Lessons learned in the abuse of pain-relief medication: a focus on healthcare costs

Manchikanti, Laxmaiah; Boswell, Mark V.; Hirsch, Joshua A

doi:10.1586/ern.13.33

Cited by 32 publications

(30 citation statements)

References 92 publications

(56 reference statements)

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“…The nonmedical use of prescription opioids (POs) has emerged as a major public health concern, especially in North America where it has reached epidemic proportions, causing extensive morbidity and mortality (Dhalla et al, 2009; Fischer & Argento, 2012; Manchikanti, Boswell, & Hirsch, 2013). POs, pharmaceutical analgesic drugs (such as oxycodone and hydrocodone) designed for the treatment of moderate to severe chronic pain, are the most commonly misused class of prescription drugs (Fischer & Argento, 2012; Substance Abuse and Mental Health Service Administration, 2010).…”

Section: Introductionmentioning

confidence: 99%

Prevalence and correlates of nonmedical prescription opioid use among a cohort of sex workers in Vancouver, Canada

Argento¹,

Chettiar²,

Nguyen³

et al. 2015

International Journal of Drug Policy

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Background The nonmedical use of prescription opioids (POs) is a major public health concern, causing extensive morbidity and mortality in North America. Canada has the second highest consumption rate of POs globally and data indicate nonmedical PO use (NPOU) is growing among key populations and increasingly available in street-level drug markets. Despite accumulating evidence documenting the rise of NPOU, few studies have systematically examined NPOU in Canada among key vulnerable populations, such as sex workers. This study prospectively evaluated the prevalence and correlates of NPOU within a Vancouver cohort of sex workers over three-years follow-up. Methods Data were drawn from an open prospective cohort, AESHA (An Evaluation of Sex Workers Health Access) in Metro Vancouver, Canada (2010-2013). Women were recruited through outreach from outdoor street locations and indoor venues. Bivariate and multivariable logistic regression using Generalized Estimating Equations (GEE) were used to examine social and structural correlates of NPOU over 36 months. Results Of the 692 sex workers at baseline, close to one-fifth (n=130, 18.8%) reported NPOU (injection or non-injection) in the last six months. In multivariable GEE analyses, factors independently correlated with recent NPOU were: exchanging sex while high (AOR 3.26, 95%CI 2.29-4.64), police harassment/arrest (AOR 1.83, 95%CI 1.43-2.35), intimate partner injects drugs (AOR 1.66, 95%CI 1.11-2.49), and recent physical/sexual intimate partner violence (AOR 1.65, 95%CI 1.21-2.24). Conclusion Our results demonstrate that nearly one-fifth of sex workers in Metro Vancouver report NPOU. Factors independently statistically associated with NPOU included exchanging sex while high, police harassment/arrest, a drug injecting intimate partner and recent physical/sexual intimate partner violence. The high prevalence of NPOU use among sex workers underscores the need for further prevention and management strategies tailored to this key population. The correlates of NPOU uncovered here suggest that structural interventions may be further implemented to ameliorate this growing concern.

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Section: Introductionmentioning

confidence: 99%

Prevalence and correlates of nonmedical prescription opioid use among a cohort of sex workers in Vancouver, Canada

Argento¹,

Chettiar²,

Nguyen³

et al. 2015

International Journal of Drug Policy

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“…Unfortunately, there is a tendency for some clinicians to be unsuccessful at pain management and the prevention of unintentional overdoses. Some of the most common errors associated with opioid prescribing for noncancer pain treatment include (1) inadequate screening for safe and effective opioid use, (2) failure to monitor adherence, (3) improper selection of opioids, and (4) insufficient consideration of comorbid conditions …”

Section: Contributing Factors To Patient Harmmentioning

confidence: 99%

Mitigating the prescription drug abuse epidemic

Midgley

2017

J of Healthc Risk Manag

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Focused attention on the prescription drug abuse epidemic needs to include evidence-based training for clinicians who manage patients with pain to facilitate accurate screening with consideration of comorbid conditions, diagnosis, selection of the appropriate treatment regimen, and focused monitoring of adherence to the established course of therapy. DEA licensure requirements need to be amended to mandate targeted training focused on pain medication upon initial application and renewal of license. A nationwide mandated real-time dispenser database that requires verification every time a clinician prescribes opioids and other key controlled substances should be a top priority.

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“…Antiepileptics have been described to be associated with multiple adverse effects. Benzodiazepines have been shown to be associated with significant side effects, s pecifically in combination with opioids [46,58]. Despite the wide use of benzodiazepines in chronic pain, for various reasons the evidence for pain relief and improvement in functional status with benzodiazepines is lacking.…”

Section: • Drug Therapymentioning

confidence: 99%

“…Opioids are the most commonly used drugs in chronic low back pain; however, their use has encountered extensive controversy and criticism [30,[40][41][42][43]46,[58][59][60][61][62][63][64][65][66][67]. Numerous manuscripts have described chronic opioid therapy with no significant long-term benefit and severe adverse consequences.…”

Section: • Drug Therapymentioning

confidence: 99%

An Update on the Management of Chronic Lumbar Discogenic Pain

Manchikanti

Hirsch

2015

Pain Manag.

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Lumbar degenerative disc disease without disc herniation, also known as discogenic pain, is an elusive diagnosis of chronic low back pain. Lumbar provocation discography and fusion surgery have been frequently utilized for several decades as the gold standards for the diagnosis and treatment of symptomatic lumbar discogenic pain, though controversial, based on conjecture, rather than evidence. In addition to lumbar fusion, various other operative and nonoperative modalities of treatments are available in managing chronic lumbar discogenic pain. This review provides an updated assessment of the management of chronic lumbar discogenic pain with a critical look at the many modalities of treatments that are currently available.

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Lessons learned in the abuse of pain-relief medication: a focus on healthcare costs

Cited by 32 publications

References 92 publications

Prevalence and correlates of nonmedical prescription opioid use among a cohort of sex workers in Vancouver, Canada

Prevalence and correlates of nonmedical prescription opioid use among a cohort of sex workers in Vancouver, Canada

Mitigating the prescription drug abuse epidemic

An Update on the Management of Chronic Lumbar Discogenic Pain

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