Revising the US CDC Guidelines on Opioid Prescription A Commentary

Abstract Healthcare-acquired infections are a tremendous challenge to the US medical system. Stethoscopes touch many patients, but current guidance from the Centers for Disease Control and Prevention does not support disinfection between each patient. Stethoscopes are rarely disinfected between patients by healthcare providers. When cultured, even after disinfection, stethoscopes have high rates of pathogen contamination, identical to that of unwashed hands. The consequence of these practices may bode poorly in the coronavirus 2019 disease (COVID-19) pandemic. Alternatively, the CDC recommends the use of disposable stethoscopes. However, these instruments have poor acoustic properties, and misdiagnoses have been documented. They may also serve as pathogen vectors among staff sharing them. Disposable aseptic stethoscope diaphragm barriers can provide increased safety without sacrificing stethoscope function. We recommend that the CDC consider the research regarding stethoscope hygiene and effective solutions to contemporize this guidance and elevate stethoscope hygiene to that of the hands, by requiring stethoscope disinfection or change of disposable barrier between every patient encounter.

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Must access laws for opioid prescription and county gross domestic product: evidence from the US

Applied Economics Letters ◽

10.1080/13504851.2020.1740155 ◽

2020 ◽

Vol 28 (3) ◽

pp. 196-200

Author(s):

Srikant Devaraj ◽

Pankaj C. Patel ◽

Michael J. Hicks

Keyword(s):

Gross Domestic Product ◽

Domestic Product ◽

Opioid Prescription ◽

The Us

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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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Prevalence of Psychotropic and Opioid Prescription Fills Among Community-Dwelling Older Adults With Dementia in the US

JAMA ◽

10.1001/jama.2020.8519 ◽

2020 ◽

Vol 324 (7) ◽

pp. 706 ◽

Cited By ~ 3

Author(s):

Donovan T. Maust ◽

Julie Strominger ◽

Julie P. W. Bynum ◽

Kenneth M. Langa ◽

Lauren B. Gerlach ◽

...

Keyword(s):

Older Adults ◽

Community Dwelling ◽

Opioid Prescription ◽

The Us ◽

Community Dwelling Older Adults

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Opioid prescription patterns among patients with fibromyalgia

Journal of Opioid Management ◽

10.5055/jom.2019.0537 ◽

2019 ◽

Vol 15 (6) ◽

pp. 469-477 ◽

Cited By ~ 1

Author(s):

Caio V. M. Sarmento, PT, PhD ◽

Mehrdad Maz, MD ◽

Taylor Pfeifer, DPT ◽

Marco Pessoa, PhD ◽

Wen Liu, PhD

Keyword(s):

Prescribing Patterns ◽

Chi Square ◽

Opioid Prescription ◽

Healthcare Enterprise ◽

The Us ◽

Chi Square Test ◽

Opioid Medications ◽

Chronic Pain Conditions ◽

Opioid Users ◽

Harmful Effects

Objectives: To investigate opioid prescribing patterns among patients with fibromyalgia (FM) in terms of age, gender, race, type of opioids, and to examine changes in opioid prescription over the past 8 years compared to the US Food and Drug Administration (FDA)-approved FM medications.Design: Retrospective review of data using the Healthcare Enterprise Repository for Ontological Narration database. The collected data were analyzed descriptively and a chi-square test for trend was used to analyze a possible linear relationship between the proportions of opioid and non-opioid users along the time.Participants: Patients with a diagnosis of FM who had received opioid prescriptions from January 1, 2010 to December 31, 2017, and FM patients who had received prescriptions of FDA-approved FM medications in the same period. Main outcome measure: Trends in opioid and non-opioid prescriptions in patients with FM.Results: The opioid medications were prescribed more frequently in 2010 (40 percent) and 2011 (42 percent), but the percentages have decreased since 2012 and reached the lowest numbers in 2016 (27 percent). The chi-square test for trend shows that from 2010 to 2017 the prescriptions of opioids had a statistically significant (p 0.0001) decrease.Conclusion: This study suggests that the frequency of prescribed opioids in FM patients has decreased since 2012. This decline could be attributed to (1) FDA monitoring programs, (2) national efforts to increase awareness of the addictive and harmful effects of opioids, and (3) the growing research on the efficacy of non-opioid therapies to treat chronic pain conditions including FM.

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O84: OPIOID PRESCRIPTION AT OPERATIVE DISCHARGE (OPIOID STUDY)

British Journal of Surgery ◽

10.1093/bjs/znab117.084 ◽

2021 ◽

Vol 108 (Supplement_1) ◽

Keyword(s):

Risk Factors ◽

Acute Pain ◽

Prescription Opioids ◽

Opioid Use ◽

Opioid Prescription ◽

Opioid Crisis ◽

Number Of Patients ◽

The Us ◽

The Uk ◽

Major General

Abstract Presenting Author Email: [email protected] Research Question Opioid misuse is a major health epidemic. Surveys in the US have shown that over 130 patients die daily due to opioid related drug overdose with 10.3 million patients misused prescription opioids in 2018. This is the first study in the UK to explore the magnitude of the opioid crisis in our country. The opioid crisis was identified first in the US after life expectancy reduced dramatically in 2015. One of the main reasons attributed to this was the increase in the number of overdoses and suicides, both linked with the use of opioid drugs. Between 1999 and 2017 the number of deaths from opioid overdoses increased almost six fold. The 2019 National Survey on Drug use and Health in the US showed that 10.3 million patients misused prescription opioids in 2018 and 2 million patients with an opioid use disorder. Factors contributing to opioid dependence were identified as the use of modified release formulations, the use of repeat opioid prescriptions and the treatment of acute pain. Background and Aim The aim of the study is to explore the magnitude of the opioid crisis in the UK, by identifying risk factors for persistent opioid use following major general surgical intervention. Design Phase 1 of the OPiOiD study is a national retrospective audit. We are aiming to identify risk factors for persistent opioid use in patients undergoing major general surgical interventions. Specifically we will be assessing the number of patients given a duration or point of review when opioids should be stopped and whether any written information has been given to these patients on discharge regarding safe use of opioids and de-prescribing advice. 23 hospitals across the UK have registered so far. Data are collected using the electronic discharge summaries send to the GPs and copies given to patients. Phase 2 of the study will be to proceed with a national observational study with the aim to develop strategies to promote safe and effective management of acute pain. Team and infrastructure The East Midlands Surgical Academic Network (EMSAN) leads the study, supervised by Dr Roger Knaggs, Associate Professor School of Pharmacy University of Nottingham, Dr Nicholas Levy, Department of Anaesthesia and peri-operative Medicine West Suffolk NHS Foundation Trust and Professor Dileep Lobo, Nottingham Digestive Diseases Centre National Institute for Health Research.

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Trends in Fentanyl and Fentanyl Derivative Utilization in the United States

10.1101/2021.03.01.21252669 ◽

2021 ◽

Author(s):

Raymond A. Stemrich ◽

Jordan V. Weber ◽

Kenneth L. McCall ◽

Brian J. Piper

Keyword(s):

United States ◽

Census Data ◽

Distribution Patterns ◽

The United States ◽

Primary Objective ◽

Opioid Prescription ◽

Part D ◽

The Us ◽

Production And Distribution ◽

Opioid Deaths

AbstractObjectiveThe primary objective of this study was to explore fentanyl and fentanyl derivative distribution patterns from 2010 and 2019 across the United States (US). This study builds upon previous literature that has analyzed the trends in opioid distribution and assesses changes in opioid prescription preferences.MethodsThe amount of fentanyl base distributed in the US from 2010-2019 was obtained from the Drug Enforcement Administration’s Automated Reports and Consolidated Ordering System (ARCOS). Fentanyl derivatives (sufentanil, alfentanil, remifentanil) were also analyzed using ARCOS from 2010-2017, the most recent date reported. Census data from the American Community Survey was used to correct for population. Prescriptions, units, and reimbursement of fentanyl and fentanyl citrate formulations for 2010 and 2019 were obtained from Medicaid and prescriber specialty in Medicare Part D.ResultsTotal grams of fentanyl distributed in the US from 2010 to 2019 decreased by 63%. Correspondingly, there was a 65% decrease in the milligrams per person distributed when correcting for population. From a regional perspective, Ohio had the greatest decrease (−79.3%) while Mississippi saw the smallest (−44.5%). Medicaid reimbursement in 2019 was $165 million for over eight hundred-thousand prescriptions with the majority to generic (99.7%) and injectable (77.6%) formulations. Interventional pain management and anesthesia were over-represented, and hematology/oncology under-represented for fentanyl in Medicare.ConclusionThe production and distribution of fentanyl-based substances has decreased, although not uniformly, in the US over the last decade. Additionally, the most prescribed formulations of fentanyl have transitioned away from transdermal, potentially in an effort to regulate its availability. Although impactful, the overdose deaths attributed to synthetic opioid deaths continue to increase highlighting the need for public health interventions beyond the pharmaceutical and medical communities.

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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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Hand Hygiene Promotion from the US Perspective: Putting WHO and CDC Guidelines into Practice

Hand Hygiene ◽

10.1002/9781118846810.ch32 ◽

2017 ◽

pp. 221-229

Author(s):

Katherine Ellingson

Keyword(s):

Hand Hygiene ◽

The Us ◽

Hygiene Promotion ◽

Cdc Guidelines

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A non-randomized pilot study to test the feasibility of treating chronic pain and opioid prescription use in rural areas with acceptance and commitment therapy (T-PACT)

Journal of Clinical and Translational Science ◽

10.1017/cts.2020.26 ◽

2020 ◽

Vol 4 (5) ◽

pp. 472-476

Author(s):

Robert L Rhyne ◽

Heidi Rishel Brakey ◽

Jacquie R. Halladay ◽

Kathleen Mottus ◽

K. Allen Greiner ◽

...

Keyword(s):

Acceptance And Commitment Therapy ◽

Rural Areas ◽

Feasibility Studies ◽

Lessons Learned ◽

Opioid Prescription ◽

Commitment Therapy ◽

Acceptance And Commitment ◽

The Us ◽

Control And Prevention ◽

Implementation Data

AbstractChronic non-cancer pain (CNCP) involves one-third of the US population, and prescription opioids contribute to the opioid epidemic. The Centers for Disease Control and Prevention emphasizes maximizing non-opioid treatment, but many rural populations cannot access alternative therapies. Clinical and Translational Science Award hubs across four rural states performed a multi-site, single-arm intervention feasibility study testing methods and procedures of implementing a behavioral intervention, acceptance and commitment therapy, in primary care CNCP patients on chronic opioids. Using the CONSORT extension for feasibility studies, we describe lessons learned in recruiting/retaining participants, intervention implementation, data measurement, and multi-site procedures. Results inform a future definitive trial and potentially others conducting rural trials.

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