Articles: opioid.
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This retrospective cohort study on adults undergoing colectomy from 2010 to 2019 used linked primary (Clinical Practice Research Datalink), and secondary (Hospital Episode Statistics) care data to determine the prevalence of persistent postoperative opioid use following colectomy, stratified by pre-admission opioid exposure, and identify associated predictors. Based on pre-admission opioid exposure, patients were categorised as opioid-naïve, currently exposed (opioid prescription 0-6 months before admission) and previously exposed (opioid prescription within 7-12 months before admission). Persistent postoperative opioid use was defined as requiring an opioid prescription within 90 days of discharge, along with one or more opioid prescriptions 91-180 days after hospital discharge. ⋯ The odds of developing persistent opioid use were higher among individuals who used long-acting opioid formulations in the 180 days before colectomy than those who used short-acting formulations (odds ratio 3.41 (95%CI 3.07-3.77)). Predictors of persistent opioid use included: previous opioid exposure; high deprivation index; multiple comorbidities; use of long-acting opioids; white race; and open surgery. Minimally invasive surgical approaches were associated with lower odds of persistent opioid use and may represent a modifiable risk factor.
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J Pain Palliat Care Pharmacother · Sep 2023
Buprenorphine Inductions via Transdermal Patches for Opioid Use Disorder in the Inpatient Setting.
Buprenorphine inductions traditionally require an opioid-free period due to the risk of precipitated opioid withdrawal. Hospitalized patients with opioid use disorder and concurrent acute pain may be eligible for buprenorphine therapy. However, effective buprenorphine induction strategies in this patient population have not been well established. ⋯ All seven patients completed the induction and were discharged on sublingual buprenorphine. Low dose transdermal buprenorphine provides a reasonable strategy for hospitalized patients on full agonist opioid therapy or those who have failed conventional buprenorphine induction strategies. Reducing barriers such as opioid abstinence is key to combating opioid use disorder.
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Anaesth Intensive Care · Sep 2023
Supply of opioids and information provided to patients after surgery in an Australian hospital: A cross-sectional study.
Opioids are commonly prescribed to manage pain after surgery. However, excessive supply on discharge can increase patients' risk of persistent opioid use and contribute to the reservoir of unused opioids in the community that may be misused. This study aimed to evaluate the use of opioids in Australian surgical patients after discharge and patient satisfaction with the provision of opioid information after discharge. ⋯ However, the majority (51.5%; 34/66) did not recall receiving any information about the signs of opioid toxicity and interactions between opioids and alcohol. In conclusion, around 40% of patients had more than half of their opioid supply remaining after they ceased taking their opioid. Although most patients recalled receiving information about their opioids, more than half did not recall receiving any information about the signs of opioid toxicity or interactions between opioids and alcohol.
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J Pain Symptom Manage · Sep 2023
Opioid prescription denials by community pharmacies for cancer-related pain: A case series.
Pain is one of the most common symptoms experienced by patients living with cancer. Guidelines recommend opioids as the mainstay in the management of cancer-related pain. ⋯ Additionally, in the setting of the opioid epidemic, there have been reports of systemic bias within community pharmacies, leading to experiences with embarrassment and shame for patients with cancer-related pain. This case series presents specific examples of community pharmacies declining to fill opioid prescriptions for patients with cancer-related pain and associated patient suffering.
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Cancer-related pain has historically been undertreated. Prescription opioids have been shown to be an integral part of the treatment of cancer pain. Despite the significant amount of scientific evidence that smoking is associated with variation in pain expression and opioid misuse in both cancer and non-cancer populations, little is known about the association between smoking status and opioid utilization in cancer populations. ⋯ Cancer pain, opioids, smoking, breast cancer, opioid-prescribing guidelines, health policy, oncology, end of life.