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IntroductionPatients with opioid use disorder often have undertreated withdrawal while in hospital, leading to high rates of premature discharges. Short-acting, full agonist opioids (SAFAOs) have been proposed to alleviate withdrawal symptoms when provided as adjuncts to opioid agonist therapy (OAT). We aimed to synthesize evidence on the safety and efficacy of SAFAOs.MethodsWe searched the scientific databases MEDLINE, Embase, CINAHL, PsycInfo, Web of Science Core Collection, and the Cochrane Library for studies with adults whose opioid withdrawal symptoms were treated with SAFAOs. Results were narratively synthesized.ResultsOur search yielded 5,616 papers screened and 15 studies included. Information was gathered mostly from patient charts, followed by cohort studies, a cross-sectional study, and a clinical trial. Hydromorphone, tramadol, fentanyl, and oxycodone were described individually or as groupings to reduce withdrawal from heroin or fentanyl, initiate OAT, or as a bridge to transition between medications. Most studies observed reduced withdrawal scores and fewer occurrences of premature discharges in those who received these medications. Oversedation was observed as an adverse event in patients with ongoing opioid use.DiscussionThis systematic review provides an up-to-date synthesis on the use of SAFAOs to treat withdrawal. Our results suggest that in-hospital use of SAFAOs can reduce patient suffering and potentially the following risk for premature discharges. More clinical studies are needed to further investigate the clinical utility of SAFAO as a combination treatment with OAT.

Abstract licence: CC BY-NC-ND

Chronic low back pain (LBP) is a major cause of disability around the world, and pharmaceutical treatments like opioids are often used to treat it. However, the efficacy and safety of opioids in LBP continue to be controversial due to inconsistent results and associated side effects. This systematic review assesses the effectiveness and safety of opioid medication in the treatment of LBP. A systematic search was performed utilising various electronic databases, including PubMed, Scopus, Google Scholar, MEDLINE, the Cochrane Library, and Web of Science, following a structured methodology in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) principles. Randomised controlled trials that were published in English within the past two decades and evaluated the use of opioids in adults with LBP were included. The Cochrane Risk of Bias tool and the Critical Appraisal Skills Programme (CASP) checklist were used to screen for bias, and a narrative synthesis was done because the studies were not all the same. There were six randomised, double-blind, placebo-controlled trials involving between 83 and 905 people. Opioid formulations, including buprenorphine, hydrocodone, oxycodone/naloxone, and oxymorphone, exhibited overall efficacy in diminishing pain intensity relative to placebo, especially in opioid-naïve individuals. But the magnitude and consistency of the advantage varied across studies, and some treatments showed only a small statistical difference. There were only a few reports of functional improvement, and they were not always constant. Nausea, constipation, and drowsiness were common side effects, although long-term safety outcomes were not fully evaluated. In general, opioids may help with short-term pain relief in people with LBP, but they aren't very useful in the long term because they aren't very effective and very safe and there isn't much evidence for their long-term use. It is advisable to select patients and use them with caution. More high-quality research is needed to understand their role in long-term management better.

Abstract licence: CC BY

ObjectiveIn this study, we evaluated the concordance between urine drug screening (UDS) and self-reported use in a pragmatic randomized clinical trial.MethodsOur data was drawn from OPTIMA, a 24-week pragmatic multicentric open-label randomized-controlled trial comparing flexible take-home dosing of buprenorphine/naloxone to the methadone standard model of care for treating prescription-type opioid use disorder. A total of 272 participants were randomized (1:1 ratio) to methadone or buprenorphine/naloxone. Following treatment initiation, participants were followed-up every 2 weeks for 24 weeks. During each visit, participants provided urine samples for UDS and self-reported their substance use over the past 2 weeks. Self-reported use was dichotomized to align with UDS detection windows. Tetrachoric correlations and 2 × 2 contingency tables were used to estimate the sensitivity, specificity, positive predictive value and negative predictive value of self-reported use. A generalized linear mixed model assessed how substance type, time in the study, treatment assignment, study site, unstable housing, and sex impacted self-report accuracy.ResultsSignificant differences were found between substance types (p p p = 0.174), time in the study (p = 0.221), unstable housing (p = 0.733), or sex (p = 0.321) on the concordance between UDS and self-reported use.ConclusionsOur results indicate that concordance between UDS and self-reported use is impacted by several factors. Combining UDS and self-reported use could help provide a more accurate assessment of substance use.Clinical trial registrationThis study was registered in ClinicalTrials.gov (NCT03033732).

Abstract licence: CC BY-NC