Patients hospitalized following a traumatic injury will be frequently treated with opioids during their stay and after discharge. We examined the relationship between acute phase (<3 months) opioid use after discharge and the risk of opioid poisoning or use disorder in older trauma patients. Methods: In a retrospective multicenter cohort study conducted on registry data, we included all patients ≥65 years admitted (hospital stay >2 days) for injury in 57 trauma centers in the province of Quebec (Canada) between 2004 and 2014. We searched for opioid poisoning and opioid use disorder from ICD-9 to ICD-10 code diagnosis after their initial injury. Patients that filled an opioid prescription within a 3-month period after sustaining the trauma were compared to those who did not, using Cox proportional hazards regressions. Results: A total of 70,314 admissions were retained for analysis; median age was 82 years (IQR: 75-87), 68% were women, and 34% of the patients filled an opioid prescription within 3 months of the initial trauma. During a median follow-up of 2.6 years (IQR: 1-5), 192 participants (0.27%; 95% CI: 0.23%-0.31%) were hospitalized for opioid poisoning and 73 (0.10%; 95% CI: 0.08%-0.13%) were diagnosed with opioid use disorder. Having filled an opioid prescription within 3 months of injury was associated with an increased hazard ratio of opioid poisoning (2.8; 95% CI: 2.1-3.8) and opioid use disorder (4.2; 95% CI: 2.4-7.4) after the injury. However, history of opioid poisoning (2.6; 95% CI: 1.1-5.8), of substance use disorder (4.3; 95% CI: 2.4-7.7), or of the opioid prescription filled (2.8; 95% CI: 2.2-3.6) before the trauma, was also related to opioid poisoning or opioid use disorder after the injury. Conclusion: Opioid poisoning and opioid use disorder are rare events after hospitalization for trauma in older patients. However, opioids should be used cautiously in patients with a history of substance use disorder, opioid poisoning or opioid use.


Assuntos
Analgésicos Opioides , Prescrição Inadequada , Transtornos Relacionados ao Uso de Opioides , Ferimentos e Lesões/tratamento farmacológico , Idoso de 80 Anos ou mais , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/toxicidade , Canadá/epidemiologia , Feminino , Humanos , Prescrição Inadequada/efeitos adversos , Prescrição Inadequada/prevenção & controle , Masculino , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Alta do Paciente/estatística & dados numéricos , Padrões de Prática Médica , Sistema de Registros/estatística & dados numéricos , Medição de Risco , Ferimentos e Lesões/epidemiologia
16.
Med Clin North Am ; 104(4): 695-708, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32505261

RESUMO

The diagnosis of opioid use disorder (OUD) is often overlooked or inadequately managed during the inpatient admission. When recognized, a common strategy is opioid detoxification, an approach that is often ineffective and can be potentially dangerous because of loss of tolerance and subsequent risk for overdose. Medication for addiction treatment (MAT), including methadone and buprenorphine, is effective and can be dispensed in the hospital for both opioid withdrawal and initiation of maintenance treatment. Hospitalists should be knowledgeable about diagnosing and managing patients with OUD, including how to manage acute pain or MAT during the perioperative setting.


Assuntos
Tratamento de Substituição de Opiáceos/métodos , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Transtornos Relacionados ao Uso de Opioides/terapia , Educação de Pacientes como Assunto/métodos , Analgésicos Opioides/uso terapêutico , Buprenorfina/uso terapêutico , Redução do Dano , Hospitalização , Humanos , Metadona/uso terapêutico , Naltrexona/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Tratamento de Substituição de Opiáceos/psicologia
17.
Pediatrics ; 145(Suppl 2): S153-S164, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32358206

RESUMO

In response to the growing impact of the current opioid public health crisis in the United States on adolescents and young adults, pediatricians have an expanding role in identifying opioid use early, preventing escalation of risky use, reducing opioid-related harms, and delivering effective therapies. Research and expert consensus suggest the use of brief interventions focused on reducing risks associated with ongoing opioid use and using motivational interviewing strategies to engage youth in treatment. Because fatal opioid overdose remains a major cause of opioid-related mortality among youth, delivering overdose education as part of any visit in which a youth endorses opioid use is one evidence-based strategy to decrease the burden of opioid-related mortality. For youth that are injecting opioids, safe injection practices and linkage to needle or syringe exchanges should be considered to reduce complications from injection drug use. It is crucial that youth be offered treatment at the time of diagnosis of an opioid use disorder (OUD), including medications, behavioral interventions, and/or referral to mutual support groups. The 2 medications commonly used for office-based OUD treatment in adolescents are extended-release naltrexone (opioid antagonist) and buprenorphine (partial opioid agonist), although there is a significant treatment gap in prescribing these medications to youth, especially adolescents <18 years of age. Addiction is a pediatric disease that pediatricians and adolescent medicine physicians are uniquely poised to manage, given their expertise in longitudinal, preventive, and family- and patient-centered care. Growing evidence supports the need for integration of OUD treatment into primary care.


Assuntos
Transtornos Relacionados ao Uso de Opioides/reabilitação , Adolescente , Medicina do Adolescente , Terapia Comportamental , Buprenorfina/uso terapêutico , Causas de Morte , Terapia Combinada , Estudos Transversais , Preparações de Ação Retardada , Feminino , Humanos , Masculino , Naltrexona/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Transtornos Relacionados ao Uso de Opioides/mortalidade , Pediatria , Grupos de Autoajuda , Abuso de Substâncias por Via Intravenosa/diagnóstico , Abuso de Substâncias por Via Intravenosa/mortalidade , Abuso de Substâncias por Via Intravenosa/reabilitação , Estados Unidos , Adulto Jovem
19.
Curr Psychiatry Rep ; 22(5): 23, 2020 04 13.
Artigo em Inglês | MEDLINE | ID: mdl-32285215

RESUMO

PURPOSE OF REVIEW: The rising prevalence of opioid use disorder (OUD) and related complications in North America coupled with limited numbers of specialists in addiction medicine has led to large gaps in treatment. Primary care providers (PCPs) are ideally suited to diagnose and care for people with OUD and are increasingly being called upon to improve access to care. This review will highlight the recent literature pertaining to the care of patients with OUD by PCPs. RECENT FINDINGS: The prevalence of patients with OUD in primary care practice is increasing, and models of office-based opioid treatment (OBOT) are evolving to meet local needs of both ambulatory practices and patients. OBOT has been shown to increase access to care and demonstrates comparable outcomes when compared to more specialty-driven care. OBOT is an effective means of increasing access to care for patients with OUD. The ideal structure of OBOT depends on local factors. Future research must explore ways to increase the identification and diagnosis of patients with OUD, improve treatment retention rates, reduce stigma, and promote interdisciplinary approaches to care.


Assuntos
Buprenorfina , Transtornos Relacionados ao Uso de Opioides , Buprenorfina/uso terapêutico , Humanos , América do Norte , Tratamento de Substituição de Opiáceos , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Atenção Primária à Saúde
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