A Review on Prescription Drug Monitoring Program

Nowadays Prescription Opioid Abuse has become a serious problem, to monitor and reduce Opioid Abuse most of countries developed Prescription Drug Monitoring Program (PDMP). Regarding to this we conduct a systematic review to understanding the PDMP impact in order to reduce Opioid Abuse and improving prescriber practices. This review can help to guide efforts to better response to the Opioid crises.

Predictive Modelling of Susceptibility to Substance Abuse, Mortality and Drug-Drug Interactions in Opioid Patients

Objective: Opioids are a class of drugs that are known for their use as pain relievers. They bind to opioid receptors on nerve cells in the brain and the nervous system to mitigate pain. Addiction is one of the chronic and primary adverse events of prolonged usage of opioids. They may also cause psychological disorders, muscle pain, depression, anxiety attacks etc. In this study, we present a collection of predictive models to identify patients at risk of opioid abuse and mortality by using their prescription histories. Also, we discover particularly threatening drug-drug interactions in the context of opioid usage.Methods and Materials: Using a publicly available dataset from MIMIC-III, two models were trained, Logistic Regression with L2 regularization (baseline) and Extreme Gradient Boosting (enhanced model), to classify the patients of interest into two categories based on their susceptibility to opioid abuse. We’ve also used K-Means clustering, an unsupervised algorithm, to explore drug-drug interactions that might be of concern.Results: The baseline model for classifying patients susceptible to opioid abuse has an F1 score of 76.64% (accuracy 77.16%) while the enhanced model has an F1 score of 94.45% (accuracy 94.35%). These models can be used as a preliminary step towards inferring the causal effect of opioid usage and can help monitor the prescription practices to minimize the opioid abuse.Discussion and Conclusion: Results suggest that the enhanced model provides a promising approach in preemptive identification of patients at risk for opioid abuse. By discovering and correlating the patterns contributing to opioid overdose or abuse among a variety of patients, machine learning models can be used as an efficient tool to help uncover the existing gaps and/or fraudulent practices in prescription writing. To quote an example of one such incidental finding, our study discovered that insulin might possibly be interacting with opioids in an unfavourable way leading to complications in diabetic patients. This indicates that diabetic patients under long term opioid usage might need to take increased amounts of insulin to make it more effective. This observation backs up prior research studies done on a similar aspect. To increase the translational value of our work, the predictive models and the associated software code are made available under the MIT License.

Public health strategies to combat opioid epidemic in the United States: A systematic review

Background The opioid epidemic in the United States is a national public health crisis. Driven by an increase in availability of pharmaceutical opioids and by an increase in their consumption, specifically, for pain treatment, more so in the past twenty years, it has led to an economic cost of prescription opioid abuse, overdose, and dependence in the United States estimated to be 78.5 billion USD. The purpose of this systematic review was to identify and evaluate public health strategies that contribute towards combatting the opioid crisis. Methods Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist, a search was conducted of the PubMed database for articles in English language that analyzed the most effective ways to regulate health markets to decrease the opioid crisis in the United States. Results The initial search yielded 2397 titles, of which 15 full-text articles were ultimately selected for inclusion in this systematic review. The review identified four categories in overcoming this epidemic nationwide, including required improvement in patient utilization of and access to safe and effective treatment options for opioid abuse and overdose, addressing the stigma correlated with opioid use, considering appropriate use of abuse deterrent formulations (ADF) along with patient education, and improving prescribing practices via utilization of drug monitoring programs, CDC opioid prescribing guidelines and provider continuing education. Conclusions Attempts to combat the opioid epidemic have been made, and the state and federal governments have only recently started to understand the magnitude of the seriousness of this public health crisis. While the methods with promising improvement of the situation have been identified, implementing them has shown to be a challenge. Continued application is needed, while considering possible new steps that could help reinforce their utilization further. Key messages Attempts to combat the opioid epidemic have been made, and the state and federal governments have only recently started to understand the magnitude of the seriousness of this public health crisis. The methods with promising improvement of the opioid crisis situation have been identified, however utilizing and implementing the existing public health strategies has shown to be a challenge.

Trends and outcomes in opioid related cardiac arrest in a contemporary US population from 2012–18

Background Opioid abuse is a significant problem and has been associated in patients presenting with cardiac arrest. We aimed to investigate and compare the contemporary trends of cardiac arrest in patients with and without opioid abuse. Methods All hospitalizations for primary diagnosis of Cardiac arrest between 2012 and 2018 identified in the Nationwide Readmissions Database were categorized into those with or without a secondary diagnosis of opioid disease. Cardiac arrest hospitalizations with opioid use using the year of admission, discharge quarter, age, sex, and elixhauser comorbidity index. Primary outcomes were inpatient mortality. Survey techniques were used to do comparative analyses using Stata 16.0. Results Of 1,410,475 cardiac arrest hospitalizations that met inclusion criteria, 43,090 (3.1%) had cardiac arrest with a secondary diagnosis of opioid use. In hospital mortality in cardiac arrest patients with and without opioid use was 56.7% vs 61.2%. Hospitalizations for cardiac arrest with opioid use were associated with higher prevalence of alcohol (16.9% vs. 7.1%; p<0.05), depression (18.8% vs. 9%; p<0.05), and smoking (37.0% vs. 21.8%; p<0.05) as compared with cardiac arrest without opioid use. Hospitalizations for cardiac arrest with opioid use was seen less likely in patients with heart failure (21.2% vs. 40.6%; p<0.05), diabetes mellitus (19.5% vs. 35.4%; p<0.05), hypertension (43.4% vs. 64.9%; p<0.05) and renal failure (14.3% vs. 30.2%; p<0.05). Over the last 7 years, there has been a significant increasing trend in opioid associated cardiac arrest (p for trend <0.05) see figure. Conclusions Opioid remains a significant cause of cardiac arrests in the contemporary US population with an increase in its incidence over last 7 years. Lifestyle choices is most attributing to this increasing trend. Opioid users that presented with cardiac arrest were twice as more likely to have depression. FUNDunding Acknowledgement Type of funding sources: None. Trends of opioid related cardiac arrest

Optimizing Opioid Abuse Prevention Strategies: Role of Pharmacist in Safe Dispensing

Misuse, violence, and distribution of opioids are also a public health concern. Pharmacists are at the forefront of the health-care response to the opioid epidemic because they have more opportunities to engage with patients than primary care or specialist medical practitioners. Because of these situations, pharmacists have more chances to provide proper prevention advice and reinforce proper opioid drug usage. Understanding dosage restrictions, learning how to use prescription drug monitoring programmes, knowing when drug take-back programmes are taking place, and advising consumers about the dangers of substance addiction are both techniques that pharmacists should be informed about. Recognising "red flag" actions that may suggest opioid abuse; using tests to determine a patient's risk of opioid abuse; collaborating with other health-care providers to plan a patient's treatment; knowing how abuse-deterrent antidepressants function and what they can't do. Pharmacists can help mitigate substance misuse and improve patient outcomes by implementing these techniques. All patients who require legitimate and effective pain management through the use of opioids must have access to them. While further study is needed in a variety of areas, pharmacists may make efforts today to follow proposed recommendations, rules, and legislation to reduce drug misuse and diversion of restricted drugs.

The Financial Burden of Opioid-Related Abuse among Surgical and Non-Surgical Patients in Florida: A Longitudinal Study

Florida is one of the eight states labeled as a high-burden opioid abuse state and is an epicenter for opioid use and misuse. The aim of our study was to measure multi-year total room charges and costs billed for opioid abuse-related events and to compare the costs of inpatient opioid abusers and non-opioid abusers for Florida hospitals from 2011 to 2017. We constructed a retrospective case-control longitudinal study design on inpatient administrative discharge data across 173 hospitals. Opioid abuse was defined using both ICD-9-CM and ICD-10-CM systems. We found a statistically significant association between opioid abuse diagnosis and total room charge. On average, opioid abuse status increased the room charges by 8.1%. We also noticed year-to-year variations in opioid abuse had a remarkable influence on hospital finances. We showed that since 2015, the differences significantly increased from 4–5% to 13–14% for both room charges and cost, which indicates the financial burden due to opioid abuse becoming more frequent. These findings are important to policymakers and hospital administrators because they provide crucial insight into Florida’s opioid crisis and its economic burden on hospitals.

A history of opioid abuse: Why buprenorphine is superior for the management of opioid use disorder and pain

Opioid abuse represents a public health crisis that has significant associated morbidity and mortality. Since beginning in the early 1990’s, the opioid abuse epidemic has been difficult to control due to regulatory, economic, and psychosocial factors that have perpetuated its existence. This era of opioid abuse has been punctuated by three distinct rises in mortality, precipitated by unique public health problems that needed to be addressed. Patients affected by opioid abuse have been historically treated with either methadone or naltrexone. While these agents have clinical utility supported by robust literature, we the authors posit that buprenorphine is a superior therapy for both opioid use disorder (OUD) as well as pain. This primacy is due to the pharmacological properties of buprenorphine which render it unique among other opioid medications. One such property is buprenorphine’s ceiling effect of respiratory depression, a common side effect and complicating factor in the administration of many classical opioid medications. This profile renders buprenorphine safer, while simultaneously retaining therapeutic utility in the medical practitioner’s pharmacopeia for the treatment of opioid use disorder and pain.