Articles: opioid.
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Fertility and sterility · Aug 2017
ReviewPerioperative pain management strategies among women having reproductive surgeries.
This review presents opioid-sparing strategies for perioperative pain management among women undergoing reproductive surgeries and procedures. Recommendations are provided regarding the use of nonsteroidal anti-inflammatory drugs, acetaminophen, other adjunctive medications, and regional anesthetic blocks. Additional considerations for chronic opioid users or patients using opioid replacement or antagonist therapy are discussed.
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Methylnaltrexone, a peripherally acting µ-opioid receptor antagonist, alleviates opioid-induced constipation. Understanding its long-term safety and efficacy profile in patients with chronic noncancer pain is warranted given the persistence of opioid-induced constipation. ⋯ Change from baseline in mean weekly bowel movement rate, Bowel Movement Straining Scale score, Bristol Stool Scale score, and mean percentage of patients with complete evacuation from baseline to week 48 were significantly improved ( P < 0.001 for all). Long-term subcutaneous methylnaltrexone was well tolerated, with no new safety concerns, and provided consistent opioid-induced constipation relief in patients with chronic noncancer pain.
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Quality of care provided by hospice and palliative care agencies depends on a thorough understanding of the patient, the family, their history, and current risk factors. It is therefore imperative for social workers and other providers in these settings to assess patients and caregivers for substance use disorders and potential for substance misuse. ⋯ We recommend that hospice care providers implement structured substance use screening focused on both the patients and family. To stem the public health impact of prescription opioid misuse, we recommend adoption of structured screening instruments to evaluate drug diversion risk.
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Community Dent Oral Epidemiol · Aug 2017
Prescribing patterns of analgesics and other medicines by dental practitioners in Australia from 2001 to 2012.
Dental practitioners are able to prescribe a variety of medicines subsidized on the Pharmaceutical Benefits Schedule (PBS), the main categories of which are analgesics and antibiotics. We aimed to investigate the patterns of PBS prescribing of non-antimicrobial medicines by dental practitioners in Australia from 2001 to 2012. ⋯ Dental prescribing of analgesics, anti-inflammatories and benzodiazepines in the concessional population has increased significantly over the past decade. These data can form the baseline to further examine appropriate medicine use in the management of dental conditions.
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Int. J. Drug Policy · Aug 2017
Comparative StudyPrevalence of prescription opioid use disorder among chronic opioid therapy patients after health plan opioid dose and risk reduction initiatives.
No studies have assessed the comparative effectiveness of guideline-recommended interventions to reduce risk of prescription opioid use disorder among chronic opioid therapy (COT) patients. We compared the prevalence of prescription opioid use disorder among COT patients from intervention clinics that had implemented opioid dose and risk reduction initiatives for more than 4 years relative to control clinics that had not. ⋯ Long-term implementation of opioid dose and risk reduction initiatives was not associated with lower rates of prescription opioid use disorder among prevalent COT patients. Extreme caution should be exercised by clinicians considering COT for patients with chronic non-cancer pain until benefits of this treatment and attendant risks are clarified.