Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 39
Filtrar
3.
N C Med J ; 81(6): 355-362, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33139463

RESUMO

BACKGROUND Deaths from unintentional opioid overdose have increased markedly over the last decade in North Carolina. In 2017 the state created a North Carolina Opioid Action Plan, which laid out a multisectoral response to the crisis that included the medical community, law enforcement, emergency medical services, and treatment professionals. It also created a website providing county-level data associated with the crisis. Using this publicly available data, we examine trends and associations between opioid-related mortality and strategies to reduce opioid prescriptions, reduce fatality of overdose, and improve treatment and recovery.METHOD We examine yearly trends from 2010-2017 for statewide unintentional opioid-related death rates, prescription of opioid pills, buprenorphine prescription rates, naloxone administrations, and number of Certified Peer Support Specialists. We compare recent opioid-related death rates for 2015-2017 with an earlier period (2010-2012) at the county level, and examine the association between death rates and rates of the supply, treatment, and recovery metrics.RESULTS Trends for all metrics increased from 2010-2017, although the number of opioid pills per capita has declined since 2015. Between 2010 and 2017, 84 of the state's 100 counties experienced an increase in opioid-related mortality. County-level mortality was positively associated with opioid prescription rate (r = +0.12, P = 0.24) and with naloxone administrations (r = +0.20, P = 0.05). Prescription of buprenorphine was associated with a reduction in opioid mortality (r = -0.27, P = 0.01). The effect of Certified Peer Support Specialists was not discernable.LIMITATIONS Data are available for only eight years and aggregated at the county level. Mortality data are based on death certificates using ICD-10 codes from the North Carolina State Center for Health Statistics, Vital Statistics, which may not capture all opioid-related fatalities. Drug-related deaths may involve multiple non-opioid substances; in addition, determining the intent of the deceased individual may be difficult (suicide versus unintentional). Naloxone administration data only includes data from emergency medical services, not community-administered naloxone, because that data was only available for 2013 and later and is based only on self-reports.CONCLUSIONS The potential efficacy of buprenorphine is promising and should be further explored. All interventions should be monitored.


Assuntos
Epidemia de Opioides , Analgésicos Opioides/envenenamento , Benchmarking , Overdose de Drogas/tratamento farmacológico , Overdose de Drogas/mortalidade , Humanos , North Carolina/epidemiologia , Epidemia de Opioides/prevenção & controle , Epidemia de Opioides/tendências
6.
J Am Assoc Nurse Pract ; 32(1): 2-4, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31913211

RESUMO

There is prevalent news media coverage about the opioid crisis in the United States. Overdose deaths are on the rise, but who's fault is it really? Perspective into the crisis is key if we as health care providers ever hope to change the current situation. Although overdose deaths are on the rise, opioid prescribing rates are decreasing. Considering a complex issue requires looking into to the lives of patients and their past experiences to truly identify those at risk for addiction, not just opioid addiction, but addiction as a whole. Nurse practitioners play a vital role in identifying those at greatest risk, making the identification early and assisting patients into treatment to help change the trajectory of their lives.


Assuntos
Analgésicos Opioides/efeitos adversos , Meios de Comunicação de Massa/tendências , Epidemia de Opioides/tendências , Analgésicos Opioides/uso terapêutico , Humanos , Epidemia de Opioides/estatística & dados numéricos , Estados Unidos
9.
Psychiatr Serv ; 71(1): 12-20, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31575353

RESUMO

OBJECTIVE: The study measured the association between local opioid problem severity and changes in the availability of substance use disorder treatment programs, including the distance required for travel to treatment. METHODS: A two-part, multivariable regression estimated the number of treatment facilities in the county (per 100,000 residents) and the number of miles to the nearest program (for all treatment programs, programs offering opioid use disorder medication, and programs accepting Medicaid) using data from the 2009-2017 National Directory of Drug and Alcohol Abuse Treatment Facilities. The unit of analysis was the county-year (N=28,270). RESULTS: The probability of having at least one treatment program meeting the established criteria was greater in counties with a high-severity opioid problem than in counties with a low-severity problem, and the probability improved over time. In counties with a high-severity problem, the probability of having a treatment program offering buprenorphine, methadone, or both was 60.3% higher than in counties with low-severity problems. Between 2009 and 2017, the likelihood of having a treatment program that accepts Medicaid grew by 25.3%. For counties without treatment programs, the distance to the nearest program improved markedly over time, but there were no differences between distance to treatment in high-, moderate-, and low-severity status counties. CONCLUSIONS: The treatment system has reduced structural barriers to treatment where it is most needed. However, these findings do not imply that the treatment system has sufficient capacity to address the present scope of the opioid crisis. Policy makers should leverage this responsiveness to incentivize additional improvements in access.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Tratamento de Substituição de Opiáceos/estatística & dados numéricos , Epidemia de Opioides/tendências , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Analgésicos Opioides/uso terapêutico , Buprenorfina/uso terapêutico , Humanos , Modelos Logísticos , Metadona/uso terapêutico , Análise Multivariada , Patient Protection and Affordable Care Act , Estados Unidos
10.
Am J Emerg Med ; 38(4): 735-740, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31227419

RESUMO

BACKGROUND: Prescription opioid related deaths have increased dramatically over the past 17 years. Although emergency physicians (EPs) have not been the primary force behind this rise, previous literature have suggested that EPs could improve their opioid prescribing practices. We designed this study to evaluate the trend in emergency department (ED) opioid prescriptions over time during the US opioid epidemic. METHODS: We conducted a retrospective cohort study from July 1, 2012 to June 30, 2018, evaluating all adult patients who presented to two study EDs for a pain-related complaint and received an analgesic prescription upon ED discharge. We compared these data to trends in lay media and medical literature regarding the opioid epidemic. We also evaluated the incidence of repeat ED visits based on the type of analgesic prescriptions provided. RESULTS: Opioid prescriptions decreased from 37.76% to 13.29% over the six year study period. This coupled with an increase in non-opioid medications from 6.12% to 11.33% and an increase in "no prescription" from 56.12% to 75.37%. This corresponded with an increase in the number of publications on the opioid epidemic within the lay-public and medical literature. Additionally, those patients that received no opiates were less likely to require a repeat ED visit. CONCLUSIONS: ED physicians are prescribing less opiates, while increasing the amount of non-narcotic analgesic prescriptions. This may be in response to the literature suggesting that prescription opioids play a large role in the opioids crisis. This decrease in opioid prescriptions did not increase the need for repeat ED visits.


Assuntos
Analgésicos Opioides/uso terapêutico , Prescrições de Medicamentos/normas , Medicina de Emergência/tendências , Epidemia de Opioides/tendências , Adulto , Idoso , Analgésicos Opioides/efeitos adversos , Estudos de Coortes , Prescrições de Medicamentos/estatística & dados numéricos , Medicina de Emergência/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Epidemia de Opioides/estatística & dados numéricos , Padrões de Prática Médica/normas , Padrões de Prática Médica/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos
11.
Pain Manag Nurs ; 21(1): 100-109, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31327624

RESUMO

A plethora of statistics and claims exist concerning the rise in prescription opioid use and the increase in opioid-related deaths. Eleven misperceptions were identified that underlie some of the growing national concern and backlash against opioid use. Misperceptions include the number of opioid overdose deaths, the quality of government-sponsored data and guidelines, the impact of opioid dose escalation on overdose risk, postoperative opioid use associated with long-term use, and the link between prescription opioid use and heroin initiation. Implications for research, practice and education include (a) a call for improvement in data recording, (b) unbiased and clear reporting of information, (c) a call for health care providers to ask critical questions when presented with data, and (d) a call for policymakers to avoid unnecessarily restrictive practices that are founded in fear and may cause unintended harm to patients in pain.


Assuntos
Analgésicos Opioides/efeitos adversos , Epidemia de Opioides/estatística & dados numéricos , Analgésicos Opioides/uso terapêutico , Causas de Morte/tendências , Confiabilidade dos Dados , Humanos , Epidemia de Opioides/tendências , Manejo da Dor/métodos
13.
Drug Alcohol Depend ; 205: 107620, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31675545

RESUMO

BACKGROUND: First responders have demanding jobs and report experiencing burnout. The opioid epidemic has added to first responder workloads, which could contribute to increased burnout. This mixed-methods study examined burnout among first responders by: 1) describing burnout among first responders specifically related to workload demands associated with the opioid epidemic; 2) exploring first responder perspectives on how the opioid epidemic has affected their profession; and 3) conducting exploratory analyses to examine how burnout and perspectives on the effect of the opioid epidemic differ across first responder professions. METHODS: First responders completed an online survey (n = 196), including a burnout questionnaire, as part of a county-wide opioid misuse resource and needs assessment. A subset completed qualitative interviews (n = 12). In both the survey and interviews, participants were asked their perspectives on how the opioid epidemic impacted their profession. RESULTS: One-third (33%; n = 179) of survey respondents reported high burnout scores. The majority saw community opioid misuse as a significant problem (98%; n = 188) that has affected their profession (95%; n = 188). Qualitative analyses supported survey findings with participants expressing increased workloads and emotional effects related to the opioid epidemic. CONCLUSIONS: First responders reported experiencing burnout, increased workloads, and negative emotional effects related to their role in responding to the opioid epidemic. Despite this, first responders view responding to community opioid misuse as part of their professional role for which they have received specialized training. Future research should continue to explore the impact of the opioid epidemic on first responders, including how to prevent or address burnout.


Assuntos
Analgésicos Opioides/efeitos adversos , Esgotamento Profissional/psicologia , Socorristas/psicologia , Epidemia de Opioides/tendências , Inquéritos e Questionários , Carga de Trabalho/psicologia , Adulto , Esgotamento Profissional/diagnóstico , Esgotamento Profissional/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/psicologia , Transtornos Relacionados ao Uso de Opioides/terapia
18.
J Pharmacol Exp Ther ; 371(2): 396-408, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31481516

RESUMO

Opioid misuse and addiction are a public health crisis resulting in debilitation, deaths, and significant social and economic impact. Curbing this crisis requires collaboration among academic, government, and industrial partners toward the development of effective nonaddictive pain medications, interventions for opioid overdose, and addiction treatments. A 2-day meeting, The Opioid Crisis and the Future of Addiction and Pain Therapeutics: Opportunities, Tools, and Technologies Symposium, was held at the National Institutes of Health (NIH) to address these concerns and to chart a collaborative path forward. The meeting was supported by the NIH Helping to End Addiction Long-TermSM (HEAL) Initiative, an aggressive, trans-agency effort to speed scientific solutions to stem the national opioid crisis. The event was unique in bringing together two research disciplines, addiction and pain, in order to create a forum for crosscommunication and collaboration. The output from the symposium will be considered by the HEAL Initiative; this article summarizes the scientific presentations and key takeaways. Improved understanding of the etiology of acute and chronic pain will enable the discovery of novel targets and regulatable pain circuits for safe and effective therapeutics, as well as relevant biomarkers to ensure adequate testing in clinical trials. Applications of improved technologies including reagents, assays, model systems, and validated probe compounds will likely increase the delivery of testable hypotheses and therapeutics to enable better health outcomes for patients. The symposium goals were achieved by increasing interdisciplinary collaboration to accelerate solutions for this pressing public health challenge and provide a framework for focused efforts within the research community. SIGNIFICANCE STATEMENT: This article summarizes key messages and discussions resulting from a 2-day symposium focused on challenges and opportunities in developing addiction- and pain-related medications. Speakers and attendees came from 40 states in the United States and 15 countries, bringing perspectives from academia, industry, government, and healthcare by researchers, clinicians, regulatory experts, and patient advocates.


Assuntos
Analgésicos Opioides/uso terapêutico , Comportamento Aditivo/terapia , Dor Crônica/tratamento farmacológico , Congressos como Assunto/tendências , National Institutes of Health (U.S.)/tendências , Epidemia de Opioides/tendências , Analgésicos Opioides/efeitos adversos , Comportamento Aditivo/epidemiologia , Dor Crônica/epidemiologia , Previsões , Humanos , Epidemia de Opioides/prevenção & controle , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Estados Unidos/epidemiologia
20.
J Pharmacol Exp Ther ; 371(2): 453-475, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31492824

RESUMO

In December 2018, the Centers for Disease Control declared fentanyl the deadliest drug in America. Opioid overdose is the single greatest cause of death in the United States adult population (ages 18-50), and fentanyl and its analogs [fentanyl/fentanyl analogs (F/FAs)] are currently involved in >50% of these deaths. Anesthesiologists in the United States were introduced to fentanyl in the early 1970s when it revolutionized surgical anesthesia by combining profound analgesia with hemodynamic stability. However, they quickly had to master its unique side effect. F/FAs can produce profound rigidity in the diaphragm, chest wall and upper airway within an extremely narrow dosing range. This clinical effect was called wooden chest syndrome (WCS) by anesthesiologists and is not commonly known outside of anesthesiology or to clinicians or researchers in addiction research/medicine. WCS is almost routinely fatal without expert airway management. This review provides relevant clinical human pharmacology and animal data demonstrating that the significant increase in the number of F/FA-induced deaths may involve α-adrenergic and cholinergic receptor-mediated mechanical failure of the respiratory and cardiovascular systems with rapid development of rigidity and airway closure. Although morphine and its prodrug, heroin, can cause mild rigidity in abdominal muscles at high doses, neither presents with the distinct and rapid respiratory failure seen with F/FA-induced WCS, separating F/FA overdose from the slower onset of respiratory depression caused by morphine-derived alkaloids. This distinction has significant consequences for the design and implementation of new pharmacologic strategies to effectively prevent F/FA-induced death. SIGNIFICANCE STATEMENT: Deaths from fentanyl and F/FAs are increasing in spite of availability and awareness of the opioid reversal drug naloxone. This article reviews literature suggesting that naloxone may be ineffective against centrally mediated noradrenergic and cholinergic effects of F/FAs, which clinically manifest as severe muscle rigidity and airway compromise (e.g., wooden chest syndrome) that is rapid and distinct from respiratory depression seen with morphine-derived alkaloids. A physiologic model is proposed and implications for new drug development and treatment are discussed.


Assuntos
Neurônios Adrenérgicos/efeitos dos fármacos , Analgésicos Opioides/efeitos adversos , Fentanila/efeitos adversos , Naloxona/administração & dosagem , Antagonistas de Entorpecentes/administração & dosagem , Epidemia de Opioides/prevenção & controle , Neurônios Adrenérgicos/metabolismo , Analgésicos Opioides/metabolismo , Overdose de Drogas/metabolismo , Overdose de Drogas/prevenção & controle , Fentanila/metabolismo , Humanos , Rigidez Muscular/induzido quimicamente , Rigidez Muscular/tratamento farmacológico , Rigidez Muscular/metabolismo , Naloxona/metabolismo , Antagonistas de Entorpecentes/metabolismo , Epidemia de Opioides/tendências , Insuficiência Respiratória/induzido quimicamente , Insuficiência Respiratória/tratamento farmacológico , Insuficiência Respiratória/metabolismo , Tempo para o Tratamento/tendências
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...