The opioid abuse and misuse epidemic: Implications for pharmacists in hospitals and health systems

Cobaugh, Daniel J.; Gainor, Carl; Gaston, Cynthia L.; Kwong, Tai C.; Magnani, B; McPherson, Mary Lynn; Painter, Jacob T.; Krenzelok, Edward P.

doi:10.2146/ajhp140157

Cited by 70 publications

(56 citation statements)

References 81 publications

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“…Total opioid supply notwithstanding, patient education regarding safe use of opioids, including not sharing them with anyone else, is still insufficient (McCarthy et al, 2015). Increasing educational touch points, including pharmacists (Cobaugh et al, 2014) and nurses (Manworren & Gilson, 2015), could be helpful in reinforcing core messages proscribing diversion or sharing even among friends and family. Additionally, further longitudinal monitoring of switches from prescription opioids to heroin is also warranted.…”

Section: Discussionmentioning

confidence: 99%

Patient-reported pathways to opioid use disorders and pain-related barriers to treatment engagement

Stumbo

Yarborough

McCarty

et al. 2017

Journal of Substance Abuse Treatment

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Background Risk factors associated with developing opioid use disorders (OUD) are documented, but less is known about different pathways to initiation of opioids or opioid dependence, or how such pathways affect treatment engagement. Methods We recruited 283 adults with electronic medical record (EMR) evidence of opioid dependence diagnoses. Open-ended and structured interview items focused on prior opioid treatment experiences, barriers to and knowledge of treatment options. Interviews were audio-recorded, transcribed, and coded. In exploratory analyses, we used a modified grounded theory approach to organize emergent, patient-reported themes describing participants’ perceived pathways to opioid dependence. Results 121 participants described one or more pathways to OUD. Qualitative analyses revealed five pathway themes. Three pathways were related to pain control: inadequately controlled chronic pain, exposure to opioids during acute pain episodes, and chronic pain among individuals with prior substance use disorders. A fourth pathway included individuals for whom opioids provided relief from emotional distress; the fifth related to recreational or non-medically supervised opioid use. We identified pain-related barriers to reducing/stopping opioids and treatment engagement barriers among individuals who perceived themselves solely as pain patients. Conclusion Patients’ perceptions of inadequately controlled pain, patients’ previous substance use disorders, and the relief from emotional distress that some patients feel while using opioids are relevant when making clinical decisions about whether to initiate or sustain opioid therapy, and for how to monitor certain individuals. Among individuals with pain and OUD, treatment barriers include fear of uncontrolled pain, and stigmatization of being treated alongside people with non-medical opioid use.

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Section: Discussionmentioning

confidence: 99%

Patient-reported pathways to opioid use disorders and pain-related barriers to treatment engagement

Stumbo

Yarborough

McCarty

et al. 2017

Journal of Substance Abuse Treatment

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“…78 The pharmacy profession has quickly expanded into clinical pharmacotherapy, information services, disease management, and other health services. 79 Combined with specialized knowledge of medications, pharmacists are uniquely positioned for taking an active role in misuse prevention.…”

Section: Discussionmentioning

confidence: 99%

Behavioral, mental, and physical health characteristics and opioid medication misuse among community pharmacy patients: A latent class analysis

Cochran

Hruschak

Bacci

et al. 2017

Research in Social and Administrative Pharmacy

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Background Community pharmacists are well-positioned to address the US opioid medication crisis, which has created a need to detect misuse risk in order to provide optimal patient care. Objectives This study sought to identify community pharmacy patient subgroups at risk for opioid medication misuse. Methods This study was a cross-sectional survey that examined behavioral, mental, and physical health characteristics among patients filling opioid pain medications. A convenience sample of adult patients filling opioid pain medications who were not receiving cancer treatment were screened in 2 urban and 2 rural community pharmacies in southwestern Pennsylvania. Patient subgroups were identified using latent class analysis. Latent class regression analysis was used to examine the association between subgroup membership and misuse. Results A total of 333 patients completed the survey (response rate 71.4%). Latent class analysis results showed that a 3-class solution best fit the data, which were labeled: mental health (8.4%, n=28), poor health (79.6%, n=265), and hazardous alcohol use (12%, n=40). Individuals within the mental health subgroup had an increased risk for opioid medication misuse (Odds Ratio=6.23, 95% CI=5.13–7.33). Conclusion These findings demonstrate heterogeneity of this population receiving prescribed opioids and the potential to identify subgroups with high misuse risk. These findings also support routine screening of patients filling opioid medications and suggest the need for evidence-based patient-centered intervention development.

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“…Patients report withdrawal symptoms even after short periods (roughly 2 weeks) of therapeutic oxycodone use (Cobaugh et al, 2014). Although people may not always experience the full spectrum of the physical signs of oxycodone withdrawal, they still may be inflicted with those unpleasant enough to promote escalation of self-dosing, with the drug obtained either through legitimate or illegitimate channels.…”

Section: Discussionmentioning

confidence: 99%

“…Patients treated with oxycodone for extended periods of time require larger doses to achieve desired analgesic effects, and eventually some patients report taking the drug to avoid or alleviate withdrawal symptoms and transitioning to abuse of the drug for nonmedical purposes (Jones et al, 2011a,b;Mars et al, 2014). The use and sales of oxycodone have greatly increased since the late 20th century in the United States, with sales increasing over 4-fold (Cobaugh et al, 2014) which has been mirrored by a pattern of illicit use and overdose deaths. Recent statistics show that prescription opioids cause over twice as many overdose deaths as heroin (Centers for Disease Control and Prevention, 2015).…”

Section: Introductionmentioning

confidence: 99%

Effects of Acute and Repeated Administration of Oxycodone and Naloxone-Precipitated Withdrawal on Intracranial Self-Stimulation in Rats

Wiebelhaus

Walentiny

Beardsley

2015

Journal of Pharmacology and Experimental Therapeutics

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Incidence of prescription opioid abuse and overdose, often led by oxycodone, continues to increase, producing twice as many overdose deaths as heroin. Surprisingly, preclinical reports relevant to oxycodone's abuse-related effects are relatively sparse considering its history and patient usage. The goal of this study was to characterize dose-and time-dependent effects of acute and repeated oxycodone administration in a frequencyrate intracranial self-stimulation (ICSS) procedure, an assay often predictive of drug-related reinforcing effects, in male Sprague-Dawley rats. We hypothesized that oxycodone would produce a biphasic profile of rate-increasing and ratedecreasing effects maintained by ICSS similar to m-opioid receptor agonists. Oxycodone (0.03, 0.3, 1, and 3 mg/kg, s.c.) produced dose-and time-dependent alterations on ICSS, with the predicted biphasic profile of rate-increasing effects at lower stimulation frequencies followed by rate-decreasing effects at higher frequencies. Peak effects were observed between 30 and 60 minutes, which were reversed by naloxone pretreatment (30 minutes). Tolerance to rate-decreasing effects was observed over a 5-day period when rats were treated with 1 mg/kg oxycodone twice a day. Subsequently, the dosing regimen was increased to 3 mg/kg twice a day over 10 days, although further marked tolerance did not develop. When then challenged with 10 mg/kg naloxone, a significant suppression below baseline levels of ICSS-maintained responding occurred indicative of dependence that recovered to baseline within 5 hours. The results of this study provide the first report of acute and chronic effects of oxycodone on responding maintained by ICSS presentation and the use of ICSS-maintained responding to characterize its tolerance and dependence effects.

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The opioid abuse and misuse epidemic: Implications for pharmacists in hospitals and health systems

Abstract: Pharmacists in hospitals and health systems can play a key role in recognizing the various forms of opioid toxicity and in preventing inappropriate prescribing and diversion of opioids.

Cited by 70 publications

References 81 publications

Patient-reported pathways to opioid use disorders and pain-related barriers to treatment engagement

Patient-reported pathways to opioid use disorders and pain-related barriers to treatment engagement

Behavioral, mental, and physical health characteristics and opioid medication misuse among community pharmacy patients: A latent class analysis

Effects of Acute and Repeated Administration of Oxycodone and Naloxone-Precipitated Withdrawal on Intracranial Self-Stimulation in Rats

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