Category Archives: Opioids

Opioids Associated with Higher Risk of Mortality in Patients with Kidney Disease and Chronic Pain

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PainRelief.com 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

PainRelief.com: 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

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PainRelief.com Interview with:
Li Wang, PhD
Associate professor
Department of Anesthesia
Michael G. DeGroote Institute of Pain Research and Care
McMaster University
Ontario, Canada

PainRelief.com: 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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Buprenorphine Initiation and Retention Through Telehealth for Opioid Use Disorder

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PainRelief.com Interview with:
Lindsey Hammerslag, Ph.D.
Assistant Research Professor
Division of Biomedical Informatics
University of Kentucky
Lexington, KY 40536

PainRelief.com: What is the background for this study? What are the main findings?

Response: This study was designed to examine whether COVID-related changes to buprenorphine prescribing policies, which allowed the use of telehealth during treatment initiation, were associated with benefits for people with opioid use disorder. There’s a push to return to normalcy, with some COVID-related policies being rolled back during the unwinding, and we felt that it was important to make sure that we could provide the evidence policy makers need to make good decisions for patients.

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Study Finds Modest Decrease in Opioid Prescriptions after Insurer Opioid Prescribing Limit

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PainRelief.com 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

PainRelief.com: What is the background for this study?

Response: Almost every state has implemented a policy to restrict the duration of opioid prescriptions for acute pain, as have many major insurers. Prior studies have evaluated the effects of these limits on opioid prescribing, but there are no large-scale studies that have evaluated the effects of limits on patient-reported outcomes, such as pain control.

In this study, we evaluated the effect of a major Michigan insurer’s
5-day opioid prescribing limit in February 2018 on both opioid prescribing and patient-reported outcomes after surgery.

To do so, we leveraged our access to a statewide surgical registry in Michigan that has been collecting data on opioid prescribing and patient-reported outcomes from adult patients undergoing common general surgical procedures since 2017.

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Columbia Model Predicts Return-to-Use Risk After Treatment for Opioid Use Disorder

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PainRelief.com Interview with:
SEAN X. LUO, M.D., PH.D.
Assistant Professor of Clinical Psychiatry
Data Science Research Group
Division on Substance Use Disorders
Department of Psychiatry
Columbia University

PainRelief.com: What is the background for this study?

Response: Opioid use disorder presents a major public health crisis, with increasing overdose death through the last 5 years. Treatment delivery continues to be difficult, with a large number of patients not stably maintained on Medication for Opioid Use Disorder (MOUD) after the initial treatment engagement.

In this study we applied novel statistical methods to a newly harmonized dataset incorporating 3 large clinical trials from the National Drug Treatment Clinical Trials Network (CTN) to develop individual level risk prediction models for opioid use disorder. We showed that urine toxicology data in the first 3 weeks after initiation of treatment can predict return-to-use at the end of 3 months with surprising accuracy.

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Miami Thoracic Surgeons Achieve Pain Control With Minimal or No Opioids

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PainRelief.com Interview with:
Dao Minh Nguyen, MD, MSc FRCSC FACS
Thoracic Cancers Group Go-Lead
Sylvester Comprehensive Cancer Center
University of Miami Miller School of Medicine

PainRelief.com: What is the background for this study?

Response: Patients undergoing thoracic surgery operations experience significant acute incisional pain as well as chronic pain many months after.

The mainstay of treatment is based on frequent use of potent and addictive-prone opioids such as hydromorphone, oxycodone at high dosages and long duration.
There is a high incidence of persistent opioid users and chronic opioids users in surgical patient population. This certainly contributes to the opioid epidemic in the USA and worldwide.

We implemented a peri-operative care protocol for patients undergoing thoracic surgery operations called Enhanced Recovery after Thoracic Surgery (ERATS). The overarching goal of ERATS is to streamline care for thoracic surgery patients particularly in the postoperative period to mitigate pain with opioid-free strategy, to minimize postoperative complications, rapid return to baseline states and safe, early discharge home. This protocol follows guidelines of the ERAS principles and is developed for thoracic patients to address their unique needs.

Once pain is adequately addressed with opioid-free strategy with elimination of opioid-associated side effects, rapid recovery after surgery can be achieved.

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Smaller Portions of Pain Relievers After ER Visits May Be Sufficient for Pain Relief

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PainRelief.com Interview with:
Raoul Daoust, MD, CSPQ, MSc
Clinical Professor and researcher
Departments of Family Medicine and Emergency Medicine
Hôpital du Sacré-Coeur de Montréal

PainRelief.com: What is the background for this study?

Response: Usually patients are prescribed too large a quantity of opioids and unused opioids are available for misuse. The tendency in the USA is to not prescribe opioids at all, leaving some patient in agonizing pain. I wanted to provide a tailored approach to prescribing opioids so patients have enough to manage their pain but almost no unused opioids available for misuse.

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Unequal Access to Chiropractic Pain Relief Care for Back Pain in Patients with Opioid Use Disorder

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PainRelief.com Interview with:
Patience Moyo, Ph.D
Assistant Professor of Health Services, Policy and Practice
Center for Gerontology and Healthcare Research
Department of Health Services, Policy, and Practice
Brown University School of Public Health

Patience Moyo, Ph.D Assistant Professor of Health Services, Policy and Practice Center for Gerontology and Healthcare Research Department of Health Services, Policy, and Practice Brown University School of Public Health

PainRelief.com: What is the background for this study?

Response: Clinical practice guidelines recommend nonpharmacologic treatments as first-line therapies for managing chronic pain. However, little is known about the use of guideline-recommended pain therapies and whether use varies in demographic subgroups. Individuals with co-occurring chronic pain and opioid use disorder deserve particular consideration because of their increased risk of harm from opioids and other pharmacologic therapies combined with their susceptibility to social and structural barriers to accessing health care.

We sought to understand whether the well-established racial and ethnic inequities in pain management extend to individuals with opioid use disorder and to nonpharmacologic pain treatments, specifically physical therapy and chiropractic care.

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Gabapentin in Overdose Patients Not Necessarily the Cause of the Overdose

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MedicalResearch.com Interview with:
Matthew S. Ellis, PhD, MPE
Department of Psychiatry
School of Medicine
Washington University in St. Louis

Kevin Xu MD, MPH
Instructor in Psychiatry
Co-Director, PGY2 Substance Use Disorders Rotation
Department of Psychiatry
School of Medicine
Washington University in St. Louis

MedicalResearch.com: What is the background for this study?

Response: Gabapentin is one of the most commonly prescribed psychotropic medications, as it is used (primarily off-label) to treat a myriad of conditions, ranging from anxiety disorders and insomnia to chronic pain, seizure disorders, and substance use disorders.
This is even more true for individuals receiving treatment for opioid use disorder, who often have multiple physical and mental co-morbid conditions.

Unfortunately, it  has increasingly been found in people who overdose, causing physicians and policymakers to consider restricting access to gabapentin and tapering/deprescribing it in stable patients taking it in the long-term.

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Buprenorphine Prescriptions for Opioid Use Disorder Increased During Pandemic, with Regional Variations

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PainRelief.com Interview with:
Zhi-Shan Hsu
Abigail Geisinger Scholar
Geisinger Commonwealth School of Medicine
Scranton, PA.

Zhi-Shan Hsu MD Abigail Geisinger Scholar Geisinger Commonwealth School of Medicine Scranton, PA.

PainRelief.com: What is the background for this study?

Response: The opioid buprenorphine is a mu and nociceptin receptor partial agonist and serves as an antagonist to kappa and delta receptors. These properties contribute to this medication being an evidence-based and first-line agent in Opioid Use Disorder (OUD) treatment. Brand names of buprenorphine include Suboxone, Zubsolv, Butrans, and Sublocade. In the face of the COVID-19 pandemic and continued annual increases in drug overdoses, modifications to payment, privacy, and licensing regulations that were designed to improve access to telehealth services have likely had an impact on prescribing practices of buprenorphine.

The objective of this study (1) was to expand upon existing knowledge regarding geographic disparities in the distribution and access to buprenorphine (2) as well as consider coinciding modifications to Medicaid, Medicare, and telemedicine regulations. Data was obtained from Drug Enforcement Administration’s Automated Reports and Consolidated Ordering System (ARCOS),(3) a comprehensive drug reporting system of controlled substances from their point of manufacturing to point of sale and distribution and also Medicaid and Medicare.

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