Urine Screening for Opiod and Illicit Drugs in the Total Joint Arthroplasty Population

Introduction. Recent studies have shown an increase in post-operative orthopaedic complications associated with pre-operative opioid use. It is, therefore, important to know if patients use opioids before scheduled surgery. The purpose of this study was to determine if urine drug screening (UDS) is an effective screening tool for detecting opioid and illicit drug use prior to joint arthroplasty (JA) procedures. Methods. This retrospective chart review was performed with IRB approval on 166 out of 172 consecutive patients in a community-based practice. All the patients had a pre-operative UDS prior to primary or revision JA by a fellowship trained orthopaedic surgeon between March 2016 and April 2017. Patient demographics documented opioid and illicit drug use, co-morbid diagnosis, and UDS results were collected from clinical charts. Statistical analysis was conducted using Pearson Chi-square, Fisher’s exact, McNemar test, and t-tests with IBM SPSS Statistics, ver. 23. Significant differences were p < 0.05. Results. Sixty-four of 166 patients (38.6%) tested positive for opioids. Among them, 55.0% (35/64) had no history of prescription opioid use. Significant differences were observed when comparing the test results of the UDS with the patient reported history of prescribed opioids (p = 0.001). Conclusion. With a significant number of patients testing positive for opioids without evidence of a previous prescription, UDS may be beneficial for initial risk assessment for patients undergoing JA procedures.

Download Full-text

Storage, disposal, and utilization of opioids among cancer outpatients.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.31_suppl.222 ◽

2013 ◽

Vol 31 (31_suppl) ◽

pp. 222-222

Author(s):

Akhila Sunkepally Reddy ◽

Maxine Grace Jaucian De La Cruz ◽

Eden Mae Rodriguez ◽

Jessica Thames ◽

Jimin Wu ◽

...

Keyword(s):

Drug Use ◽

Adult Children ◽

Illicit Drug ◽

Care Center ◽

Illicit Drug Use ◽

Patient Characteristics ◽

Prescription Opioid ◽

Opioid Use ◽

Never Married ◽

History Of

222 Background: Prescription opioid abuse is an epidemic in the US. Of the abusers, 75% obtain the opioid from a friend or relative, which may be related to improper opioid storage and disposal practices. Our aim was to determine patients’ practices of opioid use, storage, and disposal. Methods: We surveyed 300 cancer outpatients presenting to our Supportive Care Center who were receiving opioids for at least 1 month and collected information regarding opioid use, storage, and disposal along with patient characteristics and scores on Cut-down, Annoyed, Guilty, Eye-opener (CAGE) questionnaire for alcoholism. Sharing or losing their opioids was defined as an unsafe use. Results: The median age of the patients was 57 years; 53% were female, 72% were white, and 63% were married. Most (89%) had advanced cancer, and lung cancer was the most common (22%). CAGE was positive in 19%, 9% had history of illicit drug use, and 36% lived with adult/young adult children. Of the 300 respondents, 19% stored opioids in the open, 69% kept opioids hidden but unlocked, and 9% locked their opioids. Patients with history of CAGE positivity (P=.007), illicit drug use (.0002), smoking (P=.03), and those living with adult children (P=.004) were more likely to keep their opioids locked. 66% were unaware of proper opioid disposal methods. 46% had unused opioids at home. 53% did not routinely dispose opioids, of whom 44% saved them for future use. 26% indulged in unsafe use by sharing (9%) or losing (17%) their opioids, and 44% informed their family and friends that they were on pain medications. 39% were unaware that their opioid could be fatal when taken by others. Compared with married patients, those who were never married [OR=2.92; 95% CI 1.48-5.77], separated [OR=11.38; 1.52-112.5], or divorced [OR=1.27; 0.55-2.91] had higher odds of unsafe use (P=.006). CAGE positivity (40% vs. 21%, P=.003) and illicit drug use (42% vs. 23%, P=.031) were also significant predictors of unsafe use. Conclusions: An alarming proportion of patients improperly and unsafely use, store, and dispose of opioids. Patient education by physicians/pharmacists and creation of more drug take back programs may reduce availability of prescription opioids for potential abuse. More research is needed in this area.

Download Full-text

Predictors of controlled prescription drug non-medical and lifetime use among patients accessing public mental health services in Uganda: a cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2020-037602 ◽

2021 ◽

Vol 11 (3) ◽

pp. e037602

Author(s):

Pakoyo Fadhiru Kamba ◽

John Mulangwa ◽

Peter Kageni ◽

Sulah Balikuna ◽

Allan Kengo ◽

...

Keyword(s):

Drug Use ◽

Prescription Drug ◽

Illicit Drugs ◽

Illicit Drug ◽

Public Mental Health ◽

Illicit Drug Use ◽

Cross Sectional Survey ◽

Cross Sectional ◽

History Of ◽

Desk Review

ObjectivesWe determined the prevalence of controlled prescription drug (CPD) non-medical and lifetime use and their predictors among patients at three public psychiatric clinics in Uganda to identify missed care opportunities, enhanced screening priorities, and drug control needs.MethodsA cross-sectional survey of 1275 patients was performed from November to December 2018. Interviewer-administered semi-structured questionnaires, desk review guide and urine drug assays were employed. Questionnaire recorded CPD non-medical and illicit drug use history from patients’ files, CPD lifetime use and risk factors. Desk review guide recorded recently prescribed drugs in patients’ files to corroborate with urine assays. Predictors were analysed by multivariate logistic regression.ResultsFrom desk review, 145 (11.4%) patients had history of CPD non-medical use and 36 (2.8%) had used illicit drugs. Of 988 patients who provided urine, 166 (16.8%) self-medicated CPDs, particularly benzodiazepines while 12 (1.2%) used illicit drugs. Of those with drug-positive urine, 123 (69.1%) had no documented history of CPD non-medical and illicit drug use. Being an inpatient (OR=10.90, p<0.001) was independently associated with CPD non-medical use. Additionally, being an inpatient (OR=8.29, p<0.001) and tobacco consumption (OR=1.85, p=0.041) were associated with CPD non-medical and illicit drug use combined. Among participants, 119 (9.3%) reported CPD lifetime use, and this was independently associated with education level (OR=2.71, p<0.001) and history of treatment for substance abuse (OR=2.08, p=0.018).ConclusionsCPD non-medical use is common among Uganda’s psychiatric patients, and more prevalent than illicit drug use. Rapid diagnostic assays may be needed in psychiatric care in resource limited settings. It is necessary to assess how CPD non-medical use impacts mental care outcomes and patient safety. High risk groups like inpatients and tobacco consumers should be prioritised in psychiatric screening.

Download Full-text

Non‐medical prescription opioid use and in‐hospital illicit drug use among people who use drugs

Drug and Alcohol Review ◽

10.1111/dar.13246 ◽

2021 ◽

Author(s):

Gurjit S. Parmar ◽

Kanna Hayashi ◽

Seonaid Nolan ◽

M.‐J. Milloy ◽

Kora DeBeck ◽

...

Keyword(s):

Drug Use ◽

Illicit Drug ◽

Illicit Drug Use ◽

Prescription Opioid ◽

People Who Use Drugs ◽

Opioid Use ◽

Medical Prescription ◽

Prescription Opioid Use

Download Full-text

Illicit drug use and sexually transmitted infections among young adults in the US: evidence from a nationally representative survey

International Journal of STD & AIDS ◽

10.1177/0956462420950603 ◽

2020 ◽

Vol 31 (13) ◽

pp. 1238-1246

Author(s):

Mohammad Rifat Haider ◽

Caroline Kingori ◽

Monique J Brown ◽

Michele Battle-Fisher ◽

Ilana Azulay Chertok

Keyword(s):

Young Adults ◽

Drug Use ◽

Sexually Transmitted Infections ◽

Illicit Drugs ◽

Illicit Drug ◽

Illicit Drug Use ◽

The United States ◽

Sexually Transmitted ◽

The Past ◽

History Of

Young people aged 15–24 years account for half of all new sexually transmitted infections (STIs) in the United States. The aim of this study was to examine the cross-sectional associations of factors linked to STIs among US young adults (18–25 years). This study used the 2015–2018 pooled National Survey on Drug Use and Health data on 55,690 young adults. Almost 3.4% of the respondents reported having an STI in the past year. Among the participants, 38.4% used illicit drugs and 3.7% reported a history of delinquency in the past year. In the survey-weighted logistic regression model, odds for contracting STIs in the preceding year was higher among adults aged 22–25 versus 18–21 years (OR:1.26, 95%CI:1.12–1.42); male versus female (OR:2.44, 95%CI:2.11–2.82); non-Hispanic African American versus non-Hispanic White (OR:1.77, 95%CI:1.55–2.02); widowed/separated/divorced (OR:1.93, 95%CI:1.36–2.75) and never married (OR:1.29, 95%CI:1.07–1.55) versus married; full-time/part-time employed (aOR:1.17, 95% CI:1.04–1.31) compared to unemployed/other; history of delinquency (OR:2.31, 95%CI:1.89–2.83); and use of illicit drugs in the last year (OR:3.10, 95%CI:2.77–3.47). High incidence of illicit drug use by the young adults and its strong association with STI incidence in recent years warrant special attention. Tailored preventive measures should be focused on key predictors.

Download Full-text

Prevalence of Self-Reported Prescription Opioid Use and Illicit Drug Use among U.S. Adults

Journal of Occupational and Environmental Medicine ◽

10.1097/jom.0000000000002328 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Ja K. Gu ◽

Penelope Allison ◽

Alexis Grimes Trotter ◽

Luenda E. Charles ◽

Claudia C. Ma ◽

...

Keyword(s):

Drug Use ◽

Illicit Drug ◽

Illicit Drug Use ◽

Prescription Opioid ◽

Opioid Use ◽

Prescription Opioid Use

Download Full-text

Childhood sexual abuse and risks for licit and illicit drug-related outcomes: a twin study

Psychological Medicine ◽

10.1017/s0033291706008397 ◽

2006 ◽

Vol 36 (10) ◽

pp. 1473-1483 ◽

Cited By ~ 97

Author(s):

ELLIOT C. NELSON ◽

ANDREW C. HEATH ◽

MICHAEL T. LYNSKEY ◽

KATHLEEN K. BUCHOLZ ◽

PAMELA A. F. MADDEN ◽

...

Keyword(s):

Sexual Abuse ◽

Childhood Sexual Abuse ◽

Drug Use ◽

Early Onset ◽

Illicit Drugs ◽

Illicit Drug ◽

Significant Risk ◽

Illicit Drug Use ◽

Psychiatric Interview ◽

History Of

Background. This study examined the relationships between self-reported childhood sexual abuse (CSA) and drug-related outcomes in an Australian twin panel.Method. A semi-structured psychiatric interview was conducted in 1996–2000 by telephone with young adult Australian twins (mean age 29·9 years). Data reported here are from 6050 twins who responded to both CSA and drug-related items.Results. A history of CSA was associated with significant risk for subsequently occurring regular smoking and use of each illicit drug class. Further CSA-associated risk was found among regular users, for nicotine and alcohol dependence, and among illicit drug users, for abuse/dependence of most drug classes. In same-sex discordant pairs, significant risk for regular smoking and illicit drug use was found in twins with a history of CSA compared to their non-abused co-twins. Similar analyses for abuse/dependence found significant risk for opioids, any illicit drug, and any non-cannabis illicit drug. CSA was associated with significantly earlier drug use. Despite the association of CSA with risk for early-onset cannabis use and regular smoking, risks for illicit drug outcomes associated with CSA and with either form of early-onset use combine in near-additive fashion.Conclusions. CSA is associated with risk for subsequently occurring regular smoking and illicit drug use and abuse/dependence. Risks for drug use are mildly attenuated with control for familial contributions; similar risks for abuse/dependence remain significant for opioids and for illicit drugs combined across classes. Although we found evidence of earlier onset drug use with CSA, risks associated with CSA and with early-onset use combine in a largely additive manner.

Download Full-text

Outcomes in patients with acute myocardial infarction and a history of illicit drug use: a nationwide analysis

European Heart Journal ◽

10.1093/ehjci/ehaa946.1643 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

T Genet ◽

I Ma ◽

A Bisson ◽

A Bodin ◽

J Herbert ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Drug Use ◽

Illicit Drug ◽

Univariate Analysis ◽

Illicit Drug Use ◽

Opioid Use ◽

Risk Of Death ◽

History Of ◽

One Year

Abstract Background Several reports suggest that illicit drug use may be a major cause of acute myocardial infarction (AMI) independently of smoking habits, and associated with a poorer prognosis. Purpose We sought to determine the frequency of history of illicit drug use in an AMI population and its impact on short- and mid-term prognosis. Methods Based on the administrative hospital-discharge database, we collected information for all patients treated with AMI between 2010 and 2018 in France. We identified patients with history of illicit drug use and the adverse outcomes were investigated during follow-up. Results Among 797,212 patients with ST-segment elevation myocardial infarction (STEMI) or non-STEMI (mean age 69 years, 66% male), 3827 patients (0.5%) had a known history of illicit drug use (cannabis, cocaine or opioid). Patients with illicit drug use were younger and had less comorbidities. They presented more frequently with STEMI and anterior localization compared to those with no history of illicit drug use. In univariate analysis, patients with illicit drug use had lower short-term mortality rates compared to those without history of illicit drug use: 4.9% vs 10.1% at one month (p<0.0001), respectively. However, this might be attributed to a younger age at the time of presentation. Using logistic multivariable analysis with adjustment on age, gender, other cardiovascular and non-cardiovascular comorbidities, type and localisation of MI and procedures of revascularization, history of illicit drug use was associated with a non-significant higher risk of death at one year (adjusted odds ratio OR 1.12 95% CI 0.98–1.29). This trend was supported by a significantly higher risk of death at one year in patients with a history of opioid use (OR 1.27 95% CI 1.04–1.29, p=0.01). Conclusion In a large and systematic nationwide analysis of patients with AMI, history of illicit drug use was associated with a non-significant higher overall odds of mortality, which was significant among those with opioid use. Funding Acknowledgement Type of funding source: None

Download Full-text

Fire on the Mountain: Reinvigorating Legislative Measures to Quench the Flame of Illicit Drug Use in South Africa

Asian Journal of Interdisciplinary Research ◽

10.34256/ajir2032 ◽

2020 ◽

Vol 3 (2) ◽

pp. 15-29

Author(s):

Sogo Angel Olofinbiyi ◽

Thembelihle Mtambo

Keyword(s):

South Africa ◽

Drug Use ◽

South African ◽

Illicit Drugs ◽

Illicit Drug ◽

Illicit Drug Use ◽

Critical Discussion ◽

African Government ◽

Clear Cut ◽

Legislative Measures

South African societies have been characterized by the prolific incidence of illicit drug use in recent times. The paper attempts to examine the legislations implemented on the use of illicit drugs in South Africa. The study adopts a review of the literature to identify and describe the most common illicit drugs used around South Africa communities, placing emphasis on the policies developed by the South African government in combating these situations. The research follows a critical discussion on the issues associated with drug use, its causes, as well as its effects on humans and the environment. The study recommends relevant initiatives to combat all intricacies associated with drug use within the country. This approach will be appropriate in facilitating a clear-cut understanding of the possible remedies to quench the burning flame of illicit drug use across a broad range of South African communities.

Download Full-text

Silent severe myocardial ischemia in a past illicit drug user imaged with myocardial perfusion scintigraphy

Perfusion ◽

10.1177/02676591211028175 ◽

2021 ◽

pp. 026765912110281

Author(s):

Chrissa Sioka ◽

Georgios Georgiou ◽

Christos Katsouras ◽

Konstantinos Pappas ◽

Dimitris-Nikiforos Kiortsis ◽

...

Keyword(s):

Drug Use ◽

Myocardial Perfusion ◽

Myocardial Ischemia ◽

Illicit Drugs ◽

Illicit Drug ◽

Microvascular Dysfunction ◽

Illicit Drug Use ◽

Coronary Microvascular Dysfunction ◽

Illicit Drug User ◽

Cardiac Symptoms

Patients with illicit drug use may have deleterious acute and chronic cardiac effects. We present a case of a 42-year-old man, former alcohol and various illicit drugs user, who was admitted to the psychiatric unit for management of psychosis. Because of his previous drug and alcohol history, a cardiological evaluation was performed which revealed silent severe myocardial ischemia detected by myocardial perfusion imaging (MPI). The myocardial ischemia was attributed to coronary microvascular dysfunction, occurring several years after quitting the illicit drugs. This study highlights the potential myocardial ischemia that may occur in patients with previous alcohol and illicit drug use, and the role of MPI, a non-invasive test that can provide important information regarding the myocardial status of such patients, even without obvious cardiac symptoms or findings.

Download Full-text

Treatment patterns in women seeking care for endometriosis at an endometriosis center

Journal of Endometriosis and Pelvic Pain Disorders ◽

10.1177/22840265211045606 ◽

2021 ◽

pp. 228402652110456

Author(s):

Katharine E Linder ◽

Tatnai L Burnett ◽

Chia-Sui Weng ◽

Zaraq Khan ◽

Kristin Mara ◽

...

Keyword(s):

Drug Use ◽

Pelvic Pain ◽

Significant Relationship ◽

Illicit Drug ◽

Pelvic Floor Dysfunction ◽

Illicit Drug Use ◽

Surgical Excision ◽

Hormonal Contraceptives ◽

Opioid Use ◽

Prior Surgery

Objective: To determine the clinical characteristics and prior medical and surgical treatments in women undergoing surgical excision of endometriosis for pelvic pain at a single institution. Methods: In this retrospective cohort study we identified 140 women with pathology-proven endometriosis who completed a preoperative standardized pain form and underwent surgery at an endometriosis center. Women were stratified into three groups for analysis: no prior surgery, 1 prior surgery, and 2+ prior surgeries. Results: The most common treatments used prior to seeking care were hormonal contraceptives (51.6%) and surgery (46.1%). More than half of women were diagnosed with pelvic floor dysfunction at time of presentation or prior to consultation. There was a significant relationship between an increasing number of surgeries (none vs 1 vs 2+) and gonadotropin-releasing hormone (GnRH) agonist use (19.0% vs 27.5% vs 56.0%, p = 0.003). Though not significant, a trend was noted between increasing surgeries and opioid use (20.6% vs 30.0% vs 40.0%, p = 0.17). There was a statistically significant relationship between multiple surgeries and illicit drug use ( p < 0.001). Conclusion: Patients with pelvic pain and endometriosis who have undergone multiple surgeries are more likely to have used GnRH agonists and report illicit drug use prior to presenting to specialized care.

Download Full-text