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Day W, Halperin S, Surucu S, Jimenez AE, Katsnelson B, Zhu J, Grauer JN. Declining Postoperative 90-Day Opioid Prescriptions From 2010 to 2021 Following Hip Arthroscopy for Femoroacetabular Impingement Syndrome. Arthrosc Sports Med Rehabil 2025; 7:101078. [PMID: 40297098 PMCID: PMC12034067 DOI: 10.1016/j.asmr.2025.101078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2024] [Accepted: 12/30/2024] [Indexed: 04/30/2025] Open
Abstract
Purpose To analyze postoperative opioid prescriptions after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) in a large, opioid-naive population and to evaluate factors associated with receiving more opioids. Methods Opioid-naive adult patients who underwent hip arthroscopy for FAIS were queried in the 2010 to 2022 PearlDiver Mariner 161 national administrative database. Exclusion criteria included patients with a history of chronic pain and patients who received opioid prescriptions more than 30 days before surgery. Patient variables were extracted: age, sex, and Elixhauser Comorbidity Index. Ninety-day postoperative opioid prescriptions (by total morphine milligram equivalents [MMEs]) were assessed with multivariate linear regression. Ninety-day postoperative opioid prescriptions from 2011 to 2021 were assessed. Results Of 27,079 patients with postoperative opioid prescriptions identified, a mean ± standard deviation of 347.6 ± 729.2 MMEs (40 tablets of 5 mg oxycodone) were prescribed per patient, with a mean of 1.6 prescriptions filled per patient within 90 days following surgery. Seventy-five percent of patients filled fewer than 600 MMEs, but a small subset filled more than 2,000 MMEs. Multivariate analysis revealed that, compared to patients in the age 30- to 39-year group, those aged 20 to 29 years received fewer MMEs (Δ = -72.5, P < .017). Compared to those with an Elixhauser Comorbidity Index of 2 or under, those >2 were prescribed more MMEs (Δ = 52.5, P < .017). Sex did not correlate with the postoperative MMEs prescribed. From 2011 to 2021, a 58.2% decrease in the 90-day mean MMEs prescribed was noted per patient (P < .017). Conclusions Fewer postoperative MMEs were filled following FAIS hip arthroscopy for patients in their 20s relative to those in their 30s, as well as for those with lower comorbidity burden. Patient sex was not associated with differences in postoperative MMEs prescribed. The amount of mean MMEs prescribed per patient decreased from 2011 to 2021. Clinical Relevance This study provides information about the typical amount of narcotics required after surgery. This is increasingly useful information, as surgeons/clinicians continue to try to minimize the role of narcotics in postoperative recovery.
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Affiliation(s)
- Wesley Day
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Scott Halperin
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Serkan Surucu
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Andrew E. Jimenez
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Beatrice Katsnelson
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Justin Zhu
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Jonathan N. Grauer
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
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Harrison S, Capers K, Chen G, Liu JT, Pannu A, Goodspeed V, Leibowitz A, Bose S. New initiation of opioids, benzodiazepines and antipsychotics following hospitalization for COVID-19. J Hosp Med 2024; 19:877-885. [PMID: 38742528 DOI: 10.1002/jhm.13408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 04/30/2024] [Accepted: 05/03/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Patients newly initiated on opioids (OP), benzodiazepines (BZD), and antipsychotics (AP) during hospitalization are often prescribed these on discharge. Implications of this practice on outcomes remains unexplored. OBJECTIVE To explore the prevalence and risk factors of new initiation of select OP, BZD and AP among patients requiring in-patient stays. Test the hypothesis that new prescriptions are associated with higher odds of readmission or death within 28 days of discharge. DESIGN Single center retrospective cohort study. SETTING AND PARTICIPANTS Patients admitted to a tertiary-level medical center with either a primary diagnosis of RT-PCR positive for COVID-19 or high index of clinical suspicion thereof. INTERVENTION None. MAIN OUTCOME AND MEASURES Exposure was the new initiation of select common OP, BZD, and AP which were continued on hospital discharge. Outcome was a composite of 28-day readmission or death following index admission. Multivariable logistic regression was used to assess patient mortality or readmission within 28 days of discharge associated with new prescriptions at discharge. RESULTS 1319 patients were included in the analysis. 11.3% (149/1319) were discharged with a new prescription of select OP, BZD, or AP either alone or in combination. OP (110/149) were most prescribed followed by BZD (41/149) and AP (22/149). After adjusting for unbalanced confounders, new prescriptions (adjusted odds ratio: 2.44, 95% confidence interval: 1.42-4.12; p = .001) were associated with readmission or death within 28 days of discharge. One in nine patients admitted with a diagnosis of COVID-19 or high clinical suspicion thereof were discharged with a new prescription of either OP, BZD or AP. New prescriptions were associated with higher odds of 28-day readmission or death. Strengthening medication reconciliation processes focused on these classes may reduce avoidable harm.
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Affiliation(s)
- Samantha Harrison
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Center for Anesthesia Research Excellence (CARE), Boston, Massachusetts, USA
| | - Krystal Capers
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Center for Anesthesia Research Excellence (CARE), Boston, Massachusetts, USA
| | - Guanqing Chen
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Center for Anesthesia Research Excellence (CARE), Boston, Massachusetts, USA
| | - Ji T Liu
- Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Ameeka Pannu
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Valerie Goodspeed
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Center for Anesthesia Research Excellence (CARE), Boston, Massachusetts, USA
| | - Akiva Leibowitz
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Somnath Bose
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Center for Anesthesia Research Excellence (CARE), Boston, Massachusetts, USA
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Alessio-Bilowus D, Luby AO, Cooley S, Evilsizer S, Seese E, Bicket M, Waljee JF. Perioperative Opioid-Related Harms: Opportunities to Minimize Risk. Semin Plast Surg 2024; 38:61-68. [PMID: 38495063 PMCID: PMC10942841 DOI: 10.1055/s-0043-1778043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Although substantial attention has been given to opioid prescribing in the United States, opioid-related mortality continues to climb due to the rising incidence and prevalence of opioid use disorder. Perioperative care has an important role in the consideration of opioid prescribing and the care of individuals at risk for poor postoperative pain- and opioid-related outcomes. Opioids are effective for acute pain management and commonly prescribed for postoperative pain. However, failure to align prescribing with patient need can result in overprescribing and exacerbate the flow of unused opioids into communities. Conversely, underprescribing can result in the undertreatment of pain, complicating recovery and impairing well-being after surgery. Optimizing pain management can be particularly challenging for individuals who are previously exposed to opioids or have critical risk factors, including opioid use disorder. In this review, we will explore the role of perioperative care in the broader context of the opioid epidemic in the United States, and provide considerations for a multidisciplinary, comprehensive approach to perioperative pain management and optimal opioid stewardship.
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Affiliation(s)
- Dominic Alessio-Bilowus
- Section of Plastic Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
- Opioid Prescribing Engagement Network, Ann Arbor, Michigan
| | - Alexandra O. Luby
- Section of Plastic Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan
| | | | | | | | - Mark Bicket
- Opioid Prescribing Engagement Network, Ann Arbor, Michigan
- Division of Pain Research, Department of Anesthesiology, Michigan Medicine, Ann Arbor, Michigan
| | - Jennifer F. Waljee
- Section of Plastic Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
- Opioid Prescribing Engagement Network, Ann Arbor, Michigan
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan
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Hien NTK, Tsai FJ, Chang YH, Burton W, Phuc PT, Nguyen PA, Harnod D, Lam CSK, Lu TC, Chen CI, Hsu MH, Lu CY, Huang CW, Yang HC, Hsu JC. Unveiling the future of COVID-19 patient care: groundbreaking prediction models for severe outcomes or mortality in hospitalized cases. Front Med (Lausanne) 2024; 10:1289968. [PMID: 38249981 PMCID: PMC10797111 DOI: 10.3389/fmed.2023.1289968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/14/2023] [Indexed: 01/23/2024] Open
Abstract
Background Previous studies have identified COVID-19 risk factors, such as age and chronic health conditions, linked to severe outcomes and mortality. However, accurately predicting severe illness in COVID-19 patients remains challenging, lacking precise methods. Objective This study aimed to leverage clinical real-world data and multiple machine-learning algorithms to formulate innovative predictive models for assessing the risk of severe outcomes or mortality in hospitalized patients with COVID-19. Methods Data were obtained from the Taipei Medical University Clinical Research Database (TMUCRD) including electronic health records from three Taiwanese hospitals in Taiwan. This study included patients admitted to the hospitals who received an initial diagnosis of COVID-19 between January 1, 2021, and May 31, 2022. The primary outcome was defined as the composite of severe infection, including ventilator use, intubation, ICU admission, and mortality. Secondary outcomes consisted of individual indicators. The dataset encompassed demographic data, health status, COVID-19 specifics, comorbidities, medications, and laboratory results. Two modes (full mode and simplified mode) are used; the former includes all features, and the latter only includes the 30 most important features selected based on the algorithm used by the best model in full mode. Seven machine learning was employed algorithms the performance of the models was evaluated using metrics such as the area under the receiver operating characteristic curve (AUROC), accuracy, sensitivity, and specificity. Results The study encompassed 22,192 eligible in-patients diagnosed with COVID-19. In the full mode, the model using the light gradient boosting machine algorithm achieved the highest AUROC value (0.939), with an accuracy of 85.5%, a sensitivity of 0.897, and a specificity of 0.853. Age, vaccination status, neutrophil count, sodium levels, and platelet count were significant features. In the simplified mode, the extreme gradient boosting algorithm yielded an AUROC of 0.935, an accuracy of 89.9%, a sensitivity of 0.843, and a specificity of 0.902. Conclusion This study illustrates the feasibility of constructing precise predictive models for severe outcomes or mortality in COVID-19 patients by leveraging significant predictors and advanced machine learning. These findings can aid healthcare practitioners in proactively predicting and monitoring severe outcomes or mortality among hospitalized COVID-19 patients, improving treatment and resource allocation.
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Affiliation(s)
- Nguyen Thi Kim Hien
- Master Program in Global Health and Health Security, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Feng-Jen Tsai
- Master Program in Global Health and Health Security, College of Public Health, Taipei Medical University, Taipei, Taiwan
- Ph.D. Program in Global Health and Health Security, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Yu-Hui Chang
- PharmD Program, Division of Clinical Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Whitney Burton
- International Ph.D. Program in Biotech and Healthcare Management, College of Management, Taipei Medical University, Taipei, Taiwan
| | - Phan Thanh Phuc
- International Ph.D. Program in Biotech and Healthcare Management, College of Management, Taipei Medical University, Taipei, Taiwan
| | - Phung-Anh Nguyen
- Clinical Data Center, Office of Data Science, Taipei Medical University, Taipei, Taiwan
- Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
- Research Center of Health Care Industry Data Science, College of Management, Taipei Medical University, Taipei, Taiwan
| | - Dorji Harnod
- Department of Emergency, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Emergency and Critical Care Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Carlos Shu-Kei Lam
- Department of Emergency, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Emergency, Department of Emergency and Critical Care Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Tsung-Chien Lu
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chang-I Chen
- Department of Healthcare Administration, School of Management, Taipei Medical University, Taipei, Taiwan
| | - Min-Huei Hsu
- Graduate Institute of Data Science, College of Management, Taipei Medical University, Taipei, Taiwan
| | - Christine Y. Lu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, United States
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Sydney, NSW, Australia
| | - Chih-Wei Huang
- Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
- International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan
| | - Hsuan-Chia Yang
- Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
- International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
- Research Center of Big Data and Meta-analysis, Wanfang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Jason C. Hsu
- International Ph.D. Program in Biotech and Healthcare Management, College of Management, Taipei Medical University, Taipei, Taiwan
- Clinical Data Center, Office of Data Science, Taipei Medical University, Taipei, Taiwan
- Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
- Research Center of Health Care Industry Data Science, College of Management, Taipei Medical University, Taipei, Taiwan
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Lee C, Ye M, Weaver O, Jess E, Gilani F, Samanani S, Eurich DT. Defining opioid naïve and implications for monitoring opioid use: A population-based study in Alberta, Canada. Pharmacoepidemiol Drug Saf 2024; 33:e5693. [PMID: 37679887 DOI: 10.1002/pds.5693] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 07/17/2023] [Accepted: 08/21/2023] [Indexed: 09/09/2023]
Abstract
PURPOSE Reducing initial exposure of "opioid naïve" patients to opioids is a public health priority. Identifying opioid naïve patients is difficult, as numerous definitions are used. The objective is to summarize current definitions and evaluate their impact on opioid naïve measures in Alberta. METHODS An exploratory data analysis of the literature was conducted over the last 10 years to identify definitions commonly used in the literature to define opioid naïve. Then, using these definitions as a guide, we descriptively report the proportion of patients in Alberta between 2017 and 2021 who would be considered as opioid naïve using these definitions and all opioid dispensing data. RESULTS Three categories of definitions were broadly identified: (1) no opioid use within the previous 30 days/6 months/1 year, based on dispensation date; (2) no opioid use based on dispensation date plus days of supply; and, (3) exclusion of codeine from Definitions 1 and 2. Applying these definitions to the Alberta population showed a very wide range in the proportion who would be considered as opioid naïve. Overall, 36.4% of Albertans (n = 1 551 075) had an opioid dispensation in 2017-2021. The average age was 46.6 ± 18.8 and 52.8% were female. The proportion of opioid naïve were most affected by the "opioid free" period, with 97.4%, 83.2%, and 65.6% being classified as opioid naïve using time windows from Definition 1 (30 days, 6 months, 1 year of no prior opioid use). Definitions 2 and 3 did not materially change the results. Further extending the "opioid free" period to 2 years showed only 35% were opioid naïve. CONCLUSIONS The most convenient definition for "opioid naïve" was the use of an "opioid free" period. The choice of window would depend on how the information may be used to assistant in clinical decisions with longer windows more likely to reflect true opioid naïve patients. Irrespective of definition used, a large proportion of opioid users would be considered opioid naïve in Alberta.
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Affiliation(s)
- Cerina Lee
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Ming Ye
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Olivia Weaver
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Ed Jess
- College of Physicians and Surgeons of Alberta, Edmonton, Alberta, Canada
| | - Fizza Gilani
- College of Physicians and Surgeons of Alberta, Edmonton, Alberta, Canada
| | - Salim Samanani
- OKAKI Health Intelligence Inc., Calgary, Alberta, Canada
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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Baumann L, Bello C, Georg FM, Urman RD, Luedi MM, Andereggen L. Acute Pain and Development of Opioid Use Disorder: Patient Risk Factors. Curr Pain Headache Rep 2023; 27:437-444. [PMID: 37392334 PMCID: PMC10462493 DOI: 10.1007/s11916-023-01127-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2023] [Indexed: 07/03/2023]
Abstract
PURPOSE OF REVIEW Pharmacological therapy for acute pain carries the risk of opioid misuse, with opioid use disorder (OUD) reaching epidemic proportions worldwide in recent years. This narrative review covers the latest research on patient risk factors for opioid misuse in the treatment of acute pain. In particular, we emphasize newer findings and evidence-based strategies to reduce the prevalence of OUD. RECENT FINDINGS This narrative review captures a subset of recent advances in the field targeting the literature on patients' risk factors for OUD in the treatment for acute pain. Besides well-recognized risk factors such as younger age, male sex, lower socioeconomic status, White race, psychiatric comorbidities, and prior substance use, additional challenges such as COVID-19 further aggravated the opioid crisis due to associated stress, unemployment, loneliness, or depression. To reduce OUD, providers should evaluate both the individual patient's risk factors and preferences for adequate timing and dosing of opioid prescriptions. Short-term prescription should be considered and patients at-risk closely monitored. The integration of non-opioid analgesics and regional anesthesia to create multimodal, personalized analgesic plans is important. In the management of acute pain, routine prescription of long-acting opioids should be avoided, with implementation of a close monitoring and cessation plan.
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Affiliation(s)
- Livia Baumann
- Department of Anaesthesiology and Pain Medicine, Kantonsspital Aarau, Aarau, Switzerland
- Faculty of Medicine, University of Bern, Bern, Switzerland
| | - Corina Bello
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Filipovic Mark Georg
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Richard D Urman
- Department of Anesthesiology, The Ohio State University, Columbus, OH, USA
| | - Markus M Luedi
- Faculty of Medicine, University of Bern, Bern, Switzerland
- Department of Anaesthesiology and Pain Medicine, Cantonal Hospital of St, Gallen, St. Gallen, Switzerland
| | - Lukas Andereggen
- Faculty of Medicine, University of Bern, Bern, Switzerland.
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland.
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Kasanagottu K, Herzig SJ. Opioids, benzodiazepines, and COVID-19: A recipe for risk. J Hosp Med 2022; 17:580-581. [PMID: 35700321 PMCID: PMC9349968 DOI: 10.1002/jhm.12889] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 05/23/2022] [Accepted: 05/23/2022] [Indexed: 12/03/2022]
Affiliation(s)
- Koushik Kasanagottu
- Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical CenterDivision of General MedicineBostonMassachusettsUSA
| | - Shoshana J. Herzig
- Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical CenterDivision of General MedicineBostonMassachusettsUSA
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