Estimating the Prevalence of Opioid Diversion by “Doctor Shoppers” in the United States

Prescription drug abuse is the fastest growing problem in the United States. According to the Centers for Disease Control and Prevention (CDC), enough opioid pain relievers were sold in 2010 to provide every adult in the United States with the equivalent of a typical dose of 5 mg of hydrocodone every 4 hours for 1 month. Many solutions have been proposed to address this problem, including treatment guidelines, political solutions (statutory changes), Risk Evaluation and Mitigation Strategy (REMS), and technological innovations. Many opioid products are manipulated (crushed, snorted, injected, etc.) to facilitate abuse. Since extended-release/long-acting (ER/LA) opioids contain a large amount of opioid contained in a single delivery system, they are a favorite target of abusers. In short, the goal of an abuser is to convert an ER/LA opioid into an immediate-release one. Abuse-deterrent formulations (ADFs) are intended to make manipulation more difficult or to make abuse of the manipulated product less attractive or less rewarding. One such technological solution is the development of ADFs for opioid pain medications. The Food and Drug Administration's (FDA) guidelines for industry released in 2015 establish the rationale and methodology for the development of ER/LA opioids that contain abuse-deterrent properties. The goal is to deter abuse, realizing that it is impossible to prevent abuse. Key words: abuse-deterrent formulations, abuse-deterrent opioids, CDC guidelines, FDA opioid guidelines, opioid abuse, opioid deaths, opioid diversion, opioid overdose, prescription drug abuse, REMS

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Prescription Drug Monitoring Programs and Prescription Opioid–Related Outcomes in the United States

Epidemiologic Reviews ◽

10.1093/epirev/mxaa002 ◽

2020 ◽

Cited By ~ 2

Author(s):

Victor Puac-Polanco ◽

Stanford Chihuri ◽

David S Fink ◽

Magdalena Cerdá ◽

Katherine M Keyes ◽

...

Keyword(s):

United States ◽

Substance Use ◽

Prescription Drug ◽

Substance Use Disorders ◽

Drug Monitoring ◽

The United States ◽

Mortality Rates ◽

Prescription Opioid ◽

Prescription Drug Monitoring Programs ◽

Opioid Diversion

Abstract Prescription drug monitoring programs (PDMPs) are a crucial component of federal and state governments’ response to the opioid epidemic. Evidence about the effectiveness of PDMPs in reducing prescription opioid–related adverse outcomes is mixed. We conducted a systematic review to examine whether PDMP implementation within the United States is associated with changes in 4 prescription opioid–related outcome domains: opioid prescribing behaviors, opioid diversion and supply, opioid-related morbidity and substance-use disorders, and opioid-related deaths. We searched for eligible publications in Embase, Google Scholar, MEDLINE, and Web of Science. A total of 29 studies, published between 2009 and 2019, met the inclusion criteria. Of the 16 studies examining PDMPs and prescribing behaviors, 11 found that implementing PDMPs reduced prescribing behaviors. All 3 studies on opioid diversion and supply reported reductions in the examined outcomes. In the opioid-related morbidity and substance-use disorders domain, 7 of 8 studies found associations with prescription opioid–related outcomes. Four of 8 studies in the opioid-related deaths domain reported reduced mortality rates. Despite the mixed findings, emerging evidence supports that the implementation of state PDMPs reduces opioid prescriptions, opioid diversion and supply, and opioid-related morbidity and substance-use disorder outcomes. When PDMP characteristics were examined, mandatory access provisions were associated with reductions in prescribing behaviors, diversion outcomes, hospital admissions, substance-use disorders, and mortality rates. Inconsistencies in the evidence base across outcome domains are due to analytical approaches across studies and, to some extent, heterogeneities in PDMP policies implemented across states and over time.

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Party Strength in the United States: Some Corrections

The Journal of Politics ◽

10.1017/s0022381600041591 ◽

1975 ◽

Vol 37 (2) ◽

pp. 641-642 ◽

Cited By ~ 1

Author(s):

Paul T. David

Keyword(s):

United States ◽

The United States ◽

Party Strength

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Correlative microscopy in distrubuted (client/server) computing environments: tools for catalyzing the rapid dissemination of information about the cell biology of the human prostate

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100139780 ◽

1995 ◽

Vol 53 ◽

pp. 682-683

Author(s):

A. Hakam ◽

J.T. Gau ◽

M.L. Grove ◽

B.A. Evans ◽

M. Shuman ◽

...

Keyword(s):

United States ◽

Cell Biology ◽

Tissue Bank ◽

The United States ◽

Prostate Adenocarcinoma ◽

Correlative Microscopy ◽

Client Server ◽

Critical Elements ◽

Transplant Organ

Prostate adenocarcinoma is the most common malignant tumor of men in the United States and is the third leading cause of death in men. Despite attempts at early detection, there will be 244,000 new cases and 44,000 deaths from the disease in the United States in 1995. Therapeutic progress against this disease is hindered by an incomplete understanding of prostate epithelial cell biology, the availability of human tissues for in vitro experimentation, slow dissemination of information between prostate cancer research teams and the increasing pressure to “ stretch” research dollars at the same time staff reductions are occurring.To meet these challenges, we have used the correlative microscopy (CM) and client/server (C/S) computing to increase productivity while decreasing costs. Critical elements of our program are as follows:1) Establishing the Western Pennsylvania Genitourinary (GU) Tissue Bank which includes >100 prostates from patients with prostate adenocarcinoma as well as >20 normal prostates from transplant organ donors.

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Digital image acquisition, processing, and analysis in a polymer microscopy laboratory

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100170001 ◽

1994 ◽

Vol 52 ◽

pp. 454-455

Author(s):

Vinod K. Berry ◽

Xiao Zhang

Keyword(s):

United States ◽

Image Analysis ◽

Digital Image ◽

Image Acquisition ◽

Image Transmission ◽

The United States ◽

Quantitative Image Analysis ◽

Quantitative Image

In recent years it became apparent that we needed to improve productivity and efficiency in the Microscopy Laboratories in GE Plastics. It was realized that digital image acquisition, archiving, processing, analysis, and transmission over a network would be the best way to achieve this goal. Also, the capabilities of quantitative image analysis, image transmission etc. available with this approach would help us to increase our efficiency. Although the advantages of digital image acquisition, processing, archiving, etc. have been described and are being practiced in many SEM, laboratories, they have not been generally applied in microscopy laboratories (TEM, Optical, SEM and others) and impact on increased productivity has not been yet exploited as well.In order to attain our objective we have acquired a SEMICAPS imaging workstation for each of the GE Plastic sites in the United States. We have integrated the workstation with the microscopes and their peripherals as shown in Figure 1.

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Silence of the Land: On the Historical Irrelevance of Territory to Congressional Districting and Political Representation in the United States

Studies in American Political Development ◽

10.1017/s0898588x01010045 ◽

2001 ◽

Vol 15 (01) ◽

pp. 53-87 ◽

Cited By ~ 2

Author(s):

Andrew Rehfeld

Keyword(s):

United States ◽

House Of Representatives ◽

Political Representation ◽

The United States ◽

Representative Government ◽

Congressional District ◽

Congressional Districts ◽

Communities Of Interest

Every ten years, the United States “constructs” itself politically. On a decennial basis, U.S. Congressional districts are quite literally drawn, physically constructing political representation in the House of Representatives on the basis of where one lives. Why does the United States do it this way? What justifies domicile as the sole criteria of constituency construction? These are the questions raised in this article. Contrary to many contemporary understandings of representation at the founding, I argue that there were no principled reasons for using domicile as the method of organizing for political representation. Even in 1787, the Congressional district was expected to be far too large to map onto existing communities of interest. Instead, territory should be understood as forming a habit of mind for the founders, even while it was necessary to achieve other democratic aims of representative government.

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