Category Archives: Opioids

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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Opioid Prescriptions Differ Between Surgeons and Advanced Practice Clinicians

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PainRelief.com Interview with:
Caitlin Priest, MD
Integrated Plastic Surgery Residency
Department of Surgery
Michigan Medicine

Dr. Priest

PainRelief.com: 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.

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Potential Unintended Harms of Discontinuing Opioid Treatment For Chronic Pain

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PainRelief.com 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

PainRelief.com: 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. 

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Marijuana May Be Substituting for Opioids for Cancer-Related Pain Relief

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PainRelief.com Interview with:
Yuhua Bao, PhD
Department of Population Health Sciences, Department of Psychiatry
Weill Cornell Medicine, New York, New York

Dr. Yuhua Bao

PainRelief.com: 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.

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Home Sensors Developed for Overnight Monitoring in Opioid Use Disorder

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PainRelief.com Interview with:
Marian Wilson, PhD, MPH, RN, PMGT-BC 
Associate Professor
Assistant Editor, Pain Management Nursing
Washington State University College of Nursing

Dr. Wilson

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

Response: People with opioid use disorder often experience withdrawal symptoms that can interfere with recovery success. Our team was interested in whether noninvasive home sensors could provide accurate information to detect overnight restlessness and sleep problems that could indicate opioid withdrawal for adults prescribed methadone for opioid use disorder.

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Novel Protocol Reduced Use of Opioid Pain Relievers After Knee and Shoulder Surgeries

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PainRelief.com Interview with:
Nicole Simunovic, MSc
On behalf of the NO PAin Principal Investigators

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

Response: Orthopaedic surgeons prescribe more opioids than any other type of surgeon in North America. Opioids have the potential to be highly addictive and can cause serious harm or even death if taken in excess. The goal of our clinical study was to determine if an opioid sparing approach to postoperative pain management was safe and effective in patients undergoing arthroscopic knee and shoulder surgery.

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States with Mandated Prescription Monitoring Programs Had Marked Increase in Heroin-Related Deaths

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PainRelief.com Interview with:
Dr. Tongil “TI” Kim,
Assistant professor of marketing
Naveen Jindal School of Management
The University of Texas at Dallas (abbreviated UT Dallas)

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

Response: We examine the early deployment of mandated prescription drug monitoring program (PDMP) use (2006-2015) in the U.S., when 19 states mandated PDMP use. We find 6.37 more heroin-related deaths per million population per year—a 50.1% increase—following PDMP mandates compared to states that did not.

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Uninsured Pay Higher Out-of-Pocket Costs for Opioid Antidote Naloxone

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PainRelief.com Interview with:
Evan D. Peet, PhD Professor
Pardee RAND Graduate School

Dr. Peet

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

Response: This study is part of a broader CDC funded project looking at access to naloxone and naloxone’s impacts on opioid-related overdose deaths. There have been increasing efforts to expand access to naloxone, with a variety of different laws being passed by states across the nation. But one part of access that has been understudied is the cost borne by patients.

High out-of-pocket costs may act as a barrier to this life-saving drug, so in this study we look at trends in out-of-pocket costs of naloxone and how they vary by payor and drug brand.

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More Nonopioid Medications Prescribed for Pain Relief since CDC Released Chronic Pain Guidelines

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PainRelief.com Interview with:

JASON GOLDSTICK
Dr. Goldstick

Jason E. Goldstick, PhD
Injury Prevention Center
Department of Emergency Medicine
University of Michigan, Ann Arbor

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

Response: In 2016, the CDC released the Guideline for Prescribing Opioids for Chronic Pain. A primary goal of this voluntary guideline is that individuals should receive pain management care that provides the greatest overall benefit. Among other things, this may entail beginning opioid treatment only when the clinician determines that the expected benefits outweigh the risks.

Other research has shown reductions in opioid prescribing as reduced since the guideline release; this report examines whether there were changes in nonopioid pain medication prescribing.

Our overall findings were that nonopioid prescribing increased nationally following the guideline release, above and beyond what would’ve been predicted based on the pre-guideline trends, and this finding was generally consistent across patient subpopulations (e.g., those with vs. without prior opioid exposure).

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Study Highlights Challenges of Opioid Use Disorder in Patients with Cancer Pain

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PainRelief.com Interview with:
Katie Fitzgerald Jones MSN, APN
PhD candidate Connell School of Nursing
Boston College
Jonas Mental Health Scholar 2021-2023
American Academy of Nursing Jonas Policy Scholar 
Ruth L. Kirschstein National Service Award (F31NR019929-01)

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

Response: I am a Palliative and Addiction Nurse Practitioner at VA Boston and a Ph.D. candidate at Boston College Connell School of Nursing. In my clinical practice, I regularly care for people with cancer who have a co-occurring substance use disorder. 

How to best care for people with substance use disorders, such as opioid use disorder is especially complex in people with cancer because opioid management is a standard of cancer-pain management and cancer prognoses can influence opioid decisions and vary. It is important when prescribing opioids that you attend to safety while also addressing pain. People with untreated opioid use disorder or concerning opioid behaviors (such as taking more opioids than prescribed or using opioids with unprescribed medications that increase the risk for opioid-related harm such as benzodiazepines) have an increased risk for opioid related-harms. It is also an area that lacks consensus and is absent from cancer-specific pain guidelines.

This study was conducted with leaders in palliative care including senior author, Jessica Merlin to tackle the question of what is consensus among palliative care and addiction clinicians to caring for people with opioid misuse or use disorder and cancer-related pain and how this is influenced by prognosis?

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