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Opioid dosing guidelines

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https://www.readbyqxmd.com/read/29319627/opioid-prescription-morbidity-and-mortality-in-us-transplant-recipients
#1
Kevin C Abbott, Chyng-Wen Fwu, Paul W Eggers, Anne W Eggers, Prudence P Kline, Paul L Kimmel
BACKGROUND: CDC guidelines recommend caution in prescribing opioids for chronic pain. The characteristics of opioid prescription (OpRx) among kidney transplant (KTx) recipients has not been described in a national population. METHODS: We assessed OpRx prevalence among prevalent KTx recipients, and associated duration (chronic, defined as ≥90 days in a year) and dosing (in morphine milligram equivalents per day, MME, of <50, 50-89, and ≥90) with outcomes, death and graft loss, among incident KTx recipients using 2006-2010 US Renal Data System files, including Medicare Part D for medication ascertainment...
January 10, 2018: Transplantation
https://www.readbyqxmd.com/read/29310928/sofosbuvir-and-velpatasvir-for-hepatitis-c-virus-infection-in-people-with-recent-injection-drug-use-simplify-an-open-label-single-arm-phase-4-multicentre-trial
#2
Jason Grebely, Olav Dalgard, Brian Conway, Evan B Cunningham, Philip Bruggmann, Behzad Hajarizadeh, Janaki Amin, Julie Bruneau, Margaret Hellard, Alain H Litwin, Philippa Marks, Sophie Quiene, Sharmila Siriragavan, Tanya L Applegate, Tracy Swan, Jude Byrne, Melanie Lacalamita, Adrian Dunlop, Gail V Matthews, Jeff Powis, David Shaw, Maria Christine Thurnheer, Martin Weltman, Ian Kronborg, Curtis Cooper, Jordan J Feld, Chris Fraser, John F Dillon, Phillip Read, Ed Gane, Gregory J Dore
BACKGROUND: Despite revised guidelines that no longer exclude people who inject drugs (PWID) from treatment for hepatitis C virus (HCV) infection, many clinicians are reluctant to treat recent PWID. This study aimed to evaluate the efficacy of sofosbuvir and velpatasvir therapy in people with chronic HCV infection and recent injection drug use. METHODS: In this open-label, single-arm phase 4 trial (SIMPLIFY), we recruited participants with recent injection drug use (past 6 months) and chronic HCV genotype 1-6 infection from seven countries (19 sites)...
January 5, 2018: Lancet. Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/29275265/anesthetic-and-pharmacologic-considerations-in-perioperative-care-of-obese-children
#3
REVIEW
Vidya Chidambaran, Anurag Tewari, Mohamed Mahmoud
PURPOSE: Anesthetic management of obese pediatric patients is challenging. With increasing prevalence of childhood obesity, more severely obese children with comorbidities present for surgery every day. The purpose of this review is to provide an up-to-date comprehensive narrative review on the impact of pathophysiological changes imposed by pediatric obesity on the perioperative management of obese children, especially drug dosing. This knowledge is necessary to provide safe delivery of anesthesia for severely obese children...
December 21, 2017: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/29238824/effect-of-perioperative-gabapentin-on-postoperative-pain-resolution-and-opioid-cessation-in-a-mixed-surgical-cohort-a-randomized-clinical-trial
#4
Jennifer Hah, Sean C Mackey, Peter Schmidt, Rebecca McCue, Keith Humphreys, Jodie Trafton, Bradley Efron, Debra Clay, Yasamin Sharifzadeh, Gabriela Ruchelli, Stuart Goodman, James Huddleston, William J Maloney, Frederick M Dirbas, Joseph Shrager, John Costouros, Catherine Curtin, Ian Carroll
Importance: Guidelines recommend using gabapentin to decrease postoperative pain and opioid use, but significant variation exists in clinical practice. Objective: To determine the effect of perioperative gabapentin on remote postoperative time to pain resolution and opioid cessation. Design, Setting, and Participants: A randomized, double-blind, placebo-controlled trial of perioperative gabapentin was conducted at a single-center, tertiary referral teaching hospital...
December 13, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/29226971/intravenous-dexamethasone-for-prophylaxis-of-postoperative-nausea-and-vomiting-after-administration-of-long-acting-neuraxial-opioids-a-systematic-review-and-meta-analysis
#5
REVIEW
S Grape, I Usmanova, K R Kirkham, E Albrecht
Long-acting neuraxial opioids provide excellent analgesia after surgery, but are associated with higher rates of postoperative nausea and vomiting. Dexamethasone effectively prevents postoperative nausea and vomiting after general anaesthesia, but its value in patients receiving long-acting neuraxial opioids is undetermined. Therefore, the objective of this meta-analysis was to assess the prophylactic anti-emetic efficacy of intravenous (i.v.) dexamethasone in this population. The study methodology followed the PRISMA statement guidelines...
December 11, 2017: Anaesthesia
https://www.readbyqxmd.com/read/29204977/managing-concerning-behaviors-in-patients-prescribed-opioids-for-chronic-pain-a-delphi-study
#6
Jessica S Merlin, Sarah R Young, Joanna L Starrels, Soraya Azari, E Jennifer Edelman, Jamie Pomeranz, Payel Roy, Shalini Saini, William C Becker, Jane M Liebschutz
BACKGROUND: Current guideline-recommended monitoring of patients prescribed long-term opioid therapy (LTOT) for chronic pain will likely result in increased identification of behaviors of concern for misuse and addiction, but there is a dearth of empiric evidence about how these behaviors should be managed. OBJECTIVE: To establish expert consensus about treatment approaches for common and challenging concerning behaviors that arise among patients on LTOT. DESIGN: We used a Delphi approach, which allows for generation of consensus...
December 4, 2017: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/29189368/opioid-prescribing-for-the-treatment-of-acute-pain-in-children-on-hospital-discharge
#7
Constance L Monitto, Aaron Hsu, Shuna Gao, Paul T Vozzo, Paul S Park, Deborah Roter, Gayane Yenokyan, Elizabeth D White, Deepa Kattail, Amy E Edgeworth, Kelly J Vasquenza, Sara E Atwater, Joanne E Shay, Jessica A George, Barbara A Vickers, Sabine Kost-Byerly, Benjamin H Lee, Myron Yaster
BACKGROUND: The epidemic of nonmedical use of prescription opioids has been fueled by the availability of legitimately prescribed unconsumed opioids. The aim of this study was to better understand the contribution of prescriptions written for pediatric patients to this problem by quantifying how much opioid is dispensed and consumed to manage pain after hospital discharge, and whether leftover opioid is appropriately disposed of. Our secondary aim was to explore the association of patient factors with opioid dispensing, consumption, and medication remaining on completion of therapy...
December 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29184448/older-adults-and-high-risk-medication-administration-in-the-emergency-department
#8
Mitchell Kim, Steven H Mitchell, Medley Gatewood, Katherine A Bennett, Paul R Sutton, Carol A Crawford, Itay Bentov, Mamatha Damodarasamy, Stephen J Kaplan, May J Reed
Background: Older adults are susceptible to adverse effects from opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and benzodiazepines (BZDs). We investigated factors associated with the administration of elevated doses of these medications of interest to older adults (≥65 years old) in the emergency department (ED). Patients and methods: ED records were queried for the administration of medications of interest to older adults at two academic medical center EDs over a 6-month period...
2017: Drug, Healthcare and Patient Safety
https://www.readbyqxmd.com/read/29138592/dose-related-beneficial-and-harmful-effects-of-gabapentin-in-postoperative-pain-management-post-hoc-analyses-from-a-systematic-review-with-meta-analyses-and-trial-sequential-analyses
#9
REVIEW
Maria Louise Fabritius, Jørn Wetterslev, Ole Mathiesen, Jørgen B Dahl
Background: During the last 15 years, gabapentin has become an established component of postoperative pain treatment. Gabapentin has been employed in a wide range of doses, but little is known about the optimal dose, providing the best balance between benefit and harm. This systematic review with meta-analyses aimed to explore the beneficial and harmful effects of various doses of gabapentin administered to surgical patients. Materials and methods: Data in this paper were derived from an original review, and the subgroup analyses were predefined in an International Prospective Register of Systematic Reviews published protocol: PROSPERO (ID: CRD42013006538)...
2017: Journal of Pain Research
https://www.readbyqxmd.com/read/29121327/short-acting-opioids-are-associated-with-comparable-analgesia-to-long-acting-opioids-in-patients-with-chronic-osteoarthritis-with-a-reduced-opioid-equivalence-dosing
#10
Ameer Ghodke, Stephanie Barquero, Paul R Chelminski, Timothy J Ives
Setting: There are no studies that exist within the primary care setting that address optimal opioid therapy in osteoarthritis patients. In light of the recently released US Centers for Disease Control and Prevention guidelines on opioid use in chronic noncancer pain, there is a pressing need to better characterize the effectiveness of long- and short-acting opioids. Objective: To examine the effectiveness of short-acting opioids (SAO) vs long-acting opioids (LAO) and combination therapies (SAO and LAO) for treating chronic osteoarthritis pain in a retrospective trial...
November 7, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/29065873/high-variability-of-tb-hiv-hepatitis-c-treatment-and-opioid-substitution-therapy-among-prisoners-in-germany
#11
Jana Müller, Daniel Schmidt, Christian Kollan, Marc Lehmann, Viviane Bremer, Ruth Zimmermann
BACKGROUND: In Germany, medical care of prisoners is completely separated from extramural health care. The extent and quality of medical care among prisoners in Germany are therefore largely unknown. We performed a secondary data analysis of pharmacy sales data for tuberculosis (TB), HIV, hepatitis C (HCV) and opioid substitution treatment (OST) delivered to prisons in 11 federal states (FS) in Germany between 01/2012 and 03/2013. The aims of this study were to assess (i) the treatment availability for the selected diseases and OST in German prisons, (ii) the proportion of prisoners treated per FS and overall for TB, HIV, HCV and OST during the study period...
October 25, 2017: BMC Public Health
https://www.readbyqxmd.com/read/29048972/new-persistent-opioid-use-among-patients-with-cancer-after-curative-intent-surgery
#12
Jay Soong-Jin Lee, Hsou Mei Hu, Anthony L Edelman, Chad M Brummett, Michael J Englesbe, Jennifer F Waljee, Jeffrey B Smerage, Jennifer J Griggs, Hari Nathan, Jacqueline S Jeruss, Lesly A Dossett
Purpose The current epidemic of prescription opioid misuse has increased scrutiny of postoperative opioid prescribing. Some 6% to 8% of opioid-naïve patients undergoing noncancer procedures develop new persistent opioid use; however, it is unknown if a similar risk applies to patients with cancer. We sought to define the risk of new persistent opioid use after curative-intent surgery, identify risk factors, and describe changes in daily opioid dose over time after surgery. Methods Using a national data set of insurance claims, we identified patients with cancer undergoing curative-intent surgery from 2010 to 2014...
December 20, 2017: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/29025128/opioid-therapy-for-chronic-pain-overview-of-the-2017%C3%A2-us-department-of-veterans-affairs-and-us-department-of-defense-clinical-practice-guideline
#13
Jack M Rosenberg, Brandon M Bilka, Sara M Wilson, Christopher Spevak
Description: The US Department of Veterans Affairs (VA) and US Department of Defense (DoD) revised the 2010 clinical practice guideline (CPG) for the management of opioid therapy for chronic pain, considering the specific needs of the VA and DoD and new evidence regarding prescribing opioid medication for non-end-of-life-related chronic pain. This paper summarizes the major recommendations and compares them with the US Centers for Disease Control and Prevention (CDC) guideline for prescribing opioids...
September 1, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/29016245/effect-of-a-high-dosage-opioid-prior-authorization-policy-on-prescription-opioid-use-misuse-and-overdose-outcomes
#14
Daniel M Hartung, Hyunjee Kim, Sharia M Ahmed, Luke Middleton, Shellie Keast, Richard A Deyo, Kun Zhang, K John McConnell
High dosage opioid use is a risk factor for opioid-related overdose commonly cited in guidelines, recommendations, and policies. In 2012, the Oregon Medicaid program developed a prior authorization policy for opioid prescriptions above 120 mg per day morphine equivalent dose (MED). This study aimed to evaluate the effects of that policy on utilization, prescribing patterns, and health outcomes. Methods: Using administrative claims data from Oregon and a control state (Colorado) between 2011 and 2013, we used difference-in-differences analyses to examine changes in utilization, measures of high risk opioid use, and overdose after introduction of the policy...
October 10, 2017: Substance Abuse
https://www.readbyqxmd.com/read/28994902/corrected-qt-interval-and-methadone-dose-and-concentrations-in-pregnant-and-postpartum-women
#15
Debra L Bogen, Barbara H Hanusa, James M Perel, Frederick Sherman, Marla A Mendelson, Katherine L Wisner
BACKGROUND: Methadone is a standard treatment for opioid dependence in pregnancy; however, its impact on maternal corrected QT interval (QTc) has not been evaluated. We studied the association between methadone dose and enantiomer-specific plasma concentrations and QTc among pregnant and postpartum women and newborns. We assessed the relevance of QTc screening guidelines for pregnant women and infants. METHODS: From 2006 to 2008, plasma methadone concentrations were measured during pregnancy, postpartum, and in cord blood in women treated for opioid dependence at a single treatment program...
September 26, 2017: Journal of Clinical Psychiatry
https://www.readbyqxmd.com/read/28967517/opioid-prescribing-for-opioid-naive-patients-in-emergency-departments-and-other-settings-characteristics-of-prescriptions-and-association-with-long-term-use
#16
Molly Moore Jeffery, W Michael Hooten, Erik P Hess, Ellen R Meara, Joseph S Ross, Henry J Henk, Bjug Borgundvaag, Nilay D Shah, M Fernanda Bellolio
STUDY OBJECTIVE: We explore the emergency department (ED) contribution to prescription opioid use for opioid-naive patients by comparing the guideline concordance of ED prescriptions with those attributed to other settings and the risk of patients' continuing long-term opioid use. METHODS: We used analysis of administrative claims data (OptumLabs Data Warehouse 2009 to 2015) of opioid-naive privately insured and Medicare Advantage (aged and disabled) beneficiaries to compare characteristics of opioid prescriptions attributed to the ED with those attributed to other settings...
September 21, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28964282/adherence-to-swedish-guidelines-for-pain-treatment-in-relation-to-pediatric-tonsil-surgery-a-survey-of-the-multidisciplinary-team
#17
F Alm, M Jaensson, S Lundeberg, E Ericsson
BACKGROUND: Pain management in children after tonsil surgery is essential, and optimal pain treatment has been discussed for many years. Data from the National Tonsil Register in Sweden (NTRS) and a national mapping have demonstrated the need for national pain treatment guidelines for pediatric tonsil surgery. As a result, Swedish national guidelines, together with updated patient information on the website tonsilloperation.se, were developed and implemented in 2013. OBJECTIVES: The objective of this study was to evaluate the professionals' opinions of and adherence to pain treatment guidelines for pediatric tonsil surgery patients in a two-year follow-up...
October 2017: International Journal of Pediatric Otorhinolaryngology
https://www.readbyqxmd.com/read/28956283/the-effect-of-computerized-physician-order-entry-template-modifications-on-the-administration-of-high-risk-medications-in-older-adults-in-the-emergency-department
#18
Mitchell Kim, Stephen J Kaplan, Steven H Mitchell, Medley Gatewood, Itay Bentov, Katherine A Bennett, Carol A Crawford, Paul R Sutton, Diane Matsuwaka, Mamatha Damodarasamy, May J Reed
BACKGROUND: Older adults are more susceptible to adverse events when administered certain medications at doses appropriate for younger adults. OBJECTIVE: The aim of this study was to investigate the effect of default geriatric dosing on computerized physician order entry (CPOE) templates on the subsequent administration of recommended starting doses of opioids, benzodiazepines (BZDs) and non-steroidal anti-inflammatory drugs (NSAIDs) to older adults in the emergency department (ED)...
October 2017: Drugs & Aging
https://www.readbyqxmd.com/read/28953194/guideline-recommended-vs-high-dose-long-term-opioid-therapy-for-chronic-noncancer-pain-is-associated-with-better-health-outcomes-data-from-a-representative-sample-of-the-german-population
#19
Winfried Häuser, Tino Schubert, Norbert Scherbaum, Thomas Tölle
Recent evidence-based guidelines for long-term opioid therapy (LTOT) for chronic noncancer pain (CNCP) have defined daily morphine equivalent doses (MEQ/d) that require particular caution. The recommendation for a threshold MEQ/d is based on North American studies that have demonstrated negative health outcomes associated with high-dose LTOT for CNCP. We have conducted a retrospective cross-sectional study using an anonymized German health claims database, including 4,028,618 persons insured by 69 German statutory health insurances, representative of age and sex for the German population in 2014...
October 31, 2017: Pain
https://www.readbyqxmd.com/read/28937443/reducing-disability-durations-and-medical-costs-for-patients-with-a-carpal-tunnel-release-surgery-through-the-use-of-opioid-prescribing-guidelines
#20
Fraser W Gaspar, Roman Kownacki, Catherine S Zaidel, Craig F Conlon, Kurt T Hegmann
OBJECTIVE: The impacts of compliance with opioid prescribing guidelines on disability durations and medical costs for carpal tunnel release (CTR) were examined. METHODS: Using a dataset of insured US employees, opioid prescriptions for 7840 short-term disability cases with a CTR procedure were identified. Opioids prescriptions were compared with the American College of Occupational and Environmental Medicine (ACOEM)'s opioid prescribing guidelines for postoperative, acute pain, which recommends no more than a 5-day supply, a maximum morphine equivalent dose of 50 mg/day, and only short-acting opioids...
September 20, 2017: Journal of Occupational and Environmental Medicine
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