Investigating the Use of a Serious Game to Improve Opioid Safety Awareness Among Adolescents: A Quantitative Study (Preprint)

BACKGROUND The misuse of opioid medications among adolescents is a serious problem in the United States. Serious games (SGs) are a novel way to promote safe and responsible management of opioid medications among adolescents, thereby reducing the number of adolescent opioid misuse cases reported annually. OBJECTIVE This study aimed to examine the effect of the SG MedSMA℞T: Adventures in PharmaCity on adolescents’ opioid safety knowledge, awareness, behavioral intent, and self-efficacy. METHODS A nationally representative sample of adolescents age 12 to 18 years old were recruited online through Qualtrics panels from October to November 2020. Data collection consisted of a pre-game survey, 30 minutes of gameplay, and a post-game survey. The pre- and post-game survey included 66 items examining participants’ baseline opioid knowledge, safety, and use, and demographic information. The post-game survey had 25 additional questions regarding the MedSMA℞T game. Gameplay scenarios included five levels intended to mimic adolescents’ daily life while educating players about appropriate opioid storage and disposable practices, negative consequences of sharing opioid medications, and use of Narcan®. Survey questions were divided into 10 categories to represent key concepts and summarized into concept scores. Differences in concept scores were described by overall mean (SD) when stratified by gender, race, school, grade, and age. Differences of change in concept score were analyzed using Kruskal-Wallis and correlation tests. RESULTS A total of 117 responses were analyzed. Results showed significant improvement on all concept scores except for Narcan® knowledge (mean change = -0.04, SD = 0.29, p = 0.600) and safe storage (mean change = 0.03, SD = 0.20, p = 0.088). Female participants had greater improvement than males for safe disposal (female mean (SD) = 0.12 (0.25), male = 0.04 (0.17), p = 0.050). Male participants had higher improvement than females for misuse behavior (female mean (SD) = 0.05 (0.28) male = 0.14 (0.27), p = 0.043). Perceived knowledge for participants who were non-white or Hispanic had higher improvement than non-Hispanic white participants (non-white mean (SD) = 1.10 (1.06), white = 0.75 (0.91), p = 0.026). Older grades were associated with greater improvement in opioid knowledge (correlation coefficient -0.23 (95% CI -0.40 to -0.05), p = 0.012). There were 28 (23.9%) participants who played all 5 levels of the game and had better improvement in opioid use self-efficacy. CONCLUSIONS Findings suggest MedSMA℞T: Adventures in PharmaCity can be used as an effective tool to educate adolescents on the safe and responsible use of prescribed opioid medications. Future testing of the effectiveness of this SG should involve a randomized control trial. Additionally, the feasibility of implementing and disseminating MedSMA℞T: Adventures in PharmaCity in schools and healthcare settings, such as adolescent health or primary care clinics, emergency departments, and pharmacies, should be investigated.

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Identifying Predictive Characteristics of Opioid Medication Use among a Nationally Representative Sample of United States Older Adults with Pain and Comorbid Hypertension or Hypercholesterolemia

Healthcare ◽

10.3390/healthcare8030341 ◽

2020 ◽

Vol 8 (3) ◽

pp. 341

Author(s):

David R. Axon ◽

Shannon Vaffis ◽

Srujitha Marupuru

Keyword(s):

United States ◽

Older Adults ◽

Representative Sample ◽

Chronic Conditions ◽

Functional Limitation ◽

The United States ◽

Medical Expenditure ◽

Opioid Use ◽

Nationally Representative ◽

Opioid Users

The prevalence of older adults with pain and comorbid cardiovascular conditions is increasing in the United States (U.S.). This retrospective, cross-sectional database study used 2017 Medical Expenditure Panel Survey data and hierarchical logistic regression models to identify predictive characteristics of opioid use among a nationally representative sample of older U.S. adults (aged ≥50 years) with pain in the past four weeks and comorbid hypertension (pain–hypertension group) or hypercholesterolemia (pain–hypercholesterolemia group). The pain–hypertension group included 2733 subjects (n = 803 opioid users) and the pain–hypercholesterolemia group included 2796 subjects (n = 795 opioid users). In both groups, predictors of opioid use included: White race versus others, Hispanic versus non-Hispanic ethnicity, 1 versus ≥5 chronic conditions, little/moderate versus quite a bit/extreme pain, good versus fair/poor perceived mental health, functional limitation versus no functional limitation, smoker versus non-smoker, and Northeast versus West census region. In addition, Midwest versus West census region was a predictor in the pain–hypertension group, and 4 versus ≥5 chronic conditions was a predictor in the pain–hypercholesterolemia group. In conclusion, several characteristics of older U.S. adults with pain and comorbid hypertension or hypercholesterolemia were predictive of opioid use. These characteristics could be addressed to optimize individuals’ pain management and help address the opioid overdose epidemic.

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Illicit Opioid Intoxication: Diagnosis and Treatment

Substance Abuse Research and Treatment ◽

10.4137/sart.s7090 ◽

2011 ◽

Vol 5 ◽

pp. SART.S7090

Author(s):

A. Fareed ◽

S. Stout ◽

J. Casarella ◽

S. Vayalapalli ◽

J. Cox ◽

...

Keyword(s):

Signs And Symptoms ◽

The United States ◽

Opioid Overdose ◽

Opioid Use ◽

Heroin Use ◽

Treatment And Prevention ◽

Pain Medications ◽

Opioid Intoxication ◽

Opioid Drugs ◽

Opioid Medications

Opioid intoxications and overdose are associated with high rates of morbidity and mortality. Opioid overdose may occur in the setting of intravenous or intranasal heroin use, illicit use of diverted opioid medications, intentional or accidental misuse of prescription pain medications, or iatrogenic overdose. In this review, we focused on the epidemiology of illict opioid use in the United States and on the mechanism of action of opioid drugs. We also described the signs and symptoms, and diagnoses of intoxication and overdose. Lastly, we updated the reader about the most recent recommendations for treatment and prevention of opioid intoxications and overdose.

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Discrepancies in Written Versus Calculated Durations in Opioid Prescriptions: Pre-Post Study (Preprint)

10.2196/preprints.16199 ◽

2019 ◽

Author(s):

Benjamin H Slovis ◽

John Kairys ◽

Bracken Babula ◽

Melanie Girondo ◽

Cara Martino ◽

...

Keyword(s):

The United States ◽

Opioid Use ◽

Duration Of Treatment ◽

Record System ◽

Opioid Prescription ◽

Increased Risk ◽

The Us ◽

Control And Prevention ◽

Opioid Medications

BACKGROUND The United States is in the midst of an opioid epidemic. Long-term use of opioid medications is associated with an increased risk of dependence. The US Centers for Disease Control and Prevention makes specific recommendations regarding opioid prescribing, including that prescription quantities should not exceed the intended duration of treatment. OBJECTIVE The purpose of this study was to determine if opioid prescription quantities written at our institution exceed intended duration of treatment and whether enhancements to our electronic health record system improved any discrepancies. METHODS We examined the opioid prescriptions written at our institution for a 22-month period. We examined the duration of treatment documented in the prescription itself and calculated a duration based on the quantity of tablets and doses per day. We determined whether requiring documentation of the prescription duration affected these outcomes. RESULTS We reviewed 72,314 opioid prescriptions, of which 16.96% had a calculated duration that was greater than what was documented in the prescription. Making the duration a required field significantly reduced this discrepancy (17.95% vs 16.21%, <i>P</i><.001) but did not eliminate it. CONCLUSIONS Health information technology vendors should develop tools that, by default, accurately represent prescription durations and/or modify doses and quantities dispensed based on provider-entered durations. This would potentially reduce unintended prolonged opioid use and reduce the potential for long-term dependence.

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Emergency Department Visits and Trends Related to Cocaine, Psychostimulants, and Opioids in the United States, 2008-2018

10.21203/rs.3.rs-821189/v1 ◽

2021 ◽

Author(s):

Leslie W. Suen ◽

Thibaut Davy-Mendez ◽

Kathy T. LeSaint ◽

Elise D. Riley ◽

Phillip Coffin

Keyword(s):

Emergency Department ◽

Drug Toxicity ◽

The United States ◽

Emergency Department Visits ◽

Opioid Use ◽

Stimulant Use ◽

Care Survey ◽

Ed Visits ◽

Nationally Representative ◽

Psychiatric Complications

Abstract Background Drug-related emergency department (ED) visits are escalating, especially for stimulant use (i.e., cocaine and psychostimulants such as methamphetamine). We sought to characterize rates, presentation, and management of US ED visits related to cocaine and psychostimulant use, compared to opioid use. Methods We used 2008–2018 National Hospital Ambulatory Medical Care Survey data to identify a nationally representative sample of ED visits related to cocaine and psychostimulant use, with opioids as the comparator. We excluded visits related to ≥2 of the three possible drug categories. We estimated annual rate trends using unadjusted Poisson regression; described demographics, presenting concerns, and management; and determined associations between drug-type and presenting concerns (categorized as psychiatric, neurologic, cardiopulmonary, and drug toxicity/withdrawal) using logistic regression, adjusting for age, sex, race/ethnicity, and homelessness. Results Cocaine-related ED visits did not significantly increase, while psychostimulant-related ED visits increased from 2008 to 2018 (2.2 visits per 10,000 population to 12.9 visits per 10,000 population; p < 0.001). Cocaine-related ED visits had higher usage of cardiac testing, while psychostimulant-related ED visits had higher usage of chemical restraints than opioid-related ED visits. Cocaine- and psychostimulant-related ED visits had greater odds of presenting with cardiopulmonary concerns (cocaine adjusted odds ratio [aOR] 2.95, 95% CI 1.70–5.13; psychostimulant aOR 2.46, 95% CI 1.42–4.26), while psychostimulant-related visits had greater odds of presenting with psychiatric concerns (aOR 2.69; 95% CI 1.83–3.95) and lower odds of presenting with drug toxicity/withdrawal concerns (aOR 0.47, 95%CI 0.30–0.73) compared to opioid-related ED visits. Conclusion Presentations for stimulant-related ED visits differ from opioid-related ED visits: compared to opioids, ED presentations related to cocaine and psychostimulants are less often identified as related to drug toxicity/withdrawal and more often require interventions to address acute cardiopulmonary and psychiatric complications.

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Predictors of Emergency Preparedness Among Older Adults in the United States

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2020.80 ◽

2020 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Sue Anne Bell ◽

Dianne Singer ◽

Erica Solway ◽

Mattias Kirch ◽

Jeffrey Kullgren ◽

...

Keyword(s):

United States ◽

Older Adults ◽

Emergency Preparedness ◽

The United States ◽

Community Dwelling ◽

Power Outage ◽

Evacuation Plans ◽

Nationally Representative ◽

Community Dwelling Older Adults ◽

Hispanic White

ABSTRACT Objectives: Emergency preparedness becomes more important with increased age, as older adults are at heightened risk for harm from disasters. In this study, predictors of preparedness actions and confidence in preparedness among older adults in the United States were assessed. Methods: This nationally representative survey polled community-dwelling older adults ages 50-80 y (n = 2256) about emergency preparedness and confidence in addressing different types of emergencies. Logistic regression was used to identify predictors of reported emergency preparedness actions and confidence in addressing emergencies. Results: Participants’ mean age was 62.4 y (SD = 8); 52% were female, and 71% were non-Hispanic white. Living alone was associated with lower odds of having a 7-d supply of food and water (adjusted odds ratio [aOR] = 0.74; 95% confidence interval [CI]: 0.56-0.96), a stocked emergency kit (aOR = 0.64; 95% CI: 0.47-0.86), and having had conversations with family or friends about evacuation plans (aOR = 0.59; 95% CI: 0.44-0.78). Use of equipment requiring electricity was associated with less confidence in addressing a power outage lasting more than 24 h (aOR = 0.66; 95% CI: 0.47-0.94), as was use of mobility aids (OR = 0.65; 95% CI: 0.45-0.93). Conclusions: These results point to the need for tailored interventions to support emergency preparedness for older adults, particularly among those who live alone and use medical equipment requiring electricity.

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Engineering Approaches for Addressing Opioid Use Disorder in the Community

Annual Review of Biomedical Engineering ◽

10.1146/annurev-bioeng-082719-040832 ◽

2020 ◽

Vol 22 (1) ◽

pp. 207-229 ◽

Cited By ~ 1

Author(s):

Paul M. Griffin

Keyword(s):

Learning Community ◽

Systems Engineering ◽

Evaluation Process ◽

The United States ◽

Opioid Use Disorder ◽

Negative Consequences ◽

Opioid Use ◽

Community Stakeholders ◽

Common Goals ◽

Goals And Objectives

Many communities in the United States are struggling to deal with the negative consequences of illicit opioid use. Effectively addressing this epidemic requires the coordination and support of community stakeholders in a change process with common goals and objectives, continuous engagement with individuals with opioid use disorder (OUD) through their treatment and recovery journeys, application of systems engineering principles to drive process change and sustain it, and use of a formal evaluation process to support a learning community that continuously adapts. This review presents strategies to improve OUD treatment and recovery with a focus on engineering approaches grounded in systems thinking.

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A Narrative Systematic Literature Review: A Focus on Qualitative Studies on HIV and Medication-Assisted Therapy in the United States

Pharmacy ◽

10.3390/pharmacy9010067 ◽

2021 ◽

Vol 9 (1) ◽

pp. 67

Author(s):

Alina Cernasev ◽

Sunitha Kodidela ◽

Michael P. Veve ◽

Theodore Cory ◽

Hilary Jasmin ◽

...

Keyword(s):

United States ◽

Literature Review ◽

Healthcare Providers ◽

The United States ◽

Hiv And Aids ◽

Opioid Use ◽

Screening Process ◽

Persons Living With Hiv ◽

Opioid Medications

Over the last two decades, the United States (U.S.) has experienced an opioid crisis that has had a significant negative societal and economic impact. Due to the high utilization of opioids in Persons Living with HIV and AIDS (PLWHA), there is a need for a qualitative literature review that presents opioid-use related problems in this population. This study aims to present and identify a thematic overview of the qualitative manuscripts on PLWHA who take opioid medications in the U.S., with a focus on perceptions surrounding medication assisted therapy. The systematic literature search was performed in December 2019. Four databases were searched: PubMed/MEDLINE, Scopus, Web of Science, and Cumulative Index to Nursing & Allied Health Literature (CINAHL). A total of 5348 results were exported from databases into EndNote x9, and duplicates were removed for a total of 3039 unique abstracts to screen. The records were imported into Rayyan, an online platform designed to expedite the screening process. Three authors screened titles and abstracts and determined 19 articles that would be screened in full text. On 9 April 2020, it was determined that eight articles would be included for review. The analysis of the eight manuscripts that fit the inclusion and exclusion criteria revealed barriers and facilitators to medication assisted therapy (MAT) in PLWHA. This review communicates or describes the story of PLWHA who might have delayed access to HIV healthcare providers and the commencement of antiretroviral therapy. In the literature, several studies have focused on the role of physicians in prescribing and addressing the medication regimens but none of the studies examined the role of pharmacists in access to care in this population. Therefore, further research is needed for a better understanding of the social aspects of taking opioid medications in PLWHA and the role of pharmacists within the continuum of care.

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Discrepancies in Written Versus Calculated Durations in Opioid Prescriptions: Pre-Post Study

JMIR Medical Informatics ◽

10.2196/16199 ◽

2020 ◽

Vol 8 (3) ◽

pp. e16199

Author(s):

Benjamin H Slovis ◽

John Kairys ◽

Bracken Babula ◽

Melanie Girondo ◽

Cara Martino ◽

...

Keyword(s):

The United States ◽

Opioid Use ◽

Duration Of Treatment ◽

Record System ◽

Opioid Prescription ◽

Increased Risk ◽

The Us ◽

Control And Prevention ◽

Opioid Medications

Background The United States is in the midst of an opioid epidemic. Long-term use of opioid medications is associated with an increased risk of dependence. The US Centers for Disease Control and Prevention makes specific recommendations regarding opioid prescribing, including that prescription quantities should not exceed the intended duration of treatment. Objective The purpose of this study was to determine if opioid prescription quantities written at our institution exceed intended duration of treatment and whether enhancements to our electronic health record system improved any discrepancies. Methods We examined the opioid prescriptions written at our institution for a 22-month period. We examined the duration of treatment documented in the prescription itself and calculated a duration based on the quantity of tablets and doses per day. We determined whether requiring documentation of the prescription duration affected these outcomes. Results We reviewed 72,314 opioid prescriptions, of which 16.96% had a calculated duration that was greater than what was documented in the prescription. Making the duration a required field significantly reduced this discrepancy (17.95% vs 16.21%, P<.001) but did not eliminate it. Conclusions Health information technology vendors should develop tools that, by default, accurately represent prescription durations and/or modify doses and quantities dispensed based on provider-entered durations. This would potentially reduce unintended prolonged opioid use and reduce the potential for long-term dependence.

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Take Home Injectable Opioids for Opioid Use Disorder During and After the COVID-19 Pandemic Is in Urgent Need: A Case Study

10.21203/rs.3.rs-136113/v1 ◽

2020 ◽

Author(s):

Eugenia Oviedo-Joekes ◽

Scott MacDonald ◽

Charles Boissonneault ◽

Kelli Harper

Keyword(s):

Addiction Treatment ◽

Risk Mitigation ◽

Opioid Use Disorder ◽

Negative Consequences ◽

Opioid Use ◽

Regulatory Structure ◽

Opioid Agonist ◽

Opioid Agonist Treatment ◽

First Case ◽

Opioid Medications

Abstract Background: In North America the opioid poisoning crisis currently faces the unprecedented challenges brought by the COVID-19 pandemic, further straining people and communities already facing structural and individual vulnerabilities. People with opioid use disorder (OUD) are facing unique challenges in response to COVID-19, such as not being able to adopt best practices (e.g., physical distancing) if they’re financially insecure or living in shelters (or homeless). They also have other medical conditions that make them more likely to be immunocompromised and at risk of developing COVID-19. In response to the COVID-19 public health emergency, national and provincial regulatory bodies introduced guidance and exemptions to mitigate the spread of the virus. Among them, clinical guidance for prescribers were issued to allow take home opioid medications for opioid agonist treatment (OAT). Take Home for injectable opioid agonist treatment (iOAT) is only considered within a restrictive regulatory structure, specific to the pandemic. Nevertheless, this risk mitigation guidance allowed carries, mostly daily dispensed, to a population that would not have access to it prior to the pandemic. In this case it is presented and discussed that if a carry was possible during the pandemic, then the carry could continue post COVID-19 to address a gap in our approach to individualize care for people with OUD receiving iOAT.Case Presentation: Here we present the first case of a patient in Canada with long-term OUD that received take home injectable diacetylmorphine to self-isolate in an approved site after being diagnosed with COVID-19 during a visit to the emergency room where he was diagnosed with cellulitis and admitted to receive antibiotics. Conclusion: In the present case we demonstrated that it is feasible to provide iOAT outside the community clinic with no apparent negative consequences. Improving upon and making permanent these recently introduced risk mitigating guidance during COVID-19, have the potential not just to protect during the pandemic, but also to address long-overdue barriers to access evidence-based care in addiction treatment.

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Opioid-Induced Constipation: A Comprehensive Overview

10.2310/pm.15036 ◽

2016 ◽

Author(s):

Trisha Patel ◽

Hamilton Chen ◽

John Michels ◽

Justin Hata

Keyword(s):

The United States ◽

Opioid Antagonists ◽

Submucosal Plexus ◽

Opioid Use ◽

Comprehensive Overview ◽

Opioid Receptor Antagonists ◽

Successful Resolution ◽

Fiber Consumption ◽

Specific Receptors ◽

Opioid Medications

In the United States, 4.3 million adults are regularly taking opioid medications. Opioid-induced constipation (OIC) is underdiagnosed considering the prevalence of opioid use among Americans. This review is intended to clarify issues related to OIC. OIC is caused by opioids binding to specific receptors in the gastrointestinal system, resulting in various anatomic effects, including decreased gastric motility, increased sphincter tone, reduced intestinal secretions, and increased water absorption in the bowel. Various treatments include water and fiber consumption, laxatives, enemas, cessation of opioids, and central and peripheral opioid antagonists. OIC is treatable, but timely diagnosis and patient education are paramount for successful resolution. Key words: chronic pain; constipation; mu, delta, and kappa receptors; myenteric plexus; opioid; opioid-induced constipation; opioid receptor antagonists; submucosal plexus

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