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Morphine milligram equivalents

Yuan Hong, Marco Geraci, Margaret A Turk, Bryan L Love, Suzanne W McDermott
OBJECTIVES: To investigate the opioid prescription patterns for adults with longstanding physical disability and inflammatory conditions, compared to a mixed group of other opioid users, after excluding cancer patients. DESIGN: Nationally representative cross-sectional study, 2010-2014 SETTING: Medical Expenditure Panel Survey (MEPS) PARTICIPANTS: The subjects were adults who participated in MEPS and had at least one opioid prescription, did not have cancer, and were between 18 years and 64 years of age...
August 10, 2018: Archives of Physical Medicine and Rehabilitation
Ashley W Gerrish, Sandy Fogel, Ellen Rachel Lockhart, Michael Nussbaum, Farrell Adkins
BACKGROUND: Enhanced recovery programs have demonstrated a decrease in opioid use in hospitals where patients have undergone colorectal surgery. This study is to investigate whether similar decreases in opioid prescribing are achieved at discharge and postdischarge. METHODS: Patients undergoing colorectal surgery November 2014-November 2016 were reviewed. Postdischarge opioid prescribing was quantified in morphine milligram equivalents at time of discharge, 30 days postdischarge, and 60 days postdischarge...
August 9, 2018: Surgery
Jason N Doctor, Andy Nguyen, Roneet Lev, Jonathan Lucas, Tara Knight, Henu Zhao, Michael Menchine
Most opioid prescription deaths occur among people with common conditions for which prescribing risks outweigh benefits. General psychological insights offer an explanation: People may judge risk to be low without available personal experiences, may be less careful than expected when not observed, and may falter without an injunction from authority. To test these hypotheses, we conducted a randomized trial of 861 clinicians prescribing to 170 persons who subsequently suffered fatal overdoses. Clinicians in the intervention group received notification of their patients' deaths and a safe prescribing injunction from their county's medical examiner, whereas physicians in the control group did not...
August 10, 2018: Science
Wen Hui Tan, Sara Feaman, Laurel Milam, Valerie Garber, Jared McAllister, Jeffrey A Blatnik, L Michael Brunt
BACKGROUND: In 2014, hydrocodone was moved from Schedule III to II, thus it could no longer be "called in" to a pharmacy. We analyzed current postoperative opioid prescribing patterns and the impact of the schedule change on the type and amount prescribed. METHODS: Opioid prescriptions for common surgeries at 1 medical center from 2013 to 2016 were analyzed retrospectively. Milligram morphine equivalents prescribed before and after the schedule change were compared by t tests, and interrupted time series models and drug frequencies were compared by χ2 and Fisher exact tests...
August 6, 2018: Surgery
M Kit Delgado, Yanlan Huang, Zachary Meisel, Sean Hennessy, Michael Yokell, Daniel Polsky, Jeanmarie Perrone
STUDY OBJECTIVE: To inform opioid stewardship efforts, we describe the variation in emergency department (ED) opioid prescribing for a common minor injury, ankle sprain, and determine the association between initial opioid prescription intensity and transition to prolonged opioid use. METHODS: We analyzed 2011 to 2015 US private insurance claims (Optum Clinformatics DataMart) for ED-treated ankle sprains among opioid-naive patients older than 18 years. We determined the patient- and state-level variation in the opioid prescription rate and characteristics, and the risk-adjusted association between total morphine milligram equivalents (MMEs) of the prescription and transition to prolonged use (filling 4 or more opioid prescriptions 30 to 180 days after the index visit)...
July 24, 2018: Annals of Emergency Medicine
Laxmaiah Manchikanti, Jaya Sanapati, Ramsin M Benyamin, Sairam Atluri, Alan D Kaye, Joshua A Hirsch
The opioid epidemic has been called the "most consequential preventable public health problem in the United States." Though there is wide recognition of the role of prescription opioids in the epidemic, evidence has shown that heroin and synthetic opioids contribute to the majority of opioid overdose deaths. It is essential to reframe the preventive strategies in place against the opioid crisis with attention to factors surrounding the illicit use of fentanyl and heroin. Data on opioid overdose deaths shows 42,000 deaths in 2016...
July 2018: Pain Physician
Corey J Hayes, Nalin Payakachat, Chenghui Li
PURPOSE: Long-term opioid use for chronic pain has increased, but limited evidence exists on its benefits. Evaluation of long-term benefits in pain is based on patient-reported measures such as health-related quality of life (HRQoL). This study examined the long-term effects of opioid use on HRQoL and its subdomains in patients with back pain or arthritis by comparing opioid users to non-opioid users for three metrics: (1) any opioid use, (2) duration of opioid use, and (3) average daily morphine equivalent dose...
July 23, 2018: Quality of Life Research
Michele Buonora, Hector R Perez, Moonseong Heo, Chinazo O Cunningham, Joanna L Starrels
Objective: Among patients with chronic pain, risk of opioid use is elevated with high opioid dose or concurrent benzodiazepine use. This study examined whether these clinical factors, or sociodemographic factors of race and gender, are associated with opioid dose reduction. Design and Setting: A retrospective cohort study of outpatients prescribed chronic opioid therapy between 2007 and 2012 within a large, academic health care system in Bronx, New York, using electronic medical record data...
July 18, 2018: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Alexander S Chiu, Raymond A Jean, Jessica R Hoag, Mollie Freedman-Weiss, James M Healy, Kevin Y Pei
Importance: Reliance on prescription opioids for postprocedural analgesia has contributed to the opioid epidemic. With the implementation of electronic medical record (EMR) systems, there has been increasing use of computerized order entry systems for medication prescriptions, which is now more common than handwritten prescriptions. The EMR can autopopulate a default number of pills prescribed, and 1 potential method to alter prescriber behavior is to change the default number presented via the EMR system...
July 18, 2018: JAMA Surgery
Ching Man Carmen Tong, Jacob Lucas, Ankur Shah, Christopher Foote, Jay Simhan
BACKGROUND: Inflatable penile prosthesis (IPP) surgery is associated with significant perioperative pain that may reduce patient satisfaction. Though various pain management strategies have been proposed, most implanters manage postoperative patients with only prescription opioids. No protocol to date has been implemented and reported for pain management in IPP patients throughout the entire recovery process following surgery. AIM: Develop a multimodal analgesic (MMA) regimen consisting of perioperative administration of acetaminophen, meloxicam, and gabapentin with intraoperative local anesthetic injections, and compare post-operative pain control to a matched cohort of patients managed with an opioid-based (OB) regimen...
August 2018: Journal of Sexual Medicine
Cornelius A Thiels, Daniel S Ubl, Kathleen J Yost, Sean C Dowdy, Tad M Mabry, Halena M Gazelka, Robert R Cima, Elizabeth B Habermann
OBJECTIVE: The aim of this study was to conduct a prospective, multicenter survey of patients regarding postoperative opioid use to inform development of standardized, evidence-based, procedure-specific opioid prescribing guidelines. SUMMARY OF BACKGROUND DATA: Previous work has shown significant variation in the amount of opioids prescribed after elective procedures, calling for optimization of prescribing. METHODS: Adults (n = 3412) undergoing 25 elective procedures were identified prospectively from 3 academic centers (March 2017 to January 2018) to complete a 29-question telephone interview survey 21 to 35 days post-discharge (n = 688 not contacted, n = 107 refused)...
September 2018: Annals of Surgery
Malavika Prabhu, Elizabeth M Garry, Sonia Hernandez-Diaz, Sarah C MacDonald, Krista F Huybrechts, Brian T Bateman
OBJECTIVE: To describe nationwide patterns in outpatient opioid dispensing after vaginal delivery. METHODS: Using the Truven Health Analytics MarketScan database, we performed a large, nationwide retrospective cohort study of commercially insured beneficiaries who underwent vaginal delivery between 2003 and 2015 and who were opioid-naive for 12 weeks before the delivery admission. We assessed the proportion of women dispensed an oral opioid within 1 week of discharge, the associated median oral morphine milligram equivalent dose dispensed, and the frequency of opioid refills during the 6 weeks after discharge...
August 2018: Obstetrics and Gynecology
Timothy T Pham, Grant H Skrepnek, Christopher Bond, Thomas Alfieri, Terry J Cothran, Shellie L Keast
BACKGROUND: Medicaid members are predisposed to unintentional prescription opioid overdose. However, little is known about their individual risk factors. OBJECTIVES: To describe demographic and clinical characteristics, medical utilization, opioid use, concurrent use of benzodiazepines, risk factors, and substances involved in death for Oklahoma's Medicaid members who died of unintentional prescription opioid poisoning. SUBJECTS: Decedents who were Medicaid eligible in Oklahoma during the year of death, had an opioid recorded in cause of death, and had ≥1 opioid prescription claim between January 1, 2011 and June 30, 2016 were cases...
August 2018: Medical Care
Shankar Raman, Mayin Lin, Nivedita Krishnan
Objective: The objective of the study was to systematically investigate the outcomes of Liposomal Bupivacaine following major colorectal resections. Patients and methods: We conducted a comprehensive literature search of PubMed, Medline, Google scholar, Cochrane Central Registry and clinical databases through May 2017 for studies published regarding liposomal bupivacaine. Studies were filtered based on relevance to perioperative analgesia in colorectal resections. Data comparing type of study, techniques of resection, mode of administration of liposomal bupivacaine, details of control group, outcomes were collected...
2018: Journal of Drug Assessment
Kevin R Olsen, David J Hall, Juan C Mira, Patrick W Underwood, Ajay B Antony, Terrie Vasilopoulos, George A Sarosi
BACKGROUND: Increasing mortality from opioid overdoses has prompted increased focus on prescribing practices of physicians. Unfortunately, resident physicians rarely receive formal education in effective opioid prescribing practices or postoperative pain management. Data to inform surgical training programs regarding the utility and feasibility of formal training are lacking. METHODS: Following Institutional Review Board approval, a single institution's resident physicians who had completed at least one surgical rotation were surveyed to assess knowledge of pain management and evaluate opioid prescribing practices...
September 2018: Journal of Surgical Research
Kristin E Rojas, Donna-Marie Manasseh, Peter L Flom, Solomon Agbroko, Nicole Bilbro, Charusheela Andaz, Patrick I Borgen
BACKGROUND: The evolving conceptualization of the management of surgical pain was a major contributor to the supply of narcotics that led to the opioid crisis. We designed and implemented a breast surgery-specific Enhanced Recovery After Surgery (ERAS) protocol using opioid-sparing techniques to eliminate narcotic prescription at discharge without sacrificing perioperative pain control. METHODS: A pilot observational study included patients with and without cancer undergoing lumpectomy...
June 18, 2018: Breast Cancer Research and Treatment
Shirley Musich, Shaohung S Wang, Luke Slindee, Sandra Kraemer, Charlotte S Yeh
Our primary objective was to determine the prevalence and characteristics of high dose opioid users among older adults. Study populations included adults ≥65 years with: 1) 12-month continuous medical plan enrollment; and 2) at least 2 opioid prescriptions with a cumulative day supply ≥15 days. Opioid users were categorized as high dose >120 milligram morphine equivalents (MME) per day or lower dose ≤120 MMEs per day. Among eligible insureds, 3% (N = 7616) were identified as high dose opioid users...
June 11, 2018: Geriatric Nursing
Malavika Prabhu, Mark A Clapp, Emily McQuaid-Hanson, Samsiya Ona, Taylor OʼDonnell, Kaitlyn James, Brian T Bateman, Blair J Wylie, William H Barth
OBJECTIVE: To evaluate whether a liposomal bupivacaine incisional block decreases postoperative pain and represents an opioid-minimizing strategy after scheduled cesarean delivery. METHODS: In a single-blind, randomized controlled trial among opioid-naive women undergoing cesarean delivery, liposomal bupivacaine or placebo was infiltrated into the fascia and skin at the surgical site, before fascial closure. Using an 11-point numeric rating scale, the primary outcome was pain score with movement at 48 hours postoperatively...
July 2018: Obstetrics and Gynecology
Jessica C Young, Jennifer L Lund, Nabarun Dasgupta, Michele Jonsson Funk
BACKGROUND: In recognition of potential for increased overdose risk, drug labels for extended-release and long-acting (ER/LA) opioids emphasize the need for established opioid tolerance prior to initiating high dosages. OBJECTIVES: Describe the proportion of patients with opioid tolerance prior to initiation of 90 morphine milligram equivalents (MME) ER/LA opioids and examine subsequent risk of opioid poisoning. METHODS: We used Truven Health Analytics' MarketScan Databases (2006-2015) to identify patients initiating ER/LA opioids ≥90 MME...
June 11, 2018: Pharmacoepidemiology and Drug Safety
Ashkan Mobini, Pushkar Mehra, Radhika Chigurupati
PURPOSE: The purpose of this study was to determine the effect of individual characteristics, such as age, gender, and type of surgery, on postoperative pain intensity and opioid analgesic consumption after orthognathic surgery. PATIENTS AND METHODS: This prospective observational study was conducted at a single academic medical center during a 12-month period from 2015 to 2016. Thirty of 125 patients 18 to 65 years of age who had American Society of Anesthesiologists status I and II and were admitted to the hospital after orthognathic surgery were recruited...
May 19, 2018: Journal of Oral and Maxillofacial Surgery
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