opiods

Background: Less than 20% of individuals with opioid use disorder (OUD) are receiving a medication treatment for OUD in the United States. Though nurses can assume critical roles in outpatient models of OUD care, there are no published reports of buprenorphine standing orders for nurses that guide a nuanced response for patients returning as expected versus those re-engaging after a treatment lapse, without requiring real-time prescriber consultation.

Methods: Standing orders for buprenorphine were created with multiple stakeholders within an urban community health center that includes traditional clinics as well as non-traditional homeless care sites. After more than two years of use, an anonymous survey assessed staff perception of usability and safety of the standing orders using the validated system usability scale (SUS) and a 5-item Likert scale. Patient retention rates at 12 and 18 months were compared for sites that were early- and late-adopters of the standing orders.

Results: Of 24 clinicians and 7 nurses who responded to the survey, 46% had used the standing orders. More than 85% reported a perception that the standing orders improved team-based care and increased access to buprenorphine refills. None reported any safety concerns. The median SUS score was 75.0 (SD 15.4), rated as “excellent”. There was no statistically significant difference in 12- or 18-month retention rates between early- and late-adopter sites of the standing orders.

Conclusions: Nurse standing orders for buprenorphine follow-up and re-engagement care are feasible, usable and perceived as safe in varied community health center settings.

Author/s:

Richard C. Waters, Meaghan Mugleston, Anina Terry, Carrie Reinhart, Megan Wilson

Provision of a Drug Deactivation System for Unused Opioid Disposal at Surgical Dismissal: Opportunity to Reduce Community Opioid Supply

Brian Desmarais — Mon, 10 Aug 2020 18:35:02 +0000

Date Added:

August 10, 2020

Journal/Publication:

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

Publication Date:

August 4, 2020

Issue:

Volume:

Pages:

357-361

URL:

Provision of a Drug Deactivation System for Unused Opioid Disposal at Surgical Dismissal: Opportunity to Reduce Community Opioid Supply

Type:

Best Local Practices

Format:

Article

DOI (1):

https://doi.org/10.1016/j.mayocpiqo.2020.04.007

Keywords

MeSH

A relatively simply way to help patients dispose of unused opioids. James W. Mold, MD, MPH

Commercial full text (fees may apply)

View

Objective

To determine the impact of a drug deactivation system to post-surgical patients on the rate of opioid prescription disposal.

Patients and Methods

Two hundred post-operative patients discharged after inpatient surgery at a large academic medical center. This study was conducted August 20, 2018, through November 30, 2018. Patients were provided with a drug deactivation system (DDS) and instruction sheet along with their opioid prescription. Three to 4 weeks after dismissal, patients were surveyed about quantity of opioids remaining, use of DDS or other disposal methods, and satisfaction with DDS if used.

Results

One hundred forty-nine of 200 (74.5%) patients were surveyed. One hundred six reported leftover opioids and 29 (27.3%) had disposed of these medications. By the time of survey, 23 (21.2%) participants with leftover opioids had used the DDS to destroy their remaining supply and an additional 33 (31.1%) participants reported plans to use the disposal bag on a future date. Of the 23 participants who used the DDS, 22 (96.0%) reported that they were very satisfied with the disposal process.

Conclusion

Participants are willing to use a DDS and are satisfied with the process; however, additional education is needed to ensure timely disposal.

Author/s:

Ramel, C.M., Habermann, E.B., Thiels, C.A., Dierkhising, R.A.

Forecasting Opioid Use Disorder at 25 Years of Age in 16-Year Old Adolescents

Brian Desmarais — Thu, 09 Jul 2020 21:14:01 +0000

Date Added:

July 9, 2020

Journal/Publication:

The Journal of Pediatrics

Publication Date:

July 8, 2020

URL:

Forecasting Opioid Use Disorder at 25 Years of Age in 16-Year Old Adolescents

Type:

Clinical Research Results

Format:

Article

DOI (1):

https://www.jpeds.com

Keywords

People who, at 16, have a positive family history of substance abuse and are currently using addictive substances are very likely to develop a substance abuse disorder by age 25. Obvious but also important to remember when seeing adolescents for other reasons because addiction is really hard to cure and a major impediment to a long and happy life. James W. Mold, MD, MPH

Commercial full text (fees may apply)

View

Objective

t To evaluate the accuracy of detecting 16 year old male (N=465) and female (N=162) youths who subsequently manifest opioid use disorder (OUD) at 25 years of age. We hypothesized that the combined measures of two components of etiology, heritable risk and substance use, accurately detect youths who develop OUD.

Study design

Heritable risk was measured by the transmissible liability index (TLI). Severity of the prodrome presaging OUD was quantified by the revised Drug Use Screening Inventory (DUSI-R) containing the consumption frequency index (CFI) documenting substance use events during the past month and the overall problem density (OPD) score indicating co-occurring biopsychosocial problems. Diagnosis of OUD was formulated by a clinical committee based on results of the Structured Clinical Interview for DSM-IV in conjunction with medical and social history records.

Results

Bivariate analysis shows that the TLI, CFI, and OPD scores at 16 years of age predict OUD at 25 years. Multivariate modeling indicates that the TLI combined with the CFI predict OUD with 86% accuracy (sensitivity = 87%; specificity = 62%). The TLI and CFI at 16 years of age mediate the association between parental substance use disorder and OUD in offspring at 25 years of age, indicating that these measures respectively evaluate risk and prodrome.

Conclusion

These results demonstrate the feasibility of identifying youths requiring intervention to prevent OUD.

Author/s:

Tarter, R.E., Kirisci, L., Reynolds, M., Seybert, A., Cochran, C., Vanyukov, M.

Action Collaborative on Countering the U.S. Opioid Epidemic May 21 Public Virtual Symposium

Brian Desmarais — Thu, 14 May 2020 00:04:20 +0000

Date Added:

May 13, 2020

Publisher:

National Academy of Medicine

Publication Date:

May 1, 2020

URL:

Action Collaborative on Countering the U.S. Opioid Epidemic May 21 Public Virtual Symposium

Type:

Notifications and Opportunities

Format:

Poster

Keywords

An opportunity to learn more about how to address the opioid misuse epidemic. James W. Mold, MD, MPH

Free full text

View

Not available.

Tapering Long-term Opioid Therapy in Chronic Noncancer Pain: Evidence and Recommendations for Everyday Practice

Tracy Ashby — Mon, 15 Apr 2019 05:00:00 +0000

Date Added:

April 15, 2019

Journal/Publication:

Mayo Clinic Proceedings

Publisher:

Elsevier Inc.

Publication Date:

June 1, 2015

Issue:

Volume:

Pages:

828-842

URL:

Tapering Long-term Opioid Therapy in Chronic Noncancer Pain: Evidence and Recommendations for Everyday Practice

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/j.mayocp.2015.04.003

Keywords

opiods

taper

pain management

PMID (1):

26046416

MeSH

substance withdrawal syndrome

weaning

adaptation, psychological

This is a detailed article from Mayo on how to safely taper opioids. James W. Mold, MD, MPH

Commercial full text (fees may apply)

View

Increasing concern about the risks and limited evidence supporting the therapeutic benefit of long-term opioid therapy for chronic noncancer pain are leading prescribers to consider discontinuing the use of opioids. In addition to overt addiction or diversion, the presence of adverse effects, diminishing analgesia, reduced function and quality of life, or the absence of progress toward functional goals can justify an attempt at weaning patients from long-termopioid therapy. However, discontinuing opioid therapy is often hindered by patients' psychiatric comorbidities and poor coping skills, as well as the lack of formal guidelines for the prescribers. The aim of this article is to review the existing literature and formulate recommendations for practitioners aiming to discontinue long-term opioid therapy. Specifically, this review aims to answer the following questions: What is an optimal opioid tapering regimen? How can the risks involved in a taper be managed? What are the alternatives to an opioid taper? A PubMed literature search was conducted using the keywords chronic pain combined with opioidwithdrawal, taper, wean and detoxification. Six hundred ninety-five documents were identified and screened; 117 were deemed directly relevant and are included. On the base of this literature review, this article proposes evidence-based recommendations and expert-based suggestions for clinical practice. Furthermore, areas of lack of evidence are identified, providing opportunities for further research.

Author/s:

Berna, Chantal, Kulich, Ronald J., Rathmell, James P.