Addiction, Author Interviews, Opiods, Pain Research / 23.05.2018

MedicalResearch.com Interview with: [caption id="attachment_41977" align="alignleft" width="160"]Dr. Stuart Lustig, M.D., M.P.H National Medical Executive for Behavioral Health Cigna Dr. Lustig[/caption] Dr. Stuart Lustig, M.D., M.P.H National Medical Executive for Behavioral Health Cigna Dr. Lustig discusses Cigna’s efforts to curb the opioid epidemic. MedicalResearch.com: What is the background for the Applying American Society of Addiction Medicine Performance Measures in Commercial Health Insurance and Services Data study? Response: In 2016 Cigna announced a collaboration with the American Society of Addiction Medicine (ASAM) to improve treatment for people suffering from substance use disorders and establish performance measures and best practices for addiction treatment. Mining anonymized data from Cigna’s administrative data, Brandeis University researchers have validated a new way to hone in on trouble spots where substance use disorder treatment for opioid, alcohol and other drug dependence is suboptimal, like the way police departments use computers to identify high crime areas in need of greater scrutiny and attention. The technique uses ASAM-defined performance measures to assess substance use disorder treatment patterns, giving researchers the ability to sort through administrative data and measure to the extent to which patients being treated for opioid or alcohol use disorder are receiving and using evidenced-based medications proven to be effective in improving outcomes and retention in treatment. It also measures whether those patients received support during substance withdrawal – a critical factor in the success of addiction treatment plans. The performance measures were first tested on the Veterans’ Health Administration in 2016 and now, on data from Cigna.
Author Interviews, Critical Care - Intensive Care - ICUs, Opiods, University of Pittsburgh / 21.05.2018

MedicalResearch.com Interview with: [caption id="attachment_41908" align="alignleft" width="125"]Jason Kennedy, MS Research project manager Department of Critical Care Medicine University of Pittsburgh Jason Kennedy[/caption] Jason Kennedy, MS Research project manager Department of Critical Care Medicine University of Pittsburgh MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Most previous studies of opioid use in health care have focused on the outpatient setting. But opioids are often introduced during hospitalization. That’s something clinicians can control, so we looked at inpatient prescription of these drugs to identify targets that may reduce opioid use once patients are out of the hospital. We analyzed the medical records of 357,413 non-obstetrical adults hospitalized between 2010 and 2014 at 12 University of Pittsburgh Medical Center (UPMC) hospitals in southwestern Pennsylvania. The region is one of the areas of the country where opioid addiction is a major public health problem. We focused on the 192,240 patients who had not received an opioid in the year prior to their hospitalization – otherwise known as “opioid naïve” patients. Nearly half (48 percent) of these patients received an opioid while hospitalized.  After discharge, those patients receiving hospital opioids were more than twice as likely to report outpatient opioid use within 90-days (8.4 percent vs. 4.1 percent). Patients who receive an opioid for most of their hospital stay and patients who are still taking an opioid within 12 hours of being discharged from the hospital appear more likely to fill a prescription for opioids within 90 days of leaving the hospital. 
Addiction, Author Interviews, JAMA, Opiods, Pharmaceutical Companies / 14.05.2018

MedicalResearch.com Interview with: “Big Lunch Extras Reading” by Big Lunch Extras is licensed under CC BY 2.0Scott E. Hadland, MD, MPH, MS Assistant Professor of Pediatrics | Boston University School of Medicine Boston Medical Center Director of Urban Health & Advocacy Track | Boston Combined Residency Program Boston, MA 02118 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Numerous pharmaceutical companies have received media attention for their role in promoting opioid prescribing through speaker programs and other marketing plans in which large-value payments are given to a small number of doctors to promote opioids. In our study, we sought to tell the other side of the story. We wanted to identify whether low-value marketing, including industry-sponsored meals, which are commonplace in the US, were associated with increased opioid prescribing. We found that 1 in 14 doctors received opioid marketing from pharmaceutical companies in 2014, and those that received marketing prescribed 9% more opioids the following year. With each additional meal a doctor received, he or she prescribed more and more opioids the following year. Our sample included 43% of the active physician workforce in the US, suggesting how widespread and far-reaching this effect might be.
Author Interviews, Opiods, Race/Ethnic Diversity, University of Michigan / 03.05.2018

MedicalResearch.com Interview with: [caption id="attachment_41477" align="alignleft" width="160"]Matthew A. Davis, MPH, PhD Assistant Professor Department of Systems, Populations and Leadership University of Michigan Dr. Davis[/caption] Matthew A. Davis, MPH, PhD Assistant Professor Department of Systems, Populations and Leadership University of Michigan MedicalResearch.com: What is the background for this study? What are the main findings? Response: The premise for the study was based on prior work that demonstrated that the likelihood of being prescribed an opioid differs according to a patient’s race and ethnicity.  Collectively this work has shown that Non-Hispanic Whites are more likely to receive opioids than other groups for pain. We decided to look at trends in the prescribing of different pain medications over the last 16 years to see if we could detect any differences in prescribing patterns among racial and ethnic groups.  To do so we used national health data for a large sample of Americans who live with significant pain.
Author Interviews, Dental Research, Pain Research, University of Pittsburgh / 03.05.2018

MedicalResearch.com Interview with: “Dental Exam” by 807th Medical Command (Deployment Support) is licensed under CC BY 2.0Paul A. Moore, DMD, PhD, MPH School of Dental Medicine University of Pittsburgh  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Effective pain management is a priority in dental practice. Government and private agencies highlight the need to provide optimal pain relief, balancing potential benefits and harms of both opioid and nonopioid analgesic agents. The purpose of our study is to summarize the available evidence on the benefits and harms of analgesic agents, focusing on preexisting systematic reviews. We found combinations of ibuprofen and acetaminophen as having the highest association with treatment benefit in adult patients and the highest proportion of adult patients who experienced maximum pain relief. Diflunisal, acetaminophen, and oxycodone were found to have the longest duration of action in adult patients. Medication and medication combinations that included opioids were among those associated most frequently with acute adverse events in both child and adult-aged patient populations.
Addiction, Author Interviews, Opiods, Pharmacology / 30.04.2018

MedicalResearch.com Interview with: [caption id="attachment_41358" align="alignleft" width="200"]Dr. Maria Sullivan MD PhD Senior Medical Director of Clinical Research and Development Alkermes Dr. Sullivan[/caption] Maria Sullivan, M.D., Ph.D Senior Medical Director of Clinical Research and Development Alkermes MedicalResearch.com: What is the background for this study? Response: Extended release injectable naltrexone is approved for the prevention of relapse to opioid dependence after detoxification and when used with counseling. It is recommended that patients abstain from opioids for a minimum of seven to 10 days prior to induction onto XR-naltrexone to avoid precipitating opioid withdrawal. This requirement of detoxification represents a substantial clinical challenge, particularly in the outpatient setting. There is currently no single recognized best method for opioid detoxification prior to first dose of extended-release naltrexone (XR-naltrexone). A number of induction regimens have been explored, including the use of low doses of oral naltrexone to shorten the transition period from dependence on opioids to XR-naltrexone treatment. The goal of the study was to help establish an outpatient regimen to transition subjects from physiological opioid dependence to XR-naltrexone treatment and mitigate the severity of opioid withdrawal symptoms. We hypothesized that low-dose oral naltrexone, combined with buprenorphine and psychoeducational counseling, would assist with the transition of patients with opioid use disorder onto XR-naltrexone. In this 3-arm trial, we examined the utility of oral naltrexone, buprenorphine, and a fixed regimen of ancillary medications (oral naltrexone + buprenorphine vs. oral naltrexone + placebo buprenorphine vs. placebo +placebo), to determine whether any of these regimens was associated with higher rates of induction onto XR-naltrexone.
Annals Internal Medicine, Author Interviews, Hepatitis - Liver Disease, Johns Hopkins, Opiods / 24.04.2018

MedicalResearch.com Interview with: Christine Marie Durand, M.D. Assistant Professor of Medicine Johns Hopkins Medicine  MedicalResearch.com: What is the background for this study Response: Most Americans know that the United States faces an epidemic of deaths due to drug overdose.  And many are also aware that there is a critical shortage of organs available for transplant.  Perhaps less widely known is that today, more than 1 in every 8 deceased organ donors died from a drug overdose.  The objective of our study was to look at the outcomes of patients who received transplants with organs donated after an overdose.
Author Interviews, Gastrointestinal Disease, Pain Research / 09.04.2018

MedicalResearch.com Interview with: [caption id="attachment_41084" align="alignleft" width="133"]Dr. Joseph Pergolizzi MD Senior Partner and Director of Research Naples Anesthesia and Pain Associates Naples, Florida Adjunct Assistant Professor Johns Hopkins University School of Medicine Baltimore, Maryland Dr. Pergolizzi[/caption] Dr. Joseph Pergolizzi MD Senior Partner and Director of Research Naples Anesthesia and Pain Associates Naples, Florida MedicalResearch.com: What is the background for this study? What are the main findings?  Response: There are roughly 100 million Americans living with chronic pain and many battle debilitating side effects because of their pain medication, including Painstipation otherwise known as opioid-induced constipation (OIC.) In fact, OIC is the most common side effect with approximately 40-80 percent of patients on chronic opioid therapy experiencing it. To better understand this community, the Painstipation survey, conducted by Salix Pharmaceuticals in partnership with the U.S. Pain Foundation, surveyed 441 U.S. adults with chronic pain who were on opioid therapy and suffering from OIC. It gave great insight into this community as it found:
  • More than half (51 percent) of chronic pain patients have been suffering from opioid-induced constipation  for three years or longer
  • Most patients (73 percent) agree that one of the biggest challenges of having OIC is that medications don’t work quickly enough to relieve pain associated with OIC.
  • 53 percent of patients say they want relief for OIC in under four hours
  • Only half of patients surveyed (73 percent) surveyed said they were informed by their doctors that taking opioid medications might result in constipation before they began taking them
  • 77 percent of respondents reported suffering from OIC for at least one year
  • When asked, roughly one-third (32 percent) of patients reported that their doctor does not talk to them specifically about potential adverse drug-to-drug interactions (DDI) of their current prescription and/or over-the-counter medications.
Author Interviews, Emergency Care, Opiods / 08.04.2018

MedicalResearch.com Interview with: [caption id="attachment_41064" align="alignleft" width="136"]Frank Scheuermeyer MD MHSc Clinical Associate Professor Department of Emergency Medicine St Paul’s Hospital and the University of British Columbia Dr. Scheuermeyer[/caption] Frank Scheuermeyer MD MHSc Clinical Associate Professor Department of Emergency Medicine St Paul’s Hospital and the University of British Columbia  MedicalResearch.com: What is the background for this study? Response: Mortality from the opioid epidemic is dramatically increasing and a main culprit appears to be illicit fentanyl. Current research states that patients with presumed fentanyl overdoses are at high risk of deterioration and death, and require prolonged emergency department stays or hospital admission to ensure a safe outcome. Our inner-city hospital adopted a protocol initially developed for patients with heroin overdose, modified it to account for the greater potency of fentanyl, and studied 1009 consecutive patients who arrived with an overdose.
Addiction, Author Interviews, Opiods, Pharmaceutical Companies / 04.04.2018

MedicalResearch.com Interview with: http://usworldmeds.com/Mark Pirner, MD, PhD Senior Medical Director US WorldMeds   MedicalResearch.com: What is the background for this study? Would you briefly explain how lofexidine works? Response: LUCEMYRA (lofexidine) was studied in two phase 3 pivotal randomized, double-blind, placebo-controlled clinical studies, and a phase 3 open-label study. Clinical pharmacology studies included evaluation of drug-drug interaction studies that demonstrated lofexidine can be safely administered concomitantly with methadone, buprenorphine or naltrexone. LUCEMYRA is an alpha 2 adrenergic receptor agonist that reduces the surge of norepinephrine signaling in the brain which results from abrupt opioid withdrawal, and thereby reduces the severity of opioid withdrawal symptoms. 
Author Interviews, Cannabis, JAMA, Opiods / 02.04.2018

MedicalResearch.com Interview with: [caption id="attachment_18486" align="alignleft" width="200"]Dr. Italia V. Rolle, PhD and Dr. Tim McAfee, MD Office on Smoking and Health National Center for Chronic Disease Prevention and Health Promotion CDC Marijuana plant[/caption] Hefei Wen, PhD Assistant Professor, Department of Health Management & Policy University of Kentucky College of Public Health  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Marijuana is one of the potential, non-opioid alternatives that can relieve pain at a relatively lower risk of addiction and virtually no risk of overdose. Medical and adult-use marijuana laws, has made marijuana available to more Americans. Yet no study to date has focused on the effect of medical and adult-use marijuana laws on opioid prescribing in particular. Our study provides some of the first empirical evidence that the implementation of medical and adult-use marijuana laws between 2011 and 2016 was associated with lower opioid prescribing rates and spending among Medicaid enrollees.  
Author Interviews, Cannabis, JAMA, Opiods / 02.04.2018

MedicalResearch.com Interview with “Cannabis sativa” by Manuel is licensed under CC BY 2.0 David Bradford, Ph.D. Busbee Chair in Public Policy Department of Public Administration and Policy University of Georgia Athens, GA 30602 MedicalResearch.com: What is the background for this study? Response: To give you some background, in 2016, part of our research team (Bradford and Bradford) published the first study to directly examine the impact that medical cannabis laws (MCLs) may be having on prescription use. We used yearly physician-level Medicare Part D data, looked at nearly all prescription drugs used to treat 9 broad categories of illness/diagnoses, and found substantial reductions in prescriptions. We published a follow-up study in 2017, this time using data from Medicaid Fee-for-Service. Again, we found significant substitution away from prescription medications. In both of these studies, pain was included in the list of conditions for which cannabis may be used in patients, and in both studies, pain prescriptions fell. One of the unanswered questions from both of those studies, though, was what *type* of pain medications were being reduced.  From a public health standpoint, when we're worried about opioid overdose, it matters whether the substitution away from pain medications is coming from substitutions away from things like NSAIDs or whether there is substitution away from opioids.
Author Interviews, Opiods, Pediatrics / 28.03.2018

MedicalResearch.com Interview with: http://www.phc4.org/reports/researchbriefs/neonatal/17/ Joe Martin Executive Director PA Health Care Cost Containment Council Commonwealth of Pennsylvania Harrisburg, PA 17101 MedicalResearch.com: What is the background for this study? Response: Several years ago, our agency noted that while mortality data for opioid addition was being reported, it did not include hospitalizations where death did not occur.  We believed our agency could make a valuable contribution to the data by beginning to report that.  We began with adults hospitalized in PA for opioid addiction, and supplemented that over time with reporting about maternity cases and newborns. Today’s report covers babies born with neonatal abstinence syndrome.
Author Interviews, CMAJ, Opiods / 26.03.2018

MedicalResearch.com Interview with: [caption id="attachment_40728" align="alignleft" width="133"]Andrea Schaffer PhD Research Fellow Centre for Big Data Research in Health UNSW Sydney NSW Australia Dr. Schaffer[/caption] Andrea Schaffer PhD Research Fellow Centre for Big Data Research in Health UNSW Sydney NSW Australia  MedicalResearch.com: What is the background for this study? Response: Use and misuse of opioids has increased dramatically in Australia over the past 20 years. In 2014, Australia introduced tamper-resistant controlled-release (CR) oxycodone, which forms a viscous gel when crushed, and is designed to deter its injection or snorting. However, this formulation does not prevent dependence, and can still be misused orally. Tamper-resistant oxycodone CR was also introduced in the US (2010) and Canada (2012), resulting in reductions in oxycodone CR use. However, no large population-level studies have looked at switching behaviour in individuals using oxycodone CR, either in Australia or abroad.
Author Interviews, Opiods, Pharmaceutical Companies / 23.03.2018

MedicalResearch.com Interview with: [caption id="attachment_40738" align="alignleft" width="133"]Vishal Bala Senior Quantitative Data Analyst CareDash Vishal Bala[/caption] Vishal Bala Senior Quantitative Data Analyst CareDash MedicalResearch.com: What is the background for this study? What are the main findings? Response: Prior research into physicians and their relationships with the pharmaceutical industry has typically retained a narrow scope, focusing on how payments may be associated with prescription habits (sometimes limited to specific regions) for specific categories of drugs. For example, Modi et al. 2017 and Bandari et al. 2017 explored these connections in the context of some urologic drugs specifically. Research conducted by ProPublica in 2016 studied the connection between industry payments and physician prescriptions across some of the largest medical specialties, but was only able to look at “brand-name” vs. “generic” categories and were limited by overlapping timeframes for payments and prescriptions. CareDash took this analysis further by using Open Payments and Medicare Part D data to investigate the relationship between payments made by individual companies for specific drugs and the prescribing habits of the recipient physicians for those drugs. CareDash’s main findings are that healthcare providers who received payments for a drug from a pharmaceutical company are 5 times more likely to be high prescribers for that drug than those physicians who did not receive a payment. Physicians are 5.3 times more likely to prescribe a drug than their peers after they have received a payment for that drug from the manufacturer. When physicians already prescribe a drug significantly more often than their peers, they are 5.6 times more likely to later receive payment for that drug from the drug's manufacturer. Looking at the opioid drug class specifically, CareDash found that physicians receiving payment on behalf of an opioid were 14.5 times more likely to prescribe that opioid over alternatives.
Author Interviews, Opiods / 19.03.2018

MedicalResearch.com Interview with: [caption id="attachment_40639" align="alignleft" width="200"]Brian J. Piper, PhD, MS Assistant Professor of Neuroscience Department of Basic Sciences, Geisinger Commonwealth School of Medicine, Scranton PA 18509 Dr. Brian Piper[/caption] Brian J. Piper, PhD, MS Assistant Professor of Neuroscience Department of Basic Sciences, Geisinger Commonwealth School of Medicine, Scranton PA 18509  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: The US is experiencing an opioid crisis. There were 63,800 drug overdose deaths in 2016 which is three-fold higher than in 1999. Drug overdose deaths involving synthetic opioids like fentanyl increased 27-fold. Overdoses may even have contributed to decreases in the US lifespan. Emergency Room visits involving opioids have also shown recent increases, particularly in the Southwest and Western US. The US accounts for less than 5% of the world’s population but consumed over two-thirds (69.1%) of the world’s supply of six opioids (fentanyl: 30.1%, methadone: 48.1%, morphine: 51.2%, hydromorphone: 53.0%, oxycodone: 73.1% and hydrocodone: 99.7%) in 2014. The goal of this study was to examine changes in medical use of ten opioids within the United States, and US Territories, from 2006 to 2016 as reported to the Drug Enforcement Administration’s Automation of Reports and Consolidated Orders System (ARCOS). Prior estimates of the Morphine Mg Equivalent (MME), per person in the US (640), although much higher than most other developed countries, may be an underestimate because of a federal regulation (42 CFR Part 2) that prevents reporting methadone from narcotic treatment programs. We discovered that prescription opioid use peaked in 2011 (389.5 metric ton MMEs) and has been rapidly declining (346.5 in 2016). Relative to 2011, there were decreases in hydrocodone (–28.4%); oxymorphone (–28.0%); fentanyl (–21.4%); morphine (–18.9%); oxycodone (–13.8%); and meperidine (–58.0%). However, there was a pronounced increase in buprenorphine (75.2%). Similar changes were observed from 2015 to 2016 with a statistically significant reduction in all opioids except buprenorphine which was increased. There were substantial geographical variations in rates with a seven fold difference between the highest Morphine Milligram Equivalents in 2016 (Rhode Island = 2,624 mg/person) relative to Puerto Rico (351 mg/person). Two drugs used in treating an opioid use disorder (methadone and buprenorphine) accounted for over-half (52%) of the total MME in 2016.  
Author Interviews, Infections, Opiods, Vanderbilt / 13.02.2018

MedicalResearch.com Interview with: [caption id="attachment_39899" align="alignleft" width="200"]Andrew Wiese, PhD Postdoctoral Research Fellow, Department of Health Policy Vanderbilt University Medical Center Dr. Wiese[/caption] 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.
Author Interviews, Cannabis, Cost of Health Care, Opiods / 07.02.2018

MedicalResearch.com Interview with: [caption id="attachment_39890" align="alignleft" width="130"]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 <a href=michigan dispensaries and other dispensaries across America 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." width="130" height="150" /> Dr. Powell[/caption]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.
Addiction, Author Interviews, Opiods, University of Pittsburgh / 05.02.2018

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.
Addiction, Author Interviews, JAMA, Opiods / 01.02.2018

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) 
Author Interviews, JAMA, Johns Hopkins, Opiods, Pain Research / 12.12.2017

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.
Author Interviews, JAMA, Opiods, Surgical Research / 16.11.2017

MedicalResearch.com Interview with: “Surgery” by mrpbps is licensed under CC BY 2.0Sagar 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.
Author Interviews, Cancer Research, Opiods, Pain Research / 06.11.2017

MedicalResearch.com Interview with: [caption id="attachment_37962" align="alignleft" width="104"]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[/caption] 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.
Addiction, Author Interviews, CDC, Opiods / 03.11.2017

MedicalResearch.com Interview with: “no drugs” by Anderson Mancini is licensed under CC BY 2.0Julie 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.
Anesthesiology, Author Interviews, Opiods, Pain Research, Surgical Research / 31.10.2017

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.
AHRQ, Author Interviews, Health Care Systems, Opiods / 24.10.2017

MedicalResearch.com Interview with: [caption id="attachment_37708" align="alignleft" width="150"]Anne Elixhauser, Ph.D. Senior Research Scientist Agency for Healthcare Research and Quality Rockville MD 20857 Dr. Elixhauser[/caption] 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%.
Addiction, Author Interviews, CDC, Cocaine / 20.10.2017

MedicalResearch.com Interview with: “Pills” by Kurtis Garbutt is licensed under CC BY 2.0Christopher M. Jones, PharmD Office of the Assistant Secretary for Planning and Evaluation Office of the Secretary U.S. Department of Health and Human Services  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Drug overdoses are the leading cause of injury death in the United States, resulting in approximately 52,000 deaths in 2015. Although prescription drugs, in particular opioid pain relievers, were primarily responsible for the rapid expansion of this large and growing public health crisis, illicit drugs (heroin, illicit fentanyl, cocaine, and methamphetamines) now are contributing substantially to the problem. Understanding differences in illicit drug use, illicit drug use disorders, and overall drug overdose deaths in metropolitan and nonmetropolitan areas is important for informing public health programs, interventions, and policies. We found that the prevalence of self-reported past-month use of illicit drugs increased significantly across urban status (large metropolitan, small metropolitan, and nonmetropolitan) between 2003-2005 and 2012-2014. Prevalence was higher for males than females, however, in the large metropolitan group, the percentage increase in prevalence from 2003–2005 to 2012–2014 was greater for females (23.4%) than for males (21.6%). There were notable differences by age. During 2012–2014, respondents aged 18–25 years had the highest prevalence of past-month use of illicit drugs for all urban levels. For respondents in this age group, the prevalence increased slightly from 2003–2005 to 2012–2014 in large metropolitan areas while the prevalence remained stable among small metropolitan area respondents and nonmetropolitan area respondents. Past-month use of illicit drugs declined over the study period for the youngest respondents (aged 12–17 years), with the largest decline among small metropolitan area youth.
Author Interviews, CDC, JAMA, Opiods / 19.09.2017

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

MedicalResearch.com Interview with: [caption id="attachment_36629" align="alignleft" width="130"]Julie M. Donohue, Ph.D. Associate professor in Pitt Public Health’s Department of Health Policy and Management and Director of the Medicaid Research Center Pitt’s Health Policy Institute University of Pittsburgh Dr. Donohue[/caption] Julie M. Donohue, Ph.D. Associate professor in Pitt Public Health’s Department of Health Policy and Management and Director of the Medicaid Research Center Pitt’s Health Policy Institute University of Pittsburgh  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Medicaid enrollees have three times higher risk of opioid overdose than non-enrollees, and for every fatal opioid overdose, there are about 30 nonfatal overdoses, according to the U.S. Centers for Disease Control and Prevention (CDC). My colleagues and I analyzed claims data from 2008 to 2013 for all Pennsylvania Medicaid enrollees aged 12 to 64 years with a medical record of a heroin or prescription opioid overdose and who had six months of continuous enrollment in Medicaid before and after the overdose claim. The 6,013 patients identified were divided into two groups—3,945 who overdosed on prescription opioids and 2,068 who overdosed on heroin, all of whom received treatment for overdose in a hospital or emergency department setting. We found that Pennsylvania Medicaid recipients who suffer an opioid or heroin overdose continue to be prescribed opioids at high rates, with little change in their use of medication-assisted treatment programs after the overdose. Opioid prescriptions were filled after overdose by 39.7 percent of the patients who overdosed on heroin, a decrease of 3.5 percentage points from before the overdose; and by 59.6 percent of the patients who overdosed on prescription opioids, a decrease of 6.5 percentage points. Medication-assisted treatment includes coupling prescriptions for buprenorphine, methadone or naltrexone—medications that can reduce opioid cravings—with behavioral therapy in an effort to treat the opioid use disorder. Our team found that such treatment increased modestly among the patients using heroin by 3.6 percentage points to 33 percent after the overdose, and by 1.6 percentage points to 15.1 percent for the prescription opioid overdose patients.
Addiction, Annals Internal Medicine, Author Interviews, Social Issues / 23.08.2017

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.