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Article ; Online: Perspectives on opioid misuse from public service psychology: An introduction.

Magaletta, Philip R / Morasco, Benjamin J

2021 Volume 18, Issue 3, Page(s) 285–286

Abstract: Despite practicing in multiple venues where people with opioid use disorders require services, most public service psychology providers are not delivering, or being trained to deliver, treatment for substance use disorders. In addition, unintentional ... ...

Abstract	Despite practicing in multiple venues where people with opioid use disorders require services, most public service psychology providers are not delivering, or being trained to deliver, treatment for substance use disorders. In addition, unintentional overdose and death from opioids continue, treatment options for chronic pain remain limited, and a larger discussion on the problem and role of drug and alcohol addiction in society remains largely unspoken. The articles received and included in this special section present some changes in the way that precipitants and prevention of opioid use disorder may be addressed and the role of psychologists in this work. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
MeSH term(s)	Alcoholism ; Analgesics, Opioid/therapeutic use ; Chronic Pain ; Drug Overdose ; Humans ; Opioid-Related Disorders/epidemiology ; Opioid-Related Disorders/therapy
Chemical Substances	Analgesics, Opioid
Language	English
Publishing date	2021-08-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	2156662-8
ISSN	1939-148X ; 1541-1559
ISSN (online)	1939-148X
ISSN	1541-1559
DOI	10.1037/ser0000485
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Cannabis use is associated with pain severity and interference among cancer survivors.

Nugent, Shannon M / Latour, Emile / Lim, Jeong / Shannon, Jackilen / Morasco, Benjamin J

Research square

2023

Abstract: Context: Cannabis use for symptom management among individuals with cancer is increasingly common.: Objectives: We sought to describe the 1) prevalence and characteristics of cannabis use, 2) perceived therapeutic benefits of cannabis use, and 3) ... ...

Abstract	Context: Cannabis use for symptom management among individuals with cancer is increasingly common. Objectives: We sought to describe the 1) prevalence and characteristics of cannabis use, 2) perceived therapeutic benefits of cannabis use, and 3) examine how use of cannabis was associated with self-reported pain, mood, and general health outcomes among a representative sample of patients treated at NCI designated OHSU Knight Cancer Institute. Methods: We conducted a population-based, cross-sectional survey developed in conjunction with 11 other NCI designated cancer centers and distributed to eligible individuals. The survey inquired about characteristics of cannabis use, perception of therapeutic benefits, pain, mood, and general health. Responses were population weighted. We examined the association of cannabis use with self-reported pain, mood, and general health using logistic regression controlling for relevant sociodemographic and clinical characteristics. Results: 523 individuals were included in our analytic sample. 54% endorsed using cannabis at any time since their cancer diagnosis and 42% endorsed using cannabis during active treatment. The most endorsed reasons for use included: sleep disturbance (54.7%), pain (47.1%), and mood (42.6%). We found moderate pain was associated with more than a 2-fold (OR = 2.4 [95% CI = 1.3-4.6], Conclusions: In a state with medical and recreational cannabis legislation, a high number of cancer survivors report cannabis use. Those with pain were more likely to use cannabis. Oncologists should be aware of this trend and assess use of cannabis when managing long-term symptoms of cancer and its treatments.
Language	English
Publishing date	2023-07-07
Publishing country	United States
Document type	Preprint
DOI	10.21203/rs.3.rs-3126192/v1
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Article ; Online: Patients' Perspectives on Discontinuing Buprenorphine for the Treatment of Opioid Use Disorder.

Wyse, Jessica J / Eckhardt, Alison / Waller, Dylan / Gordon, Adam J / Shull, Sarah / Lovejoy, Travis I / Mackey, Katherine / Morasco, Benjamin J

Journal of addiction medicine

2024

Abstract: Objectives: Buprenorphine and other medications for opioid use disorder (OUD) are recommended as standard of care in the treatment of OUD and are associated with positive health and addiction-related outcomes. Despite benefits, discontinuation is common, ...

Abstract	Objectives: Buprenorphine and other medications for opioid use disorder (OUD) are recommended as standard of care in the treatment of OUD and are associated with positive health and addiction-related outcomes. Despite benefits, discontinuation is common, with half of patients discontinuing in the first year of treatment. Addressing OUD is a major clinical priority, yet little is known about the causes of medication discontinuation from the patient perspective. Methods: From March 2021 to April 2022, we conducted qualitative interviews with patients who had discontinued buprenorphine for the treatment of OUD within the past 12 months. Eligible participants were selected from 2 Veterans Health Administration Health Care Systems in Oregon. Coding and analysis were guided by conventional qualitative content analysis. Results: Twenty participants completed an interview; 90% were White and 90% were male, and the mean age was 54.2 years. Before discontinuation, participants had received buprenorphine for 8.3 months on average (range, 1-40 months); 80% had received buprenorphine for less than 12 months. Qualitative analysis identified the following themes relating to discontinuation: health system barriers (eg, logistical hurdles, rules and policy violations), medication effects (adverse effects; attributed adverse effects, lack of efficacy in treating chronic pain) and desire for opioid use. Patient description of decisions to discontinue buprenorphine could be multicausal, reflecting provider or system-level barriers in interaction with patient complexity or medication ambivalence. Conclusions: Study results identify several actionable ways OUD treatment could be modified to enhance patient retention.
Language	English
Publishing date	2024-03-18
Publishing country	Netherlands
Document type	Journal Article
ISSN	1935-3227
ISSN (online)	1935-3227
DOI	10.1097/ADM.0000000000001292
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Article ; Online: "They Ask Questions, But They Don't Want the Answers"-Perceptions of Clinical Communication Among Veterans Discontinuing Buprenorphine for the Treatment of Opioid Use Disorder.

Eckhardt, Alison / Waller, Dylan E / Shull, Sarah / Lovejoy, Travis I / Morasco, Benjamin J / Gordon, Adam J / Wyse, Jessica J

Substance use & addiction journal

2024 , Page(s) 29767342241251761

Abstract: Background: Many patients with opioid use disorder (OUD) discontinue treatment prematurely, increasing their risk of opioid-related overdose and death. While patient-centered care is considered the gold standard in treating chronic illness, it may be ... ...

Abstract	Background: Many patients with opioid use disorder (OUD) discontinue treatment prematurely, increasing their risk of opioid-related overdose and death. While patient-centered care is considered the gold standard in treating chronic illness, it may be practiced less frequently in the context of OUD care. Patient-provider communication can influence patients' care experiences, potentially having an impact on treatment retention and care decision-making. Methods: This study was conducted at the VA Portland Health Care System from March 2021 to April 2022. We conducted qualitive interviews with patients who had discontinued buprenorphine for the treatment of OUD within the past year. Coding and analysis were guided by inductive qualitative content analysis. Retrospective medical record review identified clinical and demographic characteristics of participants. Results: Twenty patients completed an interview. Participant age ranged from 28 to 74 years (median 63 years). Ninety percent of participants were white and 90% male. Many participants expressed frustration and feelings of disempowerment in OUD care processes. Patients with a history of long-term prescribed opioid use frequently expressed stigmatizing views of OUD, and perceptions of disagreement with providers over diagnosis and care choices. Elderly patients and those with multiple comorbidities expressed confusion over significant aspects of their care, as well as difficulty navigating treatment logistics like appointment requirements and medication dose changes. Some patients reported later restarting buprenorphine in new settings, and described feeling respected and involved in care decisions as a facilitator for continuing treatment. Conclusions: Prioritizing patient-centered communication in OUD treatment could improve the patient experience and potentially support treatment retention. Subgroups of OUD patients, such as those with a history of long-term prescribed opioid use, elderly patients with multiple comorbidities, or those who express stigmatizing medication views, could particularly benefit from tailored communication strategies that address their individual concerns.
Language	English
Publishing date	2024-05-20
Publishing country	United States
Document type	Journal Article
ISSN	2976-7350
ISSN (online)	2976-7350
DOI	10.1177/29767342241251761
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Article ; Online: Cannabis Use and Nonfatal Opioid Overdose among Patients Enrolled in Methadone Maintenance Treatment.

Bryson, William C / Morasco, Benjamin J / Cotton, Brandi P / Thielke, Stephen M

Substance use & misuse

2021 Volume 56, Issue 5, Page(s) 697–703

Abstract: Background: Some ecological studies found lower rates of opioid overdose in states with liberalized cannabis legislation, but results are mixed, and the association has not been analyzed in individuals. We quantified the association between cannabis use ...

Abstract	Background: Some ecological studies found lower rates of opioid overdose in states with liberalized cannabis legislation, but results are mixed, and the association has not been analyzed in individuals. We quantified the association between cannabis use and nonfatal opioid overdose among individuals enrolled in methadone maintenance treatment (MMT) for opioid use disorder (OUD). Methods: We recruited a convenience sample of individuals enrolled in four MMT clinics in Washington State and southern New England who completed a one-time survey.Descriptive statistics and multivariate logistic regression compared the prevalence and risk of nonfatal opioid overdose in the past 12 months between participants reporting frequent (at least weekly) or infrequent (once or none) cannabis use in the past month. Results: Of 446 participants, 35% ( Conclusions: Among individuals enrolled in MMT, frequent cannabis use in the past month was associated with fewer self-reported nonfatal opioid overdoses in the past year. Methodological limitations caution against causal interpretation of this relationship. Additional studies are needed to understand the prospective impact of co-occurring cannabis on opioid-related outcomes.
MeSH term(s)	Analgesics, Opioid/therapeutic use ; Cannabis ; Drug Overdose/drug therapy ; Drug Overdose/epidemiology ; Humans ; Methadone/therapeutic use ; New England ; Opiate Overdose ; Opiate Substitution Treatment ; Opioid-Related Disorders/drug therapy ; Opioid-Related Disorders/epidemiology ; Prospective Studies ; Washington/epidemiology
Chemical Substances	Analgesics, Opioid ; Methadone (UC6VBE7V1Z)
Language	English
Publishing date	2021-03-22
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	1310358-1
ISSN	1532-2491 ; 1082-6084
ISSN (online)	1532-2491
ISSN	1082-6084
DOI	10.1080/10826084.2021.1892137
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Article ; Online: "I'm Clean and Sober, But Not Necessarily Free": Perceptions of Buprenorphine Among Patients in Long-Term Treatment.

Wyse, Jessica J / Lovejoy, Travis I / Gordon, Adam J / Mackey, Katherine / Herreid-O'Neill, Anders / Morasco, Benjamin J

Substance abuse

2023 Volume 44, Issue 1, Page(s) 41–50

Abstract: Background: Patients receiving buprenorphine for the treatment of opioid use disorder (OUD) experience a roughly 50% reduction in mortality risk relative to those not receiving medication. Longer periods of treatment are also associated with improved ... ...

Abstract	Background: Patients receiving buprenorphine for the treatment of opioid use disorder (OUD) experience a roughly 50% reduction in mortality risk relative to those not receiving medication. Longer periods of treatment are also associated with improved clinical outcomes. Despite this, patients often express desires to discontinue treatment and some view taper as treatment success. Little is known about the beliefs and medication perspectives of patients engaged in long-term buprenorphine treatment that may underlie motivations to discontinue. Methods: This study was conducted at the VA Portland Health Care System (2019-2020). Qualitative interviews were conducted with participants prescribed buprenorphine for ≥2 years. Coding and analysis were guided by directed qualitative content analysis. Results: Fourteen patients engaged in office-based buprenorphine treatment completed interviews. While patients expressed strong enthusiasm for buprenorphine as a medication, the majority expressed the desire to discontinue, including patients actively tapering. Motivations to discontinue fell into 4 categories. First, patients were troubled by perceived side effects of the medication, including effects on sleep, emotion, and memory. Second, patients expressed unhappiness with being "dependent" on buprenorphine, framed in opposition to personal strength/independence. Third, patients expressed stigmatized beliefs about buprenorphine, describing it as "illicit," and associated with past drug use. Finally, patients expressed fears about buprenorphine unknowns, including potential long-term health effects and interactions with medications required for surgery. Conclusions: Despite recognizing benefits, many patients engaged in long-term buprenorphine treatment express a desire to discontinue. Findings from this study may help clinicians anticipate patient concerns and can be used to inform shared decision-making conversations regarding buprenorphine treatment duration.
MeSH term(s)	Humans ; Long-Term Care ; Motivation ; Communication ; Buprenorphine/therapeutic use ; Fear
Chemical Substances	Buprenorphine (40D3SCR4GZ)
Language	English
Publishing date	2023-05-03
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S. ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	1458030-5
ISSN	1547-0164 ; 0889-7077
ISSN (online)	1547-0164
ISSN	0889-7077
DOI	10.1177/08897077231165625
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Article ; Online: CE: Implementing Guidelines for Treating Chronic Pain with Prescription Opioids.

Maloy, Patricia E / Iacocca, Megan O / Morasco, Benjamin J

The American journal of nursing

2019 Volume 119, Issue 11, Page(s) 22–29

Abstract: Chronic pain, stemming primarily from musculoskeletal conditions and severe headaches, is a growing problem in the United States, affecting as many as 43% of adults. Opioids are frequently prescribed to manage chronic pain despite limited data on their ... ...

Abstract	Chronic pain, stemming primarily from musculoskeletal conditions and severe headaches, is a growing problem in the United States, affecting as many as 43% of adults. Opioids are frequently prescribed to manage chronic pain despite limited data on their long-term efficacy and the potential risks of long-term use. In 2017, more than 47,000 people died as a result of an opioid overdose involving illicit opioids (such as heroin), illicitly manufactured opioids, diverted opioids, prescription opioids, or some combination thereof. Although it's been more than three years since the nationwide opioid crisis prompted the Centers for Disease Control and Prevention (CDC) to release a guideline outlining safe practices for prescribing opioids to patients with chronic pain (unrelated to active cancer or palliative and end-of-life care), opioid misuse remains a significant concern. Historically, physicians have been tasked with the primary responsibility for implementing opioid safety measures, but nurses in the primary care setting are being increasingly relied on to incorporate these measures as part of their practice. In this article, we discuss the use of five tools outlined in the CDC guideline: prescription opioid treatment agreements, urine drug screening, prescription drug monitoring program databases, calculation of morphine milligram equivalents, and naloxone kits. Primary care nurses can use these tools to promote opioid safety among patients receiving opioid therapy for chronic pain.
MeSH term(s)	Analgesics, Opioid/administration & dosage ; Analgesics, Opioid/adverse effects ; Chronic Pain/drug therapy ; Drug Overdose/prevention & control ; Guidelines as Topic ; Humans ; Prescription Drug Misuse/prevention & control ; Primary Care Nursing
Chemical Substances	Analgesics, Opioid
Language	English
Publishing date	2019-10-23
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	390780-6
ISSN	1538-7488 ; 0002-936X
ISSN (online)	1538-7488
ISSN	0002-936X
DOI	10.1097/01.NAJ.0000605344.99391.78
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Article ; Online: A qualitative study of VHA clinicians' knowledge and perspectives on cannabis for medical purposes.

Christensen, Vivian A / Nugent, Shannon M / Ayers, Chelsea K / Morasco, Benjamin J / Kansagara, Devan

Family practice

2021 Volume 38, Issue 4, Page(s) 479–483

Abstract: Background: The legalization of cannabis is expanding across the USA, and its use has increased significantly, including among Veterans. Although the Veterans Health Administration (VHA) abides by the classification of cannabis as a Schedule I substance, ...

Abstract	Background: The legalization of cannabis is expanding across the USA, and its use has increased significantly, including among Veterans. Although the Veterans Health Administration (VHA) abides by the classification of cannabis as a Schedule I substance, it recently recommended that clinicians discuss cannabis with their patients. Little is known about VHA clinicians' perspectives on and knowledge of cannabis. Objective: We sought to better understand clinicians' attitudes, beliefs, knowledge and communication with patients regarding cannabis. Methods: We conducted semi-structured phone interviews with 14 VHA clinicians. Interviews were audio-recorded, transcribed verbatim and analysed using qualitative thematic analysis. Results: VA clinicians described ambivalence towards cannabis for therapeutic purposes and identified several factors that inhibit conversations about cannabis use with their patients including discomfort with the lack of product standardization; lack of research examining the effectiveness and risks of cannabis use; unfamiliarity with pharmacology, formulations, and dosing of cannabis; and uncertainty regarding VHA policy. Clinicians had differing views on cannabis in the context of the opioid crisis. Conclusions: VA clinicians face challenges in navigating the topic of medical cannabis. Educational materials about cannabis products, dose and harms would be helpful to clinicians.
MeSH term(s)	Cannabis ; Communication ; Humans ; Qualitative Research ; Veterans
Language	English
Publishing date	2021-01-22
Publishing country	England
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	605939-9
ISSN	1460-2229 ; 0263-2136
ISSN (online)	1460-2229
ISSN	0263-2136
DOI	10.1093/fampra/cmaa151
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Article ; Online: Associations of Pain Numeric Rating Scale Scores Collected during Usual Care with Research Administered Patient Reported Pain Outcomes.

Nugent, Shannon M / Lovejoy, Travis I / Shull, Sarah / Dobscha, Steven K / Morasco, Benjamin J

Pain medicine (Malden, Mass.)

2021 Volume 22, Issue 10, Page(s) 2235–2241

Abstract: Objective: The purpose of this study is to examine the extent to which numeric rating scale (NRS) scores collected during usual care are associated with more robust and validated measures of pain, disability, mental health, and health-related quality of ...

Abstract	Objective: The purpose of this study is to examine the extent to which numeric rating scale (NRS) scores collected during usual care are associated with more robust and validated measures of pain, disability, mental health, and health-related quality of life (HRQOL). Design: We conducted a secondary analysis of data from a prospective cohort study. Subjects: We included 186 patients with musculoskeletal pain who were prescribed long-term opioid therapy. Setting: VA Portland Health Care System outpatient clinic. Methods: All patients had been screened with the 0-10 NRS during routine outpatient visits. They also completed research visits that assessed pain, mental health and HRQOL every 6 months for 2 years. Accounting for nonindependence of repeated measures data, we examined associations of NRS data obtained from the medical record with scores on standardized measures of pain and its related outcomes. Results: NRS scores obtained in clinical practice were moderately associated with pain intensity scores (B's = 0.53-0.59) and modestly associated with pain disability scores (B's = 0.33-0.36) obtained by researchers. Associations between pain NRS scores and validated measures of depression, anxiety, and health related HRQOL were low (B's = 0.09-0.26, with the preponderance of B's < .20). Conclusions: Standardized assessments of pain during usual care are moderately associated with research-administered measures of pain intensity and would be improved from the inclusion of more robust measures of pain-related function, mental health, and HRQOL.
MeSH term(s)	Humans ; Pain/diagnosis ; Pain/drug therapy ; Pain Measurement ; Patient Reported Outcome Measures ; Prospective Studies ; Quality of Life
Language	English
Publishing date	2021-03-22
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2015903-1
ISSN	1526-4637 ; 1526-2375
ISSN (online)	1526-4637
ISSN	1526-2375
DOI	10.1093/pm/pnab110
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Article ; Online: Cannabis-Based Products for Chronic Pain : A Systematic Review.

McDonagh, Marian S / Morasco, Benjamin J / Wagner, Jesse / Ahmed, Azrah Y / Fu, Rongwei / Kansagara, Devan / Chou, Roger

Annals of internal medicine

2022 Volume 175, Issue 8, Page(s) 1143–1153

Abstract: Background: Contemporary data are needed about the utility of cannabinoids in chronic pain.: Purpose: To evaluate the benefits and harms of cannabinoids for chronic pain.: Data sources: Ovid MEDLINE, PsycINFO, EMBASE, the Cochrane Library, and ... ...

Abstract	Background: Contemporary data are needed about the utility of cannabinoids in chronic pain. Purpose: To evaluate the benefits and harms of cannabinoids for chronic pain. Data sources: Ovid MEDLINE, PsycINFO, EMBASE, the Cochrane Library, and Scopus to January 2022. Study selection: English-language, randomized, placebo-controlled trials and cohort studies (≥1 month duration) of cannabinoids for chronic pain. Data extraction: Data abstraction, risk of bias, and strength of evidence assessments were dually reviewed. Cannabinoids were categorized by THC-to-CBD ratio (high, comparable, or low) and source (synthetic, extract or purified, or whole plant). Data synthesis: Eighteen randomized, placebo-controlled trials ( Limitation: Variation in interventions; lack of study details, including unclear availability in the United States; and inadequate evidence for some products. Conclusion: Oral, synthetic cannabis products with high THC-to-CBD ratios and sublingual, extracted cannabis products with comparable THC-to-CBD ratios may be associated with short-term improvements in chronic pain and increased risk for dizziness and sedation. Studies are needed on long-term outcomes and further evaluation of product formulation effects. Primary funding source: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services. (PROSPERO: CRD42021229579).
MeSH term(s)	Analgesics ; Cannabinoids/adverse effects ; Cannabis ; Chronic Pain/drug therapy ; Dizziness/chemically induced ; Dronabinol/adverse effects ; Humans
Chemical Substances	Analgesics ; Cannabinoids ; Dronabinol (7J8897W37S)
Language	English
Publishing date	2022-06-07
Publishing country	United States
Document type	Journal Article ; Review ; Systematic Review ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	336-0
ISSN	1539-3704 ; 0003-4819
ISSN (online)	1539-3704
ISSN	0003-4819
DOI	10.7326/M21-4520
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