Curtailing Diversion and Abuse of Opioid Analgesics Without Jeopardizing Pain Treatment

National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD 20892, USA.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 04/2011; 305(13):1346-7. DOI: 10.1001/jama.2011.369
Source: PubMed
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    • "In Indiana, counties with higher rates of dentists and pharmacists had more per capita opioid prescriptions. While it is true that primary care physicians and internists write the most prescriptions for opioids (Governale, 2010; Volkow et al., 2011), other research has demonstrated that dentists are a significant source of opioid prescriptions (Volkow et al., 2011). Our findings regarding pharmacists further reinforce the need to think more systemically about the problem as the accessibility and abuse of "
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    ABSTRACT: Background Opioid use and abuse in the United States continues to expand at an alarming rate. In this study, we examine the county-level determinants of the availability and abuse of prescription opioids to better understand the socio-ecological context, and in particular the role of the healthcare delivery system, on the prescription drug abuse epidemic. Methods. We use community-level information, data from Indiana's prescription drug monitoring program in 2011, and geospatial regression methods to identify county-level correlates of the availability and abuse of prescription opioids among Indiana's 92 counties. Results. The findings suggest that access to healthcare generally, and to dentists and pharmacists in particular, increases the availability of prescription opioids in communities, which, in turn, is associated with higher rates of opioid abuse. Conclusions. The results suggest that the structure of the local healthcare system is a major determinant of community-level access to opioids adding to a growing body of evidence that the problem of prescription opioid abuse is, at least in part, an “iatrogenic epidemic.”
    Drug and alcohol dependence 05/2014; 138(1). DOI:10.1016/j.drugalcdep.2014.03.002 · 3.42 Impact Factor
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    • "[80]. Finally, the literature has shown that opioid overdose is the second leading cause of unintentional death in the U.S. [81], while the estimated total healthcare costs attributed to prescription opioid abuse are estimated at US $25.0 billion [82]. "
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    ABSTRACT: Chronic non-cancer pain is a debilitating condition associated with high individual and societal costs. While opioid treatment for pain has been available for centuries, it is associated with high variability in outcome, and a considerable proportion of patients is unable to attain relief from symptoms while suffering adverse events and developing medication dependence. We performed a review of the efficacy of pharmacogenomic markers and their abilities to predict adverse events, dependence, and associated economic costs, focusing on two genes: OPRM1 and CYP2D6. Data sources were articles indexed by PubMed on or before August 6, 2013. Articles were first selected after review of their titles and abstracts, and full papers were read to confirm eligibility. Initially, fifty-two articles were identified. Of these, 17 were relevant to biological actions of pharmacogenomic markers and their effect on therapeutic efficacy, 16 to adverse events, 15 to opioid dependence, and eight to economic costs. In conclusion, increasing costs of opioid therapy have made the advances in pharmacogenomics an attractive solution to personalize care with unclear repercussions related to the impact on costs, morbidity, and outcomes. This intersection of pharmacoeconomics and pharmacogenomics presents a unique platform to further examine current advances in clinical medicine and their utility in cost-effective treatment of chronic pain.
    Pain Research and Treatment 09/2013; 2013:943014. DOI:10.1155/2013/943014
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    • "Since about 2000, non-medical use and harms (e.g., morbidity, mortality) related to prescription opioids (POs) have emerged as a major substance use and public health problem in North America, including Canada [1,2]. While key facets of this very problem are solidly documented in the United States (US), the only country in the world with a higher overall PO consumption (in Defined Daily Doses, DDD) per capita than Canada, relevant indicator data for Canada have been available only selectively, in part due to inadequate monitoring systems [1,3,4]. "
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    ABSTRACT: Background Non-medical prescription opioid use (NMPOU) and prescription opioid (PO) related harms have become major substance use and public health problems in North America, the region with the world’s highest PO use levels. In Ontario, Canada’s most populous province, NMPOU rates, PO-related treatment admissions and accidental mortality have risen sharply in recent years. A series of recent policy interventions from governmental and non-governmental entities to stem PO-related problems have been implemented since 2010. Findings We compared the prevalence of NMPOU in the Ontario general adult population (18 years+) in 2010 and 2011 based on data from the ‘Centre for Addiction and Mental Health (CAMH) Monitor’ (CM), a long-standing annual telephone interview-based representative population survey of substance use and health indicators. While ‘any PO use’ (in past year) changed non-significantly from 26.6% to 23.9% (Chi2 = 2.511; df = 1; p = 0.113), NMPOU decreased significantly from 7.7% to 4.0% (Chi2 = 14.786; df = 1; p < 0.001) between 2010 and 2011. Over-time changes varied by age group but not by sex. Conclusions The observed substantial decrease in NMPOU in the Ontario adult population could be related to recent policy interventions, alongside extensive media reporting, focusing on NMPOU and PO-related harms, and may mean that these interventions have shown initial effects. However, other casual factors could have been involved. Thus, it is necessary to systematically examine whether the observed changes will be sustained, and whether other key PO-related harm indicators (e.g., treatment admissions, accidental mortality) change correspondingly in order to more systematically assess the impact of the policy measures.
    Substance Abuse Treatment Prevention and Policy 02/2013; 8(1):7. DOI:10.1186/1747-597X-8-7 · 1.16 Impact Factor
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