scholarly journals Patterns of prescription opioid use in Swiss emergency department patients and its association with outcome: a retrospective analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e038079
Author(s):  
Bertram K Woitok ◽  
Petra Büttiker ◽  
Svenja Ravioli ◽  
Georg-Christian Funk ◽  
Aristomenis K Exadaktylos ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hospital Mortality ◽  
Hospitalisation Rate ◽  
Secondary Outcome ◽  
Prescription Opioid ◽  
Neoplastic Disease ◽  
Prescription Opioids ◽  
Opioid Use ◽  
Prescription Opioid Use ◽  
Rehospitalisation Rate

ObjectivesWe aimed to clarify the prevalence, indications, analgesic comedications and complications of prescription opioid use in patients presenting to a large emergency department (ED).DesignRetrospective chart review.SettingLarge, interdisciplinary ED of a public hospital.ParticipantsAll patients aged ≥18 years presenting between 1 January 2017, and 31 December 2018, with documentation on medication were included.InterventionsNone.Primary and secondary outcome measuresPrevalence rates for prescription opioid use and its indication. Prevalence of analgesic comedications in prescription opioid users. Hospitalisation rate, 72 hours ED reconsultation rate, 30-day rehospitalisation rate, in-hospital mortality.ResultsA total of 26 224 consultations were included in the analysis; 1906 (7.3%) patients had prescriptions for opioids on admission to the ED. The main indications for opioid prescriptions were musculoskeletal disease in 1145 (60.1%) patients, followed by neoplastic disease in 374 (19.6%) patients. One hundred fifty-four (8.2%) consultations were directly related to opioid intake, and 50.1% of patients on opioids also used other classes of analgesics. Patients on prescription opioids were older (76 vs 62 years, p<0.0001) and female individuals were over-represented (58 vs 48.9%, p<0.0001). Hospitalisation rate (78.3 vs 49%, p<0.0001), 72 hours ED reconsultation rate (0.8 vs 0.3%, p=0.004), 30-day rehospitalisation rate (6.2 vs 1.5%, p<0.0001) and in-hospital mortality (6.3 vs 1.6%, p<0.0001) were significantly higher in patients with opioid therapy than other patients. In 25 cases (1.3%), admission to the ED was due to opioid intoxication.ConclusionsDaily prescription opioid use is common in patients presenting to the ED. The use of prescription opioids is associated with adverse outcomes, whereas intoxication is a minor issue in the studied population.

354 Trends in the Drug-Sparing Effects for Benzodiazepines and Prescription Opioids among Insomnia Patients on Suvorexant in the US

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A141-A141
Author(s):  
Hrishikesh Kale ◽  
Rezaul Khandker ◽  
Ruchit Shah ◽  
Marc Botteman ◽  
Weilin Meng ◽  
...  
Keyword(s):  
Interrupted Time Series ◽  
Charlson Comorbidity Index Score ◽  
Prescription Opioid ◽  
Prescription Opioids ◽  
Opioid Use ◽  
Before And After ◽  
Prescription Opioid Use ◽  
Incident Cohort ◽  
Over Time ◽  
Post Period

Abstract Introduction Use of benzodiazepines to treat insomnia has been associated with serious side effects and abuse potential. Insomnia patients are at high risk of opioid abuse and better sleep patterns may help to reduce opioid use. This study examined the trend in the use of benzodiazepines and prescription opioids before and after initiation of suvorexant in insomnia patients. Methods The study analyzed 2015–2019, Optum Clinformatics Data Mart. Insomnia patients, identified using ICD-9/10 codes and prescribed suvorexant were included. The study included incident (newly diagnosed) and prevalent cohorts of insomnia patients. The proportion of patients on benzodiazepines or prescription opioids were calculated for 12 monthly intervals before (pre-period) and after initiation of suvorexant (post-period). Interrupted time series (ITS) analysis was conducted to assess trends for use of benzodiazepine or prescription opioids over time. Results A total of 5,939 patients from the incident insomnia cohort and 18,920 from the prevalent cohort were included. For the incident cohort, mean age was 64.47 (SD: 15.48), 63% were females, 71% had Medicare Advantage coverage, 59% had Charlson comorbidity index score (CCI) ≥ 1, 27% had an anxiety disorder and 16% had substance abuse disorder. Prevalent insomnia cohort was similar but had higher CCI. Results from ITS suggested that at the beginning of the pre-period, 28% of incident insomnia patients used either opioids or benzodiazepines with the rate of use in the pre-period increasing by 0.11% per month. In the post-period, the rate of use decreased by 0.33% per month. About 26% patients used benzodiazepines or opioids at 12-month after suvorexant initiation. In the absence of suvorexant, this proportion would have been 31%. Similar findings were observed for the prevalent insomnia cohort. A larger decrease was observed for opioid use than benzodiazepines. Conclusion The rate of benzodiazepines or prescription opioid use decreased over time after the initiation of suvorexant. Suvorexant has the potential to reduce the use of opioids and benzodiazepines among insomnia patients. Further research is needed to confirm these findings. Support (if any) This study was sponsored by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA.

scholarly journals Targeting the Orexin System for Prescription Opioid Use Disorder

2020 ◽  
Vol 10 (4) ◽  
pp. 226 ◽  
Author(s):  
Alessandra Matzeu ◽  
Rémi Martin-Fardon
Keyword(s):  
Opioid Use Disorder ◽  
Prescription Opioid ◽  
Prescription Opioids ◽  
Opioid Use ◽  
Effective Strategies ◽  
System A ◽  
Clinical Pain ◽  
Promising Target ◽  
Nonmedical Use ◽  
Prescription Opioid Use

Prescription opioids are potent analgesics that are used for clinical pain management. However, the nonmedical use of these medications has emerged as a major concern because of dramatic increases in abuse and overdose. Therefore, effective strategies to prevent prescription opioid use disorder are urgently needed. The orexin system has been implicated in the regulation of motivation, arousal, and stress, making this system a promising target for the treatment of substance use disorder. This review discusses recent preclinical studies that suggest that orexin receptor blockade could be beneficial for the treatment of prescription opioid use disorder.

scholarly journals US Emergency Department Visits for Acute Harms From Prescription Opioid Use, 2016–2017

2019 ◽  
Vol 109 (5) ◽  
pp. 784-791 ◽  
Author(s):  
Maribeth C. Lovegrove ◽  
Deborah Dowell ◽  
Andrew I. Geller ◽  
Sandra K. Goring ◽  
Kathleen O. Rose ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Department Visits ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Prescription Opioid Use

scholarly journals Prescription Opioid Use and Laboratory Value Derangements: A Cross-Sectional Analysis of NHANES Data

2020 ◽  
Vol 1;24 (1;1) ◽  
pp. E95-E100
Keyword(s):  
Pain Management ◽  
Reference Range ◽  
Comparison Group ◽  
Prescription Opioid ◽  
Prescription Opioids ◽  
Opioid Use ◽  
Cross Sectional ◽  
Laboratory Values ◽  
The Us ◽  
Prescription Opioid Use

BACKGROUND: The use of opioids for the treatment of pain is a risk versus benefit analysis and metabolic disease is an often overlooked variable in the equation and may lead to increased risk of comorbidities of cardiovascular and cerebrovascular disease and diabetes. OBJECTIVES: Our objective was to identify and describe abnormalities among the comprehensive metabolic and lipid panels of individuals taking prescription opioids. STUDY DESIGN: We performed a cross-sectional study of the laboratory values with 3 cycles (2011–2016) of the National Health and Nutrition Examination Survey (NHANES) in March 2020. SETTING: NHANES sampling is conducted using a multistaged, stratified, cluster sampling technique to create a representative sample of the United States. METHODS: We excluded patients with histories of cancer and under the age of 25 years. Our final sample size was 11,061 (n = 162,547,635), with 797 reportedly using a prescription opioid in the past 30 days—a weighted percent representing 22.95% of the US population. Our analyses identified mean differences in biomarkers between individuals taking prescription opioids and the US population. RESULTS: Laboratory values from the comprehensive metabolic panel were all within reference ranges for both groups, with only bilirubin levels being statistically lower in the group currently taking prescription opioids. Values from the lipid panel of both the opioid using and comparison groups were above reference range for total cholesterol and fasting glucose. The opioid using group was also higher than the reference range for triglycerides (mean [M] = 165.4, standard deviation [SD] = 14.2) and insulin (M = 15.5, SD = 2.2), whereas the comparison group was not. The oral glucose measure was within normal ranges for both groups; however, the opioid using group was 13.7 points higher than the comparison group (M = 122.3, SD = 1.8; M = 108.6, SD = 4.0; P < 0.01). LIMITATIONS: While our study uses a large sample for a robust generalizable analysis it is a correlation study and a longitudinal cohort would provide better evidence linking potential disease states to prescription opioid use. CONCLUSIONS: Although all Americans should be alarmed at the lipid levels reported in this study, specific combinations of heightened lipid laboratory values among prescription opioid users accelerate the trajectories toward comorbidities—heart disease, cerebrovascular disease, and diabetes—leading to diminished quality of life. Therefore pain management and comprehensive drug recovery programs should include nutritional counseling and physical activity as part of their overall treatment plan. KEY WORDS: Opioid use, NHANES, pain management, lab values, analgesics

scholarly journals Disparities in Opioid Use for Pain Control Among Older Adults: The Role of Social Factors

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 832-832
Author(s):  
Taylor Jansen
Keyword(s):  
Social Support ◽  
Older Adults ◽  
Severe Pain ◽  
Age Groups ◽  
Prescription Opioid ◽  
Prescription Opioids ◽  
Opioid Use ◽  
Moderation Effect ◽  
Core Dataset ◽  
Prescription Opioid Use

Abstract Over 50% of older adults (65+ years old) suffer from pain, and an estimated 25% of older adults use prescription opioids to treat their pain. Older adults are physiologically vulnerable to the effects of opioids; yet, they are prescribed more than all other age groups. This study used the Health and Retirement Study 2016 Core dataset (N=3,916) to analyze the moderation effect of social support on the association between pain and prescription opioid use in people aged 65+ using logistical regression analysis. Results show that older adults with severe pain were more likely to use prescription opioids (OR= 4.84) after considering covariates. Higher perceived social support was associated with higher likelihood of prescription opioid use for severe pain (OR=1.53). Older adults are at greater risk of pain and social isolation compared to younger age groups, making them a vulnerable group to consider as policy makers tackle this nationwide epidemic.

Suicidal ideation and attempts following nonmedical use of prescription opioids and related disorder

2020 ◽  
pp. 1-7
Author(s):  
Julian Santaella-Tenorio ◽  
Silvia S. Martins ◽  
Magdalena Cerdá ◽  
Mark Olfson ◽  
Katherine M. Keyes
Keyword(s):  
Suicidal Ideation ◽  
Suicidal Behavior ◽  
Suicide Attempts ◽  
Opioid Use Disorder ◽  
Prescription Opioid ◽  
Prescription Opioids ◽  
Opioid Use ◽  
Related Disorder ◽  
Nonmedical Use ◽  
Prescription Opioid Use

Abstract Background Since 1999, the rate of fatal prescription opioid overdoses and of suicides has dramatically increased in the USA. These increases, which have occurred among similar demographic groups, have led to the hypothesis that the opioid epidemic contributed to increases in suicidal behavior, though the underlying association remains poorly defined. We examine the association between nonmedical use of prescription opioids/opioid use disorder and suicidal ideation/attempts. Methods We used longitudinal data from a national representative sample of the US adult population, the National Epidemiologic Survey on Alcohol and Related Conditions. Participants (n = 34 653) were interviewed in 2001–2002 (wave 1) and re-interviewed approximately 3 years later (wave 2). A propensity score analysis estimated the association between exposure to prescription opioids at wave 1 and prevalent/incident suicidal behavior at wave 2. Results Heavy/frequent (⩾2–3 times a month) prescription opioid use was associated with prevalent suicide attempts [adjusted risk ratio (ARR) = 2.75, 95% CI 1.35–5.60]. Prescription opioid use disorder was associated with prevalent (ARR = 1.98, 95% CI 1.20–3.28) and incident suicidal ideation (ARR = 2.59, 95% CI 1.25–5.37), and prevalent attempts (ARR = 4.19, 95% CI 1.71–10.27). None of the exposures was associated with incident suicide attempts. Conclusions Heavy/frequent opioid use and related disorder were associated with prevalent suicide attempts; opioid use disorder was also associated with the incident and prevalent suicidal ideation. Given population increases in nonmedical use of prescription opioids and disorder, the opioid crisis may have contributed to population increases in suicidal ideation.

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