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Objectives: Recent data suggest concomitant gabapentinoid use increases opioid-related overdose (ORO) risk; however, this association has not been well studied in the hospital setting. The primary objective of this study was to compare ORO risk, indicated by naloxone administration, in patients receiving opioids plus gabapentinoids versus opioids alone. Methods: In this retrospective case-control study of adults admitted to a large community hospital from 1/1/20 to 12/31/21, all cases (defined as patients who received naloxone more than 24 hours after admission) identified were matched 1:1 to randomly selected controls (defined as patients on opioids who did not receive naloxone). The primary outcome was the percentage of cases and controls with concomitant inpatient gabapentinoid use. Logistic regression was performed to determine the independent association between gabapentinoids and ORO (as evidenced by inpatient naloxone administration). Results: Baseline characteristics were similar between the 144 cases and 144 controls. Gabapentinoid exposure was greater for cases than controls (34.0%vs 20.8%, P =.0118). Median hospital length of stay (11vs 4 days, P <.0001) and mortality (19%vs 5%; P =.0018) were also higher for cases. In logistic regression analysis, ORO (adjusted OR 4.91; 95% CI 1.86-12.96) and serotonergic medication exposure (adjusted OR 4.31; 95% CI 1.50-12.38) were significantly associated with gabapentinoid use. Conclusions: Concomitant gabapentinoid use with opioids was associated with increased ORO risk in the inpatient setting. When considering prescribing gabapentinoids in conjunction with opioids in the hospital setting, potential benefits should be weighed against increased overdose risk. [ABSTRACT FROM AUTHOR]

Background: The prevalence of deaths involving synthetic opioids has historically been lower in Texas than most U.S. states but more than quadrupled from January 2020 to January 2022. This paper explores the emergence of fentanyl in a drug supply where black tar heroin predominates, a factor considered protective against fentanyl adulteration, through the perspectives of people who use drugs (PWUD). Objectives: We describe experiences of unintentional exposure to fentanyl, illustrate how some people identify fentanyl in their supply, and present harm reduction strategies that PWUD use to avoid overdose. Methods: Thirty rapid assessment interviews were conducted in July 2021 at 2 mobile outreach sites of a harm reduction organization in Austin, Texas. The brief semistructured interviews were designed to assess participant fentanyl exposure experiences. Results: Participants were clients who reported using heroin or fentanyl in the past week and had lived in Texas for at least 6 months. Seventeen participants identified as male, 10 as female, and 3 as nonbinary. Half identified as white; other participants were Latinx (6), black (2), American Indian (1), and mixed race (6). Two-thirds were unhoused or in transitional housing. The drug supply in Texas has evolved; most participants reported that the heroin and other drugs they obtained contain fentanyl. Participants detected differences by observing changes in the physical characteristics of the drug, experiencing unexpected effects, and using fentanyl test strips. Many had been unintentionally exposed to fentanyl and expressed concerns about fentanyl’s presence. The presence of fentanyl had negative unintended consequences for participants, including adverse effects and developing a dependence on opioids. Conclusion: PWUD in Austin, Texas, report increasing prevalence of unintentional fentanyl exposure, despite the predominance of black tar heroin. Pharmacists can provide crucial supplies and education to safeguard the health of this vulnerable population. [ABSTRACT FROM AUTHOR]

Background and Aims: Patients with opioid use disorder (OUD) must be able to obtain prescribed buprenorphine/naloxone films (BUP/NX) and naloxone nasal spray (NNS) from a pharmacy promptly to reduce risk for a recurrence of use and subsequent morbidity and mortality. Telephone audits have identified concerning gaps in availability of NNS within US pharmacies, but the availability of BUP/NX has not been rigorously evaluated. This study estimated the availability of BUP/NX and NNS in the US state of Texas and compared availability by pharmacy type and metropolitan status. Design A cross‐sectional telephone audit with a secret shopper approach conducted from 18 May 2020 to 7 June 2020. Setting and Participants A random sample of 800 of 5078 (16%) community pharmacies licensed with the Texas State Board of Pharmacy. Measurements Primary outcomes included availability of a 1‐week supply of generic BUP/NX 8/2 mg films and a single unit of NNS 4 mg, overall and by pharmacy type. Secondary outcomes included willingness and estimated time‐frame to order BUP/NX if unavailable. Findings Data from 704 pharmacies (471 chain, 233 independent) were included for analyses. Of these, 34.1% of pharmacies (45.0% of chains versus 12.0% of independents, P < 0.0001) were willing and able to dispense a 1‐week supply of generic BUP/NX and a single unit of NNS. BUP/NX alone was available in 42.2% of pharmacies (52.4% of chains versus 21.5% of independents, P < 0.0001). NNS alone was available in 60.1% of pharmacies (77.9% of chains versus 24.0% of independents, P < 0.0001). Of the 397 pharmacies with generic BUP/NX unavailable, 62.2% of pharmacies (73.9% of chains versus 48.0% of independents, P < 0.0001) indicated willingness to order. Conclusions: Most pharmacies in Texas do not appear to be willing and able to dispense prescribed buprenorphine/naloxone films and naloxone nasal spray to patients with opioid use disorder in a timely manner. Deficiencies in availability are markedly more pronounced in independent pharmacies compared with chain pharmacies. [ABSTRACT FROM AUTHOR]

Background: In the U.S., medications for opioid use disorder (MOUD) include methadone, buprenorphine, and naltrexone. Despite substantial evidence of efficacy, the use of MOUD by health professionals remains controversial. This scoping review sought to identify and describe policies related to the use of MOUD by physicians, pharmacists, and nurses in professional health programs (PHP). Methods: A systematic search of PubMed, Medline, Web of Science, and Google Scholar was performed in August 2020 to identify pertinent articles from the U.S. which were then evaluated for inclusion by a team of trained reviewers. Results: Nine articles were ultimately identified for inclusion, and their years of publication ranged from 1984 to 2012. The treatment of physicians was addressed in seven articles, nurses in four, and pharmacists in two. Data from one veterinarian and several dentists could not be disaggregated from three studies. Naltrexone was the most commonly accepted form of MOUD within PHPs. A 2011 survey of physician and nurse PHP administrators found that 11/22 (50%) physician programs and 15/33 (45%) nursing programs forbade practice reentry while taking buprenorphine with the remainder indicating it could be allowed under some circumstances. The use of methadone within PHPs was extremely rare, and no specific details regarding PHP policies related to its use or practice reentry could be identified. No articles reported specifically on practice reentry policies for pharmacists. Conclusions: This scoping review identified one article detailing explicit policies concerning MOUD use in the target professions. Implicit policies extrapolated from other articles found that naltrexone was the most commonly accepted form of MOUD, with methadone and buprenorphine being avoided due to dubious concerns of impairment. A unified, contemporary, comprehensive survey of current PHP policies and evaluation of actual treatment data to ascertain real-world practices is needed.