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Yaseliani M, Noor-E-Alam M, Hasan MM. Mitigating Sociodemographic Bias in Opioid Use Disorder Prediction: Fairness-Aware Machine Learning Framework. JMIR AI 2024; 3:e55820. [PMID: 39163597 PMCID: PMC11372321 DOI: 10.2196/55820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 06/22/2024] [Accepted: 06/29/2024] [Indexed: 08/22/2024]
Abstract
BACKGROUND Opioid use disorder (OUD) is a critical public health crisis in the United States, affecting >5.5 million Americans in 2021. Machine learning has been used to predict patient risk of incident OUD. However, little is known about the fairness and bias of these predictive models. OBJECTIVE The aims of this study are two-fold: (1) to develop a machine learning bias mitigation algorithm for sociodemographic features and (2) to develop a fairness-aware weighted majority voting (WMV) classifier for OUD prediction. METHODS We used the 2020 National Survey on Drug and Health data to develop a neural network (NN) model using stochastic gradient descent (SGD; NN-SGD) and an NN model using Adam (NN-Adam) optimizers and evaluated sociodemographic bias by comparing the area under the curve values. A bias mitigation algorithm, based on equality of odds, was implemented to minimize disparities in specificity and recall. Finally, a WMV classifier was developed for fairness-aware prediction of OUD. To further analyze bias detection and mitigation, we did a 1-N matching of OUD to non-OUD cases, controlling for socioeconomic variables, and evaluated the performance of the proposed bias mitigation algorithm and WMV classifier. RESULTS Our bias mitigation algorithm substantially reduced bias with NN-SGD, by 21.66% for sex, 1.48% for race, and 21.04% for income, and with NN-Adam by 16.96% for sex, 8.87% for marital status, 8.45% for working condition, and 41.62% for race. The fairness-aware WMV classifier achieved a recall of 85.37% and 92.68% and an accuracy of 58.85% and 90.21% using NN-SGD and NN-Adam, respectively. The results after matching also indicated remarkable bias reduction with NN-SGD and NN-Adam, respectively, as follows: sex (0.14% vs 0.97%), marital status (12.95% vs 10.33%), working condition (14.79% vs 15.33%), race (60.13% vs 41.71%), and income (0.35% vs 2.21%). Moreover, the fairness-aware WMV classifier achieved high performance with a recall of 100% and 85.37% and an accuracy of 73.20% and 89.38% using NN-SGD and NN-Adam, respectively. CONCLUSIONS The application of the proposed bias mitigation algorithm shows promise in reducing sociodemographic bias, with the WMV classifier confirming bias reduction and high performance in OUD prediction.
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Affiliation(s)
- Mohammad Yaseliani
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, United States
| | - Md Noor-E-Alam
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA, United States
- The Institute for Experiential AI, Northeastern University, Boston, MA, United States
| | - Md Mahmudul Hasan
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, United States
- Department of Information Systems and Operations Management, Warrington College of Business, University of Florida, Gainesville, FL, United States
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Sani AR, Zin CS. Factors Associated with an Increased Risk of Opioid Misuse Among Patients with Non-Cancer Pain in Malaysian Pain Clinic Settings. J Psychoactive Drugs 2024:1-11. [PMID: 39101200 DOI: 10.1080/02791072.2024.2387602] [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: 01/24/2024] [Revised: 05/03/2024] [Accepted: 05/06/2024] [Indexed: 08/06/2024]
Abstract
This study examined the factors associated with a high risk of opioid misuse among patients receiving opioid treatment for their non-cancer pain in Malaysian pain clinics. The Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R), a validated instrument for predicting the risk of aberrant drug-related behaviors, were used as a proxy to indicate risk of opioid misuse. Data analysis was stratified into high-risk and low-risk patient groups. Patient factors assessed included pain intensity, pain interference with daily activities, and health-related quality of life. Prescription opioid exposure was examined via patient medical and prescription records review. Among the 61 patients recruited, 62.3% scored ≥18 on the SOAPP-R, which indicates a high risk for opioid misuse. Factors associated with a high risk of opioid misuse were found to be high level of pain interference with daily activities, poorer mental health, and younger age. High-risk patients were found to be prescribed a lower mean daily opioid dose of <20 mg/day compared to low-risk patients (20-49 mg/day). This highlights the need for further research to distinguish aberrant drug-related behaviors due to inadequate pain management from that of actual prescription opioid misuse among non-cancer pain patients attending pain clinics.
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Affiliation(s)
- Asween R Sani
- Pharmacy Practice Department, Kulliyyah of Pharmacy, International Islamic University Malaysia (IIUM), Kuantan, Pahang, Malaysia
- Basic Health Sciences & Pharmacology Department, Faculty of Pharmacy, University College MAIWP International (UCMI), Batu Caves, Kuala Lumpur, Malaysia
| | - Che Suraya Zin
- Pharmacy Practice Department, Kulliyyah of Pharmacy, International Islamic University Malaysia (IIUM), Kuantan, Pahang, Malaysia
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Kwagala C, Munube D, Abbo C, Muhwezi WW, Mwesiga EK. Prevalence and factors associated with opioid use disorder among adolescents with sickle cell disease in Mulago hospital, Uganda. Child Adolesc Psychiatry Ment Health 2024; 18:94. [PMID: 39090740 PMCID: PMC11295896 DOI: 10.1186/s13034-024-00790-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 07/25/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Opioid use disorder (OUD) among adolescents with sickle cell disease (SCD) patients increases their risk of complications from sickle cell disease, such as infections, stroke, acute chest syndrome, sudden death, and organ failure. This negatively impacts families, communities, the national health system, and the economy. This study aimed to determine the prevalence and factors associated with opioid use disorder among adolescents with SCD at Mulago Hospital Uganda. METHODS This study was carried out at the Sickle Cell Clinic of Mulago Hospital, the national referral hospital in Uganda. The study participants were adolescents aged 10 to 19 years. Following informed consent/ assent, a sociodemographic questionnaire, the WHO Alcohol, Smoking and Substance Involvement Screening Test - Young (ASSIST-Y), the Beck Depression Inventory-II (BDI II), and Generalized Anxiety Disorder - 7 (GAD-7) questionnaires were used to collect data. Data was entered in EpiInfo and analyzed in STATA 15. RESULTS The prevalence of opioid use disorder was 5.3%. The significant risk factor was increasing depressive score AOR: 1.11(95% CI: 1.01-1.22, p = 0.035), while living with a family was protective against opioid use disorders AOR: 0.01; (95% CI: 0.0004, 0.27, p = 0.007). CONCLUSION There was a significant problem of OUD among adolescents with SCD. There is, therefore, needed to integrate screening of OUD and mental illnesses like depression among adolescents with SCD and to emphasize the importance of family support in their care.
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Affiliation(s)
- Claire Kwagala
- Department of Psychiatry, School of Medicine, College of Health Sciences, Makerere University, P. O. Box 7062, Kampala, Uganda.
| | - Deogratias Munube
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Catherine Abbo
- Department of Psychiatry, School of Medicine, College of Health Sciences, Makerere University, P. O. Box 7062, Kampala, Uganda
| | - Wilson Winstons Muhwezi
- Department of Psychiatry, School of Medicine, College of Health Sciences, Makerere University, P. O. Box 7062, Kampala, Uganda
| | - Emmanuel Kiiza Mwesiga
- Department of Psychiatry, School of Medicine, College of Health Sciences, Makerere University, P. O. Box 7062, Kampala, Uganda
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Kelley AM, Del Valle EJ, Zaman S, Karkhanis AN. Adolescent ethanol exposure promotes mechanical allodynia and alters dopamine transmission in the nucleus accumbens shell. Pain 2024; 165:e55-e64. [PMID: 37962155 PMCID: PMC11090756 DOI: 10.1097/j.pain.0000000000003097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 10/03/2023] [Indexed: 11/15/2023]
Abstract
ABSTRACT Excessive alcohol consumption in adolescence can disrupt neural development and may augment pain perception. Recent studies have shown that the nucleus accumbens (NAc) shell is involved in mediating pain sensitivity after peripheral inflammation in rodent models of chronic pain and alcohol use disorder. Interestingly, there have been very few studies examining the impact of chronic ethanol exposure during adolescence on pain sensitivity in adulthood. Therefore, in this project, we investigated the impact of adolescent chronic intermittent ethanol (aCIE) exposure on mechanical allodynia. Furthermore, given the involvement of the NAc shell in pain processing and chronic ethanol-mediated changes, we measured changes in accumbal dopamine kinetics during protracted withdrawal. We found that both male and female aCIE rats show mechanical allodynia during withdrawal. Furthermore, male and female aCIE rats show greater evoked tonic dopamine release, maximal rate of dopamine reuptake, and dopamine affinity to the dopamine transporter in the NAc shell compared with controls. With phasic stimulation, aCIE rats also showed greater dopamine release compared with AIR-exposed rats. Inhibition of dopamine transmission targeted in the NAc shell reversed the aCIE-associated facilitation of mechanical allodynia in both sexes. These data suggest that aCIE exposure exacerbates pain sensitivity during withdrawal in an accumbal dopamine-dependent manner.
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Affiliation(s)
- Abigail M Kelley
- Department of Psychology, Developmental Exposure to Alcohol Research Center, Binghamton University-SUNY, Binghamton, NY, United States
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Carroll A, Bayes A, Montebello M, Brett J, Arunogiri S, Saunders JB, Loo CK. Drug dependence and prescribing ketamine for treatment-resistant depression in Australia and New Zealand. Aust N Z J Psychiatry 2024:48674241242315. [PMID: 38561896 DOI: 10.1177/00048674241242315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Ketamine is a restricted and regulated medication in Australia and New Zealand, which has implications when considering treatment for patients with treatment-resistant depression and a history of illicit drug use, abuse or dependence. Regulations governing prescription of ketamine for treatment-resistant depression vary between jurisdictions in Australia and New Zealand, though most restrict use in those with drug dependence. There is substantial variation in definitions of drug dependence used in each jurisdiction, and between the legal and clinical definitions, with the latter specified in the current International Classification of Diseases, Eleventh Revision and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. This paper reviews the literature assessing the risk of ketamine misuse and dependence in patients with a history of illicit drug use, abuse or dependence and presents recommendations for psychiatrists who prescribe ketamine in such patients with treatment-resistant depression.
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Affiliation(s)
- Alistair Carroll
- Neuromodulation and Interventional Psychiatry, Black Dog Institute, Sydney, NSW, Australia
- Psychiatry & Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Adam Bayes
- Neuromodulation and Interventional Psychiatry, Black Dog Institute, Sydney, NSW, Australia
- Psychiatry & Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Mark Montebello
- Drug and Alcohol Services, Northern Sydney Local Health District, St Leonards, NSW, Australia
- Specialty of Addiction Medicine, The University of Sydney, Camperdown, NSW, Australia
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Jonathan Brett
- Clinical Pharmacology & Toxicology and Addiction Medicine, St Vincent's Hospital, Sydney, NSW, Australia
- NSW Poisons Information Centre, The Children's Hospital at Westmead, NSW, Australia
- St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
- Medicines and Health Intelligence, School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Shalini Arunogiri
- Statewide Addiction and Mental Health Centre, Turning Point, Eastern Health, Melbourne, VIC, Australia
- Monash Addiction Research Centre, Monash University, Melbourne, VIC, Australia
| | - John B Saunders
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, QLD, Australia
| | - Colleen K Loo
- Neuromodulation and Interventional Psychiatry, Black Dog Institute, Sydney, NSW, Australia
- Psychiatry & Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
- Cardiovascular program. The George Institute for Global Health, Sydney, NSW, Australia
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Holkenborg J, Frenken BA, Bon BVDKV, Vroegop MP, Van Meggelen MGM, Kramers C, Schellekens AFA, Kraaijvanger N. The prevalence of prescription opioid use and misuse among emergency department patients in The Netherlands. J Eval Clin Pract 2024; 30:473-480. [PMID: 38251860 DOI: 10.1111/jep.13965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/06/2023] [Accepted: 12/31/2023] [Indexed: 01/23/2024]
Abstract
RATIONALE Prescription opioid use and misuse have increased rapidly in many Western countries in the past decade. Patients (mis)using opioids are at risk of presenting to the emergency department (ED) with opioid-related problems. European data concerning prescription opioid (mis)use among the ED population is lacking. AIMS AND OBJECTIVES This study aims to determine prevalence of prescription opioid use, misuse, and opioid use disorder (OUD) among Dutch ED patients. Secondary objectives were to explore factors associated with prescription opioid misuse and the number of patients discharged with a new opioid prescription. METHODS In a cross-sectional multicenter study at three hospitals in the Netherlands, adult ED patients were screened for current prescription opioid use. Opioid users filled out questionnaires regarding opioid (mis)use, and underwent a structured interview to assess OUD criteria. The primary outcomes were prevalence rates of (1) current prescription opioid use, (2) prescription opioid misuse (based on a Current Opioid Misuse Measure [COMM] score > 8), (3) OUD, based on DSM-5 criteria. Independent T-tests, Pearson χ2 and Fisher's Exact tests were used to analyse differences in characteristics between groups. RESULTS A total of 997 patients were screened, of which 15% (n = 150) used prescription opioids. Out of 93 patients assessed, 22.6% (n = 21) showed signs of prescription opioid misuse, and 9.8% (n = 9, 95% CI: 4.5-17.8) fulfilled criteria for OUD. A medical history of psychiatric disorder was significantly more common in patients with prescription opioid misuse and OUD. CONCLUSION This study shows that prescription opioid use is relatively common in ED patients in the Netherlands, compared to the overall population. Over one fifth of these patients shows signs of opioid misuse or OUD. Awareness among ED personnel about the high prevalence of prescription opioid (mis)use in their population is critical for signalling opioid-related problems.
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Affiliation(s)
- Joris Holkenborg
- Emergency Department, Rijnstate Hospital, Arnhem, The Netherlands
| | | | | | - Maurice P Vroegop
- Emergency Department, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Cees Kramers
- Department of Pharmacology-Toxicology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Arnt F A Schellekens
- Nijmegen Institute for Science Practitioners in Addiction (NISPA), Nijmegen, The Netherlands
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
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Galán S, de la Vega R, Esteve R, López-Martínez AE, Fernández Baena M, Ramírez-Maestre C. Physicians' perception about predictors of opioid abuse in patients with chronic non-cancer pain: a Delphi study. FRONTIERS IN PAIN RESEARCH 2023; 4:1269018. [PMID: 37928367 PMCID: PMC10621745 DOI: 10.3389/fpain.2023.1269018] [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: 07/28/2023] [Accepted: 10/10/2023] [Indexed: 11/07/2023] Open
Abstract
Background Opioids are being prescribed widely, and increasingly, for the treatment of chronic non-cancer pain (CNCP). However, several side effects are associated with mid- and long-term opioid use and, for certain patients, with the risk of problematic opioid use. The aim of this study is to know the perception of the physicians about which variables could be associated with increased risk of patients with CNCP developing a problem of abuse or misuse of the prescribed opioid medication. Methods Twenty-nine physicians with experience in CNCP pain management and opioids prescription participated in a two-round Delphi study focused on the risk factors for opioid misuse and abuse. Results The variables that reached consensus regarding their relationship with the increased risk of suffering a problem of opioid abuse or misuse were: (1) Experiencing pain on a daily basis, (2) previous use of high-dose opioids, (3) generalized anxiety, (4) hopelessness, (5) benzodiazepine intake, (6) use of opioids for reasons other than pain, (7) family problems, family instability or family breakdown, and (8) having access to several opioid prescribers. The only variable that reached consensus regarding it not being associated to a possible risk of abuse or misuse was having mild pain intensity (0-4 on a NRS-11). Conclusions This study provides useful information that could help make decisions about the use of opioids for CNCP treatment and prevent future difficulties. Prospective studies testing the relationship of the variables that reached consensus with the risk of opioid misuse and abuse are warranted. Significance This study shows the variables of CNCP that the professional must take into account in order to avoid possible problems when prescribing opioids.
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Affiliation(s)
- Santiago Galán
- Instituto de Investigación Biomédica de Málaga (IBIMA Plataforma BIONAND), Málaga, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Prevención y Promoción de la Salud (RICAPPS), Málaga, Spain
| | - Rocío de la Vega
- Instituto de Investigación Biomédica de Málaga (IBIMA Plataforma BIONAND), Málaga, Spain
- Personalidad, Evaluación y tratamiento Psicológico, Facultad de Psicología y Logopedia, Andalucía Tech, Universidad de Málaga (Spain), Málaga, Spain
| | - Rosa Esteve
- Instituto de Investigación Biomédica de Málaga (IBIMA Plataforma BIONAND), Málaga, Spain
- Personalidad, Evaluación y tratamiento Psicológico, Facultad de Psicología y Logopedia, Andalucía Tech, Universidad de Málaga (Spain), Málaga, Spain
| | - Alicia E. López-Martínez
- Instituto de Investigación Biomédica de Málaga (IBIMA Plataforma BIONAND), Málaga, Spain
- Personalidad, Evaluación y tratamiento Psicológico, Facultad de Psicología y Logopedia, Andalucía Tech, Universidad de Málaga (Spain), Málaga, Spain
| | | | - Carmen Ramírez-Maestre
- Instituto de Investigación Biomédica de Málaga (IBIMA Plataforma BIONAND), Málaga, Spain
- Personalidad, Evaluación y tratamiento Psicológico, Facultad de Psicología y Logopedia, Andalucía Tech, Universidad de Málaga (Spain), Málaga, Spain
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Hu Y, Liu J, Zhuang R, Zhang C, Lin F, Wang J, Peng S, Zhang W. Progress in Pathological and Therapeutic Research of HIV-Related Neuropathic Pain. Cell Mol Neurobiol 2023; 43:3343-3373. [PMID: 37470889 DOI: 10.1007/s10571-023-01389-7] [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: 02/23/2023] [Accepted: 07/10/2023] [Indexed: 07/21/2023]
Abstract
HIV-related neuropathic pain (HRNP) is a neurodegeneration that gradually develops during the long-term course of acquired immune deficiency syndrome (AIDS) and manifests as abnormal sock/sleeve-like symmetrical pain and nociceptive hyperalgesia in the extremities, which seriously reduces patient quality of life. To date, the pathogenesis of HRNP is not completely clear. There is a lack of effective clinical treatment for HRNP and it is becoming a challenge and hot spot for medical research. In this study, we conducted a systematic review of the progress of HRNP research in recent years including (1) the etiology, classification and clinical symptoms of HRNP, (2) the establishment of HRNP pathological models, (3) the pathological mechanisms underlying HRNP from three aspects: molecules, signaling pathways and cells, (4) the therapeutic strategies for HRNP, and (5) the limitations of recent HRNP research and the future research directions and prospects of HRNP. This detailed review provides new and systematic insight into the pathological mechanism of HRNP, which establishes a theoretical basis for the future exploitation of novel target drugs. HIV infection, antiretroviral therapy and opioid abuse contribute to the etiology of HRNP with symmetrical pain in both hands and feet, allodynia and hyperalgesia. The pathogenesis involves changes in cytokine expression, activation of signaling pathways and neuronal cell states. The therapy for HRNP should be patient-centered, integrating pharmacologic and nonpharmacologic treatments into multimodal intervention.
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Affiliation(s)
- YanLing Hu
- Zhejiang Provincial Key Laboratory of Silkworm Bioreactor and Biomedicine, College of Life Sciences and Medicine, Zhejiang Sci-Tech University, Hangzhou, Zhejiang, China
| | - JinHong Liu
- Zhejiang Provincial Key Laboratory of Silkworm Bioreactor and Biomedicine, College of Life Sciences and Medicine, Zhejiang Sci-Tech University, Hangzhou, Zhejiang, China
| | - Renjie Zhuang
- Zhejiang Provincial Key Laboratory of Silkworm Bioreactor and Biomedicine, College of Life Sciences and Medicine, Zhejiang Sci-Tech University, Hangzhou, Zhejiang, China
| | - Chen Zhang
- Department of Biological Sciences, University of Denver, Denver, CO, 80210, USA
| | - Fei Lin
- Zhejiang Provincial Key Laboratory of Silkworm Bioreactor and Biomedicine, College of Life Sciences and Medicine, Zhejiang Sci-Tech University, Hangzhou, Zhejiang, China
| | - Jun Wang
- Department of Orthopedics, Rongjun Hospital, Jiaxing, Zhejiang, China
| | - Sha Peng
- Zhejiang Provincial Key Laboratory of Silkworm Bioreactor and Biomedicine, College of Life Sciences and Medicine, Zhejiang Sci-Tech University, Hangzhou, Zhejiang, China
| | - Wenping Zhang
- Zhejiang Provincial Key Laboratory of Silkworm Bioreactor and Biomedicine, College of Life Sciences and Medicine, Zhejiang Sci-Tech University, Hangzhou, Zhejiang, China.
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Lu CH, Jette G, Falls Z, Jacobs DM, Gibson W, Bednarczyk EM, Kuo TY, Lape-Newman B, Leonard KE, Elkin PL. A cohort of patients in New York State with an alcohol use disorder and subsequent treatment information - A merging of two administrative data sources. J Biomed Inform 2023; 144:104443. [PMID: 37455008 PMCID: PMC11178131 DOI: 10.1016/j.jbi.2023.104443] [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: 03/17/2023] [Revised: 07/05/2023] [Accepted: 07/08/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE Despite the high prevalence of alcohol use disorder (AUD) in the United States, limited research is focused on the associations among AUD, pain, and opioids/benzodiazepine use. In addition, little is known regarding individuals with a history of AUD and their potential risk for pain diagnoses, pain prescriptions, and subsequent misuse. Moreover, the potential risk of pain diagnoses, prescriptions, and subsequent misuse among individuals with a history of AUD is not well known. The objective was to develop a tailored dataset by linking data from 2 New York State (NYS) administrative databases to investigate a series of hypotheses related to AUD and painful medical disorders. METHODS Data from the NYS Office of Addiction Services and Supports (OASAS) Client Data System (CDS) and Medicaid claims data from the NYS Department of Health Medicaid Data Warehouse (MDW) were merged using a stepwise deterministic method. Multiple patient-level identifier combinations were applied to create linkage rules. We included patients aged 18 and older from the OASAS CDS who initially entered treatment with a primary substance use of alcohol and no use of opioids between January 1, 2003, and September 23, 2019. This cohort was then linked to corresponding Medicaid claims. RESULTS A total of 177,685 individuals with a primary AUD problem and no opioid use history were included in the dataset. Of these, 37,346 (21.0%) patients had an OUD diagnosis, and 3,365 (1.9%) patients experienced an opioid overdose. There were 121,865 (68.6%) patients found to have a pain condition. CONCLUSION The integrated database allows researchers to examine the associations among AUD, pain, and opioids/benzodiazepine use, and propose hypotheses to improve outcomes for at-risk patients. The findings of this study can contribute to the development of a prognostic prediction model and the analysis of longitudinal outcomes to improve the care of patients with AUD.
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Affiliation(s)
- Chi-Hua Lu
- Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY, USA.
| | - Gail Jette
- Division of Outcomes, Management, and Systems Information, Office of Addiction Services and Supports, Albany, NY, USA
| | - Zackary Falls
- Department of Biomedical Informatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - David M Jacobs
- Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Walter Gibson
- Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Edward M Bednarczyk
- Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Tzu-Yin Kuo
- Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY, USA
| | | | - Kenneth E Leonard
- Clinical and Research Institute on Addictions, University at Buffalo, Buffalo, NY, USA
| | - Peter L Elkin
- Department of Biomedical Informatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA; Faculty of Engineering, University of Southern Denmark, Denmark; U.S. Department of Veterans Affairs, WNY VA, Buffalo, NY, USA
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10
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Kiamanesh CS, Fuller MC, Lu M, Nordin EJ, Ma JX, Dugan SM, Cummings CE, Sherman K, Ebert TJ. New Opioid Persistence in Veterans Following Major and Minor Surgery. Mil Med 2023; 188:e1813-e1820. [PMID: 36317545 PMCID: PMC10362993 DOI: 10.1093/milmed/usac322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/14/2022] [Accepted: 10/07/2022] [Indexed: 07/25/2023] Open
Abstract
INTRODUCTION Opioids are often a mainstay of managing postsurgical pain. Persistent use of opioids for more than 90 days after surgery is problematic, and the incidence of this adverse outcome has been reported in the civilian population ranging from 0.4% to 7%. Veterans compose a special population exposed to trauma and stressful situations and consequently face increased risk for habit-forming behavior and drug overdose. This evaluation determined the prevalence of opioid persistence after surgery and its relationship to patient characteristics in a military veteran population. METHODS A retrospective chart review was completed on 1,257 veterans who were opioid naive and had undergone a surgical procedure between January 2017 and May 2018. Patient characteristics, health conditions, and discharge opioid medications were recorded, and the incidence of persistent opioid use beyond 90 days was determined. RESULTS The incidence of opioid persistence following major (3.3%) and minor (3.4%) procedures was similar. The incidence in patients younger than 45 years (3.3%), between 45 and 64 years (4.3%), and 65 years and older (2.2%) was also determined to be similar. Univariate patient factors associated with an increased risk for persistent opioid use include cancer (odds ratio [OR], 2.13; 95% CI, 1.11-4.09), mental health disorders (OR, 2.32; 95% CI, 1.17-4.60), and substance use disorders (OR, 2.09; 95% CI, 1.09-4.00). CONCLUSIONS Among a cohort of over 1,200 opioid-naïve veterans undergoing surgery at a VA Medical Center, just over 3% went on to develop persistent opioid use beyond 3 months following their procedure. Persistent use was not found to be related to the type of procedure (major or minor) or patient age. Significant patient-level risk factors for opioid persistence were cancer and a history of mental health and substance use disorders.
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Affiliation(s)
| | | | - Marvin Lu
- Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | | | - Jessie X Ma
- Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Shannon M Dugan
- Department of Anesthesiology, 112A, Zablocki VA Medical Center, Milwaukee, WI 53295, USA
| | - Craig E Cummings
- Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Department of Anesthesiology, 112A, Zablocki VA Medical Center, Milwaukee, WI 53295, USA
| | - Katherine Sherman
- Research Service, Zablocki VA Medical Center, Milwaukee, WI 53295, USA
| | - Thomas J Ebert
- Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Department of Anesthesiology, 112A, Zablocki VA Medical Center, Milwaukee, WI 53295, USA
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Bakhshaie J, Storch PhD EA, Zvolensky PhD MJ. Pain-related disability and opioid use in a sample of young adults with current pain: The explanatory role of distress tolerance. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:1206-1212. [PMID: 34694216 DOI: 10.1080/07448481.2021.1925677] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 01/08/2021] [Accepted: 01/15/2021] [Indexed: 05/31/2023]
Abstract
Objective: The current study examined the mediating role of distress tolerance on the association between pain-related disability and addiction to opioids, past-month opioid use, and risky opioid use among an ethno-racially diverse sample of young adults with current pain.Methods: Participants were 141 undergraduate college students (78.7% female, M age = 22.50, SD = 5.41) who reported experiencing current pain.Results: Results indicated that distress tolerance statistically significantly explained the relationship between pain-related disability and addiction to opioids, past-month opioid use, and risky opioid use after controlling for the variance accounted for by pain intensity, negative affectivity, gender, and other substance misuses.Conclusions: Clinical implications are discussed in terms of targeting distress tolerance in the context of pain-related disability among young adults with pain who are at risk for opioid misuse.
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Affiliation(s)
- Jafar Bakhshaie
- Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Eric A Storch PhD
- Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Michael J Zvolensky PhD
- Department of Psychology, University of Houston, Houston, TX, USA
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- HEALTH Institute, University of Houston, Houston, TX, USA
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Loh J, Buxton J, Kaida A, Voon P, Grant C, Milloy MJ. Estimating the prevalence and correlates of pain among people living with HIV who use unregulated drugs in a Canadian setting. J Opioid Manag 2023; 19:225-237. [PMID: 37145925 PMCID: PMC10811581 DOI: 10.5055/jom.2023.0778] [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] [Indexed: 05/07/2023]
Abstract
Although prevalent among people living with human immunodeficiency virus (HIV) (PLWH) and people who use unregulated drugs (PWUD), pain and its possible links to substance use patterns and engagement in HIV treatment remains poorly characterized. We sought to evaluate the prevalence and correlates of pain among a cohort of PLWH who use un-regulated drugs. Between December 2011 and November 2018, 709 participants were recruited, and data were analyzed using generalized linear mixed-effects (GLMM). At baseline, 374 (53 percent) individuals reported moderate-to-extreme pain in the previous 6 months. In a multivariable model, pain was significantly associated with nonmedical prescrip-tion-opioid use (adjusted odds ratio (AOR) = 1.63, 95 percent confidence interval (CI): 1.30-2.05), nonfatal overdose (AOR = 1.46, 95 percent CI: 1.11-1.93), self-managing pain (AOR = 2.25, 95 percent CI: 1.94-2.61), requesting pain medication in the previous 6 months (AOR = 2.01, 95 percent CI: 1.69-2.38), and ever being diagnosed with a mental illness (AOR = 1.47, 95 percent CI: 1.11-1.94). Establishing accessible pain management interventions that address the complex intersection of pain, drug use, and HIV-infection has potential to improve quality of life outcomes among this population.
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Affiliation(s)
- Jane Loh
- British Columbia Centre on Substance Use, School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Jane Buxton
- School of Population and Public Health, University of British Columbia, British Columbia Centre for Disease Control, Vancouver, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Pauline Voon
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Cameron Grant
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - M-J Milloy
- British Columbia Centre on Substance Use, Department of Medicine, University of British Columbia, Vancouver, Canada
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Cooke A, Castellanos S, Enriquez C, Olsen P, Miaskowski C, Kushel M, Knight KR. Telehealth for management of chronic non-cancer pain and opioid use disorder in safety net primary care. BMC Health Serv Res 2023; 23:325. [PMID: 37005610 PMCID: PMC10067010 DOI: 10.1186/s12913-023-09330-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 03/21/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND The SARS-CoV-2 (COVID-19) pandemic increased use of telehealth for the management of opioid use disorder and chronic non-cancer pain in primary care safety net clinical systems. Significant barriers to telehealth exist, little is known about how these barriers impact urban safety net, primary care providers and their patients. The objective of this study was to qualitatively assess the benefits and challenges of telehealth for management of chronic non-cancer pain, opioid use disorder, and multi-morbidity in primary care, safety net clinical systems. METHODS We interviewed patients with chronic non-cancer pain and history of substance use (n = 22) and their primary care clinicians (n = 7) in the San Francisco Bay Area, March-July 2020. We recorded, transcribed, coded, and content analyzed interviews. RESULTS COVID-19 shelter-in-place orders contributed to increases in substance use and uncontrolled pain, and posed challenges for monitoring opioid safety and misuse through telehealth. None of the clinics used video visits due to low digital literacy/access. Benefits of telehealth included decreased patient burden and missed appointments and increased convenience and control of some chronic conditions (e.g., diabetes, hypertension). Telehealth challenges included loss of contact, greater miscommunication, and less comprehensive care interactions. CONCLUSIONS This study is one of the first to examine telehealth use in urban safety net primary care patients with co-occurring chronic non-cancer pain and substance use. Decisions to continue or expand telehealth should consider patient burden, communication and technology challenges, pain control, opioid misuse, and medical complexity.
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Affiliation(s)
- Alexis Cooke
- Department of Community Health Systems, School of Nursing, University of California - San Francisco, 2 Koret Way, N505, San Francisco, CA, 94143-0608, USA
| | - Stacy Castellanos
- Department of Humanities and Social Sciences, School of Medicine, University of California - San Francisco, 490 Illinois Street, 7th Floor, San Francisco, CA, 94143-0850, USA
| | - Celeste Enriquez
- Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, Department of Medicine, School of Medicine, University of California - San Francisco, UCSF Box 1339, San Francisco, CA, 94143-0608, USA
| | - Pamela Olsen
- Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, Department of Medicine, School of Medicine, University of California - San Francisco, UCSF Box 1339, San Francisco, CA, 94143-0608, USA
| | - Christine Miaskowski
- Department of Physiological Nursing, School of Nursing, University of California - San Francisco, 2 Koret Way, Rm 631, San Francisco, CA, 94143-0608, USA
| | - Margot Kushel
- Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, Department of Medicine, School of Medicine, University of California - San Francisco, UCSF Box 1339, San Francisco, CA, 94143-0608, USA
| | - Kelly Ray Knight
- Department of Humanities and Social Sciences, School of Medicine, University of California - San Francisco, 490 Illinois Street, 7th Floor, San Francisco, CA, 94143-0850, USA.
- Department of Humanities and Social Sciences, School of Medicine, University of California - San Francisco, 490 Illinois Street, 7th Floor, San Francisco, CA, 94143-0608, USA.
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Hartzell SYT, Keller MS, Albertson EM, Liu Y, Larson M, Friedman S. Variation in Nevada primary care clinicians' use of urine drug testing to mitigate opioid harm. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 145:208940. [PMID: 36880912 DOI: 10.1016/j.josat.2022.208940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 10/11/2022] [Accepted: 12/30/2022] [Indexed: 05/23/2023]
Abstract
INTRODUCTION The prescription opioid epidemic led to federal, state, and health system guidelines and policies aimed at mitigating opioid misuse, including presumptive urine drug testing (UDT). This study identifies whether a difference exists in UDT use among different primary care medical license types. METHODS The study used January 2017-April 2018 Nevada Medicaid pharmacy and professional claims data to examine presumptive UDTs. We examined correlations between UDTs and clinician characteristics (medical license type, urban/rural status, care setting) along with clinician-level measures of patient mix characteristics (proportions of patients with behavioral health diagnoses, early refills). Adjusted odds ratios (AORs) and predicted probabilities (PPs) from a logistic regression with a binomial distribution are reported. The analysis included 677 primary care clinicians (medical doctors [MD], physician assistants [PA], nurse practitioners [NP]). RESULTS Of those in the study, 85.1 % of clinicians did not order any presumptive UDTs. NPs had the highest proportion of UDT use (21.2 % of NPs), followed by PAs (20.0 % of PAs), and MDs (11.4 % of MDs). Adjusted analyses showed that being a PA or NP was associated with higher odds of UDT (PA: AOR: 3.6; 95 % CI: 3.1-4.1; NP: AOR: 2.5; 95 % CI: 2.2-2.8) compared to being an MD. PAs had the highest PP for ordering UDTs (2.1 %, 95 % CI: 0.5 %-8.4 %). Among clinicians who ordered UDTs, midlevel clinicians had higher mean and median UDT use (PA and NP mean: 24.3 % vs. MDs: 19.4 %; PA and NP median: 17.7 % vs. MDs: 12.5 %). CONCLUSION In Nevada Medicaid, UDTs are concentrated among 15 % of primary care clinicians who are frequently non-MDs. More research should include PAs and NPs when examining clinician variation in mitigating opioid misuse.
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Affiliation(s)
- Sarah Y T Hartzell
- School of Public Health, University of Nevada, Reno, 1664 N. Virginia St., Reno, NV 89557, United States.
| | - Michelle S Keller
- Division of General Internal Medicine, Department of Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd #2900A, Los Angeles, CA 90040, United States; Department of Health Policy and Management, UCLA Fielding School of Public Health, 650 Charles E Young Dr S, Los Angeles, CA 90095, United States
| | - Elaine Michelle Albertson
- Department of Health Policy and Management, UCLA Fielding School of Public Health, 650 Charles E Young Dr S, Los Angeles, CA 90095, United States
| | - Yan Liu
- School of Public Health, University of Nevada, Reno, 1664 N. Virginia St., Reno, NV 89557, United States
| | - Madalyn Larson
- School of Public Health, University of Nevada, Reno, 1664 N. Virginia St., Reno, NV 89557, United States
| | - Sarah Friedman
- School of Public Health, University of Nevada, Reno, 1664 N. Virginia St., Reno, NV 89557, United States
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15
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Discharge to inpatient rehabilitation following arthroplasty is a strong predictor of persistent opioid use 90 days after surgery: a prospective, observational study. BMC Musculoskelet Disord 2023; 24:31. [PMID: 36639624 PMCID: PMC9840321 DOI: 10.1186/s12891-023-06142-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 01/05/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Total knee and hip arthroplasty are considered a clinically and cost-effective intervention, however, persistent pain post-surgery can occur, and some continue to take opioid medications long-term. One factor which has infrequently been included in prediction modelling is rehabilitation pathway, in particular, one which includes inpatient rehabilitation. As discharge to inpatient rehabilitation post-arthroplasty is common practice, we aimed to identify whether rehabilitation pathway (discharge to in-patient rehabilitation or not) predicts continued use of opioids at 3 months (90 days) post- total knee arthroplasty (TKA) and total hip arthroplasty (THA) whilst controlling for other covariates. METHODS The study was nested within a prospective observational study capturing pre-operative, acute care and longer-term data from 1900 osteoarthritis (OA) patients who underwent primary TKA or THA. The larger study involved a part-random, part-convenience sample of 19 high-volume hospitals across Australia. Records with complete pre-and post-operative analgesic (35 days and 90 days) use were identified [1771 records (93% of sample)] and included in logistic regression analyses. RESULTS Three hundred and thirteen people (17.8%) reported ongoing opioid use at 90 days post-operatively. In the adjusted model, admission to inpatient rehabilitation after surgery was identified as an independent and significant predictor of opioid use at 90-days. Inpatient rehabilitation was associated with almost twice the odds of persistent opioid use at 90-days compared to discharge directly home (OR = 1.9 (1.4, 2.5), p < .001). CONCLUSION The inpatient rehabilitation pathway is a strong predictor of longer-term opioid use (90 days) post-arthroplasty, accounting for many known and possible confounders of use including sex, age, insurance status, major complications, smoking status and baseline body pain levels. TRIAL REGISTRATION The study was nested within a prospective cohort observational study capturing pre-operative, acute-care and longer-term data from patients undergoing primary TKA or THA for osteoarthritis (ClinicalTrials.gov NCT01899443).
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16
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Iqbal A, Knaggs R, Anderson C, Toh LS. Logic model for opioid safety in chronic non-malignant pain management, an in-depth qualitative study. Int J Clin Pharm 2023; 45:220-232. [PMID: 36434367 PMCID: PMC9702900 DOI: 10.1007/s11096-022-01493-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 09/20/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Opioids are commonly used for the management of chronic non-malignant pain in Pakistan; but there is a lack of literature around precursors or motivators in the use of opioids. AIM The study holistically explored factors contributing towards the unsafe use of opioids and identifies strategies to overcome them. METHOD Exploratory qualitative methods using interviews, focus groups and non-participant observational case studies were used. Interviews and focus groups were carried out face-to-face as well as virtually and observations were conducted in community pharmacies in Islamabad and Khyber Pukhtoon Khuwa province, Pakistan. Data were collected from 4 stakeholder groups; pharmacy policy makers (n = 11), people with chronic non-malignant pain (n = 14), doctors (n = 31) and community pharmacists (n = 36) by purposive critical case sampling method. Data were analysed inductively using reflexive thematic analysis and then deductively mapped to a social ecological framework. Non-participant observations were analysed using a cross case synthesis using explanation building technique. Data from all three methods were triangulated to develop a logic model. RESULTS Identified factors at macro (regulation), meso (social perceptions of pain and opioids) and micro levels (uncontrolled pain, self-medication, health literacy) and strategies are presented holistically and were used to develop a logic model for the prevention and mitigation of factors currently causing unsafe use of opioids. CONCLUSION The study provides an in-depth view of factors contributing towards diversion of pharmaceutical opioids and can help guide national and international policy makers in their future initiatives to promote safe use of opioids in the management of chronic non-malignant pain in Pakistan.
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Affiliation(s)
- Ayesha Iqbal
- Division of Pharmacy Practice and Policy, School of Pharmacy, University of Nottingham, Nottingham, NG7 2RD, UK.
| | - Roger Knaggs
- Division of Pharmacy Practice and Policy, School of Pharmacy, University of Nottingham, Nottingham, NG7 2RD, UK
- Primary Integrated Community Services, Unit H4 Ash Tree Court, Nottingham Business Park, Nottingham, NG8 6PY, UK
| | - Claire Anderson
- Division of Pharmacy Practice and Policy, School of Pharmacy, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Li Shean Toh
- Division of Pharmacy Practice and Policy, School of Pharmacy, University of Nottingham, Nottingham, NG7 2RD, UK
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17
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Hijji FY, Sanda T, Huff SD, Froehle AW, Henningsen JD, Schneider AD, Lyons JG, Mian HM, Jerele J, Venkatarayappa I. Accuracy of self-reported opioid use in orthopaedic trauma patients. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:185-190. [PMID: 34981218 DOI: 10.1007/s00590-021-03178-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/27/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE Opioids have long been a mainstay of treatment for pain in patients with orthopaedic injuries, but little is known about the accuracy of self-reported narcotic usage in orthopaedic trauma. The purpose of this study is to evaluate the accuracy of self-reported opioid usage in orthopaedic trauma patients. METHODS A retrospective review of all new patients presenting to the orthopaedic trauma clinic of a level 1 trauma centre with a chief complaint of recent orthopaedic-related injury over a 2-year time frame was conducted. Participants were administered a survey inquiring about narcotic usage within the prior 3 months. Responses were cross-referenced against a query of a statewide prescription drug monitoring program system. RESULTS The study comprised 241 participants; 206 (85.5%) were accurate reporters, while 35 (14.5%) were inaccurate reporters. Significantly increased accuracy was associated with hospital admission prior to clinic visit (β = - 1.33; χ2 = 10.68, P < 0.01; OR: 0.07, 95% CI 0.01-0.62). Decreased accuracy was associated with higher pre-visit total morphine equivalent dose (MED) (β = 0.002; χ2 = 11.30, P < 0.01), with accurate reporters having significantly lower pre-index visit MED levels compared to underreporters (89.2 ± 208.7 mg vs. 249.6 ± 509.3 mg; P = 0.04). An Emergency Department (ED) visit prior to the index visit significantly predicted underreporting (β = 0.424; χ2 = 4.28, P = 0.04; OR: 2.34, 95% CI 1.01-5.38). CONCLUSION This study suggests that most new patients presenting to an orthopaedic trauma clinic with acute injury will accurately report their narcotic usage within the preceding 3 months. Prior hospital admissions increased the likelihood of accurate reporting while higher MEDs or an ED visit prior to the initial visit increased the likelihood of underreporting.
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Affiliation(s)
- Fady Y Hijji
- Department of Orthopaedic Surgery, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Tyler Sanda
- Department of Orthopaedic Surgery, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Scott D Huff
- Department of Orthopaedic Surgery, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Andrew W Froehle
- Department of Orthopaedic Surgery, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Joseph D Henningsen
- Department of Orthopaedic Surgery, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Andrew D Schneider
- Department of Orthopaedic Surgery, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Joseph G Lyons
- Department of Orthopaedic Surgery, Wright State University Boonshoft School of Medicine, Dayton, OH, USA.
| | - Humza M Mian
- Department of Orthopaedic Surgery, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Jennifer Jerele
- Department of Orthopaedic Surgery, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Indresh Venkatarayappa
- Department of Orthopaedic Surgery, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
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Atkins N, Mukhida K. The relationship between patients’ income and education and their access to pharmacological chronic pain management: A scoping review. Can J Pain 2022; 6:142-170. [PMID: 36092247 PMCID: PMC9450907 DOI: 10.1080/24740527.2022.2104699] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Nicole Atkins
- Department of Anesthesiology, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Karim Mukhida
- Department of Anesthesiology, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Shah J, Fermo O. Review of systemic and syndromic complications of cannabis use: A review. Medicine (Baltimore) 2022; 101:e32111. [PMID: 36626471 PMCID: PMC9750691 DOI: 10.1097/md.0000000000032111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
PURPOSE OF REVIEW Prescribed and non-prescribed cannabis use is common. Providers in specialties treating chronic pain - primary care, pain management, and neurology-will be coming across medical cannabis as a treatment for chronic pain, regardless of whether they are prescribers. It is important to be aware of the systemic and syndromic complications of acute and chronic cannabis use in the differential diagnosis of cardiac, cardiovascular, cerebrovascular, gastrointestinal, and psychiatric disorders. RECENT FINDINGS Medical cannabis is legal in 36 states. Studies have shown several potentially serious adverse effects associated with cannabis use. SUMMARY Cannabis use has the potential to cause several complications that can be easily overlooked without a preexisting high index of suspicion.
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Affiliation(s)
- Jay Shah
- University of Queensland/Ochsner Clinical School, Brisbane, QLD, Australia
| | - Olga Fermo
- Department of Neurology, Mayo Clinic Florida, Jacksonville, FL, USA
- * Correspondence: Olga Fermo, Department of Neurology, Mayo Clinic Florida, 4500 San Pablo Rd., Jacksonville, FL, USA (e-mail: )
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20
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Peck CJ, Carney M, Chiu A, Park KE, Prassinos A, Allam O, Thomson JG, Prsic A. Sex, Race, Insurance, and Pain: Do Patient Sociodemographics Influence Postoperative Opioid Prescriptions Among Hand Surgeons? Hand (N Y) 2022; 17:1133-1138. [PMID: 33682465 PMCID: PMC9608288 DOI: 10.1177/1558944721998020] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Social and demographic factors may influence patient treatment by physicians. This study analyzes the influence of patient sociodemographics on prescription practices among hand surgeons. METHODS We performed a retrospective analysis of all hand surgeries (N = 5278) at a single academic medical center from January 2016 to September 2018. The average morphine milligram equivalent (MME) prescribed following each surgery was calculated and then classified by age, race, sex, type of insurance, and history of substance use or chronic pain. Multivariate linear regression was used to compare MME among groups. RESULTS Overall, patients with a history of substance abuse were prescribed 31.2 MME more than those without (P < .0001), and patients with a history of chronic pain were prescribed 36.7 MME more than those without (P < .0001). After adjusting for these variables and the type of procedure performed, women were prescribed 11.2 MME less than men (P = .0048), and Hispanics were prescribed 16.6 MME more than whites (P = .0091) overall. Both Hispanic and black patients were also prescribed more than whites following carpal tunnel release (+19.0 and + 20.0 MME, respectively; P < .001). Patients with private insurance were prescribed 24.5 MME more than those with Medicare (P < .0001), but 25.0 MME less than those with Medicaid (P < .0001). There were no differences across age groups. CONCLUSIONS Numerous sociodemographic factors influenced postoperative opioid prescription among hand surgeons at our institution. These findings highlight the importance of establishing more uniform, evidence-based guidelines for postoperative pain management, which may help minimize subjectivity and prevent the overtreatment or undertreatment of pain in certain patient populations.
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Affiliation(s)
| | | | | | | | | | - Omar Allam
- Yale School of Medicine, New Haven, CT, USA
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21
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Toor T, Murphy E, Simmons AN, Palyo S, Librodo SC, Strigo IA. Craving of prescription opioids among veterans with chronic pain. Pain 2022; 163:2021-2030. [PMID: 35297818 PMCID: PMC9329486 DOI: 10.1097/j.pain.0000000000002598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 01/20/2022] [Indexed: 02/04/2023]
Abstract
ABSTRACT The United States faces a crisis because of the high prevalence of chronic pain, concurrent opioid use disorder, and overdose deaths. Prescription opioids remain a primary driver of opioid-related deaths. Craving is a core symptom of addiction, yet the degree to which craving plays a role in prescription opioid use among patients with chronic pain is unknown. Understanding the degree to which craving should be considered in patients with chronic pain is critical for developing effective interventions for supporting patients through opioid tapering. The current work combines data collected from (1) 2152 veterans screened for eligibility at a pain specialty care clinic at the San Francisco VA Health Care System and (2) medical records obtained from the VA Corporate Data Warehouse. We found that prescription opioid craving among veterans with chronic pain was low, with 66.4% of the sample reporting no craving and 33.6% reporting craving. We also found that craving had a small association with morphine equivalent daily dose and pain severity but was more strongly associated with depression. Craving of prescription opioids among veterans with chronic pain is complex. Findings are discussed in relation to chronic pain symptoms, psychiatric comorbidities, and demographics.
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Affiliation(s)
- Tiffany Toor
- Department of Veterans Affairs (VA) San Francisco Healthcare System, San Francisco, CA
| | - Emily Murphy
- Department of Veterans Affairs (VA) San Francisco Healthcare System, San Francisco, CA
| | - Alan N. Simmons
- Department of Veterans Affairs (VA) San Diego Healthcare System, San Diego, CA
- University of California, San Diego, CA
| | - Sarah Palyo
- Department of Veterans Affairs (VA) San Francisco Healthcare System, San Francisco, CA
- University of California, San Francisco, CA
| | - Sara C. Librodo
- Department of Veterans Affairs (VA) San Francisco Healthcare System, San Francisco, CA
- University of California, San Francisco, CA
| | - Irina A. Strigo
- Department of Veterans Affairs (VA) San Francisco Healthcare System, San Francisco, CA
- University of California, San Francisco, CA
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22
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Minder CR, Gorbach C, Peterson CK. Factors Associated With Pain Medication Use and the Relationship to Chiropractic Treatment Outcomes for Patients With Low Back and Neck Pain: A Cross-Sectional Study. J Manipulative Physiol Ther 2022; 45:575-585. [PMID: 37318388 DOI: 10.1016/j.jmpt.2023.03.002] [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: 02/09/2021] [Revised: 03/17/2023] [Accepted: 03/30/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVE The study objectives were to identify baseline factors associated with pain medication use and determine any differences in chiropractic treatment outcomes in patients with low back pain (LBP) and neck pain (NP) depending on their use of pain medication. METHODS This cross-sectional, prospective outcomes study included 1077 adults with acute or chronic LBP and 845 adults with acute or chronic NP recruited from Swiss chiropractors in their offices within 4 years. Demographic data and the responses to the Patient's Global Impression of Change scale collected at 1 week, 1 month, 3 months, 6 months, and 1 year were analyzed with the χ2 test. Baseline pain and disability levels were measured using the numeric rating scale (NRS), Oswestry questionnaire for LBP, and Bournemouth questionnaire for patients with NP and analyzed with the Mann-Whitney U test between the 2 groups. To detect significant predictors of medication use at baseline, logistic regression analysis was performed. RESULTS Patients with acute LBP and NP were more likely than those with chronic pain to take pain medication (P < .001 LBP; P = .003 NP). Medication use was more likely with patients with radiculopathy (P < .001 LBP; P = .05 NP) who were smokers (P = .008 LBP; P = .024 NP) and those reporting below-average general health (P < .001 LBP and NP). Pain medication users had higher baseline pain (P < .001 LBP and NP) and disability (P < .001 LBP and NP) scores. CONCLUSION Patients with LBP and NP had significantly higher pain and disability levels at baseline, tended to have radiculopathy and poor health, were smokers, and presented during the acute phase. However, for this sample of patients, there were no differences in subjective improvement between users and non-users of pain medication for any data collection time point, which has management implications.
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Affiliation(s)
- Corinne R Minder
- Chiropractic Medicine Department, Faculty of Medicine, University of Zürich, Zürich, Switzerland.
| | - Christoph Gorbach
- Departments of Chiropractic Medicine and Orthopedic Rheumatology, Balgrist University Hospital, Zürich, Switzerland
| | - Cynthia K Peterson
- Department of Chiropractic Medicine, Orthopaedic University Hospital Balgrist, Zürich, Switzerland
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Do Urine Drug Tests Reveal Substance Misuse Among Patients Prescribed Opioids for Chronic Pain? J Gen Intern Med 2022; 37:2365-2372. [PMID: 34405344 PMCID: PMC9360386 DOI: 10.1007/s11606-021-07095-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 07/30/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Urine drug testing (UDT) is a recommended risk mitigation strategy for patients prescribed opioids for chronic pain, but evidence that UDT supports identification of substance misuse is limited. OBJECTIVE Identify the prevalence of UDT results that may identify substance misuse, including diversion, among patients prescribed opioids for chronic pain. DESIGN Retrospective cohort study. SUBJECTS Patients (n=638) receiving opioids for chronic pain who had one or more UDTs, examining up to eight substances per sample, during a one 1-year period. MAIN MEASURES Experts adjudicated the clinical concern that UDT results suggest substance misuse or diversion as not concerning, uncertain, or concerning. KEY RESULTS Of 638 patients, 48% were female and 49% were over age 55 years. Patients had a median of three UDTs during the intervention year. We identified 37% of patients (235/638) with ≥1 concerning UDT and a further 35% (222/638) having ≥1 uncertain UDT. We found concerning UDTs due to non-detection of a prescribed substance in 24% (156/638) of patients and detection of a non-prescribed substance in 23% (147/638). Compared to patients over 65 years, those aged 18-34 years were more likely to have concerning UDT results with an adjusted odds ratio (AOR) of 4.8 (95% confidence interval [CI] 1.9-12.5). Patients with mental health diagnoses (AOR 1.6 [95% CI 1.1-2.3]) and substance use diagnoses (AOR 2.3 [95% CI 1.5-3.7]) were more likely to have a concerning UDT result. CONCLUSIONS Expert adjudication of UDT results identified clinical concern for substance misuse in 37% of patients receiving opioids for chronic pain. Further research is needed to determine if UDTs impact clinical practice or patient-related outcomes.
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Freda PJ, Kranzler HR, Moore JH. Novel digital approaches to the assessment of problematic opioid use. BioData Min 2022; 15:14. [PMID: 35840990 PMCID: PMC9284824 DOI: 10.1186/s13040-022-00301-1] [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: 08/26/2021] [Accepted: 06/30/2022] [Indexed: 11/16/2022] Open
Abstract
The opioid epidemic continues to contribute to loss of life through overdose and significant social and economic burdens. Many individuals who develop problematic opioid use (POU) do so after being exposed to prescribed opioid analgesics. Therefore, it is important to accurately identify and classify risk factors for POU. In this review, we discuss the etiology of POU and highlight novel approaches to identifying its risk factors. These approaches include the application of polygenic risk scores (PRS) and diverse machine learning (ML) algorithms used in tandem with data from electronic health records (EHR), clinical notes, patient demographics, and digital footprints. The implementation and synergy of these types of data and approaches can greatly assist in reducing the incidence of POU and opioid-related mortality by increasing the knowledge base of patient-related risk factors, which can help to improve prescribing practices for opioid analgesics.
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Affiliation(s)
- Philip J Freda
- Cedars-Sinai Medical Center, Department of Computational Biomedicine, 700 N. San Vicente Blvd., Pacific Design Center Suite G540, West Hollywood, CA, 90069, USA.
| | - Henry R Kranzler
- University of Pennsylvania, Center for Studies of Addiction, 3535 Market St., Suite 500 and Crescenz VAMC, 3800 Woodland Ave., Philadelphia, PA, 19104, USA
| | - Jason H Moore
- Cedars-Sinai Medical Center, Department of Computational Biomedicine, 700 N. San Vicente Blvd., Pacific Design Center Suite G540, West Hollywood, CA, 90069, USA
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Kim K, Yang Y, Wang Z, Chen J, Barandouzi ZA, Hong H, Han HR, Starkweather A. A systematic review of the association between health literacy and pain self-management. PATIENT EDUCATION AND COUNSELING 2022; 105:1427-1440. [PMID: 34629232 DOI: 10.1016/j.pec.2021.09.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 08/03/2021] [Accepted: 09/28/2021] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To synthesize the impact of health literacy on pain self-management contexts, processes, and outcomes. METHODS This systematic review employed a narrative synthesis. We used databases, including PubMed and PsycINFO, and handsearching of the reference lists to identify articles published before December 2020. Pain self-management variables were chosen based on the Individual and Family Self-Management Theory. Quality was assessed using the National Institute of Health quality assessment tool for observational and cross-sectional studies. RESULTS Twenty studies that included 6173 participants were used. Most studies measured functional domains of the health literacy concept. Twelve studies reported small to large associations between health literacy and pain knowledge, medication regimen adherence, or pain. Thirteen studies considered health literacy clinical risks in tailoring education, while seven viewed it as personal assets developed via education. CONCLUSIONS Limited information on the contribution of health literacy to pain self-management context factors and processes exists. Current evidence was limited by a lack of temporality, theoretical basis, and a priori sample estimation. PRACTICE IMPLICATIONS Using brief functional literacy scales in the clinical environment can be more practical. Identifying patients' literacy levels helps clinicians personalize education, which then promotes patients' knowledge of pain, medication regimen adherence, and pain control.
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Affiliation(s)
- Kyounghae Kim
- College of Nursing, Korea University, Seoul, South Korea; Institute of Nursing Research, Korea University, Seoul, South Korea; Transdisciplinary Major in Learning Health Systems, Department of Healthcare Sciences, Graduate School, Korea University, South Korea.
| | - Yuxuan Yang
- School of Nursing, University of Connecticut, Storrs, CT, USA; Center for Advancement in Managing Pain, University of Connecticut, Storrs, CT, USA
| | - Zequan Wang
- School of Nursing, University of Connecticut, Storrs, CT, USA; Center for Advancement in Managing Pain, University of Connecticut, Storrs, CT, USA
| | - Jie Chen
- School of Nursing, University of Connecticut, Storrs, CT, USA; Center for Advancement in Managing Pain, University of Connecticut, Storrs, CT, USA
| | | | - Hyejeong Hong
- School of Nursing, University of Washington School of Nursing, Seattle, WA, USA
| | - Hae-Ra Han
- School of Nursing, Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Angela Starkweather
- School of Nursing, University of Connecticut, Storrs, CT, USA; Center for Advancement in Managing Pain, University of Connecticut, Storrs, CT, USA
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Chen C, Lo-Ciganic WH, Winterstein AG, Tighe P, Wei YJJ. Concurrent Use of Prescription Opioids and Gabapentinoids in Older Adults. Am J Prev Med 2022; 62:519-528. [PMID: 34802816 PMCID: PMC9426287 DOI: 10.1016/j.amepre.2021.08.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Concurrent use of prescription opioids with gabapentinoids may pose risks of serious drug interactions. Yet, little is known about the trends in and patient characteristics associated with concurrent opioid-gabapentinoid use among older Medicare opioid users with chronic noncancer pain. METHODS A cross-sectional study was conducted among Medicare older beneficiaries (aged ≥65 years) with chronic noncancer pain who filled ≥1 opioid prescription within 3 months after a randomly selected chronic noncancer pain diagnosis (index date) in a calendar year between 2011 and 2018. Patient characteristics were measured in the 6-month baseline before the index date, and concurrent opioid-gabapentinoid use for ≥1 day was measured in the 3-month follow-up after the index date. Multivariable modified Poisson regression hwas used to assess the trends and characteristics of concurrent opioid-gabapentinoid use. Analyses were conducted from January to June 2021. RESULTS Among 464,721 eligible older beneficiaries with chronic noncancer pain and prescription opioids, the prevalence of concurrent opioid-gabapentinoid use increased from 17.0% in 2011 to 23.5% in 2018 (adjusted prevalence ratio=1.48, 95% CI=1.45, 1.53). Concurrent users versus opioid-only users tended to be non-Black, low-income subsidy recipients, and Southern residents. The clinical factors associated with concurrent opioid-gabapentinoid use included having a diagnosis of neuropathic pain, polypharmacy, and risk factors for opioid-related adverse events. CONCLUSIONS Concurrent opioid-gabapentinoid use among older Medicare beneficiaries with chronic noncancer pain and prescription opioids has increased significantly between 2011 and 2018. Future studies are warranted to investigate the impact of concurrent use on outcomes in older patients. Interventions that reduce inappropriate concurrent use may target older patients with identified characteristics.
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Affiliation(s)
- Cheng Chen
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Wei-Hsuan Lo-Ciganic
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida; Center for Drug Evaluation and Safety, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Almut G Winterstein
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida; Center for Drug Evaluation and Safety, College of Pharmacy, University of Florida, Gainesville, Florida; Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, Florida
| | - Patrick Tighe
- Department of Anesthesiology, College of Medicine, University of Florida, Gainesville, Florida
| | - Yu-Jung J Wei
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida; Center for Drug Evaluation and Safety, College of Pharmacy, University of Florida, Gainesville, Florida.
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Grant AD, Miller MM, Anastas TM, Quinn P, Lok B, Hirsh AT. Opioid-related risk perceptions in chronic pain: influence of patient gender and previous misuse behaviors. Pain 2022; 163:711-718. [PMID: 34285152 PMCID: PMC8761212 DOI: 10.1097/j.pain.0000000000002412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 07/07/2021] [Indexed: 10/20/2022]
Abstract
ABSTRACT Little is known about the factors that influence providers' perceptions of patient risk for aberrant opioid use. Patient gender may interact with previous opioid misuse to influence these perceptions. We asked 131 physicians to view videos and vignettes for 8 virtual patients with chronic pain. Gender (male/female) and previous prescription opioid misuse (present/absent) varied across patients; the vignettes were otherwise balanced on demographic and clinical characteristics. For each patient, providers assessed 4 risk domains: opioid-related adverse events, opioid misuse or abuse, opioid addiction, and opioid diversion. Results indicated a significant gender-by-misuse interaction for risk of opioid misuse orabuse. When previous misuse behaviors were absent, providers rated men at higher risk; there was no gender difference when previous misuse behaviors were present. A significant gender-by-misuse interaction was found for risk of opioid-related adverse events. Providers perceived men to be at higher risk when previous misuse behaviors were absent; there was no gender difference when previous misuse behaviors were present. A significant gender-by-misuse interaction was found for risk of opioid addiction. Providers rated women at higher risk when previous misuse behaviors were present and men at higher risk when previous misuse behaviors were absent. There were significant main effects of gender and misuse for risk of opioid diversion. Providers rated men and those with previous misuse behaviors at higher risk. These results demonstrate that patient gender and previous opioid misuse have unique and interactive effects on provider perceptions of prescription opioid-related risks. Studies are needed to identify the mechanisms underlying these effects, such as gender-based stereotypes about risk-taking and drug abuse.
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Affiliation(s)
- Alexis D. Grant
- Department of Psychology, Indiana University-Purdue University Indianapolis
| | - Megan M. Miller
- Department of Psychology, Indiana University-Purdue University Indianapolis
| | - Tracy M. Anastas
- Department of Psychology, Indiana University-Purdue University Indianapolis
| | - Patrick Quinn
- School of Public Health, Indiana University Bloomington
| | - Benjamin Lok
- Department of Computer and Information Science and Engineering, University of Florida
| | - Adam T. Hirsh
- Department of Psychology, Indiana University-Purdue University Indianapolis
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Diagnostic and Predictive Capacity of the Spanish Versions of the Opioid Risk Tool and the Screener and Opioid Assessment for Patients with Pain-Revised: A Preliminary Investigation in a Sample of People with Noncancer Chronic Pain. Pain Ther 2022; 11:493-510. [PMID: 35128624 PMCID: PMC9098780 DOI: 10.1007/s40122-022-00356-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/17/2022] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Accurate assessment of the risk of opioid abuse and misuse in people with noncancer chronic pain is crucial for their prevention. This study aimed to provide preliminary evidence of the diagnostic and predictive capacity of the Spanish versions of the Opioid Risk Tool (ORT) and the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R). METHODS We used the Current Opioid Misuse Measure (COMM) as criterion measure to assess the capacity of each tool to identify patients misusing opioids at the time of the assessment. Eighteen months later, we used the COMM and the Drug Abuse Screening Test-10 (DAST-10) to assess their predictive capacity. In total, 147 people with noncancer chronic pain participated in the diagnostic study, and 42 in the predictive study. RESULTS Receiver operating curve analysis showed that the SOAPP-R had an excellent capacity to identify participants who were misusing opioids at the time of assessment (area under the curve [AUC] = 0.827). The diagnostic capacity of the ORT was close to acceptable (AUC = 0.649-0.669), whereas its predictive capacity was poor (AUC = 0.522-0.554). The predictive capacity of the SOAPP-R was close to acceptable regarding misuse (AUC = 0.672) and poor regarding abuse (AUC = 0.423). CONCLUSION In the setting of Spanish-speaking communities, clinicians should be cautious when using these instruments to make decisions on opioid administration. Further research is needed on the diagnostic and predictive capacity of the Spanish versions of both instruments.
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Na L, Hsieh HF, Glassman T. Misuse of Prescription Medications among Individuals with Mobility Disability. Subst Use Misuse 2022; 57:1425-1433. [PMID: 35699138 DOI: 10.1080/10826084.2022.2086696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The ability of walking a quarter mile is predictive of subsequent disability, mortality, and health care costs. Individuals with mobility disability are at increased risk of chronic conditions and unmet care needs. Thus they may misuse prescription medications to self-medicate. OBJECTIVES We aimed to explore the difference of misuse of four types of prescription medications (sedatives, tranquilizers, painkillers, depression medications) and overall misuse by mobility status and identify the correlates of overall misuse. METHODS A national probability sample from the survey Midlife in the United States (MIDUS) was used to assess the difference in misuse by mobility status during 2011-2014. To assess the correlates of misuse, mobility status, usual source of care, unmet care needs, insurance coverage, sociodemographic variables, and clinical conditions were added to a survey weighted logistic regression model with backward selection. RESULTS Compared to those without mobility disability, individuals with mobility disability had higher risk of misuse in most types of medications and in overall misuse. Mobility disability, lower education, unmarried status, the emergency room or public health clinic as the most often used care, pain, and depressed affect were identified as correlates of overall misuse of studied medications. CONCLUSIONS Individuals with mobility disability are a vulnerable group susceptible to medication misuse, which warrants the urgent need for interventions to ameliorate misuse and reduce risks in this population.
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Affiliation(s)
- Ling Na
- School of Population Health, University of Toledo, Toledo, OH, USA
| | - Hsing-Fang Hsieh
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Tavis Glassman
- School of Population Health, University of Toledo, Toledo, OH, USA
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Matta MS, Janikowski TP. Predictors of Pain Reliever Misuse Among Respondents of the United States 2017 National Survey on Drug Use and Health. Subst Abuse 2022; 16:11782218221111843. [PMID: 35845968 PMCID: PMC9280814 DOI: 10.1177/11782218221111843] [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: 02/22/2022] [Accepted: 06/20/2022] [Indexed: 11/21/2022]
Abstract
The risk factors for potential opioid misuse and abuse in patients receiving long-term opioid pain treatment have been a topic of interest in research for many years. There are differences among patients who receive long-term opioid pain treatment. These differences may or may not lead to opioid misuse. This study analyzes the different characteristics and predictors of prescription pain reliever misuse among respondents of the United States 2017 National Survey on Drug Use and Health. It examines the relationships of age, gender, income, perception of risk and availability of heroin, past substance use and alcohol use, the source of the pain relievers, and motivation to misuse pain relievers to pain reliever misuse and if these variables significantly predict pain reliever misuse. Data used in this study were analyzed through sequential multiple linear regression analyses. The significant positive predictors of prescription pain reliever misuse were being 26 or older, perceiving heroin as easily obtainable, and past methamphetamine use. The significant negative predictors of prescription pain reliever misuse were being 12 to 25 years old, perceiving heroin as a great risk, past alcohol use, and obtaining pain relievers from a friend or relative. The goal of this study was to increase the amount of knowledge regarding predictors of prescription opioid misuse to identify those who are at risk and decrease prescription opioid misuse and overdose rates in the United States.
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Hasan MM, Young GJ, Patel MR, Modestino AS, Sanchez LD, Noor-E-Alam M. A machine learning framework to predict the risk of opioid use disorder. MACHINE LEARNING WITH APPLICATIONS 2021. [DOI: 10.1016/j.mlwa.2021.100144] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Shaw DJ, Johnson ME. Primary Purpose for Committing a Crime and Past-30 Day Opioid Misuse: A Statewide Sample of Justice-Involved Children. JOURNAL OF DRUG ISSUES 2021; 52:97-113. [DOI: 10.1177/00220426211037608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The prevalence of opioid misuse (OM) among justice-involved children (JIC) is significantly higher than children in the general population, yet little research has examined the predictors of OM among JIC. Goldstein’s “economic compulsive model” hypothesizes that JIC who commit crimes for material gain will have a higher likelihood of meeting past-30 day (P30D) OM criteria. The data in this study were cross-sectional and represented 79,960 Florida JIC. To test the hypothesis, logistic regression analyses were utilized. Over 2000 JIC (2.67%) met P30D OM criteria and JIC who committed crimes for material gain were 2.55 times as likely to meet P30D OM criteria. Findings indicate that children may be incarcerated due to an inability to afford their addiction, contributing to the criminalization of mental health. JIC could benefit from the increased utilization of drug courts and the implementation of a cascade of care model.
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Affiliation(s)
- Dylan J. Shaw
- College of Medicine, University of Central Florida, Orlando, FL, USA
| | - Micah E. Johnson
- Department of Mental Health Law and Policy, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, USA
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Psychological Flexibility, Pain Characteristics and Risk of Opioid Misuse in Noncancerous Chronic Pain Patients. J Clin Psychol Med Settings 2021; 28:405-417. [PMID: 32519037 DOI: 10.1007/s10880-020-09729-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Chronic pain has an estimated annual prevalence rate between 10 and 35%. In the US, first-line treatment for chronic pain is often opioids. OBJECTIVE To our knowledge, this is the first study exploring psychological flexibility and its association with pain severity, pain interference and risk of opioid misuse in chronic pain patients. METHODS Data were collected at two outpatient pain clinics in the northeastern United States. Adults (N = 99) completed a cross-sectional survey with validated measures. Pain severity and pain interference were hypothesized to uniquely predict the risk of opioid misuse. Pain severity was hypothesized to predict pain interference. Finally, psychological flexibility was hypothesized as an indirect effect in these relationships. RESULTS Main findings suggest that pain severity predicts risk of opioid misuse, mediated by psychological flexibly. Pain interference also predicts risk of opioid misuse, mediated by psychological flexibility. Finally, results suggest pain severity predicts pain interference, mediated by psychological flexibility. DISCUSSION Implications of findings are discussed in terms of future psychological and medical assessments and interventions for chronic pain patients seeking prescription opioids.
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Clinical Implications of Opioid Therapy. Cancer Treat Res 2021; 182:107-124. [PMID: 34542879 DOI: 10.1007/978-3-030-81526-4_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Although opioids are potent central acting broad-spectrum analgesics, their effectiveness is diminished by various factors pertaining to their metabolism, drug interactions, genetic issues, adverse/side effects, and potential for abuse. All these factors present potential barriers to effective analgesia requiring specific considerations in clinical practice, which include monitoring and case-based intervention.
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Ramírez-Maestre C, López-Martínez AE, Esteve R. Predictive variables of prescription opioid misuse in patients with chronic noncancer pain. Development of a risk detection scale: A registered report protocol. PLoS One 2021; 16:e0251586. [PMID: 33984037 PMCID: PMC8118327 DOI: 10.1371/journal.pone.0251586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/29/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Opioid therapy is utilized for a broad range of chronic pain conditions. Several studies have highlighted the adverse effects of opioid medication due to the misuse of these drugs. The gradual increase in the use of opioids has become a global phenomenon and is generating social concern. Several treatment guidelines have strongly recommended assessing the risks and benefits of pharmacological treatment with opioids. These guidelines also recommend the psychological assessment of patients with chronic noncancer pain in order to make informed decisions on the advisability of intervention with opioids. Some authors have emphasized the relevance of assessing the risk of opioid misuse in patients with noncancer chronic pain before initiating treatment. METHODS AND ANALYSIS Two studies will be conducted, each with a different primary objective. The primary objective of the first study (Study 1) will be to conduct a comprehensive investigation to identify the factors most closely associated with subsequent opioid misuse; and based on the results of Study 1, the primary objective of the second study (Study 2) will be to develop a brief, reliable, valid, and useful instrument that would enable health care providers to make decisions on opioid prescription and on the required level of monitoring and follow-up. These decisions would have positive consequences for patient wellbeing. Study 1 will include a logistic regression analysis to test the hypothetical model. Study 2 will have a longitudinal design and include three assessment sessions in order to develop a measure to assess the risk of prescribed opioid misuse and to analyse its reliability and validity. Participants will be individuals with chronic noncancer pain attending three Pain Units. These individuals will either be undergoing pharmacological treatment that includes opioid analgesics (Study 1, N = 400) or are going to commence such treatment (Study 2, N = 250).
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Affiliation(s)
- Carmen Ramírez-Maestre
- Universidad de Málaga, Facultad de Psicología, Andalucía Tech, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga, Málaga, Spain
| | - Alicia E. López-Martínez
- Universidad de Málaga, Facultad de Psicología, Andalucía Tech, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga, Málaga, Spain
| | - Rosa Esteve
- Universidad de Málaga, Facultad de Psicología, Andalucía Tech, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga, Málaga, Spain
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Vitzthum LK, Riviere P, Sheridan P, Nalawade V, Deka R, Furnish T, Mell LK, Rose B, Wallace M, Murphy JD. Predicting Persistent Opioid Use, Abuse, and Toxicity Among Cancer Survivors. J Natl Cancer Inst 2021; 112:720-727. [PMID: 31754696 DOI: 10.1093/jnci/djz200] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/08/2019] [Accepted: 09/27/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Although opioids play a critical role in the management of cancer pain, the ongoing opioid epidemic has raised concerns regarding their persistent use and abuse. We lack data-driven tools in oncology to understand the risk of adverse opioid-related outcomes. This project seeks to identify clinical risk factors and create a risk score to help identify patients at risk of persistent opioid use and abuse. METHODS Within a cohort of 106 732 military veteran cancer survivors diagnosed between 2000 and 2015, we determined rates of persistent posttreatment opioid use, diagnoses of opioid abuse or dependence, and admissions for opioid toxicity. A multivariable logistic regression model was used to identify patient, cancer, and treatment risk factors associated with adverse opioid-related outcomes. Predictive risk models were developed and validated using a least absolute shrinkage and selection operator regression technique. RESULTS The rate of persistent opioid use in cancer survivors was 8.3% (95% CI = 8.1% to 8.4%); the rate of opioid abuse or dependence was 2.9% (95% CI = 2.8% to 3.0%); and the rate of opioid-related admissions was 2.1% (95% CI = 2.0% to 2.2%). On multivariable analysis, several patient, demographic, and cancer and treatment factors were associated with risk of persistent opioid use. Predictive models showed a high level of discrimination when identifying individuals at risk of adverse opioid-related outcomes including persistent opioid use (area under the curve [AUC] = 0.85), future diagnoses of opioid abuse or dependence (AUC = 0.87), and admission for opioid abuse or toxicity (AUC = 0.78). CONCLUSION This study demonstrates the potential to predict adverse opioid-related outcomes among cancer survivors. With further validation, personalized risk-stratification approaches could guide management when prescribing opioids in cancer patients.
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Affiliation(s)
- Lucas K Vitzthum
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA.,Center for Precision Radiation Medicine, University of California San Diego, La Jolla, CA
| | - Paul Riviere
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - Paige Sheridan
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - Vinit Nalawade
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - Rishi Deka
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - Timothy Furnish
- Department of Family Medicine and Public Health and Division of Pain Medicine, Department of Internal Medicine, University of California San Diego, La Jolla, CA
| | - Loren K Mell
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA.,Center for Precision Radiation Medicine, University of California San Diego, La Jolla, CA
| | - Brent Rose
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA.,Center for Precision Radiation Medicine, University of California San Diego, La Jolla, CA
| | | | - James D Murphy
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA.,Center for Precision Radiation Medicine, University of California San Diego, La Jolla, CA
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Pylväs-Korolainen M, Karjalainen K, Lintonen T. Factors associated with non-medical use of prescription drugs among individuals with a legitimate prescription for medical purposes: A population-based study. NORDIC STUDIES ON ALCOHOL AND DRUGS 2021; 39:50-63. [PMID: 35308469 PMCID: PMC8899272 DOI: 10.1177/14550725211003417] [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: 02/22/2021] [Accepted: 03/01/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Psychoactive prescription drugs are known to have abuse potential. This study was aimed at studying the non-medical use of prescription drugs (NMUPD) among individuals with prescriptions for anxiolytics, sedatives, or strong analgesics. We examined the association of socio-demographics, binge drinking, the number of drug prescriptions, and drug types prescribed for medical purposes with NMUPD among the general Finnish population. Methods: Data were derived from population-based (ages 15–69 years) Drug Surveys conducted in Finland in 2006, 2010, and 2014. The response rates varied between 48% and 55%. Individuals with prescriptions for one or more prescription drugs in the last 12 months were included (n = 1,602) and divided into three groups: medical use only, NMUPD, and NMUPD with illicit drug use (ILLICIT USE). Multinomial logistic regression was used. Results: Among individuals with a prescription for at least one prescription drug, 5.7% reported NMUPD. Living alone and being outside the labour force were associated with NMUPD. Younger age, living in a large city, living alone, and unemployment were associated with ILLICIT USE. Frequent binge drinking and a high number of drug prescriptions were associated with both NMUPD and ILLICIT USE. Those reporting ILLICIT USE were more likely to have a prescription for sedatives. Conclusions: Although NMUPD is on a rather low level among those who have a prescription for legitimate purposes, having multiple prescriptions increased the likelihood of NMUPD. Low socio-economic position and binge drinking are associated with NMUPD and this should be taken into account when planning interventions and preventive actions.
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Affiliation(s)
| | | | - Tomi Lintonen
- Finnish Foundation for Alcohol Studies, Helsinki, Finland
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Fernandez AC, Lin LA, Bazzi AR, Boissoneault J, Borsari B, Blow F. Beliefs about Perioperative Opioid and Alcohol Use among Elective Surgical Patients Who Report Unhealthy Drinking: A Qualitative Study. PAIN MEDICINE 2021; 22:2384-2392. [PMID: 33892495 PMCID: PMC8500720 DOI: 10.1093/pm/pnab104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES Elective surgical patients with unhealthy alcohol use have unique pain management needs and addiction risk factors that are relevant to surgical preparation and recovery. This descriptive qualitative study sought to better understand patients' beliefs and behaviors related to opioid use, alcohol use, and pain management in the perioperative context. DESIGN We conducted individual semi-structured interviews between July 2017 and March 2018. SETTING A large Midwestern academic health system. SUBJECTS Participants were elective surgical patients meeting unhealthy alcohol use criteria, recruited from the health system's preoperative anesthesia clinic. METHOD Semi-structured interview guides explored beliefs and behaviors relating to alcohol and opioid use, health status, and surgical care. Interview recordings were transcribed and coded for thematic analysis. RESULTS Among 20 elective surgical patients (25% female), we identified three key themes regarding alcohol use, opioid use, and their co-use before and after surgery. First, desires and intentions to use opioids for postoperative pain management varied widely, even before opioids were prescribed. Second, some participants described alcohol as a preferred pain management strategy. Third, participants held a range of beliefs about the risks and benefits of alcohol and opioid co-use. CONCLUSION Appropriate assessment of beliefs and intentions regarding opioid and alcohol use could help identify patients most vulnerable to new opioid problems and unhealthy alcohol use in the context of perioperative surgical pain. These findings have important implications for perioperative pain management.
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Affiliation(s)
- Anne C Fernandez
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
- Correspondence to: Anne C. Fernandez, PhD, Department of Psychiatry, University of Michigan. North Campus Research Complex, 2800 PlymouthRoad, Building 16, Ann Arbor, MI 48109, USA. Tel: 734-232-0313; Fax: 734-764-7932; E-mail:
| | - Lewei A Lin
- Department of Psychiatry, University of Michigan and Center for Clinical Management Research, HSR&D, Veterans Affairs Health Care System, Ann Arbor, Michigan
| | - Angela R Bazzi
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, California
| | - Jeff Boissoneault
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida
| | - Brian Borsari
- Department of Psychiatry and Behavioral Sciences, San Francisco Veterans Affairs Health Care System, University of California San Francisco, San Francisco, California, USA
| | - Frederic Blow
- Department of Psychiatry, University of Michigan and Center for Clinical Management Research, HSR&D, Veterans Affairs Health Care System, Ann Arbor, Michigan
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Freda PJ, Moore JH, Kranzler HR. The phenomics and genetics of addictive and affective comorbidity in opioid use disorder. Drug Alcohol Depend 2021; 221:108602. [PMID: 33652377 PMCID: PMC8059867 DOI: 10.1016/j.drugalcdep.2021.108602] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 12/21/2022]
Abstract
Opioid use disorder (OUD) creates significant public health and economic burdens worldwide. Therefore, understanding the risk factors that lead to the development of OUD is fundamental to reducing both its prevalence and its impact. Significant sources of OUD risk include co-occurring lifetime and current diagnoses of both psychiatric disorders, primarily mood disorders, and other substance use disorders, and unique and shared genetic factors. Although there appears to be pleiotropy between OUD and both mood and substance use disorders, this aspect of OUD risk is poorly understood. In this review, we describe the prevalence and clinical significance of addictive and affective comorbidities as risk factors for OUD development as a basis for rational opioid prescribing and OUD treatment and to improve efforts to prevent the disorder. We also review the genetic variants that have been associated with OUD and other addictive and affective disorders to highlight targets for future study and risk assessment protocols.
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Affiliation(s)
- Philip J. Freda
- University of Pennsylvania, Biostatistics, Epidemiology, & Informatics, The Perelman School of Medicine, University of Pennsylvania A201 R…, Philadelphia, Pennsylvania 19104, United States
| | - Jason H. Moore
- Edward Rose Professor of Informatics, Director, Institute for Biomedical Informatics, Director, Division of Informatics, Department of Biostatistics, Epidemiology, & Informatics, Senior Associate Dean for Informatics, The Perelman School of Medicine, University of Pennsylvania, Contact Information: D202 Richards Building, 3700 Hamilton Walk, University of Pennsylvania, Philadelphia, PA 19104-6116
| | - Henry R. Kranzler
- Benjamin Rush Professor in Psychiatry, Department of Psychiatry, University of Pennsylvania, Treatment Research Center, 3535 Market Street, Suite 500, Philadelphia, PA 19104-6178
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Ngo B, Liebschutz JM, Cheng DM, Colasanti JA, Merlin JS, Armstrong WS, Forman LS, Lira MC, Samet JH, Del Rio C, Tsui JI. Hazardous alcohol use is associated with greater pain interference and prescription opioid misuse among persons living with HIV and chronic pain. BMC Public Health 2021; 21:564. [PMID: 33752634 PMCID: PMC7986380 DOI: 10.1186/s12889-021-10566-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 03/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Alcohol use is common among persons living with HIV (PLWH), who often experience chronic pain, yet its impact on pain and opioid misuse is not fully characterized. METHODS We assessed associations between hazardous alcohol use and pain interference, defined as the self-reported impact of pain on daily living, pain severity, and risk for opioid misuse among PLWH who were on long-term opioid therapy (LTOT). A cohort was recruited as part of the "Targeting Effective Analgesia in Clinics for HIV" (TEACH) study, a randomized controlled trial to improve LTOT in HIV clinics. The Alcohol Use Disorders Test (AUDIT), Brief Pain Inventory (BPI) and the Current Opioid Misuse Measure (COMM) were administered at both baseline and 12-months. Linear mixed and generalized estimating equation models, incorporating data from both time points, evaluated associations between hazardous alcohol use (AUDIT ≥8) and: pain interference (0-10), pain severity (0-10), and opioid misuse risk (COMM ≥13), adjusting for age, gender, depressive symptoms, use of non-alcohol substances, time-point, and study-arm. RESULTS The sample was comprised of 166 participants, of which 31 (19%) reported hazardous alcohol use. The majority were male (65%), black (72%), and the mean age was 54 (range: 29-77). Hazardous alcohol use was significantly associated with higher pain interference (adjusted mean difference [AMD]: 1.02; 95% CI: 0.08, 1.96) and higher odds of opioid misuse risk (AOR: 3.73, 95% CI: 1.88-7.39), but not pain severity (AMD: 0.47, 95% CI: - 0.35, 1.29). CONCLUSIONS Hazardous alcohol use was associated with greater functional impairment in daily living from their pain and higher odds for prescription opioid misuse in this study of PLWH on LTOT. Providers should be attentive to alcohol use among PLWH who are prescribed opioids given associations with pain and opioid misuse. TRIAL REGISTRATION ClinicalTrials.gov NCT02564341 (Intervention, September 30, 2015) and NCT02525731 (Patient Cohort, August 17, 2015). Both prospectively registered.
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Affiliation(s)
- Belle Ngo
- University of Washington School of Medicine, Seattle, WA, USA
| | - Jane M Liebschutz
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Debbie M Cheng
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Jonathan A Colasanti
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jessica S Merlin
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Wendy S Armstrong
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Leah S Forman
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Marlene C Lira
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Jeffrey H Samet
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Carlos Del Rio
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Judith I Tsui
- University of Washington School of Medicine, Seattle, WA, USA.
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Integrating human services and criminal justice data with claims data to predict risk of opioid overdose among Medicaid beneficiaries: A machine-learning approach. PLoS One 2021; 16:e0248360. [PMID: 33735222 PMCID: PMC7971495 DOI: 10.1371/journal.pone.0248360] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 02/24/2021] [Indexed: 12/23/2022] Open
Abstract
Health system data incompletely capture the social risk factors for drug overdose. This study aimed to improve the accuracy of a machine-learning algorithm to predict opioid overdose risk by integrating human services and criminal justice data with health claims data to capture the social determinants of overdose risk. This prognostic study included Medicaid beneficiaries (n = 237,259) in Allegheny County, Pennsylvania enrolled between 2015 and 2018, randomly divided into training, testing, and validation samples. We measured 290 potential predictors (239 derived from Medicaid claims data) in 30-day periods, beginning with the first observed Medicaid enrollment date during the study period. Using a gradient boosting machine, we predicted a composite outcome (i.e., fatal or nonfatal opioid overdose constructed using medical examiner and claims data) in the subsequent month. We compared prediction performance between a Medicaid claims only model to one integrating human services and criminal justice data with Medicaid claims (i.e., integrated model) using several metrics (e.g., C-statistic, number needed to evaluate [NNE] to identify one overdose). Beneficiaries were stratified into risk-score decile subgroups. The samples (training = 79,087, testing = 79,086, validation = 79,086) had similar characteristics (age = 38±18 years, female = 56%, white = 48%, having at least one overdose = 1.7% during study period). Using the validation sample, the integrated model slightly improved on the Medicaid claims only model (C-statistic = 0.885; 95%CI = 0.877–0.892 vs. C-statistic = 0.871; 95%CI = 0.863–0.878), with small corresponding improvements in the NNE and positive predictive value. Nine of the top 30 most important predictors in the integrated model were human services and criminal justice variables. Using the integrated model, approximately 70% of individuals with overdoses were members of the top risk decile (overdose rates in the subsequent month = 47/10,000 beneficiaries). Few individuals in the bottom 9 deciles had overdose episodes (0-12/10,000). Machine-learning algorithms integrating claims and social service and criminal justice data modestly improved opioid overdose prediction among Medicaid beneficiaries for a large U.S. county heavily affected by the opioid crisis.
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Baranidharan G, Edgar D, Bretherton B, Crowther T, Lalkhen AG, Fritz AK, Vajramani G. Efficacy and Safety of 10 kHz Spinal Cord Stimulation for the Treatment of Chronic Pain: A Systematic Review and Narrative Synthesis of Real-World Retrospective Studies. Biomedicines 2021; 9:180. [PMID: 33670252 PMCID: PMC7918133 DOI: 10.3390/biomedicines9020180] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/27/2021] [Accepted: 02/05/2021] [Indexed: 12/14/2022] Open
Abstract
10 kHz spinal cord stimulation (SCS) is increasingly utilized globally to treat chronic pain syndromes. Real-world evidence complementing randomized controlled trials supporting its use, has accumulated over the last decade. This systematic review aims to summarize the retrospective literature with reference to the efficacy and safety of 10 kHz SCS. We performed a systematic literature search of PubMed between 1 January 2009 and 21 August 2020 for English-language retrospective studies of ≥3 human subjects implanted with a Senza® 10 kHz SCS system and followed-up for ≥3 months. Two independent reviewers screened titles/abstracts of 327 studies and 46 full-text manuscripts. In total, 16 articles were eligible for inclusion; 15 reported effectiveness outcomes and 11 presented safety outcomes. Follow-up duration ranged from 6-34 months. Mean pain relief was >50% in most studies, regardless of follow-up duration. Responder rates ranged from 67-100% at ≤12 months follow-up, and from 46-76% thereafter. 32-71% of patients decreased opioid or nonopioid analgesia intake. Complication incidence rates were consistent with other published SCS literature. Findings suggest 10 kHz SCS provides safe and durable pain relief in pragmatic populations of chronic pain patients. Furthermore, it may decrease opioid requirements, highlighting the key role 10 kHz SCS can play in the medium-term management of chronic pain.
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Affiliation(s)
- Ganesan Baranidharan
- Leeds Teaching Hospitals NHS Trust Leeds, Leeds LS1 3EX, UK; (B.B.); (T.C.)
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds LS2 9JT, UK
| | | | - Beatrice Bretherton
- Leeds Teaching Hospitals NHS Trust Leeds, Leeds LS1 3EX, UK; (B.B.); (T.C.)
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds LS2 9JT, UK
| | - Tracey Crowther
- Leeds Teaching Hospitals NHS Trust Leeds, Leeds LS1 3EX, UK; (B.B.); (T.C.)
| | | | - Ann-Katrin Fritz
- Pain Management Centre, Norfolk and Norwich University Hospital, Norwich NR4 7UY, UK;
| | - Girish Vajramani
- Centre for Functional Neurosurgery, University Hospital Southampton NHS Foundation Trust, Hampshire SO16 6YD, UK;
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Starrels JL, Young SR, Azari SS, Becker WC, Jennifer Edelman E, Liebschutz JM, Pomeranz J, Roy P, Saini S, Merlin JS. Disagreement and Uncertainty Among Experts About how to Respond to Marijuana Use in Patients on Long-term Opioids for Chronic Pain: Results of a Delphi Study. PAIN MEDICINE 2021; 21:247-254. [PMID: 31393585 DOI: 10.1093/pm/pnz153] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Marijuana use is common among patients on long-term opioid therapy (LTOT) for chronic pain, but there is a lack of evidence to guide clinicians' response. OBJECTIVE To generate expert consensus about responding to marijuana use among patients on LTOT. DESIGN Analysis from an online Delphi study. SETTING/SUBJECTS Clinician experts in pain and opioid management across the United States. METHODS Participants generated management strategies in response to marijuana use without distinction between medical and nonmedical use, then rated the importance of each management strategy from 1 (not at all important) to 9 (extremely important). A priori rules for consensus were established, and disagreement was explored using cases. Thematic analysis of free-text responses examined factors that influenced participants' decision-making. RESULTS Of 42 participants, 64% were internal medicine physicians. There was consensus that it is not important to taper opioids as an initial response to marijuana use. There was disagreement about the importance of tapering opioids if there is a pattern of repeated marijuana use without clinical suspicion for a cannabis use disorder (CUD) and consensus that tapering is of uncertain importance if there is suspicion for CUD. Three themes influenced experts' perceptions of the importance of tapering: 1) benefits and harms of marijuana for the individual patient, 2) a spectrum of belief about the overall riskiness of marijuana use, and 3) variable state laws or practice policies. CONCLUSIONS Experts disagree and are uncertain about the importance of opioid tapering for patients with marijuana use. Experts were influenced by patient factors, provider beliefs, and marijuana policy, highlighting the need for further research.
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Affiliation(s)
- Joanna L Starrels
- Division of General Internal Medicine, Albert Einstein College of Medicine and Montefiore Health System, Bronx, New York
| | - Sarah R Young
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama.,Department of Social Work, College of Community and Public Affairs, Binghamton University, Binghamton, New York
| | - Soraya S Azari
- Division of General Internal Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California
| | - William C Becker
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.,VA Connecticut Healthcare System, West Haven, Connecticut
| | - E Jennifer Edelman
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Jane M Liebschutz
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jamie Pomeranz
- Department of Occupational Therapy, University of Florida, Gainesville, Florida
| | - Payel Roy
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Shalini Saini
- Department of Medicine, Information Technology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jessica S Merlin
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Hettie G, Nwaneshiudu C, Ziadni MS, Darnall BD, Mackey SC, You DS. Lack of Premeditation Predicts Aberrant Behaviors Related to Prescription Opioids in Patients with Chronic Pain: A Cross-Sectional Study. Subst Use Misuse 2021; 56:1904-1909. [PMID: 34369839 PMCID: PMC8928584 DOI: 10.1080/10826084.2021.1958853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE In light of the opioid epidemic, there is a need to identify factors that predict aberrant opioid behaviors including misuse and abuse. Impulsivity has been extensively studied in addiction literature, but not in the context of opioid misuse. Hence, this study aimed to identify which of the impulsivity facets (negative urgency, positive urgency, sensation seeking, lack of perseverance, and lack of premeditation) would predict current aberrant opioid-related behaviors in patients with chronic pain. METHODS Data were collected through an online survey from patients with chronic pain who visited a tertiary pain clinic. Patients were predominately female (74%), middle aged (M = 55 years), and White/Caucasian (84%). Upon consent, they completed a series of surveys including UPPS-P Impulsive Behavior Scale, the Current Opioid misuse Measure, Pain Catastrophizing Scale, PROMIS-anxiety, depression, and physical function, and a 0-10 numerical pain rating scale. Ordinal regression analyses were conducted to test study hypotheses. RESULTS Contrary to expectations, only lack of premeditation predicted higher odds of aberrant opioid-related behaviors in the past 30 days, after controlling for known covariates, and explained 26% of variance. Interestingly, lack of premeditation together with pain catastrophizing as a covariate explained 56% of the variance in aberrant opioid-related behaviors. DISCUSSION The current study is the first to identify a potential role of lack of premeditation as an impulsivity facet predicting aberrant opioid-related behaviors among patients with chronic pain.
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Affiliation(s)
- Gabrielle Hettie
- Department Anesthesiology, Perioperative and Pain medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Chinwe Nwaneshiudu
- Department Anesthesiology, Perioperative and Pain medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Maisa S Ziadni
- Department Anesthesiology, Perioperative and Pain medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Beth D Darnall
- Department Anesthesiology, Perioperative and Pain medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Sean C Mackey
- Department Anesthesiology, Perioperative and Pain medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Dokyoung S You
- Department Anesthesiology, Perioperative and Pain medicine, Stanford University School of Medicine, Palo Alto, CA, USA
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Johnson ME, Clerjuste S. The association between somatic complaints and past-30 day opioid misuse among justice-involved children. HEROIN ADDICTION AND RELATED CLINICAL PROBLEMS 2020; 22:15-23. [PMID: 34949973 PMCID: PMC8694337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Individuals in the criminal justice system are especially vulnerable to the adverse effects of opioid misuse. Research on justice-involved children (JIC) is needed to uncover the variables that predict opioid misuse initiation to prevent misuse or reduce harm in this population. Somatic symptoms are symptoms experienced in the body, such as physical sensations, movements or experiences, which can cause severe distress and dysfunction. These include pain, nausea, dizziness, and fainting. In this study, we hypothesize that somatic complaints will be associated with a higher likelihood of opioid misuse among Florida JIC. METHODS The study examined statewide data on 79,960 JIC in the Florida Department of Juvenile Justice database. Logistic regression was employed to investigate an ordinal measure of somatic complaints at first screen and a binary outcome measure of past-30 day illicit or nonmedical opioid use at final screen while controlling for sociodemographic and mental health factors. RESULTS Nearly 28% of JIC had a history of one or more somatic complaints. Compared to those with no history of somatic complaints, JIC with a history of one or two somatic complaints were 1.23 times more likely to misuse opioids in the past 30 days and those with three or four somatic complaints were 1.5 times more likely to meet criteria for past-30 day opioid misuse. CONCLUSIONS Individuals may consume illicit or non-medical prescription opioids to manage somatic symptoms - indicating that increased access to healthcare may reduce misuse. Risk of opioid overdose sharply increases as justice-involved individuals are released from correctional settings largely due to a reduced tolerance to opioids as a result of incarceration and diminished access to legal medicines that are provided in the justice system. Justice systems must ensure seamless access to quality healthcare services as individuals transition from correctional settings to their communities.
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Affiliation(s)
- Micah E. Johnson
- Department of Mental Health Law and Policy, College of Behavioural and Community Sciences, University of South Florida, Tampa, FL, USA
| | - Sarah Clerjuste
- The Study of Teen Opioid Misuse and Prevention Laboratory, Health Street, University of Florida, Gainesville, FL, USA
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Nauser JW, Nelson CI, Gross RT, Vargovich AM. Pain Experiences and Their Relation to Opioid Misuse Risk and Emotion Dysregulation. Pain Res Manag 2020; 2020:7234625. [PMID: 33224363 PMCID: PMC7673950 DOI: 10.1155/2020/7234625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 10/21/2020] [Accepted: 10/25/2020] [Indexed: 11/17/2022]
Abstract
Pain is a complex, multidimensional experience but often is measured as a unidimensional experience. This study aimed to separately assess the sensory and affective components of pain and identify their relations to important pain-related outcomes, particularly in terms of opioid misuse risk and emotion dysregulation among patients with chronic pain receiving treatment in Appalachia. Two hundred and twelve patients presenting to a multidisciplinary pain center completed the Difficulties in Emotion Regulation Scale (DERS-18), Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R), and short-form McGill Pain Questionnaire (SF-MPQ). The sensory experience of pain was unrelated to emotion dysregulation (r = 0.06, p = 0.57) and weakly related to opioid misuse risk (r = 0.182, p < 0.05). In contrast, the affective experience of pain was moderately related to emotion dysregulation (r = 0.217, p < 0.05) and strongly related to opioid misuse risk (r = 0.37, p < 0.01). In addition, emotion dysregulation predicted variance in opioid misuse risk above and beyond the affective and sensory experiences of pain ((b = 0.693, p < 0.001). The results suggest patients with a strong affective experience versus sensory experience of pain and challenges with emotion regulation may require a more comprehensive intervention to address these underlying components in order to reduce their risk of misusing opioid medications.
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47
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Ghodke A, Ives TJ, Austin AE, Bennett WC, Patel NY, Eshet SA, Chelminski PR. Pain Agreements and Time-to-Event Analysis of Substance Misuse in a Primary Care Chronic Pain Program. PAIN MEDICINE 2020; 21:2154-2162. [PMID: 32186725 DOI: 10.1093/pm/pnaa033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Types and correlates of pain medication agreement (PMA) violations in the primary care setting have not been analyzed. METHODS A retrospective analysis was completed to examine patient characteristics and correlates of PMA violations, a proxy for substance misuse, over a 15-year period in an outpatient General Medicine Pain Service within the Division of General Medicine and Clinical Epidemiology, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill. Patients who signed the PMA were managed for chronic pain from 2002 through 2017 (N = 1,210). The incidence of PMA violations was measured over a 15-year span. Substance misuse was defined a priori in the study as urine toxicology screen positive for illicit or nonprescribed controlled substances, patient engagement in prescription alteration, doctor-shopping, or diversion. RESULTS Most patients received a prescription for a controlled substance (77.4%). During enrollment, 488 (40.3%) patients had one or more violations of their PMA. One-third (33.4%) of pain service patients had a violation within 365 days of signing the agreement. Active tobacco smokers had double the incidence of agreement violation within the first 30 days of enrollment. Almost one-half (49.8%) of violations were due to inconsistent use of controlled substances. Patients with any prior DWI/DUI or drug-related offense had a significantly increased rate of substance misuse (P < 0.0001). CONCLUSIONS PMA violations were common among a population of patients managed for chronic nonmalignant pain. Universal opioid prescribing precautions, including PMAs, require further investigation to assess their roles in mitigating the potential patient and societal harms associated with opioid prescribing.
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Affiliation(s)
- Ameer Ghodke
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Timothy J Ives
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Anna E Austin
- Injury Prevention Research Center, Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - William C Bennett
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Naishal Y Patel
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sharon A Eshet
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Paul R Chelminski
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Papp LM, Kouros CD, Curtin JJ. Real-time associations between young adults' momentary pain and prescription opioid misuse intentions in daily life. ACTA ACUST UNITED AC 2020; 75:761-771. [PMID: 32915021 DOI: 10.1037/amp0000648] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Managing pain has been identified (mainly through retrospective reports) as a robust motivator for individuals engaging in prescription opioid misuse. However, surprisingly little work has directly examined whether momentary pain experiences are associated with prescription opioid misuse in daily life. Participants included 297 young-adult college students recruited on the basis of recent prescription drug misuse. Ecological momentary assessment over a 28-day period was utilized to collect participants' pain experiences and prescription opioid misuse intention and behavior. Hierarchical generalized linear modeling and binary logistic regression tested hypotheses. Findings revealed that higher in-the-moment pain was positively associated with intentions to engage in prescription opioid misuse, accounting for report timing and participant sex and background substance use. Also, the between-person result indicated that participants who reported higher levels of pain across the reporting period were more likely to intend to misuse prescription opioids in daily life. There was a similar reliable association between higher pain ratings across the reporting period and greater likelihood of engaging in misuse behavior, although actual misuse frequency was low. Reliable moderation was observed: As hypothesized, the within-person association between momentary pain and misuse intentions was stronger for females compared with males. Also, the within-person link between pain and misuse intentions was stronger for those who reported lower (vs. higher) levels of problematic alcohol use; this was not consistent with the hypothesized direction. Understanding the role of college students' pain in their intentions to engage in prescription opioid misuse is important for informing future research and prevention efforts. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Lauren M Papp
- Department of Human Development and Family Studies, University of Wisconsin-Madison
| | | | - John J Curtin
- Department of Psychology, University of Wisconsin-Madison
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Psychiatric comorbidity among women with endometriosis: nationwide cohort study in Sweden. Am J Obstet Gynecol 2020; 223:415.e1-415.e16. [PMID: 32112731 DOI: 10.1016/j.ajog.2020.02.033] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 02/13/2020] [Accepted: 02/14/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Endometriosis is a common gynecologic condition affecting women of reproductive age. It has been linked with greater rates of depression and anxiety in small, cross-sectional, and clinical studies. Other studies have reported that women with endometriosis have increased risk of bipolar disorder. These reports suggest that psychiatric disorders might be more common among women with endometriosis, contributing to increased burden of mental ill-health in this population of women. However, this hypothesis has not been adequately studied. OBJECTIVES In this population-based study, we investigated the overall psychiatric comorbidity among women with endometriosis, and the role of familial liability. STUDY DESIGN Several Swedish national registers were linked and used to follow all women born in Sweden in 1973-1990 for diagnosed psychiatric disorders and endometriosis from age 14 years until year 2016. Sibling comparison analyses were performed in a subsample of 173,650 families. RESULTS After adjustment for birth characteristics and education, women with endometriosis had an increased risk of being later diagnosed with depressive-, anxiety and stress-related disorders, alcohol/drug dependence, and attention-deficit hyperactivity disorder compared with the general population and with their sisters without endometriosis. The adjusted hazard ratios ranged from 1.56 (95% confidence interval, 1.29-1.88) for depressive disorders to 1.98 (95% confidence interval, 1.34-2.93) for attention-deficit hyperactivity disorder in the sibling analysis. Also, women with previous affective psychotic disorders, depressive-, anxiety and stress-related disorders, eating disorders, personality disorders, and attention-deficit hyperactivity disorder were more likely to be later diagnosed with endometriosis. The adjusted hazard ratios ranged from 1.51 (95% confidence interval, 1.30-1.76) for depressive disorders to 1.93 (95% confidence interval, 1.47-2.52) for personality disorders. CONCLUSION These findings reveal a high degree of comorbidity between endometriosis and many psychiatric disorders that was not entirely explained by shared familial confounding. Clinical practice may consider psychosocial support to women with endometriosis and treating them from a multidisciplinary perspective.
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Lo-Ciganic WH, Huang JL, Zhang HH, Weiss JC, Kwoh CK, Donohue JM, Gordon AJ, Cochran G, Malone DC, Kuza CC, Gellad WF. Using machine learning to predict risk of incident opioid use disorder among fee-for-service Medicare beneficiaries: A prognostic study. PLoS One 2020; 15:e0235981. [PMID: 32678860 PMCID: PMC7367453 DOI: 10.1371/journal.pone.0235981] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/25/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To develop and validate a machine-learning algorithm to improve prediction of incident OUD diagnosis among Medicare beneficiaries with ≥1 opioid prescriptions. METHODS This prognostic study included 361,527 fee-for-service Medicare beneficiaries, without cancer, filling ≥1 opioid prescriptions from 2011-2016. We randomly divided beneficiaries into training, testing, and validation samples. We measured 269 potential predictors including socio-demographics, health status, patterns of opioid use, and provider-level and regional-level factors in 3-month periods, starting from three months before initiating opioids until development of OUD, loss of follow-up or end of 2016. The primary outcome was a recorded OUD diagnosis or initiating methadone or buprenorphine for OUD as proxy of incident OUD. We applied elastic net, random forests, gradient boosting machine, and deep neural network to predict OUD in the subsequent three months. We assessed prediction performance using C-statistics and other metrics (e.g., number needed to evaluate to identify an individual with OUD [NNE]). Beneficiaries were stratified into subgroups by risk-score decile. RESULTS The training (n = 120,474), testing (n = 120,556), and validation (n = 120,497) samples had similar characteristics (age ≥65 years = 81.1%; female = 61.3%; white = 83.5%; with disability eligibility = 25.5%; 1.5% had incident OUD). In the validation sample, the four approaches had similar prediction performances (C-statistic ranged from 0.874 to 0.882); elastic net required the fewest predictors (n = 48). Using the elastic net algorithm, individuals in the top decile of risk (15.8% [n = 19,047] of validation cohort) had a positive predictive value of 0.96%, negative predictive value of 99.7%, and NNE of 104. Nearly 70% of individuals with incident OUD were in the top two deciles (n = 37,078), having highest incident OUD (36 to 301 per 10,000 beneficiaries). Individuals in the bottom eight deciles (n = 83,419) had minimal incident OUD (3 to 28 per 10,000). CONCLUSIONS Machine-learning algorithms improve risk prediction and risk stratification of incident OUD in Medicare beneficiaries.
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Affiliation(s)
- Wei-Hsuan Lo-Ciganic
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida, United States of America
- Center for Drug Evaluation and Safety (CoDES), College of Pharmacy, University of Florida, Gainesville, Florida, United States of America
| | - James L. Huang
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida, United States of America
- Center for Drug Evaluation and Safety (CoDES), College of Pharmacy, University of Florida, Gainesville, Florida, United States of America
| | - Hao H. Zhang
- Department of Mathematics, University of Arizona, Tucson, Arizona, United States of America
| | - Jeremy C. Weiss
- Carnegie Mellon University, Heinz College, Pittsburgh, Pennsylvania, United States of America
| | - C. Kent Kwoh
- Division of Rheumatology, Department of Medicine, University of Arizona, Tucson, Arizona, United States of America
- The University of Arizona Arthritis Center, University of Arizona, Tucson, Arizona, United States of America
| | - Julie M. Donohue
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Center for Pharmaceutical Policy and Prescribing, Health Policy Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Adam J. Gordon
- Division of Epidemiology, Department of Internal Medicine, Program for Addiction Research, Clinical Care, Knowledge, and Advocacy, University of Utah, Salt Lake City, Utah, United States of America
- Informatics, Decision-Enhancement, and Analytic Sciences Center, Salt Lake City VA Health Care System, Salt Lake City, Utah, United States of America
| | - Gerald Cochran
- Division of Epidemiology, Department of Internal Medicine, Program for Addiction Research, Clinical Care, Knowledge, and Advocacy, University of Utah, Salt Lake City, Utah, United States of America
| | - Daniel C. Malone
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, Utah, United States of America
| | - Courtney C. Kuza
- Center for Pharmaceutical Policy and Prescribing, Health Policy Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Walid F. Gellad
- Center for Pharmaceutical Policy and Prescribing, Health Policy Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Division of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United Sates of America
- Center for Health Equity Research Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, United States of America
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