Assessment of Tapentadol API Abuse Liability With the Researched Abuse,Diversion and Addiction-Related Surveillance System

Tapentadol, a Schedule II opioid with a combination of µ-opioid activity and norepinephrine reuptake inhibition, is used for the management of moderate to severe acute and chronic pain. Its dual mechanism of action is thought to reduce opioid-related side effects that can complicate pain management. Since approval, tapentadol has been tracked across multiple outcomes suggesting abuse liability, and a pattern of relatively low, although not absent, abuse liability has been found. This retrospective cohort study further details the abuse liability of tapentadol as an active pharmaceutical ingredient (API) when immediate-release as well as extended-release formulations were on the market together (fourth quarter of 2011 to second quarter of 2016). Tapentadol (API) was compared with tramadol, hydrocodone, morphine, oxycodone, hydromorphone, and oxymorphone across Poison Center, Drug Diversion, and Treatment Center Programs Combined data streams from the Researched Abuse, Diversion and Addiction-Related Surveillance system. Findings suggest the public health burden related to tapentadol to date is low, but present. Event rates of abuse per population-level denominators were significantly lower than all other opioids examined. However, when adjusted for drug availability, event rates of abuse were lower than most Schedule II opioids studied, but were not the lowest. Disentangling these 2 sets of findings further by examining various opioid formulations, such as extended-release and the role of abuse-deterrent formulations, is warranted.

Risks for possible and probable opioid misuse among recipients of chronic opioid therapy in commercial and medicaid insurance plans: The TROUP Study

The use of chronic opioid therapy (COT) for chronic non-cancer pain (CNCP) has increased dramatically in the past two decades. There has also been a marked increase in the abuse of prescribed opioids and in accidental opioid overdose. Misuse of prescribed opioids may link these trends, but has thus far only been studied in small clinical samples. We therefore sought to validate an administrative indicator of opioid misuse among large samples of recipients of COT and determine the demographic, clinical, and pharmacological risks associated with possible and probable opioid misuse. A total of 21,685 enrollees in commercial insurance plans and 10,159 in Arkansas Medicaid who had at least 90 days of continuous opioid use 2000–2005 were studied for one year. Criteria were developed for possible and probable opioid misuse using administrative claims data concerning excess days supplied of short-acting and long-acting opioids, opioid prescribers and opioid pharmacies. We estimated possible misuse at 24% of COT recipients in the commercially insured sample and 20% in the Medicaid sample and probable misuse at 6% in commercially insured and at 3% in Medicaid. Among non-modifiable factors, younger age, back pain, multiple pain complaints and substance abuse disorders identify patients at high risk for misuse. Among modifiable factors, treatment with high daily dose opioids (especially >120 mg MED per day) and short-acting Schedule II opioids appears to increase the risk of misuse. The consistency of the findings across diverse patient populations and the varying levels of misuse suggest that these results will generalize broadly, but await confirmation in other studies.     

Predictors of nurses' experience of verbal abuse by nurse colleagues

Background

Between 45% and 94% of registered nurses (RNs) experience verbal abuse, which is associated with physical and psychological harm. Although several studies examined predictors of RNs' verbal abuse, none examined predictors of RNs' experiences of verbal abuse by RN colleagues.

Prevalence of Prescription Opioid Misuse/Abuse as Determined by International Classification of Diseases Codes: A Systematic Review

We conducted a systematic review to evaluate worldwide human English published literature from 2009 to 2014 on prevalence of opioid misuse/abuse in retrospective databases where International Classification of Diseases (ICD) codes were used. Inclusion criteria for the studies were use of a retrospective database, measured abuse, dependence, and/or poisoning using ICD codes, stated prevalence or it could be derived, and documented time frame. A meta-analysis was not performed. A qualitative narrative synthesis was used, and 16 studies were included for data abstraction. ICD code use varies; 10 studies used ICD codes that encompassed all three terms: abuse, dependence, or poisoning. Eight studies limited determination of misuse/abuse to an opioid user population. Abuse prevalence among opioid users in commercial databases using all three terms of ICD codes varied depending on the opioid; 21 per 1000 persons (reformulated extended-release oxymorphone; 2011–2012) to 113 per 1000 persons (immediate-release opioids; 2010–2011). Abuse prevalence in general populations using all three ICD code terms ranged from 1.15 per 1000 persons (commercial; 6 months 2010) to 8.7 per 1000 persons (Medicaid; 2002–2003). Prevalence increased over time. When similar ICD codes are used, the highest prevalence is in US government-insured populations. Limiting population to continuous opioid users increases prevalence. Prevalence varies depending on ICD codes used, population, time frame, and years studied. Researchers using ICD codes to determine opioid abuse prevalence need to be aware of cautions and limitations.     

Chronic promethazine misuse and the possibility of dependence: a brief review of antihistamine abuse and dependence

Objective: Misuse of centrally acting antihistamines is potentially a significant under-recognised issue contributing to problems of abuse and dependence, with the potential to complicate management of other mental disorders. This article considers this problem with the aim of increasing practitioner awareness.

Method: This article considers the literature relating to abuse of centrally acting antihistamines and presents a unique case, with features suggesting of psychological and physiological dependence following prolonged misuse of promethazine.

Results: Increased understanding of the potential problem of centrally acting antihistamine abuse and consideration of the possibility of a dependence syndrome associated with promethazine.

Conclusions: The need for vigilance for abuse potential of promethazine and other centrally acting antihistamines by doctors and pharmacists is emphasised.     

Brugada-Type Pattern on Electrocardiogram Associated with High-Dose Loperamide Abuse

Background

Loperamide has been increasing in popularity recently for its effects separate from treatment of diarrhea. In large doses or in combination with other agents, it can lead to desirable effects in the central nervous system. However, cardiotoxicity has been reported with its abuse.

Fentanyl: A Review for Clinical and Analytical Toxicologists

Fentanyl is a highly potent, short acting synthetic analgesic indicated as a preanesthetic medication. It is available for intravenous injection, as a transdermal patch and a lozenge dosage form. Fentanyl displays a large apparent volume of distribution, short plasma half life and extensive biotransformation. It is a popular drug of abuse among health care professionals. Diversion of pharmaceutical fentanyl preparations, as well as the availability of illicitly synthesized potent and highly toxic fentanyl analogs have resulted in numerous overdose deaths. Analysis of fentanyl and fentanyl analogs requires highly selective and sensitive methodologies. This review is intended as a quick reference source for clinical and analytical toxicologists.     

A Comparison of Three Measures of Elder Abuse

PURPOSE: To present a comparison of three measures for assessing elder abuse. DESIGN AND METHODS: Three measures for assessing elder abuse were identified through a literature review. The characteristics and uses of each measure were reviewed and evaluated. FINDINGS: The Indicators of Abuse (IOA) is a 22-item tool for discriminating abuse and nonabuse cases; it is completed by a health care professional after a home assessment is conducted. The Elder Abuse and Neglect Assessment (EAI) is a 44-item scale comprised of seven sections to review signs, symptoms, and subjective complaints of elder abuse, neglect, exploitation, and abandonment; it can be used by health care providers in all clinical settings. The Elder Abuse Screening Test (EAST) is a 15-item tool to be completed by a health care provider based on the patient's responses. This screening tool is limited because of the small unrepresentative samples used to test it, the low internal consistency, and a relatively high false-negative rate. CONCLUSIONS: An instrument to accurately assess elder abuse in long-term care is needed. Proper identification of elder abuse is the first step in assisting victims in dealing with abusive situations.