scholarly journals A Framework for “Driving Under the Influence of Drugs” Policy for the Opioid Using Driver

2012 ◽  
Vol 3S;15 (3S;7) ◽  
pp. ES215-ES230
Author(s):  
Brian Wilhelmi
Keyword(s):  
Prescription Drugs ◽  
Opioid Analgesic ◽  
The United States ◽  
Driving Under The Influence ◽  
Steady Increase ◽  
Acute Administration ◽  
Opioid Use ◽  
Unique Challenge ◽  
Psychomotor Effects ◽  
Psychomotor Impairment

Background: Driving under the influence of drugs (DUID) is a term used to designate the action of driving an automobile after the consumption of drugs or medications other than alcohol that interfere with the capacity to operate a vehicle safely. Unlike recreational drugs, prescription medications pose a unique challenge to those attempting to harness their benefits yet protect the driving public. As studies demonstrate a steady increase in opioid use and abuse in the United States, these same constituencies must regulate a significant percentage of drivers who are under the influence of opioids. Objective: This article examines current DUID policy and attempts to present unified suggestions for improvement based on best scientific evidence of opioid-induced psychomotor impairment. Study Design: Literature Review Methods: A literature search was conducted regarding the epidemiology of opioid use and abuse, psychomotor effects of opioids, DUID, and state policy concerning DUID. A total of 23 epidemiological studies, 3 studies on acute psychomotor effects, 32 on chronic psychomotor effects, and selected pertinent law and policy were reviewed. Results: Current state law concerning DUID is variable and often relies on prosecutorial discretion to provide protection of the driving public and prosecution of the truly impaired. Limitations: The design of various studies included in this review imposes limitations on the epidemiological data extracted. Relationships between opioids and automobile accidents are commonly reviewed in retrospect. The data on opioid-induced psychomotor impairment and its effects on driving an automobile require further direct study to examine current inferences. Conclusions: A sizable percentage of the driving public has detectable levels of opioids within their bodies. The best available evidence demonstrates psychomotor impairment following acute administration of opioids or an increase in opioid dosage, but impairment diminishes with chronic, stable opioid usage. Policy makers must account for this evidence when balancing the benefit of pain relief against the need for public roadway protection when drafting DUID legislation. Key words: Driving under the influence of drugs, DUID, psychomotor impairment, opioids, regulation, automobile accident(s), driver impairment, prescription drugs, chronic opioid analgesic therapy, driving under the influence

scholarly journals Postoperative Pain and Opioid Use Following Surgical Treatment of Ankle Fractures

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0033
Author(s):  
Matthew Pate ◽  
Jacob Hall ◽  
John Anderson ◽  
Donald Bohay ◽  
John Maskill ◽  
...  
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Ankle Fracture ◽  
Management Practices ◽  
Opioid Analgesic ◽  
The United States ◽  
Ankle Fractures ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Opioid Medication

Category: Ankle, Bunion, Trauma Introduction/Purpose: Chronic opioid abuse is one of the greatest public health challenges in the United States. The most common first exposure to opioids comes from acute care prescriptions, such as those after surgery. Moreover, opioids are often prescribed excessively, with current estimates suggesting ˜75% of the pills prescribed are unused. Ankle fractures are the most common operatively treated fracture in orthopaedic surgery, and management of acute pain following surgery is challenging. The optimal perioperative pain regimen is still a point of controversy, as there is limited data available regarding appropriate amount of opioid to prescribe. This study evaluates opioid prescribing techniques of multiple foot and ankle surgeons, and associated patient outcomes. We aim to help surgeons improve their pain management practices and to limit opioid overprescription. Methods: Chart review and phone survey were performed on forty two adult patients within three to six months of ankle fracture fixation at our institution. These patients were offered to voluntarily participate in a standardized questionnaire regarding pain scores, opioid use, non-opioid analgesic use, pain management satisfaction, and patient prescription education. Results: 57% of patients reported that they were given “more” or ”much more” opioid medication than needed, 38% stated that they were given the “right amount”, and 5% reported that they were given ”less” or “much less” than needed. 40.0% were on opioids prior to operation. 53.5% did not require refill of discharge opioid prescriptions, 30.2% of patients did not fill any posteroperative opioid prescription. 16.3% of patients filled their discharge prescription and at least one additionall refill (mean refill = 2.22). Mean number of reported opioid pills taken after surgery was 17.4. Mean satisfaction with overall pain management at phone follow up was 8.6/10. Conclusion: While postoperative pain and management vary substantially, a majority of patients feel that they are given more opioid medication than necessary following ankle fracture repair, and a majority of opioid prescriptions are not completely used. Going forward, it is likely that a majority of patients could experience the same beneficial results with less prescription opioid pain medication, which would reduce overpresciption and potential misuse.

Health providers’ perspectives on medical marijuana use.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 235-235 ◽  
Author(s):  
Diana Martins-Welch ◽  
Christian Nouryan ◽  
Myriam Kline ◽  
Sony Modayil
Keyword(s):  
Health Care ◽  
Chronic Pain ◽  
Side Effects ◽  
Health Care Providers ◽  
Prescription Drugs ◽  
Medical Marijuana ◽  
The United States ◽  
Care Providers ◽  
Opioid Use ◽  
Cord Injury

235 Background: According to the CDC, 117 million Americans have one or more chronic health conditions and 31% have used two or more prescription drugs in the past month. Approximately 40% of adults in the United States are using some form of Complementary and Alternative Medicine. Medical marijuana is one such medicine, and to date 29 states have legalized medical marijuana. Methods: A multicenter, anonymous, on-line survey of health care providers was distributed via e-mail within a large health system in the NY Metropolitan area. The survey was distributed in April and May of 2017. The specific aim was to collect information about health care providers’ perspectives on the use of MM in general and for specific medical conditions. Results: The sample (n = 137) consisted of 4% RNs, 10% NPs, 10% fellows, 21% resident physicians, and 52% attending physicians. Average experience was 13 years (range: 0-43), half (53%) were under 40 years old and just over half (56%) were female. Most practitioners recognized a benefit of MM for the treatment of cancer-associated symptoms, few were concerned with side effects and 5% of responders answered that MM was not appropriate at any stage of illness. Responders were “most likely to recommend or refer MM if other therapies were not effective” for cancer (83%), chronic pain (68%), spinal cord injury with spasticity (50%), MS (46%), epilepsy (42%), neuropathy (42%) and Parkinson’s disease (41%). Most providers (77%) believed that MM has the potential to reduce overall opioid use, this was found to be statistically more common in younger providers. The most common conditions that providers reported their patients were requesting MM for were cancer (37%), chronic pain (26%) and neuropathy (10%). The most common concerns about MM use were side effects (16%), addiction (13%), legal consequences (11%), cost (7%) and that other providers would judge MM use (7%). Conclusions: Our survey shows that providers are overwhelmingly in support of MM use in patients with chronic illness, particularly in cancer patients. However providers describe significant and practical concerns about MM utilization. Given the rate at which MM is being legalized throughout the country, it is imperative that there be increased focus on education and clinical studies on MM.

Assessment of cognitive and psychomotor impairment, subjective effects, and blood THC concentrations following acute administration of oral and vaporized cannabis

2021 ◽  
pp. 026988112110215
Author(s):  
Tory R Spindle ◽  
Erin L Martin ◽  
Megan Grabenauer ◽  
Thomas Woodward ◽  
Michael A Milburn ◽  
...  
Keyword(s):  
Psychomotor Performance ◽  
Subjective Effects ◽  
Drug Effects ◽  
Driving Under The Influence ◽  
Acute Administration ◽  
Performance Tests ◽  
Double Blind ◽  
Routes Of Administration ◽  
Psychomotor Impairment ◽  
Novel Biomarkers

Background: Cannabis legalization is expanding, but there are no established methods for detecting cannabis impairment. Aim: Characterize the acute impairing effects of oral and vaporized cannabis using various performance tests. Methods: Participants ( N = 20, 10 men/10 women) who were infrequent cannabis users ingested cannabis brownies (0, 10, and 25 mg Δ-9-tetrahydrocannabinol, THC) and inhaled vaporized cannabis (0, 5, and 20 mg THC) in six double-blind outpatient sessions. Cognitive/psychomotor impairment was assessed with a battery of computerized tasks sensitive to cannabis effects, a novel test (the DRiving Under the Influence of Drugs, DRUID®), and field sobriety tests. Blood THC concentrations and subjective drug effects were evaluated. Results: Low oral/vaporized doses did not impair cognitive/psychomotor performance relative to placebo but produced positive subjective effects. High oral/vaporized doses impaired cognitive/psychomotor performance and increased positive and negative subjective effects. The DRUID® was the most sensitive test to cannabis impairment, as it detected significant differences between placebo and active doses within both routes of administration. Women displayed more impairment on the DRUID® than men at the high vaporized dose only. Field sobriety tests showed little sensitivity to cannabis-induced impairment. Blood THC concentrations were far lower after cannabis ingestion versus inhalation. After inhalation, blood THC concentrations typically returned to baseline well before pharmacodynamic effects subsided. Conclusions: Standard approaches for identifying impairment due to cannabis exposure (i.e. blood THC and field sobriety tests) have severe limitations. There is a need to identify novel biomarkers of cannabis exposure and/or behavioral tests like the DRUID® that can reliably and accurately detect cannabis impairment at the roadside and in the workplace.

scholarly journals How Motivations for Using Buprenorphine Products Differ From Using Opioid Analgesics: Evidence from an Observational Study of Internet Discussions Among Recreational Users (Preprint)

2019 ◽  
Author(s):  
Stephen F Butler ◽  
Natasha K Oyedele ◽  
Taryn Dailey Govoni ◽  
Jody L Green
Keyword(s):  
Addiction Treatment ◽  
Opioid Analgesic ◽  
The United States ◽  
Small Sample ◽  
Abuse Potential ◽  
Online Forums ◽  
Opioid Use ◽  
Web Based ◽  
Recreational Use ◽  
Withdrawal Management

BACKGROUND Opioid use disorder (OUD) poses medical and societal concerns. Although most individuals with OUD in the United States are not in drug abuse treatment, buprenorphine is considered a safe and effective OUD treatment, which reduces illicit opioid use, mortality, and other drug-related harms. However, as buprenorphine prescriptions increase, so does evidence of misused, abused, or diverted buprenorphine. Users’ motivations for extratreatment use of buprenorphine (ie, misuse or abuse of one’s own prescription or use of diverted medication) may be different from the motivations involved in analgesic opioid products. Previous research is based on small sample sizes and use surveys, and none directly compare the motivations for using buprenorphine products (ie, tablet or film) with other opioid products having known abuse potential. OBJECTIVE The aim of the study was to describe and compare the motivation-to-use buprenorphine products, including buprenorphine/naloxone (BNX) sublingual film and oxycodone extended-release (ER), as discussed in online forums. METHODS Web-based posts from 2012 to 2016 were collected from online forums using the Web Informed Services internet monitoring archive. A random sample of posts was coded for motivation to use. These posts were coded into the following motivation categories: (1) use to avoid withdrawal, (2) pain relief, (3) tapering from other drugs, (4) opioid addiction treatment, (5) recreational use (ie, to get high), and (6) other use. Oxycodone ER, an opioid analgesic with known abuse potential, was selected as a comparator. RESULTS Among all posts, 0.81% (30,576/3,788,922) discussed motivation to use one of the target products. The examination of query-selected posts revealed significantly greater discussion of buprenorphine products than oxycodone ER (<i>P</i>&lt;.001). The posts mentioning buprenorphine products were more likely than oxycodone ER to discuss treatment for OUD, tapering down use, and/or withdrawal management (<i>P</i>&lt;.001). Buprenorphine-related posts discussed recreational use (375/1020, 36.76%), although much less often than in oxycodone ER posts (425/508, 83.7%). Despite some differences, the overall pattern of motivation to use was similar for BNX sublingual film and other buprenorphine products. CONCLUSIONS An analysis of spontaneous, Web-based discussion among recreational substance users who post on online drug forums supports the contention that motivation-to-use patterns associated with buprenorphine products are different from those reported for oxycodone ER. Although the findings presented here are not expected to reflect the actual use of the target products, they may represent the interests and motivations of those posting on the online forums. Buprenorphine-related posts were more likely to discuss treatment for OUD, tapering, and withdrawal management than oxycodone ER. Although the findings are consistent with a purported link between the limited availability of medication-assisted therapies for substance use disorders and use of diverted buprenorphine products for self-treatment, recreational use was a motivation expressed in more than one-third of buprenorphine posts.

scholarly journals How Motivations for Using Buprenorphine Products Differ From Using Opioid Analgesics: Evidence from an Observational Study of Internet Discussions Among Recreational Users

10.2196/16038 ◽  
2020 ◽  
Vol 6 (1) ◽  
pp. e16038 ◽  
Author(s):  
Stephen F Butler ◽  
Natasha K Oyedele ◽  
Taryn Dailey Govoni ◽  
Jody L Green
Keyword(s):  
Addiction Treatment ◽  
Opioid Analgesic ◽  
The United States ◽  
Small Sample ◽  
Abuse Potential ◽  
Online Forums ◽  
Opioid Use ◽  
Web Based ◽  
Recreational Use ◽  
Withdrawal Management

Background Opioid use disorder (OUD) poses medical and societal concerns. Although most individuals with OUD in the United States are not in drug abuse treatment, buprenorphine is considered a safe and effective OUD treatment, which reduces illicit opioid use, mortality, and other drug-related harms. However, as buprenorphine prescriptions increase, so does evidence of misused, abused, or diverted buprenorphine. Users’ motivations for extratreatment use of buprenorphine (ie, misuse or abuse of one’s own prescription or use of diverted medication) may be different from the motivations involved in analgesic opioid products. Previous research is based on small sample sizes and use surveys, and none directly compare the motivations for using buprenorphine products (ie, tablet or film) with other opioid products having known abuse potential. Objective The aim of the study was to describe and compare the motivation-to-use buprenorphine products, including buprenorphine/naloxone (BNX) sublingual film and oxycodone extended-release (ER), as discussed in online forums. Methods Web-based posts from 2012 to 2016 were collected from online forums using the Web Informed Services internet monitoring archive. A random sample of posts was coded for motivation to use. These posts were coded into the following motivation categories: (1) use to avoid withdrawal, (2) pain relief, (3) tapering from other drugs, (4) opioid addiction treatment, (5) recreational use (ie, to get high), and (6) other use. Oxycodone ER, an opioid analgesic with known abuse potential, was selected as a comparator. Results Among all posts, 0.81% (30,576/3,788,922) discussed motivation to use one of the target products. The examination of query-selected posts revealed significantly greater discussion of buprenorphine products than oxycodone ER (P<.001). The posts mentioning buprenorphine products were more likely than oxycodone ER to discuss treatment for OUD, tapering down use, and/or withdrawal management (P<.001). Buprenorphine-related posts discussed recreational use (375/1020, 36.76%), although much less often than in oxycodone ER posts (425/508, 83.7%). Despite some differences, the overall pattern of motivation to use was similar for BNX sublingual film and other buprenorphine products. Conclusions An analysis of spontaneous, Web-based discussion among recreational substance users who post on online drug forums supports the contention that motivation-to-use patterns associated with buprenorphine products are different from those reported for oxycodone ER. Although the findings presented here are not expected to reflect the actual use of the target products, they may represent the interests and motivations of those posting on the online forums. Buprenorphine-related posts were more likely to discuss treatment for OUD, tapering, and withdrawal management than oxycodone ER. Although the findings are consistent with a purported link between the limited availability of medication-assisted therapies for substance use disorders and use of diverted buprenorphine products for self-treatment, recreational use was a motivation expressed in more than one-third of buprenorphine posts.

Risky Driving Behaviors of Drivers Who Use Alcohol and Cannabis

2021 ◽  
pp. 036119812198972
Author(s):  
Tara Kelley-Baker ◽  
Leon Villavicencio ◽  
Lindsay S. Arnold ◽  
Aaron J. Benson ◽  
Victoria Anorve ◽  
...  
Keyword(s):  
Prescription Drugs ◽  
Traffic Safety ◽  
Risky Behaviors ◽  
The United States ◽  
Driving Under The Influence ◽  
Risky Driving ◽  
Driving Behaviors ◽  
Effective Interventions ◽  
Nationally Representative ◽  
Risky Driving Behaviors

Many drivers in the United States use alcohol or cannabis, including some who co-use both substances. Using data from a nationally representative survey, self-reported engagement in various risky driving behaviors is examined among drivers who co-use alcohol and cannabis, those who use alcohol but not cannabis, those who use cannabis but not alcohol, and those who use neither. Results were adjusted for age, gender, education, and race. Co-users, compared with those who use only alcohol, were more likely to engage in nearly all of the risky behaviors measured in the survey, including driving under the influence of alcohol. Compared with those who neither drink nor use cannabis, those who use only cannabis were more likely to drive under the influence of prescription drugs, engage in aggressive driving, and ride with an intoxicated driver. Results of this and future related research will assist with understanding the differences in driving behavior among users of alcohol, cannabis, or both, so more effective interventions can be developed to improve traffic safety.

Benzodiazepines

2014 ◽  
Vol 27 (1) ◽  
pp. 5-16 ◽  
Author(s):  
Michael Jann ◽  
William Klugh Kennedy ◽  
Gaylord Lopez
Keyword(s):  
Health Care ◽  
Prescription Drug ◽  
Prescription Drugs ◽  
Health Care Professionals ◽  
Opioid Analgesic ◽  
Opioid Analgesics ◽  
Fold Increase ◽  
The United States ◽  
Emergency Department Visits ◽  
Prescribing Patterns

The misuse and abuse of prescription medications in the United States continues to increase despite interventions by health care professionals, regulatory, and law enforcement agencies. Opioid analgesics are the leading class of prescription drugs that have caused unintentional overdose deaths. Benzodiazepines when taken alone are relatively safe agents in overdose. However, a 5-fold increase in deaths attributed to benzodiazepines occurred from 1999 to 2009. Emergency department visits related to opioid analgesics increased by 111% followed by benzodiazepines 89%. During 2003 to 2009, the 2 prescriptions drugs with the highest increase in death rates were oxycodone 264.6% and alprazolam 233.8%. Therefore, benzodiazepines have a significant impact on prescription drug unintentional overdoses second only to the opioid analgesics. The combination prescribing of benzodiazepines and opioid analgesics commonly takes place. The pharmacokinetic drug interactions between benzodiazepines and opioid analgesics are complex. The pharmacodynamic actions of these agents differ as their combined effects produce significant respiratory depression. Physician and pharmacy shopping by patients occurs, and prescription drug-monitoring programs can provide important information on benzodiazepine and opioid analgesic prescribing patterns and patient usage. Health care professionals need to inform patients and work closely with regulatory agencies and legislatures to stem the increasing fatalities from prescription drug unintentional overdoses.

Multidisciplinary Evidence to Treat Bilingual Individuals with Aphasia

2008 ◽  
Vol 15 (3) ◽  
pp. 66-72 ◽  
Author(s):  
José G. Centeno
Keyword(s):  
Stroke Rehabilitation ◽  
Culturally Diverse ◽  
Treatment Strategies ◽  
The United States ◽  
Intervention Strategies ◽  
Steady Increase ◽  
Clinical Procedures ◽  
Bilingual Speakers ◽  
Aphasic Clients

Abstract The steady increase in linguistic and cultural diversity in the country, including the number of bilingual speakers, has been predicted to continue. Minorities are expected to be the majority by 2042. Strokes, the third leading cause of death and the leading cause of long-term disability in the U.S., are quite prevalent in racial and ethnic minorities, so population estimates underscore the imperative need to develop valid clinical procedures to serve the predicted increase in linguistically and culturally diverse bilingual adults with aphasia in post-stroke rehabilitation. Bilingualism is a complex phenomenon that interconnects culture, cognition, and language; thus, as aphasia is a social phenomenon, treatment of bilingual aphasic persons would benefit from conceptual frameworks that exploit the culture-cognition-language interaction in ways that maximize both linguistic and communicative improvement leading to social re-adaptation. This paper discusses a multidisciplinary evidence-based approach to develop ecologically-valid treatment strategies for bilingual aphasic individuals. Content aims to spark practitioners' interest to explore conceptually broad intervention strategies beyond strictly linguistic domains that would facilitate linguistic gains, communicative interactions, and social functioning. This paper largely emphasizes Spanish-English individuals in the United States. Practitioners, however, are advised to adapt the proposed principles to the unique backgrounds of other bilingual aphasic clients.

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