The prevalence of problem opioid use in patients receiving chronic opioid therapy

Palmer, Roy E.; Carrell, David; Cronkite, David; Saunders, Kathleen; Gross, David E; Masters, Elizabeth T.; Donevan, Sean D.; Hylan, Timothy R.; Kroff, Michael Von

doi:10.1097/j.pain.0000000000000145

Cited by 63 publications

(45 citation statements)

References 19 publications

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“…Palmer et al. employed natural language processing to evaluate the prevalence of OUD from 2006 to 2012 and reported an upward trend resulting in a 9.4% increase among 22,142 patients receiving chronic opioid therapy . A similar systematic review incorporating 16 reports of OUD from 2009 to 2014 also showed an upward trend and overall increase in prevalence within this time period .…”

Section: Discussionmentioning

confidence: 99%

Trends of Opioid Use Disorder Among Hospitalized Patients With Chronic Pain

et al. 2019

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Background Patients with chronic pain treated with opioids are at an increased risk for opioid misuse or opioid use disorder (OUD). Recent years have seen a stark increase in abuse, misuse, and diversion of prescription opioid medications. The aim of this study was to investigate trends in changing rates of opioid use disorder among patients with chronic pain. Methods The National Inpatient Sample (NIS) database identified chronic pain admissions with OUD from 2011 to 2015. Patients were identified from the NIS database using International Classification of Diseases (9th and 10th revisions) diagnosis codes for chronic pain and OUD. Annual estimates and trends were determined for OUD, patient characteristics, OUD among subgroups of chronic pain conditions, and discharge diagnosis. Results We identified 10.3 million patients with chronic pain. Of these, 680,631 patients were diagnosed with OUD. The number of patients with OUD increased from 109,222 in 2011 to 172,680 in 2015 (P < 0.001). Similarly, there were upward trends of OUD among females (53.2% to 54.5%; P = 0.09), patients 65 to 84 years of age (11.8% to 17%; P < 0.001), Medicare‐insured patients (39.5% to 46.0%; P < 0.01), patients with low annual household incomes (27.8% to 33.3%; P < 0.001), and patients with cannabinoid use disorder (7.2% to 8.3%; P = 0.01). The prevalence of OUD increased from 2011 to 2015 in patients with chronic regional pain syndrome (5.53% to 7.46%; P = 0.01) and spondylosis (1.32% to 1.81%; P < 0.001). Conclusions These findings suggest that the prevalence of OUD increased substantially from 2011 to 2015. Disparities of OUD with increasing opioid use among vulnerable populations including women, those with Medicare insurance, tobacco use disorder, and low annual income should be explored further.

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Section: Discussionmentioning

confidence: 99%

Trends of Opioid Use Disorder Among Hospitalized Patients With Chronic Pain

et al. 2019

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“…Prior research has shown that receiving an excess opioid days supplied is associated with opioid abuse. [6,15,19]…”

Section: Methodsmentioning

confidence: 99%

The Impact of Opioid Risk Reduction Initiatives on High-Dose Opioid Prescribing for Patients on Chronic Opioid Therapy

Korff

Dublin

Walker

et al. 2016

The Journal of Pain

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Avoiding high opioid doses may reduce chronic opioid therapy (COT) risks, but the feasibility of reducing opioid doses in community practice is unknown. Washington State and a health plan's group practice implemented initiatives to reduce high dose COT prescribing. The group practice physicians were exposed to both initiatives, while its contracted physicians were exposed only to statewide changes. Using interrupted time series analyses, we assessed whether these initiatives reduced opioid doses among COT patients in group practice (N=16,653) and contracted care settings (N=5,552). From 2006 through June 2014, the percent of COT patients receiving 120 or more milligrams morphine equivalent dose declined from 16.8% to 6.3% in the group practice versus 20.6% to 13.6% among COT patients of contracted physicians. The proportion receiving excess opioid days supplied declined from 24.0% to 10.4% among group practice COT patients and from 20.1% to 14.7% among COT patients of contracted physicians. Reductions in prescribing of high opioid dose and excess opioid days supplied followed state and health plan initiatives to change opioid prescribing. Reductions were substantially greater in the group practice setting that implemented additional initiatives to alter shared physician expectations regarding appropriate COT prescribing, compared to the contracted physicians’ patients.

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“…6 Furthermore, opioids are highly addictive and many patients administered chronic opioids develop addiction. 7–9 Consequently, there is a pressing need to develop novel efficacious, non-addictive analgesics for the treatment of chronic pain.…”

Section: Introductionmentioning

confidence: 99%

Fatty-acid-binding protein inhibition produces analgesic effects through peripheral and central mechanisms

et al. 2017

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BackgroundFatty-acid-binding proteins (FABPs) are intracellular carriers for endocannabinoids, N-acylethanolamines, and related lipids. Previous work indicates that systemically administered FABP5 inhibitors produce analgesia in models of inflammatory pain. It is currently not known whether FABP inhibitors exert their effects through peripheral or central mechanisms. Here, we examined FABP5 distribution in dorsal root ganglia and spinal cord and examined the analgesic effects of peripherally and centrally administered FABP5 inhibitors.ResultsImmunofluorescence revealed robust expression of FABP5 in lumbar dorsal root ganglia. FABP5 was distributed in peptidergic calcitonin gene-related peptide-expressing dorsal root ganglia and non-peptidergic isolectin B4-expressing dorsal root ganglia. In addition, the majority of dorsal root ganglia expressing FABP5 also expressed transient receptor potential vanilloid 1 (TRPV1) and peripherin, a marker of nociceptive fibers. Intraplantar administration of FABP5 inhibitors reduced thermal and mechanical hyperalgesia in the complete Freund’s adjuvant model of chronic inflammatory pain. In contrast to its robust expression in dorsal root ganglia, FABP5 was sparsely distributed in the lumbar spinal cord and intrathecal administration of FABP inhibitor did not confer analgesic effects. Administration of FABP inhibitor via the intracerebroventricular (i.c.v.) route reduced thermal hyperalgesia. Antagonists of peroxisome proliferator-activated receptor alpha blocked the analgesic effects of peripherally and i.c.v. administered FABP inhibitor while antagonism of cannabinoid receptor 1 blocked the effects of peripheral FABP inhibition and a TRPV1 antagonist blocked the effects of i.c.v. administered inhibitor. Although FABP5 and TRPV1 were co-expressed in the periaqueductal gray region of the brain, which is known to modulate pain, knockdown of FABP5 in the periaqueductal gray using adeno-associated viruses and pharmacological FABP5 inhibition did not produce analgesic effects.ConclusionsThis study demonstrates that FABP5 is highly expressed in nociceptive dorsal root ganglia neurons and FABP inhibitors exert peripheral and supraspinal analgesic effects. This indicates that peripherally restricted FABP inhibitors may serve as a new class of analgesic and anti-inflammatory agents.

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The prevalence of problem opioid use in patients receiving chronic opioid therapy

Cited by 63 publications

References 19 publications

Trends of Opioid Use Disorder Among Hospitalized Patients With Chronic Pain

Trends of Opioid Use Disorder Among Hospitalized Patients With Chronic Pain

The Impact of Opioid Risk Reduction Initiatives on High-Dose Opioid Prescribing for Patients on Chronic Opioid Therapy

Fatty-acid-binding protein inhibition produces analgesic effects through peripheral and central mechanisms

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