Office-based Methadone Prescribing for Opioid Use Disorder: The Canadian Model
In the context of the US overdose crisis, improving access to medications for opioid use disorder is urgently needed. The Canadian model of methadone treatment, whereby clinicians can prescribe methadone for opioid use disorder in office-based settings and methadone can be dispensed through community pharmacies, offers a compelling model for adoption in the US. Office-based settings in which methadone is prescribed often adopt a rapid-access model, allowing walk-in appointments and same-day initiation of methadone. Prescribing authorization requirements have been relaxed over the past 25 years to improve access to methadon...
Source: Journal of Addiction Medicine - September 1, 2022 Category: Addiction Tags: Review Source Type: research
Postoperative Cesarean Pain Management and Opioid Use Disorder: Anticipate the Need for Higher Opioid Doses and Communicate Expectations With Patients and the Obstetric Team
Peripartum care coordination for the obstetric patient on medications for opioid use disorder (OUD) can be challenging and is best accomplished by a multidisciplinary team. The benefits of buprenorphine, methadone, or naltrexone initiation or continuation in pregnancy are well established and beyond the scope of this commentary; instead, we narrow the focus on planning for sufficient pain management in labor and during recovery from cesarean delivery. Conversations about postoperative pain management should begin in the antepartum period, and likely do for the 15%–20% of individuals with a history of cesarean delivery wh...
Source: Journal of Addiction Medicine - September 1, 2022 Category: Addiction Tags: Commentary Source Type: research
Oxazepam Detected in Urine 79 Days After Withdrawal of Diazepam: A Case Report
Patients suffering from substance use disorder, including for instance benzodiazepines, may have comorbidity with attention deficit hyperactivity disorder (ADHD). Centrally acting stimulants play an important role in the treatment of ADHD. Before such treatment can be initiated, withdrawal of benzodiazepines may be necessary. Urine testing is the preferred method for monitoring adherence in benzodiazepine withdrawal, but there is a lack of studies reporting detection time. Here, we report a case of a 30-year-old woman with substance use disorder and ADHD who had detectable metabolites of diazepam 79 days after withdrawal. ...
Source: Journal of Addiction Medicine - July 1, 2022 Category: Addiction Tags: Case Reports Source Type: research
Bupropion Use Disorder by Chewing
We present a case with alcohol use disorder and attention deficit hyperactivity disorder, who developed a substance use disorder to bupropion while chewing it in doses up to 2250 mg, in an attempt to get “high” with no history of seizures.
Discussion
Our case suggests that bupropion can also be misused by chewing even at high doses and that it can lead to a substance use disorder. Its use in various indications in treating mental disorders and its over-the-counter accessibility, along with a lower risk of stigmatization, could increase the prevalence of bupropion misuse. It is essential to know the medical conse...
Source: Journal of Addiction Medicine - July 1, 2022 Category: Addiction Tags: Case Reports Source Type: research
Rapid Transition to Buprenorphine in a Patient With Methadone-Related QTc Interval Prolongation
Conclusions
A patient requiring an urgent taper off of methadone due to adverse cardiac effects successfully transitioned to buprenorphine/naloxone within 2 hours by using naltrexone to precipitate withdrawal followed by a “rescue” with buprenorphine/naloxone. A relatively high dose of 16 mg/4 mg buprenorphine/naloxone successfully arrested withdrawal symptoms. With further refinement, this protocol may be an important technique for urgent methadone-to-buprenorphine transitions in the inpatient setting. (Source: Journal of Addiction Medicine)
Source: Journal of Addiction Medicine - July 1, 2022 Category: Addiction Tags: Case Reports Source Type: research
Synergistic Effect of Ketamine and Buprenorphine Observed in the Treatment of Buprenorphine Precipitated Opioid Withdrawal in a Patient With Fentanyl Use
Conclusions
This single case observation raises important questions about the potential therapeutic role of ketamine as a treatment for BPOW. BPOW is an important clinical problem for which there is currently only limited guidance and no universally accepted approach. Prospective study comparing the effectiveness of differing pharmacologic approaches to treat BPOW is urgently needed. (Source: Journal of Addiction Medicine)
Source: Journal of Addiction Medicine - July 1, 2022 Category: Addiction Tags: Case Reports Source Type: research
Association Between Prenatal Cannabis Use and Psychotropic Medication Use in Pregnant Patients With Depression and Anxiety
This study included 35,047 pregnancies (32,278 patients; 17.6% aged (Source: Journal of Addiction Medicine)
Source: Journal of Addiction Medicine - July 1, 2022 Category: Addiction Tags: Brief Reports Source Type: research
Barriers to Engagement in Opioid Use Disorder Treatment After Buprenorphine Induction
Conclusions
Engagement in OUD treatment would be improved with interventions to mitigate the significant social and psychiatric comorbidities of addiction. Community- and emergency department-initiated buprenorphine is a promising intervention whose full promise cannot be realized without interventions to improve treatment retention. (Source: Journal of Addiction Medicine)
Source: Journal of Addiction Medicine - July 1, 2022 Category: Addiction Tags: Brief Reports Source Type: research
Alignment Between Resident Medical Condition Regard Scale Scores and Desire to Treat Patients With Opioid Use Disorder
Objectives
To (1) evaluate attitudes of resident physicians towards patients with opioid use disorder (OUD) and (2) identify characteristics associated with residents’ desire to treat patients with OUD.
Methods
We administered the validated medical condition regard scale (MCRS), a question regarding desire to treat patients with OUD, and a demographic questionnaire to residents in multiple specialties at the University of New Mexico (family medicine, psychiatry, emergency medicine, internal medicine, anesthesiology, general surgery, obstetrics/gynecology).
Results
One hundred sixty-three of 307 resident...
Source: Journal of Addiction Medicine - July 1, 2022 Category: Addiction Tags: Brief Reports Source Type: research
Racial-ethnic Differences in Reasons for Misuse of Prescription Medications Among US Adults
Conclusions
The increased misuse of prescription pain relievers for medical reasons among racial-ethnic minority groups demonstrates a continued need to investigate underlying structural factors driving these behaviors. The higher odds of sedative and tranquilizer misuse for recreational purposes among racial-ethnic minority groups warrant further investigation. (Source: Journal of Addiction Medicine)
Source: Journal of Addiction Medicine - July 1, 2022 Category: Addiction Tags: Brief Reports Source Type: research
Causes of Death in the 12 Months After Hospital Discharge Among Patients With Opioid Use Disorder
Conclusions
Hospitalized patients with OUD are at high risk of death, from drug and non-drug related causes, in the year after discharge. Future research should consider not only overdose, but a more comprehensive definition of drug-related death in understanding post-discharge mortality among hospitalized patients with OUD, and care systems should work to mitigate the risk of death in this population. (Source: Journal of Addiction Medicine)
Source: Journal of Addiction Medicine - July 1, 2022 Category: Addiction Tags: Brief Reports Source Type: research
Evidence of Buprenorphine-precipitated Withdrawal in Persons Who Use Fentanyl
Conclusions
This study supports previous anecdotal reports of buprenorphine-precipitated withdrawal from fentanyl. The odds of withdrawal symptoms significantly increased when taking buprenorphine after recent (within 48 hours) fentanyl use, however, this relationship was not observed in persons taking methadone, suggesting that this effect is specific to buprenorphine. Further research is urgently needed to describe the pharmacokinetics of non-medical fentanyl use to improve buprenorphine inductions strategies. (Source: Journal of Addiction Medicine)
Source: Journal of Addiction Medicine - July 1, 2022 Category: Addiction Tags: Brief Reports Source Type: research
Low Dose Buprenorphine Induction With Full Agonist Overlap in Hospitalized Patients With Opioid Use Disorder: A Retrospective Cohort Study
Conclusions
Low dose inductions with overlap of full opioid agonists were largely successful in transitioning hospitalized patients from full agonist opioids to buprenorphine. However, there were several factors associated with lower likelihood of success. Future work could focus on treatment of withdrawal symptoms and system-level changes ensuring patient-centered medication decisions. (Source: Journal of Addiction Medicine)
Source: Journal of Addiction Medicine - July 1, 2022 Category: Addiction Tags: Original Research Source Type: research
Thematic Analysis of Reddit Content About Buprenorphine-naloxone Using Manual Annotation and Natural Language Processing Techniques
Conclusions
Discussions on Reddit are rich in information about buprenorphine-naloxone. Information derived from analysis of Reddit posts about buprenorphine-naloxone may not be available elsewhere and may help providers improve treatment of people with OUD through better understanding of the experiences of people who have used buprenorphine-naloxone. (Source: Journal of Addiction Medicine)
Source: Journal of Addiction Medicine - July 1, 2022 Category: Addiction Tags: Original Research Source Type: research
Factors Associated With Increased Opioid Use During the COVID-19 Pandemic: A Prospective Study of Patients Enrolled in Opioid Agonist Treatment
Objectives
The opioid use disorder (OUD) crisis in North America has become “an epidemic within a pandemic” in the context of the COVID-19 virus. We aimed to explore the association between the COVID-19 pandemic and changes in opioid use patterns among patients receiving treatment for OUD.
Methods
We used prospectively collected data from 456 patients attending 31 opioid agonist clinics across Ontario, Canada. All included participants underwent routine urine drug screens (UDSs) both before and after the onset of the COVID-19 pandemic. A paired sample t-test was used to compare the proportion of opioid-posit...
Source: Journal of Addiction Medicine - July 1, 2022 Category: Addiction Tags: Original Research Source Type: research
