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1.
J Am Board Fam Med ; 34(6): 1071-1073, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34772762

RESUMO

This issue of the JABFM features research on a broad array of clinical topics. The topics of 5 articles involve controlled substances, including a sobering article on the risks of amphetamines in older adults. An excellent quick reference guide for managing common COVID-19 symptoms is presented. Two other articles consider hypertension treatment in primary care, demonstrating that treating blood pressure is anything but straightforward. Several additional clinical topics include mononucleosis, influenza, and the impact of home life on childhood weight and eating habits. A study from Virginia underscores that primary care, as a system, is distressed. A review of the existing literature on "slow medicine" comes to important conclusions. Some health systems are partnering with local resources to practically address such social determinants as food insecurity. Not surprisingly, family physicians are filling gaps in emergency care around the country.


Assuntos
COVID-19 , Hipertensão , Idoso , Criança , Substâncias Controladas , Humanos , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Médicos de Família , SARS-CoV-2
3.
J Fam Pract ; 70(3): 112-120, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-34314334

RESUMO

Avoid error by ordering the appropriate test at a risk-based frequency. Be alert to sources of false-positives and adulteration. Be careful not to overreact to unexpected results.


Assuntos
Substâncias Controladas/análise , Medicina de Família e Comunidade/métodos , Drogas Ilícitas/urina , Manejo de Espécimes/métodos , Detecção do Abuso de Substâncias/métodos , Urinálise/métodos , Assistência Ambulatorial/métodos , Reações Falso-Positivas , Humanos , Guias de Prática Clínica como Assunto
4.
Breast Cancer Res Treat ; 189(2): 445-454, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34089118

RESUMO

PURPOSE: Prolonged use of controlled substances can place patients at increased risk of dependence and complications. Women who have mastectomy and reconstructive surgery (M + R) may be vulnerable to becoming new persistent users (NPUs) of opioid and sedative-hypnotic medications. METHODS: Using the MarketScan health-care claims database, we identified opioid- and sedative-hypnotic-naïve women who had M + R from 2008 to 2017. Women who filled ≥ 1 peri-operative prescription and ≥ 2 post-operative prescriptions within one year after surgery were classified as NPUs. Univariate and multivariable logistic regression analyses were used to estimate rates of new persistent use and predictive factors. Risk summary scores were created based on the sum of associated factors. RESULTS: We evaluated 23,025 opioid-naïve women and 25,046 sedative-hypnotic-naïve women. We found that 17,174 opioid-naïve women filled a peri-operative opioid prescription, and of those, 2962 (17.2%) became opioid NPUs post-operatively. Additionally, 9426 sedative-hypnotic-naïve women filled a peri-operative sedative-hypnotic prescription, and of those, 1612 (17.1%) became sedative-hypnotic NPUs. Development of new persistent sedative-hypnotic use was associated with age ≤ 49 [OR 1.77 (95% CI 1.40-2.24)] and age 50-64 [1.60 (1.27-2.03)] compared to age ≥ 65; Medicaid insurance [2.34 (1.40-3.90)]; southern residence [1.42 (1.22-1.64)]; breast cancer diagnosis [2.24 (1.28-3.91)]; and chemotherapy [2.17 (1.94-2.42)]. Risk of NPU increased with higher risk score. Women with ≥ 3 of these risk factors were three times more likely to become sedative-hypnotic NPUs than patients with 0 or 1 factors [2.94 (2.51-3.43)]. Comparable findings were seen regarding new persistent opioid use. CONCLUSION: Women who have M + R are at risk of developing both new persistent opioid and new persistent sedative-hypnotic use. A patient's risk of becoming an NPU increases as their number of risk factors increases. Non-pharmacologic strategies are needed to manage pain and anxiety following cancer-related surgery.


Assuntos
Neoplasias da Mama , Procedimentos Cirúrgicos Reconstrutivos , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/cirurgia , Substâncias Controladas , Feminino , Humanos , Mastectomia , Pessoa de Meia-Idade , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/etiologia , Estudos Retrospectivos , Fatores de Risco , Estados Unidos
5.
Nurse Pract ; 46(6): 48-55, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34004642

RESUMO

ABSTRACT: Two years after the Florida legislature expanded APRN prescribing to include schedule II-IV drugs in 2017, we studied APRN utilization of this prescriptive authority. Study results reveal that Florida APRNs are meeting the educational requirements to prescribe and apply the use of these drugs in practice, improving patient access to care.


Assuntos
Prática Avançada de Enfermagem/legislação & jurisprudência , Substâncias Controladas , Prescrições de Medicamentos/enfermagem , Controle de Medicamentos e Entorpecentes/legislação & jurisprudência , Padrões de Prática em Enfermagem/legislação & jurisprudência , Florida , Humanos
6.
J Opioid Manag ; 17(2): 155-167, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33890279

RESUMO

OBJECTIVE: Prescription opioid misuse represents a social and economic challenge in the United States. We evaluated Schedule II opioid prescribing practices by primary care providers (PCPs), orthopedic and general surgeons, and pain management specialists. DESIGN: Prospective evaluation of prescribing practices of PCPs, orthopedic and general surgeons, and pain management specialists over 5 years (October 1, 2014-September 30, 2019) in an outpatient setting. METHODS: An analysis of Schedule II opioid prescribing following the implementation of federal and state guidelines and evidence-based standards at our institution. RESULTS: There were significantly more PCPs, orthopedic and general surgeons, and pain management specialists with a significantly increased number who prescribed Schedule II opioids, whereas there was a simultaneous significant decline in the average number of Schedule II opioid prescriptions per provider, Schedule II opioid pills prescribed per provider, and Schedule II opioid pills prescribed per patient by providers. The average number of Schedule II opioid prescriptions with a quantity >90 and Opana/Oxycontin prescriptions per PCP, orthopedic surgeon, and pain management specialist significantly decreased. The total morphine milligram equivalent (MME)/day of Schedule II opioids ordered by PCPs, orthopedic and general surgeons, and pain management specialists significantly declined. The ages of the providers remained consistent throughout the study. CONCLUSIONS: This study reports the implementation of federal and state regulations and institutional evidence-based guidelines into primary care and medical specialty practices to reduce the number of Schedule II opioids prescribed. Further research is warranted to determine alternative therapies to Schedule II opioids that may alleviate a patient's pain without initiating or exacerbating a potentially lethal opioid addiction.


Assuntos
Analgésicos Opioides , Cirurgiões , Analgésicos Opioides/uso terapêutico , Substâncias Controladas , Prescrições de Medicamentos , Humanos , Dor/tratamento farmacológico , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/tratamento farmacológico , Padrões de Prática Médica , Atenção Primária à Saúde , Estudos Prospectivos , Especialização , Estados Unidos
7.
J Am Pharm Assoc (2003) ; 61(4): 418-424.e2, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33812783

RESUMO

OBJECTIVE: Clinical review of a prescription drug monitoring program (PDMP) is considered a valuable tool for opioid prescribing risk mitigation; however, PDMP use is often low, even in states with mandatory registration and use policies. The objective was to evaluate the impact of an academic detailing (AD) outreach intervention on PDMP use among primary care prescribers. METHODS: AD intervention was delivered to primary care based controlled substance prescribers (N = 87) and their associated PDMP delegates (n = 42) by a clinical pharmacist as 1 component of a large-scale, statewide initiative to improve opioid prescribing safety. Prescriber PDMP use behavior was assessed by prescriber self-report and analysis of objective 2016-2018 PDMP data regarding the number of monthly report requests. We compared means between pre- and postintervention using a paired t test and plotted the monthly average reports over time to assess the trend of mean reports over time. Generalized linear mixed model with a negative binomial distribution was used to assess the difference in the trend and magnitude of the combined count of reports for the entire sample and prescriber subsets that were segmented on the basis of the adoption status of PDMP. RESULTS: The monthly mean of reports by combined prescribers and delegates significantly increased after the AD intervention (mean 28.1 pre vs. 53.0 post; P < 0.001), with the increase in delegate reports (mean 17.1 pre vs. 60.0 post; P < 0.001) driving the overall increase. Reports were requested 40.4 times more often than in the preintervention period (P < 0.001). Patterns of pre- to postchanges in mean monthly report requests differed by baseline PDMP adoption status. CONCLUSION: The AD intervention was transformative in facilitating practice change to use delegates to run reports. Visits with both prescribers and delegates, including hands-on PDMP training and registration assistance, can be viewed as beneficial for practice facilitation.


Assuntos
Programas de Monitoramento de Prescrição de Medicamentos , Analgésicos Opioides/efeitos adversos , Substâncias Controladas , Humanos , Padrões de Prática Médica , Atenção Primária à Saúde
8.
J Am Pharm Assoc (2003) ; 61(4): e218-e224, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33674205

RESUMO

Gabapentin is approved to treat postherpetic neuralgia and epilepsy with partial-onset seizures. The large majority of gabapentin prescribing is off label. Gabapentin may be abused for euphoria, potentiating the high from opiates, reduction of alcohol cravings, a cocaine-like high, as well as sedation or sleep. Individuals at the highest risk for abusing gabapentin include those with opioid abuse, mental illness, or previous history of prescription drug abuse. States are now taking action to track gabapentin use through prescription monitoring programs, and some states have reclassified it as a Schedule V controlled substance. This commentary summarizes gabapentin's abuse potential, identifies state-level actions regarding gabapentin monitoring, and discusses possible clinical implications and ways to enhance patient safety when prescribing gabapentin.


Assuntos
Ácidos Cicloexanocarboxílicos , Epilepsia , Transtornos Relacionados ao Uso de Substâncias , Aminas/efeitos adversos , Substâncias Controladas , Ácidos Cicloexanocarboxílicos/efeitos adversos , Gabapentina/uso terapêutico , Humanos , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle
9.
Drug Alcohol Depend ; 221: 108618, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33677354

RESUMO

BACKGROUND: The term "doctor and pharmacy shopping" colloquially describes patients with high multiple provider episodes (MPEs)-a threshold count of distinct prescribers and/or pharmacies involved in prescription fulfillment. Opioid-related MPEs are implicated in the global opioid crisis and heavily monitored by government databases such as U.S. state prescription drug monitoring programs (PDMPs). We applied a widely-used MPE definition to examine U.S. trends from a large, commercially-insured population from 2010 to 2017. Further, we examined the proportion of enrollees identified as "doctor shoppers" with evidence of a cancer diagnosis to examine the risk of false positives. METHODS: Using a large, commercially-insured population, we identified patients with opioid-related MPEs: opioid prescriptions (Schedule II-V, no buprenorphine) filled from ≥5 prescribers AND ≥ 5 pharmacies within the past 90 days ("5x5x90d"). Quarterly rates per 100,000 enrollees (two specifications) were calculated between 2010 and 2017. We examined the trend in a recently published all-payer, 7 state cohort from the U.S. Centers for Disease Control and Prevention for comparison. Cancer-related ICD-9/10-CM codes were used. RESULTS: Quarterly MPE rates declined by approximately 73 % from 18.2-4.9 per 100,000 enrollee population with controlled substance prescriptions. In 2017, nearly one fifth of these commercially-insured enrollees identified by the 5x5x90d algorithm were diagnosed with cancer. Approximately 8% of this sample included patients with ≥ 1 buprenorphine prescriptions. CONCLUSIONS: Opioid "shopping" flags are a long-standing but rapidly fading PDMP signal. To avoid unintended consequences, such as identifying legitimate medical encounters requiring high healthcare utilization or opioid treatment, while maintaining vigilance, more nuanced and sophisticated approaches are needed.


Assuntos
Analgésicos Opioides/uso terapêutico , Epidemia de Opioides/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Uso Indevido de Medicamentos sob Prescrição/estatística & dados numéricos , Programas de Monitoramento de Prescrição de Medicamentos/estatística & dados numéricos , Adulto , Buprenorfina/uso terapêutico , Estudos de Coortes , Substâncias Controladas , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Farmácias/estatística & dados numéricos , Farmácia/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Uso Indevido de Medicamentos sob Prescrição/prevenção & controle , Prescrições/estatística & dados numéricos , Estados Unidos/epidemiologia
10.
J Am Pharm Assoc (2003) ; 61(3): 316-324, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33579594

RESUMO

OBJECTIVES: Prescription drug monitoring programs (PDMPs) are state-maintained databases that providers may reference when deciding to prescribe or dispense controlled substances. As more states begin to mandate PDMP use at the point of care, it is imperative to assess how pharmacists use PDMP information when determining whether to fill a controlled substance prescription (CSP). The objective of this study was to evaluate which factors affected fourth-year student pharmacists' decision to fill an opioid prescription, their level of confidence in their decision making, and familiarity with the PDMP. METHODS: We used a 24 factorial design to present a series of text-based vignettes to fourth-year student pharmacists. Each participant received 8 vignettes (5 randomly selected, 3 fixed), representing a hypothetical hydrocodone-acetaminophen combination prescription with varying levels of the following dichotomous factors: doctor shopping, dosage, pharmacy shopping, and concurrent benzodiazepine prescription. Participants were asked to decide whether or not they would fill each of the hypothetical prescriptions they received. A multilevel model was used to measure the association between each of the vignette factors, age, race, sex, experience with PDMP, and the decision to refuse to fill a prescription. Each vignette response served as an independent observation. RESULTS: A total of 87 participants yielded 696 vignette responses. Participants were significantly more likely to refuse to fill prescriptions with doctor shopping (adjusted odds ratio [aOR] 19.86 [95% CI 10.78-36.58]), pharmacy shopping (6.78 [4.13-11.12]), dosage (1.83 [1.16-2.90]), or if the student pharmacist was of female sex (1.73 [1.02-2.93]). Concomitant benzodiazepine use was not associated with a no-fill decision (1.45 [0.92-2.27]). CONCLUSION: This study reveals that student pharmacists' decision to fill a prescription is dependent on both prescription characteristics and a patient's CSP history. The importance of PDMP history cannot be downplayed and suggests that PDMP use may be effective in informing patient care decisions. Still, the variability in filling decision highlights the need to teach a formulaic approach to CSP dispensing in colleges of pharmacy.


Assuntos
Uso Indevido de Medicamentos sob Prescrição , Programas de Monitoramento de Prescrição de Medicamentos , Analgésicos Opioides , Tomada de Decisão Clínica , Substâncias Controladas , Feminino , Humanos , Farmacêuticos , Estudantes
12.
J Am Pharm Assoc (2003) ; 61(3): e86-e92, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33422420

RESUMO

BACKGROUND: Owing to increasing concern over the potential for gabapentin misuse, gabapentin was reclassified as a schedule V controlled substance in Kentucky (July 2017). OBJECTIVE: This study aimed to characterize gabapentin use among Kentucky residents in the first year after its scheduling. METHODS: This study used Kentucky All Schedule Prescription Electronic Reporting data (2018). Gabapentin use was defined as having at least 1 dispensed gabapentin prescription, and high-dose gabapentin use was defined as an average daily dose of more than 3600 mg at the patient level. The prevalence of gabapentin use, concurrent use of gabapentin with opioid analgesics (OAs) (gabapentin-OA), and gabapentin with OAs and benzodiazepines (BDZs) (gabapentin-OA-BDZ) were assessed. Estimated prevalence rate ratio and its 95% CI were reported to compare gabapentin use rates across different demographic groups. RESULTS: A total of 16% of all 2018 controlled substance prescriptions were for gabapentin, and approximately 20% of Kentucky residents with controlled substance prescriptions received gabapentin at least once in 2018. The overall prevalence of gabapentin use was 63 per 1000 residents, with the highest rates among residents aged 55-64 years (126.9 per 1000). The prevalence of gabapentin use was higher in females (74.6 per 1000) versus males (50.6 per 1000) and in residents living in the Appalachian region (88.57 per 1000) versus Central (51.78 per 1000) and Delta (66.41 per 1000) regions. Among gabapentin users, 1% were high-dose users; 27.4% and 11.9% received gabapentin-OA or gabapentin-OA-BDZ concurrently, respectively. As the average daily dose increased from less than 900 mg to high-dose, the percentage of concurrent gabapentin-OA use increased from 13.4% to 50.7%. CONCLUSION: Gabapentin is widely prescribed in Kentucky, with higher rates of use observed in females, those older than 55 years and individuals living in the Appalachian region. Concurrent use of gabapentin and OAs is common, especially in those receiving high-dose gabapentin. Future studies are needed to assess the risks associated with gabapentin use.


Assuntos
Analgésicos Opioides , Substâncias Controladas , Benzodiazepinas , Feminino , Gabapentina , Humanos , Kentucky/epidemiologia , Masculino
13.
Int J Drug Policy ; 91: 103110, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33476862

RESUMO

BACKGROUND: Many nations place drugs into various "schedules" according to their risk of abuse and/or recognized medical value that vary in terms of their restrictions. To mitigate diversion or abuse, drugs sometimes get rescheduled or are scheduled for the first time. Until now, there have not been efforts to integrate lessons from across the range of such past events. METHODS AND DATA: We searched for peer-reviewed evaluations of instances of (re-)scheduling drugs in the United States after 1969 and a comparably large set of instances from other countries. Those 109 articles were supplemented by 30 others found in other ways but not meeting those search criteria (e.g., because the information on rescheduling was a minor part of a more general article). FINDINGS: Findings are reported for many outcomes and with diverse measures over different timelines, making standardization of outcomes difficult. For more than half of the events for which quantitative outcomes were reported, there were declines in use-related measures by at least 40 percent. It is common for there to be reports of increases in indicators pertaining to other substances, sometimes more dangerous but sometimes less dangerous; overall, substitution appears to occur, but be partial. CONCLUSION: Scheduling and up-scheduling can - though does not always - have substantial effects on a range of outcomes. Substitution to other substances is a possibility and so should be anticipated.


Assuntos
Substâncias Controladas , Humanos , Estados Unidos
14.
J Am Pharm Assoc (2003) ; 61(1): e103-e109, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32912756

RESUMO

OBJECTIVES: Adderall (amphetamine-dextroamphetamine) is a controlled substance with harmful adverse effects if abused or misused. We assessed the availability of Adderall from common search engines, and evaluated the safety and marketing characteristics of online pharmacies selling Adderall. DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: From December 2019 to February 2020, the phrase "buy Adderall online" was queried in four search engines: Google (N = 100), Bing (N = 100), Yahoo (N = 50) and DuckDuckGo (N = 50). Online pharmacies that claimed to sell Adderall and had unique Uniform Resource Locators, were active, free-access, and in English language were included. OUTCOME MEASURES: Online pharmacies were categorized as rogue, unclassified, or legitimate on the basis of LegitScript classifications. Safety and marketing characteristics, and costs were collected. RESULTS: Of the 62 online pharmacies found to sell Adderall, 61 were rogue or unclassified. Across all rogue and unclassified online pharmacies, prescriptions were not required (100%), pharmacist services were not offered (100%), and quantity limits were not placed on the number of Adderall purchases (100%). Rogue and unclassified online pharmacies appealed to cost, offering price discounts (61%), bulk discounts (67%), and coupon codes (70%). Contrary to their claims, cheaper prices were available for all formulations and dosages of Adderall from GoodRx than from these online pharmacies. Rogue and unclassified online pharmacies promoted and enabled the illicit purchase of Adderall, appealing to privacy (74%), offering purchase through cryptocurrency (74%), and claiming registration or accreditation of their sites (33%). CONCLUSION: Rogue online pharmacies are pervasive in search engine results, enabling the illicit purchase of Adderall without a prescription. Consumers are at risk of purchasing Adderall, a medication with high abuse potential, from unsafe sources. Law enforcement, regulatory agencies, and search engines should work to further protect consumers from unregistered and illegitimate online pharmacies selling Adderall.


Assuntos
Disponibilidade de Medicamentos Via Internet , Farmácias , Anfetaminas , Substâncias Controladas , Estudos Transversais , Humanos , Internet
15.
J Am Pharm Assoc (2003) ; 61(2): e20-e44, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33127312

RESUMO

OBJECTIVE: To evaluate opioid prescribing, dispensing, and use in relation to hydrocodone-containing product (HCP) rescheduling. METHODS: Seven biomedical databases and grey literature sources were searched with keywords and database-specific controlled vocabulary relevant to HCP rescheduling for items published between January 2014 and July 2019. We included English-language quasi-experimental studies that assessed changes in HCP and other opioid prescribing, dispensing, utilization, and opioid-related health outcomes before and after HCP rescheduling. A data extraction sheet was created for this review. Two authors evaluated risk of bias for each included study. Two of 4 authors each independently extracted patient demographics and opioid-related outcomes from the included studies. Conflicts were resolved by a third author. RESULTS: All studies identified (n = 44) were quasi-experimental in design with 10 using an interrupted time series approach. A total of 24 studies reported a decrease in HCP prescribing by 3.1%-66.0%. Six studies reported a decrease in HCP days' supply or doses by 14.0%-80.8%. There was increased prescribing of oxycodone-containing products by 4.5%-13.9% in 5 studies, tramadol by 2.7%-53.0% in 9 studies, codeine-containing products by 0.8%-1352.9% in 8 studies). Five studies reported a decrease in morphine equivalents by at least 10%, whereas 2 studies reported an increase in morphine equivalents. Differences in populations, sample sizes, and approaches did not allow for a meta-analysis. Details regarding approach and findings were limited in published conference abstracts (n = 16). CONCLUSIONS: Hydrocodone rescheduling was associated with reductions in prescribing and use of HCPs but was also associated with increased prescribing and use of other opioids, both schedule II and nonschedule II.


Assuntos
Analgésicos Opioides , Hidrocodona , Analgésicos Opioides/efeitos adversos , Substâncias Controladas , Prescrições de Medicamentos , Controle de Medicamentos e Entorpecentes , Humanos , Padrões de Prática Médica
16.
J Oral Maxillofac Surg ; 79(1): 58-63, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32956617

RESUMO

PURPOSE: The goal of this study was to examine the medication wasting and disposal practices of oral and maxillofacial surgeons (OMSs) who deliver outpatient anesthesia using controlled substances, and to determine what factors, if any, influence those practices. METHODS: The investigators composed an anonymous online survey that was emailed to OMSs currently practicing in the United States. Participants were questioned about their length of practice experience, drug disposal training, specific methods employed for medication disposal, and the use of a witness during the disposal process. Descriptive and bivariate statistics were computed. The P value was set at 0.05. RESULTS: A total of 5,551 surveys were sent, yielding 719 responses (13%) and 656 completed surveys. The most common disposal methods reported were pouring the unused medications into an absorbent (n = 207, 32.4%), pouring into the sink (n = 196, 30.7%), placing into the sharps container (n = 141, 22.1%), and pouring into the trash (n = 32, 5%). Most respondents (n = 543, 84.7%) utilize a witness during the drug inactivation process. There was a statistically significant negative relationship between years of practice experience and receiving formal training in guidelines for the disposal of controlled substances during residency (P < .001). Those OMSs who received formal training regarding drug inactivation were more likely to standardize medication disposal methods (P < .001) and to utilize witnesses during the process (P = .013). OMSs who employed a standard method for drug disposal were more likely to involve witness confirmation during the process (P < .001). CONCLUSIONS: Medication disposal practices vary widely among OMSs who deliver outpatient anesthesia using controlled substances. Formal training in this area is associated with a greater likelihood of maintaining a standardized disposal method that utilizes a witness during drug disposal but is not associated with rendering the medications nonretrievable during the process. Further educational opportunities among OMSs and residents may help to improve compliance with drug disposal regulations.


Assuntos
Anestesia Dentária , Anestesiologia , Substâncias Controladas , Estudos Transversais , Humanos , Cirurgiões Bucomaxilofaciais , Estados Unidos
17.
R I Med J (2013) ; 103(8): 53-58, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-33003681

RESUMO

OBJECTIVE: To estimate the prevalence of concurrent prescription opioid and non-opioid controlled substance use in Rhode Island (RI). METHODS: We conducted a cross sectional observational study using data from the RI Prescription Drug Monitoring Program on controlled substance prescriptions dispensed in 2018. We estimated the prevalence of concurrent use of other prescribed controlled substances among adults who received at least one opioid prescription. RESULTS: In 2018, 142,692 RI adult residents received at least one opioid prescription, of whom 25.1% (99% confidence interval [CI]: 24.8-25.4) were concurrently prescribed at least one other controlled substance, including benzodiazepines (17.0%, 99% CI: 16.8-17.3), medications for insomnia (4.0%, 99% CI: 3.9-4.2), and stimulants (3.8%, 99% CI: 3.6-3.9). CONCLUSION: The concurrent use of prescription opioids and other prescribed controlled substances is common. Our findings suggest an urgent need to implement focused initiatives to address controlled substance polypharmacy to reduce the risk of overdose.


Assuntos
Analgésicos Opioides , Overdose de Drogas , Programas de Monitoramento de Prescrição de Medicamentos , Adulto , Idoso , Analgésicos Opioides/uso terapêutico , Substâncias Controladas , Estudos Transversais , Overdose de Drogas/tratamento farmacológico , Feminino , Humanos , Masculino , Medicare , Prescrições , Rhode Island , Estados Unidos
18.
J Chromatogr Sci ; 58(10): 985-991, 2020 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-32945334

RESUMO

The aim of this work was to investigate the applicability of a mathematical model developed for the description of supercritical fluid extraction (SFE) of cannabinoids from marijuana and hashish for liquid extraction of other substances. The mentioned model is applicable for dynamic SFE whose implementation is analogous to liquid-solid extraction in quasi-counter current mode. According to this model, quasi-counter current liquid-solid extractions were designed by calculation of component transport constants for extractions of psilocin from hallucinogenic mushroom, mescaline from hallucinogenic cactus, harmine from tropical lyan and salvinorin A from hallucinogenic sage. The mentioned model was found to be suitable for the determination of extraction time needed to reach a predefined extraction recovery for quasi-counter current liquid-solid extractions, as well, which allows the elimination of systematic error caused by the non-extracted part. The calculated component transport constants predict the expectable velocity of the extraction, i.e., the higher the component transport constant is, the higher the extraction velocity is. For mushrooms, it could be stated that preliminary treatment of mushrooms with liquid nitrogen significantly increases the extractability of psilocin.


Assuntos
Agaricales/química , Cromatografia com Fluido Supercrítico/métodos , Substâncias Controladas/isolamento & purificação , Alucinógenos/isolamento & purificação , Plantas/química , Alcaloides/análise , Alcaloides/isolamento & purificação , Canabinoides/análise , Canabinoides/isolamento & purificação , Cannabis/química , Substâncias Controladas/análise , Alucinógenos/análise , Modelos Químicos , Psilocibina/análogos & derivados , Psilocibina/análise , Psilocibina/isolamento & purificação
19.
J Am Pharm Assoc (2003) ; 60(6): 943-950, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32792293

RESUMO

OBJECTIVE: To (1) measure the average time community pharmacists require to query prescription drug monitoring program (PDMP) reports, and (2) estimate pharmacist labor costs associated with PDMP use. DESIGN: This exploratory project consisted of an observational time study followed by analysis of existing PDMP data sets. Data collected included time spent by pharmacists in Final Verification of controlled substance prescriptions (CSPs), and whether or not they queried the PDMP. Zip code level PDMP query rates and prescription volume of opioid and benzodiazepines (O&BZD) were linked to time-study results to calculate cost estimates of pharmacist labor. SETTING AND PARTICIPANTS: Community pharmacists in Connecticut were observed and timed in their usual pharmacy setting as they verified CSPs. Deidentified PDMP data were obtained from the Connecticut Prescription Monitoring and Reporting System. OUTCOME MEASURES: (1) The time required by community pharmacists to query their PDMP in prescription filling workflow, and (2) the estimated labor costs associated with variable PDMP utilization rates. RESULTS: Between November 2018 and January 2019, 9 pharmacists in 4 independent community pharmacies were observed verifying 53 CSPs. Pharmacists spent more time verifying CSPs when they queried the PDMP versus when they did not query the PDMP (106 ± 66 seconds vs. 28 ± 27 seconds; p < 0.01). Between June 2016 and May 2017, community pharmacists in 24 community pharmacies in 4 represented zip codes queried the PDMP for 11% (n = 19,074) of CSPs dispensed, costing an estimated $24,769 in pharmacist labor. To meet a 100% PDMP query rate for O&BZDs alone, an additional 3735 hours of pharmacist labor ($224,100) would be required. CONCLUSION: Pharmacists require considerably more time to verify CSPs when they query PDMPs. This extra time requirement may challenge community pharmacy operating costs, and also impose time pressures on community pharmacists.


Assuntos
Assistência Farmacêutica , Farmácias , Programas de Monitoramento de Prescrição de Medicamentos , Substâncias Controladas , Humanos , Farmacêuticos
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