Concurrent prescribing of opioids with other sedating medications after cancer diagnosis: a population-level analysis

Purpose: Cancer is a major reason for concurrent prescription of opioids with other sedating medications—particularly benzodiazepines and gabapentinoids—yet population-based assessments of the extent and predictors of concurrent prescribing among clinically and demographically diverse patients with cancer are lacking. Methods: We conducted a retrospective cohort study of patients with non-metastatic cancer using North Carolina cancer registry data linked with Medicare and private insurance claims (2013–2016). We used modified Poisson regression to assess associations of patient characteristic with adjusted relative risk (aRR) of new concurrent prescribing of opioids with benzodiazepines or gabapentinoids after diagnosis. Results: Overall, 15% of patients were concurrently prescribed opioids with benzodiazepines or gabapentinoids. Characteristics independently associated with an increased risk of concurrent prescribing included cancer type (e.g., aRR cervical vs. colorectal cancer: 1.55, 95% CI: 1.12–2.14); prior use of opioids (aRR: 2.43, 95% CI:2.21–2.67), benzodiazepines (aRR: 4.08, 95% CI: 3.72–4.48), or gabapentinoids (3.82, 95% CI: 3.31–4.39), and premorbid mental health conditions, including substance use disorder (aRR: 1.27, 95% CI: 1.05–1.54). Black and Hispanic patients were less likely to experience concurrent prescribing (aRR, Black vs. White: 0.35, 95% CI: 0.15–0.83; aRR, Hispanic vs. White: 0.75, 95% CI: 0.66–0.85). Conclusion: Approximately 1 in 7 patients with cancer was concurrently prescribed opioids with other sedating medications. Associations between patient characteristics and risk of concurrent prescribing highlight predictors of concurrent prescribing and suggest a rationale for systematic assessment of substance use history at diagnosis. Future research could explore inequitable pain and symptom management and investigate risk of adverse medication-related events

Evolution of cosmic star formation in the SCUBA-2 Cosmology Legacy Survey

We present a new exploration of the cosmic star formation history and dust obscuration in massive galaxies at redshifts 0.5 1010M⊙ galaxies at 0.5 10. One third of this is accounted for by 450-μm-detected sources, while one-fifth is attributed to UV-luminous sources (brighter than L∗UV), although even these are largely obscured. By extrapolating our results to include all stellar masses, we estimate a total SFRD that is in good agreement with previous results from IR and UV data at z ≲ 3, and from UV-only data at z ∼ 5. The cosmic star formation history undergoes a transition at z ∼ 3–4, as predominantly unobscured growth in the early Universe is overtaken by obscured star formation, driven by the build-up of the most massive galaxies during the peak of cosmic assembly

Prevalence and impact of comorbid chronic pain and cigarette smoking among people living with HIV

Rates of chronic pain and cigarette smoking are each substantially higher among people living with HIV (PLWH) than in the general population. The goal of these analyses was to examine the prevalence and impact of comorbid chronic pain and cigarette smoking among PLWH. Participants included 3289 PLWH (83% male) who were recruited from five HIV clinics. As expected, the prevalence of smoking was higher among PLWH with chronic pain (41.9%), than PLWH without chronic pain (26.6%, p <.0001), and the prevalence of chronic pain was higher among current smokers (32.9%), than among former (23.6%) or never (17%) smokers (ps <.0001). PLWH who endorsed comorbid chronic pain and smoking (vs. nonsmokers without chronic pain) were more likely to report cocaine/crack and cannabis use, be prescribed long-term opioid therapy, and have virologic failure, even after controlling for relevant sociodemographic and substance-related variables (ps <.05). These results contribute to a growing empirical literature indicating that chronic pain and cigarette smoking frequently co-occur, and extend this work to a large sample of PLWH. Indeed, PLWH may benefit from interventions that are tailored to address bidirectional pain-smoking effects in the context of HIV

Marijuana Use Is Not Associated with Changes in Opioid Prescriptions or Pain Severity among People Living with HIV and Chronic Pain

Background:People living with HIV (PLWH) commonly report marijuana use for chronic pain, although there is limited empirical evidence to support its use. There is hope that marijuana may reduce prescription opioid use. Our objective was to investigate whether marijuana use among PLWH who have chronic pain is associated with changes in pain severity and prescribed opioid use (prescribed opioid initiation and discontinuation).Methods:Participants completed self-report measures of chronic pain and marijuana use at an index visit and were followed up for 1 year in the Center for AIDS Research Network of Integrated Clinical Systems (CNICS). Self-reported marijuana use was the exposure variable. Outcome variables were changes in pain and initiation or discontinuation of opioids during the study period. The relationship between exposure and outcomes was assessed using generalized linear models for pain and multivariable binary logistic regression models for opioid initiation/discontinuation.Results:Of 433 PLWH and chronic pain, 28% reported marijuana use in the past 3 months. Median pain severity at the index visit was 6.3/10 (interquartile range 4.7-8.0). Neither increases nor decreases in marijuana use were associated with changes in pain severity, and marijuana use was not associated with either lower odds of opioid initiation or higher odds of opioid discontinuation.Conclusions:We did not find evidence that marijuana use in PLWH is associated with improved pain outcomes or reduced opioid prescribing. This suggests that caution is warranted when counseling PLWH about potential benefits of recreational or medical marijuana

Brief report: The association of chronic pain and long-term opioid therapy with HIV treatment outcomes

Background: Chronic pain occurs in up to 85% of persons living with HIV and is commonly treated with long-term opioid therapy (LTOT). We investigated the impact of chronic pain and LTOT on HIV outcomes. Methods: This was prospective cohort study conducted between July 2015 and July 2016 in 5 HIV primary care clinics. Chronic pain was defined as ≥moderate pain for ≥3 months on the Brief Chronic Pain Questionnaire. Chronic pain and LTOT were assessed at an index visit. Suboptimal retention, defined as at least one "no-show" to primary care, and virologic failure were measured over the subsequent year. Multivariable logistic regression models were built for each outcome adjusting for site. Results: Among 2334 participants, 25% had chronic pain, 27% had suboptimal retention, 12% had virologic failure, and 19% were prescribed LTOT. Among individuals not on LTOT, chronic pain was associated with increased odds of suboptimal retention [adjusted odds ratio (aOR) 1.46, 95% confidence interval (CI): 1.10 to 1.93, P = 0.009] and virologic failure (aOR 1.97, 95% CI: 1.39 to 2.80, P < 0.001). Among individuals with chronic pain, there was no association between LTOT and retention, but LTOT was associated with lower rates of virologic failure (aOR 0.56, 95% CI: 0.33 to 0.96, P = 0.03). Conclusions: Chronic pain in participants not on LTOT was associated with virologic failure. This reinforces the need to identify effective chronic pain treatments for persons living with HIV and investigate their impact on HIV outcomes. The apparent protective association between LTOT and virologic failure in those with pain merits further exploration

Erratum: Evolution of cosmic star formation in the SCUBA-2 Cosmology Legacy Survey

Large scale structure and cosmolog

Measurements of differential production cross sections for a Z boson in association with jets in pp collisions at root s=8 TeV

Peer reviewe

Search for third-generation scalar leptoquarks in the tτ channel in proton-proton collisions at √s=8 TeV

A search for pair production of third-generation scalar leptoquarks decaying to top quark and τ lepton pairs is presented using proton-proton collision data at a center-of-mass energy of s = 8 s√=8 TeV collected with the CMS detector at the LHC and corresponding to an integrated luminosity of 19.7 fb −1 . The search is performed using events that contain an electron or a muon, a hadronically decaying τ lepton, and two or more jets. The observations are found to be consistent with the standard model predictions. Assuming that all leptoquarks decay to a top quark and a τ lepton, the existence of pair produced, charge −1 / 3, third-generation leptoquarks up to a mass of 685 GeV is excluded at 95% confidence level. This result constitutes the first direct limit for leptoquarks decaying into a top quark and a τ lepton, and may also be applied directly to the pair production of bottom squarks decaying predominantly via the R-parity violating coupling λ 333 ′

Forward-backward asymmetry of Drell-Yan lepton pairs in pp collisions at root s=8 TeV

Peer reviewe

Search for single production of scalar leptoquarks in proton-proton collisions at root s=8 TeV

Correction DOI:10.1103/PhysRevD.95.039906Peer reviewe