2018
DOI: 10.1177/1049909118771374
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What Parenteral Opioids to Use in Face of Shortages of Morphine, Hydromorphone, and Fentanyl

Abstract: Parenteral potent opioid availability is becoming an issue in acute pain management. Two opioids, nalbuphine and buprenorphine, are available which can be substituted for hydromorphone, fentanyl, and morphine. There are advantages and disadvantages in using these 2 opioids which are discussed, and potential dosing strategies are outlined.

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Cited by 20 publications
(14 citation statements)
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“…Use in that year was deemed low in 21 countries and very low in more than 100.” Patients in Latin American often have limited access to opioids for pain control (used for both analgesia and anesthesia). Yet even in the U.S.A., there are currently shortages of pharmaceutical medical opioid analgesics needed for acute pain control during medical procedures (Davis et al, 2018). And because of a large increase in opioid related overdose deaths unrelated to burn patients (Chen et al, 2019), there is growing political and legal pressure to further reduce reliance on opioids for pain control in the U.S.A.…”
Section: Introductionmentioning
confidence: 99%
“…Use in that year was deemed low in 21 countries and very low in more than 100.” Patients in Latin American often have limited access to opioids for pain control (used for both analgesia and anesthesia). Yet even in the U.S.A., there are currently shortages of pharmaceutical medical opioid analgesics needed for acute pain control during medical procedures (Davis et al, 2018). And because of a large increase in opioid related overdose deaths unrelated to burn patients (Chen et al, 2019), there is growing political and legal pressure to further reduce reliance on opioids for pain control in the U.S.A.…”
Section: Introductionmentioning
confidence: 99%
“…Interestingly, this reduction in the overall production quotas of opioids is concurrent with the rise in the production of marijuana (14,17). Indeed, another factor contributing to the decline in morphine prescriptions may be the nationwide shortage of parenteral opioids (notably morphine, hydromorphone, and fentanyl) that has resulted in a transition to alternative opioids such as nalbuphine and buprenorphine (18).…”
Section: Discussionmentioning
confidence: 99%
“…5 For those patients with severe pain, the parenteral route has been proven to be a fast, reliable, and safe mode for opioid dose titration. [24][25][26] After the POS, the primary oncology teams prescribed significantly higher MEDDs, which suggests that even higher doses of nonparenteral opioids were not sufficient to treat severe pain. Oral opioid formulations may have highly variable bioavailability in patients with cancer who have persistent nausea and vomiting or those with certain gastrointestinal issues such as bowel obstruction, malabsorption syndrome, or cachexia.…”
Section: Discussionmentioning
confidence: 99%