#Mortality risk during and after #opioid substitution treatment: systematic review and meta-analysis of cohort studies

http://www.bmj.com/content/357/bmj.j1550

Retention in methadone and buprenorphine treatment is associated with substantial reductions in the risk for all cause and overdose mortality in people dependent on opioids. The induction phase onto methadone treatment and the time immediately after leaving treatment with both drugs are periods of particularly increased mortality risk, which should be dealt with by both public health and clinical strategies to mitigate such risk. These findings are potentially important, but further research must be conducted to properly account for potential confounding and selection bias in comparisons of mortality risk between opioid substitution treatments, as well as throughout periods in and out of each treatment.

Social #Laughter Triggers Endogenous #Opioid Release in Humans
http://www.jneurosci.org/content/early/2017/05/23/JNEUROSCI.0688-16.2017

Social contacts are of prime importance to humans. The size of human social networks significantly exceeds the network that can be maintained by social grooming in other primates. Here we used positron emission tomography to show that endogenous opioid release following social laughter may provide a neurochemical mechanism supporting long-term relationships in humans. Participants were scanned twice; following 30-minute social laughter session, and after spending 30 minutes alone in the testing room (baseline). Endogenous opioid release was stronger following laughter versus baseline scan. Opioid receptor density in the frontal cortex predicted social laughter rates, Modulation of the opioidergic activity by social laughter may be an important neurochemical mechanism reinforcing and maintaining social bonds between humans.

Adverse cardiac events associated with incident #opioid drug use among older adults with #COPD

https://link.springer.com/article/10.1007/s00228-017-2278-3

We evaluated whether incident opioid drug use was associated with adverse cardiac events among older adults with chronic obstructive pulmonary disease (COPD).

Incident use of any opioid was associated with significantly decreased rates of emergency room (ER) visits and hospitalizations for congestive heart failure (CHF) among community-dwelling older adults (HR 0.84; 95% CI 0.73–0.97), but significantly increased rates of ischemic heart disease (IHD)-related mortality among long-term care residents (HR 2.15; 95% CI 1.50–3.09). In the community-dwelling group, users of more potent opioid-only agents without aspirin or acetaminophen combined had significantly increased rates of ER visits and hospitalizations for IHD (HR 1.38; 95% CI 1.08–1.77) and IHD-related mortality (HR 1.83; 95% CI 1.32–2.53).

Conclusions

New opioid use was associated with elevated rates of IHD-related morbidity and mortality among older adults with COPD. Adverse cardiac events may need to be considered when administering new opioids to older adults with COPD, but further studies are required to establish if the observed associations are causal or related to residual confounding.

#Opioid use disorder and type 2 #diabetes mellitus
Effect of participation in buprenorphine-naloxone substitution programs on glycemic control
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5507246/

To measure the effect of buprenorphine-naloxone as opioid substitution therapy on glycemic control in patients with type 2 diabetes mellitus and opioid use disorder.

Over a 2-year period, there was an absolute decrease of 1.20% in mean glycated hemoglobin A1c values in patients with diabetes who also received opioid substitution therapy, compared with patients with diabetes who were not being treated for opioid dependence, whose values rose by 0.02% Patients with diabetes who also suffer from opioid use disorder achieve significant (P = .011) improvement in glycemic control when treated with buprenorphine-naloxone substitution therapy compared with other patients with diabetes. Treating opioid use disorder with buprenorphine-naloxone substitution therapy has an unintended positive effect on diabetes management

Effect of a Single Dose of Oral #Opioid and #Nonopioid Analgesics on Acute Extremity #Pain in the Emergency Department
A Randomized Clinical Trial
https://jamanetwork.com/journals/jama/article-abstract/2661581

The choice of analgesic to treat acute pain in the emergency department (ED) lacks a clear evidence base. The combination of ibuprofen and acetaminophen (paracetamol) may represent a viable nonopioid alternative Of 416 patients randomized, 411 were analyzed (mean SD age, 37 12 years; 199 48% women; 247 60% Latino). The baseline mean NRS pain score was 8.7 (SD, 1.3). At 2 hours, the mean NRS pain score decreased by 4.3 (95% CI, 3.6 to 4.9) in the ibuprofen and acetaminophen group; by 4.4 (95% CI, 3.7 to 5.0) in the oxycodone and acetaminophen group; by 3.5 (95% CI, 2.9 to 4.2) in the hydrocodone and acetaminophen group; and by 3.9 (95% CI, 3.2 to 4.5) in the codeine and acetaminophen group (P = .053). The largest difference in decline in the NRS pain score from baseline to 2 hours was between the oxycodone and acetaminophen group and the hydrocodone and acetaminophen group (0.9; 99.2% CI, −0.1 to 1.8), which was less than the minimum clinically important difference in NRS pain score of 1.3. Adverse events were not assessed.

Conclusions and Relevance For patients presenting to the ED with acute extremity pain, there were no statistically significant or clinically important differences in pain reduction at 2 hours among single-dose treatment with ibuprofen and acetaminophen or with 3 different opioid and acetaminophen combination analgesics. Further research to assess adverse events and other dosing may be warranted

#Opioid Analgesic Use and Risk for Invasive #Pneumococcal Diseases: A Nested Case–Control Study

http://annals.org/aim/article-abstract/2672601/opioid-analgesic-use-risk-invasive-pneumococcal-diseases-nested-case-control


Persons in the case group had greater odds than control participants of being current opioid users (adjusted odds ratio aOR, 1.62 95% CI, 1.36 to 1.92). Associations were strongest for opioids that were long acting (aOR, 1.87 CI, 1.24 to 2.82), of high potency (aOR, 1.72 CI, 1.32 to 2.25), or were used at high dosages (50 to 90 morphine milligram equivalents MME/d: aOR, 1.71 CI, 1.22 to 2.39; ≥90 MME/d: aOR, 1.75 CI, 1.33 to 2.29). Results were consistent when the IPD risk score was taken into account and pneumonia and nonpneumonia IPD were analyzed separately

Opioid use is associated with an increased risk for IPD and represents a novel risk factor for these diseases

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Prescription #opioid and #benzodiazepine misuse is associated with #suicidal ideation in older adults

https://onlinelibrary.wiley.com/doi/10.1002/gps.4999

After controlling for all correlates, past‐year use without misuse of prescription opioids or benzodiazepines was not associated with past‐year suicidal ideation in older adults. In contrast, past‐year opioid misuse (AOR = 1.84, 95% CI = 1.07‐3.19) and benzodiazepine misuse (AOR = 2.00, 95% CI = 1.01‐3.94) were significantly associated with past‐year suicidal ideation, even after controlling for all covariates. While 2.2% of US older adults not engaged in either opioid or benzodiazepine misuse reported past‐year suicidal ideation, 25.4% of those who misused both medication classes endorsed such suicidality (AOR = 4.73, 95% CI = 2.07‐10.79).

Conclusions
Both past‐year prescription opioid and benzodiazepine misuse are associated with past‐year suicidal ideation in US older adults. Clinicians encountering older adult patients at‐risk for or engaged in prescription medication misuse also should screen for suicidality.

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#Gastroschisis Trends and Ecologic Link to #Opioid Prescription Rates — United States, 2006–2015

https://www.cdc.gov/mmwr/volumes/68/wr/mm6802a2.htm?s_cid=mm6802a2_w

What is already known about this topic?

Gastroschisis prevalence has increased worldwide. A previous U.S. report found that gastroschisis increased during 1995–2012, with the greatest increase among mothers aged <20 years.

What is added by this report?

During 2011–2015, gastroschisis prevalence was 4.5 per 10,000 live births, which was 10% higher than the prevalence during 2006–2010. An ecologic analysis found a higher prevalence of gastroschisis in areas where opioid prescriptions rates were high, supporting epidemiologic data suggesting an association between opioid use during pregnancy and gastroschisis.

What are the implications for public health practice?

Further public health research on gastroschisis is needed to gain insight into etiology, including the possible role of opioid exposure during pregnancy on birth defects.

Association Between Parental Medical Claims for #Opioid Prescriptions and Risk of #Suicide Attempt by Their Children

https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2733148

Of the children with parents who did not use opioids, 212 (0.14%) attempted suicide; of the children with parents who did use opioids, 678 (0.37%) attempted suicide. Parental use of opioids was associated with a doubling of the risk of a suicide attempt by their offspring (odds ratio OR, 1.99; 95% CI, 1.71-2.33). The association remained significant after adjusting for child age and sex (OR, 1.85; 95% CI, 1.58-2.17), addition of child and parental depression and diagnoses of substance use disorder (OR, 1.46; 95% CI, 1.24-1.72), and addition of parental history of suicide attempt (OR, 1.45; 95% CI, 1.23-1.71). Geographical variation in opioid use did not change the association (OR, 2.00; 95% CI, 1.71-2.34).

Conclusions and Relevance Children of parents who use prescription opioids are at increased risk for suicide attempts, which could be a contributing factor to the time trend in adolescent suicidality. The care of families with a parent who uses opioids should include mental health screening of their children.

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Associations of #Opioid Prescriptions with Death and Hospitalization across the Spectrum of Estimated #GFR

People receiving their first opioid prescription were propensity matched to people receiving NSAIDS (and, in sensitivity analysis, gabapentinoids) and the risk of death and hospitalization were compared, classifying opioid medication exposure as time-varying daily oral morphine milligram equivalents (MMEs) across time-varying eGFR.

Prescriptions for 1–59 and ≥60 MMEs were associated with higher risk of death .. and hospitalization.. compared with NSAID prescriptions, when evaluated at eGFR 80 ml/min per 1.73 m2. The relative risk of death associated with ≥60 MMEs was higher at lower GFR .. When gabapentinoids were used as the comparison medication, only ≥60 MMEs were significantly associated with higher risk of death (HR, 2.72; 95% CI, 1.71 to 4.34), although both 1–59 and ≥60 MMEs were associated with risk of hospitalization..

Conclusions The receipt of prescription opioids was associated with a higher risk of death and hospitalization compared with other pain medications, particularly with higher doses and at lower eGFR

https://cjasn.asnjournals.org/content/early/2019/10/02/CJN.00440119

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Association Between #Automotive Assembly Plant Closures and #Opioid Overdose Mortality in the United States

..Automotive assembly plant closures are culturally significant events that substantially erode local economic opportunities.

..Automotive assembly plant closures were associated with statistically significant increases in opioid overdose mortality. Five years after a plant closure, mortality rates had increased by 8.6 opioid overdose deaths per 100 000 individuals (95% CI, 2.6-14.6; P = .006) in exposed counties compared with unexposed counties, an 85% increase relative to the mortality rate of 12 deaths per 100 000 observed in unexposed counties at the same time point. In analyses stratified by age, sex, and race/ethnicity, the largest increases in opioid overdose mortality were observed among non-Hispanic white men aged 18 to 34 years (20.1 deaths per 100 000; 95% CI, 8.8-31.3; P = .001) and aged 35 to 65 years (12.8 deaths per 100 000; 95% CI, 5.7-20.0; P = .001). We observed similar patterns of prescription vs illicit drug overdose mortality. Estimates for opioid overdose mortality in nonmanufacturing counties were not statistically significant.

Conclusions and Relevance From 1999 to 2016, automotive assembly plant closures were associated with increases in opioid overdose mortality. These findings highlight the potential importance of eroding economic opportunity as a factor in the US opioid overdose crisis.

https://bit.ly/39tp23k