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Over the last several decades, the opioid crisis has had an increasing impact on the educational environment of schools. The role that principals and superintendents have in leading schools that have been affected by opioids has been mostly overlooked in the research. The present study was conducted in Ohio, a state with areas that have some of the highest death rates due to opioid-related incidents in the nation. Purpose: This study collected data on the perspectives and perceptions of school leaders in Ohio to better understand how principals and superintendents frame their decisions regarding the opioid crisis. Design: We analyze data collected from a survey of 217 Ohio school leaders (n = 164 principals and n = 53 superintendents). The survey required principals and superintendents to rate their perception of the opioid crisis in their schools based on their socioeconomic status, school typology as rural or non-rural, and school location within or outside the Appalachian region. Results: Findings emphasize that opioids remain a factor negatively impacting schools of varying typologies, economic levels, and geographical locations.

This article summarizes a project focused on the PROSPER program delivery system as a formal vehicle for addressing substance misuse and abuse in Ohio communities. Promoting School-community-university Partnerships to Enhance Resilience (PROSPER) is a nationally recognized, evidence-based program delivery system designed to implement prevention programming provided by a partnership among local schools and communities, the university-based Cooperative Extension system, and state leadership. A case study is presented that describes a midproject effort to develop strategies for advancing PROSPER goals through a process called "strategic doing." Strategic doing brings partners together to develop strong collaborations that achieve highly desired outcomes. The case study is an example of a formal effort to translate scientific knowledge into applications that address real-life problems. Implications for translational research are discussed.

Teach-Ins have historically been used as a way for educators to raise knowledge and awareness around an urgent social problem. We report findings from an action evaluation of the Bowling Green State University (BGSU) Opioid Awareness Teach-In, which was designed to (a) make clear that the BGSU community believes we can work to change the story of the opioid epidemic in northwest Ohio and (b) raise awareness of resources available for those struggling with opioid dependence in our community. Campus wide, anonymous questionnaires administered to students, faculty, and staff before (n = 275) and after (n = 140) the Teach-In indicated positive, and statistically significant, changes in knowledge of resources available, treatment options, and the attitude that BGSU is a community that cares about those struggling with opioid addiction. Qualitative feedback suggests that the Teach-In was helpful as a step toward changing the story and inspiring hope. In particular, our work to facilitate communication and awareness around opioid addiction, and reduce the silence and stigma associated with addiction, appears to have resonated strongly with participants.

Background: Illicit drug use by school-aged teens can adversely affect their health and academic achievement. This study used a survey administered in schools to assess the prevalence of problematic drug use among teenagers in a Midwestern community. Methods: Self-report data were collected from 11th- and 12th-grade students (N = 3974) in 16 school districts in the Dayton, Ohio, area. Students responded to a drug use survey that also included CRAFFT, a brief substance abuse screening instrument. Binomial and zero-inflated Poisson regressions were used to examine the association between CRAFFT scores and drug use practices, including abstinence. Results: More than one third of students had CRAFFT scores suggestive of problematic use. Of these, 14.1% had scores suggesting drug dependence. Although alcohol, marijuana, and tobacco were the drugs most commonly used, an array of other drugs including opioids, benzodiazepines, stimulants, hallucinogens, and dextromethorphan were also commonly used. Higher CRAFFT scores were associated with a greater number of drugs used (p less than 0.0001). Proportionately more 12th graders than 11th graders had CRAFFT scores indicating problems (p less than 0.0001). Among 12th graders, boys were more likely than girls to have CRAFFT scores indicating dependence (p = 0.01). Conclusions: The results suggest that problematic drug use among high school students is more prevalent than has been recognized previously. CRAFFT can be used easily to assess the prevalence of problematic drug use among teenagers in school settings. CRAFFT results can also inform prevention and intervention activities, particularly if the CRAFFT instrument is paired with a drug use survey. (Contains 3 tables and 1 figure.)

Background: Withdrawal is believed to play a central role in the brain disease model of addiction. However, little research describes withdrawal-motives among untreated individuals in community settings. Methods: This cross-sectional study surveyed syringe exchange program participants (n = 139) with untreated opioid use disorder (OUD) in Columbus, Ohio from January 10th to March 25th, 2023, to assess their perceptions of the role of withdrawal in OUD maintenance, treatment delay, and OUD's refractoriness to buprenorphine. Participants responded to a survey including DSM-5 OUD criteria, demographics, and questions about substance use and opioid withdrawal. Participant ages ranged from 21 to 65 years with a mean age of 37.5 years and standard deviation of 8.1. The racial distribution of the sample was as follows: 81% White/Caucasian, 12% Black/African American, 3% Native American or Alaskan Native. Results: Sixty-six percent of participants agreed, or strongly agreed that opioid withdrawal was "the most important reason" they had been unable to stop using opioids. Almost seventy-one percent agreed, or strongly agreed that worry about opioid withdrawal had caused them to "put off or delay" OUD treatment. Although all participants had active, untreated OUD at the time of recruitment, most (85%) had previously tried buprenorphine, and the majority (78%) reported having experienced buprenorphine-precipitated withdrawal. Conclusions: Among this community sample of individuals with untreated OUD, withdrawal was perceived to have an important role in maintaining OUD, including by motivating OUD treatment delay. Prior buprenorphine-precipitated withdrawal was common, suggesting aversion to withdrawal might possibly be associated with OUD's refractoriness to buprenorphine. [ABSTRACT FROM AUTHOR]

Background: This study explored the risk mitigation practices of multidisciplinary oncology health-care personnel for the nonmedical use of opioids in people with cancer. Methods: An anonymous, cross-sectional descriptive survey was administered via email to eligible providers over 4 weeks at The Ohio State University's Arthur G. James Cancer Hospital. The survey asked about experiences and knowledge related to opioid use disorders. Results: The final sample of 773 participants included 42 physicians, 213 advanced practice providers (APPs consisted of advanced practice nurses, physician assistants, and pharmacists), and 518 registered nurses. Approximately 40% of participants responded feeling "not confident" in addressing medication diversion. The most frequent risk reduction measure was "Checking the prescription drug monitoring program" when prescribing controlled medications, reported by physicians (n = 29, 78.4%) and APPs (n = 164, 88.6%). Conclusion: People with cancer are not exempt from the opioid epidemic and may be at risk for nonmedical opioid use (NMOU) and substance use disorders. Implementing risk reduction strategies with every patient, with a harm reduction versus abstinence focus, minimizes harmful consequences and improves. This study highlights risk mitigation approaches for NMOU, representing an opportunity to improve awareness among oncology health-care providers. Multidisciplinary oncology teams are ideally positioned to navigate patients through complex oncology and health-care journeys. This study explored the risk mitigation practices of multidisciplinary oncology health-care personnel for the nonmedical use of opioids in people with cancer. [ABSTRACT FROM AUTHOR]

Our objectives were to examine the impact of methamphetamine use on opioid use disorder (OUD) treatment retention in patients prescribed either buprenorphine/buprenorphine-naloxone (BUP-NX) or naltrexone/extended-release naltrexone (XR-NTX), while also exploring the role of other risk factors that may modify the impact of methamphetamine use. We conducted an exploratory retrospective study examining OUD treatment retention in 127 patients in Ohio (USA). Patients were prescribed either BUP-NX or naltrexone/XR-NTX. Cox proportional hazard regression was used to compare time to dropout of treatment between patients positive and negative on screening for methamphetamines at intake, estimate the association between other risk factors and time to dropout, and test interactions between risk factors and methamphetamine status. Among patients prescribed naltrexone/XR-NTX, those positive for methamphetamines had almost three times the risk of treatment dropout (AHR = 2.89, 95% CI =1.11, 7.07), significantly greater (interaction p =.039) than the methamphetamine effect among those prescribed BUP-NX (AHR = 0.94, 95% CI = 0.51, 1.65). Early in treatment, being prescribed BUP-NX was strongly associated with a greater risk of treatment dropout (at baseline: AHR = 2.90, 95% CI = 1.33, 7.15), regardless of baseline methamphetamine use status. However, this effect decreased with time and shifted to greater risk of dropout among those prescribed naltrexone/XR-NTX (non-proportional hazard; interaction with time AHR = 0.66, 95% CI = 0.49, 0.86), with the shift occurring sooner among those positive for methamphetamine at baseline. Additional support should be provided to patients who use methamphetamines prior to starting OUD treatment. [ABSTRACT FROM AUTHOR]

Although medication-assisted treatment (MAT) effectively treats opioid use disorders (OUD), MAT access is restricted in criminal justice (CJ) settings. Previous studies have documented that stigma and limited knowledge about MAT are prevalent among CJ court personnel. We describe development and pilot testing of an eLearning intervention to improve MAT knowledge and increase MAT referrals in Ohio courts. Methods: Building upon a nationwide survey conducted in 2011 of drug courts and informed by MAT opinions from judges who supervised OUD clients, we developed two eLearning MAT modules. Judges completed a brief online MAT knowledge-attitude scale (K-A) before, after, and at 3 months. Judges were asked about MAT referrals pretest and 3 months later. Results: Sixty-three judges expressed interest in the study, 25 completed the pretest and viewed the modules, 11 completed a 3 month posttest. At pretest, K-A scores were significantly (p<.05) lower for agonist medications than for extended-release naltrexone (XR-NTX; Vivitrol). K-A scores improved at posttest for agonist medications (p<.05) but declined to pretest levels three months later. Three months after the pretest, buprenorphine referrals increased from 2.6% to 9.7% (p<.05). There was no significant difference on K-A scores for agonist medication between the Ohio sample (at pretest) and the 2011 sample. Conclusion: Although there is some indication that eLearning may have strengthened knowledge gains and increased buprenorphine referrals, a more robust eLearning intervention will likely be required to increase court personnel participation and sustain eLearning knowledge gains. Recruiting and sustaining judges' participation in the study represented a significant study limitation. [ABSTRACT FROM AUTHOR]

Background: Because of the need for perioperative pain management, orthopaedic surgeons play an important role in opioid use. Purpose/Hypothesis: To evaluate the impact of opioid-limiting legislation on postoperative opioid use and pain-related complications after anterior cruciate ligament reconstruction (ACLR). The hypothesis was that the opioid-limiting legislation would reduce postoperative opioid use after ACLR. Study Design: Cohort study; level of evidence, 3. Methods: We retrospectively reviewed patients who underwent ACLR 1 year before and 1 year after Ohio's opioid-limiting legislation, which was passed in August 2017. Clinicians were prohibited from prescribing more than 30 morphine milligram equivalents (MMEs) per day, with a maximum duration of 7 days for adults. The Ohio Automated Rx Reporting System database and patients' medical charts were reviewed for prescriptions of all controlled substances (oral oxycodone, hydrocodone, morphine, codeine, tramadol, and hydromorphone) filled from 30 days before and 90 days after ACLR. The total number of postoperative prescriptions, total MMEs, the number of pills in each patient's prescription, and pain-related complications (emergency department visits, office calls for pain control issues, unplanned readmissions, unplanned surgeries, and provider notes indicating opioid prescription refill demands) were evaluated. Results: A total of 243 patients (127 prelegislation, 116 postlegislation) were included in the study. There were no significant differences in demographics or preoperative opioid use between the study groups. The number of pills prescribed initially decreased by 34% after legislation (63.5 ± 16.7 [prelegislation] vs 42 ± 15.7 pills [postlegislation]; P <.001). Correspondingly, there was a significant decrease in total quantity of initial prescriptions in the postlegislation period (474.6 ± 123.8 vs 310.7 ± 115.3 MMEs; P <.001). The number of documented pain medication refill demands and pain-related complications did not increase in the postlegislation period (42 prelegislation vs 43 postlegislation; P =.514). Preoperative opioid use was the strongest predictor of opioid-refill demand (odds ratio, 4.19 [95% CI, 1.76-9.99]; P =.001). Conclusion: After the Ohio legislation was passed limiting opioid prescription, there was a significant reduction in opioids provided for patients undergoing ACLR. In spite of this decrease, no rebound increase in refill demands or postoperative pain-related complications were observed. [ABSTRACT FROM AUTHOR]

Objective: Effective treatments for opioid use disorder exist, but rural areas of the United States have a shortage of services offering such treatments. Physician bias toward patients with opioid use disorder can also limit care access, but no studies have assessed whether physician bias is a more acute barrier in rural compared with urban communities.Methods: In total, 408 board-certified physicians in Ohio, a state with a high rate of opioid overdoses, completed an online survey examining perspectives on clinical care for patients who misuse opioids. Respondents with missing county-level data were excluded, leaving a total sample of 274. The authors used t tests to determine rural-urban differences in bias, key predictors of bias, and availability of opioid services. Multivariable regression modeling was used to estimate rural-urban differences in bias independent of key bias predictors.Results: Physicians in rural areas (N=37) reported higher levels of bias toward patients with opioid use disorder than did their urban counterparts (N=237). This difference remained statistically significant even after accounting for known bias predictors and physician specialty. Physicians specializing in addiction medicine reported lower bias than did physicians not working in this specialty.Conclusions: Given existing disparities in harm reduction and addiction treatment services in rural areas, increased physician bias in counties lacking these services suggests that rural patients with opioid use disorder face numerous challenges to finding effective treatment. Bias reduction interventions should target health care professionals in rural communities where such efforts may have the most pronounced impact on improving health care access. [ABSTRACT FROM AUTHOR]

Background and Aims: It is widely believed that the 2018 decline in overdose deaths in the United States was attributable to a range of public health interventions, however, this decline also coincided with the regulation and decline in use of potent fentanyl analogs, especially carfentanil. The aim of this study was to investigate the association between overdose deaths and carfentanil availability in the United States. Design Secondary analysis of drug overdose deaths from the Center for Disease Control and Prevention (CDC) and carfentanil exhibit data from drug seizures submitted to drug crime labs and published by the Drug Enforcement Administration (DEA). Trends in overdose deaths were compared in states with high carfentanil exhibits with states with low or no carfentanil exhibits. Setting: United States. Participants: A total of 1 035 923 drug overdose death records in the United States from 1979 through 2019 were studied. Measurements The outcomes studied were number of overdose deaths and mortality rates by state. Findings Drug overdose deaths have been closely tracked along an exponential curve. The years 2016 and 2017 witnessed a hyper‐exponential surge with increases in overdose deaths of 11 228 (+21.4%) and 6605 (+10.4%), respectively. Subsequently in 2018, drug overdose deaths declined by −2870 (−4.1%). This rise and then fall coincided with a surge and then decline in carfentanil drug seizure exhibits during these same years: 0 (2015), 1292 (2016), 5857 (2017) and 804 (2018). The majority of carfentanil exhibits were localized to a few states. The 2018 decline in overdose deaths in the top five states with the greatest spike in carfentanil exhibits in 2017 (Ohio, Florida, Pennsylvania, Kentucky and Michigan) was 2848, which accounted for nearly all of the total US decline. Conclusions: The 2016–2017 acceleration and then 2018 decline in drug overdose deaths in the United States was associated with the sudden rise and then fall of carfentanil availability. Given the regional variation, carfentanil's decreased availability may have contributed to the reduction in overdose deaths in 2018. [ABSTRACT FROM AUTHOR]

BACKGROUND: Emergency personnel operate in environments that put them at higher risk of injury to the musculoskeletal system. These injuries result in lost workdays, medical costs, and decreased productivity, all which impact emergency response systems. OBJECTIVE: This study serves to assess the causes, costs, and disability of common work-related musculoskeletal injuries within the police, emergency medical service (EMS) workers, and firefighters of Ohio based on data from the OBWC (Ohio Bureau of Workers' Compensation). METHODS: Our dataset included all OBWC injury claims involving a shoulder, low back, or knee from 2010 through 2014. Police and Firefighter leaders were analyzed separately from those not in a leadership role, and workers with combined Firefighter/EMS roles were analyzed separately from "pure" Firefighters and EMS personnel. Data were organized through univariate analysis of variance with post-hoc Tukey tests and analyzed based on the job of the individual and whether the individual was in a leadership role. RESULTS: Police Officers had the highest number of total injuries in the dataset, followed by Firefighters and Firefighters/EMS workers. Police Officers and Firefighters injured their back and knees more often than their shoulders, while EMS workers injured their backs and shoulders more often than their knees. CONCLUSIONS: The mechanisms through which injuries occur are also dependent on the job. Police officers experienced a higher percentage of motor vehicle related back problems, while firefighters had a higher percentage of injuries from overexertion. Musculoskeletal injury claims in these emergency personnel resulted in opioid prescriptions approximately 10%of the time. [ABSTRACT FROM AUTHOR]

With the rise of opioid deaths and methadone maintenance treatment (MMT) being the "gold standard," evidence lacks the quality of life for those on Methadone. Objective: This study aimed to develop educational materials for communities and clinics about MMT and abstinence, utilizing the PhotoVoice technique to represent the voice of those on Methadone treatment (MMT) and abstinence for recovery from opioid use disorder (OUD). Participants shared firsthand experiences of life on Methadone and abstinence, resulting in a short video clip and a poster. Design: Participants were recruited following meetings of Alcoholics Anonymous and Narcotics Anonymous. An introduction letter was handed out, and questions were answered. After COVID‐19 Pandemic, further communications were delivered through Email. Five participants on Methadone and four who were abstinent were recruited. Participants were 18 years and over, male and female, were on MMT or abstinent for 6 months or more. Results: Common themes among participants were extracted and discussed with the participants and a short video clip and a poster were developed. Conclusion: Further study in MMT from the patient's perspective need to be explored. The PhotoVoice project revealed personal barriers, while on Methadone, that impede a full and rich life spiritually, mentally, and physically. [ABSTRACT FROM AUTHOR]

Objective This study evaluated the characteristics of opioid prescriptions, including prescriber specialty, given to opioid-naïve patients and their association with chronic use. Design Cross-sectional analysis of the Ohio prescription drug monitoring program from January 2010 to November 2017. Setting Ohio, USA. Subjects Patients who had no opioid prescriptions from 2010 to 2012 and a first-time prescription from January 2013 to November 2016. Methods Chronic use was defined as at least six opioid prescriptions in one year and either one or more years between the first and last prescription or an average of ≤30 days not covered by an opioid during that year. Results A total of 4,252,809 opioid-naïve patients received their first opioid prescription between 2013 and 2016; 364,947 (8.6%) met the definition for chronic use. Those who developed chronic use were older (51.7 vs 45.6 years) and more likely to be female (53.6% vs 52.8%), and their first prescription had higher pill quantities (44.9 vs 30.2), higher morphine milligram equivalents (MME; 355.3 vs 200.0), and was more likely to be an extended-release formulation (2.9% vs 0.7%, all P  < 0.001). When compared with internal medicine, the adjusted odds of chronic use were highest with anesthesiology (odds ratio [OR] = 1.46) and neurology (OR = 1.43) and lowest with ophthalmology (OR = 0.33) and gynecology (OR = 0.37). Conclusions Eight point six percent of opioid-naïve individuals who received an opioid prescription developed chronic use. This rate varied depending on the specialty of the provider who wrote the prescription. The risk of chronic use increased with higher MME content of the initial prescription and use of extended-release opioids. [ABSTRACT FROM AUTHOR]

Objective To assess the impact of Ohio's 2012, 2013, and 2016 opioid prescribing guidelines on opioid and nonsteroidal anti-inflammatory drug (NSAID) prescription filling and health care utilization for pain among children with sickle cell disease (SCD). Design Quasi-experimental retrospective cohort study. Setting Ohio Medicaid claims data from August 2011 to August 2016. Subjects Medicaid beneficiaries under age 19 years with SCD. Methods Interrupted time series analyses comparing population-level rates of opioids and NSAID prescriptions filled, standardized amounts of opioids dispensed, and acute health care utilization for pain before and after release of each guideline. Results In our cohort of 1,505 children with SCD, there was a temporary but significant decrease in the opioid filling rate (–2.96 prescriptions per 100 children, P  = 0.01) and in the amount of opioids dispensed (–31.39 milligram morphine equivalents per filled prescription, P  < 0.001) after the 2013 guideline but a temporary but significant increase in the opioid filling rate (7.44 prescriptions per 100 children, P  < 0.001) and in the amount of opioids dispensed (72.73 mg morphine equivalents per filled prescription, P  < 0.001) after the 2016 guideline. The NSAID filling rate did not significantly change after any of the guidelines. Acute health care utilization rates for pain after the 2016 guideline were similar to those before the 2013 guideline (rate ratio = 1.04, P  = 0.63). Conclusions Our results suggest that Ohio's 2013 and 2016 guidelines were associated with significant but nonsustained changes in opioid prescription filling among children with SCD. Additional studies are needed to confirm that opioid guidelines have a sustained impact on excessive opioid prescribing, filling, and misuse. [ABSTRACT FROM AUTHOR]

Background: U.S. is experiencing a surging trend of methamphetamine use among individuals who use opioids. More research is needed to characterize this emerging "twin epidemic." Objectives: The study aims to identify social and behavioral characteristics associated with methamphetamine use among individuals with opioid use disorder (OUD) in the Dayton, Ohio, area, an epicenter of the opioid crisis and an emerging frontier of methamphetamine epidemic. Methods: 357 adult individuals with current OUD were recruited using targeted and respondent-driven sampling. Structured interviews collected information on social and drug use characteristics. Multivariable Logistic Regression was used to identify characteristics associated with the past 6-month use of methamphetamine. Results: 49.7% were female, and 88.8% were non-Hispanic whites. 55.6% used methamphetamine in the past 6-months, and 84.9% reported first use of methamphetamine after initiation of illicit opioids. Methamphetamine use was associated with homelessness (aOR = 2.46, p =.0001), lifetime history of diverted pharmaceutical stimulant use (aOR = 2.97, p <.001), injection route of heroin/fentanyl use (aOR = 1.89, p =.03), preference for fentanyl over heroin (aOR = 1.82, p =.048), lifetime history of extended-release injectable naltrexone (Vivitrol)-based treatment (aOR = 2.89, p =.003), and more frequent marijuana use (aOR = 1.26, p =.04). Discussion: The findings point to the complexity of motivational and behavioral pathways associated with methamphetamine and opioid co-use, ranging from self-treatment and substitution behaviors, attempts to endure homelessness, and greater risk taking to experience euphoria. More research is needed to understand the causal relationships and the association between methamphetamine and Vivitrol use. Public health responses to the opioid crisis need to be urgently expanded to address the growing epidemic of methamphetamine use. [ABSTRACT FROM AUTHOR]

Background We quantified opioid prescribing after the 2014 rescheduling of hydrocodone from schedule III to II in the United States using a state-wide prescription database and studied trends three years before and after the policy change, focusing on certain specialties. Methods We used Ohio's state prescription drug monitoring program database, which includes all filled schedule II and III prescriptions regardless of payer or pharmacy, to conduct an interrupted time series analysis of the nine most prescribed opioids: hydrocodone, oxycodone, tramadol, codeine, and others. We analyzed hydrocodone prescribing trends for the physician specialties of internal medicine, anesthesiology, and emergency medicine. We evaluated trends 37 months before and after the rescheduling change. Results Rescheduling was associated with a hydrocodone level change of –26,358 (95% confidence interval [CI] = –36,700 to –16,016) prescriptions (–5.8%) and an additional decrease in prescriptions of –1,568 (95% CI = –2,296 to –839) per month (–0.8%). Codeine prescribing temporarily increased, at a level change of 6,304 (95% CI = 3,003 to 9,606) prescriptions (18.5%), indicating a substitution effect. Hydrocodone prescriptions by specialty were associated with a level change of –805 (95% CI = –1,280 to –330) prescriptions (–8.5%) for anesthesiologists and a level change of –14,619 (95% CI = –23,710 to –5,528) prescriptions (–10.2%) for internists. There was no effect on prescriptions by emergency physicians. Conclusions The 2014 federal rescheduling of hydrocodone was associated with declines in hydrocodone prescriptions in Ohio beyond what had already been occurring, and hydrocodone may have been briefly substituted with codeine. These results indicate that rescheduling did have a lasting effect but affected prescribing specialties variably. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this article is to describe the creation and outcomes of a collaborative model and care facility for opioid overdose and addiction treatment based on compassion, patience, and respect: The Maryhaven Addiction Stabilization Center (MASC). Approach: MASC was created with the vision to serve clients who have recently overdosed on opioids. In this article, the research, planning, building, and implementation of an opioid treatment center composed of an admission and triage unit, inpatient withdrawal management unit, and inpatient residential unit are described. A multi‐agency and multi‐disciplinary approach were used to immediately engage patients and connect them to treatment for opioid addiction. Findings: Implementation of a collaborative model of care offers patients who overdose on opioids with immediate access to admission for treatment. This has resulted in significantly higher numbers of patients seeking and staying in treatment. Conclusions: Through multi‐agency collaboration and a shared commitment to addressing the challenges of the opioid epidemic in innovative ways, more patients who are struggling with addiction have increased opportunities to engage in treatment and move towards recovery. Clinical Relevance: Clinicians, first responders, and communities can employ MASC principles to guide their approaches to serve patients who have recently overdosed on opioids or who are in active addiction. [ABSTRACT FROM AUTHOR]

The article describes the naloxone dispensing program implemented by supermarket company Kroger at its community pharmacy chains in Ohio. Topics discussed include the epidemic of opioid-related drug overdose deaths in the U.S., naloxone use for opioid reversal, and the key role of pharmacists and pharmacy interns in the distribution of naloxone without a prescription to increase access to the drug in the community.

Addiction in patients with cancer is not well described. Patients with substance use disorders (SUDs) and cancer experience worse outcomes; however, no guidelines exist for identifying and successfully managing these issues in oncology. With the goal to improve patient safety and outcomes, an interprofessional work group at a major academic cancer hospital initiated a trial screening process for identifying substance abuse issues in an oncology population. Simultaneously, guidelines for patients with cancer and SUDs were created. [ABSTRACT FROM AUTHOR]

The problem of opioid diversion and its contribution to the opioid epidemic are well known nationally, existing even within hospice care. Proper disposal of opioids may be a critical factor in reducing diversion. In 2014, Ohio implemented legislation requiring a hospice employee to destroy or witness disposal of all unused opioids within a patient's plan of care. The purpose of this study was to determine the impact of Ohio Revised Code 3712.062 on hospice programs' policies and procedures to prevent opioid diversion in the home. Directors of Ohio-licensed hospices were surveyed to assess the percentage of programs with a written policy in place for disposal of opioids and to calculate a compliance score based on responses to survey questions assessing compliance with legislation components. Fifty-two surveys were completed (39.4%). All survey respondents reported having a written policy in place. A 95.5% average compliance score was calculated, with the largest disparity occurring with timing of opioid disposal. While Ohio Revised Code 3712.062 requires opioid disposal at the time of patient's death or when no longer needed by the patient, only 84% of respondents report disposing opioids upon discontinuation. Overall, a high compliance rate was seen among hospice programs indicating such regulation is manageable to meet. Background [ABSTRACT FROM AUTHOR]

This retrospective cohort study aimed to explore the study institution's intraoperative ketamine use during kyphoplasty and compare narcotic requirements in patients who received intraoperative ketamine with those who did not. The authors hypothesized that a single dose of ketamine during kyphoplasty would reduce postoperative narcotic consumption. Included patients underwent kyphoplasty under monitored anesthesia care between 2012 and 2013. Excluded patients were younger than 18 years or had general anesthesia, endotracheal intubation, or major intraoperative complications. Narcotics were converted into morphine equivalents for comparison. Analysis included χ², correlation analyses, multivariate regression analysis, and analysis of variance. Overall, 279 patients were included. Men were a minority of the sample, 26.2% (73/279). More than 83% of patients were ASA class 3 (232/279), and more than 50% repaired a single vertebra (154/279). A single dose of ketamine was administered in 15.8% of kyphoplasties, with an average dose of 38.7 mg (range = 2-150 mg). Intraoperative ketamine administration was predictive of decreased intraoperative narcotic requirements (P < .001) but was not associated with decreased postoperative narcotic requirements (P = .442). Patients remained hemodynamically stable in the preoperative and postoperative period. Ketamine did not reduce postoperative narcotic consumption but reduced intraoperative narcotic consumption in this sample. [ABSTRACT FROM AUTHOR]

The objective was to compare diagnosis rates representing developmental outcomes and medical complications between infants with intrauterine opioid exposures who did not receive pharmacologic treatment for neonatal abstinence syndrome at the time of birth and infants for whom no exposure to substances of abuse were detected. This retrospective, descriptive study included approximately 95% of Hamilton County, Ohio resident births in 2014 and 2015. Universal maternal drug test results, performed at the time of birth, were documented and linked to electronic health records representing pediatric primary and subspecialty follow-up care as well as urgent care, emergency care, and inpatient services provided by Cincinnati Children's Hospital Medical Center through 2017, when all children were at least 24 months old. Diagnosis rates were compared between drug exposure groups using chi-square tests. Among infants born at >34 weeks gestation and without other complex clinical conditions, infants with subclinical opioid exposures (N = 473) were more likely than infants with no drug exposures (N = 14,933) to be diagnosed with behavioral or emotional disorders (3.0% vs 1.1%, P = 0.0008), developmental delay (15.6% vs 7.6%, P < 0.0001), speech disorder (10.1% vs 6.5%, P = 0.001), or strabismus (3.4% vs 1.0%, P < 0.0001), and more likely to be exposed to the hepatitis C virus (6.8% vs 0.1%, P < 0.0001). Increased diagnosis rates among all opioid exposed infants, regardless of withdrawal severity, may warrant the additional allocation of resources for screening and follow-up. Awareness of the increased risk for certain developmental delays and medical conditions is critical to early intervention and treatment supporting improved outcomes. [ABSTRACT FROM AUTHOR]

Background: Opioid-related injuries and deaths continue to present challenges for public health practitioners. Prescription Drug Monitoring Programs (PDMPs) are a prevalent policy option intended to address problematic opioid pain reliever (OPR) prescribing, but previous research has not thoroughly characterized their unintended consequences. Objectives: To examine state actors' perceptions of the unintended consequences of PDMPs. Methods: We conducted 37 interviews with PDMP staff, law enforcement officials, and administrative agency employees in Florida, Kentucky, New Jersey, and Ohio from May 2015 to June 2016. Results: We identified six themes from the interviews. Perceived negative unintended consequences included: access barriers for those with medical needs, heroin use as OPR substitute and related deaths, and need for adequate PDMP security infrastructure and management. Perceived positive unintended consequences were: community formation and problem awareness, proactive population-level OPR monitoring, and increased knowledge about population-level drug diversion. Conclusions/Importance: State actors perceive a range of both negative and positive unintended consequences of PDMPs. Our findings suggest that there may be unintended risks of PDMPs that states should address, but also opportunities to maximize certain benefits. [ABSTRACT FROM AUTHOR]

Background: The increasing use of prescription opioids has contributed to the epidemic of opioid abuse in the United States. Efforts to reduce opioid prescriptions and offer alternatives for pain management are needed.Objective: To determine the success of a multidisciplinary project to manage chronic pain while reducing reliance on opioids in a population of patients with spinal cord injury (SCI).Design: Retrospective analysis.Setting: This study was conducted in an SCI system of care in northeast Ohio.Participants: Individuals with SCI receiving outpatient care were included.Interventions: Clinicians in SCI and pain management specialties developed a plan to manage individuals with SCI, particularly for individuals using opioids, including physical, occupational, recreational, and vocational therapy. These services worked closely with the SCI physicians when chronic pain was identified to help better medically manage their pathology and support efforts to decrease opioid use in a multipronged approach.Main Outcomes: The primary outcome measures from opioid prescription data from 2008 to 2016 were the percent of outpatients receiving opioids, opioid prescription rates, and opioid prescription doses over time.Results: The percentage of outpatients receiving opioids and the number of opioid prescriptions through the outpatient service significantly decreased, from 39% to 16% and from 2.5 to 1.5 prescriptions per patient per quarter, respectively, correlating with the introduction of the multidisciplinary interventions. The total morphine equivalent quantities of prescription medications, particularly nonmethadone opioids, also decreased significantly.Conclusions: The multidisciplinary interventional approach was associated with marked decreases in the percentage of patients receiving opioids and the amounts of opioids being prescribed. This reduction could have a significant impact on the opioid crisis.Level Of Evidence: IV. [ABSTRACT FROM AUTHOR]

Background: Ohio has the fifth highest rate of prescription opioid overdose deaths in the United States. One strategy implemented to address this concern is a state-wide opioid prescribing guideline in the emergency department (ED).Objective: Our aim was to explore emergency physicians' perceptions on barriers and strategies for the Ohio ED opioid prescribing guideline.Methods: Semi-structured interviews with emergency physicians in Ohio were conducted from October to December 2016. Emergency physicians were recruited through the American College of Emergency Physicians Ohio State Chapter. The interview guide explored issues related to the implementation of the guidelines. Interview data were transcribed and thematically analyzed and coded using a scheme of inductively determined labels.Results: In total, we conducted 20 interviews. Of these, 11 were also the ED medical director at their institution. Main themes we identified were: 1) increased organizational responsibility, 2) improved prescription drug monitoring program (PDMP) integration, 3) concerns regarding patient satisfaction scores, and 4) increased patient involvement. In addition, some physicians wanted the guidelines to contain more clinical information and be worded more strongly against opioid prescribing. Emergency physicians felt patient satisfaction scores were perceived to negatively impact opioid prescribing guidelines, as they may encourage physicians to prescribe opioids. Furthermore, some participants reported that this is compounded if the emergency physicians' income was linked to their patient satisfaction score.Conclusions: Emergency physicians interviewed generally supported the state-wide opioid prescribing guideline but felt hospitals needed to take additional organizational responsibility for addressing inappropriate opioid prescribing. [ABSTRACT FROM AUTHOR]

Background: Since 2000, heroin use patterns have shifted within the United States. How this change may relate to polydrug use among local heroin users is unknown. Although polydrug use has been studied, user perceptions of drug use in terms of health risks, arrest risk, availability, cost, liking, and dependence have not been considered.Methods: Data are presented from a brief, face-to-face survey conducted in 2016 of 200 non-in-treatment heroin users from Cleveland, OH. We assessed the use of and attitudes on alcohol, marijuana, methamphetamine, heroin, crack cocaine, powder cocaine, and prescription drugs. We estimated polydrug (concurrent past month) use with cluster analysis and latent profiles. Regression analysis estimated the strength of relationships between attitudes and frequency of use.Results: We identified five clusters: Cluster 1 used heroin concomitantly with alcohol and occasionally crack; Cluster 2 used heroin and crack cocaine daily; Cluster 3 used heroin daily and almost exclusively; Cluster 4 used heroin and marijuana daily; and Cluster 5 were part-time drug users. Drug use frequency was associated with liking and being anxious when drugs could not be obtained. High perceived availability of heroin and cocaine and low cost facilitated polydrug use.Conclusions: Understanding polydrug use clusters among heroin users is important for addressing the larger opioid epidemic. Users' perceptions of a drug's availability and cost appeared to facilitate polydrug use and justify more detailed future research on drug access. [ABSTRACT FROM AUTHOR]

Background. The current US opioid epidemic is attributed to the large volume of prescribed opioids. This study analyzed the contribution of different medical specialties to overall opioids by evaluating the pill counts and morphine milligram equivalents (MMEs) of opioid prescriptions, stratified by provider specialty, and determined temporal trends. Methods. This was an analysis of the Ohio prescription drug monitoring program database, which captures scheduled medication prescriptions filled in the state as well as prescriber specialty. We extracted prescriptions for pill versions of opioids written in the calendar years 2010 to 2014. The main outcomes were the number of filled prescriptions, pill counts, MMEs, and extended-released opioids written by physicians in each specialty, and annual prescribing trends. Results. There were 56,873,719 prescriptions for the studied opioids dispensed, for which 41,959,581 (73.8%) had prescriber specialty type available. Mean number of pills per prescription and MMEs were highest for physical medicine/rehabilitation (PM&R; 91.2 pills, 1,532mg, N51,680,579), anesthesiology/pain (89.3 pills, 1,484mg, N53,261,449), hematology/oncology (88.2 pills, 1,534mg, N5516,596), and neurology (84.4 pills, 1,230 mg, N5573,389). Family medicine (21.8%) and internal medicine (17.6%) wrote the most opioid prescriptions overall. Time trends in the average number of pills and MMEs per prescription also varied depending on specialty. Conclusions. The numbers of pills and MMEs per opioid prescription vary markedly by prescriber specialty, as do trends in prescribing characteristics. Pill count and MME values define each specialty's contribution to overall opioid prescribing more accurately than the number of prescriptions alone. [ABSTRACT FROM AUTHOR]

The last decade has seen an exponential increase in the use of illicit and prescription opioids during pregnancy. Opioid dependency during pregnancy increases the risks of obstetric complications for mothers and potential dangers for newborns during infancy and later in life. The mother--child dyad faces specific hurdles when it comes to getting their medical and psychosocial needs met. The purpose of this article is to identify gaps in care of families affected by opiate abuse and review how the Mother and Child Dependency Program at the MetroHealth System in Cleveland, Ohio, is trying to bridge these gaps through comprehensive, multidisciplinary, and standardized treatment for this vulnerable population. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Neonatal abstinence syndrome (NAS) after an infant's in-utero exposure to opioids has increased dramatically in incidence. No treatment standards exist, leading to substantial variations in practice, degree of opioid exposure, and hospital length of stay, methods: The Ohio Perinatal Quality Collaborative conducted an extensive multi-modal quality improvement initiative with the goal to (1) standardize identification, nonpharmacologic and pharmacologic treatment in level-2 and 3 NICUs in Ohio, (2) reduce the use of and length of treatment with opioids, and (3) reduce hospital length of stay in pharmacologically treated newborns with NAS, results: Fifty-two of 54 (96%) Ohio NICUs participated in the collaborative, Compliance with the nonpharmacologic bundle improved from 37% to 59%, and the pharmacologic bundle improved from 59% to 68%. Forty-eight percent of the 3266 opioid-exposed infants received pharmacologic treatment of symptoms of NAS, and this rate did not change significantly across the time period. Regardless of the opioid used to pharmacologically treat infants with NAS, the length of treatment decreased from 13.4 to 12.0 days, and length of stay decreased from 18.3 to 17 days, conclusions: Standardized approaches to the identification and nonpharmacologic and pharmacologic care were associated with a reduced length of opioid exposure and hospital stay in a large statewide collaborative. Other states and institutions treating opioid-exposed infants may benefit from the adoption of these practices. [ABSTRACT FROM AUTHOR]

Background: Employment is a central component of economic independence and is widely viewed as an essential element of social control. Whether frequent drug use reduces the likelihood of employment or obstructs hours worked, wages, and job commitment is therefore an important question about which there remains uncertainty. Methods: We improve on shortcomings of prior research through a monthly within-person analysis of a population at high-risk of both drug use and poor employment outcomes. We present multilevel models of the 18 months spent on the street preceding the arrest that led to incarceration in minimum/medium security facilities in Ohio from a random sample of 250 adult male inmates interviewed during the outset of a prison spell. Results: The analysis reveals consistently strong, negative effects of frequent drug use on employment, hours worked, and wages in the month following frequent drug use, including marijuana, cocaine, heroin, and prescription opioids. As well, frequent drug use (with the exception of marijuana) undermines job commitment during the months that participants are employed. Conclusions: The consequences of frequent drug use for future employment are consistently negative within this criminal justice sample. Results suggest that lower levels of drug use may improve the success of postrelease employment programs. In a context of increasing concern over rising opioid and heroin, but also cocaine and marijuana abuse, the findings suggest a renewed focus on and perhaps expansion of evidence-based drug treatment among populations embedded within the criminal justice system, particularly if employment constrains criminal behavior. [ABSTRACT FROM AUTHOR]

BACKGROUND: The pneumonia 30-d readmission rate has been endorsed by the National Quality Forum as a quality metric. Hospital readmissions can potentially be lowered by improving inhospital care, transitions of care, and post-discharge disease management programs. The purpose of this study was to create an accurate prediction model for determining the risk of 30-d readmission at the point of discharge. METHODS: The model was created using a data set of 1,295 hospitalizations at the Cleveland Clinic Main Campus with pneumonia over 3 y. Candidate variables were limited to structured variables available in the electronic health record. The final model was compared with the Centers for Medicare and Medicaid Services (CMS) model among subjects 65 y of age and older (n = 628) and was externally validated. RESULTS: Three hundred thirty subjects (25%) were readmitted within 30 d. The final model contained 13 variables and had a bias-corrected C statistic of 0.74 (95% CI 0.71- 0.77). Number of admissions in the prior 6 months, opioid prescription, serum albumin during the first 24 h, international normalized ratio and blood urea nitrogen during the last 24 h were the predictor variables with the greatest weight in the model. In terms of discriminative performance, the Cleveland Clinic model outperformed the CMS model on the validation cohort (C statistic 0.69 vs 0.60, P = .042). CONCLUSIONS: The proposed risk prediction model performed better than the CMS model. Accurate readmission risk prediction at the point of discharge is feasible and can potentially be used to focus post-acute care interventions in a high-risk group of patients. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective cohort study.Objective: To investigate the impact of prolonged opioid use in the preoperative treatment plan of degenerative lumbar stenosis (DLS).Summary Of Background Data: Patients undergoing operative treatment for DLS with concomitant opioid use represent a clinically challenging population. The relative paucity of data on the relationship between preoperative opioid use and clinical outcomes in the workers' compensation (WC) population necessitates further study of this unique population.Methods: We identified 140 Ohio WC patients who underwent lumbar decompression and had received preoperative opioid prescriptions between 1993 and 2013. Our study cohorts were formed based on opioid use duration, which included short-term use (<3 months) and long-term use (>3 months). Our primary outcome was if patients were able to make a stable return to work (RTW). A multivariate regression analysis was used to determine the impact of the duration of preoperative opioid use on return to work rates. We also compared many secondary outcomes after surgery between both groups.Results: Patients on opioids less than 3 months had a significantly higher RTW rate compared with those who used opioids longer than 3 months [25/60 (42%) vs. 18/80 (23%); P = 0.01]. A logistic regression was performed to examine the effect of preoperative opioid therapy duration on RTW status. Our regression model showed that opioid use greater than 3 months remained a significant negative predictor of RTW (OR: 0.35, 95% CI: 0.13-0.89; P = 0.02). Patients who remained on opioid therapy longer than 3 months cost the Ohio Bureau of Workers' Compensation $70,979 more than patients who were on opioid therapy for less than 3 months (P < 0.01).Conclusion: Prolonged preoperative opioid use was associated with poor clinical outcomes after lumbar decompression. These results suggest that a shorter course of opioid therapy and earlier surgical intervention may improve outcomes and lower postoperative morbidity in patients with DLS.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

Concerns about the ethical and social implications of genetics persist as more applications of genetic and genomic technology have become available. Pediatric testing for genetic influences on response to opioids like codeine is one area of application. We interviewed parents of children enrolled in a mixed-methods study following the communication of actual or hypothetical results forCYP2D6, which impacts opioid response. Forty-one parents of children naive to opioids and 42 parents of children previously exposed to opioids participated in qualitative interviews. Findings did not differ by the child’s opioid exposure or by actual versus hypothetical results. Parents’ responses centered on the experience of the parent(s) and the potential impact of that information on the parent, rather than the result’s impact on the child. Parents also emphasized that the results did not impact their perceptions of the child, reaffirming that the child was still “normal” regardless of test result. When asked about the impact of receiving secondary results, parents’ responses emphasized how the results would impact their ability to advocate for the child or impact their state of mind. While the answers reflect parents’ role as surrogate decision maker for their child, they also reinforced concerns that health care decisions might be influenced by secondary parental concerns as much as by the best interests of the child. Emphasis on the child’s “normality” challenges concerns about the impact of genetic essentialism, but further research is required to see whether the type of testing done or the way results were communicated shaped this response. [ABSTRACT FROM PUBLISHER]

Background: Little is known about the relationship between opioid prescribing practices and the prevalence of adolescent opioid misuse.Objective: To examine the relationships between both opioid prescriptions filled by adolescents and adults and adolescents seeking treatment for opioid misuse in Ohio.Methods: Analyses of large statewide databases from 2008 to 2012, including all 88 counties in Ohio. The Ohio Board of Pharmacy provided data regarding prescription opioids filled by adolescents (12-20 years, N = 50,030,820 doses) and adults (>20 years, N = 3,811,288,395 doses) by county of residence. The Ohio Department of Mental Health and Drug Addiction Services provided annual treatment admissions for adolescent opioid misuse by county of residence (N = 6446).Results: Adults filled prescriptions for nearly 100 oral opioid doses per capita annually, while adolescents filled prescriptions for approximately 7 oral opioid doses per capita annually. In Bayesian Poisson modeling examining the effect of annual adult per capita dose on adolescent treatment admissions, adjusted for annual adolescent per capita dose and year, an increase of one in the annual adult per capita opioid dose resulted in an increase of 1.3% (RR = 1.013, 95% HPD CI = [1.008, 1.017]) in the rate of adolescent treatment admissions. This association corresponds to a 99.99% chance that the adolescent treatment rate increases when the annual per capita adult dose is increased by one unit.Conclusion: The amount of opioids filled by adults in Ohio, although relatively stable from 2008 to 2012, is approximately 13 times that filled by adolescents and is significantly associated with adolescents seeking treatment for opioid misuse. Efforts to decrease adolescent opioid misuse should also focus on reducing adult opioid prescriptions. [ABSTRACT FROM AUTHOR]

Objective: To describe the strategies and policies implemented in Ohio to improve opioid safety and to discuss the role that pharmacists can play in implementing, promoting, and enhancing the effectiveness of these policies.Setting: Ohio has the fifth highest rate of drug overdose deaths (24.6 deaths per 100,000) in the United States. Unintentional drug overdose has become the leading cause of injury-related death in Ohio. In 2015, there were 3050 overdose deaths in Ohio, and in 2014 there were an estimated 12,847 overdose events reversed by emergency medical services with naloxone.Practice Description: Not applicable.Practice Policy Innovation: In 2011, the Governor's Cabinet Opiate Action Team was created to implement a multifaceted strategy, in part (1) to promote the responsible use of opioids, (2) to reduce the supply of opioids, and (3) to support overdose prevention and expand access to naloxone. Innovations to assist these goals include the development of Ohio guidelines on the responsible use of opioids, mandatory use of Ohio's prescription drug monitoring program, closing pill mills, promotion of drug take-back programs and increased access to naloxone and public health campaigns.Evaluation: Not applicable.Results: Since the development of the Governor's Cabinet Opiate Action Team, there were 81 million fewer doses of opioids dispensed to Ohio patients in 2015 compared with 782 million doses dispensed in 2011. As such, the proportion of unintentional drug overdose deaths involving prescription opioids has reduced from 45% in 2011 to 22% in 2015.Conclusion: Strong political support was crucial in Ohio to facilitate the rapid implementation opioid overdose prevention programs and the promotion of public awareness campaigns. However, the misuse and abuse of prescription opioids are complex problems requiring a comprehensive and multifaceted approach. Pharmacists are identified as a crucial component of the state strategy to addressing opioid abuse by promoting responsible prescribing and adopting prevention practices. [ABSTRACT FROM AUTHOR]

Objective To develop and implement an algorithm for the management of headaches presenting to the emergency department (ED) in order to decrease the frequency of opioid and barbiturate treatment both acutely as well as on discharge. Background Headache is the fifth leading cause of ED visits in the United States. In the case of primary headache, particularly migraine, treatment in the ED can be highly variable. Patients with migraine continue to be treated with opioids more commonly than nonopioid, migraine specific medications. In addition, discharge plans seldom include measures to prevent recurrence or instructions to re-treat if pain persists. At this time, there is no standardized management protocol directed at acute headaches presenting to the ED. Methods An ED headache treatment algorithm with step-wise instructions for diagnosis, treatment, and discharge planning was piloted at Lakewood Hospital, a regional Cleveland Clinic affiliated hospital. This non-randomized interventional study compared outcomes after implementation of the algorithm to historical controls. Patient demographic data including age, gender, and payer mix was collected. Outcomes measured included the frequency of treatment with opioids or barbiturates, imaging, neurology consults, admissions, and a patient reported pain score. Data relevant to patient disposition and follow-up, including prescriptions for opioids or barbiturates given at discharge, and ensuring PCP or neurology follow-up appointments at discharge was also reviewed. Results Demographic data did not differ significantly between the pre- and post-algorithm groups. There was a significant decline in the number of patients treated with opioids and barbiturates from 66.0% pre-algorithm to 6.8% immediately after algorithm implementation ( P <. 001), and to 28% ( P < .001) one year after algorithm implementation, indicating both an immediate effect of the algorithm and a sustained effect. Similarly, pre-algorithm implementation, 37% of patients were discharged with a prescription for opioids or barbiturates as compared to 12% and 6% in the early post-algorithm cohort and at 1 year, respectively. There was also an increase in scheduled follow-up appointments after discharge from the ED from 59% to 98% immediately post algorithm ( P < .001). Other measures including the frequency of imaging, and patient reported pain did not significantly change. There was a significant increase in neurology consults and admissions a year after the algorithm was implemented. Conclusions A quality improvement pilot study aimed at treating headache in an Emergency Department setting was successfully implemented in a regional Cleveland Clinic Hospital. Our results demonstrated significant decrease in acute treatment with opioids or barbiturates and a decrease in prescriptions written for opioids or barbiturates on discharge. This study is limited by small sample size. More data are needed to determine the reason for 1) increased consultation and subsequent admission after algorithm implementation and 2) decreased scheduled follow-up appointments at one-year post algorithm. [ABSTRACT FROM AUTHOR]

Opioid overdoses are taking the lives of young people, and it's creating unimaginable sorrow and tragedy among families. Prescription opioid manufacturers and distributors are being held accountable. There is a court in Cleveland, Ohio, that is aiming for a settlement from opioid manufacturers and distributors in cases that have been merged into one huge case. There are also attorneys general who have decided not to be part of such a settlement and now are pursuing their own cases against various named manufacturers and distributors. The litigation is complicated, but at its root, the concept is that the opioid crisis is the fault of the manufacturers and distributors. [ABSTRACT FROM AUTHOR]

Lumbar diskography (LD) is frequently used in the evaluation of patients with degenerative disk disease and diskogenic low back pain. Its safety and diagnostic accuracy are a topic of debate. No study has evaluated the efficacy of LD within the clinically distinct workers' compensation population. Within this setting, the authors wished to determine the effect of undergoing LD before diskogenic fusion on rates of postoperative failed back surgery syndrome (FBSS). Also, the authors compared opioid analgesic use between patients undergoing LD and patients not undergoing LD. ICD-9 diagnoses and CPT procedural codes were used to identify 1591 patients from the Ohio Bureau of Workers' Compensation who underwent diskogenic fusion between 1993 and 2013. A total of 682 patients underwent LD before fusion, which formed the LD group, with the remaining 909 patients as controls. The authors used a multivariate logistic regression analysis while correcting for relevant covariates. Diskography before fusion was a positive predictor of postoperative FBSS (P=.04; odds ratio, 1.44). The rate of FBSS was 13.9% of the LD group and 8.8% in the control group. Postoperatively, the LD group was supplied with a significantly higher daily opioid analgesic load (P=.04) for an average of 130 additional days (P<.01). Additional predictors of FBSS included the ability to remain at work within 1 week of index fusion (P=.02; odds ratio, 0.54), male sex (P=.03; odds ratio, 1.51), preoperative narcotic use for more than 1 year (P=.02; odds ratio, 1.53), and fusion technique (P=.03). Diskography should ideally help identify good candidates for lumbar fusion. However, the authors' study raises significant concerns regarding LD's current role within the workers' compensation population. [ABSTRACT FROM AUTHOR]

The article offers political news brief on topics including State Medical Board of Ohio voted to reject the petitions for autism spectrum disorder and opioid use disorder.

Background Intrathecal drug delivery ( IDD) system with implantable pumps has been used to treat cancer-related pain as well as noncancer-related chronic pain. Opioids, including morphine and hydromorphone, are the most commonly used intrathecal ( IT) agents. Although technology, techniques, and knowledge of IDD have improved, dose escalation occurs relatively rapidly in noncancer pain. Methods Retrospective chart review of IDD pump patients, implanted for a minimum of 2 years, was designed to investigate possible existing predictors that might impact IDD dose escalation, such as patient's demographic risk factors, duration of the treatment, and diagnosis of the patient's pain correlates with increase in medication requirement. Primary outcome was defined as the annual percent escalation in daily opioid dosage, and secondary outcome was the average annual percent reduction in VRS pain scores. Results Median dosage escalation was 17% per year for patients with neuropathic pain compared with 12% per year for patients with other pain modalities. Mean opioid dosage increased 30.4% more rapidly for patients with neuropathic pain than for other pain modalities. The adjusted difference in means was 28.8% ( P = 0.001). None of the secondary exposures were statistically significant after the Bonferroni adjustment. No association was found between pain modality and annual percent change in VRS pain score. Conclusion Annual increases in daily opioid dosage were higher among patients with neuropathic pain than among patients with other modalities; we also found no evidence of difference in annual pain reduction. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of the current analysis was to examine the factors associated with prescription opiate misuse among stimulant users from rural counties in Arkansas, Kentucky, and Ohio (N = 714). Methods: Multiple logistic regression was utilized to determine the independent correlates of recent (prior 6 months) prescription opiate misuse. Results: More than half of participants (53.2%) reported prescription opiate misuse in the previous 6 months. Other drug use (heroin, cocaine, methamphetamine, and marijuana) and anxiety (Adjusted Odds Ratio: 2.04, 95% Confidence Interval: 1.60, 2.59) were independently associated with prescription opiate misuse. Chronic pain and other health indicators were not associated with prescription opiate misuse after adjustment for covariates. Conclusions: Results indicate that illicit drug involvement and psychiatric symptoms may be driving the high rates of prescription opiate misuse among rural stimulant users. These findings have implications for the provision of treatment in resource-deprived rural areas. [ABSTRACT FROM AUTHOR]

Aims Although crack cocaine first appeared in cities in the United States in the mid-1980s, little is known about its use over long periods of time. This study identified crack cocaine user groups on the basis of long-term trajectories. Design Following a natural history approach, data were collected periodically from 1996 to 2005. Group-based modeling assessed the probability of a crack smoker becoming abstinent during the observation period. Setting A targeted sampling plan guided the recruitment of a community sample of crack cocaine users in Dayton, Ohio. Participants Crack smokers ( n = 430) 18 years or older whose urine tested positive for cocaine metabolites at the baseline interview. Measurements Interviewer-administered and audio computer self-administered, structured questionnaires were used to collect data on a range of variables, including frequency of crack use. Abstinence was defined as not having used crack for at least 6 consecutive months during the study. Findings Three trajectory-based groups were identified: (1) No Change, characterized by a very low probability of abstinence; (2) Some Change, characterized by a low to moderate probability of abstinence; and (3) Dramatic Change, characterized by a high probability of abstinence. African Americans and men were significantly less likely to become abstinent. For the majority of the people (63.6%), crack use was uninterrupted by extended periods of abstinence during the study. Conclusion Crack cocaine use that persists for a decade or longer may well be the norm for a large proportion of people who have experience with the drug. [ABSTRACT FROM AUTHOR]

Although there has been much research on the social context of heroin injection, little has been reported outside of major urban areas. This article examines contextual factors associated with initiation to heroin injection in rural Ohio, based on semistructured qualitative interviews and focus groups involving 25 recent heroin injectors (12 women, 13 men) recruited from three contiguous counties between June 2002 and February 2004. Curiosity about the drug's effects, the growing pressures of drug dependence and economic need, and the influence of intimate and group relations were all identified as factors that offset fears commonly associated with injection. This study complements other research on the social ecology of heroin injection and may contribute to improved services for injection drug users in rural areas and small communities. [ABSTRACT FROM AUTHOR]