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Chen Q, Gopaldas M, Castillo F, Leckman-Westin E, Nunes EV, Levin FR, Finnerty MT. Prevalence of Opioid Use Disorder and Opioid Overdose Rates Among People With Mental Illness. Psychiatr Serv 2024; 75:953-960. [PMID: 38650488 DOI: 10.1176/appi.ps.20230338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
OBJECTIVE The authors examined the prevalence and correlates of co-occurring opioid use disorder and opioid overdose among individuals receiving psychiatric services. METHODS This was a cross-sectional study of adults with continuous enrollment in New York State Medicaid who received at least one psychiatric service in 2020 (N=523,885). Logistic regression models were used to examine the correlates of both opioid use disorder and overdose. RESULTS In the study sample, the prevalence rate of opioid use disorder was 8.1%; within this group, 7.7% experienced an opioid overdose in the study year. Opioid use disorder rates were lower among younger (18-24 years; 2.0%) and older (≥65 years; 3.1%) adults and higher among men (11.1%) and among those residing in rural areas (9.9%). Compared with Whites (9.4%), opioid use disorder rates were lower for Asian Americans (2.0%, adjusted odds ratio [AOR]=0.22) and Blacks (6.8%, AOR=0.76) and higher for American Indians (13.2%, AOR=1.43) and Hispanics (9.6%, AOR=1.29). Individuals with any substance use (24.9%, AOR=5.20), posttraumatic stress (15.7%, AOR=2.34), bipolar (14.9%, AOR=2.29), or anxiety (11.3%, AOR=2.18) disorders were more likely to have co-occurring opioid use disorder; those with conduct (4.5%, AOR=0.51), adjustment (7.4%, AOR=0.88), or schizophrenia spectrum (7.4%, AOR=0.87) disorders were less likely to have opioid use disorder. Those with suicidality (23.9%, AOR=3.83) or economic instability (23.7%, AOR=3.35) had higher odds of having opioid use disorder. Overdose odds were higher among individuals with suicidality (34.0%, AOR=6.82) and economic instability (16.0%, AOR=2.57). CONCLUSIONS These findings underscore the importance of providing opioid use disorder screening and treatment for patients receiving psychiatric services.
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Affiliation(s)
- Qingxian Chen
- New York State Office of Mental Health, Albany (Chen, Leckman-Westin, Finnerty); Division of Substance Use Disorders, New York State Psychiatric Institute, and Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Gopaldas, Castillo, Nunes, Levin); School of Public Health, State University of New York at Albany, Albany (Leckman-Westin); Department of Child and Adolescent Psychiatry, New York University, New York City (Finnerty)
| | - Manesh Gopaldas
- New York State Office of Mental Health, Albany (Chen, Leckman-Westin, Finnerty); Division of Substance Use Disorders, New York State Psychiatric Institute, and Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Gopaldas, Castillo, Nunes, Levin); School of Public Health, State University of New York at Albany, Albany (Leckman-Westin); Department of Child and Adolescent Psychiatry, New York University, New York City (Finnerty)
| | - Felipe Castillo
- New York State Office of Mental Health, Albany (Chen, Leckman-Westin, Finnerty); Division of Substance Use Disorders, New York State Psychiatric Institute, and Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Gopaldas, Castillo, Nunes, Levin); School of Public Health, State University of New York at Albany, Albany (Leckman-Westin); Department of Child and Adolescent Psychiatry, New York University, New York City (Finnerty)
| | - Emily Leckman-Westin
- New York State Office of Mental Health, Albany (Chen, Leckman-Westin, Finnerty); Division of Substance Use Disorders, New York State Psychiatric Institute, and Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Gopaldas, Castillo, Nunes, Levin); School of Public Health, State University of New York at Albany, Albany (Leckman-Westin); Department of Child and Adolescent Psychiatry, New York University, New York City (Finnerty)
| | - Edward V Nunes
- New York State Office of Mental Health, Albany (Chen, Leckman-Westin, Finnerty); Division of Substance Use Disorders, New York State Psychiatric Institute, and Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Gopaldas, Castillo, Nunes, Levin); School of Public Health, State University of New York at Albany, Albany (Leckman-Westin); Department of Child and Adolescent Psychiatry, New York University, New York City (Finnerty)
| | - Frances R Levin
- New York State Office of Mental Health, Albany (Chen, Leckman-Westin, Finnerty); Division of Substance Use Disorders, New York State Psychiatric Institute, and Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Gopaldas, Castillo, Nunes, Levin); School of Public Health, State University of New York at Albany, Albany (Leckman-Westin); Department of Child and Adolescent Psychiatry, New York University, New York City (Finnerty)
| | - Molly T Finnerty
- New York State Office of Mental Health, Albany (Chen, Leckman-Westin, Finnerty); Division of Substance Use Disorders, New York State Psychiatric Institute, and Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Gopaldas, Castillo, Nunes, Levin); School of Public Health, State University of New York at Albany, Albany (Leckman-Westin); Department of Child and Adolescent Psychiatry, New York University, New York City (Finnerty)
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Karaye IM, Gonzalez J, Owens S, Jalal S, Sosa S, Alexander K, Thomas M, Granger GG, Markowitz WL, Kyriacou CM. Contemporary burden and trends of opioid-overdose mortality in New York State. Prev Med 2024; 185:108010. [PMID: 38801836 DOI: 10.1016/j.ypmed.2024.108010] [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: 07/05/2023] [Revised: 05/08/2024] [Accepted: 05/24/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Limited research exists on contemporary opioid overdose mortality burden and trends in New York State, with most studies focusing on New York City. This study aimed to assess opioid overdose burden and death trends in New York State by age, sex, race/ethnicity, geographic area, opioid type, and overdose intent from 1999 to 2020. METHODS Mortality data were obtained from the Centers for Disease Control and Prevention's WONDER database. Opioid overdose decedents were identified using relevant International Classification of Diseases, 10th Revision codes. Joinpoint regression analyzed trends, estimating annual and average annual percentage changes in age-adjusted mortality rates (AAMR). 95% confidence intervals were derived using the Parametric Method. RESULTS From 1999 to 2020, New York State recorded 34,109 opioid overdose deaths (AAMR = 7.9 per 100,000 persons; 95% CI: 7.8-7.9). The overall trend increased by 12.6% per year (95% CI: 10.8, 14.4) from 2004 to 2020. Subgroups exhibited varying trends, with an 11.1% yearly increase among Non-Hispanic White persons from 2007 to 2020 (95% CI: 9.0, 13.2), a 24.6% annual rise among Non-Hispanic Black persons from 2012 to 2020 (95% CI: 17.7, 31.8), and an 18.3% increase yearly among Hispanic individuals from 2011 to 2020 (95% CI: 14.0, 22.9). Recent trends have worsened in both males and females, across all age groups, in both New York City (NYC) and areas outside NYC, and for heroin, natural and semisynthetic opioids, and synthetic opioids. CONCLUSIONS Opioid overdose mortality in New York State has worsened significantly in the last two decades. Further research is essential to identify driving factors for targeted public health interventions.
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Affiliation(s)
- Ibraheem M Karaye
- Department of Population Health, Hofstra University, 106 Hofstra Dome, Hempstead, NY 11549, United States of America; Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States of America.
| | - Jirel Gonzalez
- Pipeline Programs, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, United States of America
| | - Serenity Owens
- Pipeline Programs, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, United States of America
| | - Shubha Jalal
- Pipeline Programs, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, United States of America.
| | - Sofia Sosa
- Pipeline Programs, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, United States of America.
| | - Kaden Alexander
- Pipeline Programs, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, United States of America
| | - Michelle Thomas
- Department of Population Health, Hofstra University, 106 Hofstra Dome, Hempstead, NY 11549, United States of America.
| | - Gina G Granger
- Pipeline Programs, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra University, Hempstead, NY 11549, United States of America.
| | - Walter L Markowitz
- Department of Population Health, Hofstra University, United States of America.
| | - Corinne M Kyriacou
- School of Health Professions and Human Services, Hofstra University, Hempstead, NY 11549, United States of America.
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Howard-Azzeh M, Wasfi R, Kakkar T, Flynn M, Rotondo J, Schleihauf E, Bowes M, Rees EE. Spatiotemporal epidemiology of substance-related accidental acute toxicity deaths in Canada from 2016 to 2017. BMC Public Health 2024; 24:1641. [PMID: 38898445 PMCID: PMC11188508 DOI: 10.1186/s12889-024-18883-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/17/2024] [Indexed: 06/21/2024] Open
Abstract
OBJECTIVES In Canada, substance-related accidental acute toxicity deaths (AATDs) continue to rise at the national and sub-national levels. However, it is unknown if, where, when, and to what degree AATDs cluster in space, time, and space-time across the country. The objectives of this study were to 1) assess for clusters of AATDs that occurred in Canada during 2016 and 2017 at the national and provincial/territorial (P/T) levels, and 2) examine the substance types detected in AATD cases within each cluster. METHODS Two years of person-level data on AATDs were abstracted from coroner and medical examiner files using a standardized data collection tool, including the decedent's postal code and municipality information on the places of residence, acute toxicity (AT) event, and death, and the substances detected in the death. Data were combined with Canadian census information to create choropleth maps depicting AATD rates by census division. Spatial scan statistics were used to build Poisson models to identify clusters of high rates (p < 0.05) of AATDs at the national and P/T levels in space, time, and space-time over the study period. AATD cases within clusters were further examined for substance types most present in each cluster. RESULTS Eight clusters in five regions of Canada at the national level and 24 clusters in 15 regions at the P/T level were identified, highlighting where AATDs occurred at far higher rates than the rest of the country. The risk ratios of identified clusters ranged from 1.28 to 9.62. Substances detected in clusters varied by region and time, however, opioids, stimulants, and alcohol were typically the most commonly detected substances within clusters. CONCLUSION Our findings are the first in Canada to reveal the geographic disparities in AATDs at national and P/T levels using spatial scan statistics. Rates associated with substance types within each cluster highlight which substance types were most detected in the identified regions. Findings may be used to guide intervention/program planning and provide a picture of the 2016 and 2017 context that can be used for comparisons of the geographic distribution of AATDs and substances with different time periods.
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Affiliation(s)
- Mohammad Howard-Azzeh
- Health Promotion and Chronic Disease Prevention Branch, Substance-Related Harms Division, Public Health Agency of Canada, Ontario, Canada.
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Ontario, Canada.
| | - Rania Wasfi
- Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, Quebec, Canada
| | - Tanya Kakkar
- Health Promotion and Chronic Disease Prevention Branch, Substance-Related Harms Division, Public Health Agency of Canada, Ontario, Canada
| | - Mallory Flynn
- Department of Statistics, University of British Columbia, British Columbia, Canada
| | - Jenny Rotondo
- Health Promotion and Chronic Disease Prevention Branch, Substance-Related Harms Division, Public Health Agency of Canada, Ontario, Canada
| | - Emily Schleihauf
- Canadian Public Health Service, Public Health Agency of Canada, Ontario, Canada
| | - Matthew Bowes
- Nova Scotia Medical Examiner Service, Department of Justice, Nova Scotia, Canada
| | - Erin E Rees
- Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, Quebec, Canada
- Department of Pathology and Microbiology, Faculty of Veterinary Medicine, University of Montreal, Quebec, Canada
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4
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Giakas JA, Israel HA, Ali AH, Kaar SG. Does the addition of post-operative gabapentin reduce the use of narcotics after orthopedic surgery? PHYSICIAN SPORTSMED 2024; 52:283-290. [PMID: 37545473 DOI: 10.1080/00913847.2023.2246177] [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: 05/25/2023] [Revised: 07/27/2023] [Accepted: 08/06/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVES To evaluate the efficacy of post-operative gabapentin administration as an analgesic agent and its effect on narcotic use after orthopedic surgery in an outpatient sports medicine practice by comparing patients prior to and after initiating the routine use of gabapentin as part of a standardized post-operative pain medication regimen. We hypothesized that adding gabapentin to a multimodal post-operative pain regimen would decrease the number of requested pain medication refills and have no detrimental effect on Visual Analogue Scale and Single Assessment Numerical Evaluation scores at these early post-operative visits. METHODS All outpatient surgical patients, <90 years of age, undergoing outpatient orthopedic surgery by the study's senior author were included between 08/05/2021 and 02/22/2022. Patients were allowed 1 narcotic refill post-operatively and only in the first 3 weeks. The primary outcome was difference in percentage of patients who requested a narcotic refill within 3 weeks post-op. Two- and 6-week Visual Analogue Scale and Single Assessment Numerical Evaluation scores, and baseline health and demographic data. T-tests were run on continuous variables, Chi-Square or Fisher's Exact Test were run on dichotomous variables, and Mann-Whitney U test was run on all other categorical variables. Statistical significance was set at P < .05 for all tests. RESULTS There was a significant difference in narcotic refills at 3 weeks: 23 pre-gabapentin patients and 9 post-gabapentin patients (22.8% vs 9.0%, respectively: P = .006). There were no differences between 2- and 6-week Visual Analogue Scale and 2-week Single Assessment Numerical Evaluation scores. There was a significant difference in 6-week SANE between groups: mean difference = 6.4 (P = .027) though less than the established MCID. CONCLUSION Addition of gabapentin to a post-operative multimodal pain regimen reduced the use of narcotics after orthopedic sports medicine surgeries while also providing equivalent pain control.
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Affiliation(s)
- Julian A Giakas
- Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Heidi A Israel
- Department of Orthopedic Surgery, Division of Sports Medicine and Shoulder Surgery, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Ashley H Ali
- Department of Orthopedic Surgery, Division of Sports Medicine and Shoulder Surgery, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Scott G Kaar
- Department of Orthopedic Surgery, Division of Sports Medicine and Shoulder Surgery, Saint Louis University School of Medicine, Saint Louis, MO, USA
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5
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Zhu T, Baker ZG, Trabold M, Kelley-Quon LI, Basin MF, Vazirani R, Chen J, Kokorowski PJ. Sociodemographic differences in opioid use and recovery following ambulatory pediatric urologic procedures. J Child Health Care 2024; 28:291-301. [PMID: 36062326 DOI: 10.1177/13674935221124738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Our aim was to examine associations between sociodemographic factors and postoperative opioid use and recovery among pediatric patients undergoing outpatient urologic procedures. We retrospectively evaluated 831 patients undergoing ambulatory urologic procedures from 2013 to 2017 at an urban pediatric hospital. Patients were evaluated for days of opioid use and days until return to baseline behavior. Differences in outcomes by race/ethnicity, primary language, median neighborhood household income, and health insurance type were analyzed using negative binomial regression models. Overall, patients reported a median of 1.0 day (IQR: 2.0) of postoperative opioid use and 3.0 days (IQR: 6.0) of recovery time. After controlling for covariates, patients with non-English speaking parents took opioids for 26.5% (95% CI: 11.4-41.7%) longer and had 27.8% (95% CI: 8.1-51.0%) longer recovery time than patients with English-speaking parents. Hispanic patients took opioids for 27.5% (95% CI: 0.1-54.9%) longer than White patients. Patients with public insurance used opioids for 47.6% (95% CI: 5.0-107.4%) longer than privately insured patients. Non-English speaking, Hispanic, and publicly insured patients had a longer duration of postoperative opioid use than primarily English-speaking, White, and privately insured patients, respectively. Identifying these disparities is important for designing equitable postoperative care pathways.
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Affiliation(s)
- Terry Zhu
- Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Zoë G Baker
- Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
- Division of Urology, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Melissa Trabold
- Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
- Division of Urology, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Lorraine I Kelley-Quon
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michael F Basin
- Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Ragini Vazirani
- Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Jiayao Chen
- Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Paul J Kokorowski
- Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
- Division of Urology, Children's Hospital Los Angeles, Los Angeles, CA, USA
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6
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Ramdin C, Zembrzuska M, Zembrzuski K, Nelson L. Layperson knowledge on naloxone and medications for opioid use disorder in an urban population: a cross sectional survey study. J Addict Dis 2024:1-9. [PMID: 38764149 DOI: 10.1080/10550887.2024.2353431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
BACKGROUND AND OBJECTIVES There has been little research in an urban population regarding knowledge of harm reduction measures and treatment options. The objective of our study was to evaluate knowledge and perceptions of harm reduction measures and types of treatment available for opioid use disorder among patients and family in an urban emergency department (ED) waiting room. METHODS We conducted a single center, cross-sectional survey study that occurred between September 2021 and August 2022. A convenience sample of patients and family members that were above 18 and English speaking were recruited by research assistants. Participants were assessed on knowledge and preferences around drug treatment options and harm reduction. Data were summarized using descriptive statistics and compared using the Freeman-Halton/Kruskall-Wallis/Mann-Whitney U tests. p-Values were reported at the 0.05 significance level. RESULTS We collected 200 responses. Of these, 104 people had a connection to someone with a substance use disorder (SUD) and 50 had an SUD. Of those who had a connection to someone with SUD, 63 had heard of naloxone (60.6%, CI: [50.5, 69.9]). Fewer than 60% of respondents in each group had heard of Medications for Opioid Use Disorder (MOUD) (p = 0.46) and fewer than 50% thought that among people who use drugs that they knew would be interested in receiving treatment (p = 0.10). DISCUSSION AND CONCLUSIONS Our study found that among people who came to an urban emergency department, there was a lack of awareness of harm reduction and MOUD. Interventions should be put into place to educate on the importance of MOUD and harm reduction.
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Affiliation(s)
- Christine Ramdin
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | | | - Krzysztof Zembrzuski
- School of Medicine, Rowan-Virtua School of Osteopathic Medicine, Stratford, NJ, USA
| | - Lewis Nelson
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
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7
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Berman RB, Villanueva J, Margolin EJ, Balasubramanian A, Lee J, Shah O. Trends in Opioid and Nonsteroidal Anti-Inflammatory Drug Use for Patients with Kidney Stones in United States Emergency Departments from 2015 to 2021. J Endourol 2024; 38:458-465. [PMID: 38308477 DOI: 10.1089/end.2023.0636] [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] [Indexed: 02/04/2024] Open
Abstract
Introduction: Renal colic is frequently treated with opioids; however, narcotic analgesic use can lead to dependence and abuse. We evaluated use trends of opioids and nonsteroidal anti-inflammatory drugs (NSAIDs) for pain management of kidney stones in United States emergency departments (EDs) from 2015 to 2021. Methods: Kidney stone encounters were identified using National Hospital Ambulatory Medical Care Survey data. We applied a multistage survey weighting procedure to account for selection probability, nonresponse, and population weights. Medication use trends were estimated through logistic regressions on the timing of the encounter, adjusted for selected demographic and clinical characteristics. Results: Between 2015 and 2021, there were an estimated 9,433,291 kidney stone encounters in United States EDs. Opioid use decreased significantly (annual odds ratio [OR]: 0.87, p = 0.003), and there was no significant trend in NSAID use. At discharge, male patients were more likely than females (OR: 1.93, p = 0.001) to receive opioids, and Black patients were less likely than White patients (OR: 0.34, p = 0.010) to receive opioids. Regional variation was also observed, with higher odds of discharge prescriptions in the West (OR: 3.15, p = 0.003) and Midwest (OR: 2.49, p = 0.010), compared with the Northeast. Thirty-five percent of patients received opioids that were stronger than morphine. Conclusion: These results suggest improved opioid stewardship from ED physicians in response to the national opioid epidemic. However, regional variation as well as disparities in discharge prescriptions for Black and female patients underscore opportunities for continued efforts.
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Affiliation(s)
- Richard B Berman
- Department of Urology, Columbia University Irving Medical Center, New York, New York, USA
| | - Juliana Villanueva
- Department of Urology, Columbia University Irving Medical Center, New York, New York, USA
| | - Ezra J Margolin
- Department of Urology, Duke University Medical Center, Durham, North Carolina, USA
| | | | - Justin Lee
- Department of Urology, Columbia University Irving Medical Center, New York, New York, USA
| | - Ojas Shah
- Department of Urology, Columbia University Irving Medical Center, New York, New York, USA
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Xia C, Chander G, Hutton HE, McCaul ME, Delaney JA, Mayer KH, Jacobson JM, Puryear S, Crane HM, Shapiro AE, Cachay ER, Lau B, Napravnik S, Saag M, Lesko CR. Association of Alcohol Use with COVID-19 Infection and Hospitalization Among People Living with HIV in the United States, 2020. AIDS Behav 2024; 28:1795-1807. [PMID: 38421512 PMCID: PMC11238908 DOI: 10.1007/s10461-024-04301-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2024] [Indexed: 03/02/2024]
Abstract
Alcohol use was associated with elevated COVID-19 risk in the general population. People with HIV (PWH) have high prevalences of alcohol use. To evaluate the effect of alcohol use on COVID-19 risks among PWH, we estimated the risk of COVID-19 diagnosis and COVID-19-related hospitalization among PWH in routine care at 8 HIV primary care centers that contributed data to the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort according to their alcohol use just prior to the COVID-19 pandemic. The CNICS data repository includes demographic characteristics, clinical diagnoses, and laboratory test results from electronic medical records and other sources. Alcohol use, substance use, and mental health symptoms were self-reported on tablet-based standardized surveys. Alcohol use was categorized according to standard, sex-specific Alcohol Use Disorder Identification Test-Consumption instrument cut-offs. We followed 5,496 PWH (79% male, 48% Black race, median age = 53 years) from March 1, 2020 to December 31, 2020. Relative to PWH with no baseline alcohol use, the adjusted hazard ratio (aHR) of COVID-19 diagnosis was 1.09 (95% confidence interval [CI]: 0.78, 1.51) for lower-risk drinking and 1.19 (95%CI: 0.81, 1.73) for unhealthy drinking. The aHR of COVID-19-related hospitalization was 0.82 (95%CI: 0.33, 1.99) for lower-risk drinking and 1.25 (95%CI: 0.50, 3.09) for unhealthy drinking. Results were not modified by recent cocaine or non-prescribed opioid use, depressive symptoms, or diagnoses of alcohol use disorder. The study suggested a slightly increased, but not statistically significant risk of COVID-19 diagnosis and hospitalization associated with unhealthy alcohol use.
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Affiliation(s)
- Chunyi Xia
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA
| | - Geetanjali Chander
- Division of General Internal Medicine, University of Washington, Seattle, WA, 98104, USA
| | - Heidi E Hutton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA
| | - Mary E McCaul
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA
| | - Joseph A Delaney
- Division of General Internal Medicine, University of Washington, Seattle, WA, 98104, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, 02215, USA
- Department of Global Health and Population, Harvard University T.C. Chan School of Public Health, Boston, MA, 02115, USA
| | - Jeffrey M Jacobson
- Division of Infectious Diseases, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA
| | - Sarah Puryear
- Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, 94110, USA
| | - Heidi M Crane
- Division of Allergy and Infectious Disease, Department of Medicine, University of Washington School of Medicine, Seattle, WA, 98195, USA
| | - Adrienne E Shapiro
- Division of Allergy and Infectious Disease, Department of Medicine, University of Washington School of Medicine, Seattle, WA, 98195, USA
- Department of Global Health, University of Washington, Seattle, WA, 98195, USA
| | - Edward R Cachay
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego School of Medicine, San Diego, CA, 92093, USA
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA
| | - Sonia Napravnik
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, 27599, USA
| | - Michael Saag
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL, 35233, USA
| | - Catherine R Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA.
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Bromley MI, Gain EP, Ajoku M, Ray MA, Mzayek F, Kedia SK, Yu X. Burden of Chronic and Heavy Opioid Use Among Elderly Community Dwellers in the U.S. AJPM FOCUS 2024; 3:100175. [PMID: 38298247 PMCID: PMC10828592 DOI: 10.1016/j.focus.2023.100175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
Introduction Opioid overprescribing may fuel the opioid epidemic and increase the risk of complications of opioid misuse. This study examined trends and determinants of chronic and heavy opioid use among elderly community dwellers in the U.S. Methods Medicare Current Beneficiary Surveys data from 2006 to 2019 were used. Common opioid medications were identified in the prescription medication files (n=47,264). Patients with Chronic users were defined as those receiving 6 or more opioid prescriptions within a year or on medication for 3 or more months, and heavy users were those having an average daily dose of 90 or more morphine milligram equivalents or 3,780 morphine milligram equivalents or more per continuous treatment episode. Results One in 6 elderly community dwellers ever used opioids during the study period. Chronic users were more likely to be women than men (68.9% vs 31.1%, p<0.001). Of all survey participants, 4.3% were chronic users, and 2.8% were heavy users. Among ever users, 27.7% were chronic users, and 18.1% were heavy users. The rate of opioid use rose from 12.1% in 2006, peaked at 22.8% in 2013, and decreased to 11.7% in 2019. Chronic use was 5.1%, 10.7%, and 7.6%, respectively. Heavy use was 5.5%, 10.7%, and 7.6%, respectively. However, for chronic and heavy users, there was no significant difference in the median opioid dosage and opioid duration between males and females. Conclusions Among elderly Medicare beneficiaries, opioid prescriptions have been decreasing since 2013. However, a substantial number of elderly people were chronic and heavy users, calling for better opioid management among them.
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Affiliation(s)
- Morgan I. Bromley
- Epidemiology, Biostatistics, and Environmental Health Division, School of Public Health, The University of Memphis, Memphis, Tennessee
| | - Easter P. Gain
- Epidemiology, Biostatistics, and Environmental Health Division, School of Public Health, The University of Memphis, Memphis, Tennessee
| | - Mark'Quest Ajoku
- Epidemiology, Biostatistics, and Environmental Health Division, School of Public Health, The University of Memphis, Memphis, Tennessee
| | - Meredith A. Ray
- Epidemiology, Biostatistics, and Environmental Health Division, School of Public Health, The University of Memphis, Memphis, Tennessee
| | - Fawaz Mzayek
- Epidemiology, Biostatistics, and Environmental Health Division, School of Public Health, The University of Memphis, Memphis, Tennessee
| | - Satish K. Kedia
- Epidemiology, Biostatistics, and Environmental Health Division, School of Public Health, The University of Memphis, Memphis, Tennessee
| | - Xinhua Yu
- Epidemiology, Biostatistics, and Environmental Health Division, School of Public Health, The University of Memphis, Memphis, Tennessee
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Pak R, Cho M, Pride K, Abd-Elsayed A. The Gut Microbiota and Chronic Pain. Curr Pain Headache Rep 2024; 28:259-269. [PMID: 38345694 DOI: 10.1007/s11916-024-01221-x] [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] [Accepted: 01/30/2024] [Indexed: 03/16/2024]
Abstract
PURPOSE OF REVIEW To examine the effects and interactions between gut microbia and chronic pain. RECENT FINDINGS The gut microbiome has been an area of interest in both the scientific and general audience due to a growing body of evidence suggesting its influence in a variety of health and disease states. Communication between the central nervous system (CNS) and gut microbiome is said to be bidirectional, in what is referred to as the gut-brain axis. Chronic pain is a prevalent costly personal and public health burden and so, there is a vested interest in devising safe and efficacious treatments. Numerous studies, many of which are animal studies, have been conducted to examine the gut microbiome's role in the pathophysiology of chronic pain states, such as neuropathy, inflammation, visceral pain, etc. As the understanding of this relationship grows, so does the potential for therapeutic targeting of the gut microbiome in chronic pain.
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Affiliation(s)
- Ray Pak
- Department of Physical Medicine and Rehabilitation, New York Medical College/Metropolitan, New York, NY, USA
| | - Michelle Cho
- Department of Physical Medicine and Rehabilitation, New York Medical College/Metropolitan, New York, NY, USA
| | - Keth Pride
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, B6/319 CSC, Madison, WI, 53792-3272, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, B6/319 CSC, Madison, WI, 53792-3272, USA.
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11
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Balouch B, Vontela S, Ranjbar PA, Alnouri G, Sataloff RT. Assessment of Postoperative Pain and Opioid Consumption Following Laryngeal Surgery: A Pilot Study. J Voice 2024; 38:516-520. [PMID: 34600800 DOI: 10.1016/j.jvoice.2021.08.024] [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: 06/07/2021] [Revised: 08/18/2021] [Accepted: 08/23/2021] [Indexed: 11/23/2022]
Abstract
The epidemic of opioid use in the United States has been declared a national public health crisis due to the rapid increase in drug overdose mortality. Physician overprescribing has been identified as one of many contributing factors, with most patients receiving excess opioid pain medication. Furthermore, there is a significant correlation between prescribed opioid dosage and mortality. Postoperative pain is a well-recognized clinical problem, but little has been done to advance or standardize pain management protocols. The purpose of this study was to determine the expected postoperative pain severity and quantity of opioid analgesic required for adequate pain management after laryngeal surgery. METHODS Adult voice center patients who had recently undergone laryngeal surgery were included in this retrospective review. Tylenol #3 had been prescribed for all patients for pain management and they had been instructed to take additional over-the-counter acetaminophen as needed. In the senior author's (RTS) practice, patients are asked routinely to report pain severity and analgesic use during postoperative visits. All patients who had this information available were included in the cohort. Opioid medication consumed, over-the-counter medication consumed, and pain level (scale of 0-10 with 10 being most severe) were analyzed over the first week postoperatively. RESULTS There were 43 patients (19 male, 24 female) included in the retrospective cohort (average age = 46.8 ± 18.6, range = 18-82). Procedures performed included vocal fold mass excision (48.8%), type I thyroplasty (27.9%), laser vaporization of vascular lesions (11.6%), laser stenosis resection (9.3%), and VF medialization injection with abdominal fat harvest (7.0%). Overall, voice surgery patients reported mild to moderate pain (2.1-4.7 out of 10). An average of 13.2 ± 2.8 T3 tablets were prescribed for pain management (range = 10-20), and no patient required more T3 tablets than the number provided. Sixteen patients (37.2%) supplemented or substituted their T3 medication for it with OTC acetaminophen. No patients used non-steroidal anti-inflammatory drugs (NSAIDs) for supplemental pain management. Consumption of both T3 pain medication (r = 0.444) and OTC acetaminophen (r = 0.274) was correlated significantly with postoperative pain severity (P < 0.001). When stratified by type of surgical procedure performed, one-way ANOVA (F = 2.749, P = 0.043) and post-hoc Games-Howell test revealed that the patients who underwent type I thyroplasty reported a significantly higher (P = 0.041) pain severity score than patients who underwent vocal fold mass excision (4.7 versus 2.1, respectively). No significant differences in pain severity existed between other procedures (P > 0.05). There were no significant differences between type of procedure performed for number of T3 tablets prescribed, number of T3 tablets taken, or number of OTC tablets taken (P > 0.05). Younger age was correlated significantly with a higher number of OTC tablets consumed (r = -0.316, P = 0.039). Women consumed more OTC pain medications than men. CONCLUSIONS Most patients in this study reported mild to moderate postoperative pain. Adequate pain management was achieved using less pain medication tablets than the number prescribed. Type I thyroplasty was associated with more severe pain than other surgeries. Women used more OTC pain medications than men with no significant difference in reported pain level.
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Affiliation(s)
| | | | | | - Ghiath Alnouri
- Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine, Philadlephia, PA
| | - Robert T Sataloff
- Department of Otolaryngology - Head and Neck Surgery,Senior Associate Dean for Clinical Academic Specialties, Drexel University College of Medicine, Director of Otolaryngology and Communication Sciences Research, Lankenau Institute for Medical Research, Philadelphia, Pennsylvania.
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Martin SE, Hughes TD, Roller J, Ferreri SP. Assessing pharmacists' knowledge, attitudes, and practices of opioid management within different patient populations. J Am Pharm Assoc (2003) 2024; 64:414-421.e1. [PMID: 38049067 DOI: 10.1016/j.japh.2023.11.022] [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: 08/30/2023] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Racial disparities in drug overdose exist, with black, indigenous, and Hispanic individuals experiencing higher rates of opioid overdose deaths. Opioid use disorder prevention services, such as opioid deprescribing and naloxone dispensing, have been identified as ways to prevent opioid overdose. Pharmacists can help use these strategies, but racial disparities in use exist. OBJECTIVE This study aimed to evaluate North Carolina (NC) pharmacist knowledge, attitudes, and practices (KAP) of opioid management practices, including opioid deprescribing and naloxone dispensing, across different racial and ethnic groups. METHODS This was a prospective, cross-sectional study conducted through a Web-based KAP survey distributed via e-mail to all NC pharmacists using a modified Dillman's method. Descriptive statistics were used to analyze demographics and pharmacist KAP data. Attitudes data were further analyzed using one-way analysis of variance tests and Tukey's post hoc analyses. RESULTS After applying exclusion criteria, 527 participants were eligible for analysis; 254 of these individuals completed the entire survey. The survey response rate was 15.3% and respondents were mostly female (59.1%) and white (86.6%). Approximately half of pharmacists knew the correct opioid morphine milliequivalent cutoffs considered to be high risk (47.7%) and not to be exceeded (51.9%). When asked about chronic opioid statistics within the United States, respondents overestimated that 23.70% of patients on chronic opioid therapy receive naloxone (SD = 18.93%). Pharmacists believed that black patients were more likely to adhere to an opioid taper than any other race or ethnicity and Hispanic patients were more likely to adhere to naloxone treatment than any other race or ethnicity. Finally, 91% of pharmacists knew what an opioid taper was, but 77% of pharmacists had never designed one. CONCLUSIONS Gaps in knowledge may contribute to further disparities in opioid management. Pharmacists' attitudes may contribute to biases in opioid management practices and practices related to opioid deprescribing may limit the pharmacists' current role. More education is needed so pharmacists can play an increased role in opioid management across all patient populations.
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Aghaie Meybodi M, Shah V, Razdan R, Amer K, Ahlawat S. National Trends and Predictors of Opioid Administration in Patients Presenting With Abdominal Pain to the Emergency Department (2010-2018). Gastroenterol Nurs 2024; 47:122-128. [PMID: 38567855 DOI: 10.1097/sga.0000000000000795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 09/27/2023] [Indexed: 04/05/2024] Open
Abstract
Given the current opioid crisis, in this study, we assess the national trend and factors associated with opioid administration for patients presenting to the emergency department with abdominal pain. This is a retrospective cross-sectional study conducted using the National Hospital Ambulatory Medical Care Survey from 2010 to 2018. Weighted multiple logistic regression was applied to assess the independent factors associated with opioid administration in the emergency department. Trends of opioid administration were evaluated using the linear trend analysis. There were an estimated total of 100,925,982 emergency department visits for abdominal pain. Overall, opioid was administered in 16.8% of visits. Age less than 25 years was associated with lower odds of receiving opioids. Patients living in the Northeast had the lower odds of receiving opioids (odds ratio [OR] = 0.82, p = .006) than patients living in the Midwest. Patients in the West had the highest odds of receiving opioids (OR = 1.16, p = .01). Non-Hispanic White patients had higher odds of opioid administration (OR = 1.29, p < .001). Trend analysis demonstrated a statistically significant reduction in opioid administration. From 2010 to 2018, opioid administration has approximately decreased in half. Living in the West and the non-Hispanic White racial group were the significant factors associated with a higher risk of opioid administration.
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Affiliation(s)
- Mohamad Aghaie Meybodi
- Mohamad Aghaie Meybodi, MD, is at Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
- Vraj Shah, MD, is at Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
- Reena Razdan, MD, is at Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
- Kamal Amer, MD, is at Department of Medicine and Division of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, New Jersey
- Sushil Ahlawat, MD, is at Department of Medicine and Division of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Vraj Shah
- Mohamad Aghaie Meybodi, MD, is at Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
- Vraj Shah, MD, is at Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
- Reena Razdan, MD, is at Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
- Kamal Amer, MD, is at Department of Medicine and Division of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, New Jersey
- Sushil Ahlawat, MD, is at Department of Medicine and Division of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Reena Razdan
- Mohamad Aghaie Meybodi, MD, is at Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
- Vraj Shah, MD, is at Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
- Reena Razdan, MD, is at Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
- Kamal Amer, MD, is at Department of Medicine and Division of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, New Jersey
- Sushil Ahlawat, MD, is at Department of Medicine and Division of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Kamal Amer
- Mohamad Aghaie Meybodi, MD, is at Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
- Vraj Shah, MD, is at Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
- Reena Razdan, MD, is at Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
- Kamal Amer, MD, is at Department of Medicine and Division of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, New Jersey
- Sushil Ahlawat, MD, is at Department of Medicine and Division of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Sushil Ahlawat
- Mohamad Aghaie Meybodi, MD, is at Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
- Vraj Shah, MD, is at Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
- Reena Razdan, MD, is at Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
- Kamal Amer, MD, is at Department of Medicine and Division of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, New Jersey
- Sushil Ahlawat, MD, is at Department of Medicine and Division of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, New Jersey
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Trickey A, McGinnis K, Gill MJ, Abgrall S, Berenguer J, Wyen C, Hessamfar M, Reiss P, Kusejko K, Silverberg MJ, Imaz A, Teira R, d'Arminio Monforte A, Zangerle R, Guest JL, Papastamopoulos V, Crane H, Sterling TR, Grabar S, Ingle SM, Sterne JAC. Longitudinal trends in causes of death among adults with HIV on antiretroviral therapy in Europe and North America from 1996 to 2020: a collaboration of cohort studies. Lancet HIV 2024; 11:e176-e185. [PMID: 38280393 DOI: 10.1016/s2352-3018(23)00272-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 10/13/2023] [Accepted: 10/17/2023] [Indexed: 01/29/2024]
Abstract
BACKGROUND Mortality rates among people with HIV have fallen since 1996 following the widespread availability of effective antiretroviral therapy (ART). Patterns of cause-specific mortality are evolving as the population with HIV ages. We aimed to investigate longitudinal trends in cause-specific mortality among people with HIV starting ART in Europe and North America. METHODS In this collaborative observational cohort study, we used data from 17 European and North American HIV cohorts contributing data to the Antiretroviral Therapy Cohort Collaboration. We included data for people with HIV who started ART between 1996 and 2020 at the age of 16 years or older. Causes of death were classified into a single cause by both a clinician and an algorithm if International Classification of Diseases, Ninth Revision or Tenth Revision data were available, or independently by two clinicians. Disagreements were resolved through panel discussion. We used Poisson models to compare cause-specific mortality rates during the calendar periods 1996-99, 2000-03, 2004-07, 2008-11, 2012-15, and 2016-20, adjusted for time-updated age, CD4 count, and whether the individual was ART-naive at the start of each period. FINDINGS Among 189 301 people with HIV included in this study, 16 832 (8·9%) deaths were recorded during 1 519 200 person-years of follow-up. 13 180 (78·3%) deaths were classified by cause: the most common causes were AIDS (4203 deaths; 25·0%), non-AIDS non-hepatitis malignancy (2311; 13·7%), and cardiovascular or heart-related (1403; 8·3%) mortality. The proportion of deaths due to AIDS declined from 49% during 1996-99 to 16% during 2016-20. Rates of all-cause mortality per 1000 person-years decreased from 16·8 deaths (95% CI 15·4-18·4) during 1996-99 to 7·9 deaths (7·6-8·2) during 2016-20. Rates of all-cause mortality declined with time: the average adjusted mortality rate ratio per calendar period was 0·85 (95% CI 0·84-0·86). Rates of cause-specific mortality also declined: the most pronounced reduction was for AIDS-related mortality (0·81; 0·79-0·83). There were also reductions in rates of cardiovascular-related (0·83, 0·79-0·87), liver-related (0·88, 0·84-0·93), non-AIDS infection-related (0·91, 0·86-0·96), non-AIDS-non-hepatocellular carcinoma malignancy-related (0·94, 0·90-0·97), and suicide or accident-related mortality (0·89, 0·82-0·95). Mortality rates among people who acquired HIV through injecting drug use increased in women (1·07, 1·00-1·14) and decreased slightly in men (0·96, 0·93-0·99). INTERPRETATION Reductions of most major causes of death, particularly AIDS-related deaths among people with HIV on ART, were not seen for all subgroups. Interventions targeted at high-risk groups, substance use, and comorbidities might further increase life expectancy in people with HIV towards that in the general population. FUNDING US National Institute on Alcohol Abuse and Alcoholism.
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Affiliation(s)
- Adam Trickey
- Population Health Sciences, University of Bristol, Bristol, UK.
| | | | - M John Gill
- Department of Medicine, University of Calgary, South Alberta HIV Clinic, Calgary, AB, Canada
| | - Sophie Abgrall
- Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Béclère, Service de Médecine Interne, Clamart, France; APHP, Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP INSERM U1018, Le Kremlin-Bicêtre, France
| | - Juan Berenguer
- Hospital General Universitario Gregorio Marañón, IiSGM, CIBERINFEC, Madrid, Spain
| | - Christoph Wyen
- Department I for Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Mojgan Hessamfar
- University of Bordeaux, ISPED, INSERM U1219, Bordeaux, France; Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
| | - Peter Reiss
- Stichting HIV Monitoring, Amsterdam, Netherlands; Amsterdam UMC, University of Amsterdam, Global Health, Amsterdam, Netherlands; Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands
| | - Katharina Kusejko
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland; Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | | | - Arkaitz Imaz
- Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Spain
| | - Ramon Teira
- Servicio de Medicina Interna, Hospital Universitario de Sierrallana, Torrelavega, Spain
| | | | - Robert Zangerle
- Department of Dermatology, Venereology and Allergy, Medical University Innsbruck, Innsbruck, Austria
| | - Jodie L Guest
- Atlanta VA Medical Center, Decatur, GA, USA; Rollins School of Public Health at Emory University, Atlanta, GA, USA
| | - Vasileios Papastamopoulos
- 5th Department of Internal Medicine & Infectious Diseases Unit, Evangelismos General Hospital, Athens, Greece
| | - Heidi Crane
- Division of Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Timothy R Sterling
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Sophie Grabar
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Paris, France; Department of Public Health, AP-HP, St Antoine hospital, Paris, France
| | - Suzanne M Ingle
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Jonathan A C Sterne
- Population Health Sciences, University of Bristol, Bristol, UK; NIHR Bristol Biomedical Research Centre, Bristol, UK; Health Data Research UK South-West, Bristol, UK
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Bianco MCM, Tardelli VS, Brooks ER, Areco KC, Tardelli AO, Bandiera-Paiva P, Santaella J, Segura LE, Castaldelli-Maia JM, Martins SS, Fidalgo TM. Drug overdose deaths in Brazil between 2000 and 2020: an analysis of sociodemographics and intentionality. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2023; 45:405-413. [PMID: 37718117 PMCID: PMC10894626 DOI: 10.47626/1516-4446-2022-3023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 07/19/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVES To examine drug overdose records in Brazil from 2000 to 2020, analyzing trends over time in overdoses and overall sociodemographic characteristics of the deceased. METHODS Using data from the Brazilian Mortality Information System (Sistema de Informações sobre Mortalidade), we identified records from 2000-2020 in which the underlying cause-of-death was one of the following codes: X40-X45 (accidental poisoning), X60-X65 (intentional poisoning), or Y10-Y15 (undetermined intentionality poisoning). The Brazilian dataset included 21,410 deaths. We used joinpoint regression analysis to assess changes in trends over time. RESULTS People who died of drug overdoses in Brazil between 2000 and 2020 had a mean age of 38.91 years; 38.45% were women, and 44.01% were identified as White. Of the overdose deaths, 44.70% were classified as intentional and 32.12% were classified as unintentional. Among the identified drugs, stimulants were the most common class. However, most records did not report which drug was responsible for death. CONCLUSION Sociodemographic trends in overdose deaths in Brazil must guide country-specific policies. Nevertheless, data collection protocols must be improved, particularly regarding the drug used in overdoses.
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Affiliation(s)
| | - Vitor S. Tardelli
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Emily Rose Brooks
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Kelsy C.N. Areco
- Departamento de Informática em Saúde, UNIFESP, São Paulo, SP, Brazil
| | | | | | - Julian Santaella
- Department of Population Health, New York University, New York, NY, USA
| | - Luis E. Segura
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - João M. Castaldelli-Maia
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
- Departamento de Psiquiatria, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Silvia S. Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Thiago M. Fidalgo
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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Ascandar N, Vadlakonda A, Verma A, Chervu N, Roberts JS, Sakowitz S, Williamson C, Benharash P. Association of opioid use disorder with outcomes of hospitalizations for acute myocardial infarction in the United States. Clinics (Sao Paulo) 2023; 78:100251. [PMID: 37473624 PMCID: PMC10372160 DOI: 10.1016/j.clinsp.2023.100251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 06/27/2023] [Accepted: 07/03/2023] [Indexed: 07/22/2023] Open
Abstract
OBJECTIVE While Opioid Use Disorder (OUD) has been linked to inferior clinical outcomes, studies examining the clinical outcomes and readmission of OUD patients experiencing Acute Myocardial Infarction (AMI) remain lacking. The authors analyze the clinical and financial outcomes of OUD in a contemporary cohort of AMI hospitalizations. METHODS All non-elective adult (≥ 18 years) hospitalizations for AMI were tabulated from the 2016‒2019 Nationwide Readmissions Database using relevant International Classification of Disease codes. Patients were grouped into OUD and non-OUD cohorts. Bivariate and regression analyses were performed to identify the independent association of OUD with outcomes after non-elective admission for AMI, as well as subsequent readmission. RESULTS Of an estimated 3,318,257 hospitalizations for AMI meeting study criteria, 36,057 (1.1%) had a concomitant diagnosis of OUD. While OUD was not significantly associated with mortality, OUD patients experienced superior cardiovascular outcomes compared to non-OUD. However, OUD was linked to increased odds of non-cardiovascular complications, length of stay, costs, non-home discharge, and 30-day non-elective readmission. CONCLUSIONS Patients with OUD presented with AMI at a significantly younger age than non-OUD. While OUD appears to have a cardioprotective effect, it is associated with several markers of increased resource use, including readmission. The present findings underscore the need for a multifaceted approach to increasing social services and treatment for OUD at index hospitalization.
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Affiliation(s)
- Nameer Ascandar
- Cardiovascular Outcomes Research Laboratories, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Amulya Vadlakonda
- Cardiovascular Outcomes Research Laboratories, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Arjun Verma
- Cardiovascular Outcomes Research Laboratories, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Nikhil Chervu
- Cardiovascular Outcomes Research Laboratories, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jacob S Roberts
- Cardiovascular Outcomes Research Laboratories, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Sara Sakowitz
- Cardiovascular Outcomes Research Laboratories, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Catherine Williamson
- Cardiovascular Outcomes Research Laboratories, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
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Chen S, Guo Z, Wei X, Chen Z, Liu N, Yin W, Lan L. Efficacy of preemptive intercostal nerve block on recovery in patients undergoing video-assisted thoracic lobectomy. J Cardiothorac Surg 2023; 18:168. [PMID: 37118846 PMCID: PMC10148478 DOI: 10.1186/s13019-023-02243-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 04/02/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Preemptive intercostal nerve block (pre-ICNB) achieves the same analgesic effects as postoperative ICNB (post-ICNB) remains unclear. This study aimed to evaluate the efficacy of preemptive ICNB on perioperative outcomes for patients undergoing video-assisted thoracic surgery (VATS). METHODS This was a randomized, open-label study (ChiCTR2200055667) from August 1, 2021, to December 30, 2021. Eligible patients scheduled for lobectomy for lung cancer were allocated into the pre-ICNB group and the post-ICNB group. The postoperative pain evaluation, patient rehabilitation, and opioid consumption were observed. RESULTS A total of 81 patients were included. When compared with the post-ICNB group, the pre-ICNB group had a lower proportion of hypertension comorbidity (P = 0.023), significantly lower total consumption of morphine milligram equivalents (MMEs) (P = 0.016), shorter extubation time (P = 0.019). The pre-ICNB group has similar Numeric Rating Scales (NRS) scores of dynamic pain in the post-anesthesia care unit (PACU), postoperative 6 h, 12 h, 24 h, and 48 h (P > 0.05), and had simialr scores of Bruggrmann Comfort Scale (BCS) in postoperative 6 h, 12 h, 24 and 48 h (P > 0.05). The scores of the Mini-mental state examination (MMSE) and Ramsay in the pre-ICNB group were comparable to those in the post-ICNB group, except the scores of MMSE and Ramsay in postoperative 6 h were lower (P = 0.048 and P = 0.019). The pain evaluation in the 1-month follow-up was comparable with that in the post-ICBN group (P > 0.05). CONCLUSIONS Pre- ICNB is equally efficacious in perioperative pain management as post-ICNB, and pre-ICNB significantly reduces intra-operative opioid consumption, providing faster recovery in PACU. TRIAL REGISTRATION Registered in the Chinese Clinical Trial Register (ChiCTR2200055667).
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Affiliation(s)
- Shaojuan Chen
- Department of Anesthesiology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhihua Guo
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xin Wei
- Department of Anesthesiology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhenzhu Chen
- Department of Anesthesiology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Na Liu
- Department of Anesthesiology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Weiqiang Yin
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
| | - Lan Lan
- Department of Anesthesiology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
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18
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Pérez-Figueroa RE, Oser CB, Malinowska K. Access to naloxone in underserved communities. BMJ 2023; 381:894. [PMID: 37185348 DOI: 10.1136/bmj.p894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Affiliation(s)
| | - Carrie B Oser
- University of Kentucky College of Arts and Sciences, Lexington, KY, USA
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Risk Factors for Emergency Department Presentations after the Initiation of Opioid Analgesics in Non-Cancer Patients in Korea: A Nationwide Study. Medicina (B Aires) 2023; 59:medicina59030519. [PMID: 36984520 PMCID: PMC10056559 DOI: 10.3390/medicina59030519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/23/2023] [Accepted: 03/03/2023] [Indexed: 03/09/2023] Open
Abstract
Background and Objectives: Opioid use in Korea is lower than in other developed countries. However, recent studies have reported an increase in opioid prescriptions and the number of chronic opioid users. The current status of adverse events (AEs) associated with opioid analgesics in Korea is unclear. This nested case–control study aimed to evaluate the influence of opioid analgesic use patterns on all emergency department (ED) visits and opioid-related ED visits after opioid analgesic initiation using the national claims database. Materials and Methods: Adult non-cancer patients who initiated non-injectable opioid analgesics (NIOA) between January 2017 and June 2018 were included. We defined the case group as patients who visited the ED within six months of opioid initiation, and the control group was selected in a 1:1 ratio using an exact matching method. Results: A total of 97,735 patients (13.58%) visited the ED within six months of NIOA initiation. Nearly 32% of cases were linked to opioid-related AEs. The most frequent AEs were falls and fractures (61.27%). After adjusting for covariates, opioid initiation at the ED was associated with all-cause or opioid-related ED visits (adjusted odds ratio (aOR) = 3.19, 95% confidence interval (CI) = 3.09–3.29; aOR = 3.82, 95% CI = 3.62–4.04, respectively). Chronic NIOA use was associated with all-cause and opioid-related ED visits (aOR = 1.32, 95% CI = 1.23–1.40; aOR = 1.56, 95% CI = 1.39–1.76, respectively). Conclusion: This study found that 13% of non-cancer patients visited the ED within six months of NIOA initiation. In addition, the NIOA use pattern was significantly associated with all-cause and opioid-related ED visits.
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Runge W, Gabig AM, Karzon A, Suh N, Wagner ER, Gottschalk MB. Prolonged Opioid Use Following Distal Radius Fracture Fixation: Who Is at Risk and What are the Consequences? JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023. [DOI: 10.1016/j.jhsg.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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21
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Grant MJ, Gilreath TD, Smith-Douglas A, Bowring A, Pacheco N. Predictors of suicide and associated factors in Texas high school adolescents. COGENT PSYCHOLOGY 2023. [DOI: 10.1080/23311908.2022.2149291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Morgan James Grant
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, United States
- Center for Health Equity and Evaluation Research, School of Public Health, Texas A&M University, College Station, United States
| | - Tamika D. Gilreath
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, United States
- Center for Health Equity and Evaluation Research, School of Public Health, Texas A&M University, College Station, United States
| | | | - Abigail Bowring
- Department of Psychology, Texas A&M University, College Station, United States
| | - Natalia Pacheco
- Department of Statistics, Texas A&M University, College Station, United States
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22
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Lee H, Singh GK. Estimating the impact of the COVID-19 pandemic on rising trends in drug overdose mortality in the United States, 2018-2021. Ann Epidemiol 2023; 77:85-89. [PMID: 36455852 PMCID: PMC9703855 DOI: 10.1016/j.annepidem.2022.11.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE During the COVID-19 pandemic, social and economic disruption such as social isolation, job and income losses, and increased psychological distress, may have contributed to the increase in drug-overdose mortality. This study aims to measure the impact of the pandemic on monthly trends in drug-overdose mortality in the United States. METHODS We used the 2018-2020 final and 2021 provisional monthly deaths from the National Vital Statistics System and monthly population estimates from the Census Bureau to compute monthly mortality rates by age, sex, and race/ethnicity. We use log-linear regression models to estimate monthly percent increases in mortality rates from January 2018 through November 2021. RESULTS The age-adjusted drug-overdose mortality rate among individuals aged older than or equal to 15 years increased by 30% between 2019 (70,459 deaths) and 2020 (91,536 deaths). During January 2018-November 2021, the monthly drug-overdose mortality rate increased by 2.05% per month for Blacks, 2.25% for American Indians/Alaska Natives, 1.96% for Hispanics, 1.33% for Asian/Pacific Islanders, and 0.96% for non-Hispanic Whites. Average monthly increases in mortality were most marked among those aged 15-24 and 35-44 years. CONCLUSIONS The COVID-19 pandemic had a substantial impact on the rising trends in drug-overdose mortality during the peak months in 2020 and 2021.
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Affiliation(s)
- Hyunjung Lee
- Department of Public Policy and Public Affairs, John McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, MA.
| | - Gopal K Singh
- The Center for Global Health and Health Policy, Global Health and Education Projects, Inc., Riverdale, MD
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23
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Liu EY, McCall KL, Piper BJ. Variation in adverse drug events of opioids in the United States. Front Pharmacol 2023; 14:1163976. [PMID: 37033633 PMCID: PMC10079914 DOI: 10.3389/fphar.2023.1163976] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 03/13/2023] [Indexed: 04/11/2023] Open
Abstract
Background: The United States (US) ranks high, nationally, in opioid consumption. The ongoing increase in the misuse and mortality amid the opioid epidemic has been contributing to its rising cost. The worsening health and economic impact of opioid use disorder in the US warrants further attention. We, therefore, assessed commonly prescribed opioids to determine the opioids that were over-represented versus under-represented for adverse drug events (ADEs) to better understand their distribution patterns using the Food and Drug Administration's Adverse Event Reporting System (FAERS) while correcting for distribution using the Drug Enforcement Administration's Automation of Reports and Consolidated Orders System (ARCOS). Comparing the ratio of the percentage of adverse drug events as reported by the FAERS relative to the percentage of distribution as reported by the ARCOS database is a novel approach to evaluate post-marketing safety surveillance and may inform healthcare policies and providers to better regulate the use of these opioids. Methods: We analyzed the adverse events for 11 prescription opioids, when correcting for distribution, and their ratios for three periods, 2006-2010, 2011-2016, and 2017-2021, in the US. The opioids include buprenorphine, codeine, fentanyl, hydrocodone, hydromorphone, meperidine, methadone, morphine, oxycodone, oxymorphone, and tapentadol. Oral morphine milligram equivalents (MMEs) were calculated by conversions relative to morphine. The relative ADEs of the selected opioids, opioid distributions, and ADEs relative to distribution ratios were analyzed for the 11 opioids. Results: Oxycodone, fentanyl, and morphine accounted for over half of the total number of ADEs (n = 667,969), while meperidine accounted for less than 1%. Opioid distributions were relatively constant over time, with methadone repeatedly accounting for the largest proportions. Many ADE-to-opioid distribution ratios increased over time, with meperidine (60.6), oxymorphone (11.1), tapentadol (10.3), and hydromorphone (7.9) being the most over-represented for ADEs in the most recent period. Methadone was under-represented (<0.20) in all the three periods. Conclusion: The use of the FAERS with the ARCOS provides insights into dynamic changes in ADEs of the selected opioids in the US. There is further need to monitor and address the ADEs of these drugs.
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Affiliation(s)
- Edward Y. Liu
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA, United States
- *Correspondence: Edward Y. Liu,
| | - Kenneth L. McCall
- Department of Pharmacy Practice, Binghamton University, Binghamton, NY, United States
| | - Brian J. Piper
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA, United States
- Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, PA, United States
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24
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Calac AJ, McMann T, Cai M, Li J, Cuomo R, Mackey TK. Exploring substance use disorder discussions in Native American communities: a retrospective Twitter infodemiology study. Harm Reduct J 2022; 19:141. [PMID: 36517902 PMCID: PMC9753320 DOI: 10.1186/s12954-022-00728-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/13/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The opioid epidemic has had a devastating impact on youth from American Indian and Alaska Native (AI/AN) Tribes and Villages, which also experience disparate suicide rates. The use of publicly available social media data originating from AI/AN communities may enhance public health response time to substance use disorder (SUD)-related overdose and augment Tribal public health surveillance systems, but these concepts have yet to be adequately explored. The goal of this exploratory analysis was to identify primary and secondary accounts of overdose and characterize relevant contextual factors in the AI/AN population on social media. METHODS The Twitter application programming interface was queried for all Tweets containing geocoded data between March 2014 and June 2020 and filtered for the keyword ['overdose']. This sample of Tweets (n = 146,236) was then restricted to those geolocated from US Tribal lands (n = 619). Tweets were manually annotated for primary or secondary accounts of overdose as well as suicidal ideation, substance(s) used, stigma of drug use, and community-wide incidents. RESULTS We collected a total of 146,235 tweets that were geocoded and contained the word 'overdose,' of which 9.5% were posted on Tribal lands (n = 619). 9.4% of these tweets (n = 58) met our study inclusion criteria and were mainly posted from Oklahoma (n = 26, 45%) and North Carolina (n = 13, 22.4%). Most Tweets (n = 41, 71%) described a primary account of an overdose and were mostly posted from 2014 to 2015. Less than half of the Tweets (n = 27, 46.5%) referenced a specific substance. Those substances mentioned included alcohol, marijuana, methamphetamine, heroin, laundry softener, cocaine, K2-Spice (synthetic cannabinoid), codeine, morphine, Nyquil, and Xanax. DISCUSSION Though exploratory, our study identified SUD-related content self-reported by AI/AN communities on Twitter, especially in Oklahoma and North Carolina. These results may assist in the future design and detection of infodemiology trends and early warning signs that can better facilitate intervention specific to the ongoing Tribal opioid epidemic. While all data were collected from the public domain, additional care should be given to individual and community privacy.
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Affiliation(s)
- Alec J Calac
- UC San Diego School of Medicine, La Jolla, CA, USA
- UC San Diego Herbert Wertheim School of Public Health and Human Longevity Science, La Jolla, CA, USA
- Global Health Policy and Data Institute, San Diego, CA, USA
| | - Tiana McMann
- Global Health Policy and Data Institute, San Diego, CA, USA
- S-3 Research, San Diego, CA, USA
| | - Mingxiang Cai
- Global Health Policy and Data Institute, San Diego, CA, USA
- S-3 Research, San Diego, CA, USA
| | - Jiawei Li
- Global Health Policy and Data Institute, San Diego, CA, USA
- S-3 Research, San Diego, CA, USA
| | - Raphael Cuomo
- UC San Diego School of Medicine, La Jolla, CA, USA
- Global Health Policy and Data Institute, San Diego, CA, USA
| | - Tim K Mackey
- Global Health Policy and Data Institute, San Diego, CA, USA.
- Department of Anthropology, UC San Diego, La Jolla, CA, USA.
- S-3 Research, San Diego, CA, USA.
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25
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Lee H, Singh GK. Monthly Trends in Drug Overdose Mortality among Youth Aged 15-34 Years in the United States, 2018-2021: Measuring the Impact of the COVID-19 Pandemic. Int J MCH AIDS 2022; 11:e583. [PMID: 36506108 PMCID: PMC9730739 DOI: 10.21106/ijma.583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Adolescents and young adults in the United States (US) have experienced a significant increase in drug overdose mortality rates in the last two decades. During the Coronavirus disease 2019 (COVID-19) pandemic, they experienced a lack of access to substance use disorder treatment, stay-home orders, school closure, social isolation, increased psychological distress, and financial strain. Few studies have examined the impact of the pandemic on monthly trends in drug-overdose mortality among youth by race/ethnicity. This study estimates differential changes in monthly drug overdose mortality among youth in the US by age, sex, and race/ethnicity. Methods Monthly deaths from the final 2018-2020 national mortality data and the 2021 provisional mortality data were used, and monthly population estimates were obtained from the Census Bureau. We calculated age-specific monthly drug overdose deaths per one million population and used log-linear regression models to estimate monthly percent increases in mortality rates from January 2018 through October 2021. Results Drug-overdose deaths among individuals aged 15-34 increased by 36.5% from 2019 (21,152 deaths) to 2020 (28,879 deaths). From February 2020 to May 2020, the drug-overdose mortality rate increased by 62% for males, 53% for females, 79% for Blacks, 62% for American Indians/Alaska Natives (AIANs), 57% for Hispanics, 56% for non-Hispanic Whites, and 47% for Asians. From January 2018 to October 2021, the average monthly drug-overdose mortality rate increased by 2.69% per month for Blacks, 2.54% for AIANs, 2.27% for Hispanics, 1.37% for Asians, and 0.81% for non-Hispanic Whites. Increases in drug-overdose mortality were more rapid among males than females and among youth aged 15-24 than youth aged 25-34. Conclusion and Global Health Implications During the peak months in 2020 and 2021, the COVID-19 pandemic had a disproportionate impact by race/ethnicity on trends in drug overdose mortality among the youth. Drug overdose mortality rates increased faster among Blacks, Hispanics, AIANs, and Asians compared to non-Hispanic Whites.
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Affiliation(s)
- Hyunjung Lee
- Department of Public Policy and Public Affairs, John McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, 100 William T. Morrissey Blvd., Boston, MA 02125, USA
| | - Gopal K. Singh
- The Center for Global Health and Health Policy, Global Health and Education Projects, Inc., Riverdale, MD 20738, USA
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Galivanche AR, Zhu J, Mercier MR, McLean R, Wilhelm CV, Varthi AG, Grauer JN, Rubin LE. Admission NarxCare Narcotic Scores Are Associated With Increased Odds of Readmission and Prolonged Length of Hospital Stay After Primary Elective Total Knee Arthroplasty. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202212000-00002. [PMID: 36732305 PMCID: PMC9726283 DOI: 10.5435/jaaosglobal-d-22-00040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/07/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION The association of preoperative narcotic use with postoperative outcomes after primary elective total knee arthroplasty (TKA) has remained poorly characterized. The NarxCare platform analyzes patients' state Prescription Drug Monitoring Program records to assign numerical scores that approximate a patient's overall opioid usage. The present study investigated the utility of admission NarxCare narcotic scores in predicting the odds of adverse events (AEs) after primary elective TKA. METHODS Elective primary TKA patients performed at a single institution between October 2017 and May 2020 were evaluated. NarxCare narcotic scores at the time of admission, patient characteristics, 30-day AEs, readmissions, revision surgeries, and mortality were abstracted. Elective TKA patients were binned based on admission NarxCare narcotic scores. The odds of experiencing adverse outcomes were compared. RESULTS In total, 1136 patients met the criteria for inclusion in the study (Narx Score 0: n = 293 [25.8%], 1 to 99: n = 253 [22.3%], 100 to 299: n = 368 [32.4%], 300 to 499: n = 161 [14.2%], and 500+: n = 61 [5.37%]). By logistic regression, patients with higher admission narcotic scores tended to have a dose-dependent increase in the odds of prolonged length of hospital stay, readmission within 30 days, and aggregated AEs. DISCUSSION Admission narcotic scores may be used to predict readmission and to stratify TKA patients by risk of AEs.
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Affiliation(s)
- Anoop R. Galivanche
- From the Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Justin Zhu
- From the Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Michael R. Mercier
- From the Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Ryan McLean
- From the Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Christopher V. Wilhelm
- From the Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Arya G. Varthi
- From the Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Jonathan N. Grauer
- From the Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Lee E. Rubin
- From the Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
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Blum K, Elman I, Dennen CA, McLaughlin T, Thanos PK, Baron D, Gold MS, Badgaiyan RD. "Preaddiction" construct and reward deficiency syndrome: genetic link via dopaminergic dysregulation. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:1181. [PMID: 36467361 PMCID: PMC9708493 DOI: 10.21037/atm-2022-32] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/21/2022] [Indexed: 09/10/2024]
Affiliation(s)
- Kenneth Blum
- Center for Sports and Mental Health, Western University Health Sciences, Pomona, CA, USA
- The Kenneth Blum Behavioral and Neurogenetic Institute, LLC, Austin, TX, USA
| | - Igor Elman
- Department of Psychiatry, Harvard School of Medicine, Cambridge, MA, USA
| | - Catherine A. Dennen
- Department of Family Medicine, Jefferson Health Northeast, Philadelphia, PA, USA
| | - Thomas McLaughlin
- The Kenneth Blum Behavioral and Neurogenetic Institute, LLC, Austin, TX, USA
| | - Panayotis K. Thanos
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Clinical Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biosciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - David Baron
- Center for Sports and Mental Health, Western University Health Sciences, Pomona, CA, USA
| | - Mark S. Gold
- Department of Psychiatry, Washington University School of Medicine, St. Luis, MO, USA
| | - Rajendra D. Badgaiyan
- Department of Psychiatry, South Texas Veteran Health Care System, Audie L. Murphy Memorial VA Hospital, Long School of Medicine, University of Texas Health Science Center, San Antonio, TX, USA
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Kelson M, Chaudhry A, Nguyen A, Girgis S. Injection drug induced septic embolism—A growing concern. Radiol Case Rep 2022; 17:4345-4349. [PMID: 36188073 PMCID: PMC9520423 DOI: 10.1016/j.radcr.2022.08.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 08/14/2022] [Accepted: 08/18/2022] [Indexed: 11/22/2022] Open
Abstract
Septic pulmonary embolism is an obstruction of the pulmonary vasculature due to embolization of an infected thrombus. In many instances, the etiology is cardiac in origin, given the increased prevalence of intravenous drug users in the United States. This condition usually presents with fever, chest pain, dyspnea, and cough. In order to make the diagnosis, it is helpful to utilize tools like the modified Duke criteria when evaluating for infective endocarditis in the context of pulmonary emboli and septic shock. The gold standard method for establishing the diagnosis of this condition involves imaging modalities, including echocardiogram and computed tomography findings. This case report details a 36-year-old male with a history of drug abuse and hepatitis C, who was found to have an isolated vegetation on the pulmonic valve and septic pulmonary embolism. The patient experienced a rapidly deteriorating clinical course, however improved over the course of 2 weeks with supportive measures and appropriate antibiotic treatment. The purpose of this case report is to highlight the uncommon nature of pulmonary valve involvement in patients with infective endocarditis. Moreover, the goal of this report is to recognize the paralleled increase in septic pulmonary emboli with the rising incidence of patients using injectable opioids in the United States.
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Lalani K, Bakos-Block C, Cardenas-Turanzas M, Cohen S, Gopal B, Champagne-Langabeer T. The Impact of COVID-19 on Opioid-Related Overdose Deaths in Texas. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13796. [PMID: 36360676 PMCID: PMC9657935 DOI: 10.3390/ijerph192113796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/20/2022] [Accepted: 10/18/2022] [Indexed: 06/16/2023]
Abstract
Prior to the COVID-19 pandemic, the United States was facing an epidemic of opioid overdose deaths, clouding accurate inferences about the impact of the pandemic at the population level. We sought to determine the existence of increases in the trends of opioid-related overdose (ORO) deaths in the Greater Houston metropolitan area from January 2015 through December 2021, and to describe the social vulnerability present in the geographic location of these deaths. We merged records from the county medical examiner's office with social vulnerability indexes (SVIs) for the region and present geospatial locations of the aggregated ORO deaths. Time series analyses were conducted to determine trends in the deaths, with a specific focus on the years 2019 to 2021. A total of 2660 deaths were included in the study and the mean (standard deviation, SD) age at death was 41.04 (13.60) years. Heroin and fentanyl were the most frequent opioids detected, present in 1153 (43.35%) and 1023 (38.46%) ORO deaths. We found that ORO deaths increased during the years 2019 to 2021 (p-value ≤ 0.001) when compared with 2015. Compared to the year 2019, ORO deaths increased for the years 2020 and 2021 (p-value ≤ 0.001). The geographic locations of ORO deaths were not associated with differences in the SVI. The COVID-19 pandemic had an impact on increasing ORO deaths in the metropolitan Houston area; however, identifying the determinants to guide targeted interventions in the areas of greatest need may require other factors, in addition to community-level social vulnerability parameters.
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Butler KE, Baker ES. A High-Throughput Ion Mobility Spectrometry-Mass Spectrometry Screening Method for Opioid Profiling. JOURNAL OF THE AMERICAN SOCIETY FOR MASS SPECTROMETRY 2022; 33:1904-1913. [PMID: 36136315 PMCID: PMC9616473 DOI: 10.1021/jasms.2c00186] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
In 2017, the United States Department of Health and Human Services declared the widespread misuse and abuse of prescription and illicit opioids an epidemic. However, this epidemic dates back to the 1990s when opioids were extensively prescribed for pain management. Currently, opioids are still recommended for pain management, and given their abuse potential, rapid screening is imperative for patient treatment. Of particular importance is assessing pain management patient compliance, where evaluating drug use is crucial for preventing opioid abuse and potential overdoses. In this work, we utilized drift tube ion mobility spectrometry coupled with mass spectrometry (DTIMS-MS) to develop a rapid screening method for 33 target opioids and opioid urinary metabolites. Collision cross section values were determined for all target molecules using a flow-injection DTIMS-MS method, and clear differentiation of 27 out of the 33 opioids without prior chromatographic separation was observed when utilizing a high resolution demultiplexing screening approach. An automated solid phase extraction (SPE) platform was then coupled to DTIMS-MS for 10 s sample-to-sample analyses. This SPE-IMS-MS approach enabled the rapid screening of urine samples for opioids and presents a major improvement in sample throughput compared to traditional chromatographic analyses coupled with MS, which routinely take several minutes per sample. Overall, this vast reduction in analysis time facilitates a faster turn-around for patient samples, providing great benefits to clinical applications.
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Affiliation(s)
- Karen E Butler
- Department of Chemistry, North Carolina State University, Raleigh, North Carolina 27695, United States
| | - Erin S Baker
- Department of Chemistry, North Carolina State University, Raleigh, North Carolina 27695, United States
- Center for Human Health and the Environment, North Carolina State University, Raleigh, North Carolina 27695, United States
- Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina 27695, United States
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Beseran E, Pericàs JM, Cash-Gibson L, Ventura-Cots M, Porter KMP, Benach J. Deaths of Despair: A Scoping Review on the Social Determinants of Drug Overdose, Alcohol-Related Liver Disease and Suicide. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912395. [PMID: 36231697 PMCID: PMC9566538 DOI: 10.3390/ijerph191912395] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/22/2022] [Accepted: 09/26/2022] [Indexed: 05/31/2023]
Abstract
BACKGROUND There is a lack of consensus on the social determinants of Deaths of Despair (DoD), i.e., an increase in mortality attributed to drug overdose, alcohol-related liver disease, and suicide in the United States (USA) during recent years. The objective of this study was to review the scientific literature on DoD with the purpose of identifying relevant social determinants and inequalities related to these mortality trends. METHODS Scoping review focusing on the period 2015-2022 based on PubMed search. Articles were selected according to the following inclusion criteria: published between 1 January 2000 and 31 October 2021; including empirical data; analyzed DoD including the three causes defined by Case and Deaton; analyzed at least one social determinant; written in English; and studied DoD in the USA context only. Studies were excluded if they only analyzed adolescent populations. We synthesized our findings in a narrative report specifically addressing DoD by economic conditions, occupational hazards, educational level, geographical setting, and race/ethnicity. RESULTS Seventeen studies were included. Overall, findings identify a progressive increase in deaths attributable to suicide, drug overdose, and alcohol-related liver disease in the USA in the last two decades. The literature concerning DoD and social determinants is relatively scarce and some determinants have been barely studied. However different, however, large inequalities have been identified in the manner in which the causes of death embedded in the concept of DoD affect different subpopulations, particularly African American, and Hispanic populations, but blue collar-whites are also significantly impacted. Low socioeconomic position and education levels and working in jobs with high insecurity, unemployment, and living in rural areas were identified as the most relevant social determinants of DoD. CONCLUSIONS There is a need for further research on the structural and intermediate social determinants of DoD and social mechanisms. Intersectional and systemic approaches are needed to better understand and tackle DoD and related inequalities.
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Affiliation(s)
- Elisabet Beseran
- Research Group on Health Inequalities, Environment, and Employment Conditions, Pompeu Fabra University, 08002 Barcelona, Spain
| | - Juan M. Pericàs
- Research Group on Health Inequalities, Environment, and Employment Conditions, Pompeu Fabra University, 08002 Barcelona, Spain
- Liver Unit, Internal Medicine Department, Vall d’Hebron University Hospital, Vall d’Hebron Institute for Research, CIBERehd, 08036 Barcelona, Spain
- Johns Hopkins University—Pompeu Fabra University Public Policy Center (UPF-BSM), 08002 Barcelona, Spain
| | - Lucinda Cash-Gibson
- Research Group on Health Inequalities, Environment, and Employment Conditions, Pompeu Fabra University, 08002 Barcelona, Spain
- Johns Hopkins University—Pompeu Fabra University Public Policy Center (UPF-BSM), 08002 Barcelona, Spain
- UPF Barcelona School of Management, Pompeu Fabra University, 08008 Barcelona, Spain
| | - Meritxell Ventura-Cots
- Liver Unit, Internal Medicine Department, Vall d’Hebron University Hospital, Vall d’Hebron Institute for Research, CIBERehd, 08036 Barcelona, Spain
| | - Keshia M. Pollack Porter
- Johns Hopkins University—Pompeu Fabra University Public Policy Center (UPF-BSM), 08002 Barcelona, Spain
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Joan Benach
- Research Group on Health Inequalities, Environment, and Employment Conditions, Pompeu Fabra University, 08002 Barcelona, Spain
- Johns Hopkins University—Pompeu Fabra University Public Policy Center (UPF-BSM), 08002 Barcelona, Spain
- Ecological Humanities Research Group (GHECO), Universidad Autónoma de Madrid, 28049 Madrid, Spain
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Maguire-Jack K, Steinman KJ, Lesnick J, Solomon A, West K, Roush K, Zimpfer K, Cunningham N. Implementing Triple P during the COVID-19 pandemic with families at risk for substance use. CHILD ABUSE & NEGLECT 2022; 129:105636. [PMID: 35483219 PMCID: PMC9021129 DOI: 10.1016/j.chiabu.2022.105636] [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: 01/12/2022] [Revised: 04/09/2022] [Accepted: 04/13/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Many studies have examined the Positive Parenting Program (Triple P), yet few have considered its effectiveness during the twin challenges of the opioid crisis and COVID-19 pandemic. OBJECTIVE This study examines the implementation of, and parenting outcomes associated with the Positive Parenting Program (Triple P) in 13 counties in central Ohio. PARTICIPANTS AND SETTING The program was provided to parents who were at heightened risk for substance use. From July 2020 through June 2021, 890 parents received services from Triple P. METHODS Parents completed pre- and post-test assessments of protective factors within their families and parenting behaviors. Parents also participated in qualitative interviews regarding their experiences in the program. CONCLUSIONS Overall, the results were promising, with improvements seen in family functioning/resilience, nurturing and attachment, parental laxness, and parental over-reactivity. Parents reported positive experiences participating in the program and felt that their relationship with their child had improved. Despite the profound, recent challenges to parenting and service provision, Triple P continues to show promise as an approach to reducing child maltreatment. Expansion of Triple P to other areas may improve parenting behaviors and reduce child maltreatment among parents at risk for substance use.
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Affiliation(s)
| | - Kenneth J Steinman
- The Ohio State University, College of Education and Human Ecology, United States of America.
| | - Julia Lesnick
- University of California, Los Angeles, United States of America.
| | | | | | - Kathleen Roush
- Nationwide Children's Hospital, United States of America.
| | - Kayla Zimpfer
- Nationwide Children's Hospital, United States of America.
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Chiappini S, Vickers-Smith R, Guirguis A, Corkery JM, Martinotti G, Harris DR, Schifano F. Pharmacovigilance Signals of the Opioid Epidemic over 10 Years: Data Mining Methods in the Analysis of Pharmacovigilance Datasets Collecting Adverse Drug Reactions (ADRs) Reported to EudraVigilance (EV) and the FDA Adverse Event Reporting System (FAERS). Pharmaceuticals (Basel) 2022; 15:ph15060675. [PMID: 35745593 PMCID: PMC9231103 DOI: 10.3390/ph15060675] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/21/2022] [Accepted: 05/24/2022] [Indexed: 01/14/2023] Open
Abstract
In the past twenty years, the consumption of opioid medications has reached significant proportions, leading to a rise in drug misuse and abuse and increased opioid dependence and related fatalities. Thus, the purpose of this study was to determine whether there are pharmacovigilance signals of abuse, misuse, and dependence and their nature for the following prescription opioids: codeine, dihydrocodeine, fentanyl, oxycodone, pentazocine, and tramadol. Both the pharmacovigilance datasets EudraVigilance (EV) and the FDA Adverse Events Reporting System (FAERS) were analyzed to identify and describe possible misuse-/abuse-/dependence-related issues. A descriptive analysis of the selected Adverse Drug Reactions (ADRs) was performed, and pharmacovigilance signal measures (i.e., reporting odds ratio, proportional reporting ratio, information component, and empirical Bayesian geometric mean) were computed for preferred terms (PTs) of abuse, misuse, dependence, and withdrawal, as well as PTs eventually related to them (e.g., aggression). From 2003 to 2018, there was an increase in ADR reports for the selected opioids in both datasets. Overall, 16,506 and 130,293 individual ADRs for the selected opioids were submitted to EV and FAERS, respectively. Compared with other opioids, abuse concerns were mostly recorded in relation to fentanyl and oxycodone, while tramadol and oxycodone were more strongly associated with drug dependence and withdrawal. Benzodiazepines, antidepressants, other opioids, antihistamines, recreational drugs (e.g., cocaine and alcohol), and several new psychoactive substances, including mitragynine and cathinones, were the most commonly reported concomitant drugs. ADRs reports in pharmacovigilance databases confirmed the availability of data on the abuse and dependence of prescription opioids and should be considered a resource for monitoring and preventing such issues. Psychiatrists and clinicians prescribing opioids should be aware of their misuse and dependence liability and effects that may accompany their use, especially together with concomitant drugs.
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Affiliation(s)
- Stefania Chiappini
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire AL10 9EU, UK; (S.C.); (J.M.C.); (G.M.); (F.S.)
| | - Rachel Vickers-Smith
- Department of Epidemiology, University of Kentucky College of Public Health, 111 Washington Avenue, Lexington, KY 40536, USA
- Correspondence:
| | - Amira Guirguis
- Department of Pharmacy, Swansea University Medical School, The Grove, Swansea University, Swansea, Wales SA2 8PP, UK;
| | - John M. Corkery
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire AL10 9EU, UK; (S.C.); (J.M.C.); (G.M.); (F.S.)
| | - Giovanni Martinotti
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire AL10 9EU, UK; (S.C.); (J.M.C.); (G.M.); (F.S.)
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D’Annunzio, 66100 Chieti-Pescara, Italy
| | - Daniel R. Harris
- Institute for Pharmaceutical Outcomes and Policy, University of Kentucky College of Pharmacy, 289 South Limestone Street, Lexington, KY 40536, USA;
- Center for Clinical and Translational Sciences, University of Kentucky, 800 Rose Street, Lexington, KY 40506, USA
| | - Fabrizio Schifano
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire AL10 9EU, UK; (S.C.); (J.M.C.); (G.M.); (F.S.)
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Askari MS, Rutherford CG, Mauro PM, Kreski NT, Keyes KM. Structure and trends of externalizing and internalizing psychiatric symptoms and gender differences among adolescents in the US from 1991 to 2018. Soc Psychiatry Psychiatr Epidemiol 2022; 57:737-748. [PMID: 34773140 PMCID: PMC8589095 DOI: 10.1007/s00127-021-02189-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 10/31/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE We aimed to estimate the structure of internalizing and externalizing symptoms and potential time dynamics in their association. This is understudied among adolescents, despite increasing internalizing and decreasing externalizing symptoms in recent years. METHODS We analyzed data from US Monitoring the Future cross-sectional surveys (1991-2018) representative of school-attending adolescents (N = 304,542). Exploratory factor analysis using maximum likelihood estimation method and promax rotation resulted in a two-factor solution (factor correlation r = 0.24) that differentiated eight internalizing and seven conduct-related externalizing symptoms. Time-varying effect modification linear regression models estimated the association between standardized internalizing and externalizing symptoms factor scores over time overall and by gender. RESULTS In 2012, trends in average factor scores diverged for internalizing and externalizing factors. The average standardized internalizing factor score increased from - 0.03 in 2012 to 0.06 in 2013 and the average externalizing factor score decreased from - 0.06 in 2011 to - 0.13 in 2012. We found that for every one-unit increase in standardized internalizing factor score, standardized externalizing factor score increased by 0.224 units in 2010 (95% CI: 0.215, 0.233); the magnitude of this increase was 22.3% lower in 2018 (i.e., 0.174 units; 95% CI: 0.160, 0.188). Decoupling of internalizing and externalizing symptoms began earlier among boys (~ 1995) than among girls (~ 2010). CONCLUSION The decoupling of internalizing and externalizing symptoms among adolescents suggests that changes in the prevalence of shared risk factors for adolescent psychiatric symptoms affect these dimensions in opposing directions, raising the importance of considering symptoms and their risk factors together in prevention and intervention efforts.
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Affiliation(s)
- Melanie S Askari
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168th St., New York, NY, 10032, USA.
| | - Caroline G Rutherford
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168th St., New York, NY, 10032, USA
| | - Pia M Mauro
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168th St., New York, NY, 10032, USA
| | - Noah T Kreski
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168th St., New York, NY, 10032, USA
| | - Katherine M Keyes
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168th St., New York, NY, 10032, USA
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Watson DP, Staton MD, Grella CE, Scott CK, Dennis ML. Navigating intersecting public health crises: a qualitative study of people with opioid use disorders' experiences during the COVID-19 pandemic. Subst Abuse Treat Prev Policy 2022; 17:22. [PMID: 35303913 PMCID: PMC8931576 DOI: 10.1186/s13011-022-00449-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The decades-long opioid epidemic and the more recent COVID-19 pandemic are two interacting events with significant public health impacts for people with opioid use disorder (OUD). Most published studies regarding the intersection of these two public health crises have focused on community, state, or national trends using pre-existing data. There is a need for complementary qualitative research aimed at identifying how people with opioid use disorder (OUD) are understanding, experiencing, and navigating this unprecedented time. The current study examines understandings and experiences of people with OUD while they have navigated these crises. METHODS The study was guided by a pragmatic lens. We conducted brief semi-structured qualitative interviews with 25 individuals in Chicago, the majority of which had received methadone treatment during the pandemic. Thematic inductive analysis was guided by primary interview questions. RESULTS The sample represents a high-risk group, being composed mostly of older non-Hispanic African American males and having considerable socioeconomic barriers. Themes demonstrate how individuals are keeping safe despite limited knowledge of COVID-19, how the pandemic has increased treatment motivation for some, how adaptations impacted treatment and recovery supports, how the availability social support had been reduced, and difficulties individuals had keeping or obtaining financial support. CONCLUSIONS The findings can be useful for informing future public health response to ensure appropriate treatment access and supports are available. In particular are the need for treatment providers to ensure people with OUD receive appropriate and understandable health crisis-related information and ensuring funds are appropriately allocated to address mental health impacts of social isolation. Finally, there is a need for appropriate financial and infrastructure supports to ensure health and treatment access disparities are not exacerbated for those in greatest need.
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Affiliation(s)
- Dennis P. Watson
- grid.413870.90000 0004 0418 6295Chestnut Health Systems, 221 W. Walton St, Chicago, IL 60610 USA
| | - Monte D. Staton
- grid.185648.60000 0001 2175 0319Department of Medicine, Center for Dissemination and Implementation Science, University of Illinois College of Medicine at Chicago, 818 S Wolcott Ave, Chicago, IL 60613 USA
| | - Christine E. Grella
- grid.413870.90000 0004 0418 6295Chestnut Health Systems, 221 W. Walton St, Chicago, IL 60610 USA
| | - Christy K. Scott
- grid.413870.90000 0004 0418 6295Chestnut Health Systems, 221 W. Walton St, Chicago, IL 60610 USA
| | - Michael L. Dennis
- grid.413870.90000 0004 0418 6295Chestnut Health Systems, 448 Wylie Dr, Normal, IL 61761 USA
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Cano M, Sparks CS. Drug overdose mortality by race/ethnicity across US-born and immigrant populations. Drug Alcohol Depend 2022; 232:109309. [PMID: 35077954 DOI: 10.1016/j.drugalcdep.2022.109309] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/14/2022] [Accepted: 01/14/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND The present study examined racial/ethnic differences in US drug overdose mortality among US-born and foreign-born men and women. METHODS In this cross-sectional analysis of 2010-2019 data from the National Center for Health Statistics, Bayesian hierarchical models predicted drug overdose mortality based on the interaction of race/ethnicity, nativity, and sex, adjusting for age, for 518,553 drug overdose deaths among individuals ages 15-74 identified as Non-Hispanic (NH) White, NH Black, Hispanic, or NH Asian/Pacific Islander (PI). Rate ratios with 95% Highest Posterior Density Intervals (HPDIs) were examined by race/ethnicity and nativity. RESULTS In the US-born population, 2017-2019 estimated overdose mortality rates were higher for NH Black than NH White men (ratio 1.48 [95% HPDI 1.28-1.72]), similar between NH Black and NH White women (ratio 1.03 [95% HPDI 0.89-1.20]), similar between Hispanic and NH White men (ratio 0.96 [95% HPDI 0.82-1.10]), and lower for NH Asian/PI than NH White men and women. In the foreign-born population, both for men and women, estimated overdose mortality rates were lower in every racial/ethnic group relative to the NH White group. For men and women of all racial/ethnic groups examined, estimated overdose mortality rates were higher in US-born than foreign-born subpopulations, yet the extent of this nativity differential was least pronounced in the NH White group. CONCLUSIONS In the US-born population, NH Black men experienced the highest recent rates of overdose mortality; in the foreign-born population, the highest rates of overdose mortality were observed among NH White men and women.
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Affiliation(s)
- Manuel Cano
- Department of Social Work, The University of Texas at San Antonio, 501W. César E. Chávez Blvd., San Antonio, TX 78207, USA.
| | - Corey S Sparks
- Department of Demography, The University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249, USA.
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Iseppon F, Linley JE, Wood JN. Calcium imaging for analgesic drug discovery. NEUROBIOLOGY OF PAIN (CAMBRIDGE, MASS.) 2022; 11:100083. [PMID: 35079661 PMCID: PMC8777277 DOI: 10.1016/j.ynpai.2021.100083] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/17/2021] [Accepted: 12/27/2021] [Indexed: 11/24/2022]
Abstract
Somatosensation and pain are complex phenomena involving a rangeofspecialised cell types forming different circuits within the peripheral and central nervous systems. In recent decades, advances in the investigation of these networks, as well as their function in sensation, resulted from the constant evolution of electrophysiology and imaging techniques to allow the observation of cellular activity at the population level both in vitro and in vivo. Genetically encoded indicators of neuronal activity, combined with recent advances in DNA engineering and modern microscopy, offer powerful tools to dissect and visualise the activity of specific neuronal subpopulations with high spatial and temporal resolution. In recent years various groups developed in vivo imaging techniques to image calcium transients in the dorsal root ganglia, the spinal cord and the brain of anesthetised and awake, behaving animals to address fundamental questions in both the physiology and pathophysiology of somatosensation and pain. This approach, besides giving unprecedented details on the circuitry of innocuous and painful sensation, can be a very powerful tool for pharmacological research, from the characterisation of new potential drugs to the discovery of new, druggable targets within specific neuronal subpopulations. Here we summarise recent developments in calcium imaging for pain research, discuss technical challenges and advances, and examine the potential positive impact of this technique in early preclinical phases of the analgesic drug discovery process.
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Affiliation(s)
- Federico Iseppon
- Molecular Nociception Group, Wolfson Institute for Biomedical Research, University College London, Gower Street, WC1E 6BT London, UK
- Discovery UK, Neuroscience, Biopharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - John E. Linley
- Discovery UK, Neuroscience, Biopharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - John N. Wood
- Molecular Nociception Group, Wolfson Institute for Biomedical Research, University College London, Gower Street, WC1E 6BT London, UK
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Randall DJ, Vanood A, Jee Y, Moore DD. National and State Level Opioid-Restricting Legislation in Total Joint Arthroplasty: A Systematic Review. J Arthroplasty 2022; 37:176-185. [PMID: 34456092 DOI: 10.1016/j.arth.2021.07.013] [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: 05/18/2021] [Revised: 07/07/2021] [Accepted: 07/24/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The opioid epidemic is a health crisis in the United States. Within orthopedic surgery, opioid misuse and incautious prescription remains a concern. In the last several years, there has been a growing interest and public effort toward reducing opioid use in total joint arthroplasty (TJA) in response to the opioid epidemic in the United States. We aim to review opioid-limiting practices, policies, and legislations that are implemented at the state level and nationally that are relevant to TJA, as well as evaluate studies that measure the efficacy of these policies in the management of patients undergoing TJA. METHODS Two independent reviewers conducted a systematic review of national and state level opioid-limiting policies implemented in the United States and their effects on opioid prescription, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA). RESULTS We identified 3 national bills and 9 policies set forth by national organizations that imposed limits on opioid prescription. Opioid-reducing legislation was also identified in 24 states, with the majority specifying a 7-day limit on initial opioid prescription for acute pain management. Six research studies evaluating the impact of opioid-restricting policies on postoperative opioid prescription for TJA patients were found. Three studies assessed legislation at the state level while the others were institution-based guidelines. Overall, these studies demonstrated a significant decrease in mean morphine milligram equivalents of initial opioid prescription after implementing the policies. CONCLUSION Recent opioid-restricting legislation is effective in decreasing postoperative opioid prescriptions following TJA.
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Affiliation(s)
- Dustin J Randall
- Oakland University William Beaumont School of Medicine, Rochester, MI
| | - Aimen Vanood
- Oakland University William Beaumont School of Medicine, Rochester, MI; Department of Neurology, Mayo Clinic, Scottsdale, AZ
| | - Young Jee
- Department of Orthopaedic Surgery, Beaumont Health, Royal Oak, MI
| | - Drew D Moore
- Department of Orthopaedic Surgery, Beaumont Health, Royal Oak, MI
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Xu AL, Dunham AM, Enumah ZO, Humbyrd CJ. Patient understanding regarding opioid use in an orthopaedic trauma surgery population: a survey study. J Orthop Surg Res 2021; 16:736. [PMID: 34952626 PMCID: PMC8709537 DOI: 10.1186/s13018-021-02881-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 12/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prior studies have assessed provider knowledge and factors associated with opioid misuse; similar studies evaluating patient knowledge are lacking. The purpose of this study was to assess the degree of understanding regarding opioid use in orthopaedic trauma patients. We also sought to determine the demographic factors and clinical and personal experiences associated with level of understanding. METHODS One hundred and sixty-six adult orthopaedic trauma surgery patients across two clinical sites of an academic institution participated in an internet-based survey (2352 invited, 7.1% response rate). Demographic, clinical, and personal experience variables, as well as perceptions surrounding opioid use were collected. Relationships between patient characteristics and opioid perceptions were identified using univariate and multivariable logistic regressions. Alpha = 0.05. RESULTS Excellent recognition (> 85% correct) of common opioids, side effects, withdrawal symptoms, and disposal methods was demonstrated by 29%, 10%, 30%, and 2.4% of patients; poor recognition (< 55%) by 11%, 56%, 33%, and 52% of patients, respectively. Compared with white patients, non-white patients had 7.8 times greater odds (95% confidence interval [CI] 1.9-31) of perceiving addiction discrepancy (p = 0.004). Employed patients with higher education levels were less likely to have excellent understanding of side effects (adjusted odds ratio [aOR] 0.06, 95% CI 0.006-0.56; p = 0.01) and to understand that dependence can occur within 2 weeks (aOR 0.28, 95% CI 0.09-0.86; p = 0.03) than unemployed patients. Patients in the second least disadvantaged ADI quartile were more knowledgeable about side effects (aOR 8.8, 95% CI 1.7-46) and withdrawal symptoms (aOR 2.7, 95% CI 1.0-7.2; p = 0.046) than those in the least disadvantaged quartile. Patients who knew someone who was dependent or overdosed on opioids were less likely to perceive addiction discrepancy (aOR 0.24, 95% CI 0.07-0.76; p = 0.02) as well as more likely to have excellent knowledge of withdrawal symptoms (aOR 2.6, 95% CI 1.1-6.5, p = 0.03) and to understand that dependence can develop within 2 weeks (aOR 3.8, 95% CI 1.5-9.8, p = 0.005). CONCLUSIONS Level of understanding regarding opioid use is low among orthopaedic trauma surgery patients. Clinical and personal experiences with opioids, in addition to demographics, should be emphasized in the clinical history.
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Affiliation(s)
- Amy L Xu
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Alexandra M Dunham
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Zachary O Enumah
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Casey J Humbyrd
- Department of Orthopaedic Surgery, The University of Pennsylvania, 230 West Washington Square, 5th Floor Farm Journal Building,, Philadelphia, PA, 19106, USA.
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Beating Pain with Psychedelics: Matter over Mind? Neurosci Biobehav Rev 2021; 134:104482. [PMID: 34922987 DOI: 10.1016/j.neubiorev.2021.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/19/2021] [Accepted: 12/04/2021] [Indexed: 02/08/2023]
Abstract
Basic pain research has shed light on key cellular and molecular mechanisms underlying nociceptive and phenomenological aspects of pain. Despite these advances, [[we still yearn for] the discovery of novel therapeutic strategies to address the unmet needs of about 70% of chronic neuropathic pain patients whose pain fails to respond to opioids as well as to other conventional analgesic agents. Importantly, a substantial body of clinical observations over the past decade cumulatively suggests that the psychedelic class of drugs may possess heuristic value for understanding and treating chronic pain conditions. The present review presents a theoretical framework for hitherto insufficiently understood neuroscience-based mechanisms of psychedelics' potential analgesic effects. To that end, searches of PubMed-indexed journals were performed using the following Medical Subject Headings' terms: pain, analgesia, inflammatory, brain connectivity, ketamine, psilocybin, functional imaging, and dendrites. Recursive sets of scientific and clinical evidence extracted from this literature review were summarized within the following key areas: (1) studies employing psychedelics for alleviation of physical and emotional pain; (2) potential neuro-restorative effects of psychedelics to remediate the impaired connectivity underlying the dissociation between pain-related conscious states/cognitions and the subcortical activity/function leading to the eventual chronicity through immediate and long-term effects on dentritic plasticity; (3) anti-neuroinflammatory and pro-immunomodulatory actions of psychedelics as the may pertain to the role of these factors in the pathogenesis of neuropathic pain; (4) safety, legal, and ethical consideration inherent in psychedelics' pharmacotherapy. In addition to direct beneficial effects in terms of reduction of pain and suffering, psychedelics' inclusion in the analgesic armamentarium will contribute to deeper and more sophisticated insights not only into pain syndromes but also into frequently comorbid psychiatric condition associated with emotional pain, e.g., depressive and anxiety disorders. Further inquiry is clearly warranted into the above areas that have potential to evolve into further elucidate the mechanisms of chronic pain and affective disorders, and lead to the development of innovative, safe, and more efficacious neurobiologically-based therapeutic approaches.
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Abraham O, Rosenberger C, Tierney K, Birstler J. Investigating the Use of a Serious Game to Improve Opioid Safety Awareness Among Adolescents: A Quantitative Study. JMIR Serious Games 2021; 9:e33975. [PMID: 34747712 PMCID: PMC8738992 DOI: 10.2196/33975] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/27/2021] [Accepted: 11/06/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The misuse of opioid medications among adolescents is a serious problem in the United States. Serious games (SGs) are a novel way to promote safe and responsible management of opioid medications among adolescents, thereby reducing the number of adolescent opioid misuse cases reported annually. OBJECTIVE This study aimed to examine the effect of the SG MedSMA℞T: Adventures in PharmaCity on adolescents' opioid safety knowledge, awareness, behavioral intent, and self-efficacy. METHODS A nationally representative sample of adolescents age 12 to 18 years old were recruited online through Qualtrics panels from October to November 2020. Data collection consisted of a pre-game survey, 30 minutes of gameplay, and a post-game survey. The pre- and post-game survey included 66 items examining participants' baseline opioid knowledge, safety, and use, and demographic information. The post-game survey had 25 additional questions regarding the MedSMA℞T game. Gameplay scenarios included five levels intended to mimic adolescents' daily life while educating players about appropriate opioid storage and disposable practices, negative consequences of sharing opioid medications, and use of Narcan®. Survey questions were divided into 10 categories to represent key concepts and summarized into concept scores. Differences in concept scores were described by overall mean (SD) when stratified by gender, race, school, grade, and age. Differences of change in concept score were analyzed using Kruskal-Wallis and correlation tests. RESULTS A total of 117 responses were analyzed. Results showed significant improvement on all concept scores except for Narcan® knowledge (mean change = -0.04, SD = 0.29, p = 0.600) and safe storage (mean change = 0.03, SD = 0.20, p = 0.088). Female participants had greater improvement than males for safe disposal (female mean (SD) = 0.12 (0.25), male = 0.04 (0.17), p = 0.050). Male participants had higher improvement than females for misuse behavior (female mean (SD) = 0.05 (0.28) male = 0.14 (0.27), p = 0.043). Perceived knowledge for participants who were non-white or Hispanic had higher improvement than non-Hispanic white participants (non-white mean (SD) = 1.10 (1.06), white = 0.75 (0.91), p = 0.026). Older grades were associated with greater improvement in opioid knowledge (correlation coefficient -0.23 (95% CI -0.40 to -0.05), p = 0.012). There were 28 (23.9%) participants who played all 5 levels of the game and had better improvement in opioid use self-efficacy. CONCLUSIONS Findings suggest MedSMA℞T: Adventures in PharmaCity can be used as an effective tool to educate adolescents on the safe and responsible use of prescribed opioid medications. Future testing of the effectiveness of this SG should involve a randomized control trial. Additionally, the feasibility of implementing and disseminating MedSMA℞T: Adventures in PharmaCity in schools and healthcare settings, such as adolescent health or primary care clinics, emergency departments, and pharmacies, should be investigated. CLINICALTRIAL
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Affiliation(s)
- Olufunmilola Abraham
- Social and Administrative Sciences Division, School of Pharmacy, University of Wisconsin-Madison, 777 Highland Ave, Madison, US
| | - Claire Rosenberger
- Social and Administrative Sciences Division, School of Pharmacy, University of Wisconsin-Madison, 777 Highland Ave, Madison, US
| | - Kathleen Tierney
- Social and Administrative Sciences Division, School of Pharmacy, University of Wisconsin-Madison, 777 Highland Ave, Madison, US
| | - Jen Birstler
- Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, US
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Nalven T, Spillane NS, Schick MR, Weyandt LL. Diversity inclusion in United States opioid pharmacological treatment trials: A systematic review. Exp Clin Psychopharmacol 2021; 29:524-538. [PMID: 34242040 PMCID: PMC8511246 DOI: 10.1037/pha0000510] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pharmacological treatments for opioid use disorders (OUDs) may have mixed efficacy across diverse groups, i.e., sex/gender, race/ethnicity, and socioeconomic status (SES). The present systematic review aims to examine how diverse groups have been included in U.S. randomized clinical trials examining pharmacological treatments (i.e., methadone, buprenorphine, or naltrexone) for OUDs. PubMed was systematically searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The initial search yielded 567 articles. After exclusion of ineligible articles, 50 remained for the present review. Of the included articles, 14.0% (n = 7) reported both full (i.e., accounting for all participants) sex/gender and race/ethnicity information; only two of those articles also included information about any SES indicators. Moreover, only 22.0% (n = 11) reported full sex/gender information, and 42.0% (n = 21) reported full racial/ethnic information. Furthermore, only 10.0% (n = 5) reported that their lack of subgroup analyses or diverse samples was a limitation to their studies. Particularly underrepresented were American Indian/Alaska Native (AI/AN), Asian, Native Hawaiian/Other Pacific Islander (NH/OPI), and multiracial individuals. These results also varied by medication type; Black individuals were underrepresented in buprenorphine randomized controlled trials (RCTs) but were well represented in RCTs for methadone and/or naltrexone. In conclusion, it is critical that all people receive efficacious pharmacological care for OUDs given the ongoing opioid epidemic. Findings from the present review, however, support that participants from diverse or marginalized backgrounds are underrepresented in treatment trials, despite being at increased risk for disparities related to OUDs. Suggestions for future research are advanced. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Tessa Nalven
- Department of Psychology, University of Rhode Island
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Seak YS, Nor J, Tuan Kamauzaman TH, Arithra A, Islam MA. Efficacy and Safety of Intranasal Ketamine for Acute Pain Management in the Emergency Setting: A Systematic Review and Meta-Analysis. J Clin Med 2021; 10:jcm10173978. [PMID: 34501425 PMCID: PMC8432265 DOI: 10.3390/jcm10173978] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/07/2021] [Accepted: 08/31/2021] [Indexed: 02/06/2023] Open
Abstract
Due to overcrowding, personnel shortages, or problematic intravenous (IV) cannulation, acute pain management is often sub-optimal in emergency departments (EDs). The objective of this systematic review and meta-analysis was to evaluate the efficacy and safety of intranasal (IN) ketamine for adult acute pain in the emergency setting. We searched and identified studies up to 21 May 2021 via PubMed, Scopus, Web of Science, Cochrane Database, and Google Scholar. The random-effects model with 95% confidence intervals (CIs) was used to estimate mean differences (MDs) and odds ratios (ORs). The I2 statistic and Cochran’s Q test were used to determine heterogeneity. The protocol was registered in PROSPERO (CRD42020213391). Seven randomised controlled trials were included with a total of 1760 patients. There was no significant difference in pain scores comparing IN ketamine with IV analgesics or placebo at 5 (MD 0.94, p = 0.26), 15 (MD 0.15, p = 0.74), 25 (MD 0.24, p = 0.62), 30 (MD −0.05, p = 0.87), and 60 (MD −0.42, p = 0.53) minutes. There was also no significant difference in the need for rescue analgesics between IN ketamine and IV analgesics (OR 1.66, 95% CI: 0.57−4.86, p = 0.35, I2 = 70%). Only mild adverse effects were observed in patients who received IN ketamine. Our results suggest that IN ketamine is non-inferior to IV analgesics and may have a role in acute pain management among adults in the ED.
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Affiliation(s)
- Yee Sin Seak
- Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (Y.S.S.); (T.H.T.K.); (A.A.)
- Hospital Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Junainah Nor
- Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (Y.S.S.); (T.H.T.K.); (A.A.)
- Hospital Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
- Correspondence: (J.N.); (M.A.I.)
| | - Tuan Hairulnizam Tuan Kamauzaman
- Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (Y.S.S.); (T.H.T.K.); (A.A.)
- Hospital Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Ariff Arithra
- Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (Y.S.S.); (T.H.T.K.); (A.A.)
- Hospital Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Md Asiful Islam
- Department of Haematology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
- Correspondence: (J.N.); (M.A.I.)
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Gupta S, Butler SJ. Getting in touch with your senses: Mechanisms specifying sensory interneurons in the dorsal spinal cord. WIREs Mech Dis 2021; 13:e1520. [PMID: 34730293 PMCID: PMC8459260 DOI: 10.1002/wsbm.1520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/10/2021] [Accepted: 01/11/2021] [Indexed: 11/18/2022]
Abstract
The spinal cord is functionally and anatomically divided into ventrally derived motor circuits and dorsally derived somatosensory circuits. Sensory stimuli originating either at the periphery of the body, or internally, are relayed to the dorsal spinal cord where they are processed by distinct classes of sensory dorsal interneurons (dIs). dIs convey sensory information, such as pain, heat or itch, either to the brain, and/or to the motor circuits to initiate the appropriate response. They also regulate the intensity of sensory information and are the major target for the opioid analgesics. While the developmental mechanisms directing ventral and dorsal cell fates have been hypothesized to be similar, more recent research has suggested that dI fates are specified by novel mechanisms. In this review, we will discuss the molecular events that specify dorsal neuronal patterning in the spinal cord, thereby generating diverse dI identities. We will then discuss how this molecular understanding has led to the development of robust stem cell methods to derive multiple spinal cell types, including the dIs, and the implication of these studies for treating spinal cord injuries and neurodegenerative diseases. This article is categorized under: Neurological Diseases > Stem Cells and Development.
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Affiliation(s)
- Sandeep Gupta
- Department of NeurobiologyUniversity of California, Los AngelesLos AngelesCaliforniaUSA
| | - Samantha J. Butler
- Department of NeurobiologyUniversity of California, Los AngelesLos AngelesCaliforniaUSA
- Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell ResearchUniversity of California, Los AngelesLos AngelesCaliforniaUSA
- Intellectual and Developmental Disabilities Research CenterUniversity of California, Los AngelesLos AngelesCaliforniaUSA
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Alexander K, Pogorzelska-Maziarz M, Gerolamo A, Hassen N, Kelly EL, Rising KL. The impact of COVID-19 on healthcare delivery for people who use opioids: a scoping review. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2021; 16:60. [PMID: 34372900 PMCID: PMC8352141 DOI: 10.1186/s13011-021-00395-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/20/2021] [Indexed: 02/02/2023]
Abstract
Research objective The COVID-19 pandemic disrupted healthcare delivery worldwide with likely negative effects on people who use opioids (PWUO). This scoping review of the original research literature describes the impact of the COVID-19 pandemic on healthcare delivery for PWUO and identifies gaps in the literature. Methods This scoping review of the original research literature maps the available knowledge regarding the impact of the COVID-19 pandemic on healthcare delivery for PWUO. We utilized the methodology developed by the Joanna Briggs Institute for scoping reviews, and content analyses methodology to characterize the current state of the literature. Results Of the 14 included studies, administrative database (n = 11), cross-sectional (n = 1) or qualitative (n = 2) studies demonstrated service gaps (n = 7), patient/provider experiences (n = 3), and patient outcomes for PWUO (n = 4). In March 2020, healthcare utilization dropped quickly, sharply increasing only for reasons of opioid overdose by May 2020. Service gaps existed in accessing treatment for new patients during the pandemic due to capacity and infrastructure limits. Physicians reported difficulty referring patients to begin an outpatient opioid treatment program due to increased restrictions in capacity and infrastructure. Patients also reported uncertainty about accessing outpatient treatment, but that telehealth initiation of buprenorphine increased access to treatment from home. Disproportionate increases in overdose rates among African Americans were reported in two studies, with differences by race and gender not examined in most studies. Fatal overdoses increased 60% in African Americans during the pandemic, while fatal overdoses in Non-Hispanic White individuals decreased. Conclusions In summary, this beginning evidence demonstrates that despite early reluctance to use the healthcare system, opioid overdose-related use of healthcare increased throughout the pandemic. Service delivery for medications to treat OUD remained at or above pre-pandemic levels, indicating the ability of telehealth to meet demand. Yet, racial disparities that existed pre-pandemic for PWUO are intensifying, and targeted intervention for high-risk groups is warranted to prevent further mortality. As the pandemic progresses, future research must focus on identifying and supporting subgroups of PWUO who are at heightened risk for experiencing negative outcomes and lack of access to care.
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Affiliation(s)
- Karen Alexander
- Jefferson College of Nursing, Thomas Jefferson University, 901 Walnut St., Suite 800, Philadelphia, PA, 19107, USA.
| | - Monika Pogorzelska-Maziarz
- Jefferson College of Nursing, Thomas Jefferson University, 901 Walnut St., Suite 800, Philadelphia, PA, 19107, USA
| | - Angela Gerolamo
- Jefferson College of Nursing, Thomas Jefferson University, 901 Walnut St., Suite 800, Philadelphia, PA, 19107, USA
| | - Nadia Hassen
- Jefferson College of Nursing, Thomas Jefferson University, 901 Walnut St., Suite 800, Philadelphia, PA, 19107, USA
| | - Erin L Kelly
- Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, 1015 Walnut Street, Suite 40, Philadelphia, PA, 19107, USA
| | - Kristin L Rising
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, 1020 Sansom Street, Suite 239, Philadelphia, PA, 19107, USA
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Henrik G, Patrik M, Anders H, Ulf J, Marcelo RF, Åsa R. Tapering of prescribed opioids in patients with long-term non-malignant pain (TOPIO)-efficacy and effects on pain, pain cognitions, and quality of life: a study protocol for a randomized controlled clinical trial with a 12-month follow-up. Trials 2021; 22:503. [PMID: 34321058 PMCID: PMC8318331 DOI: 10.1186/s13063-021-05449-5] [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: 09/04/2020] [Accepted: 07/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background Opioids are still widely prescribed to long-term pain patients although they are no longer recommended for long-term treatments due to poor evidence for long-term efficacy, risks of serious side effects, and the possibility of inducing opioid hyperalgesia. In a Cochrane study from 2017, the authors identified an urgent need for more randomized controlled trials investigating the efficiency and effects of opioid tapering. The study aimed to assess (1) the efficiency of a structured intervention in causing stable reductions of opioid consumption in a population with long-term non-malignant pain and (2) effects on pain, pain cognitions, physical and mental health, quality of life, and functioning in response to opioid tapering. Methods The study is a randomized controlled trial. The sample size was set to a total of 140 individuals after estimation of power and dropout. Participants will be recruited from a population with long-term non-malignant pain who will be randomly allocated to (1) the start of tapering immediately or (2) the control group who return to usual care and will commence tapering of opioids 4 months later. A 12-month follow-up is included. When all follow-ups are closed, data from the Swedish drug register of the National Board of Health and Welfare will be collected and individual mean daily opioid dose in morphine equivalents will be calculated at three time points: baseline, 4 months, and 12 months after the start of the intervention. At the same time points, participants fill out the following questionnaires: Numeric Pain Rating Scale (NPRS), Tampa Scale of Kinesiophobia (TSK), Pain Catastrophizing Scale (PCS), Chronic Pain Acceptance Questionnaire (CPAQ-8), Hospital Anxiety and Depression Scale (HADS), and RAND-36. At baseline and follow-up, a clinical assessment of opioid use disorder is performed. Discussion A better understanding of the efficiency and effects of opioid tapering could possibly facilitate attempts to taper opioid treatments, which might prove beneficial for both the individual and society. Trial registration ClinicalTrials.gov NCT03485430. Retrospectively registered on 26 March 2018, first release date. “Tapering of Long-term Opioid Therapy in Chronic Pain Population. RCT with 12 Months Follow up (TOPIO).” First patient in trial 22 March 2018.
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Affiliation(s)
- Grelz Henrik
- Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lasarettsgatan 13, 221 85, Lund, Sweden. .,Center for Primary Health Care Research, Faculty of Medicine Department of Clinical Sciences Malmö, Lund University, Jan Waldenströms gata 35, 202 13, Malmö, Sweden.
| | - Midlöv Patrik
- Center for Primary Health Care Research, Faculty of Medicine Department of Clinical Sciences Malmö, Lund University, Jan Waldenströms gata 35, 202 13, Malmö, Sweden
| | - Håkansson Anders
- Department of Clinical Sciences Lund, Faculty of Medicine, Psychiatry, Lund University, Baravägen 1, 221 00, Lund, Sweden
| | - Jakobsson Ulf
- Center for Primary Health Care Research, Faculty of Medicine Department of Clinical Sciences Malmö, Lund University, Jan Waldenströms gata 35, 202 13, Malmö, Sweden
| | - Rivano Fischer Marcelo
- Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lasarettsgatan 13, 221 85, Lund, Sweden.,Center for Primary Health Care Research, Faculty of Medicine Department of Clinical Sciences Malmö, Lund University, Jan Waldenströms gata 35, 202 13, Malmö, Sweden
| | - Ringqvist Åsa
- Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lasarettsgatan 13, 221 85, Lund, Sweden.,Center for Primary Health Care Research, Faculty of Medicine Department of Clinical Sciences Malmö, Lund University, Jan Waldenströms gata 35, 202 13, Malmö, Sweden
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Scoville JP, Joyce E, Hunsaker J, Reese J, Wilde H, Arain A, Bollo RL, Rolston JD. Stereotactic Electroencephalography Is Associated With Reduced Pain and Opioid Use When Compared with Subdural Grids: A Case Series. Oper Neurosurg (Hagerstown) 2021; 21:6-13. [PMID: 33733680 DOI: 10.1093/ons/opab040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/25/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Minimally invasive surgery (MIS) has been shown to decrease length of hospital stay and opioid use. OBJECTIVE To identify whether surgery for epilepsy mapping via MIS stereotactically placed electroencephalography (SEEG) electrodes decreased overall opioid use when compared with craniotomy for EEG grid placement (ECoG). METHODS Patients who underwent surgery for epilepsy mapping, either SEEG or ECoG, were identified through retrospective chart review from 2015 through 2018. The hospital stay was separated into specific time periods to distinguish opioid use immediately postoperatively, throughout the rest of the stay and at discharge. The total amount of opioids consumed during each period was calculated by transforming all types of opioids into their morphine equivalents (ME). Pain scores were also collected using a modification of the Clinically Aligned Pain Assessment (CAPA) scale. The 2 surgical groups were compared using appropriate statistical tests. RESULTS The study identified 43 patients who met the inclusion criteria: 36 underwent SEEG placement and 17 underwent craniotomy grid placement. There was a statistically significant difference in median opioid consumption per hospital stay between the ECoG and the SEEG placement groups, 307.8 vs 71.5 ME, respectively (P = .0011). There was also a significant difference in CAPA scales between the 2 groups (P = .0117). CONCLUSION Opioid use is significantly lower in patients who undergo MIS epilepsy mapping via SEEG compared with those who undergo the more invasive ECoG procedure. As part of efforts to decrease the overall opioid burden, these results should be considered by patients and surgeons when deciding on surgical methods.
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Affiliation(s)
- Jonathan P Scoville
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, USA
| | - Evan Joyce
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, USA
| | - Joshua Hunsaker
- School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Jared Reese
- School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Herschel Wilde
- School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Amir Arain
- Department of Neurology, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Robert L Bollo
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, USA
| | - John D Rolston
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, USA.,Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, Utah, USA
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Multimodal Nonopioid Pain Protocol Provides Equivalent Pain Versus Opioid Control Following Meniscus Surgery: A Prospective Randomized Controlled Trial. Arthroscopy 2021; 37:2237-2245. [PMID: 33713756 DOI: 10.1016/j.arthro.2021.02.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 02/18/2021] [Accepted: 02/25/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess the effectiveness of a nonopioid pain regimen in controlling postoperative pain as compared with a traditional opioid pain control following primary meniscectomy or meniscal repair. METHODS Ninety-nine patients undergoing primary meniscectomy or meniscal repair were assessed for participation. A prospective randomized control trial was performed in accordance with the Consolidated Standards of Reporting Trials 2010 statement. The 2 arms of the study included a multimodal nonopioid analgesic protocol and a standard opioid regimen with a primary outcome of postoperative pain level (visual analog scale) for the first 10 days postoperatively. Secondary outcomes included patient-reported outcomes, complications, and patient satisfaction. Randomization was achieved using a random-number generator. Patients were not blinded. Data collection was done by a blinded observer. RESULTS Eleven patients did not meet the inclusion criteria, and 27 declined participation. A total of 61 patients were analyzed with 30 randomized to the opioid regimen and 31 randomized to the nonopioid regimen. Patients receiving the nonopioid regimen demonstrated noninferior visual analog scale scores compared with patients who received opioid pain medication (P > .05). No significant differences were found in preoperative (opioid: 58.9 ± 7.0; nonopioid: 58.2 ± 5.5, P = .724) or postoperative (opioid: 59.8 ± 6.5; nonopioid: 54.9 ± 7.1, P = .064) Patient-Reported Outcomes Measurement and Information System Pain Interference Short Form scores. No difference was found in recorded side effects between both groups at any given time point: constipation, nausea, diarrhea, upset stomach, and drowsiness (P > .05). CONCLUSIONS This study found that a multimodal nonopioid pain protocol provided equivalent pain control and patient outcomes following primary meniscus surgery while having an equivalent side effect profile. All patients reported satisfaction with their pain management without requiring emergency opioid analgesia. LEVEL OF EVIDENCE Level I, prospective randomized controlled trial.
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Pharmacological mechanisms underlying the efficacy of antibodies generated by a vaccine to treat oxycodone use disorder. Neuropharmacology 2021; 195:108653. [PMID: 34126123 DOI: 10.1016/j.neuropharm.2021.108653] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/07/2021] [Accepted: 06/06/2021] [Indexed: 11/24/2022]
Abstract
Therapeutic vaccines offer a viable strategy to treat opioid use disorders (OUD) complementary to current pharmacotherapies. The candidate Oxy(Gly)4-sKLH vaccine targeting oxycodone displayed pre-clinical proof of efficacy, selectivity and safety, and it is now undergoing clinical evaluation. To further support its implementation in the clinic, this study tested critical in vivo neuropsychopharmacological properties of the Oxy(Gly)4-sKLH vaccine in rats. While repeated immunizations with Oxy(Gly)4-sKLH were necessary to maintain the antibody response overtime, exposure to free oxycodone did not boost oxycodone-specific antibody levels in vaccinated rats, limiting concerns of immune-related side effects. Immunization with Oxy(Gly)4-sKLH achieved sustained antibody titers over a period of five months following initial vaccination, supporting its potential for providing long-lasting protection. In vivo studies of selectivity showed that vaccination prevented oxycodone-induced but not methadone-induced antinociception, while still preserving the opioid antagonist naloxone's pharmacological effects. Vaccination did not interfere with fentanyl-induced antinociception or fentanyl distribution to the brain. These in vivo data confirm the previously reported in vitro selectivity profile of Oxy(Gly)4-sKLH. Vaccination extended oxycodone's half-life up to 25 h compared to control. While vaccination reduced the reinforcing efficacy of oxycodone in an intravenous self-administration model, signs of toxicity were not observed. These rodent studies confirm that active immunization with Oxy(Gly)4-sKLH induces highly specific and long-lasting antibodies which are effective in decreasing the reinforcing effects of oxycodone while preserving the efficacy of medications used to treat OUD and overdose.
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Ellis JL, Sudhakar A, Simhan J. Enhanced recovery strategies after penile implantation: a narrative review. Transl Androl Urol 2021; 10:2648-2657. [PMID: 34295750 PMCID: PMC8261412 DOI: 10.21037/tau-20-1220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 11/02/2020] [Indexed: 12/03/2022] Open
Abstract
Optimizing pain management strategies in penile implantation has historically been a challenge to urologists assuming care of patients post-operatively. In addition to the complex pathophysiology of male genital pain, the responsibility of opioid stewardship in the face of the ongoing narcotics epidemic presents its own set of challenges to experienced implanters. Recent innovations in pre- and intra-operative analgesia have provided some improvement in patient-reported pain outcomes. When used together in protocols spanning each phase of operative care, multimodal analgesia (MMA) regimens provide superior patient pain control and successfully decrease opioid usage compared to traditional opioid-based pain control. This review will systematically present literature that discusses interventions in the preoperative and intraoperative spaces aimed at optimally controlling pain. We will also highlight surgical techniques that have been demonstrated to help ameliorate post-operative pain in penile implant recipients. We will discuss the impact of MMA protocols across urology and further explore its larger impact on reducing opioid burden in the ongoing epidemic.
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Affiliation(s)
- Jeffrey L Ellis
- Department of Urology, Einstein Healthcare Network, Philadelphia, PA, USA
| | - Architha Sudhakar
- Department of Urology, Einstein Healthcare Network, Philadelphia, PA, USA
| | - Jay Simhan
- Department of Urology, Einstein Healthcare Network, Philadelphia, PA, USA.,Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
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