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

Columbia Model Predicts Return-to-Use Risk After Treatment for Opioid Use Disorder Interview with:
Assistant Professor of Clinical Psychiatry
Data Science Research Group
Division on Substance Use Disorders
Department of Psychiatry
Columbia University 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 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 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 Interview with:
Raoul Daoust, MD, CSPQ, MSc
Clinical Professor and researcher
Departments of Family Medicine and Emergency Medicine
Hôpital du Sacré-Coeur de Montréal 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 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 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 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 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 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. 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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Opioid Prescriptions Differ Between Surgeons and Advanced Practice Clinicians Interview with:
Caitlin Priest, MD
Integrated Plastic Surgery Residency
Department of Surgery
Michigan Medicine

Dr. Priest What is the background for this study? What are the main findings?

Response: Opioid pain medications are commonly provided after surgery to help with acute postsurgical pain, however, these prescriptions often exceed what is used by most patients, resulting in excess opioids. Advanced practice clinicians (nurse practitioners and physicians assistants) are becoming an increasingly important part of surgical care teams. Despite their growing role in providing care for surgical patients, there is little data on the perioperative opioid prescribing practices of advanced practice clinicians.

Potential Unintended Harms of Discontinuing Opioid Treatment For Chronic Pain Interview with:
Mary Clare Kennedy, PhD
Canada Research Chair in Substance Use Policy and Practice Research
Assistant Professor, School of Social Work
University of British Columbia | Okanagan Campus
Research Scientist, British Columbia Centre on Substance Use What is the background for this study?

Response: In an effort to reduce opioid-related harms, Canada and the United States have implemented guidelines for prescribing opioids for chronic pain. One of the recommendations in these guidelines is that prescribers reduce opioid doses and potentially discontinue treatment when risks outweigh benefits. Concerns have been raised that these guidelines could result in more clinicians inappropriately reducing doses or cutting patients off of prescribed opioids, which could increase the risk of harms such as overdose. However, the effects of discontinuing and tapering opioid treatment for pain on overdose risk have been understudied. 

Marijuana May Be Substituting for Opioids for Cancer-Related Pain Relief Interview with:
Yuhua Bao, PhD
Department of Population Health Sciences, Department of Psychiatry
Weill Cornell Medicine, New York, New York

Dr. Yuhua Bao What is the background for this study?

Response: We know that opioid use is declining among cancer patients. We also know that marijuana use is increasing among cancer patients; this increase is related to the recent wave of medical marijuana legalization (adopted by 37 states and D.C. as of Feb 2022).

We do not know if medical marijuana legalization has led to changes in opioid use for cancer patients and what were the implications for cancer pain outcomes.