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Every day, patients access and generate online health content through a variety of channels, creating an ever-expanding sea of digital data. At the same time, proponents of public health have recently called for timely, granular, and actionable data to address a range of public health issues, stressing the need for social listening platforms that can identify and compile this valuable data. Yet previous attempts at social listening in healthcare have yielded mixed results, largely because they have failed to incorporate sufficient context to understand the communications they seek to analyze. Guided by activity theory to design HealthSense, we propose a platform for efficiently sensing and gathering data across the web for real-time analysis to support public health outcomes. HealthSense couples theory-guided content analysis and graph propagation with graph neural networks (GNNs) to assess the relevance and credibility of information, as well as intelligently navigate the complex online channel landscape, leading to significant improvements over existing social listening tools. We demonstrate the value of our artifact in gathering information to support two exemplar public health tasks: (1) performing postmarket drug surveillance for adverse reactions and (2) addressing the opioid crisis by monitoring for potent synthetic opioids released into communities. Our results across data, user, and event experiments show that effective design artifacts can enable better outcomes across both automated and human decision-making contexts, making social listening for public health possible, practical, and valuable. Through our design process, we extend activity theory to address the complexities of modern online communication platforms, where information resides not only in the collection of individual communication activities but also in the complex network of interactions among them. [ABSTRACT FROM AUTHOR]

Opioid use disorder (OUD) has reached epidemic proportions, with many countries facing high levels of opioid use and related fatalities. Although currently prescribed medications for OUD are considered lifesaving, they inadequately address negative affect and cognitive impairment, resulting in high relapse rates to nonmedical opioid use even years after drug cessation (protracted abstinence). Evidence supports the notion that ketamine, an anesthetic and rapid-acting antidepressant drug, holds promise as a candidate for OUD treatment, including the management of acute withdrawal somatic symptoms, negative affect during protracted opioid abstinence, and prevention of retaking nonmedical opioids. In this review, we comprehensively discuss preclinical and clinical research that has evaluated ketamine and its metabolites as potential novel therapeutic strategies for treating OUD. Furthermore, we examine evidence that supports the relevance of the molecular targets of ketamine and its metabolites in relation to their potential effects and therapeutic outcomes in OUD. Overall, existing evidence demonstrates that ketamine and its metabolites can effectively modulate pathophysiological processes affected in OUD, suggesting a promising therapeutic role in the treatment of OUD and the prevention of return to opioid use during abstinence. [ABSTRACT FROM AUTHOR]

Background/Objectives: The opioid crisis has disproportionately impacted U.S. military veterans, who face heightened risks of opioid use disorder and overdose due to chronic pain and mental health conditions. The pharmaceutical industry's role in misrepresenting opioid risks—leading to over USD 50 billion in legal settlements—has included targeted marketing to vulnerable populations. This study examines Janssen Pharmaceuticals' "Imagine the Possibilities Pain Coalition" (IPPC), which aimed to increase opioid use among veterans with chronic non-cancer pain. Insights from this public health industry document analysis offer guidance for military medicine and healthcare policymaking. Methods: Using the Opioid Industry Document Archive (OIDA), housed at Johns Hopkins University and the University of California, San Francisco, researchers conducted retrospective content analysis. Documents referencing veterans were identified through keyword searches on Johns Hopkins' SciServer portal and reviewed using CoCounsel, an AI-based legal document platform using a human-in-the-loop approach. Relevant documents were examined by the authors to extract material aligned with the research focus. Results: The IPPC employed strategies to influence opioid prescribing for veterans. These included educational materials that minimized addiction risks and exaggerated long-term benefits and empathy-driven narratives prioritizing immediate pain relief over potential harms. Ghostwriting ensured favorable perspectives on opioids in scientific literature, aligning with broader industry strategies to promote opioids for chronic pain. Conclusions: The targeted marketing of opioids to veterans has exacerbated the opioid crisis, as documented in government reports and litigation. Rigorous oversight of industry-funded coalitions and evidence-based practices are critical to insulating military healthcare from corporate influence and addressing the opioid crisis among veterans. [ABSTRACT FROM AUTHOR]

The worsening opioid epidemic in the United States, exacerbated by the COVID-19 pandemic, necessitates innovative approaches to pain management. Buprenorphine, a long-acting opioid, has gained popularity due to its safety profile and accessibility. Orthopaedic surgeons, encountering an increasing number of patients on buprenorphine, face challenges in perioperative management. This article will update orthopaedic surgeons on new developments in the understanding of buprenorphine as a pain reliever and share evidence-based practice guidelines for buprenorphine management. For patients on buprenorphine for opioid use disorder or chronic pain, the updated recommendation is to continue their home dose of buprenorphine through the perioperative period. The patient's buprenorphine prescriber should be contacted and notified of any impending surgery. The continuation of buprenorphine should be accompanied by a multimodal approach to analgesia, including a preoperative discussion about expectations of pain and pain control, regional anesthesia, standing acetaminophen, Nonsteroidal anti-inflammatory drugs when possible, gabapentinoids at night for patients under 65 years, cryotherapy, elevation, and early mobilization. Patients can also be prescribed short-acting, immediate-release opioids for breakthrough pain. Transdermal buprenorphine is emerging as an excellent option for the management of acute perioperative pain in both elective and nonelective orthopaedic patients. A single patch can provide a steady dose of pain medication for up to 1 week during the postoperative period. A patch delivery method can help combat patient nonadherence and ultimately provide better overall pain control. In the future, transdermal buprenorphine patches could be applied in virtually all fracture surgery, spinal surgery, total joint arthroplasty, ligament reconstructions with bony drilling, etc. As the stigma surrounding buprenorphine decreases, further opportunities for perioperative use may develop. [ABSTRACT FROM AUTHOR]

Foregrounding the increasing global crisis of opioids as the “leading cause of deaths in fatal overdoses,” the World Drug Report 2023, published by the United Nations Office on Drugs and Crime (UNODC), mentioned that in 2021 more than 80,000 people died due to opioid overdose in the United States of America. The Centers for Disease Control and Prevention (CDC), the national public health protection agency in the United States, has reported that “the predicted number of drug overdose deaths showed an increase of 0.5% from the 12 months ending in December 2021 to the 12 months ending in December 2022, from 109,179 to 179,680” (“Provisional Data”). Although the trajectory of opioid use disorders (OUDs) has affected different sociodemographic groups in the country since its first wave in the 1990s, teenagers in poverty-stricken rural areas are more vulnerable to such addiction (Keyes et al.). Poor parental guidance, impoverishment, troubled childhoods, detrimental familial structure, scarce opportunities, and accessibility to opioids are often considered to be the primary risk factors for unprivileged teenagers to develop a psychic reliance on opioids for engendering a perpetual sense of contentment. According to the incentive sensitization theory, the persistent desire to transcend physical and psychical limitations for a sense of relief, triggered by chronic drug misuse, often evokes a sense of “wanting” or incentive salience, a compulsive inclination towards drug-associated stimuli (Berridge and Robinson, “Drug Addiction” 22). This intense desire of “wanting” often generates a perpetual sensitization of the mesolimbic systems in the brain which is also activated by mental representations of drug-associated cues (Robinson and Berridge 3139). Focusing on drug-induced changes in the brain such as hypersensitization and neuroadaptation, this study analyzes Barbara Kingsolver’s Demon Copperhead, a modern reimagining of David Copperfield by Charles Dickens. The selected text addresses primarily some pertinent socio-political crises, such as the poor foster care system, poverty, and the engrossing opioid endemic in Southern Appalachia. However, this study attempts to analyze the precarious state of some characters, who become addicted to opioids seeking recognition from peer groups and perpetual psychic stability, in the selected text from a neuropsychological perspective.

Abstract Background Overdose deaths due to opioids are a major concern in the United States. Physicians often report inadequate training in chronic pain and substance use disorder management. Here, we evaluate whether a specialized program, the Train New Trainers Primary Care Psychiatry (TNT PCP) Fellowship, affected opioid prescription practices among primary care physicians. Methods We retrieved information from a publicly insured health program in Southern California on 11,975 patients and 180 primary care providers (PCPs) engaged in care between 2017 and 2021. Of the 180 PCPs, 38 received TNT training and 142 did not. We considered a patient as exposed to the provider’s TNT “treatment” if they received care from a provider after the provider completed the 1-year fellowship. We utilized the number of opioid prescriptions per patient per quarter-year as the key independent variable. Linear regression models controlled for provider characteristics and time trends. Robustness checks included clustering patients by provider identification. Results Post-TNT training, PCPs prescribed fewer than expected opioids. This result remains robust after controlling for several covariates (coef: − 0.209 ; standard error = 0.052, p

Introduction: The opioid syndemic presents a critical need for effective interprofessional training in health care, especially in behavioral health disciplines. Addressing this need, the Interdisciplinary Training Academy for Integrated Substance/Opioid Use Disorder Prevention and Health care (ITA) was developed to provide adaptable educational experiences for emerging behavioral health professionals. This study, reflecting years 2020–2023, explored the experiences and perspectives of ITA fellows regarding interprofessional collaboration and opioid workforce development, focusing on how these elements are integrated. Method: After conducting focus groups, we employed applied thematic analysis to qualitatively analyze the experiences of ITA fellows (11 women and six men; 41% Hispanic/Latino and 59% White; 14 Master of Social Work students and three psychology postdoctoral fellows). This method allowed for a detailed exploration of their perceptions and the nuances of their learning process within the context of opioid workforce development. Results: The findings indicated that fellows' learning processes were adaptive, evolving over time to meet their changing needs. Initially, fellows faced challenges related to role clarity and process understanding. However, they reported significant professional growth as the program progressed, highlighting the effectiveness of the ITA's interprofessional approach in a remote learning setting. Discussion: The study emphasizes the need for ongoing research to identify and overcome barriers to effective interprofessional collaboration. The results contribute insights into the role of remote field education in preparing future health care professionals to address complex health crises effectively. Public Significance Statement: This study highlights the importance of interprofessional training in preparing health care professionals to address the opioid crisis. Findings emphasize the need for continued efforts to improve health care collaboration in substance use disorder care. [ABSTRACT FROM AUTHOR]

Background: Overdose deaths due to opioids are a major concern in the United States. Physicians often report inadequate training in chronic pain and substance use disorder management. Here, we evaluate whether a specialized program, the Train New Trainers Primary Care Psychiatry (TNT PCP) Fellowship, affected opioid prescription practices among primary care physicians. Methods: We retrieved information from a publicly insured health program in Southern California on 11,975 patients and 180 primary care providers (PCPs) engaged in care between 2017 and 2021. Of the 180 PCPs, 38 received TNT training and 142 did not. We considered a patient as exposed to the provider's TNT "treatment" if they received care from a provider after the provider completed the 1-year fellowship. We utilized the number of opioid prescriptions per patient per quarter-year as the key independent variable. Linear regression models controlled for provider characteristics and time trends. Robustness checks included clustering patients by provider identification. Results: Post-TNT training, PCPs prescribed fewer than expected opioids. This result remains robust after controlling for several covariates (coef: − 0.209 ; standard error = 0.052, p < 0.001) as well as after clustering patient observations by provider. Conclusion: In a large Southern California healthcare system, the TNT training program preceded a reduction in primary care providers' prescription rates of opioids. If replicated in larger samples, a low-cost provider training program has the potential to promote more judicious use of opioids for pain management. We encourage more studies to understand the program's long-term impact on physician behavior and, potentially, on patient outcomes. [ABSTRACT FROM AUTHOR]

Background/Objectives: The objective of this study was to determine whether preoperative opioid education reduces opioid consumption after spine surgery and which educational methods are the most effective. Orthopedists are the most likely to prescribe opioids among all specialists. To alleviate the prescription opioid crisis, studies have identified ways to taper narcotic dosage and use following surgery. The role of preoperative education and its varying modalities on opioid consumption following spine surgery has yet to be reported in the literature. Methods: The study group received formal education describing the use of opioids, side effects, and alternatives to pain management. Patients were to choose their preferred modality of a 2 min narrated video and two handouts to be watched and read in their individual time, attending a small class led by a physician assistant where they watched the 2 min narrated video along with reading the two handouts or receiving a one-on-one session with the treating spine surgeon. Meanwhile, the control group received standard preoperative education. Refill prescriptions were collected from patients' electronic medical record charts at the 2-week, 1-month, 3-month, and 6-month postoperative follow-ups. The primary outcome measure was morphine equivalents (MME) of prescription opioids at six months following spine surgery. Results: At 2 weeks postoperatively, there were no statistically significant differences between patients who received any formal narcotic education and those who did not. At 1 and 3 months postoperatively, the video education group (p-value < 0.001), class education group (p-value < 0.001), and the one-on-one education group (p-value < 0.05) all had significant reductions in opioid consumption. At 6 months postoperatively, only the video education group (p-value < 0.001) and the class education group (p-value < 0.01) had significant reductions in opioid consumption. Conclusions: A two-fold approach with a video and handouts significantly decreases the prescription dosage at six months postoperatively and allows for early opioid cessation after undergoing spine surgery. [ABSTRACT FROM AUTHOR]

Justice‐involved adolescents (JIA) are at higher risk for opioid misuse (OM) and opioid‐related overdose than nonoffending adolescents. Untreated OM can lead to severe consequences (e.g., trauma), which may be harsher for female JIA. Therefore, examining risk and protective factors, such as parental supervision, is essential to identify factors that may impact OM. The current study used a statewide, cross‐sectional dataset including 79,960 JIA from the Florida Department of Juvenile Justice. Stratified logistic regression analyses were conducted. Results indicated that JIA who experienced sporadic or inadequate supervision had 2.14 and 3.54 higher odds, respectively, of misusing opioids compared to JIA who experienced consistent supervision. Female JIA who experienced sporadic or inadequate supervision had 2.23 and 3.70 higher odds, respectively, of misusing opioids. Results suggest parental supervision is an important protective factor that should be considered in developing prevention and treatment efforts that serve JIA who misuse opioids, especially females. [ABSTRACT FROM AUTHOR]

Introduction: In this perspective review, we evaluated the clinical management of fatal fentanyl overdose in several routes of administration, concentrating on both legally prescribed and illegally produced formulations. Methods: A literature search was conducted on Web of Science, PubMed, and Google Scholar databases, using the following keywords: fentanyl, illicit fentanyl, deaths, misuse, abuse, and naloxone. We included only articles whose abstracts were available in English. All articles were screened using their abstracts to determine their relevance to the current review. Results: The gold standard for treating both acute and chronic pain is fentanyl, but abuse of the drug has exploded globally since the late 2000s. Fentanyl abuse has been shown to frequently result in serious harm and even death. Conclusion: By educating patients and physicians, making rescue kits easily accessible, developing vaccines to prevent opioid addiction, and perhaps even creating new tamper-resistant fentanyl formulations, it may be possible to prevent fentanyl misuse, therapeutic errors, and the repercussions that follow. [ABSTRACT FROM AUTHOR]

Objectives: The United States faces an ongoing drug overdose crisis, but accurate information on the prevalence of opioid use disorder (OUD) remains limited. A recent analysis by Keyes et al used a multiplier approach with drug poisoning mortality data to estimate OUD prevalence. Although insightful, this approach made stringent and partly inconsistent assumptions in interpreting mortality data, particularly synthetic opioid (SO)--involved and non--opioid-involved mortality. We revise that approach and resulting estimates to resolve inconsistencies and examine several alternative assumptions. Methods:We examine 4 adjustments to Keyes and colleagues' estimation approach: (A) revising how the equations account for SOeffects on mortality, (B) incorporating fentanyl prevalence data to inform estimates of SO lethality, (C) using opioid-involved drug poisoning data to estimate a plausible range for OUD prevalence, and (D) adjusting mortality data to account for underreporting of opioid involvement. Results: Revising the estimation equation and SO lethality effect (adj. A and B) while using Keyes and colleagues' original assumption that people with OUD account for all fatal drug poisonings yields slightly higher estimates, with OUD population reaching 9.3 million in 2016 before declining to 7.6 million by 2019. Using only opioid-involved drug poisoning data (adj. C and D) provides a lower range, peaking at 6.4 million in 2014--2015 and declining to 3.8 million in 2019. Conclusions: The revised estimation equation presented is feasible and addresses limitations of the earlier method and hence should be used in future estimations. Alternative assumptions around drug poisoning data can also provide a plausible range of estimates for OUD population. [ABSTRACT FROM AUTHOR]

Background: Chronic pain significantly impacts quality of life and poses substantial public health challenges. Buprenorphine, a synthetic analog of thebaine, is recognized for its potential in managing moderate to severe chronic pain with fewer side effects and a lower incidence of tolerance compared to traditional opioids. Objective: This retrospective study aimed to assess the long-term efficacy and safety of buprenorphine transdermal patches in patients with moderate and severe chronic pain, with a focus on pain relief sustainability and tolerance development. Methods: This retrospective observational study involved 246 patients prescribed buprenorphine transdermal patches. We evaluated changes in pain intensity using the Numeric Rating Scale (NRS), assessed opioid tolerance based on FDA guidelines for morphine-equivalent doses, and measured patientreported outcomes through the Patients' Global Impression of Change (PGIC). Any adverse events were also recorded. Results: Over the 36-month period, there was a significant reduction in NRS scores for both moderate and severe pain patients, demonstrating buprenorphine's sustained analgesic effect. Tolerance measurement indicated that no patients required increases in morphine-equivalent doses that would meet or exceed the FDA's threshold for opioid tolerance (60 mg/day of morphine or equivalent). Additionally, patient satisfaction was high, with the PGIC reflecting significant improvements in pain management and overall wellbeing. The side effects were minimal, with skin reactions and nausea being the most commonly reported but manageable adverse events. Conclusion: The study findings validate the long-term use of buprenorphine transdermal patches as an effective and safe option for chronic pain management, maintaining efficacy without significant tolerance development. These results support the continued and expanded use of buprenorphine in clinical settings, emphasizing its role in reducing the burdens of chronic pain and opioid-related side effects. Further research is encouraged to refine pain management protocols and explore buprenorphine's full potential in diverse patient populations. [ABSTRACT FROM AUTHOR]

Background: Fentanyl has emerged as the leading cause of fatal drug overdoses in the U.S. Individuals misusing drugs may not always be aware of exposure to fentanyl. Objectives: To determine the prevalence of fentanyl use and extent of awareness of fentanyl exposure among a national sample of treatment-seeking individuals with opioid use disorder (n = 1098). Methods: Participants provided oral fluid and urine specimens, which were tested for drugs by liquid chromatography/tandem mass spectrometry. Participants also provided self-reports of fentanyl use. Results: 49.5% tested positive for fentanyl in oral fluid, urine, or both. Of those testing positive for fentanyl, 29.8% were unaware that they had been exposed to fentanyl. Participants testing positive for opioids methadone, and specifically 6-monoacetylmorphine (6-MAM), a unique metabolite of heroin, were significantly more likely to be unaware of fentanyl exposure than participants testing negative for these substances, with a similar trend for oxycodone and tramadol. Conclusions: These findings may be due to fentanyl's effect being difficult to distinguish from that of other opioids, whereas when other types of drugs are adulterated with fentanyl, the differences in effects are likely to be readily discernable. These results support the importance of expanded drug-checking services. [ABSTRACT FROM AUTHOR]

Individuals from a variety of backgrounds are affected by the opioid crisis. To provide optimal care for individuals at risk of opioid overdose and prevent subsequent overdoses, a more targeted response that goes beyond the traditional taxonomical diagnosis approach to care management needs to be adopted. In previous works, Graph Machine Learning and Natural Language Processing methods were used to model the products for planning and evaluating the treatment of patients with complex issues. This study proposes a methodology of partitioning patients in the opioid overdose cohort into various communities based on their patterns of service utilization (PSUs) across the continuum of care using graph community detection and applying survival analysis to predict time-to-second overdose for each of the communities. The results demonstrated that the overdose cohort is not homogeneous with respect to the determinants of risk. Moreover, the risk for subsequent overdose was quantified: there is a 51% higher chance of experiencing a second overdose for a high-risk community compared to a low-risk community. The proposed method can inform a more efficient treatment heterogeneity approach for a cohort made of diverse individuals, such as the opioid overdose cohort. It can also guide targeted support for patients at risk of subsequent overdoses.

Summary: Background: In recent years, the use of central nervous system stimulant medications has increased among the population already using opioids, referred to as a “twin epidemic.” There is an increasing concern about its harmful outcomes in large populations. However, very few studies examined the co-prescription pattern of these two drug categories over a long period, and there is currently no clear restriction on stimulant prescriptions among patients under opioid treatment in the United States. The objectives of our study were to identify opioid prescription dosage time-dependent patterns and patient subgroups representing distinct trajectories on a national level in the recent 10 years, and to further investigate longitudinal associations between stimulant and opioid prescriptions and the impact of stimulant prescriptions on opioid dosage patterns. Methods: We obtained patient records from MarketScan, one of the largest clinical databases of health insurance in the United States. 10 years (2012–2021) of prescription records and related patient profiles, who received at least two independent opioid prescriptions, were utilized for developing a group-based opioid dose trajectory model. Findings: From an initial cohort including 22 million patients with 96 million opioid prescriptions, we developed a study cohort of 2,895,960 patients with a mean age of 43.9 years (standard deviation [SD] 13.0), of whom 1,244,077 (43%) were male. Significant geographical variations in opioid prescription frequency and dosage among four U.S. regions were observed. The trajectory model identified five distinct opioid dose groups. Stimulant prescription before the initial opioid prescription was positively associated with escalating opioid doses (odds ratio [OR]: 7.58; 95% confidence intervals [CI] 6.14–9.35, opioid dose increasing group compared to the decreasing group). Stimulant co-prescriptions were also associated with increasing opioid doses (OR: 1.73; 95% CI 1.40–2.14) and were identified in patients with a higher prevalence of opioid use disorder. Interpretation: During the recent 10 years, stimulant prescription is positively associated with escalating opioid prescription activities in U.S. healthcare systems, suggesting co-prescriptions of these two types of drugs are an important contributing factor for a national-level twin epidemic. Healthcare leaders and policymakers should pay more attention to this issue and its potential harms. Funding: National Institute of General Medical Sciences, National Institute on Drug Abuse, and National Science Foundation.

Older and younger adults are offered similar analgesic options after hemorrhoid surgery (HS), but the differences in pain between the two populations are unknown. This study aims to compare postoperative pain outcomes after HS in older and younger individuals. This is a retrospective analysis of electronic medical records of patients who underwent HS between 2018 and 2023. Patients were excluded if additional anorectal procedures were performed at the time of HS. Data related to pain-related outcomes were compiled: (1) need for narcotic prescription refills; (2) documentation of a pain-related phone call within 30 d; (3) urgent postoperative office visit before regular scheduled follow-up; and (4) pain-related postoperative emergency department visits. Associations between age and pain-related outcomes were tested using Fisher's exact test, chi-square test, and covariate adjusted logistic regression modeling. There were a total of 249 patients, 60 older adults, and 189 younger adults. Compared to younger patients, older adults demonstrated a reduced frequency of pain-related phone calls (10.3 versus 32.1%, P < 0.01) and opioid refills (0 versus 14.4%, P < 0.01). After adjusting for confounders, older age remained inversely associated with pain-related postoperative phone calls (odds ratio = 0.25, 95% confidence interval = [0.1-0.6], P = 0.003). Older adults had better pain outcomes after HS in comparison to younger patients. These findings suggest that the postoperative analgesic needs of older patients after HS are lower than those of younger patients. Decisions regarding opioid prescription in older adults recovering from HS should be tailored to avoid narcotic-related complications. [ABSTRACT FROM AUTHOR]

Individuals from a variety of backgrounds are affected by the opioid crisis. To provide optimal care for individuals at risk of opioid overdose and prevent subsequent overdoses, a more targeted response that goes beyond the traditional taxonomical diagnosis approach to care management needs to be adopted. In previous works, Graph Machine Learning and Natural Language Processing methods were used to model the products for planning and evaluating the treatment of patients with complex issues. This study proposes a methodology of partitioning patients in the opioid overdose cohort into various communities based on their patterns of service utilization (PSUs) across the continuum of care using graph community detection and applying survival analysis to predict time-to-second overdose for each of the communities. The results demonstrated that the overdose cohort is not homogeneous with respect to the determinants of risk. Moreover, the risk for subsequent overdose was quantified: there is a 51% higher chance of experiencing a second overdose for a high-risk community compared to a low-risk community. The proposed method can inform a more efficient treatment heterogeneity approach for a cohort made of diverse individuals, such as the opioid overdose cohort. It can also guide targeted support for patients at risk of subsequent overdoses. [ABSTRACT FROM AUTHOR]

The rates of opioid use and opioid related deaths are escalating in the United States. Despite this, evidence-based treatments for Opioid Use Disorder are underutilized. There are three medications FDA approved for treatment of Opioid Use Disorder: Methadone, Buprenorphine, and Naltrexone. This article reviews the history, criteria, and mechanisms associated with Opioid Use Disorder. Pertinent pharmacology considerations, treatment strategies, efficacy, safety, and challenges of Methadone, Buprenorphine, and Naltrexone are outlined. Lastly, a practical decision making algorithm is discussed to address pertinent psychiatric and medical comorbidities when prescribing pharmacology for Opioid Use Disorder. [ABSTRACT FROM AUTHOR]

Police officers are stationed on the frontlines of open-air drug markets and regularly intervene in issues resulting from public drug consumption and overdoses. Police departments are increasingly being asked to adopt harm reduction approaches to deal with the health and safety consequences of drug use. As officer buy-in is essential to intervention success, it is important to assess officer attitudes towards their evolving duties. This study draws on over 400 hours of field observation data with transit officers deployed on an overdose rapid response programme in Philadelphia's Kensington neighbourhood. Generally, officers were supportive of Narcan for overdose reversal, but some pointed out limitations to its use. Officers also identified how widespread availability of Narcan has changed the local overdose landscape and community response. Officers expressed mixed opinions towards ancillary support via food and clothing distribution by local organisations. They were more supportive of long-term treatment efforts though recognised the rarity of treatment initiation. Findings illuminate a tension in contemporary policing as officers rely less on law enforcement and adapt to harm reduction approaches in their daily work. Their perspectives identify potential benefits to enhanced training and understanding of harm reduction principles among police officers. [ABSTRACT FROM AUTHOR]

This study aimed to explore and identify motivational factors and barriers for pharmacy personnel participation in specific opioid mitigation programs, using the Theory of Planned Behavior (TPB) as an investigational framework. A naturalistic inquiry method was employed involving semi-structured interviews with pharmacy personnel to assess their intentions, attitudes, normative beliefs, and behaviors towards participating in naloxone dispensing and provision of at-home drug disposal solutions. Purposive sampling was utilized to recruit participants, with saturation achieved after 12 interviews. Interviews were transcribed and coded to identify recurring themes. Four primary themes emerged: 1) the value and benefits of helping others, emphasizing societal, patient, and environmental benefits; 2) limits and barriers to participation, including financial concerns, management support, and time constraints; 3) pharmacists' intrinsic motivators, highlighting personal motivations and differentiation between programs for specific patient types; and 4) program implementation challenges and strategies. The findings underscore the applicability of the TPB in understanding pharmacy engagement in opioid abatement programs. Despite facing barriers such as financial considerations and time constraints, the overall positive attitudes towards the programs indicate a strong motivation to contribute to public health efforts. Addressing identified barriers and leveraging motivators could enhance participation, potentially mitigating the opioid crisis. Future research should incorporate patient perspectives to fully understand the impact and effectiveness of pharmacy-led interventions, such as naloxone dispensing and disposal solutions, in opioid misuse prevention. • Community pharmacies can help combat the opioid crisis through novel services. • Theory of Planned Behavior provides insight into motivational factors influencing engagement. • Uncovered themes highlight diverse factors impacting participation in opioid related services. • There is enthusiasm among community pharmacy personnel for providing opioid-related services. [ABSTRACT FROM AUTHOR]

The opioid crisis in Canada continues to cause a devastating number of deaths. Community-based naloxone programs have been identified as one of the solutions for combatting this crisis; however, there are disparities in which pharmacies stock and offer naloxone. Opioid-related stigma is a major barrier for limited naloxone distribution through pharmacies. Therefore, the development of anti-stigma interventions is crucial to improve naloxone distribution in Canada. However, there is no validated tool to specifically measure opioid-related stigma. The Opening Minds Stigma Scale for Healthcare Providers (OMS-HC) is a validated scale used to measure mental illness-related stigma. This study will adapt the OMS-HC by using four different opioid-related terminologies to determine which is the most stigmatizing to use in an opioid-related anti-stigma intervention. Pharmacy students completed four versions of the adapted OMS-HC. The average OMS-HC scores and Cronbach's α co-efficient were calculated for each version. The term "opioid addiction" was found to be the most stigmatizing term among participants and will be used in the adapted version of the OMS-HC in a future anti-stigma interventions. [ABSTRACT FROM AUTHOR]

Introduction: Multiple Canadian jurisdictions have reported a pattern of chronic pain among people who died from substance-related acute toxicity. This study examined the prevalence and characteristics of those with chronic pain using data from a national study of people who died of accidental acute toxicity. Methods: A cross-sectional analysis of accidental substance-related acute toxicity deaths that occurred in Canada between 1 January 2016 and 31 December 2017 was conducted. The prevalence of pain and pain-related conditions were summarized as counts and percentages of the overall sample. Subgroups of people with and without a documented history of chronic pain were compared across sociodemographic characteristics, health history, contextual factors and substances involved. Results: From the overall sample (n = 7902), 1056 (13%) people had a history of chronic pain while 6366 (81%) had no documented history. Those with chronic pain tended to be older (40 years and older), unemployed, retired and/or receiving disability supports around the time of death. History of mental health conditions, trauma and surgery or injury was significantly more prevalent among people with chronic pain. Of the substances that most frequently contributed to death, opioids typically prescribed for pain (hydromorphone and oxycodone) were detected in toxicology more often among those with chronic pain than those without. Conclusion: Findings underscore the cross-cutting role of multiple comorbidities and unmanaged pain, which could compound the risk of acute toxicity death. Continued prioritization of harm reduction and regular patient engagement to assess ongoing needs are among the various opportunities for intervention. [ABSTRACT FROM AUTHOR]

With opioid overdose rates on the rise, we aimed to develop a county-level risk stratification that specifically focused on access to medications for opioid use disorder (MOUDs) and high overdose rates. We examined over 15 million records from the South Carolina Prescription Tracking System (SCRIPTS) across 46 counties. Additionally, we incorporated data from opioid treatment programs, healthcare professionals prescribing naltrexone, clinicians with buprenorphine waivers, and county-level overdose fatality statistics. To assess the risk of opioid misuse, we classified counties into high-risk and low-risk categories based on their prescription rates, overdose fatalities, and treatment service availability. Statistical methods employed included the two-sample t-test and linear regression. The t-test assessed the differences in per capita prescription rates between high-risk and low-risk counties. Linear regression was used to analyze the trends over time. Our study showed that between 2017 and 2021, opioid prescriptions decreased from 64,223 to 41,214 per 100,000 residents, while fentanyl-related overdose deaths increased by 312%. High-risk counties had significantly higher rates of fentanyl prescriptions and relied more on out-of-state doctors. They also exhibited higher instances of doctor shopping and had fewer medical doctors per capita, with limited access to MOUDs. To effectively combat the opioid crisis, we advocate for improved local healthcare infrastructure, broader treatment access, stricter management of out-of-state prescriptions, and vigilant tracking of prescription patterns. Tailored local strategies are essential for mitigating the opioid epidemic in these communities. [ABSTRACT FROM AUTHOR]

Lynn Webster,1 Jeffrey Gudin2 1Dr. Vince Clinical Research, Overland Park, KS, USA; 2Department of Anesthesiology and Pain Management, University of Miami, Miller School of Medicine, Miami, FL, USACorrespondence: Lynn Webster, Dr. Vince Clinical Research, 1285 3rd Avenue, Salt Lake City, UT, 84103, USA, Tel +1 801-560-1707, Email LRWebsterMD@gmail.comAbstract: The misuse and abuse of opioid analgesics continue to pose a serious public health concern, but for some patients, opioids remain an important analgesic option. Extended-release (ER) opioid formulations are effective for treating chronic pain and are supported by multiple 12-week efficacy studies. ER opioids often contain a high opioid content, and similar to immediate-release (IR) formulations, are subject to abuse, misuse, and diversion. Unintentional misuse may also occur when ER formulations are manipulated for medicinal administration, such as crushing a dose for easier oral intake. As part of a multipronged strategy designed to fight the opioid epidemic, abuse-deterrent formulations (ADFs) were developed to deter misuse, abuse, and diversion of opioids by making manipulation more difficult and nonoral routes of administration less rewarding. Although ADF opioids have been shown to decrease rates of abuse and diversion, they are not equally effective in terms of deterring manipulation for abuse or misuse. Xtampza ER utilizes DETERx technology, which allows it to retain ER characteristics when chewed or crushed, making it the only ER opioid without a boxed warning against these types of manipulation. OxyContin was also developed as an ADF but uses RESISTEC technology, making the tablet hard to crush and viscous in aqueous solutions. ADF utilization has been hampered by patient access issues, including high prices due to lack of insurance coverage. Postmarket real-world studies demonstrate lower rates of abuse, misuse, and diversion for ADF ER opioids compared with non-ADF formulations. However, similar studies comparing abuse-related effectiveness and health care costs for ADF opioids are warranted if clinicians are expected to utilize these potentially safer opioid formulations. These studies would support further education surrounding the benefits and utilization of ADFs and manipulation potential of different ADFs.Keywords: opioid analgesics, opioid crisis, chronic pain, tamper, abuse-deterrent, extended release

The correction notice in the journal "Frontiers in Pharmacology" addresses errors in Figures 1, 4, and 5 of an article on the long-term efficacy and reduced side-effects of buprenorphine in patients with chronic pain. The corrected figures now accurately represent additional therapies prescribed alongside buprenorphine, patient-reported outcomes assessed by the PGIC scale, and trends in morphine-equivalent doses for patients with moderate pain. The authors acknowledge the mistake but clarify that it does not impact the scientific conclusions of the original article. [Extracted from the article]

Escalating drug overdose death rates in Canada are of ever-increasing concern. To better understand the extent of this health threat, we obtained mortality statistics and population figures for the years 2000 to 2020, and examined rates of overdose deaths, coded (using ICD-10) as accidental, suicide or "undetermined intent." The drug deemed as primarily responsible for the death was categorized as opioid, non-opioid, or unspecified. Age patterns of drug deaths were graphed. Joinpoint analysis was used to test the significance of changes in death rates. Accidental opioid and stimulant overdose death rates in Canada have climbed faster since 2011, though not as high as corresponding US rates. Unknown cause death rates have increased. However, opioid and non-opioid suicide rates have decreased significantly since 2011, and there have been fewer drug deaths of undetermined intent. Increased attention to the possibility that some suicides are being misclassified is warranted. [ABSTRACT FROM AUTHOR]

The surge in opioid-related deaths, driven predominantly by fentanyl and its synthetic derivatives, has become a critical public health concern, which is particularly evident in the United States. While the situation is less severe in Europe, the European Monitoring Centre for Drugs and Drug Addiction reports a rise in drug overdose deaths, with emerging concerns about the impact of fentanyl-related molecules. Synthetic opioids, initially designed for medical use, have infiltrated illicit markets due to their low production costs and high potency, with carfentanil posing additional threats, including potential chemical weaponization. Existing overdose mitigation heavily relies on naloxone, requiring timely intervention and caregiver presence, while therapeutic prevention strategies face many access challenges. To provide an additional treatment option, we propose the use of a fentanyl-specific monoclonal antibody (mAb), as a non-opioid method of prophylaxis against fentanyl and carfentanil. This mAb shows protection from opioid effects in a pre-clinical murine model. mAbs could emerge as a versatile countermeasure in civilian and biodefense settings, offering a novel approach to combat opioid-associated mortality. • FenAb024 has picomolar affinity to fentanyl and minimal affinity loss to carfentanil • The antibody is robustly thermostable • FenAb024 is a fentanyl and carfentanil-binding IgG that protects from drug effects • Protection is strongly correlated with antibody and drug dosage [ABSTRACT FROM AUTHOR]

The limitations and disadvantages of opioids in anesthesia are very well known but the advantages combined with a lack of effective alternatives even now still prevents refraining from using opioids as part of an adequate pain therapy. For decades, pain research has had the declared goal of replacing opioids with new substances which have no serious side effects; however, currently this goal seems to be a long way off. Due to the media coverage of the "opioid crisis" in North America, the use of opioids for pain management is also increasingly being questioned by the patients. Measures to contain this crisis are only slowly taking effect in view of the increasing number of deaths, which is why the triggers are still being sought. The perioperative administration of opioids is not only a possible gateway to addiction and abuse but it can also cause outcome-relevant complications, such as respiratory depression, postoperative nausea and vomiting and an increase in postoperative pain. Therefore, these considerations gave rise to the idea of an opioid-free anesthesia (OFA), i.e., opioids are not administered as part of anesthesia to carry out surgical procedures. Although this idea may make sense at first glance, a rapid introduction of this concept appears to be risky as it entails significant changes for the entire anesthesiological management. Based on relatively robust data from clinical studies, this concept can now be evaluated and discussed not only emotionally but also objectively. This review article presents arguments for or against the complete avoidance of intraoperative or even perioperative opioids. The current conditions in Germany are primarily taken into account, so that the perioperative pain therapy is transferable to the established standards. The results from current clinical studies on the implementation of an opioid-free anesthesia are summarized and discussed. [ABSTRACT FROM AUTHOR]

Summary: Background: The United States’ opioid crisis is worsening, with the number of deaths reaching 81,806 in 2022 after more than tripling over the past decade. This study aimed to comprehensively characterize changes in burden of opioid overdose mortality in terms of life expectancy reduction and years of life lost between 2019 and 2022, including differential burden across demographic groups and the contribution of polysubstance use. Methods: Using life tables and counts for all-cause and opioid overdose deaths from the National Center for Health Statistics, we constructed cause-eliminated life tables to estimate mortality by age in the absence of opioid-related deaths. We calculated the loss in life expectancy at birth (LLE) and total years of life lost (YLL) due to opioid overdose deaths by state of residency, sex, racial/ethnic group, and co-involvement of cocaine and psychostimulants. Findings: Opioid-related deaths in the US led to an estimated 3.1 million years of life lost in 2022 (38 years per death), compared to 2.0 million years lost in 2019. Relative to a scenario with no opioid mortality, we estimate that opioid-related deaths reduced life expectancy nationally by 0.67 years in 2022 vs 0.52 years in 2019. This LLE worsened in all racial/ethnic groups during the study period: 0.76 y–0.96 y for white men, 0.36 y–0.55 y for white women, 0.59 y–1.1 y for Black men, 0.27 y–0.53 y for Black women, 0.31 y–0.82 y for Hispanic men, 0.19 y–0.31 y for Hispanic women, 0.62 y–1.5 y for American Indian/Alaska Native (AI/AN) men, 0.43 y–1 y for AI/AN women, 0.09 y–0.2 y for Asian men, and 0.08 y–0.13 y for Asian women. Nearly all states experienced an increase in years of life lost (YLL) per capita from 2019 to 2022, with YLL more than doubling in 16 states. Cocaine or psychostimulants with abuse potential (incl. methamphetamines) were involved in half of all deaths and years of life lost in 2022, with substantial variation in the predominant drug class by state and racial/ethnic group. Interpretation: The burden of opioid-related mortality increased dramatically in the US between 2019 and 2022, coinciding with the period of the COVID-19 pandemic and the associated disruptions to social, economic, and health systems. Opioid overdose deaths are an important contributor to decreasing US life expectancy, and Black, Hispanic, and Native Americans now experience mortality burdens approaching or exceeding white Americans. Funding: None.

BackgroundChronic pain significantly impacts quality of life and poses substantial public health challenges. Buprenorphine, a synthetic analog of thebaine, is recognized for its potential in managing moderate to severe chronic pain with fewer side effects and a lower incidence of tolerance compared to traditional opioids.ObjectiveThis retrospective study aimed to assess the long-term efficacy and safety of buprenorphine transdermal patches in patients with moderate and severe chronic pain, with a focus on pain relief sustainability and tolerance development.MethodsThis retrospective observational study involved 246 patients prescribed buprenorphine transdermal patches. We evaluated changes in pain intensity using the Numeric Rating Scale (NRS), assessed opioid tolerance based on FDA guidelines for morphine-equivalent doses, and measured patient-reported outcomes through the Patients’ Global Impression of Change (PGIC). Any adverse events were also recorded.ResultsOver the 36-month period, there was a significant reduction in NRS scores for both moderate and severe pain patients, demonstrating buprenorphine’s sustained analgesic effect. Tolerance measurement indicated that no patients required increases in morphine-equivalent doses that would meet or exceed the FDA’s threshold for opioid tolerance (60 mg/day of morphine or equivalent). Additionally, patient satisfaction was high, with the PGIC reflecting significant improvements in pain management and overall wellbeing. The side effects were minimal, with skin reactions and nausea being the most commonly reported but manageable adverse events.ConclusionThe study findings validate the long-term use of buprenorphine transdermal patches as an effective and safe option for chronic pain management, maintaining efficacy without significant tolerance development. These results support the continued and expanded use of buprenorphine in clinical settings, emphasizing its role in reducing the burdens of chronic pain and opioid-related side effects. Further research is encouraged to refine pain management protocols and explore buprenorphine’s full potential in diverse patient populations.

Kara Bragg, Michael Albus, Bradley Bragg, Rachelle M Beste, Leslie V Simon Emergency Department, Mayo Clinic, Jacksonville, FL, USACorrespondence: Kara Bragg, Email bragg.kara@mayo.eduBackground: The United States has an opioid abuse crisis that has been increasing exponentially since 2013. In 2021, there were 220 deaths each day from opioid overdoses in the United States alone. Patients suffering from addiction often present to the emergency department (ED) anticipating that an intravenous (IV) catheter will be placed. This catheter is then accessible for patients to self-inject illicit drugs while under medical care or elope from the facility with the IV in place to self-inject. The misuse of medical IV access is a potential source of prolonged hospitalizations and fatal overdoses nationwide. On two separate occasions, patients were found dead in our ED bathroom after overdosing by accessing their IV site for self-injection. These events prompted the development of the IV SafeLock prototype. The IV SafeLock is designed to prevent intravenous access by the patient while allowing access by specified providers to administer medications. This study aims to investigate prototype usability and functionality by nursing staff in the ED.Methods: A prospective study was performed with twenty ED nurses in a clinical trial to use the IV SafeLock in the clinical setting. Each nurse was given two months to complete an evaluation of 20 patients requiring IV access. They used the IV SafeLock on infusion ports and Intermittent Needle Therapy (INT) access sites. A Likert scale was used to measure the ease of function and use of the IV SafeLock.Results and conclusion: The nurses felt that the IV SafeLock was easy to use and achieved its function of protecting the intravenous access site from self-injection. The IV SafeLock prototypes used in the trial were easy to use and functioned as intended most of the time. The IV SafeLock can be used by nursing staff in a clinical setting to help prevent self-injection.Clinical Trial Registration: NCT05695183 enrolled 01/12/2023.Keywords: overdose, accidental death, self-injection, opioid crisis, IV safelock, patient safety, intravenous line infection

Jeremy Adler,1 Theresa Mallick-Searle,2 Mark Garofoli,3 Amanda Zimmerman4 1Pacific Pain Medicine Consultants, Encinitas, CA, USA; 2Division of Pain Medicine, Stanford Health Care, Redwood City, CA, USA; 3West Virginia University School of Pharmacy, Morgantown, WV, USA; 4West Forsyth Pain Management, Winston-Salem, NC, USACorrespondence: Jeremy Adler, Pacific Pain Medicine Consultants, 477 N. El Camino Real, Ste B301, Encinitas, CA, 92024, USA, Email jadler@pacificpainmed.comAbstract: Due to the prevalence of chronic pain and high-impact chronic pain in the US, a significant percentage of the population is prescribed opioids for pain management. However, opioid use disorder is associated with reduced quality of life, along with fatal opioid overdoses, and is a significant burden on the US economy. Considering the clinical needs of patients with intractable chronic pain and the potential harms associated with prescribed and illicit opioids in our communities, having a deep understanding of current treatment options, supporting evidence, and clinical practice guidelines is essential for optimizing treatment selections. Buprenorphine is a Schedule III opioid with a unique mechanism of action, allowing effective and long-lasting analgesia at microgram doses with fewer negative side effects and adverse events, including respiratory depression, when compared with other immediate-release, long-acting, and extended-release prescription opioids. Due to its relatively lower risk for overdose and misuse, buprenorphine was recently added to the Clinical Practice Guideline for the Use of Opioids in the Management of Chronic Pain as a first-line treatment for chronic pain managed by opioids by the US Departments of Defense and Veterans Affairs, and the Department of Health and Human Services recommends that buprenorphine be made available for the treatment of chronic pain. In this narrative review, we discuss the different buprenorphine formulations, clinical efficacy, advantages for older adults and other special populations, clinical practice guideline recommendations, and payer considerations of buprenorphine and suggest that buprenorphine products approved for chronic pain should be considered as a first-line treatment for this indication.Keywords: opioid analgesics, partial opioid agonists, opioid crisis, chronic pain

This analysis examines the opioid crisis in the United States as a significant public health challenge. It highlights the increasing prevalence of opioid misuse and overdose-related deaths over the past two decades, emphasizing the need for innovative and adaptive public health approaches to effectively address the crisis's root causes, mitigate its impacts, and support recovery for those affected. The inquiry focuses on resilience as a key concept in public health, exploring its relevance and application in responding to the opioid crisis. Resilience, understood as the capacity of individuals, communities, and systems to adapt and respond effectively to adversity, is presented as vital for enhancing public health preparedness, response, and recovery efforts. The goal of the article is to provide insights for policymakers, practitioners, and researchers on how to build resilience into public health systems and interventions to better confront the challenges posed by the opioid crisis.

This article, titled "Consumption trends and policies under scrutinisation," explores various topics related to consumption trends and policies in the Nordic countries. It includes research on the decline in alcohol consumption among Nordic adolescents and investigates whether this decline has led to a decrease in alcohol-related consequences. Another study examines the decline in tobacco and nicotine product use during the COVID-19 pandemic, revealing a significant rise in cigarette sales and sales of nicotine replacement therapy products. The article also discusses the challenges of cross-sectoral collaboration in treating patients with alcohol problems and evaluates health professionals' assessments of driving ability in relation to alcohol use severity and cognitive functions. Additionally, it provides overviews of the legal framework for alcohol production for personal use in the European Union and the framing of contemporary violence policies in England and Wales. Finally, the article includes a commentary on the fentanyl death crisis in North America and discusses potential lessons for Europe in addressing this public health crisis. [Extracted from the article]

Prescription drug misuse is a global problem, especially in the United States (US). Clinician involvement is necessary in this crisis, and prescription drug monitoring programs (PDMPs) are a recommended tool for the prevention, recognition, and management of prescription opioid misuse. However, because of the plethora of differences between different PDMPs, research on their effects is mixed. Yet, despite varied evidence, policy on PDMP use is trending stricter and more comprehensive. We aimed to identify patterns in the research to inform clinicians and policy. Through a systematic review of four literature databases (CINAHL, Cochrane Database, Embase, and Medline/OVID), we found 56 experimental and quasi-experimental studies published between 2016 and 2023 evaluating PDMP effects on clinician behavior. To address study heterogeneity, we categorized studies by type of intervention and study outcome. The review suggests that more comprehensive PDMP legislation is associated with decreases in the number of opioid prescriptions overall and the number of risky prescriptions prescribed or dispensed. However, this review shows that much is still unknown, encourages improvements to PDMPs and policies, and suggests further research.