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Song W, Simona A, Zhang P, Bates DW, Urman RD. Stimulant Drugs and Stimulant Use Disorder. Anesthesiol Clin 2024; 42:103-115. [PMID: 38278583 DOI: 10.1016/j.anclin.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
The authors aim to summarize several key points of stimulant drugs and stimulant use disorder, including their indications, short-term and long-term adverse effects, current treatment strategies, and association with opioid medications. The global prevalence of stimulant use has seen annual increase in the last decade. Multiple studies have shown that stimulant use and stimulant use disorder are associated with a range of individual and public health issues. Stimulant misuse has led to a significant increase of overdose deaths in the United States.
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Affiliation(s)
- Wenyu Song
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont Street, Boston, MA 02120, USA.
| | - Aurélien Simona
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont Street, Boston, MA 02120, USA; Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland
| | - Ping Zhang
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH 43210, USA; Department of Computer Science and Engineering, The Ohio State University, Columbus, OH 43210, USA
| | - David W Bates
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont Street, Boston, MA 02120, USA
| | - Richard D Urman
- Department of Anaesthesiology, College of Medicine The Ohio State University, Columbus, OH 43210, USA
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Callaway Kim K, Khouja T, Burgette JM, Evans CT, Calip GS, Gellad WF, Suda KJ. Trends in dispensed prescriptions for opioids, sedatives, benzodiazepines, gabapentin, and stimulants to children by general dentists, 2012-2019. Pharmacoepidemiol Drug Saf 2023; 32:625-634. [PMID: 36573575 DOI: 10.1002/pds.5589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 12/14/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE Opioids, benzodiazepines and sedatives can manage dental pain, fear and anxiety but have a narrow margin of safety in children. General dentists may inappropriately prescribe gabapentin and stimulants. National evidence on dispensing rates of these high-alert medicines by dentists to children is limited. METHODS We utilize join-point regression to identify changes in fills for opioids, sedatives, benzodiazepines, gabapentin, and stimulants to children <18 years from 2012 to 2019 in a national dataset comprising 92% of dispensed outpatient prescriptions by dentists. RESULTS From 2012 to 2019, 3.8 million children filled prescriptions for high-alert drugs from general dentists. National quarterly dispensing of high-alert drugs decreased 63.1%, from 10456.0 to 3858.8 days per million. Opioids accounted for 69.4% of high-alert prescriptions. From 2012 to 2019, fills for opioids, sedatives, benzodiazepines, and stimulants decreased by 65.2% (7651.8 to 2662.7), 43.4% (810.9 to 458.7), 43.6% (785.7 to 442.7) and 89.3% (825.6 to 88.6 days per million), respectively. Gabapentin increased 8.1% (121.8 to 131.7 days per million). A significant decrease in high-alert fills occurred in 2016, (-6.0% per quarter vs. -1.6% pre-2016, P-value<0.001), especially for opioids (-7.0% vs. -1.2%, P-value<0.001). Older teenagers (15-17 years) received 42.5% of high-alert prescriptions. Low-income counties in the South were overrepresented among top-prescribing areas in 2019. CONCLUSIONS We found promising national decreases in fills for high-alert medicines to children by general dentists from 2012 to 2019. However, older teenagers and children in some counties continued to receive dental opioids at high rates. Future efforts should address non-evidence-based pain management in these groups.
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Affiliation(s)
- Katherine Callaway Kim
- University of Pittsburgh School of Medicine, Department of Medicine, Division of General Internal Medicine, Pittsburgh, Pennsylvania, USA
- Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Tumader Khouja
- University of Pittsburgh School of Medicine, Department of Medicine, Division of General Internal Medicine, Pittsburgh, Pennsylvania, USA
| | - Jacqueline M Burgette
- Departments of Dental Public Health and Pediatric Dentistry, School of Dental Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Charlesnika T Evans
- Department of Preventative Medicine and Center for Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr VA Hospital, Hines, Illinois, USA
| | - Gregory S Calip
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Walid F Gellad
- University of Pittsburgh School of Medicine, Department of Medicine, Division of General Internal Medicine, Pittsburgh, Pennsylvania, USA
- Center of Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Katie J Suda
- University of Pittsburgh School of Medicine, Department of Medicine, Division of General Internal Medicine, Pittsburgh, Pennsylvania, USA
- Center of Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
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Yan CH, Lee TA, Sharp LK, Hubbard CC, Evans CT, Calip GS, Rowan SA, McGregor JC, Gellad WF, Suda KJ. Trends in Opioid Prescribing by General Dentists and Dental Specialists in the U.S., 2012-2019. Am J Prev Med 2022; 63:3-12. [PMID: 35232618 PMCID: PMC9233039 DOI: 10.1016/j.amepre.2022.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 12/22/2021] [Accepted: 01/07/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Evidence suggests that U.S. dentists prescribe opioids excessively. There are limited national data on recent trends in opioid prescriptions by U.S. dentists. In this study, we examined trends in opioid prescribing by general dentists and dental specialists in the U.S. from 2012 to 2019. METHODS Dispensed prescriptions for oral opioid analgesics written by dentists were identified from IQVIA Longitudinal Prescription Data from January 2012 through December 2019. Autoregressive integrated moving average and joinpoint regression models described monthly population-based prescribing rates (prescriptions/100,000 individuals), dentist-based prescribing rates (prescriptions/1,000 dentists), and opioid dosages (mean daily morphine milligram equivalents/day). All analyses were performed in 2020. RESULTS Over the 8 years, dentists prescribed >87.2 million opioid prescriptions. Population- and dentist-based prescribing rates declined monthly by -1.97 prescriptions/100,000 individuals (95% CI= -9.98, -0.97) and -39.12 prescriptions/1,000 dentists (95% CI= -58.63, -17.65), respectively. Opioid dosages declined monthly by -0.08 morphine milligram equivalents/day (95% CI= -0.13, -0.04). Joinpoint regression identified 4 timepoints (February 2016, May 2017, December 2018, and March 2019) at which monthly prescribing rate trends were often decreasing in greater magnitude than those in the previous time segment. CONCLUSIONS Following national trends, dentists became more conservative in prescribing opioids. A greater magnitude of decline occurred post 2016 following the implementation of strategies aimed to further regulate opioid prescribing. Understanding the factors that influence prescribing trends can aid in development of tailored resources to encourage and support a conservative approach by dentists, to prescribing opioids.
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Affiliation(s)
- Connie H Yan
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois.
| | - Todd A Lee
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois
| | - Lisa K Sharp
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois
| | - Colin C Hubbard
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois
| | - Charlesnika T Evans
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr VA Hospital, Hines, Illinois; Department of Preventive Medicine, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Gregory S Calip
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois
| | - Susan A Rowan
- College of Dentistry, University of Illinois at Chicago, Chicago, Illinois
| | | | - Walid F Gellad
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Katie J Suda
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Nikpour J, Broome M, Silva S, Allen KD. Influence of Primary Care Provider Type on Chronic Pain Management Among Veterans. JOURNAL OF NURSING REGULATION 2022; 13:35-44. [PMID: 35694638 PMCID: PMC9182699 DOI: 10.1016/s2155-8256(22)00032-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Chronic pain disproportionately impacts veterans and is often treated in primary care, where physician shortages in the Veterans Health Administration (VHA) healthcare system are well documented. Nurse practitioners (NPs) may represent a solution to the care shortage; however, concerns of NP opioid overprescribing have led to NP practice and prescribing restrictions in individual VHA facilities and at the state level. Little is known regarding the prescribing patterns of NPs and physician assistants (PAs) for veterans with chronic pain in the VHA. Purpose The purpose of this study was to compare opioid and non-opioid prescribing patterns of physicians, NPs, and PAs for chronic pain patients at VHA centers. Methods We used data from the U.S. Department of Veterans Affairs Survey of Healthcare Experience of Patients and Corporate Data Warehouse from October 2015 to September 2016. Patient medical records for the year were analyzed by provider type (physician, NP, or PA) for differences in providers' rates of prescribing opioid and non-opioid medications, as well as characteristics of the opioid prescriptions (e.g., high daily morphine milligram equivalent [90 MME/day] dose, long-term opioid therapy [90 days]). Results Medical records of a total of 39,936 patients were included. In FY 2016, 55% of patients received one opioid prescription, whereas 83.8% received one non-opioid prescription. Compared to patients of NPs and PAs, patients of physicians had higher odds of receiving opioid (vs. NPs: OR = 1.13, p < 0.01; vs. PAs: OR = 1.16, p < 0.01) and non-opioid prescriptions (vs. NPs: OR=1.08, p = 0.02; vs. PAs: OR=1.20, p < 0.01) after adjusting for patient characteristics. There were no differences in high MME/day dose (p = 0.59) or long-term opioid therapy (p = 0.99). Conclusion In a national sample of veterans with chronic pain, NPs and PAs did not have higher odds of opioid prescribing. Concerns of NP or PA opioid overprescribing may be addressed by considering evidence that patients of these providers are not at higher odds of receiving an opioid prescription.
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Affiliation(s)
| | - Marion Broome
- Ruby F. Wilson Distinguished Professor of Nursing, Duke University School of Nursing, Durham, North Carolina
| | | | - Kelli D Allen
- Associate Director, Durham (North Carolina) Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Healthcare System, and a Professor of Medicine, School of Medicine, University of North Carolina-Chapel Hill
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Nikpour J, Franklin M, Calhoun N, Broome M. Influence of provider type on chronic pain prescribing patterns A systematic review. J Am Assoc Nurse Pract 2022; 34:474-488. [PMID: 34935726 PMCID: PMC9562618 DOI: 10.1097/jxx.0000000000000673] [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: 07/07/2021] [Accepted: 09/29/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Chronic pain affects 100 million Americans and is most often treated in primary care, where the health care provider shortage remains a challenge. Nurse practitioners (NPs) represent a growing solution, yet their patterns of chronic pain management are understudied. Additionally, prescriptive authority limitations in many states limit NPs from prescribing opioids and often exist due to concerns of NP-driven opioid overprescribing. Little evidence on NP pain management prescribing patterns exists to address these issues. OBJECTIVE Systematic review, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, to examine opioid and nonopioid prescribing patterns of physicians, NPs, and physician assistants (PAs) in primary care. Eligible studies scored ≥60% on the Joanna Briggs Institute Critical Appraisal checklist. DATA SOURCES Searches within PubMed, Embase, CINAHL, and Web of Science. CONCLUSIONS Three themes were elucidated: 1) opioid prescribing in primary care, 2) similarities and differences in opioid prescribing by provider type, and 3) nonopioid pain management strategies. All provider groups had similar opioid prescribing patterns, although NPs and PAs may be slightly less likely to prescribe opioids than physicians. Although some studies suggested that NPs/PAs had higher opioid prescribing rates compared with physicians, methodological flaws may undermine these conclusions. Evidence is also lacking on nonopioid prescribing patterns across disciplines. IMPLICATIONS FOR PRACTICE Nurse practitioner/PA prescriptive authority limitations may not be as effective of a solution for addressing opioid overprescribing as transdisciplinary interventions targeting the highest subset of opioid prescribers. Future research should examine prescribing patterns of nonopioid, including nonpharmacologic, therapies.
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Affiliation(s)
- Jacqueline Nikpour
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Durham, North Carolina
| | | | - Nicole Calhoun
- Duke University School of Nursing, Durham, North Carolina
| | - Marion Broome
- Ruby F. Wilson Professor of Nursing, Duke University School of Nursing, Durham, North Carolina
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Li Y, Cimiotti JP, Evans KA, Clevenger CK. The characteristics and practice proficiency of nurse practitioners who care for older adults. Geriatr Nurs 2022; 46:213-217. [PMID: 35241307 DOI: 10.1016/j.gerinurse.2022.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 11/28/2022]
Abstract
Roughly 54 million Americans are 65 years of age or older. Given the number of comorbid diseases reported in older adults, healthcare tailored to the specific needs of this population is imperative. Nurse practitioners (NPs) are uniquely positioned to provide care to older adults; yet little is known about the geriatric-oriented NP workforce. In this study, four professional organizations distributed a survey link to their members who were queried on their demographic, employment, and practice characteristics; one organization's members responded to a previous survey, providing two time points for comparison. Compared with 2016 respondents, there was minimal growth in diversity, fewer who practice in suburban or rural areas, and restrictions on clinical education related to the ongoing pandemic. The findings from this study should alert policymakers of the need to address the development of an adequate workforce of clinicians who specialize in geriatrics.
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Affiliation(s)
- Yin Li
- Assistant Professor of Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road NE, Atlanta, GA 30322, USA
| | - Jeannie P Cimiotti
- Associate Professor of Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road NE, Room 358, Atlanta, GA 30322-4027, USA
| | | | - Carolyn K Clevenger
- Associate Dean for Transformative Clinical Practice, Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road NE, Atlanta, GA 30322, USA.
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Hoppe D, Karimi L, Khalil H. Mapping the research addressing prescription drug monitoring programs: A scoping review. Drug Alcohol Rev 2022; 41:803-817. [PMID: 35106867 DOI: 10.1111/dar.13431] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 10/19/2021] [Accepted: 12/08/2021] [Indexed: 12/29/2022]
Abstract
ISSUES Prescription drug monitoring programs are a harm minimisation intervention and clinical decision support tool that address the public health concern surrounding prescription drug misuse. Given the large number of studies published to date and the ongoing implementation of these programs, it is important to map the literature and identify areas for further research to improve practice. APPROACH A scoping review was undertaken to identify the research on prescription drug monitoring programs published between January 2015 and April 2021. KEY FINDINGS A total of 153 citations were included in this scoping review. The majority of the studies originated from the USA and were quantitative. Results on program effectiveness are mixed and mainly examine their association with opioid-related outcomes. Unintended consequences are revealed in the literature and this review also highlights barriers to program use. IMPLICATIONS Overall, findings are mixed despite the large number of studies published to date. Mapping the literature identifies priority areas for further research that can advise policymakers and clinicians on practice improvement. CONCLUSION Results on prescription drug monitoring program effectiveness are mixed and mainly examine their association with opioid-related outcomes. This review highlights barriers to prescription drug monitoring program effectiveness related to program use and system integration. Further research is needed in these areas to improve prescription drug monitoring program use and patient outcomes.
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Affiliation(s)
- Dimi Hoppe
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Leila Karimi
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Hanan Khalil
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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Evans CT, Fitzpatrick MA, Poggensee L, Gonzalez B, Gibson G, Jurasic MM, Echevarria K, McGregor JC, Cunningham F, Gellad WF, Suda KJ. Outpatient Prescribing of Antibiotics and Opioids by Veterans Health Administration Providers, 2015-2017. Am J Prev Med 2021; 61:e235-e244. [PMID: 34376291 PMCID: PMC8541933 DOI: 10.1016/j.amepre.2021.05.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 05/04/2021] [Accepted: 05/06/2021] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Antibiotics and opioids are targeted by public health and stewardship communities for reductions in prescribing across the country. This study evaluates trends and factors associated with outpatient prescribing by dental and medical providers in a large integrated health system. METHODS This was a cross-sectional study of national dental and medical outpatient visits from Department of Veterans Affairs facilities in 2015-2017; analyzed in 2019-2020. Antibiotic and opioid prescribing rates were assessed by provider and facility characteristics. Multivariable Poisson regression adjusted for repeated measures by the provider was used to assess the independent association between facility and provider characteristics and rate of prescribing. RESULTS Over the study period, 4,625,840 antibiotic and 10,380,809 opioid prescriptions were identified for 115,625,890 visits. Physicians prescribed most antibiotics (67%). Dentists prescribed 6% of the antibiotics but had the highest per-visit antibiotic prescribing rate compared to medical providers (6.75 vs 3.90 prescriptions per 100 visits, p<0.0001), which was largely driven by dental specialists. By contrast, dentists had lower opioid prescribing than medical providers (3.02 vs 9.20 prescriptions per 100 visits, p<0.0001). Overall, antibiotic and opioid prescribing decreased over time, with opioids having the greatest decreases (-28.0%). In multivariable analyses, U.S. geographic region, rurality, and complexity were associated with prescribing for both drug classes. Opioid and antibiotic prescribing were positively correlated. CONCLUSIONS Although antibiotic and opioid prescribing has decreased, there are still important target areas for improvement. Interventions need to be tailored to community characteristics such as rurality and provider type.
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Affiliation(s)
- Charlesnika T Evans
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr VA Hospital, Hines, Illinois; Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Center for Health Services & Outcomes Research, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
| | - Margaret A Fitzpatrick
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr VA Hospital, Hines, Illinois; Division of Infectious Diseases, Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
| | - Linda Poggensee
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr VA Hospital, Hines, Illinois
| | - Beverly Gonzalez
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr VA Hospital, Hines, Illinois; Department of Psychiatry & Behavioral Sciences, Northwestern University, Chicago, Illinois
| | - Gretchen Gibson
- Veterans Health Administration Office of Dentistry, Washington, District of Columbia
| | - M Marianne Jurasic
- Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts; VA Center for Healthcare Organization & Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts
| | - Kelly Echevarria
- Antimicrobial Stewardship Task Force, Pharmacy Benefits Management Program, U.S. Department of Veterans Affairs, Washington, District of Columbia
| | | | - Fran Cunningham
- Pharmacy Benefits Management Services, U.S. Department of Veterans Affairs, Hines, Illinois
| | - Walid F Gellad
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, U.S. Department of Veterans Affairs, Pittsburgh, Pennsylvania; Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Katie J Suda
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, U.S. Department of Veterans Affairs, Pittsburgh, Pennsylvania; Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Tucker J, Salas J, Zhang Z, Grucza R, Scherrer JF. Provider specialty and odds of a new codeine, hydrocodone, oxycodone and tramadol prescription before and after the CDC opioid prescribing guideline publication. Prev Med 2021; 146:106466. [PMID: 33636196 DOI: 10.1016/j.ypmed.2021.106466] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 02/15/2021] [Accepted: 02/20/2021] [Indexed: 11/19/2022]
Abstract
The CDC Guideline for Prescribing Opioids for Chronic Pain cautioned against high dose prescribing but did not provide guidance on type of opioid for new pain episodes. We determined if new prescriptions for Schedule II opioids vs. tramadol decreased in the 18 months after vs. before the CDC guideline and if this decrease was associated with physician specialty. New opioid prescriptions, provider type and covariates were measured using a nationally distributed, Optum® de-identified Electronic Health Record (EHR) data base. Eligible patients were free of cancer and HIV and started a new prescription for Schedule II opioids (i.e. codeine, hydrocodone, oxycodone) or Schedule IV (tramadol) in the 18 months before (n = 141,219) or 18 months after (n = 138,216) guideline publication. Fully adjusted multilevel multinomial models estimated the association between provider type (anesthesiology/pain medicine, surgical specialty, emergency, hospital, primary care, other specialty and unknown) before and after adjusting for covariates. New oxycodone prescriptions were most common among surgical and anesthesia/pain management, and new tramadol prescriptions were most common in primary care. The greatest decreases in odds of a Schedule II opioid vs. tramadol were observed in emergency care (oxycodone vs. tramadol OR = 0.82; 95%CI:0.76-0.88) and primary care (hydrocodone vs. tramadol OR = 0.85; 95%CI:0.81-0.89). Surgical specialists were least likely to start opioid therapy with tramadol. In the 18 months after vs. before the CDC guideline, emergency care and primary care providers increased tramadol prescribing. Guidelines tailored to specialists that frequently begin opioid therapy with oxycodone may enhance safe opioid prescribing.
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Affiliation(s)
- Jane Tucker
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis, MO 63104, United States of America
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis, MO 63104, United States of America; AHEAD Institute, Saint Louis University School of Medicine, Salus Center, 4th Floor, 3545, Lafayette Ave., St. Louis, MO 63104, United States of America
| | - Zidong Zhang
- AHEAD Institute, Saint Louis University School of Medicine, Salus Center, 4th Floor, 3545, Lafayette Ave., St. Louis, MO 63104, United States of America
| | - Richard Grucza
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis, MO 63104, United States of America; AHEAD Institute, Saint Louis University School of Medicine, Salus Center, 4th Floor, 3545, Lafayette Ave., St. Louis, MO 63104, United States of America
| | - Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis, MO 63104, United States of America; AHEAD Institute, Saint Louis University School of Medicine, Salus Center, 4th Floor, 3545, Lafayette Ave., St. Louis, MO 63104, United States of America.
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Fiorillo L, Cervino G, De Stefano R, Iannello G, Cicciù M. Socioeconomic behaviors on dental professions: a Google Trends investigation in Italy. ACTA ACUST UNITED AC 2020; 69:317-323. [PMID: 32278342 DOI: 10.23736/s0026-4970.20.04352-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Dental profession has expanded, and the knowledge that oral health affects systemic health is of greater concern to patients. The purpose of this study is to understand the demand for dental treatments in Italy, knowing if there is any correlation between socioeconomic condition and oral rehabilitation typology. Moreover, focusing on the requested rehabilitations type and on finding alternatives, unconventional solutions. EVIDENCE ACQUISITION The research was conducted using an important research database defined Google Trends, with search terms such as "dolore denti" (toothache). A statistical analysis has been conducted in this study evaluation Pearson Correlation Coefficient. EVIDENCE SYNTHESIS The results divided region by region provide data that reflect the socio-economic conditions of the population concerned. Other results have been obtained from government source, to learn about the economic situations of the individual regions, for this reason the GDP was examined. Furthermore, there are important results regarding the parasanitary professions to which patients, for economic reasons, tend to refer. CONCLUSIONS This study will surely be an excellent starting point to investigate professional abuse and above all to assess the needs of the different regions.
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Affiliation(s)
- Luca Fiorillo
- Department of Biomedical and Dental Sciences, Morphological and Functional Imaging, School of Dentistry, G. Martino Polyclinic, University of Messina, Messina, Italy -
| | - Gabriele Cervino
- Department of Biomedical and Dental Sciences, Morphological and Functional Imaging, School of Dentistry, G. Martino Polyclinic, University of Messina, Messina, Italy
| | - Rosa De Stefano
- Department of Biomedical and Dental Sciences, Morphological and Functional Imaging, School of Dentistry, G. Martino Polyclinic, University of Messina, Messina, Italy
| | - Gaetano Iannello
- Department of Biomedical and Dental Sciences, Morphological and Functional Imaging, School of Dentistry, G. Martino Polyclinic, University of Messina, Messina, Italy
| | - Marco Cicciù
- Department of Biomedical and Dental Sciences, Morphological and Functional Imaging, School of Dentistry, G. Martino Polyclinic, University of Messina, Messina, Italy
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