scholarly journals Targeting the Orexin System for Prescription Opioid Use Disorder

2020 ◽  
Vol 10 (4) ◽  
pp. 226 ◽  
Author(s):  
Alessandra Matzeu ◽  
Rémi Martin-Fardon
Keyword(s):  
Opioid Use Disorder ◽  
Prescription Opioid ◽  
Prescription Opioids ◽  
Opioid Use ◽  
Effective Strategies ◽  
System A ◽  
Clinical Pain ◽  
Promising Target ◽  
Nonmedical Use ◽  
Prescription Opioid Use

Prescription opioids are potent analgesics that are used for clinical pain management. However, the nonmedical use of these medications has emerged as a major concern because of dramatic increases in abuse and overdose. Therefore, effective strategies to prevent prescription opioid use disorder are urgently needed. The orexin system has been implicated in the regulation of motivation, arousal, and stress, making this system a promising target for the treatment of substance use disorder. This review discusses recent preclinical studies that suggest that orexin receptor blockade could be beneficial for the treatment of prescription opioid use disorder.

Suicidal ideation and attempts following nonmedical use of prescription opioids and related disorder

2020 ◽  
pp. 1-7
Author(s):  
Julian Santaella-Tenorio ◽  
Silvia S. Martins ◽  
Magdalena Cerdá ◽  
Mark Olfson ◽  
Katherine M. Keyes
Keyword(s):  
Suicidal Ideation ◽  
Suicidal Behavior ◽  
Suicide Attempts ◽  
Opioid Use Disorder ◽  
Prescription Opioid ◽  
Prescription Opioids ◽  
Opioid Use ◽  
Related Disorder ◽  
Nonmedical Use ◽  
Prescription Opioid Use

Abstract Background Since 1999, the rate of fatal prescription opioid overdoses and of suicides has dramatically increased in the USA. These increases, which have occurred among similar demographic groups, have led to the hypothesis that the opioid epidemic contributed to increases in suicidal behavior, though the underlying association remains poorly defined. We examine the association between nonmedical use of prescription opioids/opioid use disorder and suicidal ideation/attempts. Methods We used longitudinal data from a national representative sample of the US adult population, the National Epidemiologic Survey on Alcohol and Related Conditions. Participants (n = 34 653) were interviewed in 2001–2002 (wave 1) and re-interviewed approximately 3 years later (wave 2). A propensity score analysis estimated the association between exposure to prescription opioids at wave 1 and prevalent/incident suicidal behavior at wave 2. Results Heavy/frequent (⩾2–3 times a month) prescription opioid use was associated with prevalent suicide attempts [adjusted risk ratio (ARR) = 2.75, 95% CI 1.35–5.60]. Prescription opioid use disorder was associated with prevalent (ARR = 1.98, 95% CI 1.20–3.28) and incident suicidal ideation (ARR = 2.59, 95% CI 1.25–5.37), and prevalent attempts (ARR = 4.19, 95% CI 1.71–10.27). None of the exposures was associated with incident suicide attempts. Conclusions Heavy/frequent opioid use and related disorder were associated with prevalent suicide attempts; opioid use disorder was also associated with the incident and prevalent suicidal ideation. Given population increases in nonmedical use of prescription opioids and disorder, the opioid crisis may have contributed to population increases in suicidal ideation.

Patterns of storage, use, and disposal of prescription opioids by parents of children with cancer.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 114-114
Author(s):  
Kevin Madden ◽  
Akhila Sunkepally Reddy ◽  
Maxine Grace De la Cruz ◽  
Eduardo Bruera
Keyword(s):  
Pain Medication ◽  
Prescription Opioid ◽  
Prescription Opioids ◽  
Opioid Use ◽  
Cross Sectional Survey ◽  
Universal Education ◽  
Children With Cancer ◽  
Cross Sectional ◽  
Nonmedical Use ◽  
Prescription Opioid Use

114 Background: Multiple studies have demonstrated that adults do not store prescription opioids safely. Increased prescription opioid rates have led to an increased incidence of opioid poisonings in children and adolescents. We investigated whether parents of children with cancer that were prescribed opioids practiced safe storage, use, and disposal techniques. Methods: We conducted a prospective cross-sectional survey of parents whose children were prescribed opioids and asked them about their patterns of storage, use, and disposal of prescription opioids. Results: Virtually all parents (106/109, 97%) completed the survey. Most parents (95/106, 90%) did not store opioids safely. Six of 106 parents (6%) gave their child's opioid pain medication to someone else with pain, and 3 of 106 parents (3%) personally took some of their child’s opioid. Parents who personally took their child’s opioid ( P = .01) or gave it to another person ( P < .001) were more likely to use opioids unsafely with their child. A minority of parents (22/106, 21%) did not use opioids safely in their child. A small number of parents (3/22, 14%) did not dispose of opioids safely. Conclusions: Universal education about the safe, use, and disposal of opioids should be adopted when prescribing opioids. Pediatricians need to maintain vigilance about the nonmedical use of prescription opioid use by parents of children.

354 Trends in the Drug-Sparing Effects for Benzodiazepines and Prescription Opioids among Insomnia Patients on Suvorexant in the US

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A141-A141
Author(s):  
Hrishikesh Kale ◽  
Rezaul Khandker ◽  
Ruchit Shah ◽  
Marc Botteman ◽  
Weilin Meng ◽  
...  
Keyword(s):  
Interrupted Time Series ◽  
Charlson Comorbidity Index Score ◽  
Prescription Opioid ◽  
Prescription Opioids ◽  
Opioid Use ◽  
Before And After ◽  
Prescription Opioid Use ◽  
Incident Cohort ◽  
Over Time ◽  
Post Period

Abstract Introduction Use of benzodiazepines to treat insomnia has been associated with serious side effects and abuse potential. Insomnia patients are at high risk of opioid abuse and better sleep patterns may help to reduce opioid use. This study examined the trend in the use of benzodiazepines and prescription opioids before and after initiation of suvorexant in insomnia patients. Methods The study analyzed 2015–2019, Optum Clinformatics Data Mart. Insomnia patients, identified using ICD-9/10 codes and prescribed suvorexant were included. The study included incident (newly diagnosed) and prevalent cohorts of insomnia patients. The proportion of patients on benzodiazepines or prescription opioids were calculated for 12 monthly intervals before (pre-period) and after initiation of suvorexant (post-period). Interrupted time series (ITS) analysis was conducted to assess trends for use of benzodiazepine or prescription opioids over time. Results A total of 5,939 patients from the incident insomnia cohort and 18,920 from the prevalent cohort were included. For the incident cohort, mean age was 64.47 (SD: 15.48), 63% were females, 71% had Medicare Advantage coverage, 59% had Charlson comorbidity index score (CCI) ≥ 1, 27% had an anxiety disorder and 16% had substance abuse disorder. Prevalent insomnia cohort was similar but had higher CCI. Results from ITS suggested that at the beginning of the pre-period, 28% of incident insomnia patients used either opioids or benzodiazepines with the rate of use in the pre-period increasing by 0.11% per month. In the post-period, the rate of use decreased by 0.33% per month. About 26% patients used benzodiazepines or opioids at 12-month after suvorexant initiation. In the absence of suvorexant, this proportion would have been 31%. Similar findings were observed for the prevalent insomnia cohort. A larger decrease was observed for opioid use than benzodiazepines. Conclusion The rate of benzodiazepines or prescription opioid use decreased over time after the initiation of suvorexant. Suvorexant has the potential to reduce the use of opioids and benzodiazepines among insomnia patients. Further research is needed to confirm these findings. Support (if any) This study was sponsored by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA.

Opioid tapering in patients with prescription opioid use disorder: A retrospective study

2017 ◽  
Vol 17 (1) ◽  
pp. 167-173 ◽  
Author(s):  
Kehua Zhou ◽  
Peng Jia ◽  
Swati Bhargava ◽  
Yong Zhang ◽  
Taslima Reza ◽  
...  
Keyword(s):  
Trigger Point ◽  
Retrospective Chart Review ◽  
Opioid Use Disorder ◽  
Prescription Opioid ◽  
Office Visits ◽  
Opioid Use ◽  
Clinical Practices ◽  
Medication Assisted Treatment ◽  
Opioid Tapering ◽  
Prescription Opioid Use

AbstractBackground and aimsOpioid use disorder (OUD) refers to a maladaptive pattern of opioid use leading to clinically significant impairment or distress. OUD causes, and vice versa, misuses and abuse of opioid medications. Clinicians face daily challenges to treat patients with prescription opioid use disorder. An evidence-based management for people who are already addicted to opioids has been identified as the national priority in the US; however, options are limited in clinical practices. In this study, we aimed to explore the success rate and important adjuvant medications in the medication assisted treatment with temporary use of methadone for opioid discontinuation in patients with prescription OUD.MethodsThis is a retrospective chart review performed at a private physician office for physical medicine and rehabilitation. We reviewed all medical records dated between December 1st, 2011 and August 30th, 2016. The initial evaluation of the included patients (N =140) was completed between December 1st, 2011 and December 31st, 2014. They all have concumittant prescription OUD and chronic non-cancer pain. The patients (87 female and 53 male) were 46.7 ± 12.7 years old, and had a history of opioid use of 7.7 ±6.1 years. All patients received the comprehensive opioid taper treatments (including interventional pain management techniques, psychotherapy, acupuncture, physical modalities and exercises, and adjuvant medications) on top of the medication assisted treatment using methadone (transient use). Opioid tapering was considered successful when no opioid medication was used in the last patient visit.ResultsThe 140 patients had pain of 9.6 ± 8.4 years with 8/10 intensity before treatment which decreased after treatment in all comparisons (p < 0.001 for all). Opioids were successfully tapered off in 39 (27.9%) patients after 6.6 ±6.7 visits over 8.8 ±7.2 months; these patients maintained opioid abstinence over 14.3 ± 13.0 months with regular office visits. Among the 101 patients with unsuccessful opioid tapering, 13 patients only visited the outpatient clinic once. Significant differences were found between patients with and without successful opioid tapering in treatment duration, number of clinic visits, the use of mirtazepine, bupropion, topiramate, and trigger point injections with the univariate analyses. The use of mirtazepine (OR, 3.75; 95% CI, 1.48–9.49), topiramate (OR, 5.61; 95% CI, 1.91–16.48), or bupropion (OR, 2.5; 95% CI, 1.08–5.81) was significantly associated with successful opioid tapering. The associations remain significant for mirtazepine and topiramate (not bupropion) in different adjusted models.ConclusionsWith comprehensive treatments, 27.9% of patients had successful opioid tapering with opioid abstinence for over a year. The use of mirtazepine, topiramate, or likely bupropion was associated with successful opioid tapering in the medication assisted treatment with temporary use of methadone. Opioid tapering may be a practical option and should be considered for managing prescription OUD.ImplicationsFor patients with OUD, indefinite opioid maintenance treatment may not be necessary. Considering the ethical values of autonomy, nonmaleficence, and beneficence, clinicians should provide patients with OUD the option of opioid tapering.

scholarly journals Social Stigma Toward Persons With Prescription Opioid Use Disorder: Associations With Public Support for Punitive and Public Health–Oriented Policies

2017 ◽  
Vol 68 (5) ◽  
pp. 462-469 ◽  
Author(s):  
Alene Kennedy-Hendricks ◽  
Colleen L. Barry ◽  
Sarah E. Gollust ◽  
Margaret E. Ensminger ◽  
Margaret S. Chisolm ◽  
...  
Keyword(s):  
Public Health ◽  
Social Stigma ◽  
Public Support ◽  
Opioid Use Disorder ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Prescription Opioid Use
Sign in / Sign up

Export Citation Format

Share Document