Opioids For Pain Can Exacerbate Pneumococcal Infections

MedicalResearch.com Interview with:

Andrew Wiese, PhD Postdoctoral Research Fellow, Department of Health Policy Vanderbilt University Medical Center

Dr. Wiese

Andrew Wiese, PhD
Postdoctoral Research Fellow
Department of Health Policy
Vanderbilt University Medical Center

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

Response: As opioid use has increased in the U.S., the safety of prescription opioids has come under further scrutiny.

In animal studies, use of certain opioids has been associated with increased susceptibility to bacterial infections, including infectious due to Streptococcus pneumoniae, the pathogen that causes invasive pneumococcal disease. Invasive pneumococcal disease includes bacteremia, meningitis, and invasive pneumonia, all of which are associated with high mortality. Although those associations have been well established in animal experiments, it is important to understand the risk of serious infections among humans taking prescription opioid analgesics.

We found that prescription opioid use is associated with a significantly increased risk for laboratory-confirmed invasive pneumococcal diseases, and that this association was strongest for opioids used at high doses, those classified as high potency and long-acting formulations.

The data also showed that opioids previously described as immunosuppressive in prior experimental studies conducted in animals had the strongest association with invasive pneumococcal diseases in humans. Continue reading

Marijuana Dispensaries Have Ability To Reduce Opioid Overdoses and Substance Abuse

MedicalResearch.com Interview with:

MedicalResearch.com Interview with: David Powell  PhD Economist; Core Faculty, Pardee RAND Graduate School RAND, Santa Monica     MedicalResearch.com:  What is the background for this study?  What are the main findings?   Response: There has been some research suggesting that the adoption of state medical marijuana laws leads to reductions in prescriptions for opioid analgesics among certain populations and opioid-related overdoses overall.  However, medical marijuana laws are very different across states and they have changed over time as well.  We wanted to understand what components of a medical marijuana law could potentially lead to reductions in overdoses and substance abuse.  We focused specifically on the role of dispensaries, given their importance in providing access to medical marijuana, and tested for different effects in states with and without legally-protected and operational dispensaries.  We found that dispensaries are critical to reduce opioid-related overdoses and substance abuse.  We also found evidence that more recently-adopting states have experienced smaller reductions in overdoses and opioid substance abuse, potentially because the more recent adopters tend to enforce more stringent guidelines for dispensaries than the early adopters.   MedicalResearch.com: What should readers take away from your report?  Response: We find that the introduction of medical marijuana dispensaries has the potential to reduce opioid-related harms quite significantly.  More broadly, it also suggests that, when we think about the opioid crisis, improving access to pain management alternatives may be a useful mechanism for reducing dependence on opioids.        MedicalResearch.com: What recommendations do you have for future research as a result of this work?  Response: During most of the time period that we studied, prescription opioids were driving the opioid crisis, but it has recently transitioned to the point where heroin and illicit synthetic opioids are playing more prominent roles.  We are hesitant to suggest that medical marijuana access will have the same scope in a climate in which synthetic opioids and heroin are the primary substances of abuse.  Future work could do more to explore the potential of different types of medical marijuana laws to reduce overdoses related to these substances.        Citations: Do medical marijuana laws reduce addictions and deaths related to pain killers? ☆ •David Powella, , ,  •	Rosalie Liccardo Paculaa, b,  Mireille Jacobsonb  RAND, Santa Monica, United States  NBER Cambridge, MA, United StatesUniversity of California, Irvine, United States Received 14 November 2015, Revised 15 August 2017, Accepted 30 December 2017, Available online 3 February 2018  Journal of Health Economics Volume 58, March 2018, Pages 29–42  https://doi.org/10.1016/j.jhealeco.2017.12.007  [wysija_form id="3"]   The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

Dr. Powell

David Powell  PhD
Economist; Core Faculty, Pardee RAND Graduate School
RAND, Santa Monica 

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

Response: There has been some research suggesting that the adoption of state medical marijuana laws leads to reductions in prescriptions for opioid analgesics among certain populations and opioid-related overdoses overall.  However, medical marijuana laws are very different across states and they have changed over time as well.  We wanted to understand what components of a medical marijuana law could potentially lead to reductions in overdoses and substance abuse.  We focused specifically on the role of dispensaries, given their importance in providing access to medical marijuana, and tested for different effects in states with and without legally-protected and operational dispensaries.

We found that dispensaries are critical to reduce opioid-related overdoses and substance abuse.  We also found evidence that more recently-adopting states have experienced smaller reductions in overdoses and opioid substance abuse, potentially because the more recent adopters tend to enforce more stringent guidelines for dispensaries than the early adopters.   Continue reading

Analyzing Street Drugs Can Provide Early Warning of Potential For Fatal Overdoses

MedicalResearch.com Interview with:
“MEXICO-DRUGS/” by Claudio Toledo is licensed under CC BY 2.0Kathleen Creppage, M.P.H., C.P.H.
Doctoral candidate Graduate School of Public Health
University of Pittsburgh

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

Response: In the U.S., fatal heroin overdoses have increased in the past decade by 300 percent, with fentanyl – a substance that is 20 to 50 times more potent than heroin – and its analogs increasingly contributing to overdoses. The drug often is implicated in clusters of overdose deaths when it is mixed with heroin and users do not realize what they are taking is more powerful than usual.

We analyzed the test results of 16,594 stamp bags seized as evidence by law enforcement authorities in Allegheny County that were submitted to the county’s Office of the Medical Examiner for laboratory testing from 2010 through 2016. Stamp bags are small wax packets that contain mixtures of illicit drugs, most commonly heroin, packaged for sale and sometimes stamped with a graphical logo by drug dealers to market their contents.

Before 2014, none of the tested bags contained fentanyl. By 2016 it was found in 15.5 percent of the tested stamp bags, with 4.1 percent containing fentanyl as the only controlled substance present.

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Vancouver Study: 100% of Opioid-Users Tested Positive for Fentanyl

MedicalResearch.com Interview with:
“Drugs” by Ben Harvey is licensed under CC BY 2.0William G. Honer, MD, FRCPC, FCAHS

Jack Bell Chair in Schizophrenia
Professor and Head, Department of Psychiatry
University of British Columbia
Vancouver, BC

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

Response: The Province of British Columbia, Canada, has experienced a tremendous increase in the number of opioid related overdoses and deaths. In 2012, there were 269 drug overdose deaths, five years later in 2017 the overdose deaths are predicted to have increased 500%. Toxicology studies of deaths, and examination of seized drugs indicate fentanyl is the major cause.

These indirect measures suggest widespread exposure to fentanyl in opioid users, however direct studies of the extent of exposure of opioid users to fentanyl in the community are lacking. We carried out a community-based, longitudinal study using fentanyl testing in urine samples from volunteer participants. (It is called the “Hotel Study” since many of the participants live, or have lived in single room occupancy hotels)  Continue reading

Family Members of Patients Prescribed Opioids More Likely To Fill Opioid Prescriptions Themselves

MedicalResearch.com Interview with:
“Pills” by Victor is licensed under CC BY 2.0Marissa J. Seamans, Ph.D

Postdoctoral Fellow
Department of Mental Health
Johns Hopkins School of Public Health
Baltimore, MD 21205 

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

Response: Many patients report sharing their prescriptions for opioids with family members. What we didn’t know is whether family members of opioid users are more likely to fill opioid prescriptions themselves than family members of non-opioid users. Our study found that the 1-year risk of prescription opioid initiation among family members of prescription opioid users was an absolute 0.71% higher than among family members of non-opioid users. The risks were particularly higher for initial prescriptions with refills or longer days supply.

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No Clear Guidelines To Manage Pain After Surgical Procedures

MedicalResearch.com Interview with:
“Surgery” by mrpbps is licensed under CC BY 2.0
Sagar Patel MD
Facial Plastic Surgeon
Board Certified Otolaryngology, Head and Neck Surgeon
Facial Plastic Surgery Associates, Houston, Texas

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

Response: While the majority of diverted opioids that are abused originate from pills prescribed for chronic conditions, with 214,000 rhinoplasties performed in the US in 2015, assessing opioid usage after rhinoplasty is an important view into prescription practices for acute pain after surgical procedures. Opioid use, pain control, and adverse effects were examined and opioid use was compared across patient demographic and surgical procedure characteristics, including rhinoplasty and septoplasty, open vs closed techniques, revision vs primary operations, reduction of turbinates, and use of osteotomies. Opioid use was self-reported as the number of prescribed tablets containing a combination of hydrocodone bitartrate (5 mg) and acetaminophen (325 mg) that were consumed. We them mathematically analyzed.

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Methadone As First Line Opioid in Cancer Pain Management

MedicalResearch.com Interview with:

Sebastiano Mercadante, MD Anesthesia and Intensive Care Unit and Pain Relief and Palliative Care Unit La Maddalena Cancer Center Department of Anesthesia, Intensive Care & Emergencies University of Palermo Palermo, Italy

Dr. Mercadante

Sebastiano Mercadante, MD
Anesthesia and Intensive Care Unit and Pain Relief and Palliative Care Unit
La Maddalena Cancer Center
Department of Anesthesia, Intensive Care & Emergencies
University of Palermo
Palermo, Italy

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

Response: There are many clinical experiences suggesting that methadone, when optimally used by skilled physicians, has invaluable properties in the management of cancer pain. Methadone used as first opioid may provide interesting advantages due to the low tendency to induce tolerance, while providing a clinical profile similar to that of other opioids. Moreover, methadone possesses other extra-opioid effects that can be of interest.

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Half Of People Who Died of Opioid Overdoses Tested Positive For Fentanyl

MedicalResearch.com Interview with:
“no drugs” by Anderson Mancini is licensed under CC BY 2.0
Julie K. O’Donnell, PhD
Division of Unintentional Injury Prevention
National Center for Injury Prevention and Control
CDC

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

Response: The opioid overdose epidemic has killed over 300,000 Americans from 1999 to 2015—including 33,091 in 2015. Over this time, the epidemic has evolved from being primarily driven by prescription opioids to increasingly being driven by illicit opioids. The first wave of the epidemic began in 1999 with a steep increase in deaths involving prescription opioids, such as hydrocodone, oxycodone, and morphine. The second wave began in 2010 with rapid increases in overdose deaths involving heroin. The third wave of the epidemic began in 2013, with significant increases in overdose deaths involving synthetic opioids—particularly those involving illicitly-manufactured fentanyl (IMF), which are commonly laced into heroin products. Most recently, the IMF market continues to evolve, with an ever-widening array of illicitly manufactured fentanyl analogs being distributed.

This report indicates that over half of people in 10 states who died of opioid overdoses tested positive for fentanyl during the second half of 2016. The report found that out of a total of 5,152 opioid overdose deaths, almost 3,000 tested positive for fentanyl, and over 700 tested positive for drugs that have similar chemical structures to fentanyl (fentanyl analogs) – including the extremely potent fentanyl analog, carfentanil, which is used to sedate large animals.

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Fewer Patients Receiving Opioids Alone Following Hip or Knee Replacement

MedicalResearch.com Interview with:
Philipp Gerner

MD Candidate – Class of 2018
University of Massachusetts Medical School

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

Response: Over 1 million patients undergo total joint replacement surgery in the United States alone every year, with many experiencing significant pain postoperatively. These procedures often require large amounts of pain medication to keep patients comfortable, which historically has been treated with opioids. Currently, increasing awareness of safe opioid prescribing has created an increased interest in other ways to effectively treat post-operative pain without the dangers and side-effects of opioids.

As part of an analysis of the impact of multimodal pain management (i.e. multiple drug classes or procedures to treat post-operative pain) and opioid usage, we conducted this study to considered how trends have changed over the last 10 years. Our data shows that opioid use for post-operative pain has declined substantially in patients undergoing total hip and knee arthroplasty (THA & TKA), two very common and often painful orthopedic procedures. Patients being treated with opioids alone for THA decreased from 47.6% in 2006 to 7.5% in 2016, with similar trends being seen in TKA patients.

Importantly, our data also showed that patients are increasingly being treated with a multimodal approach to pain control; especially patients being treated with 3 or more different pain modalities increased sharply in the last 10 years for both procedures in our study. This allows patients the benefit of managing their pain without many of the side-effect associated with large doses of a single pain medication. This trend was found to be especially true in small and medium sized hospitals, compared to larger hospitals. With increasing emphasis on limiting opioid use, this data shows us that the medical community is actively pursuing alternate possibilities for successfully treating post-operative pain.

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Trends in Opioid-Related Inpatient Stays Shifted After Switch to ICD-10 Coding

MedicalResearch.com Interview with:

Anne Elixhauser, Ph.D. Senior Research Scientist Agency for Healthcare Research and Quality Rockville MD 20857

Dr. Elixhauser

Anne Elixhauser, Ph.D.
Senior Research Scientist
Agency for Healthcare Research and Quality
Rockville MD 20857

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

Response: Hospital inpatient data began using ICD-10-CM (I-10) codes on October 1, 2015.  We have been doing analysis using the new codeset to determine to what extent we can follow trends crossing the ICD transition—do the trends look consistent when we switch from I-9 to I-10?  Tracking the opioid epidemic is a high priority so we made this one of our first detailed analyses.  We were surprised to find that hospital stays jumped 14% across the transition, compared to a 5% quarterly increase before the transition (under I-9) and a 3.5% quarterly increase after the transition (under I-10).  The largest increase (63.2%) was for adverse effects in therapeutic use (side effects of legal drugs), whereas stays involving opioid abuse decreased 21% and opioid poisoning (overdose) decreased 12.4%.

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