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Callen EF, Lutgen CB, Robertson E, Loskutova NY. Assessment and management patterns for chronic musculoskeletal pain in the family practice setting. J Bodyw Mov Ther 2024; 39:50-56. [PMID: 38876675 DOI: 10.1016/j.jbmt.2024.02.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 01/25/2024] [Accepted: 02/25/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Chronic pain affects 11% of the US population. Most patients who experience pain, particularly chronic musculoskeletal pain, seek care in primary care settings. Assessment of the patient pain experience is the cornerstone to optimal pain management; however, pain assessment remains a challenge for medical professionals. It is unknown to what extent the assessment of pain intensity is considered in context of function and quality of life. OBJECTIVE To understand common practices related to assessment of pain and function in patients with chronic musculoskeletal disorders. DESIGN Cross-sectional survey. METHODS A 42-item electronic survey was developed with self-reported numeric ratings and responses related to knowledge, beliefs, and current practices. All physicians and non-physician clinicians affiliated with the AAFP NRN and 2000 AAFP physician members were invited to participate. RESULTS/FINDINGS Primary care clinicians report that chronic joint pain assessment should be comprehensive, citing assessment elements that align with the comprehensive pain assessment models. Pain intensity remains the primary focus of pain assessment in chronic joint pain and the most important factor in guiding treatment decisions, despite well-known limitations. Clinicians also report that patients with osteoarthritis should be treated by Family Medicine. CONCLUSIONS Pain assessment is primarily limited to pain intensity scales which may contribute to worse patient outcomes. Given that most respondents believe primary care/family medicine should be primary responsible for the care of patients with osteoarthritis, awareness of and comfort with existing guidelines, validated assessment instruments and the comprehensive pain assessment models could contribute to delivery of more comprehensive care.
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Affiliation(s)
- Elisabeth F Callen
- American Academy of Family Physicians, Leawood, KS, 66211, USA; DARTNet Institute, Aurora, CO, 80045, USA.
| | - Cory B Lutgen
- American Academy of Family Physicians, Leawood, KS, 66211, USA; DARTNet Institute, Aurora, CO, 80045, USA
| | - Elise Robertson
- American Academy of Family Physicians, Leawood, KS, 66211, USA; DARTNet Institute, Aurora, CO, 80045, USA
| | - Natalia Y Loskutova
- American Academy of Family Physicians, Leawood, KS, 66211, USA; University of Kansas Medical Center, Kansas City, KS, 66160, USA
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Cai C, Knudsen S, Weant K. Opioid Prescribing by Emergency Physicians: Trends Study of Medicare Part D Prescriber Data 2013-2019. J Emerg Med 2024; 66:e313-e322. [PMID: 38290881 DOI: 10.1016/j.jemermed.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/01/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Emergency physicians play a critical role in mitigating the opioid epidemic in public health. OBJECTIVES To analyze the prescribing of emergency physicians for opioids among Medicare beneficiaries enrolled in the Part D program from 2013 to 2019. METHODS We conducted a retrospective, cross-sectional, descriptive analysis of Medicare Part D prescriber data, focusing on opioid claims between 2013 and 2019. The primary outcome variables evaluated included proportion of opioid claims, trends of the most prescribed opioids, cost of opioid claims, and days' supply per claim. RESULTS A total of 63,586 emergency physicians were identified over the study period. Opioid prescription by emergency physicians decreased from 14.45% to 11.55%, and the cost spent on opioid drugs declined by 50%. The use of drugs such as hydrocodone-acetaminophen and oxycodone-acetaminophen declined substantially, whereas tramadol and acetaminophen-codeine prescription increased. The opioid prescribing rate and days' supply also decreased. CONCLUSIONS The decline in traditional opioid agents such as hydrocodone-acetaminophen was partly offset by an increase in opioids like tramadol, which carry additional potential adverse events. Opioid prescribing rate, average days' supply, and cost of opioid drugs significantly decreased from 2015 to 2019, after a spike in 2015. All regions observed a decrease in emergency physicians, but opioid prescribing rates varied across regions. These trends highlight successful opioid stewardship practices in some areas and the need for further development in others. This information can aid in designing tailored guidelines and policies for emergency physicians to promote effective opioid stewardship practices.
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Affiliation(s)
- Chao Cai
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, South Carolina
| | - Sophia Knudsen
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, South Carolina
| | - Kyle Weant
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, South Carolina
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CERDÁ MAGDALENA, KRAWCZYK NOA, KEYES KATHERINE. The Future of the United States Overdose Crisis: Challenges and Opportunities. Milbank Q 2023; 101:478-506. [PMID: 36811204 PMCID: PMC10126987 DOI: 10.1111/1468-0009.12602] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
Policy Points People are dying at record numbers from overdose in the United States. Concerted action has led to a number of successes, including reduced inappropriate opioid prescribing and increased availability of opioid use disorder treatment and harm-reduction efforts, yet ongoing challenges include criminalization of drug use and regulatory and stigma barriers to expansion of treatment and harm-reduction services. Priorities for action include investing in evidence-based and compassionate policies and programs that address sources of opioid demand, decriminalizing drug use and drug paraphernalia, enacting policies to make medication for opioid use disorder more accessible, and promoting drug checking and safe drug supply.
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Affiliation(s)
- MAGDALENA CERDÁ
- Center for Opioid Epidemiology and PolicyNYU Grossman School of Medicine
| | - NOA KRAWCZYK
- Center for Opioid Epidemiology and PolicyNYU Grossman School of Medicine
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Punches BE, Stolz U, Freiermuth CE, Ancona RM, McLean SA, House SL, Beaudoin FL, An X, Stevens JS, Zeng D, Neylan TC, Clifford GD, Jovanovic T, Linnstaedt SD, Germine LT, Bollen KA, Rauch SL, Haran JP, Storrow AB, Lewandowski C, Musey PI, Hendry PL, Sheikh S, Jones CW, Kurz MC, Gentile NT, McGrath ME, Hudak LA, Pascual JL, Seamon MJ, Harris E, Chang AM, Pearson C, Peak DA, Merchant RC, Domeier RM, Rathlev NK, O’Neil BJ, Sanchez LD, Bruce SE, Pietrzak RH, Joormann J, Barch DM, Pizzagalli DA, Smoller JW, Luna B, Harte SE, Elliott JM, Kessler RC, Ressler KJ, Koenen KC, Lyons MS. Predicting at-risk opioid use three months after ed visit for trauma: Results from the AURORA study. PLoS One 2022; 17:e0273378. [PMID: 36149896 PMCID: PMC9506640 DOI: 10.1371/journal.pone.0273378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 08/07/2022] [Indexed: 11/18/2022] Open
Abstract
Objective Whether short-term, low-potency opioid prescriptions for acute pain lead to future at-risk opioid use remains controversial and inadequately characterized. Our objective was to measure the association between emergency department (ED) opioid analgesic exposure after a physical, trauma-related event and subsequent opioid use. We hypothesized ED opioid analgesic exposure is associated with subsequent at-risk opioid use. Methods Participants were enrolled in AURORA, a prospective cohort study of adult patients in 29 U.S., urban EDs receiving care for a traumatic event. Exclusion criteria were hospital admission, persons reporting any non-medical opioid use (e.g., opioids without prescription or taking more than prescribed for euphoria) in the 30 days before enrollment, and missing or incomplete data regarding opioid exposure or pain. We used multivariable logistic regression to assess the relationship between ED opioid exposure and at-risk opioid use, defined as any self-reported non-medical opioid use after initial ED encounter or prescription opioid use at 3-months. Results Of 1441 subjects completing 3-month follow-up, 872 participants were included for analysis. At-risk opioid use occurred within 3 months in 33/620 (5.3%, CI: 3.7,7.4) participants without ED opioid analgesic exposure; 4/16 (25.0%, CI: 8.3, 52.6) with ED opioid prescription only; 17/146 (11.6%, CI: 7.1, 18.3) with ED opioid administration only; 12/90 (13.3%, CI: 7.4, 22.5) with both. Controlling for clinical factors, adjusted odds ratios (aORs) for at-risk opioid use after ED opioid exposure were: ED prescription only: 4.9 (95% CI 1.4, 17.4); ED administration for analgesia only: 2.0 (CI 1.0, 3.8); both: 2.8 (CI 1.2, 6.5). Conclusions ED opioids were associated with subsequent at-risk opioid use within three months in a geographically diverse cohort of adult trauma patients. This supports need for prospective studies focused on the long-term consequences of ED opioid analgesic exposure to estimate individual risk and guide therapeutic decision-making.
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Affiliation(s)
- Brittany E. Punches
- College of Nursing, The Ohio State University, Columbus, OH, United States of America
- Department of Emergency Medicine College of Medicine, The Ohio State University, Columbus, OH, United States of America
- * E-mail:
| | - Uwe Stolz
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, United States of America
| | - Caroline E. Freiermuth
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, United States of America
- Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
| | - Rachel M. Ancona
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Samuel A. McLean
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- Department of Anesthesiology, Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Stacey L. House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Francesca L. Beaudoin
- Department of Emergency Medicine & Department of Health Services, Policy, and Practice, The Alpert Medical School of Brown University, Rhode Island Hospital and The Miriam Hospital, Providence, RI, United States of America
| | - Xinming An
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Jennifer S. Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Donglin Zeng
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States of America
| | - Thomas C. Neylan
- Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco, CA, United States of America
| | - Gari D. Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, United States of America
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States of America
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MA, United States of America
| | - Sarah D. Linnstaedt
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Laura T. Germine
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, United States of America
- The Many Brains Project, Belmont, MA, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Kenneth A. Bollen
- Department of Psychology and Neuroscience & Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Scott L. Rauch
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
- Department of Psychiatry, McLean Hospital, Belmont, MA, United States of America
| | - John P. Haran
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Alan B. Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Christopher Lewandowski
- Department of Emergency Medicine, Henry Ford Health System, Detroit, MI, United States of America
| | - Paul I. Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Phyllis L. Hendry
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, United States of America
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, United States of America
| | - Christopher W. Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, United States of America
| | - Michael C. Kurz
- Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL, United States of America
- Department of Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham, AL, United States of America
- Center for Injury Science, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Nina T. Gentile
- Department of Emergency Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States of America
| | - Meghan E. McGrath
- Department of Emergency Medicine, Boston Medical Center, Boston, MA, United States of America
| | - Lauren A. Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Jose L. Pascual
- Department of Surgery, Department of Neurosurgery, University of Pennsylvania, Pennsylvania, PA, United States of America
- Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA, United States of America
| | - Mark J. Seamon
- Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA, United States of America
- Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Pennsylvania, PA, United States of America
| | - Erica Harris
- Department of Emergency Medicine, Einstein Healthcare Network, Pennsylvania, PA, United States of America
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Pennsylvania, PA, United States of America
| | - Anna M. Chang
- Department of Emergency Medicine, Jefferson University Hospitals, Pennsylvania, PA, United States of America
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Detroit, MA, United States of America
| | - David A. Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Roland C. Merchant
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA, United States of America
| | - Robert M. Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ypsilanti, MI, United States of America
| | - Niels K. Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, United States of America
| | - Brian J. O’Neil
- Department of Emergency Medicine, Wayne State University, Detroit, MA, United States of America
| | - Leon D. Sanchez
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, United States of America
| | - Steven E. Bruce
- Department of Psychological Sciences, University of Missouri—St. Louis, St. Louis, MO, United States of America
| | - Robert H. Pietrzak
- National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, United States of America
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America
| | - Jutta Joormann
- Department of Psychology, Yale School of Medicine, New Haven, CT, United States of America
| | - Deanna M. Barch
- Department of Psychological & Brain Sciences, Washington University in St. Louis, MO, United States of America
| | - Diego A. Pizzagalli
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, United States of America
| | - Jordan W. Smoller
- Department of Psychiatry, Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, MA, United States of America
- Stanley Center for Psychiatric Research, Broad Institute, Cambridge, MA, United States of America
| | - Beatriz Luna
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Steven E. Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, United States of America
- Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, United States of America
| | - James M. Elliott
- Kolling Institute, University of Sydney, St Leonards, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Northern Sydney Local Health District, New South Wales, Australia
- Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, United States of America
| | - Kerry J. Ressler
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, United States of America
| | - Karestan C. Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States of America
| | - Michael S. Lyons
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, United States of America
- Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
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McGinty EE, Bicket MC, Seewald NJ, Stuart EA, Alexander GC, Barry CL, McCourt AD, Rutkow L. Effects of State Opioid Prescribing Laws on Use of Opioid and Other Pain Treatments Among Commercially Insured U.S. Adults. Ann Intern Med 2022; 175:617-627. [PMID: 35286141 PMCID: PMC9277518 DOI: 10.7326/m21-4363] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There is concern that state laws to curb opioid prescribing may adversely affect patients with chronic noncancer pain, but the laws' effects are unclear because of challenges in disentangling multiple laws implemented around the same time. OBJECTIVE To study the association between state opioid prescribing cap laws, pill mill laws, and mandatory prescription drug monitoring program query or enrollment laws and trends in opioid and guideline-concordant nonopioid pain treatment among commercially insured adults, including a subgroup with chronic noncancer pain conditions. DESIGN Thirteen treatment states that implemented a single law of interest in a 4-year period and unique groups of control states for each treatment state were identified. Augmented synthetic control analyses were used to estimate the association between each state law and outcomes. SETTING United States, 2008 to 2019. PATIENTS 7 694 514 commercially insured adults aged 18 years or older, including 1 976 355 diagnosed with arthritis, low back pain, headache, fibromyalgia, and/or neuropathic pain. MEASUREMENTS Proportion of patients receiving any opioid prescription or guideline-concordant nonopioid pain treatment per month, and mean days' supply and morphine milligram equivalents (MME) of prescribed opioids per day, per patient, per month. RESULTS Laws were associated with small-in-magnitude and non-statistically significant changes in outcomes, although CIs around some estimates were wide. For adults overall and those with chronic noncancer pain, the 13 state laws were each associated with a change of less than 1 percentage point in the proportion of patients receiving any opioid prescription and a change of less than 2 percentage points in the proportion receiving any guideline-concordant nonopioid treatment, per month. The laws were associated with a change of less than 1 in days' supply of opioid prescriptions and a change of less than 4 in average monthly MME per day per patient prescribed opioids. LIMITATIONS Results may not be generalizable to non-commercially insured populations and were imprecise for some estimates. Use of claims data precluded assessment of the clinical appropriateness of pain treatments. CONCLUSION This study did not identify changes in opioid prescribing or nonopioid pain treatment attributable to state laws. PRIMARY FUNDING SOURCE National Institute on Drug Abuse.
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Affiliation(s)
- Emma E McGinty
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (E.E.M., N.J.S., A.D.M., L.R.)
| | - Mark C Bicket
- Departments of Anesthesiology and Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan (M.C.B.)
| | - Nicholas J Seewald
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (E.E.M., N.J.S., A.D.M., L.R.)
| | - Elizabeth A Stuart
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (E.A.S.)
| | - G Caleb Alexander
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (G.C.A.)
| | - Colleen L Barry
- Jeb E. Brooks School of Public Policy, Cornell University, Ithaca, New York (C.L.B.)
| | - Alexander D McCourt
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (E.E.M., N.J.S., A.D.M., L.R.)
| | - Lainie Rutkow
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (E.E.M., N.J.S., A.D.M., L.R.)
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State Medical Board Policy and Opioid Prescribing: A Controlled Interrupted Time Series. Am J Prev Med 2021; 60:343-351. [PMID: 33309449 PMCID: PMC7902466 DOI: 10.1016/j.amepre.2020.09.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/10/2020] [Accepted: 09/22/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION In March 2016, the Centers for Disease Control and Prevention issued opioid prescribing guidelines for chronic noncancer pain. In response, in April 2016, the North Carolina Medical Board launched the Safe Opioid Prescribing Initiative, an investigative program intended to limit the overprescribing of opioids. This study focuses on the association of the Safe Opioid Prescribing Initiative with immediate and sustained changes in opioid prescribing among all patients who received opioid and opioid discontinuation and tapering among patients who received high-dose (>90 milligrams of morphine equivalents), long-term (>90 days) opioid therapy. METHODS Controlled and single interrupted time series analysis of opioid prescribing outcomes before and after the implementation of Safe Opioid Prescribing Initiative was conducted using deidentified data from the North Carolina Controlled Substances Reporting System from January 2010 through March 2017. Analysis was conducted in 2019-2020. RESULTS In an average study month, 513,717 patients, including patients who received 47,842 high-dose, long-term opioid therapy, received 660,912 opioid prescriptions at 1.3 prescriptions per patient. There was a 0.52% absolute decline (95% CI= -0.87, -0.19) in patients receiving opioid prescriptions in the month after Safe Opioid Prescribing Initiative implementation. Abrupt discontinuation, rapid tapering, and gradual tapering of opioids among patients who received high-dose, long-term opioid therapy increased by 1% (95% CI= -0.22, 2.23), 2.2% (95% CI=0.91, 3.47), and 1.3% (95% CI=0.96, 1.57), respectively, in the month after Safe Opioid Prescribing Initiative implementation. CONCLUSIONS Although Safe Opioid Prescribing Initiative implementation was associated with an immediate decline in overall opioid prescribing, it was also associated with an unintended immediate increase in discontinuations and rapid tapering among patients who received high-dose, long-term opioid therapy. Better policy communication and prescriber education regarding opioid tapering best practices may help mitigate unintended consequences of statewide policies.
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Yenerall J, McPheeters M. The effect of an opioid prescription days' supply limit on patients receiving long-term opioid treatment. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 77:102662. [PMID: 31968287 DOI: 10.1016/j.drugpo.2020.102662] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 12/17/2019] [Accepted: 01/02/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Since 2016, an increasing number of states have passed laws restricting the days' supply for opioid prescriptions, yet little is known about how these laws affect patients. This study evaluates the effect of the Tennessee Prescription Regulatory Act, which was implemented on Oct. 1st, 2013 and restricted the maximum days' supply that could be dispensed for any opioid prescription by any prescriber to 30 days, on patients receiving long-term opioid treatment. METHODS A quasi experimental model, an interrupted time series (ITS), was used with observational data to estimate the effect of the policy on monthly patient opioid prescription outcomes. Data for this study came from the Tennessee Controlled Substance Monitoring Database between October 1st, 2012 and October 31st, 2014. The study population included patients receiving long-term opioid treatment who filled an opioid prescription in at least 4 months in the 12-month pre-policy period and received at least one prescription in the pre-policy period with a days' supply exceeding 30 days. Three outcomes were measured each month for every patient based on their opioid prescriptions: per-prescription days' supply per-prescription, daily morphine milligram equivalent (DMME), and total opioid prescriptions. All models controlled for individual fixed effects, age, and benzodiazepine prescriptions and utilized cluster robust standard errors to address serial correlation. RESULTS The change in law was associated with a decline in the average days' supply by -5.30 days (95% CI: -5.64, -4.96), and number of prescriptions by -1.3% (95% CI: -3%, -0.07%), but an increase in the average DMME by 1.41 (95% CI: 0.37, 2.45). CONCLUSIONS Prescribers responded to the Addison Sharp Prescription Regulatory Act by significantly decreasing the days' supply in opioid prescriptions among current patients receiving long-term opioid treatment who had at least one prescription exceeding the maximum days' supply set by the law in the pre-policy period.
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Affiliation(s)
- Jackie Yenerall
- Tennessee Department of Health, 710 James Robertson Parkway, Nashville, TN 37243.
| | - Melissa McPheeters
- Tennessee Department of Health, 710 James Robertson Parkway, Nashville, TN 37243.
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Schatman ME, Shapiro H. Damaging State Legislation Regarding Opioids: The Need To Scrutinize Sources Of Inaccurate Information Provided To Lawmakers. J Pain Res 2019; 12:3049-3053. [PMID: 31807060 PMCID: PMC6857667 DOI: 10.2147/jpr.s235366] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 11/01/2019] [Indexed: 12/13/2022] Open
Affiliation(s)
- Michael E Schatman
- Boston PainCare, Waltham, MA, USA
- Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA, USA
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Hannah Shapiro
- Department of Biopsychology, Tufts University, Medford, MA, USA
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Treating Chronic Nonmalignant Pain: Evidence and Faith-Based Approaches. J Christ Nurs 2018; 36:22-30. [PMID: 30531509 DOI: 10.1097/cnj.0000000000000569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
A significant portion of the world's population is impacted by chronic pain; in the United States, chronic pain costs billions annually in treatment and lost productivity. A needs assessment was conducted to evaluate the prevalence of chronic nonmalignant pain (CNMP) at a university occupational therapy clinic over a 3-month period; recommendations were made to improve pain management at the clinic and referring hospital system. Graded Chronic Pain Scale 2.0 results indicated the prevalence of CNMP was a significant problem. Three evidence-based interventions based on the biblically based CREATION Health Model were developed.
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Ratycz MC, Papadimos TJ, Vanderbilt AA. Addressing the growing opioid and heroin abuse epidemic: a call for medical school curricula. MEDICAL EDUCATION ONLINE 2018; 23:1466574. [PMID: 29708863 PMCID: PMC5933286 DOI: 10.1080/10872981.2018.1466574] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 04/10/2018] [Indexed: 05/25/2023]
Abstract
Substance abuse is a growing public health concern in the USA (US), especially now that the US faces a national drug overdose epidemic. Over the past decade, the number of drug overdose deaths has rapidly grown, largely driven by increases in prescription opioid-related overdoses. In recent years, increased heroin and illicitly manufactured fentanyl overdoses have substantially contributed to the rise of overdose deaths. Given the role of physicians in interacting with patients who are at risk for or currently abusing opioids and heroin, it is essential that physicians are aware of this issue and know how to respond. Unfortunately, medical school curricula do not devote substantial time to addiction education and many physicians lack knowledge regarding assessment and management of opioid addiction. While some schools have modified curricula to include content related to opioid prescription techniques and pain management, an added emphasis about the growing role of heroin and fentanyl is needed to adequately address the epidemic. By adapting curricula to address the rising opioid and heroin epidemic, medical schools have the potential to ensure that our future physicians can effectively recognize the signs, symptoms, and risks of opioid/heroin abuse and improve patient outcomes. This article proposes ways to include heroin and fentanyl education into medical school curricula and highlights the potential of simulation-based medical education to enable students to develop the skillset and emotional intelligence necessary to work with patients struggling with opioid and heroin addiction. This will result in future doctors who are better prepared to both prevent and recognize opioid and heroin addiction in patients, an important step in helping reduce the number of addicted patients and address the drug overdose epidemic.
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Affiliation(s)
- Madison C. Ratycz
- College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
| | - Thomas J. Papadimos
- Simulation Center Department of Anesthesiology, College of Medicine and the Life Sciences, University of Toledo, Toledo, OH, USA
| | - Allison A. Vanderbilt
- Curriculum Evaluation and Innovation, Family Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
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Kuo YF, Raji MA, Liaw V, Baillargeon J, Goodwin JS. Opioid Prescriptions in Older Medicare Beneficiaries After the 2014 Federal Rescheduling of Hydrocodone Products. J Am Geriatr Soc 2018; 66:945-953. [PMID: 29656382 PMCID: PMC5992099 DOI: 10.1111/jgs.15332] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 01/25/2018] [Accepted: 01/27/2018] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To examine how an October 2014 Drug Enforcement Administration policy reclassified hydrocodone product from schedule III to II has affected older adults, who are among the largest consumers of prescription opioids in the United States. DESIGN Retrospective cohort study. SETTING United States. PARTICIPANTS A 20% sample of Medicare Part D beneficiaries aged 65 and older from 2013 through 2015 (> 2,500,000 beneficiaries each year) MEASUREMENTS: From January 2013 to December 2015, we calculated the monthly prevalence of opioid prescriptions and the prevalence of individuals who received prescriptions for a 90-day supply or longer (prolonged), as well as hospitalizations related to opioid toxicity in 2013 and 2015. RESULTS From 2013 to 2015, the proportion of Medicare Part D enrollees who received a hydrocodone prescription in a year decreased from 21.9% to 18.3%. Monthly rates for hydrocodone prescriptions declined significantly in 2014. The risk of receiving prolonged opioid prescriptions decreased by approximately 7% in the multivariable analyses comparing 2015 to 2013 (prevalence ratio=0.93, 95% confidence interval (CI)=0.93-0.94). Medicare enrollees with an original entitlement because of disability or with Medicaid eligibility had smaller decreases in prolonged prescriptions and, unexpectedly, small increases in high-dose prescriptions. Opioid-related hospitalizations did not change significantly, but opioid-related hospitalizations without a documented opioid prescription increased (odds ratio=1.24, 95% CI=1.03-1.50). CONCLUSION The 2014 change in hydrocodone from schedule III to schedule II was associated with modest decreases in rates of opioid use in the elderly. The unexpected increase in opioid-related hospitalizations without documented opioid prescriptions may represent an increase in illegal use.
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Affiliation(s)
- Yong-Fang Kuo
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas
- Institute for Translational Science, University of Texas Medical Branch, Galveston, Texas
| | - Mukaila A. Raji
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas
| | - Victor Liaw
- College of Natural Sciences, University of Texas at Austin, Austin, Texas
| | - Jacques Baillargeon
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas
- Institute for Translational Science, University of Texas Medical Branch, Galveston, Texas
| | - James S. Goodwin
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas
- Institute for Translational Science, University of Texas Medical Branch, Galveston, Texas
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13
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Alaska nurse practitioners' barriers to use of prescription drug monitoring programs. J Am Assoc Nurse Pract 2018; 30:35-42. [DOI: 10.1097/jxx.0000000000000002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hirschtritt ME, Delucchi KL, Olfson M. Outpatient, combined use of opioid and benzodiazepine medications in the United States, 1993-2014. Prev Med Rep 2017; 9:49-54. [PMID: 29340270 PMCID: PMC5766756 DOI: 10.1016/j.pmedr.2017.12.010] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 12/12/2017] [Accepted: 12/18/2017] [Indexed: 01/22/2023] Open
Abstract
The combined use of opioid and benzodiazepine medications increases the risk of hazardous effects, such as respiratory depression. Although recent increases in outpatient use of opioid prescriptions have been documented, there are limited data regarding rates and correlates of combined opioid and benzodiazepines among adults in outpatient settings. Our objective was to examine annual trends in outpatient visits including opioids, benzodiazepines, and their combination among adults as well as clinical and demographic correlates. We used data from the 1993–2014 National Ambulatory Medical Care Survey (NAMCS) among non-elderly (i.e., ages 18–64 years) adults to examine the probability of a visit including an opioid, benzodiazepine, or their combination, in addition to clinical and demographic correlates. From 1993 to 2014, benzodiazepines-with-opioids visits increased from 9.8 to 62.5 (OR = 9.23, 95% CI = 5.45–15.65) per 10,000 visits. Highest-represented groups among benzodiazepines-with-opioids visits were older (50–64 years) (49.1%), white (88.8%), commercially insured (58.0%) patients during their first visit (87.6%) to a primary-care physician (41.9%). We identified a significant increase in the outpatient co-prescription of opioids and benzodiazepines, notably among adults aged 50–64 years during primary-care visits. Educational and policy changes to provide alternatives to benzodiazepine-with-opioid co-prescription and limiting opioid prescription to pain specialists may reduce rates of this potentially hazardous combination. Current guidelines for prescribing opioids recommend against co-administration with benzodiazepines Concurrent use of opioids and benzodiazepines increases the risk of overdose, respiratory depression, and death. We examined 22 years of outpatient prescribing patterns of opioids and benzodiazepines using a survey of US physicians. Over this period, visits with both opioids and benzodiazepines increased from roughly 9.8 to 62.5 per 10,000 visits. These visits were more likely among older (50–64 years), white, privately insured patients with a low-back pain diagnosis.
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Affiliation(s)
- Matthew E Hirschtritt
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Ave, Box 0984-RTP, San Francisco, CA 94143, United States
| | - Kevin L Delucchi
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Ave, Box 0984, San Francisco, CA 94143, United States
| | - Mark Olfson
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States
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15
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Al Achkar M, Revere D, Dennis B, MacKie P, Gupta S, Grannis S. Exploring perceptions and experiences of patients who have chronic pain as state prescription opioid policies change: a qualitative study in Indiana. BMJ Open 2017; 7:e015083. [PMID: 29133312 PMCID: PMC5695446 DOI: 10.1136/bmjopen-2016-015083] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The misuse and abuse of prescription opioids (POs) is an epidemic in the USA today. Many states have implemented legislation to curb the use of POs resulting from inappropriate prescribing. Indiana legislated opioid prescribing rules that went into effect in December 2013. The rules changed how chronic pain is managed by healthcare providers. This qualitative study aims to evaluate the impact of Indiana's opioid prescription legislation on the patient experiences around pain management. SETTING This is a qualitative study using interviews of patient and primary care providers to obtain triangulated data sources. The patients were recruited from an integrated pain clinic to which chronic pain patients were referred from federally qualified health clinics (FQHCs). The primacy care providers were recruited from the same FQHCs. The study used inductive, emergent thematic analysis. PARTICIPANTS Nine patient participants and five primary care providers were included in the study. RESULTS Living with chronic pain is disruptive to patients' lives on multiple dimensions. The established pain management practices were disrupted by the change in prescription rules. Patient-provider relationships, which involve power dynamics and decision making, shifted significantly in parallel to the rule change. CONCLUSIONS As a result of the changes in pain management practice, some patients experienced significant challenges. Further studies into the magnitude of this change are necessary. In addition, exploring methods for regulating prescribing while assuring adequate access to pain management is crucial.
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Affiliation(s)
- Morhaf Al Achkar
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Debra Revere
- School of Public Health, University of Washington, Seattle, Washington, USA
| | - Barbara Dennis
- School of Education, Indiana University, Bloomington, Indiana, USA
| | - Palmer MacKie
- Department of Clinical Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Sumedha Gupta
- School of Liberal Arts, Indiana University-Purdue University, Indianapolis, Indiana, USA
| | - Shaun Grannis
- Department of Family Medicine, Indiana University, Indianapolis, Indiana, USA
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Kahler ZP, Musey PI, Schaffer JT, Johnson AN, Strachan CC, Shufflebarger CM. Effect Of A "No Superuser Opioid Prescription" Policy On ED Visits And Statewide Opioid Prescription. West J Emerg Med 2017; 18:894-902. [PMID: 28874942 PMCID: PMC5576626 DOI: 10.5811/westjem.2017.6.33414] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 06/19/2017] [Accepted: 06/26/2017] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION The U.S. opioid epidemic has highlighted the need to identify patients at risk of opioid abuse and overdose. We initiated a novel emergency department- (ED) based interventional protocol to transition our superuser patients from the ED to an outpatient chronic pain program. The objective was to evaluate the protocol's effect on superusers' annual ED visits. Secondary outcomes included a quantitative evaluation of statewide opioid prescriptions for these patients, unique prescribers of controlled substances, and ancillary testing. METHODS Patients were referred to the program with the following inclusion criteria: ≥ 6 visits per year to the ED; at least one visit identified by the attending physician as primarily driven by opioid-seeking behavior; and a review by a committee comprising ED administration and case management. Patients were referred to a pain management clinic and informed that they would no longer receive opioid prescriptions from visits to the ED for chronic pain complaints. Electronic medical record (EMR) alerts notified ED providers of the patient's referral at subsequent visits. We analyzed one year of data pre- and post-referral. RESULTS A total of 243 patients had one year of data post-referral for analysis. Median annual ED visits decreased from 14 to 4 (58% decrease, 95% CI [50 to 66]). We also found statistically significant decreases for these patients' state prescription drug monitoring program (PDMP) opioid prescriptions (21 to 13), total unique controlled-substance prescribers (11 to 7), computed tomography imaging (2 to 0), radiographs (5 to 1), electrocardiograms (12 to 4), and labs run (47 to 13). CONCLUSION This program and the EMR-based alerts were successful at decreasing local ED visits, annual opioid prescriptions, and hospital resource allocation for this population of patients. There is no evidence that these patients diverted their visits to neighboring EDs after being informed that they would not receive opioids at this hospital, as opioid prescriptions obtained by these patients decreased on a statewide level. This implies that individual ED protocols can have significant impact on the behavior of patients.
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Affiliation(s)
- Zachary P Kahler
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana.,University of South Carolina, Greenville School of Medicine, Department of Emergency Medicine, Greenville, South Carolina
| | - Paul I Musey
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana.,Indiana University Health Methodist Hospital, Indianapolis, Indiana
| | - Jason T Schaffer
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana.,Indiana University Health Methodist Hospital, Indianapolis, Indiana
| | - Annelyssa N Johnson
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana.,Indiana University Health Methodist Hospital, Indianapolis, Indiana
| | - Christian C Strachan
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana.,Indiana University Health Methodist Hospital, Indianapolis, Indiana
| | - Charles M Shufflebarger
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana.,Indiana University Health Methodist Hospital, Indianapolis, Indiana
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17
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Affiliation(s)
- Karen McQueen
- From Lakehead University Schools of Nursing (K.M.) and Social Work (J.M.-O.), Thunder Bay, ON, Canada
| | - Jodie Murphy-Oikonen
- From Lakehead University Schools of Nursing (K.M.) and Social Work (J.M.-O.), Thunder Bay, ON, Canada
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18
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Yang YT, Haffajee RL. Murder Liability for Prescribing Opioids: A Way Forward? Mayo Clin Proc 2016; 91:1331-1335. [PMID: 27502463 PMCID: PMC7490802 DOI: 10.1016/j.mayocp.2016.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 06/14/2016] [Accepted: 06/24/2016] [Indexed: 10/21/2022]
Abstract
In February 2016, Dr. Hsiu-Ying Tseng was sentenced to 30-years to life in prison after a jury found her guilty of second-degree murder for three patient drug overdose deaths in California. For the first time in American history, a physician was held criminally liable for the murder of a patient by means of extreme recklessness in opioid prescribing. Although Dr. Tseng’s unique conviction reflects her outlier prescribing practices, the conviction and sentencing has sent ripples through the medical community, causing concerns for many physicians who now worry they will be held criminally liable when their patients abuse and misuse opioid prescriptions. However, physicians—particularly the majority that prescribe opioids in an earnest attempt to alleviate legitimate patient pain—may take comfort that the legal risks can be managed. Prescribers can take a number of steps to minimize criminal liability concerns, including following available guidelines, such as those recently issued on opioid prescribing for chronic pain by the Centers for Disease Control and Prevention. While outlier physicians like Dr. Tseng may meet the standards for criminal liability, criminal prosecution may do little to curb prescription opioid abuse—an epidemic that calls for more upstream prevention measures.
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Affiliation(s)
- Y Tony Yang
- Department of Health Administration and Policy, George Mason University, Fairfax, VA.
| | - Rebecca L Haffajee
- Department of Population Medicine, Harvard Medical School, Boston, MA; Harvard Pilgrim Health Care Institute, Boston, MA
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19
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Garcia-Orjuela MG, Alarcon-Franco L, Sanchez-Fernandez JC, Agudelo Y, Zuluaga AF. Dependence to legally prescribed opioid analgesics in a university hospital in Medellin-Colombia: an observational study. BMC Pharmacol Toxicol 2016; 17:42. [PMID: 27624605 PMCID: PMC5022208 DOI: 10.1186/s40360-016-0087-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 09/07/2016] [Indexed: 11/16/2022] Open
Abstract
Background In some countries the misuse and diversion of prescribed opioid analgesic is increasing considerably, but there is no official data regarding the situation in Colombia. The aim of this study was to identify all dependent to opioid analgesics legally prescribed patients that were treated in a University Hospital in Medellin, Colombia during 4 years and to characterize this population. Methods Observational study in a University Hospital in Medellin, Colombia, searching for patients with ICD-10 codes related with opioid related disorders, adverse events or pain and treated between January 2011 and December 2014. Results Sixty patients with opioid dependence according to DSM-IV criteria were found from 3332 clinical charts reviewed. The median age was 43 years. Although all patients met the DSM-IV criteria, 33 % of patients were wrongly diagnosed by other ICD-10 codes. Almost all patient (88 %) initiated opioids after medical prescription although the adherence to pain scale was low (25 %). The median time of consumption was 48 months. Tramadol was the opioid more frequently used by patients, followed by morphine and oxycodone. A statistically significant higher consumption of other psychotropic substances was observed in male than female (P = 0.005 by Fisher’s test). After be diagnosed, 55 % of patients gone a methadone-based replacement therapy. Conclusion Legally prescribed opioid dependence was belatedly diagnosed in 60 patients in a University hospital, after prolonged use of drugs to treat chronic pain and with low adherence to pain scale or guidelines. This is the first report in Colombia.
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Affiliation(s)
- Maria G Garcia-Orjuela
- Departamento de Farmacología y Toxicología, CIEMTO: Centro de Información y Estudio de Medicamentos y Tóxicos, Facultad de Medicina, Universidad de Antioquia, Carrera 51D No. 62-42, Medellín, Colombia
| | - Lineth Alarcon-Franco
- Departamento de Farmacología y Toxicología, CIEMTO: Centro de Información y Estudio de Medicamentos y Tóxicos, Facultad de Medicina, Universidad de Antioquia, Carrera 51D No. 62-42, Medellín, Colombia
| | - Juan C Sanchez-Fernandez
- Departamento de Farmacología y Toxicología, CIEMTO: Centro de Información y Estudio de Medicamentos y Tóxicos, Facultad de Medicina, Universidad de Antioquia, Carrera 51D No. 62-42, Medellín, Colombia
| | - Yuli Agudelo
- Hospital Universitario San Vicente Fundación, Calle 64 No. 51 D-154, Medellín, Colombia
| | - Andres F Zuluaga
- Departamento de Farmacología y Toxicología, CIEMTO: Centro de Información y Estudio de Medicamentos y Tóxicos, Facultad de Medicina, Universidad de Antioquia, Carrera 51D No. 62-42, Medellín, Colombia. .,GRIPE: Grupo Investigador de Problemas en Enfermedades Infecciosas, Facultad de Medicina, Universidad de Antioquia, Calle 70 No. 52-21, Medellín, Colombia.
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Abstract
The 114th Congress (2014-2016) has received recent attention for the high number of legislative bills directed to the public health crisis in prescription opioid abuse. The US government does not have a single source for determining public policy; however, the people expect that there will be some level of efficiency and coordination between federal and state leaders to improve the nation's health. A search of the National Library of Congress database to analyze legislative bills introduced between 1973 and 2016 and which contain the term "opioid" identified 127 bills that characterize consistency and coordination with other governmental efforts in prescription opioid abuse. Despite the recent number of introduced bills, there does not appear to be a close coordination between Congress and Federal Administrative agencies regarding this crisis.
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Kennedy MC, Kerr T, DeBeck K, Dong H, Milloy MJ, Wood E, Hayashi K. Seeking prescription opioids from physicians for nonmedical use among people who inject drugs in a Canadian setting. Am J Addict 2016; 25:275-82. [PMID: 27143485 DOI: 10.1111/ajad.12380] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 03/12/2016] [Accepted: 04/19/2016] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Despite the high prevalence of prescription opioid (PO) misuse, little is known about the phenomenon of seeking POs for nonmedical use among high-risk populations, such as people who inject drugs (PWID). We therefore sought to examine the prevalence and correlates of seeking POs from a physician for nonmedical use among PWID in Vancouver, Canada. METHODS Cross-sectional data from two open prospective cohort studies of PWID in Vancouver were collected between June 2013 and May 2014 (n = 1252). Multivariable logistic regression was used to identify factors associated with seeking POs from physicians for nonmedical use. RESULTS Of 1252 participants, 458 individuals (36.6%) reported ever trying to get a PO prescription from a physician for nonmedical use and, of these, 343 (74.9%, comprising 27.4% of the total sample) reported ever being successful. Variables independently and positively associated with PO-seeking behavior included older age (adjusted odds ratio [AOR] = 1.02), Caucasian ethnicity (AOR = 1.38), having ever overdosed (AOR = 1.32), having ever participated in methadone maintenance therapy (AOR = 1.90), having ever dealt drugs (AOR = 1.65), and having ever been refused a prescription for pain medication (AOR = 2.02) (all p < .05). DISCUSSION AND CONCLUSIONS We observed that PO-seeking behavior was common among this sample of PWID and associated with several markers of higher intensity drug use. SCIENTIFIC SIGNIFICANCE Our findings highlight the need to identify evidence-based public health and clinical strategies to mitigate PO misuse among PWID without compromising care for PWID with legitimate medical concerns. (Am J Addict 2016;25:275-282).
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Affiliation(s)
- Mary Clare Kennedy
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kora DeBeck
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.,School of Public Policy, Simon Fraser University, Vancouver, BC, Canada
| | - Huiru Dong
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
| | - M-J Milloy
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kanna Hayashi
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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Larochelle MR, Zhang F, Ross-Degnan D, Wharam JF. Trends in opioid prescribing and co-prescribing of sedative hypnotics for acute and chronic musculoskeletal pain: 2001-2010. Pharmacoepidemiol Drug Saf 2015; 24:885-92. [DOI: 10.1002/pds.3776] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 02/11/2015] [Accepted: 02/27/2015] [Indexed: 11/07/2022]
Affiliation(s)
- Marc R. Larochelle
- Department of Population Medicine; Harvard Medical School and Harvard Pilgrim Health Care Institute; Boston MA USA
- Section of General Internal Medicine, Department of Medicine; Boston University School of Medicine and Boston Medical Center; Boston MA USA
| | - Fang Zhang
- Department of Population Medicine; Harvard Medical School and Harvard Pilgrim Health Care Institute; Boston MA USA
| | - Dennis Ross-Degnan
- Department of Population Medicine; Harvard Medical School and Harvard Pilgrim Health Care Institute; Boston MA USA
| | - J. Frank Wharam
- Department of Population Medicine; Harvard Medical School and Harvard Pilgrim Health Care Institute; Boston MA USA
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The Effects of North Carolina’s Prescription Drug Monitoring Program on the Prescribing Behaviors of the State’s Providers. J Prim Prev 2014; 36:131-7. [DOI: 10.1007/s10935-014-0381-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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25
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26
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Shepherd J. Combating the prescription painkiller epidemic: a national prescription drug reporting program. AMERICAN JOURNAL OF LAW & MEDICINE 2014; 40:85-112. [PMID: 24844043 DOI: 10.1177/009885881404000103] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Prescription painkiller abuse is the fastest growing drug problem in the United States. In the past year, approximately one out of twenty Americans reported misuse or abuse of prescription painkillers. Several factors contribute to the prescription painkiller epidemic. Drug abusers use various methods--such as doctor shopping, paying with cash, and filling prescriptions in different states--to avoid detection and obtain prescription painkillers for illegitimate uses. A few rogue physicians and pharmacists, lured by substantial profits, enable drug abusers by illegally prescribing or supplying controlled substances. Even ethical physicians rarely have adequate training to recognize and address prescription drug abuse, and as a result, prescribe painkillers to patients who are not using them for legitimate medical purposes. Similarly, although the majority of pharmacies have taken steps to combat drug abuse and reduce prescription painkiller dispensing, under current reporting systems, pharmacists lack visibility into several important indicators of drug abuse. As a result, even the most vigilant pharmacists find it extremely difficult to identify and detect drug abuse with certainty. While state governments have established prescription drug monitoring programs (PDMPs) to crack down on prescription drug abuse, these programs have proven to be inadequate. The programs currently suffer from inadequate data collection, ineffective utilization of data, insufficient interstate data sharing, and constraints on sharing data with law enforcement and state agencies. By contrast, third-party prescription payment systems run by pharmacy benefit managers (PBMs) or health insurers have been effective in detecting prescription drug abuse. This paper suggests that a national prescription drug reporting program building on existing PBM networks could be significantly more effective than existing state PDMPs in detecting prescription drug abuse.
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