Trends in long-term prescribing of dependence forming medicines

Using patient-level primary care data to estimate the extent to which antidepressant medicines are prescribed to people continuously for long periods of time. Aim This descriptive research used patient-level primary care data to estimate the extent to which antidepressant medicines are prescribed to people continuously for long periods of time. The study also drew on survey data and data on the number of prescriptions dispensed. Findings - The number of antidepressant prescriptions dispensed each year in England doubled between 2008 and 2018 - Survey data show that the proportion of adults reporting use of antidepressants in the past year increased in the 1990s, and again between 2007 and 2014 - The average length of time that antidepressants are continuously prescribed to people for has increased over time. - Some types of antidepressants (for example, tricyclics and other antidepressants) tend to be prescribed for longer periods than other types (such as SSRIs). - In 2014, one in twelve prescribing periods for tricyclics and other antidepressants lasted for three years or more Methods The analyses in this report are descriptive and show the overall prevalence of long-term prescribing in each year. We used a sample of around 50,000 patients prescribed at least one antidepressant medicine between 2000 and 2017. This was drawn from the Clinical Practice Research Datalink (CPRD). The CPRD contains data about prescriptions issued by GPs (including the length and size of prescription) and characteristics of the patients prescribed to (such as their age, sex, and area where they live). Medicines were grouped for analysis into: tricyclics, selective serotonin reuptake inhibitors (SSRIs), and other ADMs. The length of individual prescriptions and continuous prescribing periods were derived using information on consultation dates, the quantity of tablets prescribed, and the numeric daily dose

Systematic Literature Search for MSCR Thesis: Intrathecal Pain Pumps for the Treatment of Neuropathic Pain

This search strategy sought to construct an evidence-based position on the use of intrathecal pumps. We identified literature pertaining to the safety and efficacy of intrathecal pumps for the treatment of neuropathic pain. Articles obtained using this search strategy provided the background information for our thesis manuscript, which sought to determine if delivering opioids via the secure, non-tamperable intrathecal pain pump, in combination with other synergistic medications, would show improved pain scores and reduced side effects in patients with chronic neuropathic pain

Prevalence, Incremental Cost and Resource Utilization Associated with Opioid Overdoses

Background – An increase in opioid prescribing has led to an increase in opioid overdoses.1,2 No study has estimated the incremental costs subsequent to an opioid overdose event in prescription opioid users, or the prevalence and costs of overdose events in family members of prescription opioid users and in overdose victims with no identifiable source of prescription opioid. The latter group will be referred to as “others”. Objectives – The first objective of this study was to estimate the prevalence of opioid overdoses in aforementioned groups. The second objective was to estimate the incremental costs and resource utilization associated with opioid overdoses in these groups. Methods – This study is a retrospective analysis using claims data from SelectHealth, a not-for-profit health insurance organization in Utah and southern Idaho. We estimated the prevalence of opioid overdoses in the sample population, as well as in each group, by year. For the cost estimation we collapsed family members and others into one category – “non-medical users”. To estimate costs we used an incremental cost approach whereby we used propensity scores to match cases (patients who suffered from an opioid overdose) to appropriate controls (patients who did not suffer from an opioid overdose) and estimated the direct medical costs incurred in each group in the year following an overdose. Generalized Linear Models were used to estimate incremental costs and resource utilization. Sensitivity analyses were conducted to measure the robustness of the estimates. Results – The prevalence of opioid overdoses increased by 84.8% in prescription opioid users (from 55.6 per 100,000 in 2011 to 102.8 per 100,000 in 2014), increased by 37.9% in family members of prescription opioid users (from 5.9 per 100,000 in 2011 to 8.2 per 100,000 in 2014) and increased by 179.9% in others (from 8.2 per 100,000 in 2011 to 23.1 per 100,000 in 2014). The prevalence of opioid overdoses in acute users increased by 14.7% (from 43.8 per 100,000 in 2011 to 50.3 per 100,000 in 2014) as compared to 165.9% in chronic users (from 187.0 per 100,000 in 2011 to 497.3 per 100,000 in 2014). The incremental direct medical costs per patient per year were estimated to be $65,277 (p-value\u3c0.05) in prescription opioid users who suffered from an overdose and$41,102 (p-value\u3c0.05) in non-medical users who suffered from an overdose. Overdose-specific costs were estimated to be $12,111 for prescription opioid users and$11,070 in non-users. Conclusions – Our study found that the prevalence of opioid overdoses increased steadily from 2011 to 2014 in the sample population. The prevalence of overdoses was much higher in chronic opioid users as compared to acute users. Differences between overdose-specific costs and total incremental costs may suggest that overdoses are associated with substantial costs in addition to costs for the initial treatment of the overdose. While the cost to payers due to overdoses in prescription opioid users is substantial, payers also incur costs from diversion of opioids

The Society for Pediatric Anesthesia recommendations for the use of opioids in children during the perioperative period

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149726/1/pan13639_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149726/2/pan13639.pd

Is the injection of tramadol effective at control of pain after impacted mandibular third molar extractions? A systematic review and meta-analysis

Third molar extraction is among the most common surgical procedures performed by oral-maxillofacial surgeons. Postoperative pain, swelling and trismus are common, especially in wisdom teeth, due to trauma to local tissues and the duration of the surgical procedure, among other factors. This systematic review was conducted in accordance with the ?Preferred Reporting Items for Systematic Reviews and Meta-Analyses? in order to answer the focused question: ?Is the local submucosal injection of tramadol effective at the control of postoperative pain in patients submitted to impacted mandibular third molar extractions??. We analyzed papers published until March 30, 2021 in the MEDLINE|PubMed, Web of Science and Cochrane Library databases. Gray literature was also consulted. Standard pairwise meta-analyses of direct comparisons were performed using a fixed-effect model; I2 ? 50 % or ? 75 % indicated moderate or high heterogeneity, respectively. Risk of bias was assessed by Cochrane Collaboration?s tool. In total, 172 participants (98 males and 74 females, aged 18 or over) from three randomized placebo-controlled trials were considered for analysis. The submucosal injection of 2 ml of tramadol adjacent to the impacted mandibular third molar was effective in controlling pain up to 6-hours after surgery, in increasing the onset of consumption of rescue analgesic and in reducing the total number of rescue analgesics used. The submucosal injection of tramadol can be considered a safe and effective procedure for pain control after impacted mandibular third molar extractions

Drugs that lower the seizure threshold

Drugs with potential to lower the seizure threshold are numerous and diverse. Whether they contribute to clinically overt seizures depends on the dosage in which they are taken, the time-course of their effects and the susceptibility of the patient. Crucially, however, their contribution to seizure risk is potentially modifiable

State Benchmark Plan Coverage of Opioid Use Disorder Treatments and Services: Trends and Limitations

Professor Tovino offers a survey of state benchmark plan coverage of opioid use disorder treatments and services, and identifies trends and limitations relevant thereto. Part II of the article provides background information regarding opioid use disorder and the treatments and services available for individuals with this disorder. Part III reviews federal mental health parity law and federal mandatory mental health and substance use disorder law as applied to insurance coverage of treatments and services for opioid use disorder, with a focus on the Affordable Care Act\u27s (ACA\u27s) state benchmark health plan selection requirement and the effect on that requirement of a recent federal district court opinion striking down the ACA. Appendix A documents state benchmark plan limitations potentially applicable to individuals with opioid use disorder, and Part IV analyzes these trends. A conclusion clarifies how the invalidation of the entire ACA could affect insurance coverage of opioid use disorder treatments and services going forward

A REVIEW STUDY ON TRAMADOL ABUSE AMONG EGYPTIAN UNIVERSITY STUDENTS

Tramadol, which is a medication used for moderate and severe pains, has caused drug abuse and addiction to the Egyptian community. This study aimed to observe the prevalence of tramadol abuse among Egyptian university students. By following the PRISMA reporting guideline, a systematic review of evidence was conducted. Search strategy was conducted through PubMed-NCBI to yield appropriate published literature between 2014-2019, as well as performed literature screening, eligibility criteria, and data extraction. The process of selection yielded a total number of 2 studies to be eligible for the review inclusion criteria. The characteristics evaluated that correlate to tramadol were classified into four groups: gender, smoking, alcohol consumption, and failure in exams before. In general, tramadol showed positively associated with other prevalence characteristics. Tramadol is the second most commonly abused drug among university students in Egypt. The review highlights that tramadol abuse has become a common phenomenon among Egyptian university students which necessitates for ample attention. Future research is recommended to identify the causal effects of tramadol abuse and its role as a potential gateway drug.                          Peer Review History: Received 2 January 2020;   Revised 22 February; Accepted 1 March, Available online 15 March 2020 Academic Editor: Dr. Amany Mohamed Alboghdadly, Princess Nourah bint abdulrahman university, Riyadh, [email protected] UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency. Received file:                Reviewer's Comments: Average Peer review marks at initial stage: 5.5/10 Average Peer review marks at publication stage: 7.0/10 Reviewer(s) detail: Hebatallaha A  Moustafa, Ain Shams University, Egypt, [email protected] Prof. Dr. Hassan A.H. Al-Shamahy, Sana'a University, Yemen, [email protected] Dr. Ali Abdullah Al-yahawi, Al-Razi university, Department of Pharmacy, Yemen, [email protected] Similar Articles: A CROSS-SECTIONAL STUDY ON BENZODIAZIPINE (BZD) ABUSERS OF DHAKA CITY: A SOCIO-PSYCHOLOGICAL CONDITION OF BANGLADESH AWARENESS AMONGST YOUTH ABOUT USE AND ABUSE OF STEROIDS IN KARACHI, PAKISTAN ALCOHOL INFLUENCES AGGRESSIVE BEHAVIOUR THAT INCREASES LIKELIHOOD OF INITIATING DATING VIOLENCE AMONG MALE YOUTH IN COLLEGES WITHIN WESTERN COUNTRIES: A SCOPING REVIE

Propofol-alfentanil vs propofol-remifentanil for posterior spinal fusion including wake-up test

Background. Wake-up test can be used during posterior spinal fusion (PSF) to ensure that spinal function remains intact. This study aims at assessing the characteristics of the wake-up test during propofol-alfentanil (PA) vs propofol-remifentanil (PR) infusions for PSF surgery. Methods. Sixty patients with scoliosis and candidates for PSF surgery were randomly allocated in either alfentanil (PA) or remifentanil (PR) group. After an i.v. bolus of alfentanil 30 μg kg-1 in the PA group or remifentanil 1 μg kg-1 in the PR group, anaesthesia was induced with thiopental and atracurium. During maintenance, opioid infusion consisted of alfentanil 1 μg kg-1 min-1 or remifentanil 0.2 μg kg-1 min-1, in the PA group and the PR group, respectively. All patients received propofol 50 μg kg-1 min-1. Atracurium was given to maintain the required surgical relaxation. At the surgeon's request, all infusions were discontinued. Patients were asked to move their hands and feet. Time from anaesthetic discontinuation to spontaneous ventilation (T1), and from then until movement of the hands and feet (T2), and its quality were recorded. Results. The average T1 and T2 were significantly shorter in the PR group 3.6 (2.5) and 4.1 (2) min than the PA group 6.1 (4) and 7.5 (4.5) min. Quality of wake-up test, however, did not show significant difference between the two groups studied. Conclusion. Wake-up test can be conducted faster with remifentanil compared with alfentanil infusion during PSF surgery. © 2006 Oxford University Press