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What Johns Hopkins is Doing
As a steward of health care for our local communities, Johns Hopkins Medicine takes the challenges surrounding opioids very seriously. We see the devastation caused by substance use disorders firsthand. In keeping with our mission, our efforts include clinical care, medical education and research. We realize that the work we are doing here is just one piece of a vast, complicated puzzle.
Through a variety of clinical settings, we are treating existing disorders and preventing future addiction. For example, our Broadway Center for Addiction, located in East Baltimore, logs about 25,000 outpatient visits annually, providing comprehensive care and addressing not only medical issues but also mental health, social service and family needs. Other specialized programs help a range of populations affected by substance use disorder, including mothers and infants, and adolescents and young adults.
We have also implemented guidelines emphasizing wise prescribing of opioids, including limiting the number of doses for first time prescriptions and prohibiting automatic refills. Our hospital specialists are working with patients to find alternate ways to control pain. And we provide access to naloxone for patients with substance use disorder who visit our emergency department.
As educators, we are teaching the next generation of physicians these “best practices” in treatment and prevention by incorporating these principles into all aspects of their training.
Our research in this area dates back to the 1970s, starting with the original identification of the opioid receptor in the brain by Solomon Snyder, M.D., and continuing today through a multitude of current clinical trials.
Here is a list of our recent research:
- Researchers have found that activating nerve cell receptors along two chemical pathways — one that has previously been linked to how the brain senses “itch” — may improve pain relief when combined with conventional ways to blunt pain using opioid drugs, such as morphine. The team, which included Yun Guan, M.D., Ph.D., associate professor of anesthesiology and critical care medicine, Xinzhong Dong, Ph.D., professor of neuroscience, and Srinivasa Raja, M.D., professor of anesthesiology and critical care medicine and neurology, published the study results in Science Signaling in June 2018. The findings describe experiments in mice that suggest using chemical compounds to jointly activate these receptors may reduce the risk of opioid tolerance and central side effects — a problem common to highly addictive painkillers — by reducing the amount of opioids needed overall.
- A study led by Mark Bicket, M.D., assistant professor of anesthesiology and critical care, and a team of researchers adds to growing evidence that patients underuse pain medications, such as ibuprofen or acetaminophen, that reduce the need for opioids to manage pain after spine and joint surgery. A report on the findings, published in the journal Anesthesia & Analgesia in April 2018, also shows that patients improperly store and dispose of unused opioids.
- In a multicenter database study of adults who had undergone surgery for spinal deformities, orthopaedic surgery professor Khaled Kebaish, M.B.B.Ch., M.S., and a team of researchers found that those who had used opioids daily on average had worse outcomes after spine surgery, such as longer intensive care unit stays and more severe postop disability, compared with those who did not use opioids preoperatively. A report on the findings, published in Spine in March 2018, adds to evidence of the negative effects of preoperative opioid use on outcomes.
- In a review of a half-dozen published studies in which patients self-reported about use of opioids prescribed to them after surgery, Johns Hopkins researchers including Mark Bicket, M.D., an assistant professor of anesthesiology and critical care, reported that a substantial majority of patients used only some or none of the pills, and more than 90 percent failed to dispose of the leftovers in recommended ways. A summary of the review, published in August 2017 in JAMA Surgery, highlights the need for more personalized pain management to avoid overprescribing opioids and to reduce risks linked to improperly stored opioids in the home.
- Kelly Dunn, Ph.D., associate professor of psychiatry and behavioral sciences, recently reported on findings from a study that looked at a novel medication that might provide an alternative treatment for people who need to undergo opioid withdrawal. Published in JAMA Psychiatry, the findings could lead to new methods for helping to transition patients on to opioid blocking drugs.
- In a small study of opioid prescriptions filled at a Johns Hopkins Medicine outpatient pharmacy, lead researcher Bicket and his team found that handwritten orders for the drugs contribute heavily to a trio of prescribing and processing errors in contrast to those created electronically. The quality improvement study, which was published in the January/February 2017 issue of the Journal of Opioid Management, aimed to determine whether and how prescription processing methods contribute to variations, inconsistencies and errors in opioid distribution.
- Patrick Finan, Ph.D., assistant professor of psychiatry and behavioral sciences, is among researchers at Johns Hopkins who say they have found a link between negative emotions, such as sadness and anxiety, and higher opioid use in people with sickle cell disease whose pain levels were self-reported as relatively low. Their study, described online in September 2017 in The Journal of Pain, adds to efforts to better identify those at risk for overuse of opioids, improve pain control, and decrease dependency and the side effects of long-term opioid use.
- Lead investigator J. William McEvoy, M.B.B.Ch., M.H.S., assistant professor of medicine and member of the Ciccarone Center for the Prevention of Heart Disease at Johns Hopkins, and other Johns Hopkins researchers have found the routine use of fentanyl for sedation and comfort during coronary angiography reduces the effectiveness of the platelet blocking drug ticagrelor, and it doesn’t appear to provide any better pain relief than local anesthesia. McEnvoy presented his team’s finding at the European Society of Cardiology Congress in August 2017.