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Bedene A, van Dorp ELA, Faquih T, Cannegieter SC, Mook-Kanamori DO, Niesters M, van Velzen M, Gademan MGJ, Rosendaal FR, Bouvy ML, Dahan A, Lijfering WM. Causes and consequences of the opioid epidemic in the Netherlands: a population-based cohort study. Sci Rep 2020; 10:15309. [PMID: 32943678 PMCID: PMC7499208 DOI: 10.1038/s41598-020-72084-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 08/18/2020] [Indexed: 11/09/2022] Open
Abstract
Over the past decade opioid use has risen globally. The causes and consequences of this increase, especially in Europe, are poorly understood. We conducted a population-based cohort study using national statistics on analgesics prescriptions, opioid poisoning hospital admissions and deaths in the Netherlands from 2013 to 2017. Pain prevalence and severity was determined by using results of 2014-2017 Health Interview Surveys. Between 2013 and 2017 the proportion of residents receiving opioid prescription rose from 4.9% to 6.0%, and the proportion of those receiving NSAIDs decreased from 15.5% to 13.7%. Self-reported pain prevalence and severity remained constant, as 44.7% of 5,119 respondents reported no pain-impeded activities-of-daily-living in 2014 (aRR, 1.00 [95% CI, 0.95-1.06] in 2017 vs 2014). Over the observation period, the incidence of opioid poisoning hospitalization and death increased from 8.6 to 12.9 per 100,000 inhabitants. The incidence of severe outcomes related to opioid use increased, as 3.9% of 1,343 hospitalized for opioid poisoning died in 2013 and 4.6% of 2,055 in 2017. We demonstrated that NSAIDs prescription decreased and opioid prescription increased in the Netherlands since 2013, without an increase in pain prevalence and severity. Consequently, the incidence of severe outcomes related to opioids increased.
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Affiliation(s)
- Ajda Bedene
- Department of Clinical Epidemiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.,Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Eveline L A van Dorp
- Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Tariq Faquih
- Department of Clinical Epidemiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Suzanna C Cannegieter
- Department of Clinical Epidemiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.,Department of Internal Medicine, Section of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Dennis O Mook-Kanamori
- Department of Clinical Epidemiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.,Department of Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Marieke Niesters
- Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Monique van Velzen
- Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Maaike G J Gademan
- Department of Clinical Epidemiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.,Department of Orthopedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Marcel L Bouvy
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, University Utrecht, Utrecht, The Netherlands
| | - Albert Dahan
- Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Willem M Lijfering
- Department of Clinical Epidemiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
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Bach P, Robinson S, Sutherland C, Brar R. Innovative strategies to support physical distancing among individuals with active addiction. Lancet Psychiatry 2020; 7:731-733. [PMID: 32473096 PMCID: PMC7255226 DOI: 10.1016/s2215-0366(20)30231-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/13/2020] [Accepted: 05/20/2020] [Indexed: 01/26/2023]
Affiliation(s)
- Paxton Bach
- Department of Medicine, University of British Columbia, Vancouver, BC, V5Z 1M9, Canada; British Columbia Centre on Substance Use, Vancouver, BC, Canada.
| | - Samantha Robinson
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; School of Nursing, University of British Columbia, Vancouver, Canada
| | - Christy Sutherland
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Department of Family Practice, University of British Columbia, Vancouver, Canada
| | - Rupinder Brar
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Department of Family Practice, University of British Columbia, Vancouver, Canada
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Lawal OD, Gold J, Murthy A, Ruchi R, Bavry E, Hume AL, Lewkowitz AK, Brothers T, Wen X. Rate and Risk Factors Associated With Prolonged Opioid Use After Surgery: A Systematic Review and Meta-analysis. JAMA Netw Open 2020; 3:e207367. [PMID: 32584407 PMCID: PMC7317603 DOI: 10.1001/jamanetworkopen.2020.7367] [Citation(s) in RCA: 136] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
IMPORTANCE Prolonged opioid use after surgery may be associated with opioid dependency and increased health care use. However, published studies have reported varying estimates of the magnitude of prolonged opioid use and risk factors associated with the transition of patients to long-term opioid use. OBJECTIVES To evaluate the rate and characteristics of patient-level risk factors associated with increased risk of prolonged use of opioids after surgery. DATA SOURCES For this systematic review and meta-analysis, a search of MEDLINE, Embase, and Google Scholar from inception to August 30, 2017, was performed, with an updated search performed on June 30, 2019. Key words may include opioid analgesics, general surgery, surgical procedures, persistent opioid use, and postoperative pain. STUDY SELECTION Of 7534 articles reviewed, 33 studies were included. Studies were included if they involved participants 18 years or older, evaluated opioid use 3 or more months after surgery, and reported the rate and adjusted risk factors associated with prolonged opioid use after surgery. DATA EXTRACTION AND SYNTHESIS The Meta-analysis of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines were followed. Two reviewers independently assessed and extracted the relevant data. MAIN OUTCOMES AND MEASURES The weighted pooled rate and odds ratios (ORs) of risk factors were calculated using the random-effects model. RESULTS The 33 studies included 1 922 743 individuals, with 1 854 006 (96.4%) from the US. In studies with available sex and age information, participants were mostly female (1 031 399; 82.7%) and had a mean (SD) age of 59.3 (12.8) years. The pooled rate of prolonged opioid use after surgery was 6.7% (95% CI, 4.5%-9.8%) but decreased to 1.2% (95% CI, 0.4%-3.9%) in restricted analyses involving only opioid-naive participants at baseline. The risk factors with the strongest associations with prolonged opioid use included preoperative use of opioids (OR, 5.32; 95% CI, 2.94-9.64) or illicit cocaine (OR, 4.34; 95% CI, 1.50-12.58) and a preoperative diagnosis of back pain (OR, 2.05; 95% CI, 1.63-2.58). No significant differences were observed with various study-level factors, including a comparison of major vs minor surgical procedures (pooled rate: 7.0%; 95% CI, 4.9%-9.9% vs 11.1%; 95% CI, 6.0%-19.4%; P = .20). Across all of our analyses, there was substantial variability because of heterogeneity instead of sampling error. CONCLUSIONS AND RELEVANCE The findings suggest that prolonged opioid use after surgery may be a substantial burden to public health. It appears that strategies, such as proactively screening for at-risk individuals, should be prioritized.
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Affiliation(s)
- Oluwadolapo D. Lawal
- Department of Pharmacy Practice, University of Rhode Island College of Pharmacy, Kingston
| | - Justin Gold
- Department of Pharmacy Practice, University of Rhode Island College of Pharmacy, Kingston
| | - Amala Murthy
- Department of Pharmacy Practice, University of Rhode Island College of Pharmacy, Kingston
| | - Rupam Ruchi
- Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida, Gainesville
| | - Egle Bavry
- Pain Medicine Section, Anesthesiology Service, Malcom Randall VA Medical Center, Gainesville, Florida
| | - Anne L. Hume
- Department of Pharmacy Practice, University of Rhode Island College of Pharmacy, Kingston
- Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Adam K. Lewkowitz
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women and Infants Hospital of Rhode Island, Providence
| | - Todd Brothers
- Department of Pharmacy Practice, University of Rhode Island College of Pharmacy, Kingston
- Roger Williams Medical Center, Providence, Rhode Island
| | - Xuerong Wen
- Department of Pharmacy Practice, University of Rhode Island College of Pharmacy, Kingston
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Roncero C, Vicente-Hernández B, Casado-Espada NM, Aguilar L, Gamonal-Limcaoco S, Garzón MA, Martínez-González F, Llanes-Álvarez C, Martínez R, Franco-Martín M, Álvarez-Navares A. The Impact of COVID-19 Pandemic on the Castile and Leon Addiction Treatment Network: A Real-Word Experience. Front Psychiatry 2020; 11:575755. [PMID: 33324254 PMCID: PMC7723843 DOI: 10.3389/fpsyt.2020.575755] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/29/2020] [Indexed: 12/31/2022] Open
Abstract
Background: Patients suffering from addiction are a vulnerable group in the midst of COVID-19, so their healthcare is considered essential. In this paper, the measures and responses of the Drug Addiction Assistance Network of Castile and Leon (DAACYL) in Spain during the first 6 weeks of the COVID-19 pandemic are explained. The aim is that this experience could be useful in places where this problem will continue and could help future interventions. Methods: A telephone survey was carried out as the main methodology, to collect information for the subsequent organization and repercussion on professionals and patients. This was carried out by the heads of the 18 DAACYL units. Among the interventions applied, the following stand out: implantation of telemedicine techniques, restriction of daily methadone dispensing, suspension of urine controls and initiation of care programs for the homeless. Results: As a result of these interventions, the professionals observed that patients are less demanding and mostly stable, with a low percentage of relapses. An increase in the consumption of alcohol and benzodiazepines have been reported as more common among people who relapse. Furthermore, the prevalence of COVID-19 infection in the sample is minimal; therefore, different hypotheses should be considered as an explanation (infra-diagnosis, immune system used to aggression, possible anti-inflammatory effect of some psychotropic drugs and a greater perception of danger against infection than the general population). Conclusions: The rapid adaptation and successful implementation of DAACYL have had satisfactory results. On the other hand, the prevention of the possible increase in the development of behavioral addictions and the use of homemade drugs should be considered.
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Affiliation(s)
- Carlos Roncero
- Psychiatry Service, University of Salamanca Health Care Complex, Salamanca, Spain.,Institute of Biomedicine of Salamanca (IBSAL), University of Salamanca, Salamanca, Spain.,Psychiatry Unit, School of Medicine, University of Salamanca, Salamanca, Spain
| | - Begoña Vicente-Hernández
- Addictions and Dual Disorders Unit, Psychiatry Service, Salamanca University Health Care Complex, Salamanca, Spain
| | - Nerea M Casado-Espada
- Psychiatry Service, University of Salamanca Health Care Complex, Salamanca, Spain.,Institute of Biomedicine of Salamanca (IBSAL), University of Salamanca, Salamanca, Spain.,Psychiatry Unit, School of Medicine, University of Salamanca, Salamanca, Spain
| | - Lourdes Aguilar
- Institute of Biomedicine of Salamanca (IBSAL), University of Salamanca, Salamanca, Spain.,Psychiatry Unit, School of Medicine, University of Salamanca, Salamanca, Spain.,Addictions and Dual Disorders Unit, Psychiatry Service, Salamanca University Health Care Complex, Salamanca, Spain
| | | | - María A Garzón
- Addictions and Dual Disorders Unit, Psychiatry Service, Salamanca University Health Care Complex, Salamanca, Spain
| | - Fernando Martínez-González
- Regional Commissioner for Drugs, Social Services Management, Castile and Leon Regional Government, Valladolid, Spain
| | | | - Ruth Martínez
- Addictions and Dual Disorders Unit, Psychiatry Service, Salamanca University Health Care Complex, Salamanca, Spain
| | - Manuel Franco-Martín
- Institute of Biomedicine of Salamanca (IBSAL), University of Salamanca, Salamanca, Spain.,Psychiatry Service, Zamora Health Care Complex, Zamora, Spain.,Psychiatry Service, Rio Hortega University Hospital, Valladolid, Spain
| | - Ana Álvarez-Navares
- Addictions and Dual Disorders Unit, Psychiatry Service, Salamanca University Health Care Complex, Salamanca, Spain
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