Do New Medical Marijuana Laws Reduce Opioid Prescriptions?

MedicalResearch.com Interview with:

Silvia S. Martins, MD, PHD Associate Professor of Epidemiology Department of Epidemiology Mailman School Of Public Health Columbia University New York, NY 10032

Dr. Silvia Martins

Silvia S. Martins, MD, PHD
Associate Professor of Epidemiology
Department of Epidemiology
Mailman School Of Public Health
Columbia University 

MedicalResearch.com: What is the background for this study?

Response: Prior studies have suggested t6hat medical marijuana legalization might play a role in decreasing opioid use.

We aimed to test this hypothesis using individual level data on nonmedical use of prescription opioids and opioid use disorder  from the US National Survey on Drug Use and Health.  Continue reading

Drug Overdoses and Mental Disorders Tied to Drop in Longevity in US

MedicalResearch.com Interview with:

Samuel Preston, Ph.D. Professor of Sociology University of Pennsylvania 

Dr. Preston

Samuel Preston, Ph.D.
Professor of Sociology
University of Pennsylvania

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Life expectancy at birth in the United States is low by international standards and has been declining in recent years. Our study aimed to identify how these trends differed by age, sex, cause of death, metropolitan status, and region.

We found that, over the period 2009-11 to 2014-16, mortality rose at ages 25-44 in large metropolitan areas and their suburbs as well as in smaller metropolitan areas and non-metropolitan areas. Mortality at ages 45-64 also rose in all of these areas except large metropolitan areas. These were the ages responsible for declining life expectancy.

Changes in life expectancy were particularly adverse for non-metropolitan areas and for women. The metropolitan distinctions in mortality changes were similar from region to region.

The cause of death contributing most strongly to mortality declines was drug overdose for males and mental and nervous system disorders for women. Continue reading

Opioid use in Knee or Hip Osteoarthritis

MedicalResearch.com Interview with:

Professor Martin Englund MD PhD Department of Orthopaedics Lund University

Prof. Englund

Professor Martin Englund MD PhD
Department of Orthopaedics
Lund University 

MedicalResearch.com: What is the background for this study?

Response: Currently, there is lack of knowledge of opioid usage in osteoarthritis patients. Opioids are typically not recommended for the treatment of osteoarthritis pain.  Continue reading

Limited Opioid Addiction Treatment Resources Should Be Geared Towards Most Affected Counties

MedicalResearch.com Interview with:

Rebecca L. Haffajee, J.D., Ph.D., M.P.H. Assistant Professor Department of Health Management & Policy University of Michigan School of Public Health

Dr. Haffajee

Rebecca L. Haffajee, J.D., Ph.D., M.P.H.
Assistant Professor
Department of Health Management & Policy
umichsphumichsph

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Evidence suggests that the availability of medications to treat opioid use disorder (OUD) has been slow to expand, particularly in rural areas, despite the efficacy and effectiveness of these medications in reducing overdose deaths and other adverse life outcomes. We were interested in understanding the characteristics of counties both with high need (as measured by above-national rates in opioid overdose deaths) AND low provider capacity to deliver medications to treat OUD in 2017.

We found that such “opioid high-risk” counties were likely to be in the East North Central (e.g., Michigan, Ohio, Illinois, Indiana), South Atlantic (e.g., North Carolina, South Carolina, Virginia, West Virginia), and Mountain (e.g., New Mexico, Arizona, Nevada) regions.

We also found that these opioid high-risk counties were more likely to have higher rates of unemployment and less likely to have fewer primary care clinicians or be micropolitan Continue reading

Walgreens DisposeRx Program Will Provide Free Drug Disposal System at Pharmacies

MedicalResearch.com Interview with:

John Holaday, PhD Chairman and CEO of DisposeRx

Dr. Holaday

John Holaday, PhD
Chairman and CEO of DisposeRx

Dr. Holaday discusses the recentannouncement that Walgreen’s has added DisposeRx to its safe medication drop off kiosks. 

MedicalResearch.com: What is the background for this study? How big is the problem of unused risky medications leftover after the need or indication period has passed?

Response: Keeping leftover medications in the home significantly increases the risk of accidental poisonings as well as diversion, which can lead to addiction, overdoses and death. According to the Centers for Disease Control & Prevention (CDC), accidental medicine poisonings send nearly 60,000 children under 5 years old to emergency rooms annually. And, a study by the National Institute on Drug Abuse found that the first opioid used by 70% of individuals with heroin-use disorder was a prescription pain medication, often remaining in their medicine cabinet well after the pain subsided and then a remaining temptation for abuse.

This is a pervasive problem across the country. In an independent survey DisposeRx sponsored, it was found that 4 out of 10 Americans are keeping leftover prescriptions—including opioids – in their medicine cabinets. Other results of the survey include: 62% of respondents who said they stored medications in case a condition returns; and 37% said they save prescription drugs in case a friend or family member needs them.

Walgreens sees value in adding DisposeRx at-home solution to its comprehensive medication management and opioid stewardship programs

These consumers need to be educated about all the potential harm resulting from saving leftover medications. Leading pharmacy chains such as Walgreens are committed, as responsible corporate citizens, to making DisposeRx available upon request for their customers and to educate them about its use in getting rid of leftover drugs before they cause harm. Walgreens sees value in adding DisposeRx at-home solution to its comprehensive medication management and opioid stewardship programs as an additional method to reduce risks and exposure.

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Drug Disposal Bags After Hospitalizations Can Get Rid of Some Leftover Opioids

MedicalResearch.com Interview with:

Jennifer N. Cooper, PhD Principal Investigator Center for Innovation in Pediatric Practice The Research Institute at Nationwide Children's Hospital, Research Assistant Professor of Pediatrics The Ohio State University College of Medicine

Dr. Cooper

Jennifer N. Cooper, PhD
Principal Investigator
Center for Innovation in Pediatric Practice
The Research Institute at Nationwide Children’s Hospital,
Research Assistant Professor of Pediatrics
The Ohio State University College of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Although postoperative opioid prescribing has decreased in recent years due to an increased awareness of the risks of excess opioid prescribing, many patients are still prescribed more opioids than they need after surgery. In the pediatric population, most opioids are prescribed after surgical and dental procedures.

Although patients are often prescribed more opioids than they need after surgery, previous studies have found that excess opioids left unused after surgery are rarely properly disposed. These leftover opioids can be misused or accidentally ingested by young children. Previous studies have targeted the problem of non-disposal of opioids leftover after surgery by providing patients and families with educational materials describing proper methods of postoperative opioid disposal. However, these studies have had mixed results with some finding an increase in opioid disposal after education and others finding no effect of such education. In addition to education, another means of facilitating postoperative opioid disposal is the provision of drug disposal products. These products contain compounds that irreversible adsorb or oxidize medications, enabling them to be safely disposed of in the home garbage.

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Opioids During Hospitalization Linked to Post-Discharge Opioid Prescriptions

MedicalResearch.com Interview with:

Dr. Julie Donohue, Ph.D. Professor, Department of Health Policy and Management Vice Chair for Research Graduate School of Public Health University of Pittsburgh

Dr. Donohue

Dr. Julie Donohue, Ph.D.
Professor, Department of Health Policy and Management
Vice Chair for Research
Graduate School of Public Health
University of Pittsburgh

MedicalResearch.com: What is the background for this study?

Response: The opioid epidemic is exacting a significant burden on families, communities and health systems across the U.S. Prescription and illicit opioids are responsible for the highest drug overdose mortality rates ever recorded. We know from previous studies that some surgical and medical patients who fill opioid prescriptions immediately after leaving the hospital go on to have chronic opioid use. Until our study, however, little was known about how and if those patients were being introduced to the opioids while in the hospital.

My colleagues and I reviewed the electronic health records of 191,249 hospital admissions of patients who had not been prescribed opioids in the prior year and were admitted to a community or academic hospital in Pennsylvania between 2010 and 2014. Opioids were prescribed in 48% of the admissions, with those patients being given opioids for a little more than two-thirds of their hospital stay, on average.

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Opioid ‘Deaths of Despair’ Don’t Explain Mortality Gap

MedicalResearch.com Interview with:

Arline T. Geronimus Sc.D Professor, Health Behavior and Health Education School of Public Health Research Professor Population Studies Center Institute for Social Research University of Michigan Member, National Academy of Medicine

Dr. Geronimus

Arline T. Geronimus Sc.D
Professor, Health Behavior and Health Education
School of Public Health
Research Professor
Population Studies Center
Institute for Social Research
University of Michigan
Member, National Academy of Medicine 

MedicalResearch.com: What is the background for this study?

Response: The gap in life expectancy between less and more educated Americans grew over the last 30 years, a deeply troubling fact. We are alone among western nations in these trends. We aimed to determine what causes of death account for this growing educational gap in life expectancy and whether the gap has continued to grow in the most recent years.

Disturbingly, we found the educational gap in life expectancy has continued to grow.

Why? A common theory is that this growing inequality is due to the opioid epidemic. Some even speculate that the less educated are dying from a composite of what they call “deaths of despair” – opioid and other drug overdose, suicide and alcoholic liver disease – with the theory being that as less educated and working class Americans have faced job loss and stagnating wages, they experience hopelessness and despair and turn to drugs, alcohol, or even suicide to ease or end their pain and feelings of hopelessness.

However, while opioid, suicide and alcoholic liver disease deaths have increased among white youth and young adults and is cause for concern, this does not imply that these deaths should be grouped together as “deaths of despair” (DOD) or that they explain the growing educational gaps in life expectancy across all groups – men, women, whites, blacks, or older as well as younger adults.

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Prenatal Exposure to Nicotine May Increase Risk of Nicotine Susceptibility Later in Life

MedicalResearch.com Interview with:

Davide Dulcis, PhDAssociate ProfessorDepartment of Psychiatry, UCSD School of MedicineUniversity of California, San DiegoLa Jolla, CA 92093-0603

Dr. Dulcis

Davide Dulcis, PhD
Associate Professor
Department of Psychiatry, UCSD School of Medicine
University of California, San Diego
La Jolla, CA 92093-0603

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Previous studies in humans have shown that pre-natal and early life exposure to nicotine can lead to altered children behavior and propensity for drug abuse, but the precise mechanisms involved are still unclear.

In this pre-clinical study we showed how nicotine “primes” neurons of the mouse brain’s reward center for a fate they normally would not have taken, making them more susceptible to the effects of nicotine when the animals are again exposed to nicotine later in life, said Dr. Benedetto Romoli, first author of the research article.   Continue reading

Caffeine Cravers Really Do Wake Up and Smell the Coffee

MedicalResearch.com Interview with:

Dr Lorenzo Stafford, PhD, CPsycholSenior Lecturer, Department of PsychologyUniversity of PortsmouthPortsmouth

Stafford

Dr Lorenzo Stafford, PhD, CPsychol
Senior Lecturer, Department of Psychology
University of Portsmouth
Portsmouth 

MedicalResearch.com: What is the background for this study?  

Response: The background to this work was that I had been thinking for sometime on the role of our sense of smell in drug consumption and addiction.  Most of the research in this area is dominated by visual processes, in particular showing how cues associated to drugs (e.g. packet of cigarettes, bottle of beer) become conditioned in such drug users. That work has been useful in explaining how in recovering addicts, long after the withdrawal symptoms have subsided, when exposed to such cues, they can nevertheless relapse to craving and consuming the drug; hence though a powerful driver, addiction is not just about reversing withdrawal symptoms.

However, most of our richer experiences are multisensory, so it seems likely that other senses must also play a role in the addictive process. Years ago, I completed a PhD on the topic of caffeine and with the general importance placed on the sensory (especially smell) aspects of coffee, all planted the seed for a possible study. We completed two experiments that examined the lowest concentration at which participants (high, moderate and non-coffee consumers) could detect (Threshold test) a coffee associated chemical (exp 1) and in a separate task, how fast they were at identifying (Recognition test) the odour of real coffee. In experiment 2, participants (coffee consumers and non-consumers) completed the same Threshold test for the coffee odour but also completed a Threshold test for a control odour.

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Over a Million Opioid Prescriptions at Risk of Diversion by Family Members

MedicalResearch.com Interview with:

Kao-Ping Chua, M.D., Ph.D.Department of PediatricsSusan B. Meister Child Health Evaluation and Research CenterUniversity of Michigan, Ann Arbor

Dr. Kao-Ping Chua

Kao-Ping Chua, M.D., Ph.D.
Department of Pediatrics
Susan B. Meister Child Health Evaluation and Research Center
University of Michigan, Ann Arbor

MedicalResearch.com: What is the background for this study?  

Response: Doctor and pharmacy shopping is a high-risk behavior in which patients obtain opioid prescriptions from multiple prescribers and fill them at multiple pharmacies. Because this behavior is associated with a high risk of overdose death, there have been many efforts to help clinicians detect doctor and pharmacy shopping among patients prescribed opioids. For example, 49 states have a prescription drug monitoring program that provides information on patients’ prior controlled substance prescriptions.

In contrast, there has been little attention to the possibility that patients prescribed opioids may have family members who are engaged in opioid doctor and pharmacy shopping. Such family members may divert opioids prescribed to patients because of their access to these opioids.

Continue reading

Few Valid Tools to Identify Pain Patients Who Can Be Safely Prescribed Opioids

MedicalResearch.com Interview with:

Jan Klimas, PhD, MScSenior Postdoctoral FellowBC Centre on Substance Use (BCCSU) Vancouver, BC

Dr. Klimas

Jan Klimas, PhD, MSc
Senior Postdoctoral Fellow
BC Centre on Substance Use (BCCSU)
Vancouver, BC

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Some individuals prescribed opioid analgesic medications for pain develop opioid use disorder. So, much research has been conducted to develop strategies to identify patients who can be safely prescribed opioid analgesics. However, this research has not been critically reviewed through rigorous quality assessment.

This study therefore sought to identify signs, symptoms & screening tools to identify patients with pain who can be safely prescribed opioids  Continue reading

Billions in Tax Revenue Lost Due to Misuse of Opioids

MedicalResearch.com Interview with:

Joel Segel, Ph.D.Assistant ProfessorDepartment of Health Policy and AdministrationThe Pennsylvania State UniversityUniversity Park, PA 16802

Dr. Segel

Joel E. Segel, Ph.D.
Assistant Professor
Department of Health Policy and Administration
The Pennsylvania State University
University Park, PA 16802

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Earlier research has shown that the societal costs of opioid misuse are high, including the impact on employment. However, previous work to understand the costs of opioid misuse borne by state and federal governments has largely focused on medical costs such as care related to overdoses and the cost of treating opioid use disorder.

Our main findings are that when individuals who misuse opioids are unable to work, state and federal governments may bear significant costs in the form of lost income and sales tax revenue. We estimate that between 2000 and 2016, state governments lost $11.8 billion in tax revenue and the federal government lost $26.0 billion.  Continue reading

Genes Linked to Alcohol Use Disorder Identified

MedicalResearch.com Interview with:

Henry R. Kranzler, MDProfessor of PsychiatryPerelman School of MedicineUniversity of Pennsylvania

Dr. Kranzler

Henry R. Kranzler, MD
Professor of Psychiatry
Perelman School of Medicine
University of Pennsylvania

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Alcohol consumption and alcohol use disorder (AUD) are moderately heritable traits.  To date, genome-wide association studies (GWAS) have not examined these traits in the same sample, which limits an assessment of the extent to which genetic variation is unique to one or the other or shared.

This GWAS examined a large sample (nearly 275,000 individuals) from the U.S. Veterans Affairs Million Veteran Program (MVP) for whom data on both alcohol consumption and alcohol use disorder diagnoses were available from an electronic health record.  We identified 18 genetic variants that were significantly associated with either alcohol consumption, AUD, or both. Five of the variants were associated with both traits, eight with consumption only, and five with alcohol use disorder only.  Continue reading

Opioid-Related Hospitalizations Among Cancer Patients are Rare

MedicalResearch.com Interview with:

Isaac Chua MDInstructor of Medicine at Harvard Medical SchoolBoston, Massachusetts

Dr. Chua

Isaac Chua MD
Instructor of Medicine at Harvard Medical School
Boston, Massachusetts 

MedicalResearch.com: What is the background for this study?  

Response: Opioids are routinely prescribed for cancer-related pain, but little is known about the prevalence of opioid-related hospitalizations for patients with cancer. Although opioid addiction among patients with cancer is estimated to be as high as 7.7%, our understanding of opioid misuse is based on small, preliminary studies.

In light of the wider opioid epidemic, oncologists and palliative care clinicians frequently balance providing patients with legitimate access to opioids while protecting them and the general public from the risks of prescribing these medications.

Continue reading

Nonmedical Use of Prescription Drugs a Common Cause of Emergency Room Visits

CDR Andrew Geller, MDMedical Officer, Medication Safety ProgramDivision of Healthcare Quality Promotion,CDCAtlanta GA 30329

Dr. Geller

MedicalResearch.com Interview with:
CDR Andrew Geller, MD
Medical Officer, Medication Safety Program
Division of Healthcare Quality Promotion,
CDC
Atlanta GA 30329

MedicalResearch.com: What is the background for this study?

Response: There has been a lot of recent attention on drug overdoses in the United States, particularly fatal overdoses which involve opioids. But the overall frequency with which patients end up in the emergency department (ED) due to nonmedical use of medications across the US is unknown.

  • Nonmedical use refers to a spectrum of circumstances, including intentionally using more medication than is recommended in an attempt to treat a health condition (therapeutic misuse) to using medication to attain euphoria or get “high” (abuse).

With this analysis, we wanted to focus on the acute harms to individual patients from nonmedical use of all medications, in order to help target prevention efforts.

  • Specifically, we used data from a nationally-representative sample of hospital EDs to identify the medications with the highest numbers of emergency visits for harms following nonmedical use of medications and to identify the patient groups with the highest risks. 

Continue reading

Number of Opioid Prescriptions for New Users Has Dropped More Than 50%

MedicalResearch.com Interview with:

Wenjia Zhu, PhD. Marshall J. Seidman FellowDepartment of Health Care PolicyHarvard Medical School

Dr. Zhu

Wenjia Zhu, PhD.
Marshall J. Seidman Fellow
Department of Health Care Policy
Harvard Medical School 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The current opioid epidemic continues to cause deaths and tremendous suffering in the United States, driven in large part by overuse of prescription opioids. Of special concern are new opioid prescriptions, i.e. opioids given to patients who have not used opioids before, which research tells us are an important gateway to long-term opioid use, misuse, overdoes and death. Recently, in their efforts to curb over prescribing of opioids, the CDC issued guidelines (December 2015 in draft form; March 2016 in final version) to encourage opioid prescribers to limit the use, duration and dose of opioids, particularly opioids to first-time users. Despite these, little is known about the prescribing of opioids to first-time users on a national scale, particularly among commercially insured patients.

In this study, we examined national monthly trends in the rate at which opioid therapy was started among commercially insured patients. Using administrative claims from Blue Cross Blue Shield Association commercial insurers from 2012 to 2017, we analyzed more than 86 million commercially insured patients across the United States.

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More Hospitals Dropped Addiction Services Than Added Them

MedicalResearch.com Interview with:

Cory E. Cronin PhDDepartment of Social and Public HealthOhio University College of Health Sciences and ProfessionsAthens, Ohio

Dr. Cronin

Cory E. Cronin PhD
Department of Social and Public Health
Ohio University College of Health Sciences and Professions
Athens, Ohio

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: One of my primary areas of research is exploring how hospitals interact with their local communities. My own background is in health administration and sociology, and I have been working with colleagues in the Heritage College of Osteopathic Medicine here at Ohio University (Berkeley Franz, Dan Skinner and Zelalem Haile) to conduct a series of studies looking at questions related to these hospital-community interactions.

This particular question occurred to us because of the timeliness of the opioid epidemic. In analyzing data collected from the American Hospital Association and other sources, we identified that the number of hospitals offering in-patient and out-patient substance use disorder services actually dropped in recent years, in spite of the rising number of overdoses due to opioid use. Other factors seemed to matter more in regard to whether a hospital offered these services or not.

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When Evaluating Teens for Surgery, Check Family Opioid Use

MedicalResearch.com Interview with:

Calista Harbaugh, MD House Officer, General Surgery Clinician Scholar, National Clinician Scholars Program Research Fellow, Michigan Opioid Prescribing Engagement Network University of Michigan 

Dr. Harbaugh

Calista Harbaugh, MD
House Officer, General Surgery
Clinician Scholar, National Clinician Scholars Program
Research Fellow
Michigan Opioid Prescribing Engagement Network
University of Michigan 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Nonmedical prescription opioid use and prescription opioid-related overdose remain significant concerns among adolescents and young adults. Among adolescents and young adults prescribed an opioid after surgery, prior work found that 4.8% of opioid-naïve patients develop new persistent use, filling additional opioid prescriptions at 3-6 months after surgery. This work found associations of persistent use with diagnoses such as chronic pain disorders, depression, anxiety, and prior substance use disorder. It is likely that for young patients, family members may also play an important role in development of new persistent use, but this has not previously been explored. We performed this study to evaluate whether long-term opioid use among family members was associated with prescription opioid fills among adolescents and young adults perioperatively – and we found that opioid-naïve adolescents and young adults who have 1 or more family members with long-term opioid use are more likely to fill at the time of surgery, during recovery, and in the long-term with a near-doubling of rates of new persistent use.

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Synthetic Opioids Are Primary Driver of Current Opioid Epidemic

MedicalResearch.com Interview with:

Dr-Mathew Vinhhoa Kiang

Dr. Kiang

Mathew Vinhhoa Kiang, PhD
Postdoctoral Research Fellow
Primary Care and Outcomes Research
Stanford University School of Medicine
Stanford, California

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Nationally, opioid-related mortality has continued to climb for decades and resulted in over 42,000 deaths in 2016 — more than the number of deaths from car accidents or firearms. However, there are substantial differences across states and by opioid type. We sought to systematically describe these differences by examining state-level opioid mortality by opioid type. Deaths from synthetic opioids, such as fentanyl, are rapidly increasing in the eastern half of the US. Specifically, 28 states have synthetic opioid mortality rates that are more than doubling every two years. Twelve of those states already have high levels of synthetic opioid mortality — above 10 deaths per 100,000. Lastly, the opioid epidemic has reached our nation’s capital — Washington DC has the fastest rate of increase, more than tripling every year, and a high opioid mortality rate.

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Prescription Fentanyl Reductions and Opioid Prescribing Laws

MedicalResearch.com Interview with:

Brian J. Piper, PhD, MS Department of Basic Sciences Geisinger Commonwealth School of Medicine Scranton, PA 18509

Dr. Brian Piper

Brian J. Piper, PhD, MS
Assistant Professor of Neuroscience
Geisinger Commonwealth School of Medicine

MedicalResearch.com: What is the background for this study?

Response: Fentanyl is an important opioid for pain management but also has exceptional potential for misuse. Illicitly manufactured fentanyl accounts for a large portion of opioid overdoses. Seven states including Maine, Connecticut, Massachusetts, New York, Rhode Island, and Vermont have recently implemented opioid prescribing laws. The objectives of this study were to:

  • 1) characterize how medical use of fentanyl, fentanyl analogues like sufentanil, alfentanil, and remifentanil, and other opioid use changed over the past decade, and
  • 2) determine whether opioid prescribing laws impacted fentanyl use in the US.

    The Drug Enforcement Administration’s Automation of Reports and Consolidated Ordering System (ARCOS) is the gold-standard for pharmacoepidemiology research of controlled substances in the US for its comprehensiveness. 

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Most Counties See Opioid Prescription Rates Falling

MedicalResearch.com Interview with:

Gery P. Guy Jr., PhD, MPH Senior Health Economist Division of Unintentional Injury CDC

Dr. Gery Guy

Gery Guy, PhD, MPH
Injury Center
CDC

MedicalResearch.com: What is the background for this study?

Response: This study examined opioid prescribing at the national and county-level in 2015 and 2017.

During 2015 to 2017, the amount of opioids prescribed decreased 20.1% in the United States. The amount of opioids prescribed per person varies substantially at the county-level. The average amount of opioids prescribed in the highest quartile of counties was nearly 6 times the amount in the lowest quartile. Reductions in opioid prescribing could be related to policies and strategies aimed at reducing inappropriate prescribing, increased awareness of the risks associated with opioids, and release of the CDC Guideline for Prescribing Opioids for Chronic Pain.

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Prescription Opioids Lead to Decrease in Labor Participation and Increase in Unemployment

Dr. Kessler

MedicalResearch.com Interview with:
Lawrence M. Kessler, PhD 
Research Assistant Professor

Matthew C. Harris, PhD, Assistant Professor Boyd Center for Business and Economic Research and Department of Economics, The University of Tennessee

Dr. Harris

Matthew C. Harris, PhD Assistant Professor

Boyd Center for Business and Economic Research and Department of Economics
The University of Tennessee  

 

MedicalResearch.com: What is the background for this study?

Response: Motivation for this study came from Co-Author, Matt Murray, who was at a speaking engagement and heard a community business leader say “we’ve got jobs, but no one is applying, could opioids be a contributing factor?” This led to a conversation back at the Boyd Center between us and Matt Murray, where we decided that if we could get data on prescription rates, we could answer this question empirically.

We started by contacting each state agency in charge of their respective prescription drug monitoring program to see if they’d be willing to share county-level data on prescription opioid rates. From this letter-writing campaign we received data from 10 states, which formed the basis for our analysis. As time went on, new data was made publicly available and we were able to expand the analysis to all 50 states.

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Dramatic Rise in Benzodiazepine/ Z-Drugs and Opioid Co-Use

MedicalResearch.com Interview with:

Dr. Nicholas Vozoris, MHSc, MD, FRCPC Division of Respirology, Department of Medicine St. Michael’s Hospital, 30 Bond Street Toronto, Ontario, Canada

Dr. Vozoris

Dr. Nicholas Vozoris, MHSc, MD, FRCPC
Division of Respirology, Department of Medicine
St. Michael’s Hospital, 30 Bond Street
Toronto, Ontario, Canada

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: While there has been a lot of attention and research devoted to understanding trends in opioid use in North America, there has been relatively less attention paid to a more concerning drug use pattern, combination of benzodiazepines and opioids. Co-use of benzodiazepines and opioids is associated with a many more-fold risk of hospitalization and death than opioid use alone. Another concerning drug use pattern that has received little attention is combinations of benzodiazepines and Z-drugs. Z-drugs act similarly as benzodiazepine drugs, and when one is receiving both drug types, one is exposing oneself to excessive benzodiazepine receipt.

The purpose of my study was to characterize the trends in benzodiazepine and opioid co-use, and benzodiazepine and Z-drug co-use, in the United States over the past two decades, and to identify risk factors for receipt of these suboptimal drug use patterns.

The main findings were that there has been a dramatic rise in both benzodiazepine and opioid co-use, and benzodiazepine and Z-drug co-use, in the United States between 1999 and 2014. Benzodiazepine and opioid co-use increased by about 250% and benzodiazepine and Z-drug use increased by about 850%. Individuals with mental health disorders was one group at increased risk for getting a combination of benzodiazepines and opioids and morbidly obese individuals were at risk for being prescribed both a benzodiazepine and a Z-drug. 

MedicalResearch.com: What should readers take away from your report?

Response: I hope readers of my study come away with a greater awareness of the potential concerns and problems that can arise with combining benzodiazepines and opioids, and benzodiazepines and Z-drugs. I hope prescribers become more reflective of their prescribing practices relating to such drugs as benzodiazepines, Z-drugs and opioids, and prescribe these agents with more judiciousness. In particular, I think there is a lot on confusion and lack of knowledge around the Z-drugs, that is, what drug group do they belong to and how do they act. Even though they go by the name Z-drugs, they act in the same way as benzodiazepines do, and so in effect, they can be considered as benzodiazepine-equivalents. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Although this can be challenging to get at, understanding the ‘why’ behind these rising concerning drug use patterns is important. Why are doctors prescribing, and why are patients receiving, in increasing numbers these concerning drug combinations? Having this knowledge would help us potentially reverse the trends of rising benzodiazepine and opioid co-use, and benzodiazepine and Z-drug co-use, and also potentially help prevent future ‘drug crises’. In September 2017, the US Food & Drug Administration issued that a safety warning be printed on all opioid and benzodiazepine drug labels, warning about the dangerous of combination use. In would be interesting to know if the frequency of combined benzodiazepines and opioids decreased as a result. Unfortunately, my study included only data up to 2014, so it was unable to ascertain an answer to this question.

No disclosures

Citation:

Nicholas T Vozoris; Benzodiazepineand Opioid Co-Usage in the United States Population, 1999–2014: An Exploratory Analysis, Sleep, , zsy264, https://doi.org/10.1093/sleep/zsy264

[last-modified] 

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Take Control of Your Life and Treat Your Gambling Addiction

gambling addictionAn addiction to gambling can be an isolating ordeal that causes havoc among someone’s personal relationships, destroys personal finances, and exacerbates any mental health issues that a person may have.

Addiction is rarely an isolated incident. Typically there are many factors at play that can manifest themselves in the form of gambling. By tackling these underlying causes one can treat their addiction and eliminate the toxic habits that created it. In addition to confronting this by oneself, it is important for those who suffer from this to confide in those close to them as well as seeking advice from their doctor.

One major issue brought on by any kind of addiction is the sense of alienation that someone can experience. This is where it is important for them to open up to those who are close to them, like a loved one or a close friend. It will help alleviate the burden of struggling alone and will help others to understand what they are going through. Getting in touch with self-help groups can be another means of alleviating the feelings of alienation that addicts can experience while they are treating their compulsive gambling. This provides an outlet for an addict to express what they are going through while simultaneously getting the perspective of others who have struggled in a similar fashion.

One of the most important steps to take is the very first one. That is to be able to admit that there is a problem with gambling. Once this has been done, the problem becomes tangible and the addiction can be confronted directly.

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Reporters Covering Drugs Should Include 1-800-662-HELP In Their Stories

MedicalResearch.com Interview with:

Dr-John W. Ayers

Dr. Ayers

John W. Ayers, PhD MA
Division of Infectious Diseases and Global Public Health
Department of Medicine, University of California
San Diego, La Jolla

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: The Substance Abuse and Mental Health Services Administration national helpline (1-800-662-HELP) is the only free, federally managed and endorsed US drug treatment referral service, helping callers find the best local services that match their needs. Are millions suffering simply because they are not aware that lifesaving help is a phone call away?

In our new study, published in JAMA Internal Medicine, Mark Dredze, Alicia Nobles and I delved into Americans’ engagement with 1-800-662-HELP following singer Demi Lovato’s July 24, 2018 hospitalization for a reported overdose that on-the-scene investigators originally linked to heroin. Lovato has since recovered.

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Cutting Back on Alcohol May Help You Quit Smoking

MedicalResearch.com Interview with:

Dr. Sarah Dermody, PhD Assistant Professor School of Psychological Science Oregon State University Corvallis Oregon

Dr. Dermody

Dr. Sarah Dermody, PhD
Assistant Professor
School of Psychological Science
Oregon State University
Corvallis Oregon 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Drinking alcohol is a risk factor for sustained smoking. In a sample of daily cigarette smokers receiving treatment for alcohol use disorder, we examined if reductions in drinking corresponded with reductions in nicotine metabolism as indexed by the nicotine metabolite ratio. The nicotine metabolite ratio is important because it is associated with smoking level and lapses. We found that for men, alcohol use and the nicotine metabolite ratio reduced significantly; however, for women, neither drinking nor nicotine metabolite ratio changed.

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Preventing Opioid Relapse: Cost-Effectiveness of Buprenorphine–Naloxone vs Extended-Release Naltrexone

MedicalResearch.com Interview with:

Sean M. Murphy, PhD Associate Professor of Research Director, CHERISH Consultation Service  Weill Cornell Medicine Department of Healthcare Policy & Research New York, NY 10065-8722

Dr. Murphy

Sean M. Murphy, PhD
Associate Professor of Research
Director, CHERISH Consultation Service
Weill Cornell Medicine
Department of Healthcare Policy & Research
New York, NY 10065-8722

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: A recent eight-site US randomized effectiveness trial compared buprenorphine-naloxone to extended-release naltrexone to prevent opioid-use relapse. Participants were recruited from inpatient detoxification or short-term residential treatment programs.

Current treatment protocols require persons initiating extended-release naltrexone, but not buprenorphine-naloxone, be fully detoxified from opioids. Both medications were effective at treating opioid use disorder with regard to time abstinent from opioid use and health-related quality-of-life; however, the higher cost of extended-release naltrexone and additional costs associated with detoxification prior to administering this medication, resulted in buprenorphine-naloxone being the better value to the healthcare sector, among patients who require detoxification before initiating extended-release naltrexone.

The economic value of extended-release naltrexone, compared to buprenorphine-naloxone, became more attractive after accounting for additional costs to society (participant time and travel, criminal activity, workforce productivity), and among persons who were successfully initiated on treatment. 

MedicalResearch.com: What should readers take away from your report?

Response: Because the economic value of extended-release naltrexone compared to buprenorphine-naloxone increased among persons who were successfully initiated on treatment, identifying persons who are most likely to achieve superior outcomes on extended-release naltrexone in advance would be a preferred to offering this medication to everyone. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response: Narrowing the cost gap by identifying the best possible patients for each medication, lowering the cost of extended-release naltrexone, and shortening or eliminating the induction period could improve its relative economic value, thereby increasing its attractiveness to payers and allowing more people to access either alternative according to their clinical needs and preferences.

Thus, I would really like to see additional research on treatment models that could achieve these objectives. I am also eager to see comparative effectiveness and economic evaluations of extended-release naltrexone compared to extended-release buprenorphine products. 

Citation:

Murphy SM, McCollister KE, Leff JA, Yang X, Jeng PJ, Lee JD, et al. Cost-Effectiveness of Buprenorphine–Naloxone Versus Extended-Release Naltrexone to Prevent Opioid Relapse. Ann Intern Med. [Epub ahead of print ] doi: 10.7326/M18-0227

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Health Effects of Alcohol May Depend on How Much You Drink

MedicalResearch.com Interview with:
"Schott Zwiesel Wine Glasses" by Didriks is licensed under CC BY 2.0 <a href="https://creativecommons.org/licenses/by/2.0"> CC BY 2.0</a>Simona Costanzo MS, PhD
Laboratory of Molecular and Nutritional Epidemiology,
Department of Epidemiology and Prevention.
IRCCS Istituto Neurologico Mediterraneo Neuromed,
Italy

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: We investigated how the different intake of alcohol relates to all-cause and cause-specific hospitalizations. In particular, we mainly investigated the association of alcohol consumption with total number of hospitalizations that occurred during 6 years of follow-up.

We also examined cause-specific hospitalizations (e.g., alcohol-related diseases, vascular diseases, cancer, traumatic injury, and neurodegenerative diseases).

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Wisdom Teeth Extractions Can Lead to Opioid Addiction in Adolescents and Young Adults

MedicalResearch.com Interview with:

Alan Schroeder MD Associate chief for research Division of pediatric hospital medicine Lucile Packard Children’s Hospital Stanford

Dr. Schroeder

Alan Schroeder MD
Associate Chief for Research
Division of pediatric hospital medicine
Lucile Packard Children’s Hospital Stanford

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Third molar “wisdom teeth” extractions are one of the most common surgeries performed in adolescents and young adults, but an adequate appraisal of risks and benefits is lacking. Most patients who undergo this procedure are exposed to opioids post-operatively.

We demonstrate that, for privately-insured opioid-naïve patients 16-25 years of age, exposure to opioids from a dental provider is associated with persistent use at 90-365 days in 7% of patients and a subsequent diagnosis relating to abuse in 6% of patients. In contrast persistent use and abuse were significantly lower in control patients not exposed to dental opioids (0.1% and 0.4%, respectively). The median number of pills dispensed for the initial prescriptions was 20.

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