Opioid-related Disorders Research Articles

Differences in the Rates of Diagnoses of Mental and Behavioral Disorders Due to Psychoactive Substance Use by Sex and Age during Pre-Pandemic and COVID-19 Pandemic Periods in Kazakhstan.

The COVID-19 pandemic had profound impacts worldwide on individuals with mental and behavioral disorders, including disorders due to psychoactive substance use. We investigated how the COVID-19 pandemic affected the trends in these disorders in the Republic of Kazakhstan. We researched and compared ICD-10 data on mental and behavioral disorders due to substance use in Kazakhstan that were diagnosed in 2018-2019 (pre-pandemic) versus 2020-2021 (the pandemic period). The data for the pandemic period were significantly different from those of the pre-pandemic in that (i) 'other stimulant-related disorders (F15)' and 'other psychoactive substance-related disorders (F19)' were increased in the younger age groups, (ii) the risk of 'opioid-related disorders (F11)' was decreased in the 30-year-old group in both males and females, and (iii) the risk of 'alcohol-related disorders (F10)' was increased in the 30-year-old group and decreased in the 20- and 50-year-old groups. In only the males, (iv) the risk of 'other psychoactive substance-related disorders (F19)' was increased in almost all of the age groups, and (v) the risk of 'cannabis-related disorders (F12)' was increased in the ≥50-year-olds. The pre-pandemic and pandemic periods thus involved changes due to COVID-19 in both males and females that were especially notable in males. These results indicate that further measures designed to prevent mental and behavioral disorders due to psychoactive substances are necessary at the primary, secondary, and tertiary levels, and personnel in medicine/nursing, the government, private organizations, and the public need to collaborate to devise such measures.

Impact of opioid-related disorders on complications in patients undergoing bariatric surgery: a propensity score-matched analysis of the national inpatient sample.

The opioid crisis caused a huge health concern in the United States. Despite this, few studies haveexamined the influence of opioid-related disorders (OD) on outcomes after bariatric surgery. The major goal of this study is to determine the impact of OD on in-hospital outcomes for patients undergoing bariatric surgery. The National Inpatient Sample (NIS) database from 2016 to 2020 was used to evaluate patients with OD who underwent bariatric operations including sleeve gastrectomy, Roux-en-Y gastric bypass, and biliopancreatic diversion with duodenal switch. The non-OD comparison group was created using a propensity score match (1:1). Weighted analysis was carried out utilizing NIS-provided weights. The odds ratios were obtained using multivariate logistic regression. A total of 159,455 patients who underwent bariatric surgery were evaluated. Propensity score matching and weighted analysis were used to compare 11,025 in the OD group and 11,025 in the non-OD group. OD was an independent predictor for postoperative complications (odds ratio: 1.29, 95% confidence interval: 1.19-1.39, p < 0.001). Among complications, OD was a predictor for bleeding complications, postoperative nausea and vomiting, anastomotic leak, and mechanical ventilation. In addition, the OD group experienced significantly longer lengths of stay (LOS) and a higher total hospital charges. In patients undergoing bariatric surgery, OD is associated with a significantly higher risk of postoperative complications, as well as increased LOS and total hospital charges. These patients may benefit from further preoperative optimization, including decreasing the opioid dose and closer postoperative monitoring.

Acetaminophen overdose: analysis of 2018 US nationwide emergency database.

Recognized risk factors for acetaminophen overdose include alcohol, opioids, and mood disorders. The aim of this study is to assess additional risk factors for acetaminophen overdose evaluated in the emergency department (ED). A retrospective study was performed using the 2018 US Nationwide Emergency Department Sample (NEDS). All adult ED visits for acetaminophen overdose were included in the study group and those without it were taken as control. STATA, 16.1 was used to perform multivariable logistic regression analysis and adjusted odds ratios (ORadj) were reported. We identified 27,792 ED visits for acetaminophen overdose. Relative to non-acetaminophen ED visits, this group was younger (median age 32 vs 47years; p < 0.0001), more oftenfemale (66.1% vs 57.0%; p < 0.0001), had higher ED charges ($3,506 vs $2,714; p < 0.0001), higher proportion of alcohol-related disorders (15.8% vs 3.5%; p < 0.0001), anxiety disorders (30.2% vs 8.3%; p < 0.0001), cannabis use (8.7% vs 1.4%; p < 0.0001), hematology/oncology diagnoses (13.3% vs 10.9%; p < 0.0001), mood disorders (52.4% vs 7.9%; p < 0.0001), opioid-related disorders (4.1% vs 1.0%; p < 0.0001), and suicide attempt/ideation (12.2% vs 1.1%; p < 0.0001). Multivariable analysis showed alcohol-related disorders (ORadj 2.67), anxiety disorders (ORadj 1.24), cannabis (ORadj 1.63), females (ORadj 1.45), Income Q3 (ORadj 1.09), hematology/oncology diagnoses (ORadj 1.40), mood disorders (ORadj 10.07), opioid-related disorders(ORadj 1.20), and suicide attempt/ideation (ORadj 1.68) were associated with acetaminophen overdose. In addition to previously recognized risks, our study demonstrated thatcannabis use and hematologic/oncologic comorbidities were more common among acetaminophen-overdose ED visits. These newfindings are concerning because of rapid legalization of cannabis and the increasing incidence of cancerworldwide. Additionalinvestigation into these risksshould be a priorityfor clinicians, policymakers, and researchers.

Prior Diagnosis of Opioid-Related Disorder Is Associated With Higher Medical Resource Utilization Following Primary Hip Arthroscopy: A National Database Study

To compare adverse events, medical resource utilization, prescribing patterns, and revision surgery rates of patients with opioid-related disorders (ORDs) undergoing primary hip arthroscopy against a propensity-matched group with no opioid-related disorders (NORDs). The TriNetX database was queried between January 2015 and December 2020 using International Classification of Diseases, 10th Revision and Current Procedural Terminology codes to identify patients undergoing primary hip arthroscopy between ages 18 and 70 years. The ORD cohort was propensity matched in a 1:1 ratio to NORD patients based on age, sex, alcohol-related disorders, heart disease, hypertension, metabolic disorders, anxiety disorders, major depressive disorder, diabetes mellitus, and antidepressant prescriptions. Postoperative rates of adverse events and medical resources were compared within 90 days of procedure, prescriptions were compared within 1 year, and revision surgery was compared within 2 years. A total of 809 ORD patients were propensity matched in a 1:1 ratio to NORD patients. Postoperative adverse events were similar between groups (P= .693). Rates of revision arthroscopy were also similar for both ORD (9.3%) and NORD (8.0%) cohorts (odds ratio [OR], 1.17; 95% confidence interval [CI], 0.83-1.66; P= .377). ORD patients received care from the emergency department, inpatient admission, outpatient visit, and physical therapy evaluations at higher rates. The ORD cohort received a greater amount of new opioid (OR, 2.66; 95% CI, 2.17-3.26; P < .0001) and antidepressant prescriptions (OR, 1.58; 95% CI, 1.26-1.97; P < .0001) compared to NORD patients within 1 year of surgery. ORD patients demonstrated similar rates of adverse events and revision surgery when compared to a propensity-matched group of NORD patients undergoing primary hip arthroscopy. However, ORD patients experienced increased rates of emergency department visits and hospitalizations and were prescribed higher rates of opioid and antidepressant prescriptions. Level III, cohort study.

The association between suspected long–COVID and stimulant prescribing in the United States

ObjectivesThis study sought to determine the association between suspected long–COVID and receipt of a stimulant prescription among persons diagnosed with COVID-19 and to describe clinical and demographic factors associated with receiving a stimulant prescription. MethodsUS patients 18 and older who had a COVID–19 diagnosis or a positive COVID–19 PCR test from April 1st, 2020 through December 21st, 2022 recorded in a national electronic health record data set obtained from TriNetX were assessed. Comparison subjects were propensity score matched on baseline covariates to those with a symptom of or diagnosis of long–COVID. A Cox Proportional Hazards models was used to estimate the influence of long–COVID on stimulant prescription receipt. ResultsThose with long–COVID (n = 65,329) were twice as likely to be prescribed a stimulant as persons with only acute COVID–19 (n = 189,438, HR=2.162; 1.929–2.423). Among persons with long–COVID, persons with new onset ADHD (HR=7.196; 5.749– 9.007), opioid–related disorders (HR=2.140; 1.264–3.621) and mood disorders (HR=1.649; 1.336–2.035) were more likely to be prescribed a stimulant. ConclusionFurther research describing the risks associated with increased stimulant use among persons with long–COVID is warranted.

Opioid prescription and opioid disorders in burns: A large database analysis from 1990 to 2019

BackgroundOpioids remain crucial in the management of burn pain. A comprehensive analysis of opioid use in burns and their complications has not been investigated. MethodsData were collected from TriNetX, a large multicenter database with de-identified patient information. The population included patients prescribed opioids on or following burn injury from January 1st, 1990, to December 31st, 2019. Opioid prescription use was analyzed after cohort stratification by decades: 1990–1999, 2000–2009, and 2010–2019. Outcomes for opioid-related disorders, opioid dependence, opioid abuse, intentional self-harm, and mental and behavioral disorders from psychoactive substance use were investigated. ResultsHydrocodone was the most frequently prescribed opioid in 1990–1999 and 2000–2009, with oxycodone taking the lead in 2010–2019 (p < 0.0001). During 1990–1999, patients had a decreased risk of recorded opioid-related disorders (RR=0.52), opioid dependence (RR=0.46), opioid abuse (RR=0.55), mental and behavioral disorders (RR=0.88), and intentional self-harm (RR=0.37) when compared to 2000–2009. A comparison of the 2000–2009–2010–2019 cohorts showed an increased risk of recorded opioid-related disorders (RR= 1.91), opioid dependence (RR=1.56), opioid abuse (RR=1.67), mental and behavioral disorders (RR =1.73), and intentional self-harm (RR=2.02). ConclusionsThe risk of opioid-related disorders has nearly doubled since the year 2000 warranting precautions when prescribing pain medications to burn patients.

Computational phenotypes for patients with opioid-related disorders presenting to the emergency department.

We aimed to discover computationally-derived phenotypes of opioid-related patient presentations to the ED via clinical notes and structured electronic health record (EHR) data. This was a retrospective study of ED visits from 2013-2020 across ten sites within a regional healthcare network. We derived phenotypes from visits for patients ≥18 years of age with at least one prior or current documentation of an opioid-related diagnosis. Natural language processing was used to extract clinical entities from notes, which were combined with structured data within the EHR to create a set of features. We performed latent dirichlet allocation to identify topics within these features. Groups of patient presentations with similar attributes were identified by cluster analysis. In total 82,577 ED visits met inclusion criteria. The 30 topics were discovered ranging from those related to substance use disorder, chronic conditions, mental health, and medical management. Clustering on these topics identified nine unique cohorts with one-year survivals ranging from 84.2-96.8%, rates of one-year ED returns from 9-34%, rates of one-year opioid event 10-17%, rates of medications for opioid use disorder from 17-43%, and a median Carlson comorbidity index of 2-8. Two cohorts of phenotypes were identified related to chronic substance use disorder, or acute overdose. Our results indicate distinct phenotypic clusters with varying patient-oriented outcomes which provide future targets better allocation of resources and therapeutics. This highlights the heterogeneity of the overall population, and the need to develop targeted interventions for each population.

Misuse of Pregabalin: a qualitative study from a patient’s perspective

IntroductionThe misuse of Pregabalin has been the subject of growing concern for several years. The effects sought are multiple and it is rarely taken as a single drug. It is most frequently used together with opioids, which may increase the risk of fatal overdose. In response to this emerging phenomenon, we seek to better understand the situation of misuse in Belgium and identify the people involved in it.MethodologyA qualitative study using semi-structured interviews with 20 participants who misuse Pregabalin was conducted throughout the French-speaking region of Belgium between August 2021 and January 2022. Recruitment mostly took place in addictions centers, shelters for migrants and homeless persons and primary care centers. We then conducted a thematic analysis with the help of Nvivo software.ResultsA profile emerged, of young male users, immigrants, mainly first generation immigrants coming from North Africa. They had in common a challenging or even traumatic migration pathway and precarious living conditions in Belgian territory. Most of them had no stable income. They saw Pregabalin as enabling them to cope with their daily situation. All had psychiatric and/or somatic comorbidities for which they had apparently not recieved adequate medical care. This seemed to lead many of them to use Pregabalin as self-medication, for anxiety-depressive disorders and chronic pain, and it was sometimes initiated in their home country. Pregabalin was never used alone.ConclusionThis study has highlighted a rare and insufficient documented profile of Pregabalin misuse: self-medication among a group of first generation immigrants, most of whom have no previous history of opioid-related disorders. Measures should be taken to improve access to health and social care for this population, considering all their biopsychosocial vulnerabilities.

Misuse of pregabalin: a qualitative study from a patient's perspective.

The misuse of pregabalin has been the subject of increasing concerns for several years. The effects sought are multiple and it is rarely taken as a single drug. The most frequent association is with opioids, which may increase the risk of fatal overdose. In the face of this emerging phenomenon, a better understanding was needed of the misuse situation in Belgium and to identify the people involved. A qualitative study using semi-structured interviews with 20 participants who misuse pregabalin was conducted through all the French-speaking part of Belgium between August 2021 and January 2022. This proceeded to a thematic analysis method with the help of NVivo software. A profile of young users, new immigrants, mainly coming from North Africa emerged. They had in common a challenging or even traumatic migration pathway and precarious living conditions on Belgian territory. Most of them had no stable income. Pregabalin seemed to enable them to cope with their daily situation. All had psychiatric and/or somatic comorbidities for which they did not seem to benefit from adequate medical care. It seemed to lead many of them to use pregabalin as self-medication for anxio-depressive disorders and chronic pain. Pregabalin was never used alone. This study has highlighted a rarely documented profile of pregabalin misuse: self-medication among a group of new immigrants, most of whom have no previous history of opioid-related disorders. Measures should be taken to improve access to health and social care for this population, considering all their biopsychosocial vulnerabilities.

63 Adjunctive Ketamine Reduces the Risk of Developing Chronic Opioid Use in Burn Patients

Abstract Introduction Opioid use for perioperative pain management in burn patients is associated with a high risk of developing chronic opioid use. Ketamine is commonly used as an analgesic adjunct due to its opioid-sparing effects. The purpose of this study is to determine whether analgesia with adjunctive ketamine reduces the risk of developing chronic opioid use in burn patients. Methods Burn patients who underwent burn-related surgeries were identified using relevant ICD-10 Codes. Data were collected using the TriNetX Research Network, a national research database providing de-identified patient medical records. Burn patients undergoing surgical procedures were identified based on their use of opioids alone or in combination with ketamine as adjunctive analgesia. Both groups excluded patients with a prior history of opioid-related and psychiatric disorders to control for potential pre-existing conditions affecting the study outcomes. Outcome analysis included continued opioid use and related psychiatric disorders, including nicotine dependence and anxiety, up to one year after burn injury. Risk ratios for each outcome were then generated using a measure of association analysis through TriNetX. Results We identified 107,270 patients across 51 health care organizations who underwent burn-related surgeries within one month after burn injury. Excluded from the study were 3,296 (3.07%) patients who had a prior history of opioid-related and psychiatric disorders. The remaining 103,974 patients were sorted into respective groups that received opioids with ketamine (n = 8,328) and without ketamine (n = 51,413). The two cohorts were balanced using (1:1) propensity score matching for age, sex, race, ethnicity, and burn surface area. Patients without ketamine had a higher risk of continuing opioid use (risk ratio [RR], 1.14, p &amp;lt; 0.001), developing nicotine dependence ([RR], 1.32, p &amp;lt; 0.001), and developing anxiety disorders ([RR], 1.21, p = 0.007) at least one year after burn injury. Conclusions Burn patients whose pain management included adjunctive ketamine ceased opioid use sooner and demonstrated a lesser risk of developing various psychiatric disorders associated with chronic opioid use. Applicability of Research to Practice This study supports the use of adjunctive ketamine as part of a multimodal approach to pain management in burn patients in order to minimize the risk of chronic opioid use.

Retrospectively evaluating trends in opioid prescriptions and medication-assisted treatment in a mid-Michigan region.

To evaluate opioid prescribing and monitoring trends for musculoskeletal (MSK) conditions and the use of medication-assisted treatment (MAT) for opioid-related disorders in mid-Michigan. Retrospective chart review of 500 randomly selected charts coded for MSK conditions and opioid-related disorders based on the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) codes during the time frame of January 1 to June 30, 2019. Data were compared to baseline data collected in a previous 2016 study to evaluate prescribing trends. Outpatient clinics and emergency departments. Variables included prescription of opioid, nonopioid, use of prescription monitoring such as assessing urine drug screens (UDSs), a Prescription Drug Monitoring Program (PDMP), pain agreements, prescription of MAT, and sociodemographic factors. 31.3 percent of patients in 2019 had a new or current opioid prescription, which is a significant decrease compared to opioid prescriptions in 2016 (65.7 percent) (p = 0.001). Monitoring of opioid prescribing using PDMP and pain agreements increased, whereas UDS monitoring remained low. MAT prescribing for patients with opioid use disorder in 2019 was 31.4 percent. State-sponsored insurance was associated with a higher odds of using PDMP and pain agreements with an odds ratio (OR) of 1.72 (0.97, 3.13), while alcohol misuse had a lower odds of using PDMP (OR 0.40). Opioid prescribing guidelines have been effective in reducing opioid prescribing and increasing opioid prescription monitoring. MAT prescribing is low in 2019 and does not reflect a declining trend of opioid prescriptions during a public health crisis.

Mental health and substance use disorders in young adults with spina bifida.

Although medical advances have allowed most patients with spina bifida (SB) to survive into adulthood, these patients may have physical impairments, urological complications, infections, and neurocognitive deficits. These factors can cause psychological distress and impact the transition from pediatric to adult care. There remains limited research on mental health disorders (MHDs) and substance use disorders (SUDs) in SB patients during this vulnerable transition period. This study aimed to investigate the 10-year incidence of MHDs and SUDs in 18- to 25-year-old patients with SB. TriNetX, a federated de-identified database, was retrospectively queried to identify 18- to 25-year-old patients with SB. The presence of MHDs and SUDs based on ICD-10 codes in SB patients (cohort 1) was analyzed and compared with those of patients without SB (cohort 2). Subgroup analysis was performed on SB patients with hydrocephalus and neurogenic bladder (NB). SB patients were further compared to patients with a spinal cord injury (SCI). After propensity score matching, the authors identified 1494 patients in each cohort. SB patients were more likely to have depression (OR 1.949, 95% CI 1.64-2.317), anxiety (OR 1.603, 95% CI 1.359-1.891), somatoform disorders (OR 2.102, 95% CI 1.052-4.199), and suicidal ideations or attempts and self-harm (OR 1.424, 95% CI 1.014-1.999). The prevalence of attention-deficit/hyperactivity disorder (ADHD) and eating disorders were comparable between cohorts. SB patients also had increased rates of nicotine dependence (OR 1.546, 95% CI 1.22-1.959) but not of alcohol or opioid disorders. In SB patients, the presence of hydrocephalus and NB was not associated with significantly increased rates of any measured MHDs or SUDs. When compared with SCI patients, SB patients were more likely to have anxiety (OR 1.377, 95% CI 1.028-1.845) and ADHD (OR 1.875, 95% CI 1.084-3.242). However, SB patients had lower rates of nicotine dependence (OR 0.682, 95% CI 0.482-0.963) and opioid-related disorders (OR 0.434, 95% CI 0.223-0.845). SB and SCI patients shared similar rates of depression, suicidal ideations or attempts and self-harm, and alcohol-related disorders. Young adults with SB have higher prevalence rates of MHDs and SUDs compared with the general population. Therefore, incorporation of mental health and substance use management is critical to facilitate transition to adulthood.

A Cross Sectional Study of Personality Profile of Patients with Opioid Related Disorders in a Medical College of Eastern India

Background: In India, one of the most common substances for which people seek treatment is opioids (including opioids taken by the injecting route). This group is often characterized by use of multiple substances. Various biological, social and psychological factors have been implicated in initiation and maintenance of substance use disorders, for example, family history, getting involved with deviant peer group, presence of other psychiatric comorbidities and personality factors. Methods: 70 people with Opioid related disorders diagnosed by DSM 5 were interviewed with LDQ and NEO FFI3 to assess severity of opioid related disorders and personality of those patients.Results: The study shows that most of the OUD patients were male. Majority of the OUD patients belonged to urban background. 70 % had initiated use of opioid before 20yrs of age. Patients with low dependence had high neuroticism (32.67±1.15) and extraversion (31.00±2.65). Patients with high dependence had very low conscientiousness (19.5±2.32) and very high neuroticism (38.25±3.55). Discussion: Neuroticism (38.25±3.55) was very high in high dependency OUD group and so was extraversion (34.92±3.65). Openness to experience, agreeableness and conscientiousness had neutral findings in all the threedependence category. Hence, there was significant association between the personality profile factors and alcohol dependence and severity of Opioid dependence.

Antibiotic Knockdown of Gut Bacteria Sex-Dependently Enhances Intravenous Fentanyl Self-Administration in Adult Sprague Dawley Rats.

Communication between the brain and gut bacteria impacts drug- and addiction-related behaviors. To investigate the role of gut microbiota on fentanyl reinforcement and reward, we depleted gut bacteria in adult Sprague Dawley male and female rats using an oral, nonabsorbable antibiotic cocktail and allowed rats to intravenously self-administer fentanyl on an escalating schedule of reinforcement. We found that antibiotic treatment enhanced fentanyl self-administration in males, but not females, at the lowest schedule of reinforcement (i.e., fixed ratio 1). Both males and females treated with antibiotics self-administered greater amounts of fentanyl at higher schedules of reinforcement. We then replete microbial metabolites via short-chain fatty acid administration to evaluate a potential mechanism in gut-brain communication and found that restoring metabolites decreases fentanyl self-administration back to controls at higher fixed ratio schedules of reinforcement. Our findings highlight an important relationship between the knockdown and rescue of gut bacterial metabolites and fentanyl self-administration in adult rats, which provides support for a significant relationship between the gut microbiome and opioid use. Further work in this field may lead to effective, targeted treatment interventions in opioid-related disorders.

Diagnosis and treatment of opioid-related disorders in a South African private sector medical insurance scheme: A cohort study.

The use of opioids is increasing globally, but data from low- and middle-income countries on opioid-related mental and behavioural disorders (hereafter referred to as opioid-related disorders) are scarce. This study examines the incidence of opioid-related disorders, opioid agonist use, and excess mortality among persons with opioid-related disorders in South Africa's private healthcare sector. We analysed longitudinal data of beneficiaries (≥ 11 years) of a South African medical insurance scheme using reimbursement claims from Jan 1, 2011, to Jul 1, 2020. Beneficiaries were classified as having an opioid-related disorder if they received an opioid agonist (buprenorphine or methadone) or an ICD-10 diagnosis for harmful opioid use (F11.1), opioid dependence or withdrawal (F11.2-4), or an unspecified or other opioid-related disorder (F11.0, F11.5-9). We calculated adjusted hazard ratios (aHR) for factors associated with opioid-related disorders, estimated the cumulative incidence of opioid agonist use after receiving an ICD-10 diagnosis for opioid dependence or withdrawal, and examined excess mortality among beneficiaries with opioid-related disorders. Of 1,251,458 beneficiaries, 1286 (0.1%) had opioid-related disorders. Between 2011 and 2020, the incidence of opioid-related disorders increased by 12% (95% CI 9%-15%) per year. Men, young adults in their twenties, and beneficiaries with co-morbid mental health or other substance use disorders were at increased risk of opioid-related disorders. The cumulative incidence of opioid agonist use among beneficiaries who received an ICD-10 diagnosis for opioid dependence or withdrawal was 18.0% (95% CI 14.0-22.4) 3 years after diagnosis. After adjusting for age, sex, year, medical insurance coverage, and population group, opioid-related disorders were associated with an increased risk of mortality (aHR 2.28, 95% CI 1.84-2.82). Opioid-related disorders were associated with a 7.8-year shorter life expectancy. The incidence of people diagnosed with or treated for an opioid-related disorder in the private sector is increasing rapidly. People with opioid-related disorders are a vulnerable population with substantial psychiatric comorbidity who often die prematurely. Evidence-based management of opioid-related disorders is urgently needed to improve the health outcomes of people with opioid-related disorders.

Factors associated with risk of death by suicide after psychiatric hospitalization by the Unified Health System in Brazil (2002–2015)

ObjectiveTo investigate overall and sex-related characteristics associated with the risk of death by suicide within 365 days of discharge in patients admitted to psychiatric hospitals in the Brazilian Unified Health System (SUS). MethodA non-concurrent prospective cohort of adult patients admitted to psychiatric hospitals in the SUS, from 2002 to 2015. Patients were stratified according to sociodemographic and clinical variables. Adjusted hazard ratios (aHRs) of suicide within 365 days of discharge were estimated using Cox proportional hazard regression models. ResultsThis sample comprised 1,228,784 adult patients admitted to psychiatric hospitals. Of these, 3201 died by suicide within 365 days of discharge. The risk of suicide was positively associated with male sex, age between 18 and 29 years, living in the South region, and living in rural or intermediate municipalities. The highest risk of suicide was among patients with depressive disorders (aHR, 3.87; 95%CI, 3.41–4.38) follow by opioid-related disorders (aHR, 2.71; 95%CI, 2.00–3.67), particularly among female patients. ConclusionPatients with a psychiatric hospital admission should have access to mental health care services immediately after discharge and in the long term. Findings of this study may support suicide prevention policies and have implications for clinical decisions related to patient discharge and follow-up.

Hospitalisation with injection-related infections: Validation of diagnostic codes to monitor admission trends at a tertiary care hospital in Melbourne, Australia.

Injection-related infections (IRI) cause morbidity and mortality in people who inject drugs. Hospital administrative datasets can be used to describe hospitalisation trends, but there are no validated algorithms to identify injecting drug use and IRIs. We aimed to validate International Classification of Diseases (ICD) codes to identify admissions with IRIs and use these codes to describe IRIs within our hospital. We developed a candidate set of ICD codes to identify current injecting drug use and IRI and extracted admissions satisfying both criteria. We then used manual chart review data from 1 January 2017 to 30 April 2019 to evaluate the performance of these codes and refine our algorithm by selecting codes with a high-positive predictive value (PPV). We used the refined algorithm to describe trends and outcomes of people who inject drugs with an IRI at Alfred Hospital, Melbourne from 2008 to 2020. Current injecting drug use was best predicted by opioid-related disorders (F11), 80% (95% confidence interval [CI] 74-85%), and other stimulant-related disorders (F15), 82% (95% CI 70-90%). All PPVs were ≥67% to identify specific IRIs, and ≥84% for identifying any IRI. Using these codes over 12 years, IRIs increased from 138 to 249 per 100 000 admissions, and skin and soft tissues infections (SSTI) were the most common (797/1751, 46%). Validated ICD-based algorithms can inform passive surveillance systems. Strategies to reduce hospitalisation with IRIs should be supported by early intervention and prevention, particularly for SSTIs which may represent delayed access to care.

Relative effectiveness of medications for opioid-related disorders: A systematic review and network meta-analysis of randomized controlled trials.

IntroductionSeveral pharmacotherapeutic interventions are available for maintenance treatment for opioid-related disorders. However, previous meta-analyses have been limited to pairwise comparisons of these interventions, and their efficacy relative to all others remains unclear. Our objective was to unify findings from different healthcare practices and generate evidence to strengthen clinical treatment protocols for the most widely prescribed medications for opioid-use disorders.MethodsWe searched Medline, EMBASE, PsycINFO, CENTRAL, and ClinicalTrials.gov for all relevant randomized controlled trials (RCT) from database inception to February 12, 2022. Primary outcome was treatment retention, and secondary outcome was opioid use measured by urinalysis. We calculated risk ratios (RR) and 95% credible interval (CrI) using Bayesian network meta-analysis (NMA) for available evidence. We assessed the credibility of the NMA using the Confidence in Network Meta-Analysis tool.ResultsSeventy-nine RCTs met the inclusion criteria. Due to heterogeneity in measuring opioid use and reporting format between studies, we conducted NMA only for treatment retention. Methadone was the highest ranked intervention (Surface Under the Cumulative Ranking [SUCRA] = 0.901) in the network with control being the lowest (SUCRA = 0.000). Methadone was superior to buprenorphine for treatment retention (RR = 1.22; 95% CrI = 1.06–1.40) and buprenorphine superior to naltrexone (RR = 1.39; 95% CrI = 1.10–1.80). However, due to a limited number of high-quality trials, confidence in the network estimates of other treatment pairs involving naltrexone and slow-release oral morphine (SROM) remains low.ConclusionAll treatments had higher retention than the non-pharmacotherapeutic control group. However, additional high-quality RCTs are needed to estimate more accurately the extent of efficacy of naltrexone and SROM relative to other medications. For pharmacotherapies with established efficacy profiles, assessment of their long-term comparative effectiveness may be warranted.Trial RegistrationThis systematic review has been registered with PROSPERO (https://www.crd.york.ac.uk/prospero) (identifier CRD42021256212).

26 Opioid Prescription in Burns: A Large Database Analysis from 1990 to 2021

IntroductionThe use of opioids in the medical field has contributed to the growing opioid epidemic. Nonetheless, opioids remain imperative in the treatment for pain management in burns. While some studies have addressed the use of opioids in surgery, a comprehensive analysis of the pattern of opioids use in burns has not been investigated. This study aims to identify trends of opioid use and investigate the risk of opioid related disorders in burn patients.MethodsData was obtained from TriNetX, a national research database that provides medical records of de-identified patients. The study population includes patients that were prescribed an opioid, ICD-10 code CN101, on or after any instance of burn between January 1st, 1990 and September 19th, 2021. Patient population was further stratified by the decade in which patients received opioids for pain following burn injury: 1990-1999, 2000-2009, 2010-2019, and 2020-September 19th, 2021. Five outcomes were investigated: opioid related disorders, opioid dependence, opioid abuse, intentional self-harm, and mental and behavioral disorders due to psychoactive substance use. Cohorts were matched for age at index, sex, and race. Statistical analysis used risk ratios with a 95% confidence interval, and p< 0.05 was considered significant.ResultsWe identified 8,421 patients that were prescribed an opioid between 1990-1999, 30,846 patients from 2000-2009, 169,991 patients from 2010-2019, and 30,966 patients from 2020-present. When compared to the 2000s cohorts, the 1990s patients had a 47% decrease in risk of opioid related disorders, with a 53% decrease in risk of opioid dependence, 45% decrease in risk in opioid abuse, 11% decrease in risk of mental and behavioral disorders due to psychoactive substance use, and 63% reduced risk of intentional self-harm.Comparison of the 2000-2009 to 2010-2019 cohorts showed increased risk of opioid related disorders (RR= 1.912), opioid dependence (RR=1.569), opioid abuse (RR=1.677), mental and behavioral disorders (RR =1.733), and intentional self-harm (RR=2.027). When compared to 2020-present, the 2010-2019 patient cohort had 10 times the risk of developing opioid-related disorders, with 3 times the risk for opioid dependence and behavioral disorders, and 5 times the risk for opioid abuse and intentional self-harm.ConclusionsThe risk of opioid related disorders in the 1990s was lower compared to the 2000s. Since 2000, the risk of opioid related disorders has significantly increased. Recognizing the risks of opioid prescriptions in burn patients is imperative when addressing the role of physicians in controlling the constantly growing opioid epidemic.

Defining the Psychiatric and Financial Landscape of Mental and Substance Use Disorders in Head and Neck Cancer Patients

<h3>Purpose/Objective(s)</h3> To evaluate and describe mental and substance use disorders (MSUD) among head and neck cancer patients admitted to the emergency department (ED) in the United States. <h3>Materials/Methods</h3> We analyzed the Nationwide Emergency Database Sample (NEDS) which produces national estimates of ED visits across the United States. Inclusion criteria included patients with a head and neck cancer diagnosis identified through the Clinical Classifications Software. Mental and Substance use disorders were identified using ICD-9 and ICD-10 codes. Variables analyzed include patient demographics, hospital characteristics, expected payment source, and total visit charge. Survey weighted multivariable logistic regression was used to analyze predictors of MSUD. <h3>Results</h3> From 2009-2018, there were 1,398,671 discharges from the ED associated with head and neck cancer, of which 334,056 (23.9%) also presented with a concurrent MSUD. Patients presenting with a MSUD as the primary visit reason (2.3%) were more likely to be younger (58 vs 66 years, p<0.001), male (73.3% vs 70.6%, p<0.001), and less likely to be admitted to the hospital (51.6% vs 53.5%, p<0.001). Among all patients, the 5 most common MSUD disorders were depressive disorders (n=133,377; 9.5%), anxiety disorders (n=122,679; 8.8%), alcohol related disorders (n=80,994; 5.8%), opioid related disorders (n=23,801; 1.7%), and schizophrenia related disorders (n=22,540; 1.6%). Suicidal ideation or attempt was found in 10,228 discharges (3.1%). The total cost of ED admissions related to a primary MSUD was $103,828,679. The cost of ED admission was most expensive for patients with a primary admission diagnosis of alcohol related disorders (34.8%), opioid related disorders (12.5%), and suicidal ideation or attempt (10.9%). On multivariable logistic regression, younger age (OR: 0.98, p<0.001), female gender (OR:1.26, p<0.001), and non-Medicare insurance were associated with the odds of having any diagnosis of MSUD. <h3>Conclusion</h3> There is a high rate of concomitant MSUD in head and neck cancer patients who present to the ED. Our study identifies a subset of younger and female patients who may be at high risk of developing an MSUD. The financial burden of MSUD was high and the head and neck cancer population are particularly vulnerable to depressive, anxiety, and alcohol related disorders. Future studies should design therapeutic or behavioral interventions to mitigate and address mental health disorders in this population.