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Malik A, Vu PD, Cohen AS, Bansal V, Cowan MR, Blazek GM, Champagne-Langabeer T. "I Just Don't Feel Heard": A Case Study on Opioid Use Disorder and Pain Management. J Pain Palliat Care Pharmacother 2023; 37:308-313. [PMID: 37640434 DOI: 10.1080/15360288.2023.2250340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 06/09/2023] [Accepted: 08/06/2023] [Indexed: 08/31/2023]
Abstract
The nation's opioid epidemic requires a paradigm shift in the way patients with co-occurring opioid use disorder are treated during episodes of acute pain. Patients are often introduced to prescription opioids after an extremity fracture or sprain or resulting from musculoskeletal back, abdominal, or dental pain. Opioid naive patients who receive their first opioid prescription on discharge from the emergency department may be more likely to develop chronic opioid use compared to patients receiving non-opioid pain medications. This case report will highlight one patient's journey including initial prescription opioid use, escalation into illicit opioids, entry to a recovery and treatment program, discussions with her physician about alternative therapies, and barriers to satisfactory pain relief. A shared decision-making model will be explored.
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Affiliation(s)
- Aila Malik
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, UTHealth Houston, Fannin, Houston, Texas, USA
| | - Peter D Vu
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, UTHealth Houston, Fannin, Houston, Texas, USA
| | - A Sarah Cohen
- Houston ER Opioid System (HEROES), School of Biomedical Informatics, UTHealth Houston, Fannin, Houston, Texas, USA
| | - Vishal Bansal
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, UTHealth Houston, Fannin, Houston, Texas, USA
| | - Morgan R Cowan
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, UTHealth Houston, Fannin, Houston, Texas, USA
| | - Gregory M Blazek
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, UTHealth Houston, Fannin, Houston, Texas, USA
| | - Tiffany Champagne-Langabeer
- Houston ER Opioid System (HEROES), School of Biomedical Informatics, UTHealth Houston, Fannin, Houston, Texas, USA
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Tata V, Al Saadi R, Cho SK, Varisco TJ, Wanat M, Thornton JD. Physician perspective on the implementation of risk mitigation strategies when prescribing opioid medications: a qualitative analysis. BMC Health Serv Res 2023; 23:1185. [PMID: 37907915 PMCID: PMC10617230 DOI: 10.1186/s12913-023-10136-z] [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: 01/13/2023] [Accepted: 10/12/2023] [Indexed: 11/02/2023] Open
Abstract
OBJECTIVE To understand the physician perspective on the barriers and facilitators of implementing nine different opioid risk mitigation strategies (RMS) when prescribing opioid medications. METHODS We created and dispersed a cross-sectional online survey through the Qualtrics© data collection platform among a nationwide sample of physicians licensed to practice medicine in the United States who have prescribed an opioid medication within the past year. The responses were analyzed using a deductive thematic analysis approach based on the Consolidated Framework for Implementation Research (CFIR) to ensure a holistic approach to identifying the barriers and facilitators for each RMS assessed. In concordance with this method, the themes and codes for the thematic analysis were defined prior to the analysis. The five domains within the CFIR were used as themes and the 39 nested constructs were treated as the codes. Two members of the research team independently coded the transcripts and discussed points of disagreement until consensus was reached. All analyses were conducted in ATLAS.ti© V7. RESULTS The completion rate for this survey was 85.1% with 273 participant responses eligible for analysis. Intercoder reliability was calculated to be 82%. Deductive thematic analysis yielded 2,077 descriptions of factors affecting implementation of the nine RMS. The most salient code across all RMS was Knowledge and Beliefs about the Intervention, which refers to individuals' attitudes towards and value placed on the intervention. Patient Needs and Resources, a code referring to the extent to which patient needs are known and prioritized by the organization, also emerged as a salient code. The physicians agreed that the patient perspective on the issue is vital to the uptake of each of the RMS. CONCLUSIONS This deductive thematic analysis identified key points for actionable intervention across the nine RMS assessed and established the importance of patient concordance with physicians when deciding on a course of treatment.
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Affiliation(s)
- Vaishnavi Tata
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, 4349 Martin Luther King Jr. Blvd, Houston, TX, 77204, USA.
- Prescription Drug Misuse and Education Research (PREMIER) Center, University of Houston College of Pharmacy, Houston, TX, 77204, USA.
| | - Randa Al Saadi
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, 4349 Martin Luther King Jr. Blvd, Houston, TX, 77204, USA.
- Prescription Drug Misuse and Education Research (PREMIER) Center, University of Houston College of Pharmacy, Houston, TX, 77204, USA.
| | - Sang Kyu Cho
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, 4349 Martin Luther King Jr. Blvd, Houston, TX, 77204, USA
- Prescription Drug Misuse and Education Research (PREMIER) Center, University of Houston College of Pharmacy, Houston, TX, 77204, USA
| | - Tyler J Varisco
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, 4349 Martin Luther King Jr. Blvd, Houston, TX, 77204, USA
- Prescription Drug Misuse and Education Research (PREMIER) Center, University of Houston College of Pharmacy, Houston, TX, 77204, USA
| | - Matthew Wanat
- Prescription Drug Misuse and Education Research (PREMIER) Center, University of Houston College of Pharmacy, Houston, TX, 77204, USA
- College of Pharmacy, Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, TX, 77204, USA
| | - J Douglas Thornton
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, 4349 Martin Luther King Jr. Blvd, Houston, TX, 77204, USA
- Prescription Drug Misuse and Education Research (PREMIER) Center, University of Houston College of Pharmacy, Houston, TX, 77204, USA
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Champagne-Langabeer T, Cardenas-Turanzas M, Ugalde IT, Bakos-Block C, Stotts AL, Cleveland L, Shoptaw S, Langabeer JR. The Impact of Pediatric Opioid-Related Visits on U.S. Emergency Departments. CHILDREN 2022; 9:children9040524. [PMID: 35455568 PMCID: PMC9030094 DOI: 10.3390/children9040524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/25/2022] [Accepted: 03/31/2022] [Indexed: 11/16/2022]
Abstract
Background: While there is significant research exploring adults’ use of opioids, there has been minimal focus on the opioid impact within emergency departments for the pediatric population. Methods: We examined data from the Agency for Healthcare Research, the National Emergency Department Sample (NEDS), and death data from the Centers for Disease Control and Prevention. Sociodemographic and financial variables were analyzed for encounters during 2014–2017 for patients under age 18, matching diagnoses codes for opioid-related overdose or opioid use disorder. Results: During this period, 59,658 children presented to an ED for any diagnoses involving opioids. The majority (68.5%) of visits were related to overdoses (poisoning), with a mean age of 11.3 years and a majority female (53%). There was a curvilinear relationship between age and encounters, with teens representing the majority of visits, followed by infants. The highest volume was seen in the Southern U.S., with over 58% more opioid visits than the next highest region (Midwest). Charges exceeded USD 157 million, representing 2% of total ED costs, with Medicaid responsible for 54% of the total. Conclusions: With increases in substance use among children, there is a growing need for pediatric emergency physicians to recognize, refer, and initiate treatments.
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Affiliation(s)
- Tiffany Champagne-Langabeer
- Center for Health Systems Analytics, School of Biomedical Informatics, The University of Texas Health Science Center at Houston (UTHealth Houston), Houston, TX 77030, USA; (M.C.-T.); (C.B.-B.); (J.R.L.)
- Correspondence:
| | - Marylou Cardenas-Turanzas
- Center for Health Systems Analytics, School of Biomedical Informatics, The University of Texas Health Science Center at Houston (UTHealth Houston), Houston, TX 77030, USA; (M.C.-T.); (C.B.-B.); (J.R.L.)
| | - Irma T. Ugalde
- Department of Emergency Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth Houston), Houston, TX 77030, USA;
| | - Christine Bakos-Block
- Center for Health Systems Analytics, School of Biomedical Informatics, The University of Texas Health Science Center at Houston (UTHealth Houston), Houston, TX 77030, USA; (M.C.-T.); (C.B.-B.); (J.R.L.)
| | - Angela L. Stotts
- Department of Family and Community Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth Houston), Houston, TX 77030, USA;
| | - Lisa Cleveland
- UTHealth San Antonio, School of Nursing, San Antonio, TX 78229, USA;
| | - Steven Shoptaw
- Center for Behavioral and Addiction Medicine, Department of Family Medicine, University of California, Los Angeles, CA 90024, USA;
| | - James R. Langabeer
- Center for Health Systems Analytics, School of Biomedical Informatics, The University of Texas Health Science Center at Houston (UTHealth Houston), Houston, TX 77030, USA; (M.C.-T.); (C.B.-B.); (J.R.L.)
- Department of Emergency Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth Houston), Houston, TX 77030, USA;
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Gottlieb A, Bakos-Block C, Langabeer JR, Champagne-Langabeer T. Sociodemographic and Clinical Characteristics Associated with Improvements in Quality of Life for Participants with Opioid Use Disorder. Healthcare (Basel) 2022; 10:healthcare10010167. [PMID: 35052330 PMCID: PMC8775674 DOI: 10.3390/healthcare10010167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/14/2022] [Accepted: 01/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The Houston Emergency Opioid Engagement System was established to create an access pathway into long-term recovery for individuals with opioid use disorder. The program determines effectiveness across multiple dimensions, one of which is by measuring the participant’s reported quality of life (QoL) at the beginning of the program and at successive intervals. Methods: A visual analog scale was used to measure the change in QoL among participants after joining the program. We then identified sociodemographic and clinical characteristics associated with changes in QoL. Results: 71% of the participants (n = 494) experienced an increase in their QoL scores, with an average improvement of 15.8 ± 29 points out of a hundred. We identified 10 factors associated with a significant change in QoL. Participants who relapsed during treatment experienced minor increases in QoL, and participants who attended professional counseling experienced the largest increases in QoL compared with those who did not. Conclusions: Insight into significant factors associated with increases in QoL may inform programs on areas of focus. The inclusion of counseling and other services that address factors such as psychological distress were found to increase participants’ QoL and success in recovery.
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Affiliation(s)
- Assaf Gottlieb
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, 7000 Fannin St., Houston, TX 77030, USA; (A.G.); (C.B.-B.); (J.R.L.)
| | - Christine Bakos-Block
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, 7000 Fannin St., Houston, TX 77030, USA; (A.G.); (C.B.-B.); (J.R.L.)
| | - James R. Langabeer
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, 7000 Fannin St., Houston, TX 77030, USA; (A.G.); (C.B.-B.); (J.R.L.)
- McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin St., Houston, TX 77030, USA
| | - Tiffany Champagne-Langabeer
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, 7000 Fannin St., Houston, TX 77030, USA; (A.G.); (C.B.-B.); (J.R.L.)
- Correspondence:
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Martinotti G, Merino Del Villar C, Garcia Cordoba A, Andrés Tubau L, Castro Sánchez I, Di Carlo F, Chiappini S, Pettorruso M, Schifano F, Di Giannantonio M. Club Drugs and Psychiatric Sequelae: An Issue of Vulnerability and Previous Psychiatric History. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136944. [PMID: 34209645 PMCID: PMC8297170 DOI: 10.3390/ijerph18136944] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/26/2021] [Accepted: 06/27/2021] [Indexed: 11/16/2022]
Abstract
The pursuit of pleasure among clubbers and disco-goers often involves drug use. However, whether substance use may represent a relevant risk factor contributing to the development of psychiatric symptoms and of mental illness remains debated. The purposes of this study were to evaluate the percentage of subjects who developed long-lasting psychiatric symptoms in a sample of subjects reporting use of substances in nightclubs, and to evaluate the role of a previous psychiatric diagnosis in these subjects. Data were collected during three consecutive years in dedicated nursing units inside all the nightclubs of Ibiza, in emergency hospital rooms at the Can Misses Hospital and inside the psychiatric ward. A total of 10,163 subjects required medical assistance inside discos in the medical-nursing units, of which 223 required transfers to hospital emergency rooms. Of these, 110 required subsequent psychiatric hospitalization. Ninety-one (82.7%) of these patients had a positive psychiatric history, which was also found in thirty-one of the 113 subjects (27.4%) not requiring psychiatric hospitalization. Negative psychiatric history was negatively associated with hospitalization (Coefficient = −2.574; p = 0.000) and for subjects with a negative psychiatric history the odds to be hospitalized changed by a factor of 0.076. Gender, age, civil status and nationality were not significant predictors of hospitalization. Overall, the number of subjects who developed major psychiatric disorders appeared to be limited. However, the presence of a psychiatric history here played a crucial role. Club drugs are therefore able to induce psychiatric sequelae requiring hospitalization mainly in subjects who are already vulnerable from a psychopathological point of view.
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Affiliation(s)
- Giovanni Martinotti
- Department of Neuroscience, Imaging, Clinical Sciences, University G. d’Annunzio, 66100 Chieti-Pescara, Italy; (F.D.C.); (S.C.); (M.P.); (M.D.G.)
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire AL10 9EU, UK;
- Correspondence:
| | | | - Andrés Garcia Cordoba
- Emergency Staff Group, Calle Pere Francés 43, 07800 Eivissa, Illes Balears, Spain; (A.G.C.); (L.A.T.); (I.C.S.)
| | - Lluís Andrés Tubau
- Emergency Staff Group, Calle Pere Francés 43, 07800 Eivissa, Illes Balears, Spain; (A.G.C.); (L.A.T.); (I.C.S.)
| | - Ivan Castro Sánchez
- Emergency Staff Group, Calle Pere Francés 43, 07800 Eivissa, Illes Balears, Spain; (A.G.C.); (L.A.T.); (I.C.S.)
- Plan Municipal Sobre Drogas, Ayuntamiento de Ibiza, Carrer de Canàries, 35-Edif. CETIS, 1r piso, 07800 Eivissa, Illes Balears, Spain
| | - Francesco Di Carlo
- Department of Neuroscience, Imaging, Clinical Sciences, University G. d’Annunzio, 66100 Chieti-Pescara, Italy; (F.D.C.); (S.C.); (M.P.); (M.D.G.)
| | - Stefania Chiappini
- Department of Neuroscience, Imaging, Clinical Sciences, University G. d’Annunzio, 66100 Chieti-Pescara, Italy; (F.D.C.); (S.C.); (M.P.); (M.D.G.)
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire AL10 9EU, UK;
| | - Mauro Pettorruso
- Department of Neuroscience, Imaging, Clinical Sciences, University G. d’Annunzio, 66100 Chieti-Pescara, Italy; (F.D.C.); (S.C.); (M.P.); (M.D.G.)
| | - Fabrizio Schifano
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire AL10 9EU, UK;
| | - Massimo Di Giannantonio
- Department of Neuroscience, Imaging, Clinical Sciences, University G. d’Annunzio, 66100 Chieti-Pescara, Italy; (F.D.C.); (S.C.); (M.P.); (M.D.G.)
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