The unsuspected threat of three opioid-like substitutes

Kim, Sarah

doi:10.1016/j.apnu.2019.01.003

Cited by 9 publications

(4 citation statements)

References 28 publications

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“…Reasons for kratom use vary by age. 7,9 Kratom has been as identified as an opioid substitute, 7,[10][11][12][13][14][15] and such use is supported by patients and advocates. 8,[16][17][18] Several recent surveys identified self-treatment of acute or chronic pain as the primary reason for kratom use.…”

Section: Introductionmentioning

confidence: 99%

Kratom exposures among older adults reported to U.S. poison centers, 2014–2019

Graves

Dilley

Terpak

et al. 2021

J American Geriatrics Society

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Background In recent years, use of the herbal supplement kratom has increased in the United States. The reasons for use include pain relief, particularly as a substitute for opioids. Objectives To describe epidemiologic trends in kratom‐related exposures among older adults reported to U.S. poison centers. Design Retrospective analysis of American Association of Poison Control Center's National Poison Data System (NPDS). Setting Data from all U.S. poison centers from 2014 to 2019 were examined. Participants Kratom exposure cases involving adults aged 18 and older. Kratom cases were identified by product and NPDS generic codes. Non‐human and information‐only calls were excluded. Data were examined for all calls for exposures among adults, with a focus on older adults aged 60–69 years and above 70 years. Measurements Descriptive analyses were used to characterize individual demographic, exposure information, clinical effects, and medical outcomes associated with kratom exposures among older adults. Comparisons across age groups (18–59, 60–69, and 70+ years) were made using Fisher's exact tests. Results Among 3484 kratom‐related exposures reported between 2014 and 2019, 4.6% (n = 162) were among adults over 60 years. The number of kratom‐related exposures increased over time. Most cases originated with calls from healthcare facilities (81.1%) and involved kratom as a single ingestant (63.0%). The reason for most ingestions was intentional (74.5%). One in five exposures among adults aged 70 and older involved an adverse reaction (e.g., drug interaction; 21.9%), compared with 12.3% among ages 60–69 and 9.6% among ages 18–59 years. Neurological and cardiovascular clinical effects were observed. Twenty‐three deaths were observed among older adults. Conclusion Healthcare providers and older adult patients should be aware of the potential risks of kratom use, including medication interactions and falls. When reviewing medication lists, providers should query this population for all medications and substances being used, especially in people being treated for pain.

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Section: Introductionmentioning

confidence: 99%

Kratom exposures among older adults reported to U.S. poison centers, 2014–2019

Graves

Dilley

Terpak

et al. 2021

J American Geriatrics Society

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“…25,26 Attempts to reduce opioid abuse by shifting prescribing toward different drugs for pain management have the potential of unintentionally creating new avenues of abuse. 27,28 The off-label use of these medications to manage surgical pain should be carefully balanced against known harm, and more research is needed to understand the efficacy and safety of preoperative gabapentinoid use. E…”

Section: Discussionmentioning

confidence: 99%

Day-of-Surgery Gabapentinoids and Prolonged Opioid Use: A Retrospective Cohort Study of Medicare Patients Using Electronic Health Records

Young

Dasgupta

Chidgey

et al. 2021

Anesthesia &Amp; Analgesia

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Background: While preoperative gabapentinoids are commonly used in surgical multimodal analgesia protocols, little is known regarding the effects this therapy has on prolonged postsurgical opioid use. In this observational study, we used data from a large integrated health care system to estimate the association between preoperative day-of-surgery gabapentinoids and the risk of prolonged postsurgical opioid use. Methods:We identified adults age ≥65 years undergoing major therapeutic surgical procedures from a large integrated health care system from 2016 to 2019. Exposure to preoperative gabapentinoids on the day of surgery was measured using inpatient medication administration records, and the outcome of prolonged opioid use was measured using outpatient medication orders. We used stabilized inverse probability of treatment-weighted log-binomial regression to estimate risk ratios and 95% confidence intervals (CIs) of prolonged opioid use, comparing patients who received preoperative gabapentinoids to those who did not and adjusting for relevant clinical factors. The main analysis was conducted in the overall surgical population, and a secondary analysis was conducted among procedures where at least 30% of all patients received a preoperative gabapentinoid.Results: Overall, 13,958 surgical patients met inclusion criteria, of whom 21.0% received preoperative gabapentinoids. The observed 90-day risk of prolonged opioid use following surgery was 0.91% (95% CI, 0.77-1.08). Preoperative gabapentinoid administration was not associated with a reduced risk of prolonged opioid use in the main analysis conducted in a broad surgical population (adjusted risk ratio [adjRR], 1.19 [95% CI, 0.67-2.12]) or in the secondary analysis conducted in patients undergoing colorectal resection, hip arthroplasty, knee arthroplasty, or hysterectomy (adjRR, 1.01 [95% CI, 0.30- 3.33]). Conclusions:In a large integrated health system, we did not find evidence that preoperative gabapentinoids were associated with reduced risk of prolonged opioid use in patients undergoing a broad range of surgeries.

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“…There are other medications with misuse potential that are not listed on the U.S. Drug Enforcement Administration's scheduling classes and may not be widely known for their abuse potential. For example, gabapentinoids, antihypertensives such as clonidine, and antipsychotics have shown potential for misuse and diversion (Bogart, 2011;Buttram et al, 2019;Kim, 2019;Wood, 2015).…”

Section: Misused Medicationsmentioning

confidence: 99%

“…The American Nurses Association issued a statement on abuse of prescription medications and encouraged comprehensive pharmacological education on the misuse and addictive potential of prescription medications in 1991 (American Nurses Association, 1991). The misuse of amphetamines, barbiturates, benzodiazepines, gabapentinoids, hypnotics, opioids, second-generation antipsychotics, stimulants, and over-the-counter medications has continued to produce worse health outcomes (Bogart, 2011;Buttram et al, 2019;Kim, 2019). Cycles of misuse and addiction intersect with the domains of public health and health care services, often with dire consequences.…”

Section: Introductionmentioning

confidence: 99%

Empowering Nurses: Communicating Potential Medication Misuse

Carlson

Potter

2021

J Am Psychiatr Nurses Assoc

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BACKGROUND In nursing education and practice, we prepare nurses on topics such as patient care, pathophysiology, pharmacology, nursing leadership, and nursing competencies. Unfortunately, we may be missing the mark when it comes to integrating these topics and applying them to situations that arise in health care such as medication misuse. Nurses work intimately with patients and can recognize potential medication misuse by reviewing medication regimens and assessing necessity of PRN patient requests. In cases where nurses suspect misuse, they may or may not feel comfortable addressing these concerns with other members of the health care team. AIMS Study aims were to assess the baseline of whether nurses are comfortable with their level of skill to recognize potential patient medication misuse and to assess nurses’ comfortability with communicating these concerns with other nurses, providers, and patients. METHODS This survey study was designed to obtain practical information about nurses understanding of misused and diverted prescription medications and level of comfort with expressing concerns about the use of central nervous system depressants to inform education, practice, and research. Three-hundred and fifty nurses at one hospital were invited to participate in an anonymous REDCap survey. RESULTS Thirty-five percent of the surveyed nurses returned the survey. Responding nurses were more comfortable sharing their own knowledge and the need for more education on the topic than they were discussing interdisciplinary communication. CONCLUSIONS Empowering nurses to communicate this knowledge with others on the health care team has major public health implications to reduce the negative outcomes of misused medications.

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The unsuspected threat of three opioid-like substitutes

Cited by 9 publications

References 28 publications

Kratom exposures among older adults reported to U.S. poison centers, 2014–2019

Kratom exposures among older adults reported to U.S. poison centers, 2014–2019

Day-of-Surgery Gabapentinoids and Prolonged Opioid Use: A Retrospective Cohort Study of Medicare Patients Using Electronic Health Records

Empowering Nurses: Communicating Potential Medication Misuse

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