(Press-News.org) July 15, 2015 - Overdoses of opioid pain medications frequently occur in people who aren't chronic users with high prescribed opioid doses--the groups targeted by current opioid prescribing guidelines, reports a study in the August issue of Medical Care. The journal is published by Wolters Kluwer.
"It may be prudent to revise guidelines to also address opioid poisonings occurring at relatively low prescribed doses and with acute and intermittent opioid use, in addition to chronic, high-dose use," comments lead author Deborah Fulton-Kehoe, PhD, a research scientist in the Department of Environmental and Occupational Health Sciences at the University of Washington School of Public Health, Seattle. Guidelines may also need to target prescription sedatives, which are involved in nearly half of opioid overdoses.
Trends Suggest Need to Update Opioid Prescribing Guidelines
The researchers analyzed Medicaid data on opioid prescribing and opioid poisoning in Washington State between 2006 and 2010. They identified 2,250 opioid overdoses occurring in 1,809 patients. About 35 percent of these events were associated with methadone, which can be used to treat heroin and other narcotic addictions, in addition to use as a pain treatment. The remaining 65 percent of overdoses were due to other opioid medications.
In response to the ongoing opioid epidemic, Washington introduced new State Opioid Guidelines in 2007--emphasizing the high risk of overdose in chronic (long-term) users with high prescribed opioid doses. The number of methadone poisonings continued to increase after the prescribing guideline.
However, nonfatal overdoses from prescription opioid pain medications seemed to level off in Washington State, after introduction of the new guidelines. That was in contrast to increasing rates nationally.
The researchers analyzed the prescription histories of patients with nonfatal overdose caused by opioid pain medications. Previous research has shown that both fatal and nonfatal overdoses were more likely for chronic opioid users and those with higher prescribed opioid doses.
However, many patients in the study met neither of these criteria. Only 44 percent of patients who overdosed on opioid pain medications were chronic users, with more than a 90-day supply of prescribed opioid medications in the prior year. In the week before the poisoning, only 17 percent of patients had a "yellow-flag" opioid dose targeted by the prescribing guideline: a (morphine-equivalent) dose of more than 120 milligrams per day. In contrast, 28 percent of overdose patients had a relatively low dose of less than 50 mg per day.
Concurrent use of sedatives was another important contributing factor--nearly half of patients also had a sedative prescription at the time of their opioid overdose. That was so for poisonings caused by either methadone or prescription opioids.
Dr. Fulton-Kehoe and coauthors believe their study has important implications for efforts to prevent opioid poisonings. Because only a small fraction of users are at high "yellow-flag" doses (120 mg per day or more) and many opioid poisonings occur at lower prescribed doses in patients who would not be considered chronic users, "Opioid guidelines and other education interventions will need to be developed to address the opioid poisonings occurring among these patients," the researchers write. They also call for strategies targeting patients with prescriptions for sedatives.
"The topic of overdose from prescription opioid medication is a current national crisis," comments Dr. Jeroan J. Allison of University of Massachusetts Medical School, Co-Editor-in-Chief of Medical Care. He notes that the Centers for Disease Control and Prevention has declared opioid overdose to be a national epidemic. "The statistics are quite overwhelming and dramatic, and this problem affects every state in our nation."
While the study is regional, it has national and even global implications, Dr. Allison believes. "Namely, the article notes that many overdoses occur when patients are prescribed medications at low doses. This has important implications for national policy and debate."
INFORMATION:
Click here to read "Opioid Poisonings in Washington State Medicaid: Trends, Dosing, and Guidelines."
Article: "Opioid Poisonings in Washington State Medicaid: Trends, Dosing, and Guidelines" (doi: 10.1097/MLR.0000000000000384)
About Medical Care
Rated as one of the top ten journals in health care administration, Medical Care is devoted to all aspects of the administration and delivery of health care. This scholarly journal publishes original, peer-reviewed papers documenting the most current developments in the rapidly changing field of health care. Medical Care provides timely reports on the findings of original investigations into issues related to the research, planning, organization, financing, provision, and evaluation of health services. In addition, numerous special supplementary issues that focus on specialized topics are produced with each volume. Medical Care is the official journal of the Medical Care Section of the American Public Health Association.
About Wolters Kluwer
Wolters Kluwer is a global leader in professional information services. Professionals in the areas of legal, business, tax, accounting, finance, audit, risk, compliance and healthcare rely on Wolters Kluwer's market leading information-enabled tools and software solutions to manage their business efficiently, deliver results to their clients, and succeed in an ever more dynamic world.
Wolters Kluwer reported 2014 annual revenues of €3.7 billion. The group serves customers in over 170 countries, and employs over 19,000 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands. Wolters Kluwer shares are listed on NYSE Euronext Amsterdam (WKL) and are included in the AEX and Euronext 100 indices. Wolters Kluwer has a sponsored Level 1 American Depositary Receipt program. The ADRs are traded on the over-the-counter market in the U.S. (WTKWY).
For more information about our products and organization, visit http://www.wolterskluwer.com, follow @WKHealth or @Wolters_Kluwer on Twitter, like us on Facebook, follow us on LinkedIn, or follow WoltersKluwerComms on YouTube.
CHICAGO --- You can fake a smile, but your phone knows the truth. Depression can be detected from your smartphone sensor data by tracking the number of minutes you use the phone and your daily geographical locations, reports a small Northwestern Medicine study.
The more time you spend using your phone, the more likely you are depressed. The average daily usage for depressed individuals was about 68 minutes, while for non-depressed individuals it was about 17 minutes.
Spending most of your time at home and most of your time in fewer locations -- as measured by GPS ...
Substantial improvements in the care and survival of older people with hip fracture in England have followed the introduction of a collaborative national initiative to tackle the issue, according to a new study published in the Medical Care journal.
Hip fracture is the most common serious injury of older people. In the UK there are around 70,000 cases per year (in people aged 60 years and older), while in the US there are approximately 250,000 cases (in people aged 65 years and older).
The UK National Hip Fracture Database (NHFD) is a clinician-led audit initiative ...
Epidural electrostimulation is a medical technique that has been used for several years now to help patients affected by paralysis due to a spinal cord injury. It involves implanting electrodes over the dorsal nerve roots (which convey incoming "sensory" inputs) of the spinal cord below the level of the trauma and applying electrical stimuli of varying intensity and frequency. This technique, which produces or helps produce activation patterns of the motor nerves (ventral, outgoing) has shown promising results, and the scientists hope that one day it will be able to help ...
Oxford, July 15, 2015 - A recent study, published in the International Journal of Nursing Studies, reveals a set of ten low-cost interventions that can increase safety on psychiatric wards. This Safewards Model reduces aggression, self-harm and other risky behaviours by 15% and reduces coercive control, such as restraint, by 24%.
The study stems from a 20-year research program led by Professor of Psychiatric Nursing, Len Bowers, at the Institute of Psychiatry, Psychology & Neuroscience, King's College London.
The study reveals that, by using a set of ten small, low ...
UK investment in pneumonia research is lacking when compared to spending on influenza and tuberculosis, according to a new study by the University of Southampton and University College London (UCL).
By calculating the amount spent on researching respiratory infections and their mortality rates, the study authors were able to assess UK public and charitable sector investment against the global burden of the diseases.
Published in EBioMedicine the study found that while £484.21 per death was invested in influenza research, less than a tenth of that figure (£43.08) ...
Findings, published today [15 Jul] in Nature Communications, reveal the extent a mutation associated with autism and epilepsy plays in impairing a biochemical process in the brain. The study, led by University of Bristol researchers, could provide a new target for treating neurological disorders.
The brain contains billions of nerve cells which communicate via the release of chemicals at connections called synapses. Each nerve cell can have thousands of synaptic connections to hundreds of other nerve cells. The protein Synapsin 1a plays a key role in regulating how synapses ...
Spinal cord injuries cause serious functional deficits, including paraplegia or tetraplegia, depending on the scale of the injury. This is due to degeneration of the spinal pathways that carry nerve signals from the brain to the various parts of the body, and vice versa, leading to loss of mobility and sensitivity below the injury.
An international team of scientists coordinated by Rubèn López Vales, of the Department of Cell Biology, Physiology and Immunology of the Universitat Autònoma de Barcelona (UAB), the UAB Institute of Neuroscience, and the Centre ...
Academies in some of the most socio-economically deprived areas of England are proving to be successful in raising academic achievement and aspirations among pupils, according to a new report.
Improved pupil behaviour and a greater level of engagement in learning, sharper focus on continued professional development for staff, and a more entrepreneurial style of leadership, often from a new head appointed at the time of transition, were all found to be characteristics of those studied in the research.
Led by education experts at Plymouth University and the Cornwall College ...
Osteoarthritis (OA) is one of the most common age-related degenerative joint concerns. Although articular cartilage degradation is its main feature, this disease induces whole-joint damage characterized by synovitis, bone remodelling and osteophyte formation. Regarding bone, Yohann Wittrant, a researcher at the Human Nutrition Unit (INRA -France), has recently reported that stimulation of the orphan receptor GPR40, a fatty acid-activated receptor, preserved bone mass. Dietary fatty acids were described to improve joint function and reduce pain in OA patients and to decrease ...
Marine litter can undermine the psychological benefits of coastal environments, a study has shown.
The beneficial effects of the blue environment to human health and well-being are well documented, but there has been little research into how the growing global issue of marine litter might negate them.
To measure this, Plymouth University secured funding from the Natural Environment Research Council (NERC) and the Economic and Social Research Council (ESRC) to assess public reaction to the differing conditions of coastlines.
Participants were shown images of clean ...
