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Huang LC, Bleicher J, Torre M, Johnson JE, Presson A, Millar MM, Gordon AJ, Brooke BS, Kaphingst KA, Harris AHS. Evaluating a health system-wide opioid disposal intervention distributing home-disposal bags. Health Serv Res 2023; 58:1256-1265. [PMID: 37700549 PMCID: PMC10622267 DOI: 10.1111/1475-6773.14227] [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: 09/14/2023] Open
Abstract
OBJECTIVE To evaluate a health system-wide intervention distributing free home-disposal bags to surgery patients prescribed opioids. DATA SOURCES AND STUDY SETTING We collected patient surveys and electronic medical record data at an academic health system. STUDY DESIGN We conducted a prospective observational study. The bags were primarily distributed at pharmacies, though pharmacists delivered bags to some patients. The primary outcome was disposal of leftover opioids (effectiveness). Secondary outcomes were patient willingness to dispose and factors associated with disposal (effectiveness), recalling receipt of the bag (reach), and recalling receipt of bags and disposal over time (maintenance). We used a modified Poisson regression to evaluate the relative risk of disposal. Inverse probability of treatment weighting, based on propensity scores, was used to account for differences between survey responders and non-responders and reduce nonresponse bias. DATA COLLECTION/EXTRACTION METHODS From August 2020 to May 2021, we surveyed patients 2 weeks after discharge (allowing for home opioid use). Eligibility criteria were age ≥18, English being primary language, valid email address, hospitalization ≤30 days, discharge home, and an opioid prescription sent to a system pharmacy. PRINCIPAL FINDINGS We identified 5134 patients with 2174 completing the survey (response rate 42.3%). Among respondents, 1375 (63.8%) recalled receiving the disposal bag. Among 1075 respondents with leftover opioids, 284 (26.4%) disposed, 552 (51.3%) planned to dispose, 79 (7.4%) did not plan to dispose, 69 (6.4%) had undecided, and 91 (8.5%) had not considered disposal. Recalling receipt of the bag (incidence rate ratio [IRR] 1.25, 95% confidence interval [CI] 1.13-1.37) was positively associated with disposal. Patients who used opioids in the last year were less likely to dispose (IRR 0.82, 95% CI 0.73-0.93). Disposal rates remained stable over the study period while recalling receipt of bags trended up. CONCLUSIONS A pragmatic implementation of a disposal intervention resulted in lower disposal rates than prior trials.
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Affiliation(s)
- Lyen C. Huang
- Department of SurgeryUniversity of UtahSalt Lake CityUtahUSA
- Huntsman Cancer InstituteUniversity of UtahSalt Lake CityUtahUSA
| | - Josh Bleicher
- Department of SurgeryUniversity of UtahSalt Lake CityUtahUSA
| | - Michael Torre
- Department of Internal MedicineUniversity of UtahSalt Lake CityUtahUSA
| | | | - Angela Presson
- Department of Internal MedicineUniversity of UtahSalt Lake CityUtahUSA
| | - Morgan M. Millar
- Department of Internal MedicineUniversity of UtahSalt Lake CityUtahUSA
| | - Adam J. Gordon
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal MedicineUniversity of Utah School of MedicineSalt Lake CityUtahUSA
- Informatics, Decision‐Enhancement, and Analytic Sciences (IDEAS) CenterVA Salt Lake City Health Care SystemSalt Lake CityUtahUSA
| | | | - Kimberly A. Kaphingst
- Huntsman Cancer InstituteUniversity of UtahSalt Lake CityUtahUSA
- Department of CommunicationUniversity of UtahSalt Lake CityUtahUSA
| | - Alex H. S. Harris
- Department of SurgeryStanford UniversityStanfordCaliforniaUSA
- VA HSR&D Center for Innovation to ImplementationPalo Alto VA Health Care SystemPalo AltoCaliforniaUSA
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Zhang R, Volkow ND. Seasonality of brain function: role in psychiatric disorders. Transl Psychiatry 2023; 13:65. [PMID: 36813773 PMCID: PMC9947162 DOI: 10.1038/s41398-023-02365-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 02/07/2023] [Accepted: 02/09/2023] [Indexed: 02/24/2023] Open
Abstract
Seasonality patterns are reported in various psychiatric disorders. The current paper summarizes findings on brain adaptations associated with seasonal changes, factors that contribute to individual differences and their implications for psychiatric disorders. Changes in circadian rhythms are likely to prominently mediate these seasonal effects since light strongly entrains the internal clock modifying brain function. Inability of circadian rhythms to accommodate to seasonal changes might increase the risk for mood and behavior problems as well as worse clinical outcomes in psychiatric disorders. Understanding the mechanisms that account for inter-individual variations in seasonality is relevant to the development of individualized prevention and treatment for psychiatric disorders. Despite promising findings, seasonal effects are still understudied and only controlled as a covariate in most brain research. Rigorous neuroimaging studies with thoughtful experimental designs, powered sample sizes and high temporal resolution alongside deep characterization of the environment are needed to better understand the seasonal adaptions of the human brain as a function of age, sex, and geographic latitude and to investigate the mechanisms underlying the alterations in seasonal adaptation in psychiatric disorders.
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Affiliation(s)
- Rui Zhang
- Laboratory of Neuroimaging, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, 20892-1013, USA.
| | - Nora D. Volkow
- grid.94365.3d0000 0001 2297 5165Laboratory of Neuroimaging, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD 20892-1013 USA
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Han B, Compton WM, Einstein EB, Cotto J, Hobin JA, Stein JB, Volkow ND. Intentional Drug Overdose Deaths in the United States. Am J Psychiatry 2022; 179:163-165. [PMID: 35105166 DOI: 10.1176/appi.ajp.2021.21060604] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Beth Han
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Md
| | - Wilson M Compton
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Md
| | - Emily B Einstein
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Md
| | - Jessica Cotto
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Md
| | - Jennifer A Hobin
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Md
| | - Jack B Stein
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Md
| | - Nora D Volkow
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Md
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Seasonal Variation in the Brain μ-Opioid Receptor Availability. J Neurosci 2021; 41:1265-1273. [PMID: 33361461 PMCID: PMC7888218 DOI: 10.1523/jneurosci.2380-20.2020] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 11/19/2020] [Accepted: 12/07/2020] [Indexed: 02/08/2023] Open
Abstract
Seasonal rhythms influence mood and sociability. The brain μ-opioid receptor (MOR) system modulates a multitude of seasonally varying socioemotional functions, but its seasonal variation remains elusive with no previously reported in vivo evidence. Here, we first conducted a cross-sectional study with previously acquired human [11C]carfentanil PET imaging data (132 male and 72 female healthy subjects) to test whether there is seasonal variation in MOR availability. We then investigated experimentally whether seasonal variation in daylength causally influences brain MOR availability in rats. Rats (six male and three female rats) underwent daylength cycle simulating seasonal changes; control animals (two male and one female rats) were kept under constant daylength. Animals were scanned repeatedly with [11C]carfentanil PET imaging. Seasonally varying daylength had an inverted U-shaped functional relationship with brain MOR availability in humans. Brain regions sensitive to daylength spanned the socioemotional brain circuits, where MOR availability peaked during spring. In rats, MOR availabilities in the brain neocortex, thalamus, and striatum peaked at intermediate daylength. Varying daylength also affected the weight gain and stress hormone levels. We conclude that cerebral MOR availability in humans and rats shows significant seasonal variation, which is predominately associated with seasonal photoperiodic variation. Given the intimate links between MOR signaling and socioemotional behavior, these results suggest that the MOR system might underlie seasonal variation in human mood and social behavior.SIGNIFICANCE STATEMENT Seasonal rhythms influence emotion and sociability. The central μ-opioid receptor (MOR) system modulates numerous seasonally varying socioemotional functions, but its seasonal variation remains elusive. Here we used positron emission tomography to show that MOR levels in both human and rat brains show daylength-dependent seasonal variation. The highest MOR availability was observed at intermediate daylengths. Given the intimate links between MOR signaling and socioemotional behavior, these results suggest that the MOR system might underlie seasonal variation in human mood and social behavior.
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Strong MA, Schmitz S, Fiedorowicz JG. Improving Psychiatry Resident Knowledge and Reported Practices Regarding Patient Access to Medications and Safe Disposal. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2019; 43:631-634. [PMID: 31407229 DOI: 10.1007/s40596-019-01096-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/02/2019] [Accepted: 07/28/2019] [Indexed: 06/10/2023]
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Raji MA, Kuo YF, Chen NW, Hasan H, Wilkes DM, Goodwin JS. Impact of Laws Regulating Pain Clinics on Opioid Prescribing and Opioid-Related Toxicity Among Texas Medicare Part D Beneficiaries. J Pharm Technol 2017; 33:60-65. [PMID: 29888344 PMCID: PMC5990015 DOI: 10.1177/8755122516686226] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Pain management clinics are major sources of prescription opioids. Texas government passed several laws regulating pain clinics between 2009 and 2011 to reduce opioid-related toxicity. Understanding the impact of these laws can inform policy geared toward making the laws more effective in curbing the growing epidemic of opioid overdose, especially among the elderly population. OBJECTIVES To examine the longitudinal association of laws regulating pain clinics on opioid-prescribing and opioid-related toxicity among Texas Medicare recipients. METHODS The 2007 to 2012 claims data for Texas Medicare Part D recipients were used to assess temporal trends in the percentage of patients filling any schedule II or schedule III opioid prescription, hospitalization for opioid toxicity, and their relationships to the 2009 to 2011 Texas laws regulating pain clinics. We excluded those with a cancer diagnosis. Join-point trend analysis with Bayesian Information Criterion selection methods were used to evaluate the change in monthly percentages of patients filling opioid prescriptions and hospitalization over time. RESULTS There was a short-lived decline in the monthly percentages of patients who filled a schedule II or schedule III opioid prescription after the 2009 laws regulating pain clinics. The decline lasted about 3 months. Subsequent new laws had no effect on the percentages of patients who filled any opioid prescription or were hospitalized for potential opioid toxicity. Hospitalizations for opioid toxicity were highest in the winter and lowest in the summer. CONCLUSIONS Changes in the percentages of opioid-prescribing or opioid-related hospitalizations over time were not associated with laws regulating pain clinics.
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Affiliation(s)
| | - Yong-Fang Kuo
- University of Texas Medical Branch,
Galveston, TX, USA
| | - Nai-Wei Chen
- University of Texas Medical Branch,
Galveston, TX, USA
| | - Hunaid Hasan
- University of Texas Medical Branch,
Galveston, TX, USA
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Abstract
Despite advances in theory and the development and implementation of evidence-based treatments, the United States suicide rate has been rising continuously for over a decade. Although this does not indicate that traditional treatment approaches should be abandoned, it does highlight the need to supplement such approaches with alternatives. One seemingly highly valuable option is means safety, defined as the reduced access to and/or increased safe storage of potentially lethal methods for suicide. This paper provides a review of the current literature on the prevalence of six methods for suicide and preventative efforts aimed to reduce suicide rates. The majority of means safety interventions seem promising given that these methods are common and highly lethal. However, cultural and practical barriers will need to be taken into consideration when implementing these plans. Overall, means safety efforts and preventative measures seem to be promising ways to reduce the national suicide rate if implemented.
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Affiliation(s)
- Hyejin M Jin
- Department of Psychology, University of Southern Mississippi, 118 College Drive, Box #5025, Hattiesburg, MS, 39406, USA
| | - Lauren R Khazem
- Department of Psychology, University of Southern Mississippi, 118 College Drive, Box #5025, Hattiesburg, MS, 39406, USA
| | - Michael D Anestis
- Department of Psychology, University of Southern Mississippi, 118 College Drive, Box #5025, Hattiesburg, MS, 39406, USA.
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Davis JM, Mendelson B, Berkes JJ, Suleta K, Corsi KF, Booth RE. Public Health Effects of Medical Marijuana Legalization in Colorado. Am J Prev Med 2016; 50:373-379. [PMID: 26385161 PMCID: PMC4762755 DOI: 10.1016/j.amepre.2015.06.034] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 06/11/2015] [Accepted: 06/30/2015] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The public health consequences of the legalization of marijuana, whether for medical or recreational purposes, are little understood. Despite this, numerous states are considering medical or recreational legalization. In the context of abrupt changes in marijuana policy in 2009 in Colorado, the authors sought to investigate corresponding changes in marijuana-related public health indicators. METHODS This observational, ecologic study used an interrupted time-series analysis to identify changes in public health indicators potentially related to broad policy changes that occurred in 2009. This was records-based research from the state of Colorado and Denver metropolitan area. Data were collected to examine frequency and trends of marijuana-related outcomes in hospital discharges and poison center calls between time periods before and after 2009 and adjusted for population. Analyses were conducted in 2014. RESULTS Hospital discharges coded as marijuana-dependent increased 1% per month (95% CI=0.8, 1.1, p<0.001) from 2007 to 2013. A change in trend was detected in poison center calls mentioning marijuana (p<0.01). After 2009, poison center calls increased 0.8% per month (95% CI=0.2, 1.4, p<0.01). Poison center calls also increased 56% (95% CI=49%, 63%, p<0.001) in the period following the policy change. Further, there was one hospital discharge coded as dependent for every 3,159 (95% CI=2465, 3853, p<0.001) medical marijuana registrant applications. CONCLUSIONS The abrupt nature of these changes suggests public health effects related to broad policy changes associated with marijuana. This report may be used to assist in policy decisions regarding the short-term public health effects of marijuana legalization.
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Affiliation(s)
- Jonathan M Davis
- Project Safe, Department of Psychiatry, School of Medicine, University of Colorado Denver, Denver, Colorado.
| | | | - Jay J Berkes
- Project Safe, Department of Psychiatry, School of Medicine, University of Colorado Denver, Denver, Colorado
| | - Katie Suleta
- Project Safe, Department of Psychiatry, School of Medicine, University of Colorado Denver, Denver, Colorado
| | - Karen F Corsi
- Project Safe, Department of Psychiatry, School of Medicine, University of Colorado Denver, Denver, Colorado
| | - Robert E Booth
- Project Safe, Department of Psychiatry, School of Medicine, University of Colorado Denver, Denver, Colorado
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Ford JA, Perna D. Prescription drug misuse and suicidal ideation: Findings from the National Survey on Drug Use and Health. Drug Alcohol Depend 2015; 157:192-6. [PMID: 26520564 DOI: 10.1016/j.drugalcdep.2015.10.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 10/01/2015] [Accepted: 10/04/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Suicide is one of the leading causes of injury-related mortality in the United States and prior research has identified alcohol and other drug use as a major risk factor. In recent years, prescription drug misuse has become a serious public health issue; however, very little research examines the relationship between prescription drug misuse and suicide or suicidal ideation. METHODS Using data from the National Survey on Drug Use and Health, the current research examines the relationship between prescription drug misuse and suicidal ideation among adults. Suicidal ideation was measured by asking respondents if they seriously thought about killing themselves in the past 12 months. Prescription drug misuse was defined as use without a prescription or solely for the feeling or experience caused by the drug in the past 12 months. Several multivariable logistic regression models were estimated. RESULTS Findings show that respondents who report prescription drug misuse in the past year, specifically pain relievers, are more likely to report that they had seriously though about killing themselves. CONCLUSIONS The current research fills an important gap in the literature by examining the relationship between prescription drug misuse and suicidal ideation. Consistent with the extant literature, prescription drug misuse is significantly associated with suicidal ideation among adults.
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Affiliation(s)
- Jason A Ford
- Department of Sociology, University of Central Florida, Orlando, FL 32816, USA.
| | - Danielle Perna
- Department of Sociology, University of Central Florida, Orlando, FL 32816, USA.
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