The double opioid crisis: A call for balance

Vranken, Marjolein J. M.; Schutjens, M H; Mantel‐Teeuwisse, Aukje K.

doi:10.1002/pds.4720

Cited by 5 publications

(4 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 34 Nonetheless, growing calls for greater balance when treating chronic pain have been made, with many highlighting the increasing challenges of unmet pain needs. 35 , 36 For example, Vranken et al 36 highlighted the growing crisis of uncontrolled and undertreated chronic pain due to a growing fear and hesitancy to prescribe opioids. A reluctance to prescribe medically needed opiates, along with a lack of confidence in pain management, has been previously documented and may contribute to poor pain management in this population.…”

Section: Discussionmentioning

confidence: 99%

Chronic scrotal content pain: the experiences of patients undergoing microsurgical spermatic cord denervation

Banner,

Cassidy,

Appleby

et al. 2023

Therapeutic Advances in Urology

View full text Add to dashboard Cite

Background: Chronic scrotal content pain, sometimes referred to as chronic orchialgia, is a common urological condition that gives rise to persistent and often severe painful stimuli to the scrotum and surrounding structures. Despite its relative commonality, accounting for over 2% of urological visits, chronic scrotal content pain is complex to manage and patients may be required to access multiple providers and undergo invasive procedures, including microsurgical spermatic cord denervation (MSCD) surgery. Objective: The objective of this study was to understand the experiences and perspectives of persons with chronic scrotal content pain and accessing MSCD surgery. Design: An exploratory qualitative design, guided by interpretive description and integrated knowledge translation, was adopted. Methods: We conducted in-depth qualitative interviews with six patients with chronic scrotal content pain who underwent MSCD surgery in a surgical center in Western Canada. Data were analyzed thematically. Results: Analysis of the study data resulted in three core themes: living with chronic scrotal content pain, quality of life, and MSCD procedure and outcomes. We highlight the debilitating nature of pain and the broad impacts upon health, quality of life, and social functioning. Participants described how MSCD surgery offered an effective solution for persistent and debilitating pain. For the participants, MSCD surgery offered hope and the chance to regain their normality. Conclusion: For those with chronic scrotal content pain, access to a pain specialist, along with the adoption of a biopsychosocial approach to pain and early access to MSCD surgery, may improve patient experiences and outcomes. Considering the high prevalence of urological pain, greater interdisciplinary care is needed in order to support more effective and timely management.

show abstract

Section: Discussionmentioning

confidence: 99%

Chronic scrotal content pain: the experiences of patients undergoing microsurgical spermatic cord denervation

Banner,

Cassidy,

Appleby

et al. 2023

Therapeutic Advances in Urology

View full text Add to dashboard Cite

show abstract

“…Morphine as a palliation medication survived the 'opiaphobia' and 'morphinophobia' which continued to circulate in pain specialist quarters in America and Europe [68][69][70][71]. Most specialists in the 1970s advocated for multidisciplinary pain treatment programs involving physical therapy, psychotherapy and additional pharmacological therapy in the form of the new generation of nonnarcotic analgesics (e.g., non-steroidal anti-inflammatory drugs, NSAIDS such as ibuprofen) and psychotropic drugs.…”

Section: Unforeseen Consequences Of a New Dosage Form: Slow Releasementioning

confidence: 99%

The Imperative of Regulation: The Co-Creation of a Medical and Non-Medical US Opioid Crisis

Pieters

2023

Psychoactives

View full text Add to dashboard Cite

The ravaging COVID-19 pandemic has almost pushed into oblivion the fact that the United States is still struggling with an immense addiction crisis. Drug overdose deaths rose from 16,849 in 1999 to nearly 110,000—of which an estimated 75,000 involved opioids—in 2022. On a yearly basis, the opioid casualty rate is higher than the combined number of victims of firearm violence and car accidents. The COVID-19 epidemic might have helped to worsen the addiction crisis by stimulating drug use among adolescents and diverting national attention to yet another public health crisis. In the past decade, the sharpest increase in deaths occurred among those related to fentanyl and fentanyl analogs (illicitly manufactured, synthetic opioids of greater potency). In the first opioid crisis wave (1998–2010), opioid-related deaths were mainly associated with prescription opioids such as Oxycontin (oxycodone hydrochloride). The mass prescription of these narcotic drugs did anything but control the pervasive phenomenon of ‘addiction on prescription’ that played such an important role in the emergence and robustness of the US opioid crisis. Using a long-term drug lifecycle analytic approach, in this article I will show how opioid-producing pharmaceutical companies created a medical market for opioid painkillers. They thus fueled a consumer demand for potent opioid drugs that was eagerly capitalized on by criminal entrepreneurs and their international logistic networks. I will also point out the failure of US authorities to effectively respond to this crisis due to the gap between narcotic product regulation, regulation of marketing practices and the rise of a corporate-dominated health care system. Ironically, this turned the most powerful geopolitical force in the war against drugs into its greatest victim. Due to formulary availability and regulatory barriers to accessibility, European countries have been relatively protected against following suit the US opioid crisis.

show abstract

“…Prevalence estimates of non-cancer pain among LTC residents range from approximately 25–50%, depending on the study population, pain measure, and time period examined [ 8 – 11 ]. For some residents in pain, opioids may be an appropriate alternative when other therapies are contraindicated or ineffective [ 12 – 15 ]. Further, it is well-known that pain is poorly recognized and treated in the LTC setting, despite awareness of the adverse health and quality-of-life consequences of inadequate pain control [ 13 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

Correlates of Opioid Use Among Ontario Long-Term Care Residents and Variation by Pain Frequency and Intensity: A Cross-sectional Analysis

et al. 2022

View full text Add to dashboard Cite

Background Chronic non-cancer pain is common among older residents of long-term care (LTC) homes and often poorly recognized and treated. With heightened concerns regarding opioid prescribing in recent years, it is important to examine the current prevalence of opioid use and its association with resident characteristics to help identify those potentially at risk of medication harms as well as suboptimal pain management. Objectives The aims were to estimate the prevalence and correlates of opioid use among non-palliative LTC residents and explore variation in opioid prevalence and correlates across strata defined by pain frequency and intensity. Methods We conducted a population-based cross-sectional study of all older (aged > 65 years) LTC residents (excluding those with cancer or receiving palliative care) in Ontario, Canada during 2018–2019. Health administrative databases were linked with standardized clinical assessment data to ascertain residents’ health and pain characteristics and their opioid and other medication use. Modified Poisson regression models estimated unadjusted and adjusted associations between residents’ characteristics and opioid use, overall and across strata capturing pain frequency and intensity. Results Among 75,020 eligible residents (mean age 85.1 years; 70% female), the prevalence of opioid use was 18.5% and pain was 29.4%. Opioid use ranged from 12.2% for residents with no current pain to 55.7% for those with severe pain. In adjusted models, residents newly admitted to LTC (adjusted risk ratio [aRR] = 0.60, 95% confidence interval [CI] 0.57–0.62) and with moderate to severe cognitive impairment (aRR = 0.69, 95% CI 0.66–0.72) or dementia (aRR = 0.76, 95% CI 0.74–0.79) were significantly less likely to receive an opioid, whereas residents with select conditions (e.g., arthritis, aRR = 1.37, 95% CI 1.32–1.41) and concurrently using gabapentinoids (aRR = 1.80, 95% CI 1.74–1.86), benzodiazepines (aRR = 1.33, 95% CI 1.28–1.38), or antidepressants (aRR = 1.31, 95% CI 1.27–1.35) were significantly more likely to receive an opioid. The associations observed for residents newly admitted, with dementia, and concurrently using gabapentinoids, benzodiazepines, or antidepressants were largely consistent across all pain strata. Conclusions Our findings describe resident sub-groups at potentially higher risk of adverse health outcomes in relation to both opioid use and non-use. LTC clinical and policy changes informed by research are required to ensure the appropriate recognition and management of non-cancer pain in this setting. Supplementary Information The online version contains supplementary material available at 10.1007/s40266-022-00972-9.

show abstract

The double opioid crisis: A call for balance

Cited by 5 publications

References 12 publications

Chronic scrotal content pain: the experiences of patients undergoing microsurgical spermatic cord denervation

Chronic scrotal content pain: the experiences of patients undergoing microsurgical spermatic cord denervation

The Imperative of Regulation: The Co-Creation of a Medical and Non-Medical US Opioid Crisis

Correlates of Opioid Use Among Ontario Long-Term Care Residents and Variation by Pain Frequency and Intensity: A Cross-sectional Analysis

Contact Info

Product

Resources

About