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Alvarez AA, Palka JM, Khan DA. Severe Multiple Drug Intolerance Syndrome in Fibromyalgia and Irritable Bowel Syndrome. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1192-1201. [PMID: 38278325 DOI: 10.1016/j.jaip.2024.01.021] [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: 12/06/2022] [Revised: 01/05/2024] [Accepted: 01/13/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND Multiple drug intolerance syndrome (MDIS) describes patients with multiple nonimmunologically mediated adverse reactions to medications. Patients with more than 10 medication intolerance labels are considered to have severe MDIS. There is overlap in the characteristics of patients with MDIS and fibromyalgia and irritable bowel syndrome (IBS). Severe MDIS can limit treatment options in this already complex patient group. OBJECTIVE This study assessed the prevalence of severe MDIS in patients with fibromyalgia and IBS and its associated risk factors. METHODS A retrospective chart review identified patients diagnosed with fibromyalgia or IBS who had been seen at a large academic center from August 2019 to July 2020. Exact birthdate- and sex-matched controls who had been seen within the same time frame were selected at random. Listed drug intolerance data and patient characteristics were then analyzed with logistic regression and χ2 testing. RESULTS Patients with fibromyalgia and IBS were 12 and 3 times more likely to have severe MDIS compared with controls, respectively. Severe MDIS was associated with polypharmacy in both groups. Opiates were the most frequently reported drug intolerance across all participants. Although patients with IBS more often reported gastrointestinal symptoms as adverse reactions, individuals with fibromyalgia did not more frequently report pain or behavioral changes as adverse reactions. CONCLUSIONS There was an increased rate of severe MDIS in patients diagnosed with fibromyalgia and IBS. Additional studies are needed to better understand the morbidity of MDIS and how it can best be managed in patients with fibromyalgia and IBS.
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Affiliation(s)
- Alicia A Alvarez
- First Physicians Group, Sarasota Memorial Hospital, Sarasota, Fla.
| | - Jayme M Palka
- Department of Internal Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas
| | - David A Khan
- Department of Internal Medicine, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, Texas
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Moran TE, Wagner RD, Grogan G, Taleghani ER, DeGeorge BR. Regional Anesthesia for Wrist Fractures and Dislocations: Are We Really Blocking Opioid Prescribing? Hand (N Y) 2023:15589447231198265. [PMID: 37746738 DOI: 10.1177/15589447231198265] [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: 09/26/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the impact of regional anesthesia for the treatment of wrist fractures or dislocation on opioid prescription-filling patterns. METHODS Patients undergoing surgery for hand and wrist fractures or dislocations from 2010 to 2018 were identified by using a national insurance claims database. Patients were stratified by procedures conducted with and without regional anesthesia. Preoperative opioids were defined by a filled opioid prescription within 1 month prior to surgery, postoperative within 1 month following the surgery, and prolonged postoperative 3 to 6 months following surgery. Patients' demographic data, comorbidities, additional medications, 30-day emergency department (ED) visits, and hospital readmissions were analyzed. RESULTS A total of 24 598 patients treated with and 115 199 patients treated without a regional nerve block for wrist fractures and dislocations were identified. Regional anesthesia was associated with greater postoperative opioid prescription but fewer prolonged postoperative prescriptions. There was an increased odds of all-cause 30-day ED visits but a decreased odds of 30-day hospital readmissions when patients received a regional nerve block prior to surgery. CONCLUSIONS In this study, receiving regional anesthesia prior to surgical intervention for wrist fractures or dislocations was associated with increased filling of postoperative opioid prescriptions, but not prolonged postoperative opioid prescriptions. Additional investigation is needed to identify and implement nonnarcotic multimodal analgesia regimens that may help decrease usage of narcotic medications surrounding these procedures. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Lyden JR, Xu S, Narwaney KJ, Glanz JM, Binswanger IA. Opioid Overdose Risk Following Hospital Discharge Among Individuals Prescribed Long-Term Opioid Therapy: a Risk Interval Analysis. J Gen Intern Med 2023; 38:2560-2567. [PMID: 36697930 PMCID: PMC9876414 DOI: 10.1007/s11606-022-08014-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/23/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Individuals prescribed long-term opioid therapy (LTOT) have increased risk of readmission and death after hospital discharge. The risk of opioid overdose during the immediate post-discharge time period is unknown. OBJECTIVE To examine the association between time since hospital discharge and opioid overdose among individuals prescribed LTOT. DESIGN Self-controlled risk interval analysis. PARTICIPANTS Adults prescribed LTOT with at least one hospital discharge at a safety-net health system and a non-profit healthcare organization in Colorado. MAIN MEASURES We identified individuals prescribed LTOT who were discharged from January 2006 through June 2019. The outcome was a composite of fatal and non-fatal opioid overdoses during a 90-day post-discharge observation period, identified using electronic health record (EHR) and vital statistics data. Risk intervals included days 0-6 after index and subsequent hospital discharges. Control intervals ranged from days 7 to 89 after index discharge and included all other time during the observation period that did not fall within a risk interval or time readmitted during a subsequent hospitalization, which was excluded. Poisson regression was used to estimate incidence rate ratios (IRR) and 95% confidence intervals (CI) for overdose events during risk in comparison to control intervals. KEY RESULTS We identified 7695 adults (63.3% over 55 years, 59.4% female, 20.3% Hispanic) who experienced 9499 total discharges during the study period. Twenty-one overdoses occurred during their observation periods (1174 per 100,000 person-years [9 in risk, 12 in control]). Overdose risk was significantly higher during the risk interval in comparison to the control interval (IRR 6.92; 95% CI 2.92-16.43). CONCLUSION During the first 7 days after hospital discharge, individuals prescribed LTOT appear to be at elevated risk for opioid overdose. Clarifying mechanisms of overdose risk may help inform in-hospital and post-discharge prevention strategies.
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Affiliation(s)
- Jennifer R Lyden
- Division of Hospital Medicine, Department of Medicine, Denver Health, 777 Bannock Street, Denver, CO, 80204, USA.
- Division of Hospital Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Stanley Xu
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Komal J Narwaney
- Institute of Health Research, Kaiser Permanente Colorado, Denver, CO, USA
| | - Jason M Glanz
- Institute of Health Research, Kaiser Permanente Colorado, Denver, CO, USA
- Department of Epidemiology, University of Colorado School of Public Health, Aurora, CO, USA
| | - Ingrid A Binswanger
- Institute of Health Research, Kaiser Permanente Colorado, Denver, CO, USA
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
- Colorado Permanente Medical Group, Denver, CO, USA
- Bernard J. Tyson Kaiser Permanente School of Medicine, Pasadena, CA, USA
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Lee SW, Werner B, Nguyen D, Wang C, Kang M, Ayutyanont N, Lee S. Opioid Utility and Hospital Outcomes Among Inpatients Admitted With Osteoarthritis and Spine Disorders. Am J Phys Med Rehabil 2023; 102:353-359. [PMID: 36095159 DOI: 10.1097/phm.0000000000002101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of the study is to evaluate opioid analgesic utilization and predictors for adverse events during hospitalization and discharge disposition among patients admitted with osteoarthritis or spine disorders. DESIGN This is a retrospective study of 12,747 adult patients admitted to six private community hospitals from 2017 to 2020. Opioid use during hospitalization and risk factors for hospital-acquired adverse events and nonhome discharge were investigated. RESULTS The total number of patients using opioids decreased; however, the daily morphine milligram equivalent use for patients on opioids increased from 2017 to 2020. Increased odds of nonhome discharge were associated with older age, Medicaid, Medicare insurance, and increased lengths of stay, increased body mass index, daily morphine milligram equivalent, and electrolyte replacement in the osteoarthritis group. In the spine group, older age, Black race, Medicaid, Medicare, no insurance, increased Charlson Comorbidity Index, lengths of stay, polypharmacy, and heparin use were associated with nonhome discharge. Adverse events were associated with increased age, lengths of stay, Medicare, polypharmacy, antiemetic, and benzodiazepine use in the osteoarthritis group and increased Charlson Comorbidity Index, lengths of stay, and electrolyte replacement in the spine group. CONCLUSIONS Despite the decreasing number of patients using opioids over the years, patients on opioids had an increased daily morphine milligram equivalent over the same period.
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Affiliation(s)
- Se Won Lee
- From the Sunrise Health GME Consortium, HCA Healthcare, Las Vegas, Nevada (SWL, BW, DN, CW, NA); Department of Computer Science, University of Nevada, Las Vegas, Nevada (MK); and Yeshiva University, New York, New York (SL)
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5
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Hereford TE, Porter A, Stambough JB, Cherney SM, Mears SC. Prevalence of Chronic Opioid Use in the Elderly After Hip Fracture Surgery. J Arthroplasty 2022; 37:S530-S535. [PMID: 35219575 DOI: 10.1016/j.arth.2022.01.071] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/18/2022] [Accepted: 01/24/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND While interest has focused on opioid use after total hip arthroplasty, little research has investigated opioid use in elderly patients after hip fracture. We hypothesize that a substantial number of opioid-naïve elderly patients go on to chronic opioid use after hip fracture surgery. METHODS We reviewed a consecutive series of 219 patients 65 years and older who underwent surgical fixation between January 1, 2016 and February 28, 2019 for a native hip fracture. Patients were excluded for polytrauma, periprosthetic or pathologic fractures, recent major surgery, or death within 90 days of their hip surgery. The state prescription monitoring database was used to determine opioid use. RESULTS Overall, 58 patients (26%) were postoperative chronic opioid users. Of the initial 188 opioid-naïve patients, 43 (23%) became chronic users. Of the 31 preoperative opioid users, 15 (48%) continued as chronic users. Chronic postoperative users were more likely to be White (76% vs 91%, P = .04), younger (78 vs 82 years, P = .003), and preoperative opioid users (odds ratio 3.3, P = .007). Arthroplasty vs fixation did not affect the rate of chronic opioid use (P = .22). CONCLUSION Chronic opioid use is surprisingly common after hip fracture repair in the elderly. Twenty-three percent of opioid-naïve hip fracture patients became chronic users after surgery. Continued vigilance is needed by orthopedic surgeons to limit the amount and duration of postoperative narcotic prescriptions and to monitor for continued use.
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Affiliation(s)
- Timothy E Hereford
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Austin Porter
- Fay W. Boozman College of Public Health, Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, AR; Arkansas Department of Health, Little Rock, AR
| | - Jeffrey B Stambough
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Steven M Cherney
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Simon C Mears
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR
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Weyh AM, Pucci R, Busby E, Kansal L, Joy R, Bunnell A, Valentini V, Dyalram D, Pattatheyill A, Figari M, Boccalatte L, Larrañaga J, Cassoni A, Fernandes R. Contrasting opioid use for pain management in microvascular head and neck reconstruction: an international study. Int J Oral Maxillofac Surg 2022; 51:1412-1419. [PMID: 35599083 DOI: 10.1016/j.ijom.2022.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 11/30/2022]
Abstract
Opioids are often the mainstay of postoperative pain management, despite strong evidence of their ill effects and potential for long-term addiction. The goal of this study was to quantify opioid use and contrast pain management strategies of multiple international institutions performing fibula free flap reconstruction. A retrospective multicenter cohort study was designed, including five international centers. For inclusion, the patients had to have undergone a primary fibula free flap reconstruction of the mandible. A total of 185 patients were included. The median opioid use across all centers at 72 hours was 133 oral morphine equivalents. The highest utilization was in the USA (P < 0.001), which was approximately six times that of Italy, four times that of Argentina, and twice that of India, despite all centers performing a similar procedure. Based on this study there are clear differences in prescribing practices and ideologies among surgeons from different countries.
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Affiliation(s)
- A M Weyh
- Department of Oral and Maxillofacial Surgery, University of Florida Jacksonville, Jacksonville, FL, USA.
| | - R Pucci
- Department of Maxillofacial Surgery, Sapienza University of Rome, Rome, Italy.
| | - E Busby
- Department of Oral and Maxillofacial Surgery, University of Florida Jacksonville, Jacksonville, FL, USA.
| | - L Kansal
- Department of Head and Neck Surgery, Tata Medical Center, Kolkata, India.
| | - R Joy
- Department of Oral and Maxillofacial Surgery, University of Maryland, Baltimore, MD, USA.
| | - A Bunnell
- Department of Oral and Maxillofacial Surgery, University of Florida Jacksonville, Jacksonville, FL, USA.
| | - V Valentini
- Department of Maxillofacial Surgery, Sapienza University of Rome, Rome, Italy.
| | - D Dyalram
- Department of Oral and Maxillofacial Surgery, University of Maryland, Baltimore, MD, USA.
| | - A Pattatheyill
- Department of Head and Neck Surgery, Tata Medical Center, Kolkata, India.
| | - M Figari
- Department of Head and Neck Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - L Boccalatte
- Department of Head and Neck Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - J Larrañaga
- Department of Head and Neck Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - A Cassoni
- Department of Maxillofacial Surgery, Sapienza University of Rome, Rome, Italy.
| | - R Fernandes
- Department of Oral and Maxillofacial Surgery, University of Florida Jacksonville, Jacksonville, FL, USA.
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Walker DM, Childerhose JE, Chen S, Coovert N, Jackson RD, Kurien N, McAlearney AS, Volney J, Alford DP, Bosak J, Oyler DR, Stinson LK, Behrooz M, Christopher MC, Drainoni ML. Exploring perspectives on changing opioid prescribing practices: A qualitative study of community stakeholders in the HEALing Communities Study. Drug Alcohol Depend 2022; 233:109342. [PMID: 35151024 PMCID: PMC8957585 DOI: 10.1016/j.drugalcdep.2022.109342] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/27/2022] [Accepted: 01/29/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Community-based perspectives are needed to more broadly inform policy-makers, public health practitioners, prescribers, and pharmacists about community-led and broader efforts to reduce opioid overprescribing, and ultimately reduce prescription opioid use disorder, overdoses and fatalities. The aim of this study is to explore community-based perspectives on efforts to change opioid prescribing practices in their communities. METHODS Semi-structured interviews were conducted with 388 community stakeholders across four states (Kentucky, Massachusetts, New York, Ohio) from November 2019 to January 2020 about community approaches and goals of community-led responses to the opioid crisis. Data analysis combined deductive and inductive approaches to identify themes and sub-themes related to improving opioid prescribing practices. RESULTS Three major themes and different subthemes were characterized: (1) acknowledging progress (i.e., healthcare providers being part of the solution, provider education, and prescription drug monitoring programs); (2) emergent challenges (i.e., physician nonadherence with safer opioid prescribing guidelines, difficulty identifying appropriate use of opioids, and concerns about accelerating the progression from opioid misuse to drug abuse); and (3) opportunities for change (i.e., educating patients about safer use and proper disposal of opioids, expanding prescriber and pharmacist education, changing unrealistic expectations around eliminating pain, expanding and increasing insurance coverage for alternative treatment options). CONCLUSIONS Community stakeholders appeared to support specific opportunities to reduce prescription opioid misuse and improve safer prescribing. The opportunities included culture change around pain expectations, awareness of safe disposal, additional provider education, and increased coverage and acceptability of non-opioid treatments.
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Affiliation(s)
- Daniel M. Walker
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, 460 Medical Center Dr., Suite 530, Columbus, OH, 43210, USA,CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, 700 Ackerman Road, Suite 4000, Columbus, OH, 43202, USA
| | - Janet E. Childerhose
- CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, 700 Ackerman Road, Suite 4000, Columbus, OH, 43202, USA,Department of Internal Medicine, College of Medicine, The Ohio State University, Martha Morehouse Pavilion, 2050 Kenny Road, Suite 2428, Columbus, OH, 43221, USA
| | - Sadie Chen
- CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, 700 Ackerman Road, Suite 4000, Columbus, OH, 43202, USA
| | - Nicolette Coovert
- CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, 700 Ackerman Road, Suite 4000, Columbus, OH, 43202, USA
| | - Rebecca D. Jackson
- Center for Clinical and Translational Science and the Division of Endocrinology, Diabetes, and Metabolism, Department of Internal Medicine, The Ohio State University, 376 W. 10 Ave, Suite 205, Columbus, OH, 43210, USA
| | - Natasha Kurien
- CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, 700 Ackerman Road, Suite 4000, Columbus, OH, 43202, USA
| | - Ann Scheck McAlearney
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, 460 Medical Center Dr., Suite 530, Columbus, OH, 43210, USA,CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, 700 Ackerman Road, Suite 4000, Columbus, OH, 43202, USA
| | - Jaclyn Volney
- CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, 700 Ackerman Road, Suite 4000, Columbus, OH, 43202, USA
| | - Daniel P. Alford
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Ave, Rm 2060, Boston, MA, 02118, USA
| | - Julie Bosak
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Ave, Rm 2060, Boston, MA, 02118, USA
| | - Douglas R. Oyler
- Pharmacy Practice and Science Department, College of Pharmacy, University of Kentucky, 780 S. Limestone, Lee T. Todd, Jr. Bldg, Rm 285, Lexington, KY, 40506, USA
| | - Laura K. Stinson
- Pharmacy Practice and Science Department, College of Pharmacy, University of Kentucky, 780 S. Limestone, Lee T. Todd, Jr. Bldg, Rm 285, Lexington, KY, 40506, USA
| | - Melika Behrooz
- Social Intervention Group, Columbia University School of Social Work, 1255 Amsterdam Ave, New York, NY, 10027, USA
| | - Mia-Cara Christopher
- Social Intervention Group, Columbia University School of Social Work, 1255 Amsterdam Ave, New York, NY, 10027, USA
| | - Mari-Lynn Drainoni
- Boston Medical Center and Boston University School of Medicine, Boston, MA, 801 Massachusetts Ave, Rm 2014, Boston, MA, 02118, USA
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Yiu CH, Vitharana N, Gnjidic D, Patanwala AE, Fong I, Rimington J, Begley D, Bugeja B, Penm J. Patient risk factors for opioid‐related adverse drug events in hospitalized patients: A systematic review. Pharmacotherapy 2022; 42:194-215. [DOI: 10.1002/phar.2666] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/09/2021] [Accepted: 12/09/2021] [Indexed: 01/13/2023]
Affiliation(s)
- Chin Hang Yiu
- Faculty of Medicine and Health Sydney Pharmacy School The University of Sydney Camperdown New South Wales Australia
| | - Nilru Vitharana
- Department of Anaesthesia The Children’s Hospital at Westmead Westmead New South Wales Australia
| | - Danijela Gnjidic
- Faculty of Medicine and Health Sydney Pharmacy School The University of Sydney Camperdown New South Wales Australia
| | - Asad E. Patanwala
- Faculty of Medicine and Health Sydney Pharmacy School The University of Sydney Camperdown New South Wales Australia
- Department of Pharmacy Royal Prince Alfred Hospital Camperdown New South Wales Australia
| | - Ian Fong
- Department of Pharmacy Prince of Wales Hospital Randwick New South Wales Australia
| | - Joanne Rimington
- District Pharmacy Services South Eastern Sydney Local Health District Randwick New South Wales Australia
| | - David Begley
- Department of Pain Management Prince of Wales Hospital Randwick New South Wales Australia
| | - Bernadette Bugeja
- Department of Pain Management Prince of Wales Hospital Randwick New South Wales Australia
| | - Jonathan Penm
- Faculty of Medicine and Health Sydney Pharmacy School The University of Sydney Camperdown New South Wales Australia
- Department of Pharmacy Prince of Wales Hospital Randwick New South Wales Australia
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Roof MA, Sullivan CW, Feng JE, Anoushiravani AA, Waren D, Friedlander S, Lajam CM, Schwarzkopf R, Slover JD. Inpatient Opioid Consumption Variability following Total Knee Arthroplasty: Analysis of 4,038 Procedures. J Knee Surg 2021; 34:1196-1204. [PMID: 32311746 DOI: 10.1055/s-0040-1702183] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This study examined an early iteration of an inpatient opioid administration-reporting tool, which standardized patient opioid consumption as an average daily morphine milligram equivalence per surgical encounter (MME/day/encounter) among total knee arthroplasty (TKA) recipients. The objective was to assess the variability of inpatient opioid administration rates among surgeons after implementation of a multimodal opioid sparing pain protocol. We queried the electronic medical record at our institution for patients undergoing elective primary TKA between January 1, 2016 and June 30, 2018. Patient demographics, inpatient and surgical factors, and inpatient opioid administration were retrieved. Opioid consumption was converted into average MME for each postoperative day. These MME/day/encounter values were used to determine mean and variance of opioids prescribed by individual surgeons. A secondary analysis of regional inpatient opioid consumption was determined by patient zip codes. In total, 23 surgeons performed 4,038 primary TKA. The institutional average opioid dose was 46.24 ± 0.75 MME/day/encounter. Average intersurgeon (IS) opioid prescribing ranged from 17.67 to 59.15 MME/day/encounter. Intrasurgeon variability ranged between ± 1.01 and ± 7.51 MME/day/encounter. After adjusting for patient factors, the average institutional MME/day/encounter was 38.43 ± 0.42, with average IS variability ranging from 18.29 to 42.84 MME/day/encounter, and intrasurgeon variability ranging between ± 1.05 and ± 2.82 MME/day/encounter. Our results suggest that there is intrainstitutional variability in opioid administration following primary TKA even after controlling for potential patient risk factors. TKA candidates may benefit from the implementation of a more rigid standardization of multimodal pain management protocols that can control pain while minimizing the opioid burden. This is a level of evidence III, retrospective observational analysis.
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Affiliation(s)
- Mackenzie A Roof
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Connor W Sullivan
- Division of Orthopaedic Surgery, Albany Medical Center, Albany, New York
| | - James E Feng
- NYU Langone Orthopedics, NYU Langone Health, New York, New York
| | | | - Daniel Waren
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Scott Friedlander
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | | | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - James D Slover
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
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10
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Helget LN, England BR, Roul P, Sayles H, Petro AD, Michaud K, Mikuls TR. Incidence, Prevalence, and Burden of Gout in the Veterans Health Administration. Arthritis Care Res (Hoboken) 2021; 73:1363-1371. [PMID: 32475070 DOI: 10.1002/acr.24339] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 05/22/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To determine the prevalence, incidence, and burden of gout in the Veterans Health Administration (VHA) from 2005 to 2014. METHODS We used national VHA data from January 1999 to December 2014 to determine the annual incidence and prevalence of gout in the VHA. Gout burden to the VHA was determined by the proportion of patients with an encounter related to gout. Rates of urate-lowering therapy (ULT) and opiate use were determined annually. Characteristics of those with and without gout were compared using 2014 data. RESULTS From 2005 to 2014, gout prevalence in the VHA increased from 4.2% to 5.8%, while disease incidence ranged from 5.8 to 7.4 cases per 1,000 patient-years. Gout prevalence was highest among men, older patients, and non-Hispanic black patients. During 2014, 4.0% of all inpatient or outpatient encounters and 1.3% of hospitalizations were gout related. Administration of ULT remained stable over the 10-year period, with 46% of gout patients receiving ULT in 2014. In contrast, 16.4% of prevalent gout patients were receiving a weak opioid in 2014, nearly doubling the prescription rate of weak opioids in 2005, while the use of stronger opioids did not change significantly over this period. Patients with gout had greater comorbidity and health care utilization than patients without gout. CONCLUSION The burden posed by gout in the VHA is considerable and increased between 2005 and 2014. While the use of ULT has remained stable, the use of opioid therapy has increased among patients with gout.
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Affiliation(s)
- Lindsay N Helget
- Veterans Affairs Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha, Nebraska
| | - Bryant R England
- Veterans Affairs Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha, Nebraska
| | - Punyasha Roul
- Veterans Affairs Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha, Nebraska
| | | | - Alison D Petro
- Veterans Affairs Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha, Nebraska
| | - Kaleb Michaud
- Veterans Affairs Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha, Nebraska
| | - Ted R Mikuls
- Veterans Affairs Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha, Nebraska
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11
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Khanna AK, Jungquist CR, Buhre W, Soto R, Di Piazza F, Saager L, Bergese SD, Morimatsu H, Uezono S, Lee S, Ti LK, Urman RD, McIntyre R, Tornero C, Dahan A, Weingarten TN, Wittmann M, Auckley D, Brazzi L, Le Guen M, Schramm F, Overdyk FJ. Modeling the Cost Savings of Continuous Pulse Oximetry and Capnography Monitoring of United States General Care Floor Patients Receiving Opioids Based on the PRODIGY Trial. Adv Ther 2021; 38:3745-3759. [PMID: 34031858 PMCID: PMC8143066 DOI: 10.1007/s12325-021-01779-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 05/06/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Despite the high incidence of respiratory depression on the general care floor and evidence that continuous monitoring improves patient outcomes, the cost-benefit of continuous pulse oximetry and capnography monitoring of general care floor patients remains unknown. This study modeled the cost and length of stay savings, investment break-even point, and likelihood of cost savings for continuous pulse oximetry and capnography monitoring of general care floor patients at risk for respiratory depression. METHODS A decision tree model was created to compare intermittent pulse oximetry versus continuous pulse oximetry and capnography monitoring. The model utilized costs and outcomes from the PRediction of Opioid-induced respiratory Depression In patients monitored by capnoGraphY (PRODIGY) trial, and was applied to a modeled cohort of 2447 patients receiving opioids per median-sized United States general care floor annually. RESULTS Continuous pulse oximetry and capnography monitoring of high-risk patients is projected to reduce annual hospital cost by $535,531 and cumulative patient length of stay by 103 days. A 1.5% reduction in respiratory depression would achieve a break-even investment point and justify the investment cost. The probability of cost saving is ≥ 80% if respiratory depression is decreased by ≥ 17%. Expansion of continuous monitoring to high- and intermediate-risk patients, or to all patients, is projected to reach a break-even point when respiratory depression is reduced by 2.5% and 3.5%, respectively, with a ≥ 80% probability of cost savings when respiratory depression decreases by ≥ 27% and ≥ 31%, respectively. CONCLUSION Compared to intermittent pulse oximetry, continuous pulse oximetry and capnography monitoring of general care floor patients receiving opioids has a high chance of being cost-effective. TRIAL REGISTRATION www.clinicaltrials.gov , Registration ID: NCT02811302.
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Nonmedical Prescription Opioid Use among a Sample of College Students: Prevalence and Predictors. PHARMACY 2021; 9:pharmacy9020106. [PMID: 34071670 PMCID: PMC8167772 DOI: 10.3390/pharmacy9020106] [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: 03/12/2021] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 11/16/2022] Open
Abstract
Nonmedical use of prescription opioid medication (NMPO) in the United States is a public health crisis, resulting in high rates of emergency room visits, morbidity, and mortality. The purpose of this study was to explore prevalence estimates and correlates of NMPO among a convenience sample of college students in the northeast and southeast regions of the US to help generate directions for future research. Motivations for misuse, age of onset, access, concomitant substance use, and individual factors were investigated among a sample of undergraduate students from two universities. Participants (N = 847) completed a battery of various self-report measures. Findings revealed that 7.7% (Southeastern University) and 12.8% of students (Northeastern University) reported lifetime NMPO, whereas past-month NMPO was reported by 0.8% and 0.9% of participants, respectively. Lifetime history of regularly using alcohol, nonmedical use of benzodiazepine medication, nonmedical use of prescription stimulants, symptoms of depression and anxiety, and executive functioning (i.e., metacognition and behavioral regulation) were significantly related to lifetime history of NMPO in this college sample. These findings offer several potential subsequent lines of investigation regarding the associations between various demographic and psychological factors and NMPO. Future research is needed to help identify college students who are at risk of NMPO.
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Mort SC, Díaz SR, Beverly EA. Using contact-based education to destigmatize opioid use disorder among medical students. TEACHING AND LEARNING IN MEDICINE 2021; 33:196-209. [PMID: 33196302 DOI: 10.1080/10401334.2020.1820869] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
All first- and second-year (i.e., pre-clinical) medical students at a large, Midwestern medical school with three campuses were invited to participate in a two-arm, parallel educational study comparing the efficacy of two types of curricular interventions. Students at the main campus attended the modified contact-based education panel or the didactic lecture in person, while students at the two distance campuses attended the modified contact-based education or lecture remotely using the University's videoconferencing system. Impact: A total of 109 students participated in the study (average age 24.2 years (SD = 2.6), 64.2% female, 79.8% white, 56.0% second-year students, 67.9% attended on main campus, lecture = 52 participants, modified contact-based = 57 participants). Baseline responses were similar across groups. Following the session, participants in both interventions rated drug abuse (percent increase = 21.2%, p < .001) and prescription drug diversion (percent increase = 7.6%, p = .004) as more serious problems. Participants from both interventions expressed increased confidence in caring for patients with OUD (percent increase = 45.5%, p < .001) and increased interest in pursuing MAT training (percent increase = 21.5%, p = .04). Both curricular interventions were equally effective at reducing OUD stigma with a significant 8.2% decrease in total stigma scores and a large effect size (p < .001, ηp2 = .34). Lastly, participants with lower post-assessment OUD stigma scores were more likely to indicate that they would pursue additional training to provide MAT (p = .02). Lessons learned: Exposure to opioid-specific education with a focus on MAT and recovery, regardless of education type, positively affected opioid-related postgraduate intentions and reduced OUD stigma. Notably, these findings suggest that there are multiple efficacious techniques to reduce OUD stigma during preclinical training.
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Affiliation(s)
- Sophia C Mort
- Department of Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio, USA
- The Graduate College, Translational Biomedical Sciences Program, Ohio University, Athens, Ohio, USA
| | - Sebastián R Díaz
- Dean's Office of Medical Education, Northeast Ohio Medical University College of Medicine, Rootstown, Ohio, USA
| | - Elizabeth A Beverly
- Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio, USA
- The Diabetes Institute, Ohio University, Athens, Ohio, USA
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Khateeb R, Keniston A, Moore A, Hrach C, Indovina KA, Kneeland P, Rudolph M, Burden M. Perspectives on Patient Experience: A National Survey of Hospitalists. J Patient Exp 2021; 7:1482-1490. [PMID: 33457605 PMCID: PMC7786688 DOI: 10.1177/2374373520948669] [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] [Indexed: 11/16/2022] Open
Abstract
Despite efforts to improve patient experience (PX), little is known about the perspective of hospitalists regarding PX initiatives and priorities. A survey was distributed to hospitalist groups across the country assessing involvement in PX initiatives and their perceived effectiveness, what PX means to providers, and facilitators/barriers in improving PX. Ninety-nine percent of respondents had encountered some improvement activity around PX. The most prevalent were communication training, group Hospital Consumer Assessment of Healthcare Providers and Systems data, and interdisciplinary bedside rounding. Respondents rated most initiatives a 5 to 6 out of 10 for their effectiveness, with the perception of effectiveness increasing with respondents' assessment of patient experience priority. Learning about others' experiences in improving PX and learning about potential collaborations for quality improvement or research in these areas were areas of interest for future work. Qualitative work highlighted potential barriers in improving PX such as workload and staffing constraints, uncontrollable environmental factors, and unrealistic patient expectations. Improving PX is a priority, and there are many initiatives in place with perceived variable success and perceived barriers in improving PX.
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Affiliation(s)
- Rafina Khateeb
- Division of Hospital Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Angela Keniston
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Amber Moore
- Division of Hospital Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Christine Hrach
- Division of Hospitalist Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Kimberly A Indovina
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA.,Denver Health, Denver, CO, USA
| | - Patrick Kneeland
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Marisha Burden
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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Woodward MA, Waljee J. Decisions Ahead of Time: The Power of Guidelines to Change Opioid Prescribing in Today's World. Ophthalmology 2020; 127:1460-1461. [PMID: 33097107 PMCID: PMC7573631 DOI: 10.1016/j.ophtha.2020.05.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/13/2020] [Accepted: 05/15/2020] [Indexed: 11/20/2022] Open
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Friedman SR, Krawczyk N, Perlman DC, Mateu-Gelabert P, Ompad DC, Hamilton L, Nikolopoulos G, Guarino H, Cerdá M. The Opioid/Overdose Crisis as a Dialectics of Pain, Despair, and One-Sided Struggle. Front Public Health 2020; 8:540423. [PMID: 33251171 PMCID: PMC7676222 DOI: 10.3389/fpubh.2020.540423] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 10/09/2020] [Indexed: 12/20/2022] Open
Abstract
The opioid/overdose crisis in the United States and Canada has claimed hundreds of thousands of lives and has become a major field for research and interventions. It has embroiled pharmaceutical companies in lawsuits and possible bankruptcy filings. Effective interventions and policies toward this and future drug-related outbreaks may be improved by understanding the sociostructural roots of this outbreak. Much of the literature on roots of the opioid/overdose outbreak focuses on (1) the actions of pharmaceutical companies in inappropriately promoting the use of prescription opioids; (2) "deaths of despair" based on the deindustrialization of much of rural and urban Canada and the United States, and on the related marginalization and demoralization of those facing lifetimes of joblessness or precarious employment in poorly paid, often dangerous work; and (3) increase in occupationally-induced pain and injuries in the population. All three of these roots of the crisis-pharmaceutical misconduct and unethical marketing practices, despair based on deindustrialization and increased occupational pain-can be traced back, in part, to what has been called the "one-sided class war" that became prominent in the 1970s, became institutionalized as neo-liberalism in and since the 1980s, and may now be beginning to be challenged. We describe this one-sided class war, and how processes it sparked enabled pharmaceutical corporations in their misconduct, nurtured individualistic ideologies that fed into despair and drug use, weakened institutions that created social support in communities, and reduced barriers against injuries and other occupational pain at workplaces by reducing unionization, weakening surviving unions, and weakening the enforcement of rules about workplace safety and health. We then briefly discuss the implications of this analysis for programs and policies to mitigate or reverse the opioid/overdose outbreak.
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Affiliation(s)
- Samuel R. Friedman
- Division of Epidemiology, Department of Population Health, Center for Opioid Epidemiology and Policy, School of Medicine, New York University, New York, NY, United States
| | - Noa Krawczyk
- Department of Population Health, School of Medicine, New York University, New York, NY, United States
| | - David C. Perlman
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Mount Sinai Medical Center, Miami Beach, FL, United States
| | - Pedro Mateu-Gelabert
- Graduate School of Public Health & Health Policy, City University of New York, New York, NY, United States
| | - Danielle C. Ompad
- Department of Epidemiology, College of Global Public Health, New York University, New York, NY, United States
- Center for Drug Use and HIV Research (CDUHR), New York, NY, United States
| | - Leah Hamilton
- Division of Epidemiology, Department of Population Health, Center for Opioid Epidemiology and Policy, School of Medicine, New York University, New York, NY, United States
| | | | - Honoria Guarino
- Graduate School of Public Health & Health Policy, City University of New York, New York, NY, United States
| | - Magdalena Cerdá
- Division of Epidemiology, Department of Population Health, Center for Opioid Epidemiology and Policy, School of Medicine, New York University, New York, NY, United States
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Opioid Use Disorders in People Living with HIV/AIDS: A Review of Implications for Patient Outcomes, Drug Interactions, and Neurocognitive Disorders. PHARMACY 2020; 8:pharmacy8030168. [PMID: 32932786 PMCID: PMC7559328 DOI: 10.3390/pharmacy8030168] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/03/2020] [Accepted: 09/05/2020] [Indexed: 01/05/2023] Open
Abstract
The opioid epidemic has had a significant, negative impact in the United States, and people living with HIV/AIDS (PLWHA) represent a vulnerable sub-population that is at risk for negative sequela from prolonged opioid use or opioid use disorder (OUD). PLWHA are known to suffer from HIV-related pain and are commonly treated with opioids, leading to subsequent addictive disorders. PLWHA and OUD are at an increased risk for attrition in the HIV care continuum, including suboptimal HIV laboratory testing, delayed entry into HIV care, and initiation or adherence to antiretroviral therapy. Barriers to OUD treatment, such as medication-assisted therapy, are also apparent for PLWHA with OUD, particularly those living in rural areas. Additionally, PLWHA and OUD are at a high risk for serious drug–drug interactions through antiretroviral-opioid metabolic pathway-related inhibition/induction, or via the human ether-a-go-go-related gene potassium ion channel pathways. HIV-associated neurocognitive disorders can also be potentiated by the off-target inflammatory effects of opioid use. PLWHA and OUD might require more intensive, individualized protocols to sustain treatment for the underlying opioid addiction, as well as to provide proactive social support to aid in improving patient outcomes. Advancements in the understanding and management of PLWHA and OUD are needed to improve patient care. This review describes the effects of prescription and non-prescription opioid use in PLWHA.
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18
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Schirle L, Stone AL, Morris MC, Osmundson SS, Walker PD, Dietrich MS, Bruehl S. Leftover opioids following adult surgical procedures: a systematic review and meta-analysis. Syst Rev 2020; 9:139. [PMID: 32527307 PMCID: PMC7291535 DOI: 10.1186/s13643-020-01393-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 05/20/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND US opioid prescribing and use escalated over the last two decades, with parallel increases in opioid misuse, opioid-related deaths, and concerns about diversion. Postoperatively prescribed opioids contribute to these problems. Policy makers have addressed this issue by limiting postoperative opioid prescribing. However, until recently, little data existed to guide prescribers on opioid needs postoperatively. This meta-analysis quantitatively integrated the growing literature regarding extent of opioids leftover after surgery and identified factors associated with leftover opioid proportions. METHODS We conducted a meta-analysis of observational studies quantifying postoperative opioid consumption in North American adults, and evaluated effect size moderators using robust variance estimation meta-regression. Medline, EMBASE, Cumulative Index of Nursing and Allied Health Literature, and Cochrane Database of Systematic Reviews were searched for relevant articles published January 1, 2000 to November 10, 2018. The Methodological Index for Non-Randomized Studies (MINORS) tool assessed risk of study bias. The proportion effect size quantified the primary outcome: proportion of prescribed postoperative opioids leftover at the time of follow-up. Primary meta-regression analyses tested surgical type, amount of opioids prescribed, and study publication year as possible moderators. Secondary meta-regression models included surgical invasiveness, age, race, gender, postoperative day of data collection, and preoperative opioid use. RESULTS We screened 911 citations and included 44 studies (13,068 patients). The mean weighted effect size for proportion of postoperative opioid prescriptions leftover was 61% (95% CI, 56-67%). Meta-regression models revealed type of surgical procedure and level of invasiveness had a statistically significant effect on proportion of opioids leftover. Proportion of opioids leftover was greater for "other soft tissue" surgeries than abdominal/pelvic surgeries, but did not differ significantly between orthopedic and abdominal/pelvic surgeries. Minimally invasive compared to open surgeries resulted in a greater proportion of opioids leftover. Limitations include predominance of studies from academic settings, inconsistent reporting of confounders, and a possible publication bias toward studies reporting smaller leftover opioid proportions. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS A significant proportion of opioids are leftover postoperatively. Surgery type and level of invasiveness affect postoperative opioid consumption. Integration of such factors into prescribing guidelines may help minimize opioid overprescribing while adequately meeting analgesic needs.
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Affiliation(s)
- Lori Schirle
- School of Nursing, Vanderbilt University, 461 21st Avenue South, Nashville, TN 37240 USA
| | - Amanda L. Stone
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN USA
| | - Matthew C. Morris
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS USA
| | - Sarah S. Osmundson
- Department of Obstetrics & Gynecology, Vanderbilt University Medical Center, Nashville, TN USA
| | - Philip D. Walker
- Eskind Biomedical Library, Vanderbilt University, Nashville, TN USA
| | - Mary S. Dietrich
- School of Nursing, Vanderbilt University, 461 21st Avenue South, Nashville, TN 37240 USA
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN USA
| | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN USA
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19
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Mazurenko O, Andraka-Christou BT, Bair MJ, Kara AY, Harle CA. Clinical perspectives on hospitals' role in the opioid epidemic. BMC Health Serv Res 2020; 20:521. [PMID: 32513158 PMCID: PMC7281936 DOI: 10.1186/s12913-020-05390-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 06/02/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Policymakers, legislators, and clinicians have raised concerns that hospital-based clinicians may be incentivized to inappropriately prescribe and administer opioids when addressing pain care needs of their patients, thus potentially contributing to the ongoing opioid epidemic in the United States. Given the need to involve all healthcare settings, including hospitals, in joint efforts to curb the opioid epidemic, it is essential to understand if clinicians perceive hospitals as contributors to the problem. Therefore, we examined clinical perspectives on the role of hospitals in the opioid epidemic. METHODS We conducted individual semi-structured interviews with 23 clinicians from 6 different acute care hospitals that are part of a single healthcare system in the Midwestern United States. Our participants were hospitalists (N = 12), inpatient registered nurses (N = 9), and inpatient adult nurse practitioners (N = 2). In the interviews, we asked clinicians whether hospitals play a role in the opioid epidemic, and if so, how hospitals may contribute to the epidemic. We used a qualitative thematic analysis approach to analyze coded text for patterns and themes and examined potential differences in themes by respondent type using Dedoose software. RESULTS The majority of clinicians believed hospitals contribute to the opioid epidemic. Multiple clinicians cited Center for Medicare and Medicaid Services' (CMS) reimbursement policy and the Joint Commission's report as drivers of inappropriate opioid prescribing in hospitals. Furthermore, numerous clinicians stated that opioids are inappropriately administered in the emergency department (ED), potentially as a mechanism to facilitate discharge and prevent re-admission. Many clinicians also described how overreliance on pre-populated pain care orders for surgical (orthopedic) patients, may be contributing to inappropriate opioid use in the hospital. Finally, clinicians suggested the following initiatives for hospitals to help address the crisis: 1) educating patients about negative consequences of using opioids long-term and setting realistic pain expectations; 2) educating medical staff about appropriate opioid prescribing practices, particularly for patients with complex chronic conditions (chronic pain; opioid use disorder (OUD)); and 3) strengthening the hospital leadership efforts to decrease inappropriate opioid use. CONCLUSIONS Our findings can inform efforts at decreasing inappropriate opioid use in hospitals.
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Affiliation(s)
- Olena Mazurenko
- Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd, RG5135, Indianapolis, IN 46202 USA
| | | | - Matthew J. Bair
- VA Center for Health Information and Communication, Indianapolis, USA
- Division of General Internal Medicine, Indiana University School of Medicine, Indianapolis, USA
- Regenstrief Institute, Inc., Indianapolis, USA
| | - Areeba Y. Kara
- Division of Clinical Medicine, Indiana University School of Medicine, Indianapolis, USA
| | - Christopher A. Harle
- Department of Health Outcomes and Biomedical Informatics; College of Medicine, University of Florida, Gainesville, USA
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20
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Bakker CJ, Wise KL, Williams BR, Swiontkowski MF. Complementary and Alternative Medicine for Postoperative Pain: A Systematic Review. J Bone Joint Surg Am 2020; 102 Suppl 1:36-46. [PMID: 32251133 DOI: 10.2106/jbjs.19.01439] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The treatment of postoperative pain is an ongoing challenge for orthopaedic surgeons. Poorly controlled pain is associated with poorer patient outcomes, and the prescription of opioids may lead to prolonged, nonmedical use. Complementary and alternative medicine is widely adopted by the general public, and its use in chronic musculoskeletal pain conditions has been studied; however, its efficacy in a postoperative context has not yet been established. METHODS We conducted a systematic literature review of 10 databases to identify all relevant publications. We extracted variables related to pain measurement and postoperative opioid prescriptions. RESULTS We identified 8 relevant publications from an initial pool of 2,517 items. Of these, 5 were randomized studies and 3 were nonrandomized studies. All 8 studies addressed postoperative pain, with 5 showing significant decreases (p < 0.05) in postoperative pain. Also, 5 studies addressed postoperative opioid use, with 2 showing significant differences (p < 0.05) in opioid consumption. Substantial heterogeneity among the studies precluded meta-analysis. No articles were found to be free of potential bias. CONCLUSIONS Currently, there is insufficient evidence to determine the efficacy of complementary and alternative medicines for postoperative pain management or as an alternative to opioid use following orthopaedic surgery. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Caitlin J Bakker
- Health Sciences Libraries (C.J.B.) and Department of Orthopaedic Surgery (K.L.W., B.R.W., and M.F.S.), University of Minnesota, Minneapolis, Minnesota
| | - Kelsey L Wise
- Health Sciences Libraries (C.J.B.) and Department of Orthopaedic Surgery (K.L.W., B.R.W., and M.F.S.), University of Minnesota, Minneapolis, Minnesota
| | - Benjamin R Williams
- Health Sciences Libraries (C.J.B.) and Department of Orthopaedic Surgery (K.L.W., B.R.W., and M.F.S.), University of Minnesota, Minneapolis, Minnesota
| | - Marc F Swiontkowski
- Health Sciences Libraries (C.J.B.) and Department of Orthopaedic Surgery (K.L.W., B.R.W., and M.F.S.), University of Minnesota, Minneapolis, Minnesota.,TRIA Orthopaedic Center, Bloomington, Minnesota
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Loh FE, Herzig SJ. Pain in the United States: Time for a Culture Shift in Expectations, Messaging, and Management. J Hosp Med 2019; 14:787-788. [PMID: 31339835 PMCID: PMC6897535 DOI: 10.12788/jhm.3277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Opioid prescribing has dramatically increased in the
United States (US) over the past two decades, fueling
the current crisis of opioid-related adverse
events and deaths.1 Understanding the potential
contributors to this increased prescribing is paramount to developing
effective strategies for preventing propagation. In this
issue of the Journal of Hospital Medicine, Burden et al. report
the results of a cross-sectional observational study investigating
the rates of opioid receipt, patient satisfaction with pain control,
and other perceptions of pain management in a sample of patients
from geographically diverse US hospitals compared with
patients hospitalized in seven other countries.2 Although cultural
influences on pain perceptions have been demonstrated by
others previously, this is the first study to measure opioid receipt
and patient satisfaction with pain control across an international
sample of hospitalized patients.
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Affiliation(s)
- F Ellen Loh
- Department of Social, Behavioral and Administrative Sciences, Touro College of Pharmacy, New York, New York
| | - Shoshana J Herzig
- Department of Medicine, Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Corresponding Author: Shoshana J. Herzig, MD, MPH; E-mail: ; Telephone: 617-754-1413; Twitter:@ShaniHerzig
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