Early buprenorphine-naloxone initiation for opioid use disorder reduces opioid overdose, emergency room visits and healthcare cost compare to late initiation

2021 ◽  
pp. 1-9
Author(s):  
Tianyu Sun ◽  
Hilary Aroke ◽  
Stephen Kogut ◽  
Natallia Katenka ◽  
Jeffrey Bratberg ◽  
...  
Keyword(s):  
Emergency Room ◽  
Healthcare Cost ◽  
Opioid Use Disorder ◽  
Opioid Overdose ◽  
Emergency Room Visits ◽  
Opioid Use ◽  
Late Initiation

scholarly journals Patients with Opioid Use Disorder Have Increased Readmission Rates, Emergency Room Visits, and Costs Following Hallux Valgus Procedures

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0038
Author(s):  
James M. Parrish ◽  
Rushabh M. Vakharia ◽  
Dillon Benson ◽  
Aaron K. Hoyt ◽  
Nathaniel W. Jenkins ◽  
...  
Keyword(s):  
Emergency Room ◽  
Hallux Valgus ◽  
Opioid Use Disorder ◽  
Orthopedic Procedures ◽  
Emergency Room Visits ◽  
Opioid Use ◽  
Readmission Rates ◽  
Episode Of Care ◽  
History Of ◽  
Care Costs

Category: Ankle; Bunion; Midfoot/Forefoot; Other Introduction/Purpose: Patients with a history of opioid use disorder (OUD) have been shown to incur more severe medical complications, higher readmission rates, and increased cost following various orthopedic procedures. There is a scarcity in the literature investigating the effects of OUD following a hallux valgus procedure. Therefore, the purpose of this study was to evaluate whether OUD patients undergoing a hallux valgus correction are at greater odds of: 1) readmission rates, 2) emergency room (ER) visits, and 3) costs. Methods: Patients undergoing a hallux valgus correction with a history of OUD were identified using a health insurance claims database. To search for patients undergoing hallux valgus surgical corrections the following current procedural terminology (CPT) medical codes were used: 28290, 28292, 28293, 28294, 28296, 28297, 28298, 28299, 28306, and 28307. To include all eligible patients the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes were also utilized, including: 77.51 and 77.59. OUD patients were matched to non-opioid use disorder (NUD) patients in a 1:4 ratio by age, sex, Elixhauser-Comorbidity Index (ECI), diabetes mellitus, hyperlipidemia, hypertension, and tobacco use. Primary outcomes analyzed included odds of 90-day readmission rates, 30-day emergency room visit, and 90-day episode of care costs. Pearson’s chi-squared test was used to compare demographics. Logistic regression analysis calculated odds-ratios for readmission and ER visits. Welch’s t-test was used for significance in ECI and cost between cohorts. Results: The query yielded 6,318 patients (OUD=1,276; NUD=5,042) who underwent a hallux valgus correction. There were no significant difference between any of the compared age ranges (p=0.859, p=0.952, p=0.909, p=0.961), ECI (p=1.000) and comorbidities between OUD and NUD patients. OUD patients had higher incidence and odds of 90-day readmission rates (9.56 vs. 6.04%; OR: 1.55, p<0.001) and 30-day ER visits (.86 vs. .35%; OR: 2.42, p=0.021) compared to controls. OUD patients also incurred significantly greater 90-day episode of care costs ($7,208.28 vs. $6,134.75, p<0.0001) compared to NUD patients. Conclusion: Patients with a history of OUD who underwent a hallux valgus correction had a higher odds ratio of 90-day readmission rates, 30-day emergency room visits, and 90-day total global episode of care cost compared to those with NUD. These findings expand on a rapidly growing body of current literature that demonstrate OUD increases numerous costs associated with outcomes of foot and ankle surgery. OUD is a risk factor for poor post operative outcomes for patients undergoing a hallux valgus correction. The findings of this study are likely to improve preoperative counseling and selection when addressing patients with preoperative opioid use. [Table: see text]

The Influence of Opioid Use Disorder on Open Reduction and Internal Fixation Following Ankle Fracture

2020 ◽  
pp. 193864002091471
Author(s):  
Megan K. Allen ◽  
James M. Parrish ◽  
Rushabh Vakharia ◽  
Jonathan R. M. Kaplan ◽  
Ettore Vulcano ◽  
...  
Keyword(s):  
Emergency Room ◽  
Internal Fixation ◽  
Open Reduction ◽  
Opioid Use Disorder ◽  
Cost Of Care ◽  
Administrative Claims ◽  
Emergency Room Visits ◽  
Opioid Use ◽  
Readmission Rates ◽  
Costs Of Care

Background. Ankle fractures are common and may require open reduction and internal fixation (ORIF). Literature is scarce evaluating the associations of opioid use disorder (OUD) with ORIF postoperative outcomes. This study investigates whether OUD patients have increased (1) costs of care, (2) emergency room visits, and (3) readmission rates. Methods. ORIF patients with a 90-day history of OUD were identified using an administrative claims database. OUD patients were matched (1:4) to controls by age, sex, and medical comorbidities. The Welch t-test determined the significance of cost of care. Logistic regression yielded odds ratios (ORs) for emergency room visits and 90-day readmission rates. Results. A total of 2183 patients underwent ORIF (n = 485 with OUD vs n = 1698 without OUD). OUD patients incurred significantly higher costs of care compared with controls ($5921.59 vs $5128.22, P < .0001). OUD patients had a higher incidence and odds of emergency room visits compared with controls (3.50% vs 0.64%; OR = 5.57, 95% CI = 2.59-11.97, P < .0001). The 90-day readmission rates were not significantly different between patients with and without OUD (8.65% vs 7.30%; OR = 1.20, 95% CI = 0.83-1.73, P = .320). Conclusion. OUD patients have greater costs of care and odds of emergency room visits within 90 days following ORIF. Levels of Evidence: Level III: Retrospective cohort study

scholarly journals The Influence of Opioid Use Disorder on Open Reduction and Internal Fixation following Ankle Fracture

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0010
Author(s):  
Megan K. Allen ◽  
James M. Parrish ◽  
Rushabh M. Vakharia ◽  
Jonathan R. Kaplan ◽  
Ettore Vulcano ◽  
...  
Keyword(s):  
Emergency Room ◽  
Ankle Fracture ◽  
Open Reduction ◽  
Opioid Use Disorder ◽  
Foot And Ankle ◽  
Emergency Room Visits ◽  
Opioid Use ◽  
Readmission Rates ◽  
Costs Of Care ◽  
History Of

Category: Ankle; Other Introduction/Purpose: Ankle fractures are common injuries that may require surgical treatment consisting of open reduction and internal fixation (ORIF). Injuries associated with increased pain levels are also correlated with increased opioid use, which is also recognized as a risk factor for bone fracture. There is a paucity of literature evaluating the impact of patients with a history of opioid use disorder (OUD) on postoperative complications following ORIF for ankle fracture. This study aims to investigate whether OUD patients are at greater odds of: 1) readmission rates, 2) emergency room visits, and 3) costs of care. Methods: Patients undergoing ORIF for ankle fracture with a 90-day history of OUD prior to the procedure were identified using national health insurance claims database. We selected patients that underwent surgical corrections as recorded by the following current procedural terminology (CPT) medical codes: 27792, 27814, 27822, 27823, 27766, 27829, and 27769. We matched cases with OUD to controls with a 1:4 of OUD to non-OUD controls. Variables that were matched between non-controls and controls included age, sex, Elixhauser- Comorbidity Index (ECI), in addition to comorbidities including diabetes, hyperlipidemia, hypertension, and tobacco usage. Logistic regression analysis was used to calculate odds-ratios (OR) for outcomes of 90-day readmission rates and emergency room visits. Welch’s t-test was used to test for significance of outcomes of cost of care and ECI between the cohorts. A p-value less than 0.001 was statistically significant. Results: A total of 2,198 patients were included with (n= 485) and without (n = 1,698) OUD undergoing ORIF for ankle fracture (Table 1). OUD patients undergoing ORIF for ankle fractures were found to have a higher incidence and odds of 90-day readmission rates compared to controls (8.65 vs. 7.30%; OR: 1.20, 95%CI: 0.83 - 1.73, p=0.320), but failed to reach statistical significance. OUD patients were found to have a higher incidence and odds of emergency room visits compared to controls (3.50 vs. 0.64%; OR: 5.57, 95% CI: 2.59 - 11.97, p<0.0001). OUD patients also incurred significantly higher costs of care compared to controls ($5,921.59 vs. $5,128.22, p<0.0001). Conclusion: Patients with OUD have greater odds of 90-day hospital readmission rates, emergency room visits, and costs of care following ORIF procedures for ankle fracture. These outcomes are consistent with previous research which found increased costs associated with individuals diagnosed with OUD prior to undergoing other foot and ankle procedures. This study, establishes that patients with OUD place a significant, but preventable, financial burden on healthcare resources. The findings of this study highlight the role that foot and ankle orthopaedic surgeons can play in reducing healthcare costs and improving patient outcomes by addressing OUD prior to the occurrence of injury. [Table: see text]

scholarly journals Assessing the Relationships Between COVID-19 Stay-at-Home Orders and Opioid Overdoses in the State of Pennsylvania

2021 ◽  
pp. 002204262110063
Author(s):  
Brian King ◽  
Ruchi Patel ◽  
Andrea Rishworth
Keyword(s):  
Age Groups ◽  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Overdose ◽  
Policy Recommendations ◽  
Opioid Use ◽  
Fentanyl Analogs ◽  
Measure Change ◽  
Using Data ◽  
At Home

COVID-19 is compounding opioid use disorder throughout the United States. While recent commentaries provide useful policy recommendations, few studies examine the intersection of COVID-19 policy responses and patterns of opioid overdose. We examine opioid overdoses prior to and following the Pennsylvania stay-at-home order implemented on April 1, 2020. Using data from the Pennsylvania Overdose Information Network, we measure change in monthly incidents of opioid-related overdose pre- versus post-April 1, and the significance of change by gender, age, race, drug class, and naloxone doses administered. Findings demonstrate statistically significant increases in overdose incidents among both men and women, White and Black groups, and several age groups, most notably the 30–39 and 40–49 ranges, following April 1. Significant increases were observed for overdoses involving heroin, fentanyl, fentanyl analogs or other synthetic opioids, pharmaceutical opioids, and carfentanil. The study emphasizes the need for opioid use to be addressed alongside efforts to mitigate and manage COVID-19 infection.

Predicting Opioid Overdose Readmission and Opioid Use Disorder with Machine Learning

2020 ◽  
Author(s):  
Sarah McDougall ◽  
Priyanka Annapureddy ◽  
Praveen Madiraju ◽  
Nicole Fumo ◽  
Stephen Hargarten
Keyword(s):  
Machine Learning ◽  
Opioid Use Disorder ◽  
Opioid Overdose ◽  
Opioid Use

Fentanyl analogue overdose: Key lessons in management in the synthetic opioid age

2019 ◽  
Vol 15 (5) ◽  
pp. 428-432
Author(s):  
Amer Raheemullah, MD ◽  
Neal Andruska, MD, PhD
Keyword(s):  
Addiction Treatment ◽  
Opioid Use Disorder ◽  
Prescription Opioid ◽  
Opioid Overdose ◽  
Health Departments ◽  
Opioid Use ◽  
Public Health Departments ◽  
Disorder Treatment ◽  
Fentanyl Analogues ◽  
Overdose Deaths

Fentanyl overdoses are growing at an alarming rate. Fentanyl is often mixed into heroin and counterfeit prescription opioid pills without the customer’s knowledge and only detected upon laboratory analysis. This is problematic because fentanyl analogues like carfentanil are 10,000 times more potent than morphine and pose new challenges to opioid overdose management. A 62-year-old male with an overdose from a rare fentanyl analogue, acrylfentanyl, was given two doses of intranasal 2 mg naloxone with improvements in respiratory rate. In lieu of more naloxone, his trachea was intubated and he was admitted to the intensive care unit. He subsequently developed ventilator-associated pneumonia and then a pulmonary embolism. He did not receive any opioid use disorder treatment and returned back to the emergency department with an opioid overdose 21 days after discharge.We are encountering an unprecedented rise in synthetic opioid overdose deaths as we enter the third decade of the opioid epidemic. Thus, it is imperative to be aware of the features and management of overdoses from fentanyl and its analogues. This includes protecting against occupational exposure, administering adequate doses of naloxone, and working with public health departments to respond to fentanyl outbreaks. Additionally, fentanyl overdoses represent a critical opportunity to move beyond acute stabilization, start buprenorphine or methadone for opioid use disorder during hospitalization, link patients to ongoing addiction treatment, and distribute naloxone into the community to help curb the overdose epidemic.

scholarly journals Pharmacologic and Clinical Considerations of Nalmefene, a Long Duration Opioid Antagonist, in Opioid Overdose

2021 ◽  
Vol 2 (4) ◽  
pp. 365-378
Author(s):  
Amber N. Edinoff ◽  
Catherine A. Nix ◽  
Tanner D. Reed ◽  
Elizabeth M. Bozner ◽  
Mark R. Alvarez ◽  
...  
Keyword(s):  
Respiratory Depression ◽  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Antagonist ◽  
Opioid Overdose ◽  
Opioid Use ◽  
Physical Damage ◽  
Onset Of Action ◽  
Duration Of Action ◽  
Opioid Intoxication

Opioid use disorder is a well-established and growing problem in the United States. It is responsible for both psychosocial and physical damage to the affected individuals with a significant mortality rate. Given both the medical and non-medical consequences of this epidemic, it is important to understand the current treatments and approaches to opioid use disorder and acute opioid overdose. Naloxone is a competitive mu-opioid receptor antagonist that is used for the reversal of opioid intoxication. When given intravenously, naloxone has an onset of action of approximately 2 min with a duration of action of 60–90 min. Related to its empirical dosing and short duration of action, frequent monitoring of the patient is required so that the effects of opioid toxicity, namely respiratory depression, do not return to wreak havoc. Nalmefene is a pure opioid antagonist structurally similar to naltrexone that can serve as an alternative antidote for reversing respiratory depression associated with acute opioid overdose. Nalmefene is also known as 6-methylene naltrexone. Its main features of interest are its prolonged duration of action that surpasses most opioids and its ability to serve as an antidote for acute opioid overdose. This can be pivotal in reducing healthcare costs, increasing patient satisfaction, and redistributing the time that healthcare staff spend monitoring opioid overdose patients given naloxone.

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