Associations of clinical personnel characteristics and controlled substance prescribing practices.

CONTEXT: Over 68,000 deaths were attributed to opioid-related overdose in 2020. Evaluative studies have shown that states that utilized Prescription Drug Monitoring Program (PDMP) systems have decreased opioid-related deaths. With the growing use of PDMPs and an ongoing opioid epidemic, determining the demographics of physicians at risk of overprescribing can elucidate prescribing practices and inform recommendations to change prescribing behaviors. OBJECTIVES: This study aims to assess prescribing behaviors by physicians in 2021 based on four demographics utilizing the National Electronic Health Record System (NEHRS): physician's age, sex, specialty, and degree (MD or Doctor of Osteopathic Medicine [DO]). METHODS: We performed a cross-sectional study of the 2021 NEHRS to determine the relationship between physician characteristics and PDMP use on opioid-prescribing behaviors. Differences between groups were measured via design-based chi-square tests. We constructed multivariable logistic regression models to assess the relationships, via adjusted odds ratios (AOR), between physician characteristics and alternate prescribing patterns. RESULTS: Compared to female physicians, male physicians were more likely to alter their original prescription to reduce morphine milligram equivalents (MMWs) prescribed for a patient (AOR: 1.60; CI: 1.06-2.39; p=0.02), to change to a nonopioid/nonpharmacologic option (AOR: 1.91; 95 % CI: 1.28-2.86; p=0.002), to prescribe naloxone (AOR=2.06; p=0.039), or to refer for additional treatment (AOR=2.07; CI: 1.36-3.16; p<0.001). Compared to younger physicians, those over the age of 50 were less likely to change their prescription to a nonopioid/nonpharmacologic option (AOR=0.63; CI: 0.44-0.90; p=0.01) or prescribe naloxone (AOR=0.56, CI: 0.33-0.92; p=0.02). CONCLUSIONS: Our results showed a statistically significant difference between specialty category and frequency of prescribing controlled substances. After checking the PDMP, male physicians were more likely to alter their original prescription to include harm-reduction strategies. Optimizing the use of PDMP systems may serve to improve prescribing among US physicians.

Impact assessment of energy utilization in agriculture for India and Pakistan.

Sustainable food production is a key concern across countries in South Asia. Most assessments of sustainable agriculture in this region focus on the availability and affordability of resource inputs. However, studies accounting for environmental footprint of agricultural activities in South Asian countries are limited in the existing literature. This paper analyzed the environmental impact of energy utilization in agriculture in India and Pakistan. More specifically, the study analyzes the trends of fuel and electricity consumption for crop production in these countries during a ten-year period between the years 2002 and 2011. Life cycle impact assessment categories including global warming potential, human toxicity, acidification and eutrophication were used to holistically analyze the end-user impact of energy consumption. Results indicated an increase in these impacts for both countries during the study period. On a per hectare basis, the assessed impacts were relatively greater in India than in Pakistan during the study period. The main reason behind larger impacts in India was its significantly greater use of coal for electricity generation. Overall, this study showed that further electrification of agriculture will not necessarily lead to cleaner environment in these countries. Due to high population growth rates, energy consumption for agriculture is expected to grow in these countries in the future. Unless cleaner sources of electricity are used, further energy intensification in agriculture will be detrimental to ecosystem and human health, which in turn will be counterproductive for sustainable agriculture.