A claims analysis of the utilization of tramadol for acute pain in patients prescribed buprenorphine/naloxone for opioid use disorder.

OBJECTIVE: To determine the prevalence of tramadol prescribing among commercially insured adults receiving medication-assisted therapy (MAT) with buprenorphine/naloxone. DESIGN: The authors conducted a cross-sectional descriptive study to evaluate the use of tramadol among patients prescribed buprenorphine/suboxone for MAT. SETTING: This study utilized data from 2010 to 2013 Optum® Clinformatics® Data Mart. This cohort is an administrative health claims database from a large national insurer. These data included pharmacy and medical care utilization and information describing patient enrollment. PATIENTS/PARTICIPANTS: Patients were 12-64 years of age and had complete and available medical, pharmacy, and administrative records in the Optum Clinformatics Data Mart during the study period. MAIN OUTCOME MEASURES: Patients who received at least one paid claim for buprenorphine/naloxone from 2010 to 2013 and also received at least one overlapping pharmacy dispensing for tramadol were identified for analysis. The authors determined if the concurrent buprenorphine/naloxone and tramadol dispensings were from the same or a different prescriber. RESULTS: In this analysis of 18,734 US commercially insured patients receiving MAT with buprenorphine/naloxone, the authors identified 1,198 (6.4 percent) patients who received at least one overlapping dispensing for tramadol during a 4-year period spanning 2010-2013. Among these patients, 266 (1.42 percent) were co-prescribed buprenorphine/naloxone and tramadol from the same provider. CONCLUSIONS: These results suggest that the use of tramadol among patients receiving buprenorphine/naloxone is not uncommon. Further study is warranted to further determine the benefits and risks associated with the use of tramadol for pain management among patients prescribed buprenorphine/naloxone.

Gram-positive marine bacteria as a potential resource for the discovery of quorum sensing inhibitors.

Inhibitors of bacterial quorum sensing have been proposed as potentially novel therapeutics for the treatment of certain bacterial diseases. We recently reported a marine Halobacillus salinus isolate that secretes secondary metabolites capable of quenching quorum sensing phenotypes in several Gram-negative reporter strains. To investigate how widespread the production of such compounds may be in the marine bacterial environment, 332 Gram-positive isolates from diverse habitats were tested for their ability to interfere with Vibrio harveyi bioluminescence, a cell signaling-regulated phenotype. Rapid assay methods were employed where environmental isolates were propagated alongside the reporter strain. "Actives" were defined as bacteria that interfered with bioluminescence without visible cell-killing effects (antibiotic activity). A total of 49 bacterial isolates interfered with bioluminescence production in the assays. Metabolite extracts were generated from cultures of the active isolates, and 28 reproduced the bioluminescence inhibition against V. harveyi. Of those 28, five extracts additionally inhibited violacein production by Chromobacterium violaceum. Chemical investigations revealed that phenethylamides and a cyclic dipeptide are two types of secondary metabolites responsible for the observed activities. The active bacterial isolates belonged primarily to either the genus Bacillus or Halobacillus. The results suggest that Gram-positive marine bacteria are worthy of further investigation for the discovery of quorum sensing antagonists.