Prevention of Prescription Opioid Misuse and Projected Overdose Deaths in the United States

What is the projected effect of lowering incident nonmedical prescription opioid use on the future trajectory of the opioid overdose crisis in the United States? Read the abstract . 
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Randomized Study of Electronic Health Record Defaults and Comparison Feedback to Effectively Decrease Opioid Prescription Pill Burden (NCT03825549)

In this study, the investigators will evaluate the effect of a health system initiative aiming to change clinician opioid prescribing behaviors using two behavioral economic interventions - default options and social comparison feedback on performance to clinicians. Read the details . 
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Penn’s ‘Enhanced Recovery’ Protocol Reduces Opioid Use in Spinal Surgery Patients

A new study published in the Journal of Neurosurgery: Spine showed that when an ERAS protocol was employed—which optimizes patients' surgical care before, during, and after surgery, including patient education, post-operative medications, and recovery plans—fewer patients needed pain medications one month after surgery. Full story
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Training the Prescriber: An Institutional Effort to Reduce the Amount of Opioids Prescribed Following Lumbar Surgery

A new study shows that an educational program on opiate use and misuse, the role of the orthopedic prescriber, multimodal analgesia, and state laws regarding opioid prescription could change prescriber behavior and result in a lower amount of prescribed opioids after lumbar surgery. Full story .
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Parents Worried About Risks, But Still Think Opioids Are Best for Kids’ Pain Relief, Nationwide Survey Shows

A new survey shows that parents remain conflicted about opioids: while more than half express concern their child may be at risk for opioid addiction, nearly two-thirds believe opioids are more effective at managing their child's pain after surgery or a broken bone than non-prescription medication or other alternatives. Full story .
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Chronic Pain Patients: The Baby with the Bathwater?

AAPM longtime member David Nagel, MD , spoke to the New Hampshire Medical Society about unintended consequence of the battle against the opioid epidemic, and the negative impact on chronic pain patients. Full story .

Association of Pharmaceutical Industry Marketing of Opioid Products with Mortality From Opioid-Related Overdoses

This study identifies the association between direct-to-physician marketing of opioid products by pharmaceutical companies and mortality from prescription opioid overdoses across US counties. Read the abstract . 
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Phosphorylation-Deficient G-Protein-Biased μ-Opioid Receptors Improve Analgesia and Diminish Tolerance but Worsen Opioid Side Effects

Findings identify carboxyl-terminal multisite phosphorylation as key step that drives acute μ-opioid receptor desensitization and long-term tolerance. Read the abstract . 
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Statement from FDA Commissioner Scott Gottlieb, MD, on Unprecedented New Efforts to Support Development of Over-the-Counter Naloxone to Help Reduce Opioid Overdose Deaths

To encourage drug companies to enter the OTC market and increase access to naloxone, the FDA took an unprecedented step of developing a model Drug Facts label (DFL) with easy-to-understand pictograms on how to use the drug. Full story.
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Rapidly Taking Patients off Opioids Might Not Be a Good Idea, Experts Say

Forcing patients off opioid painkillers could sometimes do more harm than good, international medical experts warn in an open letter published in Pain Medicine to health authorities. Full story . Read the letter .
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NCATS Announces HEAL Design Challenges to Inspire Innovative Opioid Crisis Solutions

  The National Center for Advancing Translational Sciences (NCATS) at the National Institutes of Health (NIH) invites innovators to submit novel design solutions for its ASPIRE (A Specialized Platform for Innovative Research Exploration) Design Challenges. The deadline to submit solutions is May 31.  Full story.
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Randomized Trial of Telephonic Pain Self-Management to Promote Opioid Tapering (NCT03743402)

In the Pain Self-Management Training for Opioid Taper (PSMOT) study, the effectiveness of a multicomponent intervention will be tested, compared with usual care, on opioid dose and pain outcomes among patients on high dose (≥ 50 mg morphine equivalent dose) long-term opioid therapy in a randomized controlled trial. This intervention will have 4 com...
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Pain Abstracts

Association of Opioid Prescribing with Opioid Consumption after Surgery in Michigan. Read the abstract . Knee Pain as a Predictor of Structural Progression Over 4 Years: Data from the Osteoarthritis Initiative, a Prospective Cohort Study. Read the abstract . Migraine with Visual Aura, Incident AF, and Stroke Risk: Is Migraine with Aura an Embolic T...
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West Virginia University First Site to Launch Clinical Trial Utilizing Non-Opioid Micropellet Implant for Chronic Pain

As part of an ongoing commitment to battle opioid addiction, the Rockefeller Neuroscience Institute at West Virginia University marked a major milestone, enrolling the first patient in a randomized clinical trial that will test the effectiveness of an injectable non-opioid, non-steroid micropellet to treat sciatica. Full story .
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Pain Medicine Physician Perspective Represented in AMA House of Delegates

Pain medicine was represented at the recent American Medical Association House of Delegates Interim meeting by delegate Robert Wailes, MD , and alternate delegate Donna Bloodworth, MD . Among topics discussed, delegates spoke against insurers and pharmacists using CDC guidelines to restrict the provision of opioids. See AMA Delegates Back Physician...
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The National Science and Technology Council (NSTC) Seeks Public Comment

The NSTC is seeking public comment on the Draft Report of the Fast Track Action Committee (FTAC) on Health Science and Technology Response to the Opioid Crisis. Comments are requested by December 5. Full story .
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Nonaddictive Drug Compound Could Replace Opioids for Chronic Pain Sufferers

Source: Purdue University A compound shows unparalleled selectivity in inhibiting the adenylyl cyclase 1 (AC1), making it a potential target for treating pain and reducing the dependency on opioids for pain management. Full story .
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Students Learn to Treat Pain, With and Without Opioids

Source: AAMCNews As the opioid epidemic claims even more lives, medical schools are rethinking how they teach students to manage patients' pain. The result? A better understanding of the nature of pain, addiction, and substance use disorder. Full story .
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A Before and After Analysis of Health Care Utilization by Patients Enrolled in Opioid Controlled Substance Agreements for Chronic Noncancer Pain

Source: Mayo Clinic Read the abstract .
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Poorest Americans Most Likely to Have Used Prescription Opioids — and Most Users View Opioids Positively

Source: University at Buffalo University at Buffalo study raises important questions about access to pain management options for the disadvantaged in the current climate of the opioid epidemic. Full story .
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Study Finds Racial Disparities in Prescribing Opioids for Chronic Pain

Source: Yale News Yale researchers have identified racial disparities in the treatment of patients who are prescribed opioids for chronic pain. Black patients who receive opioids long-term are more likely than whites to be tested for illicit drug use. Full story.
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Opioid Prescribing Decreases after Learning of a Patient's Fatal Overdose

Source: PubMed.gov Read the abstract .
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Number of Opioid Prescriptions Remains Unchanged, Mayo Clinic Research Finds

Source: Mayo Clinic Despite increased attention to opioid abuse, prescriptions have remained relatively unchanged for many U.S. patients, research led by Mayo Clinic and published in The BMJ . Full story.
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Outpatient Opioid Prescriptions for Children and Opioid-Related Adverse Events

Source: Pediatrics Abstract: BACKGROUND AND OBJECTIVES: Little is known about opioid prescribing for children without severe conditions. We studied the prevalence of and indications for outpatient opioid prescriptions and the incidence of opioid-related adverse events in this population. Read more...
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Study with Implications for Opioid Crisis Finds Opioids Raise Risk of Fracture Nonunion

Source: Louisiana State University Health Sciences Center Dr. Robert Zura, Professor and Chair of Orthopaedic Surgery at LSU Health New Orleans School of Medicine, was part of a research team reporting that not only may opioid use increase the risk of bone fractures, but opioids may also impair healing. The authors also question their effectiveness...
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Structure of the µ-Opioid Receptor-Gi Protein Complex

Source: PubMed.gov Read more...
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Inpatient Opioid Use and Insufficient Weaning Pre-Discharge May Increase Outpatient Opioid Prescriptions

Source: American Thoracic Society According to the University of Pittsburgh School of Medicine scientists who conducted the study, theirs is the first large-scale evaluation of the impact of in-hospital opioid prescribing on post-discharge opioid use. Full story...
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Less is More When it Comes to Prescription Opioids for Hospital Patients, Study Finds

Source: Yale School of Medicine In a pilot study published in JAMA Internal Medicine , Yale researchers significantly reduced doses of opioid painkillers given to hospital patients. By delivering the opioids with a shot under the skin or with a pill instead of an IV, the research team found they could decrease patient exposure to the medications wh...
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Blacks, Whites Equally as Likely to Be Prescribed Opioids for Pain

Source: University of Michigan Racial disparities in pain management have been well-documented, with doctors historically more willing to prescribe opiates to whites than to other racial and ethnic groups. But in light of new national policies to improve prescribing practices, University of Michigan researchers wanted to know whether racial and eth...
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Opioid Dose- and Route-Dependent Efficacy of Oxycodone and Heroin Vaccines in Rats

Source: PubMed.gov Read more...  
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Association between Facility-Level Utilization of Non-pharmacologic Chronic Pain Treatment and Subsequent Initiation of Long-Term Opioid Therapy

[Source: PubMed.gov] Read more...
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Safe Opioid Prescribing for Acute Noncancer Pain in Hospitalized Adults: A Systematic Review of Existing Guidelines

Source: Journal of Hospital Medicine Abstract: BACKGROUND: Pain is common among hospitalized patients. Inpatient prescribing of opioids is not without risk. Acute pain management guidelines could inform safe prescribing of opioids in the hospital and limit associated unintended consequences. Read more...  
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Storing and Disposing of Opioid Analgesics: What Does Our Medicine Tell Us?

Source: Annals of Internal Medicine Abstract: Background: Medication diversion represents the largest source of misused opioid analgesics (1). Unused opioid analgesics are seldom safely stored or disposed of (1–3), creating a large supply for diversion. Most patients lack knowledge about safe storage and disposal of opioids (4). Recent reports call...
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Physician Prescribing of Opioids to Patients at Increased Risk of Overdose from Benzodiazepine Use in the United States

Source: JAMA Psychiatry Abstract: Importance: Recent increases in US opioid-related deaths underscore the need to understand drivers of fatal overdose. The initial prescription of opioids represents a critical juncture because it increases the risk of future opioid use disorder and is preventable. Read more...  
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Stopping Long-Term Opioid Therapy Has No Effect on Pain

Source: OHSU Patients may experience no discernible difference in their level of pain after discontinuing the long-term use of opioids, new research suggests. Researchers examined the electronic health records of 600 patients in a national database maintained by the U.S. Department of Veterans Affairs. They found that patients, on average, experien...
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Association Between US State Medical Cannabis Laws and Opioid Prescribing in the Medicare Part D Population

Source: JAMA Internal Medicine Abstract: Importance: Opioid-related mortality increased by 15.6% from 2014 to 2015 and increased almost 320% between 2000 and 2015. Recent research finds that the use of all pain medications (opioid and nonopioid collectively) decreases in Medicare Part D and Medicaid populations when states approve medical cannabis ...
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Association of Medical and Adult-Use Marijuana Laws with Opioid Prescribing for Medicaid Enrollees

Source: JAMA Internal Medicine Abstract: Importance: Overprescribing of opioids is considered a major driving force behind the opioid epidemic in the United States. Marijuana is one of the potential nonopioid alternatives that can relieve pain at a relatively lower risk of addiction and virtually no risk of overdose. Marijuana liberalization, inclu...
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Ketamine and Norketamine Attenuate Oxycodone Tolerance Markedly Less than that of Morphine: From Behaviour to Drug Availability

Source: PubMed.gov Read more...
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Blue Cross Blue Shield Association Affirms Opioids Should Not Be Prescribed as First or Second Lines of Pain Therapy

Source: BCBSA The Blue Cross Blue Shield Association (BCBSA) National Council of Physician and Pharmacist Executives (NCPE) at its March meeting adopted a professional standard that opioids should not be prescribed as first or second lines of pain therapy in most clinical situations. Full story...
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Oxycodone Use Shifts in Australia After Tamper-Resistant Versions Introduced

Source: Canadian Medical Association Journal After the introduction of tamper-resistant oxycodone in Australia, dispensing rates for higher-strength formulations decreased for people younger than 65 years, but there was no change in older adults, according to new research in CMAJ ( Canadian Medical Association Journal ). Full story...
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Association of Mental Health Conditions and Treatments with Long-Term Opioid Analgesic Receipt Among Adolescents

Source: JAMA, Pediatrics Abstract: Importance: Adults with mental health conditions are more likely than those without to receive long-term opioid therapy. Less is known about opioid therapy among adolescents, especially those with mental health conditions. Objective: To examine associations between preexisting mental health conditions and treatmen...
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Jennifer Whistler: On the Search for Safer Opioids

Source: UC Davis According to Jennifer Whistler, associate director of the UC Davis Center for Neuroscience, drug development is headed in the wrong direction. Trends favor synthetic opioids that may mitigate side-effects, such as respiratory failure, while overlooking the larger issues of tolerance and addiction. Full story...
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Integrated Health Services to Reduce Opioid Use While Managing Chronic Pain

Source: ClinicalTrials.gov Read more...
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Separating Side Effects Could Hold Key for Safer Opioids

Source: National Council on Alcoholism and Drug Dependence Scientists have discovered a way to separate the two effects of opioid pain relievers -- pain relief and breathing -- opening a window of opportunity to make effective pain medications without the risk of respiratory failure. The research, published in Cell , was funded by the National Inst...
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Opioid Prescribing Behavior of Interventional Radiologists Across the United States

Source: Journal of the American College of Radiology Abstract: Purpose: To study opioid prescribing behavior of US interventional radiologists (IRs). Conclusion: Most IRs write few, if any, prescriptions for Medicare beneficiaries. Of those who do, the large majority writes for opioids, at rates higher than national physician benchmarks. Read more....
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Patient-Centered Prescription Opioid Tapering in Community Outpatients with Chronic Pain

Source: JAMA Internal Medicine Beth D. Darnall, PhD; Maisa S. Ziadni, PhD; Richard L. Stieg, MD, MPH; Ian G. Mackey; Ming-Chih Kao, PhD, MD; Pamela Flood, MD, PhD Abstract: The risks associated with prescription opioids are well described.1,2 Although reducing opioid use is a national priority, existing opioid tapering models use costly interdiscip...
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Prescription Opioids Increase Risk for Serious Infections

Source: Medscape Full story (login required)... View abstract in Annals of Internal Medicine ...
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Efficacy of Treatments for Opioid-induced Constipation: A Systematic Review and Meta-Analysis

Source: Clinical Gastroenterology and Hepatology Abstract: Background & Aims: Opioid induced constipation (OIC) is a common problem in patients on chronic opioid therapy for cancer-related and non-cancer related pain. Approved treatments for OIC are methylnaltrexone, naloxone, naloxegol, alvimopan, naldemedine, and lubiprostone. Since a meta-an...
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Decline in Prescription Opioids Attributable to Decreases in Long-Term Use: A Retrospective Study in the Veterans Health Administration 2010–2016

Source: Journal of General Internal Medicine Abstract: Background: Improved understanding of temporal trends in short- and long-term opioid prescribing may inform efforts to curb the opioid epidemic. Conclusions: Opioid prescribing trends followed similar trajectories in VHA and non-VHA settings, peaking around 2012 and subsequently declining. Howe...
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Intrathecal Morphine Microdose Method Sensory Changes

Source: ClinicalTrials.gov Read more...
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Scientists Take a Big Step Toward Building a Better Opioid

Source: University of North Carolina School of Medicine For the first time, scientists at the University of North Carolina School of Medicine and collaborators solved the crystal structure of the activated kappa opioid receptor bound to a morphine derivative. They then created a new drug-like compound that activates only that receptor, a key step i...
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Reduction of Opioid Use and Improvement in Chronic Pain in Opioid-Experienced Patients After Topical Analgesic Treatment: An Exploratory Analysis

Source: PubMed.gov Read more...  
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The Appropriate Use of Opioids in the Treatment of Refractory Restless Legs Syndrome

Source: Mayo Clinic Proceedings Abstract: Restless legs syndrome (RLS) is a distinct disorder, differing from chronic pain in many ways. Refractory RLS is characterized by unresponsiveness to dopamine agonists or alpha-2-delta ligands due to inadequate efficacy, augmentation, or adverse effects. This may result in severely impaired quality of life,...
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