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Nisavic, Mladen

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Nisavic

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Mladen

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Nisavic, Mladen

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    Perioperative Buprenorphine Continuous Maintenance and Administration Simultaneous With Full Opioid Agonist; Patient Priority at the Interface Between Medical Disciplines
    (Physicians Postgraduate Press, Inc, 2020-01-07) Acampora, Gregory; Nisavic, Mladen; Zhang, Yi
    Buprenorphine is a partial-agonist opioid that is prescribed as a Medication-assisted treatment (MAT) for opioid use disorder (OUD). Buprenorphine is also a potent analgesic with high opioid-receptor (OR) affinity and binding co-efficient; when buprenorphine is administered simultaneously with a mu-opioid receptor full agonist (FAO), the combination can yield unexpected outcomes depending on dosing and timing. Buprenorphine is sometimes perceived as a powerful competitive opioid blocker that will hamper pharmacological management that requires the use of FAO. When patients receiving buprenorphine-MAT have come for operative procedures there has been clinical variance in approach to their MAT management. Recognizing the risk management challenge from both analgesia and MAT perspectives, we convened a multi-disciplinary group of clinicians who treat MAT patients and completed a literature review with the goal of generating a guideline for appropriate management of these patients presenting for a broad spectrum of surgical procedures. Our conclusion is that continuous simultaneous administration of buprenorphine products with FAO is safe when accounting for dose and timing, including surgeries that historically produce moderate to severe pain, and may further provide a beneficial analgesic synergy, less FAO burden and reduce relapse risk to this group.
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    (PO-176) Suicidal Ideation and Behavior During the COVID-19 Pandemic: A Retrospective, Single-Center Case Series
    (Elsevier BV, 2022-05) Sorg, Emily; Nisavic, Mladen; Beach, Scott; Maclean, Rachel; Kontos, Nicholas; Smith, Felicia
    Objective: In the few months since the first cases were reported, the coronavirus disease 2019 (COVID-19) has emerged as a global pandemic and significant source of morbidity and mortality. Case reports from early-hit countries raise concerns for potential worsening behavioral health outcomes, including suicidality, due to infection and/or related psychosocial and financial stressors. Our project offers an early examination of the impacts of the COVID-19 pandemic on suicidality for patients hospitalized at a tertiary hospital in a hard-hit urban area. Data Sources and Study Selection: We performed a retrospective chart review of all hospitalized adult patients who required psychiatric consultation during the first month of the COVID-19 outbreak (March 15, 2020 - April 15, 2020). Charts were reviewed for key demographic factors including COVID-19 infection status, premorbid/active behavioral health and substance use concerns, and presence of suicidality. Cases/Results: We present six cases, outlining important demographic, psychiatric, and psychosocial risk factors for suicidality in the setting of ongoing COVID-19 pandemic. We further contextualize the cases with additional data regarding all COVID-19 related consultations for suicidality during this period. Discussion: Our findings add to the growing literature on psychiatric implications of the COVID-19 pandemic and offer additional insights into potential risks factors for suicidality in vulnerable patient populations, as well as in patients with no premorbid psychiatric issues. Conclusion: To our knowledge, we present the first case series on suicidality coincident with the COVID-19 pandemic in a tertiary hospital setting. Further investigation of the topic is clearly warranted.