Opioid Abuse [keywords]
- Exploring trends of nonmedical use of prescription drugs and polydrug abuse in the Twittersphere using unsupervised machine learning. [JOURNAL ARTICLE]
- Addict Behav 2016 Aug 17.
Nonmedical use of prescription medications/drugs (NMUPD) is a serious public health threat, particularly in relation to the prescription opioid analgesics abuse epidemic. While attention to this problem has been growing, there remains an urgent need to develop novel strategies in the field of "digital epidemiology" to better identify, analyze and understand trends in NMUPD behavior.We conducted surveillance of the popular microblogging site Twitter by collecting 11 million tweets filtered for three commonly abused prescription opioid analgesic drugs Percocet® (acetaminophen/oxycodone), OxyContin® (oxycodone), and Oxycodone. Unsupervised machine learning was applied on the subset of tweets for each analgesic drug to discover underlying latent themes regarding risk behavior. A two-step process of obtaining themes, and filtering out unwanted tweets was carried out in three subsequent rounds of machine learning.Using this methodology, 2.3M tweets were identified that contained content relevant to analgesic NMUPD. The underlying themes were identified for each drug and the most representative tweets of each theme were annotated for NMUPD behavioral risk factors. The primary themes identified evidence high levels of social media discussion about polydrug abuse on Twitter. This included specific mention of various polydrug combinations including use of other classes of prescription drugs, and illicit drug abuse.This study presents a methodology to filter Twitter content for NMUPD behavior, while also identifying underlying themes with minimal human intervention. Results from the study track accurately with the inclusion/exclusion criteria used to isolate NMUPD-related risk behaviors of interest and also provides insight on NMUPD behavior that has a high level of social media engagement. Results suggest that this could be a viable methodology for use in big data substance abuse surveillance, data collection, and analysis in comparison to other studies that rely upon content analysis and human coding schemes.
- Physicians' intention to prescribe hydrocodone combination products after rescheduling: A theory of reasoned action approach. [JOURNAL ARTICLE]
- Res Social Adm Pharm 2016 Jul 29.
The U.S. Drug Enforcement Administration (DEA) rescheduled hydrocodone combination products (HCPs) in an attempt to mitigate the prescription opioid epidemic. Many in the medical and pharmacy community expressed concerns of unintended consequences as a result of rescheduling.This study examined physicians' intentions to prescribe HCPs after rescheduling using the framework of the theory of reasoned action (TRA).A cover letter containing a link to the online questionnaire was sent to physicians of the Texas Medical Association who were likely to prescribe opioids. The questionnaire assessed physicians' intentions to prescribe HCPs after rescheduling. Predictor variables included attitude toward rescheduling, subjective norm toward HCP prescribing, and past prescribing behavior of schedule II prescriptions. All variables were measured on a 7-point, Likert-type scale. Intention to prescribe as a dependent variable was regressed over TRA variables and respondent characteristics.A total of 1176 usable responses were obtained, yielding a response rate of 13.3%. Mean (M) age was 53.07 ± 11 and most respondents were male (70%) and Caucasian (75%). Physicians held a moderately positive intention to prescribe HCPs (M = 4.36 ± 2.08), held a moderately negative attitude towards rescheduling, M = 4.68 ± 1.51 (reverse coded). Subjective norm was moderately low, M = 3.06 ± 1.78, and past prescribing behavior M = 2.43 ± 1.21. The linear regression analysis indicated that attitude (β = 0.10; P = 0.006), subjective norm (β = 0.35; P < 0.0001) and past prescribing behavior (β = 0.59; P < 0.0001) were significant predictors of intention to prescribe HCPs after rescheduling.TRA was shown to be a predictive model of physicians' intentions to prescribe HCPs after rescheduling. Overall, physicians held a moderately positive intention to prescribe HCPs. Past behavior concerning schedule II prescribing was found to be the most significant predictor of intention. Understanding the impact of federal rule changes on pain management care and patient satisfaction is necessary to determine whether this change has produced the intended consequences without harming patients in need of HCPs.
- A Systematic Review of Opioid and Benzodiazepine Misuse in Older Adults. [REVIEW, JOURNAL ARTICLE]
- Am J Geriatr Psychiatry 2016 Jun 7.
The authors assessed the prevalence of opioid and benzodiazepine prescription drug misuse in older adults, the risk factors associated with misuse, and age-appropriate interventions.Following PRISMA guidelines, a literature search of PubMed, PsycINFO, and EMBASE for peer-reviewed journal articles in English through April 2014 with updates through November 2015 was conducted for reports on misuse of prescription benzodiazepines and opioids in older adults. Relevant publications were reviewed that included participants age ≥65 years. Reference lists were manually searched for key identified articles and geriatric journals through April 2016. Information on the study design, sample, intervention, comparators, outcome, time frame, and risk of bias were abstracted for each article.Of 4,932 reviewed reports, 15 were included in this systematic review. Thirteen studies assessed the prevalence of prescription drug misuse and included studies related to opioid shopping behavior, assessment of morbidity and mortality associated with opioid and/or benzodiazepine use, frequency and characteristics of opioid prescribing, frequency of substance use disorders and nonprescription use of pain relievers, and health conditions and experiences of long-term benzodiazepine users. One study identified risk factors for misuse, and one study described the effects of provider education and an electronic support tool as an intervention.There is a dearth of high quality research on prescription drug misuse in older adults. Existing studies are heterogeneous, making it difficult to draw broad conclusions. The need for further research specific to prescription drug misuse among older adults is discussed.
- Pain management strategies for patients on methadone maintenance therapy: a systematic review of the literature. [REVIEW, JOURNAL ARTICLE]
- BMJ Support Palliat Care 2016 Aug 26.
Prescription opioid and heroin abuse has increased substantially in recent years. Enrolment on opioid agonist therapy programmes is consequently increasing as well. As a result of these trends, more patients who present with acute pain secondary to a malignancy are also on chronic methadone maintenance therapy (MMT) for substance abuse. This combination of diagnoses presents a pain management challenge for palliative care providers.This paper aims to gather and review the available medical literature pertaining to the use of opioid analgesia in methadone-maintained patients.The authors searched PubMED, PsychINFO, EMBASE, Clinical Key, the Cochrane Library and CINAHL from their inception to May 2015 for relevant articles. All articles that discuss opioid therapy in adult patients on methadone maintenance for opioid addiction with cancer or advanced illness were included. Data were extracted and study quality was rated independently by the authors.Our searches resulted in 680 hits. Of those, only 7 met inclusion criteria for the study. Most of the studies favoured the use of methadone either in scheduled divided doses every 4-8 hours or by continuous intravenous infusion. The overall strength of the evidence was poor, consisting mainly of case series, case reports and 1 single-centre retrospective cohort study lacking a comparison group.Treating MMT-maintained patients with methadone for analgesia may be preferable to using other opioid analgesics. However, there are many systems barriers that may make this approach challenging and the evidence favouring methadone over other opioid analgesics is weak.
- The Surgeon's Role in Stemming the Prescription Opioid Abuse Epidemic. [LETTER]
- J Oral Maxillofac Surg 2016 Aug 23.
- Opioid Abuse. [LETTER]
- J Oral Maxillofac Surg 2016 Aug 23.
- Does Breast Milk Affect Neonatal Abstinence Syndrome Severity, the Need for Pharmacologic Therapy, and Length of Stay for Infants of Mothers on Opioid Maintenance Therapy During Pregnancy? [JOURNAL ARTICLE]
- Adv Neonatal Care 2016 Aug 25.
The United States is in an opioid crisis with abuse among women on the rise over the past 10 years. Infants of opioid-dependent mothers are at risk for neonatal abstinence syndrome (NAS). Neonatal abstinence syndrome can affect multiple systems and disrupt normal growth and development. It is for this reason that strategies to promote health such as breastfeeding need to be explored. This brief evaluates current evidence regarding breast milk and the impact it has on NAS.The question guiding this brief is: "Does provision of breast milk reduce NAS withdrawal symptoms, decrease length of stay, and decrease the need for pharmacologic therapy for infants whose mothers are maintained on methadone or buprenorphine?"CINHAL/MEDLINE Complete and PubMed databases were searched using key words-NAS and breastfeeding-and the search was limited to 10 years for English studies evaluating the effects of breast milk on severity of NAS, pharmacologic therapy, and length of stay whose mothers received methadone or buprenorphine during pregnancy. The search yielded 10 studies addressing these concerns.Breast milk may be beneficial for decreasing NAS severity, pharmacologic therapy, and length of stay.Strategies should be developed to support individualized plans based on maternal history, safety, and mother's choice.Further research is needed utilizing matched case-controlled studies regarding breast milk and the influence on severity of NAS, need for pharmacologic therapy, length of stay, and neurologic outcomes. In addition, other factors should be investigated including abrupt weaning, polysubstance use, and readmissions.
- Maternal Buprenorphine Maintenance and Lactation. [JOURNAL ARTICLE]
- J Hum Lact 2016 Aug 25.
In addition to the well-known benefits of human milk and breastfeeding for the mother and infant, breastfeeding may mitigate neonatal abstinence syndrome severity in prenatally opioid-exposed infants. However, lack of conclusive data regarding the extent of the presence of buprenorphine and active metabolites in human milk makes the recommendation of breastfeeding for buprenorphine-maintained women difficult for many providers.This study seeks to determine the concentrations of buprenorphine and its active metabolites (norbuprenorphine, buprenorphine-glucuronide, and norbuprenorphine-glucuronide) in human milk, maternal plasma, and infant plasma of buprenorphine-maintained women and their infants.Up to 10 buprenorphine-maintained women provided paired breast milk and plasma samples at 2, 3, 4, 14, and 30 days postdelivery, and 9 infants provided plasma samples on day 14 of life. All samples were analyzed via liquid chromatography tandem mass spectrometry to determine concentrations of buprenorphine, norbuprenorphine, buprenorphine-glucuronide, and norbuprenorphine-glucuronide by a fully validated method.Concentrations of buprenorphine and metabolites are low in human milk and maternal plasma. Breastfed infant plasma concentrations of buprenorphine were low or undetectable and metabolite concentrations undetectable at 14 days of infant age. There were significant correlations between maternal buprenorphine dose and maternal plasma and human milk buprenorphine concentrations.These data find low concentrations of buprenorphine and metabolites in human milk and lend support to the recommendation for lactation among stable buprenorphine-maintained women. However, the correlation between maternal dose and maternal plasma and human milk buprenorphine concentrations bears further study.
- The paradox of decreasing nonmedical opioid analgesic use and increasing abuse or dependence - An assessment of demographic and substance use trends, United States, 2003-2014. [JOURNAL ARTICLE]
- Addict Behav 2016 Aug 17.
The harms related to nonmedical use of opioid analgesics have impacted the United States for more than a decade. Examining trends in nonmedical use, abuse, and dependence among various demographic and substance using groups can provide critical insight for prevention and treatment activities.Data from the National Survey on Drug Use and Health were used to assess trends in opioid analgesic nonmedical use, abuse, and dependence for 2003-2005, 2006-2008, 2009-2011, and 2012-2014. Multivariable logistic regression was used to identify characteristics associated with opioid analgesic abuse or dependence.Rates of past-year opioid analgesic nonmedical use decreased from 48.4 per 1000 persons aged 12years and older in 2003-2005 to 43.3 in 2012-2014. Declines were seen among most demographic and substance using groups. In contrast, rates of past-year opioid analgesic abuse or dependence increased from 6.0 per 1000 persons in 2003-2005 to 7.5 in 2012-2014; increases were seen among most demographic and substance using groups. In 2012-2014, odds of opioid analgesic abuse or dependence were highest among those with sedative or tranquilizer and heroin abuse or dependence.These findings indicate encouraging trends in overall nonmedical use of opioid analgesics which declined among many demographic and substance using groups. However, continued increases in rates of opioid analgesic abuse or dependence highlight the critical importance of maintaining efforts to drive down inappropriate opioid prescribing and expanding efforts to increase the provision of medication assisted treatment and psychosocial services for opioid use disorders and equipping individuals with naloxone to reverse opioid overdose.
- Survey of Primary Care and Mental Health Prescribers' Perspectives on Reducing Opioid and Benzodiazepine Co-Prescribing Among Veterans. [JOURNAL ARTICLE]
- Pain Med 2016 Aug 24.
Due to the involvement of opioids and benzodiazepines in rising pharmaceutical overdoses, a reduction in coprescribing of these medications is a national priority, particularly among patients with substance use disorders and other high-risk conditions. However, little is known about primary care (PC) and mental health (MH) prescribers' perspectives on these medications and efforts being implemented to reduce coprescribing. An anonymous survey. One multisite VA health care system. Participants were 55 PC and 31 MH prescribers. Survey development was guided by the Promoting Action on Research Implementation in Health Services (PARIHS) conceptual framework. PC and MH prescribers of opioids or benzodiazepines were invited to complete an anonymous electronic survey. Responses were collapsed to highlight agreement, disagreement, and neutrality and summarized with means and percentages. Over 80% of both prescriber groups reported concern about concurrent use and > 75% strongly agreed with clinical practice guidelines (CPG) that recommend caution in coprescribing among patients with high-risk conditions. More than 40% of both prescriber groups indicated that coprescribing continues because of beliefs that patients appear stable without adverse events and tapering/discontinuation is too difficult. Over 70% of prescribers rated strategies for addressing patients who refuse to discontinue, more time with patients, and identification of high-risk patients as helpful in reducing coprescribing. Despite strong agreement with CPGs, prescribers reported several barriers that contribute to coprescribing of opioids and benzodiazepines and challenge their ability to taper these medications. Multiple interventions are likely needed to reduce opioid and benzodiazepine coprescribing.