1
|
Anna O, Michael A, Apostolakis M, Mammadov E, Mitka A, Kalatta MA, Koumas M, Georgiou A, Chatzittofis A, Panayiotou G, Gergiou P, Zarate CA, Zanos P. Ketamine and hydroxynorketamine as novel pharmacotherapies for the treatment of Opioid-Use Disorders. Biol Psychiatry 2024:S0006-3223(24)01591-9. [PMID: 39293647 DOI: 10.1016/j.biopsych.2024.09.008] [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: 07/10/2024] [Revised: 08/30/2024] [Accepted: 09/11/2024] [Indexed: 09/20/2024]
Abstract
Opioid use disorder (OUD) has reached epidemic proportions, with many countries facing high opioid use and related fatalities. Although currently-prescribed medications for OUD (MOUD) are considered life-saving, they inadequately address negative affect and cognitive impairment, resulting in high relapse rates to non-medical opioid use, even years after drug cessation (protracted abstinence). Evidence supports the notion that ketamine, an anesthetic and rapid-acting antidepressant drug, holds promise as a candidate for OUD treatment, including the management of acute withdrawal somatic symptoms, negative affect during protracted opioid abstinence and prevention of re-taking non-medical opioids. In this review, we comprehensively discuss preclinical and clinical research evaluating ketamine and its metabolites as potential novel therapeutic strategies for treating OUDs. We further examine evidence supporting the relevance of the molecular targets of ketamine and its metabolites in relation to their potential effects and therapeutic outcomes in OUDs. Overall, existing evidence demonstrates that ketamine and its metabolites can effectively modulate pathophysiological processes affected in OUD, suggesting their promising therapeutic role in the treatment of OUD and the prevention of return to opioid use during abstinence.
Collapse
Affiliation(s)
- Onisiforou Anna
- Department of Psychology, University of Cyprus, Nicosia, 2109, Cyprus
| | - Andria Michael
- Department of Psychology, University of Cyprus, Nicosia, 2109, Cyprus
| | - Markos Apostolakis
- Department of Psychology, University of Cyprus, Nicosia, 2109, Cyprus; Center for Applied Neuroscience, University of Cyprus, Nicosia, Cyprus
| | - Elmar Mammadov
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201 USA
| | - Angeliki Mitka
- Department of Psychology, University of Cyprus, Nicosia, 2109, Cyprus
| | - Maria A Kalatta
- Department of Psychology, University of Cyprus, Nicosia, 2109, Cyprus
| | - Morfeas Koumas
- Department of Biological Sciences, University of Cyprus, Nicosia, 2109, Cyprus
| | - Andrea Georgiou
- Department of Psychology, University of Cyprus, Nicosia, 2109, Cyprus
| | - Andreas Chatzittofis
- Department of Clinical Sciences/Psychiatry, Umeå University, Umeå, Sweden; Medical School, University of Cyprus, Nicosia, Cyprus
| | - Georgia Panayiotou
- Department of Psychology, University of Cyprus, Nicosia, 2109, Cyprus; Center for Applied Neuroscience, University of Cyprus, Nicosia, Cyprus
| | - Polymnia Gergiou
- Department of Psychology, University of Wisconsin-Milwaukee, Wisconsin, 53211, USA
| | - Carlos A Zarate
- Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Panos Zanos
- Department of Psychology, University of Cyprus, Nicosia, 2109, Cyprus; Center for Applied Neuroscience, University of Cyprus, Nicosia, Cyprus; Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201 USA.
| |
Collapse
|
2
|
Oernskov MP, Kurita GP, Herling SF, Sjøgren P, Skurtveit SO, Odsbu I, Ekholm O, Wildgaard K. Opioid use after surgical treatment in the Danish population-Protocol for a register-based cohort study. Acta Anaesthesiol Scand 2024. [PMID: 39129648 DOI: 10.1111/aas.14506] [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: 07/09/2024] [Accepted: 07/18/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND Over the past 25 years, global opioid consumption has increased. Denmark ranks fifth in opioid use globally, exceeding other Scandinavian countries. Postsurgical pain is a common reason for opioid prescriptions, but opioid use patterns after patient discharge from the hospital are unclear. This study examines trends in opioid prescription among Danish surgical patients over a year. METHODS This register-based cohort study will use data from Danish governmental databases related to patients undergoing the 10 most frequent surgical procedures in 2018, excluding cancer-related and minor procedures. The primary outcome will be the dispensed postoperative opioid prescriptions at retail pharmacies over four quarters. Secondary analyses will include associations with sex, age, education attainment, and oral morphine equivalent quotient. Surgical treatments and diagnoses will be identified using NOMESCO procedure codes and ICD-10 codes. Opioids will be identified by ATC codes N02A and R05DA04. Subjects will be classified as preoperative opioid consumers or non-opioid consumers based on opioid prescriptions redeemed in the 6 months before surgery. DISCUSSION The study will use extensive national register-based data, ensuring consistent data collection and enhancing the generalizability of the findings to similar healthcare systems. The study may identify high-risk populations for long-term opioids and provide information to support opioid prescribing guidelines and public health policies.
Collapse
Affiliation(s)
- Mark Puch Oernskov
- Department of Anaesthesiology, Pain and Respiratory Support, Neuroscience Centre Rigshospitalet, Copenhagen University Hospital, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Geana Paula Kurita
- Department of Anaesthesiology, Pain and Respiratory Support, Neuroscience Centre Rigshospitalet, Copenhagen University Hospital, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
- Section of Palliative Medicine, Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Suzanne Forsyth Herling
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
- Neuroscience Centre, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Per Sjøgren
- Section of Palliative Medicine, Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Svetlana Ondrasova Skurtveit
- Department of Chronic Diseases, The Norwegian Institute of Public Health, Oslo, Norway
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingvild Odsbu
- Department of Chronic Diseases, The Norwegian Institute of Public Health, Oslo, Norway
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Kim Wildgaard
- Department of Anaesthesiology and Herlev Anaesthesia Critical and Emergency Care Science Unit, Copenhagen University Hospital Herlev-Gentofte, Denmark
| |
Collapse
|
3
|
Kyei EF, Zhang L, Leveille S. A Conceptual Analysis of Opioid Use Disorder in Chronic Noncancer Pain Using Rodger's Evolutionary Approach. Pain Manag Nurs 2024; 25:354-362. [PMID: 38729848 DOI: 10.1016/j.pmn.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 02/15/2024] [Accepted: 03/24/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE This study aims to examine the complex nature of opioid use disorder (OUD) in chronic noncancer pain (CNCP) by exploring its antecedents, attributes, consequences, and interrelated concepts. DESIGN A systematic literature review was conducted to gather relevant studies published between 2015 and 2022, utilizing the CINAHL, MEDLINE, PsycINFO, and PubMed databases. DATA SOURCES The selected databases provided a comprehensive range of articles related to OUD in CNCP, ensuring a comprehensive topic analysis. METHODS Twenty-two articles meeting the inclusion criteria were included in the analysis. These articles were critically reviewed and analyzed to identify key themes and concepts related to OUD in CNCP. RESULTS The findings of this study shed light on the multifaceted aspects of OUD in CNCP, including its antecedents, such as goals of physical function improvement, prescription of opioids for CNCP, social influences, and mental health dynamics. The attributes of OUD in CNCP were identified as chronic pain, noncancer pain, opioid use, misuse, and abuse. OUD's consequences in CNCP include impaired functioning, increased health risks, psychological distress, social challenges, and economic burden. CONCLUSION Understanding the complexity of OUD in CNCP is crucial for improving patient outcomes. Collaborative efforts among healthcare systems, regulatory bodies, and professional organizations are needed to develop policies promoting safe and effective pain management while mitigating risks associated with opioid use in CNCP. IMPLICATIONS FOR PRACTICE Implementing policy recommendations derived from this study enhances care and outcomes for individuals with CNCP. By addressing complex issues of OUD in CNCP and adopting evidence-based practices, healthcare providers can optimize pain management and promote well-being in CNCP patients.
Collapse
Affiliation(s)
- Evans F Kyei
- Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts.
| | - Lingling Zhang
- Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts
| | - Suzanne Leveille
- Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts
| |
Collapse
|
4
|
Hébert AH, Hill AL. Impact of opioid overdoses on US life expectancy and years of life lost, by demographic group and stimulant co-involvement: a mortality data analysis from 2019 to 2022. LANCET REGIONAL HEALTH. AMERICAS 2024; 36:100813. [PMID: 38978785 PMCID: PMC11228948 DOI: 10.1016/j.lana.2024.100813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/21/2024] [Accepted: 05/29/2024] [Indexed: 07/10/2024]
Abstract
Background The United States' opioid crisis is worsening, with the number of deaths reaching 81,806 in 2022 after more than tripling over the past decade. This study aimed to comprehensively characterize changes in burden of opioid overdose mortality in terms of life expectancy reduction and years of life lost between 2019 and 2022, including differential burden across demographic groups and the contribution of polysubstance use. Methods Using life tables and counts for all-cause and opioid overdose deaths from the National Center for Health Statistics, we constructed cause-eliminated life tables to estimate mortality by age in the absence of opioid-related deaths. We calculated the loss in life expectancy at birth (LLE) and total years of life lost (YLL) due to opioid overdose deaths by state of residency, sex, racial/ethnic group, and co-involvement of cocaine and psychostimulants. Findings Opioid-related deaths in the US led to an estimated 3.1 million years of life lost in 2022 (38 years per death), compared to 2.0 million years lost in 2019. Relative to a scenario with no opioid mortality, we estimate that opioid-related deaths reduced life expectancy nationally by 0.67 years in 2022 vs 0.52 years in 2019. This LLE worsened in all racial/ethnic groups during the study period: 0.76 y-0.96 y for white men, 0.36 y-0.55 y for white women, 0.59 y-1.1 y for Black men, 0.27 y-0.53 y for Black women, 0.31 y-0.82 y for Hispanic men, 0.19 y-0.31 y for Hispanic women, 0.62 y-1.5 y for American Indian/Alaska Native (AI/AN) men, 0.43 y-1 y for AI/AN women, 0.09 y-0.2 y for Asian men, and 0.08 y-0.13 y for Asian women. Nearly all states experienced an increase in years of life lost (YLL) per capita from 2019 to 2022, with YLL more than doubling in 16 states. Cocaine or psychostimulants with abuse potential (incl. methamphetamines) were involved in half of all deaths and years of life lost in 2022, with substantial variation in the predominant drug class by state and racial/ethnic group. Interpretation The burden of opioid-related mortality increased dramatically in the US between 2019 and 2022, coinciding with the period of the COVID-19 pandemic and the associated disruptions to social, economic, and health systems. Opioid overdose deaths are an important contributor to decreasing US life expectancy, and Black, Hispanic, and Native Americans now experience mortality burdens approaching or exceeding white Americans. Funding None.
Collapse
Affiliation(s)
- Anne H. Hébert
- Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Alison L. Hill
- Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
5
|
Burt CI, McCurdy M, Schneider MB, Zhang T, Weir TB, Langhammer CG, Pensy RA, Akabudike NM, Henn RF. Preoperative opioid use is associated with worse two-year patient-reported outcomes after hand surgery: A retrospective cohort study. J Hand Microsurg 2024; 16:100060. [PMID: 39035863 PMCID: PMC11257131 DOI: 10.1016/j.jham.2024.100060] [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: 07/23/2024] Open
Abstract
Introduction Opioid overprescribing has caused a substantial increase in opioid related deaths and billions of dollars in additional healthcare costs. Orthopaedic surgeons commonly prescribe opioids in the perioperative period; however, research has shown preoperative opioid use may be associated with worse postoperative outcomes. Despite this body of evidence, there are few studies investigating the association between preoperative opioid use and two-year outcomes after hand surgery. Materials and methods This study evaluated two-year postoperative patient-reported outcomes in patients who used opioids prior to hand surgery, and those who did not. Patients completed pre and postoperative questionnaires including Patient-Reported Outcomes Measurement Information System (PROMIS) domains, the Brief Michigan Hand Questionnaire (BMHQ), and other questionnaires related to pain, function, and satisfaction. 342 patients undergoing upper-extremity surgery were enrolled into a prospective orthopaedic surgery outcome registry, and 69.9% completed the follow-up surveys. Preoperative opioid use and its association to patient outcome scores was analyzed through bivariate analysis. Significant associations were further tested by multivariable analysis to determine independent predictors. Results Preoperative opioid use was associated with worse two-year PROMIS Fatigue (p < .01), PROMIS Anxiety (p < .01), PROMIS Depression (p < .01), SSQ-8 (p = .01), BMHQ (p = .01), NPS Hand (p < .01) and MODEMS met expectations (p = .03). No significant differences were observed in patient-reported outcome change scores. Multivariable analysis demonstrated that preoperative opioid use was predictive of worse two-year PROMIS Fatigue (p < .01), PROMIS Anxiety (p < .01), PROMIS Depression (p = .02), BMHQ (p = .01), SSQ-8 (p < .01), NPS Hand (p = .02) and MODEMS met expectations (p < .01). Conclusion Preoperative opioid use was associated with worse patient-reported outcomes two years after elective hand surgery. There was no significant difference in the improvement from baseline between the two groups. Clinically significant differences were observed in follow-up PROMIS Anxiety, BMHQ and NPS - Hand scores. Clinically significant change scores were noted in both groups for PROMIS PF, PROMIS PI, PROMIS SS, BMHQ, and NPS - Hand.
Collapse
Affiliation(s)
- Cameran I. Burt
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Michael McCurdy
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Matheus B. Schneider
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Tina Zhang
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Tristan B. Weir
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Raymond A. Pensy
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ngozi M. Akabudike
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - R Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| |
Collapse
|
6
|
Laing R, Donnelly CA. Evolution of an epidemic: Understanding the opioid epidemic in the United States and the impact of the COVID-19 pandemic on opioid-related mortality. PLoS One 2024; 19:e0306395. [PMID: 38980856 PMCID: PMC11233025 DOI: 10.1371/journal.pone.0306395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 05/31/2024] [Indexed: 07/11/2024] Open
Abstract
We conduct this research with a two-fold aim: providing a quantitative analysis of the opioid epidemic in the United States (U.S.), and exploring the impact of the COVID-19 pandemic on opioid-related mortality. The duration and persistence of the opioid epidemic lends itself to the need for an overarching analysis with extensive scope. Additionally, studying the ramifications of these concurrent severe public health crises is vital for informing policies to avoid preventable mortality. Using data from CDC WONDER, we consider opioid-related deaths grouped by Census Region spanning January 1999 to October 2022 inclusive, and later add on a demographic component with gender-stratification. Through the lens of key events in the opioid epidemic, we build an interrupted time series model to reveal statistically significant drivers of opioid-related mortality. We then employ a counterfactual to approximate trends in the absence of COVID-19, and estimate excess opioid-related deaths (defined as observed opioid-related deaths minus projected opioid-related deaths) associated with the pandemic. According to our model, the proliferation of fentanyl contributed to sustained increases in opioid-related death rates across three of the four U.S. census regions, corroborating existing knowledge in the field. Critically, each region has an immediate increase to its opioid-related monthly death rate of at least 0.31 deaths per 100,000 persons at the start of the pandemic, highlighting the nationwide knock-on effects of COVID-19. There are consistent positive deviations from the expected monthly opioid-related death rate and a sizable burden from cumulative excess opioid-related deaths, surpassing 60,000 additional deaths nationally from March 2020 to October 2022, ∼70% of which were male. These results suggest that robust, multi-faceted measures are even more important in light of the COVID-19 pandemic to prevent overdoses and educate users on the risks associated with potent synthetic opioids such as fentanyl.
Collapse
Affiliation(s)
- Rachel Laing
- Department of Statistics, University of Oxford, Oxford, United Kingdom
- Division of Infectious Diseases, Massachusetts General Hospital, Cambridge, Massachusetts, United States of America
| | - Christl A Donnelly
- Department of Statistics, University of Oxford, Oxford, United Kingdom
- Pandemic Sciences Institute, University of Oxford, Oxford, United Kingdom
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, United Kingdom
| |
Collapse
|
7
|
Feinstein AB, Brown K, Dunn AL, Neville AJ, Sokol O, Poupore-King H, Sturgeon JA, Kwon AH, Griffin AT. Where do we start? Health care transition in adolescents and young adults with chronic primary pain. Pain 2024:00006396-990000000-00645. [PMID: 38981053 DOI: 10.1097/j.pain.0000000000003324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 05/27/2024] [Indexed: 07/11/2024]
Affiliation(s)
- Amanda B Feinstein
- Department of Anesthesiology, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Kimberly Brown
- Department of Psychology, Palo Alto University, Palo Alto, CA, United States
| | - Ashley L Dunn
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
| | - Alexandra J Neville
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | | | - Heather Poupore-King
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - John A Sturgeon
- Department of Anesthesiology, University of Michigan School of Medicine, Ann Arbor, MI, United States
| | - Albert H Kwon
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Anya T Griffin
- Department of Pediatrics & Department of Psychiatry and Behavioral Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States
- Children's Hospital Los Angeles, Los Angeles, CA, United States
| |
Collapse
|
8
|
Rehl D, Mangapora M, Love M, Love C, Shaw K, McCarthy J, Beverly EA. Feasibility of a cinematic-virtual reality training program about opioid use disorder for osteopathic medical students: a single-arm pre-post study. J Osteopath Med 2024; 0:jom-2023-0188. [PMID: 38965036 DOI: 10.1515/jom-2023-0188] [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: 08/09/2023] [Accepted: 05/16/2024] [Indexed: 07/06/2024]
Abstract
CONTEXT Opioid use disorder (OUD) has a considerable morbidity and mortality in the United States. Healthcare providers are key points of contact for those with OUD; however, some providers may hold stigma toward OUD. Stigma toward OUD can lead to lower quality of care and more negative health outcomes. Thus, new trainings designed to reduce stigma toward OUD while increasing empathy are critical. We created a web-based cinematic virtual reality (cine-VR) training program on OUD for osteopathic medical students. OBJECTIVES The aim of this pilot study was to assess changes in stigma toward OUD and empathy before and after the online cine-VR training program on OUD. METHODS We employed a single-arm, pre- and posttest pilot study to assess changes in stigma toward OUD and empathy. Osteopathic medical students from one large medical school in the Midwest with three campuses were invited to participate in the online cine-VR training. Participants completed two surveys before and after the cine-VR training. We performed paired t tests to examine changes in stigma toward OUD and empathy scores before and after the cine-VR OUD training program. RESULTS A total of 48 participants completed the training. We observed a decrease in stigma toward OUD posttraining (t=4.402, p<0.001); this change had a Cohen's d of 0.64, indicating a medium effect. We also observed an increase in participants' empathy scores posttraining (t=-2.376, p=0.023), with a Cohen's d of 0.40 signifying a small effect. CONCLUSIONS Findings from this pilot study suggest that the online cine-VR training may reduce stigma toward OUD while increasing empathy. Future research employing a randomized controlled trial design with a larger, more diverse sample and a proper attention control condition is needed to confirm the effectiveness of the online cine-VR training. If confirmed, this cine-VR training may be an accessible approach to educating osteopathic medical students about OUD.
Collapse
Affiliation(s)
- Dominique Rehl
- Department of Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
| | - Mason Mangapora
- Department of Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
| | - Matthew Love
- Department of Primary Care, 105810 Ohio University Heritage College of Osteopathic Medicine, The Ohio University Diabetes Institute , Athens, OH, USA
| | - Carrie Love
- Department of Primary Care, 105810 Ohio University Heritage College of Osteopathic Medicine, The Ohio University Diabetes Institute , Athens, OH, USA
| | - Kerri Shaw
- Ohio Alliance for Population Health, Ohio University, Athens, OH, USA
| | - John McCarthy
- College of Health Sciences Professions, Ohio University, Athens, OH, USA
| | - Elizabeth A Beverly
- Department of Primary Care, 105810 Ohio University Heritage College of Osteopathic Medicine, The Ohio University Diabetes Institute , Athens, OH, USA
| |
Collapse
|
9
|
Honda A, Iizuka Y, Tokue M, Takasawa E, Ishiwata S, Tomomatsu Y, Ito S, Inomata K, Okada A, Matsui H, Yasunaga H, Chikuda H. Association Between Early Surgery and Postoperative Opioid Use in Patients With Lumbar Disc Herniation: A Propensity Score-Matching Analysis Using an Administrative Claims Database in Japan. Global Spine J 2024; 14:1738-1744. [PMID: 36696513 PMCID: PMC11268305 DOI: 10.1177/21925682231154854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES This study aimed to investigate whether early surgery shortens the duration of opioid use in patients who underwent surgery with lumbar disc herniation. METHODS We extracted patients who underwent surgery at least 2 weeks after they were diagnosed with lumbar disc herniation between April 2014 and May 2021. Opioid use after surgery was compared between patients who underwent surgery within 90 days (early surgery group) and 90 days or later (late surgery group). Propensity-score-matching analysis and multivariable Cox hazard regression analysis with a restricted cubic spline model were conducted to evaluate the association between the timing of surgery and termination of opioid use after surgery. RESULTS A total of 1597 eligible patients were identified, with 807 (51%) in the early surgery group. In the propensity-score-matched cohort, the early surgery group had a significantly lower proportion of opioid use than the control group (28% vs 48%, percent difference -20%, P < .001). Multivariable Cox hazard regression analysis showed that early surgery was significantly associated with the earlier termination of opioid use (HR, 3.13; 95% CI, 1.97-4.97; P < .001). Restricted cubic spline model showed a monotonically decreased hazard ratio and decreased hazard ratio of .50 in patients who underwent surgery 111 days or later after the diagnosis. CONCLUSIONS Early surgery, especially within 90 days, was associated with earlier opioid use termination after surgery. Regarding the duration of opioid use following surgery, surgical treatment may be preferable to perform within around 4 months after the diagnosis.
Collapse
Affiliation(s)
- Akira Honda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Yoichi Iizuka
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Mieda Tokue
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Eiji Takasawa
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Sho Ishiwata
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Yusuke Tomomatsu
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Shunsuke Ito
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Kazuhiro Inomata
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| |
Collapse
|
10
|
Garcia S, Teater J, Trimble C, Entrup P, Hall OE, Hall OT. Years of life lost due to unintentional drug overdose relative to the leading underlying causes of death in the United States: a comparative analysis of excess mortality 2017-2019. J Addict Dis 2024; 42:205-209. [PMID: 36876385 DOI: 10.1080/10550887.2023.2173929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
The present study aims to compare Years of Life Lost for unintentional drug overdose and the leading underlying causes of death in the United States annually from 2017 to 2019. Years of Life Lost provide valuable context to incident deaths when comparing the relative mortality burden of underlying causes of death. Prior research has shown unintentional drug overdose was the third leading cause of Years of Life Lost in the state of Ohio in 2017. However, this finding has yet to be replicated at the national level in the US. Death statistics for 2017-2019 were accessed via CDC WONDER. Years of Life Lost were calculated for unintentional drug overdose and each of the top five causes of incident deaths in the US during the study period. Unintentional drug overdose caused nearly seven million Years of Life Lost in the US during the three-year period of study and was the fourth leading cause of Years of Life Lost after cancer, heart disease and other accidents. Incidence alone provides an incomplete picture of the effect of unintentional drug overdose on overall mortality burden in the US. Years of Life Lost give critical context to the overdose crisis, underscoring unintentional drug overdose as a leading cause of premature mortality.
Collapse
Affiliation(s)
| | - Julie Teater
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Candice Trimble
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Parker Entrup
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Orman E Hall
- College of Health Sciences and Professions, Ohio University, Athens, OH, USA
- National Emerging Threat Initiative, National HIDTA Assistance Center Miami, Miami, FL, USA
| | - O Trent Hall
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, USA
| |
Collapse
|
11
|
Weber A, Smith JB, Simpson MC, Brinkmeier JV, Massa ST. Chronic Opioid Prescribing After Common Otolaryngology Procedures in Adults. Otolaryngol Head Neck Surg 2024. [PMID: 38881383 DOI: 10.1002/ohn.858] [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: 12/30/2023] [Revised: 05/12/2024] [Accepted: 05/29/2024] [Indexed: 06/18/2024]
Abstract
OBJECTIVE (1) Describe short and long-term opioid prescribing patterns and variation after common otolaryngologic procedures and (2) assess risk factors for chronic opioid use in this cohort. STUDY DESIGN Retrospective cohort. SETTING Optum's deidentified Integrated Claims-Clinical data set. METHODS An adult cohort of patients undergoing common otolaryngology procedures from 2010 to 2017 was identified. Associations between procedure and other covariates with any initial opioid prescription and continuous opioid prescriptions were assessed with multivariable modeling. Opioid use was defined as continuous if a new prescription was filled within 30 days of the previous prescription. A time-to-event analysis assessed continuous prescriptions from the index procedure to end of the last continuous opioid prescription. RESULTS Among a cohort of 19,819 patients undergoing predominately laryngoscopy procedures (12,721, 64.2%), 2585 (13.0%) received an opioid prescription with variation in receiving a prescription, daily dose, and total initially prescribed dose varying by procedure, patient demographics, provider characteristics, and facility type. Opioids were prescribed most frequently after tonsillectomy (45.4%) and least frequently after laryngoscopy with interventions (3.9%), which persisted in the multivariable models. Overall rates of continuous use at 180 and 360 days were 0.48% and 0.27%, respectively. Among patients receiving an initial opioid prescription, maintaining continuous prescriptions was associated with tonsillectomy procedures, age (adjusted hazard ratio [aHR]: 0.997 per year, 95% confidence interval [CI]: 0.993-0.999), opioid prescriptions 6 months preprocedure (aHR: 0.42, 95% CI: 0.37-0.47), and nonotolaryngology initial prescribers (aHRs: <1, P < .05). CONCLUSION There is substantial variation in initial prescribing practices and continuous opioid prescriptions after common Otolaryngology procedures, but the overall rate of maintaining a continuous prescription starting after these procedures is very low. LEVEL OF EVIDENCE Level 3.
Collapse
Affiliation(s)
- Alizabeth Weber
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St Louis, Missouri, USA
| | - Joshua B Smith
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St Louis, Missouri, USA
| | - Matthew C Simpson
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St Louis, Missouri, USA
- Advanced Health Data (AHEAD) Institute, Saint Louis University, St Louis, Missouri, USA
| | - Jennifer V Brinkmeier
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Sean T Massa
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St Louis, Missouri, USA
| |
Collapse
|
12
|
Yuan Y, Kasson E, Taylor J, Cavazos-Rehg P, De Choudhury M, Aledavood T. Examining the Gateway Hypothesis and Mapping Substance Use Pathways on Social Media: Machine Learning Approach. JMIR Form Res 2024; 8:e54433. [PMID: 38713904 PMCID: PMC11109860 DOI: 10.2196/54433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 03/15/2024] [Accepted: 04/01/2024] [Indexed: 05/09/2024] Open
Abstract
BACKGROUND Substance misuse presents significant global public health challenges. Understanding transitions between substance types and the timing of shifts to polysubstance use is vital to developing effective prevention and recovery strategies. The gateway hypothesis suggests that high-risk substance use is preceded by lower-risk substance use. However, the source of this correlation is hotly contested. While some claim that low-risk substance use causes subsequent, riskier substance use, most people using low-risk substances also do not escalate to higher-risk substances. Social media data hold the potential to shed light on the factors contributing to substance use transitions. OBJECTIVE By leveraging social media data, our study aimed to gain a better understanding of substance use pathways. By identifying and analyzing the transitions of individuals between different risk levels of substance use, our goal was to find specific linguistic cues in individuals' social media posts that could indicate escalating or de-escalating patterns in substance use. METHODS We conducted a large-scale analysis using data from Reddit, collected between 2015 and 2019, consisting of over 2.29 million posts and approximately 29.37 million comments by around 1.4 million users from subreddits. These data, derived from substance use subreddits, facilitated the creation of a risk transition data set reflecting the substance use behaviors of over 1.4 million users. We deployed deep learning and machine learning techniques to predict the escalation or de-escalation transitions in risk levels, based on initial transition phases documented in posts and comments. We conducted a linguistic analysis to analyze the language patterns associated with transitions in substance use, emphasizing the role of n-gram features in predicting future risk trajectories. RESULTS Our results showed promise in predicting the escalation or de-escalation transition in risk levels, based on the historical data of Reddit users created on initial transition phases among drug-related subreddits, with an accuracy of 78.48% and an F1-score of 79.20%. We highlighted the vital predictive features, such as specific substance names and tools indicative of future risk escalations. Our linguistic analysis showed that terms linked with harm reduction strategies were instrumental in signaling de-escalation, whereas descriptors of frequent substance use were characteristic of escalating transitions. CONCLUSIONS This study sheds light on the complexities surrounding the gateway hypothesis of substance use through an examination of web-based behavior on Reddit. While certain findings validate the hypothesis, indicating a progression from lower-risk substances such as marijuana to higher-risk ones, a significant number of individuals did not show this transition. The research underscores the potential of using machine learning with social media analysis to predict substance use transitions. Our results point toward future directions for leveraging social media data in substance use research, underlining the importance of continued exploration before suggesting direct implications for interventions.
Collapse
Affiliation(s)
- Yunhao Yuan
- Department of Computer Science, Aalto University, Espoo, Finland
| | - Erin Kasson
- School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Jordan Taylor
- Carnegie Mellon University, Pittsburgh, PA, United States
| | - Patricia Cavazos-Rehg
- School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | | | | |
Collapse
|
13
|
Sankaran D, Rawat S, Kachelmeyer JL, Li ES, Reynolds AM, Rawat M, Chandrasekharan P. Severe Neonatal Opioid Withdrawal Requiring Pharmacotherapy: Impact of Region of Residence. Am J Perinatol 2024; 41:e654-e663. [PMID: 35973797 DOI: 10.1055/a-1925-1659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Our objective was to evaluate the trend and to assess the impact of maternal region of residence in Western New York (WNY), on severe neonatal opioid withdrawal syndrome (NOWS). STUDY DESIGN Term infants' born at gestational age greater than or equal to 37 weeks with severe NOWS, defined as withdrawal resulting in the receipt of pharmacologic therapy from WNY admitted to our neonatal intensive care unit (NICU) from January 1, 2008 to December 31, 2016, were included. Severe NOWS admissions to our NICU from the following five regions were controlled with birth and insurance data: (1) Urban North, (2) Erie Coastal, (3) Niagara Frontier, (4) Southern Tier, and (5) Urban South. RESULTS "Urban South" residence was associated with an increased risk of severe NOWS (adjusted odds ratio = 1.8, 97.5% confidence interval: 1.1-2.9). The trend in admission for severe NOWS doubled between 2008 to 2010 and 2014 to 2016 (p = 0.01). More infants born to maternal nonprescribed opioid users were placed in foster care at discharge (36.5 vs. 1.9%, p < 0.001). CONCLUSION In WNY, neonates born to mothers from the "Urban South" were twice at risk of being admitted for severe NOWS. One-third of infants with severe NOWS after nonprescribed opioid use were placed in foster care. Implementing targeted strategies at the community level may help improve outcomes in NOWS. KEY POINTS · Maternal region of residence is a risk factor for severe neonatal opioid withdrawal.. · Admissions for severe neonatal opioid withdrawal trended up from 2008 to 2010 to 2014 to 2016.. · One-third of the infants born to mothers on nonprescribed opioids were discharged to foster care..
Collapse
Affiliation(s)
- Deepika Sankaran
- Division of Neonatology, Department of Pediatrics, University at Buffalo, Buffalo, New York
- Division of Neonatology, Department of Pediatrics, University of California at Davis, Sacramento, California
| | - Shikha Rawat
- Department of Economics, Stony Brook University, Stony Brook, New York
- Research Analyst, American Express, New York, New York
| | - Jennifer L Kachelmeyer
- Division of Neonatology, Department of Pediatrics, University at Buffalo, Buffalo, New York
| | - Emily S Li
- Division of Neonatology, Department of Pediatrics, University at Buffalo, Buffalo, New York
| | - Anne M Reynolds
- Division of Neonatology, Department of Pediatrics, University at Buffalo, Buffalo, New York
| | - Munmun Rawat
- Division of Neonatology, Department of Pediatrics, University at Buffalo, Buffalo, New York
| | | |
Collapse
|
14
|
M FM, Doug LM, Peter F, Vivian F G, Wiley J, P Todd K, William M, Mai P, David S, Tom S, Ryan W, William Z, M YA, Lf CH. Correlates of overdose among 2711 people who use drugs and live in 7 rural US sites. Drug Alcohol Depend 2024; 258:111261. [PMID: 38581919 DOI: 10.1016/j.drugalcdep.2024.111261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 02/29/2024] [Accepted: 03/03/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Overdose rates in rural areas have been increasing globally, with large increases in the United States. Few studies, however, have identified correlates of non-fatal overdose among rural people who use drugs (PWUD). The present analysis describes correlates of nonfatal overdose among a large multistate sample of rural PWUD. METHODS This is a cross-sectional analysis of data gathered via surveys with PWUD recruited through seven Rural Opioid Initiative (ROI) sites. Descriptive analyses were conducted to assess the prevalence of past 30-day overdose. Generalized estimating equations were used to estimate a series of multivariable models quantifying relationships of select factors to past-month overdose; factors were selected using the Risk Environment Framework. RESULTS The multisite sample included 2711 PWUD, 6% of whom reported overdosing in the past 30 days. In the fully adjusted model, houselessness (AOR=2.27, 95%CI[1.48, 3.48]), a positive test result for Hepatitis C infection (AOR=1.73 95%CI[1.18, 2.52]) and heroin/fentanyl use (AOR= 8.58 95%CI [3.01, 24.50]) were associated with an increased risk of reporting past 30-day overdose, while having a high-school education or less was associated with reduced odds of overdose (AOR=0.52, 95% CI[0.37, 0.74]). CONCLUSION As in urban areas, houselessness, Hepatitis C infection, and the use of heroin and fentanyl were significant correlates of overdose. Widespread access to overdose prevention interventions - including fentanyl test strips and naloxone - is critical in this rural context, with particular outreach needed to unhoused populations, people living with Hepatitis C, and people using opioids.
Collapse
Affiliation(s)
- Fadanelli Monica M
- Rollins School of Public Health, 1518 Clifton Dr, Atlanta, GA 30329, USA.
| | | | - Friedmann Peter
- UMass Chan Medical School - Baystate, 3601 Main Street, Springfield, MA 01199, USA
| | - Go Vivian F
- Gillings School of Global Public Health, 135 Dauer Dr, Chapel Hill, NC 27599, USA
| | - Jenkins Wiley
- SIU School of Medicine, 801 N Rutledge St., Springfield, IL 62702, USA
| | - Korthuis P Todd
- Oregon Health & Science University, School of Medicine, 3266 SW Research Dr, Portland, OR 97239, USA
| | - Miller William
- Gillings School of Global Public Health, 135 Dauer Dr, Chapel Hill, NC 27599, USA
| | - Pho Mai
- The University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, IL 60637, USA
| | - Seal David
- Tulane School of Public Health & Tropical Medicine, 1440 Canal St, New Orleans, LA 70112, USA
| | - Stopka Tom
- Tufts University School of Medicine, Public Health and Community Medicine, 136 Harrison Avenue, Boston, MA 02111, USA
| | - Westergaard Ryan
- University of Wisconsin, School of Medicine and Public Health, 1685 Highland Ave, Madison, WI 53705-2281, USA
| | - Zule William
- Research Triangle Park, 3040 East Cornwallis Road, P.O. Box 12194, NC 27709-2194, USA
| | - Young April M
- University of Kentucky, College of Public Health, 111 Washington Ave., Lexington, KY 40536, USA
| | - Cooper Hannah Lf
- Rollins School of Public Health, 1518 Clifton Dr, Atlanta, GA 30329, USA
| |
Collapse
|
15
|
Johnson A, Nguyen F, Richardson M, Rabi S, Mann S, Gilron I, Yach J, Milne B, Evans G, Parlow J. Postdischarge opioid use after lumbar spine surgery among older adults in Ontario: a population-based cohort study. Can J Surg 2024; 67:E252-E260. [PMID: 38925858 PMCID: PMC11230664 DOI: 10.1503/cjs.003723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Prescription opioid use places a considerable economic burden on health care systems. Older patients undergoing surgical procedures for painful conditions commonly receive opioids pre- and postoperatively, and are susceptible to adverse reactions. This study explores predictors of prolonged postoperative opioid use among older patients after lumbar spine surgery and the consequences in terms of health care utilization and costs. METHODS We conducted a retrospective population-based cohort study using Ontario administrative data from older adults undergoing spine surgery between 2006 and 2017. Data were analyzed from 90 days preoperatively to 1 year after hospital discharge, with last postoperative opioid prescriptions stratified into 90-day increments. We used multivariable ordinal logistic regression to identify predictors of long-term opioid use and generalized linear modelling to examine resource utilization and health care costs (2021 Canadian dollars). RESULTS Of 15 109 patients included, 40.8% received preoperative opioid prescriptions. Preoperative opioid use strongly predicted prolonged postoperative use (odds ratio [OR] 4.47, 95% confidence interval [CI] 4.16-4.79), with 48.3% of patients who received preoperative opioids continuing to use opioids for longer than 9 months, relative to 12.7% of those without preoperative use. Several other risk factors for prolonged use were identified. Patients receiving long-term postoperative opioids incurred greater health care costs relative to those with opioids prescribed for fewer than 90 days (OR 1.49, 95% CI 1.44-1.54). CONCLUSION Among older adults undergoing spine surgery, preoperative opioid use was a strong predictor of prolonged postoperative use, which was associated with increased health care costs. These results form an important baseline for future studies evaluating strategies to reduce opioid use targeting older surgical populations.
Collapse
Affiliation(s)
- Ana Johnson
- From the Department of Public Health Sciences, Queen's University, Kingston, Ont. (Johnson); ICES Queen's (Johnson), Queen's University, Kingston, Ont.; ICES McMaster, McMaster University, Hamilton, Ont. (Nguyen); the School of Rehabilitation Therapy, Queen's University, Kingston, Ont. (Richardson); the Department of Community Health Sciences, University of Calgary, Calgary, Alta. (Rabi); the Department of Surgery, Queen's University, Kingston, Ont. (Mann, Yach); the Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ont. (Gilron, Milne, Parlow); the Department of Medicine, Queen's University, Kingston, Ont. (Evans)
| | - Francis Nguyen
- From the Department of Public Health Sciences, Queen's University, Kingston, Ont. (Johnson); ICES Queen's (Johnson), Queen's University, Kingston, Ont.; ICES McMaster, McMaster University, Hamilton, Ont. (Nguyen); the School of Rehabilitation Therapy, Queen's University, Kingston, Ont. (Richardson); the Department of Community Health Sciences, University of Calgary, Calgary, Alta. (Rabi); the Department of Surgery, Queen's University, Kingston, Ont. (Mann, Yach); the Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ont. (Gilron, Milne, Parlow); the Department of Medicine, Queen's University, Kingston, Ont. (Evans)
| | - Melissa Richardson
- From the Department of Public Health Sciences, Queen's University, Kingston, Ont. (Johnson); ICES Queen's (Johnson), Queen's University, Kingston, Ont.; ICES McMaster, McMaster University, Hamilton, Ont. (Nguyen); the School of Rehabilitation Therapy, Queen's University, Kingston, Ont. (Richardson); the Department of Community Health Sciences, University of Calgary, Calgary, Alta. (Rabi); the Department of Surgery, Queen's University, Kingston, Ont. (Mann, Yach); the Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ont. (Gilron, Milne, Parlow); the Department of Medicine, Queen's University, Kingston, Ont. (Evans)
| | - Sarah Rabi
- From the Department of Public Health Sciences, Queen's University, Kingston, Ont. (Johnson); ICES Queen's (Johnson), Queen's University, Kingston, Ont.; ICES McMaster, McMaster University, Hamilton, Ont. (Nguyen); the School of Rehabilitation Therapy, Queen's University, Kingston, Ont. (Richardson); the Department of Community Health Sciences, University of Calgary, Calgary, Alta. (Rabi); the Department of Surgery, Queen's University, Kingston, Ont. (Mann, Yach); the Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ont. (Gilron, Milne, Parlow); the Department of Medicine, Queen's University, Kingston, Ont. (Evans)
| | - Steve Mann
- From the Department of Public Health Sciences, Queen's University, Kingston, Ont. (Johnson); ICES Queen's (Johnson), Queen's University, Kingston, Ont.; ICES McMaster, McMaster University, Hamilton, Ont. (Nguyen); the School of Rehabilitation Therapy, Queen's University, Kingston, Ont. (Richardson); the Department of Community Health Sciences, University of Calgary, Calgary, Alta. (Rabi); the Department of Surgery, Queen's University, Kingston, Ont. (Mann, Yach); the Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ont. (Gilron, Milne, Parlow); the Department of Medicine, Queen's University, Kingston, Ont. (Evans)
| | - Ian Gilron
- From the Department of Public Health Sciences, Queen's University, Kingston, Ont. (Johnson); ICES Queen's (Johnson), Queen's University, Kingston, Ont.; ICES McMaster, McMaster University, Hamilton, Ont. (Nguyen); the School of Rehabilitation Therapy, Queen's University, Kingston, Ont. (Richardson); the Department of Community Health Sciences, University of Calgary, Calgary, Alta. (Rabi); the Department of Surgery, Queen's University, Kingston, Ont. (Mann, Yach); the Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ont. (Gilron, Milne, Parlow); the Department of Medicine, Queen's University, Kingston, Ont. (Evans)
| | - Jeff Yach
- From the Department of Public Health Sciences, Queen's University, Kingston, Ont. (Johnson); ICES Queen's (Johnson), Queen's University, Kingston, Ont.; ICES McMaster, McMaster University, Hamilton, Ont. (Nguyen); the School of Rehabilitation Therapy, Queen's University, Kingston, Ont. (Richardson); the Department of Community Health Sciences, University of Calgary, Calgary, Alta. (Rabi); the Department of Surgery, Queen's University, Kingston, Ont. (Mann, Yach); the Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ont. (Gilron, Milne, Parlow); the Department of Medicine, Queen's University, Kingston, Ont. (Evans)
| | - Brian Milne
- From the Department of Public Health Sciences, Queen's University, Kingston, Ont. (Johnson); ICES Queen's (Johnson), Queen's University, Kingston, Ont.; ICES McMaster, McMaster University, Hamilton, Ont. (Nguyen); the School of Rehabilitation Therapy, Queen's University, Kingston, Ont. (Richardson); the Department of Community Health Sciences, University of Calgary, Calgary, Alta. (Rabi); the Department of Surgery, Queen's University, Kingston, Ont. (Mann, Yach); the Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ont. (Gilron, Milne, Parlow); the Department of Medicine, Queen's University, Kingston, Ont. (Evans)
| | - Gerald Evans
- From the Department of Public Health Sciences, Queen's University, Kingston, Ont. (Johnson); ICES Queen's (Johnson), Queen's University, Kingston, Ont.; ICES McMaster, McMaster University, Hamilton, Ont. (Nguyen); the School of Rehabilitation Therapy, Queen's University, Kingston, Ont. (Richardson); the Department of Community Health Sciences, University of Calgary, Calgary, Alta. (Rabi); the Department of Surgery, Queen's University, Kingston, Ont. (Mann, Yach); the Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ont. (Gilron, Milne, Parlow); the Department of Medicine, Queen's University, Kingston, Ont. (Evans)
| | - Joel Parlow
- From the Department of Public Health Sciences, Queen's University, Kingston, Ont. (Johnson); ICES Queen's (Johnson), Queen's University, Kingston, Ont.; ICES McMaster, McMaster University, Hamilton, Ont. (Nguyen); the School of Rehabilitation Therapy, Queen's University, Kingston, Ont. (Richardson); the Department of Community Health Sciences, University of Calgary, Calgary, Alta. (Rabi); the Department of Surgery, Queen's University, Kingston, Ont. (Mann, Yach); the Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ont. (Gilron, Milne, Parlow); the Department of Medicine, Queen's University, Kingston, Ont. (Evans)
| |
Collapse
|
16
|
Crego N, Douglas C, Bonnabeau E, Eason K, Earls M, Tanabe P, Shah N. Opioid Use Among Children and Adults With Sickle Cell Disease in North Carolina Medicaid Enrollees in the Era of Opioid Harm Reduction. J Pediatr Hematol Oncol 2024; 46:181-187. [PMID: 38551912 DOI: 10.1097/mph.0000000000002852] [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] [Received: 07/10/2023] [Accepted: 02/12/2024] [Indexed: 04/24/2024]
Abstract
Adults and children with sickle cell disease (SCD) are predominantly African American, with pain-related health disparities. We examined opioid prescription fill patterns in adults and children with SCD and compared factors associated with fills in North Carolina Medicaid enrollees. Our retrospective cohort study included 955 enrollees diagnosed with SCD having at least one opioid fill. Associations were measured between two cohorts (12 and 24 mo of continuous enrollment) for the following characteristics: sex, age, enrollee residence, hydroxyurea adherence, comanagement, enrollment in Community Care North Carolina, prescription for short versus short and long-acting opioids, and emergency department reliance. The majority of individuals did not have an opioid claim over a 12 or 24-month period. Claims increased at ages 10 to 17, peaking at ages 18 to 30. The increased number of claims was associated with the following factors: increasing age, male, short versus long-acting opioids, and Medicaid enrollment for 24 versus 12 months. Community Care North Carolina enrollees in the 12-month cohort had higher opioid days of supply per month; the inverse was true of the 24-month cohort.
Collapse
Affiliation(s)
| | | | | | - Kern Eason
- School of Medicine, Duke University, Durham
| | | | - Paula Tanabe
- School of Nursing
- School of Medicine, Duke University, Durham
| | | |
Collapse
|
17
|
Turner JP, Halme AS, Caetano P, Langford A, Tannenbaum C. Government Direct-to-Consumer Education to Reduce Prescription Opioid Use: A Cluster Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2413698. [PMID: 38809554 PMCID: PMC11137632 DOI: 10.1001/jamanetworkopen.2024.13698] [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] [Received: 12/14/2023] [Accepted: 03/12/2024] [Indexed: 05/30/2024] Open
Abstract
Importance Direct-to-consumer education reduces chronic sedative use. The effectiveness of this approach for prescription opioids among patients with chronic noncancer pain remains untested. Objectives To evaluate the effectiveness of a government-led educational information brochure mailed to community-dwelling, long-term opioid consumers to reduce prescription opioid use compared with usual care. Design, Setting, and Participants This cluster randomized clinical trial was conducted from July 2018 to January 2019 in Manitoba, Canada. All adults with long-term opioid prescriptions were enrolled (n = 4225). Participants were identified via the Manitoba Drug Program Information Network. Individuals receiving palliative care or with a diagnosis of cancer or dementia were excluded. Data were analyzed from July 2019 to March 2020. Intervention Participants were clustered according to their primary care clinic and randomized to the intervention (a codesigned direct-to-consumer educational brochure sent by mail) or usual care (comparator group). Main Outcomes and Measures The main outcome was discontinuation of opioid prescriptions at the participant level after 6 months, ascertained by pharmacy drug claims. Secondary outcomes included dose reduction (in morphine milligram equivalents [MME]) and/or therapeutic switch. Reduction in opioid use was assessed using generalized estimating equations to account for clustering, with prespecified subgroup analyses by age and sex. Analysis was intention to treat. Results Of 4206 participants, 2409 (57.3%) were male; mean (SD) age was 60.0 (14.4) years. Mean (SD) baseline opioid use was comparable between groups (intervention, 157.7 [179.7] MME/d; control, 153.4 [181.8] MME/d). After 6 months, 235 of 2136 participants (11.0%) in 127 clusters in the intervention group no longer filled opioid prescriptions compared with 228 of 2070 (11.0%) in 124 clusters in the comparator group (difference, 0.0%; 95% CI, -1.9% to 1.9%). More participants in the intervention group than in the control group reduced their dose (1410 [66.0%] vs 1307 [63.1%]; difference, 2.8% [95% CI, 0.0%-5.7%]). Receipt of the brochure led to greater dose reductions for participants who were male (difference, 3.9%; 95% CI, 0.1%-7.7%), aged 18 to 64 years (difference, 3.7%; 95% CI, 0.2%-7.2%), or living in urban areas (difference, 5.9%; 95% CI, 1.9%-9.9%) compared with usual care. Conclusions and Relevance In this cluster randomized clinical trial, no significant difference in the prevalence of opioid cessation was observed after 6 months between the intervention and usual care groups; however, the intervention resulted in more adults reducing their opioid dose compared with usual care. Trial Registration ClinicalTrials.gov Identifier: NCT03400384.
Collapse
Affiliation(s)
- Justin P. Turner
- Centre for Medicine Use and Safety, Monash University, Parkville, Victoria, Australia
- Faculté de Pharmacie, Université de Montréal, Montréal, Québec, Canada
- Centre de Recherche de l’Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada
| | - Alex S. Halme
- Département de Médecine Spécialisée, Centre Intégré de Santé et de Services Sociaux de la Gaspésie, Sainte-Anne-des-Monts, Québec, Canada
| | - Patricia Caetano
- Drug Data Services and Analytics, Canadian Agency for Drugs and Technologies in Health, Ontario, Canada
| | - Aili Langford
- Centre for Medicine Use and Safety, Monash University, Parkville, Victoria, Australia
| | - Cara Tannenbaum
- Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada
- Centre de Recherche de l’Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada
| |
Collapse
|
18
|
Durpoix A, Rolling J, Coutelle R, Lalanne L. Psychotherapies in opioid use disorder: toward a step-care model. J Neural Transm (Vienna) 2024; 131:437-452. [PMID: 37987829 PMCID: PMC11055728 DOI: 10.1007/s00702-023-02720-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/01/2023] [Indexed: 11/22/2023]
Abstract
Opioid use disorder (OUD) is characterized by a lack of control in opioid use, resulting in psychological distress and deficits in interpersonal and social functioning. OUD is often associated with psychiatric comorbidities that increase the severity of the disorder. The consequences of OUD are dramatic in terms of increased morbi-mortality. Specific medications and psychotherapies are essential tools not only in the treatment of OUD but also in the prevention of suicide and overdoses. In our review, we assess the different types of psychotherapies (counseling, motivational interviewing, contingency management, cognitive-behavioral therapy, and dialectical-behavior therapy) that are delivered to opioid users, either associated or un-associated with OUD medications and/or medications for psychiatric disabilities. We describe the application of these therapies first to adult opioid users and then to adolescents. This work led us to propose a stepped-care model of psychotherapies for OUD which provided information to assist clinicians in decision-making regarding the selection of psychotherapeutic strategies according to patients' OUD severity.
Collapse
Affiliation(s)
- Amaury Durpoix
- Addictology Department, Strasbourg University Hospital, 1, place de l'Hôpital, 67091, Strasbourg, France
- Strasbourg University, Faculty of Medicine, Strasbourg, France
| | - Julie Rolling
- Psychiatry, Mental Health and Addictology Department, Strasbourg University Hospital, Strasbourg, France
- Regional Center for Psychotrauma Great East, Strasbourg, France
- Centre National de la Recherche Scientifique Unité Propre de Recherche 3212 (CNRS UPR 3212), Institute for Cellular and Integrative Neurosciences (INCI), Strasbourg, France
| | - Romain Coutelle
- Psychiatry, Mental Health and Addictology Department, Strasbourg University Hospital, Strasbourg, France
- INSERM U1114, Cognitive Neuropsychology, and Pathophysiology of Schizophrenia, Strasbourg, France
| | - Laurence Lalanne
- Addictology Department, Strasbourg University Hospital, 1, place de l'Hôpital, 67091, Strasbourg, France.
- INSERM U1114, Cognitive Neuropsychology, and Pathophysiology of Schizophrenia, Strasbourg, France.
- Strasbourg University, Faculty of Medicine, Strasbourg, France.
- Fédération de Médecine translationnelle de Strasbourg, Strasbourg, France.
| |
Collapse
|
19
|
Ledlie S, Tadrous M, Bayoumi AM, McCormack D, Cheng C, Besharah J, Munro C, Gomes T. Trends in opioid toxicities among people with and without opioid use disorder and the impact of the COVID-19 pandemic in Ontario, Canada: A population-based analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 127:104392. [PMID: 38522177 DOI: 10.1016/j.drugpo.2024.104392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/03/2024] [Accepted: 03/06/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Across Canada, the COVID-19 pandemic occurred amidst an ongoing drug toxicity crisis. Although elevated rates of substance-related harms have been observed nationally, it remains unknown if the pandemic state of emergency led to disproportionate increases in opioid toxicities among people with opioid use disorder (OUD) compared to those without. METHODS We conducted a population-based repeated cross-sectional time series analysis of fatal and non-fatal opioid toxicities between January 1, 2014, and December 31, 2021, in Ontario, Canada. We used interventional autoregressive integrated moving average models to examine the impact of the pandemic on monthly rates of opioid toxicities per 100,000 Ontario residents stratified by people with and without OUD. RESULTS We identified 80,296 opioid toxicities of which 53.5 % occurred among people with OUD. Among 52,052 unique individuals, 60.5 % were male and 46.2 % were 25-44 years old. Between January 2014 and December 2021, the rate of opioid toxicities increased from 2.6 to 10.5 per 100,000 (rate ratio [RR]=4.07). The magnitude of this increase differed among people with OUD (0.8 to 7.4 per 100,000; RR=9.35) and without OUD (1.8 to 3.1 per 100,000; RR=1.74). We observed a significant ramp increase in the overall rate of opioid toxicities following the declaration of the pandemic emergency in March 2020 (+0.19 per 100,000 monthly, 95 % CI: 0.029, 0.36, p = 0.021). In a stratified analysis, we found a similar ramp increase among people with OUD (+0.19 per 100,000 monthly, 95 % CI: 0.10, 0.28, p < 0.001); however, this was not observed among people without OUD (p = 0.95). CONCLUSIONS The rate of opioid toxicities accelerated across Ontario following the pandemic-related state of emergency, with the majority of this increase among people with OUD. The important differences observed among people with OUD compared with those without, highlights the critical need for improved access to harm reduction and treatment interventions among this population.
Collapse
Affiliation(s)
- Shaleesa Ledlie
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada; ICES, Toronto, ON, Canada.
| | - Mina Tadrous
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada; ICES, Toronto, ON, Canada; Women's College Research Institute, Toronto, ON, Canada
| | - Ahmed M Bayoumi
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada; Division of General Internal Medicine, St. Michael's Hospital, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | | | - Clare Cheng
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Jes Besharah
- Ontario Drug Policy Research Network Lived Experience Advisory Group, Toronto, ON, Canada
| | - Charlotte Munro
- Ontario Drug Policy Research Network Lived Experience Advisory Group, Toronto, ON, Canada
| | - Tara Gomes
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada; ICES, Toronto, ON, Canada; MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
20
|
Ledlie S, Juurlink DN, Tadrous M, Mamdani M, Paterson JM, Gomes T. Opioid-related deaths between 2019 and 2021 across 9 Canadian provinces and territories. CMAJ 2024; 196:E469-E476. [PMID: 38621782 PMCID: PMC11019600 DOI: 10.1503/cmaj.231339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND The drug toxicity crisis continues to accelerate across Canada, with rapid increases in opioid-related harms following the onset of the COVID-19 pandemic. We sought to describe trends in the burden of opioid-related deaths across Canada throughout the pandemic, comparing these trends by province or territory, age, and sex. METHODS We conducted a repeated cross-sectional analysis of accidental opioid-related deaths between Jan. 1, 2019, and Dec. 31, 2021, across 9 Canadian provinces and territories using aggregated national data. Our primary measure was the burden of premature opioid-related death, measured by potential years of life lost. Our secondary measure was the proportion of all deaths attributable to opioids; we used the Cochrane-Armitage test for trend to compare proportions. RESULTS Between 2019 and 2021, the annual number of opioid-related deaths increased from 3007 to 6222 and years of life lost increased from 126 115 to 256 336 (from 3.5 to 7.0 yr of life lost per 1000 population). In 2021, the highest number of years of life lost was among males (181 525 yr) and people aged 30-39 years (87 045 yr). In 2019, we found that 1.7% of all deaths among those younger than 85 years were related to opioids, rising to 3.2% in 2021. Significant increases in the proportion of deaths related to opioids were observed across all age groups (p < 0.001), representing 29.3% and 29.0% of deaths among people aged 20-29 and 30-39 years in 2021, respectively. INTERPRETATION Across Canada, the burden of premature opioid-related deaths doubled between 2019 and 2021, representing more than one-quarter of deaths among younger adults. The disproportionate loss of life in this demographic group highlights the critical need for targeted prevention efforts.
Collapse
Affiliation(s)
- Shaleesa Ledlie
- Li Ka Shing Knowledge Institute (Ledlie, Mamdani, Gomes), St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Ledlie, Tadrous, Mamdani, Gomes), University of Toronto; ICES (Ledlie, Juurlink, Tadrous, Paterson, Gomes); Institute for Health Policy, Management and Evaluation (Juurlink, Mamdani, Paterson, Gomes), University of Toronto; Sunnybrook Research Institute (Juurlink), Toronto, Ont
| | - David N Juurlink
- Li Ka Shing Knowledge Institute (Ledlie, Mamdani, Gomes), St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Ledlie, Tadrous, Mamdani, Gomes), University of Toronto; ICES (Ledlie, Juurlink, Tadrous, Paterson, Gomes); Institute for Health Policy, Management and Evaluation (Juurlink, Mamdani, Paterson, Gomes), University of Toronto; Sunnybrook Research Institute (Juurlink), Toronto, Ont
| | - Mina Tadrous
- Li Ka Shing Knowledge Institute (Ledlie, Mamdani, Gomes), St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Ledlie, Tadrous, Mamdani, Gomes), University of Toronto; ICES (Ledlie, Juurlink, Tadrous, Paterson, Gomes); Institute for Health Policy, Management and Evaluation (Juurlink, Mamdani, Paterson, Gomes), University of Toronto; Sunnybrook Research Institute (Juurlink), Toronto, Ont
| | - Muhammad Mamdani
- Li Ka Shing Knowledge Institute (Ledlie, Mamdani, Gomes), St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Ledlie, Tadrous, Mamdani, Gomes), University of Toronto; ICES (Ledlie, Juurlink, Tadrous, Paterson, Gomes); Institute for Health Policy, Management and Evaluation (Juurlink, Mamdani, Paterson, Gomes), University of Toronto; Sunnybrook Research Institute (Juurlink), Toronto, Ont
| | - J Michael Paterson
- Li Ka Shing Knowledge Institute (Ledlie, Mamdani, Gomes), St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Ledlie, Tadrous, Mamdani, Gomes), University of Toronto; ICES (Ledlie, Juurlink, Tadrous, Paterson, Gomes); Institute for Health Policy, Management and Evaluation (Juurlink, Mamdani, Paterson, Gomes), University of Toronto; Sunnybrook Research Institute (Juurlink), Toronto, Ont
| | - Tara Gomes
- Li Ka Shing Knowledge Institute (Ledlie, Mamdani, Gomes), St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Ledlie, Tadrous, Mamdani, Gomes), University of Toronto; ICES (Ledlie, Juurlink, Tadrous, Paterson, Gomes); Institute for Health Policy, Management and Evaluation (Juurlink, Mamdani, Paterson, Gomes), University of Toronto; Sunnybrook Research Institute (Juurlink), Toronto, Ont.
| |
Collapse
|
21
|
Cohen MJ, Dressler RL, Kaliner E. Receipt of prescription opioid medication is associated with increased mortality in an Israeli population. Isr J Health Policy Res 2024; 13:17. [PMID: 38570850 PMCID: PMC10988899 DOI: 10.1186/s13584-024-00606-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 03/28/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Despite Israel's increased use of prescription opioids, reported deaths resulting or associated with opioids have decreased, in fact dramatically, since 2005. This contrast is unique and difficult to explain. We sought to examine whether higher prescribed opioid dosages among adults without oncologic diagnoses were associated with higher all-cause mortality rates. METHODS A historical cohort study in Clalit Health Services, using a data repository including all adult patients prescribed opiates between 2010 and 2020, excluding patients with oncologic diagnoses. Patients were classified into three groups according to opioid use: below 50 Morphine milligram equivalents (MME) per day, 50 to 90 MME per day, and above 90 MME per day. Sex, Charlson comorbidity score, age and socioeconomic status were recorded. Mortality rates were compared between the dosage groups and compared to age-standardized mortality rates in the general population. RESULTS On multivariate analysis, patients receiving 90 or more MME per day were 2.37 (95%CI 2.1 to 2.68) more likely to have died compared to patients receiving below 50 MME per day. The respective hazard ratio among patients receiving between 50 and 90 MME per day was 2.23 (2.01 to 2.46). Among patients aged 18 to 50, standardized mortality ratios (SMRs) compared to the general population ranged between 5.4 to 8.6 among women, receiving between 50 and 90 MME per day, and between 8.07 and 10.7 among women receiving 90 or more MME per day. The respective SMRs among men were 1.2 to 3.8 and 2.7 to 5.4. CONCLUSION Increased opioid use is independently associated with increased all-cause mortality among non-oncological patients. This result is most notable among young adults with little or no known comorbidities. These findings are consistent with results in other countries and seem more credible than previous Israeli reports. Healthcare regulators and providers should, therefore, act to curtail the increasing opioid prescriptions and devise and enhance controls in the healthcare system, which, until 2020, had very limited mechanisms in place.
Collapse
Affiliation(s)
- Matan J Cohen
- Clalit Health Services, Jerusalem district, Hebrew University of Jerusalem Faculty of Medicine, Bet Shemesh, Israel.
| | - Reuven L Dressler
- Clalit Health Services, Department of Family Medicine, Jerusalem district, Hebrew University of Jerusalem Faculty of Medicine, Maale Adumim, Israel
| | - Ehud Kaliner
- State of Israel Ministry of Health, Central District, Ramla, Israel
| |
Collapse
|
22
|
Silva GN, Brandão VG, Perez MV, Sobrinho SL, Villardi JGDCC, Sacramento PMD, Ribeiro LCP, Alvim Fiorelli RK. Immunotherapeutic Properties of Dexmedetomidine on Pain Management and Cardiovascular Function in Videolaparoscopic Cholecystectomies: A Randomized, Two-Arm, Double-Blinded, Placebo-Controlled Trial. Surg Innov 2024; 31:137-147. [PMID: 38383315 DOI: 10.1177/15533506241234591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
BACKGROUND Laparoscopy represented one of the most innovative surgical techniques approached in the surgery field. Dexmedetomidine association with general anesthesia promotes the response control to trauma by altering the neuroinflammatory reflex, provides better clinical outcomes in the postoperative period and reduces the excessive use of drugs with risk for addiction. This trial aims to evaluate the potential drug treatment of dexmedetomidine on organic function, with the targets in neuroinflammation, perioperative pain control and blood pressure measurements in a medium-sized surgical model. METHODS Fifty-two patients were randomized in two groups: Sevoflurane and Dexmedetomidine - A (dexmedetomidine infusion [1 μg/kg loading, .2-.5 μg/kg/h thereafter]) vs Sevoflurane and Saline .9% - B. Three blood samples were collected at three times: before surgery, 4 to 6 hours after surgery and 24 hours postoperatively. The primary outcome was inflammatory and endocrine mediators dosage analisys. Finally, we evaluated pain and opioid use as secondary outcomes, also the hemodynamic values. RESULTS In Dexmedetomidine group A, a reduction of Interleukin 6 was found during 4-6 hours after surgery. A reduction of IL-10 was noted in the measurement of its values 24 hours after the procedure, with statistical significance. Also, systolic and diastolic blood pressure, as well heart rate were attenuated, and there was a lower incidence of pain and opioid consumption in the first postoperative hour (P < .0001) in the anesthetic recovery room. CONCLUSIONS Dexmedetomidine provided anti-inflammatory activity, sympatholytic effect and analgesia with cardiovascular safety. It reinforces the therapeutic nature of highly selective α2-adrenergic agonists when combined within anesthetic interventions.
Collapse
Affiliation(s)
- Gustavo Nascimento Silva
- Department of Anesthesiology, Gaffrée e Guinle University Hospital, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Virna Guedes Brandão
- Department of Anesthesiology, Gaffrée e Guinle University Hospital, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Marcelo Vaz Perez
- Department of Surgery and Anesthesia, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Sandoval Lage Sobrinho
- Department of General and Specialized Surgery, Gaffrée e Guinle University Hospital, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | | | | | | | - Rossano Kepler Alvim Fiorelli
- Department of General and Specialized Surgery, Gaffrée e Guinle University Hospital, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| |
Collapse
|
23
|
Haddad M, Coman E, Bifulco L. Nine-year substance use treatment outcomes with buprenorphine for opioid use disorder in a federally qualified health center. Drug Alcohol Depend 2024; 257:111252. [PMID: 38484404 DOI: 10.1016/j.drugalcdep.2024.111252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/23/2024] [Accepted: 02/24/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND Prescribing medication for opioid use disorder (MOUD) in primary care helps meet treatment demand, but few studies examine long-term treatment retention among medically-underserved primary care patients. METHODS This 9-year retrospective study assessed overall retention at 6 months, and yearly up to 9 years, among 1451 patients with at least 6 months of buprenorphine prescription data from a federally-qualified health center (FQHC). We also examined whether patients who had gaps in treatment (>14 days without medication) later returned to care. Associations with treatment retention over total time in care were assessed. RESULTS On average, patients received buprenorphine treatment for 2.26 years. Among patients who experienced gaps in treatment but returned to care within 90 days, 64% were still receiving buprenorphine at six months (n=930 of 1451), and 70% (n =118 of 169) at 9 years, with an average yearly interval retention of 69% (range: 58-74%). Patients were on MOUD treatment and not in a gap about 81% of the time, and averaged 1.0 gap per patient per year (SD: 1.09; range 0-7.87). The mean gap length over the treatment period was 33.16 days. Older age, higher percentages of negative opioid tests, negative cocaine tests, and positive buprenorphine tests, and having diabetes were associated with longer treatment retention. CONCLUSIONS Opioid use disorder (OUD) can be treated successfully in primary care FQHCs. Treatment gaps are common and reflect the chronic relapsing nature of OUD.
Collapse
Affiliation(s)
- Marwan Haddad
- Center for Key Populations, Community Health Center, Inc., 631 Main Street, Middletown, CT 06457, USA; Weitzman Institute, Moses-Weitzman Health System, 19 Grand Street, Middletown, CT 06457, USA.
| | - Emil Coman
- Health Disparities Institute, University of Connecticut School of Medicine, Hartford, CT 06106, USA
| | - Lauren Bifulco
- Weitzman Institute, Moses-Weitzman Health System, 19 Grand Street, Middletown, CT 06457, USA
| |
Collapse
|
24
|
Coute RA, Nathanson BH, Shekhar AC, White CN, Kurz MC, Jackson EA, Mader TJ. The Public Health and Economic Impact of Drug Overdose Out-of-Hospital Cardiac Arrest in the United States. PREHOSP EMERG CARE 2024:1-7. [PMID: 38451237 PMCID: PMC11427595 DOI: 10.1080/10903127.2024.2327526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/07/2024] [Accepted: 02/18/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVE To calculate disability-adjusted life years (DALY) and labor productivity loss due to drug overdose out-of-hospital cardiac arrest (DO-OHCA) and compare its contribution to the burden of disease and economic impact of all-cause nontraumatic out-of-hospital cardiac arrest (OHCA) in the US. METHODS We performed a retrospective observational cohort analysis of all adult (age ≥18 years) nontraumatic emergency medical services-treated OHCA events, including those due to DO-OHCA, from the national Cardiac Arrest Registry to Enhance Survival (CARES) database from January 1, 2017 and December 31, 2020. The main outcome measures of interest were disability-adjusted life years, annual, and lifetime labor productivity loss over the 4-year study period. The findings for the study population were extrapolated to a national level using the CARES population catchment and U.S. population estimates by year. RESULTS A total of 378,088 adult OHCA events, including 23,252 DO-OHCA (6.2%) met study inclusion criteria. The DO-OHCA DALY increased from 156,707 in 2017 to 265,692 in 2020. Per year, DO-OHCA contributed to 11.4%, 12.0%, 10.5%, and 11.4% of all OHCA DALY lost from 2017-2020, respectively. The mean annual and lifetime productivity losses for all OHCA were stable over time (annual: $47K in 2017 to $50K in 2020; lifetime: $647K in 2017 to $692K in 2020). The CARES population catchment increased by 39.8% over the study period (102.6 M in 2017 to 143.4 M in 2020). For DO-OHCA, the mean annual productivity loss was approximately 30% higher than non-DO-OHCA ($64K vs. $49K in 2020, respectively). The mean lifetime productivity loss for DO-OHCA was 2.5 times higher than non-DO-OHCA ($1.6 M vs. $630K in 2020, respectively). CONCLUSIONS The DALY due to DO-OHCA has increased over time with expansion of the CARES dataset, but its relative contribution to total OHCA DALY (all non-traumatic etiologies) remained fairly stable. The DO-OHCAs represent approximately 6% of all adult non-traumatic EMS-treated OHCA events but has a disproportionately greater economic impact. Continued efforts to reduce DO-OHCA through public health initiatives are warranted to lessen the societal impact of OHCA in the U.S.
Collapse
Affiliation(s)
- Ryan A. Coute
- Department of Emergency Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL
| | | | | | - Christopher N. White
- Department of Emergency Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL
| | - Michael C. Kurz
- Section of Emergency Medicine, Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, IL
| | - Elizabeth A. Jackson
- Division of Cardiovascular Disease, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL
| | - Timothy J. Mader
- Department of Emergency Medicine, UMass Chan Medical School—Baystate, Springfield, MA
- Department of Healthcare Delivery and Population Science, UMass Chan Medical School—Baystate, Springfield, MA
| | | |
Collapse
|
25
|
Jones KF, White G, Bennett A, Bulls H, Escott P, Orris S, Escott E, Fischer S, Hamm M, Krishnamurti T, Wong R, LeBlanc TW, Liebschutz J, Meghani S, Smith C, Temel J, Ritchie C, Merlin JS. Benefits, Harms, and Stakeholder Perspectives Regarding Opioid Therapy for Pain in Individuals With Metastatic Cancer: Protocol for a Descriptive Cohort Study. JMIR Res Protoc 2024; 13:e54953. [PMID: 38478905 PMCID: PMC10973954 DOI: 10.2196/54953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Opioids are a key component of pain management among patients with metastatic cancer pain. However, the evidence base available to guide opioid-related decision-making in individuals with advanced cancer is limited. Patients with advanced cancer or cancer that is unlikely to be cured frequently experience pain. Opioids are a key component of pain management among patients with metastatic cancer pain. Many individuals with advanced cancer are now living long enough to experience opioid-related harm. Emerging evidence from chronic noncancer pain literature suggests that longer-term opioid therapy may have limited benefits for pain and function, and opioid-related harms are also a major concern. However, whether these benefits and harms of opioids apply to patients with cancer-related pain is unknown. OBJECTIVE This manuscript outlines the protocol for the "Opioid Therapy for Pain in Individuals With Metastatic Cancer: The Benefits, Harms, and Stakeholder Perspectives (BEST) Study." The study aims to better understand opioid decision-making in patients with advanced cancer, along with opioid benefits and harms, through prospective examination of patients' pain experiences and opioid side effects and understanding the decision-making by patients, care partners, and clinicians. METHODS This is a multicenter, prospective cohort study that aims to enroll 630 patients with advanced cancer, 20 care partners, and 20 clinicians (670 total participants). Patient participants must have an advanced solid cancer diagnosis, defined by the American Cancer Society as cancer that is unlikely to be cured. We will recruit patient participants within 12 weeks after diagnosis so that we can understand opioid benefits, harms, and perspectives on opioid decision-making throughout the course of their advanced cancer (up to 2 years). We will also specifically elicit information regarding long-term opioid use (ie, opioids for ≥90 consecutive days) and exclude patients on long-term opioid therapy before an advanced cancer diagnosis. Lived-experience perspectives related to opioid use in those with advanced cancer will be captured by qualitative interviews with a subset of patients, clinicians, and care partners. Our data collection will be grounded in a behavioral decision research approach that will allow us to develop future interventions to inform opioid-related decision-making for patients with metastatic cancer. RESULTS Data collection began in October 2022 and is anticipated to end by November 2024. CONCLUSIONS Upon successful execution of our study protocol, we anticipate the development of a comprehensive evidence base on opioid therapy in individuals with advanced cancer guided by the behavioral decision research framework. The information gained from this study will be used to guide interventions to facilitate opioid decisions among patients, clinicians, and care partners. Given the limited evidence base about opioid therapy in people with cancer, we envision this study will have significant real-world implications for cancer-related pain management and opioid-related clinical decision-making. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/54953.
Collapse
Affiliation(s)
- Katie Fitzgerald Jones
- New England Geriatrics Research, Education, and Clinical Center (GRECC), Jamaica Plain, MA, United States
| | | | - Antonia Bennett
- University of North Carolina, Chapel Hill, NC, United States
| | - Hailey Bulls
- University of Pittsburgh, Pittsburgh, PA, United States
| | - Paula Escott
- University of Pittsburgh, Pittsburgh, PA, United States
| | - Sarah Orris
- University of Pittsburgh, Pittsburgh, PA, United States
| | | | | | - Megan Hamm
- University of Pittsburgh, Pittsburgh, PA, United States
| | | | - Risa Wong
- University of Pittsburgh, Pittsburgh, PA, United States
| | | | | | | | - Cardinale Smith
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jennifer Temel
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA, United States
| | - Christine Ritchie
- Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
| | | |
Collapse
|
26
|
Phillips KG, James L, Rabadi M, Grossi EA, Smith D, Galloway AC, Moazami N. Impact of the coronavirus disease 2019 pandemic on drug overdoses in the United States and the effect on cardiac transplant volume and survival. J Heart Lung Transplant 2024; 43:471-484. [PMID: 37890684 DOI: 10.1016/j.healun.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 09/25/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Drug overdose (DO) deaths rose to unprecedented levels during the coronavirus disease 2019 (COVID-19) pandemic. This study examines the impact of COVID-19 on the availability of cardiac allografts from DO donors and the implications of DO donor use on recipient survival. METHODS Heart transplants reported to the United Network for Organ Sharing from January 2017 to November 2019 ("pre-COVID") and from March 2020 to June 2021 ("COVID pandemic") were analyzed with respect to DO donor status. Outcomes were analyzed using Kaplan-Meier survival and Cox regression to identify predictors of survival. Characteristics of discarded cardiac allografts were also compared by DO donor status. RESULTS During the COVID-19 pandemic, 27.2% of cardiac allografts were from DO donors vs 20.5% pre-COVID, a 32.7% increase (p < 0.001). During the pandemic, DO donors were younger (84.7% vs 76.3% <40 years, p < 0.001), had higher cigarette use (16.1% vs 10.8%, p < 0.001), higher cocaine use (47.4% vs 19.7%, p < 0.001), and higher incidence of hepatitis C antibodies (26.8% vs 6.1%, p < 0.001) and RNA positivity (16.2% vs 4.2%, p < 0.001). While DO donors were less likely to require inotropic support (30.8% vs 35.4%, p = 0.008), they were more likely to have received cardiopulmonary resuscitation (95.3% vs 43.2%, p < 0.001). Recipient survival was equivalent using Kaplan-Meier analysis (log-rank, p = 0.33) and survival probability at 36 months was 85.6% (n at risk = 398) for DO donors vs 83.5% (n at risk = 1,633) for all other donors. Cox regression demonstrated that DO donor status did not predict mortality (hazard ratio 1.05; 95% confidence interval 0.90-1.23, p = 0.53). CONCLUSIONS During the COVID-19 pandemic, there was a 32.7% increase in heart transplants utilizing DO donor hearts, and DO became the most common mechanism of death for donors. The use of DO donor hearts did not have an impact on short-term recipient survival.
Collapse
Affiliation(s)
- Katherine G Phillips
- Department of Cardiothoracic Surgery, Division of Cardiac Surgery, NYU Langone Health, New York, New York
| | - Les James
- Department of Cardiothoracic Surgery, Division of Cardiac Surgery, NYU Langone Health, New York, New York
| | - Marie Rabadi
- Department of Cardiothoracic Surgery, Division of Cardiac Surgery, NYU Langone Health, New York, New York
| | - Eugene A Grossi
- Department of Cardiothoracic Surgery, Division of Cardiac Surgery, NYU Langone Health, New York, New York
| | - Deane Smith
- Department of Cardiothoracic Surgery, Division of Cardiac Surgery, NYU Langone Health, New York, New York
| | - Aubrey C Galloway
- Department of Cardiothoracic Surgery, Division of Cardiac Surgery, NYU Langone Health, New York, New York
| | - Nader Moazami
- Department of Cardiothoracic Surgery, Division of Cardiac Surgery, NYU Langone Health, New York, New York.
| |
Collapse
|
27
|
Basabe MS, Suki TS, Munsell MF, Iniesta MD, Garcia Lopez JE, Hillman RT, Cain K, Huepenbecker S, Mena G, Taylor JS, Ramirez PT, Meyer LA. Evaluation of a tiered opioid prescription algorithm in an ERAS pathway: exploring opportunities for further refinement. Int J Gynecol Cancer 2024; 34:251-259. [PMID: 38123191 PMCID: PMC11186977 DOI: 10.1136/ijgc-2023-004948] [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] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Opioid over-prescription is wasteful and contributes to the opioid crisis. We implemented a personalized tiered discharge opioid protocol and education on opioid disposal to minimize over-prescription. OBJECTIVE To evaluate the intervention by investigating opioid use post-discharge for women undergoing abdomino-pelvic surgery, and patient adherence to opioid disposal education. METHODS We analyzed post-discharge opioid consumption among 558 patients. Eligible patients included those who underwent elective gynecologic surgery, were not taking scheduled opioids pre-operatively, and received discharge opioids according to a tiered prescribing algorithm. A survey assessing discharge opioid consumption and disposal safety knowledge was distributed on post-discharge day 21. Over-prescription was defined as >20% of the original prescription left over. Descriptive statistics were used for analysis. RESULTS The survey response rate was 61% and 59% in the minimally invasive surgery and open surgery cohorts, respectively. Overall, 42.8% of patients reported using no opioids after hospital discharge, 45.2% in the minimally invasive surgery and 38.6% in the open surgery cohort. Furthermore, 74.9% of respondents were over-prescribed, with median age being statistically significant for this group (p=0.004). Finally, 46.4% of respondents expressed no knowledge regarding safe disposal practices, with no statistically significant difference between groups (p>0.99). CONCLUSION Despite implementation of the tiered discharge opioid algorithm aimed to personalize opioid prescriptions to estimated need, we still over-prescribed opioids. Additionally, despite targeted education, nearly half of all patients who completed the survey did not know how to dispose of their opioid tablets. Additional efforts are needed to further refine the algorithm to reduce over-prescription of opioids and improve disposal education.
Collapse
Affiliation(s)
- M Sol Basabe
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Tina S Suki
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mark F Munsell
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Maria D Iniesta
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Juan E Garcia Lopez
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Robert Tyler Hillman
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Katherine Cain
- Department of Pharmacy Clinical Programs, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sarah Huepenbecker
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Gabriel Mena
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jolyn S Taylor
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Pedro T Ramirez
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Larissa A Meyer
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| |
Collapse
|
28
|
Paschen-Wolff MM, DeSousa A, Paine EA, Hughes TL, Campbell ANC. Experiences of and recommendations for LGBTQ+-affirming substance use services: an exploratory qualitative descriptive study with LGBTQ+ people who use opioids and other drugs. Subst Abuse Treat Prev Policy 2024; 19:2. [PMID: 38172902 PMCID: PMC10765665 DOI: 10.1186/s13011-023-00581-8] [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: 08/28/2023] [Accepted: 11/10/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Lesbian, gay, bisexual, transgender, queer, and other LGBTQ populations (LGBTQ+; e.g., asexual individuals) have higher rates of substance use (SU) and disorders (SUD) compared to heterosexual and cisgender populations. Such disparities can be attributed to minority stress, including stigma and discrimination in healthcare settings. LGBTQ+-affirming SU treatment and related services remain limited. The purpose of this exploratory qualitative descriptive study was to characterize LGBTQ+ people's experiences in SU services and recommendations for LGBTQ+- affirming care. METHODS We conducted demographic surveys (characterized using descriptive statistics) and individual qualitative interviews with N = 23 LGBTQ+ people. We employed flexible coding and a thematic analysis approach to describe participants' experiences with stigma, discrimination, and support within SU services at the patient-, staff-, and organizational-level; and participant recommendations for how to make such services LGBTQ+-affirming. We highlighted components of minority stress and mitigators of adverse stress responses throughout our thematic analysis. RESULTS Patient-level experiences included bullying, name-calling, sexual harassment, and physical distancing from peers; and support via community-building with LGBTQ+ peers. Staff-level experiences included name-calling, denial of services, misgendering, lack of intervention in peer bullying, and assumptions about participants' sexuality; and support via staff advocacy for LGBTQ+ patients, holistic treatment models, and openly LGBTQ+ staff. Organizational-level experiences included stigma in binary gendered program structures; and support from programs with gender-affirming groups and housing, and in visual cues (e.g., rainbow flags) of affirming care. Stigma and discrimination led to minority stress processes like identity concealment and stress coping responses like SU relapse; support facilitated SU treatment engagement and retention. Recommendations for LGBTQ+-affirming care included non-discrimination policies, LGBTQ+-specific programming, hiring LGBTQ+ staff, routine staff sensitivity training, and gender-inclusive program structures. CONCLUSIONS LGBTQ+ people experience stigma and discrimination within SU services; supportive and affirming care is vital to reducing treatment barriers and promoting positive health outcomes. The current study offers concrete recommendations for how to deliver LGBTQ+-affirming care, which could reduce SU disparities and drug overdose mortality overall.
Collapse
Affiliation(s)
- Margaret M Paschen-Wolff
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA.
| | - Avery DeSousa
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Emily Allen Paine
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Tonda L Hughes
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
- Center for Sexual and Gender Minority Health Research, Columbia University School of Nursing, 560 W. 168th Street, New York, NY, 10032, USA
| | - Aimee N C Campbell
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| |
Collapse
|
29
|
Ranjkeshzadeh H, Sepahi S, Zare-Zardini H, Taghavizadeh Yazdi ME, Ghorani-Azam A, Jafari A. A Review of Drug Abuse, Misuse, and Related Laboratory Challenges. Curr Drug Saf 2024; 19:417-430. [PMID: 37957844 DOI: 10.2174/0115748863266621231023112044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/20/2023] [Accepted: 08/31/2023] [Indexed: 11/15/2023]
Abstract
Various definitions can be considered for drugs and substance abuse. According to the National Institute on Abuse, the use of an over-the-counter drug in a different way than that prescribed to experience or arouse emotion is a simple form of drug abuse. The World Health Organization (WHO) also defines drug abuse as the persistent or sporadic use of drugs that are incompatible or unrelated to acceptable medical practice. With the increasing non-therapeutic use of prescription drugs, serious related consequences have also increased. Therefore, there is a need to know more precisely about the types of substances and drug abuse, which is the most important part of diagnosis and recognizing the tests that cause false positive and negative results. The purpose of this review article is to collect and summarize the most important and more common types of drugs of abuse and review the drugs that cause false results in screening tests. In addition, the most common detection methods of the drug will be reviewed and the advantages and drawbacks of each method will be discussed. In this article, we aimed to point out all the facts about the emerging problems in drug abuse, the methods of screening, and the possible false results in addition to troubleshooting strategies.
Collapse
Affiliation(s)
- Haniye Ranjkeshzadeh
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Pharmacology and Toxicology Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Samaneh Sepahi
- Food and Beverages Safety Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Hadi Zare-Zardini
- Hematology and Oncology Research Center, Shahid Sadoughi, University of Medical Sciences, Yazd, Iran
- Department of Sciences, Farhangian University, Isfahan, Iran
| | | | - Adel Ghorani-Azam
- Department of Forensic Medicine and Toxicology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Abbas Jafari
- Cellular and Molecular Research Center, Cellular and Molecular Medicine Research Institute, Urmia University of Medical Sciences, Urmia, Iran
| |
Collapse
|
30
|
Gimenez L, Bonis D, Morel M, Palmaro A, Dassieu L, Dupouy J. Barriers and facilitators to the involvement of general practitioners in the prescription of buprenorphine. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 156:209182. [PMID: 37858793 DOI: 10.1016/j.josat.2023.209182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/26/2023] [Accepted: 10/16/2023] [Indexed: 10/21/2023]
Abstract
INTRODUCTION France has one of the highest opioid agonist treatment (OAT) coverage rates in the world. French general practitioners (GPs) are providing the majority of prescriptions. However, a fall in the number of GPs initiating buprenorphine has been observed over the last decade. METHODS The objective of this study was to explore the obstacles and facilitators to the involvement of GPs in the prescription of buprenorphine. A qualitative study comprising 14 individual interviews and a focus group bringing together 5 GPs was conducted among GPs based in France between June 2021 and March 2022. We performed data analysis using a grounded theory methodology. RESULTS The interviews showed a great diversity in the level of involvement of GPs, depending on their experience, their representations of patients with OUD, their mode of exercise, and their personal preferences. The negative representations of the patients associated with the feeling of physical and ethical endangerment, the feeling of powerlessness, the fear of a disruption of the practice and the feeling of incompetence appeared at the forefront of the difficulties stated. Conversely, the strengthening of initial training and the facilitation of access to self-training tools and multidisciplinarity, the consideration of opioid use disorder (OUD) as a chronic illness with the application of a patient-centered motivational approach, as well as the defining and respecting one's own limits when prescribing buprenorphine seem to be the keys to a balanced and fulfilling practice. CONCLUSION Raising awareness of the frequency of OUD appeared to be an additional lever to enhance the interest of the GPs concerned. Additional studies focusing on the evolution of professional practices would be necessary to extend these findings.
Collapse
Affiliation(s)
- Laëtitia Gimenez
- Département Universitaire de Médecine Générale, Université de Toulouse, Faculté de Médecine, 133 route de Narbonne, 31063 Toulouse, France; MSPU La Providence, 1 avenue Louis Blériot, 31500 Toulouse, France; CERPOP, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Délia Bonis
- Département Universitaire de Médecine Générale, Université de Toulouse, Faculté de Médecine, 133 route de Narbonne, 31063 Toulouse, France
| | - Mathilde Morel
- Département Universitaire de Médecine Générale, Université de Toulouse, Faculté de Médecine, 133 route de Narbonne, 31063 Toulouse, France
| | - Aurore Palmaro
- Département Universitaire de Médecine Générale, Université de Toulouse, Faculté de Médecine, 133 route de Narbonne, 31063 Toulouse, France
| | - Lise Dassieu
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, 850 rue Saint Denis, Montréal, QC H2X0A9, Canada
| | - Julie Dupouy
- Département Universitaire de Médecine Générale, Université de Toulouse, Faculté de Médecine, 133 route de Narbonne, 31063 Toulouse, France; CERPOP, Université de Toulouse, Inserm, UPS, Toulouse, France; MSPU de Pins Justaret, 1 chemin de la gare, 31860 Pins Justaret, France.
| |
Collapse
|
31
|
Ballatori AM, Shahrestani S, Ton A, Chen X, Gettleman BS, Buser Z, Wang JC. Post-Operative Complications Associated with Long-Term NSAID or Long-Term Opioid Use Prior to Lumbar Spinal Fusion Surgery. Clin Neurol Neurosurg 2024; 236:108093. [PMID: 38183953 DOI: 10.1016/j.clineuro.2023.108093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/11/2023] [Accepted: 12/17/2023] [Indexed: 01/08/2024]
Abstract
OBJECTIVE Lower back pain (LBP) has been implicated as a significant cause of chronic pain in the United States, often requiring analgesic use. In this study, we investigate the trends in long-term preoperative NSAID (LTN) and Opioid (LTO) use in patients with low back pain in the United States, and the resultant postoperative complications following lumbar fusion. METHODS In this retrospective cohort study of patients with lumbar pathologies, multivariate population-based regression models were developed using the 2010-2017 National Readmission Database. Short-term complications (30-, 90-day) and long-term complications (180-, 300-day) were analyzed at readmission. RESULTS Of patients diagnosed with LBP (N = 1427,190) we found a rise in LTO users and a fall in LTN users following 2015. We identified 654,264 individuals who received a lumbar spine fusion, of which 22,975 were LTN users and 11,213 were LTO users. LTO users had significantly higher total inpatient charges (p-value<0.0001) and LOS (p-value<0.0001), while LTN users had lower rates of acute infection (OR: 0.993, 95% CI: 0.987-0.999, p = 0.017) and acute posthemorrhagic anemia (OR: 0.957, 95% CI: 0.935-0.979, p < 0.001) at primary admission. Readmission analysis showed that LTN use had significantly lower odds of readmission compared to LTO use at all time points (p < 0.01 for all). LTN use had significantly higher odds of hardware failure (OR: 1.134, 95% CI: 1.039-1.237, p = 0.005) within 300-days of receiving a lumbar fusion. CONCLUSIONS LTO users had significantly higher readmission rates compared to LTN. In addition, we found that LTN use was associated with significantly higher odds of hardware failure at long-term follow-up in patients receiving lumbar fusion surgery.
Collapse
Affiliation(s)
- Alexander M Ballatori
- Keck School of Medicine of University of Southern California Department of Orthopedics, Los Angeles, California
| | - Shane Shahrestani
- Keck School of Medicine of University of Southern California Department of Orthopedics, Los Angeles, California; Department of Medical Engineering, California Institute of Technology, Pasadena, California
| | - Andy Ton
- Keck School of Medicine of University of Southern California Department of Orthopedics, Los Angeles, California
| | - Xiao Chen
- Keck School of Medicine of University of Southern California Department of Orthopedics, Los Angeles, California
| | - Brandon S Gettleman
- University of South Carolina School of Medicine, Columbia, South Carolina, USA
| | - Zorica Buser
- Keck School of Medicine of University of Southern California Department of Orthopedics, Los Angeles, California.
| | - Jeffrey C Wang
- Keck School of Medicine of University of Southern California Department of Orthopedics, Los Angeles, California
| |
Collapse
|
32
|
Emam OS, Eldaly AS, Avila FR, Torres-Guzman RA, Maita KC, Garcia JP, Anne Brown S, Haider CR, Forte AJ. Machine Learning Algorithms Predict Long-Term Postoperative Opioid Misuse: A Systematic Review. Am Surg 2024; 90:140-151. [PMID: 37732536 DOI: 10.1177/00031348231198112] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
INTRODUCTION A steadily rising opioid pandemic has left the US suffering significant social, economic, and health crises. Machine learning (ML) domains have been utilized to predict prolonged postoperative opioid (PPO) use. This systematic review aims to compile all up-to-date studies addressing such algorithms' use in clinical practice. METHODS We searched PubMed/MEDLINE, EMBASE, CINAHL, and Web of Science using the keywords "machine learning," "opioid," and "prediction." The results were limited to human studies with full-text availability in English. We included all peer-reviewed journal articles that addressed an ML model to predict PPO use by adult patients. RESULTS Fifteen studies were included with a sample size ranging from 381 to 112898, primarily orthopedic-surgery-related. Most authors define a prolonged misuse of opioids if it extends beyond 90 days postoperatively. Input variables ranged from 9 to 23 and were primarily preoperative. Most studies developed and tested at least two algorithms and then enhanced the best-performing model for use retrospectively on electronic medical records. The best-performing models were decision-tree-based boosting algorithms in 5 studies with AUC ranging from .81 to .66 and Brier scores ranging from .073 to .13, followed second by logistic regression classifiers in 5 studies. The topmost contributing variable was preoperative opioid use, followed by depression and antidepressant use, age, and use of instrumentation. CONCLUSIONS ML algorithms have demonstrated promising potential as a decision-supportive tool in predicting prolonged opioid use in post-surgical patients. Further validation studies would allow for their confident incorporation into daily clinical practice.
Collapse
Affiliation(s)
- Omar S Emam
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Abdullah S Eldaly
- Department of General Surgery, Houston Methodist Hospital, Houston, TX, USA
| | | | | | - Karla C Maita
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - John P Garcia
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Sally Anne Brown
- Department of Administration, Mayo Clinic, Jacksonville, FL, USA
| | - Clifton R Haider
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Antonio J Forte
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
| |
Collapse
|
33
|
Alshawadfy A, Elewa AM, Mewafy MA, Ellilly AA. Comparison between pericapsular nerve group block and morphine infusion in reducing pain of proximal femur fracture in the emergency department: A randomized controlled study. EGYPTIAN JOURNAL OF ANAESTHESIA 2023. [DOI: 10.1080/11101849.2023.2165888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- Abdelrhman Alshawadfy
- Department of Anesthesia and Intensive Care, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Ahmed M. Elewa
- Department of Anesthesia and Intensive Care, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Mahmoud Ahmed Mewafy
- Department of Anesthesia and Intensive Care, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Ahmed A. Ellilly
- Department of Anesthesia and Intensive Care, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| |
Collapse
|
34
|
Lyu Z, Tian S, Bao G, Huang R, Gong L, Zhou J, Kong X, Zhang W, Ran R, Nie N, Liu Y, Ji C, Liu S, Shao X, Kai G, Lin X, Fang J, Liang Y. Transcutaneous electrical acupoint stimulation for cancer-related pain management in patients receiving chronic opioid therapy: a randomized clinical trial. Support Care Cancer 2023; 32:16. [PMID: 38085376 DOI: 10.1007/s00520-023-08240-1] [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: 06/02/2023] [Accepted: 12/04/2023] [Indexed: 12/18/2023]
Abstract
PURPOSE The opioid crisis resulting from its use disorder and overdose poses additional challenges for cancer pain management. The American Society of Clinical Oncology Practice Guideline recommends acupuncture therapy for the management of adult cancer-related pain (CRP), but the effectiveness of transcutaneous electrical acupoint stimulation (TEAS) on CRP remains uncertain. METHODS This 5-week prospective randomized clinical trial was conducted at 2 hospitals in China, and participants with CRP receiving chronic opioid therapy were randomized 1:1 into two groups between December 2014 and June 2018. The true TEAS group underwent 15 sessions of TEAS treatments over 3 consecutive weeks, while the control group received sham stimulation. The primary outcome was the numerical rating scale (NRS) score in the past 24h at week 3. The secondary outcomes included morphine equivalent daily dose, quality of life and adverse events. RESULTS A total of 159 participants were included in the modified intention-to-treat population. The baseline characteristics were similar in both groups. The mean NRS scores were 0.98 points at week 3 in the true TEAS group and 1.41 points in the sham group, with the mean difference between groups of -0.43 points (P < 0.001; OR = 0.68, P < 0.05). The proportion of patients with NRS reduction more than thirty percentage at week 3 was 50.00% in the true TEAS group and 35.44% in the sham group (RD = 0.15, P > 0.05; RR = 1.41, P > 0.05). No significant difference in pain intensity between the two groups was observed during the follow-up period without TEAS intervention (week 4, OR = 0.83, P > 0.05; week 5, OR = 0.83, P > 0.05). The Karnofsky Performance Status value suggested that patients in the true TEAS group experienced an improved quality of life (Between-group differences: week 3, 3.5%, P < 0.05; week 4, 4.6%, P < 0.001; week 5, 5.6%, P < 0.001). CONCLUSIONS The 3-week application of TEAS in patients with CRP receiving chronic opioid therapy resulted in a statistically significant reduction in pain scores, but the observed reduction was of uncertain clinical significance. The prolonged analgesic effect of TEAS was not confirmed in this trial. CLINICALTRIAL GOV: ChiCTR-TRC-13003803.
Collapse
Affiliation(s)
- Zhengyi Lyu
- The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310005, China
| | - Shuxin Tian
- The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310005, China
| | - Guanai Bao
- Department of Integrated Chinese Traditional Medicine and Western Medicine, Zhejiang Cancer Hospital, Hangzhou, 310022, China
| | - Rui Huang
- Department of Acupuncture and Tuina, Wenzhou Central Hospital, Wenzhou, 325000, China
| | - Liyan Gong
- Department of Integrated Chinese Traditional Medicine and Western Medicine, Zhejiang Cancer Hospital, Hangzhou, 310022, China
| | - Jie Zhou
- Department of Acupuncture, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310000, China
| | - Xiangming Kong
- Department of Integrated Chinese Traditional Medicine and Western Medicine, Zhejiang Cancer Hospital, Hangzhou, 310022, China
| | - Weiping Zhang
- Department of Oncology, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310000, China
| | - Ran Ran
- Department of Oncology, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310000, China
| | - Na Nie
- Department of Acupuncture, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310000, China
| | - Yang Liu
- The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310005, China
| | - Conghua Ji
- Zhejiang Chinese Medical University, Hangzhou, 310005, China
| | - Shan Liu
- Department of Clinical Evaluation Center, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Hangzhou, 310000, China
| | - Xiaomei Shao
- Department of Acupuncture, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310000, China
| | - Guoyin Kai
- Zhejiang Chinese Medical University, Hangzhou, 310005, China
| | - Xianming Lin
- Department of Acupuncture, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310000, China
| | - Jianqiao Fang
- Department of Acupuncture, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310000, China.
| | - Yi Liang
- Department of Acupuncture, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310000, China.
| |
Collapse
|
35
|
Niu C, Zhang J, Bapaye J, Liu H, Zhu K, Farooq U, Zahid S, Zhang Q, Boppana H, Elkhapery A, Okolo PI. Systematic Review With Meta-Analysis: Chronic Opioid Use Is Associated With Esophageal Dysmotility in Symptomatic Patients. Am J Gastroenterol 2023; 118:2123-2132. [PMID: 37463432 DOI: 10.14309/ajg.0000000000002410] [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] [Received: 01/29/2023] [Accepted: 07/13/2023] [Indexed: 07/20/2023]
Abstract
INTRODUCTION We aimed to conduct a systematic review and meta-analysis to assess the impact of chronic opioid exposure on esophageal motility in patients undergoing manometric evaluation. METHODS Multiple databases were searched through October 2022 for original studies comparing the manometric results of patients who have used chronic opioids (for >90 days) with those who do not. The primary outcomes were esophageal dysmotility disorders. Three high-resolution manometry parameters were conducted as secondary outcomes. A random-effects model was applied to calculate the odds ratio (OR) and means difference (MD) along with a 95% confidence interval (CI). RESULTS Nine studies were included in this meta-analysis. Opioid use was associated with higher esophageal dysmotility disorders, including distal esophageal spasm (pooled OR 4.84, 95% CI 1.60-14.63, P = 0.005, I 2 = 96%), esophagogastric junction outflow obstruction (pooled OR 5.13, 95% CI 2.11-12.43, P = 0.0003, I 2 = 93%), and type III achalasia (pooled OR 4.15, 95% CI 2.15-8.03, P < 0.0001, I 2 = 64%). No significant differences were observed for hypercontractile esophagus, type I achalasia, or type II achalasia. The basal lower esophageal sphincter pressure (MD 3.02, 95% CI 1.55-4.50, P < 0.0001, I 2 = 90%), integrated relaxation pressure (MD 2.51, 95% CI 1.56-3.46, P < 0.00001, I 2 = 99%), and distal contractile integral (MD 640.29, 95% CI 469.56-811.03, P < 0.00001, I 2 = 91%) significantly differed between the opioid use and nonopioid use group. However, opioid use was associated with a lower risk of ineffective esophageal motility (pooled OR 0.68, 95% CI 0.49-0.95, P = 0.02, I 2 = 53%). DISCUSSION Chronic opioid exposure is associated with an increased frequency esophageal dysmotility disorders. Our results revealed that opioid use is significantly associated with type III achalasia but not with type I and II achalasia. Therefore, opioid treatment should be taken into account as a potential underlying risk factor when diagnosing these major esophageal motor abnormalities.
Collapse
Affiliation(s)
- Chengu Niu
- Internal Medicine Residency Program, Rochester General Hospital, Rochester, New York, New York, USA
| | - Jing Zhang
- Harbin Medical University, Harbin, China
| | - Jay Bapaye
- Internal Medicine Residency Program, Rochester General Hospital, Rochester, New York, New York, USA
| | - Hongli Liu
- Internal Medicine Residency Program, Rochester General Hospital, Rochester, New York, New York, USA
| | - Kaiwen Zhu
- Internal Medicine Residency Program, Rochester General Hospital, Rochester, New York, New York, USA
| | - Umer Farooq
- Internal Medicine Residency Program, Rochester General Hospital, Rochester, New York, New York, USA
| | - Salman Zahid
- Internal Medicine Residency Program, Rochester General Hospital, Rochester, New York, New York, USA
| | - Qian Zhang
- Internal Medicine Residency Program, Rochester General Hospital, Rochester, New York, New York, USA
| | - Hemanth Boppana
- Internal Medicine Residency Program, Rochester General Hospital, Rochester, New York, New York, USA
| | - Ahmed Elkhapery
- Internal Medicine Residency Program, Rochester General Hospital, Rochester, New York, New York, USA
| | - Patrick I Okolo
- Division of Gastroenterology, Rochester General Hospital, Rochester, New York, USA
| |
Collapse
|
36
|
Dressler RL, Kaliner E, Cohen MJ. Trends in Israeli community-based opioid prescribing, 2010-2020, an observational study of the country's largest HMO. Isr J Health Policy Res 2023; 12:34. [PMID: 37974249 PMCID: PMC10652579 DOI: 10.1186/s13584-023-00581-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Prescription opioids are widely used for pain control and palliative care but have been associated with a variety of untoward effects, including opioid use disorder, addiction, and increased mortality. Patterns of opioid use in Israel are to date poorly described. METHODS Using a community-based database, the authors performed a retrospective analysis of filled opioid prescriptions of Israeli HMO members 18 years of age or older during the years of 2010-2020 that filled at least one opioid prescription. Morphine milligram equivalent (MME) calculations were stratified by presence or absence of oncology diagnosis and by specific opioid medication. RESULTS The percentage of HMO members who filled at least one opioid prescription increased every year from 2.1% in 2010 to 4.2% in 2020. There was an increase in the MME per prescription (44.2%), daily MME per capita (142.1%) and MME per prescription-filling patient (39%) from 2010 to 2020. Increased prescription opioid use is driven by a small group of non-oncological patients, which is less than 1.5% of opioid-prescribed patients and 0.1% of the adult population, primarily owing to fentanyl use. CONCLUSION Supervision and control of opioid prescriptions in Israel should be a focused effort directed at patients prescribed uniquely high dosages rather than a population-wide strategy that focuses on all patients prescribed opioids. This should be complemented by improved physician training and access to non-opioid therapies, as well as improved data collection and analysis.
Collapse
Affiliation(s)
- Reuven L Dressler
- Clalit Health Services, Department of Family Medicine, Hebrew University of Jerusalem Faculty of Medicine, Jerusalem District, HaGitit 64-B, 9839037, Maale Adumim, Israel
| | - Ehud Kaliner
- State of Israel Ministry of Health, Central District, 91 Herzl St., 7243003, Ramla, Israel
| | - Matan J Cohen
- Clalit Health Services, Hebrew University of Jerusalem Faculty of Medicine, Jerusalem District, 1 Ygal Alon St., Bet Shemesh, Israel.
| |
Collapse
|
37
|
Smith WR, Valrie CR, Jaja C, Kenney MO. Precision, integrative medicine for pain management in sickle cell disease. FRONTIERS IN PAIN RESEARCH 2023; 4:1279361. [PMID: 38028431 PMCID: PMC10666191 DOI: 10.3389/fpain.2023.1279361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Sickle cell disease (SCD) is a prevalent and complex inherited pain disorder that can manifest as acute vaso-occlusive crises (VOC) and/or chronic pain. Despite their known risks, opioids are often prescribed routinely and indiscriminately in managing SCD pain, because it is so often severe and debilitating. Integrative medicine strategies, particularly non-opioid therapies, hold promise in safe and effective management of SCD pain. However, the lack of evidence-based methods for managing SCD pain hinders the widespread implementation of non-opioid therapies. In this review, we acknowledge that implementing personalized pain treatment strategies in SCD, which is a guideline-recommended strategy, is currently fraught with limitations. The full implementation of pharmacological and biobehavioral pain approaches targeting mechanistic pain pathways faces challenges due to limited knowledge and limited financial and personnel support. We recommend personalized medicine, pharmacogenomics, and integrative medicine as aspirational strategies for improving pain care in SCD. As an organizing model that is a comprehensive framework for classifying pain subphenotypes and mechanisms in SCD, and for guiding selection of specific strategies, we present evidence updating pain research pioneer Richard Melzack's neuromatrix theory of pain. We advocate for using the updated neuromatrix model to subphenotype individuals with SCD, to better select personalized multimodal treatment strategies, and to identify research gaps fruitful for exploration. We present a fairly complete list of currently used pharmacologic and non-pharmacologic SCD pain therapies, classified by their mechanism of action and by their hypothesized targets in the updated neuromatrix model.
Collapse
Affiliation(s)
- Wally R. Smith
- Division of General Internal Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Cecelia R. Valrie
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, United States
| | - Cheedy Jaja
- College of Nursing, University of South Florida School of Nursing, Tampa, FL, United States
| | - Martha O. Kenney
- Department of Anesthesiology, Duke University, Durham, NC, United States
| |
Collapse
|
38
|
Yogeswaran V, Drucker C, Kume K, Poel A, Yarid N, Leyde S, Rea TD, Chatterjee NA. Presentation and Outcomes of Adults With Overdose-Related Out-of-Hospital Cardiac Arrest. JAMA Netw Open 2023; 6:e2341921. [PMID: 37934498 PMCID: PMC10630895 DOI: 10.1001/jamanetworkopen.2023.41921] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/21/2023] [Indexed: 11/08/2023] Open
Abstract
Importance Drug overdose (OD) is a public health challenge and an important cause of out-of-hospital cardiac arrest (OHCA). Existing studies evaluating OD-related OHCA (OD-OHCA) either aggregate all drugs or focus on opioids. The epidemiology, presentation, and outcomes of drug-specific OHCA are largely unknown. Objective To evaluate the temporal pattern, clinical presentation, care, and outcomes of adult patients with OHCA overall and according to the drug-specific profile. Design, Setting, and Participants This cohort study of adults with OHCA in King County Washington was conducted between January 1, 2015, and December 31, 2021. Etiology of OHCA was determined using emergency medical service, hospital, and medical examiner records. Etiology was classified as non-OD OHCA or OD-OHCA, with drug-specific profiles categorized as (1) opioid without stimulant, (2) stimulant without opioid, (3) opioid and stimulant, or (4) all other nonstimulant, nonopioid drugs. Statistical analysis was performed on July 1, 2023. Exposure Out-of-hospital cardiac arrest. Main Outcomes and Measures The primary outcome was survival to hospital discharge. The secondary outcome was survival with favorable functional status defined by Cerebral Performance Category 1 or 2 based on review of the hospital record. Results In this cohort study, there were 6790 adult patients with emergency medical services-treated OHCA from a US metropolitan system. During the 7-year study period, there were 702 patients with OD-OHCA (median age, 41 years [IQR, 29-53 years]; 64% male [n = 450] and 36% female [n = 252]) and 6088 patients with non-OD OHCA (median age, 66 years [IQR, 56-77 years]; 65% male [n = 3944] and 35% female [n = 2144]). The incidence of OD-OHCA increased from 5.2 (95% CI, 3.8-6.6) per 100 000 person-years in 2015 to 13.0 (95% CI, 10.9-15.1) per 100 000 person-years in 2021 (P < .001 for trend), whereas there was no significant temporal change in the incidence of non-OD OHCA (P = .30). OD-OHCA were more likely to be unwitnessed (66% [460 of 702] vs 41% [2515 of 6088]) and less likely to be shockable (8% [56 of 702] vs 25% [1529 of 6088]) compared with non-OD OHCA. Unadjusted survival was not different (20% [138 of 702] for OD vs 18% [1095 of 6088] for non-OD). When stratified by drug profile, combined opioid-stimulant OHCA demonstrated the greatest relative increase in incidence. Presentation and outcomes differed by drug profile. Patients with stimulant-only OHCA were more likely to have a shockable rhythm (24% [31 of 129]) compared with patients with opioid-only OHCA (4% [11 of 295]) or patients with combined stimulant-opioid OHCA 5% [10 of 205]), and they were more likely to have a witnessed arrest (50% [64 of 129]) compared with patients with OHCA due to other drugs (19% [14 of 73]) or patients with combined stimulant-opioid OHCA (23% [48 of 205]). Patients with a combined opioid-stimulant OHCA had the lowest survival to hospital discharge (10% [21 of 205]) compared with patients with stimulant-only OHCA (22% [29 of 129]) or patients with OHCA due to other drugs (26% [19 of 73]), a difference that persisted after multivariable adjustment. Conclusions and Relevance In a population-based cohort study, the incidence of OD-OHCA increased significantly from 2015 to 2021, with the greatest increase observed among patients with a combined stimulant-opioid OHCA. Presentation and outcome differed according to the drug-specific profile. The combination of increasing incidence and lower survival among among patients with a opioid-stimulant OHCA supports prevention and treatment initiatives that consider the drug-specific profile.
Collapse
Affiliation(s)
| | - Christopher Drucker
- Public Health–Seattle & King County Division of Emergency Medical Services, Seattle, Washington
| | - Kosuke Kume
- Public Health–Seattle & King County Division of Emergency Medical Services, Seattle, Washington
| | - Amy Poel
- Public Health–Seattle & King County Division of Emergency Medical Services, Seattle, Washington
| | - Nicole Yarid
- King County Medical Examiner’s Office, Seattle, Washington
| | - Sarah Leyde
- Department of Medicine, University of Washington, Seattle, Washington
| | - Thomas D. Rea
- Department of Medicine, University of Washington, Seattle, Washington
- Public Health–Seattle & King County Division of Emergency Medical Services, Seattle, Washington
| | | |
Collapse
|
39
|
Khalil LS, Castle JP, Akioyamen NO, Corsi MP, Cominos ND, Dubé M, Lynch TS. What are patients asking and reading online? An analysis of online patient searches for rotator cuff repair. J Shoulder Elbow Surg 2023; 32:2245-2255. [PMID: 37263485 DOI: 10.1016/j.jse.2023.04.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/09/2023] [Accepted: 04/12/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Patients undergoing rotator cuff surgery often search the internet for information regarding the procedure. One popular source, Google, compiles frequently asked questions and links to websites that may provide answers. This study provides an analysis of the most frequently searched questions associated with rotator cuff surgery. We hypothesize that there will be distinct search patterns associated with online queries about rotator cuff surgery that could provide unique insights into patient concerns. METHODS A set of search terms were entered into Google Web Search using a clean-install Google Chrome browser. Frequently associated questions and their webpages were extracted to a database via a data mining extension. Questions were categorized by topics relevant for rotator cuff arthroscopy. Websites were categorized by source and scored for quality using the JAMA Benchmark Criteria. Pearson's χ2 tests were used to analyze nominal data. Student t tests were performed to compare JAMA Benchmark Scores. RESULTS Of the 595 questions generated from the initial search, 372 unique questions associated with 293 websites were extracted and categorized. The most popular question topics were activities/restrictions (20.7%), pain (18.8%), and indications/management (13.2%). The 2 most common websites searched were academic (35.2%) and medical practice (27.4%). Commercial websites were significantly more likely to be associated with questions about cost (57.1% of all cost questions, P = .01), anatomy/function (62.5%, P = .001), and evaluation of surgery (47.6%, P < .001). Academic websites were more likely to be associated with questions about technical details of surgery (58.1%, P < .001). Medical practice and social media websites were more likely associated with activities/restrictions (48.1%, P < .001, and 15.6%, P < .001, respectively). Government websites were more likely associated with timeline of recovery (12.8%, P = .01). On a scale of 0-4, commercial and academic websites had the highest JAMA scores (3.06 and 2.39, respectively). CONCLUSION Patients seeking information regarding rotator cuff repair primarily use the Google search engine to ask questions regarding postoperative activity and restrictions, followed by pain, indications, and management. Academic websites, which were associated with technical details of surgery, and medical practice websites, which were associated with activities/restrictions, were the 2 most commonly searched resources. These results emphasize the need for orthopedic surgeons to provide detailed and informative instructions to patients undergoing rotator cuff repair, especially in the postoperative setting.
Collapse
Affiliation(s)
- Lafi S Khalil
- McLaren Flint Hospital, Department of Orthopaedic Surgery, Flint, MI, USA.
| | - Joshua P Castle
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Noel O Akioyamen
- Department of Orthopaedic Surgery, Montefiore Medical Center, The Bronx, NY, USA
| | | | | | - Michael Dubé
- Northeast Ohio Medical University, Rootstown, OH, USA
| | - T Sean Lynch
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, MI, USA
| |
Collapse
|
40
|
Kapinos KA, DeYoreo M, Gracner T, Stein BD, Cantor J. Trends in Geographic Proximity to Substance Use Disorder Treatment. Am J Prev Med 2023; 65:618-626. [PMID: 37037326 PMCID: PMC10524906 DOI: 10.1016/j.amepre.2023.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 04/12/2023]
Abstract
INTRODUCTION This study aims to assess the trends in the number and characteristics of substance use disorder (SUD) treatment facilities within the county of residence of adults aged 50+ years over time. METHODS Using retrospective longitudinal data from the 1992-2018 Health and Retirement Study merged with the county-level data on all licensed treatment facilities in the country, linear mixed models were estimated to calculate geographic accessibility to SUD treatment, adjusted for person-level demographics, state-level controls, and calendar year-fixed effects. Analysis was conducted in 2022. RESULTS Overall, older adults experienced a decline in the average number of SUD treatment facilities within their counties of residence from 4.80 per 100,000 residents (95% CI=4.69, 4.92) in 1992 to 4.50 (95% CI=4.35, 4.64) in 2018. However, the number accepting Medicare increased from 0.26 (95% CI=0.21, 0.30) in 1992 to 1.88 (95% CI=1.80, 1.96) facilities per 100,000 (42% of facilities); Medicaid increased from 0.20 (95% CI=0.13, 0.26) in 1992 to 3.50 (95% CI=3.39, 3.62) facilities per 100,000 (78% of facilities) in 2018. Older adults living in more rural areas experienced the most growth in SUD treatment facilities per capita in their counties but with less significant growth in facilities offering medication for opioid use disorder than those living in more urban areas. CONCLUSIONS Despite increases in the number of SUD treatment facilities in rural areas, there has been less growth in nearby facilities offering evidence-based medication treatment for opioid use disorder.
Collapse
Affiliation(s)
- Kandice A Kapinos
- RAND Corporation, Arlington, Virginia; Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas.
| | | | | | | | | |
Collapse
|
41
|
Tibbs GR, Uprety R, Warren JD, Beyer NP, Joyce RL, Ferrer MA, Mellado W, Wong VSC, Goldberg DC, Cohen MW, Costa CJ, Li Z, Zhang G, Dephoure NE, Barman DN, Sun D, Ingólfsson HI, Sauve AA, Willis DE, Goldstein PA. An anchor-tether 'hindered' HCN1 inhibitor is antihyperalgesic in a rat spared nerve injury neuropathic pain model. Br J Anaesth 2023; 131:745-763. [PMID: 37567808 PMCID: PMC10541997 DOI: 10.1016/j.bja.2023.06.067] [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: 04/13/2023] [Revised: 06/20/2023] [Accepted: 06/29/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Neuropathic pain impairs quality of life, is widely prevalent, and incurs significant costs. Current pharmacological therapies have poor/no efficacy and significant adverse effects; safe and effective alternatives are needed. Hyperpolarisation-activated cyclic nucleotide-regulated (HCN) channels are causally implicated in some forms of peripherally mediated neuropathic pain. Whilst 2,6-substituted phenols, such as 2,6-di-tert-butylphenol (26DTB-P), selectively inhibit HCN1 gating and are antihyperalgesic, the development of therapeutically tolerable, HCN-selective antihyperalgesics based on their inverse agonist activity requires that such drugs spare the cardiac isoforms and do not cross the blood-brain barrier. METHODS In silico molecular dynamics simulation, in vitro electrophysiology, and in vivo rat spared nerve injury methods were used to test whether 'hindered' variants of 26DTB-P (wherein a hydrophilic 'anchor' is attached in the para-position of 26DTB-P via an acyl chain 'tether') had the desired properties. RESULTS Molecular dynamics simulation showed that membrane penetration of hindered 26DTB-Ps is controlled by a tethered diol anchor without elimination of head group rotational freedom. In vitro and in vivo analysis showed that BP4L-18:1:1, a variant wherein a diol anchor is attached to 26DTB-P via an 18-carbon tether, is an HCN1 inverse agonist and an orally available antihyperalgesic. With a CNS multiparameter optimisation score of 2.25, a >100-fold lower drug load in the brain vs blood, and an absence of adverse cardiovascular or CNS effects, BP4L-18:1:1 was shown to be poorly CNS penetrant and cardiac sparing. CONCLUSIONS These findings provide a proof-of-concept demonstration that anchor-tethered drugs are a new chemotype for treatment of disorders involving membrane targets.
Collapse
Affiliation(s)
- Gareth R Tibbs
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Rajendra Uprety
- Department of Pharmacology, Weill Cornell Medicine, New York, NY, USA
| | - J David Warren
- Department of Biochemistry, Weill Cornell Medicine, New York, NY, USA
| | - Nicole P Beyer
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Rebecca L Joyce
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Matthew A Ferrer
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | | | | | | | | | | | - Zhucui Li
- Department of Biochemistry, Weill Cornell Medicine, New York, NY, USA
| | - Guoan Zhang
- Department of Biochemistry, Weill Cornell Medicine, New York, NY, USA
| | - Noah E Dephoure
- Department of Biochemistry, Weill Cornell Medicine, New York, NY, USA; Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Dipti N Barman
- Department of Biochemistry, Weill Cornell Medicine, New York, NY, USA
| | - Delin Sun
- Lawrence Livermore National Laboratory, Livermore, CA, USA
| | | | - Anthony A Sauve
- Department of Pharmacology, Weill Cornell Medicine, New York, NY, USA
| | - Dianna E Willis
- Burke Neurological Institute, White Plains, NY, USA; Feil Family Brain & Mind Research Institute, Weill Cornell Medicine, New York, NY, USA.
| | - Peter A Goldstein
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA; Feil Family Brain & Mind Research Institute, Weill Cornell Medicine, New York, NY, USA; Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
| |
Collapse
|
42
|
Hauck TS, Ladha KS, Le Foll B, Wijeysundera DN, Kurdyak P. Postoperative buprenorphine continuation in stabilized buprenorphine patients: A population cohort study. Addiction 2023; 118:1953-1964. [PMID: 37332171 DOI: 10.1111/add.16223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/05/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND AND AIMS Sudden discontinuation of buprenorphine in the treatment of opioid use disorder can increase the risk of subsequent relapse and overdose. Little is known about buprenorphine use in the perioperative period. The aim of this study was to determine the rate of buprenorphine continuation after hospital discharge following surgery and factors associated with continuation. DESIGN A population-based retrospective cohort study was conducted using administrative data from Ontario, Canada, between 2012 and 2018. The cohort included individuals on continuous buprenorphine prior to surgery. Logistic regression modeling was used to estimate the association of buprenorphine continuation with demographic, opioid agonist treatment, surgical and health service use factors. SETTING Administrative databases from Institute for Clinical Evaluative Sciences (ICES) were used, which capture the Ontario, Canada, population. The data sets describe physician billing, monitoring of controlled substances and hospital discharges. PARTICIPANTS Adults (≥ 18 years, n = 2176) had received a buprenorphine/naloxone product continuously for at least 60 days for the treatment of opioid use disorder and subsequently underwent a surgical procedure. MEASUREMENTS Continuation (versus discontinuation) of buprenorphine prescriptions in the 14 days after surgical discharge was recommended. Exposures included demographic, comorbidity, opioid agonist treatment, surgical and health service use characteristics. FINDINGS About 176 (8.1%) of the 2176 patients discontinued buprenorphine after surgery. Inpatient surgery (versus ambulatory) was associated with reduced odds of continuation, with an unadjusted odds ratio (OR) of 0.17 [95% confidence interval (CI) = 0.12-0.25] and an adjusted OR of 0.16 (95% CI = 0.11-0.23) after accounting for age, sex, rural residence, neighborhood income quintile, Charlson comorbidity index, psychiatric hospitalizations in the past 5 years and recent dispensed supply of buprenorphine (number needed to harm of 6.6). CONCLUSIONS In Ontario, Canada, from 2012 to 2018, most patients receiving continuous preoperative buprenorphine therapy continued buprenorphine use after surgery. Inpatient surgery was a strong predictor of discontinuation compared with ambulatory procedures.
Collapse
Affiliation(s)
- Tanya S Hauck
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- ICES Central, Toronto, ON, Canada
| | - Karim S Ladha
- Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia, St Michael's Hospital, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Bernard Le Foll
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Duminda N Wijeysundera
- Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia, St Michael's Hospital, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Paul Kurdyak
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- ICES Central, Toronto, ON, Canada
| |
Collapse
|
43
|
Sabesan V, Lapica H, Fernandez C, Fomunung C. Evolution of Perioperative Pain Management in Shoulder Arthroplasty. Orthop Clin North Am 2023; 54:435-451. [PMID: 37718083 DOI: 10.1016/j.ocl.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Historically, opioids have been used as a primary conservative treatment for pain related to glenohumeral osteoarthritis (GHOA). However, this practice is concerning as it often leads to overuse, which has contributed to the current epidemic of addiction and overdoses in the United States. Studies have shown that preoperative opioid use is associated with higher complication rates and worse outcomes following surgery, particularly for shoulder arthroplasty. To address these concerns, perioperative pain management for shoulder arthroplasty has evolved over the years to the use of multimodal analgesia.
Collapse
Affiliation(s)
- Vani Sabesan
- Department of Orthopedics, JFK/University of Miami, Palm Beach, FL, USA.
| | - Hans Lapica
- Department of Orthopedics, JFK/University of Miami, Palm Beach, FL, USA
| | - Carlos Fernandez
- Department of Orthopedics, JFK/University of Miami, Palm Beach, FL, USA
| | - Clyde Fomunung
- Department of Orthopedics, JFK/University of Miami, Palm Beach, FL, USA
| |
Collapse
|
44
|
Todaro DR, Li X, Pereira-Rufino LDS, Manza P, Nasrallah IM, Das S, Childress AR, Kranzler HR, Volkow ND, Langleben DD, Shi Z, Wiers CE. Hippocampal volume loss in individuals with a history of non-fatal opioid overdose. Addict Biol 2023; 28:e13336. [PMID: 37753562 PMCID: PMC10626561 DOI: 10.1111/adb.13336] [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: 04/18/2023] [Revised: 08/08/2023] [Accepted: 08/24/2023] [Indexed: 09/28/2023]
Abstract
Incidence of opioid-related overdoses in the United States has increased dramatically over the past two decades. Despite public emphasis on overdose fatalities, most overdose cases are not fatal. Although there are case reports of amnestic syndromes and acute injury to the hippocampus following non-fatal opioid overdose, the effects of such overdoses on brain structure are poorly understood. Here, we investigated the neuroanatomical correlates of non-fatal opioid overdoses by comparing hippocampal volume in opioid use disorder (OUD) patients who had experienced an opioid overdose (OD; N = 17) with those who had not (NOD; N = 32). Voxel-based morphometry showed lower hippocampal volume in the OD group than in the NOD group, which on post hoc analysis was evident in the left but not the right hippocampus. These findings strengthen the evidence that hippocampal injury is associated with non-fatal opioid overdose, which is hypothesized to underlie overdose-related amnestic syndrome.
Collapse
Affiliation(s)
- Dustin R. Todaro
- Center for Studies of Addiction, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market St Ste 500, Philadelphia, PA 19104
| | - Xinyi Li
- Center for Studies of Addiction, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market St Ste 500, Philadelphia, PA 19104
| | - Laís da Silva Pereira-Rufino
- Center for Studies of Addiction, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market St Ste 500, Philadelphia, PA 19104
- Department of Morphology and Genetics, Federal University of São Paulo-UNIFESP, São Paulo, SP, Brazil, 04023-900
| | - Peter Manza
- Laboratory of Neuroimaging, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892
| | - Ilya M. Nasrallah
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104
| | - Sandhitsu Das
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104
| | - Anna Rose Childress
- Center for Studies of Addiction, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market St Ste 500, Philadelphia, PA 19104
| | - Henry R. Kranzler
- Center for Studies of Addiction, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market St Ste 500, Philadelphia, PA 19104
- Mental Illness Research, Education and Clinical Center, Crescenz Veterans Affairs Medical Center, Philadelphia, PA 19104
| | - Nora D. Volkow
- Laboratory of Neuroimaging, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892
| | - Daniel D. Langleben
- Center for Studies of Addiction, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market St Ste 500, Philadelphia, PA 19104
| | - Zhenhao Shi
- Center for Studies of Addiction, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market St Ste 500, Philadelphia, PA 19104
| | - Corinde E. Wiers
- Center for Studies of Addiction, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market St Ste 500, Philadelphia, PA 19104
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104
| |
Collapse
|
45
|
Cunningham DJ, Kwon NF, Allen NB, Hanselman AM, Adams SB. Time and State Legislation Have Decreased Opioid Prescribing in Elective Foot and Ankle Surgery in the United States. Foot Ankle Spec 2023; 16:485-496. [PMID: 34612756 DOI: 10.1177/19386400211043361] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Legislation in the United States has been enacted to reduce opioid overuse and abuse in the setting of the opioid epidemic, and a notable target has been opioid overprescription. However, the impact of this legislation on elective foot and ankle surgery is largely unknown. The purpose of this study was to evaluate the impact of opioid-limiting legislation on opioid prescribing in elective foot and ankle surgery. METHODS The 90-day perioperative opioid prescription filling in oxycodone 5-mg equivalents was identified in all patients 18 years of age and older undergoing nontrauma, nonarthroplasty foot and ankle surgery from 2010 to 2019 using a commercial database. States with and without legislation were identified, and opioid prescription filling before and after the legislation were tabulated. Unadjusted and adjusted analyses were performed to evaluate the impact of time and state legislation on perioperative opioid prescribing in this patient population. RESULTS Initial and cumulative opioid prescribing decreased significantly from 2010 to 2019 (39 vs 35.7 initial and 98.1 vs 55.7 cumulative). States with legislation had larger and more significant reductions in initial and cumulative opioid prescribing compared with states without legislation over similar time frames (41.6 to 35.1 with legislation vs 40.6 to 39.1 without legislation initial prescription filling volume and 87.7 to 62.8 vs 88.6 to 74.1 cumulative prescription filling volume). CONCLUSION State legislation and time have been associated with large, clinically relevant reductions in 90-day perioperative cumulative opioid prescription filling, although reductions in initial opioid prescription filing have remained low. These results encourage states without legislation to enact restraints to reduce the opioid epidemic. LEVELS OF EVIDENCE Level III: Retrospective, prognostic cohort study.
Collapse
Affiliation(s)
| | - Nicholas F Kwon
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
| | - Nicholas B Allen
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
| | - Andrew M Hanselman
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
| | - Samuel B Adams
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
| |
Collapse
|
46
|
Dunlap LJ, Kuklinski MR, Cowell A, McCollister KE, Bowser DM, Campbell M, Fernandes CSF, Kemburu P, Livingston BJ, Prosser LA, Rao V, Smart R, Yilmazer T. Economic Evaluation Design within the HEAL Prevention Cooperative. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:50-60. [PMID: 35947282 PMCID: PMC9364296 DOI: 10.1007/s11121-022-01400-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 11/01/2022]
Abstract
The rapid rise in opioid misuse, disorder, and opioid-involved deaths among older adolescents and young adults is an urgent public health problem. Prevention is a vital part of the nation's response to the opioid crisis, yet preventive interventions for those at risk for opioid misuse and opioid use disorder are scarce. In 2019, the National Institutes of Health (NIH) launched the Preventing Opioid Use Disorder in Older Adolescents and Young Adults cooperative as part of its broader Helping to End Addiction Long-term (HEAL) Initiative ( https://heal.nih.gov/ ). The HEAL Prevention Cooperative (HPC) includes ten research projects funded with the goal of developing effective prevention interventions across various settings (e.g., community, health care, juvenile justice, school) for older adolescent and young adults at risk for opioid misuse and opioid use disorder (OUD). An important component of the HPC is the inclusion of an economic evaluation by nine of these research projects that will provide information on the costs, cost-effectiveness, and sustainability of these interventions. The HPC economic evaluation is integrated into each research project's overall design with start-up costs and ongoing delivery costs collected prospectively using an activity-based costing approach. The primary objectives of the economic evaluation are to estimate the intervention implementation costs to providers, estimate the cost-effectiveness of each intervention for reducing opioid misuse initiation and escalation among youth, and use simulation modeling to estimate the budget impact of broader implementation of the interventions within the various settings over multiple years. The HPC offers an extraordinary opportunity to generate economic evidence for substance use prevention programming, providing policy makers and providers with critical information on the investments needed to start-up prevention interventions, as well as the cost-effectiveness of these interventions relative to alternatives. These data will help demonstrate the valuable role that prevention can play in combating the opioid crisis.
Collapse
Affiliation(s)
- Laura J Dunlap
- RTI International, E. Cornwallis Rd, PO Box 12194, Research Triangle Park, NC, 27709-2194, USA.
| | | | - Alexander Cowell
- The University of North Carolina at Chapel Hill, School of Government of Chapel Hill, NC, USA
| | - Kathryn E McCollister
- Soffer Clinical Research Center, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Diana M Bowser
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | | | | | - Pranav Kemburu
- RTI International, E. Cornwallis Rd, PO Box 12194, Research Triangle Park, NC, 27709-2194, USA
| | | | - Lisa A Prosser
- Department of Health Management and Policy, University of Michigan, Ann Arbor, MI, USA
- Susan B. Meister Child Health Evaluation and Research (CHEAR) Center, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Vinod Rao
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | | | - Tansel Yilmazer
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, Columbus, OH, USA
| |
Collapse
|
47
|
Schneider T, Kuussaari K, Virtanen P. Drug treatment service procurement: A systematic review of models, goals, and outcomes. NORDIC STUDIES ON ALCOHOL AND DRUGS 2023; 40:424-442. [PMID: 37969897 PMCID: PMC10634391 DOI: 10.1177/14550725231157503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 01/31/2023] [Indexed: 11/17/2023] Open
Abstract
Aim: To explore the goals and outcomes of public procurement of drug treatment services in OECD countries. The study explores how these complex services are procured and delivered. Methods and data: A systematic review of the literature (1990-2020) identified four partly overlapping models of drug treatment service procurement that are here labelled traditional, value-based, outcome-based, and innovative. Results: Even though different forms of drug treatment services procurement are common, only 12 empirical studies that focused on procurement were found. The four models differ in their approaches to design and performance specifications and the role of competition and collaboration in the co-creation of value. Conclusions: Competition and incentives improve neither the efficiency nor the quality or the outcomes of complex drug treatment services. Whereas many studies focus on payment mechanisms, there are important research gaps that relate to the co-creation of value with and for the service-users and other stakeholders.
Collapse
Affiliation(s)
- Taina Schneider
- University of Vaasa, Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Petri Virtanen
- University of Vaasa, Itla Children's Foundation, Vaasa, Finland
| |
Collapse
|
48
|
Eglovitch M, Parlier-Ahmad AB, Legge C, Chithranjan S, Kolli S, Violante S, Dzierzewski JM, Huhn AS, Wilkerson A, Martin CE. Patient reported preferences for sleep interventions among women receiving buprenorphine for opioid use disorder. Front Psychiatry 2023; 14:1244156. [PMID: 37779614 PMCID: PMC10537926 DOI: 10.3389/fpsyt.2023.1244156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/29/2023] [Indexed: 10/03/2023] Open
Abstract
Aim Among individuals receiving medication for OUD (MOUD), insomnia is highly prevalent and increases the risk for negative OUD outcomes. However, little is known about MOUD patient-reported preferences for insomnia treatments among women with OUD. This mixed-methods study explored acceptability of and patient preferences for sleep interventions among women in OUD treatment. Methods This is an analysis from an ongoing cross-sectional survey and interview study investigating the relationship between sleep and OUD recovery. The parent study is actively enrolling non-pregnant women between 18-45 years stabilized on buprenorphine from an outpatient program. Participants complete measures including the Insomnia Severity Index (ISI), with scores of ≥10 identifying clinically significant insomnia symptoms. A sub-sample who met this threshold completed semi-structured interviews. Descriptive statistics were generated for survey responses, and applied thematic analysis was used for interview data. Results Participants selected for the qualitative interview (n = 11) highlighted prior positive and negative experiences with sleep treatments, challenges with employing non-pharmacological sleep strategies, and preferences for both medical and behavioral sleep interventions while in recovery. Women emphasized the need for flexibility of sleep therapy sessions to align with ongoing social determinants (e.g., caregiving responsibilities) as well as for sleep medications without sedating effects nor risk of dependency. Conclusions Many women receiving MOUD have concomitant insomnia symptoms, and desire availability of both pharmacologic and behavioral sleep interventions within the OUD treatment setting. Qualitative findings underscore the need for evidence-based sleep interventions that account for the unique socioenvironmental factors that may impact strategy implementation in this population.
Collapse
Affiliation(s)
- Michelle Eglovitch
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, United States
| | | | - Catherine Legge
- School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Sajanee Chithranjan
- School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Saisriya Kolli
- School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Stephanie Violante
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, United States
| | | | | | - Allison Wilkerson
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Caitlin Eileen Martin
- Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, United States
- Department of Obstetrics and Gynecology, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| |
Collapse
|
49
|
Sigmon SC, Peck KR, Batchelder SR, Badger GJ, Heil SH, Higgins ST. Technology-Assisted Buprenorphine Treatment in Rural and Nonrural Settings: Two Randomized Clinical Trials. JAMA Netw Open 2023; 6:e2331910. [PMID: 37755833 PMCID: PMC10534272 DOI: 10.1001/jamanetworkopen.2023.31910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/27/2023] [Indexed: 09/28/2023] Open
Abstract
Importance Expansion of opioid use disorder treatment is needed, particularly in rural communities. Objective To evaluate technology-assisted buprenorphine (TAB) efficacy (1) over a longer period than previously examined, (2) with the addition of overdose education, and (3) among individuals residing in rural communities. Design, Setting, and Participants Two parallel, 24-week randomized clinical trials were conducted at the University of Vermont between February 1, 2018, and June 30, 2022. Participants were adults with untreated opioid use disorder from nonrural (trial 1) or rural (trial 2) communities. These trials are part of a programmatic effort to develop TAB protocols to improve treatment availability in underserved areas. Interventions Within each trial, 50 participants were randomized to TAB or control conditions. Participants in the TAB group completed bimonthly visits to ingest medication and receive take-home doses via a computerized device. They received nightly calls via an interactive voice response (IVR) system, IVR-generated random call-backs, and iPad-delivered HIV, hepatitis C virus (HCV), and overdose education. Control participants received community resource guides and assistance with contacting resources. All participants received harm reduction supplies and completed monthly assessments. Main Outcomes and Measures The primary outcome was biochemically verified illicit opioid abstinence across monthly assessments. Secondary outcomes included self-reported opioid use in both groups and abstinence at bimonthly and random call-back visits, treatment adherence, satisfaction, and changes in HIV, HCV, and overdose knowledge among TAB participants. Results Fifty individuals (mean [SD] age, 40.6 [13.1] years; 28 [56.0%] male) participated in trial 1, and 50 (mean [SD] age, 40.3 [10.8] years; 30 [60.0%] male) participated in trial 2. Participants in the TAB group achieved significantly greater illicit opioid abstinence vs controls at all time points in both trial 1 (85.3% [128 of 150]; 95% CI, 70.7%-93.3%; vs 24.0% [36 of 150]; 95% CI, 13.6%-38.8%) and trial 2 (88.0% [132 of 150]; 95% CI, 72.1%-95.4%; vs 21.3% [32 of 150]; 95% CI, 11.4%-36.5%). High abstinence rates were also observed at TAB participants' bimonthly dosing visits (83.0% [95% CI, 67.0%-92.0%] for trial 1 and 88.0% [95% CI, 71.0%-95.0%] for trial 2). Treatment adherence was favorable and similar between trials (with rates of approximately 99% for buprenorphine administration, 93% for daily IVR calls, and 92% for random call-backs), and 183 of 187 urine samples (97.9%) tested negative for illicit opioids at random call-backs. iPad-delivered education was associated with significant and sustained increases in HIV, HCV, and overdose knowledge. Conclusions and Relevance In these randomized clinical trials of TAB treatment, demonstration of efficacy was extended to a longer duration than previously examined and to patients residing in rural communities. Trial Registration ClinicalTrials.gov Identifier: NCT03420313.
Collapse
Affiliation(s)
- Stacey C. Sigmon
- Vermont Center on Behavior and Health, University of Vermont, Burlington
- Department of Psychiatry, University of Vermont, Burlington
- Department of Psychological Science, University of Vermont, Burlington
| | - Kelly R. Peck
- Vermont Center on Behavior and Health, University of Vermont, Burlington
- Department of Psychiatry, University of Vermont, Burlington
- Department of Psychological Science, University of Vermont, Burlington
| | - Sydney R. Batchelder
- Vermont Center on Behavior and Health, University of Vermont, Burlington
- Department of Psychiatry, University of Vermont, Burlington
| | - Gary J. Badger
- Department of Medical Biostatistics, University of Vermont, Burlington
| | - Sarah H. Heil
- Vermont Center on Behavior and Health, University of Vermont, Burlington
- Department of Psychiatry, University of Vermont, Burlington
- Department of Psychological Science, University of Vermont, Burlington
| | - Stephen T. Higgins
- Vermont Center on Behavior and Health, University of Vermont, Burlington
- Department of Psychiatry, University of Vermont, Burlington
- Department of Psychological Science, University of Vermont, Burlington
| |
Collapse
|
50
|
McCorquodale CL, Greening R, Tulloch R, Forget P. Opioid prescribing for acute postoperative pain: an overview of systematic reviews related to two consensus statements relevant at patient, prescriber, system and public health levels. BMC Anesthesiol 2023; 23:294. [PMID: 37648969 PMCID: PMC10468854 DOI: 10.1186/s12871-023-02243-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/16/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND National guidelines for rational opioid prescribing for acute postoperative pain are needed to optimise postoperative pain control and function whilst minimising opioid-related harm. OBJECTIVES This overview of systematic reviews aims to summarise and critically assess the quality of systematic reviews related to the 20 recommendations from two previously published consensus guideline papers (ten relevant at patient and prescriber levels and ten at a system / Public Health level). It also aims to identify gaps in research that require further efforts to fill these in order to augment the evidence behind creating national guidelines for rational opioid prescribing for acute postoperative pain. METHODS A systematic database search using PubMed/MEDLINE and Cochrane was conducted in November 2022. Furthermore, reference lists were reviewed. All identified systematic reviews were assessed for eligibility. Data from each study was extracted using a pre-standardised data extraction form. The methodological quality of the included reviews was assessed by two independent reviewers using the AMSTAR 2 checklist. Descriptive synthesis of the results was performed. RESULTS A total of 12 papers were eligible for analysis. Only eight out of the total 20 prioritised recommendations had systematic reviews that provided evidence related to them. These systematic reviews were most commonly of critically low quality. CONCLUSION The consensus papers provide guidance and recommendations based on the consensus of expert opinion that is based on the best available evidence. However, there is a lack of evidence supporting many of these consensus statements. Efforts to further analyse interventions that aim to reduce the rates of opioid prescribing and their adverse effects should therefore continue.
Collapse
Affiliation(s)
- C L McCorquodale
- University of Aberdeen School of Medicine, Medical Sciences and Nutrition, Aberdeen, Scotland, UK.
| | - R Greening
- NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK
| | - R Tulloch
- University of Aberdeen School of Medicine, Medical Sciences and Nutrition, Aberdeen, Scotland, UK
| | - P Forget
- University of Aberdeen School of Medicine, Medical Sciences and Nutrition, Aberdeen, Scotland, UK
- Department of Anaesthetics, NHS Grampian, Aberdeen, Scotland, UK
- Pain AND Opioid After Surgery (PANDOS) European Society of Anaesthesiology and Intensive Care (ESAIC) Research Group, Brussels, Belgium
| |
Collapse
|