Articles: opioid-analgesics.
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Codeine is one of the most commonly used opioid analgesics. Significant codeine-related morbidity and mortality prompted regulatory responses, with the up-scheduling of codeine combination analgesics to prescription-only medicines implemented in Australia in February 2018. This study investigated the impact of codeine up-scheduling on the number of codeine and other (noncodeine) prescription opioid-related emergency department (ED) presentations in a large metropolitan tertiary hospital. ⋯ Noncodeine prescription opioid-related (B = -1.90, P = 0.446) and ED presentations overall (B = -118.04, P = 0.140) remained unchanged immediately post-up-scheduling, with a significant change in trend from upward to downward for noncodeine (B = -0.76; P = 0.002) and ED presentations overall (B = -19.34, P = 0.022). A significant reduction of 4.58 (B = -4.58, P = 0.009) in codeine presentations involving subsequent hospital admission immediately post-up-scheduling was found; but no immediate reduction in codeine-related suicide-related overdoses, length of inpatient stay, or re-presentations (P > 0.0125; adjusted for multiple comparisons). Restricting supply of codeine to prescription-only may have resulted in less harmful codeine-related use in the community, without a corresponding immediate decrease in other opioid-related harms.
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Drug Alcohol Depend · Apr 2021
Behavioral economic demand in opioid treatment: Predictive validity of hypothetical purchase tasks for heroin, cocaine, and benzodiazepines.
Behavioral economics provides a framework in which to understand choice and motivation in the field of substance use disorders. Hypothetical purchase tasks (HPT), which indicate the amount or probability of purchasing substances at different prices, have been suggested as a clinical tool that can help predict future substance use and identify targets for intervention. ⋯ This report provides evidence that demand assessment is predictive of future substance use and could help guide treatment planning at intake. These results also demonstrated that the ZBEn model provides good fits to consumption data and allows for sensitive statistical analyses.
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Little is known about opioid and gabapentinoid (OPI-GABA) use duration and dose patterns' associations with adverse outcome risks. We examined associations between OPI-GABA dose and duration trajectories and subsequent drug overdose. ⋯ Risk of drug overdose varied substantially among US Medicare beneficiaries on different use trajectories of opioids and gabapentinoids. High-dose opioid-only users and all consistent opioid and gabapentinoid users (regardless of doses) had more than double the risk of subsequent drug overdose compared with opioid-only early discontinuers.
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Otolaryngol Head Neck Surg · Apr 2021
The Impact of MassPAT on Opioid Prescribing Patterns for Otolaryngology Surgeries.
Determine whether opioid prescriber patterns have changed for tonsillectomy, parotidectomy, and thyroidectomy after implementation of the Massachusetts Prescription Awareness Tool (MassPAT). ⋯ We have demonstrated that there is an association with state drug monitoring programs and decrease in the amount of opioids prescribed for acute postoperative pain control for common otolaryngology surgeries.
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Eur Rev Med Pharmacol Sci · Apr 2021
Efficacy of intranasal ketamine for acute pain management in adults: a systematic review and meta-analysis.
This study aimed to compare the efficacy of intranasal (IN) ketamine for pain control with placebo and other analgesics in an emergency setting. ⋯ There may be a role of IN ketamine for acute pain management in adults in an emergency setting. There is a tendency for better pain control with IN ketamine as compared to control and the possibility of similar efficacy of IN ketamine as compared to opioids. However, the results are not unequivocal and are limited by the low number of studies in literature and limited pain indications studied. Further RCTs are required to strengthen the evidence.