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Madsen AM, Martin JM, Linder BJ, Gebhart JB. Perioperative opioid management for minimally invasive hysterectomy. Best Pract Res Clin Obstet Gynaecol 2022; 85:68-80. [PMID: 35752553 DOI: 10.1016/j.bpobgyn.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 05/18/2022] [Accepted: 05/20/2022] [Indexed: 12/14/2022]
Abstract
Given the high volume of hysterectomies performed, the contribution of gynecologists to the opioid crisis is potentially significant. Following a hysterectomy, most patients are over-prescribed opioids, are vulnerable to developing new persistent opioid use, and can be the source of misuse, diversion, or accidental exposure. People who misuse opioids are at risk of an overdose related death, which is now one of the leading causes of death in the United States and is rising in other countries. It is the physician's responsibility to reduce opioid use by making impactful practice changes, such as 1) using pre-emptive opioid sparing strategies, 2) optimizing multimodal nonopioid pain management, 3) restricting postoperative opioid prescribing, and 4) educating patients on proper disposal of unused opioids. These changes can be implemented with an enhanced recovery after surgery protocol, shared decision-making, and patient education strategies related to opioids.
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Affiliation(s)
- Annetta M Madsen
- Department of Obstetrics & Gynecology, Division of Urogynecology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Jessica M Martin
- Department of Obstetrics & Gynecology, Division of Urogynecology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Brian J Linder
- Department of Obstetrics & Gynecology, Division of Urogynecology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - John B Gebhart
- Department of Obstetrics & Gynecology, Division of Urogynecology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Healthcare Equity in Pediatric Otolaryngology. Otolaryngol Clin North Am 2022; 55:1287-1299. [DOI: 10.1016/j.otc.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Cina RA, Ward RC, Basco WT, Taber DJ, Gebregziabher M, McCauley JL, Lockett MA, Moran WP, Mauldin PD, Ball SJ. Incidence and patterns of persistent opioid use in children following appendectomy. J Pediatr Surg 2022; 57:912-919. [PMID: 35688690 DOI: 10.1016/j.jpedsurg.2022.04.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/12/2022] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The past 5 years have witnessed a concerted national effort to assuage the rising tide of the opioid misuse in our country. Surgical procedures often serve as the initial exposure of children to opioids, however the trajectory of use following these exposures remains unclear. We hypothesized that opioid exposure following appendectomy would increase the risk of persistent opioid use among publicly insured children. STUDY DESIGN A retrospective longitudinal cohort study was conducted on South Carolina Medicaid enrollees who underwent appendectomy between January 2014 and December 2017 using administrative claims data. The primary outcome was chronic opioid use. Generalized linear models and finite mixture models were employed in analysis. RESULTS 1789 Medicaid pediatric patients underwent appendectomy and met inclusion criteria. The mean age was 11.1 years and 40.6% were female. Most patients (94.6%) did not receive opioids prior to surgery. Opioid prescribing ≥90 days after surgery (chronic opioid use) occurred in 127 (7.1%) patients, of which 102 (80.3%) had no opioid use in the preexposure period. Risk factors for chronic opioid use included non-naïve opioid status, re-hospitalization more than 30 days following surgery, multiple opioid prescribers, age, and multiple antidepressants/antipsychotic prescriptions. Group-based trajectory analysis demonstrated four distinct post-surgical opioid use patterns: no opioid use (91.3%), later use (6.7%), slow wean (1.9%), and higher use throughout (0.4%). CONCLUSION Opioid exposure after appendectomy may serve as a priming event for persistent opioid use in some children. Eighty percent of children who developed post-surgical persistent opioid use had not received opioids in the 90 days leading up to surgery. Several mutable and immutable factors were identified to target future efforts toward opioid minimization in this at-risk patient population. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Robert A Cina
- Department of Surgery, The Medical University of South Carolina, 10 McClennan Banks Drive, MSC 918
- SJCH 2190, Charleston, SC 29425, USA.
| | - Ralph C Ward
- Department of Public Health Sciences, The Medical University of South Carolina, Charleston, SC, USA
| | - William T Basco
- Department of Pediatrics, The Medical University of South Carolina, Charleston, SC, USA
| | - David J Taber
- Department of Surgery, The Medical University of South Carolina, 10 McClennan Banks Drive, MSC 918
- SJCH 2190, Charleston, SC 29425, USA
| | - Mulugeta Gebregziabher
- Department of Public Health Sciences, The Medical University of South Carolina, Charleston, SC, USA
| | - Jenna L McCauley
- Department of Psychiatry and Behavioral Science, The Medical University of South Carolina, Charleston, SC, USA
| | - Mark A Lockett
- Department of Surgery, The Medical University of South Carolina, 10 McClennan Banks Drive, MSC 918
- SJCH 2190, Charleston, SC 29425, USA
| | - William P Moran
- Department of Medicine, The Medical University of South Carolina, Charleston, SC, USA
| | - Patrick D Mauldin
- Department of Medicine, The Medical University of South Carolina, Charleston, SC, USA
| | - Sarah J Ball
- Department of Medicine, The Medical University of South Carolina, Charleston, SC, USA
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Marchand K, Turuba R, Katan C, Brasset C, Fogarty O, Tallon C, Fairbank J, Mathias S, Barbic S. Becoming our young people’s case managers: caregivers’ experiences, needs, and ideas for improving opioid use treatments for young people using opioids. Subst Abuse Treat Prev Policy 2022; 17:34. [PMID: 35525987 PMCID: PMC9077957 DOI: 10.1186/s13011-022-00466-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2022] [Indexed: 11/23/2022] Open
Abstract
Background Evidence continues to show that young people, ages 15-24, remain at significant risk of harms from non-medical opioid use and opioid use disorder (OUD), with experts calling for widespread implementation of developmentally-appropriate interventions. These recommendations include the involvement of caregivers in the prevention, early intervention, and treatment of young people using opioids. However, little research has investigated caregivers’ experiences supporting young people, leaving critical gaps in understanding this role. The aim of this study is to explore caregivers’ experiences accessing opioid use treatments with young people and their needs and ideas for improving such treatments. Methods This study reports qualitative findings from Phase 1 of the Improving Treatment Together project, a multi-phase, multi-site community-based participatory study broadly aimed at co-designing opioid use treatments to improve the experiences and outcomes of young people using non-medical opioids. During Phase 1, a total of 27 caregivers (parents, guardians) participated in full-day workshops that were conducted in three communities in British Columbia, Canada. Following human-centred co-design methods, caregivers engaged in small and large group discussions of their experiences, needs, and ideas for improving opioid use treatments for young people. Discussions were audio-recorded, transcribed verbatim, and thematically analysed. Results Across communities, caregivers’ main experiences were defined as ‘becoming our young people’s case managers’ and ‘enduring a never-ending rollercoaster’. To improve these experiences, two needs themes were identified – expanding organizational and system-level capacity and wider-spread understanding of opioid use as a health issue. Caregivers brainstormed a total of 378 individual ideas to meet these needs, several of which spanned multiple needs themes. Conclusions Caregivers’ experiences, needs, and ideas reveal critical opportunities for improving the quality of interventions for opioid use among young people. This study represents a substantial contribution to the design and implementation of developmentally-appropriate and family-centred interventions for young people using opioids.
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Yakubi H, Gac B, Apollonio DE. Industry strategies to market opioids to children and women in the USA: a content analysis of internal industry documents from 1999 to 2017 released in State of Oklahoma v. Purdue Pharma, L.P. et al. BMJ Open 2022; 12:e052636. [PMID: 36323465 PMCID: PMC9639061 DOI: 10.1136/bmjopen-2021-052636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 10/19/2022] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE Identify advertising strategies used to market opioids to women and children. DESIGN Qualitative content analysis of internal pharmaceutical industry documents released in litigation, dated between 1999 and 2017. SETTING USA. PARTICIPANTS Opioid manufacturers (Janssen, Ortho-McNeil, Purdue, Teva (Actavis), Janus, Cephalon); women; children. PRIMARY AND SECONDARY OUTCOME MEASURES Advertising campaigns, industry executive statements regarding marketing goals METHODS: We examined ((DATASET) link: https://www.industrydocuments.ucsf.edu/drug/) documents released in State of Oklahoma v. Johnson & Johnson (2019) to identify marketing strategies and campaigns developed by opioid manufacturers that focused on children and women, as well as public records, including websites developed by manufacturers and their allies, to confirm whether marketing campaigns proposed in internal industry documents were implemented. Documents identified as relevant were coded for themes based on expectations drawn from previous research on marketing using internal industry documents, which included making emotional appeals and understating the risks of addiction. RESULTS We found that opioid manufacturers sought to recruit coaches and school nurses to encourage opioid use by children, developed unbranded initiatives suggesting adolescents ask providers for pain care medications, suggested that opioid use could reduce health risks associated with untreated pain among women and advocated to policy makers that women faced unmet needs for pain medication. CONCLUSIONS The USA strictly regulates direct marketing of medications but does not place the same restrictions on indirect marketing and unbranded campaigns, which encourage people to seek treatment without indicating the names of specific products. Opioid manufacturers in the early 21st century appear to have relied largely on unbranded campaigns for marketing, which they described externally as public health promotion and internally as a way to increase sales of opioids. The rapid increase in opioid use concomitant with these campaigns suggests that additional scrutiny of this kind of marketing may be needed in order to protect vulnerable groups.
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Affiliation(s)
- Hanna Yakubi
- Department of Clinical Pharmacy, University of California, San Francisco, California, USA
| | - Brian Gac
- Department of Clinical Pharmacy, University of California, San Francisco, California, USA
| | - Dorie E Apollonio
- Department of Clinical Pharmacy, University of California, San Francisco, California, USA
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Leyrer-Jackson JM, Acuña AM, Olive MF. Current and emerging pharmacotherapies for opioid dependence treatments in adults: a comprehensive update. Expert Opin Pharmacother 2022; 23:1819-1830. [PMID: 36278879 PMCID: PMC9764962 DOI: 10.1080/14656566.2022.2140039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 10/21/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Opioid use disorder (OUD) is characterized by compulsive opioid seeking and taking, intense drug craving, and intake of opioids despite negative consequences. The prevalence of OUDs has now reached an all-time high, in parallel with peak rates of fatal opioid-related overdoses, where 15 million individuals worldwide meet the criteria for OUD. Further, in 2020, 120,000 opioid-related deaths were reported worldwide with over 75,000 of those deaths occurring within the United States. AREAS COVERED In this review, we highlight pharmacotherapies utilized in patients with OUDs, including opioid replacement therapies, and opioid antagonists utilized for opioid overdoses and deterrent of opioid use. We also highlight newer treatments, such as those targeting the neuroimmune system, which are potential new directions for research given the recently established role of opioids in activating neuroinflammatory pathways, as well as over the counter remedies, including kratom, that may mitigate withdrawal. EXPERT OPINION To effectively treat OUDs, a deeper understanding of the current therapeutics being utilized, their additive effects, and the added involvement of the neuroimmune system are essential. Additionally, a complete understanding of opioid-induced neuronal alterations and therapeutics that target these abnormalities - including the neuroimmune system - is required to develop effective treatments for OUDs.
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Affiliation(s)
- Jonna M. Leyrer-Jackson
- Department of Medical Education, School of Medicine, Creighton University, Phoenix, AZ, 85012, USA
| | - Amanda M. Acuña
- Department of Psychology, Arizona State University, Tempe, AZ, 85257, USA
- Interdepartmental Graduate Program in Neuroscience, Arizona State University, Tempe, AZ, 85257, USA
| | - M. Foster Olive
- Department of Psychology, Arizona State University, Tempe, AZ, 85257, USA
- Interdepartmental Graduate Program in Neuroscience, Arizona State University, Tempe, AZ, 85257, USA
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Lynch WJ, Bakhti-Suroosh A, Abel JM. Impact of high-access exercise prior to and during early adolescence on later vulnerability to opioid use and relapse in male rats. Transl Psychiatry 2022; 12:425. [PMID: 36192388 PMCID: PMC9529880 DOI: 10.1038/s41398-022-02180-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 09/07/2022] [Accepted: 09/13/2022] [Indexed: 11/15/2022] Open
Abstract
Middle- and high-school athletes participating in certain team sports are at greater risk of opioid misuse and addiction than those who do not. While this risk is thought to be due to increased access to opioids, in this study we explored the possibility that the sensitizing effects of discontinued high-intensity exercise may also contribute. Specifically, using male rat models with fentanyl, we tested the hypothesis that high-access exercise (24 h/day access to a running wheel) during pre/early adolescence (two weeks, postnatal-day 24-37) would enhance vulnerability to opioid use and relapse during late adolescence/adulthood. Rats with a history of high-access exercise showed stronger fentanyl-associated lever discrimination during acquisition, greater motivation to obtain infusions of fentanyl following acquisition, and had an enhanced sensitivity to the reinstating effects of fentanyl-associated cues following extended (24 h/day), intermittent-access self-administration and protracted abstinence (14 days) compared to sedentary controls. In contrast, sedentary rats had greater overall responding (active- and inactive-lever) during acquisition and greater non-specific (inactive-lever) responding during extended-access self-administration. Molecular markers associated with opioid seeking/relapse were also differentially expressed in the nucleus accumbens core of rats with versus without a history of high-access exercise following relapse testing (e.g., Bdnf-IV and Drd2 expression). Together, these findings demonstrate that high-access exercise prior to and throughout early-adolescence enhances vulnerability to the reinforcing and cue-induced reinstating effects of opioids during later adolescence/adulthood. Thus, it is possible that the discontinuation of high intensity exercise contributes to the enhanced vulnerability observed in middle- and high-school athletes.
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Affiliation(s)
- Wendy J Lynch
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, 22904, USA.
| | - Anousheh Bakhti-Suroosh
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, 22904, USA
| | - Jean M Abel
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, 22904, USA
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Abraham O, Rosenberger CA, Birstler J. Psychometric validation of the AOSL scale using confirmatory factor analysis: A nationally representative sample. J Am Pharm Assoc (2003) 2022; 62:1638-1643.e6. [PMID: 35450831 PMCID: PMC9680980 DOI: 10.1016/j.japh.2022.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/14/2022] [Accepted: 03/24/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The opioid overdose epidemic has worsened during the COVID-19 pandemic. Recent data revealed a 28.5% increase in drug-related overdose deaths from 2019 to 2020. Adolescents often misuse family members' and friends' prescription opioid medications. Furthermore, adolescents may not possess the knowledge or understanding to safely manage opioid medications. There is a need for a validated scale to effectively measure adolescents' opioid misuse knowledge, attitudes, and interest in learning about prescription opioid safety. OBJECTIVE The purpose of this study was to validate the Adolescent Opioid Safety and Learning (AOSL) scale with a nationally representative sample of adolescents and confirm the factor structure of the scale using confirmatory factor analysis (CFA). METHODS Adolescent participants (aged 13-18 years) completed the 16-item AOSL scale in Qualtrics from November to December 2020. A total of 774 responses were analyzed. A CFA was performed to determine the fit of the data to the 4-factor model proposed by a prior exploratory factor analysis of the AOSL scale. Fit was assessed using the chi-square test, comparative fit index (CFI), Tucker-Lewis index (TLI), and root mean-squared error of approximation (RMSEA). RESULTS Participants were 50% male and 62% white non-Hispanic. The CFI was 0.984, TLI was 0.980, and RMSEA was 0.048 ([95% CI 0.041-0.054], P-value that RMSEA ≤ 0.05 = 0.712). The chi-square test results were χ2 = 268.752 on 98 degrees of freedom (P < 0.001). Cronbach's alpha, a measure of internal consistency, was high within each factor. CFA indicated good fit of the current study's data to the 4-factor model. CONCLUSION We found the AOSL scale measures adolescents' knowledge of opioid misuse, knowledge of opioid harm, interest in learning about prescription opioids, and likelihood to practice misuse behaviors. This scale can help researchers understand adolescent perceptions and opinions about opioid safety.
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Affiliation(s)
| | | | - Jen Birstler
- Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin-Madison
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Pilarinos A, Kwa Y, Joe R, Thulien M, Buxton JA, DeBeck K, Fast D. Navigating Opioid Agonist Therapy among Young People who use Illicit Opioids in Vancouver, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 107:103773. [PMID: 35780565 PMCID: PMC9872974 DOI: 10.1016/j.drugpo.2022.103773] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Opioid agonist therapy (OAT) has been shown to reduce opioid use and related harms. However, many young people are not accessing OAT. This study sought to explore how young people navigated OAT over time, including periods of engagement, disengagement, and avoidance. METHODS Semi-structured, in-depth qualitative interviews were conducted between January 2018 and August 2020 with 56 young people in Vancouver, Canada who reported illicit, intensive heroin and/or fentanyl use. Following the verbatim transcription of longitudinal interviews, an iterative thematic analysis was used to extrapolate key themes. RESULTS Young people contemplating OAT expressed fears about its addictiveness. Many experienced pressure from providers and family members to initiate buprenorphine-naloxone, despite a desire to explore other treatment options such as methadone. Once young people initiated OAT, staying on it was difficult and complicated by daily witnessed dosing requirements and strict rules around repeated missed doses, especially for those receiving methadone. Most young people envisioned tapering off OAT in the not-too-distant future. CONCLUSIONS Findings underscore the importance of working collaboratively with young people to develop treatment plans and timelines, and suggest that OAT engagement and retention among young people could be improved by expanding access to the full range of OAT; updating clinical guidelines to improve access to safer prescription alternatives to the increasingly poisonous, unregulated drug supply; addressing treatment gaps arising from missed doses and take-home dosing; and providing a clear pathway to OAT tapering.
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Affiliation(s)
- Andreas Pilarinos
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, Canada, V6Z 2A9; Interdisciplinary Studies Graduate Program, University of British Columbia, 270-2357 Main Mall, Vancouver, BC, Canada V6T 1Z4
| | - Yandi Kwa
- Vancouver Coastal Health, 520 West 6(th) Avenue, Vancouver, BC, Canada, V5Z 1A1
| | - Ronald Joe
- Vancouver Coastal Health, 520 West 6(th) Avenue, Vancouver, BC, Canada, V5Z 1A1
| | - Madison Thulien
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, Canada, V6Z 2A9
| | - Jane A Buxton
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada, V6T 1Z3
| | - Kora DeBeck
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, Canada, V6Z 2A9; School of Public Policy, Simon Fraser University, 515 West Hastings Street, Suite 3271, Vancouver, BC, Canada, V6B 5K3
| | - Danya Fast
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, Canada, V6Z 2A9; Department of Medicine, University of British Columbia, 317-2914 Health Sciences Mall, Vancouver, BC, Canada, V6T1Z3.
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Renny MH, Thaker RH, Dayan PS. Caregiver Practices and Knowledge Regarding Leftover Prescription Medications in Homes With Children. Pediatr Emerg Care 2022; 38:e1557-e1563. [PMID: 35857916 DOI: 10.1097/pec.0000000000002680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aims of the study were to determine the frequency of and factors associated with leftover or expired prescription medication ("leftover medication") presence in homes with children and to assess caregivers' reported behaviors and knowledge regarding disposal of leftover medications in the home. METHODS This study is a planned secondary analysis from a survey of primary caregivers of children aged 1 to 17 years presenting to an emergency department. The survey assessed leftover medications in the home and medication disposal practices, knowledge, and guidance. The survey was developed iteratively and pilot tested. Multivariable logistic regression was used to identify factors associated with leftover medication presence in the home. RESULTS We enrolled 550 primary caregivers; 97 of the 538 analyzed (18.0%; 95% confidence interval [CI], 14.8-21.5) reported having leftover medications in their home, most commonly antibiotics and opioids. Of respondents, 217/536 (40.5%) reported not knowing how to properly dispose of medications and only 88/535 (16.4%) reported receiving guidance regarding medication disposal. Most caregivers reported throwing leftover medications in the trash (55.7%) or flushing them down the toilet (38.5%). Caregivers with private insurance for their child were more likely to have leftover medications (adjusted odds ratio [aOR], 1.99; CI, 1.15-3.44), whereas Hispanic caregivers (aOR, 0.24; CI, 0.14-0.42) and those who received guidance on leftover medications (aOR, 0.30; CI, 0.11-0.81) were less likely to have leftover medications in the home. CONCLUSIONS Leftover medications are commonly stored in homes with children and most caregivers do not receive guidance on medication disposal. Improved education and targeted interventions are needed to ensure proper medication disposal practices.
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Affiliation(s)
| | - Riddhi H Thaker
- From the Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University College of Physicians and Surgeons
| | - Peter S Dayan
- From the Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University College of Physicians and Surgeons
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Stone EM, Tormohlen KN, McCourt AD, Schmid I, Stuart EA, Davis CS, Bicket MC, McGinty EE. Association Between State Opioid Prescribing Cap Laws and Receipt of Opioid Prescriptions Among Children and Adolescents. JAMA HEALTH FORUM 2022; 3:e222461. [PMID: 36003417 PMCID: PMC9356320 DOI: 10.1001/jamahealthforum.2022.2461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/14/2022] [Indexed: 01/18/2023] Open
Abstract
Importance High-dose and long-duration opioid prescriptions remain relatively common among children and adolescents, but there is insufficient research on the association of state laws limiting the dose and/or duration of opioid prescriptions (referred to as opioid prescribing cap laws) with opioid prescribing for this group. Objective To examine the association between state opioid prescribing cap laws and the receipt of opioid prescriptions among children and adolescents. Design Setting and Participants This repeated cross-sectional study used a difference-in-differences approach accounting for staggered policy adoption to assess the association of state opioid prescribing cap laws in the US from January 1, 2013, to December 31, 2019, with receipt of opioid prescriptions among children and adolescents. Analyses were conducted between March 22 and December 15, 2021. Data were obtained from the OptumLabs Data Warehouse, a national commercial insurance claims database. The analysis included 482 118 commercially insured children and adolescents aged 0 to 17 years with full calendar-year continuous insurance enrollment between 2013 and 2019. Individuals were included for every year in which they were continuously enrolled; they did not need to be enrolled for the entire 7-year study period. Those with any cancer diagnosis were excluded from analysis. Exposure Implementation of a state opioid prescribing cap law between January 1, 2017, and July 1, 2019. This date range allowed analysis of the same number years for both pre-cap and post-cap data. Main Outcomes and Measures Outcomes of interest included receipt of any opioid prescription and, among those with at least 1 opioid prescription, the mean number of opioid prescriptions, mean morphine milligram equivalents (MMEs) per day, and mean days' supply. Results Among 482 118 children and adolescents (754 368 person-years of data aggregated to the state-year level), 245 178 (50.9%) were male, with a mean (SD) age of 9.8 (4.8) years at the first year included in the sample (data on race and ethnicity were not collected as part of this data set, which was obtained from insurance billing claims). Overall, 10 659 children and adolescents (2.2%) received at least 1 opioid prescription during the study period. Among those with at least 1 prescription, the mean (SD) number of filled opioid prescriptions was 1.2 (0.8) per person per year. No statistically significant association was found between state opioid prescribing cap laws and any outcome. After opioid prescribing cap laws were implemented, a -0.001 (95% CI, -0.005 to 0.002) percentage point decrease in the proportion of youths receiving any opioid prescription was observed. In addition, percentage point decreases of -0.01 (95% CI, -0.10 to 0.09) in high-dose opioid prescriptions (>50 MMEs per day) and -0.02 (95% CI, -0.12 to 0.08) in long-duration opioid prescriptions (>7 days' supply) were found after cap laws were implemented. Conclusions and Relevance In this cross-sectional study, no association was observed between state opioid prescribing cap laws and the receipt of opioid prescriptions among children and adolescents. Alternative strategies, such as opioid prescribing guidelines tailored to youths, are needed.
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Affiliation(s)
- Elizabeth M. Stone
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kayla N. Tormohlen
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Alexander D. McCourt
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ian Schmid
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Elizabeth A. Stuart
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Mark C. Bicket
- Department of Anesthesiology, School of Public Health, University of Michigan, Ann Arbor,Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Emma E. McGinty
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland,Visiting Fellow, OptumLabs, Cambridge, Massachusetts
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Mittal S, Eftekharzadeh S, Aghababian A, Shah J, Fischer K, Weaver J, Tan C, Plachter N, Long C, Weiss D, Zaontz M, Kolon T, Zderic S, Canning D, Van Batavia J, Shukla A, Srinivasan A. Trends in opioid and nonsteroidal anti-inflammatory (NSAID) usage in children undergoing common urinary tract reconstruction: A large, single-institutional analysis. J Pediatr Urol 2022; 18:501.e1-501.e7. [PMID: 35803865 DOI: 10.1016/j.jpurol.2022.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/20/2022] [Accepted: 05/31/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND OBJECTIVE Opioid stewardship is recognized as a critical clinical priority. We previously reported marked reductions in narcotic administration after implementation of an opioid reduction protocol for pediatric ambulatory urologic surgery. We hypothesize that a decrease in post-operative and discharge opioid administration will not increase short-term adverse events. STUDY DESIGN All pediatric patients undergoing open or robot-assisted laparoscopic pyeloplasty or ureteral reimplantation between 2015 and 2019 were included. Patients' demographics, opioid and NSAID administration, urology or pain-related emergency department (ED) visits, readmissions, and reoperations within 30 days of surgery, were aggregated. RESULTS 438 patients, with a median age of 3.5 years (IQR 1.5-8.3) at the time of surgery, met the inclusion criteria. Annual rates of inpatient opioid administration and prescriptions decreased significantly over the study period, while rates of intra-operative, inpatient, and prescribed NSAIDs significantly increased. There was no significant difference in the occurrence of ED visits, readmissions, or reoperations within 30 days of surgery between patients who received an opioid prescription and those who did not. Multivariate regression showed that patients who did not receive an opioid prescription at discharge were found to be at a lower risk for unplanned encounters including ED visits, readmissions, or reoperations (OR:0.5, 95%CI: 0.2-0.9, p = 0.04). DISCUSSION The present study shows the decreasing trend in inpatient opioid administration and opioid prescription after discharge, when accompanied by an increase NSAID administration, does not result in a significant change in rates of unplanned encounters and complications, similar to results from previous studies on non-urological and ambulatory urological surgeries. CONCLUSIONS Non-opioid pain control after major pediatric urologic reconstruction is safe and effective. We found that a reduction in opioid administration can be associated with a reduced risk of unplanned ED visits, readmissions, or reoperations. Further investigations are required to corroborate this finding.
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Affiliation(s)
- Sameer Mittal
- Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA; Division of Urology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Care, 3400 Civic Center Blvd, 3rd Floor West Pavilion, Philadelphia, PA 19104, USA
| | - Sahar Eftekharzadeh
- Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Aznive Aghababian
- Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Jay Shah
- Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Katherine Fischer
- Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - John Weaver
- Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Connie Tan
- Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Natalie Plachter
- Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Christopher Long
- Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA; Division of Urology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Care, 3400 Civic Center Blvd, 3rd Floor West Pavilion, Philadelphia, PA 19104, USA
| | - Dana Weiss
- Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA; Division of Urology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Care, 3400 Civic Center Blvd, 3rd Floor West Pavilion, Philadelphia, PA 19104, USA
| | - Mark Zaontz
- Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA; Division of Urology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Care, 3400 Civic Center Blvd, 3rd Floor West Pavilion, Philadelphia, PA 19104, USA
| | - Thomas Kolon
- Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA; Division of Urology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Care, 3400 Civic Center Blvd, 3rd Floor West Pavilion, Philadelphia, PA 19104, USA
| | - Stephen Zderic
- Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA; Division of Urology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Care, 3400 Civic Center Blvd, 3rd Floor West Pavilion, Philadelphia, PA 19104, USA
| | - Douglas Canning
- Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA; Division of Urology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Care, 3400 Civic Center Blvd, 3rd Floor West Pavilion, Philadelphia, PA 19104, USA
| | - Jason Van Batavia
- Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA; Division of Urology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Care, 3400 Civic Center Blvd, 3rd Floor West Pavilion, Philadelphia, PA 19104, USA
| | - Aseem Shukla
- Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA; Division of Urology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Care, 3400 Civic Center Blvd, 3rd Floor West Pavilion, Philadelphia, PA 19104, USA
| | - Arun Srinivasan
- Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA; Division of Urology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Care, 3400 Civic Center Blvd, 3rd Floor West Pavilion, Philadelphia, PA 19104, USA.
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Cordray H, Alfonso K, Brown C, Evans S, Goudy S, Govil N, Landry AM, Raol N, Smith K, Prickett KK. Sustaining standardized opioid prescribing practices after pediatric tonsillectomy. Int J Pediatr Otorhinolaryngol 2022; 159:111209. [PMID: 35749955 DOI: 10.1016/j.ijporl.2022.111209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 04/19/2022] [Accepted: 06/09/2022] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Opioid prescribing patterns after pediatric tonsillectomy are highly variable, and opioids may not improve pain control compared to over-the-counter pain relievers. We evaluated whether a standardized, opioid-sparing analgesic protocol effectively reduced opioid prescriptions without compromising patient outcomes. METHODS A quality improvement project was initiated in July 2019 to standardize analgesic prescribing after hospital-based tonsillectomy with/without adenoidectomy. An electronic order set provided weight-based dosing and defaulted to non-opioid prescriptions (acetaminophen and ibuprofen). Patients ages 0-6 received non-opioid analgesics alone. Patients ages 7-18 received non-opioid analgesics as first-line pain control, and providers could manually add hydrocodone-acetaminophen for breakthrough pain. Opioid prescriptions and quantities were compared for 18 months of cases pre- versus post-standardization. Postoperative returns to the system were reviewed as a balancing measure. RESULTS From 2018 through 2020, 1817 cases were reviewed. The frequency of opioid prescriptions decreased significantly post-standardization, from 64.9% to 33.5% of cases (P < .001). Opioid prescribing for young children steadily decreased from over 50% to 2.4%. Protocol adherence improved over time; outlier prescriptions were eliminated. Opioid quantities per prescription decreased by 16.3 doses on average (P < .001), and variance decreased significantly post-standardization (P < .001). The incidence of returns to the system did not change (P = .33), including returns for pain or decreased intake (P = .28). CONCLUSION An age-based and weight-based analgesic protocol reduced post-tonsillectomy opioid prescriptions without a commensurate increase in returns for postoperative complaints. Standardized protocols can facilitate sustained changes in prescribing patterns and limit potentially unnecessary pediatric opioid exposure.
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Affiliation(s)
- Holly Cordray
- Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA; Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Kristan Alfonso
- Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA; Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Clarice Brown
- Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA; Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Sean Evans
- Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA; Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Steven Goudy
- Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA; Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Nandini Govil
- Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA; Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - April M Landry
- Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA; Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Nikhila Raol
- Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA; Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Kathleen Smith
- Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA
| | - Kara K Prickett
- Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA; Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
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Wilson JD, Bagley SM. An Urgent Need to Focus on Youth With Opioid Use Disorder. J Adolesc Health 2022; 71:143-144. [PMID: 35870825 PMCID: PMC9483656 DOI: 10.1016/j.jadohealth.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 04/30/2022] [Accepted: 05/02/2022] [Indexed: 11/25/2022]
Affiliation(s)
| | - Sarah M Bagley
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts; Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts; Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts
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Meier KM, Zheng A, Rollins ZH, Asantey KA, Shah MD, Banooni AB, Liss ZJ. Elimination of postoperative narcotics in infant robotic pyeloplasty using caudal anesthesia and a non-narcotic pain pathway. J Endourol 2022; 36:1431-1435. [PMID: 35850585 DOI: 10.1089/end.2022.0263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Research suggests that narcotic pain medications are dramatically overprescribed. We hypothesize that narcotics are unnecessary for post-operative pain control in most infants undergoing robotic pyeloplasty. In this series, we report our experience combining caudal blocks with a non-narcotic postoperative pathway as a means of eliminating postoperative narcotics following infant robotic pyeloplasty. METHODS We reviewed 24 consecutive patients who underwent robotic pyeloplasty by a single surgeon treated with an end-procedure caudal block followed by a non-narcotic postoperative pain pathway treated between May 2017 and May 2021. The standardized postoperative pathway consisted of an end-procedure caudal block followed by alternating intravenous acetaminophen and ketorolac. We reviewed demographics, outcomes and unscheduled healthcare encounters within 30 postoperative days. RESULTS 63% (15/24) patients were male and average age was 12.1 months (range 4-34 months). 58% (9/15) underwent surgery on the left. 16.7% (4/24) of patients received a single postoperative dose of narcotics in the PACU. No patient required narcotic prescriptions at discharge or anytime thereafter. The average length of stay was 1.13 days. There was no pain-related, unscheduled visits or phone calls after discharge. CONCLUSIONS This series shows that a non-narcotic standardized pain management strategy is a viable option for infants undergoing robotic pyeloplasty. Post procedure caudal block is a good addition to a non-narcotic pathway. In the future, we intend to expand these findings to other pediatric urologic procedures in the hope of eliminating unnecessary narcotic use.
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Affiliation(s)
- Kristen M Meier
- Beaumont Health System, 7005, Department of Urology, Royal Oak, Michigan, United States;
| | - Anna Zheng
- Michigan Institute of Urology, 20952 Twelve Mile Road, Suite #200, St. Clair Shores , Michigan, United States, 48081;
| | - Zach H Rollins
- Oakland University William Beaumont School of Medicine, 159878, Rochester, Michigan, United States;
| | - Kwesi A Asantey
- Oakland University William Beaumont School of Medicine, 159878, Rochester, Michigan, United States;
| | - Mit D Shah
- Beaumont Health System, 7005, Department of Urology, Royal Oak, Michigan, United States;
| | - Andrew B Banooni
- Beaumont Health System, 7005, Department of Anesthesia, Royal Oak, Michigan, United States;
| | - Zachary J Liss
- Beaumont Health System, 7005, Department of Urology, Royal Oak, Michigan, United States.,Oakland University William Beaumont School of Medicine, 159878, Rochester, Michigan, United States.,Michigan Institute of Urology, St. Clair Shores , United States;
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Kelley-Quon LI, Cho J, Barrington-Trimis J, Kipke MD, Clapp JD, Krueger EA, Leventhal AM. Longitudinal trajectories of prescription opioid misuse in adolescents. Drug Alcohol Depend 2022; 236:109470. [PMID: 35504242 PMCID: PMC10027390 DOI: 10.1016/j.drugalcdep.2022.109470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Adolescent misuse of prescription opioids is hazardous. This study aimed to generate data on prescription opioid misuse trajectories across adolescence and identify risk factors and mechanisms for more dangerous use trajectories. METHODS Using a prospective longitudinal cohort repeated measures design, baseline (Fall 2013) and seven semiannual assessments were administered through Spring 2017 in 10 public high schools in Los Angeles, CA. Frequency of past 30-day prescription opioid misuse was captured. Trajectory groups were identified using growth mixture modeling and multinomial logistic regression identified associations between baseline risk factors with membership in each trajectory group. RESULTS Overall, 3395 students were evaluated (53.4% female, Mean [SD] age at baseline=14.58[0.40]; range=12.83-16.29). Four discrete misuse trajectories were identified among 1062 students: (1) Minimal/Experimental (infrequent time-limited use; range of estimated mean number of days using prescription opioid across waves=0.0-0.6 days]; N = 705[20.8%]); (2) Low Deescalating (range=2.0-0.7 days; N = 189[5.6%]); (3) Moderate Escalating (range=0.7-3.6 days; N = 108[3.2%]); and (4) Frequent Persistent (range=4.7-9.4 days; N = 60[1.8%]). Students reporting tobacco, cannabis, alcohol use, or impulsivity in 9th grade were more likely to demonstrate membership in the Moderate Escalating trajectory class when compared to 2333 (68.7%) students reporting sustained abstinence. Female sex, peer opioid misuse, alcohol use, other substance use, impulsivity, or delinquent behavior reported in 9th grade was associated with membership in the Frequent Persistent trajectory class. CONCLUSIONS Prescription opioid misuse in adolescence appears to follow 4 discrete trajectories, including the potentially problematic Moderate Escalating and Frequent Persistent trajectories. Female sex, peer influences, substance use, and intrapersonal risk factors were associated with membership in these classes.
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Affiliation(s)
- Lorraine I Kelley-Quon
- Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA; Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA; Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA.
| | - Junhan Cho
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Jessica Barrington-Trimis
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Michele D Kipke
- Division of Research on Children, Youth and Families, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - John D Clapp
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Evan A Krueger
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Adam M Leventhal
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
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Lai RK, Friedson KE, Reveles KR, Bhakta K, Gonzales G, Hill LG, Evoy KE. Naloxone Accessibility Without an Outside Prescription from U.S. Community Pharmacies: A Systematic Review. J Am Pharm Assoc (2003) 2022; 62:1725-1740. [DOI: 10.1016/j.japh.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 10/16/2022]
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Chavez LJ, Steelesmith DL, Bridge JA, Fontanella CA. Predictors of substance use disorder treatment initiation and engagement among adolescents enrolled in Medicaid. Subst Abus 2022; 43:1260-1267. [PMID: 35670769 DOI: 10.1080/08897077.2022.2074603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background: Adolescents with substance use disorders (SUD) should receive timely access to treatment to improve lifelong outcomes. The Healthcare Effectiveness Data and Information Set (HEDIS) initiation and engagement in treatment (IET) performance measure was intended to promote quality improvement for patients with SUD. Yet, few studies have assessed predictors of measure performance among adolescents or other engagement in mental health services, which is critical to understanding disparities in treatment quality or opportunities for targeted improvement strategies. The present study reports the rates and predictors of IET among adolescents with SUD, as well as receipt of any mental health services. Methods: The sample included adolescents enrolled in Medicaid in 14 states who had a qualifying diagnosis for SUD (2009-2013) and met HEDIS IET performance measure eligibility criteria. Three outcomes were assessed, including initiation of SUD treatment within 14 days of qualifying diagnosis, engagement in SUD treatment (2 or more encounters) within 30 days of initiation, and receipt of any mental health services (1 or more encounters) within 30 days of initiation. Logistic regression was used to identify demographic and clinical characteristics associated with outcomes. Results: Among 20,602 adolescents who met eligibility criteria, 49.5% initiated SUD treatment, 48.5% engaged in SUD treatment, and 70% received any mental health service. Adolescents with higher levels of clinical need (e.g., medical complexity, mental health comorbidity, and multiple SUD diagnoses) had significantly higher odds of initiating, but lower odds of engaging in treatment or receiving any mental health service. Conclusions: To increase the delivery of SUD treatment, efforts should target adolescents with co-occurring mental health needs, many of whom are receiving mental health services after SUD diagnosis. Integrating addiction and mental health services could address these missed opportunities.
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Affiliation(s)
- Laura J Chavez
- Center for Child Health Equity and Outcomes Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Danielle L Steelesmith
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Jeffrey A Bridge
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, USA.,Center for Suicide Prevention and Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Cynthia A Fontanella
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, USA
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Risk factors associated with recent opioid-related hospitalizations in children: a nationwide analysis. Pediatr Surg Int 2022; 38:843-851. [PMID: 35239012 DOI: 10.1007/s00383-022-05088-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Identifying at-risk children can provide a crucial opportunity for preventative measures to avoid opioid addiction. This study sought to determine at-risk pediatric patients that were previously hospitalized due to other causes prior to their opioid-related admission. METHODS The Nationwide Readmissions Database (2010-2014) was queried for children 1-18 years old with an opioid-related hospitalization. Previous admissions (up to 1 year prior) and associated diagnoses were compared. Results were weighted for national estimates. RESULTS 51,349 opioid-related hospitalizations were identified with an overall in-hospital mortality of 0.8%. Seventeen percent had a previous admission during the same calendar year of which 44% had > 1 and 11% had ≥ 5 prior admissions. Only 4% of prior admissions occurred at a different hospital. Males and females were equally represented, and 82% were ≥ 13 years old. Only 16% of previously admitted patients underwent a major surgical procedure during a previous hospitalization. The most common concomitant diagnoses for patients with prior hospitalizations were drug abuse (37%), chronic pulmonary disease (18%), and depression (10%). CONCLUSION Opioid-related hospitalizations often occur among children with multiple recent admissions, usually to the same hospital. Most patients do not have a history of cancer or recent surgery to account for their opioid use.
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Keane AM, Larson EL, Payne RM, Cooke S, Zubovic E, Patel KB, Mackinnon SE, Snyder-Warwick AK. Dispose with dish soap: a simple and convenient method to increase proper opioid disposal in postoperative pediatric patients. J Plast Reconstr Aesthet Surg 2022; 75:3845-3852. [DOI: 10.1016/j.bjps.2022.06.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 03/09/2022] [Accepted: 06/08/2022] [Indexed: 10/17/2022]
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Welsh JW, Mataczynski MJ, Passetti LL, Hunter BD, Godley MD. Attitudes and beliefs among Georgia addiction treatment staff about medication for opioid use disorder in adolescents, young adults, and adults: a multi-mixed methods study. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2022; 48:347-355. [PMID: 35416739 DOI: 10.1080/00952990.2022.2043335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/07/2022] [Accepted: 02/13/2022] [Indexed: 06/14/2023]
Abstract
Background: Adverse consequences, including non-fatal overdose and death, are prevalent in adolescents and young adults with opioid use disorder (OUD). Barriers toward medication for opioid use disorder (MOUD) have been identified in adult populations but are poorly understood in youth.Objective: This exploratory multi-mixed methods study examines beliefs and attitudes of addiction treatment program staff about the use of MOUD in youth.Methods: A 40-item survey was distributed electronically to 299 addiction treatment programs in Georgia from May 2020 to January 2021. Participant (N = 215; 74% female) attitudes regarding the use of MOUD in three age groups (adolescents (aged 16-17), young adults (aged 18-25), and adults (aged 26+) on a 6-point Likert scale were compared using paired samples t-tests. A series of one-way ANOVA analyses examined differences in attitudes and beliefs across participant characteristics. Verbatim responses to qualitative survey questions were analyzed using a coding reliability approach to thematic analysis.Results: Participants were less likely to support MOUD in adolescents (M = 3.68, SD 1.5) compared with young (M = 4.38, SD 1.36, t = 8.19, p < .001, d = .51) and older adults (M = 4.64, SD 1.3, t = 9.83, p < .001 d = .74). Participants endorsed higher response rates for the use of both naltrexone and buprenorphine over methadone in young adults. A total of 1,412 text responses were reviewed. Participants highlighted barriers to acceptance and use of MOUD in adolescents including safety concerns and impact on brain development.Conclusions: The results support a comprehensive approach to reducing the barriers to using medications to treat OUDs in adolescent populations. Formal and focused continuing education to correct attitudes and beliefs about MOUD treatment for adolescents is necessary.
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Affiliation(s)
- Justine W Welsh
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Maggie J Mataczynski
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
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Dispensed Opioid Prescription Patterns, by Racial/Ethnic Groups, Among South Carolina Medicaid-Funded Children Experiencing Limb Fracture Injuries. Acad Pediatr 2022; 22:631-639. [PMID: 35257927 DOI: 10.1016/j.acap.2022.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 02/13/2022] [Accepted: 02/26/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To examine dispensed opioid prescription patterns for limb fractures across racial/ethnic groups in a pediatric population. METHODS We used South Carolina's Medicaid claims data 2000 to 2018 for pediatric limb fracture cases (under age 19) discharged from the emergency department. The key independent variable was the child's race/ethnicity. The outcomes were: 1) whether the patient had a dispensed opioid prescription; and 2) whether dispensed opioid supply was longer than 5 days among cases with any dispensed opioid prescriptions. Logistic regression models were used to test the association between race/ethnicity and the outcomes. Covariates included age-at-service, gender, service year, and having multiple fracture injuries. RESULTS Compared with non-Hispanic White cases (NHW), the odds of receiving dispensed opioid prescriptions were lower for cases of non-Hispanic Black (NHB) (OR = 0.73; 95% confidence interval [CI]: 0.71, 0.75), Asian (OR = 0.69; CI: 0.53, 0.90), Other/Unknown (OR = 0.86; CI: 0.80, 0.92), and Hispanic (OR = 0.84; CI: 0.79, 0.90) race/ethnicity. The odds of receiving >5 days of dispensed opioid prescription supply did not differ significantly among race/ethnic categories. CONCLUSIONS Our study confirms previous findings that as compared to NHW, the NHB children were less likely to receive dispensed opioid prescriptions. Also, it reveals that the different minority race/ethnic groups are not homogenous in their likelihoods of receiving dispensed opioid prescriptions after a limb fracture compared to NHW, findings underreported in previous studies. Children in the Other/Unknown race/ethnicity category have prescribing patterns different from those of other minority race/ethnic groups and should be analyzed separately.
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Marchand K, Fogarty O, Pellatt KM, Vig K, Melnychuk J, Katan C, Khan F, Turuba R, Kongnetiman L, Tallon C, Fairbank J, Mathias S, Barbic S. “We need to build a better bridge”: findings from a multi-site qualitative analysis of opportunities for improving opioid treatment services for youth. Harm Reduct J 2022; 19:37. [PMID: 35430803 PMCID: PMC9013476 DOI: 10.1186/s12954-022-00623-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 04/06/2022] [Indexed: 11/23/2022] Open
Abstract
Background Adolescence and young adulthood is an important period for substance use initiation and related harms. In the context of the ongoing opioid crisis, the risks for youth (ages 16–29) who use opioids are particularly heightened. Despite recommendations to adopt a developmentally appropriate and comprehensive approach to reduce opioid-related harms among youth, data continue to show that youth are not adequately engaged in opioid treatments and encounter many barriers. The aim of this study is to identify youth-centered opportunities for improving opioid treatment services.
Methods This paper reports multi-site qualitative findings from youth participating in the ‘Improving Treatment Together’ project, a community-based participatory project being conducted in British Columbia and Alberta, two western Canadian provinces that have been dramatically impacted by the opioid crisis. Qualitative data were collected during three workshops with youth who used opioids and accessed opioid treatment services in the prior 12 months. These workshops were conducted in three communities following the core elements of human-centered co-design. A multi-site qualitative analysis was conducted to identify within- and between-site themes surrounding youths’ needs for improving opioid treatment service experiences and outcomes. Results Three overarching needs themes were identified from across the communities. The first reflected youths’ difficulties finding and staying connected to opioid treatment services, with the overarching need theme suggesting opportunities to reduce organizational and systems-related barriers to care, such as waiting times and wider information about service availability. The second area of need was rooted in youths’ feelings of judgment when accessing services. Consequently, opportunities to increase respectful and empathic interactions were the overarching need. The final theme was more nuanced across communities and reflected opportunities for an individualized approach to opioid treatment services that consider youths’ unique basic safety, social, and health needs. Conclusions This study identifies fundamental directions for the operationalization and implementation of youth-centered opioid treatment services. These directions are contextualized in youths’ lived experiences accessing services in their local communities, with overarching themes from across sites strengthening their transferability to other settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12954-022-00623-7.
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Champagne-Langabeer T, Cardenas-Turanzas M, Ugalde IT, Bakos-Block C, Stotts AL, Cleveland L, Shoptaw S, Langabeer JR. The Impact of Pediatric Opioid-Related Visits on U.S. Emergency Departments. CHILDREN 2022; 9:children9040524. [PMID: 35455568 PMCID: PMC9030094 DOI: 10.3390/children9040524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/25/2022] [Accepted: 03/31/2022] [Indexed: 11/16/2022]
Abstract
Background: While there is significant research exploring adults’ use of opioids, there has been minimal focus on the opioid impact within emergency departments for the pediatric population. Methods: We examined data from the Agency for Healthcare Research, the National Emergency Department Sample (NEDS), and death data from the Centers for Disease Control and Prevention. Sociodemographic and financial variables were analyzed for encounters during 2014–2017 for patients under age 18, matching diagnoses codes for opioid-related overdose or opioid use disorder. Results: During this period, 59,658 children presented to an ED for any diagnoses involving opioids. The majority (68.5%) of visits were related to overdoses (poisoning), with a mean age of 11.3 years and a majority female (53%). There was a curvilinear relationship between age and encounters, with teens representing the majority of visits, followed by infants. The highest volume was seen in the Southern U.S., with over 58% more opioid visits than the next highest region (Midwest). Charges exceeded USD 157 million, representing 2% of total ED costs, with Medicaid responsible for 54% of the total. Conclusions: With increases in substance use among children, there is a growing need for pediatric emergency physicians to recognize, refer, and initiate treatments.
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Affiliation(s)
- Tiffany Champagne-Langabeer
- Center for Health Systems Analytics, School of Biomedical Informatics, The University of Texas Health Science Center at Houston (UTHealth Houston), Houston, TX 77030, USA; (M.C.-T.); (C.B.-B.); (J.R.L.)
- Correspondence:
| | - Marylou Cardenas-Turanzas
- Center for Health Systems Analytics, School of Biomedical Informatics, The University of Texas Health Science Center at Houston (UTHealth Houston), Houston, TX 77030, USA; (M.C.-T.); (C.B.-B.); (J.R.L.)
| | - Irma T. Ugalde
- Department of Emergency Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth Houston), Houston, TX 77030, USA;
| | - Christine Bakos-Block
- Center for Health Systems Analytics, School of Biomedical Informatics, The University of Texas Health Science Center at Houston (UTHealth Houston), Houston, TX 77030, USA; (M.C.-T.); (C.B.-B.); (J.R.L.)
| | - Angela L. Stotts
- Department of Family and Community Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth Houston), Houston, TX 77030, USA;
| | - Lisa Cleveland
- UTHealth San Antonio, School of Nursing, San Antonio, TX 78229, USA;
| | - Steven Shoptaw
- Center for Behavioral and Addiction Medicine, Department of Family Medicine, University of California, Los Angeles, CA 90024, USA;
| | - James R. Langabeer
- Center for Health Systems Analytics, School of Biomedical Informatics, The University of Texas Health Science Center at Houston (UTHealth Houston), Houston, TX 77030, USA; (M.C.-T.); (C.B.-B.); (J.R.L.)
- Department of Emergency Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth Houston), Houston, TX 77030, USA;
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Eltorki M, Busse JW, Freedman SB, Thompson G, Beattie K, Serbanescu C, Carciumaru R, Thabane L, Ali S. Intravenous ketorolac versus morphine in children presenting with suspected appendicitis: a pilot single-centre non-inferiority randomised controlled trial. BMJ Open 2022; 12:e056499. [PMID: 35383071 PMCID: PMC8984007 DOI: 10.1136/bmjopen-2021-056499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Despite a lack of evidence demonstrating superiority to non-steroidal anti-inflammatory drugs, like ketorolac, that are associated with lower risk of harms, opioids remain the most prescribed analgesic for acute abdominal pain. In this pilot trial, we will assess the feasibility of a definitive trial comparing ketorolac with morphine in children with suspected appendicitis. We hypothesise that our study will be feasible based on a 40% consent rate. METHODS AND ANALYSIS A single-centre, non-inferiority, blinded (participant, clinician, investigators and outcome assessors), double-dummy randomised controlled trial of children aged 6-17 years presenting to a paediatric emergency department with ≤5 days of moderate to severe abdominal pain (≥5 on a Verbal Numerical Rating Scale) and are investigated for appendicitis. We will use variable randomised blocks of 4-6 and allocate participants in 1:1 ratio to receive either intravenous (IV) ketorolac 0.5 mg/kg+IV morphine placebo or IV morphine 0.1 mg/kg+IV ketorolac placebo. Analgesic co-intervention will be limited to acetaminophen (commonly used as first-line therapy). Participants in both groups will be allowed rescue therapy (morphine 0.5 mg/kg) within 60 min of our intervention. Our primary feasibility outcome is the proportion of eligible patients approached who provide informed consent and are enrolled in our trial. Our threshold for feasibility will be to achieve a ≥40% consent rate, and we will enrol 100 participants into our pilot trial. ETHICS AND DISSEMINATION Our study has received full approval by the Hamilton integrated Research Ethics Board. We will disseminate our study findings at national and international paediatric research conferences to garner interest and engage sites for a future multicentre definitive trial. TRIAL REGISTRATION NCT04528563, Pre-results.
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Affiliation(s)
- Mohamed Eltorki
- Pediatrics, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Jason W Busse
- Department of Health Research Methods, Evidence & Impact, McMaster, Hamilton, Ontario, Canada
- Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | | | - Graham Thompson
- Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Karen Beattie
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Redjana Carciumaru
- Pediatrics, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Pediatrics, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- St Joseph's Research Institute, St Joseph's Health Care, Hamilton, Ontario, Canada
| | - Samina Ali
- Pediatrics, Stollery Children's Hospital, Edmonton, Alberta, Canada
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Purtle J, Nelson KL, Henson RM, Horwitz SM, McKay MM, Hoagwood KE. Policy Makers' Priorities for Addressing Youth Substance Use and Factors That Influence Priorities. Psychiatr Serv 2022; 73:388-395. [PMID: 34384231 PMCID: PMC9704547 DOI: 10.1176/appi.ps.202000919] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Understanding public policy makers' priorities for addressing youth substance use and the factors that influence these priorities can inform the dissemination and implementation of strategies that promote evidence-based decision making. This study characterized the priorities of policy makers in substance use agencies of U.S. states and counties for addressing youth substance use, the factors that influenced these priorities, and the differences in priorities and influences between state and county policy makers. METHODS In 2020, a total of 122 substance use agency policy makers from 35 states completed a Web-based survey (response rate=22%). Respondents rated the priority of 14 issues related to youth substance use and the extent to which nine factors influenced these priorities. Data were analyzed as dichotomous and continuous variables and for state and county policy makers together and separately. RESULTS The highest priorities for youth substance use were social determinants of substance use (87%), adverse childhood experiences and childhood trauma (85%), and increasing access to school-based substance use programs (82%). The lowest priorities were increasing access to naloxone for youths (49%), increasing access to medications for opioid use disorder among youths (49%), and deimplementing non-evidence-based youth substance use programs (41%). The factors that most influenced priorities were budget issues (80%) and state legislature (69%), federal (67%), and governor priorities (65%). Issues related to program implementation and deimplementation were significantly higher priorities for state than for county policy makers. CONCLUSIONS These findings can inform the tailoring of dissemination and implementation strategies to account for the inner- and outer-setting contexts of substance use agencies.
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Affiliation(s)
- Jonathan Purtle
- Department of Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia (Purtle, Nelson, Henson); Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York City (Horwitz, Hoagwood); Brown School at Washington University in St. Louis, St. Louis (McKay)
| | - Katherine L Nelson
- Department of Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia (Purtle, Nelson, Henson); Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York City (Horwitz, Hoagwood); Brown School at Washington University in St. Louis, St. Louis (McKay)
| | - Rosie Mae Henson
- Department of Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia (Purtle, Nelson, Henson); Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York City (Horwitz, Hoagwood); Brown School at Washington University in St. Louis, St. Louis (McKay)
| | - Sarah McCue Horwitz
- Department of Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia (Purtle, Nelson, Henson); Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York City (Horwitz, Hoagwood); Brown School at Washington University in St. Louis, St. Louis (McKay)
| | - Mary M McKay
- Department of Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia (Purtle, Nelson, Henson); Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York City (Horwitz, Hoagwood); Brown School at Washington University in St. Louis, St. Louis (McKay)
| | - Kimberly E Hoagwood
- Department of Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia (Purtle, Nelson, Henson); Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York City (Horwitz, Hoagwood); Brown School at Washington University in St. Louis, St. Louis (McKay)
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Marengo L, Douaihy A, Zhong Y, Krancevich K, Brummit B, Sakolsky D, Deal M, Zelazny J, Goodfriend E, Saul M, Murata S, Thoma B, Mansour H, Tew J, Ahmed N, Marsland A, Brent D, Melhem NM. Opioid use as a proximal risk factor for suicidal behavior in young adults. Suicide Life Threat Behav 2022; 52:199-213. [PMID: 34767271 PMCID: PMC10697688 DOI: 10.1111/sltb.12806] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 06/14/2021] [Accepted: 08/12/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION There is a concomitant rise in suicide rates with the prevalence of opioids involved in overdose deaths, especially among adolescents and young adults. However, there are limited studies on whether opioid use prospectively predicts suicidal behavior in youth. METHODS Our sample included 183 psychiatric patients (18-30 years) admitted for a suicide attempt (SA), have current suicidal ideation (SI), and psychiatric controls without ideation or attempt (PC). Suicidal behavior was assessed using the Columbia Suicide Severity Rating Scale. We also recruited a healthy control group (HC; n = 40). Patients and controls were followed over a year. ANOVA, regression, and cox regression were used. RESULTS Suicide attempt (β = 0.87, CI [0.1-1.6], p = 0.02) and SI [(β = 0.75, CI [0.03-1.5], p = 0.04) were significantly more likely than HCs to have used opioids in the past year at baseline. Opioid use was associated with increased anxiety symptoms (β = 0.75, CI [0.001-1.5], p = 0.05), PTSD symptoms (β = 3.90, CI [1.1-6.7], p = 0.01), and aggression (β = 0.02, CI [0.01-0.04], p = 0.02). Opioid use in the month prior to hospitalization predicted SA at 6 months (OR = 1.87, CI [1.06-3.31], p = 0.032). CONCLUSIONS Opioid use is a proximal predictor for SA. These findings may help clinicians better identify patients at risk for suicidal behavior, allowing for more personalized treatment approaches.
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Affiliation(s)
- Laura Marengo
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Antoine Douaihy
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Yongqi Zhong
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Katie Krancevich
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Bradley Brummit
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Dara Sakolsky
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Meredith Deal
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jamie Zelazny
- University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
| | - Eli Goodfriend
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Melissa Saul
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Stephen Murata
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Brian Thoma
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Hader Mansour
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jamie Tew
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Nadeem Ahmed
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Anna Marsland
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - David Brent
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Nadine M Melhem
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Cornwell LB, Campbell PC, Ewing E, Swords KA. Children undergoing outpatient complex penile surgery and hypospadias repair may not require opioid analgesics. J Pediatr Surg 2022; 57:678-682. [PMID: 34162480 DOI: 10.1016/j.jpedsurg.2021.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/04/2021] [Accepted: 05/20/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND/PURPOSE Pain control is important after penile surgery, and opioid use should be minimized as able. We sought to describe our experience performing complex penile surgeries with vs without post-operative opioids. METHODS A retrospective review of penile surgeries, including 3998 between 2009 and 2019. We identified patients <8 years who underwent outpatient penile surgery requiring either penile degloving or hypospadias repair. Patients who were or were not prescribed opioids were matched 1:1 by age and type of penile surgery. Primary outcomes of interest were pain-related encounters, delayed opioid prescription, and predictors of pain. RESULTS 200 children were identified, 100 per group, with mean age 1.3 ± 0.8 years. 48% were penile degloving procedures, 31% hypospadias repairs with catheters, and the remaining 21% hypospadias repairs without catheters. Perioperative features were comparable between groups(p > 0.05). 59% of patients without opioids had an impromptu post-operative encounter vs 41%, and 20% had an associated pain complaint vs 9%(p = 0.026). Two patients in both groups received delayed opioid prescription(p = 1.00). The presence of a catheter (OR 2.9) and no opioid prescription (OR 2.6) were independent predictors for pain complaint. CONCLUSIONS Patients discharged without an opioid were more likely to contact a provider postoperatively and were more likely to endorse pain complaint (number needed to treat: 9).
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Affiliation(s)
- Laura B Cornwell
- Department of Urology, University of California San Diego, 200 West Arbor Drive MC 7897, San Diego, CA 92103, USA; Rady Children's Hospital - San Diego, 3020 Childrens Way MC 5120, San Diego, CA 92123, USA.
| | - Paul C Campbell
- Naval Medical Center, San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, USA
| | - Emily Ewing
- Department of Urology, University of California San Diego, 200 West Arbor Drive MC 7897, San Diego, CA 92103, USA
| | - Kelly A Swords
- Department of Urology, University of California San Diego, 200 West Arbor Drive MC 7897, San Diego, CA 92103, USA; Rady Children's Hospital - San Diego, 3020 Childrens Way MC 5120, San Diego, CA 92123, USA
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Kelley-Quon LI, Ourshalimian S, Lee J, Russell KW, Kling K, Shew SB, Mueller C, Jensen AR, Vu L, Padilla B, Ostlie D, Smith C, Inge T, Roach J, Ignacio R, Lofberg K, Radu S, Rohan A, Wang KS. Multi-Institutional Quality Improvement Project to Minimize Opioid Prescribing in Children after Appendectomy Using NSQIP-Pediatric. J Am Coll Surg 2022; 234:290-298. [PMID: 35213491 DOI: 10.1097/xcs.0000000000000056] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND There is wide variation in opioid prescribing after appendectomy in children and adolescents, with recent increases noted in opioid-related pediatric deaths from prescription and illicit opioids. The goal of this project was to minimize opioid prescribing at the time of discharge for children undergoing appendectomy by using Quality Improvement (QI) methodology. STUDY DESIGN Children (18 years of age or less) who underwent appendectomy were evaluated from January to December 2019 using NSQIP-Pediatric at 10 children's hospitals within the Western Pediatric Surgery Research Consortium. Before project initiation, 5 hospitals did not routinely prescribe opioids after appendectomy (protocol). At the remaining 5 hospitals, prescribing was not standardized and varied by surgeon (no-protocol). A prospective multi-institutional QI project was used to minimize outpatient opioid prescriptions for children after appendectomy. The proportion of children at each hospital receiving an opioid prescription at discharge was compared for 6 months before and after the intervention using chi-square analysis. RESULTS Overall, 1,524 children who underwent appendectomy were evaluated from January to December 2019. After the QI intervention, overall opioid prescribing decreased from 18.2% to 4.0% (p < 0.001), with significant decreases in protocol hospitals (2.7% vs 0.8%, p = 0.038) and no-protocol hospitals (37.9% vs 8.8%, p < 0.001). The proportion of 30-day emergency room visits did not change after the QI intervention (8.9% vs 9.9%, p = 0.54) and mean postintervention pain management satisfaction scores were high. CONCLUSION Opioid prescribing can be minimized in children after appendectomy without increasing emergency room visits or decreasing patient satisfaction. Furthermore, NSQIP-Pediatric can be used as a platform for multi-institutional collaboration for successful implementation of QI projects.
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Affiliation(s)
- Lorraine I Kelley-Quon
- From the Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA; Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA (Kelley-Quon, Ourhsalimian, Wang)
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA (Kelley-Quon)
| | - Shadassa Ourshalimian
- From the Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA; Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA (Kelley-Quon, Ourhsalimian, Wang)
| | - Justin Lee
- Division of Surgery, Phoenix Children's Hospital, Phoenix, AZ (Lee, Padilla, Ostlie)
| | - Katie W Russell
- Division of Pediatric Surgery, University of Utah and Primary Children's Hospital, Salt Lake City, UT (Russell, Rohan)
| | - Karen Kling
- Division of Pediatric Surgery, Rady Children's Hospital San Diego, San Diego, CA; Department of Surgery, University of California San Diego School of Medicine, San Diego, CA (Kling, Ignacio)
| | - Stephen B Shew
- Division of Pediatric Surgery, Lucile Packard Children's Hospital, Palo Alto, CA; Department of Surgery, Stanford University School of Medicine, Palo Alto, CA (Shew, Mueller)
| | - Claudia Mueller
- Division of Pediatric Surgery, Lucile Packard Children's Hospital, Palo Alto, CA; Department of Surgery, Stanford University School of Medicine, Palo Alto, CA (Shew, Mueller)
| | - Aaron R Jensen
- Division of Pediatric Surgery, UCSF Benioff Children's Hospitals, and Department of Surgery, University of California San Francisco School of Medicine, San Francisco, CA (Jensen, Vu)
| | - Lan Vu
- Division of Pediatric Surgery, UCSF Benioff Children's Hospitals, and Department of Surgery, University of California San Francisco School of Medicine, San Francisco, CA (Jensen, Vu)
| | - Benjamin Padilla
- Division of Surgery, Phoenix Children's Hospital, Phoenix, AZ (Lee, Padilla, Ostlie)
| | - Daniel Ostlie
- Division of Surgery, Phoenix Children's Hospital, Phoenix, AZ (Lee, Padilla, Ostlie)
| | - Caitlin Smith
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Seattle WA; Department of Surgery, University of Washington School of Medicine, Seattle, WA (Smith)
| | - Thomas Inge
- Children's Hospital Colorado, University of Colorado, Aurora, CO (Inge, Roach)
| | - Jonathan Roach
- Children's Hospital Colorado, University of Colorado, Aurora, CO (Inge, Roach)
| | - Romeo Ignacio
- Division of Pediatric Surgery, Rady Children's Hospital San Diego, San Diego, CA; Department of Surgery, University of California San Diego School of Medicine, San Diego, CA (Kling, Ignacio)
| | - Katrine Lofberg
- the Division of Pediatric Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR (Lofberg, Radu)
| | - Stephanie Radu
- the Division of Pediatric Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR (Lofberg, Radu)
| | - Autumn Rohan
- Division of Pediatric Surgery, University of Utah and Primary Children's Hospital, Salt Lake City, UT (Russell, Rohan)
| | - Kasper S Wang
- From the Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA; Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA (Kelley-Quon, Ourhsalimian, Wang)
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Raval MV. Invited Commentary: Moving the Needle on Postoperative Pediatric Opioid Prescribing. J Am Coll Surg 2022; 234:298-299. [PMID: 35213492 DOI: 10.1097/xcs.0000000000000046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ramos O, Speirs J, Morrison M, Danisa O. Effect of narcotic prescription limiting legislation on opioid utilization following pediatric spinal fusion for scoliosis. Spine Deform 2022; 10:335-341. [PMID: 34449074 DOI: 10.1007/s43390-021-00406-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 08/21/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND CONTEXT Since 2016, 35 of 50 US states have approved opioid-limiting and monitoring laws. The impact on postoperative opioid prescribing and secondary outcomes following pediatric scoliosis deformity correction surgery remains unknown. PURPOSE To evaluate the effect of CURES 2.0 opioid-limiting regulations on postoperative opioid prescriptions and unplanned readmissions following pediatric scoliosis deformity correction surgery. STUDY DESIGN Retrospective review of prospectively collected data. PATIENT SAMPLE Two patient cohorts (pre-CURES January 1, 2017-October 22, 2018 and post-CURES September 1, 2018-May 30, 2020) that included all patients undergoing pediatric scoliosis deformity surgery at a single institution. METHODS Demographic, medical, surgical, clinical, and pharmacological data was collected from all patients. Total morphine milligram equivalents (MMEs) prescribed was compared at 30-day postoperative intervals. Readmission rates were calculated. Categorical variables were evaluated with Chi squared analysis and continuous variables were evaluated with t test or Mann-Whitney U test as appropriate. Logistic regression was used to evaluate risk factors for increased postoperative opioid. RESULTS Of 108 identified patients, 94 (49 pre-CURES, 45 post-CURES) were included in the study. Post-CURES patients were older (p = 0.001). All other demographic, medical, and surgical factors were similar between pre-CURES and post-CURES patients (all p > 0.05). Post-CURES, patients received fewer pills in their first postoperative prescription (43.4 vs. 57.4 pills, p = 0.006), less opioids (MMEs) during the first 0 to 30-day and 31 to 60-day postoperative intervals (261.8 MMEs vs. 337.6 MMEs, p = 0.028 and 17.8 MMEs vs. 59.7 MMEs, p = 0.016, respectively). Increased 120-day opioid utilization was associated with surgery in the pre-CURES period, age, BMI, and decreased number of levels fused (all p < 0.05). Postoperative readmission within 90 days was associated with age, BMI, number of levels fused, and length of stay. CONCLUSIONS Implementation of CURES 2.0 has resulted in a reduction in the opioid prescription following pediatric scoliosis deformity surgery without an increase in readmissions. Further studies are needed to evaluate how legislations of this kind affect patient reported outcomes, satisfaction, and quality of life.
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Affiliation(s)
- Omar Ramos
- Department of Orthopaedic Surgery, Loma Linda University, 11406 Loma Linda Drive, Suite 213, Loma Linda, CA, 02354, USA.
| | - Joshua Speirs
- Department of Orthopaedic Surgery, Loma Linda University, 11406 Loma Linda Drive, Suite 213, Loma Linda, CA, 02354, USA
| | - Martin Morrison
- Department of Orthopaedic Surgery, Loma Linda University, 11406 Loma Linda Drive, Suite 213, Loma Linda, CA, 02354, USA
| | - Olumide Danisa
- Department of Orthopaedic Surgery, Loma Linda University, 11406 Loma Linda Drive, Suite 213, Loma Linda, CA, 02354, USA
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Rosen DM, Alcock MM, Palmer GM. Opioids for acute pain management in children. Anaesth Intensive Care 2022; 50:81-94. [PMID: 35172638 DOI: 10.1177/0310057x211065769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Opioids are integral to multimodal analgesic regimens in children with moderate to severe acute pain. Throughout normal childhood there are marked changes in physiology, and social and psychological development that influence the perception and expression of pain, the pharmacology of opioids, and how they are used. A multidimensional pain assessment is key to guiding appropriate opioid prescribing. Most of the commonly used opioids in adults are used in children, with the increasing exception of codeine (as a result of regulatory change), and are generally well tolerated. Patient groups at increased risk of ventilatory impairment include neonates and those with obstructive sleep apnoea, severe neurodevelopmental conditions, trisomy 21, and severe epilepsy. Slow-release opioids are not recommended for general use, but may be used in select populations, for example, following scoliosis surgery, major trauma or burns. Prescribing and administration errors are a major issue in paediatrics generally; the potential consequences of opioid prescribing or administration errors are serious, particularly following hospital discharge. Opioids prescribed at discharge are frequently in excess of a child's analgesic requirements; three to five days supply appears sufficient for the majority of common paediatric operations. Discharge opioid prescriptions have been linked to long-term opioid use in adolescents with risk factors. Misuse of prescription opioids by adolescents is also concerning, with prevalence estimates ranging from 1.1% to 20%. Caregivers have a tendency to underdose opioids in their children; caregiver education may improve appropriate administration. Caregivers must also be provided with instructions on safe storage and disposal of unused opioids.
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Affiliation(s)
- Derek M Rosen
- Department of Anaesthesia and Pain Management, Queensland Children's Hospital, Brisbane, Queensland, Australia.,University of Queensland, Queensland, Brisbane, Australia
| | - Mark M Alcock
- Department of Anaesthesia and Pain Management, Queensland Children's Hospital, Brisbane, Queensland, Australia.,University of Queensland, Queensland, Brisbane, Australia
| | - Greta M Palmer
- Department of Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
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83
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Drago MJ, Shabanova V, Hochreiter D, Grossman M, Mercurio M. Does Maternal Incarceration Impact Infants with Neonatal Abstinence Syndrome? Matern Child Health J 2022; 26:1095-1103. [PMID: 35088297 DOI: 10.1007/s10995-021-03356-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Opioid exposed infants born to incarcerated women represent a vulnerable and understudied subset of infants with neonatal abstinence syndrome (NAS). The impact of maternal incarceration on length of stay (LOS) for infants with NAS is unknown. We hypothesized that infants with NAS born to incarcerated women have longer hospitalizations compared to infants with NAS born to non-incarcerated women. METHODS This is a retrospective cohort study of infants with NAS born between 2011 and 2018 at the primary delivery site for Connecticut's only women's prison. Opioid exposed infants were assessed by Finnegan Scores for withdrawal and received morphine as a first line agent and phenobarbital as a second line agent. LOS was compared using Poisson regression. RESULTS Of 206 infants identified, 166 were included in the analysis, with 28 born to incarcerated women and 138 to non-incarcerated women. Incarcerated women were more likely to report prenatal alcohol use, 14.3% vs 2.2% p = 0.016 and benzodiazepine use 21.4% vs 7.3% p = 0.032. Infants of incarcerated women were less likely to be fed breast milk at discharge, 3.6% vs 37% p < 0.001. Adjusted mean LOS was longer among infants born to incarcerated women, 18.5 vs 16.6 days (p = 0.009). CONCLUSIONS FOR PRACTICE Infants with NAS born to incarcerated women in Connecticut had longer LOS, lower rates of being fed breast milk, and different prenatal substance exposures than infants with NAS born to non-incarcerated women. Supporting the maternal-infant dyad until infant discharge may mitigate the potential negative impact of maternal incarceration on the care of infants with NAS.
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Affiliation(s)
- Matthew J Drago
- Department of Pediatrics, Section of Neonatology, Yale School of Medicine, New Haven, CT, USA. .,Division of Newborn Medicine, Icahn School of Medicine at Mount Sinai, 1176 Fifth Avenue, 3rd Floor, New York, NY, 10029, USA.
| | - Veronika Shabanova
- Department of Pediatrics, Section of General Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Daniela Hochreiter
- Department of Pediatrics, Section of Hospitalist Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Matthew Grossman
- Department of Pediatrics, Section of Hospitalist Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Mark Mercurio
- Department of Pediatrics, Section of Neonatology, Yale School of Medicine, New Haven, CT, USA
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84
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Azad A, Levy J, Kefer E, Loubani L, Brinton M, Wollen J. The impact of a pharmacy student‐led community naloxone education program in high school, college, and pharmacy students on knowledge, preparedness, and responsiveness in the event of an opioid overdose. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Atra Azad
- University of Houston College of Pharmacy Houston Texas USA
| | - Jason Levy
- University of Houston College of Pharmacy Houston Texas USA
| | - Emily Kefer
- University of Houston College of Pharmacy Houston Texas USA
| | - Lamees Loubani
- University of Houston College of Pharmacy Houston Texas USA
| | - Meghan Brinton
- University of Houston College of Pharmacy Houston Texas USA
| | - Joshua Wollen
- University of Houston College of Pharmacy Houston Texas USA
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85
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Welsh JW, Dennis ML, Funk R, Mataczynski MJ, Godley MD. Trends and age-related disparities in opioid use disorder treatment admissions for adolescents and young adults. J Subst Abuse Treat 2022; 132:108584. [PMID: 34391589 PMCID: PMC8671231 DOI: 10.1016/j.jsat.2021.108584] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 06/25/2021] [Accepted: 07/25/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Treatment of opioid use disorder (OUD) in adolescents and young adults is imperative to reduce the risk of overdose and other opioid-related harms. Limited information has been published about national trends in health disparities including utilization, access to medication for opioid use disorder (MOUD), and treatment retention of adolescents and young adults with OUD. METHODS This secondary data analysis tested for trends and age-related disparities in national OUD treatment admissions, as well as length of stay (defined as continuous enrollment in some form of treatment at a program) and planned use of MOUD for adolescents (age 12-17) and young adults (age 18-24) using the Treatment Episode Data Set from 2008 to 2017. The study also used data from the National Survey on Drug Use and Health to identify population prevalence of OUD and presentation to OUD treatment in adolescents and young adults compared to older adults (age 25+). RESULTS OUD treatment admissions significantly decreased over the decade by 63% (z = 2.61, p < .01) for adolescents and 13% (z = 2.25, p < .01) for young adults. The rate of planned MOUD at intake increased from 1.1% to 3.0% for adolescents but did not achieve significance. MOUD was more commonly recommended in young adults across the time period (13.5 to 21.8%, z = 2.24, p < .01). Treatment length of stay did not change significantly for adolescents, but did increase for young adults from 2008 to 2017 in the 91+ (19.9-23.9%, z = 2.22, p < .01) and 181+ days (9.7-12.5%, z = 2.26, p < .01) categories. Relative to older adults, the percent of people with OUD presenting for OUD treatment is significantly lower for adolescents (44.6% vs. 3.6%, OR = 0.05, p < .05) and young adults (44.6% vs. 22.2%, OR = 0.36, p < .05). Among those who initiated treatment, lower rates occurred of planned MOUD for adolescents (93% vs. 2%, OR = 0.002, p < .05) and young adults (93% vs. 56%, OR = 0.10, p < .05). CONCLUSIONS A significant unmet need exists for OUD treatment and recommendation of MOUD in adolescents and young adults with OUD. These trends are concerning given increasing rates of opioid-related emergency room admissions and deaths during the same time period. Federal and state funders should examine adolescent and young adult's services separately from older adults (25+) to reduce age-related access disparities and ensure adequate MOUD treatment capacity.
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Affiliation(s)
- Justine W. Welsh
- Department of Psychiatry and Behavioral Services, Emory University School of Medicine, 12 Executive Park Drive NE, Atlanta, GA 30329, USA
| | | | - Rodney Funk
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL 61716, USA
| | - Maggie J. Mataczynski
- Department of Psychiatry and Behavioral Services, Emory University School of Medicine, 12 Executive Park Drive NE, Atlanta, GA 30329, USA
| | - Mark D. Godley
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL 61716, USA
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86
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Aytur SA, Carlino S, Bernard F, West K, Dobrzycki V, Malik R. Social-ecological theory, substance misuse, adverse childhood experiences, and adolescent suicidal ideation: Applications for community-academic partnerships. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:265-284. [PMID: 33942321 PMCID: PMC9292564 DOI: 10.1002/jcop.22560] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 06/12/2023]
Abstract
Suicide is the second leading cause of death among youth in the United States. Data from the 2015 Youth Risk Behavior Survey of 9th-12th grade students in New Hampshire (N = 14,837) were utilized. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated using logistic regression models to evaluate associations between suicidal ideation, adverse childhood experiences (ACEs), and other risk factors including using opioids/drugs without a prescription and food insecurity. We also examined whether potentially protective behaviors may attenuate the relationship between ACEs and suicidal ideation. The prevalence of suicidal ideation was 15.4% (girls 20.15; boys 10.67). In unadjusted models, the crude odds ratio reflecting the relationship between suicidal ideation and higher ACE scores was 1.85 (95% CI 1.76-1.94). In adjusted models, suicidal ideation remained positively associated with higher ACE scores (aOR 1.61, 95% CI 1.52-1.70). Risk and protective behavioral factors identified in relation to suicidal ideation and ACEs are discussed within the context of community-academic partnerships and policy.
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Affiliation(s)
- Semra A. Aytur
- Department of Health Management and PolicyUniversity of New HampshireDurhamNew HampshireUSA
| | - Sydney Carlino
- Department of Health Management and PolicyUniversity of New HampshireDurhamNew HampshireUSA
| | - Felicity Bernard
- Institute for Health Practice and Policy (IHPP), College of Health and Human ServicesUniversity of New HampshireConcordNew HampshireUSA
| | - Kelsi West
- Institute for Health Practice and Policy (IHPP), College of Health and Human ServicesUniversity of New HampshireConcordNew HampshireUSA
| | - Victoria Dobrzycki
- Department of Health Management and PolicyUniversity of New HampshireDurhamNew HampshireUSA
| | - Riana Malik
- Department of Health Management and PolicyUniversity of New HampshireDurhamNew HampshireUSA
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87
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Shackleford TL, Ray JJ, Bronikowski DM, Lancaster JD, Grant DR. Effect of State Legislation on Opioid Prescribing Practices After Surgery at a Pediatric Hospital. Acad Pediatr 2022; 22:137-142. [PMID: 34610461 PMCID: PMC8741651 DOI: 10.1016/j.acap.2021.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 09/15/2021] [Accepted: 09/26/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE As abuse of prescription narcotics continues to create a growing healthcare crisis throughout the United States, states have passed legislation designed to alter narcotic prescribing habits. West Virginia State Bill 273 limited the quantity of narcotics practitioners were able to prescribe. Our objective was to determine the effect of this bill on narcotic prescribing practices for pediatric surgical patients. METHODS A hospital-wide database at a pediatric trauma center was queried to identify all pediatric patients undergoing surgery between January 1, 2017 and December 9, 2019 and all medications prescribed to this cohort. Narcotic prescriptions written for these patients in the 2 months following surgery were isolated. The percent of patients receiving a postoperative narcotic prescription and the morphine milligram equivalents (MME) per prescription were compared before and after the law's implementation. RESULTS The number of pediatric patients identified as having surgery in the study period was 10,176; 6069 were before the law passed and 4107 were after. The percentage of patients receiving a narcotic prescription was 46.0% before the law was passed, decreasing to 36.8% after the law (P < .0001). Adjusted for age, the average MME of each prescription before the law's implementation was 104.0, which decreased to 79.2 after the law (P < .0001). CONCLUSIONS The amount of narcotic per prescription written for pediatric patients after surgery and the percentage of patients receiving a prescription decreased after West Virginia State Bill 273 was implemented. This law was associated with decreased narcotics written by providers, providing an example for future legislation targeting opioid prescribing and abuse.
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Affiliation(s)
- Taylor L. Shackleford
- Department of Orthopaedics, West Virginia University, PO Box 9196, Morgantown, WV 26506-9196
| | - Justin J. Ray
- Department of Orthopaedics, West Virginia University, PO Box 9196, Morgantown, WV 26506-9196
| | - Diane M. Bronikowski
- School of Medicine, West Virginia University, PO Box 9111, Morgantown, WV 26506-9111
| | - Jeffrey D. Lancaster
- Department of Pediatrics, West Virginia University, PO Box 9214, Morgantown, WV 26506-9214
| | - Daniel R. Grant
- Department of Orthopaedics, West Virginia University, PO Box 9196, Morgantown, WV 26506-9196
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Baker CE, Larson AN, Ubl DS, Shaughnessy WJ, Rutledge JD, Stans AA, Habermann EB, Milbrandt TA. Tiered Guidelines in a Pediatric Orthopaedic Practice Reduce Opioids Prescribed at Discharge. J Pediatr Orthop 2022; 42:e83-e90. [PMID: 34560763 DOI: 10.1097/bpo.0000000000001974] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Data regarding opioid prescribing patterns following pediatric orthopaedic procedures is limited. The aim of this work was to evaluate the effects of tiered guidelines for discharge opioid prescriptions following common pediatric orthopaedic procedures. METHODS Quality improvement project conducted at a single academic institution. Guidelines for discharge opioid prescriptions were implemented January 2018 and established 4 tiers of increasing invasiveness for 28 common pediatric orthopaedic procedures. Patients who underwent these procedures in 2017 comprised the preguideline cohort (N=258), while patients treated in 2019 comprised the postguideline cohort (N=212). Opioid prescriptions were reported as oral morphine equivalents (OMEs). Univariate tests were performed to assess statistically significant differences before and after implementation of the guidelines. RESULTS There was a significant decrease in OME prescribed between preguideline and postguideline cohorts (median OME 97.5 vs. 37.5). When analyzed according to procedure tiers, tiers 1, 2, and 4 showed significant decreases in OME prescribed between 2017 and 2019. The rate of no opioids prescribed at discharge increased from 13% to 23% between preguideline and postguideline cohorts. The 30-day refill rate did not significantly change. After implementation of guidelines, 91% of all prescriptions were within the guideline parameters, and there was a significant reduction in prescription variability. In tier 4 procedures, median OME prescribed decreased from 375 preguideline to 188 postguideline, but was associated with greater opioid refills within 30 days of discharge (10.2% preguideline vs. 28.8% postguideline). CONCLUSIONS Tiered guidelines for discharge opioid prescriptions following pediatric orthopaedic procedures can significantly decrease the quantity of opioids prescribed. Furthermore, we noted excellent adherence and no overall increase in the rates of narcotic refills. Such guidelines may improve pediatric orthopaedists' ability to responsibly treat postoperative pain while limiting the distribution of unneeded opioids. LEVEL OF EVIDENCE Level IV-quality improvement project.
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Affiliation(s)
| | | | - Daniel S Ubl
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | | | | | | | - Elizabeth B Habermann
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
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89
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Sun N, Steinberg BE, Faraoni D, Isaac L. Variability in discharge opioid prescribing practices for children: a historical cohort study. Can J Anaesth 2021; 69:1025-1032. [PMID: 34904210 DOI: 10.1007/s12630-021-02160-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 08/12/2021] [Accepted: 10/13/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Legitimate opioid prescriptions can increase the risk of misuse, addiction, and overdose of opioids in children and adolescents. This study aimed to describe the prescribing patterns of discharge opioid analgesics following inpatient visits and to determine patient and prescriber characteristics that are associated with prolonged opioid prescription. METHODS In a historical cohort study, we identified patients discharged from hospital with an opioid analgesic prescription in a tertiary pediatric hospital from 1 January 2016 to 30 June 2017. The primary outcome was the duration of opioid prescription in number of days. We assessed the association between patient and prescriber characteristics and an opioid prescription duration > five days using a generalized estimating equation to account for clustering due to repeated admissions of the same patient. RESULTS During the 18-month study period, 15.4% of all admitted patients (3,787/24,571) were given a total of 3,870 opioid prescriptions at discharge. The median [interquartile range] prescribed duration of outpatient opioid therapy was 3.75 [3.00-5.00] days. Seventy-seven percent of the opioid prescriptions were for five days or less. Generalized estimating equation analysis revealed that hospital stay > four days, oxycodone prescription, and prescription by clinical fellows and the orthopedics service were all independently associated with a discharge opioid prescription of > five days. CONCLUSIONS Most discharge opioids for children were prescribed for less than five days, consistent with current guidelines for adults. Nevertheless, the dosage and duration of opioids prescribed at discharge varied widely.
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Affiliation(s)
- Naiyi Sun
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, University of Toronto, 555 University Ave., Toronto, ON, M5G 1X8, Canada.
| | - Benjamin E Steinberg
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, University of Toronto, 555 University Ave., Toronto, ON, M5G 1X8, Canada
| | - David Faraoni
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, University of Toronto, 555 University Ave., Toronto, ON, M5G 1X8, Canada
| | - Lisa Isaac
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, University of Toronto, 555 University Ave., Toronto, ON, M5G 1X8, Canada
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Basco WT, McCauley JL, Zhang J, Marsden JE, Simpson KN, Heidari K, Mauldin PD, Ball SJ. High-risk opioid analgesic dispensing to adolescents 12-18 years old in South Carolina: 2010-2017. Pharmacoepidemiol Drug Saf 2021; 31:353-360. [PMID: 34859532 DOI: 10.1002/pds.5389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 11/23/2021] [Accepted: 11/29/2021] [Indexed: 11/09/2022]
Abstract
PURPOSE To evaluate "high-risk" opioid dispensing to adolescents, including daily morphine milligram equivalents (MME) above recommended amounts, the percentage of extended-release opioid prescriptions dispensed to opioid-naïve adolescents, and concurrent use of opioids and benzodiazepines, and to evaluate changes in those rates over time. METHODS Retrospective cohort study of one state's prescription drug monitoring program data (2010-2017), evaluating adolescents 12-18 years old dispensed opioid analgesic prescriptions. Outcomes of interest were the quarterly frequencies of the high-risk measures. We utilized generalized linear regression to determine whether the rate of the outcomes changed over time. RESULTS The quarterly percentage of adolescents ages 12-18 years old dispensed an opioid who received ≥90 daily MME declined from 4.1% in the first quarter (Q1) of 2010 to 3.4% in the final quarter (Q4) of 2017 (p < 0.0001). The frequency of adolescents dispensed ≥50 daily MME changed little over time. In 2010, the percentage of adolescents receiving an extended-release opioid who were opioid naïve was 60.7%, declining to 50.6% by Q4 of 2017 (p > 0.10 overall change 2010-2017). The percentage of adolescent opioid days overlapping with benzodiazepine days was 1.6% in Q1 of 2010, declining to 1.1% by Q4 of 2017 (p < 0.001). CONCLUSIONS Among persons 12-18 years old dispensed an opioid analgesic, receipt of ≥90 daily MME declined during the years 2010-2017, as did the percentage of adolescent opioid days that overlapped with benzodiazepines. More than half of the individuals who received extended-release opioid analgesics were identified as opioid naïve and, counter to guidelines, received products intended for opioid-tolerant individuals.
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Affiliation(s)
- William T Basco
- Department of Pediatrics, College of Medicine, The Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jenna L McCauley
- Department of Psychiatry and Behavioral Services, College of Medicine, The Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jingwen Zhang
- Department of Medicine, College of Medicine, The Medical University of South Carolina, Charleston, South Carolina, USA
| | - Justin E Marsden
- Department of Medicine, College of Medicine, The Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kit N Simpson
- Department of Healthcare Leadership and Management, College of Health Professions, The Medical University of South Carolina, Charleston, South Carolina, USA
| | - Khosrow Heidari
- Blue Cross Blue Shield of South Carolina, Columbia, South Carolina, USA
| | - Patrick D Mauldin
- Department of Medicine, College of Medicine, The Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sarah J Ball
- Department of Medicine, College of Medicine, The Medical University of South Carolina, Charleston, South Carolina, USA
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Renny MH, Cerdá M. Addressing drug overdose deaths in pediatrics: Where do we go from here? Pediatr Res 2021; 90:1108-1109. [PMID: 34482376 DOI: 10.1038/s41390-021-01722-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 07/19/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Madeline H Renny
- Center for Opioid Epidemiology and Policy, Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA. .,Department of Emergency Medicine, New York University Grossman School of Medicine, New York, NY, USA. .,Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA.
| | - Magdalena Cerdá
- Center for Opioid Epidemiology and Policy, Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
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Lee J, Thrul J. Trends in opioid misuse by cigarette smoking status among US adolescents: Results from National Survey on Drug Use and Health 2015-2018. Prev Med 2021; 153:106829. [PMID: 34624387 DOI: 10.1016/j.ypmed.2021.106829] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 09/28/2021] [Accepted: 10/03/2021] [Indexed: 12/26/2022]
Abstract
Increasing rates of opioid-related emergency department visits and deaths among adolescents in the United States are a public health concern. Adolescent cigarette smoking may be a risk factor for opioid misuse; though, there is a paucity of research on adolescents' cigarette smoking and opioid misuse. This study investigates current trends and the association between cigarette smoking and opioid misuse among US adolescents. Using pooled youth samples (ages 12-17) from the National Survey on Drug Use and Health (NSDUH) 2015-2018 (N = 54,866), we calculated weighted estimates of past-year opioid misuse by cigarette smoking status across years. We further estimated a multivariable logistic regression model to examine the past-year opioid misuse by ever-cigarette-smoking, controlling for sociodemographics and other substance use. While there was a significant reduction in opioid misuse among the entire sample and among never-smokers over time (2.5% in 2015 to 1.9% in 2018), this trend was not significant among ever-smokers (14.2% in 2015 to 11.1% in 2018). Multivariable logistic regression showed ever-smokers (vs. never-smokers) had higher odds of past-year opioid misuse (aOR = 2.01; 95% CI = 1.66, 2.43). Findings suggest that comprehensive tobacco control policies and opioid misuse prevention programs are warranted to curb opioid misuse among adolescents.
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Affiliation(s)
- Juhan Lee
- Department of Health Behavior, College of Health and Human Performance, University of Florida, USA; Department of Psychiatry, Yale School of Medicine, USA.
| | - Johannes Thrul
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, USA; Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA; Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia.
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93
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Renny MH, Hadland SE, Cerdá M. Appropriateness of Opioid Prescription in Children, Adolescents, and Younger Adults-The Elephant in the Room-Reply. JAMA Pediatr 2021; 175:1295. [PMID: 34605852 PMCID: PMC8998091 DOI: 10.1001/jamapediatrics.2021.3849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Madeline H. Renny
- Center for Opioid Epidemiology and Policy, Department of
Population Health, New York University Grossman School of Medicine, New York, New
York
| | - Scott E. Hadland
- Division of Adolescent and Young Adult Medicine,
MassGeneral Hospital for Children, Boston, Massachusetts
| | - Magdalena Cerdá
- Center for Opioid Epidemiology and Policy, Department of
Population Health, New York University Grossman School of Medicine, New York, New
York
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94
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Emdin A, Strzelecki M, Seto W, Feinstein J, Bogler O, Cohen E, Roth DE. Medications Reconciled at Discharge Versus Admission Among Inpatients at a Children's Hospital. Hosp Pediatr 2021:hpeds.2021-006080. [PMID: 34807980 PMCID: PMC9156657 DOI: 10.1542/hpeds.2021-006080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Discharge prescription practices may contribute to medication overuse and polypharmacy. We aimed to estimate changes in the number and types of medications reported at inpatient discharge (versus admission) at a tertiary care pediatric hospital. METHODS Electronic medication reconciliation data were extracted for inpatient admissions at The Hospital for Sick Children from January 1, 2016, to December 31, 2017 (n = 22 058). Relative changes in the number of medications and relative risks (RRs) of specific types and subclasses of medications at discharge (versus admission) were estimated overall and stratified by the following: sex, age group, diagnosis of a complex chronic condition, surgery, or ICU (PICU) admission. Micronutrient supplements, nonopioid analgesics, cathartics, laxatives, and antibiotics were excluded in primary analyses. RESULTS Medication counts at discharge were 1.27-fold (95% confidence interval [CI]: 1.25-1.29) greater than admission. The change in medications at discharge (versus admission) was increased by younger age, absence of a complex chronic condition, surgery, PICU admission, and discharge from a surgical service. The most common drug subclasses at discharge were opioids (22% of discharges), proton pump inhibitors (18%), bronchodilators (10%), antiemetics (9%), and corticosteroids (9%). Postsurgical patients had higher RRs of opioid prescriptions at discharge (versus admission; RR: 13.3 [95% CI: 11.5-15.3]) compared with nonsurgical patients (RR: 2.38 [95% CI: 2.22-2.56]). CONCLUSIONS Pediatric inpatients were discharged from the hospital with more medications than admission, frequently with drugs that may be discretionary rather than essential. The high frequency of opioid prescriptions in postsurgical patients is a priority target for educational and clinical decision support interventions.
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Affiliation(s)
- Abby Emdin
- Child Health Evaluative Sciences and SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Dalla Lana School of Public Health
| | - Marina Strzelecki
- Department of Pharmacy, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Winnie Seto
- Child Health Evaluative Sciences and SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pharmacy, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - James Feinstein
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, Children's Hospital Colorado and School of Medicine, University of Colorado, Aurora, Colorado
| | | | - Eyal Cohen
- Child Health Evaluative Sciences and SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation
| | - Daniel E Roth
- Child Health Evaluative Sciences and SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Dalla Lana School of Public Health
- Institute of Health Policy, Management and Evaluation
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95
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Kelly BC, Vuolo M, Frizzell LC. Pediatric drug overdose mortality: contextual and policy effects for children under 12 years. Pediatr Res 2021; 90:1258-1265. [PMID: 34021271 PMCID: PMC8606008 DOI: 10.1038/s41390-021-01567-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 03/10/2021] [Accepted: 04/19/2021] [Indexed: 12/04/2022]
Abstract
BACKGROUND We determine trends in fatal pediatric drug overdose from 1999 to 2018 and describe the influence of contextual factors and policies on such overdoses. METHODS Combining restricted CDC mortality files with data from other sources, we conducted between-county multilevel models to examine associations of demographic and socioeconomic characteristics with pediatric overdose mortality and a fixed-effects analysis to identify how changes in contexts and policies over time shaped county-level fatal pediatric overdoses per 100,000 children under 12 years. RESULTS Pediatric overdose deaths rose from 0.08/100,000 children in 1999 to a peak of 0.19/100,000 children in 2016, with opioids accounting for an increasing proportion of deaths. Spatial patterns of pediatric overdose deaths are heterogenous. Socioeconomic characteristics are not associated with between-county differences in pediatric overdose mortality. Greater state expenditures on public welfare (B = -0.099; CI: [-0.193, -0.005]) and hospitals (B = -0.222; CI: [-.437, -.007]) were associated with lower pediatric overdose mortality. In years when a Good Samaritan law was in effect, the county-level pediatric overdose rate was lower (B = -0.095; CI: [-0.177, -0.013]). CONCLUSIONS Pediatric overdose mortality increased since 1999, peaking in 2016. Good Samaritan laws and investment in hospitals and public welfare may temper pediatric overdoses. Multi-faceted approaches using policy and individual intervention is necessary to reduce pediatric overdose mortality. IMPACT Pediatric fatalities from psychoactive substances have risen within the U.S. since 1999. Higher levels of state spending on public welfare and hospitals are significantly associated with lower pediatric overdose mortality rates. The implementation of Good Samaritan laws is significantly associated with lower pediatric overdose mortality rates. We identified no county-level sociodemographic factors associated with pediatric overdose mortality. The findings indicate that a multi-faceted approach to the reduction of pediatric overdose is necessary.
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Affiliation(s)
- Brian C Kelly
- Department of Sociology, Purdue University, West Lafayette, IN, USA
| | - Mike Vuolo
- Department of Sociology, The Ohio State University, Columbus, OH, USA.
| | - Laura C Frizzell
- Department of Sociology, The Ohio State University, Columbus, OH, USA
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96
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Rostam-Abadi Y, Gholami J, Noroozi A, Ansari M, Baheshmat S, Hamzehzadeh M, Ghadirzadeh MR, Vahdani B, Ekhtiari H, Mojtabai R, Rahimi-Movaghar A. Public health risks associated with methadone in Iran: A systematic review and meta-analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 100:103529. [PMID: 34826790 DOI: 10.1016/j.drugpo.2021.103529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 09/25/2021] [Accepted: 10/30/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND There has been a marked growth in methadone maintenance treatment (MMT) in Iran in the past two decades with positive health outcomes. We conducted a systematic review of studies on the prevalence of non-prescribed methadone use, methadone use disorder, and methadone-related poisoning and mortality in Iran. METHODS We searched International and Iranian databases up to May 2020 and contacted relevant experts. The pooled proportions were estimated through random-effects model. Methadone-related adverse outcomes were evaluated over time. RESULTS Sixty-five studies were included. The pooled estimates of non-prescribed methadone use in the last 12-month were 2.7% (95%CI: 0.9-5.4) and 0.1% (95%CI: 0.03-0.2) in the male and female general population, respectively. Among people who use drugs, 8.4% reported daily non-prescribed use in 2018. Four heterogeneous studies in drug treatment centers reported the existence of treatment-seeking for methadone use disorder. Methadone was responsible for 10.4% (95%CI: 4.5-18.3) of cases of acute poisoning in adults and 16.0% (95%CI: 9.3-24.1) in children. Methadone was reported as a cause of death in 53.5% of substance-related deaths referred to the Legal Medicine Organization while being the only cause in 35.8% of all cases. CONCLUSION Non-prescribed use of methadone in the general population is much less than opiates and some other available prescription opioids, like tramadol. However, notwithstanding the large and successful MMT program in Iran, increasing trends in methadone-related poisoning and deaths pose serious public health concerns. There is an urgent need to explore these fatal and non-fatal poisoning cases and implement policies to curb the harms associated with methadone use.
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Affiliation(s)
- Yasna Rostam-Abadi
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Jaleh Gholami
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Noroozi
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Mina Ansari
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Shahab Baheshmat
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran; Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine (SATiM), Tehran University of Medical Sciences, Tehran, Iran
| | - Marziyeh Hamzehzadeh
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran; Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine (SATiM), Tehran University of Medical Sciences, Tehran, Iran
| | | | - Bita Vahdani
- Center for Disease Affairs and Transplant, Ministry of Health, Tehran, Iran
| | - Hamed Ekhtiari
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
| | - Ramin Mojtabai
- Department of Mental Health, Bloomberg School of Public Health and Department of Psychiatry, Johns Hopkins University, Baltimore, Maryland, USA
| | - Afarin Rahimi-Movaghar
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran.
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97
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Lloyd AR, Savage R, Eaton EF. Opioid use disorder: a neglected human immunodeficiency virus risk in American adolescents. AIDS 2021; 35:2237-2247. [PMID: 34387219 PMCID: PMC8563394 DOI: 10.1097/qad.0000000000003051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In 2017 alone, 783 000 children aged 12-17 years misused opioids with 14 000 using heroin. Opioid misuse and opioid use disorder (OUD) in adolescents and young adults are significant barriers to ending the HIV epidemic. To address these synergistic scourges requires dedicated practitioners and improved access to life-saving evidence-based treatment. Adolescents and young adults make up over one in five new HIV diagnoses even though they are less likely to be tested or know they are infected. Adolescents and young adults living with HIV are less likely to be retained in care or achieve virological suppression. OUD further leads to increased rates of risky behaviours (like sex without condoms), deceased retention in HIV care and decreased rates of viral suppression in this vulnerable population. Medications for opioid use disorder (MOUD) are recommended for adolescents and young adults with severe OUD and help retain youth in HIV treatment and decrease risk of death. However, due to stigma and lack of experience prescribing MOUD in adolescents, MOUD is often perceived as a last line option. MOUD remains difficult to access for adolescents with a shortage of providers and decreased options for treatment as compared to adults. Addiction treatment is infection prevention, and integrated addiction and HIV services are recommended to improve health outcomes. A multipronged approach including patient education, provider training and policy changes to improve access to treatment and harm reduction are urgently needed confront the drug use epidemic in youth.
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Affiliation(s)
- Audrey R Lloyd
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham
| | - Rebekah Savage
- Division of Adolescent Medicine, University of Alabama at Birmingham
| | - Ellen F Eaton
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabamas, USA
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98
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Wing E, Saadat S, Bhargava R, Yun H, Chakravarthy B. Racial disparities in opioid prescriptions for fractures in the pediatric population. Am J Emerg Med 2021; 51:210-213. [PMID: 34775193 DOI: 10.1016/j.ajem.2021.10.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/10/2021] [Accepted: 10/11/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Racial disparities have been well documented in literature regarding pain management. However, few studies have focused on its effect in the pediatric population. This study seeks to examine the relationship between race and opioid prescription patterns for children with fractures. METHODS A retrospective study was conducted by reviewing all analgesic prescriptions of discharged pediatric patients (ages 0-21, median 10 years) from a large children's hospital over a five-year period. Multiple logistic regression analysis was applied to examine racial differences in opioid prescriptions for patients with long bone fractures after adjusting for sex, age, length of stay, and payer type. RESULTS 58,402 analgesic prescriptions were reviewed in this study; 5061 were given for the primary discharge diagnosis of "fracture" of any bone. Overall, 52% of analgesics prescribed for this diagnosis were opioid medications. The relative frequency of opioid prescriptions was 48.7% in Hispanic White patients and 63.1% in non-Hispanic White patients. The odds ratio for non-Hispanic White patients to be prescribed an opioid medication was 1.44 (CI 1.20-1.73) compared to Black patients and to Hispanic White patients after adjustment for sex, age, length of hospital stay, and payer type. The same racial disparity pattern was observed in patients regardless of long bone fracture location. CONCLUSIONS Racial bias is suggested in opioid prescription patterns, even in the pediatric population, which may have untoward negative downstream effects. This study delineates the need for improved and standardized methods to adequately treat pain and reduce variations in prescriber habits.
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Affiliation(s)
- Emily Wing
- University of California, Irvine, 333 City Boulevard West Suite 640, Orange, CA 92868, USA
| | - Soheil Saadat
- University of California, Irvine, 333 City Boulevard West Suite 640, Orange, CA 92868, USA
| | - Rishi Bhargava
- University of California, Irvine, 333 City Boulevard West Suite 640, Orange, CA 92868, USA; Long Beach Memorial Miller's Children Hospital, 2801 Atlantic Ave, Long Beach, CA 90806, USA
| | - Haein Yun
- University of California, Irvine, 333 City Boulevard West Suite 640, Orange, CA 92868, USA
| | - Bharath Chakravarthy
- University of California, Irvine, 333 City Boulevard West Suite 640, Orange, CA 92868, USA.
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99
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Li H, Dodd-Butera T, Beaman ML, Pritty MB, Heitritter TE, Clark RF. Trends in Childhood Poison Exposures and Fatalities: A Retrospective Secondary Data Analysis of the 2009-2019 U.S. National Poison Data System Annual Reports. Pediatr Rep 2021; 13:613-623. [PMID: 34842797 PMCID: PMC8628925 DOI: 10.3390/pediatric13040073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/06/2021] [Accepted: 11/10/2021] [Indexed: 11/28/2022] Open
Abstract
Despite significant prevention efforts, childhood poison exposures remain a serious public health challenge in the United States. This study aimed to assess annual trends of pharmaceutical vs. non-pharmaceutical poison exposures in the US among children 0-19 years and compare the odds of death by children's age group. Poison exposure and fatality data were retrospectively extracted from 2009 to 2019 National Poison Data System (NPDS) annual reports for children in all reported age groups. Overall, there was a significant reduction in the annual population-adjusted poison exposures in children (annual percentage change = -2.54%, 95% CI = -3.94% to -1.15%, p < 0.01), but not in poisoning-related fatalities. Children 0-5 had similar odds of dying from exposure to non-pharmaceuticals vs. pharmaceuticals. The odds of children 6-12 dying from non-pharmaceuticals vs. pharmaceuticals was 2.38 (95% CI = 1.58, 3.58), χ2 = 18.53, p < 0.001. In contrast, the odds of children 13-19 dying from pharmaceuticals vs. non-pharmaceuticals was 3.04 (95% CI = 2.51, 3.69), χ2 = 141.16, p < 0.001. Suicidal intent accounted for 40.63% of pharmaceutical deaths in children 6-12, as well as 48.66% of pharmaceutical and 31.15% of non-pharmaceutical deaths in children 13-19. While a significant decline in overall childhood poison exposures was reported, a decrease in poisoning-related fatalities was not observed. Children in different age groups had contrasting relative odds of death from pharmaceutical and non-pharmaceutical exposures. Among older children, a greater proportion of poisoning-related deaths was due to intentional suicide. These findings provide evidence of age-specific trends in childhood poison exposure risk and directions for future poison prevention efforts and behavioral health partnerships.
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Affiliation(s)
- Hong Li
- Biobehavioral and Health Research Center, Department of Doctoral Studies, School of Nursing, Azusa Pacific University, Monrovia, CA 91016, USA
| | - Teresa Dodd-Butera
- Biobehavioral and Health Research Center, Department of Public Health and Doctoral Studies, School of Nursing, Azusa Pacific University, San Diego, CA 92108, USA
| | - Margaret L Beaman
- Department of Nursing, California State University, San Bernardino, CA 92407, USA
| | | | - Thomas E Heitritter
- Pharmacy Informatics, Eisenhower Medical Center, Rancho Mirage, CA 92270, USA
| | - Richard F Clark
- California Poison Control System, San Diego, CA 92103, USA
- Department of Emergency Medicine, University of California San Diego Medical Center, San Diego, CA 92093, USA
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100
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Understanding Socioeconomic Status and Adolescent Behavioral health-Time to Move Beyond Simplistic Measures and Cross-sectional Data. J Adolesc Health 2021; 69:685-686. [PMID: 34688453 DOI: 10.1016/j.jadohealth.2021.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 08/18/2021] [Indexed: 11/24/2022]
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