Prescription size predicts persistent opioid use after cardiothoracic surgery

Prescription size is associated with increased new persistent opioid use among patients after cardiothoracic surgery, according to a study published online Aug. 22 in the Annals of Thoracic Surgery.

Alexander A. Brescia, M.D., from the University of Michigan in Ann Arbor, and colleagues identified opioid-naive Medicare patients undergoing cardiothoracic surgery between 2009 and 2015. They selected 24,549 patients who filled an opioid prescription between 30 days before surgery and 14 days after discharge and with continuous Medicare enrollment. The correlation for prescription size with new persistent opioid use was examined.

The researchers found that new persistent use was 12.8 percent overall and decreased annually, from 17 to 7.1 percent from 2009 to 2015. Associations with new persistent use were seen for prescription size, preoperative prescription fills, black race, gastrointestinal complications, disability status, open lung resection, dual eligibility (Medicare and Medicaid), drug and substance abuse, female sex, tobacco use, high comorbidity, pain disorders, longer hospital stay, and younger age. Among patients prescribed more than 450 oral morphine equivalents, adjusted new persistent use was 19.6 percent compared with 10.4 percent among those prescribed 200 oral morphine equivalents or less.

Full story at Medical Xpress

Alternative to ‘revolving door’ of opioid detox and relapse

In a first-ever randomized trial, patients at a short-term inpatient program began long-term outpatient treatment with buprenorphine before discharge, with better outcomes than detox patients.

Three out of four people who complete an inpatient opioid withdrawal management program — commonly known as “detox” — relapse within a month, leading to a “revolving door” effect. Few successfully transition from the inpatient setting to long-term treatment with proven medications such as buprenorphine, methadone, or naltrexone to prevent overdose.

But patients who start long-term buprenorphine treatment at a detox program, instead of going through detox and getting a referral for such treatment at discharge, are less likely to use opioids illicitly over the following six months, and more likely to keep up treatment, according to a first-of-its-kind study led by a Boston University School of Public Health (BUSPH) researcher and published in the journal Addiction.

Full story at Science Daily

Dopamine and serotonin: Brain chemicals explained

Dopamine and serotonin are chemical messengers, or neurotransmitters, that help regulate many bodily functions. They have roles in sleep and memory, as well as metabolism and emotional well-being.

People sometimes refer to dopamine and serotonin as the “happy hormones” due to the roles they play in regulating mood and emotion.

They are also involved in several mental health conditions, including low mood and depression.

Dopamine and serotonin are involved in similar bodily processes, but they operate differently. Imbalances of these chemicals can cause different medical conditions that require different treatments.

Full story at Medical News Today

Alzheimer’s in women: Could midlife stress play a role?

For reasons as yet unknown, Alzheimer’s disease is more likely to affect women. However, new research sheds light on the potential impact of stress on their cognitive functioning.

Alzheimer’s disease is the most common type of dementia.

Affecting millions of people in the United States, this progressive condition has no proven cause, treatment, or cure.

What researchers do know, however, is that women bear the brunt of the condition.

Almost two-thirds of U.S. individuals with Alzheimer’s are women, according to the Alzheimer’s Association.

Full story at Medical News Today

Co-prescribing naloxone in Medicare Part D increases

The practice of co-prescribing the opioid overdose reversal drug naloxone to Medicare Part D patients who take opioids for chronic pain increased between 2016 and 2017, though such co-prescriptions were provided to only a small minority of patients who might benefit, according to research led by scientists at the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), and the Office of the Assistant Secretary for Health, all within the U.S. Department of Health and Human Services (HHS). The study found that overall national rates for naloxone co-prescription along with any opioid among Medicare Part D patients increased from 1.5 per 1000 patients receiving opioid prescriptions in 2016 to 4.6 per 1000 in 2017.

In 2016, CDC released a guideline advising clinicians to consider co-prescribing naloxone to patients at increased overdose risk, such as those taking higher doses of opioids or those who also have prescriptions for benzodiazepines to treat anxiety. Consistent with these recommendations, the highest rates of co-prescribing were among patients receiving opioids at doses of more than 90 morphine milligram equivalents per day and benzodiazepines for more than 300 days. In addition, two states that mandated naloxone co-prescribing (Vermont and Virginia) have the highest rates of all U.S. states for co-prescribing.

Full story at National Institute of Drug Abuse