101
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Donroe JH, Bhatraju EP, Tsui JI, Edelman EJ. Identification and Management of Opioid Use Disorder in Primary Care: an Update. Curr Psychiatry Rep 2020; 22:23. [PMID: 32285215 DOI: 10.1007/s11920-020-01149-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE OF REVIEW The rising prevalence of opioid use disorder (OUD) and related complications in North America coupled with limited numbers of specialists in addiction medicine has led to large gaps in treatment. Primary care providers (PCPs) are ideally suited to diagnose and care for people with OUD and are increasingly being called upon to improve access to care. This review will highlight the recent literature pertaining to the care of patients with OUD by PCPs. RECENT FINDINGS The prevalence of patients with OUD in primary care practice is increasing, and models of office-based opioid treatment (OBOT) are evolving to meet local needs of both ambulatory practices and patients. OBOT has been shown to increase access to care and demonstrates comparable outcomes when compared to more specialty-driven care. OBOT is an effective means of increasing access to care for patients with OUD. The ideal structure of OBOT depends on local factors. Future research must explore ways to increase the identification and diagnosis of patients with OUD, improve treatment retention rates, reduce stigma, and promote interdisciplinary approaches to care.
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Affiliation(s)
- Joseph H Donroe
- Yale School of Medicine, 1450 Chapel Street, Office MOB211, New Haven, CT, 06511, USA.
| | | | - Judith I Tsui
- University of Washington School of Medicine, Seattle, WA, USA
| | - E Jennifer Edelman
- Yale School of Medicine, 1450 Chapel Street, Office MOB211, New Haven, CT, 06511, USA.,Yale Schools of Medicine and Public Health, E.S. Harkness Memorial Hall, Building A, 367 Cedar Street, Ste Suite 401, New Haven, CT, 06510, USA
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102
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Nestadt PS, Bohnert ASB. Clinical Perspective on Opioids in the Context of Suicide Risk. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2020; 18:100-105. [PMID: 33162847 PMCID: PMC7587892 DOI: 10.1176/appi.focus.20200003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Psychiatrists are on the front lines of two simultaneous public health crises: the increasing rates of suicide and opioid-related deaths. In this review, the authors discuss ways in which these two classes of preventable deaths may be linked, with an emphasis on identifying and preventing both outcomes through increased understanding of their shared risk factors. As clinicians, it is crucial to maintain awareness of the ways in which opioid use may contribute to depression and suicidality, as well as how mood disorders may complicate opioid use. In light of this interplay, interventions which target risk factors for both suicide and overdose are key. Interventions include early treatment of substance dependence and depression, as well as harm reduction measures, such as provision of naloxone, medication-assisted treatments for dependency, and multidisciplinary approaches to chronic pain that do not rely solely on escalating opioid doses. It is also important to address social determinants of health, which may increase risk for both accidental and intentional overdose. The roads to overdose and suicide overlap considerably and cannot be considered separately.
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Affiliation(s)
- Paul S Nestadt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, and Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore (Nestadt); Department of Psychiatry, University of Michigan, and U.S. Department of Veterans Affairs, Ann Arbor, Michigan (Bohnert)
| | - Amy S B Bohnert
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, and Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore (Nestadt); Department of Psychiatry, University of Michigan, and U.S. Department of Veterans Affairs, Ann Arbor, Michigan (Bohnert)
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103
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Zvolensky MJ, Rogers AH, Shepherd JM, Vujanovic AA, Bakhshaie J. Anxiety sensitivity and opioid misuse and dependence among trauma-exposed adults with chronic pain. J Behav Med 2020; 43:174-184. [PMID: 32072365 DOI: 10.1007/s10865-020-00142-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 02/14/2020] [Indexed: 12/12/2022]
Abstract
It is unclear if anxiety sensitivity may serve as mechanism underlying the relation between posttraumatic stress symptom severity and opioid misuse and dependence among trauma-exposed persons with chronic pain. Therefore, the current study evaluated the explanatory role of anxiety sensitivity in the relations between posttraumatic stress symptom severity and opioid misuse and dependence. Participants included 294 trauma-exposed adults with chronic pain (71.4% female, Mage = 37.79 years, SD = 10.85, Mpain rating = 7.32/10) that reported current moderate to severe chronic pain and prescription opioid use. Participants were recruited via an online national survey in the United States of America. There were statistically significant indirect effects of posttraumatic stress symptom severity via anxiety sensitivity in relation to opioid misuse and dependence. The indirect effects of the reverse models for opioid misuse and dependence also were significant and suggest the potential for bi-directional relations; however, the magnitude of the effect was smaller in the tests of specificity than in the original models. The present findings provide initial empirical evidence that greater posttraumatic stress symptom severity is related to anxiety sensitivity, which in turn, is associated with increased opioid misuse and dependence among trauma-exposed individuals with chronic pain.
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Affiliation(s)
- Michael J Zvolensky
- Anxiety and Health Research Laboratory/Substance Use Treatment Clinic, Department of Psychology, University of Houston, 126 Fred J. Heyne Building, Suite 104, Houston, TX, 77204-5502, USA.
- Department of Behavioral Sciences, MD Anderson Cancer Center, University of Texas, Houston, TX, USA.
- HEALTH Institute, University of Houston, Houston, TX, USA.
| | - Andrew H Rogers
- Anxiety and Health Research Laboratory/Substance Use Treatment Clinic, Department of Psychology, University of Houston, 126 Fred J. Heyne Building, Suite 104, Houston, TX, 77204-5502, USA
| | - Justin M Shepherd
- Anxiety and Health Research Laboratory/Substance Use Treatment Clinic, Department of Psychology, University of Houston, 126 Fred J. Heyne Building, Suite 104, Houston, TX, 77204-5502, USA
| | - Anka A Vujanovic
- Anxiety and Health Research Laboratory/Substance Use Treatment Clinic, Department of Psychology, University of Houston, 126 Fred J. Heyne Building, Suite 104, Houston, TX, 77204-5502, USA
| | - Jafar Bakhshaie
- Anxiety and Health Research Laboratory/Substance Use Treatment Clinic, Department of Psychology, University of Houston, 126 Fred J. Heyne Building, Suite 104, Houston, TX, 77204-5502, USA
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104
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Sullivan MD. Commentary on Higgins et al. (2020): How are chronic pain, psychological distress and opioid dependence related? Addiction 2020; 115:259-260. [PMID: 31884702 DOI: 10.1111/add.14850] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 10/02/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Mark D Sullivan
- University of Washington, Psychiatry and Behavioral Sciences University of Washington System, Seattle,, WA, USA
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105
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Haider MR, Brown MJ, Gupta RD, Karim S, Olatosi B, Li X. Psycho-Social Correlates of Opioid Use Disorder among the US Adult Population: Evidence from the National Survey on Drug Use and Health, 2015-2018. Subst Use Misuse 2020; 55:2002-2010. [PMID: 32633664 PMCID: PMC7952032 DOI: 10.1080/10826084.2020.1788086] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The United States (US) has experienced an opioid epidemic over the last two decades. Drug overdose deaths increased by 21% from 2015 to 2016, with two-thirds of these deaths attributed to opioid use disorder (OUD). This study assessed the psycho-social correlates associated with OUD over 2015-2018 in the US. Methods: This study used data collected from 171,766 (weighted = 245,838,163) eligible non-institutionalized US adults in the pooled National Survey on Drug Use and Health from 2015-2018. Survey-weighted descriptive, bivariate, and multivariable analyses were performed to assess the psycho-social correlates of OUD. Results: About 0.85% of the respondents reported having OUD in the past year. About one-quarter (26.3%), one-sixth (14.8%), and half (47.3%) of the respondents with OUD reported alcohol, marijuana, and nicotine dependence, respectively. One-sixth (16.7%) had a criminal justice involvement history, and almost one-third (30.8%) experienced a major depressive episode (MDE) in the past year. In multivariable analysis, ≤64 years, White race, male gender, lower educational attainment, unemployment, large metro area residence, history of alcohol, marijuana, nicotine use disorder, history of criminal justice involvement, and MDE in previous year were associated with higher odds of OUD. In contrast, being married, non-Hispanic African American, non-Hispanic Other, and Hispanic ethnicity, good physical health, private health insurance, and higher risk perception about addictive substance use were associated with lower odds of OUD. Conclusions: OUD is more prevalent among certain sociodemographic groups in the US. Targeted interventions focusing on young, White, unmarried, male, and uninsured/Medicaid/Medicare populations should be implemented to reduce the OUD.
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Affiliation(s)
- Mohammad Rifat Haider
- Department of Social and Public Health, College of Health Sciences and Professions, Ohio University, Athens, Ohio, USA
| | - Monique J Brown
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.,South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Rajat Das Gupta
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Sabrina Karim
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Bankole Olatosi
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Xiaoming Li
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.,Department of Health, Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
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106
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Chan K, Moller M, Marsack-Topolewski C, Winston P, Jennings R, Prifti A. Age Differences in Non-Medical Prescription Opioid Use and Psychological Distress. Subst Use Misuse 2020; 55:1808-1816. [PMID: 32441182 DOI: 10.1080/10826084.2020.1765808] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background/Purpose: Prescription opioid use has been recognized as an epidemic in the United States and globally. More research is needed to understand the association of opioids and mental health for older adults. This study examined age differences in the association of non-medical prescription opioid use (NMPOU) and psychological distress, with a focus on older adult populations. Methods: This study used the 2016 National Survey on Drug Use and Health (NSDUH), and included 37,842 adults aged 18 and older. Weighted multiple regression and logistic regression analyses were used to examine the association of NMPOU and psychological distress, measured by the Kessler Psychological Distress Scale (K6). Results: NMPOU was associated with higher psychological distress (b = 0.48, SE = 0.16, p < .01). For those 50 and older, NMPOU was associated with 224% increased odds of meeting the clinical threshold for having a serious mental illness (SMI; OR = 2.24, p < .01, 95% CI: 1.23, 4.09). Conclusions: Although the prevalence of NMPOU and psychological distress trended downward throughout the lifespan, the association of NMPOU on SMI was highest among the youngest and oldest adults. These findings highlight the need for services and supports that are tailored for older adult populations. Future research is needed to investigate vulnerabilities from life stage stressors specific to older adults, which may account for the disproportionate odds of opioid use on mental health pathology. Interprofessional collaboration is needed among geriatric professionals to provide effective mental health treatment for this at-risk population.
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Affiliation(s)
- Keith Chan
- School of Social Welfare, University at Albany, SUNY, Albany, New York, USA.,School of Social Work, Eastern Michigan University, Ypsilanti, Michigan, USA
| | - Mary Moller
- School of Social Welfare, University at Albany, SUNY, Albany, New York, USA
| | | | - Priya Winston
- School of Social Welfare, University at Albany, SUNY, Albany, New York, USA
| | - Rubin Jennings
- School of Social Welfare, University at Albany, SUNY, Albany, New York, USA
| | - Andriana Prifti
- School of Social Welfare, University at Albany, SUNY, Albany, New York, USA
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107
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Macintyre PE, Roberts LJ, Huxtable CA. Management of Opioid-Tolerant Patients with Acute Pain: Approaching the Challenges. Drugs 2019; 80:9-21. [DOI: 10.1007/s40265-019-01236-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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108
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Grecco GG, Andrew Chambers R. The Penrose Effect and its acceleration by the war on drugs: a crisis of untranslated neuroscience and untreated addiction and mental illness. Transl Psychiatry 2019; 9:320. [PMID: 31780638 PMCID: PMC6882902 DOI: 10.1038/s41398-019-0661-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/05/2019] [Accepted: 11/07/2019] [Indexed: 12/15/2022] Open
Abstract
In 1939, British psychiatrist Lionel Penrose described an inverse relationship between mental health treatment infrastructure and criminal incarcerations. This relationship, later termed the 'Penrose Effect', has proven remarkably predictive of modern trends which have manifested as reciprocal components, referred to as 'deinstitutionalization' and 'mass incarceration'. In this review, we consider how a third dynamic-the criminalization of addiction via the 'War on Drugs', although unanticipated by Penrose, has likely amplified the Penrose Effect over the last 30 years, with devastating social, economic, and healthcare consequences. We discuss how synergy been the Penrose Effect and the War on Drugs has been mediated by, and reflects, a fundamental neurobiological connection between the brain diseases of mental illness and addiction. This neuroscience of dual diagnosis, also not anticipated by Penrose, is still not being adequately translated into improving clinical training, practice, or research, to treat patients across the mental illness-addictions comorbidity spectrum. This failure in translation, and the ongoing fragmentation and collapse of behavioral healthcare, has worsened the epidemic of untreated mental illness and addictions, while driving unsustainable government investment into mass incarceration and high-cost medical care that profits too exclusively on injuries and multi-organ diseases resulting from untreated addictions. Reversing the fragmentation and decline of behavioral healthcare with decisive action to co-integrate mental health and addiction training, care, and research-may be key to ending criminalization of mental illness and addiction, and refocusing the healthcare system on keeping the population healthy at the lowest possible cost.
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Affiliation(s)
- Gregory G Grecco
- Medical Scientist Training Program, Indiana University of School of Medicine, Indianapolis, IN, USA
- Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | - R Andrew Chambers
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA.
- Laboratory for Translational Neuroscience of Dual Diagnosis & Development, IU Neuroscience Research Center, Indianapolis, IN, USA.
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109
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Majid Z, Tanveer M, Ali Asghar S, Tahir F, Minhaj A, Khan HA, Sialvi T, Mahmood SH, Qadar LT, Imtiaz F. Opioids Use and Abuse: Prescription Practice, Attitude, and Beliefs among Doctors of Karachi. Cureus 2019; 11:e5253. [PMID: 31572638 PMCID: PMC6760877 DOI: 10.7759/cureus.5253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Opioid analgesics, also known as narcotics, are medicinal drugs used primarily for the management of pain secondary to any type of cancer, severe injury or surgery. Due to the ease of availability, opioids are commonly abused. In 2015, reported deaths exceeded 33,000 Americans from opioid overdose. A survey in 2013 revealed nearly 1.6 million Pakistanis abusing prescription opioids for non-medical needs. Although commonly prescribed by primary care physicians, most of them are diffident to stand by all the recommended strategies to reduce the incidence of opioid abuse. Methods A cross-sectional study was conducted during the period of August through October 2018. A sample size of 365 was determined using a 95% confidence interval at a degree of precision of 5%. A 22-item questionnaire was given to doctors with at least two years practicing experience either from a private or a public healthcare setup. Doctors who had never prescribed opioids were excluded from the study. Out of the eligible participants, 15 refused to take part in the survey, and the co-operation rate was recorded as 95.8%. Collected data were analyzed using statistical package for social science (SPSS) version 22 for Windows. Frequencies, percentages, mean, standard deviation, and chi-square were used to explore the variables. The statistical significance level was considered at p < 0.5. Results Opioids were reported to be used mainly for treating acute pain (40.5%), chronic pain (24.7%) and both acute and chronic (34.8%). A minority of doctors (29%) screened their patients for opioid addiction. A significant association (p = 0.000) between the frequency of opioid prescription and prior screening for depression was determined. Surprisingly, only 23.2% clinicians frequently screened their patients for depression before prescribing opioids. The rate of counselling regarding drug tapering was found to be 71.6%. A majority, i.e., 88%, of the respondents anticipated the misuse of opioids they prescribe whereas 74% also held a belief that patients self-medicate their untreated pain. Participants reported addiction (54%) as the most common reason for abuse followed by the role of pharmaceutical companies (43%) and pharmacies (41%). About 80.2% clinicians believed that patients addicted to opioids could get well and return to their daily routine. Conclusion The rising opioid epidemic is a major concern for doctors prescribing opioids. Adaptation of medical school curricula and appropriate training can equip doctors for better management of patients requiring opioids. This includes the screening of patients using standard risk assessment tools for opioid abuse leading to a more controlled opioid prescription practice. Dissemination of these tools will boost doctors' confidence and may help in reducing morbidity and mortality from opioid abuse.
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Affiliation(s)
- Zainab Majid
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Mahpara Tanveer
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | | | - Faryal Tahir
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Areeba Minhaj
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Hamza Aijaz Khan
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Tehzeeb Sialvi
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | | | - Laila Tul Qadar
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Fouzia Imtiaz
- Genetics, Dow University of Health Sciences, Karachi, PAK
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110
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Griesler PC, Hu MC, Wall MM, Kandel DB. Medical Use and Misuse of Prescription Opioids in the US Adult Population: 2016-2017. Am J Public Health 2019; 109:1258-1265. [PMID: 31318593 DOI: 10.2105/ajph.2019.305162] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Objectives. To characterize prescription opioid medical users and misusers among US adults.Methods. We used the 2016-2017 National Surveys on Drug Use and Health to compare medical prescription opioid users with misusers without prescriptions, misusers of own prescriptions, and misusers with both types of misuse. Multinomial logistic regressions identified substance use characteristics and mental and physical health characteristics that distinguished the groups.Results. Among prescription opioid users, 12% were misusers; 58% of misusers misused their own prescriptions. Misusers had higher rates of substance use than did medical users. Compared with with-prescription-only misusers, without-and-with-prescription misusers and without-prescription-only misusers had higher rates of marijuana use and benzodiazepine misuse; without-and-with-prescription misusers had higher rates of heroin use. Compared with without-prescription-only misusers, without-and-with-prescription and with-prescription-only misusers had higher rates of prescription opioid use disorder. Most misusers, especially with-prescription-only misusers, used prescription opioids to relieve pain. Misusers were more likely to be depressed than medical users.Conclusions. Prescription opioid misusers who misused both their own prescriptions and prescription opioid drugs not prescribed to them may be most at risk for overdose. Prescription opioid misuse is a polysubstance use problem.
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Affiliation(s)
- Pamela C Griesler
- Pamela C. Griesler, Mei-Chen Hu, Melanie M. Wall, and Denise B. Kandel are with the Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY. Pamela C. Griesler, Melanie M. Wall, and Denise B. Kandel are also with the New York State Psychiatric Institute, New York
| | - Mei-Chen Hu
- Pamela C. Griesler, Mei-Chen Hu, Melanie M. Wall, and Denise B. Kandel are with the Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY. Pamela C. Griesler, Melanie M. Wall, and Denise B. Kandel are also with the New York State Psychiatric Institute, New York
| | - Melanie M Wall
- Pamela C. Griesler, Mei-Chen Hu, Melanie M. Wall, and Denise B. Kandel are with the Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY. Pamela C. Griesler, Melanie M. Wall, and Denise B. Kandel are also with the New York State Psychiatric Institute, New York
| | - Denise B Kandel
- Pamela C. Griesler, Mei-Chen Hu, Melanie M. Wall, and Denise B. Kandel are with the Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY. Pamela C. Griesler, Melanie M. Wall, and Denise B. Kandel are also with the New York State Psychiatric Institute, New York
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111
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De Aquino JP, Sofuoglu M, Stefanovics E, Rosenheck R. Adverse Consequences of Co-Occurring Opioid Use Disorder and Cannabis Use Disorder Compared to Opioid Use Disorder Only. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2019; 45:527-537. [PMID: 31112429 DOI: 10.1080/00952990.2019.1607363] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: While there is growing interest in the possibility that cannabis may be a partial substitute for opioids, studies have yet to examine whether individuals with co-occurring opioid and cannabis use disorders (OUD and CUD) have less risk of negative outcomes than those with OUD only. Objective: This study sought to compare the sociodemographic and clinical characteristics of patients diagnosed with co-occurring OUD and CUD to patients with OUD only, CUD only, and patients with any other drug use disorders. We hypothesized that co-occurring OUD and CUD would be associated with lower risk of inpatient admissions and emergency department (ED) visits, lower rates of homelessness, and fewer opioid prescriptions. Methods: Comparisons were based on bivariate analyses, logistic and linear multiple regression models of National Veterans Health Administration (VHA) data from Fiscal Year 2012. Results: Of the 234,181 (94% male) patients diagnosed with drug use disorders, 8.6% were diagnosed with co-occurring OUD and CUD; 33.3% with OUD only; 26.5% with CUD only; and 31.6% with other drug use disorders. Compared to the OUD only group (Mean = 4.8 (SD = 8.84)), the group with co-occurring OUD and CUD was associated with a lower number of opioid prescriptions (Mean = 3.79 (SD = 8.22)) (d = -0.16), but higher likelihood of inpatient psychiatric admission (RR = 1.95) and homelessness (RR = 1.52), and no significant difference in ED visits. Conclusions: These data highlight the need to further investigate whether the complex effects of cannabis use on patients with OUD are counterbalanced by potential benefits of reduced in opioid prescribing.
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Affiliation(s)
- Joao P De Aquino
- a Department of Psychiatry, Yale University School of Medicine , New Haven , CT , USA
| | - Mehmet Sofuoglu
- a Department of Psychiatry, Yale University School of Medicine , New Haven , CT , USA.,b U.S. Department of Veterans Affairs, New England Mental Illness, Research, Education and Clinical Center (MIRECC), VA Connecticut Healthcare System , West Haven , CT , USA
| | - Elina Stefanovics
- a Department of Psychiatry, Yale University School of Medicine , New Haven , CT , USA.,b U.S. Department of Veterans Affairs, New England Mental Illness, Research, Education and Clinical Center (MIRECC), VA Connecticut Healthcare System , West Haven , CT , USA
| | - Robert Rosenheck
- a Department of Psychiatry, Yale University School of Medicine , New Haven , CT , USA.,b U.S. Department of Veterans Affairs, New England Mental Illness, Research, Education and Clinical Center (MIRECC), VA Connecticut Healthcare System , West Haven , CT , USA
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112
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Goplen CM, Verbeek W, Kang SH, Jones CA, Voaklander DC, Churchill TA, Beaupre LA. Preoperative opioid use is associated with worse patient outcomes after Total joint arthroplasty: a systematic review and meta-analysis. BMC Musculoskelet Disord 2019; 20:234. [PMID: 31103029 PMCID: PMC6525974 DOI: 10.1186/s12891-019-2619-8] [Citation(s) in RCA: 131] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 05/08/2019] [Indexed: 12/21/2022] Open
Abstract
Background A significant number of patients use opioids prior to total joint arthroplasty (TJA) in North America and there is growing concern that preoperative opioid use negatively impacts postoperative patient outcomes after surgery. This systematic review and meta-analysis evaluated the current evidence investigating the influence of preoperative opioid use on postoperative patient-reported outcomes (PRO) after total joint arthroplasty. Methods A systematic search was performed using Ovid, Embase, Cochrane Library, Scopus, Web of Science Core Collection, CINAHL on February 15th, 2018. Studies reporting baseline and postoperative PRO among those prescribed preoperative opioids and those who were not prior to total knee and hip arthroplasty were included. Standardized mean differences (SMD) in absolute difference and relative change in PRO measures between the two groups was calculated using random effect models. Results Six studies were included (n = 7356 patients); overall 24% of patients were prescribed preoperative opioids. Patients with preoperative opioid use had worse absolute postoperative PRO scores when compared to those with no preoperative opioid use (standardized mean difference (SMD) -0.53, 95% Confidence interval (CI) -0.75, − 0.32, p < 0.0001). When relative change in PRO score was analyzed, as measured by difference between postoperative and preoperative PRO scores, there was no group differences (SMD -0.26, 95% CI -0.56, 0.05, p = 0.10). Conclusion Patients prescribed preoperative opioids may attain worse overall pain and function benefits after TJA when compared to opioid-naïve patients, but do still benefit from undergoing TJA. These results suggest preoperative opioid users should be judiciously counselled regarding potential postoperative pain and function improvements after TJA. Electronic supplementary material The online version of this article (10.1186/s12891-019-2619-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- C Michael Goplen
- Department of Surgery, University of Alberta, Edmonton, AB, T6G 2B7, Canada.
| | - Wesley Verbeek
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, T6G 2R7, Canada
| | - Sung Hyun Kang
- Alberta Bone and Joint Institute, Calgary, Alberta, T2N 4Z6, Canada
| | - C Allyson Jones
- Department of Physical Therapy, University of Alberta, Edmonton, AB, T6G 2G4, Canada.,School of Public Health, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada
| | - Donald C Voaklander
- School of Public Health, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada
| | - Thomas A Churchill
- Department of Surgery, University of Alberta, Edmonton, AB, T6G 2B7, Canada
| | - Lauren A Beaupre
- Department of Surgery, University of Alberta, Edmonton, AB, T6G 2B7, Canada.,Department of Physical Therapy, University of Alberta, Edmonton, AB, T6G 2G4, Canada
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113
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Han BH, Sherman SE, Palamar JJ. Prescription opioid misuse among middle-aged and older adults in the United States, 2015-2016. Prev Med 2019; 121:94-98. [PMID: 30763631 PMCID: PMC6399064 DOI: 10.1016/j.ypmed.2019.02.018] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 12/19/2018] [Accepted: 02/08/2019] [Indexed: 11/30/2022]
Abstract
Adults ≥50 years of age have high rates of prescription opioid use. The purpose of this study is to estimate the prevalence and correlates of prescription opioid misuse among middle-aged and older adults in the United States who use prescription opioids. Data from adults age ≥ 50 from the two most recent cohorts (2015 and 2016) of the National Survey of Drug Use and Health were examined (N = 17,608). Characteristics of past-year prescription opioid misusers, including demographics, substance use, depression, chronic disease, and emergency department (ED) use, were compared to adults who used prescription opioids as prescribed in the past year and non-users. We used multivariable logistic regression to determine correlates of prescription opioid misuse among adults who used prescription opioids. Among the entire sample, 61.4% reported no past-year prescription opioid use, 36.0% reported past-year prescription opioid use without misuse, and 2.5% reported past-year prescription opioid misuse. Among past-year prescription opioid users, 6.6% reported misuse. Past-year misuse was higher among males, adults age 50-64, misusers of prescription sedatives, stimulants, and tranquilizers, users of other substances (i.e., tobacco, marijuana, cocaine), and those with alcohol use disorder. Past-year misuse was lower among adults with 2 or more chronic diseases. Past-year prescription misuse of sedatives (AOR 4.08 [95% CI 2.05-8.12]), stimulants (AOR 3.88 [95% CI 2.00-7.53]), and tranquilizers (AOR 10.02 [95% CI 6.48-15.50]) were all associated with past-year opioid misuse. Characteristics of opioid misusers determined in this study-particularly misuse of other substances-may help determine middle-aged and older adults at risk for prescription opioid misuse.
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Affiliation(s)
- Benjamin H Han
- New York University School of Medicine, Department of Medicine, Division of Geriatric Medicine and Palliative Care, 550 First Avenue, BCD 615, New York, NY 10016, United States of America; Center for Drug Use and HIV/HCV Research, NYU College of Global Public Health, 665 Broadway, 11th Floor, New York, NY 10012, United States of America; New York University Langone Medical Center, Department of Population Health, 550 First Avenue, New York, NY 10016, United States of America.
| | - Scott E Sherman
- New York University School of Medicine, Department of Medicine, Division of Geriatric Medicine and Palliative Care, 550 First Avenue, BCD 615, New York, NY 10016, United States of America; Center for Drug Use and HIV/HCV Research, NYU College of Global Public Health, 665 Broadway, 11th Floor, New York, NY 10012, United States of America; New York University Langone Medical Center, Department of Population Health, 550 First Avenue, New York, NY 10016, United States of America; VA New York Harbor Healthcare System, New York, NY 10010, United States of America
| | - Joseph J Palamar
- Center for Drug Use and HIV/HCV Research, NYU College of Global Public Health, 665 Broadway, 11th Floor, New York, NY 10012, United States of America; New York University Langone Medical Center, Department of Population Health, 550 First Avenue, New York, NY 10016, United States of America
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114
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Characteristics associated with transition from opioid initiation to chronic opioid use among opioid-naïve older adults. Geriatr Nurs 2019; 40:190-196. [DOI: 10.1016/j.gerinurse.2018.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/01/2018] [Accepted: 10/04/2018] [Indexed: 11/18/2022]
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115
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Abstract
Opioid abuse and overdosing have reached epidemic status in the United States, and this epidemic has profound negative effects on the lives of adolescents and their families. A combination of readily available opioids (including illicit opioids, such as heroin, and overprescribed prescription opioid-based painkillers) and an abuse vulnerability inherent to adolescence drives the problem. The pharmacology of opioids in the context of adolescent brain neurobiology helps explain the enhanced vulnerability to drug abuse experienced by the young. This report overviews these topics as they relate to orthopaedic procedures employed for adolescent patients.
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