A Challenging Crossroad for Emergency Medicine: The Epidemics of Pain and Pain Medication Deaths

Perrone, Jeanmarie; Mycyk, Mark B.

doi:10.1111/acem.12323

Cited by 11 publications

(5 citation statements)

References 7 publications

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“…The lag between White and Black OOD peaks can be attributed to biased prescribing that promote unequal access to prescription opioids based on race or ethnicity, where young White women (and men) were more likely to receive opioids for pain management than Black counterparts of any age [14][15][16]. This trend of indiscriminate prescribing to Whites for emergency and surgical interventions, cancer treatment and/or pain management was referred to as the natural/semi-synthetic wave and involved mostly codeine, morphine, hydrocodone, and oxycodone abuse [17][18][19]).…”

Section: Introduction/backgroundmentioning

confidence: 99%

The Opioid Epidemic: a Crisis Disproportionately Impacting Black Americans and Urban Communities

Gondré–Lewis

Abijo

Gondré-Lewis

2022

J. Racial and Ethnic Health Disparities

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The heroin epidemic has existed for decades, but a sharp rise in opioid overdose deaths (OODs) jolted the nation in the mid-twenty-teens and continues as a major health crisis to this day. Although the new wave of OODs was initially approached as a rural problem impacting a White/Caucasian demographic, surveillance records suggest severe impacts on African Americans and urban-dwelling individuals, which have been largely underreported. The focus of this report is on specific trends in OOD rates in Black and White residents in states with a significant Black urban population and declared as hotspots for OOD: (Maryland (MD), Illinois (IL), Michigan (MI), and Pennsylvania (PA)), and Washington District of Columbia (DC). We compare OODs by type of opioid, across ethnicities, across city/rural demographics, and to homicide rates using 2013–2020 data acquired from official Chief Medical Examiners’ or Departments of Health (DOH) reports. With 2013 or 2014 as baseline, the OOD rate in major cities (Baltimore, Chicago, Detroit, Philadelphia) were elevated two-fold over all other regions of their respective state. In DC, Wards 7 and 8 OODs were consistently greater than other jurisdictions, until 2020 when the rate of change of OODs increased for the entire city. Ethnicity-wise, Black OOD rates exceeded White rates by four- to six-fold, with fentanyl and heroin having a disproportionate impact on Black opioid deaths. This disparity was aggravated by its intersection with the COVID-19 pandemic in 2020. African Americans and America’s urban dwellers are vulnerable populations in need of social and political resources to address the ongoing opioid epidemic in under-resourced communities. Supplementary Information The online version contains supplementary material available at 10.1007/s40615-022-01384-6.

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Section: Introduction/backgroundmentioning

confidence: 99%

The Opioid Epidemic: a Crisis Disproportionately Impacting Black Americans and Urban Communities

Gondré–Lewis

Abijo

Gondré-Lewis

2022

J. Racial and Ethnic Health Disparities

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“…Chronic pain affects 100 million Americans or 30% of the US population 26 . About 2.5 million Americans suffer from opioid abuse 27 from prescription narcotics or heroin, placing researchers at an interesting crossroads of the two epidemics 28 . It is the view of many that the health profession is responsible for the opioid epidemic we face, and as such, it is the responsibility of the health profession to confront it.…”

Section: Discussionmentioning

confidence: 99%

Genetic and pharmacological antagonism of NK1 receptor prevents opiate abuse potential

et al. 2017

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Development of an efficacious, non-addicting analgesic has been challenging. Discovery of novel mechanisms underlying addiction may present a solution. Here, we target the neurokinin system, which is involved in both pain and addiction. Morphine exerts its rewarding actions, at least in part, by inhibiting GABAergic input onto substance P (SP) neurons in the ventral tegmental area (VTA), subsequently increasing SP release onto dopaminergic neurons. Genome editing of the neurokinin 1 receptor (NK1R) in the VTA renders morphine non-rewarding. Complementing our genetic approach, we demonstrate utility of a bivalent pharmacophore with dual activity as a μ/δ opioid agonist and NK1R antagonist in inhibiting nociception in an animal model of acute pain while lacking any positive reinforcement. These data indicate that dual targeting of the dopaminergic reward circuitry and pain pathways with a multifunctional opioid agonist-NK1R antagonist may be an efficacious strategy in developing future analgesics that lack abuse potential.

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“…It is now widely accepted that opioid medications taken as directed for therapeutic indications can contribute to the development of opioid use disorder (OUD). [1][2][3] Opioid prescriptions, even in limited duration, are associated with later long-term use, [4][5][6][7] and individuals suffering from OUD often recall that their first exposure to opioids was through a prescription for pain. 8,9 Yet, the relationship between therapeutic opioid exposure and subsequent OUD remains largely unexplored.…”

Section: Introductionmentioning

confidence: 99%

Incidence of opioid use disorder in the year after discharge from an emergency department encounter

et al. 2021

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A Challenging Crossroad for Emergency Medicine: The Epidemics of Pain and Pain Medication Deaths

Cited by 11 publications

References 7 publications

The Opioid Epidemic: a Crisis Disproportionately Impacting Black Americans and Urban Communities

The Opioid Epidemic: a Crisis Disproportionately Impacting Black Americans and Urban Communities

Genetic and pharmacological antagonism of NK1 receptor prevents opiate abuse potential

Incidence of opioid use disorder in the year after discharge from an emergency department encounter

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