This study found that the frequency of opioid use disorders was 4 times higher in patients receiving opioid therapy compared with general population samples (3.8% vs 0.9%). The study also provides quantitative data linking aberrant drug behaviors to opioid use disorders.

The authors define sufficiently important difference (SID) as the smallest amount of patient-valued benefit that an intervention would require to justify associated costs, risks, and other harms. As a means toward estimation of SID, the authors propose benefit-harm tradeoff methods, in which domains of benefit and harm are systematically traded off against each other and assessed in relation to the global decision of whether a treatment choice is worthwhile. Specific SID estimates can be used to power and interpret clinical trials or to inform health services research and/or public health policy. This article briefly describes the evolution of the important difference concept and outlines similarities and differences between MID and SID.

Depression and suicide are of increasing concern on college campuses. This article presents data from the College Health Intervention Projects on the frequency of depression and suicide ideation among 1,622 college students who accessed primary care services in 4 university clinics in the Midwest, Northwest, and Canada. Students completed the Beck Depression Inventory and other measures related to exercise patterns, alcohol use, sensation seeking, and violence. The frequency of depression was similar for men (25%) and women (26%). Thought of suicide was higher for men (13%) than women (10%). Tobacco use, emotional abuse, and unwanted sexual encounters were all associated with screening positive for depression. "Days of exercise per week" was inversely associated with screening positive for depression. Because the majority of students access campus-based student health centers, medical providers can serve a key role in early identification and intervention. With every 4th student reporting symptoms of depression and every 10th student having suicidal thoughts, such interventions are needed.Keywords university students; full and reduced-form logistic regression; randomized controlled trials; depression; suicidal ideation; university health clinics Correspondence concerning this article should be addressed to Michael Fleming, Feinberg School of Medicine, Northwestern University, Abbott Hall, 710 N. Lake Shore Dr., Chicago, IL 60611. Electronic mail may be sent to m-fleming@northwestern.edu. Brian Harahan is now at the University of Minnesota. Michael Fleming is now at Northwestern University. NIH Public Access Author ManuscriptAm J Orthopsychiatry. Author manuscript; available in PMC 2012 January 1. Depression and other mental health disorders are a significant public health problem on college campuses. Many students experience their first psychiatric episode while at college, and 12 to 18% of students have a diagnosable mental illness (Mowbray, Megivern & Mandiberg, 2006). Epidemiological studies suggest that the 15 to 21 age category (typical college years) has the highest past-year prevalence rate of mental illness at 39%. Eisenberg (2007) reported that the general prevalence of depression and anxiety is 16% among undergraduate students and 13% among graduate students. Based on findings from the American College Health Association (ACHA) National College Health Assessment (NCHA), the rates of students reporting having been diagnosed with depression has increased from 10% in 2000 to 18% in 2008 (2000, 2008). A number of factors contribute to the initial presentation of depression during college. The transition itself from home to college places additional life stressors on young adults as they explore their identity, strive to master new skills, are away from established social support systems, and have increased time demands (Dyson & Renk, 2006).The consequences of depression are significant. Depression has long been associated with academic impairment (Heiligenstein, Guenther, Hsu, & Herman, 1996). Depr...

Objective-To assess the use of opioids by primary care physicians for the treatment of chronic pain.Methods-A written survey was completed by 248 primary care physicians. Outcomes of interest included type of opioids prescribed, common pain diagnoses treated, opioid prescribing concerns, treatment of patients with a history of substance use disorders and clinic-based protocols for pain management.Results-The mean age of the physicians who completed the questionnaire was 41 years. The majority were between the ages of 30 and 49 years (68%) with an equal number of men and women. Seventy percent were family physicians, 28.7% internists and less than 2% were community physicians and geriatricians. Physician concerns regarding opioid therapy included prescription drug abuse (84.2%), addiction (74.9%), adverse effects (68%), tolerance (60.7%), and medication interaction (32%). The survey found that the majority of the physicians were comfortable in prescribing narcotics to patients with terminal cancer. However, they were less comfortable prescribing narcotics to patients with low back pain and persons with a current or past history of drug or alcohol abuse. Physician management practices suggested that urine toxicology tests were underutilized with only 6.9% reporting obtaining this test before prescribing opioids and only 15.0% performing urine toxicology tests on patients already prescribed opioids. Logistic regression analysis revealed that whether or not physicians routinely conducted urine toxicology screens was significantly (p = 0.015) predicted by whether they had a system to track patients on opioids when prescribing narcotics. The primary limitation of the study is the reliance on physician self-report rather than objective measures of physician behavior. Conclusions-The survey suggests physicians are concerned about drug abuse, addiction, adverse effects, tolerance, and medication interaction. Their comfort level in prescribing opioids varies with the patient characteristics. Urine toxicology testing is underutilized in the primary care setting.

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