Risk Of Opioid Use Research Articles

Dyadic associations between relationship quality and risk of opioid use among couples receiving methadone for opioid use disorder

BackgroundSocial relationships may serve as both protective factors and risk factors for opioid use (nonmedical prescription opioid or illicit opioid use) among patients receiving methadone for opioid use disorder (OUD). Yet little is known about how relationship quality is linked to outcomes among couples receiving methadone. We evaluated the links between relationship quality and risk of opioid use among couples in which both partners received methadone. MethodsParticipants included 53 heterosexual married or cohabiting couples aged 18 and older who were drawn from two opioid treatment programs in Rhode Island and Massachusetts. Both members of the couple completed a self-administered survey assessing their sociodemographic information, relationship and treatment characteristics, and risk of opioid use. ResultsRoughly half of women (47.2%) and men (52.8%) had a moderate to high risk of nonmedical prescription opioid use and almost two-thirds (64.2%) had a moderate to high risk of street opioid use. Risk of street opioid use was highly correlated within couples. Actor-partner interdependence models revealed that when women reported higher positive relationship quality, they had a lower risk of nonmedical prescription opioid use and their partners had a lower risk of street opioid use. Negative relationship quality was not significantly linked to risk of opioid use. ConclusionsCouples in which both partners receive methadone for OUD may be at risk of return to use, and positive partner relationships may play a role in lowering this risk. Women’s perceptions of relationship quality might be a particularly important target for clinical care and interventions.

Impact of pain and nonpain co-morbidities on opioid use in women with endometriosis.

Aim: To evaluate impact of co-morbidities on opioid use in endometriosis. Patients & methods: This was a retrospective analysis of data obtained from the Symphony Health database (July 2015-June 2018), which contains medical and pharmacy claims information on 79,947 women with endometriosis. Relative risk (RR) of postdiagnosis opioid use and supply duration associated with baseline co-morbidities were determined. Results: Women with endometriosis using opioids at baseline were 61% more likely to receive opioids postdiagnosis (RR: 1.61; 95% CI: 1.59-1.63). Risk of prolonged opioid supply postdiagnosis was highest for those with prolonged supply at baseline (RR: 21.14; 20.14-22.19), and was 1.32 (1.26-1.38) for patients with ≥1 co-morbidity, 1.37 (1.31-1.43) for pain co-morbidities and 1.07 (1.04-1.11) for psychiatric co-morbidities. Conclusion: Risk of opioid use after endometriosis diagnosis was greater in patients who used opioids before diagnosis. Risk of prolonged opioid use was greater if co-morbidities existed before diagnosis.

Celecoxib significantly reduces opioid use after shoulder arthroplasty

The opioid crisis has illuminated the risks of opioid use for pain management, with renewed interest in reducing opioid consumption after common orthopedic procedures. Anti-inflammatory medication is an important component of multimodal pain management for patients undergoing orthopedic surgery. The purpose of this study was to evaluate the effect of celecoxib on pain control and opioid use after shoulder surgery. Patients scheduled for either total shoulder replacement (group 1) or rotator cuff repair (group 2) were candidates for the study. The exclusion criteria included allergy to celecoxib, coagulopathy, use of anticoagulants, baseline use of long-acting opioids, and a history of medical conditions such as myocardial infarction or stroke. Consenting patients were randomized by type of procedure using block randomization to receive either placebo or celecoxib 1 hour prior to the procedure and for 3 weeks postoperatively. The primary outcome measure assessed was opioid utilization as measured by morphine-equivalent dose (MED). Secondary outcome measures included pain scores at 3 and 6 weeks postoperatively. Data were analyzed using multiple linear regression. Of 1081 patients scheduled for either total shoulder replacement or rotator cuff repair from February 2014 to February 2018, 78 were enrolled for arthroplasty (group 1, with 39 receiving celecoxib and 39 receiving placebo) and 79 were enrolled for rotator cuff repair (group 2, with 40 receiving celecoxib and 39 receiving placebo). Compared with the placebo arm, patients prescribed celecoxib took fewer MEDs by -168 (95% confidence interval [CI], -272 to -64; P < .01) at 3 weeks in the total population and by -197.7 (95% CI, -358 to -38; P = .02) in the arthroplasty group. Similarly, at 6 weeks, total MEDs used was -199 (95% CI, -356 to -42; P < .01) in the total populationand -270 (95% CI, -524 to -16; P = .04) in the arthroplasty group. No statistically significant differences in opioid consumption were found between study arms in the cuff repair group, at either 3 or 6 weeks. Of note, preoperative opioid use was statistically associated with higher levels of opioid use in the total population and group 1 at 3 and 6 weeks (P < .01 for all)but not in group 2 (P > .05 for both). Use of morphine equivalents was statistically significantly less at 3 and 6 weeks in patients who took celecoxib in the total population and in the arthroplasty group. Patients prescribed celecoxib for 3 weeks after shoulder surgery took less opioid medication for pain at 3 and 6 weeks. Multimodal pain control using celecoxib is an effective way to reduce postoperative opioid use in shoulder arthroplasty patients. Preoperative opioid use is associated with higher levels of opioid use after shoulder arthroplasty.

Does revision shoulder arthroplasty increase your risk of opioid use and dependence?

As the number of shoulder arthroplasties (SA) increased exponentially over the past 2 decades, so have associated complications and revision surgery rates. Pain control after revision surgery can be difficult to manage given patients are not typically opioid naïve, however, to date opioid usage after revision SA has not been studied. The purpose of our study was to compare opioid use and dependence after revision SA to a primary SA cohort. A retrospective review was performed of revision and primary SA patients at a single institution from 2014 to 2016. The cohort was divided into 2 groups: primary ( n = 82) and revision ( n = 80) SA patients. Demographics including age, sex, BMI, ASA class and smoking status were collected. Opioid consumption within 90 days of SA was collected for the preoperative and postoperative period using a state drug monitoring registry and converted to total morphine equivalence (TME) for analyses. Opioid dependence was defined as ≥2 opioid prescriptions within 3 months. Analysis of Variance was used to compare TME between groups and Chi square test was used for categorical variables. Logistic regression analyses were performed to determine impact of various risk factors on postoperative opioid dependence. Demographics were similar between the 2 groups for BMI ( P =.73), sex ( P = .51), smoking status ( P = .49) and ASA class ( P = .96). There was a significant difference with the revision group having an average younger age (66.0 revision, 70.1 primary; P = .005). The mean preoperative TME was significantly higher for revision SA cohort (115.2) compared to the primary SA cohort (31.5) and postoperatively 188.7 for the revision SA cohort compared to an average of 117 for the primary cohort ( P < .001). The revision SA group had significantly more patients with preoperative dependence (38.8%) compared to 19.5% for the primary cohort ( P = .006) and postoperative dependence 43.8% ( n = 35) compared to 29.3% ( n = 24) patients in the primary group ( P = .04). Revision SA patients have higher rates of preoperative and postoperative opioid usage and dependence when compared to primary SA. Preoperatively dependent revision patients are more likely to remain dependent in the postoperative period than primary SA patients. Orthopedic surgeons should be aware that revision SA patients have higher opioid dependence rates and require more opioids which may indicate the need for additional consideration for risk assessments, education, and interventions when performing revision SA surgery. III

Patterns and predictors of opioid use among migraine patients at emergency departments: A retrospective database analysis

To compare medication use and health resource utilization between migraineurs with evidence of opioid use at emergency department visit versus no opioid use at emergency department visit, and to examine predictors of opioid use among migraineurs at emergency department visits. This was a retrospective study using REACHnet electronic health records (December 2013 to April 2017) from Baylor Scott & White Health Plan. The index date was defined as the first migraine-related emergency department visit after ≥6 months of enrollment. Adult patients with a migraine diagnosis and ≥6 months of continuous enrollment before and after their index dates were included. Descriptive statistics and bivariate analyses were used to compare medication use and health resource utilization between opioid users and non-opioid users. Multivariable logistic regression was used to examine predictors of opioid use at emergency department visits. A total of 788 migraineurs met eligibility criteria. Over one-third (n = 283, 35.9%) received ≥1 opioid medication during their index date emergency department visit. Morphine (n = 103, 13.1%) and hydromorphone (n = 85, 10.8%) were the most frequently used opioids. Opioid users had more hospitalizations and emergency department visits during their pre-index period (both p < 0.05). Significant (p < 0.05) predictors of opioid use at emergency department visits included past migraine-related opioid use (2-4 prescriptions, Odds Ratio = 1.66; 5-9 prescriptions, Odds Ratio = 2.12; ≥10 prescriptions, Odds Ratio = 4.43), past non-migraine-related opioid use (≥10 prescriptions, Odds Ratio = 1.93), past emergency department visits (1-3 visits, Odds Ratio = 1.84), age (45-64 years, Odds Ratio = 1.45), and sleep disorder (Odds Ratio = 1.43), controlling for covariates. Opioids were commonly given to migraineurs at emergency departments. Previous opioid use, health resource utilization, age, and specific comorbidities might be used to identify migraineurs with a high risk of opioid use.

‘How much heroin is too much heroin?’ Youth inquiries regarding opioids

Primary prevention initiatives specifically designed for youth are an important strategy to combat the opioid crisis in the United States. The developmental period of adolescence is critical for impacting lifetime patterns of opioid misuse. Providing youth with relevant information to guide decisions around initiation of drug use may reduce the most serious opioid related harms. Prevention interventions have primarily been developed by experts in the field, with little emphasis on addressing the desires of youth. This study is a content analysis of opioid related questions posed by youth to substance use experts during the National Institute on Drug Abuse’s Chat Day program. Findings indicate youth could benefit from definitional information about opioids, the relative risk of opioid use, and the development and outcomes of dependence. Implications for addressing youth curiosity about the use of opioids and youth exposure to opioid use and related harms are discussed within conceptual categories for prevention curricula.

Stakeholder Perspective on Opioid Stewardship After Prostatectomy: Evaluating Barriers and Facilitators From the Pennsylvania Urology Regional Collaborative

OBJECTIVETo evaluate existing practice patterns and potential barriers to implementing opioid stewardship protocols after robot-assisted prostatectomies among providers in the Pennsylvania Urology Regional Collaborative. METHODSThe Pennsylvania Urology Regional Collaborative (PURC) is a voluntary quality improvement initiative of 11 academic and community urology practices in Pennsylvania and New Jersey representing 97 urologists. PURC distributed a web-based survey of 24 questions, with 74 respondents, including 56 attendings, 11 residents, and 7 advanced practice providers. RESULTSMore pills were prescribed if there was a default number of pills from the electronic health record (median 30) then if the number of pills was manually placed (P = .01). Only 8% discussed how to dispose of opioids with their patients, and less than a third of respondents discussed postoperative pain expectations or risks of opioid use. Patient level risk factors were often not reviewed, as 42% did not ask about previous opioid exposure. CONCLUSIONThis study revealed extensive knowledge disparities among providers about opioid stewardship and significant gaps in the evidence-to-practice continuum of care. In the next year, PURC will be implementing targeted interventions to augment provider education, establish clear pathways for opioid disposal, improve utilization of known resources and implement opioid reduction protocols in all participating sites.

Inpatient and outpatient opioid requirements after total joint replacement are strongly influenced by patient and surgical factors

AimsCurrently, there is no single, comprehensive national guideline for analgesic strategies for total joint replacement. We compared inpatient and outpatient opioid requirements following total hip arthroplasty (THA) versus total knee arthroplasty (TKA) in order to determine risk factors for increased inpatient and outpatient opioid requirements following total hip or knee arthroplasty.MethodsOutcomes after 92 primary total knee (n = 49) and hip (n = 43) arthroplasties were analyzed. Patients with repeat surgery within 90 days were excluded. Opioid use was recorded while inpatient and 90 days postoperatively. Outcomes included total opioid use, refills, use beyond 90 days, and unplanned clinical encounters for uncontrolled pain. Multivariate modelling determined the effect of surgery, regional nerve block (RNB) or neuraxial anesthesia (NA), and non-opioid medications after adjusting for demographics, ength of stay, and baseline opioid use.ResultsTKAs had higher daily inpatient opioid use than THAs (in 5 mg oxycodone pill equivalents: median 12.0 vs 7.0; p < 0.001), and greater 90 day use (median 224.0 vs 100.5; p < 0.001). Opioid refills were more likely in TKA (84% vs 33%; p < 0.001). Patient who underwent TKA had higher independent risk of opioid use beyond 90 days than THA (adjusted OR 7.64; 95% SE 1.23 to 47.5; p = 0.01). Inpatient opioid use 24 hours before discharge was the strongest independent predictor of 90-day opioid use (p < 0.001). Surgical procedure, demographics, and baseline opioid use have greater influence on in/outpatient opioid demand than RNB, NA, or non-opioid analgesics.ConclusionOpioid use following TKA and THA is most strongly predicted by surgical and patient factors. TKA was associated with higher postoperative opioid requirements than THA. RNB and NA did not diminish total inpatient or 90-day postoperative opioid consumption. The use of acetaminophen, gabapentin, or NSAIDs did not significantly alter inpatient opioid requirements.Cite this article: Bone Joint Open 2020;1-7:398–404.

Inpatient and outpatient opioid requirements after total joint replacement are strongly influenced by patient and surgical factors

Aims Currently, there is no single, comprehensive national guideline for analgesic strategies for total joint replacement. We compared inpatient and outpatient opioid requirements following total hip arthroplasty (THA) versus total knee arthroplasty (TKA) in order to determine risk factors for increased inpatient and outpatient opioid requirements following total hip or knee arthroplasty. Methods Outcomes after 92 primary total knee (n = 49) and hip (n = 43) arthroplasties were analyzed. Patients with repeat surgery within 90 days were excluded. Opioid use was recorded while inpatient and 90 days postoperatively. Outcomes included total opioid use, refills, use beyond 90 days, and unplanned clinical encounters for uncontrolled pain. Multivariate modelling determined the effect of surgery, regional nerve block (RNB) or neuraxial anesthesia (NA), and non-opioid medications after adjusting for demographics, ength of stay, and baseline opioid use. Results TKAs had higher daily inpatient opioid use than THAs (in 5 mg oxycodone pill equivalents: median 12.0 vs 7.0; p &lt; 0.001), and greater 90 day use (median 224.0 vs 100.5; p &lt; 0.001). Opioid refills were more likely in TKA (84% vs 33%; p &lt; 0.001). Patient who underwent TKA had higher independent risk of opioid use beyond 90 days than THA (adjusted OR 7.64; 95% SE 1.23 to 47.5; p = 0.01). Inpatient opioid use 24 hours before discharge was the strongest independent predictor of 90-day opioid use (p &lt; 0.001). Surgical procedure, demographics, and baseline opioid use have greater influence on in/outpatient opioid demand than RNB, NA, or non-opioid analgesics. Conclusion Opioid use following TKA and THA is most strongly predicted by surgical and patient factors. TKA was associated with higher postoperative opioid requirements than THA. RNB and NA did not diminish total inpatient or 90-day postoperative opioid consumption. The use of acetaminophen, gabapentin, or NSAIDs did not significantly alter inpatient opioid requirements. Cite this article: Bone Joint Open 2020;1-7:398–404.

Patterns of prescription opioid utilization among adolescents and adults with comorbid chronic pain and mental health diagnosis.

Our goal was to examine the association between mental health disorders (MHD) and subsequent risk of opioid use among commercially insured youth and adults (aged 14-64 years) with comorbid chronic noncancer pain (CNCP) conditions. We conducted a retrospective cohort study using IQVIA Health Plan Claims database from January 1, 2006, to December 31, 2015. Chronic noncancer pain was defined as any diagnosis of back, head, neck, arthritis, or chronic pain (index date). Mental health disorders were assessed in the 12 months before the index pain diagnosis. Based on days supply (none, acute, and chronic) and average daily dose (none, low, medium, and high), we constructed a 7-level categorical dependent measure of opioid use. We estimated the overall prevalence of MHD and opioid receipt. Among those with CNCP, multinomial logistic regression (AOR; 95 confidence interval) was used to estimate the association of MHD with opioid receipt. Among 879,815 individuals diagnosed with CNCP, 143,923 (16.4%) had comorbid MHD. Chronic/high-dose use of opioids was more common among those with CNCP and MHD compared to those with only CNCP. After adjusting for demographic and clinical factors, individuals with comorbid CNCP and MHD were significantly more likely to be prescribed opioids compared to those with only CNCP conditions. This effect varied by average daily dose and days supply: acute/low dose (1.08; 1.07-1.08); chronic/low dose (1.49; 1.49-1.50); acute/medium dose (1.07; 1.07-1.08); chronic/medium dose (1.61; 1.61-1.62); acute/high dose (1.03; 1.02-1.03); and chronic/high dose (1.53; 1.53-1.54). In individuals with CNCP, having a MHD was a strong predictor of prescription opioid use, particularly chronic use.

PRS57 ASSOCIATION BETWEEN TRANSIENT OPIOID USE AND ACUTE COPD EXACERBATION AMONG OLDER ADULTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)

Evidence regarding the short-term risk of COPD exacerbation from transient opioid exposure has been found among adult patients under 65 years old, but this relationship has not been evaluated among older adults in the U.S. The objective of this study was to examine the association of transient opioid use and COPD exacerbations among older Medicare beneficiaries with COPD. This study used 5% national Medicare claims data from 2012-2016. A case-crossover design was employed to evaluate the impact of short-term opioid exposure on abrupt COPD exacerbations with each subject serving as their own control. The study population included enrollees in the Medicare fee-for-service program who were diagnosed with COPD and had an acute COPD exacerbation between July 1st, 2012 and December 31st, 2016. The impact of opioid use in the seven days immediately prior to COPD exacerbation was compared to opioid exposure in ten control windows prior to this case window. Adjusted odds ratios (OR) were estimated using conditional logistic regression models to assess the risk of opioid use on COPD exacerbations after controlling for time-varying use of bronchodilators, corticosteroids, benzodiazepines, and β-blockers. Recurrent exacerbation on the same individual was allowed. The robust sandwich estimate for the covariance matrix was utilized to account for the within-subject dependence. A total of 57,542 COPD exacerbation events occurred among the 37,089 beneficiaries who met study inclusion criteria. Opioid exposure in the seven days before an acute COPD exacerbation was significantly associated with the exacerbation (OR: 3.02 [95% CI: 2.94, 3.11]). Transient use of inhaled bronchodilators, methylxanthines, inhaled corticosteroids, systemic corticosteroids, benzodiazepines, and β-blockers were also found to be associated with increased odds of acute COPD exacerbation. Opioids can exacerbate COPD among older adults even when used short-term. Guidelines recommending use of opioids in this population may need to be revisited.

Optimization of opioid utility in cancer pain populations.

In this era of crisis and controversy surrounding opioid therapy, we must remember that cancer patients entrust us with supporting them through what might be the most difficult, and oftentimes final, period of their life. The factors that affect the benefits and risks of opioid use in cancer patients and the non-cancer population are quite different. In fact, opioid-associated deaths are 10 times less likely in the former than the latter population, suggesting that a reluctance to initiate opioids in cancer patients can risk under treatment of complex pain. In this review, we outline the considerations and evidence-based practices required to manage the clinical situations that challenge the judicious use of opioids in patients with cancer. A comprehensive review that enable us to better understand and quantify the root causes of variability in pain control, as well as risks of opioid misuse or abuse, would arm healthcare providers with the tools they need to implement multi-modal approaches to treatment planning.

Opioid-Related Disparities in Sexual Minority Youth, 2017

In light of the opioid epidemic, it is essential to understand which subgroups of youth are at elevated risk for opioid use. Sexual minority groups have increased rates of substance use compared to heterosexual youth. Our study aims to examine the prevalence of both prescription opioid misuse and heroin use in adolescents. We then examine odds of prescription opioid misuse and heroin use adjusting for common covariates. Using 2017 Youth Risk Behavior Surveillance System data, we examined lifetime odds of prescription opioid misuse and heroin use among sexual minority youth as defined by sexual identity and sexual behavior. We used logistic regression adjusting for age, sex, and race. 28.5% of gay/lesbian and 25.1% of bisexual youth reported misuse compared to 12.5% of heterosexual youth. Nearly 1 in 10 gay/lesbian youth reported a history of heroin use compared to 4.1% of bisexual and 1.1% of heterosexual young people. Among those who reported having a history of sexual contact, those with same sex contact and sexual contact with both sexes had elevated odds of lifetime heroin use compared to those with a history of opposite sex contact only (aOR: 3.77; 95% CI: 1.68, 8.44 and aOR: 7.44; 95% CI: 4.59, 12.06, respectively). We demonstrated preliminary evidence sexual minority youth have significant opioid-related health disparities with greater odds of lifetime prescription opioid misuse and heroin use. As early exposure to opioids is associated with greater risk for developing an opioid use disorder and increased opioid-morbidity and mortality, it is critical that providers recognize and incorporate the unique needs for sexual minority youth into traditional treatment and prevention models.

Try-It-On: Preparing family nurse practitioners to use holistic integrative interventions to reduce opioid prescriptions in chronic pain management.

In the United States, more than 130 people die each day from an opioid overdose. Nonopioid chronic pain management options are necessary in primary care. This educational innovation describes a new curriculum to teach future family nurse practitioner (FNP) prescribers holistic integrative interventions to decrease overprescribing of opioids for chronic pain management. The Modeling and Role Modeling theory and Kirkpatrick Evaluation Model guided the development and implementation of the curriculum innovation using a Try-It-On teaching-learning strategy, which focuses on immersion experience. The focus was to teach students to communicate effectively with patients in an effort to increase patient awareness of the pathophysiology of pain, risks of opioid use, and holistic integrative pain management options. Students learned to manage chronic pain within a holistic focus through immersion within integrative modalities, such as yoga, meditation, mindfulness, and guided imagery. Pre and post participation evaluations documented students' increased comfort level managing patients with chronic pain. Students reported they were much more likely to prescribe holistic integrative modalities after completing the Try-It-On learning modules. Holistic integrative interventions are a viable treatment option and/or adjunct treatment for chronic pain management. In conclusion, using the Try-It-On, teaching-learning strategy provided FNP students with the tools needed to prescribe nonopioid holistic integrative interventions to manage chronic pain.

PIT2 PATTERNS OF OPIOID USE FOLLOWING FRACTURE BASED ON TIME BETWEEN PRESCRIPTION ORDER AND PATIENT FILL

Opioids are commonly prescribed for acute pain, including treatment of fractures. However, there is risk for dependence and abuse, particularly among opioid-naïve populations. This study used linked claims and electronic medical records to examine the impact of timing of opioid use on outcomes within a fracture population. Individuals with a fracture (index date) between 2012-2017 and continuous eligibility for 6-months preceding and following index were identified in the IBM MarketScan®Explorys®Claims-EMR Dataset. Evidence of fracture or opioid use/dependence during baseline resulted in exclusion. Patients had to have a prescription order for a study opioid (oxycodone, hydrocodone, or tramadol) in the 45 days following index, and a fill for a study opioid anytime during follow-up. Patients were stratified by age (<18; 18-64; and 65+) and time from prescription to first opioid fill (0-7, 8-14, 15-30, and >30 days). Opioid utilization and healthcare costs were compared between sub-groups. A total of 16,181 patients qualified for the study. Mean time from fracture to prescription was 3.5±8.2 days. The majority of the sample (83.6%) filled an opioid within 0-7 days; 7.7% filled >30 days. Patients aged 65+ were more likely than patients <18 to delay opioid fills 30+ days (16.2% vs. 1.6%) and evidenced greater total days’ supply of opioids (36.5±42.1 vs. 6.5±3.0). Compared to patients filling an opioid >30 days from the order, patients filling an opioid within 7 days presented significantly reduced opioid usage (21.2±31.2 vs. 34.9±45.5 days’ supply) and lower fracture-related costs ($9,907±$18,963 vs. $36,321±$85,055; ps< 0.01). Trends in healthcare expenditure were similar across age groups stratified by timing of opioid fill. Although serious risks of opioid use remain, timely utilization of opioids by fracture patients may help manage pain and contain healthcare costs. Once opioids were prescribed, prompt utilization was associated with improved outcomes.

Decreasing Opioid Use Postpartum: A Quality Improvement Initiative.

To estimate the effects of an inpatient initiative to decrease opioid use among women admitted to labor and delivery. We created a multimodal pain power plan with standard therapeutic postpartum activity goals rather than pain goals, tiered order sets with scheduled administration of nonsteroidal antiinflammatory drugs (NSAIDs), and embedded changes into the electronic health record. Before the multimodal pain power plan launch, pain was assessed on a 10-point scale; women received NSAIDs for pain levels of 3 or less and opioids for pain levels higher than 3. For this analysis, we included women who delivered at 5 hospitals in the 10 months before and 12 months after the multimodal pain power plan launch. Women with prior substance use disorder or complicated deliveries were excluded and we stratified analyses into women who delivered vaginally compared with by cesarean. Opioid use was converted to morphine milligram equivalent (MME). Women rated pain control in 24-hour blocks using individually ascertained cutoffs. A multivariable regression analysis was performed, and adjusted odds ratios are reported. We compared the 6,892 women who delivered 10 months before the pain power plan launch to the 7,527 who delivered in the 12 months after the launch. The mean cohort age was 29.6±6.0 years; the majority (75%) were white. Risk of opioid use decreased by 26% among women who delivered vaginally (risk ratio [RR] 0.74; 95% CI [0.68, 0.81]) and 18% among women who delivered by cesarean (RR 0.82; 95% CI [0.72, 0.92]). Among women who received opioids, mean MME use decreased 21% (RR 0.79; 95% CI [0.70, 0.88]) and 54% (RR 0.46; 95% CI [0.35, 0.61]) in the vaginal and cesarean delivery groups, respectively. Fewer women reported acceptable pain levels, with decreases of 82-69% (P<.01) and 82-74% (P<.01) in the vaginal and cesarean delivery groups, respectively. Within the postlaunch cesarean delivery group, women also reported that they were less likely to have their pain well controlled on the Hospital Consumer Assessment of Healthcare Providers and Systems questionnaires (82% vs 62%, P <.01). A standardized multimodal pain power plan reduced opioid use among a large cohort of women admitted to labor and delivery in Central Texas. Despite meeting functional goals, some women reported increased pain during their hospital stay.

Association Between Transient Opioid Use and Short-Term Respiratory Exacerbation Among Adults With Chronic Obstructive Pulmonary Disease: A Case-Crossover Study.

The association of historical opioid use with health care use and death among patients with chronic obstructive pulmonary disease (COPD) has been tested. Using Mississippi Medicaid data, we examined the association of transient or short-term opioid use and acute respiratory exacerbations among adults with COPD. We used a case-crossover design and 2013-2017 Mississippi Medicaid administrative claims data. A total of 1,972 qualifying exacerbation events occurred in 1,354 beneficiaries. The frequency and dose of opioid exposure in the 7 days before the exacerbation were examined and compared with the opioid exposure in 10 control windows, each 7 days long, before the exacerbation. Adjusted odds ratios were estimated using conditional logistic regression models to estimate the risk of opioid use on exacerbations after accounting for use of bronchodilators, corticosteroids, benzodiazepines, and β-blockers. Overall, opioid exposure in the 7 days before an exacerbation was significantly associated with acute respiratory exacerbation (odds ratio = 1.81; 95% confidence interval: 1.60, 2.05). Each 25-mg increase in morphine equivalent daily dose was associated with an 11.2% increase in the odds of an acute respiratory exacerbation (odds ratio = 1.11; 95% confidence interval: 1.04, 1.20). Transient use of opioids was significantly associated with acute respiratory exacerbation of COPD.

Mental Health Comorbidities and Elevated Risk of Opioid Use in Elderly Breast Cancer Survivors Using Adjuvant Endocrine Treatments.

Prolonged opioid use is common and associated with lower survival rates in breast cancer survivors. We explored whether opioid use in elderly breast cancer survivors using adjuvant endocrine therapy (AET) regimens was affected by the prevalence of mental health comorbidity and, in turn, how this affected survival in this population. This retrospective study analyzed 2006 to 2012 SEER-Medicare data sets and followed patients for at least 2 years from the index date, defined as the first date they filled an AET prescription. The study included adult women with incident, primary, hormone receptor-positive, stage I to III breast cancer. They were also first-time AET users and fee-for-service Medicare enrollees continuously enrolled in Medicare Parts A, B, and D. We measured whether patients with a clinical diagnosis of a mental health comorbid condition used opioids after the initiation of AET and their survival at the end of the study period. A total of 10,452 breast cancer survivors who began AET treatments were identified, among whom the most commonly diagnosed mental health comorbidities were depression (n = 554) and anxiety (n = 246). Using a propensity score risk adjustment model, we found that opioid use was significantly higher in women with a mental health comorbidity (odds ratio,1.33; 95% CI, 1.06 to 1.68). In addition, mental health comorbidity was associated with a significantly increased hazard of mortality in this population (hazard ratio, 1.49; 95% CI, 1.02 to 2.18). The presence of mental health comorbidity in breast cancer survivors significantly increases the risk of opioid use and mortality, which highlights the need for better management of comorbid mental health conditions.

Addressing the impact of opioids on women and children

Women and children bear a substantial part of the burden of opioid overuse in the United States. Opioid use during pregnancy can lead to neonatal opioid withdrawal syndrome, and both the mothers and babies may be at higher risk of opioid use and its consequences later in the life course, setting up intergenerational cycles of opioid overuse. As part of the HEAL (Helping to End Addiction Long-term) Initiative of the National Institutes of Health, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the Environmental influences on Child Health Outcomes program are together launching observational and intervention research programs to interrupt these cycles, beginning with opportunities in pregnancy and the newborn period. The Eunice Kennedy Shriver National Institute of Child Health and Human Development has also launched programs to find alternatives to opioids for painful conditions in women of reproductive age, including a range of gynecologic conditions. These coordinated efforts promise to help turn the tide against the opioid crisis by providing the necessary evidence to improve care for women and children affected by these substances.

Opioid use after hip fracture surgery: A Danish nationwide cohort study from 2005 to 2015

There is currently a knowledge gap regarding persistent opioid use after hip fracture surgery. Thus, opioid use within a year after hip fracture surgery in patients with/without opioid use before surgery was examined. This population-based cohort study included all patients (aged≥65) undergoing primary hip fracture surgery in Denmark (2005-2015) identified from the Danish Multidisciplinary Hip Fracture Database. Opioid use was assessed from The Danish National Health Service Prescription Database as redeemed prescriptions. The proportion of patients with ≥1 opioid prescription was computed within 6months before surgery and each of four 3-month periods (quarters) after surgery, among patients alive first day in each period. Proportion differences (95% CI) were calculated for each quarter compared to before surgery. Proportions were calculated for users and nonusers before surgery, including initiators after first quarter. This study included 69,456 patients. Proportion differences of opioid users were 35.0 (95% CI 34.5-35.5), 7.0 (95% CI 6.5-7.5), 2.9 (95% CI 2.4-3.4) and 1.4 percentage-points (95% CI 0.9-1.9) the four quarters after surgery compared to before. Among opioid nonusers before surgery, 54.7% (95% CI 54.3-55.1), 21.8% (95% CI 21.4-22.2), 17.8% (95% CI 17.4-18.2) and 16.8% (95% CI 16.4-17.2) were opioid users in 1st-4th quarter after surgery. However, 8.5% (95% CI 8.2-8.7) of the nonusers before surgery in 4th quarter initiated opioid use more than a quarter after surgery. The proportion of opioid users increased after hip fracture surgery and was 1.4 percentage-points increased in fourth quarter compared to before. Of opioid nonusers before surgery, 16.8% were opioid users fourth quarter after surgery. Opioid use 1year after hip fracture surgery is common, both in patients who were opioid users and nonusers before the surgery. These significant findings point out the need for indication of benefits and risks of opioid use in the acute and long-term management of patients undergoing hip fracture surgery.