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Shankar DS, Kim J, Bienstock DM, Gao M, Lee Y, Zubizarreta NJ, Poeran J, Lin JD, Chaudhary SB, Hecht AC. Postoperative Opioid Use and Prescribing Patterns among Patients Undergoing Cervical Laminectomy with Instrumented Fusion versus Cervical Laminoplasty with Reconstruction. Global Spine J 2024; 14:561-567. [PMID: 35861211 PMCID: PMC10802526 DOI: 10.1177/21925682221116825] [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: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To compare patterns in opioid usage and prescriptions between patients who undergo cervical laminectomy with instrumented fusion (LF) vs cervical laminoplasty with reconstruction (LP) within single surgeon and national database cohorts. METHODS We identified patients with cervical myelopathy undergoing primary LF or LP in both a single-surgeon series cohort (2004-2018) and a nationally representative cohort drawn from the IBM® Marketscan® database (2014-2016). We recorded opioid usage within 6 months of surgery and identified differences in unadjusted opioid use rates between LF and LP patients. Multivariable logistic regression was used to evaluate the association between procedure type and postoperative opioid use. RESULTS Without adjusting for covariates, LF patients had a higher rate of 6-month opioid use in the single-surgeon cohort (15.7% vs 5.1%, P = .02). After adjusting for covariates, LF patients had higher odds of 6-month postoperative opioid use (OR 2.8 [95% CI 1.0-7.7], P = .04). In the national cohort, without adjusting for covariates, there was no significant difference in 6-month opioid use between LF and LP patients. Even after adjusting for covariates, we found no significant difference in odds. CONCLUSIONS Findings from a single-surgeon cohort reveal that LF is associated with a higher rate of 6-month opioid use than LP. This is at odds with findings from a national database cohort, which suggested that LP and LF patients have similar rates of opioid usage at 6-months postoperatively. To prevent overuse of narcotics, surgeons must consider the distinct pain requirements associated with different procedures even in treatment of the same condition.
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Affiliation(s)
- Dhruv S. Shankar
- Leni & Peter May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jinseong Kim
- Leni & Peter May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dennis M. Bienstock
- Leni & Peter May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael Gao
- Leni & Peter May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yunsoo Lee
- Leni & Peter May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nicole J. Zubizarreta
- Leni & Peter May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jashvant Poeran
- Leni & Peter May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - James D. Lin
- Leni & Peter May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Saad B. Chaudhary
- Leni & Peter May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrew C. Hecht
- Leni & Peter May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Alwafi H. Trends in hospital admission related to poisoning by, narcotics and psychodysleptics and poisoning by antiepileptic, sedative-hypnotic, and antiparkinsonism drugs in England and Wales between April 1999 and April 2020: An ecological study. Saudi Pharm J 2023; 31:101670. [PMID: 37576854 PMCID: PMC10415227 DOI: 10.1016/j.jsps.2023.06.003] [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: 04/03/2023] [Accepted: 06/06/2023] [Indexed: 08/15/2023] Open
Abstract
Background This study aimed to investigate the trend of hospital admissions related to poisoning by narcotics and psychodysleptics and poisoning by antiepileptic, sedative-hypnotic, and antiparkinsonism drugs in England and Wales between April 1999 and April 2020. Methods An observational ecological study were conducted using data from the Hospital Episode Statistics database in England and the Patient Episode Database for Wales. The rate of hospital admissions with 95% confidence intervals (CIs) was calculated by dividing the number of episodes of poisoning by narcotics and psychodysleptics related admission and poisoning by antiepileptic, sedative-hypnotic, and antiparkinsonism drugs-related admission by the mid-year population from the Office for National Statistics. All analyses were conducted using SPSS version 27. Results The total annual number of hospital admissions for narcotics and psychodysfunctionals poisonings increased by 1.40-fold [from 15.70 (95% CI 15.36-16.04) in 1999 to 37.64 (95% CI 37.15-38.13) in 2020 per 100,000 people, p < 0.01]. However, the overall annual number of poisonings by antiepileptic, sedative-hypnotic and antiparkinsonism drugs hospital admissions for various reasons decreased by 12.8% [from 33.55 (95% CI 33.05-34.04) in 1999 to 29.26 (95% CI 28.82-29.69) in 2020 per 100,000 persons, p < 0.05]. Poisoning by other opioids (53.2%), heroin (15.1%), and other synthetic narcotics (13.3%) were the most common reasons for narcotic and psychodysfunctional poisoning. While poisoning by benzodiazepines (54.2%) and poisoning: other antiepileptic and sedative-hypnotic drugs (30.7%) were the most common hospital admission reasons for poisoning by antiepileptic, sedative-hypnotic, and antiparkinsonism. Conclusion Poisoning by narcotics have increased in England and Wales over the study period, however, poisoning by antiepileptic, sedative-hypnotic, and antiparkinsonism drugs in England and Wales were relatively stable during the same period. Future initiatives and awareness programs to prevent harmful use and drug poisoning by narcotics, sedative-hypnotic and other medications are needed.
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Affiliation(s)
- Hassan Alwafi
- Pharmacology and Toxicology Department, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
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Bhadra-Heintz NM, Garcia S, Entrup P, Trimble C, Teater J, Rood K, Trent Hall O. Years of Life Lost due to Unintentional Drug Overdose among Perinatal Individuals in the United States. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 36:100842. [PMID: 37028239 DOI: 10.1016/j.srhc.2023.100842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 02/20/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND The United States has one of the highest maternal mortality rates of developing countries, but the contribution of perinatal drug overdose is not known. Communities of color also have higher rates of maternal morbidity and mortality when compared to White communities, however the contribution due to overdose has not yet been examined in this population. OBJECTIVES To quantify the years of life lost due to unintentional overdose in perinatal individuals from 2010 to 2019 and assess for disparity by race. STUDY DESIGN This was a cross-sectional retrospective study with summary-level mortality statistics for the years 2010-2019 obtained from the Centers for Disease Control (CDC) Wide-Ranging Online Data for Epidemiologic Research (WONDER) mortality file. A total of 1,586 individuals of childbearing age (15-44 years) who died during pregnancy or six weeks postpartum (perinatal) from unintentional overdose in the United States from January 1, 2010 to December 31, 2019 were included. Total years of life lost (YLL) was calculated and summated for White, Black, Hispanic, Asian/Pacific Islander, and American Indian/Native Alaska women. Additionally, the top three overall causes of death were also identified for women in this age group for comparison. RESULTS Unintentional drug overdose accounted for 1,586 deaths and 83,969.78 YLL in perinatal individuals from 2010 to 2019 in the United States. Perinatal American Indian/Native American individuals had a disproportionate amount of YLL when compared to other ethnic groups, with 2.39% of YLL due to overdose, while only making up 0.80% of the population. During the last two years of the study, only American Indian/Native American and Black individuals had increased rates of mortality when compared to other races. During the ten-year study period, when including the top three causes of mortality, unintentional drug overdoses made up 11.98% of the YLL overall and 46.39% of accidents. For the years 2016-2019, YLL due to unintentional overdose was the third leading cause of YLL overall for this population. CONCLUSIONS Unintentional drug overdose is a leading cause of death for perinatal individuals in the United States, claiming nearly 84,000 years of life over a ten-year period. When examining by race, American Indian/Native American women are most disproportionately affected.
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Chhabra N, Smith DL, Maloney CM, Archer J, Sharma B, Thompson HM, Afshar M, Karnik NS. The Identification of Subphenotypes and Associations with Health Outcomes in Patients with Opioid-Related Emergency Department Encounters Using Latent Class Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148882. [PMID: 35886733 PMCID: PMC9321801 DOI: 10.3390/ijerph19148882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/17/2022] [Accepted: 07/19/2022] [Indexed: 02/05/2023]
Abstract
The emergency department (ED) is a critical setting for the treatment of patients with opioid misuse. Detecting relevant clinical profiles allows for tailored treatment approaches. We sought to identify and characterize subphenotypes of ED patients with opioid-related encounters. A latent class analysis was conducted using 14,057,302 opioid-related encounters from 2016 through 2017 using the National Emergency Department Sample (NEDS), the largest all-payer ED database in the United States. The optimal model was determined by face validity and information criteria-based metrics. A three-step approach assessed class structure, assigned individuals to classes, and examined characteristics between classes. Class associations were determined for hospitalization, in-hospital death, and ED charges. The final five-class model consisted of the following subphenotypes: Chronic pain (class 1); Alcohol use (class 2); Depression and pain (class 3); Psychosis, liver disease, and polysubstance use (class 4); and Pregnancy (class 5). Using class 1 as the reference, the greatest odds for hospitalization occurred in classes 3 and 4 (Ors 5.24 and 5.33, p < 0.001) and for in-hospital death in class 4 (OR 3.44, p < 0.001). Median ED charges ranged from USD 2177 (class 1) to USD 2881 (class 4). These subphenotypes provide a basis for examining patient-tailored approaches for this patient population.
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Affiliation(s)
- Neeraj Chhabra
- Division of Medical Toxicology, Department of Emergency Medicine, Cook County Health, Chicago, IL 60612, USA
- Department of Emergency Medicine, Rush Medical College, Rush University, Chicago, IL 60612, USA
- Correspondence:
| | - Dale L. Smith
- Addiction Data Science Laboratory, Department of Psychiatry & Behavioral Science, Rush University Medical Center, Chicago, IL 60612, USA; (D.L.S.); (B.S.); (H.M.T.); (N.S.K.)
- Department of Psychology, Olivet Nazarene University, Bourbonnais, IL 60914, USA
| | - Caitlin M. Maloney
- Doctor of Medicine Program, Rush Medical College, Rush University, Chicago, IL 60612, USA;
| | - Joseph Archer
- School of Medicine and Public Health, University of Wisconsin, Madison, WI 53715, USA;
| | - Brihat Sharma
- Addiction Data Science Laboratory, Department of Psychiatry & Behavioral Science, Rush University Medical Center, Chicago, IL 60612, USA; (D.L.S.); (B.S.); (H.M.T.); (N.S.K.)
| | - Hale M. Thompson
- Addiction Data Science Laboratory, Department of Psychiatry & Behavioral Science, Rush University Medical Center, Chicago, IL 60612, USA; (D.L.S.); (B.S.); (H.M.T.); (N.S.K.)
| | - Majid Afshar
- Department of Medicine, University of Wisconsin-Madison, Madison, WI 53715, USA;
| | - Niranjan S. Karnik
- Addiction Data Science Laboratory, Department of Psychiatry & Behavioral Science, Rush University Medical Center, Chicago, IL 60612, USA; (D.L.S.); (B.S.); (H.M.T.); (N.S.K.)
- Institute for Juvenile Research, Department of Psychiatry, University of Illinois Chicago, Chicago, IL 60612, USA
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Siegert TF, Chambers LC, Weidele H, Scagos R, McDonald J, Onyejekwe C, Hallowell BD. Controlled Substance Prescription History among Individuals Who Died of an Accidental Opioid-Involved Drug Overdose in Rhode Island. Subst Use Misuse 2022; 57:2142-2145. [PMID: 36305842 DOI: 10.1080/10826084.2022.2137814] [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: 10/31/2022]
Abstract
Background: Accidental opioid-involved overdose deaths are increasing nationally in the wake of the COVID-19 pandemic, but it is unclear if this reflects a change in populations most at risk. Objective: To determine whether the demographic characteristics and controlled substance prescription history of accidental opioid-involved drug overdose decedents in 2020 differed from prior years. Methods: We identified accidental opioid-involved overdose decedents using Rhode Island (RI) State Medical Examiner's Office data. Decedents were linked to the RI Prescription Drug Monitoring Program database. We compared demographic characteristics and prescription history by year of death. Results: From 2018 to 2020, 763 RI residents died from accidental opioid-involved overdose in RI. From 2018 to 2019, deaths decreased by 7%, but then increased by 31% from 2019 to 2020. Demographic characteristics were similar by year of death (all p > 0.05). The percentage of decedents with a prior opioid prescription and a prior benzodiazepine prescription declined from 2018 to 2020 (p < 0.01 and p = 0.03). Conclusions: We found that opioid-involved overdose deaths in RI are increasing overall, but without significant changes in demographics. While prior exposure to some controlled substances did decline over time, it is not clear if these changes reflect more responsible prescribing practices, or a more concerning pattern such as patient abandonment or decreased healthcare access. More studies are needed to better describe the current trend of increasing opioid-involved deaths while also pursuing current evidence-based interventions.
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Affiliation(s)
- Thomas F Siegert
- Division of Medicine-Pediatrics, Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Laura C Chambers
- Substance Use Epidemiology Program, Center for Health Data and Analysis, Rhode Island Department of Health, Providence, Rhode Island, USA
| | - Heidi Weidele
- Substance Use Epidemiology Program, Center for Health Data and Analysis, Rhode Island Department of Health, Providence, Rhode Island, USA
| | - Rachel Scagos
- Substance Use Epidemiology Program, Center for Health Data and Analysis, Rhode Island Department of Health, Providence, Rhode Island, USA
| | - James McDonald
- Prescription Drug Monitoring Program, Rhode Island Department of Health, Providence, Rhode Island, USA
| | - Collette Onyejekwe
- Prescription Drug Monitoring Program, Rhode Island Department of Health, Providence, Rhode Island, USA
| | - Benjamin D Hallowell
- Substance Use Epidemiology Program, Center for Health Data and Analysis, Rhode Island Department of Health, Providence, Rhode Island, USA
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Tatara E, Schneider J, Quasebarth M, Collier N, Pollack H, Boodram B, Friedman S, Salisbury-Afshar E, Mackesy-Amiti ME, Ozik J. Application of Distributed Agent-based Modeling to Investigate Opioid Use Outcomes in Justice Involved Populations. IEEE INTERNATIONAL SYMPOSIUM ON PARALLEL & DISTRIBUTED PROCESSING, WORKSHOPS AND PHD FORUM : [PROCEEDINGS]. IEEE INTERNATIONAL SYMPOSIUM ON PARALLEL & DISTRIBUTED PROCESSING, WORKSHOPS AND PHD FORUM 2021; 2021:989-997. [PMID: 35865008 PMCID: PMC9297575 DOI: 10.1109/ipdpsw52791.2021.00157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Criminal justice involved (CJI) individuals with a history of opioid use disorder (OUD) are at high risk of overdose and death in the weeks following release from jail. We developed the Justice-Community Circulation Model (JCCM) to investigate OUD/CJI dynamics post-release and the effects of interventions on overdose deaths. The JCCM uses a synthetic agent-based model population of approximately 150,000 unique individuals that is generated using demographic information collected from multiple Chicago-area studies and data sets. We use a high-performance computing (HPC) workflow to implement a sequential approximate Bayesian computation algorithm for calibrating the JCCM. The calibration results in the simulated joint posterior distribution of the JCCM input parameters. The calibrated model is used to investigate the effects of a naloxone intervention for a mass jail release. The simulation results show the degree to which a targeted intervention focusing on recently released jail inmates can help reduce the risk of death from opioid overdose.
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Affiliation(s)
- Eric Tatara
- Decision and Infrastructure Sciences Division, Argonne National Laboratory, Lemont, IL, USA
- Consortium for Advanced Science and Engineering, University of Chicago, Chicago, IL, USA
| | - John Schneider
- Departments of Medicine and Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Madeline Quasebarth
- Departments of Medicine and Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Nicholson Collier
- Decision and Infrastructure Sciences Division, Argonne National Laboratory, Lemont, IL, USA
- Consortium for Advanced Science and Engineering, University of Chicago, Chicago, IL, USA
| | - Harold Pollack
- Crown School of Social Work Policy and Practice, University of Chicago, Chicago, IL, USA
| | - Basmattee Boodram
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Sam Friedman
- Department of Population Health, New York University Langone Medical School, New York, NY, USA
| | - Elizabeth Salisbury-Afshar
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Mary Ellen Mackesy-Amiti
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Jonathan Ozik
- Decision and Infrastructure Sciences Division, Argonne National Laboratory, Lemont, IL, USA
- Consortium for Advanced Science and Engineering, University of Chicago, Chicago, IL, USA
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Association of co-occurring opioid or other substance use disorders with increased healthcare utilization in patients with depression. Transl Psychiatry 2021; 11:265. [PMID: 33941761 PMCID: PMC8093211 DOI: 10.1038/s41398-021-01372-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 03/23/2021] [Accepted: 04/08/2021] [Indexed: 02/03/2023] Open
Abstract
Substance use disorders (SUDs) commonly co-occur with mental illness. However, the ongoing addiction crisis raises the question of how opioid use disorder (OUD) impacts healthcare utilization relative to other SUDs. This study examines the utilization patterns of patients with major depressive disorder (MDD) and: (1) co-occurring OUD (MDD-OUD); (2) a co-occurring SUD other than OUD (MDD-NOUD); and (3) no co-occurring SUD (MDD-NSUD). We analyzed electronic health records (EHRs) derived from multiple health systems across the New York City (NYC) metropolitan area between January 2008 and December 2017. 11,275 patients aged ≥18 years with a gap of 30-180 days between 2 consecutive MDD diagnoses and an antidepressant prescribed 0-180 days after any MDD diagnosis were selected, and prevalence of any SUD was 24%. Individuals were stratified into comparison groups and matched on age, gender, and select underlying comorbidities. Prevalence rates and encounter frequencies were measured and compared across outpatient, inpatient, and emergency department (ED) settings. Our key findings showed that relative to other co-occurring SUDs, OUD was associated with larger increases in the rates and odds of using substance-use-related services in all settings, as well as services that integrate mental health and substance abuse treatments in inpatient and ED settings. OUD was also associated with larger increases in total encounters across all settings. These findings and our proposed policy recommendations could inform efforts towards targeted OUD interventions, particularly for individuals with underlying mental illness whose treatment and recovery are often more challenging.
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Abstract
This study analyzes trends in hospital emergency room visits and admissions for patients with opioid diagnoses seen at 214 hospitals in Illinois over 42 months. Visits were coded hierarchically for opioid overdose, dependence, abuse, or use. Visit rates per 100,000 were stratified by zip code level of poverty. Regression estimates of the likelihood of inpatient admission and death are presented. There were 239,069 visits accounting for almost $5 billion in total charges and over 710,000 inpatient hospital days with less than a 1% death rate. The Illinois opioid epidemic is concentrated in the poorest areas of the Chicago metropolitan area. There was a sharp gradient in visits rates and deaths rates by poverty level area and more than a fivefold difference in hospital deaths. Effective state policy responses should expand to include decriminalization and proven harm reduction strategies such as medically assisted treatment, access to safe syringes, take home naloxone, and supervised safe consumption facilities.
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Law RH, Ko AB, Jones LR, Peterson EL, Craig JR, Deeb RH. Postoperative pain with or without nasal splints after septoplasty and inferior turbinate reduction. Am J Otolaryngol 2020; 41:102667. [PMID: 32823039 DOI: 10.1016/j.amjoto.2020.102667] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 08/09/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To determine the effect of intranasal Doyle splints on postoperative pain following septoplasty and inferior turbinate reduction (ITR). Changes in Nasal Obstruction Symptom Evaluation (NOSE) scores were also evaluated. MATERIALS AND METHODS A prospective cohort study conducted from January 2017 to January 2019. Patients were recruited if they experienced nasal obstruction due to septal deviation and inferior turbinate hypertrophy, and failed a one-month trial of intranasal corticosteroids. All patients underwent septoplasty with ITR, and either had Doyle splints or no splints placed. Patients were prescribed hydrocodone-acetaminophen 5-325 mg and asked to keep a daily log of pain medication use and visual analog scale (VAS) scores. Pain logs and NOSE scores were compared between patients who had splints versus patients who had no splints placed after septoplasty and ITR over the first postoperative week. NOSE scores were also collected at every postoperative visit (1 week, 1 month, and 6 months). RESULTS Fifty-seven patients were enrolled (37 splints, 20 no-splints). The median postoperative pain VAS score was 3.0 (interquartile range [IQR] 2.0-5.0) for the splint group and 4.0 (IQR 2.0-5.0) for the no-splint group (P = 0.906). The median postoperative pain medication requirement in morphine equivalents at the first postoperative visit was 5.4 mg/day (IQR 2.0-13.3) for the splint group and 8.4 mg/day (IQR 1.8-15.3) for the no-splint group (P = 0.833). CONCLUSIONS There were no statistically significant differences in postoperative pain VAS scores or pain medication use between the two groups. All patients experienced significant reductions in NOSE scores postoperatively.
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Delcher C, Pauly N, Moyo P. Advances in prescription drug monitoring program research: a literature synthesis (June 2018 to December 2019). Curr Opin Psychiatry 2020; 33:326-333. [PMID: 32250984 PMCID: PMC7409839 DOI: 10.1097/yco.0000000000000608] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Nearly every U.S. state operates a prescription drug monitoring program (PDMP) to monitor dispensing of controlled substances. These programs are often considered key policy levers in the ongoing polydrug epidemic. Recent years have seen rapid growth of peer-reviewed literature examining PDMP consultation and the impacts of these programs on diverse patient populations and health outcomes. This literature synthesis presents a review of studies published from June 2018 to December 2019 and provides relevant updates from the perspective of three researchers in this field. RECENT FINDINGS The analyzed studies were primarily distributed across three overarching research focus areas: outcome evaluations (n = 29 studies), user surveys (n = 23), and surveillance (n = 22). Identified themes included growing awareness of the unintended consequences of PDMPs on access to opioids, effects on benzodiazepines and stimulant prescribing, challenges with workflow integration across multiple specialties, and new opportunities for applied data science. SUMMARY There is a critical gap in existing PDMP literature assessing how these programs have impacted psychiatrists, their prescribing behaviors, and their patients. Although PDMPs have improved population-level monitoring of controlled substances from medical sources, their role in responding to a drug epidemic shifting to illicitly manufactured drugs is under scrutiny.
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Affiliation(s)
- Chris Delcher
- Institute for Pharmaceutical Outcomes and Policy, University of Kentucky College of Pharmacy, Lexington, Kentucky
| | - Nathan Pauly
- Department of Health Policy Management and Leadership, West Virginia University School of Public Health, Morgantown, West Virginia
| | - Patience Moyo
- Department of Health Services, Policy, and Practice, Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
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Averitt AJ, Slovis BH, Tariq AA, Vawdrey DK, Perotte AJ. Characterizing non-heroin opioid overdoses using electronic health records. JAMIA Open 2020; 3:77-86. [PMID: 32607490 PMCID: PMC7309230 DOI: 10.1093/jamiaopen/ooz063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/21/2019] [Accepted: 10/30/2019] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION The opioid epidemic is a modern public health emergency. Common interventions to alleviate the opioid epidemic aim to discourage excessive prescription of opioids. However, these methods often take place over large municipal areas (state-level) and may fail to address the diversity that exists within each opioid case (individual-level). An intervention to combat the opioid epidemic that takes place at the individual-level would be preferable. METHODS This research leverages computational tools and methods to characterize the opioid epidemic at the individual-level using the electronic health record data from a large, academic medical center. To better understand the characteristics of patients with opioid use disorder (OUD) we leveraged a self-controlled analysis to compare the healthcare encounters before and after an individual's first overdose event recorded within the data. We further contrast these patients with matched, non-OUD controls to demonstrate the unique qualities of the OUD cohort. RESULTS Our research confirms that the rate of opioid overdoses in our hospital significantly increased between 2006 and 2015 (P < 0.001), at an average rate of 9% per year. We further found that the period just prior to the first overdose is marked by conditions of pain or malignancy, which may suggest that overdose stems from pharmaceutical opioids prescribed for these conditions. CONCLUSIONS Informatics-based methodologies, like those presented here, may play a role in better understanding those individuals who suffer from opioid dependency and overdose, and may lead to future research and interventions that could successfully prevent morbidity and mortality associated with this epidemic.
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Affiliation(s)
- Amelia J Averitt
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - Benjamin H Slovis
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Abdul A Tariq
- NewYork-Presbyterian Hospital, The Value Institute, New York, New York, USA
| | - David K Vawdrey
- Geisinger, Steele Institute for Health Innovation, Danville, Pennsylvania, USA
| | - Adler J Perotte
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
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Abbasi AB, Salisbury-Afshar E, Berberet CE, Layden JE, Pho MT. Opioid Prescribing Patterns Before Fatal Opioid Overdose. Am J Prev Med 2020; 58:250-253. [PMID: 31959322 PMCID: PMC6986381 DOI: 10.1016/j.amepre.2019.09.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 09/11/2019] [Accepted: 09/12/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Although opioid prescribing has decreased since 2010, overdose deaths involving illicit opioids have continued to rise. This study explores prescribing patterns before fatal overdose of decedents who died of prescription and illicit opioid overdoses. METHODS This retrospective cohort study was conducted in 2019 and included all 1,893 Illinois residents who died of an opioid-related overdose in 2016. Each decedent was linked to any existing Prescription Monitoring Program records, calculating weekly morphine milligram equivalents for 52 weeks before overdose. RESULTS Among the 1,893 fatal opioid overdoses, 309 involved any prescription opioid and 1,461 involved illicit opioids without the involvement of prescription opioids. The death rate because of illicit opioids was 23/100,000 among black residents versus 10.5/100,000 among whites. During the last year of life, 76% of prescription opioid decedents filled any opioid prescription totaling 10.7 prescriptions per decedent, compared with 36% of illicit opioid decedents totaling 2.6 prescriptions per decedent. During the last week of life, 33% of prescription opioid decedents filled an opioid prescription totaling 0.42 prescriptions per decedent, compared with 4% of illicit opioid decedents totaling 0.05 prescriptions per decedent. CONCLUSIONS Prescribing patterns alone may not be sufficient to identify patients who are at high risk for opioid overdose, especially for those using illicit opioids. Interventions aimed at reducing opioid overdoses should take into account different patterns of opioid prescribing associated with illicit and prescription opioid overdose deaths and be designed around the local characteristics of the opioid overdose epidemic.
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Affiliation(s)
- Ali B Abbasi
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois.
| | - Elizabeth Salisbury-Afshar
- Center for Addiction Research and Effective Solutions, American Institutes for Research, Washington, D.C
| | - Craig E Berberet
- Prescription Monitoring Program, Illinois Department of Human Services, Springfield, Illinois
| | - Jennifer E Layden
- Office of the Director, Illinois Department of Public Health, Chicago, Illinois
| | - Mai T Pho
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
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14
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Rushovich T, Arwady MA, Salisbury-Afshar E, Arunkumar P, Aks S, Prachand N. Opioid-related overdose deaths by race and neighborhood economic hardship in Chicago. J Ethn Subst Abuse 2020; 21:22-35. [PMID: 31990245 DOI: 10.1080/15332640.2019.1704335] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Compared to national findings, Chicago has both a higher rate of opioid-related overdose death and a markedly different distribution by demographics. The Chicago Department of Public Health analyzed fatal overdoses by level of neighborhood economic hardship. The highest rate of opioid-related deaths occurred in neighborhoods with high economic hardship (36.9 per 100,000 population) compared to medium- (20.5) and low- (12.3) hardship neighborhoods. However, these patterns were not consistent across racial/Hispanic ethnicity subgroups. These data support the need to consider the role of racism and other structural, social, and economic factors when designing interventions to reduce opioid-related overdose deaths.
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Affiliation(s)
- Tamara Rushovich
- Chicago Department of Public Health, Harvard University, Chicago, Illinois
| | - M Allison Arwady
- Chicago Department of Public Health, Harvard University, Chicago, Illinois
| | | | | | | | - Nikhil Prachand
- Chicago Department of Public Health, Harvard University, Chicago, Illinois
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