scholarly journals Usefulness of the Brief Pain Inventory in Patients with Opioid Addiction Receiving Methadone Maintenance Treatment

2016 ◽  
Vol 1;19 (1;1) ◽  
pp. E181-E195
Author(s):  
Zainab Samaan
Keyword(s):  
Chronic Pain ◽  
Methadone Maintenance Treatment ◽  
Prognostic Value ◽  
Maintenance Treatment ◽  
Methadone Maintenance ◽  
Brief Pain Inventory ◽  
Opioid Addiction ◽  
Opioid Use ◽  
Illicit Opioid Use ◽  
Urine Screens

Background: Chronic pain is implicated as a risk factor for illicit opioid use among patients with opioid addiction treated with methadone. However, there exists conflicting evidence that supports and refutes this claim. These discrepancies may stem from the large variability in pain measurement reported across studies. Objectives: We aim to determine the clinical and demographic characteristics of patients reporting pain and evaluate the prognostic value of different pain classification measures in a sample of opioid addiction patients. Study Design: Multi-center prospective cohort study. Setting: Methadone maintenance treatment facilities for managing patients with opioid addiction. Methods: This study includes participants from the Genetics of Opioid Addiction (GENOA) prospective cohort study. We assessed the prognostic value of different pain measures for predicting opioid relapse. Pain measures include the Brief Pain Inventory (BPI) and patients’ response to a direct pain question all study participants were asked from the GENOA case report form (CRF) “are you currently experiencing or have been diagnosed with chronic pain?” Performance characteristics of the GENOA CRF pain measure was estimated with sensitivity and specificity using the BPI as the gold standard reference. Prognostic value was assessed using pain classification as the primary independent variable in an adjusted analysis using 1) the percentage of positive opioid urine screens and 2) high-risk opioid use (≥ 50% positive opioid urine screens) as the dependent variables in a linear and logistic regression analyses, respectively. Results: Among participants eligible for inclusion (n = 444) the BPI was found to be highly sensitive, classifying a large number of GENOA participants with pain (n = 281 of the 297 classified with pain, 94.6%) in comparison to the GENOA CRF (n = 154 of 297 classified with pain, 51.8%). Participants concordantly classified as having pain according to the GENOA CRF and BPI were found to have an estimated 7.79% increase in positive opioid urine screens (estimated coefficient: 7.79; 95%CI 0.74, 14.85: P = 0.031) and a 4 times greater odds (odds ratio [OR]: 4.10 P = 0.008; 95%CI: 1.44, 11.63) of engaging in a “high risk” level of illicit opioids use. The prognostic relevance of pain classification was not maintained for the additional participants classified by the BPI (n = 143 discordant). Conclusion: These results suggest that while the BPI may be more sensitive in capturing pain among patients with opioid addiction, this tool is of less value for predicting the impact of pain on illicit opioid use for opioid addiction patients on methadone maintenance treatment. The GENOA CRF showed high predictive ability, whereby patients classified according to the GENOA CRF are at serious risk for opioid relapse. Using the appropriate tool to assess pain in opioid addiction may serve to improve the current detection and management of comorbid painLimitations: We caution the interpretation of these result since they are still reflective of participants already maintained on an opioid substitution therapy (OST), which can largely differ from patients who drop out of methadone maintenance treatment (MMT) or never seek treatment altogether. Key words: Chronic pain, opioid adiction, methadone maintenance treatment, relapse, addiction, measurement, brief pain inventory

scholarly journals Loneliness and Illicit Opioid Use Among Methadone Maintenance Treatment Patients

2019 ◽  
Vol 54 (13) ◽  
pp. 2089-2098 ◽  
Author(s):  
Courtney A. Polenick ◽  
Brandi Parker Cotton ◽  
William C. Bryson ◽  
Kira S. Birditt
Keyword(s):  
Methadone Maintenance Treatment ◽  
Maintenance Treatment ◽  
Methadone Maintenance ◽  
Opioid Use ◽  
Illicit Opioid Use

scholarly journals Association Between Socio-Demographic and Health Functioning Variables Among Patients with Opioid Use Disorder Introduced by Prescription: A Prospective Cohort Study

2018 ◽  
Vol 1 (21;1) ◽  
pp. E623-E642
Author(s):  
Dr. Zainab Samaan
Keyword(s):  
Chronic Pain ◽  
Cohort Study ◽  
Methadone Maintenance Treatment ◽  
Prospective Cohort ◽  
Maintenance Treatment ◽  
Methadone Maintenance ◽  
Opioid Use Disorder ◽  
Prescription Opioid ◽  
Opioid Use

Background: Prescription opioid misuse in Canada has become a serious public health concern and has contributed to Canada’s opioid crisis. There are thousands of Canadians who are currently receiving treatment for opioid use disorder, which is a chronic relapsing disorder with enormous impact on individuals and society. Objectives: The aim of this study was to compare the clinical and demographic differences between cohorts of patients who were introduced to opioids through a prescription and those introduced to opioids for non-medical purposes. Study Design: This was an observational, prospective cohort study. Setting: The study took place in 19 Canadian Addiction Treatment Centres across Ontario. Methods: We included a total of 976 participants who were diagnosed with Opioid Use Disorder and currently receiving methadone maintenance treatment. We excluded participants who were on any other type of prescription opioid or who were missing their 6-month follow-up urine screens. We measured the participants’ initial source of introduction to opioids along with other variables using the Maudsley Addiction Profile. We also measured illicit opioid use using urine screens at baseline and at 6-months follow-up. Results: Almost half the sample (n = 469) were initiated to opioids via prescription. Women were more likely to be initiated to opioids via a prescription (OR = 1.385, 95% CI 1.027-1.866, P = .033). Those initiated via prescription were also more likely to have post-secondary education, older age of onset of opioid use, less likely to have hepatitis C and less likely to have use cannabis. Chronic pain was significantly associated with initiation to opioids through prescription (OR = 2.720, 95% CI 1.998-3.722, P < .0001). Analyses by gender revealed that men initiated by prescription were less likely to have liver disease and less likely to use cannabis, while women initiated by prescription had a higher methadone dose. Limitations: This project was limited by its study design being observational in nature; no causal relationships can be inferred. Also, the data did not allow determination of the role that the prescribed opioids played in developing opioid use disorder. Conclusions: Our results have revealed that almost half of this methadone maintenance treatment (MMT) population has been introduced to opioids through a prescription. Given that the increasing prescribing rates of opioids has an impact on this at-risk population, alternative treatments for pain should be considered to help decrease this opioid epidemic in Canada. Key words: Opioid use disorder, chronic pain relief, methadone maintenance treatment, prescriptions, male, female

Significantly higher methadone dose for methadone maintenance treatment (MMT) patients with chronic pain

Pain ◽  
2005 ◽  
Vol 113 (3) ◽  
pp. 340-346 ◽  
Author(s):  
Einat Peles ◽  
Shaul Schreiber ◽  
Jacob Gordon ◽  
Miriam Adelson
Keyword(s):  
Chronic Pain ◽  
Methadone Maintenance Treatment ◽  
Maintenance Treatment ◽  
Methadone Maintenance ◽  
Methadone Dose

Methadone as an analgesic for patients with chronic pain in methadone maintenance treatment programs (MMTPs)

2018 ◽  
Vol 5 (2) ◽  
pp. 107 ◽  
Author(s):  
Craig D. Blinderman, MD, MA ◽  
Ryuichi Sekine, MD ◽  
Baohui Zhang, MS ◽  
Matthew Nillson, MS ◽  
Lauren Shaiova, MD
Keyword(s):  
Chronic Pain ◽  
Methadone Maintenance Treatment ◽  
Maintenance Treatment ◽  
Methadone Maintenance ◽  
Pain Clinic ◽  
Treatment Programs ◽  
Methadone Dose ◽  
Pain Syndromes ◽  
The Mean ◽  
Chronic Pain Syndromes

Background: Limited case reports have suggested a role for methadone as an analgesic for chronic pain in patients maintained on methadone for treatment of opiate addiction. Patients with HIV are disproportionately represented in this population and often have severe, debilitating chronic pain syndromes of multiple etiologies, including cancer-related pain syndromes.Objective: This study evaluated the safety and efficacy of initiating and maintaining additional methadone for chronic pain in HIV-positive patients with ongoing treatment for opiate addiction in methadone maintenance treatment programs (MMTPs).Methods: We performed a retrospective chart review of 53 HIV/AIDS patients (36 male, 17 female; 24 with cancer) with diverse chronic pain syndromes who were followed in an HIV Pain Clinic and were currently enrolled in an MMTP. The outcome measure was pain, assessed using a numeric rating scale (0-10). Incidence of heroin use was also measured.Results: The mean methadone dose initially prescribed for analgesia was approximately equal to 67 percent of the methadone dose used in the MMTP for addiction. Over the 12-month retrospective observation period, methadone was titrated to approximately 200 percent of the methadone maintenance dose. The mean pain score at initial visit to the Pain Clinic was 9.4 + 1.03. After methadone for analgesia has been administered for 1 month, the mean pain score decreased to 5.35 ± 1.7 (p < 0.001), at 3 months, 4.8 ± 1.3 (p < 0.001), at 6 months, 4.2 ± 1.7 (p < 0.001), and at 12 months, 4.2 ± 1.4 (p < 0.001). No serious adverse events or side effects were observed with methadone therapy for analgesia.Conclusion: HIV/AIDS patients with chronic pain enrolled in MMTPs achieved improved analgesia with no serious side effects when additional methadone was administered for pain relief. Further controlled studies are needed to confirm our findings and to establish the safety and efficacy of methadone therapy for chronic pain in this population.

scholarly journals The association between health conditions and cannabis use in patients with opioid use disorder receiving methadone maintenance treatment

BJPsych Open ◽  
2019 ◽  
Vol 5 (6) ◽  
Author(s):  
Ieta Shams ◽  
Nitika Sanger ◽  
Meha Bhatt ◽  
Tea Rosic ◽  
Candice Luo ◽  
...  
Keyword(s):  
Anxiety Disorders ◽  
Methadone Maintenance Treatment ◽  
Odds Ratio ◽  
Maintenance Treatment ◽  
Methadone Maintenance ◽  
Current Treatment ◽  
Opioid Use Disorder ◽  
Cannabis Use ◽  
Health Conditions ◽  
Opioid Use

Background Cannabis is the most commonly used substance among patients in methadone maintenance treatment (MMT) for opioid use disorder. Current treatment programmes neither screen nor manage cannabis use. The recent legalisation of cannabis in Canada incites consideration into how this may affect the current opioid crisis. Aims Investigate the health status of cannabis users in MMT. Method Patients were recruited from addiction clinics in Ontario, Canada. Regression analyses were used to assess the association between adverse health conditions and cannabis use. Further analyses were used to assess sex differences and heaviness of cannabis use. Results We included 672 patients (49.9% cannabis users). Cannabis users were more likely to consume alcohol (odds ratio 1.46, 95% CI 1.04–2.06, P = 0.029) and have anxiety disorders (odds ratio 1.75, 95% CI 1.02–3.02, P = 0.043), but were less likely to use heroin (odds ratio 0.45, 95% CI 0.24–0.86, P = 0.016). There was no association between cannabis use and pain (odds ratio 0.98, 95% CI 0.94–1.03, P = 0.463). A significant association was seen between alcohol and cannabis use in women (odds ratio 1.79, 95% CI 1.06–3.02, P = 0.028), and anxiety disorders and cannabis use in men (odds ratio 2.59, 95% CI 1.21–5.53, P = 0.014). Heaviness of cannabis use was not associated with health outcomes. Conclusions Our results suggest that cannabis use is common and associated with psychiatric comorbidities and substance use among patients in MMT, advocating for screening of cannabis use in this population. Declaration of interest None.

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