A Proactive Response to Prescription Opioid Abuse

Califf, Robert M.; Woodcock, Janet; Ostroff, Stephen M.

doi:10.1056/nejmsr1601307

Cited by 214 publications

(180 citation statements)

References 0 publications

Supporting

Mentioning

177

Contrasting

Unclassified

Order By: Relevance

“…The large variation in results also from previous studies may, indeed, partly be explained by the use of numerous different indicators of misuse that are not comparable (69,70,103).Thus, while there appears to be a lower prevalence of misuse in the general population of patients on prescribed therapy with psychoactive drugs, the prevalence of misuse and abuse is suggested to be high in sub-populations of substance abusers. Many subjects may need to be exposed in order for a fatal intoxication to occur, or for a signal of substance use 69 disorder to be caught by the pharmacovigilance system.…”

Section: Specific Drug Classes N (%)mentioning

confidence: 80%

“…the set of included variables) and quality (the accuracy, specificity, sensitivity and reliability of variables) of each register. In the USA, an extensive prescription drug abuse monitoring system is present (70,103), including a variety of tools, annual surveys, prescription drug monitoring programs, registers that collect reported adverse events related to drug abuse, analysis tools to identify "doctor shopping" in prescription databases, as well as multi-source approaches combining information from several data sources (70,103). Equivalent data sources are missing in most other countries, including the European countries (with the exception of France) (72,104,105).…”

Section: Pharmacoepidemiological Methods In Studies Of Psychoactive Pmentioning

confidence: 99%

“…One important limitation of drug prescription and dispensing databases is that only personally prescribed drugs are covered, while the sources of abused drugs are diverse (84,117 (103,124). In the USA, by far the class of prescription drugs most commonly implicated in misuse and abuse are the opioid analgesics (such as oxycodone) (106,124).…”

Section: Pharmacoepidemiological Methods In Studies Of Psychoactive Pmentioning

confidence: 99%

“…The harms of prescription drug use disorders, misuse, and abuse are substantial and the consequences extend by far the medical system (36,103,127,145,213). Prescription drug misuse and abuse are associated with a range of serious medical, psychosocial and other adverse shortand long-term outcomes, including intoxications, mental and somatic co-morbidities, and premature death (36,127,145,213).…”

Section: Rationale Of This Thesismentioning

confidence: 99%

See 3 more Smart Citations

Psychoactive prescription drug use disorders, misuse and abuse : Pharmacoepidemiological aspects

Tjäderborn

2016

Linköping University Medical Dissertations

View full text Add to dashboard Cite

Background: There is a widespread and increasing use of psychoactive prescription drugs, such as opioid analgesics, anxiolytics, hypnotics and anti-epileptics, but their use is associated with a risk of drug use disorder, misuse and abuse. Today, these are globally recognised and emerging public health concerns. Aim:The aim of this thesis is to estimate the occurrence and prevalence of psychoactive prescription drug use disorders, misuse and abuse, and to investigate the association with some potential risk factors. Methods:A study using register data from forensic cause of death investigations analysed and described cases of fatal unintentional intoxications with tramadol (Study I). Based on register data on spontaneously reported adverse drug reactions (ADRs) reported cases of tramadol dependence were scrutinized and summarised (Study II). In a study in suspected drug-impaired drivers with a toxicology analysis confirming intake of tramadol, diazepam, flunitrazepam, zolpidem and zopiclone, the prevalence of non-prescribed use was assessed and associated factors were investigated (Study III). From a national cohort of patients initiating prescribed treatment with pregabalin, identified using data on prescription fills, a study investigated longitudinal utilisation patterns during five years with regards to use above the maximum approved daily dose (MAD) of the drug, and factors associated with the utilisation patterns (Study IV).Results: In the first study, 17 cases of unintentional intoxications were identified, in which tramadol was judged to have caused or contributed to the death. Of the deceased, more were men, the median age was 44 years and the majority used multiple psychoactive substances (prescription drugs, alcohol and/or illicit drugs). In the second study, 104 spontaneously vi reported cases of possible or probable tramadol dependence were identified, of which more concerned women. The median age in these cases was 45 years and in about a third of cases the person had a history of substance abuse and in 40% of cases there was documented history of psychoactive medication use. Severe addiction was reported. In the third study, more than half of the individuals suspected of drug-impaired driving used the drug without a recent prescription.Non prescribed use was most frequent in users of benzodiazepines and of tramadol compared to users of zolpidem or zopiclone, and was more likely in younger individuals and in multiplesubstance users and less likely in individuals with a recent prescription for another psychoactive medication. In the last paper, five longitudinal utilisation patterns were found in pregabalin users, with two patterns associated with a particularly high risk of use of doses above the maximum approved daily dose. The highest risk of use of daily doses above the MAD over time was associated with male sex, younger age, non-urban residency, and a recent prescribed treatment with an antiepileptic or opioid analgesic drug. Conclusions

show abstract

Section: Specific Drug Classes N (%)mentioning

confidence: 80%

Section: Pharmacoepidemiological Methods In Studies Of Psychoactive Pmentioning

confidence: 99%

Section: Pharmacoepidemiological Methods In Studies Of Psychoactive Pmentioning

confidence: 99%

Section: Rationale Of This Thesismentioning

confidence: 99%

See 2 more Smart Citations

Psychoactive prescription drug use disorders, misuse and abuse : Pharmacoepidemiological aspects

Tjäderborn

2016

Linköping University Medical Dissertations

View full text Add to dashboard Cite

show abstract

“…Entre los estadounidenses, la muerte prematura de la estrella del pop Prince destacó los peligros del uso indebido y el abuso de los opioides recetados. Para los médicos de pacientes agudos, la historia subyacente tenía un problema cotidiano, como el uso indebido de sustancias recetadas previamente y que comenzó con la tolerancia a los opioides prescritos después de la cirugía ortopédica de cadera (1). Recientemente, hemos visto un aumento en los artículos de noticias y revistas médicas centrados en la epidemia de uso excesivo y abuso de opioides en los Estados Unidos.…”

Section: Introductionunclassified

Coadyuvantes farmacológicos con efecto ahorrador de opioides en el periodo perioperatorio

Bujedo

Santos

Uría-Azpiazu

et al. 2018

Rev. Soc. Esp. Dolor.

View full text Add to dashboard Cite

Improving Adherence to Long-term Opioid Therapy Guidelines to Reduce Opioid Misuse in Primary Care

et al. 2017

View full text Add to dashboard Cite

IMPORTANCE Prescription opioid misuse is a national crisis. Few interventions have improved adherence to opioid-prescribing guidelines.OBJECTIVE To determine whether a multicomponent intervention, Transforming Opioid Prescribing in Primary Care (TOPCARE; http://mytopcare.org/), improves guideline adherence while decreasing opioid misuse risk. DESIGN, SETTING, AND PARTICIPANTSCluster-randomized clinical trial among 53 primary care clinicians (PCCs) and their 985 patients receiving long-term opioid therapy for pain. The study was conducted from January 2014 to March 2016 in 4 safety-net primary care practices.INTERVENTIONS Intervention PCCs received nurse care management, an electronic registry, 1-on-1 academic detailing, and electronic decision tools for safe opioid prescribing. Control PCCs received electronic decision tools only. MAIN OUTCOMES AND MEASURESPrimary outcomes included documentation of guideline-concordant care (both a patient-PCC agreement in the electronic health record and at least 1 urine drug test [UDT]) over 12 months and 2 or more early opioid refills. Secondary outcomes included opioid dose reduction (ie, 10% decrease in morphine-equivalent daily dose [MEDD] at trial end) and opioid treatment discontinuation. Adjusted outcomes controlled for differing baseline patient characteristics: substance use diagnosis, mental health diagnoses, and language.RESULTS Of the 985 participating patients, 519 were men, and 466 were women (mean [SD] patient age, 54.7 [11.5] years). Patients received a mean (SD) MEDD of 57.8 (78.5) mg. At 1 year, intervention patients were more likely than controls to receive guideline-concordant care (65.9% vs 37.8%; P < .001; adjusted odds ratio [AOR], 6.0; 95% CI, 3.6-10.2), to have a patient-PCC agreement (of the 376 without an agreement at baseline, 53.8% vs 6.0%; P < .001; AOR, 11.9; 95% CI, 4.4-32.2), and to undergo at least 1 UDT (74.6% vs 57.9%; P < .001; AOR, 3.0; 95% CI, 1.8-5.0). There was no difference in odds of early refill receipt between groups (20.7% vs 20.1%; AOR, 1.1; 95% CI, 0.7-1.8). Intervention patients were more likely than controls to have either a 10% dose reduction or opioid treatment discontinuation (AOR, 1.6; 95% CI, 1.3-2.1; P < .001). In adjusted analyses, intervention patients had a mean (SE) MEDD 6.8 (1.6) mg lower than controls (P < .001). CONCLUSIONS AND RELEVANCEA multicomponent intervention improved guideline-concordant care but did not decrease early opioid refills.TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01909076

show abstract

A Proactive Response to Prescription Opioid Abuse

Cited by 214 publications

References 0 publications

Psychoactive prescription drug use disorders, misuse and abuse : Pharmacoepidemiological aspects

Psychoactive prescription drug use disorders, misuse and abuse : Pharmacoepidemiological aspects

Coadyuvantes farmacológicos con efecto ahorrador de opioides en el periodo perioperatorio

Improving Adherence to Long-term Opioid Therapy Guidelines to Reduce Opioid Misuse in Primary Care

Contact Info

Product

Resources

About