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Kuang W, Yang EJ, Truong R, Woo BK. Bringing Virtual Reality to Mainstream Pediatric Care. J Patient Cent Res Rev 2024; 11:107-111. [PMID: 39044851 PMCID: PMC11262837 DOI: 10.17294/2330-0698.2063] [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: 07/25/2024] Open
Abstract
Virtual reality (VR) stands as an innovative technology transforming our interactions with the digital world. Its integration into health care has proven advantageous for both patients and health care providers across multiple levels and modalities. Given that VR is becoming increasingly accessible and prevalent, health care providers should explore incorporating the technology into their practices, particularly within the pediatric population, which is becoming progressively more accustomed to the technology. This topic synopsis provides a broad discussion of the current literature, exploring current and probable future applications of VR in pediatric patient care, particularly in improving the hospital experience, facilitating education during hospitalizations, providing an alternative to pharmacological therapy for pain management, and enhancing mental health care practices.
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Affiliation(s)
- Wayne Kuang
- Department of Pediatrics, Los Angeles General Medical Center, Los Angeles, CA
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Eric J. Yang
- Keck School of Medicine, University of Southern California, Los Angeles, CA
- Department of Bioengineering, Henry Samueli School of Engineering and Applied Sciences, University of California, Los Angeles, Los Angeles, CA
| | - Roland Truong
- KPC Health Graduate Medical Education, Hemet Valley Medical Center, Hemet, CA
- Department of Anesthesiology, Indiana University School of Medicine, Indianapolis, IN
| | - Benjamin K.P. Woo
- Department of Psychiatry, Olive View – UCLA Medical Center, Sylmar, CA
- Chinese American Health Promotion Laboratory, University of California, Los Angeles, Los Angeles, CA
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Córdoba-Grueso WS, Mattey-Mora PP, Chen C, Galaviz KI, Parker MA. The association between exercise and prescription opioid misuse: A scoping review. Exp Clin Psychopharmacol 2024; 32:140-149. [PMID: 37602998 PMCID: PMC10879450 DOI: 10.1037/pha0000675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
Exercise prevents chronic diseases and modulates pain. People experiencing pain often use opioids for relief, increasing the risk of prescription opioid misuse. Nonetheless, exercise may influence prescription opioid misuse through the release of endorphins or induced injury-related pain. We aimed to summarize the existing literature on the association between exercise and prescription opioid misuse. We identified studies published through December 2021 in Cochrane, Embase, Medline, and Pubmed, using search terms like "opioid-related disorders," "opioid misuse," "exercise," and "sports." Observational and experimental studies with adult samples published in English were included. Exclusion criteria included participants < 18 years old, studies including heroin use as the outcome, and studies conducted among pregnant or institutionalized individuals. The risk of bias and quality assessment were conducted independently by two authors using the National Institutes of Health Study Quality Assessment Tools, and decisions were cross-checked with a third author. Our search yielded 10,796 records, of which eight studies were included. These studies were heterogeneous clinically and methodologically. Three were intervention trials, three were cross-sectional, and two were cohort studies. Three studies evaluated yoga, two evaluated exercise, and three evaluated sports. Significant findings showed lower prescription opioid misuse among people who exercise, except for one study that showed greater odds of prescription opioid misuse among college athletes. We conclude that the findings on the association between exercise and prescription opioid misuse vary, even within similar study types and samples. Future researchers should consider large samples, standardized questions, and common outcome measures in research on exercise and prescription opioid misuse. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Whitney S. Córdoba-Grueso
- 1025 E. Seventh Street, Bloomington, IN 47045. United States of America. Indiana University School of Public Health, Department of Epidemiology & Biostatistics, Bloomington, IN
| | - Paola P. Mattey-Mora
- 1025 E. Seventh Street, Bloomington, IN 47045. United States of America. Indiana University School of Public Health, Department of Epidemiology & Biostatistics, Bloomington, IN
| | - Chen Chen
- 1025 E. Seventh Street, Bloomington, IN 47045. United States of America. Indiana University School of Public Health, Department of Epidemiology & Biostatistics, Bloomington, IN
| | - Karla I. Galaviz
- 1025 E. Seventh Street, Bloomington, IN 47045. United States of America. Indiana University School of Public Health, Department of Applied Health Science, Bloomington, IN
| | - Maria A. Parker
- 1025 E. Seventh Street, Bloomington, IN 47045. United States of America. Indiana University School of Public Health, Department of Epidemiology & Biostatistics, Bloomington, IN
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Sebastian RA, Gunderson LM, Ramos MM, Willging CE. Readiness to implement screening, brief intervention, and referral to treatment in school-based health centers. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:1571-1590. [PMID: 36126223 DOI: 10.1002/jcop.22937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/26/2022] [Accepted: 08/27/2022] [Indexed: 05/23/2023]
Abstract
The purpose of this study was to evaluate the readiness of a university-based school-based health center (SBHC) program to implement the screening, brief intervention, and referral to treatment (SBIRT) model. We completed preimplementation surveys and interviews with providers, staff, and administrators at participating SBHCs (N = 19) to measure current protocols for and barriers to addressing adolescent substance use and barriers and facilitators to implementing SBIRT. We used the R = MC2 heuristic (readiness equals motivation, general organizational capacity, and innovation-specific capacity) to interpret findings from the data. Using the R = MC2 heuristic, we identified factors that may aid implementation, including the prioritization of substance use and a supportive organizational culture, as well as potential barriers, including competing high-priority health issues and a lack of resources for innovation. This study contributes to the emerging literature on the implementation of the SBIRT model with adolescents and in SBHCs and demonstrates the practical applicability of the R = MC2 heuristic for assessing implementation readiness. SBHCs are ideal locations for addressing substance use but SBHC providers also face unique challenges when implementing the SBIRT model.
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Affiliation(s)
- Rachel A Sebastian
- Pacific Institute for Research and Evaluation, Albuquerque, New Mexico, USA
| | - Lara M Gunderson
- Pacific Institute for Research and Evaluation, Albuquerque, New Mexico, USA
| | - Mary M Ramos
- Department of Pediatrics, University of New Mexico, Albuquerque, New Mexico, USA
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Appiah L, John D, Owoade DR, Mendenhall J, Appiah D. Factors Influencing Racial and Ethnic Differences in Prescription Opioid Misuse Among Young Adolescents in the USA, 2009-2019. J Racial Ethn Health Disparities 2023; 10:32-42. [PMID: 34845676 DOI: 10.1007/s40615-021-01194-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/15/2021] [Accepted: 11/22/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Prescription opioid misuse (POM) is an important public health concern. Not many studies have evaluated factors influencing racial and ethnic differences in POM exclusively in young adolescents. We evaluated factors influencing the racial and ethnic differences in POM in a nationally representative sample of 8th- and 10th-grade (12-15 years old) US adolescents. METHODS Data were from 107,786 adolescents who participated in the 2009-2019 Monitoring the Future survey. Logistic regression and mediation analysis were used to identify risk factors for POM and evaluate mediators of the association of race and ethnicity on the frequency of POM in the past year. RESULTS From 2009 to 2019, the prevalence of POM in the past year decreased from 3.2% to 1.8% (p = 0.032), with significant differences in POM trends by race and ethnicity. Overall, the prevalence was higher among non-Hispanic White adolescents (3.2%) than Hispanic (2.5%) and non-Hispanic Black adolescents (1.6%), p < 0.001. After adjustment for demographic, substance use, lifestyle, and family-related factors, the odds of POM were lower among Black (odds ratio (OR) = 0.81, 95% confidence interval (CI): 0.66-0.98) and Hispanic adolescents (OR = 0.64, CI: 0.55-0.74) compared to White adolescents. Illicit drug use and misuse of other prescription drugs together explained 77.2% and 47.3% of the racial and ethnic disparities in POM among Black and Hispanic adolescents, respectively. CONCLUSION In this study, significant racial and ethnic differences in the trends of POM were observed. Illicit drug use and misuse of other prescription drugs substantially explained the racial and ethnic disparities in POM among young adolescents.
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Affiliation(s)
- Linda Appiah
- College of Education, Texas Tech University, Lubbock, TX, USA
| | - Dijo John
- Department of Public Health, Texas Tech University Health Sciences Center, 3601 4th Street STOP 9430, Lubbock, TX, 79430, USA
| | - Damilola R Owoade
- Department of Epidemiology and Population Health, University of Louisville, Louisville, KY, USA
| | - Janet Mendenhall
- Department of Public Health, Texas Tech University Health Sciences Center, Abilene, TX, USA
| | - Duke Appiah
- Department of Public Health, Texas Tech University Health Sciences Center, 3601 4th Street STOP 9430, Lubbock, TX, 79430, USA.
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Prescription Opioid Misuse Among School-Aged Adolescents: Gender Differences and Related Factors. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00954-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Rugg CM, Cheah JW, Vomer RP, Lau B. Opiate Use Patterns Among Collegiate Athletes. Cureus 2022; 14:e31152. [PMID: 36483908 PMCID: PMC9724194 DOI: 10.7759/cureus.31152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE/AIM The purpose of this study is to determine the rates of prescribed opiate use and misuse among current collegiate athletes. MATERIALS AND METHODS This was an observational survey study conducted at a single institution; Division I Collegiate Athletics Department. The participants in the study were current Division I Collegiate Student-Athletes. The survey queried athletes' age, gender, and history of injury or orthopedic surgery before and during college. Athletes were asked about prior opiate prescriptions, length of medication use, and reasons for opiate use. RESULTS Of196 student-athlete respondents, the average age was 20.1 years and 62.8% were female. Pre-collegiate orthopedic injuries/surgeries were reported by 45.4% of athletes, of which 40.4% received an opiate prescription. Collegiate orthopedic injuries/surgeries were reported by 28.6% of athletes; 46.4% received an opiate prescription. Fifty-two student-athletes (26.5%) had received an opiate prescription after an orthopedic injury or surgery. The length of opiate use was most commonly 2 weeks or less. Female athletes had a higher rate of collegiate injuries (P<0.05) and a nonsignificant trend towards more opiate prescriptions. Among the 26 student-athletes who received collegiate opiate prescriptions, the reasons for taking opiates were most commonly pain (84.6%) and sleep (46.2%). Opiate use outside of prescribed indication was present in 14 athletes (7.1% of the total); 12 were female. CONCLUSION A quarter of collegiate student-athletes had received an opiate prescription due to orthopedic injury or surgery, with a small subset using opiates for non-analgesic functions. Future research should examine risk factors for opiate misuse among collegiate athletes.
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Affiliation(s)
- Caitlin M Rugg
- Department of Orthopedic Surgery, Kaiser Permanente San Jose Medical Center, San Jose, USA
| | - Jonathan W Cheah
- Department of Orthopedic Surgery, Santa Clara Valley Medical Center, San Jose, USA
| | - Rock P Vomer
- Family and Community Health and Orthopedics, Division of Sports Medicine, Duke University, Durham, USA
| | - Brian Lau
- Orthopedic Surgery, Duke University, Durham, USA
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Leyrer-Jackson JM, Acuña AM, Olive MF. Current and emerging pharmacotherapies for opioid dependence treatments in adults: a comprehensive update. Expert Opin Pharmacother 2022; 23:1819-1830. [PMID: 36278879 PMCID: PMC9764962 DOI: 10.1080/14656566.2022.2140039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 10/21/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Opioid use disorder (OUD) is characterized by compulsive opioid seeking and taking, intense drug craving, and intake of opioids despite negative consequences. The prevalence of OUDs has now reached an all-time high, in parallel with peak rates of fatal opioid-related overdoses, where 15 million individuals worldwide meet the criteria for OUD. Further, in 2020, 120,000 opioid-related deaths were reported worldwide with over 75,000 of those deaths occurring within the United States. AREAS COVERED In this review, we highlight pharmacotherapies utilized in patients with OUDs, including opioid replacement therapies, and opioid antagonists utilized for opioid overdoses and deterrent of opioid use. We also highlight newer treatments, such as those targeting the neuroimmune system, which are potential new directions for research given the recently established role of opioids in activating neuroinflammatory pathways, as well as over the counter remedies, including kratom, that may mitigate withdrawal. EXPERT OPINION To effectively treat OUDs, a deeper understanding of the current therapeutics being utilized, their additive effects, and the added involvement of the neuroimmune system are essential. Additionally, a complete understanding of opioid-induced neuronal alterations and therapeutics that target these abnormalities - including the neuroimmune system - is required to develop effective treatments for OUDs.
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Affiliation(s)
- Jonna M. Leyrer-Jackson
- Department of Medical Education, School of Medicine, Creighton University, Phoenix, AZ, 85012, USA
| | - Amanda M. Acuña
- Department of Psychology, Arizona State University, Tempe, AZ, 85257, USA
- Interdepartmental Graduate Program in Neuroscience, Arizona State University, Tempe, AZ, 85257, USA
| | - M. Foster Olive
- Department of Psychology, Arizona State University, Tempe, AZ, 85257, USA
- Interdepartmental Graduate Program in Neuroscience, Arizona State University, Tempe, AZ, 85257, USA
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Carrasco-Garrido P, Gallardo-Pino C, Jiménez-Trujillo I, Hernández-Barrera V, García-Gómez-Heras S, Lima Florencio L, Palacios-Ceña D. Nationwide Population-Based Study About Patterns of Prescription Opioid Use and Misuse Among Young Adults in Spain. Int J Public Health 2022; 67:1604755. [PMID: 36059585 PMCID: PMC9437214 DOI: 10.3389/ijph.2022.1604755] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 07/05/2022] [Indexed: 11/13/2022] Open
Abstract
Objective: Prescription opioid misuse has become one of the most common ways drugs are consumed among young adults. The objective of our study was to describe the prevalence and factors associated with prescription opioid use and misuse among young adults living in Spain.Methods: A nationwide, cross-sectional epidemiological study on the use and misuse of prescription opioids in Spanish Youngers. We used individualized secondary data provided by the Household Survey on Alcohol and Drugs in Spain 2017–2018.Results: Prevalence of prescription opioid use among young adults was 4.89%. Misuse among this population reached prevalence values of 13.4%, with higher values observed among women . The variables associated with a greater probability of prescription opioid use and misuse were misuse of tranquilizers, sedatives, and sleeping pills, along with using cannabis and other illicit psychoactive drugs (aOR = 2.99; 95% CI: 1.10–8.15).Conclusion: Prescription opioid use and misuse in Youngers has important implications for the Spanish public health system, because, even though not currently comparable to the situation in other countries, this drug use could be on the verge of creating similar problems.
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Affiliation(s)
- Pilar Carrasco-Garrido
- Department of Medical Specialties and Public Health, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Spain
- *Correspondence: Pilar Carrasco-Garrido,
| | - Carmen Gallardo-Pino
- Department of Medical Specialties and Public Health, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Isabel Jiménez-Trujillo
- Department of Medical Specialties and Public Health, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Valentín Hernández-Barrera
- Department of Medical Specialties and Public Health, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Soledad García-Gómez-Heras
- Department of Basic Health Sciences, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Lidiane Lima Florencio
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Domingo Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Spain
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Ruskin D, Rasul R, McCann-Pineo M. Predictors of Emergency Department Opioid Use Among Adolescents and Young Adults. Pediatr Emerg Care 2022; 38:e1409-e1416. [PMID: 35686972 PMCID: PMC9351695 DOI: 10.1097/pec.0000000000002777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE It is well established that adolescents and young adults are increasingly vulnerable to the effects of early opioid exposures, with the emergency department (ED) playing a critical role in such introduction. Our objective was to identify predictors of ED opioid administration (ED-RX) and prescribing at discharge (DC-RX) among adolescent and young adults using a machine learning approach. METHODS We conducted a secondary analysis of ED visit data from the National Hospital Ambulatory Medical Care Survey from 2014 to 2018. Visits where patients were aged 10 to 24 years were included. Predictors of ED-RX and DC-RX were identified via machine learning methods. Separate weighted logistic regressions were performed to determine the association between each predictor, and ED-RX and DC-RX, respectively. RESULTS There were 12,693 ED visits identified within the study time frame, with the majority being female (58.6%) and White (70.7%). Approximately 12.3% of all visits were administered an opioid during the ED visit, and 11.5% were prescribed one at discharge. For ED-RX, the strongest predictors were fracture injury (odds ratio [OR], 5.24; 95% confidence interval [CI], 3.73-7.35) and Southern geographic region (OR, 3.01; 95% CI, 2.14-4.22). The use of nonopioid analgesics significantly reduced the odds of ED-RX (OR, 0.46; 95% CI, 0.37-0.57). Fracture injury was also a strong predictor of DC-RX (OR, 5.91; 95% CI, 4.24-8.25), in addition to tooth pain (OR, 5.47; 95% CI, 3.84-7.69). CONCLUSIONS Machine learning methodologies were able to identify predictors of ED-RX and DC-RX, which can be used to inform ED prescribing guidelines and risk mitigation efforts among adolescents and young adults.
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Park YJ, Yo CH, Hsu WT, Tsou EPY, Wang YC, Ling DA, Lee AF, Liu MA, Lee CC. Use of Opioids and Outcomes of Pneumonia: Results From the US Nationwide Inpatient Sample. J Acute Med 2021; 11:113-128. [PMID: 35106277 PMCID: PMC8748203 DOI: 10.6705/j.jacme.202112_11(4).0001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/25/2020] [Accepted: 12/23/2020] [Indexed: 06/14/2023]
Abstract
BACKGROUND Opioids have been shown to increase risk of pneumonia among susceptible population. However, the effect of opioid abuse on the outcome of pneumonia has not been evaluated at the population level. We aimed to compare the outcomes of pneumonia among patients with opioid use disorder and patients without substance use disorder using a large population database. METHODS We assembled a pneumonia cohort composed of 11,186,564 adult patients from the National Inpatient Sample (NIS; 2005-2014). Patients with opioid disorder were identified using the International Classification of Diseases, 9th Revision, Clinical Modification codes. We compared health-related and economic outcomes between patients with and without opioid disorders using propensity score matching (PSM) analysis to balance baseline differences. The survival differences between two groups of patients were assessed using a Cox proportional hazard model. We further explored the possibility of effect modification by interaction analyses in different populations. RESULTS After PSM, patients with opioid use disorder were at increased risk of ventilator use (odds ratio [OR]: 1.22, 95% confidence interval [CI]: 1.08 to 1.38, p = 0.0014) and associated with increased length of hospital stay by 0.59 days (95% CI: 0.35 to 0.83, p < 0.001), compared with those without substance use disorder. Patients with opioid use also had higher daily (228.00 USD, 95% CI: 180.51 to 275.49, p < 0.001) and total (1,875.72 USD, 95% CI: 1,259.63 to 2,491.80, p < 0.001) medical costs. Subgroup analyses showed similar results. CONCLUSIONS Compared with patients without any drug dependence, patients with opioid use disorders had increased risk of complications and resource utilization. This study adds evidence for increased risk for pneumonia complications in the growing patients with opioid use disorders.
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Affiliation(s)
- Yeongjun James Park
- Harvard TH Chan School of Public Health Department of Biostatistics Boston, MA USA
- Far Eastern Memorial Hospital Department of Emergency Medicine New Taipei City Taiwan
- Harvard TH Chan School of Public Health Department of Epidemiology Boston, MA USA
- Johns Hopkins Bloomberg School of Public Health Department of Epidemiology Baltimore USA
- Driscoll Children's Hospital Department of Pediatrics Corpus Christi, TX USA
- Albert Einstein College of Medicine/Jacobi Medical Center Department of Medicine NY USA
- National Taiwan University Hospital Department of Emergency Medicine Taipei Taiwan
- Warren Alpert Medical School of Brown University Department of Medicine Providence, RI USA
| | - Chia-Hung Yo
- Far Eastern Memorial Hospital Department of Emergency Medicine New Taipei City Taiwan
| | - Wan-Ting Hsu
- Harvard TH Chan School of Public Health Department of Epidemiology Boston, MA USA
| | - Eric Po-Yang Tsou
- Johns Hopkins Bloomberg School of Public Health Department of Epidemiology Baltimore USA
- Driscoll Children's Hospital Department of Pediatrics Corpus Christi, TX USA
| | - Yu-Chiang Wang
- Albert Einstein College of Medicine/Jacobi Medical Center Department of Medicine NY USA
| | - Dean-An Ling
- National Taiwan University Hospital Department of Emergency Medicine Taipei Taiwan
| | - An-Fu Lee
- National Taiwan University Hospital Department of Emergency Medicine Taipei Taiwan
| | - Michael A Liu
- Warren Alpert Medical School of Brown University Department of Medicine Providence, RI USA
| | - Chien-Chang Lee
- National Taiwan University Hospital Department of Emergency Medicine Taipei Taiwan
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Connelly M, Glynn EF, Hoffman MA, Bickel J. Rates and Predictors of Using Opioids in the Emergency Department to Treat Migraine in Adolescents and Young Adults. Pediatr Emerg Care 2021; 37:e981-e987. [PMID: 31246788 DOI: 10.1097/pec.0000000000001851] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study aimed to determine the rate and context in which opioids are used to treat migraine in adolescents and young adults seen in emergency care settings. METHODS Data from 2010 to 2016 in the Cerner Health Facts electronic health record data warehouse were analyzed using multilevel logistic regression to estimate the population likelihood of an opioid being used in the emergency department (ED) to treat a primary diagnosis of migraine in adolescents and young adults and to evaluate the extent to which this likelihood varies as a function of characteristics of the patient (age, sex, race, and insurance), encounter (referral source, provider specialty, and encounter duration and year), and ED (region, setting, size, payer mix, and academic status). RESULTS The study identified 14,494 eligible ED encounters with unique patients, of which 23% involved an opioid. Likelihood of being treated with opioids was significantly higher for patients who were older, female, white, and seen by a surgeon and who had longer encounters and encounters earlier in the time period sampled. Sites varied widely in percentage of encounters involving opioids (mean, 26.4% ± 20.1%; range, 0-100%), with higher rates associated with smaller sites with relatively higher proportions of commercially insured patients. CONCLUSIONS Use of opioids in the ED to treat migraine in youth is fairly common, with rate variation reflecting broader trends in for whom opioids tend to be more likely to be prescribed. These findings may be helpful for benchmarking and informing quality improvement efforts aimed at reducing unwarranted opioid exposure in youth.
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Affiliation(s)
- Mark Connelly
- From the Children's Mercy Kansas City, Kansas City, MO
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Beneficial Effects of Opioid Rotation to Buprenorphine/Naloxone on Opioid Misuse, Craving, Mental Health, and Pain Control in Chronic Non-Cancer Pain Patients with Opioid Use Disorder. J Clin Med 2021; 10:jcm10163727. [PMID: 34442024 PMCID: PMC8396821 DOI: 10.3390/jcm10163727] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 12/12/2022] Open
Abstract
Patients with chronic non-cancer pain (CNCP) often use opioids for long periods of time. This may lead to opioid use disorder (OUD) and psychiatric symptoms: mainly depression and anxiety. The current study investigated the effect of buprenorphine/naloxone (BuNa) rotation on opioid misuse, craving, psychiatric symptoms and pain in patients with CNCP and OUD. Forty-three participants with CNCP and OUD were converted from a full mu-receptor agonist opioid (mean morphine equivalent dose: 328.3 mg) to BuNa, in an inpatient setting. Opioid misuse, craving, co-occurring psychiatric symptoms, and pain perception were determined at baseline and after a two-month follow-up, using the following self-report questionnaires: Current Opioid Misuse Measurement (COMM), Visual Analog Scale (VAS-craving and VAS-pain) and Depression, Anxiety and Stress Scale (DASS), respectively. VAS-craving and VAS-pain were also determined immediately after conversion. A total of 37 participants completed the protocol. The mean COMM decreased from 17.1 to 6.7 (F = 36.5; p < 0.000), the mean VAS-craving decreased from 39.3 to 5.3 (−86.6%; F = 26.5, p < 0.000), the mean DASS decreased from 12.1 to 6.6 (F = 56.3, p < 0.000), and the mean VAS-pain decreased from 51.3 to 37.2 (−27.4%, F = 3.3; p = 0.043). Rotation to BuNa in patients with CNCP and OUD was accompanied by reductions in (i) opioid misuse, (ii) opioid craving, (iii) the severity of co-occurring psychiatric symptoms, and (iv) self-reported pain. BuNa as opioid agonist treatment may therefore be a beneficial strategy in CNCP patients with OUD. The limited sample size and the observational nature of this study underline the need for the replication of the current findings in large-scale, controlled studies.
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Manworren JR, Hajduk J, Hill JN, Raad AA, Manworren RCB. Adolescents' Understanding of Opioid-Induced Euphoria Measures and Proposed Measurement Revisions. J Psychoactive Drugs 2021; 54:258-268. [PMID: 34355666 DOI: 10.1080/02791072.2021.1953642] [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: 10/20/2022]
Abstract
Prescription opioid misuse is an unintended consequence of acute pain management. Opioid-induced euphoria (OIE) with first therapeutic opioid exposure may influence opioid misuse. OIE is not assessed in clinical care and self-report measures of OIE have not been validated in adolescents. We (1) determined adolescents' ability to understand existing self-reported OIE measures, (2) revised measures for better understanding by this population, and (3) established initial content validity of revised measures with adolescents. Using runner's euphoria to simulate OIE in Study 1, 29 adolescents' (14 males) understanding of the Drug Effects Questionnaire (DEQ-5), the Addiction Resource Center Inventory Morphine Benzedrine Group scale (ARCI-MBG), and the ARCI Lysergic Acid Diethylamide scale (ARCI-LSD) were tested. In Study 2, 29 additional adolescents (9 males) participated in a modified Delphi study with focus groups to revise survey items to improve understanding by peers. In Study 1, runners understood <40% of ARCI-MBG and ARCI-LSD statements. In Study 2, all but 7 survey items were revised. Revised measures of OIE for adolescents may help define at-risk OIE phenotypes and validate risk assessments using survey methodology. Additional studies are needed to validate the revised OIE self-report measures with opioid-naive adolescents receiving opioids to treat acute pain.
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Affiliation(s)
- Jordon R Manworren
- Case Western Reserve University, Cleveland, OH, USA.,Department of Nursing, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - John Hajduk
- Department of Pediatric Anesthesia, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | | | - Alice A Raad
- Department of Nursing, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Renee C B Manworren
- Department of Nursing, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Pediatrics, Northwestern Feinberg School of Medicine, Chicago, IL, USA
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Hah J. Risk factors and screening for opioid misuse: current clinical implications for prescription opioid therapy. Pain Manag 2021; 11:625-630. [PMID: 34155912 DOI: 10.2217/pmt-2021-0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Jennifer Hah
- Division of Pain Medicine, Department of Anesthesiology, Perioperative, & Pain Medicine, Stanford University, 1070 Arastradero Road, Suite 200, Palo Alto, CA 94304, USA
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Qeadan F, Madden EF, Bern R, Parsinejad N, Porucznik CA, Venner KL, English K. Associations between opioid misuse and social relationship factors among American Indian, Alaska Native, and Native Hawaiian college students in the U.S. Drug Alcohol Depend 2021; 222:108667. [PMID: 33771399 DOI: 10.1016/j.drugalcdep.2021.108667] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/23/2021] [Accepted: 01/31/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Despite declining overall rates of opioid misuse among college students, racial and ethnic differences in percentage and correlates of opioid misuse among student populations remains unclear. This study seeks to estimate percentages of opioid misuse among American Indian, Alaska Native, and Native Hawaiian (AI/AN/NH) college students and determine whether problems in social bonds affect AI/AN/NH opioid misuse. METHODS Guided by social relationship factors associated with substance use in the Social Development Model, we used 2015-2019 data from the American College Health Association-National College Health Assessment survey in multivariable logistic regression models to examine the role of social bonds with peers and family in opioid misuse (prescription and non-prescription) among AI/AN/NH college students across the U.S. RESULTS The percentage of opioid misuse was highest among AI/AN/NH college students (7.12 %) relative to other race/ethnicity groups. AI/AN/NH college students who reported experiencing loneliness (aOR: 1.68; 95 % CI 1.33-2.12; P < .0001), difficult social relationships (aOR: 1.27; 95 % CI 1.04-1.55; P = 0.0196), family problems (aOR: 1.32; 95 % CI 1.07-1.63; P = 0.0097), and intimate partner violence (aOR: 1.92; 95 % CI 1.56-2.36; P < .0001) were significantly more likely to misuse opioids than students who did not report experiencing these relationship problems. CONCLUSIONS Relationship problems with peers and family increase AI/AN/NH college student risk for opioid misuse, indicating opportunities for colleges to support programs addressing healthy social relationships as a means to reduce opioid misuse among AI/AN/NH students.
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Affiliation(s)
- Fares Qeadan
- University of Utah School of Medicine, Department of Family and Preventive Medicine, United States.
| | - Erin F Madden
- Wayne State University, Department of Family Medicine and Public Health Sciences, United States
| | - Rona Bern
- University of Utah School of Medicine, Department of Family and Preventive Medicine, United States
| | - Nasim Parsinejad
- University of Utah School of Medicine, Department of Family and Preventive Medicine, United States
| | - Christina A Porucznik
- University of Utah School of Medicine, Department of Family and Preventive Medicine, United States
| | - Kamilla L Venner
- University of New Mexico, Department of Psychology, Center on Alcohol, Substance use, And Addiction (CASAA), United States
| | - Kevin English
- Albuquerque Area Southwest Tribal Epidemiology Center, New Mexico, United States
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Morgan JR, Barocas JA, Murphy SM, Epstein RL, Stein MD, Schackman BR, Walley AY, Linas BP. Comparison of Rates of Overdose and Hospitalization After Initiation of Medication for Opioid Use Disorder in the Inpatient vs Outpatient Setting. JAMA Netw Open 2020; 3:e2029676. [PMID: 33320266 PMCID: PMC7739119 DOI: 10.1001/jamanetworkopen.2020.29676] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
IMPORTANCE Whereas outpatient treatment with medication for opioid use disorder (MOUD) is evidence based, there is a large network of inpatient facilities in the US that are reimbursed by commercial insurers and do not typically offer MOUD. OBJECTIVE To compare the rates of opioid-related overdose and all-cause hospitalization after outpatient MOUD treatment vs inpatient care. DESIGN, SETTING, AND PARTICIPANTS This comparative effectiveness research study used deidentified claims of commercially insured individuals in the US from the MarketScan Commercial Claims and Encounters Database from January 1, 2010, to December 31, 2017, to obtain a sample of 37 090 individuals with opioid use disorder who initiated treatment with inpatient care and/or MOUD. Data were analyzed from October 1, 2019, to May 1, 2020. To address nonrandom treatment assignment, individuals with opioid use disorder who initiated MOUD or who entered inpatient care were matched 1:1 based on propensity scores. EXPOSURES The independent variable of interest was the type of treatment initiated. Individuals could initiate 1 of 5 potential treatments: (1) outpatient MOUD, (2) short-term inpatient care, (3) short-term inpatient care followed by outpatient MOUD within 30 days, (4) long-term inpatient care, or (5) long-term inpatient care followed by outpatient MOUD within 30 days. MAIN OUTCOMES AND MEASURES Opioid-related overdose and all-cause hospitalization at any point within the 12 months after treatment of opioid use disorder. The hazard for each outcome was estimated using a time-to-event Cox proportional hazards regression model. RESULTS The cohort included 37 090 individuals matched 1:1 between inpatient and outpatient treatment (20 723 [56%] were younger than 30 years; 23 250 [63%] were male). After propensity score matching, compared with the inpatient treatments, initiation of outpatient MOUD alone was followed by the lowest 1-year overdose rate (2.2 [95% CI, 2.0-2.5] per 100 person-years vs 3.5 [95% CI, 2.7-4.4] to 7.0 [95% CI, 4.6-10.7] per 100 person-years) and hospitalization rate (39 [95% CI, 38-40] per 100 person-years vs 57 [95% CI, 54-61] to 74 [95% CI, 73-76] per 100 person-years). Outpatient MOUD was also associated with the lowest hazard of these events compared with inpatient care, which had hazard ratios ranging from 1.71 (95% CI, 1.35-2.17) to 2.67 (95% CI, 1.68-4.23) for overdose and 1.33 (95% CI, 1.23-1.44) to 1.90 (95% CI, 1.83-1.97) for hospitalizations. CONCLUSIONS AND RELEVANCE The results of this comparative effectiveness research study suggest that lower rates of subsequent overdose and hospitalization are associated with outpatient MOUD compared with short- or long-term inpatient care. When patients and clinicians have a choice of treatment, outpatient MOUD treatment may be associated with lower overdose and hospitalization on balance. Future research should assess which patients benefit most from inpatient care and how best to leverage existing inpatient treatment infrastructure.
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Affiliation(s)
- Jake R. Morgan
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts
| | - Joshua A. Barocas
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Sean M. Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Rachel L. Epstein
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Michael D. Stein
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts
| | - Bruce R. Schackman
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Alexander Y. Walley
- Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts
| | - Benjamin P. Linas
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
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Tucker JS, Davis JP, Seelam R, Stein BD, D’Amico EJ. Predictors of Opioid Misuse During Emerging Adulthood: An Examination of Adolescent Individual, Family and Peer Factors. Drug Alcohol Depend 2020; 214:108188. [PMID: 32717502 PMCID: PMC7448784 DOI: 10.1016/j.drugalcdep.2020.108188] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 07/06/2020] [Accepted: 07/13/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Opioid misuse has reached epidemic proportions among emerging adults in the U.S. To inform prevention efforts, this study examined adolescent factors related to alcohol and marijuana (AM) use that are associated with a higher or lower risk for opioid misuse during emerging adulthood. METHODS We used 11 waves of survey data from a diverse California cohort (N = 6,509). Predictor variables from waves 1-7 (ages 11-17) included individual (resistance self-efficacy, positive expectancies) family (older sibling and important adult use), and peer (perceived norms, time spent with peers who use, peer approval) factors. Opioid misuse at wave 8 (mean age = 18.3) and wave 11 (mean age = 21.6) included heroin and nonmedical prescription drug use. RESULTS Initial latent growth models (LGMs) indicated that nearly all intercepts and slopes for individual, family, and peer AM factors predicted opioid misuse at waves 8 and 11. These associations were reduced to non-significance after adjusting for prior other substance use with the exception of three intercepts: positive expectancies, peer approval, and older sibling use predicted a higher probability of opioid misuse at wave 8. CONCLUSIONS Stronger AM positive expectancies, perceived peer approval of AM use, and older sibling AM use during adolescence are associated with a higher likelihood of opioid misuse during the transition to emerging adulthood. However, most adolescent factors were no longer associated with subsequent opioid misuse after adjusting for history of other substance use, highlighting the importance of considering the larger context of substance use in studies of opioid misuse among young people.
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Affiliation(s)
- Joan S. Tucker
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407-2138
| | - Jordan P. Davis
- Suzanne Dworak-Peck School of Social Work, USC Center for Artificial Intelligence in Society, USC Center for Mindfulness Science, USC Institute for Addiction Science, University of Southern California
| | - Rachana Seelam
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407-2138
| | - Bradley D. Stein
- RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213
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Evans R, Widman L, Javidi H, Adams ET, Cacace S, Prinstein MJ, Desmarais SL. Preliminary Evaluation of a Prescription Opioid Misuse Prevention Program Among Rural Middle School Students. J Community Health 2020; 45:1139-1148. [PMID: 32785872 DOI: 10.1007/s10900-020-00899-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Adolescent opioid misuse, addiction, and overdose have emerged as national health crises. Nearly 17% of high school students have misused prescription opioids. The purpose of this study was to evaluate the reach and acceptability of a widely-used prescription opioid misuse prevention program, This Is (Not) About Drugs© (TINAD), and its preliminary efficacy at improving opioid misuse knowledge, opioid misuse attitudes, self-efficacy to avoid opioid misuse, and intentions to misuse opioids. Participants were 576 7th grade students (Mage = 11.8; 51% boys; 39% Hispanic, 31% White, 20% Black) from a rural county in the southeastern U.S. All participants received the TINAD program and completed pretest and immediate posttest assessments. The program was school-based and implemented in collaboration with school teachers and administrators. Over 91% of all eligible students in the school district participated in the TINAD program. Most participants found the program acceptable-over 83% of students liked the program. Approximately 9% of participants reported prior misuse of prescription opioids. After participating in TINAD, students self-reported higher knowledge and self-efficacy as well as safer attitudes. However, there was no change in intentions to misuse opioids in the future. Effects of the program were consistent across gender, socioeconomic status, race/ethnicity, and previous opioid misuse. TINAD is acceptable and shows promise for improving opioid-related cognitions. However, more rigorous experimental and longitudinal research is needed to understand whether TINAD reduces opioid misuse over time. Given the limited research on adolescent opioid misuse prevention, this study lays the ground work for future randomized control trials.
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Affiliation(s)
- Reina Evans
- Department of Psychology, North Carolina State University, 640 Poe Hall, Campus Box 7650, Raleigh, NC, 27695, USA.
| | - Laura Widman
- Department of Psychology, North Carolina State University, 640 Poe Hall, Campus Box 7650, Raleigh, NC, 27695, USA
| | - Hannah Javidi
- Department of Psychology, North Carolina State University, 640 Poe Hall, Campus Box 7650, Raleigh, NC, 27695, USA
| | - Elizabeth Troutman Adams
- School of Journalism and Media, University of North Carolina at Chapel Hill, Carroll Hall, CB 3365, Chapel Hill, NC, 27599, USA
| | - Sam Cacace
- Center for Family and Community Engagement, North Carolina State University, 2700 Katharine Stinson Dr., Raleigh, NC, 27695, USA
| | - Mitchell J Prinstein
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, 240 Davie Hall, Campus Box 3270, Chapel Hill, NC, 27599, USA
| | - Sarah L Desmarais
- Department of Psychology, North Carolina State University, 640 Poe Hall, Campus Box 7650, Raleigh, NC, 27695, USA
- Center for Family and Community Engagement, North Carolina State University, 2700 Katharine Stinson Dr., Raleigh, NC, 27695, USA
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Elkington KS, Spaulding A, Gardner S, Knight D, Belenko S, Becan JE, Robertson AA, Oser C, DiClemente R. A System-Level Intervention to Encourage Collaboration Between Juvenile Justice and Public Health Agencies to Promote HIV/STI Testing. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2020; 32:337-355. [PMID: 32897134 PMCID: PMC9426765 DOI: 10.1521/aeap.2020.32.4.337] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Justice-involved youth are at high risk for HIV and STIs, and justice agencies are uniquely poised to offer HIV/STI testing. However, testing in these settings is not routine and represents a missed opportunity. This study describes a system-level implementation intervention designed to increase access to HIV/STI testing through juvenile justice (JJ) and public health agency collaboration across six counties in six states in the United States. Local change teams, active facilitation, and training were utilized to facilitate agency partnerships and development of HIV/STI practice change protocols. Five counties established health and JJ partnerships and four counties successfully implemented their protocols. Sites with HIV/STI education and testing protocols behaviorally screened 98.5% of youth and tested 41.2% of those youth; 0% were HIV+ and 43.2% had an STI. The intervention provides a feasible, scalable solution, through promoting partnerships between JJ and health agencies, to link youth to testing and treatment services.
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Affiliation(s)
- Katherine S. Elkington
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY
| | - Anne Spaulding
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Sheena Gardner
- Social Science Research Center, Mississippi State University, Starkville, MS
| | - Danica Knight
- Institute of Behavioral Research, Texas Christian University, Fort Worth, TX
| | - Steven Belenko
- Department of Criminal Justice, Temple University, Philadelphia, PA
| | - Jennifer E. Becan
- Institute of Behavioral Research, Texas Christian University, Fort Worth, TX
| | - Angela A. Robertson
- Social Science Research Center, Mississippi State University, Starkville, MS
| | - Carrie Oser
- Department of Sociology, University of Kentucky, Lexington, KY
| | - Ralph DiClemente
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
- Department of Social and Behavioral Sciences, New York University (NYU) College of Global Public Health, New York, NY
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20
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DiGiorgio AM, Stein R, Morrow KD, Robichaux JM, Crutcher CL, Tender GC. The increasing frequency of intravenous drug abuse-associated spinal epidural abscesses: a case series. Neurosurg Focus 2020; 46:E4. [PMID: 30611170 DOI: 10.3171/2018.10.focus18449] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 10/12/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEFew studies have been published specifically examining intravenous drug abuse (IVDA)-associated spinal epidural abscesses (SEAs), an unfortunate sequela of the opioid crisis in the United States. Here, the authors examined a series of patients with IVDA-associated SEAs in order to shed light on this challenging disease entity.METHODSThis study is a retrospective chart review of patients presenting with IVDA-associated SEAs at the authors' institution from 2013 to 2018, spanning the statewide implementation of opioid-prescribing restrictions.RESULTSA total of 45 patients presented with IVDA-associated SEAs; 46.5% presented with a neurological deficit. Thirty-one patients underwent surgery for neurological deficit, failure of medical therapy, or both. Nineteen surgical patients underwent a fusion procedure along with decompression. The complication rate was 41.9%, and the mortality rate was 6.7%. The average length of stay was 27.6 days. Patients who underwent surgery within 24 hours of onset of neurological symptoms trended toward more improvement in their American Spinal Cord Association Impairment Scale grade than those who did not (0.5 vs -0.2, p = 0.068). Methicillin-resistant Staphylococcus aureus was isolated as the causative pathogen in 57.8% of patients. Twenty-three patients (51.5%) kept their scheduled clinic follow-up appointments. Of the fusion patients with adequate follow-up, 5 showed bony arthrodesis and 3 had pseudarthrosis. The rate of IVDA-associated SEAs increased after opioid-prescribing restrictions were put in place, from 0.54 cases per month to 1.15 cases per month (p = 0.017).CONCLUSIONSPatients with IVDA-associated SEAs are challenging to treat, with high complication rates and poor follow-up. This disease is increasing in frequency, and opioid-prescribing restrictions did not slow that rise. Community outreach to promote prevention, early medical attention, and medication compliance would benefit this largely publicly funded patient population.
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Affiliation(s)
- Anthony M DiGiorgio
- 1Department of Neurosurgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana; and
| | - Rachel Stein
- 2School of Medicine, Edward Via College of Osteopathic Medicine, Spartanburg, South Carolina
| | - Kevin D Morrow
- 1Department of Neurosurgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana; and
| | - Jared M Robichaux
- 1Department of Neurosurgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana; and
| | - Clifford L Crutcher
- 1Department of Neurosurgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana; and
| | - Gabriel C Tender
- 1Department of Neurosurgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana; and
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Prescription opioid misuse among adolescents and emerging adults in the United States: A scoping review. Prev Med 2020; 132:105972. [PMID: 31904397 PMCID: PMC7024638 DOI: 10.1016/j.ypmed.2019.105972] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/06/2019] [Accepted: 12/27/2019] [Indexed: 02/06/2023]
Abstract
The U.S. opioid epidemic is a critical public health problem. As substance use and misuse typically begin in adolescence and emerging adulthood, there is a critical need for prevention efforts for this key developmental period to disrupt opioid misuse trajectories, reducing morbidity and mortality [e.g., overdose, development of opioid use disorders (OUD)]. This article describes the current state of research focusing on prescription opioid misuse (POM) among adolescents and emerging adults (A/EAs) in the U.S. Given the rapidly changing nature of the opioid epidemic, we applied PRISMA Scoping Review (PRISMA-ScR) guidelines to identify empirical articles published in the past 5 years (January 2013-September 2018) from nine databases examining POM among A/EAs (ages 10-25) in the U.S. Seventy-six articles met our inclusion criteria focusing on POM in the following areas: cross-sectional surveys (n = 60), longitudinal cohort studies (n = 5), objective, non-self-reported data sources (n = 9), and interventions (n = 2). Final charted data elements were organized by methodology and sample, with results tables describing design, sample, interventions (where applicable), outcomes, and limitations. Most studies focused on the epidemiology of POM and risk/protective factors, including demographic (e.g., sex, race), individual (e.g., substance use, mental health), and social (e.g., peer substance use) factors. Despite annual national surveys conducted, longitudinal studies examining markers of initiation and escalation of prescription opioid misuse (e.g., repeated overdoses, time to misuse) are lacking. Importantly, few evidence-based prevention or early intervention programs were identified. Future research should examine longitudinal trajectories of POM, as well as adaptation and implementation of promising prevention approaches.
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Capaldi DM, Kerr DCR, Tiberio SS, Owen LD. Men's misuse of prescription opioids from early to middle adulthood: An examination of developmental and concurrent prediction models. J Consult Clin Psychol 2019; 87:893-903. [PMID: 31556666 DOI: 10.1037/ccp0000442] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The prevalence of misuse of prescription opioids across adulthood and the associations of such misuse with symptoms of psychopathology and use of other substances were examined for an at-risk community sample of men. METHOD For a longitudinal study of boys (N = 206) followed to adulthood, misuse of prescription opioids was assessed on 13 occasions from ages 20-21 years to 37-38 years. Prediction of misuse was examined from prospectively assessed risk factors in 3 models: (a) parental substance use during the men's adolescence; (b) the men's own risk behaviors in adolescence-delinquent behavior, depressive symptoms, and use of tobacco, alcohol, marijuana, and opioids; and (c) within- and between-individual effects of the men's risk behaviors during adulthood. RESULTS Opioid misuse was reported by 29% of men. After accounting for effects of age and considered individually, parent marijuana use and all of the adolescent and adult risk factors (except adolescent depressive symptoms) were significant between-individual predictors of opioid misuse. Furthermore, within-individual prediction was significant for adult delinquency and alcohol use after accounting for increases in opioid misuse with age. When risk factors were tested simultaneously, men's adult delinquency and use of marijuana and tobacco remained significant between-individual predictors, whereas no parental or adolescent risk factors remained significant in these models. CONCLUSION Both adolescent and adult risk factors were examined that predicted adult opioid misuse. Preventing adolescent problem behavior and using such histories to inform screening for misuse risk in adulthood may reduce the burden of the opioid crisis. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Abstract
Although recent spikes in overdose deaths are largely attributable to heroin and fentanyl, prescription opioids still account for a significant percentage of overdose deaths. Additionally, overdose deaths are not a problem solely for adults; roughly 8% of all overdose deaths occur in persons aged 15 to 24. In addition to identifying factors that increase risk for misuse and negative outcomes among adolescents, research must examine the causal mechanisms that link these factors to increased risk. Finally, the extant research must serve as the foundation for prevention/intervention strategies and identify treatments that are effective among adolescents with opioid use disorders.
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Hudgins JD, Porter JJ, Monuteaux MC, Bourgeois FT. Prescription opioid use and misuse among adolescents and young adults in the United States: A national survey study. PLoS Med 2019; 16:e1002922. [PMID: 31689290 PMCID: PMC6830740 DOI: 10.1371/journal.pmed.1002922] [Citation(s) in RCA: 137] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 09/25/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Prescription opioid misuse has become a leading cause of unintentional injury and death among adolescents and young adults in the United States. However, there is limited information on how adolescents and young adults obtain prescription opioids. There are also inadequate recent data on the prevalence of additional drug abuse among those misusing prescription opioids. In this study, we evaluated past-year prevalence of prescription opioid use and misuse, sources of prescription opioids, and additional substance use among adolescents and young adults. METHODS AND FINDINGS This was a retrospective analysis of the National Survey on Drug Use and Health (NSDUH) for the years 2015 and 2016. Prevalence of opioid use, misuse, use disorder, and additional substance use were calculated with 95% confidence intervals (CIs), stratified by age group and other demographic variables. Sources of prescription opioids were determined for respondents reporting opioid misuse. We calculated past-year prevalence of opioid use and misuse with or without use disorder, sources of prescription opioids, and prevalence of additional substance use. We included 27,857 adolescents (12-17 years of age) and 28,213 young adults (18-25 years of age) in our analyses, corresponding to 119.3 million individuals in the extrapolated national population. There were 15,143 respondents (27.5% [95% CI 27.0-28.0], corresponding to 32.8 million individuals) who used prescription opioids in the previous year, including 21.0% (95% CI 20.4-21.6) of adolescents and 32.2% (95% CI 31.4-33.0) of young adults. Significantly more females than males reported using any prescription opioid (30.3% versus 24.8%, P < 0.001), and non-Hispanic whites and blacks were more likely to have had any opioid use compared to Hispanics (28.9%, 28.1%, and 25.8%, respectively; P < 0.001). Opioid misuse was reported by 1,050 adolescents (3.8%; 95% CI 3.5-4.0) and 2,207 young adults (7.8%; 95% CI 7.3-8.2; P < 0.001). Male respondents using opioids were more likely to have opioid misuse without use disorder compared with females (23.2% versus 15.8%, respectively; P < 0.001), with similar prevalence by race/ethnicity. Among those misusing opioids, 55.7% obtained them from friends or relatives, 25.4% from the healthcare system, and 18.9% through other means. Obtaining opioids free from friends or relatives was the most common source for both adolescents (33.5%) and young adults (41.4%). Those with opioid misuse reported high prevalence of prior cocaine (35.5%), hallucinogen (49.4%), heroin (8.7%), and inhalant (30.4%) use. In addition, at least half had used tobacco (55.5%), alcohol (66.9%), or cannabis (49.9%) in the past month. Potential limitations of the study are that we cannot exclude selection bias in the study design or socially desirable reporting among participants, and that longitudinal data are not available for long-term follow-up of individuals. CONCLUSIONS Results from this study suggest that the prevalence of prescription opioid use among adolescents and young adults in the US is high despite known risks for future opioid and other drug use disorders. Reported prescription opioid misuse is common among adolescents and young adults and often associated with additional substance abuse, underscoring the importance of drug and alcohol screening programs in this population. Prevention and treatment efforts should take into account that greater than half of youths misusing prescription opioids obtain these medications through friends and relatives.
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Affiliation(s)
- Joel D. Hudgins
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - John J. Porter
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Michael C. Monuteaux
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Florence T. Bourgeois
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Pediatric Therapeutics and Regulatory Science Initiative, Computational Health Informatics Program, Boston Children’s Hospital, Boston, Massachusetts, United States of America
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Patel A, Levi JR, Brook CD. Should Excess Topical Decongestant Use Raise a Red Flag? Rhinitis Medicamentosa and Opioid Use Disorder. Ann Otol Rhinol Laryngol 2019; 129:164-169. [PMID: 31581795 DOI: 10.1177/0003489419880576] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The objective of this study was to determine whether patients with rhinitis medicamentosa (RM) have an increased odds of having an opioid use disorder (OUD) and which characteristics may predict this association. METHODS The authors conducted a retrospective case control study of patients 18 years and older who presented to the otolaryngology clinic at an academic medical center from January 2013 through December 2017. Cases, defined as patients who presented with excessive decongestant nasal spray usage based on history, were matched to control patients who presented with chronic rhinitis and did not report regular nasal decongestant usage. The charts were reviewed for patients that carried a problem of opioid abuse, identified using ICD-9 codes 304.XX or ICD-10 codes F11.XX. The primary outcome of this study was the odds of having an OUD. Secondary outcomes were assessed by summary statistics. RESULTS One hundred and thirty-one cases of RM were matched to 1871 controls of chronic rhinitis. Seven cases (5.3%) and 24 (1.3%) controls had a diagnosis of OUD, consistent with an odds ratio of 3.98 for opioid abuse in patients with RM (95% CI: 1.47-9.71). Oxymetazoline was used by 85.5% (n = 112) of patients with RM. Thirty-six patients (27.1%) with RM underwent nasal surgery following a diagnosis of RM, of which twenty patients (55.6%) were prescribed opioids following the procedure. CONCLUSIONS RM is associated with increased odds of having an OUD.
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Affiliation(s)
- Aneesh Patel
- Boston University School of Medicine, Boston, MA, USA
| | - Jessica R Levi
- Boston University School of Medicine, Boston, MA, USA.,Department of Otolaryngology, Boston University Medical Center, Boston, MA, USA
| | - Christopher D Brook
- Boston University School of Medicine, Boston, MA, USA.,Department of Otolaryngology, Boston University Medical Center, Boston, MA, USA
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Prescription Opioid Misuse Associated With Risk Behaviors Among Adolescents. Am J Prev Med 2019; 57:533-539. [PMID: 31443955 DOI: 10.1016/j.amepre.2019.05.017] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 05/29/2019] [Accepted: 05/30/2019] [Indexed: 12/28/2022]
Abstract
INTRODUCTION With the ongoing opioid overdose epidemic in the U.S., it is important to explore how prescription opioid misuse correlates with health behaviors that increase the risk for adverse health outcomes among adolescents. The objective of this study is to determine if lifetime nonmedical use of prescription opioids is associated with health risk behaviors among adolescents. METHODS Data from the 2017 nationally representative Youth Risk Behavior Survey (14,765 high school students in Grades 9-12) were used to explore associations between lifetime nonmedical use of prescription opioids and 29 health risk behaviors. Logistic regression models (adjusted for sex, race/ethnicity, grade, and sexual identity) estimated adjusted prevalence ratios and 95% CIs. Analyses were completed in 2018. RESULTS Nonmedical use of prescription opioids was associated with all but 1 of the health risk behaviors included in the analyses. Substance use ranged from adjusted prevalence ratio=2.46 (current alcohol use) to adjusted prevalence ratio=17.52 (heroin use); violence victimization from adjusted prevalence ratio=1.80 (bullied at school) to adjusted prevalence ratio=3.12 (threatened or injured with a weapon); suicidal thoughts/behaviors from adjusted prevalence ratio=2.23 (considered suicide) to adjusted prevalence ratio=3.45 (attempted suicide); and sexual behavior from adjusted prevalence ratio=1.06 (did not use a dual pregnancy prevention method) to adjusted prevalence ratio=3.42 (4 or more sexual partners). Poor academic performance (adjusted prevalence ratio=1.53), receiving an HIV test (adjusted prevalence ratio=1.77), and having persistent feelings of sadness/hopelessness (adjusted prevalence ratio=1.80) were also associated with nonmedical use of prescription opioids. CONCLUSIONS Nonmedical use of prescription opioids is associated with many health risk behaviors. Opportunities to reduce nonmedical use of prescription opioids include screening pediatric patients for opioid use disorder, improved prescribing practices, and, from a primary prevention perspective, integrated evidence-based health education programs in schools.
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Editorial: Prescription for Addiction. J Am Acad Child Adolesc Psychiatry 2019; 58:659-660. [PMID: 31002865 DOI: 10.1016/j.jaac.2019.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 03/20/2019] [Indexed: 11/21/2022]
Abstract
In the most recent 2016 National Survey on Drug Use and Health (NSDUH),1 more than 1.3 million adolescents aged 12 to 17 years reported past-year nonmedical use of prescription drugs. About 70% started using in the past year, and about half report nonmedical use of prescription opioid medications. Misuse of prescription opioid medication is associated with 19 times greater risk of transitioning to heroin compared to no misuse.2 Although the national opioid crisis affects all age groups, the steepest rise in unintentional opioid overdose fatalities has been in young adults aged 18 to 25 years.2,3 More than 80% of young adult injection heroin users report that they started using prescription opioids, most during adolescence, before transitioning to heroin.3 While it is clear that the seeds of opioid addiction often begin during adolescence, there are many gaps in our knowledge and understanding of sources and predictive risk factors to guide development of more effective and targeted youth interventions.
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Orhurhu V, Olusunmade M, Urits I, Viswanath O, Peck J, Orhurhu MS, Adekoya P, Hirji S, Sampson J, Simopoulos T, Jatinder G. Trends of Opioid Use Disorder Among Hospitalized Patients With Chronic Pain. Pain Pract 2019; 19:656-663. [PMID: 31077526 DOI: 10.1111/papr.12789] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 04/15/2019] [Accepted: 04/24/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Patients with chronic pain treated with opioids are at an increased risk for opioid misuse or opioid use disorder (OUD). Recent years have seen a stark increase in abuse, misuse, and diversion of prescription opioid medications. The aim of this study was to investigate trends in changing rates of opioid use disorder among patients with chronic pain. METHODS The National Inpatient Sample (NIS) database identified chronic pain admissions with OUD from 2011 to 2015. Patients were identified from the NIS database using International Classification of Diseases (9th and 10th revisions) diagnosis codes for chronic pain and OUD. Annual estimates and trends were determined for OUD, patient characteristics, OUD among subgroups of chronic pain conditions, and discharge diagnosis. RESULTS We identified 10.3 million patients with chronic pain. Of these, 680,631 patients were diagnosed with OUD. The number of patients with OUD increased from 109,222 in 2011 to 172,680 in 2015 (P < 0.001). Similarly, there were upward trends of OUD among females (53.2% to 54.5%; P = 0.09), patients 65 to 84 years of age (11.8% to 17%; P < 0.001), Medicare-insured patients (39.5% to 46.0%; P < 0.01), patients with low annual household incomes (27.8% to 33.3%; P < 0.001), and patients with cannabinoid use disorder (7.2% to 8.3%; P = 0.01). The prevalence of OUD increased from 2011 to 2015 in patients with chronic regional pain syndrome (5.53% to 7.46%; P = 0.01) and spondylosis (1.32% to 1.81%; P < 0.001). CONCLUSIONS These findings suggest that the prevalence of OUD increased substantially from 2011 to 2015. Disparities of OUD with increasing opioid use among vulnerable populations including women, those with Medicare insurance, tobacco use disorder, and low annual income should be explored further.
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Affiliation(s)
- Vwaire Orhurhu
- Department of Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Mayowa Olusunmade
- Department of Psychiatry, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Ivan Urits
- Department of Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Omar Viswanath
- Valley Anesthesiology and Pain Consultants, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, U.S.A.,Creighton University School of Medicine, Omaha, Nebraska, U.S.A
| | - Jacquelin Peck
- Department of Anesthesiology, Mt. Sinai Medical Center of Florida, Miami Beach, Florida, U.S.A
| | - Mariam Salisu Orhurhu
- Departments of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
| | - Peju Adekoya
- Pain Division, Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Sameer Hirji
- Departments of Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, U.S.A
| | - John Sampson
- Departments of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
| | - Thomas Simopoulos
- Department of Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Gill Jatinder
- Department of Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
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Kaski SW, Brooks S, Wen S, Haut MW, Siderovski DP, Berry JH, Lander LR, Setola V. Four single nucleotide polymorphisms in genes involved in neuronal signaling are associated with Opioid Use Disorder in West Virginia. J Opioid Manag 2019; 15:103-109. [PMID: 31057342 DOI: 10.5055/jom.2019.0491] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objective Pilot study to assess utility in opioid use disorder (OUD) of a panel of single nucleotide polymorphisms in genes previously related to substance use disorder (SUD) and/or phenotypes that predispose individuals to OUD/SUD. Design Genetic association study. Setting West Virginia University's Chestnut Ridge Center Comprehensive Opioid Abuse Treatment (COAT) clinic for individuals diagnosed with OUD. Patients Sixty patients 18 years of age or older with OUD undergoing medication (buprenorphine/naloxone)-assisted treatment (MAT); all sixty patients recruited contributed samples for genetic analysis. Outcome Measures Minor allele frequencies for single nucleotide polymorphisms. Results Four of the fourteen single nucleotide polymorphisms examined were present at frequencies that are statistically significantly different than in a demographically-matched general population. Conclusions For the purposes of testing WV individuals via genetic means for predisposition to OUD, at least four single nucleotide polymorphisms in three genes are likely to have utility in predicting susceptibility. Additional studies with larger populations will need to be conducted to confirm these results before use in a clinical setting.
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Affiliation(s)
- Shane W Kaski
- Department of Physiology & Pharmacology, West Virginia University School of Medicine, Morgantown, WV
| | | | - Sijin Wen
- Department of Biostatistics, West Virginia University School of Public Health, Morgantown, WV
| | - Marc W Haut
- Department of Behavioral Medicine & Psychiatry, West Virginia University School of Medicine, Morgantown, WV
| | - David P Siderovski
- Department of Physiology & Pharmacology, West Virginia University School of Medicine, Morgantown, WV
| | - James H Berry
- Chestnut Ridge Center and Inpatient Acute Dual Diagnosis Program, West Virginia University School of Medicine, Morgantown, WV
| | - Laura R Lander
- West Virginia University School of Medicine, Morgantown, WV
| | - Vincent Setola
- Departments of Behavioral Medicine & Psychiatry, Neuroscience, and Physiology & Pharmacology, West Virginia University School of Medicine, Morgantown, WV
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Gicquelais RE, Foxman B, Coyle J, Eisenberg MC. Hepatitis C transmission in young people who inject drugs: Insights using a dynamic model informed by state public health surveillance. Epidemics 2019; 27:86-95. [PMID: 30930214 DOI: 10.1016/j.epidem.2019.02.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 12/18/2018] [Accepted: 02/18/2019] [Indexed: 12/12/2022] Open
Abstract
Increasing injection of heroin and prescription opioids have led to increases in the incidence of hepatitis C virus (HCV) infections in US young adults since the early 2000s. How best to interrupt transmission and decrease HCV prevalence in young people who inject drugs (PWID) is uncertain. We developed an age-stratified ordinary differential equation HCV transmission model of PWID aged 15-64, which we fit to Michigan HCV surveillance data among young PWID aged 15-29. We used Latin hypercube sampling to fit to data under 10,000 plausible model parameterizations. We used the best-fitting 10% of simulations to predict the potential impact of primary (reducing injection initiation), secondary (increasing cessation, reducing injection partners, or reducing injection drug use relapse), and tertiary (HCV treatment) interventions (over the period 2017-2030) on acute and chronic HCV cases by the year 2030. Treating 3 per 100 current and former PWID per year could reduce chronic HCV by 27.3% (range: 18.7-30.3%) and acute HCV by 23.6% (range: 6.7-29.5%) by 2030 among PWID aged 15-29 if 90% are cured (i.e. achieved sustained virologic response [SVR] to treatment). Reducing the number of syringe sharing partners per year by 10% was predicted to reduce chronic HCV by 15.7% (range: 9.4-23.8%) and acute cases by 21.4% (range: 14.2-32.3%) among PWID aged 15-29 by 2030. In simulations of combinations of interventions, reducing injection initiation, syringe sharing, and relapse rates each by 10% while increasing cessation rates by 10% predicted a 27.7% (range: 18.0-39.7%) reduction in chronic HCV and a 38.4% (range: 28.3-53.3%) reduction in acute HCV. Our results highlight the need for HCV treatment among both current and former PWID and the scale up of both primary and secondary interventions to concurrently reduce HCV prevalence and incidence in Michigan.
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Affiliation(s)
- Rachel E Gicquelais
- University of Michigan School of Public Health, Department of Epidemiology, 1415 Washington Heights, Ann Arbor, MI 48109, United States; Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, 615 N. Wolfe St, Baltimore, MD 21205, United States.
| | - Betsy Foxman
- University of Michigan School of Public Health, Department of Epidemiology, 1415 Washington Heights, Ann Arbor, MI 48109, United States.
| | - Joseph Coyle
- Michigan Department of Health and Human Services, 320 S Walnut St, Lansing, MI 48933, United States.
| | - Marisa C Eisenberg
- University of Michigan School of Public Health, Department of Epidemiology, 1415 Washington Heights, Ann Arbor, MI 48109, United States.
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Schifano F, Chiappini S, Corkery JM, Guirguis A. Assessing the 2004-2018 Fentanyl Misusing Issues Reported to an International Range of Adverse Reporting Systems. Front Pharmacol 2019; 10:46. [PMID: 30774595 PMCID: PMC6367955 DOI: 10.3389/fphar.2019.00046] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 01/14/2019] [Indexed: 01/15/2023] Open
Abstract
Objective: A recent, global, increase in the use of opioids including the prescribing, highly potent, fentanyl has been recorded. Due its current popularity and the potential lethal consequences of its intake, we aimed here at analyzing the fentanyl misuse, abuse, dependence and withdrawal-related adverse drug reactions (ADRs) identified within the European Medicines Agency (EMA), the United Kingdom Yellow Card Scheme (YCS), and the United States Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) databases. Methods: Descriptive analysis of both ADRs and related cases. Results: The analysis of fentanyl-related misuse, abuse, dependence and withdrawal cases reported during years 2004-2018 to the EMA, the YCS, and the FAERS showed increasing levels overtime, specifically, EMA-related data presented two peaks (e.g., in 2008 and 2015), whilst the FAERS dataset was characterized by a dramatic increase of the ADRs collected over the last 18 months, and particularly from 2016. Some 127,313 ADRs (referring to n = 6,161 patients/single cases) related to fentanyl's misuse/abuse/dependence/withdrawal issues were reported to EMA, with 14,287 being judged by the reporter as "suspect." The most represented ADRs were: "drug dependence "(76.87%), "intentional product misuse" (13.06%), and "drug abuse" (7.45%). Most cases involved adult males and the concomitant use of other prescribing/illicit drugs. A range of idiosyncratic (i.e., ingestion/injection of transdermal patches' fentanyl) and very high-dosage intake cases were here identified. Significant numbers of cases required either a prolonged hospitalization (192/559 = 34.35%) or resulted in death (185/559 = 33.09%). Within the same time frame, YCS collected some 3,566 misuse/abuse/dependence/withdrawal ADRs, corresponding to 1,165 single patients/cases, with those most frequently reported being "withdrawal," "intentional product misuse," and "overdose" ADRs. Finally, FAERS identified a total of 19,145 misuse/abuse/dependence/withdrawal-related cases, being "overdose," withdrawal, and "drug use disorder/drug abuse/drug diversion" the most represented ADRs (respectively, 43.11, 20.80, and 20.29%). Conclusion: Fentanyl abuse may be considered a public health issue with significant implications for clinical practice. Spontaneous pharmacovigilance reporting systems should be considered for mapping new trends of drug abuse.
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Affiliation(s)
| | - Stefania Chiappini
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
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Wojciechowski TW. Developmental Trajectories of Opioid Use Among Juvenile Offenders: An Epidemiological Examination of Group Characteristics and Criminological Risk Factors. Subst Use Misuse 2019; 54:1203-1213. [PMID: 30767596 DOI: 10.1080/10826084.2019.1573837] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIMS Investigate patterns of change and continuity in opioid use among juvenile offenders during adolescence and early adulthood. Identify demographic characteristics of trajectory groups of opioid users. Examine the relevance of risk factors for predicting assignment to opioid use trajectory groups. METHODS The Pathways to Desistance sample, consisting of longitudinal data of 1,134 juvenile offenders, was utilized in analyses. Using group-based trajectory modeling, patterns of opioid use were identified. χ2 tests provide information about the significant differences in gender, race, and socioeconomic status composition among the subgroups. Multinomial logistic regression were estimated to identify the relevance of risk factors for predicting assignment to subgroups. RESULTS A four-group model best fit the opioid use data (Abstaining, Low Accelerating, High Accelerating, Desisting). Race significantly delineated group membership at the bivariate level. Risk factor analysis indicated that lower self-control assessed at baseline predicted elevated risk of assignment to the Low Accelerating and High Accelerating groups. Higher frequency of marijuana use at baseline and a lifetime history of having experienced victimization was associated with assignment to the Desisting group. CONCLUSIONS Chronic opioid use exists at elevated prevalence among juvenile offenders. Adolescents in the criminal justice system with low self-control should be targeted for intervention.
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Affiliation(s)
- Thomas W Wojciechowski
- a Department of Sociology and Criminology & Law and Society , University of Florida , Gainesville , FL , USA
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Voepel-Lewis T, Boyd CJ, McCabe SE, Zikmund-Fisher BJ, Malviya S, Grant J, Weber M, Tait AR. Deliberative Prescription Opioid Misuse Among Adolescents andEmerging Adults: Opportunities for Targeted Interventions. J Adolesc Health 2018; 63:594-600. [PMID: 30348282 PMCID: PMC6658888 DOI: 10.1016/j.jadohealth.2018.07.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 06/20/2018] [Accepted: 07/13/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND One in five adolescents and emerging adults have reported prescription opioid misuse (POM), posing significant risks for opioid-related adverse outcomes. Devising prevention strategies requires a better understanding of the decisional factors underlying risky misuse behavior. This research examined the associations between past opioid use behavior, opioid risk knowledge and perceptions, and intentional POM decisions. METHODS Participants aged 15-23years completed surveys assessing past prescription opioid use and misuse, opioid risk knowledge, opioid risk perceptions, and pain relief preferences (i.e., analgesic benefit vs. risk aversion preference). The outcome, Willingness to Misuse (i.e., intentional decisions to use a prescription opioid in a non-compliant manner) was measured using hypothetical pain decision scenarios. RESULTS Surveys were completed by 972 adolescents and young adults. In total, 44% had taken a prescription opioid and 32% of these reported past POM. Willingness to Misuse was significantly associated with lower opioid misuse risk perceptions (β = .75 [95% CI .66-.86]) and past opioid misuse (β = 1.81 [95% CI 1.13-2.91]) but not simple risk knowledge (β = .81 [95% CI .58-1.11]. The probability of future misuse was highest for those who reported past opioid misuse and had low risk perceptions (58.7% [95% CI 51.3-65.8]) and high pain relief preferences (53.4% [95% CI 45.3%-61.3%]). CONCLUSIONS Findings suggest that simple knowledge of prescription opioid risks is insufficient to curtail misuse among adolescents and emerging adults. Rather, it may be important to heighten opioid risk perceptions and strengthen opioid risk aversion values when prescribing opioid analgesics to better prevent future misuse in this high risk population.
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Affiliation(s)
- Terri Voepel-Lewis
- Department of Anesthesiology, Children's and Women's Hospital, University of Michigan, Ann Arbor, Michigan.
| | - Carol J Boyd
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan
| | - Sean E McCabe
- Institute for Research on Women and Gender, University of Michigan, Ann Arbor, Michigan
| | - Brian J Zikmund-Fisher
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Shobha Malviya
- Department of Anesthesiology, Children's and Women's Hospital, University of Michigan, Ann Arbor, Michigan
| | - John Grant
- Departments of Orthopaedic Surgery and Sports Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Monica Weber
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan
| | - Alan R Tait
- Department of Anesthesiology, Children's and Women's Hospital, University of Michigan, Ann Arbor, Michigan
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Addington EL, Cheung EO, Moskowitz JT. Positive affect skills may improve pain management in people with HIV. J Health Psychol 2018; 25:1784-1795. [PMID: 29649914 DOI: 10.1177/1359105318769355] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Non-opioid pain management strategies are critically needed for people with HIV. We therefore conducted a secondary analysis of pain-related outcomes in a randomized controlled trial of a positive affect skills intervention for adults newly diagnosed with HIV (N = 159). Results suggest that, even if pain prevalence rises, positive affect skills may reduce pain interference and prevent increased use of opioid analgesics by people living with HIV. Future research should replicate and extend these findings by conducting trials that are specifically designed to target pain outcomes.
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Grebely J, Bruneau J, Bruggmann P, Harris M, Hickman M, Rhodes T, Treloar C. Elimination of hepatitis C virus infection among PWID: The beginning of a new era of interferon-free DAA therapy. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 47:26-33. [DOI: 10.1016/j.drugpo.2017.08.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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