NEJM: Despite Removal of DEA Waiver Requirement, Buprenorphine Still Widely Underprescribed for Opioid Addiction Interview with:
Kao-Ping Chua, MD, PhD|
Susan B. Meister Child Health Evaluation and Research Center
Department of Pediatrics, University of Michigan Medical School
Ann Arbor MI 48109

Kao-Ping-Chua What is the background for this study?
Response: Buprenorphine is one of 3 FDA-approved medications to treat opioid addiction. It is the only one of the 3 that can be prescribed during office visits. Although buprenorphine is highly effective in treating opioid addiction, it is widely underused. Addressing this underuse is a key step towards slowing the epidemic of U.S. opioid overdose deaths.

In 2000, the federal government allowed clinicians to prescribe buprenorphine if they obtained a waiver from the Drug Enforcement Administration. Clinicians have cited the waiver requirement as a key barrier to buprenorphine prescribing. In part because of this, the government eliminated this requirement on January 12, 2023.

Neuropathy: Repeated High Concentration Capsaicin Patches Provided Back Pain Relief and Reduced Need for Opioids Interview with:
Kai-Uwe Kern MD, PhD
Institute of Pain Medicine/Pain Practice
Wiesbaden, Germany What is the background for this study?

Response: In recent studies a progressive response to high-concentration capsaicin patch (HCCP) with repeated treatment was observed, meaning that patients with insufficient pain relief after the first application of HCCP, still may respond to a second, third, or even fourth application. Based on these latest findings, and also on my personal clinical experience, we aimed to systematically analyse the pool of patients in my Pain Practice with at least two HCCP treatments.

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NCCIH Study Finds Marked Increase in Complementary Health Approaches Among US Adults, Including for Pain Management Interview with:
Richard L. Nahin, Ph.D., M.P.H
Lead Epidemiologist
National Center for Complementary and Integration Health
NCCIH What is the background for this study?

Response: Millions of US adults use complementary health approaches (CHAs) each year. CHAs are health approaches typically not part of conventional medical care or with origins outside of Western medicine that are used together with conventional medical practice.

Some of the most well-known complementary health approaches include meditation, acupuncture, and yoga. While the safety and efficacy of many of these approaches previously lacked rigorous clinical trials, the last two decades saw an increase in evidence supporting the use of select approaches to manage health and pain.

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Prenatal Opioids Increase Risk of Multiple Adverse Health Effects Interview with:
Erin Kelty PhD
Research Fellow
NHMRC Emerging Leader
School of Population & Global Health What is the background for this study?

Response: Recent research from Dr Lauren Jantzie at John Hopkins found that in mice prenatal opioid exposure altered the immune system.
Our research aimed to see if the same was true in children who had been exposed to opioids in utero.

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Opioid Use Disorder: Rutgers Study Demonstrates Improved Mood and Emotional Regulation with Guided Mindfulness Interview with:
Suchismita Ray, Ph.D.
Associate Professor                                      
Department of Health Informatics            
Rutgers School of Health Professions
Rutgers Biomedical and Health Sciences
Rutgers, The State University of New Jersey
Newark, NJ 07101

Dr. Suchismita Ray
Photo by John O’Boyle What is the background for this study?

Response: In this pilot study, we examined longer-term changes after the Mindfulness-Oriented Recovery Enhancement (MORE) intervention and immediate effects of a brief MORE guided meditation session in women with opioid use disorder (OUD) who were on medications for OUD (MOUD). Participants completed the first assessment, then the 8-week MORE intervention (once weekly for two hours) during residential treatment, and then the second assessment.

The assessments were identical and conducted at Rutgers University Brain Imaging Center in Newark.

First, participants completed an emotion regulation questionnaire, and then they entered the magnetic resonance imaging (MRI) environment for scanning. Participants listened to a 10-minute guided MORE meditation in the scanner while viewing a picture of an outdoor garden, and brain images were recorded to measure functional connectivity (i.e., brain communication) during the meditation. We examined the immediate effects of a 10-minute guided MORE meditation on mood and craving. We further examined the effects of 8-week MORE intervention on changes in emotional regulation difficulty and brain communication.

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Cancer Doctors Prescribing Fewer Opioids Since Opioid Crisis Interview with:
Joshua Kra, MD
Assistant Professor of Medicine, Rutgers NJMS
Division of Hematology/Oncology
Rutgers Cancer Institute of New Jersey at University Hospital What is the background for this study?

Response: We aimed to characterize pain management practices by medical oncologists to assess whether CDC guidelines from 2017 for nononcologic settings changed prescribing patterns for oncologists. What are the main findings?

Response: There was a significant decrease in opioid prescriptions from medical oncologists starting in 2017, which coincided with the recognition of the opioid crisis as a national public health emergency and the publication of CDC guidelines for opiate prescribing in non-cancer settings. This would suggest these factors contributed to how oncologists changed their management of opioid prescriptions for cancer patients.

Opioid Prescriptions by Surgeons for Post-Op Pain Relief Decline, but Progress Has Slowed Interview with:
Kao-Ping Chua, MD, PhD
Susan B. Meister Child Health Evaluation and Research Center
Department of Pediatrics, University of Michigan Medical School
Ann Arbor MI 48109

Dr. Kao-Ping Chua
Dr. Kao-Ping Chua What is the background for this study?

Response: Surgery is one of the most common reasons for opioid prescribing. Ensuring the appropriateness of opioid prescribing by surgeons is important, as prescriptions that exceed patient need result in leftover pills that can be a source for misuse or diversion. Although there have been numerous recent policy and clinical efforts to improve opioid prescribing by surgeons, recent national data on this prescribing are unavailable.

In this study, we analyzed a comprehensive prescription dispensing database that captures 92% of prescriptions from U.S. pharmacies. From 2016 to 2022, we found that the rate of surgical opioid prescriptions at the population level declined by 36%, while the average amount of opioids in these prescriptions declined by 46%. As a result of these two changes, the total amount of opioids dispensed to surgical patients declined by 66%.

However, there were two caveats:

First, the decline in surgical opioid prescribing was most rapid before 2020 and has slowed since then.

Second, the average surgical opioid prescription in December 2022 still contained the equivalent of about 44 pills containing 5 milligrams of hydrocodone, far higher than most patients need after surgery.

Rutgers Study Finds Modest Decrease in Non-Prescription Opioid Use with Cannabis Legalization, But Concentrated in People Addicted to Cannabis Interview with:
Hillary Samples, PhD, MHS
Assistant Professor of Health Systems and Policy
Rutgers School of Public Health
Core Faculty
Center for Pharmacoepidemiology and Treatment Science

Rutgers Institute for Health, Health Care Policy and Aging Research
New Brunswick, NJ 08901 What is the background for this study?

Response: Early studies suggesting that cannabis legalization is associated with lower rates of opioid-related harms received considerable media attention. At the time, overdose deaths were driven by prescription opioids, and medical cannabis was often framed as a policy approach to address the opioid epidemic. However, as research in this area grew, the relationship between medical cannabis legalization and opioid-related harms became less clear. Many studies of cannabis legalization were unable to examine opioid use by individual people, and individual-level studies outside the legal context showed links between cannabis use and higher risk of opioid-related harms. Thus, our goal was to build evidence of the relationship between medical cannabis legalization and individual-level opioid use.

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Opioids Associated with Higher Risk of Mortality in Patients with Kidney Disease and Chronic Pain Interview with:
Satya Surbhi, PhD
Assistant Professor, Division of General Internal Medicine, Department of Medicine
and Center for Health System Improvement, College of Medicine
Director of Measurement and Reporting, Tennessee Population Health Consortium
University of Tennessee Health Science Center What is the background for this study?

Response: Pain is highly prevalent among individuals with chronic kidney disease (CKD), in whom commonly utilized analgesics such as non-steroidal anti-inflammatory drugs (NSAIDs) are often contraindicated. Opioids can be an alternative means of analgesia in patients with CKD, but they are associated with numerous unwanted adverse effects and current efforts are aimed at curbing opioid use in general, which leaves patients with few choices for analgesia. Non-opioid non-NSAID analgesics (e.g., gabapentin, acetaminophen, antipyrine) represent potential alternative choices, but their long-term outcomes in CKD compared to opioids are unknown.    

The objectives of this study were to

1) compare the association of chronic opioid vs. non-opioid analgesics with end-stage kidney disease (ESKD) and all-cause mortality among patients with CKD and chronic pain and

2) to examine the heterogeneity of treatment effects on outcomes by factors including age, sex, race, smoking status, BMI, cancer, eGFR and UACR levels, benzodiazepine use, and opioid/non-opioid prescription year. 

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Chronic Pain Relief: CMAJ Study Evaluates Predictors of Fatal and Non-Fatal Overdoses Interview with:
Li Wang, PhD
Associate professor
Department of Anesthesia
Michael G. DeGroote Institute of Pain Research and Care
McMaster University
Ontario, Canada What is the background for this study? What are the main findings?

Response: Chronic pain affects one in five people globally and is commonly treated with opioids. Unfortunately, opioid use may lead to serious harms including fatal and nonfatal overdose. Identifying predictors of opioid overdose may improve the shared decision-making for clinicians and patients when considering a trial of opioids for chronic pain. Although there have been previous reviews looking at predictors of opioid overdose following prescription for chronic pain, they have important limitations.

Our systematic review included 28 studies and 23,963,716 patients prescribed opioids for chronic pain that reported the associations of 103 predictors with opioid overdose. The baseline risk of non-fatal overdose was 1 in 500, and the risk of fatal overdose was 1 in 1000.

We identified 10 predictors, supported by moderate-to-high certainty evidence, that increased the risk of opioid overdose by 2-fold or more, including prescription of high-dose opioids (≥90mg morphine equivalent/day), fentanyl prescription, multiple opioid prescribers, use of multiple pharmacies, history of overdose, current substance use disorder, depression, bipolar disorder, other mental illness, or pancreatitis. The absolute risks of development of opioid overdose in patients with the predictor range from 4-12 per 1000 for non-fatal overdose and 2-6 per 1000 for fatal overdose, respectively.

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