Opioid dosing among patients with 3 or more years of continuous prescription opioid use before and after the CDC opioid prescribing guideline

Estimation of the prevalence of opioid misuse in New York State counties, 2007-2018: a bayesian spatiotemporal abundance model approach

An important challenge to addressing the opioid overdose crisis is the lack of information on the size of the population of people who misuse opioids (PWMO) in local areas. This estimate is needed for better resource allocation, estimation of treatment and overdose outcome rates using appropriate denominators (ie, the population at risk), and proper evaluation of intervention effects. In this study, we used a bayesian hierarchical spatiotemporal integrated abundance model that integrates multiple types of county-level surveillance outcome data, state-level information on opioid misuse, and covariates to estimate the latent (hidden) numbers of PWMO and latent prevalence of opioid misuse across New York State counties (2007-2018). The model assumes that each opioid-related outcome reflects a partial count of the number of PWMO, and it leverages these multiple sources of data to circumvent limitations of parameter estimation associated with other types of abundance models. Model estimates showed a reduction in the prevalence of PWMO during the study period, with important spatial and temporal variability. The model also provided county-level estimates of rates of treatment and opioid overdose using the numbers of PWMO as denominators. This modeling approach can identify the sizes of hidden populations to guide public health efforts in confronting the opioid overdose crisis across local areas. This article is part of a Special Collection on Mental Health.

Experiencing COMFORT: Perceptions of Virtually-delivered Nonpharmacologic Therapies in Adults Prescribed Opioids for Chronic Pain

BACKGROUND

An opioid task force within an urban public health district sought to increase access to, and utilization of, non-opioid, nonpharmacologic alternatives for pain management.

AIMS

The COMFORT (Community-engaged Options to Maximize and Facilitate Opioid ReducTion) study was designed to provide virtual multidimensional integrated nonpharmacologic therapies via a cloud-based videoconferencing platform over six weeks to adults with chronic pain who were prescribed an opioid to investigate measurable health improvements.

METHODS

A qualitative descriptive analysis explored participants' experiences of a novel pain management intervention. A total of 19 participants consented to participate in the study and 15 completed six virtual consultations with either yoga, massage, chiropractic, or physical therapists. Semi-structured exit interviews were conducted, and data analyzed using content analysis.

RESULTS

Five main themes were identified, including unmet pain needs, self-care practices, incentive for participation, perception of a virtual environment, and benefits of the intervention. All participants reported at least minor benefits, with about half reporting improvement in pain levels, and some were able to reduce their opioid use. A virtual environment posed challenges for a few participants who found it more difficult to engage with than in-person therapy; others found the platform easy to navigate.

CONCLUSIONS

Participants with chronic pain were open and willing to try a novel way to access nonpharmacologic consultations to address unmet pain needs. Virtual consultations with pain management experts may increase access to, and utilization of, complementary and integrative treatment modalities.

The effect of state policies on rates of high-risk prescribing of an initial opioid analgesic

BACKGROUND

Multiple state policies, such as prescription drug monitoring programs (PDMPs) and duration limits, have been implemented to decrease high-risk opioid prescribing. Studies demonstrate that many policies decrease certain opioid prescribing behaviors, but few examine their intended effects on the targeted high-risk prescribing practices, nor disentangle the effects of concurrent state or federal policies likely to influence those practices.

METHODS

Forty-one million initial prescriptions for new opioid episodes from 2007 to 2018 were identified using national pharmacy claims. We identified high-risk initial prescriptions, defined as >7 days' supply, average daily MME >90, or concurrent with benzodiazepines and estimated three multivariable logistic regression models to assess the association between policies and outcomes controlling for patient, prescriber, and county characteristics.

RESULTS

Initial prescriptions for >7 days declined from 23.8% in 2007 to 14.9% in 2018, associated with mandatory and interoperable PDMPs and prescription duration limits but not other policies examined. Initial prescriptions with daily MME > 90 declined from 13.2% to 1.9%, associated with pain management clinic laws but not consistently with other policies. Initial prescriptions concurrent with benzodiazepines declined only modestly from 6.9% to 6.5%, associated with pain management clinic laws but not other policies examined.

CONCLUSIONS

The opioid policy environment has changed rapidly with a range of different policies being implemented addressing high-risk prescribing. PDMP laws mandating prescriber use and pain clinic laws both appear efficacious but decrease different types of high-risk opioid prescribing. New policies should be considered in light of the prevalence of the problem being addressed.

Opioid Dosage Levels, Concurrent Risk Factors and Self-Perceptions among Chronic Pain, Opioid-Managed Individuals at Elevated Risk for Opioid Overdose

While current opioid prescribing guidelines highlight a dose-response relationship between therapeutic management and overdose risk, other concurrent risk factors have also been identified. However, there is little data in assessing the relationship between risk factor prevalence, associated provider communication, and subsequent perceptions of overdose risk among chronic pain, opioid-managed (CPOM) patients. An online questionnaire was distributed in June 2020 to a sample of CPOM individuals (n = 190) treated with an opioid prescription at or above 50 daily MME, or any dosage alongside benzodiazepines. CPOM individuals reported a mean daily MME of 470, with half (52.6%) receiving a concurrent benzodiazepine prescription. All patients reported past month alcohol use, and 67.4% indicated a risk-elevating diagnosed medical condition. In assessing provider communication, 41.6% reported no discussion focusing on the risks of one’s opioid therapy. Subsequently, 62.1% perceived themselves as having “no risk”, and 60.0% were “not at all concerned” (60.0%) about experiencing an opioid overdose. Organizational policies should focus on implementing consistent methods of patient education regarding overdose risk, as well as assessments of behaviors or characteristics that my increase an individual’s risk of opioid overdose. These policies should also include other forms of evidence-based overdose risk prevention such as co-prescriptions of naloxone.