scholarly journals Treatment of opioid use disorder in primary care

BMJ ◽  
2021 ◽  
pp. n784
Author(s):  
Megan Buresh ◽  
Robert Stern ◽  
Darius Rastegar
Keyword(s):  
Primary Care ◽  
Randomized Controlled Trials ◽  
Opioid Use Disorder ◽  
Opioid Antagonist ◽  
Controlled Trials ◽  
Opioid Use ◽  
Opioid Agonist ◽  
Randomized Controlled ◽  
Primary Care Settings ◽  
Illicit Opioid Use

AbstractOpioid use disorder (OUD) is a common, treatable chronic disease that can be effectively managed in primary care settings. Untreated OUD is associated with considerable morbidity and mortality—notably, overdose, infectious complications of injecting drug use, and profoundly diminished quality of life. Withdrawal management and medication tapers are ineffective and are associated with increased rates of relapse and death. Pharmacotherapy is the evidence based mainstay of OUD treatment, and many studies support its integration into primary care settings. Evidence is strongest for the opioid agonists buprenorphine and methadone, which randomized controlled trials have shown to decrease illicit opioid use and mortality. Discontinuation of opioid agonist therapy is associated with increased rates of relapse and mortality. Less evidence is available for the opioid antagonist extended release naltrexone, with a meta-analysis of randomized controlled trials showing decreased illicit opioid use but no effect on mortality. Treating OUD in primary care settings is cost effective, improves outcomes for both OUD and other medical comorbidities, and is highly acceptable to patients. Evidence on whether behavioral interventions improve outcomes for patients receiving pharmacotherapy is mixed, with guidelines promoting voluntary engagement in psychosocial supports, including counseling. Further work is needed to promote the integration of OUD treatment into primary care and to overcome regulatory barriers to integrating methadone into primary care treatment in the US.

scholarly journals The external validity of published randomized controlled trials in primary care

2009 ◽  
Vol 10 (1) ◽  
Author(s):  
Ritu Jones ◽  
Robert O Jones ◽  
Colin McCowan ◽  
Alan A Montgomery ◽  
Tom Fahey
Keyword(s):  
Primary Care ◽  
Randomized Controlled Trials ◽  
External Validity ◽  
Controlled Trials ◽  
Randomized Controlled

scholarly journals A Review of Adjunctive Therapies for Burn Injury Pain During the Opioid Crisis

2019 ◽  
Vol 40 (6) ◽  
pp. 983-995 ◽  
Author(s):  
Daniel E Kim ◽  
Kaitlin A Pruskowski ◽  
Craig R Ainsworth ◽  
Hans R Linsenbardt ◽  
Julie A Rizzo ◽  
...  
Keyword(s):  
Pain Management ◽  
Randomized Controlled Trials ◽  
Systematic Reviews ◽  
Burn Injury ◽  
The United States ◽  
Pain Severity ◽  
Controlled Trials ◽  
Burn Patients ◽  
Opioid Use ◽  
Randomized Controlled

Abstract Opioids are the mainstay of pain management after burn injury. The United States currently faces an epidemic of opioid overuse and abuse, while simultaneously experiencing a nationwide shortage of intravenous narcotics. Adjunctive pain management therapies must be sought and utilized to reduce the use of opioids in burn care to prevent the long-term negative effects of these medications and to minimize the dependence on opioids for analgesia. The purpose of this review was to identify literature on adjunctive pain management therapies that have been demonstrated to reduce pain severity or opioid consumption in adult burn patients. Three databases were searched for prospective studies, randomized controlled trials, and systematic reviews that evaluated adjunctive pain management strategies published between 2008 and 2019 in adult burn patients. Forty-six studies were analyzed, including 24 randomized controlled trials, six crossover trials, and 10 systematic reviews. Various adjunctive pain management therapies showed statistically significant reduction in pain severity. Only one randomized controlled trial on music therapy for acute background pain showed a reduction in opioid use. One cohort study on hypnosis demonstrated reduced opioid use compared with historical controls. We recommend the development of individualized analgesic regimens with the incorporation of adjunctive therapies in order to improve burn pain management in the midst of an abuse crisis and concomitant national opioid shortage.

scholarly journals Methodological aspects of randomized controlled trials of psychotherapy in primary care

2003 ◽  
Vol 33 (2) ◽  
pp. 191-196 ◽  
Author(s):  
JAN SCOTT ◽  
TOM SENSKY
Keyword(s):  
Primary Care ◽  
Mental Disorders ◽  
Randomized Controlled Trials ◽  
Common Mental Disorders ◽  
Psychological Interventions ◽  
Controlled Trials ◽  
Drug Trials ◽  
Single Issue ◽  
Randomized Controlled ◽  
Methodological Aspects

Randomized controlled trials (RCTs) of psychological interventions are still much less frequently published than drug trials. To have four papers (Bower et al. 2003; Proudfoot et al. 2003; Simpson et al. 2003; Gabbay et al. 2003) within a single issue of a leading psychiatry journal is indeed unusual. Together these four major papers provide evidence of the benefits and limitations of psychological interventions for common mental disorders.

scholarly journals Evaluating comparative effectiveness of psychosocial interventions for persons receiving opioid agonist therapy for opioid use disorder: protocol for a systematic review

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e023902 ◽  
Author(s):  
Danielle B Rice ◽  
Brian Hutton ◽  
Patricia Poulin ◽  
Beth A Sproule ◽  
Dianna Wolfe ◽  
...  
Keyword(s):  
Systematic Review ◽  
Transmitted Disease ◽  
Psychosocial Interventions ◽  
Opioid Use Disorder ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Opioid Use ◽  
Agonist Therapy ◽  
Opioid Agonist ◽  
Opioid Agonist Therapy

IntroductionThe opioid crisis has resulted in increasing rates of death caused by problematic opioid use. Current clinical guidelines recommend that individuals with persons with opioid use disorder (OUD) receive pharmacological (eg, opioid agonist therapy) and psychosocial (eg, cognitive behavioural therapy) therapy; however, the best combination of pharmacologic and psychosocial components is not known. Our objective of the planned study is to conduct a comprehensive systematic review to assess the relative benefits of psychosocial interventions as an adjunct to opioid agonist therapy among persons with OUD.Methods and analysisA comprehensive search for randomised controlled trials published in English or French will be conducted from database inception to March 2018. The search will be conducted in MEDLINE and translated for Embase, PsycINFO and the Cochrane Central Register of Controlled Trials. Two independent reviewers will screen, extract and assess risk of bias of eligible articles. Primary outcomes of interest will be treatment retention and opioid use (based on urinalysis results). Secondary outcomes will include self-reported opioid use, abstinence from illicit drugs, adherence to psychosocial therapy and opioid agonist therapy, risk for sexually transmitted disease, risk for blood borne pathogens, changes in mental health symptoms (eg, depression), measures of craving and changes in patients’ quality of life and relevant adverse events. If sufficient data and adequate homogeneity exists, network meta-analyses (NMA) will be performed.Ethics and disseminationThis will be the first systematic review to incorporate NMA to compare psychosocial treatments used as an adjunct to opioid agonist therapy for OUD. Results of this review will inform clinical management of persons with OUD.Trial registration numberCRD42018090761.

scholarly journals Cannabinoids and orthopedic surgery: a systematic review of therapeutic studies

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Bradley J. Vivace ◽  
Allyson N. Sanders ◽  
Steven D. Glassman ◽  
Leah Y. Carreon ◽  
Joseph L. Laratta ◽  
...  
Keyword(s):  
Systematic Review ◽  
Randomized Controlled Trials ◽  
Orthopedic Surgery ◽  
Current Evidence ◽  
Orthopedic Procedures ◽  
Controlled Trials ◽  
Opioid Use ◽  
Randomized Controlled ◽  
Quasi Experimental ◽  
Meta Analyses

Abstract Background Recent work has shed light on the potential benefits of cannabinoids for multimodal pain control following orthopedic procedures. The objective of this review was to summarize the available evidence of analgesic and opioid-sparing effects cannabinoids have in orthopedic surgery and identify adverse events associated with their use. Methods A systematic review of the literature using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines including PubMed, EMBASE, MEDLINE, PsycINFO, and Google Scholar was performed to include all primary, therapeutic studies published on the use of cannabis, and cannabis-derived products in orthopedic surgery. Results The literature review returned 4292 citations. Thirteen publications were found to meet inclusion criteria. Four randomized controlled trials were evaluated while the remaining studies were of quasi-experimental design. Conclusion Research on cannabinoids in orthopedic surgery is mostly of a quasi-experimental nature and is mainly derived from studies where orthopedics was not the primary focus. The overall results demonstrate potential usefulness of cannabinoids as adjunctive analgesics and in mitigating opioid use. However, the current evidence is far from convincing. There is a need to produce rigorous evidence with well-designed randomized controlled trials specific to orthopedic surgery to further establish these effects.

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