Author Interviews, CDC, JAMA, Opiods / 19.09.2017

MedicalResearch.com Interview with: Dr. Deborah Dowell, MD MPH Senior Medical Advisor Division of Unintentional Injury Prevention Centers for Disease Control and Prevention MedicalResearch.com: What is the background for this study? Response: Increases in U.S. life expectancy at birth have leveled off from an average of 0.20 years gained per year from 1970 to 2000 to 0.15 years gained per year from 2000 to 2014. U.S. life expectancy decreased from 2014 to 2015 and is now lower than in most high-income countries, with this gap projected to increase. Drug poisoning (overdose) death rates more than doubled in the United States from 2000-2015; those involving opioids more than tripled. Increases in poisoning have been reported to have reduced life expectancy for non-Hispanic white Americans from 2000-2014. Specific contributions of drug, opioid, and alcohol poisoning to changes in U.S. life expectancy since 2000 were unknown.
Addiction, Author Interviews, JAMA, Opiods, University of Pittsburgh / 24.08.2017

MedicalResearch.com Interview with: [caption id="attachment_36629" align="alignleft" width="130"]Julie M. Donohue, Ph.D. Associate professor in Pitt Public Health’s Department of Health Policy and Management and Director of the Medicaid Research Center Pitt’s Health Policy Institute University of Pittsburgh Dr. Donohue[/caption] Julie M. Donohue, Ph.D. Associate professor in Pitt Public Health’s Department of Health Policy and Management and Director of the Medicaid Research Center Pitt’s Health Policy Institute University of Pittsburgh  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Medicaid enrollees have three times higher risk of opioid overdose than non-enrollees, and for every fatal opioid overdose, there are about 30 nonfatal overdoses, according to the U.S. Centers for Disease Control and Prevention (CDC). My colleagues and I analyzed claims data from 2008 to 2013 for all Pennsylvania Medicaid enrollees aged 12 to 64 years with a medical record of a heroin or prescription opioid overdose and who had six months of continuous enrollment in Medicaid before and after the overdose claim. The 6,013 patients identified were divided into two groups—3,945 who overdosed on prescription opioids and 2,068 who overdosed on heroin, all of whom received treatment for overdose in a hospital or emergency department setting. We found that Pennsylvania Medicaid recipients who suffer an opioid or heroin overdose continue to be prescribed opioids at high rates, with little change in their use of medication-assisted treatment programs after the overdose. Opioid prescriptions were filled after overdose by 39.7 percent of the patients who overdosed on heroin, a decrease of 3.5 percentage points from before the overdose; and by 59.6 percent of the patients who overdosed on prescription opioids, a decrease of 6.5 percentage points. Medication-assisted treatment includes coupling prescriptions for buprenorphine, methadone or naltrexone—medications that can reduce opioid cravings—with behavioral therapy in an effort to treat the opioid use disorder. Our team found that such treatment increased modestly among the patients using heroin by 3.6 percentage points to 33 percent after the overdose, and by 1.6 percentage points to 15.1 percent for the prescription opioid overdose patients.
Author Interviews, Opiods, Orthopedics, Pain Research, Stanford / 21.08.2017

MedicalResearch.com Interview with: [caption id="attachment_36469" align="alignleft" width="200"]Tina Hernandez-Boussard, PhD MPH, MS Associate Professor of Medicine, Biomedical Data Science, and Surgery Stanford School of Medicine Stanford, CA 94305-5479 Dr. Hernandez-Boussard[/caption] Tina Hernandez-Boussard, PhD MPH, MS Associate Professor of Medicine, Biomedical Data Science, and Surgery Stanford School of Medicine Stanford, CA 94305-5479 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Opioid addiction is a national crisis.  As surgery is thought to be a gateway to opioid misuse, opioid-sparing approaches for pain management following surgery are a top priority. We conducted a meta-analysis of 39 randomized clinical trials of common non-pharmalogical interventions used for postoperative pain management. We found that acupuncture and electrotherapy following total knee replacement reduced or delayed patients’ opioid use.
Author Interviews, Cancer, Cancer Research, Opiods / 09.08.2017

MedicalResearch.com Interview with: [caption id="attachment_36364" align="alignleft" width="160"]Rinku Sutradhar, Ph.D. Senior Scientist, Institute for Clinical Evaluative Sciences Associate Professor, Dalla Lana School of Public Health University of Toronto, Canada Dr. Sutradhar[/caption] Rinku Sutradhar, Ph.D. Senior Scientist, Institute for Clinical Evaluative Sciences Associate Professor, Dalla Lana School of Public Health University of Toronto, Canada MedicalResearch.com: What is the background for this study? What are the main findings?
  • We suspected that pain was prevalent among survivors of cancer, but there were no comprehensive estimates on the magnitude of this prevalence. For example, recent work had reported pain prevalence among cancer survivors to be anywhere from 5% to 56%, which is quite a wide range.
  • To our knowledge, there has been no prior research conducted at the individual-level that specifically examines opioid prescribing rates for cancer survivors, compared to matched control groups who have no prior cancer diagnosis.
  • We also know that socio-economically disadvantaged populations are more at risk for opioid dependency, but previous studies have not examined cancer survivors who a part of this disadvantaged group, so this is an important knowledge gap to fill.
  • We found that cancer survivors have significantly higher rates of opioid prescriptions compared with their matched controls (who had no prior cancer diagnosis). In fact, after adjusting for other study factors, we found that the rate of opioid prescriptions was 22% higher among survivors.
  • MOST SURPRISING: This higher rate of opioid prescriptions persisted even among survivors who were 10 or more years past their cancer diagnosis (compared to matched control individuals who had no prior cancer diagnosis).
  • When we broke the cohort down based on the type of cancer, we didn’t see a significant spike in opioid prescriptions for breast cancer survivors compared to their non-cancer controls, but we did see higher opioid prescriptions for survivors of lung, gastrointestinal, genitourinary, or gynaecological cancers, compared to their controls.
Author Interviews, BMJ, Brigham & Women's - Harvard, Opiods, Pediatrics / 04.08.2017

MedicalResearch.com Interview with: [caption id="attachment_27170" align="alignleft" width="179"]Krista F. Huybrechts, M.S., Ph.D. Assistant Professor of Medicine at Harvard Medical School Epidemiologist in the Division of Pharmacoepidemiology and Pharmacoeconomics Brigham and Women’s Hospital. Boston, MA 02120 Dr. Krista Huybrechts[/caption] Krista F. Huybrechts, MS PhD Assistant Professor of Medicine Brigham and Women’s Hospital Harvard Medical School Boston, MA 02120 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Neonatal drug withdrawal is common; in the U.S. about 1 infant is born every 25 minutes with signs of drug withdrawal. Neonatal drug withdrawal is a well-recognized complication of intrauterine exposure to illicit or prescription opioids, but other psychotropic medications can also cause signs of withdrawal. Psychotropic medications are frequently co-prescribed with opioids in pregnancy, and the use of both has increased significantly, raising concerns about an increase in the incidence and severity of neonatal drug withdrawal due to potential drug-drug interactions, but these risks are not well understood. In this study, we found a 30-60% increase in the risk of neonatal drug withdrawal associated with co-exposure to antidepressants, benzodiazepines and gabapentin, compared to opioids alone; no significant increase in risk was observed for atypical antipsychotics and Z-drugs. Exposure to psychotropic polypharmacy along with opioids was associated with a two-fold increased risk of withdrawal.
Addiction, Author Interviews, Gender Differences, Mental Health Research, Opiods / 28.07.2017

MedicalResearch.com Interview with: Andrea M. Tilstra Doctoral Student, Department of Sociology Population Program, Institute of Behavioral Science University of Colorado Boulder and Ryan K. Masters Assistant Professor, Department of Sociology Faculty Associate, Population Program and Health & Society Program Institute of Behavioral Science University of Colorado Boulder MedicalResearch.com: What is the background for this study? What are the main findings? Response:  “Despair” deaths – deaths from suicides, alcohol poisonings, and drug overdoses – have been a topic of interest in recent mortality research. For instance, existing findings suggest that mortality among white Americans has increased as a result of middle-aged whites experiencing elevated levels of despair and distress. These factors supposedly are driving white Americans to cope in unhealthy ways – excessive drinking, drug use, and suicides. However, there were two major problems with the existing research that supported this narrative. First, men and women were analyzed together, despite the knowledge that overall mortality levels and trends differ significantly by gender. Second, all three of the aforementioned causes of death were pooled together and analyzed as one group. This is highly problematic if deaths from suicides, alcohol use, and drug use are not, in fact, moving in conjunction with one another. We addressed these issues and expanded previous analyses by analyzing cause-specific death rates for men and women separately, for years 1980-2014, and decomposing the trends into period- and cohort- based analyses. We find that there are huge gender differences in U.S. white mortality rates and that trends in mortality from the three causes of death are quite distinct from one another. Recent increases in U.S. white mortality are largely driven by period-based increases in drug poisoning deaths and cohort-based increases in metabolic disease deaths.
Accidents & Violence, Author Interviews, Opiods / 28.07.2017

MedicalResearch.com Interview with: [caption id="attachment_36183" align="alignleft" width="200"]Stanford Chihuri, MPH Staff Associate/Data Analyst Department of Anesthesiology, College of Physicians and Surgeons Columbia University Medical Center NY, NY 10032 Stanford Chihuri[/caption] Stanford Chihuri, MPH Staff Associate/Data Analyst Department of Anesthesiology, College of Physicians and Surgeons Columbia University Medical Center NY, NY 10032  MedicalResearch.com: What is the background for this study? What are the main findings? Response: In the past 2 decades, consumption of prescription opioids has substantially increased in the U.S. Prescription drugs may cause drowsiness and impaired cognition which may interfere with psychomotor functioning necessary during the operation of a motor vehicle. The current study assessed time trends in prescription opioids detected in drivers killed in motor vehicle crashes from 1995 to 2015 in 6 states in the U.S. Results of the study showed that the prevalence of prescription opioids detected in fatally injured drivers has increased 700% in the past 2 decades.
Author Interviews, JAMA, Opiods, Pain Research, Primary Care / 17.07.2017

MedicalResearch.com Interview with: [caption id="attachment_35965" align="alignleft" width="110"]Jane M. Liebschutz, MD, MPH Associate Professor of Medicine Section of General Internal Medicine Boston University School of Medicine Boston, Massachusetts Dr. Liebschutz[/caption] Jane M. Liebschutz, MD, MPH Associate Professor of Medicine Section of General Internal Medicine Boston University School of Medicine Boston, Massachusetts MedicalResearch.com: What is the background for this study? Response: The number of patients receiving opioids for chronic pain has risen over the past 2 decades in the US, in parallel with an increase in opioid use disorder. The CDC and professional medical societies have created clinical guidelines to improve the safety of opioid prescribing, yet individual prescribers can find them onerous to implement. We developed an intervention to change clinical practice to support primary care physicians who prescribe the majority of opioids for chronic pain. The intervention included 4 elements- a nurse care manager to help assess, educate and monitor patients, an electronic registry to keep track of patient data and produce physician level reports, an individualized educational session for the physician by an opioid prescribing expert based on the physician-specific practice information and online resources to help with decision-making for opioid prescribing (www.mytopcare.org). We tested whether the intervention would improve adherence to guidelines, decrease opioid doses and decrease early refills, as a marker of potential prescription opioid misuse among 985 patients of 53 primary care clinicians in four primary care practices.
Addiction, Author Interviews, CDC, Opiods / 11.07.2017

MedicalResearch.com Interview with: [caption id="attachment_35848" align="alignleft" width="100"]Deborah Dowell, MD, MPH Chief Medical Officer, Division of Unintentional Injury Prevention National Center for Injury Prevention and Control Centers for Disease Control and Prevention Dr. Dowell[/caption] Deborah Dowell, MD, MPH Chief Medical Officer, Division of Unintentional Injury Prevention National Center for Injury Prevention and Control Centers for Disease Control and Prevention  MedicalResearch.com: What is the background for this study? Response: CDC analyzed retail prescription data from QuintilesIMS which provides estimates of the number of opioid prescriptions dispensed in the United States from approximately 59,000 pharmacies, representing 88% of prescriptions in the United States. CDC assessed opioid prescribing in the United States from 2006 to 2015, including rates, amounts, dosages, and durations prescribed. CDC examined county-level prescribing patterns in 2010 and 2015.
Author Interviews, Opiods, Pharmacology / 10.07.2017

Medical Research.com Interview with: [caption id="attachment_35821" align="alignleft" width="200"]Dr. Christian Heidbreder, PhD Chief Scientific Officer Indivior Inc. Richmond, VA 23235, USA Dr. Heidbreder[/caption] Dr. Christian Heidbreder, PhD Chief Scientific Officer Indivior Inc. Richmond, VA 23235, USA MedicalResearch.com: What is the background for this study? What are the main findings? Response: This pivotal Phase 3 clinical trial (RB-US-13-0001) evaluated the efficacy and safety of RBP-6000, an investigational once-monthly injectable buprenorphine in the ATRIGEL® delivery system for the treatment of adults with moderate-to-severe opioid use disorder (OUD) as part of a complete treatment plan to include counseling and psychosocial support1. The 24-week Phase 3 study met its primary and key secondary endpoints, demonstrating statistically significant differences in percentage abstinence and treatment success across both dosage regimens of RBP-6000 versus placebo1. The findings also showed that outcomes with RBP-6000 are consistent across other secondary clinical endpoints, including control of craving and withdrawal symptoms, as compared to placebo. These outcomes were associated with buprenorphine plasma concentrations ≥ 2 ng/mL and predicted whole brain mu-opioid receptor occupancy of ≥ 70%, and were also maintained for the one-month dosing intervals and for the entire treatment duration1. The results were confirmed by exposure-response analyses demonstrating a relationship between buprenorphine plasma concentrations, abstinence, withdrawal symptoms and opioid craving1. RBP-6000 was generally well tolerated and had a safety profile consistent with that of transmucosal buprenorphine. Injection site reactions were not treatment-limiting. The most common (reported in ≥ 5% of subjects) treatment-emergent adverse events (TEAEs) reported in the active total group were constipation, headache, nausea, injection site pruritus, vomiting, increased hepatic enzyme, fatigue and injection site pain1.
Addiction, Author Interviews, JAMA, Opiods, Pediatrics / 19.06.2017

MedicalResearch.com Interview with: [caption id="attachment_35432" align="alignleft" width="154"]Scott Hadland, MD, MPH, MS Youth Addiction Specialist Assistant Professor of Pediatrics Boston University School of Medicine Dr. Hadland[/caption] Scott Hadland, MD, MPH, MS Youth Addiction Specialist Assistant Professor of Pediatrics Boston University School of Medicine Director, Urban Health and Advocacy Track, Boston Children’s Hospital and Boston Medical Center Associate Program Director, Boston Combined Residency Program in Pediatrics, Boston Medical Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: Almost no data have been available on this topic to date.  A recent study showed that teens in subspecialty treatment for opioid addiction were significantly less likely than adults to receive a medication.  Our study was the first to comprehensively look across the health care system, including looking at adolescents and young adults diagnosed with opioid use disorder in outpatient clinics, emergency departments, and inpatient hospitals. We had three important findings.  First, looking at a large sample of 9.7 million adolescents and young adults between the age of 13 and 25 years, we found that the number of youth diagnosed with opioid use disorder increased six-fold from 2001 to 2014.  This is perhaps not surprising given the national opioid crisis we know to be occurring. Second, we found that only a minority of youth (1 in 4) received buprenorphine or naltrexone, the two medications available for opioid addiction that can be prescribed in usual medical settings.  These two medications are evidence-based and their use is recommended by the American Academy of Pediatrics.  Utilizing them is critical to ensure that we offer effective treatment early in the life course of addiction, which can help prevent the long-term harms of addiction. Third, we found significant differences in who received medications.  Whereas approximately 1 in 3 young adults in our study received a medication, only 1 in 10 of the 16- and 17-year-olds we studied received one, and among adolescents under 15 years of age, 1 in 67 received a medication.  Females were less likely than males to receive medications, as were black youth and Hispanic youth relative to white youth.
Author Interviews, Opiods / 19.06.2017

MedicalResearch.com Interview with: [caption id="attachment_35380" align="alignleft" width="200"]Robin Gelburd, JD President FAIR Health Robin Gelburd[/caption] Robin Gelburd, JD President FAIR Health MedicalResearch.com: What is the background for this study? Response: The opioid crisis is affecting the entire nation, but not in the same way in every location. Although a number of studies have been conducted on geographic variations in the opioid epidemic, there remains a need for more information on the regional level. To help meet that need, FAIR Health consulted its database of more than 23 billion privately billed healthcare claims, the largest such repository in the country. Focusing on the most recent complete ten-year period (2007-2016), FAIR Health examined claims data from rural and urban settings, the country’s five most populous cities (Chicago, Houston, Los Angeles, New York and Philadelphia) and the states where those cities are located. When the term “opioid-related diagnoses” is used in this study, it refers to opioid abuse, opioid dependence, heroin overdose and opioid overdose (i.e., overdose of opioids excluding heroin).
Addiction, Author Interviews, Cost of Health Care, Opiods, PLoS / 10.06.2017

MedicalResearch.com Interview with: [caption id="attachment_35195" align="alignleft" width="200"]A. Simon Pickard, PhD Dr. Pickard[/caption] A. Simon Pickard, PhD Professor, Dept of Pharmacy Systems, Outcomes and Policy University of Ilinois at Chicago College of Pharmacy MedicalResearch.com: What is the background for this study? What are the main findings? Response: The heroin epidemic, which has left virtually no part of American society unscathed, can be viewed as an illness.  Unlike some illnesses, however, it was largely manufactured by stakeholders in the healthcare system, wittingly or unwittingly. The main finding, that heroin addiction costs us just over $50 billion per year, is likely a conservative estimate.
Author Interviews, Cost of Health Care, HIV, Opiods, PLoS / 31.05.2017

MedicalResearch.com Interview with: [caption id="attachment_34943" align="alignleft" width="150"]Cora Bernard, MS, PhD candidate Pre-doctoral Student in Management Science and Enginnering Affiliate, Center for Health Policy and the Center for Primary Care and Outcomes Research Stanford Health Policy Cora Bernard[/caption] Cora Bernard, MS, PhD candidate Pre-doctoral Student in Management Science and Enginnering Affiliate, Center for Health Policy and the Center for Primary Care and Outcomes Research Stanford Health Policy MedicalResearch.com: What is the background for this study? Response: The US opioid epidemic is leading to an increase in the US drug-injecting population, which also increases the risks of HIV transmission. It is critical to public health that the US invests in a coherent and cost-effective suite of HIV prevention programs. In our model-based analysis, we considered programs that have the potential both to prevent HIV and to improve long-term health outcomes for people who inject drugs. Specifically, we evaluated opioid agonist therapy, which reduces the frequency of injection; needle and syringe exchange programs, which reduce the frequency of injecting equipment sharing; enhanced HIV screening and antiretroviral therapy programs, which virally suppress individuals and decrease downstream transmission; and oral HIV pre-exposure prophylaxis (PrEP), which is taken by an uninfected individual and lowers the risk of infection.
Author Interviews, JAMA, Opiods, Pain Research, Surgical Research / 03.05.2017

MedicalResearch.com Interview with: [caption id="attachment_34305" align="alignleft" width="124"]Chad M. Brummett, M.D. Associate Professor Director, Clinical Anesthesia Research Director, Pain Research Department of Anesthesiology Division of Pain Medicine University of Michigan Medical School Ann Arbor, MI 48109 Dr. Brummett[/caption] Chad M. Brummett, M.D. Associate Professor Director, Clinical Anesthesia Research Director, Pain Research Department of Anesthesiology Division of Pain Medicine University of Michigan Medical School Ann Arbor, MI  48109  MedicalResearch.com: What is the background for this study? What are the main findings? Response: The opioid epidemic has received tremendous attention in recent years, but most of the focus has been on chronic pain, opioid abuse and overdose. Far less attention has been paid to the importance of acute care prescribing (e.g. surgical pain) in patients that are not chronic opioid users. We found that 5-6% of patients not using opioids prior to surgery continued to fill prescriptions for opioids long after what would be considered normal surgical recovery. Moreover, the rates of new chronic use did not differ between patients having major and minor surgeries, suggesting that patients continue to use these pain medications for something other than simply pain from surgery. Building on other work by our group, and the few additional studies done on the topic to date, these data suggest that pain medications written for surgery are a major cause of new chronic opioid use for millions of Americans each year.
Addiction, Genetic Research, Opiods / 24.04.2017

MedicalResearch.com Interview with: [caption id="attachment_34113" align="alignleft" width="154"]Maneesh Sharma, M.D</strong> Director of Pain Medicine MedStar Good Samaritan Hospital Medical Director of the Interventional Pain Institute Baltimore, Maryland Dr. Maneesh Sharma[/caption] Maneesh Sharma, M.D Director of Pain Medicine MedStar Good Samaritan Hospital Medical Director of the Interventional Pain Institute Baltimore, Maryland MedicalResearch.com: What is the background for this study? Response: Opioid abuse in chronic pain patients is a major public health issue, with rapidly increasing addiction rates and deaths from unintentional overdose more than quadrupling since 1999. Just in the last year alone according to the CDC, synthetic opioid deaths have increased 72%. As a practicing interventional pain specialist, I am confronted with the challenge of assessing patient risk for opioids as I evaluate multi-modal approaches to effective pain management. Existing tools are inadequate, as they either rely on a urine toxicology test to evaluate a patient’s current potential substance abuse as a predictor of future abuse, or on a patient’s honesty to fill out a questionnaire. We know that many patients who are not currently abusing illicit drugs or misusing prescription medications can develop prescription opioid tolerance, dependence, or abuse—especially with prolonged opioid therapy. Furthermore, we know that patients who are looking to abuse medications or divert those prescriptions will obviously lie on questionnaires.
Author Interviews, JAMA, Opiods, Surgical Research, University of Michigan / 18.04.2017

MedicalResearch.com Interview with: [caption id="attachment_33814" align="alignleft" width="124"]Chad M. Brummett, MD Division of Pain Medicine, Department of Anesthesiology University of Michigan Medical School Ann Arbor, MI 48109 Dr. Brummett[/caption] Chad M. Brummett, MD Division of Pain Medicine, Department of Anesthesiology University of Michigan Medical School Ann Arbor, MI 48109  MedicalResearch.com: What is the background for this study? What are the main findings? Response: The opioid epidemic has received considerable attention, but most of the focus has been on chronic pain and primary care. However, surgeons prescribe ~40% of the opioids in the US, and little attention has been given to the importance of prescribing after surgery. In this study, we found that among patients not using opioids in the year prior to surgery, ~6% of patients continued to use opioids long after what would be considered normal surgical recovery. Furthermore, there was no difference between patients undergoing minor and major surgeries, thereby suggesting that some patients continue to use opioids for reasons other than pain related to surgery.
Author Interviews, Opiods, Pharmacology, University Texas / 11.04.2017

MedicalResearch.com Interview with: Christina R. Merritt and Kathryn A. Cunningham Center for Addiction Research University of Texas Medical Branch Galveston, TX 77555 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Opioid use disorder (OUD) is one of the top public health problems in the United States. Overdoses on prescription opioids, heroin and fentanyl accounted for 33,091 deaths in the U.S. in 2015 (https://www.cdc.gov/mmwr/volumes/65/wr/mm655051e1.htm); each day, 91 Americans die from an opioid overdose. The first-ever Surgeon General’s Report on Alcohol, Drugs and Health (https://addiction.surgeongeneral.gov/ ) observed that more people used prescription opioids than tobacco in 2015. Furthermore, individuals with OUD, the most problematic pattern of opioid abuse, often relapse, particularly in environments associated with past drug use, and new means to help maintain abstinence are needed. Serotonin (5-hydroxytryptamine; 5-HT) function in the brain, particularly through its cognate 5-HT2C receptor, is an important regulator of the abuse liability of cocaine and other psychostimulants. Previous studies suggested that the weight loss medication and selective 5-HT2C receptor agonist lorcaserin (Belviq®) can curb cocaine- and nicotine-seeking in preclinical models, even when tested in tempting environments. We administered lorcaserin to rats who were trained to take the powerful painkiller oxycodone (OxyContin®), a prescription opioid currently approved for treatment of acute and chronic pain with characteristically high abuse potential. Lorcaserin suppressed oxycodone intake as well as the drug-seeking behaviors observed when rats were exposed to cues such as the lights and sounds previously associated with drug intake. Taken together, these findings highlights the therapeutic potential for lorcaserin to extend abstinence and enhance recovery from OUD.
Author Interviews, Opiods, Pain Research / 19.03.2017

MedicalResearch.com Interview with: [caption id="attachment_32718" align="alignleft" width="196"]Dr. Hammoud Dr. Sommer Hammoud[/caption] Dr. Sommer Hammoud MD ABOS Board Certified Assistant Professor of Orthopedic Surgery Thomas Jefferson University  MedicalResearch.com: What is the background for this study? What are the main findings? Response: The background for this exhibit stemmed from the growing problem of prescription opioid abuse in the United States.  As we saw this issue developing, we aimed to investigate the history behind this epidemic, what information we have now to fight it, and what information we need in the future to improve care our patients. Our main findings for each of those aims are the following: 1) It would appear that a large push at the end of the last century led to a lower threshold to prescribe opiates in the effort to control pain, leading to the current opioid epidemic 2) Mulitmodal methods of pain control and the expanding skill of regional anesthesia can be used to help decrease narcotic use and thus limit exposure to narcotics, and 3) Future research needs to focus on the psychologic aspect of patients' ability to manage pain and we should strive to be able to categorize patients in order to create an individualized pain management protocol which will most effectively manage pain.
Author Interviews, CDC, Opiods, Pain Research / 19.03.2017

MedicalResearch.com Interview with: Anuj Shah (B.Pharm) Doctoral Student Division of Pharmaceutical Evaluation and Policy University of Arkansas for Medical Sciences MedicalResearch.com: What is the background for this study? Response: The CDC guideline on opioid prescribing, published in March 2016, included recommendations for initiation of opioid therapy. The guideline noted that there is a lack of data describing how acute opioid use transitions to long-term opioid use. This report seeks to address this gap by determining characteristics of initial opioid prescribing prognostic of long-term use, among opioid naïve cancer-free adults.
Anesthesiology, Author Interviews, BMJ, Opiods, Stanford / 15.03.2017

MedicalResearch.com Interview with: [caption id="attachment_32934" align="alignleft" width="200"]Eric C Sun MD PhD, assistant professor Department of Anesthesiology Perioperative and Pain Medicine Stanford University School of Medicine Stanford, CA Dr. Eric Sun[/caption] Eric C Sun MD PhD, assistant professor Department of Anesthesiology Perioperative and Pain Medicine Stanford University School of Medicine Stanford, CA MedicalResearch.com: What is the background for this study? What are the main findings? Response: There have been large increases in opioid-related adverse events over the past decade. The goal of our study was to examine the extent to which these increases may have been driven by combined use of opioids and benzodiazepines, a combination that is known to be potentially risky. Overall, we found that the combined use of opioids and benzodiazepines nearly doubled (80% increase) between 2001 and 2013, and that opioid users who also used benzodiazepines were at a higher risk of an opioid-related adverse event. Indeed, our results suggest eliminating the combined use of opioids and benzodiazepines could have reduced the population risk of an opioid-related adverse event by 15%.
Author Interviews, Electronic Records, Opiods, Pain Research / 07.03.2017

MedicalResearch.com Interview with: Michelle S. Keller, MPH, PhD Candidate Health Policy and Management Cedars-Sinai Los Angeles CA 90048 MedicalResearch.com: What is the background for this new funding award? Response: Research shows that treating and managing chronic pain is tough, and it can be hard for patients and their physicians to be on the same page. Chronic pain touches so many facets of people’s lives—relationships, mental health, sleep, work—that treating it in a 15-minute visit can lead to a lot of frustration and disappointment. Our hope is that by arming patients and clinicians with evidence-based tools, we can help foster a better dialogue about what is ultimately important to patients, how to achieve fully functional lives while managing chronic pain. We’re testing two different types of communication tools: electronic health record alerts pointing physicians to guidelines when they write opioid prescriptions and patient portal-based tools that can help patients prepare for visits and become active, engaged partners in their care.
Addiction, Author Interviews, Emergency Care, Opiods / 02.03.2017

MedicalResearch.com Interview with: Alexander Diaz Bode M.D. Candidate University of Miami Leonard M. Miller School of Medicine Miami, FL MedicalResearch.com: What is the background for this study? What are the main findings? Response: Our country is in the midst of an opiate epidemic. This is particularly evident in the emergency department (ED), which continues to see an alarmingly large number heroin overdose. With the shutdown of “pill-mills”, where opioid prescriptions would be prescribed indiscriminately, Florida has seen particularly large increases in opiate use and overdose. In Miami, we noticed that during the summer of 2016, there was a disproportionate increase in heroin overdose being treated at our hospital relative to previous years. Our recently published study showed that fentanyl or fentanyl analog laced heroin likely contributed to this massive spike in heroin overdose observed during the summer of 2016. Fentanyl and its synthetic analogs are opioid receptor agonists that bind with hundreds of times higher affinity than diamorphine, aka heroin. Naloxone, better known by the brand name Narcan®, is used to reverse heroin overdose in the ED. This drug works by competitively inhibiting the opioid receptor, effectively “knocking off” the bound heroin. Using naloxone dosing as a surrogate marker of heroin purity, our study found that during the investigated spike there was a disproportionate increase in the amount of naloxone used in our ED to reverse overdose relative to the increase in opiate overdose. This indicated that a stronger opioid receptor agonist, such as fentanyl or fentanyl analogs, likely was involved in the massive spike in overdose observed during the summer of 2016.
Author Interviews, Cannabis, Opiods / 01.03.2017

MedicalResearch.com Interview with: [caption id="attachment_32519" align="alignleft" width="200"]Philippe Lucas VP, Patient Research & Access, Tilray Graduate Researcher, Centre for Addictions Research of BC Philippe Lucas[/caption] Philippe Lucas VP, Patient Research & Access, Tilray Graduate Researcher, Centre for Addictions Research of BC MedicalResearch.com: What is the background for this study? Response: In 2001 Canada become one of the first nations to develop a federally regulated program to allow access to cannabis for medical purposes with the launch of the Marihuana Medical Access Regulations (MMAR). The program has undergone numerous convolutions, culminating in the establishment by Health Canada of the Marihuana for Medical Purposes Regulations (MMPR) in 2014, which was replaced by the Access to Cannabis for Medical Purposes (ACMPR) in 2016. One of the primary changes in the new program(s) has been to move from a single Licensed Producer (LP) of cannabis to multiple large-scale Licensed Producers. This is the first comprehensive survey of patients enrolled in the MMPR/ACMPR, and with 271 complete responses, it’s the largest survey of federally-authorized medical cannabis patients to date.
Accidents & Violence, Addiction, Author Interviews, NIH, Opiods, Race/Ethnic Diversity / 27.01.2017

[caption id="attachment_31594" align="alignleft" width="160"]Dr. Meredith Shiels Dr. Meredith Shiels[/caption] MedicalResearch.com Interview with: Dr Meredith S Shiels Division of Cancer Epidemiology and Genetics National Cancer Institute Bethesda, MD MedicalResearch.com: What is the background for this study? Response: In most high-income countries, premature death rates have been declining, due to the overwhelming successes of public health efforts to prevent and treat chronic disease. The US is a major outlier, where death rates overall have plateaued, or even increased, as reported recently by our sister agency, the Centers for Disease Control and Prevention. Of particular concern are recent reports of increasing death rates among Americans during mid-life. To expand upon prior findings, we focused on premature death, which we defined as death occurring between the ages of 25 and 64. We examined finely detailed death certificate data for the entire U.S. population and described changes in death rates during 1999-2014 by cause of death, sex, race, ethnicity, and geography. To provide context to our findings, we compared trends in death rates in the U.S. to England and Wales and Canada.
Author Interviews, BMJ, End of Life Care, Opiods, Pain Research / 21.01.2017

MedicalResearch.com Interview with: Dr. Katherine Irene Pettus, PhD, OSB Advocacy Officer International Association for Hospice and Palliative Care Vice Chair, Vienna NGO Committee on Drugs Secretary NGO Committee on Ageing, Geneva MedicalResearch.com: What is the background for this study? Response: The background for this study is analysis of the three international drug control treaties, official attendance and participation at meetings of the Commission on Narcotic Drugs for the past four years, ongoing discussion of national opioid consumption rates with INCB, and years of home hospice visits in developing countries.
Author Interviews, CDC, Cost of Health Care, Opiods / 19.01.2017

MedicalResearch.com Interview with: Dora Lin, MHS Sr. Research Assistant Johns Hopkins Bloomberg School of Public Health Center for Drug Safety and Effectiveness Baltimore, MD 21205  MedicalResearch.com: What is the background for this study? What are the main findings? Response: In response to the opioid epidemic and growing number of overdose deaths each year, the CDC released draft guidelines to improve the safe use of opioids in primary care. The draft guidelines were open to public comment, and many organizations, ranging from professional societies to consumer advocates to local governmental organizations, submitted comments regarding the guidelines. We examined the levels of support or non-support for the draft guidelines among the 158 organizations who submitted comments.   We also examined each organization’s relationship to opioid manufacturers. Most organizations supported the guidelines, regardless of whether or not they had a financial relationship to a drug company. However, organizations receiving funding from opioid manufacturers were significantly more likely to be opposed to the guidelines than those who did not receive such funding.
AHRQ, Author Interviews, Opiods / 27.12.2016

MedicalResearch.com Interview with: Claudia Steiner, M.D., MPH. Agency for Healthcare Research and Quality (AHRQ) Rockville, MD MedicalResearch.com: What is the background for this study? Response: The Agency for Healthcare Research and Quality (AHRQ) has a longstanding project and partnership, The Healthcare Cost and Utilization Project (HCUP, pronounced "H-Cup"). HCUP is a family of health care databases and related software tools and products developed through a Federal-State-Industry partnership. HCUP databases bring together the data collection efforts of State data organizations, hospital associations, and private data organizations (HCUP Partners) and the Federal government to create a national information resource of encounter-level health care data. HCUP includes the largest collection of longitudinal hospital care data in the United States, with all-payer, encounter-level information. These databases enable research on a broad range of health policy issues, including cost and quality of health services, medical practice patterns, access to health care programs, and outcomes of treatments at the national, State, and local market levels. The HCUP Partners recognized the urgency of providing descriptive statistics to help inform the growing opioid epidemic in the U.S., and therefore agreed to supporting this statistical brief as well as the Opioid-Related Hospital Use path on Fast Stats: http://www.hcup-us.ahrq.gov/faststats/landing.jsp
Addiction, Author Interviews, Opiods, Pediatrics / 12.12.2016

MedicalResearch.com Interview with: Nicole Villapiano, MD, MSc Robert Wood Johnson Clinical Scholar Internal Medicine/Pediatrics Institute for Healthcare Policy & Innovation University of Michigan MedicalResearch.com: What is the background for this study? What are the main findings? Response: Over the past few years, research has highlighted that the opioid epidemic is accelerating at a rapid pace across the United States, including in rural areas. What we don’t know is how the opioid crisis is affecting rural moms and their infants. As a doctor that takes care of kids, I was concerned about this. So our team took on this study to explore the differences in rates of maternal opioid use and neonatal abstinence syndrome in rural and urban areas of the US from 2004-2013. Neonatal abstinence syndrome is what happens to babies who are exposed to opioids in their mothers’ womb. When these babies are born and no longer have opioid exposure from mom, they go through a period of opioid withdrawal. These babies can have symptoms that range from difficulty taking a bottle, jitteriness, difficulty sleeping, irritability, and discomfort to more serious problems like prematurity, difficulty breathing, and seizures. Symptoms can last several days to many weeks. Babies with neonatal abstinence syndrome are in the hospital longer than the average newborn, and sometimes require special treatment to help control their symptoms.
Addiction, Author Interviews, CDC, Opiods / 09.12.2016

MedicalResearch.com Interview with: [caption id="attachment_30338" align="alignleft" width="142"]Cyprian Wejnert, Ph.D. National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention CDC Dr. Cyprian Wejnert[/caption] Cyprian Wejnert, Ph.D. National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention CDC MedicalResearch.com: What is the background for this study? What are the main findings? Response: Our country is dealing with a devastating epidemic of opioid misuse and overdose that affects individuals, families and communities. We have long known that sharing needles and syringes is an incredibly efficient route for HIV, hepatitis and other infections to spread. Yet, about 10% of annual HIV diagnoses in the United States occur among people who inject drugs, and there are clusters of hepatitis C infections across the country. These infections can be prevented when people who inject drugs use sterile needles, syringes and other injection equipment. One of the main findings of this study is that use of syringe services programs (SSPs) has increased substantially during the past decade, but most people who inject drugs still don’t always use sterile needles. The analysis finds that more than half (54%) of people who inject drugs in 22 cities with a high number of HIV cases reported in 2015 they used an SSP in the past year, compared to only about one-third (36%) in 2005. Although syringe services program use has increased, findings indicate that too few people who inject drugs use only sterile needles. One in three (33%) reported in 2015 that they had shared a needle within the past year – about the same percentage that reported sharing a decade ago (36% in 2005). The report also highlights some successes in HIV prevention among African Americans and Latinos who inject drugs, as well as concerning trends in whites who inject drugs. From our study of 22 urban areas, it appears that fewer African Americans are injecting drugs. However, it also appears there has been an increase in white Americans injecting drugs.