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1.
PLoS One ; 16(4): e0249453, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33793663

RESUMO

Patient access and adherence to chronic medications is critical. In this work, we evaluate whether disruptions related to Covid-19 have affected new and existing patients' access to pharmacological therapies without interruption. We do so by performing a retrospective analysis on a dataset of 9.4 billion US prescription drug claims from 252 million patients from May, 2019 through August, 2020 (about 93% of prescriptions dispensed within those months). Using fixed effect (conditional likelihood) linear models, we evaluate continuity of care, how many days of supply patients received, and the likelihood of discontinuing therapy for drugs from classes with significant population health impacts. Findings indicate that more prescriptions were filled in March 2020 than in any prior month, followed by a significant drop in monthly dispensing. Compared to the pre-Covid era, a patient's likelihood of discontinuing some medications increased after the spread of Covid: norgestrel-ethinyl estradiol (hormonal contraceptive) discontinuation increased 0.62% (95% CI: 0.59% to 0.65%, p<0.001); dexmethylphenidate HCL (ADHD stimulant treatment) discontinuation increased 2.84% (95% CI: 2.79% to 2.89%, p<0.001); escitalopram oxalate (SSRI antidepressant) discontinuation increased 0.57% (95% CI: 0.561% to 0.578%, p<0.001); and haloperidol (antipsychotic) discontinuation increased 1.49% (95% CI: 1.41% to 1.57%, p<0.001). In contrast, the likelihood of discontinuing tacrolimus (immunosuppressant) decreased 0.15% (95% CI: 0.12% to 0.19%, p<0.001). The likelihood of discontinuing buprenorphine/naloxone (opioid addiction therapy) decreased 0.59% (95% CI: 0.55% to 0.62% decrease, p<0.001). We also observe a notable decline in new patients accessing these latter two therapies. Most US patients were able to access chronic medications during the early months of Covid-19, but still were more likely to discontinue their therapies than in previous months. Further, fewer than normal new patients started taking medications that may be vital to their care. Providers would do well to inquire about adherence and provide prompt, nonjudgmental, re-initiation of medications. From a policy perspective, opioid management programs seem to demonstrate a robust ability to manage existing patients in spite of disruption.


Assuntos
/epidemiologia , Prescrições de Medicamentos/estatística & dados numéricos , Seguro de Serviços Farmacêuticos/estatística & dados numéricos , Adesão à Medicação/estatística & dados numéricos , Pandemias , Analgésicos Opioides/provisão & distribução , Antidepressivos/provisão & distribução , Antipsicóticos/provisão & distribução , Estimulantes do Sistema Nervoso Central/provisão & distribução , Contraceptivos Hormonais/provisão & distribução , Conjuntos de Dados como Assunto , Humanos , Imunossupressores/provisão & distribução , Estudos Retrospectivos , Estados Unidos/epidemiologia
3.
Pan Afr Med J ; 35(Suppl 2): 130, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33193945

RESUMO

The COVID-19 pandemic has strained health care systems beyond capacity resulting in many people not having access to life-sustaining measures even in well-resourced countries. Palliative and end-of-life care are therefore essential to alleviate suffering and ensure a continuum of care for patients unlikely to survive. This is challenging in sub-Saharan Africa where lack of trained teams on basic palliative care and reduced access to opioids limit implementation of palliative and end-of-life care. At the same time, health care providers have to cope with local cultural conceptions of death and absence of advance care directives.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Cuidados Paliativos/organização & administração , Pandemias , Pneumonia Viral/terapia , Assistência Terminal/organização & administração , Diretivas Antecipadas , África ao Sul do Saara/epidemiologia , Analgésicos Opioides/provisão & distribução , Analgésicos Opioides/uso terapêutico , Atitude Frente a Morte , Barreiras de Comunicação , Continuidade da Assistência ao Paciente , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Cultura , Acesso aos Serviços de Saúde , Humanos , Cuidados Paliativos/psicologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , Relações Profissional-Paciente , Insuficiência Respiratória/tratamento farmacológico , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/mortalidade , Estigma Social , Assistência Terminal/psicologia
4.
J Subst Abuse Treat ; 119: 108153, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33032862

RESUMO

The global coronavirus disease 2019 (COVID-19) will exacerbate the negative health outcomes associated with the concurrent opioid overdose crisis in North America. COVID-19 brings unique challenges for practitioners who provide opioid use disorder (OUD) care. The majority of overdose deaths in the Canadian province of British Columbia occur in housing environments. Some supportive housing environments in Vancouver, British Columbia, have on-site primary care and substance use disorder treatment clinics. Some of these housing environments also include supervised consumption services. These housing environments needed to make adjustments to their care to adhere to COVID-19 physical distancing measures. Such adjustments included a pandemic withdrawal management program to provide patients with a pharmaceutical grade alternative to the toxic illicit drug supply, which allow patients to avoid the heightened overdose risk while using illicit drugs alone or potentially exposing themselves to COVID-19 while using drugs in a group setting. Other modifications to the OUD care continuum included modified supervised injection spaces to adhere to physical distancing, the use of personal protective equipment for overdose response, virtual platforms for clinical encounters, writing longer prescriptions, and providing take-home doses to promote opioid agonist treatment retention. These strategies aim to mitigate indoor overdose risk while also addressing COVID-19 risks.


Assuntos
Analgésicos Opioides/envenenamento , Infecções por Coronavirus/prevenção & controle , Overdose de Drogas/prevenção & controle , Transtornos Relacionados ao Uso de Opioides/reabilitação , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Analgésicos Opioides/provisão & distribução , Colúmbia Britânica , Overdose de Drogas/epidemiologia , Habitação , Humanos , Drogas Ilícitas/envenenamento , Drogas Ilícitas/provisão & distribução , Programas de Troca de Agulhas , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Equipamento de Proteção Individual , Risco , Centros de Tratamento de Abuso de Substâncias/estatística & dados numéricos
5.
PLoS One ; 15(6): e0234199, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32497141

RESUMO

INTRODUCTION: To mitigate the recent nationwide shortage of intravenous opioids, we developed a standardized perioperative oral opioid guideline anchored with appropriate use of nonopioid analgesia, neuraxial and loco-regional techniques. We hypothesize that adoption of this new guideline was associated with: 1) equivalent patient reported pain scores in the post-anesthesia care unit (PACU); and 2) equivalent total opioid use (oral and parenteral) during the perioperative period. METHODS: Cases performed from July 1, 2017 to May 31, 2019 were screened. All opioids administered were converted to intravenous morphine milligram equivalents. Segmented regression analyses of interrupted time series were performed examining the change in opioid use, PACU pain scores and number of non-opioid analgesic medications used before and after the protocol implementation in April 2018. RESULTS: After exclusions, 29, 621 cases were included in the analysis. No significant differences in demographic, ASA status, case length and surgical procedure type were present in the pre and post-intervention period. A significant decrease in total (Estimate: -39.9 mg, SE: 6.9 mg, p < 0.001) and parenteral (Estimate: -51.6 mg, SE: 7.1 mg, p < 0.001) opioid use with a significant increase in oral opioid use (Estimate: 9.4 mg, SE: 1.1 mg, p < 0.001) was noted after the intervention. Pain scores were not significantly different between the pre- and post-intervention period (Estimate: 0.05, SE: 0.13, p = 0.69). CONCLUSION: We report our experience with a primary perioperative oral based opioid regimen that is associated with decreased total opioid consumption and equivalent patient reported pain scores.


Assuntos
Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/farmacologia , Análise de Séries Temporais Interrompida , Período Perioperatório , Administração Intravenosa , Administração Oral , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Analgésicos Opioides/provisão & distribução , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Adulto Jovem
6.
JAMA Netw Open ; 3(6): e208974, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32584410

RESUMO

Importance: Prolonged prescribing of opioids after spine surgery is often perceived as a negative outcome, but successful opioid reduction may occur despite continued prescribing. Improved characterization of opioid availability before and after surgery is necessary to identify these successes. Objective: To evaluate the association between spine surgery and modification of opioid availability postoperatively by using consistent definitions to classify opioid availability before and after surgery. Design, Setting, and Participants: This population-based cohort study included 2223 adults (age ≥18 years) who underwent spine surgery in Olmsted County, Minnesota, from January 1, 2005, through December 31, 2016. Data were analyzed from April 1, 2019, to December 1, 2019. Exposures: Preoperative opioid availability based on prescription data in the 180 days before surgery in accordance with Consortium to Study Opioid Risks and Trends (CONSORT) definitions. Main Outcomes and Measures: Successful modification of opioid availability, defined as an improvement in CONSORT status postoperatively (assessed from 181 to 365 days after surgery) compared with preoperative status, or continued absence of opioid availability for patients with no preoperative availability. Multivariable logistic regression was used to assess the association between preoperative opioid availability and successful modification by 1 year after undergoing surgery. Results: Of 2223 patients included in the study, 1214 were male (54.6%), with a median age of 55 years (interquartile range, 43-68) years. Patients were classified as having no (778 [35.0%]), short-term (1118 [50.3%]), episodic (227 [10.2%]), or long-term (100 [4.5%]) preoperative opioid availability. Of the 2148 patients (96.6%) who were alive at 1 year, postoperative opioid availability was classified as no (1583 [73.7%]), short-term (398 [18.5%]), episodic (104 [4.8%]), and long-term (63 [2.9%]). A total of 1672 patients (77.8%) had successful modification of opioid availability, with success of 83.0% for those with no preoperative availability, 74.9% for those with short-term preoperative availability, 79.8% for those with episodic preoperative availability, and 64.4% for those with long-term preoperative opioid availability. In multivariable analysis, success was significantly associated with preoperative opioid availability (odds ratio [OR] for short term, 0.61 [95% CI, 0.48-0.77]; OR for episodic, 0.95 [95% CI, 0.64-1.40]; OR long term, 0.49 [95% CI, 0.30-0.82]; P < .001 overall vs no availability). Conclusions and Relevance: In this study, when following standardized CONSORT definitions, 4 of 5 adults undergoing spine surgery in a population-based cohort met the criteria for a successful pattern of postoperative opioid prescribing. Similar methods to objectively assess changes in opioid prescribing may be clinically useful in other perioperative settings.


Assuntos
Analgésicos Opioides/provisão & distribução , Analgésicos Opioides/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Coluna Vertebral/cirurgia , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Minnesota , Procedimentos Ortopédicos/estatística & dados numéricos , Dor Pós-Operatória/tratamento farmacológico , Cuidados Pós-Operatórios/estatística & dados numéricos , Cuidados Pré-Operatórios/estatística & dados numéricos
7.
Sci Rep ; 10(1): 8463, 2020 05 21.
Artigo em Inglês | MEDLINE | ID: mdl-32439950

RESUMO

The misuse of pharmaceutical opioids is a major public health issue. In Australia, codeine was re-scheduled on 1 February 2018 to restrict access; it is now only available on prescription. The aim of this study was to measure the change in dental opioid prescriptions, one year before and after the codeine re-scheduling in Australia and to assess dental prescribing rates of opioids for 2018 by population and by clinician. Data was extracted for dental opioids for the year immediately prior and after the codeine up-schedule (1 February 2017-31 January 2019) from the publicly-available national prescription database (Pharmaceutical Benefits Scheme). Descriptive statistics, T-tests and odds ratios were used to identify significant prescribing differences. Codeine, codeine/paracetamol, oxycodone and tramadol use increased significantly the year after the codeine restriction than the previous year (13.8-101.1%). Australian dentists prescribed 8.6 prescriptions/1,000 population in 2018, with codeine/paracetamol accounting for most prescriptions (96%). The significant increase in opioid prescribing highlights that Australian dentists may be contributing to the misuse of pharmaceutical opioids. Educational efforts should be targeted at the appropriate use of opioids and patient selection. Dentists should be added to the prescription monitoring system SafeScript so they can make informed decisions for patients who are potentially misusing opioids.


Assuntos
Analgésicos Opioides/provisão & distribução , Codeína/provisão & distribução , Prescrições de Medicamentos/estatística & dados numéricos , Padrões de Prática Odontológica/estatística & dados numéricos , Uso Indevido de Medicamentos sob Prescrição/estatística & dados numéricos , Programas de Monitoramento de Prescrição de Medicamentos/normas , Doenças Dentárias/tratamento farmacológico , Analgésicos Opioides/administração & dosagem , Codeína/administração & dosagem , Humanos
8.
Am J Health Syst Pharm ; 77(Supplement_2): S41-S45, 2020 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-32426835

RESUMO

PURPOSE: To address the intravenous (i.v.) opioid shortage, computer-based alerts and modifications were implemented over 2 phases beginning in August 2017 and February 2018, respectively. A study was conducted to assess the impact of these interventions on dispenses of intermittent doses of i.v. opioids during a national shortage. METHODS: A retrospective, single-center, pre- and postimplementation study was conducted to compare opioid dispenses from September 2017 through December 2017 (phase 1) and March 2018 through May 2018 (phase 2) with dispenses during the same time periods of the previous year (historical control periods). Dispense data for intermittent doses of i.v. fentanyl, hydromorphone, and morphine and select oral opioids were collected from automated dispensing cabinets (ADCs) located in nonprocedural areas. The primary endpoint was the percentage of total intermittent doses of i.v. and oral opioids that were dispensed for i.v. administration. A subanalysis accounting for unit type was conducted. Key secondary endpoints were the numbers of oral and i.v. opioid dispenses by month. RESULTS: The final analysis included data from 92 ADCs. The percentage of i.v. opioid dispenses significantly decreased, by 9.8% during phase 1 (P < 0.0001) and by 16.8% during phase 2 (P < 0.0001) compared to dispenses during the historical control periods. These decreases were significant across all unit types except pediatric units during phase 1. Average monthly dispenses of i.v. opioids were 49.9% and 74.2% fewer than dispenses during the historical control periods after the phase 1 and phase 2 implementations, respectively. CONCLUSION: Order entry alerts and modifications significantly decreased dispenses of intermittent doses of i.v. opioids during a national shortage, with demonstrated sustainability of decreases over 7 months.


Assuntos
Analgésicos Opioides/administração & dosagem , Sistemas de Registro de Ordens Médicas , Padrões de Prática Médica/estatística & dados numéricos , Administração Intravenosa , Administração Oral , Analgésicos Opioides/provisão & distribução , Relação Dose-Resposta a Droga , Fentanila/administração & dosagem , Humanos , Hidromorfona/administração & dosagem , Morfina/administração & dosagem , Estudos Retrospectivos
9.
J Card Surg ; 35(4): 840-844, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32160336

RESUMO

BACKGROUND: The national supply of intravenous pain medications has been restricted since 2018 due to shortages. In late 2017, the ongoing shortages combined with the increased demand for alternative formulations resulted in interruptions in the supply of medications. The cascading effect of interruptions in supply caused hospitals to implement restrictive measures to extend the availability of these medications. This study aims to evaluate differences in pain control in postoperative cardiac patients due to intravenous opioid shortage at a standalone pediatric hospital. METHOD: A retrospective chart review of postoperative patients in the cardiac intensive care unit at Children's National Hospital was conducted from January to September 2017 and 2018. The objective of this study is to determine if a difference in postoperative pain scores in the period before and during the national intravenous opioid shortage exists, analyzed by differences in Face, Legs, Activity, Cry, Consolability (FLACC) scores. RESULTS: No differences were found in mean FLACC scores for the 140 patients who were evaluated. Patients in 2017 reported faster decline of pain symptoms compared with those in 2018. No differences in baseline characteristics or secondary outcomes were noted. CONCLUSION: Pain management was better controlled immediately postoperatively in 2018 compared with 2017, but the pain was better controlled for the duration of the postoperative period in 2017.


Assuntos
Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/provisão & distribução , Hospitais Pediátricos/estatística & dados numéricos , Unidades de Terapia Intensiva Pediátrica , Manejo da Dor , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Cuidados Pós-Operatórios , Estudos Retrospectivos , Fatores de Tempo
10.
Med J Aust ; 212(7): 321-327, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32200566

RESUMO

OBJECTIVE: To investigate changes in sales to pharmacies of over-the-counter (OTC) and prescription analgesics, cold and flu products, and cough suppressants after the rescheduling of codeine as a prescription only medicine in February 2018. DESIGN: Interrupted time series analysis of sales to pharmacies. SETTING: Pharmaceutical sales to community pharmacies in Australia, March 2015 - March 2019. The period January 2017 (month after rescheduling was announced) to January 2018 (month before rescheduling was implemented) was excluded from the time series analysis. MAIN OUTCOME MEASURES: Monthly pack and tablet sales per 10 000 population of OTC and prescription analgesics, cold and flu products, and cough suppressants. RESULTS: During 2016, 7586 packs and 248 127 tablets of OTC codeine per 10 000 population were sold to pharmacies; in the 14 months after rescheduling, a small level increase in monthly prescription codeine sales was evident (2247 tablets/capsules per 10 000 population; 95% CI, 1231-3264 per 10 000 population). Monthly OTC analgesic sales increased by 258 (95% CI, 151-365) packs per 10 000 population and 37 856 (95% CI, 26 143-49 569) tablet/capsules per 10 000 population. Monthly sales of single ingredient paracetamol (41 415 [95% CI, 31 374-51 456] tablets/capsules per 10 000 population), ibuprofen (1392 [95% CI 916-1868] tablets/capsules per 10 000 population), paracetamol/ibuprofen (1618 tablets [95% CI, 1567-1669] tablets/capsules per 10 000 population), and other paracetamol combinations (233 [95% CI, 112-353] tablets/capsules per 10 000 population) all increased, but not those of prescription analgesic products not containing codeine. Rises for OTC cold/flu products containing the opioid derivative dextromethorphan were small; sales of OTC cough suppressants containing opioid derivatives (dextromethorphan, pholcodine, dihydrocodeine) did not change. CONCLUSIONS: The rescheduling of codeine was followed by increased sales to pharmacies of paracetamol, ibuprofen, and paracetamol combination products. While these products carry no risk of dependence, their inappropriate use is also associated with harms that warrant adverse event monitoring.


Assuntos
Analgésicos Opioides/provisão & distribução , Codeína/provisão & distribução , Comércio/estatística & dados numéricos , Serviços Comunitários de Farmácia/organização & administração , Medicamentos sob Prescrição/provisão & distribução , Austrália , Comércio/tendências , Controle de Medicamentos e Entorpecentes/legislação & jurisprudência , Análise de Séries Temporais Interrompida , Medicamentos sem Prescrição/provisão & distribução
11.
JAMA Netw Open ; 3(2): e1920843, 2020 02 05.
Artigo em Inglês | MEDLINE | ID: mdl-32031650

RESUMO

Importance: While many individuals with opioid use disorder seek treatment at residential facilities to initiate long-term recovery, the availability and use of medications for opioid use disorder (MOUDs) in these facilities is unclear. Objective: To examine differences in MOUD availability and use in residential facilities as a function of Medicaid policy, facility-level factors associated with MOUD availability, and admissions-level factors associated with MOUD use. Design, Setting, and Participants: This cross-sectional study used deidentified facility-level and admissions-level data from 2863 residential treatment facilities and 232 414 admissions in the United States in 2017. Facility-level data were extracted from the 2017 National Survey of Substance Abuse Treatment Services, and admissions-level data were extracted from the 2017 Treatment Episode Data Set-Admissions. Statistical analyses were conducted from June to November 2019. Exposures: Admissions for opioid use disorder at residential treatment facilities in the United States that identified opioids as the patient's primary drug of choice. Main Outcomes and Measures: Availability and use of 3 MOUDs (ie, extended-release naltrexone, buprenorphine, and methadone). Results: Of 232 414 admissions, 205 612 (88.5%) contained complete demographic data (166 213 [80.8%] aged 25-54 years; 136 854 [66.6%] men; 151 867 [73.9%] white). Among all admissions, MOUDs were used in only 34 058 of 192 336 (17.7%) in states that expanded Medicaid and 775 of 40 078 (1.9%) in states that did not expand Medicaid (P < .001). A relatively low percentage of the 2863 residential treatment facilities in this study offered extended-release naltrexone (854 [29.8%]), buprenorphine (953 [33.3%]), or methadone (60 [2.1%]). Compared with residential facilities that offered at least 1 MOUD, those that offered no MOUDs had lower odds of also offering psychiatric medications (odds ratio [OR], 0.06; 95% CI, 0.05-0.08; Wald χ21 = 542.09; P < .001), being licensed by a state or hospital authority (OR, 0.39; 95% CI, 0.27-0.57; Wald χ21 = 24.28; P < .001), or being accredited by a health organization (OR, 0.28; 95% CI, 0.23-0.33; Wald χ21 = 180.91; P < .001). Residential facilities that did not offer any MOUDs had higher odds of accepting cash-only payments than those that offered at least 1 MOUD (OR, 4.80; 95% CI, 3.47-6.64; Wald χ21 = 89.65; P < .001). Conclusions and Relevance: In this cross-sectional study of residential addiction treatment facilities in the United States, MOUD availability and use were sparse. Public health and policy efforts to improve access to and use of MOUDs in residential treatment facilities could improve treatment outcomes for individuals with opioid use disorder who are initiating recovery.


Assuntos
Analgésicos Opioides/provisão & distribução , Acesso aos Serviços de Saúde/estatística & dados numéricos , Tratamento de Substituição de Opiáceos/estatística & dados numéricos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Tratamento Domiciliar/estatística & dados numéricos , Centros de Tratamento de Abuso de Substâncias/estatística & dados numéricos , Buprenorfina/provisão & distribução , Estudos Transversais , Humanos , Medicaid , Metadona/provisão & distribução , Naltrexona/provisão & distribução , Estados Unidos
12.
Burns ; 46(1): 90-96, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31859088

RESUMO

BACKGROUND: Determining the amount of analgesics required will help burn centers improve their ability to plan for a burn mass casualty incident (BMCI). We sought to quantify the amount of analgesics needed in an inpatient burn population. We hoped that assessing the analgesic use in daily burn care practice will potentially help estimate opioid needs in a burn mass casualty incident (BMCI). METHODS: We included patients with burns covering equal to or less than 30% total body surface area (TBSA), admitted from spring 2013 to spring 2015. Patient records were reviewed for analgesics and adjuncts, pain scores, age and TBSA. The doses of the different opioids administered were converted into morphine equivalent doses (MED). RESULTS: We enrolled 141 acute burn survivors with a mean TBSA of 8.2±0.6%. The lowest daily average MED per person was 24.6±2.0mg MED, recorded on the day of injury. The daily average MED per person increased until it peaked at 52.5±5.6mg MED at day 8 post-burn. Then, it declined to 24.6±3.4mg MED by day 14. Bivariate regression analysis of average MED by TBSA showed a significant positive correlation (p<0.001). The analysis of average MED by age showed a significant negative correlation (p<0001). CONCLUSION: Our study quantified opioid requirements in an inpatient burn population and identified TBSA (positively) and age (negatively) as significant predictors.


Assuntos
Analgésicos não Entorpecentes/uso terapêutico , Analgésicos Opioides/uso terapêutico , Queimaduras/terapia , Planejamento em Desastres , Incidentes com Feridos em Massa , Manejo da Dor/métodos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Analgésicos Opioides/provisão & distribução , Anti-Inflamatórios não Esteroides/uso terapêutico , Anticonvulsivantes/uso terapêutico , Antidepressivos/uso terapêutico , Superfície Corporal , Unidades de Queimados , Queimaduras/patologia , Feminino , Antagonistas dos Receptores Histamínicos/uso terapêutico , Humanos , Hipnóticos e Sedativos/uso terapêutico , Masculino , Pessoa de Meia-Idade , Capacidade de Resposta ante Emergências , Adulto Jovem
13.
Healthc Q ; 22(3): 6-11, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31845850

RESUMO

North America is currently in the midst of an opioid overdose crisis, leading to changes in drug policy and clinical practice guideline recommendations. Data from Ontario's prescription monitoring program and the Office of the Chief Coroner for Ontario can be used to characterize changing prescription opioid trends and their role in fatal opioid overdoses. A better understanding of historical patterns of opioid use and overdose can help inform a more nuanced drug policy in the future.


Assuntos
Analgésicos Opioides/provisão & distribução , Overdose de Drogas/epidemiologia , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Overdose de Drogas/mortalidade , Política de Saúde , Humanos , Ontário/epidemiologia , Transtornos Relacionados ao Uso de Opioides/etiologia , Padrões de Prática Médica/estatística & dados numéricos , Medicamentos sob Prescrição/provisão & distribução
14.
Drug Alcohol Depend ; 205: 107636, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31704377

RESUMO

INTRODUCTION: To examine opioid prescribing rates following emergency department (ED) discharge stratified by patient's clinical and demographic characteristics over an 11-year period. MATERIAL AND METHODS: We used 3.9 million ED visits from commercially insured enrollees and 15.2 million ED visits from Medicaid enrollees aged 12 to 64 over 2005-2016 from the IBM® MarketScan® Research Databases. We calculated rates of opioid prescribing at discharge from the ED and the average number of pills per opioid prescription filled. RESULTS: Approximately 15-20% of ED visits resulted in opioid prescriptions filled. Rates increased from 2005 into late 2009 and 2010 and then declined steadily through 2016. Prescribing rates were similar for commercially insured and Medicaid enrollees. Being aged 25-54 years was associated with the highest rates of opioid prescriptions being filled. Hydrocodone was the most commonly prescribed opioid, but rates for hydrocodone prescription filling also fell the most. Rates for oxycodone were stable, and rates for tramadol increased. The average number of pills dispensed from prescriptions filled remained steady over the study period at 18-20. DISCUSSION: Opioid prescribing rates from the ED have declined steadily since 2010 in reversal of earlier trends; however, about 15% of ED patients still received opioid prescriptions in 2016 amidst a national opioid crisis. CONCLUSIONS: Efforts to reduce opioid prescribing could consider focusing on the pain types, age groups, and regions with high prescription rates identified in this study.


Assuntos
Analgésicos Opioides , Prescrições de Medicamentos/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Padrões de Prática Médica/tendências , Adolescente , Adulto , Analgésicos Opioides/provisão & distribução , Analgésicos Opioides/uso terapêutico , Criança , Bases de Dados Factuais/estatística & dados numéricos , Serviço Hospitalar de Emergência/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Prescrições , Estados Unidos , Adulto Jovem
15.
Int J Drug Policy ; 74: 216-222, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31677483

RESUMO

BACKGROUND: In recent years there have been growing concerns regarding non-prescription codeine use in Australia. Efforts to mitigate risks associated with non-prescription codeine, such as addiction and toxicity, have been primarily through two initiatives; regulatory changes restricting their availability, and voluntary live-recording supply of non-prescription codeine combination analgesics (CCAs). This study sought to explore the supply of CCAs in the climate of regulatory change. METHODS: Eighty University of Sydney pharmacy students mystery-shopped 34 community pharmacies across metropolitan Sydney, Australia from August 2016 to November 2017, with scripted symptom-based (SBR) or direct product requests (DPR) for a CCA. Questions asked, staff involvement, regulatory compliance, voluntary recording, and product(s) supplied were recorded. RESULTS: Of 158 total visits, a non-prescription CCA was supplied in 101 instances. Sixty-one (60%) of these supplies complied with the legislative requirement for a pharmacist to supply the medicine. Voluntary recording was surmised to have been utilised 13 times (13% CCA supplies). CCAs were supplied less frequently in 2017 DPR scenarios compared to 2016 DPR scenarios (64% vs 86%; p = 0.024), and a greater proportion of 2017 DPR supplies were compliant with the legislative requirement of pharmacist supply (72% vs 46%; p = 0.041). No difference in proportion of sales surmised to have been voluntarily recorded was observed between the years. Interactions involving pharmacists resulted in less frequent supply of codeine than those without (58% vs 82%; p = 0.012). CONCLUSION: Mandatory legislative regulation of pharmacist supply of non-prescription codeine was more likely to be complied with than voluntary recording. Compliance with pharmacist supply for DPRs appeared to improve following the announcement of regulatory change to prescription-only, whereas voluntary recording of supply did not appear to change.


Assuntos
Analgésicos Opioides/provisão & distribução , Codeína/provisão & distribução , Serviços Comunitários de Farmácia/estatística & dados numéricos , Medicamentos sem Prescrição/provisão & distribução , Analgésicos Opioides/administração & dosagem , Austrália , Codeína/administração & dosagem , Serviços Comunitários de Farmácia/legislação & jurisprudência , Serviços Comunitários de Farmácia/organização & administração , Combinação de Medicamentos , Humanos , Medicamentos sem Prescrição/administração & dosagem , Simulação de Paciente , Farmacêuticos/legislação & jurisprudência , Farmacêuticos/organização & administração , Papel Profissional
16.
Int J Drug Policy ; 74: 174-180, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31627159

RESUMO

BACKGROUND: Prescription drug monitoring programs (PDMP), by reducing access to prescribed opioids (POs), may contribute to a policy environment in which some people with opioid dependence are at increased risk for transitioning from POs to heroin/other illegal opioids. This study examines how PDMP adoption and changes in the characteristics of PDMPs over time contribute to changes in fatal heroin poisoning in counties within states from 2002 to 2016. METHODS: Latent transition analysis to classify PDMPs into latent classes (Cooperative, Proactive, and Weak) for each state and year, across three intervals (1999-2004, 2005-2009, 2010-2016). We examined the association between probability of PDMP latent class membership and the rate of county-level heroin poisoning death. RESULTS: After adjustment for potential county-level confounders and co-occurring policy changes, adoption of a PDMP was significantly associated with increased heroin poisoning rates (22% increase by third year post-adoption). Findings varied by PDMP type. From 2010-2016, states with Cooperative PDMPs (those more likely to share data with other states, to require more frequent reporting, and include more drug schedules) had 19% higher heroin poisoning rates than states with Weak PDMPs (adjusted rate ratio [ARR] = 1.19; 95% CI = 1.14, 1.25). States with Proactive PDMPs (those more likely to report outlying prescribing and dispensing and provide broader access to law enforcement) had 6% lower heroin poisoning rates than states with No/Weak PDMPs (ARR = 0.94; 95% CI = 0.90, 0.98). CONCLUSION: There is a consistent, positive association between state PDMP adoption and heroin poisoning mortality. However, this varies by PDMP type, with Proactive PDMPs associated with a small reduction in heroin poisoning deaths. This raises questions about the potential for PDMPs to support efforts to decrease heroin overdose risk, particularly by using proactive alerts to identify patients in need of treatment for opioid use disorder. Future research on mechanisms explaining the reduction in heroin poisonings after enactment of Proactive PDMPs is merited.


Assuntos
Overdose de Drogas/epidemiologia , Dependência de Heroína/complicações , Heroína/envenenamento , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Programas de Monitoramento de Prescrição de Medicamentos/organização & administração , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/provisão & distribução , Feminino , Dependência de Heroína/epidemiologia , Dependência de Heroína/mortalidade , Humanos , Masculino , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Uso Indevido de Medicamentos sob Prescrição/prevenção & controle , Estados Unidos/epidemiologia
17.
JAMA Surg ; 154(11): 1049-1054, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31617880

RESUMO

Importance: Opioid overdose is the leading cause of injury-related death in the United States. Several studies have shown that surgeons overprescribe opioids, and guidelines for appropriate opioid prescribing are available. Concern about patient-reported satisfaction scores may be a barrier to surgeons adopting guideline-directed prescribing. Objective: To determine whether decreased opioid prescribing is associated with a decrease in patient-reported satisfaction with their surgeon. Design, Setting, and Participants: Retrospective analysis of clinician satisfaction scores at Dartmouth-Hitchcock Medical Center obtained in 2 periods: 1 before (period A) and 1 after (period B) an educational intervention that resulted in decreased opioid prescribing. The analysis included 11 surgeons who performed 5 common outpatient general surgical operations on 996 patients. Data were analyzed between March and August 2018. Main Outcomes and Measures: Patient-reported overall satisfaction rating of the surgeon (scale, 0-10). This was collected by a nonstudy-related, routine general institutional survey of approximately 40% of all outpatient encounters. Results: Of the total number of patients, 67% were women (667 of 996), and the mean patient age was 58 years. Comparing period A with B, the proportion of patients prescribed opioids decreased from 90.2% (n = 367 of 407) to 72.8% (n = 429 of 589) (P < .001). The mean number of opioid pills per prescription decreased from 28.3 to 13.3 (P < .001) and significantly decreased for each of the 11 surgeons. One hundred five of 996 patients (10.5%) undergoing index operations responded to the survey. There was no difference in the mean clinician satisfaction ratings from period A vs B (9.70 vs 9.65; P = .69). During the study periods, 640 total surveys were collected referencing these surgeons (including outpatient encounters associated with operations other than the 5 index cases). There was no difference in the mean satisfaction ratings from period A vs period B (9.55 vs 9.59; P = .62). When individual clinicians were analyzed, none had a significant difference in overall satisfaction rating from period A vs period B. Conclusions and Relevance: Despite a marked decrease in the proportion of patients receiving opioids and in the number of pills prescribed, there was no significant change in clinician satisfaction ratings.


Assuntos
Analgésicos Opioides/uso terapêutico , Oxicodona/uso terapêutico , Dor Pós-Operatória/prevenção & controle , Satisfação do Paciente , Padrões de Prática Médica , Analgésicos Opioides/provisão & distribução , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , New Hampshire , Oxicodona/provisão & distribução , Dor Pós-Operatória/psicologia , Medidas de Resultados Relatados pelo Paciente , Relações Médico-Paciente , Cuidados Pós-Operatórios/psicologia , Cuidados Pós-Operatórios/estatística & dados numéricos , Estudos Retrospectivos
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