Perioperative Opioids and Public Health

2016 ◽  
Vol 124 (4) ◽  
pp. 960-965 ◽  
Author(s):  
Evan D. Kharasch ◽  
L. Michael Brunt
Keyword(s):  
Public Health ◽  
Research Agenda ◽  
Prescription Opioid ◽  
Opioid Prescribing ◽  
Opioid Diversion

Abstract Prescription opioid diversion, abuse, addiction, and overdose are epidemic. Although unclear whether postoperative opioid prescribing is contributory, or how anesthesiologists and surgeons can contribute to a solution, nonetheless awareness and a research agenda are needed.

Opioids and Public Health: The Prescription Opioid Ecosystem and Need for Improved Management

2021 ◽  
Author(s):  
Evan D. Kharasch ◽  
J. David Clark ◽  
Jerome M. Adams
Keyword(s):  
Public Health ◽  
Prescription Opioid ◽  
Supply Side ◽  
Demand Side ◽  
Opioid Prescribing ◽  
The Past ◽  
New Approaches ◽  
Opioid Deaths

While U.S. opioid prescribing has decreased 38% in the past decade, opioid deaths have increased 300%. This opioid paradox is poorly recognized. Current approaches to opioid management are not working, and new approaches are needed. This article reviews the outcomes and shortcomings of recent U.S. opioid policies and strategies that focus primarily or exclusively on reducing or eliminating opioid prescribing. It introduces concepts of a prescription opioid ecosystem and opioid pool, and it discusses how the pool can be influenced by supply-side, demand-side, and opioid returns factors. It illuminates pressing policy needs for an opioid ecosystem that enables proper opioid stewardship, identifies associated responsibilities, and emphasizes the necessity of making opioid returns as easy and common as opioid prescribing, in order to minimize the size of the opioid pool available for potential diversion, misuse, overdose, and death. Approaches are applicable to opioid prescribing in general, and to opioid prescribing after surgery.

scholarly journals Doctor Shopping Behavior and the Diversion of Prescription Opioids

2017 ◽  
Vol 11 ◽  
pp. 117822181769607 ◽  
Author(s):  
Ronald Simeone
Keyword(s):  
Public Health ◽  
Drug Treatment ◽  
Shopping Behavior ◽  
Prescription Opioid ◽  
Prescription Opioids ◽  
Doctor Shopping ◽  
Health Measures ◽  
Related Drug ◽  
Opioid Diversion ◽  
Morphine Equivalent

Objectives: “Doctor shopping” as a means of prescription opioid diversion is examined. The number and percentage of prescriptions and morphine-equivalent milligrams diverted in this manner are estimated by state and molecule for the period 2008-2012. Methods: Eleven billion prescriptions with unique patient, doctor, and pharmacy identifiers were used to construct diversion “events” that involved between 1 and 6 unique doctors and between 1 and 6 unique pharmacies. Diversion thresholds were established based on the probability of each contingency. Results: A geographically widespread decline occurred between 2008 and 2012. The number of prescriptions diverted fell from approximately 4.30 million (1.75% of all prescriptions) in 2008 to approximately 3.37 million (1.27% of all prescriptions) in 2012, and the number of morphine-equivalent milligrams fell from approximately 6.55 metric tons (2.95% of total metric tons) in 2008 to approximately 4.87 metric tons (2.19% of total metric tons) in 2012. Conclusions: Diversion control efforts have likely been effective. But given increases in opioid-related deaths, opioid-related drug treatment admissions, and the more specific resurgence of heroin-related events, it is clear that additional public health measures are required.

An Older Adult Falls Research Agenda from a Public Health Perspective

2010 ◽  
Vol 26 (4) ◽  
pp. 767-779 ◽  
Author(s):  
Judy A. Stevens ◽  
Grant T. Baldwin ◽  
Michael F. Ballesteros ◽  
Rita K. Noonan ◽  
David A. Sleet
Keyword(s):  
Public Health ◽  
Older Adult ◽  
Research Agenda ◽  
Public Health Perspective

scholarly journals Evaluation of a Medicaid performance improvement project to reduce high-dose opioid prescriptions

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Daniel M. Hartung ◽  
Jonah Geddes ◽  
Sara E. Hallvik ◽  
P. Todd Korthuis ◽  
Luke Middleton ◽  
...  
Keyword(s):  
Performance Improvement ◽  
Emergency Department Visits ◽  
Prescription Opioid ◽  
High Dose ◽  
Opioid Overdose ◽  
Opioid Use ◽  
Improvement Project ◽  
Opioid Prescribing ◽  
Percentage Points ◽  
Prescription Opioid Use

Abstract Background In 2015, Oregon’s Medicaid program implemented a performance improvement project to reduce high-dose opioid prescribing across its 16 coordinated care organizations (CCOs). The objective of this study was to evaluate the effect of that program on prescription opioid use and outcomes. Methods Using Medicaid claims data from 2014 to 2017, we conducted interrupted time-series analyses to examine changes in the prescription opioid use and overdose rates before (July 2014 to June 2015) and after (January 2016 to December 2017) implementation of Oregon’s high-dose policy initiative (July 2015 to December 2015). Prescribing outcomes were: 1) total opioid prescriptions 2) high-dose [> 90 morphine milligram equivalents per day] opioid prescriptions, and 3) proportion of opioid prescriptions that were high-dose. Opioid overdose outcomes included emergency department visits or hospitalizations that involved an opioid-related poisoning (total, heroin-involved, non-heroin involved). Analyses were performed at the state and CCO level. Results There was an immediate reduction in high dose opioid prescriptions after the program was implemented (− 1.55 prescription per 1000 enrollee; 95% CI − 2.26 to − 0.84; p < 0.01). Program implementation was also associated with an immediate drop (− 1.29 percentage points; 95% CI − 1.94 to − 0.64 percentage points; p < 0.01) and trend reduction (− 0.23 percentage point per month; 95% CI − 0.33 to − 0.14 percentage points; p < 0.01) in the monthly proportion of high-dose opioid prescriptions. The trend in total, heroin-involved, and non-heroin overdose rates increased significantly following implementation of the program. Conclusions Although Oregon’s high-dose opioid performance improvement project was associated with declines in high-dose opioid prescriptions, rates of opioid overdose did not decrease. Policy efforts to reduce opioid prescribing risks may not be sufficient to address the growing opioid 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.

Sign in / Sign up

Export Citation Format

Share Document