Hieu-Pham/cpgQA huggingface dataset:
Recommendations

Naloxone administration has been identified as a life saving measure following opioid overdose. A  systematic review of 22 observational studies provided moderate quality evidence that take home  naloxone programs are effective in improving overdose survival and decreasing mortality, with a low rate  of adverse events.[108] One meta-analysis of nine studies determined that take home naloxone kits were  used approximately nine times within the first three months of follow-up for every 100 individuals  trained.[109] Further, studies have shown that naloxone administration has been efficacious whether  given by medical personnel or lay people, with more than 26,000 reversals documented by the CDC from  1996-2014.[110,111] In addition, prescription of naloxone rescue and accompanying education has also  been found to reduce opioid-related emergency department visits.[112] Distribution of naloxone for  reversal is supported by SAMHSA, the American Medical Association (AMA), and other medical societies,  and is facilitated through the VA via Pharmacy Benefits Management. Clinical efficacy has been established  for its use on short-acting opioids, but not for its use on long-acting opioids such as methadone or  exceptionally potent opioids.[108]  

Question: On which kind of opioids the use of the distribution of naloxone has established clinical efficacy?
Answer: short-acting opioids
Recommendations

Naloxone administration has been identified as a life saving measure following opioid overdose. A  systematic review of 22 observational studies provided moderate quality evidence that take home  naloxone programs are effective in improving overdose survival and decreasing mortality, with a low rate  of adverse events.[108] One meta-analysis of nine studies determined that take home naloxone kits were  used approximately nine times within the first three months of follow-up for every 100 individuals  trained.[109] Further, studies have shown that naloxone administration has been efficacious whether  given by medical personnel or lay people, with more than 26,000 reversals documented by the CDC from  1996-2014.[110,111] In addition, prescription of naloxone rescue and accompanying education has also  been found to reduce opioid-related emergency department visits.[112] Distribution of naloxone for  reversal is supported by SAMHSA, the American Medical Association (AMA), and other medical societies,  and is facilitated through the VA via Pharmacy Benefits Management. Clinical efficacy has been established  for its use on short-acting opioids, but not for its use on long-acting opioids such as methadone or  exceptionally potent opioids.[108]  

Question: On which kind of opioids the use of the distribution of naloxone does not have established clinical efficacy?
Answer: long-acting opioids such as methadone or  exceptionally potent opioids
Recommendations

Synthetic opioids such as fentanyl analogs, potent opioid receptor agonists, are responsible for a recent  rise in death rates. Fentanyl analogs that may be used to create counterfeit opioid analgesic pills can cause  a toxidrome characterized by significant CNS and profound respiratory depression requiring multiple  naloxone doses for reversal.[113]  

Question: Which opioids are responsible for a recent rise in death rates?
Answer: Synthetic opioids such as fentanyl analogs, potent opioid receptor agonists
Recommendations

Synthetic opioids such as fentanyl analogs, potent opioid receptor agonists, are responsible for a recent  rise in death rates. Fentanyl analogs that may be used to create counterfeit opioid analgesic pills can cause  a toxidrome characterized by significant CNS and profound respiratory depression requiring multiple  naloxone doses for reversal.[113]  

Question: What are some examples of synthetic opioids?
Answer: fentanyl analogs, potent opioid receptor agonists
Recommendations

Synthetic opioids such as fentanyl analogs, potent opioid receptor agonists, are responsible for a recent  rise in death rates. Fentanyl analogs that may be used to create counterfeit opioid analgesic pills can cause  a toxidrome characterized by significant CNS and profound respiratory depression requiring multiple  naloxone doses for reversal.[113]  

Question: What can cause a toxidrome?
Answer: Fentanyl analogs that may be used to create counterfeit opioid analgesic pills
Recommendations

Synthetic opioids such as fentanyl analogs, potent opioid receptor agonists, are responsible for a recent  rise in death rates. Fentanyl analogs that may be used to create counterfeit opioid analgesic pills can cause  a toxidrome characterized by significant CNS and profound respiratory depression requiring multiple  naloxone doses for reversal.[113]  

Question: What can be caused by fentanyl analogs that may be used to create counterfeit opioid analgesic pills?
Answer: a toxidrome characterized by significant CNS and profound respiratory depression requiring multiple  naloxone doses for reversal
Recommendations

Those patients receiving opioid analgesics who do not meet DSM-5 criteria for OUD may benefit from an  alternative management strategy: close follow-up and CBT. Jamison et al. (2010) randomized patients at  high-risk for OUD (as measured by standard rating scales) to receive either standard pain management or  close follow-up with CBT for pain.[114] Both of these groups were compared to a low-risk, chronic pain  control group receiving standard management. The authors report that, compared to a matched high-risk  group receiving standard care, patients receiving additional monitoring and CBT exhibited significantly  reduced illicit substance use over six months (percentage of patients with positive drug misuse index  scores: 73.7% versus 26.3% versus 25.0%; p<0.01). At six months, there was no difference between the  high-risk group receiving close follow-up and the low-risk group receiving standard therapy. Authors also  reported that pain perception was less in the high-risk group receiving additional monitoring and behavior  therapy; however, analysis of activity interference reporting reflected no significant difference between  study groups. 

Question: Who may benefit from an alternative management strategy?
Answer: Those patients receiving opioid analgesics who do not meet DSM-5 criteria for OUD
Recommendations

Those patients receiving opioid analgesics who do not meet DSM-5 criteria for OUD may benefit from an  alternative management strategy: close follow-up and CBT. Jamison et al. (2010) randomized patients at  high-risk for OUD (as measured by standard rating scales) to receive either standard pain management or  close follow-up with CBT for pain.[114] Both of these groups were compared to a low-risk, chronic pain  control group receiving standard management. The authors report that, compared to a matched high-risk  group receiving standard care, patients receiving additional monitoring and CBT exhibited significantly  reduced illicit substance use over six months (percentage of patients with positive drug misuse index  scores: 73.7% versus 26.3% versus 25.0%; p<0.01). At six months, there was no difference between the  high-risk group receiving close follow-up and the low-risk group receiving standard therapy. Authors also  reported that pain perception was less in the high-risk group receiving additional monitoring and behavior  therapy; however, analysis of activity interference reporting reflected no significant difference between  study groups. 

Question: Patients receiving opioid analgesics who do not meet DSM-5 criteria for OUD may benefit from what?
Answer: an  alternative management strategy: close follow-up and CBT
Recommendations

Those patients receiving opioid analgesics who do not meet DSM-5 criteria for OUD may benefit from an  alternative management strategy: close follow-up and CBT. Jamison et al. (2010) randomized patients at  high-risk for OUD (as measured by standard rating scales) to receive either standard pain management or  close follow-up with CBT for pain.[114] Both of these groups were compared to a low-risk, chronic pain  control group receiving standard management. The authors report that, compared to a matched high-risk  group receiving standard care, patients receiving additional monitoring and CBT exhibited significantly  reduced illicit substance use over six months (percentage of patients with positive drug misuse index  scores: 73.7% versus 26.3% versus 25.0%; p<0.01). At six months, there was no difference between the  high-risk group receiving close follow-up and the low-risk group receiving standard therapy. Authors also  reported that pain perception was less in the high-risk group receiving additional monitoring and behavior  therapy; however, analysis of activity interference reporting reflected no significant difference between  study groups. 

Question: What is the alternative management strategy that is beneficial for patients receiving opioid analgesics who do not meet DSM-5 criteria for OUD?
Answer: close follow-up and CBT
Recommendations

Take Back Programs: Returning unused opioid medications has been explored as a strategy to reduce the amount of opioids in  the community, as it has been estimated that 70% of opioid prescriptions are left unused.[115]  Accordingly, the National Drug Control Strategy advocates take back programs as an effective tool.[24] For  example, in a 2013 medication take back event in a Michigan community, 3,633 containers containing 345  different prescription medications were collected in four hours. The top five most common medications  collected were pain relievers.[116] System-wide efficacy of a nationwide program is unknown.[117]  

Question: What has been explored as a strategy to reduce the amount of opioids in  the community?
Answer: Returning unused opioid medications
Recommendations

Take Back Programs: Returning unused opioid medications has been explored as a strategy to reduce the amount of opioids in  the community, as it has been estimated that 70% of opioid prescriptions are left unused.[115]  Accordingly, the National Drug Control Strategy advocates take back programs as an effective tool.[24] For  example, in a 2013 medication take back event in a Michigan community, 3,633 containers containing 345  different prescription medications were collected in four hours. The top five most common medications  collected were pain relievers.[116] System-wide efficacy of a nationwide program is unknown.[117]  

Question: What is the ratio of opioid prescriptions that are left unused?
Answer: 70%
Recommendations

Take Back Programs: Returning unused opioid medications has been explored as a strategy to reduce the amount of opioids in  the community, as it has been estimated that 70% of opioid prescriptions are left unused.[115]  Accordingly, the National Drug Control Strategy advocates take back programs as an effective tool.[24] For  example, in a 2013 medication take back event in a Michigan community, 3,633 containers containing 345  different prescription medications were collected in four hours. The top five most common medications  collected were pain relievers.[116] System-wide efficacy of a nationwide program is unknown.[117]  

Question: Returning unused opioid medications has been explored as a strategy for what?
Answer: to reduce the amount of opioids in  the community
Recommendations

Take Back Programs: Returning unused opioid medications has been explored as a strategy to reduce the amount of opioids in  the community, as it has been estimated that 70% of opioid prescriptions are left unused.[115]  Accordingly, the National Drug Control Strategy advocates take back programs as an effective tool.[24] For  example, in a 2013 medication take back event in a Michigan community, 3,633 containers containing 345  different prescription medications were collected in four hours. The top five most common medications  collected were pain relievers.[116] System-wide efficacy of a nationwide program is unknown.[117]  

Question: Why has returning unused opioid medications been explored as a strategy to reduce the amount of opioids in  the community?
Answer: it has been estimated that 70% of opioid prescriptions are left unused
Recommendations

Take Back Programs: Returning unused opioid medications has been explored as a strategy to reduce the amount of opioids in  the community, as it has been estimated that 70% of opioid prescriptions are left unused.[115]  Accordingly, the National Drug Control Strategy advocates take back programs as an effective tool.[24] For  example, in a 2013 medication take back event in a Michigan community, 3,633 containers containing 345  different prescription medications were collected in four hours. The top five most common medications  collected were pain relievers.[116] System-wide efficacy of a nationwide program is unknown.[117]  

Question: Who does advocate take back programs as an effective tool?
Answer: the National Drug Control Strategy
Recommendations

Take Back Programs: Returning unused opioid medications has been explored as a strategy to reduce the amount of opioids in  the community, as it has been estimated that 70% of opioid prescriptions are left unused.[115]  Accordingly, the National Drug Control Strategy advocates take back programs as an effective tool.[24] For  example, in a 2013 medication take back event in a Michigan community, 3,633 containers containing 345  different prescription medications were collected in four hours. The top five most common medications  collected were pain relievers.[116] System-wide efficacy of a nationwide program is unknown.[117]  

Question: What does the National Drug Control Strategy advocate?
Answer: take back programs
Recommendations

Take Back Programs: Returning unused opioid medications has been explored as a strategy to reduce the amount of opioids in  the community, as it has been estimated that 70% of opioid prescriptions are left unused.[115]  Accordingly, the National Drug Control Strategy advocates take back programs as an effective tool.[24] For  example, in a 2013 medication take back event in a Michigan community, 3,633 containers containing 345  different prescription medications were collected in four hours. The top five most common medications  collected were pain relievers.[116] System-wide efficacy of a nationwide program is unknown.[117]  

Question: The National Drug Control Strategy advocates take back programs as what?
Answer: an effective tool
Recommendations

Take Back Programs: Returning unused opioid medications has been explored as a strategy to reduce the amount of opioids in  the community, as it has been estimated that 70% of opioid prescriptions are left unused.[115]  Accordingly, the National Drug Control Strategy advocates take back programs as an effective tool.[24] For  example, in a 2013 medication take back event in a Michigan community, 3,633 containers containing 345  different prescription medications were collected in four hours. The top five most common medications  collected were pain relievers.[116] System-wide efficacy of a nationwide program is unknown.[117]  

Question: In a 2013 medication take back event in a Michigan community, how many containers were collected in four hours?
Answer: 3,633 containers containing 345  different prescription medications
Recommendations

Take Back Programs: Returning unused opioid medications has been explored as a strategy to reduce the amount of opioids in  the community, as it has been estimated that 70% of opioid prescriptions are left unused.[115]  Accordingly, the National Drug Control Strategy advocates take back programs as an effective tool.[24] For  example, in a 2013 medication take back event in a Michigan community, 3,633 containers containing 345  different prescription medications were collected in four hours. The top five most common medications  collected were pain relievers.[116] System-wide efficacy of a nationwide program is unknown.[117]  

Question: What were the top five most common medications collected in a 2013 medication take back event in a Michigan community?
Answer: pain relievers
Recommendations

Community-based Needle Exchange Programs or Syringe Service Programs: Nearly 80% of new users of injectable opioids had previously used prescription oral opioid pain medication.[118,119] Illicit use of injectable opioids is accompanied by an increased rate of human immunodeficiency virus (HIV) and hepatitis infection. Community-based needle exchange programs have been shown to be an effective risk mitigation strategy for reducing high-risk behaviors (e.g., sharing needles) and infectious disease transmission among injection drug users.[120] For those patients who develop OUD and progress to intravenous drug use, the first recommendation should be for medication assisted treatment (MAT) for OUD (see Recommendation 17). For patients who decline MAT for OUD,  clinicians should consider educating the patient regarding sterile injection techniques and community based needle exchange programs, if programs are available. The 2015 outbreak of HIV/hepatitis in rural  Indiana and subsequent successful implementation of a needle exchange program is an example of the threat to rural communities from non-prescription opioid use and the potential benefits of needle exchange programs for use as a risk mitigation strategy.[121,122]  

Question: What is the ratio of new users of injectable opioids who had previously used prescription oral opioid pain medication?
Answer: 80%
Recommendations

Community-based Needle Exchange Programs or Syringe Service Programs: Nearly 80% of new users of injectable opioids had previously used prescription oral opioid pain medication.[118,119] Illicit use of injectable opioids is accompanied by an increased rate of human immunodeficiency virus (HIV) and hepatitis infection. Community-based needle exchange programs have been shown to be an effective risk mitigation strategy for reducing high-risk behaviors (e.g., sharing needles) and infectious disease transmission among injection drug users.[120] For those patients who develop OUD and progress to intravenous drug use, the first recommendation should be for medication assisted treatment (MAT) for OUD (see Recommendation 17). For patients who decline MAT for OUD,  clinicians should consider educating the patient regarding sterile injection techniques and community based needle exchange programs, if programs are available. The 2015 outbreak of HIV/hepatitis in rural  Indiana and subsequent successful implementation of a needle exchange program is an example of the threat to rural communities from non-prescription opioid use and the potential benefits of needle exchange programs for use as a risk mitigation strategy.[121,122]  

Question: What is accompanied by an increased rate of the human immunodeficiency virus (HIV) and hepatitis infection?
Answer: Illicit use of injectable opioids
Recommendations

Community-based Needle Exchange Programs or Syringe Service Programs: Nearly 80% of new users of injectable opioids had previously used prescription oral opioid pain medication.[118,119] Illicit use of injectable opioids is accompanied by an increased rate of human immunodeficiency virus (HIV) and hepatitis infection. Community-based needle exchange programs have been shown to be an effective risk mitigation strategy for reducing high-risk behaviors (e.g., sharing needles) and infectious disease transmission among injection drug users.[120] For those patients who develop OUD and progress to intravenous drug use, the first recommendation should be for medication assisted treatment (MAT) for OUD (see Recommendation 17). For patients who decline MAT for OUD,  clinicians should consider educating the patient regarding sterile injection techniques and community based needle exchange programs, if programs are available. The 2015 outbreak of HIV/hepatitis in rural  Indiana and subsequent successful implementation of a needle exchange program is an example of the threat to rural communities from non-prescription opioid use and the potential benefits of needle exchange programs for use as a risk mitigation strategy.[121,122]  

Question: What accompanies the illicit use of injectable opioids?
Answer: an increased rate of human immunodeficiency virus (HIV) and hepatitis infection
Recommendations

Community-based Needle Exchange Programs or Syringe Service Programs: Nearly 80% of new users of injectable opioids had previously used prescription oral opioid pain medication.[118,119] Illicit use of injectable opioids is accompanied by an increased rate of human immunodeficiency virus (HIV) and hepatitis infection. Community-based needle exchange programs have been shown to be an effective risk mitigation strategy for reducing high-risk behaviors (e.g., sharing needles) and infectious disease transmission among injection drug users.[120] For those patients who develop OUD and progress to intravenous drug use, the first recommendation should be for medication assisted treatment (MAT) for OUD (see Recommendation 17). For patients who decline MAT for OUD,  clinicians should consider educating the patient regarding sterile injection techniques and community based needle exchange programs, if programs are available. The 2015 outbreak of HIV/hepatitis in rural  Indiana and subsequent successful implementation of a needle exchange program is an example of the threat to rural communities from non-prescription opioid use and the potential benefits of needle exchange programs for use as a risk mitigation strategy.[121,122]  

Question: What has been an effective risk mitigation strategy for reducing high-risk behaviors and infectious disease transmission among injection drug users?
Answer: Community-based needle exchange programs
Recommendations

Community-based Needle Exchange Programs or Syringe Service Programs: Nearly 80% of new users of injectable opioids had previously used prescription oral opioid pain medication.[118,119] Illicit use of injectable opioids is accompanied by an increased rate of human immunodeficiency virus (HIV) and hepatitis infection. Community-based needle exchange programs have been shown to be an effective risk mitigation strategy for reducing high-risk behaviors (e.g., sharing needles) and infectious disease transmission among injection drug users.[120] For those patients who develop OUD and progress to intravenous drug use, the first recommendation should be for medication assisted treatment (MAT) for OUD (see Recommendation 17). For patients who decline MAT for OUD,  clinicians should consider educating the patient regarding sterile injection techniques and community based needle exchange programs, if programs are available. The 2015 outbreak of HIV/hepatitis in rural  Indiana and subsequent successful implementation of a needle exchange program is an example of the threat to rural communities from non-prescription opioid use and the potential benefits of needle exchange programs for use as a risk mitigation strategy.[121,122]  

Question: What is an example of high-risk behaviors?
Answer: sharing needles