Category Archives: Opioids

Safety And Efficacy Of The Unique Opioid Buprenorphine For Chronic Pain Relief

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PainRelief.com Interview with:
Joseph V. Pergolizzi, Jr., M.D.
Co-Founder and Chief Operating OfficerNEMA Research Inc.

Joseph V. Pergolizzi, Jr., M.D. Co-Founder and Chief Operating OfficerNEMA Research Inc.

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

Response: Chronic low back pain (CLBP) is a leading cause of disability.

  • Acetaminophen and nonsteroidal anti-inflammatory drugs are first-line analgesic options or mild CLBP; however, when certain patients with moderate to severe CLBP do not achieve adequate pain relief, opioids are considered as an add-on therapy. Unfortunately, most opioid analgesics have the potential for adverse effects, abuse, and diversion.
  • Buprenorphine buccal film (Belbuca®) is an opioid analgesic classified as a Schedule III controlled substance in the United States and is a partial μ-opioid receptor agonist.
  • Buprenorphine buccal film is a unique analgesic that is approved by the US Food and Drug Administration for use in patients with chronic pain severe enough to require daily, around-the-clock, long-term opioid treatment for whom alternative treatment options are inadequate.
  • Two pivotal phase 3 clinical trials (Study 307, Clinical Trial ID NCT01675167, and Study 308, Clinical Trial ID NCT01633944) established the efficacy and safety profiles of buprenorphine buccal film.
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Older Adults More Likely to Misuse Opioids for Pain Relief

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PainRelief.com Interview with:

Ty S. Schepis, PhD
Department of Psychology
Texas State University
San Marcos, TX

Ty S. Schepis, PhD Department of Psychology Texas State University San Marcos, TX
Dr. Schepis

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

Response: Prescription opioid misuse motives have been studied in adolescents, young adults, and across the population. One study across the population suggested that older adults differed from younger adults, but this was not fully clear.

We wanted to examine motives across age groups and to investigate the correlates of opioid motive groups in older adults (50 and older). We found that motives changed with aging, with increasing endorsement of pain relief motives, particularly pain relief without other motives.

In contrast, more recreational opioid misuse motives (e.g., to experiment, to get high) peaked in adolescents or young adults. Finally, non-pain relief motives in older adults (50 and older) were associated with higher rates of any past year substance use disorder and past year suicidal ideation.

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Adults 50+ More Likely to Misuse Opioids for Pain Relief

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PainRelief.com Interview with:
Ty S. Schepis, Ph.D.
Associate Professor
Department of Psychology
Texas State University

Ty S. Schepis, Ph.D. Associate Professor Department of Psychology Texas State University

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

Response: We were interested in examining the underlying reasons for prescription opioid misuse both across the population and in older adults specifically. Given that pain conditions and physical health limitations increase with aging, we wondered if different age groups would display different patterns of motives. Indeed, they did. Adults 50 and older were particularly likely to misuse opioid medication only for pain relief reasons (over 80%); in contrast, roughly 65% of young adults (18-25 years) endorsed only non-pain relief motives for misuse.

For older adults, opioid misuse involving any non-pain relief motives was associated with a greater rate of also having another substance use disorder and past-year suicidal thoughts.

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No Current Credible Evidence Cannabis Use is Helpful in Opioid Addiction

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PainRelief.com Interview with:

Dr. Zena Samaan , MBChB, MSc, DMMD, MRCPsych (UK), PhD
Associate Professor
Program Director
Clinician Investigator Program
Faculty of Health Sciences
Department of Psychiatry
Dr. Zena Samaan , MBChB, MSc, DMMD, MRCPsych (UK), PhD

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

Response: The study background: the interest in cannabis use as a replacement for opioid use was sparked by reports suggesting that cannabis is a safer alternative and the public perception of cannabis as the answer for many health problems is growingly fueling the debate on the potential use of cannabis to help in the opioid crisis. Reports from USA for example in 2014 using administrative data suggested that in States were there is medical cannabis law, the rate of death attributed to opioids was lower, generating wide media attention. Since then however an updated study using the same data published in 2019 showed that when the data were re-analyzed and the time frame was extended, the opposite was seen, in that states with cannabis law had higher opioid related mortality.

Our study came form the observations that patients with opioid use disorder are commonly using cannabis (~50% of patients used cannabis while on treatment for opioid addiction) and given the recent public interest, our goal was to provide evidence informed conclusions on the potential effects of cannabis on opioid use in patients with opioid addiction.

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Opioids Commonly Prescribed for Pain Relief from Osteoarthritis

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PainRelief.com Interview with:

Dr. Jonas Bloch Thorlund  MSc, PhD
Professor of Musculoskeletal Health
Department of Sports Science and Clinical Biomechanics &
Research Unit for General Practice (Dept. of Public Health) 
Dr. Thorlund

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

Response: Opioids are commonly prescribed to patients with knee and hip osteoarthritis (OA). But for newly diagnosed patients’ clinical guidelines recommend exercise therapy, patient education and weight loss (if needed) as first line treatment. These treatments can be supplemented or replaced with biomechanical interventions (insoles, wedges, cane use, etc.), and paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) if needed. Generally, opioids are should only be used when other treatment options are exhausted, ineffective or contraindicated. Thus, treatment with opioids shortly after OA diagnosis is considered inappropriate according to guidelines.

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Knee Osteoarthritis: Orthopedists Prescribing More NSAIDS and Less Lifestyle Management for Pain Relief

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PainRelief.com Interview with:

Samannaaz Khoja, PT, PhD
Research Assistant Professor
Department of Physical Therapy
University of Pittsburgh School of Health and Rehabilitation Sciences

Samannaaz Khoja, PT, PhD Research Assistant Professor Department of Physical Therapy University of Pittsburgh School of Health and Rehabilitation Sciences
Dr. Khoja

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

Response: The purpose of this study was to describe and compare rates of physicians’ recommendation for physical therapy (PT), lifestyle-counseling, and pain medication for knee osteoarthritis (KOA) between 2007 and 2015. The study also aimed to identify patient, physician and practice-level factors associated with each treatment recommendation.   We used survey data from the National Ambulatory Medical Care Survey, data from this survey is publicly available and is housed within the CDC. We identified 2297 knee OA related visits, which approximated to 67 (±4) million weighted physician visits between 2007 and 2015 (around 8 million visits/year).

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Do Men and Women Have Different Pain Relief Response to Opioids?

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PainRelief.com Interview with:
Roberta Agabio, M.D.
Dpt. Biomedical Sciences
University of Cagliari
Cittadella Universitaria Monserrato
Monserrato (CA) – ITALY

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

Response: Pain is the leading cause for seeking medical care worldwide, and opioids are the most frequently prescribed drugs for pain relief. Differences and similarities between men and women in both effectiveness and side effects to opioids used for pain relief have been described. In addition, individuals may respond differently to these medications for other reasons for example: the intensity of pain experienced, amount and type of administration of opioids (e.g. fixed doses established by physicians or flexible doses decided by patients), mental condition, age, body weight, and use of alcohol, tobacco and/or cannabis.

However, the role of these factors in influencing sex differences and similarities in the response to opioids used for pain control has not been thoroughly investigated.

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Who Teaches Faculty to Educate Medical Residents About Opioids for Chronic Pain?

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PainRelief.com Interview with:

Payel Roy, MD
 Section of General Internal Medicine
Department of Medicine
Boston University School of Medicine and Boston Medical Center
Boston, Massachusetts.

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

Response: Given the current opioid crisis, we know how important it is to educate physicians-in-training in safer opioid prescribing.  But we can’t educate them properly if their faculty mentors don’t feel comfortable prescribing opioids themselves.  Our study evaluated a program designed to improve faculty physicians’ comfort in prescribing opioids safely and teaching these practices to trainee physicians.  

We found that faculty development programs can improve their confidence in prescribing opioids safely and teaching their trainees about prescribing, however translating these attitudes into teaching practice remains a challenge.

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Who Prescribes More Opioids for Pain Relief? Physicians or Physician Extenders?

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Photo of Dr. Michael Issac Ellenbogen, M.D.

Michael Ellenbogen, MD
Assistant Professor of Internal Medicine
Johns Hopkins School of Medicine 

What is the background for this study? What are the main findings?

Nurse practitioners (NPs) and physician assistants (PAs) are becoming an increasingly important and larger part of the healthcare workforce, especially in general internal medicine. To our knowledge, differences in opioid prescribing among generalist physicians, NPs, and PAs have not been evaluated. We aimed to learn if there are differences in opioid prescribing among generalist physicians, NPs, and PAs to Medicare beneficiaries.     

We performed a serial cross-sectional analysis of prescription claims from 2013 to 2016 using publicly available data from the Centers for Medicare and Medicaid Services. All generalist physicians, NPs, and PAs who provided more than ten total prescription claims between 2013 and 2016 were included. These prescribers were subsetted as practicing in a primary care, urgent care, or hospital-based setting.

We found that the overall volume and proportion of opioid prescribing is heavily right-skewed. The mean opioid prescription proportions (as a proportion of all prescription claims) for physicians in primary care, urgent care/walk-in clinics, and hospital medicine were 4.69, 6.72, and 6.66 relative to 7.10, 11.97, and 11.01 for PAs.  The adjusted total opioid claims across these four years for physicians was 660 (95% confidence interval: 660-661), for NPs was 755 

(95% CI: 753-757), and for PAs was 812 (95% CI: 811-814). 

What should readers take away from your report?

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Nordic Countries Also See Rapid Increase in Opioid Prescriptions for Pain Relief

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PainRelief.com Interview with:
Ley (Ashley) Muller, PhD
University of Oslo

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

Response: The North American opioid crisis is clearly linked to the high availability of prescription opioids. In the Nordic countries of Denmark, Sweden, and Norway, the pharmaceutical industry is much more regulated, including bans on marketing to physicians, so the market isn’t flush with opioids. However, these countries have ageing populations with some of the highest rates of chronic non-cancer pain in the world, and over-prescription for this type of pain was one of the triggers of the North American crisis. 

This begs the question: how sure are we that strong pharmaceutical regulations alone can protect countries from prescription opioid problems?  

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