Opioid Prescribing Research Articles

Comparison of postoperative and outpatient opioid use in adolescent idiopathic scoliosis patients treated with posterior spinal fusion surgery and vertebral body tethering.

Surgical treatments for adolescent idiopathic scoliosis (AIS) include posterior spinal fusion (PSF) and vertebral body tethering (VBT), but there is limited data that compares pain between these groups. We aimed to compare postoperative pain between these patients through inpatient opioid use and opioid prescriptions post-discharge. A retrospective review of patients diagnosed with AIS whounderwent PSF or VBT surgery was reviewed to determine LOS, inpatient opioid use, and opioids prescribed post-discharge. Only PSF patients who received liposomal bupivacaine and intrathecal (IT) hydromorphone, and VBT patients who received a paravertebral catheter of lidocaine and in addition toIT hydromorphone were included. Opioid amounts were reported as oral morphine equivalents (OMEs). Of 198 AIS patients that met inclusion, there were 89 PSF and 109 VBT patients. PSF patients had an increased LOS by 0.6 days compared to VBT patients (p < 0.001). Patients in the PSF group were administered a mean of 30.0 OMEs/day compared with the VBT group who received 12.5 OMEs/day (p < 0.001). At discharge, PSF patients were initially prescribed a mean of 227.7 OMEs while VBT patients' mean prescription was 139.7 (p < 0.001). PSF patients received more refills (Χ2 (1, n = 198) = 26.8, p < .001) and had a higher mean total of outpatient OMEs prescribed when compared to VBT patients (359.4 vs 185.8, p < 0.001). In AIS patients undergoing surgical correction, those who underwent PSF had longer LOS, received more inpatient OMEs, and were prescribed more OMEs both at initial discharge and total as an outpatient, when compared to VBT patients. Level III: (retrospective cohort study).

Application of Machine Learning to Identify Risk Factors for Outpatient Opioid Prescriptions Following Spine Surgery

Application of Machine Learning to Identify Risk Factors for Outpatient Opioid Prescriptions Following Spine Surgery

Pain Assessment Following Opioid Administration in Aneurysmal Subarachnoid Hemorrhage Associated Headache

Background: Headache is a debilitating complication following an aneurysmal subarachnoid hemorrhage (aSAH). Despite its impact on morbidity and quality of life, limited evidence characterizes the effectiveness of opioids. Objective: The aim of this study was to evaluate opioid associated reduction in pain scores in patients with aSAH-associated headache. Methods: This is a retrospective study of adult patients with an aSAH, Hunt and Hess grades I – III, admitted to a neurosciences intensive care unit. Descriptive and inferential statistics were used to characterize headache treatment strategies and opioid associated reduction in pain scores. Results: Opioids were used in up to 97.6% of patients for the management of aSAH-associated headache. Median reduction in pain after opioid administration was −1 (IQR: -3-0). Correlation between opioid dose and change in pain scores was negligible (rs = .01). Overall, 68.8% of patients were discharged on an opioid analgesic with predictive factors being severe headache (OR 2.52; 1.04 – 6.14) and oral morphine milligram equivalents ≥60 mg per day during the hospital stay (OR 3.02; 1.22 – 7.47). Conclusions: Opioids were associated with a small reduction in pain when assessed via the NRS. An increased opioid dose did not correlate with a greater reduction in assessed pain scores. A high percentage of patients remained on opioids throughout hospitalization and were eventually discharged on an opioid. The impact of discharge opioid prescriptions and risk of opioid persistence creates a cause for concern. It is imperative that we seek improved pain management strategies for aSAH-associated headache.

Rates and predictors of opioid deprescribing after fracture: A retrospective study of Medicare fee‐for‐service claims

AbstractBackgroundAdults with Alzheimer's disease and Alzheimer's disease related dementias (ADRD) or frailty are susceptible to fractures. Opioid analgesics are frequently prescribed after fractures. Documenting post‐fracture opioid discontinuation rates and predictors of discontinuation among adults with ADRD or frailty can inform clinical practice, identify potential disparities, and improve pain management guidelines. The objective of this paper was to investigate opioid discontinuation in opioid‐naïve older adults who used opioids after an acute fracture.MethodsThis retrospective cohort study included opioid‐naïve Medicare fee‐for‐service beneficiaries (N = 33,027) ≥65 years of age who filled an opioid prescription within 30 days of a vertebral, lower extremity, or upper extremity fracture from 2013 to 2018. Beneficiaries were classified according to ADRD (yes/no) and frailty (yes/no) status using validated claims‐based algorithms. The primary outcome was opioid discontinuation, defined as a 30‐day supply gap. We estimated discontinuation rates with the Kaplan–Meier method and identified predictors of opioid discontinuation using Cox proportional hazards regression.ResultsThe 30‐day opioid discontinuation rate was similar among non‐frail beneficiaries without ADRD (81% [95% CI, 80%–81%]) and those who were non‐frail with ADRD (83% [81%–84%]). Comparatively, 30‐day discontinuation rates were lower among those with frailty and ADRD (76% [75%–77%]) and those with frailty alone (77% [75%–78%]). After adjusting for sociodemographic characteristics, health status, healthcare utilization, and calendar year, beneficiaries with both ADRD and frailty (HR, 0.90 [0.87–0.93]) and those with frailty alone (HR, 0.85 [0.82–0.89]), but not those with ADRD alone (HR, 1.06 [1.01–1.10]), were less likely to discontinue opioids compared with those without ADRD or frailty.Conclusions and RelevanceOur findings suggest that frailty, but not ADRD, was associated with a lower likelihood of opioid discontinuation among older adults who initiated opioids after an acute fracture. Further research is needed to understand how opioid deprescribing practices depend on patient and provider preferences.

Black Race is Associated with Decreased Exposure to Advanced Therapies and Worse Outcomes in Individuals with Ulcerative Colitis.

For people diagnosed with ulcerative colitis (UC), racial disparities exist both in access to medications and clinical outcomes. We used the TriNetX database for two population-based retrospective analyses with Black (n = 22,519) and Asian (n = 8,626) individuals with UC matched for age, sex, and ethnicity. Outcomes included mortality, medication prescriptions, and clinical encounters at 6 months and 10 years. At 6 months and 10 years after diagnosis, Black people had increased mortality (2.7% vs. 1.9% and 8.1% vs. 6.9%, p < 0.0001), were prescribed fewer UC-specific therapies (21.3% vs. 26.4% and 30% vs. 36%, p < 0.0001), had higher rates of emergency department visits (22.3% vs. 13.6% and 41.2% vs. 31.5%, p < 0.0001), and higher hospitalisation rates (30.1% vs. 25.8% and 42.6% vs. 39.9%, p < 0.0001). At 6 months, they had more opioid prescriptions (18.5% vs. 15.7%, p < 0.0001). Asian people had lower mortality at 10 years (5.6% vs. 7.7%, p < 0.0001), higher rates of UC-specific medications at 6 months (28.6% vs. 26.5%, p = 0.002), and more hospitalizations (38.8% vs. 27.7%, p < 0.0001 at 6 months and 50% vs. 42.2%, p < 0.0001 at 10 years). Black individuals with UC are prescribed fewer disease-specific therapies compared to White individuals and have increased hospitalizations and mortality. Black individuals have higher rates of opioid prescriptions. Opioids have been associated with increased complication rates in inflammatory bowel disease. These trends are not seen in Asian individuals. This reveals critical disparities in the care of Black people with UC with opportunity for targeted interventions.

Systematic Approaches to Optimize Opioid Prescribing in Surgical Patients

The opioid crisis has highlighted the urgent need to optimize pain management strategies in surgical settings, prompting a shift towards opioid-sparing therapies. While opioids are crucial for alleviating moderate to severe postoperative pain, their over prescription poses significant risks, including addiction and overdose. This paper examines the feasibility of achieving opioid-free surgical recovery, particularly for minor and minimally invasive procedures, with the goal of extending this practice to more invasive surgeries through enhanced recovery after surgery (ERAS) programs. It also considers the cultural factors that influence patient expectations regarding pain management in countries with lower opioid prescribing rates, such as Japan and Germany, emphasizing the need for tailored approaches in the United States. The study advocates for the exclusion of opioids at every stage of the perioperative experience, promoting opioid-free anesthesia and analgesia. A framework for optimizing opioid prescribing practices in surgical contexts is proposed, highlighting the vital roles of acute pain specialists and pharmacists in developing comprehensive pain management strategies. By incorporating multimodal analgesia techniques, including non-opioid medications and alternative therapies, healthcare providers can effectively mitigate the risks associated with opioids while ensuring adequate pain relief

INVESTIGATION OF GEOSPATIAL DISPARITIES IN CHRONIC PANCREATITIS OUTCOMES.

Chronic pancreatitis (CP) is a fibro-inflammatory disorder characterized by abdominal pain and exocrine and endocrine pancreatic insufficiency resulting in significant morbidity. This study evaluates the impact of geospatial parameters, assessed using the Social Vulnerability Index (SVI), a tool comprising sixteen social attributes, on CP outcomes, including opioid use. We conducted a retrospective analysis of CP patients with available addresses followed at our pancreas center. We reviewed demographics, clinical variables including number of CP flares, local complications, pancreatic function, and healthcare-resource utilization (HRU) including imaging, endoscopic procedures, and surgeries, and outpatient opioid prescriptions measured in morphine milligram equivalents (MME). Regression analysis was performed to assess the association between outcomes and SVI [divided into 4 quartiles (I-IV; IV being most vulnerable]. Among 324 CP patients followed over 8 years, we noted trends of higher dependence on governmental insurance or no insurance among patients in higher SVI quartiles (III/IV vs. I/II) but no differences in demographics, comorbidities, or etiology of CP. In patients residing in more vulnerable SVI quartiles, we noted significantly higher frequency of hospitalizations for CP flares and lower daily MME. Rates of exocrine and endocrine pancreatic dysfunction and HRU were similar across all SVI quartiles. Despite multidisciplinary guideline-based care, residence in the most vulnerable neighborhoods may be associated with less opioid use and more frequent CP flares, suggesting possible inadequate pain control in these patients. These findings should guide prospective investigation of the impact of geospatial social determinants of health in CP and efforts to mitigate the above disparities.

Changes in Postpartum Opioid Prescribing After Implementation of State Opioid Prescribing Limits

In response to the growing opioid crisis, states implemented opioid prescribing limits to reduce exposure to opioid analgesics. Research in other clinical contexts has found that these limits are relatively ineffective at changing opioid analgesic prescribing. To examine the association of state-level opioid prescribing limits with opioid prescribing within the 30-day postpartum period, as disaggregated by type of delivery (vaginal vs cesarean) and opioid naivete. This retrospective, observational cohort study used commercial claims data from January 1, 2014, to December 31, 2021, from 49 US states and a difference-in-differences staggered adoption estimator to examine changes in postpartum opioid prescribing among all deliveries to enrollees between the ages of 18 and 44 years in the US. The implementation of a state opioid prescribing limit between 2017 and 2019. The primary outcomes for this analysis were the number of prescriptions for opioid analgesics, proportion of prescriptions with a supply greater than 7 days, and milligrams of morphine equivalent (MMEs) per delivery between 3 days before and 30 days after delivery. A total of 1 572 338 deliveries (enrollee mean [SD] age, 30.20 [1.59] years) were identified between 2014 and 2021, with 32.3% coded as cesarean deliveries. A total of 98.4% of these were to opioid-naive patients. The mean MMEs per delivery was 310.79, with higher rates in earlier years, states that had an opioid prescribing limit, and cesarean deliveries. In a covariate-adjusted difference-in-differences regression analysis, opioid prescribing limits were associated with a decrease of 148.70 MMEs per delivery (95% CI, -657.97 to 360.57) compared with states without such limits. However, these changes were not statistically significant. The pattern of results was similar among other opioid-prescribing outcomes and types of deliveries. The results of this cohort study suggest that opioid prescribing limits are not associated with changes in postpartum opioid prescribing regardless of delivery type or opioid naivete, which is consistent with research findings on these limits in other conditions or settings. Future research could explore what kinds of prevention mechanisms reduce the risk of opioid prescribing during pregnancy and postpartum.

Opioid Use Following Open Reduction and Internal Fixation of Mandibular Fractures.

A mandible fracture is a common traumatic craniofacial injury for which surgery is sometimes indicated. Post-fracture and postoperative pain are often controlled through prescribed narcotics, which have received increased attention for potential abuse. The current work identified 90-day opioid prescribing patterns following surgically treated mandible fractures. Patients who underwent open reduction and internal fixation to treat a closed mandible fracture between 2011 and 2021 were identified in the PearlDiver Mariner165 database. Exclusion criteria included: (1) patients with records active for fewer than 180 days before the injury and 90 days post-fracture, (2) age younger than 18, and (3) those with long bone fracture within 30 days of mandible fracture. Variables associated with filling an opioid prescription and utilizing excess morphine milligram equivalents (MMEs) were identified through multivariate regression. Prescribing patterns between 2011 and 2021 were analyzed using simple linear regression. A total of 15,049 patients were identified. Of these patients, opioid prescriptions were filled by 10,389 (69.0%). Greater MMEs were filled for those with greater age, prior opioid use, and history of chronic pain (P < 0.01 for all). The proportion of patients who received opioids decreased from 2011 to 2021 (73.3% versus 61.9%) during which declines were also seen for median MMEs (225.0 versus 128.4) and mean number of filled prescriptions (4.1 versus 2.8). The present work identified age and preexisting risk factors as significantly associated with excess MMEs following open reduction and internal fixation-treated mandible fracture. The decreasing proportion of patients receiving opioids along with decreasing MMEs suggests more refined practice with regard to their use.

Precision Opioid Prescription in ICU Surgery: Insights from an Interpretable Deep Learning Framework

Precision Opioid Prescription in ICU Surgery: Insights from an Interpretable Deep Learning Framework

Opioid prescriptions following behavioral health training among primary care providers

BackgroundOverdose deaths due to opioids are a major concern in the United States. Physicians often report inadequate training in chronic pain and substance use disorder management. Here, we evaluate whether a specialized program, the Train New Trainers Primary Care Psychiatry (TNT PCP) Fellowship, affected opioid prescription practices among primary care physicians.MethodsWe retrieved information from a publicly insured health program in Southern California on 11,975 patients and 180 primary care providers (PCPs) engaged in care between 2017 and 2021. Of the 180 PCPs, 38 received TNT training and 142 did not. We considered a patient as exposed to the provider’s TNT “treatment” if they received care from a provider after the provider completed the 1-year fellowship. We utilized the number of opioid prescriptions per patient per quarter-year as the key independent variable. Linear regression models controlled for provider characteristics and time trends. Robustness checks included clustering patients by provider identification.ResultsPost-TNT training, PCPs prescribed fewer than expected opioids. This result remains robust after controlling for several covariates (coef: − 0.209 ; standard error = 0.052, p < 0.001) as well as after clustering patient observations by provider.ConclusionIn a large Southern California healthcare system, the TNT training program preceded a reduction in primary care providers’ prescription rates of opioids. If replicated in larger samples, a low-cost provider training program has the potential to promote more judicious use of opioids for pain management. We encourage more studies to understand the program’s long-term impact on physician behavior and, potentially, on patient outcomes.

Navigating the COVID-19 Risk Environment, Overdose Prevention, and Self Care Practices of People Who Use Illicit Opioids in New York City

Background The concurrent opioid overdose crisis and COVID-19 pandemic created a perfect storm of risk for drug overdose mortality and other negative health outcomes. Methods This study is based on semi-structured interviews with 29 adults in New York City who were using illicit opioids (heroin, fentanyl, and prescription opioids without prescription) between April and September 2020 to gain their perspectives on navigating COVID as the pandemic was unfolding. Interviews explored both challenges posed by the pandemic and participants’ navigation of these challenges to prevent overdose, procure drugs, manage drug use, and maintain their health and safety. Results Participants tried to adhere to best public health policies and practices and adapted as needed to protect their own and others’ health. They procured larger amounts of drugs to reduce travel, arranged drop-offs, and adhered to social distancing mandates during transactions. Homeless participants formed supportive and protective “bubbles” with network members to ensure safety and maximize resources. Participants addressed service access challenges by stockpiling MOUD, injection equipment and naloxone and reported using drugs when protected by naloxone and someone to administer when possible. Conclusions Despite the many challenges posed by COVID to people who use drugs in NYC, this research documents the ways people who use drugs drew on experiences of navigating stigma, structural violence, and social exclusion on a daily basis to enhance self-care and harm reduction practices. Powerful narratives of adaptation and resilience speak to the need to include people who use drugs in future public health and disaster planning initiatives.

Adjunctive Use of Gabapentinoids Increases Opioid Consumption Following 1- to 3-Level Anterior Lumbar Interbody Fusion with Posterior Fixation: A Propensity-Score Matched Analysis.

Retrospective cohort. To evaluate the impact of adjunctive gabapentinoid therapy on postoperative opioid consumption following 1-3 levels anterior lumbar interbody fusion (ALIF) with posterior fixation. Gabapentin and pregabalin are analogues of the inhibitory neurotransmitter Gamma-Aminobutyric Acid (GABA) and are frequently employed as adjuncts in multimodal anesthesia strategies for managing acute pain. However, the opioid-sparing effect of gabapentinoids in the context of spine surgery has yet to be consistently demonstrated. The PearlDiver Database was queried from 2010 to 2021 for patients who underwent primary 1-3 levels ALIF with posterior fixation. Patients with opioid or gabapentinoid use within 6 months prior to index surgery were excluded. Patients with both gabapentinoid and opioid treatment were propensity score-matched to patients with opioid-only treatment. The propensity score-matching resulted in two equal groups of 2,617 patients with and without adjunctive gabapentinoid treatment for pain management. Adjunctive use of gabapentinoids was associated with a modest 2.9% reduction in average Morphine Milligram Equivalent (MME) per day (Standardized Mean Difference (SMD) -1.33, 95% Confidence Interval (CI) [-2.657, -0.002], P=0.050). However, this was accompanied by a 37.1% increase in the total duration of opioid prescriptions (SMD 94.97, 95% CI [56.976, 132.967], P<0.001) and a 41.7% increase in total MME consumption per patient (SMD 4817.23, 95% CI [1864.410, 7770.044], P=0.001). Additionally, gabapentinoid use was associated with an increased risk of readmission due to pain (Relative Risk (RR) 1.10, 95% CI [1.002, 1.212], P=0.050) and the development of drug abuse (RR 1.37, 95% CI [1.016, 1.833], P=0.046). Despite the modest daily opioid-sparing effect observed, adjunctive gabapentinoid treatment appears to increase total opioid consumption due to prolonged opioid use and may compromise pain management in the context of ALIF with posterior fixation.

Discharge Pain Medications: Do They Affect 6-Month Patient-Reported Outcomes After Operative Treatment of CMC Arthritis?

The purpose of this study is to analyze the relationship between discharge opioids after operative treatment of carpometacarpal (CMC) arthritis and patient-reported outcomes (PROs) over a 6-month episode of care. A total of 172 patients met inclusion criteria for this study. Patient-reported outcomes including patient-reported wrist/hand evaluation (PRWHE), single assessment numeric evaluation, and PRO measurement information system (PROMIS) global-10 questionnaires were collected prospectively and stored in an electronic data capture system until review for the purpose of this study. Morphine milligram equivalents (MMEs) were calculated using a Centers for Disease Control and Prevention-published opioid conversion table. Of the 172 patients who met inclusion criteria for this study, 121 (70.4%) were female. The average patient age on the day of procedure was 63.6 ± 7.4 years. All patients received a prescription pain medication upon discharge with an average of 191.3 MMEs (range: 40.00-800.00 MMEs) prescribed per patient. Overall, there was no correlation between the amount of pain medication prescribed in MMEs and change in PROs between baseline, 6-weeks, 3-months, and 6-months (r < .14). Surgeons should feel confident limiting postoperative opioid prescription for patients after CMC arthroplasty without jeopardizing outcomes.

Implementation of Electronic Medical Record Interventions to Maximize Opioid Disposal after Surgery in Routine Clinical Practice.

Despite guideline directed opioid prescribing after surgery, many patients retain excess opioids. Leftover pills increase the risk for misuse, diversion, and dependency. It is unclear whether interventions applied in routine clinical practice can increase excess opioid disposal rates. All adult patients at our institution with postoperative opioid prescriptions were identified in general surgery, otolaryngology, plastic surgery, neurosurgery, urology and transplant surgery. Disposal rates for 453 pre-intervention patients (surgery between 3/1/23-6/30/23) were compared with 545 intervention patients (surgery between 10/1/23-1/31/24). Pre- and post-intervention patients were called 1-3 months after surgery and asked about excess opioids.Interventions:1. Opioid disposal information sheets provided after surgery.2. Opioid disposal reminder delivered via patient portal in electronic medical record (EMR).3. Best practice alert (BPA) triggered in EMR at post operative visit reminded providers to discuss opioid disposal. Opioid disposal outcomes were obtained from 70% (699/998) of patients. 54% (375/699) had excess opioids. The percentage of patients disposing of their excess opioids increased from 30% (39/130) pre-intervention to 83% (204/245) post-intervention, p<0.00001. Forty-seven percent (247/545) of post-intervention patients had discussions with their providers after a BPA fired at their post-operative visits. Patients who had a provider discussion were more likely to dispose of excess opioids than those who only received an information sheet and patient portal reminder (92% vs 70%, p < 0.00001). Interventions easily incorporated into the EMR as part of routine clinical practice can markedly increase excess opioid disposal rates after surgery. When information on opioid disposal and patient portal reminders are combined with disposal discussions with providers at the postoperative visit, opioid disposal rates of >90% can be achieved.

Identifying factors associated with persistent opioid use after total joint arthroplasty: A retrospective review.

To identify predictors of persistent opioid use in opioid-naïve individuals undergoing total joint arthroplasty. Retrospective cohort study. Maine Health System. Opioid-naïve patients who underwent at least one total joint arthroplasty (knee, hip, or shoulder) between 2015 and 2020. Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression was used to create a predictive model for persistent opioid use after surgery from a US Electronic Health Record dataset in the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM) format. 75% of the data was used to build the LASSO model using 10-fold cross-validation and 25% of the data was used to determine the optimal probability threshold for predicting the binary outcome. Out of 6432 patients, 12.3% (792) were identified as having persistent opioid use across combined total joint arthroplasties defined as at least one opioid prescription between 90 days and one year after surgery. Patients with persistent opioid use were more likely to be current smokers (OR 1.65), use antidepressants (OR 1.76), or have a diagnosis of post-traumatic stress disorder (OR 2.07), or a substance related disorder (OR 1.69). Other factors associated with persistent opioid use included back pain (OR 1.43), dementia (OR 1.65), and BMI over 40 (OR 2.50). The probability of persistent opioid use was not associated with age, sex, or ethnicity. This predictive model for persistent opioid use after total joint arthroplasty shows promise as an evidence-based, validated, and standardized tool for identifying high-risk patients before surgery in order to target strategies and interventions to reduce the reliance on opioids for post-operative pain control.

Postpartum Opioid Prescribing and Persistent Use in Western Countries

(Anesth Analg. 2024;138(5):967–969. doi: 10.1213/ANE.0000000000006953) Pain during childbirth varies from person to person, but many women rate their pain as severe and persistent, with roughly 20% of individuals who underwent cesarean delivery reporting scar pain and ∼6% of individuals who had a vaginal delivery reporting perineal or vaginal pain 6 months after delivery. Due to this persistent and severe pain, prescription of opioids directly after birth is not uncommon, but many clinicians are concerned about persistent opioid use that affects up to 2% of those exposed to opioids during the postpartum period. In countries with high numbers of births annually, this translates to a large burden, and solutions are difficult to identify due to varying opioid use patterns across countries and unavailable data in many of them.

Community opioid dispensing after rib fracture injuries: CODI study.

Pain from rib fractures often requires inpatient management with opioid medication. The need for ongoing opioid prescriptions following hospital discharge is poorly understood. Harms associated with long-term opioid use are generally accepted. However, a deeper understanding of current prescribing patterns in this population at-risk is required. A retrospective cohort of adult patients hospitalised in Queensland, Australia between 2014 and 2015 with rib fractures (ICD-10-AM: S22.3, S22.4, S22.5), was obtained from the Community Opioid Dispensing after Injury (CODI) study, which includes person-linked hospitalisation, mortality and community opioid dispensing data. Data were extracted 90-days prior to the index-hospitalisation and 720-days after discharge. Factors associated with long-duration (>90 days cumulatively) and increased end-dose were examined using multivariable logistic regressions, odds ratios (OR), and 95% confidence intervals (95% CI). In total, 4306 patients met the inclusion criteria, and 58.8% had opioids dispensed in the community within 30 days of hospital discharge. 23.6% had long-duration dispensing and 13.7% increased opioid end-doses. Pre-injury opioid use was most associated with long-duration (OR = 12.00, 95% CI 8.99-16.01) and increased end-dose (OR = 9.00, 95% CI 6.75-12.00). Females and older persons had higher odds of long-duration dispensing (Females OR = 1.75, 95% CI 1.38-2.22; Age 65+ OR = 1.86, 95% CI 1.32-2.61). Injury severity and presence of concurrent injuries were not statistically significantly associated with duration or dose (p > .05). Subsequent hospitalisations and death during the follow-up period had statistically significant associations with long-duration and increased end-dose (p < .001). Opiate prescribing following rib fractures is prolonged in older, and female patients, beyond the traditionally reported recovery time frames requiring analgesia. Previous opioid use (without dependence) is associated with long-duration opioid use and increased end-dose in rib fracture patients. These results support the need for a collaborative health system approach and individualised strategies for high-risk patients with rib fractures to reduce long-term opiate use. Level III, Prognostic/Epidemiological.

Discovering opioid slang on social media: A Word2Vec approach with reddit data

The CDC reported that the overdose of prescription or illicit opioids was responsible for the deaths of over 80,000 Americans in 2021. Social media is a valuable source of insight into problematic patterns of substance misuse. The way people converse with illicit drugs in online forums is highly variable, and slang terms are frequently used. Manually identifying names of specific drugs can be difficult in both time and labor. Subjects and methodsThe study utilized the Gensim Python library and its Word2Vec neural network model to develop an auto-encoding neural network, enabling the innovative analysis of drug-related discourse downloaded from the Reddit website. The slang terms were then used to qualitatively analyze the topics and categories of drugs discussed on the forum. ResultsThe inclusion of slang terms facilitated the introduction of 200,000 specific mentions of opioid drugs and that stimulant drugs share a substantial semantic similarity with opioids, a 200 % increase in the number of drug-related terms as compared to using existing datasets. ConclusionsThis study advances the academic field with an extended collection of drug-related terms, offering a useful methodology and resource for tackling the opioid crisis with innovative, reduced-time detection and surveillance methods.

Prior Antidepressant Prescription is Associated with Greater Opioid Prescriptions and Complications in Cervical Spine Surgery

Study Design: Retrospective cohort study of national database. Objective: This study evaluates the impact of antidepressant prescriptions on postoperative outcomes and complications in cervical spine surgery. Summary of Background Data: Patients who underwent cervical spine surgery often receive antidepressant prescriptions (ADP) to address concurrent mental health issues such as depression and anxiety. However, the use of antidepressants can affect bone metabolism. Yet, there is an opacity in the literature regarding the effects of ADP on outcomes of cervical spine surgery. Methods: Utilizing the TriNetX database, ACDF and Cervical Arthroplasty patients were matched on a 1:1 basis according to ADP status. Outcome variables such as emergency department visits, hospital readmissions, opioid prescription, and misuse, pseudoarthrosis, adjacent segment disease, and hardware failure were evaluated over follow-up periods ranging from 2 to 24 months. Results: In a matched sample of 12,838 patients, those with ADP exhibited significantly higher rates of opioid prescriptions at 2 weeks (OR 1.34, P&lt;0.0001), 6 months (OR 1.36, P&lt;0.0001), 12 months (OR 1.36, P&lt;0.0001), and 24 months (OR 1.33, P&lt;0.0001). Emergency Department visits were significantly higher at 6 months (OR 1.11, P=0.0082) and 24 months (OR 1.083, P=0.014). Opioid abuse is notably higher by 24 months (OR 1.37, P=0.0033). Hospitalization rates were significantly increased at 12 months (OR 1.16, P=0.0013) and 24 months (OR 1.18, P&lt;0.0001). Adjacent segment disease (OR 1.54, P&lt;0.0001 at 24 mo), hardware failure (OR 1.42, P=0.013 at 24 mo), and pseudarthrosis (OR 1.48, P&lt;0.0001 at 24 mo) were also significantly higher in the ADP group. Conclusions: Patients with ADP undergoing cervical spine surgery experience higher risks of opioid use and abuse, increased hospital readmissions, emergency department visits, and a higher rate of mechanical complications. Level of Evidence: III