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  1. Article ; Online: Opioids and Immunosuppression: Clinical Evidence, Mechanisms of Action, and Potential Therapies.

    Bettinger, Jeffrey J / Friedman, Bruce C

    Palliative medicine reports

    2024  Volume 5, Issue 1, Page(s) 70–80

    Abstract: Background: In addition to the more well-known adverse effects of opioids, such as constipation, mounting evidence supports underlying immunosuppressive effects as well.: Methods: In this study, we provide a narrative review of preclinical and ... ...

    Abstract Background: In addition to the more well-known adverse effects of opioids, such as constipation, mounting evidence supports underlying immunosuppressive effects as well.
    Methods: In this study, we provide a narrative review of preclinical and clinical evidence of opioid suppression of the immune system as well as possible considerations for therapies.
    Results: In vitro
    Conclusions: As selective antagonists of peripheral opioid receptors, peripherally acting mu-opioid receptor (MOR) antagonists may be able to protect against immune impairment while still allowing for opioid analgesia. Future research is warranted to further investigate the relationship between opioids and infection risk as well as the potential application of peripherally acting MOR antagonists to counteract these risks.
    Language English
    Publishing date 2024-02-02
    Publishing country United States
    Document type Journal Article
    ISSN 2689-2820
    ISSN (online) 2689-2820
    DOI 10.1089/pmr.2023.0049
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Misinterpretation of the "Overdose Crisis" Continues to Fuel Misunderstanding of the Role of Prescription Opioids.

    Bettinger, Jeffrey J / Amarquaye, William / Fudin, Jeffrey / Schatman, Michael E

    Journal of pain research

    2022  Volume 15, Page(s) 949–958

    Language English
    Publishing date 2022-04-05
    Publishing country New Zealand
    Document type Editorial
    ZDB-ID 2495284-9
    ISSN 1178-7090
    ISSN 1178-7090
    DOI 10.2147/JPR.S367753
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  3. Article ; Online: Opioids and pituitary function: expert opinion.

    Gadelha, Mônica R / Karavitaki, Niki / Fudin, Jeffrey / Bettinger, Jeffrey J / Raff, Hershel / Ben-Shlomo, Anat

    Pituitary

    2022  Volume 25, Issue 1, Page(s) 52–63

    Abstract: Purpose: Opioids are highly addictive potent analgesics and anti-allodynics whose use has dramatically increased in recent decades. The precipitous rise in opioid dependency and opioid use disorder is an important public health challenge given the risks ...

    Abstract Purpose: Opioids are highly addictive potent analgesics and anti-allodynics whose use has dramatically increased in recent decades. The precipitous rise in opioid dependency and opioid use disorder is an important public health challenge given the risks for severely adverse health outcomes. The long-term opioid impact on hypothalamic-pituitary axes is particularly underappreciated among both endocrinologists and primary care physicians. We review the effects of opioids on hypothalamic-pituitary-target gland function and their implications for clinical practice.
    Methods: Experts in hypothalamic-pituitary disorders and opioid pharmacology reviewed recently published literature and considered strategies for diagnosing and managing these opioid-induced endocrine effects.
    Results: Opioid suppression of hypothalamic-pituitary axes can lead to hypogonadotropic hypogonadism, central adrenal insufficiency, and hyperprolactinemia. These important clinical manifestations are often under-estimated, poorly evaluated, and typically either untreated or not optimally managed. Data on biochemical testing for diagnosis and on the effect of hormone replacement in these patients is limited and prospective randomized controlled studies for guiding clinical practice are lacking.
    Conclusions: Patients should be informed about risks for hypogonadism, adrenal insufficiency, and hyperprolactinemia, and encouraged to report associated symptoms. Based on currently available evidence, we recommend clinical and biochemical evaluation for potential central adrenal insufficiency, central hypogonadism, and/or hyperprolactinemia in patients chronically treated with opioids as well as the use of current expert guidelines for the diagnosis and treatment of these conditions.
    MeSH term(s) Analgesics, Opioid/adverse effects ; Expert Testimony ; Humans ; Hyperprolactinemia ; Hypogonadism/chemically induced ; Hypogonadism/diagnosis ; Hypogonadism/drug therapy ; Prospective Studies
    Chemical Substances Analgesics, Opioid
    Language English
    Publishing date 2022-01-23
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1385151-2
    ISSN 1573-7403 ; 1386-341X
    ISSN (online) 1573-7403
    ISSN 1386-341X
    DOI 10.1007/s11102-021-01202-y
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 6139: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular
    ab Jg. 2022: Lesesaal (EG)

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  4. Article ; Online: A Survey on Opioid Tapering Practices, Policies, and Perspectives by Pain and Palliative Care Pharmacists.

    Kral, Lee A / Bettinger, Jeffrey J / Vartan, Christine M / Hadlandsmyth, Katherine / Kullgren, Justin / Smith, Michael A

    Journal of pain & palliative care pharmacotherapy

    2022  Volume 36, Issue 1, Page(s) 2–10

    Abstract: Opioid tapering is an essential clinical tool to utilize for a variety of reasons, including safety and analgesic optimization. The need for individualized regimens reveals a corresponding need for healthcare providers who can actively manage patients ... ...

    Abstract Opioid tapering is an essential clinical tool to utilize for a variety of reasons, including safety and analgesic optimization. The need for individualized regimens reveals a corresponding need for healthcare providers who can actively manage patients throughout the process. Pharmacists have taken on an integral role for achieving success in opioid tapering. This survey was conducted to describe the current opioid tapering practices of pain and palliative care pharmacists. A Qualtrics survey was offered to the Society of Pain and Palliative Care Pharmacist members. The majority (87%) indicated they specialized in pain management. Almost all respondents (98%) reported providing tapering recommendations and 82% reported being involved with patient monitoring throughout the taper. The majority (multiple responses could be chosen) noted that the indication for initiating an opioid taper was due to abuse/misuse (91%), reduced overall efficacy (89%), and adverse drug reactions (78%). The most common follow-up intervals during tapering were weekly (15%), every 2 weeks (22%), and every 4 weeks (44%). This practice-based survey, though small, showed that pharmacists in pain management and palliative care are actively involved in opioid tapering. This survey will hopefully serve as a foundation for continuing research into opioid tapering and the pharmacist's role therein.
    MeSH term(s) Analgesics, Opioid/adverse effects ; Humans ; Pain/chemically induced ; Pain/drug therapy ; Palliative Care ; Pharmacists ; Policy ; Surveys and Questionnaires
    Chemical Substances Analgesics, Opioid
    Language English
    Publishing date 2022-03-07
    Publishing country England
    Document type Journal Article
    ZDB-ID 2078852-6
    ISSN 1536-0539 ; 1536-0288
    ISSN (online) 1536-0539
    ISSN 1536-0288
    DOI 10.1080/15360288.2022.2041147
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 2463: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (2.OG)
    ab Jg. 2022: Lesesaal (EG)

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  5. Article: Opioid Taper Practices Among Clinicians.

    Persico, Amelia L / Bettinger, Jeffrey J / Wegrzyn, Erica L / Fudin, Jeffrey / Strassels, Scott A

    Journal of pain research

    2021  Volume 14, Page(s) 3353–3358

    Abstract: Introduction: Opioid dose tapers are used frequently when cross-titrating from one or more opioids to another or when discontinuing therapy. Currently, there is no universally accepted evidence-based standard of care for this procedure which can leave ... ...

    Abstract Introduction: Opioid dose tapers are used frequently when cross-titrating from one or more opioids to another or when discontinuing therapy. Currently, there is no universally accepted evidence-based standard of care for this procedure which can leave patients at risk for withdrawal symptoms, inadequate pain control, or elevated suicide risk.
    Objective: The objective of this study was to examine practices and rationale among clinicians, to determine if there is a difference among respondents in their comfort level, method and rationale for tapering opioids at various morphine milligram equivalents (MME) and to assess the need for the development of a standard of care.
    Methods: Data were derived from an electronic survey developed using SurveyMonkey
    Results: A total of 149 clinicians completed the survey, physicians, NPs, pharmacists, and PAs accounted for 51%, 20%, 19%, and 10% of participants, respectively. Overall, 55% of the respondents self-identified as pain specialists. There were no statistically significant differences in reported comfort level among the different types of providers. Nearly 50% of participants indicated their rationale for tapering or discontinuing opioids was the 2016 CDC guidelines.
    Conclusion: Despite that the majority of providers surveyed self-identified as pain specialists, over 50% were not comfortable tapering opioids at doses greater than 120 MME/day. This observation suggests a need for further education and establishment of consensus guidelines on method and rationale for opioid tapering. Provider motivation for tapering was largely influenced by CDC guidelines based on low quality evidence. This strengthens the argument for the creation of guidelines based on high quality evidence.
    Language English
    Publishing date 2021-10-20
    Publishing country New Zealand
    Document type Journal Article
    ZDB-ID 2495284-9
    ISSN 1178-7090
    ISSN 1178-7090
    DOI 10.2147/JPR.S322299
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  6. Article ; Online: A Practical Guide to Urine Drug Monitoring.

    Raouf, Mena / Bettinger, Jeffrey J / Fudin, Jeffrey

    Federal practitioner : for the health care professionals of the VA, DoD, and PHS

    2017  Volume 35, Issue 4, Page(s) 38–44

    Abstract: Urine drug monitoring is an important tool for substance misuse or abuse and adherence to a prescribed regimen. ...

    Abstract Urine drug monitoring is an important tool for substance misuse or abuse and adherence to a prescribed regimen.
    Language English
    Publishing date 2017-12-12
    Publishing country United States
    Document type Journal Article
    ISSN 1945-337X
    ISSN (online) 1945-337X
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article: Pharmacotherapeutic considerations for chronic pain in chronic kidney and end-stage renal disease.

    Mathew, Roy O / Bettinger, Jeffrey J / Wegrzyn, Erica L / Fudin, Jeffrey

    Journal of pain research

    2016  Volume 9, Page(s) 1191–1195

    Language English
    Publishing date 2016-12-08
    Publishing country New Zealand
    Document type Editorial
    ZDB-ID 2495284-9
    ISSN 1178-7090
    ISSN 1178-7090
    DOI 10.2147/JPR.S125270
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article: In silico ordinary differential equation/partial differential equation hemodialysis model estimates methadone removal during dialysis.

    Linares, Oscar A / Schiesser, William E / Fudin, Jeffrey / Pham, Thien C / Bettinger, Jeffrey J / Mathew, Roy O / Daly, Annemarie L

    Journal of pain research

    2015  Volume 8, Page(s) 417–429

    Abstract: Background: There is a need to have a model to study methadone's losses during hemodialysis to provide informed methadone dose recommendations for the practitioner.: Aim: To build a one-dimensional (1-D), hollow-fiber geometry, ordinary differential ... ...

    Abstract Background: There is a need to have a model to study methadone's losses during hemodialysis to provide informed methadone dose recommendations for the practitioner.
    Aim: To build a one-dimensional (1-D), hollow-fiber geometry, ordinary differential equation (ODE) and partial differential equation (PDE) countercurrent hemodialyzer model (ODE/PDE model).
    Methodology: We conducted a cross-sectional study in silico that evaluated eleven hemodialysis patients. Patients received a ceiling dose of methadone hydrochloride 30 mg/day. Outcome measures included: the total amount of methadone removed during dialysis; methadone's overall intradialytic mass transfer rate coefficient, km

    and, methadone's removal rate, j ME. Each metric was measured at dialysate flow rates of 250 mL/min and 800 mL/min.
    Results: The ODE/PDE model revealed a significant increase in the change of methadone's mass transfer with increased dialysate flow rate, %Δkm =18.56, P=0.02, N=11. The total amount of methadone mass transferred across the dialyzer membrane with high dialysate flow rate significantly increased (0.042±0.016 versus 0.052±0.019 mg/kg, P=0.02, N=11). This was accompanied by a small significant increase in methadone's mass transfer rate (0.113±0.002 versus 0.014±0.002 mg/kg/h, P=0.02, N=11). The ODE/PDE model accurately predicted methadone's removal during dialysis. The absolute value of the prediction errors for methadone's extraction and throughput were less than 2%.
    Conclusion: ODE/PDE modeling of methadone's hemodialysis is a new approach to study methadone's removal, in particular, and opioid removal, in general, in patients with end-stage renal disease on hemodialysis. ODE/PDE modeling accurately quantified the fundamental phenomena of methadone's mass transfer during hemodialysis. This methodology may lead to development of optimally designed intradialytic opioid treatment protocols, and allow dynamic monitoring of outflow plasma opioid concentrations for model predictive control during dialysis in humans.
    Language English
    Publishing date 2015-07-22
    Publishing country New Zealand
    Document type Journal Article
    ZDB-ID 2495284-9
    ISSN 1178-7090
    ISSN 1178-7090
    DOI 10.2147/JPR.S84615
    Database MEDical Literature Analysis and Retrieval System OnLINE

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