scholarly journals Prescriptions of Strong Opioid Analgesics in Primary Care (Pharmacy Care)

2019 ◽  
Vol 02 (04) ◽  
Author(s):  
Andrea Gazova ◽  
Maria Kolesarova ◽  
Marek Orinak ◽  
Dalibor Kolesar ◽  
Jan Kyselovic
Keyword(s):  
Primary Care ◽  
Opioid Analgesics ◽  
Strong Opioid

Do-not-resuscitate status is correlated with the prescribed use of systemic strong opioid analgesics in patients with terminal cancer: an observational study

2019 ◽  
Vol 27 (12) ◽  
pp. 4507-4513
Author(s):  
Chun-Li Wang ◽  
Chia-Yen Lin ◽  
Chun-Che Huang ◽  
Chu-Sheng Lin ◽  
Chung-Chieh Hu ◽  
...  
Keyword(s):  
Observational Study ◽  
Opioid Analgesics ◽  
Terminal Cancer ◽  
Do Not Resuscitate ◽  
Strong Opioid

scholarly journals Relationship Between Opioid Analgesic Prescription and Unemployment in Patients Seeking Acupuncture for Chronic Pain in Urban Primary Care

Pain Medicine ◽  
2018 ◽  
Vol 20 (8) ◽  
pp. 1528-1533 ◽  
Author(s):  
Elizabeth Chuang ◽  
Eric N Gil ◽  
Qi Gao ◽  
Benjamin Kligler ◽  
M Diane McKee
Keyword(s):  
Primary Care ◽  
Low Income ◽  
Pain Treatment ◽  
Opioid Analgesic ◽  
Opioid Analgesics ◽  
Baseline Survey ◽  
Patient Reported ◽  
Nonmalignant Pain ◽  
Chronic Nonmalignant Pain ◽  
Analgesic Use

Abstract Objective The widespread use of opioid analgesics to treat chronic nonmalignant pain has contributed to the ongoing epidemic of opioid-related morbidity and mortality. Previous studies have also demonstrated a relationship between opioid analgesic use and unemployment due to disability. These studies have been limited to mainly white European and North American populations. The objective of this study is to explore the relationship between opioid analgesic use for chronic nonmalignant pain in an urban, mainly black and Hispanic, low-income population. Design This is a cross-sectional observational study. Setting Subjects were recruited from six urban primary care health centers. Subjects Adults with chronic neck, back, or osteoarthritis pain participating in an acupuncture trial were included. Methods Survey data were collected as a part of the Acupuncture Approaches to Decrease Disparities in Pain Treatment two-arm (AADDOPT-2) comparative effectiveness trial. Participants completed a baseline survey including employment status, opioid analgesic use, the Brief Pain Inventory, the global Patient Reported Outcomes Measurement Information Systems quality of life measure, the Patient Health Questionnaire-9 (PHQ-9), and demographic information. A multivariable logistic regression model was built to examine the association between opioid analgesic use and unemployment. Results Opioid analgesic use was associated with three times the odds of unemployment due to disability while controlling for potential confounders, including depression, pain severity, pain interference, global physical and mental functioning, and demographic characteristics. Conclusions This study adds to the growing body of evidence that opioid analgesics should be used with caution in chronic nonmalignant pain.

scholarly journals Psychiatrists are stakeholders in improving access to controlled medicines

2011 ◽  
Vol 8 (4) ◽  
pp. 98-100
Author(s):  
Willem Scholten
Keyword(s):  
Severe Pain ◽  
Opioid Analgesics ◽  
Drug Control ◽  
Insufficient Data ◽  
Need For Treatment ◽  
Strong Opioid ◽  
The World

Medicines made from substances that are controlled under the international drug control treaties (‘controlled medicines’) are out of reach for the majority of patients around the world. Seya et al (2011) demonstrated that 5.5 billion people (83% of the world's population) live in countries with little or no access to opioid analgesics, 250 million (4%) have moderate access and only 460 million people (7%) have adequate access. Insufficient data are available for 430 million (7%). If the need for treatment of moderate to severe pain were to be satisfied adequately, the global consumption of strong opioid analgesics would go up from 231 tonnes of morphine-equivalents to 1292 tonnes.

scholarly journals Associations between breast cancer survivorship and adverse mental health outcomes: A matched population-based cohort study in the United Kingdom

PLoS Medicine ◽  
2021 ◽  
Vol 18 (1) ◽  
pp. e1003504
Author(s):  
Helena Carreira ◽  
Rachael Williams ◽  
Garth Funston ◽  
Susannah Stanway ◽  
Krishnan Bhaskaran
Keyword(s):  
Breast Cancer ◽  
Mental Health ◽  
Primary Care ◽  
Cancer Survivorship ◽  
Cancer Diagnosis ◽  
Opioid Analgesics ◽  
Anxiety And Depression ◽  
Breast Cancer Survivorship ◽  
The United Kingdom ◽  
Health Related

Background Breast cancer is the most common cancer diagnosed in women globally, and 5-year net survival probabilities in high-income countries are generally >80%. A cancer diagnosis and treatment are often traumatic events, and many women struggle to cope during this period. Less is known, however, about the long-term mental health impact of the disease, despite many women living several years beyond their breast cancer and mental health being a major source of disability in modern societies. The objective of this study was to quantify the risk of several adverse mental health–related outcomes in women with a history of breast cancer followed in primary care in the United Kingdom National Health Service, compared to similar women who never had cancer. Methods and findings We conducted a matched cohort study using data routinely collected in primary care across the UK to quantify associations between breast cancer history and depression, anxiety, and other mental health–related outcomes. All women with incident breast cancer in the Clinical Practice Research Datalink (CPRD) GOLD primary care database between 1988 and 2018 (N = 57,571, mean = 62 ± 14 years) were matched 1:4 to women with no prior cancer (N = 230,067) based on age, primary care practice, and eligibility of the data for linkage to hospital data sources. Cox models were used to estimate associations between breast cancer survivorship and each mental health–related outcome, further adjusting for diabetes, body mass index (BMI), and smoking and drinking status at baseline. Breast cancer survivorship was positively associated with anxiety (adjusted hazard ratio (HR) = 1.33; 95% confidence interval (CI): 1.29–1.36; p < 0.001), depression (1.35; 1.32–1.38; p < 0.001), sexual dysfunction (1.27; 1.17–1.38; p < 0.001), and sleep disorder (1.68; 1.63–1.73; p < 0.001), but not with cognitive dysfunction (1.00; 0.97–1.04; p = 0.88). Positive associations were also found for fatigue (HR = 1.28; 1.25–1.31; p < 0.001), pain (1.22; 1.20–1.24; p < 0.001), receipt of opioid analgesics (1.86; 1.83–1.90; p < 0.001), and fatal and nonfatal self-harm (1.15; 0.97–1.36; p = 0.11), but CI was wide, and the relationship was not statistically significant for the latter. HRs for anxiety and depression decreased over time (p-interaction <0.001), but increased risks persisted for 2 and 4 years, respectively, after cancer diagnosis. Increased levels of pain and sleep disorder persisted for 10 years. Younger age was associated with larger HRs for depression, cognitive dysfunction, pain, opioid analgesics use, and sleep disorders (p-interaction <0.001 in each case). Limitations of the study include the potential for residual confounding by lifestyle factors and detection bias due to cancer survivors having greater healthcare contact. Conclusions In this study, we observed that compared to women with no prior cancer, breast cancer survivors had higher risk of anxiety, depression, sleep problems, sexual dysfunction, fatigue, receipt of opioid analgesics, and pain. Relative risks estimates tended to decrease over time, but anxiety and depression were significantly increased for 2 and 4 years after breast cancer diagnosis, respectively, while associations for fatigue, pain, and sleep disorders were elevated for at least 5–10 years after diagnosis. Early diagnosis and increased awareness among patients, healthcare professionals, and policy makers are likely to be important to mitigate the impacts of these raised risks.

scholarly journals Changes in trends and pattern of strong opioid prescribing in primary care

2014 ◽  
Vol 18 (9) ◽  
pp. 1343-1351 ◽  
Author(s):  
C.S. Zin ◽  
L.-C. Chen ◽  
R.D. Knaggs
Keyword(s):  
Primary Care ◽  
Opioid Prescribing ◽  
Strong Opioid

scholarly journals Examining patterns in opioid prescribing for non-cancer-related pain in Wales: preliminary data from a retrospective cross-sectional study using large datasets

2018 ◽  
Vol 13 (3) ◽  
pp. 145-158 ◽  
Author(s):  
Emma Davies ◽  
Ceri Phillips ◽  
Jaynie Rance ◽  
Berni Sewell
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Large Scale ◽  
Study Cohort ◽  
Age Group ◽  
Cross Sectional ◽  
Opioid Prescription ◽  
Adult Age ◽  
Opioid Prescribing ◽  
Strong Opioid

Objectives: To examine trends in strong opioid prescribing in a primary care population in Wales and identify if factors such as age, deprivation and recorded diagnosis of depression or anxiety may have influenced any changes noted. Design: Trend, cross-sectional and longitudinal analyses of routine data from the Primary Care General Practice database and accessed via the Secure Anonymised Information Linkage (SAIL) databank. Setting: A total of 345 Primary Care practices in Wales. Participants: Anonymised records of 1,223,503 people aged 18 or over, receiving at least one opioid prescription between 1 January 2005 and 31 December 2015 were analysed. People with a cancer diagnosis (10.1%) were excluded from the detailed analysis. Results: During the study period, 26,180,200 opioid prescriptions were issued to 1,223,503 individuals (55.9% female, 89.9% non-cancer diagnoses). The greatest increase in annual prescribing was in the 18–24 age group (10,470%), from 0.08 to 8.3 prescriptions/1000 population, although the 85+ age group had the highest prescribing rates across the study period (from 149.9 to 288.5 prescriptions/1000 population). The number of people with recorded diagnoses of depression or anxiety and prescribed strong opioids increased from 1.2 to 5.1 people/1000 population (328%). The increase was 366.9% in areas of highest deprivation compared to 310.3 in the least. Areas of greatest deprivation had more than twice the rate of strong opioid prescribing than the least deprived areas of Wales. Conclusion: The study highlights a large increase in strong opioid prescribing for non-cancer pain, in Wales between 2005 and 2015. Population groups of interest include the youngest and oldest adult age groups and people with depression or anxiety particularly if living in the most deprived communities. Based on this evidence, development of a Welsh national guidance on safe and rational prescribing of opioids in chronic pain would be advisable to prevent further escalation of these medicines. Summary points This is the first large-scale, observational study of opioid prescribing in Wales. Over 1 million individual, anonymised medical records have been searched in order to develop the study cohort, thus reducing recall bias. Diagnosis and intervention coding in the Primary Care General Practice database is limited at input and may lead to under-reporting of diagnoses. There are limitations to the data available through the Secure Anonymised Information Linkage databank because anonymously linked dispensing data (what people collect from the pharmacy) are not currently available. Consequently, the results presented here could be seen as an ‘intention to treat’ and may under- or overestimate what people in Wales actually consume.

scholarly journals The chronic need to improve the management of pain

2003 ◽  
Vol 8 (4) ◽  
pp. 187-188 ◽  
Author(s):  
Eldon Tunks
Keyword(s):  
Primary Care ◽  
Palliative Care ◽  
Primary Care Physicians ◽  
Opioid Analgesics ◽  
Care Practice ◽  
Eligibility Criteria ◽  
Chronic Noncancer Pain ◽  
Primary Care Doctors ◽  
Third Line ◽  
Noncancer Pain

In this issue, Drs Morley-Forster, Clark, Speechley and Moulin report on their survey conducted by Ipsos-Reid in June 2001 (pages 189-194). Only physicians who met the eligibility criteria of having written 20 or more prescriptions for moderate to severe pain in the preceding four weeks or having devoted 20% of their time to palliative care were eligible to participate. Sixty-eight per cent of the respondents thought that moderate to severe chronic pain was not well managed in Canada. Despite this opinion, 23% of physicians in palliative care practice and 34% of primary care doctors stated that they would not use opioids to treat moderate to severe chronic noncancer pain even as a third-line treatment after two previous medications had failed. One-quarter to one-third were concerned about the potential for addiction, and a smaller percentage reported concern about the potential for patient abuse and/or misuse, and side effects. Fear of a College audit resulting in the loss of their medical licence was cited by 10% of primary care physicians. When asked what obstacle hindered their use of strong opioid analgesics, an unexplained 10% of palliative care doctors and 14% of primary care doctors answered "nothing in particular".

scholarly journals Opioid analgesics and chronic non-cancer pain: a prescription for research in primary care

2016 ◽  
Vol 33 (6) ◽  
pp. 569-571 ◽  
Author(s):  
Jeffrey F Scherrer ◽  
F David Schneider ◽  
Patrick J Lustman
Keyword(s):  
Primary Care ◽  
Cancer Pain ◽  
Opioid Analgesics
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