scholarly journals Chronic High Risk Prescription Opioid Use Among Persons With HIV

2021 ◽  
Vol 6 ◽  
Author(s):  
Ana Ventuneac ◽  
Gavriella Hecht ◽  
Emily Forcht ◽  
Bianca A. Duah ◽  
Shafaq Tarar ◽  
...  
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
High Risk ◽  
Substance Use Disorders ◽  
Prescribing Patterns ◽  
Hiv Care ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Opioid Prescribing ◽  
Prescription Opioid Use

Persons with HIV (PWH) are a population at risk for adverse sequelae of opioid use. Yet, few studies have examined correlates of chronic high risk opioid use and its impact on HIV outcomes. Trends in prescribing patterns and identification of factors that impact the use of opioid prescriptions among PWH are crucial to determine prevention and treatment interventions. This study examined electronic medical records (EMR) of patients receiving HIV care to characterize prescribing patterns and identify risk factors for chronic high risk prescription opioid use and the impact on HIV outcomes among PWH in primary care from July 1, 2016–December 31, 2017. EMR were analyzed from 8,882 patients who were predominantly male and ethnically and racially diverse with half being 50 years of age or older. The majority of the 8,744 prescriptions (98% oral and 2% transdermal preparations) given to 1,040 (12%) patients were oxycodone (71%), 8% were morphine, 7% tramadol, 4% hydrocodone, 4% codeine, 2% fentanyl, and 4% were other opioids. The number of monthly prescriptions decreased about 14% during the study period. Bivariate analyses indicated that most demographic and clinical variables were associated with receipt of any opioid prescription. After controlling for patient socio-demographic characteristics and clinical factors, the odds of receipt of any prescription were higher among patients with pain diagnoses and opioid use and mental health disorders. In addition, the odds of receipt of high average daily morphine equivalent dose (MED) prescriptions were higher for patients with pain diagnoses. Lastly, patients with substance use disorders (SUD) had an increased likelihood of detectable viral load compared to patients with no SUD, after adjusting for known covariates. Our findings show that despite opioid prescribing guidelines and monitoring systems, additional efforts are needed to prevent chronic high risk prescriptions in patients with comorbid conditions, including pain-related, mental health and substance use disorders. Evidence about the risk for chronic high risk use based on prescribing patterns could better inform pain management and opioid prescribing practices for patients receiving HIV care.

scholarly journals Identifying a Need for Mental Health Services Posthospitalization in Adolescent Trauma Patients

2020 ◽  
Vol 3 ◽  
Author(s):  
Alexandra Hochstetler ◽  
Ashley Vetor ◽  
Jodi Raymond ◽  
Hannah Bozell ◽  
Teresa Bell
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Alcohol Use ◽  
Mental Health Disorders ◽  
Pain Severity ◽  
Pain Interference ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Health Disorders ◽  
Prescription Opioid Use

Background: Nearly 150,000 children were hospitalized due to an injury in 2018. Hospitalized patients are often prescribed opioids and as a result, one in eight adolescents will continue using opioids twelve months after hospitalization. Predictors of sustained opioid use and future misuse posthospitalization have yet to be studied in adolescents. One of these predictors may be mental health disorders following hospitalization. It is known mental health disorders can lead to substance use disorders if not addressed properly. In this study we examined the associations between injury severity, mental health, and substance use among adolescents.     Methods: Patients between 12 to 18 years old admitted for trauma were surveyed upon enrollment, and subsequently at 1, 3, 6, and 12 months posthospitalization. These surveys measured anxiety, depression, posttraumatic stress, prescription and non-prescription drug use, pain severity and pain interference.   Results: At enrollment and one-month posthospitalization, higher pain interference was associated with anxiety (p=.003), depression (p<.001), and PTSD (p=.004). Increased pain severity was also associated with higher PTSD (p=.003) However, at three months, pain severity and interference were only associated with PTSD (p=.005, p=.009). Frequent alcohol use and higher PTSD were found to be statistically significant at six and twelve months (p=.02). Regular prescription opioid use was related to higher anxiety (p=.048) and depression (p=.048) only at enrollment and higher PTSD only at one month (p=.034). Prescription opioid use was not associated with pain severity and interference at enrollment but was found significant at one month (p=.016, p=.36).    Conclusion: Adolescents who reported higher pain severity and interference also more commonly had mental health disorders such as PTSD, anxiety, and depression. Higher PTSD scores and frequent alcohol use were also related post-injury. Screening for mental health after hospitalization should be further investigated in identifying adolescents who may be at risk for future opioid use disorders. 

scholarly journals Evaluation of a Medicaid performance improvement project to reduce high-dose opioid prescriptions

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Daniel M. Hartung ◽  
Jonah Geddes ◽  
Sara E. Hallvik ◽  
P. Todd Korthuis ◽  
Luke Middleton ◽  
...  
Keyword(s):  
Performance Improvement ◽  
Emergency Department Visits ◽  
Prescription Opioid ◽  
High Dose ◽  
Opioid Overdose ◽  
Opioid Use ◽  
Improvement Project ◽  
Opioid Prescribing ◽  
Percentage Points ◽  
Prescription Opioid Use

Abstract Background In 2015, Oregon’s Medicaid program implemented a performance improvement project to reduce high-dose opioid prescribing across its 16 coordinated care organizations (CCOs). The objective of this study was to evaluate the effect of that program on prescription opioid use and outcomes. Methods Using Medicaid claims data from 2014 to 2017, we conducted interrupted time-series analyses to examine changes in the prescription opioid use and overdose rates before (July 2014 to June 2015) and after (January 2016 to December 2017) implementation of Oregon’s high-dose policy initiative (July 2015 to December 2015). Prescribing outcomes were: 1) total opioid prescriptions 2) high-dose [> 90 morphine milligram equivalents per day] opioid prescriptions, and 3) proportion of opioid prescriptions that were high-dose. Opioid overdose outcomes included emergency department visits or hospitalizations that involved an opioid-related poisoning (total, heroin-involved, non-heroin involved). Analyses were performed at the state and CCO level. Results There was an immediate reduction in high dose opioid prescriptions after the program was implemented (− 1.55 prescription per 1000 enrollee; 95% CI − 2.26 to − 0.84; p < 0.01). Program implementation was also associated with an immediate drop (− 1.29 percentage points; 95% CI − 1.94 to − 0.64 percentage points; p < 0.01) and trend reduction (− 0.23 percentage point per month; 95% CI − 0.33 to − 0.14 percentage points; p < 0.01) in the monthly proportion of high-dose opioid prescriptions. The trend in total, heroin-involved, and non-heroin overdose rates increased significantly following implementation of the program. Conclusions Although Oregon’s high-dose opioid performance improvement project was associated with declines in high-dose opioid prescriptions, rates of opioid overdose did not decrease. Policy efforts to reduce opioid prescribing risks may not be sufficient to address the growing opioid crisis.

scholarly journals Characteristics of opioid prescribing to outpatients with chronic liver diseases: A call for action

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261377
Author(s):  
Olufunso M. Agbalajobi ◽  
Theresa Gmelin ◽  
Andrew M. Moon ◽  
Wheytnie Alexandre ◽  
Grace Zhang ◽  
...  
Keyword(s):  
Liver Disease ◽  
High Risk ◽  
Chronic Liver Disease ◽  
Medical Center ◽  
Chronic Liver ◽  
Prescribing Patterns ◽  
Prescription Opioid ◽  
Alcoholic Fatty Liver ◽  
Opioid Prescribing ◽  
One Year

Background Chronic liver disease (CLD) is among the strongest risk factors for adverse prescription opioid-related events. Yet, the current prevalence and factors associated with high-risk opioid prescribing in patients with chronic liver disease (CLD) remain unclear, making it challenging to address opioid safety in this population. Therefore, we aimed to characterize opioid prescribing patterns among patients with CLD. Methods This retrospective cohort study included patients with CLD identified at a single medical center and followed for one year from 10/1/2015-9/30/2016. Multivariable, multinomial regression was used identify the patient characteristics, including demographics, medical conditions, and liver-related factors, that were associated with opioid prescriptions and high-risk prescriptions (≥90mg morphine equivalents per day [MME/day] or co-prescribed with benzodiazepines). Results Nearly half (47%) of 12,425 patients with CLD were prescribed opioids over a one-year period, with 17% of these receiving high-risk prescriptions. The baseline factors significantly associated with high-risk opioid prescriptions included female gender (adjusted incident rate ratio, AIRR = 1.32, 95% CI = 1.14–1.53), Medicaid insurance (AIRR = 1.68, 95% CI = 1.36–2.06), cirrhosis (AIRR = 1.22, 95% CI = 1.04–1.43) and baseline chronic pain (AIRR = 3.40, 95% CI = 2.94–4.01), depression (AIRR = 1.93, 95% CI = 1.60–2.32), anxiety (AIRR = 1.84, 95% CI = 1.53–2.22), substance use disorder (AIRR = 2.16, 95% CI = 1.67–2.79), and Charlson comorbidity score (AIRR = 1.27, 95% CI = 1.22–1.32). Non-alcoholic fatty liver disease was associated with decreased high-risk opioid prescriptions (AIRR = 0.56, 95% CI = 0.47–0.66). Conclusion Opioid medications continue to be prescribed to nearly half of patients with CLD, despite efforts to curtail opioid prescribing due to known adverse events in this population.

Mental Health Conditions and Substance Use Disorders Among Youth Subsequently Diagnosed With Opioid Use Disorder or Opioid Poisoning

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Edeanya Agbese ◽  
Bradley D. Stein ◽  
Benjamin G. Druss ◽  
Andrew W. Dick ◽  
Rosalie L. Pacula ◽  
...  
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Substance Use Disorders ◽  
Opioid Use Disorder ◽  
Health Conditions ◽  
Opioid Use ◽  
Mental Health Conditions

scholarly journals Nonmedical Prescription Opioid Use and Mental Health and Pain Comorbidities: A Narrative Review

2011 ◽  
Vol 56 (8) ◽  
pp. 495-502 ◽  
Author(s):  
Erica Amari ◽  
Jürgen Rehm ◽  
Elliot Goldner ◽  
Benedikt Fischer
Keyword(s):  
Mental Health ◽  
Narrative Review ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Prescription Opioid Use

scholarly journals Mood and anxiety disorders and their association with non-medical prescription opioid use and prescription opioid-use disorder: longitudinal evidence from the National Epidemiologic Study on Alcohol and Related Conditions

2011 ◽  
Vol 42 (6) ◽  
pp. 1261-1272 ◽  
Author(s):  
S. S. Martins ◽  
M. C. Fenton ◽  
K. M. Keyes ◽  
C. Blanco ◽  
H. Zhu ◽  
...  
Keyword(s):  
Substance Use ◽  
Anxiety Disorder ◽  
Anxiety Disorders ◽  
Mood Disorders ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Medical Prescription ◽  
Self Medication ◽  
Prescription Opioid Use

BackgroundNon-medical use of prescription opioids represents a national public health concern of growing importance. Mood and anxiety disorders are highly associated with non-medical prescription opioid use. The authors examined longitudinal associations between non-medical prescription opioid use and opioid disorder due to non-medical opioid use and mood/anxiety disorders in a national sample, examining evidence for precipitation, self-medication and general shared vulnerability as pathways between disorders.MethodData were drawn from face-to-face surveys of 34 653 adult participants in waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Logistic regression models explored the temporal sequence and evidence for the hypothesized pathways.ResultsBaseline lifetime non-medical prescription opioid use was associated with incidence of any mood disorder, major depressive disorder (MDD), bipolar disorder, any anxiety disorder and generalized anxiety disorder (GAD in wave 2, adjusted for baseline demographics, other substance use, and co-morbid mood/anxiety disorders). Lifetime opioid disorder was not associated with any incident mood/anxiety disorders. All baseline lifetime mood disorders and GAD were associated with incident non-medical prescription opioid use at follow-up, adjusted for demographics, co-morbid mood/anxiety disorders, and other substance use. Baseline lifetime mood disorders, MDD, dysthymia and panic disorder were associated with incident opioid disorder due to non-medical prescription opioid use at follow-up, adjusted for the same covariates.ConclusionsThese results suggest that precipitation, self-medication as well as shared vulnerability are all viable pathways between non-medical prescription opioid use and opioid disorder due to non-medical opioid use and mood/anxiety disorders.

scholarly journals Opioid Prescribing Among Adults With Disabilities in the United States After the 2014 Federal Hydrocodone Rescheduling Regulation

2019 ◽  
Vol 135 (1) ◽  
pp. 114-123
Author(s):  
Victor Liaw ◽  
Yong-Fang Kuo ◽  
Mukaila A. Raji ◽  
Jacques Baillargeon
Keyword(s):  
United States ◽  
High Risk ◽  
The United States ◽  
Prescribing Patterns ◽  
Prescription Opioid ◽  
High Dose ◽  
Medicare Beneficiaries ◽  
Persons With Disabilities ◽  
Adults With Disabilities ◽  
Opioid Prescribing

Objectives: Deaths from prescription opioid overdoses have reached an epidemic level in the United States, particularly among persons with disabilities. The 2014 federal rescheduling regulation is associated with reduced opioid prescribing in the general US population; however, to date, no data have been published on this regulation’s effect on persons with disabilities. We examined whether the 2014 hydrocodone rescheduling change was associated with reduced opioid prescribing among adult Medicare beneficiaries with disabilities. Methods: We identified 680 876 Medicare beneficiaries with disabilities aged 21-64 in 2013 and 657 687 in 2015 from a 20% national sample. We examined changes in the monthly opioid-prescribing rates from January 1, 2013, through December 31, 2015. We also compared opioid-prescribing rates in 2013 with rates in 2015. Results: In 2014, the percentage of Medicare beneficiaries with disabilities who received hydrocodone prescriptions decreased by 0.154% per month (95% confidence interval [CI], –0.186 to –0.121, P < .001). The percentage of Medicare beneficiaries with disabilities who received hydrocodone prescriptions decreased from 32.2% in 2013 to 27.7% in 2015, whereas rates of any opioid prescribing, prolonged prescribing (≥90-day supply), and high-dose prescribing (≥100 morphine milligram equivalents per day for >30 days) decreased only modestly, from 50.2% to 49.0%, from 27.4% to 26.5%, and from 7.5% to 7.0%, respectively. Conclusions: The 2014 federal rescheduling of hydrocodone was associated with only minor changes in overall and potentially high-risk opioid-prescribing rates. Neither state variation in long-term prescribing nor beneficiary characteristics explained the changes in persistently high opioid-prescribing rates among adults with disabilities after the 2014 regulation. Future studies should examine patient and provider characteristics underlying the persistent high-risk prescribing patterns in this population.

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