MedicalResearch.com Interview with:
Rachel H. Alinsky, MD, MPH
Adolescent Medicine and Addiction Medicine Fellow
Division of General Pediatrics and Adolescent Medicine
Johns Hopkins University School of Medicine
MedicalResearch.com: What is the background for this study? Response: We know that over 4,000 adolescents and young adults between the ages of 15-24 are dying from an opioid overdose every year. Nonfatal opioid overdose has been identified as a potential touchpoint with the healthcare system when individuals can be drawn into treatment, yet very little is known about health care use following opioid overdose in youth. We were interested in figuring out the extent to which adolescents and young adults are receiving evidence-based treatment after an opioid overdose. (more…)
MedicalResearch.com Interview with:
Dr. Eric Dawson, PharmD
Vice President, Clinical Affairs
Millennium Health
MedicalResearch.com: What is the background for this study? Response: The US Centers for Disease Control and Prevention has projected a drop in the number of overdose deaths for 2018; the first reported decline since 1990. They cite a decrease in prescription opioid deaths as the leading contributor to the overall reduction, but caution that deaths associated with synthetic opioids, primarily fentanyl, as well as stimulants appear to be increasing.
In 2019, we reported a 798% increase in urine drug test positivity rates for nonprescribed fentanyl among results positive for methamphetamine and an 1850% increase among results positive for cocaine. In an effort to conduct ongoing surveillance of the polysubstance use landscape and help characterize these evolving trends in a more timely manner, we examined our UDT data as close to real-time as possible to observe trends in positivity for methamphetamine, cocaine, and heroin, with and without illicit fentanyl. (more…)
MedicalResearch.com Interview with:
Sunil Agarwal, MD
Michigan Opioid Prescribing Engagement Network
Ann Arbor, MI
MedicalResearch.com: What is the background for this study? Response: Excess opioid prescribing after surgery often leads to misuse and diversion into the community.
To prevent excessive prescribing for acute pain, 31 states have implemented legislation that limits the duration of opioid prescriptions. Our study examined the effect of prescribing limits and postoperative opioid prescribing on surgical patients in Massachusetts and Connecticut, the first two states to implement opioid prescribing limits for acute pain after the CDC guidelines were released.(more…)
MedicalResearch.com Interview with:
Megan Land, MD, PGY 6
Pediatric Critical Care Medicine Fellowship
Emory University School of Medicine
MedicalResearch.com: What is the background for this study?
Much of the research on the opioid crisis has focused on the impact to adults; however, children and adolescents in the US are also negatively affected by the opioid epidemic.
The percentage of children admitted to a pediatric intensive care unit increased over the study period as the clinical effects of the opioid ingestions increased in severity.
The primary intent of opioid ingestions was suspected suicide attempts in adolescents resulting in increasing admissions to a psychiatric hospital.
Opioids associated with the highest odds of needing an intervention in an intensive care unit were methadone, fentanyl, and heroin.
MedicalResearch.com Interview with:
Kao-Ping Chua, MD PhD
Assistant Professor, Department of Pediatrics
Susan B. Meister Child Health Evaluation and Research Center
University of Michigan
MedicalResearch.com: What is the background for this study? Response: Opioids are frequently prescribed to adolescents and young adults aged 12-21 years – in a recent study, 1 in 8 patients in this population were prescribed opioids during the year. At the same time, almost 30% of the 3000 opioid-related overdose deaths in 2016 among adolescents and young adults involved prescription opioids. Given the frequency of opioid prescribing and the risk of overdose, it is important to understand how to prescribe opioids safely to adolescents and young adults.
However, there have been few studies that examine which opioid prescribing patterns are associated with prescription opioid overdose in adolescents and young adults. Prior studies examining these patterns have focused on older adults, particularly U.S. Veterans, so the generalizability of these findings to younger populations is unclear. (more…)
MedicalResearch.com Interview with:
Anna Konova, PhD
Assistant Professor, Dept. of Psychiatry & UBHC
Core Faculty, Brain Health Institute
Rutgers University - New Brunswick
MedicalResearch.com: What is the background for this study? Response: Opioid reuse and relapse are common outcomes even when a person is seeking treatment for their addiction. These reuse events pose many health risks, as well as risk for treatment failure. We currently lack the much needed tools to understand and predict this reuse vulnerability.
In this study, we used computer games that assess a person's decision making process, to get at psychological processes related to how people make decisions involving risks, when they transitioned between lower and higher reuse vulnerability states during the first few months of opioid treatment.
(more…)
MedicalResearch.com Interview with:
Dr. Rupa Radhakrishnan, MD
Assistant professor of Radiology and Imaging Sciences
Indiana University School of Medicine
MedicalResearch.com: What is the background for this study? Response: Opioid use in pregnancy is a major public health crisis. Opioids adversely impact maternal, fetal and infant health. Infants who were exposed to opioids in the womb, can have withdrawal symptoms soon after birth, and are also at risk for poor long term neurodevelopment outcomes.
Our group studied the changes in brain function in infants exposed to opioids in the womb, to understand how opioids affect the developing brain. We used resting state functional MRI to study these infants.(more…)
MedicalResearch.com Interview with:
Raveendhara R. Bannuru MD, PhD, FAGE
Director, Center for Treatment Comparison and Integrative Analysis (CTCIA)
Deputy Director, Center for Complementary and Integrative Medicine (CCIM)
Asst Professor of Medicine, Tufts University School of Medicine
Asst Professor of Clinical & Translational Science, Sackler School of Graduate Biomedical Sciences
Division of Rheumatology, Tufts Medical Center
Boston, MA
MedicalResearch.com: What is the background for this study? Response: Given the current controversy regarding the use of opioids in chronic pain, we wanted to delve deeper into the efficacy and safety profiles of oral opioid drugs in osteoarthritis patients. Temporal assessments like ours can reveal peak periods of efficacy, and can provide clinicians with a blueprint for optimal durations of treatment regimens. With respect to subgroup analyses based on strength of opioid binding affinity, we sought to explore currently held paradigms that strong opioids may be useful for the treatment of severe pain, and to specifically assess their relevance in OA populations. Knowledge of the relative efficacy and safety profiles of strong versus weak opioids can give clinicians the information they need to weigh benefits and harms of specific subgroups of opioids. (more…)
MedicalResearch.com Interview with:
Jack E. Henningfield, PhD
Vice President, Research, Health Policy, and Abuse Liability
Pinney Associates
Adjunct Professor of Behavioral Biology
Department of Psychiatry and Behavioral Science
Johns Hopkins University School of Medicine (more…)
MedicalResearch.com Interview with:
Dr. Hannah T. Neprash, PhD
Assistant Professor, Division of Health Policy and Management
School of Public Health
University of MinnesotaMedicalResearch.com: What is the background for this study? Response: Physicians play a pivotal role in the opioid epidemic and it's important to understand what factors that drive opioid prescribing. Variation in opioid prescribing across physicians has been well-documented, but there’s very little research on variation within physicians…which is surprising, given the widespread concern about time pressure and cognitive fatigue having a potentially detrimental effect on the quality of care provided by physicians.
(more…)
MedicalResearch.com Interview with:
Isaac Sasson, PhD
Department of Sociology and Anthropology and the
Herczeg Institute on Aging
Tel Aviv University
Tel Aviv, Israel
MedicalResearch.com: What is the background for this study? Response: Life expectancy at birth in the United States has been declining steadily since 2014, which is very unusual for a high-income country in times of peace. In fact, the last time that life expectancy declined in the US was in the early 1990s, and only briefly. Studies from the past few years have shown that the rise in mortality is concentrated among middle-aged Americans and particularly the lower socioeconomic classes.
Our study analyzed over 4.6 million death records in 2010 and 2017 to understand which causes of death account for the rise in mortality among white and black non-Hispanic US adults. In addition, given the substantial socioeconomic inequality in health in the US, we broke down our results by level of education, which is a good proxy for socioeconomic status. Essentially, our goal was to measure how many years of life were lost, on average, to each cause of death across different social groups.(more…)
MedicalResearch.com Interview with:
Greg Midgette, PhD
Assistant Professor
Department of Criminology and Criminal Justice
University of Maryland
MedicalResearch.com: What is the background for this study?Response: This report estimates marijuana, cocaine, heroin, and methamphetamine use in the U.S. between 2006 and 2016 on three dimensions: the number of past-month chronic users per year, where "chronic" has previously been defined as consuming the drug at least four days in the past month, expenditure per drug among those users, and consumption of each drug. These measures are meant to aid the public and policy makers' understanding of changes in drug use, outcomes, and policies. (more…)
MedicalResearch.com Interview with:
Kao-Ping Chua, M.D., Ph.D.
Assistant Professor,
Department of Pediatrics and Communicable DiseasesSusan B. Meister Child Health Evaluation and Research Center
University of Michigan
Ann Arbor, Michigan
MedicalResearch.com: What is the background for this study? Response: Tonsillectomy is one of the most common surgeries performed in children. It is also one of the most common reasons children are prescribed opioids, even though randomized trials suggest that non-opioids like ibuprofen are equally effective for pain control. We were interested in understanding whether it is possible to safely reduce opioid exposure after tonsillectomy in children without increasing the risk of complications such as emergency department visits for uncontrolled throat pain, which could lead to dehydration.
(more…)
MedicalResearch.com Interview with:
Gery P. Guy Jr., PhD, MPH
Senior Health Economist
Division of Unintentional Injury Prevention
CDCMedicalResearch.com: What is the background for this study? Response: In 2017, among the 70,237 drug overdose deaths in the United States, 47,600 (67.8%) involved prescription or illicit opioids. Distribution of the opioid receptor antagonist naloxone to reverse overdose is a key part of the public health response to the opioid overdose epidemic. The 2016 CDC Guideline for Prescribing Opioids for Chronic Pain recommended clinicians consider offering naloxone when overdose risk factors, such as history of overdose or opioid use disorder, higher opioid dosages, or concurrent benzodiazepine use, are present.
However, recent analyses examining pharmacy-based naloxone dispensing are lacking. To address this gap and to inform future overdose prevention and response efforts, CDC examined trends and characteristics of naloxone dispensed from retail pharmacies at the national and county level in the United States.
(more…)
MedicalResearch.com Interview with:
Brian J Piper, PhD MS
Department of Medical Education
Geisinger Commonwealth School of Medicine
Scranton, PennsylvaniaMedicalResearch.com: What is the background for this study?Response: All states have a Prescription Monitoring Program to collect data about controlled substance prescriptions. Maine also had a Diversion Alert Program to obtain information about arrests involving prescription and illicit drugs.
Buprenorphine is a treatment for an opioid use disorder. Naloxone is an opioid antagonist. Prior pharmacoepidemiology research found that buprenorphine accounted for half of prescriptions for males in their twenties in Maine.1
This study examined the current status of the opioid crisis using three complementary data sources:
1) Arrests as reported to the Diversion Alert Program;
2) Medical opioid use as reported by the Drug Enforcement Administration; and
3) Overdoses as reported to the medical examiner.
(more…)
MedicalResearch.com Interview with:Devan Hawkins ScD
Instructor of Public Health
School of Arts and Sciences
MCPHS University
MedicalResearch.com: What is the background for this study?Response: As has been well established, mortality due to opioids has been increasing rapidly in recent years. We were interested in understanding whether mortality rates may be high among workers in certain industries and occupations for two primary reasons.
First, if we were to find that mortality rates differed according to industry and/or occupation it might indicate that some aspect of these industries and occupations put workers at elevated risk for opioid-related overdose death.
Second, interventions could be created to target these workers and hopefully prevent more deaths.
(more…)
MedicalResearch.com Interview with:
Lauren A. Hoffman, Ph.D.
Research Fellow
Recovery Research Institute
Center for Addiction Medicine
Massachusetts General Hospital
Harvard Medical School
MedicalResearch.com: What is the background for this study? Response: In 2017, an estimated 11.4 million Americans reported past-year opioid misuse1 and opioid-related overdose accounted for more than 47,000 deaths2. Prior research has helped further our understanding of the prevalence and consequences of opioid misuse, but we know substantially less about recovery from opioid use problems. Recovery-focused research conducted to-date has largely focused on alcohol use disorder, the most common type of substance use disorder. Characterizing recovery from opioid use problems and the pathways that individuals take to resolve such problems can ultimately help identify effective ways to address opioid misuse.
Using data from the first national probability-based sample of US adults who have resolved a significant substance use problem (National Recovery Survey3), we provide the first national prevalence estimate of opioid recovery, and characterize treatment/recovery service use and psychological well-being in individuals who resolved a primary problem with opioids, relative to individuals who resolved a primary alcohol problem. We focused our cross-sectional investigation of service use and well-being on 2 time-horizons associated with continued vulnerability: <1 year since problem resolution (early-recovery) and 1 – 5 years since problem resolution (mid-recovery).
(more…)
MedicalResearch.com Interview with:
Marisha Burden, MD, FACP, SFHM
Associate Professor of Medicine
Division Head of Hospital Medicine
University of Colorado School of Medicine
MedicalResearch.com: What is the background for this study? Response: The United States has seen a marked increase in opioid prescribing since 2000 and while there has been a slight decline in prescribing since 2012, prescription rates for opioids still remain much higher than in the late 1990’s and are considerably higher when compared to other countries.
The US continues to see opioid-related complications such as overdoses, hospitalizations, and deaths. Hospitalized patients frequently experience pain and opioid medications are often the mainstay for treatment of pain. Studies have suggested that receipt of opioid prescriptions at the time of hospital discharge may increase risk for long-term use.
(more…)
MedicalResearch.com Interview with:
Silvia S. Martins, MD, PHD
Associate Professor of Epidemiology
Department of Epidemiology
Mailman School Of Public Health
Columbia UniversityMedicalResearch.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.(more…)
MedicalResearch.com Interview with:
Craig A. Pedersen, RPh, PhD, FAPhA
Manager, Sterile Compounding and Investigational Drug Service,
Pharmacy Clinical Professor
University of Washington
MedicalResearch.com: What is the background for this study? Response: The ASHP national survey of pharmacy practice in hospitals originated with the Mirror to Hospital pharmacy, the first comprehensive, national audit of pharmaceutical services in hospitals, published in 1964. Since that time, ASHP has conducted national surveys to document practices and technologies for managing the improving the medication-use system and the role that pharmacist play in that effort. Beginning in 1998, the national survey became an annual project by ASHP. This survey provides important information to pharmacists, managers, and external stakeholders to document the current state of pharmacy practice. (more…)
MedicalResearch.com Interview with:
Lorraine Kelley-Quon, MD, MSHS, FAAP
Assistant Professor | Division of Pediatric Surgery
Children's Hospital Los Angeles
Department of Surgery & Preventive Medicine
Keck School of Medicine of USCMedicalResearch.com: What is the background for this study? What are the main findings?Response: Prescription opioids are pharmacologically similar to heroin, and previous research has shown an association between nonmedical opioid use and heroin use.
This is the first study to follow a group of teenagers through all 4 years of high school and identify an association between nonmedical prescription opioid use and later heroin use.
(more…)
MedicalResearch.com Interview with:
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. (more…)
MedicalResearch.com Interview with:
Professor Martin Englund MD PhD
Department of Orthopaedics
Lund UniversityMedicalResearch.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.(more…)
MedicalResearch.com Interview with:
Dr. Stuart Lieblich, DMD
Oral and maxillofacial surgeon Avon, CT
MedicalResearch.com: What is the background for this study? How does EXPAREL® differ from other pain medication for dental work or other short-term procedures?Response: This study analyzed the use of opioids and non-opioid options for postsurgical pain following third molar extraction (wisdom teeth removal). Our research team reviewed data from 600 patients who underwent third molar extraction, with 300 patients having received non-opioid option EXPAREL (bupivacaine liposome injectable suspension) and 300 patients that did not receive an infiltration of EXPAREL. The study aimed to show that reducing opioid prescriptions following this procedure may decrease opioid-related adverse events and the risk of opioid dependence.
(more…)
MedicalResearch.com Interview with:
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 (more…)
MedicalResearch.com Interview with:
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.
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.
(more…)
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
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.
(more…)
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
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.
(more…)
MedicalResearch.com Interview with:
Nicole Tang, D.Phil, C.Psychol (Reader)
Department of Psychology
Warwick Sleep and Pain Lab
University of Warwick
MedicalResearch.com: What is the background for this study? What are the main findings?Response: Current guidelines recommend non-opioid therapy as the preferred treatment of chronic non-malignant (CNP) pain, with opioids reserved to situations “when benefits for pain and function are expected to outweigh risks” [1,10]. Whilst the effectiveness of opioid therapy is usually measured in terms of pain outcomes, less is known about its effect on day-to-day functions.
A particular function of concern to patients with chronic non-malignant pain
is the ability to get a good night's sleep.
The current systematic review has identified a set of papers with relevant outcomes regarding the effect of opioid therapy on sleep quality and sleep architecture in CNP patients. It
extends our understanding from the drug's respiratory depression effect in healthy
individuals to the potential risks and utility of opioid therapy for chronic non-malignant pain
patients with sleep disturbances.
Whilst the narrative synthesis and the exploratory meta-analysis of a subset of data both suggest that the use of opioid therapy is associated with an overall report of sleep quality improvement, such an improvement is not consistently replicated across studies
or substantiated by improvements in sleep parameters linked to deeper and better-sleep quality. Moreover, the improvement may be accompanied by undesirable side effects and increased daytime sleepiness that contradict with the very idea of improved
sleep quality. We are also painfully aware of the methodological limitations of the studies reviewed; their exposure to different sources of biases has heightened the risk of result inflation.
To many patients with chronic non-malignant pain, improved sleep is a top priority
when evaluating the performance of a new drug and non-drug intervention.
If we were to advance our current understanding of the
opioid-sleep relationship, future trials need to be designed with
this interdisciplinary question in mind such that validated measures
of sleep can be incorporated as an outcome measure alongside pain.
(more…)
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