1
|
Amin-Esmaeili M, Alinsky R, Johnson RM, Gribble A, Oyedele N, Parnham T, Goddard L, Susukida R. Impact of unsolicited reporting notifications on providers' prescribing behavior: An experimental study on Maryland PDMP data. Drug Alcohol Depend 2023; 248:109896. [PMID: 37163865 DOI: 10.1016/j.drugalcdep.2023.109896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 04/19/2023] [Accepted: 04/21/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Unsolicited Reporting Notifications(URNs) have been a component of Maryland's Prescription Drug Monitoring Program (PDMP) since 2016. We evaluated the effect of URNs on providers' prescription behaviors. METHODS This is a quasi-experimental study of providers who were issued at least one URN from January 2018 to April 2021. Providers for whom URNs were not successfully delivered were designated as a comparison group. The outcome variables were average daily opioid and benzodiazepine prescriptions, average morphine milligram equivalents per patient, and proportion of overlapping opioid and benzodiazepine, either with or without muscle relaxant prescriptions. Changes were compared before versus after the issuance of a URN among the intervention and comparison groups using "Generalized Estimation Equation" and "Generalized Linear" Models. We also conducted stratified analyses by types of URN, including notifications for multiple provider episodes (MPE), overdose fatality (ODF), and dangerous drug combinations (DDC). RESULTS The average daily number of opioids prescriptions (3.3% decrease in the intervention group vs 22.7% increase in the comparison group, P<0.001), co-prescription of opioids and benzodiazepines either with muscle relaxants (68.0% decrease vs. 36.1% decrease, P<0.001), or without muscle relaxants (6.0% decrease vs. 16.3% increase, P<0.001), significantly reduced after the first URN regardless of the type of URN. Stratified analysis by types of URNs showed that ODF and DDC URNs had a significant effect on most of the outcomes of interest. CONCLUSION The findings suggest that unsolicited reporting, especially particular types of URNs including ODF and DDC, is associated with subsequent changes in unsafe prescribing behaviors.
Collapse
Affiliation(s)
- Masoumeh Amin-Esmaeili
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, United States.
| | - Rachel Alinsky
- Department of Pediatrics, Johns Hopkins University School of Medicine, United States; Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, United States
| | - Renee M Johnson
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, United States
| | - Anna Gribble
- Maryland Department of Health (MDH), Office of Provider Engagement and Regulation (OPER), United States
| | - Natasha Oyedele
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, United States
| | - Taylor Parnham
- Department of Health Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, United States
| | - Lindsey Goddard
- Maryland Department of Health (MDH), Office of Provider Engagement and Regulation (OPER), United States
| | - Ryoko Susukida
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, United States
| |
Collapse
|
2
|
Koch NV, Butterfield RJ. An observational study of the factors associated with frequency of outpatient benzodiazepine prescribing to patients receiving chronic opioid analgesic therapy in primary care at a major academic center. BMC Prim Care 2022; 23:322. [PMID: 36513985 PMCID: PMC9749278 DOI: 10.1186/s12875-022-01936-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Prescribing benzodiazepines to patients taking chronic opioid analgesic therapy increases risks of adverse events. In 2016, the Centers for Disease Control and Prevention recommended avoidance of benzodiazepine prescribing concurrently with opioids, and various organizations have instituted similar guidelines. We aimed to determine the frequency and patterns of benzodiazepine prescribing at Mayo Clinic primary care (Community Internal Medicine, Family Medicine) clinics for patients taking chronic opioid analgesic therapy and the characteristics of patients receiving the prescriptions and providers administering them. METHODS This retrospective observational study included adult patients taking chronic opioid analgesic therapy for 2 full years in 2018 and 2019 at Mayo Clinic primary care practices in Arizona and Florida. We assessed electronic health records for these individual patients to determine whether they received a benzodiazepine prescription during the study period and how frequently they received a prescription. Variations in prescriptions by provider specialty, location, and sex were studied. Documented data included receipt of a benzodiazepine prescription by patients with at-risk alcohol use or alcohol use disorder, depression, anxiety, chronic obstructive pulmonary disease, falls, and psychiatric referral. Data were compared between patients who received benzodiazepines and those who did not with the Kruskal-Wallis test or χ2 test, and the Wilcoxon signed rank test was used to assess whether the change in number of benzodiazepine prescriptions (2018 vs. 2019) was different from zero. RESULTS Study participants (N = 457) were predominantly women (n = 266, 58.2%); median age was 69 years. In total, 148 patients (32.4%) received benzodiazepine prescription. These patients were more likely to be women (P = .046) and younger (P = .02). Mean percentage change was 176.9% (P < .001) in number of benzodiazepine prescriptions provided from 2018 to 2019. Frequency of referral to mental health providers was low, as was presence of an established mental health provider despite a greater prevalence of anxiety (P < .001) and depression (P = .001) among patients receiving benzodiazepines. CONCLUSION Benzodiazepine prescription to individual patients taking chronic opioid analgesic therapy significantly increased from 2018 to 2019 despite the documented risks and harms associated with such practice. No statistically significant difference was observed in frequency of benzodiazepine prescriptions between practice location, sex of provider, or specialty.
Collapse
|
3
|
Cheng S, Siddiqui TG, Gossop M, Stavem K, Kristoffersen ES, Lundqvist C. Health-related quality of life in hospitalized older patients with versus without prolonged use of opioid analgesics, benzodiazepines, and z-hypnotics: a cross-sectional study. BMC Geriatr 2020; 20:425. [PMID: 33096993 PMCID: PMC7585301 DOI: 10.1186/s12877-020-01838-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 10/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Central nervous system depressant medications (CNSDs) such as opioid analgesics and sedative-hypnotics are commonly prescribed to older patients for the treatment of chronic pain, anxiety and insomnia. Yet, while many studies reported potential harms, it remains unknown whether persistent use of these medications is beneficial for older patients' self-reported health-related quality of life (HRQoL). The present study clarified this knowledge gap through comparing HRQoL of hospitalized older patients with versus without using CNSD drugs for ≥4 weeks. Moreover, we explored the relationship between such use and HRQoL, adjusting for the effects of polypharmacy, comorbidity burden and other clinically relevant covariates. METHODS The study was cross-sectional and included 246 older patients recruited consecutively from somatic departments of a large regional university hospital in Norway. We defined prolonged CNSD use as using opioids, benzodiazepines and/or z-hypnotics for ≥4 weeks. Patients' self-reported HRQoL were measured with scales of the EuroQol EQ-5D-3L instrument. Data analyses were mainly descriptive statistics and regression models. RESULTS Patients with prolonged use of CNSDs reported lower scores on both EQ-5D index and EQ VAS compared with those without such use (p < 0.001). They had higher odds of having more problems performing usual activities (OR = 3.37, 95% CI: 1.40 to 8.13), pain/discomfort (OR = 2.06, 95% CI: 1.05 to 4.04), and anxiety/depression (OR = 3.77, 95% CI: 1.82 to 7.82). In multivariable regression models, there was no significant association between prolonged CNSD use and HRQoL when including pain as a predictor variable. In models not including pain, CNSD use was strongly associated with HRQoL (adjusted for sociodemographic background, polypharmacy, comorbidity, anxiety and depressive symptoms, regression coefficient - 0.19 (95% CI, - 0.31 to - 0.06). CONCLUSIONS Older patients with prolonged CNSD use reported poorer HRQoL. They also had more pain and higher depression scores. Prolonged use of CNSDs was not independently associated with higher HRQoL.
Collapse
Affiliation(s)
- Socheat Cheng
- Health Services Research Unit (HØKH), Akershus University Hospital, PO Box 1000, 1478, Lørenskog, Norway. .,Institute of Clinical Medicine, Campus Ahus, Faculty of Medicine, University of Oslo, Lørenskog, Norway.
| | - Tahreem Ghazal Siddiqui
- Health Services Research Unit (HØKH), Akershus University Hospital, PO Box 1000, 1478, Lørenskog, Norway.,Institute of Clinical Medicine, Campus Ahus, Faculty of Medicine, University of Oslo, Lørenskog, Norway
| | - Michael Gossop
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Knut Stavem
- Health Services Research Unit (HØKH), Akershus University Hospital, PO Box 1000, 1478, Lørenskog, Norway.,Institute of Clinical Medicine, Campus Ahus, Faculty of Medicine, University of Oslo, Lørenskog, Norway.,Department of Pulmonary Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Espen Saxhaug Kristoffersen
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway.,Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| | - Christofer Lundqvist
- Health Services Research Unit (HØKH), Akershus University Hospital, PO Box 1000, 1478, Lørenskog, Norway.,Institute of Clinical Medicine, Campus Ahus, Faculty of Medicine, University of Oslo, Lørenskog, Norway.,Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| |
Collapse
|
4
|
Mukherjee D, Shukla L, Saha P, Mahadevan J, Kandasamy A, Chand P, Benegal V, Murthy P. Tapentadol abuse and dependence in India. Asian J Psychiatr 2020; 49:101978. [PMID: 32120298 DOI: 10.1016/j.ajp.2020.101978] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 02/07/2020] [Accepted: 02/21/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Tapentadol is a synthetic opioid analgesic available in India since 2011. International evidence suggests a low risk of abuse and diversion. Our study aims to question this perception in Indian context. METHOD We report the trend and profile of Tapentadol abuse cases that were treated at a tertiary level addiction treatment centre in southern India. We also describe the ease of repurposing oral tablets of Tapentadol into an injection. At the national level, we have examined the temporal and spatial trends of online interest in Tapentadol and compared it with a non-opioid drug Ilaprazole and an opioid drug Tramadol using Google Trends. We have used the National Drug Use Survey 2019 to illustrate the regional data. RESULTS 23 cases of Tapentadol abuse sought treatment between 01/01/2011 and 30/08/2019. In last one year, the number of cases has more than doubled. A majority (N = 19, 83 %) of cases had intravenous Tapentadol abuse, needle sharing and 60 % were diagnosed with Hepatitis C. Tapentadol is attracting new users (N = 13, 56.5 %) as well as replacing other opioids (N = 10, 43.5 %) amongst drug users. Tapentadol has received more online interest than Ilaprazole. Temporal and spatial trends of online interest in Tapentadol parallel Tramadol. States with high prevalence of opioid users have shown high online interest in both opioid drugs. CONCLUSION Tapentadol is being widely abused, and urgent regulatory measures are required.
Collapse
Affiliation(s)
- Diptadhi Mukherjee
- Centre for Addiction Medicine, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, 560011, India.
| | - Lekhansh Shukla
- Centre for Addiction Medicine, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, 560011, India.
| | - Priyanka Saha
- Centre for Addiction Medicine, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, 560011, India.
| | - Jayant Mahadevan
- Centre for Addiction Medicine, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, 560011, India.
| | - Arun Kandasamy
- Centre for Addiction Medicine, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, 560011, India.
| | - Prabhat Chand
- Centre for Addiction Medicine, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, 560011, India.
| | - Vivek Benegal
- Centre for Addiction Medicine, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, 560011, India.
| | - Pratima Murthy
- Centre for Addiction Medicine, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, 560011, India.
| |
Collapse
|
5
|
Abstract
Background: Prescription drug abuse is a public health problem in the United States and the region of Appalachia, specifically. Primary care and addiction medicine-as possible points of access for prescription drugs with abuse potential and points of intervention for prescription drug abuse-are among the medical fields at its forefront. Little is known, however, about perceptions of prescription drug abuse across the two patient populations. Objectives: The objective of this qualitative analysis was to explore perceptions of the scale and context of prescription drug abuse among primary care and addiction medicine patients in Appalachia. Methods: As part of a mixed methods study, semi-structured interviews were conducted with 20 patients from primary care and addiction medicine in Central and South Central Appalachia from 2014 to 2015. The interviews were audio-recorded and transcribed verbatim. Thematic analysis was used to identify themes. Results: Three themes were identified: (1) pervasiveness of prescription drug abuse, describing perceptions of its high prevalence and negative consequences; (2) routes and routine practices for prescription drug acquisition and distribution, describing perceptions of routes of access to prescription drugs and behaviors exhibited to acquire and distribute prescription drugs; and (3) rationales for prescription drug acquisition and distribution, describing perceptions of the two underlying reasons for these processes-tolerance/addiction and revenue source. Conclusions/Importance: Perceptions of prescription drug abuse among primary care and addiction medicine patients in Appalachia are multifaceted, especially regarding prescription drug acquisition and distribution. Clinical practice implications for mitigating prescription drug abuse are discussed.
Collapse
Affiliation(s)
- Stephanie M Mathis
- Department of Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA.,Center for Prescription Drug Abuse Prevention and Treatment, East Tennessee State University, Johnson City, Tennessee, USA
| | - Nicholas Hagemeier
- Center for Prescription Drug Abuse Prevention and Treatment, East Tennessee State University, Johnson City, Tennessee, USA.,Department of Pharmacy Practice, Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, Tennessee, USA
| | - Kelly N Foster
- Department of Sociology and Anthropology, College of Arts and Sciences, East Tennessee State University, Johnson City, Tennessee, USA.,Applied Social Research Laboratory, East Tennessee State University, Johnson City, Tennessee, USA
| | - Katie Baker
- Department of Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Robert P Pack
- Department of Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA.,Center for Prescription Drug Abuse Prevention and Treatment, East Tennessee State University, Johnson City, Tennessee, USA
| |
Collapse
|
6
|
Ramachandran S, Rosenthal M, Young J, Holmes E, Bentley JP. Subtle scales: An avenue for identification of prescription drug abuse. Res Social Adm Pharm 2019; 15:936-942. [PMID: 30954396 DOI: 10.1016/j.sapharm.2019.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 02/19/2019] [Accepted: 02/20/2019] [Indexed: 11/26/2022]
Abstract
Prescription drug abuse and diversion behavior is sustained by overprescribing of abuse-liable substances. Individuals who intend to abuse or divert prescriptions can feign symptoms easily and effectively. Efforts to identify such faking behavior have been lacking because most drug abuse screening tools and self-reported symptom inventories are known to have poor sensitivities to faking. This paper makes the case for the potential of subtle scales in the identification of faking behavior. Subtlety in scale development is the degree to which the psychopathological meaning of an item can be determined in an a priori fashion. Scales containing subtle items, such as the Minnesota Multiphasic Personality Inventory and the Substance Abuse Subtle Screening Inventory, have traditionally shown only moderate sensitivity to faking due to the lack of a tailored and focused approach. This paper provides a guide for the development of a subtle scale that is tailored to a specific condition and using sound measurement theory, a theoretical framework, and knowledge derived from literature. The Accuracy of Knowledge framework proposed by Lanyon is presented along with its application to the development of a subtle scale. Further, specific recommendations have been provided for the various steps involved in the development of a subtle scale including item development, sample selection, item refinement, and scale scoring. Use of well-developed subtle scales can present opportunities to reduce overprescribing, over-diagnosis, and help in the early identification of abuse behavior for targeted interventions. We conclude by presenting opportunities, scope, and possible avenues for research within the cultural context of the United States.
Collapse
Affiliation(s)
- Sujith Ramachandran
- Department of Pharmacy Administration, University of Mississippi, University, MS, USA.
| | - Meagen Rosenthal
- Department of Pharmacy Administration, University of Mississippi, University, MS, USA
| | - John Young
- Department of Psychology, University of Mississippi, University, MS, USA
| | - Erin Holmes
- Department of Pharmacy Administration, University of Mississippi, University, MS, USA
| | - John P Bentley
- Department of Pharmacy Administration, University of Mississippi, University, MS, USA
| |
Collapse
|
7
|
Evoy KE, Covvey JR, Peckham AM, Ochs L, Hultgren KE. Reports of gabapentin and pregabalin abuse, misuse, dependence, or overdose: An analysis of the Food And Drug Administration Adverse Events Reporting System (FAERS). Res Social Adm Pharm 2019; 15:953-8. [PMID: 31303196 DOI: 10.1016/j.sapharm.2018.06.018] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 04/10/2018] [Accepted: 06/27/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Reports of gabapentinoid (gabapentin and pregabalin) misuse have increased in recent years. Pharmacovigilance data from the Food and Drug Administration Adverse Event Reporting System (FAERS) provides a useful examination of adverse drug event (ADE) reporting for safety signal detection. OBJECTIVE This study was conducted to analyze epidemiological information on the nature and extent of gabapentin/pregabalin abuse utilizing the FAERS database. METHODS A query was designed utilizing SafeRx, an indexed, searchable database of FAERS data from October 2012-December 2016. All-cause and abuse-related (including abuse/misuse/dependence/overdose events) ADE reports for gabapentin and pregabalin were isolated, as well as limited demographic data. The proportional reporting ratio (PRR) was calculated to compare signal detection. RESULTS A total of 10,038 all-cause ADEs were reported to FAERS for gabapentin, including 576 (5.7%) abuse-related events. For pregabalin, 571 all-cause ADEs were identified, including 58 (10.2%) related to abuse. Compared to all-cause ADEs, those involved in abuse-related events were younger and more likely to be male. The PRR of pregabalin versus gabapentin abuse-related events was 1.77. CONCLUSION Though not traditionally thought of as drugs of abuse, over 600 cases of gabapentinoid abuse were reported in the time frame analyzed, prompting the need for further study and regulatory investigation.
Collapse
|
8
|
Roberts AW, Farley JF, Holmes GM, Oramasionwu CU, Ringwalt C, Sleath B, Skinner AC. Controlled Substance Lock-In Programs: Examining An Unintended Consequence Of A Prescription Drug Abuse Policy. Health Aff (Millwood) 2018; 35:1884-1892. [PMID: 27702963 DOI: 10.1377/hlthaff.2016.0355] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Controlled substance lock-in programs are garnering increased attention from payers and policy makers seeking to combat the epidemic of opioid misuse. These programs require high-risk patients to visit a single prescriber and pharmacy for coverage of controlled substance medication services. Despite high prevalence of the programs in Medicaid, we know little about their effects on patients' behavior and outcomes aside from reducing controlled substance-related claims. Our study was the first rigorous investigation of lock-in programs' effects on out-of-pocket controlled substance prescription fills, which circumvent the programs' restrictions and mitigate their potential public health benefits. We linked claims data and prescription drug monitoring program data for the period 2009-12 for 1,647 enrollees in North Carolina Medicaid's lock-in program and found that enrollment was associated with a roughly fourfold increase in the likelihood and frequency of out-of-pocket controlled substance prescription fills. This finding illuminates weaknesses of lock-in programs and highlights the need for further scrutiny of the appropriate role, optimal design, and potential unintended consequences of the programs as tools to prevent opioid abuse.
Collapse
Affiliation(s)
- Andrew W Roberts
- Andrew W. Roberts is an assistant professor in the Department of Pharmacy Sciences, School of Pharmacy and Health Professions, and a program faculty member in the Center for Health Services Research and Patient Safety, both at Creighton University, in Omaha, Nebraska
| | - Joel F Farley
- Joel F. Farley is a professor in the Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, at the University of North Carolina at Chapel Hill
| | - G Mark Holmes
- G. Mark Holmes is an associate professor in the Department of Health Policy and Management, Gillings School of Global Public Health, and director of the the Cecil G. Sheps Center for Health Services Research, both at UNC-Chapel Hill
| | - Christine U Oramasionwu
- Christine U. Oramasionwu is an assistant professor in the Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, at UNC-Chapel Hill
| | - Chris Ringwalt
- Chris Ringwalt is a senior research scientist at the Injury Prevention Research Center, UNC-Chapel Hill
| | - Betsy Sleath
- Betsy Sleath is the George H. Cocolas Distinguished Professor; chair of the Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy; and director of the Child and Adolescent Health Services Program at the Sheps Center, all at UNC-Chapel Hill
| | - Asheley C Skinner
- Asheley C. Skinner is an associate professor at the Duke Clinical Research Institute, Duke University, in Durham, North Carolina
| |
Collapse
|
9
|
Naumann RB, Marshall SW, Lund JL, Gottfredson NC, Ringwalt CL, Skinner AC. Evaluating short- and long-term impacts of a Medicaid "lock-in" program on opioid and benzodiazepine prescriptions dispensed to beneficiaries. Drug Alcohol Depend 2018; 182:112-119. [PMID: 29150151 PMCID: PMC7475002 DOI: 10.1016/j.drugalcdep.2017.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 09/11/2017] [Accepted: 10/01/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Insurance-based "lock-in" programs (LIPs) have become a popular strategy to address controlled substance (CS) (e.g., opioid) misuse. However, little is known about their impacts. We examined changes in CS dispensing to beneficiaries in the 12-month North Carolina Medicaid LIP. METHODS We analyzed Medicaid claims linked to Prescription Drug Monitoring Program (PDMP) records for beneficiaries enrolled in the LIP between October 2010 and September 2012 (n=2702). Outcomes of interest were 1) number of dispensed CS prescriptions and 2) morphine milligram equivalents (MMEs) of dispensed opioids while a) locked-in and b) in the year following release. RESULTS Compared to a period of stable CS dispensed prior to LIP enrollment, numbers of dispensed CS during lock-in and post-release were lower (count difference per person-month: -0.05 (95% CI: -0.11, 0.01); -0.23 (95% CI: -0.31, -0.15), respectively). However, beneficiaries' average daily MMEs of opioids were elevated during both lock-in and post-release (daily mean difference per person: 18.7 (95% CI: 13.9, 23.6); 11.1 (95% CI: 5.1, 17.1), respectively). Stratification by payer source revealed increases in using non-Medicaid (e.g., out-of-pocket) payment during lock-in that persisted following release. CONCLUSION While the LIP reduced the number of CS dispensed, the program was also associated with increased acquisition of CS prescriptions using non-Medicaid payment. Moreover, beneficiaries acquired greater dosages of dispensed opioids from both Medicaid and non-Medicaid payment sources during lock-in and post-release. Refining LIPs to increase beneficiary access to substance use disorder screening and treatment services and provider use of PDMPs may address important unintended consequences.
Collapse
Affiliation(s)
- Rebecca B. Naumann
- Injury Prevention Research Center and Department of Epidemiology, University of North Carolina at Chapel Hill, CVS Plaza, Suite 500, 137 East Franklin St., CB#7505, Chapel Hill, NC 27599 USA,Corresponding Author: Rebecca Naumann, Phone: 919-966-6625, Fax: 919-966-0466,
| | - Stephen W. Marshall
- Injury Prevention Research Center and Department of Epidemiology, University of North Carolina at Chapel Hill, CVS Plaza, Suite 500, 137 East Franklin St., CB#7505, Chapel Hill, NC 27599 USA
| | - Jennifer L. Lund
- Department of Epidemiology, University of North Carolina at Chapel Hill, 2102D McGavran-Greenberg Hall, CB#7435, Chapel Hill, NC 27590 USA
| | - Nisha C. Gottfredson
- Department of Health Behavior, University of North Carolina at Chapel Hill, 319C Rosenau Hall, CB#7440, Chapel Hill, NC 27599 USA
| | - Christopher L. Ringwalt
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, CVS Plaza, Suite 500, 137 East Franklin St., CB#7505, Chapel Hill, NC 27599 USA
| | | |
Collapse
|
10
|
Green JL, Bucher Bartelson B, Le Lait MC, Roland CL, Masters ET, Mardekian J, Bailey JE, Dart RC. Medical outcomes associated with prescription opioid abuse via oral and non-oral routes of administration. Drug Alcohol Depend 2017; 175:140-145. [PMID: 28414990 DOI: 10.1016/j.drugalcdep.2017.01.039] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 01/13/2017] [Accepted: 01/14/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Prescription opioid abuse and misuse is a serious and growing public health issue. While the most common form of abuse is swallowing intact tablets/capsules, some abusers manipulate, or tamper with, these medications by altering the dosage form to allow for non-oral routes of administration (e.g., injection, inhalation) in order to achieve more rapid or enhanced psychoactive effects. Because administration of opioids via non-oral routes results in greater systemic availability and more rapid central nervous system penetration, we hypothesized that death and major medical outcomes occur more frequently with non-oral routes compared to oral route alone. METHODS This retrospective cohort study analyzed data from the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS) System Poison Center Program to investigate relative risk of prescription opioid abuse via oral and non-oral routes. RESULTS While the oral route was the most commonly reported route of abuse (64.0%), non-oral routes were reported in 14.6% exposures and unknown routes in 21.4% exposures. The relative risk of an exposure resulting in death or major effect was 2.43 (95% CI 1.97, 2.99) if non-oral routes were reported compared to exposures involving oral route only. CONCLUSION Analysis of acute health events recorded by poison centers indicates that death or major effects are twice as likely to occur with intentional abuse of prescription opioids via non-oral routes of administration than ingestion alone. Effective interventions to prevent abuse via non-oral routes of solid dosage forms of prescription opioids, such as abuse-deterrent formulations could have a significant public health impact.
Collapse
Affiliation(s)
- Jody L Green
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, 660 Bannock Street, MC 0180, Denver, CO 80204 USA.
| | - Becki Bucher Bartelson
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, 660 Bannock Street, MC 0180, Denver, CO 80204 USA.
| | - M Claire Le Lait
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, 660 Bannock Street, MC 0180, Denver, CO 80204 USA.
| | - Carl L Roland
- Pfizer Inc, 4222 Emperor Blvd., Suite 335, Durham, NC 27703 USA.
| | | | | | - J Elise Bailey
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, 660 Bannock Street, MC 0180, Denver, CO 80204 USA.
| | - Richard C Dart
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, 660 Bannock Street, MC 0180, Denver, CO 80204 USA.
| |
Collapse
|
11
|
Liakoni E, Müller S, Stoller A, Ricklin M, Liechti ME, Exadaktylos AK. Presentations to an urban emergency department in Bern, Switzerland associated with acute recreational drug toxicity. Scand J Trauma Resusc Emerg Med 2017; 25:26. [PMID: 28264690 PMCID: PMC5340017 DOI: 10.1186/s13049-017-0369-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 02/21/2017] [Indexed: 12/01/2022] Open
Abstract
Background Although the recreational use of psychoactive substances is common there is only limited systematic collection of data on acute drug toxicity or hospital presentations. Currently, data from Switzerland are only available from the University Hospital of Basel. The present study aimed to describe the presentations due to recreational drug use at an emergency department in Bern, Switzerland during a 4 year period. Methods Retrospective analysis of cases presenting from May 2012 to April 2016 at the emergency department of the University Hospital of Bern, Switzerland, with symptoms/signs consistent with acute toxicity of recreational drug use. The cases were retrieved using a comprehensive full-text search algorithm of the electronic health records. Isolated ethanol intoxications were excluded. Results During the study period, 503 of the 157,328 emergency department attendances were directly related to acute toxicity of substances used recreationally. The mean patient age was 33 years (range 16–74), 68% were male. Alcohol co-ingestion was reported in 54% of the cases, and use of more than one recreational drug in 37% of the cases. Most presentations were related to cocaine (29%), cannabis (26%), heroin (20%) and benzodiazepines/sedatives (18%). Urine drug screening immunoassay was available in 277 cases (55%). The most frequently detected substances were cannabis (29%), cocaine (22%), benzodiazepines (21%) and opioids excluding methadone (20%). There were only two intoxications with novel psychoactive substances (NPSs): One with methylone and one with 2,5-dimethoxy-4(n)-propylphenethylamine (2C-P). The majority of patients (58%) displayed impaired consciousness (Glasgow Coma Scale (GCS) <15) upon presentation and/or pre-hospital; 21% were unconscious (GCS <8). Other frequent symptoms were agitation (36%), tachycardia (29%), and anxiety (24%). Severe complications included two fatalities, three acute myocardial infarctions, two intracranial haemorrhages, as well as psychosis and seizures in 71 and 26 cases, respectively. Conclusions Most medical problems related to recreational drug use were associated with cocaine and cannabis use and were mainly characterised by central nervous system depression, sympathomimetic toxicity and/or psychiatric disorders. Presentations related to acute toxicities of NPSs appear to be uncommon, while prescription drugs were after classical recreational drugs the substances most commonly reported. Electronic supplementary material The online version of this article (doi:10.1186/s13049-017-0369-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Evangelia Liakoni
- Department of Nephrology, Hypertension and Clinical Pharmacology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Sabine Müller
- Department of Nephrology, Hypertension and Clinical Pharmacology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adrian Stoller
- Department of Nephrology, Hypertension and Clinical Pharmacology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Meret Ricklin
- Emergency Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Matthias E Liechti
- Division of Clinical Pharmacology and Toxicology, Basel University Hospital and University of Basel, Basel, Switzerland
| | | |
Collapse
|
12
|
Rolland B, Bouhassira D, Authier N, Auriacombe M, Martinez V, Polomeni P, Brousse G, Schwan R, Lack P, Bachellier J, Rostaing S, Bendimerad P, Vergne-Salle P, Dematteis M, Perrot S. [Misuse and dependence on prescription opioids: Prevention, identification and treatment]. Rev Med Interne 2017; 38:539-546. [PMID: 28214183 DOI: 10.1016/j.revmed.2016.12.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 10/23/2016] [Accepted: 12/30/2016] [Indexed: 11/26/2022]
Abstract
Since the 1990s, the use of prescription opioids has largely spread, which has brought a real progress in the treatment of pain. The long-term use of prescription opioid is sometimes required, and may lead to pharmacological tolerance and withdrawal symptoms, i.e. pharmacological dependence on prescription opioids. Occasionally, this may also lead to misuse of prescription opioids (MPO). MPO preferentially occurs in vulnerable individuals, i.e., those with a young age, history of other addictive or psychiatric disorders, especially anxious and depressive disorders. MPO is associated with numerous complications, including an increased risk of fatal overdose. Prevention of MPO begins before the opioid prescription, with the identification of potential vulnerability factors. A planned and personalized monitoring should be systematically implemented. In vulnerable patients, contractualizing the prescription is warranted. During follow-up, the relevance of the prescription should be regularly reconsidered, according to the benefit observed on pain and the potential underlying signs of MPO. Patients with suspected MPO should be referred early to pain or addiction centers. The treatment of MPO should be based on multidisciplinary strategies, involving both the addiction and pain aspects: progressive opioid withdrawal, non-pharmacological measures against pain, or switching to medication-assisted treatment of addiction (i.e., buprenorphine or methadone).
Collapse
Affiliation(s)
- B Rolland
- Service d'addictologie, hôpital Fontan 2, CHRU de Lille, CS 70001, 59037 Lille cedex, France.
| | - D Bouhassira
- Inserm U-987, centre d'évaluation et de traitement de la douleur, hôpital Ambroise-Paré, 92100 Boulogne-Billancourt, France
| | - N Authier
- UMR Inserm 1107, faculté de médecine, pharmacologie médicale, CRPV/CEIP/CETD, centre d'évaluation et de traitement de la douleur/institut Analgesia, CHU de Clermont-Ferrand, F-63000 Clermont-Ferrand, France
| | - M Auriacombe
- Université de Bordeaux et CNRS USR 3413 (sanpsy), pôle addictologie, CH Ch. Perrens et CHU de Bordeaux, 33076 Bordeaux, France
| | - V Martinez
- Service d'anesthésie, hôpital Raymond-Poincaré, 92380 Garches, France
| | - P Polomeni
- Service d'addictologie, hôpital René-Muret, hôpitaux universitaires Paris Seine-Saint-Denis, 93270 Sevran, France
| | - G Brousse
- Service de psychiatrie B, CHU, hôpital Gabriel-Montpied, F-63003 Clermont-Ferrand, France
| | - R Schwan
- Pôle hospitalo-universitaire de psychiatrie d'adultes du Nancy, centre psychothérapique de Nancy, 54520 Laxou, France
| | - P Lack
- CSAPA, hôpital de la Croix-Rousse, hospices civils de Lyon, 69004 Lyon, France
| | - J Bachellier
- CSAPA centre Port-Bretagne, CHU de Tours, 37000 Tours, France
| | - S Rostaing
- Hôpital Saint-Antoine, centre d'évaluation et de traitement de la douleur, 75012 Paris, France
| | - P Bendimerad
- Service de psychiatrie, secteur 2, CH de La Rochelle, 17019 La Rochelle, France
| | - P Vergne-Salle
- Service de rhumatologie et centre de la douleur, CHU de Limoges, 87042 Limoges, France
| | - M Dematteis
- Service d'addictologie, CHU de Grenoble-Alpes, université Grenoble-Alpes, 38700 La Tronche, France
| | - S Perrot
- Inserm U-987, centre de la douleur, hôpital Hôtel-Dieu, université Paris-Descartes, 75014 Paris, France
| |
Collapse
|
13
|
Arria AM, Caldeira KM, Vincent KB, O'Grady KE, Cimini MD, Geisner IM, Fossos-Wong N, Kilmer JR, Larimer ME. Do college students improve their grades by using prescription stimulants nonmedically? Addict Behav 2017; 65:245-249. [PMID: 27469455 DOI: 10.1016/j.addbeh.2016.07.016] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 07/08/2016] [Accepted: 07/18/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Many college students engage in nonmedical use of prescription stimulants (NPS) because they believe it provides academic benefits, but studies are lacking to support or refute this belief. METHODS Using a longitudinal design, 898 undergraduates who did not have an ADHD diagnosis were studied. Year 3 GPA (from college records) of four groups was compared: Abstainers (did not engage in NPS either year; 68.8%); Initiators (NPS in Year 3 but not Year 2; 8.7%); Desisters (NPS in Year 2 but not Year 3; 5.8%); and Persisters (NPS in both years; 16.7%). Generalized estimating equations regression was used to estimate the association between NPS and change in GPA, controlling for sex and Year 2 GPA. RESULTS GPA increased significantly within Abstainers (p<0.05), but did not change significantly within the other groups. Overall, the relationship between NPS pattern group and change in GPA was not statistically significant (p=0.081). NPS was generally infrequent, but Persisters used more frequently than Desisters (11.7 versus 3.4days in Year 2) and Initiators (13.6 versus 4.0days in Year 3, both ps<0.001), controlling for sex and Year 2 GPA. CONCLUSIONS We cannot rule out the possibility that NPS prevented declines in GPA, but we can conclude that students who engaged in NPS showed no increases in their GPAs and gained no detectable advantages over their peers. The results suggest that prevention and intervention strategies should emphasize that the promise of academic benefits from NPS is likely illusory.
Collapse
|
14
|
Abstract
Drug addiction is present in a significant proportion of the population in the USA and worldwide. Drug addiction can occur with the abuse of many types of substances including cocaine, marijuana, stimulants, alcohol, opioids, and tranquilizers. There is a high likelihood that clinicians will encounter patients with substance abuse disorders on a regular basis with the prevalence of the use of illicit substances and the high rate of abuse of prescription drugs. The use of abuse deterrent formulations of prescription opioid agents, pill counts, and urine drug abuse screenings are all useful strategies. Optimum pain management of patients with addiction in the outpatient and inpatient setting is essential to minimize pain states. Careful selection of medications and appropriate oversight, including drug agreements, can reduce drug-induced impairments, including sleep deficits and diminished physical, social, and sexual functioning. This review, therefore, discusses the prevalence of illicit and prescription drug addiction, the challenges of achieving optimum pain control, and the therapeutic approaches to be considered in this challenging population. More research is warranted to develop improved therapies and routes of treatments for optimum pain relief and to prevent the development of central sensitization, chronic pain, and impaired physical and social functioning in patients with drug addiction.
Collapse
Affiliation(s)
- Nalini Vadivelu
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, 06520, USA.
| | | | - Richard Zhu
- Yale University School of Medicine, New Haven, CT, 06520, USA
| | - Gopal Kodumudi
- California North State University College of Medicine, 9700 W Taron, Elk Grove, CA, 95757, USA
| | - Amir O Elhassan
- Department of Anesthesiology, LSU School of Medicine, New Orleans, LA, USA
| | - Alan David Kaye
- Department of Anesthesiology, LSU School of Medicine, New Orleans, LA, USA
| |
Collapse
|
15
|
Pomerleau AC, Schrager JD, Morgan BW. Pilot Study of the Importance of Factors Affecting Emergency Department Opioid Analgesic Prescribing Decisions. J Med Toxicol 2016; 12:282-8. [PMID: 27150104 PMCID: PMC4996790 DOI: 10.1007/s13181-016-0553-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 04/26/2016] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Little is known about the factors driving decision-making among emergency department (ED) providers when prescribing opioid analgesics (OA). The aim of this pilot study was to identify the importance of factors influencing OA-prescribing decisions and to determine how this varied among different types of providers. METHODS This was an observational cross-sectional survey study of 203 ED providers. The importance of decisional factors was rated on a 5-point Likert scale. Differences between provider groups were tested using Chi-squared or ANOVA tests where applicable. RESULTS Overall, 142/203 (69.9 %) potential respondents participated in the study. The five highest-rated factors were (mean ± SD) patient's opioid prescription history (4.4 ± 0.8), patient's history of substance abuse or dependence (4.4 ± 0.7), diagnosis thought to be the cause of patient's pain (4.2 ± 0.8), clinical gestalt (4.2 ± 0.7), and provider's concern about unsafe use of the medication (4.0 ± 0.9). The importance of 6 of 21 decisional factors varied significantly between different groups of providers. CONCLUSION In this pilot study of ED providers, the self-reported importance of several factors influencing OA-prescribing decisions were significantly different among attending physicians, resident physicians, and advanced practice providers. Further investigation into how ED providers make OA-prescribing decisions is needed to help guide interventions aimed at improving appropriate pain management.
Collapse
Affiliation(s)
- Adam C Pomerleau
- Department of Emergency Medicine, Emory University School of Medicine, 50 Hurt Plaza, Suite 600, Atlanta, GA, 30303, USA.
| | - Justin D Schrager
- Department of Emergency Medicine, Emory University School of Medicine, 50 Hurt Plaza, Suite 600, Atlanta, GA, 30303, USA
| | - Brent W Morgan
- Department of Emergency Medicine, Emory University School of Medicine, 50 Hurt Plaza, Suite 600, Atlanta, GA, 30303, USA
| |
Collapse
|
16
|
Seymour RB, Leas D, Wally MK, Hsu JR. Prescription reporting with immediate medication utilization mapping (PRIMUM): development of an alert to improve narcotic prescribing. BMC Med Inform Decis Mak 2016; 16:111. [PMID: 27549364 PMCID: PMC4994311 DOI: 10.1186/s12911-016-0352-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 08/18/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prescription narcotic overdoses and abuse have reached alarming numbers. To address this epidemic, integrated clinical decision support within the electronic medical record (EMR) to impact prescribing behavior was developed and tested. METHODS A multidisciplinary Expert Panel identified risk factors for misuse, abuse, or diversion of opioids or benzodiazepines through literature reviews and consensus building for inclusion in a rule within the EMR. We ran the rule "silently" to test the rule and collect baseline data. RESULTS Five criteria were programmed to trigger the alert; based on data collected during a "silent" phase, thresholds for triggers were modified. The alert would have fired in 21.75 % of prescribing encounters (1.30 % of all encounters; n = 9998), suggesting the alert will have a low prescriber burden yet capture a significant number of at-risk patients. CONCLUSIONS While the use of the EMR to provide clinical decision support is not new, utilizing it to develop and test an intervention is novel. We successfully built an alert system to address narcotic prescribing by providing critical, objective information at the point of care. The silent phase data were useful to appropriately tune the alert and obtain support for widespread implementation. Future healthcare initiatives can utilize similar methodology to collect data prospectively via the electronic medical record to inform the development, delivery, and evaluation of interventions.
Collapse
Affiliation(s)
- Rachel B. Seymour
- Department of Orthopaedic Surgery, Carolinas Health Care System, 1000 Blythe Boulevard, Charlotte, 28203 NC USA
- Carolinas Trauma Network Research Center of Excellence, Carolinas Health Care System, 1320 Scott Avenue, Charlotte, NC 28204 USA
| | - Daniel Leas
- Department of Orthopaedic Surgery, Carolinas Health Care System, 1000 Blythe Boulevard, Charlotte, 28203 NC USA
- Carolinas Trauma Network Research Center of Excellence, Carolinas Health Care System, 1320 Scott Avenue, Charlotte, NC 28204 USA
| | - Meghan K. Wally
- Department of Orthopaedic Surgery, Carolinas Health Care System, 1000 Blythe Boulevard, Charlotte, 28203 NC USA
- Carolinas Trauma Network Research Center of Excellence, Carolinas Health Care System, 1320 Scott Avenue, Charlotte, NC 28204 USA
| | - Joseph R. Hsu
- Department of Orthopaedic Surgery, Carolinas Health Care System, 1000 Blythe Boulevard, Charlotte, 28203 NC USA
- Carolinas Trauma Network Research Center of Excellence, Carolinas Health Care System, 1320 Scott Avenue, Charlotte, NC 28204 USA
| | - the PRIMUM Group
- Department of Orthopaedic Surgery, Carolinas Health Care System, 1000 Blythe Boulevard, Charlotte, 28203 NC USA
- Carolinas Trauma Network Research Center of Excellence, Carolinas Health Care System, 1320 Scott Avenue, Charlotte, NC 28204 USA
| |
Collapse
|
17
|
Chang HY, Lyapustina T, Rutkow L, Daubresse M, Richey M, Faul M, Stuart EA, Alexander GC. Impact of prescription drug monitoring programs and pill mill laws on high-risk opioid prescribers: A comparative interrupted time series analysis. Drug Alcohol Depend 2016; 165:1-8. [PMID: 27264166 DOI: 10.1016/j.drugalcdep.2016.04.033] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 04/23/2016] [Accepted: 04/24/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Prescription drug monitoring programs (PDMPs) and pill mill laws were implemented to reduce opioid-related injuries/deaths. We evaluated their effects on high-risk prescribers in Florida. METHODS We used IMS Health's LRx Lifelink database between July 2010 and September 2012 to identify opioid-prescribing prescribers in Florida (intervention state, N: 38,465) and Georgia (control state, N: 18,566). The pre-intervention, intervention, and post-intervention periods were: July 2010-June 2011, July 2011-September 2011, and October 2011-September 2012. High-risk prescribers were those in the top 5th percentile of opioid volume during four consecutive calendar quarters. We applied comparative interrupted time series models to evaluate policy effects on clinical practices and monthly prescribing measures for low-risk/high-risk prescribers. RESULTS We identified 1526 (4.0%) high-risk prescribers in Florida, accounting for 67% of total opioid volume and 40% of total opioid prescriptions. Relative to their lower-risk counterparts, they wrote sixteen times more monthly opioid prescriptions (79 vs. 5, p<0.01), and had more prescription-filling patients receiving opioids (47% vs. 19%, p<0.01). Following policy implementation, Florida's high-risk providers experienced large relative reductions in opioid patients and opioid prescriptions (-536 patients/month, 95% confidence intervals [CI] -829 to -243; -847 prescriptions/month, CI -1498 to -197), morphine equivalent dose (-0.88mg/month, CI -1.13 to -0.62), and total opioid volume (-3.88kg/month, CI -5.14 to -2.62). Low-risk providers did not experience statistically significantly relative reductions, nor did policy implementation affect the status of being high- vs. low- risk prescribers. CONCLUSIONS High-risk prescribers are disproportionately responsive to state policies. However, opioids-prescribing remains highly concentrated among high-risk providers.
Collapse
|
18
|
Fleming ML, Driver L, Sansgiry SS, Abughosh SM, Wanat M, Sawant RV, Ferries E, Reeve K, Todd KH. Physicians' intention to prescribe hydrocodone combination products after rescheduling: A theory of reasoned action approach. Res Social Adm Pharm 2016; 13:503-512. [PMID: 27567741 DOI: 10.1016/j.sapharm.2016.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 07/16/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The U.S. Drug Enforcement Administration (DEA) rescheduled hydrocodone combination products (HCPs) in an attempt to mitigate the prescription opioid epidemic. Many in the medical and pharmacy community expressed concerns of unintended consequences as a result of rescheduling. OBJECTIVES This study examined physicians' intentions to prescribe HCPs after rescheduling using the framework of the theory of reasoned action (TRA). METHODS A cover letter containing a link to the online questionnaire was sent to physicians of the Texas Medical Association who were likely to prescribe opioids. The questionnaire assessed physicians' intentions to prescribe HCPs after rescheduling. Predictor variables included attitude toward rescheduling, subjective norm toward HCP prescribing, and past prescribing behavior of schedule II prescriptions. All variables were measured on a 7-point, Likert-type scale. Intention to prescribe as a dependent variable was regressed over TRA variables and respondent characteristics. RESULTS A total of 1176 usable responses were obtained, yielding a response rate of 13.3%. Mean (M) age was 53.07 ± 11 and most respondents were male (70%) and Caucasian (75%). Physicians held a moderately positive intention to prescribe HCPs (M = 4.36 ± 2.08), held a moderately negative attitude towards rescheduling, M = 4.68 ± 1.51 (reverse coded). Subjective norm was moderately low, M = 3.06 ± 1.78, and past prescribing behavior M = 2.43 ± 1.21. The linear regression analysis indicated that attitude (β = 0.10; P = 0.006), subjective norm (β = 0.35; P < 0.0001) and past prescribing behavior (β = 0.59; P < 0.0001) were significant predictors of intention to prescribe HCPs after rescheduling. CONCLUSIONS TRA was shown to be a predictive model of physicians' intentions to prescribe HCPs after rescheduling. Overall, physicians held a moderately positive intention to prescribe HCPs. Past behavior concerning schedule II prescribing was found to be the most significant predictor of intention. Understanding the impact of federal rule changes on pain management care and patient satisfaction is necessary to determine whether this change has produced the intended consequences without harming patients in need of HCPs.
Collapse
Affiliation(s)
- Marc L Fleming
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston, College of Pharmacy, Texas Medical Center Campus, 1441 Moursund St, Houston, TX 77030, USA.
| | - Larry Driver
- Department of Pain Medicine, Division of Anesthesiology and Critical Care, The University of Texas-MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Sujit S Sansgiry
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston, College of Pharmacy, Texas Medical Center Campus, 1441 Moursund St, Houston, TX 77030, USA
| | - Susan M Abughosh
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston, College of Pharmacy, Texas Medical Center Campus, 1441 Moursund St, Houston, TX 77030, USA
| | - Matthew Wanat
- Department of Pharmacy Practice and Translational Research, University of Houston, College of Pharmacy, Texas Medical Center Campus, 1441 Moursund St, Houston, TX 77030, USA
| | - Ruta V Sawant
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston, College of Pharmacy, Texas Medical Center Campus, 1441 Moursund St, Houston, TX 77030, USA
| | - Erin Ferries
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston, College of Pharmacy, Texas Medical Center Campus, 1441 Moursund St, Houston, TX 77030, USA
| | - Kathleen Reeve
- School of Nursing, University of Houston, 14000 University Blvd., Sugar Land, TX 77479, USA
| | - Knox H Todd
- The University of Texas-MD Anderson Cancer Center, Unit 1468, 1515 Holcombe Blvd., Houston, TX 77030, USA
| |
Collapse
|
19
|
Hagemeier NE, Tudiver F, Brewster S, Hagy EJ, Hagaman A, Pack RP. Prescription drug abuse communication: A qualitative analysis of prescriber and pharmacist perceptions and behaviors. Res Social Adm Pharm 2015; 12:937-948. [PMID: 26806859 DOI: 10.1016/j.sapharm.2015.12.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 12/15/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Interpersonal communication is inherent in a majority of strategies seeking to engage prescriber and pharmacist health care professionals (HCPs) in the reduction and prevention of prescription drug abuse (PDA). However, research on HCP PDA communication behavioral engagement and factors that influence it is limited. OBJECTIVES This study quantitatively examined communication behaviors and trait-level communication metrics, and qualitatively described prescription drug abuse-related communication perceptions and behaviors among primary care prescribers and community pharmacists. METHODS Five focus groups (N = 35) were conducted within the Appalachian Research Network (AppNET), a rural primary care practice-based research network (PBRN) in South Central Appalachia between February and October, 2014. Focus groups were structured around the administration of three previously validated trait-level communication survey instruments, and one instrument developed by the investigators to gauge HCP prescription drug abuse communication engagement and perceived communication importance. Using a grounded theory approach, focus group themes were inductively derived and coded independently by study investigators. Member-checking interviews were conducted to validate derived themes. RESULTS Respondents' trait-level communication self-perceptions indicated low communication apprehension, high self-perceived communication competence, and average willingness to communicate as compared to instrument specific criteria and norms. Significant variation in HCP communication behavior engagement was noted specific to PDA. Two overarching themes were noted for HCP-patient communication: 1) influencers of HCP communication and prescribing/dispensing behaviors, and 2) communication behaviors. Multiple sub-themes were identified within each theme. Similarities were noted in perceptions and behaviors across both prescribers and pharmacists. CONCLUSIONS Despite the perceived importance of engaging in PDA communication, HCPs reported that prescription drug abuse communication is uncomfortable, variable, multifactorial, and often avoided. The themes that emerged from this analysis support the utility of communication science and health behavior theories to better understand and improve PDA communication behaviors of both prescribers and pharmacists, and thereby improve engagement in PDA prevention and treatment.
Collapse
Affiliation(s)
- Nicholas E Hagemeier
- Department of Pharmacy Practice, East Tennessee State University Gatton College of Pharmacy, P.O. Box 70657, Johnson City, TN 37614, USA.
| | - Fred Tudiver
- Department of Family Medicine, East Tennessee State University Quillen College of Medicine, USA
| | - Scott Brewster
- East Tennessee State University Gatton College of Pharmacy, USA
| | | | - Angela Hagaman
- East Tennessee State University College of Public Health, USA
| | - Robert P Pack
- Department of Community and Behavioral Health, East Tennessee State University College of Public Health, USA
| |
Collapse
|
20
|
Maughan BC, Bachhuber MA, Mitra N, Starrels JL. Prescription monitoring programs and emergency department visits involving opioids, 2004-2011. Drug Alcohol Depend 2015; 156:282-8. [PMID: 26454836 DOI: 10.1016/j.drugalcdep.2015.09.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 09/04/2015] [Accepted: 09/22/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the association between prescription drug monitoring program (PDMP) implementation and emergency department (ED) visits involving opioid analgesics. METHODS Rates of ED visits involving opioid analgesics per 100,000 residents were estimated from the Drug Abuse Warning Network dataset for 11 geographically diverse metropolitan areas in the United States on a quarterly basis from 2004 to 2011. Generalized estimating equations assessed whether implementation of a prescriber-accessible PDMP was associated with a difference in ED visits involving opioid analgesics. Models were adjusted for calendar quarter, metropolitan area, metropolitan area-specific linear time trends, and unemployment rate. RESULTS Rates of ED visits involving opioid analgesics increased in all metropolitan areas. PDMP implementation was not associated with a difference in ED visits involving opioid analgesics (mean difference of 0.8 visits [95% CI: -3.7 to 5.2] per 100,000 residents per quarter). CONCLUSIONS During 2004-2011, PDMP implementation was not associated with a change in opioid-related morbidity, as measured by emergency department visits involving opioid analgesics. Urgent investigation is needed to determine the optimal PDMP structure and capabilities to improve opioid analgesic safety.
Collapse
|
21
|
Norwood CW, Wright ER. Integration of prescription drug monitoring programs (PDMP) in pharmacy practice: Improving clinical decision-making and supporting a pharmacist's professional judgment. Res Social Adm Pharm 2016; 12:257-66. [PMID: 26143489 DOI: 10.1016/j.sapharm.2015.05.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 05/14/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Pharmacists have shared responsibility to investigate the validity of controlled substance prescriptions (CSPs) that raise concerns, or red flags, and subsequently exercise their right to refuse to dispense a CSP if its validity cannot be verified. Improving access to clinical practice tools, such as prescription drug monitoring programs (PDMPs), may increase availability of a patient's drug history, which is critical to making informed clinical decisions about dispensing CSPs. OBJECTIVES The purpose of this study was to examine how integration and consistent use of a PDMP in pharmacy practice impacts pharmacists' dispensing practices related to CSPs. METHODS A cross-sectional study examined pharmacists' knowledge and use of Indiana's (US State) PDMP (INSPECT) and dispensing practices of CSPs. Three outcome measures were analyzed using multiple logistic regression so as to examine the relationship between PDMP use and pharmacists' controlled substance dispensing behaviors. RESULTS Pharmacists were 6.4 times more likely to change their dispensing practice to dispense fewer CSPs if they reported that INSPECT provides increased access to patient information. Pharmacists who always use INSPECT refused an average of 25 CSPs annually compared to an average of 7 refusals for pharmacists not using INSPECT. Pharmacists using INSEPCT consistently (at every visit) were 3.3 times more likely to refuse to dispense more CSPs than pharmacists who report never using INSPECT. CONCLUSIONS Integration of PDMPs in pharmacy practice may improve a pharmacist's ability to make informed clinical decisions and exercise sound professional judgment. Providing clinical practice tools to both prescribers and pharmacists is important to preventing drug diversion and prescription drug abuse. Future research should focus on understanding the barriers and challenges to successful integration of PDMPs in pharmacy practice.
Collapse
|
22
|
Abstract
BACKGROUND Concomitant use of opioids and promethazine has been reported in various subpopulations, including methadone maintenance patients, injection drug users, and at-risk teenagers. Promethazine is thought to potentiate the "high" from opioids. However, to date, the prevalence of promethazine use has not been determined among patients prescribed opioids for chronic pain. METHODS Urine samples from 921 patients prescribed opioids for chronic pain were analyzed for promethazine. Demographic data, toxicology results, and opioid prescription information were obtained through medical record abstraction. We assessed the prevalence and factors associated with promethazine use with bivariable and multivariable statistics. RESULTS The prevalence of promethazine-positive urine samples among chronic pain patients was 9%. Only 50% of promethazine-positive patients had an active prescription for promethazine. Having benzodiazepine-positive urine with no prescription for a benzodiazepine was statistically associated with promethazine use. Also, having a prescription for methadone for pain or being in methadone maintenance for the treatment of opioid dependence were both statistically associated with promethazine use. Chronic pain patients prescribed only a long-acting opioid were more likely to have promethazine-positive urines than patients prescribed a short-acting opioid. CONCLUSIONS The study provides compelling evidence of significant promethazine use in chronic pain patients. Promethazine should be considered as a potential drug of abuse that could cause increased morbidity in opioid-using populations.
Collapse
Affiliation(s)
- Kara L. Lynch
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA,Address Correspondence to this author at: University of California San Francisco, San Francisco General Hospital, 1001 Potrero Ave. NH2M16, San Francisco, CA 94110 Phone: 415-206-5477, Fax: 415-206-3045,
| | - Brad J. Shapiro
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA,Department of Psychiatry, University of California San Francisco, San Francisco, CA
| | - Diana Coffa
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA
| | - Scott P. Novak
- RTI International, Behavioral Health Epidemiology, Research Triangle Park, NC
| | - Alex H. Kral
- RTI International, Urban Health Program, San Francisco, CA
| |
Collapse
|
23
|
Abstract
Prescription drug abuse has reached an epidemic level in the United States. The prevalence of prescription drug abuse escalated rapidly beginning in the late 1990s, requiring a significant increase in research to better understand the nature and treatment of this problem. Since this time, a research literature has begun to develop and has provided important information about how prescription drug abuse is similar to, and different from the abuse of other substances. This introduction to a special issue of the Journal of Substance Abuse Treatment on prescription drug abuse provides an overview of the current status of the research literature in this area. The papers in this special issue include a sampling of the latest research on the epidemiology, clinical correlates, treatment, and public policy considerations of prescription drug abuse. Although much has been learned about prescription drug abuse in recent years, this research remains in early stages, particularly with respect to understanding effective treatments for this population. Future research priorities include studies on the interaction of prescription drugs with other licit and illicit substances, the impact of prescription drug abuse across the lifespan, the optimal treatment for prescription drug abuse and co-occurring conditions, and effective public policy initiatives for reducing prescription drug abuse.
Collapse
Affiliation(s)
- R Kathryn McHugh
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
| | - Suzanne Nielsen
- University of New South Wales, National Drug and Alcohol Research Centre, New South Wales, Australia; Drug and Alcohol Services, South Eastern Sydney Local Health District, New South Wales, Australia
| | - Roger D Weiss
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| |
Collapse
|
24
|
Wright NMJ, Mohammed Z, Hughes GJ. Comparative prices of diverted buprenorphine/naloxone and buprenorphine in a UK prison setting: a cross-sectional survey of drug using prisoners. Drug Alcohol Depend 2014; 144:254-8. [PMID: 25305714 DOI: 10.1016/j.drugalcdep.2014.09.775] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 07/24/2014] [Accepted: 09/20/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is evidence regarding the abuse potential of buprenorphine in prison settings. There is also emerging evidence from community settings that buprenorphine/naloxone is less amenable to abuse than the single preparation buprenorphine hydrochloride as evidenced by cost-differentials of diverted medication. This study sought to explore cost-differentials within a prison setting of diverted buprenorphine/naloxone medication relative to either single preparation buprenorphine hydrochloride or methadone. METHODS Cross-sectional survey in one remand prison. RESULTS A total of 85 prisoners participated in the survey. Prisoners estimated buprenorphine to have a significantly (p<0.001) higher cost than buprenorphine/naloxone both inside and outside of prison. This finding was supported when the analysis was restricted to both the prisoners with a longer-term experience of taking opioid substitution drugs during their current prison stay and those with a longer-term experience prior to reception. CONCLUSIONS Consideration should be given to the recommendation that buprenorphine/naloxone medication is the prescribed buprenorphine preparation of choice for clinicians offering opiate substitution therapy to prisoners, pending developments of buprenorphine preparations that have less abuse potential than sublingual preparations.
Collapse
Affiliation(s)
- Nat M J Wright
- HMP Leeds, Healthcare Department, 2 Gloucester Terrace, Armley, Leeds, LS12 2TJ, United Kingdom; Leeds Community Healthcare NHS Trust, Leeds, LS6 1PF, United Kingdom.
| | - Zanib Mohammed
- HMP Leeds, Healthcare Department, 2 Gloucester Terrace, Armley, Leeds, LS12 2TJ, United Kingdom; Leeds Community Healthcare NHS Trust, Leeds, LS6 1PF, United Kingdom
| | - Gareth J Hughes
- Leeds Community Healthcare NHS Trust, Leeds, LS6 1PF, United Kingdom; Leeds Institute of Health Sciences, University of Leeds, LS2 9LJ, United Kingdom
| |
Collapse
|
25
|
Chen LY, Curm RM, Martins SS, Kaufmann CN, Strain EC, Mojtabai R. Patterns of concurrent substance use among nonmedical ADHD stimulant users: results from the National Survey on Drug Use and Health. Drug Alcohol Depend 2014; 142:86-90. [PMID: 24957742 PMCID: PMC4127416 DOI: 10.1016/j.drugalcdep.2014.05.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 05/26/2014] [Accepted: 05/31/2014] [Indexed: 10/25/2022]
Abstract
AIMS To examine patterns of concurrent substance use among adults with nonmedical ADHD stimulant use. METHODS We used latent class analysis (LCA) to examine patterns of past-year problematic substance use (meeting any criteria for abuse or dependence) in a sample of 6103 adult participants from the National Surveys on Drug Use and Health 2006-2011 who reported past-year nonmedical use of ADHD stimulants. Multivariable latent regression was used to assess the association of socio-demographic characteristics, mental health and behavioral problems with the latent classes. RESULTS A four-class model had the best model fit, including (1) participants with low probabilities for any problematic substance use (Low substance class, 53.3%); (2) problematic users of all types of prescription drugs (Prescription drug class, 13.3%); (3) participants with high probabilities of problematic alcohol and marijuana use (Alcohol-marijuana class, 28.8%); and (4) those with high probabilities of problematic use of multiple drugs and alcohol (Multiple substance class, 4.6%). Participants in the 4 classes had distinct socio-demographic, mental health and service use profiles with those in the Multiple substance class being more likely to report mental health and behavioral problems and service use. CONCLUSION Nonmedical users of ADHD stimulants are a heterogeneous group with a large subgroup with low prevalence of problematic use of other substances. These subgroups have distinct patterns of mental health comorbidity, behavior problems and service use, with implications for prevention and treatment of nonmedical stimulant use.
Collapse
Affiliation(s)
- Lian-Yu Chen
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 7th Floor, Baltimore, MD 21205, United States; Center for Drug Safety and Effectiveness, Johns Hopkins University, 615 N. Wolfe Street W6035, Baltimore, MD 21205, United States.
| | - Rosa M. Curm
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 7th floor, Baltimore, MD 21205,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive Baltimore, MD 21224,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street W6035, Baltimore, MD 21205
| | - Silvia S. Martins
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th street, Rm. 509, New York, NY 10032
| | - Christopher N. Kaufmann
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 7th floor, Baltimore, MD 21205
| | - Eric C. Strain
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive Baltimore, MD 21224
| | - Ramin Mojtabai
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 7th floor, Baltimore, MD 21205,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive Baltimore, MD 21224
| |
Collapse
|
26
|
O'Connor AB, Turk DC, Dworkin RH, Katz NP, Colucci R, Haythornthwaite JA, Klein M, O'Brien C, Posner K, Rappaport BA, Reisfield G, Adams EH, Balster RL, Bigelow GE, Burke LB, Comer SD, Cone E, Cowan P, Denisco RA, Farrar JT, Foltin RW, Haddox DJ, Hertz S, Jay GW, Junor R, Kopecky EA, Leiderman DB, McDermott MP, Palmer PP, Raja SN, Rauschkolb C, Rowbotham MC, Sampaio C, Setnik B, Smith SM, Sokolowska M, Stauffer JW, Walsh SL, Zacny JP. Abuse liability measures for use in analgesic clinical trials in patients with pain: IMMPACT recommendations. Pain 2014; 154:2324-2334. [PMID: 24148704 DOI: 10.1016/j.pain.2013.06.035] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 06/10/2013] [Accepted: 06/19/2013] [Indexed: 10/26/2022]
Abstract
Assessing and mitigating the abuse liability (AL) of analgesics is an urgent clinical and societal problem. Analgesics have traditionally been assessed in randomized clinical trials (RCTs) designed to demonstrate analgesic efficacy relative to placebo or an active comparator. In these trials, rigorous, prospectively designed assessment for AL is generally not performed. The Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) convened a consensus meeting to review the available evidence and discuss methods for improving the assessment of the AL of analgesics in clinical trials in patients with pain. Recommendations for improved assessment include: (1) performing trials that include individuals with diverse risks of abuse; (2) improving the assessment of AL in clinical trials (eg, training study personnel in the principles of abuse and addiction behaviors, designing the trial to assess AL outcomes as primary or secondary outcome measures depending on the trial objectives); (3) performing standardized assessment of outcomes, including targeted observations by study personnel and using structured adverse events query forms that ask all subjects specifically for certain symptoms (such as euphoria and craving); and (4) collecting detailed information about events of potential concern (eg, unexpected urine drug testing results, loss of study medication, and dropping out of the trial). The authors also propose a research agenda for improving the assessment of AL in future trials.
Collapse
Affiliation(s)
- Alec B O'Connor
- Department of Medicine, University of Rochester, Rochester, NY, USA Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA Department of Anesthesiology, University of Rochester, Rochester, NY, USA Analgesic Solutions, Natick, MA, USA Department of Anesthesiology, Tufts University School of Medicine, Boston, MA, USA Colucci & Associates LLC, Newtown, CT, USA Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA United States Food and Drug Administration, Silver Spring, MD, USA Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA, USA Center for Suicide Risk Assessment, New York State Psychiatric Institute/College of Physicians and Surgeons, Columbia University, New York, NY, USA Department of Psychiatry, University of Florida College of Medicine, Gainesville, FL, USA Covance, Princeton, NJ, USA Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, USA American Chronic Pain Association, Rocklin, CA, USA National Institute on Drug Abuse, Rockville, MD, USA Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA Purdue Pharma LP, Stamford, CT, USA Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA, USA Pfizer Inc, Ann Arbor, MI, USA Eisai Limited, Woodcliff Lake, NJ, USA Endo Pharmaceuticals Inc, Chadds Ford, PA, USA CNS Drug Consulting LLC, McLean, VA, USA Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, USA AcelRx Pharmaceuticals Inc, Redwood City, CA, USA Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore School of Medicine, MD, USA Johnson & Johnson Pharmaceutical Research & Development LLC, Raritan, NJ, USA California Pacific Medical Center Research Institute, San Francisco, CA, USA Clinical Pharmacology and Therapeutics Laboratory, Faculdade de Medicina de Lisboa, Lisbon, Portugal King Pharmaceuticals Inc, Cary, NC, USA Grünenthal USA Inc, Bedminster, NJ, USA Durect Corporation, Cupertino, CA, USA Department of Behavioral Science, Center on Drug and Alcohol Research, University of Kentucky, KY, USA Department of Anesthesia & Critical Care, University of Chicago, Chicago, IL, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Weiss RD, Potter JS, Griffin ML, McHugh RK, Haller D, Jacobs P, Gardin J, Fischer D, Rosen KD. Reasons for opioid use among patients with dependence on prescription opioids: the role of chronic pain. J Subst Abuse Treat 2014; 47:140-5. [PMID: 24814051 DOI: 10.1016/j.jsat.2014.03.004] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 02/07/2014] [Accepted: 03/24/2014] [Indexed: 11/19/2022]
Abstract
The number of individuals seeking treatment for prescription opioid dependence has increased dramatically, fostering a need for research on this population. The aim of this study was to examine reasons for prescription opioid use among 653 participants with and without chronic pain, enrolled in the Prescription Opioid Addiction Treatment Study, a randomized controlled trial of treatment for prescription opioid dependence. Participants identified initial and current reasons for opioid use. Participants with chronic pain were more likely to report pain as their primary initial reason for use; avoiding withdrawal was rated as the most important reason for current use in both groups. Participants with chronic pain rated using opioids to cope with physical pain as more important, and using opioids in response to social interactions and craving as less important, than those without chronic pain. Results highlight the importance of physical pain as a reason for opioid use among patients with chronic pain.
Collapse
Affiliation(s)
- Roger D Weiss
- McLean Hospital, 115 Mill St, Belmont, MA 02478, United States; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, United States.
| | - Jennifer Sharpe Potter
- McLean Hospital, 115 Mill St, Belmont, MA 02478, United States; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, United States; University of Texas Health Science Center San Antonio, 7526 Louis Pasteur MC7733, San Antonio, TX, 78229, United States
| | - Margaret L Griffin
- McLean Hospital, 115 Mill St, Belmont, MA 02478, United States; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, United States
| | - R Kathryn McHugh
- McLean Hospital, 115 Mill St, Belmont, MA 02478, United States; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, United States
| | - Deborah Haller
- Behavioral Science Research Unit, Mt. Sinai at St. Luke's, 1111 Amsterdam Ave., New York, NY, 10025, United States
| | - Petra Jacobs
- Universidad San Francisco de Quinto, Escuela De Medicina, Quito, Ecuador
| | - John Gardin
- Adapt, Inc., 548 SE Jackson St., Roseburg, OR 97470, United States
| | - Dan Fischer
- University of New Mexico Center on Alcoholism, Substance Abuse, and Addictions (CASAA), 2650 Yale SE MSC11-6280 Albuquerque, NM 87106, United States
| | - Kristen D Rosen
- University of Texas Health Science Center San Antonio, 7526 Louis Pasteur MC7733, San Antonio, TX, 78229, United States
| |
Collapse
|
28
|
Abstract
Medicating ADHD is a controversial subject that was acutely inflamed in 1995 when high rates of ADHD diagnosis and treatment were documented in southeastern Virginia. Psychologists in southeastern Virginia formed a regional school health coalition to implement and evaluate interventions to address the problem. Other professionals with strong ties to the pharmaceutical industry launched ad hominem attacks on the coalition's research and work. These attacks contributed to the work being terminated in 2005. In the ensuing years, ADHD drug treatment continued to escalate. Today, the national rate of ADHD diagnosis exceeds all reasonable estimates of the disorder's true prevalence, with 14 % of American children being diagnosed before reaching young adulthood. Notable key opinion leaders continue to claim that there is no cause for concern, but with a message shift from "the prevalence is not too high" to "high prevalence is not too concerning." This paper provides an object lesson about how innovative research can be derailed to the detriment of sound medical and mental health care of children when industry interests are threatened. Tenure may be the only option for protecting innovative research from specious attacks. The authors offer a summary of the data on ADHD drug treatments, suggest judicious use of such treatments, and add their voices to others who are once again sounding a cautionary alarm.
Collapse
|
29
|
McDonald J. Opioid prescribing: guidelines, laws, rules, regulations, policies, best practices. R I Med J (2013) 2013; 96:38-41. [PMID: 24187678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Prescription drug abuse, misuse and unintentional overdose deaths are major public health concerns and have captured the attention of regulators at every level. There is no shortage of guidelines, laws, rules, regulations, and policies regarding opioid prescribing. Physicians struggle with their duty to treat pain, and yet balance this against the risk to patients as well as the potential for diversion. There are gaps in policy and resources such as lack of interdisciplinary pain clinics, addiction treatment, and education for prescribers and patients.
Collapse
Affiliation(s)
- James McDonald
- Chief Administrative Officer of the Board of Medical Licensure and Discipline for the State of Rhode Island
| |
Collapse
|
30
|
McDonald J. Appropriate prescribing of opiates as professional conduct. R I Med J (2013) 2013; 96:33-35. [PMID: 24187676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Prescription drug abuse/misuse in Rhode Island and the US is an epidemic. Chronic pain is often treated with prescription opiates which offer some relief, yet present risks to the patient of dependence, addiction and overdose. Physicians find themselves at times at odds with their patients regarding the management of pain and may feel bullied or pressured regarding prescribing. The Rhode Island Board of Medical Licensure and Discipline recognizes the value of established parameters for responsible and safe prescribing.
Collapse
Affiliation(s)
- James McDonald
- Chief Administrative Officer of the Board of Medical Licensure and Discipline for the State of Rhode Island
| |
Collapse
|
31
|
Smith SM, Dart RC, Katz NP, Paillard F, Adams EH, Comer SD, Degroot A, Edwards RR, Haddox JD, Jaffe JH, Jones CM, Kleber HD, Kopecky EA, Markman JD, Montoya ID, O’Brien C, Roland CL, Stanton M, Strain EC, Vorsanger G, Wasan AD, Weiss RD, Turk DC, Dworkin RH. Classification and definition of misuse, abuse, and related events in clinical trials: ACTTION systematic review and recommendations. Pain 2013; 154:2287-2296. [PMID: 23792283 PMCID: PMC5460151 DOI: 10.1016/j.pain.2013.05.053] [Citation(s) in RCA: 163] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 04/29/2013] [Accepted: 05/17/2013] [Indexed: 11/25/2022]
Abstract
As the nontherapeutic use of prescription medications escalates, serious associated consequences have also increased. This makes it essential to estimate misuse, abuse, and related events (MAREs) in the development and postmarketing adverse event surveillance and monitoring of prescription drugs accurately. However, classifications and definitions to describe prescription drug MAREs differ depending on the purpose of the classification system, may apply to single events or ongoing patterns of inappropriate use, and are not standardized or systematically employed, thereby complicating the ability to assess MARE occurrence adequately. In a systematic review of existing prescription drug MARE terminology and definitions from consensus efforts, review articles, and major institutions and agencies, MARE terms were often defined inconsistently or idiosyncratically, or had definitions that overlapped with other MARE terms. The Analgesic, Anesthetic, and Addiction Clinical Trials, Translations, Innovations, Opportunities, and Networks (ACTTION) public-private partnership convened an expert panel to develop mutually exclusive and exhaustive consensus classifications and definitions of MAREs occurring in clinical trials of analgesic medications to increase accuracy and consistency in characterizing their occurrence and prevalence in clinical trials. The proposed ACTTION classifications and definitions are designed as a first step in a system to adjudicate MAREs that occur in analgesic clinical trials and postmarketing adverse event surveillance and monitoring, which can be used in conjunction with other methods of assessing a treatment's abuse potential.
Collapse
Affiliation(s)
- Shannon M. Smith
- Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Richard C. Dart
- University of Colorado School of Medicine and Rocky Mountain Poison & Drug Center, Denver Health, Denver, CO
| | - Nathaniel P. Katz
- Analgesic Solutions, Natick, MA, and Tufts University, Boston, MA, USA
| | | | | | - Sandra D. Comer
- Columbia University; New York State Psychiatric Institute, New York, NY, USA
| | | | | | - J. David Haddox
- Purdue Pharma L.P., Stamford, CT, and Tufts University, Boston, MA, USA
| | - Jerome H. Jaffe
- University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Herbert D. Kleber
- Columbia University; New York State Psychiatric Institute, New York, NY, USA
| | | | - John D. Markman
- Department of Neurosurgery, University of Rochester, Rochester, NY, USA
| | | | | | | | | | - Eric C. Strain
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | - Roger D. Weiss
- Harvard Medical School, Boston, MA, USA and Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, MA, USA
| | - Dennis C. Turk
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Robert H. Dworkin
- Departments of Anesthesiology and Neurology and Center for Human Experimental Therapeutics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| |
Collapse
|
32
|
Cameron D, Smith GA, Daniulaityte R, Sheth AP, Dave D, Chen L, Anand G, Carlson R, Watkins KZ, Falck R. PREDOSE: a semantic web platform for drug abuse epidemiology using social media. J Biomed Inform 2013; 46:985-97. [PMID: 23892295 DOI: 10.1016/j.jbi.2013.07.007] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Revised: 07/04/2013] [Accepted: 07/19/2013] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The role of social media in biomedical knowledge mining, including clinical, medical and healthcare informatics, prescription drug abuse epidemiology and drug pharmacology, has become increasingly significant in recent years. Social media offers opportunities for people to share opinions and experiences freely in online communities, which may contribute information beyond the knowledge of domain professionals. This paper describes the development of a novel semantic web platform called PREDOSE (PREscription Drug abuse Online Surveillance and Epidemiology), which is designed to facilitate the epidemiologic study of prescription (and related) drug abuse practices using social media. PREDOSE uses web forum posts and domain knowledge, modeled in a manually created Drug Abuse Ontology (DAO--pronounced dow), to facilitate the extraction of semantic information from User Generated Content (UGC), through combination of lexical, pattern-based and semantics-based techniques. In a previous study, PREDOSE was used to obtain the datasets from which new knowledge in drug abuse research was derived. Here, we report on various platform enhancements, including an updated DAO, new components for relationship and triple extraction, and tools for content analysis, trend detection and emerging patterns exploration, which enhance the capabilities of the PREDOSE platform. Given these enhancements, PREDOSE is now more equipped to impact drug abuse research by alleviating traditional labor-intensive content analysis tasks. METHODS Using custom web crawlers that scrape UGC from publicly available web forums, PREDOSE first automates the collection of web-based social media content for subsequent semantic annotation. The annotation scheme is modeled in the DAO, and includes domain specific knowledge such as prescription (and related) drugs, methods of preparation, side effects, and routes of administration. The DAO is also used to help recognize three types of data, namely: (1) entities, (2) relationships and (3) triples. PREDOSE then uses a combination of lexical and semantic-based techniques to extract entities and relationships from the scraped content, and a top-down approach for triple extraction that uses patterns expressed in the DAO. In addition, PREDOSE uses publicly available lexicons to identify initial sentiment expressions in text, and then a probabilistic optimization algorithm (from related research) to extract the final sentiment expressions. Together, these techniques enable the capture of fine-grained semantic information, which facilitate search, trend analysis and overall content analysis using social media on prescription drug abuse. Moreover, extracted data are also made available to domain experts for the creation of training and test sets for use in evaluation and refinements in information extraction techniques. RESULTS A recent evaluation of the information extraction techniques applied in the PREDOSE platform indicates 85% precision and 72% recall in entity identification, on a manually created gold standard dataset. In another study, PREDOSE achieved 36% precision in relationship identification and 33% precision in triple extraction, through manual evaluation by domain experts. Given the complexity of the relationship and triple extraction tasks and the abstruse nature of social media texts, we interpret these as favorable initial results. Extracted semantic information is currently in use in an online discovery support system, by prescription drug abuse researchers at the Center for Interventions, Treatment and Addictions Research (CITAR) at Wright State University. CONCLUSION A comprehensive platform for entity, relationship, triple and sentiment extraction from such abstruse texts has never been developed for drug abuse research. PREDOSE has already demonstrated the importance of mining social media by providing data from which new findings in drug abuse research were uncovered. Given the recent platform enhancements, including the refined DAO, components for relationship and triple extraction, and tools for content, trend and emerging pattern analysis, it is expected that PREDOSE will play a significant role in advancing drug abuse epidemiology in future.
Collapse
Affiliation(s)
- Delroy Cameron
- Ohio Center of Excellence in Knowledge-enabled Computing (Kno.e.sis), Wright State University, Dayton, OH 45435, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Redican KJ, Marek LI, Brock DJ, McCance-Katz EF. Exploring the etiologic factors and dynamics of prescription drug abuse in southwest virginia. Health Promot Perspect 2012; 2:153-65. [PMID: 24688929 DOI: 10.5681/hpp.2012.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 10/28/2012] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Prescription drug abuse in Southwest Virginia is a serious problem affecting indi-viduals, families, and communities. The aim of this study was to characterize and understand the extent of the prescription drug abuse problem in Southwest, Virginia as well as the dynamics that surround that abuse. More specifically, the study focused on learning the extent of the problem along with which prescription drugs are typically used prior to entering treatment, reasons for prescription drug and methadone abuse, and the sources for prescription drug use, misuse and abuse. METHODS Mixed methodology was employed which included surveying methadone clinic con-sumers at two treatment clinics in Southwest, Virginia and seven focus field interviews of key community stakeholders. RESULTS The extent of prescription drug abuse is high and that the demographics of prescription drug users are getting younger and now involve more males than females. Oxycodone, hydroco¬done, methadone, and morphine were the most commonly used drugs prior to enrollment in the clinics with over one-half of methadone-maintained consumers reporting that they had abused benzodiazepines along with opioids. Focus groups and clinic consumer data highlighted the key etiological factors in prescription drug abuse: use (due to workforce related injuries) turning to abuse, wanting to get high, overprescribing and physician issues, lack of information, and cultural acceptance of drug taking as problem solving behavior. The two most common sources for the abused prescription drugs were physicians and street dealers. CONCLUSIONS A constellation of conditions have led to the epidemic of prescription drug abuse in Southwest Virginia, including poverty, unemployment and work-related injuries, besides, public health education programs on the dangers of prescription opiate misuse and abuse are urgently needed.
Collapse
Affiliation(s)
- Kerry J Redican
- Department of Population Health Sciences, College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia, USA ; Department of Basic Sciences, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Lydia I Marek
- Department of Human Development, Virginia Tech, Blacksburg, Virginia, USA
| | | | | |
Collapse
|