Articles: opioid.
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European heart journal · Apr 2016
Multicenter Study Observational StudyCorrelates of pre-hospital morphine use in ST-elevation myocardial infarction patients and its association with in-hospital outcomes and long-term mortality: the FAST-MI (French Registry of Acute ST-elevation and non-ST-elevation Myocardial Infarction) programme.
The use of opioids is recommended for pain relief in patients with myocardial infarction (MI) but may delay antiplatelet agent absorption, potentially leading to decreased treatment efficacy. ⋯ Clinicaltrials.gov identifier: NCT00673036 (FAST-MI 2005); NCT01237418 (FAST-MI 2010).
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The Opioid Compliance Checklist (OCC) is a self-report measure for chronic pain patients prescribed long-term opioid therapy. The original measure includes 'yes' or 'no' items that reflect the content of a typical opioid therapy agreement. The aim of the study was to assess the efficacy of the OCC for monitoring opioid adherence among chronic noncancer pain patients within primary care. One hundred seventy-seven chronic pain patients were recruited as part of a larger study from 8 primary care centers. All patients completed pre- and poststudy measures as well as the OCC once a month for 6 months. Patients were classified on the Drug Misuse Index on the basis of results of urine toxicology screens, physician misuse behavior ratings, and self-report questionnaire results. Patients treated in primary care reported fewer incidences of misuse compared with patients from pain specialty centers in the original study. Three items from the OCC were found to be most predictive of opioid misuse measured according to the area under the curve (AUC = .681) analyses, although use of the 8-item OCC seemed equally valid. By the end of the study the patients reported lower scores on the OCC (greater compliance with their opioid medication). Results of this study suggest that the psychometric parameters of the shortened 8-item OCC are not based solely on unique characteristics of the initial validation sample. The OCC seemed to be a reliable and valid screening tool to help detect current and future aberrant drug-related behavior and nonadherence among chronic pain patients in primary care. ⋯ The OCC is a brief 'yes' or 'no' questionnaire that reflects areas of compliance that are often included in an opioid therapy agreement. Repeated administrations of the OCC among patients who receive opioids for chronic pain can increase the chance of identifying those who misuse or are likely to misuse opioids.
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More than one million people each year in the United States are diagnosed with cancer. Surgery is considered curative, but the perioperative phase represents a vulnerable period for residual disease to spread. Regional anesthesia has been proposed to reduce the incidence of recurrence by attenuating the sympathetic nervous system's response during surgery, reducing opioid requirements thus diminishing their immunosuppressant effects, and providing antitumor and anti-inflammatory effects directly through systemic local anesthetic action. In this article, we present a description of the perioperative period, a summary of the proposed hypotheses and available literature on the effects of regional anesthesia on cancer recurrence, and put regional anesthesia in context in regard to its potential role in reducing cancer recurrence during the perioperative period. ⋯ The benefits of regional anesthesia in reducing cancer recurrence have a sound theoretical basis and, in certain cancers, are supported by the existing body of literature. This article outlines the current state of our knowledge on the relationship between cancer progression and regional analgesia.
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This study aims to determine risk factors of opioid overdose among the Colorado Medicaid population. A retrospective nested case-control study was undertaken. Medicaid beneficiaries who had ≥1 medical claim for an emergency department visit or a hospitalization associated with an opioid overdose from July 2009 to June 2014 were defined as cases. Controls were selected using a nearest neighbor matching without replacement. The matched controls were selected on the basis of age, sex, and opioid prescription. One case was matched with three controls. Multivariate conditional logistic regression was used to compare risk factors. A total of 816 cases with 2,448 controls were included. Six factors were associated with opioid overdose: mean morphine dose equivalent (>50 mg/d; odds ratio [OR] = 1.986 [95% confidence interval [CI], 1.509-2.614]), methadone use (switching opioid to methadone vs. no methadone use; OR = 7.230 [95% CI, 2.346-22.286]), drug/alcohol abuse (OR = 3.104 [95% CI, 2.195-4.388]), other psychiatric illness (OR = 1.730 [95% CI, 1.307-2.291]), benzodiazepine use (OR = 2.005 [95% CI, 1.516-2.652]), and the number of pharmacies used by the beneficiary (≥4 pharmacies vs. 1 pharmacy; OR = 1.514 [95% CI, 1.003-2.286]). In conclusion, several factors are associated with opioid overdose. States and communities should ensure the availability of at-home intranasal naloxone for overdose rescue on the basis of the presence of risk factors. ⋯ This article presents the risk factors of opioid overdose among the Colorado Medicaid population. On the basis of study findings, Colorado Medicaid is currently working with physicians, hospitals, and other health system stakeholders to continue to develop policies to identify and assist this subset of our population. One such policy will be to provide at-home intranasal naloxone for overdose rescue.