Journal of opioid management
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Prescription opioid analgesics play an important role in the management of moderate to severe pain. An unintended consequence of prescribing opioid analgesics is the abuse and diversion of these medications. The authors estimated abuse and diversion rates for tapentadol immediate release (IR) compared with oxycodone, hydrocodone, and tramadol during the first 24 months of tapentadol IR availability. ⋯ Rates of tapentadol IR abuse and diversion have been low during the first 24 months after its launch. Continued monitoring of trends in these data is warranted.
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To describe the development, implementation, and effects of collaborative effort to reduce diversion of prescription drugs in Caldwell County, NC. ⋯ This county wide medical initiative appears to have resulted in a significant improvement in the abuse and diversion of medically derived opioids.
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Hyperalgesia has been observed in active opioid addicts (OAs). The aim of this study was to explore whether opioid-induced hyperalgesia (OIH) is a reversible phenomenon. ⋯ It is suggested that altered pain perception in OAs is a reversible phenomenon that may require a long period of abstinence to reset, rather than being an individual long-term stable trait.
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Sublingual buprenorphine/naloxone (Bup/Nx) is approved for addiction treatment and may be useful for pain management, particularly in opioid-treated patients with pain with nonadherence behaviors. The transition of opioid-treated patients with pain to buprenorphine carries the risk of precipitated withdrawal and increased pain. This study convened pain and addiction specialists to develop and pilot a clinical protocol for safe transitioning to Bup/Nx. ⋯ Based on this experience, the protocol recommends Bup/Nx for pain only when baseline opioid doses are within bounds that reduce AEs at transition and incorporates dose flexibility to further reduce risks. This protocol warrants further testing.
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The reasons providers choose one parenteral opioid over another are not well understood. The authors sought to determine why emergency department (ED) providers choose one parenteral opioid over another. ⋯ ED providers seem to prescribe "usual" dosages of morphine and relatively higher usual dosages of hydromorphone. The reasons for choosing one opioid over the other for a specific patient vary from simple preference to common misconceptions about opioid pharmacology. Improved understanding of opioid pharmacology may improve analgesic outcomes for some patients.