Tag Archives: addiction

National Trends in Prescription Opioid Risk Reduction Practices

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PainRelief.com Interview with:
Daniel P. Alford, MD, MPH
Professor of Medicine
Associate Dean, Continuing Medical Education
Director, Clinical Addiction Research and Education (CARE) Unit
Director, Safe and Competent Opioid Prescribing Education (SCOPE of Pain) Program
Boston University School of Medicine
Boston Medical Center, Boston MA 02118

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

Response: Boston University School of Medicine’s Safe and Competent Opioid Prescribing Education (SCOPE of Pain) is the longest-running safer opioid prescribing educational program under the FDA’s opioid Risk Evaluation and Mitigation Strategy (REMS). 

This study analyzed clinicians’, who were registering to attend a SCOPE of Pain training, self-report of performing five opioid prescribing risk-mitigation practices with patients prescribed opioids for chronic pain including:

  1. Use of patient-prescriber agreements,

2) Informing patients about taking opioids exactly as prescribed,

3) Discussing safe opioid storage and disposal,

4) Discussing risks of opioid-associated respiratory depression and overdose, and

5) Monitoring for misuse including urine drug test and/or pill counts, prior to participating in the training.

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Pain and Substance Use Can Interact in a Vicious Cycle

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PainRelief.com Interview with:

Emily L. Zale PhD Department of Psychology Syracuse University Syracuse, New York

Dr. Zale

Emily L. Zale PhD
Department of Psychology
Syracuse University
Syracuse, New York

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

Response: When people think of pain and substance use, it’s common for opioids to come to mind. While the opioid crisis has rightfully garnered considerable attention, our research suggests that non-opioid substances, like nicotine/tobacco, alcohol, and cannabis, are also important to consider in relation to pain. In fact, nicotine/tobacco, alcohol, and cannabis are the most commonly used substances in the US, and research into associations between pain and these non-opioid substances is continuing to increase in popularity.

Research studies usually examine either how substance use affects pain or how pain affects substance use. We looked at results from over 100 studies and put these two different types of research together to understand how pain and substance use affect each other.

On one hand, substance use can be a risk factor for chronic pain and may worsen pain over time. On the other hand, experiencing pain can motivate people to use substances and might make it harder to quit. By putting these two types of studies together, we found that pain and substance use  interact in a vicious cycle that can ultimately worsen and maintain both chronic pain and addiction.

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New Opioid Ligands May Provide Pain Relief Without Addiction Risk

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PainRelief.com Interview with:

Prof. Dr. Christoph Stein Direktor Institut für Experimentelle Anaesthesiologie Charité Campus Benjamin Franklin Freie Universität Berlin 

Prof. Stein

Prof. Dr. Christoph Stein
Direktor
Institut für Experimentelle Anaesthesiologie
Charité Campus Benjamin Franklin
Freie Universität Berlin 

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

Response: Our group has studied the biology and pharmacology of opioid receptors on peripheral sensory neurons (i.e. outside the central or intestinal nervous system) for over 25 years. We have always aimed at finding mechanisms and opioid receptor ligands that can be developed into drugs inhibiting pain without eliciting typical adverse effects of conventional opioids such as apnoea, addiction, sedation or constipation.

From our previous work we knew that the selective activation of opioid receptors on peripheral sensory neurons can produce powerful pain relief in animals and human patients. Those analgesic effects are particularly strong in pain caused by tissue injury and inflammation (e.g. postoperative pain, arthritis). Together with mathematicians (Dr. Marcus Weber) at the Zuse Institute Berlin, we started out with computer simulations examining the interaction between opioid ligands and receptors in normal (noninflamed) and inflamed environments. These studies indicated a stronger binding of conventional opioid ligands (morphine, fentanyl) to opioid receptors at increased proton concentrations (i.e. low pH, as present in acidotic/inflamed tissue). We also knew that the protonation of a tertiary amine in the ligand is required for opioid receptor activation. Using those in silico simulations, we now designed a new ligand (NFEPP) that is only protonated (and capable of activating opioid receptors) at low pH, but not at normal pH (as in brain and intestinal wall). After synthesis of NFEPP (and similar derivatives) by a contractor we tested them in vitro and in vivo. NFEPP produced opioid receptor activation and analgesia selectively at low pH/tissue inflammation (as present in nerve injury/neuropathy and abdominal inflammation) without eliciting respiratory depression, addiction potential, sedation or constipation. 

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