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Walters JK, Repp KK, Mew MC. Alcohol and drug presence in traffic crash fatalities before and after the COVID-19 pandemic: Evaluation of the fatality analysis reporting system (FARS) and linked medical examiner-vital records data in Clackamas, Multnomah, and Washington County, Oregon, 2019-2021. Forensic Sci Int Synerg 2024; 8:100468. [PMID: 38707715 PMCID: PMC11066131 DOI: 10.1016/j.fsisyn.2024.100468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/10/2024] [Accepted: 04/13/2024] [Indexed: 05/07/2024]
Abstract
Traffic fatalities, with and from increased risky behaviors (reduced seat belt use, increased impairment from licit and illicit substances), have been increasing, especially during the COVID-19 pandemic. Death certificates are a major source of epidemiologic data in the United States, but have known underreporting of drug and alcohol presence. The Fatality Analysis Reporting System (FARS) is one major source of data on fatal crashes with intoxication. This study links FARS data for three counties in Oregon (2019-2021) with local medical examiner and death certificate data (FARS source data) and compares their concordance with blood alcohol concentration and toxicology for three major drug classes by year. For drivers only, our study finds good concordance between FARS and its source data in 2019 but poor concordance in 2020. This discordance may impact future analysis of impaired crash deaths, and we list some suggestions for amelioration.
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Affiliation(s)
- Jaime K. Walters
- Multnomah County Health Department, Public Health Division, Community Epidemiology Services, USA
| | - Kimberly K. Repp
- Washington County Health and Human Services Department, Public Health Division, Research, Analytics, Informatics, and Data (RAID) Program), USA
| | - Molly C. Mew
- Clackamas County Health, Housing and Human Services Department, Public Health Division, USA
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2
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Abstract
BACKGROUND The benzodiazepine drug alprazolam, a fast-acting tranquiliser, cannot be prescribed on the National Health Service in the United Kingdom. Illicit alprazolam supply and consumption have increased. Concern about increasing numbers of alprazolam-related fatalities started circulating in 2018. However, statistics on this issue are very limited. This study examined patterns in such mortality in Scotland. METHODS Statistics on deaths where alprazolam was mentioned in the 'cause of death' were obtained from official mortality registers. Anonymised Scottish case-level data were obtained. Data were examined in respect of the characteristics of decedents and deaths using descriptive statistics. RESULTS Scotland registered 370 deaths in 2004-2020; 366 of these occurred in 2015-2020: most involved males (77.1%); mean age 39.0 (SD 12.6) years. The principal underlying cause of death was accidental poisoning: opiates/opioids (77.9%); sedatives/hypnotics (15.0%). Two deaths involved alprazolam alone. Main drug groups implicated: opiates/opioids (94.8%), 'other benzodiazepines' (67.2%), gabapentinoids (42.9%), stimulants (30.1%), antidepressants (15.0%). Two-thirds (64.2%) involved combinations of central nervous system (CNS) depressants. DISCUSSION Alprazolam-related deaths are likely due to an increasing illicit supply. The fall in deaths in 2019-2020 is partially due to increased use of designer benzodiazepines. Treatment for alprazolam dependence is growing. Clinicians need to be aware of continuing recreational alprazolam use. When such consumption occurs with CNS depressants, overdose and death risks increase. CONCLUSIONS More awareness of alprazolam contributing to deaths, especially in conjunction with other CNS depressants, is needed by consumers and clinicians. Improved monitoring of illicit supplies could identify emerging issues of medicines' abuse.
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Affiliation(s)
- John Martin Corkery
- Psychopharmacology, Drug Misuse and
Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences,
University of Hertfordshire, Hertfordshire, UK,John Martin Corkery, Psychopharmacology,
Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and
Medical Sciences, University of Hertfordshire, Health Research Building, College
Lane Campus, Hertfordshire AL10 9AB, UK.
| | - Amira Guirguis
- Psychopharmacology, Drug Misuse and
Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences,
University of Hertfordshire, Hertfordshire, UK,Swansea University Medical School,
Swansea University, Swansea, UK
| | - Stefania Chiappini
- Psychopharmacology, Drug Misuse and
Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences,
University of Hertfordshire, Hertfordshire, UK
| | - Giovanni Martinotti
- Psychopharmacology, Drug Misuse and
Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences,
University of Hertfordshire, Hertfordshire, UK,Department of Neuroscience, Imaging and
Clinical Sciences, “G. D’Annunzio” University, Chieti, Italy
| | - Fabrizio Schifano
- Psychopharmacology, Drug Misuse and
Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences,
University of Hertfordshire, Hertfordshire, UK
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3
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Effect of community pharmacist-provided patient education of partial fill availability for acute opioid prescriptions. J Am Pharm Assoc (2003) 2022; 62:S22-S28. [DOI: 10.1016/j.japh.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 04/08/2022] [Accepted: 04/10/2022] [Indexed: 11/23/2022]
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4
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Ellyson AM, Grooms J, Ortega A. Flipping the script: The effects of opioid prescription monitoring on specialty-specific provider behavior. HEALTH ECONOMICS 2022; 31:297-341. [PMID: 34773311 DOI: 10.1002/hec.4446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 08/20/2021] [Accepted: 10/05/2021] [Indexed: 06/13/2023]
Abstract
Mandatory access Prescription Drug Monitoring Programs (MA-PDMPs) aim to curb the epidemic at a common point of initiation of use, the prescription. However, there is recent concern about whether opioid policies have been too restrictive and reduced appropriate access to patients with the most need for opioid pharmaceuticals. We assess MA-PDMP's effect on specialty-specific opioid prescribing behavior of Medicare providers. Our findings suggest that requiring providers to query a PDMP differentially affects opioid prescribing across provider specialties. We find a three to four percent decrease in prescribing for Primary Care and Internal Medicine providers. This result is driven by healthcare providers at the lower end of the prescribing distribution. There is also suggestive evidence of an increase in opioid use disorder treatment drugs prescribed by these same providers. We also find no evidence for the hypothesis that MA-PDMPs restrict prescribing by providers who treat patients with potentially high levels of pain, few drug substitutes, or urgency for pain treatment (e.g., Oncology/Palliative care). This result is not dependent on whether a state provides exemptions for these providers. Our results indicate that MA-PDMPs may help close provider-patient informational gaps while retaining a provider's ability to supply these drugs to patients with a need for opioids.
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Affiliation(s)
- Alice M Ellyson
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, Washington, USA
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Jevay Grooms
- Department of Economics, Howard University, Washington, District of Columbia, USA
| | - Alberto Ortega
- O'Neill School of Public and Environmental Affairs, Indiana University, Bloomington, Indiana, USA
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5
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Griffith KN, Feyman Y, Auty SG, Crable EL, Levengood TW. Implications of county-level variation in U.S. opioid distribution. Drug Alcohol Depend 2021; 219:108501. [PMID: 33421805 PMCID: PMC8115932 DOI: 10.1016/j.drugalcdep.2020.108501] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 12/06/2020] [Accepted: 12/08/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Prescription opioids accounted for the majority of opioid-related deaths in the United States prior to 2010, and continue to contribute to opioid misuse and mortality. We used a novel dataset to investigate the distributional patterns of prescription opioids, whether opioid pill volume was associated with opioid-related mortality, and whether early state Medicaid expansions were associated with either pill volume or opioid-related mortality. METHODS Data on opioid shipments to retail pharmacies for 2006-2013 were obtained from the U.S. Drug Enforcement Administration, and opioid-related deaths (ORDs) were obtained from the Centers for Disease Control and Prevention. We first compared characteristics of counties in the highest and lowest quartiles for per capita pill volume (PCPV). We used adjusted difference-in-differences regression models to identify factors associated with PCPV or ORDs, and whether early state Medicaid expansions were associated with either outcome. All models were estimated as linear regressions with standard errors clustered by county, and weighted by county population. RESULTS We found large geographic variations in opioid distribution, and this variation appears to be driven by differences in demographics, healthcare access, and healthcare supply. In adjusted models, a one-pill increase in PCPV was associated with a 0.20 increase in ORDs per 100,000 population (95 % CI 0.11-0.30). Early Medicaid expansions were associated with lower PCPV (-2.20, 95 % CI -2.97 to -1.43). CONCLUSIONS Our findings validate the relationship between PCPV and ORDs, identify important environmental drivers of the opioid epidemic, and suggest early state Medicaid expansions were beneficial in reducing opioid pill volume.
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Affiliation(s)
- Kevin N Griffith
- Department of Health Policy, Vanderbilt University Medical Center, 2525 West End Ave., Suite 1200, Nashville, TN 37203, USA; Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, Bldg. 9, 150 S. Huntington Ave., Boston, MA 02130, USA.
| | - Yevgeniy Feyman
- Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, Bldg. 9, 150 S. Huntington Ave., Boston, MA 02130, USA; Department of Health Law, Policy & Management, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
| | - Samantha G Auty
- Department of Health Law, Policy & Management, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
| | - Erika L Crable
- Department of Health Law, Policy & Management, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
| | - Timothy W Levengood
- Department of Health Law, Policy & Management, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
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6
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Black JC, Bau GE, Rosen T, Cepeda MS, Wedin GP, Green JL, Dart RC. Changes in Mortality Involving Extended-Release and Long-Acting Opioids After Implementation of a Risk Evaluation and Mitigation Strategy. PAIN MEDICINE 2021; 21:92-100. [PMID: 30877807 PMCID: PMC6953333 DOI: 10.1093/pm/pnz031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Objective To assess changes in mortality rates in extended-release and long-acting (ER/LA) opioid analgesics after the implementation of the Risk Evaluation and Mitigation Strategy (REMS). Setting All drug poisoning deaths in three states: Florida, Oregon, and Washington. Data were obtained through state vital records offices and the Researched Abuse, Diversion and Addiction-Related Surveillance System Medical Examiner Program. Methods Using cause-of-death literal text from death certificates, individual opioid active pharmaceutical ingredients (APIs) involved in each death were identified using rules-based natural language processing. Population-adjusted and prescriptions dispensed–adjusted mortality rates were calculated for all ER/LA opioid analgesic and individual opioid APIs. Rates before and after implementation of the REMS were compared. Rate changes were compared with rates from two APIs with little or no inclusion in the REMS: benzodiazepines and hydrocodone. Results The mean ER/LA opioid analgesic population-adjusted mortality rate significantly decreased in all three states (FL: P = 0.003; OR: P = 0.003; WA: P < 0.001). Mortality rates for benzodiazepines and hydrocodone also decreased and were not statistically different. Significant heterogeneity in mortality rates of individual opioids was observed between the three states. When adjusted for prescription volume, the ER/LA opioid analgesic mortality rate decreased in all three states, but was significant only for Washington (P < 0.001). Conclusions The population-adjusted mortality rate of ER/LA opioid analgesics has decreased in three states. Notably, the contributions to mortality rates by individual opioid analgesics were not uniform across the three states in this study. However, these changes were not generally distinct from changes in mortality rates where comparator substances were involved.
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Affiliation(s)
- Joshua C Black
- Rocky Mountain Poison & Drug Center, Denver Health and Hospital Authority, Denver, Colorado
| | - Gabrielle E Bau
- Rocky Mountain Poison & Drug Center, Denver Health and Hospital Authority, Denver, Colorado
| | - Travis Rosen
- Rocky Mountain Poison & Drug Center, Denver Health and Hospital Authority, Denver, Colorado
| | - M Soledad Cepeda
- Janssen Pharmaceutical Research & Development LLC, Titusville, New Jersey
| | | | - Jody L Green
- Rocky Mountain Poison & Drug Center, Denver Health and Hospital Authority, Denver, Colorado.,Inflexxion, Inc., Waltham, Massachusetts, USA
| | - Richard C Dart
- Rocky Mountain Poison & Drug Center, Denver Health and Hospital Authority, Denver, Colorado
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7
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Cano M, Huang Y. Overdose deaths involving psychostimulants with abuse potential, excluding cocaine: State-level differences and the role of opioids. Drug Alcohol Depend 2021; 218:108384. [PMID: 33158665 DOI: 10.1016/j.drugalcdep.2020.108384] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/15/2020] [Accepted: 10/15/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Over the course of the past decade, psychostimulants such as methamphetamines have been increasingly reported in overdose deaths in the United States (US). Methamphetamine use has recently risen among individuals who use opioids, yet it is unclear what role the opioid crisis has played in the increase in psychostimulant-involved overdose mortality in states across the US. METHODS Mortality data from the Centers for Disease Control and Prevention were used to examine recent state-level changes in overdose deaths involving psychostimulants with abuse potential, excluding cocaine. Psychostimulant-involved overdose mortality rates, changes in rates, and opioid co-involvement were compared by state and plotted on choropleth maps. Ordinary least squares regression analyses were used to test the associations between a state's psychostimulant-involved overdose mortality rate change and several state-level indicators related to the opioid crisis. RESULTS From 2015/2016-2017/2018, significant increases in psychostimulant-involved overdose mortality rates were observed in 42 of 47 states with data available. Each of the three state-level indicators examined in the study (opioid prescribing rate in 2012, past-year prevalence of opioid use disorder from 2015-2018, and increase in drug overdose mortality during the earliest stages of the opioid crisis from 1999-2012) was positively associated with the absolute rate change in psychostimulant-involved overdose mortality from 2015/2016-2017/2018. CONCLUSIONS Although deaths involving methamphetamine have historically been primarily concentrated in the western US, results of the study reflect the alarming increase in psychostimulant-involved overdose mortality across the nation, especially in some of the states heavily impacted by the opioid crisis.
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Affiliation(s)
- Manuel Cano
- Department of Social Work, University of Texas at San Antonio, 501 W. César E. Chávez Blvd., San Antonio, TX, 78207, USA.
| | - Ying Huang
- Department of Demography, University of Texas at San Antonio, 301 South Frio Street, San Antonio, TX, 78207, USA
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8
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Crystal DT, Cuccolo NG, Plewinski MJ, Ibrahim AMS, Sinkin JC, Lin SJ, Agag RL, Lee BT. Assessment of Opioid-Prescribing Practices in Breast Augmentation: Future Directions for Prescribing Guidelines. Ann Plast Surg 2021; 86:11-18. [PMID: 32568754 DOI: 10.1097/sap.0000000000002430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The United States (US) is in the mid of an opioid epidemic propagated, in part, by prescription opioids. With excess overprescribing documented in a variety of surgical procedures, several societies have recommended opioid-prescribing guidelines. Considering the scope and postoperative pain associated with aesthetic plastic surgery procedures, earnest evaluation into opioid-prescribing practices for breast augmentation was conducted. METHODS Members of the American Society for Aesthetic Plastic Surgery were electronically surveyed on their opioid-prescribing patterns. The survey was distributed to 1709 plastic surgeons. Descriptive statistics were collated into percentages, deviations, and morphine milligram equivalents (MMEs), when appropriate. RESULTS Two hundred twenty-nine American Society for Aesthetic Plastic Surgery members (13.4%) provided responses. A total of 91.2% of respondents prescribe opioids to patients undergoing breast augmentation. The most commonly prescribed agents included oxycodone/acetaminophen (Percocet, 47.0%) and hydrocodone/acetaminophen (Vicodin, 38.3%). On average, 165.3 ± 81.7 MMEs were dispensed (range, 25.0-600.0 MMEs; number tablets, 5-60). Prescribers felt that a lack of phone-in prescribing (52.4%) and the ease of preemptively prescribing opioids (52.4%) propagate opioid overprescribing. A total of 61.3% of respondents reported that they are or may be in favor of developing plastic surgery societal guidelines related to opioid prescribing. These respondents indicated support for guidelines on opioid-sparing pain management strategies (74.2%) and guidelines identifying the type (54.7%), duration of use (69.5%), and number of opioid tablets (61.7%) necessary for procedures. CONCLUSIONS Considerable variability exists among prescribing patterns after breast augmentation. Societal guidelines aimed at providers and patients may serve a future role in opioid prescribing.
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Affiliation(s)
| | | | - Michael J Plewinski
- Division of Plastic Surgery, Robert Wood Johnson University Hospital, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Ahmed M S Ibrahim
- From the Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Jeremy C Sinkin
- Division of Plastic Surgery, Robert Wood Johnson University Hospital, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Samuel J Lin
- From the Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Richard L Agag
- Division of Plastic Surgery, Robert Wood Johnson University Hospital, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Bernard T Lee
- From the Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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9
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Drug overdose mortality among stateside Puerto Ricans: Evidence of a health disparity. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 90:103079. [PMID: 33341699 DOI: 10.1016/j.drugpo.2020.103079] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/23/2020] [Accepted: 11/29/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND This study compared drug overdose mortality rates in Puerto Rican-heritage and Non-Hispanic (NH) White individuals in the United States (US), examining time trends and recent variation by age, sex, state of residence, and drugs involved in overdose. METHODS Death certificate data from the National Center for Health Statistics, as well as American Community Survey population estimates, were used to calculate age-specific and age-adjusted drug overdose mortality rates for Puerto Rican-heritage and NH White residents of the 50 United States or District of Columbia (DC). Rates for 2018 were compared between Puerto Rican-heritage and NH White individuals, overall and by sex, age, state, and specific drug involved in overdose. Joinpoint Regression was used to examine trends in drug overdose mortality rates from 2009 to 2018. RESULTS From 2009 to 2018, the age-adjusted drug overdose mortality rate in stateside Puerto Ricans doubled among women (from 6.0 to 12.5 per 100,000) and nearly tripled among men (from 15.3 to 45.2 per 100,000). In 2018, the age-adjusted drug overdose mortality rate was significantly higher in Puerto Rican-heritage than NH White individuals (28.7 vs. 26.2 per 100,000, respectively). The 2018 drug overdose mortality rate was highest among Puerto Rican-heritage men ages 45-54 (104.1 per 100,000). CONCLUSION Findings emphasize the necessity of policies, programs, and interventions to mitigate risk of fatal overdose in stateside Puerto Rican communities.
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10
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Perianesthesia Patient Education for the Promotion of Opioid Stewardship. J Perianesth Nurs 2020; 36:108-115. [PMID: 33334681 DOI: 10.1016/j.jopan.2020.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 06/01/2020] [Accepted: 06/07/2020] [Indexed: 11/24/2022]
Abstract
Opioid overdose deaths and opioid use disorders are a crisis in the United States and other western countries around the globe. Opioid prescriptions more than doubled after the turn of the century, particularly for postoperative patients. Unfortunately, many who have abused opioids were able to obtain those opioids from friends or family who had held on to prescribed, but unused opioids. One method to manage and decrease the opportunity for unused opioids to become black-market opioids is to educate patients and families regarding the safe use, safe storage, and proper disposal of unused prescription opioids. Perianesthesia nurses, particularly those who educate patients before and after surgery, have an excellent opportunity to educate patients and families who are discharged to home after surgery.
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11
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MacDorman MF, Thoma M, Declercq E. Improving US maternal mortality reporting by analyzing literal text on death certificates, United States, 2016-2017. PLoS One 2020; 15:e0240701. [PMID: 33112910 PMCID: PMC7592741 DOI: 10.1371/journal.pone.0240701] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/01/2020] [Indexed: 11/18/2022] Open
Abstract
Changes in data collection and processing of US maternal mortality data across states over time have led to inconsistencies in maternal death reporting. Our purpose was to identify possible misclassification of maternal deaths and to apply alternative coding methods to improve specificity of maternal causes. We analyzed 2016-2017 US vital statistics mortality data with cause-of-death literals (actual words written on the death certificate) added. We developed an alternative coding strategy to code the "primary cause of death" defined as the most likely cause that led to death. We recoded deaths with or without literal pregnancy mentions to maternal and non-maternal causes, respectively. Originally coded and recoded data were compared for overall maternal deaths and for a subset of deaths originally coded to ill-defined causes. Among 1691 originally coded maternal deaths, 597 (35.3%) remained a maternal death upon recoding and 1094 (64.7%) were recoded to non-maternal causes. The most common maternal causes were eclampsia and preeclampsia, obstetric embolism, postpartum cardiomyopathy, and obstetric hemorrhage. The most common non-maternal causes were diseases of the circulatory system and cancer, similar to the leading causes of death among all reproductive-age women (excluding injuries). Among 735 records originally coded to ill-defined causes, 94% were recoded to more specific, informative causes from literal text. Eighteen deaths originally coded as non-maternal mentioned pregnancy in the literals and were recoded as maternal deaths. Literal text provides more detailed information on cause of death which is often lost during coding. We found evidence of both underreporting and overreporting of maternal deaths, with possible overreporting predominant. Accurate data is essential for measuring the effectiveness of maternal mortality reduction programs.
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Affiliation(s)
- Marian F. MacDorman
- Maryland Population Research Center, University of Maryland, College Park, Maryland, United States of America
| | - Marie Thoma
- Department of Family Science, University of Maryland School of Public Health, College Park, Maryland, United States of America
| | - Eugene Declercq
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, United States of America
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12
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Cano M, Oh S, Salas-Wright CP, Vaughn MG. Cocaine use and overdose mortality in the United States: Evidence from two national data sources, 2002-2018. Drug Alcohol Depend 2020; 214:108148. [PMID: 32702620 PMCID: PMC7423708 DOI: 10.1016/j.drugalcdep.2020.108148] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/24/2020] [Accepted: 06/27/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cocaine-involved overdose mortality has recently risen in the United States (US), yet it is unclear to what extent patterns in cocaine-involved overdose mortality parallel patterns in cocaine use. This study: examined time trends (2002-2018) in past-year cocaine use and cocaine-involved overdose mortality in the US; and compared demographics and drug involvement of adults who reported past-year cocaine use versus adults who died of a cocaine-involved overdose. METHODS Data from two sources were utilized: (1) the National Survey on Drug Use and Health (n = 1,334 adults self-reporting cocaine use in 2018); and (2) the Multiple Cause of Death dataset of the National Center for Health Statistics (N = 14,630 adults who died of a cocaine-involved overdose in 2018). The study examined prevalence of past-year cocaine use, mortality rates for cocaine-involved overdose, 2002-2018 trends, demographic characteristics, and involvement of other drugs. RESULTS Results of Joinpoint Regression indicated that the prevalence of past-year cocaine use increased after 2011, with an annual percent change of 5.13, while age-adjusted cocaine-involved overdose mortality rates escalated after 2012, with an annual percent change of 26.54. In 2018, prevalence of past-year cocaine use did not significantly differ (p = 0.09) by racial/ethnic group, yet Non-Hispanic Blacks had an age-adjusted cocaine-involved overdose mortality rate more than double the rate in Non-Hispanic Whites and significantly higher (p < 0.001) than in any other group. CONCLUSIONS While the prevalence of cocaine use has increased modestly, cocaine-involved overdose mortality has risen dramatically. Cocaine-involved overdose mortality is disproportionately affecting individuals who are Black, older, or with lower educational attainment.
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Affiliation(s)
- Manuel Cano
- Department of Social Work, University of Texas at San Antonio, 501 W. César E. Chávez Blvd., San Antonio, TX, 78207, USA.
| | - Sehun Oh
- College of Social Work, The Ohio State University, 1947 College Rd., Columbus, OH 43210, USA
| | - Christopher P. Salas-Wright
- School of Social Work, Boston University, 264 Bay State Rd, Boston, MA 02215, USA,Department of Public Health Sciences, Division of Prevention Science & Community Health, University of Miami, Miami, FL, USA
| | - Michael G. Vaughn
- School of Social Work, St. Louis University, 3550 Lindell Blvd., St. Louis, MO 63103, USA,Graduate School of Social Welfare and College of Social Science, Yonsei University, Republic of Korea
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13
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Ruhm CJ. Commentary on Boslett et al. (2020): Towards better measurement of drug involvement in fatal overdoses. Addiction 2020; 115:1318-1319. [PMID: 32107833 DOI: 10.1111/add.14988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 01/27/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Christopher J Ruhm
- Frank Batten School of Leadership and Public Policy, University of Virginia and National Bureau of Economic Research
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14
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Black JC, Margolin ZR, Olson RA, Dart RC. Online Conversation Monitoring to Understand the Opioid Epidemic: Epidemiological Surveillance Study. JMIR Public Health Surveill 2020; 6:e17073. [PMID: 32597786 PMCID: PMC7367521 DOI: 10.2196/17073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 04/06/2020] [Accepted: 05/12/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Between 2016 and 2017, the national mortality rate involving opioids continued its escalation; opioid deaths rose from 42,249 to 47,600, bringing the public health crisis to a new height. Considering that 69% of adults in the United States use online social media sites, a resource that builds a more complete understanding of prescription drug misuse and abuse could supplement traditional surveillance instruments. The Food and Drug Administration has identified 5 key risks and consequences of opioid drugs-misuse, abuse, addiction, overdose, and death. Identifying posts that discuss these key risks could lead to novel information that is not typically captured by traditional surveillance systems. OBJECTIVE The goal of this study was to describe the trends of online posts (frequency over time) involving abuse, misuse, addiction, overdose, and death in the United States and to describe the types of websites that host these discussions. Internet posts that mentioned fentanyl, hydrocodone, oxycodone, or oxymorphone were examined. METHODS Posts that did not refer to personal experiences were removed, after which 3.1 million posts remained. A stratified sample of 61,000 was selected. Unstructured data were classified into 5 key risks by manually coding for key outcomes of misuse, abuse, addiction, overdose, and death. Sampling probabilities of the coded posts were used to estimate the total post volume for each key risk. RESULTS Addiction and misuse were the two most commonly discussed key risks for hydrocodone, oxycodone, and oxymorphone. For fentanyl, overdose and death were the most discussed key risks. Fentanyl had the highest estimated number of misuse-, overdose-, and death-related mentions (41,808, 42,659, and 94,169, respectively). Oxycodone had the highest estimated number of abuse- and addiction-related mentions (3548 and 12,679, respectively). The estimated volume of online posts for fentanyl increased by more than 10-fold in late 2017 and 2018. The odds of discussing fentanyl overdose (odds ratios [OR] 4.32, 95% CI 2.43-7.66) and death (OR 5.05, 95% CI 3.10-8.21) were higher for social media, while the odds of discussing fentanyl abuse (OR 0.10, 95% CI 0.04-0.22) and addiction (OR 0.24, 95% CI 0.15-0.38) were higher for blogs and forums. CONCLUSIONS Of the 5 FDA-defined key risks, fentanyl overdose and death has dominated discussion in recent years, while discussion of oxycodone, hydrocodone, and oxymorphone has decreased. As drug-related deaths continue to increase, an understanding of the motivations, circumstances, and consequences of drug abuse would assist in developing policy responses. Furthermore, content was notably different based on media origin, and studies that exclusively use either social media sites (such as Twitter) or blogs and forums could miss important content. This study sets out sustainable, ongoing methodology for surveilling internet postings regarding these drugs.
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Affiliation(s)
- Joshua C Black
- Rocky Mountain Poison and Drug Safety, Denver, CO, United States
| | | | - Richard A Olson
- Rocky Mountain Poison and Drug Safety, Denver, CO, United States
| | - Richard C Dart
- Rocky Mountain Poison and Drug Safety, Denver, CO, United States
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Golladay M, Donner K, Nechuta S. Using statewide death certificate data to understand trends and characteristics of polydrug overdose deaths in Tennessee, 2013–2017. Ann Epidemiol 2020; 41:43-48.e1. [DOI: 10.1016/j.annepidem.2019.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 11/18/2019] [Accepted: 12/04/2019] [Indexed: 01/30/2023]
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Slavova S, Delcher C, Buchanich JM, Bunn TL, Goldberger BA, Costich JF. Methodological Complexities in Quantifying Rates of Fatal Opioid-Related Overdose. CURR EPIDEMIOL REP 2019; 6:263-274. [PMID: 31259141 PMCID: PMC6559129 DOI: 10.1007/s40471-019-00201-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW Effective responses to the US opioid overdose epidemic rely on accurate and timely drug overdose mortality data, which are generated from medicolegal death investigations (MDI) and certifications of overdose deaths. We identify nuances of MDI and certification of overdose deaths that can influence drug overdose mortality surveillance, as well as recent research, recommendations, and epidemiological tools for improved identification and quantification of specific drug involvement in overdose mortality. RECENT FINDINGS Death certificates are the foundation of drug overdose mortality surveillance. Accordingly, counts and rates of specific drug involvement in overdose deaths are only as accurate as the drug listed on death certificates. Variation in systematic approaches or jurisdictional office policy in drug overdose death certification can lead to bias in mortality rate calculations. Recent research has examined statistical adjustments to improve underreported opioid involvement in overdose deaths. New cause-of-death natural language text analysis tools improve quantification of specific opioid overdose mortality rates. Enhanced opioid overdose surveillance, which combines death certificate data with other MDI-generated data, has the potential to improve understanding of factors and circumstances of opioid overdose mortality. SUMMARY The opioid overdose crisis has brought into focus some of the limitations of US MDI systems for drug overdose surveillance and has given rise to a sense of urgency regarding the pressing need for improvements in our MDI data for public health action and research. Epidemiologists can stimulate positive changes in MDI data quality by demonstrating the critical role of data in guiding public health and safety decisions and addressing the challenges of accurate and timely overdose mortality measures with stakeholders. Education, training, and resources specific to drug overdose surveillance and analysis will be essential as the nation's overdose crisis continues to evolve.
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Affiliation(s)
- Svetla Slavova
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY USA
- Kentucky Injury Prevention and Research Center, University of Kentucky, 333 Waller Ave, Suite 242, Lexington, KY 40504 USA
| | - Chris Delcher
- Department of Pharmacy Practice and Science, Institute for Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Kentucky, Lexington, KY USA
| | - Jeannine M. Buchanich
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA USA
| | - Terry L. Bunn
- Kentucky Injury Prevention and Research Center, University of Kentucky, 333 Waller Ave, Suite 242, Lexington, KY 40504 USA
- Department of Preventive Medicine and Environmental Health, College of Public Health, University of Kentucky, Lexington, KY USA
| | - Bruce A. Goldberger
- Department of Pathology, Immunology and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Julia F. Costich
- Kentucky Injury Prevention and Research Center, University of Kentucky, 333 Waller Ave, Suite 242, Lexington, KY 40504 USA
- Department of Health Management and Policy, College of Public Health, University of Kentucky, Lexington, KY USA
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Pruyn S, Frey J, Baker B, Brodeur M, Graichen C, Long H, Zheng H, Dailey MW. Quality Assessment of Expired Naloxone Products from First-Responders' Supplies. PREHOSP EMERG CARE 2019; 23:647-653. [PMID: 30596290 DOI: 10.1080/10903127.2018.1563257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: Naloxone is an opioid receptor antagonist that reverses life-threatening effects of opioid overdose. Since the 1970s, naloxone products have been developed as injectable solutions, and more recently as nasal sprays. Naloxone products have saved many lives in emergency settings. These products are routinely carried by public safety first-responders including fire fighters (FF), law enforcement officers (LEO), and emergency medical services (EMS). Now, they are also distributed through community access programs to the public. While public safety medications are monitored, those publically distributed are not, so expired products can be possibly found on-hand in an emergency. This study analyzed the quality and stability of expired Naloxone HCl Solutions for Injection, to assess their remaining efficacies and potential risks. Methods: The samples were collected from EMS or law enforcement training supplies and expired returns, with expiration dates ranging from 1990 to 2018. Using standardized techniques, the remaining naloxone was quantified, and the main degradation products, nornaloxone (also known as noroxymorphone) and other possible species, were monitored and quantified systematically. Results: Most tested samples were found containing more than 90% of labeled naloxone, including those stored for nearly 30 years. The naloxone degradation was slow, but generally correlated with storage time length. There was no significant amount of degradation products detected across all samples. Nornaloxone was detected from some older samples, but all less than 1%. Therefore, although it is an opioid agonist, the risk caused by nornaloxone should be low. Conclusion: This quality assessment demonstrates that expired naloxone products may still meet USP standards, even after many years. Further pharmaceutical, clinical, and regulatory investigation should be conducted to confirm our findings, especially for new naloxone products with different formulations and routes of administration. Extending the shelf-life of naloxone products may have important financial and public health consequences in addressing future drug shortages and meeting the needs for this critical drug.
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Agrawal Y, Smith RM, Garbuz DS, Masri BA. Opioids in Arthroplasty: Mind the Gap Between North America and the Rest of the World. J Bone Joint Surg Am 2018; 100:2162-2171. [PMID: 30562297 DOI: 10.2106/jbjs.17.01422] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Yuvraj Agrawal
- Department of Orthopaedics, Northern General Hospital, Sheffield, United Kingdom.,Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - R Malcolm Smith
- Department of Orthopaedics, Massachusetts General Hospital, Boston, Massachusetts
| | - Donald S Garbuz
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bassam A Masri
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
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Phalen P, Ray B, Watson DP, Huynh P, Greene MS. Fentanyl related overdose in Indianapolis: Estimating trends using multilevel Bayesian models. Addict Behav 2018; 86:4-10. [PMID: 29631798 DOI: 10.1016/j.addbeh.2018.03.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 01/20/2018] [Accepted: 03/06/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The opioid epidemic has been largely attributed to changes in prescribing practices over the past 20 years. Although current overdose trends appear driven by the opioid fentanyl, heroin has remained the focus of overdose fatality assessments. We obtained full toxicology screens on lethal overdose cases in a major US city, allowing more accurate assessment of the time-course of fentanyl-related deaths. METHODS We used coroner data from Marion County, Indiana comprising 1583 overdose deaths recorded between January 1, 2010 and April 30, 2017. Bayesian multilevel models were fitted to predict likelihood of lethal fentanyl-related overdose using information about the victim's age, race, sex, zip code, and date of death. RESULTS Three hundred and seventy-seven (23.8%) overdose deaths contained fentanyl across the seven-year period. Rates rose exponentially over time, beginning well below 15% from 2010 through 2013 before rising to approximately 50% by 2017. At the beginning of the study period, rates of fentanyl overdose were lowest among Black persons but increased more rapidly, eventually surpassing Whites. Currently, White females are at particularly low risk of fentanyl overdose whereas Black females are at high risk. Rates were highest for younger and middle-aged groups. Over time, fentanyl was more likely detected without the presence of other opioids. CONCLUSIONS Fentanyl has increasingly been detected in fatal overdose deaths in Marion County. Policy and program responses must focus on education for those at highest risk of fentanyl exposure and death. These responses should also be tailored to meet the unique needs of high-risk demographics.
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Affiliation(s)
- Peter Phalen
- Department of Psychiatry, University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD 21201, United States
| | - Bradley Ray
- School of Public and Environmental Affairs, Indiana University Purdue University-Indianapolis, 801 W. Michigan St., Indianapolis, IN 46202, United States.
| | - Dennis P Watson
- Indiana University Richard M. Fairbanks School of Public Health, Department of Social and Behavioral Sciences, 1050 Wishard Blvd, Indianapolis, IN 46202, United States
| | - Philip Huynh
- Indiana University Richard M. Fairbanks School of Public Health, Department of Social and Behavioral Sciences, 1050 Wishard Blvd, Indianapolis, IN 46202, United States
| | - Marion S Greene
- Center for Health Policy, Indiana University Richard M. Fairbanks School of Public Health, Department of Health Policy and Management, 1050 Wishard Blvd, Indianapolis, IN 46202, United States
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Mota DM, Vigo Á, Kuchenbecker RDS. [Recommendation of ICD-10 codes for surveillance of adverse drug reactions and drug intoxication]. CIENCIA & SAUDE COLETIVA 2018; 23:3041-3054. [PMID: 30281741 DOI: 10.1590/1413-81232018239.20692016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 10/03/2016] [Indexed: 11/22/2022] Open
Abstract
ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization. It contains codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases. Associations between variables were evaluated using Pearson's chi-squared test and multiple correspondence analysis. Six hundred and ninety-one (691) codes were identified related to adverse drug reactions (52.1%) and drug poisoning (47.9%). A total of 687 (99.4%) and 511 (73.9%) codes were validated in 1st and 2nd validation, respectively. There were statistically significant differences (p <0.05) between adverse reactions and drug poisoning in the variables used to characterize the reference list. The association between drug and hospital admission and death was statistically significant when stratified by type of adverse event (p <0.001). Three groupings of codes were identified in multiple correspondence analysis where there are associations between categories of response assessed. The reference list can be a useful tool in pharmacovigilance actions in Brazil.
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Affiliation(s)
- Daniel Marques Mota
- Programa de Pós-Graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul. R. Ramiro Barcelos 2.400/2º, Rio Branco. 90035-003 Porto Alegre RS Brasil.
| | - Álvaro Vigo
- Programa de Pós-Graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul. R. Ramiro Barcelos 2.400/2º, Rio Branco. 90035-003 Porto Alegre RS Brasil.
| | - Ricardo de Souza Kuchenbecker
- Programa de Pós-Graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul. R. Ramiro Barcelos 2.400/2º, Rio Branco. 90035-003 Porto Alegre RS Brasil.
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Babu MA, Nahed BV, Heary RF. Commentary: Prescription Drug Monitoring Programs and the Neurosurgeon: Impact on Workflow and Overall Perceptions. Neurosurgery 2018; 83:E169-E176. [PMID: 30011043 DOI: 10.1093/neuros/nyy314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Maya A Babu
- Department of Neurologic Surgery, Ryder Trauma Center/Jackson Memorial Hospital, Miami, Florida
| | - Brian V Nahed
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Robert F Heary
- Division of Neurosurgery, Rutgers New Jersey Medical School, Newark, New Jersey
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Mohan S, Bhattacharyya N. Opioids and the Otolaryngologist: An Ambulatory Assessment. Otolaryngol Head Neck Surg 2018; 159:29-34. [DOI: 10.1177/0194599818765125] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives To recognize current opioid prescription patterns in otolaryngology and determine changes in rates of outpatient opioid prescribing over time. Study Design Cross-sectional analysis of national survey database. Setting Ambulatory care settings in the United States. Subjects and Methods The National Ambulatory Medical Care Survey from 2006 to 2013 was analyzed for outpatient otolaryngology visits. The rate of opioid medication prescribing was determined with patient and visit characteristics associated with an opioid prescription, including corresponding diagnoses. Calendar trends for the rate of opioid prescribing were determined and compared biennially. Results Among 19.2 ± 1.7 million otolaryngology visits annually (raw N = 11,905), there were 728,000 ± 96,000 visits with an opioid prescription (3.8% ± 0.4%). Adults were more likely than children to receive a narcotic (4.3% vs 1.9%, P < .001); there was no significant difference according to sex (3.9% female vs 3.7% male, P = .567). With respect to calendar trend, the opioid prescription rate increased significantly from 2.3% in 2006-2007 to 4.6% in 2008-2011 and then decreased to 3.5% in 2012-2013 ( P < .031). The most common visit diagnosis categories associated with opioid prescribing were as follows: postoperative care (19.7% of prescriptions), adenotonsillitis (13.9%), chronic otitis media (8.7%), otitis externa (6.2%), and nasal obstruction (5.6%). Conclusion Despite the opioid epidemic in the United States, only a small portion of otolaryngology visits were associated with opioid prescription. However, given the significant increase in prescribing from 2008 to 2011, continued surveillance of prescribing patterns is warranted.
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Affiliation(s)
- Suresh Mohan
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Neil Bhattacharyya
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Tran S, Lavitas P, Stevens K, Greenwood BC, Clements K, Alper CJ, Lenz K, Price M, Hydery T, Arnold JL, Takeshita M, Bacon R, Peristere JP, Jeffrey PL. The Effect of a Federal Controlled Substance Act Schedule Change on Hydrocodone Combination Products Claims in a Medicaid Population. J Manag Care Spec Pharm 2018; 23:532-539. [PMID: 28448772 PMCID: PMC10398091 DOI: 10.18553/jmcp.2017.23.5.532] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND In 2012, hydrocodone combination products (HCPs) were the most prescribed medications in the United States. Under the Controlled Substance Act of 1970, hydrocodone alone was classified as a Schedule II drug, while HCPs were classified as Schedule III, indicating a lower risk for abuse and misuse. However, according to a Drug Enforcement Agency analysis, the addition of nonopioids has not been shown to diminish abuse potential of hydrocodone. In response to concerns for drug abuse and overdose, the Drug Enforcement Agency rescheduled HCPs to Schedule II in October 2014, with the intent of limiting overprescribing and increasing awareness of their abuse potential. However, it is unknown whether this has affected the overall claims for HCPs in a Medicaid population. OBJECTIVES To (a) compare the trend in HCP prescription claims with select non-HCP (opioid and nonopioid) analgesic claims before and after the HCP schedule change in the Massachusetts Medicaid fee-for-service/Primary Care Clinician plan population and (b) identify if there was a change in HCP new start member and claim characteristics before and after the HCP schedule change. METHODS This quasi-experimental, retrospective study used enrollment and pharmacy claims data to evaluate all members in the study population 1 year before and after the HCP schedule change. The number of claims for HCPs and select non-HCP analgesics was reported as the monthly rate per total population, and an interrupted time series analysis compared the change in the monthly rate of claims across groups. Members with 1 or more pharmacy claims for a new HCP prescription during a 5-month period before or after the HCP schedule change were analyzed to determine member demographics (age, gender, and number of claims) and claim characteristics (average daily dose, average quantity per claim, and days supply). RESULTS The rate of HCP claims increased before and decreased after the HCP schedule change. Controlling for the trend during the period before the HCP schedule change, the rate of HCP claims per 1,000 members per month decreased at a greater rate than non-HCP analgesics in the period after the HCP schedule change (P < 0.001). The percentage of HCP claims for new start members decreased after the HCP schedule change (44.9% vs. 34.1% of all HCP claims pre- to post-schedule change; P < 0.001). In the group of new starts, there was not a significant difference in the average daily dose (26.3 mg vs. 26.4 mg; P = 0.69), while there was a decrease in average number of tablets dispensed per claim (from 37.1 to 20.3 tablets; P < 0.001) and an increase in the percentage of claims for a shorter days supply (from 57.7% to 81.6%; P < 0.001). CONCLUSIONS The findings of this study suggest that the HCP schedule change may have contributed to the decrease in claims for HCPs in a Medicaid population. After the HCP schedule change, there was a trend towards decreased HCP use among new starts. DISCLOSURES No outside funding supported this study. The authors have nothing to disclose. Study concept and design were contributed by all authors except for Arnold and Clements. Tran, Arnold, and Clements took the lead in data collection, along with Peristere, and data interpretation was performed by all the authors, except Arnold. The manuscript was written primarily by Tran, along with Lavitas, Stevens, and Greenwood, and revised by all the authors except Arnold and Peristere. A poster of this research project was presented at the Academy of Managed Care Pharmacy's 2016 Annual Meeting in San Francisco, California, April 2016.
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Affiliation(s)
- Stephanie Tran
- 1 Clinical Pharmacy Services, University of Massachusetts Medical School, Shrewsbury
| | - Pavel Lavitas
- 1 Clinical Pharmacy Services, University of Massachusetts Medical School, Shrewsbury
| | - Karen Stevens
- 1 Clinical Pharmacy Services, University of Massachusetts Medical School, Shrewsbury
| | - Bonnie C Greenwood
- 1 Clinical Pharmacy Services, University of Massachusetts Medical School, Shrewsbury
| | - Karen Clements
- 2 Center for Health Policy and Research, University of Massachusetts Medical School, Shrewsbury
| | - Caroline J Alper
- 1 Clinical Pharmacy Services, University of Massachusetts Medical School, Shrewsbury
| | - Kimberly Lenz
- 3 Office of Clinical Affairs, University of Massachusetts Medical School, Quincy
| | - Mylissa Price
- 1 Clinical Pharmacy Services, University of Massachusetts Medical School, Shrewsbury
| | - Tasmina Hydery
- 1 Clinical Pharmacy Services, University of Massachusetts Medical School, Shrewsbury
| | - Jennifer L Arnold
- 1 Clinical Pharmacy Services, University of Massachusetts Medical School, Shrewsbury
| | - Mito Takeshita
- 1 Clinical Pharmacy Services, University of Massachusetts Medical School, Shrewsbury
| | - Rachel Bacon
- 1 Clinical Pharmacy Services, University of Massachusetts Medical School, Shrewsbury
| | - Justin P Peristere
- 1 Clinical Pharmacy Services, University of Massachusetts Medical School, Shrewsbury
| | - Paul L Jeffrey
- 3 Office of Clinical Affairs, University of Massachusetts Medical School, Quincy
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Kim M, Shin SD, Jeong S, Kwak YH, Suh GJ. Poisoning-induced Out-of-Hospital Cardiac Arrest and Outcomes according to Poison Agent. J Korean Med Sci 2017; 32:2042-2050. [PMID: 29115089 PMCID: PMC5680506 DOI: 10.3346/jkms.2017.32.12.2042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 09/17/2017] [Indexed: 11/20/2022] Open
Abstract
It is unclear whether specific agent groups are associated with outcomes in cases of poisoning-induced out-of-hospital cardiac arrest (P-OHCA). The study population comprised cases of confirmed P-OHCA drawn from the national out-of-hospital cardiac arrest (OHCA) registry (2008-2013). Exposures were categorized into five groups according to the International Classification of Disease, 10th version: group 1, prescribed drugs; group 2, vapors and gases; group 3, pesticides; group 4, alcohol and organic solvents; and group 5, other poisons. The outcome was survival to discharge and good neurological recovery. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated to test the association between specific groups and outcomes. A total of 2,083 patients were analyzed; group 1 (10.3%), group 2 (23.6%), group 3 (52.9%), group 4 (1.4%), and group 5 (13.2%). The survival to discharge and good neurological recovery rates were 3.3%/1.3% for all patients, 10.3%/5.6% (group 1), 6.9%/3.4% (group 2), 2.4%/0.4% (group 3), 2.2%/1.0% (group 4), and 3.3%/2.4% (group 5) (all P < 0.001). The aORs (95% CIs) of groups 2-5 compared with group 1 for survival to discharge were 0.47 (0.09-2.51), 0.34 (0.17-0.68), 0.33 (0.14-0.77), and 0.31 (0.13-0.77), respectively. The odds ratios (95% CIs) for good neurological recovery were significant only in group 1, the pesticides group (0.07 [0.02-0.26]) and were not significant in the other groups. P-OHCA outcomes differed significantly among the poisoning agent groups. The pesticides group showed the worst outcomes, followed by the group of vapors or gases.
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Affiliation(s)
- Minjee Kim
- Department of Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea.
| | - Seungmin Jeong
- Department of Preventive Medicine, Seoul National University Graduate School of Public Health, Seoul, Korea
| | - Young Ho Kwak
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Gil Joon Suh
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
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Ruhm CJ. Drug involvement in fatal overdoses. SSM Popul Health 2017; 3:219-226. [PMID: 29349219 PMCID: PMC5769014 DOI: 10.1016/j.ssmph.2017.01.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 01/27/2017] [Accepted: 01/28/2017] [Indexed: 12/04/2022] Open
Abstract
Death certificate data from the Multiple Cause of Death (MCOD) files were analyzed to better understand the drug categories most responsible for the increase in fatal overdoses occurring between 1999 and 2014. Statistical adjustment methods were used to account for the understatement in reported drug involvement occurring because death certificates frequently do not specify which drugs were involved in the deaths. The frequency of combination drug use introduced additional uncertainty and so a distinction was made between any versus exclusive drug involvement. Many results were sensitive to the starting and ending years chosen for examination. Opioid analgesics played a major role in the increased drug deaths for analysis windows starting in 1999 but other drugs, particularly heroin, became more significant for recent time periods. Combination drug use was important for all time periods and needs to be accounted for when designing policies to slow or reverse the increase in overdose deaths.
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Affiliation(s)
- Christopher J. Ruhm
- Frank Batten School of Leadership and Public Policy, University of Virginia, USA, P.O. Box 400893, Charlottesville, VA 22904-4893, United States
- National Bureau of Economic Research, Cambridge, MA, United States
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Heroin and fentanyl overdoses in Kentucky: Epidemiology and surveillance. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 46:120-129. [DOI: 10.1016/j.drugpo.2017.05.051] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 05/19/2017] [Accepted: 05/28/2017] [Indexed: 01/05/2023]
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Duran D, Messina RD, Beslow LA, Montejo JD, Karimy JK, Gavankar Furey C, Sheridan AD, Sze G, Yarman Y, DiLuna ML, Kahle KT. Malignant Cerebellar Edema Subsequent to Accidental Prescription Opioid Intoxication in Children. Front Neurol 2017; 8:362. [PMID: 28790973 PMCID: PMC5524743 DOI: 10.3389/fneur.2017.00362] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 07/07/2017] [Indexed: 01/20/2023] Open
Abstract
We present two recent cases of toddlers who developed malignant cerebellar edema subsequent to accidental ingestion of prescription opioids. Both children presented acute neurological decline, hydrocephalus, and tonsillar herniation requiring emergent ventricular drain placement, suboccipital craniectomy, and partial cerebellectomy. Together with several other reports, these cases suggest the existence of an uncommon yet severe syndrome of acute opioid-induced malignant cerebellar edema. We hypothesize that the condition results from a combination of primary opioid receptor-mediated changes in neuronal metabolism that are exacerbated by secondary hypoxic insult. If recognized promptly, this syndrome can be treated with emergent neurosurgical intervention with good clinical outcomes. These cases also illustrate the unintended consequences and innocent victims of the spiraling prescription opioid epidemic, which will likely increase in prevalence. Recognition of this syndrome by clinicians is thus critical.
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Affiliation(s)
- Daniel Duran
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, United States
| | - Robert D Messina
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States
| | - Lauren A Beslow
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Julio D Montejo
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, United States.,Yale School of Medicine, New Haven, CT, United States
| | - Jason K Karimy
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, United States
| | - Charuta Gavankar Furey
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, United States.,Yale School of Medicine, New Haven, CT, United States
| | - Alison D Sheridan
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States
| | - Gordon Sze
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States
| | - Yanki Yarman
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, United States
| | - Michael L DiLuna
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, United States.,Department of Pediatrics, Yale School of Medicine, New Haven, CT, United States
| | - Kristopher T Kahle
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, United States.,Department of Pediatrics, Yale School of Medicine, New Haven, CT, United States.,Department of Cellular and Molecular Physiology, Yale School of Medicine, New Haven, CT, United States
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Vallmuur K, Marucci-Wellman HR, Taylor JA, Lehto M, Corns HL, Smith GS. Harnessing information from injury narratives in the 'big data' era: understanding and applying machine learning for injury surveillance. Inj Prev 2016; 22 Suppl 1:i34-42. [PMID: 26728004 DOI: 10.1136/injuryprev-2015-041813] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 12/08/2015] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Vast amounts of injury narratives are collected daily and are available electronically in real time and have great potential for use in injury surveillance and evaluation. Machine learning algorithms have been developed to assist in identifying cases and classifying mechanisms leading to injury in a much timelier manner than is possible when relying on manual coding of narratives. The aim of this paper is to describe the background, growth, value, challenges and future directions of machine learning as applied to injury surveillance. METHODS This paper reviews key aspects of machine learning using injury narratives, providing a case study to demonstrate an application to an established human-machine learning approach. RESULTS The range of applications and utility of narrative text has increased greatly with advancements in computing techniques over time. Practical and feasible methods exist for semiautomatic classification of injury narratives which are accurate, efficient and meaningful. The human-machine learning approach described in the case study achieved high sensitivity and PPV and reduced the need for human coding to less than a third of cases in one large occupational injury database. CONCLUSIONS The last 20 years have seen a dramatic change in the potential for technological advancements in injury surveillance. Machine learning of 'big injury narrative data' opens up many possibilities for expanded sources of data which can provide more comprehensive, ongoing and timely surveillance to inform future injury prevention policy and practice.
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Affiliation(s)
- Kirsten Vallmuur
- Queensland University of Technology, Centre for Accident Research and Road Safety-Queensland, Brisbane, Queensland, Australia
| | - Helen R Marucci-Wellman
- Center for Injury Epidemiology, Liberty Mutual Research Institute for Safety, Hopkinton, Massachusetts, USA
| | - Jennifer A Taylor
- Department of Environmental & Occupational Health, School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Mark Lehto
- School of Industrial Engineering, Purdue University, West Lafayette, Indiana, USA
| | - Helen L Corns
- Center for Injury Epidemiology, Liberty Mutual Research Institute for Safety, Hopkinton, Massachusetts, USA
| | - Gordon S Smith
- National Center for Trauma and EMS, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Brady JE, DiMaggio CJ, Keyes KM, Doyle JJ, Richardson LD, Li G. Emergency department utilization and subsequent prescription drug overdose death. Ann Epidemiol 2015; 25:613-619.e2. [PMID: 25935710 PMCID: PMC4675463 DOI: 10.1016/j.annepidem.2015.03.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 03/15/2015] [Accepted: 03/26/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE Prescription drug overdose (PDO) deaths are a critical public health problem in the United States. This study aims to assess the association between emergency department (ED) utilization patterns in a cohort of ED patients and the risk of subsequent unintentional PDO mortality. METHODS Using data from the New York Statewide Planning and Research Cooperative System for 2006-2010, a nested case-control design was used to examine the relationship between ED utilization patterns in New York State residents of age 18-64 years and subsequent PDO death. RESULTS The study sample consisted of 2732 case patients who died of PDO and 2732 control ED patients who were selected through incidence density sampling. With adjustment for demographic characteristics, and diagnoses of pain, substance abuse, and psychiatric disorders, the estimated odds ratios of PDO death relative to one ED visit or less in the previous year were 4.90 (95% confidence interval [CI]: 4.50-5.34) for those with two ED visits, 16.61 (95% CI: 14.72-18.75) for those with three ED visits, and 48.24 (95% CI: 43.23-53.83) for those with four ED visits or more. CONCLUSIONS Frequency of ED visits is strongly associated with the risk of subsequent PDO death. Intervention programs targeting frequent ED users are warranted to reduce PDO mortality.
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Affiliation(s)
- Joanne E Brady
- Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Center for Injury Epidemiology and Prevention, Columbia University Medical Center, New York, NY.
| | - Charles J DiMaggio
- Department of Surgery, New York University School of Medicine, New York, NY
| | - Katherine M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Center for Injury Epidemiology and Prevention, Columbia University Medical Center, New York, NY
| | - John J Doyle
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Lynne D Richardson
- Department of Emergency Medicine, Mount Sinai School of Medicine, New York, NY
| | - Guohua Li
- Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Center for Injury Epidemiology and Prevention, Columbia University Medical Center, New York, NY
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Ossiander EM. Volatile substance misuse deaths in Washington State, 2003–2012. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2014; 41:30-4. [DOI: 10.3109/00952990.2014.956110] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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