Evidence map›Paper›PMID 34216862›Full record

Trial reportDrug and alcohol dependence2021

Methadone maintenance patients lack analgesic response to a cumulative intravenous dose of 32 mg of hydromorphone.

Gabrielle Agin-Liebes, Andrew S Huhn, Eric C Strain, George E Bigelow, Michael T Smith, Robert R Edwards, Valerie A Gruber, D Andrew Tompkins

Open access · greenAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Drug and alcohol dependence, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 1 pooled it
1.0field-weighted citation impact, top 23% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 1 synthesis or guideline pooled it, 9 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Review
  4. Article
  5. Call for the Standardization of Opioid Related Terminologies.Translational perioperative and pain medicine · 2024
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 3 institutions in 1 country.

Gabrielle Agin-LiebesUniversity of California, San Francisco, Department of Psychiatry and Behavioral Sciences, 401 Parnassus Ave, San Francisco, CA, 94143, USA; Zuckerberg San Francisco General Hospital, 1001 Potrero Ave, Ward 95, San Francisco, CA, 94110, USA. Electronic address: gabrielle.agin-liebes@ucsf.edu.
Andrew S HuhnJohns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, 4940 Eastern Avenue, Baltimore, MD, 21224, USA.
Eric C StrainJohns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, 4940 Eastern Avenue, Baltimore, MD, 21224, USA.
George E BigelowJohns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, 4940 Eastern Avenue, Baltimore, MD, 21224, USA.
Michael T SmithJohns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, 4940 Eastern Avenue, Baltimore, MD, 21224, USA.
Robert R EdwardsHarvard Medical School, Brigham and Women's Hospital, Department of Anesthesiology, Perioperative, and Pain Medicine, 75 Francis St, Boston, MA, 02115, USA.
Valerie A GruberUniversity of California, San Francisco, Department of Psychiatry and Behavioral Sciences, 401 Parnassus Ave, San Francisco, CA, 94143, USA; Zuckerberg San Francisco General Hospital, 1001 Potrero Ave, Ward 95, San Francisco, CA, 94110, USA.
D Andrew TompkinsUniversity of California, San Francisco, Department of Psychiatry and Behavioral Sciences, 401 Parnassus Ave, San Francisco, CA, 94143, USA; Zuckerberg San Francisco General Hospital, 1001 Potrero Ave, Ward 95, San Francisco, CA, 94110, USA. Electronic address: david.tompkins@ucsf.edu.
Johns Hopkins University · USSan Francisco General Hospital · USBrigham and Women's Hospital · US

Funding

QAQC Johns Hopkins Institute for Clinical and Translational ResearchUL1TR003098 · NCATS · JOHNS HOPKINS UNIVERSITY · PI FORD, DANIEL ERNEST · 2019 to 2023
$57.7M
HUMAN BEHAVIORAL PHARMACOLOGY OF SUBSTANCE ABUSET32DA007209 · NIDA · JOHNS HOPKINS UNIVERSITY · PI Eric C. Strain, Elise M Weerts · 1985 to 2026
$12.9M
Substance Use Disorders Treatment/Services Research Training ProgramT32DA007250 · NIDA · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI Derek D Satre, Janice Y Tsoh · 1991 to 2026
$7.4M
Institute for Clinical and Translational ResearchUL1TR000424 · NCATS · JOHNS HOPKINS UNIVERSITY · PI FORD, DANIEL ERNEST · 2012 to 2012
$6.0M
Optimizing Pain Treatment while Reducing Abuse Liability in Opioid DependenceK23DA029609 · NIDA · JOHNS HOPKINS UNIVERSITY · PI TOMPKINS, DAVID ANDREW · 2012 to 2016
$929k
The Effect of Chronic Pain on Delay Discounting in Methadone PatientsR21DA047520 · NIDA · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI TOMPKINS, DAVID ANDREW · 2019 to 2020
$460k
NCATS NIH HHS UL1 TR000424NCATS NIH HHS UL1 TR003098NIDA NIH HHS K23 DA029609NIDA NIH HHS R21 DA047520NIDA NIH HHS T32 DA007209NIDA NIH HHS T32 DA007250
6 · The paper itself

Abstract

objectivesAcute pain management in patients with opioid use disorder who are maintained on methadone presents unique challenges due to high levels of opioid tolerance in this population. This randomized controlled study assessed the analgesic and abuse liability effects of escalating doses of acute intravenous (IV) hydromorphone versus placebo utilizing a validated experimental pain paradigm, quantitative sensory testing (QST).

methodsIndividuals (N = 8) without chronic pain were maintained on 80-100 mg/day of oral methadone. Participants received four IV, escalating/incremental doses of hydromorphone over 270 min (32 mg total) or four placebo doses within a session test day. Test sessions were scheduled at least one week apart. QST and abuse liability measures were administered at baseline and after each injection.

resultsNo significant differences between the hydromorphone and placebo control conditions on analgesic indices for any QST outcomes were detected. Similarly, no differences on safety or abuse liability indices were detected despite the high doses of hydromorphone utilized. Few adverse events were detected, and those reported were mild in severity.

conclusionsThe findings demonstrate that methadone-maintained individuals are highly insensitive to the analgesic effects of high-dose IV hydromorphone and may require very high doses of opioids, more efficacious opioids, or combined non-opioid analgesic strategies to achieve adequate analgesia.

Indexed as

HydromorphoneOpioid-Related DisordersAnalgesics, OpioidDrug ToleranceHumansMethadoneAnalgesics, OpioidHydromorphoneMethadoneAnalgesiaHydromorphoneMethadone maintenancePainQuantitative sensory testing

Identifiers

PMID34216862
PMCPMC9559787
OpenAlexW3175393268

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.