Opioid use following the introduction of an extended-release oxycodone formulation with tamper-resistant properties: Prospective historical chart review in methadone-maintained patients

2016 ◽  
Vol 12 (2) ◽  
pp. 149 ◽  
Author(s):  
Christopher Sankey, MD, CCFP (EM) ◽  
Beatrice Setnik, PhD ◽  
Zoltan Harsanyi, BSc (Hon), MLS, MBA, PStat. (SSC), PSTAT® (ASA) ◽  
Ken Michalko, PharmD, MBA ◽  
Zejiang Yang, PhD ◽  
...  
Keyword(s):  
Chart Review ◽  
Extended Release ◽  
Methadone Maintenance ◽  
Baseline Period ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Opioid Dependency ◽  
Urine Drug ◽  
Historical Element ◽  
Prescription Opioid Abuse

Objective: Emerging data are demonstrating that tamper-resistant opioids may play an important role in changing prescription opioid abuse behaviors. This study was a chart review to examine if the reformulation of OxyContin® into a version with tamper-resistant properties (OxyNEO®) had an impact on oxycodone-positive urine drug screens (UDSs) in opioid-dependent patients receiving methadone maintenance therapy (MMT).Design: The historical element of this study examined 250 eligible charts from patients on MMT who had data during the time periods when only OxyContin was available (baseline period), during the transition to OxyNEO, and when only OxyNEO was available. The prospective element included an exploratory questionnaire regarding retrospective opioid use.Setting: The study was conducted at three methadone clinics, in Oshawa, Peterborough, and Scarborough in Ontario, Canada.Participants: Male and female patients were eligible if they had a diagnosis of opioid dependency, received MMT, and had at least one oxycodone-positive UDS during the baseline period.Intervention: This was a noninterventional study.Main outcome measure: The main outcome was the number of oxycodone-positive UDSs.Results: The results demonstrated a marked reduction in oxycodone-positive UDSs that showed stepwise, statistically significant decreases during the transition and post-OxyContin periods relative to baseline. While the oxycodone-positive UDS results were decreasing, morphine-related-positive UDSs remained relatively stable during the same periods. There were no significant gender differences noted.Conclusions: The introduction of OxyNEO was associated with a statistically significant reduction in oxycodone exposure in a population of methadone-maintained patients.

Tapentadol is the least common opioid found in admission urine drug-test results at an intensive outpatient opioid-use disorder treatment program in Ohio: A brief report

2021 ◽  
Vol 17 (1) ◽  
pp. 13-17
Author(s):  
Adam Rzetelny, PhD ◽  
Diana Meske, PhD ◽  
Parag Patel, MD, FACOG, FASAM ◽  
Steven Passik, PhD
Keyword(s):  
Treatment Program ◽  
Opioid Use Disorder ◽  
Common Finding ◽  
Prescription Opioid ◽  
Test Results ◽  
Opioid Use ◽  
Drug Test ◽  
Urine Drug ◽  
Urine Drug Test ◽  
Dispensing Data

Background: Previous data suggest that tapentadol, an atypical opioid with a putative dual mechanism of action, has relatively low rates of abuse. A better understanding of the rates of abuse among different prescription opioids may help clinicians when considering their potential risks and benefits. The results of urine drug tests (UDTs) may provide a unique opportunity to help answer this question.Method: To investigate different rates of prescription-opioid abuse in this retrospective study, we examined urine drug test results from patients seeking treatment at four facilities of an opioid-use-disorder (OUD) treatment program in Ohio. Urine specimens were collected on admission, one from each patient, in the regular course of care. The opioids reviewed in the present study were tapentadol, hydrocodone, oxycodone, hydromorphone, oxymorphone, and tramadol. Drug dispensing data, including morphine-milligram equivalents (MME) dispensed, were examined to adjust for the relative prevalence of each opioid being examined.Results: Data from 4,162 patients were examined. Tapentadol was the least common finding in UDT results in this cohort and remained so after adjusting for drug availability. The percentage of specimens positive for a given opioid ranged from 0.12 percent (tapentadol) to 7.04 percent (oxycodone). The availability and MME adjustments resulted in a change of rank order, with tapentadol remaining the lowest but tramadol replacing oxycodone as the prescription opioid with the highest rate of abuse.Conclusions: In this sample of UDT results from patients seeking treatment at an OUD program in Ohio, tapentadol was the least frequent finding among the opioids examined, and this remained true when adjusting for dispensing data. Factors potentially contributing to this difference may include pharmacological properties unique to tapentadol. Several important limitations notwithstanding, these findings are consistent with previous real-world evidence and warrant an ongoing line of inquiry. 

scholarly journals Psychosis and Comorbid Opioid Use Disorder: Characteristics and Outcomes in Opioid Substitution Therapy

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Rachel Lamont ◽  
Tea Rosic ◽  
Nitika Sanger ◽  
Zainab Samaan
Keyword(s):  
Psychotic Disorder ◽  
Psychotic Disorders ◽  
Methadone Maintenance ◽  
Opioid Use Disorder ◽  
Mood Stabilizers ◽  
Opioid Use ◽  
Opioid Substitution Therapy ◽  
Group Status ◽  
Urine Drug ◽  
Retention In Treatment

Abstract Background and Objectives Substance use disorders are highly prevalent among individuals with psychotic disorders and are associated with negative outcomes. This study aims to explore differences in characteristics and treatment outcomes for individuals with psychotic disorders when compared with individuals with other nonpsychotic psychiatric disorders enrolled in treatment for opioid use disorder (OUD). Methods Data were collected from a prospective cohort study of 415 individuals enrolled in outpatient methadone maintenance treatment (MMT). Psychiatric comorbidity was assessed using the Mini-International Neuropsychiatric Interview. Participants were followed for 12 months. Participant characteristics associated with having a psychotic disorder versus another nonpsychotic psychiatric disorder were explored by logistic regression analysis. Results Altogether, 37 individuals (9%) with a psychotic disorder were identified. Having a psychotic disorder was associated with less opioid-positive urine drug screens (odds ratio [OR] = 0.97, 95% confidence interval [CI] = 0.95, 0.99, P = .046). Twelve-month retention in treatment was not associated with psychotic disorder group status (OR = 0.73, 95% CI = 0.3, 1.77, P = .485). Participants with psychotic disorders were more likely to be prescribed antidepressants (OR = 2.12, 95% CI = 1.06, 4.22, P = .033), antipsychotics (OR = 3.57, 95% CI = 1.74, 7.32, P = .001), mood stabilizers (OR = 6.61, 95% CI = 1.51, 28.97, P = .012), and benzodiazepines (OR = 2.22, 95% CI = 1.11, 4.43, P = .024). Discussion and Conclusions This study contributes to the sparse literature on outcomes of individuals with psychotic disorders and OUD-receiving MMT. Rates of retention in treatment and opioid use are encouraging and contrast to the widely held belief that these individuals do more poorly in treatment. Higher rates of coprescription of sedating and QTc-prolonging medications in this group may pose unique safety concerns.

scholarly journals Subcutaneous Extended-Release Buprenorphine Use in Pregnancy

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Craig V. Towers ◽  
Heather Deisher
Keyword(s):  
Extended Release ◽  
Opioid Use Disorder ◽  
Adverse Outcomes ◽  
Extensive Literature ◽  
Opioid Use ◽  
Sublingual Buprenorphine ◽  
Medication Assisted Treatment ◽  
Urine Drug ◽  
Long Acting ◽  
In Pregnancy

Background. Opioid use disorder (OUD) in pregnancy is managed by medication-assisted treatment. Sublingual buprenorphine is one option, but subcutaneous extended-release buprenorphine (Sublocade®) is an alternate form administered in monthly injections. Through an extensive literature search, we did not find any prior publication on the use of Sublocade in pregnancy. Case. Two patients with OUD switched from sublingual buprenorphine to Sublocade. One patient received a total of eight injections and then discovered she was pregnant. Based on ultrasound dating, the last 5 administrations occurred during her pregnancy. The second patient received 6 injections with the last occurring at the time of her last menstrual period. Both declined further injections, as well as oral buprenorphine. Serial urine drug screens remained positive for buprenorphine through delivery in both cases. Neither the mothers nor the neonates experienced withdrawal symptoms or adverse outcomes. No birth anomalies were found. Discussion. Though further research is needed regarding the use of Sublocade in pregnancy, it is likely that other pregnancies will occur during this treatment modality. If this long-acting form of buprenorphine medication is found to be safe, it might play a role in managing some pregnant patients with OUD.

Physicians' Role in Curbing the Worst Drug Crisis in America: Prescription Opioid Abuse

2018 ◽  
Author(s):  
Sairam Atluri ◽  
Gururau Sudarshan
Keyword(s):  
Chronic Pain ◽  
Opioid Abuse ◽  
Screening Tools ◽  
Prescription Drug Abuse ◽  
Prescription Opioid ◽  
Dose Limitation ◽  
Chronic Pain Patients ◽  
Urine Drug ◽  
Pain Patients ◽  
Prescription Opioid Abuse

Opioids have an important role in the management of acute, cancer, and chronic pain. However, their indiscriminate use in chronic pain has led, in part, to the epidemic of prescription drug abuse, resulting in a dramatic increase in morbidity and mortality in America. Most of this abuse originates from legitimate prescriptions by physicians. Prescribing opioids to chronic pain patients while restricting them to those who abuse them is very challenging, and physicians seek appropriate and unbiased prescribing guidelines. Our review, based on analysis of the available literature, focuses on striking a balance between overprescribing and underprescribing. The core concept of this strategy relies in using screening tools to identify patients who are at high risk for opioid abuse along with diligent monitoring using prescription monitoring programs and urine drug screens, while also limiting opioid doses. Hopefully, using these principles, physicians can more confidently prescribe opioids to those who would benefit from these powerful drugs and at the same time keep opioids away from those who could potentially be harmed. Key Words: abuse, addiction, chronic pain, dose limitation, misuse, monitoring, opioids, overdose, screening

Physicians' Role in Curbing the Worst Drug Crisis in America: Prescription Opioid Abuse

2018 ◽  
Author(s):  
Sairam Atluri ◽  
Gururau Sudarshan
Keyword(s):  
Chronic Pain ◽  
Opioid Abuse ◽  
Screening Tools ◽  
Prescription Drug Abuse ◽  
Prescription Opioid ◽  
Dose Limitation ◽  
Chronic Pain Patients ◽  
Urine Drug ◽  
Pain Patients ◽  
Prescription Opioid Abuse

Opioids have an important role in the management of acute, cancer, and chronic pain. However, their indiscriminate use in chronic pain has led, in part, to the epidemic of prescription drug abuse, resulting in a dramatic increase in morbidity and mortality in America. Most of this abuse originates from legitimate prescriptions by physicians. Prescribing opioids to chronic pain patients while restricting them to those who abuse them is very challenging, and physicians seek appropriate and unbiased prescribing guidelines. Our review, based on analysis of the available literature, focuses on striking a balance between overprescribing and underprescribing. The core concept of this strategy relies in using screening tools to identify patients who are at high risk for opioid abuse along with diligent monitoring using prescription monitoring programs and urine drug screens, while also limiting opioid doses. Hopefully, using these principles, physicians can more confidently prescribe opioids to those who would benefit from these powerful drugs and at the same time keep opioids away from those who could potentially be harmed. Key Words: abuse, addiction, chronic pain, dose limitation, misuse, monitoring, opioids, overdose, screening

scholarly journals Trends in Urine Drug Monitoring Among Persons Receiving Long-Term Opioids and Persons with Opioid Use Disorder in the United States

2021 ◽  
pp. E249-E256
Keyword(s):  
Chronic Pain ◽  
Drug Monitoring ◽  
Opioid Analgesics ◽  
The United States ◽  
Opioid Use Disorder ◽  
Prescription Opioid ◽  
Administrative Claims ◽  
Opioid Use ◽  
Urine Drug ◽  
Prescription Opioid Analgesics

BACKGROUND: Practice guidelines recommend urine drug monitoring (UDM) at least annually in the setting of chronic opioid therapy as an objective assessment of substance use. However, empirical evidence on who gets tested and how often testing occurs is lacking. OBJECTIVES: This study investigates 10-year UDM trends in the United States based on 2 factors: (1) the duration of prescription opioid treatment, and (2) having an opioid use disorder (OUD) diagnosis and medications for opioid use disorder (MOUD) prescriptions. STUDY DESIGN: Observational cross-sectional study. SETTING: Research was conducted using administrative claims data from Optum’s deidentified Clinformatics Data Mart Database for the period 2007 to 2016. The dataset contained information on the plan enrollment and health care claims from 50 states and the District of Columbia. METHODS: To examine trends in UDM based on the duration of prescription opioid treatment, persons receiving prescription opioid analgesics were categorized into 4 groups based on the number of days covered: (a) less than 90 days, (b) 90 to 179 days, (c) 180 to 269 days, and (d) at least 270 days. To examine trends based on an OUD diagnosis and MOUD prescriptions, persons diagnosed with OUD were identified and categorized based on the presence of MOUD prescriptions as follows: (a) OUD with buprenorphine (BPN) and naltrexone (NTX) in the same year; (b) OUD with BPN only; (c) OUD with NTX only; (d) OUD with chronic prescription opioid analgesics (≥ 90 days); (e) OUD without prescription opioid analgesics, BPN, or NTX; and (f) chronic prescription opioid analgesics (≥ 90 days) without an OUD diagnosis. For analysis, the percent receiving UDM was estimated per group per year. Then the data were restricted to those receiving at least one UDM to estimate the average number of UDM per person. RESULTS: Data included an average of 364,485 persons per year receiving prescription opioid analgesics for chronic use, and 10,277 per year receiving an OUD diagnosis. Among those receiving prescription opioid analgesics, less than 50% received UDM. For those receiving at least one UDM, one additional UDM was performed per person as the duration of opioids increased by 90 days. Among persons with OUD, the percent receiving UDM was the highest for those receiving both BPN and NTX (87%), followed by those receiving BPN only (80%), chronic opioids (79%), NTX only (72%), and those not receiving any MOUD/opioids (54%). LIMITATIONS: Methadone dispensing for OUD treatments was not captured in administrative claims data. CONCLUSIONS: Although recommended for patients with chronic pain, UDM is provided less than half of the time for these patients. However, once patients received at least one UDM, they would continue to receive it on a fairly regular basis. Compared with those with chronic pain, persons diagnosed with OUD are more likely to receive UDM at a more frequent interval. KEY WORDS: Urine drug monitoring, urine drug testing, urine drug screening, chronic pain, opioid use disorder, prescription opioid analgesic, buprenorphine, naltrexone, medications for opioid use disorder

scholarly journals Retrospective Review of Physician Opioid Prescribing Practices in Patients with Aberrant Behaviors

2011 ◽  
Vol 4;14 (4;7) ◽  
pp. 383-389 ◽  
Author(s):  
Anita Gupta
Keyword(s):  
Chronic Pain ◽  
Prescribing Patterns ◽  
Prescription Opioid ◽  
Drug Screen ◽  
Urine Drug Screen ◽  
Opioid Use ◽  
Prescribing Practices ◽  
Urine Drug ◽  
Aberrant Behaviors ◽  
Noncancer Pain

In the past few decades, opioid use for the treatment of chronic noncancer pain has slowly gained acceptance. With this increase in prescription opioid use, there has also been an increase in prescription opioid abuse. To help detect aberrant drug related behaviors, clinicians have utilized urine drug screens to determine patient noncompliance in outpatient pain clinics. The primary objective is to determine how the use of urine drug testing (UDT) affects health care outcomes. The secondary outcome is to evaluate these findings as it relates to pharmacoeconomics and aberrant behaviors in an outpatient clinical setting. In this study we will determine if UDT influences prescribing practices among physicians. Patients at an academic center’s chronic pain outpatient clinic were categorized as having urine screens that were “normal” (expected findings based on their prescribed drugs) or abnormal. Abnormal findings were those with either 1) the absence of a prescribed opioid, 2) the presence of an additional nonprescribed controlled substance, 3) detection of an illicit substance, or 4) an adulterated urine sample. We examined the incidence of such aberrant behaviors as well as concomitant pain diagnoses, psychiatric comorbidities, and the ultimate effect upon the prescribing patterns of the physicians in this clinic. Results of the study showed that the patients exhibiting aberrant drug behaviors have similar pain and psychiatric diagnoses as other chronic pain patients. The most common aberrancy detected was an abnormal urine drug screen, often with the presence of illegal substances. However, in the great majority of aberrancies detected, providers chose to continue prescribing opioids. We speculate on the reasons for this, and discuss the role of the urine drug screen in influencing prescriber behaviors. Key words: Chronic pain, noncancer pain, opioid, aberrant behavior, urine drug test, prescriber pattern, preference

scholarly journals Abuse and dependence on prescription opioids in adults: a mixture categorical and dimensional approach to diagnostic classification

2010 ◽  
Vol 41 (3) ◽  
pp. 653-664 ◽  
Author(s):  
L.-T. Wu ◽  
G. E. Woody ◽  
C. Yang ◽  
J.-J. Pan ◽  
D. G. Blazer
Keyword(s):  
Mixture Model ◽  
Latent Class ◽  
Opioid Abuse ◽  
Diagnostic Classification ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Dimensional Approach ◽  
Factor Mixture Model ◽  
Dsm Iv ◽  
Prescription Opioid Abuse

BackgroundFor the emerging DSM-V, it has been recommended that dimensional and categorical methods be used simultaneously in diagnostic classification; however, little is known about this combined approach for abuse and dependence.MethodUsing data (n=37 708) from the 2007 National Survey on Drug Use and Health (NSDUH), DSM-IV criteria for prescription opioid abuse and dependence among non-prescribed opioid users (n=3037) were examined using factor analysis (FA), latent class analysis (LCA, categorical), item response theory (IRT, dimensional), and factor mixture (hybrid) approaches.ResultsA two-class factor mixture model (FMM) combining features of categorical latent classes and dimensional IRT estimates empirically fitted more parsimoniously to abuse and dependence criteria data than models from FA, LCA and IRT procedures respectively. This mixture model included a severely affected group (7%) with a comparatively moderate to high probability (0.32−0.88) of endorsing all abuse and dependence criteria items, and a less severely affected group (93%) with a low probability (0.003−0.16) of endorsing all criteria. The two empirically defined groups differed significantly in the pattern of non-prescribed opioid use, co-morbid major depression, and substance abuse treatment use.ConclusionsA factor mixture model integrating categorical and dimensional features of classification fits better to DSM-IV criteria for prescription opioid abuse and dependence in adults than a categorical or dimensional approach. Research is needed to examine the utility of this mixture classification for substance use disorders and treatment response.

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