Journal of opioid management
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Comparative Study
Preliminary data on a new opioid risk assessment measure: the Brief Risk Interview.
Risk assessment and stratification have become a central issue in prescribing opioids to patients with chronic pain. Research to date on various risk screening measures has shown that a clinical interview by an experienced clinician offers superior predictive ability in identifying patients who are more likely to engage in future medication aberrant behavior. The current study represents a pilot study of an interview rating scale that is designed to replicate this clinical assessment. ⋯ A sample of 196 patients was assessed by each of the three risk measures and then follow-up data were gathered at 6 months post interview to determine which patients had engaged in medication aberrant behavior and had been discharged from the practice. The BRI shows superior predictive ability in identifying patients who later engage in medication aberrant behavior. Although more study in other settings is needed, these preliminary data suggest that the Brief Risk Interview could be a useful tool for any pain clinician in assessing risk through the use of information gathered in a brief interview.
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To answer a question whether or not rapid methadone dose increase can be associated with onset of hypoglycemia. This hypothesis is based on the previously reported case reports of hypoglycemia with rapid methadone increase and our clinical experience of a number of cases when symptomatic hypoglycemia during rapid methadone escalation was initially mistaken for methadone overdose. ⋯ Present report is the first reported series of patients with hypoglycemic episodes associated with rapid methadone dose escalation. Based on our results, a patient who develops unexplained sweating, palpitations, or lethargy during methadone titration may benefit from blood glucose monitoring.
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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.
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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.