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Opioids & SU
The Literature Collection contains over 10,000 references for published and grey literature on the integration of behavioral health and primary care. Learn More
Use the Search feature below to find references for your terms across the entire Literature Collection, or limit your searches by Authors, Keywords, or Titles and by Year, Type, or Topic. View your search results as displayed, or use the options to: Show more references per page; Sort references by Title or Date; and Refine your search criteria. Expand an individual reference to View Details. Full-text access to the literature may be available through a link to PubMed, a DOI, or a URL. References may also be exported for use in bibliographic software (e.g., EndNote, RefWorks, Zotero).
10858 Results
1981
Chronic noncancer pain management in primary care: Family medicine physicians' risk assessment of opioid misuse
Type: Journal Article
Year: 2015
Publication Place: England
Abstract: OBJECTIVE: The majority of patients with chronic noncancer pain (CNCP) are managed in the primary care settings. The primary care family physician (PCFP) generally has limited time, training, or access to resources to effectively evaluate and treat these patients, particularly when there is the added potential liability of prescribing opioids. The aim of this study is to make a favorable change in PCFPs' knowledge, attitudes, and practices about opioid use in CNCP via education on assessment of the risk of opioid misuse. MATERIALS AND METHODS: The universe of this cross-sectional study comprised 36 family physicians working at Family Health Centers affiliated to Antalya Provincial Directorate of Health who volunteered to participate in the study. Initially, a survey on patients risk assessment was performed in both intervention and control groups; whereas the intervention group received education on assessment of the risk of opioid misuse, the control group did not. The survey was repeated after 6 months and the intervention group underwent a core examination. Data obtained were analyzed with Statistical Package for the Social Sciences 18.0 statistics program. Intervention and control groups were compared. Additionally, pre- and post-education results of the intervention group were also compared. RESULTS: About 61.1% of family physicians reported concern and hesitation in prescribing opioids due to known risks, such as overdose, addiction, dependence, or diversion, and agreed that family physicians should apply risk assessment before opioid use in CNCP. Only 16.6% of PCFP reported that risk assessment is not so necessary, whereas 22.2% of PCFP were undecided. Although 47.2% of the family physicians expressed a willingness to apply risk assessment before starting opioids, the rate of eagerness increased markedly to 77.7% after the education, but the rate of increase in practicing was not statistically significant. CONCLUSION: Knowledge and competency of the family physicians in managing CNCP were improved as was expected. Although the rate of eagerness about risk assessment of opioid misuse was increased, expected increase in the rate of using risk assessment was not achieved. Further studies are needed to identify the reasons of the difficulties on changing the attitudes and practices of primary care physicians about this subject.
Topic(s):
Opioids & Substance Use
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, Education & Workforce
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Reference Links: 
View the DOI record for Chronic noncancer pain management in primary care: Family medicine physicians' risk assessment of opioid misuse
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View the PubMed citation for Chronic noncancer pain management in primary care: Family medicine physicians' risk assessment of opioid misuse1982
Chronic obstructive pulmonary disease (COPD) among opioid-dependent patients in agonist treatment. A diagnostic study
Type: Journal Article
Year: 2019
Publication Place: England
Topic(s):
Measures
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, Opioids & Substance Use
See topic collection
Reference Links:
View the DOI record for Chronic obstructive pulmonary disease (COPD) among opioid-dependent patients in agonist treatment. A diagnostic study
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View the PubMed citation for Chronic obstructive pulmonary disease (COPD) among opioid-dependent patients in agonist treatment. A diagnostic study1983
Chronic opioid therapy for chronic non-cancer pain: a review and comparison of treatment guidelines
Type: Journal Article
Year: 2014
Publication Place: United States
Abstract: BACKGROUND: Long-term opioid use for chronic non-cancer pain has increased substantially in recent years despite the paucity of strong supporting scientific data and concerns regarding adverse effects and potential misuse. STUDY DESIGN: Review and summary of practice guidelines available on PubMed and Cochrane databases as well as on the Internet on chronic opioid therapy from June 2004 to June 2013. OBJECTIVE: To review expert-developed practice guidelines on chronic opioid therapy, published in different countries over the past decade in order to reveal similar principles of therapy and to provide useful information and references for future development of opioid guidelines to identify adequately supported practice points and areas in need of further scientific evidence. METHOD: Seven guidelines were identified as pertaining specifically to the long-term use of opioids for general chronic non-cancer pain from an initial search of the PubMed/Medline and Cochrane databases using combinations of the search terms "opioid," "chronic opioid therapy," "chronic pain," "chronic non-cancer pain," "chronic non-malignant pain," "guidelines," "practice guidelines," and "clinical practice guidelines," filtered to include only articles on humans published in the English language over the past 10 years. RESULTS: All guidelines espouse an individual approach to management, beginning with a comprehensive patient evaluation, with particular focus on eliciting factors that may indicate potential drug misuse and abuse, and a trial of therapy to determine the course of treatment. Goals of treatment should be adequately discussed with and consented to by the patient. Opioids are generally not recommended as first-line therapy but, when used, clinicians should closely monitor patients for loss of response, adverse effects or aberrant behavior, and revise the treatment plan accordingly. Urine drug testing (UDT) may be used as a tool to monitor for aberrant behavior or drug misuse; opioid rotation may be considered when loss of response or adverse effects are a concern, at a starting dose lower than the calculated equianalgesic dose. LIMITATIONS: Information on some African nations, countries in the Middle-East, and Pacific Islands is not available and therefore was not included in this review. CONCLUSION: There is a growing body of scientific evidence to support opioid use in chronic pain. Future work should focus on continuing to generate good-quality evidence on the long-term benefits of opioid therapy, as well as scientific data to guide drug choice and dosing for specific conditions, populations, and situations.
Topic(s):
Opioids & Substance Use
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Reference Links: View the PubMed citation for Chronic opioid therapy for chronic non-cancer pain: a review and comparison of treatment guidelines
1984
Chronic opioid therapy for nonmalignant pain: The patient's perspective. Part II--Barriers to chronic opioid therapy
Type: Journal Article
Year: 2010
Publication Place: United States
Topic(s):
Opioids & Substance Use
See topic collection
Reference Links:
View the DOI record for Chronic opioid therapy for nonmalignant pain: The patient's perspective. Part II--Barriers to chronic opioid therapy
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View the PubMed citation for Chronic opioid therapy for nonmalignant pain: The patient's perspective. Part II--Barriers to chronic opioid therapy1985
Chronic opioid therapy urine drug testing in primary care: prevalence and predictors of aberrant results
Type: Journal Article
Year: 2014
Publication Place: United States
Abstract: BACKGROUND: Urine drug tests (UDTs) are recommended for patients on chronic opioid therapy (COT). Knowledge of the risk factors for aberrant UDT results could help optimize their use. OBJECTIVE: To identify primary care COT patient and opioid regimen characteristics associated with aberrant UDT results. DESIGN: Population-based observational. SAMPLE: 5,420 UDTs for Group Health integrated group practice COT patients. MEASURES: Group Health database measures of patient demographics, medical history, COT characteristics, and UDT results. RESULTS: Thirty percent of UDTs had aberrant results, including prescribed opioid non-detection (12.3%), tetrahydrocannabinol (THC; 11.2%), non-prescribed opioid (5.3%), illicit drug (excluding THC; 0.6%), non-prescribed benzodiazepine (1.7%), and dilute (4.8%). Adjusted odds ratios (95% CI) of any aberrant result were higher for males than females (1.24 [1.07, 1.43]), patients with versus without prior substance use disorder diagnoses (1.42 [1.17, 1.72]), and current smokers versus non-smokers (1.50 [1.30, 1.73]). Odds ratios were lower for patients aged 45-64 (0.77 [0.65, 0.92]) and 65+ (0.40 [0.32, 0.50]) versus patients aged 20-44 and for patients on long-acting opioids only (0.72 [0.55, 0.95]) or long-acting plus short-acting (0.67 [0.54, 0.83]) versus short-acting only. Adjusted odds of prescribed opioid non-detection were lower for patients aged 45-64 (0.79 [0.63, 0.998]) and 65+ (0.44 [0.32, 0.59]) versus patients aged 20-44, for those on 40-<120 mg daily morphine-equivalent dose (0.52 [0.39, 0.70]) or 120+ mg (0.22 [0.11, 0.43]) versus <40 mg, and for patients on long-acting (0.35 [0.21, 0.57]) or long-acting plus short-acting (0.35 [0.24, 0.50]) opioids (versus short-acting only); and odds ratios were higher for patients with versus without prior diagnoses of substance use disorder (1.70 [1.31, 2.20]). CONCLUSIONS: In this primary care setting, results were aberrant for 30% of UDTs of COT patients, largely because of prescribed opioid non-detection and THC. Aberrant results of almost all types were more likely among patients under the age of 45. Other risk factors varied across aberrancies, but commonly included current smoking and prior substance use disorder diagnosis.
Topic(s):
Opioids & Substance Use
See topic collection
Reference Links:
View the DOI record for Chronic opioid therapy urine drug testing in primary care: prevalence and predictors of aberrant results
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View the PubMed citation for Chronic opioid therapy urine drug testing in primary care: prevalence and predictors of aberrant results1986
Chronic pain and depression among primary care patients treated with buprenorphine
Type: Journal Article
Year: 2015
Publication Place: United States
Abstract: BACKGROUND: Pain and depression are each prevalent among opioid dependent patients receiving maintenance buprenorphine, but their interaction has not been studied in primary care patients. OBJECTIVE: We set out to examine the relationship between chronic pain, depression, and ongoing substance use, among persons maintained on buprenorphine in primary care settings. DESIGN: Between September 2012 and December 2013, we interviewed buprenorphine patients at three practice sites. PARTICIPANTS: Opioid dependent persons at two private internal medicine offices and a federally qualified health center participated in the study. MAIN MEASURES: Pain was measured in terms of chronicity, with chronic pain being defined as pain lasting at least 6 months; and in terms of severity, as measured by self-reported pain in the past week, measured on a 0-100 scale. We defined mild chronic pain as pain severity between 0 and 39 and lasting at least 6 months, and moderate/severe chronic pain as severity >/= 40 and lasting at least 6 months. To assess depression, we used the Center for Epidemiologic Studies Depression (CESD) ten-item symptom scale and the two-item Patient Health Questionnaire (PHQ-2). KEY RESULTS: Among 328 participants, 169 reported no chronic pain, 56 reported mild chronic pain, and 103 reported moderate/severe chronic pain. Participants with moderate/severe chronic pain commonly used non-opioid pain medications (56.3%) and antidepressants (44.7%), yet also used marijuana, alcohol, or cocaine (40.8%) to help relieve pain. Mean CESD scores were 7.1 (+/-6.8), 8.3 (+/-6.0), and 13.6 (+/-7.6) in the no chronic, mild, and moderate/severe pain groups, respectively. Controlling for covariates, higher CESD scores were associated with a higher likelihood of moderate/severe chronic pain relative to both no chronic pain (OR = 1.09, p < 0.001) and mild chronic pain (OR = 1.06, p = 0.04). CONCLUSION: Many buprenorphine patients are receiving over-the-counter or prescribed pain medications, as well as antidepressants, and yet continue to have significant and disabling pain and depressive symptoms. There is a clear need to address the pain-depression nexus in novel ways.
Topic(s):
Opioids & Substance Use
See topic collection
, Measures
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Reference Links:
View the DOI record for Chronic pain and depression among primary care patients treated with buprenorphine
View DOI Record
View the PubMed citation for Chronic pain and depression among primary care patients treated with buprenorphine1988
Chronic pain severity in opioid-dependent patients
Type: Journal Article
Year: 2008
Publication Place: England
Abstract: Treatment-seeking opioid-dependent patients present frequently with chronic pain (CP). This pilot study examined the feasibility and utility of a single-item rapid screening tool for identifying CP with implications for substance use disorder (SUD) treatment in a sample of patients presenting for inpatient opioid detoxification (n = 110). Most respondents (91.2%) reported pain in the past week. Forty-seven (42.8%) had CP. Individuals with severe CP had significantly greater depressive symptom severity, pain-related functional interference, and were more likely to be on disability than individuals with mild to moderate CP or no CP. The relationships were supported in a multivariate model. The results suggest it is feasible and important to assess for CP severity in SUD treatment settings.
Topic(s):
Measures
See topic collection
, Opioids & Substance Use
See topic collection
1989
Chronic prescription opioid use in pregnancy in the United States
Type: Journal Article
Year: 2021
Publication Place: England
Topic(s):
Healthcare Disparities
See topic collection
, Opioids & Substance Use
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Reference Links:
View the DOI record for Chronic prescription opioid use in pregnancy in the United States
View DOI Record
View the PubMed citation for Chronic prescription opioid use in pregnancy in the United States1990
Chronic Treatment with Opiate Agonists in Bulgaria - Assessing the Quality of Life Using SF 36 v. 2
Type: Journal Article
Year: 2016
Publication Place: Germany
Abstract: INTRODUCTION: Drug addictions to psychoactive substances are disorders with a complex bio-psycho-social genesis, which are characterized with chronic relapses. Substance addiction causes multifactorial damage to the normal functioning of individuals and requires a multicenter approach for the treatment process. AIM: The aim of the study was to assess the quality of life of patients undergoing chronic treatment with the opiate agonist methadone using a standardized questionnaire method in Bulgarian. MATERIAL AND METHODS: The study included patients aged 18 to 40 years undergoing chronic treatment with methadone for at least six months. The study included 100 subjects. Seventy-six patients were from 5 clinical programs in Bulgaria; twenty- four clinically healthy age-matched subjects with no history of drug abuse, psychiatric and somatic diseases were the control group. RESULTS: We found significant differences between patients and controls in all components of the survey (P<0.05). The patients had lower scores than the control group in the SF-36 in terms of all eight components and both the physical and mental component summaries of the SF-36-survey. Patients compared between the groups by dose, duration of treatment with methadone and period of heroin abuse before initiating treatment did not show significant differences. There were no significant differences between patients with and without hepatitis C virus. CONCLUSIONS: Opiate addiction is a state associated with poor quality of life. The duration of treatment, the methadone dose, period of heroin abuse before initiating treatment and illness of hepatitis C virus does not correlate with lower results.
Topic(s):
Opioids & Substance Use
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Reference Links:
View the DOI record for Chronic Treatment with Opiate Agonists in Bulgaria - Assessing the Quality of Life Using SF 36 v. 2
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View the PubMed citation for Chronic Treatment with Opiate Agonists in Bulgaria - Assessing the Quality of Life Using SF 36 v. 21995
CKD quality improvement intervention with PCMH integration: health plan results
Type: Journal Article
Year: 2019
Publication Place: United States
Abstract: OBJECTIVES: To execute a chronic kidney disease (CKD) intervention to assess feasibility and preliminary outcomes for a health plan. STUDY DESIGN: This CKD quality improvement study was incorporated into an existing CareFirst primary care patient-centered medical home cohort with a pre- and postintervention assessment from July 1, 2015, to June 30, 2017. METHODS: The study targeted the population at risk for CKD with diabetes and/or hypertension by implementing a care plan according to the stratification by estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio (uACR) or CKD heat map class. RESULTS: The population included 7420 individuals (51.8% female) with a mean age of 55.9 years; 19.1% had diabetes only, 42.2% had hypertension only, and 38.2% had both conditions. Overall, there was no change in eGFR testing among risk groups (84.8%), but a small significant increase in uACR testing occurred (from 31.3% to 33.0%; P = .0020). Reductions in admissions per 1000 patients were from 362.5 to 249.0 for class 3, 311.7 to 219.2 for class 4, and 590.9 to 323.5 for class 5. Lastly, there were reductions in 30-day readmissions per 1000 patients, from 51.9 to 13.7 for class 4 and 45.5 to 0 for class 5. Although there were increases in many of the per-member per-month costs assessed pre- versus post intervention, net savings in medical costs were $276.80 and $480.79 for CKD classes 3 and 5, respectively. CONCLUSIONS: This scalable CKD intervention demonstrated feasibility. For advanced CKD, decreased hospitalization and a reduction in several important costs were observed. These preliminary results support the stratification of laboratory data for CKD population health innovation in commercial health plans.
Topic(s):
Financing & Sustainability
See topic collection
, Medical Home
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Reference Links: View the PubMed citation for CKD quality improvement intervention with PCMH integration: health plan results
1996
CKD quality improvement intervention with PCMH integration: health plan results
Type: Journal Article
Year: 2019
Publication Place: United States
Abstract: OBJECTIVES: To execute a chronic kidney disease (CKD) intervention to assess feasibility and preliminary outcomes for a health plan. STUDY DESIGN: This CKD quality improvement study was incorporated into an existing CareFirst primary care patient-centered medical home cohort with a pre- and postintervention assessment from July 1, 2015, to June 30, 2017. METHODS: The study targeted the population at risk for CKD with diabetes and/or hypertension by implementing a care plan according to the stratification by estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio (uACR) or CKD heat map class. RESULTS: The population included 7420 individuals (51.8% female) with a mean age of 55.9 years; 19.1% had diabetes only, 42.2% had hypertension only, and 38.2% had both conditions. Overall, there was no change in eGFR testing among risk groups (84.8%), but a small significant increase in uACR testing occurred (from 31.3% to 33.0%; P = .0020). Reductions in admissions per 1000 patients were from 362.5 to 249.0 for class 3, 311.7 to 219.2 for class 4, and 590.9 to 323.5 for class 5. Lastly, there were reductions in 30-day readmissions per 1000 patients, from 51.9 to 13.7 for class 4 and 45.5 to 0 for class 5. Although there were increases in many of the per-member per-month costs assessed pre- versus post intervention, net savings in medical costs were $276.80 and $480.79 for CKD classes 3 and 5, respectively. CONCLUSIONS: This scalable CKD intervention demonstrated feasibility. For advanced CKD, decreased hospitalization and a reduction in several important costs were observed. These preliminary results support the stratification of laboratory data for CKD population health innovation in commercial health plans.
Topic(s):
Financing & Sustainability
See topic collection
, Medical Home
See topic collection
Reference Links: View the PubMed citation for CKD quality improvement intervention with PCMH integration: health plan results
1997
Classes of depression symptom trajectories in patients with major depression receiving a collaborative care intervention
Type: Journal Article
Year: 2018
Publication Place: United States
Abstract: PURPOSE: Collaborative care is effective in improving symptoms of patients with depression. The aims of this study were to characterize symptom trajectories in patients with major depression during one year of collaborative care and to explore associations between baseline characteristics and symptom trajectories. METHODS: We conducted a cluster-randomized controlled trial in primary care. The collaborative care intervention comprised case management and behavioral activation. We used the Patient Health Questionnaire-9 (PHQ-9) to assess symptom severity as the primary outcome. Statistical analyses comprised latent growth mixture modeling and a hierarchical binary logistic regression model. RESULTS: We included 74 practices and 626 patients (310 intervention and 316 control recipients) at baseline. Based on a minimum of 12 measurement points for each intervention recipient, we identified two latent trajectories, which we labeled 'fast improvers' (60.5%) and 'slow improvers' (39.5%). At all measurements after baseline, 'fast improvers' presented higher PHQ mean values than 'slow improvers'. At baseline, 'fast improvers' presented fewer physical conditions, higher health-related quality of life, and had made fewer suicide attempts in their history. CONCLUSIONS: A notable proportion of 39.5% of patients improved only 'slowly' and probably needed more intense treatment. The third follow-up in month two could well be a sensible time to adjust treatment to support 'slow improvers'.
Topic(s):
General Literature
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Reference Links:
View the DOI record for Classes of depression symptom trajectories in patients with major depression receiving a collaborative care intervention
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View the PubMed citation for Classes of depression symptom trajectories in patients with major depression receiving a collaborative care intervention1998
Classes of depression symptom trajectories in patients with major depression receiving a collaborative care intervention
Type: Journal Article
Year: 2018
Publication Place: United States
Abstract: PURPOSE: Collaborative care is effective in improving symptoms of patients with depression. The aims of this study were to characterize symptom trajectories in patients with major depression during one year of collaborative care and to explore associations between baseline characteristics and symptom trajectories. METHODS: We conducted a cluster-randomized controlled trial in primary care. The collaborative care intervention comprised case management and behavioral activation. We used the Patient Health Questionnaire-9 (PHQ-9) to assess symptom severity as the primary outcome. Statistical analyses comprised latent growth mixture modeling and a hierarchical binary logistic regression model. RESULTS: We included 74 practices and 626 patients (310 intervention and 316 control recipients) at baseline. Based on a minimum of 12 measurement points for each intervention recipient, we identified two latent trajectories, which we labeled 'fast improvers' (60.5%) and 'slow improvers' (39.5%). At all measurements after baseline, 'fast improvers' presented higher PHQ mean values than 'slow improvers'. At baseline, 'fast improvers' presented fewer physical conditions, higher health-related quality of life, and had made fewer suicide attempts in their history. CONCLUSIONS: A notable proportion of 39.5% of patients improved only 'slowly' and probably needed more intense treatment. The third follow-up in month two could well be a sensible time to adjust treatment to support 'slow improvers'.
Topic(s):
General Literature
See topic collection
Reference Links:
View the DOI record for Classes of depression symptom trajectories in patients with major depression receiving a collaborative care intervention
View DOI Record
View the PubMed citation for Classes of depression symptom trajectories in patients with major depression receiving a collaborative care intervention1999
Classification and diagnosis of patients with medically unexplained symptoms
Type: Journal Article
Year: 2007
Publication Place: United States
Abstract: Patients with medically unexplained symptoms (MUS) have little or no demonstrable disease explanation for the symptoms, and comorbid psychiatric disorders are frequent. Although common, costly, distressed, and often receiving ill-advised testing and treatments, most MUS patients go unrecognized, which precludes effective treatment. To enhance recognition, we present an emerging perspective that envisions a unitary classification for the entire spectrum of MUS where this diagnosis comprises severity, duration, and comorbidity. We then present a specific approach for making the diagnosis at each level of severity. Although our disease-based diagnosis system dictates excluding organic disease to diagnose MUS, much exclusion can occur clinically without recourse to laboratory or consultative evaluation because the majority of patients are mild. Only the less common, "difficult" patients with moderate and severe MUS require investigation to exclude organic diseases. By explicitly diagnosing and labeling all severity levels of MUS, we propose that this diagnostic approach cannot only facilitate effective treatment but also reduce the cost and morbidity from unnecessary interventions.
Topic(s):
Medically Unexplained Symptoms
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Reference Links:
View the DOI record for Classification and diagnosis of patients with medically unexplained symptoms
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View the PubMed citation for Classification and diagnosis of patients with medically unexplained symptoms