Comparison of the Centers for Disease Control (CDC) recommendations and the risk index for overdose or serious opioid-induced respiratory depression (RIOSORD) tool for guiding naloxone coprescribing.

PURPOSE: Patients treated with ongoing opioid therapy may be at an increased risk of respiratory depression or death, which may be mitigated through prompt administration of naloxone. The Centers for Disease Control (CDC) guidelines for prescribing opioids in primary care settings recommend patients treated with ongoing opioid analgesic therapy be offered a coprescription of naloxone based on total oral morphine milligram equivalents per day or concurrent benzodiazepine therapy. Opioid overdose risk is dose-dependent, yet other patient-specific factors contribute to this risk. The risk index for overdose or serious opioid-induced respiratory depression (RIOSORD) incorporates additional risk factors to assess the risk of overdose or clinically relevant respiratory depression. OBJECTIVES: This study compared the frequency of meeting CDC, Veterans' Health Administration (VA) RIOSORD, or civilian RIOSORD criteria for naloxone coprescribing. METHODS: A retrospective chart review of 42 Federally Qualified Health Centers in Illinois was conducted for all CII-CIV opioid analgesic prescriptions. Ongoing opioid therapy was defined as patients who received seven or more CII-CIV opioid analgesic prescriptions during the 1-year study period. Patients aged 18-89, receiving opioids for nonmalignant pain, and meeting the criteria of ongoing opioid therapy were included in the analysis. RESULTS: A total of 41,777 controlled substance analgesic prescriptions were prescribed during the study period. Data from 651 individual patient charts were evaluated. Of those, 606 patients met inclusion criteria. From these data, 57.9 percent of patients (N = 351) met civilian RIOSORD criteria, 36.5 percent (N = 221) met VA RIOSORD criteria, and 22.8 percent (N = 138) met CDC guideline recommendations for naloxone coprescribing. The percentage of patients who met RIOSORD criteria compared to CDC criteria was significantly higher (p < 0.001). Of all patients meeting ongoing opioid therapy criteria, only seven had been coprescribed naloxone. CONCLUSION: Coprescribing of naloxone is significantly underutilized in patients treated with opioid therapy for nonmalignant chronic pain and should not solely be based on total oral morphine milligram equivalents per day or concurrent benzodiazepine therapy. As risk assessment improves, consideration of other risk-conferring variables, such as gabapentinoids, skeletal muscle relaxants, and sleep hypnotics, should be considered.

Assessment of the impact of an opioid-specific education series on rates of medication-assisted treatment for opioid use disorder in veterans.

PURPOSE: The impact of a focused inpatient educational intervention on rates of medication-assisted therapy (MAT) for veterans with opioid use disorder (OUD) was evaluated. METHODS: A retrospective cohort analysis compared rates of MAT, along with rates of OUD-related emergency department (ED) visits and/or hospital admission within 1 year, between veterans with a diagnosis of OUD who completed inpatient rehabilitation prior to implementation of a series of group sessions designed to engage intrinsic motivation to change behavior surrounding opioid abuse and provide education about MAT (the control group) and those who completed rehabilitation after implementation of the education program (the intervention group). A post hoc, multivariate analysis was performed to evaluate possible predictors of MAT use and ED and/or hospital readmission, including completion of the opioid series, gender, age (>45 years), race, and specific prior substance(s) of abuse. RESULTS: One hundred fifty-eight patients were included: 95 in the control group and 63 in the intervention group. Rates of MAT were 25% (24 of 95 veterans) and 75% (47 of 63 veterans) in control and intervention groups, respectively (P < 0.01). Gender, completion of the opioid series, prior heroin use, and marijuana use met prespecified significance criteria for inclusion in multivariate regression modeling of association with MAT utilization, with participation in the opioid series (odds ratio [OR], 9.56; 95% confidence interval [CI], 4.36-20.96) and prior heroin use (OR, 3.26; 95% CI, 1.18-9.01) found to be significant predictors of MAT utilization on multivariate analysis. Opioid series participation and MAT use were independently associated with decreased rates of OUD-related ED visits and/or hospital admission (hazard ratios of 0.16 [95% CI, 0.06-0.44] and 0.32 [95% CI, 0.14-0.77], respectively) within 1 year after rehabilitation completion. CONCLUSION: Focused OUD-related education in a substance abuse program for veterans with OUD increased rates of MAT and was associated with a decrease in OUD-related ED visits and/or hospital admission within 1 year.

Motives for drinking alcohol and eating palatable foods: An evaluation of shared mechanisms and associations with drinking and binge eating.

BACKGROUND: Young adulthood is a high-risk period for heavy drinking and binge eating, both of which can impact weight and lead to obesity. Examining motives for drinking alcohol and eating palatable foods may facilitate a more integrated understanding of these behaviors during the college years. The current study tested whether shared or distinct (i.e., behavior-specific) motivational mechanisms may explain the occurrence of reward-driven drinking and eating in young adults. METHODS: A sample of college freshmen (N = 103) stratified by sex, race/ethnicity, and heavy drinking status were selected to participate. Participants completed questionnaires measuring alcohol use, eating behavior, and motives assessed by the Drinking Motives Questionnaire-Revised and Palatable Eating Motives Scale. Confirmatory factor analysis (CFA) tested whether drinking and eating motives were better represented as single latent motives, or two behavior-specific motives. Structural equation modeling (SEM) was used to test the association between motivational factors and behaviors. RESULTS: Behavior-specific CFA models demonstrated stronger model fit and higher factor loadings than single motive models. SEM models indicated that eating to cope with negative emotions, to enhance positive experiences, to obtain social reinforcement, and to conform with peers were significantly associated with binge eating (p values < .001). Enhancement and social drinking motives were significantly associated with number of weekly drinks (p values < .001). CONCLUSIONS: While motives for drinking alcohol and eating palatable foods may satisfy common goals, findings suggest motivational mechanisms may be behavior-specific. Enhancement and social motives may be important factors to target in prevention programs for both drinking and binge eating.

Moderate Physical Activity is Associated with Cerebral Glucose Metabolism in Adults at Risk for Alzheimer's Disease.

The objective of this study was to investigate the relationship between accelerometer-measured physical activity (PA) and glucose metabolism in asymptomatic late-middle-aged adults. Ninety-three cognitively healthy late-middle-aged adults from the Wisconsin Registry for Alzheimer's Prevention participated in this cross-sectional study. They underwent 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) imaging and wore an accelerometer (ActiGraph GT3X+) to measure free-living PA. Accelerometer data yielded measures of light (LPA), moderate (MPA), and vigorous (VPA) intensity PA. FDG-PET images were scaled to the cerebellum and pons, and cerebral glucose metabolic rate was extracted from specific regions of interest (ROIs) known to be hypometabolic in AD, i.e., hippocampus, posterior cingulate, inferior temporal cortex, and angular gyrus. Regression analyses were utilized to examine the association between PA and glucose metabolism, while adjusting for potential confounds. There were associations between MPA and glucose metabolism in all ROIs examined. In contrast, LPA was not associated with glucose uptake in any ROI and VPA was only associated with hippocampal FDG uptake. Secondary analyses did not reveal associations between sedentary time and glucose metabolism in any of the ROIs. Exploratory voxel-wise analysis identified additional regions where MPA was significantly associated with glucose metabolism including the precuneus, supramarginal gyrus, amygdala, and middle frontal gyrus. These findings suggest that the intensity of PA is an important contributor to neuronal function in a late-middle-aged cohort, with MPA being the most salient. Prospective studies are necessary for fully elucidating the link between midlife engagement in PA and later life development of AD.

Epidemiologic study of the C-3 epimer of 25-hydroxyvitamin D(3) in a population-based sample.

BACKGROUND & AIMS: Vitamin D is associated with many health outcomes and the blood concentration of 25-hydroxyvitamin D [25(OH)D] is commonly measured in clinical practice. A C-3 epimer of this compound, 3-epi-25(OH)D3, has recently been detected in blood samples. Few clinical assays currently detect this epimer and its physiological function is unknown, as are the demographic, behavioral, and physiologic factors that may be correlated with it. We sought to determine the correlation between these factors and 3-epi-25(OH)D3. METHODS: We conducted a cross-sectional population-based study of 303 non-Hispanic white participants in the Survey of the Health of Wisconsin. Serum 25(OH)D2, 25(OH)D3 and 3-epi-25(OH)D3 were measured by high-performance liquid chromatography tandem mass spectrometry. We measured vitamin D intake from foods and supplements via a food frequency questionnaire, sun exposure by spectrophotometry, waist circumference during a physical exam, and additional demographic and behavioral factors by questionnaire. We calculated the percent of 3-epi-25(OH)D3 out of the total 25(OH)D3. RESULTS: Summer season (P = 0.009), higher alcohol intake (P = 0.007), and higher vitamin D intake from supplements (P = 0.0004), but not food (P = 0.20), were significantly associated with a higher percent of 3-epi-25(OH)D3 relative to the total 25(OH)D3, although these associations appear to be partially driven by individuals with low 3-epi-25(OH)D3. Moreover, the percent of 3-epi-25(OH)D3 was significantly correlated with the total 25(OH)D3 (r = 0.37, P < 0.0001). CONCLUSIONS: We report findings from an epidemiologic study of 3-epi-25(OH)D3 and show that individuals with lower total 25(OH)D3 tend to have a lower percent of 3-epi-25(OH)D3 relative to the total. While this is the largest reported sample of adults with measured 3-epi-25(OH)D3, the sample size of 303 is relatively small and replication of our findings is necessary.