New Opioid Analgesic Approvals and Outpatient Utilization of Opioid Analgesics in the United States, 1997 through 2015.

BACKGROUND: The opioid epidemic, driven in part by increased prescribing, is a public health emergency. This study examines dispensed prescription patterns and approvals of new opioid analgesic products to investigate whether the introduction of these new drugs increases prescribing. METHODS: Prescribing patterns based on dispensed prescription claims from the U.S. retail setting were assessed with new brand and generic opioid analgesic products approved in the United States from 1997 through 2015. RESULTS: From 1997 through 2015, the U.S. Food and Drug Administration (Silver Spring, Maryland) approved 263 opioid analgesic products, including 33 brand products. Dispensed prescriptions initially increased 80% from 145 million prescriptions in 1997 to a peak of 260 million prescriptions in 2012 before decreasing by 12% to 228 million prescriptions in 2015. Morphine milligram equivalents dispensed per prescription increased from 486 in 1997 to a peak of 950 in 2010, before decreasing to 905 in 2015. In 2015, generic products accounted for 96% (218/228 million prescriptions) of all opioid analgesic prescriptions dispensed. The remaining prescriptions were dispensed for brand products, of which nearly half were dispensed for one brand product (OxyContin, Purdue, USA). CONCLUSIONS: There has been a dramatic increase in prescriptions dispensed for opioid analgesics since 1997 and an increasing number of opioid analgesic approvals; however, the number of prescriptions dispensed has declined since 2012 despite an increasing number of approvals. Examination of dispensed prescriptions shows a shifting and complex market where multiple factors likely influence prescribing; the approval of new products alone may not be sufficient to be a primary driver of increased prescribing. VISUAL ABSTRACT: An online visual overview is available for this article at http://links.lww.com/ALN/B705.

Reliability of a Squat Movement Competency Screen in Individuals With a Previous Knee Injury.

CONTEXT: Movement screens are a common method of assessing movement efficiency either against a specific criterion of segments/joint(s) motion (segmental method) or a summary label of general quality of the whole movement (overall method). While not as commonly utilized within clinical practice as the segmental method, the overall method is less time consuming to perform and more reliable. OBJECTIVES: The aim of this study was to assess the reliability of the "overall" method approach during a squat in individuals with a previous knee joint injury. DESIGN: Cross-sectional, clinical measurement. PARTICIPANTS: Two-dimensional video recordings of 5 squat trials were recorded for 16 participants with a history of a major knee joint injury(s) and were visually rated by 3 novice and 3 expert raters. MAIN OUTCOME MEASURES: Weighted quadratic Kappa was used to determine the intra- and inter-rater reliability of the squat movement competency screen. RESULTS: Good inter-rater reliability for the expert and novice groups was observed. Intra-rater reliability was very good between analysis sessions for 1 expert rater. CONCLUSIONS: The overall method is a reliable method that enables allied health professionals of different levels of clinical experience to utilize a framework to assess movement quality during a squat in patients with a previous knee joint injury.