Opioid Overdoses Biggest Cause of Decreasing Life Expectancy

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.

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Medicaid Patients Who Overdose Likely To Get More Opioids

MedicalResearch.com Interview with:

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

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.

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Almost 40% US Adults Used Prescription Opioids In Course of One Year

MedicalResearch.com Interview with:
Beth Han, MD, PhD, MPH

From Substance Abuse and Mental Health Services Administration, Rockville, Maryland
National Institute on Drug Abuse, Bethesda, Maryland and
Office of the Assistant Secretary for Planning and Evaluation
U.S. Department of Health and Human Services
Washington, DC. 

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

Response: Using the 2015 National Survey on Drug Use and Health (NSDUH), this is the first study examining the prevalence of overall prescription opioid use in addition to misuse, use disorders, and motivations for misuse in the U.S. adult population. The 2015 NSDUH collected nationally representative data on prescription opioid use, misuse, use disorder, and motivations for misuse among the U.S. civilian, noninstitutionalized population aged 12 or older. In 2015, NSDUH started to collect data on overall prescription opioid use as well as data on motivations for prescription opioid misuse.

This study found that in 2015, 91.8 million (37.8%) U.S. civilian, non-institutionalized adults used prescription opioids, 11.5 million (4.7%) misused them, and 1.9 million (0.8%) had a prescription opioid use disorder. Among adults who used prescription opioids, 12.5% reported misuse and, of those reporting misuse, 16.7% reported a prescription opioid use disorder.

The most common reported misuse motivation was to relieve physical pain (63.4%). Misuse and use disorders were most commonly reported in adults who were uninsured, were unemployed, had low income, or had behavioral health problems. Among adults with misuse, 59.9% reported using opioids without a prescription, and 40.8% obtained prescription opioids free from friends or relatives for their most recent misuse.

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Opioid Prescriptions Common Among Cancer Survivors

MedicalResearch.com Interview with:

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

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.

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More Babies Experiencing Neonatal Drug Withdrawal After Exposure To Opioids and Psychotropic Meds

MedicalResearch.com Interview with:

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

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.

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Long Acting Local Anesthetic Reduced Need For Opioids After Knee Replacement

MedicalResearch.com Interview with:

Michael A. Mont, MD Department of Orthopaedic Surgery Cleveland Clinic Cleveland, OH

Dr. Mont

Michael A. Mont, MD
Department of Orthopaedic Surgery
Cleveland Clinic
Cleveland, OH 

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

Response: Postoperative pain after total knee arthroplasty (TKA) is a major hurdle for both the patients and the orthopaedists. Many analgesic modalities are currently in use, and can be used alone or in combination in order to augment their effect. Addition of local anesthetic analgesia has been shown to improve pain control and reduce opioid consumption during postoperative period. However, the effects of this analgesia tend to dissipate with time, with the longest duration of action (bupivacaine) of approximately 12 hours. Therefore, long acting local anesthetic (liposomal bupivacaine) has been developed in order to expand the duration of effectiveness of pain relief for up to 96 hours. Many studies evaluated the effectiveness of this anesthetic and demonstrated contradictory results, however, they did not use the same methods and infiltration technique. Therefore, we conducted a prospective, randomized, double-blind, controlled study at 16 hospitals using optimal infiltration techniques. Our study demonstrated significant improvement in pain, decreased opioid consumption, increased time to first opioid rescue, more opioid free patients in liposomal bupivacaine cohort. In addition, there were no unexpected safety concerns.

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Dramatic Increase in Prescription Opioids Found In Fatally Injured Drivers

MedicalResearch.com Interview with:

Stanford Chihuri, MPH Staff Associate/Data Analyst Department of Anesthesiology, College of Physicians and Surgeons Columbia University Medical Center NY, NY 10032

Stanford Chihuri

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.

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Drug-Related Deaths Among Whites Soar But Alcohol and Suicide Mortality Stable

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.

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Primary Care Practice Interventions Helped Maintain Adherence to Opioid Prescription Guidelines

MedicalResearch.com Interview with:

Jane M. Liebschutz, MD, MPH Associate Professor of Medicine Section of General Internal Medicine Boston University School of Medicine Boston, Massachusetts

Dr. Liebschutz

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.

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Opioid Prescriptions Decrease But Still Elevated Compared To 20 Years Ago

MedicalResearch.com Interview with:

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

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.
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