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Oya R, Ogawa S, Oya K, Hirakawa Y, Maeda C, Amaya F. Prevalence of preoperative opioid usage and its impact on postoperative outcomes: a retrospective cohort study. J Anesth 2023:10.1007/s00540-023-03198-0. [PMID: 37160444 DOI: 10.1007/s00540-023-03198-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 04/25/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE Preoperative opioid treatment increases postoperative adverse events. This study was aimed to analyze preoperative opioid prevalence in countries with low opioid consumption. Additionally, the effect of low opioid usage on postoperative outcomes was also investigated. METHODS We conducted this single center retrospective cohort analysis in a Japanese university-affiliated hospital to investigate opioid usage and its impact on the duration of postoperative hospitalization and in-hospital mortality. Adult patients who underwent general anesthesia between 2015 and 2020 were included. We extracted the patients' characteristics, surgical information and postoperative outcomes. Subgroup analysis to address opioid dose effect was performed in high and low dose opioid subgroups. RESULTS Among 20,306 inpatients, 535 (2.63%) patients used opioids preoperatively. Tramadol was the most frequently used opioid. The median morphine equivalent (MME) dose was 15 mg/day. Median duration of hospitalization was 18 and 9 days in the opioid and non-opioid groups, and in-hospital mortality was 2.06% and 0.42%. Multivariable regression analysis demonstrated that preoperative opioid use was associated with a longer duration of hospitalization and in-hospital mortality. Subgroup analysis demonstrated longer durations of hospitalization in both high (> 30 mg/day MME) and low (≤ 30 mg/day MME) dose opioid groups, while higher in-hospital mortality was seen only in the high dose opioid group. CONCLUSIONS Preoperative opioid usage was one-tenth of the United States average. Despite its low prevalence and small dosage, preoperative opioid usage was associated with poor postoperative outcomes. Dedicated perioperative interventions to prevent opioid-associated adverse events should be developed even in countries with low opioid consumption.
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Affiliation(s)
- Rina Oya
- Department of Pain Management and Palliative Care Medicine, Kyoto Prefectural University of Medicine, Kajiicho 465, Kamigyo-ku, Kyoto, 602-0841, Japan
| | - Satoru Ogawa
- Department of Pain Management and Palliative Care Medicine, Kyoto Prefectural University of Medicine, Kajiicho 465, Kamigyo-ku, Kyoto, 602-0841, Japan
| | - Kiyofumi Oya
- Peace Home Care Clinic, 16-21 Oiwake-cho, Otsu, Shiga, 520-0064, Japan
| | - Yuka Hirakawa
- Department of Pain Management and Palliative Care Medicine, Kyoto Prefectural University of Medicine, Kajiicho 465, Kamigyo-ku, Kyoto, 602-0841, Japan
| | - Chika Maeda
- Department of Pain Management and Palliative Care Medicine, Kyoto Prefectural University of Medicine, Kajiicho 465, Kamigyo-ku, Kyoto, 602-0841, Japan
| | - Fumimasa Amaya
- Department of Pain Management and Palliative Care Medicine, Kyoto Prefectural University of Medicine, Kajiicho 465, Kamigyo-ku, Kyoto, 602-0841, Japan.
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Hasan M, Sarker SA. New Psychoactive Substances: A Potential Threat to Developing Countries. ADDICTION & HEALTH 2023; 15:136-143. [PMID: 37560390 PMCID: PMC10408757 DOI: 10.34172/ahj.2023.1411] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/30/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND New psychoactive substances (NPS) have become a global phenomenon, with over 134 countries and territories from all world regions reporting them. Since December 2021, governments, laboratories, and partner agencies have confirmed to the UNODC Early Warning Advisory (EWA) on NPS over 1124 substances. It is agreed that NPS control is one of the most challenging tasks for developing countries. Identifying the present and future threads of NPS is the most challenging task for law enforcement officials. The NPS research has a great impact on substance abuse policy-making and harm reduction strategies. METHODS The data in this study were collected from the official websites of online journals, Google Scholar, UNODC, International Narcotics Control Board (INCB), and the Department of Narcotics Control (DNC). FINDINGS Among the eleven groups of NPS, synthetic cannabinoids and cathinones are the most prevalent and alarming in developing countries. In Bangladesh, NPS abuse has been first identified in 2016. Almost 60 countries adopted legislative solutions to manage NPS by 2021, with many using or amending existing legislation and others employing novel legal mechanisms. It is widely agreed by researchers that reducing the menace of NPS requires increased awareness among all stakeholders. CONCLUSION In the fight against the spread of NPS and its severe effects, law enforcement authorities and healthcare professional training must be seen as crucial aspects as well. Financing is also crucial for international organizations dealing with the NPS impact to continue fighting this war. The only way for policymakers to reduce NPS spread globally is through national and international cooperation.
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Affiliation(s)
- Mehedi Hasan
- Deputy Director, Department of Narcotics Control, Security Services Division, Ministry of Home Affairs, Bangladesh
| | - Shahjahan Ali Sarker
- Department of Microbiology and Hygiene, Bangladesh Agricultural University, Mymensingh-2202, Bangladesh
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Takasusuki T, Hayashi S, Koretaka Y, Yamaguchi S. Prevalence of and Risk Factors for Prescription Opioid Misuse, Abuse, Diversion and Doctor Shopping in Japan: A Survey Study. Pain Ther 2022; 11:987-1009. [PMID: 35790601 PMCID: PMC9314531 DOI: 10.1007/s40122-022-00409-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 06/15/2022] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Opioid use disorder is a global problem. Although opioid analgesics are prescribed less frequently in Japan than in many other countries, the rate of aberrant prescription opioid-taking behaviors in Japan is unknown. METHODS An internet survey was conducted to estimate the prevalence of and risk factors for prescription opioid misuse, abuse, diversion and doctor shopping in Japanese subjects with chronic pain who had been prescribed opioid analgesics. RESULTS The proportion of respondents (n = 387) who reported opioid misuse was 45.5% (95% confidence interval [CI]: 40.4-50.6); rates were: 24.6% (95% CI: 20.3-29.2) for abuse; 15.0% (95% CI: 11.6-19.0) for diversion; and 10.6% (95% CI: 7.7-14.1) for doctor shopping. Aberrant prescription opioid-taking behaviors were higher in participants with chronic post-cancer treatment pain (misuse, 64.2%; abuse, 52.2%) or chronic cancer pain (misuse, 57.4%; abuse, 26.2%) than in those with chronic noncancer pain (misuse, 37.8%; abuse, 17.0%). Younger age, male sex, smoking, habitual drinking, diagnosis of psychiatric disease, use of opioids other than tramadol, and use of opioids for chronic post-cancer treatment pain and chronic cancer pain were identified as risk factors for aberrant prescription opioid-taking behaviors. CONCLUSION Even in Japan, which has not experienced the surge in opioid consumption documented in other countries, aberrant prescription opioid-taking behaviors were observed. When prescribing opioid analgesics, universal precautions should always be taken for both cancer and non-cancer patients. TRIAL REGISTRATION UMIN000041788.
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Affiliation(s)
- Toshifumi Takasusuki
- Department of Anesthesiology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, Japan
| | - Shinji Hayashi
- Integrated Disease Care Division, Shionogi & Co., Ltd., 1-8, Doshomachi 3-chome, Chuo-ku, Osaka, Japan
| | - Yuichi Koretaka
- DX Promotion Division, Shionogi & Co., Ltd., 1-8, Doshomachi 3-chome, Chuo-ku, Osaka, Japan
| | - Shigeki Yamaguchi
- Department of Anesthesiology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, Japan
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Seidel MF, Hügle T, Morlion B, Koltzenburg M, Chapman V, MaassenVanDenBrink A, Lane NE, Perrot S, Zieglgänsberger W. Neurogenic inflammation as a novel treatment target for chronic pain syndromes. Exp Neurol 2022; 356:114108. [PMID: 35551902 DOI: 10.1016/j.expneurol.2022.114108] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/01/2022] [Accepted: 05/03/2022] [Indexed: 11/24/2022]
Abstract
Chronic pain syndrome is a heterogeneous group of diseases characterized by several pathological mechanisms. One in five adults in Europe may experience chronic pain. In addition to the individual burden, chronic pain has a significant societal impact because of work and school absences, loss of work, early retirement, and high social and healthcare costs. Several anti-inflammatory treatments are available for patients with inflammatory or autoimmune diseases to control their symptoms, including pain. However, patients with degenerative chronic pain conditions, some with 10-fold or more elevated incidence relative to these manageable diseases, have few long-term pharmacological treatment options, limited mainly to non-steroidal anti-inflammatory drugs or opioids. For this review, we performed multiple PubMed searches using keywords such as "pain," "neurogenic inflammation," "NGF," "substance P," "nociception," "BDNF," "inflammation," "CGRP," "osteoarthritis," and "migraine." Many treatments, most with limited scientific evidence of efficacy, are available for the management of chronic pain through a trial-and-error approach. Although basic science and pre-clinical pain research have elucidated many biomolecular mechanisms of pain and identified promising novel targets, little of this work has translated into better clinical management of these conditions. This state-of-the-art review summarizes concepts of chronic pain syndromes and describes potential novel treatment strategies.
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Affiliation(s)
- Matthias F Seidel
- Department of Rheumatology, Spitalzentrum Biel-Centre Hospitalier Bienne, 2501 Biel-Bienne, Switzerland.
| | - Thomas Hügle
- Department of Rheumatology, University Hospital Lausanne, 1011 Lausanne, Switzerland
| | - Barton Morlion
- The Leuven Center for Algology and Pain Management, University of Leuven, Leuven, Belgium
| | - Martin Koltzenburg
- Department of Clinical and Movement Neuroscience, UCL Queen Square Institute of Neurology, London, United Kingdom; Department of Clinical Neurophysiology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Victoria Chapman
- Pain Centre Versus Arthritis, School of Life Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, United Kingdom
| | - Antoinette MaassenVanDenBrink
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Nancy E Lane
- Center for Musculoskeletal Health, University of California Davis School of Medicine, Sacramento, CA, USA; Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Serge Perrot
- Unité INSERM U987, Hôpital Ambroise Paré, Paris Descartes University, Boulogne Billancourt, France; Centre d'Evaluation et Traitement de la Douleur, Hôpital Cochin, Paris Descartes University, Paris, France
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Wu Z, Li X, Lu N, Wang Y, Ding X. Association between tramadol use and risk of pneumonia in the middle-aged and elderly populations: a propensity-score matched cohort study. Eur J Pain 2022; 26:1245-1255. [PMID: 35332612 DOI: 10.1002/ejp.1943] [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: 05/04/2021] [Revised: 12/12/2021] [Accepted: 03/19/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Tramadol is a widely used weak opioid; however, the evidence for its safety profile in respiratory system needs additional information. We aimed to examine whether tramadol use is associated with an increased risk of pneumonia in the general population. METHODS We conducted five propensity-score (PS) matched cohort studies in The Health Improvement Network database. Participants aged ≥50-years initiated tramadol were compared with those initiated one of the following analgesics: codeine (n=144,506), naproxen (n=113,028), diclofenac (n=74,297), celecoxib (n=42,538), or etoricoxib (n=27,232). The outcome was incident pneumonia. OUTCOMES During six-month follow-up, 395 pneumonia (5.6/1000 person-years) occurred in the tramadol group and 414 pneumonia (5.9/1000 person-years) occurred in the PS matched codeine group. Compared with codeine group, the risk of pneumonia was lower in the tramadol group (hazard ratio [HR]=0.63, 95% confidence interval [CI]: 0.49-0.82) during the first 30-day follow-up, but comparable between groups over the entire six-month follow-up (HR=0.95, 95%CI: 0.83-1.09). In addition, the risk of pneumonia was higher in the tramadol group than that in the PS matched naproxen (HR=1.68, 95%CI: 1.37-2.06), diclofenac (HR=1.63, 95%CI: 1.31-2.03), celecoxib (HR=1.64, 95%CI: 1.20-2.24), or etoricoxib (HR=1.61, 95%CI: 1.04-2.49) group. CONCLUSIONS The present study indicated that tramadol initiators had a lower risk of incident pneumonia than codeine initiators during the short-time follow-up, but had a comparable pneumonia risk compared to codeine initiators and had a higher risk of pneumonia compared to NSAIDs initiators over the entire six-month follow-up duration. Confirmation of the present findings and determination of the underlying mechanism will require more studies.
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Affiliation(s)
- Ziying Wu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Xiaoxiao Li
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, China
| | - Na Lu
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Yilun Wang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Xiang Ding
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
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Nagai J, Ishikawa Y. Analysis of anticholinergic adverse effects using two large databases: The US Food and Drug Administration Adverse Event Reporting System database and the Japanese Adverse Drug Event Report database. PLoS One 2021; 16:e0260980. [PMID: 34855908 PMCID: PMC8638968 DOI: 10.1371/journal.pone.0260980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/21/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Anticholinergic adverse effects (AEs) are a problem for elderly people. This study aimed to answer the following questions. First, is an analysis of anticholinergic AEs using spontaneous adverse drug event databases possible? Second, what is the main drug suspected of inducing anticholinergic AEs in the databases? Third, do database differences yield different results? METHODS We used two databases: the US Food and Drug Administration Adverse Event Reporting System database (FAERS) and the Japanese Adverse Drug Event Report database (JADER) recorded from 2004 to 2020. We defined three types of anticholinergic AEs: central nervous system (CNS) AEs, peripheral nervous system (PNS) AEs, and a combination of these AEs. We counted the number of cases and evaluated the ratio of drug-anticholinergic AE pairs between FAERS and JADER. We computed reporting odds ratios (RORs) and assessed the drugs using Beers Criteria®. RESULTS Constipation was the most reported AE in FAERS. The ratio of drug-anticholinergic AE pairs was statistically significantly larger in FAERS than JADER. Overactive bladder agents were suspected drugs common to both databases. Other drugs differed between the two databases. CNS AEs were associated with antidementia drugs in FAERS and opioids in JADER. In the assessment using Beers Criteria®, signals were detected for almost all drugs. Between the two databases, a significantly higher positive correlation was observed for PNS AEs (correlation coefficient 0.85, P = 0.0001). The ROR was significantly greater in JADER. CONCLUSIONS There are many methods to investigate AEs. This study shows that the analysis of anticholinergic AEs using spontaneous adverse drug event databases is possible. From this analysis, various suspected drugs were detected. In particular, FAERS had many cases. The differences in the results between the two databases may reflect differences in the reporting countries. Further study of the relationship between drugs and CNS AEs should be conducted.
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Affiliation(s)
- Junko Nagai
- The Office of Institutional Research, Meiji Pharmaceutical University, Kiyose, Tokyo, Japan
- * E-mail:
| | - Yoichi Ishikawa
- Division of Clinical Pharmacy, Department of Pediatric Pharmaceutical Sciences, Education and Research Center for Pharmacy, Meiji Pharmaceutical University, Kiyose, Tokyo, Japan
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