Use Of Prescription Opioid Drugs Research Articles

Prescription-related risk factors for opioid-related overdoses in the era of fentanyl contamination of illicit drug supply: A retrospective case-control study

Background:We sought to quantify the association between clinical, physiological, and contextual factors and opioid-related overdose, specifically focusing on current and past use of select prescription medications. Methods: We conducted a case-control study of individuals who experienced a non-fatal opioid-related overdose between January 2015 and November 2016 in British Columbia, Canada. We matched 8,831 cases to 44,155 controls on birth year, sex, and local health area of residence and examined 5-year prescribing history for opioids for pain, medications for opioid use disorder (MOUD), benzodiazepines/z-drugs, and other psychoactive medications. Results: The overall prevalence of prescription opioid drug use was generally low in the study population. Cases had a relatively higher use of selected prescription medications, a higher physical and mental morbidity burden, and were less connected to health services compared with controls. For opioids for pain, current therapy was associated with experiencing an overdose (OR = 8.5, 95%CI: 7.3–10); history of long-term use had a stronger association than history of short-term use (OR = 2.9, 95%CI: 2.6–3.3 vs OR = 1.7, 95%CI: 1.5–1.8, respectively). While persons on MOUD were more likely to overdose compared to persons who were not on therapy (OR = 2.0, 95%CI 1.7–2.4), recent discontinuation of MOUD greatly increased the likelihood of overdose (OR = 25.6, 95%CI 17.5–37.4). Active therapy of benzodiazepines/z-drugs and other sedating medications also significantly increased the likelihood of overdose. Conclusions: While this study supports expansion of efforts to prevent overdoses among individuals actively using opioids for pain and improve retention among those on MOUD, it is also important to address other clinical, physiological, and contextual risk and protective factors to help curb the current overdose crisis.

Risk‐factors for continuous long‐term use of prescription opioid drugs 3 years after hysterectomy: A nationwide cohort study

The widespread misuse of prescription pain medication, including opioids, has serious public health implications. Postoperative pain is a risk factor for persistent or chronic pain unless treated effectively. There are only a few studies that have assessed the use of opioid-containing drugs after gynecological surgery and most of these usually have a short follow-up period. The aim of this study was to identify risk-factors for long-term use of prescription opioid drugs following hysterectomy. We performed a nationwide cohort study based on prospectively collected data. Information from two population-based registers, the Swedish National Quality Register of Gynecological Surgery and the Swedish National Drug Register, was linked. The study population consisted of women with benign disease undergoing a total hysterectomy from 1 January 2012 until 31 December 2015. To identify long-term changes in prescription of opioids, individual data were collected from 1year prior to to 3years after surgery between 2011 and 2018. Data analysis was performed using multivariable logistic regression models. The population included 17385 women having had hysterectomy for benign disease. Of these women, 4233 (24.4%) were prescribed analgesics continuously for 3years postoperatively and 1225 (7.1%) used opioids long term. Perioperative predictors of opioid use 3years after surgery included a diagnosis of adenomyosis (adjusted odds ratio [aOR] 1.8, 95% confidence interval [CI] 1.2-2.7) and preoperative use of opioids (aOR 29.6, 95% CI 19.7-44.4), psycho- (aOR 3.5, 95% CI 2.4-5.0) and neuroactive drugs (aOR 1.8, 95% CI 1.0-3.1). For women with no opioid prescription preoperatively (n=260, 1.5%), mild (aOR 2.8, 95% CI 1.1-7.3) and severe (3.0% vs 6.2%: aOR 6.4, 95% CI 1.4-20.0) postoperative complications and preoperative prescription of psychoactive drugs (aOR 4.6, 95% CI 1.9-10.7) were associated with long-term use of drugs containing opioids. Long-term use of prescription opioids after hysterectomy is common and is, among other risk factors, strongly associated with preoperative use of opioids, as well as psychoactive drugs and adenomyosis. To avoid opioid misuse disorders among women at risk for long-term opioid drug prescriptions after hysterectomy, further studies and strategies are needed.

Immunohistochemical studies of codeine medication on the prefrontal cortex and cerebellum of adult Wistar rats

Despite the dangers associated with the increased use of prescription opioid drugs, limited researches have addressed the specific effects of prescription opioids on the brain. The objective of thi...

From time use to contingent work to labor supply: thoughts on the contributions of Alan Kreuger

Alan had a real concern with “getting it right,” even when getting it right was something that was going to be very, very difficult to do. I focus on some trends in labor supply that Alan was very concerned about. There has been a huge employment and earnings shift in recent years toward those with a Bachelor’s Degree or greater. Moreover, within each educational attainment group, the earnings of those who either have a certificate but no license, or a license, are higher. As for labor force participation, there has been a consistent decline for white men aged 25–54. Alan demonstrated that geographic areas with the greatest decline in labor force participation rates have been those with the highest use of prescription opioid drugs. My work with the National Longitudinal Survey further shows that, in the wake of the Great Recession, younger cohorts of workers are more prone to spells of unemployment or nonpartication in the labor force than those of the past.

Educational Intervention Changes College Students’ Attitudes toward Prescription Opioid Drug Use

Background: More than 47,000 people in the United States died from opioid drug overdoses in 2017. Among college students, opioid drugs are the second most abused drug. Objective: This study aimed to examine if an educational intervention impacted college students’ attitudes towards prescription opioid drugs (POD). Methods: Two hundred forty-two participants (72 males, 21 ± 3 years) from an American university participated. After collecting demographic data (questionnaire 1; Q1), investigators recited a narrative in which the protagonist was injured and prescribed POD. Next, participants rated their agreement on 10 Likert prompts and two visual analog scales (VAS) before (Q2) and after (Q3) an educational intervention, then noted (Q4) which topics were most or least influential in any changed responses. Results: 7/10 Likert prompts (all p < 0.002) and both VAS (both p < 0.001) changed between Q2 and Q3. Educational intervention topics related to risk were most influential and topics related to alternative therapies were least influential. Conclusion/Importance: Educational interventions may be beneficial for college students. Any interventions that are employed should focus on risks associated with POD use.

Problematic use of prescription opioid drugs: Classification and effective treatments

Problematic use of prescription opioid drugs: Classification and effective treatments

Non-medical use of prescription drugs in the millennial generation: A public health concern

Non-medical use of prescription opioid drugs by the millennial generation has been an ongoing topic in modern literature. Recent increases in mortality and morbidity related to prescription drug abuse have indicated the need for increased research and allocation of resources. This article provides a review of current literature on non-medical use of prescription drug use within this population in the United States. Initial searches yielded over 100 results. After identifying the 11 most applicable studies, a more thorough evaluation was conducted. Each study was published within the last 5 years and contributed to the compilation of consistent themes and findings. Literature has focused on factors that predispose millennials to prescription opioid misuse, methods of obtainment, related health consequences, and the implications within communities and schools. Components include complementary findings and demonstrate the increasingly detrimental impact that non-medical use of prescription opioid drugs has on millennial and adolescent populations.

Illicit Drug Use and its Correlations Among Hookah Users in Khalil Abad, Northeast of Iran

Background and aims: One of the most important problems of public health is illicit drug use. The aim of this study was to assess the status of illicit drug use and associated factors among hookah smokers in Khalil Abad city in 2015. Methods: The cross-sectional study was conducted in Khalil Abad city (northeast of Iran) in 2015. A sample of 161 hookah users was selected using 2-stage sampling. Structured questionnaires were distributed among the subjects and participants were included in the study after completing informed consent form. To analyze the data, we used chi-square, t test and logistic regression model. Results: The prevalence of illicit drug use was 36%. The result of final logistic regression model, with inclusion of confounders, showed that job status (odds ratio [OR] = 4.13), smoking in the last year (OR = 3.84) and prescription opioid drug use (OR = 3.77), were associated with illicit drug use. Conclusion: Our results showed high prevalence of illicit drug use, which was strongly associated with unemployment and other substances use. The results of this study can be used for planning for epidemiological studies in national scale in order to implement and evaluating interventions by considering the risk factors of hookah smoking in this type of individuals.

Opioid Misuse/Abuse and Quality Persistent Pain Management in Older Adults.

The United States is amid an epidemic of prescription opioid drug abuse, bringing with it not only high rates of overdose, but growing rates of heroin abuse and addiction. Liberal opioid drug prescribing on the part of well-meaning clinicians has in part fueled this epidemic, being correlated to opioid death and addiction treatment admission rates. Misuse and abuse of prescription opioid drugs is greatest among young adults (ages 18 to 25); however, the fastest growing age group for opioid drug misuse/abuse is older (ages 50 to 64). Prescription opioid drug use issues may emerge in the context of persistent pain, and risk factors for misuse/abuse and overdose in older patients with pain require further description. In keeping with national initiatives to combat prescription opioid drug abuse and overdose, current clinical guidelines reflect an "opioid-sparing" approach. To the degree that these guidelines improve persistent pain and opioid drug misuse/abuse outcomes, significant public health benefits will be accrued. Efforts to reduce both require action and are national priorities. [Journal of Gerontological Nursing, 42(12), 21-30.].

Opioid Use Found to Be Decreasing, While Opioid-Related Deaths Increase

To reverse adverse outcomes associated with the illicit use of prescription opiates, guidelines are needed to address prescription practices for such drugs, experts say.

Use of electronic health records for early detection of high-cost, low back pain patients.

Low back pain (LBP) is a debilitating condition that is complex to manage. One reason is that clinicians lack means to identify early on patients who are likely to become high care utilizers. To explore the feasibility of developing a 'dynamic' predictive model using electronic health record data to identify costly LBP patients within the first year after their initial LBP encounter with a primary care provider. Dynamic, in this context, indicates a process in which the decision on how to manage patients is dependent on whether they are at their first, second or third LBP visit with the provider. A series of logistic regression models was developed to predict who will be a high-cost patient (defined as top 30% of the cost distribution) at each of the first three LBP visits. The c-statistics of the three logistic regression models corresponding to each of the first three visits were 0.683, 0.795 and 0.741, respectively. The overall sensitivity of the model was 42%, the specificity was 86% and the positive predictive value was 48%. Men were more likely to become expensive than women, while patients who had workers' compensation as their primary payer type had higher use of prescription opioid drugs or were smokers before the first LBP visit were also more likely to become expensive. The results suggest that it is feasible to develop a dynamic, primary care provider visit-based predictive model for LBP care based on longitudinal data obtained via electronic health records.

Treatment of Central Sleep Apnea in US Veterans

There are no standard therapies for the management of central sleep apnea (CSA). Either positive pressure therapy (PAP) or supplemental oxygen (O(2)) may stabilize respiration in CSA by reducing ventilatory chemoresponsiveness. Additionally, increasing opioid use and the presence of comorbid conditions in US veterans necessitates investigations into alternative titration protocols to treat CSA. The goal was to report on the effectiveness of titration with PAP, used alone or in conjunction with O(2), for the management of CSA associated with varying comorbidities and opioid use. This was a retrospective chart review over 3 years, performed at a VA sleep disorders center. The effects of CPAP, CPAP+O(2), and BPAP+O(2), used in a step-wise titration protocol, on consecutive patients diagnosed with CSA were studied. CSA was diagnosed in 162 patients. The protocol was effective in eliminating CSA (CAI ≤ 5/h) in 84% of patients. CPAP was effective in 48%, while CPAP+O(2) combination was effective in an additional 25%, and BPAP+O(2) in 11%. The remaining 16% were non-responders. Forty-seven patients (29%) were on prescribed opioid therapy for chronic pain, in whom CPAP, CPAP+O(2), or BPAP+O(2) eliminated CSA in 54%, 28%, and 10% cases, respectively. CPAP, CPAP+O(2), and BPAP+O(2) each produced significant declines in the AHI, CAI, and arousal index, and an increase in the SpO(2). The data demonstrate that using a titration protocol with CPAP and then PAP with O(2) effectively eliminates CSA in individuals with underlying comorbid conditions and prescription opioid use. Comparative studies with other therapeutic modalities are required.

Prescription Drug Monitoring Programs and Death Rates from Drug Overdose

Drug overdoses resulting from the abuse of prescription opioid analgesics and other controlled substances have increased in number as the volume of such drugs prescribed in the United States has grown. State prescription drug monitoring programs (PDMPs) are designed to prevent the abuse of such drugs. This study quantifies the relation of PDMPs to rates of death from drug overdose and quantities of opioid drugs distributed at the state level. Observational study of the United States during 1999-2005. Rates of drug overdose mortality, opioid overdose mortality, and opioid consumption by state. PDMPs were not significantly associated with lower rates of drug overdose or opioid overdose mortality or lower rates of consumption of opioid drugs. PDMP states consumed significantly greater amounts of hydrocodone (Schedule III) and nonsignificantly lower amounts of Schedule II opioids. The increases in overdose mortality rates and use of prescription opioid drugs during 1999-2005 were significantly lower in three PDMP states (California, New York, and Texas) that required use of special prescription forms. While PDMPs are potentially an important tool to prevent the nonmedical use of prescribed controlled substances, their impact is not reflected in drug overdose mortality rates. Their effect on overall consumption of opioids appears to be minimal. PDMP managers need to develop and test ways to improve the use of their data to affect the problem of prescription drug overdoses.