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Rey RT, Pezalla AE. Parents, Pain, and Over-the-Counter Medicine: Athletes' Perceived Alternatives to Prescription Opioid Misuse. Healthcare (Basel) 2023; 11:2671. [PMID: 37830708 PMCID: PMC10572744 DOI: 10.3390/healthcare11192671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/27/2023] [Accepted: 09/29/2023] [Indexed: 10/14/2023] Open
Abstract
Youth athletes are often prescribed opioids after sustaining sport-related injuries, and because of their age, warrior-like culture in sport, and the desire to perform at the highest level, they are at risk for opioid misuse. Due to the nature of sport, youth athletes are at a greater risk to misuse opioids, and although it does not always predict misuse in adults, it is almost always a precursor among those addicted to opioids in adulthood. This crisis has been classified by the National Center for Health Statistics at the Centers for Disease Control and Prevention as an epidemic, resulting in over a hundred deaths a day and has cost over a billion dollars. To better understand athletes' experiences and use of opioids, the current study uses in-depth, semi-structured interviews with 35 current athletes and highlights their lived experiences with opioid use. Qualitative, line-by-line coding revealed three main themes: the protective role of parents, the teaching potential of athletes' own pain, and the easy access to over-the-counter medication and supplements that allow athletes to address their pain or enhance their performance. The results highlight that youth athletes may not misuse opioids to the extent previously predicted by past research and provide insight into the opioid epidemic from a youth sporting perspective.
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Affiliation(s)
- Rikishi T. Rey
- Department of Communication, Clemson University, Clemson, SC 29634, USA
| | - Anne E. Pezalla
- Department of Psychology, Macalester College, St Paul, MN 55105, USA;
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The Opioid Epidemic in America: Pandemic Impacts. J Am Acad Orthop Surg 2022; 30:e1302-e1310. [PMID: 35944546 DOI: 10.5435/jaaos-d-21-01158] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 05/25/2022] [Indexed: 02/01/2023] Open
Abstract
There is still an ongoing epidemic of opioid abuse in the United States. It has resulted in a major healthcare crisis and led to an alarming number of daily overdose deaths. Strong interventions from the medical community and the government had made progress toward control. Tragically, the COVID-19 pandemic made the death rate dramatically worse. The purpose of this article is to reexamine the origins of this situation and provide updates from the pandemic period. The authors review the medical-legal risks physicians face when prescribing pain-relieving medications for their orthopaedic patients. Methods for providing responsible pain management plans for patients are suggested.
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Hedges EA, Livingston MH, Esce A, Browne M, Moriarty KP, Raval MV, Rothstein DH, Wakeman D. Post-Procedural Opioid Prescribing in Children: A Survey of the American Academy of Pediatrics. J Surg Res 2021; 269:1-10. [PMID: 34507081 DOI: 10.1016/j.jss.2021.07.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 07/08/2021] [Accepted: 07/20/2021] [Indexed: 01/07/2023]
Abstract
INTRODUCTION North America is in the midst of an opioid epidemic. The role of pediatric surgeons and other procedural specialists in this public health crisis remains unclear. There is likely considerable variation in the use of opioid and non-opioid analgesics, but the spectrum of practice is still uncertain. METHODS We performed an online survey in July 2018 of the 2086 pediatric surgeons and proceduralists who were active members in the American Academy of Pediatrics. The survey inquired about practice environment, use of opioid and non-opioid pain medications, and attitudes towards the opioid epidemic. RESULTS 178 specialists completed the survey for a response rate of 8.5%. Most respondents utilize oral acetaminophen (86%) and ibuprofen (80%) after procedures >75% of the time. Self-reported opioid prescribing increases with age after both outpatient and inpatient procedures (P < 0.001). Pediatric general surgeons prescribe opioids less frequently than other specialists, particularly after inpatient procedures. The majority of respondents (81%) believe that the opioid epidemic is a major problem but only 31% indicated that they have a major role to play. CONCLUSIONS There is significant variation in opioid prescribing patterns as reported by pediatric surgeons and proceduralists. Guidelines are needed to standardize the use of non-opioid analgesics and decrease reliance on opioids for outpatient and inpatient procedures.
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Affiliation(s)
- Elizabeth A Hedges
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
| | - Michael H Livingston
- Division of Pediatric Surgery, Department of Surgery, University of Rochester, Golisano Children's Hospital, Rochester, New York
| | - Antoinette Esce
- Division of Otolaryngology Head and Neck Surgery, Department of Surgery, University of New Mexico, Albuquerque, New Mexico
| | - Marybeth Browne
- Division of Pediatric Surgical Specialties, Department of Surgery, Lehigh Valley Reilly Children's Hospital, Lehigh Valley Health Network, Allentown, Pennsylvania
| | - Kevin P Moriarty
- Division of Pediatric Surgery, Baystate Children's Hospital, University of Massachusetts Medical School-Baystate, Springfield, Maryland
| | - Mehul V Raval
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - David H Rothstein
- Pediatric General and Thoracic Surgery, Seattle Children's Hospital; Department of Surgery, University of Washington, Seattle, Washington
| | - Derek Wakeman
- Division of Pediatric Surgery, Department of Surgery, University of Rochester, Golisano Children's Hospital, Rochester, New York
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Ball SJ, Simpson K, Zhang J, Marsden J, Heidari K, Moran WP, Mauldin PD, McCauley JL. High-Risk Opioid Prescribing Trends: Prescription Drug Monitoring Program Data From 2010 to 2018. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2021; 27:379-384. [PMID: 32956292 PMCID: PMC7940459 DOI: 10.1097/phh.0000000000001203] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Deaths due to opioids have continued to increase in South Carolina, with 816 opioid-involved overdose deaths reported in 2018, a 9% increase from the prior year. The objective of the current study is to examine longitudinal trends (quarter [Q] 1 2010 through Q4 2018) of opioid prescribing volume and high-risk opioid prescribing behaviors in South Carolina using comprehensive dispensing data available in the South Carolina Prescription Drug Monitoring Program (SC PDMP). DESIGN Retrospective analyses of SC PDMP data were performed using general linear models to assess quarterly time trends and change in rate of each outcome Q1 2010 through Q4 2018. PARTICIPANTS Opioid analgesic prescription fills from SC state residents between Q1 2010 and Q4 2018. MAIN OUTCOME MEASURES High-risk prescribing behaviors included (1) opioid prescribing rate; (2) percentage of patients receiving opioids dispensed 90 or more average morphine milligram equivalents daily; (3) percentage of opioid prescribed days with overlapping opioid and benzodiazepine prescriptions; (4) rate per 100 000 residents of multiple provider episodes; and (5) percentage of patients prescribed extended release opioids who were opioid naive. RESULTS A total of 33 027 461 opioid prescriptions were filled by SC state residents within the time period of Q1 2010 through Q4 2018. A 41% decrease in the quarterly prescribing rate of opioids occurred from Q1 2010 to Q4 2018. The decrease in overall opioid prescribing was mirrored by significant decreases in all 4 high-risk prescribing behaviors. CONCLUSION PDMPs may represent the most complete data regarding the dispensing of opioid prescriptions and as such be valuable tools to inform and monitor the supply of licit opioids. Our results indicate that public health policy, legislative action, and multiple clinical interventions aimed at reducing high rates of opioid prescribing across the health care ecosystem appear to be succeeding in the state of South Carolina.
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Affiliation(s)
- Sarah J. Ball
- Division of General Internal Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Kit Simpson
- Department of Health Administration and Policy, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Jingwen Zhang
- Division of General Internal Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Justin Marsden
- Division of General Internal Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | | | - William P. Moran
- Division of General Internal Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Patrick D. Mauldin
- Division of General Internal Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Jenna L. McCauley
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
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Marchetti Calônego MA, Sikandar S, Ferris FD, Moreira de Barros GA. Spread the Word: There Are Two Opioid Crises! Drugs 2021; 80:1147-1154. [PMID: 32533500 DOI: 10.1007/s40265-020-01342-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Pain is associated with emotional and physical suffering that severely impacts quality of life. Many guidelines for the treatment of moderate to severe cancer pain indicate the use of opioids. For a small proportion of the global population, opioids are readily accessible, but are consequently also subject to risk of overuse and misuse. On the other hand, many regions provide limited access to licensed opioid therapeutics and patients struggle for better pain management. The use of prescription opioids for treatment of severe cancer and acute pain is well established, but opioid use in chronic non-cancer pain is controversial and not supported by the literature. The opioid crisis and the increasing overdose fatalities in some countries have resulted in a resurgence of opiophobia in these countries, but even worse, amplified opiophobia in countries with lower opioid consumption. In this narrative review, we highlight how the opioid crisis of overuse in some countries can negatively impact appropriate access to opioids elsewhere. The availability of opioids for clinical and recreational use differs between countries worldwide-this is an important factor in determining the occurrence of a 'crisis of recreational use of opioids' or a 'crisis of under-prescription of opioids' for pain management.
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Affiliation(s)
| | - Shafaq Sikandar
- William Harvey Research Institute, Barts, The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Frank D Ferris
- Palliative Medicine, Research and Education, OhioHealth, Columbus, OH, USA
| | - Guilherme Antonio Moreira de Barros
- Anesthesiology Department, Medical School, Sao Paulo State University (UNESP), Av. Prof. Mario Rubens Guimaraes Montenegro, s/n, Botucatu, São Paulo, 18618687, Brazil.
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Sanger N, Bhatt M, Singhal N, Panesar B, D’Elia A, Trottier M, Shahid H, Hillmer A, Baptist-Mohseni N, Roczyki V, Soni D, Brush M, Lovell E, Sanger S, Samaan MC, de Souza RJ, Thabane L, Samaan Z. Treatment Outcomes in Patients With Opioid Use Disorder Who Were First Introduced to Opioids by Prescription: A Systematic Review and Meta-Analysis. Front Psychiatry 2020; 11:812. [PMID: 33005151 PMCID: PMC7485127 DOI: 10.3389/fpsyt.2020.00812] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 07/28/2020] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Prescription opioid misuse has led to a new cohort of opioid use disorder (OUD) patients who were introduced to opioids through a legitimate prescription. This change has caused a shift in the demographic profile of OUD patients from predominantly young men to middle age and older people. The management of OUD includes medication-assisted treatment (MAT), which produces varying rates of treatment response. In this study, we will examine whether the source of first opioid use has an effect on treatment outcomes in OUD. Using a systematic review of the literature, we will investigate the association between source of first opioid introduction and treatment outcomes defined as continuing illicit opioid use and poly-substance use while in MAT. METHODS Medline, EMBASE, CINHAL, and PsycInfo were searched from inception to December 31st, 2019 inclusive using a comprehensive search strategy. Five pairs of reviewers conducted screening and data extraction independently in duplicate. The review is conducted and reported according to the PRISMA guidelines. A random-effects model was used for meta analyses assuming heterogeneity among the included studies. RESULTS The initial search results in 27,345 articles that were screened, and five observational studies were included in the qualitative and quantitative analyses. Our results found that those who were introduced to opioids through a legitimate prescription were significantly less likely to have illicit opioid use (0.70, 95% CI 0.50, 0.99) while on MAT. They were also less likely to use cannabis (0.54, 95% CI 0.32, 0.89), alcohol (0.75, 95% CI 0.59, 0.95), cocaine (0.50, 95% CI 0.29, 0.85), and injection drug use (0.25, 95% CI 0.14, 0.43) than those introduced to opioids through recreational means. CONCLUSION This study shows that the first exposure to opioids, whether through a prescription or recreationally, influences prognosis and treatment outcomes of opioid use disorder. Although the increased pattern of prescribing opioids may have led to increased OUD in a new cohort of patients, these patients are less likely to continue to use illicit drugs and have a different prognostic and clinical profile that requires a tailored approach to treatment. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017058143.
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Affiliation(s)
- Nitika Sanger
- Medical Sciences Graduate Program, McMaster University, Hamilton, ON, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Meha Bhatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Nikhita Singhal
- Undergraduate MD Program, McMaster University, Hamilton, ON, Canada
| | - Balpreet Panesar
- Life Sciences Undergraduate Program, McMaster University, Hamilton, ON, Canada
- Department of Biology, McMaster University, Hamilton, ON, Canada
| | - Alessia D’Elia
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- McMaster Integrative Neuroscience Discovery & Study Program, McMaster University, Hamilton, ON, Canada
| | - Maegan Trottier
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada
| | - Hamnah Shahid
- Arts & Sciences, McMaster University, Hamilton, ON, Canada
| | - Alannah Hillmer
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada
| | - Natasha Baptist-Mohseni
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada
| | - Victoria Roczyki
- Department of Biology, McMaster University, Hamilton, ON, Canada
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada
| | - Divya Soni
- Health Sciences Undergraduate Program, McMaster University, Hamilton, ON, Canada
| | - Maurana Brush
- Undergraduate MD Program, McMaster University, Hamilton, ON, Canada
| | - Elizabeth Lovell
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Postgraduate Psychiatry Program, McMaster University, Hamilton, ON, Canada
| | - Stephanie Sanger
- Health Science Library, McMaster University, Hamilton, ON, Canada
| | - M. Constantine Samaan
- Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, ON, Canada
| | - Russell J. de Souza
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Biostatistics Unit, St Joseph’s Healthcare—Hamilton, Hamilton, ON, Canada
| | - Zainab Samaan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
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7
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McCauley JL, Nelson JD, Gilbert GH, Gordan V, Durand SH, Mungia R, Meyerowitz C, Leite RS, Fillingim RB, Brady KT. Prescription Drug Abuse Among Patients in Rural Dental Practices Reported by Members of the National Dental PBRN. J Rural Health 2019; 36:145-151. [PMID: 31385367 DOI: 10.1111/jrh.12386] [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] [Received: 01/25/2019] [Revised: 05/28/2019] [Accepted: 06/26/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE This study compared rural to nonrural dentists with respect to opioid prescribing practices, perceptions about prescription drug abuse among patients, and training relevant to pain management and addictions. METHODS A web-based, cross-sectional questionnaire was administered to practicing dentist members of the National Dental Practice-Based Research Network (PBRN; N = 822) and linked with network enrollment questionnaire data regarding practitioner demographics and practice characteristics. Pain management prescribing practices and perceptions regarding relevance and scope of addiction and drug diversion among patients were assessed. Rural practice was defined as a practice whose ZIP Code has more than 50% of its population in either a nonmetropolitan county and/or a rural Census tract. FINDINGS Rural dentists were significantly more likely than their nonrural counterparts to recommend nonsteroidal anti-inflammatory agents/acetaminophen in combination with prescribing an opioid [F (1,820) = 4.59, P = .03]. Compared to nonrural dentists, rural dentists were more likely to report that opioid abuse/diversion was a problem in their practices [χ2 [1, n = 807] = 6.85, P < .001], were more likely to have suspected a patient of abuse or diversion [χ2 [1, n = 807] = 10.12, P = .001], and were more likely to have refrained from prescribing due to suspicions of abuse or diversion [χ2 [1, n = 807] = 12.49, P < .001]. CONCLUSION Rural dentists may be disproportionately impacted by patients' opioid abuse and represent a viable target for educational outreach that encourages screening, identification, and referral of patients in need of drug abuse treatment.
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Affiliation(s)
- Jenna L McCauley
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Joni D Nelson
- Department of Stomatology, College of Dental Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Gregg H Gilbert
- Department of Clinical & Community Sciences, University of Alabama at Birmingham, Birmingham, Alabama
| | - Valeria Gordan
- Department of Restorative Dental Sciences, University of Florida, Gainesville, Florida
| | | | - Rahma Mungia
- Department of Periodontics, University of Texas Health Science Center, San Antonio, Texas
| | - Cyril Meyerowitz
- University of Rochester, Eastman Institute for Oral Health, Rochester, New York
| | - Renata S Leite
- Department of Stomatology, College of Dental Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Roger B Fillingim
- Department of Community Dentistry and Behavioral Sciences, University of Florida, Gainesville, Florida
| | - Kathleen T Brady
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina.,Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina
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- The National Dental PBRN Collaborative Group includes practitioner, faculty, and staff investigators who contributed to this activity. A list is available at:, http://nationaldentalpbrn.org/collaborative-group.php
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Pravetoni M, Comer SD. Development of vaccines to treat opioid use disorders and reduce incidence of overdose. Neuropharmacology 2019; 158:107662. [PMID: 31173759 DOI: 10.1016/j.neuropharm.2019.06.001] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 05/01/2019] [Accepted: 06/02/2019] [Indexed: 02/06/2023]
Abstract
Vaccines offer a promising therapeutic strategy to treat substance use disorders (SUD). Vaccines have shown extensive preclinical proof of selectivity, safety, and efficacy against opioids, nicotine, cocaine, methamphetamine, and designer drugs. Despite clinical evaluation of vaccines targeting nicotine and cocaine showing proof of concept for this approach, no vaccine for SUD has yet reached the market. This review first discusses how vaccines for treatment of opioid use disorders (OUD) and reduction of opioid-induced fatal overdoses fit within the current medication assisted treatment (MAT) portfolio, and then summarizes ongoing efforts toward translation of vaccines targeting heroin, oxycodone, fentanyl, and other opioids. This article is part of the Special Issue entitled 'New Vistas in Opioid Pharmacology'.
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Affiliation(s)
- Marco Pravetoni
- University of Minnesota Medical School, Departments of Pharmacology and Medicine, Minneapolis, MN, USA; Hennepin Healthcare Research Institute, Minneapolis, MN, USA.
| | - Sandra D Comer
- Columbia University Irving Medical Center, Department of Psychiatry, The New York State Psychiatric Institute, New York, NY, USA
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9
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McCauley JL, Reyes S, Meyerowitz C, Gordan VV, Rindal DB, Gilbert GH, Leite RS, Fillingim RB, Brady KT. Training experiences regarding pain management, addiction, and drug diversion of dentists enrolled in the National Dental Practice-Based Research Network. Subst Abus 2019; 40:344-349. [PMID: 30829128 DOI: 10.1080/08897077.2019.1576085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: The purpose of this study was to describe dentists' training experiences relevant to pain management, addiction, and prescription opioid drug diversion and examine associations between these training experiences and dentists' opioid prescribing practices. Methods: A Web-based, cross-sectional survey was conducted among practicing dentist members of the National Dental Practice-Based Research Network (PBRN; N = 822). The survey assessed pain management prescribing practices and training experiences related to pain management and assessment for addiction and drug diversion. Survey data were linked with National Dental PBRN Enrollment Questionnaire data regarding practitioner demographics and practice characteristics. Results: The majority of dentists (67%) reported prior training in pain management; however, a minority of dentists reported prior training regarding identification and assessment of drug abuse or addiction (48%) or identification of prescription drug diversion (25%). The majority of training experiences across all topics occurred through continuing dental education participation. Dental school training relevant to pain management, addiction, and identification of drug diversion was more prevalent among more recent dental school graduates. Training experiences were associated with prescribing practices. Conclusions: Results suggest that across multiple levels of training, many dentists are not receiving training specific to addiction assessment and identification of drug diversion. Such training is associated with greater consistency of risk mitigation implementation in practice.
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Affiliation(s)
- Jenna L McCauley
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Stephanie Reyes
- Department of Periodontics, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Cyril Meyerowitz
- Eastman Institute for Oral Health, University of Rochester, Rochester, New York, USA
| | - Valeria V Gordan
- Department of Restorative Dental Sciences, University of Florida, Gainesville, Florida, USA
| | - D Brad Rindal
- HealthPartners Institute, Bloomington, Minnesota, USA
| | - Gregg H Gilbert
- Department of Clinical & Community Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Renata S Leite
- Department of Stomatology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Roger B Fillingim
- Department of Community Dentistry and Behavioral Sciences, University of Florida, Gainesville, Florida, USA
| | - Kathleen T Brady
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.,Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina, USA
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10
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Mital S, Windle M, Cooper HLF, Crawford ND. Trends in non-medical prescription opioids and heroin co-use among adults, 2003-2014. Addict Behav 2018; 86:17-23. [PMID: 29778489 DOI: 10.1016/j.addbeh.2018.05.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 04/24/2018] [Accepted: 05/07/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patterns in non-medical prescription opioid (NMPO) and heroin use have recently shifted, with evidence that NMPO-only users transition to NMPO and heroin co-use. Co-use is associated with increased risk of morbidity and overdose, highlighting the need for further investigation. This study aims to quantify, describe, and explore trends in co-use. METHODS Using data from the 2003-2014 National Surveys on Drug Use and Health, we compared co-use to NMPO- and heroin-only use across demographic, substance use and mental health characteristics with chi-squared tests. Logistic regression models assessed trends in opioid use overall, and among co-users. RESULTS From 2003 to 2014, the prevalence of all opioid use (NMPO-only, heroin-only, and co-use) and NMPO-only use decreased 6.08% (p < 0.01) and 4.65% (p < 0.001), respectively, while prevalence of heroin-only use increased 21.32% (non-significant). Co-use increased 248.17% (p < 0.001) overall, and did so in all demographic, substance use, and mental health groups. Demographic, substance use, and mental health characteristics of co-users were more similar to the heroin-only group than to NMPO-only. The highest co-use prevalence was among those: without health insurance (8.72%), aged 26-34 (9.76%), reporting unemployment (12.08%), and with a major depressive episode, psychological distress, and who illicitly use or abuse drugs other than opioids or marijuana in the past year (9.33%, 10.75%, 11.87%, and 16.81%, respectively). DISCUSSION The increased prevalence of co-use and differences across demographic, substance use, and mental health characteristics highlight the need for targeted prevention and response interventions for this emerging, high-risk group.
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Affiliation(s)
- Sasha Mital
- Department of Behavioral Sciences and Health Education, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, United States.
| | - Michael Windle
- Department of Behavioral Sciences and Health Education, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, United States
| | - Hannah L F Cooper
- Department of Behavioral Sciences and Health Education, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, United States
| | - Natalie D Crawford
- Department of Behavioral Sciences and Health Education, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, United States
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11
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Naloxone access among an urban population of opioid users. Am J Emerg Med 2018; 36:2126-2127. [DOI: 10.1016/j.ajem.2018.03.066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/23/2018] [Accepted: 03/23/2018] [Indexed: 12/28/2022] Open
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12
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Nguyen THC, Lombana NF, Zavlin D, Moliver CL. Transition to Nonopioid Analgesia Does Not Impair Pain Control After Major Aesthetic Plastic Surgery. Aesthet Surg J 2018; 38:1139-1144. [PMID: 29608639 DOI: 10.1093/asj/sjy050] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Multimodal analgesic protocols are increasingly favored over traditional opioid regimens due to decreased adverse side effects and reduced opioid consumption. Concomitant use of selective cyclooxygenase (COX)-2 inhibitor celecoxib and anticonvulsant gabapentin have been proposed to adequately control acute postoperative pain. OBJECTIVES To determine efficacy of postoperative pain control using nonopioid pain regimen vs traditional opioids for all aesthetic plastic surgery procedures. METHODS A retrospective chart review was performed on 462 consecutive outpatient plastic surgery procedures by a single surgeon between November 2015 and July 2017. Procedures in the historical control group (n = 275) received traditional postoperative narcotic, hydrocodone-acetaminophen. Patients in the more recent nonopioid study group (n = 187) received a pre-, peri-, and postoperative regimen of celecoxib and gabapentin. RESULTS Similar demographic characteristics between the control and study groups were observed: mean age, 39.7 vs 39.5 years; BMI, 24.6 vs 24.4 kg/m2; and ratio of female patients 92.7% vs 92.4%. A significant reduction in rescue analgesia (meperidine 44.6% vs 14.9%, P < 0.001) and antiemetic use (ondansetron 24.2% vs 16.3%, P < 0.05; promethazine 17.0% vs 4.7%, P < 0.001) in postanesthesia recovery unit (PACU) was noted in the nonopioid group compared to the control. The average stay in PACU also decreased in the study group (82 ± 39 min vs 70 ± 22 min, P < 0.001). Both groups reported low numbers of adverse events and need for additional pain prescriptions. These findings were reproducible in the breast subgroup. CONCLUSIONS This nonopioid regimen is as effective as traditional opioid use for acute postoperative pain control and decreased recovery time for outpatient aesthetic plastic breast surgeries. LEVEL OF EVIDENCE 3
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Affiliation(s)
- Thu-Hoai C Nguyen
- Division of Plastic Surgery, The University of Texas Medical Branch, Galveston, TX
| | - Nicholas F Lombana
- Division of Plastic Surgery, The University of Texas Medical Branch, Galveston, TX
| | - Dmitry Zavlin
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, TX
| | - Clayton L Moliver
- Division of Plastic Surgery, The University of Texas Medical Branch, Galveston, TX
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13
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Prior prescription opioid misuse in a cohort of heroin users in a treatment study. Addict Behav Rep 2018; 8:8-10. [PMID: 29977990 PMCID: PMC6029944 DOI: 10.1016/j.abrep.2018.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/18/2018] [Accepted: 04/20/2018] [Indexed: 11/22/2022] Open
Abstract
This study investigates prior prescription opioid misuse in a cohort of heroin users whose progress was tracked in a treatment study conducted in the US from 2006 to 2010. Half of the sample misused prescription opioids ("other opiates/analgesics") prior to their onset of heroin misuse (POBs). We found that POBs were demographically younger and more likely to be white than other heroin users (OHUs). There were differences between the two groups with respect to the reporting of at least one year of regular use of substances and age of onset of substance use. POBs were more likely to report regular use, and earlier onset of use of several substances, mostly of the type potentially obtained via prescription. POBs were more persistent in their opioid use and more likely to suffer near-term elevated depressive symptoms compared with OHUs. These findings suggest that heroin addiction treatment may need to be tailored according to opioid misuse history.
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14
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Opioid prescribing and risk mitigation implementation in the management of acute pain: Results from The National Dental Practice-Based Research Network. J Am Dent Assoc 2018; 149:353-362. [PMID: 29550022 DOI: 10.1016/j.adaj.2017.11.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/26/2017] [Accepted: 11/14/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Minimal information exists regarding the consistency and correlates of dentists' implementation of risk mitigation strategies when prescribing opioids, including risk screening, prescription drug monitoring program (PDMP) use, and patient education. METHODS The authors conducted a Web-based, cross-sectional survey among practicing dentist members of The National Dental Practice-Based Research Network. The authors used the survey to assess pain management prescribing practices and risk mitigation implementation. The authors linked survey data with network enrollment questionnaire data to include practitioner demographic and practice characteristics. RESULTS A total of 822 dentists completed the survey. A minority of dentists reported prescribing opioids only (11%) or opioids in combination with a recommendation for nonsteroidal anti-inflammatory drugs or acetaminophen (18%) to one-half or more of their patients needing management of acute pain. Higher levels of opioid prescribing were associated significantly with less consistent implementation of PDMP use (r = -0.20) and patient education (r = -0.11). CONCLUSIONS Most dentists reported infrequent PDMP use and counseling patients regarding risks, storage, and disposal of opioids. Higher frequency of opioid prescribing was associated with less consistent risk mitigation implementation. PRACTICAL IMPLICATIONS When opioid prescribing is indicated, risk of misuse and diversion may be mitigated by consistent PDMP use and provision of patient education. Dental education in this arena is needed.
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Mundkur ML, Rough K, Huybrechts KF, Levin R, Gagne JJ, Desai RJ, Patorno E, Choudhry NK, Bateman BT. Patterns of opioid initiation at first visits for pain in United States primary care settings. Pharmacoepidemiol Drug Saf 2017; 27:495-503. [PMID: 28971545 DOI: 10.1002/pds.4322] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 07/28/2017] [Accepted: 08/21/2017] [Indexed: 11/07/2022]
Abstract
PURPOSE The primary objective of this study was to characterize variation in patterns of opioid prescribing within primary care settings at first visits for pain, and to describe variation by condition, geography, and patient characteristics. METHODS 2014 healthcare utilization data from Optum's Clinformatics™ DataMart were used to evaluate individuals 18 years or older with an initial presentation to primary care for 1 of 10 common pain conditions. The main outcomes assessed were (1) the proportion of first visits for pain associated with an opioid prescription fill and (2) the proportion of opioid prescriptions with >7 days' supply. RESULTS We identified 205 560 individuals who met inclusion criteria; 9.1% of all visits were associated with an opioid fill, ranging from 4.1% (headache) to 28.2% (dental pain). Approximately half (46%) of all opioid prescriptions supplied more than 7 days, and 10% of prescriptions supplied ≥30 days. We observed a 4-fold variation in rates of opioid initiation by state, with highest rates of prescribing in Alabama (16.6%) and lowest rates in New York (3.7%). CONCLUSIONS In 2014, nearly half of all patients filling opioid prescriptions received more than 7 days' of opioids in an initial prescription. Policies limiting initial supplies have the potential to substantially impact opioid prescribing in the primary care setting.
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Affiliation(s)
- Mallika L Mundkur
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Kathryn Rough
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Krista F Huybrechts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Raisa Levin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Joshua J Gagne
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Rishi J Desai
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Elisabetta Patorno
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Niteesh K Choudhry
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Brian T Bateman
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
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Mouravska N, Zielinski L, Bhatt M, Sanger N, Bawor M, Dennis B, Banfield L, MacKillop J, Paul J, Worster A, Laplante P, Thabane L, Samaan Z. Adverse outcomes associated with opioid prescription for acute low back pain: a systematic review protocol. Syst Rev 2017; 6:163. [PMID: 28807047 PMCID: PMC5557568 DOI: 10.1186/s13643-017-0556-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 08/01/2017] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Acute low back pain (ALBP) is the top cause of global disability, demonstrating a significant impact on individuals and society and demanding the need for appropriate management. There is a trend towards an increasing number of opioid prescriptions for ALBP despite the lack of investigation for its various short- and long-term outcomes. The objective of this review is to examine adverse outcomes associated with opioid use for ALBP. METHODS/DESIGN Using a search strategy, the search will be conducted using the following electronic databases: PubMed/MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, Cochrane Library, the National Institutes for Health Clinical Trials Registry and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP). We will include randomized clinical trials and observational studies investigating the impact of opioid use in ALBP in the adult population. All phases of screening, data extraction and assessment of methodological quality will be performed by two independent reviewers. We will perform quality and risk of bias assessment for the included articles and compare high and low risk of bias with a sensitivity analysis. We will conduct random- and fixed-effects meta-analyses with heterogeneity calculated using the I 2 statistic and evaluate publication bias. DISCUSSION There are current guidelines published to alert clinicians in prescribing opioids for ALBP due to its likelihood of misuse, yet there is little change in prescribing patterns. To date, there is an absence of systematic information about the outcomes of prescription opioid in patients with ALBP. We will address this gap by providing evidence that will be useful for clinical practice. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016033090.
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Affiliation(s)
- Natalia Mouravska
- Juravinski Hospital, Hamilton Health Sciences, 711 Concession Street, Hamilton, ON, L8V 1C1, Canada.,Mood Disorders Research Unit, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada.,MiNDS Neuroscience Graduate Program, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Laura Zielinski
- Juravinski Hospital, Hamilton Health Sciences, 711 Concession Street, Hamilton, ON, L8V 1C1, Canada.,Mood Disorders Research Unit, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada.,MiNDS Neuroscience Graduate Program, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.,Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada.,Population Genomics Program, Chanchlani Research Centre, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Meha Bhatt
- Mood Disorders Research Unit, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada.,MiNDS Neuroscience Graduate Program, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.,Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada.,Population Genomics Program, Chanchlani Research Centre, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.,Health Research Methodology Graduate Program, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Nitika Sanger
- Mood Disorders Research Unit, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada.,MiNDS Neuroscience Graduate Program, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Monica Bawor
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada.,St. George's University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Brittany Dennis
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada.,St. George's University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Laura Banfield
- Health Science Library, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - James MacKillop
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - James Paul
- Department of Anaesthesia, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Andrew Worster
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada.,Department of Medicine, Hamilton General Hospital, 237 Barton St East, Hamilton, ON, L8L 2X2, Canada
| | - Philip Laplante
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.,Biostatistics Unit, Research Institute at St Joes, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue E, Hamilton, ON, L8N 4A6, Canada
| | - Zainab Samaan
- Mood Disorders Research Unit, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada. .,MiNDS Neuroscience Graduate Program, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada. .,Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada. .,Population Genomics Program, Chanchlani Research Centre, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada. .,Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada. .,Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada. .,Mood Disorders Program, St. Joseph's Healthcare Hamilton, 100 West 5th St, Hamilton, ON, L8N 3K7, Canada.
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Liebling EJ, Yedinak JL, Green TC, Hadland SE, Clark MA, Marshall BDL. Access to substance use treatment among young adults who use prescription opioids non-medically. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2016; 11:38. [PMID: 27894311 PMCID: PMC5127054 DOI: 10.1186/s13011-016-0082-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 11/23/2016] [Indexed: 02/03/2023]
Abstract
Background Non-medical prescription opioid (NMPO) use is a substantial public health problem in the United States, with 1.5 million new initiates annually. Only 746,000 people received treatment for NMPO use in 2013, demonstrating substantial disparities in access to treatment. This study aimed to assess correlates of accessing substance use treatment among young adult NMPO users in Rhode Island, a state heavily impacted by NMPO use and opioid overdose. Methods This analysis uses data from a study of 200 Rhode Island residents aged 18 to 29 who reported NMPO use in the past 30 days. We compared individuals who had ever successfully enrolled in a substance use treatment program without ever facing barriers, individuals who had ever attempted to enroll but were unable, and individuals who never attempted to enroll. We used multinomial logistic regression to determine the independent correlates of never attempting and unsuccessfully attempting to access substance use treatment. Results Among 200 participants, the mean age was 24.5, 65.5% were male, and 61.5% were white. Nearly half (45.5%) had never attempted to enroll in substance use treatment, while 35.0% had successfully enrolled without ever facing barriers and 19.5% were unsuccessful in at least one attempt to enroll. In multivariable models, non-white participants were more likely to never have attempted to enroll compared to white participants. Previous incarceration, experiencing drug-related discrimination by the medical community, and a monthly income of $501 - $1500 were associated with a decreased likelihood of never attempting to enroll. A history of overdose and a monthly income of $501 - $1500 were associated with an increased likelihood of unsuccessfully accessing treatment. The most commonly reported barriers to accessing treatment were waiting lists (n = 23), health insurance not approving enrollment (n = 20), and inability to pay (n = 16). Conclusions This study demonstrates significant disparities in access to treatment among young adults who report NMPO use. A history of overdose was shown to correlate with experiencing barriers to substance use treatment utilization. Interventions are needed to reduce drug-related discrimination in clinical settings and to provide mechanisms that link young adults (particularly with a history of overdose) to evidence-based treatment.
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Affiliation(s)
- Elliott J Liebling
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-4, Providence, RI, 02912, USA
| | - Jesse L Yedinak
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-4, Providence, RI, 02912, USA
| | - Traci C Green
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-4, Providence, RI, 02912, USA.,Department of Emergency Medicine, Boston University School of Medicine, 771 Albany Street, Room 1208, Boston, MA, 02118, USA.,The Warren Alpert School of Medicine of Brown University, Rhode Island Hospital, 55 Claverick Street, Providence, RI, 02903, USA
| | - Scott E Hadland
- Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, 88 East Newton Street, Vose Hall Room 322, Boston, MA, 02118, USA.,Division of Adolescent/Young Adult Medicine, Department of Medicine, Boston Children's Hospital, 333 Longwood Avenue, Boston, MA, 02115, USA.,Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| | - Melissa A Clark
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-4, Providence, RI, 02912, USA.,Department of Quantitative Health Sciences & Center for Health Policy and Research, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA, 01605, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-4, Providence, RI, 02912, USA.
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18
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Strayer RJ, Motov SM, Nelson LS. Something for pain: Responsible opioid use in emergency medicine. Am J Emerg Med 2016; 35:337-341. [PMID: 27802876 DOI: 10.1016/j.ajem.2016.10.043] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 10/18/2016] [Accepted: 10/20/2016] [Indexed: 10/20/2022] Open
Abstract
The United States is currently experiencing a public health crisis of opioid addiction, which has its genesis in an industry marketing effort that successfully encouraged clinicians to prescribe opioids liberally, and asserted the safety of prescribing opioids for chronic non-cancer pain, despite a preponderance of evidence demonstrating the risks of dependence and misuse. The resulting rise in opioid use has pushed drug overdose deaths in front of motor vehicle collisions to become the leading cause of accidental death in the country. Emergency providers frequently treat patients for complications of opioid abuse, and also manage patients with acute and chronic pain, for which opioids are routinely prescribed. Emergency providers are therefore well positioned to both prevent new cases of opioid misuse and initiate appropriate treatment of existing opioid addicts. In opioid-naive patients, this is accomplished by a careful consideration of the likelihood of benefit and harm of an opioid prescription for acute pain. If opioids are prescribed, the chance of harm is reduced by matching the number of pills prescribed to the expected duration of pain and selecting an opioid preparation with low abuse liability. Patients who present to acute care with exacerbations of chronic pain or painful conditions associated with opioid misuse are best managed by treating symptoms with opioid alternatives and encouraging treatment for opioid addiction.
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Affiliation(s)
- Reuben J Strayer
- 79-01 Broadway, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, Elmhurst, NY 11373, United States.
| | - Sergey M Motov
- 4802 Tenth Ave, Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY 11219, United States
| | - Lewis S Nelson
- 185 South Orange Avenue, Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ 07103, United States
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19
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Type of opioid dependence among patients seeking opioid substitution treatment: are there differences in background and severity of problems? SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2016; 11:23. [PMID: 27401680 PMCID: PMC4940729 DOI: 10.1186/s13011-016-0066-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 05/27/2016] [Indexed: 11/23/2022]
Abstract
Background The study explores differences and similarities in background and problem severity among those seeking Opioid Substitution Treatment (OST), comparing those who primarily had misused "opiates", e.g. heroin, morphine and opium, with those who primarily had misused other opioids. Methods Patients (n = 127) assessed for possible admittance in OST are compared based on the Addiction Severity Index. Two groups based on primary type of opioid misused are compared (opiates vs. other opioids). Results In the global severity ratings there were no significant differences between the groups other than tautological artefacts concerning heroin. There were few specific differences between the groups. The opiate group more often had Hepatitis C and more often had legal problems related to financing their misuse. Injection of drugs was the main method of administration in both groups, i.e. 90 % for mostly opiates vs. 75 % for mostly other opioids. A great majority in both groups, 96 % vs. 91 %, had misused most other types of drugs. Both groups were found to have severe problems in all areas investigated. Conclusions The study demonstrates great similarities in problem severity among those seeking OST, both those who primarily had misused opiates and those who primarily had misused other opioids.
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20
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Abstract
Opioid use and addiction in adolescents and young adults is a health problem of epidemic proportions, with devastating consequences for youth and their families. Opioid overdose is a life-threatening emergency that should be treated with naloxone, and respiratory support if necessary. Overdose should always be an opportunity to initiate addiction treatment. Detoxification is often a necessary, but never sufficient, component of treatment for OUDs. Treatment for OUDs is effective but treatment capacity is alarmingly limited and under-developed. Emerging consensus supports the incorporation of relapse prevention medications such as buprenorphine and extended release naltrexone into comprehensive psychosocial treatment including counseling and family involvement.
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Affiliation(s)
| | - Ann Bruner
- Mountain Manor Treatment Center, Baltimore, MD, USA; Department of Pediatrics, Johns Hopkins University, Baltimore, MD, USA
| | | | - Marc Fishman
- Mountain Manor Treatment Center, Baltimore, MD, USA; Department of Psychiatry, Johns Hopkins University, Baltimore, MD, USA.
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21
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Wakeland W, Nielsen A, Geissert P. Dynamic model of nonmedical opioid use trajectories and potential policy interventions. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2015; 41:508-18. [PMID: 25982491 PMCID: PMC4685710 DOI: 10.3109/00952990.2015.1043435] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Nonmedical use of pharmaceutical opioid analgesics (POA) increased dramatically over the past two decades and remains a major health problem in the United States, contributing to over 16 000 accidental poisoning deaths in 2010. OBJECTIVES To create a systems-oriented theory/model to explain the historical behaviors of interest, including the various populations of nonmedical opioid users and accidental overdose mortality within those populations. To use the model to explore policy interventions including tamper-resistant drug formulations and strategies for reducing diversion of opioid medicines. METHODS A system dynamics model was constructed to represent the population of people who initiate nonmedical POA usage. The model incorporates use trajectories including development of use disorders, transitions from reliance on informal sharing to paying for drugs, transition from oral administration to tampering to facilitate non-oral routes of administration, and transition to heroin use by some users, as well as movement into and out of the population through quitting and mortality. Empirical support was drawn from national surveys (NSDUH, TEDS, MTF, and ARCOS) and published studies. RESULTS The model was able to replicate the patterns seen in the historical data for each user population, and the associated overdose deaths. Policy analysis showed that both tamper-resistant formulations and interventions to reduce informal sharing could significantly reduce nonmedical user populations and overdose deaths in the long term, but the modeled effect sizes require additional empirical support. CONCLUSION Creating a theory/model that can explain system behaviors at a systems level scale is feasible and facilitates thorough evaluation of policy interventions.
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Affiliation(s)
- Wayne Wakeland
- a Systems Science Program, Portland State University , Portland , Oregon , USA
| | - Alexandra Nielsen
- a Systems Science Program, Portland State University , Portland , Oregon , USA
| | - Peter Geissert
- a Systems Science Program, Portland State University , Portland , Oregon , USA
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22
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Daniulaityte R, Falck R, Carlson RG. Sources of pharmaceutical opioids for non-medical use among young adults. J Psychoactive Drugs 2014; 46:198-207. [PMID: 25052878 DOI: 10.1080/02791072.2014.916833] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The study uses qualitative and quantitative data to describe sources of pain pills for illicit use among young adult (18- to 23-year-old) users. Respondent-driven sampling was used to recruit 383 individuals in the Columbus, Ohio, area. The sample was almost 50% Caucasian and about 55% male. Qualitative interview participants (n = 45) were selected from the larger sample. Qualitative data suggest that pharmaceutical opioid availability was so pervasive that most individuals did not have to venture outside of their immediate social networks to find people who sold or shared pills. Participants emphasized differences between those who are actively involved in obtaining pills and those who play a more passive role. Active involvement was described as going out searching for pills and paying money to obtain them. In contrast, passive role included obtaining pills when somebody offered or shared them free of charge. Multiple logistic regression analysis indicates that a more active role in obtaining pharmaceutical opioids was related to being White, more frequent use of pharmaceutical opioids, extended-release oxycodone use, and using pharmaceutical opioids to get high, as opposed to self-treating a health problem. The study results can help inform drug use epidemiology, interventions, and policy.
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Affiliation(s)
- Raminta Daniulaityte
- a Associate Professor and Associate Director, Center for Interventions, Treatment, and Addictions Research, Boonshoft School of Medicine , Wright State University , Dayton , OH
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23
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Ashrafioun L, Carels RA. Prescription opioid use among university students: assessment of post-cue exposure craving. Addict Behav 2014; 39:586-92. [PMID: 24345309 DOI: 10.1016/j.addbeh.2013.11.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 10/28/2013] [Accepted: 11/13/2013] [Indexed: 10/26/2022]
Abstract
Despite the increasing number of prescriptions written to adolescents and young adults for opioid analgesics, the rise in non-medical use of such drugs among university students, and the potential role of craving in the misuse of opioids, there have been no published studies assessing craving for prescription opioids in this population. Therefore, the current study was designed to assess the impact of prescription opioid-related cue exposure on craving in university students. Students (n=277) recruited from a large university in the Midwestern United States were randomly assigned to two conditions to test the impact of cue exposure to either prescription opioid-related stimuli or control stimuli. Relative to the control condition, prescription opioid-related cue exposure significantly increased overall craving, desire and intention to use prescription opioids, relief from negative states by using prescription opioids, and perceived control over prescription opioid use. In addition, when assessing correlates of post-cue exposure craving, negative mood and procurement of prescription opioids from non-medical sources were the only measured variables that were significantly associated with overall craving and/or any of the craving measure's subscales. Craving may be important aspect of prescription opioid use among university students. Future research assessing craving as a function of non-medical user subtype is warranted.
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24
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Jones CM. Heroin use and heroin use risk behaviors among nonmedical users of prescription opioid pain relievers - United States, 2002-2004 and 2008-2010. Drug Alcohol Depend 2013; 132:95-100. [PMID: 23410617 DOI: 10.1016/j.drugalcdep.2013.01.007] [Citation(s) in RCA: 356] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Revised: 11/08/2012] [Accepted: 01/14/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Heroin use and overdose deaths have increased in recent years. Emerging information suggests this is the result of increases in nonmedical use of opioid pain relievers and nonmedical users transitioning to heroin use. Understanding this relationship is critically important for the development of public health interventions. METHODS Combined data from the 2002-2004 National Surveys on Drug Use and Health were compared to the 2008-2010 surveys to examine patterns of heroin use and risk behaviors among past year nonmedical users of opioid pain relievers. RESULTS Between 2002-2004 and 2008-2010, past year heroin use increased among people reporting past year nonmedical use (PYNMU) of opioid pain relievers (p<0.01), but not among those reporting no PYNMU. Frequent nonmedical users - people reporting 100-365 days of PYNMU - had the highest rate of past year heroin use and were at increased risk for ever injecting heroin (aOR 4.3, 95% CI 2.5-7.3) and past year heroin abuse or dependence (aOR 7.8, 95% CI 4.7-12.8) compared to infrequent nonmedical users (1-29 days of PYNMU). In 2008-2010, 82.6% of frequent nonmedical users who used heroin in the past year reported nonmedical use of opioid pain relievers prior to heroin initiation compared to 64.1% in 2002-2004. CONCLUSIONS Heroin use among nonmedical users of opioid pain relievers increased between 2002-2004 and 2008-2010, with most reporting nonmedical use of opioid pain relievers before initiating heroin. Interventions to prevent nonmedical use of these drugs are needed and should focus on high-risk groups such as frequent nonmedical users of opioids.
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Affiliation(s)
- Christopher M Jones
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention, 4770 Buford Highway, Atlanta, GA 30341, United States.
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Cameron D, Smith GA, Daniulaityte R, Sheth AP, Dave D, Chen L, Anand G, Carlson R, Watkins KZ, Falck R. PREDOSE: a semantic web platform for drug abuse epidemiology using social media. J Biomed Inform 2013; 46:985-97. [PMID: 23892295 DOI: 10.1016/j.jbi.2013.07.007] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Revised: 07/04/2013] [Accepted: 07/19/2013] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The role of social media in biomedical knowledge mining, including clinical, medical and healthcare informatics, prescription drug abuse epidemiology and drug pharmacology, has become increasingly significant in recent years. Social media offers opportunities for people to share opinions and experiences freely in online communities, which may contribute information beyond the knowledge of domain professionals. This paper describes the development of a novel semantic web platform called PREDOSE (PREscription Drug abuse Online Surveillance and Epidemiology), which is designed to facilitate the epidemiologic study of prescription (and related) drug abuse practices using social media. PREDOSE uses web forum posts and domain knowledge, modeled in a manually created Drug Abuse Ontology (DAO--pronounced dow), to facilitate the extraction of semantic information from User Generated Content (UGC), through combination of lexical, pattern-based and semantics-based techniques. In a previous study, PREDOSE was used to obtain the datasets from which new knowledge in drug abuse research was derived. Here, we report on various platform enhancements, including an updated DAO, new components for relationship and triple extraction, and tools for content analysis, trend detection and emerging patterns exploration, which enhance the capabilities of the PREDOSE platform. Given these enhancements, PREDOSE is now more equipped to impact drug abuse research by alleviating traditional labor-intensive content analysis tasks. METHODS Using custom web crawlers that scrape UGC from publicly available web forums, PREDOSE first automates the collection of web-based social media content for subsequent semantic annotation. The annotation scheme is modeled in the DAO, and includes domain specific knowledge such as prescription (and related) drugs, methods of preparation, side effects, and routes of administration. The DAO is also used to help recognize three types of data, namely: (1) entities, (2) relationships and (3) triples. PREDOSE then uses a combination of lexical and semantic-based techniques to extract entities and relationships from the scraped content, and a top-down approach for triple extraction that uses patterns expressed in the DAO. In addition, PREDOSE uses publicly available lexicons to identify initial sentiment expressions in text, and then a probabilistic optimization algorithm (from related research) to extract the final sentiment expressions. Together, these techniques enable the capture of fine-grained semantic information, which facilitate search, trend analysis and overall content analysis using social media on prescription drug abuse. Moreover, extracted data are also made available to domain experts for the creation of training and test sets for use in evaluation and refinements in information extraction techniques. RESULTS A recent evaluation of the information extraction techniques applied in the PREDOSE platform indicates 85% precision and 72% recall in entity identification, on a manually created gold standard dataset. In another study, PREDOSE achieved 36% precision in relationship identification and 33% precision in triple extraction, through manual evaluation by domain experts. Given the complexity of the relationship and triple extraction tasks and the abstruse nature of social media texts, we interpret these as favorable initial results. Extracted semantic information is currently in use in an online discovery support system, by prescription drug abuse researchers at the Center for Interventions, Treatment and Addictions Research (CITAR) at Wright State University. CONCLUSION A comprehensive platform for entity, relationship, triple and sentiment extraction from such abstruse texts has never been developed for drug abuse research. PREDOSE has already demonstrated the importance of mining social media by providing data from which new findings in drug abuse research were uncovered. Given the recent platform enhancements, including the refined DAO, components for relationship and triple extraction, and tools for content, trend and emerging pattern analysis, it is expected that PREDOSE will play a significant role in advancing drug abuse epidemiology in future.
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Affiliation(s)
- Delroy Cameron
- Ohio Center of Excellence in Knowledge-enabled Computing (Kno.e.sis), Wright State University, Dayton, OH 45435, USA
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Bonhomme J, Shim RS, Gooden R, Tyus D, Rust G. Opioid addiction and abuse in primary care practice: a comparison of methadone and buprenorphine as treatment options. J Natl Med Assoc 2012; 104:342-50. [PMID: 23092049 DOI: 10.1016/s0027-9684(15)30175-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Opioid abuse and addiction have increased in frequency in the United States over the past 20 years. In 2009, an estimated 5.3 million persons used opioid medications nonmedically within the past month, 200000 used heroin, and approximately 9.6% of African Americans used an illicit drug. Racial and ethnic minorities experience disparities in availability and access to mental health care, including substance use disorders. Primary care practitioners are often called upon to differentiate between appropriate, medically indicated opioid use in pain management vs inappropriate abuse or addiction. Racial and ethnic minority populations tend to favor primary care treatment settings over specialty mental health settings. Recent therapeutic advances allow patients requiring specialized treatment for opioid abuse and addiction to be managed in primary care settings. The Drug Addiction Treatment Act of 2000 enables qualified physicians with readily available short-term training to treat opioid-dependent patients with buprenorphine in an office-based setting, potentially making primary care physicians active partners in the diagnosis and treatment of opioid use disorders. Methadone and buprenorphine are effective opioid replacement agents for maintenance and/or detoxification of opioid-addicted individuals. However, restrictive federal regulations and stigmatization of opioid addiction and treatment have limited the availability of methadone. The opioid partial agonist-antagonist buprenorphine/naloxone combination has proven an effective alternative. This article reviews the literature on differences between buprenorphine and methadone regarding availability, efficacy, safety, side-effects, and dosing, identifying resources for enhancing the effectiveness of medication-assisted recovery through coordination with behavioral/psychological counseling, embedded in the context of recovery-oriented systems of care.
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Affiliation(s)
- Jean Bonhomme
- Department of Psychiatry and Behavioral Sciences,Morehouse School of Medicine, Atlanta, Georgia, USA.
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Peavy KM, Banta-Green CJ, Kingston S, Hanrahan M, Merrill JO, Coffin PO. “Hooked on” Prescription-Type Opiates Prior to Using Heroin: Results from a Survey of Syringe Exchange Clients. J Psychoactive Drugs 2012; 44:259-65. [DOI: 10.1080/02791072.2012.704591] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
Acute pain is the hallmark of sickle cell disease and is the most common cause of hospital admissions. Tissue damage due to vaso-occlusion releases numerous inflammatory mediators that initiate the transmission of painful stimuli that culminate in the perception of pain. The acute sickle cell painful crisis evolves along four phases. Each phase is coupled with changes in certain markers of the disease. Hospital readmission occurs within 1 week in about 16% of discharged patients and within 1 month in about 50% of discharged patients. Failure to treat acute pain aggressively may lead to chronic pain syndrome which, in turn, initiates neuropathic pain. Management of sickle pain is primarily pharmacological in nature and opioids are the analgesics used most often. Adverse effects of opioids include histaminergic, excitatory, dopaminergic and proserotonergic effects. Cellular and molecular mechanisms of opioids explain individual differences among patients and justify the use of individualized treatment plans.
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Affiliation(s)
- Samir K Ballas
- Department of Medicine, Cardeza Foundation, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
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Cicero TJ, Surratt HL, Kurtz S, Ellis MS, Inciardi JA. Patterns of prescription opioid abuse and comorbidity in an aging treatment population. J Subst Abuse Treat 2011; 42:87-94. [PMID: 21831562 DOI: 10.1016/j.jsat.2011.07.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Revised: 06/29/2011] [Accepted: 07/05/2011] [Indexed: 10/17/2022]
Abstract
Very little is known about the impact of age and gender on drug abuse treatment needs. To examine this, we recruited 2,573 opioid-dependent patients, aged from 18 to 75 years, entering treatment across the country from 2008 to 2010 to complete a self-administered survey examining drug use histories and the extent of comorbid psychiatric and physical disorders. Moderate to very severe pain and psychiatric disorders, including polysubstance abuse, were present in a significant fraction of 18- to 24-year-olds, but their severity grew exponentially as a function of age: 75% of those older than 45 years had debilitating pain and psychiatric problems. Women had more pain than men and much worse psychiatric issues in all age groups. Our results indicate that a "one-size-fits-all" approach to prevention, intervention, and treatment of opioid abuse that ignores the shifting needs of opioid-abusing men and women as they age is destined to fail.
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Affiliation(s)
- Theodore J Cicero
- Washington University Department of Psychiatry, Campus Box 8134, 660 S. Euclid Avenue, St. Louis MO 63110, USA.
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Prescription Opioid Use Among Patients Seeking Treatment for Opioid Dependence: Erratum. J Addict Med 2011. [DOI: 10.1097/adm.0b013e3182106f0d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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