Articles: opioid.
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To identify predictors of persistent opioid use in opioid-naïve individuals undergoing total joint arthroplasty. ⋯ This predictive model for persistent opioid use after total joint arthroplasty shows promise as an evidence-based, validated, and standardized tool for identifying high-risk patients before surgery in order to target strategies and interventions to reduce the reliance on opioids for post-operative pain control.
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To evaluate the cost-effectiveness of implementation facilitation compared with a standard educational strategy to promote emergency department (ED)-initiated buprenorphine with linkage to ongoing opioid use disorder care in the community, from a health care-sector perspective. ⋯ Implementation facilitation, relative to a standard educational strategy, has a moderate-to-high likelihood of being considered cost-effective from a health care-sector perspective, depending on decisionmakers' willingness to pay for units of effectiveness.
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Rapid opioid reduction or discontinuation among high-dose long-term opioid therapy patients (HD-LTOT) is associated with increased risk of heroin use, overdose, opioid use disorder, and mental health crises. We examined the association of residential segregation and healthcare access with rapid opioid reduction or discontinuation among HD-LTOT patients, and examined effect measure modification of individual-level characteristics. ⋯ Healthcare providers need to address potential biases towards patients living in underserved and marginalized communities and intersectionality with mental health stigma by prioritizing training and education in delivering unbiased care during opioid tapering.
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The epidemic of opioid use disorder (OUD) remains pervasive in the United States. In an effort to increase the availability and timeliness of medications for opioid use disorder (MOUD), several agencies in the United States (US) offer buprenorphine by prehospital providers to selected patients, though published data remains limited. We describe the preliminary safety and feasibility of training all paramedics within a single agency to administer buprenorphine in the field without online medical control to simultaneously treat opioid withdrawal and initiate MOUD. ⋯ In a single prehospital system, the use of buprenorphine appears to be a feasible and safe strategy for treating patients experiencing acute opioid withdrawal.