The opioid crisis in the USA

Hancocks, Stephen

doi:10.1038/s41415-019-0420-6

Cited by 5 publications

(6 citation statements)

References 5 publications

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“…The top three causes of years lived with disability include two kinds of chronic pain [ 1 ], which cause negative emotion, cognitive impairments [ 2 ], and lost productivity [ 3 ]. Additionally, excessive use of analgesics, especially opioids, has posed critical challenges to pain management in the United States [ 4 ] and United Kingdom [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Retracted: Effect of Sham Acupuncture on Chronic Pain: A Bayesian Network Meta-Analysis

Zhu

Chen

et al. 2022

Pain Medicine

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Background Along with increasing research on acupuncture for chronic pain, the validity of sham acupuncture (SA) has also been argued. Methods Nine databases were searched for randomized controlled trials (RCTs) from the inception date to July 5, 2022. Using Markov Chain Monte Carlo methods, a Bayesian multiple treatment network meta-analysis (NMA) with random-effects model was conducted. Results A total of 62 RCTs with 6806 patients and four kinds of treatments (real acupuncture (RA), non-acupuncture (NA), penetrative SA (PSA) and non-penetrative SA (NPSA)) were included. The results indicated that both NPSA and PSA were not superior to NA in improving chronic pain (NPSA: MD -4.77 [95% CI, -11.09 to 1.52]; PSA: MD, -4.96 [95% CI, -10.38 to 0.48]). After combining NPSA and PSA into the SA group, the weak trend of pain relief from SA was still not statistically significant (MD, -4.91 [95% CI, -9.93 to 0.05]). NPSA and PSA had similar effects (MD, 0.18 [95% CI, -5.45 to 5.81]). RA was significantly associated with pain relief, compared with NPSA and PSA (NPSA: MD, -12.03 [95% CI, -16.62 to -7.41]; PSA: MD, -11.85 [95% CI, -15.48 to -8.23]). The results were generally consistent regardless of pain phenotype, frequency, duration, acupuncture methods, analgesic intake, or detection bias. Conclusion These results suggested that acupuncture was significantly associated with reduced chronic pain. The two kinds of placebo acupuncture, NPSA and PSA, have similar effects. Both NPSA and PSA, with a weak but not significant effect, are appropriate to be inert placebo controls in RCTs for chronic pain.

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Section: Introductionmentioning

confidence: 99%

Retracted: Effect of Sham Acupuncture on Chronic Pain: A Bayesian Network Meta-Analysis

Zhu

Chen

et al. 2022

Pain Medicine

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“…In the early 21st century there was an explosion of deaths in the US population caused by opioid abuse which is termed "The Opioid Crisis" [16,17]. Since then, there has been an increased interest in the scienti c community regarding the various implications of these drugs, especially in oncology.…”

Section: Introductionmentioning

confidence: 99%

Intraoperative opioids and disease-free survival in glioblastoma multiforme

Naufal,

Izadora,

Reyes

et al. 2023

Preprint

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Introduction: Glioblastoma multiforme (GBM) is a primary tumor of the Central Nervous System (CNS). It is one of the most aggressive tumors that can affect humans, with no cure so far and an extremely inverse prognosis, with an average survival ranging from 7 to 15 months. Recently, the role of opioids, either in stopping or stimulating tumor progression, has been demonstrated for both sides. The main objective of this study was to investigate the influence of intraoperative opioid use on the overall and disease-free survival of these patients. Methods: This observational and retrospective study analyzed the medical records of 133 patients who underwent 167 surgical procedures for resection of Glioblastoma Multiforme. Inclusion and exclusion criteria were as follows: patients older than 18 years of age, of both sexes, and who had confirmed GBM. Patients who died in the postoperative period from causes unrelated to the underlying disease were excluded, as were those who did not have specific data on the medications used in the perioperative period in their records. The following outcomes were analyzed: age, preoperative and postoperative Karnofsky scale (KPS), duration of the surgical procedure, opioid doses, overall survival, disease-free survival, sex, and race. To verify the existence of a correlation between quantitative variables, the Spearman Test was applied; for categorical (qualitative) variables, the Chi-square Test was used. The Kruskal–Wallis test was used to evaluate the variance in means between groups. In addition, the log-rank test was used to evaluate survival between the groups. The significance level adopted for all tests was 5% (p≤0.05). Results: Analysis of the correlation between total opioid dosage and the investigated variables showed that surgical duration and age at surgery were significantly correlated with total opioid dosage. There was no correlation between total opioid dosage and the overall and disease-free survival times of patients. Conclusion: This study suggests that there is no relationship between the intraoperative opioid dose and overall and disease-free survival in patients undergoing surgical treatment for Glioblastoma Multiforme.

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“…Worldwide, hospital admissions related to opioid use have increased in past years 14. In the USA, more than 4% of the adult population currently misuse prescription opioids, and the number of opioid-related deaths per year increased sixfold between 1999 and 2017 15 16. While this ‘opioid crisis’, as it is often called in the USA, is not comparable with the increase in opioid misuse in Europe, opioid prescription rates are nonetheless increasing and opioid-related hospitalisations and deaths are concerning 17–20.…”

Section: Introductionmentioning

confidence: 99%

General practitioners’ attitudes towards opioids for non-cancer pain: a qualitative systematic review

et al. 2022

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ObjectivesWorldwide the use of opioids, both doctor-prescribed and illicit, has increased. In most countries, opioids are first prescribed by general practitioners (GPs). Identifying factors that influence GPs’ opioid prescription decision-making may help reduce opioid misuse and overuse. We performed a systematic review to gain insight into GP attitudes towards opioid prescription and to identify possible solutions to promote changes in the field of primary care.Design and settingSystematic review of qualitative studies reporting GPs’ attitudes towards opioid use in non-cancer pain management.MethodsWe searched Embase, Medline, Web of Science Core Collection, Cochrane, PsychInfo, Cumulative Index to Nursing & Allied Health Literature (CINAHL) and Google Scholar. Two independent reviewers selected studies based on prespecified eligibility criteria. Study quality was evaluated with the Critical Appraisal Skills Programme checklist, and their results were analysed using thematic analysis. Quality of evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation—Confidence in the Evidence from Reviews of Qualitative research approach.ResultsWe included 14 studies. Four themes were established using thematic analyses: (1) GPs caught in the middle of ‘the opioid crisis’; (2) Are opioids always bad? (3) GPs’ weighing scale, taking patient-related and therapeutic relationship-related factors into account; and (4) GPs’ sense of powerlessness—lack of alternatives, support by specialists and lack of time in justifying non-prescriptions.ConclusionGP attitudes towards opioid prescribing for non-cancer pain are subject to several GP-related, patient-related and therapeutic relationship-related factors. Raising GP and patient awareness on the inefficacy of opioids in chronic non-cancer pain management and providing non-opioid alternatives to treat chronic pain might help to promote opioid reduction in primary care. More research is needed to develop practical guidelines on appropriate opioid prescribing, tapering off opioid use and adopting effective communication strategies.PROSPERO registration numberCRD42020194561.Cite Now

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The opioid crisis in the USA

Cited by 5 publications

References 5 publications

Retracted: Effect of Sham Acupuncture on Chronic Pain: A Bayesian Network Meta-Analysis

Retracted: Effect of Sham Acupuncture on Chronic Pain: A Bayesian Network Meta-Analysis

Intraoperative opioids and disease-free survival in glioblastoma multiforme

General practitioners’ attitudes towards opioids for non-cancer pain: a qualitative systematic review

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