bluuebunny/crossref_metadata_2025 huggingface dataset:
Do transdermal opioids reduce healthcare use in an Australian rural pain population? A comparison with oral opioids
Authors: Henshaw, MBBS, MMed, FANZCA, FFPMANZCA John S.
Published: February 2018

Objective: To determine whether transdermal (TD) opioids reduce healthcare contacts when compared with oral opioids in a rural population with chronic noncancer pain (CNCP).Design: An observational longitudinal study to measure the changes in selfreported healthcare use by the route of opioid administration over time (monthly for 1 year). Subjects were opioid-treated CNCP patients from North West Tasmania. The subjects completed the monthly datasheets by recording all healthcare contacts and the routes of opioid administration. The outcome measures of mean monthly healthcare contacts (MHCs) by the routes of opioid administration were analyzed using generalized estimating equations with robust standard errors.Results: The details of 10,564 healthcare contacts from 198 subjects were obtained during the study. General practitioner (GP) mean MHCs were 2.01 (95% confidence intervals [CI] = 1.58-2.45) for oral opioids and significantly (p = 0.02) lower by 0.38 (95% CI = −0.70 to −0.05) contacts for TD opioids. Pharmacy mean MHCs were 2.44 (95% CI = 1.88-3.00) for oral opioids and unchanged (p = 0.86) by −0.04 (95% CI = −0.44-0.37) for TD opioids. Total mean MHCs with oral opioid use were 5.98 (95% CI = 4.93-7.03). With TD opioid use, this was nonsignificantly lower (p = 0.12) by 0.62 (95% CI = −1.40-0.15) contacts.Conclusions: The use of TD opioid preparations, with their prolonged analgesic effect, may reduce total healthcare activity and significantly reduce GP contact. This may particularly benefit a rural population where there is a relative shortage of doctors.
Torsades-de-Pointes associated with Taku-Tsubo cardiomyopathy following greatly reduced oxycodone use in an elderly woman
Authors: Daniell, MD Harry W.
Published: February 2018

This article reports an elderly female oxycodone consumer who developed Torsades-de-Pointes soon after her opioid-associated rate-corrected QT interval (QTC; a standard measurement on electrocardiograms) prolongation had been augmented by the development of Taku-Tsubo cardiomyopathy (TC), a sequence that followed greatly reduced oxycodone ingestion. Factors that likely contributed to this sequence are discussed, including direct opioid-induced inhibition of human ether-a-go-go-related gene activity and of androgen formation plus QTc prolongation induced by the presence of TC.
Pain responsiveness to opioids: Central versus peripheral neuropathic pain
Authors: Smith, MD Howard S. , Meek, PharmD, MSPH Patrick D.
Published: February 2018

Neuropathic pain is initiated or caused by a primary lesion or dysfunction in the nervous system. Neuropathic pain is composed of peripheral neuropathic pain (with a primary lesion or dysfunction in the peripheral nervous system) and central neuropathic pain (CNP; with a primary lesion or dysfunction in the central nervous system). CNP may be further subdivided into supraspinal central neuropathic pain and spinal central neuropathic pain. Opioids have a role in the pharmacologic management of neuropathic pain; however, there is a scarcity of literature on the treatment of CNP with opioids. One of the few statements in the literature regarding the analgesic efficacy of opioids for CNP suggests that despite limited data, the opioid responsiveness for neuropathic pain of central and peripheral etiologies is similar. After reviewing the extremely limited data, it is proposed that although there may be a subpopulation of patients with CNP who have a reasonable analgesic response to opioids, overall, when sensory pain rating is used as the yardstick, CNP appears to respond less well to opioids than peripheral neuropathic pain. Thus, opioids should be considered a second- or third-line agent in any algorithm of the pharmacologic treatment of CNP. Also within CNP, it appears that supraspinal central neuropathic pain may respond less well to a trial of opioids than spinal central neuropathic pain. Moreover, under close monitoring for side effects (eg, constipation), it is suggested that clinicians may want to consider titrating to higher doses of potent opioids before the trial is judged to be unsuccessful for refractory supraspinal central neuropathic pain.
Beliefs and attitudes about prescribing opioids among healthcare providers seeking continuing medical education
Authors: Hooten, MD W. Michael , Bruce, PhD Barbara K.
Published: February 2018

Objective: The purpose of this study was to assess the beliefs and attitudes of healthcare providers about prescribing opioids for chronic pain.Setting: The setting was a continuing medical education conference that was specifically designed to deliver content about chronic pain and prescription opioids to providers without specialty expertise in pain medicine.Participants: Conference attendees with prescribing privileges were eligible to participate, including physicians, physician assistants, and advance practice nurses.Intervention: Study participants completed a questionnaire using an electronic response system.Main outcome measures: Study participants completed a validated questionnaire that was specifically developed to measure the beliefs and attitudes of healthcare providers about prescribing opioids for chronic pain.Results: The questionnaire was completed by 128 healthcare providers. The majority (58 percent) indicated that they were “likely” to prescribe opioids for chronic pain. A significant proportion of respondents had favorable beliefs and attitudes toward improvements in pain (p < 0.001) and quality of life (p < 0.001) attributed to prescribing opioids. However, a significant proportion had negative beliefs and attitudes about medication abuse (p < 0.001) and addiction (p < 0.001). Respondents also indicated that prescribing opioids could significantly increase the complexity of patient care and could unfavorably impact several administrative aspects of clinical practice.Conclusions: The beliefs and attitudes identified in this study highlight important educational gaps that exist among healthcare providers about prescribing opioids. Knowledge of these educational gaps could build the capacity of medical educators to develop targeted educational materials that could improve the opioid prescribing practices of healthcare providers.
Evaluation of the reinforcing and subjective effects of heroin in combination with dextromethorphan and quinidine
Authors: Vosburg, PhD Suzanne K. , Sullivan, MD, PhD Maria A. , Comer, PhD Sandra D.
Published: February 2018

Objective: Studies have suggested that the N-methyl-D-aspartate antagonist dextromethorphan may be useful in the treatment of opioid dependence.Design: This double-blinded, placebo-controlled inpatient study evaluated the effects of 0, 30, and 60 mg of dextromethorphan and quinidine (DMQ) on the reinforcing and subjective effects of heroin in recently detoxified heroin abusers.Participants: Nine heroin-dependent participants were admitted and then detoxified from heroin over the course of several days.Interventions: Participants were subsequently stabilized on 0, 30, or 60 mg of DMQ. Each dose of DMQ was administered for two consecutive weeks, and the effects of heroin (0, 12.5, and 50 mg) were studied under each DMQ maintenance dose condition. DMQ and heroin dose were administered in random order both within and between participants.Results: Planned comparisons revealed statistically significant increases in progressive ratio breakpoint values and positive subjective ratings as a function of heroin dose. There were no consistent changes in any of the responses as a function of DMQ maintenance dose, other than a modest reduction in craving.Conclusions: In summary, results from this study suggest that maintenance on dextromethorphan in combination with quinidine has a limited role in the treatment of opioid dependence.
Ideas and innovations: Inclusion of pharmacists in chronic pain management services in a primary care practice
Authors: Li, PharmD Robin Moorman , Franks, PharmD Rachel Hrabchak , Dimmitt, DO Steven G. , Wilson, MD George R.
Published: February 2018

Nonmalignant chronic pain management involves an ongoing process of complex evaluations including proper patient selection, proper prescribing, and careful monitoring. In the Pain Management Refill Clinic, patients are stabilized on an opioid regimen by either a pain specialist or a primary care physician (PCP). The PCP assumes long-term prescription of the regimen and proper follow-up. The inclusion of pharmacists in the management of patients suffering from chronic pain has allowed the physicians to improve opioid prescribing, documentation, and monitoring in accordance with chronic nonmalignant pain guidelines.
International Conference on Opioids, June 10-12, 2012
Authors: DeVito, Jr. Richard A.
Published: February 2018

The first International Conference on Opioids was held in Boston, June 10-12, 2012, at the Joseph B. Martin Conference Center at Harvard Medical School. Attendees from around the world participated in this two plus day conference that featured renowned speakers from many countries presenting the latest research, ethics, legal and clinical application of opioids.
Loperamide: From antidiarrheal to analgesic
Authors: Kumar, MSc, PhD Rakesh
Published: February 2018

Loperamide, an antidiarrheal drug has been observed to produce analgesia in animal models of pain. However, the exact mechanism underlying loperamide analgesia needs further studies.
ER/LA opioid REMS supplement
Authors: Sloan, MD Paul A. , Davis, MD, FCCP Mellar P. , Garnier, RN, BSN, CHPN Pamela
Published: February 2018

Extended-Release and Long-Acting Opioids for Chronic Pain ManagementGeneral Pharmacology of Long-Acting, Extended-Release, and Sustained-Release Opioids for the Treatment of Chronic Nonmalignant PainSpecific Pharmacology of Long-Acting, Extended-Release, and Sustained-Release Opioids for the Treatment of Chronic Nonmalignant PainCase Studies of Long-Acting, Extended-Release, and Sustained-Release Opioids for the Treatment of Chronic Nonmalignant Pain
Simple solution for a complex problem: Rewriting the script
Authors: Ruan, MD Xiulu , Chiravuri, MD Srinivas , Kaye, MD, PhD Alan David
Published: February 2018

no abstract
Acetaminophen, a reasonable option, but not a panacea
Authors: Ruan, MD Xiulu , Narahari, MD, MS Praveen , Kaye, MD, PhD Alan D.
Published: February 2018

no abstract
The prescription opioid epidemic in developed versus underdeveloped countries: Is there a happy medium?
Authors: Kaddoum, MD Roland N. , Anghelescu, MD Doralina L. , Karam Cynthia , Aouad, MD Marie T. , Hitti, MD, MBA Eveline
Published: February 2018

No abstract
Establishing “abuse-deterrence equivalence” for generic abuse-deterrent opioid formulations: A proposed development framework
Authors: Setnik, PhD Beatrice , Cone, PhD Edward J.
Published: February 2018

Abuse-deterrent formulations are one strategy for mitigating the epidemic of prescription opioid abuse. Regulatory guidance documents describe the requirements for developing abuse-deterrent formulations of novel drugs and formulations; however, they do not address “abuse-deterrence equivalence” for generic formulations. As generics may be produced with different excipients and formulations compared to reference drugs, differences in their properties may impact their abuse-deterrent features. Currently, it is unclear what specific studies are needed to support generic abuse-deterrence claims. This commentary outlines several recommendations on the in vitro and in vivo testing required, including the conditions for conducting a human abuse potential study.
Six-month, open-label study of hydrocodone extended release formulated with abuse-deterrence technology: Safety, maintenance of analgesia, and abuse potential
Authors: Hale, MD Martin E. , Ma, MS Yuju , Malamut, MD Richard
Published: February 2018

Objective: To evaluate long-term safety, maintenance of analgesia, and aberrant drug-related behaviors of hydrocodone extended release (ER) formulated with CIMA® Abuse-Deterrence Technology.Design: Phase 3, multicenter, open-label extension.Setting: Fifty-six US centers.Patients: Adults with chronic low back pain completing a 12-week placebo-controlled study of abuse-deterrent hydrocodone ER were eligible. One hundred eighty-two patients enrolled and received ≥1 dose of study drug, 170 entered open-label treatment, and 136 completed the study.Interventions: Patients receiving hydrocodone ER in the 12-week, placebo-controlled study continued their previous dose unless adjustment was needed; those previously receiving placebo (n = 78) underwent dose titration/adjustment to an analgesic dose (15-90 mg every 12 hours). Patients received 22 weeks of open-label treatment.Main outcome measures: Safety: adverse events (AEs). Maintenance of analgesia: worst pain intensity (WPI) and average pain intensity (API) at each study visit. Aberrant drug behavior: study drug loss and diversion. Results: AEs were reported for 65/182 (36 percent) patients during dose titration/adjustment and 88/170 (52 percent) during open-label treatment. No treatment-related serious AEs were reported. There were no clinically meaningful trends in other safety assessments, including physical examinations and pure tone audiometry. One patient receiving hydrocodone ER 30 mg twice daily experienced a severe AE of neurosensory deafness that was considered treatment related. Mean WPI and API remained steady throughout open-label treatment. Six (3 percent) patients reported medication loss, and 5 (3 percent) reported diversion.Conclusions: Abuse-deterrent hydrocodone ER was generally well tolerated in patients with chronic low back pain, maintained efficacy, and was associated with low rates of loss and diversion.
Opioid use following the introduction of an extended-release oxycodone formulation with tamper-resistant properties: Prospective historical chart review in methadone-maintained patients
Authors: Sankey, MD, CCFP (EM) Christopher , Setnik, PhD Beatrice , Harsanyi, BSc (Hon), MLS, MBA, PStat. (SSC), PSTAT® (ASA) Zoltan , Michalko, PharmD, MBA Ken , Yang, PhD Zejiang , Geoffroy, MDCM, MSc, FCFP, DABAM Pierre
Published: February 2018

Objective: Emerging data are demonstrating that tamper-resistant opioids may play an important role in changing prescription opioid abuse behaviors. This study was a chart review to examine if the reformulation of OxyContin® into a version with tamper-resistant properties (OxyNEO®) had an impact on oxycodone-positive urine drug screens (UDSs) in opioid-dependent patients receiving methadone maintenance therapy (MMT).Design: The historical element of this study examined 250 eligible charts from patients on MMT who had data during the time periods when only OxyContin was available (baseline period), during the transition to OxyNEO, and when only OxyNEO was available. The prospective element included an exploratory questionnaire regarding retrospective opioid use.Setting: The study was conducted at three methadone clinics, in Oshawa, Peterborough, and Scarborough in Ontario, Canada.Participants: Male and female patients were eligible if they had a diagnosis of opioid dependency, received MMT, and had at least one oxycodone-positive UDS during the baseline period.Intervention: This was a noninterventional study.Main outcome measure: The main outcome was the number of oxycodone-positive UDSs.Results: The results demonstrated a marked reduction in oxycodone-positive UDSs that showed stepwise, statistically significant decreases during the transition and post-OxyContin periods relative to baseline. While the oxycodone-positive UDS results were decreasing, morphine-related-positive UDSs remained relatively stable during the same periods. There were no significant gender differences noted.Conclusions: The introduction of OxyNEO was associated with a statistically significant reduction in oxycodone exposure in a population of methadone-maintained patients.
Effect of preoperative intravenous oxycodone on sufentanil consumption after laparoscopic radical gastrectomy
Authors: Wang, MD, PhD Jinguo , Fu, MD, PhD Yaowen , Zhou, MD, PhD Honglan , Wang, MD, PhD Na
Published: February 2018

Objective: To investigate the effect of preoperative intravenous oxycodone on sufentanil consumption by patient-controlled intravenous analgesia (PCIA) after laparoscopic radical gastrectomy.Methodology: Forty-six patients scheduled for laparoscopic radical gastrectomy were randomly divided into two groups: group O (n = 23) received intravenous oxycodone (0.1 mg/kg) 10 minutes before surgery over 2 minutes and group C (n = 23) received normal saline as a placebo. A standardized general anesthesia and intravenous sufentanil PCIA were applied to all patients. Postoperative sufentanil doses delivered by PCIA, rescue analgesia, Ramsay sedation scale, visual analog scale (VAS) scores at rest, the overall satisfaction, and side effects were assessed.Results: The numbers of sufentanil doses delivered by PCIA were significantly fewer and VAS scores at rest were significantly lower in group O than in group C at various time points after operation. The overall satisfaction degree was higher in group O than in group C. The incidences of side effects were similar between the two groups.Conclusions: Preoperative intravenous oxycodone can reduce postoperative pain and sufentanil consumption after laparoscopic radical gastrectomy without an increase of side effects.
Effectiveness and tolerability of tapentadol sustained release in the Australian setting
Authors: Russo, MBBS, DA(UK), FANZCA, FFPMANZCA Marc A. , Santarelli, PhD Danielle M.
Published: February 2018

Objective: To assess the effectiveness and tolerability of tapentadol sustained release (SR) following its introduction to the Australian private market.Design: A retrospective audit of routine clinical practice with data collection beginning 2 months after the first tapentadol SR prescription.Setting: A multidisciplinary Australian pain clinic.Patients: Fifty patients who were prescribed tapentadol SR as part of routine clinical management at the pain clinic.Interventions: Trial of tapentadol SR with subsequent dose titration if the patient was satisfied with or tolerant of the medication.Main outcome measures: Patient-reported pain outcome, side effects, medication adherence, and concomitant analgesic medications.Results: Sixty-eight percent of patients reported major reductions in pain. Seventy-two percent of patients tolerated and adhered to treatment and 76 percent reported no side effects. Pain outcome was independent of pain type and prior opioid exposure; however, patients taking tapentadol in combination were more likely to report a positive outcome (Pearson χ2 = 9.867, n = 46, p = 0.0072).Conclusions: Tapentadol was effective and generally well tolerated in the majority of patients for neuropathic, nociceptive and mixed pain types and this was regardless of prior opioid use.
Acceptability of the use of cellular telephone and computer pictures/video for “pill counts” in buprenorphine maintenance treatment
Authors: Welsh, MD Christopher
Published: February 2018

Objective: As part of a comprehensive plan to attempt to minimize the diversion of prescribed controlled substances, many professional organization and licensing boards are recommending the use of “pill counts.” This study sought to evaluate acceptability of the use of cellular phone and computer pictures/video for “pill counts” by patients in buprenorphine maintenance treatment.Setting and intervention: Patients prescribed buprenorphine/naloxone were asked a series of questions related to the type(s) of electronic communication to which they had access as well as their willingness to use these for the purpose of performing a “pill/film count.”Results: Of the 80 patients, 4 (5 percent) did not have a phone at all. Only 28 (35 percent) had a “smart phone” with some sort of data plan and Internet access. Forty (50 percent) of the patients had a phone with no camera and 10 (12.5 percent) had a phone with a camera but no video capability. All patients said that they would be willing to periodically use the video or camera on their phone or computer to have buprenorphine/naloxone pills or film counted as long as the communication was protected from electronic tampering.Conclusions: With the advent of applications for smart phones that allow for Health Insurance Portability and Accountability Act of 1996-compliant picture/video communication, a number of things can now be done that can enhance patient care as well as reduce the chances of misuse/diversion of prescribed medications. This could be used in settings where a larger proportion of controlled substances are prescribed including medication assisted therapy for opioid use disorders and pain management programs.
Physician conviction for prescription related deaths: How will this affect the opioid debate?
Authors: Rana, MD Humair , Braithwaite, MD Brian
Published: February 2018

no abstract
Clinical analgesia correlates with decline in temporal summation in response to remifentanil infusion in patients with chronic neuropathic (radicular) pain
Authors: Suzan, PhD Erica , Midbari, MD Ayelet , Pud, PhD Dorit , Hadad, PhD Salim , Eisenberg, MD Elon
Published: February 2018

Background: Animal studies have shown that in addition to their antinociceptive effects, opioids have attenuated the electrophysiological “wind-up” phenomenon. Although effects of opioids on clinical pain and on temporal summation (TS), the human correlatives of this phenomenon, have been tested repeatedly, correlations between these two parameters have not been reported so far.Objectives: To search for possible correlations between the effects of remifentanil on clinical pain intensity and on the magnitude of TS in patients with chronic pain.Design: A single-blinded prospective study.Setting: A tertiary care pain clinic.Patients: Thirty-one patients (24 men) with chronic lumbar (radicular) neuropathic pain.Intervention: Intervenous administration of saline followed by remifentanil infusions.Main Outcome Measures: Clinical pain intensity and thermal TS measured at baseline, during infusion of each drug and 20 minutes after termination of remifentnail infusion.Results: Friedman test revealed statistically significant differences in the magnitudes of both clinical pain intensity and TS (χ2(3) = 73, p < 0.001 and χ2(3) = 11.38, p = 0.01, respectively). Post hoc analysis (Wilcoxon signed-rank test) showed significant differences between clinical pain intensities measured at all time points but significant reductions in the magnitudes of TS were found only during remifentanil compared to baseline (p = 0.014) and to saline (p = 0.019). The difference in clinical pain between saline and remifentanil positively correlated with the difference in TS measured at the same time points (Spearman's test; r = 0.444, p = 0.012).Conclusions: These results point to a possible causative relationship between TS and opioid analgesia.
Caveat emptor: Erroneous safety information about opioids in online drug-information compendia
Authors: Talwar, PharmD Sonia R. , Randhawa, PharmD Amarita S. , Dankiewicz, PharmD Erica H. , Crudele, PharmD Nancy T. , Haddox, DDS, MD J. David
Published: February 2018

Background: Healthcare professionals and consumers refer to online drug-information compendia (eg, Epocrates and WebMD) to learn about prescription medications, including opioid analgesics. With the significant risks associated with opioids, including abuse, misuse, and addiction, any of which can result in life-threatening overdose, it is important for those seeking information from online compendia to have access to current, accurate, and complete drug information to help support clinical treatment decisions. Although compendia are informative, readily available, and user friendly, studies have shown that they may contain errors.Objective: To review and identify misinformation in drug summaries of online drug-information compendia for selected opioid analgesic products and submit content corrections to the respective editors.Methods: Between 2011 and 2013, drug summaries for Purdue's prescription opioid analgesic products from seven leading online drug-information compendia were systematically reviewed, and the requests for corrections were retrospectively categorized and classified. At least 2 months following requests, the same compendia were then reexamined to assess the degree of error resolution.Results: A total of 859 errors were identified, with the greatest percentage in Safety and Patient Education categories. Across the seven compendia, the complete or partial resolution of errors was 34 percent; therefore, nearly two thirds of the identified errors remain.Conclusion: The results of this analysis, consistent with past studies, demonstrate that online drug-information compendia may contain inaccurate information. Healthcare professionals and consumers must be informed of potential misinformation so they may consider using multiple resources to obtain accurate and current drug information, thereby helping to ensure safer use of prescription medications, such as opioids.
Rhode Island Board of Medical Licensure and Discipline: Illustration of the disciplinary process as it pertains to cases involving opioid prescribing
Authors: McDonald, MD, MPH James V.
Published: February 2018

Prescription-drug overuse/overdose and misuse is an important and pivotal issue to state medical boards. This is an illustration of how some cases involving overprescribing of opioids have been addressed by the Rhode Island Board of Medical Licensure and Discipline.
Volume 12, Number 5; Journal of Opioid Management; September/October 2016
Authors: Publishing, LLC Weston Medical
Published: February 2018

Complete issue PDF
A more balanced approach to opioid use and management is also needed in end-of-life care
Authors: Dy, MD, MSc Sydney Morss , Rushton, PhD, RN, FAAN Cynda Hylton
Published: February 2018

Significant pain and suffering are frequent at the end-of-life, and opioids are often essential for relief. Although opioids must be readily available when appropriate, particularly for unbearable physical pain, some of the same issues causing current reconsideration of aggressive opioid guidelines for chronic pain1 also apply at the end of life. These patients may be given opioids when other potentially beneficial treatments should be tried first or for reasons other than physical pain, prescribed excessive doses, and insufficiently counseled or supported. Opioids are easy to start but challenging to discontinue and can cause dependence and psychosocial consequences, and vulnerability at end-of-life may increase risk of and burden from harms and side effects. These patients and their families usually also have multifactorial suffering requiring multidisciplinary teams and approaches other than or in addition to opioids.
Volume 13, Number 2
Authors: DeVito, Jr. Richard A.
Published: February 2018

Complete issue PDF
Volume 13, Number 3, May/June 2017
Authors: DeVito, Jr. Richard A
Published: February 2018

Complete issue PDF
Volume 13, Number 4
Authors: DeVito, Jr. Richard A.
Published: February 2018

Complete issue PDF
Projecting the cost, utilization, and patient care impact of prescribing extended release non-abuse-deterrent opioids to chronic pain patients
Authors: Yenikomshian, MBA Mihran Ara , White, PhD Alan G. , Carson, BS Michael E. , Garrison, PhD Louis P. , Oderda, PharmD, MPH Gary M. , Biskupiak, PhD, MBA Joseph E. , Hlavacek, MPH Patrick R. , Roland, PharmD, MS Carl L.
Published: February 2018

Objectives: To estimate healthcare resource utilization, associated costs, and number needed to harm (NNH) from a physician's decision to prescribe extended-release (ER) non-abuse-deterrent opioids (non-ADO) as compared to ER ADOs in a chronic pain population.Design: A 12-month probabilistic simulation model was developed to estimate the reduction of misuse and/or abuse from a physician's prescribing decisions for 10,000 patients. Model inputs included probabilities for opioid misuse and/ or abuse-related events, opioid discontinuation, and switching from ADO to non- ADO. Estimated reductions in abuse associated with ADOs were obtained from positive subjective measures using human abuse liability studies. The model was run separately for commercial, Medicare, Medicaid, and Veterans Administration (VA) populations. The difference in healthcare resource utilization and associated costs (2015 USD) between the ADO and non-ADO simulations was calculated. NNH for non-ADO was also calculated.Results: Misuse and/or abuse-related events for patients prescribed ER non-ADOs ranged from 223−1,410 and associated costs ranged from $20−$98 per patient for commercial and Medicare populations, respectively. Prescribing ER ADOs were associated with 87, 289, 264, and 417 fewer misuse and/or abuse−related events, saving $8, $35, $21, and $29 per patient in commercial, VA, Medicaid, and Medicare populations, respectively. NNH ranged from 185 in the commercial population to 40 in the Medicare population. Results were sensitive to decreases in the probability of misuse and/or abuse events but showed reductions.Conclusions: A physician's decision to prescribe ER ADOs could lead to large reductions in misuse and/or abuse-related events and associated costs across many patient populations.
Abuse-deterrent formulations of opioids: Many questions still to answer
Authors: Brown Jr, MD, FAAP Raeford E.
Published: February 2018

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From the publisher
Authors: DeVito, Jr Richard A.
Published: February 2018

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The effect of toothpicks containing flavoring and flavoring plus jambu extract (spilanthol) to promote salivation in patients diagnosed with opioid-induced dry mouth (xerostomia)
Authors: Davis, MD Bennet , Davis, ANP-C Kathy , Bigelow, PhD, DABT Sandy , Healey, MPH Patricia
Published: February 2018

Objective: To determine if the use of toothpicks infused with flavoring and flavoring plus the food additive spilanthol (Xerosticks™) improve saliva flow in people with opioid-induced dry mouth.Design: Time series, nonrandomized, double-blind within-subject design.Setting: Private practice/academic multidisciplinary pain and palliative care clinic.Participants: Ten subjects with opioid-induced dry mouth were recruited, and all finished the study.Methods: Salivary flow and pH were measured consecutively at baseline, following use of a mango-flavored toothpick, and again after use of a mango-flavored toothpick infused with spilanthol. Salivary flow rates and saliva pH were compared between flavored and baseline, between flavored + spilanthol and baseline, and between the flavored and flavored + spilanthol. Mouthfeel of each toothpick was assessed using the Bluestone Mouthfeel Questionnaire.Outcomes: The primary measure was salivary flow, and the secondary measures were salivary pH and mouthfeel.Results: Saliva flow increased 440 percent over baseline with use of a flavored toothpick and 628 percent over baseline with similarly flavored toothpicks infused with spilanthol, and these differences are significant (p = 0.00002). Saliva pH increased with both toothpicks (p = 0.04). The addition of spilanthol produced a greater increase in salivary flow (p = 0.05) compared to control toothpicks with flavoring alone. Furthermore, addition of spilanthol improved the “mouthfeel” of the toothpick (p = 0.00001).Conclusions: Toothpicks infused with either flavoring or flavoring plus spilanthol are likely to be an effective remedy for opioid-induced dry mouth. Addition of spilanthol may improve effectiveness over flavoring alone and may be better accepted because spilanthol appears to improve mouthfeel.
September/October 2017, Volume 13, Number 5
Authors: DeVito, Jr. Richard A.
Published: February 2018

Complete issue PDF
Interpreting labels of abuse-deterrent opioid analgesics
Authors: Webster, MD, FACPM, FASAM Lynn R.
Published: February 2018

Objective: To provide an overview of available abuse-deterrent opioids (ADOs) and the labeling text that describes abuse-deterrent (AD) properties. Design: A nonsystematic review of ADO literature and regulatory documents guiding their development.Outcome Measures/Results: A critical assessment and discussion of common routes of opioid abuse, AD methods and properties, US Food and Drug Administration (FDA) study requirements to achieve AD labeling, and brief guide to understanding AD labels.Conclusions: The FDA has issued guidance as incentive and direction to industry to develop ADOs as one component of a multi-pronged public-health strategy to combat opioid abuse and misuse. The guidance describes separate categories of premarket and postmarket studies and makes recommendations for claims that may be made based on study findings. Ten ADOs have FDA-approved labeling attesting to AD properties. Available formulations that fail to conform to FDA guidance in study and labeling recommendations cannot be considered ADO. Formulations with AD properties are expected to reduce risk compared to the same agents without AD properties but cannot prevent all abuse and adverse clinical outcomes.
Abuse of reformulated OxyContin: Updated findings from a sentinel surveillance sample of individuals assessed for substance use disorder
Authors: Cassidy, MPH Theresa A. , Thorley, MPH Eileen , Black, PhD Ryan A. , DeVeaugh-Geiss, PhD Angela , Butler, PhD Stephen F. , Coplan, ScD Paul
Published: February 2018

Objective: To examine abuse prevalence for OxyContin and comparator opioids over a 6-year period prior to and following market entry of reformulated OxyContin and assess consistency in abuse across treatment settings and geographic regions. Design: An observational study examining longitudinal changes using cross-sectional data from treatment centers for substance use disorder.Setting: A total of 874 facilities in 39 states in the United States within the National Addictions Vigilance Intervention and Prevention Program (NAVIPPRO®) surveillance system.Participants: Adults (72,060) assessed for drug problems using the Addiction Severity Index-Multimedia Version (ASI-MV®) from January 2009 through December 2015 who abused prescription opioids.Main outcome measure(s): Percent change in past 30-day abuse. Results: OxyContin had significantly lower abuse 5 years after reformulation compared to levels for original OxyContin. Consistency of magnitude in OxyContin abuse reductions across geographic regions, ranging from 41 to 52 percent with differences in abuse reductions in treatment setting categories occurred. Changes in geographic region and treatment settings across study years did not bias the estimate of lower OxyContin abuse through confounding.Conclusion: In the postmarket setting, limitations and methodologic challenges in abuse measurement exist and it is difficult to isolate singular impacts of any one intervention given the complexity of prescription opioid abuse. Expectations for a reasonable threshold of abuse for any one ADF product or ADF opioids as a class are still uncertain and undefined. A significant decline in abuse prevalence of reformulated OxyContin was observed 5 years after its reformulation among this treatment sample of individuals assessed for substance use disorder that was lower historically for the original formulation of this product.
Intranasal abuse potential of an abuse-deterrent oxycodone formulation compared to oxycodone immediate release and placebo in nondependent, recreational opioid users
Authors: Setnik, PhD Beatrice , Schoedel, PhD Kerri , Bartlett, MMath Cindy , Dick, MS, MBA Chris , Hakim, MS, LLM Nasrat , Geoffroy, MDCM, MSc, FCFP, DABAM Pierre
Published: February 2018

Objective: To assess the intranasal (IN) human abuse potential of ELI-200, a novel immediate-release (IR) oxycodone formulation containing sequestered naltrexone.Design: Randomized, double-blind, double-dummy, active and placebo-controlled, five-way crossover study. Pharmacodynamics, safety, and pharmacokinetics (PKs) were evaluated for up to 36 hours postdose.Setting: Single site in Canada (INC Research Toronto).Participants: Healthy male and female nondependent recreational opioid users underwent a naloxone challenge and drug discrimination qualification test.Intervention: Single IN dose of ground ELI-200 (30-mg oxycodone hydrochloride [HCl]/3-mg naltrexone HCl), crushed 30-mg oxycodone HCl IR (Roxicodone ®), placebo, fixed placebo, and single oral dose of intact ELI-200 (30 mg/3 mg).Main Outcome Measure: Peak effect (E max) for bipolar Drug Liking (0-100 point visual analog scale).Results: Of the 44 randomized subjects, 37 completed all five treatment periods. All active treatments showed significantly higher (p < 0.001) median Drug Liking E max relative to placebo. Significant reductions (p < 0.001) in median Drug Liking [E max ] were observed for IN ELI-200 [56.0] compared to IN oxycodone IR [100.0]. Secondary positive or objective measures (High, Good Drug Effects, Overall Drug Liking, Take Drug Again, and maximum pupil constriction) showed significantly lower E max for IN ELI-200 (p < 0.001) compared to IN oxycodone IR.Conclusions: IN administration of ELI-200 demonstrated significantly decreased effects on subjective and physiologic measures, and greater nasal irritation, compared to IN oxycodone IR. These findings, along with the PK profile of naltrexone, demonstrated that when ELI-200 capsules were ground and administered intranasally, the naltrexone component was rapidly released and conferred meaningful abuse-deterrent properties.
Sexualidade no idoso: percepção de profissionais da geriatria e gerontologia
Authors: Costa Dayara Carla Amaral da , Uchôa Yasmim da Silva , Silva Junior Ivan Arnaldo Pamplona da , Silva Saulo de Tarso Saldanha Eremita de , Freitas Wiviane Maria Torres de Matos , Soares Soanne Chyara
Published: February 2018

OBJETIVO: Identificar a percepção dos profissionais da saúde acerca da sexualidade em idosos.

METODOLOGIA: Estudo quantitativo, observacional, do tipo transversal analítico, em instituição especializada na assistência a terceira idade em Belém-PA. Foi aplicado questionário com 20 profissionais da saúde. Os dados foram submetidos à análise estatística com teste G de aderência.

RESULTADOS: Os profissionais, de ambos os sexos, tinham idade média de 41,8 anos (±12,2), formados há aproximadamente 17,1 anos (±12,4). A casuística foi formada por médicos, fisioterapeutas, enfermeiros, assistentes sociais, odontólogos, psicólogo, terapeuta ocupacional, nutricionista e farmacêuticos. Os resultados quanto à percepção dos profissionais sobre a sexualidade evidenciam que 100% relatam saber distinguir sexo de sexualidade, 45% relatou nenhuma formação acadêmica sobre sexualidade em idosos, 75% se sentem razoavelmente preparados para lidar com o tema. Quanto a atuação profissional, 35% ainda acham de nada a pouco importante abordar o tema com os idosos, mas a maioria 75% relata conversar com os idosos sobre o tema, as principais orientações passadas dizem respeito ao uso de preservativos e doenças sexualmente transmissíveis, e as dificuldades mais relatadas dizem respeito à resistência dos idosos ao abordar o tema. Metade dos profissionais reconhece que a precária abordagem interfere muito na qualidade de vida dos mesmos.

CONCLUSÃO: Embora os profissionais reconheçam a importância da sexualidade na integralidade do ser, existe carência na formação profissional, resistência dos idosos, e tabus socioculturais que são barreiras para abordagem do tema, consequentemente surge negligência por parte de alguns profissionais podendo interferir na qualidade de vida dos idosos.
Perfil epidemiológico dos casos de coqueluche no Brasil de 2010 a 2014
Authors: Castro Hannah Waleska Viegas de , Milagres Bruno Silva
Published: February 2018

A Coqueluche é uma doença infecciosa aguda de notificação compulsória causada pela bactéria Bordetella pertussis. Ela acomete o trato respiratório e seu principal sintoma é a tosse paroxística. Essa acomete todas as idades, mas é mais frequente e grave em menores de 1 ano. O objetivo desse trabalho é apresentar a epidemiologia descritiva e a cobertura vacinal no Brasil nos anos de 2010 a 2014, sendo realizado por meio de revisão bibliográfica no contexto epidemiológico. A cobertura vacinal atingiu o preconizado em todos os anos, entretanto este não ocorreu de forma homogênea. Houve um aumento de 1.505% de casos do ano de 2010 a 2014, configurando uma possível reemergência da doença. A causa desse aumento ainda não foi elucidada, porém há hipóteses que relacionam com a melhora diagnóstica, vigilância epidemiológica mais sensível, uma cepa mais virulenta e a redução da imunização após alguns anos da última dose da vacina.
Seasonal and diurnal variability in air pollutants and short-lived climate forcers measured at the Rwanda Climate Observatory
Authors: DeWitt H. Langley , Gasore Jimmy , Rupakheti Maheswar , Potter Katherine E. , Prinn Ronald G. , Ndikubwimana Jean de Dieu , Nkusi Julius , Safari Bonfils
Published: February 2018

Abstract. Air pollution is still largely unstudied in sub-Saharan Africa, resulting in a gap in scientific understanding of emissions, atmospheric processes, and impacts of air pollutants in this region. The Rwanda Climate Observatory, a joint partnership between MIT and the government of Rwanda, has been measuring ambient concentrations of key long-lived greenhouse gases and short-lived climate-forcing pollutants (CO2, CO, CH4, BC, O3) with state-of-the-art instruments on the summit of Mt. Mugogo (1.586° S, 29.566° E, 2590 m above sea level) since May 2015. Rwanda is a small, mountainous, and densely populated country in equatorial East Africa, currently undergoing rapid development but still at less than 20 % urbanization. The position and meteorology of Rwanda is such that the emissions transported from both the northern and southern African biomass burning seasons affect BC, CO, and O3 concentrations in Rwanda. Black carbon concentrations during Rwanda's two dry seasons, which coincide with the two biomass burning seasons, are higher at Mt. Mugogo than in major European cities. Higher BC baseline concentrations at Mugogo are loosely correlated with fire radiative power data for the region acquired with MODIS satellite instrument. Spectral aerosol absorption measured with a dual-spot Aethalometer also varies in different seasons, likely due to change in types of fuel burned and direction of pollution transport to the site. Ozone concentration was found to be higher in air masses from southern Africa than from northern Africa during their respective biomass burning seasons. These higher ozone concentration in air masses from the south could be indicative of more anthropogenic emissions mixed with the biomass burning emissions from southern Africa as Rwanda is downwind of major East African capital cities in this season. During the rainy season, local emitting activities (e.g., cooking, transportation, trash burning) remain steady, regional biomass burning is low, and transport distances are shorter as rainout of pollution occurs regularly. Thus local pollution at Mugogo can be estimated during this time period. Understanding and quantification of the percent contributions of regional and local emissions is essential to guide policy in the region. Our measurements indicate that air pollution is a current and growing problem in equatorial East Africa that deserves immediate attention.
Mediterranean Sea Hydrographic Atlas: towards optimal data analysis by including time-dependent statistical parameters
Authors: Iona Athanasia , Theodorou Athanasios , Watelet Sylvain , Troupin Charles , Beckers Jean-Marie
Published: February 2018

Abstract. The goal of the present work is to provide the scientific community with a high-resolution Atlas of temperature and salinity for the Mediterranean Sea based on the most recent datasets available and contribute to the studies of the long-term variability in the region. Data from the Pan-European Marine Data Infrastructure SeaDataNet were used, the most complete and, to our best knowledge, of best quality dataset for the Mediterranean Sea as of today. The dataset is based on in situ measurements acquired between 1900–2015. The Atlas consists of horizontal gridded fields produced by the Data Interpolating Variational Analysis, where unevenly spatial distributed measurements were interpolated onto a 1/8° x 1/8° regular grid on 31 depth levels. Seven different types of climatological fields were prepared with different temporal integration of observations. Monthly, seasonal and annual climatological fields have been calculated for all the available years, seasonal to annual climatologies for overlapping decades and specific periods. The seasonal and decadal time frames have been chosen in accordance with the regional variability and in coherence with atmospheric indices. The decadal and specific periods analysis was not extended to monthly resolution due to the lack of data, especially for the salinity. The Data Interpolating Variational Analysis software has been used in the Mediterranean Region for the SeaDataNet and its predecessor Medar/Medatlas Climatologies. In the present study, a more advanced optimization of the analysis parameters was performed in order to produce more detailed results. The Mediterranean Region past and present states have been extensively studied and documented in a series of publications. The purpose of this Atlas is to contribute to these climatological studies and get a better understanding of the variability on time scales from month to decades and longer. Our gridded fields provide a valuable complementary source of knowledge in regions where measurements are scarce, especially in critical areas of interest such as the Marine Strategy Framework Directive (MSFD) regions. The dataset used for the preparation of the Atlas is available from https://doi.org/10.12770/8c3bd19b-9687-429c-a232-48b10478581c.
Glacial Isostatic Adjustment modelling: historical perspectives, recent advances, and future directions
Authors: Whitehouse Pippa L.
Published: February 2018

Abstract. Glacial Isostatic Adjustment (GIA) describes the response of the solid Earth, the gravitational field, and consequently the oceans to the growth and decay of the global ice sheets. It is a process that takes place relatively rapidly, triggering 100 m-scale changes in sea level and solid Earth deformation over just a few tens of thousands of years. Indeed, the first-order effects of GIA could already be quantified several hundred years ago without reliance on precise measurement techniques and scientists have been developing a unifying theory for the observations for over 200 years. Progress towards this goal required a number of significant breakthroughs to be made, including the recognition that ice sheets were once more extensive, the solid Earth changes shape over time, and gravity plays a central role in determining the pattern of sea-level change. This article describes in detail the historical development of the field of GIA and an overview of the processes involved. Significant recent progress has been made as concepts associated with GIA have begun to be incorporated into parallel fields of research; these advances are discussed, along with the role that GIA is likely to play in addressing outstanding research questions within the field of Earth system modelling.