Prevalence, Distribution, and Characteristics Associated With Possession of Buprenorphine Waivers Among Infectious Diseases Physicians in the United States.

BACKGROUND: Persons with opioid use disorder (OUD) may present with infectious complications from injection drug use; thus, infectious diseases (ID) physicians are uniquely positioned to treat OUD. Buprenorphine is safe and effective for OUD but remains underutilized. The prevalence and geographic distribution of ID physicians who are waivered to prescribe buprenorphine are unknown. METHODS: This cross-sectional study merged data from several publicly available datasets from 1 November 2021 to 15 January 2022. Our primary outcome was the proportion of ID physicians possessing buprenorphine waivers in the United States. We identified individual- and county-level characteristics associated with buprenorphine waiver possession. We then used geospatial analysis to determine the geographic distribution of waivered ID physicians. RESULTS: We identified 6372 ID physicians in the United States, among whom 170 (2.7%) possessed waivers. Most ID physicians (97.3%) practiced in metropolitan counties. In our multivariable analysis, ID physicians had lower odds of having a waiver for every 10-year increase since graduating medical school (OR: .79; 95% CI: .68-.91). ID physicians practicing in counties with a higher proportion of uninsured residents had lower odds of having a waiver (OR: .75; 95% CI: .62-.90). Among counties with ≥1 ID physician (n = 729), only 11.2% had ≥1 waivered ID physician. CONCLUSIONS: We found an extremely low prevalence and skewed geographic distribution of ID physicians with buprenorphine waivers. Our findings suggest an urgent need to increase the workforce of ID physicians waivered to prescribe buprenorphine and a call for increased integration of OUD education into ID training and continuing medical education.

Benefit of N-Acetylcysteine in Postoperative Hepatic Dysfunction: Case Report and Review of Literature.

N-Acetylcysteine (NAC) is reported to have multiple clinical applications in addition to being the specific antidote for acetaminophen toxicity. NAC stimulates glutathione biosynthesis, promotes detoxification, and acts directly as a scavenger of free radicals. It is a powerful antioxidant and a potential treatment option for diseases characterized by the generation of free oxygen radicals. We present a case of postoperative hepatic dysfunction of multifactorial etiology in a patient with therapeutic acetaminophen levels, where hepatic function improved considerably following administration of intravenous NAC. This case suggests that NAC should be considered for treatment of acute liver dysfunction in the postoperative setting, even in the absence of elevated acetaminophen levels.

Themes and gaps in research for opioid use and misuse pertinent to orthopaedic injury patients.

INTRODUCTION: Prescription opioid use and misuse has accelerated rapidly in the United States over the past 2 decades. Orthopaedic surgeons are the third highest prescribers of opioids, and thus are contributing to this problem at a significant rate. Despite a surge in the number of publications on this issue, there has been little emphasis in the literature on disentangling the various factors contributing to opioid use and misuse among fracture patients. The goal of this study was to describe areas of focus and identify knowledge gaps present in the current literature on this important issue. METHODS: We employed a scoping review technique due to its ability to successfully address a broad research question. In order to better understand the type of information deemed relevant by opioid researchers, we further analyzed our search results by sorting the publications into the following categories: consumer-focused, provider-focused, focus on substitutes, industry-focused, and focus on regulations (at the institution, profession, and government level). RESULTS: The search strategies generated 8760 citations; of these, 1166 publications satisfied our inclusion criteria. Around 607 of these final abstracts were marked as "extremely relevant" (52%) and the other 559 (48%) were marked "relevant." About 36.4% of the total included articles applied to the providers and 19.6% provided information on the consumer. A total of 25.2% of the included papers concerned substitutes for opioids, 15.7% focused on regulatory power in the opioid industry, and 14% considered opioids as an industry, including power of both current stakeholders and potential new entrants. DISCUSSION: The present study provides a thorough summary of existing literature on opioid use and misuse relevant to musculoskeletal trauma patients. Furthermore, the categorical division of the literature provides a unique perspective into the drivers contributing to the opioid epidemic, and may assist in development of effective interventions to reduce excessive opioid use following traumatic injuries. Our review allowed us to identify important aspects of the opioid industry and various drivers of abuse that were absent from the literature including involvement of the pharmaceutical industry on the opioid epidemic, the involvement of insurance companies in opioid distribution, and the use of nonopioid alternative medications such as nonsteroidal anti-inflammatory drugs (NSAIDs).