The Other Victims of the Opioid Epidemic

Glod, Susan A.

doi:10.1056/nejmp1702188

Cited by 27 publications

(23 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…34,35 We share these concerns, but our data did not support the presence of large numbers of dissatisfied patients. Indeed, care was taken to create referral pathways for detoxification programs for those patients interested in addressing long-term habits.…”

Section: Discussioncontrasting

confidence: 56%

Assessment of Opioid Prescribing Practices Before and After Implementation of a Health System Intervention to Reduce Opioid Overprescribing

et al. 2018

View full text Add to dashboard Cite

Key Points Question Can a series of focused interventions targeting different aspects of opioid overprescribing reduce opioid overprescribing within a health system? Findings This quality improvement study found postintervention reductions in opioid prescribing occurred at a statistically significantly faster pace than a preintervention downward trend. Overall reductions for key measures were 58% for morphine milligram equivalents per clinical encounter per month, 34% for morphine milligram equivalents per opioid prescription, and 38% for opioid prescriptions per encounter. Meaning Overprescribing can be reduced in different clinical departments using tools available to most health systems.

show abstract

Section: Discussioncontrasting

confidence: 56%

Assessment of Opioid Prescribing Practices Before and After Implementation of a Health System Intervention to Reduce Opioid Overprescribing

et al. 2018

View full text Add to dashboard Cite

show abstract

“…O pioid abuse is among the most consequential, and sadly, preventable public health threats facing the nation (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13), with recent authority and news reports of 115 deaths per day due to opioids.…”

mentioning

confidence: 99%

Reframing the Prevention Strategies of the Opioid Crisis: Focusing on Prescription Opioids, Fentanyl, and Heroin Epidemic

et al. 2018

View full text Add to dashboard Cite

The opioid epidemic has been called the “most consequential preventable public health problem in the United States.” Though there is wide recognition of the role of prescription opioids in the epidemic, evidence has shown that heroin and synthetic opioids contribute to the majority of opioid overdose deaths. It is essential to reframe the preventive strategies in place against the opioid crisis with attention to factors surrounding the illicit use of fentanyl and heroin. Data on opioid overdose deaths shows 42,000 deaths in 2016. Of these, synthetic opioids other than methadone were responsible for over 20,000, heroin for over 15,000, and natural and semisynthetic opioids other than methadone responsible for over 14,000. Fentanyl deaths increased 520% from 2009 to 2016 (increased by 87.7% annually between 2013 and 2016), and heroin deaths increased 533% from 2000 to 2016. Prescription opioid deaths increased by 18% overall between 2009 and 2016. The Drug Enforcement Administration (DEA) mandated reductions in opioid production by 25% in 2017 and 20% in 2018. The number of prescriptions for opioids declined significantly from 252 million in 2013 to 196 million in 2017 (9% annual decline over this period), falling below the number of prescriptions in 2006. In addition, data from 2017 shows significant reductions in the milligram equivalence of morphine by 12.2% and in the number of patients receiving high dose opioids by 16.1%. This manuscript describes the escalation of opioid use in the United States, discussing the roles played by drug manufacturers and distributors, liberalization by the DEA, the Food and Drug Administration (FDA), licensure boards and legislatures, poor science, and misuse of evidencebased medicine. Moreover, we describe how the influence of pharma, improper advocacy by physician groups, and the promotion of literature considered peer-reviewed led to the explosive use of illicit drugs arising from the issues surrounding prescription opioids. This manuscript describes a 3-tier approach presented to Congress. Tier 1 includes an aggressive education campaign geared toward the public, physicians, and patients. Tier 2 includes facilitation of easier access to non-opioid techniques and the establishment of a National All Schedules Prescription Electronic Reporting Act (NASPER). Finally, Tier 3 focuses on making buprenorphine more available for chronic pain management as well as for medication-assisted treatment. Key words: Opioid epidemic, fentanyl and heroin epidemic, prescription opioids, National All Schedules Prescription Electronic Reporting Act (NASPER), Prescription Drug Monitoring Programs (PDMPs)

show abstract

“…27 Since 2011, the general use of prescription opioids has declined significantly to the extent that access for appropriate medical use was significantly compromised and many would say that the pendulum has swung too far against opioid use. [27][28][29][30] This is the context within which we were trying to recruit for this study. According to Table 2, recruitment in this study may have suffered from both ends of this spectrum.…”

Section: The Opioid Pendulum and Impact On Recruitmentmentioning

confidence: 99%

Methadone vs. morphine SR for treatment of neuropathic pain: A randomized controlled trial and the challenges in recruitment

Lynch

Moulin

Perez

2019

Canadian Journal of Pain

View full text Add to dashboard Cite

Introduction: Accumulating evidence has identified a number of advantages for methadone over other opioids for the treatment of chronic pain including: agonist action at both μ and δ opioid receptors, N-methyl-D-aspartate (NMDA) antagonist activity and the ability to inhibit the reuptake of monoamines. It was hypothesized that with these three mechanisms of action methadone might be a good option for the treatment of neuropathic pain. Methods: This was a double-blind randomized controlled trial comparing methadone to controlled-release morphine. The primary objective was to determine whether methadone is clinically inferior versus noninferior to morphine as an analgesic. Results: We attempted recruitment at three academic pain centers over a 3-year period. In the end only 14 participants were able to be recruited; 5 withdrew and only 9 completed the trial. This study was underpowered. All participants showed a mean reduction in pain intensity according to the Numeric Rating Scale for Pain Intensity (morphine 5.86 to 4.38, methadone 6.11 to 4.5) and reported pain relief compared to pretreatment, but the sample size was too small for statistical analysis. Discussion: Reasons for challenges in recruitment included tight inclusion and exclusion criteria and high participant burden. In addition, there was significant heterogeneity of patients between the three sites, leading to differences in reasons for exclusion. This included seemingly disparate reasons at the different sites, including few participants who were methadone naïve vs. avoidance or fear of opioids. In the end, we were unable to answer the question of the study. RÉSUMÉ

show abstract

The Other Victims of the Opioid Epidemic

Cited by 27 publications

References 3 publications

Assessment of Opioid Prescribing Practices Before and After Implementation of a Health System Intervention to Reduce Opioid Overprescribing

Assessment of Opioid Prescribing Practices Before and After Implementation of a Health System Intervention to Reduce Opioid Overprescribing

Reframing the Prevention Strategies of the Opioid Crisis: Focusing on Prescription Opioids, Fentanyl, and Heroin Epidemic

Methadone vs. morphine SR for treatment of neuropathic pain: A randomized controlled trial and the challenges in recruitment

Contact Info

Product

Resources

About