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Effective Treatment of Chronic Pain in Detained Drug Users

Explore the prevalence, treatment, and safety of opioids for chronic non-cancer pain in detainees, with a focus on misuse and diversion risks. Study conducted in Padua, Italy. Considerations for enhancing opioid efficacy and safety in prison settings.

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Effective Treatment of Chronic Pain in Detained Drug Users

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  1. Felice A. Nava, MD, PhD DirectorPenitentiary Medicine and DrugAbuse Unit Padua Director of ScientificCommittee of the Italian Society of Addiction Medicine (FeDeSerD) Felice Nava, MD, PhD Direttore U.O. Sanità Penitenziaria Azienda ULSS 6 Euganea – Padova Direttore Comitato Scientifico Nazionale FeDerSerD Orienting the Appropriate Treatment of Pain in Detained Drug Users: Indications from a Retrospective Study

  2. Disclosures • Grant/research support: Gilead • Speaker honoraria: D&A Pharma, Gilead Sciences and Reckitt Benckiser • Consulting fees: Gilead Sciences, Indivior, Laboratorio Farmaceutico CT, Merck Serono, Molteni Farmaceutici, Mundipharma Pharmaceuticals, Reckitt Benckiser, MartindalePharma

  3. Definition of Chronic Non-Cancer Pain (CNCP) A painful condition lasting at least 3 months, including musculoskeletal pain, neuropathic pain, fibromyalgia, osteoarthritis and rheumatoid arthritis (excluding headache, migraine, angina pectoris, cancer pain and pain associated with specific disease conditions) International Association for the Study of Pain

  4. Prevalence of Chronic Non Cancer Pain (CNCP) - WHO suggests that 1 person in 5 has a chronic pain • 25% of Americans report chronic pain (Gallagher et al., 2008; Arch Phys Med Rehabil; 89:S77-S82) • In most cases CNCP is not well treated with enormous cost of the Society (Breivick et al., 2006; Eur J Pain; 10:287-333) • The opioids are often the gold standard for the treatment of CNCP, although they may be induced misuse and abuse (Volkow et al., 2017; Annu Rev Med 2017 Oct 13. doi: 10.1146/annurev-med-011817-044739)

  5. Pain in Prison • There are not clear epidemiological data on pain in detainees • The most prevalent pain in detainees is the CNCP (Chou et al., 2009; J Pain; 10: 113-130; Croft, Mayhew, 2015; Br J Pain; 9: 96-108) • A study showed that about 20% of English detainees receive a treatment for pain (lasting more 3 months) (Croft, Maythew, 2015; Br J Pain; 9: 96-10) • Some of them (44%) are in opioid treatment (Croft, Maythew, 2015; Br J Pain; 9: 96-108) • Pain is frequently associated in detainees with psychiatric or physical co-morbidities (Fazel et al., 2001; Br J Psychiatry; 179: 535-539) • The main concerns of the use of opioids in detainees (specially if drug users) are misuse and diversion (Levy, 2012; BMJ; 344; e447)

  6. Aims of the Study Retrospective study able to evaluate in detainees of Padua, Italy (a Remand Centre), n = 598 (on 30 June 2016): • the prevalence of patients treated for CNCP with opioids • the efficacy and safety of the opioid treatments

  7. Design of the Study A naturalist retrospective study

  8. Sample of the Study

  9. The Opiods Used

  10. Drug Regimen

  11. Causes of CNCP

  12. Results: Efficacy and Safety 🔵 🔴 🔴

  13. Misuse and Diversion Most of the patients that had misuse and diversion were those that: • received a rapid action opioids (n = 28; 67%) • received “a high dose” and “ a long term” benzodiazepines treatment (n = 35; 83%) • are drug users, most of them not in treatment with OST (n = 38; 90%)

  14. Conclusion • The study suggests that the pain opioid are effective and safe also in prison population with CNCP, including the drug users • The misuse and diversion episodes are more frequently associated in people treated with rapid onset opioids (67%), benzodiazepines (83%) and in drug users, specially if they are not in OST treatment (90%) • Long lasting opioids and a “correct” use of benzodiazepine may limit the misuse and diversion episodes • The study confirms that the expanded access to the OST in prison may be improve also the efficacy and the safety of the opioids used for CNCP

  15. Acknowledgement Debora Lageder – Penitentiaty Medicine and Drug Abuse Unit in Prison Padua

  16. Felice Nava, MD, PhD Director Penitentiary Medicine and Drug Abuse Unit in Prison Padua Tel. 049-8214904 Fax 049-8214908 felicealfonso.nava@aulss6.veneto.it Director Scientific Committee Italian Society of Addiction (FeDerSerD) www.federserd.it http://www.felice-nava.it felnava@tin.it

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