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Mergler BD, Toles AO, Alexander A, Mosquera DC, Lane-Fall MB, Ejiogu NI. Racial and Ethnic Patient Care Disparities in Anesthesiology: History, Current State, and a Way Forward. Anesth Analg 2024; 139:420-431. [PMID: 38153872 DOI: 10.1213/ane.0000000000006716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
Disparities in patient care and outcomes are well-documented in medicine but have received comparatively less attention in anesthesiology. Those disparities linked to racial and ethnic identity are pervasive, with compelling evidence in operative anesthesiology, obstetric anesthesiology, pain medicine, and critical care. This narrative review presents an overview of disparities in perioperative patient care that is grounded in historical context followed by potential solutions for mitigating disparities and inequities.
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Affiliation(s)
- Blake D Mergler
- From the Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Allyn O Toles
- From the Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anthony Alexander
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Diana C Mosquera
- Department of Anesthesiology, Albany Medical Center, Albany, New York
| | - Meghan B Lane-Fall
- From the Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nwadiogo I Ejiogu
- From the Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Mahrs-Gould R, Jallo N, Svikis D, Ameringer S, Robins J, Elswick RK. Family history of substance problems among African Americans: Associations with drug use, drug use disorder, and prescription drug misuse. J Ethn Subst Abuse 2024:1-28. [PMID: 38530153 DOI: 10.1080/15332640.2024.2331108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
A family history of substance problems is a well-known risk factor for substance use and use disorders; however, much of this research has been conducted in studies with predominantly White subjects. The aim of this study was to examine the associations between family history density of substance problems and drug use, risk for drug use disorder, and prescription drug misuse in a sample of African American adults. Results indicate that family history density of substance problems increased the risk for all drug outcomes in the full sample. However, when subgroup analyses by gender were conducted, family history was not a risk factor among men for prescription drug misuse.
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Affiliation(s)
| | - Nancy Jallo
- Virginia Commonwealth University, Richmond, Virginia, USA
| | - Dace Svikis
- Virginia Commonwealth University, Richmond, Virginia, USA
- Institute for Women's Health, Virginia Commonwealth University, Richmond, Virginia, USA
| | | | - Jo Robins
- Virginia Commonwealth University, Richmond, Virginia, USA
| | - R K Elswick
- Virginia Commonwealth University, Richmond, Virginia, USA
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Lin CC, Callaghan BC, Burke JF, Kerber KA, Bicket MC, Esper GJ, Skolarus LE, Hill CE. Prescription Opioid Initiation for Neuropathy, Headache, and Low Back Pain: A US Population-based Medicare Study. THE JOURNAL OF PAIN 2023; 24:2268-2282. [PMID: 37468023 DOI: 10.1016/j.jpain.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/07/2023] [Accepted: 07/08/2023] [Indexed: 07/21/2023]
Abstract
Neuropathy, headache, and low back pain (LBP) are common conditions requiring pain management. Yet little is known regarding whether access to specialists impacts opioid prescribing. We aimed to identify factors associated with opioid initiation among opioid-naïve older adults and evaluate how access to particular specialists impacts prescribing. This retrospective cohort study used a 20% Medicare sample from 2010 to 2017. Opioid initiation was defined as a first opioid prescription filled within 12 months after a diagnosis encounter. Disease-related opioid initiation was defined as a first opioid prescription filled within 7 days following a disease-specific claim. Logistic regression using generalized estimating equations was used to determine the association of patient demographics, provider types, and regional physician specialty density with disease-related opioid initiation, accounting for within-region correlation. We found opioid initiation steadily declined from 2010 to 2017 (neuropathy: 26-19%, headache: 31-20%, LBP: 45-32%), as did disease-related opioid initiation (4-3%, 12-7%, 29-19%) and 5 to 10% of initial disease-related prescriptions resulted in chronic opioid use within 12 months of initiation. Certain specialist visits were associated with a lower likelihood of disease-related opioid initiation compared with primary care. Residence in high neurologist density regions had a lower likelihood of disease-related opioid initiation (headache odds ratio [OR] .76 [95% CI: .63-.92]) and LBP (OR .7 [95% CI: .61-.81]) and high podiatrist density regions for neuropathy (OR .56 [95% CI: .41-.78]). We found that specialist visits and greater access to specialists were associated with a lower likelihood of disease-related opioid initiation. These data could inform strategies to perpetuate reductions in opioid use for these common pain conditions. PERSPECTIVE: This article presents how opioid initiation for opioid-naïve patients with newly diagnosed neuropathy, headache, and LBP varies across providers. Greater access to certain specialists decreased the likelihood of opioid initiation. Future work may consider interventions to support alternative treatments and better access to specialists in low-density regions.
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Affiliation(s)
- Chun Chieh Lin
- Department of Neurology, The Ohio State University, Columbus, Ohio; Health Services Research Program, Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - Brian C Callaghan
- Health Services Research Program, Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - James F Burke
- Department of Neurology, The Ohio State University, Columbus, Ohio
| | - Kevin A Kerber
- Department of Neurology, The Ohio State University, Columbus, Ohio
| | - Mark C Bicket
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | | | - Lesli E Skolarus
- Department of Neurology, Northwestern University, Chicago, Illinois
| | - Chloe E Hill
- Health Services Research Program, Department of Neurology, University of Michigan, Ann Arbor, Michigan
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Vest JR, Hinrichs RJ, Hosler H. How legal problems are conceptualized and measured in healthcare settings: a systematic review. HEALTH & JUSTICE 2023; 11:48. [PMID: 37979059 PMCID: PMC10656991 DOI: 10.1186/s40352-023-00246-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 10/22/2023] [Indexed: 11/19/2023]
Abstract
Legal problems encompass issues requiring resolution through the justice system. This social risk factor creates barriers in accessing services and increases risk of poor health outcomes. A systematic review of the peer-reviewed English-language health literature following the PRISMA guidelines sought to answer the question, how has the concept of patients' "legal problems" been operationalized in healthcare settings? Eligible articles reported the measurement or screening of individuals for legal problems in a United States healthcare or clinical setting. We abstracted the prevalence of legal problems, characteristics of the sampled population, and which concepts were included. 58 studies reported a total of 82 different measurements of legal problems. 56.8% of measures reflected a single concept (e.g., incarcerated only). The rest of the measures reflected two or more concepts within a single reported measure (e.g., incarcerations and arrests). Among all measures, the concept of incarceration or being imprisoned appeared the most frequently (57%). The mean of the reported legal problems was 26%. The literature indicates that legal concepts, however operationalized, are very common among patients. The variation in measurement definitions and approaches indicates the potential difficulties for organizations seeking to address these challenges.
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Affiliation(s)
- Joshua R Vest
- Indiana University Richard M Fairbanks School of Public Health, Indianapolis, IN, USA.
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA.
| | - Rachel J Hinrichs
- University Library, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA
| | - Heidi Hosler
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA.
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Ragheb H, Ahmad S, Uddin S, Le Foll B, Hassan AN. The prevalence and treatment utilization of substance use disorders among Muslims in the United States: A national epidemiological survey. Am J Addict 2023; 32:497-505. [PMID: 37329255 DOI: 10.1111/ajad.13443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 04/23/2023] [Accepted: 06/05/2023] [Indexed: 06/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Research on substance use disorder (SUD) among Muslims in the United States (US) is limited. There are several unique factors, including denial and stigma, that make this population at risk of SUD. This study explored the prevalence, treatment utilization, and impact of SUD among Muslims in the US compared with a matched control group from general respondents. METHODS Data from 372 self-identified Muslims were obtained from the National Epidemiologic Survey on Alcohol and Related Conditions III. A matched non-Muslim control group (N = 744) were selected based on demographics and other SUD-related clinical variables. The impact of SUD was assessed using the 12-Item Short Form Health Survey (SF-12). RESULTS Among the 372 Muslims, 53 (10.85%) had lifetime alcohol/drug use disorder, while 75 (18.42%) had lifetime tobacco use disorder (TUD). With statistical significance, alcohol use disorder (AUD) was lower while TUD was higher in the Muslim group than in the control group. The rates of all other substances were not statistically different between the Muslim and control groups. The Muslim group have higher help-seeking and a lower mean score on the SF-12 emotional scale than the control group. CONCLUSION AND SCIENTIFIC SIGNIFICANCE Muslim Americans have higher prevalence of TUD, lower prevalence of AUD, and similar prevalence of other SUD compared to the public. Affected individuals have poor emotional functioning which may be exacerbated by the impact of stigma. This is the first study to estimate prevalence of variety of SUD in American Muslims from a national representative sample.
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Affiliation(s)
- Heba Ragheb
- Social Work Department, University of Toronto, Toronto, Canada
| | - Shireen Ahmad
- Department of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Sarah Uddin
- School of Medicine, University College Cork, Cork, Ireland
| | - Bernard Le Foll
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, Ontario, Canada
| | - Ahmed N Hassan
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Department of Medicine, King Abdulaziz University, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
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Schepis TS, Wastila L, McCabe SE. Family history of substance use disorder and likelihood of prescription drug misuse in adults 50 and older. Aging Ment Health 2023; 27:1020-1027. [PMID: 35686721 PMCID: PMC9734280 DOI: 10.1080/13607863.2022.2084711] [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] [Received: 10/15/2021] [Accepted: 05/28/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Individuals who are family history positive (FHP) for substance use problems have increased risk for substance use, substance use disorders (SUDs), and psychopathology. Links between FHP status and prescription drug misuse (PDM) have not been well investigated; this study examined PDM in adults 50 and older by FHP status. METHODS Data were from the US NESARC-III (n = 14,667). Participants reported their opioid PDM, tranquilizer/sedative PDM, SUD, psychopathology, and family history status (i.e. first- and second-degree relatives with alcohol/substance use problems). Prevalence rates were estimated by FHP status, and logistic regressions compared FHP and family history negative (FHN) groups. RESULTS FHP status was associated with significantly higher rates of PDM (e.g. past-year opioid PDM, FHP: 3.8%, FHN: 1.5%) and SUD from PDM (e.g. past-year SUD, FHP: 1.2%, FHN: 0.2%); also, prevalence varied by family history density, with the highest rates in those with three or more relatives with substance use problems (e.g. past-year opioid PDM: 5.5%). Overall, 32.2% of FHP individuals with past-year PDM had past-year co-occurring SUD and psychopathology diagnoses, versus 11.0% of FHN individuals. CONCLUSION FHP status could inform treatment decisions in adults 50 and older with conditions for which prescription opioids or tranquilizer/sedatives are indicated.
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Affiliation(s)
- Ty S. Schepis
- Department of Psychology, Texas State University, San Marcos, Texas, USA
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
| | - Linda Wastila
- Peter Lamy Center on Drug Therapy and Aging, University of Maryland, Baltimore, Maryland, USA
| | - Sean Esteban McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Research on Women and Gender, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
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Lape EC, Powers JM, Hooker JE, Edwards RR, Ditre JW. Benzodiazepine Use and Dependence in Relation to Chronic Pain Intensity and Pain Catastrophizing. THE JOURNAL OF PAIN 2023; 24:345-355. [PMID: 36243316 PMCID: PMC9898110 DOI: 10.1016/j.jpain.2022.09.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 09/21/2022] [Accepted: 09/27/2022] [Indexed: 11/07/2022]
Abstract
Benzodiazepines (BZDs), a class of sedative-hypnotic medications, generated concern as their popularity grew, with particular alarm regarding elevated rates of BZD use among chronic pain populations. Consistent with negative reinforcement/motivational models of substance use, desire for pain alleviation may motivate BZD use. Yet, little is known about relations between pain and addiction-relevant BZD use processes. This cross-sectional survey study aimed to: a) test associations between pain intensity and clinically relevant BZD use patterns, and b) examine the role of pain catastrophizing in hypothesized pain-BZD relations. Participants included 306 adults with chronic musculoskeletal pain and a current BZD prescription who completed an online survey study (Mage = 38.7, 38.9% female). Results indicated that pain intensity was positively associated with past-month BZD use frequency, BZD dependence severity, and likelihood of endorsing BZD misuse behaviors (ps < .05). Pain catastrophizing was positively associated with BZD dependence/likelihood of BZD misuse, covarying for pain intensity (P < .05). These findings build upon an emerging literature by highlighting positive covariation of pain intensity and pain catastrophizing with addiction-relevant BZD use behaviors. Results underscore the need to further investigate high-risk BZD use among individuals with chronic pain, with and without concurrent opioid use, to inform prevention/intervention efforts. PERSPECTIVE: This article presents findings on cross-sectional associations of pain intensity and pain catastrophizing with clinically relevant benzodiazepine (BZD) use outcomes, including dependence and misuse, among individuals with chronic pain. Findings help elucidate the higher burden of BZD misuse/dependence in chronic pain populations and suggest that pain relief may be a common, yet under recognized, self-reported motivation for taking BZDs.
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Affiliation(s)
- Emma C Lape
- Department of Psychology, Syracuse University, Syracuse, New York
| | - Jessica M Powers
- Department of Psychology, Syracuse University, Syracuse, New York
| | - Julia E Hooker
- Department of Psychology, Syracuse University, Syracuse, New York
| | - Robert R Edwards
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham & Women's Hospital, Boston, Massachusetts
| | - Joseph W Ditre
- Department of Psychology, Syracuse University, Syracuse, New York.
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Minder CR, Gorbach C, Peterson CK. Factors Associated With Pain Medication Use and the Relationship to Chiropractic Treatment Outcomes for Patients With Low Back and Neck Pain: A Cross-Sectional Study. J Manipulative Physiol Ther 2022; 45:575-585. [PMID: 37318388 DOI: 10.1016/j.jmpt.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/17/2023] [Accepted: 03/30/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVE The study objectives were to identify baseline factors associated with pain medication use and determine any differences in chiropractic treatment outcomes in patients with low back pain (LBP) and neck pain (NP) depending on their use of pain medication. METHODS This cross-sectional, prospective outcomes study included 1077 adults with acute or chronic LBP and 845 adults with acute or chronic NP recruited from Swiss chiropractors in their offices within 4 years. Demographic data and the responses to the Patient's Global Impression of Change scale collected at 1 week, 1 month, 3 months, 6 months, and 1 year were analyzed with the χ2 test. Baseline pain and disability levels were measured using the numeric rating scale (NRS), Oswestry questionnaire for LBP, and Bournemouth questionnaire for patients with NP and analyzed with the Mann-Whitney U test between the 2 groups. To detect significant predictors of medication use at baseline, logistic regression analysis was performed. RESULTS Patients with acute LBP and NP were more likely than those with chronic pain to take pain medication (P < .001 LBP; P = .003 NP). Medication use was more likely with patients with radiculopathy (P < .001 LBP; P = .05 NP) who were smokers (P = .008 LBP; P = .024 NP) and those reporting below-average general health (P < .001 LBP and NP). Pain medication users had higher baseline pain (P < .001 LBP and NP) and disability (P < .001 LBP and NP) scores. CONCLUSION Patients with LBP and NP had significantly higher pain and disability levels at baseline, tended to have radiculopathy and poor health, were smokers, and presented during the acute phase. However, for this sample of patients, there were no differences in subjective improvement between users and non-users of pain medication for any data collection time point, which has management implications.
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Affiliation(s)
- Corinne R Minder
- Chiropractic Medicine Department, Faculty of Medicine, University of Zürich, Zürich, Switzerland.
| | - Christoph Gorbach
- Departments of Chiropractic Medicine and Orthopedic Rheumatology, Balgrist University Hospital, Zürich, Switzerland
| | - Cynthia K Peterson
- Department of Chiropractic Medicine, Orthopaedic University Hospital Balgrist, Zürich, Switzerland
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Do Urine Drug Tests Reveal Substance Misuse Among Patients Prescribed Opioids for Chronic Pain? J Gen Intern Med 2022; 37:2365-2372. [PMID: 34405344 PMCID: PMC9360386 DOI: 10.1007/s11606-021-07095-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 07/30/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Urine drug testing (UDT) is a recommended risk mitigation strategy for patients prescribed opioids for chronic pain, but evidence that UDT supports identification of substance misuse is limited. OBJECTIVE Identify the prevalence of UDT results that may identify substance misuse, including diversion, among patients prescribed opioids for chronic pain. DESIGN Retrospective cohort study. SUBJECTS Patients (n=638) receiving opioids for chronic pain who had one or more UDTs, examining up to eight substances per sample, during a one 1-year period. MAIN MEASURES Experts adjudicated the clinical concern that UDT results suggest substance misuse or diversion as not concerning, uncertain, or concerning. KEY RESULTS Of 638 patients, 48% were female and 49% were over age 55 years. Patients had a median of three UDTs during the intervention year. We identified 37% of patients (235/638) with ≥1 concerning UDT and a further 35% (222/638) having ≥1 uncertain UDT. We found concerning UDTs due to non-detection of a prescribed substance in 24% (156/638) of patients and detection of a non-prescribed substance in 23% (147/638). Compared to patients over 65 years, those aged 18-34 years were more likely to have concerning UDT results with an adjusted odds ratio (AOR) of 4.8 (95% confidence interval [CI] 1.9-12.5). Patients with mental health diagnoses (AOR 1.6 [95% CI 1.1-2.3]) and substance use diagnoses (AOR 2.3 [95% CI 1.5-3.7]) were more likely to have a concerning UDT result. CONCLUSIONS Expert adjudication of UDT results identified clinical concern for substance misuse in 37% of patients receiving opioids for chronic pain. Further research is needed to determine if UDTs impact clinical practice or patient-related outcomes.
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Crouch TB, Martin CE, Polak K, Smith W, Dillon P, Ondersma S, Svikis D. Gender-specific correlates of nonmedical use of prescription medications in a diverse primary care sample. Drug Alcohol Depend 2022; 234:109399. [PMID: 35299006 PMCID: PMC9096812 DOI: 10.1016/j.drugalcdep.2022.109399] [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] [Received: 01/20/2022] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Nonmedical use of prescription medications (NUPM) is a growing problem but little is known about its gender-specific mechanisms despite NIDA's call for gender-stratified research over a decade ago. We explored gender differences in NUPM in a diverse sample of primary care patients. METHODS N = 4458 participants participated in an anonymous health survey in urban primary care clinics. The primary outcome was past month NUPM. All analyses were stratified by gender. Bivariate relationships among NUPM and demographic, medical, psychological, and substance use-related variables were analyzed. Stepwise multivariate logistic regression models (LRMs) were estimated by gender. RESULTS More men (9.5%) reported NUPM than women (7.4%). The final LRM among men included age (OR=0.98), race (OR=0.49), chronic pain diagnosis (OR=1.73), hepatitis (OR=1.78), depression diagnosis (OR=1.77), positive alcohol misuse screen (OR=1.58), and mood disturbance (OR=1.04). Among women, the model included mood disturbance (OR=1.04), illicit drug use (OR=2.22), family history of drug problems (OR=1.41), and heart disease diagnosis (OR=0.48). Effect sizes ranged from small to moderate. CONCLUSIONS Among a sample of primary care patients, gender-stratified analyses indicated differential presentation of NUPM by gender. Demographic factors were more relevant correlates among men, with younger, White men at higher risk. Chronic pain and depression were more notable risk factors for men. Recent illicit drug use and family history of drug problems were uniquely associated among women, while recent distress was a strong correlate among both men and women. A better understanding of gender-specific correlates of NUPM can inform gender-tailored prevention and treatment efforts.
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Affiliation(s)
- Taylor B Crouch
- Department of Psychiatry, Virginia Commonwealth University School of Medicine, USA; Institute for Women's Health, Virginia Commonwealth University, USA.
| | - Caitlin E Martin
- Department of Obstetrics and Gynecology, Virginia Commonwealth University School of Medicine, USA; Virginia Commonwealth University Institute for Drug and Alcohol Studies, USA
| | - Kathryn Polak
- Virginia Commonwealth University Institute for Drug and Alcohol Studies, USA; Department of Psychology, Virginia Commonwealth University, USA
| | - Wally Smith
- Department of Internal Medicine, Virginia Commonwealth University School of Medicine, USA
| | - Pamela Dillon
- School of Pharmacy, Virginia Commonwealth University, USA
| | - Steve Ondersma
- Division of Public Health and Department of Obstetrics, Gynecology, & Reproductive Biology, Michigan State University, USA
| | - Dace Svikis
- Institute for Women's Health, Virginia Commonwealth University, USA; Department of Obstetrics and Gynecology, Virginia Commonwealth University School of Medicine, USA; Virginia Commonwealth University Institute for Drug and Alcohol Studies, USA
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Zaveri S, Nobel TB, Khetan P, Srinivasan M, Divino CM. Surgeon Bias in Postoperative Opioid Prescribing. World J Surg 2022; 46:1660-1666. [PMID: 35394230 DOI: 10.1007/s00268-022-06532-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The misuse of opioids is a serious national crisis that is fueled by prescriptions medications. Opioid prescribing habits are known to be highly varied amongst providers. The purpose of this study is to identify patient and surgeon characteristics that predict postoperative opioid prescribing patterns. METHODS This is a serial cross-sectional analysis of 20,497 patients who underwent general surgical procedures at a large academic center. Our primary outcome was the total amount of opioids prescribed within 30 days of the surgery. Univariate and multivariate linear regression models were used to identify patient and provider characteristics that were associated with increased opioids prescribed. RESULTS Among patient characteristics studied, patient age, sex, ethnicity, and insurance status were found to have a significant association with the amount of opioids prescribed. Younger patients and male patients received higher morphine milligram equivalents (MMEs) on discharge (p < 0.05). Patients of Hispanic background were prescribed significantly lower opioids compared to Non-Hispanic patients (p < 0.0001). Among the provider characteristics studied, surgeon sex and years in practice were significantly predictive of the amount of opioids prescribed, with surgeons in practice for <15 years prescribing the highest MMEs (p < 0.0001). CONCLUSION While opioid prescribing habits after surgery seem highly varied and arbitrary, we have identified key predictors that highlight biases in surgeon opioid prescribing patterns. Surgeons tend to prescribe significantly larger amounts of opioids to younger, male patients and those of certain ethnic backgrounds, and surgeons with fewer years in practice are more likely to prescribe more opioids.
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Affiliation(s)
- Shruti Zaveri
- Department of Surgery, Icahn School of Medicine, Mount Sinai Hospital, 1 Gustave L Levy Place, New York, 10023, USA
| | - Tamar B Nobel
- Department of Surgery, Icahn School of Medicine, Mount Sinai Hospital, 1 Gustave L Levy Place, New York, 10023, USA
| | - Prerna Khetan
- Department of Surgery, Icahn School of Medicine, Mount Sinai Hospital, 1 Gustave L Levy Place, New York, 10023, USA
| | - Maya Srinivasan
- Department of Surgery, Icahn School of Medicine, Mount Sinai Hospital, 1 Gustave L Levy Place, New York, 10023, USA
| | - Celia M Divino
- Department of Surgery, Icahn School of Medicine, Mount Sinai Hospital, 1 Gustave L Levy Place, New York, 10023, USA.
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Factors Associated with Pain Treatment Satisfaction Among Patients with Chronic Non-Cancer Pain and Substance Use. J Am Board Fam Med 2021; 34:1082-1095. [PMID: 34772764 PMCID: PMC8813175 DOI: 10.3122/jabfm.2021.06.210214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/09/2021] [Accepted: 07/26/2021] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION A better understanding of pain treatment satisfaction in patients with chronic noncancer pain (CNCP) and substance use is needed, especially as opioid prescribing policies are changing. We sought to identify factors associated with pain treatment satisfaction in individuals with CNCP on recent opioid therapy and prior or active substance use. METHODS An exploratory cross-sectional analysis using baseline data from a cohort study of 300 adults with CNCP receiving >20 morphine milligram equivalents of opioids for ≥3 of the preceding 12 months and prior or active substance use. Participants completed interviews, clinical assessments, urine drug screening, and medical chart review. RESULTS Participants were predominantly middle-aged (mean age 57.5 years), Black (44%), and cisgender men (60%). One-third (33%) had high, 28% moderate, and 39% low pain treatment satisfaction. Post-traumatic stress disorder (PTSD), tobacco use, past-year opioid discontinuation, and higher average pain scores were associated with lower satisfaction. HIV and prescription cannabis use were associated with higher satisfaction. CONCLUSIONS The relationship between PTSD and tobacco use with lower satisfaction should be explored to augment pain outcomes. Higher satisfaction among individuals with HIV and prescription cannabis use presents potential research areas to guide CNCP management and reduce reliance on opioid therapies.
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Hadland SE, Bagley SM, Gai MJ, Earlywine JJ, Schoenberger SF, Morgan JR, Barocas JA. Opioid use disorder and overdose among youth following an initial opioid prescription. Addiction 2021; 116:2790-2800. [PMID: 33739476 PMCID: PMC8429061 DOI: 10.1111/add.15487] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/27/2020] [Accepted: 03/03/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND AIMS Some adolescents and young adults (termed "youth") prescribed an opioid will develop opioid use disorder or experience overdose. This study aimed to identify patient and prescription characteristics associated with subsequent risk of opioid use disorder or overdose during the year after an opioid is first dispensed. DESIGN Retrospective cohort study. SETTING Commercial health insurance claims in a large United States (US) database from 2006 to 2016. PARTICIPANTS Youth age 11 to 25 years filling an initial opioid prescription (n = 3 278 990). MEASUREMENTS The primary outcome was development of an 'opioid-related complication' (a diagnosis of opioid use disorder or opioid-related overdose) during the subsequent 12 months. Exposures of interest were patient (sociodemographic information, and physical and mental health diagnoses) and prescription characteristics (opioid formulation, dose, and duration). FINDINGS Among youth filling an initial opioid prescription, median age was 18 years (interquartile range [IQR] = 16-21) and 56.1% were female. During the subsequent 12 months, 10 405 (0.3%) youth experienced an opioid-related complication. Conditions associated with increased risk included mood/anxiety disorders (adjusted relative risk [aRR] = 4.45; 95% CI = 4.25-4.66) and substance use (aRR = 20.77; 95% CI = 19.74-21.84). Comorbid substance use disorders were present among 72.8% of youth experiencing an opioid-related complication and included alcohol (33.4%), cannabis (33.0%), nicotine (43.2%), and other substance use disorders (75.5%). Long-acting opioids (aRR = 2.59; 95% CI = 2.18-3.09) and longer durations were associated with increased risk (7-14 days: aRR = 1.15; 95% CI = 1.08-1.22; ≥15 days: aRR = 1.96; 95% CI = 1.80-2.12) compared with short-acting formulations and durations ≤3 days, respectively. CONCLUSIONS Among United States youth, complications after an initial opioid prescription appear to be relatively rare and appear to be associated with mood/anxiety disorders, substance use, comorbid substance use disorders, and prescriptions involving long-acting opioids or long durations.
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Affiliation(s)
- Scott E. Hadland
- Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, 801 Albany Street, Room 2055, Boston, MA, 02119,Grayken Center for Addiction and Department of Pediatrics, Boston Medical Center, One Boston Medical Center Place, Boston, MA, 02118
| | - Sarah M. Bagley
- Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, 801 Albany Street, Room 2055, Boston, MA, 02119,Grayken Center for Addiction and Department of Pediatrics, Boston Medical Center, One Boston Medical Center Place, Boston, MA, 02118,Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, 801 Massachusetts Avenue, 2 Floor, Boston, MA, 02118
| | - Mam Jarra Gai
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, 801 Massachusetts Avenue, 2 Floor, Boston, MA, 02118
| | - Joel J. Earlywine
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Talbot T2W, 715 Albany St, Boston, MA 02118
| | - Samantha F. Schoenberger
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, 801 Massachusetts Avenue, 2 Floor, Boston, MA, 02118
| | - Jake R. Morgan
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Talbot T2W, 715 Albany St, Boston, MA 02118
| | - Joshua A. Barocas
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, 801 Massachusetts Avenue, 2 Floor, Boston, MA, 02118
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Amezcua V, Doello K, González-Callejas D. Pseudo-addiction in cancer patients and rapid-release fentanyl for breakthrough pain: An increasingly common concern. Med Clin (Barc) 2021; 157:e287. [PMID: 32819770 DOI: 10.1016/j.medcli.2020.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/04/2020] [Accepted: 07/09/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Víctor Amezcua
- Medical Oncology Department, Virgen de las Nieves University Hospital, Granada, Spain.
| | - Kevin Doello
- Medical Oncology Department, Virgen de las Nieves University Hospital, Granada, Spain
| | - Desirée González-Callejas
- Pharmacy Department, Virgen de las Nieves University Hospital, Granada, Spain; Opioids Prescription Program, Andalusian Government, Spain
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15
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Morales ME, Yong RJ. Racial and Ethnic Disparities in the Treatment of Chronic Pain. PAIN MEDICINE 2021; 22:75-90. [PMID: 33367911 DOI: 10.1093/pm/pnaa427] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To summarize the current literature on disparities in the treatment of chronic pain. METHODS We focused on studies conducted in the United States and published from 2000 and onward. Studies of cross-sectional, longitudinal, and interventional designs were included. RESULTS A review of the current literature revealed that an adverse association between non-White race and treatment of chronic pain is well supported. Studies have also shown that racial differences exist in the long-term monitoring for opioid misuse among patients suffering from chronic pain. In addition, a patient's sociodemographic profile appears to influence the relationship between chronic pain and quality of life. Results from interventional studies were mixed. CONCLUSIONS Disparities exist within the treatment of chronic pain. Currently, it is unclear how to best combat these disparities. Further work is needed to understand why disparities exist and to identify points in patients' treatment when they are most vulnerable to unequal care. Such work will help guide the development and implementation of effective interventions.
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Affiliation(s)
- Mary E Morales
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - R Jason Yong
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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16
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Christian ZK, Youssef CA, Aoun SG, Afuwape O, Barrie U, Johnson ZD, El Ahmadieh TY, Hall K, Peinado Reyes V, Wingfield SA, Bagley CA. Smoking has a dose-dependent effect on the incidence of preoperative opioid consumption in female geriatric patients with spine disease. J Clin Neurosci 2020; 81:173-177. [PMID: 33222910 DOI: 10.1016/j.jocn.2020.09.066] [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: 07/03/2020] [Revised: 09/08/2020] [Accepted: 09/28/2020] [Indexed: 10/23/2022]
Abstract
Tobacco use and narcotic medication have been associated with worse functional outcomes after surgery. Our goal was to investigate potential associations between smoking and preoperative opioid consumption in a geriatric population undergoing spine surgery, and their impact on postoperative outcomes. The records of 536 consecutive patients aged more than 65 years who underwent elective spinal surgery between November 2014 and August 2017 at a single institution were reviewed. Primary outcomes included rates of preoperative opioid consumption and postoperative hospital length of stay and complications. Males were more likely to be smokers than females (p < 0.001), whereas females were more likely to take opioid analgesics preoperatively (p = 0.022). Women with a history of smoking were more likely to have increased preoperative opioid consumption compared to those with no history of smoking (63.64% vs. 42.04%; p < 0.001). Such a relationship was not found in men. Subgroups analysis of female patients with a history of tobacco use comparing current and former smoker status showed that both groups exhibited increased preoperative opioid consumption compared to patients who never smoked (88.89% vs 42.04%; p < 0.001 for current users; 59.42% vs 42.04% for former users; p = 0.008). There was also a dose-depended relationship between smoking and increased preoperative opioid consumption. Geriatric female spine patients with a history of smoking have a higher incidence of preoperative opioid consumption. Opioid intake appears to increase with the number of pack-years, both in patients with a history of smoking and in those who currently smoke.
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Affiliation(s)
- Zachary K Christian
- UT Southwestern Medical Center, Department of Neurological Surgery, United States
| | - Carl A Youssef
- UT Southwestern Medical Center, Department of Neurological Surgery, United States
| | - Salah G Aoun
- UT Southwestern Medical Center, Department of Neurological Surgery, United States; UT Southwestern Spine Center, United States.
| | - Olusoji Afuwape
- UT Southwestern Medical Center, Department of Neurological Surgery, United States
| | - Umaru Barrie
- UT Southwestern Medical Center, Department of Neurological Surgery, United States
| | - Zachary D Johnson
- UT Southwestern Medical Center, Department of Neurological Surgery, United States
| | - Tarek Y El Ahmadieh
- UT Southwestern Medical Center, Department of Neurological Surgery, United States
| | - Kristen Hall
- UT Southwestern Medical Center, Department of Neurological Surgery, United States; UT Southwestern Spine Center, United States
| | - Valery Peinado Reyes
- UT Southwestern Medical Center, Department of Neurological Surgery, United States; UT Southwestern Spine Center, United States
| | - Sarah A Wingfield
- UT Southwestern Medical Center, Department of Internal Medicine, Division of Geriatric Medicine, United States
| | - Carlos A Bagley
- UT Southwestern Medical Center, Department of Neurological Surgery, United States; UT Southwestern Medical Center, Department of Orthopedic Surgery, United States; UT Southwestern Spine Center, United States
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17
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Bailey J, Nafees S, Jones L, Poole R. Rationalisation of long-term high-dose opioids for chronic pain: development of an intervention and conceptual framework. Br J Pain 2020; 15:326-334. [PMID: 34381614 DOI: 10.1177/2049463720958731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
There has been a large increase in the number of prescriptions for opioid drugs in the United Kingdom over the last 20 years or more and the prescribing of opioids in high doses continues to increase. Much opioid prescribing is for chronic non-cancer pain (CNCP) despite serious doubts about the long-term effectiveness of opioids for this indication. Clinical experience is that there are increasing numbers of patients who are on high dosages of opioid drugs over sustained periods which provide limited or no pain relief while having significant negative effects on functioning and quality of life. The aim of this article is to bring readers' attention to some clinical observations of the CNCP population with high doses and to describe an intervention to reduce these doses. Many of these patients have no clinical features of addiction; we suggest that those who show little or no substance misuse behaviours are best understood as a distinct clinical population who have different treatment needs. In order to understand and treat these patients, a model is required which, rather than seeing the problem as lying solely with the patient, focuses on the interaction between the individual and his or her environment and seeks a change in what the patient does every day, rather than a simple, and largely unattainable, goal of symptom elimination. The clinician authors worked together to develop an intervention based upon approaches taken from both pain management and psychiatric practice. A detailed description of this rapid opioid reduction intervention (RORI) is provided along with some preliminary outcome data.
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Affiliation(s)
- John Bailey
- Centre for Mental Health and Society, Bangor University, Wrexham, UK
| | - Sadia Nafees
- Centre for Mental Health and Society, Bangor University, Wrexham, UK
| | - Lucy Jones
- Betsi Cadwaladr University Health Board, Wrexham, UK
| | - Rob Poole
- Centre for Mental Health and Society, Bangor University, Wrexham, UK.,Betsi Cadwaladr University Health Board, Wrexham, UK
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18
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Papp LM, Kouros CD, Curtin JJ. Real-time associations between young adults' momentary pain and prescription opioid misuse intentions in daily life. ACTA ACUST UNITED AC 2020; 75:761-771. [PMID: 32915021 DOI: 10.1037/amp0000648] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Managing pain has been identified (mainly through retrospective reports) as a robust motivator for individuals engaging in prescription opioid misuse. However, surprisingly little work has directly examined whether momentary pain experiences are associated with prescription opioid misuse in daily life. Participants included 297 young-adult college students recruited on the basis of recent prescription drug misuse. Ecological momentary assessment over a 28-day period was utilized to collect participants' pain experiences and prescription opioid misuse intention and behavior. Hierarchical generalized linear modeling and binary logistic regression tested hypotheses. Findings revealed that higher in-the-moment pain was positively associated with intentions to engage in prescription opioid misuse, accounting for report timing and participant sex and background substance use. Also, the between-person result indicated that participants who reported higher levels of pain across the reporting period were more likely to intend to misuse prescription opioids in daily life. There was a similar reliable association between higher pain ratings across the reporting period and greater likelihood of engaging in misuse behavior, although actual misuse frequency was low. Reliable moderation was observed: As hypothesized, the within-person association between momentary pain and misuse intentions was stronger for females compared with males. Also, the within-person link between pain and misuse intentions was stronger for those who reported lower (vs. higher) levels of problematic alcohol use; this was not consistent with the hypothesized direction. Understanding the role of college students' pain in their intentions to engage in prescription opioid misuse is important for informing future research and prevention efforts. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Lauren M Papp
- Department of Human Development and Family Studies, University of Wisconsin-Madison
| | | | - John J Curtin
- Department of Psychology, University of Wisconsin-Madison
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19
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Risk of Chronic Opioid Use in Opioid-Naïve and Non-Naïve Patients after Ambulatory Surgery. J Gastrointest Surg 2020; 24:688-694. [PMID: 31152348 DOI: 10.1007/s11605-019-04265-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 05/06/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Chronic postoperative opioid use has been demonstrated after surgery, but there is a paucity of data on whether the amount of opioids given at discharge is a significant contributor to the risk of prolonged use. The purpose of this study was to determine if higher amounts of opioids prescribed after ambulatory surgery increases chronic opioid use in opioid-naïve and non-naïve patients. METHODS Using the Institutional Data Warehouse, 15,220 adult patients were identified who underwent ambulatory elective surgeries at our institution between January 2014 and July 2018 and received a perioperative opioid prescription. Multivariate logistic regression was used to characterize the relationship between amount of perioperative opioids prescribed and chronic opioid use. RESULTS The study population consisted of 14,378 (94%) opioid-naïve and 842 (6%) non-naïve patients. Seven hundred fifty-seven (5%) patients received a new opioid prescription 90 to 365 days after surgery. Patients that had a lower amount of total perioperative opioids (0-150MMEs, 151-300MMEs, or 301-450MMEs) had 44-54% lower risk of persistent opioid use after surgery compared to those who received > 450 MMEs or > 60 pills of 5 mg oxycodone (p < 0.0001). This relationship was especially prominent on subset analysis of opioid non-naïve patients, a group that has thus far been left out of opioid-related studies. CONCLUSION Persistent opioid use is a known complication after surgery. A higher number of opioid pills on discharge after ambulatory surgery is associated with increased risk of chronic opioid use. Surgeons should consider limiting the number of opioid pills prescribed after ambulatory surgery for both opioid-naïve and non-naïve patients.
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20
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López-Martínez AE, Reyes-Pérez Á, Serrano-Ibáñez ER, Esteve R, Ramírez-Maestre C. Chronic pain, posttraumatic stress disorder, and opioid intake: A systematic review. World J Clin Cases 2019; 7:4254-4269. [PMID: 31911906 PMCID: PMC6940350 DOI: 10.12998/wjcc.v7.i24.4254] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 10/17/2019] [Accepted: 11/26/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The literature suggests that there is a high degree of co-occurrence between chronic pain and posttraumatic stress disorder (PTSD). An association has been found between PTSD and substance abuse. PTSD is a severe disorder that should be taken into account when opioids are prescribed. It has been found that the prevalence of opioid use disorder (OUD) in chronic pain patients is higher among those with PTSD than those without this disorder.
AIM To perform a systematic review on the association between PTSD, chronic non-cancer pain (CNCP), and opioid intake (i.e., prescription, misuse, and abuse).
METHODS We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Patient, Intervention, Comparator, and Outcomes (PICOS) criteria were formulated a priori in the protocol of the systematic review. A search was conducted of the PROSPERO database. In March 2019, searches were also conducted of 5 other databases: PubMed, MEDLINE, PsycINFO, Web of Science, and PILOTS. The Scottish Intercollegiate Guidelines Network checklist for cohort studies was used to assess the selected studies for their methodological quality and risk of bias. Each study was evaluated according to its internal validity, participant sampling, confounding variables, and the statistical analysis.
RESULTS A total of 151 potentially eligible studies were identified of which 17 were retained for analysis. Only 10 met the selection criteria. All the studies were published between 2008 and 2018 and were conducted in the United States. The eligible studies included a total of 1622785 unique participants. Of these, 196516 had comorbid CNCP and PTSD and were consuming opiates. The participants had a cross-study mean age of 35.2 years. The majority of participants were men (81.6%). The most common chronic pain condition was musculoskeletal pain: back pain (47.14% across studies; range: 16%-60.6%), arthritis and joint pain (31.1%; range: 18%-67.5%), and neck pain (28.7%; range: 3.6%-63%). In total, 42.4% of the participants across studies had a diagnosis of PTSD (range: 4.7%-95%). In relation to opioid intake, we identified 2 different outcomes: opioid prescription and OUD. All the studies reported evidence of a greater prevalence of PTSD in CNCP patients who were receiving prescribed opioids and that PTSD was associated with OUD in CNCP patients.
CONCLUSION Opioid analgesic prescription as the treatment of choice for CNCP patients should include screening for baseline PTSD to ensure that these drugs are safely consumed.
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Affiliation(s)
- Alicia E López-Martínez
- Facultad de Psicología, Instituto de Investigaciones Biomédicas (IBIMA), Universidad de Málaga, Málaga 29071, Spain
| | - Ángela Reyes-Pérez
- Facultad de Psicología, Instituto de Investigaciones Biomédicas (IBIMA), Universidad de Málaga, Málaga 29071, Spain
| | - Elena Rocío Serrano-Ibáñez
- Facultad de Psicología, Instituto de Investigaciones Biomédicas (IBIMA), Universidad de Málaga, Málaga 29071, Spain
| | - Rosa Esteve
- Facultad de Psicología, Instituto de Investigaciones Biomédicas (IBIMA), Universidad de Málaga, Málaga 29071, Spain
| | - Carmen Ramírez-Maestre
- Facultad de Psicología, Instituto de Investigaciones Biomédicas (IBIMA), Universidad de Málaga, Málaga 29071, Spain
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21
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Esposito DB, Cepeda MS, Lyons JG, Yin R, Lanes S. Medical record-based ascertainment of behaviors suggestive of opioid misuse, diversion, abuse, and/or addiction among individuals showing evidence of doctor/pharmacy shopping. J Pain Res 2019; 12:2291-2303. [PMID: 31413626 PMCID: PMC6661981 DOI: 10.2147/jpr.s203350] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 05/24/2019] [Indexed: 12/04/2022] Open
Abstract
Objectives Doctor/pharmacy shopping, the practice of seeking prescriptions from multiple healthcare sources without their coordination, may be a measure of prescription medicine abuse. This cross-sectional study examined the relationship between a claims-based doctor/pharmacy shopping definition and medical record documented behaviors suggestive of misuse, diversion, abuse and/or addiction. Methods Patients with ≥2 opioid dispensings starting in 2012 in a US administrative claims database were grouped into doctor/pharmacy shopping categories by number of providers and pharmacies used over 18 months: no shopping, minimal shopping, moderate shopping and severe shopping. Medical charts of opioid prescribers were reviewed to identify behaviors suggestive of misuse, diversion, abuse and/or addiction. Results Among 581,940 opioid users, 78% were classified as no shopping, 11% minimal shopping, 8% moderate shopping and 3% severe shopping. Almost 40% of severe shopping patients had no medical record documented behaviors (positive predictive value: 24.3%). Compared with no shopping, the odds ratio [OR] of ≥3 behaviors was 1.70 (95% confidence interval [CI] 0.50–5.78) for minimal shopping, 1.81 (95% CI 0.54–6.03) for moderate shopping, and 8.93 (95% CI 3.12–25.54) for severe shopping. Conclusions Claims-identified severe doctor/pharmacy shopping was strongly associated with behaviors suggestive of misuse, diversion, abuse and/or addiction, but the proportion of medical records documenting these was low.
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Affiliation(s)
- Daina B Esposito
- Department of Safety and Epidemiology, HealthCore, Inc, Wilmington, DE, USA
| | - M Soledad Cepeda
- Department of Research and Development, Janssen, Titusville, NJ, USA
| | - Jennifer G Lyons
- Department of Safety and Epidemiology, HealthCore, Inc, Wilmington, DE, USA
| | - Ruihua Yin
- Department of Safety and Epidemiology, HealthCore, Inc, Wilmington, DE, USA
| | - Stephan Lanes
- Department of Safety and Epidemiology, HealthCore, Inc, Wilmington, DE, USA
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22
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Kim U, Kim N. Factors associated with prescription pain reliever misuse: An analysis of statewide data. J Am Pharm Assoc (2003) 2019; 59:498-505. [PMID: 31080147 PMCID: PMC8544289 DOI: 10.1016/j.japh.2019.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 03/26/2019] [Accepted: 03/28/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Characterize the individual-level risk factors associated with recent prescription pain reliever misuse (PPRM). DESIGN A multivariable logistic regression was developed with 21 covariates. SETTING AND PARTICIPANTS The 2015 Ohio Medicaid Assessment Survey (OMAS) was analyzed. The 2015 OMAS was a complex-designed representative survey of all adult Ohioans, regardless of Medicaid status (n = 42,876). OUTCOME MEASURES The main outcome was PPRM within the past year ("yes" vs. "no"). RESULTS An estimated 2.75% of adults in Ohio reported PPRM in the past year (approximately 242,232 individuals). The regression model identified 11 covariates with significantly higher odds of PPRM within the past year. The 5 covariates with the largest, significant effect sizes were binge drinking habits (adjusted odds ratio [AOR] for binge drinking in the past month: 2.35, 95% CI 1.97-2.81; AOR for drinking in the past month but no bingeing: 1.43, 95% CI 1.22-1.67), did not get medical examination, medical supplies, mental health care, or eyeglasses in the past year because of cost (AOR 1.74, 95% CI 1.44-2.11), no insurance (AOR 1.67, 95% CI 1.15-2.45), emergency room visits in the past year (AOR 1.66, 95% CI 1.42-1.93), and had problems paying medical bills in the past year (AOR 1.52, 95% CI 1.29-1.80). CONCLUSION In this cross-sectional study of 42,847 adult Ohioans, the covariates associated with PPRM in the past year were identified and quantified. The significant covariates can be broadly grouped into substance use history, poor health care access, demographic characteristics, and chronic health conditions. The single covariate with the largest effect size was binge drinking in the past month; those individuals were more than twice as likely to have endorsed PPRM in the past year compared with those who did not drink at all in the past month.
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23
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Wheeler PB, Stevens-Watkins D, Moody M, Dogan J, Lewis D. Culturally relevant risk and protective factors for nonmedical use of prescription opioids among incarcerated African American men. Addict Behav 2019; 93:46-51. [PMID: 30690415 PMCID: PMC6488416 DOI: 10.1016/j.addbeh.2019.01.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 01/10/2019] [Accepted: 01/14/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Recent studies have demonstrated that nonmedical use of prescription opioids (NMUPO) is a national phenomenon affecting a multitude of subpopulations, including incarcerated African American men. However, there has been little investigation of the correlates of NMUPO among this population. OBJECTIVE Grounded in primary socialization theory, the current study aimed to examine the association between family bonds, family history of prescription drug misuse, and mental health symptoms on NMUPO among African American incarcerated men. METHOD A step-wise logistic regression was conducted to determine whether family and mental health factors affected the likelihood of lifetime NMUPO. RESULTS Prescription drug misuse among immediate family members (p < 0.001) and lifetime experience of serious anxiety (p = 0.003) were significantly associated with an increased likelihood of NMUPO. Having a close personal relationship with one's father was significantly associated with a decreased likelihood of NMUPO (p = 0.034). CONCLUSIONS/IMPORTANCE Risk and protective factors are identified that can be incorporated into interventions aimed at reducing or preventing NMUPO among African American men. Directions for future research on NMUPO among African American incarcerated men are discussed.
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Affiliation(s)
- Paris B Wheeler
- College of Education, Department of Educational, School, and Counseling Psychology, University of Kentucky, Dickey Hall, 251 Scott Street, Lexington, KY 40508, United States.
| | - Danelle Stevens-Watkins
- College of Education, Department of Educational, School, and Counseling Psychology, University of Kentucky, Dickey Hall, 251 Scott Street, Lexington, KY 40508, United States.
| | - Myles Moody
- College of Liberal Arts and Sciences, Department of Sociology, University of Kentucky, 1515 Patterson Office Tower, Lexington, KY 40506-0027, United States.
| | - Jardin Dogan
- College of Education, Department of Educational, School, and Counseling Psychology, University of Kentucky, Dickey Hall, 251 Scott Street, Lexington, KY 40508, United States.
| | - Dominiqueca Lewis
- College of Education, Department of Educational, School, and Counseling Psychology, University of Kentucky, Dickey Hall, 251 Scott Street, Lexington, KY 40508, United States.
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Bolliger L, Stevens H. From Opioid Pain Management to Opioid Crisis in the USA: How Can Public-Private Partnerships Help? Front Med (Lausanne) 2019; 6:106. [PMID: 31157226 PMCID: PMC6528705 DOI: 10.3389/fmed.2019.00106] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 04/29/2019] [Indexed: 11/13/2022] Open
Abstract
The current opioid crisis in the USA arose from (at first) successful opioid pain management in three waves, starting in the'90s. Today, USA patients consume opioid drugs on a massive scale. Considering their potential for tolerance, as well as their potential for lethality in relatively small overdose, the overuse of opioids form an urgent threat to public health in the USA. Since the opioid crisis is a complex phenomenon, several stakeholders are needed to tackle the problem. Both public and private stakeholders should collaborate, e.g., in Public-Private Partnerships. Those collaborations should focus on different aspects related to the opioid crisis such as medical and societal (e.g., pain management process, including addressing opioid use disorders), as well as economical and regulatory issues (e.g., incentivizing the search for alternative non-addictive pain medication and banning aggressive marketing tactics used by the pharmaceutical industry). Additionally, collaborations should cover interdisciplinary education and training of various healthcare actors involved. In conclusion, interdisciplinary collaboration on the various opioid abuse-related aspects is urgently needed to tackle the opioid crisis in the USA.
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Affiliation(s)
- Larissa Bolliger
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Hilde Stevens
- Institute for Interdisciplinary Innovation in healthcare (I3h), Université libre de Bruxelles, Brussels, Belgium
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25
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Coloma-Carmona A, Carballo JL, Rodríguez-Marín J, Pérez-Carbonell A. Withdrawal symptoms predict prescription opioid dependence in chronic pain patients. Drug Alcohol Depend 2019; 195:27-32. [PMID: 30562677 DOI: 10.1016/j.drugalcdep.2018.11.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 11/12/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND The last version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes substantial changes for prescription opioid-use disorder (POUD). After its removal as a criterion, the goal of this study was to estimate the prevalence of withdrawal symptoms in long-term users of prescription opioids and its association with the new DSM-5 POUD classification. METHODS Data were collected from 215 long-term consumers of opioid medication who were chronic non-cancer pain patients. Participants completed sociodemographic, Adjective Rating Scale for Withdrawal (ARSW), opioid treatment characteristics, POUD criteria (DSM-5), and pain intensity measurements. RESULTS 26.6% of the participants were classified with moderate to severe POUD. Higher intensity of withdrawal symptoms was found in patients with moderate/severe POUD, younger age, and higher pain intensity (p < .01). Anxiolytics (p < .01) and antidepressants use (p < .05) and percentage of smokers (p < .05) were significantly higher in patients with severe withdrawal. Logistic regression analyses suggested moderate [odds ratio (OR) = 3.25] and severe (OR = 10.52) withdrawal as the strongest predictor of POUD. Age, anxiolytics use, and smoking were also associated with POUD, but multilevel analysis showed that these variables do not moderate the association between withdrawal intensity and POUD. CONCLUSION Escalation of withdrawal intensity during opioid treatment can be used to identify patients with POUD. Further studies are needed to assess the clinical implications of these findings during long-term opioid therapy for chronic pain.
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Affiliation(s)
- Ainhoa Coloma-Carmona
- Center for Applied Psychology, Miguel Hernández University, Avenida Universidad, s/n, 03202, Elche, Spain.
| | - José L Carballo
- Center for Applied Psychology, Miguel Hernández University, Avenida Universidad, s/n, 03202, Elche, Spain.
| | - Jesús Rodríguez-Marín
- Center for Applied Psychology, Miguel Hernández University, Avenida Universidad, s/n, 03202, Elche, Spain.
| | - Ana Pérez-Carbonell
- University General Hospital of Elche, Camino de la Almazara, 11, 03203, Elche, Spain.
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Transnational trends in prescription drug misuse among women: A systematic review. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 63:56-73. [DOI: 10.1016/j.drugpo.2018.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 09/14/2018] [Accepted: 10/09/2018] [Indexed: 12/21/2022]
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Sutherland AM, Nicholls J, Bao J, Clarke H. Overlaps in pharmacology for the treatment of chronic pain and mental health disorders. Prog Neuropsychopharmacol Biol Psychiatry 2018; 87:290-297. [PMID: 30055217 DOI: 10.1016/j.pnpbp.2018.07.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 07/13/2018] [Accepted: 07/18/2018] [Indexed: 12/17/2022]
Abstract
There is significant overlap in the pharmacological management of pain and psychological disorders. Appropriate treatment of patients' comorbid psychological disorders, including sleep disturbances often leads to an improvement in reported pain intensity. The three first line agents for neuropathic pain include tricyclic antidepressants and serotonin norepinephrine reuptake inhibitors which are medications originally developed as antidepressants. The other first line medication for chronic neuropathic pain are anticonvulsant medications initially brought to the market-place for the treatment of epilepsy and are also now being used for the treatment of anxiety disorders and substance withdrawal symptoms. The efficacy of opioids for chronic pain is contentious, but it is agreed that the patients at highest risk for opioid misuse and addiction are patients with underlying psychological disorders who use opioids for their euphoric effects. Similarly, benzodiazepines may present a problem in patients with chronic pain, as up to one third of patients with pain are concomitantly prescribed benzodiazepines, and when combined with other sedating analgesic medications they put patients at increased risk for adverse events and polysubstance misuse. Finally, there is growing evidence for the efficacy of cannabis for treating neuropathic pain, but the consumption of cannabis has been associated with increased risk of psychosis in adolescents, and may be associated with an increased risk for developing bipolar disorder and anxiety disorders. The use of cannabis is associated with an increased risk of substance misuse in both adolescents and adults. In this narrative review, we examine the evidence for the use of several medications used for the treatment of both pain and psychological disorders, and their proposed mechanisms of action, in addition to special concerns for patients with comorbid pain and psychological disorders.
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Affiliation(s)
- Ainsley M Sutherland
- Department of Anesthesia, University of British Columbia, Vancouver, British Columbia, Canada
| | - Judith Nicholls
- Pain Research Unit, Department of Anesthesia and Pain Medicine, Toronto General Hospital, University Health Network, Toronto, Ontario M5G 2C4, Canada
| | - James Bao
- Pain Research Unit, Department of Anesthesia and Pain Medicine, Toronto General Hospital, University Health Network, Toronto, Ontario M5G 2C4, Canada
| | - Hance Clarke
- Pain Research Unit, Department of Anesthesia and Pain Medicine, Toronto General Hospital, University Health Network, Toronto, Ontario M5G 2C4, Canada; Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada.
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Substance-related disorders: A review of prevalence and correlates among patients with chronic pain. Prog Neuropsychopharmacol Biol Psychiatry 2018; 87:245-254. [PMID: 28669582 DOI: 10.1016/j.pnpbp.2017.06.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/26/2017] [Accepted: 06/27/2017] [Indexed: 01/25/2023]
Abstract
Over the past few decades, research has revealed high rates of substance-related disorders among patients with chronic pain. In addition to their potentially deleterious health consequences, substance-related disorders have consistently been associated with negative pain-related outcomes among patients with chronic pain. The goal of this narrative review was to provide an overview of studies that have examined the prevalence and correlates of substance-related disorders among patients with chronic pain. A particular focus was placed on opioids, sedatives/hypnotics, cannabis, tobacco, and alcohol given that these substances have received the bulk of research attention among patients with pain. Research conducted to date suggests that a host of biological and psychological factors are likely to contribute to the elevated rates of substance-related disorders among patients with chronic pain. In this review, in addition to reviewing the prevalence and correlates of substance-related disorders among patients with pain, we briefly discussed the changes that were recently made from the DSM-4 to the DSM-5 in the diagnostic criteria for substance-related disorders, and the implications of these changes for the assessment of patients with chronic pain. We also provided a brief overview of instruments that can be used for the assessment of these disorders in clinical and research settings.
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Knighton JS, Stevens-Watkins D, Staton M, Pangburn K. Trends and mental health correlates of nonmedical opioid use among criminal justice-involved African American men. Addict Behav 2018; 85:14-20. [PMID: 29803098 DOI: 10.1016/j.addbeh.2018.04.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 04/26/2018] [Accepted: 04/27/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The Centers for Disease Control and Prevention has deemed nonmedical opioid use (NMOU) an epidemic. Population-based survey data indicate high rates of NMOU among Caucasians, however, these estimates exclude incarcerated samples and may underestimate use among criminal justice-involved African Americans. Despite opioid-associated risks of co-occurring mental illness and mortality, to our knowledge, this is the first study to examine NMOU and mental health among a sample of African American men receiving corrections-based substance use disorder (SUD) treatment in jail, prison, or the community. METHOD We conducted a cross-sectional study examining trends and mental health correlates of NMOU during the year prior to each participant's incarceration, across five cohorts of African American men (N = 4021) enrolled in corrections-based SUD treatment between the years, 2010 and 2014. A series of chi-square, ANOVAs, correlations, and logistic regression models were conducted. RESULTS Over 20% of our sample reported NMOU during the year prior to incarceration. On average, participants were 36-years-old, earned 13 years of education, and were generally unemployed, prior to incarceration. We found a statistically significant positive linear trend between NMOU prior to incarceration and cohort year. The final stepwise multivariate regression model was significant and revealed, older age was associated with lower odds of NMOU. More years of education and frequent mental health symptoms were associated with significantly increased odds of NMOU. DISCUSSION Our findings are unique in that extant literature has primarily described NMOU as a 'White suburban' problem. Culturally-adapted behavioral interventions and medication assisted therapies are discussed.
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Affiliation(s)
| | | | - Michele Staton
- University of Kentucky, 141 Medical Behavioral Science Building, Lexington, KY 40506, United States.
| | - Kevin Pangburn
- Kentucky Department of Corrections, Substance Abuse Division, 275 E Main St., Frankfort, KY 40601, United States.
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Speed TJ, Parekh V, Coe W, Antoine D. Comorbid chronic pain and opioid use disorder: literature review and potential treatment innovations. Int Rev Psychiatry 2018; 30:136-146. [PMID: 30398071 DOI: 10.1080/09540261.2018.1514369] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Chronic pain (CP) and opioid use disorder (OUD) remain challenging complex public health concerns. This is an updated review on the relationship between CP and OUD and the use of stepped care models for assessment and management of this vulnerable population. A literature search was conducted from 2008 to the present in PubMed, Embase, and PsycInfo using the terms pain or chronic pain and opioid-related disorders, opiate, methadone, buprenorphine, naltrexone, opioid abuse, opioid misuse, opioid dependen*, heroin addict, heroin abuse, heroin misuse, heroin dependen*, or analgesic opioids, and stepped care, integrated services, multidisciplinary treatment, or reinforcement-based treatment. Evidenced-based data exists on the feasibility, implementation, and efficacy of stepped care models in primary care settings for the management of CP and opioid use. Although these studies did not enroll participants with OUD, they included a sub-set of patients at risk for the development of OUD. There remains a dearth of treatment options for those with comorbid CP and OUD. Future research is needed to explore the aetiology and impact of CP and OUD, and greater emphasis is needed to improve access to comprehensive pain and substance use programmes for high-risk individuals.
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Affiliation(s)
- Traci J Speed
- a Psychiatry and Behavioral Sciences , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Vinay Parekh
- a Psychiatry and Behavioral Sciences , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - William Coe
- a Psychiatry and Behavioral Sciences , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Denis Antoine
- a Psychiatry and Behavioral Sciences , Johns Hopkins University School of Medicine , Baltimore , MD , USA
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Dash GF, Wilson AC, Morasco BJ, Feldstein Ewing SW. A Model of the Intersection of Pain and Opioid Misuse in Children and Adolescents. Clin Psychol Sci 2018; 6:629-646. [PMID: 30333942 PMCID: PMC6186448 DOI: 10.1177/2167702618773323] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Despite being a significant public health concern, the role of opioid prescriptions in potentiating risk of opioid misuse in the context of pediatric pain has been under-investigated. To address this gap, the present review identifies theory-based hypotheses about these associations, reviews the extant literature on opioid prescriptions that supports these hypotheses, and provides routes for future empirical studies. A multi-level model of mechanisms through which opioid prescriptions may impact pain and other negative outcomes in youth, including risk for opioid misuse and related problems, is proposed with particular attention paid to the role that psychologists can play in informing policies and developing preventative interventions in healthcare settings.
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Affiliation(s)
- Genevieve F. Dash
- Department of Psychological Sciences, University of Missouri, Columbia, MO USA
| | - Anna C. Wilson
- Department of Pediatrics, Institute on Development and Disability, Oregon Health & Science University, Portland, OR USA
| | - Benjamin J. Morasco
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System; Department of Psychiatry, Oregon Health & Science University, Portland, OR USA
| | - Sarah W. Feldstein Ewing
- Department of Child & Adolescent Psychiatry, Oregon Health & Science University, Portland, OR USA
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Ramzan AA, Fischer S, Buss MK, Urban RR, Patsner B, Duska LR, Fisher CM, Lefkowits C. Opioid use in gynecologic oncology in the age of the opioid epidemic: Part II – Balancing safety & accessibility. Gynecol Oncol 2018; 149:401-409. [DOI: 10.1016/j.ygyno.2018.02.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/09/2018] [Accepted: 02/12/2018] [Indexed: 12/15/2022]
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Voon P, Buxton JA, Wood E, Montaner JS, Kerr T. Dose-response relationship between functional pain interference and nonmedical analgesic use: Findings from a nationally representative Canadian survey. Can J Pain 2018; 2:103-112. [PMID: 35005370 PMCID: PMC8730557 DOI: 10.1080/24740527.2018.1452147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Despite the epidemic of nonmedical analgesic use (NMAU) in North America, there is a scarcity of research quantifying the effect of pain on NMAU. Aims This study sought to investigate the relationship between NMAU and functional pain interference, defined as the perceived level of interference in performing activities of daily living due to pain, in a population-based sample of the general Canadian population. Methods Data from the 2012 Canadian Community Health Survey (CCHS)–Mental Health, a nationally representative cross-sectional survey, were used to conduct bivariable and multivariable logistic regression analyses. Results The weighted prevalences of pain and NMAU were 20.6% and 6.6%, respectively. After adjusting for age, sex, education, culture/race, and chronic mental health diagnosis, a dose–response relationship was observed between higher functional pain interference and increased odds of NMAU, ranging from 1.61 (95% confidence interval [CI], 1.22–2.12) to 2.98 (95% CI, 2.21–4.01) from the lowest to the highest levels of functional pain interference. Elevated odds of NMAU were also observed among younger respondents aged 20–29 years and 15–19 years, respondents with a chronic mental illness diagnosis, and males. Secondary analyses revealed that the dose–response relationship between greater function pain interference and increased odds of NMAU persisted within subgroups with and without mental illness, as well as within subgroups aged 40 to 69. Conclusions These findings highlight the potential role of pain on increasing NMAU and the need for targeted strategies to reduce harms of NMAU among high-risk subgroups such as young adults.
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Affiliation(s)
- Pauline Voon
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.,School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jane A Buxton
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Harm Reduction Program, BC Centre for Disease Control, Vancouver, BC, Canada
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada
| | - Julio S Montaner
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada
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Ware MA, Martel MO, Jovey R, Lynch ME, Singer J. A prospective observational study of problematic oral cannabinoid use. Psychopharmacology (Berl) 2018; 235:409-417. [PMID: 29250737 DOI: 10.1007/s00213-017-4811-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 12/05/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Despite evidence supporting the benefits of cannabinoids for symptom control across a wide range of medical conditions, concerns have been raised regarding the potential misuse and/or problematic use of cannabinoids (CBs). OBJECTIVE The first objective of this study was to examine the incidence of problematic prescription cannabinoid use (PPCBU) over a 12-month period among patients initiating cannabinoid therapy. The second objective was to examine the factors associated with PPCBU. A total of 265 patients who were prescribed oral cannabinoid therapy as part of usual medical practice were enrolled into this prospective observational study. Patients first completed a series of baseline questionnaires assessing demographic, clinical, and substance use variables. Three measures designed to assess PPCBU were then administered at 3, 6, and 12 months after initiation of cannabinoid therapy. RESULTS At each of the follow-up assessment time points, a significantly greater number of patients scored below (vs above) cutoff scores on the three main PPCBU outcomes (all p's < .001). At any follow-up time point, a maximum of roughly 25% of patients demonstrated PPCBU. Heightened odds of PPCBU were observed among patients with a history of psychiatric problems, tobacco smokers, and recreational cannabis users (all p's < .05). Results indicated that past-year substance abuse, assessed using the DAST-20, was the strongest predictor of PPCBU (p < .005). CONCLUSION Findings from the present study could have implications for clinicians considering the use of cannabinoids for the management of patients with medical conditions. Although results indicated that the majority of patients included in this study did not reach cutoff scores on the three main PPCBU outcomes, our findings suggest that PPCBU should be routinely assessed and monitored over the course of cannabinoid therapy, particularly among patients with a history of psychiatric or substance use problems.
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Affiliation(s)
- Mark A Ware
- Department of Anesthesia, Faculty of Medicine, McGill University, Montreal, Canada. .,Department of Family Medicine, McGill University, Montreal, Canada. .,Alan Edwards Pain Management Unit, McGill University Health Centre, Montreal, Canada. .,Montreal General Hospital, A5.140, 1650 Cedar Avenue, Montreal, Quebec, H3G 1A4, Canada.
| | - Marc O Martel
- Department of Anesthesia, Faculty of Medicine, McGill University, Montreal, Canada.,Alan Edwards Pain Management Unit, McGill University Health Centre, Montreal, Canada.,Faculty of Dentistry, McGill University, Montreal, Canada
| | - Roman Jovey
- CPM Centres for Pain Management, Mississauga, Ontario, Canada
| | - Mary E Lynch
- Department of Anesthesia, Pain Medicine, and Perioperative Care, Dalhousie University, Halifax, Canada
| | - Joel Singer
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
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Kovatch M, Feingold D, Elkana O, Lev-Ran S. Evaluation and comparison of tools for diagnosing problematic prescription opioid use among chronic pain patients. Int J Methods Psychiatr Res 2017; 26:e1542. [PMID: 27774717 PMCID: PMC6877121 DOI: 10.1002/mpr.1542] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 07/10/2016] [Accepted: 08/24/2016] [Indexed: 11/09/2022] Open
Abstract
Prescription opioid medications are commonly used for the treatment of chronic pain. Assessments of problematic opioid use among pain patients are inconsistent across studies, partially due to differences between various measures. Therefore, the most appropriate measure to use is often unclear. In this study we assessed problematic opioid use in a sample of 551 individuals receiving treatment for chronic pain, using three questionnaires: the Alcohol Use Disorder and Associated Disabilities Interview Schedule - Fourth Edition (AUDADIS-IV), the Current Opioid Misuse Measure (COMM) questionnaire and Portenoy's criteria (PC). These questionnaires yielded discordant positive rates of problematic use: 52.6%, 28.7%, and 17.1%, respectively, which did not change substantially when excluding AUDADIS-IV criteria of physical symptoms of tolerance and withdrawal. Although these three questionnaires share some statistically correlated content-based congruent questions, positive response rates to them were significantly different based on construction features, including questionnaires' referred time-frame, wording of questions and response alternatives. The findings of the present study illustrate strengths and limitations of the AUDADIS-IV, COMM and PC in diagnosing problematic opioid use in a population of adults suffering from chronic pain, and highlight the importance of recognizing and addressing specific questionnaire and question-related differences when identifying problematic opioid use in this population.
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Affiliation(s)
- Merav Kovatch
- Behavioral Sciences, Academic College of Tel Aviv-Jaffa, Tel Aviv, Israel
| | - Daniel Feingold
- Ariel University, Ariel, Israel.,Addiction Medicine and Dual Diagnosis Services, Department of Psychiatry, Sheba Medical Center, Tel Hashomer, Israel
| | - Odelia Elkana
- Behavioral Sciences, Academic College of Tel Aviv-Jaffa, Tel Aviv, Israel
| | - Shaul Lev-Ran
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Addiction Medicine and Dual Diagnosis Services, Department of Psychiatry, Sheba Medical Center, Tel Hashomer, Israel
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Abstract
BACKGROUND Although prescription opioid misuse in older adults results in serious health complications, this issue has been overlooked. PURPOSE This study aimed to describe the prevalence of prescription opioid misuse and identify factors associated with misuse in adults aged 50 years or older. METHODS This study used a cross-sectional design with a convenience sample. One hundred and thirty patients with chronic pain aged 50 years or older, taking prescription opioids, participated in the study. FINDINGS Approximately 35% of the participants misused their prescription opioids. Factors associated with opioid misuse included age (younger), level of education (higher), level of depression (moderate level), alcohol use problem, illicit drug use, and a higher level of pain interference on walking ability and normal walk. Significant predictors of opioid misuse included education, illicit drug use, depression, and pain interference with normal work. DISCUSSION Our study provided important information to health-care providers about identifying high-risk older adults.
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Affiliation(s)
- Yu-Ping Chang
- School of Nursing, The State University of New York at Buffalo, Buffalo, NY.
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Risk of Opioid Abuse and Biopsychosocial Characteristics Associated With This Risk Among Chronic Pain Patients Attending a Multidisciplinary Pain Treatment Facility. Clin J Pain 2017; 32:859-69. [PMID: 26670615 DOI: 10.1097/ajp.0000000000000337] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The objectives of this study were to (1) determine the proportion of patients referred to a multidisciplinary pain treatment facility at risk of opioid abuse, (2) examine biopsychosocial factors associated with this risk, and (3) compare patient outcomes 6 months later across risk of opioid abuse and type of treatment (opioids vs. no opioids). METHODS Participants were 3040 patients (mean age=53.3±14.7 y; female=56%) enrolled in the Quebec Pain Registry between July 2012 and May 2014. Patients answered self-report and nurse-administered questionnaires (pain and psychosocial constructs, Opioid Risk Tool, pain medication, etc.) before initiating treatment at the multidisciplinary pain treatment facility and 6 months later. Data were analyzed using the Pearson χ tests, multivariable binary logistic regression, and multivariate general linear model. RESULTS Results showed that 81%, 13%, and 6% of patients were at low, moderate, and severe risk of opioid abuse, respectively. Civil status, pain duration, mental health-related quality of life, and cigarette smoking were significantly associated with risk of opioid abuse (P<0.001). There was a significant interaction between risk of opioid abuse and type of treatment in predicting 6-month pain outcomes and quality of life. DISCUSSION Almost 20% of patients had a moderate/severe risk of opioid abuse; whether these patients were taking opioids or not for their pain, they had worse outcomes at follow-up. These results point to the importance of assessing risk of opioid abuse in chronic pain patients and to consider how this risk may impact on their clinical evolution.
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Hassan AN, Le Foll B, Imtiaz S, Rehm J. The effect of post-traumatic stress disorder on the risk of developing prescription opioid use disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions III. Drug Alcohol Depend 2017; 179:260-266. [PMID: 28818717 DOI: 10.1016/j.drugalcdep.2017.07.012] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 06/24/2017] [Accepted: 07/11/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To evaluate the effect of baseline post-traumatic stress disorder (PTSD) and each symptoms cluster on the risk of developing opioid use disorder (OUD) in those exposed to opioid painkillers and to assess the effect of comorbid PTSD and OUD on functioning, OUD severity, and treatment seeking compared with individuals with OUD only. METHODS We obtained data from 4025 individuals exposed to opioid painkillers from the National Epidemiologic Survey on Alcohol and Related Conditions III. We matched individuals with baseline PTSD with individuals without PTSD on demographics, developmental background, family history, personalities, and exposure to stressful life events with propensity score methodology. We controlled for clinical diagnoses and other risk factors that may have occurred after PTSD onset. Quality of life was assessed with the SF-12; the number of diagnostic criteria met indicated OUD severity. RESULTS Baseline PTSD predicted OUD after controlling for matching variables and other risk factors, including baseline mood/anxiety disorders and other substance use disorders (odds ratio[OR]: 1.58; 95% confidence interval[CI]: 1.14-2.17; p=0.02). Among individuals with PTSD, arousal/reactivity cluster predicted OUD. Individuals with comorbid PTSD and OUD had lower mean scores on the SF-12 scale and greater severity of OUD than individuals with OUD. There were no differences in help-seeking. CONCLUSION Baseline PTSD increases the risk of developing OUD after exposure to opioid painkillers. Clinicians should screen for PTSD diagnosis and arousal/reactivity symptoms prior to prescribing painkillers. Integrated treatments are strongly recommended for patients with this dual diagnosis.
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Affiliation(s)
- Ahmed N Hassan
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada.
| | - Bernard Le Foll
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Departments of Family and Community Medicine, Pharmacology and Toxicology, and Psychiatry, Institute of Medical Sciences, University of Toronto, Toronto, Canada; Campbell Family Mental Health Research Institute, CAMH, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Sameer Imtiaz
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Jürgen Rehm
- Department of Psychiatry, University of Toronto, Toronto, Canada; Campbell Family Mental Health Research Institute, CAMH, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto,155 College Street, Toronto, Ontario, Canada
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Liebschutz JM, Xuan Z, Shanahan CW, LaRochelle M, Keosaian J, Beers D, Guara G, O'Connor K, Alford DP, Parker V, Weiss RD, Samet JH, Crosson J, Cushman PA, Lasser KE. Improving Adherence to Long-term Opioid Therapy Guidelines to Reduce Opioid Misuse in Primary Care: A Cluster-Randomized Clinical Trial. JAMA Intern Med 2017; 177:1265-1272. [PMID: 28715535 PMCID: PMC5710574 DOI: 10.1001/jamainternmed.2017.2468] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
IMPORTANCE Prescription opioid misuse is a national crisis. Few interventions have improved adherence to opioid-prescribing guidelines. OBJECTIVE To determine whether a multicomponent intervention, Transforming Opioid Prescribing in Primary Care (TOPCARE; http://mytopcare.org/), improves guideline adherence while decreasing opioid misuse risk. DESIGN, SETTING, AND PARTICIPANTS Cluster-randomized clinical trial among 53 primary care clinicians (PCCs) and their 985 patients receiving long-term opioid therapy for pain. The study was conducted from January 2014 to March 2016 in 4 safety-net primary care practices. INTERVENTIONS Intervention PCCs received nurse care management, an electronic registry, 1-on-1 academic detailing, and electronic decision tools for safe opioid prescribing. Control PCCs received electronic decision tools only. MAIN OUTCOMES AND MEASURES Primary outcomes included documentation of guideline-concordant care (both a patient-PCC agreement in the electronic health record and at least 1 urine drug test [UDT]) over 12 months and 2 or more early opioid refills. Secondary outcomes included opioid dose reduction (ie, 10% decrease in morphine-equivalent daily dose [MEDD] at trial end) and opioid treatment discontinuation. Adjusted outcomes controlled for differing baseline patient characteristics: substance use diagnosis, mental health diagnoses, and language. RESULTS Of the 985 participating patients, 519 were men, and 466 were women (mean [SD] patient age, 54.7 [11.5] years). Patients received a mean (SD) MEDD of 57.8 (78.5) mg. At 1 year, intervention patients were more likely than controls to receive guideline-concordant care (65.9% vs 37.8%; P < .001; adjusted odds ratio [AOR], 6.0; 95% CI, 3.6-10.2), to have a patient-PCC agreement (of the 376 without an agreement at baseline, 53.8% vs 6.0%; P < .001; AOR, 11.9; 95% CI, 4.4-32.2), and to undergo at least 1 UDT (74.6% vs 57.9%; P < .001; AOR, 3.0; 95% CI, 1.8-5.0). There was no difference in odds of early refill receipt between groups (20.7% vs 20.1%; AOR, 1.1; 95% CI, 0.7-1.8). Intervention patients were more likely than controls to have either a 10% dose reduction or opioid treatment discontinuation (AOR, 1.6; 95% CI, 1.3-2.1; P < .001). In adjusted analyses, intervention patients had a mean (SE) MEDD 6.8 (1.6) mg lower than controls (P < .001). CONCLUSIONS AND RELEVANCE A multicomponent intervention improved guideline-concordant care but did not decrease early opioid refills. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01909076.
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Affiliation(s)
- Jane M Liebschutz
- Section of General Internal Medicine, Boston Medical Center, Boston, Massachusetts.,Boston University School of Medicine, Boston, Massachusetts
| | - Ziming Xuan
- Boston University School of Public Health, Boston, Massachusetts
| | - Christopher W Shanahan
- Section of General Internal Medicine, Boston Medical Center, Boston, Massachusetts.,Boston University School of Medicine, Boston, Massachusetts
| | - Marc LaRochelle
- Section of General Internal Medicine, Boston Medical Center, Boston, Massachusetts.,Boston University School of Medicine, Boston, Massachusetts
| | - Julia Keosaian
- Boston University School of Public Health, Boston, Massachusetts
| | - Donna Beers
- Section of General Internal Medicine, Boston Medical Center, Boston, Massachusetts
| | - George Guara
- Section of General Internal Medicine, Boston Medical Center, Boston, Massachusetts
| | - Kristen O'Connor
- Section of General Internal Medicine, Boston Medical Center, Boston, Massachusetts
| | - Daniel P Alford
- Section of General Internal Medicine, Boston Medical Center, Boston, Massachusetts.,Boston University School of Medicine, Boston, Massachusetts
| | - Victoria Parker
- Boston University School of Public Health, Boston, Massachusetts
| | - Roger D Weiss
- McLean Hospital, Belmont, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Jeffrey H Samet
- Section of General Internal Medicine, Boston Medical Center, Boston, Massachusetts.,Boston University School of Medicine, Boston, Massachusetts.,Boston University School of Public Health, Boston, Massachusetts
| | - Julie Crosson
- Section of General Internal Medicine, Boston Medical Center, Boston, Massachusetts.,Dorchester House Community Health Center, Boston, Massachusetts
| | - Phoebe A Cushman
- Section of General Internal Medicine, Boston Medical Center, Boston, Massachusetts.,Boston University School of Medicine, Boston, Massachusetts
| | - Karen E Lasser
- Section of General Internal Medicine, Boston Medical Center, Boston, Massachusetts.,Boston University School of Medicine, Boston, Massachusetts.,Boston University School of Public Health, Boston, Massachusetts
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40
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Collaborative care from the emergency department for injured patients with prescription drug misuse: An open feasibility study. J Subst Abuse Treat 2017; 82:12-21. [PMID: 29021110 DOI: 10.1016/j.jsat.2017.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 08/18/2017] [Accepted: 08/22/2017] [Indexed: 11/21/2022]
Abstract
Collaborative Care is a comprehensive longitudinal care management strategy. The purpose of this pilot effectiveness-implementation hybrid study was to determine the feasibility of a Collaborative Care intervention initiated from the Emergency Department and proceeding longitudinally for six months for injured patients with prescription drug misuse (PDM). Adult patients presenting to an urban ED with an injury were screened for eligibility from 2/2015-8/2015. Eligible participants with a positive screen for PDM were enrolled in the 'ED-LINC' intervention which included the following elements: 1) active care coordination and linkage, 2) medication safety and utilization of opioid guidelines 3) longitudinal care management and 4) utilization of Electronic Medical Record (EMR) innovations such as the statewide Emergency Department Information Exchange (EDIE) and statewide prescription monitoring program information for assessment and follow-up. Baseline characteristics of the sample were assessed and regression models were used to evaluate longitudinal trajectories of risk for PDM. A total of 36 participants (56% of patients approached) had PDM and 30 participants were enrolled. Of those enrolled, 37% had prescription stimulant misuse, 20% with prescription sedative misuse and 97% had prescription opioid misuse. Follow-up rates at all time points were ≥83%. Baseline levels of comorbidity were high; 57% endorsed recent heroin use and 70% endorsed symptoms consistent with major depression. Over 50% had five or more statewide ED visits and 53% had used three or more different ED's in the past year. On average, participants received a total of 85 minutes of ED-LINC over six months with 90% of participants receiving all four intervention elements. All patients had care coordinated with new or existing primary care providers (PCP's) and 23% were linked to a new PCP. A majority of patients (≥80%) reported receiving high quality, desired intervention services. There was no significant change in PDM over time. Collaborative Care initiated from the ED is feasible and acceptable to patients with trauma and PDM. Future directions could include effectiveness-implementation hybrid trials to study implementation barriers and strategies as well as patient-level outcomes of this intervention for this complex patient population.
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41
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Cook CE, Rhon DI, Lewis BD, George SZ. Post-operative opioid pain management patterns for patients who receive hip surgery. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2017; 12:14. [PMID: 28298221 PMCID: PMC5353894 DOI: 10.1186/s13011-017-0094-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 02/14/2017] [Indexed: 01/07/2023]
Abstract
Background Identifying optimal, post-operative opioid management strategies is a priority of health providers and government agencies. At present, there are no studies we are aware of that have formally investigated opioid prescribing patterns for post-operative non-arthroplasty orthopedic conditions such as femoroacetabular impingement, nor has any study investigated the influence of opioid prescription patterns on health care costs and utilization. We aimed to investigate a subgrouping scheme associated with post-operative opioid prescription strategies and measure the subgroups’ direct and indirect health care utilization and costs in individuals undergoing non-arthroplasty orthopedic hip surgery. Methods The study was an observational cohort of routine military clinical practices. We used cluster analysis to characterize pre-operative (12 months) and post-operative (24 months) opioid prescription patterns. Linear mixed effects modeling (with statistical controls for baseline status) identified opioid prescription pattern subgroups and identified subgroup differences in health care utilization and costs. Results Two distinct clusters were identified representing 1) short-duration, high total days’ supply (SD-HD), and 2) long-duration, lesser total days’ supply (LD-LD) post-operative prescription patterns. Significantly higher costs and health care utilization for both hip-related and non-hip-related variables were consistently identified in the SD-HD group. Conclusions Long-term opioid prescription use has been identified as a concern, but our findings demonstrate that LD-LD post-operative opioid management for hip surgery recipients was associated with lower costs and utilization. Whether these management patterns were a reflection of pre-operative health status, impacted pain-related outcomes, or can be replicated in other orthopedic procedures remains a consideration for future studies. Trial registration NA.
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Affiliation(s)
- Chad E Cook
- Division of Physical Therapy, Duke University, 2200 West Main Street, Durham, NC, 27705, USA.
| | - Daniel I Rhon
- Clinical Outcomes Research, Center for the Intrepid, Brooke Army Medical Center, Fort Sam Houston, San Antonio, TX, 78234, USA.,Baylor University, Fort Sam Houston, San Antonio, TX, 78234, USA
| | - Brian D Lewis
- Department of Orthopaedics, Duke University, Box 3389, Durham, NC, 27710, USA
| | - Steven Z George
- Department of Orthopaedics, Musculoskeletal Research, Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC, 27705, USA
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42
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Bennett M, Paice JA, Wallace M. Pain and Opioids in Cancer Care: Benefits, Risks, and Alternatives. Am Soc Clin Oncol Educ Book 2017; 37:705-713. [PMID: 28561731 DOI: 10.1200/edbk_180469] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Pain remains common in the setting of malignancy, occurring as a consequence of cancer and its treatment. Several high-quality studies confirm that more than 50% of all patients with cancer experience moderate to severe pain. The prevalence of pain in cancer survivors is estimated to be 40%, while close to two-thirds of those with advanced disease live with pain. Progress has occurred in the management of cancer pain, yet undertreatment persists. Additionally, new challenges are threatening these advances. These challenges are numerous and include educational deficits, time restraints, and limited access to all types of care. New challenges to access are occurring as a result of interventions designed to combat the prescription drug abuse epidemic, with fewer clinicians willing to prescribe opioids, pharmacies reluctant to stock the medications, and payers placing strict limits on reimbursement. A related challenge is our evolving understanding of the risks of long-term adverse effects associated with opioids. And reflective of the opioid abuse epidemic affecting the general population, the potential for misuse or abuse exists in those with cancer. Guidelines have been developed to support oncologists when prescribing the long-term use of opioids for cancer survivors. The challenges surrounding the use of opioids, and the need for safe and effective alternative analgesics, are leading to intense interest in the potential benefits of cannabis for cancer-related pain. Oncologists are faced with questions regarding the types of cannabis available, differences between routes of administration, data concerning safety and efficacy, and legal and regulatory dynamics.
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Affiliation(s)
- Mike Bennett
- From the Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, United Kingdom; Division of Hematology-Oncology, Feinberg School of Medicine, Northwestern University; Chicago, IL; Department of Anesthesiology, University of California, San Diego, San Diego, CA
| | - Judith A Paice
- From the Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, United Kingdom; Division of Hematology-Oncology, Feinberg School of Medicine, Northwestern University; Chicago, IL; Department of Anesthesiology, University of California, San Diego, San Diego, CA
| | - Mark Wallace
- From the Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, United Kingdom; Division of Hematology-Oncology, Feinberg School of Medicine, Northwestern University; Chicago, IL; Department of Anesthesiology, University of California, San Diego, San Diego, CA
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43
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Chang YP, Compton P. Opioid Misuse/Abuse and Quality Persistent Pain Management in Older Adults. J Gerontol Nurs 2016; 42:21-30. [DOI: 10.3928/00989134-20161110-06] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 10/27/2016] [Indexed: 01/04/2023]
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44
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Clark JMR, Cao Y, Krause JS. Risk of Pain Medication Misuse After Spinal Cord Injury: The Role of Substance Use, Personality, and Depression. THE JOURNAL OF PAIN 2016; 18:166-177. [PMID: 27836813 DOI: 10.1016/j.jpain.2016.10.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 10/11/2016] [Accepted: 10/18/2016] [Indexed: 12/11/2022]
Abstract
Our purpose was to identify risk of pain medication misuse (PMM) among participants with spinal cord injury (SCI) by examining associations with multiple sets of risk factors including demographic and injury characteristics, pain experiences, frequency of pain medication use, substance use, personality, and depressive symptoms. Risk of PMM was defined by a cutoff score ≥30 measured using the Pain Medication Questionnaire (PMQ) and examined in 1,619 adults with traumatic SCI of at least 1 year duration who reported at least 1 painful condition and use of prescription pain medication using a cross-sectional design. Results indicated 17.6% of participants had scores of ≥30 on the PMQ. After controlling for demographic, injury, and pain characteristics, logistic regression analysis showed that being a current smoker, recently using cannabis (behavioral factors), and multiple psychological factors were associated with risk of PMM, as indicated by scores on the PMQ. These included elevated depressive symptomatology and exhibiting impulsive or anxious personality traits. Because risk of PMM is indicated in individuals with SCI, prescribers should assess and monitor multiple risk factors for PMM including substance use behaviors and psychological indicators. PERSPECTIVE This article identifies behavioral substance use and psychological factors associated with risk of PMM, measured using the PMQ, among those with SCI. Identification of these related variables will help health care professionals better prescribe and monitor pain medication use and/or misuse among individuals with SCI.
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Affiliation(s)
- Jillian M R Clark
- College of Health Professions, Medical University of South Carolina, Charleston, South Carolina; Department of Psychology, University of Missouri-Kansas City, Kansas City, Missouri
| | - Yue Cao
- College of Health Professions, Medical University of South Carolina, Charleston, South Carolina
| | - James S Krause
- College of Health Professions, Medical University of South Carolina, Charleston, South Carolina.
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45
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Paice JA, Portenoy R, Lacchetti C, Campbell T, Cheville A, Citron M, Constine LS, Cooper A, Glare P, Keefe F, Koyyalagunta L, Levy M, Miaskowski C, Otis-Green S, Sloan P, Bruera E. Management of Chronic Pain in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol 2016; 34:3325-45. [PMID: 27458286 DOI: 10.1200/jco.2016.68.5206] [Citation(s) in RCA: 363] [Impact Index Per Article: 45.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
PURPOSE To provide evidence-based guidance on the optimum management of chronic pain in adult cancer survivors. METHODS An ASCO-convened expert panel conducted a systematic literature search of studies investigating chronic pain management in cancer survivors. Outcomes of interest included symptom relief, pain intensity, quality of life, functional outcomes, adverse events, misuse or diversion, and risk assessment or mitigation. RESULTS A total of 63 studies met eligibility criteria and compose the evidentiary basis for the recommendations. Studies tended to be heterogeneous in terms of quality, size, and populations. Primary outcomes also varied across the studies, and in most cases, were not directly comparable because of different outcomes, measurements, and instruments used at different time points. Because of a paucity of high-quality evidence, many recommendations are based on expert consensus. RECOMMENDATIONS Clinicians should screen for pain at each encounter. Recurrent disease, second malignancy, or late-onset treatment effects in any patient who reports new-onset pain should be evaluated, treated, and monitored. Clinicians should determine the need for other health professionals to provide comprehensive pain management care in patients with complex needs. Systemic nonopioid analgesics and adjuvant analgesics may be prescribed to relieve chronic pain and/or to improve function. Clinicians may prescribe a trial of opioids in carefully selected patients with cancer who do not respond to more conservative management and who continue to experience distress or functional impairment. Risks of adverse effects of opioids should be assessed. Clinicians should clearly understand terminology such as tolerance, dependence, abuse, and addiction as it relates to the use of opioids and should incorporate universal precautions to minimize abuse, addiction, and adverse consequences. Additional information is available at www.asco.org/chronic-pain-guideline and www.asco.org/guidelineswiki.
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Affiliation(s)
- Judith A Paice
- Judith A. Paice, Northwestern University Feinberg School of Medicine, Chicago, IL; Russell Portenoy, MJHS Institute for Innovation in Palliative Care; Paul Glare, Memorial Sloan Kettering Cancer Center, New York; Marc Citron, ProHealth Care Assoc, Lake Success; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Toby Campbell, University of Wisconsin, Madison, WI; Andrea Cheville, Mayo Clinic, Minnesota, MO; Andrea Cooper, Mercy Medical Center, Baltimore, MD; Frank Keefe, Duke University, Durham, NC; Lakshmi Koyyalagunta and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX; Michael Levy, Fox Chase Cancer Center, Philadelphia, PA; Christine Miaskowski, University of California-San Francisco, San Francisco; Shirley Otis-Green, Coalition for Compassionate Care of California, Sacramento, CA; and Paul Sloan, University of Kentucky, Lexington, KY
| | - Russell Portenoy
- Judith A. Paice, Northwestern University Feinberg School of Medicine, Chicago, IL; Russell Portenoy, MJHS Institute for Innovation in Palliative Care; Paul Glare, Memorial Sloan Kettering Cancer Center, New York; Marc Citron, ProHealth Care Assoc, Lake Success; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Toby Campbell, University of Wisconsin, Madison, WI; Andrea Cheville, Mayo Clinic, Minnesota, MO; Andrea Cooper, Mercy Medical Center, Baltimore, MD; Frank Keefe, Duke University, Durham, NC; Lakshmi Koyyalagunta and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX; Michael Levy, Fox Chase Cancer Center, Philadelphia, PA; Christine Miaskowski, University of California-San Francisco, San Francisco; Shirley Otis-Green, Coalition for Compassionate Care of California, Sacramento, CA; and Paul Sloan, University of Kentucky, Lexington, KY
| | - Christina Lacchetti
- Judith A. Paice, Northwestern University Feinberg School of Medicine, Chicago, IL; Russell Portenoy, MJHS Institute for Innovation in Palliative Care; Paul Glare, Memorial Sloan Kettering Cancer Center, New York; Marc Citron, ProHealth Care Assoc, Lake Success; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Toby Campbell, University of Wisconsin, Madison, WI; Andrea Cheville, Mayo Clinic, Minnesota, MO; Andrea Cooper, Mercy Medical Center, Baltimore, MD; Frank Keefe, Duke University, Durham, NC; Lakshmi Koyyalagunta and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX; Michael Levy, Fox Chase Cancer Center, Philadelphia, PA; Christine Miaskowski, University of California-San Francisco, San Francisco; Shirley Otis-Green, Coalition for Compassionate Care of California, Sacramento, CA; and Paul Sloan, University of Kentucky, Lexington, KY
| | - Toby Campbell
- Judith A. Paice, Northwestern University Feinberg School of Medicine, Chicago, IL; Russell Portenoy, MJHS Institute for Innovation in Palliative Care; Paul Glare, Memorial Sloan Kettering Cancer Center, New York; Marc Citron, ProHealth Care Assoc, Lake Success; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Toby Campbell, University of Wisconsin, Madison, WI; Andrea Cheville, Mayo Clinic, Minnesota, MO; Andrea Cooper, Mercy Medical Center, Baltimore, MD; Frank Keefe, Duke University, Durham, NC; Lakshmi Koyyalagunta and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX; Michael Levy, Fox Chase Cancer Center, Philadelphia, PA; Christine Miaskowski, University of California-San Francisco, San Francisco; Shirley Otis-Green, Coalition for Compassionate Care of California, Sacramento, CA; and Paul Sloan, University of Kentucky, Lexington, KY
| | - Andrea Cheville
- Judith A. Paice, Northwestern University Feinberg School of Medicine, Chicago, IL; Russell Portenoy, MJHS Institute for Innovation in Palliative Care; Paul Glare, Memorial Sloan Kettering Cancer Center, New York; Marc Citron, ProHealth Care Assoc, Lake Success; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Toby Campbell, University of Wisconsin, Madison, WI; Andrea Cheville, Mayo Clinic, Minnesota, MO; Andrea Cooper, Mercy Medical Center, Baltimore, MD; Frank Keefe, Duke University, Durham, NC; Lakshmi Koyyalagunta and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX; Michael Levy, Fox Chase Cancer Center, Philadelphia, PA; Christine Miaskowski, University of California-San Francisco, San Francisco; Shirley Otis-Green, Coalition for Compassionate Care of California, Sacramento, CA; and Paul Sloan, University of Kentucky, Lexington, KY
| | - Marc Citron
- Judith A. Paice, Northwestern University Feinberg School of Medicine, Chicago, IL; Russell Portenoy, MJHS Institute for Innovation in Palliative Care; Paul Glare, Memorial Sloan Kettering Cancer Center, New York; Marc Citron, ProHealth Care Assoc, Lake Success; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Toby Campbell, University of Wisconsin, Madison, WI; Andrea Cheville, Mayo Clinic, Minnesota, MO; Andrea Cooper, Mercy Medical Center, Baltimore, MD; Frank Keefe, Duke University, Durham, NC; Lakshmi Koyyalagunta and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX; Michael Levy, Fox Chase Cancer Center, Philadelphia, PA; Christine Miaskowski, University of California-San Francisco, San Francisco; Shirley Otis-Green, Coalition for Compassionate Care of California, Sacramento, CA; and Paul Sloan, University of Kentucky, Lexington, KY
| | - Louis S Constine
- Judith A. Paice, Northwestern University Feinberg School of Medicine, Chicago, IL; Russell Portenoy, MJHS Institute for Innovation in Palliative Care; Paul Glare, Memorial Sloan Kettering Cancer Center, New York; Marc Citron, ProHealth Care Assoc, Lake Success; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Toby Campbell, University of Wisconsin, Madison, WI; Andrea Cheville, Mayo Clinic, Minnesota, MO; Andrea Cooper, Mercy Medical Center, Baltimore, MD; Frank Keefe, Duke University, Durham, NC; Lakshmi Koyyalagunta and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX; Michael Levy, Fox Chase Cancer Center, Philadelphia, PA; Christine Miaskowski, University of California-San Francisco, San Francisco; Shirley Otis-Green, Coalition for Compassionate Care of California, Sacramento, CA; and Paul Sloan, University of Kentucky, Lexington, KY
| | - Andrea Cooper
- Judith A. Paice, Northwestern University Feinberg School of Medicine, Chicago, IL; Russell Portenoy, MJHS Institute for Innovation in Palliative Care; Paul Glare, Memorial Sloan Kettering Cancer Center, New York; Marc Citron, ProHealth Care Assoc, Lake Success; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Toby Campbell, University of Wisconsin, Madison, WI; Andrea Cheville, Mayo Clinic, Minnesota, MO; Andrea Cooper, Mercy Medical Center, Baltimore, MD; Frank Keefe, Duke University, Durham, NC; Lakshmi Koyyalagunta and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX; Michael Levy, Fox Chase Cancer Center, Philadelphia, PA; Christine Miaskowski, University of California-San Francisco, San Francisco; Shirley Otis-Green, Coalition for Compassionate Care of California, Sacramento, CA; and Paul Sloan, University of Kentucky, Lexington, KY
| | - Paul Glare
- Judith A. Paice, Northwestern University Feinberg School of Medicine, Chicago, IL; Russell Portenoy, MJHS Institute for Innovation in Palliative Care; Paul Glare, Memorial Sloan Kettering Cancer Center, New York; Marc Citron, ProHealth Care Assoc, Lake Success; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Toby Campbell, University of Wisconsin, Madison, WI; Andrea Cheville, Mayo Clinic, Minnesota, MO; Andrea Cooper, Mercy Medical Center, Baltimore, MD; Frank Keefe, Duke University, Durham, NC; Lakshmi Koyyalagunta and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX; Michael Levy, Fox Chase Cancer Center, Philadelphia, PA; Christine Miaskowski, University of California-San Francisco, San Francisco; Shirley Otis-Green, Coalition for Compassionate Care of California, Sacramento, CA; and Paul Sloan, University of Kentucky, Lexington, KY
| | - Frank Keefe
- Judith A. Paice, Northwestern University Feinberg School of Medicine, Chicago, IL; Russell Portenoy, MJHS Institute for Innovation in Palliative Care; Paul Glare, Memorial Sloan Kettering Cancer Center, New York; Marc Citron, ProHealth Care Assoc, Lake Success; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Toby Campbell, University of Wisconsin, Madison, WI; Andrea Cheville, Mayo Clinic, Minnesota, MO; Andrea Cooper, Mercy Medical Center, Baltimore, MD; Frank Keefe, Duke University, Durham, NC; Lakshmi Koyyalagunta and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX; Michael Levy, Fox Chase Cancer Center, Philadelphia, PA; Christine Miaskowski, University of California-San Francisco, San Francisco; Shirley Otis-Green, Coalition for Compassionate Care of California, Sacramento, CA; and Paul Sloan, University of Kentucky, Lexington, KY
| | - Lakshmi Koyyalagunta
- Judith A. Paice, Northwestern University Feinberg School of Medicine, Chicago, IL; Russell Portenoy, MJHS Institute for Innovation in Palliative Care; Paul Glare, Memorial Sloan Kettering Cancer Center, New York; Marc Citron, ProHealth Care Assoc, Lake Success; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Toby Campbell, University of Wisconsin, Madison, WI; Andrea Cheville, Mayo Clinic, Minnesota, MO; Andrea Cooper, Mercy Medical Center, Baltimore, MD; Frank Keefe, Duke University, Durham, NC; Lakshmi Koyyalagunta and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX; Michael Levy, Fox Chase Cancer Center, Philadelphia, PA; Christine Miaskowski, University of California-San Francisco, San Francisco; Shirley Otis-Green, Coalition for Compassionate Care of California, Sacramento, CA; and Paul Sloan, University of Kentucky, Lexington, KY
| | - Michael Levy
- Judith A. Paice, Northwestern University Feinberg School of Medicine, Chicago, IL; Russell Portenoy, MJHS Institute for Innovation in Palliative Care; Paul Glare, Memorial Sloan Kettering Cancer Center, New York; Marc Citron, ProHealth Care Assoc, Lake Success; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Toby Campbell, University of Wisconsin, Madison, WI; Andrea Cheville, Mayo Clinic, Minnesota, MO; Andrea Cooper, Mercy Medical Center, Baltimore, MD; Frank Keefe, Duke University, Durham, NC; Lakshmi Koyyalagunta and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX; Michael Levy, Fox Chase Cancer Center, Philadelphia, PA; Christine Miaskowski, University of California-San Francisco, San Francisco; Shirley Otis-Green, Coalition for Compassionate Care of California, Sacramento, CA; and Paul Sloan, University of Kentucky, Lexington, KY
| | - Christine Miaskowski
- Judith A. Paice, Northwestern University Feinberg School of Medicine, Chicago, IL; Russell Portenoy, MJHS Institute for Innovation in Palliative Care; Paul Glare, Memorial Sloan Kettering Cancer Center, New York; Marc Citron, ProHealth Care Assoc, Lake Success; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Toby Campbell, University of Wisconsin, Madison, WI; Andrea Cheville, Mayo Clinic, Minnesota, MO; Andrea Cooper, Mercy Medical Center, Baltimore, MD; Frank Keefe, Duke University, Durham, NC; Lakshmi Koyyalagunta and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX; Michael Levy, Fox Chase Cancer Center, Philadelphia, PA; Christine Miaskowski, University of California-San Francisco, San Francisco; Shirley Otis-Green, Coalition for Compassionate Care of California, Sacramento, CA; and Paul Sloan, University of Kentucky, Lexington, KY
| | - Shirley Otis-Green
- Judith A. Paice, Northwestern University Feinberg School of Medicine, Chicago, IL; Russell Portenoy, MJHS Institute for Innovation in Palliative Care; Paul Glare, Memorial Sloan Kettering Cancer Center, New York; Marc Citron, ProHealth Care Assoc, Lake Success; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Toby Campbell, University of Wisconsin, Madison, WI; Andrea Cheville, Mayo Clinic, Minnesota, MO; Andrea Cooper, Mercy Medical Center, Baltimore, MD; Frank Keefe, Duke University, Durham, NC; Lakshmi Koyyalagunta and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX; Michael Levy, Fox Chase Cancer Center, Philadelphia, PA; Christine Miaskowski, University of California-San Francisco, San Francisco; Shirley Otis-Green, Coalition for Compassionate Care of California, Sacramento, CA; and Paul Sloan, University of Kentucky, Lexington, KY
| | - Paul Sloan
- Judith A. Paice, Northwestern University Feinberg School of Medicine, Chicago, IL; Russell Portenoy, MJHS Institute for Innovation in Palliative Care; Paul Glare, Memorial Sloan Kettering Cancer Center, New York; Marc Citron, ProHealth Care Assoc, Lake Success; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Toby Campbell, University of Wisconsin, Madison, WI; Andrea Cheville, Mayo Clinic, Minnesota, MO; Andrea Cooper, Mercy Medical Center, Baltimore, MD; Frank Keefe, Duke University, Durham, NC; Lakshmi Koyyalagunta and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX; Michael Levy, Fox Chase Cancer Center, Philadelphia, PA; Christine Miaskowski, University of California-San Francisco, San Francisco; Shirley Otis-Green, Coalition for Compassionate Care of California, Sacramento, CA; and Paul Sloan, University of Kentucky, Lexington, KY
| | - Eduardo Bruera
- Judith A. Paice, Northwestern University Feinberg School of Medicine, Chicago, IL; Russell Portenoy, MJHS Institute for Innovation in Palliative Care; Paul Glare, Memorial Sloan Kettering Cancer Center, New York; Marc Citron, ProHealth Care Assoc, Lake Success; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Toby Campbell, University of Wisconsin, Madison, WI; Andrea Cheville, Mayo Clinic, Minnesota, MO; Andrea Cooper, Mercy Medical Center, Baltimore, MD; Frank Keefe, Duke University, Durham, NC; Lakshmi Koyyalagunta and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX; Michael Levy, Fox Chase Cancer Center, Philadelphia, PA; Christine Miaskowski, University of California-San Francisco, San Francisco; Shirley Otis-Green, Coalition for Compassionate Care of California, Sacramento, CA; and Paul Sloan, University of Kentucky, Lexington, KY
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Park NK, Melander L, Sanchez S. Nonmedical Prescription Drug Use Among Midwestern Rural Adolescents. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2016. [DOI: 10.1080/1067828x.2015.1049392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Mitchell MM, Maragh-Bass AC, Nguyen TQ, Isenberg S, Knowlton AR. The role of chronic pain and current substance use in predicting negative social support among disadvantaged persons living with HIV/AIDS. AIDS Care 2016; 28:1280-6. [PMID: 27050708 DOI: 10.1080/09540121.2016.1168916] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Chronic pain and substance use can strain the supportive relationships of persons with serious chronic illness, which may increase the likelihood of receiving negative, rather than positive, social support from informal caregivers and social network members. To our knowledge, this is the first study to longitudinally examine the effects of chronic pain and substance use on negative social support. The sample (N = 383) comprised disadvantaged, primarily African-American, persons living with HIV/AIDS with a history of injection drug use, 32.4% of whom reported frequent or constant pain in the prior 6 months. Using factor analysis and structural equation modeling, current substance use and greater levels of chronic pain positively predicted negative social support 12 months later, after controlling for baseline negative support, viral load, age and sex. We also found a significant interaction effect such that among those not using substances, there was a significant positive association between pain and negative support, but no such association among those currently using substances. The findings emphasize the importance of treatment of chronic pain and substance use in the supportive functioning of social networks of a disadvantaged population with serious chronic conditions and persistent health disparities.
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Affiliation(s)
- Mary M Mitchell
- a Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Allysha C Maragh-Bass
- b Department of Surgery, Harvard School of Medicine, Harvard School of Public Health, Center for Surgery and Public Health , Brigham and Women's Hospital , Boston , MA , USA
| | - Trang Q Nguyen
- c Department of Mental Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Sarina Isenberg
- a Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Amy R Knowlton
- a Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
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Aly Z, Rosen N, Evans RW. Migraine and the Risk of Suicide. Headache 2016; 56:753-61. [PMID: 27028299 DOI: 10.1111/head.12815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 02/26/2016] [Indexed: 01/09/2023]
Abstract
Rarely and tragically, migraineurs commit suicide or overdose on medications we prescribe.
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Affiliation(s)
- Zarmeneh Aly
- Department of Neuro Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - Noah Rosen
- Cushing Neuroscience Institute, Hofstra Northwell Health, Great Neck, NY, USA
| | - Randolph W Evans
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
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Factors Associated with Opioid Use in a Cohort of Patients Presenting for Surgery. PAIN RESEARCH AND TREATMENT 2015; 2015:829696. [PMID: 26881072 PMCID: PMC4736213 DOI: 10.1155/2015/829696] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 12/15/2015] [Indexed: 01/09/2023]
Abstract
Objectives. Patients taking opioids prior to surgery experience prolonged postoperative opioid use, worse clinical outcomes, increased pain, and more postoperative complications. We aimed to compare preoperative opioid users to their opioid naïve counterparts to identify differences in baseline characteristics. Methods. 107 patients presenting for thoracotomy, total knee replacement, total hip replacement, radical mastectomy, and lumpectomy were investigated in a cross-sectional study to characterize the associations between measures of pain, substance use, abuse, addiction, sleep, and psychological measures (depressive symptoms, Posttraumatic Stress Disorder symptoms, somatic fear and anxiety, and fear of pain) with opioid use. Results. Every 9-point increase in the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R) score was associated with 2.37 (95% CI 1.29–4.32) increased odds of preoperative opioid use (p = 0.0005). The SOAPP-R score was also associated with 3.02 (95% CI 1.36–6.70) increased odds of illicit preoperative opioid use (p = 0.007). Also, every 4-point increase in baseline pain at the future surgical site was associated with 2.85 (95% CI 1.12–7.27) increased odds of legitimate preoperative opioid use (p = 0.03). Discussion. Patients presenting with preoperative opioid use have higher SOAPP-R scores potentially indicating an increased risk for opioid misuse after surgery. In addition, legitimate preoperative opioid use is associated with preexisting pain.
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Lin LA, Bohnert ASB, Price AM, Jannausch M, Bonar EE, Ilgen MA. Pain acceptance and opiate use disorders in addiction treatment patients with comorbid pain. Drug Alcohol Depend 2015; 157:136-42. [PMID: 26530502 DOI: 10.1016/j.drugalcdep.2015.10.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 10/08/2015] [Accepted: 10/11/2015] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Studies from pain treatment settings indicate that poor acceptance of pain may be an important and modifiable risk factor for higher severity of opioid use. However, the degree to which pain acceptance relates to opioid use severity in the addiction treatment population is unknown. In this study of addiction treatment patients with co-morbid pain, we examined correlates of severity of opiate (heroin and prescription opioid) use, with a particular focus on the role of pain acceptance. METHODS Patients in residential addiction treatment with comorbid pain (N=501) were stratified into low, moderate and high severity of opiate use. Demographic and clinical characteristics were compared across opiate severity categories. RESULTS 72% (N=360) of the participants had symptoms that were consistent with an opiate use disorder. Younger age, Caucasian race, female gender, cocaine use and lower pain acceptance were associated with higher severity of opiate use, whereas pain intensity was not. Controlling for demographic and other risk factors, such as substance use and pain intensity, higher pain acceptance was associated with lower odds of severe prescription opioid (AOR 0.50, 95% CI 0.38-0.68 for a one SD increase in pain acceptance) and heroin use (AOR 0.57, 95% CI 0.44-0.75 for a one SD increase in pain acceptance). CONCLUSIONS Problematic opiate use is common in addictions treatment patients with chronic pain. Lower pain acceptance is related to greater opiate use severity, and may be an important modifiable target for interventions to successfully treat both pain and opiate use disorders.
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Affiliation(s)
- Lewei Allison Lin
- University of Michigan, Department of Psychiatry, North Campus Research Complex, 2800 Plymouth Road, Ann Arbor, MI 48109, United States.
| | - Amy S B Bohnert
- University of Michigan, Department of Psychiatry, North Campus Research Complex, 2800 Plymouth Road, Ann Arbor, MI 48109, United States
| | - Amanda M Price
- University of Michigan, Department of Psychiatry, North Campus Research Complex, 2800 Plymouth Road, Ann Arbor, MI 48109, United States
| | - Mary Jannausch
- University of Michigan, Department of Psychiatry, North Campus Research Complex, 2800 Plymouth Road, Ann Arbor, MI 48109, United States
| | - Erin E Bonar
- University of Michigan, Department of Psychiatry, North Campus Research Complex, 2800 Plymouth Road, Ann Arbor, MI 48109, United States
| | - Mark A Ilgen
- University of Michigan, Department of Psychiatry, North Campus Research Complex, 2800 Plymouth Road, Ann Arbor, MI 48109, United States
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