Articles: opioid.
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J Pain Palliat Care Pharmacother · Nov 2024
Evaluating the Impact of Buprenorphine on Depressive Symptoms Among Veterans with Chronic Pain.
Buprenorphine has demonstrated benefit for acute and chronic pain and various psychiatric disorders. However, many studies evaluating buprenorphine's effect on psychiatric conditions are not specific to the chronic pain population. This retrospective study was conducted to assess the impact of buprenorphine on depressive symptoms in patients with chronic pain at a Veterans Affairs healthcare facility. ⋯ Median change in PHQ-9 was -5 in the buprenorphine group and -1.5 in the traditional opioid group. Compared to traditional opioids, buprenorphine was associated with a greater reduction in depressive symptoms among Veterans with chronic pain. Although this reduction met the threshold for clinically significant improvement, further investigation is needed to evaluate the clinical relevance of these findings.
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J Pain Palliat Care Pharmacother · Nov 2024
Longitudinal Evaluation of the Risk Index for Overdose or Serious Opioid-Induced Respiratory Depression in Patients with Cancer.
The Commercially Insured health Plan Risk Index for Overdose or Serious Opioid-induced Respiratory Depression (CIP-RIOSORD) is an evidence-based screening tool to determine an individual's risk of opioid-induced respiratory depression (OIRD) or overdose. Chronic opioid use and changes in a patient's clinical status and/or medication regimen may impact OIRD or overdose risk. This study evaluated longitudinal CIP-RIOSORD scores over three consecutive visits. ⋯ Visit 1 CIP-RIOSORD scores were similar compared to visit 2 and visit 3 (p = 0.14-0.31). CIP-RIOSORD intraindividual variability was low to moderate; the median (range) coefficient of variation was 22.3% (0-173%). Beyond a baseline OIRD/overdose risk assessment, reevaluation of such risk using the CIP-RIOSORD does not to be performed at each palliative care visit.
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To evaluate the cost-effectiveness of implementation facilitation compared with a standard educational strategy to promote emergency department (ED)-initiated buprenorphine with linkage to ongoing opioid use disorder care in the community, from a health care-sector perspective. ⋯ Implementation facilitation, relative to a standard educational strategy, has a moderate-to-high likelihood of being considered cost-effective from a health care-sector perspective, depending on decisionmakers' willingness to pay for units of effectiveness.
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The epidemic of opioid use disorder (OUD) remains pervasive in the United States. In an effort to increase the availability and timeliness of medications for opioid use disorder (MOUD), several agencies in the United States (US) offer buprenorphine by prehospital providers to selected patients, though published data remains limited. We describe the preliminary safety and feasibility of training all paramedics within a single agency to administer buprenorphine in the field without online medical control to simultaneously treat opioid withdrawal and initiate MOUD. ⋯ In a single prehospital system, the use of buprenorphine appears to be a feasible and safe strategy for treating patients experiencing acute opioid withdrawal.