Addressing the prescription opioid crisis: Potential for hospital‐based interventions?

Kim, Brian; Nolan, Seonaid; Ti, Lianping

doi:10.1111/dar.12541

Cited by 14 publications

(9 citation statements)

References 29 publications

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“…A small, but clinically significant, portion of non-fatal overdose patients (1 in 10) were at risk for repeat non-fatal overdose over a multiyear period; roughly 1 in 50 patients were at risk for fatal overdose. More broadly, patients with repeat non-fatal overdoses are at heightened risk of drug-related death and are unlikely to receive evidence-based treatment for opioid use disorder following non-fatal overdose,33 highlighting the critical role of emergency medical settings in the identification and treatment engagement of high-risk patients 34 35…”

Section: Discussionmentioning

confidence: 99%

Individual and county-level variation in outcomes following non-fatal opioid-involved overdose

Lowder

Amlung

Ray

2020

J Epidemiol Community Health

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BackgroundA lack of large-scale, individually linked data often has impeded efforts to disentangle individual-level variability in outcomes from area-level variability in studies of many diseases and conditions. This study investigated individual and county-level variability in outcomes following non-fatal overdose in a state-wide cohort of opioid overdose patients.MethodsParticipants were 24 031 patients treated by emergency medical services or an emergency department for opioid-involved overdose in Indiana between 2014 and 2017. Outcomes included repeat non-fatal overdose, fatal overdose and death. County-level predictors included sociodemographic, socioeconomic and treatment availability indicators. Individual-level predictors included age, race, sex and repeat non-fatal opioid-involved overdose. Multilevel models examined outcomes following non-fatal overdose as a function of patient and county characteristics.Results10.9% (n=2612) of patients had a repeat non-fatal overdose, 2.4% (n=580) died of drug overdose and 9.2% (n=2217) died overall. Patients with a repeat overdose were over three times more likely to die of drug-related causes (OR=3.68, 99.9% CI 2.62 to 5.17, p<0.001). County-level effects were limited primarily to treatment availability indicators. Higher rates of buprenorphine treatment providers were associated with lower rates of mortality (OR=0.82, 95% CI 0.68 to 0.97, p=0.024), but the opposite trend was found for naltrexone treatment providers (OR=1.20, 95% CI 1.03 to 1.39, p=0.021). Cross-level interactions showed higher rates of Black deaths relative to White deaths in counties with high rates of naltrexone providers (OR=1.73, 95% CI 1.09 to 2.73, p=0.019).ConclusionAlthough patient-level differences account for most variability in opioid-related outcomes, treatment availability may contribute to county-level differences, necessitating multifaceted approaches for the treatment and prevention of opioid abuse.

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Section: Discussionmentioning

confidence: 99%

Individual and county-level variation in outcomes following non-fatal opioid-involved overdose

Lowder

Amlung

Ray

2020

J Epidemiol Community Health

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“…36 Studies have shown that opioid over-prescribing to hospital patients contributes significantly to increasing misuse of opioids. 37 Moreover, hospitals are a crucial point of contact for opioid victims in crisis. Hospital EDs experienced a 30% increase in the number of visits related to opioid overdoses in 2017 38 making the hospital setting an important opportunity for coordinated care linking services from health departments, mental health professionals, community based organization and law enforcement to prevent repeat overdoses.…”

Section: How Hospitals Could Advance Racial Equity In the Opioid Crisismentioning

confidence: 99%

Next Steps in Health Reform: Hospitals, Medicaid Expansion, and Racial Equity

Matthew¹

2018

J. Law. Med. Ethics

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The confluence of racial unrest and Medicaid expansion in Virginia should inspire a national reimagining of how health care can contribute to health equity. Hospitals in particular can leverage their role as economic drivers in communities to equalize health and social outcomes for all. The urgent need for innovative opioid intervention presents a fertile proving ground for new ways that hospitals can act to reduce the impact of racial inequity. Inspired by the role hospitals played to achieve desegregation during the Civil Rights era, this essay proposes an integrated approach to use Medicaid expansion to advance health and racial healing in America.

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“…Especially in the United States (US), the misuse of opioids has reached the level of a national crisis, impacting not only public health but also social and economic welfare [ 18 , 37 ]. Since opioid consumption in the hospital environment can substantially increase the risk of continued opioid use [ 3 , 15 , 17 , 22 ], hospital-based opioid use policies are likely to play a crucial role in the global opioid epidemic.…”

Section: Introductionmentioning

confidence: 99%

In-hospital postoperative opioid use and its trends in neurosurgery between 2007 and 2018

2021

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Background Postoperative opioid use plays an important role in the global opioid crisis, but little is known about in-hospital opioid use trends of large surgical units. We investigated whether postoperative in-hospital opioid consumption changed in a large academic neurosurgical unit between 2007 and 2018. Methods We extracted the data of consumed opioids in the neurosurgical intensive care unit and two bed wards between 2007 and 2018. Besides overall consumption, we analyzed the trends for weak (tramadol and codeine), strong, and the most commonly used opioids. The use of various opioids was standardized using the defined daily doses (DDDs) of each opioid agent. A linear regression analysis was performed to estimate annual treatment day-adjusted changes with 95% confidence intervals. Results Overall, 121 361 opioid DDDs were consumed during the 196 199 treatment days. Oxycodone was the most commonly used postoperative opioid (49% of all used opioids) in neurosurgery. In the bed wards, the use of oral oxycodone increased 375% (on average 13% (9–17%) per year), and the use of transdermal buprenorphine 930% (on average 26% (9–45%) per year) over the 12-year period. Despite the increased use of strong opioids in the bed wards (on average 3% (1–4%) per year), overall opioid use decreased 39% (on average 6% (4–7%) per year) between 2007 and 2018. Conclusions Due to the increase of strong opioid use in the surgical bed wards, we encourage other large teaching hospitals and surgical units to investigate whether their opioid use trends are similarly worrisome and whether the opioid consumption changes in the hospital setting are transferred to opioid use patterns or opioid-related harms after discharge.

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Addressing the prescription opioid crisis: Potential for hospital‐based interventions?

Cited by 14 publications

References 29 publications

Individual and county-level variation in outcomes following non-fatal opioid-involved overdose

Individual and county-level variation in outcomes following non-fatal opioid-involved overdose

Next Steps in Health Reform: Hospitals, Medicaid Expansion, and Racial Equity

In-hospital postoperative opioid use and its trends in neurosurgery between 2007 and 2018

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