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Prescribing Guidelines "AND"Controlled Substances

Jane M Liebschutz, Ziming Xuan, Christopher W Shanahan, Marc LaRochelle, Julia Keosaian, Donna Beers, George Guara, Kristen O'Connor, Daniel P Alford, Victoria Parker, Roger D Weiss, Jeffrey H Samet, Julie Crosson, Phoebe A Cushman, Karen E Lasser
Importance: Prescription opioid misuse is a national crisis. Few interventions have improved adherence to opioid-prescribing guidelines. Objective: To determine whether a multicomponent intervention, Transforming Opioid Prescribing in Primary Care (TOPCARE;, improves guideline adherence while decreasing opioid misuse risk. Design, Setting, and Participants: Cluster-randomized clinical trial among 53 primary care clinicians (PCCs) and their 985 patients receiving long-term opioid therapy for pain...
July 17, 2017: JAMA Internal Medicine
Michael Von Korff, Rod L Walker, Kathleen Saunders, Susan M Shortreed, Manu Thakral, Michael Parchman, Ryan N Hansen, Evette Ludman, Karen J Sherman, Sascha Dublin
BACKGROUND: No studies have assessed the comparative effectiveness of guideline-recommended interventions to reduce risk of prescription opioid use disorder among chronic opioid therapy (COT) patients. We compared the prevalence of prescription opioid use disorder among COT patients from intervention clinics that had implemented opioid dose and risk reduction initiatives for more than 4 years relative to control clinics that had not. METHODS: After a healthcare system in Washington State implemented interventions to reduce opioid dose and risks, we surveyed 1588 adult primary care COT patients to compare the prevalence of prescription opioid use disorder among COT patients from the intervention and control clinics...
June 27, 2017: International Journal on Drug Policy
Shannon M Nugent, Steven K Dobscha, Benjamin J Morasco, Michael I Demidenko, Thomas H A Meath, Joseph W Frank, Travis I Lovejoy
BACKGROUND: It is unclear whether substance use disorder (SUD) treatment is offered to, or utilized by, patients who are discontinued from long-term opioid therapy (LTOT) following aberrant urine drug tests (UDTs). OBJECTIVE: To describe the proportion of patients who were referred to, and engaged in, SUD treatment following LTOT discontinuation and to examine differences in SUD treatment referral and engagement based on the substances that led to discontinuation...
June 9, 2017: Journal of General Internal Medicine
Karishma Kulkarni, Rashmi Arasappa, Krishna Prasad M, Amit Zutshi, Prabhat K Chand, Pratima Murthy, Mariamma Philip, Kesavan Muralidharan
There is a dearth of prospective trials studying treatment response in Persistent Delusional Disorder (PDD) to guide clinical practice. Available retrospective data indicate good response to second-generation antipsychotics (SGAs). We selected the data of patients prescribed either olanzapine or risperidone from a retrospective chart review of PDD (n=455) at our centre. We compared the two groups olanzapine (n =86) versus risperidone (n =280) on dose, drug adherence, response and adverse effects. The two groups were comparable on socio-demographic and clinical characteristics of PDD...
April 9, 2017: Psychiatry Research
Alan D Kaye, Mark R Jones, Adam M Kaye, Juan G Ripoll, Donald E Jones, Vincent Galan, Burton D Beakley, Frank Calixto, Jamie L Bolden, Richard D Urman, Laxmaiah Manchikanti
Chronic pain and prescription opioid abuse are extremely prevalent in the United States and worldwide. The consequences of opioid misuse can be life-threatening with significant morbidity and mortality, exacting a heavy toll on patients, physicians, and society. The risk for misuse of prescribed opioids is much higher in patients with chronic pain, especially those with concurrent substance use and /or mental health disorders. Several reasons can account for the occurrence of opioid abuse and misuse, including self-medication, use for reward, compulsive use related to addiction, and diversion for profit...
February 2017: Pain Physician
Alan D Kaye, Mark R Jones, Adam M Kaye, Juan G Ripoll, Vincent Galan, Burton D Beakley, Frank Calixto, Jamie L Bolden, Richard D Urman, Laxmaiah Manchikanti
Chronic pain and prescription opioid abuse are extremely prevalent both in this country and worldwide. Consequences of opioid misuse can be life-threatening with significant morbidity and mortality, exacting a heavy toll on patients, physicians, and society. Individuals with chronic pain and co-occurring substance use disorders and/or mental health disorders, are at a higher risk for misuse of prescribed opioids. Opioid abuse and misuse occurs for a variety of reasons, including self-medication, use for reward, compulsive use because of addiction, and diversion for profit...
February 2017: Pain Physician
Laxmaiah Manchikanti, Adam M Kaye, Nebojsa Nick Knezevic, Heath McAnally, Konstantin Slavin, Andrea M Trescot, Susan Blank, Vidyasagar Pampati, Salahadin Abdi, Jay S Grider, Alan D Kaye, Kavita N Manchikanti, Harold Cordner, Christopher G Gharibo, Michael E Harned, Sheri L Albers, Sairam Atluri, Steve M Aydin, Sanjay Bakshi, Robert L Barkin, Ramsin M Benyamin, Mark V Boswell, Ricardo M Buenaventura, Aaron K Calodney, David L Cedeno, Sukdeb Datta, Timothy R Deer, Bert Fellows, Vincent Galan, Vahid Grami, Hans Hansen, Standiford Helm Ii, Rafael Justiz, Dhanalakshmi Koyyalagunta, Yogesh Malla, Annu Navani, Kent H Nouri, Ramarao Pasupuleti, Nalini Sehgal, Sanford M Silverman, Thomas T Simopoulos, Vijay Singh, Daneshvari R Solanki, Peter S Staats, Ricardo Vallejo, Bradley W Wargo, Arthur Watanabe, Joshua A Hirsch
BACKGROUND: Opioid use, abuse, and adverse consequences, including death, have escalated at an alarming rate since the 1990s. In an attempt to control opioid abuse, numerous regulations and guidelines for responsible opioid prescribing have been developed by various organizations. However, the US opioid epidemic is continuing and drug dose deaths tripled during 1999 to 2015. Recent data show a continuing increase in deaths due to natural and semisynthetic opioids, a decline in methadone deaths, and an explosive increase in the rates of deaths involving other opioids, specifically heroin and illicit synthetic fentanyl...
February 2017: Pain Physician
Gillian J Leichtling, Jessica M Irvine, Christi Hildebran, Deborah J Cohen, Sara E Hallvik, Richard A Deyo
Objectives.:  Little is known about clinicians' use of prescription drug monitoring program (PDMP) profiles in decision-making. The objective of this qualitative study was to understand how clinicians use, interpret, and integrate PDMP profiles with other information in making clinical decisions. Design.:  Qualitative interviews of clinician PDMP users. Setting.:  Oregon registrants in the state's PDMP. Subjects.:  Thirty-three clinicians practicing in primary care, emergency medicine, pain management, psychiatry, dentistry, and surgery...
June 1, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Catherine Barber, David Gagnon, Jennifer Fonda, Kelly Cho, John Hermos, Matthew Miller
PURPOSE: The study aimed to test whether directives on opioid prescribing released by the Veterans Health Administration (VHA) or the Food and Drug Administration (FDA) had an impact on prescribing among VHA providers. METHODS: We used the VHA's linked pharmacy and patient medical records database to identify new prescriptions written for propoxyphene, fentanyl, and controlled release (CR) oxycodone between 1/1/2000 and 12/31/2009. We plotted the monthly proportion of these prescriptions that complied with components of four specific safety alerts or directives for these substances issued by the VHA or FDA between 1/1/2001 and 12/31/2008...
August 16, 2016: Pharmacoepidemiology and Drug Safety
Tracy A Klein, Shannon Panther, Teri Woo, Tamara Odom-Maryon, Kenn Daratha
OBJECTIVE: This study compares nurse practitioner (NP) and physician (MD/DO) prescribing patterns for treatment of children with an attention-deficit/hyperactivity disorder (ADHD)-related diagnosis covered by Oregon Medicaid from 2012 to 2013. METHODS: This study is a limited data set review of Oregon pharmacy claims for youth aged 3-18 at time of prescription fill, who were continuously enrolled for at least 10 months of the index year. Claims with selected ICD-9 codes (n = 197,364) were further defined by 30-day prescriptions and prescription drug events (PDE) linked to each prescriber type of interest...
August 2016: Journal of Child and Adolescent Psychopharmacology
(no author information available yet)
With deaths from opioid overdoses up sharply, a number of organizations are calling for systematic changes to curb the prescription of opioids while also making it easier for patients with addiction problems to access evidence- based treatment. New data from the National Center for Health Statistics un- derscore the scope of the problem: Deaths related to prescription overdoses reached an all-time high in 2014, nearing the 19,000 mark. Deaths linked to heroin reached 10,574, a three-fold increase from 2010...
February 2016: ED Management: the Monthly Update on Emergency Department Management
Marjolein J M Vranken, John A Lisman, Aukje K Mantel-Teeuwisse, Saskia Jünger, Willem Scholten, Lukas Radbruch, Sheila Payne, Marie-Hélène D B Schutjens
Control measures designed to prevent the misuse of opioid medicines can often unintentionally restrict legitimate medical use, leaving patients with cancer in pain. This study aimed to develop and validate an assessment instrument based on WHO policy guidelines to systematically identify legal and regulatory barriers to opioid access in 11 European countries (Bulgaria, Cyprus, Estonia, Greece, Hungary, Latvia, Lithuania, Serbia, Slovakia, Slovenia, and Turkey) as part of the Access to Opioid Medication in Europe project...
January 2016: Lancet Oncology
Nipa R Shah, Judella Haddad-Lacle, Thanh Hogan
OBJECTIVE: To use fundamental population health and Patient Centered Medical Home guidelines to create an effective intervention that would decrease the quantity of inappropriate oxycodone controlled release (CR) prescriptions within an uninsured population. DESIGN: This was a prospective interventional study. PATIENTS, PARTICIPANTS: Patients seen in the newly formed University of Florida Community Health and Family Medicine Department Total Care Clinic, for chronic nonmalignant pain...
November 2015: Journal of Opioid Management
Sara C Jacobs, Elizabeth K Son, Christina Tat, Phillip Chiao, Maya Dulay, Alison Ludwig
BACKGROUND: In response to the national epidemic of prescription opioid misuse and related adverse outcomes, two clinical pharmacists developed a telephone risk assessment clinic to promote safe opioid prescribing through a monthly assessment of patient medication use, aberrant behaviors, and side effects. METHODS: A pilot group of five primary care providers and their patients with chronic nonmalignant pain on chronic opioid therapy, defined as having received prescription opioid medications for ≥90 days in the last 120 days, were identified...
2016: Substance Abuse
V D Mendelevich, K Yu Zalmunin
BACKGROUND: For many years, clinical protocols for treatment of drug abuse patients and treatment standards in Russian Federation were not grounded on the principles of evidence-based medicine [1]. Recommendations for use of certain drugs were not accompanied by any indication of the level of credibility of the evidence supporting it. The appearance in 2014 of such indications in clinical recommendations can be considered a significant step forward for the science of addiction medicine [2]...
2015: International Journal of Risk & Safety in Medicine
Charlene M Dewey, Marine V Ghulyan, William H Swiggart
BACKGROUND: Controlled prescription drug (CPD) abuse has reached epidemic proportions in the United States. Most physicians attending a 3-day continuing medical education (CME) professional development program (PDP) lack training in identifying risk and in managing patients who misuse CPDs. To address this issue, the authors conducted an evaluation of a PDP that trains physicians on proper prescribing, identifying substance abuse, utilizing screening, brief intervention, and referral to treatment (SBIRT), and implementing motivational interviewing (MI)...
July 2016: Substance Abuse
Lynn R Webster, Martin Grabois
It is the responsibility of medical professionals to do all that is possible to safely alleviate pain. Opioids are frequently prescribed for pain but are associated with the potential for misuse, addiction, diversion, and overdose mortality, and thus they are strictly regulated. To adhere to legitimate practice standards, physicians and other health care providers who prescribe opioids for pain, particularly on a long-term basis, need current information on federal and state laws, treatment guidelines, and regulatory actions aimed at reducing opioid-related harm...
November 2015: PM & R: the Journal of Injury, Function, and Rehabilitation
Johannes P Borde, Sarah Nussbaum, Stefanie Hauser, Philip Hehn, Johannes Hübner, Gabriela Sitaru, Sebastian Köller, Bruno Schweigert, Katja deWith, Winfried V Kern, Klaus Kaier
BACKGROUND: Hospital antibiotic stewardship (ABS) programmes offer several evidence-based tools to control prescription rates of antibiotics in different settings, influence the incidence of nosocomial infections and to contain the development of multi-drug-resistant bacteria. In the context of endoprosthetic surgery, however, knowledge of core antibiotic stewardship strategies, comparisons of costs and benefits of hospital ABS programmes are still lacking. MATERIALS AND METHODS: We identified a high daptomycin use for the treatment of methicillin-sensitive staphylococcal infections as a potential target for our ABS intervention...
June 2016: Infection
Karen E Lasser, Christopher Shanahan, Victoria Parker, Donna Beers, Ziming Xuan, Orlaith Heymann, Allison Lange, Jane M Liebschutz
BACKGROUND: Prescription opioid misuse is a significant public health problem as well as a patient safety concern. Primary care providers (PCPs) are the leading prescribers of opioids for chronic pain, yet few PCPs follow standard practice guidelines regarding assessment and monitoring. This cluster randomized controlled trial will determine whether four implementation strategies; nurse care management, use of a patient registry, academic detailing, and electronic tools, will increase PCP adherence to chronic opioid therapy guidelines and reduce opioid misuse among patients, relative to electronic tools alone...
January 2016: Journal of Substance Abuse Treatment
Denise Paone, Ellenie Tuazon, Jessica Kattan, Michelle L Nolan, Daniella Bradley O'Brien, Deborah Dowell, Thomas A Farley, Hillary V Kunins
From 2000 to 2011, the rate of unintentional drug poisoning (overdose) deaths involving opioid analgesics increased 435% in Staten Island, from 2.0 to 10.7 per 100,000 residents. During 2005-2011, disparities widened between Staten Island and the other four New York City (NYC) boroughs (Bronx, Brooklyn, Manhattan, and Queens); in 2011, the rate in Staten Island was 3.0-4.5 times higher than in the other boroughs. In response, the NYC Department of Health and Mental Hygiene (DOHMH) implemented a comprehensive five-part public health strategy, with both citywide and Staten Island-targeted efforts: 1) citywide opioid prescribing guidelines, 2) a data brief for local media highlighting Staten Island mortality and prescribing data, 3) Staten Island town hall meetings convened by the NYC commissioner of health and meetings with Staten Island stakeholders, 4) a Staten Island campaign to promote prescribing guidelines, and 5) citywide airing of public service announcements with additional airing in Staten Island...
May 15, 2015: MMWR. Morbidity and Mortality Weekly Report
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