Diversion of prescribed opioids by people living with chronic pain: Results from an <scp>A</scp>ustralian community sample

Belcher, Jessica; Nielsen, Suzanne; Campbell, Gabrielle; Bruno, Raimondo; Hoban, Bianca; Larance, Briony; Lintzeris, Nicholas; Degenhardt, Louisa

doi:10.1111/dar.12084

Cited by 14 publications

(6 citation statements)

References 19 publications

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“…The most effective pharmacotherapy for alcohol withdrawal is an open question, although available evidence suggests that GHB is just as effective as naltrexone or acamprosate [ 37 , 191 ]. To our knowledge there does not appear to be any diversion of sodium oxybate (GHB) from the licit to illicit market as has happened on such a large scale with other medications subject to abuse, such as methadone and oxycodone [ 192 ] both widely used for pain management [ 192 , 193 ].…”

Section: Discussionmentioning

confidence: 99%

GHB Pharmacology and Toxicology: Acute Intoxication, Concentrations in Blood and Urine in Forensic Cases and Treatment of the Withdrawal Syndrome

Busardò¹,

Jones²

2015

186

227

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The illicit recreational drug of abuse, γ-hydroxybutyrate (GHB) is a potent central nervous system depressant and is often encountered during forensic investigations of living and deceased persons. The sodium salt of GHB is registered as a therapeutic agent (Xyrem®), approved in some countries for the treatment of narcolepsy-associated cataplexy and (Alcover®) is an adjuvant medication for detoxification and withdrawal in alcoholics. Trace amounts of GHB are produced endogenously (0.5-1.0 mg/L) in various tissues, including the brain, where it functions as both a precursor and a metabolite of the major inhibitory neurotransmitter γ-aminobutyric acid (GABA). Available information indicates that GHB serves as a neurotransmitter or neuromodulator in the GABAergic system, especially via binding to the GABA-B receptor subtype. Although GHB is listed as a controlled substance in many countries abuse still continues, owing to the availability of precursor drugs, γ-butyrolactone (GBL) and 1,4-butanediol (BD), which are not regulated. After ingestion both GBL and BD are rapidly converted into GHB (t½ ~1 min). The Cmax occurs after 20-40 min and GHB is then eliminated from plasma with a half-life of 30-50 min. Only about 1-5% of the dose of GHB is recoverable in urine and the window of detection is relatively short (3-10 h). This calls for expeditious sampling when evidence of drug use and/or abuse is required in forensic casework. The recreational dose of GHB is not easy to estimate and a concentration in plasma of ~100 mg/L produces euphoria and disinhibition, whereas 500 mg/L might cause death from cardiorespiratory depression. Effective antidotes to reverse the sedative and intoxicating effects of GHB do not exist. The poisoned patients require supportive care, vital signs should be monitored and the airways kept clear in case of emesis. After prolonged regular use of GHB tolerance and dependence develop and abrupt cessation of drug use leads to unpleasant withdrawal symptoms. There is no evidence-based protocol available to deal with GHB withdrawal, apart from administering benzodiazepines.

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Section: Discussionmentioning

confidence: 99%

GHB Pharmacology and Toxicology: Acute Intoxication, Concentrations in Blood and Urine in Forensic Cases and Treatment of the Withdrawal Syndrome

Busardò¹,

Jones²

2015

186

227

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“…Although our descriptive analyses do not address the potential causes in the rise of these trends, it seeks to present the evidence in order to raise awareness and urgency to address these rising and problematic trends among youth. There is some evidence that increases in prescription opioid use disorder secondary to NMPO use might be rooted in health policy, medical practice, pharmaceutical industry interests and patient behavior (Belcher et al, 2014). While pain management is an important feature in the medical conversation and practice when patients are prescribed prescription opioids (Dowell, Haegerich, & Chou, 2016), it is imperative that the general public, particularly youth, are informed about the related harms and disorders that can occur when prescription opioids are used without regular medical supervision.…”

Section: Discussionmentioning

confidence: 99%

Prescription opioid use disorder and heroin use among 12-34 year-olds in the United States from 2002 to 2014

Martins

Segura

Santaella-Tenorio

et al. 2017

Addictive Behaviors

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“…New research about different pain phenotypes, e.g., nociplastic pain, is driving a shift in understanding and management of persistent pain 6. Furthermore, increasing opioid misuse and opioid-related deaths around the world are helping to bring these conversations into the light 5,7,8…”

Section: Introductionmentioning

confidence: 99%

<p>Counseling interactions between patients living with persistent pain and pharmacists in Australia: are we on the same page?</p>

Lau¹,

Hui²,

Antwertinger³

et al. 2019

JPR

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Background People living with persistent pain in Australia often cannot access adequate care to manage their pain. Therefore, as the most accessible healthcare professionals, community pharmacists have an important role to play in helping to improve patient outcomes. Hence, it is important to investigate patient needs and expectations in terms of counseling interactions with pharmacists, along with pharmacists’ approach to counseling interactions with these patients. Method The nature of patient–pharmacist counseling interactions was explored with seven patients (one focus group), and 10 practicing pharmacists (two focus groups, three semi-structured interviews). The themes identified informed the development of an online survey that was advertised online to patients and pharmacists across Australia. Results A total of 95 patients and 208 pharmacists completed the survey. Overall, more than half of patients (77/95) were satisfied with the care provided by their pharmacist, but only a third (71/205) of pharmacists were satisfied with the care they provided to patients. The majority of patients (67/94) reported that pharmacists provided good information about medications. This aligned with pharmacists’ responses, as most reported focusing on medication side effects (118/188) and instructions for taking pain medication (93/183) during patient interactions. However, when asked about empathy and rapport from pharmacists, only half to two-thirds (48–61/95) of patients expressed positive views. Overall, half of the patients (39/75) wanted a caring, empathetic, respectful, and private conversation with the pharmacist, and nearly half (40/89) perceived the pharmacist's role as providing (new) information on alternative pharmacological and non-pharmacological therapies, including general advice on pain management. Conclusion There was a disparity in the nature of the interaction and information that patients wanted from pharmacists, compared to what was provided by pharmacists. Training and education may help pharmacists to better engage in patient-centered care when interacting with people living with persistent pain, thereby improving health outcomes for these patients.

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Diversion of prescribed opioids by people living with chronic pain: Results from an Australian community sample

Cited by 14 publications

References 19 publications

GHB Pharmacology and Toxicology: Acute Intoxication, Concentrations in Blood and Urine in Forensic Cases and Treatment of the Withdrawal Syndrome

GHB Pharmacology and Toxicology: Acute Intoxication, Concentrations in Blood and Urine in Forensic Cases and Treatment of the Withdrawal Syndrome

Prescription opioid use disorder and heroin use among 12-34 year-olds in the United States from 2002 to 2014

<p>Counseling interactions between patients living with persistent pain and pharmacists in Australia: are we on the same page?</p>

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