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Heterogeneity of nonadherent buprenorphine patients: subgroup characteristics and outcomes.

August 18, 2017 - 6:39am

Heterogeneity of nonadherent buprenorphine patients: subgroup characteristics and outcomes.

Am J Manag Care. 2017 Jun 01;23(6):e172-e179

Authors: Ruetsch C, Tkacz J, Nadipelli VR, Brady BL, Ronquest N, Un H, Volpicelli J

Abstract
OBJECTIVES: To examine patient characteristics and outcomes associated with nonadherence to buprenorphine and to identify specific patterns of nonadherent behavior.
STUDY DESIGN: Cross-sectional, retrospective analysis of health claims data.
METHODS: Aetna's administrative claims data were used to categorize incident opioid use disorder (OUD) patients based on buprenorphine medication possession ratio (MPR) into adherent (n = 172) and nonadherent (n = 305) groups. Adherent groups were then divided into 5 subgroups based on level of MPR, as well as 2 a priori-defined groups: intermittent adherent (IA) and early treatment discontinuation-no consequences (ETDNC). Groups were compared on patient characteristics and outcomes.
RESULTS: Nonadherent members incurred significantly greater healthcare costs and were more likely to relapse (P <.05). The use of high-cost healthcare services increased as a function of decreasing MPR (P <.05). Assessment of the a priori groups revealed IA members to have outcomes similar to nonadherent patients, while ETDNC members exhibited outcomes similar to adherent members.
CONCLUSIONS: Administrative claims can be used to define subgroups of buprenorphine-medication assisted treatment (B-MAT) patients. Nonadherence was related to an increased likelihood of relapse, and there is an inverse relationship between MPR and cost. The heterogeneity observed within this sample indicates that treatment regimens effective for 1 subgroup may not be appropriate for all OUD patients. Increased understanding of B-MAT nonadherent subgroups may facilitate development of new interventions and medications specifically designed for nonadherent B-MAT patients, potentially leading to improved outcomes and reduced costs of care.

PMID: 28817294 [PubMed - in process]

The promise and challenges of buprenorphine implant for treatment of opioid dependence.

August 18, 2017 - 6:39am

The promise and challenges of buprenorphine implant for treatment of opioid dependence.

Natl Med J India. 2017 Mar-Apr;30(2):80-81

Authors: Basu D, Sahoo S, Ghosh A

PMID: 28816216 [PubMed - in process]

Cost-effectiveness of emergency department-initiated treatment for opioid dependence.

August 18, 2017 - 6:39am
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Cost-effectiveness of emergency department-initiated treatment for opioid dependence.

Addiction. 2017 Aug 16;:

Authors: Busch SH, Fiellin DA, Chawarski MC, Owens PH, Pantalon MV, Hawk K, Bernstein SL, O'Connor PG, D'Onofrio G

Abstract
BACKGROUND AND AIMS: In a recent randomized trial, patients with opioid dependence receiving brief intervention, emergency department (ED)-initiated buprenorphine and ongoing follow-up in primary care with buprenorphine (buprenorphine) were twice as likely to be engaged in addiction treatment compared with referral to community-based treatment (referral) or brief intervention and referral (brief intervention). Our aim was to evaluate the relative cost-effectiveness of these three methods of intervening on opioid dependence in the ED.
DESIGN: Measured health-care use was converted to dollar values. We considered a health-care system perspective and constructed cost-effectiveness acceptability curves that indicate the probability each treatment is cost-effective under different thresholds of willingness-to-pay for outcomes studied.
SETTING: An urban ED in the United States.
PARTICIPANTS: Opioid-dependent patients aged 18 years or older.
MEASUREMENTS: Self-reported 30-day assessment data were used to construct cost-effectiveness acceptability curves for patient engagement in formal addiction treatment at 30 days and the number of days illicit opioid-free in the past week.
FINDINGS: Considering only health-care system costs, cost-effectiveness acceptability curves indicate that at all positive willingness-to-pay values, ED-initiated buprenorphine treatment was more cost-effective than brief intervention or referral. For example, at a willingness-to-pay threshold of $1000 for 30-day treatment engagement, we are 79% certain ED-initiated buprenorphine is most cost-effective compared with other studied treatments. Similar results were found for days illicit opioid-free in the past week. Results were robust to secondary analyses that included patients with missing cost data, included crime and patient time costs in the numerator, and to changes in unit price estimates.
CONCLUSION: In the United States, emergency department-initiated buprenorphine intervention for patients with opioid dependence provides high value compared with referral to community-based treatment or combined brief intervention and referral.

PMID: 28815789 [PubMed - as supplied by publisher]

A mixed methods study of HIV-related services in buprenorphine treatment.

August 18, 2017 - 6:39am
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A mixed methods study of HIV-related services in buprenorphine treatment.

Subst Abuse Treat Prev Policy. 2017 Aug 16;12(1):37

Authors: Knudsen HK, Cook J, Lofwall MR, Walsh SL, Studts JL, Havens JR

Abstract
BACKGROUND: Opioid use disorder (OUD) is a major risk factor in the acquisition and transmission of HIV. Clinical practice guidelines call for the integration of HIV services in OUD treatment. This mixed methods study describes the integration of HIV services in buprenorphine treatment and examines whether HIV services vary by prescribers' medical specialty and across practice settings.
METHODS: Data were obtained via qualitative interviews with buprenorphine experts (n = 21) and mailed surveys from US buprenorphine prescribers (n = 1174). Survey measures asked about screening for HIV risk behaviors at intake, offering HIV education, recommending all new patients receive HIV testing, and availability of on-site HIV testing. Prescribers' medical specialty, practice settings, caseload demographics, and physician demographics were measured. Multivariate models of HIV services were estimated, while accounting for the nesting of physicians within states.
RESULTS: Qualitative interviews revealed that physicians often use injection behaviors as the primary indicator for whether a patient should be tested for HIV. Interviews revealed that HIV-related services were often viewed as beyond the scope of practice among general psychiatrists. Surveys indicated that prescribers screened for an average of 3.2 of 5 HIV risk behaviors (SD = 1.6) at intake. About 62.0% of prescribers delivered HIV education to patients and 53.2% recommended HIV testing to all new patients, but only 32.3% offered on-site HIV testing. Addiction specialists and psychiatrists screened for significantly more HIV risk behaviors than physicians in other specialties. Addiction specialists and psychiatrists were significantly less likely than other physicians to offer on-site testing. Physicians in individual medical practice were significantly less likely to recommend HIV testing and to offer onsite testing than physicians in other settings.
CONCLUSIONS: Buprenorphine treatment providers have not uniformly integrated HIV-related screening, education, and testing services for patients. Differences by medical specialty and practice setting suggest an opportunity for targeting efforts to increase implementation.

PMID: 28814313 [PubMed - in process]

Neonatal Abstinence Syndrome Management: A Review of Recent Evidence.

August 18, 2017 - 6:39am
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Neonatal Abstinence Syndrome Management: A Review of Recent Evidence.

Rev Recent Clin Trials. 2017 Aug 16;:

Authors: Grossman M, Seashore C, Holmes AV

Abstract
BACKGROUND: The evaluation and management of infants with neonatal abstinence syndrome (NAS), the constellation of opioid withdrawal specific to newborns, has received renewed attention over the past decade during a new epidemic of opioid use, misuse, abuse, and dependence. Infants with NAS often endure long and costly hospital stays.
OBJECTIVE: We aim to review recent literature on the management and outcomes of infants with, and at risk for, opioid withdrawal.
METHODS: We reviewed articles indexed in PubMed over the past 5 years that examined interventions and/or outcomes related to the management of infants with NAS. Thirty-seven studies were included in our review comprising 8 categories: 1) identification of infants at risk for NAS, 2) prenatal factors, 3) evaluation of signs and symptoms, 4) non-pharmacologic care, including rooming-in and breastfeeding, 5) standardization of traditional protocols, 6) pharmacologic management, 7) alternative treatment approaches, and 8) long-term outcomes.
RESULTS: Non-pharmacologic interventions, standardization of traditional protocols, and alternative treatment approaches were all associated with improved outcomes. Lengths of stay were generally lowest in the studies of non-pharmacologic interventions. Patients exposed to buprenorphine in utero tended to have better short-term outcomes than those exposed to methadone. Longer-term outcomes for infants with NAS appear to be worse than those of control groups.
CONCLUSION: The current epidemic necessitates both continued research, and the application of new evidence-based practices in the assessment and treatment of newborns exposed to opioids in utero. Projects focused on non-pharmacologic interventions appear to hold the most promise.

PMID: 28814260 [PubMed - as supplied by publisher]

No Clinically Relevant Drug-Drug Interactions Between Methadone or Buprenorphine/Naloxone and Anti-Viral Combination Glecaprevir and Pibrentasvir.

August 17, 2017 - 12:09pm
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No Clinically Relevant Drug-Drug Interactions Between Methadone or Buprenorphine/Naloxone and Anti-Viral Combination Glecaprevir and Pibrentasvir.

Antimicrob Agents Chemother. 2017 Aug 14;:

Authors: Kosloski M, Zhao W, Asatryan A, Kort J, Geoffroy P, Liu W

Abstract
The combination of glecaprevir (formerly ABT-493), a nonstructural (NS) protein 3/4A protease inhibitor, and pibrentasvir (formerly ABT-530), a NS5A protein inhibitor, is being developed as treatment for HCV genotype 1-6 infection. The pharmacokinetics, pharmacodynamics, safety, and tolerability of methadone or buprenorphine/naloxone when coadministered with the glecaprevir and pibrentasvir combination in HCV-negative subjects on stable opioid maintenance therapy were investigated in a Phase 1, single-center, two-arm, multiple-dose, open-label sequential study. Subjects received methadone (Arm 1) or buprenorphine/naloxone (Arm 2) once daily (QD) as per their existing individual prescriptions alone (days 1-9) and then in combination with glecaprevir 300 mg QD and pibrentasvir120 mg QD (days 10-16) each morning. Dose-normalized exposures were similar with and without glecaprevir and pibrentasvir for R- and S- methadone (≤ 5% difference) and for buprenorphine and naloxone (≤ 24% difference); norbuprenorphine area under the curve was 30% higher, consistent with maximum and trough plasma concentrations that increased by 21% to 25%. No changes in pupil response, short opiate withdrawal scale, or desire for drugs questionnaire were observed when glecaprevir and pibrentasvir were added to methadone or buprenorphine/naloxone therapy. No dose adjustment is required when glecaprevir and pibrentasvir are coadministered with methadone or buprenorphine/naloxone.

PMID: 28807904 [PubMed - as supplied by publisher]

Naltrexone- or Nalmefene-Related Buprenorphine Withdrawal: Treat it With… More Buprenorphine.

August 15, 2017 - 6:39am

Naltrexone- or Nalmefene-Related Buprenorphine Withdrawal: Treat it With… More Buprenorphine.

J Clin Psychopharmacol. 2017 Aug 10;:

Authors: Lescut C, Gaboriau L, Carton L, Rolland B

PMID: 28806388 [PubMed - as supplied by publisher]

Effects of buprenorphine in the adrenal, thyroid, and cytokine intra-operative responses in a rat model (Rattus norvegicus): a preliminary study.

August 15, 2017 - 6:39am
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Effects of buprenorphine in the adrenal, thyroid, and cytokine intra-operative responses in a rat model (Rattus norvegicus): a preliminary study.

Iran J Basic Med Sci. 2017 Apr;20(4):368-379

Authors: Félix NM, Leal RO, Goy-Thollot I, Walton RS, Gil SA, Mateus LM, Matos AS, Niza MMRE

Abstract
OBJECTIVES: Buprenorphine is a common analgesic in experimental research, due to effectiveness and having few side-effects, including a limited influence in the immune and endocrine systems. However, how buprenorphine affects cytokine levels and the adrenal and thyroid response during general anesthesia and surgery is incompletely understood. This study aimed to assess whether buprenorphine modulated significantly those responses in rats submitted to general anesthesia, mechanical ventilation, and surgical insertion of intravascular catheters.
MATERIALS AND METHODS: Animals were anesthetized with isoflurane, mechanically ventilated, and surgically instrumented for carotid artery and the femoral vein catheter placement. The test group (n=16), received buprenorphine subcutaneously before surgery, whereas the control group (n=16) received normal saline. Blood sampling to determine plasma levels of adrenocorticotropic hormone (ACTH), corticosterone (CS), total thyroxine (TT4), total triiodothyronine (TT3), thyroid-stimulating hormone (TSH), TNF-α, IL6, IL10, TNF-α, IL6, and IL10 mRNA was performed at 10 min after completion of all surgical procedures and at 90, 150, 240, and 300 min thereafter, with the animals still anesthetized and with mechanical ventilation.
RESULTS: Buprenorphine-treated animals had higher levels of ACTH, CS, and TT4 at several time points (P<0.05) and TSH and TT3 at all-time points (P<0.05). They also had increased IL10, TNF-α, and IL10 mRNA levels.
CONCLUSION: In this model, buprenorphine significantly modulated the intra-operative cytokine and endocrine response to anesthesia, mechanical ventilation, and surgical placement of intravascular catheters. The mechanism and significance of these findings remain undetermined. Researchers should be aware of these effects when considering the use of buprenorphine for analgesic purposes.

PMID: 28804607 [PubMed]

Retention in medication-assisted treatment programs in Ukraine-Identifying factors contributing to a continuing HIV epidemic.

August 12, 2017 - 6:01am

Retention in medication-assisted treatment programs in Ukraine-Identifying factors contributing to a continuing HIV epidemic.

Int J Drug Policy. 2017 Aug 08;48:44-53

Authors: Dumchev K, Dvoryak S, Chernova O, Morozova O, Altice FL

Abstract
BACKGROUND: Opioid agonist treatments (OAT) are widely-used, evidence-based strategies for treating opioid dependence and reducing HIV transmission. The positive benefits of OAT are strongly correlated with time spent in treatment, making retention a key indicator for program quality. This study assessed patient retention and associated factors in Ukraine, where OAT was first introduced in 2004.
METHODS: Data from clinical records of 2916 patients enrolled in OAT at thirteen sites from 2005 to 2012 were entered into an electronic monitoring system. Survival analysis methods were used to determine the probability of retention and its correlates.
RESULTS: Twelve-month retention was 65.8%, improving from 27.7% in 2005, to 70.9% in 2011. In multivariable analyses, the correlates of retention were receiving medium and high doses of medication (compared to low doses, dropout aHR=0.57 for both medium and high doses), having not been tested for HIV and tuberculosis (compared to not being tested, dropout aHR=4.44 and 3.34, respectively), and among those who were tested-a negative TB test result (compared to receiving a positive test result, dropout aHR=0.67).
CONCLUSION: Retention in Ukrainian OAT programs, especially in recent years, is comparable to other countries. The results confirm the importance of adequate OAT dosing (≥60mg of methadone, ≥8mg of buprenorphine). Higher dosing, however, will require interventions that address negative attitudes toward OAT by patients and providers. Interruption of OAT, in the case developing tuberculosis, should incorporate continuity of OAT for TB patients through integrated care delivery systems.

PMID: 28800420 [PubMed - as supplied by publisher]

Text message reminders for improving patient appointment adherence in an office-based buprenorphine program: A feasibility study.

August 12, 2017 - 6:01am

Text message reminders for improving patient appointment adherence in an office-based buprenorphine program: A feasibility study.

Am J Addict. 2017 Aug 11;:

Authors: Tofighi B, Grazioli F, Bereket S, Grossman E, Aphinyanaphongs Y, Lee JD

Abstract
BACKGROUND AND OBJECTIVES: Missed visits are common in office-based buprenorphine treatment (OBOT). The feasibility of text message (TM) appointment reminders among OBOT patients is unknown.
METHODS: This 6-month prospective cohort study provided TM reminders to OBOT program patients (N = 93). A feasibility survey was completed following delivery of TM reminders and at 6 months.
RESULTS: Respondents reported that the reminders should be provided to all OBOT patients (100%) and helped them to adhere to their scheduled appointment (97%). At 6 months, there were no reports of intrusion to their privacy or disruption of daily activities due to the TM reminders. Most participants reported that the TM reminders were helpful in adhering to scheduled appointments (95%), that the reminders should be offered to all clinic patients (95%), and favored receiving only TM reminders rather than telephone reminders (95%). Barriers to adhering to scheduled appointment times included transportation difficulties (34%), not being able to take time off from school or work (31%), long clinic wait-times (9%), being hospitalized or sick (8%), feeling sad or depressed (6%), and child care (6%).
CONCLUSIONS: This study demonstrated the acceptability and feasibility of TM appointment reminders in OBOT. Older age and longer duration in buprenorphine treatment did not diminish interest in receiving the TM intervention. Although OBOT patients expressed concern regarding the privacy of TM content sent from their providers, privacy issues were uncommon among this cohort. Scientific Significance Findings from this study highlighted patient barriers to adherence to scheduled appointments. These barriers included transportation difficulties (34%), not being able to take time off from school or work (31%), long clinic lines (9%), and other factors that may confound the effect of future TM appointment reminder interventions. Further research is also required to assess 1) the level of system changes required to integrate TM appointment reminder tools with already existing electronic medical records and appointment records software; 2) acceptability among clinicians and administrators; and 3) financial and resource constraints to healthcare systems. (Am J Addict 2017;XX:1-6).

PMID: 28799677 [PubMed - as supplied by publisher]

Opioid agonist therapy.

August 12, 2017 - 6:01am
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Opioid agonist therapy.

Can Fam Physician. 2017 07;63(7):509-510

Authors: Broad K, Colon-Rivera HA, Haque L

PMID: 28701435 [PubMed - indexed for MEDLINE]

Utilization of buprenorphine and methadone among opioid users who inject drugs.

August 11, 2017 - 6:09am

Utilization of buprenorphine and methadone among opioid users who inject drugs.

Subst Abus. 2017 Aug 10;:0

Authors: Tsui JI, Burt R, Thiede H, Glick SN

Abstract
BACKGROUND: There has been a rise in opioid abuse and related injection drug use in the United States and treatment for opioid use disorders may be underutilized. The study aim was to describe utilization of opioid agonist therapy (OAT), and assess factors associated with utilization of OAT, among persons who inject drugs (PWID) in the Seattle metropolitan area.
METHODS: We used data from the 2015 National HIV Behavioral Surveillance (NHBS) system among PWID in the Seattle area. Persons aged ≥18 years who injected drugs in the past year were recruited using respondent-driven sampling. Local supplemental questions assessed whether participants had received methadone or buprenorphine treatment in the past year. The analysis was restricted to participants who reported use of any opioids in the past year. We compared the demographic, health insurance status, duration of injection drug use, prior history of overdose, prior receipt of HCV/HIV testing (self-report), and screening positive for HCV/HIV via study testing between methadone or buprenorphine treated and untreated PWID. Multivariate logistic models were performed to assess adjusted associations with receipt of any OAT.
RESULTS: The sample included 487 PWID who used opioids in the past year, of whom 27.1% (95% CI: 23.1-31.1) reported past-year treatment with methadone and 4.7% (95% CI: 2.8-6.6) reported treatment with buprenorphine. There were no significant differences in demographics among participants who did and did not report past-year OAT; however, participants who were treated with methadone were more likely to be insured and have hepatitis C. After adjustment for other covariates, having health insurance was strongly associated with receipt of OAT (aOR = 18.6; 95% CI: 2.5-138.7) Conclusions: OAT, in particular buprenorphine, has been under-utilized by opioid-using PWID in the Seattle area. Health insurance is a critical factor for enabling PWID to utilize OAT treatment for opioid use disorders.

PMID: 28796591 [PubMed - as supplied by publisher]

Opioid Medications in the Management of Chronic Abdominal Pain.

August 10, 2017 - 6:28am
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Opioid Medications in the Management of Chronic Abdominal Pain.

Curr Pain Headache Rep. 2017 Aug 08;21(9):40

Authors: Wang D

Abstract
PURPOSE OF REVIEW: Chronic abdominal pain is a complex medical condition. The causes of chronic abdominal pain are extremely diverse ranging from chronic pancreatitis, Crohn's disease, to chronic pain with no clear etiology. Treatment of chronic abdominal pain remains a challenge in our clinical practice. While current interventions with celiac plexus blocks and pain medications provide some relief for these patients, but these treatments are typically less efficacious and limited by various adverse effects. Opioid medications are commonly used to manage chronic pain syndromes that are refectory to other pain management interventions. The potential problems related to opioids include misuse, abuse, constipation, nausea pruritus, et al. Moreover, according to the recent centers for disease (CDC) control report, opioid abuse has reached epidemic proportions in the USA (LJ P. Centers for Disease Control and Prevention. 2016) and accounted for 28,000 deaths in 2014. Rudd et al. (MMWR Morb Mortal Wkly Rep 64(50-51):1378-82, 2016) Given this current situation, it is apparent that a careful review of clinical evidences supporting the use of opioid medications is necessary to guide our treatment approaches in the management of complex chronic abdominal pain patients. This review is set out to analyze efficacy of opioid medications for chronic abdominal pain.
RECENT FINDINGS: The literature referenced was obtained via a computer search with Google Scholar, Pubmed, Medline, and EMbase. The search terms used included Opioid, Oxycodone, Buprenorphine, Morphine, Fentanyl, Oxymorphone, Hydromorphone, chronic abdominal pain, Crohn's disease, and pancreatitis. All studies were considered eligible for inclusion if they were clinical studies evaluating the efficacy of opioid medications for chronic abdominal pain. Two studies were found according to these criteria. Chronic abdominal pain is a challenging medical condition in our daily practice. This condition often requires opioid medications when other treatments fail. This review provided very limited clinical evidence to support long-term opioid use for chronic abdominal pain. Given recent CDC report of opioid epidemic, it is prudent to use the best medical practice with appropriate evaluation of psychological comorbidities, urine drug screening, prescription drug monitor, and opioid treatment agreements to minimize adverse side effects related to opioids. Furthermore, well-designed clinical trials are needed to evaluate the effectiveness of long-term use of opioid medications, and more clinical research on which opioid medication is more effective for chronic abdominal pain.

PMID: 28791598 [PubMed - in process]

Evaluation of in-sewer transformation of selected illicit drugs and pharmaceutical biomarkers.

August 10, 2017 - 6:28am
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Evaluation of in-sewer transformation of selected illicit drugs and pharmaceutical biomarkers.

Sci Total Environ. 2017 Aug 04;609:1172-1181

Authors: Gao J, Banks A, Li J, Jiang G, Lai FY, Mueller JF, Thai PK

Abstract
Wastewater-based epidemiology (WBE) is considered to be a useful tool for monitoring chemical consumption in the population. However, the lack of information on potential transformation of biomarkers in the sewer system can compromise the accuracy of the consumption estimation. The present study contributes to addressing this issue by investigating the in-sewer stability of biomarkers from a number of commonly used drugs using laboratory sewer reactors that can mimic different sewer conditions. A stable and an unstable chemical (carbamazepine and caffeine) were also used as benchmarking chemicals to reflect the chemical degradation potential in different sewer conditions. The results suggested that ketamine and norketamine were unstable in gravity and rising main sewers, ketamine was unstable in bulk liquid while norketamine was stable under the same condition. Similarly, mephedrone and methylone were unstable in sewer conditions with considerable deviation. Significant loss of buprenorphine, methadone, oxycodone and codeine was observed in the rising main sewer. Morphine and codeine glucuronide were found to be deconjugated from their glucuronides quickly in the presence of biofilms. This study indicates that it is important to evaluate the stability of biomarkers in the sewer system before using them in WBE for estimating consumption/exposure to reduce uncertainties.

PMID: 28787791 [PubMed - as supplied by publisher]

Industry Payments to Physicians for Opioid Products, 2013-2015.

August 9, 2017 - 6:39am

Industry Payments to Physicians for Opioid Products, 2013-2015.

Am J Public Health. 2017 Sep;107(9):1493-1495

Authors: Hadland SE, Krieger MS, Marshall BDL

Abstract
OBJECTIVES: To identify payments that involved opioid products from the pharmaceutical industry to physicians.
METHODS: We used the Open Payments program database from the Centers for Medicare and Medicaid Services to identify payments involving an opioid to physicians between August 2013 and December 2015. We used medians, interquartile ranges, and ranges as a result of heavily skewed distributions to examine payments according to opioid product, abuse-deterrent formulation, nature of payment, state, and physician specialty.
RESULTS: During the study, 375 266 nonresearch opioid-related payments were made to 68 177 physicians, totaling $46 158 388. The top 1% of physicians received 82.5% of total payments in dollars. Abuse-deterrent formulations constituted 20.3% of total payments, and buprenorphine marketed for addiction treatment constituted 9.9%. Most payments were for speaking fees or honoraria (63.2% of all dollars), whereas food and beverage payments were the most frequent (93.9% of all payments). Physicians specializing in anesthesiology received the most in total annual payments (median = $50; interquartile range = $16-$151).
CONCLUSIONS: Approximately 1 in 12 US physicians received a payment involving an opioid during the 29-month study. These findings should prompt an examination of industry influences on opioid prescribing.

PMID: 28787210 [PubMed - in process]

Probuphine (Buprenorphine) Subdermal Implants for the Treatment Of Opioid-Dependent Patients.

August 7, 2017 - 1:39pm
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Probuphine (Buprenorphine) Subdermal Implants for the Treatment Of Opioid-Dependent Patients.

P T. 2017 Aug;42(8):505-508

Authors: Smith L, Mosley J, Johnson J, Nasri M

Abstract
Probuphine (buprenorphine) subdermal implants for the treatment of opioid-dependent patients.

PMID: 28781503 [PubMed]

Screening, treatment initiation, and referral for substance use disorders.

August 7, 2017 - 1:39pm
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Screening, treatment initiation, and referral for substance use disorders.

Addict Sci Clin Pract. 2017 Aug 07;12(1):18

Authors: Bernstein SL, D'Onofrio G

Abstract
Substance use remains a leading cause of preventable death globally. A model of intervention known as screening, brief intervention, and referral to treatment (SBIRT) was developed decades ago to facilitate time- and resource-sensitive interventions in acute care and outpatient settings. SBIRT, which includes a psychosocial intervention incorporating the principles of motivational interviewing, has been shown to be effective in reducing alcohol consumption and consequences in unhealthy drinkers both in primary care and emergency department settings. Subsequently, SBIRT for unhealthy alcohol use has been endorsed by governmental agencies and professional societies in multiple countries. Although most trials support the efficacy of SBIRT for unhealthy alcohol use (McQueen et al. in Cochrane Database Syst Rev 8, 2011; Kaner et al. in Cochrane Database Syst Rev 2, 2007; O'Donnell et al. in Alcohol Alcohol 49(1):66-78, 2014), results are heterogenous; negative studies exist. A newer approach to screening and intervention for substance use can incorporate initiation of medication management at the index visit, for individuals willing to do so, and for providers and healthcare systems that are appropriately trained and resourced. Our group has conducted two successful trials of an approach we call screening, treatment initiation, and referral (STIR). In one trial, initiation of nicotine pharmacotherapy coupled with screening and brief counseling in adult smokers resulted in sustained biochemically confirmed abstinence. In a second trial, initiation of buprenorphine for opioid dependent individuals resulted in greater engagement in treatment at 30 days and greater self-reported abstinence. STIR may offer a new, clinically effective approach to the treatment of substance use in clinical care settings.

PMID: 28780906 [PubMed - in process]

Effectiveness and tolerability of transdermal buprenorphine patches: a multicenter, prospective, open-label study in Asian patients with moderate to severe chronic musculoskeletal pain.

August 6, 2017 - 6:24am
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Effectiveness and tolerability of transdermal buprenorphine patches: a multicenter, prospective, open-label study in Asian patients with moderate to severe chronic musculoskeletal pain.

BMC Musculoskelet Disord. 2017 Aug 04;18(1):337

Authors: Yoon DH, Bin SI, Chan SK, Chung CK, In Y, Kim H, Lichauco JJ, Mok CC, Moon YW, Ng TK, Penserga EG, Shin DA, You D, Moon H

Abstract
BACKGROUND: We examined the effectiveness and tolerability of transdermal buprenorphine (TDB) treatment in real-world setting in Asian patients with musculoskeletal pain.
METHODS: This was an open-label study conducted in Hong Kong, Korea, and the Philippines between June 2013 and April 2015. Eligible patients fulfilled the following criteria: 18 to 80 years of age; clinical diagnosis of osteoarthritis, rheumatoid arthritis, low back pain, or joint/muscle pain; chronic non-malignant pain of moderate to severe intensity (Box-Scale-11 [BS-11] pain score ≥ 4), not adequately controlled with non-opioid analgesics and requiring an opioid for adequate analgesia; and no prior history of opioid treatment. Patients started with a 5 μg/h buprenorphine patch and were titrated as necessary to a maximum of 40 μg/h over a 6-week period to achieve optimal pain control. Patients continued treatment with the titrated dose for 11 weeks. The primary efficacy endpoint was the change in BS-11 pain scores. Other endpoints included patients' sleep quality and quality of life as assessed by the 8-item Global Sleep Quality Assessment Scale (GSQA) questionnaire and the EuroQol Group 5-Dimension Self-Report Questionnaire-3 Level version (EQ-5D-3 L), respectively. Tolerability was assessed by collecting adverse events.
RESULTS: A total of 114 eligible patients were included in the analysis. The mean BS-11 score at baseline was 6.2 (SD 1.6). Following initiation of TDB, there was a statistically significant improvement in BS-11 score from baseline to visit 3 (least squares [LS] mean change: -2.27 [95% CI -2.66 to -1.87]), which was maintained till the end of the study (visit 7) (LS mean change: -2.64 [95% -3.05 to -2.23]) (p < 0.0001 for both). The proportion of patients who rated sleep quality as 'good' increased from 14.0% at baseline to 26.9% at visit 6. By visit 6, the mean EQ VAS score increased by 7.7 units (SD 17.9). There were also significant improvements in patients' levels of functioning for all EQ-5D-3 L dimensions from baseline at visit 6 (p < 0.05 for all). Seventy-eight percent of patients reported TEAEs and 22.8% of patients discontinued due to TEAEs. TEAEs were generally mild to moderate in intensity (96.5%).
CONCLUSIONS: TDB provides effective pain relief with an acceptable tolerability profile over the 11-week treatment period in Asian patients with chronic musculoskeletal pain. More studies are needed to examine the long-term efficacy and safety of TBD treatment in this patient population.
TRIAL REGISTRATION: ClinicalTrials.gov NCT01961271 . Registered 7 October 2013 (retrospectively registered; first patient was enrolled on 28 June 2013 and last patient last visit date was 26 Apr 2015).

PMID: 28778219 [PubMed - in process]

Addressing Stigma in Medication Treatment of Adolescents With Opioid Use Disorder.

August 3, 2017 - 6:39am

Addressing Stigma in Medication Treatment of Adolescents With Opioid Use Disorder.

J Addict Med. 2017 Aug 01;:

Authors: Bagley SM, Hadland SE, Carney BL, Saitz R

Abstract
: In September 2016, the American Academic of Pediatrics released a policy statement that adolescents with opioid use disorder should be offered pharmacotherapy with buprenorphine/naloxone, methadone, or naltrexone. In our clinical practice, however, we have encountered the perception among patients, families, and clinicians alike that medications should be used as a last resort. That we should wait until things get worse is a discarded approach. As addiction specialists, it is imperative that we prevent and identify risky use and use disorders, then intervene early and offer timely, evidence-based treatment. We suggest that adolescents deserve special attention and that specific efforts should be made to reduce the stigma associated with treating adolescents with opioid use disorder with medications to optimize those efforts.

PMID: 28767537 [PubMed - as supplied by publisher]

Efficacy and safety of buprenorphine in peripheral nerve blocks: A meta-analysis of randomised controlled trials.

August 2, 2017 - 8:01am
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Efficacy and safety of buprenorphine in peripheral nerve blocks: A meta-analysis of randomised controlled trials.

Eur J Anaesthesiol. 2017 Sep;34(9):576-586

Authors: Schnabel A, Reichl SU, Zahn PK, Pogatzki-Zahn EM, Meyer-Frießem CH

Abstract
BACKGROUND: The duration of analgesia provided by nerve blocks is limited if local anaesthetics are administered alone. Therefore, a variety of additives to local anaesthetics have been investigated to prolong postoperative analgesia following single-shot nerve blocks.
OBJECTIVE(S): The aims of the current meta-analysis were to assess the efficacy and safety of the addition of perineural buprenorphine to local anaesthetic compared with local anaesthetic alone, or combined with systemic administration of buprenorphine, or other perineural opioids for peripheral nerve blocks.
DESIGN: Systematic review and meta-analysis of randomised controlled trials (RCTs).
DATA SOURCES: The following data sources were systematically searched: MEDLINE, CENTRAL and EMBASE (till 03/2016).
ELIGIBILITY CRITERIA: All RCTs focusing on the efficacy and safety of perineural buprenorphine combined with local anaesthetic compared with local anaesthetic alone, or in combination with systemic buprenorphine, or other perineural opioids for peripheral nerve blocks were included.
RESULTS: We included 13 RCTs (685 patients). Participants treated with perineural buprenorphine combined with local anaesthetic showed a longer duration of analgesia compared with those receiving local anaesthetic alone [mean difference 8.64 h, 95% confidence interval (CI) (6.44 to 10.85); P < 0.01]. However, the buprenorphine group had a significantly higher relative risk (RR) for postoperative nausea and vomiting (PONV) [RR 5.0, 95% CI (1.12 to 22.27); P = 0.03]. The perineural administration of buprenorphine provided a longer duration of analgesia than an intramuscular application [mean difference 6.87 h, 95% CI (4.02 to 9.71); P < 0.01] without evidence of a difference in the incidence of PONV between the modes of administration [RR 0.76, 95% CI (0.28 to 2.03); P = 0.58].
CONCLUSION: This meta-analysis revealed that the addition of buprenorphine to a local anaesthetic peripheral nerve block prolongs postoperative analgesia for about 8 h but significantly increases the risk for PONV. Perineural administration is more effective than systemic application but is associated with a similar risk of PONV. However, these results were influenced by heterogeneity so that further trials (especially head-to-head comparisons) are needed in the future.
TRIAL REGISTRATION: PROSPERO(www.crd.york.ac.uk) identifier: CRD42016036054.

PMID: 28763315 [PubMed - in process]

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