Factors predicting opioid dependence in patients undergoing surgery for degenerative spondylolisthesis: analysis from the MarketScan databases

OBJECTIVEThe opioid crisis is identified as a national emergency and epidemic in the United States. The aim of this study was to identify risk factors associated with opioid dependence in patients undergoing surgery for degenerative spondylolisthesis (DS).METHODSThe authors queried MarketScan databases to investigate the factors affecting postsurgery opioid use in patients with DS between 2000 and 2012. The outcome of interest was opioid dependence, which was defined as continued opioid use, > 10 opioid prescriptions, or diagnosis of or prescription for opioid dependence disorder in the period of 1 year before or 3–15 months after the procedure. Comparisons of outcomes were performed using nonparametric 2-group tests and generalized regression models.RESULTSA cohort of 10,708 patients was identified from the database. The median patient age was 61 years (interquartile range 54–69 years), and 65.1% were female (n = 6975). A majority of patients had decompression with fusion (n = 10,068; 94%) and underwent multilevel procedures (n = 8123; 75.9%). Of 10,708 patients, 14.85% (n = 1591) were identified as having opioid dependence within 12 months prior to the index surgical procedure and 9.90% (n = 1060) were identified as having opioid dependence within 3–15 months after the procedure. Of all the variables, prior opioid dependence (OR 16.29, 95% CI 14.10–18.81, p < 0.001) and younger age (1-year increase in age: OR 0.972, 95% CI 0.963–0.980, p < 0.001) were independent predictors of opioid dependence following surgery for DS. The use of fusion was not associated with opioid dependence following the procedure (p = 0.8396). Following surgery for DS, patients were more likely to become opioid independent than they were to become opioid dependent (8.54% vs 3.58%, p < 0.001).CONCLUSIONSThe majority of patients underwent fusion for DS. Surgical decompression with fusion was not associated with increased risk of postsurgery opioid dependence in patients with DS. Overall, opioid dependence was reduced by 4.96% after surgery for DS. Prior opioid dependence is associated with increased risk and increasing age is associated with decreased risk of opioid dependence following surgery for DS.

Download Full-text

Risk factors associated with suicide in patients with prostate cancer in the United States.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.31_suppl.84 ◽

2019 ◽

Vol 37 (31_suppl) ◽

pp. 84-84

Author(s):

Manojna Konda ◽

Rohan Sharma ◽

Arya Mariam Roy ◽

Rashmi Verma

Keyword(s):

Prostate Cancer ◽

Risk Factors ◽

Health Care Providers ◽

The United States ◽

Care Providers ◽

Suicide Death ◽

Factors Associated ◽

Younger Age ◽

Increased Risk ◽

Caucasian Race

84 Background: For a patient, receiving a diagnosis of cancer can be quite challenging and is often associated with depression and increased suicidal ideation. Previous studies have indicated that the risk of suicide in cancer patients is twice that of general population. Prostate cancer is the most common cancer in men. It has also been found to be associated with highest rates of suicide in genitourinary malignancies. We sought to evaluate the incidence and identify risk factors associated with suicide among men with prostate cancer. Methods: Patients with prostate cancer between the years 1973 and 2016 were identified in the Surveillance, Epidemiology, and End Results database (SEER). Multivariate logistic regression analysis was performed to identify independent risk factors for suicide death only on variables that were statistically significant in univariate statistical analysis. Results: In 1,307,625 patients with prostate cancer, 3,435 patients had committed suicide. Younger age (≤50 vs > 70: OR = 4.73 , P < 0.0001; 51-70 vs > 70: OR = 1.93, P < 0.04), Caucasian race (OR: 3.61, P < 0.0001) and not undergoing surgery (OR: 1.33, P < 0.0001) were significantly associated with increased risk of suicide. Furthermore, patients with < 1 year since the diagnosis of prostate cancer were also found to be associated with increased risk of suicide death ( < 1 vs > 5 years: OR = 1.46, P < 0.0001). Conclusions: Addressing mental health in patients with prostate cancer is an important issue. We found that several factors such as younger age, Caucasian race were significantly associated with risk of suicide. Patients who did not undergo surgery likely had advanced disease, which could explain their increased risk of suicide. Patients with < 1 year since the diagnosis of prostate cancer are more vulnerable and at increased risk of suicide which emphasizes the necessity of identifying and treating patients at risk of suicide as early as possible. It is vital that health care providers recognize these patients and offer them appropriate support.

Download Full-text

Exploring Condom Use Behaviors Among African American Adolescent Boys in the Deep South

American Journal of Men s Health ◽

10.1177/15579883211009039 ◽

2021 ◽

Vol 15 (2) ◽

pp. 155798832110090

Author(s):

Jessica Thames Chambliss ◽

Retta Evans ◽

Anneliese Bolland ◽

Martha S. Wingate ◽

John M. Bolland

Keyword(s):

African American ◽

Condom Use ◽

Sexual Behaviors ◽

Unplanned Pregnancy ◽

The United States ◽

Deep South ◽

Adolescent Boys ◽

African American Adolescent ◽

Factors Associated ◽

Increased Risk

Risky sexual behaviors among adolescents can increase adverse outcomes including unplanned pregnancy or contraction or transmission of disease. Adolescents who engage in risky sexual activities are at increased risk for adverse health and social outcomes compared to those who do not engage. Despite declines in adolescent pregnancy and birth rates, the diagnosis of sexually transmitted infections (STIs) is steadily increasing among adolescents. Moreover, African American adolescent boys in the United States, specifically in the southeastern region are disproportionally at greater risk for STIs, and STI diagnosis within this population has increased over time, compared to their white counterparts. This study sought to identify factors associated with condom use among adolescent boys in the Deep South. Using data from the Mobile Youth Survey, a longitudinal adolescent community-based survey, this study assessed the relationship between personal, behavioral, and environmental factors and condom use among African American adolescent boys (14–19 years). Younger participants (14–15 and 16–17) were more likely to use a condom during the last sexual intercourse compared to older participants (18–19 years). High positive attachment to boy/girlfriend was associated with increased condom use. The number of sexual partners, age at their first sexual encounter, recent sexual behavior, and having an STI were also associated with increased condom use among participants. The study provides further insights into factors associated with condom use among African American adolescent boys and results can inform the development of sexual health interventions.

Download Full-text

Neurofeedback for Opioid Dependent Patients in an Outpatient Setting: A Pilot Feasibility Study

10.21203/rs.3.rs-966830/v1 ◽

2021 ◽

Author(s):

Helena A. Rempala ◽

Justin A. Barterian

Keyword(s):

Large Scale ◽

The United States ◽

Outpatient Setting ◽

Opioid Use Disorder ◽

High Rate ◽

Treatment Center ◽

Opioid Use ◽

Treatment As Usual ◽

Factors Affecting ◽

Study Approach

Abstract Background: Neurofeedback (NF) has been described as “probably efficacious” when used in conjunction with other interventions for substance use disorders, including the most recent studies in population of individuals with opioid use disorder. Despite these promising outcomes, the seriousness of the opioid epidemic, and the high rate of relapse even with the most effective medication-assisted maintenance treatments NF continues to be an under-researched treatment modality. This article explores factors that affected the feasibility of adding Alpha/Theta Neurofeedback to treatment as usual for opioid dependence in an outpatient urban treatment center. The study strived to replicate previous research completed in Iran that found benefits of NF for opioid dependence.Methods: Out of approximately two dozen patients eligible for Alpha/Theta NF, about 60% (n=15) agreed to participate; however, only 2 participants completed treatment. The rates of enrollment in response to active treatment were monitored. Results: The 4 factors affecting feasibility were: 1) the time commitment required of participants, 2) ineffectiveness of standard incentives to promote participation, 3) delayed effects of training, and 4) the length and number of treatments required.Conclusion: The findings indicate a large scale study examining the use of NF for the treatment of opioid use disorder in the United States will likely be difficult to accomplish without modification to the traditional randomized control study approach and suggests challenges to the implementation of this treatment in an outpatient setting.

Download Full-text

Health care utilization and overall costs based on opioid dependence in patients undergoing surgery for degenerative spondylolisthesis

Neurosurgical FOCUS ◽

10.3171/2018.2.focus17764 ◽

2018 ◽

Vol 44 (5) ◽

pp. E14 ◽

Cited By ~ 5

Author(s):

Mayur Sharma ◽

Beatrice Ugiliweneza ◽

Zaid Aljuboori ◽

Maxwell Boakye

Keyword(s):

Health Care ◽

Health Care Utilization ◽

Opioid Dependence ◽

Degenerative Spondylolisthesis ◽

Opioid Use Disorder ◽

Hospital Length Of Stay ◽

Care Utilization ◽

Opioid Use ◽

Opioid Dependency ◽

Linear Contrasts

OBJECTIVEOpioid abuse is highly prevalent in patients with back pain. The aim of this study was to identify health care utilization and overall costs associated with opioid dependence in patients undergoing surgery for degenerative spondylolisthesis (DS).METHODSThe authors queried the MarketScan database using ICD-9 and CPT-4 codes from 2000 to 2012. Opioid dependency was defined as having a diagnosis of opioid use disorder, having a prescription for opioid use disorder, or having 10 or more opioid prescriptions. Opioid dependency was evaluated in 12-month period leading to surgery and in the period 3–15 months following the procedure. Patients were segregated into 4 groups based on opioid dependence before and after surgery: group NDND (prior nondependent who remain nondependent), group NDD (prior nondependent who become dependent), group DND (prior dependent who become nondependent), and group DD (prior dependent who remain dependent). The outcomes of interest were discharge disposition, hospital length of stay (LOS), complications, and health care resource costs. The 4 groups were compared using the Kruskal-Wallis test and linear contrasts built from generalized regression models.RESULTSA total of 10,708 patients were identified, with 81.57%, 3.58%, 8.54%, and 6.32% of patients in groups NDND, NDD, DND, and DD, respectively. In group DD, 96.31% of patients had decompression with fusion, compared with 93.59% in group NDND. Patients in group NDD, DND, and DD had longer hospital LOS compared with those in group NDND. Patients in group DD were less likely to be discharged home compared with those in group NDND (odds ratio 0.639, 95% confidence interval 0.52–0.785). At 3–15 months postdischarge, patients in group DD incurred 21% higher hospital readmission costs compared with those in group NDND. However, patients in groups NDD and DD were likely to incur 2.8 times the overall costs compared with patients in group NDND (p < 0.001) at 3–15 months after surgery (median overall payments: group NDD $20,033 and group DD $19,654, vs group NDND $7994).CONCLUSIONSPatients who continued to be opioid dependent or became opioid dependent following surgery for DS incurred significantly higher health care utilization and costs within 3 months and in the period 3–15 months after discharge from surgery.

Download Full-text

Use of Buprenorphine for the Treatment of Opioid Use Disorder

Substance Use Disorders ◽

10.1093/med/9780190920197.003.0009 ◽

2020 ◽

pp. 155-168

Author(s):

Paul J. Fudala ◽

Anne Cramer Andorn

Keyword(s):

Opioid Dependence ◽

Addiction Treatment ◽

Partial Agonist ◽

The United States ◽

Opioid Use Disorder ◽

Sublingual Administration ◽

Opioid Use ◽

The Us ◽

Monthly Administration ◽

Drug Addiction Treatment

Buprenorphine is a mu-opioid partial agonist that was first developed as a parenteral analgesic and subsequently as a treatment for opioid dependence. In the United States, the first two products approved by the US Food and Drug Administration (in 2002) for the latter indication were buprenorphine (Subutex) and buprenorphine/naloxone (Suboxone) tablet formulations for sublingual administration. Since that time, additional products for both sublingual and buccal administration have also been approved, as well as a subcutaneous injection for once-monthly administration for the treatment of moderate or severe opioid use disorder (OUD) and a subdermal implant for the maintenance treatment of opioid dependence that delivers buprenorphine over a 6-month period. Under the Drug Addiction Treatment Act of 2000 (DATA 2000), qualified practitioners may apply for waivers to treat opioid dependence/OUD with approved buprenorphine products in any setting in which they are qualified to practice. Like other opioids, buprenorphine has the potential for being misused and abused.

Download Full-text

Opioid Consumption Patterns and the Risk of Prolonged Opioid Use Among Opioid-Naïve Patients Following Ankle Fracture Surgery

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00068 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0006

Author(s):

Hope Skibicki ◽

Sundeep Saini ◽

Ryan Rogero ◽

Kristen Nicholson ◽

Rachel J. Shakked ◽

...

Keyword(s):

Ankle Fracture ◽

The United States ◽

Opioid Consumption ◽

Consumption Patterns ◽

Opioid Use ◽

Index Procedure ◽

Factors Associated ◽

Tibial Plafond ◽

Significant Difference ◽

Fracture Surgery

Category: Ankle Introduction/Purpose: Over the past two decades, the number of opioids dispensed in the United States has nearly tripled. Previous literature has demonstrated an association between acute opioid exposure and the risk of long-term opioid use. Statewide Prescription Drug Monitoring Programs (PDMPs) have been implemented to deter overprescribing and help monitor information pertaining to suspected abuse. The purpose of this study was to assess the immediate postoperative opioid consumption patterns as well as the incidence of new prolonged opioid use among opioid naïve patients following ankle fracture surgery. Methods: This was a retrospective review of prospectively collected data. Patients were included if they underwent outpatient open reduction and internal fixation of an ankle or tibial plafond fracture between October 2016 and September 2017. Patients were excluded if they received any narcotic prescriptions prior to the date of the initial injury. Patient demographics, medical history, fracture pattern, and opioid prescription and consumption details were collected. The morphine equivalent dose was calculated for each prescription and then converted to the equivalent of a 5-mg oxycodone “pill”. The New Jersey PDMP was used to determine all prescriptions of controlled substances filled up to 1 year postoperatively. Prolonged use was defined as filling a postoperative prescription for a controlled substance 90 days after the index procedure. Linear regression analysis was performed to identify independent factors associated with immediate postoperative opioid consumption and repeated to identify factors associated with prolonged use. Results: One-hundred seventy-one patients were included in this study. At the first postoperative visit, patients consumed a median of 24 pills, whereas the median number prescribed was 40. This resulted in an initial utilization rate of 60% and 2,736 pills left unused. Additionally, we found that 18.7% (n=32) of patients required a narcotic prescription after 90 days from the index procedure. There was no statistically significant difference found between specific fracture type (isolated distal fibula, bimalleolar, trimalleolar) and prolonged opioid consumption, however tibial plafond fractures could not be included due to insufficient sample size (n=5). Patients with a self-reported history of depression (p=.094) or diabetes (p=.097) demonstrated marginal correlation with prolonged narcotic use. Conclusion: Our study demonstrated that patients who underwent outpatient surgical fixation of an ankle or tibial plafond fracture were initially overprescribed narcotics by nearly 67%, leaving a significant quantity of pills unused for potential abuse or diversion. 18.7% of originally opioid naïve patients required continued analgesia 90 days after the index procedure, however large variations in consumption rates make it difficult for physicians to predict prolonged narcotic use.

Download Full-text

Basic Opioid Pharmacology — An Update

British Journal of Pain ◽

10.1177/2049463720911986 ◽

2020 ◽

Vol 14 (2) ◽

pp. 115-121 ◽

Cited By ~ 2

Author(s):

Arul James ◽

John Williams

Keyword(s):

Opioid Receptors ◽

The United States ◽

Opioid Use Disorder ◽

G Protein Coupled Receptors ◽

Opioid Use ◽

Synthetic Compounds ◽

Analgesic Agents ◽

National Emergency ◽

G Protein Coupled ◽

Receptor Family

Opioids are a group of analgesic agents commonly used in clinical practice. The three classical opioid receptors are MOP, DOP and KOP. The NOP (N/OFQ) receptor is considered to be a non-opioid branch of the opioid receptor family. Opioid receptors are G-protein-coupled receptors which cause cellular hyperpolarisation when bound to opioid agonists. Opioids may be classified according to their mode of synthesis into alkaloids, semi-synthetic and synthetic compounds. Opioid use disorder (OUD) is an emerging issue and important lessons can be learnt from the United States where opioid epidemic was declared as a national emergency in 2017.

Download Full-text

352. Characteristics Associated with Pre-Frailty in Older People Living with HIV

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.425 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S186-S186

Author(s):

Peter Mazonson ◽

Theoren Loo ◽

Jeff Berko ◽

Sarah-Marie Chan ◽

Ryan Westergaard ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Cognitive Function ◽

Older People ◽

Logistic Regression Analysis ◽

The United States ◽

People Living With Hiv ◽

Factors Associated ◽

Increased Risk ◽

Living With Hiv

Abstract Background Frailty is a concern among older people living with HIV (PLHIV). There is a paucity of research characterizing PLHIV who are at risk of becoming frail (pre-frailty). To investigate how HIV impacts older PLHIV in the United States, a new study called Aging with Dignity, Health, Optimism and Community (ADHOC) was launched at ten sites to collect self-reported data. This analysis uses data from ADHOC to identify factors associated with pre-frailty. Methods Pre-frailty was assessed using the Frailty Index for Elders (FIFE), where a score of zero indicated no frailty, 1–3 indicated pre-frailty, and 4–10 indicated frailty. A cross-sectional analysis was performed on 262 PLHIV (age 50+) to determine the association between pre-frailty and self-reported sociodemographic, health, and clinical indicators using bivariate analyses. Factors associated with pre-frailty were then included in a logistic regression analysis using backward selection. Results The average age of ADHOC participants was 59 years. Eighty-two percent were male, 66% were gay or lesbian, and 56% were white. Forty-seven percent were classified with pre-frailty, 26% with frailty, and 27% with no frailty. In bivariate analyses, pre-frailty was associated with depression, low cognitive function, depression, multiple comorbidities, low income, low social support and unemployment (Table 1). In the multiple logistic regression analysis, pre-frailty was associated with having low cognitive function (Odds Ratio [OR] 8.56, 95% Confidence Interval [CI]: 3.24–22.63), 4 or more comorbid conditions (OR 4.00, 95% CI: 2.23–7.06), and an income less than $50,000 (OR 2.70, 95% CI: 1.56–4.68) (Table 2). Conclusion This study shows that commonly collected clinical and sociodemographic metrics can help identify PLWH who are more likely to have pre-frailty. Early recognition of factors associated with pre-frailty among PLHIV may help to prevent progression to frailty. Understanding markers of increased risk for pre-frailty may help clinicians and health systems better target multi-modal interventions to prevent negative health outcomes associated with frailty. Disclosures All authors: No reported disclosures.

Download Full-text

A 2-Month Follow-Up Study of Psychological Distress among Italian People during the COVID-19 Lockdown

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17218180 ◽

2020 ◽

Vol 17 (21) ◽

pp. 8180 ◽

Cited By ~ 3

Author(s):

Paolo Roma ◽

Merylin Monaro ◽

Marco Colasanti ◽

Eleonora Ricci ◽

Silvia Biondi ◽

...

Keyword(s):

Psychological Distress ◽

Coping Strategies ◽

Multivariate Regression ◽

Regression Models ◽

Anxiety And Depression ◽

Factors Associated ◽

Younger Age ◽

Post Traumatic ◽

Traumatic Symptoms

The spread of coronavirus disease 2019 (COVID-19) has called for unprecedented measures, including a national lockdown in Italy. The present study aimed at identifying psychological changes (e.g., changes in depression, stress, and anxiety levels) among the Italian public during the lockdown period, in addition to factors associated with these changes. An online follow-up survey was administered to 439 participants (original sample = 2766), between 28 April and 3 May 2020. A paired sample t-test tested for differences in stress, anxiety, and depression over the period. Multivariate regression models examined associations between sociodemographic variables, personality traits, coping strategies, depression, and stress. Results showed an increase in stress and depression over the lockdown, but not anxiety. Negative affect and detachment were associated with higher levels of depression and stress. Higher levels of depression at the start of the lockdown, as well as fewer coping strategies and childlessness, were associated with increased depression at follow-up, whereas higher levels of stress at the start of the lockdown and younger age were associated with higher stress at follow-up. These results may help us to identify persons at greater risk of suffering from psychological distress as a result lockdown conditions, and inform psychological interventions targeting post-traumatic symptoms.

Download Full-text

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.

Download Full-text