Substance abuse : official publication of the Association for Medical Education and Research in Substance Abuse
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In response to the opioid epidemic and new guidelines, many patients on high-dose long term opioid therapy (LTOT) for chronic pain are getting tapered off opioids. As a result, a unique clinical challenge is emerging: while many on LTOT have poor pain control, functional decline, psychiatric instability, aberrancies and misuse, these issues may often worsen with opioid tapering. Currently, a clear explanation and practical guidance on how to manage this perplexing clinical scenario is lacking. ⋯ Awareness of the science of the neuroplasticity effects of repeated use of opioids is necessary to better manage these patients with complex challenges.
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To implement a telephone-based pharmacy driven clinic and increase access to opioid overdose education and naloxone distribution (OEND) in an effort to reduce opioid mortality across the catchment area of one Department of Veterans Affairs (VA) Medical Center. The project intended to assess the feasibility of telephone-based OEND, which has not been reported in the literature. ⋯ Using a combination of printed material and telephone discussion with a pharmacist, the Clinic greatly increased naloxone access in the catchment area. No statistical tests or analysis were performed, however, the clinic dramatically increased the raw number of patients with access to OEND.
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In recognition of the importance of safe and effective pain management, the Department of Veterans Affairs and the Office of the Under Secretary for Health have encouraged implementation of opioid overdose education and naloxone distribution (OEND) programs at Veterans Affairs Medical Centers (VAMCs). ⋯ OEND educated 30% of the Veterans referred into the program via the consult service, the majority of whom were at a relatively low risk for opioid overdose.