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Edwards JN, Whitney MA, Smith BB, Fah MK, Buckner Petty SA, Durra O, Sell-Dottin KA, Portner E, Wittwer ED, Milam AJ. The role of methadone in cardiac surgery for management of postoperative pain. BJA OPEN 2024; 10:100270. [PMID: 38560623 PMCID: PMC10978480 DOI: 10.1016/j.bjao.2024.100270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/27/2024] [Indexed: 04/04/2024]
Abstract
Background This retrospective study evaluated the efficacy and safety of intraoperative methadone compared with short-acting opioids. Methods Patients undergoing cardiac surgery with cardiopulmonary bypass (n=11 967) from 2018 to 2023 from a single health system were categorised into groups based on intraoperative opioid administration: no methadone (Group O), methadone plus other opioids (Group M+O), and methadone only (Group M). Results Patients in Groups M and M+O had lower mean pain scores until postoperative day (POD) 7 compared with Group O after adjusting for covariates (P<0.01). Both Groups M and M+O had lower total opioid administered compared with Group O for all days POD0-POD6 (all P<0.001). The median number of hours until initial postoperative opioid after surgery was 2.55 (inter-quartile range [IQR]=1.07-5.12), 6.82 (IQR=3.52-12.98), and 7.0 (IQR=3.82-12.95) for Group O, Group M+O, and Group M, respectively. The incidence of postoperative complications did not differ between groups. Conclusions Intraoperative administration of methadone was associated with better pain control without significant side-effects after cardiac surgery.
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Affiliation(s)
- Jordan N. Edwards
- Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | | | - Bradford B. Smith
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Megan K. Fah
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ, USA
| | | | - Omar Durra
- Keck School of Medicine of USC, Los Angeles, CA, USA
| | | | - Erica Portner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Erica D. Wittwer
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Adam J. Milam
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ, USA
- Department of Quantitative Health Sciences, Mayo Clinic, Phoenix, AZ, USA
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2
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Horn A, Adgent MA, Osmundson SS, Wiese AD, Phillips SE, Patrick SW, Griffin MR, Grijalva CG. Risk of Death at 1 Year Following Postpartum Opioid Exposure. Am J Perinatol 2024; 41:949-960. [PMID: 35640619 PMCID: PMC9708936 DOI: 10.1055/s-0042-1745848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Opioids are commonly prescribed to women for acute pain following childbirth. Postpartum prescription opioid exposure is associated with adverse opioid-related morbidities but the association with all-cause mortality is not well studied. This study aimed to examine the association between postpartum opioid prescription fills and the 1-year risk of all-cause mortality among women with live births. METHODS In a retrospective cohort study of live births among women enrolled in Tennessee Medicaid (TennCare) between 2007 and 2015, we compared women who filled two or more postpartum outpatient opioid prescriptions (up to 41 days of postdelivery discharge) to women who filled one or fewer opioid prescription. Women were followed from day 42 postdelivery discharge through 365 days of follow-up or date of death. Deaths were identified using linked death certificates (2007-2016). We used Cox's proportional hazard regression and inverse probability of treatment weights to compare time to death between exposure groups while adjusting for relevant confounders. We also examined effect modification by delivery route, race, opioid use disorder, use of benzodiazepines, and mental health condition diagnosis. RESULTS Among 264,135 eligible births, 216,762 (82.1%) had one or fewer maternal postpartum opioid fills and 47,373 (17.9%) had two or more fills. There were 182 deaths during follow-up. The mortality rate was higher in women with two or more fills (120.5 per 100,000 person-years) than in those with one or fewer (57.7 per 100,000 person-years). The risk of maternal death remained higher in participants exposed to two or more opioid fills after accounting for relevant covariates using inverse probability of treatment weighting (adjusted hazard ratio: 1.46 [95% confidence interval: 1.01, 2.09]). Findings from stratified analyses were consistent with main findings. CONCLUSION Filling two or more opioid prescriptions during the postpartum period was associated with a significant increase in 1-year risk of death among new mothers. KEY POINTS · Opioid prescribing in the postpartum period is common.. · Prior studies show that >1 postnatal opioid fill is associated with adverse opioid-related events.. · > 1 opioid fill within 42 days of delivery was associated with an increase in 1-year risk of death..
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Affiliation(s)
- Arlyn Horn
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN
| | - Margaret A. Adgent
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN
| | - Sarah S. Osmundson
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN
| | - Andrew D. Wiese
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN
| | - Sharon E. Phillips
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Stephen W. Patrick
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center, Nashville, TN
| | - Marie R. Griffin
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Veterans’ Health Administration Tennessee Valley Healthcare System, Geriatric Research Education and Clinical Center (GRECC), Nashville, TN
| | - Carlos G. Grijalva
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN
- Veterans’ Health Administration Tennessee Valley Healthcare System, Geriatric Research Education and Clinical Center (GRECC), Nashville, TN
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3
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Bharat C, Degenhardt L, Pearson S, Buizen L, Wilson A, Dobbins T, Gisev N. A data-informed approach using individualised dispensing patterns to estimate medicine exposure periods and dose from pharmaceutical claims data. Pharmacoepidemiol Drug Saf 2023; 32:352-365. [PMID: 36345837 PMCID: PMC10947320 DOI: 10.1002/pds.5567] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 10/28/2022] [Accepted: 11/04/2022] [Indexed: 11/10/2022]
Abstract
Pharmaceutical claims data are often used as the primary information source to define medicine exposure periods in pharmacoepidemiological studies. However, often critical information on directions for use and the intended duration of medicine supply are not available. In the absence of this information, alternative approaches are needed to support the assignment of exposure periods. This study summarises the key methods commonly used to estimate medicine exposure periods and dose from pharmaceutical claims data; and describes a method using individualised dispensing patterns to define time-dependent estimates of medicine exposure and dose. This method extends on important features of existing methods and also accounts for recent changes in an individual's medicine use. Specifically, this method constructs medicine exposure periods and estimates the dose used by considering characteristics from an individual's prior dispensings, accounting for the time between prior dispensings and the amount supplied at prior dispensings. Guidance on the practical applications of this method is also provided. Although developed primarily for application to databases, which do not contain duration of supply or dose information, use of this method may also facilitate investigations when such information is available and there is a need to consider individualised and/or changing dosing regimens. By shifting the reliance on prescribed duration and dose to determine exposure and dose estimates, individualised dispensing information is used to estimate patterns of exposure and dose for an individual. Reflecting real-world individualised use of medicines with complex and variable dosing regimens, this method offers a pragmatic approach that can be applied to all medicine classes.
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Affiliation(s)
- Chrianna Bharat
- National Drug and Alcohol Research CentreUNSW SydneySydneyNew South WalesAustralia
| | - Louisa Degenhardt
- National Drug and Alcohol Research CentreUNSW SydneySydneyNew South WalesAustralia
| | - Sallie‐Anne Pearson
- Centre for Big Data Research in HealthFaculty of Medicine, UNSW SydneyKensingtonNew South WalesAustralia
| | - Luke Buizen
- National Drug and Alcohol Research CentreUNSW SydneySydneyNew South WalesAustralia
| | - Andrew Wilson
- Menzies Centre for Health Policy and EconomicsSydney School of Public Health, University of SydneySydneyNew South WalesAustralia
| | - Timothy Dobbins
- School of Population HealthUNSW SydneySydneyNew South WalesAustralia
| | - Natasa Gisev
- National Drug and Alcohol Research CentreUNSW SydneySydneyNew South WalesAustralia
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4
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Acharya M, Hayes CJ, Li C, Painter JT, Dayer L, Martin BC. Comparative Study of Opioid Initiation With Tramadol, Short-acting Hydrocodone, or Short-acting Oxycodone on Opioid-related Adverse Outcomes Among Chronic Noncancer Pain Patients. Clin J Pain 2023; 39:107-118. [PMID: 36728675 PMCID: PMC10210068 DOI: 10.1097/ajp.0000000000001093] [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: 03/04/2022] [Accepted: 12/14/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To compare the safety profiles of low and high-dose tramadol, short-acting hydrocodone, and short-acting oxycodone therapies among chronic noncancer pain individuals. MATERIALS AND METHODS A retrospective cohort study of individuals with back/neck pain/osteoarthritis with an initial opioid prescription for tramadol, hydrocodone, or oxycodone was conducted using IQVIA PharMetrics Plus claims for Academics database (2006 to 2020). Two cohorts were created for separately studying opioid-related adverse events (overdoses, accidents, self-inflicted injuries, and violence-related injuries) and substance use disorders (opioid and nonopioid). Patients were followed from the index date until an outcome event, end of enrollment, or data end. Time-varying exposure groups were constructed and Cox regression models were estimated. RESULTS A total of 1,062,167 (tramadol [16.5%], hydrocodone [61.1%], and oxycodone [22.4%]) and 986,809 (tramadol [16.5%], hydrocodone [61.3%], and oxycodone [22.2%]) individuals were in the adverse event and substance use disorder cohorts. All high-dose groups had elevated risk of nearly all outcomes, compared with low-dose hydrocodone. Compared with low-dose hydrocodone, low-dose oxycodone was associated with a higher risk of opioid overdose (hazard ratio: 1.79 [1.37 to 2.33]). No difference in risk was observed between low-dose tramadol and low-dose hydrocodone (hazard ratio: 0.85 [0.64 to 1.13]). Low-dose oxycodone had higher risks of an opioid use disorder, and low-dose tramadol had a lower risk of accidents, self-inflicted injuries, and opioid use disorder compared with low-dose hydrocodone. DISCUSSION Low-dose oxycodone had a higher risk of opioid-related adverse outcomes compared with low-dose tramadol and hydrocodone. This should be interpreted in conjunction with the benefits of pain control and functioning associated with oxycodone use in future research.
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Affiliation(s)
| | - Corey J Hayes
- Department of Biomedical Informatics, College of Medicine
- Center for Mental Health Care and Outcomes Research, Central Arkansas Veterans Health Care Systems, North Little Rock, AR
| | - Chenghui Li
- Division of Pharmaceutical Evaluation and Policy
| | | | - Lindsey Dayer
- College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock
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5
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Hageman IC, Tien MY, Trajanovska M, Palmer GM, Corlette SJ, King SK. Perioperative opioid use in paediatric inguinal hernia patients: A systematic review and retrospective audit of practice. J Pediatr Surg 2022; 57:1249-1257. [PMID: 35397872 DOI: 10.1016/j.jpedsurg.2022.02.039] [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: 02/08/2022] [Accepted: 02/23/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Opioids play a major role in postoperative pain management in children, but their administration remains an under investigated topic. This study aimed to describe perioperative opioid prescribing practices for paediatric inguinal hernia patients in the literature and at The Royal Children's Hospital (RCH) in Melbourne, Australia. MATERIAL/METHOD A systematic review of English articles (published from 2009 to 2019) was conducted on paediatric (0-18y) inguinal hernia patients who received a postoperative or discharge opioid prescription, or both. The review was combined with a retrospective audit of RCH patients. Demographic, surgical, and analgesic details were collected from the electronic medical records. RESULTS Fifteen studies (n = 1166; combined mean age 4.93y) met the systematic review criteria. The percentage of patients receiving opioids postoperatively overall ranged from 3.33-100%, and doses ranged from 0.07 to 0.35 mg/kg oMEDD. At the RCH, perioperative opioid use was analyzed from 150 inguinal hernia patients (male - 113, median age - 3 months old). Postoperatively, 26 (17.3%) patients received opioids. The most commonly administered opioids were fentanyl (0.04-0.60 mg/kg oMEDD) in the post anaesthesia care unit and oxycodone (0.14-0.40 mg/kg oMEDD) in the first 24 h postoperatively. Older age at surgery, female sex and absence of regional anaesthesia were significantly associated with higher risk of total opioid use. No patients received an opioid prescription at discharge. CONCLUSION There is demonstratable variability in opioid prescribing practices for paediatric inguinal hernia patients as described in the literature. At our institution opioids were not used frequently in postoperative period.
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Affiliation(s)
- Isabel C Hageman
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria 3052, Australia; Faculty of Medicine, Utrecht University, Utrecht, the Netherland.
| | - Melissa Y Tien
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria 3052, Australia
| | - Misel Trajanovska
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria 3052, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Greta M Palmer
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria 3052, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia; Department of Anaesthesia and Pain Management, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Sebastian J Corlette
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria 3052, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia; Department of Anaesthesia and Pain Management, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Sebastian K King
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria 3052, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia; Department of Paediatric Surgery, The Royal Children's Hospital, Parkville, Victoria, Australia
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6
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Olatoke O, Zah V, Stanicic F, Vukicevic D, Yfantopoulos P, Thompson C, DeGeorge MK, Passik S. A US Retrospective Claims Analysis Comparing Healthcare Costs of Patients Transitioning from Immediate-Release Oxycodone to Two Different Formulations of Extended-Release Oxycodone: Xtampza ER or OxyContin. Clinicoecon Outcomes Res 2022; 14:119-128. [PMID: 35264862 PMCID: PMC8901186 DOI: 10.2147/ceor.s340290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 02/23/2022] [Indexed: 11/23/2022]
Affiliation(s)
- Oluwadara Olatoke
- HEOR Department, ZRx Outcomes Research, Mississauga, Ontario, Canada
- Correspondence: Oluwadara Olatoke, HEOR Department, ZRx Outcomes Research Inc., 3450 Cawthra Road, Mississauga, ON, L5A 2X7, Canada, +1 416 953 4427, Email
| | - Vladimir Zah
- HEOR Department, ZRx Outcomes Research, Mississauga, Ontario, Canada
| | - Filip Stanicic
- HEOR Department, ZRx Outcomes Research, Mississauga, Ontario, Canada
| | - Djurdja Vukicevic
- HEOR Department, ZRx Outcomes Research, Mississauga, Ontario, Canada
| | | | - Christy Thompson
- Medical Department, Collegium Pharmaceutical Inc., Stoughton, MA, USA
| | | | - Steven Passik
- Medical Department, Collegium Pharmaceutical Inc., Stoughton, MA, USA
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7
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Ahrari M, Ali S, Hartling L, Dong K, Drendel AL, Klassen TP, Schreiner K, Dyson MP. Nonmedical Opioid Use After Short-term Therapeutic Exposure in Children: A Systematic Review. Pediatrics 2021; 148:183452. [PMID: 34816280 DOI: 10.1542/peds.2021-051927] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2021] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Opioid-related harms continue to rise for children and youth. Analgesic prescribing decisions are challenging because the risk for future nonmedical opioid use or disorder is unclear. OBJECTIVE To synthesize research examining the association between short-term therapeutic opioid exposure and future nonmedical opioid use or opioid use disorder and associated risk factors. DATA SOURCES We searched 11 electronic databases. STUDY SELECTION Two reviewers screened studies. Studies were included if: they were published in English or French, participants had short-term (≤14 days) or an unknown duration of therapeutic exposure to opioids before 18 years, and reported opioid use disorder or misuse. DATA EXTRACTION Data were extracted, and methodologic quality was assessed by 2 reviewers. Data were summarized narratively. RESULTS We included 21 observational studies (49 944 602 participants). One study demonstrated that short-term therapeutic exposure may be associated with opioid abuse; 4 showed an association between medical and nonmedical opioid use without specifying duration of exposure. Other studies reported on prevalence or incidence of nonmedical use after medical exposure to opioids. Risk factors were contradictory and remain unclear. LIMITATIONS Most studies did not specify duration of exposure and were of low methodologic quality, and participants might not have been opioid naïve. CONCLUSIONS Some studies suggest an association between lifetime therapeutic opioid use and nonmedical opioid use. Given the lack of clear evidence regarding short-term therapeutic exposure, health care providers should carefully evaluate pain management options and educate patients and caregivers about safe, judicious, and appropriate use of opioids and potential signs of misuse.
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Affiliation(s)
| | - Samina Ali
- Departments of Pediatrics.,Emergency Medicine.,Women and Children's Health Research Institute
| | | | | | - Amy L Drendel
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Terry P Klassen
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Kurt Schreiner
- Pediatric Parents' Advisory Group, University of Alberta, Edmonton, Alberta, Canada
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8
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Al-Janabi N, Olesen AE, Straszek CL, Guldhammer C, Rathleff MS, Andreucci A. Pain medication use for musculoskeletal pain among children and adolescents: a systematic review. Scand J Pain 2021; 21:653-670. [PMID: 34506696 DOI: 10.1515/sjpain-2021-0033] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 08/13/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Musculoskeletal pain is common among children and adolescents. Despite the lack of evidence regarding harms and benefits, musculoskeletal pain is often managed with pain medication. The aim of this systematic review is to assess the prevalence of pain medication use for musculoskeletal pain among children and adolescents and the factors and side effects associated with use. CONTENT Three databases (EMBASE, CINAHL and PsychINFO) were systematically searched to identify studies designed to examine the prevalence, frequency or factors associated with the use of pain medication for musculoskeletal pain in children and adolescents (aged 6-19 years). The included studies were assessed for study quality and data were extracted. SUMMARY The search initially provided 20,135 studies. After screening titles, abstracts and full-texts, 20 studies were included. In school settings, 8-42% of children used pain medication for musculoskeletal pain, and 67-75% of children in sports clubs and from pain clinics used pain medication. The most consistent factors associated with the use of pain medications were pain characteristics and psychological factors (e.g. being bullied, low-self-esteem), while mixed evidence was found for increasing age and female gender. Only two studies reported on the duration of use and only one study on adverse effects related to the use of pain medication. OUTLOOK We found that 8-42% of adolescents from school-based samples use pain medication for MSK pain, while the prevalence among adolescents from sports clubs and pain clinics is higher (67-75%). Pain characteristics (pain duration, severity, intensity, disability levels and the presence of ≥2 pain conditions or multisite pain) and psychological factors were associated with a higher use of pain medication, while for higher age and female gender the evidence of association was mixed. Future studies should systematically collect information on the type, duration of use of pain medication and side effects to confirm the findings of this review.
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Affiliation(s)
- Nabil Al-Janabi
- Center for General Practice, Aalborg University, Aalborg, Denmark
| | - Anne Estrup Olesen
- Department of Clinical Pharmacology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Christian Lund Straszek
- Center for General Practice, Aalborg University, Aalborg, Denmark.,Department of Physiotherapy, University College of Northern Denmark, Aalborg, Denmark.,Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Clara Guldhammer
- Center for General Practice, Aalborg University, Aalborg, Denmark
| | - Michael Skovdal Rathleff
- Center for General Practice, Aalborg University, Aalborg, Denmark.,Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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9
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Jouanjus E, Gibaja V, Fabre F, Lapeyre-Mestre M. Medical prescription forms of opioid cough suppressants falsified by the patients before and after they switched from OTC to prescription-only in France. Br J Clin Pharmacol 2021; 88:1713-1721. [PMID: 34427950 DOI: 10.1111/bcp.15052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 06/07/2021] [Accepted: 07/09/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The French Ministry of Health scheduled opioid cough suppressants as prescription-only drugs on July 12th , 2017. The present study assessed the impact of this regulation on the diversion modalities of the concerned drugs and the related drug pholcodine by analysing the national OSIAP (Ordonnances suspectes indicateur d'abus possible) database. METHODS Medical prescriptions with at least one mention of codeine, dextromethorphan, ethylmorphine, noscapine or pholcodine for cough suppression recorded in 2013-2019 were extracted from OSIAP. Annual mentioning rates were estimated by dividing numbers of mentions over those of prescriptions recorded the year considered. A descriptive analysis compared the characteristics of prescriptions before and after July 12th , 2017. RESULTS Overall, 832 mentions of the requested drugs were retrieved on 827 prescription forms. Codeine was the most frequent (n=809, 8.7%) with 6 additional mentions of codeine/ethylmorphine combination, followed by dextromethorphan (n=11, 0.1%) and pholcodine (n=6, 0.1%). There was no mention of noscapine. Annual mentioning rates varied between 0 and 0.3% for all drugs except codeine. Codeine mentioning rates ranged between 0.3% (n=2) and 0.7% (n=9) before July 12th , 2017 and increased to 10.1% (n= 61) thereafter in 2017, 16.1% (n=314) in 2018, and 19.8% (n=414) in 2019. The profile of subjects evolved accordingly with an arisen male/female ratio (10.0 versus 1.5 before), a younger age (23 years versus 40 before, p<0.001). DISCUSSION The sharp increase of recourse to falsified prescription forms indicates that codeine diversion continues despite a restricted access, whereas the other drugs studied do not seem to have been impacted.
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Affiliation(s)
- Emilie Jouanjus
- Addictovigilance Centre, Department of Medical and Clinical Pharmacology, Toulouse University Hospital, Toulouse, France.,CERPOP, University of Toulouse, Inserm, UPS, Toulouse, France
| | - Valérie Gibaja
- Addictovigilance Centre, Nancy University Hospital, Vandoeuvre les Nancy, France
| | - Florence Fabre
- Addictovigilance Centre, Department of Medical and Clinical Pharmacology, Toulouse University Hospital, Toulouse, France
| | - Maryse Lapeyre-Mestre
- Addictovigilance Centre, Department of Medical and Clinical Pharmacology, Toulouse University Hospital, Toulouse, France
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10
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Okunev I, Frantsve-Hawley J, Tranby E. Trends in national opioid prescribing for dental procedures among patients enrolled in Medicaid. J Am Dent Assoc 2021; 152:622-630.e3. [PMID: 34325778 DOI: 10.1016/j.adaj.2021.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 03/16/2021] [Accepted: 04/18/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The authors examined trends in opioid prescriptions by dentists for children and nonsenior adults enrolled in Medicaid. METHODS The authors used the IBM Watson Medicaid claims databases for 2012 through 2019 and the Centers for Disease Control and Prevention conversion data set. Opioid prescriptions were linked to a dental visit when prescribed within 3 days of the dental visit and if the patient had no medical visit reported during that period. The authors conducted descriptive analyses for age, procedures performed, treatment history, and prescription strength. RESULTS The results of the study showed consistent decreases in opioid prescription rates in dentistry during the study period from 2.7% to 1.6% among children (aged 0-20 years) and from 28.6% to 12.2% for adults (aged 21-64 years). The adult opioid prescription rate decreased for nonsurgical dental procedures from 9.7% to 2.9%. For surgical procedures, the adult prescription rate decreased from 48.0% to 28.7%. Most dental-related opioids were prescribed for oral surgeries (children, 70.8%; adults, 58.6%). By 2019, 23% of all opioid prescriptions for children were dental related. CONCLUSIONS The authors found that opioid prescription rates in dentistry for people enrolled in Medicaid declined substantially from 2012 through 2019 for both children and adults. The percentage of prescriptions written for nonsurgical visits consistently declined over the observed time. During the same time, opioid prescription rates for both dental surgical procedures and dental nonsurgical procedures. PRACTICAL IMPLICATIONS Although the trends revealed in the analysis show declining opioid prescription patterns, these results suggest that the overall rate is still too high and prescriptions are being written unnecessarily.
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Abstract
This paper is the forty-second consecutive installment of the annual anthological review of research concerning the endogenous opioid system, summarizing articles published during 2019 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides and receptors as well as effects of opioid/opiate agonists and antagonists. The review is subdivided into the following specific topics: molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors (1), the roles of these opioid peptides and receptors in pain and analgesia in animals (2) and humans (3), opioid-sensitive and opioid-insensitive effects of nonopioid analgesics (4), opioid peptide and receptor involvement in tolerance and dependence (5), stress and social status (6), learning and memory (7), eating and drinking (8), drug abuse and alcohol (9), sexual activity and hormones, pregnancy, development and endocrinology (10), mental illness and mood (11), seizures and neurologic disorders (12), electrical-related activity and neurophysiology (13), general activity and locomotion (14), gastrointestinal, renal and hepatic functions (15), cardiovascular responses (16), respiration and thermoregulation (17), and immunological responses (18).
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, 65-30 Kissena Blvd., Flushing, NY, 11367, United States.
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12
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Alobaidi A, Pickard AS, Jarrett JB, Lee TA. Hospitalizations for opioid-related overdose and timing of concurrent opioid and benzodiazepine use: A nested case-control study. Pharmacotherapy 2021; 41:722-732. [PMID: 34170554 DOI: 10.1002/phar.2608] [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: 04/08/2021] [Revised: 06/20/2021] [Accepted: 06/20/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Concurrent opioid and benzodiazepine (BZD) use is a prevalent high-risk prescribing behavior that increases the risk of opioid overdose. However, there is limited evidence on the relationship between timing of concurrent use and risk of opioid overdose. OBJECTIVE To evaluate the likelihood of opioid-related overdose across levels of duration, recency, and daily dose of concurrent use. DESIGN A nested case-control study was conducted using Truven MarketScan claims data (2009-2018). PARTICIPANTS Commercially insured adults (age 18-64 years old) with a new opioid dispensing in 2010-2018. MAIN MEASURES Cases of opioid-related overdose were identified based on hospitalization diagnosis codes. Controls were matched to cases in a 10:1 ratio by age, sex, opioid start date, and cancer history. Concurrent use was classified based on duration, timing, and daily dose of overlapping opioids and BZDs during 90 days before the event. Conditional logistic regression models were used to evaluate the relationship between concurrent use and opioid-related overdose. KEY RESULTS Among 11,137,866 dispensed a new opioid, a total of 3388 patients experienced opioid-related overdose and were matched to 33,893 controls. Cases and controls were 34 years old on average and 54% female. Patients with concurrent use were significantly more likely to have opioid-related overdose compared to patients receiving opioids, BZDs, or neither (OR 9.28; 95% CI 7.87, 10.93). Longer concurrent use of 1-7, 8-30, and 31-90 days was associated with 4.6, 12.1, and 26.7-fold higher likelihood of opioid-related overdose (p < 0.01). Patients with overlapping prescriptions during previous 0-30, 31-60, and 61-90 days were 13.2, 6.0, and 3.2-times more likely to experience an overdose (p < 0.01). CONCLUSIONS Patients with an opioid-related overdose were more likely to be prescribed concurrent opioid and BZD across all levels of duration, timing, and daily dose. Future policies and quality measures should be pursued to prevent concurrent use unless medically necessary.
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Affiliation(s)
- Ali Alobaidi
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - A Simon Pickard
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jennie B Jarrett
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Todd A Lee
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, USA
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Interpreting trends in paediatric opioid prescribing. THE LANCET CHILD & ADOLESCENT HEALTH 2019; 3:839-840. [PMID: 31604615 DOI: 10.1016/s2352-4642(19)30325-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 09/19/2019] [Indexed: 11/23/2022]
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