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Constance JE, McFarland MM, Casucci T, Deininger MW, Enioutina EY, Job K, Lemons RS, Lim CS, Ward RM, Yellepeddi V, Watt KM. Mapping the Evidence for Opioid-Mediated Changes in Malignancy and Chemotherapeutic Efficacy: Protocol for a Scoping Review. JMIR Res Protoc 2023; 12:e38167. [PMID: 37213193 PMCID: PMC10242459 DOI: 10.2196/38167] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 03/19/2023] [Accepted: 04/05/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Numerous reports contend opioids can augment or inhibit malignancy. At present, there is no consensus on the risk or benefit posed by opioids on malignancy or chemotherapeutic activity. Distinguishing the consequences of opioid use from pain and its management is challenging. Additionally, opioid concentration data is often lacking in clinical studies. A scoping review approach inclusive of preclinical and clinical data will improve our understanding of the risk-benefit relationship concerning commonly prescribed opioids and cancer and cancer treatment. OBJECTIVE The aim of the study is to map diverse studies spanning from preclinical to clinical regarding opioids with malignancy and its treatment. METHODS This scoping review will use the Arksey six stages framework to (1) identify the research question; (2) identify relevant studies; (3) select studies meeting criteria; (4) extract and chart data; (5) collate, summarize, and report results; and (6) conduct expert consultation. An initial pilot study was undertaken to (1) parameterize the extent and scale of existing data for an evidence review, (2) identify key factors to be extracted in systematic charting efforts, and (3) assess opioid concentration as a variable for its relevance to the central hypothesis. Six databases will be searched with no filters: MEDLINE, Embase, CINAHL Complete, Cochrane Library, Biological Sciences Collection, and International Pharmaceutical Abstracts. Trial registries will include ClinicalTrials.gov, Cochrane CENTRAL, International Standard Randomised Controlled Trial Number Registry, European Union Clinical Trials Register, and World Health Organization International Clinical Trials Registry. Eligibility criteria will include preclinical and clinical study data on opioids effects on tumor growth or survival, or alteration on the antineoplastic activity of chemotherapeutics. We will chart data on (1) opioid concentration from human subjects with cancer, yielding a "physiologic range" to better interpret available preclinical data; (2) patterns of opioid exposure with disease and treatment-related patient outcomes; and (3) the influence of opioids on cancer cell survival, as well as opioid-related changes to cancer cell susceptibility for chemotherapeutics. RESULTS This scoping review will present results in narrative forms as well as with the use of tables and diagrams. Initiated in February 2021 at the University of Utah, this protocol is anticipated to generate a scoping review by August 2023. The results of the scoping review will be disseminated through scientific conference proceedings and presentations, stakeholder meetings, and by publication in a peer-reviewed journal. CONCLUSIONS The findings of this scoping review will provide a comprehensive description of the consequences of prescription opioids on malignancy and its treatment. By incorporating preclinical and clinical data, this scoping review will invite novel comparisons across study types that could inform new basic, translational, and clinical studies regarding risks and benefits of opioid use among patients with cancer. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/38167.
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Affiliation(s)
- Jonathan E Constance
- Division of Clinical Pharmacology, Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Mary M McFarland
- Spencer S. Eccles Health Science Library, University of Utah, Salt Lake City, UT, United States
| | - Tallie Casucci
- J Willard Marriott Library, University of Utah, Salt Lake City, UT, United States
| | - Michael W Deininger
- Versiti Blood Research Institute, Milwaukee, WI, United States
- Division of Hematology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Elena Y Enioutina
- Division of Clinical Pharmacology, Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Kathleen Job
- Division of Clinical Pharmacology, Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Richard S Lemons
- Division of Hematology and Oncology, Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Carol S Lim
- Department of Molecular Pharmaceutics, College of Pharmacy, University of Utah, Salt Lake City, UT, United States
| | - Robert M Ward
- Division of Clinical Pharmacology, Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Venkata Yellepeddi
- Division of Clinical Pharmacology, Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Kevin M Watt
- Division of Clinical Pharmacology, Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
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Testa A, Jacobs B, Zhang L, Jackson D, Ganson K, Nagata J. Adverse Childhood Experiences and Prescription Opioid Use During Pregnancy: An Analysis of the North and South Dakota PRAMS, 2019-2020. Res Sq 2023:rs.3.rs-2547252. [PMID: 37214797 PMCID: PMC10197742 DOI: 10.21203/rs.3.rs-2547252/v1] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Objectives: This study assesses the association between adverse childhood experiences (ACEs) and prescription opioid use during pregnancy. Methods: This study uses data on 2,999 individuals from the 2019 and 2020 Pregnancy Risk Assessment Monitoring System (PRAMS) from North Dakota and South Dakota. The relationship between ACEs and prescription opioid use during pregnancy is examined using multiple logistic regression. Results: The prevalence of prescription opioid use increases alongside accumulating ACEs. Compared to those with no ACEs, recent mothers with three or more ACEs have a 2.4 greater odds of prescription opioid use during pregnancy (aOR [adjusted odds ratio] = 2.437; 95% CI [confidence interval] = 1.319, 4.503). Conclusion: Accumulating ACEs are associated with an increased risk of prescription opioid use during pregnancy. Additional research is needed better understand the mechanisms that link ACEs and prescription opioid use during pregnancy, as well as how to best support those with ACEs exposure in a trauma-informed manner to reduce the risk of substance use.
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Tscharke BJ, O'Brien JW, Ahmed F, Nguyen L, Ghetia M, Chan G, Thai P, Gerber C, Bade R, Mueller J, Thomas KV, White J, Hall W. A wastewater-based evaluation of the effectiveness of codeine control measures in Australia. Addiction 2023; 118:480-488. [PMID: 36367203 PMCID: PMC10099390 DOI: 10.1111/add.16083] [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: 06/16/2022] [Accepted: 10/24/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND AIM From 1 February 2018, codeine was rescheduled from an over-the-counter (OTC) to a prescription-only medicine in Australia. We used wastewater-based epidemiology to measure changes in population codeine consumption before and after rescheduling. METHODS We analysed 3703 wastewater samples from 48 wastewater treatment plants, taken between August 2016 and August 2019. Our samples represented 10.6 million people, 45% of the Australian population in state capitals and regional areas in each state or territory. Codeine concentrations were determined by liquid chromatography-tandem mass spectrometry and converted to per-capita consumption estimates using the site daily wastewater volume, catchment populations and codeine excretion kinetics. RESULTS Average per-capita consumption of codeine decreased by 37% nationally immediately after the rescheduling in February 2018 [95% confidence interval (CI) = 35.3-39.4%] and substantially in all states between 24 and 51% (95% CI = 22.4-27.0% and 41.8-59.4%). The decrease was sustained at the lower level to August 2019. Locations with least pharmacy access decreased by 51% (95% CI = 41.7-61.7%), a greater decrease than 37% observed for those with greater pharmacy access (95% CI = 35.1-39.4%). Regional areas decreased by a smaller margin to cities (32 versus 38%, 95% CI = 30.2-34.1% versus 34.9-40.4%, respectively) from a base per-capita usage approximately 40% higher than cities. CONCLUSION Wastewater analysis shows that codeine consumption in Australia decreased by approximately 37% following its rescheduling as a prescription-only medicine in 2018. Wastewater-based epidemiology can be used to evaluate changes in population pharmaceutical consumption in responses to changes in drug scheduling.
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Affiliation(s)
- Benjamin J Tscharke
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, Woolloongabba, Queensland, Australia
| | - Jake W O'Brien
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, Woolloongabba, Queensland, Australia
| | - Fahad Ahmed
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, Woolloongabba, Queensland, Australia
| | - Lynn Nguyen
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Maulik Ghetia
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Gary Chan
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Queensland, Australia
| | - Phong Thai
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, Woolloongabba, Queensland, Australia
| | - Cobus Gerber
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Richard Bade
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Jochen Mueller
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, Woolloongabba, Queensland, Australia
| | - Kevin V Thomas
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, Woolloongabba, Queensland, Australia
| | - Jason White
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Wayne Hall
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, Woolloongabba, Queensland, Australia.,National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Queensland, Australia
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Muacevic A, Adler JR, Silva SC, Agualusa L. The Overuse of the Emergency Department at a Multidisciplinary Pain Clinic by Patients with Chronic Pain: A Cross-Sectional Study. Cureus 2023; 15:e33757. [PMID: 36793836 PMCID: PMC9925021 DOI: 10.7759/cureus.33757] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2023] [Indexed: 01/15/2023] Open
Abstract
Introduction Pain represents up to 78% of emergency department (ED) appointments, and an average of 16% of patients that consume ED resources have chronic pain. ED overuse could be an indicator of poor pain management. We are not aware of any study that has ever been carried out to understand the incidence of patients followed up at a multidisciplinary pain clinic (MPC) who overuse the ED. We aim to characterize patients in our MPC who overuse the emergency department, comprehend our percentages, and develop effective methods to reduce these numbers in the near future. Materials and methods We reviewed the medical records of patients observed in our MPC in 2019, selected patients with more than six ED visits from 2019 to 2021, and registered their ED visit diagnosis and evolution. We followed up on these patients and characterized them according to demographic aspects, chronic pain diagnostics, comorbidities, chronic medication, number of chronic pain department appointments, and patients that underwent invasive pain treatment. Results In 2019, 1892 patients were evaluated at our MPC, and only 1% were classified as overusers of the ED. The average number of episodes per patient was 10 in 2019, seven in 2020, and four in 2021. 70% of episodes were due to pain, and 94% were discharged immediately. The majority were women, and 69% were under the age of 69. Seventy-three percent had psychiatric disorders, and 95% and 89% were medicated with opioid and antidepressant medication, respectively, prior to the ED evaluation. Chronic primary pain was the most common diagnosis (47%), followed by chronic secondary musculoskeletal pain (21%). In 2019, most of these patients had only one appointment at our MPC, and in 2021, 79% had no appointments at all. Conclusion Our findings emphasize the particularities of patients with chronic pain who are followed in an MPC and misuse the ED. We observe the predominance of middle-aged people, which raises concerns about the impact of chronic pain in the active population. Issues like the predominance of patients with a diagnosis of primary chronic pain, psychiatric disorders, and being polymedicated with antidepressants and opioids are also a concern. We also realized that a high percentage of patients who overuse EDs lost follow-up at MPC over the past three years, which may reinforce the idea that they were misguided in the treatment of their chronic pain. We recognized the need to improve teamwork with primary care in the follow-up of these patients as well as sensitize emergency service professionals to refer this patient rather than medicate acutely so that follow-up could be carried out in the appropriate places to reduce the percentage of ED overuse.
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Bruijnzeel AW, Behnood-Rod A, Malphurs W, Chellian R, Caudle RM, Febo M, Setlow B, Neubert JK. Oxycodone decreases anxiety-like behavior in the elevated plus-maze test in male and female rats. Behav Pharmacol 2022; 33:418-426. [PMID: 35947068 PMCID: PMC9373716 DOI: 10.1097/fbp.0000000000000690] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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] [Indexed: 11/26/2022]
Abstract
The prescription opioid oxycodone is widely used for the treatment of pain in humans. Oxycodone misuse is more common among people with an anxiety disorder than those without one. Therefore, oxycodone might be misused for its anxiolytic properties. We investigated if oxycodone affects anxiety-like behavior in adult male and female rats. The rats were treated with oxycodone (0.178, 0.32, 0.56, or 1 mg/kg), and anxiety-like behavior was investigated in the elevated plus-maze test. Immediately after the elevated plus-maze test, a small open field test was conducted to determine the effects of oxycodone on locomotor activity. In the elevated plus-maze test, oxycodone increased the percentage of time spent on the open arms, the percentage of open arm entries, time on the open arms, open arm entries, and the distance traveled. The males treated with vehicle had a lower percentage of open arm entries than the females treated with vehicle, and oxycodone treatment led to a greater increase in the percentage of open arm entries in the males than females. Furthermore, the females spent more time on the open arms, made more open arm entries, spent less time in the closed arms, and traveled a greater distance than the males. In the small open field test, treatment with oxycodone did not affect locomotor activity or rearing. Sex differences were observed; the females traveled a greater distance and displayed more rearing than the males. In conclusion, oxycodone decreases anxiety-like behavior in rats, and oxycodone has a greater anxiolytic-like effect in males than females.
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Affiliation(s)
- Adriaan W Bruijnzeel
- Department of Psychiatry, University of Florida
- Center for Addiction Research and Education, University of Florida
| | | | | | | | - Robert M Caudle
- Oral and Maxillofacial Surgery, University of Florida, Gainesville, Florida, USA
| | - Marcelo Febo
- Department of Psychiatry, University of Florida
- Center for Addiction Research and Education, University of Florida
| | - Barry Setlow
- Department of Psychiatry, University of Florida
- Center for Addiction Research and Education, University of Florida
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Black E, Monds LA, Chan B, Brett J, Hutton JE, Acheson L, Penm J, Harding S, Strumpman D, Demirkol A, Lintzeris N. Overdose and take-home naloxone in emergency settings: A pilot study examining feasibility of delivering brief interventions addressing overdose prevention with 'take-home naloxone' in emergency departments. Emerg Med Australas 2022; 34:509-518. [PMID: 35021268 DOI: 10.1111/1742-6723.13925] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 08/31/2021] [Revised: 11/16/2021] [Accepted: 12/02/2021] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Although most unintentional opioid deaths in Australia are attributed to pharmaceutical opioids, take-home naloxone (THN) programmes have to date predominantly targeted people using illicit opioids in drug treatment and harm reduction settings. We sought to examine the feasibility of delivering THN brief interventions (THN-BIs) with intranasal naloxone in EDs. METHODS This pilot feasibility study was conducted across three major metropolitan EDs in Sydney and Melbourne. ED staff were surveyed about their perspectives regarding THN before completing a 30-min training programme in THN-BI delivery. Patients presenting with opioid overdose or considered high risk for future overdose were eligible to receive the THN-BI. Staff survey responses were compared between hospitals and provider types using one-way analysis of variances. Patient demographic and clinical characteristics were extracted from medical records and compared between hospitals and overdose type using Fisher's exact test and one-way analysis of variances. RESULTS One hundred and twenty-two ED staff completed the survey. One hundred and ten (90.2%) agreed that EDs should provide THN-BIs, whereas 23 (19.2%) identified time constraints and 17 (12.9%) felt uncomfortable discussing overdose with patients. Fifty-seven patients received the THN-BI, with the majority (n = 50, 87.7%) having presented following opioid overdose. The median age was 44 years and 40 (71.4%) were men. Two-thirds of the overdoses (n = 31, 66.0%) were attributed to heroin with one-third (n = 16, 34%) being attributed to pharmaceutical opioids. CONCLUSIONS ED-based delivery of THN-BIs can reach a wide range of individuals at-risk of overdose. The present study supports the feasibility of THN interventions in EDs and underscores the importance of addressing implementation barriers including staff training.
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Affiliation(s)
- Eleanor Black
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia.,School of Population Health, The University of New South Wales, Sydney, New South Wales, Australia.,New South Wales Drug and Alcohol Clinical Research and Improvement Network (DACRIN), Sydney, New South Wales, Australia
| | - Lauren A Monds
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia.,New South Wales Drug and Alcohol Clinical Research and Improvement Network (DACRIN), Sydney, New South Wales, Australia.,Faculty of Medicine and Health, Specialty of Addiction Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Betty Chan
- Emergency Department, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Jonathan Brett
- New South Wales Drug and Alcohol Clinical Research and Improvement Network (DACRIN), Sydney, New South Wales, Australia.,Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
| | - Jennie E Hutton
- Emergency Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Liam Acheson
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia.,National Drug and Alcohol Research Centre, The University of New South Wales, Sydney, New South Wales, Australia
| | - Jonathan Penm
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia.,Pharmacy Department, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Sally Harding
- Emergency Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Dana Strumpman
- Pharmacy Department, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Apo Demirkol
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia.,School of Population Health, The University of New South Wales, Sydney, New South Wales, Australia.,New South Wales Drug and Alcohol Clinical Research and Improvement Network (DACRIN), Sydney, New South Wales, Australia
| | - Nicholas Lintzeris
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia.,New South Wales Drug and Alcohol Clinical Research and Improvement Network (DACRIN), Sydney, New South Wales, Australia.,Faculty of Medicine and Health, Specialty of Addiction Medicine, The University of Sydney, Sydney, New South Wales, Australia
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7
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Schepis TS, Ford JA, McCabe SE. Co-ingestion of prescription drugs and alcohol in US adults aged 50 years or older. Hum Psychopharmacol 2021; 36:e2803. [PMID: 34237180 PMCID: PMC9254454 DOI: 10.1002/hup.2803] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/09/2021] [Accepted: 06/18/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To examine prevalence of past-month prescription drug misuse (PDM) and alcohol co-ingestion and its correlates in adults age 50 or older. METHODS Data were from the 2015-2018 US National Survey on Drug Use and Health (n = 35,190). PDM-alcohol co-ingestion was defined as prescription opioid, tranquilizer/sedative, or stimulant misuse while "drinking alcohol or within a couple of hours of drinking." Co-ingestion prevalence was estimated, and logistic and negative binomial regressions examined the sociodemographic, physical health, mental health, substance use, and substance use disorder (SUD) correlates of co-ingestion. RESULTS Over 344,000 adults aged 50 years or older (0.3%) engaged in past-month PDM-alcohol co-ingestion, or 27.4% of those with past-month PDM. Past-month co-ingestion was linked to greater past-month alcohol use frequency and elevated adjusted odds ratios (aORs) for all examined substance use outcomes (e.g., non-PDM SUD aOR = 21.8; 49.7% prevalence rate). The aOR for suicidal ideation was 506% higher in those with co-ingestion than those without past-year PDM. CONCLUSIONS US adults aged 50 years or older with past-month PDM-alcohol co-ingestion are at high risk for SUD and concerning mental health symptoms. Screening for mental health and substance use treatment is warranted among aging adults with signs of PDM, especially involving co-ingestion.
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Affiliation(s)
- Ty S. Schepis
- Department of Psychology, Texas State University
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan
| | - Jason A. Ford
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan
- Department of Sociology, University of Central Florida
| | - Sean Esteban McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan
- Institute for Research on Women and Gender, University of Michigan
- Institute for Healthcare Policy and Innovation, University of Michigan
- Institute for Social Research, University of Michigan
- Rogel Cancer Center, University of Michigan
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Christie NC, Vojvodic V, Meda P, Monterosso JR. Changes in Social, Romantic, and General Life Satisfaction Over the Course of a Substance Use Disorder. Front Psychiatry 2021; 12:734352. [PMID: 34777045 PMCID: PMC8581205 DOI: 10.3389/fpsyt.2021.734352] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 10/04/2021] [Indexed: 11/29/2022] Open
Abstract
Background: The pandemic has highlighted the importance of social connection for health and well-being. Satisfaction across domains of life is associated with substance use outcomes, such as risk of relapse and mortality. Previous work has delineated the relationship between substance use and social connections, yet there is a lack of research exploring the relationship between substance use and satisfaction with domains of life over time. Methods: We retrospectively assessed satisfaction with social life, romantic life, and general life across five phases of substance use among 339 adults, of whom 289 identify as formerly having a problem with substance use, and a comparison group of 50 who report no history of problematic drug use. We compared those whose primary drug of choice was alcohol, marijuana, methamphetamine, non-prescription opioids, and prescription opioids. Results: Those who used prescription opioids reported a larger drop in satisfaction in social life, romantic life, and general life during the course of substance use than those who used other drugs. However, we report no significant differences in current satisfaction, social well-being, or quality of life between people in recovery and people with no history of problematic substance use. Conclusions: These findings-alongside neuropsychological work on the opioid system and sociality-paint a picture that those who formerly used prescription opioids may experience lower satisfaction across life domains during the course of their substance use than those who used other substances. However, people in prolonged recovery-regardless of their drug of choice-all show similar levels of satisfaction compared to people with no history of problematic substance use.
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Affiliation(s)
- Nina C. Christie
- Department of Psychology, University of Southern California, Los Angeles, CA, United States
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Vanya Vojvodic
- Department of Psychology, University of Southern California, Los Angeles, CA, United States
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Pranav Meda
- Department of Psychology, College of Life Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - John R. Monterosso
- Department of Psychology, University of Southern California, Los Angeles, CA, United States
- Brain and Creativity Institute, University of Southern California, Los Angeles, CA, United States
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, United States
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Sejdiu A, Pereira KN, Joundi H, Patel YR, Basith SA, Ayala V, Mathialagan K, Majumder P. Demographic Pattern and Mortality Risk Factors for Prescription Opioid Overdose Hospitalizations: Results From Nationwide Inpatient Sample Analysis. Cureus 2021; 13:e15674. [PMID: 34277265 PMCID: PMC8281797 DOI: 10.7759/cureus.15674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 11/05/2022] Open
Abstract
Objectives To explore the demographic patterns of hospitalizations related to prescription opioid overdose (POD) and evaluate the mortality risk of association in POD inpatients. Methodology We conducted a cross-sectional study using the Nationwide Inpatient Sample of 184,711 POD inpatients. A binomial logistic regression model was used to evaluate the odds ratio (OR) of association for mortality risk due to comorbidities (substance use disorders (SUD) and medical complications) in POD inpatients. Results POD inpatients were majorly females (54.1%), older adults aged 51-75 years (48.5%), whites (81.5%), and from lower household income quartet (32.8%). The most prevalent comorbid SUD among POD inpatients was alcohol (15.7%), followed by cannabis (5.7%), cocaine (4.2%), and amphetamine (1.8%). Comorbid alcohol use disorders had a minimally increased association with mortality but were not statistically significant (OR = 1.036; P = 0.438). POD in patients with cardiac arrest had the highest risk of mortality (OR = 103.423; P < 0.001), followed by shock (OR = 15.367; P < 0.001), coma (OR = 13.427; P < 0.001), and respiratory failure (OR = 12.051; P < 0.001). Conclusions Our study indicates that the hospitalizations related to POD were more prevalent among females, elders between 51 and 75 years of age, whites, and those in the lower household income quartet. The prevalence of prescription opioid use and the hospitalization related to POD remains a significant public health issue. POD inpatients with medical complications were at a higher risk of mortality than with comorbid SUD.
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Affiliation(s)
- Albulena Sejdiu
- Psychiatry, Saints Cyril and Methodius University, Skopje, MKD
| | | | - Hajara Joundi
- Internal Medicine, University Cadi Ayyad, Faculty of Medicine and Pharmacy, Marrakesh, MAR
| | | | - Sayeda A Basith
- Psychiatry and Behavioral Sciences, Medical University of the Americas, Charlestown, KNA
| | - Victoria Ayala
- Psychiatry, Ross University School of Medicine, Bridgetown, BRB
| | | | - Pradipta Majumder
- Psychiatry, Drexel University College of Medicine, Philadelphia, USA.,Psychiatry, WellSpan Health, York, USA
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Weyandt LL, Gudmundsdottir BG, Shepard E, Brick L, Buchanan A, Clarkin C, Francis A, Marraccini M. Nonmedical Prescription Opioid Use among a Sample of College Students: Prevalence and Predictors. Pharmacy (Basel) 2021; 9:106. [PMID: 34071670 DOI: 10.3390/pharmacy9020106] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 11/16/2022] Open
Abstract
Nonmedical use of prescription opioid medication (NMPO) in the United States is a public health crisis, resulting in high rates of emergency room visits, morbidity, and mortality. The purpose of this study was to explore prevalence estimates and correlates of NMPO among a convenience sample of college students in the northeast and southeast regions of the US to help generate directions for future research. Motivations for misuse, age of onset, access, concomitant substance use, and individual factors were investigated among a sample of undergraduate students from two universities. Participants (N = 847) completed a battery of various self-report measures. Findings revealed that 7.7% (Southeastern University) and 12.8% of students (Northeastern University) reported lifetime NMPO, whereas past-month NMPO was reported by 0.8% and 0.9% of participants, respectively. Lifetime history of regularly using alcohol, nonmedical use of benzodiazepine medication, nonmedical use of prescription stimulants, symptoms of depression and anxiety, and executive functioning (i.e., metacognition and behavioral regulation) were significantly related to lifetime history of NMPO in this college sample. These findings offer several potential subsequent lines of investigation regarding the associations between various demographic and psychological factors and NMPO. Future research is needed to help identify college students who are at risk of NMPO.
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Coyne KS, Barsdorf AI, Brooks A, Mazière JY, Pierson RF, Butler SF, Schnoll SH. Establishing the content validity of the Prescription Opioid Misuse and Abuse Questionnaire (POMAQ) among chronic pain patients. Curr Med Res Opin 2021; 37:505-514. [PMID: 33331184 DOI: 10.1080/03007995.2020.1865891] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Content validation is essential in the development of patient-reported instruments to ensure relevancy and understandability. The aim was to evaluate patient understanding of the Prescription Opioid Misuse and Abuse Questionnaire (POMAQ) using cognitive interviewing among adults with chronic moderate to severe pain. METHODS This qualitative study involved a one-time in-clinic visit to conduct one-on-one cognitive interviews among participants with chronic moderate to severe pain from four groups: (1) Known Opioid Abuse; (2) Known Abuse of Other Substances (e.g. alcohol, benzodiazepines); (3) Opioid Non-abuse; and (4) No Chronic Opioid Use. Patients were recruited from 6 US clinical centers. Concept elicitation questions regarding misuse and abuse were asked at interview start; the POMAQ was completed via a web interface followed by a cognitive interview regarding POMAQ items and response options. RESULTS 56 patients were enrolled. Mean age was 48.7 ± 12.3 years; 57% female; 80% Caucasian; mean duration of chronic pain was 11.2 ± 8.2 years with lower back pain predominating at 75%. Overall, the POMAQ was well-understood and received positive feedback. A few (n = 6, 11%) expressed concerns about completing the POMAQ using a secure internet site as they either indicated they were not computer savvy (n = 3, 5%) or were concerned about internet security (n = 3, 5%). Minor wording modifications were made to the POMAQ to enhance clarity and understanding of the POMAQ. CONCLUSIONS The POMAQ demonstrated content validity among patients with moderate to severe chronic pain and is undergoing psychometric evaluation among a larger cohort of patients.
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Affiliation(s)
- Karin S Coyne
- Patient-centered Research, Evidera, Bethesda, MD, USA
| | | | - Anne Brooks
- Patient-centered Research, Evidera, Bethesda, MD, USA
| | | | - Renee F Pierson
- Global Patient-Reported Outcomes, Janssen, Inc, Titusville, NJ, USA
| | | | - Sidney H Schnoll
- Pharmaceutical Risk Management Services, Pinney Associates, Inc, Bethesda, MD, USA
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12
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Abstract
Introduction: With the opioid epidemic escalating across the country, we sought to evaluate and characterize post-operative opioid prescribing habits and trends among urology residents in the United States. Methods: Urology residents were sent a 16-question survey regarding opioid prescribing patterns, influencing factors, opioid training experience, and amounts of opioids prescribed for common urologic procedures. Results: One hundred and four urology residents participated in the survey (75% male and 25% female). Common factors influencing opioid prescribing were standard prescribing practice for certain operations (80%), attending/senior resident preference (62.1%), and immediate post-operative pain (54.7%). Residents reported prescribing more opioids at discharge for open abdominal and robotic procedures (167.9 and 134.2 morphine milligram equivalents, MME, respectively) and lower amounts for outpatient surgeries (39.7 and 55.8 MME for vasectomy and transurethral resections). Only 15.5% of residents utilize any formal algorithm for post-operative opioid prescribing at their institution. Further, 51.6% of residents received no formal education on safe opioid prescribing during residency, and only 42.1% routinely assess patient risk for opioid abuse. Urology residents who received formal opioid training prescribed less opioids on average for common urologic procedures compared to those who had not trained. Conclusions: This study highlights the importance of increasing resident education on opioid prescribing during residency training, as well as an opportunity for the implementation of standardized post-operative opioid prescribing regimens to help improve trends in urology resident opioid prescribing.
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Affiliation(s)
- James J Kelley
- Urology, Charleston Area Medical Center, Charleston, USA
| | - Sharon Hill
- Urology, Charleston Area Medical Center, Charleston, USA
| | - Samuel Deem
- Urology, Charleston Area Medical Center, Charleston, USA
| | - Nathan E Hale
- Urology, Charleston Area Medical Center, Charleston, USA
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13
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Pankaj A, Oraka K, Caraballo-Rivera EJ, Ahmad M, Zahid S, Munir S, Gurumurthy G, Okoeguale O, Verma S, Patel RS. Recreational Cannabis Use and Risk of Prescription Opioid Overdose: Insights from Pediatric Inpatients. Cureus 2020; 12:e11058. [PMID: 33224654 PMCID: PMC7676440 DOI: 10.7759/cureus.11058] [Citation(s) in RCA: 2] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objectives Our first goal is to evaluate the prevalence of hospital admissions for prescription opioid overdose (POD) in pediatric inpatients, and next goal is to measure the independent association between cannabis use disorders (CUD) and POD. Methods We used the nationwide inpatient sample (NIS) and included 27,444,239 pediatric inpatients (age ≤ 18 years), and 10,562 (0.04%) were managed primarily for POD. The odds ratio (OR) of the association of variables in POD inpatients was measured using the binomial logistic regression model that was adjusted for demographic confounders and psychiatric comorbidities. Results Adolescents have higher odds (OR 10.75, 95% CI 10.16-11.36) of POD-related hospitalization compared to children ≤ 12 years. Whites formed the significant proportion (67%), and those from low-income families (<50th percentile) had higher likelihood for POD-related hospitalization. The most prevalent psychiatric comorbidities were mood disorders (44.3%) and anxiety disorders (14.6%). Prevalent comorbid substance use disorders (SUDs) included cannabis (14.2%), tobacco (13.1%), and opioid (9.4%). A higher odds of association with POD-related hospitalizations were seen in pediatric inpatients with comorbid opioid (OR 8.79, 95% CI 8.08-9.56), tobacco (OR 1.58, 95% CI 1.47-1.70), and cannabis (OR 1.68, 95% CI 1.57-1.81) use disorders. Conclusion The prescription opioid is a bridge to opioid abuse/dependence, thereby increasing the risk of other SUDs like tobacco (by 58%) and cannabis (by 68%). Regulating the easy availability of prescription opioids and also improving the existing prescription trends are an essential way to reduce this problem. Finally, awareness and counseling are recommended strategies for harm reduction/rehabilitation among the pediatric population.
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Affiliation(s)
- Amaya Pankaj
- Pediatric Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | | | | | - Munazza Ahmad
- Medicine, Lahore Medical & Dental College, Lahore, PAK
| | - Shaheer Zahid
- Psychiatry, Saint James School of Medicine, Park Ridge, USA
| | - Sadaf Munir
- Psychiatry, Jersey Shore University Medical Center, Neptune, USA
| | | | - Onose Okoeguale
- Psychiatry, Vinnytsia National Medical University, Vinnytsia, UKR
| | - Shikha Verma
- Psychiatry and Behavioral Sciences, Rogers Behavioral Health, Kenosha, USA
| | - Rikinkumar S Patel
- Psychiatry and Behavioral Sciences, Oklahoma State University, Tulsa, USA.,Psychiatry, Griffin Memorial Hospital, Norman, USA
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14
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Stephenson JJ, Cepeda MS, Zhang J, Dinh J, Hall K, Esposito DB, Kern DM. The Association Between Doctor and Pharmacy Shopping and Self-Reported Misuse and Abuse of Prescription Opioids: A Survey Study. J Pain Res 2020; 13:689-701. [PMID: 32308468 PMCID: PMC7140905 DOI: 10.2147/jpr.s232409] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 09/25/2019] [Accepted: 02/19/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND/RATIONALE Little is known about the reasons for visiting multiple doctors/pharmacies, known as doctor/pharmacy shopping, to obtain opioids. OBJECTIVE To investigate patients' self-reported reasons for doctor/pharmacy shopping and assess whether doctor/pharmacy shopping behavior can be used as a surrogate measure of opioid abuse/misuse. METHODS We conducted a cross-sectional web-based survey among adult patients with ≥2 pharmacy claims for immediate-release or extended-release/long-acting opioids between 7/1/2015 and 12/31/2016, identified from a large United States (US) commercial claims database. Patients were classified into no, mild, moderate, or severe shopping categories based on their claims. Reasons for doctor/pharmacy shopping and opioid abuse/misuse were determined from patient responses to the Prescription Opioid Misuse and Abuse Questionnaire. RESULTS A random sample of 10,081 patients was invited to participate in the survey and 1085 (11%) completed surveys. The most frequently reported reasons for doctor/pharmacy shopping were convenience, availability, price, and multiple morbidities requiring pain management. Among patients in the no, minimal, moderate, and severe shopping categories, only 7.8%, 8.5%, 11.8% and 12.6% reported opioid abuse/misuse, respectively. CONCLUSION In this commercially-insured population, patient-reported reasons for doctor/pharmacy shopping do not suggest opioid abuse/misuse. Less than 15% of patients with shopping behavior in the past 3 months reported any reasons attributable to opioid abuse/misuse, indicating that shopping behavior in this population may not be a good surrogate for abuse/misuse.
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Affiliation(s)
| | - M Soledad Cepeda
- Epidemiology, Janssen Research and Development, Titusville, NJ, USA
| | - Jie Zhang
- Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA
- Safety and Epidemiology, HealthCore, Inc., Wilmington, DE, USA
| | - Jade Dinh
- Safety and Epidemiology, HealthCore, Inc., Wilmington, DE, USA
| | - Kelsey Hall
- Safety and Epidemiology, HealthCore, Inc., Wilmington, DE, USA
| | - Daina B Esposito
- Safety and Epidemiology, HealthCore, Inc., Wilmington, DE, USA
- Ciconia, Inc, Westford, MA, USA
- Epidemiology, Boston University, Boston, MA, USA
| | - David M Kern
- Epidemiology, Janssen Research and Development, Titusville, NJ, USA
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Abstract
AIMS Prescription opioid misuse (POM) contributes to a larger opioid crisis in the US and Canada, with over 17 000 US POM-related overdose deaths in 2017. Our aims were to (1) identify specific profiles of respondents based on POM motives using the US National Survey on Drug Use and Health (NSDUH) and (2) compare profile respondents on sociodemographics, substance use and mental and physical health outcomes. METHODS Analyses included 2017-18 NSDUH respondents with data on POM motives (n = 4810). POM was defined as prescription opioid use in a way not intended by the prescriber, including use without a prescription, in larger amounts or more frequently. Nine POM motives for the most recent episode were assessed, including 'to relieve physical pain' and 'to get high'. Latent classes, based on POM motives, were estimated. Classes were compared on sociodemographics, substance use and physical and mental health outcomes. RESULTS Eight latent classes were identified (in order of prevalence): pain relief only, relax-pain relief, sleep-pain relief, multi-motive, high, experimenter, emotional coping and dependent/hooked. Compared to the pain relief only group, the high and multi-motive classes had higher odds of all substance use outcomes, with the dependent/hooked class having higher odds on all but one outcome. Six of the eight classes had higher odds of past-year mental health treatment and suicidal ideation than the pain relief only class. CONCLUSIONS Screening for pain, pain conditions, problematic substance use and psychopathology are recommended in those with any POM. While those in the dependent/hooked, multi-motive and emotional coping classes are most likely to have prescription opioid use disorder (OUD), screening for OUD symptoms in all individuals with POM is also warranted.
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16
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Affiliation(s)
- Michael H. Bernstein
- Brown University, School of Public Health, Center for Alcohol and Addiction Studies, Providence RI,Corresponding Author: . 121 South Main Street, Box G-S121-4, Providence RI 02912
| | - Francesca L. Beaudoin
- Alpert Medical School of Brown University, Department of Emergency Medicine, Providence RI
| | - Molly Magill
- Brown University, School of Public Health, Center for Alcohol and Addiction Studies, Providence RI
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Islam MM, Wollersheim D. Who Are Dispensed the Bulk Amount of Prescription Opioids? J Clin Med 2019; 8:E293. [PMID: 30832231 DOI: 10.3390/jcm8030293] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/07/2019] [Accepted: 01/08/2019] [Indexed: 01/01/2023] Open
Abstract
Background: Excessive and non-medical use of prescription opioids is a public health crisis in many settings. This study examined the distribution of user types based on duration of use, trends in and associated factors of dispensing of prescription opioids in New South Wales and Victoria, Australia. Methods: 10% sample of unit-record data of four-year dispensing of prescription opioids was analysed. Quantities dispensed were computed in defined daily dose (DDD). Multilevel models examined factors associated with the duration of dispensing and the quantity dispensed in local government areas. Results: Overall, 53% were single-quarter, 37.3% medium-episodic (dispensed 2–6 quarters), 5% long-episodic (dispensed 7–11 quarters) and 5% were chronic users (dispensed 12–14 quarters). More than 80% of opioids in terms of DDD/1000 people/day were dispensed to long-episodic and chronic users. Codeine and oxycodone were most popular items—both in terms of number of users and quantity dispensed. Duration of dispensing was significantly higher for women than men. Dispensing quantity and duration increased with increasing age and residence in relatively poor neighborhoods. Conclusions: Although only 5% were chronic users, almost 60% of opioids (in DDD/1000 people/day) were dispensed to them. Given that chronic use is linked to adverse health outcomes, and there is a progression toward chronic use, tailored interventions are required for each type of users.
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18
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Mojtabai R, Amin-Esmaeili M, Nejat E, Olfson M. Misuse of prescribed opioids in the United States. Pharmacoepidemiol Drug Saf 2019; 28:345-353. [PMID: 30723973 DOI: 10.1002/pds.4743] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 04/09/2018] [Revised: 12/23/2018] [Accepted: 12/30/2018] [Indexed: 12/16/2022]
Abstract
PURPOSE To assess the prevalence and correlates of self-reported misuse of prescribed-opioid medications in the US general population. METHOD In 31 068 adult participants of the National Survey on Drug Use and Health (NSDUH) 2015 and 2016 who reported using opioids in the past year, we assessed the prevalence and correlates of self-reported misuse of prescribed opioids, defined as using a larger dose, more frequently, or longer than prescribed. Multivariable logistic-regression models and the machine-learning method of boosted regression were used to identify the correlates of misuse. RESULTS On the basis of weighted NSDUH estimates, of more than 89 million US adults who used prescription opioids every year, close to 3.9 million (4.4%) reported misused the prescribed medications. Prescribed-opioid misuse was most strongly associated with co-occurring misuse of opioids without a prescription, misuse of benzodiazepines, other drug-use disorders, history of illegal activity, and psychological distress. Misuse of prescribed opioids was also strongly associated with prescription opioid-use disorder, especially among those who misused more potent opioids or started misusing opioids before the current year. CONCLUSIONS Misuse of prescribed opioids is associated with other high-risk behaviors and adverse health outcomes. The findings call for better monitoring of opioid prescription in clinical practice.
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Affiliation(s)
- Ramin Mojtabai
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Masoumeh Amin-Esmaeili
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.,Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Eleeka Nejat
- College of Dentistry, University of Tennessee Health Sciences Center, Memphis, TN, USA
| | - Mark Olfson
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA
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Bruneau J, Arruda N, Zang G, Jutras-Aswad D, Roy É. The evolving drug epidemic of prescription opioid injection and its association with HCV transmission among people who inject drugs in Montréal, Canada. Addiction 2019; 114:366-373. [PMID: 30399197 DOI: 10.1111/add.14487] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 04/28/2018] [Revised: 08/03/2018] [Accepted: 10/26/2018] [Indexed: 01/30/2023]
Abstract
AIMS To examine temporal trends in prescription opioid (PO) injection and to assess its association with hepatitis C virus (HCV) seroconversion among people who inject drugs (PWID). DESIGN Prospective cohort study spanning 2004 to 2016. SETTING Montréal, Canada. PARTICIPANTS PWID reporting injection during the past 6 months. MEASUREMENTS PWID were recruited between 2004 and 2016. At each 3-6-month follow-up visit, participants completed interview-administered questionnaires and were tested for HCV-antibody. FINDINGS Among 1524 PWID [83% males, mean age 38 years, standard deviation (SD) = 10, 34% (31-36) prescription opioid (PO) injection past month] included in trends analyses, PO injection use expanded between 2004 and 2009, and plateaued between 2010 and 2016 (trend tests < 0.001 and 0.335, respectively). Of the 432 HCV-seronegative PWIDs followed at least once (81% males, mean age 34, SD 9.8, 38% injection PO), 153 became HCV-antibody-positive during 1230 years of follow-up, for an incidence of 12.4 per 100 person-years [95% confidence interval (CI) = 10.6, 14.6]. PO injectors were 3.9 times more likely to seroconvert to HCV, relative to non-PO injectors. In a multivariate analysis, a stronger association between PO injection and HCV seroconversion was found post-2009 [adjusted hazard ratio (aHR) = 5.4, 95% CI = 2.7, 10.8] than before (aHR = 1.5, 95% CI = 0.9, 2.4) (P-value for interaction = 0.001). CONCLUSION Prescription opioid injection increased among people who inject drugs in Montréal, Canada from 2004 to 2009, to reach a plateau between 2010 and 2016. The association between prescription opioid injection and HCV seroconversion was stronger during the second period than the first according to the epidemic phase.
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Affiliation(s)
- Julie Bruneau
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada.,Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Nelson Arruda
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, QC, Canada
| | - Geng Zang
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Didier Jutras-Aswad
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada.,Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Élise Roy
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, QC, Canada.,Institut National de Santé Publique, Montréal, QC, Canada
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20
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Islam MM, Wollersheim D. Variation in Prescription Opioid Dispensing across Neighborhoods of Diverse Socioeconomic Disadvantages in Victoria, Australia. Pharmaceuticals (Basel) 2018; 11:ph11040116. [PMID: 30388736 PMCID: PMC6315505 DOI: 10.3390/ph11040116] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 08/29/2018] [Revised: 10/12/2018] [Accepted: 10/24/2018] [Indexed: 01/10/2023] Open
Abstract
The study examined the relationship between dispensing patterns of prescription opioids, neighborhood-disadvantage-index, and standardized doses dispensed. Three-year’s dispensing data drawn from 80 local government areas (LGAs) within Victoria, Australia’s second most populous state, was analyzed. Quantities dispensed in defined daily dose (DDD)/1000-people/day were computed for LGAs of low, moderate, high, and very high socio-economic disadvantage. LGAs with various levels of dispensing, and neighborhood disadvantage were identified and mapped. A multivariable regression model examined the effect of neighborhood level disadvantage and identified other factors that are associated with standardized doses dispensed. More women were dispensed opioids than men. Dispensing increased with increasing age. Most of the LGAs with relatively high dispensing were socioeconomically disadvantaged and located outside the major cities. Dispensing gradually increased from low disadvantage to very high disadvantage areas. Dispensing of standardized doses were consistently higher in rural areas than in urban areas. Neighborhood level disadvantage, age, sex, and urbanization were significant factors in the standardized doses dispensed. As inappropriate dispensing of opioids is a major public health problem, research should facilitate understanding of utilization in small areas to enable tailored public health programs. Nationwide and consistent introduction of real-time prescription drug-monitoring programs, and structural interventions to reduce the fundamental causes of socioeconomic disadvantage and isolation are recommended.
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Affiliation(s)
- M Mofizul Islam
- Department of Public Health, La Trobe University, Melbourne, Victoria 3086, Australia.
| | - Dennis Wollersheim
- Health Information Management, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria 3086, Australia.
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Wang T, Ma J, Wang R, Liu Z, Shi J, Lu L, Bao Y. Poly-Drug Use of Prescription Medicine among People with Opioid Use Disorder in China: A Systematic Review and Meta-Analysis. Subst Use Misuse 2018; 53:1117-1127. [PMID: 29281497 DOI: 10.1080/10826084.2017.1400066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Indexed: 10/18/2022]
Abstract
BACKGROUND Opioid use disorder (OUD) causes substantial public health and social problems worldwide. Poly-drug use is common in people with OUD and increases morbidity and mortality. Investigation of the patterns and characteristics of poly-drug use of prescription medicine among opioid users is needed to develop appropriate prevention and intervention strategies. OBJECTIVES To estimate the prevalence of poly-drug use of prescription medicine among people with OUD in China using meta-analysis. METHODS We searched relevant epidemiological studies published before February 2017 in English and Chinese databases. The quality of included studies was assessed using the Agency for Healthcare Research and Quality scale. The pooled prevalences of prescription medicine use among people with OUD were estimated. RESULTS We included 80 eligible studies in the meta-analysis. The main prescription medicines were benzodiazepines (BZDs) and prescription opioid analgesics. The pooled prevalence of unclassified BZDs and prescription opioids was 40.6% and 23.2%, respectively. Diazepam was the most frequently co-used BZD (32.6%), followed by triazolam (32.1%), and estazolam (9.2%). Tramadol was the most commonly used prescription opioid (27.3%), followed by methadone (16.8%), buprenorphine (12.6%), pethidine (8.9%), morphine (6.5%), dihydroetorphine (3.9%), and codeine-containing cough syrup (3.7%). BZDs were mainly used for self-medication (56.1%), whereas prescription opioids were primarily coused for nonmedical purposes (69.4%). CONCLUSIONS The results demonstrate that prescription medicine use is widespread among opioid users in China. There needs to be more consideration of poly-drug use, and early interventions and management strategies are needed to prevent poly-drug use among opioid users in China.
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Affiliation(s)
- Tongyu Wang
- a National Institute on Drug Dependence , Peking University , Beijing , China.,b School of Public Health , Peking University , Beijing , China.,d Beijing Center for Diseases Prevention and Control , Beijing , China
| | - Jun Ma
- a National Institute on Drug Dependence , Peking University , Beijing , China.,b School of Public Health , Peking University , Beijing , China
| | - Rujia Wang
- a National Institute on Drug Dependence , Peking University , Beijing , China.,b School of Public Health , Peking University , Beijing , China
| | - Zhimin Liu
- a National Institute on Drug Dependence , Peking University , Beijing , China
| | - Jie Shi
- a National Institute on Drug Dependence , Peking University , Beijing , China
| | - Lin Lu
- a National Institute on Drug Dependence , Peking University , Beijing , China.,c Institute of Mental Health, National Clinical Research Center for Mental Disorders, Key Laboratory of Mental Health and Peking University Sixth Hospital , Peking University , Beijing , China
| | - Yanping Bao
- a National Institute on Drug Dependence , Peking University , Beijing , China.,e National Drug and Alcohol Research Centre , University of New South Wales Australia , Sydney , NSW , Australia
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22
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Rough K, Huybrechts KF, Hernandez-Diaz S, Desai RJ, Patorno E, Bateman BT. Using prescription claims to detect aberrant behaviors with opioids: comparison and validation of 5 algorithms. Pharmacoepidemiol Drug Saf 2018; 28:62-69. [PMID: 29687539 DOI: 10.1002/pds.4443] [Citation(s) in RCA: 13] [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: 06/19/2017] [Revised: 02/09/2018] [Accepted: 03/26/2018] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Compare and validate 5 algorithms to detect aberrant behavior with opioids: Opioid Misuse Score, Controlled Substance-Patterns of Utilization Requiring Evaluation (CS-PURE), Overutilization Monitoring System, Katz, and Cepeda algorithms. STUDY DESIGN AND SETTING We identified new prescription opioid users from 2 insurance databases: Medicaid (2000-2006) and Clinformatics Data Mart (CDM; 2004-2013). Patients were followed 1 year, and aberrant opioid behavior was defined according to each algorithm, using Cohen's kappa to assess agreement. Risk differences were calculated comparing risk of opioid-related adverse events for identified aberrant and nonaberrant users. RESULTS About 3.8 million Medicaid and 4.3 million CDM patients initiated prescription opioid use. Algorithms flagged potential aberrant behavior in 0.02% to 12.8% of initiators in Medicaid and 0.01% to 7.9% of initiators in CDM. Cohen's kappa values were poor to moderate (0.00 to 0.50 in Medicaid; 0.00 to 0.30 in CDM). Algorithms varied substantially in their ability to predict opioid-related adverse events; the Overutilization Monitoring System had the highest risk differences between aberrant and nonaberrant users (14.0% in Medicaid; 13.4% in CDM), and the Katz algorithm had the lowest (0.96% in Medicaid; 0.47% in CDM). CONCLUSIONS In 2 large databases, algorithms applied to prescription data had varying accuracy in identifying increased risk of adverse opioid-related events.
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Affiliation(s)
- Kathryn Rough
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Krista F Huybrechts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Sonia Hernandez-Diaz
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Rishi J Desai
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Elisabetta Patorno
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Brian T Bateman
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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Marshall JR, Gassner SF, Anderson CL, Cooper RJ, Lotfipour S, Chakravarthy B. Socioeconomic and geographical disparities in prescription and illicit opioid-related overdose deaths in Orange County, California, from 2010-2014. Subst Abus 2018; 40:80-86. [PMID: 29465301 DOI: 10.1080/08897077.2018.1442899] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [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: 12/16/2022]
Abstract
Background: Reports indicate a geographic effect of socioeconomic inequalities on the occurrence of opioid-related fatal overdoses. This study aims to (1) estimate the rates of opioid-related overdoses, (2) estimate the association of benzodiazepine co-ingestion with opioid-related deaths, (3) estimate associations between socioeconomic indicators and opioid-related deaths, and (4) map the distribution of fatal overdoses, in Orange County (OC), California. Methods: An ecologic study was conducted of all opioid- related deaths (1205 total) from 2010 to 2014 obtained from the OC Coroner Division database (1065 OC residents, 55 nonresidents, 85 OC homeless) (analyzed 2016-2017). Rates of opioid overdose, benzodiazepine co-ingestion prevalence, and associations with socioeconomic status (SES; education, poverty, median income) using ZIP code analysis in the residential and homeless communities were calculated. Results: Of 1205 deaths, 904 involved prescription-type opioids, 223 involved heroin, 39 involved both, and 39 not stated; 973 were classified unintentional overdoses, 180 suicides, and 52 undetermined; 49% of cases involved benzodiazepines. Prescription-type opioid and heroin death rates for residents were 5.4/ 100,000 person-years (95% confidence interval [CI]: 5.0-5.8) and 1.2/100,000 person-years (95% CI: 1.0-1.4), respectively. Males, age group 45-54, and Caucasian race had the highest rate (13.6/100,000) of opioid mortality. The highest death rates were seen in homeless adults, at 136/100,000 person-years for prescription-type opioids (95% CI: 99.0-185.5) and 156/100,000 person-years for heroin (95% CI: 116.8-209.5). Conclusions: The burden of prescription-type opioid-related deaths in OC affects all demographics and levels of SES; there is a disproportionately high rate of opioid-related deaths in the OC homeless population.
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Affiliation(s)
- John R Marshall
- a Department of Emergency Medicine , University of California, Irvine , Irvine , California , USA
| | | | - Craig L Anderson
- a Department of Emergency Medicine , University of California, Irvine , Irvine , California , USA
| | - Richelle J Cooper
- c Department of Emergency Medicine , University of California Los Angeles , Los Angeles , California , USA
| | - Shahram Lotfipour
- a Department of Emergency Medicine , University of California, Irvine , Irvine , California , USA
| | - Bharath Chakravarthy
- a Department of Emergency Medicine , University of California, Irvine , Irvine , California , USA
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24
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Fraser H, Zibbell J, Hoerger T, Hariri S, Vellozzi C, Martin NK, Kral AH, Hickman M, Ward JW, Vickerman P. Scaling-up HCV prevention and treatment interventions in rural United States-model projections for tackling an increasing epidemic. Addiction 2018; 113:173-182. [PMID: 28734093 PMCID: PMC6211174 DOI: 10.1111/add.13948] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [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: 02/03/2017] [Revised: 04/06/2017] [Accepted: 07/18/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS Effective strategies are needed to address dramatic increases in hepatitis C virus (HCV) infection among people who inject drugs (PWID) in rural settings of the United States. We determined the required scale-up of HCV treatment with or without scale-up of HCV prevention interventions to achieve a 90% reduction in HCV chronic prevalence or incidence by 2025 and 2030 in a rural US setting. DESIGN An ordinary differential equation model of HCV transmission calibrated to HCV epidemiological data obtained primarily from an HIV outbreak investigation in Indiana. SETTING Scott County, Indiana (population 24 181), USA, a rural setting with negligible baseline interventions, increasing HCV epidemic since 2010, and 55.3% chronic HCV prevalence among PWID in 2015. PARTICIPANTS PWID. MEASUREMENTS Required annual HCV treatments per 1000 PWID (and initial annual percentage of infections treated) to achieve a 90% reduction in HCV chronic prevalence or incidence by 2025/30, either with or without scaling-up syringe service programmes (SSPs) and medication-assisted treatment (MAT) to 50% coverage. Sensitivity analyses considered whether this impact could be achieved without re-treatment of re-infections, and whether greater intervention scale-up was required due to the increasing epidemic in this setting. FINDINGS To achieve a 90% reduction in incidence and prevalence by 2030, without MAT and SSP scale-up, 159 per 1000 PWID (initially 24.9% of infected PWID) need to be HCV-treated annually. However, with MAT and SSP scaled-up, treatment rates are halved (89 per 1000 annually or 14.5%). To reach the same target by 2025 with MAT and SSP scaled-up, 121 per 1000 PWID (19.9%) need treatment annually. These treatment requirements are threefold higher than if the epidemic was stable, and the impact targets are unattainable without retreatment. CONCLUSIONS Combined scale-up of hepatitis C virus treatment and prevention interventions is needed to decrease the increasing burden of hepatitis C virus incidence and prevalence in rural Indiana, USA, by 90% by 2025/30.
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Affiliation(s)
- Hannah Fraser
- Social and Community Medicine, University of Bristol, UK
| | - Jon Zibbell
- RTI International, Research Triangle Park, USA
| | | | - Susan Hariri
- U.S. Centers for Disease Control and Prevention, Atlanta, USA
| | | | - Natasha K Martin
- Social and Community Medicine, University of Bristol, UK,Division of Global Public Health, University of California San Diego, California, USA
| | | | | | - John W. Ward
- U.S. Centers for Disease Control and Prevention, Atlanta, USA
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Abstract
INTRODUCTION Substance use disorders are a group of chronic relapsing disorders of the brain, which have massive public health and societal impact. In some disorders (e.g., heroin/prescription opioid addictions) approved medications have a major long-term benefit. For other substances (e.g., cocaine, amphetamines and cannabis) there are no approved medications, and for alcohol there are approved treatments, which are not in wide usage. Approved treatments for tobacco use disorders are available, and novel medications are also under study. Areas covered: Medication-based approaches which are in advanced preclinical stages, or which have reached proof-of concept clinical laboratory studies, as well as clinical trials. Expert opinion: Current challenges involve optimizing translation between preclinical and clinical development, and between clinical laboratory studies to therapeutic clinical trials. Comorbidities including depression or anxiety are challenges for study design and analysis. Improved pharmacogenomics, biomarker and phenotyping approaches are areas of interest. Pharmacological mechanisms currently under investigation include modulation of glutamatergic, GABA, vasopressin and κ-receptor function, as well as inhibition of monoamine re-uptake. Other factors that affect potential market size for emerging medications include stigma, availability of treatment settings, adoption by clinicians, and the prevalence of persons with SUD who are not actively treatment-seeking.
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Affiliation(s)
- Eduardo R Butelman
- a Laboratory in the Biology of Addictive Diseases , The Rockefeller University , New York , NY , USA
| | - Mary Jeanne Kreek
- a Laboratory in the Biology of Addictive Diseases , The Rockefeller University , New York , NY , USA
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26
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Hsu DJ, McCarthy EP, Stevens JP, Mukamal KJ. Hospitalizations, costs and outcomes associated with heroin and prescription opioid overdoses in the United States 2001-12. Addiction 2017; 112:1558-1564. [PMID: 28191702 PMCID: PMC5544564 DOI: 10.1111/add.13795] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 09/13/2016] [Accepted: 02/08/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS The full burden of the opioid epidemic on US hospitals has not been described. We aimed to estimate how heroin (HOD) and prescription opioid (POD) overdose-associated admissions, costs, outcomes and patient characteristics have changed from 2001 to 2012. DESIGN Retrospective cohort study of hospital admissions from the National Inpatient Sample (NIS). SETTING United States of America. PARTICIPANTS Hospital admissions in patients aged 18 years or older admitted with a diagnosis of HOD or POD. The NIS sample included 94 492 438 admissions from 2001 to 2012. The final unweighted study sample included 138 610 admissions (POD: 122 147 and HOD: 16 463). MEASUREMENTS Primary outcomes were rates of admissions per 100 000 people using US Census Bureau annual estimates. Other outcomes included in-patient mortality, hospital length-of-stay, cumulative and mean hospital costs and patient demographics. All analyses were weighted to provide national estimates. FINDINGS Between 2001 and 2012, an estimated 663 715 POD and HOD admissions occurred nation-wide. HOD admissions increased 0.11 per 100 000 people per year [95% confidence interval (CI) = 0.04, 0.17], while POD admissions increased 1.25 per 100 000 people per year (95% CI = 1.15, 1.34). Total in-patient costs increased by $4.1 million dollars per year (95% CI = 2.7, 5.5) for HOD admissions and by $46.0 million dollars per year (95% CI = 43.1, 48.9) for POD admissions, with an associated increase in hospitalization costs to more than $700 million annually. The adjusted odds of death in the POD group declined modestly per year [odds ratio (OR) = 0.98, 95% CI = 0.97, 0.99], with no difference in HOD mortality or length-of-stay. Patients with POD were older, more likely to be female and more likely to be white compared with HOD patients. CONCLUSIONS Rates and costs of heroin and prescription opioid overdose related admissions in the United States increased substantially from 2001 to 2012. The rapid and ongoing rise in both numbers of hospitalizations and their costs suggests that the burden of POD may threaten the infrastructure and finances of US hospitals.
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Affiliation(s)
- Douglas J Hsu
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Ellen P McCarthy
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jennifer P Stevens
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Kenneth J Mukamal
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Abstract
BACKGROUND Ibogaine is a monoterpene indole alkaloid used in medical and nonmedical settings for the treatment of opioid use disorder. Its mechanism of action is apparently novel. There are no published prospective studies of drug use outcomes with ibogaine. OBJECTIVES To study outcomes following opioid detoxification with ibogaine. METHODS In this observational study, 30 subjects with DSM-IV Opioid Dependence (25 males, 5 females) received a mean total dose of 1,540 ± 920 mg ibogaine HCl. Subjects used oxycodone (n = 21; 70%) and/or heroin (n = 18; 60%) in respective amounts of 250 ± 180 mg/day and 1.3 ± 0.94 g/day, and averaged 3.1 ± 2.6 previous episodes of treatment for opioid dependence. Detoxification and follow-up outcomes at 1, 3, 6, 9, and 12 months were evaluated utilizing the Subjective Opioid Withdrawal Scale (SOWS) and Addiction Severity Index Composite (ASIC) scores, respectively. RESULTS SOWS scores decreased from 31.0 ± 11.6 pretreatment to 14.0 ± 9.8 at 76.5 ± 30 hours posttreatment (t = 7.07, df = 26, p < 0.001). At 1-month posttreatment follow-up, 15 subjects (50%) reported no opioid use during the previous 30 days. ASIC Drug Use and Legal and Family/Social Status scores were improved relative to pretreatment baseline at all posttreatment time points (p < .001). Improvement in Drug Use scores was maximal at 1 month, and subsequently sustained from 3 to 12 months at levels that did not reach equivalence to the effect at 1 month. CONCLUSION Ibogaine was associated with substantive effects on opioid withdrawal symptoms and drug use in subjects for whom other treatments had been unsuccessful, and may provide a useful prototype for discovery and development of innovative pharmacotherapy of addiction.
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Affiliation(s)
| | - Kenneth Alper
- b Departments of Psychiatry and Neurology , New York University School of Medicine , New York , NY , USA
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Pilgrim JL, Jenkins EL, Baber Y, Caldicott D, Drummer OH. Fatal acute poisonings in Australian children (2003-13). Addiction 2017; 112:627-639. [PMID: 27766705 DOI: 10.1111/add.13669] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 08/21/2016] [Accepted: 10/19/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIMS Fatal poisonings in children comprise a small proportion of cases investigated by an Australian coroner; however, they present a major opportunity for death prevention. This study aimed to examine fatal child poisonings in Australia to (1) estimate the rate of acute poisoning deaths in children; (2) describe the key characteristics of the cohort; and (3) describe the outcomes of coronial recommendations made as a death prevention measure. DESIGN Retrospective case series. SETTING The National Coronial Information System (NCIS), a database of cases reported to an Australian coroner. PARTICIPANTS Ninety poisoning deaths reported to an Australian coroner between January 2003 and December 2013 involving children (≤ 16 years of age). MEASURES Logistic regression, Pearson's correlation coefficient and descriptive statistics were used to examine the significance of associations. The primary outcome measures were poisoning type and cause of death. Covariates included age and mental illness. FINDINGS There were marginally more males (52.2%) [confidence interval (CI) = 44.4-45.6] in the cohort and most occurred in the 13-16-year age group (58.9%) (CI = 7.5-12.5). Deaths were typically unintentional (61.1%) (CI = 17.9-27.1) and occurred in the home (68.9%) (CI = 6.8-15.7). The most common form of poisoning was due to opioids (24.4%), followed by carbon monoxide (20%) and volatile substances (18.9%) (CI = 18.5-19.6). Males had slightly higher odds of dying from prescription opioids compared with females [odds ratio (OR) = 1.9, CI = 0.7-5.1], but this was not statistically significant. A recommendation was made by a coroner in 12 cases, 10 of which related to poisons (including drugs). Of these, eight recommendations were implemented. CONCLUSIONS In Australia between 2003 and 2013 there were on average eight acute poisoning deaths in children each year, most commonly involving prescription opioids and adolescents. There has been a downward trend in mortality since 2003. These cases generated more than twice as many recommendations for public safety compared with other Australian coroners' cases.
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Affiliation(s)
- Jennifer L Pilgrim
- Department of Forensic Medicine, Monash University, Australia.,Deaths from Emergencies and Accidents Data Set (DEADSet) Project, Australia
| | - Elizabeth L Jenkins
- Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia.,Deaths from Emergencies and Accidents Data Set (DEADSet) Project, Australia
| | - Yeliena Baber
- Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia
| | - David Caldicott
- Deaths from Emergencies and Accidents Data Set (DEADSet) Project, Australia.,Calvary Health Care, Australian National University, Australian Capital Territory, Australia
| | - Olaf H Drummer
- Department of Forensic Medicine, Monash University, Australia.,Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia
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Morizio KM, Baum RA, Dugan A, Martin JE, Bailey AM. Characterization and Management of Patients with Heroin versus Nonheroin Opioid Overdoses: Experience at an Academic Medical Center. Pharmacotherapy 2017; 37:781-790. [PMID: 28100012 DOI: 10.1002/phar.1902] [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] [Indexed: 11/06/2022]
Abstract
STUDY OBJECTIVES To characterize the differences between patients who had heroin and nonheroin opioid overdoses and to determine whether there were any significant differences in their management with regard to the naloxone use. DESIGN Retrospective cohort study. SETTING Large academic medical center. PATIENTS A total of 923 patients admitted to the medical center who were identified for overdose by heroin or other opiate-related narcotics between January 2010 and September 2015; 480 patients experienced a nonheroin opioid overdose event, and 443 patients experienced a heroin overdose event. MEASUREMENTS AND MAIN RESULTS Patients presenting with heroin overdose tended to be younger and male, with higher rates of hepatitis C virus (HCV) infection compared with those presenting with nonheroin opioid overdose (p<0.05). Patients in the heroin group were also more likely to have a previous overdose event, history of injection drug use, and history of prescription opioid abuse compared with the nonheroin group (p<0.05). Those presenting with heroin overdose were more likely to receive naloxone in the prehospital setting (p<0.05) but were less likely to receive naloxone once admitted (p<0.05). Patients with nonheroin opioid overdoses required more continuous infusions of naloxone (p<0.05) and admission to the intensive care unit (p<0.05). Of all 923 patients, 178 (19.3%) had a repeat admission for any reason, and 70 (7.6%) were readmitted over the course of the study period for another overdose event with the same drug. The proportion of patients presenting with a heroin overdose steadily increased from 2010-2015; the number of patients presenting to the emergency department with nonheroin opioid overdoses steadily decreased. As rates of heroin overdose increased each year, the incidence of HCV infection increased dramatically. CONCLUSION This study indicates that the incidence of heroin overdoses has significantly increased over the last several years, and the rates of HCV infection 4-fold since the start of the study period. Patients admitted for nonheroin opioid overdose were more likely to be admitted to the hospital and intensive care unit compared with those admitted for heroin overdose. The rise in overdose events only further illustrates a gap in our understanding of the cycle of addiction, drug abuse, and overdose events.
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Affiliation(s)
- Kate M Morizio
- Department of Pharmacy, Banner University Medical Center at the University of Arizona, Tucson, Arizona
| | - Regan A Baum
- Department of Pharmacy, University of Kentucky HealthCare, Lexington, Kentucky
| | - Adam Dugan
- Department of Emergency Medicine, University of Kentucky HealthCare, Lexington, Kentucky
| | - Julia E Martin
- Department of Emergency Medicine, University of Kentucky HealthCare, Lexington, Kentucky
| | - Abby M Bailey
- Department of Pharmacy, University of Kentucky HealthCare, Lexington, Kentucky
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30
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Marks KR, Leukefeld CG. A Preliminary Study Examining Women's Physical Health and Nonmedical Prescription Opioid Use in a Recovering Framework. J Womens Health (Larchmt) 2017; 26:286-293. [PMID: 28072916 DOI: 10.1089/jwh.2016.5961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/12/2022] Open
Abstract
BACKGROUND There is a growing need for research on women recovering from nonmedical prescription opioid use. A paradigm shift is to focus on wellness and factors that support, rather than hinder, recovering women. For example, although physical health is impacted by nonmedical prescription opioid use, improved health may be a strength-based factor among recovering women. The aim of this preliminary study was to examine physical health in a recovering framework as women begin recovering from nonmedical prescription opiate use. MATERIALS AND METHODS This study conducted secondary data analysis using self-report data from Kentucky's Targeted Assessment Program (TAP). TAP assesses and provides pretreatment for problems impeding work or interfering with parental responsibilities. Data included 1247 adult women reporting a history of nonmedical prescription opioid use and receiving pretreatment. Bivariate and logistic regression analyses examined whether physical health and access to health services at baseline were associated with substance-related behavior change upon completion of pretreatment. RESULTS Women reporting better physical health and fewer days with no activities due to health barriers were more likely to engage in pretreatment substance-related behavior change [χ2(8) = 34.6, p < 0.05]. However, ∼40% of women reported barriers in accessing healthcare. CONCLUSION Using a recovering framework, women's physical health, as expected, is associated with engagement in pretreatment substance-related behavior change. Ongoing service coordination with practitioners and medical providers should be incorporated into care to meet the need. Future research should continue to examine factors that support recovering women, using a recovering framework.
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Affiliation(s)
- Katherine R Marks
- Behavioral Science, University of Kentucky College of Medicine , Lexington, Kentucky
| | - Carl G Leukefeld
- Behavioral Science, University of Kentucky College of Medicine , Lexington, Kentucky
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Abstract
BACKGROUND Opioid overdoses can often be reversed with naloxone hydrochloride. Past studies on attitudes toward expanded naloxone access have surveyed drug users, family members, and providers. OBJECTIVES To explore how the general public perceives take-home or nonmedical first-responder access to naloxone to reverse opioid overdoses. Additionally, little is known about how support for expanded access is related to participant's endorsement of Individualism and Just World Belief-colloquially people getting what they deserve and deserving what they get. METHODS Lay participants completed an online survey examining concerns with and support for expanding naloxone access. Just World Belief, Individualism, and participants' dependence history were also measured. Four different hypothetical situations were considered, varying according to type of opioid (heroin versus nonmedical prescription opioid) and recipient (suburban middle class versus recent parolee). RESULTS Most participants agreed with at least some degree of expanded access. Analyses of variance indicated that type of opioid or recipient did not affect attitudes toward expansion. Pearson correlations and multiple regressions revealed that endorsement of Just World Beliefs and Individualism were associated with greater concerns with and less support for expansion. IMPORTANCE While there is general agreement with some degree of expanding naloxone access, participants' level of endorsement was influenced by their level of individualism and belief in a just world. These factors need to be considered in how to best frame messages to maximize layperson support for expansion.
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O'Kane N, Hallvik SE, Marino M, Van Otterloo J, Hildebran C, Leichtling G, Deyo RA. Preparing a prescription drug monitoring program data set for research purposes. Pharmacoepidemiol Drug Saf 2016; 25:993-7. [PMID: 27273809 DOI: 10.1002/pds.4039] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 11/08/2015] [Revised: 04/21/2016] [Accepted: 04/29/2016] [Indexed: 11/07/2022]
Abstract
PURPOSE To develop a complete and consistent prescription drug monitoring program (PDMP) data set for use by drug safety researchers in evaluating patterns of high-risk use and potential abuse of scheduled drugs. METHODS Using publically available data references from the US Food and Drug Administration and the Centers for Disease Control and Prevention, we developed a strategic methodology to assign drug categories based on pharmaceutical class for the majority of prescriptions in the PDMP data set. We augmented data elements required to calculate morphine milligram equivalents and assigned duration of action (short-acting or long acting) properties for a majority of opioids in the data set. RESULTS About 10% of prescriptions in the PDMP data set did not have a vendor-assigned drug category, and 20% of opioid prescriptions were missing data needed to calculate risk metrics. Using inclusive methods, 19 133 167 (>99.9%) of prescriptions in the PDMP data set were assigned a drug category. For the opioid category, augmenting data elements resulted in 10 760 669 (99.8%) having required values to calculate morphine milligram equivalents and evaluate duration of action properties. CONCLUSIONS Drug safety researchers who require a complete and consistent PDMP data set can use the methods described here to ensure that prescriptions of interest are assigned consistent drug categories and complete opioid risk variable values. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
| | | | - Miguel Marino
- Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA.,Division of Biostatistics, Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, OR, USA
| | | | | | | | - Richard A Deyo
- Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA.,Department of Medicine, Oregon Health and Science University, Portland, OR, USA.,Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, OR, USA.,Oregon Institute of Occupational Health Sciences, Portland, OR, USA
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Hagemeier NE, Alamian A, Murawski MM, Flippin H, Hagy EJ, Pack RP. Correlates of Prescription Opioid Legitimacy Judgments Among Community Pharmacists. Subst Use Misuse 2016; 51:692-9. [PMID: 27070040 DOI: 10.3109/10826084.2015.1135952] [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] [Indexed: 11/13/2022]
Abstract
BACKGROUND Community pharmacists are legally required to evaluate and confirm the legitimacy of prescription opioids (POs) prior to dispensing. Yet, previous research has indicated community pharmacists perceive nearly 50% of dispensed POs to be issued lacking a legitimate medical purpose. OBJECTIVE To analyze correlates of PO legitimacy judgments across pharmacist and pharmacy setting characteristics. METHODS A cross-sectional study of 2000 Tennessee pharmacists was conducted during October and November of 2012. Community pharmacists' self-reported attitudes, beliefs, and behaviors specific to PO legitimacy were elicited. Step-wise multinomial logistic regression techniques were used to model correlates of PO legitimacy across low, moderate and high PO legitimacy estimations. RESULTS Being female, practicing in a chain or independent practice setting, fear of employer disciplinary action if PO legitimacy is questioned, and self-confidence in one's ability to detect PO abuse increased the odds of low (vs. high) PO legitimacy estimation (p < 0.05). Employment in chain and independent pharmacies, having POs as a greater percent of total prescriptions filled, and having the perception of PO abuse as a problem in the practice setting were significant positive correlates of moderate (vs high) PO legitimacy estimation (p < 0.05). CONCLUSIONS Both modifiable and non-modifiable correlates were statistically significantly associated with PO legitimacy judgments. Distinct correlates were noted across low and moderate as compared to high estimations of PO legitimacy. Legitimacy judgments can inform theoretical exploration of PO dispensing behaviors and inform intervention development targeted at reducing and preventing prescription drug abuse.
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Affiliation(s)
- Nicholas E Hagemeier
- a Gatton College of Pharmacy, East Tennessee State University , Johnson City , Tennessee , USA
| | - Arsham Alamian
- b College of Public Health, East Tennessee State University , Johnson City , Tennessee , USA
| | - Matthew M Murawski
- c College of Pharmacy, Purdue University , West Lafayette , Indiana , USA
| | - Heather Flippin
- a Gatton College of Pharmacy, East Tennessee State University , Johnson City , Tennessee , USA
| | - Elizabeth J Hagy
- a Gatton College of Pharmacy, East Tennessee State University , Johnson City , Tennessee , USA
| | - Robert P Pack
- b College of Public Health, East Tennessee State University , Johnson City , Tennessee , USA
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Chang YP, Compton P, Almeter P, Fox CH. The Effect of Motivational Interviewing on Prescription Opioid Adherence Among Older Adults With Chronic Pain. Perspect Psychiatr Care 2015; 51:211-9. [PMID: 25159493 DOI: 10.1111/ppc.12082] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [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: 03/05/2014] [Revised: 05/20/2014] [Accepted: 07/10/2014] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To test the effect of office-based motivational interviewing (MI) on prescription opioid adherence in older adults with chronic pain. DESIGN AND METHODS Pre- and post-design was used. Thirty chronic pain patients participated in a 4-week MI in two outpatient settings. FINDINGS Participants demonstrated a significantly reduced risk of prescription opioid misuse, decreased substance use, increased self-efficacy, increased motivation to change, and decreased depression at both the post-test and 1-month follow-up. PRACTICE IMPLICATION MI can be effectively delivered in outpatient settings for older adults who are at risk for opioid misuse. Clinicians could incorporate MI techniques to enhance prescription opioid adherence.
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Affiliation(s)
- Yu-Ping Chang
- School of Nursing, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Peggy Compton
- School of Nursing and Health Studies, Georgetown University, Washington DC, USA
| | - Pamela Almeter
- School of Nursing, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Chester H Fox
- Department of Family Medicine, University at Buffalo, The State University of New York, New York, New York, USA
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35
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Datta D, Pandey S, Dutta S, Verma Y, Chakrabarti A. Descriptive epidemiology and high risk behavior of male prescription opioid abusers: Cross-sectional study from Sikkim, North East India. Indian J Psychiatry 2015; 57:284-9. [PMID: 26600583 PMCID: PMC4623648 DOI: 10.4103/0019-5545.166631] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Sikkim is emerging as an important area for prescription opioid abuse with frequent news of seizures and arrests due to possession of prescription opioids. However, till date there is a little information on descriptive epidemiology and high risk behavior of prescription opioid abusers from Sikkim. AIMS The aim was to describe demographic (age, sex, religion, marital status, community, occupation, etc.); socioeconomic (income, education, family information etc.); and high risk behavior (e.g., injection sharing, visit to commercial sex workers [CSWs], homosexuality etc.) among treatment-seeking prescription opioid abusers in Sikkim. MATERIALS AND METHODS Epidemiological data were collected by administering predevised questionnaires from n = 223 prescription opioid abusers (main problem prescription opioids) reporting for treatment at five different drug abuse treatment centers across Sikkim. RESULTS The mean age of prescription opioid abusers in Sikkim was 27 years; all were male, of Nepalese ethnicity and single/never married, school dropout and/or illiterate, earning < Rs. 10,000/month with most spending almost Rs. 5000 a month on prescription opioids. Most (57.4%) prescription opioid abusers belonged to the urban community. Commonly abused prescription opioids were dextropropoxyphene and codeine. Injection sharing was more in urban areas whereas syringe exchange was observed equally among rural and urban prescription opioid abusers. Among urban injectors visits to CSWs, and multiple sex partners were also common in spite of knowledge about AIDS. Limited condom use was observed among rural respondents. Incidences of arrests, public intoxication, and violence under the influence of prescription opioids were also reported. CONCLUSION Both the rural and urban areas of Sikkim show increasing rates of prescription opioid abuse among males. It is more prevalent among school dropouts and unemployed youth. Trends of injection drug use, unsafe injection, high risk behavior have also been observed.
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Affiliation(s)
- D Datta
- Department of Pharmacology and Psychiatry, Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim, India
| | - S Pandey
- Department of Pharmacology and Psychiatry, Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim, India
| | - S Dutta
- Department of Pharmacology and Psychiatry, Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim, India
| | - Y Verma
- Department of Pathology, STNM Hospital, Government of Sikkim, Gangtok, Sikkim, India
| | - Amit Chakrabarti
- Department of Toxicology, Regional Occupational Health Centre (Eastern), National Institute of Occupational Health, Indian Council of Medical Research, Kolkata, West Bengal, India
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Voon P, Callon C, Nguyen P, Dobrer S, Montaner JSG, Wood E, Kerr T. Denial of prescription analgesia among people who inject drugs in a Canadian setting. Drug Alcohol Rev 2014; 34:221-8. [PMID: 25521168 DOI: 10.1111/dar.12226] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [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: 04/03/2014] [Accepted: 10/05/2014] [Indexed: 01/18/2023]
Abstract
INTRODUCTION AND AIMS Despite the high prevalence of pain among people who inject drugs (PWIDs), clinicians may be reluctant to prescribe opioid-based analgesia to those with a history of drug use or addiction. We sought to examine the prevalence and correlates of PWIDs reporting being denied of prescription analgesia (PA). We also explored reported reasons for and actions taken after being denied PA. DESIGN AND METHODS Using data from two prospective cohort studies of PWIDs, multivariate logistic regression was used to identify the prevalence and correlates of reporting being denied PA. Descriptive statistics were used to characterise reasons for denials and subsequent actions. RESULTS Approximately two-thirds (66.5%) of our sample of 462 active PWIDs reported having ever been denied PA. We found that reporting being denied PA was significantly and positively associated with having ever been enrolled in methadone maintenance treatment (adjusted odds ratio 1.76, 95% confidence interval 1.11-2.80) and daily cocaine injection (adjusted odds ratio 2.38, 95% confidence interval 1.00-5.66). The most commonly reported reason for being denied PA was being accused of drug seeking (44.0%). Commonly reported actions taken after being denied PA included buying the requested medication off the street (40.1%) or obtaining heroin to treat pain (32.9%). DISCUSSION AND CONCLUSIONS These findings highlight the challenges of addressing perceived pain and the need for strategies to prevent high-risk methods of self-managing pain, such as obtaining diverted medications or illicit substances for pain. Such strategies may include integrated pain management guidelines within methadone maintenance treatment and other substance use treatment programs.
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Affiliation(s)
- Pauline Voon
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
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Fischer B, Jones W, Urbanoski K, Skinner R, Rehm J. Correlations between prescription opioid analgesic dispensing levels and related mortality and morbidity in Ontario, Canada, 2005-2011. Drug Alcohol Rev 2013; 33:19-26. [PMID: 24261474 DOI: 10.1111/dar.12089] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [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: 09/06/2013] [Accepted: 10/16/2013] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND AIMS Prescription opioid analgesic (POA)-related harms constitute a major public health problem in North America. Ontario features above-average POA use levels in Canada and has seen consistent increases in related mortality and morbidity. Recent studies documented strong correlations between POA dispensing levels and related harm outcomes on population levels. We examined correlations between POA dispensing and key POA-related mortality and morbidity indicators in Ontario, 2005-2011. DESIGN AND METHODS Correlations between (i) annual dispensing levels of four strong POA formulations (fentanyl, hydromorphone, morphine and oxycodone; from IMS Brogan's Compuscript converted to defined daily doses) and POA-related mortality (based on provincial coroner's data) and (ii) annual total POA dispensing and POA-related treatment caseload (from the Drug and Alcohol Treatment Information System) were examined for the study context. RESULTS Strong and significant correlations were observed between POA dispensing and mortality for three formulations, namely hydromorphone: 0.98 [95% confidence interval (CI) 0.89-1.00; P<0.001], fentanyl: 0.93 (95% CI 0.58-0.99; P=0.003) and oxycodone: 0.93 (95% CI 0.57-0.99; P=0.003), but not morphine (-0.29; 95% CI-0.86-0.59; P=0.523), as well as for treatment when examining congruent years [0.99 (95% CI 0.92-1.00); P<0.001] and when using a 1-year offset (1.00; 95% CI 0.96-1.00; P<0.001). DISCUSSION AND CONCLUSIONS POA dispensing levels were found to be strongly correlated with mortality and morbidity (treatment) indicators. Targeted and sensible reductions of POA use level would likely constitute a primary measure to reduce POA-related harms on a population level, especially in a jurisdiction with high POA consumption levels.
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Affiliation(s)
- Benedikt Fischer
- Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada; Social and Epidemiological Research, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
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Vosburg SK, Jones JD, Manubay JM, Ashworth JB, Benedek IH, Comer SD. Assessment of a formulation designed to be crush-resistant in prescription opioid abusers. Drug Alcohol Depend 2012; 126:206-15. [PMID: 22721679 PMCID: PMC3654549 DOI: 10.1016/j.drugalcdep.2012.05.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 05/10/2012] [Accepted: 05/15/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND The extent of prescription opioid abuse has led to the development of formulations that are difficult to crush. The purpose of the present studies was to examine whether experienced prescription opioid abusers (individuals using prescription opioids for non-medical purposes regardless of how they were obtained) were able to prepare a formulation of oxymorphone hydrochloride ER 40 mg designed to be crush-resistant (DCR) for intranasal (study 1) or intravenous abuse (study 2), utilizing a non-crush-resistant formulation of oxymorphone (40 mg; OXM) as a positive control. METHODS No drug was administered in these studies. Participants were provided with DCR and OXM tablets in random order and asked to prepare them for abuse with tools/solutions that they had previously requested. The primary outcome for study 1 was particle size distribution, and the primary outcome for study 2 was percent yield of active drug in the extracts. Other descriptive variables were examined to better understand potential responses to these formulations. RESULTS Fewer DCR than OXM particles were smaller than 1.705 mm (9.8% vs. 97.7%), and thus appropriate for analyses. Percent yield of active drug in extract was low and did not differ between the two formulations (DCR: 1.95%; OXM: 1.29%). Most participants were not willing to snort (92%) or inject (84%) the tampered products. Participants indicated that they found less relative value in the DCR than the OXM formulation across both studies. CONCLUSIONS These data suggest that the oxymorphone DCR formulations may be a promising technology for reducing opioid abuse.
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Affiliation(s)
- Suzanne K Vosburg
- Division on Substance Abuse, New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, Department of Psychiatry, 1051 Riverside Drive, Unit 120, New York, NY 10032, USA.
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Zacny JP, Paice JA, Coalson DW. Separate and combined psychopharmacological effects of alprazolam and oxycodone in healthy volunteers. Drug Alcohol Depend 2012; 124:274-82. [PMID: 22365897 PMCID: PMC3568773 DOI: 10.1016/j.drugalcdep.2012.01.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [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: 11/16/2011] [Revised: 01/26/2012] [Accepted: 01/28/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND There are epidemiological data indicating that medical and/or nonmedical use of prescription opioids oftentimes involves concurrent use of other substances. One of those substances is benzodiazepines. It would be of relevance to characterize the effects of an opioid and a benzodiazepine when taken together to determine if measures related to abuse liability-related effects and psychomotor performance impairment are increased compared to when the drugs are taken alone. METHODS Twenty volunteers participated in a crossover, randomized, double-blind study in which they received placebo, 0.5mg alprazolam, 10mg oxycodone, and 0.5mg alprazolam combined with 10 mg oxycodone, all p.o. Subjective, psychomotor, and physiological measures were assessed during each of the four sessions. RESULTS Oxycodone by itself increased drug liking and "take again" ratings relative to placebo, but these ratings were not increased when oxycodone was taken with alprazolam, which by itself did not increase either of these ratings. The two drugs in combination produced stronger effects (larger in magnitude or longer lasting) than when either was taken alone on a number of measures, including psychomotor performance impairment. CONCLUSIONS In healthy volunteers, abuse liability-related subjective effects of oxycodone were not enhanced by alprazolam. There was enhanced behavioral toxicity when the drugs were taken together, and thus, this is of significant concern from a public safety standpoint.
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Affiliation(s)
- James P. Zacny
- Department of Anesthesia & Critical Care, The University of Chicago, Chicago, IL, United States,Corresponding author at: Department of Anesthesia & Critical Care MC 4028, The University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, United States. Tel.: +1 773 702 9920; fax: +1 773 702 6179., (J.P. Zacny)
| | - Judith A. Paice
- Division of Hematology-Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Dennis W. Coalson
- Department of Anesthesia & Critical Care, The University of Chicago, Chicago, IL, United States
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Zacny JP, Paice JA, Coalson DW. Subjective and psychomotor effects of carisoprodol in combination with oxycodone in healthy volunteers. Drug Alcohol Depend 2012; 120:229-32. [PMID: 21840651 PMCID: PMC3240720 DOI: 10.1016/j.drugalcdep.2011.07.006] [Citation(s) in RCA: 11] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Revised: 07/08/2011] [Accepted: 07/09/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Some chronic pain patients on long-term opioid therapy also take centrally active skeletal muscle relaxants. One of those muscle relaxants is carisoprodol, a drug that is abused and capable of producing impairment. It would be of relevance to characterize the effects of an opioid and carisoprodol when taken together to determine if abuse liability-related measures and psychomotor impairment are increased compared to when the drugs are taken alone. METHODS As part of a larger crossover, randomized, double-blind study, we examined the subjective and psychomotor responses of 15 healthy volunteers to four experimental conditions: placebo, 350 mg carisoprodol, 10mg oxycodone, and 350 mg carisoprodol followed 60 min later by 10mg oxycodone (intended to test the interaction of the two drugs when they were producing their maximal effects). RESULTS Preliminary data analyses indicated that some of carisoprodol's effects were declining when we tested for drug interactions. Despite this, on some outcome measures in which the drugs alone did not differ from placebo, when tested together subjective effects were increased, including those that were abuse liability-related, and psychomotor performance decreased, relative to placebo. CONCLUSIONS This is the first study that we are aware of that has shown that carisoprodol and oxycodone, two drugs that are sometimes co-prescribed for relief of pain, produce effects when administered "together" (i.e., separated by 60 min) that are of greater magnitude than when they are administered alone. Some of the effects were not benign, and are of concern from both abuse liability and public safety standpoints.
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Affiliation(s)
- James P. Zacny
- Department of Anesthesia and Critical Care, The University of Chicago, Chicago, Illinois
| | - Judith A. Paice
- Division of Hematology-Oncology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Dennis W. Coalson
- Department of Anesthesia and Critical Care, The University of Chicago, Chicago, Illinois
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Green TC, Grau LE, Carver HW, Kinzly M, Heimer R. Epidemiologic trends and geographic patterns of fatal opioid intoxications in Connecticut, USA: 1997-2007. Drug Alcohol Depend 2011; 115:221-8. [PMID: 21131140 PMCID: PMC3095753 DOI: 10.1016/j.drugalcdep.2010.11.007] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [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: 09/28/2010] [Revised: 11/07/2010] [Accepted: 11/08/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND The leading cause of injury death among adults in Connecticut (CT), USA is drug poisonings. We analyzed the epidemiology and geographic distribution of opioid-involved accidental drug-involved intoxication deaths ("overdoses") in CT over an 11-year period. METHODS We reviewed data from 1997 to 2007 on all adult accidental/undetermined drug intoxication deaths in CT that were referred to the Office of the Chief Medical Examiner (OCME). Regression analyses were conducted to uncover risk factors for fatal opioid-involved intoxications and to compare heroin- to prescription opioid- and methadone-involved deaths. Death locations were mapped to visualize differences in the geographic patterns of overdose by opioid type. RESULTS Of the 2900 qualifying deaths, 2231 (77%) involved opioids. Trends over time revealed increases in total opioid-related deaths although heroin-related deaths remained constant. Methadone, oxycodone and fentanyl, the most frequently cited prescription opioids, exhibited significant increases in opioid deaths. Prescription opioid-only deaths were more likely to involve other medications (e.g., benzodiazepines) and to have occurred among residents of a suburban or small town location, compared to heroin-involved or methadone-involved deaths. Heroin-only deaths tended to occur among non-Whites, were more likely to involve alcohol or cocaine and to occur in public locations and large cities. CONCLUSIONS The epidemiology of fatal opioid overdose in CT exhibits distinct longitudinal, risk factor, and geographic differences by opioid type. Each of these trends has implications for public health and prevention efforts.
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Affiliation(s)
- Traci C. Green
- The Warren Alpert Medical School of Brown University, Box G-1, Providence, RI 02912 USA
| | - Lauretta E. Grau
- Yale School of Medicine, 135 College Street, Suite 200, New Haven, CT 06510 USA
| | - H. Wayne Carver
- Office of the Chief Medical Examiner, 11 Shuttle Road, Farmington, CT 06032 USA
| | - Mark Kinzly
- Yale School of Medicine, 135 College Street, Suite 200, New Haven, CT 06510 USA
| | - Robert Heimer
- Yale School of Medicine, 135 College Street, Suite 200, New Haven, CT 06510 USA
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Abstract
Starting in 2007, a 2-year study based on ethnographic methodology was carried out downtown Montréal, Canada. A thematic analysis of observational and interview-based notes was conducted. Illicit prescription opioid (PO) use was widespread among street-based participants. Injection was the main mode of PO administration observed among users. Some injection practices such as "doing a wash" could pose new challenges in terms of prevention of infections. More research is needed to examine the role of illicit PO use in the development of opiate addiction and to better understand drug-using contexts that put PO users at risk of infections. The study's limitations are noted.
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Affiliation(s)
- Elise Roy
- Faculté de Médicine et des Sciences de la Santé, Université de Sherbrooke, Service de Toxicomanie, Longueuil, Québec, Canada.
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