Статті в журналах з теми "Prescription opioid education"
Щоб переглянути інші типи публікацій з цієї теми, перейдіть за посиланням: Prescription opioid education.
Оформте джерело за APA, MLA, Chicago, Harvard та іншими стилями
Ознайомтеся з топ-50 статей у журналах для дослідження на тему "Prescription opioid education".
Біля кожної праці в переліку літератури доступна кнопка «Додати до бібліографії». Скористайтеся нею – і ми автоматично оформимо бібліографічне посилання на обрану працю в потрібному вам стилі цитування: APA, MLA, «Гарвард», «Чикаго», «Ванкувер» тощо.
Також ви можете завантажити повний текст наукової публікації у форматі «.pdf» та прочитати онлайн анотацію до роботи, якщо відповідні параметри наявні в метаданих.
Переглядайте статті в журналах для різних дисциплін та оформлюйте правильно вашу бібліографію.
1
Weekes, Danielle G., Jenna A. Feldman, Richard E. Campbell, Michael DeFrance, Fotios P. Tjoumakaris, and Luke Austin. "The Incidence of Chronic Opioid Use Following Arthroscopic Rotator Cuff Repair and Patient Opioid Education." Orthopaedic Journal of Sports Medicine 7, no. 7_suppl5 (July 2019): 2325967119S0025. http://dx.doi.org/10.1177/2325967119s00258.
Анотація:
Objectives: Opioids are commonly prescribed for pain management following Arthroscopic Rotator Cuff Repair (ARCR). While their efficacy outweighs their risks in the short term, chronic opioid use is associated with significant adverse effects, such as dependence, endocrine imbalance or respiratory depression. The rate of chronic opioid use and dependence following ARCR is unknown. The purpose of this study is to determine the rate of chronic opioid use following ARCR and establish the effect of preoperative opioid education on reducing chronic consumption. A secondary aim is to determine if any correlation exists between chronic opioid use and shoulder functionality. Methods: A prospective, randomized study of 140 patients undergoing ARCR was performed with a minimum follow-up of 24 months. Patients were randomized to receive preoperative opioid education (risks of abuse, dependence, etc.) or no education. State registry database opioid prescription data monitoring software were utilized to search for all opioid prescriptions following ARCR in our patient population and this was compared to our electronic medical database for accuracy/discrepancy. The total number of opioid prescriptions and number of tablets was determined as well as time from surgery to most recent prescription. Patients were contacted to determine a shoulder Single Assessment Numeric Evaluation (SANE) score and Visual Analog Scale (VAS) pain score. Categorical data was analyzed via chi-squared tests as appropriate. Numeric data was analyzed using t-tests as appropriate. Results: Forty-five patients (32%) continued to fill opioid prescriptions chronically following ARCR. Seventeen (38%) of these patents received pre-operative opioid educated, whereas twenty-eight (62%) did not (p=0.05). Sixty percent of patients with a history of pre-operative opioid use continued to take opioids, while 23% of opioid naive patients continued (p< 0.01). There was no significant difference in SANE (p= 0.53) or VAS (p= 0.65) scores between the education and control group. Patients taking opioids prior to surgery had worse SANE scores (71.28) than the non-users (86.28), p< 0.01. Conclusion: Almost a third of patients will chronically use opioids following ARCR, including 23% of opioid naive patients. Preoperative opioid use is strongly associated with chronic opioid utilization, as well as decreased shoulder function 2 years after ARCR. Preoperative opioid education significantly decreased the rate of chronic opioid use; however, there is no effect on long-term shoulder function. [Table: see text]
2
Manchikanti, Laxmaiah. "Reframing the Prevention Strategies of the Opioid Crisis: Focusing on Prescription Opioids, Fentanyl, and Heroin Epidemic." January 2018 1, no. 21;1 (July 15, 2018): 309–26. http://dx.doi.org/10.36076/ppj.2018.4.309.
Анотація:
The opioid epidemic has been called the “most consequential preventable public health problem in the United States.” Though there is wide recognition of the role of prescription opioids in the epidemic, evidence has shown that heroin and synthetic opioids contribute to the majority of opioid overdose deaths. It is essential to reframe the preventive strategies in place against the opioid crisis with attention to factors surrounding the illicit use of fentanyl and heroin. Data on opioid overdose deaths shows 42,000 deaths in 2016. Of these, synthetic opioids other than methadone were responsible for over 20,000, heroin for over 15,000, and natural and semisynthetic opioids other than methadone responsible for over 14,000. Fentanyl deaths increased 520% from 2009 to 2016 (increased by 87.7% annually between 2013 and 2016), and heroin deaths increased 533% from 2000 to 2016. Prescription opioid deaths increased by 18% overall between 2009 and 2016. The Drug Enforcement Administration (DEA) mandated reductions in opioid production by 25% in 2017 and 20% in 2018. The number of prescriptions for opioids declined significantly from 252 million in 2013 to 196 million in 2017 (9% annual decline over this period), falling below the number of prescriptions in 2006. In addition, data from 2017 shows significant reductions in the milligram equivalence of morphine by 12.2% and in the number of patients receiving high dose opioids by 16.1%. This manuscript describes the escalation of opioid use in the United States, discussing the roles played by drug manufacturers and distributors, liberalization by the DEA, the Food and Drug Administration (FDA), licensure boards and legislatures, poor science, and misuse of evidencebased medicine. Moreover, we describe how the influence of pharma, improper advocacy by physician groups, and the promotion of literature considered peer-reviewed led to the explosive use of illicit drugs arising from the issues surrounding prescription opioids. This manuscript describes a 3-tier approach presented to Congress. Tier 1 includes an aggressive education campaign geared toward the public, physicians, and patients. Tier 2 includes facilitation of easier access to non-opioid techniques and the establishment of a National All Schedules Prescription Electronic Reporting Act (NASPER). Finally, Tier 3 focuses on making buprenorphine more available for chronic pain management as well as for medication-assisted treatment. Key words: Opioid epidemic, fentanyl and heroin epidemic, prescription opioids, National All Schedules Prescription Electronic Reporting Act (NASPER), Prescription Drug Monitoring Programs (PDMPs)
3
Samaan, Dr Zainab. "Association Between Socio-Demographic and Health Functioning Variables Among Patients with Opioid Use Disorder Introduced by Prescription: A Prospective Cohort Study." January 2018 1, no. 21;1 (November 14, 2018): E623—E642. http://dx.doi.org/10.36076/ppj.2018.6.e623.
Анотація:
Background: Prescription opioid misuse in Canada has become a serious public health concern and has contributed to Canada’s opioid crisis. There are thousands of Canadians who are currently receiving treatment for opioid use disorder, which is a chronic relapsing disorder with enormous impact on individuals and society. Objectives: The aim of this study was to compare the clinical and demographic differences between cohorts of patients who were introduced to opioids through a prescription and those introduced to opioids for non-medical purposes. Study Design: This was an observational, prospective cohort study. Setting: The study took place in 19 Canadian Addiction Treatment Centres across Ontario. Methods: We included a total of 976 participants who were diagnosed with Opioid Use Disorder and currently receiving methadone maintenance treatment. We excluded participants who were on any other type of prescription opioid or who were missing their 6-month follow-up urine screens. We measured the participants’ initial source of introduction to opioids along with other variables using the Maudsley Addiction Profile. We also measured illicit opioid use using urine screens at baseline and at 6-months follow-up. Results: Almost half the sample (n = 469) were initiated to opioids via prescription. Women were more likely to be initiated to opioids via a prescription (OR = 1.385, 95% CI 1.027-1.866, P = .033). Those initiated via prescription were also more likely to have post-secondary education, older age of onset of opioid use, less likely to have hepatitis C and less likely to have use cannabis. Chronic pain was significantly associated with initiation to opioids through prescription (OR = 2.720, 95% CI 1.998-3.722, P < .0001). Analyses by gender revealed that men initiated by prescription were less likely to have liver disease and less likely to use cannabis, while women initiated by prescription had a higher methadone dose. Limitations: This project was limited by its study design being observational in nature; no causal relationships can be inferred. Also, the data did not allow determination of the role that the prescribed opioids played in developing opioid use disorder. Conclusions: Our results have revealed that almost half of this methadone maintenance treatment (MMT) population has been introduced to opioids through a prescription. Given that the increasing prescribing rates of opioids has an impact on this at-risk population, alternative treatments for pain should be considered to help decrease this opioid epidemic in Canada. Key words: Opioid use disorder, chronic pain relief, methadone maintenance treatment, prescriptions, male, female
4
Pate, Matthew, Jacob Hall, John Anderson, Donald Bohay, John Maskill, Michelle Padley, Lindsey Behrend, and Omar Yaldo. "Postoperative Pain and Opioid Use Following Surgical Treatment of Ankle Fractures." Foot & Ankle Orthopaedics 4, no. 4 (October 1, 2019): 2473011419S0033. http://dx.doi.org/10.1177/2473011419s00339.
Анотація:
Category: Ankle, Bunion, Trauma Introduction/Purpose: Chronic opioid abuse is one of the greatest public health challenges in the United States. The most common first exposure to opioids comes from acute care prescriptions, such as those after surgery. Moreover, opioids are often prescribed excessively, with current estimates suggesting ˜75% of the pills prescribed are unused. Ankle fractures are the most common operatively treated fracture in orthopaedic surgery, and management of acute pain following surgery is challenging. The optimal perioperative pain regimen is still a point of controversy, as there is limited data available regarding appropriate amount of opioid to prescribe. This study evaluates opioid prescribing techniques of multiple foot and ankle surgeons, and associated patient outcomes. We aim to help surgeons improve their pain management practices and to limit opioid overprescription. Methods: Chart review and phone survey were performed on forty two adult patients within three to six months of ankle fracture fixation at our institution. These patients were offered to voluntarily participate in a standardized questionnaire regarding pain scores, opioid use, non-opioid analgesic use, pain management satisfaction, and patient prescription education. Results: 57% of patients reported that they were given “more” or ”much more” opioid medication than needed, 38% stated that they were given the “right amount”, and 5% reported that they were given ”less” or “much less” than needed. 40.0% were on opioids prior to operation. 53.5% did not require refill of discharge opioid prescriptions, 30.2% of patients did not fill any posteroperative opioid prescription. 16.3% of patients filled their discharge prescription and at least one additionall refill (mean refill = 2.22). Mean number of reported opioid pills taken after surgery was 17.4. Mean satisfaction with overall pain management at phone follow up was 8.6/10. Conclusion: While postoperative pain and management vary substantially, a majority of patients feel that they are given more opioid medication than necessary following ankle fracture repair, and a majority of opioid prescriptions are not completely used. Going forward, it is likely that a majority of patients could experience the same beneficial results with less prescription opioid pain medication, which would reduce overpresciption and potential misuse.
5
Harbaugh, Calista M., Preeti Malani, Erica Solway, Matthias Kirch, Dianne Singer, Michael J. Englesbe, Chad M. Brummett, and Jennifer F. Waljee. "Self-reported disposal of leftover opioids among US adults 50–80." Regional Anesthesia & Pain Medicine 45, no. 12 (October 6, 2020): 949–54. http://dx.doi.org/10.1136/rapm-2020-101544.
Анотація:
ObjectiveTo test the association between self-reported opioid disposal education and self-reported disposal of leftover opioids among older adults.DesignWeb-based survey from the National Poll on Healthy Aging (March 2018) using population-based weighting for nationally representative estimates.SubjectsOlder adults aged 50–80 years who reported filling an opioid prescription within the past 2 years.MethodsRespondents were asked whether they received education from a prescriber or pharmacist on how to dispose of leftover opioids and whether they disposed of leftover opioids from recent prescriptions. The association between self-reported opioid disposal education and self-reported disposal of leftover opioids was estimated with multivariable logistic regression, testing for interactions with respondent demographics.ResultsAmong 2013 respondents (74% response rate), 596 (28.9% (26.8%–31.2%)) were prescribed opioids within the past 2 years. Education on opioid disposal was reported by 40.1% of respondents (35.8%–44.5%). Among 295 respondents with leftover medication, 19.0% (14.6%–24.5%) disposed of the leftover medications. Opioid disposal education was associated with a greater likelihood of self-reported disposal of leftover opioids among non-white respondents as compared with white non-Hispanic respondents (36.7% (16.8%–56.6%) vs 7.8% (0.1%–15.6%), p<0.01).ConclusionsIn this nationally representative survey, 49% had leftover opioids, yet only 20% of older adults reported disposal of leftover opioids. Opioid disposal education was variable in delivery, but was associated with disposal behaviors among certain populations. Strategies to promote disposal should integrate patient education on the risks of leftover opioid medications and explore additional barriers to accessing opioid disposal methods.
6
Brown, Whitnee C., and Kelli Whitted. "Provider Prescription Drug Monitoring Program Utilization and Self-Auditing—A Pilot Study." Journal of Doctoral Nursing Practice 13, no. 2 (July 1, 2020): 142–47. http://dx.doi.org/10.1891/jdnp-d-19-00064.
Анотація:
BackgroundAlabama has the highest prescription rate in the country. The national incidence of overdose deaths from prescription opioids exceeds the combined death rates from heroin and cocaine overdose. Monitoring prescription access should be an essential activity among providers and can be used to protect patient health and well-being. Prescription drug monitoring programs (PDMPs) are tools that assist in diminishing opioid therapy risks such as diversion, abuse, overdose, and death.ObjectiveThe purpose of the study was to examine the effects of an educational intervention on opioid prescriptive rates, frequency of self-auditing and days of opioid supply among healthcare providers. The anticipated goal of the project was that rates and days of supply for opioid prescriptions would decrease.MethodA pretest–posttest design was used to assess a sample of 21 DEA licensed providers who attended a PDMP presentation and conducted a self-audit using the PDMP.ResultsAnalysis showed that 81% of the participants had never conducted a self-audit prior to the intervention. Self-report data indicated that 85.7% of the providers planned to increase their self-auditing use postintervention and 14.3% planned to make no changes to their current use of the PDMP. Among those who prescribed opioids, the range of monthly prescriptions written was 3–142 preintervention (M = 32.28, SD = 41.04) and 3–149 postintervention (M = 32.26, SD = 43.32). Analysis also found the days of opioid supply prescribed were also high. In both cases, these numbers were correlated to patient census.Implications for NursingThe PDMP is an effective surveillance tool that provides aggregate data to state public health officials. For a PDMP to be effective, it must be used by prescribing providers. While the anticipated goal for this study was not achieved, the PDMP is an effective surveillance tool for monitoring the controlled substance prescription histories of patients. Using the PDMP before prescribing can aid providers in distinguishing those who legitimately have a need from those who may be seeking to misuse the medications. Additionally, use of a PDMP can provide aggregate data to state public health officials so that education programs, for practitioners and patients, can be developed.
7
Lee, Matthew L., Lauren B. Camp, Mehul V. Raval, and Eunice Y. Huang. "Opioid Prescribing and Use After Pediatric Umbilical Hernia Repair." American Surgeon 86, no. 5 (May 2020): 437–40. http://dx.doi.org/10.1177/0003134820918261.
Анотація:
Background Opioid overuse is a concern in adult and pediatric populations. Physician education may improve appropriate opioid prescribing and patient instruction for use. Prescribing and use of opioid for pain control after pediatric umbilical hernia repair (UH) before and after surgeon education was evaluated. This is a substudy of a multi-institutional study assessing prescribing practice before and after surgeon education. This study further assessed patient prescription filling pattern and parent report of pain control. Methods A retrospective study was performed evaluating children who underwent UH 6 months before and after an educational presentation on opioid use. Prescriptions, prescription fills, patient medication use, and pain control effectiveness were assessed. Adverse events were collected. Results There were 78 subjects in the pre- and 99 in the posteducation group. Opioid prescribed changed from 98.7% to 61.6% ( P < .0001), and nonopioid prescriptions increased following education ( P = .0063). The number of opioid prescriptions filled decreased ( P = .0296). There were limited data on opioid doses used and quality of pain control, but the posteducation group showed good pain control. There was no difference in adverse events. Discussion Surgeon education on current opioid epidemic and strategies for opioid stewardship improves opioid prescribing and use without adversely impacting pain control or clinical outcome.
8
Madden, Kevin, Akhila Sunkepally Reddy, Maxine Grace De la Cruz, and Eduardo Bruera. "Patterns of storage, use, and disposal of prescription opioids by parents of children with cancer." Journal of Clinical Oncology 37, no. 31_suppl (November 1, 2019): 114. http://dx.doi.org/10.1200/jco.2019.37.31_suppl.114.
Анотація:
114 Background: Multiple studies have demonstrated that adults do not store prescription opioids safely. Increased prescription opioid rates have led to an increased incidence of opioid poisonings in children and adolescents. We investigated whether parents of children with cancer that were prescribed opioids practiced safe storage, use, and disposal techniques. Methods: We conducted a prospective cross-sectional survey of parents whose children were prescribed opioids and asked them about their patterns of storage, use, and disposal of prescription opioids. Results: Virtually all parents (106/109, 97%) completed the survey. Most parents (95/106, 90%) did not store opioids safely. Six of 106 parents (6%) gave their child's opioid pain medication to someone else with pain, and 3 of 106 parents (3%) personally took some of their child’s opioid. Parents who personally took their child’s opioid ( P = .01) or gave it to another person ( P < .001) were more likely to use opioids unsafely with their child. A minority of parents (22/106, 21%) did not use opioids safely in their child. A small number of parents (3/22, 14%) did not dispose of opioids safely. Conclusions: Universal education about the safe, use, and disposal of opioids should be adopted when prescribing opioids. Pediatricians need to maintain vigilance about the nonmedical use of prescription opioid use by parents of children.
9
Harbaugh, Calista M., Gracia Vargas, Kenneth R. Sloss, Lauren A. Bohm, Karen A. Cooper, Aaron L. Thatcher, David A. Zopf, Kao-Ping Chua, Jennifer F. Waljee, and Samir K. Gadepalli. "Association of Opioid Quantity and Caregiver Education with Pain Control after Pediatric Tonsillectomy." Otolaryngology–Head and Neck Surgery 162, no. 5 (March 24, 2020): 746–53. http://dx.doi.org/10.1177/0194599820912033.
Анотація:
Objective To examine whether a service guideline reducing postoperative opioid prescription quantities and caregiver-reported education to use nonopioid analgesics first are associated with caregiver-reported pain control after pediatric tonsillectomy. Study Design Prospective cohort study (July 2018–April 2019). Setting Pediatric otolaryngology service at a tertiary academic children’s hospital. Subjects and Methods Caregivers of patients aged 1 to 11 years undergoing tonsillectomy (N = 764) were surveyed 7 to 21 days after surgery regarding pain control, education to use nonopioid analgesics first, and opioid use. Respondents who were not prescribed opioids or had missing data were excluded. Logistic regression modeled caregiver-reported pain control as a function of service guideline implementation (December 2018) recommending 20 rather than 30 doses for postoperative opioid prescriptions and caregiver-reported analgesic education, adjusting for patient demographics. Results Among 430 respondents (56% response), 387 patients were included. The sample was 43% female with a mean age of 5.0 years (SD, 2.5). Pain control was reported as good (226 respondents, 58%) or adequate/poor (161 respondents, 42%). Mean opioid prescription quantity was 27 doses (SD, 7.9) before and 21 doses (SD, 6.1) after guideline implementation ( P < .001). Education to use nonopioids first was reported by 308 respondents (80%). In regression, prescribing guideline implementation was not associated with pain control (adjusted odds ratio, 1.3; 95% CI, 0.9-2.0; P = .22), but caregiver-reported education to use nonopioids first was associated with a higher odds of good pain control (adjusted odds ratio, 1.9; 95% CI, 1.1-3.2; P = .02). Conclusion Caregiver education to use nonopioid analgesics first may be a modifiable health care practice to improve pain control as postoperative opioid prescription quantities are reduced.
10
Shahi, Niti, Maxene Meier, Ryan Phillips, Gabrielle Shirek, Ashley Banks, John Recicar, Candace Fry, Alan Bielsky, and Steven Moulton. "869 Opioid Utilization in Pediatric Burn Patients." Journal of Burn Care & Research 41, Supplement_1 (March 2020): S273—S274. http://dx.doi.org/10.1093/jbcr/iraa024.435.
Анотація:
Abstract Introduction Childhood burns are extremely common and distressing for children and their parents. Pain is the most common complaint and often thought to be undertreated, disrupting care and increasing the risk of post-traumatic stress disorder. There is limited literature on the role of opioids and multimodal therapy in the treatment of burns in pediatric patients. We sought to evaluate the current use of multimodal therapy as well as the use, storage, and disposal of opioids in this patient population. Methods We prospectively surveyed parents of pediatric burn patients (0–18 years old) who presented to the burn clinic within two weeks of burn injury. Parents were surveyed regarding over-the-counter pain medication use and opioid medication use, storage, and disposal in the treatment of their child. Medians and interquartile ranges were used to describe continuous variables and frequencies and percentages were used for categorical variables. Results A total of 92 parents of burn-injured children were surveyed at a single institution in the outpatient burn clinic. The median age of burn-injured children was 3.1 years old, and 50% of patients were male. The majority had a TBSA of 1%. The hand was the most frequently burned location (45.7%). Acetaminophen (58.7%) and ibuprofen (69.6%) were the most common treatments for both constant and breakthrough pain. Approximately 28% (26/92) of patients were prescribed opioids, of which 18.5% (17/92) filled their prescription. Only 29% of patients (5/17) consumed their entire prescription, and a median of 3 doses of opioids remained for those who did not finish the entire prescription. Parents most commonly decided to give their children opioid pain medications because “my child is in severe pain” or “I give my child pain medications as scheduled (written on prescription).” Approximately 40% (7/17) of patients who filled opioid prescriptions stored them in a locked area, and only 35.3% (6/17) were educated on how to dispose of excess opioid pain medication. Conclusions Presently, multimodal therapy with over-the-counter pain medications is used to treat the majority of pediatric burns. This study demonstrates an increased need for education on opioid administration, storage, and disposal for parents of burn-injured children. Applicability of Research to Practice We aimed to evaluate what current trends in opioid use are in pediatric burn patients and areas for improvement in parent education for over-the-counter pain medication use, opioid use, opioid storage, and disposal. From the study, we were able to glean that the majority of patients are successfully managed with over-the-counter pain medications. However, parents and patients managed with opioids need additional education on appropriate administration of opioid pain medications, safe locked storage of opioids, and opioid disposal. This demonstrates an area for quality improvement inpatient and outpatient.
11
Ukert, Benjamin, Yanlan Huang, Brian Sennett, and Kit Delgado. "State-level variation in opioid prescribing after knee arthroscopy among the opioid-naïve in the USA: 2015–2019." BMJ Open 10, no. 8 (August 2020): e035126. http://dx.doi.org/10.1136/bmjopen-2019-035126.
Анотація:
ObjectiveIt has been established that most patients prescribed opioids after minor surgery have tablets left over, better understanding the variation in opioid prescribing and variation in dosage of the prescription could guide efforts to reduce prescribing. This study describes the state-level variation in opioid prescribing after a knee arthroscopy among opioid-naïve patients.DesignRetrospective cohort study.SettingCommercial insurance claims data.Participants98 623 individual across the USA with commercial insurance who were opioid-naïve and had a knee arthroscopy between 2015 and 2019.ExposurePatients who filled an opioid prescription within 3 days of a knee arthroscopy.Outcome measuresOpioid prescriptions were measured as a pharmacy claim for filling an opioid within 3 days of a knee arthroscopy. We measured the patient and state-level opioid prescribing rate, tablet count, morphine milligram equivalent dose per prescription and risk-adjusted predicted opioid quantity.ResultsOverall, 72% of patients filled an opioid prescription with a median tablet count of 40 and median morphine milligram equivalent of 250. Patients with an invasive procedure (27.9% vs 22.4%; p<0.001), higher education level (p<0.001) and fewer comorbidities (0.9 vs 1.2, p<0.001) had higher rates of opioid prescribing. The prescribing rate in the highest state, Nebraska (85%), was double the prescribing rate in the lowest state, South Dakota (40%). Comparing the casemix adjusted expected prescribing rate to the observed prescribing rate displayed that 18 states had observed prescribing rates that were higher than their expected prescribing rates.ConclusionWide variation in the likelihood of receiving a prescription, depending on state of residence, was observed. The dosages prescribed were high and have been associated with transition to long-term use. These findings suggest that there is substantial opportunity for the development of guidelines to reduce variability in opioid prescribing for this common ambulatory procedure.
12
McDonald, Douglas C., Sharmini Radakrishnan, Alicia C. Sparks, Nida H. Corry, Carlos E. Carballo, Kenneth Carlson, and Valerie A. Stander. "High-risk and Long-term Opioid Prescribing to Military Spouses in the Millennium Cohort Family Study." Military Medicine 185, no. 9-10 (July 22, 2020): e1759-e1769. http://dx.doi.org/10.1093/milmed/usaa146.
Анотація:
Abstract Introduction The use and misuse of opioids by active service members has been examined in several studies, but little is known about their spouses’ opioid use. This study estimates the number of military spouses who received high-risk or long-term opioid prescriptions between 2010 and 2014, and addresses how the Military Health System can help prevent risky prescribing in order to improve military force readiness. Materials and Methods This study used data from the Millennium Cohort Family Study, a nationwide survey of 9,872 spouses of service members with 2 to 5 years of military service, augmented with information from the military’s Pharmacy Data Transaction Service about prescriptions for controlled drugs dispensed to these service members’ spouses. Our objectives were to estimate the prevalence of opioid prescribing indicative of long-term use (≥60 day supply or at least one extended-release opioid prescription in any 3-month period) and, separately, high-risk use (daily dosage of ≥90 morphine mg equivalent or total dosage of ≥8,190 morphine mg equivalent, or prescriptions from more than three pharmacies, or concurrent prescriptions). For each of these dependent variables, we conducted bivariate analyses and multiple logistic regression models using information about spouses’ physical health, sociodemographic characteristics, substance use behaviors, perceived social support, and stresses associated with military stress, among others. Informed consent, including consent to link survey responses to medical and personnel records, was obtained from all participants. The Naval Health Research Center’s Institutional Review Board and the Office of Management and Budget approved the study. Results Spouses were predominantly female (86%), had not served in the military themselves (79%), and were spouses of enlisted (91%) active duty (86%) service members. Almost half (47.6%) of spouses obtained at least one opioid prescription during the 2-year observation window, and 8.5% had received opioid prescriptions that posed risk to their health. About 7% met the criteria for receipt of high-risk opioid prescriptions, 3% obtained opioids from three or more pharmacies during a 3-month period, and 4% of spouses who received any opioids received both long-term and high-risk prescriptions. Adverse childhood experiences, physical pain, and lack of social support were associated with increased odds of obtaining high-risk opioid prescriptions. Conclusions Approximately 48% of military spouses had used Military Health System insurance to fill at least one opioid prescription during the 2-year observation period. The Department of Defense has taken measures to minimize high-risk opioid prescribing, including passing prescribing guidelines in 2017, establishing the controlled drug management analysis reporting tool, establishing a pain management education and training program, and more. These efforts should continue to expand as reducing the numbers of service members and spouses at risk for adverse events may be effective in reducing opioid misuse and improve the overall health and safety of military spouses and thus, the readiness of the U.S. Armed Forces.
13
Mears, MD, PhD, Simon C., Asa Shnaekel, MD, MPH, John Wilkinson, MD, Caroline Chen, BS, and C. Lowry Barnes, MD. "A departmental policy can reduce opioid prescribing after orthopedic surgery." Journal of Opioid Management 16, no. 1 (January 1, 2020): 41–47. http://dx.doi.org/10.5055/jom.2020.0549.
Анотація:
Objective: The authors hypothesized that implementation of a department-wide opioid prescribing program would reduce opioid tablets and morphine milligram equivalents (MMEs) prescribed as well as prescription refills.Design: A retrospective study was conducted to determine the effects of a department wide opioid prescribing policy.Setting: A university teaching hospital Orthopaedic Surgery Department. Patients, participants: All prescriptions written by members of our department were reviewed for 3 months before and 3 months after program implementation. There were 1,445 patients in the pre-intervention and 1,209 patients in the postintervention cohort. Two thousand two hundred forty-six total prescriptions written during the pre-intervention period and 1,530 written during the post-intervention period of the study.Interventions: A departmental opioid prescribing policy was introduced through several department teaching sessions. The policy included recommendations on numbers of tablets per procedures and patient education about the dangers of narcotic medications.Main outcome measure(s): The primary study outcome measures were the number of opioid tablets prescribed, the number of MMEs prescribed, and the number of prescription refills.Results: The mean number of tablets per prescription decreased from 47.2 (95% confidence interval (CI): 46.4-47.9) tablets in the pre-intervention cohort to 39.2 (95% CI: 38.1-40.4) tablets in the post-intervention cohort (p 0.0001). Likewise, the mean MME per prescription decreased from 354 (95% CI: 344-364) in the pre-intervention cohort to 265 (95% CI: 249-281) in the post-intervention cohort (p 0.0001). A refill prescription was provided 949 times in the pre-intervention group and 404 times in the post-intervention group. Prior to the introduction of prescription guidelines, the average number of prescriptions was 1.76 per patient (95% CI: 1.71-1.81). This fell to 1.34 prescriptions per patient (95% CI: 1.31-1.38) after policy institution. Noncompliance with policy was not related to provider, service, or procedure size. Conclusions: Implementation of a departmental policy can successfully reduce the number of opioid tablets and MMEs prescribed per procedure. Policies also decrease the number of refill prescriptions per procedure. Standardization of prescription practices is effective in improving opioid prescription stewardship. Level of evidence: Level III, retrospective cohort study.
14
Hanna, Marie N., Traci J. Speed, Ronen Shechter, Michael C. Grant, Rosanne Sheinberg, Elizabeth Goldberg, Claudia M. Campbell, Nicholas Theodore, Colleen G. Koch, and Kayode Williams. "An Innovative Perioperative Pain Program for Chronic Opioid Users: An Academic Medical Center’s Response to the Opioid Crisis." American Journal of Medical Quality 34, no. 1 (May 23, 2018): 5–13. http://dx.doi.org/10.1177/1062860618777298.
Анотація:
Increased utilization of prescription opioids for pain management has led to a nationwide public health crisis with alarming rates of addiction and opioid-related deaths. In the surgical setting, opioid prescriptions have been implicated as a contributing factor to the opioid epidemic. The authors developed an innovative model to address aspects of pain management and opioid utilization during preoperative evaluation, acute surgical hospitalization, and postoperative follow-up for chronic opioid users. This program involves multidisciplinary teams that include acute and chronic pain specialists, psychiatrists, integrative medicine specialists, and physical medicine and rehabilitation services. It also features a novel infrastructure for triage and pain management education and treatment. Individualized patient plans are devised that can include preoperative opioid weaning, regional anesthesia that minimizes opioid use, and multimodal techniques for surgical pain treatment. Multidisciplinary programs such as this have the potential to both improve perioperative pain control and prevent escalation of opioid use among chronic opioid users.
15
Tran, M., C. Thompson, C. Walsh, S. McLeod, and B. Borgundvaag. "LO64: A systematic review of interventions to influence opioid prescribing from the emergency department." CJEM 22, S1 (May 2020): S30—S31. http://dx.doi.org/10.1017/cem.2020.119.
Анотація:
Introduction: The opioid crisis has reached epidemic levels in Canada, driven in large part by prescription drug use. Emergency physicians are frequent prescribers of opioids; therefore, the emergency department (ED) represents an important setting for potential intervention to encourage rational and safe prescribing. The objective of this study was to systematically review the literature on interventions aimed to influence opioid prescribing in the ED. Methods: Electronic searches of Medline and Cochrane were conducted and reference lists were hand-searched. All quantitative studies published in English from 2009 to 2019 were eligible for inclusion. Two reviewers independently screened the search output to identify potentially eligible studies, the full texts of which were retrieved and assessed for inclusion. Outcomes of interest included opioid prescribing rate (proportion of ED visits resulting in an opioid prescription at discharge), morphine milligram equivalents per prescription and variability among prescribers. Results: The search strategy yielded 797 potentially relevant citations. After eliminating duplicate citations and studies that did not meet eligibility criteria, 34 potentially relevant studies were retrieved in full text. Of these, 28 studies were included in the review. The majority (26, 92.9%) of studies were based in the United States and two (7.1%) were from Australia. Four (14.3%) were randomized controlled trials. The interventions were classified into six categories: prescribing guidelines (n = 10), regulation/rescheduling of opioids (n = 6), prescribing data transparency (n = 4), education (n = 4), care coordination (n = 3), and electronic medical record changes (n = 1). The majority of interventions reduced the opioid prescribing rate from the ED (21/28, 75.0%), although regulation/rescheduling of opioids had mixed effectiveness, with 3/6 (50%) studies reporting a small increase in the opioid prescribing rate post-intervention. Education had small yet consistent effects on reducing the opioid prescribing rate. Conclusion: A variety of interventions have attempted to improve opioid prescribing from the ED. These interventions include prescribing guidelines, regulation/rescheduling, data transparency, education, care coordination, and electronic medical record changes. The majority of interventions reduced the opioid prescribing rate; however, regulation/rescheduling of opioids demonstrated mixed effectiveness.
16
Balough, Meghan, Stephen Nwankpa, and Elizabeth Unni. "Readiness of Pharmacists Based in Utah About Pain Management and Opioid Dispensing." Pharmacy 7, no. 1 (January 15, 2019): 11. http://dx.doi.org/10.3390/pharmacy7010011.
Анотація:
Prescription opioid use disorder is a growing epidemic and pharmacists as the dispensers of prescription drugs can play a crucial role in the management of the opioid crisis. However, few studies have examined pharmacists’ perceptions of their role in it. The objective of this study was to evaluate the perceptions of pharmacists in Utah regarding their role in the opioid epidemic. The study utilized a cross sectional online survey design to understand the pharmacist knowledge and beliefs regarding pain management, opioids, naloxone, and the various opioid risk identification tools. Frequencies, t-tests, and chi-squared were used to describe and analyze the data. A total of 239 surveys were qualified for analysis. Analysis showed that pharmacists have positive attitudes towards opioid crisis management; however, this positive attitude was higher among newer pharmacists. Though the pharmacists were knowledgeable with the opioid pharmacotherapy and prescribing guidelines, they demonstrated education needs for hands-on training when faced with a situation of prescription opioid use disorder in their practice. The use of risk identification tools was not prevalent. Results show lack of active participation by pharmacists in this major public health challenge, and the need for education in several aspects of opioid dispensing, naloxone use, and efficient use of risk identification tools.
17
Andelman, Steven M., Nicholas Debellis, Daniel Bu, University of Connecticut, Chukwuma Nwachukwu, James N. Gladstone, and Alexis Chiang Colvin. "Preoperative Education Significantly Decreases Postoperative Opioid Use after Arthroscopic Meniscectomy." Orthopaedic Journal of Sports Medicine 7, no. 7_suppl5 (July 2019): 2325967119S0035. http://dx.doi.org/10.1177/2325967119s00355.
Анотація:
Objectives: Arthroscopic meniscectomy is one of the most common procedures in orthopedic surgery and is thus a frequent reason for prescription of post-operative opioid narcotics. Recent emphasis has been placed on limiting the number of opioid pills given for post-operative analgesia, with the goal being to provide adequate post-operative pain control while minimizing the number of unused pills after surgery. A number of modifiable variables have been identified to prevent over-prescription of opioids including prescriber education and identification of patient-specific factors associated with increased opioid use. To date, no study has evaluated the role of patient education to decrease post-operative opioid use. The goal of this study is to determine the utility of pre-operative patient education in decreasing post-operative opioid consumption after arthroscopic meniscectomy. Methods: All patients 18 years and older from a group of five attending surgeons undergoing isolated arthroscopic unicompartmental meniscectomy were prospectively identified for inclusion in this cohort study. Patients were split into two groups: patients in Group 1 did not receive any specific education regarding opioid usage after surgery while patients in Group 2 received a formalized three-minute overview from a physician on both appropriate usage of opioid narcotics as well as options for non-narcotic post-operative analgesia. Patients were assigned to each group consecutively - all patients at the beginning of the study were assigned to Group 1 while all patients at the end of the study were assigned to Group 2. Post-operatively, patients in both groups were surveyed via phone call one, two, three, and four weeks after surgery to determine the number of opioid pills taken each week. Patient descriptive statistics and post-operative opioid consumption were analyzed and compared between the two groups. Results: 62 patients completed the study, with 32 in Group 1 (no pre-operative education) and 24 in Group 2 (received pre-operative education). There were no significant demographic differences between the two groups. Patients in Group 1 used an average of 16.71 (95% CI, 9.67-23.75) opioid pills after surgery while patients in Group 2 used an average 3.21 (95% CI, 1.78-6.06) opioids after surgery. Patients in Group 2 used 13.5 less opioid pills (p = 0.001) representing a 420.0% decrease in post-operative opioid consumption over a four-week course (Figure 1). 7 (21.9%) patients in Group 1 continued to take opioid pills four weeks after surgery, while only 1 (4.2%) patient in Group 2 did the same. Conclusion: Pre-operative patient education regarding appropriate usage of opioid and options for non-narcotic analgesia significantly decreases post-operative opioid consumption and the duration which patients take opioid pills after arthroscopic meniscectomy. Pre-operative education is quick and inexpensive method to decrease post-operative opioid prescription requirements. [Figure: see text]
18
Kahl, Lauren Krystine, Martha W. Stevens, Andrea C. Gielen, Eileen M. McDonald, and Leticia Ryan. "Characteristics of opioid prescriptions for discharged pediatric emergency department patients with acute injuries." Journal of Investigative Medicine 67, no. 6 (May 19, 2019): 1024–27. http://dx.doi.org/10.1136/jim-2019-001035.
Анотація:
This study describes the characteristics of opioid prescriptions for pediatric patients discharged from the emergency department (ED) with acute injuries, including type, formulation, quantity dispensed, and associations with patient age group and prescriber level of training. This retrospective cohort study enrolled all acutely injured patients receiving opioid prescriptions at discharge from an urban academic pediatric ED in a 1-year period. Electronic medical records were reviewed to abstract clinical and prescription data and prescriber level of training. Descriptive statistics were used for analysis. We identified 254 patients with injuries who received opioid prescriptions at ED discharge during the study period (mean age 9.5 years, 65% male). The most common injury was fracture (71%). Oxycodone was the opioid most frequently prescribed (96.1%). Liquid formulations were prescribed in 51.6% of cases. The median number of doses prescribed per prescription was 12 (SD±9.1), with a range of 1–50. Residents wrote 72.9% of prescriptions and prescribed more doses than non-residents (15.5 vs 12.2, p=0.01). Post-graduate year 2 (PGY2) residents prescribed more doses than PGY1 or PGY3+ residents. Our data show wide variation in the number of opioid doses prescribed to acutely injured pediatric patients at ED discharge and frequent use of liquid formulation; both factors may place this population at risk for accidental ingestion. These findings also support the development of pediatric clinical guidelines to define appropriate quantities of opioids to prescribe, promote poisoning prevention strategies, and design post-graduate education for medical trainees about safe prescribing practices.
19
Sheldon, Rowan R., Jessica B. Weiss, Woo S. Do, Dominic M. Forte, Preston L. Carter, Matthew J. Eckert, and Vance Y. Sohn. "Stemming the Tide of Opioid Addiction—Dramatic Reductions in Postoperative Opioid Requirements Through Preoperative Education and a Standardized Analgesic Regimen." Military Medicine 185, no. 3-4 (October 17, 2019): 436–43. http://dx.doi.org/10.1093/milmed/usz279.
Анотація:
Abstract Introduction Surgery is a known gateway to opioid use that may result in long-term morbidity. Given the paucity of evidence regarding the appropriate amount of postoperative opioid analgesia and variable prescribing education, we investigated prescribing habits before and after institution of a multimodal postoperative pain management protocol. Materials and Methods Laparoscopic appendectomies, laparoscopic cholecystectomies, inguinal hernia repairs, and umbilical hernia repairs performed at a tertiary military medical center from 01 October 2016 until 30 September 2017 were examined. Prescriptions provided at discharge, oral morphine equivalents (OME), repeat prescriptions, and demographic data were obtained. A pain management regimen emphasizing nonopioid analgesics was then formulated and implemented with patient education about expected postoperative outcomes. After implementation, procedures performed from 01 November 2017 until 28 February 2018 were then examined and analyzed. Additionally, a patient satisfaction survey was provided focusing on efficacy of postoperative pain control. Results Preprotocol, 559 patients met inclusion criteria. About 97.5% were provided an opioid prescription, but prescriptions varied widely (256 OME, standard deviation [SD] 109). Acetaminophen was prescribed often (89.5%), but nonsteroidal anti-inflammatory drug (NSAID) prescriptions were rare (14.7%). About 6.1% of patients required repeat opioid prescriptions. After implementation, 181 patients met inclusion criteria. Initial opioid prescriptions decreased 69.8% (77 OME, SD 35; P < 0.001), while repeat opioid prescriptions remained statistically unchanged (2.79%; P = 0.122). Acetaminophen prescribing rose to 96.7% (P = 0.002), and NSAID utilization increased to 71.0% (P < 0.001). Postoperative survey data were obtained in 75 patients (41.9%). About 68% stated that they did not use all of the opioids prescribed and 81% endorsed excellent or good pain control throughout their postoperative course. Conclusions Appropriate preoperative counseling and utilization of nonopioid analgesics can dramatically reduce opioid use while maintaining high patient satisfaction. Patient-reported data suggest that even greater reductions may be possible.
20
Saffore, Christopher D., Sarette T. Tilton, Stephanie Y. Crawford, Michael A. Fischer, Todd A. Lee, A. Simon Pickard, and Lisa K. Sharp. "Identification of barriers to safe opioid prescribing in primary care: a qualitative analysis of field notes collected through academic detailing." British Journal of General Practice 70, no. 697 (June 15, 2020): e589-e597. http://dx.doi.org/10.3399/bjgp20x711737.
Анотація:
Background Understanding barriers to safe opioid prescribing in primary care is critical amid the epidemic of prescription opioid abuse, misuse, and overdose in the US. Educational outreach strategies, such as academic detailing (AD), provide a forum for identification of barriers to, and strategies to facilitate, safe opioid prescribing in primary care.AimTo identify barriers to safe opioid prescribing among primary care providers (PCPs) through AD.Design and settingQualitative analysis of data was collected through an existing AD intervention to improve safe opioid prescribing in primary care. The AD intervention was delivered from June 2018 to August 2018 to licensed PCPs with prescriptive authority within a large independent health system in the metropolitan Chicagoland area.MethodThe AD intervention involved visits by trained detailers to PCPs who contemporaneously documented details from each visit via field notes. Using qualitative analysis, field notes were analysed to identify recurring themes related to opioid prescribing barriers.ResultsDetailer-entered field notes from 186 AD visits with PCPs were analysed. Barriers to safe opioid prescribing were organised into six themes: 1) gaps in knowledge; 2) lack of prescription monitoring programme (PMP) utilisation; 3) patient pressures to prescribe opioids; 4) insurance coverage policies; 5) provider beliefs; and 6) health system pain management practices.ConclusionBarriers to safe opioid prescribing in primary care, identified through AD visits among this large group of PCPs, support the need for continued efforts to enhance pain-management education, maximise PMP utilisation, and increase access to, and affordability of, non-opioid treatments.
21
Manchikanti, Laxmaiah. "National Drug Control Policy and Prescription Drug Abuse: Facts and Fallacies." Pain Physician 3;10, no. 5;3 (May 14, 2007): 399–424. http://dx.doi.org/10.36076/ppj.2007/10/399.
Анотація:
In a recent press release Joseph A. Califano, Jr., Chairman and President of the National Center on Addiction and Substance Abuse at Columbia University called for a major shift in American attitudes about substance abuse and addiction and a top to bottom overhaul in the nation’s healthcare, criminal justice, social service, and eduction systems to curtail the rise in illegal drug use and other substance abuse. Califano, in 2005, also noted that while America has been congratulating itself on curbing increases in alcohol and illicit drug use and in the decline in teen smoking, abuse and addition of controlled prescription drugs-opioids, central nervous system depressants and stimulants-have been stealthily, but sharply rising. All the statistics continue to show that prescription drug abuse is escalating with increasing emergency department visits and unintentional deaths due to prescription controlled substances. While the problem of drug prescriptions for controlled substances continues to soar, so are the arguments of undertreatment of pain. The present state of affairs show that there were 6.4 million or 2.6% Americans using prescription-type psychotherapeutic drugs nonmedically in the past month. Of these, 4.7 million used pain relievers. Current nonmedical use of prescription-type drugs among young adults aged 18-25 increased from 5.4% in 2002 to 6.3% in 2005. The past year, nonmedical use of psychotherapeutic drugs has increased to 6.2% in the population of 12 years or older with 15.172 million persons, second only to marijuana use and three times the use of cocaine. Parallel to opioid supply and nonmedical prescription drug use, the epidemic of medical drug use is also escalating with Americans using 80% of world’s supply of all opioids and 99% of hydrocodone. Opioids are used extensively despite a lack of evidence of their effectiveness in improving pain or functional status with potential side effects of hyperalgesia, negative hormonal and immune effects, addiction and abuse. The multiple reasons for continued escalation of prescription drug abuse and overuse are lack of education among all segments including physicians, pharmacists, and the public; ineffective and incoherent prescription monitoring programs with lack of funding for a national prescription monitoring program NASPER; and a reactive approach on behalf of numerous agencies. This review focuses on the problem of prescription drug abuse with a discussion of facts and fallacies, along with proposed solutions. Key words: Prescription drug abuse, opioid abuse, opioid misuse, National Drug Control Policy, NASPER, prescription drug monitoring programs.
22
Shanahan, Christopher W., Olivia Reding, Inga Holmdahl, Julia Keosaian, Ziming Xuan, David McAneny, Marc Larochelle, and Jane Liebschutz. "Opioid analgesic use after ambulatory surgery: a descriptive prospective cohort study of factors associated with quantities prescribed and consumed." BMJ Open 11, no. 8 (August 2021): e047928. http://dx.doi.org/10.1136/bmjopen-2020-047928.
Анотація:
ObjectivesTo prospectively characterise: (1) postoperative opioid analgesic prescribing practices; (2) experience of patients undergoing elective ambulatory surgeries and (3) impact of patient risk for medication misuse on postoperative pain management.DesignLongitudinal survey of patients 7 days before and 7–14 days after surgery.SettingAcademic urban safety-net hospital.Participants181 participants recruited, 18 surgeons, follow-up data from 149 participants (82% retention); 54% women; mean age: 49 years.InterventionsNone.Primary and secondary outcome measuresTotal morphine equivalent dose (MED) prescribed and consumed, percentage of unused opioids.ResultsSurgeons postoperatively prescribed a mean of 242 total MED per patient, equivalent to 32 oxycodone (5 mg) pills. Participants used a mean of 116 MEDs (48%), equivalent to 18 oxycodone (5 mg) pills (~145 mg of oxycodone remaining per patient). A 10-year increase in patient age was associated with 12 (95% CI (−2.05 to –0.35)) total MED fewer prescribed opioids. Each one-point increase in the preoperative Graded Chronic Pain Scale was associated with an 18 (6.84 to 29.60) total MED increase in opioid consumption, and 5% (−0.09% to –0.005%) fewer unused opioids. Prior opioid prescription was associated with a 55 (5.38 to –104.82) total MED increase in opioid consumption, and 19% (−0.35% to –0.02%) fewer unused opioids. High-risk drug use was associated with 9% (−0.19% to 0.002%) fewer unused opioids. Pain severity in previous 3 months, high-risk alcohol, use and prior opioid prescription were not associated with postoperative prescribing practices.ConclusionsParticipants with a preoperative history of chronic pain, prior opioid prescription, and high-risk drug use were more likely to consume higher amounts of opioid medications postoperatively. Additionally, surgeons did not incorporate key patient-level factors (eg, substance use, preoperative pain) into opioid prescribing practices. Opportunities to improve postoperative opioid prescribing include system changes among surgical specialties, and patient education and monitoring.
23
Sturgill, Karli, Richard B. Lou, and Maryke Bard. "812 Standardization of Burn Pain Control in the Outpatient Burn Population." Journal of Burn Care & Research 41, Supplement_1 (March 2020): S245. http://dx.doi.org/10.1093/jbcr/iraa024.389.
Анотація:
Abstract Introduction Nationwide there is a recognized need for regulation and standardization of prescription opioids for acute pain due to the opioid epidemic. Limited data exists about standardization of burn pain treatment in the outpatient setting; however, there are various treatment plans and minimal regulation of opioid prescriptions. The purpose of this study was to create a method of standardization of burn pain treatment and prescription of opioids for the burn outpatient. Methods A retrospective chart review was performed analyzing burn outpatient pain control regimens and indications for prescription opioids at a verified burn center. Factors such as burn size (TBSA), anatomical location, hospital length of stay, procedural sedation use, past medical history, surgical intervention, time since surgery, and psych history or elevated depression score were examined to create an objective scorecard. From the collected data, a treatment tier was created using ibuprofen and acetaminophen alternation as baseline pain control. The second and third tiers added oxycodone in increasing frequency for breakthrough of severe pain. Two exceptions were created for active cellulitis and a burn presenting in the first 12 hours since injury. Remaining unused opioid doses were also reviewed. Results Preliminary data collected from a 3 month trial demonstrated no significant change in the amount of opioids prescribed. There were 136 patients treated by burn advanced practice providers and the scorecard was used on 68 patients. On average, 7 opioid unused doses were remaining. Data using the current scorecard continues to be collected in the outpatient burn population. Conclusions Initial results conclude that there was no significant change in the amount of opioids prescribed but compliance was found to be a limiting factor in the data, as the scorecard was only used in 50% of the patients treated by the burn advance practice providers. Additional studies are needed to quantify improved compliance, patient satisfaction and increase in patient education on the treatment of pain. Applicability of Research to Practice A pain medication tool to standardize pain treatment for the outpatient may be valuable in burn centers.
24
Grol-Prokopczyk, Hanna. "Use and Opinions of Prescription Opioids Among Older American Adults: Sociodemographic Predictors." Journals of Gerontology: Series B 74, no. 6 (August 13, 2018): 1009–19. http://dx.doi.org/10.1093/geronb/gby093.
Анотація:
Abstract Objectives This study identifies sociodemographic predictors of prescription opioid use among older adults (age 65+) during the peak decade of U.S. opioid prescription, and tests whether pain level and Medicaid coverage mediate the association between low wealth and opioid use. Predictors of prescription nonsteroidal anti-inflammatory drug (NSAID) use, and of opinions of both drug classes, are also examined. Method Regressions of opioid and NSAID use on sociodemographic characteristics, pain level, and insurance type were conducted using Health and Retirement Study 2004 core and 2005 Prescription Drug Study data (n = 3,721). Mediation analyses were conducted, and user opinions of drug importance, quality, and side effects were assessed. Results Low wealth was a strong, consistent predictor of opioid use. Both pain level and Medicaid coverage significantly, but only partially, mediated this association. Net of wealth, there were no significant associations between education and use of, or opinions of, either class of drugs. Discussion Among older American adults, the poorest are disproportionately likely to have been exposed to prescription opioid analgesics. Wealth, rather than education, drove social class differences in mid-2000s opioid use. Opioid-related policies should take into account socioeconomic contributors to opioid use, and the needs and treatment histories of chronic pain patients.
25
Reddy, Akhila Sunkepally, Julio Silvestre, Maxine Grace De la Cruz, Jimin Wu, Diane D. Liu, Eduardo Bruera, and Knox H. Todd. "Patterns of storage, use, and disposal of opioids among cancer patients presenting to the emergency center." Journal of Clinical Oncology 33, no. 29_suppl (October 10, 2015): 184. http://dx.doi.org/10.1200/jco.2015.33.29_suppl.184.
Анотація:
184 Background: Approximately 75% of prescription opioid abusers obtain the drug from an acquaintance. Improper opioid storage, use, and disposal along with lack of patient education may lead to increased availability of the drug for abuse by others. Our aim was to determine the opioid storage, use, and disposal patterns in patients presenting to the emergency center (EC) of a comprehensive cancer center. Methods: We surveyed 113 cancer patients receiving opioids for at least 2 months and collected information regarding opioid use, storage, and disposal. Unsafe storage was defined as storing the opioids in plain sight and sharing or losing their opioids was defined as unsafe use. Results: The median age was 53 years, 55% were female, and 64% were white and 86% had advanced cancer. 19% of the patients had history of illicit drug use and 24% reported that drug abuse is prevalent in their neighborhood. 59% obtained the opioid from their oncologist and 6% believed they were prescribed more medication than required. Of the 113 respondents, 36% stored opioids in plain sight, 53% kept them hidden but unlocked, and only 15% locked their opioids. 73% agreed that they would use a lockbox to store their opioids if given one, 78% were unaware of proper opioid disposal methods, and 67% had unused opioids at home. Only 13% previously received education about safe disposal of opioids. Patients who reported that others have asked them for their pain medications (P = .004) and those who would use a lockbox if given one (P = .019) were more likely to keep them locked. 13 patients (12%) used opioids unsafely by either sharing (5%) or losing (8%) them. Patients who reported to being prescribed more pain pills than required (P = .032), others having asked them for their pain pills (P = .06), being unemployed (P = .07), and those who were unaware of drug take-back programs (P = .06) were more likely to participate in unsafe use. Overall, 77% (87) of the patients reported unsafe storage, unsafe use, or possessed unused opioids at home. Conclusions: A large number of cancer patients improperly and unsafely store, use, or dispose of opioids. More research is needed to determine whether patient education has an effect on minimizing prescription opioid abuse.
26
Moride, Yola. "A Systematic Review of Interventions and Programs Targeting Appropriate Prescribing of Opioids." Pain Physician 3, no. 22;3 (May 11, 2019): 229–40. http://dx.doi.org/10.36076/ppj/2019.22.229.
Анотація:
Background: Canada and the United States have the highest levels of prescription opioid consumption in the world. In an attempt to curb the opioid epidemic, a variety of interventions have been implemented. Thus far, evidence regarding their effectiveness has not been consolidated. Objectives: The objectives of this study were to: 1) identify interventions that target opioid prescribing; 2) assess and compare the effectiveness of interventions on opioid prescription and related harms; 3) determine the methodological quality of evaluation studies. Study Design: The study involved a systematic review of the literature including bibliographical databases and gray literature sources. Setting: Systematic review including bibliographical databases and gray literature sources. Methods: We searched MEDLINE, Embase, and LILACS databases from January 1, 2005 to September 23, 2016 for any intervention that targeted the prescription of opioids. We also examined websites of relevant organizations and scanned bibliographies of included articles and reviews for additional references. The target population was that of all health care providers (HCPs) or users of opioids with no restriction on indication. Endpoints were those related to process (implementation), outcomes (effectiveness), or impact. Sources were screened independently by 2 reviewers using pre-defined eligibility criteria. Synthesis of findings was qualitative; no pooling of results was conducted. Results: Literature search yielded 12,278 unique sources. Of these, 142 were retained. During full-text review, 75 were further excluded. Searches of the gray literature and bibliographies yielded 49 additional sources. Thus, a total of 95 distinct interventions were identified. Over half consisted of prescription monitoring programs (PMPs) and mainly targeted HCPs. Evaluation studies addressed mainly opioid prescription rate (30.6%), opioid use (19.4%), or doctor shopping or diversion (9.7%). Fewer studies considered overdose death (9.7%), abuse (9.7%), misuse (4.2%), or diversion (5.6%). Study designs consisted of cross-sectional surveys (23.3%), pre-post intervention (26.7%), or time series without a comparison group (13.3%), which limit the robustness of the evidence. Although PMPs and policies have been associated with a reduction in opioid prescription, their impact on appropriateness of use according to clinical guidelines and restriction of access to patients in need is inconsistent. Continuing medical education (CME) and pain management programs were found effective in improving chronic pain management, but studies were conducted in specific settings. The impact of interventions on abuse and overdose-death is conflicting. Limitations: Due to the very large number of publications and programs found, it was difficult to compare interventions owing to the heterogeneity of the programs and to the methodologies of evaluation studies. No assessment of publication bias was done in the review. Conclusions: Evidence of effectiveness of interventions targeting the prescription of opioids is scarce in the literature. Although PMPs have been associated with a reduction in the overall prescription rates of Schedule II opioids, their impact on the appropriateness of use taking into consideration benefits, misuse, legal and illegal use remains elusive. Our review suggests that existing interventions have not addressed all determinants of inappropriate opioid prescribing and usage. A well-described theoretical framework would be the backdrop against which targeted interventions or policies may be developed. Key words: Opioid, prescription, abuse, misuse, diversion, interventions, prescription monitoring programs
27
Shahi, Niti, Maxene Meier, Ryan Phillips, Gabrielle Shirek, Adam Goldsmith, John Recicar, Jeannie Zuk, Alan Bielsky, Myron Yaster, and Steven Moulton. "Pain Management for Pediatric Burns in the Outpatient Setting: A Changing Paradigm?" Journal of Burn Care & Research 41, no. 4 (April 18, 2020): 814–19. http://dx.doi.org/10.1093/jbcr/iraa049.
Анотація:
Abstract Childhood burns are common and distressing for children and their parents. Pain is the most common complaint and often thought to be undertreated, which can negatively influence the child’s care and increase the risk of posttraumatic stress disorder. There is limited literature on the role of opioids and multimodal therapy in the treatment of pediatric outpatient burns. We sought to evaluate the current use of opioids (including the use of multimodal therapies), storage, and disposal of opioids in this patient population. Parents of burn-injured children 8 months to 18 years old, who were seen in an outpatient setting within 2 weeks of their burn injury, were queried from April to December 2019 regarding their child’s pain control, opioid medication use, over-the-counter pain medication use, opioid storage, and disposal. A total of 142 parents of burn-injured children and their parents were surveyed. The median age of the burn-injured children was 2.7 years old and the majority (54.2%; 77/142) were male. The mean total body surface area (TBSA) was 1.8% and half sustained burn injuries to one or both hands. The most frequently used regimens for constant and/or breakthrough pain control were acetaminophen (62.7%) and nonsteroidal anti-inflammatory drugs (NSAIDs; 68.3%). Less than one fifth (26/142;18%) of patients were prescribed opioids and 88% filled their prescription. The median number of doses of opioids prescribed was eight doses, with a median of four doses of opioids unused. Only three patients used all of their prescribed opioids and no patient ≥12 years old used their entire prescription. Burns greater than 3% TBSA, irrespective of burn injury location, were associated with opioid prescription (P = .003). Approximately 40% (10/26) of parents who filled their child’s opioid prescription stored the opioid in a locked area. Fewer than one third (7/26) of patients were educated on how to dispose of excess opioid pain medication. Overall, most pediatric outpatient burn injuries can be successfully managed with over-the-counter medications. Providers, who care for burn-injured children ≤ 12 years old with burns that cover ≥3% TBSA in the outpatient setting, should consider no more than four opioid doses for initial pain control. This guideline, coupled with family and provider-centered education on multimodal therapy at the time of initial presentation and safe use of opioids, are important first steps to minimizing the use of opioids in the management of small area burns in children.
28
Omaki, Elise, Renan Castillo, Karen Eden, Steve Davis, Eileen McDonald, Umbreen Murtaza, and Andrea Gielen. "Using m-health tools to reduce the misuse of opioid pain relievers." Injury Prevention 25, no. 4 (April 6, 2017): 334–39. http://dx.doi.org/10.1136/injuryprev-2017-042319.
Анотація:
BackgroundEmergency department (ED) patients are among the many groups at risk for prescription drug overdose. There is limited research on how best to communicate with ED patients about options for pain management and the risks of opioids. The aim of this study is to pilot test a web-based, patient-centred educational programme that encourages the patient to have an informed discussion about pain medication options with their ED provider.MethodsThis multisite, randomised trial will evaluate an m-health programme designed to aid the patient in making an informed decision about their pain treatment. Patients reporting to the ED with an injury-related or pain- related chief complaint who agree to participate are randomised to receive the intervention programme, My Healthy Choices, or an attention-matched control. My Healthy Choices pairs tailored education with a patient decision aid to describe what opioid and non-opioid pain medications are, assess the patient's risk factors for opioid-related adverse effects, and produce a tailored report that patients are encouraged to share with their doctor. Data are collected through surveys at three time points during the ED encounter (baseline, immediately after the intervention and just before discharge), and at a 6-week follow-up survey. The primary outcomes are whether the patient prefers an opioid pain reliever (OPR) and whether the patient takes an OPR.DiscussionWe hope this programme will facilitate patient-provider communication, as well as reduce the number of prescriptions written for OPRs and thus the number of patients exposed to prescription opioids and the associated risks of addiction and overdose.Trial registration numberNCT03012087; Pre-results.
29
Tubbs, Andrew, Michelle Naps, Michael Grandner, and Louis Rivera. "350 Opioid Use and Abuse are Associated with Use of Sedative Hypnotic Medications." Sleep 44, Supplement_2 (May 1, 2021): A140. http://dx.doi.org/10.1093/sleep/zsab072.349.
Анотація:
Abstract Introduction The Department of Health and Human Services recently reported that 10.3 million people misused opioid drugs in 2018. Recent research attributed 21% of the deaths from opioid overdose to benzodiazepines. The overdose data and clinical experience show that opioid misusers commonly complain of insomnia and use hypnotic medications to self-medicate their sleep disturbance. At the same time, it remains unclear from a scientific perspective whether those who use/abuse opioids are more likely to use drugs in the sedative-hypnotic medication category. Consequently, the present study explores the relationship between comorbid use of opioids and sedative-hypnotic medications. Methods We extracted data from the 2015–2018 waves of the National Survey on Drug Use and Health (N=171,766). The primary outcome was the use of sedative-hypnotic medications, either in the z-class (zaleplon, zolpidem, eszopiclone) or sedating benzodiazepines (temazepam, flurazepam, triazolam). The primary exposures were prescription use of an opioid or abuse of an opioid (i.e., use of an illegal opioid such as heroin or misuse of a prescription opioid). Covariates included age, sex, race, income, education, and predicted mental illness category (none, mild, moderate, severe). Exposures were balanced on covariates using inverse probability of treatment weighting. Sequential binomial logistic regression estimated the association between opioid use/abuse and sedative-hypnotic use after adjusting for covariates. Results Opioid use and abuse varied by age, sex, race, education, and income (all p < 0.001). When adjusted for age, sex, and race (Model 1), sedative benzodiazepine use was more common among opioid users (OR 4.4 [4.04–4.79] and opioid abusers (OR 11.9 [9.72–14.5]). The use of z-class drugs was also more prevalent in opioid users (OR 3.69 [3.48–3.89]) and abusers (OR 7.74 [6.97–8.60]). Further adjusting for income and education (Model 2) and mental illness category (Model 3) attenuated but did not eliminate these associations. Conclusion Individuals who use or abuse opioids are significantly more likely to receive a sedative-hypnotic medication, a finding that is of concern and one that also suggests that sleep disturbance is common in this population. Further research is needed to determine the underlying nature and prevalence of sleep continuity disturbances in this population. Support (if any) VA grant IK2CX000855 and I01 CX001957 (S.C.).
30
Petersen, Michael J., Kathryne W. Adams, and Nicole F. Siparsky. "Avoiding Opioid Misuse After Surgery in the Era of the Opioid Epidemic." American Surgeon 86, no. 11 (August 7, 2020): 1565–72. http://dx.doi.org/10.1177/0003134820939933.
Анотація:
Background Chronic pain patients at risk of addiction can be identified through pre-prescription screening with the opioid risk tool (ORT); there is no equivalent for surgical patients. Our aims were to validate the ORT in the surgical population and assess the impact of patient education on compliance with proper storage and disposal (S&D) of unused opioid therapy (UOT). Methods Each subject completed the ORT, prevideo and postvideo surveys, educational video viewing, and compliance survey. Aberrant behavior was assessed by questionnaire, chart review, and Illinois Prescription Monitoring Program review. Results We recruited 24 subjects who underwent emergency surgery; 18 (of 24) were prescribed an opioid on discharge and 15 (of 18) were followed for 1 month. Before education, 38% (n = 9 of 24) of subjects identified proper UOT disposal and 63% (n = 15 of 24) identified safe handling of opioids. After education, 75% (n = 18 of 24) identified proper S&D. On ORT, 9 of 24 subjects (38%) scored moderate-risk to high-risk for opioid misuse. Half of subjects who demonstrated aberrant behavior (n = 7 of 12, 58%) scored in the low-risk range on ORT; 67% of subjects (n = 10 of 15) retained UOT, and 67% (n = 10 of 15) safely stored UOT. Few subjects (30%; n = 3 of 10) who stored their UOT reported proper disposal of UOT. Discussion The ORT is not useful in identifying acute pain surgical patients at risk for aberrant behavior. An educational video increased awareness of, but not compliance with, safe S&D of UOT. Opioid overprescription continues to contribute to opioid misuse.
31
Thompson, Samuel F., Zackary P. Burrow, Scott H. Conant, Samantha P. Kelly, Evan S. Fene, Ryan W. Morrisett, and Amgad M. Haleem. "Patient Reported Opioid Consumption Following Outpatient Foot and Ankle Surgery." Foot & Ankle Orthopaedics 4, no. 4 (October 1, 2019): 2473011419S0007. http://dx.doi.org/10.1177/2473011419s00073.
Анотація:
Category: opioid consumption Introduction/Purpose: The expanding opioid crisis has forced orthopedic surgeons to evaluate their prescribing practices, yet there remains limited evidence to guide providers in achieving safe and effective postoperative analgesia. Our goal was to prospectively evaluate opioid consumption following outpatient foot and ankle surgery and determine predictors of increased narcotic usage. Methods: We prospectively enrolled adult patients scheduled for outpatient foot and ankle surgery and conducted phone and in- person interviews postoperatively to determine pain level, number of pills consumed, satisfaction with pain control, and whether other analgesic medication was used. Interviews were performed at four separate time points: 5 days, 10 days, 2 weeks, and 6 weeks following surgery. Additional data collected included age, gender, payer status, education level, preoperative pain level, procedure performed, whether opioid pain medication had been used by the patient in the 12 months preceding surgery, and the amount of narcotic prescribed postoperatively. Results: Complete data was available for 52 patients (median age, 42 years). The median number of opioids prescribed postoperatively was 45 pills (337.5 morphine milligram equivalents (MMEs)). A refill narcotic prescription was provided for 36.5% of patients. The number of opioid pills consumed following surgery ranged from 0 to 120 (median, 40 pills). Forty-six percent of patients had discontinued the use of opioids by post-op day 10 and 86.5% by post-op day 20. Increased pre-operative pain level (p = 0.02) and an increased quantity of pills prescribed at the first prescription (<0.0001) were significantly associated with increased narcotic consumption. Eighteen (39.1%) patients filled a narcotic prescription in the 12 months prior to surgery, however, narcotic use prior to surgery did not significantly increase total opioid consumption. Conclusion: We found that the median number of opioids consumed following outpatient foot and ankle surgery was 40 pills. Nearly 90% of patients had discontinued narcotic use by 20 days postoperatively. Pre-operative pain level and the number of pills provided at the first prescription were predictive of increased narcotic usage.
32
Hemmert, Rachael, Gabriella E. Dull, and Linda S. Edelman. "THE OPIOID EPIDEMIC IN LONG-TERM CARE: A STAFF PERSPECTIVE." Innovation in Aging 3, Supplement_1 (November 2019): S709. http://dx.doi.org/10.1093/geroni/igz038.2604.
Анотація:
Abstract Opioid-based analgesic therapy is a common treatment for moderate to severe pain among long term care (LTC) residents. It has been estimated that 60% of LTC residents have an opioid prescription. Of these, 14% use opioids as part of a long term pain management strategy. LTC residents are particularly vulnerable to opioid misuse, exhibiting higher rates of adverse drug events. However, addressing pain, polypharmacological needs and resident well-being in the LTC setting is challenging. More research and education regarding opioid use in LTC is needed. The Utah Geriatric Education Consortium conducted interprofessional focus groups with LTC partners to 1) determine educational needs of staff regarding opioid use, and 2) gather qualitative data about the pain management experiences of staff when working with residents and families. Staff identified the following training needs: pain manifestation and assessment; certified nurse assistant education on opioid use; non-pharmacological options for pain management. Review of staff’s perception of the intersection of opioids, family and staff in a LTC setting revealed that 1) family is concerned about opioid use; 2) conversely, staff may not see opioid use as a problem; and 3) non-pharmacological options for pain management are often costly and unavailable to those in LTC. Identifying educational needs of LTC staff will help guide the development of educational materials and provide baseline data for future assessments of the impact of opioid education on long-term care patient outcomes.
33
Marszalek, Deanna, Amber Martinson, Andrew Smith, William Marchand, Caroline Sweeney, Julie Carney, Tiffany Lowery, and Jamie Clinton-Lont. "Examining the Effect of a Whole Health Primary Care Pain Education and Opioid Monitoring Program on Implementation of VA/DoD-Recommended Guidelines for Long-term Opioid Therapy in a Primary Care Chronic Pain Population." Pain Medicine 21, no. 10 (June 11, 2020): 2146–53. http://dx.doi.org/10.1093/pm/pnaa155.
Анотація:
Abstract Objective To describe the core elements of a Whole Health Primary Care Pain Education and Opioid Monitoring Program (PC-POP) and examine its effectiveness at increasing adherence to six of the Veteran Affairs/Department of Defense (VA/DoD) recommended guidelines for long-term opioid therapy (LOT) among chronic noncancer patients seen in primary care (i.e., urine drug screens [UDS], prescription drug monitoring program [PDMP] queries, informed consent, naloxone education/prescriptions, morphine equivalent daily dose [MEDD], and referrals to nonpharmacological pain interventions). Design/Methods A within-subjects comparison of outcomes was conducted between pre- and post-PC-POP enrollees (N = 25), as was a a between-subjects comparison to a comparison group (N = 25) utilizing a six-month range post–index date of 10/1/2018 (i.e., between-subjects comparison at Time 2). Subjects A convenience sample of adult veterans with chronic noncancer pain receiving opioid therapy consecutively for the past three months in primary care. Results Results showed increased concordance with VA/DoD guidelines among those enrolled in the PC-POP, characterized by increased documentation of urine drug screens, prescription drug monitoring program queries, informed consent, naloxone education/prescriptions, and a decrease in MEDD among patients enrolled in the PC-POP. Conclusions The PC-POP shows promise for increasing guideline-concordant care for providers working in primary care.
34
Trivedi, Sunny, Kevin Shea, Whitney Chadwick, Shabnam Gaskari, Ellen Wang, and Thomas Caruso. "A QUALITY IMPROVEMENT PROJECT TO REDUCE THE USE OF COMBINATION OPIOID/ACETAMINOPHEN MEDICATIONS WITHIN A LARGE HEALTH SYSTEM." Orthopaedic Journal of Sports Medicine 8, no. 4_suppl3 (April 1, 2020): 2325967120S0025. http://dx.doi.org/10.1177/2325967120s00258.
Анотація:
Background: Combination analgesics are among the most commonly prescribed pain medications in pediatric orthopedic patients. However, combined analgesics do not allow for individual medication titration, which can increase the risk of opioid misuse and hepatoxicity from acetaminophen. Increasingly, the risks of combined analgesics associated with opioid misuse and hepatotoxicity are recognized by the FDA and other organizations. Given these risks, consideration should be made for independent administration of acetaminophen and opioids. Hypothesis/Purpose: The primary aim was to alter the prescribing habits of pediatric orthopedic providers at our institution from postoperative combined opioid/acetaminophen medicines to independent opioids and acetaminophen. Methods: The study took place at a children’s hospital level one trauma center. A multidisciplinary team of health professionals utilized lean methodology to develop a project plan. Guided by a key driver diagram, (1) combination oxycodone/acetaminophen products were removed from hospital formulary, (2) a revised inpatient and outpatient electronic order set was implemented, and (3) multiple education efforts (emails, in person meetings) were conducted. Outcomes included inpatient and outpatient percent combined opioid/acetaminophen orders by surgical providers over twenty-seven months. Statistical process control charts were used to measure combination opioid prescribing practices for orthopedic and other surgical specialties. Results: Prior to intervention, inpatient combination opioid/acetaminophen products were prescribed for an average of 46% of all opioid prescriptions for orthopedic patients. After intervention and multiple educational efforts, the percent of combined opioid/acetaminophen products dropped to 31% and then to 3% by end of the investigational period. For outpatient prescriptions, the combined products accounted for 88% prior to intervention and dropped to 15% at project completion. Conclusion: By removing combined oxycodone/acetaminophen products from hospital formulary, educating the medical staff, and employing electronic order sets, the inpatient/outpatient prescribing practice of pediatric orthopedic surgeons changed from the common use of combined opioid/acetaminophen products to independent medications. This project demonstrates that changing medication prescription practice can be accomplished with 3 steps within a hospital system. Reducing the use of combination opioid/acetaminophen products may have further positive impacts on opioid misuse and hepatoxicity.
35
Kattail, MD, MHS, Deepa, Aaron Hsu, MHS, Myron Yaster, MD, Paul T. Vozzo, BA, Shuna Gao, BA, John M. Thompson, MD, Debra L. Roter, DrPH, et al. "Attitudes and self-reported practices of orthopedic providers regarding prescription opioid use." Journal of Opioid Management 15, no. 3 (May 1, 2019): 213–28. http://dx.doi.org/10.5055/jom.2019.0505.
Анотація:
Objective: Orthopedic surgeons are the third-highest opioid prescribers in the United States. Their prescribing practices can significantly affect the quantity of unconsumed opioids available to fuel the current opioid epidemic. The aim of this study was to identify prescribing patterns and knowledge gaps among orthopedic providers for targeted future interventions and investigation.Design: An online survey describing six common orthopedic surgical scenarios was distributed electronically to determine opioid type and quantity prescribed at discharge, medication disposal instructions, and the use of prescription drug monitoring programs (PDMPs) in the prescription writing process.Setting: Tertiary care academic hospitals.Participants: Orthopedic physicians and mid-level providers practicing at Johns Hopkins Medical Institutions and University of Maryland Medical System. Of 179 providers contacted, 127 (71 percent) completed the survey.Main outcome measures: Quantity of opioid prescribed, utilization of PDMPs, and provision of opioid disposal instructions.Results: While statistically significant associations were identified between quantity of opioid prescribed and surgical procedure, for five of six scenarios 95 percent of respondents recommended prescribing 55 oxycodone 5 mg pill equivalents (PEs) at discharge. An inverse correlation between years of clinical practice and mean number of PEs prescribed was observed. Fewer than 40 percent of respondents modified prescribing when presented with clinically relevant changes in scenario (history of depression or drug abuse). Over 60 percent of respondents do not use PDMPs, and 79 percent do not provide opioid disposal instructions.Conclusions: Our findings support a need for targeted education to mitigate the role of orthopedic postoperative prescribing practices on the current opioid abuse epidemic.
36
Langford, Dale J., Jacob B. Gross, Ardith Z. Doorenbos, David J. Tauben, John D. Loeser, and Debra B. Gordon. "Evaluation of the Impact of an Online Opioid Education Program for Acute Pain Management." Pain Medicine 21, no. 1 (January 25, 2019): 55–60. http://dx.doi.org/10.1093/pm/pny300.
Анотація:
Abstract Objective The University of Washington instituted a policy requiring all credentialed clinicians who prescribe opioids to complete a one-time education activity about safe and responsible opioid prescribing. A scenario-based, interactive online learning module was developed for opioid management of acute pain in hospitalized adults. This study examined the impact of the education module on learners’ knowledge, perceived competence, and use of guideline-adherent practices. Methods Clinicians who completed the education module participated in a voluntary de-identified online survey approximately six months after the learning activity. Survey questions were related to 1) the perception of improved knowledge; 2) impact on learner’s use of three guideline-adherent practices; and 3) perceived competence in managing opioids for acute pain. Descriptive statistics were generated, and multiple linear regression models were used for analysis. Results Clinicians (N = 167) reported improvement in knowledge and perceived competence. Controlling for other aspects of knowledge evaluated, learning to construct a safe opioid taper plan for acute pain, distinguishing between short- and long-acting opioids, and safely initiating opioids for acute pain were significantly associated with increased self-reported likelihood of incorporating the Washington state Prescription Monitoring Program (P = 0.003), using multimodal analgesia (P = 0.022), and reducing the duration of opioids prescribed (P = 0.016). Only improvement in knowledge of how to construct a safe opioid taper plan was significantly associated with increased perceived competence (P = 0.002). Conclusions Our findings suggest that this online education module about safe opioid prescribing for acute pain management was effective at improving knowledge, increasing the likelihood of using guideline-adherent clinical practices, and increasing perceived competence.
37
Moreno Martínez, Diego Alberto, Paola Natyaly Ilva Enríquez, and Jairo Ricardo Moyano Acevedo. "Methadone Prescription Patterns among Pain Physicians in Colombia." Universitas Médica 59, no. 3 (July 26, 2018): 1–10. http://dx.doi.org/10.11144/javeriana.umed59-3.ppmm.
Анотація:
Background: Chronic pain is a disease with serious consequences for people, physicians, and health care systems. Chronic opioid usage is one of the therapy strategies. Methadone is among the available opioids in Colombia and it is characterized by unique pharmacological properties and increased mortality reports because of overdose and cardiovascular complications. Appropriate monitoring and prescribing patterns of methadone are associated with complications similar to chronic management with other opioids. Aim: To describe methadone prescribing patterns among Colombian pain physicians and compare them to the accepted recommendations by the international scientific community. Materials and Methods: An electronic structured survey was applied to pain specialist physicians identified through major pain study associations and national training programs. Results: Respondents of the survey are mostly experienced university certified physicians and anesthesiologists with clinical training working at university hospitals. Most of them perceive chronic opioid therapy as an effective strategy for pain relief and functional outcomes despite the lack of empirical support. Most of them know clinical practice guidelines but are not applying them despite this matter. Conclusions: We must enhance education for prescribers in order to improve patient safety. The recommended clinical practice guidelines are poorly applied by Colombian doctors. The results of this study must be cautiously assessed.
38
Cochran, Gerald T., Rafael J. Engel, Valerie J. Hruschak, and Ralph E. Tarter. "Prescription Opioid Misuse Among Rural Community Pharmacy Patients: Pilot Study for Screening and Implications for Future Practice and Research." Journal of Pharmacy Practice 30, no. 5 (July 8, 2016): 498–505. http://dx.doi.org/10.1177/0897190016656673.
Анотація:
Background: Opioid misuse imposes a disproportionately heavy burden on individuals living in rural areas. Community pharmacy has the potential to expand and coordinate with health professionals to identify and intervene with those who misuse opioids. Objective: Rural and urban community pharmacy patients were recruited in this pilot project to describe and compare patterns of opioid misuse. Methods: We administered a health screening survey in 4 community pharmacies among patients filling opioid medications. Univariate statistics were used to assess differences in health characteristics and opioid medication misuse behaviors between rural and urban respondents. Multivariable statistics were used to identify risk factors associated with rural and urban opioid misuse. Results: A total of 333 participants completed the survey. Participants in rural settings had poorer overall health, higher pain levels, lower education, and a higher rate of unemployment compared to patients in urban pharmacies. Rural respondents with illicit drug use (adjustable odds ratio [aOR]: 14.34, 95% confidence interval [CI] = 2.16-95.38), posttraumatic stress disorder (aOR: 5.44, 95% CI = 1.52-19.50), and ≤high school education (aOR: 6.68, 95% CI = 1.06-42.21) had increased risk for opioid misuse. Conclusions: Community pharmacy represents a promising resource for potential identification of opioid misuse, particularly in rural communities. Continued research must extend these findings and work to establish collaborative services in rural settings.
39
Glose, Susan, Tamatha Arms, and Noell Rowan. "Older adults’ knowledge, beliefs and attitudes about prescription opioids." Advances in Dual Diagnosis 14, no. 2 (April 6, 2021): 47–57. http://dx.doi.org/10.1108/add-12-2020-0030.
Анотація:
Purpose The purpose of this study is to explore the knowledge, beliefs and attitudes surrounding prescription opioid medications of community living older adults in southeast North Carolina. Design/methodology/approach A cross-sectional, descriptive, anonymous survey design of participants aged 55 or over was used. Findings Study participants (N = 119) reported bias in their attitudes and beliefs about the use and misuse of prescription opioid medications. Multiple regression analyses revealed that gender, age, work, marital status and education level all had significant results in explaining variance in the statistical models. Even though study participants demonstrated high levels of education and understanding of the potential of addiction to opiates, there were a number of misconceptions about prescription pain medications revealed. Originality/value There is a dearth of studies looking at older adults’ knowledge, beliefs and attitudes about prescription pain medications. This urges the necessity of increased awareness via further research, presentations and creative discourse to assist in the understanding of precursors of addiction and ways to deal with pain that do not automatically depend on prescription opioid medicines. Implications include outreach to a larger and more diverse sample to address knowledge, beliefs and attitudes surrounding prescription opioid medications of community living older adults in southeast North Carolina and beyond.
40
Hopkins, Ria E. "Prescriber Education Interventions to Optimize Opioid Prescribing in Acute Care: A Systematic Review." November 2019 6, no. 22;6 (November 14, 2019): E551—E562. http://dx.doi.org/10.36076/ppj/2019.22.e551.
Анотація:
Background: Opioid medications are frequently used effectively for analgesia in acute settings, however, they are associated with dependence and addiction, and were implicated in 47,600 American fatalities in 2017. Evidence suggests that despite guidelines and professional body recommendations, acute prescribing remains highly variable. Educational interventions targeting prescribers have potential to optimize prescribing in-line with evidence-based best practice. Objectives: To identify the objective impacts of education interventions on opioid prescribing in the acute care setting. Study Design: A systematic literature review. Setting: The electronic databases MEDLINE, Embase, and Cochrane for works published until December 31, 2018. Bibliographies of relevant studies and the gray literature were also searched. Methods: Databases were searched for interventional studies (clinical trials and pre- and poststudies). Studies describing an educational intervention delivered to clinicians and reporting at least one objective measure of opioid use in the acute care setting were included. Studies reporting only subjective outcomes and those focused on chronic pain or set in primary care were excluded. Two reviewers (RB, TB) extracted data and assessed the quality of included studies using the Downs and Black Tool. Results: Nine studies met inclusion criteria; all used pre- and postdesigns. Three studies described stand-alone education, and the others described multifaceted interventions. All 9 interventions significantly reduced at least one of the following: high-risk agent use including meperidine use by up to 71%; total or daily dosage of opioids at discharge, including median morphine milligram equivalence (MME) from 90 mg to 45 mg per patient; and quantity of medications such as oxycodone supplied to patients, halved in one study from 6,170 expected to 2,932 supplied tablets. No increase in pain complaints or prescription refill requests were reported in those studies assessing these outcomes. The longest study examined prescribing 15 months after education delivery, reporting sustained practice changes. Limitations: Overall study quality was fair to poor. Significant heterogeneity in settings, patient groups, methodologies, and outcomes prevented pooled quantitative analysis. No studies examined all available opioid agents or formulations. Conclusions: These findings support prescriber education as an effective strategy to reduce opioid use and optimize prescribing in acute settings. Further research, particularly high quality randomized studies, describing the impact of education on all available opioid formulations and total MME is required. Reviewing the existing literature has offered useful models that can be implemented to improve care with opioid prescribing in acute settings. Key words: Opioids, education, physician education, prescriber education, opioid education, opioid prescribing, systematic review, prescriptions, prevention
41
Bromberg, MD, FACS, Warren D., Tracey Emanuel, MSN, RN, FNP-BC, Valerie Zeller, MA, RN, Elizabeth Galloway, BSN, RN, CAPA, Susan Mogan, DNP, ANP-BC, ACHPN, AP-PMN, Justin Diamond, BS, Debra Statler, RN III-C, BC, and Fay Wright, PhD, RN, APRN-BC. "Assessment of post-operative opioid prescribing practices in a community hospital ambulatory surgical center." Journal of Opioid Management 17, no. 3 (July 19, 2021): 241–49. http://dx.doi.org/10.5055/jom.2021.0634.
Анотація:
Objective: To evaluate the prescribing practices and opioid consumption in an ambulatory setting to inform the development of evidence-based guidelines.Design: A prospective study of adults undergoing outpatient open and laparoscopic surgeries over 3 months. One week after discharge, a telephonic interview quantified the number of opioids prescribed and consumed, degree of pain control and satisfaction, and whether additional pain medication was requested. Setting: Community hospital ambulatory surgery center in Westchester County, New York.Participants: This study included 304 adults undergoing a variety of procedures by surgeons from multiple specialties.Main outcome measures: Quantify surgeons’ postoperative opioid prescribing compared with patient opioid consumption.Results: Eighty-one percent (N = 245) responded to the survey, of which 64 percent were prescribed opioids. Males and females were equally represented with the mean age of 59.4 years. Of those prescribed opioids, 92 percent filled the prescription. The most commonly prescribed opioids reported by the patients that filled their prescription (N = 145) were oxycodone (36.5 percent), oxycodone/acetaminophen (28.9 percent), and tramadol (22.7 percent). The mean number of opioid pills prescribed was 20 and the mean consumption was 6.7 pills, resulting in an average of 13 retained pills. Only 3.8 percent of the patients prescribed opioids at discharge called their provider for additional analgesia. Despite the low opioid consumption patients reported high satisfaction (4.5 on scale of 0-5) with pain control. Only 10.4 percent reported that the surgeon recommended an over the counter (OTC) analgesic option. There was variability in the amount of opioids prescribed within each surgical category.Conclusions: One week after outpatient surgery, patients consumed one-third of physician-prescribed opioids, yet they reported high pain management satisfaction. Our study will inform the development of a patient-centered interdisciplinary perioperative education program to more effectively tailor multimodal pain management in ambulatory surgical patients and collaterally reduce the number of retained opioids.
42
Cook, Amy Kyle, and Henry H. Brownstein. "Public Opinion and Public Policy: Heroin and Other Opioids." Criminal Justice Policy Review 30, no. 8 (November 29, 2017): 1163–85. http://dx.doi.org/10.1177/0887403417740186.
Анотація:
Virginia, much like other states, has experienced unprecedented rates of heroin and prescription opioid abuse, overdoses, and deaths. Given the wide range of competing voices concerning drug policy and the complicated situation of the contemporary opioid epidemic, this study examines whether public opinion is reflected in public policy toward illicit involvement with opioids. The 2016 Commonwealth Public Policy Survey, a statewide representative sample of 1,000 Virginia residents, found that Virginians are supportive of treatment over arrest for heroin and prescription pill abusers and factors such as race, education, and political affiliation are predictive of support for treatment over arrest. More importantly, the results of this poll converge with legislative policies of the 2017 General Assembly, supporting the notion that public support can have an influence on the policymaking process. Policy implications are discussed.
43
Rindal, D. Brad, Stephen E. Asche, Jan Gryczynski, Sheryl M. Kane, Anjali R. Truitt, Tracy L. Shea, Jeanette Y. Ziegenfuss, Robert P. Schwartz, Donald C. Worley, and Shannon G. Mitchell. "De-Implementing Opioid Use and Implementing Optimal Pain Management Following Dental Extractions (DIODE): Protocol for a Cluster Randomized Trial." JMIR Research Protocols 10, no. 4 (April 12, 2021): e24342. http://dx.doi.org/10.2196/24342.
Анотація:
Background Overdose deaths from prescription opioid analgesics are a continuing crisis in the United States. Opioid analgesics are among the most frequently prescribed drugs by dentists. An estimated 5 million people undergo third-molar extractions in the United States each year, resulting in postoperative pain. Studies show that, in most cases, the combination of ibuprofen and acetaminophen is an effective alternative to commonly prescribed opioid analgesics for the management of postextraction pain. Nevertheless, many dentists routinely prescribe opioids after dental extractions. Objective We describe the rationale, design, and methods for a randomized trial of interventions designed to de-implement opioid prescribing by dentists while implementing effective nonopioid analgesics following dental extractions. Methods Using a prospective, 3-arm, cluster randomized trial design with dentists as the unit randomized and patient-level prescribing data as the primary outcome, we will compare different strategies to reduce the reliance on opioids and increase the use of alternative pain management approaches utilizing information support tools aimed at both providers and their patients. The study will test the efficacy of 2 interventions to decrease opioid prescribing following dental extractions: clinical decision support with (CDS-E) and without patient education (CDS). Providers will be randomized to CDS, CDS-E, or standard practice. Patient-level outcomes will be determined via review of comprehensive electronic health records. We will compare study arms on differential change in prescribing patterns from pre- to postimplementation of the intervention. The primary outcome of interest is a binary indicator of whether or not the patient received an opioid prescription on the day of the extraction encounter. We will also examine recommendations or prescriptions for nonopioid analgesics, patients’ perceptions of shared decision making, and patients’ pain experiences following the extraction. Results The HealthPartners Institutional Review Board approved the study. All study materials including the CDS and patient education materials have been developed and pilot tested, and the protocol has been approved by the National Institute of Dental and Craniofacial Research. The intervention was implemented in February 2020, with 51 dentists who were randomized to 1 of the 3 arms. Conclusions If the intervention strategies are shown to be effective, they could be implemented more broadly in dental settings with high levels of opioid prescribing. Trial Registration ClinicalTrials.gov NCT03584789, https://clinicaltrials.gov/ct2/show/NCT03584789 International Registered Report Identifier (IRRID) DERR1-10.2196/24342
44
Lovecchio, Francis, Jeffrey G. Stepan, Ajay Premkumar, Michael E. Steinhaus, Maria Sava, Peter Derman, Han Jo Kim, and Todd Albert. "An institutional intervention to modify opioid prescribing practices after lumbar spine surgery." Journal of Neurosurgery: Spine 30, no. 4 (April 2019): 483–90. http://dx.doi.org/10.3171/2018.8.spine18386.
Анотація:
OBJECTIVEPatients with lumbar spine pathology are at high risk for opioid misuse. Standardizing prescribing practices through an institutional intervention may reduce the overprescribing of opiates, leading to a decrease in the risk for opioid misuse and the number of pills available for diversion. Without quantitative data on the “minimum necessary quantity” of opioids appropriate for postdischarge prescriptions, the optimal method for changing existing prescribing practices is unknown. The purpose of this study was to determine whether mandatory provider education and prescribing guidelines could modify prescriber behavior and lead to a decreased amount of opioids prescribed at hospital discharge following lumbar spine surgery.METHODSQualified staff were required to attend a mandatory educational conference, and a consensus method among the spine service was used to publish qualitative prescribing guidelines. Prescription data for 2479 patients who had undergone lumbar spine surgery were captured and compared based on the timing of surgery. The preintervention group consisted of 1177 patients who had undergone spine surgery in the period before prescriber education and guidelines (March 1, 2016–November 1, 2016). The postintervention group consisted of 1302 patients who had undergone spine surgery after the dissemination of the guidelines (February 1, 2017–October 1, 2017). Surgeries were classified as decompression or fusion procedures. Patients who had undergone surgeries for infection and patients on long-acting opioids were excluded.RESULTSFor all lumbar spine surgeries (decompression and fusion), the mean amount of opioids prescribed at discharge was lower after the educational program and distribution of prescribing guidelines (629 ± 294 oral morphine equivalent [OME] preintervention vs 490 ± 245 OME postintervention, p < 0.001). The mean number of prescribed pills also decreased (81 ± 26 vs 66 ± 22, p < 0.001). Prescriptions for 81 or more tablets dropped from 65.5% to 25.5%. Tramadol was prescribed more frequently after prescriber education (9.9% vs 18.6%, p < 0.001). Refill rates within 6 weeks were higher after the institutional intervention (7.6% vs 12.4%, p < 0.07).CONCLUSIONSQualitative guidelines and prescriber education are effective in reducing the amount of opioids prescribed at discharge and encouraging the use of weaker opioids. Coupling provider education with prescribing guidelines is likely synergistic in achieving larger reductions. The sustainability of these changes is yet to be determined.
45
Litten, Kathryn, Lucas G. Hill, Aida Garza, and Maaya Srinivasa. "Increasing Naloxone Knowledge and Use Through Direct-to-Patient Education." Journal of Pharmacy Technology 36, no. 6 (September 11, 2020): 237–42. http://dx.doi.org/10.1177/8755122520954218.
Анотація:
Background: In the United States, opioid overdoses account for 130 deaths daily. Barriers to obtaining naloxone, the drug-of-choice for opioid overdose reversal, include limited education, access, and perceptions of provider judgement. Objectives: This study aimed to assess the efficacy of mailed education about naloxone, with or without a live teaching seminar, to patients at risk for opioid overdose. Methods: This observational study was conducted in a federally qualified health system. A phone presurvey was administered to patients on long-term opioid therapy or with a diagnosis of opioid use disorder to assess opioid overdose-related knowledge. Subjects were mailed a handout about naloxone and an invitation to receive naloxone at no cost at a seminar. Three-month phone postsurveys were conducted. The primary outcome was change in mean knowledge score from presurvey to postsurvey. Secondary outcomes included scores on individual survey items, naloxone prescriptions provided, and overdose reversals reported. Results: Ninety-four patients received mailed education. Sixty-two subjects took presurveys and 23 took 3-month follow-up surveys. Five subjects attended the live seminar. The mean cumulative knowledge score improved by 8.7% from the presurvey to the postsurvey. During the study period, one new naloxone prescription was written and one overdose reversal was reported. Conclusion: Direct-to-patient mailed education slightly improved knowledge regarding naloxone and opioid overdose response, and it may have led to one successful overdose reversal. Mailing education to a larger population of patients at risk for opioid overdose may be necessary to observe a substantial clinical impact.
46
Mandava, Nikhil, Demetris Delos, Katherine Vadasdi, R. Greene, Marc Kowalsky, Francis Alberta, Paul Sethi, and Parth Kamdar. "An Evidence Driven Opioid Prescribing Guideline following Knee Arthroscopy and Anterior Cruciate Ligament Reconstruction." Orthopaedic Journal of Sports Medicine 8, no. 7_suppl6 (July 1, 2020): 2325967120S0039. http://dx.doi.org/10.1177/2325967120s00393.
Анотація:
Objectives: Opioid prescriptions following knee arthroscopy vary substantially, ranging from 15 to 60 opioid pills.[1-3] Expert panel guidelines recommend up to 30 pills for knee arthroscopy and 60 pills for anterior cruciate ligament reconstruction (ACLR) using an autograft; however, these recommendations are based on consensus rather than evidence.[4] Currently, orthopaedic surgeons do not possess any evidence driven guidelines for opioid prescriptions following knee arthroscopy or ACLR. The purpose of this study was to record patients’ postoperative opioid requirement to develop evidence driven prescription guidelines for knee arthroscopy and ACLR. Tepolt FA, Bido J, Burgess S, Micheli LJ, Kocher MS. Opioid Overprescription After Knee Arthroscopy and Related Surgery in Adolescents and Young Adults. Arthroscopy. 2018;34(12):3236-3243. Gardner V, Gazzaniga D, Shepard M, et al. Monitoring Postoperative Opioid Use Following Simple Arthroscopic Meniscectomy: A Performance-Improvement Strategy for Prescribing Recommendations and Community Safety. JB JS Open Access. 2018;3(4):e0033. Wojahn RD, Bogunovic L, Brophy RH, et al. Opioid Consumption After Knee Arthroscopy. J Bone Joint Surg Am. 2018;100(19):1629-1636. Stepan JG, Lovecchio FC, Premkumar A, et al. Development of an Institutional Opioid Prescriber Education Program and Opioid-Prescribing Guidelines: Impact on Prescribing Practices. J Bone Joint Surg Am. 2019;101(1):5-13. Methods: This prospective multicenter observational study enrolled 50 subjects undergoing outpatient knee arthroscopy for meniscal repair, meniscectomy, or ACLR. Opioid prescriptions, refills, and subject demographics were recorded. All patients followed the same perioperative, multimodal analgesic regimen (Table 1). Subjects were provided a pain journal to record visual analog scale (VAS) pain scores and opioid consumption for one week postoperatively. No changes were made to existing prescribing habits, postoperative physical rehabilitation, or surgical methodology. State databases were reviewed for additional opioid prescriptions. Results: Subjects, on average, consumed 2.5 opioid pills (range 0 to 14 pills) with a median consumption of 0.5 pills after knee arthroscopy. Eighty six percent of subjects (N = 43) consumed ≤ 5 opioid pills and 50% of subjects (N = 25) chose not to consume opioids postoperatively. Ninety two percent of subjects (N = 46) discontinued opioid consumption by the 3rd postoperative day. Subjects specifically undergoing ACLR (N = 18) consumed an average of 41 OME (Figure 1). Subjects consumed only 30% of opioids leaving 2,196 OME (approximately 293 oxycodone 5mg) available for possible distribution or misuse. Conclusion: This study demonstrates that current expert panels recommend an excess of opioids following knee arthroscopy. In contrast to these expert panel guidelines, we suggest a maximum of 5 and 15 oxycodone 5mg pills for knee arthroscopy and ACLR respectively. This evidence driven guideline will greatly assist orthopaedic surgeons in their effort to combat opioid overprescription. [Table: see text][Figure: see text]
47
Finney, Fred T., Timothy D. Gossett, Hsou Mei Hu, Jennifer Waljee, Chad Brummett, David M. Walton, Paul G. Talusan, and James R. Holmes. "Conventional Ankle Sprain Treatment is Associated with Alarmingly High Rates of Persistent Opioid Use." Foot & Ankle Orthopaedics 4, no. 2 (April 1, 2019): 2473011419S0000. http://dx.doi.org/10.1177/2473011419s00003.
Анотація:
Category: Ankle Introduction/Purpose: The opioid epidemic has been defined by over-prescribing by practitioners and increasing misuse, abuse, and diversion of opioids by patients. Orthopedic surgeons are the fourth largest prescriber of opioid medications and have a unique opportunity to play a prominent role in the solution. Many perceived barriers to such a solution have now been eliminated. For example, it has been demonstrated that neither the amount nor duration of opioid prescription correlates with patient satisfaction. To address this epidemic, it is important to first understand rates of new persistent opioid use following specific injuries and to identify patient-specific risk factors. In this study, we evaluated new persistent opioid use following nonoperatively treated ankle sprains, one of the most common orthopaedic injuries seen in any healthcare system. Methods: A widely accepted insurance claims database was used to identify patients who underwent nonoperative treatment of an ankle sprain between January 2008 and December 2016. None had an opioid prescription filled in the period of 12 months to 7 days prior to treatment (defined as “opioid naïve”). We evaluated peri-treatment and post-treatment opioid prescription fulfillment to analyze prescribing patterns and continuation of opioid use. The primary outcome, new persistent opioid use, was defined as opioid prescription fulfillment between 91 and 180 days after treatment. Logistic regression analysis was used to evaluate the effect of patient factors, including age, gender, median household income, tobacco use, mental health and pain disorders, and medical comorbidities on the likelihood of new persistent use. Results: 42,445 patients were identified who underwent nonoperative treatment of an ankle sprain and received an opioid prescription. The overall rate of new persistent opioid used following nonoperative treatment of ankle sprains was 9.3%. Rates of continued opioid use were significantly increased among patients who received an opioid dose prescribed in the peri-treatment period that was in the top 25th percentile of total oral morphine equivalents. In addition, patient-specific factors which were associated with new persistent opioid use included female gender, tobacco use, certain mental health disorders, comorbid conditions, and pre-existing arthritis. Patient factors associated with lower rates of new persistent opioid use included higher level education and median household income of $100,000 or more. Conclusion: Chronic opioid use is a major problem, even in the setting of relatively minor musculoskeletal injuries. Defining the problem and understanding contributing factors to this epidemic are paramount to developing a solution. Ankle sprains represent an orthopaedic injury which does not warrant opioid use for pain control. In this series, an alarming number of patients who sustained an ankle sprain were treated with an opioid medication, and 9.3% of these patients continued opioid use after three months. Understanding the risk factors associated with this problem provides a foundation upon which to address this sometimes lethal, public health problem.
48
Levin, Marc, Michael G. Roskies, and Jamil Asaria. "Perspectives of Facial Plastic Surgeons on Opioid Dependence in Rhinoplasty Patients." Facial Plastic Surgery 35, no. 05 (July 10, 2019): 540–45. http://dx.doi.org/10.1055/s-0039-1693133.
Анотація:
AbstractUnderstanding the perspectives and opinions of facial plastic surgeons on opioid dependence is critical in a national epidemic of opioid overuse. Findings may encourage surgeon education so that facial plastic surgeons may be able to judiciously prescribe opioids, improving patient outcomes and reducing healthcare opioid-related spending. The objective of this study is to understand facial plastic surgeons' perspectives on opioid dependence in rhinoplasty patients. A key secondary objective was to quantify facial plastic surgeons' opioid prescribing patterns. This was a prospective survey study. A nine-question survey was sent to all members of the American Academy of Facial Plastic and Reconstructive Surgery in July of 2018, and analysis of the data was completed in August of 2018. The primary study outcome measurement was surgeon perspectives on opioid dependence. This was measured by an online survey. A total of 164 facial plastic surgeons responded to the survey (response rate: 6.6%). The majority were experienced surgeons in practice for more than 10 years (61.96%) who perform less than five rhinoplasties per week (84.15%). Of the facial plastic surgeons, 89.51% prescribe some variation of opioids following rhinoplasty. Most surgeons believe that opioid dependence is not a problem in rhinoplasty patients (86.96%), but that it is a problem among surgical patients in general (61.11%). The majority (52.45%) of surgeons prescribe between 11 and 25 tablets of opioids following rhinoplasty, with 25.17% of surgeons prescribing > 25 tablets of opioids. Facial plastic surgeons do not believe opioid dependence to be a problem among rhinoplasty patients. Resultantly, many facial plastic surgeons can prescribe more than 25 tables of opioids following rhinoplasty. The findings suggest that facial plastic surgeons may require further education and complete more research regarding opioid dependence among the rhinoplasty population. Additionally, the findings are important for health policy in that they encourage the creation of rhinoplasty specific opioid prescription guidelines.
49
Abraham, Olufunmilola, Tanvee Thakur, and Randall Brown. "Developing a Theory-Driven Serious Game to Promote Prescription Opioid Safety Among Adolescents: Mixed Methods Study." JMIR Serious Games 8, no. 3 (July 3, 2020): e18207. http://dx.doi.org/10.2196/18207.
Анотація:
Background Adolescents in North America are severely affected by the opioid crisis, yet there are limited educational resources for educating teens about prescription opioid safety and misuse. Empirical literature lacks evidence regarding teen education about prescription opioid safety through serious games and lacks conceptual models and frameworks to guide the process of game development for this purpose. Objective This study aims to conceptualize and design a serious game prototype to teach teens about prescription opioid safety and propose a conceptual framework for developing a serious game to educate youth about safe and responsible use of prescription opioids. Methods The initial steps of the project comprised of the formulation of an integrated conceptual framework that included factors from health behavior models and game development models. This was followed by the formal process of serious game development, which resulted in a game prototype. The assessment of the game prototype was done through group discussions, individual interviews, and questionnaires with adolescents following gameplay. Field notes were used to keep track of the responses from the group discussions. Content and thematic analyses were used to analyze field notes and responses to the open-ended questionnaire, which were then used to refine the game prototype. Results A total of 10 playtests with over 319 adolescents and emerging young adults (AYAs) in community settings such as middle schools, high schools, and colleges were conducted by the project team between March and June 2019. The AYAs provided feedback on the initial game prototype using questionnaires administered through Qualtrics or in-person on paper. Preliminary feedback suggested that the teens found the game objectives, outcomes, and design appealing. Overall, the game was perceived as realistic, and learning outcomes seemed achievable. Suggestions for improvement included the need for additional direction on gameplay, clearer instructions, concise dialog, and reduced technical problems in the gameplay. Conclusions We propose a conceptual framework for developing a serious game prototype to educate youth about prescription opioid safety. The project used a theory-driven conceptual framework for the development of a serious game targeting the prevention of adolescent opioid misuse and garnered preliminary feedback on the game to improve the quality of gameplay and the prototype. Feedback through informal assessments in community settings suggests that the youth and their families are interested in a game-based approach to learn about prescription opioid safety in homes and schools. The next steps include modifications to the game prototype based on feedback from the community, integration of learning analytics to track the in-game behaviors of players, and formal testing of the final prototype.
50
Hsieh, Ruey Kuen, Yu-Lin Lin, and Chao-Hsiun Tang. "Difference in strong opioid prescription among different cancer and care providers in advanced cancer patients in Taiwan: Analysis using national health insurance database." Journal of Clinical Oncology 33, no. 29_suppl (October 10, 2015): 55. http://dx.doi.org/10.1200/jco.2015.33.29_suppl.55.
Анотація:
55 Background: Pain assessment and management had been adopted as an important criteria in hospital accreditation in Taiwan. National health insurance database may help to determine factors influencing patterns of strong opioid use in advanced cancer patients in their final 12 months of life. Methods: Cancer patients who died from cancer during 2008-2011 were included in the analysis. Data in prescription of strong opioids during their last 12 months of life were collected and analyzed using National Health Insurance Research Database (NHIRD). Patient’s characteristics, such as cancer types, birthdate and gender, as well as information on the provider’s characteristics, such as specialty, gender and age of the physician, the ownership and level of accreditation of the hospital, and the level of urbanization of the hospital where it is located, were also retrieved and included as the controlled variables in the analysis. Results: Of the 162,679 cancer deaths, 57,578 were prescribed strong opioids in their last year of life (35.4 percent). Strong opioid prescription steadily decreased with the corresponding increase in patient age. Besides there are difference in different cancer types. Association with prescription prevalence has also been noted among physician characteristics such as subspecialty, gender and age, as well among hospital characteristics, such as public vs private and accreditation level. Conclusions: There are significant difference in strong opioids prescription among different care providers for advanced cancer patients. Information from this study can guide further efforts in improving supportive care and education for advanced cancer care providers.