Health Literacy, Opioid Misuse, and Pain Experience Among Adults with Chronic Pain

Pain Medicine ◽  
2019 ◽  
Vol 21 (4) ◽  
pp. 670-676 ◽  
Author(s):  
Andrew H Rogers ◽  
Jafar Bakhshaie ◽  
Michael F Orr ◽  
Joseph W Ditre ◽  
Michael J Zvolensky
Keyword(s):  
Public Health ◽  
Chronic Pain ◽  
Health Literacy ◽  
Health Care Cost ◽  
Public Health Problem ◽  
The United States ◽  
Prescription Opioid ◽  
Opioid Misuse ◽  
Health Crisis ◽  
Pain Experience

Abstract Background Chronic pain is a significant public health problem that is associated with several negative health outcomes, including increased health care cost, decreased productivity, and prescription opioid misuse. Although efforts have been made to curb the growing opioid epidemic in the United States, further research is needed to better understand individual difference factors that may be associated with greater pain and opioid misuse. Lower levels of health literacy, defined as the ability to obtain, understand, and use health information to make important decisions regarding health and medical care, has been associated with several chronic illnesses. Yet little work has examined the relationship between health literacy, pain, and opioid misuse among individuals with chronic pain. Methods The current study examined health literacy in relation to current opioid misuse, severity of opioid dependence, pain severity, and pain disability among 445 adults with chronic pain (74.6% female, Mage [SD] = 38.45 [11.06] years). Results Results indicated that health literacy was significantly negatively associated with each of the criterion variables. Conclusions These results suggest that health literacy may contribute to opioid misuse and pain experience among individuals with chronic pain. Interventions targeting health literacy among individuals with chronic illness may help to address the opioid public health crisis.

scholarly journals A Critical Review of the Social and Behavioral Contributions to the Overdose Epidemic

2020 ◽  
Vol 42 (1) ◽  
Author(s):  
Magdalena Cerdá ◽  
Noa Krawczyk ◽  
Leah Hamilton ◽  
Kara E. Rudolph ◽  
Samuel R. Friedman ◽  
...  
Keyword(s):  
Public Health ◽  
Public Health Problem ◽  
The United States ◽  
Social Contexts ◽  
Prescription Opioid ◽  
Annual Review ◽  
Publication Date ◽  
Opioid Overdose ◽  
The Social ◽  
Critical Public Health

More than 750,000 people in the United States died from an overdose between 1999 and 2018; two-thirds of those deaths involved an opioid. In this review, we present trends in opioid overdose rates during this period and discuss how the proliferation of opioid prescribing to treat chronic pain, changes in the heroin and illegally manufactured opioid synthetics markets, and social factors, including deindustrialization and concentrated poverty, contributed to the rise of the overdose epidemic. We also examine how current policies implemented to address the overdose epidemic may have contributed to reducing prescription opioid overdoses but increased overdoses involving illegal opioids. Finally, we identify new directions for research to understand the causes and solutions to this critical public health problem, including research on heterogeneous policy effects across social groups, effective approaches to reduce overdoses of illegal opioids, and the role of social contexts in shaping policy implementation and impact. Expected final online publication date for the Annual Review of Public Health, Volume 42 is April 1, 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

State Laws Regulating Prescribing of Controlled Substances: Balancing the Public Health Problems of Chronic Pain and Prescription Painkiller Abuse and Overdose

2013 ◽  
Vol 41 (S1) ◽  
pp. 42-45 ◽  
Author(s):  
Andrea M. Garcia
Keyword(s):  
Public Health ◽  
Chronic Pain ◽  
Public Health Problem ◽  
The United States ◽  
Institute Of Medicine ◽  
State Laws ◽  
Controlled Substances ◽  
The Public ◽  
Lost Productivity ◽  
Subsequent Rise

According to the Institute of Medicine, chronic pain affects at least 116 million adults in the United States (U.S.), which is more than the total affected by heart disease, cancer, and diabetes combined. Pain costs the nation up to $635 billion each year in medical treatment and lost productivity. It has been conceptualized as a public health problem due to its prevalence, seriousness, disparities, vulnerable populations, the utility of population health strategies, and the importance of prevention at both the population and individual levels. For many patients, treatment of pain is inadequate due to uncertain diagnoses, societal stigma, the lack of effective treatments, and inadequate patient and clinician knowledge about the best ways to manage pain. This article explores the inadequate treatment of pain in the U.S. and the subsequent rise of prescription painkiller abuse, misuse, and overdoses. This is followed by a review of the actions taken by states to regulate the prescribing of controlled substances.

Managing Pain in Patients with a History of a Substance Use Disorder

2018 ◽  
Author(s):  
Martin D. Cheatle
Keyword(s):  
Chronic Pain ◽  
Substance Use ◽  
Opioid Use Disorder ◽  
Mitigation Strategies ◽  
Scholarly Activity ◽  
Prescription Opioid ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Health Crisis ◽  
Prescription Opioid Misuse

Patients with chronic pain tend to be complex and can present with multiple comorbidities, including anxiety, depression, functional disabilities, and substance misuse or abuse. The burgeoning rate of prescription opioid misuse and abuse and opioid-related fatalities has generated a great deal of scholarly activity on understanding the etiology of opioid misuse/abuse and developing risk assessment and mitigation strategies to curb this public health crisis. Balancing effective pain management and reducing the risk of opioid misuse/abuse and diversion can be a daunting endeavor, as is controlling pain in patients with pain and concomitant substance use disorders. This chapter provides an overview of the prevalence of opioid misuse/abuse in patients with chronic pain. It covers pharmacologic and nonpharmacologic therapies for patients with pain and co-occurring opioid use disorder and also discusses the challenges and opportunities to improve pain care and reduce misuse and abuse of opioids.

A Practical Approach to Neonatal Opiate Withdrawal Syndrome

2017 ◽  
Vol 35 (04) ◽  
pp. 324-330 ◽  
Author(s):  
Jonathan Davis ◽  
Lori Devlin
Keyword(s):  
Withdrawal Syndrome ◽  
Public Health Problem ◽  
The United States ◽  
Hospital Charges ◽  
Opiate Withdrawal ◽  
Prescription Opioid ◽  
Opioid Misuse ◽  
Medical Practitioners ◽  
Emergency Room Care ◽  
Prescription Opioid Misuse

AbstractPerinatal opioid misuse and neonatal opioid withdrawal syndrome (NOWS) are a significant public health problem that has grown exponentially over the past decade. In the United States, a woman seeks emergency room care for prescription opioid misuse every 3 minutes and approximately every 25 minutes, a child is born with signs of drug withdrawal. The economic impact of perinatal opioid misuse is significant with annual hospital charges for NOWS in 2012 as $1.5 billion dollars. Perinatal opioid misuse is a complex, multifaceted problem that demands a multidisciplinary cross specialty approach. This article will review the current state of NOWS and provide medical practitioners with a practical guide to enhance evidence based practice.

scholarly journals A Behavioral Health Harm Reduction and Preventive Intervention Targeting Chronic Pain Patients at Risk for Opioid Misuse: Study Protocol for a Small-Scale Randomized Clinical Trial

2020 ◽  
Author(s):  
Valerie Hruschak ◽  
Daniel Rosen ◽  
Megan Tierny ◽  
Shaun Eack ◽  
Ajay D. Wasan ◽  
...  
Keyword(s):  
At Risk ◽  
Chronic Pain ◽  
Harm Reduction ◽  
The United States ◽  
Small Scale ◽  
Opioid Misuse ◽  
Health Crisis ◽  
Chronic Pain Patients ◽  
Patients At Risk ◽  
Pain Patients

Abstract Background: The United States is experiencing an interrelated public health crisis, involving the management of chronic pain and the risks associated with opioid misuse. As millions of individuals suffer with chronic pain and as opioid misuse and overdose deaths continue to escalate, the need to advance evidenced-based harm reduction research in this area is critical. Methods: We developed the Integrated Psychosocial Group Treatment (IPGT) protocol, which is a harm reduction treatment targeting psychosocial factors for chronic pain patients at risk for opioid misuse. The objective of this study is to examine feasibility; acceptability; and preliminary efficacy. Chronic pain patients at risk for opioid misuse (N=30) will be randomized to either IPGT or treatment as usual (TAU). Outcome variables will be collected at pre and post-treatment (6 weeks), in addition to a follow up (9 weeks). We hypothesize that the application of IPGT will cause a reduction in opioid misuse, enhanced knowledge of overdose education and naloxone distribution, and improved pain severity, interference, and pain catastrophizing. Discussion: This study will provide initial support for IPGT as being acceptable and feasible for delivery in chronic pain patients at risk for opioid misuse in addition to preliminary efficacy. Findings will provide greater insight into strategies that address this health crisis and given the current epidemic in conjunction with the lack of literature, this research is urgently needed. Trial Registration: ClinicalTrials.gov, NCT03648177. Registered 27 August 2018, https://clinicaltrials.gov/ct2/show/NCT03648177

scholarly journals Implementing a Public Health Perspective in FDA Drug Regulation

2018 ◽  
Author(s):  
Patricia Zettler ◽  
Margaret Foster Riley ◽  
Aaron S. Kesselheim
Keyword(s):  
Public Health ◽  
Drug Approval ◽  
Health Impact ◽  
The United States ◽  
Drug Regulation ◽  
Prescription Opioid ◽  
Prescription Opioids ◽  
Public Health Perspective ◽  
Health Crisis ◽  
Prescription Opioid Misuse

There is, without question, a public health crisis in the United States arising from both illicit and prescription opioid misuse, addiction, and overdose. The Food and Drug Administration (FDA) is one regulator with an important role to play in minimizing the harms associated with prescription opioids, while also ensuring that prescription opioids are available for the evidence-based management of pain. One question, however, is to what extent the agency can consider in its decisions to approve opioids and keep existing ones on the market the provider and patient behaviors contributing to the epidemic. This is, in part, because FDA’s approval of drugs is often understood as narrowly focused on weighing the benefits and risks of the products as defined in the preapproval clinical trials that are used to set the drug’s official FDA-approved indication. Such a limited focus would exclude important information about the real-world use and public-health impact of prescription opioids and other drugs with externalities. This Article argues that, to better regulate drugs like opioids that have such externalities, one step FDA should take is to use a “public health” perspective in its approval (and withdrawal) decisions. The Article describes how the federal Food, Drug, and Cosmetic Act authorizes FDA to take this broad approach in its drug approval and withdrawal decisions and offers some principles for implementing this approach systematically.Citation: Patricia J. Zettler, Margaret Foster Riley, and Aaron S. Kesselheim, Implementing a Public Health Perspective in FDA Drug Regulation, 73 Food & Drug L.J. 221 (2018).Posted with the permission of the Food and Drug Law Institute.

Unresolved Issues in Controlling the Tuberculosis Epidemic Among the Foreign-Born in the United States

1996 ◽  
Vol 22 (4) ◽  
pp. 503-536
Author(s):  
Guido S. Weber
Keyword(s):  
Public Health ◽  
The United States ◽  
Laboratory Research ◽  
Treatment Programs ◽  
State Governments ◽  
Foreign Born ◽  
Health Crisis ◽  
Department Of Health ◽  
Public Health Officials ◽  
Year 2000

Tuberculosis (TB), “the world’s most neglected health crisis,” has returned after decades of decline, but has only gradually caught the attention of governments as a formidable threat to public health. By 1984, when TB cases hit an all-time low, federal and state governments stopped supporting the medical infrastructure that once served to contain the disease. State officials around the nation began dismantling laboratory research programs and closing TB clinics and sanitoria. Since 1985, however, TB rates have steadily increased to 26,673 reported cases in 1992, and some have estimated that by the year 2000, there could be a twenty percent increase. By 1993, Congress, realizing that TB could pose a major public health threat, allocated over $100 million to the Department of Health and Human Services for TB prevention and treatment programs. Those funds, however, were sorely needed years before and amounted to only a fraction of what public health officials believe necessary to control TB today.

Driving and Public Health

2021 ◽  
Keyword(s):  
Public Health ◽  
United States ◽  
Health Problem ◽  
Cell Phone ◽  
Motor Vehicle ◽  
Electronic Device ◽  
Public Health Problem ◽  
The United States ◽  
Distracted Driving ◽  
The Past

Distracted driving is defined in the Oxford English Dictionary as “the practice of driving a motor vehicle while engaged in another activity, typically one that involves the use of a mobile phone or other electronic device.” However, other distractions not involving the use of a cell phone or texting are important as well, contributing to this burgeoning public health problem in the United States. Examples include talking to other passengers, adjusting the radio or other controls in the car, and daydreaming. Distracted driving has been linked to increased risk of motor vehicle crashes (MVCs) in the United States, representing one of the most preventable leading causes of death for youth ages 16 to 24 years. Undoubtedly, the proliferation of cell phone, global positioning system (GPS), and other in-vehicle and personal electronic device use while driving has led to this rise in distracted driving prevalence. This behavior has impacted society—including individual and commercial drivers, passengers, pedestrians—in countless numbers of ways, ranging from increased MVCs and deaths to the enactment of new driving laws. In 2016, for example, 20 percent of all US pediatric deaths (nearly 4,000 children and adolescents) were due to fatal MVCs. It has been estimated that at any given time, more than 650,000 drivers are using cell phones or manipulating electronic devices while driving. In the United States, efforts are underway to reduce this driving behavior. In the past two decades, state and federal laws have specifically targeted cell phone use and texting while driving as priority areas for legal intervention. Distracted driving laws have become “strategies of choice” for tackling this public health problem, though their enforcement has emerged as a major challenge and varies by jurisdiction and location. Multimodal interventions using models such as the “three Es” framework—Enactment of a law, Education of the public about the law and safety practices, and Enforcement of the law—have become accepted practice or viewed as necessary steps to successfully change this behavior caused by distractions while driving. This Oxford Bibliographies review introduces these and other aspects (including psychological influences and road conditions) of distracted driving through a presentation of annotated resources from peer- and non-peer-reviewed literature. This selective review aims to provide policymakers, program implementers, and researchers with a reliable source of information on the past and current state of American laws, policies, and priorities for distracted driving.

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