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Solgama JP, Liu E, Davis M, Graham J, McCall KL, Piper BJ. State-level variation in distribution of oxycodone and opioid-related deaths from 2000 to 2021: an ecological study of ARCOS and CDC WONDER data in the USA. BMJ Open 2024; 14:e073765. [PMID: 38453203 PMCID: PMC10921485 DOI: 10.1136/bmjopen-2023-073765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 02/12/2024] [Indexed: 03/09/2024] Open
Abstract
OBJECTIVES This study aims to characterise oxycodone's distribution and opioid-related overdoses in the USA by state from 2000 to 2021. DESIGN This is an observational study. SETTING More than 80 000 Americans died of an opioid overdose in 2021 as the USA continues to struggle with an opioid crisis. Prescription opioids play a substantial role, introducing patients to opioids and providing a supply of drugs that can be redirected to those seeking to misuse them. METHODS The Drug Enforcement Administration annual summary reports from the Automation of Reports and Consolidated Orders System provided weights of oxycodone distributed per state by business type (pharmacies, hospitals and practitioners). Weights were converted to morphine milligram equivalents (MME) per capita and normalised for population. The Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research provided mortality data for heroin, other opioids, methadone, other synthetic narcotics and other/unspecified narcotics. RESULTS There was a sharp 280.13% increase in total MME/person of oxycodone from 2000 to 2010, followed by a slower 54.34% decrease from 2010 to 2021. Florida (2007-2011), Delaware (2003-2020) and Tennessee (2012-2021) displayed consistent and substantial elevations in combined MME/person compared with other states. In the peak year (2010), there was a 15-fold difference between the highest and lowest states. MME/person from only pharmacies, which constituted >94% of the total, showed similar results. Hospitals in Alaska (2000-2001, 2008, 2010-2021), Colorado (2008-2021) and DC (2000-2011) distributed substantially more MME/person over many years compared with other states. Florida stood out in practitioner-distributed oxycodone, with an elevation of almost 15-fold the average state from 2006 to 2010. Opioid-related deaths increased +806% from 2000 to 2021, largely driven by heroin, other opioids and other synthetic narcotics. CONCLUSIONS Oxycodone distribution across the USA showed marked differences between states and business types over time. Investigation of opioid policies in states of interest may provide insight for future actions to mitigate opioid misuse.
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Affiliation(s)
- Jay P Solgama
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - Edward Liu
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - Mellar Davis
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
- Palliative Care, Geisinger Health System, Danville, Pennsylvania, USA
| | - Jove Graham
- Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, Pennsylvania, USA
- Center for Health Research, Danville, Pennsylvania, USA
| | - Kenneth L McCall
- Binghamton University, Binghamton, New York, USA
- University of New England, Portland, Maine, USA
| | - Brian J Piper
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
- Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, Pennsylvania, USA
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Morales P, Santiago L, Rosario J, Garcia-Fragoso L, Duconge J, Perez N, Santiago D. Neonatal Abstinence Syndrome and Corresponding Pharmacotherapy Approaches from 2 University-affiliated Neonatal Intensive Care Units in Puerto Rico (2018-2020). P R Health Sci J 2024; 43:25-31. [PMID: 38512758 PMCID: PMC11061712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
OBJECTIVE Neonatal abstinence syndrome (NAS) is a set of drug withdrawal symptoms suffered by neonates exposed to drugs in utero. Several studies have widely described NAS incidence and treatment approach; however, little is known regarding the incidence and manifestations of this disease in Puerto Rico (PR). The principal aim of this study was to describe NAS incidence in the neonatal units of hospitals affiliated with the University of PR in terms of occurrence, clinical manifestations, and treatment approaches. METHODS Our study evaluated the medical records of NAS babies diagnosed from 2018 through 2020 at 2 hospitals affiliated with the University of PR Medical Sciences Campus. Descriptive and inferential statistics were employed to analyze trends. RESULTS We identified 12 neonates diagnosed with NAS, 5 with low birthweights (<2500 g); for a NAS incidence of 2 cases per 1000 admitted for the 3 years of recollected data. The urine toxicology results revealed that 9 had experienced intrauterine polydrug exposure. Phenobarbital loading dose were determined on the day of diagnosis (indicated by Finnegan score). The first manifestation of NAS symptoms varied: 8 neonates showed symptoms within 48 hours after birth, whereas 4 had withdrawal symptoms within 72-120 hours of their births. Differences between dosing practices and guidelines were observed, ranging from a 0.69% to a 25% difference during treatment initiation. CONCLUSION Further research on the incidence of NAS in PR (national level) is needed for a deeper understanding that we hope will lead to the development of enhanced treatment protocols in PR.
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Affiliation(s)
- Pamela Morales
- School of Pharmacy, University of Puerto Rico, Medical Sciences Campus
| | | | | | - Lourdes Garcia-Fragoso
- Neonatology section, Department of Pediatrics, School of Medicine, University of Puerto Rico
| | - Jorge Duconge
- School of Pharmacy, University of Puerto Rico, Medical Sciences Campus
| | - Naidy Perez
- The Alliance for Clinical and Translational Research
| | - Darlene Santiago
- School of Pharmacy, University of Puerto Rico, Medical Sciences Campus
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3
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Madera JD, Ruffino AE, Feliz A, McCall KL, Davis CS, Piper BJ. Declining but Pronounced State-Level Disparities in Prescription Opioid Distribution in the United States. Pharmacy (Basel) 2024; 12:14. [PMID: 38251408 PMCID: PMC10801547 DOI: 10.3390/pharmacy12010014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/04/2024] [Accepted: 01/12/2024] [Indexed: 01/23/2024] Open
Abstract
The United States (US) opioid epidemic is a persistent and pervasive public health emergency that claims the lives of over 80,000 Americans per year as of 2021. There have been sustained efforts to reverse this crisis over the past decade, including a number of measures designed to decrease the use of prescription opioids for the treatment of pain. This study analyzed the changes in federal production quotas for prescription opioids and the distribution of prescription opioids for pain and identified state-level differences between 2010 and 2019. Data (in grams) on opioid production quotas and distribution (from manufacturer to hospitals, retail pharmacies, practitioners, and teaching institutions) of 10 prescription opioids (codeine, fentanyl, hydrocodone, hydromorphone, meperidine, methadone, morphine, oxycodone, oxymorphone, and tapentadol) for 2010 to 2019 were obtained from the US Drug Enforcement Administration. Amounts of each opioid were converted from grams to morphine milligram equivalent (MME), and the per capita distribution by state was calculated using population estimates. Total opioid production quotas increased substantially from 2010 to 2013 before decreasing by 41.5% from 2013 (87.6 MME metric tons) to 2019 (51.3). The peak year for distribution of all 10 prescription opioids was between 2010 and 2013, except for codeine (2015). The largest quantities of opioid distribution were observed in Tennessee (520.70 MME per person) and Delaware (251.45) in 2011 and 2019. There was a 52.0% overall decrease in opioid distribution per capita from 2010 to 2019, with the largest decrease in Florida (-61.6%) and the smallest in Texas (-18.6%). Southern states had the highest per capita distribution for eight of the ten opioids in 2019. The highest to lowest state ratio of total opioid distribution, corrected for population, decreased from 5.25 in 2011 to 2.78 in 2019. The mean 95th/5th ratio was relatively consistent in 2011 (4.78 ± 0.70) relative to 2019 (5.64 ± 0.98). This study found a sustained decline in the distribution of ten prescription opioids during the last five years. Distribution was non-homogeneous at the state level. Analysis of state-level differences revealed a fivefold difference in the 95th:5th percentile ratio between states, which has remained unchanged over the past decade. Production quotas did not correspond with the distribution, particularly in the 2010-2016 period. Future research, focused on identifying factors contributing to the observed regional variability in opioid distribution, could prove valuable to understanding and potentially remediating the pronounced disparities in prescription opioid-related harms in the US.
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Affiliation(s)
- Joshua D. Madera
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA 18509, USA; (J.D.M.); (A.E.R.); (A.F.); (B.J.P.)
| | - Amanda E. Ruffino
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA 18509, USA; (J.D.M.); (A.E.R.); (A.F.); (B.J.P.)
| | - Adriana Feliz
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA 18509, USA; (J.D.M.); (A.E.R.); (A.F.); (B.J.P.)
| | - Kenneth L. McCall
- Department of Pharmacy Practice, University of New England, Portland, ME 04103, USA
- Department of Pharmacy Practice, Binghamton University, Johnson City, NY 13790, USA
| | | | - Brian J. Piper
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA 18509, USA; (J.D.M.); (A.E.R.); (A.F.); (B.J.P.)
- Center for Pharmacy Innovation and Outcomes, Geisinger College of Health Sciences, Danville, PA 18704, USA
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Kennalley AL, Fanelli JL, Furst JA, Mynarski NJ, Jarvis MA, Nichols SD, McCall KL, Piper BJ. Dynamic changes in methadone utilisation for opioid use disorder treatment: a retrospective observational study during the COVID-19 pandemic. BMJ Open 2023; 13:e074845. [PMID: 37973543 PMCID: PMC10661065 DOI: 10.1136/bmjopen-2023-074845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 10/18/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVES Opioid use disorder (OUD) is a major public health concern in the USA, resulting in high rates of overdose and other negative outcomes. Methadone, an OUD treatment, has been shown to be effective in reducing the risk of overdose and improving overall health and quality of life. This study analysed the distribution of methadone for the treatment of OUD across the USA over the past decade and through the COVID-19 pandemic. DESIGN Retrospective observational study using secondary data analysis of the Drug Enforcement Administration and Medicaid Databases. SETTING USA. PARTICIPANTS Patients who were dispensed methadone at US opioid treatment programmes (OTPs). PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcomes were the overall pattern in methadone distribution and the number of OTPs in the USA per year. The secondary outcome was Medicaid prescriptions for methadone. RESULTS Methadone distribution for OUD has expanded significantly over the past decade, with an average state increase of +96.96% from 2010 to 2020. There was a significant increase in overall distribution of methadone to OTP from 2010 to 2020 (+61.00%, p<0.001) and from 2015 to 2020 (+26.22%, p<0.001). However, the distribution to OTPs did not significantly change from 2019 to 2021 (-5.15%, p=0.491). There was considerable state-level variation in methadone prescribing to Medicaid patients with four states having no prescriptions. CONCLUSIONS There have been dynamic changes in methadone distribution for OUD. Furthermore, pronounced variation in methadone distribution among states was observed, with some states having no OTPs or Medicaid coverage. New policies are urgently needed to increase access to methadone treatment, address the opioid epidemic in the USA and reduce overdose deaths.
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Affiliation(s)
- Amy L Kennalley
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - Jessica L Fanelli
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - John A Furst
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - Nicholas J Mynarski
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - Margaret A Jarvis
- Division of Addiction Medicine, Department of Psychiatry, Geisinger Clinic, Danville, Pennsylvania, USA
| | - Stephanie D Nichols
- Department of Pharmacy Practice, University of New England, Portland, Maine, USA
| | - Kenneth L McCall
- Department of Pharmacy Practice, Binghamton University, Binghamton, New York, USA
| | - Brian J Piper
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
- Center for Pharmacy Innovation and Outcomes, Danville, Pennsylvania, USA
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5
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Hsu ZS, Warnick JA, Harkins TR, Sylvester BE, Bharati NK, Eley LB, Nichols SD, McCall K, Piper BJ. An analysis of patterns of distribution of buprenorphine in the United States using ARCOS, Medicaid, and Medicare databases. Pharmacol Res Perspect 2023; 11:e01115. [PMID: 37485957 PMCID: PMC10364307 DOI: 10.1002/prp2.1115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 05/23/2023] [Accepted: 06/20/2023] [Indexed: 07/25/2023] Open
Abstract
Opioid overdose remains a problem in the United States despite pharmacotherapies, such as buprenorphine, in the treatment of opioid use disorder. This study characterized changes in buprenorphine use. Using the Drug Enforcement Administration's ARCOS, Medicaid, and Medicare claims databases, patterns in buprenorphine usage in the United States from 2018 to 2020 were analyzed by examining percentage changes in total grams distributed and changes in grams per 100 K people in year-to-year usage based on ZIP code and state levels. For ARCOS from 2018 to 2019 and 2019 to 2020, total buprenorphine distribution in grams increased by 16.2% and 12.6%, respectively. South Dakota showed the largest statewide percentage increase in both 2018-2019 (66.1%) and 2019-2020 (36.7%). From 2018 to 2019, the ZIP codes ND-577 (156.4%) and VA-222 (-82.1%) had the largest and smallest percentage changes, respectively. From 2019 to 2020, CA-932 (250.2%) and IL-603 (-36.8%) were the largest and smallest, respectively. In both 2018-2019 and 2019-2020, PA-191 had the second highest increase in grams per 100K while OH-452 was the only ZIP code to remain in the top three largest decreases in grams per 100K in both periods. Among Medicaid patients in 2018, there was a nearly 2000-fold difference in prescriptions per 100k Medicaid enrollees between Kentucky (12 075) and Nebraska (6). Among Medicare enrollees in 2018, family medicine physicians and other primary care providers were the top buprenorphine prescribers. This study not only identified overall increases in buprenorphine availability but also pronounced state-level differences. Such geographic analysis can be used to discern which public policies and regional factors impact buprenorphine access.
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Affiliation(s)
- Zhi-Shan Hsu
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - Justina A Warnick
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - Tice R Harkins
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - Briana E Sylvester
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - Neal K Bharati
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - leTausjua B Eley
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - Stephanie D Nichols
- Department of Pharmacy Practice, University of New England, Portland, Maine, USA
| | - Kenneth McCall
- Department of Pharmacy Practice, Binghamton University, Binghamton, New York, USA
| | - Brian J Piper
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
- Center for Pharmacy Innovation and Outcomes, Geisinger Precision Heath Center, Pennsylvania, USA
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Sahebi-Fakhrabad A, Sadeghi AH, Handfield R. Evaluating State-Level Prescription Drug Monitoring Program (PDMP) and Pill Mill Effects on Opioid Consumption in Pharmaceutical Supply Chain. Healthcare (Basel) 2023; 11:healthcare11030437. [PMID: 36767012 PMCID: PMC9914561 DOI: 10.3390/healthcare11030437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/29/2023] [Accepted: 02/01/2023] [Indexed: 02/09/2023] Open
Abstract
The opioid crisis in the United States has had devastating effects on communities across the country, leading many states to pass legislation that limits the prescription of opioid medications in an effort to reduce the number of overdose deaths. This study evaluates the impact of two categories of PDMP and Pill Mill regulations on the supply of opioid prescriptions at the level of dispensers and distributors (excluding manufacturers) using ARCOS data. The study uses a difference-in-difference method with a two-way fixed design to analyze the data. The study finds that both of the regulations are associated with reductions in the volume of opioid distribution. However, the study reveals that these regulations may have unintended consequences, such as shifting the distribution of controlled substances to neighboring states. For example, in Tennessee, the implementation of Operational PDMP regulations reduces the in-state distribution of opioid drugs by 3.36% (95% CI, 2.37 to 4.3), while the out-of-state distribution to Georgia, which did not have effective PDMP regulations in place, increases by 16.93% (95% CI, 16.42 to 17.44). Our studies emphasize that policymakers should consider the potential for unintended distribution shifts of opioid drugs to neighboring states with laxer regulations as well as varying impacts on different dispenser types.
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Affiliation(s)
- Amirreza Sahebi-Fakhrabad
- Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, NC 27606, USA
- Department of Business Management, Poole College of Management, North Carolina State University, 2806-A Hillsborough St. Building 217, Raleigh, NC 27695, USA
| | - Amir Hossein Sadeghi
- Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, NC 27606, USA
| | - Robert Handfield
- Department of Business Management, Poole College of Management, North Carolina State University, 2806-A Hillsborough St. Building 217, Raleigh, NC 27695, USA
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Abstract
Background: The United States (US) ranks high, nationally, in opioid consumption. The ongoing increase in the misuse and mortality amid the opioid epidemic has been contributing to its rising cost. The worsening health and economic impact of opioid use disorder in the US warrants further attention. We, therefore, assessed commonly prescribed opioids to determine the opioids that were over-represented versus under-represented for adverse drug events (ADEs) to better understand their distribution patterns using the Food and Drug Administration's Adverse Event Reporting System (FAERS) while correcting for distribution using the Drug Enforcement Administration's Automation of Reports and Consolidated Orders System (ARCOS). Comparing the ratio of the percentage of adverse drug events as reported by the FAERS relative to the percentage of distribution as reported by the ARCOS database is a novel approach to evaluate post-marketing safety surveillance and may inform healthcare policies and providers to better regulate the use of these opioids. Methods: We analyzed the adverse events for 11 prescription opioids, when correcting for distribution, and their ratios for three periods, 2006-2010, 2011-2016, and 2017-2021, in the US. The opioids include buprenorphine, codeine, fentanyl, hydrocodone, hydromorphone, meperidine, methadone, morphine, oxycodone, oxymorphone, and tapentadol. Oral morphine milligram equivalents (MMEs) were calculated by conversions relative to morphine. The relative ADEs of the selected opioids, opioid distributions, and ADEs relative to distribution ratios were analyzed for the 11 opioids. Results: Oxycodone, fentanyl, and morphine accounted for over half of the total number of ADEs (n = 667,969), while meperidine accounted for less than 1%. Opioid distributions were relatively constant over time, with methadone repeatedly accounting for the largest proportions. Many ADE-to-opioid distribution ratios increased over time, with meperidine (60.6), oxymorphone (11.1), tapentadol (10.3), and hydromorphone (7.9) being the most over-represented for ADEs in the most recent period. Methadone was under-represented (<0.20) in all the three periods. Conclusion: The use of the FAERS with the ARCOS provides insights into dynamic changes in ADEs of the selected opioids in the US. There is further need to monitor and address the ADEs of these drugs.
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Affiliation(s)
- Edward Y. Liu
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA, United States
- *Correspondence: Edward Y. Liu,
| | - Kenneth L. McCall
- Department of Pharmacy Practice, Binghamton University, Binghamton, NY, United States
| | - Brian J. Piper
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA, United States
- Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, PA, United States
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Eidbo SA, Kropp Lopez AK, Hagedorn JD, Mathew V, Kaufman DE, Nichols SD, McCall KL, Piper BJ. Declines and regional variation in opioid distribution by U.S. hospitals. Pain 2022; 163:1186-1192. [PMID: 34510133 DOI: 10.1097/j.pain.0000000000002473] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/08/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT The United States is enduring a preventable opioid crisis, particularly involving a population being treated in a hospital setting, a subset of whom may escalate to illicit opioids. This project analyzed trends in distribution of opioids by hospitals in the United States. Opioids monitored included buprenorphine, codeine, fentanyl, hydrocodone, hydromorphone, meperidine, methadone, morphine, oxycodone, oxymorphone, powdered opium, remifentanil, and tapentadol. The Automation of Reports and Consolidated Orders System (ARCOS) reports on substances controlled by the Drug Enforcement Administration. National data from ARCOS reports 5 and 7 from 2000 to 2019 were used for an observational study on hospital opioid distribution. Morphine milligram equivalents (MMEs) were calculated using oral conversion factors. The MME per person per state was calculated to compare data from the peak year, 2012, with data from 2019. Opioid use peaked in 2012, with a -46.6% decline from 2012 to 2019. Half (25) of the states have seen a decrease of -50% or greater. Of the opioid compounds observed, buprenorphine has seen increased (+122.5%) hospital use from 2012 to 2019. All other opioids have been experiencing a decline (≥50%), particularly hydromorphone (-49.9%), oxymorphone (-57.7%), methadone (-58.7%), morphine (-66.9%), codeine (-67.5%), and meperidine (-77.6%). There was a 6-fold difference in population-corrected use of opioids in 2019 between the lowest (6.8 MME/person in New Jersey) and highest (Alaska = 39.6) states. This study demonstrates the considerable progress made thus far by hospitals in curbing the U.S. opioid crisis.
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Affiliation(s)
- Sarah A Eidbo
- Geisinger Commonwealth School of Medicine, Scranton, PA, United States
| | | | - Joseph D Hagedorn
- Geisinger Commonwealth School of Medicine, Scranton, PA, United States
| | - Varkey Mathew
- Geisinger Commonwealth School of Medicine, Scranton, PA, United States
| | - Daniel E Kaufman
- Geisinger Commonwealth School of Medicine, Scranton, PA, United States
| | | | | | - Brian J Piper
- Geisinger Commonwealth School of Medicine, Scranton, PA, United States
- Center for Pharmacy Innovation and Outcomes, Forty Fort, PA, United States
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9
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Armbuster YC, Banas BN, Feickert KD, England SE, Moyer EJ, Christie EL, Chughtai S, Giuliani TJ, Halden RU, Graham JH, McCall KL, Piper BJ. Decline and Pronounced Regional Disparities in Medical Cocaine Usage in the United States. J Pharm Technol 2021; 37:278-285. [PMID: 34790964 DOI: 10.1177/87551225211035563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Cocaine is a stimulant and Schedule II drug used as a local anesthetic and vasoconstrictor. Objective: This descriptive study characterized medical cocaine use in the United States. Methods: Retail drug distribution data from 2002 to 2017 were extracted for each state from the Drug Enforcement Administration, which reports on medical, research, and analytical chemistry use. The percentage of buyers (pharmacies, hospitals, and providers) was obtained. Use per state, corrected for population, was determined. Available cross-sectional data on cocaine use as reported by the Medicare and Medicaid programs for 2013-2017 and electronic medical records were examined. Results: Medical cocaine use decreased by -62.5% from 2002 to 2017. Hospitals accounted for 84.9% and practitioners for 9.9% of cocaine distribution in 2017. The number of pharmacies carrying cocaine dropped by -69.4%. The percentages of hospitals, practitioners, and pharmacies that carried cocaine in 2017 were 38.4%, 2.3%, and 0.3%, respectively. There was a 7-fold difference in 2002 (South Dakota, 76.1 mg/100 persons; Delaware, 10.1 mg/100 persons). Relative to the average state in 2017, those reporting the highest values (Montana, 20.1; North Dakota, 24.1 mg/100 persons) were significantly elevated. Cocaine use within the Medicare and Medicaid programs was negligible. Cocaine use within the Geisinger system was rare from 2002 to 2007 (<4 orders/100 000 patients per year) but increased to 48.7 in 2018. Conclusion and Relevance: If these pharmacoepidemiological patterns continue, licit cocaine may soon become a historical relic. The pharmacology and pharmacotherapeutics education of health care providers may need to be adjusted accordingly.
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Affiliation(s)
| | - Brian N Banas
- Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | | | | | - Erik J Moyer
- Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | | | - Sana Chughtai
- Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | | | - Rolf U Halden
- Arizona State University, Tempe, AZ, USA.,Arizona State University Foundation.,AquaVitas, LLC
| | - Jove H Graham
- Center for Pharmacy Innovation and Outcomes, Danville, PA, USA
| | | | - Brian J Piper
- Geisinger Commonwealth School of Medicine, Scranton, PA, USA.,Center for Pharmacy Innovation and Outcomes, Danville, PA, USA
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10
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Abstract
This paper is the forty-second consecutive installment of the annual anthological review of research concerning the endogenous opioid system, summarizing articles published during 2019 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides and receptors as well as effects of opioid/opiate agonists and antagonists. The review is subdivided into the following specific topics: molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors (1), the roles of these opioid peptides and receptors in pain and analgesia in animals (2) and humans (3), opioid-sensitive and opioid-insensitive effects of nonopioid analgesics (4), opioid peptide and receptor involvement in tolerance and dependence (5), stress and social status (6), learning and memory (7), eating and drinking (8), drug abuse and alcohol (9), sexual activity and hormones, pregnancy, development and endocrinology (10), mental illness and mood (11), seizures and neurologic disorders (12), electrical-related activity and neurophysiology (13), general activity and locomotion (14), gastrointestinal, renal and hepatic functions (15), cardiovascular responses (16), respiration and thermoregulation (17), and immunological responses (18).
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, 65-30 Kissena Blvd., Flushing, NY, 11367, United States.
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11
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Abstract
BACKGROUND Methadone is an evidence-based treatment for opioid use disorder (OUD) and pain management. Methadone for OUD may be difficult for some patients to access, particularly those in rural areas. OBJECTIVE The purpose of this study was to characterize methadone distribution patterns between 2017 and 2019 across the United States. METHODS The US Drug Enforcement Administration's Automated Reports and Consolidated Ordering System was used to acquire the number of opioid treatment programs (OTPs) per state and methadone distribution weight in grams. Methadone distributions by weight, corrected for state population and number of OTPs, were compared from 2017 to 2019 between states, within regions, and nationally. RESULTS The national distribution of methadone increased +12.3% for OTPs but decreased -34.6% for pain. Whereas all states saw a decrease in pain distribution, the Northeast showed a significantly smaller decrease than all other regions. Additionally, the majority of states experienced an increase in distribution for OTPs, and most states demonstrated a relatively stable or increasing number of OTPs, with an +11.5% increase nationally. The number of OTPs per 100K state population ranged from 2.1 in Rhode Island to 0.0 in Wyoming. CONCLUSION AND RELEVANCE Although methadone distribution for OUD was increasing in the United States, the pronounced regional disparities identified warrant further consideration to improve patient access to this evidence-based pharmacotherapy, particularly in the Midwest and West regions. Greater implementation of telehealth and involvement of primary care into opioid treatment practice offer possible solutions to eliminating geographical treatment barriers.
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Affiliation(s)
- John A Furst
- Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | | | | | - Brian J Piper
- Geisinger Commonwealth School of Medicine, Scranton, PA, USA.,Center for Pharmacy Innovation and Outcomes, Forty Fort, PA, USA
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Davis CS, Piper BJ, Gertner AK, Rotter JS. Opioid Prescribing Laws Are Not Associated with Short-term Declines in Prescription Opioid Distribution. Pain Med 2021; 21:532-537. [PMID: 31365095 DOI: 10.1093/pm/pnz159] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To determine whether the adoption of laws that limit opioid prescribing or dispensing is associated with changes in the volume of opioids distributed in states. METHODS State-level data on total prescription opioid distribution for 2015-2017 were obtained from the US Drug Enforcement Administration. We included in our analysis states that enacted an opioid prescribing law in either 2016 or 2017. We used as control states those that did not have an opioid prescribing law during the study period. To avoid confounding, we excluded from our analysis states that enacted or modified mandates to use prescription drug monitoring programs (PDMPs) during the study period. To estimate the effect of opioid prescription laws on opioid distribution, we ran ordinary least squares models with indicators for whether an opioid prescription law was in effect in a state-quarter. We included state and quarter fixed effects to control for time trends and time-invariant differences between states. RESULTS With the exception of methadone and buprenorphine, the amount of opioids distributed in states fell during the study period. The adoption of opioid prescribing laws was not associated with additional decreases in opioids distributed. CONCLUSIONS We did not detect an association between adoption of opioid prescribing laws and opioids distributed. States may instead wish to pursue evidence-based efforts to reduce opioid-related harm, with a particular focus on treatment access and harm reduction interventions.
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Affiliation(s)
- Corey S Davis
- Network for Public Health Law, Los Angeles, California.,Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Brian J Piper
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania
| | - Alex K Gertner
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jason S Rotter
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Piper BJ, McCall KL, Kogan LR, Hellyer P. Assessment of Controlled Substance Distribution to U.S. Veterinary Teaching Institutions From 2006 to 2019. Front Vet Sci 2020; 7:615646. [PMID: 33392300 PMCID: PMC7775551 DOI: 10.3389/fvets.2020.615646] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 11/24/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: To evaluate the changing pattern of distribution of Schedule II and III opioids, barbiturates, and stimulants to veterinary educational institutions in the United States. Design: Longitudinal study. Sample: Veterinary teaching institutions that use Schedule II and III drugs. Procedures: Distribution of controlled substances to veterinary teaching institutions was obtained from the Drug Enforcement Administration's Automated Reports and Consolidated Orders System (ARCOS) for opioids (e.g., methadone, fentanyl, codeine), barbiturates (pentobarbital, butalbital), and stimulants (amphetamine, methylphenidate, lisdexamfetamine) from 2006–2019. Opioids were converted to their morphine milligram equivalents (MME) for evaluation over time. Results: Controlled substance distribution to veterinary schools exhibited dynamic, and agent specific, changes. The total MME for 11 opioids peaked in 2013 and decreased by 17.3% in 2019. Methadone accounted for two-fifths (42.3%) and fentanyl over one-third (35.4%) of the total MME in 2019. Pentobarbital distribution was greatest by weight of all substances studied and peaked in 2011 at 69.4 kg. Stimulants underwent a pronounced decline and were very modest by 2014. Conclusions and Clinical Relevance: Opioids by total MME in veterinary teaching practice have undergone more modest changes than opioids used with humans. Hydrocodone, codeine and recently fentanyl use have declined while methadone increased. Stimulant distribution decreased to become negligible. Together, this pattern of findings warrant continued monitoring.
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Affiliation(s)
- Brian J Piper
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA, United States.,Center for Pharmacy Innovation and Outcomes, Geisinger Precision Health Center, Forty Fort, PA, United States
| | - Kenneth L McCall
- Department of Pharmacy Practice, University of New England, Portland, ME, United States
| | - Lori R Kogan
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, United States
| | - Peter Hellyer
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, United States
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14
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Abstract
IMPORTANCE The majority of US states have passed mandates requiring the use of electronic prescribing of controlled substances (EPCS) as a tool to reduce rates of opioid prescribing. It is not known whether increasing use of EPCS will have the intended effect. OBJECTIVE To assess the association between use of EPCS and trends in opioid prescribing. DESIGN, SETTING, AND PARTICIPANTS In this retrospective, longitudinal cohort study of all patients and prescribers in the 50 US states and the District of Columbia from 2010 to 2018, changes in state-level use of EPCS and concurrent changes in opioid prescribing in each state are described. Then the association between changes in the use of EPCS and opioid prescribing are estimated using state and year fixed-effects models that include covariates for policy change and state demographic change. Data Analysis was performed on May 5, 2020. MAIN OUTCOMES AND MEASURES The proportion of controlled substances in each state prescribed using EPCS based on opioid prescriptions per 100 persons and morphine milligram equivalents (MME) of opioids. RESULTS In 2018, the population-weighted percent of opioids prescribed using EPCS was 27%, up from 0% as of 2013. National rates of opioid prescriptions decreased from 78 prescriptions per 100 persons in 2013 to 53 in 2018. Over the same period, there was a decrease from 64 071 MME per 100 persons in 2013 to 40 906 MME per 100 persons in 2018, representing 36% of the 2013 level. By 2018, EPCS increased to 69.4% in states with mandates for its use and 23.6% in states without mandates. In multivariable models, a 10 percentage-point increase in the use of EPCS was associated with an additional 2 prescriptions per 100 persons (95% CI, 1.3-2.8) and a 0.8% (95% CI, 0.06%-1.5%) increase in MME per 100 persons. CONCLUSIONS AND RELEVANCE These data suggest that an increased use of EPCS was not associated with decreased opioid prescribing or a decrease in the amount prescribed and may have been associated with a small increase in opioid prescribing. Opioid prescribing is associated with a variety of social and public health factors, and thus, despite the appeal, EPCS adoption alone may be insufficient to reduce opioid prescribing. Policy makers should consider levers to ensure that EPCS is integrated with outside data and that information is actively used to inform prescribing decisions.
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Affiliation(s)
- Jordan Everson
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Audrey K. Cheng
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Stephen W. Patrick
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Stacie B. Dusetzina
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee
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15
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Melin K, Santiago Quiñones D, Rodríguez-Díaz CE. Socially distant and out of reach: Unintended consequences of COVID-19 prevention efforts on transgender and gender non-binary populations in Puerto Rico. J Subst Abuse Treat 2020; 122:108209. [PMID: 33279333 DOI: 10.1016/j.jsat.2020.108209] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/30/2020] [Accepted: 11/18/2020] [Indexed: 11/18/2022]
Abstract
Substance use disorders in the United States disproportionately affect minorities and socially vulnerable populations, particularly those at the intersection of racial and sexual minority status. Preceded by over a century-long subjugation to the U.S. government, a recent financial crisis, the devastating hurricanes of 2017, and a string of earthquakes at the end of 2019 and early 2020, the current COVID-19 pandemic is only the most recent disaster to disrupt the local health care system in Puerto Rico. However, the effects of the current emergency and imposed social distancing measures have only exacerbated the underlying vulnerabilities of the transgender and gender non-conforming (GNC) population made bare during these other recent disasters. Clinics and providers who treat patients with opioid use disorder (OUD) in Puerto Rico have had to develop their own safety protocols to limit the spread of the virus while trying to optimize current treatment protocols to maintain the stability of their patients. Despite these measures, we have observed a reduction in the ability of local organizations to outreach to already disconnected transgender and GNC individuals with OUD. For example, due to the government-imposed curfew that began March 15, 2020, some providers engaged in outreach with transgender and GNC sex workers have eliminated nighttime outreach completely. Additionally, a research project surveying all buprenorphine prescribers in Puerto Rico has found that few have received training in treating this vulnerable population, and even fewer report that they are currently providing treatment for transgender or GNC individuals. If Puerto Rico is to address this problem of gross under-representation of a population known to be disproportionately affected by substance use disorders, Puerto Rico must address structural factors to prevent this disparity from widening further during the inevitable future disasters our health care system will face.
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Affiliation(s)
- Kyle Melin
- School of Pharmacy, Medical Sciences Campus - University of Puerto Rico, PO Box 365067, San Juan, PR 00936-5067, Puerto Rico.
| | - Darlene Santiago Quiñones
- School of Pharmacy, Medical Sciences Campus - University of Puerto Rico, PO Box 365067, San Juan, PR 00936-5067, Puerto Rico.
| | - Carlos E Rodríguez-Díaz
- Community-Oriented Primary Care Program, Department of Prevention and Community Health, George Washington University - Milken Institute School of Public Health, 950 New Hampshire Ave, Suite 300, DPCH, Washington, DC 20052, United States of America.
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16
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Kropp Lopez AK, Nichols SD, Chung DY, Kaufman DE, McCall KL, Piper BJ. Prescription Opioid Distribution after the Legalization of Recreational Marijuana in Colorado. Int J Environ Res Public Health 2020; 17:E3251. [PMID: 32392702 DOI: 10.3390/ijerph17093251] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/23/2020] [Accepted: 04/25/2020] [Indexed: 12/11/2022]
Abstract
There have been dynamic changes in prescription opioid use in the US but the state level policy factors contributing to these are incompletely understood. We examined the association between the legalization of recreational marijuana and prescription opioid distribution in Colorado. Utah and Maryland, two states that had not legalized recreational marijuana, were selected for comparison. Prescription data reported to the Drug Enforcement Administration for nine opioids used for pain (e.g., fentanyl, morphine, hydrocodone, hydromorphone, oxycodone, oxymorphone) and two primarily for opioid use disorder (OUD, methadone and buprenorphine) from 2007 to 2017 were evaluated. Analysis of the interval pre (2007-2012) versus post (2013-2017) marijuana legalization revealed statistically significant decreases for Colorado (P < 0.05) and Maryland (P < 0.01), but not Utah, for pain medications. There was a larger reduction from 2012 to 2017 in Colorado (-31.5%) than the other states (-14.2% to -23.5%). Colorado had a significantly greater decrease in codeine and oxymorphone than the comparison states. The most prevalent opioids by morphine equivalents were oxycodone and methadone. Due to rapid and pronounced changes in prescription opioid distribution over the past decade, additional study with more states is needed to determine whether cannabis policy was associated with reductions in opioids used for chronic pain.
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Pashmineh Azar AR, Cruz-Mullane A, Podd JC, Lam WS, Kaleem SH, Lockard LB, Mandel MR, Chung DY, Simoyan OM, Davis CS, Nichols SD, McCall KL, Piper BJ. Rise and regional disparities in buprenorphine utilization in the United States. Pharmacoepidemiol Drug Saf 2020; 29:708-715. [PMID: 32173955 DOI: 10.1002/pds.4984] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 01/09/2020] [Accepted: 02/11/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE Buprenorphine is an opioid partial agonist used to treat opioid use disorder. While several policy changes have attempted to increase buprenorphine availability, access remains well below optimal levels. This study characterized how buprenorphine utilization in the United States has changed over time and whether there are regional disparities in distribution of the medication. METHODS The amount of buprenorphine distributed from 2007 to 2017 was obtained from the Drug Enforcement Administration's Automated Reports and Consolidated Ordering System. Data were expressed as the percent change and milligrams per person in each state. The formulations and cost for prescriptions covered by Medicaid (2008 to 2018) were also examined. RESULTS Buprenorphine distributed to pharmacies increased about 7-fold (476.8 to 3179.9 kg) while the quantities distributed to hospitals grew 5-fold (18.6 to 97.6 kg) nationally from 2007 to 2017. Buprenorphine distribution per person was almost 20-fold higher in Vermont (40.4 mg/person) relative to South Dakota (2.1 mg/person). There was a strong association between the number of physicians authorized to prescribe buprenorphine and distribution per state (r[49] = +0.94, P < .0005). The buprenorphine/naloxone sublingual film (Suboxone) was the predominant formulation (92.6% of 0.31 million Medicaid prescriptions) in 2008 but accounted for less than three-fifth (57.3% of 6.56 million prescriptions) in 2018. CONCLUSIONS Although buprenorphine availability has substantially increased over the last decade, distribution was very nonhomogeneous across the United States.
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Affiliation(s)
- Amir R Pashmineh Azar
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - Alexandra Cruz-Mullane
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - Jaclyn C Podd
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - Warren S Lam
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - Suhail H Kaleem
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - Laura B Lockard
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - Mark R Mandel
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - Daniel Y Chung
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - Olapeju M Simoyan
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA.,Geisinger Marworth Treatment Center, Waverly, Pennsylvania, USA
| | - Corey S Davis
- Network for Public Health Law, Los Angeles, California, USA
| | - Stephanie D Nichols
- Department of Pharmacy Practice, University of New England, Portland, Maine, USA.,Department of Psychiatry, Tufts University, Medford, Massachusetts, USA
| | - Kenneth L McCall
- Department of Pharmacy Practice, University of New England, Portland, Maine, USA
| | - Brian J Piper
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA.,Center for Pharmacy Innovation and Outcomes, Geisinger Precision Health Center, Forty Fort, Pennsylvania, USA
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Rege SV, Ngo DA, Ait-Daoud N, Rizer J, Sharma S, Holstege CP. Epidemiology of pediatric buprenorphine and methadone exposures reported to the poison centers. Ann Epidemiol 2020; 42:50-57.e2. [PMID: 31992493 DOI: 10.1016/j.annepidem.2019.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 10/24/2019] [Accepted: 12/30/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Buprenorphine prescriptions have increased dramatically within the United States, whereas methadone continues to be used widely. We investigated the trends and characteristics of buprenorphine and methadone exposures in the pediatric population. METHODS We identified pediatric exposures to buprenorphine and methadone using the National Poison Data System from 2013 to 2016. We descriptively assessed characteristics of the exposures. Trends in exposures were evaluated using generalized linear mixed models. RESULTS Pediatric buprenorphine exposures increased from 2013 (1097) to 2016 (1226) while methadone calls decreased (486 to 396). After adjusting for the random effects of the geographical region, the mean number of pediatric buprenorphine exposures (per 100,000 pediatric population) increased from 1.3 to 1.5 (P = .05). Conversely, the mean number of methadone exposures decreased from 0.6 to 0.4 (P = .03). Children aged ≤3 years constituted the highest percentage of both exposures. Unintentional exposures accounted for most of the buprenorphine (86.9%) and methadone (62.4%) exposures. Major clinical effects were demonstrated in 2.3% of buprenorphine exposures and were more frequent with methadone (13%). West Virginia and Maryland demonstrated the highest incidence of buprenorphine and methadone exposures, respectively. CONCLUSIONS Pediatric buprenorphine exposures increased but demonstrated less severe effects compared to methadone exposures, which decreased during the study period.
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Song L, Wang L, Pan X, Yang C. lncRNA OIP5-AS1 targets ROCK1 to promote cell proliferation and inhibit cell apoptosis through a mechanism involving miR-143-3p in cervical cancer. ACTA ACUST UNITED AC 2020; 53:e8883. [PMID: 31939597 PMCID: PMC6967205 DOI: 10.1590/1414-431x20198883] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 10/11/2019] [Indexed: 02/07/2023]
Abstract
Opa-interacting protein 5 antisense transcript 1 (OIP5-AS1) is one kind of
cytoplasmic long non-coding RNA (lncRNA), which has been demonstrated to play a
critical function in multiple cancers. However, the detailed mechanism of
OIP5-AS1 in the regulation of cervical cancer progression is still obscure.
Here, we demonstrated that lncRNA OIP5-AS1 was upregulated in cervical cancer
and was correlated with poor prognosis by bioinformatics studies. OIP5-AS1
depletion inhibited cell proliferation and promoted cell apoptosis in cervical
cancer cells. Furthermore, we clarified that ROCK1 was the downstream effector
of OIP5-AS1 and OIP5-AS1 acted as a molecular sponge of miR-143-3p. Finally, we
verified that OIP5-AS1 exerted its function in the regulation of cervical cancer
progression via interacting with miR-143-3p to regulate ROCK1 expression. Our
study revealed novel mechanisms about how lncRNA OIP5-AS1 executed its function
in cervical cancer and thus provided potential therapeutic targets for the
disease.
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Affiliation(s)
- Linlin Song
- Department of Gynecology, The General Hospital of Ningxia Medical University, Yinchuan, China
| | - Linlin Wang
- Medical Laboratory Center, The General Hospital of Ningxia Medical University, Yinchuan, China
| | - Xiaoli Pan
- Department of Pathology, The General Hospital of Ningxia Medical University, Yinchuan, China
| | - Caihong Yang
- Department of Gynecology, The General Hospital of Ningxia Medical University, Yinchuan, China
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Ighodaro EO, McCall KL, Chung DY, Nichols SD, Piper BJ. Dynamic changes in prescription opioids from 2006 to 2017 in Texas. PeerJ 2019; 7:e8108. [PMID: 31824762 PMCID: PMC6901007 DOI: 10.7717/peerj.8108] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 10/28/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The US is experiencing an epidemic of opioid overdoses which may be at least partially due to an over-reliance on opioid analgesics in the treatment of chronic non-cancer pain and subsequent escalation to heroin or illicit fentanyl. As Texas was reported to be among the lowest in the US for opioid use and misuse, further examination of this state is warranted. MATERIALS AND METHODS This study was conducted to quantify prescription opioid use in Texas. Data was obtained from the publicly available US Drug Enforcement Administration's Automation of Reports and Consolidated Orders System (ARCOS) which monitors controlled substances transactions from manufacture to commercial distribution. Data for 2006-2017 from Texas for ten prescription opioids including eight primarily used to relieve pain (codeine, fentanyl, hydrocodone, hydromorphone, meperidine, morphine, oxycodone, oxymorphone) and two (buprenorphine and methadone) for the treatment of an Opioid Use Disorder (OUD) were examined. RESULTS The change in morphine mg equivalent (MME) of all opioids (+23.3%) was only slightly greater than the state's population gains (21.1%). Opioids used to treat an OUD showed pronounced gains (+90.8%) which were four-fold faster than population growth. Analysis of individual agents revealed pronounced elevations in codeine (+387.5%), hydromorphone (+106.7%), and oxycodone (+43.6%) and a reduction in meperidine (-80.3%) in 2017 relative to 2006. Methadone in 2017 accounted for a greater portion (39.5%) of the total MME than hydrocodone, oxycodone, morphine, hydromorphone, oxymorphone, and meperidine, combined. There were differences between urban and rural areas in the changes in hydrocodone and buprenorphine. CONCLUSIONS Collectively, these findings indicate that continued vigilance is needed in Texas to appropriately treat pain and an OUD while minimizing the potential for prescription opioid diversion and misuse. Texas may lead the US in a return to pre-opioid epidemic prescription levels.
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Affiliation(s)
- Ebuwa O. Ighodaro
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA, United States of America
| | - Kenneth L. McCall
- Department of Pharmacy Practice, University of New England, Portland, ME, United States of America
| | - Daniel Y. Chung
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA, United States of America
| | - Stephanie D. Nichols
- Department of Pharmacy Practice, University of New England, Portland, ME, United States of America
- Department of Psychiatry, Tufts University, Medford, MA, United States of America
| | - Brian J. Piper
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA, United States of America
- Center for Pharmacy Innovation and Outcomes, Forty Fort, PA, United States of America
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