Answer Addiction

Tag: opioid misuse

  • Does Having Access To Opioids Increase Overdose Risks?

    Does Having Access To Opioids Increase Overdose Risks?

    A new study investigated whether having access to a family member’s prescriptions makes one more likely to overdose.

    People who have a family member who was prescribed opioids are nearly three times more likely to experience an opioid overdose than people who do not have a family member with access to opioids, according to a recent study reported on by Vox. 

    The study, published in JAMA Internal Medicine, looked at records from about 11,500 people, 2,303 of whom had experienced an opioid overdose that required a hospital visit. The researchers found that people whose family member had been prescribed opioids in the past were more likely to overdose. 

    “Family member prescriptions may be a risk factor for overdose,” the study authors wrote. 

    The authors said that the data proves that more needs to be done to reduce access to opioids among family members of people who are given prescriptions. 

    “Interventions may focus on expanding access to opioid antagonists, locking prescription opioids in the home, and providing greater patient education to limit fatal overdose among family members,” they wrote. 

    Although some people argue that the opioid crisis is caused by underlying factors like low social mobility, studies like this prove that access to opioids plays a significant role, said Stanford drug policy expert Keith Humphreys. 

    “The claim that opioid overdose is just about ‘root causes’ rather than drug supply cannot be sustained in light of these findings,” he wrote on Twitter. 

    The research showed that the more opioids a person was prescribed, the higher the risk that one of their family members would overdose. The study only looked at overdose victims who had not previously been prescribed opioids themselves, solidifying the link between family member use and likelihood of overdose. 

    Having Access

    This isn’t the first time that research has shown a link between access to opioids and abuse. Another study published this year found that when teens were prescribed opioids for the first time, 2.4% developed long-term use. However, that rose to 4.1% for teens who had a family member that used opioids chronically. 

    “The findings suggest that long-term opioid use among family members is associated with persistent opioid use among opioid-naive adolescents and young adults undergoing surgery and should be screened for in the preoperative period,” study authors wrote. 

    In addition, a report found that doctors and nurses were responsible for 67% of prescription drug thefts. The vast majority of those involved opioids. Tennessee doctor Stephen Loyd said that easy access to opioids and lack of accountability made it easy for him to divert pills. 

    “There was no requirements on what happened to those pills. They could go down the toilet or they could go in my pocket,” he said, adding that he’s not surprised there is so much opioid diversion among doctors. “They’ve got high stress jobs. A lot of them, like myself, have workaholism. And not only that, you have access.” 

    View the original article at thefix.com

  • FDA Issues New Opioid Guidelines, But Critics Say They’re Not Enough

    FDA Issues New Opioid Guidelines, But Critics Say They’re Not Enough

    The new guidelines say that the FDA should consider whether or not a new opioid works better than existing pain relief options.

    The Food and Drug Administration has issued new guidelines about how it should consider applications for approval of new opioids, but some critics are questioning whether the new plan does enough to restrict the harm of potentially deadly medications. 

    The FDA issues the new guidelines on June 20. The guidelines are meant to give a risk-benefit analysis over how new opioids will help patients who use them correctly, but also how they may affect people using opioids illegally. This is a departure for the agency, which usually only considers a drug’s safety when it is taken as prescribed. 

    “Opioids present unique challenges: they have benefits when used as prescribed yet have very serious risks and can cause enormous harm when misused and abused,” the agency said in a statement released at the same time. 

    Still, some people don’t think that the guidelines are enough to prevent the FDA from approving drugs that could worsen the opioid epidemic. One consumer advocacy group, Public Citizen, has demanded that the FDA halt approval of all new opioids until stricter guidelines are in place. 

    Sidney Wolfe, a former member of an FDA advisory committee and a policy expert for Public Citizen, told Pacific Standard that she was not satisfied with the new guidelines. 

    “If this is their view of what should go into a opioid framework, that is not acceptable,” she said. 

    The new guidelines say that the FDA should consider whether or not a new opioid works better than existing pain relief options. However, the guidelines don’t require that the agency reject approval for medications that do not work better than existing options, Wolfe said.

    In addition, the guidelines say that the agency will consider how opioids could be misused, but it does not require companies to provide information on potential misuse before they are given FDA approval. The guidelines are not legally binding. 

    Despite the shortcomings, some people who are in favor of stricter oversight over opioids are happy to see the guidelines issues. 

    “What I can say is that we are pleased that the agency has taken this first step in implementing our recommendations,” said University of Virginia professor Richard Bonnie, chair of a National Academies panel that called on the FDA to develop a special process for approving new opioids. 

    The FDA has come under fire for its role in the opioid epidemic. 

    “The opioid crisis is one of the largest and most complex public health tragedies that our nation has ever faced,” a spokesperson for the agency told Vanity Fair for a recent article. “Sadly, the scope of the epidemic reflects many past mistakes and many parties who missed opportunities to stem the crisis, including the FDA.” 

    View the original article at thefix.com

  • Does Binge Drinking Increase Chances Of Opioid Misuse?

    Does Binge Drinking Increase Chances Of Opioid Misuse?

    A new study examined the possible connection between binge drinking and opioid misuse.

    Binge drinking and opioid misuse are closely related, according to a new study examining drinking patterns and prescription pill misuse.

    The study, published in the American Journal of Preventive Medicine, aimed to examine the connection between drinking and using opioids. It drew on information from more than 160,000 people who provided information on their substance use as part of the National Survey on Drug Use and Health (NSDUH) from 2012-2014 as well as socioeconomic information. Researchers found that binge drinking increased the chances that people misused opioids.

    “More than half of the 4.2 million people who misused prescription opioids during 2012–2014 were binge drinkers, and binge drinkers had nearly twice the odds of misusing prescription opioids, compared with nondrinkers,” study authors wrote.

    This is especially alarming since opioids and alcohol are a dangerous combination physically.

    “Binge drinkers who misuse prescription opioids are likely to be at substantially increased risk of overdose because of the combined effect of high blood alcohol levels and prescription opioids on the central nervous system,” they wrote. “The high prevalence, frequency, and intensity of binge drinking among adults and adolescents in the U.S., along with the heightened prevalence of prescription opioid misuse among binge drinkers, emphasizes the importance of adopting a comprehensive and coordinated approach to addressing both binge drinking and prescription opioid misuse to reduce the risk of opioid overdoses.”

    The study found that opioid misuse was most common among men, people with an annual family income of $20,000 or less, and people ages 18-34. Binge drinking was also most common among men in that age bracket, although it was also associated with people with some college education, according to The American Academy of Family Physicians.

    About two-thirds of people who misused opioids and binge drank were older than 26. However, among younger adults the connection between binge drinking and opioid misuse was especially strong: 8.1% of teenage binge drinkers misused opioids, compared with just 1% of nondrinkers and 3.6% of people who used alcohol but did not binge drink.

    Since family medical providers are often on the front lines of dealing with patients with problematic drinking, they could also help interrupt this pattern of opioid misuse, said Dr. Roger Zoorob.

    “Family physicians are well-positioned to identify and address binge drinking and opioid misuse,” he said.

    Sometimes that can be as easy as pointing out that a patient’s drinking habits are veering toward unhealthy.

    “Many times, patients are unaware that their drinking patterns are harmful, and a simple, brief intervention by the family physician has been shown to reduce unhealthy alcohol use in the primary care population,” Zoorob said.

    View the original article at thefix.com

  • Does Gender-Based Violence Affect Opioid Misuse?

    Does Gender-Based Violence Affect Opioid Misuse?

    Many women who experience violence and other traumatizing situations use opioids to self-medicate, an expert suggests.

    Gender-based domestic violence plays a role in the opioid epidemic—as it relates to why women use opioids, when they access treatment, and how they are treated during overdose emergencies. 

    Writing for The Conversation, Nabila El-Bassel, professor of social work at Columbia University, said that just like women were at increased risk during the HIV epidemic because of domestic partner violence, they are at increased risk for opioid misuse today. 

    El-Bassel shared the story of Tonya, who used heroin when she anticipated being abused by her boyfriend. 

    “Tonya is only one of the hundreds of women I’ve interviewed for my research with similar stories in the span of my nearly 30-year career studying the links between intimate partner violence, sexual coercion, substance use disorders and HIV,” El-Bassel writes. 

    Many women who experience violence and other traumatizing situations use opioids as a way to self-medicate, just as Tonya did. Women who deal regularly with domestic violence often use opioids as a way to help control their emotional pain. 

    “Treatment must address the need for escape that these women seek,” El-Bassel writes.

    Yet, many women in abusive relationships have trouble accessing treatment. Partners—especially those contending with substance abuse themselves—will often undermine a woman’s attempt to get sober. This becomes yet another way that abusive partners exert dominance over the women in their lives. 

    “They can control their ability to engage in treatment, deny them potential sources of protection, and jeopardize the custody of their children to maintain control over them and, for some men, have women take care of them,” El-Bassel writes. 

    Women who are in abusive relationships often don’t feel that they can protect themselves by demanding safe sex or clean needles. Oftentimes, their partners don’t give them a choice in the matter. Because of this, harm-reduction strategies like needle exchange fail to help the most vulnerable, El-Bassel writes. 

    “Studies have shown that women are often physically or sexually abused when negotiating safe sex or refusing to engage in drug risk,” she said. 

    Alarmingly, it’s not just intimate partners who put women at higher risk for opioid abuse. Systematic gender biases also affect access to treatment, El-Bassel writes. She points to a recent study that found that women are three times less likely than men to be treated with naloxone during an overdose. 

    This “is likely due to their being devalued,” El-Bassel writes. “Emergency responders and police officers as well as family members and peers must be trained to overcome this gendered barrier and recognize signs and symptoms of overdose.”

    Overall, the treatment community needs to do a better job of understanding risk factors unique to women and providing interventions that work for this population, El-Bassel says. 

    “These issues must be changed if we are serious on addressing the opioid epidemic among women,” she writes. 

    View the original article at thefix.com

  • Sexual Orientation Tied To Increased Risk Of Opioid Abuse

    Sexual Orientation Tied To Increased Risk Of Opioid Abuse

    A new study examined the link between sexual orientation and opioid abuse. 

    People who identify as gay, lesbian or bisexual are more likely to misuse opioids, and bisexual women are at a particularly high risk, according to a study published this week. 

    The study, published in The American Journal of Preventive Medicine, found that bisexual women were about twice as likely to misuse opioids as members of the general population who identify as heterosexual. 

    Lead study author Dustin Duncan, an associate professor in the Department of Population Health at NYU School of Medicine, told The Washington Post that these findings are consistent with previous studies that have showed people who are not heterosexual have poorer health overall. 

    “I think the findings speak to the life experiences of people in society,” he said. “People who have less privilege and power generally have worse health. This isn’t a fluke or a one-time finding. It tends to be systematic.”

    For the study, researchers analyzed data from more than 40,000 individuals who took the National Survey on Drug Use and Health, an annual study conducted by the Substance Abuse and Mental Health Services Administration.

    In 2015, questions were introduced asking about sexual orientation for the first time, allowing researchers to see the connection between sexual orientation and substance abuse, particularly focused on prescription opioids.  

    Joseph Palamar, an associate professor in the Department of Population Health at New York University’s School of Medicine and another author of the study, said that he was surprised to see that bisexual women were most at risk for opioid abuse, since the opioid epidemic is usually associated with men. 

    “Typically women are more protected against drug use,” he said. “It’s usually the men we worry about.”

    Palamar theorized that bisexual woman might be more open to experimentation — both sexually and with drug use. However, Duncan pushed back on that idea, instead suggesting that the “minority stress model” can explain the increased risk factor for bisexual women. The minority stress model suggests that the stress of being a member of a minority group can contribute to negative health outcomes. 

    Bisexual woman, he said, are minorities in many ways: they are female and not heterosexual, but they also don’t fit in fully with members of the lesbian or gay communities. 

    “These things together create further stress, less ability to cope and give rise to poor health,” Duncan said.

    The National Survey on Drug Use and Health does not include questions about gender identity, so researchers were not able to study any potential links between transgender or non-binary individuals and drug abuse. However, Duncan said that doctors can use the study to better serve people who are at increased risk of abusing opioids. 

    “We need to continue documenting who is at risk,” he said. “This study is really the first step.”

    View the original article at thefix.com

  • Doctors Gave No Reason For Writing Opioid Scripts In Nearly 30% Of Cases

    Doctors Gave No Reason For Writing Opioid Scripts In Nearly 30% Of Cases

    A new study uncovered that doctors were prescribing opioids for hypertension and high cholesterol when no pain diagnosis was recorded. 

    A team at Harvard Medical School and the Rand Corp. combed through medical records from 2006 to 2015 and found that physicians gave no explanation for writing an opioid prescription in 29% of the cases.

    According to NBC News, the Centers for Disease Control and Prevention (CDC) has been working to get doctors to pull back on opioid prescriptions, citing careless prescribing as one cause of the opioid crisis. In 2016, more than 42,000 people died of opioid overdose, according to the CDC.

    The new study was led by Nicole Maestas, professor of health care policy at Harvard. Maestas and study coauthors went through tens of thousands of medical records, and then honed in on more than 31,000 physician surveys that included an opioid prescription.

    In two-thirds of the prescriptions, some type of pain diagnosis was present.

    The report, published in the Annals of Internal Medicine, then concluded, “No pain diagnosis was recorded at the remaining 28.5%.”

    “At visits with no pain diagnosis recorded, the most common diagnoses were hypertension, hyperlipidemia (high cholesterol), opioid dependence and ‘other follow-up examination,’” the research revealed.

    This over-prescribing could be unfairly impacting people who do have serious pain conditions and are finding it difficult to access the opioids they need to manage their pain due to new restrictions and doctors who fear that they will be targeted for over-prescribing.

    Dr. Tisamarie Sherry, who worked on the study, was reported in NBC News as emphasizing, “Whatever the reasons, lack of robust documentation undermines our efforts to understand physician prescribing patterns and curtails our ability to stem overprescribing.”

    The study also showed that 24% of youth who appeared with an opioid use disorder did not have a prescription to a medication-assisted treatment (MAT) drug to control their cravings.

    Drugs like buprenorphine and methadone are approved by the Food and Drug Administration for the treatment of opioid use disorder.

    “In this multistate study of addiction treatment and retention in care, we found that three-quarters of youths diagnosed with opioid use disorder received treatment within three months,” researchers wrote in JAMA Pediatrics. “However, most treatment included behavioral health services only, and fewer than one of four youths received timely buprenorphine, naltrexone or methadone treatment.”

    View the original article at thefix.com

  • Are Opioid Prescription Regulations Actually Working?

    Are Opioid Prescription Regulations Actually Working?

    New studies explored whether medical professionals are adhering to stricter opioid prescribing rules and regulations.

    While rules and regulations are often made in the interest of public safety, that doesn’t mean they are always followed hard and fast. 

    Such is the case with certain rules regarding opioid prescriptions, according to the Boston Globe. The paper states that according to the results of two studies published Wednesday (August 22) in the journal JAMA Surgery, “such well-intentioned efforts sometimes don’t have the desired effect.”

    The first study concluded that after one rule made it more difficult to refill the painkiller hydrocodone, surgeons began prescribing more of the medication right after surgery instead. 

    Meanwhile, the second study examined a regulation which required surgeons to check a database before prescribing opioids, the idea being that the database would alert them to patients at risk of opioid misuse.

    However, the study found that the procedure took up surgeons’ time but did not affect their prescribing practices in one New Hampshire hospital. 

    According to the Globe, both the studies were limited in terms of geographic area and only studying surgeon’s prescribing behaviors.

    Dr. Michael Barnett, a Harvard health-services researcher who studies opioid prescribing, tells the Globe that the results point to a bigger problem.

    “Clinician behavior is harder to predict, when you put these kinds of limits on it, than we’d like to think,” he said. “Regardless of the law you put in place, physicians are going to respond to what patients need… We need to ask a harder question: How do we influence health care decisions?”

    Prescribing practices have been under scrutiny for a number of years. In 2014, the Globe states, the U.S. Drug Enforcement Administration (DEA) changed hydrocodone from a Schedule III to a Schedule II drug, meaning patients would not be able to refill it over the phone.

    After that went into effect, researchers at the University of Michigan chose to study the effects on post-surgery prescribing. They looked at prescriptions for 21,955 patients who had had elective surgery in 75 Michigan hospitals from 2012 to 2015. Study authors found that prescription refills decreased, but the number of pills a patient left the hospital with increased.

    According to study author Dr. Michael Englesbe, the idea seemed to be that if doctors gave patients more prescriptions, they would be more likely to have the necessary pain relief and not seek more medication.

    However, Englesbe says, previous research indicates that “the number of pills you give someone has no relationship to their likelihood of calling for a refill. The more pills you give a patient, the more they take, and they don’t rate their pain care any better. It’s counterintuitive.”

    View the original article at thefix.com