The maximum daily MME was 422 from the combination of a fentanyl patch and hydromorphone tablets prescribed eight years ago in a pain clinic. Prior opioid regimens included fentanyl, hydrocodone, hydromorphone, morphine, and tramadol. He started chronic prescription opioid therapy 12 years ago when other treatments including physical therapy, acetaminophen, piroxicam, gabapentin, and amitriptyline provided insufficient pain relief. After reviewing this condition, the patient asked to discuss his opioid contract. Two weeks prior to the appointment, his primary care provider (PCP) diagnosed a flare of proximal biceps tendinopathy as the cause of worsening right shoulder pain and recommended a course of physical therapy. Herein we highlight the utility of a primary care opioid prescribing support team in empowering a primary care provider to prescribe BUP to treat a patient with complex OUD.Ī 47-year-old United States veteran with post-traumatic stress disorder (PTSD) and 15-year history of low back, knee, neck, and shoulder pain presented to PCC to discuss pain management. PST, which can be made through purchase of readily available poppy pods, carries risk for development of OUD and overdose. He remained on a stable dosage, without relapse, 24 months later. The patient discontinued all opioids, and initiated BUP under the supervision of the primary care provider. The primary care provider consulted the VA Puget Sound SUpporting Primary care Providers in Opioid Risk reduction and Treatment (SUPPORT) team to evaluate the patient for OUD. Attempts at cessation resulted in severe withdrawal symptoms, leading to return to PST use. Case presentationĪ 47-year-old man with chronic pain and prescription opioid use presented to primary care to discuss a flare of shoulder pain, and revealed in subsequent conversation a long-standing use of PST to supplement pain control. The provider in this case used a unique model of care with an opioid prescribing support team to deliver safe and effective care. This case represents the first published report of OUD from PST successfully treated with buprenorphine (BUP) in a primary care setting. We report a case of a patient with chronic pain and PST use leading to opioid use disorder (OUD). Users of poppy seed tea (PST) can consume several hundred morphine milligram equivalents per day, and opioid dependence from PST use can develop.
The 1442 patients with a documented reaction were matched with 5766 patients with a documented non-NSAID allergy for baseline comorbidities, including cardiovascular disease, renal insufficiency, connective tissue disease, peptic ulcer disease, anxiety, depression, malignancy, chronic urticaria, allergic rhinitis, asthma, and atopic dermatitis.Poppy seeds contain morphine and other opioid alkaloids and are commercially available in the United States.
"This warrants clarification." Higher Odds of Opioid Use Disorder "The high percentage of 'unknown' or 'other' reactions highlights the challenges of evaluating and caring for patients with unclear reaction histories," said Li. This is an indication that further testing might be warranted to confirm NSAID allergy. In nearly one-quarter (24.3%) of the records reporting NSAID allergy, no specific reaction was documented. Adverse effects related to the medication were reported in 749 (40.4%) cases, the most common being gastrointestinal upset, nausea, dizziness, and headache. Of the 1856 reactions documented, hypersensitivity reactions were reported in 656 cases (35.3%), with rash and angioedema or swelling being the most common. Not all reactions were "allergic", however. Reaction to NSAIDs "as a class" was reported in 22.3% of cases, and reaction to other NSAIDs - specifically, indomethacin, rofecoxib, diclofenac, nabumetone, and ketorolac - was reported in less than 5% of the cases. The most common reaction reported was to aspirin (25.6%), followed by ibuprofen (12.6%), naproxen (11.5%), celecoxib (5.7%), and "other NSAID medication" (7.4%). Of these, 1442 (9.2%) patients had 1856 NSAID reactions documented in the allergy tab of their electronic health record. The team searched the electronic health records of adults with osteoarthritis treated in a tertiary care center from January 2013 to December 2018 and identified 15,682 patients with osteoarthritis. More than 2 million Americans are addicted to opioids, and "seven out of ten opioid prescriptions are written for relief of physical pain." This is contrary to the fact that NSAIDs are indicated for musculoskeletal pain by the World Health Organization. "The opioid epidemic remains a pressing health issue," she said. Li and her colleagues set out to evaluate the potential risk for opioid addiction in NSAID-allergic osteoarthritis patients because opioids are often prescribed to patients with a history of NSAID allergy.