Patient perspectives of transitioning from prescription opioids to heroin and the role of route of administration

Monico, Laura B.; Mitchell, Shannon Gwin

doi:10.1016/j.drugalcdep.2016.08.407

Cited by 6 publications

(7 citation statements)

References 3 publications

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“…In this situation, it is possible that a loss of opioid tolerance could lead to an overdose event following opioid resumption 15 . Alternatively, the finding could reflect transitions from prescribed to non‐prescribed opioids, a phenomenon that has been described in the literature as prescription opioid supplies have been restricted 20,21 . More research is needed to further explore these phenomena at the population level.…”

Section: Discussionmentioning

confidence: 99%

Initial opioid prescription patterns and the risk of ongoing use and adverse outcomes

Gomes

Campbell

Tadrous

et al. 2020

Pharmacoepidemiology and Drug

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Purpose As clinical practice moves towards more judicious opioid prescribing, physicians require information on how to safely initiate opioids. The objective of this study was to examine the association between initial opioid prescription characteristics and risks of harm and long‐term use. Methods We conducted a population‐based retrospective cohort study among Ontario residents newly dispensed an opioid for pain between July 2013 and March 2016. The primary exposure was the average daily opioid dose dispensed at initiation (in milligram morphine equivalents; MME), with secondary exposures including the initial prescription's duration and formulation. The primary outcome was fatal or non‐fatal opioid overdose. A secondary analysis studied continued opioid use for at least 1 year. Results Among the 2 021 371 individuals meeting our inclusion criteria, 1121 (0.56 per 1000 person‐years) experienced an opioid overdose within 1 year and 64 013 (3.17%) continued treatment for at least 1 year. Higher initial daily dose, longer prescription duration, and receipt of a long‐acting formulation at initiation were significantly associated with higher hazard of overdose. Compared to daily doses of 20 MME or lower, initial doses exceeding 200 MME daily were associated with a particularly high hazard of overdose (aHR 2.97, 95% confidence interval [CI] 1.62 to 5.44). In the secondary analysis, there were similar associations between initial dose, duration, and formulation and long‐term use. Conclusions Although the absolute risk of an opioid overdose within the first year of prescription opioid use is low, better alignment of opioid initiation practices with guidelines may reduce opioid‐related harm.

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Section: Discussionmentioning

confidence: 99%

Initial opioid prescription patterns and the risk of ongoing use and adverse outcomes

Gomes

Campbell

Tadrous

et al. 2020

Pharmacoepidemiology and Drug

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“…First, vaccine effectiveness should be evaluated under experimental conditions where opioids and other target drugs of abuse are administered intravenously. Although initial prescription opioid misuse often starts via the oral route by consuming tablets, opioid use has been shown to transition to injection routes for both continued prescription opioids [78] and heroin [79]. In addition, emerging evidence suggests that vaccine effectiveness may depend on the route of administration, such that opioid vaccines are less effective against intravenously administered opioid agonists [80][81][82].…”

Section: Discussionmentioning

confidence: 99%

Preclinical Evaluation of Vaccines to Treat Opioid Use Disorders: How Close are We to a Clinically Viable Therapeutic?

Townsend¹,

Banks²

2020

CNS Drugs

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The ongoing opioid crisis, now into its second decade, represents a global public health challenge. Moreover, the opioid crisis has manifested despite clinical access to three approved opioid use disorder medications: the full opioid agonist methadone, the partial opioid agonist buprenorphine, and the opioid antagonist naltrexone. Although current opioid use disorder medications are underutilized, the ongoing opioid crisis has also identified the need for basic research to develop both safer and more effective opioid use disorder medications. Emerging preclinical evidence suggests that opioid-targeted vaccines or immunopharmacotherapies may be promising opioid use disorder therapeutics. One premise for this article is to critically examine whether vaccine effectiveness evaluated using preclinical antinociceptive endpoints is predictive of vaccine effectiveness on abuse-related endpoints such as drug self-administration, drug discrimination, and conditioned place preference. A second premise is to apply decades of knowledge in the preclinical evaluation of candidate small-molecule therapeutics for opioid use disorder to the preclinical evaluation of candidate opioid use disorder immunopharmacotherapies. We conclude with preclinical experimental design attributes to enhance preclinical-to-clinical translatability and potential future directions for immunopharmacotherapies to address the dynamic illicit opioid environment. Key Points Vaccine effectiveness should be assessed in terms of opioid agonist potency shifts. Vaccine effectiveness on a preclinical endpoint should be directly compared to effectiveness with naltrexone or buprenorphine treatment. Vaccine effectiveness should be evaluated on preclinical endpoints that are analogous to clinical opioid use disorder endpoints to enhance translational concordance.

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“…Among other adverse health risks and outcomes, rising incidences of infectious disease (e.g., Hepatitis C Virus) transmissions have been observed in some settings, especially among younger injection opioid users with a history of non-medical PO use [57][58][59][60]. While contracting supplies and the need for more 'cost-effective' administration routes more commonly led to opioid use by injection, however, the socio-behavioral profiles of many non-medical opioid users in North America (e.g., involving many non-marginalized users with principally PO-based trajectories) have been such that typical routes of heroin usage (e.g., injection or smoking) presumably were not universally realistic or desirable options [61][62][63][64][65]. Time-trend data for opioid-related mortality in U.S. (Fig.…”

Section: Main Textmentioning

confidence: 99%

The opioid mortality epidemic in North America: do we understand the supply side dynamics of this unprecedented crisis?

Fischer

Pang

Jones

2020

Subst Abuse Treat Prev Policy

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While there has been extensive attention to the 'demand side'or use and adverse consequences, including mortalityof the 'opioid crisis' presently unfolding across North America, few considerations have focused on the supply side. This paper examines the supply side dynamics of this unprecedented public health phenomenon. We provide evidence for several interrelated supply-side elements that have contributed to the present public health crisis. We observe that initially, persistently high levels of prescription opioid availability and use exposed large proportions of the North American population to opioids, resulting in correspondingly high levels of medical and non-medical use (e.g., involving diversion). While various intervention measures to control prescription opioid availability and use have been implemented in recent years, leading to eventual reductions in opioid dispensing levels, these occurred late in the crisis's evolution. Moreover, these supply reductions have not been met by corresponding reductions in opioid use or demand levels. These growing discrepancies between opioid demand and prescription-based sources have left major gaps in opioid supplies. In response to such supply gaps, highly potent and toxic illicit opioid products have rapidly proliferated across North America, and become a core driver of the dramatic spikes in opioid overdose fatality levels in recent years. These supply-related interrelations are corroborated by a corresponding increase in illicit opioid-related fatalities, which arose just as medical opioid supplies began to decrease in many jurisdictions. Improved analyses and understanding of the supplyside dynamics of the opioid crisis are urgently needed in order to inform future intervention and policy development. Meanwhile, the high mortality toll related to illicit, highly toxic opioid exposure requires sustained solutions, including supply-oriented measures (e.g., safer opioid distribution for at-risk users) towards improved public health protection.

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Patient perspectives of transitioning from prescription opioids to heroin and the role of route of administration

Cited by 6 publications

References 3 publications

Initial opioid prescription patterns and the risk of ongoing use and adverse outcomes

Initial opioid prescription patterns and the risk of ongoing use and adverse outcomes

Preclinical Evaluation of Vaccines to Treat Opioid Use Disorders: How Close are We to a Clinically Viable Therapeutic?

The opioid mortality epidemic in North America: do we understand the supply side dynamics of this unprecedented crisis?

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