The role of prescribed controlled substance acquisition as potential triggers of opioid overdose: A case-crossover study.

Background: The role of prescribed opioids and benzodiazepines as risk factors for opioid overdose are well established, however, their role as potential 'triggers' of opioid overdose has not been formally investigated.

Objective: The objective of this study was to evaluate the temporal relationship between controlled substance acquisition and opioid overdose utilizing a case-crossover design.

Methods: This study utilized Arkansas statewide data between 2014 and 2020.

A Statewide Examination of Medical Cannabis Purchasing Patterns in Arkansas Over the Three Years Immediately Following Legalization.

The use of medical cannabis (MC) to treat a host of conditions has expanded considerably in the United States; however, precise quantitative assessments of purchasing characteristics are unknown. This study sought to characterize the trends in MC purchases, US dollars spent, and type and amount purchased by demographic and clinical characteristics. This descriptive exploratory association study examined statewide MC registry data in Arkansas linked at the person level with statewide transaction data documenting each MC purchase.

Immune checkpoint inhibitors as subsequent treatment in older adults with non-small cell lung cancer and synchronous brain metastases.

Background: Immune checkpoint inhibitors (ICIs) have become the mainstay treatment for non-small cell lung cancer (NSCLC). However, there is a lack of studies assessing ICIs as subsequent treatment in older adults with NSCLC and brain metastasis (BM). This retrospective cohort study compared the real-world survival of older patients with NSCLC and BM at diagnosis [synchronous BM (SBM)] previously treated with chemotherapy receiving ICI versus chemotherapy as subsequent treatment.

Razor clam (Pinna bicolor) structural mimics as drivers of epibenthic biodiversity; a manipulative experiment.

Shellfish ecosystems facilitate important ecological functions and communities, but overexploitation and mismanagement have contributed to their decline worldwide. Within recent decades, coastal management efforts have increasingly sought to understand and reinstate valuable ecological functions provided by habitat-forming bivalves including oysters, mussels and pinnids. However, many bivalve species are critically understudied, limiting restoration and ecological engineering opportunities.

Average Daily Dose Trajectories for Episodes of Buprenorphine Treatment for Opioid Use Disorder.

Background: High-dose (≥24 mg) buprenorphine daily doses (BDD) may be important in treating patients with opioid use disorder (OUD) to improve retention and prevent overdose, particularly in the context of increased illicit fentanyl use. This study sought to: (1) identify trajectories for average BDD among patients initiating buprenorphine treatment for OUD and (2) assess patient characteristics associated with these identified trajectories.

Methods: Buprenorphine treatment episodes among patients in the US Veterans Healthcare Administration (VHA) from federal fiscal years 2006 to 2020 were identified.

Are gaps in rates of retention on buprenorphine for treatment of opioid use disorder closing among veterans across different races and ethnicities? A retrospective cohort study.

Introduction: The U.S. Veterans Health Administration has undertaken several initiatives to improve veterans' access to and retention on buprenorphine because it prevents overdose and reduces drug-related morbidity.

Development and validation of machine-learning algorithms predicting retention, overdoses, and all-cause mortality among US military veterans treated with buprenorphine for opioid use disorder.

Background: Buprenorphine for opioid use disorder (B-MOUD) is essential to improving patient outcomes; however, retention is essential.

Objective: To develop and validate machine-learning algorithms predicting retention, overdoses, and all-cause mortality among US military veterans initiating B-MOUD.

Methods: Veterans initiating B-MOUD from fiscal years 2006-2020 were identified.

Surveillance and Security in US Medicine and Equipment Supply Chains.

The COVID-19 pandemic exposed vulnerabilities of the United States' routine and emergency supply chains of medicines and critical equipment. These vulnerabilities underscore an urgent need to prevent routine and emergency shortages by making drug manufacturing more transparent and by tracking how key supplies get to end users. Near real-time surveillance systems must be developed to monitor fluctuations in supplies of medicines and equipment.

Opioid therapy trajectories of patients with chronic non-cancer pain over 1 year of follow-up after initiation of short-acting opioid formulations.

Objective: This study compared opioid utilization trajectories of persons initiating tramadol, short-acting hydrocodone, or short-acting oxycodone, and it characterized opioid dose trajectories and type of opioid in persistent opioid therapy subsamples.

Methods: A retrospective cohort study of adults with chronic non-cancer pain who were initiating opioid therapy was conducted with the IQVIA PharMetrics® Plus for Academics data (2008-2018). Continuous enrollment was required for 6 months before ("baseline") and 12 months after ("follow-up") the first opioid prescription ("index date").

The association between suspected long-COVID and stimulant prescribing in the United States.

Objectives: This study sought to determine the association between suspected long-COVID and receipt of a stimulant prescription among persons diagnosed with COVID-19 and to describe clinical and demographic factors associated with receiving a stimulant prescription.

Methods: US patients 18 and older who had a COVID-19 diagnosis or a positive COVID-19 PCR test from April 1st, 2020 through December 21st, 2022 recorded in a national electronic health record data set obtained from TriNetX were assessed. Comparison subjects were propensity score matched on baseline covariates to those with a symptom of or diagnosis of long-COVID.

Clinical Observation, Management and Function Of low back pain Relief Therapies (COMFORT): A cluster randomised controlled trial protocol.

Introduction: Low back pain (LBP) is commonly treated with opioid analgesics despite evidence that these medicines provide minimal or no benefit for LBP and have an established profile of harms. International guidelines discourage or urge caution with the use of opioids for back pain; however, doctors and patients lack practical strategies to help them implement the guidelines. This trial will evaluate a multifaceted intervention to support general practitioners (GPs) and their patients with LBP implement the recommendations in the latest opioid prescribing guidelines.

Real-World Survival of First-Line Immune Checkpoint Inhibitor Treatment Versus Chemotherapy in Older Patients With Non-Small-Cell Lung Cancer and Synchronous Brain Metastases.

Purpose: This study assessed real-world survival among older patients with non-small-cell lung cancer (NSCLC) and brain metastases (BMs) at diagnosis (synchronous BM [SBM]) receiving first-line immune checkpoint inhibitors (ICIs) compared with chemotherapy only.

Methods: Patients with NSCLC and SBM age 65 years or older at diagnosis from 2010 to 2019 SEER-Medicare database and received US Food and Drug Administration-approved ICIs (pembrolizumab/nivolumab/ipilimumab/atezolizumab/durvalumab/cemiplimab) and/or chemotherapy (platinum-based doublets/taxane/pemetrexed/gemcitabine) as first-line systemic treatment were included, excluding those with no cranial radiation or ever being treated with targeted therapies. Overall survival time was from the start of systemic treatment (ICI/chemotherapy) to death, censored at disenrollment from Medicare part A/B, enrollment in part C, or end of the study period (December 31, 2019).

Adherence to Extended Venous Thromboembolism Prophylaxis and Outcomes After Complex Gastrointestinal Oncologic Surgery.

Background: Clinical guidelines recommend extended venous thromboembolism (VTE) prophylaxis for cancer patients after major gastrointestinal (GI) operations. However, adherence to the guidelines has been low, and the clinical outcomes not well defined.

Methods: This study retrospectively analyzed a random 10 % sample of the 2009-2022 IQVIA LifeLink PharMetrics Plus database, an administrative claims database representative of the commercially insured population of the United States.

Factors Associated With Guideline-Concordant Pharmacological Treatment for Neuropathic Pain Among Breast Cancer Survivors.

Purpose: To identify factors associated with receiving guideline-concordant treatment among breast cancer survivors with neuropathic pain.

Materials And Methods: A retrospective case-control study was conducted using the SEER-Medicare linked database. We included female breast cancer survivors diagnosed with non-metastatic breast cancer (stages 0-III) between 2007 and 2015 who developed treatment-related neuropathic pain during their survivorship period.

The use of gabapentinoids and opioids and risk of developing opioid-induced respiratory depression among older breast cancer survivors with neuropathic pain.

Purpose: To estimate the combined effect of gabapentinoid and opioid therapy compared to opioid monotherapy on the risk of developing opioid-induced respiratory depression among breast cancer survivors with neuropathic pain.

Method: A nested case-control study of Medicare female breast cancer survivors with neuropathic pain receiving both opioids and gabapentinoids, opioid monotherapy, gabapentinoid monotherapy, and none of these drugs was conducted using SEER-Medicare between 2007 and 2015. Cases were survivors with respiratory depression and were matched with controls on the event date (± 1 year), age at diagnosis (± 5 years), and stage at diagnosis.

Comparative Study of Opioid Initiation With Tramadol, Short-acting Hydrocodone, or Short-acting Oxycodone on Opioid-related Adverse Outcomes Among Chronic Noncancer Pain Patients.

Objective: To compare the safety profiles of low and high-dose tramadol, short-acting hydrocodone, and short-acting oxycodone therapies among chronic noncancer pain individuals.

Materials And Methods: A retrospective cohort study of individuals with back/neck pain/osteoarthritis with an initial opioid prescription for tramadol, hydrocodone, or oxycodone was conducted using IQVIA PharMetrics Plus claims for Academics database (2006 to 2020). Two cohorts were created for separately studying opioid-related adverse events (overdoses, accidents, self-inflicted injuries, and violence-related injuries) and substance use disorders (opioid and nonopioid).

Evaluating the temporal association between the recency of prescribed controlled substance acquisition and fatal and non-fatal opioid overdose.

Background: Previous studies have explored psychosocial effects as possible triggers of opioid overdose (OOD). However, little is known about the temporal association between OOD and prescribed controlled substance (CS) acquisition.

Objective: The objective of this study was to evaluate the temporal relationship between OOD and acquiring prescribed CSs prior to OOD.

Concordance of opioid exposure in all-payer claims databases with prescription drug monitoring program database using Arkansas as a case example.

Objective: To assess the concordance between and benefit of adding prescription drug monitoring program (PDMP) data to all-payer claims database (APCD) data for identifying and classifying opioid exposure among insured individuals.

Data Sources And Study Setting: Arkansas APCD and PDMP.

Study Design: Enrollees in APCD were classified as (1) true positives: if they received opioids in both databases, (2) false positives: if they only received opioids in APCD, (3) true negatives: if they had no opioid exposure in both databases, (4) false negatives: if they only received opioids in the PDMP database.

Healthcare costs and utilization associated with pain among breast cancer survivors: a propensity score matched cohort study using SEER-Medicare data.

Purpose: To assess healthcare costs and utilization of treatment-related pain among breast cancer survivors.

Methods: A retrospective matched cohort study using Surveillance Epidemiology and End Results SEER-Medicare linked data was conducted. The study population included older breast cancer survivors continuously enrolled in Medicare parts A, B, and D in the baseline and 1-year follow-up periods.

Age Modifies Intracranial and Gastrointestinal Bleeding Risk from P2Y Inhibitors in Patients Receiving Dialysis.

Background: Individuals aged ≥75 years are the fastest-growing population starting dialysis for end-stage kidney disease (ESKD) due to living longer with coronary artery disease. ESKD alone can increase bleeding risk, but P2Y inhibitor (P2Y12-I) antiplatelet medications prescribed for cardiovascular treatment can exacerbate this risk in patients with ESKD. The age-specific rates of bleeding complications in dialysis patients with ESKD on P2Y12-I remain unclear, as does how age modifies the bleeding risk from P2Y12-I use in these patients.

Development of a potential opioid misuse measure from administrative dispensing data and contrasting opioid misuse among individuals on long-term tramadol, long-term short-acting hydrocodone or long-term short-acting oxycodone therapy in Arkansas.

Objective: This study sought to: (1) construct and validate a composite potential opioid misuse score; and (2) compare potential opioid misuse among individuals prescribed long-term therapy on tramadol, short-acting hydrocodone or short-acting oxycodone.

Methods: A retrospective cohort study was conducted using Arkansas All-Payer Claims Database (APCD; 2013-2018) linked to Arkansas Prescription Drug Monitoring Program (PDMP; 2014-2017) and state death certificate data (2013-2018). The study subjects were ambulatory, cancer-free adults with incident long-term therapy on tramadol, short-acting hydrocodone or short-acting oxycodone.

Development of a low-cost semi-automated robotic orthophosphate system for batch analysis.

Monitoring the level of nutrients in soil and their availability for crops can be time-consuming or require expensive instrumentation. This work describes a low-cost (<€500) portable, semi-automated colourimetric orthophosphate (PO) analyser supplemented with 3D printed parts. Colour development was based on the phosphomolybdenum blue formation coupled with spectrophotometric detection using a low-cost LED-photodiode assembly.

Three generations of a family diagnosed with congenital central hypoventilation syndrome: A case series.

Congenital central hypoventilation syndrome (CCHS) is an autosomal dominant disorder characterized by alveolar hypoventilation and autonomic dysregulation secondary to mutations of the genes. We present five cases from three generations within the same family with varying degrees of phenotypic expression of the gene mutation. The cases were diagnosed following identification of CCHS in index case at birth.