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1.
J Hosp Palliat Nurs ; 24(2): 112-118, 2022 04 01.
Article in English | MEDLINE | ID: covidwho-1642434

ABSTRACT

Patients with cancer are living longer, and many experience pain secondary to tumor invasion or as a consequence of cancer-directed therapies. Opioid use disorders and associated morbidity and mortality have increased with dramatic rise during the SARS-CoV-2 pandemic. National and international stakeholders have developed clinical practice guidelines in an effort to curb opioid misuse and overdose-related death. However, to ensure that patients with cancer do not experience barriers to adequate pain management, most of these guidelines are not intended for patients with cancer-related pain or for those receiving palliative or hospice care. Oncology, palliative, and hospice care providers are increasingly tasked with the management of severe disease-related pain in the setting of coexisting opioid use disorder without research on the most effective risk and harm reduction strategies to guide care. Clinicians should be familiar with addiction medicine and chronic pain literature and be able to incorporate some of these best practices. This case study reviews the management of severe cancer-related pain in a patient with co-occurring opioid use disorder, utilizing many of the best practices in available clinical practice guidelines for the management of chronic non-cancer-related pain.


Subject(s)
COVID-19 , Cancer Pain , Chronic Pain , Neoplasms , Opioid-Related Disorders , Analgesics, Opioid/therapeutic use , COVID-19/complications , Cancer Pain/drug therapy , Chronic Pain/complications , Chronic Pain/drug therapy , Humans , Neoplasms/complications , Opioid-Related Disorders/complications , Opioid-Related Disorders/drug therapy , SARS-CoV-2
2.
Semin Nephrol ; 41(1): 11-18, 2021 01.
Article in English | MEDLINE | ID: covidwho-1201952

ABSTRACT

Opioid use and misuse in the United States has been at epidemic proportions and is predicted to increase further in the setting of the Coronavirus disease 19 pandemic. Acute kidney injury is a condition associated with significant morbidity and increased mortality. We review the literature on the effect of opioids on kidney function and critically examine the association between opioid use and acute kidney injury and identify at-risk populations in whom opioids should be used with caution. We also discuss the role of biomarkers in elucidating this condition and propose preventive measures, novel therapeutic options, and research directions.


Subject(s)
Acute Kidney Injury/chemically induced , Analgesics, Opioid/adverse effects , COVID-19/epidemiology , Opioid-Related Disorders/complications , Pandemics , Acute Kidney Injury/epidemiology , Global Health , Humans , Incidence , Opioid-Related Disorders/epidemiology , SARS-CoV-2
3.
Basic Clin Pharmacol Toxicol ; 128(5): 635-641, 2021 May.
Article in English | MEDLINE | ID: covidwho-1132864

ABSTRACT

Opioids cover a broad class of natural, synthetic and semi-synthetic drugs that act on opioid receptors to produce powerful analgesic effects. Rates of opioid use and opioid agonist maintenance treatment have increased substantially in recent years, particularly among women. Trends and outcomes of opioids use on fertility, pregnancy and breastfeeding, and longer-term child developmental outcomes have not been well-described. Here, we review the existing literature on the health effects of opioid use on female fertility, pregnancy, breastmilk and the exposed infant. We find that the current literature is primarily concentrated on the impact of opioid use in pregnancy and neonatal outcomes, with little exploration of effects on fertility. Studies are limited in number, some with small sample sizes, and many are hampered by methodological challenges related to confounding and other potential biases. Opioid use is becoming more prevalent due to environmental pressures such as COVID-19. More research is needed to better elucidate its effects on reproductive health among younger women and support the development of evidence-based recommendations for safe prescription practices and public health messaging.


Subject(s)
Breast Feeding , Fertility/drug effects , Opioid-Related Disorders , Practice Patterns, Physicians' , Pregnancy Complications , COVID-19/epidemiology , Female , Humans , Infant, Newborn , Opioid-Related Disorders/complications , Opioid-Related Disorders/epidemiology , Opioid-Related Disorders/prevention & control , Practice Patterns, Physicians'/standards , Practice Patterns, Physicians'/trends , Pregnancy , Pregnancy Complications/epidemiology , Pregnancy Complications/prevention & control , Prevalence , SARS-CoV-2
4.
J Opioid Manag ; 16(6): 401-404, 2020.
Article in English | MEDLINE | ID: covidwho-1022155

ABSTRACT

Based on evidence of the immunosuppressive effects of chronic opioids, long-term users of prescription and illicit opioids comprise an unrecognized but growing population of Americans with compromised immune function and respiratory depression who may be at high risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease 19 (COVID-19)-related hospitalization, prolonged ICU stay, adverse events, and death. This perspective is of broad clinical and public health importance because the US has the highest population of long-term users of prescription opioids, a sequel of a decade-long practice of opioid overprescribing in the US. For long-term opioid users who are hospitalized for COVID-19, clinicians face clinical challenges arising from the suppressive effects of opioids on the respiratory and immune functions, as well as the potential for adverse drug-drug interaction when opioids have to be continued in long-term users. More research is needed to further understand the association of long-term opioid use and susceptibility to COVID-19 and other emerging infections.


Subject(s)
Analgesics, Opioid/adverse effects , COVID-19/complications , Opioid-Related Disorders/complications , Humans , Immunocompromised Host , Respiratory Insufficiency , United States/epidemiology
5.
Clin Pharmacol Ther ; 109(3): 578-590, 2021 03.
Article in English | MEDLINE | ID: covidwho-896660

ABSTRACT

The only medication available currently to prevent and treat opioid overdose (naloxone) was approved by the US Food and Drug Administration (FDA) nearly 50 years ago. Because of its pharmacokinetic and pharmacodynamic properties, naloxone has limited utility under some conditions and would not be effective to counteract mass casualties involving large-scale deployment of weaponized synthetic opioids. To address shortcomings of current medical countermeasures for opioid toxicity, a trans-agency scientific meeting was convened by the US National Institute of Allergy and Infectious Diseases/National Institutes of Health (NIAID/NIH) on August 6 and 7, 2019, to explore emerging alternative approaches for treating opioid overdose in the event of weaponization of synthetic opioids. The meeting was initiated by the Chemical Countermeasures Research Program (CCRP), was organized by NIAID, and was a collaboration with the National Institute on Drug Abuse/NIH (NIDA/NIH), the FDA, the Defense Threat Reduction Agency (DTRA), and the Biomedical Advanced Research and Development Authority (BARDA). This paper provides an overview of several presentations at that meeting that discussed emerging new approaches for treating opioid overdose, including the following: (1) intranasal nalmefene, a competitive, reversible opioid receptor antagonist with a longer duration of action than naloxone; (2) methocinnamox, a novel opioid receptor antagonist; (3) covalent naloxone nanoparticles; (4) serotonin (5-HT)1A receptor agonists; (5) fentanyl-binding cyclodextrin scaffolds; (6) detoxifying biomimetic "nanosponge" decoy receptors; and (7) antibody-based strategies. These approaches could also be applied to treat opioid use disorder.


Subject(s)
Analgesics, Opioid/adverse effects , Drug Overdose/therapy , Medical Countermeasures , Naloxone/therapeutic use , Narcotic Antagonists/therapeutic use , Opioid Epidemic , Opioid-Related Disorders/therapy , Animals , Congresses as Topic , Drug Overdose/etiology , Drug Overdose/mortality , Humans , Naloxone/adverse effects , Narcotic Antagonists/adverse effects , Opioid Epidemic/mortality , Opioid-Related Disorders/complications , Opioid-Related Disorders/mortality , Prognosis , Risk Assessment , Risk Factors
7.
Subst Use Misuse ; 55(11): 1900-1901, 2020.
Article in English | MEDLINE | ID: covidwho-643514

ABSTRACT

BACKGROUND: Alarms have been raised that COVID-19 may disproportionately affect certain populations with substance use disorders, particularly Opioid Use Disorder (OUD), however warnings have largely focused on social risks such as reduced availability of services. Objectives: This commentary highlights three plausible biological mechanisms for potentially worsened outcomes in patients with OUD who contract COVID-19. Results: Opioid-related respiratory depression may amplify risks of hypoxemia from COVID-19 viral pneumonia. Complex opioid immune modulation may impact host response to COVID-19, though the effect direction and clinical significance are unclear. Drug-drug interactions may affect individuals with OUD who are co-administered medications for OUD and medications for COVID-19, particularly due to cardiac adverse effects. Conclusions/Importance: There are plausible biological mechanisms for potentially worsened outcomes in patients with OUD who contract COVID-19; these mechanisms require further study, and should be considered in individuals with OUD.


Subject(s)
Analgesics, Opioid/adverse effects , Arrhythmias, Cardiac/chemically induced , Coronavirus Infections/complications , Immunocompromised Host/immunology , Opioid-Related Disorders/complications , Pneumonia, Viral/complications , Respiratory Insufficiency/chemically induced , Adaptive Immunity/immunology , Analgesics, Opioid/therapeutic use , Betacoronavirus , COVID-19 , Coronavirus Infections/drug therapy , Coronavirus Infections/immunology , Coronavirus Infections/physiopathology , Drug Interactions , Humans , Immunity, Innate/immunology , Methadone/adverse effects , Opioid-Related Disorders/drug therapy , Opioid-Related Disorders/immunology , Pandemics , Pneumonia, Viral/drug therapy , Pneumonia, Viral/immunology , Pneumonia, Viral/physiopathology , Prognosis , Respiratory Insufficiency/physiopathology , SARS-CoV-2
12.
Subst Abus ; 41(2): 147-149, 2020.
Article in English | MEDLINE | ID: covidwho-104139

ABSTRACT

We highlight the critical roles that pharmacists have related to sustaining and advancing the changes being made in the face of the current COVID-19 pandemic to ensure that patients have more seamless and less complex access to treatment. Discussed herein is how the current COVID-19 pandemic is impacting persons with substance use disorders, barriers that persist, and the opportunities that arise as regulations around treatments for this population are eased.


Subject(s)
Continuity of Patient Care , Coronavirus Infections/complications , Opioid-Related Disorders/complications , Opioid-Related Disorders/therapy , Opioid-Related Disorders/virology , Pneumonia, Viral/complications , Betacoronavirus , Buprenorphine/therapeutic use , COVID-19 , Continuity of Patient Care/legislation & jurisprudence , Humans , Methadone/therapeutic use , Pandemics , Pharmacists , SARS-CoV-2 , United States
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