National trends in long‐term use of prescription opioids

Mojtabai, Ramin

doi:10.1002/pds.4278

Cited by 99 publications

(78 citation statements)

References 36 publications

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“…From 1999 to 2010, there has been a significant increase in the use of medications that act through or have effects on serotonin receptors and levels including a large list of anti-depressant medications including monoamine oxidase inhibitor (MAOI) or selective serotonin reuptake inhibitor (SSRI) [19]. This has led to an increased incidence of serotonin syndrome.…”

Section: Discussionmentioning

confidence: 99%

Toxic Leukoencephalopathy in a Teenager Caused by the Recreational Ingestion of 25I-NBOMe: A Case Report and Review of Literature

Humston¹,

Miketic²,

Moon³

et al. 2017

J Med Cases

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Over the past 5 years, the designer drug classification of illicit substances has gained the attention of law enforcement agencies, healthcare providers, and concerned parents around the world. These drugs are often marketed as safe and legal alternatives to their already banned counterparts and are easily acquired online, at "head" shops or behind the counter at local convenient stores. This new drug class includes synthetic cathinones, synthetic cannabinoids, and phenylethylamine derivatives of the 2C class of hallucinogens. Many of these drugs were created for animal research purposes only and were never intended for human consumption. As such, little is known about their pharmacokinetic, pharmacodynamics, and adverse effect profile. Variability in preparation may further alter the already unpredictable safety profile. We report an otherwise healthy 16-year-old adolescent who presented to the emergency department for worsening left-sided weakness, new onset seizure activity, changes in mental status, and an overall decline in health. He self-reported the recreational ingestion of 25I-NBOMe prior to admission. Magnetic resonance imaging and a brain biopsy performed during the course of his admission confirmed the diagnosis of toxic leukoencephalopathy secondary to synthetic hallucinogenic drug use. The basic pharmacology and end-organ effects of 25I-NBOMe are reviewed, their adverse effect profile is presented, and potential anesthetic implications are postulated.

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Section: Discussionmentioning

confidence: 99%

Toxic Leukoencephalopathy in a Teenager Caused by the Recreational Ingestion of 25I-NBOMe: A Case Report and Review of Literature

Humston¹,

Miketic²,

Moon³

et al. 2017

J Med Cases

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“…LTOT can lead to tolerance and escalating doses, and is associated with greater risk of opioid‐related overdose and mortality . Across populations and health care settings, the rising prevalence of LTOT has paralleled increases with opioid‐related overdose and mortality rates . Previous studies, which defined LTOT as opioid use of more than 90 days, found that the prevalence of LTOT was 5.4% in the United States and 17% in Canada …”

Section: Introductionmentioning

confidence: 99%

“…6 Across populations and health care settings, the rising prevalence of LTOT has paralleled increases with opioid-related overdose and mortality rates. [7][8][9][10][11][12][13] Previous studies, which defined LTOT as opioid use of more than 90 days, found that the prevalence of LTOT was 5.4% in the United States and 17% in Canada. 11,14 Defining LTOT is critical to understanding the risk factors that lead to LTOT and the evaluation of clinical practices and policies aimed at reducing risky opioid use that may occur with LTOT (eg, high doses, concurrent benzodiazepine prescriptions, or other forms of opioid use that are associated with behaviors related to abuse, misuse, and addiction).…”

Section: Introductionmentioning

confidence: 99%

Long‐term opioid therapy definitions and predictors: A systematic review

Karmali

Bush

Raman

et al. 2019

Pharmacoepidemiology and Drug

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Purpose This review sought to (a) describe definitions of long‐term opioid therapy (LTOT) outcome measures, and (b) identify the predictors associated with the transition from short‐term opioid use to LTOT for opioid‐naïve individuals. Methods We conducted a systematic review of the peer‐reviewed literature (January 2007 to July 2018). We included studies examining opioid use for more than 30 days. We classified operationalization of LTOT based on criteria used in the definitions. We extracted LTOT predictors from multivariate models in studies of opioid‐naïve individuals. Results The search retrieved 5,221 studies, and 34 studies were included. We extracted 41 unique variations of LTOT definitions. About 36% of definitions required a cumulative duration of opioid use of 3 months. Only 17% of definitions considered consecutive observation periods, 27% used days' supply, and no definitions considered dose. We extracted 76 unique predictors of LTOT from seven studies of opioid‐naïve patients. Common predictors included pre‐existing comorbidities (21.1%), non‐opioid prescription medication use (13.2%), substance use disorders (10.5%), and mental health disorders (10.5%). Conclusions Most LTOT definitions aligned with the chronic pain definition (pain more than 3 months), and used cumulative duration of opioid use as a criterion, although most did not account for consistent use. Definitions were varied and rarely accounted for prescription characteristics, such as days' supply. Predictors of LTOT were similar to known risk factors of opioid abuse, misuse, and overdose. As LTOT becomes a central component of quality improvement efforts, researchers should incorporate criteria to identify consistent opioid use to build the evidence for safe and appropriate use of prescription opioids.

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“…Several recent studies discuss the rising opioid use in the United States and Europe focusing on different settings including primary care and nursing homes …”

Section: Discussionmentioning

confidence: 99%

Utilization of transdermal fentanyl in German nursing home residents from 2010 to 2014

Jobski

Bantel

Hoffmann

2019

Pharmacoepidemiology and Drug

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Purpose Transdermal fentanyl (TF) is the most commonly used opioid in Germany although it is associated with an increased risk for hypoventilation and potentially life‐threatening respiratory depression if used inappropriately. The objective of this study was to characterize nursing home residents newly receiving TF with regards to (1) patients' conditions at patch initiation, (2) previous analgesic treatment, and (3) the initial TF dose. Methods Using claims data (2010‐2014), we studied a cohort of new nursing home residents aged greater than or equal to 65 years initiating TF. Results TF was the most commonly prescribed opioid in nursing home residents. During their nursing home stay, 8571 persons (median age: 86 years, 79.2% female and 28.6% with a diagnosis of cancer) started TF (6.7% of all residents). Almost half of the new TF users were opioid‐naïve and 56.2% of those who had been treated with opioids in the 180 days before TF initiation had only received low potency opioids such as tilidine/naloxone or tramadol. Opioid‐naïve TF users more often were care dependent and had a higher prevalence of dementia than patients previously treated with opioids. Overall, patients often received anxiolytic/hypnotic (29.7%) or antipsychotic (31.4%) comedication. About 61% of opioid‐naïve users started with the lowest available dose (12.5 μg/h), followed by 32% treated with 25 μg/h. Conclusions TF as a noninvasive treatment option is the first‐choice opioid in German nursing homes. Although initial doses seemed more appropriate than those identified in previous studies, the large proportion of opioid‐naïve patients in this vulnerable population warrants attention, given the limited controllability of the treatment.

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National trends in long‐term use of prescription opioids

Abstract: The findings highlight the need for research on potential benefits and harms of long-term use of opioids and efforts to restrict long-term use to patients for whom the benefits outweigh the risks.

Cited by 99 publications

References 36 publications

Toxic Leukoencephalopathy in a Teenager Caused by the Recreational Ingestion of 25I-NBOMe: A Case Report and Review of Literature

Toxic Leukoencephalopathy in a Teenager Caused by the Recreational Ingestion of 25I-NBOMe: A Case Report and Review of Literature

Long‐term opioid therapy definitions and predictors: A systematic review

Utilization of transdermal fentanyl in German nursing home residents from 2010 to 2014

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