Articles: opioid.
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Recent work finds that medical marijuana laws reduce the daily doses filled for opioid analgesics among Medicare Part-D and Medicaid enrollees, as well as population-wide opioid overdose deaths. We replicate the result for opioid overdose deaths and explore the potential mechanism. ⋯ As states have become more stringent in their regulation of dispensaries, the protective value generally has fallen. These findings suggest that broader access to medical marijuana facilitates substitution of marijuana for powerful and addictive opioids.
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The purpose of our study is to examine post-operative opioid use in total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients and describe factors associated with the need for refill prescriptions. ⋯ Compared to THA patients, TKA patients were twice as likely to require refill opioid prescriptions and were prescribed a greater total MED for a longer period of time post-operatively. Patients undergoing TKA who present with a comorbidity or are currently being treated for anxiety or depression are more likely to require a refill.
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There is growing experience translating genomic data into clinical practice, as seen with the Implementing GeNomics In pracTicE (IGNITE) network. A primary example is the influence of CYP2D6 genotype on the beneficial and adverse effects of some opioids. ⋯ Limited evidence also supports the use of genetic data to guide other medications in chronic pain therapy, including tricyclic antidepressants and celecoxib. Pragmatic clinical trial data are needed in this area to better understand the impact of diverse populations, therapeutic interventions and clinical care environments on genotype-guided drug therapy for chronic pain.
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We describe a patient's personal struggle with a symptom complex consisting of profound muscle weakness requiring pyridostigmine, and metabolic abnormalities suggestive of mitochondrial disease. This included a profound sensitivity to opioids, which in the past caused severe respiratory depression during a prior hospital admission. Interestingly, the patient herself is a professor of ethics in genomic sciences, and she and her medical team thus far have not been able to formally diagnose her with mitochondrial disease. The patient now presented for a multilevel lumbar spine fusion and her hospital course and perspective on her medical odyssey are described here.