naloxone HCl (REZENOPY)

Framework for the Opioid Use Disorder Cascade of Care: Adaptation and Application for a Large Municipal Health System.

Kalmin Mariah M MM, Crowley Christina C, Pak Lia L, McCullough Colleen M CM et al.

Most people with opioid use disorder (OUD) do not receive effective treatments despite their existence. The OUD cascade of care framework can be used to inform quality improvement efforts to address this gap, but data access and linkage requirements may limit its use. We sought to adapt the framework under the constraints of electronic health record data and identify patient populations at risk for OUD treatment discontinuity. We extracted data on patients with OUD from the Los Angeles County Department of Health Services from July 2022 through June 2023. We adapted the cascade of care to include probable OUD diagnosis, receipt of naloxone prescription, and receipt of ≥1 and ≥2 buprenorphine prescriptions. We then stratified and conducted statistical analyses for associations by sex, race and ethnicity, and facility type (inpatient, primary care, emergency, or urgent care). Of 3881 patients identified with probable OUD, 49% received a naloxone prescription and 30% and 17% had ≥1 and ≥2 buprenorphine prescriptions, respectively, in 1 year. Non-Hispanic Black and Hispanic patients were less likely to receive buprenorphine prescriptions than were non-Hispanic White patients and patients of other or unknown race and ethnicity. We observed larger gaps in care between receipt of ≥1 and ≥2 buprenorphine prescriptions for patients using urgent care and emergency departments compared with patients in other settings. This study illustrates substantial gaps between OUD diagnosis and treatment. This adapted framework for the OUD cascade of care can serve as a quality-monitoring tool to aid clinicians and health care administrators in narrowing the treatment gap for people with OUD.

7-Hydroxymitragynine Withdrawal Treated With Buprenorphine-Naloxone.

Held Jacob T JT, Varicat Francisco P FP

A retrospective cohort study of a novel short-acting opioid protocol for opioid withdrawal.

Sauers Elizabeth G EG, Rafeq Rachel R, Salzman Matthew M, Fett David D

Hospitalized patients with opioid use disorder commonly experience undertreated withdrawal, leading to increases in patient-directed discharge and readmission. Short-acting opioids can mitigate withdrawal in patients who are unwilling to trial buprenorphine or methadone, or need additional symptom control during up-titration. This study assessed the safety and efficacy of a short-acting opioid protocol for opioid withdrawal. A retrospective cohort study was conducted on hospitalized patients with opioid use disorder who received a short-acting opioid protocol for withdrawal with intravenous hydromorphone or oral oxycodone. The primary endpoint was the incidence of severe withdrawal. Secondary endpoints included naloxone use, patient-directed discharge, and length of stay. A paired cohort was analyzed where patients' hospital outcomes were compared pre- versus post-protocol. Naloxone use after protocol initiation was 0% and severe withdrawal occurred in one patient (1%). The patient-directed discharge and 30-day readmission rates were 38% and 30%, respectively. Fifty-one percent of patients had a prior hospitalization within two years without use of the short-acting opioid protocol and were included in the paired cohort analysis. The pre- versus post-protocol patient-directed discharge rate was 47% vs. 43% (p = 0.774) and length of stay was 3 vs. 5 days (p = 0.180). Our findings provide preliminary evidence for the safety of a short-acting opioid protocol for opioid withdrawal. There was no significant difference in patient-directed discharge rate or length of stay in the paired cohort of patients' encounters with or without short-acting opioid protocol use. Larger studies are necessary to draw conclusions regarding safety and efficacy.

Subcutaneous Neuromodulation Activates Central Pain-Suppression Pathways for Analgesia.

Li Qiuyong Q, Qin Chuan C, Wang Can C, Lu Jiaqi J et al.

Peripheral neuromodulation, which can be considered a flow of signals from the body to the brain, induces pain relief. However, whether subcutaneous neuromodulation, which regulates specific neural circuits for analgesia, remains largely elusive. This study aimed to evaluate the analgesic effects of subcutaneous mechanical stimulation (SMS) on neuropathic pain. A stainless-steel needle (0.5 cm long) was inserted into the subcutaneous tissue. Mechanical allodynia, thermal hyperalgesia, and conditioned place preference (CPP) were assessed in rodent models of localized inflammation of the dorsal root ganglia (LID) and spared nerve injury (SNI). Optogenetic and chemogenetic tools were employed in conjunction with electrophysiological recordings, molecular analyses, and pharmacological interventions to elucidate the underlying mechanisms of SMS-induced analgesia. Subcutaneous needle insertion generated mechanical force, activating Piezo channels. SMS attenuated mechanical allodynia and thermal hyperalgesia and induced CPP in the LID and SNI models. Naloxone pretreatment did not significantly affect SMS-induced analgesia. SMS activated GABAergic neurons in the NAc shell, and their inhibition reversed the SMS effects in LID rats. Furthermore, activation of the IL-to-nucleus accumbens (NAc) shell projections was essential for SMS-induced analgesia and CPP. These findings indicate that SMS activates central pain-suppression pathways, providing a potential framework for clinical pain management.