Feasibility of a social media/online community support group intervention among chronic pain patients on opioid therapy

Aims: Assess whether the Harnessing Online Peer Education (HOPE) social media-based support group can engage patients on opioids at risk for misuse/overdose to discuss risk reduction strategies.

Methods: Fifty-one patients on chronic opioid therapy and risk factors for aberrant medication-taking behaviors were randomized to a HOPE intervention or control (Facebook) group.

Results: Compared to control group participants, intervention participants had almost 10 times higher posting engagement (n?=?411 posts versus 45; 73% versus 52% of participants). Participants discussed coping, pain, medication and non-medication treatments, and other opioid and addiction-related topics.

Discussion: Results suggest that a HOPE online community might serve as an effective behavioral intervention tool among chronic pain patients on opioid therapy.     

A Comparative Study of Substance Use in Young Adolescents With and Without Chronic Health Conditions

Abstract

This study investigated the prevalence and odds of, as well as risk factors for, substance use among Canadian adolescents with chronic health conditions. Adolescents ages 12 to 16 years from the Ontario Child Health Study were analyzed. Prevalence rates of heavy alcohol use, regular smoking, and having tried illicit drugs were 8.0% (N?=?55), 11.0% (N?=?76), and 13.8% (N?=?95), respectively. Odds of ever having tried alcohol were higher among adolescents with chronic health conditions (adjusted odds ratio [AOR]?=?2.24 [1.18, 4.25]). No associations were found with other forms of substance use. Among adolescents with chronic health conditions, those who were older and exhibited symptoms of mental health problems were at increased odds of reporting lifetime heavy alcohol use. Coordinated prevention strategies within the primary health care and educational systems are needed.     

Physicians’ attitudes and adherence to use of risk scores for primary prevention of cardiovascular disease: cross-sectional survey in three world regions

ABSTRACT

Objective: To evaluate physicians’ attitudes and adherence to the use of risk scores in the primary prevention of cardiovascular disease (CVD).

Design and methods: A cross-sectional survey of 2056 physicians involved in the primary prevention of CVD. Participants included cardiologists (47%), general practitioners (42%), and endocrinologists (11%) from several geographical regions: Brazil (n?=?968), USA (n?=?381), Greece (n?=?275), Chile (n?=?157), Venezuela (n?=?128), Portugal (n?=?42), The Netherlands (n?=?41), and Central America (Costa Rica, Panama, El Salvador and Guatemala; n?=?64).

Results: The main outcome measure was the percentage of responses on a multiple-choice questionnaire describing a hypothetical asymptomatic patient at intermediate risk for CVD according to the Framingham Risk Score.

Only 48% of respondents reported regular use of CVD risk scores to tailor preventive treatment in the case scenario. Of non-users, nearly three-quarters indicated that ‘It takes up too much of my time’ (52%) or ‘I don’t believe they add value to the clinical evaluation’ (21%).

Only 56% of respondents indicated that they would prescribe lipid-lowering therapy for the hypothetical intermediate-risk patient. A significantly greater proportion of regular users than non-users of CVD risk scores identified the need for lipid-lowering therapy in the hypothetical patient (59 vs. 41%; p?<?0.0001).

Conclusions: Based on a survey conducted in a ‘real-world’ setting, risk scores are generally not used by a majority of physicians to guide primary prevention in asymptomatic persons at intermediate risk for CVD. Appropriate prescribing of lipid-lowering therapy in such patients is equally neglected. Changing physicians’ attitudes towards the use of CVD risk scores is one of several challenges that need to be addressed to reduce the world-wide burden of CVD.     

Abuse-deterrent and tamper-resistant opioids: how valuable are novel formulations in thwarting non-medical use?

Introduction: In recent years, attention has been given to the development of abuse-deterrent and tamper-resistant opioid formulations in light of concern over the growing misuse and abuse of opioids prescribed for the treatment of chronic pain.

Areas covered: This critical review discusses abuse-deterrent and tamper-resistant formulations, which may help to overcome concerns of misuse in using opioids for pain management. The role and utility of these novel formulations in clinical practice are outlined, as well as the risks and benefits associated with formulations that are currently available or under development.

Expert opinion: Numerous concerns with the integration of these formulations into clinical practice remain, as no product is intended or capable of addressing all types of misuse or abuse. As a result, these formulations should not necessarily be considered preferred agents once available in clinical practice. Moreover, before initiating therapy with abuse-deterrent and tamper-resistant formulations, proper patient assessment to identify risk factors for misuse and abuse should be implemented and optimized. With screening and monitoring in place, it would then be sensible to consider these formulations in patients who appear to be at high risk of misuse, abuse and/or diversion.     

Risk factors for substance use among youth experiencing homelessness

Abstract

Background: Youth experiencing homelessness are at high risk for frequent substance use. This study examines individual, interpersonal, and contextual factors associated with substance use among such youth, age 13–24. Methods: Data were collected through computer-assisted structured interviews with participants (N?=?474) recruited at service agencies in Los Angeles. Results: Youth had experienced over two years of homelessness on average. Almost a third used substances frequently; significant risk factors included delinquency, sensation seeking, and ongoing homelessness. Time spent in clubs and organizations was protective. Conclusions: Providing housing and services to curb delinquency may help protect youth from becoming frequent substance users.     

Analysis of subsequent surgery rates among endometriosis patients who underwent surgery with and without concomitant leuprolide acetate therapy

Objective To compare subsequent endometriosis-related surgery following initial laparoscopy among women treated with leuprolide acetate (LA) or other endometriosis therapies versus women who received no pharmacotherapy.

Research design and methods This retrospective cohort analysis utilized MarketScan Commercial claims data. Women with endometriosis aged 18–49 who underwent laparoscopy between 1 January 2005 and 31 December 2011 were identified using diagnosis and procedures codes and were categorized into four cohorts based on claims within 90 days of laparoscopy: surgery plus adherent LA, surgery plus non-adherent LA, surgery plus other therapy, and surgery alone. Patients with proportion of days covered ≥0.80 in the 6 months after laparoscopy were considered adherent to LA.

Main outcome measures Subsequent endometriosis-related surgery (laparoscopy, laparotomy or other excision/ablation/fulguration of endometriosis lesions, oophorectomy, or hysterectomy) was measured in the 6 and 12 months following initial laparoscopy. Risk of subsequent surgery was compared using multivariable Cox proportional hazards modeling.

Results Most women were treated with surgery only (n?=?9865); fewer were treated with LA (adherent: n?=?202; non-adherent: n?=?490) or other therapies (n?=?230). The proportion of patients with subsequent surgery ranged from 2.0% to 10.0% during the 6 month follow-up (12 month: 9.7% to 13.5%). Adherent LA use was associated with significantly lower risk of surgery compared to surgery alone (hazard ratio [HR]?=?0.31, p?=?0.020) while use of other therapies was associated with significantly higher risk (HR = 1.51, p?=?0.045) over the 6 month follow-up. There was no significant difference between the surgery plus non-adherent LA and surgery only cohort over 6 months (p?=?0.247). The association between adherent LA and subsequent surgery was not significant over the 12 month follow-up.

Conclusion Therapy with LA after laparoscopy for endometriosis was associated with lower risk of subsequent surgery at 6 months among women who were adherent to LA. Key limitations include lack of ability to capture disease severity which may have resulted in uncontrolled confounding.     

Adverse clinical events in Japanese atrial fibrillation patients with and without coronary artery disease—findings from the SAKURA AF Registry

Abstract

Background: Although atrial fibrillation (AF) and coronary artery disease (CAD) are increasing in prevalence in Japan, real-world data regarding clinical outcomes in Japanese AF patients with CAD are limited.

Methods: The SAKURA AF Registry is a prospective multi-center registry created to investigate outcomes of oral anticoagulant (OAC) use in Japanese AF patients. A study was conducted involving 3237 enrollees from 63 Tokyo-area institutions who were followed up for a median of 39.3?months. Clinical adverse events were compared between the patients accompanied with (n?=?312) and without CAD (n?=?2925).

Results: The incidence of cardiovascular events and all-cause mortality rates were significantly higher among patients with CAD than among those without CAD (5.98 vs 2.52 events per 100 patient-years, respectively, p?<?0.001; 3.27 vs 1.94 deaths per 100 patient-years, respectively, p?=?0.012), but there was no difference in strokes/transient ischemic attacks or systemic embolisms (1.70 vs 1.34). After a multivariate adjustment, CAD remained a risk factor for cardiovascular events (hazard ratio [HR]?=?1.57, 95% confidence interval [CI]?=?1.08–2.25, p?=?0.018). Among CAD patients, the propensity score-adjusted risk for major bleeding was significantly decreased among direct oral anticoagulant (DOAC) users in comparison to that among warfarin users (HR?=?0.29, 95% CI?=?0.07–0.94, p?=?0.04), but other adverse clinical events did not differ significantly between these two groups.

Conclusions: CAD did not appear to be a major determinant of strokes/TIAs, major bleeding, or all-cause mortality, but appeared to increase the risk of cardiovascular events in Japanese AF patients. The risk of major bleeding in CAD patients appeared to decrease when a DOAC rather than warfarin was administered. The data suggested that patients with AF and concomitant CAD require careful management and follow-up to reduce cardiovascular risks, and DOACs may be a better choice over warfarin when considering the risk of major bleeding.     

Long-term persistence with single-pill,fixed-dose combination therapy versus two pills of amlodipine and perindopril for hypertension: Australian experience

Objective: To study treatment persistence and mortality using a single-pill, fixed-dose combination tablet compared with a two-pill combination for hypertension.

Research design and methods: We analyzed Australian Pharmaceutical Benefit Scheme records 2011–2014 in a 10% random sample of concessional patients prescribed concomitant amlodipine and perindopril – either as a single-pill, fixed-dose combination tablet (n?=?9340) or as two-pill combination therapy (n?=?3093). Main outcome measures were: (a) proportions failing to continue amlodipine?+?perindopril over time, (b) proportions failing to continue any subsequent calcium channel and angiotensin inhibition therapy over time and (c) proportions dying.

Results: After 12 months, 34% of single-pill and 57% of two-pill users discontinued amlodipine?+?perindopril, median persistence time 42 months versus 7 months; 28% and 47% respectively discontinued any calcium channel–angiotensin inhibition therapy. After 48 months, 8% of single-pill and 18% of two-pill users had died. In a multivariate model adjusted for age, gender, duration and intensity of prior hypertension therapy, initial dose of amlodipine and perindopril, diabetes, hyperlipidemia, and complexity of care, the hazard ratio for risk of discontinuation over 42 months in the two-pill versus single-pill amlodipine?+?perindopril group was 1.94 (95% CI 1.83–2.06). The hazard ratio for discontinuation in two-pill versus single-pill users of any calcium channel–angiotensin inhibition therapy was 1.86 (1.74–1.99). The adjusted hazard ratio for risk of death over 48 months was 1.83 (1.55–2.16), but the mortality outcome may be an overestimate due to residual confounding.

Conclusions: Use of a single-pill, fixed-dose combination in hypertension is associated with superior persistence and reduced mortality compared with use of two pills, suggesting a higher priority for the use of fixed-dose combinations.     

Reducing sexual risk behaviors: secondary analyses from a randomized controlled trial of a brief web-based alcohol intervention for underage,heavy episodic drinking college women

Background: Alcohol use and sexual risk behaviors (SRBs) are significant problems on college campuses. College women are at particularly high risk for negative consequences associated with sexually transmitted infections (STIs) and unwanted pregnancy.

Methods: The current study (n?=?160) examined the effect of a brief, web-based alcohol intervention (n?=?53) for college women on reducing SRBs compared to an assessment only control (n?=?107) with a randomized controlled trial. Outcome measures included condom use assertiveness and number of vaginal sex partners and data were collected at baseline and three-month follow-up.

Results: Regression analyses revealed that the alcohol intervention was associated with higher levels of condom use assertiveness at a three-month follow-up. Additionally, more alcohol use was associated with less condom use assertiveness for those with more significant sexual assault histories.

Conclusions: These findings suggest that alcohol interventions may impact college women’s beliefs but not behavior, and future interventions should more explicitly target both alcohol and sexual risk to decrease risky behaviors.     

“You’re all going to hate the word ‘recovery’ by the end of this”: Service users’ views of measuring addiction recovery

Abstract

Aims: To explore how service users’ views of measuring addiction recovery differ from those of service providers. Methods: Five focus groups conducted in two English cities with (i) people currently using Class A drugs (n?=?6); (ii) people currently using alcohol (n?=?12); (iii) individuals in residential detoxification (n?=?12); (iv) individuals in residential rehabilitation (n?=?7); and (v) people who defined themselves as ex drug or alcohol users (n?=?7). Each focus group reviewed 76 measures of recovery previously identified by senior service providers. Findings: Service users identified multiple problems with the 76 measures. Difficulties could be categorized as expecting the impossible of service users; the dangers of progress; the hidden benefits of negative outcomes; outcomes that negate the agency in recovery; contradictory measures; failure to recognise individual differences; entrenched vulnerabilities; the misattribution of feelings and behaviours; and inappropriate language. Conclusions: Service users experience recovery as a process and personal journey that is often more about ‘coping’ than ‘cure’. Involving service users in designing measures of recovery can lessen the likelihood that researchers develop assessment tools that use inappropriate, contradictory or objectionable outcomes, and ambiguous and unclear language. People who have experienced drug or alcohol problems can highlight important weaknesses in dominant recovery discourses.