scholarly journals Improving Compliance with Best Practice Standards for Patients at Risk for Opioid Use Disorder

2020 ◽  
Author(s):  
Casey Williams
Keyword(s):  
Best Practice ◽  
Opioid Use Disorder ◽  
Evidence Based ◽  
Provider Education ◽  
Opioid Use ◽  
Prescribing Practices ◽  
Post Intervention ◽  
Improvement Project ◽  
Care Plans ◽  
Opioid Use Disorders

Background: Available literature suggests that provider adherence to best practice guidelines regarding the prescribing and management of opioid therapies is low. Documentation of patient screening for present or future opioid use disorder is inconsistent. Provider incorporation of evidence-based guidelines into routine patient care is essential to optimizing outcomes related to opioid use disorders. Purpose/Specific Aims: The purpose of this scholarly project was to facilitate recognition of patients at high risk for opioid use disorders and facilitate best evidence based practices in the care of this population. Specific aims were to achieve provider compliance with: patient risk screening, PDMP review, completion of signed care plans, and reduction of inappropriate opioid prescriptions. Methods: A quasi-experimental design was used for this quality improvement project. The sample included patients receiving treatment for acute or chronic pain, or who were identified as having a substance use disorder. The project was conducted at an internal medicine practice in the northeast region. The intervention included an educational program addressing the ASAM guidelines and ORT utilization with implementation of a SmartPhrase in Epic. Baseline data was collected for the two-month period preceding the intervention and post-intervention data was collected for the three-month period following the intervention. Differences in pre- and post- intervention results were analyzed using chi square. Results: This project resulted in improved compliance with the implementation of urine toxicology screening, PDMP review, and completion of a controlled substance agreement. Compliance with ORT was not achieved. Conclusion: This project led to an increase in compliance with best opioid prescribing practices. The ORT was not consistently implemented; however, the number of new opioid prescriptions remained negligible. Additional efforts will be necessary to maintain the progress achieved in this project including attention to continued provider education. Real-time auditing and feedback will also be incorporated, and opportunities to involve office staff will be explored.

Epidemiology of Substance Use Disorders

2020 ◽  
pp. 3-28
Author(s):  
L. Morgan Snell ◽  
Andrew J. Barnes ◽  
Peter Cunningham
Keyword(s):  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Overdose ◽  
Prescription Opioids ◽  
Opioid Epidemic ◽  
Provider Education ◽  
Opioid Use ◽  
Prescribing Practices ◽  
The Us ◽  
Overdose Deaths

Nearly 3 million Americans have a current or previous opioid use disorder, and recent data indicate that 10.2% of US adults have ever misused pain relievers. In 2015, approximately 800,000 individuals used heroin, while 4 million misused prescription opioids. Although use of other drugs such as alcohol and cannabis is more prevalent, opioid use contributes to significant morbidity, mortality, and social and economic costs. While the current US opioid overdose epidemic began with prescription opioids, since 2015, heroin and synthetic opioids (e.g., fentanyl) have driven continued increases in opioid overdose deaths, contributing to a recent decline in overall life expectancy in the United States. Policies to address the opioid epidemic by changing clinical practice include provider education, monitoring prescribing practices, and expanding the clinical workforce necessary to treat opioid use disorders. The opioid epidemic appears to be largely a US phenomenon and a consequence of both structural challenges in the US healthcare system and growing socioeconomic disparities, and thus it will require policies including and beyond delivery system reforms to resolve it.

scholarly journals Addressing opioid use disorder among rural pregnant and postpartum women: a study protocol

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
M. Aryana Bryan ◽  
Marcela C. Smid ◽  
Melissa Cheng ◽  
Katherine T. Fortenberry ◽  
Amy Kenney ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Study Protocol ◽  
Repeated Measures ◽  
Perinatal Care ◽  
The United States ◽  
Opioid Use Disorder ◽  
Rural Setting ◽  
Evidence Based ◽  
Provider Education ◽  
Opioid Use

Abstract Background Opioid use disorder (OUD) among women delivering at a hospital has increased 400% from 1999–2014 in the United States. From the years 2007 to 2016, opioid-related mortality during pregnancy increased over 200%, and drug-overdose deaths made up nearly 10% of all pregnancy-associated mortality in 2016 in the US. Disproportionately higher rates of neonatal opioid withdrawal syndrome (NOWS) have been reported in rural areas of the country, suggesting that perinatal OUD is a pressing issue among these communities. There is an urgent need for comprehensive, evidence-based treatment services for pregnant women experiencing OUD. The purpose of this article is to describe a study protocol aimed at developing and evaluating a perinatal OUD curriculum, enhancing evidence-based perinatal OUD treatment in a rural setting, and evaluating the implementation of such collaborative care for perinatal OUD. Methods This two-year study employed a one group, repeated measures, hybrid type-1 effectiveness-implementation design. This study delivered interventions at 2 levels, both targeting improvement of care for pregnant women with OUD. The first area of focus was at the community healthcare provider-level, which aimed to evaluate the acceptability and feasibility of perinatal OUD education across time and to improve provider education by increasing knowledge specific to: MOUD provision; screening, brief intervention, and referral to treatment (SBIRT) utilization; and NOWS treatment. The second area of intervention focus was at the patient-level, which assessed the preliminary effect of perinatal OUD provider education in promoting illicit opioid abstinence and treatment engagement among pregnant women with OUD. We adopted constructs from the Consolidated Framework for Implementation Research (CFIR) to assess contextual factors that may influence implementation, and the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) model to comprehensively evaluate implementation outcomes. Discussion This article presents the protocol of an implementation study that is employing the CFIR and RE-AIM frameworks to implement and evaluate a perinatal OUD education and service coordination program in two rural counties. This protocol could serve as a model for clinicians and researchers seeking to implement improvements in perinatal care for women with OUD in other rural communities. Trial registration NCT04448015 clinicaltrials.gov.

Championing Change to Save Lives: A Call to Action to Implement Reforms to Increase Use of Medications to Treat Opioid Use Disorder in Correctional Settings

2020 ◽  
pp. 073401682098162
Author(s):  
Sonia L. Canzater ◽  
Regina M. LaBelle
Keyword(s):  
Standard Of Care ◽  
Opioid Use Disorder ◽  
Correctional Facilities ◽  
Evidence Based ◽  
Opioid Use ◽  
Call To Action ◽  
Evidence Based Treatment ◽  
High Prevalence ◽  
Correctional Settings ◽  
Overdose Deaths

The disproportional rates of opioid use disorder (OUD) in U.S. correctional facilities make them prime intervention points to treat OUD utilizing medication to treat opioid use disorder (MOUD), the evidence-based clinical standard of care. MOUD has been shown to be effective to support recovery and reduce recurrence of OUD, overdose deaths, and recidivism for justice-involved persons both while incarcerated and once they reenter their communities. Despite the high prevalence, most jails and prisons do not offer MOUD. Litigation has spurred expanded access in more facilities, but widespread MOUD access can only become a reality through a comprehensive effort of corrections officials, medical experts, advocates, legislators, and other champions to raise awareness and affect ideological and policy change. It is a legal and ethical imperative that the lives of justice-involved persons not be jeopardized by the lack of evidence-based treatment for OUD in correctional settings.

A review of the evidence to explain pharmacological basis of injection (ab)use of buprenorphine–naloxone tablets

2021 ◽  
Vol 17 (7) ◽  
pp. 141-152
Author(s):  
Tamoud Modak, MD, DM ◽  
Siddharth Sarkar, MD, MRCPsych ◽  
Yatan Pal Singh Balhara, MD
Keyword(s):  
Public Health Problem ◽  
Opioid Use Disorder ◽  
Critical Examination ◽  
Evidence Based ◽  
Major Public Health Problem ◽  
Opioid Use ◽  
Evidence Based Treatment ◽  
Opioid Replacement Therapy ◽  
Pharmacological Basis

Opioid use disorder is a major public health problem, and opioid replacement therapy with buprenorphine (BPN) is a clinically effective and evidence-based treatment for it. To deter misuse of the tablet through the injecting route, BPN coformulated with naloxone (BNX) in 4:1 ratio is available in many countries. Despite this, significant diversion and injecting use of the BNX combination has been reported from across the world. In this article, the pharmacological properties of BPN and BNX and the evidence for their diversion are reviewed. Also, a critical examination is made of the evidence supporting the role of naloxone in reducing the agonist effects of BPN when used through the injecting route. Based on this evidence, a hypothesis explaining the continued diversion of BNX has been proposed.

Pharmacotherapy for Opioid Use Disorders in Special Populations

2020 ◽  
pp. 185-202
Author(s):  
Tricia E. Wright
Keyword(s):  
At Risk ◽  
Pregnant Woman ◽  
Mental Disorder ◽  
Opioid Use Disorder ◽  
Special Populations ◽  
Opioid Use ◽  
Adverse Childhood ◽  
Psychiatric Conditions ◽  
Opioid Use Disorders ◽  
The Life Course

Three populations are most at risk for opioid use disorder: adolescents, pregnant women, and those with comorbid psychological or psychiatric disorders. Opioid use disorders present throughout the life course of an individual, often developing during adolescence. For women, these disorders commonly occur during peak childbearing years. In addition, the twin vulnerabilities of genetics and adverse childhood events often interact to impart a greater chance for co-occurring psychiatric conditions. Caring for the pregnant woman, the adolescent, or the person with a co-occurring mental disorder presents special challenges. This chapter focuses on special considerations when treating opioid use disorders in these populations.

scholarly journals Use of Tramadol for Management of Opioid Use Disorders: Rationale and Recommendations

2018 ◽  
Vol 09 (03) ◽  
pp. 397-403 ◽  
Author(s):  
Yatan Pal Singh Balhara ◽  
Arpit Parmar ◽  
Siddharth Sarkar
Keyword(s):  
Substance Use ◽  
Abuse Liability ◽  
Evidence Based ◽  
Psychoactive Substances ◽  
Opioid Use ◽  
Treatment Services ◽  
Wide Availability ◽  
Current Article ◽  
Disorder Treatment ◽  
Opioid Use Disorders

ABSTRACTOpioids are one of the most common illicit psychoactive substances being used in India. In fact, opioid use disorders are the most common disorder presenting to the substance use disorder treatment centers across the country. Effective and evidence-based interventions are available for management of opioid use disorders. However, the treatment for opioid use disorders remains difficult to access for most of those in need in India. The current article presents the literature on the use of tramadol for the management of opioid use disorders. It also makes recommendations on the use of tramadol for the management of opioid use disorders. Tramadol offers a viable alternative to the existing options for the management of opioid use disorders. It has been found effective when used for this indication. It offers certain major advantages such as easy and wide availability and low abuse liability. It offers a good option to expand the treatment services for opioid use disorders across the country.

scholarly journals 0259 Shiftworkers are at Increased Risk of Developing Chronic Pain and Opioid Use Disorders: A Study of 116,000 UK Biobank Participants Over a Decade

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A98-A99
Author(s):  
L Gao ◽  
P Li ◽  
L Cui ◽  
Y Luo ◽  
C Vetter ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Bone Fractures ◽  
Inflammatory Diseases ◽  
Opioid Use Disorder ◽  
Uk Biobank ◽  
Opioid Use ◽  
Logistic Regression Models ◽  
Diagnostic Coding ◽  
Increased Risk ◽  
Opioid Use Disorders

Abstract Introduction In the current epidemic of opioid-related deaths, and widespread use of opioids to treat chronic pain, there is a pressing need to understand the underlying risk factors that contribute to such devastating conditions. Shiftwork has been associated with adverse health outcomes. We tested whether shiftwork during middle age is linked to the development of chronic pain and opioid misuse. Methods We studied 116,474 participants in active employment between 2006–2010 (mean age 57±8; range 37–71) from the UK Biobank, who have been followed for up to 10 years until 2017. We included participants who were free from all forms of self-reported pain, and were not taking opioid medications at baseline. Chronic pain and opioid use disorder diagnoses were determined using hospitalization records and diagnostic coding from ICD-10. Multivariate logistic regression models were performed to examine the associations of shiftwork status (yes/no) and nightshift frequency (none/occasional/permanent) and with incident chronic pain and/or opioid use disorder during follow-up. Models were adjusted for demographics, education, Townsend deprivation index, major confounders (BMI, diabetes, bone fractures/injuries, operations, peripheral vascular disease, joint/inflammatory diseases, cancer, standing/manual labor at work) and covariates (smoking, alcohol, high cholesterol, depression/anxiety, and cardiovascular diseases). Results In total, 190 (1.6/1,000) developed chronic pain or opioid use disorders. Shiftworkers (n=17,673) saw a 1.5-fold increased risk (OR 1.56, 95% CI: 1.08–2.24, p=0.01) relative to day workers. Within shiftworkers, those who reported occasional nightshift work (n=3,966) were most vulnerable (OR 1.57, 95% CI: 1.06–2.34, p=0.02). Results remained similar after adjusting for baseline sleep duration, chronotype and insomnia. Conclusion Shiftwork, and in particular rotating nightshift work is associated with increased risk for developing chronic pain and opioid use disorders. Replication is required to confirm the findings and to examine underlying mechanisms. Support This work was supported by NIH grants T32GM007592, RF1AG064312, and RF1AG059867.

Multi-site intervention to improve emergency department care for patients who live with opioid use disorder: A quantitative evaluation

CJEM ◽  
2020 ◽  
Vol 22 (6) ◽  
pp. 784-792 ◽  
Author(s):  
Patrick McLane ◽  
Ken Scott ◽  
Zainab Suleman ◽  
Karen Yee ◽  
Brian R. Holroyd ◽  
...  
Keyword(s):  
Emergency Department ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Opioid Agonist ◽  
Emergency Department Care ◽  
Improvement Project ◽  
Health Crisis ◽  
Opioid Agonist Treatment ◽  
Before And After ◽  
Disorder Treatment

ABSTRACTBackgroundOpioid use disorder is a major public health crisis, and evidence suggests ways of better serving patients who live with opioid use disorder in the emergency department (ED). A multi-disciplinary team developed a quality improvement project to implement this evidence.MethodsThe intervention was developed by an expert working group consisting of specialists and stakeholders. The group set goals of increasing prescribing of buprenorphine/naloxone and providing next day walk-in referrals to opioid use disorder treatment clinics. From May to September 2018, three Alberta ED sites and three opioid use disorder treatment clinics worked together to trial the intervention. We used administrative data to track the number of ED visits where patients were given buprenorphine/naloxone. Monthly ED prescribing rates before and after the intervention were considered and compared with eight nonintervention sites. We considered whether patients continued to fill opioid agonist treatment prescriptions at 30, 60, and 90 days after their index ED visit to measure continuity in treatment.ResultsThe intervention sites increased their prescribing of buprenorphine/naloxone during the intervention period and prescribed more buprenorphine/naloxone than the controls. Thirty-five of 47 patients (74.4%) discharged from the ED with buprenorphine/naloxone continued to fill opioid agonist treatment prescriptions 30 days and 60 days after their index ED visit. Thirty-four patients (72.3%) filled prescriptions at 90 days.ConclusionsEmergency clinicians can effectively initiate patients on buprenorphine/naloxone when supports for this standardized evidence-based care are in place within their practice setting and timely follow-up in community is available.

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