Faculty Bibliography

Methadone treatment (MT) for opioid use disorder saves lives, but the US MT system has long been dominated by punitive policies and practices that make MT inaccessible, burdensome, and traumatic for patients. After generations without changes to methadone regulations, a confluence of circumstance-including the COVID-19 pandemic and an overdose crisis that has taken over a million lives-has begun to shift the MT advocacy and political landscape. This commentary describes the building of the "Liberate Methadone" movement; a grassroots effort led by people with lived and living experience with methadone, addiction clinicians, researchers, community leaders, and people with many of these identities. The Liberate Methadone movement is dedicated to building a more accessible, equitable MT system that prioritizes patient health, promotes dignity, and is grounded in evidence. We describe the experience of planning and hosting a national conference and generating proceedings with recommendations for needed incremental and structural reforms within the US MT system. The lessons learned from this movement can motivate others across clinical, research, and policy roles to partner with and learn from patient and community-led groups, guiding needed reforms within systems of care. It is through these joint efforts and listening to those directly impacted groups who have been left out of the conversation for far too long, that we can successfully reduce overdose and suffering, toward better health, dignity, and thriving in our communities.

For 5 decades, US federal regulations have segregated methadone treatment for opioid use disorder from the rest of the health care system, confining its availability to specialty treatment programs that are highly regulated. These regulations have led to severe shortages in the availability of methadone and grave underutilization of this lifesaving medication despite a worsening overdose crisis. In this commentary, we discuss current barriers to methadone in the US opioid treatment system and how recent changes to federal regulations fall short of the reforms needed to significantly expand access to this treatment. Instead, we propose the urgent need to expand methadone to mainstream health care settings by allowing for office-based prescribing and pharmacy dispensing of methadone, the norm in many other developed countries.

INTRODUCTION/BACKGROUND:Ketorolac is useful in acute pain management to avoid opiate-related complications; however, some surgeons fear associated acute kidney injury (AKI) and bleeding despite a paucity of literature on ketorolac use in trauma patients. We hypothesized that our institution's use of intravenous ketorolac for rib fracture pain management did not increase the incidence of bleeding or AKI. METHODS:Rib fracture patients aged 15 years and above admitted between January 2016-June 2018 were identified in our trauma registry along with frequency of bleeding events. AKI was defined as ≥ 1.5x increase in serum creatinine from baseline measured on the second day of admission (after 24 hours of resuscitation) or an increase of ≥ .3 mg/dL over a 48-hour period. Patients receiving ketorolac were compared to patients with no ketorolac use. RESULTS:= .03). Logistic regression demonstrated that ketorolac use was not an independent predictor for AKI but age and admission SBP < 90 were. CONCLUSION/CONCLUSIONS:Use of ketorolac in this cohort of trauma patients with rib fractures did not increase the incidence of AKI or bleeding events.