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Mannes ZL, Hasin DS, Abdallah AB, Cottler LB. Co-Use of Opioids and Sedatives Among Retired National Football League Athletes. Clin J Sport Med 2022; 32:322-328. [PMID: 35470340 PMCID: PMC9043466 DOI: 10.1097/jsm.0000000000001007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 11/01/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Among the general population, co-use of opioids and sedatives is associated with greater risk of overdose compared with opioid use alone. National Football League (NFL) retirees experience higher rates of opioid use than the general population, although little is known about their co-use with sedatives. The aim of this study was to examine the prevalence and risk factors of opioid and sedative co-use among NFL retirees. DESIGN Retrospective cohort study. SETTING Professional American football. PARTICIPANTS NFL retirees (N = 644). INDEPENDENT VARIABLES Self-reported concussions, pain intensity, heavy alcohol use, physical and mental health impairment, disability status. MAIN OUTCOME MEASURE Any past 30-day co-use of opioids and sedatives. RESULTS Approximately 4.9% of the sample reported past 30-day co-use of opioids and sedatives, although nearly 30% of retirees using opioids also used sedatives. Greater pain was associated with co-use of opioids and sedatives (adjusted odds ratios [aOR] = 1.58; 95% confidence interval [CI] = 1.23-1.98), although retirees with moderate/severe mental health impairment (vs none/mild; aOR = 2.47; 95% CI = 1.04-5.91) and disability (vs no disability; aOR = 1.35; 95% CI = 1.05-1.73) demonstrated greater odds of co-use compared with retirees not using either substance. CONCLUSIONS Given the high rate of sedative use among participants also using opioids, NFL retirees may be susceptible to the negative health consequences associated with co-use. Interventions focused on improving pain and mental health may be especially effective for reducing co-use of these substances among NFL retirees.
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Affiliation(s)
- Zachary L. Mannes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Deborah S. Hasin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Arbi Ben Abdallah
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO 63108, USA
| | - Linda B. Cottler
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL, USA
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Yarborough BJH, Stumbo SP, Stoneburner A, Smith N, Dobscha SK, Deyo RA, Morasco BJ. Correlates of Benzodiazepine Use and Adverse Outcomes Among Patients with Chronic Pain Prescribed Long-term Opioid Therapy. PAIN MEDICINE 2020; 20:1148-1155. [PMID: 30204893 DOI: 10.1093/pm/pny179] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To examine the correlates and odds of receiving overlapping benzodiazepine and opioid prescriptions and whether co-prescription was associated with greater odds of falling or visiting the emergency department. DESIGN Cross-sectional study. SETTING A large private integrated health system and a Veterans Health Administration integrated health system. SUBJECTS Five hundred seventeen adults with musculoskeletal pain and current prescriptions for long-term opioid therapy. METHODS A multivariate logistic regression model examined correlates of having overlapping benzodiazepine and opioid prescriptions in the year before enrollment in the cross-sectional study. Negative binomial models analyzed the number of falls in the past three months and past-year emergency department visits. In addition to propensity score adjustment, models controlled for demographic characteristics, psychiatric diagnoses, medications, overall comorbidity score, and opioid morphine equivalent dose. RESULTS Twenty-five percent (N = 127) of participants had co-occurring benzodiazepine and opioid prescriptions in the prior year. Odds of receiving a benzodiazepine prescription were significantly higher among patients with the following psychiatric diagnoses: anxiety disorder (adjusted odds ratio [AOR] = 4.71, 95% confidence interval [CI] = 2.67-8.32, P < 0.001), post-traumatic stress disorder (AOR = 2.24, 95% CI = 1.14-4.38, P = 0.019), and bipolar disorder (AOR = 3.82, 95% CI = 1.49-9.81, P = 0.005). Past-year overlapping benzodiazepine and opioid prescriptions were associated with adverse outcomes, including a greater number of falls (risk ratio [RR] = 3.27, 95% CI = 1.77-6.02, P = 0.001) and emergency department visits (RR = 1.66, 95% CI = 1.08-2.53, P = 0.0194). CONCLUSIONS Among patients with chronic pain prescribed long-term opioid therapy, one-quarter of patients had co-occurring prescriptions for benzodiazepines, and dual use was associated with increased odds of falls and emergency department visits.
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Affiliation(s)
| | - Scott P Stumbo
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
| | - Ashley Stoneburner
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
| | - Ning Smith
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
| | - Steven K Dobscha
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon.,Department of Psychiatry, Oregon Health & Science University, Portland, Oregon
| | - Richard A Deyo
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon.,Departments of Family Medicine, Internal Medicine, and the Oregon Institute for Occupational Health Sciences, Oregon Health & Science University, Portland, Oregon, USA
| | - Benjamin J Morasco
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon.,Department of Psychiatry, Oregon Health & Science University, Portland, Oregon
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Li Y, Delcher C, Wei YJJ, Reisfield GM, Brown JD, Tighe P, Winterstein AG. Risk of Opioid Overdose Associated With Concomitant Use of Opioids and Skeletal Muscle Relaxants: A Population-Based Cohort Study. Clin Pharmacol Ther 2020; 108:81-89. [PMID: 32022906 DOI: 10.1002/cpt.1807] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 01/28/2020] [Indexed: 12/20/2022]
Abstract
The recent opioid prescribing guideline cautions about the concomitant prescribing of opioids and skeletal muscle relaxants (SMRs) given the additive central nervous system depressant effect. However, the clinical relevance remains unclear. In this retrospective cohort study, we compared the risk of opioid overdose associated with concomitant use of opioids and SMRs vs. opioid use alone. Adjusted hazard ratios were 1.09 (95% confidence interval (CI), 0.74-1.62) and 1.26 (95% CI, 1.00-1.58) in the incident and prevalent opioid user cohorts, respectively, generating a combined estimate of 1.21 (95% CI, 1.00-1.48). This risk seemed to increase with treatment duration (≤ 14 days: 0.91 and 95% CI, 0.67-1.22; 15-60 days: 1.37 and 95% CI, 0.81-2.37; >60 days: 1.80 and 95% CI, 1.30-2.48) and for baclofen (1.83 and 95% CI, 1.11-3.04) and carisoprodol (1.84 and 95% CI, 1.34-2.54). Concomitant users with daily opioid dose ≥50 mg (1.50 and 95% CI, 1.18-1.92) and benzodiazepine use (1.39 and 95% CI, 1.08-1.79) also had elevated risk. Clinicians should be cautious about these potentially unsafe practices to optimize pain care and improve patient safety.
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Affiliation(s)
- Yan Li
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Chris Delcher
- Institute for Pharmaceutical Outcomes & Policy, Department of Pharmacy Practice & Science, College of Pharmacy, University of Kentucky, Lexington, Kentucky, USA
| | - Yu-Jung Jenny Wei
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA.,Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Gary M Reisfield
- Department of Psychiatry, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Joshua D Brown
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA.,Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Patrick Tighe
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA.,Department of Anesthesiology, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Almut G Winterstein
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA.,Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA.,Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, Florida, USA
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Musich S, Wang SS, Slindee LB, Ruiz J, Yeh CS. Concurrent Use of Opioids with Other Central Nervous System-Active Medications Among Older Adults. Popul Health Manag 2019; 23:286-296. [PMID: 31765280 PMCID: PMC7406999 DOI: 10.1089/pop.2019.0128] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The primary objective was to determine the prevalence and characteristics of older adults concurrently using opioids and other central nervous system (CNS)-active medications, and the specialties of providers who ordered the medications. A secondary objective was to document medication-related adverse effects associated with such concurrent drug use. Study populations were identified as older adults aged ≥65 years with 1 year continuous medical and drug plan enrollment during 2017 and opioid use of ≥2 prescriptions for ≥15 days' supply. CNS-active medications included benzodiazepines, non-benzodiazepine hypnotics, muscle relaxants, antipsychotics, and gabapentinoids. Provider specialties were identified from the National Provider Identification database. Characteristics associated with opioids only, opioids plus 1, and opioids plus ≥2 additional CNS-active medications were determined using multinomial logistic regression. Outcome measures during 2017 included injurious falls/fractures and ≥3 emergency room (ER) visits. Among eligible insureds (N = 209,947), 57% used opioids only, 28% used opioids plus 1 additional CNS medication, and 15% used ≥2 additional medications. About 60% of opioids and other concurrent CNS medications were prescribed by the same provider, generally a primary care provider. Benzodiazepines and gabapentinoids were most often used concurrently with opioids. Health status, insomnia, anxiety, depression, and low back pain had the strongest associations with concurrent medication use. Overall, concurrent use with ≥2 CNS medications increased the likelihood of injurious falls/fractures or ≥3 ER visits in this population by about 18% and 21%, respectively. Both patients and providers may benefit from an awareness of adverse outcomes associated with concurrent opioid and other CNS-active medication use.
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Affiliation(s)
- Shirley Musich
- Research for Aging Populations, Optum, Ann Arbor, Michigan, USA
| | - Shaohung S Wang
- Research for Aging Populations, Optum, Ann Arbor, Michigan, USA
| | - Luke B Slindee
- Informatics & Data Science, Optum, Minneapolis, Minnesota, USA
| | - Joann Ruiz
- Medicare & Retirement, UnitedHealthcare, Minneapolis, Minnesota, USA
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Musich S, Wang SS, Slindee L, Kraemer S, Yeh CS. The association of pain locus of control with pain outcomes among older adults. Geriatr Nurs 2019; 41:521-529. [PMID: 31078323 DOI: 10.1016/j.gerinurse.2019.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 04/24/2019] [Accepted: 04/26/2019] [Indexed: 11/30/2022]
Abstract
Our primary objective was to 1) determine the prevalence of pain locus of control (LOC) subscales in a population of older adults with pain conditions, and 2) estimate their associated protective effects on pain outcomes. A mailed survey was sent to a stratified sample of older adults age≥65 with diagnosed back pain, osteoarthritis and/or rheumatoid arthritis. Multivariate logistic regression modeling was used to determine the relative protective associations of positive resources, including LOC, resilience and social networks, on pain outcomes. Among respondents (N = 3,824), 31% were identified as internal; 34% as powerful others; and 35% as chance. In adjusted models, internal was associated with outcomes of lower pain severity, reduced chronic opioid use and increased physical functionality. Powerful others was partially protective; chance was associated with the poorest outcomes. Multidimensional pain programs should incorporate the enhancement of positive resources, including LOC, to maximize the effectiveness of pain management strategies.
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Affiliation(s)
- Shirley Musich
- Research for Aging Populations, Optum, 315 E. Eisenhower Parkway, Suite 305, Ann Arbor, MI 48108, United States.
| | - Shaohung S Wang
- Research for Aging Populations, Optum, 315 E. Eisenhower Parkway, Suite 305, Ann Arbor, MI 48108, United States.
| | - Luke Slindee
- Informatics & Data Science, Optum, 12700 Whitewater Drive, Minnetonka, MN 55343, United States.
| | - Sandra Kraemer
- Medicare & Retirement, UnitedHealthcare Alliances, PO Box 9472, Minneapolis, MN 55440, United States.
| | - Charlotte S Yeh
- AARP Services, Inc., 601 E. Street, N.W., Washington, DC 20049, United States.
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Mosher HJ, Hofmeyer BA, Hadlandsmyth K, Richardson KK, Lund BC. Predictors of Long-Term Opioid Use After Opioid Initiation at Discharge From Medical and Surgical Hospitalizations. J Hosp Med 2018; 13:243-248. [PMID: 29624187 DOI: 10.12788/jhm.2930] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Opioid analgesics may be initiated following surgical and medical hospitalization or in ambulatory settings; rates of subsequent long-term opioid (LTO) use have not been directly compared. This retrospective cohort study of the Veterans Health Administration (VHA) included all patients receiving a new outpatient opioid prescription from a VHA provider in fiscal year 2011. If a new outpatient prescription was filled within 2 days following hospital discharge, the initiation was considered a discharge prescription. LTO use was defined as an episode of continuous opioid supply lasting a minimum of 90 days and beginning within 30 days of the initial prescription. We performed bivariate and multivariate analyses to identify the factors associated with LTO use following surgical and medical discharges. Following incident prescription, 5.3% of discharged surgical patients, 15.2% of discharged medical patients, and 19.3% of outpatient opioid initiators received opioids long term. Medical and surgical patients differed; surgical patients were more likely to receive shorter prescription durations. Predictors of LTO use were similar in medical and surgical patients; the most robust predictor in both groups was the number of days' supply of the initial prescription (odds ratio [OR] = 1.24 and 95% confidence interval [CI], 1.12-1.37 for 8-14 days; OR = 1.56 and 95% CI, 1.39-1.76 for 15-29 days; and OR = 2.59 and 95% CI, 2.35-2.86 for >30 days) compared with the reference group receiving =7days. Rates of subsequent LTO use are higher among discharged medical patients than among surgical patients. Characteristics of opioid prescribing within the initial 30 days, including initial dose and days prescribed, were strongly associated with LTO use.
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Affiliation(s)
- Hilary J Mosher
- Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA.
- Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Brooke A Hofmeyer
- Iowa City Veterans Affairs Quality Scholars Fellowship Program, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA
| | - Katherine Hadlandsmyth
- Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA
- Department of Anesthesia, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Kelly K Richardson
- Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA
| | - Brian C Lund
- Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, USA
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