scholarly journals Opioid availability statistics from the International Narcotics Control Board do not reflect the medical use of opioids: comparison with sales data from Scandinavia

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Emmanuel Bäckryd ◽  
Markus Heilig ◽  
Mikael Hoffmann
Keyword(s):  
Opioid Analgesics ◽  
Warning Signal ◽  
Control Board ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Sales Data ◽  
Narcotics Control ◽  
Addiction Risk ◽  
The Usa ◽  
Prescription Rates

Abstract Objectives Opioid analgesics are essential in clinical practice, but their excessive use is associated with addiction risk. Increases in opioid prescription rates have fuelled an epidemic of opioid addiction in the USA, making statistics on medical opioid use a critical warning signal. A dramatic 150% increase in Swedish opioid access 2001–2013 was recently reported based on data from the International Narcotics Control Board (INCB; Berterame et al. 2016) in conflict with other studies of opioid use in the Nordic countries. This article aims to analyse to what degree published INCB statistics on opioids in Scandinavia (Denmark, Norway and Sweden) reflect actual medical use and study the methodological reasons for putative discrepancies. Methods Data on aggregated total national sales of opioids for the whole population, including hospitals, were collected from the Swedish e-Health Authority. Total sales data for Denmark and drugs dispensed at pharmacies in Norway are publicly available through the relevant authorities’ websites. Results INCB opioid statistics during the period 2001–2013 were markedly inconsistent with sales data from Scandinavia, calling the reliability of INCB data into question. INCB-data were flawed by (a) over-representing the volume of fentanyl, (b) under-reporting of codeine, and (c) by not including tramadol. Conclusions Opioid availability, as expressed by INCB statistics, does not reflect medical opioid use. It is crucial to underline that INCB statistics are based on the manual compilation of national production, import and export data from manufacturers and drug companies. This is not the same amount that is prescribed and consumed within the health care system. Moreover, there are methodological problems in the INCB reports, in particular concerning fentanyl, codeine and tramadol. We suggest that INCB should carefully review the quality of their data on medical opioids.

Reduced opioid requirements following unicompartmental knee arthroplasty compared with total knee arthroplasty

2019 ◽  
Vol 101-B (7_Supple_C) ◽  
pp. 22-27 ◽  
Author(s):  
I. L. Kalbian ◽  
T. L. Tan ◽  
A. J. Rondon ◽  
V. A. Bonaddio ◽  
M. R. Klement ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Multivariate Analysis ◽  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Unicompartmental Knee ◽  
The Usa ◽  
Total Knee ◽  
Continued Use

Aims Unicompartmental knee arthroplasty (UKA) provides improved early functional outcomes and less postoperative morbidity and pain compared with total knee arthroplasty (TKA). Opioid prescribing has increased in the last two decades, and recently states in the USA have developed online Prescription Drug Monitoring Programs to prevent overprescribing of controlled substances. This study evaluates differences in opioid requirements between patients undergoing TKA and UKA. Patients and Methods We retrospectively reviewed 676 consecutive TKAs and 241 UKAs. Opioid prescriptions in morphine milligram equivalents (MMEs), sedatives, benzodiazepines, and stimulants were collected from State Controlled Substance Monitoring websites six months before and nine months after the initial procedures. Bivariate and multivariate analysis were performed for patients who had a second prescription and continued use. Results Patients undergoing UKA had a second opioid prescription filled 50.2% of the time, compared with 60.5% for TKA (p = 0.006). After controlling for potential confounders, patients undergoing UKA were still less likely to require a second prescription than those undergoing TKA (adjusted odds ratio (OR) 0.58, 95% confidence interval (CI) 0.42 to 0.81; p = 0.001). Continued opioid use requiring more than five prescriptions occurred in 13.7% of those undergoing TKA and 5.8% for those undergoing UKA (p = 0.001), and was also reduced in UKA patients compared with TKA patients (adjusted OR 0.33, 95% CI 0.16 to 0.67; p = 0.022) in multivariate analysis. The continued use of opioids after six months was 11.8% in those undergoing TKA and 8.3% in those undergoing UKA (p = 0.149). The multivariate models for second prescriptions, continued use with more than five, and continued use beyond six months yielded concordance scores of 0.70, 0.86, and 0.83, respectively. Conclusion Compared with TKA, patients undergoing UKA are less likely to require a second opioid prescription and use significantly fewer opioid prescriptions. Thus, orthopaedic surgeons should adjust their patterns of prescription and educate patients about the reduced expected analgesic requirements after UKA compared with TKA. Cite this article: Bone Joint J 2019;101-B(7 Supple C):22–27

scholarly journals Use and Opinions of Prescription Opioids Among Older American Adults: Sociodemographic Predictors

2018 ◽  
Vol 74 (6) ◽  
pp. 1009-1019 ◽  
Author(s):  
Hanna Grol-Prokopczyk
Keyword(s):  
Opioid Analgesics ◽  
Study Data ◽  
Prescription Opioid ◽  
Pain Level ◽  
Opioid Use ◽  
Drug Study ◽  
Opioid Prescription ◽  
Medicaid Coverage ◽  
Mediation Analyses ◽  
Sociodemographic Predictors

Abstract Objectives This study identifies sociodemographic predictors of prescription opioid use among older adults (age 65+) during the peak decade of U.S. opioid prescription, and tests whether pain level and Medicaid coverage mediate the association between low wealth and opioid use. Predictors of prescription nonsteroidal anti-inflammatory drug (NSAID) use, and of opinions of both drug classes, are also examined. Method Regressions of opioid and NSAID use on sociodemographic characteristics, pain level, and insurance type were conducted using Health and Retirement Study 2004 core and 2005 Prescription Drug Study data (n = 3,721). Mediation analyses were conducted, and user opinions of drug importance, quality, and side effects were assessed. Results Low wealth was a strong, consistent predictor of opioid use. Both pain level and Medicaid coverage significantly, but only partially, mediated this association. Net of wealth, there were no significant associations between education and use of, or opinions of, either class of drugs. Discussion Among older American adults, the poorest are disproportionately likely to have been exposed to prescription opioid analgesics. Wealth, rather than education, drove social class differences in mid-2000s opioid use. Opioid-related policies should take into account socioeconomic contributors to opioid use, and the needs and treatment histories of chronic pain patients.

Is Opioid Prescribing Driving Trauma Recidivism or is Trauma Driving Opioid Use?

2019 ◽  
Vol 85 (6) ◽  
pp. 567-571
Author(s):  
Laura Harmon ◽  
Leah Sukri ◽  
Joseph A. Kufera ◽  
Andrew Nguyen ◽  
Meilin Grunnagle ◽  
...  
Keyword(s):  
Injury Severity ◽  
Hospital Admissions ◽  
Traumatic Injury ◽  
Previous History ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Prescription Rates ◽  
Trauma Recidivism

In the past 30 years, opioid prescription rates have quadrupled and hospital admissions for overdose are rising. Previous studies have focused on alcohol use and trauma recidivism, however rarely evaluating recidivism and opioid use. We hypothesized there is an association between opioid use and trauma recidivism. This is a retrospective review of patients with multiple admissions for traumatic injury. Demographics, opioid toxicology screen (TS) results, and injury characteristics were collected. Statistical analysis was performed with chi-squared and Poisson regression models. One thousand six hundred forty-nine patients (age ≥18 years) had multiple trauma admissions. Seven hundred nine patients had TS data for both admissions. Thirty-one per cent (218) were TS positive on the 1st admission compared with 34 per cent (244) on their 2nd admission. Fifty-five per cent of patients who were TS positive on the 1st admission were positive on their 2nd admission, whereas 25 per cent who were TS negative on the 1st admission were subsequently positive on their 2nd admission ( P < 0.0001). Patients who were TS positive on the subsequent admission were less severely injured than TS negative patients (Injury Severity Score > 15, 26.3% vs 22.3%, P = 0.04). The only significant risk factor for being TS positive on the 2nd admission was being TS positive on the 1st admission (relative risk = 2.18, P < 0.001). A previous history of opioid use is the strongest predictor of recurrent use in recidivists.

scholarly journals Impact of COVID-19 on opioid use in those awaiting hip and knee arthroplasty: a retrospective cohort study

2021 ◽  
pp. bmjqs-2021-013450
Author(s):  
Luke Farrow ◽  
William T Gardner ◽  
Chee Chee Tang ◽  
Rachel Low ◽  
Patrice Forget ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Waiting Times ◽  
Sample Size Calculation ◽  
Wait Time ◽  
University Teaching ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Hip And Knee Arthroplasty ◽  
Prescription Rates

BackgroundCOVID-19 has had a detrimental impact on access to hip and knee arthroplasty surgery. We set out to examine whether this had a subsequent impact on preoperative opioid prescribing rates for those awaiting surgery.MethodsData regarding patient demographics and opioid utilisation were collected from the electronic health records of included patients at a large university teaching hospital. Patients on the outpatient waiting list for primary hip and knee arthroplasty as of September 2020 (COVID-19 group) were compared with historical controls (Controls) who had previously undergone surgery. A sample size calculation indicated 452 patients were required to detect a 15% difference in opioid prescription rates between groups.ResultsA total of 548 patients (58.2% female) were included, 260 in the COVID-19 group and 288 in the Controls. Baseline demographics were similar between the groups. For those with data available, the proportion of patients on any opioid at follow-up in the COVID-19 group was significantly higher: 55.0% (143/260) compared with 41.2% (112/272) in the Controls (p=0.002). This remained significant when adjusted for confounding (age, gender, Scottish Index of Multiple Deprivation, procedure and wait time). The proportion of patients on a strong opioid was similar (4.2% (11/260) vs 4.8% (13/272)) for COVID-19 and Controls, respectively. The median waiting time from referral to follow-up was significantly longer in the COVID-19 group compared with the Controls (455 days vs 365 days; p<0.0001).ConclusionThe work provides evidence of potential for an emerging opioid problem associated with the influence of COVID-19 on elective arthroplasty services. Viable alternatives to opioid analgesia for those with end-stage arthritis should be explored, and prolonged waiting times for surgery ought to be avoided in the recovery from COVID-19 to prevent more widespread opioid use.

scholarly journals Use of prescription opioids among patients with rheumatic diseases compared to patients with hypertension in the USA: a retrospective cohort study

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e027495 ◽  
Author(s):  
Sarah K Chen ◽  
Candace H Feldman ◽  
Gregory Brill ◽  
Yvonne C Lee ◽  
Rishi J Desai ◽  
...  
Keyword(s):  
Rheumatic Disease ◽  
Rheumatic Diseases ◽  
Lupus Erythematosus ◽  
Underlying Disease ◽  
Prescription Opioid ◽  
Prescription Opioids ◽  
Opioid Use ◽  
Opioid Prescription ◽  
The Usa

ObjectiveLong-term opioid prescribing has increased amid concerns over effectiveness and safety of its use. We examined long-term prescription opioid use among patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), psoriatic arthritis (PsA) and ankylosing spondylitis (AS), compared with patients with hypertension (HTN).MethodsWe used Truven MarketScan, a US commercial claims database (2003–2014) and identified RA, SLE, PsA and AS cohorts, each matched by age and sex to patients with HTN. We compared long-term opioid prescription use during 1 year of follow-up and used multivariable Poisson regression model to estimate the relative risk (RR) of receiving opioid prescriptions based on underlying disease cohort.ResultsWe identified 181 710 RA (mean age 55.3±13.1, 77% female), 45 834 SLE (47.1±13.1, 91% female), 30 307 PsA (49.7±11.5, 51% female), 7686 AS (44.6±12.0, 39% female) and parallel numbers of age-matched and sex-matched patients with HTN. The proportion of patients receiving long-term opioid prescriptions, and other measures of opioid prescriptions were higher among rheumatic disease cohorts and highest in patients with AS. AS was associated with the highest RR of receiving long-term opioid prescriptions (RR 2.73, 95% CI 2.60 to 2.87) versus HTN, while RRs were 2.21 (2.16 to 2.25) for RA, 1.94 (1.87 to 2.00) for PsA and 1.82 (1.77 to 1.88) for SLE.ConclusionsPatients with rheumatic disease have higher rates of long-term opioid prescriptions, and patients with AS have the highest risk of receiving opioid prescriptions versus patients with HTN. Further studies investigating the effectiveness of disease-targeted treatments on decreasing opioid use in these four rheumatic diseases may provide strategies for reducing prescription opioids.

scholarly journals The opioid crisis: 18 years of opioid prescriptions in spine patients

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
P Calvachi ◽  
E Mezzalira ◽  
A Boaro ◽  
A Duey ◽  
F Bolivar ◽  
...  
Keyword(s):  
Spinal Surgery ◽  
Massachusetts General Hospital ◽  
Spinal Pain ◽  
Primary Diagnosis ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Prescribing Practices ◽  
Opioid Prescription ◽  
Prescription Rates ◽  
Pain Symptoms

Abstract Background The US opioid epidemic continues to afflict patients and the healthcare system. Surgery remains a risk factor for opioid misuse, and treatment of low back pain in orthopedics and neurosurgery is one of the largest introductions of opioids into the community. The objective of the study is to understand how opioid prescribing practices for spinal surgery have evolved in two academic hospital in the last 18 years. Methods Data were obtained from the Research Patient Data Registry for Brigham and Women's and Massachusetts General Hospital from January 2000 to December 2018. Patients included had a primary diagnosis of degenerative diseases, trauma, spinal infection, spinal deformities, or spinal pain symptoms/syndromes; were aged &gt; 18 years; and had an opioid prescription. Covariates included demographics, diagnoses, comorbidities, procedures, opioid type, number of prescriptions, route of administration, doses and length of prescription. Results A total of 38,250 patients with spine-related diagnoses received an opioid prescription. The median age was 63 years (18-107), 50% male and 86% white. A total of 32,304 patients (84.4%) received at least one opioid prescription during their hospitalization. The sum of opioid prescriptions filled (inpatient and outpatient) were 889,868 between 2000 and 2018 (55.2% oral, 41.7% intravenous). Oxycodone was the most prescribed. The dose of ≥ 50 morphine milligram equivalents MME/day was reduced from 65.0% in 2000 to 17.3% in 2018, and doses ≥ 90 MME/day dropped from 26.9% in 2000 to 6.4% in 2018. However, the duration of prescription has increased from 4.1% having an opioid prescription for &gt;7 days in 2000, to 21.7% in 2018. Conclusions Opioid prescription rates for spinal surgery patients have increased since 2000, declined temporarily in 2016, but are rising again. Physicians are prescribing fewer MMEs per day but have increased longitudinal dosing, which still leaves patients at risk for misuse and opioid use disorder. Key messages Between 2000 and 2016 there was an increase of 140 times the number of opioid prescriptions for spine patients. More interventions and non-pharmacological solutions are needed to reduce this public health epidemic.

Opioid prescribing attitudes of palliative care physicians versus other specialists: a questionnaire-based survey

2021 ◽  
pp. postgradmedj-2020-139152
Author(s):  
Tomasz Dzierzanowski ◽  
Michael Kozlowski
Keyword(s):  
Palliative Care ◽  
Cancer Pain ◽  
Pain Treatment ◽  
Opioid Analgesics ◽  
Continuous Medical Education ◽  
Prescribing Patterns ◽  
Opioid Use ◽  
Health Crisis ◽  
The Usa ◽  
Strong Opioids

Purpose of the studyWhile opioid overuse is a public health crisis in the USA, opioid analgesics are used suboptimally in Central and Eastern Europe, causing many pain cases to remain untreated or undertreated.Study designThis questionnaire study aimed to identify the prevalent prescribing patterns and attitudes and the possible internal impediments to optimal opioid use among palliative care physicians and other specialists in Poland.ResultsTramadol was the most commonly preferred opioid. While palliative care physicians (n=81) used various strong opioids, other physicians (n=87) prescribed mostly buprenorphine, accessible with standard prescription forms. Neither internal prejudices and beliefs nor administrative regulations impede prescribing opioids by palliative care physicians, unlike specialists other than palliative medicine. Special prescription forms for psychoactive medications, fear of drug addiction of their patients and penalties for possible errors on prescriptions affect the latter’s optimal prescribing. They also revealed significant gaps in the knowledge of prescribing opioids and would take part in additional training. Palliative care physicians appeared optimally prepared for cancer pain management and report fewer internal barriers than other specialists.ConclusionsContinuous medical education on cancer pain treatment should be provided to all specialists to ensure optimal opioid pharmacotherapy and avoid overprescribing or underprescribing opioids. Administrative restrictions are the main barrier to optimal pain treatment.

scholarly journals How do contraindications to non-opioid analgesics and opioids affect the likelihood that patients with back pain diagnoses in the primary care setting receive an opioid prescription? An observational cross-sectional study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Michelle S. Keller ◽  
Lyna Truong ◽  
Allison M. Mays ◽  
Jack Needleman ◽  
Mary Sue V. Heilemann ◽  
...  
Keyword(s):  
Primary Care ◽  
Substance Use ◽  
Back Pain ◽  
Kidney Disease ◽  
Population Attributable Risk ◽  
Opioid Analgesics ◽  
Gastrointestinal Diseases ◽  
Attributable Risk ◽  
Opioid Use ◽  
Opioid Prescription

Abstract Background Given the risks of opioids, clinicians are under growing pressure to treat pain with non-opioid medications. Yet non-opioid analgesics such as non-steroidal anti-inflammatory drugs (NSAIDs) have their own risks: patients with kidney disease or gastrointestinal diseases can experience serious adverse events. We examined the likelihood that patients with back pain diagnoses and contraindications to NSAIDs and opioids received an opioid prescription in primary care. Methods We identified office visits for back pain from 2012 to 2017 and sampled the first office visit per patient per year (N = 24,543 visits). We created indicators reflecting contraindications for NSAIDs (kidney, liver, cardiovascular/cerebrovascular, and gastrointestinal diseases; concurrent or chronic use of anticoagulants/antiplatelets, chronic corticosteroid use) and opioids (depression, anxiety, substance use (SUD) and bipolar disorders, and concurrent benzodiazepines) and estimated four logistic regression models, with the one model including all patient visits and models 2–4 stratifying for previous opioid use. We estimated the population attributable risk for each contraindication. Results In our model with all patients-visits, patients received an opioid prescription at 4% of visits. The predicted probability (PP) of receiving an opioid was 4% without kidney disease vs. 7% with kidney disease; marginal effect (ME): 3%; 95%CI: 1–4%). For chronic or concurrent anticoagulant/antiplatelet prescriptions, the PPs were 4% vs. 6% (ME: 2%; 95%CI: 1–3%). For concurrent benzodiazepines, the PPs were 4% vs. 11% (ME: 7%, 95%CI: 5–9%) and for SUD, the PPs were 4% vs. 5% (ME: 1%, 95%CI: 0–3%). For the model including patients with previous long-term opioid use, the PPs for concurrent benzodiazepines were 25% vs. 24% (ME: -1%; 95%CI: − 18-16%). The population attributable risk (PAR) for NSAID and opioid contraindications was small. For kidney disease, the PAR was 0.16% (95%CI: 0.08–0.23%), 0.44% (95%CI: 0.30–0.58%) for anticoagulants and antiplatelets, 0.13% for substance use (95%CI: 0.03–0.22%) and 0.20% for concurrent benzodiazepine use (95%CI: 0.13–0.26%). Conclusions Patients with diagnoses of kidney disease and concurrent use of anticoagulants/antiplatelet medications had a higher probability of receiving an opioid prescription at a primary care visit for low back pain, but these conditions do not explain a large proportion of the opioid prescriptions.

Impact of Preoperative Opioid Use on 2-Year Patient-Reported Outcomes in Knee Surgery Patients

2020 ◽  
Author(s):  
Ali Aneizi ◽  
Patrick M. J. Sajak ◽  
Aymen Alqazzaz ◽  
Tristan Weir ◽  
Cameran I. Burt ◽  
...  
Keyword(s):  
Physical Function ◽  
Patient Reported Outcomes ◽  
Knee Surgery ◽  
The Body ◽  
Pain Interference ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Social Satisfaction ◽  
Patient Reported ◽  
Met Expectations

AbstractThe objectives of this study are to assess perioperative opioid use in patients undergoing knee surgery and to examine the relationship between preoperative opioid use and 2-year postoperative patient-reported outcomes (PROs). We hypothesized that preoperative opioid use and, more specifically, higher quantities of preoperative opioid use would be associated with worse PROs in knee surgery patients. We studied 192 patients undergoing knee surgery at a single urban institution. Patients completed multiple PRO measures preoperatively and 2-year postoperatively, including six patient-reported outcomes measurement information system (PROMIS) domains; the International Knee Documentation Committee (IKDC) questionnaire, numeric pain scale (NPS) scores for the operative knee and the rest of the body, Marx's knee activity rating scale, Tegner's activity scale, International Physical Activity Questionnaire, as well as measures of met expectations, overall improvement, and overall satisfaction. Total morphine equivalents (TMEs) were calculated from a regional prescription monitoring program. Eighty patients (41.7%) filled an opioid prescription preoperatively, and refill TMEs were significantly higher in this subpopulation. Opioid use was associated with unemployment, government insurance, smoking, depression, history of prior surgery, higher body mass index, greater comorbidities, and lower treatment expectations. Preoperative opioid use was associated with significantly worse 2-year scores on most PROs, including PROMIS physical function, pain interference, fatigue, social satisfaction, IKDC, NPS for the knee and rest of the body, and Marx's and Tegner's scales. There was a significant dose-dependent association between greater preoperative TMEs and worse scores for PROMIS physical function, pain interference, fatigue, social satisfaction, NPS body, and Marx's and Tegner's scales. Multivariable analysis confirmed that any preoperative opioid use, but not quantity of TMEs, was an independent predictor of worse 2-year scores for function, activity, and knee pain. Preoperative opioid use and TMEs were neither independent predictors of met expectations, satisfaction, patient-perceived improvement, nor improvement on any PROs. Our findings demonstrate that preoperative opioid use is associated with clinically relevant worse patient-reported knee function and pain after knee surgery.

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