Drug Interactions of Clinical Importance among the Opioids, Methadone and Buprenorphine, and Other Frequently Prescribed Medications: A Review

McCance‐Katz, Elinore F.; Sullivan, Lynn E.; Nallani, Srikanth C.

doi:10.1111/j.1521-0391.2009.00005.x

Cited by 256 publications

(217 citation statements)

References 80 publications

(86 reference statements)

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“…The increased health risk posed by multidrug use is well established in the pharmacological literature, and simultaneous use of other drugs is usually involved in OSD-related deaths (Häkkinen et al, 2012;Kintz, 2001;McCance-Katz et al, 2010;Pirnay et al, 2004). In accordance with previous research (Daniulaityte et al, 2012;Jenkinson et al, 2005;Nielsen et al, 2007;Obadia et al, 2001), our findings show that such concerted drug use is also common among the broader group of IDUs.…”

Section: Discussionsupporting

confidence: 91%

Illicit use of opioid substitution drugs: Prevalence, user characteristics, and the association with non-fatal overdoses

Bretteville-Jensen¹,

Lillehagen²,

Gjersing³

et al. 2015

Drug and Alcohol Dependence

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Background and aims: Diversion of opioid substitution drugs (OSD) is of public concern. This study examined the prevalence, frequency, and predictors of illicit OSD use in a group of injecting drug users (IDUs) and assessed if such use was associated with non-fatal overdoses.Methods: Semi-annual cross-sectional interviews conducted in Oslo, Norway, (2006Norway, ( -2013, from 1,355 street-recruited IDUs. Hurdle, logistic, and multinomial regression models were employed.Results: Overall, 27% reported illicit OSD use in the past four weeks; 16.8% methadone, 12.5% buprenorphine, and 2.9% both drugs. Almost 1/10 reported at least one non-fatal overdose in the past four weeks, and roughly 1/3 reported such experience in the past year. Use of additional drugs tended to be equally, or more prevalent among illicit OSD users than other IDUs. In terms of illicit OSD use being a risk factor for non-lethal overdoses, our results showed significant associations only for infrequent buprenorphine use (using once or less than once per week). Other factors associated with non-fatal overdoses included age, education, homelessness, as well as the benzodiazepines, stimulants, and heroin use. Conclusions:Users of diverted OSD may represent a high-risk population, as they used more additional drugs and used them more frequently than other IDUs. However, illicit OSD use may be less harmful than previously assumed. After accounting for an extensive set of covariates, only infrequent illicit buprenorphine use, but not methadone use, was associated with non-fatal overdoses.

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Section: Discussionsupporting

confidence: 91%

Illicit use of opioid substitution drugs: Prevalence, user characteristics, and the association with non-fatal overdoses

Bretteville-Jensen¹,

Lillehagen²,

Gjersing³

et al. 2015

Drug and Alcohol Dependence

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“…18 The potential for medication interactions with antiretroviral agents also requires consideration when considering some opioid analgesics, particularly methadone. 22 In our sample, almost 5 % of the HIV-infected patients received methadone (data not otherwise shown).…”

Section: Discussionmentioning

confidence: 59%

“…Opioids may impact immune function, 18 be associated with toxicities [19][20][21] and interact with antiretrovirals. 22 There are limited recent data examining factors associated with opioid prescribing to HIV-infected patients. Existing studies focus on long-term therapy; 12,14 lack an uninfected comparison group; 7,14,15 and do not consider opioid indication.…”

Section: Introductionmentioning

confidence: 99%

Receipt of Opioid Analgesics by HIV-Infected and Uninfected Patients

et al. 2012

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BACKGROUND: Opioids are increasingly prescribed, but there are limited data on opioid receipt by HIV status. OBJECTIVES: To describe patterns of opioid receipt by HIV status and the relationship between HIV status and receiving any, high-dose, and long-term opioids. DESIGN: Cross-sectional analysis of the Veterans Aging Cohort Study. PARTICIPANTS: HIV-infected (HIV+) patients receiving Veterans Health Administration care, and uninfected matched controls. MAIN MEASURES: Pain-related diagnoses were determined using ICD-9 codes. Any opioid receipt was defined as at least one opioid prescription; high-dose was defined as an average daily dose ≥120 mg of morphine equivalents; long-term opioids was defined as ≥90 consecutive days, allowing a 30 day refill gap. Multivariable models were used to assess the relationship between HIV infection and the three outcomes. KEY RESULTS: Among the HIV+ (n = 23,651) and uninfected (n=55,097) patients, 31 % of HIV+ and 28 % of uninfected (p<0.001) received opioids. Among patients receiving opioids, HIV+ patients were more likely to have an acute pain diagnosis (7 % vs. 4 %), but less likely to have a chronic pain diagnosis (53 % vs. 69 %). HIV+ patients received a higher mean daily morphine equivalent dose than uninfected patients (41 mg vs. 37 mg, p=0.001) and were more likely to receive high-dose opioids (6 % vs. 5 %, p<0.001). HIV+ patients received fewer days of opioids than uninfected patients (median 44 vs. 60, p<0.001), and were less likely to receive long-term opioids (31 % vs. 34 %, p< 0.001). In multivariable analysis, HIV+ status was associated with receipt of any opioids (AOR 1.40, 95 % CI 1.35, 1.46) and high-dose opioids (AOR 1.22, 95 % CI 1.07, 1.39), but not long-term opioids (AOR 0.94, 95 % CI 0.88, 1.01). CONCLUSIONS:Patients with HIV infection are more likely to be prescribed opioids than uninfected individuals, and there is a variable association with pain diagnoses. Efforts to standardize approaches to pain management may be warranted in this highly complex and vulnerable patient population.

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“…47,58,77,99 For persons not known to be at a higher risk of QTc interval prolongation, the panel found insufficient evidence to routinely recommend ECG screening. 72 Lintzeris et al, 65 and Gourevitch et al 40 However, given that QTc interval prolongation without arrhythmia is asymptomatic and may not be associated with recognized risk factors, the panel suggests that clinicians consider obtaining an ECG prior to initiation of methadone in all patients. Although there is no evidence to guide recommendations on how recent an ECG should be to guide risk assessments accurately prior to initiation of methadone, the panel suggests that in patients with risk factors for QTc interval prolongation that are unchanged, an ECG within the last 3 months showing no QTc interval prolongation can be used as the baseline study and a repeat ECG is unnecessary prior to initiating methadone.…”

Section: Baseline Electrocardiogramsmentioning

confidence: 99%

“…60,70,92 Two of these guidelines were not fully endorsed by a professional society or government entity 60,92 ; the third was endorsed by the Substance Abuse and Mental Health Services Administration. 72 Although systematic literature reviews were conducted for these guidelines, a limitation is that none graded the strength of the recommendations or the quality of the evidence supporting the recommendations. In addition, they did not address methadone safety issues other than cardiac arrhythmias.…”

mentioning

confidence: 99%

Methadone Safety: A Clinical Practice Guideline From the American Pain Society and College on Problems of Drug Dependence, in Collaboration With the Heart Rhythm Society

Chou

Cruciani

Fiellin

et al. 2014

The Journal of Pain

204

188

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Methadone is used for the treatment of opioid addiction and for treatment of chronic pain. The safety of methadone has been called into question by data indicating a large increase in the number of methadone-associated overdose deaths in recent years that has occurred in parallel with a dramatic rise in the use of methadone for chronic pain. The American Pain Society and the College on Problems of Drug Dependence, in collaboration with the Heart Rhythm Society, commissioned an interdisciplinary expert panel to develop a clinical practice guideline on safer prescribing of methadone for treatment of opioid addiction and chronic pain. As part of the guideline development process, the American Pain Society commissioned a systematic review of various aspects related Clinical practice guidelines are ''guides'' only and may not apply to all patients and all clinical situations. As part of a shared decision-making approach, it may be appropriate for the clinician to inform a patient that a particular recommendation may not be applicable, after considering all circumstances pertinent to that individual. This article is based on research conducted at the Oregon Evidence-based Practice Center (now the Pacific Northwest Evidence-based Practice Center) with funding from the American Pain Society (APS to safety of methadone. After a review of the available evidence, the expert panel concluded that measures can be taken to promote safer use of methadone. Specific recommendations include the need to educate and counsel patients on methadone safety, use of electrocardiography to identify persons at greater risk for methadone-associated arrhythmia, use of alternative opioids in patients at high risk of complications related to corrected electrocardiographic QTc interval prolongation, careful dose initiation and titration of methadone, and diligent monitoring and follow-up. Although these guidelines are based on a systematic review, the panel identified numerous research gaps, most recommendations were based on low-quality evidence, and no recommendations were based on high-quality evidence.Perspective: This guideline, based on a systematic review of the evidence on methadone safety, provides recommendations developed by a multidisciplinary expert panel. Safe use of methadone requires clinical skills and knowledge in use of methadone to mitigate potential risks, including serious risks related to risk of overdose and cardiac arrhythmias. M ethadone is a synthetic opioid used for the treatment of opioid addiction and for treatment of chronic pain. 15,61 The safety of methadone has been called into question by data indicating a large increase in the number of methadone-associated overdose deaths.38 This increase appears largely related to the dramatic rise in the use of methadone for chronic pain, though a small proportion of deaths occur in patients treated for opioid addiction. 21,37,68,76,91,103 Methadone poisoning deaths in the United States increased steadily from about 800 in 1999 to a high of about 5,500 in 2007; th...

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Drug Interactions of Clinical Importance among the Opioids, Methadone and Buprenorphine, and Other Frequently Prescribed Medications: A Review

Cited by 256 publications

References 80 publications

Illicit use of opioid substitution drugs: Prevalence, user characteristics, and the association with non-fatal overdoses

Illicit use of opioid substitution drugs: Prevalence, user characteristics, and the association with non-fatal overdoses

Receipt of Opioid Analgesics by HIV-Infected and Uninfected Patients

Methadone Safety: A Clinical Practice Guideline From the American Pain Society and College on Problems of Drug Dependence, in Collaboration With the Heart Rhythm Society

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