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Edwards GF, Mierisch C, Mutcheson B, Strauss A, Coleman K, Horn K, Parker SH. Developing medical simulations for opioid overdose response training: A qualitative analysis of narratives from responders to overdoses. PLoS One 2024; 19:e0294626. [PMID: 38547079 PMCID: PMC10977769 DOI: 10.1371/journal.pone.0294626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/06/2023] [Indexed: 04/02/2024] Open
Abstract
Medical simulation offers a controlled environment for studying challenging clinical care situations that are difficult to observe directly. Overdose education and naloxone distribution (OEND) programs aim to train potential rescuers in responding to opioid overdoses, but assessing rescuer performance in real-life situations before emergency medical services arrive is exceedingly complex. There is an opportunity to incorporate individuals with firsthand experience in treating out-of-hospital overdoses into the development of simulation scenarios. Realistic overdose simulations could provide OEND programs with valuable tools to effectively teach hands-on skills and support context-sensitive training regimens. In this research, semi-structured interviews were conducted with 17 individuals experienced in responding to opioid overdoses including emergency department physicians, first responders, OEND program instructors, and peer recovery specialists. Two coders conducted qualitative content analysis using open and axial thematic coding to identify nuances associated with illicit and prescription opioid overdoses. The results are presented as narrative findings complemented by summaries of the frequency of themes across the interviews. Over 20 hours of audio recording were transcribed verbatim and then coded. During the open and axial thematic coding process several primary themes, along with subthemes, were identified, highlighting the distinctions between illicit and prescription opioid overdoses. Distinct contextual details, such as locations, clinical presentations, the environment surrounding the patient, and bystanders' behavior, were used to create four example simulations of out-of-hospital overdoses. The narrative findings in this qualitative study offer context-sensitive information for developing out-of-hospital overdose scenarios applicable to simulation training. These insights can serve as a valuable resource, aiding instructors and researchers in systematically creating evidence-based scenarios for both training and research purposes.
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Affiliation(s)
- G. Franklin Edwards
- Graduate Program in Translational Biology, Medicine, and Health, Virginia Tech, Blacksburg, Virginia, United States of America
| | - Cassandra Mierisch
- Department of Basic Science Education, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, United States of America
| | - Brock Mutcheson
- Office of Assessment and Program Evaluation, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, United States of America
| | - Allison Strauss
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, United States of America
| | - Keel Coleman
- Department of Emergency Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, United States of America
- Department of Emergency Medicine, Carilion Clinic, Roanoke, Virginia, United States of America
| | - Kimberly Horn
- Department of Population Health Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia, United States of America
- Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, United States of America
| | - Sarah Henrickson Parker
- Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, United States of America
- Department of Health Systems and Implementation Science, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, United States of America
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Goldfine CE, Chapman BP, Taylor MM, Bradley ES, Carreiro SP, Rosen RK, Babu KM, Lai JT. Experiences with Medications for Addiction Treatment Among Emergency Department Patients with Opioid Use Disorder. West J Emerg Med 2023; 24:236-242. [PMID: 36976598 PMCID: PMC10047725 DOI: 10.5811/westjem.2022.9.57821] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/19/2022] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION Medications for addiction treatment (MAT) are the evidence-based standard of care for treatment of opioid use disorder (OUD), but stigma continues to surround their use. We conducted an exploratory study to characterize perceptions of different types of MAT among people who use drugs. METHODS We conducted this qualitative study in adults with a history of non-medical opioid use who presented to an emergency department for complications of OUD. A semi-structured interview that explored knowledge, perceptions, and attitudes toward MAT was administered, and applied thematic analysis conducted. RESULTS We enrolled 20 adults. All participants had prior experience with MAT. Among participants indicating a preferred treatment modality, buprenorphine was the commonly favored agent. Previous experience with prolonged withdrawal symptoms upon MAT discontinuation and the perception of "trading one drug for another" were common reasons for reluctance to engage in agonist or partial-agonist therapy. While some participants preferred treatment with naltrexone, others were unwilling to initiate antagonist therapy due to fear of precipitated withdrawal. Most participants strongly considered the aversive nature of MAT discontinuation as a barrier to initiating treatment. Participants overall viewed MAT positively, but many had strong preferences for a particular agent. CONCLUSION The anticipation of withdrawal symptoms during initiation and cessation of treatment affected willingness to engage in a specific therapy. Future educational materials for people who use drugs may focus on comparisons of respective benefits and drawbacks of agonists, partial agonists, and antagonists. Emergency clinicians must be prepared to answer questions about MAT discontinuation to effectively engage patients with OUD.
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Affiliation(s)
- Charlotte E Goldfine
- Brigham and Women's Hospital, Division of Medical Toxicology, Department of Emergency Medicine, Boston, Massachusetts
| | - Brittany P Chapman
- University of Massachusetts Chan Medical School, Division of Medical Toxicology, Department of Emergency Medicine, Worcester, Massachusetts
| | - Melissa M Taylor
- University of Massachusetts Chan Medical School, Division of Medical Toxicology, Department of Emergency Medicine, Worcester, Massachusetts
| | - Evan S Bradley
- University of Massachusetts Chan Medical School, Division of Medical Toxicology, Department of Emergency Medicine, Worcester, Massachusetts
| | - Stephanie P Carreiro
- University of Massachusetts Chan Medical School, Division of Medical Toxicology, Department of Emergency Medicine, Worcester, Massachusetts
| | - Rochelle K Rosen
- Brown University School of Public Health, Department of Behavioral and Social Sciences, Providence, Rhode Island
| | - Kavita M Babu
- University of Massachusetts Chan Medical School, Division of Medical Toxicology, Department of Emergency Medicine, Worcester, Massachusetts
| | - Jeffrey T Lai
- University of Massachusetts Chan Medical School, Division of Medical Toxicology, Department of Emergency Medicine, Worcester, Massachusetts
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Khatri UG, Samuels EA, Xiong R, Marshall BDL, Perrone J, Delgado MK. Variation in emergency department visit rates for opioid use disorder: Implications for quality improvement initiatives. Am J Emerg Med 2021; 51:331-337. [PMID: 34800906 DOI: 10.1016/j.ajem.2021.10.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 12/18/2022] Open
Abstract
STUDY OBJECTIVE Emergency departments (ED) are critical touchpoints for encounters among patients with opioid use disorder (OUD), but implementation of ED initiated treatment and harm reduction programs has lagged. We describe national patient, visit and hospital-level characteristics of ED OUD visits and characterize EDs with high rates of OUD visits in order to inform policies to optimize ED OUD care. METHODS We conducted a descriptive, cross-sectional study with the 2017 Nationwide Emergency Department Sample (NEDS) from the Healthcare Cost and Utilization Project, using diagnostic and mechanism of injury codes from ICD-10 to identify OUD related visits. NEDS weights were applied to generate national estimates. We evaluated ED visit and clinical characteristics of all OUD encounters. We categorized hospitals into quartiles by rate of visits for OUD per 1000 ED visits and described the visit, clinical, and hospital characteristics across the four quartiles. RESULTS In 2017, the weighted national estimate for OUD visits was 1,507,550. Overdoses accounted for 295,954. (19.6%) of visits. OUD visit rates were over 8× times higher among EDs in the highest quartile of OUD visit rate (22.9 per 1000 total ED visits) compared with EDs in the lowest quartile of OUD visit rate (2.7 per 1000 ED visits). Over three fifths (64.2%) of all OUD visits nationwide were seen by the hospitals in the highest quartile of OUD visit rate. These hospitals were predominantly in metropolitan areas (86.2%), over half were teaching hospitals (51.7%), and less than a quarter (23.3%) were Level 1 or Level 2 trauma centers. CONCLUSION Targeting initial efforts of OUD care programs to high OUD visit rate EDs could improve care for a large portion of OUD patients utilizing emergency care.
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Affiliation(s)
- Utsha G Khatri
- National Clinician Scholars Program, Corporal Michael J. Crescenz Veterans Affairs Medical Center, University of Pennsylvania, Philadelphia, United States of America; Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, NY, New York, United States of America; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, United States of America.
| | - Elizabeth A Samuels
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Ruiying Xiong
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States of America
| | - Jeanmarie Perrone
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, United States of America; Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - M Kit Delgado
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, United States of America; Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America; Perelman School of Medicine, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, United States of America
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Mauro PM, Philbin MM, Greene ER, Askari MS, Martins SS. Medical and Non-Medical Opioid Use at the Intersection of Gender and Sexual Identity: Associations with State Medical Cannabis Law Status in a U.S. National Sample of Adults. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:3551-3561. [PMID: 34751862 PMCID: PMC8729119 DOI: 10.1007/s10508-021-02128-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 08/05/2021] [Accepted: 08/05/2021] [Indexed: 06/13/2023]
Abstract
At the structural level, medical cannabis laws (MCLs) have been negatively associated with opioid prescribing practices, and sexual minority adults report disproportionately high non-medical prescription opioid use. We examined medical/non-medical prescription opioid use by intersecting sexual identity and gender and explored associations with MCLs using the 2015-2017 National Survey on Drug Use and Health, which captured sexual identity and MCL state residence for adults 18 + years (N = 126,463). Survey-weighted gender-stratified multinomial logistic models estimated adjusted relative risk ratios (aRRR) of medical vs. no prescription opioid use, and any non-medical vs. no prescription opioid use, by sexual identity and MCL, and tested moderation by MCL. Past-year medical prescription opioid use was higher among women than men across sexual identities (e.g., bisexual: 38.5% women vs. 30.2% men). Non-medical prescription opioid use was lower among women than men, except for bisexual adults (12.4% women vs. 7.6% men). MCL was associated with lower medical prescription opioid vs. no use among heterosexual women (aRRR = 0.86, 95% confidence interval [CI] = 0.81-0.91), bisexual women (aRRR = 0.74, 95% CI = 0.62-0.89), and heterosexual men (aRRR = 0.91, 95% CI = 0.85-0.97). Living in an MCL state was associated with lower non-medical vs. no use among heterosexual and bisexual women, but not among men or lesbian/gay women. MCL status did not moderate associations between sexual identity and prescription opioid outcomes. Future studies should assess whether implementing MCLs could particularly affect bisexual women who reported the highest prescription opioid use and may need targeted services.
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Affiliation(s)
- Pia M Mauro
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th Street, New York, NY, 10032, USA.
| | - Morgan M Philbin
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Emily R Greene
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th Street, New York, NY, 10032, USA
| | - Melanie S Askari
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th Street, New York, NY, 10032, USA
| | - Silvia S Martins
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th Street, New York, NY, 10032, USA
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Patel AM, Carroll NV, Wheeler DC, Rose SR, Nadpara PA, Pakyz AL, Ijioma SC. Economic burden of pediatric prescription opioid poisonings in the United States. J Manag Care Spec Pharm 2020; 27:16-26. [PMID: 33377438 PMCID: PMC10391177 DOI: 10.18553/jmcp.2021.27.1.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: Among the different drugs involved in pediatric exposures and poisonings, opioids are the most important, given their rise in nonmedical use. Opioid poisonings in children can result in serious symptoms or complications, including respiratory disorders such as apnea, respiratory failure, and respiratory depression; psychiatric or nervous system disorders such as agitation, seizures, and coma; and cardiac disorders such as tachycardia, bradycardia, and cardiac arrest. Opioid poisonings in children can have delayed onset of symptoms as well as severe and prolonged toxic effects. Many studies have examined the economic burden of opioid poisoning in the general population, but very little is known about the pediatric population. OBJECTIVE: To estimate the economic burden associated with pediatric prescription opioid poisonings. METHODS: This study examined opioid poisonings in pediatric patients, defined as patients aged less than 18 years, for the 2012 base year. Costs were estimated using the 2012 Nationwide Emergency Department Sample (NEDS), Kids' Inpatient Database (KID), Multiple Cause-of-Death (MCOD) file, and other published sources, while applying a societal perspective. The Bottom Up approach was used to estimate the total cost of pediatric prescription opioid poisonings. Direct costs included costs associated with emergency department (ED) visits, hospitalizations, and ambulance transports. Indirect costs were estimated using the human capital method and included productivity costs due to caregivers' absenteeism and premature mortality among children. Descriptive statistics were employed in calculating costs. RESULTS: The total costs of pediatric prescription opioid poisonings and exposure in the United States were $230.8 million in 2012. Total direct costs were estimated to be over $21.1 million, the majority resulting from prescription opioid poisoning-related inpatient stays. Total indirect (productivity) costs were calculated at $209.7 million, and 98.6% of these costs were attributed to opioid poisoning-related mortality. Pediatric prescription opioid poisoning-related ED visits, inpatient stays, and deaths were most common in patients aged 13-17 years and those in mid to large urban areas. Most were unintentional. CONCLUSIONS: Pediatric prescription opioid poisonings resulted in direct and indirect costs of $230.8 million in 2012. While these costs are low in comparison with the costs of prescription opioid poisoning in the general population, the number of pediatric poisonings represents only a small fraction of total poisonings. Quantified costs associated with pediatric prescription opioid poisonings can help decision makers to understand the economic trade-offs in planning interventions. DISCLOSURES: This research had no external funding but was funded by an unrestricted research grant made to the Department of Pharmacotherapy & Outcomes Science by kaléo Pharma, maker of a naloxone product. The authors declare no conflicts of interest or financial interests. Portions of this study were presented as an abstract at the 22nd Annual ISPOR Meeting; May 22, 2017; Boston, MA.
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Affiliation(s)
- Anisha M Patel
- Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University, Richmond
| | - Norman V Carroll
- Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University, Richmond
| | - David C Wheeler
- Department of Biostatistics, Virginia Commonwealth University, Richmond
| | - S Rutherfoord Rose
- Department of Emergency Medicine, Virginia Commonwealth University, Richmond
| | - Pramit A Nadpara
- Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University, Richmond
| | - Amy L Pakyz
- Department of Pharmacotherapy & Outcomes Science (deceased), Virginia Commonwealth University, Richmond
| | - Stephen C Ijioma
- Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University, Richmond
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Mortality Following Nonfatal Opioid and Sedative/Hypnotic Drug Overdose. Am J Prev Med 2020; 59:59-67. [PMID: 32389530 PMCID: PMC7311279 DOI: 10.1016/j.amepre.2020.02.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Opioid and sedative/hypnotic drug overdoses are major causes of morbidity in the U.S. This study compares 12-month incidence of fatal unintentional drug overdose, suicide, and other mortality among emergency department patients presenting with nonfatal opioid or sedative/hypnotic overdose. METHODS This is a retrospective cohort study using statewide, longitudinally linked emergency department patient record and mortality data from California. Participants comprised all residents presenting to a licensed emergency department at least once in 2009-2011 with nonfatal unintentional opioid overdose, sedative/hypnotic overdose, or neither (a 5% random sample). Participants were followed for 1 year after index emergency department presentation to assess death from unintentional overdose, suicide, or other causes, ascertained using ICD-10 codes. Absolute death rates per 100,000 person years and standardized mortality ratios relative to the general population were calculated. Data were analyzed February-August 2019. RESULTS Following the index emergency department visit, unintentional overdose death rates per 100,000 person years were 1,863 following opioid overdose, 342 following sedative/hypnotic overdose, and 31 for reference patients without an index overdose (respective standardized mortality ratios of 106.1, 95% CI=95.2, 116.9; 24.5, 95% CI=21.3, 27.6; and 2.6, 95% CI=2.2, 3.0). Suicide mortality rates per 100,000 were 319, 174, and 32 following opioid overdose, sedative/hypnotic overdose, and reference visits, respectively. Natural causes mortality rates per 100,000 were 8,058 (opioid overdose patients), 17,301 (sedative/hypnotic overdose patients), and 3,097 (reference patients). CONCLUSIONS Emergency department patients with nonfatal opioid or sedative/hypnotic drug overdose have exceptionally high risks of death from unintentional overdose, suicide, and other causes. Emergency department-based interventions offer potential for reducing these patients' overdose and other mortality risks.
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Coupet E, Werner RM, Polsky D, Karp D, Delgado MK. Impact of the Young Adult Dependent Coverage Expansion on Opioid Overdoses and Deaths: a Quasi-Experimental Study. J Gen Intern Med 2020; 35:1783-1788. [PMID: 31898130 PMCID: PMC7280374 DOI: 10.1007/s11606-019-05605-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 09/27/2019] [Accepted: 12/05/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Several policymakers have suggested that the Affordable Care Act (ACA) has fueled the opioid epidemic by subsidizing opioid pain medications. These claims have supported numerous efforts to repeal the ACA. OBJECTIVE To determine the effect of the ACA's young adult dependent coverage insurance expansion on emergency department (ED) encounters and out-of-hospital deaths from opioid overdose. DESIGN Difference-in-differences analyses comparing ED encounters and out-of-hospital deaths before (2009) and after (2011-2013) the ACA young adult dependent coverage expansion. We further stratified by prescription opioid, non-prescription opioid, and methadone overdoses. PARTICIPANTS Adults aged 23-25 years old and 27-29 years old who presented to the ED or died prior to reaching the hospital from opioid overdose. MAIN MEASURES Rate of ED encounters and deaths for opioid overdose per 100,000 U.S. adults. KEY RESULTS There were 108,253 ED encounters from opioid overdose in total. The expansion was not associated with a significant change in the ED encounter rates for opioid overdoses of all types (2.04 per 100,000 adults [95% CI - 0.75 to 4.82]), prescription opioids (0.60 per 100,000 adults [95% CI - 1.98 to 0.77]), or methadone (0.29 per 100,000 adults [95% CI - 0.78 to 0.21]). There was a slight increase in the rate of non-prescription opioid overdoses (1.91 per 100,000 adults [95% CI 0.13-3.71]). The expansion was not associated with a significant change in the out-of-hospital mortality rates for opioid overdoses of all types (0.49 per 100,000 adults [95% CI - 0.80 to 1.78]). CONCLUSIONS Our findings do not support claims that the ACA has fueled the prescription opioid epidemic. However, the expansion was associated with an increase in the rate of ED encounters for non-prescription opioid overdoses such as heroin, although almost all were non-fatal. Future research is warranted to understand the role of private insurance in providing access to treatment in this population.
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Affiliation(s)
- Edouard Coupet
- Department of Emergency Medicine, Yale School of Medicine, Yale University, 464 Congress Avenue, Suite 260, New Haven, CT, 06519, USA.
- Yale Drug Use, Addiction, and HIV Research Scholars (DAHRS) Program, New Haven, USA.
- Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
| | - Rachel M Werner
- Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Department of Health Care Management, The Wharton School, University of Pennsylvania, Philadelphia, USA
| | - Daniel Polsky
- Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Department of Health Care Management, The Wharton School, University of Pennsylvania, Philadelphia, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA
- Department of Health Economics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - David Karp
- Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - M Kit Delgado
- Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Penn Injury Science Center, University of Pennsylvania, Philadelphia, USA
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Krishnaswami S, Mukhopadhyay S, McPheeters M, Nechuta SJ. Prescribing patterns before and after a non-fatal drug overdose using Tennessee's controlled substance monitoring database linked to hospital discharge data. Prev Med 2020; 130:105883. [PMID: 31704283 DOI: 10.1016/j.ypmed.2019.105883] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 10/04/2019] [Accepted: 11/04/2019] [Indexed: 01/08/2023]
Abstract
We performed a statewide evaluation of prescribing patterns of controlled substances (CS) before and after an overdose, using Tennessee's Hospital Discharge Data System and the Controlled Substance Monitoring Database (CSMD). Adults' first non-fatal overdose discharges either from the emergency department (ED) or inpatient (IP) stay occurring between 2013 and 2016 were linked to prescriptions in the CSMD. The difference in the proportion of patients filling a prescription before versus after an overdose was calculated. Included were 49,398 patients with an overdose and a prescription record; most (60.5%) were treated in the ED. Among any drug type overdose the percentage of patients who filled a CS prescription within a year of experiencing an overdose was as follows: opioid analgesics: 59.1%, benzodiazepines: 37.3%, stimulants: 5.0%, muscle relaxants: 3.4%, concurrent opioid-benzodiazepines: 24.0% with the percent difference from before to after similar in both settings. Among patients treated for an opioid overdose, this represented a decrease in opioid analgesics filled by 9.7% (95%CI: -11.2, -8.3) among those treated in the ED, and by 7.1% (95% CI: -8.3, -5.9) among treated inpatients. Among patients treated for a heroin overdose, 12.2% (95%CI: -15.2, -9.3) fewer of those treated in the ED and 8.8% (95%CI: -15.0, -2.7%) fewer of treated inpatients filled a CS prescription in that year. The most common opioid analgesics included hydrocodone and oxycodone. The number of patients filling buprenorphine for treatment increased in the year after overdoses associated with any drug or opioids but decreased among those treated for a heroin overdose.
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Affiliation(s)
- Shanthi Krishnaswami
- Tennessee Department of Health, Office of Informatics and Analytics, 710 James Robertson Parkway, Nashville, TN 37243, United States.
| | - Sutapa Mukhopadhyay
- Tennessee Department of Health, Office of Informatics and Analytics, 710 James Robertson Parkway, Nashville, TN 37243, United States
| | - Melissa McPheeters
- Tennessee Department of Health, Office of Informatics and Analytics, 710 James Robertson Parkway, Nashville, TN 37243, United States; Departments of Health Policy and Biomedical Informatics, Vanderbilt University Medical Center, 2525 West End Avenue, 408B, Nashville, TN 37203, United States
| | - Sarah J Nechuta
- Tennessee Department of Health, Office of Informatics and Analytics, 710 James Robertson Parkway, Nashville, TN 37243, United States; Department of Public Health, Grand Valley State University, 500 Lafayette Ave Northeast, Grand Rapids, MI 49503, United States
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Goedel WC, Marshall BDL, Samuels EA, Brinkman MG, Dettor D, Langdon KJ, Mahoney LA, Merchant RC, Nizami T, O'Toole GA, Ramsey SE, Yedinak JL, Beaudoin FL. Randomised clinical trial of an emergency department-based peer recovery support intervention to increase treatment uptake and reduce recurrent overdose among individuals at high risk for opioid overdose: study protocol for the navigator trial. BMJ Open 2019; 9:e032052. [PMID: 31719087 PMCID: PMC6858243 DOI: 10.1136/bmjopen-2019-032052] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 10/15/2019] [Accepted: 10/16/2019] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Effective approaches to increase engagement in treatment for opioid use disorder (OUD) and reduce the risk of recurrent overdose and death following emergency department (ED) presentation for opioid overdose remain unknown. As such, we aim to compare the effectiveness of behavioural interventions delivered in the ED by certified peer recovery support specialists relative to those delivered by licensed clinical social workers (LCSWs) in promoting OUD treatment uptake and reducing recurrent ED visits for opioid overdose. METHODS AND ANALYSIS Adult ED patients who are at high risk for opioid overdose (ie, are being treated for an opioid overdose or identified by the treating physician as having OUD) (n=650) will be recruited from two EDs in a single healthcare system in Providence, Rhode Island into a two-arm randomised trial with 18 months of follow-up postrandomisation. Eligible participants will be randomly assigned (1:1) in the ED to receive a behavioural intervention from a certified peer recovery support specialist or a behavioural intervention from an LCSW. The primary outcomes are engagement in formal OUD treatment within 30 days of the initial ED visit and recurrent ED visits for opioid overdose within 18 months of the initial ED visit, as measured through statewide administrative records. ETHICS AND DISSEMINATION This protocol was approved by the Rhode Island Hospital institutional review board (Approval Number: 212418). Data will be presented at national and international conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03684681.
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Affiliation(s)
- William C Goedel
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Elizabeth A Samuels
- Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Mark G Brinkman
- Department of Emergency Medicine, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Debra Dettor
- Anchor Recovery Community Center, Pawtucket, Rhode Island, USA
| | - Kirsten J Langdon
- Department of Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Linda A Mahoney
- Rhode Island Department of Behavioral Healthcare Developmental Disabilities and Hospitals, Cranston, Rhode Island, USA
| | - Roland C Merchant
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
- Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Tarek Nizami
- Department of Emergency Medicine, Rhode Island Hospital, Providence, Rhode Island, USA
| | | | - Susan E Ramsey
- Department of Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
- Department of Medicine, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Jesse L Yedinak
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Francesca L Beaudoin
- Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
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Deatherage Kaiser BL, Jacobs JM, Schepmoes AA, Brewer HM, Webb-Robertson BJM, Valtier S, Bebarta VS, Adkins JN. Assessment of the Utility of the Oral Fluid and Plasma Proteomes for Hydrocodone Exposure. J Med Toxicol 2019; 16:49-60. [PMID: 31677050 DOI: 10.1007/s13181-019-00731-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 08/04/2019] [Accepted: 08/14/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Non-medical use and abuse of prescription opioids is a growing problem in both the civilian and military communities, with minimal technologies for detecting hydrocodone use. This study explored the proteomic changes that occur in the oral fluid and blood plasma following controlled hydrocodone administration in 20 subjects. METHODS The global proteomic profile was determined for samples taken at four time points per subject: pre-exposure and 4, 6, or 168 hours post-exposure. The oral fluid samples analyzed herein provided greater differentiation between baseline and response time points than was observed with blood plasma, at least partially due to significant person-to-person relative variability in the plasma proteome. RESULTS A total of 399 proteins were identified from oral fluid samples, and the abundance of 118 of those proteins was determined to be significantly different upon metabolism of hydrocodone (4 and 6 hour time points) as compared to baseline levels in the oral fluid (pre-dose and 168 hours). CONCLUSIONS We present an assessment of the oral fluid and plasma proteome following hydrocodone administration, which demonstrates the potential of oral fluid as a noninvasive sample that may reveal features of hydrocodone in opioid use, and with additional study, may be useful for other opioids and in settings of misuse.
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Affiliation(s)
- Brooke L Deatherage Kaiser
- Chemical and Biological Signature Sciences Group, Pacific Northwest National Laboratory, Richland, WA, USA
| | - Jon M Jacobs
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA, USA
| | - Athena A Schepmoes
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA, USA
| | - Heather M Brewer
- Environmental Molecular Sciences Laboratory, Pacific Northwest National Laboratory, Richland, WA, USA
| | | | - Sandra Valtier
- Science and Technology, 59th Medical Wing, JBSA-Lackland AFB, San Antonio, TX, USA
| | | | - Joshua N Adkins
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA, USA
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11
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Mountcastle SB, Joyce AR, Sasinowski M, Costello N, Doshi S, Zedler BK. Validation of an administrative claims coding algorithm for serious opioid overdose: A medical chart review. Pharmacoepidemiol Drug Saf 2019; 28:1422-1428. [PMID: 31483548 DOI: 10.1002/pds.4886] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 07/24/2019] [Accepted: 07/25/2019] [Indexed: 12/30/2022]
Abstract
PURPOSE A standardized definition for serious opioid overdose has not been clearly established for disease surveillance or assessing the impact of risk mitigation strategies. The purpose of this study was to use medical chart review to clinically validate a claims-based algorithm to identify serious opioid overdose events. METHODS The algorithm for serious opioid overdose required an opioid poisoning or external cause ICD-9-CM code occurring within 1 day of (a) an adverse effect code for serious central nervous system or respiratory depression or (b) a mechanical ventilation or critical care CPT code. The claims coding algorithm identified a sample of 145 individuals 18 years or older among patients that presented to the emergency department of two large hospitals in metropolitan Atlanta, Georgia from January 2014 to August 2015. Claims-defined cases were evaluated against rigorous clinical definitions for serious opioid overdose using (a) literature-based criteria for typical clinical manifestations of opioid overdose and/or (b) clinical response to the opioid-specific reversal agent naloxone. The positive predictive value (PPV) for a serious opioid overdose was calculated as the percentage of clinically confirmed cases (definite or probable). RESULTS Among 140 evaluable claims-defined cases, 107 fulfilled clinical criteria for a serious opioid overdose [95 definite and 12 probable; PPV of 76.4% (95% CI 69.4%, 83.5%)]. Among 30 nonconfirmed cases, 20 were polyintoxications involving one or more nonopioid psychoactive agents. CONCLUSIONS An administrative claims coding algorithm for serious opioid overdose had high clinical predictive performance in a medical chart review.
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12
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Fendrich M, Becker J, Hernandez-Meier J. Psychiatric symptoms and recent overdose among people who use heroin or other opioids: Results from a secondary analysis of an intervention study. Addict Behav Rep 2019; 10:100212. [PMID: 31692644 PMCID: PMC6806381 DOI: 10.1016/j.abrep.2019.100212] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 08/05/2019] [Accepted: 08/06/2019] [Indexed: 11/30/2022] Open
Abstract
Background Drug overdose (OD) is the leading cause of accidental death in the United States and most of these deaths involve opioids. Despite research linking opioid abuse to mental illness, and evidence suggesting a large portion of opioid OD deaths are suicides, OD prevention strategies scarcely take into account mental health risk factors. Methods We examined a sample of heroin or other opioid users enrolled in an intervention study to determine the prevalence of overdose, the prevalence of suicide attempts in overdose, and whether those with higher levels of psychiatric symptomatology would be more likely to experience a recent OD compared to other opioid users. By performing bivariate analyses and multivariate logistic regression models that controlled for poly drug use, criminal justice status, age, race, gender, and education, we evaluated the association of severe depression, severe anxiety, posttraumatic stress disorder (PTSD) and, psychosis and past three-month OD. Results Just over 12% (45/368) of recent opioid users reported a recent overdose. Four of these recent overdose victims reported that the overdose was a suicide attempt. Multiple logistic regression analysis revealed that severe depression (odds ratio 2.46; 95% CI: 1.24, 4.89), PTSD (odds ratio: 2.77; 95% CI: 1.37–5.60) and psychosis (odds ratio 2.39; 95% CI: 1.10–5.15) were significantly associated with elevated odds for OD. Conclusions Findings suggest systematic mental health symptom screening and connection to mental health treatment for opioid users—especially those identified with OD—may be critical for OD prevention. A sample of recent opioid users in an intervention study was examined Over 10% of the study sample of recent opioid users reported a recent overdose Almost 9% of recent overdose victims reported that the overdose was a suicide attempt Depressive symptoms, PTSD, and psychosis were associated with recent overdose OD risk assessment tools should include validated mental health screening
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Affiliation(s)
- Michael Fendrich
- School of Social Work, University of Connecticut, 38 Prospect St., Hartford, CT 06103, United States of America
| | - Jessica Becker
- School of Social Work, University of Connecticut, 38 Prospect St., Hartford, CT 06103, United States of America
| | - Jennifer Hernandez-Meier
- Department of Emergency Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, United States of America
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13
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Management of Opioid Overdose Victims Outside the Emergency Department: A Case Discussion. J Emerg Nurs 2019; 45:12-15. [DOI: 10.1016/j.jen.2018.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 08/06/2018] [Accepted: 08/29/2018] [Indexed: 11/21/2022]
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14
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Foley M, Schwab-Reese LM. Associations of state-level rates of depression and fatal opioid overdose in the United States, 2011-2015. Soc Psychiatry Psychiatr Epidemiol 2019; 54:131-134. [PMID: 30173316 DOI: 10.1007/s00127-018-1594-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 08/20/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To assess the relationship between state-level depression and opioid overdose deaths between 2011 and 2015 in the United States. METHODS We assessed the association between percent of state populations reporting depression diagnoses and number of opioid analgesic-related deaths using negative binomial generalized estimating equations. RESULTS A 1% point increase in state-level depression diagnoses was associated with a 26% (95% CI 1-58%) increase in opioid analgesic-related deaths. CONCLUSIONS Addressing depression in the provider-patient relationship may be important, as may be addressing the mental health provider shortage in the United States.
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Affiliation(s)
- Madeline Foley
- University of Colorado, CU Science Discovery, 3400 Marine St., Boulder, CO, 80301, USA
| | - Laura M Schwab-Reese
- The Kempe Center for The Prevention and Treatment of Child Abuse and Neglect, University of Colorado, Anschutz Medical Campus, 13123 E 16th Ave., Aurora, CO, 80045, USA. .,Department of Health and Kinesiology, Purdue University, 800 W Stadium Ave., Lafayette, IN, 47905, USA.
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15
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Sevigny EL, Caces MF. When DAWN went dark: Can the Nationwide Emergency Department Sample (NEDS) fill the surveillance gap left by the discontinued Drug Abuse Warning Network (DAWN)? Drug Alcohol Depend 2018; 192:201-207. [PMID: 30268070 DOI: 10.1016/j.drugalcdep.2018.07.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/27/2018] [Accepted: 07/30/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study assessed whether the Nationwide Emergency Department Sample (NEDS) could reliably fill the national drug surveillance gap caused by the discontinuation of the Drug Abuse Warning Network (DAWN). METHODS Estimates of the drug-related emergency department (ED) visits derived from DAWN (2004-2011) and NEDS (2006-2013). Estimates of the underlying reason for the drug-related ED visit, patient characteristics, and the specific drugs involved were compared for 2011, the most recent overlapping data year in DAWN and NEDS. Trends in ED visits for major drugs of abuse were then compared over the period 2004-2013. RESULTS In 2011, DAWN and NEDS produced statistically similar estimates of the overall number of drug-related ED visits (5.1 vs. 4.9 million) and those involving drug misuse or abuse (2.65 vs. 2.77 million). Among the latter, estimates by gender, age group, and patient disposition were generally consistent across data systems, suggesting that NEDS and DAWN samples draw from a similar population. Main analyses reveal statistically similar estimates across data systems in both levels and trends for cocaine, amphetamines, and narcotic pain relievers. In contrast, the number of ED visits for sedatives and heroin was significantly undercounted in NEDS, whereas marijuana-related ED visits were undercounted in DAWN. CONCLUSIONS This study demonstrates the utility of NEDS for conducting post-DAWN drug surveillance. Because NEDS cannot provide targeted surveillance of certain established (e.g., heroin) and emerging (e.g., fentanyl) drugs, however, it is critical that a data system that employs medical record-based reviews be implemented to augment the known weaknesses of NEDS.
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Affiliation(s)
- Eric L Sevigny
- Department of Criminal Justice and Criminology, Andrew Young School of Policy Studies, Georgia State University, Atlanta, GA 30303, USA.
| | - M Fe Caces
- Office of National Drug Control Policy, Executive Office of the President, Washington DC, 20503, USA.
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16
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Cipriano LE, Zaric GS. Cost-effectiveness of naloxone kits in secondary schools. Drug Alcohol Depend 2018; 192:352-361. [PMID: 30321745 DOI: 10.1016/j.drugalcdep.2018.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 08/02/2018] [Accepted: 08/04/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND We seek to identify conditions under which a plan by the Toronto District School Board (TDSB) to equip high schools with naloxone kits would be cost-effective. METHODS We developed a decision-analytic model to evaluate the costs, benefits, and cost-effectiveness of a school-based naloxone program. We estimated model inputs from the medical literature and used Toronto-specific sources whenever available. We present our results varying both the expected total number of opioid overdoses per year across all 112 TDSB high schools and the effectiveness of a school-based naloxone program in reducing mortality. RESULTS A school naloxone program likely costs less than CAD$50,000 per quality-adjusted life-year gained if the overdose frequency is at least once each year and it reduces opioid poisoning mortality by at least 40% (from 10% to <6.0%) or if the overdose frequency is at least two per year and the program reduces mortality by at least 20% (from 10% to <8.0%). The results are sensitive to the intensity and cost of staff training, the lifetime costs and life-expectancy of overdose survivors, and the probability of an overdose being fatal in the absence of a school naloxone program. CONCLUSIONS School naloxone programs are relatively inexpensive, but that does not ensure that they are a cost-effective use of resources. While potentially cost-effective, if the risk of an overdose in a Toronto high school is low, then other programs aimed at improving the health and wellbeing of students may be better use of limited resources.
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Affiliation(s)
- Lauren E Cipriano
- Ivey Business School, Western University, London, ON, N6G 0N1, Canada; Department of Biostatistics and Epidemiology, Schulich School of Medicine and Dentistry, Western University, London, ON, N6A 5C1, Canada.
| | - Gregory S Zaric
- Ivey Business School, Western University, London, ON, N6G 0N1, Canada; Department of Biostatistics and Epidemiology, Schulich School of Medicine and Dentistry, Western University, London, ON, N6A 5C1, Canada
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17
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Ryan SA, Dunne RB. Pharmacokinetic properties of intranasal and injectable formulations of naloxone for community use: a systematic review. Pain Manag 2018; 8:231-245. [DOI: 10.2217/pmt-2017-0060] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Aim: To assess the pharmacokinetic properties of community-use formulations of naloxone for emergency treatment of opioid overdose. Methods: Systematic literature review based on searches of established databases and congress archives. Results: Seven studies met inclusion criteria: two of US FDA-approved intramuscular (im.)/subcutaneous (sc.) auto-injectors, one of an FDA-approved intranasal spray, two of unapproved intranasal kits (syringe with atomizer attachment) and two of intranasal products in development. Conclusion: The pharmacokinetics of im./sc. auto-injector 2 mg and approved intranasal spray (2 and 4 mg) demonstrated rapid uptake and naloxone exposure exceeding that of the historic benchmark (0.4 mg im.), indicating that naloxone exposure was adequate for reversal of opioid overdose.
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Affiliation(s)
- Shawn A Ryan
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, 45267 USA
- BrightView Health, Cincinnati, OH, 45206 USA
| | - Robert B Dunne
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, 48202 USA
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18
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Abstract
To provide an update on prescription of naloxone as a harm-reduction strategy, PubMed was searched to identify publications relevant to naloxone prescribing for reversal of opioid overdose. Opportunities now exist to expand naloxone use, although evidence suggests these are often missed or underexploited. The US FDA has approved an intranasal naloxone spray and an autoinjector naloxone formulation for community use. Effective use of naloxone in community settings requires screening to identify patients at risk of opioid overdose, discussing naloxone use with patients and their relatives, and providing appropriate training. The tools exist to expand the use of naloxone more widely into the community, thereby creating an opportunity to reduce opioid overdose fatalities.
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Affiliation(s)
- Robert B Dunne
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI 48202, USA
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19
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Opioid prescribing and risk mitigation implementation in the management of acute pain: Results from The National Dental Practice-Based Research Network. J Am Dent Assoc 2018; 149:353-362. [PMID: 29550022 DOI: 10.1016/j.adaj.2017.11.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/26/2017] [Accepted: 11/14/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Minimal information exists regarding the consistency and correlates of dentists' implementation of risk mitigation strategies when prescribing opioids, including risk screening, prescription drug monitoring program (PDMP) use, and patient education. METHODS The authors conducted a Web-based, cross-sectional survey among practicing dentist members of The National Dental Practice-Based Research Network. The authors used the survey to assess pain management prescribing practices and risk mitigation implementation. The authors linked survey data with network enrollment questionnaire data to include practitioner demographic and practice characteristics. RESULTS A total of 822 dentists completed the survey. A minority of dentists reported prescribing opioids only (11%) or opioids in combination with a recommendation for nonsteroidal anti-inflammatory drugs or acetaminophen (18%) to one-half or more of their patients needing management of acute pain. Higher levels of opioid prescribing were associated significantly with less consistent implementation of PDMP use (r = -0.20) and patient education (r = -0.11). CONCLUSIONS Most dentists reported infrequent PDMP use and counseling patients regarding risks, storage, and disposal of opioids. Higher frequency of opioid prescribing was associated with less consistent risk mitigation implementation. PRACTICAL IMPLICATIONS When opioid prescribing is indicated, risk of misuse and diversion may be mitigated by consistent PDMP use and provision of patient education. Dental education in this arena is needed.
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20
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Nadpara PA, Joyce AR, Murrelle EL, Carroll NW, Carroll NV, Barnard M, Zedler BK. Risk Factors for Serious Prescription Opioid-Induced Respiratory Depression or Overdose: Comparison of Commercially Insured and Veterans Health Affairs Populations. PAIN MEDICINE (MALDEN, MASS.) 2018; 19:79-96. [PMID: 28419384 PMCID: PMC5939871 DOI: 10.1093/pm/pnx038] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Objective To characterize the risk factors associated with overdose or serious opioid-induced respiratory depression (OIRD) among medical users of prescription opioids in a commercially insured population (CIP) and to compare risk factor profiles between the CIP and Veterans Health Administration (VHA) population. Subjects and Methods Analysis of data from 18,365,497 patients in the IMS PharMetrics Plus health plan claims database (CIP) who were dispensed a prescription opioid in 2009 to 2013. Baseline factors associated with an event of serious OIRD among 7,234 cases and 28,932 controls were identified using multivariable logistic regression. The CIP risk factor profile was compared with that from a corresponding logistic regression among 817 VHA cases and 8,170 controls in 2010 to 2012. Results The strongest associations with serious OIRD in CIP were diagnosed substance use disorder (odds ratio [OR] = 10.20, 95% confidence interval [CI] = 9.06-11.40) and depression (OR = 3.12, 95% CI = 2.84-3.42). Other strongly associated factors included other mental health disorders; impaired liver, renal, vascular, and pulmonary function; prescribed fentanyl, methadone, and morphine; higher daily opioid doses; and concurrent psychoactive medications. These risk factors, except depression, vascular disease, and specific opioids, largely aligned with VHA despite CIP being substantially younger, including more females and less chronic disease, and having greater prescribing prevalence of higher daily opioid doses, specific opioids, and most selected nonopioids. Conclusions Risk factor profiles for serious OIRD among US medical users of prescription opioids with private or public health insurance were largely concordant despite substantial differences between the populations in demographics, clinical conditions, health care delivery systems, and clinical practices.
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Affiliation(s)
- Pramit A Nadpara
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, Virginia
| | | | | | - Nathan W Carroll
- Department of Health Service Administration, University of Alabama at Birmingham, Birmingham, Alabama
| | - Norman V Carroll
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, Virginia
| | - Marie Barnard
- Department of Leadership and Counselor Education, University of Mississippi, Oxford, Mississippi, USA
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21
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Pergolizzi JV, LeQuang JA, Taylor R, Raffa RB. Going beyond prescription pain relievers to understand the opioid epidemic: the role of illicit fentanyl, new psychoactive substances, and street heroin. Postgrad Med 2017; 130:1-8. [PMID: 29190175 DOI: 10.1080/00325481.2018.1407618] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The opioid epidemic is associated with morbidity and mortality, and it has taken a vast toll on American society. While prescription opioid abuse is part of the opioid problem, it is by no means the entirety of it. Opioid abuse appears to have entered a technology-driven new world of clandestine labs all over the globe and many new synthetic analog, counterfeit, and adulterated drugs that arrive via the internet faster than the Drug Enforcement Administration (DEA) can catalog and outlaw them. To deal with opioid abuse, it must be recognized that it is more - far more - than a subset of chronic pain patients who become addicted. Indeed, to reduce the opioid epidemic to this population is to misunderstand it. The opioid epidemic involves illicit opioids, counterfeit opioids, new psychoactive substances, diverted opioids, and prescription opioids. The objective of this narrative review is to consider the roles of all substances that contribute to the opioid epidemic in America.
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Affiliation(s)
| | | | | | - Robert B Raffa
- b Department of Pharmacology & Toxicology , University of Arizona College of Pharmacy , Tucson , AZ , USA.,c Department of Pharmaceutical Sciences , Temple University School of Pharmacy , Philadelphia , PA , USA
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22
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Romero-Gonzalez M, Shahanaghi A, DiGirolamo GJ, Gonzalez G. Buprenorphine-naloxone treatment responses differ between young adults with heroin and prescription opioid use disorders. Am J Addict 2017; 26:838-844. [PMID: 29143399 DOI: 10.1111/ajad.12641] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 09/15/2017] [Accepted: 10/22/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Opioid use disorder among young adults is rising sharply with an increase in morbidity and mortality. This study examined differences in treatment response to a fixed dose of buprenorphine-naloxone between heroin (HU) and prescriptions opioids (POU) users. METHODS Eighty opioid dependent young adults (M = 22 years) were treated with buprenorphine-naloxone 16-4 mg/day for 8 weeks. Differences between HU (N = 17) and POU (N = 63) on changes in weekly opioid use, opioid craving, withdrawal, and depression symptoms were analyzed with mixed-effects regression models. RESULTS The HU had an overall mean proportion of weekly opioid use of .32 (SD = .14) compared to POU's weekly mean of .24 (SD = .15) showing a significant main effect (Z = 2.21, p = .02). Depressive symptoms (CES-D scores) were elevated at baseline for both groups (HU: M = 23.1, SD = 11.9; PO: M = 22.2, SD = 9.4), but only POU improved significantly to a score of 9.88 (SD = 7.4) compared to HU's score of 18.58 (SD = 10.3) at week 8 (Z = 2.24, p = .02). There were no significant differences in treatment retention, craving, or withdrawal symptoms. DISCUSSION AND CONCLUSIONS Treatment response to 16-4 mg/day of buprenorphine-naloxone was significantly diminished for heroin users relative to opioid prescription users in weekly opioid use. Heroin users also had persistent depressive symptoms suggesting the need for close monitoring. SCIENTIFIC SIGNIFICANCE These data suggest that young heroin users might require higher doses of buprenorphine. (Am J Addict 2017;26:838-844).
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Affiliation(s)
- Mauricio Romero-Gonzalez
- Division of Addiction Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts.,MAYU of New England, New Haven, Connecticut
| | - Abtin Shahanaghi
- Division of Addiction Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts.,Department of Psychiatry, Boston University, Boston, Massachusetts
| | - Gregory J DiGirolamo
- Division of Addiction Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts.,College of the Holy Cross, Worcester, Massachusetts.,Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Gerardo Gonzalez
- Division of Addiction Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts.,MAYU of New England, New Haven, Connecticut.,VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts
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23
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Factors associated with naloxone administration in an opioid dependent sample. J Subst Abuse Treat 2017; 84:17-20. [PMID: 29195589 DOI: 10.1016/j.jsat.2017.10.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 10/10/2017] [Accepted: 10/16/2017] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Naloxone is a safe and effective antidote for reversing opioid overdose. Layperson administration of naloxone is increasingly common, yet little is known about demographic and clinical factors associated with opioid users' likelihood of having administered naloxone to another opioid user who had overdosed. We examined predictors of reported naloxone administration in the past year. METHODS Four hundred and sixty-eight patients were interviewed upon admission to brief, inpatient opioid detoxification between May and December of 2015. Between group differences were tested using t-tests for differences in means and χ2-tests for differences in counts. RESULTS Participants averaged 32years of age, 28.9% were female, and 86.8% were White. Most (86.8%) reported detoxifying from heroin, 69.0% had injected drugs in the last 30days. One sixth (n=68) of those detoxifying from heroin, but none of those detoxifying from other opioids (n=62) had administered naloxone in the past year. Among the small number of Black/African American participants (n=20), none had administered naloxone, although 90% were heroin users. Respondents were more likely to have administered naloxone if they reported recent injection drug use (IDU), had a history of overdose, or witnessed an overdose in the past year (ps<0.05), even though less than one-third of bystanders of overdose reported administering naloxone. CONCLUSIONS Higher opioid-related mortality risk (heroin use, IDU, past overdose) was associated with greater likelihood of reported naloxone administration in the past year. The non-use of naloxone among certain groups-prescription pill users and Blacks-was unexpected.
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24
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Ganjavi F, Ansari M, Kazemipour M, Zeidabadinejad L. Computer-aided design and synthesis of a highly selective molecularly imprinted polymer for the extraction and determination of buprenorphine in biological fluids. J Sep Sci 2017; 40:3175-3182. [DOI: 10.1002/jssc.201700213] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 05/23/2017] [Accepted: 05/24/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Farideh Ganjavi
- Department of Chemistry, Kerman Branch; Islamic Azad University; Kerman Iran
| | - Mehdi Ansari
- Department of Drug and food control, Faculty of Pharmacy; Kerman University of Medical Sciences; Kerman Iran
| | - Maryam Kazemipour
- Department of Chemistry, Kerman Branch; Islamic Azad University; Kerman Iran
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25
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Hume B, Gabella B, Hathaway J, Proescholdbell S, Sneddon C, Brutsch E, Hedin R, Drucker CJ. Assessment of Selected Overdose Poisoning Indicators in Health Care Administrative Data in 4 States, 2012. Public Health Rep 2017. [PMID: 28633003 DOI: 10.1177/0033354917718061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES In 2012, a consensus document was developed on drug overdose poisoning definitions. We took the opportunity to apply these new definitions to health care administrative data in 4 states. Our objective was to calculate and compare drug (particularly opioid) poisoning rates in these 4 states for 4 selected Injury Surveillance Workgroup 7 (ISW7) drug poisoning indicators, using 2 ISW7 surveillance definitions, Option A and Option B. We also identified factors related to the health care administrative data used by each state that might contribute to poisoning rate variations. METHODS We used state-level hospital and emergency department (ED) discharge data to calculate age-adjusted rates for 4 drug poisoning indicators (acute drug poisonings, acute opioid poisonings, acute opioid analgesic poisonings, and acute or chronic opioid poisonings) using just the principal diagnosis or first-listed external cause-of-injury fields (Option A) or using all diagnosis or external cause-of-injury fields (Option B). We also calculated the high-to-low poisoning rate ratios to measure rate variations. RESULTS The average poisoning rates per 100 000 population for the 4 ISW7 poisoning indicators ranged from 11.2 to 216.4 (ED) and from 14.2 to 212.8 (hospital). For each indicator, ED rates were usually higher than were hospital rates. High-to-low rate ratios between states were lowest for the acute drug poisoning indicator (range, 1.5-1.6). Factors potentially contributing to rate variations included administrative data structure, accessibility, and submission regulations. CONCLUSIONS The ISW7 Option B surveillance definition is needed to fully capture the state burden of opioid poisonings. Efforts to control for factors related to administrative data, standardize data sources on a national level, and improve data source accessibility for state health departments would improve the accuracy of drug poisoning surveillance.
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Affiliation(s)
- Beth Hume
- 1 Department of Public Health, Injury Surveillance Program, Office of Statistics and Evaluation, Boston, MA, USA
| | - Barbara Gabella
- 2 Department of Public Health and Environment, Denver, CO, USA
| | - Jeanne Hathaway
- 1 Department of Public Health, Injury Surveillance Program, Office of Statistics and Evaluation, Boston, MA, USA
| | - Scott Proescholdbell
- 3 Division of Public Health, Injury and Violence Prevention Branch, Chronic Disease and Injury Section, Raleigh, NC, USA
| | - Cristy Sneddon
- 4 Violence and Injury Prevention Program, Utah Department of Health, Salt Lake City, UT, USA
| | - Elizabeth Brutsch
- 4 Violence and Injury Prevention Program, Utah Department of Health, Salt Lake City, UT, USA
| | - Riley Hedin
- 4 Violence and Injury Prevention Program, Utah Department of Health, Salt Lake City, UT, USA
| | - Christopher J Drucker
- 4 Violence and Injury Prevention Program, Utah Department of Health, Salt Lake City, UT, USA
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Cutler K, Kremer J. Safety, Generous Doctors, and Enabling Parents: A Perfect Recipe of Justifications for College Students’ Nonmedical Use of Prescription Painkillers. JOURNAL OF DRUG ISSUES 2017. [DOI: 10.1177/0022042617710953] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
National data indicate that prescription painkillers are the second most commonly misused prescription drug on college campuses. Although much research has focused on the motivations given for the nonmedical use of these drugs, few studies explore justifications for use. This article fills that gap by explicating the justifications college students incite to defend their nonmedical use of these drugs. Drawing on semistructured interviews with students ( N = 76) from a large public northwestern university, inductive analysis uncovered social learning theories of crime, more specifically Sykes and Matza’s neutralization theory, as helping to inform students’ justifications for use. These justifications were combined to form two broad justification categories: “the safety factor” and “authoritative enabling.” Given that justifications helped students to resolve any guilt, shame, or stigma associated with their deviant use of prescription painkillers, it is important that future research continue to explore and disentangle motivations from justifications.
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Abstract
Opioid use disorder is a growing epidemic, with an alarming number of associated deaths. In 2014, in the United States, 18,893 lethal overdoses were related to prescription opioids and 10,574 due to heroin. Despite the growing number of treatment options for substance use disorders, which are chronic, relapsing-remitting conditions, relapse rates remain as high as 91%. In the United States, 7.5 million children reside with at least one patient who abuses drugs or alcohol. Mothers are twice as likely to lose custody of their children. They have higher rates of comorbid abuse and psychopathology and limited social supports. Child service agencies, commonly involved in these scenarios, are often pressured to find permanent placement for children, within an expedited timeframe, inconsistent with the need for sufficient time for recovery and goals of family inclusion and unity. We present the complicated case of a 25-year-old woman with a history of opioid use disorder and depression, who, after being in and out of treatment programs for years, had a lethal overdose. She had a significant family history of addiction and had lost custody of her children. This challenging, but common presentation draws attention to challenges in providing treatment during this opioid epidemic.
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Affiliation(s)
- Nitin Chopra
- 1 Addictions Division, Centre for Addiction and Mental Health, Toronto, Canada
| | - Lauren H Marasa
- 2 Department of Psychiatry, College of Medicine, University of Kentucky, Lexington, KY, USA
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Raffa RB, Taylor R, Pergolizzi JV, Nalamachu S, Edwards ES, Edwards ET. Application of human factors engineering (HFE) to the design of a naloxone auto-injector for the treatment of opioid emergencies. Drug Deliv Transl Res 2017; 7:1-10. [PMID: 27562292 PMCID: PMC5222905 DOI: 10.1007/s13346-016-0323-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The increased use of opioids for chronic treatment of pain and the resulting epidemic of opioid overdoses have created a major public health challenge. Parenteral naloxone has been used since the 1970's to treat opioid overdose. Recently, a novel naloxone auto-injector device (EVZIO, kaleo, Inc., Richmond, VA) was approved by the Food and Drug Administration. In this article, we review the Human Factors Engineering (HFE) process used in the development and testing of this novel naloxone auto-injector currently used in nonmedical settings for the emergency treatment of known or suspected opioid overdose. HFE methods were employed throughout the product development process for the naloxone auto-injector including formative and summative studies in order to optimize the auto-injector's user interface, mitigate use-related hazards and increase reliability during an opioid emergency use scenario. HFE was also used to optimize the product's design and user interface in order to reduce or prevent user confusion and misuse. The naloxone auto-injector went through a rigorous HFE process that included perceptual, cognitive, and physical action analysis; formative usability evaluations; use error analysis and summative design validation studies. Applying HFE resulted in the development of a product that is safe, fast, easy and predictably reliable to deliver a potentially life-saving dose of naloxone during an opioid overdose emergency. The naloxone auto-injector may be considered as a universal precaution option for at-risk patients prescribed opioids or those who are at increased risk for an opioid overdose emergency.
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Affiliation(s)
- Robert B Raffa
- Temple University School of Pharmacy, Philadelphia, PA, USA
| | | | - Joseph V Pergolizzi
- NEMA Research, Bonita Springs, FL, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Winstanley EL, Clark A, Feinberg J, Wilder CM. Barriers to implementation of opioid overdose prevention programs in Ohio. Subst Abus 2017; 37:42-6. [PMID: 26682929 DOI: 10.1080/08897077.2015.1132294] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Nationally, overdose fatalities have reached epidemic proportions. Ohio has one of the highest overdose death rates in the country, as well as high rates of prescription opioid trafficking. METHODS A cross-sectional self-report survey of opioid overdose prevention programs (OOPPs) in Ohio was conducted between August and October 2014 to characterize programs and ascertain barriers to successful implementation. A 91% response rate was achieved with 18 programs participating in the study. RESULTS The first Ohio OOPP opened in August 2012, a second program opened in 2013, and the remaining programs began in 2014. All of the programs distribute nasal naloxone and provide overdose prevention education, and 89% (n = 16) provide overdose kits for free. Six OOPPs are funded by the Ohio Department of Health, 3 programs are funded by a local health foundation, and several other public and private funding sources were reported. The OOPPs have funding to distribute a combined total of 8,670 overdose kits and had distributed 1998 kits by October 2014. The OOPPs reported 149 overdose reversals. Fifteen programs (83%) reported implementation barriers that were categorized as stigma-, cost-, staffing-, legal, regulatory, and client-related problems. Legislative changes aimed at removing some of the obstacles to distribution and lay administration of naloxone have recently been enacted in Ohio. CONCLUSIONS OOPPs have rapidly expanded in Ohio during the past 3 years. Although recent legislative changes have addressed some of the reported implementation barriers, stigma and the cost of naloxone remain significant problems.
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Affiliation(s)
- Erin L Winstanley
- a James L. Winkle College of Pharmacy , University of Cincinnati , Cincinnati , Ohio , USA
| | - Angela Clark
- b College of Nursing , University of Cincinnati , Cincinnati , Ohio , USA
| | - Judith Feinberg
- c Behavioral Medicine & Psychiatry , College of Medicine , West Virginia University, Morgantown , West Virginia , USA
| | - Christine M Wilder
- d Department of Veterans Affairs Medical Center , Cincinnati , Ohio , USA.,e Addiction Sciences Division , Department of Psychiatry and Behavioral Neuroscience , University of Cincinnati College of Medicine , Cincinnati , Ohio , USA
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Is a Prehospital Treat and Release Protocol for Opioid Overdose Safe? J Emerg Med 2017; 52:52-58. [DOI: 10.1016/j.jemermed.2016.09.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 09/07/2016] [Indexed: 11/20/2022]
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Sajid A, Whiteman A, Bell RL, Greene MS, Engleman EA, Chambers RA. Prescription drug monitoring program data tracking of opioid addiction treatment outcomes in integrated dual diagnosis care involving injectable naltrexone. Am J Addict 2016; 25:557-64. [PMID: 27647699 PMCID: PMC5096257 DOI: 10.1111/ajad.12441] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 08/05/2016] [Accepted: 09/06/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Fourfold increases in opioid prescribing and dispensations over 2 decades in the U.S. has paralleled increases in opioid addictions and overdoses, requiring new preventative, diagnostic, and treatment strategies. This study examines Prescription Drug Monitoring Program (PDMP) tracking as a novel measure of opioid addiction treatment outcomes in a university-affiliated integrated mental health-addiction treatment clinic. METHODS Repeated measure parametrics examined PDMP and urine drug screening (UDS) data before and after first injection for all patients (N = 68) who received at least one long-acting naltrexone injection (380 mg/IM) according to diagnostic groupings of having either (i) alcohol (control); (ii) opioid; or (iii) combined alcohol and opioid use disorders. RESULTS There were no group differences post-injection in treatment days, injections delivered, or treatment service encounters. UDS and PDMP measures of opioid exposures were greater in opioid compared to alcohol-only patients. Post-first injection, UDS's positive for opioids declined (p < .05) along with PDMP measures of opioid prescriptions (p < .001), doses (p < .01), types (p < .001), numbers of dispensing prescribers (p < .001) and pharmacies (p < .001). Opioid patients without alcohol disorders showed the best outcomes with 50% to 80% reductions in PDMP-measures of opioids, down to levels of alcohol-only patients. CONCLUSIONS This study shows PDMP utility for measuring opioid addiction treatment outcomes, supporting the routine use of PDMPs in clinical and research settings. SCIENTIFIC SIGNIFICANCE These findings demonstrate that opioid addiction in patients with complex addictions and mental illnesses comorbidities can show effective treatment responses as measured by PDMP tracking of decreases in opioid prescriptions to those patients. (Am J Addict 2016;25:557-564).
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Affiliation(s)
- Ayesha Sajid
- Department of Psychiatry, Indiana University School of Medicine, Indianapoils, Indiana
| | - Aaron Whiteman
- Department of Psychiatry, Indiana University School of Medicine, Indianapoils, Indiana
| | - Richard L Bell
- Department of Psychiatry, Indiana University School of Medicine, Indianapoils, Indiana
| | - Marion S Greene
- Fairbanks School of Public Health, IUPUI, Indianapolis, Indiana
| | - Eric A Engleman
- Department of Psychiatry, Indiana University School of Medicine, Indianapoils, Indiana
| | - R Andrew Chambers
- Department of Psychiatry, Indiana University School of Medicine, Indianapoils, Indiana.
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Yarborough BJH, Stumbo SP, Janoff SL, Yarborough MT, McCarty D, Chilcoat HD, Coplan PM, Green CA. Understanding opioid overdose characteristics involving prescription and illicit opioids: A mixed methods analysis. Drug Alcohol Depend 2016; 167:49-56. [PMID: 27520885 DOI: 10.1016/j.drugalcdep.2016.07.024] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 04/12/2016] [Accepted: 07/21/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Opioid abuse and misuse are significant public health issues. The CDC estimated 72% of pharmaceutical-related overdose deaths in the US in 2012 involved opioids. While studies of opioid overdoses have identified sociodemographic characteristics, agents used, administration routes, and medication sources associated with overdoses, we know less about the context and life circumstances of the people who experience these events. METHODS We analyzed interviews (n=87) with survivors of opioid overdoses or family members of decedents. Individuals experiencing overdoses were members of a large integrated health system. Using ICD codes for opioid overdoses and poisonings, we identified participants from five purposefully derived pools of health-plan members who had: 1) prescriptions for OxyContin(®) or single-ingredient sustained-release oxycodone, 2) oxycodone single-ingredient immediate release, 3) other long-acting opioids, 4) other short-acting opioids, or 5) no active opioid prescriptions. RESULTS Individuals who experienced opioid overdoses abused and misused multiple medications/drugs; experienced dose-related miscommunications or medication-taking errors; had mental health and/or substance use conditions; reported chronic pain; or had unstable resources or family/social support. Many had combinations of these risks. Most events involved polysubstance use, often including benzodiazepines. Accidental overdoses were commonly the result of abuse or misuse, some in response to inadequately treated chronic pain or, less commonly, medication-related mistakes. Suicide attempts were frequently triggered by consecutive negative life events. CONCLUSIONS To identify people at greater risk of opioid overdose, efforts should focus on screening for prescribed and illicit polysubstance use, impaired cognition, and changes in life circumstances, psychosocial risks/supports, and pain control.
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Affiliation(s)
- Bobbi Jo H Yarborough
- Kaiser Permanente Northwest Center for Health Research, 3800 N Interstate Ave, Portland, OR 97227, USA.
| | - Scott P Stumbo
- Kaiser Permanente Northwest Center for Health Research, 3800 N Interstate Ave, Portland, OR 97227, USA.
| | - Shannon L Janoff
- Kaiser Permanente Northwest Center for Health Research, 3800 N Interstate Ave, Portland, OR 97227, USA.
| | - Micah T Yarborough
- Kaiser Permanente Northwest Center for Health Research, 3800 N Interstate Ave, Portland, OR 97227, USA.
| | - Dennis McCarty
- Department of Public Health & Preventive Medicine, Oregon Health & Science University, 3181 S.W. Sam Jackson Hill Road, CB 669, Portland, OR 97239, USA.
| | | | - Paul M Coplan
- Purdue Pharma, L.P. One Stamford Forum, Stamford, CT 06901, USA.
| | - Carla A Green
- Kaiser Permanente Northwest Center for Health Research, 3800 N Interstate Ave, Portland, OR 97227, USA.
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Depression - A major but neglected consequence contributing to the health toll from prescription opioids? Psychiatry Res 2016; 243:331-4. [PMID: 27434203 DOI: 10.1016/j.psychres.2016.06.053] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 05/02/2016] [Accepted: 06/28/2016] [Indexed: 01/23/2023]
Abstract
Prescription opioid analgesic (POA) use is common especially in North America, and associated with extensive morbidity and mortality. While medical and non-medical POA use have been documented to be associated with mental health problems, and specifically depression, newly emerging epidemiological evidence suggests that incident depression post-initiation of POA use may be common. Neurobiological - specifically regarding impacts of POAs on brain functioning - and/or psycho-social processes may be relevant pathways; these must be better understood, also to guide clinical practice for interventions. Incident depression outcomes may be an added component to the extensive health toll from widespread POA use.
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Elzey MJ, Fudin J, Edwards ES. Take-home naloxone treatment for opioid emergencies: a comparison of routes of administration and associated delivery systems. Expert Opin Drug Deliv 2016; 14:1045-1058. [PMID: 27606669 DOI: 10.1080/17425247.2017.1230097] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Naloxone reversal of opioid-induced respiratory depression outside of medical facilities has become more prevalent because of the escalating opioid epidemic in the USA. Take-home naloxone for treatment of opioid emergencies is now being recommended by numerous federal, state, and professional organizations. Areas covered: The scope of the opioid overdose epidemic is reviewed along with practical, clinical, regulatory, and usability considerations for take-home naloxone routes of administration currently available and associated delivery systems. Specific opioid-related factors are discussed in detail with emphasis placed on life-threatening respiratory depression and naloxone antagonism. A clinical overview, including pharmacokinetic and FDA approval information for each take-home naloxone product is discussed in detail as well as the impact of take-home naloxone in the community. Finally, given these products are to be used in a panic-stricken, life-threatening opioid emergency, an analysis of available usability data is provided with proposed directions for further study. Expert opinion: Based on the available clinical evidence, auto-injectable naloxone should be the preferred administration route for take-home naloxone treatment until additional safety, efficacy, and comparative outcomes data are available for unconventional routes of administration that unequivocally provide equal or superior results.
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Affiliation(s)
- Mark J Elzey
- a Medical Affairs , kaleo, Inc ., Richmond , VA , USA
| | - Jeffrey Fudin
- b Scientific and Clinical Affairs at Remitigate, LLC , Delmar , NY , USA.,c PGY2 Pharmacy Pain Management, Stratton VA Medical Center , Albany , NY , USA.,d Albany College of Pharmacy & Health Sciences , Albany , NY , USA.,e Western New England University College of Pharmacy , Springfield , MA , USA
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Weiner SG, Raja AS, Bittner JC, Curtis KM, Weimersheimer P, Hasegawa K, Espinola JA, Camargo CA. Opioid-related Policies in New England Emergency Departments. Acad Emerg Med 2016; 23:1086-90. [PMID: 27098615 DOI: 10.1111/acem.12992] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 03/30/2016] [Accepted: 04/17/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The opioid abuse and overdose epidemic in the United States has led to the need for new practice policies to guide clinicians. We describe implementation of opioid-related policies in emergency departments (EDs) in New England to gauge progress and determine where further work is needed. METHODS This study analyzed data from the 2015 National Emergency Department Inventory-New England survey. The survey queried directors of every ED (n = 195) in the six New England states to determine the implementation of five specific policies related to opioid management. ED characteristics (e.g., annual visits, location, and admission rates) were also obtained and a multivariable analysis was conducted to identify ED characteristics independently associated with the number of opioid-related policies implemented. RESULTS Overall, 169 EDs (87%) responded, with a >80% response rate in each state. Implementation of opioid-related policies varied as follows: 1) use of a screening tool for patients with suspected prescription opioid abuse potential (n = 30, 18%), 2) access state prescription drug monitoring program (PDMP) before prescribing opioids (n = 132, 78%), 3) notify the primary opioid prescriber when prescribing opioids for ED patients with chronic pain (n = 69, 41%), 4) refer patients with opioid abuse to recovery resources (n = 117, 70%), and 5) prescribe naloxone to patients at risk of opioid overdose after ED discharge (n = 19, 12%). EDs located in metropolitan areas and with at least one attending physician on duty 24/7 were less likely to implement opioid policies (incident rate ratio [IRR] = 0.65, 95% confidence interval [CI] = 0.48-0.89; and IRR = 0.78, 95% CI = 0.6-1.0, respectively) while EDs with ≥15% hospitalization rate that used electronic computerized medication ordering and those in Rhode Island were more likely to implement opioid policies (IRR = 1.23, 95% CI = 1.03-1.48; IRR = 1.95, 95% CI = 1.19-3.22; and IRR = 1.30, 95% CI = 1.08-1.56, respectively). CONCLUSIONS The implementation of opioid-related policies varies among New England EDs. The presence of policies recommending use of screening tools and prescribing naloxone for at-risk patients was low, whereas those regarding utilization of the PDMP and referral of patients with opioid abuse to recovery resources were more common. These data provide important benchmarks for future evaluations and recommendations.
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Affiliation(s)
- Scott G. Weiner
- Department of Emergency Medicine; Brigham and Women's Hospital; Harvard Medical School; Boston MA
| | - Ali S. Raja
- Department of Emergency Medicine; Massachusetts General Hospital; Harvard Medical School; Boston MA
| | - Jane C. Bittner
- Department of Emergency Medicine; Massachusetts General Hospital; Harvard Medical School; Boston MA
| | - Kevin M. Curtis
- Section of Emergency Medicine; Dartmouth-Hitchcock Medical Center; Geisel School of Medicine at Dartmouth; Lebanon NH
| | - Peter Weimersheimer
- Division of Emergency Medicine; Department of Surgery; University of Vermont Medical Center; University of Vermont College of Medicine; Burlington VT
| | - Kohei Hasegawa
- Department of Emergency Medicine; Massachusetts General Hospital; Harvard Medical School; Boston MA
| | - Janice A. Espinola
- Department of Emergency Medicine; Massachusetts General Hospital; Harvard Medical School; Boston MA
| | - Carlos A. Camargo
- Department of Emergency Medicine; Massachusetts General Hospital; Harvard Medical School; Boston MA
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Peles E, Seligman Z, Bloch M, Potik D, Sason A, Schreiber S, Adelson M. Sexual Abuse and its Relation to Chronic Pain among Women from a Methadone Maintenance Clinic versus a Sexual Abuse Treatment Center. J Psychoactive Drugs 2016; 48:279-87. [DOI: 10.1080/02791072.2016.1205763] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ruta NS, Ballas SK. The Opioid Drug Epidemic and Sickle Cell Disease: Guilt by Association. PAIN MEDICINE 2016; 17:1793-1798. [DOI: 10.1093/pm/pnw074] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Delorme J, Chenaf C, Kabore JL, Pereira B, Mulliez A, Tremey A, Brousse G, Zenut M, Laporte C, Authier N. Incidence of high dosage buprenorphine and methadone shopping behavior in a retrospective cohort of opioid-maintained patients in France. Drug Alcohol Depend 2016; 162:99-106. [PMID: 27006272 DOI: 10.1016/j.drugalcdep.2016.02.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 02/09/2016] [Accepted: 02/22/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Opioid Substitution Treatment (OST) misuse and diversion have significantly increased worldwide. Obtaining OST prescriptions from multiple prescribers, known as doctor shopping, is a way in which opioids may be diverted. OBJECTIVES The aim of this study was to assess the incidence of OST (high dosage buprenorphine (HDB) and methadone (MTD)) shopping behavior and identify associated risk factors, and its impact on mortality. METHODS A retrospective cohort of patients treated by OST between April 1, 2004 and December 31, 2012 from a sample of the French Health Insurance database was established. Doctor shopping was defined as ≥1 day of overlapping prescriptions written by ≥2 different prescribers and filled in ≥3 different pharmacies. RESULTS A total of 2043 patients were enrolled, 1450HDB and 593 MTD. The one-year incidence of shopping behavior was 8.4% (95% CI: 7.0-10.1) in HDB group and 0% in MTD group, compared to 0.2% (95% CI: 0.1-0.2) for diuretics. On multivariate analysis, factors associated with HDB shopping behavior were: male gender HR: 1.74 (95% CI: 1.20-2.54); low-income status HR: 2.95 (95% CI: 2.07-4.44); mental health disorders HR: 1.43 (95% CI: 1.06-1.94); concurrent hypnotics use HR: 1.90 (95% CI: 1.39-2.61); concurrent use of weak opioids HR: 1.48 (95% CI: 1.09-1.99) and morphine HR: 1.69 (95% CI: 1.02-2.80). HDB shoppers had a higher, yet non-significant risk of death (HR: 1.56 (95% CI: 0.64-3.81)) than non HDB shoppers. CONCLUSION Shopping behavior was only found in high dosage buprenorphine patients and concerned almost one out ten patients.
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Affiliation(s)
- Jessica Delorme
- INSERM, UMR 1107 NEURO-DOL, Faculté de Médecine, Université d'Auvergne, BP38, 63001 Clermont-Ferrand, France; CHU Clermont-Ferrand, Centres Addictovigilance et Pharmacovigilance Auvergne (CEIP-CRPV), Service de Pharmacologie Médicale, BP69, 63003 Clermont-Ferrand, France.
| | - Chouki Chenaf
- INSERM, UMR 1107 NEURO-DOL, Faculté de Médecine, Université d'Auvergne, BP38, 63001 Clermont-Ferrand, France; CHU Clermont-Ferrand, Centres Addictovigilance et Pharmacovigilance Auvergne (CEIP-CRPV), Service de Pharmacologie Médicale, BP69, 63003 Clermont-Ferrand, France
| | - Jean-Luc Kabore
- INSERM, UMR 1107 NEURO-DOL, Faculté de Médecine, Université d'Auvergne, BP38, 63001 Clermont-Ferrand, France; CHU Clermont-Ferrand, Centres Addictovigilance et Pharmacovigilance Auvergne (CEIP-CRPV), Service de Pharmacologie Médicale, BP69, 63003 Clermont-Ferrand, France
| | - Bruno Pereira
- CHU Clermont-Ferrand, Délégation à la Recherche Clinique et à l'Innovation, BP69, 63003 Clermont-Ferrand, France
| | - Aurélien Mulliez
- CHU Clermont-Ferrand, Délégation à la Recherche Clinique et à l'Innovation, BP69, 63003 Clermont-Ferrand, France
| | - Aurore Tremey
- CHU Clermont-Ferrand, Service de Psychiatrie et Addictologie, CMPB, BP69, 63003 Clermont-Ferrand, France
| | - Georges Brousse
- CHU Clermont-Ferrand, Service de Psychiatrie et Addictologie, CMPB, BP69, 63003 Clermont-Ferrand, France
| | - Marie Zenut
- CHU Clermont-Ferrand, Centres Addictovigilance et Pharmacovigilance Auvergne (CEIP-CRPV), Service de Pharmacologie Médicale, BP69, 63003 Clermont-Ferrand, France; EA 4681 PEPRADE, Université d'Auvergne (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), France
| | - Catherine Laporte
- Département de Médecine Générale, Faculté de Médecine, BP38, 63001 Clermont- Ferrand, France
| | - Nicolas Authier
- INSERM, UMR 1107 NEURO-DOL, Faculté de Médecine, Université d'Auvergne, BP38, 63001 Clermont-Ferrand, France; CHU Clermont-Ferrand, Centres Addictovigilance et Pharmacovigilance Auvergne (CEIP-CRPV), Service de Pharmacologie Médicale, BP69, 63003 Clermont-Ferrand, France; CHU Clermont-Ferrand, Centre d'Evaluation et de Traitement de la Douleur (CETD), Service de Pharmacologie Médicale, BP69, 63003 Clermont-Ferrand, France; Institut Analgesia, Faculté de Médecine, BP38, 63001 Clermont-Ferrand, France
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Wunsch H, Wijeysundera DN, Passarella MA, Neuman MD. Opioids Prescribed After Low-Risk Surgical Procedures in the United States, 2004-2012. JAMA 2016; 315:1654-7. [PMID: 26978756 PMCID: PMC4837043 DOI: 10.1001/jama.2016.0130] [Citation(s) in RCA: 260] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Adverse events related to opioid analgesics are common., Although opioids represent a component of pain treatment regimens following low-risk surgery,, few data exist regarding patterns of postoperative opioid prescribing over time. We assessed trends in the amount of hydrocodone/acetaminophen and oxycodone/acetaminophen prescribed, 2 opioids commonly used for postoperative pain management.
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Affiliation(s)
- Hannah Wunsch
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Molly A Passarella
- Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Mark D Neuman
- Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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Frequency of unsafe storage, use, and disposal practices of opioids among cancer patients presenting to the emergency department. Palliat Support Care 2016; 15:638-643. [PMID: 27071690 DOI: 10.1017/s1478951516000158] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Approximately 75% of prescription opioid abusers obtain the drug from an acquaintance, which may be a consequence of improper opioid storage, use, disposal, and lack of patient education. We aimed to determine the opioid storage, use, and disposal patterns in patients presenting to the emergency department (ED) of a comprehensive cancer center. METHOD We surveyed 113 patients receiving opioids for at least 2 months upon presenting to the ED and collected information regarding opioid use, storage, and disposal. Unsafe storage was defined as storing opioids in plain sight, and unsafe use was defined as sharing or losing opioids. RESULTS The median age was 53 years, 55% were female, 64% were white, and 86% had advanced cancer. Of those surveyed, 36% stored opioids in plain sight, 53% kept them hidden but unlocked, and only 15% locked their opioids. However, 73% agreed that they would use a lockbox if given one. Patients who reported that others had asked them for their pain medications (p = 0.004) and those who would use a lockbox if given one (p = 0.019) were more likely to keep them locked. Some 13 patients (12%) used opioids unsafely by either sharing (5%) or losing (8%) them. Patients who reported being prescribed more pain pills than required (p = 0.032) were more likely to practice unsafe use. Most (78%) were unaware of proper opioid disposal methods, 6% believed they were prescribed more medication than required, and 67% had unused opioids at home. Only 13% previously received education about safe disposal of opioids. Overall, 77% (87) of patients reported unsafe storage, unsafe use, or possessed unused opioids at home. SIGNIFICANCE OF RESULTS Many cancer patients presenting to the ED improperly and unsafely store, use, or dispose of opioids, thus highlighting a need to investigate the impact of patient education on such practices.
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Dental opioid prescribing and multiple opioid prescriptions among dental patients: Administrative data from the South Carolina prescription drug monitoring program. J Am Dent Assoc 2016; 147:537-44. [PMID: 27055600 DOI: 10.1016/j.adaj.2016.02.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 02/12/2016] [Accepted: 02/16/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Despite increased attention to dentists' roles in curbing opioid misuse, abuse, and diversion, information regarding prescribing practices and the frequency of multiple concurrent opioid prescriptions among dental patients is limited. METHODS The authors reviewed South Carolina prescription drug monitoring program data representing dispensed medication for patients prescribed at least 1 opioid by a dentist during the most recently available 2-year time frame (2012-2013). The authors used descriptive analyses to examine the types and frequency of dental opioid prescriptions and the frequency of existing multiple concurrent opioid prescriptions among dental patients. RESULTS Nearly all dispensed dental opioid prescriptions (99.9%; n = 653,650) were for immediate-release opioids and were initial prescription fills (96.2%). Hydrocodone (76.1%) and oxycodone (12.2%) combination products were the most frequently dispensed opioids prescribed by dentists. People younger than 21 years received 11.2% of dentist-prescribed opioids dispensed. Patients with multiple concurrent opioid prescriptions were identified within 30-day (n = 113,818), 90-day (n = 166,124), and 180-day (n = 205,576) time frames. CONCLUSIONS Dentists prescribed a high volume of the immediate-release opioids dispensed in South Carolina. A notable minority of dental patients had incidents of multiple preexisting opioid prescriptions, a factor implicated in patient misuse, abuse, overdose, and diversion. PRACTICAL IMPLICATIONS Use of a prescription drug monitoring program before prescribing provides a record of controlled substances dispensed to a patient and may inform prescribing, coordination of care, and addiction screening or referral. Patients should receive information regarding misuse behaviors and their risks, as well as the importance of secure storage and disposal of leftover opioid medications.
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Weiner SG, Horton LC, Green TC, Butler SF. A comparison of an opioid abuse screening tool and prescription drug monitoring data in the emergency department. Drug Alcohol Depend 2016; 159:152-7. [PMID: 26743334 DOI: 10.1016/j.drugalcdep.2015.12.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 11/29/2015] [Accepted: 12/09/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES This study aimed to: (a) determine the percentage of ED patients receiving prescriptions for opioid pain medications that meet the criteria for "high-risk for abuse potential" on the Screener and Opioid Assessment for Patients with Pain (SOAPP(®)-R), (b) determine the percentage of patients with high-risk behavior on the state prescription drug monitoring program (PDMP) database, (c) compare the SOAPP-R with data from the PDMP, and (d) determine psychometric properties of SOAPP-R for ED patients METHODS Convenience sample of ED patients who were being considered for discharge with a prescription for an opioid pain medication. Subjects completed SOAPP-R on an electronic tablet and PDMP data was obtained. Scores on SOAPP-R ≥ 18 were defined as "at-risk", and PDMP data showing both ≥ 4 opioid prescriptions and ≥ 4 providers in 12 months was considered the criterion standard for high-risk behavior. RESULTS 82 patients (88.2%) provided consent. 32.9% (n=27) were determined to be "at-risk" (score ≥ 18) by SOAPP-R. 15.9% (n=13) subjects met PDMP criteria and 53.9% (n=7) of those had SOAPP-R scores ≥ 18 (sensitivity 54%, specificity 71%, positive predictive value 26%, negative predictive value 89%). The association of an at-risk SOAPP-R score and PDMP high-risk criteria was an adjusted odds ratio of 1.39 (95% confidence interval 0.73-3.68). CONCLUSIONS In our population, about one-third of patients being considered for discharge with an opioid prescription scored "at-risk" on SOAPP-R and 15.9% met the PDMP high-risk criteria. The high negative predictive value of SOAPP-R indicates it may be a useful screening tool for the ED patient population.
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Affiliation(s)
- Scott G Weiner
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States.
| | - Laura C Horton
- Tufts University School of Medicine, Boston, MA, United States.
| | - Traci C Green
- Boston Medical Center and Boston University Department of Emergency Medicine Providence, RI Inflexxion, Inc., Newton, MA, United States.
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Chan WL, Wood DM, Dargan PI. Misuse of prescription and over-the-counter medicines in South London nightclubs. JOURNAL OF SUBSTANCE USE 2016. [DOI: 10.3109/14659891.2015.1068388] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Saulle R, Vecchi S. Supervised dosing with a long acting opioid medication in the management of opioid dependence. Cochrane Database Syst Rev 2015. [DOI: 10.1002/14651858.cd011983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Frank JW, Binswanger IA, Calcaterra SL, Brenner LA, Levy C. Non-medical use of prescription pain medications and increased emergency department utilization: Results of a national survey. Drug Alcohol Depend 2015; 157:150-7. [PMID: 26564754 PMCID: PMC4663179 DOI: 10.1016/j.drugalcdep.2015.10.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 10/06/2015] [Accepted: 10/22/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND There are no population-based studies of emergency department (ED) utilization by individuals using prescription pain medications non-medically. We examined whether non-medical use of prescription pain medications was independently associated with increased ED utilization. METHODS We conducted a retrospective analysis of a nationally representative sample of the non-institutionalized, civilian U.S. population in the National Survey on Drug Use and Health, 2008-2013. We used multivariable logistic regression to examine the association between past year ED utilization and non-medical use of prescription pain medications, defined as use of medications "not prescribed for you or that you took only for the experience or feeling they caused". RESULTS An estimated 10.5 million adults annually reported past year non-medical use (NMU) of prescription pain medications, and 39%, or 4.1 million adults annually, also reported one or more past year ED visits. After adjustment for sociodemographic and clinical characteristics, adults with past year NMU of prescription pain medications had increased odds of past year ED utilization (adjusted odds ratio 1.32; 95% confidence interval 1.24-1.41). In secondary analyses, individuals with more frequent NMU had increased odds of ED utilization in unadjusted analyses, but this association was attenuated with adjustment for the source of prescription pain medication (i.e., physician, friend/family, other source). CONCLUSIONS Non-medical use of prescription pain medications is associated with increased ED utilization. Further work is needed to identify the optimal role of ED settings in providing screening, education, and treatment referral for individuals using prescription pain medications non-medically.
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Affiliation(s)
- Joseph W Frank
- Division of General Internal Medicine, University of Colorado School of Medicine, 12631 East 17th Avenue, Aurora, CO 80045, United States; VA Eastern Colorado Health Care System, 1055 Clermont Street, Denver, CO 80220, United States.
| | - Ingrid A Binswanger
- Division of General Internal Medicine, University of Colorado School of Medicine, 12631 East 17th Avenue, Aurora, CO 80045, United States; Institute for Health Research, Kaiser Permanente Colorado, 10065 East Harvard Avenue, Suite 300, Denver, CO 80231, United States
| | - Susan L Calcaterra
- Division of General Internal Medicine, University of Colorado School of Medicine, 12631 East 17th Avenue, Aurora, CO 80045, United States; Denver Health Medical Center, 777 Bannock Street, Denver, CO 80204, United States
| | - Lisa A Brenner
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), 1055 Clermont Street, Denver, CO 80220, United States; Departments of Psychiatry, Physical Medicine and Rehabilitation, and Neurology, University of Colorado, Anschutz Medical Campus, 13001 East 17th Place, Aurora, CO 80045, United States
| | - Cari Levy
- VA Eastern Colorado Health Care System, 1055 Clermont Street, Denver, CO 80220, United States; Division of Health Care Policy and Research, Department of Medicine, University of Colorado School of Medicine, 13199 E. Montview Blvd., Suite 400, Aurora, CO 80045, United States
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Gonzalez G, DiGirolamo G, Romero-Gonzalez M, Smelson D, Ziedonis D, Kolodziej M. Memantine improves buprenorphine/naloxone treatment for opioid dependent young adults. Drug Alcohol Depend 2015; 156:243-253. [PMID: 26454835 PMCID: PMC4652072 DOI: 10.1016/j.drugalcdep.2015.09.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 09/11/2015] [Accepted: 09/15/2015] [Indexed: 01/24/2023]
Abstract
BACKGROUND Opioid use disorders are considered a serious public health problem among young adults. Current treatment is limited to long-term opioid substitution therapy, with high relapse rates after discontinuation. This study evaluated the co-administration of memantine to brief buprenorphine pharmacotherapy as a treatment alternative. METHODS 13-week double-blind placebo-controlled trial evaluating 80 young adult opioid dependent participants treated with buprenorphine/naloxone 16-4mg/day and randomized to memantine (15mg or 30mg) or placebo. Primary outcomes were a change in the weekly mean proportion of opioid use, and cumulative abstinence rates after rapid buprenorphine discontinuation on week 9. RESULTS Treatment retention was not significantly different between groups. The memantine 30mg group was significantly less likely to relapse and to use opioids after buprenorphine discontinuation. Among participants abstinent on week 8, those in the memantine 30mg group (81.9%) were significantly less likely to relapse after buprenorphine was discontinued compared to the placebo group (30%) (p<0.025). Also, the memantine 30mg group had significantly reduced opioid use (mean=0, SEM±0.00) compared to the placebo group (mean=0.33, SEM±0.35; p<0.004) during the last 2 weeks of study participation. CONCLUSIONS Memantine 30mg significantly improved short-term treatment with buprenorphine/naloxone for opioid dependent young adults by reducing relapse and opioid use after buprenorphine discontinuation. Combined short-term treatment with buprenorphine/naloxone may be an effective alternative treatment to long-term methadone or buprenorphine maintenance in young adults.
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Affiliation(s)
- Gerardo Gonzalez
- Division of Addiction Psychiatry, University of Massachusetts Medical School, USA; VA Central Western Massachusetts Healthcare System, USA; MAYU of New England, USA.
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Greene MS, Chambers RA. Pseudoaddiction: Fact or Fiction? An Investigation of the Medical Literature. CURRENT ADDICTION REPORTS 2015; 2:310-317. [PMID: 26550549 PMCID: PMC4628053 DOI: 10.1007/s40429-015-0074-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Tremendous growth in opioid prescribing over two decades in the USA has correlated with proportional increases in diversion, addiction, and overdose deaths. Pseudoaddiction, a concept coined in 1989, has frequently been cited to indicate that under-treatment of pain, rather than addiction, is the more pressing and authentic clinical problem in opioid-seeking patients. This investigative review searched Medline articles containing the term "pseudoaddiction" to determine its footprint in the literature with a focus on how it has been characterized and empirically validated. By 2014, pseudoaddiction was discussed in 224 articles. Only 18 of these articles contributed to or questioned pseudoaddiction from an anecdotal or theoretical standpoint, and none empirically tested or confirmed its existence. Twelve of these articles, including all four that acknowledged pharmaceutical funding, were proponents of pseudoaddiction. These papers described pseudoaddiction as an iatrogenic disease resulting from withholding opioids for pain that can be diagnosed, prevented, and treated with more aggressive opioid treatment. In contrast, six articles, none with pharmaceutical support, questioned pseudoaddiction as a clinical construct. Empirical evidence supporting pseudoaddiction as a diagnosis distinct from addiction has not emerged. Nevertheless, the term has been accepted and proliferated in the literature as a justification for opioid therapy for non-terminal pain in patients who may appear to be addicted but should not, from the perspective of pseudoaddiction, be diagnosed with addiction. Future studies should examine whether acceptance of pseudoaddiction has complicated accurate pain assessment and treatment, and whether it has contributed to or reflected medical-cultural shifts that produced the iatrogenic opioid addiction epidemic.
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Affiliation(s)
- Marion S. Greene
- />Center for Health Policy, Richard M. Fairbanks School of Public Health, Indiana University-Purdue University Indianapolis (IUPUI), 714 N Senate Ave, Indianapolis, IN 46202 USA
| | - R. Andrew Chambers
- />Laboratory for Translational Neuroscience of Dual Diagnosis & Development, Department of Psychiatry, IU Neuroscience Center, Indiana University School of Medicine, 320 W. 15th Street, Indianapolis, IN 46202 USA
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