4.6 Review

Primary care management of Long-Term opioid therapy

Related references

Note: Only part of the references are listed.
Editorial Material Substance Abuse

Prescribing the Buprenorphine Monoproduct for Adverse Effects of Buprenorphine-Naloxone COMMENT

Lucinda A. Grande

Summary: Buprenorphine-naloxone (BNX) significantly reduces the risk of mortality from untreated opioid use disorder, but adverse effects may lead to inconsistent use or discontinuation. Buprenorphine (BUP) monoproduct, although effective, is restricted in prescription due to concerns over diversion and injection. This commentary discusses the assessment of a BUP trial using bilateral flank pain reported by three patients as an example, and explores the potential cause of adverse effects of BNX in sensitive individuals through sublingual absorption of naloxone. Issues in clinical decision-making are presented to help prescribers evaluate the risk-benefit ratio of a BUP trial. The authors suggest changes in practice guidelines and insurance coverage policies for more flexible prescribing of BUP.

JOURNAL OF ADDICTION MEDICINE (2022)

Article Substance Abuse

Challenges with buprenorphine inductions in the context of the fentanyl overdose crisis: A case series

Daniel Shearer et al.

Summary: In North America, there is currently an epidemic of opioid overdose deaths driven by the proliferation of fentanyl in the street drug market. A key challenge in prescribing buprenorphine/naloxone (BUP/NX) for opioid use disorder is its potential to precipitate opioid withdrawal during induction, especially in individuals who regularly use illicit fentanyl. The case series from a Vancouver clinic highlights incidents of precipitated opioid withdrawal after extended periods of fentanyl abstinence, suggesting a possible long-acting pharmacokinetic effect of fentanyl in illicit use scenarios.

DRUG AND ALCOHOL REVIEW (2022)

Article Substance Abuse

Stimulant use for self-management of pain among safety-net patients with chronic non-cancer pain

Cathleen M. Beliveau et al.

Summary: The study found that over half of the patients used stimulants in the past year to treat pain, with women and those with more severe neuropathic pain symptoms being more likely to use stimulants. This suggests that stimulants may be used for pain self-management, especially in an era of reduced access to prescribed opioids.

SUBSTANCE ABUSE (2022)

Article Public, Environmental & Occupational Health

CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022

Deborah Dowell et al.

MMWR Recommendations and Reports (2022)

Article Emergency Medicine

Effect of a Prescription Drug Monitoring Program on Emergency Department Opioid Prescribing

Rahul Gupta et al.

Summary: The study revealed that the implementation of PDMP was linked to a reduction in overall opioid prescription rates, with patients experiencing mild pain being more frequently prescribed opioids, while those with severe pain received them less frequently.

WESTERN JOURNAL OF EMERGENCY MEDICINE (2021)

Article Primary Health Care

When Physical and Social Pain Coexist: Insights Into Opioid Therapy

Mark D. Sullivan et al.

Summary: The opioid epidemic in the US challenges us to reconsider the function of opioids and the nature of chronic pain, highlighting the interconnection between physical and social pain. Patients using opioids long term for chronic pain treatment may experience both physical and social pain, with these medications potentially leading to persistent negative effects on the brain. Recognizing the social aspects of chronic pain and opioid action can lead to improved treatment and usage of opioid medications.

ANNALS OF FAMILY MEDICINE (2021)

Article Substance Abuse

Topiramate-phentermine combinations reduce cocaine self-administration in humans

Craig R. Rush et al.

Summary: The study demonstrated the initial efficacy of topiramate-phentermine combinations for treating cocaine use disorder, with significant reductions in cocaine self-administration.

DRUG AND ALCOHOL DEPENDENCE (2021)

Article Health Care Sciences & Services

A National Survey on Patient Provider Agreements When Prescribing Opioids for Chronic Pain

Jordana Laks et al.

Summary: The survey revealed that the majority of respondents perceive patient provider agreements (PPAs) as minimally effective in reducing opioid misuse, yet still valuable. However, the readability level of PPAs is generally above recommended standards, primarily focusing on communicating consequences of non-compliance.

JOURNAL OF GENERAL INTERNAL MEDICINE (2021)

Article Medicine, General & Internal

Bupropion and Naltrexone in Methamphetamine Use Disorder

Madhukar H. Trivedi et al.

Summary: The study involved a randomized trial to evaluate the efficacy and safety of naltrexone plus bupropion in treating methamphetamine use disorder. Results showed a higher response rate among participants who received the treatment compared to those who received placebo, with gastrointestinal disorders being a common adverse event.

NEW ENGLAND JOURNAL OF MEDICINE (2021)

Article Psychiatry

Association Between Benzodiazepine or Z-Drug Prescriptions and Drug-Related Poisonings Among Patients Receiving Buprenorphine Maintenance: A Case-Crossover Analysis

Kevin Y. Xu et al.

Summary: Benzodiazepine or Z-drug treatment in patients with opioid use disorder is associated with an increased risk of nonfatal drug-related poisoning, which can be partially mitigated by buprenorphine treatment. Dose reduction of benzodiazepines or Z-drugs while maintaining buprenorphine treatment may lower the risk of drug-related poisoning.

AMERICAN JOURNAL OF PSYCHIATRY (2021)

Article Substance Abuse

Comparing actual and forecasted numbers of unique patients dispensed select medications for opioid use disorder, opioid overdose reversal, and mental health, during the COVID-19 pandemic, United States, January 2019 to May 2020

Christopher M. Jones et al.

Summary: During the COVID-19 pandemic, the dispensing of certain substances and mental health medications showed variations, with some medications significantly decreasing or increasing in dispensing numbers during mitigation measures. This highlights the importance of innovative strategies to ensure continued access to treatment for substance use and mental health during the pandemic.

DRUG AND ALCOHOL DEPENDENCE (2021)

Article Substance Abuse

COVID-19: A catalyst for change in telehealth service delivery for opioid use disorder management

Nicky J. Mehtani et al.

Summary: The Addiction Telehealth Program (ATP) demonstrates the feasibility of telephone-based management of opioid use disorder (OUD) among a highly marginalized patient population in San Francisco and supports implementing similar programs in areas where access to addiction treatment is limited in the U.S. Legal changes allowing the prescribing of buprenorphine via telehealth without an in-person visit should continue beyond the COVID-19 public health emergency.

SUBSTANCE ABUSE (2021)

Article Public, Environmental & Occupational Health

The Effect of Overdose Education and Naloxone Distribution: An Umbrella Review of Systematic Reviews

Amir Razaghizad et al.

AMERICAN JOURNAL OF PUBLIC HEALTH (2021)

Article Substance Abuse

Do people with opioid use disorder and posttraumatic stress disorder benefit from dding Individual opioid Drug Counseling to buprenorphine?

R. Kathryn McHugh et al.

Summary: The study suggests that individuals with posttraumatic stress disorder (PTSD) may benefit significantly from the addition of individual Opioid Drug Counseling (ODC) to buprenorphine maintenance treatment for opioid use disorder. This finding indicates that ODC may be an important complement to buprenorphine maintenance treatment for individuals with co-occurring PTSD and opioid use disorder, although further replication is needed.

DRUG AND ALCOHOL DEPENDENCE (2021)

Review Substance Abuse

How prescription drug monitoring programs influence clinical decision-making: A mixed methods systematic review and meta-analysis

Louisa Picco et al.

Summary: This systematic review included 39 studies and found that the use of PDMPs influenced healthcare providers' clinical decision-making, impacting areas such as drug supply, prescription refusal, risk mitigation, education and communication. Targeted research is needed to understand the unintended outcomes and clinical impact of PDMP use on patients.

DRUG AND ALCOHOL DEPENDENCE (2021)

Article Substance Abuse

Non-fatal stimulant overdose among homeless and unstably housed women in San Francisco, California

Thibaut Davy-Mendez et al.

Summary: In San Francisco, homeless and unstably housed women, particularly those who frequently use stimulants or methamphetamine, experience high rates of non-fatal stimulant overdoses, but rarely receive healthcare for these events. efforts should be made to increase awareness and reduce harm of stimulant toxicity in vulnerable populations.

DRUG AND ALCOHOL DEPENDENCE (2021)

Article Medicine, General & Internal

Association of Dose Tapering With Overdose or Mental Health Crisis Among Patients Prescribed Long-term Opioids

Alicia Agnoli et al.

Summary: Among patients prescribed stable, long-term, higher-dose opioid therapy, tapering events were significantly associated with increased risk of overdose and mental health crisis. The study suggests that reducing opioid doses may lead to negative outcomes such as overdose and mental health crisis.

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION (2021)

Review Anesthesiology

Buprenorphine management in the perioperative period: educational review and recommendations from a multisociety expert panel

Lynn Kohan et al.

Summary: This article discusses the research results of a multisociety working group on opioid use disorder, proposing that continuing buprenorphine treatment in the perioperative setting is an important strategy to reduce the risk of OUD recurrence.

REGIONAL ANESTHESIA AND PAIN MEDICINE (2021)

Article Psychiatry

Precipitated Withdrawal, Delirium, and Cerebellar Stroke: The Pharmacology of Buprenorphine Induction in Non-pharmaceutical Fentanyl and the Neuropsychiatric Manifestations of Cerebellar Stroke

Cristina Montalvo et al.

Summary: Additional digital content is available in the text.

HARVARD REVIEW OF PSYCHIATRY (2021)

Article Substance Abuse

Managing opioid withdrawal precipitated by buprenorphine with buprenorphine

Bridget Oakley et al.

Summary: Buprenorphine, a partial opioid agonist commonly used to treat opioid dependence, can increase the risk of precipitated opioid withdrawal. However, rapid increases in buprenorphine dose can be used as an effective treatment for buprenorphine-induced precipitated opioid withdrawal. In a case study, a patient successfully received further buprenorphine treatment in hospital after developing significant precipitated opioid withdrawal following buprenorphine administration.

DRUG AND ALCOHOL REVIEW (2021)

Review Substance Abuse

Microinduction of Buprenorphine/Naloxone: A Review of the Literature

Saeed Ahmed et al.

Summary: The review of literature on alternative approaches to buprenorphine induction shows promising results in successfully transitioning patients using microdosing techniques, particularly targeting those averse to withdrawal and those on high-dose opioids. Most patients completed cross titration within 4 to 8 days with initial doses ranging from 0.2 to 0.5 mg.

AMERICAN JOURNAL ON ADDICTIONS (2021)

Article Pharmacology & Pharmacy

Impact of student pharmacist-led naloxone academic detailing at community pharmacies in Texas

Kirk E. Evoy et al.

JOURNAL OF THE AMERICAN PHARMACISTS ASSOCIATION (2020)

Article Multidisciplinary Sciences

Illicit opioid use following changes in opioids prescribed for chronic non-cancer pain

Phillip O. Coffin et al.

PLOS ONE (2020)

Review Anesthesiology

Is Buprenorphine Effective for Chronic Pain? A Systematic Review and Meta-analysis

Asimina Lazaridou et al.

PAIN MEDICINE (2020)

Review Obstetrics & Gynecology

Buprenorphine-naloxone use in pregnancy: a systematic review and metaanalysis

Heather M. Link et al.

AMERICAN JOURNAL OF OBSTETRICS & GYNECOLOGY MFM (2020)

Review Substance Abuse

Contingency management for the treatment of methamphetamine use disorder: A systematic review

Hayley D. Brown et al.

DRUG AND ALCOHOL DEPENDENCE (2020)

Editorial Material Medicine, General & Internal

Case Studies in Social Medicine Structural Iatrogenesis - A 43-Year-Old Man with Opioid Misuse

Scott Stonington et al.

NEW ENGLAND JOURNAL OF MEDICINE (2019)

Editorial Material Medicine, General & Internal

No Shortcuts to Safer Opioid Prescribing

Deborah Dowell et al.

NEW ENGLAND JOURNAL OF MEDICINE (2019)

Article Substance Abuse

Circumstances of death of opioid users being treated with naltrexone

Shane Darke et al.

ADDICTION (2019)

Article Health Care Sciences & Services

Mortality After Discontinuation of Primary Care-Based Chronic Opioid Therapy for Pain: a Retrospective Cohort Study

Jocelyn R. James et al.

JOURNAL OF GENERAL INTERNAL MEDICINE (2019)

Article Medicine, General & Internal

Access to Primary Care Clinics for Patients With Chronic Pain Receiving Opioids

Pooja A. Lagisetty et al.

JAMA NETWORK OPEN (2019)

Article Psychology, Clinical

Opioid medication discontinuation and risk of adverse opioid-related health care events

Tami L. Mark et al.

JOURNAL OF SUBSTANCE ABUSE TREATMENT (2019)

Editorial Material Substance Abuse

The conundrum of opioid tapering in long-term opioid therapy for chronic pain: A commentary

Ajay Manhapra et al.

SUBSTANCE ABUSE (2018)

Article Psychology, Clinical

Transitioning from methadone to buprenorphine maintenance in management of opioid use disorder during pregnancy

Shakevia Johnson et al.

AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE (2018)

Article Medicine, General & Internal

Medication for Opioid Use Disorder After Nonfatal Opioid Overdose and Association With Mortality A Cohort Study

Marc R. Larochelle et al.

ANNALS OF INTERNAL MEDICINE (2018)

Review Clinical Neurology

Naloxone Academic Detailing: Role of Community Outreach Teaching

Alaa Abd-Elsayed et al.

CURRENT PAIN AND HEADACHE REPORTS (2018)

Article Pharmacology & Pharmacy

Opioid overdose education and naloxone distribution: Development of the Veterans Health Administration's national program

Elizabeth M. Oliva et al.

JOURNAL OF THE AMERICAN PHARMACISTS ASSOCIATION (2017)

Review Medicine, General & Internal

Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies

Luis Sordo et al.

BMJ-BRITISH MEDICAL JOURNAL (2017)

Review Medicine, General & Internal

Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies

Luis Sordo et al.

BMJ-BRITISH MEDICAL JOURNAL (2017)

Article Primary Health Care

Primary Care Patient Experience with Naloxone Prescription

Emily Behar et al.

ANNALS OF FAMILY MEDICINE (2016)

Review Medicine, General & Internal

CDC Guideline for Prescribing Opioids for Chronic Pain-United States, 2016

Deborah Dowell et al.

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION (2016)

Review Psychology, Clinical

Legal regimes surrounding naloxone access: considerations for prescribers

Joy E. Brodrick et al.

AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE (2016)

Article Medicine, General & Internal

Effect of Florida's Prescription Drug Monitoring Program and Pill Mill Laws on Opioid Prescribing and Use

Lainie Rutkow et al.

JAMA INTERNAL MEDICINE (2015)

Letter Medicine, General & Internal

The Dueling Obligations of Opioid Stewardship RESPONSE

Phillip Coffin et al.

ANNALS OF INTERNAL MEDICINE (2014)

Article Medicine, General & Internal

A Randomized Trial of Cognitive Behavioral Therapy in Primary Care-based Buprenorphine

David A. Fiellin et al.

AMERICAN JOURNAL OF MEDICINE (2013)

Review Medicine, General & Internal

Systematic Review: Treatment Agreements and Urine Drug Testing to Reduce Opioid Misuse in Patients With Chronic Pain

Joanna L. Starrels et al.

ANNALS OF INTERNAL MEDICINE (2010)

Article Medicine, General & Internal

Opioid Prescriptions for Chronic Pain and Overdose A Cohort Study

Kate M. Dunn et al.

ANNALS OF INTERNAL MEDICINE (2010)

Article Health Care Sciences & Services

Development and Initial Validation of the PEG, a Three-item Scale Assessing Pain Intensity and Interference

Erin E. Krebs et al.

JOURNAL OF GENERAL INTERNAL MEDICINE (2009)

Article Health Care Sciences & Services

Ensuring opioid availability: Methods and resources

David E. Joranson et al.

JOURNAL OF PAIN AND SYMPTOM MANAGEMENT (2007)