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Nielsen S, Horn F, McDonald R, Eide D, Walley AY, Binswanger I, Langford AV, Prathivadi P, Wood P, Clausen T, Picco L. Development of pharmacy-based best practices to support safer use and management of prescription opioids based on an e-Delphi methodology. Res Social Adm Pharm 2024:S1551-7411(24)00349-8. [PMID: 39289100 DOI: 10.1016/j.sapharm.2024.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 08/31/2024] [Accepted: 09/01/2024] [Indexed: 09/19/2024]
Abstract
BACKGROUND Opioid utilization and related harm have increased in recent decades, notably in Australia, the United States, Canada, and some European countries. For people who are prescribed opioids, pharmacies offer an accessible, regular point-of-contact, providing a unique opportunity to address opioid prescription drugs risks. OBJECTIVE This project aimed to develop consensus-based, best practice statements for improving the safer use of prescription opioids through community pharmacy settings. METHODS The e-Delphi technique is used to obtain consensus from experts about issues where conclusive evidence is lacking, using multiple rounds of online participation. The investigator group identified an international group of potential participants with relevant expertise who were invited to the study, and asked to identify other experts for invitation. The e-Delphi process comprised three online rounds, involving (1) statement idea generation, (2) developing statement consensus, and (3) confirming and ranking statements. RESULTS A diverse group of 42 experts (76 % female, 6 countries) participated, comprising pharmacists (n = 24, 57 %), medical doctors of differing specialties (n = 12, 29 %), and/or researchers (n = 28, 67 %), with a mean of 15 years' professional experience (SD = 8.08). Eighty-five statements were initially developed in Round 1, and 78 were supported with amendments, with suggestions to merge and remove items in Round 2, resulting in 72 final statements which were all endorsed in Round 3. Items spanned seven themes: education, monitoring outcomes and risk, deprescribing and pain management, overdose education and naloxone, opioid agonist treatment, staff education, and overarching practices. Preferred terminology was determined in Round 2 and confirmed in Round 3. CONCLUSIONS Community pharmacies offer a unique opportunity to support the safer use of prescription opioids. These 72 best practice statements provide practical guidance on specific practices that pharmacists can undertake to support patients' safer use of prescription opioids and prevent or reduce harms from prescribed opioid use.
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Affiliation(s)
- Suzanne Nielsen
- Monash Addiction Research Centre, Monash University, 47-49 Moorooduc Hwy, Frankston, 3199, Victoria, Australia.
| | - Freya Horn
- Monash Addiction Research Centre, Monash University, 47-49 Moorooduc Hwy, Frankston, 3199, Victoria, Australia
| | - Rebecca McDonald
- Norwegian Centre for Addiction Research (SERAF), University of Oslo, Oslo PO Box 1130, Blindern, 0315, Oslo, Norway
| | - Desiree Eide
- Norwegian Centre for Addiction Research (SERAF), University of Oslo, Oslo PO Box 1130, Blindern, 0315, Oslo, Norway
| | - Alexander Y Walley
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, 801 Massachusetts Avenue, 2nd Floor, Boston, MA, 02118, USA
| | - Ingrid Binswanger
- Institute of Health Research, Kaiser Permanente Colorado, 16601 East Centretech Parkway, Aurora, 80011, USA; Colorado Permanente Medical Group, 1375 E 20(th) Ave, Denver, CO, 80218, USA; University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO, 80045, USA; Kaiser Permanente School of Medicine, 98 S Los Robles Ave, Pasadena, CA, 91101, USA
| | - Aili V Langford
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 407 Royal Parade, Parkville, Australia; Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney, 64 Mallett Street, Camperdown, New South Wales, Australia
| | - Pallavi Prathivadi
- Equity, Primary Care, Implementation and Community (EPIC) Research Unit, Monash University, 47-49 Moorooduc Hwy, Frankston, 3199, Victoria, Australia
| | - Pene Wood
- Monash Addiction Research Centre, Monash University, 47-49 Moorooduc Hwy, Frankston, 3199, Victoria, Australia
| | - Thomas Clausen
- Norwegian Centre for Addiction Research (SERAF), University of Oslo, Oslo PO Box 1130, Blindern, 0315, Oslo, Norway
| | - Louisa Picco
- Monash Addiction Research Centre, Monash University, 47-49 Moorooduc Hwy, Frankston, 3199, Victoria, Australia
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Laabar TD, Saunders C, Auret K, Johnson CE. 'There is no such word as palliative care for us at the moment': A mixed-method study exploring the perceptions of healthcare professionals on the need for palliative care in Bhutan. Palliat Care Soc Pract 2024; 18:26323524241272102. [PMID: 39157418 PMCID: PMC11329896 DOI: 10.1177/26323524241272102] [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: 02/12/2024] [Accepted: 06/27/2024] [Indexed: 08/20/2024] Open
Abstract
Background The need for palliative care is ever-increasing globally. However, it is least developed or not available in most low-and-middle-income-countries including Bhutan. Objective This study was aimed at exploring the perspectives of Bhutanese healthcare professionals on the need for palliative care in the country. Design This is a cross-sectional, mixed-method study. Setting/subjects The study sites included all levels of healthcare in Bhutan and involved doctors, nurses, physiotherapists, pharmacists, health assistants and Drungtshos (traditional physicians). Data were collected through surveys, focus group discussions and in-depth interviews. Results While the majority of the participants were directly involved in taking care of terminally ill and dying patients, only 14% had received some form of palliative care training for a duration ranging from 1 day to 6 weeks. Ninety-five percent of the participants reported that they faced challenges related to lack of palliative care knowledge and skills; limited resources including analgesics; shortage of doctors and nurses and lack of a palliative care team; issues with low illiteracy and financial challenges among patients; and policies and other systemic issues. The qualitative data generated four major themes: past adverse experiences; unique and complex needs for palliative care; challenges faced while caring for terminally ill and dying patients; and the urgent need for palliative care in Bhutan. Conclusion Bhutanese healthcare professionals had very limited exposure to palliative care. This study identified a crucial need for palliative care and informs the development of an appropriate palliative care model for Bhutan.
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Affiliation(s)
- Tara Devi Laabar
- Department of Nursing, Faculty of Nursing and Public Health, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
| | - Christobel Saunders
- Department of Surgery, Melbourne Medical School, The University of Melbourne, Parkville, VIC, Australia
| | - Kirsten Auret
- Rural Clinical School of Western Australia, The University of Western Australia, Albany, WA, Australia
| | - Claire E. Johnson
- Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW, Australia
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Knoph CS, Lucocq J, Kamarajah SK, Olesen SS, Jones M, Samanta J, Talukdar R, Capurso G, de-Madaria E, Yadav D, Siriwardena AK, Windsor J, Drewes AM, Nayar M, Pandanaboyana S. Global trends in opioid use for pain management in acute pancreatitis: A multicentre prospective observational study. United European Gastroenterol J 2024. [PMID: 39140779 DOI: 10.1002/ueg2.12641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 07/06/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Since there is no current international consensus on the optimal approach for pain management in acute pancreatitis (AP), analgesic practices may vary across different healthcare settings. OBJECTIVE This study explored global disparities in analgesic use, in particular opioids, during admission and at discharge in hospitalised AP patients. METHODS This was a post hoc analysis of the prospective PAINAP database, which included all admissions for AP between April and June 2022 with a 1-month follow-up. Demographic details, analgesic use, and clinical outcomes were recorded during admission and at discharge. Odds ratios (ORs) for opioid use during admission and at discharge were identified using multivariable regression analyses. RESULTS Amongst the 1864 patients (52% males, median age 56 (interquartile range, 41-71)) across three different continents, simple analgesics were predominantly used as the primary analgesic (70%). Opioid use during admission was lowest in European centres (67%). Admission in Asian (OR, 2.53 (95% confidence interval (CI), 1.59-4.04), p < 0.001), and Australian (OR, 5.81 (95% CI, 3.19-10.56), p < 0.001) centres was associated with opioid administration during admission compared with European centres. Increased pain severity, longer pre-admission pain duration, organ failure, and longer length of admission increased opioid use during admission. At discharge, Asian (OR, 2.01 (95% CI, 1.40-2.88), p < 0.001) and Australian (OR, 1.91 (95% CI, 1.28-2.85), p = 0.002) centres were associated with opioid prescription compared with European centres. Increased pain severity, longer pre-admission pain duration, acute necrotic collections, and walled-off necrosis also increased the likelihood of opioid prescription at discharge. CONCLUSION There are substantial intercontinental differences in opioid use for AP pain. Accordingly, there is a need for international guidelines on pain management in AP.
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Affiliation(s)
- Cecilie Siggaard Knoph
- Department of Gastroenterology & Hepatology, Centre for Pancreatic Diseases, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - James Lucocq
- Department of HPB Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Sivesh Kathir Kamarajah
- Academic Department of Surgery, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Søren Schou Olesen
- Department of Gastroenterology & Hepatology, Centre for Pancreatic Diseases, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Michael Jones
- HPB and Transplant Unit, Freeman Hospital, Newcastle upon Tyne, UK
| | - Jayanta Samanta
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | | | - Gabriele Capurso
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Enrique de-Madaria
- Gastroenterology Department, Dr. Balmis General University Hospital, ISABIAL, Alicante, Spain
| | - Dhiraj Yadav
- Division of Gastroenterology & Hepatology, University of Pittsburgh Medical Centre, Pittsburgh, Pennsylvania, USA
| | | | - John Windsor
- Surgical and Translational Research Centre, University of Auckland, Auckland, New Zealand
| | - Asbjørn Mohr Drewes
- Department of Gastroenterology & Hepatology, Centre for Pancreatic Diseases, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Manu Nayar
- HPB and Transplant Unit, Freeman Hospital, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Sanjay Pandanaboyana
- HPB and Transplant Unit, Freeman Hospital, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
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Pandanaboyana S, Knoph CS, Olesen SS, Jones M, Lucocq J, Samanta J, Talukdar R, Capurso G, de‐Madaria E, Yadav D, Siriwardena AK, Windsor J, Drewes AM, Nayar M. Opioid analgesia and severity of acute pancreatitis: An international multicentre cohort study on pain management in acute pancreatitis. United European Gastroenterol J 2024; 12:326-338. [PMID: 38439202 PMCID: PMC11017759 DOI: 10.1002/ueg2.12542] [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: 10/30/2023] [Accepted: 12/05/2023] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND The effect of analgesic modalities on short-term outcomes in acute pancreatitis remains unknown. However, preclinical models have raised safety concerns regarding opioid use in patients with acute pancreatitis. OBJECTIVE This study aimed to assess the association between analgesics, particularly opioids, and severity and mortality in hospitalised patients with acute pancreatitis. METHODS This prospective multicentre cohort study recruited consecutive patients admitted with a first episode of acute pancreatitis between April 1 and 30 June 2022, with a 1-month follow-up. Data on aetiology, clinical course, and analgesic treatment were collected. The primary outcome was the association between opioid analgesia and acute pancreatitis severity, which was analysed using univariate and multivariate analyses. RESULTS Among a total of 1768 patients, included from 118 centres across 27 countries, 1036 (59%) had opioids administered on admission day, and 167 (9%) received opioids after admission day. On univariate analysis, moderately severe or severe acute pancreatitis was associated with male sex, Asian ethnicity, alcohol aetiology, comorbidity, predicted severe acute pancreatitis, higher pain scores, longer pain duration and opioid treatment (all p < 0.001). On multivariate analysis, comorbidity, alcohol aetiology, longer pain duration and higher pain scores increased the risk of moderately severe or severe acute pancreatitis (all p < 0.001). Furthermore, opioids administered after admission day (but not on admission day) doubled the risk of moderately severe or severe disease (OR 2.07 (95% CI, 1.29-3.33); p = 0.003). Opioid treatment for 6 days or more was an independent risk factor for moderately severe or severe acute pancreatitis (OR 3.21 (95% CI, 2.16-4.79; p < 0.001). On univariate analysis, longer opioid duration was associated with mortality. CONCLUSION Opioid treatment increased the risk of more severe acute pancreatitis only when administered after admission day or for 6 days or more. Future randomised studies should re-evaluate whether opioids might be safe in acute pancreatitis.
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Affiliation(s)
- Sanjay Pandanaboyana
- HPB and Transplant UnitFreeman HospitalNewcastle Upon TyneUK
- Population Health Sciences InstituteNewcastle UniversityNewcastle Upon TyneUK
| | - Cecilie Siggaard Knoph
- Centre for Pancreatic Diseases, Department of Gastroenterology & HepatologyAalborg University HospitalAalborgDenmark
- Department of Clinical MedicineAalborg UniversityAalborgDenmark
| | - Søren Schou Olesen
- Centre for Pancreatic Diseases, Department of Gastroenterology & HepatologyAalborg University HospitalAalborgDenmark
- Department of Clinical MedicineAalborg UniversityAalborgDenmark
| | - Michael Jones
- HPB and Transplant UnitFreeman HospitalNewcastle Upon TyneUK
| | - James Lucocq
- Department of HPB SurgeryRoyal Infirmary of EdinburghEdinburghUK
| | - Jayanta Samanta
- Department of GastroenterologyPost Graduate Institute of Medical Education and ResearchChandigarhIndia
| | | | - Gabriele Capurso
- Pancreatico‐Biliary Endoscopy DivisionVita‐Salute San Raffaele UniversityMilanItaly
| | - Enrique de‐Madaria
- Gastroenterology DepartmentDr. Balmis General University HospitalAlicanteSpain
| | - Dhiraj Yadav
- Division of Gastroenterology & HepatologyUniversity of Pittsburgh Medical CentrePittsburghPennsylvaniaUSA
| | | | - John Windsor
- Surgical and Translational Research CentreUniversity of AucklandAucklandNew Zealand
| | - Asbjørn Mohr Drewes
- Centre for Pancreatic Diseases, Department of Gastroenterology & HepatologyAalborg University HospitalAalborgDenmark
- Department of Clinical MedicineAalborg UniversityAalborgDenmark
| | - Manu Nayar
- HPB and Transplant UnitFreeman HospitalNewcastle Upon TyneUK
- Population Health Sciences InstituteNewcastle UniversityNewcastle Upon TyneUK
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Zadey S, Rao S, Gondi I, Sheneman N, Patil C, Nayan A, Iyer H, Kumar AR, Prasad A, Finley GA, Prasad CRK, Chintamani, Sharma D, Ghosh D, Jesudian G, Fatima I, Pattisapu J, Ko JS, Bains L, Shah M, Alam MS, Hadigal N, Malhotra N, Wijesuriya N, Shukla P, Khan S, Pandya S, Khan T, Tenzin T, Hadiga VR, Peterson D. Achieving Surgical, Obstetric, Trauma, and Anesthesia (SOTA) care for all in South Asia. Front Public Health 2024; 12:1325922. [PMID: 38450144 PMCID: PMC10915281 DOI: 10.3389/fpubh.2024.1325922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 02/09/2024] [Indexed: 03/08/2024] Open
Abstract
South Asia is a demographically crucial, economically aspiring, and socio-culturally diverse region in the world. The region contributes to a large burden of surgically-treatable disease conditions. A large number of people in South Asia cannot access safe and affordable surgical, obstetric, trauma, and anesthesia (SOTA) care when in need. Yet, attention to the region in Global Surgery and Global Health is limited. Here, we assess the status of SOTA care in South Asia. We summarize the evidence on SOTA care indicators and planning. Region-wide, as well as country-specific challenges are highlighted. We also discuss potential directions-initiatives and innovations-toward addressing these challenges. Local partnerships, sustained research and advocacy efforts, and politics can be aligned with evidence-based policymaking and health planning to achieve equitable SOTA care access in the South Asian region under the South Asian Association for Regional Cooperation (SAARC).
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Affiliation(s)
- Siddhesh Zadey
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
- GEMINI Research Center, Duke University School of Medicine, Durham, NC, United States
- Dr. D.Y. Patil Medical College, Hospital, and Research Centre, Pune, Maharashtra, India
| | - Shirish Rao
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India
- Global Alliance for Surgery, Obstetric, Trauma and Anaesthesia Care, Chicago, IL, United States
- Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - Isha Gondi
- Global Alliance for Surgery, Obstetric, Trauma and Anaesthesia Care, Chicago, IL, United States
- Department of Health and Human Sciences, Baylor University, Waco, TX, United States
| | - Natalie Sheneman
- Global Alliance for Surgery, Obstetric, Trauma and Anaesthesia Care, Chicago, IL, United States
| | - Chaitrali Patil
- Global Alliance for Surgery, Obstetric, Trauma and Anaesthesia Care, Chicago, IL, United States
- Department of Biology and Statistics, George Washington University, Washington, DC, United States
| | - Anveshi Nayan
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India
- Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - Himanshu Iyer
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India
| | - Arti Raj Kumar
- India Hub, NIHR Health Research Unit On Global Surgery, Christian Medical College, Ludhiana, Punjab, India
| | - Arun Prasad
- Indraprastha Apollo Hospital, New Delhi, India
| | - G. Allen Finley
- Department of Anesthesiology, Dalhousie University, Halifax, NS, Canada
| | | | - Chintamani
- Department of Surgery, Vardhman Mahavir Medical College Safdarjung Hospital, New Delhi, India
| | - Dhananjaya Sharma
- Department of Surgery, NSCB Government Medical College, Jabalpur, India
| | - Dhruva Ghosh
- India Hub, NIHR Health Research Unit On Global Surgery, Christian Medical College, Ludhiana, Punjab, India
| | - Gnanaraj Jesudian
- Karunya Rural Community Hospital Karunya Nagar, Coimbatore, Tamil Nadu, India
- Association of Rural Surgeons of India, Wardha, India
- International Federation of Rural Surgeons, Ujjain, India
- Rural Surgery Innovations Private Limited, Dimapur, Nagaland, India
| | - Irum Fatima
- IRD Pakistan and the Global Surgery Foundation, Karachi, Sindh, Pakistan
| | - Jogi Pattisapu
- University of Central Florida College of Medicine, Orlando, FL, United States
| | - Justin Sangwook Ko
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Lovenish Bains
- Department of Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
- WHO Collaborating Centre for Research in Surgical Care Delivery in LMIC, Mumbai, Maharashtra, India
| | - Mashal Shah
- Department of Surgery, Aga Khan University, Karachi, Sindh, Pakistan
| | - Mohammed Shadrul Alam
- Department of Pediatric Surgery, Mugda Medical College, Dhaka, Bangladesh
- American College of Surgeons: Bangladesh Chapter, Dhaka, Bangladesh
- Bangladesh Health Economist Forum, Dhaka, Bangladesh
- Association of Pediatric Surgeons of Bangladesh (APSB), DMCH, Dhaka, Bangladesh
| | - Narmada Hadigal
- Narmada Fertility Centre, Hyderabad, Telangana, India
- International Trauma Anesthesia and Critical Care Society, Stavander, Stavanger, Norway
| | - Naveen Malhotra
- Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Nilmini Wijesuriya
- College of Anaesthesiologists and Intensivists of Sri Lanka, Rajagiriya, Sri Lanka
| | - Prateek Shukla
- India Hub, NIHR Health Research Unit On Global Surgery, Christian Medical College, Ludhiana, Punjab, India
| | - Sadaf Khan
- Department of Surgery, Aga Khan University, Karachi, Sindh, Pakistan
| | - Sunil Pandya
- Department of Anaesthesia, Perioperative Medicine and Critical Care, AIG Hospitals, Hyderabad, Telangana, India
| | - Tariq Khan
- Department of Neurosurgery, Northwest School of Medicine, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Tashi Tenzin
- Army Medical Services, Military Hospital, Thimphu, Bhutan
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
- Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
| | | | - Daniel Peterson
- Global Alliance for Surgery, Obstetric, Trauma and Anaesthesia Care, Chicago, IL, United States
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Barbalat G, Reddy G, Franck N. Association of globalization with the burden of opioid use disorders 2019. A country-level analysis using targeted maximum likelihood estimation. Global Health 2023; 19:76. [PMID: 37845722 PMCID: PMC10577998 DOI: 10.1186/s12992-023-00980-3] [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: 03/20/2023] [Accepted: 10/07/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND The "opioid crisis" has been responsible for hundreds of thousands deaths in the US, and is at risk of dissemination worldwide. Within-country studies have demonstrated that the rise of opioid use disorders (OUD) is linked to increased access to opioid prescriptions and to so-called "diseases of despair". Both have been related to the emergence of globalization policies since the 1980s. First, globalized countries have seen a reorganization of healthcare practices towards quick and easy answers to complex needs, including increased opioid prescriptions. Second, despair has gained those suffering from the mutations of socio-economic systems and working conditions that have accompanied globalization policies (e.g. delocalization, deindustrialization, and the decline of social services). Here, using data with high quality ratings from the Global Burden of Disease database, we evaluated the country-based association between four levels of globalization and the burden of OUD 2019. RESULTS The sample included 87 countries. Taking into account potential country-level confounders, we found that countries with the highest level of globalization were associated with a 31% increase in the burden of OUD 2019 compared to those with the lowest level of globalization (mean log difference: 0.31; 95%CI, 0.04-0.57; p = 0.02). Additional analyses showed a significant effect for low back pain (mean log difference: 0.07; 95%CI, 0.02-0.12; p = 0.007). In contrast, despite sharing some of the risk factors of OUD, other mental and substance use disorders did not show any significant relationship with globalization. Finally, socio-cultural de jure globalization, which compiles indicators related to gender equality, human capital and civil rights, was specifically associated with the burden of OUD (mean log difference: 0.49; 95%CI: 0.23,0.75; p < 0.001). CONCLUSIONS These findings suggest that OUD may have inherent underpinnings linked to globalization, and more particularly socio-cultural aspects of globalization. Key factors may be increased rights to access prescriptions, as well as increased feelings of despair related to the erosion of local cultures and widening educational gaps.
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Affiliation(s)
- Guillaume Barbalat
- Centre ressource de réhabilitation psychosociale et de remédiation cognitive, Pôle Centre rive gauche UMR 5229, Hôpital Le Vinatier, CNRS & Université Lyon 1, Lyon, France.
| | - Geeta Reddy
- International Committee of the Red Cross (ICRC), 19, Avenue de la Paix, Geneva, 1202, Switzerland
| | - Nicolas Franck
- Centre ressource de réhabilitation psychosociale et de remédiation cognitive, Pôle Centre rive gauche UMR 5229, Hôpital Le Vinatier, CNRS & Université Lyon 1, Lyon, France
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7
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Sánchez-Cárdenas MA, Pourghazian N, Garralda E, van Steijn D, Slama S, Benítez E, Bouësseau MC, Centeno C. Palliative care in the Eastern Mediterranean: comparative analysis using specific indicators. Palliat Care 2022; 21:168. [PMID: 36184640 PMCID: PMC9528121 DOI: 10.1186/s12904-022-01047-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 08/29/2022] [Indexed: 11/24/2022] Open
Abstract
Background Monitoring the development of palliative care (PC) illustrates the capacity of health systems to respond to the needs of people experiencing serious health-related suffering. Aim To analyse comparatively the situation of PC in the countries of the Easter Mediterranean region using context-specific indicators. Method An online questionnaire with 15 context-specific PC indicators investigating service provision, use of medicines, policy, education, and vitality was designed. Authors Institution 1 nominated in-country experts to complete the survey. Data were analysed using a comparative description of indicators per domain and a multivariate analysis. Results In-country experts were identified in 17/22 countries. 12/17 contributed to the survey. In total, 117 specialized PC services were identified. Specialized services per population ranges from 0.09 per 100,000 inhabitants in Lebanon and Saudi Arabia, Qatar and Kuwait; to zero services in the Occupied Palestinian Territories. On average, opioid consumption was 2.40 mg/capita/year. National PC strategies were reported in nine countries. In six countries, PC is officially accredited either as a specialty or sub-specialty, and PC mandatory courses are implemented in 36% of medical schools and 46% of nursing schools. National PC associations were documented in six countries. A higher pattern of development was identified in Jordan, Kuwait, Saudi Arabia, Oman, Lebanon, Qatar. Conclusions Despite a higher development in the Arabian Peninsula, the region is characterised by a very low provision of specialized PC services and opioid consumption. Policy improvements represent an opportunity to improve access to PC. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-01047-7.
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Affiliation(s)
- Miguel Antonio Sánchez-Cárdenas
- ATLANTES Global Palliative Care Observatory, Institute for Culture and Society, University of Navarra, 31080, Pamplona, Spain.,IdiSNA-Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Nasim Pourghazian
- NCD Prevention (NCP) Unit in the Department of UHC/NCDs at the World Health Organizations Regional Office for the Eastern Mediterranean (WHO EMRO), Cairo, 11371, Egypt
| | - Eduardo Garralda
- ATLANTES Global Palliative Care Observatory, Institute for Culture and Society, University of Navarra, 31080, Pamplona, Spain. .,IdiSNA-Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain.
| | - Danny van Steijn
- ATLANTES Global Palliative Care Observatory, Institute for Culture and Society, University of Navarra, 31080, Pamplona, Spain.,IdiSNA-Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Slim Slama
- NCD Prevention (NCP) Unit in the Department of UHC/NCDs at the World Health Organizations Regional Office for the Eastern Mediterranean (WHO EMRO), Cairo, 11371, Egypt
| | - Edgar Benítez
- ATLANTES Global Palliative Care Observatory, Institute for Culture and Society, University of Navarra, 31080, Pamplona, Spain.,DATAI, Institute of Data Science and Artificial Intelligence, University of Navarra, 31080, Pamplona, Spain.,University of Navarra (UNAV), TECNUN School of Engineering, San Sebastián, Spain
| | | | - Carlos Centeno
- ATLANTES Global Palliative Care Observatory, Institute for Culture and Society, University of Navarra, 31080, Pamplona, Spain.,IdiSNA-Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
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Bettinger JJ, Amarquaye W, Fudin J, Schatman ME. Misinterpretation of the “Overdose Crisis” Continues to Fuel Misunderstanding of the Role of Prescription Opioids. J Pain Res 2022; 15:949-958. [PMID: 35414752 PMCID: PMC8994995 DOI: 10.2147/jpr.s367753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 03/29/2022] [Indexed: 12/14/2022] Open
Affiliation(s)
| | | | - Jeffrey Fudin
- President, Remitigate Therapeutics, Delmar, NY, USA
- Department of Pharmacy Practice, Albany College of Pharmacy & Health Sciences, Albany, NY, USA
- Department of Pharmacy Practice, Western New England University College of Pharmacy, Springfield, MA, USA
- Department of Pharmacy and Pain Management, Stratton VA Medical Center, Albany, NY, USA
| | - Michael E Schatman
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA
- Department of Population Health – Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY, USA
- School of Social Work, North Carolina State University, Raleigh, NC, USA
- Correspondence: Michael E Schatman, Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, 550 1st Ave., New York, NY, 10016, USA, Tel +425-647-4880, Email
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9
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Sud A, Buchman DZ, Furlan AD, Selby P, Spithoff SM, Upshur REG. Chronic Pain and Opioid Prescribing: Three Ways for Navigating Complexity at the Clinical‒Population Health Interface. Am J Public Health 2022; 112:S56-S65. [PMID: 35143271 PMCID: PMC8842204 DOI: 10.2105/ajph.2021.306500] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 11/04/2022]
Abstract
Clinically focused interventions for people living with pain, such as health professional education, clinical decision support systems, prescription drug monitoring programs, and multidisciplinary care to support opioid tapering, have all been promoted as important solutions to the North American opioid crisis. Yet none have so far delivered substantive beneficial opioid-related population health outcomes. In fact, while total opioid prescribing has leveled off or reduced in many jurisdictions, population-level harms from opioids have continued to increase dramatically. We attribute this failure partly to a poor recognition of the epistemic and ethical complexities at the interface of clinical and population health. We draw on a framework of knowledge networks in wicked problems to identify 3 strategies to help navigate these complexities: (1) designing and evaluating clinically focused interventions as complex interventions, (2) reformulating evidence to make population health dynamics apparent, and (3) appealing to the inseparability of facts and values to support decision-making in uncertainty. We advocate that applying these strategies will better equip clinically focused interventions as complements to structural and public health interventions to achieve the desired beneficial population health effects. (Am J Public Health. 2022;112(S1):S56-S65. https://doi.org/10.2105/AJPH.2021.306500).
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Affiliation(s)
- Abhimanyu Sud
- Abhimanyu Sud is with the Department of Family and Community Medicine and Institute for Health Policy, Management, and Evaluation, University of Toronto, Canada. Daniel Z. Buchman is with Centre for Addiction and Mental Health and Dalla Lana School of Public Health, Toronto. Andrea D. Furlan is with the Institute for Work and Health and Department of Medicine, University of Toronto. Peter Selby is with the Centre for Addiction and Mental Health and Department of Family and Community Medicine, Department of Psychiatry, University of Toronto. Sheryl M. Spithoff is with Department of Family and Community Medicine, University of Toronto. Ross E. G. Upshur is with the Bridgepoint Collaboratory for Research and Innovation, Department of Family and Community Medicine, Dalla Lana School of Public Health, University of Toronto
| | - Daniel Z Buchman
- Abhimanyu Sud is with the Department of Family and Community Medicine and Institute for Health Policy, Management, and Evaluation, University of Toronto, Canada. Daniel Z. Buchman is with Centre for Addiction and Mental Health and Dalla Lana School of Public Health, Toronto. Andrea D. Furlan is with the Institute for Work and Health and Department of Medicine, University of Toronto. Peter Selby is with the Centre for Addiction and Mental Health and Department of Family and Community Medicine, Department of Psychiatry, University of Toronto. Sheryl M. Spithoff is with Department of Family and Community Medicine, University of Toronto. Ross E. G. Upshur is with the Bridgepoint Collaboratory for Research and Innovation, Department of Family and Community Medicine, Dalla Lana School of Public Health, University of Toronto
| | - Andrea D Furlan
- Abhimanyu Sud is with the Department of Family and Community Medicine and Institute for Health Policy, Management, and Evaluation, University of Toronto, Canada. Daniel Z. Buchman is with Centre for Addiction and Mental Health and Dalla Lana School of Public Health, Toronto. Andrea D. Furlan is with the Institute for Work and Health and Department of Medicine, University of Toronto. Peter Selby is with the Centre for Addiction and Mental Health and Department of Family and Community Medicine, Department of Psychiatry, University of Toronto. Sheryl M. Spithoff is with Department of Family and Community Medicine, University of Toronto. Ross E. G. Upshur is with the Bridgepoint Collaboratory for Research and Innovation, Department of Family and Community Medicine, Dalla Lana School of Public Health, University of Toronto
| | - Peter Selby
- Abhimanyu Sud is with the Department of Family and Community Medicine and Institute for Health Policy, Management, and Evaluation, University of Toronto, Canada. Daniel Z. Buchman is with Centre for Addiction and Mental Health and Dalla Lana School of Public Health, Toronto. Andrea D. Furlan is with the Institute for Work and Health and Department of Medicine, University of Toronto. Peter Selby is with the Centre for Addiction and Mental Health and Department of Family and Community Medicine, Department of Psychiatry, University of Toronto. Sheryl M. Spithoff is with Department of Family and Community Medicine, University of Toronto. Ross E. G. Upshur is with the Bridgepoint Collaboratory for Research and Innovation, Department of Family and Community Medicine, Dalla Lana School of Public Health, University of Toronto
| | - Sheryl M Spithoff
- Abhimanyu Sud is with the Department of Family and Community Medicine and Institute for Health Policy, Management, and Evaluation, University of Toronto, Canada. Daniel Z. Buchman is with Centre for Addiction and Mental Health and Dalla Lana School of Public Health, Toronto. Andrea D. Furlan is with the Institute for Work and Health and Department of Medicine, University of Toronto. Peter Selby is with the Centre for Addiction and Mental Health and Department of Family and Community Medicine, Department of Psychiatry, University of Toronto. Sheryl M. Spithoff is with Department of Family and Community Medicine, University of Toronto. Ross E. G. Upshur is with the Bridgepoint Collaboratory for Research and Innovation, Department of Family and Community Medicine, Dalla Lana School of Public Health, University of Toronto
| | - Ross E G Upshur
- Abhimanyu Sud is with the Department of Family and Community Medicine and Institute for Health Policy, Management, and Evaluation, University of Toronto, Canada. Daniel Z. Buchman is with Centre for Addiction and Mental Health and Dalla Lana School of Public Health, Toronto. Andrea D. Furlan is with the Institute for Work and Health and Department of Medicine, University of Toronto. Peter Selby is with the Centre for Addiction and Mental Health and Department of Family and Community Medicine, Department of Psychiatry, University of Toronto. Sheryl M. Spithoff is with Department of Family and Community Medicine, University of Toronto. Ross E. G. Upshur is with the Bridgepoint Collaboratory for Research and Innovation, Department of Family and Community Medicine, Dalla Lana School of Public Health, University of Toronto
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10
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Richards GC, Aronson JK, Mahtani KR, Heneghan C. Global, regional, and national consumption of controlled opioids: a cross-sectional study of 214 countries and non-metropolitan territories. Br J Pain 2022; 16:34-40. [PMID: 35111312 PMCID: PMC8801686 DOI: 10.1177/20494637211013052] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The consumption of opioids has increased globally since the 1990s. Previous studies of global opioid consumption have concentrated on morphine alone or a subset of opioids, with a focus on cancer pain and palliative care. In this study, we have determined the global, regional, and national consumption of all controlled opioids, including anaesthetics, analgesics, antidiarrheals, opioid substitution therapies, and cough suppressants. METHODS We conducted a cross-sectional study using data from the International Narcotics Control Board (INCB). We calculated mean opioid consumption (mg/person) globally, regionally, and nationally for 2015-2017, where consumption refers to the total amount of controlled opioids distributed for medical purposes and excludes recreational use. We ranked countries by total consumption and quantified the types of opioids consumed globally. RESULTS Between 2015 and 2017, 90% of the world's population consumed only 11% of controlled opioids. An average of 32 mg/person was consumed annually, but this was not equally distributed across the world. Consumption was the highest in Germany (480 mg/person), followed by Iceland (428 mg/person), the United States (398 mg/person) and Canada (333 mg/person). Oxycodone (35%) was the most heavily consumed controlled opioid globally, followed by morphine (15.9%), methadone (15.8%) and tilidine (14%). CONCLUSION Large disparities persist in most of the world in accessing essential opioid medicines. Consumption patterns should continue to be monitored, and collaborative strategies should be developed to promote access and the appropriate prescribing of opioids in all countries and non-metropolitan territories.
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Affiliation(s)
- Georgia C Richards
- Global Centre on Healthcare and Urbanisation, Kellogg College, University of Oxford, Oxford, UK
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jeffrey K Aronson
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Kamal R Mahtani
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Carl Heneghan
- Global Centre on Healthcare and Urbanisation, Kellogg College, University of Oxford, Oxford, UK
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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11
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Jayawardana S, Forman R, Johnston-Webber C, Campbell A, Berterame S, de Joncheere C, Aitken M, Mossialos E. Global consumption of prescription opioid analgesics between 2009-2019: a country-level observational study. EClinicalMedicine 2021; 42:101198. [PMID: 34820610 PMCID: PMC8599097 DOI: 10.1016/j.eclinm.2021.101198] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 10/12/2021] [Accepted: 10/28/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Opioid analgesics play a key role in pain management but providing access while mitigating risk of misuse and dependence remains a challenge. Tracking global consumption of all opioids over time can help identify emerging patterns and drivers of use. METHODS Prescription opioid analgesic consumption was estimated for 76 countries between 2009 and 2019 using IQVIA MIDAS data. We reported country-level consumption trends in morphine milligram equivalents (MMEs), assessed differences in consumption between high-income (HICs), upper-middle income (UMICs), and low- and lower-middle income countries (LMICs), and identified country-level socioeconomic drivers of consumption using fixed-effects panel regression models. FINDINGS Global opioid consumption rate declined from 216·3 to 151·5 morphine milligram equivalents per 1,000 inhabitants per day (MID) between 2009 and 2019, with consumption declines in the US and Germany. Overall, consumption rates increased in HICs by a median 36·6 MID (IQR, -7·5 -124·5) with substantial heterogeneity between countries. Median consumption rates were lower in UMICs (23·6 MID) and LMICs (8·3 MID) compared to HICs (345·1 MID) and increased by median 10·4 and 3·7 MID from 2009-2019, respectively. Consumption rates were associated with income (coefficient 18·84, 95% confidence interval 3·8-33·9) and trade (13·59, 1·3-25·8) in UMICs, and physician density (1·95, 1·2-2·7) in LMICs. Tramadol consumption rate increased in the study period and accounted for a relatively large proportion of total opioid volume consumed across all country-income groups. INTERPRETATION Substantial heterogeneity in global opioid consumption patterns reflect the challenges involved with providing adequate access to opioid treatment while avoiding potential misuse.
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Affiliation(s)
- Sahan Jayawardana
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Rebecca Forman
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | | | - Allen Campbell
- IQVIA Institute for Human Data Science, Parsippany, NJ, USA
| | | | | | - Murray Aitken
- IQVIA Institute for Human Data Science, Parsippany, NJ, USA
| | - Elias Mossialos
- Department of Health Policy, London School of Economics and Political Science, London, UK
- Centre for Health Policy, The Institute of Global Health Innovation, Imperial College London, London, UK
- Corresponding author: Elias Mossialos, MD, PhD, Houghton Street, London WC2A 2AE, United Kingdom, Tel.: +44(0)20 7955 7564
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12
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Barrios CH, Werutsky G, Mohar A, Ferrigno AS, Müller BG, Bychkovsky BL, Castro E CJ, Uribe CJ, Villarreal-Garza C, Soto-Perez-de-Celis E, Gutiérrez-Delgado F, Kim JS, Ismael J, Delgado L, Santini LA, Teich N, Chavez PC, Liedke PER, Exman P, Barroso-Sousa R, Stefani SD, Cáceres SAB, Rebelatto TF, Pastrana T, Chavarri-Guerra Y, Vargas Y, Cazap E. Cancer control in Latin America and the Caribbean: recent advances and opportunities to move forward. Lancet Oncol 2021; 22:e474-e487. [PMID: 34735817 DOI: 10.1016/s1470-2045(21)00492-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 08/03/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
The increasing burden of cancer represents a substantial problem for Latin America and the Caribbean. Two Lancet Oncology Commissions in 2013 and 2015 highlighted potential interventions that could advance cancer care in the region by overcoming existing challenges. Areas requiring improvement included insufficient investment in cancer control, non-universal health coverage, fragmented health systems, inequitable concentration of cancer services, inadequate registries, delays in diagnosis or treatment initiation, and insufficient palliative services. Progress has been made in key areas but remains uneven across the region. An unforeseen challenge, the COVID-19 pandemic, strained all resources, and its negative effect on cancer control is expected to continue for years. In this Series paper, we summarise progress in several aspects of cancer control since 2015, and identify persistent barriers requiring commitment of additional resources to reduce the cancer burden in Latin America and the Caribbean.
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Affiliation(s)
- Carlos H Barrios
- Oncology Department, Oncoclinicas Group, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil.
| | - Gustavo Werutsky
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
| | - Alejandro Mohar
- Unidad de Epidemiología, Instituto Nacional de Cancerología, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Ana S Ferrigno
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo León, Mexico
| | - Bettina G Müller
- Department of Medical Oncology, Instituto Nacional del Cáncer, Santiago, Chile
| | - Brittany L Bychkovsky
- Division of Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA, USA; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | | | - Cynthia Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo León, Mexico
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, Mexico
| | - Francisco Gutiérrez-Delgado
- Centro de Estudios y Prevención del Cancer Tuxtla Gutiérrez, Chiapas, México; Latin American School of Oncology (ELO), México City, México
| | - Ji Seok Kim
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Dewpoint Therapeutics, Boston, MA, USA
| | | | - Lucia Delgado
- Faculty of Medicine, University of Uruguay, Montevideo, Uruguay; Honorary Commission for the Fight Against Cancer, Montevideo, Uruguay
| | - Luiz A Santini
- Center of Strategic Studies of FIOCRUZ (Fundação Oswaldo Cruz), Rio de Janeiro, Brazil
| | - Nelson Teich
- Teich Health Care Consulting, Rio de Janeiro, Brazil
| | - Pamela C Chavez
- Department of Internal Medicine, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
| | - Pedro E R Liedke
- Oncology Department, Oncoclinicas Group, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Department of Oncology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Unidade de Pesquisa Clínica em Oncologia, Porto Alegre, Brazil
| | - Pedro Exman
- Department of Medical Oncology, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | | | | | - Suyapa A Bejarano Cáceres
- Medicine Universidad Católica de Honduras, San Pedro Sula, Honduras; Department of Clinical Oncology, Liga Contra el Cáncer, San Pedro Sula, Honduras
| | | | - Tania Pastrana
- Department of Palliative Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Yanin Chavarri-Guerra
- Department of Hemato-Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, Mexico
| | - Yolanda Vargas
- Unidad de Cuidados Paliativos y Clínica de Alivio del Dolor Oncológico, Instituto Oncológico Nacional, Ciudad de Panamá, Panamá
| | - Eduardo Cazap
- Latin American and Caribbean Society of Medical Oncology (SLACOM), Buenos Aires, Argentina
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Nambiar AR, Rana S, Rajagopal MR. Serious health-related suffering and palliative care in South Asian countries. Curr Opin Support Palliat Care 2021; 15:169-173. [PMID: 34292186 DOI: 10.1097/spc.0000000000000565] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW South Asia, with a population of 1.79 billion, has close to 9.9 million individuals experiencing serious health-related suffering (SHS). South Asia accounts for 10.23% of the world's cancer incidence. The prevalence of cancer mortality in the region is 68.44%, significantly higher than the world average of 59.74%. This poor outcome highlights the need to focus on SHS in the region. This review was undertaken to assess the current status of palliative care inequities in the region and to guide future action. RECENT FINDINGS Using morphine-equivalent doses of opioid analgesics (excluding methadone) per cancer death as a proxy measure for access to palliative care, the International Narcotics Control Board data in 2020 show poor access to palliative care. Less than 4% of those in need are able to access palliative care in India, whereas in Afghanistan only 0.2% have access. Inappropriate end-of-life care (EOLC) and catastrophic out-of-pocket health expenditure compound the problem. SUMMARY The solutions involve the introduction of national programs for palliative care, demonstration of culturally appropriate best practices as proof of concept, favourable legislation for medical opioid access, community participation, engagement of civil society to improve awareness, inclusion of palliative and adding EOLC to medical education and need-based research. VIDEO ABSTRACT http://links.lww.com/COSPC/A30.
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Affiliation(s)
- Ashwin R Nambiar
- Trivandrum Institute of Palliative Sciences (WHO Collaborating Centre for Training and Policy on Access to Pain Relief), Pallium India, Trivandrum, Kerala, India
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14
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Qin W, Yang Y, Zhang L, Yang Q, Li P, Fan B. Impact of Continuing Medical Education for Physicians on the Quality of Cancer Pain Treatment in China. J Pain Symptom Manage 2021; 62:286-292. [PMID: 33346064 DOI: 10.1016/j.jpainsymman.2020.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/03/2020] [Accepted: 12/04/2020] [Indexed: 11/26/2022]
Abstract
CONTEXT The management of cancer pain has gained attention in China since the proposal of the three-step analgesic ladder in 1986 and has been further improved after the Chinese Ministry of Health launched the campaign for "Good Pain Management Ward" in 2011. The Beijing Pain Management Center for Quality Control and Improvement was formed with the intent to improve the quality of pain management by various means such as providing continuing medical education (CME) and conducting evaluation in Beijing, the capital of China. OBJECTIVES The objective of this study was to investigate the impact of CME on cancer pain treatment in hospitals in Beijing, China. METHODS The Beijing Pain Management Center for Quality Control and Improvement carried out annual CME on cancer pain treatment for physicians in Beijing in February from 2016 to 2019. The quality of cancer pain treatment in these hospitals was evaluated in August 2015, 2017 and 2019 by using an evaluation instrument containing eight domains. The evaluation results were retrospectively reviewed to assess the impact of CME. RESULTS After annual CME for four successive years, a significant increase in evaluation scores for cancer pain treatment was observed in the participating hospitals. The increased trend varied widely both among the levels of hospitals (secondary and two tiers of tertiary hospitals) and among evaluation domains. These hospitals scored lowest in domains related to opioid tolerance, ongoing care, and risk of nonsteroidal anti-inflammatory drugs in the last evaluation. CONCLUSION CME significantly improved the quality of cancer pain treatment in the participating hospitals. Thus, standard CME courses may be adopted to improve the quality of cancer pain treatment by other regions in China and other countries.
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Affiliation(s)
- Wangjun Qin
- Department of Pharmacy, China-Japan Friendship Hospital, Beijing, China
| | - Yang Yang
- Department of Pain Management, China-Japan Friendship Hospital, Beijing, China
| | - Lei Zhang
- Department of Pharmacy, China-Japan Friendship Hospital, Beijing, China
| | - Qing Yang
- Department of Pain Management, China-Japan Friendship Hospital, Beijing, China
| | - Pengmei Li
- Department of Pharmacy, China-Japan Friendship Hospital, Beijing, China.
| | - Bifa Fan
- Department of Pain Management, China-Japan Friendship Hospital, Beijing, China.
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15
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Sharma S, Blyth FM, Mishra SR, Briggs AM. Health system strengthening is needed to respond to the burden of pain in low- and middle-income countries and to support healthy ageing. J Glob Health 2021; 9:020317. [PMID: 33274068 PMCID: PMC7680638 DOI: 10.7189/jogh.09.020317] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Saurab Sharma
- Kathmandu University School of Medical Sciences, Dhulikhel, Nepal.,Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Fiona M Blyth
- Concord Clinical School Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | | | - Andrew M Briggs
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
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16
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Miyachi T, Ozaki A, Saito H, Sawano T, Tanimoto T, Crump A. Opioids: A 'crisis' of too much or not enough - or simply how rich you are and where you live? Eur J Pain 2021; 25:1181-1194. [PMID: 33822443 DOI: 10.1002/ejp.1767] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The 'Opioid Crisis', which originated in Western countries, has been misrepresented and is misinforming the global public. For 20 years, since the advent of the synthetic opioids, 25,000 Americans, on average, have died annually from opioid-related overdoses. The United States produces and consumes by far the greatest amounts of opioids. National regulations introduced to curb overdoses and restrict opioid availability have condemned many Americans, such as cancer patients or those in need of palliative care, to a life of extreme pain due to lack of access to adequate pain management. As is often the case, US-driven laws have informed and guided international regulations. Worldwide, 83% of countries have low or non-existent access to opioids for pain relief. Over 25 million people are at the end-of-life stage, with eight million people dying annually in unnecessary pain and distress. Ineffectively controlled pain is a global public health issue blighting the lives of billions of people worldwide with immeasurable human and socioeconomic costs. International conventions regulate the trade and use of controlled medications, including many opioids. The goal is to balance widespread access to optimal forms of pain management with restrictions to govern the use and prevent the misuse of controlled substances. Those conventions are failing to meet their goals. International guidelines to inform national legislation have been compromised and withdrawn, thanks to undue interference from US-based opioid manufacturers. The new goal must be to ensure equitable access, for all, to opioids and ensure that optimal pain management becomes a central component of Universal Health Coverage. SIGNIFICANCE: The opioid crisis is, more accurately, a multicomponent global crisis and one that is not fully apparent or well understood. Regulations of the wealthy and powerful to control a surfeit of opioids, which encourages misuse, cannot be allowed to govern legislation in the majority of countries worldwide where citizens have little or no access to opioids to reduce pain and suffering. International conventions must be revised to ensure an optimal balance that allows access to opioids for all those who need them.
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Affiliation(s)
| | - Akihiko Ozaki
- Medical Governance Research Institute, Tokyo, Japan.,Department of Breast Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, Japan
| | - Hiroaki Saito
- Department of Gastroenterology, Sendai Kousei Hospital, Sendai, Japan
| | - Toyoaki Sawano
- Department of Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, Japan
| | | | - Andy Crump
- Medical Governance Research Institute, Tokyo, Japan.,Kitasato University, Tokyo, Japan
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Synthesis and Structure of Fluorinated (Benzo[d]imidazol-2-yl)methanols: Bench Compounds for Diverse Applications. CRYSTALS 2020. [DOI: 10.3390/cryst10090786] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A simple and general approach to the synthesis (from commercial precursors) of eight out of nine possible (benzo[d]imidazol-2-yl)methanols fluorinated on the benzene ring is reported. Molecular and crystalline structures of most compounds were solved by X-ray diffraction analysis. This made it possible to reveal the influence of the number and arrangement of fluorine atoms in the benzene cycle on the formation of intermolecular hydrogen bonds. It was found that the more fluorine atoms are present in a compound, the higher the dimensionality of the H-bonded structure is. Moreover, the presence of fluorine atoms in the synthesized compounds leads to the emergence of C–F…π interactions affecting crystal packing. The synthesized fluorinated (benzo[d]imidazol-2-yl)methanols may serve as excellent bench compounds for the synthesis of a systematic series of fluorine-containing derivatives to study structure–property correlations in various fields of research from medicine to materials science.
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18
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Pettus K, Cleary JF, de Lima L, Ahmed E, Radbruch L. Availability of Internationally Controlled Essential Medicines in the COVID-19 Pandemic. J Pain Symptom Manage 2020; 60:e48-e51. [PMID: 32387575 PMCID: PMC7204700 DOI: 10.1016/j.jpainsymman.2020.04.153] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 04/30/2020] [Accepted: 04/30/2020] [Indexed: 11/25/2022]
Abstract
Section 2 of the 2019 World Health Organization Model List of Essential Medicines includes opioid analgesics formulations commonly used for the control of pain and respiratory distress, as well as sedative and anxiolytic substances such as midazolam and diazepam. These medicines, essential to palliative care, are regulated under the international drug control conventions overseen by United Nations specialized agencies and treaty bodies and under national drug control laws. Those national laws and regulations directly affect bedside availability of Internationally Controlled Essential Medicines (ICEMs). The complex interaction between national regulatory systems and global supply chains (now impacted by COVID-19 pandemic) directly affects bedside availability of ICEMs and patient care. Despite decades of global civil society advocacy in the United Nations system, ICEMs have remained chronically unavailable, inaccessible, and unaffordable in low- and-middle-income countries, and there are recent reports of shortages in high-income countries as well. The most prevalent symptoms in COVID-19 are breathlessness, cough, drowsiness, anxiety, agitation, and delirium. Frequently used medicines include opioids such as morphine or fentanyl and midazolam, all of them listed as ICEMs. This paper describes the issues related to the lack of availability and limited access to ICEMs during the COVID-19 pandemic in both intensive and palliative care patients in countries of all income levels and makes recommendations for improving access.
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Affiliation(s)
- Katherine Pettus
- International Association for Hospice and Palliative Care, Houston, Texas, USA.
| | - James F Cleary
- Walther Center for Global Palliative Care, Indiana University, Indianapolis, Indiana, USA
| | - Liliana de Lima
- International Association for Hospice and Palliative Care, Houston, Texas, USA
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Barbosa J, Faria J, Garcez F, Leal S, Afonso LP, Nascimento AV, Moreira R, Queirós O, Carvalho F, Dinis-Oliveira RJ. Repeated Administration of Clinical Doses of Tramadol and Tapentadol Causes Hepato- and Nephrotoxic Effects in Wistar Rats. Pharmaceuticals (Basel) 2020; 13:ph13070149. [PMID: 32664348 PMCID: PMC7407499 DOI: 10.3390/ph13070149] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 12/18/2022] Open
Abstract
Tramadol and tapentadol are fully synthetic and extensively used analgesic opioids, presenting enhanced therapeutic and safety profiles as compared with their peers. However, reports of adverse reactions, intoxications and fatalities have been increasing. Information regarding the molecular, biochemical, and histological alterations underlying their toxicological potential is missing, particularly for tapentadol, owing to its more recent market authorization. Considering the paramount importance of liver and kidney for the metabolism and excretion of both opioids, these organs are especially susceptible to toxicological damage. In the present study, we aimed to characterize the putative hepatic and renal deleterious effects of repeated exposure to therapeutic doses of tramadol and tapentadol, using an in vivo animal model. Male Wistar rats were randomly divided into six experimental groups, composed of six animals each, which received daily single intraperitoneal injections of 10, 25 or 50 mg/kg tramadol or tapentadol (a low, standard analgesic dose, an intermediate dose and the maximum recommended daily dose, respectively). An additional control group was injected with normal saline. Following 14 consecutive days of administration, serum, urine and liver and kidney tissue samples were processed for biochemical, metabolic and histological analysis. Repeated administration of therapeutic doses of both opioids led to: (i) increased lipid and protein oxidation in liver and kidney, as well as to decreased total liver antioxidant capacity; (ii) decreased serum albumin, urea, butyrylcholinesterase and complement C3 and C4 levels, denoting liver synthesis impairment; (iii) elevated serum activity of liver enzymes, such as alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and γ-glutamyl transpeptidase, as well as lipid profile alterations, also reflecting hepatobiliary commitment; (iv) derangement of iron metabolism, as shown through increases in serum iron, ferritin, haptoglobin and heme oxygenase-1 levels. In turn, elevated serum cystatin C, decreased urine creatinine output and increased urine microalbumin levels were detected upon exposure to tapentadol only, while increased serum amylase and urine N-acetyl-β-D-glucosaminidase activities were observed for both opioids. Collectively, these results are compatible with kidney injury. Changes were also found in the expression levels of liver- and kidney-specific toxicity biomarker genes, upon exposure to tramadol and tapentadol, correlating well with alterations in lipid profile, iron metabolism and glomerular and tubular function. Histopathological analysis evidenced sinusoidal dilatation, microsteatosis, mononuclear cell infiltrates, glomerular and tubular disorganization, and increased Bowman's spaces. Although some findings are more pronounced upon tapentadol exposure, our study shows that, when compared with acute exposure, prolonged administration of both opioids smooths the differences between their toxicological effects, and that these occur at lower doses within the therapeutic range.
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Affiliation(s)
- Joana Barbosa
- IINFACTS—Institute of Research and Advanced Training in Health Sciences and Technologies, Department of Sciences, University Institute of Health Sciences (IUCS), CESPU, CRL, 4585-116 Gandra, Portugal; (J.F.); (F.G.); (S.L.); (A.V.N.); (R.M.); (O.Q.)
- UCIBIO, REQUIMTE—Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal;
- Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Correspondence: (J.B.); (R.J.D.-O.); Tel.: +351-224-157-216 (J.B.); +351-224-157-216 (R.J.D.-O.)
| | - Juliana Faria
- IINFACTS—Institute of Research and Advanced Training in Health Sciences and Technologies, Department of Sciences, University Institute of Health Sciences (IUCS), CESPU, CRL, 4585-116 Gandra, Portugal; (J.F.); (F.G.); (S.L.); (A.V.N.); (R.M.); (O.Q.)
- UCIBIO, REQUIMTE—Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal;
| | - Fernanda Garcez
- IINFACTS—Institute of Research and Advanced Training in Health Sciences and Technologies, Department of Sciences, University Institute of Health Sciences (IUCS), CESPU, CRL, 4585-116 Gandra, Portugal; (J.F.); (F.G.); (S.L.); (A.V.N.); (R.M.); (O.Q.)
| | - Sandra Leal
- IINFACTS—Institute of Research and Advanced Training in Health Sciences and Technologies, Department of Sciences, University Institute of Health Sciences (IUCS), CESPU, CRL, 4585-116 Gandra, Portugal; (J.F.); (F.G.); (S.L.); (A.V.N.); (R.M.); (O.Q.)
- Department of Biomedicine, Unit of Anatomy, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- CINTESIS—Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
| | - Luís Pedro Afonso
- Department of Pathology, Portuguese Institute of Oncology of Porto, 4200-072 Porto, Portugal;
| | - Ana Vanessa Nascimento
- IINFACTS—Institute of Research and Advanced Training in Health Sciences and Technologies, Department of Sciences, University Institute of Health Sciences (IUCS), CESPU, CRL, 4585-116 Gandra, Portugal; (J.F.); (F.G.); (S.L.); (A.V.N.); (R.M.); (O.Q.)
| | - Roxana Moreira
- IINFACTS—Institute of Research and Advanced Training in Health Sciences and Technologies, Department of Sciences, University Institute of Health Sciences (IUCS), CESPU, CRL, 4585-116 Gandra, Portugal; (J.F.); (F.G.); (S.L.); (A.V.N.); (R.M.); (O.Q.)
| | - Odília Queirós
- IINFACTS—Institute of Research and Advanced Training in Health Sciences and Technologies, Department of Sciences, University Institute of Health Sciences (IUCS), CESPU, CRL, 4585-116 Gandra, Portugal; (J.F.); (F.G.); (S.L.); (A.V.N.); (R.M.); (O.Q.)
| | - Félix Carvalho
- UCIBIO, REQUIMTE—Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal;
| | - Ricardo Jorge Dinis-Oliveira
- IINFACTS—Institute of Research and Advanced Training in Health Sciences and Technologies, Department of Sciences, University Institute of Health Sciences (IUCS), CESPU, CRL, 4585-116 Gandra, Portugal; (J.F.); (F.G.); (S.L.); (A.V.N.); (R.M.); (O.Q.)
- UCIBIO, REQUIMTE—Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal;
- Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Correspondence: (J.B.); (R.J.D.-O.); Tel.: +351-224-157-216 (J.B.); +351-224-157-216 (R.J.D.-O.)
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Scholten W, Christensen AE, Olesen AE, Drewes AM. Analyzing and Benchmarking Global Consumption Statistics for Opioid Analgesics 2015: Inequality Continues to Increase. J Pain Palliat Care Pharmacother 2019; 34:1-12. [DOI: 10.1080/15360288.2019.1686098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Simoni AH, Nikolajsen L, Olesen AE, Christiansen CF, Pedersen AB. Opioid use after hip fracture surgery: A Danish nationwide cohort study from 2005 to 2015. Eur J Pain 2019; 23:1309-1317. [PMID: 30848038 DOI: 10.1002/ejp.1392] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 02/26/2019] [Accepted: 03/04/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND There is currently a knowledge gap regarding persistent opioid use after hip fracture surgery. Thus, opioid use within a year after hip fracture surgery in patients with/without opioid use before surgery was examined. METHODS This population-based cohort study included all patients (aged ≥ 65) undergoing primary hip fracture surgery in Denmark (2005-2015) identified from the Danish Multidisciplinary Hip Fracture Database. Opioid use was assessed from The Danish National Health Service Prescription Database as redeemed prescriptions. The proportion of patients with ≥1 opioid prescription was computed within 6 months before surgery and each of four 3-month periods (quarters) after surgery, among patients alive first day in each period. Proportion differences (95% CI) were calculated for each quarter compared to before surgery. Proportions were calculated for users and nonusers before surgery, including initiators after first quarter. RESULTS This study included 69,456 patients. Proportion differences of opioid users were 35.0 (95% CI 34.5-35.5), 7.0 (95% CI 6.5-7.5), 2.9 (95% CI 2.4-3.4) and 1.4 percentage-points (95% CI 0.9-1.9) the four quarters after surgery compared to before. Among opioid nonusers before surgery, 54.7% (95% CI 54.3-55.1), 21.8% (95% CI 21.4-22.2), 17.8% (95% CI 17.4-18.2) and 16.8% (95% CI 16.4-17.2) were opioid users in 1st-4th quarter after surgery. However, 8.5% (95% CI 8.2-8.7) of the nonusers before surgery in 4th quarter initiated opioid use more than a quarter after surgery. CONCLUSIONS The proportion of opioid users increased after hip fracture surgery and was 1.4 percentage-points increased in fourth quarter compared to before. Of opioid nonusers before surgery, 16.8% were opioid users fourth quarter after surgery. SIGNIFICANCE Opioid use 1 year after hip fracture surgery is common, both in patients who were opioid users and nonusers before the surgery. These significant findings point out the need for indication of benefits and risks of opioid use in the acute and long-term management of patients undergoing hip fracture surgery.
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Affiliation(s)
- Amalie H Simoni
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Danish Center for Clinical Health Services Research (DACS), Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| | - Lone Nikolajsen
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Anne E Olesen
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Alma B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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