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Gillies MB, Chidwick K, Bharat C, Camacho X, Currow D, Gisev N, Degenhardt L, Pearson SA. Long-term prescribed opioid use after hospitalization or emergency department presentation among opioid naïve adults (2014-2020)-A population-based descriptive cohort study. Br J Clin Pharmacol 2024. [PMID: 38803009 DOI: 10.1111/bcp.16093] [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: 01/19/2024] [Revised: 03/26/2024] [Accepted: 04/10/2024] [Indexed: 05/29/2024] Open
Abstract
AIMS The aim of this work is to describe opioid initiation and long-term use after emergency department (ED) visits or hospitalizations in New South Wales, Australia, by patient, admission and clinical characteristics. METHODS This is a population-based cohort study, including all hospitalizations and ED visits between 2014 and 2020, linked to medicine dispensings, deaths and cancer registrations (Medicines Intelligence Data Platform), among adults with no opioid dispensings in the previous year. Outcome measures were opioid initiations (dispensed within 7 days of discharge) and long-term use (90 days of continuous exposure, 90-270 days after initiation). RESULTS The cohort included 16 153 096 admissions by 4.2 million opioid-naïve adults; 39.0% were ED presentations without hospital admission, 16.8% hospital admissions via ED and 44.2% direct hospital admissions. Opioids were initiated post-discharge for 6.2% of ED, 8.3% of hospital via ED and 10.0% of direct hospital admissions; of these 1.0%, 2.5% and 0.5% progressed to long-term opioid use, respectively. Initiation was lowest in obstetric admissions without surgery (1.0%), and highest among trauma admissions (25.4%), obstetric admissions with surgical intervention (19.8%) and non-trauma surgical admissions (12.0%). Long-term use was highest among medical admissions via ED (3.5%), trauma admissions (2.3%) and ED alone (1.0%). From 2014 to 2020, overall opioid initiations decreased 16% from 8.7% to 7.2%, and long-term opioid use decreased 33% from 1.3% to 0.8%. CONCLUSIONS Both opioid initiation and long-term use decreased over time; however, the higher rates of long-term use following trauma, and medical admissions via ED, warrant further surveillance. Strategies supporting appropriate prescribing and access to multidisciplinary pain services will facilitate best practice care.
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Affiliation(s)
- Malcolm B Gillies
- Medicines Intelligence Research Program, School of Population Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Kendal Chidwick
- National Drug and Alcohol Research Centre, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Chrianna Bharat
- National Drug and Alcohol Research Centre, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Ximena Camacho
- Medicines Intelligence Research Program, School of Population Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - David Currow
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Natasa Gisev
- National Drug and Alcohol Research Centre, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Sallie-Anne Pearson
- Medicines Intelligence Research Program, School of Population Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia
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Poeran J, Park CH. Postpartum Opioid Prescribing and Persistent Use in Western Countries. Anesth Analg 2024; 138:967-969. [PMID: 38621284 DOI: 10.1213/ane.0000000000006953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Affiliation(s)
- Jashvant Poeran
- From the Departments of Orthopaedic Surgery
- Anesthesiology, Perioperative and Pain Medicine
- Medicine, Institute for Healthcare Delivery Science
- Departments of Population Health Science & Policy
| | - Chang H Park
- Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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Koch FC, Olivier J, Brett J, Buckley NA, Gisev N, Pearson S, Daniels B. The impact of tightened prescribing restrictions for PBS-subsidised opioid medicines and the introduction of half-pack sizes, Australia, 2020-21: an interrupted time series analysis. Med J Aust 2024; 220:315-322. [PMID: 38522006 DOI: 10.5694/mja2.52257] [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: 05/05/2023] [Accepted: 09/12/2023] [Indexed: 03/25/2024]
Abstract
OBJECTIVES To evaluate the impact of the tightened Pharmaceutical Benefits Scheme (PBS) prescribing rules for immediate release (IR) and controlled release (CR) opioid medicines (1 June 2020), which also eliminated repeat dispensing without authorisation for codeine/paracetamol and tramadol IR and introduced half-pack size item codes for IR formulations. DESIGN, SETTING Population-based interrupted time series analysis of PBS dispensing data claims for a 10% sample of PBS-eligible residents and IQVIA national opioid medicine sales data (PBS-subsidised and private prescriptions), 28 May 2018 - 6 June 2021. MAIN OUTCOME MEASURES Mean amount of PBS-subsidised opioid medicines dispensed per day and mean overall amount sold per day - each expressed as oral morphine equivalent milligrams (OME) - overall, by formulation type (IR, CR), and by specific formulation. RESULTS During the twelve months following the PBS changes, daily PBS-subsidised opioid medicine dispensing was 81 565 OME lower (95% CI, -106 146 to -56 984 OME) than the mean daily level for 2018-20, a decline of 3.8% after adjusting for the pre-intervention trend; the relative reduction was greater for IR (8.4%) than CR formulations (2.6%). Total daily sales of all, IR formulation, and CR formulation opioid medicines did not change significantly after the PBS changes. Repeat dispensing of prescriptions comprised 7.4% of PBS-subsidised opioid dispensing before 1 June 2020, and 1.3% after the changes. Half-pack sizes comprised 8.4% of PBS-subsidised IR opioid medicine dispensing and 2.8% of all opioid medicines sold in the twelve months after the PBS changes. CONCLUSIONS The introduction of new PBS rules for subsidised opioid medicines was followed by a decline in PBS-subsidised dispensing. Some people may have bypassed the new restrictions by switching to private prescriptions, but our findings suggest that opioid medicine use in Australia declined as a result of the new restrictions.
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Affiliation(s)
| | - Jake Olivier
- University of New South Wales, Sydney, NSW
- Transport and Road Safety Research Centre, University of New South Wales, Sydney, NSW
| | | | | | - Natasa Gisev
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW
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Zajacova A, Pereira Filho A, Limani M, Grol-Prokopczyk H, Zimmer Z, Scherbakov D, Fillingim RB, Hayward MD, Gilron I, Macfarlane GJ. Self-Reported Pain Treatment Practices Among U.S. and Canadian Adults: Findings From a Population Survey. Innov Aging 2023; 7:igad103. [PMID: 38094928 PMCID: PMC10714903 DOI: 10.1093/geroni/igad103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Indexed: 02/01/2024] Open
Abstract
Background and Objectives Pain treatments and their efficacy have been studied extensively. Yet surprisingly little is known about the types of treatments, and combinations of treatments, that community-dwelling adults use to manage pain, as well as how treatment types are associated with individual characteristics and national-level context. To fill this gap, we evaluated self-reported pain treatment types among community-dwelling adults in the United States and Canada. We also assessed how treatment types correlate with individuals' pain levels, sociodemographic characteristics, and country of residence, and identified unique clusters of adults in terms of treatment combinations. Research Design and Methods We used the 2020 "Recovery and Resilience" United States-Canada general online survey with 2 041 U.S. and 2 072 Canadian community-dwelling adults. Respondents selected up to 10 pain treatment options including medication, physical therapy, exercise, etc., and an open-ended item was available for self-report of any additional treatments. Data were analyzed using descriptive, regression-based, and latent class analyses. Results Over-the-counter (OTC) medication was reported most frequently (by 55% of respondents, 95% CI 53%-56%), followed by "just living with pain" (41%, 95% CI 40%-43%) and exercise (40%, 95% CI 38%-41%). The modal response (29%) to the open-ended item was cannabis use. Pain was the most salient correlate, predicting a greater frequency of all pain treatments. Country differences were generally small; a notable exception was alcohol use, which was reported twice as often among U.S. versus Canadian adults. Individuals were grouped into 5 distinct clusters: 2 groups relied predominantly on medication (prescription or OTC), another favored exercise and other self-care approaches, one included adults "just living with" pain, and the cluster with the highest pain levels employed all modalities heavily. Discussion and Implications Our findings provide new insights into recent pain treatment strategies among North American adults and identify population subgroups with potentially unmet need for more adaptive and effective pain management.
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Affiliation(s)
- Anna Zajacova
- Department of Sociology, University of Western Ontario, London, Ontario, Canada
| | - Alvaro Pereira Filho
- Department of Political Science, University of Western Ontario, London, Ontario, Canada
| | - Merita Limani
- Department of Sociology, University of Western Ontario, London, Ontario, Canada
| | - Hanna Grol-Prokopczyk
- Department of Sociology, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Zachary Zimmer
- Department of Family Studies and Gerontology, Global Aging and Community Initiative, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Dmitry Scherbakov
- Integrative Pain Laboratory, School of Public Health, University of Haifa, Haifa, Israel
| | - Roger B Fillingim
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, Florida, USA
| | - Mark D Hayward
- Department of Sociology, University of Texas at Austin, Austin, Texas, USA
| | - Ian Gilron
- Department of Anesthesiology and Perioperative Medicine, Queens University, Kingston, Ontario, Canada
| | - Gary J Macfarlane
- Department of Epidemiology, Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
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Jones D. Location, location, location: The variable geography of opioid use and misuse. Anaesth Intensive Care 2023; 51:316-320. [PMID: 37340681 DOI: 10.1177/0310057x231172999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Affiliation(s)
- David Jones
- Department of Anaesthesia and Pain Clinic, Dunedin Hospital, Dunedin, New Zealand
- Department of Surgical Sciences, University of Otago, Dunedin, New Zealand
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Salikhanov I, Connor SR, Kunirova G, Khashagulgova F, Nazarova G, Crape BL, Katapodi MC. Challenges for Developing Palliative Care Services in Resource- Limited Settings of Kazakhstan. Public Health Rev 2023; 44:1605672. [PMID: 37671066 PMCID: PMC10476099 DOI: 10.3389/phrs.2023.1605672] [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: 12/08/2022] [Accepted: 07/28/2023] [Indexed: 09/07/2023] Open
Abstract
Background: Approximately 40 million people in need of palliative care worldwide, while 80% of them live in low- and middle-income countries. Kazakhstan, a low-to middle-income country with a reforming healthcare system, is committed to improving quality and accessibility of care for its 100,000 terminal patients in need of palliative care. Policy Options and Recommendations: To join the group of countries where palliative care is available, accessible, and affordable, Kazakhstan must integrate palliative services into the mainstream healthcare system at all levels, from primary healthcare to hospices, and from major cities to remote villages. Based on the evidence thoroughly collected directly from the Ministry of Health, authors propose a feasible set of recommendations regarding palliative policy, pain relief, infrastructure, workforce, and education, which could be implemented in LMICs beyond Kazakhstan. Conclusion: This study presents an analysis of challenges, recent developments, and needs of palliative care in Kazakhstan, including funding, policy, workforce, education, and infrastructure, providing an evidence base and recommendations for future development of palliative care in Kazakhstan and in other LMICs.
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Affiliation(s)
- Islam Salikhanov
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Stephen R. Connor
- Worldwide Hospice Palliative Care Alliance, Fairfax, VA, United States
| | | | | | | | | | - Maria C. Katapodi
- Department of Clinical Research, University of Basel, Basel, Switzerland
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Salazar A, Moreno-Pulido S, Prego-Meleiro P, Henares-Montiel J, Pulido J, Donat M, Sotres-Fernandez G, Sordo L. Correlation Between Opioid Drug Prescription and Opioid-Related Mortality in Spain as a Surveillance Tool: Ecological Study. JMIR Public Health Surveill 2023; 9:e43776. [PMID: 37379061 PMCID: PMC10365608 DOI: 10.2196/43776] [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: 10/24/2022] [Revised: 05/08/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Opioid drug prescription (ODP) and opioid-related mortality (ORM) have increased in Spain. However, their relationship is complex, as ORM is registered without considering the type of opioid (legal or illegal). OBJECTIVE This ecological study aimed to examine the correlation between ODP and ORM in Spain and discuss their usefulness as a surveillance tool. METHODS This was an ecological descriptive study using retrospective annual data (2000-2019) from the Spanish general population. Data were collected from people of all ages. Information on ODP was obtained from the Spanish Medicines Agency in daily doses per 1000 inhabitants per day (DHD) for total ODP, total ODP excluding those with better safety protocols (codeine and tramadol), and each opioid drug separately. Rates of ORM (per 1,000,000 inhabitants) were calculated based on deaths registered (International Classification of Diseases, 10th Revision codes) as opioid poisoning by the National Statistics Institute, derived from the drug data recorded by medical examiners in death certificates. Opioid-related deaths were considered to be those that indicated opioid consumption (accidental, infringed, or self-inflicted) as the main cause of death: death due to accidental poisoning (X40-X44), intentional self-inflicted poisoning (X60-X64), drug-induced aggression (X85), and poisoning of undetermined intention (Y10-Y14). A descriptive analysis was carried out, and correlations between the annual rates of ORM and DHD of the prescribed opioid drugs globally, excluding medications of the least potential risk of overdose and lowest treatment tier, were analyzed using Pearson linear correlation coefficient. Their temporal evolution was analyzed using cross-correlations with 24 lags and the cross-correlation function. The analyses were carried out using Stata and StatGraphics Centurion 19. RESULTS The rate of ORM (2000-2019) ranged between 14 and 23 deaths per 1,000,000 inhabitants, with a minimum in 2006 and an increasing trend starting in 2010. The ODP ranged between 1.51 to 19.94 DHD. The rates of ORM were directly correlated with the DHD of total ODP (r=0.597; P=.006), total ODP without codeine and tramadol (r=0.934; P<.001), and every prescribed opioid except buprenorphine (P=.47). In the time analysis, correlations between DHD and ORM were observed in the same year, although not statistically significant (all P≥.05). CONCLUSIONS There is a correlation between greater availability of prescribed opioid drugs and an increase in opioid-related deaths. The correlation between ODP and ORM may be a useful tool in monitoring legal opiates and possible disturbances in the illegal market. The role of tramadol (an easily prescribed opioid) is important in this correlation, as is that of fentanyl (the strongest opioid). Measures stronger than recommendations need to be taken to reduce off-label prescribing. This study shows that not only is opioid use directly related to the prescribing of opioid drugs above what is desirable but also an increase in deaths.
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Affiliation(s)
- Alejandro Salazar
- Observatory of Pain, University of Cádiz, Cádiz, Spain
- Biomedical Research and Innovation Institute of Cádiz (INiBICA), Research Unit, Puerta del Mar University Hospital, University of Cadiz, Cádiz, Spain
- Department of Statistics and Operational Research, University of Cádiz, Puerto Real, Spain
| | | | - Pablo Prego-Meleiro
- Department of Public Health and Maternal-Child Health, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
- Department of Analytical Chemistry, Physical Chemistry and Chemical Engineering, Faculty of Pharmacy, University of Alcalá, Alcalá de Henares, Spain
| | - Jesús Henares-Montiel
- Center for Biomedical Research in Epidemiology and Public Health (CIBER), Madrid, Spain
- Andalusian School of Public Health, Granada, Spain
| | - José Pulido
- Department of Public Health and Maternal-Child Health, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
- Center for Biomedical Research in Epidemiology and Public Health (CIBER), Madrid, Spain
| | - Marta Donat
- National School of Health, Salud Carlos III Health Institute, Madrid, Spain
| | - Gabriel Sotres-Fernandez
- Oncology Department, Hospital Quirón Salud, Madrid, Spain
- Department of Medicine, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Luis Sordo
- Department of Public Health and Maternal-Child Health, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
- Center for Biomedical Research in Epidemiology and Public Health (CIBER), Madrid, Spain
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8
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McFadden LM. Changes in buprenorphine visits in frontier and remote locations: Effects of the SARS-CoV-2 pandemic. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 7:100155. [PMID: 37065774 PMCID: PMC10052936 DOI: 10.1016/j.dadr.2023.100155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/28/2023] [Accepted: 03/28/2023] [Indexed: 03/31/2023]
Abstract
Background The pandemic has changed many aspects of healthcare, including the treatment of people with opioid use disorder with buprenorphine. Prior to the pandemic, rural health disparities existed in the accessibility of this treatment. Rural and frontier areas of the United States, particularly the Great Plains, had few or no providers of this evidence-based treatment. This study aimed to investigate how access to buprenorphine changed in the Great Plains during the pandemic. Methods This retrospective observational study compared the number of weekly patient appointments resulting in a buprenorphine prescription for 55 weeks before the start of the SARS-CoV-2 pandemic and 55 weeks after. Electronic health records of the largest rural health provider in the Great Plains were queried. Patients were categorized as coming from a frontier location or a non-frontier location based on the home address provided at the visit. The USDA defines frontier as communities that are small and distant from urban centers. Time series analysis was utilized to understand changes in weekly visits during this period. Results A significant increase in weekly buprenorphine visits occurred after the pandemic's start. Further, females and people from frontier locations had significantly higher numbers of buprenorphine visits. Conclusions In an area of the country with low pre-existing access to buprenorphine treatment for opioid use disorder, increases in buprenorphine visits were found after the pandemic began. This was particularly true of females who reside in frontier areas. Pandemic-related changes may have reduced barriers to this critical treatment, especially among rural populations.
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Affiliation(s)
- Lisa M. McFadden
- University of South Dakota, 414 E. Clark Street, Vermillion, SD 57069, USA
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Robert M, Jouanjus E, Khouri C, Fouilhé Sam-Laï N, Revol B. The opioid epidemic: A worldwide exploratory study using the WHO pharmacovigilance database. Addiction 2023; 118:771-775. [PMID: 36331523 DOI: 10.1111/add.16081] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND AIMS The current opioid epidemic in the United States began 20 years ago and has become the leading cause of accidental deaths in the country. This crisis prompted us to explore trends in opioid abuse and dependence worldwide. We sought to identify other countries at high-risk of opioid use disorders, using the World Health Organization's (WHO) pharmacovigilance database. METHODS We performed a disproportionality analysis using VigiBase, the WHO Global Individual Case Safety Report (ICSR) database. Five opioids used worldwide were included: oxycodone, fentanyl, morphine, tramadol, and codeine. We extracted all ICSRs associated with the drugs of interest, considered as suspect medication and recorded up until 5 June 2021, using the narrow Standardised MedDRA Query (SMQ) for drug abuse and dependence. Countries with at least one ICSR for each of the five opioids were retained. The relationship between the use of a drug (i.e. an opioid) and the occurrence of an adverse drug reaction (i.e. drug abuse and dependence) for each country was assessed by calculating the information component (IC) and its 99.9% CI [IC0005 ; IC9995 ], using a quasi-Bayesian confidence propagation neural network (BCPNN). A hierarchical cluster analysis (Ward's method) of the IC0005 value for each of the five opioids was performed to identify subgroups of countries with similar reported risks of opioid abuse and dependence. RESULTS Among 21 countries, the optimal number of clusters was calculated to be four, each with a Jaccard index >0.5 (0.95, 0.78, 0.65 and 0.75, respectively). Six countries with the highest signals of drug abuse and dependence were identified in cluster 1, with significant CIs for the five opioids of interest (IC0005 > 0), ranging from 0.9 to 5.8 for the lower endpoint. CONCLUSIONS There appear to be four distinct clusters of countries with similar opioid abuse and dependence profiles. The group with the highest reported risk for the opioids oxycodone, fentanyl, morphine, tramadol and codeine includes Australia, Canada, France, Germans, the United Kingdom and the United States.
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Affiliation(s)
- Marion Robert
- Addictovigilance Department, Grenoble Alpes University Hospital, Grenoble, France.,Pharmacovigilance Department, Grenoble Alpes University Hospital, Grenoble, France
| | - Emilie Jouanjus
- Addictovigilance Department, Toulouse University Hospital, Toulouse, France.,INSERM Unit 1027, Toulouse III University, Toulouse, France
| | - Charles Khouri
- Pharmacovigilance Department, Grenoble Alpes University Hospital, Grenoble, France.,INSERM Unit 1300, HP2 Laboratory, Grenoble Alpes University, Grenoble, France
| | - Nathalie Fouilhé Sam-Laï
- Addictovigilance Department, Grenoble Alpes University Hospital, Grenoble, France.,Pharmacovigilance Department, Grenoble Alpes University Hospital, Grenoble, France
| | - Bruno Revol
- Addictovigilance Department, Grenoble Alpes University Hospital, Grenoble, France.,Pharmacovigilance Department, Grenoble Alpes University Hospital, Grenoble, France.,INSERM Unit 1300, HP2 Laboratory, Grenoble Alpes University, Grenoble, France
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10
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Eufemio CM, Hagedorn JD, McCall KL, Piper BJ. An Analysis of Oxycodone and Hydrocodone Distribution Trends in Delaware, Maryland, and Virginia Between 2006 and 2014. Cureus 2023; 15:e38211. [PMID: 37252511 PMCID: PMC10224754 DOI: 10.7759/cureus.38211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2023] [Indexed: 05/31/2023] Open
Abstract
Objective Opioid medications are widely recognized for their use in analgesia and their addictive properties that have led to the opioid epidemic. Areas with historically high prescribing patterns have been shown to suffer more from the crisis. There is also regional variability in these trends. This study is a county level analysis of oxycodone and hydrocodone use in Delaware, Maryland, and Virginia between 2006 and 2014. Materials and methods A retrospective analysis of oxycodone and hydrocodone distributed as collected by the Drug Enforcement Administration's (DEA) Washington Post Automation of Reports and Consolidated Orders System (ARCOS) in Delaware, Maryland, and Virginia. Raw drug weights in each county were adjusted to "daily average dose" (grams/county population/365) using publicly available population estimates for all state counties. Purchasing data collected from ARCOS was used to compare distribution trends during this period. This study was limited in that ARCOS report quantity of drug distribution rather than average dose of script written. Results There was a 57.59% increase in the weight of oxycodone and hydrocodone prescribed between 2006 and 2014. Oxycodone prescriptions increased by 75.50% and hydrocodone by 11.05%. Oxycodone increased across all three states between 2006 and 2010 and declined until 2014. Hydrocodone also increased but to a lesser extent than oxycodone. There was substantial variability in daily average dose of both opioids at the county level in all states. Pharmacies accounted for largest portion of oxycodone (69.17%) and hydrocodone (75.27%) purchased in the region. Hospitals accounted for 26.67% of oxycodone and 22.76% of hydrocodone purchased. Practitioners and mid-level providers, including Nurse Practitioners and Physician Assistants, did not significantly contribute to this increase. Conclusion In the states of Maryland, Delaware, and Virginia, the distribution of the prescription opioids oxycodone and hydrocodone increased by 57.59%. Daily average dose increased between 2006 and 2010 in all three states, followed by a decline until 2014. Variability in daily average dose by county highlights the relationship between geography and likelihood of receiving high-dose opioids. Increased monitoring at regional health centers and improving substance abuse treatment infrastructure at the county level may be a more efficient strategy in combating the opioid epidemic. Future research is needed to understand the socioeconomic trends that may influence prescribing trends of opioid medications.
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Affiliation(s)
- Conor M Eufemio
- School of Medicine, Geisinger Commonwealth School of Medicine, Scranton, USA
| | - Joseph D Hagedorn
- School of Medicine, Geisinger Commonwealth School of Medicine, Scranton, USA
| | - Kenneth L McCall
- School of Pharmacy, University of New England, Biddeford, USA
- School of Pharmacy, Binghamton University, Johnson City, USA
| | - Brian J Piper
- Medical Education, Geisinger Commonwealth School of Medicine, Scranton, USA
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Dowd ME, Tang EJ, Yan KT, McCall KL, Piper BJ. Reductions and pronounced regional differences in morphine distribution in the United States. Res Social Adm Pharm 2023; 19:926-930. [PMID: 36894400 DOI: 10.1016/j.sapharm.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 02/27/2023] [Accepted: 03/02/2023] [Indexed: 03/07/2023]
Abstract
OBJECTIVES The purpose of this longitudinal study was to describe the temporal pattern of morphine distribution nationally and between states. METHODS Drug weight was obtained from Report 5 of the US Drug Enforcement Administration's Automation of Reports and Consolidated Orders System (ARCOS) to characterize patterns in the distribution of morphine from 2012 to 2021. Morphine distribution amounts were separated by state and business type and corrected for population. States outside a 95% confidence interval relative to the national average were considered statistically significant. KEY FINDINGS In 2012, there was a 4.6-fold difference in morphine distribution between the highest-prescribing state, Tennessee (180.2 mg/person), and the lowest-prescribing state, Texas (39.4 mg/person). By the end of 2021, national distribution of morphine had decreased by 59.9% when compared to the peak year 2012. In 2021, Tennessee (51.1 mg/person) remained the highest-prescribing state with a 3.0-fold difference relative to Texas (17.2 mg/person). The average hospital decrease (-73.9%) from 2012 to 2021 was larger than that of pharmacies (-58.2%). CONCLUSIONS The national 59.9% decline in morphine in the last decade may be attributable to prioritization of the US opioid crisis as a public concern. Further research is necessary to understand the persistent regional difference between states.
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Affiliation(s)
- Megan E Dowd
- Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | - E Jessica Tang
- Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | - Kurlya T Yan
- Geisinger Commonwealth School of Medicine, Scranton, PA, USA.
| | - Kenneth L McCall
- Binghamton University, Binghamton, NY, USA; University of New England, Portland, ME, USA
| | - Brian J Piper
- Geisinger Commonwealth School of Medicine, Scranton, PA, USA; Center for Pharmacy Innovation & Outcomes, Danville, PA, USA.
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12
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Liu EY, McCall KL, Piper BJ. Variation in adverse drug events of opioids in the United States. Front Pharmacol 2023; 14:1163976. [PMID: 37033633 PMCID: PMC10079914 DOI: 10.3389/fphar.2023.1163976] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 03/13/2023] [Indexed: 04/11/2023] Open
Abstract
Background: The United States (US) ranks high, nationally, in opioid consumption. The ongoing increase in the misuse and mortality amid the opioid epidemic has been contributing to its rising cost. The worsening health and economic impact of opioid use disorder in the US warrants further attention. We, therefore, assessed commonly prescribed opioids to determine the opioids that were over-represented versus under-represented for adverse drug events (ADEs) to better understand their distribution patterns using the Food and Drug Administration's Adverse Event Reporting System (FAERS) while correcting for distribution using the Drug Enforcement Administration's Automation of Reports and Consolidated Orders System (ARCOS). Comparing the ratio of the percentage of adverse drug events as reported by the FAERS relative to the percentage of distribution as reported by the ARCOS database is a novel approach to evaluate post-marketing safety surveillance and may inform healthcare policies and providers to better regulate the use of these opioids. Methods: We analyzed the adverse events for 11 prescription opioids, when correcting for distribution, and their ratios for three periods, 2006-2010, 2011-2016, and 2017-2021, in the US. The opioids include buprenorphine, codeine, fentanyl, hydrocodone, hydromorphone, meperidine, methadone, morphine, oxycodone, oxymorphone, and tapentadol. Oral morphine milligram equivalents (MMEs) were calculated by conversions relative to morphine. The relative ADEs of the selected opioids, opioid distributions, and ADEs relative to distribution ratios were analyzed for the 11 opioids. Results: Oxycodone, fentanyl, and morphine accounted for over half of the total number of ADEs (n = 667,969), while meperidine accounted for less than 1%. Opioid distributions were relatively constant over time, with methadone repeatedly accounting for the largest proportions. Many ADE-to-opioid distribution ratios increased over time, with meperidine (60.6), oxymorphone (11.1), tapentadol (10.3), and hydromorphone (7.9) being the most over-represented for ADEs in the most recent period. Methadone was under-represented (<0.20) in all the three periods. Conclusion: The use of the FAERS with the ARCOS provides insights into dynamic changes in ADEs of the selected opioids in the US. There is further need to monitor and address the ADEs of these drugs.
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Affiliation(s)
- Edward Y. Liu
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA, United States
- *Correspondence: Edward Y. Liu,
| | - Kenneth L. McCall
- Department of Pharmacy Practice, Binghamton University, Binghamton, NY, United States
| | - Brian J. Piper
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA, United States
- Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, PA, United States
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In between Opioid Crisis and the Need to Treat Pain, Where Do We Stand? J Crit Care Med (Targu Mures) 2022; 8:229-231. [DOI: 10.2478/jccm-2022-0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 10/29/2022] [Indexed: 11/13/2022] Open
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Inclusion of essential components of the World Health Organization palliative care development model in national palliative care plans: A documentary analysis in 31 countries. Health Policy 2022; 126:1144-1150. [PMID: 36127163 DOI: 10.1016/j.healthpol.2022.09.003] [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: 06/13/2022] [Revised: 08/13/2022] [Accepted: 09/10/2022] [Indexed: 11/21/2022]
Abstract
CONTEXT The World Health Organization has proposed a new model for the development of palliative care. Whether the current national palliative care plans of Member States are aligned or need to be reformed to meet the new model is unknown. METHODS We conducted a documentary analysis of national palliative care plans based on an analytic framework structured with the elements recommended by the World Health Organization: (a) building a plan, (b) plan components, and (c) plan implementation. We conducted a categorical analysis of national plans by subgroups according to income and development level of palliative care. FINDINGS We identified 112 countries with a palliative care plan, of which 31 were included in the analysis. Of these 31 plans, only 8 had the six components proposed by the World Health Organization, 29 reported an implementation strategy, 23 were aligned with the country's national public health plan, and 15 allocated financial resources for plan implementation. All the national plans assessed included the component provision of palliative care in integrated health services; 93%, education and training; 83%, research; 80%, empowered people and communities; 54%, health policies related to palliative care, and 48% use of essential medicines. CONCLUSIONS National palliative care plans include the two new development components, but few are fully aligned with the 2021 World Health Organization's model.
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Sales of Over-the-Counter Products Containing Codeine in 31 Countries, 2013–2019: A Retrospective Observational Study. Drug Saf 2022; 45:237-247. [DOI: 10.1007/s40264-021-01143-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 12/13/2022]
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