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The recent death from a heroin overdose of actor Philip Seymour Hoffman at the age of 46 highlights the danger of opioid addiction. However, according to the U.S. Centers for Disease Control, prescription opioids such as OxyContin, Percocet, and Vicodin may be gateway drugs for heroin addiction and are responsible for five times as many deaths. ''The main driver of overdoses right now in our country is from opioid medications, more than from heroin,'' said Nora Volkow, director of the National Institute on Drug Abuse (NIDA). 1 Prescription drug overdose rates have more than tripled since 1990, paralleling a 300% increase in sales of strong prescription opioids. What is being done about this growing problem, and how can virtual reality (VR)-assisted behavioral interventions help? The paper presents a possible answer.
How Can Virtual Reality Interventions Help Reduce
Prescription Opioid Drug Misuse?
Brenda K. Wiederhold, PhD, MBA, BCB, BCN,
Giuseppe Riva, PhD,
and Mark D. Wiederhold, MD, PhD, FACP
The recent death from a heroin overdose of actor
Philip Seymour Hoffman at the age of 46 highlights the
danger of opioid addiction. However, according to the U.S.
Centers for Disease Control, prescription opioids such as
OxyContin, Percocet, and Vicodin may be gateway drugs for
heroin addiction and are responsible for five times as many
deaths. ‘‘The main driver of overdoses right now in our
country is from opioid medications, more than from heroin,’’
said Nora Volkow, director of the National Institute on Drug
Abuse (NIDA).
Prescription drug overdose rates have more
than tripled since 1990, paralleling a 300% increase in sales
of strong prescription opioids.
What is being done about this growing problem, and how
can virtual reality (VR)-assisted behavioral interventions
help? In addition to NIDA, other U.S. agencies involved in
the fight against prescription opioid abuse and misuse in-
clude the Drug Enforcement Administration and the Food
and Drug Administration. In February, the DEA launched a
new texting initiative, TIP411, which helps the public report
suspicious activity such as seeing a pharmacy tech drive off
in an expensive car. Tipsters can use the keyword PILLTIP
to report anomalies that may indicate illegal prescription
drug activity, and the message will be forwarded to a DEA
agent for investigation. The FDA is proposing to reclassify
hydrocodone combination pills such as Vicodin from Sche-
dule III to Schedule II. Adoption of the proposal would mean
that prescriptions for this type of drug couldn’t be called in
over the phone and would require reauthorization from the
physician before being refilled.
Studies have concluded that only a small percentage of
people who are prescribed opioids for medical reasons will
go on to develop addictions to these drugs, and that one of the
ways to prevent addiction is to preselect for no previous
history of or current problems with drug or alcohol abuse or
Consistent with other studies on the subject, one
study using Medicaid data found that about 3% of individ-
uals will graduate to abuse or dependence, with the popu-
lation most vulnerable to addiction being those younger than
Studies suggest similar rates of prescription opioid misuse
in the EU, although direct United States–Europe comparisons
are difficult because of different physician prescribing pat-
Another study found that ‘‘Native Americans had
significantly greater rates of nonmedical prescription drug use
and drug use disorders, highlighting the need for culturally-
sensitive prevention and intervention programs.’
In addition to humanitarian reasons, there are significant
financial incentives to find ways to reduce the incidence of
prescription opioid misuse. One study found that ‘‘mean
annual direct health care costs for opioid abusers were more
than eight times higher than for nonabusers.’’
Another study
noted, ‘‘The total cost of prescription opioid abuse in 2001
was estimated at $8.6 billion, including workplace, health
care, and criminal justice expenditures.’’
Of course, this amount is a drop in the bucket compared to
the total cost to the U.S. economy of chronic pain, recently
estimated by the Institute of Medicine at between $560 and
$630 billion annually.
The European Federation of Inter-
national Association for the Study of Pain (IASP) Chapters
notes that to date, ‘‘there is no comprehensive pan-European
epidemiological survey laying out the scope of the pain
However, a 2010 report noted that ‘‘chronic
pain costs Europe billions of euros every year, with national
costs ranging from 1.1 billion to nearly 50 billion Euros.’’
Combinations of prescription opioids with other drugs have a
modest additive effect on pain relief, while combinations of
prescription opioids with behavioral interventions have been
shown to be effective, for example, in reducing headache
pain. As we researchers in the field of VR-assisted therapy
have been saying for many years, it would be most helpful if
we could identify predictors of who will be likely treatment
The editor and others involved in VR research have made
strides in showing the effectiveness of ‘‘various psycholog-
ical techniques, including distraction by virtual reality en-
vironments and the playing of video games, [which] are
being employed to treat pain.’’
Perhaps if additional dollars
were directed to support evidence-based research on both the
psychological and neurophysiological mechanisms related to
pain, and the effectiveness of these nondrug modalities, we
would be able to make a significant contribution to reducing
Virtual Reality Medical Institute, Brussels, Belgium.
Interactive Media Institute, San Diego, California.
Department of Psychology, Catholic University of Milan, Italy.
Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Milan, Italy.
The Virtual Reality Medical Center (VRMC), San Diego, California.
Volume 17, Number 6, 2014
ªMary Ann Liebert, Inc.
DOI: 10.1089/cyber.2014.1512
the need for opioid prescriptions and the deadly conse-
quences of their abuse. As recently suggested by Herta Flor,
‘‘The analysis of neurophysiological mechanisms may also
lead to the development of new psychological interventions
that can target these changes in a much more specific manner
than pharmacological interventions.’’
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Profs. Brenda K. Wiederhold, Giuseppe Riva,
and Mark D. Wiederhold
... 22 Given the effectiveness of VR therapy for pain management, VR as an adjunctive non-pharmacologic pain therapy program has potential to reduce opioid utilization. 23 Other possible benefits of inpatient VR therapy include reduction in hospital LOS and increased patient satisfaction. 24,25 While the use of VR in the hospital is promising, no study to our knowledge has yet examined the cost and effectiveness thresholds required for an inpatient VR program to be cost-saving. ...
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Pain management: the real cost of virtual reality Implementing virtual reality (VR) programs for inpatient pain management can potentially save hospitals money. Recent studies have highlighted VR as an effective alternative to traditional opioid treatments for the management of pain. Brennan Spiegel, at Cedars-Sinai Medical Center in Los Angeles, and colleagues carried out an economic analysis to determine the cost implications of implementing inpatient VR therapy programs for acute pain management in different US hospital settings. They found that such programs are cost-saving when they reduce patients’ length of stay in the hospital. However, the projected costs for inpatient VR programs are higher than the savings that can be made from decreases in opioid use or additional income from Hospital Consumer Assessment of Healthcare Providers and Systems-related reimbursements through increased patient satisfaction alone.
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Introduction: The annual mortality and national expense of the opioid crisis continue to rise in the USA (130 deaths/day, $50 billion/year). Opioid use disorder usually starts with the prescription of opioids for a medical condition. Its risk is associated with greater pain intensity and coping strategies characterised by pain catastrophising. Non-pharmacological analgesics in the hospital setting are critical to abate the opioid epidemic. One promising intervention is virtual reality (VR) therapy. It has performed well as a distraction tool and pain modifier during medical procedures; however, little is known about VR in the acute pain setting following traumatic injury. Furthermore, no studies have investigated VR in the setting of traumatic brain injury (TBI). This study aims to establish the safety and effect of VR therapy in the inpatient setting for acute traumatic injuries, including TBI. Methods and analysis: In this randomised within-subjects clinical study, immersive VR therapy will be compared with two controls in patients with traumatic injury, including TBI. Affective measures including pain catastrophising, trait anxiety and depression will be captured prior to beginning sessions. Before and after each session, we will capture pain intensity and unpleasantness, additional affective measures and physiological measures associated with pain response, such as heart rate and variability, pupillometry and respiratory rate. The primary outcome is the change in pain intensity of the VR session compared with controls. Ethics and dissemination: Dissemination of this protocol will allow researchers and funding bodies to stay abreast in their fields through exposure to research not otherwise widely publicised. Study protocols are compliant with federal regulation and University of Maryland Baltimore's Human Research Protections and Institutional Review Board (protocol number HP-00090603). Study results will be published on completion of enrolment and analysis, and deidentified data can be shared by request to the corresponding author. Trial registration number: NCT04356963; Pre-results.
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Importance It is unknown whether smartphone-based virtual reality (VR) games are effective in reducing pain among pediatric patients in real-world burn clinics. Objective To evaluate the efficacy of a smartphone VR game on dressing pain among pediatric patients with burns. Design, Setting, and Participants This randomized clinical trial included children aged 6 to 17 years who seen in the outpatient clinic of a large American Burn Association–verified pediatric burn center and level I pediatric trauma center between December 30, 2016, and January 23, 2019. Speaking English as their primary language was an inclusion criterion. Intention-to-treat data analyses were conducted from December 2019 to March 2020. Interventions Active VR participants played a VR game; passive VR participants were immersed in the same VR environment without interactions. Both groups were compared with a standard care group. One researcher administered VR and observed pain while another researcher administered a posttrial survey that measured the child’s perceived pain and VR experience. Nurses were asked to report the clinical utility. Main Outcomes and Measures Patients self-reported pain using a visual analog scale (VAS; range, 0-100). A researcher observed patient pain based on the Face, Legs, Activity, Cry, and Consolability–Revised (FLACC-R) scale. Nurses were asked to report VR helpfulness (range, 0-100; higher scores indicate more helpful) and ease of use (range, 0-100; higher scores indicate easier to use). Results A total of 90 children (45 [50%] girls, mean age, 11.3 years [95% CI, 10.6-12.0 years]; 51 [57%] White children) participated. Most children had second-degree burns (81 [90%]). Participants in the active VR group had significantly lower reported overall pain (VAS score, 24.9 [95% CI, 12.2-37.6]) compared with participants in the standard care control group (VAS score, 47.1 [95% CI, 32.1-62.2]; P = .02). The active VR group also had a lower worst pain score (VAS score, 27.4 [95% CI, 14.7-40.1]) than both the passive VR group (VAS score, 47.9 [95% CI, 31.8-63.9]; P = .04) and the standard care group (VAS score, 48.8 [95% CI, 31.1-64.4]; P = .03). Simulator sickness scores (range, 0-60; lower scores indicate less sickness) were similar for active VR (19.3 [95% CI, 17.5-21.1]) and passive VR groups (19.5 [95% CI, 17.6-21.5]). Nurses also reported that the VR games could be easily implemented in clinics (helpfulness, active VR: 84.2; 95% CI, 74.5-93.8; passive VR: 76.9; 95% CI, 65.2-88.7; ease of use, active VR: 94.8, 95% CI, 91.8-97.8; passive VR: 96.0, 95% CI, 92.9-99.1). Conclusions and Relevance In this study, a smartphone VR game was effective in reducing patient self-reported pain during burn dressing changes, suggesting that VR may be an effective method for managing pediatric burn pain. Trial Registration Identifier: NCT04544631
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Tinder has become a popular online dating tool for people looking for either short- or long-term relationships. In this study we build on existing research on gender differences in the motivations of Tinder users, by analyzing gender differences in self-presentation. We predicted that women would try to attract men to right-swipe (i.e., potentially match) their profiles through largely visual means; while men would put more emphasis on showing off their skills and interests. In a sample of 300 randomly obtained Tinder profiles (150 heterosexual females and 150 heterosexual males), half from Colombia and half from the USA, we found mixed support for our hypotheses. There was no significant difference between numbers of photos uploaded by women and men, but certain types of photos were unique to one gender. Links to other social networks did not differ much between genders; however, men tended to include more textual information in their profiles.
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Annual Review of CyberTherapy and Telemedicine (ARCTT – ISSN: 1554-8716) is published annually (once per year) by the Interactive Media Institute (IMI), a 501c3 non-profit organization, dedicated to incorporating interdisciplinary researchers from around the world to create, test, and develop clinical protocols for the medical and psychological community. IMI realizes that the mind and body work in concert to affect quality of life in individuals and works to develop technology
Background Cancer patients suffer from severe pain due to the nature of their disease, the stages of chemotherapy they go through and its side effects, which may ultimately lead to physical impairments and inability to perform daily activities. Objectives The present study aimed to investigate the effect of virtual reality therapy (VRT) on pain variables among 30 adolescents with cancer at the chemotherapy stage. Method This study employed a quasi‐experimental pretest–post‐test design with follow‐up. Thirty adolescents with cancer were selected using a convenience sampling method and were randomly assigned to experimental and control groups. The experimental group underwent eight 30‐min sessions of VRT once a week for 2 months, while the control group were put on a waiting list. Results Findings revealed that there were significant differences in pain variables between the control and experimental groups (p < .001). Moreover, the effect of the treatment remained constant during the first and second follow‐up periods. Conclusions Regarding the prevalence of pain indicators and the effect of these variables on the treatment and improvement of the adolescents with cancer during the chemotherapy stage, the use of this technology is recommended.
From tools for hunting and harvesting and monumental inventions of the industrial revolution that have propelled us into today’s ubiquitous information-age, innovative technologies and technological applications have transformed human-based experience. Abounding seemingly overnight, advanced technological applications have revolutionized the healthcare industry by mobilizing treatment and intervention services. While the advent of technologically driven mobile healthcare may appear to some as an emerging field, researchers, clinicians, and practitioners have been implementing contemporary technologies, such as virtual reality (VR), into their mental healthcare practices for over two decades. Clinically validated treatments for anxiety, phobias, pain distraction, posttraumatic stress disorder (PTSD), stress management and prevention, and rehabilitation are only a handful of ways that this immersive technology transforms behavioral healthcare. Via immersive environments, clinicians are better able to expose patients to feared stimuli than traditional imaginal techniques, providing greater effectiveness in treatments and significant improvements in patients’ overall wellbeing. Additionally, the mobilization of healthcare to smartphones and other devices facilitates the migration of services beyond the walls of the traditional doctor’s office and into the homes and everyday lives of those who need it most. Ultimately, innovative applications by researchers, clinicians, and practitioners prove VR and augmented reality (AR) technologies as effective, efficient, and widely accessible tools in mental healthcare interventions.
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In 2016, the U.S. Centers for Disease Control and Prevention (CDC) issued new guidelines regarding the use and prescription of opioids for the treatment of chronic pain [1]. Today, "the CDC recommends that opioids should not be the first line or only treatment for patients who present with chronic noncancer pain" [2]. Additionally, the National Institute on Drug Abuse suggests that cognitive-behavioral therapy (CBT) offers significant advantages and is effective for pain management in many situations where narcotics were previously prescribed. The American College of Physicians has also released new guidelines for the treatment of lower back pain and recommends a nonnarcotic CBT-based approach [3]. These new approaches come at a time when new technologies are being developed as a means to enhance patient engagement and education and to supplement care with information and communication technologies (ICTs) (Figure 1) [4], [5]. For more than 20 years, researchers and clinicians have been applying technologies, such as virtual reality (VR), to conquer specific phobias and anxiety disorders, overcome posttraumatic stress disorder (PTSD), and rehabilitate patients suffering from chronic pain or other debilitating incidents [6]-[9].
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Diversas abordagem vêm sendo aplicadas para atenuar o problema do consumo de drogas por jovens e adolescentes, todas baseadas nos efeitos negativos de seu consumo. Todavia, o que se tem percebido é que este tipo de estratégia está muito aquém do convívio do adolescente. Portanto, a estratégia aqui relatada investiga o comportamento do adolescente e jovem em idade escolar no intuito de identificar a necessidade de uma intervenção para coibir não apenas o possível uso, mas também identificar a compreensão sobre os malefícios do consumo de diversos tipos de entorpecentes. Materiais e métodos: Foram usados o método qualitativo para avaliar as perguntas e respostas de crianças e adolescente ao usar o jogo (e, desta forma, avaliar a comunicabilidade) juntamente com um método quantitativo para promover as análises apresentadas no texto. Resultados: Observa-se que as informações colhidas pelo jogo assumem um caráter de colaboração às abordagens tradicionais de repressão e combate ao consumo de drogas. Conclusão: O método do uso de jogos digitais promove maior envolvimento das crianças e adolescentes e ajuda as abordagens tradicionais a ampliar a eficácia da promoção da saúde no meio escolar.
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Pain and discomfort are perceptible during many medical procedures. In the past, drugs have been the conventional means to alleviate pain, but in many instances, medications by themselves do not provide optimal results. Current advances are being made to control pain by integrating both the science of pain medications and the science of the human mind. Various psychological techniques, including distraction by virtual reality environments and the playing of video games, are being employed to treat pain. In virtual reality environments, an image is provided for the patient in a realistic, immersive manner devoid of distractions. This technology allows users to interact at many levels with the virtual environment, using many of their senses, and encourages them to become immersed in the virtual world they are experiencing. When immersion is high, much of the user’s attention is focused on the virtual environment, leaving little attention left to focus on other things, such as pain. In this way virtual reality provides an effective medium for reproducing and/or enhancing the distractive qualities of guided imagery for the majority of the population who cannot visualize successfully.
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To estimate the prevalence of and risk factors for opioid abuse/dependence in long-term users of opioids for chronic pain, including risk factors for opioid abuse/dependence that can potentially be modified to decrease the likelihood of opioid abuse/dependence, and non-modifiable risk factors for opioid abuse/dependence that may be useful for risk stratification when considering prescribing opioids. We used claims data from two disparate populations, one national, commercially insured population (HealthCore) and one state-based, publicly insured (Arkansas Medicaid). Among users of chronic opioid therapy, we regressed claims-based diagnoses of opioid abuse/dependence on patient characteristics, including physical health, mental health and substance abuse diagnoses, sociodemographic factors, and pharmacological risk factors. Among users of chronic opioid therapy, 3% of both the HealthCore and Arkansas Medicaid samples had a claims-based opioid abuse/dependence diagnosis. There was a strong inverse relationship between age and a diagnosis of opioid abuse/dependence. Mental health and substance use disorders were associated with an increased risk of opioid abuse/dependence. Effects of substance use disorders were especially strong, although mental health disorders were more common. Concerning opioid exposure; lower days supply, lower average doses, and use of Schedule III-IV opioids only, were all associated with lower likelihood of a diagnosis of opioid abuse/dependence. Opioid abuse and dependence are diagnosed in a small minority of patients receiving chronic opioid therapy, but this may under-estimate actual misuse. Characteristics of the patients and of the opioid therapy itself are associated with the risk of abuse and dependence.
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Prescription opioid abuse and its associated costs are a problem in the United States, with significant epidemiologic and economic consequences. The breadth and depth of these consequences are not fully understood at present. To summarize published, English-language biomedical evidence pertaining to the epidemiology and costs of prescription opioid analgesic misuse and abuse and to describe efforts to reduce the burden of these problems. Published English-language articles on the epidemiology and economics of abuse, misuse, or diversion of prescribed opioid analgesics in the United States were identified by searching PubMed, Web of Science, the Cumulative Index to Nursing and Allied Health Literature database (CINAHL), EconLit, and PsycInfo, using (economics OR epidemiology) AND (misuse OR abuse) AND opioid as search terms or Medical Subject Heading (MeSH) terms. Article bibliographies were also searched manually for applicable papers. The search was limited to articles published from 1995 through July 2009. The literature search identified 2,347 titles, of which all but 41 were excluded as not pertaining specifically to the epidemiology or economics of prescription opioid abuse or misuse in the United States. In 2006, approximately 5.2 million individuals in the United States reported using prescription analgesics nonmedically in the prior month, up from 4.7 million in 2005. The total cost of prescription opioid abuse in 2001 was estimated at $8.6 billion, including workplace, health care, and criminal justice expenditures. One study of commercially insured beneficiaries in the United States found that mean per-capita annual direct health care costs from 1998 to 2002 were nearly $16,000 for abusers of prescription and nonprescription opioids compared with approximately $1,800 for nonabusers who had at least 1 prescription insurance claim. The economic burden of prescription opioid misuse and abuse is large. While the existing evidence indicates that persons who abuse or misuse prescription opioids incur higher costs and health care resource use, differences in methods used to explore this question make estimating the actual societal burden imposed by this problem difficult. Efforts to establish and maintain a balance between access to these drugs for legitimate pain management while decreasing the risk of abuse and misuse are critically important and include such tools as patient and provider education, patient screening, and use of technology.
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Misuse of prescription opioid medications has continued as a major public health problem in the United States. Review of major epidemiologic databases shows that the prevalence of opioid misuse rose markedly through the 1990s and the early part of the current decade. In this same period of time, the number of prescriptions for chronic noncancer pain increased markedly, and the intersection of these two public health problems remains a concern. Further, despite some leveling off of the overall rate of prescription opioid misuse in the past several years, surveillance data show high and increasing mortality associated with these drugs. Analysis of the 2006 National Survey of Drug Use and Health indicates the increasing prevalence of prescription opioid misuse is associated more with an increase in the general availability of these medications than misuse of the medications by those who were directly prescribed them. National Institute on Drug Abuse initiatives to address the prescription opioid problem include programs to stimulate research in the basic and clinical sciences, and to educate physicians and other health personnel.
Chronic pain is a prevalent problem with significant costs to individuals, significant others, and society. In this article, which introduces the American Psychologist special issue on chronic pain, we provide an overview of the seminal contributions made by psychologists to our current understanding of this important problem. We also describe the primary treatments that have been developed based on psychological principles and models of pain, many of which have demonstrated efficacy for reducing pain and its impact on psychological and physical functioning. The article ends with an enumeration of directions for future research and clinical practice. We believe that the chronicle of psychology's role in improving our understanding and treatment of pain provides a model for how psychologists can have a significant influence on many fields, and that the models and approaches developed for understanding and treating pain may be of use to psychologists working in other areas. Thus, we think that chronic pain is an important area of study that offers insights about translational research for ALL psychologists. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
This article provides an illustrative overview of neurophysiological changes related to acute and chronic pain involving structural and functional brain changes, which might be the targets of psychological interventions. A number of psychological pain treatments have been examined with respect to their effects on brain activity, ranging from cognitive- and operant behavioral interventions, meditation and hypnosis, to neuro- and biofeedback, discrimination training, imagery and mirror treatment, as well as virtual reality and placebo applications. These treatments affect both ascending and descending aspects of pain processing and act through brain mechanisms that involve sensorimotor areas as well as those involved in affective-motivational and cognitive-evaluative aspects. The analysis of neurophysiological changes related to effective psychological pain treatment can help to identify subgroups of patients with chronic pain who might profit from different interventions, can aid in predicting treatment outcome, and can assist in identifying responders and nonresponders, thus enhancing the efficacy and efficiency of psychological interventions. Moreover, new treatment targets can be developed and tested. Finally, the use of neurophysiological measures can also aid in motivating patients to participate in psychological interventions and can increase their acceptance in clinical practice. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
Design: This is a structured evidence-based review of all available studies on the development of abuse/addiction and aberrant drug-related behaviors (ADRBs) in chronic pain patients (CPPs) with nonmalignant pain on exposure to chronic opioid analgesic therapy (COAT). Objectives: To determine what percentage of CPPs develop abuse/addiction and/or ADRBs on COAT exposure. Method: Computer and manual literature searches yielded 79 references that addressed this area of study. Twelve of the studies were excluded from detailed review based on exclusion criteria important to this area. Sixty-seven studies were reviewed in detail and sorted according to whether they reported percentages of CPPs developing abuse/addiction or developing ADRBs, or percentages diagnosed with alcohol/illicit drug use as determined by urine toxicology. Study characteristics were abstracted into tabular form, and each report was characterized according to the type of study it represented based on the Agency for Health Care Policy and Research Guidelines. Each study was independently evaluated by two raters according to 12 quality criteria and a quality score calculated. Studies were not utilized in the calculations unless their quality score (utilizing both raters) was greater than 65%. Within each of the above study groupings, the total number of CPPs exposed to opioids on COAT treatment was calculated. Similarly, the total number of CPPs in each grouping demonstrating abuse/addiction, ADRBs, or alcohol/illicit drug use was also calculated. Finally, a percentage for each of these behaviors was calculated in each grouping, utilizing the total number of CPPs exposed to opioids in each grouping. Results: All 67 reports had quality scores greater than 65%. For the abuse/addiction grouping there were 24 studies with 2,507 CPPs exposed for a calculated abuse/addiction rate of 3.27%. Within this grouping for those studies that had preselected CPPs for COAT exposure for no previous or current history of abuse/addiction, the percentage of abuse/addiction was calculated at 0.19%. For the ADRB grouping, there were 17 studies with 2,466 CPPs exposed and a calculated ADRB rate of 11.5%. Within this grouping for preselected CPPs (as above), the percentage of ADRBs was calculated at 0.59%. In the urine toxicology grouping, there were five studies (15,442 CPPs exposed). Here, 20.4% of the CPPs had no prescribed opioid in urine and/or a nonprescribed opioid in urine. For five studies (1,965 CPPs exposed), illicit drugs were found in 14.5%. Conclusion: The results of this evidence-based structured review indicate that COAT exposure will lead to abuse/addiction in a small percentage of CPPs, but a larger percentage will demonstrate ADRBs and illicit drug use. These percentages appear to be much less if CPPs are preselected for the absence of a current or past history of alcohol/illicit drug use or abuse/addiction.
To present nationally representative data on the prevalence, sociodemographic correlates, and disability of 7 of the 10 DSM-IV personality disorders. The data were derived from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (N = 43,093). Diagnoses were made using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version, and associations between personality disorders and sociodemographic correlates were determined. The relationship between personality disorders and 3 emotional disability scores (Short-Form 12, version 2) was also examined. Overall, 14.79% of adult Americans (95% CI = 14.08 to 15.50), or 30.8 million, had at least 1 personality disorder. The most prevalent personality disorder in the general population was obsessive-compulsive personality disorder, 7.88% (95% CI = 7.43 to 8.33), followed by paranoid personality disorder 4.41% (95% CI = 4.12 to 4.70), antisocial personality disorder 3.63% (95% CI = 3.34 to 3.92), schizoid personality disorder 3.13% (95% CI = 2.89 to 3.37), avoidant personality disorder 2.36% (95% CI = 2.14 to 2.58), histrionic personality disorder 1.84% (95% CI = 1.66 to 2.02), and dependent personality disorder 0.49% (95% CI = 0.40 to 0.58). The risk of avoidant, dependent, and paranoid personality disorders was significantly greater among women than men (p <.05); the risk of antisocial personality disorder was greater among men compared with women (p <.05); and no sex differences were observed in the risk of obsessive-compulsive, schizoid, or histrionic personality disorders. In general, risk factors for personality disorders included being Native American or black, being a young adult, having low socioeconomic status, and being divorced, separated, widowed, or never married. Avoidant, dependent, schizoid, paranoid, and antisocial personality disorders (p <.02 to p <.0001) were each statistically significant predictors of disability. Obsessive-compulsive personality disorder was inconsistently related to disability. In contrast, disability was not significantly different among individuals with histrionic personality disorder compared with those without the disorder. Personality disorders are prevalent in the general population and are generally highly associated with disability. This study highlights the need to develop more effective and targeted prevention and intervention initiatives for personality disorders.
To (a) describe the demographics of opioid abusers; (b) compare the prevalence rates of selected comorbidities and the medical and drug utilization patterns of opioid abusers with patients from a control group, for the period from 1998 to 2002; and (c) calculate the mean annual per-patient total health care costs (e.g., inpatient, outpatient, emergency room, drug, other) from the perspective of a private payer. An administrative database of medical and pharmacy claims from 1998 to 2002 of 16 self-insured employer health plans with approximately 2 million lives was used to identify "opioid abusers"--patients with claims associated with ICD-9-CM (International Classification of Diseases, 9th Revision, Clinical Modification) codes for opioid abuse (304.0, 304.7, 305.5, and 965.0 [excluding 965.01]). A control group of nonabusers was selected using a matched sample (by age, gender, employment status, and census region) in a 3:1 ratio. Per-patient annual health care costs (mean total medical and drug costs) were measured in 2003 U.S. dollars. Multivariate regression techniques were also used to control for comorbidities and to compare costs with a benchmark of depressed patients. 740 patients were identified as opioid abusers, a prevalence of 8 in 10,000 persons aged 12 to 64 years continuously enrolled in health care plans for whom 12 months of data were available for calculating costs. Opioid abusers, compared with nonabusers, had significantly higher prevalence rates for a number of specific comorbidities, including nonopioid poisoning, hepatitis (A, B, or C), psychiatric illnesses, and pancreatitis, which were approximately 78, 36, 9, and 21 (P<0.01) times higher, respectively, compared with nonabusers. Opioid abusers also had higher levels of medical and prescription drug utilization. Almost 60% of opioid abusers had prescription drug claims for opioids compared with approximately 20% for nonabusers. Prevalence rates for hospital inpatient visits for opioid abusers were more than 12 times higher compared with nonabusers (P<0.01). Mean annual direct health care costs for opioid abusers were more than 8 times higher than for nonabusers ($15,884 versus $1,830, respectively, P < 0.01). Hospital inpatient and physician-outpatient costs accounted for 46% ($7,239) and 31% ($5,000) of opioid abusers. health care costs, compared with 17% ($310) and 50% ($906), respectively, for nonabusers. Mean drug costs for opioid abusers were more than 5 times higher than costs for nonabusers ($2,034 vs. $386, respectively, P<0.01), driven by higher drug utilization (including opioids) for opioid abusers. Even when controlling for comorbidities using a multivariate regression model of a matched control of depressed patients, the average health care costs of opioid abusers were 1.8 times higher than the average health care costs of depressed patients. The high costs of opioid abuse were driven primarily by high prevalence rates of costly comorbidites and high utilization rates of medical services and prescription drugs.
To present national data on the prevalence, correlates, and comorbidity of nonmedical prescription drug use and drug use disorders for sedatives, tranquilizers, opioids, and amphetamines. Data were derived from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a face-to-face nationally representative survey of 43,093 adults conducted during 2001 and 2002. Lifetime prevalences of nonmedical use of sedatives, tranquilizers, opioids, and amphetamines were 4.1%, 3.4%, 4.7%, and 4.7%, respectively. Corresponding rates of abuse and/or dependence on these substances were 1.1%, 1.0%, 1.4%, and 2.0%. The odds of nonmedical prescription drug use and drug use disorders were generally greater among men, Native Americans, young and middle-aged, those who were widowed/ separated/divorced or never married, and those residing in the West. Abuse/dependence liability was greatest for amphetamines, and nonmedical prescription drug use disorders were highly comorbid with other Axis I and II disorders. The majority of individuals with non-medical prescription drug use disorders never received treatment. Nonmedical prescription drug use and disorders are pervasive in the U.S. population and highly comorbid with other psychiatric disorders. Native Americans had significantly greater rates of nonmedical prescription drug use and drug use disorders, highlighting the need for culturally-sensitive prevention and intervention programs. Unprecedented comorbidity between nonmedical prescription drug use disorders and between nonmedical prescription drug use disorders and illicit drug use disorders suggests that the typical individual abusing or dependent on these drugs obtained them illegally, rather than through a physician. Amphetamines had the greatest abuse/dependence liability, and recent increases in the potency of illegally manufactured amphetamines may portend an epidemic in the youngest NESARC cohort.