Suggested Paths to Fixing the Opioid Crisis

Samet, Jeffrey H.; Kertesz, Stefan G.

doi:10.1001/jamanetworkopen.2018.0218

Cited by 31 publications

(28 citation statements)

References 7 publications

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“…These concerns need to be balanced with the need to treat chronic pain. A recent review of deaths from opioids concluded that the burden of opioid overdose in older adults requires special attention, noting the largest relative increase in opioids occurred in persons 55 to 64 (754% increase from 0.2% to 1.7%) and 65 years and older and the absolute number of deaths in this group is moderate …”

Section: Discussionmentioning

confidence: 99%

“…A recent review of deaths from opioids concluded that the burden of opioid overdose in older adults requires special attention, noting the largest relative increase in opioids occurred in persons 55 to 64 (754% increase from 0.2% to 1.7%) and 65 years and older and the absolute number of deaths in this group is moderate. 21,22 Several drug-drug interactions involving antimicrobial agents were also added to Table 5, and the recommendation to avoid concurrent use of three or more CNS-active medications was reformatted to clarify and bring further attention to the increased risk of falls and other harms that can occur when multiple CNS-active medications are combined. 23 PIM use continues to be a serious problem in older adults and especially in vulnerable older adults with multiple chronic conditions.…”

Section: Strength Of Recommendationmentioning

confidence: 99%

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American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults

2019

J American Geriatrics Society

2,486

1,043

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The American Geriatrics Society (AGS) Beers Criteria® (AGS Beers Criteria®) for Potentially Inappropriate Medication (PIM) Use in Older Adults are widely used by clinicians, educators, researchers, healthcare administrators, and regulators. Since 2011, the AGS has been the steward of the criteria and has produced updates on a 3‐year cycle. The AGS Beers Criteria® is an explicit list of PIMs that are typically best avoided by older adults in most circumstances or under specific situations, such as in certain diseases or conditions. For the 2019 update, an interdisciplinary expert panel reviewed the evidence published since the last update (2015) to determine if new criteria should be added or if existing criteria should be removed or undergo changes to their recommendation, rationale, level of evidence, or strength of recommendation. J Am Geriatr Soc 67:674–694, 2019.

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Section: Discussionmentioning

confidence: 99%

Section: Strength Of Recommendationmentioning

confidence: 99%

American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults

2019

J American Geriatrics Society

2,486

1,043

View full text Add to dashboard Cite

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“…There is an alarming paucity of guidance on best practices for tapering opioids . Blunt, inappropriate tapering is increasingly common, causing patients unnecessary suffering and leading some to illicit drugs or suicide . Opioid‐associated patients are already at disproportionate risk of suicide, and evidence suggests that their suicides are often miscounted as unintentional overdoses .…”

Section: Policy and Politicsmentioning

confidence: 99%

Defining Misprescribing to Inform Prescription Opioid Policy

Dineen¹

2018

Hastings Center Report

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Prescription opioid policies too often reflect over a century's worth of moralizing about the nature of opioid use disorder, the value of pain, and the meaning of suffering. The social and legal penalties to prescribers run in one direction—avoid overprescribing, however defined, at all costs. The lack of shared definitions is problematic for formulating and evaluating opioid policy. For example, the variant definitions of “misuse,” “abuse,” and “addiction” complicate estimates of morbidity. There are also no widely accepted definitions of misprescribing and overprescribing. I offer here a modest attempt at the categorization of misprescribing: inadvertent overprescribing, corrupt overprescribing, qualitative overprescribing, quantitative overprescribing, multiclass overprescribing, and underprescribing.

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“…Delineation of these factors could inform efforts to help patients or be useful for patients to practice self-care. However, studies thus far have tended to focus on a small number of clinically relevant factors such as medication dose, duration and formulation (8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

Factors associated with opioid cessation: a machine learning approach

Cox

Sherva

Lunetta

et al. 2019

Preprint

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Background and Aims People with opioid use disorder (OUD) can stop using opioids on their own, with help from groups and with treatment, but there is limited research on the factors that influence opioid cessation. Methods We employed multiple machine learning prediction algorithms (LASSO, random forest, deep neural network, and support vector machine) to assess factors associated with ceasing opioid use in a sample comprised of African Americans (AAs) and European Americans (EAs) who met DSM-5 criteria for mild to severe OUD. Values for several thousand demographic, alcohol and other drug use, general health, and behavioral variables, as well as diagnoses for other psychiatric disorders, were obtained for each participant from a detailed semi-structured interview. Results Support vector machine models performed marginally better on average than those derived using other machine learning methods with maximum prediction accuracies of 75.4% in AAs and 79.4% in EAs. Subsequent stepwise regression analyses that considered the 83 most highly ranked variables across all methods and models identified less recent cocaine use (p<5×10 -8 ), a shorter duration of opioid use (p<5×10 -6 ), and older age (p<5×10 -9 ) as the strongest independent predictors of opioid cessation. Factors related to drug use comprised about half of the significant independent predictors, with other predictors related to non-drug use behaviors, psychiatric disorders, overall health, and demographics. Conclusions These proof-ofconcept findings provide information that can help develop strategies for improving OUD management and the methods we applied provide a framework for personalizing OUD treatment.

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Suggested Paths to Fixing the Opioid Crisis

Cited by 31 publications

References 7 publications

American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults

American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults

Defining Misprescribing to Inform Prescription Opioid Policy

Factors associated with opioid cessation: a machine learning approach

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