Objective: To evaluate the impact of a standardized pain management protocol on prescribing practices for opioids, nonopioid therapies, and disease-modifying agents among adult patients with sickle cell disease (SCD) in an outpatient setting. Design: A retrospective analysis comparing prescribing patterns before and after the implementation of a standardized pain management protocol.Setting: An adult sickle cell clinic at an academic medical center.Patients/participants: A total of 165 adult patients diagnosed with SCD receiving outpatient care.Interventions: Implementation of a multidisciplinary team-developed standardized pain management protocol for assessing and managing pain and psychological distress in patients with SCD.Main outcome measure(s): Changes in opioid prescribing patterns (including median morphine equivalent daily dose [MEDD]), prescribing of nonopioid therapies, eg, antidepressants, anticonvulsants, nonsteroidal anti-inflammatory drug (NSAIDs), prescribing of disease-modifying agents (hydroxyurea), and pain scores.Results: Following protocol implementation, the proportion of patients prescribed opioids decreased to 91.5 percent (p = 0.03). Although no significant change occurred in median MEDD, prescribing of nonopioid therapies significantly increased, including hydroxyurea (57.5 percent vs 21.2 percent, p < 0.01), antidepressants, anticonvulsants, and NSAIDs. Pain scores decreased slightly but not significantly.Conclusions: The standardized outpatient pain management protocol has the potential to reduce opioid usage and increase the adoption of evidence-based nonopioid therapies in patients with SCD. Further validation in diverse clinical settings is warranted to assess the protocol’s long-term effectiveness and outcomes.
Cannabis sativa is commonly known as cannabis or marijuana. It is a psychoactive drug. It has been in use for thousands of years for its medicinal and recreational properties. This article explores the regulatory frameworks governing cannabis and similar drugs in the United States (US), India, and Australia, highlighting key differences, exclusions, inclusions, and their status. In the US, cannabis is federally illegal under the Controlled Substances Act, but numerous states have legalized its use for medical and recreational purposes, creating a patchwork of laws that vary widely across the country. In India, cannabis remains largely prohibited under the Narcotic Drugs and Psychotropic Substances Act, 1985, though certain traditional uses, such as bhang, are permitted, and there are emerging efforts to explore its medicinal potential. Australia has legalized medical cannabis at the federal level, while recreational use remains illegal, except for its decriminalization in the Australian Capital Territory. The Preferred Reporting Items for Systematic reviews and Meta-Analyses methodology has been adopted to make the review more efficient. This study identifies key factors influencing regulatory decisions, including public opinion, medical research, and economic considerations. The United Nations Single Convention on Narcotic Drugs (1961) poses a regulatory challenge by requiring member states to prohibit cannabis production, distribution, and use, thereby creating conflicts with national laws that have legalized or decriminalized cannabis, and hindering international cooperation, trade, and research. By addressing these factors, regulators can create effective frameworks that minimize harms and maximize benefits. Understanding these complex regulatory environments is crucial for policymakers, healthcare professionals, and industry members. This research contributes to informed discussions on harm reduction, public health, and human rights, ultimately informing evidence-based policy decisions and future directions.
Objectives: Managing pain in oral and maxillofacial surgery (OMS) poses significant challenges due to the intricate nature of the procedures and extensive tissue manipulation. While opioids are often utilized for their strong analgesic effects, they carry serious risks, including a high potential for addiction and overdose-related fatalities. This paper aims to conduct a comprehensive literature review to explore effective, opioid-sparing pain management strategies in OMS, with a specific focus on evidence-based techniques that reduce reliance on opioids.Methods: A comprehensive literature review was conducted using PubMed, Web of Science, and Google Scholar databases, primarily focusing on the last 5 years (2019-2024) to ensure updated information, though seminal older works were also considered. The inclusion criteria focused on studies reporting alternatives to opioids for pain and discomfort control after OMS. Narrative reviews, editorials, and articles without a digital object identifier were excluded. Relevant data from the selected articles were extracted and analyzed.Results: A total of 4,306 articles were assessed, with 102 included in the review. The procedures reviewed included orthognathic surgery, maxillofacial trauma, reconstruction, dento-alveolar surgery, temporomandibular joint procedures, cleft palate surgery, and severe odontogenic infections. Thematic analysis revealed that the central question was answered affirmatively: Nonopioid strategies are effective in reducing opioid consumption. These strategies were found to maintain postoperative pain control while minimizing complications like post-operative nausea and vomiting. This review synthesizes the evidence to provide a clear hierarchy of recommended interventions.Conclusion: This review consolidates evidence indicating that a combination of stringent prescribing practices, multimodal analgesia, and regional anesthetic techniques can significantly reduce opioid dependence. To prevent opioid overprescription, it is essential to enforce strict regulatory measures, closely monitor prescriptions, establish regional guidelines, and avoid just-in-case prescribing. Effective strategies for improving post-operative outcomes and reducing opioid dependence include multimodal and pre-emptive analgesia, as well as post-operative anesthetic blocks. The findings provide a consolidated evidence base to guide maxillofacial surgeons in implementing these strategies, directly addressing the opioid crisis within the specialty.
Objective: A week-long themed interclerkship curricular experience was designed to reframe THE Opioid Epidemic as “OUR Opioid Epidemic,” humanize and normalize opioid use disorder and pain, and motivate a shift in attitudes, knowledge, comfort, and perceived skills.Design: This was a prospective cohort study with pre- and post-curriculum surveys.Setting: The curriculum was delivered at a medical school associated with a large health system over 6 academic years.Participants: Third-year medical students who previously received “Evidence-Based Screening Tools” and “Drug Use and the Brief Negotiated Interview” sessions of the longitudinal, spiraling “Addressing Substance Use” curriculum. Interventions: Over 55 faculty/facilitators spanning 40 clinical/nonclinical departments developed and delivered the “OUR Opioid Epidemic” themed interclerkship experience. Annual iterations responded to learner and faculty feedback, the ever-changing landscape of substance use, and the evolution of pain care strategies. Learners participated in first-person perspective panels, large group sessions, workshops, and a culminating capstone experience.Main outcome measure(s): Pre- and post-session surveys assessed changes in knowledge, attitudes, comfort, and perceived skills. Results: The curriculum was highly rated by students and positively shifted attitudes, knowledge, comfort, and perceived skills around opioid use, pain care, and substance use disorder.Conclusions: The landscape of substance use and pain is complex and changing. Medical school curricula must thus evolve. Experiential workshops, perspectives of individuals with lived experience, student-developed elements, and a capstone session prepared students to thoughtfully address pain care and substance use. The week served to empower learners to model-up as they continue their professional formation in clinical settings.
Objective: The number of overdose deaths rose by 60 percent between 2019 and 2021. Medications for opioid use disorder (MOUD) have been associated with reduced overdoses and opioid-related hospitalizations. Hospital addiction medicine consult services (AMCSs) have been shown to reduce all-cause 90-day mortality post-discharge. This study aimed to expand on the impact of AMCS on the initiation of MOUD in inpatients.Design, setting, patients/participants, interventions, main outcome measure: This study is a retrospective, single site, multicenter, cohort study conducted at two sites. Utilizing International Classification of Diseases, Tenth Revision codes related to opioid use disorder (OUD), inpatients older than 18 years who were not already on MOUD were assessed at two separate hospitals during two time periods each. Site 1 initiated an AMCS in 2021, while site 2 had no AMCS. Data for each site for each period were assessed at baseline and post-ACMS initiation, and we compared the change in MOUD initiation rates between these periods at site 1 and site 2.Results: A total of 504 patients were assessed. The rate of MOUD initiation at site 1 was 8 percent (10/126) for the baseline and 21 percent (26/126) for the post-period (difference in proportions = 0.13; 95 percent confidence interval [CI] 0.04-0.21; p = 0.004). The rate of MOUD initiation at site 2 was 5 percent (6/126) for the preperiod and 6 percent (8/126) for the post-period (difference in proportions = 0.016; 95 percent CI –0.04-0.075; p = 0.582).Conclusions: Availability of a hospital AMCS was associated with increased rates of MOUD initiation in inpatients with a history of OUD not on MOUD.
