Tag Archives: #opioids

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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Newly Studied Pain Pathway May Provide Pain Relief Without Opioid Side Effects

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PainRelief.com Interview with:
Daniel McGehee, PhD
Professor
Chair, Committee on Neurobiology
Department of Anesthesia & Critical Care
University of Chicago

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

Response: Chronic pain conditions are major challenges for those suffering with pain and the clinicians who struggle to find effective treatments. Identifying novel strategies for relieving pain will help limit availability of opioid drugs, as they offer alternatives to replace or reduce opioids in the clinic. 

Along with overdose and addiction issues, there are other complications and side effects of opioids, including tolerance, where the pain relieving properties diminish with repeated use, hypersensitivity to pain when patients stop taking the drug, constipation, and other peripheral side effects. 

Pain relief without those side effects would certainly be valuable for individuals struggling to treat painful conditions. 

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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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Study Finds Opioids No Better Than Placebo for Back or Neck Pain Relief

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PainRelief.com Interview with:
Christine Lin | Professor
The University of Sydney                                           
Sydney Musculoskeletal Heatlh
Faculty of Medicine and Health, Sydney School of Public Health
Institute for Musculoskeletal Health                             
Gadigal Country King George V Building
Royal Prince Alfred Hospital NSW Australia

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

Response: Opioids are one of the most commonly prescribed pain medicines for low back pain and neck pain, but before this trial we did not have robust, direct evidence that they are effective for acute low back pain and neck pain.

PainRelief.com: What are the main findings?

Response: We found that taking opioids did not relieve acute low back pain and neck pain in the short term, and led to worse outcomes in the long term. We randomly assigned people with acute low back pain or neck pain to take opioids or placebo (identical tablets but with no active ingredients) for up to 6 weeks, in addition to getting the best advise on how to manage their pain from their doctor. We followed these people up for 1 year.

At 6 weeks, people in the opioid group did not report lower pain levels compared to people in the placebo group. Nor were there differences in pain outcomes at 2 and 4 weeks, or in other outcomes such as physical function, recovery time, or quality of life.

Surprisingly at 1 year, people who took opioids had slightly worse pain and an increased risk of opioid misuse.

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JAMA Study Finds Clinicians Not Maximizing Opportunities to Initiate Buprenorphine Treatment For Patients With Opioid Addiction

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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

Kao-Ping Chua

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

Response: Opioid overdose deaths are at a record high in the U.S. Many opioid overdose deaths can be prevented by medications for opioid use disorder, such as buprenorphine, a drug that can prescribed in office settings. However, buprenorphine cannot prevent opioid overdose deaths if patients are never started on the medication or only stay on the medication for a short time. For that reason, rates of buprenorphine initiation and retention are critical metrics for measuring how well the U.S. health care system is responding to the opioid epidemic.

At the time we started our study, several other research groups had evaluated U.S. rates of buprenorphine initiation and retention using data through 2020. However, more recent national data were lacking. We felt that this was an important knowledge gap given the many changes in society that have occurred since 2020. For example, it was possible that the relaxation of social distancing measures during 2021 and 2022 might have reduced barriers to health care visits, thereby increasing opportunities to initiate treatment for opioid addiction with buprenorphine.

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State Opioid Prescribing Limits Did Little to Reduce Length of Dental Prescriptions

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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.

Kao-Ping Chua
Dr. Kao-Ping Chua

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

Response: U.S. dentists account for approximately 11 million opioid prescriptions each year. Excessive opioid prescriptions from dentists can result in leftover opioids that can be diverted or misused. In part to prevent this, most states enacted policies between 2016 and 2018 that restricted the duration of opioid prescriptions for acute pain, such as dental pain.

The objective of this study was to evaluate whether these state opioid prescribing limits were associated with reductions in the duration of opioid prescriptions from dentists. Using national prescription dispensing data from 2014-2020 and a rigorous quasi-experimental study design, we found that this duration did not change after limit enactment. A likely explanation is that most limits allow up to a 7-day supply of opioids, but the typical duration of dental opioid prescriptions during the study period was about a 3-day supply. For this reason, state limits had little ability to reduce this duration in the first place.

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