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Title: Literature search files for systematic review on naloxone distribution in emergency departments Open Access Deposited

http://creativecommons.org/licenses/by-nc/4.0/
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  • The searches were developed for a systematic review on naloxone distribution in emergency departments. The searches were run in Ovid MEDLINE, Ovid MEDLINE In-Process & Other Non-Indexed Citations, Ovid MEDLINE Epub Ahead of Print, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials. Duplicate citations were removed in Endnote X6.
Description
  • The systematic review explores the role of the emergency department in naloxone distribution and harm reduction strategies associated with opioid use.
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  • markmac@umich.edu
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Citations to related material
  • Gunn AH, Smothers ZPW, Schramm-Sapyta N, Freiermuth CE, MacEachern M, Muzyk AJ. (2018). The emergency department as an opportunity for naloxone distribution. Western Journal of Emergency Medicine, 19(6), 1036-42. doi: 10.5811/westjem.2018.8.38829 https://doi.org/10.5811/westjem.2018.8.38829
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Last modified
  • 04/27/2020
Published
  • 04/27/2018
DOI
  • https://doi.org/10.7302/Z2WD3XSM
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To Cite this Work:
MacEachern, M., Muzyk, A. (2018). Literature search files for systematic review on naloxone distribution in emergency departments [Data set]. University of Michigan - Deep Blue. https://doi.org/10.7302/Z2WD3XSM

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Files (Count: 8; Size: 19.5 MB)

Record #1 of 108
ID: CN-00058269
AU: Barsan WG
AU: Seger D
AU: Danzl DF
AU: Ling LJ
AU: Bartlett R
AU: Buncher R
AU: Bryan C
TI: Duration of antagonistic effects of nalmefene and naloxone in opiate-induced sedation for emergency department procedures
SO: American journal of emergency medicine
YR: 1989
VL: 7
NO: 2
PG: 155-161
PM: PUBMED 2645889
PT: Clinical Trial; Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
KY: Adolescent;Attention [drug effects];Consciousness [drug effects];Double-Blind Method;Emergency Service, Hospital;Meperidine [antagonists & inhibitors];Multicenter Studies as Topic;Naloxone [therapeutic use];Naltrexone [analogs & derivatives] [therapeutic use];Random Allocation;Adult[checkword];Aged[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword]
CC: SR-ANAESTH: SR-PREHOSP
AB: Naloxone is an effective opiate antagonist, but its short half-life limits its usefulness. For outpatient procedures, a longer acting opiate antagonist could eliminate two to four hours of nursing observation in patients postoperatively. A controlled, randomized, double-blind trial comparing the effects of nalmefene, naloxone, and placebo in reversing opiate-induced sedation was carried out to determine efficacy, duration of action, and adverse effects in patients undergoing outpatient procedures. Each patient received 1.5 to 3.0 mg/kg meperidine intravenously before the procedure. After the procedure, each patient received either nalmefene, 1.0 mg; naloxone, 1.0 mg; or saline, 1.0 mL intravenously. Vital signs and assessments for alertness were performed for four hours. Naloxone significantly reversed sedation for only 15 minutes, whereas nalmefene was significantly effective (P less than .05) for up to 210 minutes. Nalmefene was significantly more effective than naloxone in reversing sedation at 60, 90, and 120 minutes. Nalmefene is an effective agent for the reversal of opiate-induced sedation after outpatient procedures.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/269/CN-00058269/frame.html

Record #2 of 108
ID: CN-01066611
AU: D'Onofrio G
AU: O'Connor PG
AU: Pantalon MV
AU: Chawarski MC
AU: Busch SH
AU: Owens PH
AU: Bernstein SL
AU: Fiellin DA
TI: Emergency department-initiated buprenorphine/naloxone treatment for opioid dependence: a randomized clinical trial
SO: JAMA
YR: 2015
VL: 313
NO: 16
PG: 1636-1644
PM: PUBMED 25919527
PT: Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural
KY: Buprenorphine [therapeutic use];Emergency Service, Hospital;HIV Infections [epidemiology];Health Services [utilization];Hospitals, Teaching;Hospitals, Urban;Naloxone [therapeutic use];Narcotic Antagonists [therapeutic use];Opioid-Related Disorders [drug therapy];Referral and Consultation;Risk;Adult[checkword];Female[checkword];Humans[checkword];Male[checkword];Young Adult[checkword]
DOI: 10.1001/jama.2015.3474
AB: OBJECTIVE: To test the efficacy of 3 interventions for opioid dependence: (1) screening and referral to treatment (referral); (2) screening, brief intervention, and facilitated referral to community-based treatment services (brief intervention); and (3) screening, brief intervention, ED-initiated treatment with buprenorphine/naloxone, and referral to primary care for 10-week follow-up (buprenorphine).DESIGN, SETTING, AND PARTICIPANTS: A randomized clinical trial involving 329 opioid-dependent patients who were treated at an urban teaching hospital ED from April 7, 2009, through June 25, 2013.INTERVENTIONS: After screening, 104 patients were randomized to the referral group, 111 to the brief intervention group, and 114 to the buprenorphine treatment group.MAIN OUTCOMES AND MEASURES: Enrollment in and receiving addiction treatment 30 days after randomization was the primary outcome. Self-reported days of illicit opioid use, urine testing for illicit opioids, human immunodeficiency virus (HIV) risk, and use of addiction treatment services were the secondary outcomes.RESULTS: Seventy-eight percent of patients in the buprenorphine group (89 of 114 [95% CI, 70%-85%]) vs 37% in the referral group (38 of 102 [95% CI, 28%-47%]) and 45% in the brief intervention group (50 of 111 [95% CI, 36%-54%]) were engaged in addiction treatment on the 30th day after randomization (P .21, all comparisons). Adverse events occurred in 30.9% (2 mg nalmefene), 15.9% (1 mg nalmefene), and 15.5% (naloxone) of patients (P >.08); none were associated with morbidity.CONCLUSIONIn this study of patients with varied potential causes of altered consciousness, nalmefene (1 mg and 2 mg) and naloxone (2 mg) appeared to be efficacious, safe, and to yield similar clinical outcomes.STUDY OBJECTIVESTo compare the efficacy, safety, and withdrawal symptoms in emergency department patients with suspected narcotic overdose treated with nalmefene, an opioid antagonist with a 4- to 10-hour duration of action, with those treated with naloxone.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/712/CN-00164712/frame.html

Record #4 of 108
ID: CN-00562480
AU: Bijur PE
AU: Schechter C
AU: Esses D
AU: Chang AK
AU: Gallagher EJ
TI: Intravenous bolus of ultra-low-dose naloxone added to morphine does not enhance analgesia in emergency department patients
SO: Journal of pain
YR: 2006
VL: 7
NO: 2
PG: 75-81
PM: PUBMED 16459272
XR: EMBASE 2006068804
PT: Journal Article; Randomized Controlled Trial
KY: Acute Disease;Analgesics, Opioid [administration & dosage];Dose-Response Relationship, Drug;Double-Blind Method;Drug Therapy, Combination;Emergency Service, Hospital;Infusions, Intravenous;Morphine [administration & dosage];Naloxone [administration & dosage];Narcotic Antagonists [administration & dosage];Pain [drug therapy];Pain Measurement;Treatment Failure;Adult[checkword];Aged[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword];adult; analgesia; article; clinical trial; controlled clinical trial; controlled study; dose response; double blind procedure; emergency care; emergency ward; female; human; low drug dose; major clinical study; male; nausea/si [Side Effect]; outcome assessment; pain/dt [Drug Therapy]; pain assessment; randomized controlled trial; treatment outcome; vomiting/si [Side Effect]; *morphine/ae [Adverse Drug Reaction]; *morphine/ct [Clinical Trial]; *morphine/cb [Drug Combination]; *morphine/dt [Drug Therapy]; *morphine/iv [Intravenous Drug Administration]; *naloxone/ae [Adverse Drug Reaction]; *naloxone/ct [Clinical Trial]; *naloxone/cb [Drug Combination]; *naloxone/do [Drug Dose]; *naloxone/dt [Drug Therapy]; *naloxone/iv [Intravenous Drug Administration]; placebo
CC: SR-ANAESTH: SR-SYMPT
DOI: 10.1016/j.jpain.2005.08.008
AB: PERSPECTIVE: Ultra-low doses of naloxone in the 0.001 ng/kg to 0.1 ng/kg range do not enhance the analgesia provided by morphine alone among emergency department patients with acute, severe pain. This suggests that naloxone in these doses is not an effective adjunct to morphine for control of acute pain.There is some evidence from in vitro, animal, and postoperative clinical studies that low doses of opioid antagonists combined with morphine increase analgesia. The theoretical model of this effect posits that ultra-low doses of opioid antagonists selectively antagonize excitatory, but not inhibitory, opioid receptor-mediated signaling. To determine whether this effect occurs in emergency department patients presenting with severe acute pain, we conducted a randomized, double-blind placebo-controlled trial to assess the relative analgesic effect of morphine administered with 3 different doses of naloxone versus morphine alone. Patients received 0.1 mg/kg morphine intravenously (IV) over 2 min plus one of 3 different doses of naloxone (0.1 ng/kg, 0.01 ng/kg, or 0.001 ng/kg) or normal saline. A 0 to 10 numerical rating scale (NRS) was used to measure pain intensity at baseline and every 30 min up to 4 hours. One hundred fifty-six patients with a median NRS of 10 (IQR: 8-10) were studied. There were no clinically or statistically significant differences in the mean pain intensity of patients in the 4 treatment groups over the 4-hour study period, nor were there differences in the administration of additional analgesics or incidence of side effects.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/480/CN-00562480/frame.html

Record #5 of 108
ID: CN-00107294
AU: Storrow AB
AU: Wians FH
AU: Mikkelsen SL
AU: Norton J
TI: Does naloxone cause a positive urine opiate screen?
SO: Annals of emergency medicine
YR: 1994
VL: 24
NO: 6
PG: 1151-1153
PM: PUBMED 7978599
XR: EMBASE 24368155
PT: Clinical Trial; Journal Article; Randomized Controlled Trial
KY: Double-Blind Method;Emergencies;Enzyme Multiplied Immunoassay Technique;False Positive Reactions;Naloxone [chemistry] [pharmacokinetics] [urine];Narcotics [urine];Oxymorphone [chemistry] [urine];Pilot Projects;Prospective Studies;Substance Abuse Detection [methods];Adult[checkword];Humans[checkword];Middle Aged[checkword];adult; article; clinical trial; controlled clinical trial; controlled study; double blind procedure; *drug screening; drug structure; *drug urine level; enzyme multiplied immunoassay technique; human; human experiment; intravenous drug administration; normal human; priority journal; prospective study; randomized controlled trial; *naloxone/ct [Clinical Trial]; *naloxone/an [Drug Analysis]; *naloxone/do [Drug Dose]; *naloxone/pk [Pharmacokinetics]; *opiate/ct [Clinical Trial]; *opiate/cr [Drug Concentration]; *opiate/pk [Pharmacokinetics]; *oxymorphone/an [Drug Analysis]
AB: DESIGNProspective, randomized, double-blinded human protocol.SETTINGUrban Level I military emergency department.PARTICIPANTSFourteen adult volunteers who took no routine medications, were not pregnant, had no known sensitivity to naloxone, and who were negative for a pretest urine and serum toxicologic screen.INTERVENTIONSWe administered either 2 or 4 mg IV naloxone to 14 subjects. Urine drug screening was obtained before administration and at 60 minutes, 6 hours, and 48 hours after administration.RESULTSAll urine drug screens using the enzyme-multiplied immunoassay technique were negative for opiates at both dosage levels. The sample size of 14 yielded a power of more than .99 to detect the difference between positive and negative samples.CONCLUSIONAlthough the metabolites of naloxone hydrochloride are similar in structure to oxymorphone and are excreted in human urine for several days, naloxone was not associated with a positive enzymatic urine screen for opiates.STUDY OBJECTIVETo determine whether the excreted metabolites of naloxone hydrochloride cause positive urine toxicologic screens for opiates.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/294/CN-00107294/frame.html

Record #6 of 108
ID: CN-00731012
AU: Kerr D
AU: Kelly AM
AU: Dietze P
AU: Jolley D
AU: Barger B
TI: Randomized controlled trial comparing the effectiveness and safety of intranasal and intramuscular naloxone for the treatment of suspected heroin overdose
SO: Addiction (abingdon, england)
YR: 2009
VL: 104
NO: 12
PG: 2067-2074
PM: PUBMED 19922572
XR: EMBASE 355604538
PT: Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
KY: Administration, Intranasal;Adolescent;Allied Health Personnel;Analgesics, Opioid [poisoning];Drug Overdose [drug therapy];Emergency Medical Services;Heroin [poisoning];Injections, Intramuscular;Naloxone [administration & dosage] [adverse effects];Narcotic Antagonists [administration & dosage] [adverse effects];Prospective Studies;Treatment Outcome;Victoria;Adult[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword];Young Adult[checkword];adult; agitation; article; clinical trial; controlled clinical trial; controlled study; drug efficacy; drug safety; female; grand mal seizure/dt [Drug Therapy]; grand mal seizure/si [Side Effect]; human; intoxication/dt [Drug Therapy]; *intoxication/dt [Drug Therapy]; major clinical study; male; nausea and vomiting/si [Side Effect]; randomized controlled trial; resuscitation; side effect/si [Side Effect]; treatment outcome; treatment response; violence; *diamorphine/to [Drug Toxicity]; diazepam/dt [Drug Therapy]; diazepam/iv [Intravenous Drug Administration]; *naloxone/ae [Adverse Drug Reaction]; *naloxone/ct [Clinical Trial]; *naloxone/ad [Drug Administration]; *naloxone/dt [Drug Therapy]; *naloxone/im [Intramuscular Drug Administration]; *naloxone/na [Intranasal Drug Administration]
CC: SR-ADDICTN
DOI: 10.1111/j.1360-0443.2009.02724.x
AB: METHODSThis randomized controlled trial included patients treated for suspected opiate overdose in the pre-hospital setting. Patients received 2 mg of either i.n. or i.m. naloxone. The primary outcome was the proportion of patients who responded within 10 minutes of naloxone treatment. Secondary outcomes included time to adequate response and requirement for supplementary naloxone. Data were analysed using multivariate statistical techniques.RESULTSA total of 172 patients were enrolled into the study. Median age was 29 years and 74% were male. Rates of response within 10 minutes were similar: i.n. naloxone (60/83, 72.3%) compared with i.m. naloxone (69/89, 77.5%) [difference: -5.2%, 95% confidence interval (CI) -18.2 to 7.7]. No difference was observed in mean response time (i.n.: 8.0, i.m.: 7.9 minutes; difference 0.1, 95% CI -1.3 to 1.5). Supplementary naloxone was administered to fewer patients who received i.m. naloxone (i.n.: 18.1%; i.m.: 4.5%) (difference: 13.6%, 95% CI 4.2-22.9).CONCLUSIONSConcentrated intranasal naloxone reversed heroin overdose successfully in 82% of patients. Time to adequate response was the same for both routes, suggesting that the i.n. route of administration is of similar effectiveness to the i.m. route as a first-line treatment for heroin overdose.AIMSTraditionally, the opiate antagonist naloxone has been administered parenterally; however, intranasal (i.n.) administration has the potential to reduce the risk of needlestick injury. This is important when working with populations known to have a high prevalence of blood-borne viruses. Preliminary research suggests that i.n. administration might be effective, but suboptimal naloxone solutions were used. This study compared the effectiveness of concentrated (2 mg/ml) i.n. naloxone to intramuscular (i.m.) naloxone for suspected opiate overdose.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/012/CN-00731012/frame.html

Record #7 of 108
ID: CN-00034573
AU: Rupreht J
AU: Dworacek B
AU: Oosthoek H
AU: Dzoljic MR
AU: Valkenburg M
TI: Physostigmine versus naloxone in heroin-overdose
SO: Journal of toxicology. Clinical toxicology
YR: 1983
VL: 21
NO: 3
PG: 387-397
PM: PUBMED 6676478
PT: Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial
KY: Heroin [poisoning];Heroin Dependence [complications];Naloxone [adverse effects] [therapeutic use];Physostigmine [therapeutic use];Random Allocation;Respiration Disorders [chemically induced] [drug therapy];Substance Withdrawal Syndrome [chemically induced];Humans[checkword]
CC: SR-ADDICTN: SR-INJ
AB: Two groups of 10 chronically heroin addicted patients who were admitted to the Emergency Ward because of hypoventilation and coma, were treated random- aselectively with naloxone, 3 micrograms kg-1 BW iv, or with physostigmine salicylate 0,04 mg kg-1 BW iv. Patients in both groups completely regained consciousness and breathed spontaneously, regularly and adequately within 10 minutes. One essential difference in the treatment was that physostigmine caused no signs of acute opiate withdrawal, the patients felt fine and stayed for further control, in contrast with naloxone where the patients felt bad and occasionally escaped prematurely from the ward. Another difference is that the beneficial effect of one dose of physostigmine is shorter lived than that of naloxone. Authors emphasise the fact that treatment of heroin overdose in an addict need not jeopardize the patient's well-being by a withdrawal syndrome.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/573/CN-00034573/frame.html

Record #8 of 108
ID: CN-00502920
AU: Greenwald PW
AU: Provataris J
AU: Coffey J
AU: Bijur P
AU: Gallagher EJ
TI: Low-dose naloxone does not improve morphine-induced nausea, vomiting, or pruritus
SO: American journal of emergency medicine
YR: 2005
VL: 23
NO: 1
PG: 35-39
PM: PUBMED 15672335
XR: EMBASE 40163995
PT: Clinical Trial; Journal Article; Randomized Controlled Trial
KY: Analgesia [adverse effects] [methods];Double-Blind Method;Infusions, Intravenous;Morphine [administration & dosage] [adverse effects];Naloxone [administration & dosage];Narcotic Antagonists [administration & dosage];Nausea [chemically induced] [drug therapy];Pain Measurement;Prospective Studies;Pruritus [chemically induced] [drug therapy];Treatment Outcome;Vomiting [chemically induced] [drug therapy];Adult[checkword];Female[checkword];Humans[checkword];Male[checkword];adult; article; clinical protocol; clinical trial; confidence interval; controlled clinical trial; controlled study; double blind procedure; emergency ward; female; human; *low drug dose; major clinical study; male; *nausea/dt [Drug Therapy]; *nausea/si [Side Effect]; pain/dt [Drug Therapy]; pain assessment; priority journal; *pruritus/dt [Drug Therapy]; *pruritus/si [Side Effect]; randomized controlled trial; visual analog scale; *vomiting/dt [Drug Therapy]; *vomiting/si [Side Effect]; *morphine/ae [Adverse Drug Reaction]; *morphine/dt [Drug Therapy]; *morphine/iv [Intravenous Drug Administration]; *naloxone/ct [Clinical Trial]; *naloxone/do [Drug Dose]; *naloxone/dt [Drug Therapy]; *naloxone/iv [Intravenous Drug Administration]; *naloxone/pd [Pharmacology]; placebo; hypothesis; *nausea; pain; patient; *pruritus; *vomiting; antiemetic agent; *morphine; *naloxone
CC: SR-ANAESTH: SR-SYMPT
AB: METHODSRandomized, double-blind, placebo-controlled trial. Patients receiving 0.10 mg/kg morphine IV bolus rated pain, nausea, and pruritus on 100-mm visual analog scales at enrollment and 20 minutes. Patients were randomized to 0.25 microg/kg naloxone or equal volume placebo administered with IV morphine.RESULTSOne hundred thirty-one enrolled, 99 (76%) treated according to protocol with sufficient data for analysis. At 20 minutes the difference between groups (naloxone-placebo) was 1 mm (95% CI [confidence interval], -9 to 11) for nausea, 1 mm (95% CI, -3 to 3) for pruritus, 4% (95% CI, -1 to 9) for vomiting, and 0% (95% CI, -5 to 5) for rescue antiemetics. Pain was significantly reduced in both groups.CONCLUSIONAddition of 0.25 microg/kg naloxone to bolus morphine does not improve nausea, pruritus, vomiting, or reduce use of rescue antiemetics when administered to emergency department patients in pain.OBJECTIVEWe tested the hypothesis that low-dose naloxone delivered with intravenous (IV) bolus morphine to emergency department patients in pain would reduce nausea.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/920/CN-00502920/frame.html

Record #9 of 108
ID: CN-00422940
AU: Meissner W
AU: Dohrn B
AU: Reinhart K
TI: Enteral naloxone reduces gastric tube reflux and frequency of pneumonia in critical care patients during opioid analgesia
SO: Critical care medicine
YR: 2003
VL: 31
NO: 3
PG: 776-780
PM: PUBMED 12626983
PT: Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
KY: Administration, Oral;Analgesics, Opioid [adverse effects];Critical Care [methods];Cross Infection [etiology] [prevention & control];Defecation [drug effects];Double-Blind Method;Enteral Nutrition [adverse effects] [methods];Fentanyl [adverse effects];Gastric Emptying [drug effects];Gastrointestinal Motility [drug effects];Infection Control [methods];Intubation, Gastrointestinal [adverse effects];Naloxone [administration & dosage] [pharmacology];Narcotic Antagonists [administration & dosage] [pharmacology];Pneumonia, Aspiration [etiology] [prevention & control];Prospective Studies;Respiration, Artificial [adverse effects];Adult[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword]
CC: SR-UPPERGI
DOI: 10.1097/01.CCM.0000053652.80849.9F
AB: DESIGNProspective, randomized, double-blinded study.SETTINGUniversity hospital intensive care unit.PATIENTSEighty-four mechanically ventilated, fentanyl-treated patients without gastrointestinal surgery or diseases.INTERVENTIONSPatients were assigned to receive 8 mg naloxone or placebo four times daily via a gastric tube during fentanyl administration.MEASUREMENTS AND MAIN RESULTSThirty-eight patients received naloxone and 43 placebo; three patients were excluded because of protocol violation. Median gastric tube reflux volume (54 vs. 129 mL, p =.03) and frequency of pneumonia (34% vs. 56%, p =.04) were significantly lower in the naloxone group. In both groups, time until first defecation, ventilation time, and length of intensive care unit stay did not differ. There was no difference in fentanyl requirements between the naloxone and the placebo group (7 vs. 6.5 microg/kg/hr, p =.15).CONCLUSIONSOur results provide evidence that the administration of enteral opioid antagonists in ventilated patients with opioid analgesia might be a simple-and possibly preventive-treatment of increased gastric tube reflux and reduces frequency of pneumonia.OBJECTIVEOpioid analgesia impairs gastrointestinal motility. Enteral administration of naloxone theoretically allows selective blocking of intestinal opioid receptors caused by extensive presystemic metabolism. Therefore, we studied the effect of enteral naloxone on the amount of gastric tube reflux, the frequency of pneumonia, and the time until first defecation in mechanically ventilated patients with fentanyl analgesia.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/940/CN-00422940/frame.html

Record #10 of 108
ID: CN-00090589
AU: Kaplan JL
AU: Marx JA
TI: Effectiveness and safety of intravenous nalmefene for emergency department patients with suspected narcotic overdose: a pilot study
SO: Annals of emergency medicine
YR: 1993
VL: 22
NO: 2
PG: 187-190
PM: PUBMED 8427429
PT: Clinical Trial; Clinical Trial, Phase II; Controlled Clinical Trial; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't
KY: Adolescent;Drug Overdose [drug therapy];Emergency Service, Hospital;Injections, Intravenous;Naltrexone [administration & dosage] [adverse effects] [analogs & derivatives] [therapeutic use];Narcotic Antagonists [administration & dosage] [therapeutic use];Narcotics [poisoning];Pilot Projects;Prospective Studies;Treatment Outcome;Adult[checkword];Female[checkword];Humans[checkword];Male[checkword]
CC: SR-ADDICTN: SR-ANAESTH: SR-PREHOSP
AB: DESIGNMulti-institutional, prospective, phase II, open-label study.TYPE OF PARTICIPANTSComplete data were available for 53 cases from two teaching hospitals. Men 18 years old or older who would otherwise receive naloxone were eligible (two women were enrolled inadvertently).METHODSOver four hours, one to ten boluses (median, one) of 0.5 or 1.0 mg nalmefene IV were given as often as every two minutes based on clinical need. Respirations, blood pressure, pulse, pupil size, and overall clinical response were monitored. Overall clinical response (1, no change; 2, partial response; 3, complete response), first assessed at two minutes, was analyzed by the Mann-Whitney U test.RESULTSFifteen of 25 (0.5 mg) and nine of 28 (1.0 mg) cases were opiate positive. Twelve of 15 (0.5 mg) and six of nine (1.0 mg) opiate-positive cases had a rapid complete response. Coincident causes of depressed sensorium were identified in the remaining six opiate-positive cases. No difference in initial overall clinical response was seen between 0.5-mg and 1.0-mg opiate-positive cases (P = .59). No deterioration requiring repeat nalmefene occurred in opiate-positive cases, even if methadone (four), codeine (two), or pentazocine (one) was found. No serious adverse events were judged to be related to nalmefene.CONCLUSIONNalmefene is effective in the reversal of opiate overdose and appears to be safe in the management of patients with altered sensorium.STUDY OBJECTIVETo evaluate the efficacy and safety of nalmefene, an investigational narcotic antagonist that has potential advantages over naloxone because of its four- to eight-hour half-life, in emergency department patients with possible narcotic overdose.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/589/CN-00090589/frame.html

Record #11 of 108
ID: CN-00813355
AU: Solhi H
AU: Mostafazadeh B
AU: Vishteh HR
AU: Ghezavati AR
AU: Shooshtarizadeh A
TI: Benefit effect of naloxone in benzodiazepines intoxication: findings of a preliminary study
SO: Human & experimental toxicology
YR: 2011
VL: 30
NO: 7
PG: 535-540
PM: PUBMED 20573655
PT: Journal Article; Randomized Controlled Trial
KY: Benzodiazepines [antagonists & inhibitors] [toxicity];Hypnotics and Sedatives [antagonists & inhibitors] [toxicity];Naloxone [therapeutic use];Narcotic Antagonists [therapeutic use];Poison Control Centers;Poisoning [drug therapy] [etiology] [physiopathology];Treatment Outcome;Unconsciousness [chemically induced] [drug therapy];Adult[checkword];Female[checkword];Humans[checkword];Male[checkword]
DOI: 10.1177/0960327110374972
AB: METHODSIn this clinical-trial study, patients with typical signs and symptoms of benzodiazepines poisoning, who were referred to a poisoning center in Tehran in 2008, were selected. After recording of patients' characteristics, supportive treatment was initiated and patients were randomly assigned to the case group with intravenous (IV) injection of two 0.4 mg naloxone ampules or to the control group. Their signs and symptoms were evaluated again 0.5 hour later. Each of diazepam, clonazepam and alperazolam drug group had 30 patients and lorazepam drug group had 26 patients, half of which patients in each drug group received naloxone.RESULTSMost of the participants were female and the mean age was 28 years. There were no significant differences between case and control groups in age, sex, time of drug consumption, tablet counts, signs and symptoms and level of consciousness at the admission time in each drug types. After naloxone injection in case groups, all signs and symptoms significantly improved in all drug types in comparison to control groups except nystagmus. In addition, level of consciousness significantly improved in case groups in all drug types except lorazepam.CONCLUSIONFindings of the study showed that naloxone is effective in management of benzodiazepines poisoning. However, future clinical trials with greater sample size are recommended.BACKGROUNDNaloxone, as a low-priced and available drug, may be useful in improvement of signs and symptoms of benzodiazepines intoxication. The aim of this study was assessment of its effect on benzodiazepines poisoning.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/355/CN-00813355/frame.html

Record #12 of 108
ID: CN-00773768
AU: Solhi H
AU: Mostafazadeh B
AU: Vishteh HR
AU: Ghezavati AR
AU: Shooshtarizadeh A
TI: Benefit effect of naloxone in benzodiazepines intoxication: findings of a preliminary study
SO: Human & experimental toxicology
YR: 2011
VL: 30
NO: 7
PG: 535-540
PM: PUBMED 20573655
PT: Journal Article; Randomized Controlled Trial
KY: Benzodiazepines [antagonists & inhibitors] [toxicity];Hypnotics and Sedatives [antagonists & inhibitors] [toxicity];Naloxone [therapeutic use];Narcotic Antagonists [therapeutic use];Poison Control Centers;Poisoning [drug therapy] [etiology] [physiopathology];Treatment Outcome;Unconsciousness [chemically induced] [drug therapy];Adult[checkword];Female[checkword];Humans[checkword];Male[checkword]
CC: SR-ADDICTN
DOI: 10.1177/0960327110374972
AB: METHODS: In this clinical-trial study, patients with typical signs and symptoms of benzodiazepines poisoning, who were referred to a poisoning center in Tehran in 2008, were selected. After recording of patients' characteristics, supportive treatment was initiated and patients were randomly assigned to the case group with intravenous (IV) injection of two 0.4 mg naloxone ampules or to the control group. Their signs and symptoms were evaluated again 0.5 hour later. Each of diazepam, clonazepam and alperazolam drug group had 30 patients and lorazepam drug group had 26 patients, half of which patients in each drug group received naloxone.RESULTS: Most of the participants were female and the mean age was 28 years. There were no significant differences between case and control groups in age, sex, time of drug consumption, tablet counts, signs and symptoms and level of consciousness at the admission time in each drug types. After naloxone injection in case groups, all signs and symptoms significantly improved in all drug types in comparison to control groups except nystagmus. In addition, level of consciousness significantly improved in case groups in all drug types except lorazepam.CONCLUSION: Findings of the study showed that naloxone is effective in management of benzodiazepines poisoning. However, future clinical trials with greater sample size are recommended.BACKGROUND: Naloxone, as a low-priced and available drug, may be useful in improvement of signs and symptoms of benzodiazepines intoxication. The aim of this study was assessment of its effect on benzodiazepines poisoning.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/768/CN-00773768/frame.html

Record #13 of 108
ID: CN-00503066
AU: Kelly AM
AU: Kerr D
AU: Dietze P
AU: Patrick I
AU: Walker T
AU: Koutsogiannis Z
TI: Randomised trial of intranasal versus intramuscular naloxone in prehospital treatment for suspected opioid overdose
SO: Medical journal of Australia
YR: 2005
VL: 182
NO: 1
PG: 24-27
PM: PUBMED 15651944
XR: EMBASE 2005026902
PT: Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
KY: Administration, Intranasal;Adolescent;Drug Overdose [drug therapy];Emergency Medical Services [methods];Injections, Intramuscular;Naloxone [administration & dosage];Narcotics [poisoning];Prospective Studies;Respiratory Insufficiency [chemically induced] [drug therapy];Treatment Outcome;Adult[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword]
CC: SR-ADDICTN
AB: DESIGN: Prospective, randomised, unblinded trial of either 2 mg naloxone injected intramuscularly or 2 mg naloxone delivered intranasally with a mucosal atomiser.PARTICIPANTS AND SETTING: 155 patients (71 IM and 84 IN) requiring treatment for suspected opiate overdose and attended by paramedics of the Metropolitan Ambulance Service (MAS) and Rural Ambulance Victoria (RAV) in Victoria.MAIN OUTCOME MEASURES: Response time to regain a respiratory rate greater than 10 per minute. Secondary outcome measures were proportion of patients with respiratory rate greater than 10 per minute at 8 minutes and/or a GCS score over 11 at 8 minutes; proportion requiring rescue naloxone; rate of adverse events; proportion of the IN group for whom IN naloxone alone was sufficient treatment.RESULTS: The IM group had more rapid response than the IN group, and were more likely to have more than 10 spontaneous respirations per minute within 8 minutes (82% v 63%; P = 0.0173). There was no statistically significant difference between the IM and IN groups for needing rescue naloxone (13% [IM group] v 26% [IN group]; P = 0.0558). There were no major adverse events. For patients treated with IN naloxone, this was sufficient to reverse opiate toxicity in 74%.CONCLUSION: IN naloxone is effective in treating opiate-induced respiratory depression, but is not as effective as IM naloxone. IN delivery of naxolone could reduce the risk of needlestick injury to ambulance officers and, being relatively safe to make more widely available, could increase access to life-saving treatment in the community.OBJECTIVE: To determine the effectiveness of intranasal (IN) naloxone compared with intramuscular (IM) naloxone for treatment of respiratory depression due to suspected opiate overdose in the prehospital setting.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/066/CN-00503066/frame.html

Record #14 of 108
ID: CN-00638932
AU: Darnell CM
AU: Thompson J
AU: Stromberg D
AU: Roy L
AU: Sheeran P
TI: Effect of low-dose naloxone infusion on fentanyl requirements in critically ill children
SO: Pediatrics
YR: 2008
VL: 121
NO: 5
PG: e1363-71
PM: PUBMED 18411237
XR: EMBASE 354417089
PT: Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
KY: Adolescent;Analgesics, Opioid [administration & dosage];Conscious Sedation;Critical Illness;Double-Blind Method;Fentanyl [administration & dosage];Hypnotics and Sedatives [administration & dosage];Infant, Newborn;Infusions, Intravenous;Intensive Care Units, Pediatric;Midazolam [administration & dosage];Naloxone [administration & dosage];Narcotic Antagonists [administration & dosage];Respiration, Artificial;Substance Withdrawal Syndrome;Child[checkword];Child, Preschool[checkword];Female[checkword];Humans[checkword];Infant[checkword];Male[checkword];analgesia; anamnesis; article; artificial ventilation; child; clinical trial; controlled clinical trial; controlled study; *critically ill patient; double blind procedure; drug dependence; drug dose comparison; drug dose increase; drug withdrawal; female; human; intensive care; kidney disease; liver disease; low drug dose; major clinical study; male; neurologic disease; *pediatrics; priority journal; randomized controlled trial; treatment outcome; *fentanyl/do [Drug Dose]; midazolam/do [Drug Dose]; *naloxone/ct [Clinical Trial]; *naloxone/do [Drug Dose]; placebo
CC: SR-NEONATAL: SR-SYMPT
DOI: 10.1542/peds.2007-1468
AB: METHODSWe conducted a double-blinded, randomized, placebo-control trial from December 2002 through July 2004 in a university PICU. We enrolled 82 children age 1 day to 18 years requiring mechanical ventilation and fentanyl infusions anticipated to last for >4 days were eligible for enrollment. Those receiving additional oral analgesia or sedation, having a history of drug dependence or withdrawal, or having significant neurologic, renal, or hepatic disease were excluded. In addition to fentanyl infusions, patients received low-dose naloxone or placebo infusions. Medications were adjusted using the Modified Motor Activity Assessment Scale. Withdrawal was monitored using the Modified Narcotic Withdrawal Scale. Intervention was a low-dose naloxone infusion (0.25 microg/kg per hour) and the main outcome variable was the maximum cumulative daily fentanyl dose (micrograms per kilogram per day).RESULTSThere was no difference in the maximum cumulative daily fentanyl dose between patients treated with naloxone (N = 37) or those receiving placebo (N = 35). Adjustment for the starting fentanyl dose also failed to reveal group differences. Total fentanyl dose received throughout the study in the naloxone group (360 microg/kg) versus placebo (223 microg/kg) was not statistically different. Placebo patients trended toward fewer rescue midazolam boluses (10.7 vs 17.8), lower total midazolam dose (11.6 mg/kg vs 23.9 mg/kg), and fewer rescue fentanyl boluses (18.5 vs 23.9).CONCLUSIONSWe conclude that administration of low-dose naloxone (0.25 microg/kg per hour) does not decrease fentanyl requirements in critically ill, mechanically ventilated children.OBJECTIVESedating critically ill patients often involves prolonged opioid infusions causing opioid tolerance. Naloxone has been hypothesized to limit opioid tolerance by decreasing adenylate cyclase/cyclic adenosine monophosphate activation. The study purpose was to investigate the effect of low-dose naloxone on the maximum cumulative daily fentanyl dose in critically ill children.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/932/CN-00638932/frame.html

Record #15 of 108
ID: CN-00491023
AU: Meissner W
AU: Hartmann M
AU: Kähler G
AU: Brauer M
TI: Effect of enteral naloxone on the incidence of gastritis and esophagitis in mechanically ventilated patients
SO: Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie
YR: 2004
VL: 39
NO: 9
PG: 538-541
PM: PUBMED 15334330
PT: Clinical Trial; English Abstract; Journal Article; Randomized Controlled Trial
KY: Analgesics, Opioid [adverse effects];Double-Blind Method;Esophagitis [drug therapy] [epidemiology] [etiology];Fentanyl [adverse effects];Gastric Mucosa [pathology];Gastritis [drug therapy] [epidemiology] [etiology];Gastrointestinal Motility [drug effects];Intubation, Gastrointestinal;Naloxone [administration & dosage] [therapeutic use];Narcotic Antagonists [administration & dosage] [therapeutic use];Respiration, Artificial [adverse effects];Adult[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword]
DOI: 10.1055/s-2004-825738
AB: METHODS: After IRB approval, mechanically ventilated, fentanyl-treated patients without gastrointestinal surgery or diseases were assigned to receive 8 mg naloxone or placebo four times daily via a gastric tube. Additional inclusion criteria were opioid treatment for at least three days and endoscopy of the upper GI tract. Frequency of gastritis and esophagitis was quantified according to the Savary-Miller Score, and further parameter of GI motility (frequency of propulsive medication, amount of enteral feeding) were measured.RESULTS: In four of seventeen patients of the naloxone group (24 %) and 14 of 22 patients of the placebo group (64 %; p = 0.02), esophageal or gastral mucosal injuries were detected. In the naloxone group, gastral reflux as well as need for propulsive medication were significantly lower. Volume of enteral feeding showed an increasing trend in the second half of the study.CONCLUSION: Reduction of esophagogastral mucosal injury and reduced need for procinetic medication suggests an improvement of GI motility by enteral naloxone in fentanyl-treated, mechanically ventilated patients.BACKGROUND: Gastrtis and esophagitis are frequent and severe complications in intensive care patients, mainly caused by increased duodenogastral reflux. Opioids, commonly used in intensive care, are known to impair gastrointestinal (GI) motility which increases retrograd flow of gastric content. In a previous study, we showed that enteral administered naloxone reduces gastric reflux by selectively blocking GI opioid receptors. Therefore, in a subpopulation of these patients we studied the effect of enteral naloxone on the incidence of mucosal injury in opioid-treated, mechanically ventilated patients.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/023/CN-00491023/frame.html

Record #16 of 108
ID: CN-01155198
AU: Moore C
AU: Lloyd G
AU: Oretti R
AU: Russell I
AU: Snooks H
TI: Paramedic-supplied 'Take Home' Naloxone: protocol for cluster randomised feasibility study
SO: BMJ open
YR: 2014
VL: 4
NO: 3
PG: e004712
PM: PUBMED 24650810
PT: Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
KY: Adolescent;Allied Health Personnel [education];Analgesics, Opioid [poisoning];Clinical Protocols;Drug Overdose [drug therapy];Emergency Medical Services [methods];Feasibility Studies;Naloxone [administration & dosage];Narcotic Antagonists [administration & dosage];Patient Selection;Research Design;Wales;Adult[checkword];Female[checkword];Humans[checkword];Male[checkword];Young Adult[checkword]
DOI: 10.1136/bmjopen-2013-004712
AB: METHODS AND ANALYSIS: Cluster randomised trial with staggered allocation of paramedics (clusters) to groups. We will invite paramedics in an urban area of south Wales, UK to take part. We will randomly allocate those that accept to training sessions during the first 4 months of the trial. Patients attended by paramedics who have been trained and issued THN kits will fall into the intervention group. Patients attended by paramedics following usual practice (until they receive their training and THN kits) will fall into the control group. We will gather data about processes and outcomes of care: numbers of patients eligible for intervention, offered and accepted THN, attended emergency department, suffered further overdose, died within 3 months and about follow-up rates: numbers of patients consented, completed (postal or telephone) questionnaire. We will gather qualitative data about acceptability to patients and paramedics through interviews and focus groups.ETHICS AND DISSEMINATION: Ethical approval for this study was granted on 7 December 2011, by South East Wales Research Ethics Committee, Panel C. Results of this study will be reported through peer-reviewed scientific journals, conference presentations and internal organisational report. We will also seek to report our findings through local and national substance misuse networks and publications.TRIAL REGISTRATION NUMBER: ISRCTN98216498.INTRODUCTION: 'Take Home' Naloxone (THN) kits for use by peers in the event of an opioid overdose may reduce further overdose and deaths, but distribution through Drugs Services may not reach those at highest risk. Attendance by paramedics at emergency calls for patients who have suffered an overdose presents an opportunity to distribute THN kits. In this feasibility study we will assess the acceptability of this intervention, and gather data to inform definitive trial planning.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/198/CN-01155198/frame.html

Record #17 of 108
ID: CN-00512097
AU: Glaser A
AU: Arakaki D
AU: Chan GM
AU: Hoffman RS
TI: Randomised trial of intranasal versus intramuscular naloxone in prehospital treatment for suspected opioid overdose
SO: Medical journal of Australia
YR: 2005
VL: 182
NO: 8
PG: 427; author reply 427, 429
PM: PUBMED 15850442
XR: EMBASE 2005186483
PT: Clinical Trial; Comparative Study; Letter; Randomized Controlled Trial; Comment
KY: Administration, Intranasal;Bias;Drug Overdose [drug therapy];Emergency Medical Services;Glasgow Coma Scale;Injections, Intramuscular;Naloxone [administration & dosage];Narcotic Antagonists [administration & dosage];Narcotics [poisoning];Humans[checkword]
CC: SR-ADDICTN
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/097/CN-00512097/frame.html

Record #18 of 108
ID: CN-00055426
AU: Chernick V
AU: Manfreda J
AU: Booy V
AU: Davi M
AU: Rigatto H
AU: Seshia M
TI: Clinical trial of naloxone in birth asphyxia
SO: Journal of pediatrics
YR: 1988
VL: 113
NO: 3
PG: 519-525
PM: PUBMED 3045281
PT: Clinical Trial; Controlled Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't
KY: Apgar Score;Asphyxia Neonatorum [drug therapy] [ethnology];Clinical Trials as Topic;Delivery, Obstetric;Heart Rate [drug effects];Infant, Newborn;Injections, Intramuscular;Labor, Obstetric;Maternal Age;Naloxone [therapeutic use];Respiration [drug effects];Resuscitation;Adult[checkword];Female[checkword];Humans[checkword];Male[checkword];Pregnancy[checkword]
CC: SR-ANAESTH: SR-CHILD: SR-NEONATAL
AB: To determine whether endogenous opiates play a role in the pathogenesis of perinatal asphyxia, a blinded clinical trial of naloxone, a competitive opiate receptor blocker, was undertaken in infants with low 1-minute Apgar scores. Of 85 infants with 1-minute Apgar score 0 to 3, 44 received an injection of naloxone (approximately 0.4 mg/kg) and 41 received saline solution. In 108 infants with 1-minute Apgar score 4 to 6, 54 received naloxone and 54 saline solution. In neither group was there a significant effect of naloxone on respiratory frequency or heart rate up to 30 minutes after injection, nor at 24 hours of age. In both groups active muscle tone of upper and lower limbs was increased by naloxone, a response that may not be beneficial in the face of inadequate oxygen delivery to vital organs. We conclude that naloxone at this dose had no readily apparent benefit in the resuscitation of the asphyxiated newborn infant.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/426/CN-00055426/frame.html

Record #19 of 108
ID: CN-00743268
AU: Neligan PJ
AU: Malhotra G
AU: Fraser M
AU: Williams N
AU: Greenblatt EP
AU: Cereda M
AU: Ochroch EA
TI: Noninvasive ventilation immediately after extubation improves lung function in morbidly obese patients with obstructive sleep apnea undergoing laparoscopic bariatric surgery
SO: Anesthesia and analgesia
YR: 2010
VL: 110
NO: 5
PG: 1360-1365
PM: PUBMED 20418299
PT: Journal Article; Randomized Controlled Trial; Retracted Publication
KY: Anesthesia, Inhalation;Bariatric Surgery [mortality];Critical Care;Heart Arrest [etiology];Intubation, Intratracheal;Laparoscopy [mortality];Lung [physiopathology];Naloxone [therapeutic use];Narcotic Antagonists [therapeutic use];Obesity, Morbid [complications] [mortality] [physiopathology];Oximetry;Oxygen [blood];Peak Expiratory Flow Rate [physiology];Positive-Pressure Respiration;Respiration, Artificial;Respiratory Insufficiency [etiology];Sleep Apnea, Obstructive [complications] [mortality] [physiopathology];Spirometry;Treatment Outcome;Vital Capacity [physiology];Adult[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword]
CC: SR-AIRWAYS: SR-ENDOC
DOI: 10.1213/ANE.0b013e3181d5e3ef
AB: METHODS: Forty morbidly obese patients with known obstructive sleep apnea undergoing laparoscopic bariatric surgery with standardized anesthesia care were randomly assigned to receive NIPPV immediately after tracheal extubation (immediate group) or supplemental oxygen (standard group). All patients had continuous positive airway pressure initiated 30 minutes after extubation in the postanesthesia care unit (PACU) via identical noninvasive ventilators. Spirometry was performed by a blinded observer in the perioperative holding area 1 hour after admission to the PACU and 1 day postoperatively. The primary outcome was the change in forced vital capacity (FVC) from baseline to 24 hours (FVC baseline-FVC 24 hours).RESULTS: Forty patients, 20 in each group, were enrolled in the study. Forced expiratory volume in 1 second, FVC, and peak expiratory flow rate were significantly reduced in both groups from perioperative values throughout the study. At 24 hours, the intervention group had lost only 0.7 L FVC, versus 1.3 L for the intervention group (P = 0.0005). An analysis of covariance confirmed this and indicated that the immediate postoperative NIPPV better preserved spirometric function at 1 and 24 hours postoperatively. Specifically, the differences in the primary outcome were statistically significant.CONCLUSIONS: NIPPV given immediately after extubation significantly improves spirometric lung function at 1 hour and 1 day postoperatively, compared with continuous positive airway pressure started in the PACU, in morbidly obese patients with obstructive sleep apnea undergoing laparoscopic bariatric surgery.BACKGROUND: Noninvasive positive pressure ventilation (NIPPV) may improve postoperative lung function and reduce postoperative complications in patients undergoing abdominal surgery. The purpose of our study was to determine whether the timing of postoperative NIPPV affects lung function 1 day postoperatively.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/268/CN-00743268/frame.html

Record #20 of 108
ID: CN-00038010
AU: Steinbrook RA
AU: Weinberger SE
AU: Carr DB
AU: Gal E
AU: Fisher J
AU: Leith DE
AU: Fencl V
AU: Rosenblatt M
TI: Endogenous opioids and ventilatory responses to hypoxia in normal humans
SO: American review of respiratory disease
YR: 1985
VL: 131
NO: 4
PG: 588-591
PM: PUBMED 3158260
PT: Clinical Trial; Controlled Clinical Trial; Journal Article; Research Support, U.S. Gov't, P.H.S.
KY: Endorphins [blood];Hypoxia [etiology] [physiopathology];Lung Volume Measurements;Naloxone [pharmacology];Placebos;Respiration, Artificial;Time Factors;beta-Endorphin;Adult[checkword];Humans[checkword];Male[checkword]
CC: SR-ANAESTH
DOI: 10.1164/arrd.1985.131.4.588
AB: We studied the putative role of endorphins in modulating hypoxic ventilatory responsiveness. In 12 healthy men, minute ventilation (VE)and mouth occlusion pressure (P0.1) responses to progressive isocapnic hypoxia were determined before and after the intravenous administration of the opioid antagonist naloxone (10 mg) or placebo. Plasma levels of beta-endorphin were measured before and after hypoxia. Naloxone did not affect the slopes or x-intercepts of the relationships between either VE or P0.1 and arterial O2 saturation. There was no correlation between the baseline plasma level of beta-endorphin and any measure of responsiveness to hypoxia. Plasma beta-endorphin levels were not affected by either short-term hypoxia or naloxone alone; however, when hypoxia followed naloxone administration, mean +/- SD beta-endorphin increased from 8.0 +/- 8.9 pg/ml to 20.2 +/- 16.6 pg/ml (p less than 0.005). We concluded that endogenous opioids do not have an important modulating influence on hypoxic ventilatory responsiveness in adult human volunteers.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/010/CN-00038010/frame.html

Record #21 of 108
ID: CN-00997899
AU: Strang J
AU: Bird SM
AU: Parmar MK
TI: Take-home emergency naloxone to prevent heroin overdose deaths after prison release: rationale and practicalities for the N-ALIVE randomized trial
SO: Journal of urban health
YR: 2013
VL: 90
NO: 5
PG: 983-996
PM: PUBMED 23633090
PT: Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
KY: Drug Overdose [drug therapy] [mortality];Emergencies;Heroin Dependence [drug therapy] [mortality];Naloxone [administration & dosage];Narcotic Antagonists [adverse effects];Patient Acceptance of Health Care;Prisons;Humans[checkword]
CC: SR-ADDICTN
DOI: 10.1007/s11524-013-9803-1
AB: The naloxone investigation (N-ALIVE) randomized trial commenced in the UK in May 2012, with the preliminary phase involving 5,600 prisoners on release. The trial is investigating whether heroin overdose deaths post-prison release can be prevented by prior provision of a take-home emergency supply of naloxone. Heroin contributes disproportionately to drug deaths through opiate-induced respiratory depression. Take-home emergency naloxone is a novel preventive measure for which there have been encouraging preliminary reports from community schemes. Overdoses are usually witnessed, and drug users themselves and also family members are a vast intervention workforce who are willing to intervene, but whose responses are currently often inefficient or wrong. Approximately 10% of provided emergency naloxone is thought to be used in subsequent emergency resuscitation but, as yet, there have been no definitive studies. The period following release from prison is a time of extraordinarily high mortality, with heroin overdose deaths increased more than sevenfold in the first fortnight after release. Of prisoners with a previous history of heroin injecting who are released from prison, 1 in 200 will die of a heroin overdose within the first 4 weeks. There are major scientific and logistical challenges to assessing the impact of take-home naloxone. Even in recently released prisoners, heroin overdose death is a relatively rare event: hence, large numbers of prisoners need to enter the trial to assess whether take-home naloxone significantly reduces the overdose death rate. The commencement of pilot phase of the N-ALIVE trial is a significant step forward, with prisoners being randomly assigned either to treatment-as-usual or to treatment-as-usual plus a supply of take-home emergency naloxone. The subsequent full N-ALIVE trial (contingent on a successful pilot) will involve 56,000 prisoners on release, and will give a definitive conclusion on lives saved in real-world application. Advocates call for implementation, while naysayers raise concerns. The issue does not need more public debate; it needs good science.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/899/CN-00997899/frame.html

Record #22 of 108
ID: CN-00080030
AU: Bracken MB
AU: Shepard MJ
AU: Collins WF
AU: Holford TR
AU: Baskin DS
AU: Eisenberg HM
AU: Flamm E
AU: Leo-Summers L
AU: Maroon JC
AU: Marshall LF
TI: Methylprednisolone or naloxone treatment after acute spinal cord injury: 1-year follow-up data. Results of the second National Acute Spinal Cord Injury Study
SO: Journal of neurosurgery
YR: 1992
VL: 76
NO: 1
PG: 23-31
PM: PUBMED 1727165
PT: Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, U.S. Gov't, P.H.S.
KY: Acute Disease;Double-Blind Method;Follow-Up Studies;Methylprednisolone Hemisuccinate [therapeutic use];Naloxone [therapeutic use];Psychomotor Performance [drug effects];Spinal Cord Injuries [complications] [drug therapy] [physiopathology];Survival Rate;Time Factors;Humans[checkword]
CC: SR-INJ
DOI: 10.3171/jns.1992.76.1.0023
AB: The 1-year follow-up data of a multicenter randomized controlled trial of methylprednisolone (30 mg/kg bolus and 5.4 mg/kg/hr for 23 hours) or naloxone (5.4 mg/kg bolus and 4.0 mg/kg/hr for 23 hours) treatment for acute spinal cord injury are reported and compared with placebo results. In patients treated with methylprednisolone within 8 hours of injury, increased recovery of neurological function was seen at 6 weeks and at 6 months and continued to be observed 1 year after injury. For motor function, this difference was statistically significant (p = 0.030), and was found in patients with total sensory and motor loss in the emergency room (p = 0.019) and in those with some preservation of motor and sensory function (p = 0.024). Naloxone-treated patients did not show significantly greater recovery. Patients treated after 8 hours of injury recovered less motor function if receiving methylprednisolone (p = 0.08) or naloxone (p = 0.10) as compared with those given placebo. Complication and mortality rates were similar in either group of treated patients as compared with the placebo group. The authors conclude that treatment with the study dose of methylprednisolone is indicated for acute spinal cord trauma, but only if it can be started within 8 hours of injury.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/030/CN-00080030/frame.html

Record #23 of 108
ID: CN-00578283
AU: Bray JW
AU: Zarkin GA
AU: Miller WR
AU: Mitra D
AU: Kivlahan DR
AU: Martin DJ
AU: Couper DJ
AU: Cisler RA
TI: Measuring economic outcomes of alcohol treatment using the Economic Form 90
SO: Journal of studies on alcohol and drugs
YR: 2007
VL: 68
NO: 2
PG: 248-255
PM: PUBMED 17286343
PT: Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural
KY: Absenteeism;Accidents, Traffic [economics];Alcohol Deterrents [economics] [therapeutic use];Alcoholism [classification] [economics] [rehabilitation];Behavior Therapy [economics];Combined Modality Therapy [economics];Cost-Benefit Analysis;Criminal Law [economics];Employment [economics];Follow-Up Studies;Health Care Costs [statistics & numerical data];Health Resources [economics] [utilization];Models, Economic;Naltrexone [economics] [therapeutic use];Prisons [economics];Taurine [analogs & derivatives] [economics] [therapeutic use];Treatment Outcome;United States;Adult[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword]
CC: SR-ADDICTN
AB: METHODWe used baseline data from the Combining Medications and Behavioral Interventions (COMBINE) Study, a large, multisite clinical trial, to assess the extent to which the economic items on the Economic Form 90 instrument can detect differences across levels of alcohol dependence.RESULTSAfter adjusting for differences in demographic characteristics, the Economic Form 90 can detect significant differences across a range of dependence severity levels for the economic outcomes of inpatient medical care, emergency-department medical care, behavioral health care, being on parole or probation, and missed workdays, conditional on being employed. We did not detect significant differences across dependence severity for employment status, outpatient medical care, other criminal justice involvement, or motor vehicle accidents.CONCLUSIONSThe Economic Form 90 can identify differences in many economic outcomes associated with differing levels of alcohol dependence. This suggests that the Economic Form 90 may be useful in assessing changes in economic outcomes that result from changes in alcohol dependence.OBJECTIVEThis article assesses the ability of the economic outcome measures in the Economic Form 90 to detect differences across levels of alcohol dependence as measured by the Alcohol Dependence Scale.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/283/CN-00578283/frame.html

Record #24 of 108
ID: CN-00106917
AU: Duh MS
AU: Shepard MJ
AU: Wilberger JE
AU: Bracken MB
TI: The effectiveness of surgery on the treatment of acute spinal cord injury and its relation to pharmacological treatment
SO: Neurosurgery
YR: 1994
VL: 35
NO: 2
PG: 240-8; discussion 248-9
PM: PUBMED 7969831
PT: Clinical Trial; Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, U.S. Gov't, P.H.S.
KY: Adolescent;Combined Modality Therapy;Disability Evaluation;Double-Blind Method;Follow-Up Studies;Methylprednisolone [therapeutic use];Naloxone [therapeutic use];Neurologic Examination [drug effects];Postoperative Complications [diagnosis];Spinal Cord Injuries [surgery];Treatment Outcome;Adult[checkword];Female[checkword];Humans[checkword];Male[checkword]
CC: SR-ANAESTH: SR-INJ
AB: Using data from the Second National Acute Spinal Cord Injury Study (NASCIS II), the authors sought to characterize the role of surgery in the management of traumatic spinal cord injury and to examine the interaction between pharmacological treatment and surgery. Patients who did not undergo surgery had more severe spinal cord injuries initially than those who had surgery. However, no differences in neurological improvement at 1-year follow-up were found between those who underwent surgery and those who did not. The results suggest that either early surgery (< or = 25 hours after injury) or late surgery (> 200 hours) may be associated with increased neurological recovery, particularly motor function, but these results are equivocal. Surgery was not shown to interact with pharmacological treatments, indicating that the effect of drug treatment in NASCIS II, reported elsewhere, is not influenced by surgery. Other independent variables that best predicted improvement in motor score were age of 25 years or younger, incomplete injury, and lower baseline emergency department neurological scores. This study does not provide clinically relevant evidence concerning the efficacy of timing or the value of surgery in treating patients with spinal cord injuries. A randomized study on the timing and efficacy of spinal cord surgery is needed to obtain valid comparisons of the efficacy of surgical treatments.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/917/CN-00106917/frame.html

Record #25 of 108
ID: CN-00667994
AU: Gille J
AU: Gille M
AU: Gahr R
AU: Wiedemann B
TI: Acute pain management in proximal femoral fractures: femoral nerve block (catheter technique) vs. systemic pain therapy using a clinic internal organisation model
SO: Der anaesthesist
YR: 2006
VL: 55
NO: 4
PG: 414-422
PM: PUBMED 16320011
XR: EMBASE 2006207603
PT: Comparative Study; English Abstract; Journal Article; Randomized Controlled Trial
KY: Acute Disease;Amides;Analgesics, Opioid [therapeutic use];Anesthetics, Local;Catheterization;Femoral Neck Fractures [complications] [surgery];Femoral Nerve;Methimazole [therapeutic use];Models, Organizational;Naloxone [therapeutic use];Narcotic Antagonists [therapeutic use];Nerve Block [adverse effects];Pain [drug therapy] [etiology];Pain Measurement [drug effects];Pain, Postoperative [drug therapy];Prilocaine;Prospective Studies;Tilidine [therapeutic use];Aged[checkword];Aged, 80 and over[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword];aged; analgesia; article; catheter; *catheterization; clinic internal organization model; clinical trial; controlled clinical trial; controlled study; emergency ward; female; *femoral nerve; *femur neck fracture; Germany; human; intermethod comparison; major clinical study; male; model; *nerve block; organization; outcome assessment; *pain/co [Complication]; *pain/dt [Drug Therapy]; pain assessment; passive movement; postoperative care; preoperative treatment; prospective study; randomized controlled trial; rest; *systemic therapy; *dipyrone/ct [Clinical Trial]; *dipyrone/cb [Drug Combination]; *dipyrone/do [Drug Dose]; *dipyrone/dt [Drug Therapy]; *dipyrone/iv [Intravenous Drug Administration]; etomidate; ibuhexal; *ibuprofen/ct [Clinical Trial]; *ibuprofen/cb [Drug Combination]; *ibuprofen/do [Drug Dose]; *ibuprofen/dt [Drug Therapy]; *ibuprofen/po [Oral Drug Administration]; isoflurane; *naloxone/ct [Clinical Trial]; *naloxone/cb [Drug Combination]; *naloxone/do [Drug Dose]; *naloxone/dt [Drug Therapy]; *naloxone/po [Oral Drug Administration]; *prilocaine/ct [Clinical Trial]; *prilocaine/do [Drug Dose]; *prilocaine/dt [Drug Therapy]; rocuronium; *ropivacaine/ct [Clinical Trial]; *ropivacaine/do [Drug Dose]; *ropivacaine/dt [Drug Therapy]; *tilidine/ct [Clinical Trial]; *tilidine/cb [Drug Combination]; *tilidine/do [Drug Dose]; *tilidine/dt [Drug Therapy]; *tilidine/po [Oral Drug Administration]; valoron n
CC: SR-MUSKINJ: SR-SYMPT
DOI: 10.1007/s00101-005-0949-4
AB: METHODS: In a prospective randomised trial of patients attending the emergency department, 100 individuals were selected with a clinically diagnosed proximal femoral fracture. Patients were divided into two equal groups A and B. Group A (n=50) received a catheter-mediated femoral nerve block with 1% prilocaine (40 ml) and post-operatively 0.2% ropivacaine (30 ml) 6 hourly. Group B (n=50) initially received intravenous metamizol (1 g) and a fixed combination of oral tilidine (100 mg) + naloxone (8 mg). Patients aged 90 years or more received a reduced dose (tilidine 75 mg + naloxone 6 mg). In the post-operative period regular oral ibuprofen (400 mg, 8 hourly) in addition to oral tilidine (50 mg) + naloxone (4 mg) was given as required for break through pain. Pain intensity was measured using a verbal rating scale (VRS) from 1 to 5: pain free (=1), mild pain (=2), moderate pain (=3), severe pain (=4), excruciating pain (=5). Pain scores were recorded at rest (R), during passive anteflection (30 degrees) of the hip (PA) on arrival and at 15 and 30 min after initial administration of analgesia. Thereafter, recordings were made 4 times a day up to the third post-operative day.RESULTS: Pain scores were comparable for both groups on admission (VRS in R 2.50 vs. 2.46; VRS during PA 4.30 vs. 4.34). Significant pain relief was achieved in both groups following initial administration of analgesia, but the total pain scores in group A were significantly lower than in group B (VRS in R 1.22 vs. 1.58, p<0.01 and VRS during PA 2.66 vs. 3.26; p<0.001). No difference was noted between the two groups during the first 3 post-operative days. No severe complications occurred as a result of analgesia, however, the catheter was dislodged in 20% of patients in group A resulting in the need for systemically administered analgesia.CONCLUSION: All patients presenting with proximal femoral fractures should receive adequate analgesia within the emergency department even prior to radiographic imaging. Femoral nerve block should be considered as the method of choice. The insertion of a femoral nerve block catheter has the dual advantage of early analgesia permitting repeated clinical examination in addition to continued post-operative pain management. The cumbersome logistics inherent in this technique within the clinical setting limits its practical application. An initial single-shot regional nerve block followed by a systemic post-operative analgesia protocol was considered an appropriate alternative. The execution of safe, consistent and appropriate regional nerve block anaesthesia is reliant on formal guidelines and protocols as agreed by the multidisciplinary teams involved with patient-directed pain management and good clinical practice.BACKGROUND: The aim of this study was to compare safety and efficacy of catheter-mediated femoral nerve block analgesia with systemic pain therapy in patients with proximal femoral fractures in the pre-operative and post-operative setting using a protocol for coordinating pain management.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/994/CN-00667994/frame.html

Record #26 of 108
ID: CN-00845276
AU: Kelty E
AU: Ngo H
AU: Hulse G
TI: Assessing the usefulness of health data linkage in obtaining adverse event data in a randomised controlled trial of oral and implant naltrexone in the treatment of heroin dependence
SO: Clinical trials (london, england)
YR: 2013
VL: 10
NO: 1
PG: 170-180
PM: PUBMED 23241479
PT: Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
KY: Administration, Oral;Adverse Drug Reaction Reporting Systems;Data Collection;Drug Implants;Drug-Related Side Effects and Adverse Reactions;Follow-Up Studies;Heroin Dependence [drug therapy];Naltrexone [administration & dosage];Randomized Controlled Trials as Topic [methods];Self Report;Female[checkword];Humans[checkword];Male[checkword]
CC: SR-ADDICTN
DOI: 10.1177/1740774512467237
AB: PURPOSEThis study assesses the usefulness of a health data linkage system in obtaining SAE data in a randomised controlled study of oral and implant naltrexone.METHODSSAEs were collected from 68 heroin-dependent subjects during a randomised controlled trial of oral and implant naltrexone with follow-up to 26 weeks. Patient self-report data were cross-matched against hospital and emergency department (ED) attendances for the same period using a health data linkage system.RESULTSA total of 29 hospital admissions and 74 ED attendances were identified using health data linkage. Of these, 12 (41.4%) hospital admissions and 50 (67.7%) of ED attendances had not been reported as SAE in the randomised controlled trial. In subjects participating in the trial at the time of the event, there was a 1.25-fold increase in the number of hospital admissions and a 2.25-fold increase in the number of ED attendances recorded using data linkage. Overall (including withdrawn subjects or those lost to follow-up), there was a 1.71-fold increase in hospital admission and a 3.09-fold increase in ED attendance recorded.LIMITATIONSThe use of data linkage should not be used as a replacement for thorough follow-up, as the datasets can take substantial periods to update, making them a poor substitute for real-time follow-up. Additionally, some SAEs such as life-threatening events that do not involve ED or hospital attendance may be overlooked as would SAEs that occurred outside the dataset's range, for example, interstate or overseas.CONCLUSIONSHealth data linkage can be used to effectively reduce the extent of missing health data in a clinical trial.BACKGROUNDThe completeness of self-reported serious adverse events (SAEs) in clinical trials can be reduced by inaccuracies in subject reporting and lost to follow-up.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/276/CN-00845276/frame.html

Record #27 of 108
ID: CN-01137854
AU: Rathlev N
AU: Almomen R
AU: Deutsch A
AU: Smithline H
AU: Li H
AU: Visintainer P
TI: Randomized Controlled Trial of Electronic Care Plan Alerts and Resource Utilization by High Frequency Emergency Department Users with Opioid Use Disorder
SO: Western journal of emergency medicine
YR: 2016
VL: 17
NO: 1
PG: 28-34
PM: PUBMED 26823927
XR: EMBASE 20160163388
PT: Journal Article; Randomized Controlled Trial
KY: Analgesics, Opioid [economics] [therapeutic use];Electronic Health Records;Emergency Service, Hospital [statistics & numerical data] [utilization];Hospitalization;Longitudinal Studies;Opioid-Related Disorders [drug therapy] [epidemiology];Patient Discharge;Patient Selection;Practice Patterns, Physicians' [statistics & numerical data];Reminder Systems;United States [epidemiology];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword];adult; clinical article; computer assisted tomography; controlled study; cost control; *electronic alert care plan; *electronic medical record; emergency patient; emergency ward; female; health care cost; health care utilization; health personnel attitude; hospital admission; hospital charge; hospital discharge; hospital patient; human; intention to treat analysis; intervention study; male; middle aged; morphine addiction/dm [Disease Management]; multicenter study; nuclear magnetic resonance imaging; *opiate addiction/dm [Disease Management]; outcome assessment; parallel design; *patient care planning; prescription; randomized controlled trial; *resource allocation; review; morphine; opiate; prescription drug
CC: SR-ADDICTN
DOI: 10.5811/westjem.2015.11.28319
AB: Introduction: There is a paucity of literature supporting the use of electronic alerts for patients with high frequency emergency department (ED) use. We sought to measure changes in opioid prescribing and administration practices, total charges and other resource utilization using electronic alerts to notify providers of an opioid-use care plan for high frequency ED patients. Methods: This was a randomized, non-blinded, two-group parallel design study of patients who had 1) opioid use disorder and 2) high frequency ED use. Three affiliated hospitals with identical electronic health records participated. Patients were randomized into "Care Plan" versus "Usual Care groups". Between the years before and after randomization, we compared as primary outcomes the following: 1) opioids (morphine mg equivalents) prescribed to patients upon discharge and administered to ED and inpatients; 2) total medical charges, and the numbers of; 3) ED visits, 4) ED visits with advanced radiologic imaging (computed tomography [CT] or magnetic resonance imaging [MRI]) studies, and 5) inpatient admissions. Results: A total of 40 patients were enrolled. For ED and inpatients in the "Usual Care" group, the proportion of morphine mg equivalents received in the post-period compared with the pre-period was 15.7%, while in the "Care Plan" group the proportion received in the post-period compared with the pre-period was 4.5% (ratio=0.29, 95% CI [0.07-1.12]; p=0.07). For discharged patients in the "Usual Care" group, the proportion of morphine mg equivalents prescribed in the post-period compared with the pre-period was 25.7% while in the "Care Plan" group, the proportion prescribed in the post-period compared to the pre-period was 2.9%. The "Care Plan" group showed an 89% greater proportional change over the periods compared with the "Usual Care" group (ratio=0.11, 95% CI [0.01-0.092]; p=0.04). Care plans did not change the total charges, or, the numbers of ED visits, ED visits with CT or MRI or inpatient admissions. Conclusion: Electronic care plans were associated with an incremental decrease in opioids (in morphine mg equivalents) prescribed to patients with opioid use disorder and high frequency ED use.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/854/CN-01137854/frame.html

Record #28 of 108
ID: CN-01069821
AU: D'Onofrio G
AU: O'Connor PG
AU: Pantalon MV
AU: Chawarski MC
AU: Busch SH
AU: Owens PH
AU: Bernstein SL
AU: Fiellin DA
TI: Emergency department-initiated buprenorphine/naloxone treatment for opioid dependence: a randomized clinical trial
SO: JAMA - journal of the american medical association
YR: 2015
VL: 313
NO: 16 // 5R01DA025991 (NIDA) *National Institute on Drug Abuse*
PG: 1636-1644
XR: EMBASE 2015003107
PT: Journal: Article
KY: adult; article; brief intervention; controlled study; drug efficacy; *emergency care; female; follow up; hospital service; human; Human immunodeficiency virus infection; infection risk; major clinical study; male; *opiate addiction/dt [Drug Therapy]; outcome assessment; patient referral; primary medical care; priority journal; randomized controlled trial; screening; self report; social welfare; teaching hospital; therapy; urinalysis; *buprenorphine plus naloxone/ct [Clinical Trial]; *buprenorphine plus naloxone/pd [Pharmacology]; *buprenorphine plus naloxone/dt [Drug Therapy]; opiate
CC: SR-ADDICTN
DOI: 10.1001/jama.2015.3474
AB: IMPORTANCE: Opioid-dependent patients often use the emergency department (ED) for medical care. OBJECTIVE: To test the efficacy of 3 interventions for opioid dependence: (1) screening and referral to treatment (referral); (2) screening, brief intervention, and facilitated referral to community-based treatment services (brief intervention); and (3) screening, brief intervention, ED-initiated treatment with buprenorphine/naloxone, and referral to primary care for 10-week follow-up (buprenorphine). DESIGN, SETTING, AND PARTICIPANTS: A randomized clinical trial involving 329 opioid-dependent patients who were treated at an urban teaching hospital ED from April 7, 2009, through June 25, 2013. INTERVENTIONS: After screening, 104 patients were randomized to the referral group, 111 to the brief intervention group, and 114 to the buprenorphine treatment group. MAIN OUTCOMES AND MEASURES: Enrollment in and receiving addiction treatment 30 days after randomization was the primary outcome. Self-reported days of illicit opioid use, urine testing for illicit opioids, human immunodeficiency virus (HIV) risk, and use of addiction treatment services were the secondary outcomes. RESULTS: Seventy-eight percent of patients in the buprenorphine group (89 of 114 [95% CI, 70%-85%]) vs 37% in the referral group (38 of 102 [95% CI, 28%-47%]) and 45% in the brief intervention group (50 of 111 [95% CI, 36%-54%]) were engaged in addiction treatment on the 30th day after randomization (P < .001). The buprenorphine group reduced the number of days of illicit opioid use perweek from 5.4 days (95% CI, 5.1-5.7) to 0.9 days (95% CI, 0.5-1.3) vs a reduction from 5.4 days (95% CI, 5.1-5.7) to 2.3 days (95% CI, 1.7-3.0) in the referral group and from 5.6 days (95% CI, 5.3-5.9) to 2.4 days (95% CI, 1.8-3.0) in the brief intervention group (P < .001 for both time and intervention effects; P = .02 for the interaction effect). The rates of urine samples that tested negative for opioids did not differ statistically across groups, with 53.8% (95% CI, 42%-65%) in the referral group, 42.9% (95% CI, 31%-55%) in the brief intervention group, and 57.6% (95% CI, 47%-68%) in the buprenorphine group (P = .17). There were no statistically significant differences in HIV risk across groups (P = .66). Eleven percent of patients in the buprenorphine group (95% CI, 6%-19%) used inpatient addiction treatment services, whereas 37% in the referral group (95% CI, 27%-48%) and 35% in the brief intervention group (95% CI, 25%-37%) used inpatient addiction treatment services (P < .001). CONCLUSIONS AND RELEVANCE: Among opioid-dependent patients, ED-initiated buprenorphine treatment vs brief intervention and referral significantly increased engagement in addiction treatment, reduced self-reported illicit opioid use, and decreased use of inpatient addiction treatment services but did not significantly decrease the rates of urine samples that tested positive for opioids or of HIV risk. These findings require replication in other centers before widespread adoption. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00913770.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/821/CN-01069821/frame.html

Record #29 of 108
ID: CN-00723104
AU: Chang AK
AU: Bijur PE
AU: Davitt M
AU: Gallagher EJ
TI: Randomized clinical trial comparing a patient-driven titration protocol of intravenous hydromorphone with traditional physician-driven management of emergency department patients with acute severe pain
SO: Annals of emergency medicine
YR: 2009
VL: 54
NO: 4
PG: 561-567.e2
PM: PUBMED 19560838
PT: Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
KY: Analgesia, Patient-Controlled;Analgesics, Opioid [administration & dosage];Critical Pathways;Drug Administration Schedule;Emergency Service, Hospital;Hydromorphone [administration & dosage];Infusions, Intravenous;New York;Pain [drug therapy];Pain Measurement;Patient Satisfaction;Adult[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword]
CC: SR-SYMPT
DOI: 10.1016/j.annemergmed.2009.05.003
AB: METHODSThis was a prospective randomized clinical trial of nonelderly adults presenting to an urban academic ED with acute pain of sufficient severity to warrant intravenous (IV) opioids in the judgment of the attending physician. Patients randomized to the 1+1 hydromorphone patient-driven protocol received 1 mg IV hydromorphone followed by a second 1-mg dose 15 minutes later if the patient responded affirmatively to the question, "Do you want more pain medication?" Patients in the physician-driven group received any IV opioid in the dose chosen by the ED attending physician, with any additional analgesia provided at the discretion of that physician. The primary outcome was the difference in improvement in pain between the 2 groups at 60 minutes, as measured by a validated and reproducible numeric rating scale. Secondary outcomes included incidence of oxygen desaturation, hypoventilation, hypotension, bradycardia, nausea, vomiting, pruritus, and use of naloxone.RESULTSThe mean decrease in numeric rating scale pain scores for the 1+1 hydromorphone patient-driven group was 5.6 versus 4.5 in the physician-driven group. The difference of 1.1 numeric rating scale units (95% confidence interval 0.3 to 1.9) was statistically significant but fell 0.2 numeric rating scale units short of the 1.3 numeric rating scale unit threshold required to attain clinically significant efficacy. Safety profiles were similarly satisfactory in both groups. Ninety-four percent of the 1+1 hydromorphone patient-driven group achieved adequate analgesia (as defined by the patient) within 60 minutes of protocol initiation.CONCLUSIONThe 1+1 hydromorphone patient-driven protocol is statistically superior and at least as clinically efficacious and safe as traditional physician-driven treatment of ED patients with acute severe pain. More than 9 of 10 patients randomized to the study protocol achieved satisfactory pain control, as defined by the patient, within an hour or less.STUDY OBJECTIVEWe test the null hypothesis that the "1+1" hydromorphone patient-driven protocol is clinically and statistically equivalent in safety and efficacy to that of traditional physician-driven administration of opioids for emergency department (ED) treatment of acute severe pain.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/104/CN-00723104/frame.html

Record #30 of 108
ID: CN-00917929
AU: Chang AK
AU: Bijur PE
AU: Davitt M
AU: Gallagher EJ
TI: Randomized clinical trial of an intravenous hydromorphone titration protocol versus usual care for management of acute pain in older emergency department patients
SO: Drugs & aging
YR: 2013
VL: 30
NO: 9
PG: 747-754
PM: PUBMED 23846749
XR: EMBASE 369697134
PT: Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural
KY: Acute Pain [drug therapy];Administration, Intravenous;Emergency Service, Hospital;Hydromorphone [administration & dosage] [adverse effects] [therapeutic use];Time Factors;Aged[checkword];Female[checkword];Humans[checkword];Male[checkword];aged; analgesia; clinical protocol; controlled study; disease severity; drug dose increase; drug dose regimen; drug dose titration; drug efficacy; drug safety; *emergency patient; *emergency ward; female; *geriatric patient; human; hypotension/si [Side Effect]; low drug dose; major clinical study; male; nausea/si [Side Effect]; outcome assessment; oxygen blood level; *pain/dt [Drug Therapy]; pain/dt [Drug Therapy]; pain assessment; patient care; patient satisfaction; priority journal; prospective study; pruritus/si [Side Effect]; randomized controlled trial; review; side effect/si [Side Effect]; vomiting/si [Side Effect]; analgesic agent/dt [Drug Therapy]; *hydromorphone/ae [Adverse Drug Reaction]; *hydromorphone/ct [Clinical Trial]; *hydromorphone/cm [Drug Comparison]; *hydromorphone/do [Drug Dose]; *hydromorphone/dt [Drug Therapy]; *hydromorphone/iv [Intravenous Drug Administration]; *morphine/ae [Adverse Drug Reaction]; *morphine/ct [Clinical Trial]; *morphine/cm [Drug Comparison]; *morphine/dt [Drug Therapy]; *morphine/iv [Intravenous Drug Administration]; naloxone; adult; *clinical trial; drug therapy; *human; *pain; *patient; physician; safety; *titrimetry; *hydromorphone; morphine; opiate
DOI: 10.1007/s40266-013-0103-y
AB: METHODSThis was a prospective, randomized clinical trial of patients 65 years of age and older presenting to an adult, urban, academic ED with acute severe pain. The study was registered at http://www.clinicaltrials.gov (NCT01429285). Patients randomized to the hydromorphone titration protocol initially received 0.5 mg intravenous hydromorphone. Patients randomized to usual care received any dose of any intravenous opioid. At 15 min, patients in both groups were asked, 'Do you want more pain medication?' Patients in the hydromorphone titration group who answered 'yes' received a second dose of 0.5 mg intravenous hydromorphone. Patients in the usual care group who answered 'yes' had their ED attending physician notified, who then could administer any (or no) additional medication. The primary efficacy outcome was satisfactory analgesia defined a priori as the patient declining additional analgesia at least once when asked at 15 or 60 min after administration of the initial opioid. Dose was calculated in morphine equivalent units (MEU: 1 mg hydromorphone = 7 mg morphine). The need for naloxone to reverse adverse opioid effects was the primary safety outcome.RESULTS83.0 % of 153 patients in the hydromorphone titration group achieved satisfactory analgesia compared with 82.5 % of 166 patients in the usual care group (p = 0.91). Patients in the hydromorphone titration group received lower mean initial doses of opioids at baseline than patients in the usual care group (3.5 MEU vs. 4.7 MEU, respectively; p ≤ 0.001) and lower total opioids through 60 min (5.3 MEU vs. 6.0 MEU; p = 0.03). No patient needed naloxone.CONCLUSIONSLow-dose titration of intravenous hydromorphone in increments of 0.5 mg provides comparable analgesia to usual care with less opioid over 60 min.BACKGROUND AND OBJECTIVESOpioid titration is an effective strategy for treating pain; however, titration is generally impractical in the busy emergency department (ED) setting. Our objective was to test a rapid, two-step, hydromorphone titration protocol against usual care in older patients presenting to the ED with acute severe pain.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/929/CN-00917929/frame.html

Record #31 of 108
ID: CN-00720672
AU: Miner JR
AU: Moore J
AU: Gray RO
AU: Skinner L
AU: Biros MH
TI: Oral versus intravenous opioid dosing for the initial treatment of acute musculoskeletal pain in the emergency department
SO: Academic emergency medicine
YR: 2008
VL: 15
NO: 12
PG: 1234-1240
PM: PUBMED 18945240
PT: Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
KY: Acute Disease;Administration, Oral;Adolescent;Analgesics, Opioid [administration & dosage];Drug Administration Schedule;Emergency Service, Hospital;Infusions, Intravenous;Morphine [administration & dosage];Musculoskeletal Diseases [complications];Oxycodone [administration & dosage];Pain [diagnosis] [drug therapy] [etiology];Pain Measurement;Prospective Studies;Treatment Outcome;Adult[checkword];Aged[checkword];Aged, 80 and over[checkword];Child[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword];Young Adult[checkword]
CC: SR-SYMPT
DOI: 10.1111/j.1553-2712.2008.00266.x
AB: METHODSThis was a prospective randomized clinical trial of patients >6 years old who were going to receive IV morphine sulfate for the treatment of musculoskeletal pain but did not yet have an IV. Consenting patients were randomized to have the treating physician order either 0.1 mg/kg morphine sulfate IV or 0.125 mg/kg oxycodone orally in a 5 mg/5 mL suspension as their initial treatment for pain. The time from the placement of the order to the administration of the medication was recorded. Pain was measured using a 100-mm visual analog scale (VAS) and recorded at 0, 10, 20, 30 and 40 minutes after drug administration.RESULTSA total of 405 eligible patients were identified during the study period; 328 (81.0%) patients consented to be in the study. A total of 158 patients were randomized to the IV morphine sulfate treatment group, and 162 were randomized to the oral oxycodone treatment group. Of the patients who were randomized to IV therapy, 34 were withdrawn from the study prior to drug administration; leaving 125 patients in the IV group for analysis. Of the patients who randomized to oral therapy, 22 were withdrawn from the study prior to drug administration, leaving 140 patients for analysis. No serious adverse events were detected. There was a 12-minute difference between the median time of the order and the administration of oral oxycodone (8.5 minutes) and IV morphine (20.5 minutes). The mean percent change in VAS score was larger for patients in the IV therapy group than those in the oral therapy group at 10 and 20 minutes. At 30 and 40 minutes, the authors could no longer detect a difference. The satisfaction scale score was higher after treatment for the morphine group (median = 4; interquartile range [IQR] = 4 to 5) than for the oxycodone group (median = 4; IQR = 2 to 5; p = 0.008).CONCLUSIONSThe oral loading strategy was associated with delayed onset of analgesia and decreased patient satisfaction, but a shorter time to administration. The oral loading strategy using an oxycodone solution provided similar pain relief to the IV strategy using morphine 30 minutes after administration of the drug. Oral 0.125 mg/kg oxycodone represents a feasible alternative to 0.1 mg/kg IV morphine in the treatment of severe acute musculoskeletal pain when difficult or delayed IV placement greater than 30 minutes presents a barrier to treatment.OBJECTIVESThe objective was to compare the time to medication administration, the side effects, and the analgesic effect at sequential time points after medication administration of an oral treatment strategy using oxycodone solution with an intravenous (IV) treatment strategy using morphine sulfate for the initial treatment of musculoskeletal pain in emergency department (ED) patients.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/672/CN-00720672/frame.html

Record #32 of 108
ID: CN-01413741
AU: Neven D
AU: Paulozzi L
AU: Howell D
AU: McPherson S
AU: Murphy SM
AU: Grohs B
AU: Marsh L
AU: Lederhos C
AU: Roll J
TI: A Randomized Controlled Trial of a Citywide Emergency Department Care Coordination Program to Reduce Prescription Opioid Related Emergency Department Visits
SO: Journal of emergency medicine
YR: 2016
VL: 51
NO: 5
PG: 498-507
PM: PUBMED 27624507
PT: Journal Article; Randomized Controlled Trial
KY: Analgesics, Opioid [adverse effects] [therapeutic use];Chi-Square Distribution;Continuity of Patient Care [statistics & numerical data] [trends];Cooperative Behavior;Drug Overdose [prevention & control];Emergency Service, Hospital [organization & administration] [utilization];Pain [drug therapy];Prescription Drug Misuse [adverse effects] [statistics & numerical data];Washington;Adult[checkword];Female[checkword];Humans[checkword];Male[checkword]
CC: SR-ADDICTN
DOI: 10.1016/j.jemermed.2016.06.057
AB: OBJECTIVES: We hypothesized that the care of frequent ED users would improve using a citywide care coordination program combined with an ED care coordination information system, as measured by fewer ED visits by and decreased controlled substance prescribing to these patients.METHODS: We conducted a multisite randomized controlled trial (RCT) across all EDs in a metropolitan area; 165 patients with the most ED visits for complaints of pain were randomized. For the treatment arm, drivers of ED use were identified by medical record review. Patients and their primary care providers were contacted by phone. Each patient was discussed at a community multidisciplinary meeting where recommendations for ED care were formed. The ED care recommendations were stored in an ED information exchange system that faxed them to the treating ED provider when the patient presented to the ED. The control arm was subjected to treatment as usual.RESULTS: The intervention arm experienced a 34% decrease (incident rate ratios = 0.66, p  6 breaths/minute. Nebulized naloxone (2 mg in 3 mL normal saline) was administered through a standard face mask at the discretion of the treating physician. Structured data collection included demographics, vital signs pre and post naloxone administration and adverse events. The primary outcome was level of consciousness, which was recorded pre and 15 minutes postnaloxone administration using the Glasgow Coma Scale (GCS) and the Richmond Agitation Sedation Scale (RASS). Results: Of the 73 patients who presented with suspected opioid intoxication and were given naloxone over the study period, 26 were initially treated with nebulized naloxone. After nebulized naloxone administration, median GCS improved from 11 [interquartile range (IQR) 3.5] to 13 (IQR, 2.5), P =.001. Median RASS improved from - 3.0 (IQR, - 1.0) to - 2.0 (IQR, - 1.5), P 88,000 visits).SUBJECTS: One hundred and seventy four discharged ED patients prescribed hydrocodone-acetaminophen for acute pain.METHODS: The study analyzed data collected from a randomized controlled trial investigating patients' knowledge of opioids. ED patients discharged with hydrocodone-acetaminophen completed an audio-recorded phone interview 4–7 days later. This analysis focuses on responses about addiction. Responses were categorized using content analysis; thematic analysis identified broad themes common across different categories.RESULTS: Participants' mean age was 45.5 years (SD, 14.8), 58.6% female, 50.6% white, and the majority had an orthopedic diagnosis (24.1% back pain, 52.3% other injuries). Responses were categorized first based on whether the patient believed that opioids could be addictive (categorized as: yes, 58.7%; no, 19.5%; depends, 17.2%; or do not know, 4.6%), and second based on whether or not the patient discussed his/her own experience with the medication (categorized as: personalized, 35.6%; or not personalized, 64.4%). Cohen's Kappa was 0.84 for all categories. Three themes emerged in the thematic analysis: theme 1) patients expect to “feel” addicted if they are addicted, theme 2) patients fear addiction, and theme 3) side effects affected patient views of addiction.CONCLUSION: In this sample, patients had misconceptions about opioid addiction. Some patients did not know opioids could be addictive, others underestimated their personal risk of addiction, and others overtly feared addiction and, therefore, risked inadequate pain management. Despite limited data, we recommend providers discuss opioid addiction with their patients.OBJECTIVE: To characterize emergency department (ED) patients' knowledge and beliefs about the addictive potential of opioids.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/762/CN-01260762/frame.html

Record #37 of 108
ID: CN-01454799
AU: D'Onofrio G
AU: Chawarski MC
AU: O'Connor PG
AU: Pantalon MV
AU: Busch SH
AU: Owens PH
AU: Hawk K
AU: Bernstein SL
AU: Fiellin DA
TI: Emergency Department-Initiated Buprenorphine for Opioid Dependence with Continuation in Primary Care: outcomes During and After Intervention
SO: Journal of general internal medicine
YR: 2017
VL: 32
NO: 6
PG: 660-666
PM: PUBMED 28194688
PT: Journal Article; Randomized Controlled Trial
KY: Buprenorphine [therapeutic use];Emergency Service, Hospital;Follow-Up Studies;Narcotic Antagonists [therapeutic use];Opiate Substitution Treatment [methods];Opioid-Related Disorders [drug therapy] [urine];Outcome Assessment (Health Care);Primary Health Care [methods];Referral and Consultation;Self Report;Adult[checkword];Female[checkword];Humans[checkword];Male[checkword];Young Adult[checkword]
DOI: 10.1007/s11606-017-3993-2
AB: OBJECTIVE: To evaluate the long-term outcomes at 2, 6 and 12 months following ED interventions.DESIGN: Evaluation of treatment engagement, drug use, and HIV risk among a cohort of patients from a randomized trial who completed at least one long-term follow-up assessment.PARTICIPANTS: A total of 290/329 patients (88% of the randomized sample) were included. The followed cohort did not differ significantly from the randomized sample.INTERVENTIONS: ED-initiated buprenorphine with 10-week continuation in primary care, referral, or brief intervention were provided in the ED at study entry.MAIN MEASURES: Self-reported engagement in formal addiction treatment, days of illicit opioid use, and HIV risk (2, 6, 12 months); urine toxicology (2, 6 months).KEY RESULTS: A greater number of patients in the buprenorphine group were engaged in addiction treatment at 2 months [68/92 (74%), 95% CI 65-83] compared with referral [42/79 (53%), 95% CI 42-64] and brief intervention [39/83 (47%), 95% CI 37-58; p 90%) are discharged to home after evaluation. Acute musculoskeletal pain is the norm in this population, and such patients are typically discharged to home with prescriptions for oral opioid analgesics or nonsteroidal antiinflammatory drugs (NSAIDs). The influence of acute pain management on subsequent pain outcomes in this common ED population is unknown. We evaluated the effect of opioid analgesics vs NSAIDs initiated from the ED on the presence of moderate to severe musculoskeletal pain and ongoing opioid use at 6 weeks in a large cohort of adult ED patients presenting to the ED after MVC (n = 948). The effect of opioids vs NSAIDs was evaluated using an innovative quasi-experimental design method using propensity scores to account for covariate imbalances between the 2 treatment groups. No difference in risk for moderate to severe musculoskeletal pain at 6 weeks was observed between those discharged with opioid analgesics vs NSAIDs (risk difference = 7.2% [95% confidence interval: -5.2% to 19.5%]). However, at follow-up participants prescribed opioids were more likely than those prescribed NSAIDs to report use of prescription opioids medications at week 6 (risk difference = 17.5% [95% confidence interval: 5.8%-29.3%]). These results suggest that analgesic choice at ED discharge does not influence the development of persistent moderate to severe musculoskeletal pain 6 weeks after an MVC, but may result in continued use of prescription opioids. Supported by NIAMS R01AR056328 and AHRQ 5K12HS022998.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/558/CN-01424558/frame.html

Record #43 of 108
ID: CN-01118326
AU: Field CA
AU: Cochran G
AU: Caetano R
AU: Foreman M
AU: Brown CV
TI: Postdischarge nonmedical use of prescription opioids in at-risk drinkers admitted to urban level I trauma centers
SO: The journal of trauma and acute care surgery
YR: 2014
VL: 76
NO: 3
PG: 833-839
PM: PUBMED 24553557
PT: Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural
KY: Alcoholism [complications] [prevention & control] [psychology];Analgesics, Opioid [therapeutic use];Hospitals, Urban [statistics & numerical data];Motivational Interviewing;Patient Discharge [statistics & numerical data];Prescription Drug Misuse [statistics & numerical data];Risk Factors;Trauma Centers [statistics & numerical data];Adult[checkword];Female[checkword];Humans[checkword];Male[checkword]
DOI: 10.1097/TA.0000000000000100
AB: METHODSThis secondary analysis examines NM-PO from two separate randomized trials that delivered brief alcohol interventions to patients in urban Level I trauma centers. In the first study, data were collected from 1,493 injured patients at a single trauma center, and in the second study, data were collected from 596 injured patients at two trauma centers. All participants were considered at-risk drinkers because they were admitted for an alcohol related injury as indicated by a positive blood alcohol concentration and/or self-reported heavy drinking.RESULTSIn Study 1, NM-PO nearly doubled from 5.2% before admission to 9.8% at 6 months after discharge. At 12 months after discharge, those who reported NM-PO (odds ratio [OR], 2.31; 95% confidence interval [CI], 1.28-4.15) and drug use (OR, 2.62, 95% CI, 1.70-4.04) before admission had the highest odds for postdischarge NM-PO. In Study 2, NM-PO increased from 5.2% before admission to 6.8% at 12 months after discharge. At 12 months after discharge, those who reported NM-PO (OR, 2.71; 95% CI, 1.10-6.66) or drug use (OR, 4.05; 95% CI, 2.00-8.21) before admission had the highest odds for postdischarge NM-PO.CONCLUSIONThe results suggest that there is an increased risk of postdischarge NM-PO among injured patients with at-risk drinking, particularly among those with a recent history of drug use or NM-PO. Cautious, evidence-based opioid prescribing may reduce exposure to prescription opioids in high-risk patients, risk of subsequent misuse, and possible diversion.LEVEL OF EVIDENCEPrognostic/epidemiologic study, level II.BACKGROUNDNonmedical use of prescription opioids (NM-POs) has reached epidemic proportions in the United States. Unintentional overdose deaths involving prescription opioids have quadrupled since 1999. Herein, we examine NM-POs and their associated risk factors among two cohorts of trauma patients with at-risk drinking.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/326/CN-01118326/frame.html

Record #44 of 108
ID: CN-00460166
AU: Miller PL
AU: Ernst AA
TI: Sex differences in analgesia: a randomized trial of mu versus kappa opioid agonists
SO: Southern medical journal
YR: 2004
VL: 97
NO: 1
PG: 35-41
PM: PUBMED 14746420
PT: Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
KY: Analgesics, Opioid [therapeutic use];Analysis of Variance;Butorphanol [therapeutic use];Diastole [drug effects];Double-Blind Method;Emergency Service, Hospital;Morphine [therapeutic use];Narcotic Antagonists [therapeutic use];Pain [drug therapy] [etiology];Pain Measurement;Sex Characteristics;Time Factors;Treatment Outcome;Wounds and Injuries [complications];Adult[checkword];Female[checkword];Humans[checkword];Male[checkword]
CC: SR-ANAESTH: SR-SYMPT
AB: METHODSThe study was a randomized, double-blind, clinical trial comparing the prototypical mu-receptor agonist, morphine sulfate, to the prototypical kappa agonist, butorphanol. The primary endpoints were degree of relief by visual analog scores at 30 and 60 minutes. Statistical analysis was performed using Mann-Whitney Utest for nonparametric analysis and repeated-measures analysis of variance.RESULTSNinety-four patients were entered in the study, with 49 (52%) males and 45 (48%) females. Forty-six received morphine sulfate and 48 received butorphanol. There was no difference in demographics in the two groups. At 60 minutes, females had significantly lower visual analog scores with butorphanol compared with morphine (P = 0.046). At 60 minutes, there was a trend for a difference in response of males versus females to morphine, with males responding better than females (P = 0.06).CONCLUSIONFemales had better pain scores with butorphanol than morphine at 60 minutes.OBJECTIVESWe sought to evaluate whether there is a sex difference in the analgesic response to mu versus kappa opioids in the management of acute moderate to severe pain of injury in the emergency department.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/166/CN-00460166/frame.html

Record #45 of 108
ID: CN-01167522
AU: Samuels EA
AU: Dwyer K
AU: Mello MJ
AU: Baird J
AU: Kellogg AR
AU: Bernstein E
TI: Emergency Department-based Opioid Harm Reduction: moving Physicians from Willing to Doing
SO: Academic emergency medicine
YR: 2016
VL: 23
NO: 4
PG: 455-465
XR: EMBASE 609296955
PT: Journal: Conference Paper
KY: clinical practice; confidence interval; Cronbach alpha coefficient; doctor patient relation; drug overdose; education; emergency medicine; *emergency ward; genetic polymorphism; *harm reduction; human; human experiment; leadership; linear regression analysis; medical society; *physician; prescription; principal component analysis; syringe; tertiary care center; Theory of Planned Behavior; validation process; methadone; naloxone; *opiate
DOI: 10.1111/acem.12910
AB: Objectives Develop and internally validate a survey tool to assess emergency department (ED) physician attitudes, clinical practice, and willingness to perform opiate harm reduction (OHR) interventions and to identify barriers and facilitators in translating willingness to action. Methods This study was an anonymous, Web-based survey based on the Theory of Planned Behavior of ED physicians at three tertiary referral centers. Construction and internal validation of scaled questions was assessed through principal component and Cronbach's alpha analyses. Stepwise linear regression was conducted to measure impact of physician knowledge, attitudes, confidence, and self-efficacy on willingness to perform OHR interventions including opioid overdose education; naloxone prescribing; and referral to naloxone, methadone, and syringe access programs. Results A total of 200 of 278 (71.9%) physicians completed the survey. Principal component analysis yielded five components: attitude, confidence, self-efficacy, professional impact factors, and personal impact factors. Overall, respondents were willing to perform OHR interventions, but few actually do. Willingness was correlated with attitude, confidence, and self-efficacy (R2 = 0.50); however, overall physicians lacked confidence (mean = 3.06 of 5, 95% confidence interval [CI] = 2.94 to 3.18]). Knowledge, time, training, and institutional support were all prohibitive barriers. Physicians reported that research evidence, professional organization recommendations, and opinions of ED leaders would strongly influence a change in their clinical practice to incorporate OHR interventions (mean = 4.25 of 5, 95% CI = 4.18 to 4.32). Conclusions Compared to prior studies, emergency medicine physicians had increased willingness to perform OHR interventions, but there remains a disparity between willingness and clinical practice. Influential factors that may move physicians from "willing" to "doing" include dissemination of supportive research evidence; professional organization endorsement; ED leadership opinion; and addressing time, knowledge, and institutional barriers. Copyright © 2016 by the Society for Academic Emergency Medicine.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/522/CN-01167522/frame.html

Record #46 of 108
ID: CN-00567836
AU: Gallagher EJ
AU: Esses D
AU: Lee C
AU: Lahn M
AU: Bijur PE
TI: Randomized clinical trial of morphine in acute abdominal pain
SO: Annals of emergency medicine
YR: 2006
VL: 48
NO: 2
PG: 150-60, 160.e1-4
PM: PUBMED 16953529
XR: EMBASE 44062022
PT: Journal Article; Randomized Controlled Trial
KY: Abdomen, Acute [diagnosis] [etiology] [prevention & control];Analgesics, Opioid [therapeutic use];Double-Blind Method;Emergency Service, Hospital;Logistic Models;Morphine [therapeutic use];Pain Measurement;Prospective Studies;Adult[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword];*acute abdomen/di [Diagnosis]; *acute abdomen/dt [Drug Therapy]; adult; article; clinical trial; controlled clinical trial; controlled study; diagnostic accuracy; diagnostic error; double blind procedure; emergency ward; female; follow up; health status; human; hypotension/si [Side Effect]; male; nausea/si [Side Effect]; physician; priority journal; randomized controlled trial; visual analog scale; vomiting/si [Side Effect]; *morphine/ae [Adverse Drug Reaction]; *morphine/ct [Clinical Trial]; *morphine/dt [Drug Therapy]; *morphine/iv [Intravenous Drug Administration]; placebo
CC: SR-SYMPT
AB: METHODSPain was measured with a standard 0- to 100-mm visual analog scale. ED patients with acute abdominal pain were randomized in a double-blind fashion to 0.1 mg/kg intravenous morphine or placebo. The primary endpoint was the difference between the 2 study arms in clinically important diagnostic accuracy. Clinically important diagnostic accuracy was defined a priori by its complement, clinically important diagnostic error, using 2 independent, blinded investigators to identify any discordance between the provisional and final diagnoses that might adversely affect the patient's health status. The provisional diagnosis was provided by an ED attending physician, who examined the patient only once, 15 minutes after administration of the study agent. The final diagnosis was obtained through follow-up at least 6 weeks after the index ED visit.RESULTSWe randomized 160 patients, of whom 153 patients were available for analysis, 78 patients in the morphine group and 75 patients in the placebo group. Baseline features were similar in both groups, including initial median visual analog scale scores of 98 mm and 99 mm. The median decrease in visual analog scale score at 15 minutes was 33 mm in the morphine group and 2 mm in the placebo group. There were 11 instances of diagnostic discordance in each group, for a clinically important diagnostic accuracy of 86% (67/78) in the morphine group and 85% (64/75) in the placebo group. The difference in clinically important diagnostic accuracy between the 2 groups was 1% (95% confidence interval [CI] -11% to 12%). Analysis by efficacy and intention to treat yielded similar results. Kappa for interobserver concordance in classification of clinically important diagnostic accuracy was 0.94 (95% CI 0.79 to 1.00). No patients required naloxone.CONCLUSIONAlthough administration of intravenous morphine to adult ED patients with acute abdominal pain could lead to as much as a 12% difference in diagnostic accuracy, equally favoring opioid or placebo, our data are most consistent with the inference that morphine safely provides analgesia without impairing clinically important diagnostic accuracy.STUDY OBJECTIVEAdministration of analgesia to patients with acute abdominal pain is controversial. We test the hypothesis that morphine given to emergency department (ED) patients with acute abdominal pain will reduce discomfort and improve clinically important diagnostic accuracy.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/836/CN-00567836/frame.html

Record #47 of 108
ID: CN-00962460
AU: Whiteside LK
AU: Walton MA
AU: Bohnert AS
AU: Blow FC
AU: Bonar EE
AU: Ehrlich P
AU: Cunningham RM
TI: Nonmedical prescription opioid and sedative use among adolescents in the emergency department
SO: Pediatrics
YR: 2013
VL: 132
NO: 5
PG: 825-832
PM: PUBMED 24167166
PT: Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural
KY: Adolescent;Adolescent Behavior [psychology];Analgesics, Opioid [administration & dosage];Cross-Sectional Studies;Emergency Service, Hospital [trends];Hypnotics and Sedatives [administration & dosage];Pilot Projects;Prescription Drug Misuse [psychology] [trends];Retrospective Studies;Risk Factors;Self Report;Substance-Related Disorders [diagnosis] [epidemiology] [psychology];Female[checkword];Humans[checkword];Male[checkword];Young Adult[checkword]
DOI: 10.1542/peds.2013-0721
AB: METHODS: Participants aged 14 to 20 presenting to the ED at the University of Michigan Medical Center between September 2010 and September 2011 were systematically recruited. A computerized self-report screening survey with validated items measuring past-year NPOU, NPSU, substance use, and violence was delivered to participants, and a retrospective chart review was performed.RESULTS: Of the 2135 participants (86.0% response rate), 222 (10.4%) reported either NPOU or NPSU. Among the 185 (8.7%) participants that reported NPOU, 14.6% had a current home prescription for an opioid and among the 115 (5.4%) with NPSU, 12.3% had a current home prescription for a sedative. After controlling for demographics (age, gender, race, public assistance), correlates of NPOU or NPSU included other substance use, and drinking and driving or riding with a drinking driver. Additional correlates of NPOU included receiving an intravenous opioid in the ED and for NPSU, dating violence, presenting to the ED for a noninjury complaint, and previous ED visit in the past year.CONCLUSIONS: Nearly 1 in 10 young people who use the ED for care report NPOU or NPSU, and only 12.3% and 14.6% report having current home prescriptions for sedatives and opioids. The ED represents a key location for screening and intervention efforts.OBJECTIVES: Nonmedical prescription opiate use (NPOU) and nonmedical prescription sedative use (NPSU) are serious public health concerns. The objectives of this study were to determine the prevalence and emergency department (ED) visit characteristics and other correlates associated with past-year NPOU and NPSU among adolescents and young adults using the ED.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/460/CN-00962460/frame.html

Record #48 of 108
ID: CN-01425995
AU: Chang AK
AU: Bijur PE
AU: Esses D
AU: Barnaby DP
AU: Baer J
TI: Effect of a Single Dose of Oral Opioid and Nonopioid Analgesics on Acute Extremity Pain in the Emergency Department: a Randomized Clinical Trial
SO: JAMA
YR: 2017
VL: 318
NO: 17
PG: 1661-1667
PM: PUBMED 29114833
PT: Comparative Study; Journal Article; Randomized Controlled Trial
KY: Acetaminophen [administration & dosage];Acute Pain [drug therapy];Administration, Oral;Analgesics, Non-Narcotic [administration & dosage];Analgesics, Opioid [administration & dosage];Codeine [administration & dosage];Double-Blind Method;Drug Combinations;Emergency Service, Hospital;Extremities;Hydrocodone [administration & dosage];Ibuprofen [administration & dosage];Oxycodone [administration & dosage];Pain Measurement;Adult[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword];Young Adult[checkword]
DOI: 10.1001/jama.2017.16190
AB: Objectives: To compare the efficacy of 4 oral analgesics.Design, Settings, and Participants: Randomized clinical trial conducted at 2 urban EDs in the Bronx, New York, that included 416 patients aged 21 to 64 years with moderate to severe acute extremity pain enrolled from July 2015 to August 2016.Interventions: Participants (104 per each combination analgesic group) received 400 mg of ibuprofen and 1000 mg of acetaminophen; 5 mg of oxycodone and 325 mg of acetaminophen; 5 mg of hydrocodone and 300 mg of acetaminophen; or 30 mg of codeine and 300 mg of acetaminophen.Main Outcomes and Measures: The primary outcome was the between-group difference in decline in pain 2 hours after ingestion. Pain intensity was assessed using an 11-point numerical rating scale (NRS), in which 0 indicates no pain and 10 indicates the worst possible pain. The predefined minimum clinically important difference was 1.3 on the NRS. Analysis of variance was used to test the overall between-group difference at P = .05 and 99.2% CIs adjusted for multiple pairwise comparisons.Results: Of 416 patients randomized, 411 were analyzed (mean [SD] age, 37 [12] years; 199 [48%] women; 247 [60%] Latino). The baseline mean NRS pain score was 8.7 (SD, 1.3). At 2 hours, the mean NRS pain score decreased by 4.3 (95% CI, 3.6 to 4.9) in the ibuprofen and acetaminophen group; by 4.4 (95% CI, 3.7 to 5.0) in the oxycodone and acetaminophen group; by 3.5 (95% CI, 2.9 to 4.2) in the hydrocodone and acetaminophen group; and by 3.9 (95% CI, 3.2 to 4.5) in the codeine and acetaminophen group (P = .053). The largest difference in decline in the NRS pain score from baseline to 2 hours was between the oxycodone and acetaminophen group and the hydrocodone and acetaminophen group (0.9; 99.2% CI, -0.1 to 1.8), which was less than the minimum clinically important difference in NRS pain score of 1.3. Adverse events were not assessed.Conclusions and Relevance: For patients presenting to the ED with acute extremity pain, there were no statistically significant or clinically important differences in pain reduction at 2 hours among single-dose treatment with ibuprofen and acetaminophen or with 3 different opioid and acetaminophen combination analgesics. Further research to assess adverse events and other dosing may be warranted.Trial Registration: clinicaltrials.gov Identifier: NCT02455518.Importance: The choice of analgesic to treat acute pain in the emergency department (ED) lacks a clear evidence base. The combination of ibuprofen and acetaminophen (paracetamol) may represent a viable nonopioid alternative.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/995/CN-01425995/frame.html

Record #49 of 108
ID: CN-00876390
AU: Beaudoin FL
AU: Haran JP
AU: Liebmann O
TI: A comparison of ultrasound-guided three-in-one femoral nerve block versus parenteral opioids alone for analgesia in emergency department patients with hip fractures: a randomized controlled trial
SO: Academic emergency medicine
YR: 2013
VL: 20
NO: 6
PG: 584-591
PM: PUBMED 23758305
PT: Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
KY: Analgesia [methods];Analgesics, Opioid [administration & dosage];Cohort Studies;Emergency Medical Services [methods];Femoral Nerve [diagnostic imaging];Hip Fractures [complications];Infusions, Parenteral;Morphine [administration & dosage];Nerve Block [methods];Pain [etiology] [prevention & control];Pain Management [methods];Ultrasonography;Aged[checkword];Aged, 80 and over[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword]
CC: SR-MUSKINJ
DOI: 10.1111/acem.12154
AB: METHODS: A randomized controlled trial was conducted at a large urban academic ED over an 18-month period. A convenience sample of older adults (age ≥ 55 years) with confirmed hip fractures and moderate to severe pain (numeric rating score ≥ 5) were randomized to one of two treatment arms: US-guided three-in-one femoral nerve block plus morphine (FNB group) or standard care, consisting of placebo (sham injection) plus morphine (SC group). Intravenous (IV) morphine was prescribed and dosed at the discretion of the treating physician; physicians were advised to target a 50% reduction in pain or per-patient request. The primary outcome measure of pain relief, or pain intensity reduction, was derived using the 11-point numerical rating scale (NRS) and calculated as the summed pain-intensity difference (SPID) over 4 hours. Secondary outcome measures included the amount of rescue analgesia and occurrence of adverse events (respiratory depression, hypotension, nausea, or vomiting). Outcome measures were compared between groups using analysis of variance for continuous variables and Fisher's exact test for categorical data.RESULTS: Thirty-six patients (18 in each arm) completed the study. There was no difference between treatment groups with respect to age, sex, fracture type, vital signs (baseline and at 4 hours), ED length of stay (LOS), pre-enrollment analgesia, or baseline pain intensity. In comparing pain intensity at the end of the study period, NRS scores at 4 hours were significantly lower in the FNB group (p < 0.001). Over the 4-hour study period, patients in the FNB group experienced significantly greater overall pain relief than those in the SC group, with a median SPID of 11.0 (interquartile range [IQR] = 4.0 to 21.8) in the FNB group versus 4.0 (IQR = -2.0 to 5.8) in the SC group (p = 0.001). No patient in the SC group achieved a clinically significant reduction in pain. Moreover, patients in the SC group received significantly more IV morphine than those in the FNB group (5.0 mg, IQR = 2.0 to 8.4 mg vs. 0.0 mg, IQR = 0.0 to 1.5 mg; p = 0.028). There was no difference in adverse events between groups.CONCLUSIONS: Ultrasound-guided femoral nerve block as an adjunct to SC resulted in 1) significantly reduced pain intensity over 4 hours, 2) decreased amount of rescue analgesia, and 3) no appreciable difference in adverse events when compared with SC alone. Furthermore, standard pain management with parenteral opioids alone provided ineffective pain control in our study cohort of patients with severe pain from their hip fractures. Regional anesthesia has a role in the ED, and US-guided femoral nerve blocks for pain management in older adults with hip fractures should routinely be considered, particularly in cases of refractory or severe pain.OBJECTIVES: The primary objective was to compare the efficacy of ultrasound (US)-guided three-in-one femoral nerve blocks to standard treatment with parenteral opioids for pain control in elderly patients with hip fractures in the emergency department (ED).
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/390/CN-00876390/frame.html

Record #50 of 108
ID: CN-00812004
AU: Chang AK
AU: Bijur PE
AU: Gallagher EJ
TI: Randomized clinical trial comparing the safety and efficacy of a hydromorphone titration protocol to usual care in the management of adult emergency department patients with acute severe pain
SO: Annals of emergency medicine
YR: 2011
VL: 58
NO: 4
PG: 352-359
PM: PUBMED 21507527
PT: Journal Article; Randomized Controlled Trial
KY: Analgesics, Opioid [administration & dosage] [adverse effects] [therapeutic use];Clinical Protocols;Emergency Service, Hospital;Hydromorphone [administration & dosage] [adverse effects] [therapeutic use];Injections, Intravenous;Pain [drug therapy];Pain Measurement;Treatment Outcome;Adult[checkword];Female[checkword];Humans[checkword];Male[checkword]
DOI: 10.1016/j.annemergmed.2011.03.003
AB: METHODSThis was a prospective, randomized clinical trial of ED patients with acute severe pain. The 1+1 protocol specifies administration of 1 mg intravenous hydromorphone, followed by a second dose of 1 mg intravenous hydromorphone 15 minutes after the first bolus if the patient answers yes to the question, "Do you want more pain medication?" Usual care is the administration of any intravenous opioid, with type and dose chosen by the ED attending physician. Usual care patients who wanted more medication at 15 minutes were treated at the physician's discretion. At 60 minutes, all patients were asked again whether they wanted more pain medication. The primary outcome was successful treatment defined a priori as not wanting additional analgesia at either 15 or 60 minutes after the initial bolus. The primary endpoint was the difference in the proportion of patients with successful treatment who received the complete 1+1 protocol versus usual care with a per-protocol analysis. An intention-to-treat analysis was also performed. A 10% difference in rate of successful treatment was chosen a priori as a clinically meaningful difference.RESULTSOf 167 patients in the 1+1 group, 156 received the full 1+1 protocol, whereas 171 received usual care. Of patients who received the 1+1 protocol, 92.3% (144/156) had successful treatment versus 76.6% (131/171) of usual care patients (difference=15.7%; 95% confidence interval 7.9% to 23.3%). In the intention-to-treat analysis, 86.8% (145/167) of patients randomized to the 1+1 group received successful treatment versus 76.6% (131/171) of usual care patients (difference=10.2%; 95% confidence interval 2.0% to 18.3%). No patient required naloxone. One patient in the 1+1 group and 2 patients in the usual care group had transient oxygen saturation less than 95%. The incidence of all adverse effects was similar in both groups.CONCLUSIONWhen analyzed per protocol or with the more conservative intention-to-treat analysis, the 1+1 hydromorphone protocol is statistically and clinically more efficacious than usual care. Safety profiles were similar in both groups.STUDY OBJECTIVEWe test the efficacy and safety of the "1+1" (1 mg plus 1 mg 15 minutes later if needed) hydromorphone protocol against usual care of emergency department (ED) patients with acute severe pain.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/004/CN-00812004/frame.html

Record #51 of 108
ID: CN-01069624
AU: McCarthy DM
AU: Wolf MS
AU: McConnell R
AU: Sears J
AU: Chevrier A
AU: Ahlstrom E
AU: Engel KG
AU: Cameron KA
AU: Adams JG
AU: Courtney DM
TI: Improving patient knowledge and safe use of opioids: a randomized controlled trial
SO: Academic emergency medicine
YR: 2015
VL: 22
NO: 3
PG: 331-339
PM: PUBMED 25731073
XR: EMBASE 602795748
PT: Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
KY: Academic Medical Centers;Acetaminophen [administration & dosage] [therapeutic use];Adolescent;Analgesics, Opioid [adverse effects] [therapeutic use];Double-Blind Method;Drug Combinations;Emergency Service, Hospital;Health Knowledge, Attitudes, Practice;Health Literacy;Hydrocodone [administration & dosage] [therapeutic use];Pain [drug therapy];Patient Discharge;Patient Education as Topic [methods];Prospective Studies;United States;Adult[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword];Young Adult[checkword];adult; alcohol consumption; article; car driving; controlled study; *drug safety; drug storage; female; follow up; human; major clinical study; male; middle aged; opiate addiction; outcome assessment; pain/dt [Drug Therapy]; *patient education; prescription; priority journal; prospective study; randomized controlled trial; self report; side effect/si [Side Effect]; young adult; *hydrocodone/ae [Adverse Drug Reaction]; *hydrocodone/ct [Clinical Trial]; *hydrocodone/cb [Drug Combination]; *hydrocodone/dt [Drug Therapy]; *paracetamol/ae [Adverse Drug Reaction]; *paracetamol/ct [Clinical Trial]; *paracetamol/cb [Drug Combination]; *paracetamol/dt [Drug Therapy]; arm; backache; confidence interval; consensus; conversation; counseling; drinking; drug therapy; *human; injury; *patient; patient education; *randomized controlled trial; reading; risk; safety; scientist; side effect; storage; United States; alcohol; hydrocodone; narcotic analgesic agent; opiate; paracetamol
DOI: 10.1111/acem.12600
AB: METHODSThis was a prospective, randomized controlled trial. Consecutive discharged patients at an urban academic ED (>88,000 visits) with new prescriptions for hydrocodone-acetaminophen were enrolled. Patients were randomized to receive either usual care or the educational intervention. The educational intervention was a one-page information sheet about hydrocodone-acetaminophen, which was both given to the patients and read aloud by the research assistant (nonblinded). Follow-up phone calls were conducted 4 to 7 days after the visit to assess patient knowledge about the medication and self-report of activities associated with safety of use (e.g., double-dipping with acetaminophen, storage, use with alcohol or while driving).RESULTSA total of 274 patients were enrolled; 210 completed follow-up (110 usual care and 100 intervention). No significant differences in baseline characteristics emerged between the study arms; 42% were male, and 51% were white, with a median age of 43 years. Half of patients had non-back pain orthopedic injuries (49.5%). On follow-up, overall knowledge was poor, with only 28% able to name both active ingredients in the medication. The intervention group had better knowledge of precautions related to taking additional acetaminophen (usual care 18.2%, 95% confidence interval [CI] = 10.9% to 25.5% vs. intervention 38%, 95% CI = 28.3% to 47.7%; difference = 27.6, 95% CI of difference = 21.5 to 33.7) and knowledge of side effects (usual care median = 1, interquartile range [IQR] 0 to 2 vs. intervention median = 2, IQR = 1 to 2; p < 0.0001). Additionally, those who received the intervention were less likely to have reported driving within 6 hours after taking hydrocodone (usual care 13.6%, 95% CI = 7.2% to 20% vs. intervention 3%, 95% CI = -0.3% to 6.3%; difference = 10.6, 95% CI of difference = 3.4 to 17.9). There was no difference between groups related to knowledge about drinking alcohol while taking hydrocodone (overall 18.1%) or knowledge that the opioid could be addictive (overall 72.4%).CONCLUSIONSThis simple strategy improved several, but not all, aspects of patient knowledge and resulted in fewer patients in the intervention arm driving while taking hydrocodone. Integration of a patient education document into conversations about opioids holds promise for improving patient knowledge about these high-risk medications.OBJECTIVESThe use of opioid analgesics in the United States has significantly increased in recent years. However, there is minimal consensus on what discharge counseling should accompany these high-risk prescriptions and large variations in what is done in practice. The objective of this study was to evaluate the effect of a dual-modality (written and spoken) literacy-appropriate educational strategy on patients' knowledge of and safe use of opioid analgesics.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/624/CN-01069624/frame.html

Record #52 of 108
ID: CN-00577210
AU: Barnett PG
AU: Masson CL
AU: Sorensen JL
AU: Wong W
AU: Hall S
TI: Linking opioid-dependent hospital patients to drug treatment: health care use and costs 6 months after randomization
SO: Addiction (abingdon, england)
YR: 2006
VL: 101
NO: 12
PG: 1797-1804
PM: PUBMED 17156179
XR: EMBASE 44899702
PT: Evaluation Studies; Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural
KY: Adolescent;Case Management [economics];Emergency Medical Services [economics] [utilization];Health Care Costs [statistics & numerical data];Hospitalization [economics] [statistics & numerical data];Methadone [economics] [therapeutic use];Narcotics [economics] [therapeutic use];Opioid-Related Disorders [economics] [rehabilitation];Adult[checkword];Aged[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword];adult; aged; article; case management; clinical trial; controlled clinical trial; controlled study; disease severity; drug abuse; *drug dependence/dm [Disease Management]; *drug dependence/dt [Drug Therapy]; drug detoxification; drug use; economic evaluation; health care cost; health care utilization; hospital patient; human; major clinical study; methadone treatment; outcome assessment; randomized controlled trial; substance abuse; treatment duration; *methadone/dt [Drug Therapy]; *methadone/pe [Pharmacoeconomics]; *opiate
CC: SR-ADDICTN: SR-EPOC
DOI: 10.1111/j.1360-0443.2006.01636.x
AB: DESIGNRandomized clinical trial and evaluation of administrative data.SETTINGEmergency department, wound clinic, in-patient units and methadone clinic in a large urban public hospital.PARTICIPANTSThe study randomized 126 opioid-dependent drug users seeking medical care.INTERVENTIONSParticipants were randomized among four groups. These received vouchers for 6 months of methadone treatment, 6 months of case management, both these interventions, or usual care.FINDINGSDuring the first 6 months of this study, 90% of those randomized to vouchers alone enrolled in methadone maintenance, significantly more than the 44% enrollment in those randomized to case management without vouchers (P < 0.001). The direct costs of substance abuse treatment, including case management, was 4040 dollars for those who received vouchers, 4177 dollars for those assigned to case management and 5277 dollars for those who received the combination of both interventions. After 3 months, the vouchers alone group used less heroin than the case management alone group. The difference was not significant at 6 months. There were no significant differences in other health care costs in the 6 months following randomization.CONCLUSIONVouchers were slightly more effective but no more costly than case management during the initial 6 months of the study. Vouchers were as effective and less costly than the combination of case management and vouchers. The finding that vouchers dominate is tempered by the possibility that case management may lower medical care costs.AIMSTo conduct an economic evaluation of the first 6 months' trial of treatment vouchers and case management for opioid-dependent hospital patients.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/210/CN-00577210/frame.html

Record #53 of 108
ID: CN-01411258
TI: ED-based Counseling Sessions Reduce Risky Opioid Use Among Certain Patients
SO: ED management
YR: 2016
VL: 28
NO: 7
PG: 81-83
PM: PUBMED 27439227
PT: Journal Article; Randomized Controlled Trial
KY: Counseling;Drug Overdose;Emergency Service, Hospital;Motivation;Opioid-Related Disorders;Humans[checkword]
AB: Investigators at the University of Michigan have shown promising results from an ED-based intervention designed to curb risky opioid use among patients who have reported opioid misuse within the previous three months. The intervention includes a 30-minute counseling session with a therapist who utilizes motivational interviewing techniques to strengthen their desire to move away from opioid use behaviors. The randomized clinical trial included 204 emergency patients, divided between patients receiving printed educational materials and patients receiving printed materials as well as counseling sessions. Researchers followed up with all patients after six months, finding that those who received the counseling intervention demonstrated a substantially higher reduction in behaviors that heighten the risk of an overdose than patients who received only printed materials. Investigators are working now to adapt the counseling intervention so that it can be delivered by more cost-efficient,means, such as via interactive voice response messages or computer.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/258/CN-01411258/frame.html

Record #54 of 108
ID: CN-01441461
AU: Hawk K
AU: D'Onofrio G
AU: Fiellin DA
AU: Chawarski MC
AU: O'Connor PG
AU: Owens PH
AU: Pantalon MV
AU: Bernstein SL
TI: Past-year Prescription Drug Monitoring Program Opioid Prescriptions and Self-reported Opioid Use in an Emergency Department Population With Opioid Use Disorder
SO: Academic emergency medicine
YR: 2017
VL: (no pagination)
XR: EMBASE 619941721
PT: Article In Press
KY: adult; cohort analysis; controlled study; diagnosis; drug therapy; *emergency ward; female; health insurance; human; information processing; *monitoring; opiate addiction; *prescription; randomized controlled trial; self report; *opiate; *prescription drug
DOI: 10.1111/acem.13352
AB: Background: Despite increasing reliance on prescription drug monitoring programs (PDMPs) as a response to the opioid epidemic, the relationship between aberrant drug-related behaviors captured by the PDMP and opioid use disorder is incompletely understood. How PDMP data should guide emergency department (ED) assessment has not been studied. Objectives: The objective was to evaluate a relationship between PDMP opioid prescription records and self-reported nonmedical opioid use of prescription opioids in a cohort of opioid-dependent ED patients enrolled in a treatment trial. Methods: PDMP opioid prescription records during 1 year prior to study enrollment on 329 adults meeting Diagnostic and Statistical Manual IV criteria for opioid dependence entering a randomized clinical trial in a large, urban ED were cross-tabulated with data on 30-day nonmedical prescription opioid use self-report. The association among these two types of data was assessed by the Goodman and Kruskal's gamma; a logistic regression was used to explore characteristics of participants who had PDMP record of opioid prescriptions. Results: During 1 year prior to study enrollment, 118 of 329 (36%) patients had at least one opioid prescription (range = 1-51) in our states' PDMP. Patients who reported >=15 of 30 days of nonmedical prescription opioid use were more likely to have at least four PDMP opioid prescriptions (20/38; 53%) than patients reporting 1 to 14 days (14/38, 37%) or zero days of nonmedical prescription opioid use (4/38, 11%; p = 0.002). Female sex and having health insurance were significantly more represented in the PDMP (p < 0.05 for both). Conclusion: PDMPs may be helpful in identifying patients with certain aberrant drug-related behavior, but are unable to detect many patients with opioid use disorder. The majority of ED patients with opioid use disorder were not captured by the PDMP, highlighting the importance of using additional methods such as screening and clinical history to identify opioid use disorders in ED patients and the limitations of PDMPs to detect opioid use disorders. Copyright © 2017 Society for Academic Emergency Medicine.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/461/CN-01441461/frame.html

Record #55 of 108
ID: CN-00876503
AU: Miner JR
AU: Moore JC
AU: Plummer D
AU: Gray RO
AU: Patel S
AU: Ho JD
TI: Randomized clinical trial of the effect of supplemental opioids in procedural sedation with propofol on serum catecholamines
SO: Academic emergency medicine
YR: 2013
VL: 20
NO: 4
PG: 330-337
PM: PUBMED 23701339
PT: Comparative Study; Journal Article; Randomized Controlled Trial
KY: Adolescent;Alfentanil [administration & dosage];Analgesics, Opioid [administration & dosage];Anesthetics, Combined [administration & dosage];Biomarkers [blood];Catecholamines [blood];Conscious Sedation [methods];Emergency Medical Services [methods];Fractures, Bone [complications] [therapy];Hypnotics and Sedatives [administration & dosage];Pain [complications] [prevention & control];Pilot Projects;Propofol [administration & dosage];Stress, Physiological [drug effects];Adult[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword];Young Adult[checkword]
DOI: 10.1111/acem.12110
AB: METHODSThis was a randomized, nonblinded pilot study of adult patients undergoing PS in the ED for the reduction of fractures and dislocations. Patients with pain before the procedure were treated with intravenous (IV) morphine sulfate until their pain was adequately treated for at least 20 minutes before starting the procedure. Patients were randomized to receive either 10 μg/kg alfentanil followed by 1 mg/kg propofol, followed by 0.5 mg/kg every 3 minutes as needed, or propofol only, dosed in similar fashion without supplemental alfentanil. Doses, vital signs, nasal end-tidal CO2 (ETCO2), pulse oximetry, and bispectral electroencephalogram (EEG) analysis scores were recorded. Subclinical respiratory depression was defined as a change in ETCO2 > 10 mm Hg, an oxygen saturation of < 92% at any time, or an absent ETCO2 waveform at any time. Clinical events related to respiratory depression were noted during the procedure, including the addition of or increase in the flow rate of supplemental oxygen, the use of a bag-valve-mask apparatus, airway repositioning, or stimulation to induce breathing. Blood was drawn 1 minute prior to the administration of the medications for PS and again 1 minute after completion of the procedure for which the patient was sedated. Serum was tested for total catecholamines, epinephrine, norepinephrine, and dopamine. Postprocedure, patients were asked to report any pain perceived during the procedure. Data were analyzed using descriptive statistics, Wilcoxon rank sum tests, and chi-square tests, as appropriate.RESULTSTwenty patients were enrolled; 10 received propofol and 10 received propofol with alfentanil. No clinically significant complications were noted. Subclinical respiratory depression was seen in four of 10 (40%) patients in the propofol group and five of 10 (50%) patients in the propofol/alfentanil group (effect size = -10%, 95% confidence interval [CI] = -53% to 33%). There was no difference in the rate of clinical signs of respiratory depression between the two groups. Pain during the procedure was reported by two of 10 (20%) patients in the propofol group and five of 10 (50%) patients in the propofol/alfentanil group (effect size = -30%, 95% CI = -70% to 10%). Recall of some part of the procedure was reported by 0 of 10 (0%) patients in the propofol group and five of 10 (50%) of patients in the propofol/alfentanil group (effect size = -50%, 95% CI = -81% to -19%). There was no difference in the baseline or postprocedure catecholamine levels between the groups.CONCLUSIONSNo difference in serum catecholamines was detected immediately after PS between patients who receive propofol with and without supplemental opioid in this small pilot study. PS using propofol only without supplemental opioid did not appear to induce markers of physiologic stress in this small pilot study.OBJECTIVESThe objective was to assess the effect on stress biomarkers of supplemental opioid to a standard propofol dosing protocol for emergency department (ED) procedural sedation (PS). The hypothesis was that there is no difference in the change in serum catecholamines between PS using propofol with or without supplemental alfentanil.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/503/CN-00876503/frame.html

Record #56 of 108
ID: CN-00473480
AU: Tamayo-Sarver JH
AU: Dawson NV
AU: Hinze SW
AU: Cydulka RK
AU: Wigton RS
AU: Albert JM
AU: Ibrahim SA
AU: Baker DW
TI: The effect of race/ethnicity and desirable social characteristics on physicians' decisions to prescribe opioid analgesics
SO: Academic emergency medicine
YR: 2003
VL: 10
NO: 11
PG: 1239-1248
PM: PUBMED 14597500
PT: Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.
KY: Analgesics, Opioid [administration & dosage];Attitude of Health Personnel;Continental Population Groups;Emergency Service, Hospital;Ethnic Groups;Logistic Models;Pain [drug therapy];Practice Patterns, Physicians';Social Desirability;Female[checkword];Humans[checkword];Male[checkword]
AB: METHODSThe authors developed three clinical vignettes designed to engage physicians' decision-making processes. The patient's race/ethnicity was included. Each vignette randomly included or omitted explicit socially desirable information. The authors mailed 5,750 practicing emergency physicians three clinical vignettes and a one-page questionnaire about demographic and practice characteristics. Chi-square tests of significance for bivariate analyses and multiple logistic regression were used for multivariate analyses.RESULTSA total of 2,872 (53%) of the 5,398 potential physician subjects participated. Patient race/ethnicity had no effect on physician prescription of opioids at discharge for African Americans, Hispanics, and whites: absolute differences in rates of prescribing opioids at discharge were less than 2% for all three conditions presented. Making socially desirable information explicit increased the prescribing rates by 4% (95% CI = 0.1% to 8%) for the migraine vignette and 6% (95% CI = 3% to 8%) for the back pain vignette.CONCLUSIONSPatient race/ethnicity did not influence physicians' predispositions to treatment plans in clinical vignettes. Even knowing that the patient had a high-prestige occupation and a primary care provider only minimally increased prescribing of opioid analgesics for conditions with few objective findings.OBJECTIVERacial/ethnic disparities in physician treatment have been documented in multiple areas, including emergency department (ED) analgesia. The purpose of this study was to determine if physicians were predisposed to different treatment decisions based on patient race/ethnicity and if physicians' treatment predispositions changed when socially desirable information about the patient (occupation, socioeconomic status, and relationship with a primary care physician) was made explicit.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/480/CN-00473480/frame.html

Record #57 of 108
ID: CN-01330742
AU: D'Onofrio G
AU: Chawarski MC
AU: O'Connor PG
AU: Pantalon MV
AU: Busch SH
AU: Owens PH
AU: Hawk K
AU: Bernstein SL
AU: Fiellin DA
TI: Emergency Department-Initiated Buprenorphine for Opioid Dependence with Continuation in Primary Care: outcomes During and After Intervention
SO: Journal of general internal medicine
YR: 2017
PG: 1-7
XR: EMBASE 614423753
PT: Journal: Article In Press
KY: clinical trial; controlled clinical trial; controlled study; drug therapy; *emergency ward; follow up; human; Human immunodeficiency virus; human tissue; major clinical study; nonhuman; *opiate addiction; patient referral; *primary medical care; randomized controlled trial; toxicology; urine; *buprenorphine; opiate
DOI: 10.1007/s11606-017-3993-2
AB: Background: Emergency department (ED)-initiated buprenorphine/naloxone with continuation in primary care was found to increase engagement in addiction treatment and reduce illicit opioid use at 30 days compared to referral only or a brief intervention with referral. Objective: To evaluate the long-term outcomes at 2, 6 and 12 months following ED interventions. Design: Evaluation of treatment engagement, drug use, and HIV risk among a cohort of patients from a randomized trial who completed at least one long-term follow-up assessment. Participants: A total of 290/329 patients (88% of the randomized sample) were included. The followed cohort did not differ significantly from the randomized sample. Interventions: ED-initiated buprenorphine with 10-week continuation in primary care, referral, or brief intervention were provided in the ED at study entry. Main Measures: Self-reported engagement in formal addiction treatment, days of illicit opioid use, and HIV risk (2, 6, 12 months); urine toxicology (2, 6 months). Key Results: A greater number of patients in the buprenorphine group were engaged in addiction treatment at 2 months [68/92 (74%), 95% CI 65-83] compared with referral [42/79 (53%), 95% CI 42-64] and brief intervention [39/83 (47%), 95% CI 37-58; p < 0.001]. The differences were not significant at 6 months [51/92 (55%), 95% CI 45-65; 46/70 (66%) 95% CI 54-76; 43/76 (57%) 95% CI 45-67; p = 0.37] or 12 months [42/86 (49%) 95% CI 39-59; 37/73 (51%) 95% CI 39-62; 49/78 (63%) 95% CI 52-73; p = 0.16]. At 2 months, the buprenorphine group reported fewer days of illicit opioid use [1.1 (95% CI 0.6-1.6)] versus referral [1.8 (95% CI 1.2-2.3)] and brief intervention [2.0 (95% CI 1.5-2.6), p = 0.04]. No significant differences in illicit opioid use were observed at 6 or 12 months. There were no significant differences in HIV risk or rates of opioid-negative urine results at any time. Conclusions: ED-initiated buprenorphine was associated with increased engagement in addiction treatment and reduced illicit opioid use during the 2-month interval when buprenorphine was continued in primary care. Outcomes at 6 and 12 months were comparable across all groups. Copyright © 2017 Society of General Internal Medicine
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/742/CN-01330742/frame.html

Record #58 of 108
ID: CN-01367726
AU: Bowers KJ
AU: Mcallister KB
AU: Ray M
AU: Heitz C
TI: Ketamine as an Adjunct to Opioids for Acute Pain in the Emergency Department: a Randomized Controlled Trial
SO: Academic emergency medicine
YR: 2017
VL: (no pagination)
XR: EMBASE 615097948
PT: Article In Press
KY: adverse drug reaction; *analgesia; clinical trial; controlled clinical trial; controlled study; dizziness; drug therapy; *emergency ward; human; low drug dose; major clinical study; patient satisfaction; randomized controlled trial; sedation; side effect; single blind procedure; *ketamine; opiate; placebo
DOI: 10.1111/acem.13172
AB: Objectives: This study had five objectives: 1) to measure and compare total opioid use and number of opioid doses in patients treated with opioids versus ketamine in conjunction with opioids; 2) to measure pain scores up to 2 hours after presentation in the ED patient with pain, comparing standard opioid pain control to ketamine in conjunction with opioids; 3) to compare patient satisfaction with pain control using opioids alone versus ketamine in conjunction with opioids; 4) to monitor and compare side effects in patients treated with opioids versus ketamine in conjunction with opioids; and 5) to identify effect variation between different subgroups of patients, with the purpose of focusing future research. We hypothesized that low-dose ketamine, compared to placebo, as an adjunctive treatment to opioids would result in better pain control over 2 hours and greater patient satisfaction with pain control; further, this protocol will result in a lower opioid dosage over 2 hours. Methods: This was a randomized, double-blinded, placebo-controlled trial at a single academic emergency department evaluating the use of ketamine versus placebo in conjunction with opioids for moderate to severe pain. Subjects with a continued high level of pain after an initial dose of opioid analgesia were randomized to receive either 0.1 mg/kg ketamine or placebo prior to protocol-based dosing of additional opioid analgesia, if required. Over 120 minutes, subjects were assessed for pain level (0-10), satisfaction with pain control (0-4), side effects, sedation level, and need for additional pain medication. Total opioid dose, including the initial dose, was compared between groups. Results: Sixty-three subjects were randomized to the placebo group and 53 to the ketamine group. No significant differences were found in demographics between the groups. Patients receiving ketamine reported lower pain scores over 120 minutes than patients receiving placebo (p = 0.015). Total opioid dose was lower in the ketamine group (mean +/- SD = 9.95 +/- 4.83 mg) compared to placebo (mean +/- SD = 12.81 +/- 6.81 mg; p = 0.02). Satisfaction did not differ between groups. Fewer patients in the ketamine group required additional opioid doses. More patients reported light-headedness and dizziness in the ketamine group. Conclusions: Ketamine, as an adjunct to opioid therapy, was more effective at reducing pain over 120 minutes and resulted in a lower total opioid dose as well as fewer repeat doses of analgesia. More side effects were reported in the ketamine group (51% vs. 19%), but the side effect profile appears tolerable. Copyright © 2017 Society for Academic Emergency Medicine.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/726/CN-01367726/frame.html

Record #59 of 108
ID: CN-01376417
AU: Kim K
AU: Hoppe JA
AU: Kiemele ER
AU: Weiner SG
TI: A comparison of three screening tools for aberrant opioid drug-related behavior in the emergency department
SO: Academic emergency medicine. Conference: 2017 annual meeting of the society for academic emergency medicine, SAEM 2017. United states
YR: 2017
VL: 24
PG: S220
XR: EMBASE 616280002
PT: Conference Abstract
KY: adult; adverse drug reaction; anonymised data; *behavior disorder; clinical trial; controlled clinical trial; controlled study; convenience sample; death; diagnostic test accuracy study; drug abuse; drug therapy; *emergency ward; female; human; instrument validation; major clinical study; male; monitoring; multicenter study; observational study; pain; predictive value; prescription; *screening test; side effect; tablet; young adult; *opiate; prescription drug; unclassified drug
DOI: 10.1111/acem.13203
AB: Objectives: The increased availability of opioid analgesics (OA) has paralleled the rise in opioid related deaths. OAs are commonly prescribed from the emergency department (ED) for moderate to severe pain. Unfortunately, ED physicians do not have the benefit of validated tools to identify patients at risk of aberrant opioid use. This project evaluated three validated, office based OA risk-screening tools in the ED: Screener and Opioid Assessment for Patients with Pain - Revised (SOAPP-R), Drug Abuse Screening Test (DAST-20) and Opioid Risk Tool (ORT). Methods: This observational study included a convenience sample of ED patients >=18 years old with a painful condition in two academic hospitals for whom the clinician considered prescribing OA. Subjects completed all three tools on a tablet. The statewide prescription drug monitoring program (PDMP) was accessed as part of routine care. Risk tool scores and PDMP prescription data were linked in a de-identified data set. The pre-defined at-risk scores for each screener were analyzed relative to aberrant behavior, defined as >=4 OA prescriptions and >=4 different prescribers for scheduled medications in the prior 12-months. The study was IRB approved at both institutions. Results: A total of 154 patients were approached and 121 patients were enrolled from two hospitals (109 from site A, 12 from site B). Median age was 35 years old (IQR: 27-48), 60% were female. Past OA use was reported by 68% (104/121) and 23% (28/121) reported opioid use within the past 7 days. SOAPP-R was the only tool that was significantly associated with identifying aberrant opioid behavior: OR 2.8 (95%CI 1.04-7.4), compared with ORT: OR 1.2 (95%CI 0.5-3.4) and DAST-20: OR 0.6 (95%CI 0.1-4.9). SOAPP-R had the highest sensitivity (SN) of 33% (95%CI 17-54%), specificity (SP) of 85% (95%CI 76-91%) and positive predictive value (PPV) of 39% (95%CI 20-61%). ORT had SN 22% (95%CI 9-40%), SP 82% (95%CI 72-89%) and PPV 30% (95% CI 13-53%). DAST-20 had SN 10% (95%CI 1.0-37%), SP 79% (95%CI 69-86%) and PPV 8.7% (95% CI 1.1-28%) for aberrant OA related behavior. Conclusions: In ED patients where a prescription opioid was considered for pain, we found that SOAPP-R has superior test characteristics for detecting aberrant opioid drug-related behavior by PDMP criteria when compared to DAST-20 and ORT. Further studies are needed to investigate the utility of these tools in the ED.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/417/CN-01376417/frame.html

Record #60 of 108
ID: CN-01429529
AU: Marco CA
AU: Mann D
AU: Rasp J
AU: Ballester M
AU: Perkins O
AU: Holbrook MB
AU: Rako K
TI: Effects of opioid medications on cognitive skills among Emergency Department patients
SO: American journal of emergency medicine
YR: 2017
VL: (no pagination)
XR: EMBASE 619226338
PT: Article In Press
KY: adult; controlled study; diagnosis; drug therapy; emergency health service; *emergency ward; ethnicity; female; gender; human; insurance; major clinical study; male; mental health; mentally disabled person; Montreal cognitive assessment; pain; prospective study; randomized controlled trial; *skill; statistical significance; *opiate
DOI: 10.1016/j.ajem.2017.11.017
AB: Introduction: Treatment for pain and related conditions has been identified as the most common reason for Emergency Department (ED) visits. Concerns exist regarding the effects of opioid pain medications on cognition and patient ability to consent for procedures, hospital admission, or to refuse recommended medical interventions. This study was undertaken to identify cognitive skills before and after opioid pain medication in the ED setting. Methods: This was a prospective study comparing performance on the Mini-Mental Status Examination (MMSE) and Montreal Cognitive Assessment (MoCA) before and after administration of opioid pain medications. Eligible participants included ED patients with pain, who received opioid treatment. Participants were randomized to receive either the MMSE before pain medication and the MoCA after medication, or the reverse. MoCA scores were converted to MMSE equivalent scores for comparison. Results: Among 65 participants, the median age was 36 and median triage pain score was 8. 35% of patients were considered cognitively impaired based on their MMSE score prior to any opioid medication (MMSE. 2) Opioid Strategy (with and without text messaging) to promote safe medication use and improved patient knowledge as compared to usual care. Methods The ED EMC2 Opioid Strategy consists of 5 automated components to promote safe medication use: 1) physician reminder to counsel, 2) inbox message sent on to the patient's primary care physician, 3) pharmacist message on the prescription to counsel, 4) MedSheet supporting prescription information, and 5) patient-centered Take-Wait-Stop wording of prescription instructions. This strategy will be assessed both with and without the addition of text messages via a three-arm randomized trial. The study will take place at an urban academic ED (annual volume > 85,000) in Chicago, IL. Patients being discharged with a new prescription for hydrocodone-acetaminophen will be enrolled and randomized (based on their prescribing physician). The primary outcome of the study is medication safe use as measured by a demonstrated dosing task. Additionally actual safe use, patient knowledge and provider counseling will be measured. Implementation fidelity as well as costs will be reported. Conclusions The ED EMC2 Opioid Strategy embeds a risk communication strategy into the electronic health record and promotes medication counseling with minimal workflow disruption. This trial will evaluate the strategy's effectiveness and implementation fidelity as compared to usual care. Trial registration This trial is registered on clinicaltrials.gov with identifier NCT02431793. Copyright © 2017 Elsevier Inc.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/622/CN-01372622/frame.html

Record #63 of 108
ID: CN-00414501
AU: Macias-Islas MA
AU: Hernandez-Chavez A
AU: Ramirez-Casillas GA
TI: Efficacy of combinated naloxone-nimodipine therapy in acute cerebral infarct
SO: Archivos de neurociencias
YR: 1999
VL: 4
NO: 3
PG: 129-132
XR: EMBASE 29455033
PT: Journal: Article
KY: article; *brain infarction/dt [Drug Therapy]; clinical trial; controlled clinical trial; controlled study; drug efficacy; human; intragastric drug administration; intravenous drug administration; major clinical study; Mexico; oral drug administration; randomized controlled trial; *stroke/dt [Drug Therapy]; treatment outcome; calcium channel blocking agent/cb [Drug Combination]; calcium channel blocking agent/dt [Drug Therapy]; calcium channel blocking agent/pd [Pharmacology]; *naloxone/cb [Drug Combination]; *naloxone/dt [Drug Therapy]; *naloxone/pd [Pharmacology]; *nimodipine/cb [Drug Combination]; *nimodipine/dt [Drug Therapy]; *nimodipine/pd [Pharmacology]; *brain infarction; control group; diagnosis; emergency ward; infusion; monotherapy; nasogastric tube; patient; *stroke; *therapy; *calcium channel blocking agent; diethylaminoethyldextran; *naloxone; *nimodipine; sodium chloride
AB: The rationale for using combinated therapies is supported by the fact that two or more drugs may show potential synergistic effects. At this time there is not a single drug capable to arrest the ischemic cascade and most of them have not shown effect in limiting the 'ischemic penumbra'. We conducted a randomized clinical trial in order to asses the efficacy of the nimodipine- naloxone combination in a five day clinical outcome in non recurrent cerebral infarct. Ninety-five patients with definitive diagnosis of nonrecurrent cerebral infarction were randomized and distributed into three treatment groups. The experimental group received intravenous naloxone 1.2 mg, followed by infusion of 0.4 mg/kg in a 500cc saline 0.9% solution twice a day during a five days period plus nimodipine 30 mg every 6 hours oral or by nasogastric tube, or intravenous 15-30 micrograms/kg/day infusion when orally was not possible. Control groups received nimodipine or naloxone alone in the same doses. No differences among groups were found for basal demographic and clinical variables (Chi2 1fd.a 0.05). Basal severity and five days outcome in each treatment group showed no differences (ANOVA p<0.05). The thirteen patients who died were older and most severely affected and showed no differences among groups (Chi2 Yates 0.05). The mean of arrival time to the emergency room since the initial ischemic insult was 21 DS.12, for all groups. Combinated therapy as used in this study showed no advantages over monotherapy. The prolonged time elapsed from onset of the ischemic insult to the arrival to our medical facilities affected our results.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/501/CN-00414501/frame.html

Record #64 of 108
ID: CN-00989494
AU: Moore C
AU: Lloyd G
AU: Oretti R
AU: Russell I
AU: Snooks H
TI: Paramedic-supplied 'Take Home' Naloxone: protocol for cluster randomised feasibility study
SO: BMJ open
YR: 2014
VL: 4
NO: 3
XR: EMBASE 372764305
PT: Journal: Article
KY: article; controlled study; drug efficacy; *drug overdose; drug safety; emergency care; emergency ward; feasibility study; follow up; human; interview; major clinical study; *paramedical personnel; questionnaire; randomized controlled trial; United Kingdom; urban area; *naloxone/ct [Clinical Trial]; cluster analysis; control group; death; emergency; ethics; *feasibility study; information processing; intoxication; patient; planning; professional standard; registration; research ethics; risk; scientific literature; telephone; *naloxone; opiate
DOI: 10.1136/bmjopen-2013-004712
AB: Introduction: 'Take Home' Naloxone (THN) kits for use by peers in the event of an opioid overdose may reduce further overdose and deaths, but distribution through Drugs Services may not reach those at highest risk. Attendance by paramedics at emergency calls for patients who have suffered an overdose presents an opportunity to distribute THN kits. In this feasibility study we will assess the acceptability of this intervention, and gather data to inform definitive trial planning. Methods and analysis: Cluster randomised trial with staggered allocation of paramedics (clusters) to groups. We will invite paramedics in an urban area of south Wales, UK to take part. We will randomly allocate those that accept to training sessions during the first 4 months of the trial. Patients attended by paramedics who have been trained and issued THN kits will fall into the intervention group. Patients attended by paramedics following usual practice (until they receive their training and THN kits) will fall into the control group. We will gather data about processes and outcomes of care: numbers of patients eligible for intervention, offered and accepted THN, attended emergency department, suffered further overdose, died within 3 months and about follow-up rates: numbers of patients consented, completed (postal or telephone) questionnaire. We will gather qualitative data about acceptability to patients and paramedics through interviews and focus groups. Ethics and dissemination: Ethical approval for this study was granted on 7 December 2011, by South East Wales Research Ethics Committee, Panel C. Results of this study will be reported through peer-reviewed scientific journals, conference presentations and internal organisational report. We will also seek to report our findings through local and national substance misuse networks and publications. Trial registration number: ISRCTN98216498.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/494/CN-00989494/frame.html

Record #65 of 108
ID: CN-01335260
AU: Tanabe PJ
AU: Crawford RD
AU: Silva S
AU: Glassberg JA
AU: Miller C
AU: DeMartino T
AU: Barczak C
AU: Soliman A
AU: Bosworth H
TI: A comparison of an individualized and weight-based opioid protocols for the treatment of vaso-occlusive episodes in the emergency department
SO: Blood. Conference: 58th annual meeting of the american society of hematology, ASH 2016. United states. Conference start: 20161203. Conference end: 20161206
YR: 2016
VL: 128
NO: 22) (no pagination
XR: EMBASE 614246840
PT: Journal: Conference Abstract
KY: adult; assisted ventilation; clinical trial; controlled clinical trial; controlled study; doctor patient relation; drug therapy; electronic medical record; *emergency ward; female; hospital admission; hospital readmission; hospitalization; human; human tissue; intubation; major clinical study; male; mixed cell culture; pain; patient safety; randomized controlled trial; sickle cell anemia; statistical model; naloxone; *opiate
CC: SR-CF
AB: Introduction: Vaso-occlusive episodes are the most common complication experienced by individuals with sickle cell disease (SCD). Treatment in an emergency department (ED) is often required and significant variability in care exists. In 2014, NHLBI published evidence based recommendations suggesting treatment with either an individualized opioid dosing or standard weight-based protocol; however the supporting evidence grade was Consensus - Panel Expertise. As outlined in the results section, the aim of this project was to compare change in pain scores, patient safety and system utilization variables between patients randomized to an individualized or weight based (standard) dosing protocol for treatment of VOC from arrival to discharge in an ED setting. Methods: A randomized controlled trial was conducted in two EDs (OH and NY). Adults with SCD were eligible for inclusion and recruited during a hospitalization, clinic visit or at the end of an ED visit. Patients were randomized to treatment with an individualized opioid dosing protocol (developed by the SCD physician based on patients' prior opioid use) or standard weight based protocol. Both protocols were supported by the NHLBI recommendations for treatment of VOE (2014) to include repeat dosing. Protocols were made available on the electronic medical record for future ED visits (up to five visits/patient), should they occur. ED physicians were informed of the protocol and ordered analgesics. Research staff was notified when ED visits occurred for enrolled patients and obtained assessments of pain (0-100 cm VAS) every 30 minutes from placement in the ED to one of 3 study endpoints: 1) 6 hours; 2) decision to admit to the hospital; 3) discharge home. The unit of analysis was the ED visit rather than patient. The primary outcome was change in pain score from arrival to study endpoint. Research staff reviewed the medical record 30 days after the ED visit to determine secondary outcomes of hospital admission, re-admission and new ED visits within 72 hours, 7 and 30 days post the index ED visit. The medical record was reviewed for administration of narcan, intubation, or assisted ventilation. A hierarchical linear mixed effects model adjusting for nested patient and site effects were used to test for a difference in the mean pain change scores in the treatment arms. Generalized Linear Models adjusting for nested patient and site effects were performed to evaluate differences in the dichotomized secondary outcomes. Results: 106 patients enrolled in the study with 52 patients (sites: 25 OH, 27 NY) contributing a total of 126 ED visits over 12 months. Among the 52 patients with visits, the median number of ED visits/patient was 2.0, 58% were male, and the median age was 27 years (range: 21 to 60). No patients in either treatment arm required narcan, intubation, or assisted ventilation. Pain change: Mixed effect model adjusted mean +/- standard deviation, higher positive score = greater pain reduction; *Fisher's Exact Test result due to low cell frequency. Conclusions: An individualized opioid dosing protocol resulted in a larger reduction in pain scores and lower hospital admission rate among patients with SCD treated for VOE in two EDs when compared to treatment with a weight-based opioid protocol. However, there was a tendency for more frequent ED re-visits within 72 hours, 7 and 30 days among patients in the individualized opioid dosing protocol. A pragmatic RCT with a larger and more heterogeneous sample of patients and ED settings is required to provide definitive evidence to guide treatment of VOE.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/260/CN-01335260/frame.html

Record #66 of 108
ID: CN-01199297
AU: Busch S
AU: Hawk K
AU: Fiellin D
AU: O'Connor P
AU: Chawarski M
AU: Owens P
AU: Pantalon M
AU: Bernstein S
AU: D'Onofrio G
TI: Health service use in a randomized clinical trial comparing three methods of emergency department interventions for opioid dependence
SO: Drug and alcohol dependence.
YR: 2015
VL: 156
PG: e32
XR: EMBASE 72176474
PT: Journal: Conference Abstract
KY: *human; *clinical trial; *emergency ward; *opiate addiction; *college; *drug dependence; *health care utilization; patient; outpatient; hospital patient; primary medical care; model; interview; follow up; substance abuse; male; screening; community; medicaid; insurance; opiate; buprenorphine
DOI: 10.1016/j.drugalcdep.2015.07.1005
AB: Aims: We previously demonstrated in a randomized clinical trial that Emergency Department (ED)-initiated buprenorphine (Bup) with primary care follow-up (BupPC) was superior to standard referral to community-based treatment (RT) and Screening, Brief Intervention with a facilitated referral (SBIRT) in increasing treatment engagement and reducing opioid use at 30-days.Weaim to evaluate health service use 30 days following enrollment in this clinical trial. Methods: We randomized 329 opioid dependent patients presenting to a large, urban ED to RT (n = 104), SBIRT (n = 111) or BupPC (n = 114). RT patients received a referral to a substance Use Disorder (SUD) provider, SBIRT patients received a Brief Negotiation Interview and a facilitated referral to a SUD provider, BupPC patients received SBIRT, ED-initiated Bup and ongoing Bup in primary care. We assessed use of SUD treatment services in outpatient settings, EDs, and inpatient settings using the Treatment Services Review. Analyses were conducted using chi-square and MIXED models. Results: The groups were similar: 76% male; mean age 31; 78% had insurance (43% Medicaid); and 45% reported no usual source of care. There was no difference in number of outpatient SUD visits between groups: 4.99 (95% CI 3.14-6.84), 5.67 (95% CI 3.98-7.37) and 3.71 (95% CI 2.12-5.30) in the RT, SBIRT and BupPC groups. There were no differences in ED use for SUD across the three groups: RT (15/69; 22%); SBIRT (12/82; 15%); and BupPC (18/93; 19%); p = 0.51. Patients in the RT and SBIRT groups utilized inpatient SUD treatment services at higher rates (37%, 95% CI 27-48 and 35%, 95% CI 25-37) compared the BupPC group (11%, 95% CI 6-19); p < 0.001. Conclusions: Patients in the BupPC group were less likely to use inpatient SUD treatment and had similar numbers of outpatient visits, suggesting more efficient, less costly resource use.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/297/CN-01199297/frame.html

Record #67 of 108
ID: CN-01364494
AU: Mammen P
AU: Panchal A
AU: Daskalakis C
TI: Focused evaluation of emergency department patients who self report opiate use
SO: American journal on addictions. Conference: 27th annual meeting and symposium of the american academy of addiction psychiatry, AAAP 2017. United states
YR: 2017
VL: 26
NO: 3
PG: 286-287
XR: EMBASE 615221040
PT: Conference Abstract
KY: addiction; adult; attention; chronic pain; clinical trial; controlled clinical trial; controlled study; death; doctor patient relation; drug overdose; drug therapy; drug toxicity; emergency health service; *emergency ward; epidemic; feces; female; gender; general practitioner; human; Likert scale; logistic regression analysis; major clinical study; male; medical specialist; medicine; middle aged; multicenter study; patient education; population based case control study; prescription; race; *self report; smoking; tertiary care center; United States; urban population; benzodiazepine derivative; cannabis; *opiate
DOI: 10.1111/ajad.12545
AB: Background: Opioid use, abuse and prescribing habits have become a significant public health issue. There has been 400% increase in opioid prescribing over 10 years. Estimates show 100 million chronic pain patients at significant cost to the health system. In 2014,10.3 million people reported using prescription opioids non medically. ED visits involving misuse or abuse of prescription opioids increased 153% between 2004 and 2011. Between 2000 and 2014 the rates of death from prescription opioid overdose increased from 1.5 to 5.9 deaths per 100,000. Most physicians and prescribers do not have extensive knowledge of Addiction Medicine principles and may not adequately recognize risks of abuse or overdose. Methods: This was a case control study using a single round, categorical and Likert scale survey to a sample of ambulatory, non-urgent patients presenting to one of two campuses of an urban, academic Emergency Department-an urban tertiary care hospital and Level 1 Trauma Center with an annual census of 65,000 and an urban community based hospital with an annual census of 42,000. Cases were identified by the presence of an opiate medication on their triagemedication list. Control subjects with no self-reported opiate use were recruited near concurrent to cases. Any patient with an ESI of 1 or 2, non-English speakers and those unable to provide consent were excluded. Data were analyzed using logistic regression. Results: A total of 290 patients were enrolled, 157 cases and 133 controls. The average age of the opiate users was 57.2 years (SD 14.90) vs 59.7 years (SD 15.07) for controls. There were no statistically significant differences among the groups for gender or race. Prescription opiate users were more likely to report smoking tobacco (OR 1.94; 95% CI 1.13-3.32) and marijuana (OR 4.97; 95% CI 1.08-22.82). For cases, 92% reported chronic pain and 85.9% reported acute pain on the day of enrollment. 27% reported <3 month duration of opiate use, 18% for 6-12 months, and 42% for greater than 2 years. 96% of cases and 91% of controls reported having a primary care physician (PCP). Cases were more likely to report having at least one medical specialist (OR 6.33, 95% CI 3.71-10.7). Cases were more likely to report psychiatric medications (OR 2.76, 95% CI 1.61-4.71) and GI medications, including stool softeners (OR 3.36, 95%CI 2.01-5.64) as part of their medication regimens. There was a statically significant difference between the groups when primary care physicians were prescribers for opiates (p=0), psychiatric medications (p=0.0006) and GI medications (p=0.0006). Conclusions: This study shows that cohort patients who self-report prescription opiate use are more likely to suffer chronic pain, have prolonged duration of opiate use, and obtain prescriptions from their primary care physicians. Frequency of co-prescriptions with psychiatric medications, most commonly benzodiazepines, reflect an increased risk of accidental overdose that may be unrecognized. Further provider and patient education in safe prescribing practices, appropriate prescription opiate use and risks of overdose is warranted. Summary: Opioid use, abuse, and overdose has reached epidemic proportions in the United States. Often, indicators of addiction or risks of overdose are unrecognized by providers and prescribers. This study aimed to gather specific data from patients who presented to the ED and reported opiates as part of their medication regimen with attention to duration of opiate use and main source of opiate prescriptions.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/494/CN-01364494/frame.html

Record #68 of 108
ID: CN-01376432
AU: D'Onofrio G
AU: Chawarski MC
AU: O'Connor PG
AU: Pantalon M
AU: Busch S
AU: Owens P
AU: Hawk KF
AU: Bernstein SL
AU: Fiellin DA
TI: Emergency department-initiated buprenorphine for opioid dependence with continuation in primary care: outcomes during and after treatment
SO: Academic emergency medicine. Conference: 2017 annual meeting of the society for academic emergency medicine, SAEM 2017. United states
YR: 2017
VL: 24
PG: S49
XR: EMBASE 616279922
PT: Conference Abstract
KY: clinical trial; controlled clinical trial; controlled study; drug overdose; drug therapy; *emergency ward; female; follow up; gender; human; Human immunodeficiency virus; human tissue; insurance; major clinical study; male; nonhuman; *opiate addiction; patient referral; *primary medical care; randomized controlled trial; toxicology; urine; *buprenorphine; opiate
DOI: 10.1111/acem.13203
AB: Background: Emergency Department (ED)-initiated buprenorphine/naloxone (buprenorphine) with continuation in primary care increased engagement in addiction treatment and decreased illicit opioid use at 30-days compared to referral (referral) and brief intervention with a facilitated referral (brief intervention). Objective: To evaluate the long term outcomes at 2, 6 and 12 months following ED interventions. Methods: Evaluation of treatment engagement, drug use, and HIV risk among a cohort of patients from a randomized trial who completed at least one long term follow-up assessment. Participants: 290/329 (88% of the randomized sample) were included. The followed cohort did not differ significantly from the randomized sample on any baseline variable including age, gender, type of drug used, insurance or treatment seeking status or presenting with overdose. Interventions: ED-initiated buprenorphine with continuation in primary care for 10 weeks, referral, or brief intervention were provided in the ED at study entry. Main Measures: Self-reported engagement in formal addiction treatment, days of illicit opioid use, and HIV risk (2, 6, 12 months); urine toxicology (2, 6 months). Results: More patients in the buprenorphine group were engaged in addiction treatment at 2 months 68/92 (74% [95% CI, 65%-83%] compared with referral 42/79(53%[95%CI, 42%-64%]) and brief intervention 39/83(47%[95%CI, 37%-58%]), p < .001. The differences were not significant at 6 months 51/92(55% [95%CI, 45%-65%]); 46/70(66%[95%CI, 54%-76%]); 43/76(57%[95%CI, 45%-67%] p=0.37 or 12 months 42/86(49%[95%CI, 39%-59%]; 37/73(51%[95% CI, 39%-62%]); 49/78(63%[95%CI, 52%-73%]; p=0.16. At 2 months, the buprenorphine group reported fewer days of illicit opioid use, 1.1(95%CI, 0.6-1.6) versus referral 1.8(95%CI, 1.2-2.3) and brief intervention 2.0(95%CI, 1.5-2.6); p=0.04. No significant differences in illicit opioid use at 6 months 1.7(95%CI 1.2-2.2), 1.7(95%CI 1.1-2.3), 2.0(95%CI 1.4-2.5) p=0.54, or 12 months 1.0(95%CI 0.6-1.5), 1.2(95%CI 0.7-1.7), 1.0(95%CI 0.5-1.5); p=0.09 were observed. There were no differences in HIV risk or rates of opioid negative urine results at any time. Conclusion: ED-initiated buprenorphine improved engagement in addiction treatment and reduction of illicit opioid use during the 2-month interval when buprenorphine is continued in primary care.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/432/CN-01376432/frame.html

Record #69 of 108
ID: CN-01449314
AU: Banta-Green CJ
AU: Coffin PO
AU: Merrill JO
AU: Sears JM
AU: Dunn C
AU: Floyd AS
AU: Whiteside LK
AU: Yanez ND
AU: Donovan DM
TI: Impacts of an opioid overdose prevention intervention delivered subsequent to acute care
SO: Injury prevention
YR: 2018
PM: PUBMED 29436397
PT: Journal Article
CC: SR-ADDICTN
DOI: 10.1136/injuryprev-2017-042676
AB: BACKGROUND: Opioid overdose is a major and increasing cause of injury and death. There is an urgent need for interventions to reduce overdose events among high-risk persons. METHODS: Adults at elevated risk for opioid overdose involving heroin or pharmaceutical opioids who had been cared for in an emergency department (ED) were randomised to overdose education combined with a brief behavioural intervention and take-home naloxone or usual care. Outcomes included: (1) time to first opioid overdose-related event resulting in medical attention or death using competing risks survival analysis; and (2) ED visit and hospitalisation rates, using negative binomial regression and adjusting for time at risk. RESULTS: During the follow-up period, 24% of the 241 participants had at least one overdose event, 85% had one or more ED visits and 55% had at least one hospitalisation, with no significant differences between intervention and comparison groups. The instantaneous risk of an overdose event was not significantly lower for the intervention group (sub-HR: 0.83; 95% CI 0.49 to 1.40). DISCUSSION: These null findings may be due in part to the severity of the population in terms of housing insecurity (70% impermanently housed), drug use, unemployment and acute healthcare issues. Given the high overdose and healthcare utilisation rates, more intensive interventions, such as direct referral and provision of housing and opioid agonist treatment medications, may be necessary to have a substantial impact on opioid overdoses for this high-acuity population in acute care settings. TRIAL REGISTRATION NUMBER: NCT0178830; Results.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/314/CN-01449314/frame.html

Record #70 of 108
ID: CN-01136081
AU: Bowers KJ
AU: McAllister KB
AU: Ray M
AU: Heitz CR
TI: Ketamine as an adjunct to opiates for acute pain in the emergency department
SO: Annals of emergency medicine.
YR: 2015
VL: 66
NO: 4 SUPPL. 1
PG: S1-S2
XR: EMBASE 72032540
PT: Journal: Conference Abstract
KY: *pain; *emergency ward; *American; *college; *emergency physician; *human; patient; side effect; satisfaction; dizziness; therapy; analgesia; drug therapy; sedation; controlled study; *ketamine; *opiate; placebo; narcotic analgesic agent; morphine
AB: Study Objectives: Ketamine has emerged as a potential adjunct to opiate therapy, with potential to reduce the dose of opiate required to treat painful conditions. The primary objectives of this study were to evaluate whether patients who receive ketamine as adjunctive treatment to opiates in the emergency department experience effective pain control, better satisfaction with their pain control or lower total opiate dosage compared to patients who receive only opiate therapy. Methods: This was a randomized, double-blinded, placebo-controlled trial which evaluated the use of ketamine in conjunction with opioid analgesic versus placebo in conjunction with opioid analgesic for moderate to severe pain in the emergency department. Upon enrollment, subjects were randomly assigned to receive either ketamine or placebo followed by protocol-based dosing of morphine or an alternate opiate. Subjects were assessed at an initial evaluation, and subsequently evaluated every 30 minutes over the course of 2 hours for their pain as rated on a scale of 0-10, satisfaction with pain control as rated on a scale of 0-3, presence of side effects, sedation level and need for additional pain medication. Total opiate dosage was calculated. Results: One hundred sixteen subjects were enrolled, 63 in the placebo group and 53 in the ketamine group. There were no statistically significant differences between the two groups across demographic variables. Patients who received ketamine reported lower average pain scores over the 120 minute study period than patients who received placebo (P = .015). Total opiate dosage was lower in the ketamine group versus the standard treatment (P = .02). Patient-reported satisfaction with their pain control was not statistically significantly different between the two groups. Proportionally fewer patients in the ketamine group required additional doses of analgesia, and of those patients, fewer patients required two or more additional doses than in the placebo group. More patients reported light-headedness and dizziness in the ketamine group versus the placebo group; the most common unique side effect in the ketamine group was light-headedness. Conclusion: Ketamine, dosed at 0.1 mg/kg, as an adjunct to opiate therapy was more effective at reducing pain over the 120 minute study period, and resulted in a lower total dosage of opiate analgesia as well as fewer repeat doses of analgesia. While more side effects were reported in the ketamine group versus placebo (51% vs 19%), the side effect profile still appears to be tolerable for this treatment.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/081/CN-01136081/frame.html

Record #71 of 108
ID: CN-01362558
AU: Barnett ML
AU: Olenski A
AU: Jena AB
TI: Emergency physician opioid prescribing patterns and risk of long-term use
SO: Journal of general internal medicine. Conference: 40th annual meeting of the society of general internal medicine, SGIM 2017. United states
YR: 2017
VL: 32
NO: 2 Supplement 1
PG: S180
XR: EMBASE 615581481
PT: Conference Abstract
KY: adult; adverse outcome; aged; clinical trial; complication; controlled clinical trial; controlled study; diagnosis; drug therapy; *emergency physician; emergency ward; fracture; hospitalization; human; major clinical study; *prescription; randomization; randomized controlled trial; retrospective study; selection bias; *opiate
AB: BACKGROUND: Rising rates of opioid prescribing and opioid-related overdose deaths have increasingly affected the elderlyMedicare population, among whom hospitalization rates for opioid overdoses grew five-fold from 1993- 2012. Growing opioid overuse may be partly driven by physician prescribing. However, the extent to which individual physicians vary in opioid prescribing and the implications of that variation for patients' long-term opioid use and adverse outcomes are unknown. METHODS: We performed a retrospective analysis ofMedicare beneficiaries with an index emergency department (ED) visit during 2008-2011 without opioid prescriptions in the 6 months prior. To address selection bias, we relied on the fact that patients are unlikely to choose their ED physician once they have chosen a facility. Assigning patients to emergency physicians within a hospital, we categorized physicians as high- or low-intensity opioid prescribers based on their relative quartiles of prescribing rates within the same hospital. We compared rates of long-term opioid use, defined as 6 months of days supplied, in the 12 months subsequent to an ED visit among patients treated by high- vs. low-intensity prescribers, adjusting for patient characteristics. We also assessed rates of hospital encounters (ED visits or admissions) for opioidrelated complications in older adults such as falls/fractures. RESULTS: Our sample contained 215,678 and 161,951 patients treated by low- and high-intensity prescribers, respectively. Patient characteristics, including ED diagnoses, were similar across both groups. Opioid prescribing rates varied widely within hospital between high and low-intensity prescribers (24.1%vs. 7.3%). Overall, long-termopioid use at 12months was significantly higher among patients treated by high vs. low-intensity prescribers, 1.51% vs. 1.16% (unadjusted OR 1.31, 95% CI 1.24-1.39). After adjustment, this difference changed minimally (adjusted OR 1.30, 95% CI 1.23-1.37). Rates of hospital encounters for falls/fracture were significantly higher in the 12 months subsequent to an index ED visit for patients treated by high- vs. low-intensity opioid prescribers (4.56% vs. 4.28%; adjusted OR 1.07, 95% CI 1.03-1.11). CONCLUSIONS: We found over three-fold variation in emergency physician opioid prescribing rates within the same hospital associated with increased rates of long-term opioid use and hospitalizations for falls/fractures among patients treated by high-intensity opioid prescribers. We reduced selection bias by taking advantage of quasi-randomization of patients to ED physicians within the same facility, supported by the minimal change in our results with adjustment. These results suggest that an increased likelihood of receiving an opioid for even one encounter could drive significant future long-term opioid use and potentially increased adverse outcomes among the elderly.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/558/CN-01362558/frame.html

Record #72 of 108
ID: CN-01134742
AU: Brandow AM
AU: Nimmer M
AU: Simmons T
AU: Casper TC
AU: Cook LJ
AU: Scott JP
AU: Panepinto JA
AU: Brousseau DC
TI: Higher dose of opioids in the emergency department and earlier initiation of oral opioids after hospitalization are associated with shorter length of stay in children with sickle cell disease treated for acute pain
SO: Blood.
YR: 2015
VL: 126
NO: 23
PG: 525
XR: EMBASE 72171271
PT: Journal: Conference Abstract
KY: *hospitalization; *length of stay; *child; *human; *sickle cell anemia; *pain; *American; *society; *hematology; *emergency ward; patient; magic; hospital patient; hospital readmission; randomized controlled trial; secondary analysis; patient satisfaction; outpatient care; acute chest syndrome; side effect; thalassemia; analgesia; surgical patient; female; opiate; magnesium; hydroxyurea; morphine; placebo; sodium chloride
CC: SR-CF
AB: There is currently no standardized approach to emergency department (ED) and inpatient treatment of an acute pain event for patients with sickle cell disease (SCD). In addition, how the initial treatment of a pain event influences the outcome of that pain event is not well described. In surgical patients, aggressive pre-operative and peri-operative pain management is associated with improved pain outcomes post-operatively. Furthermore, in post-operative patients, using oral opioids alone or in combination with intravenous (IV) opioids is shown to provide better pain control, decreased IV opioid consumption, less side effects and higher patient satisfaction. In SCD, it is not known whether more aggressive opioid treatment at presentation to ED care or earlier initiation of oral opioids after hospitalization is associated with improved outcomes. Thus, we sought to determine the impact of the following treatment-related aspects of acute pain events on length of hospital stay: 1) total opioid dose at presentation, 2) time to initiation of first IV opioid at presentation, and 3) time to initiation of first oral opioid after hospitalization. We hypothesized that increased total initial dose of opioids, more rapid initiation of IV opioids in the ED, and earlier initiation of oral opioids after hospitalization would be associated with shorter length of hospital stay. We conducted a secondary analysis of data from the randomized controlled Magnesium for children in Crisis (MAGiC) trial. The MAGiC trial was a double-blind randomized controlled trial of IV magnesium versus saline placebo added to standard treatment for pediatric pain events. All patients had HbSS or HbSbeta0 thalassemia to be eligible. The primary outcome, length of stay, was a composite endpoint of actual discharge or 12 hours after administration of last IV opioid, whichever came first. Patients were defined as having severe disease if a history of acute chest syndrome and/or 3 or more pain hospitalizations in the prior 3 years existed. A priori, all pain events were considered severe as the need for hospitalization indicated failure of outpatient therapy. Our primary variables of interest were: 1) Total initial opioid dose: total mg/kg/hr of morphine equivalents administered between first opioid in ED through start of study drug, 2) Time to first IV opioid: total hours between ED arrival and first IV opioid, 3) Time to first oral opioid: total hours between ED arrival and start of first oral opioid after hospitalization. Spearman correlations were used to determine the association between the above variables and length of stay and between length of stay and rehospitalization within 7 days to determine the consequence of earlier discharge. A total of 204 patients were enrolled at 8 sites. Mean (SD) age was 13.6 (4.7) years, 51.5% were female, 88.2% had severe disease and 60.3% were taking hydroxyurea. The primary MAGiC trial analysis found IV magnesium had no impact on length of stay. The mean total initial dose of opioid was 0.043 (0.029) mg/kg/hr that was administered over a median of 8.5 (IQR 6.4-13.1) hours. Higher total initial opioid dose was correlated with shorter length of stay (r=0.34, p<0.01). The median time to first IV opioid was 1.02 (IQR 0.65-1.33) hours. There was no association between the time to first IV opioid and length of stay (r=0.006, p=0.93). The median time to time to first oral opioid was 28.3 (IQR 12.2-61.1) hours. Earlier initiation of oral opioids was strongly associated with shorter length of stay (r=0.61, p<0.01). Neither shorter length of stay (r=-0.08, p=0.28) nor earlier initiation of oral opioids (r=-0.02, p=0.82) was associated with rehospitalization within 7 days. Earlier initiation of oral opioids was strongly associated with shorter length of stay without associated increased rehospitalizations. Higher doses of opioids during the initial management of a pain event also contributed to shorter length of stay, however, more rapid initiation of IV opioids did not alter length of stay. These data suggest that higher initial doses of opioids in the ED and earlier introduction of oral opioids after hospitalization may improve outcomes of pain events. Prospective trials designed to evaluate the impact of initial ED care on outcomes of hospitalizations for pain events and trials aimed at standardizing inpatient treatment for pain events are needed and could ultimately lead to improved outcomes for pain in children with SCD.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/742/CN-01134742/frame.html

Record #73 of 108
ID: CN-01291587
AU: Jelacic S
AU: Bollag L
AU: Bowdle A
AU: Rivat C
AU: Cain KC
AU: Richebe P
TI: Intravenous Acetaminophen as an Adjunct Analgesic in Cardiac Surgery Reduces Opioid Consumption But Not Opioid-Related Adverse Effects: a Randomized Controlled Trial
SO: Journal of cardiothoracic and vascular anesthesia
YR: 2016
VL: 30
NO: 4
PG: 997-1004
PM: PUBMED 27521969
XR: EMBASE 612824889
PT: Journal Article; Randomized Controlled Trial
KY: Acetaminophen [administration & dosage] [pharmacology];Administration, Intravenous;Adolescent;Analgesia [methods];Analgesics, Non-Narcotic [administration & dosage] [pharmacology];Analgesics, Opioid [administration & dosage] [adverse effects];Cardiac Surgical Procedures;Double-Blind Method;Drug Therapy, Combination;Hyperalgesia;Length of Stay [statistics & numerical data];Pain, Postoperative [drug therapy];Prospective Studies;Respiration, Artificial [statistics & numerical data];Adult[checkword];Aged[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword];Young Adult[checkword];adult; *analgesic activity; anesthesia induction; article; artificial ventilation; controlled study; double blind procedure; drug efficacy; drug safety; drug tolerability; female; *heart surgery; human; intensive care unit; length of stay; major clinical study; male; outcome assessment; pain assessment; patient satisfaction; postoperative pain/co [Complication]; postoperative pain/dt [Drug Therapy]; priority journal; randomized controlled trial; treatment duration; unspecified side effect/si [Side Effect]; morphine; *narcotic analgesic agent/ae [Adverse Drug Reaction]; *narcotic analgesic agent/dt [Drug Therapy]; *paracetamol/cm [Drug Comparison]; *paracetamol/dt [Drug Therapy]; *paracetamol/iv [Intravenous Drug Administration]; placebo; absence of side effects; adverse drug reaction; *analgesia; clinical trial; controlled clinical trial; expectation; hyperalgesia; *opiate addiction; surgery; wound; *opiate; *paracetamol
DOI: 10.1053/j.jvca.2016.02.010
AB: DESIGN: Double-blind, randomized, placebo-controlled trial.SETTING: A single academic medical center.PARTICIPANTS: The study was comprised of 68 adult patients undergoing cardiac surgery.INTERVENTIONS: Patients were assigned randomly to receive either 1,000 mg of intravenous acetaminophen or placebo immediately after anesthesia induction, at the end of surgery, and then every 6 hours for the first 24 hours in the intensive care unit, for a total of 6-1,000 mg doses.MEASUREMENTS AND MAIN RESULTS: The primary outcome was 24-hour postoperative opioid consumption. The secondary outcomes included 48-hour postoperative opioid consumption, incisional pain scores, opioid-related adverse effects, length of mechanical ventilation, length of intensive care unit stay, and the extent of wound hyperalgesia assessed at 24 and 48 hours postoperatively. The mean±standard deviation postoperative 24-hour opioid consumption expressed in morphine equivalents was significantly less in the acetaminophen group (45.6±29.5 mg) than in the placebo group (62.3±29.5 mg), representing a 27% reduction in opioid consumption (95% CI, 2.3-31.1 mg; p = 0.024). There were no differences in pain scores and opioid-related adverse effects between the 2 groups. A significantly greater number of patients in the acetaminophen group responded "very much" and "extremely well" when asked how their overall pain experience met their expectation (p = 0.038).CONCLUSIONS: The administration of intravenous acetaminophen during cardiac surgery and for the first 24 hours postoperatively reduced opioid consumption and improved patient satisfaction with their overall pain experience but did not reduce opioid side effects.OBJECTIVES: The authors hypothesized that intravenous acetaminophen as an adjunct analgesic would significantly decrease 24-hour postoperative opioid consumption.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/587/CN-01291587/frame.html

Record #74 of 108
ID: CN-01375225
AU: Michael SS
AU: Babu KM
AU: Androski C
AU: Reznek MA
TI: A randomized trial of an intervention to influence emergency medicine providers' opioid prescribing
SO: Annals of emergency medicine. Conference: american college of emergency physicians, ACEP 2016 research forum. United states
YR: 2016
VL: 68
NO: 4 Supplement 1
PG: S143
XR: EMBASE 616474789
PT: Conference Abstract
KY: anonymised data; behavior; clinical trial; community hospital; controlled clinical trial; controlled study; electronic medical record; *emergency medicine; emergency ward; female; human; male; pharmacokinetics; practice guideline; *prescription; randomization; randomized controlled trial; resident; statistical significance; *opiate
AB: Study Objectives: While multiple groups have developed recommendations for opioid prescribing in the emergency department (ED), little is known about methods to influence practice change among providers. The recent implementation of a state-wide opioid prescribing guideline provided a unique opportunity to investigate methods to influence opioid prescribing practices. Extrapolating from studies of physician decisionmaking in other areas, we theorized that providers may be more likely to change prescribing patterns when aware of their own data and peer group norms. We hypothesized that a simultaneous intervention of providing clinicians with their individual prescribing data would alter their practices beyond any effect achieved solely by being subject to the new clinical practice guideline (CPG). Methods: We conducted a prospective, multi-center, randomized trial in which all ED attendings, residents and advanced practice providers at four EDs were randomly assigned to either routine implementation of the CPG or implementation of the CPG plus a data-driven intervention (ClinicalTrials.gov NCT02665429). Providers in the intervention arm received graphical depictions of the distributions of three measures of opioid prescribing based upon de-identified data for all ED clinicians from the preceding 12 months. Providers were asked to identify their perceived position on each distribution by decile and were given their actual data immediately afterward. Sites ranged from a 364-bed tertiary academic center with 92,000 annual ED visits to a 41-bed community hospital with 14,000 visits. We queried the electronic medical record and for each clinician calculated the number of opioid prescriptions per hundred total prescriptions written and the percentage of patients dispositioned with an opioid prescription. In this pre-specified interim analysis, we considered each provider's prescribing for the two months before randomization and the two months afterward as matched pairs for differences testing. Results: A total of 109 providers were eligible for randomization (including 36 residents); 51 providers were randomized to the intervention, and 48 completed it (94%). 14,033 prescriptions were written in the 2 months priors prior to the CPG (18.5% opioids) and 13,968 (14.4% opioids) in the 2 months after. Opioid prescriptions per hundred total prescriptions decreased in both arms (mean difference-2.5 control and-2.8 intervention), but between-groups differences did not reach statistical significance (NS). Percentage of patients dispositioned with an opioid prescription also decreased in both arms (mean difference-1.3% and-1.4%, NS). Among providers in the intervention, underestimating one's own percentage of patients dispositioned with an opioid was associated with a decrease in both prescribing measures in the two months post-intervention (p=0.008). Conclusion: While this study is ongoing, and the available data may lack power to draw definitive conclusions, this interim analysis suggests that providing clinicians with their prescribing data may be associated with a change in behavior more so than CPG implementation alone. Larger-magnitude decreases among providers who underestimated their own prescribing lends credence to the hypothesized mechanism.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/225/CN-01375225/frame.html

Record #75 of 108
ID: CN-00563349
AU: Richman PS
AU: Baram D
AU: Varela M
AU: Glass PS
TI: Sedation during mechanical ventilation: a trial of benzodiazepine and opiate in combination
SO: Critical care medicine
YR: 2006
VL: 34
NO: 5
PG: 1395-1401
PM: PUBMED 16540957
XR: EMBASE 43754561
PT: Journal Article; Randomized Controlled Trial
KY: Analgesics, Opioid [administration & dosage] [adverse effects] [economics];Cost-Benefit Analysis;Drug Costs;Drug Therapy, Combination;Fentanyl [administration & dosage] [adverse effects] [economics];Hypnotics and Sedatives [administration & dosage] [adverse effects] [economics];Infusions, Intravenous;Linear Models;Midazolam [administration & dosage] [adverse effects] [economics];Prospective Studies;Respiration, Artificial;Statistics, Nonparametric;Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword];adult; aged; article; *artificial ventilation; clinical article; clinical trial; coma/si [Side Effect]; continuous infusion; controlled clinical trial; controlled study; drug cost; drug efficacy; female; human; hypotension/si [Side Effect]; hypoventilation/si [Side Effect]; ileus/si [Side Effect]; intensive care unit; male; priority journal; prospective study; Ramsay Sedation Score; randomized controlled trial; *respiratory failure/th [Therapy]; scoring system; *sedation; *benzodiazepine derivative/ae [Adverse Drug Reaction]; *benzodiazepine derivative/cb [Drug Combination]; *benzodiazepine derivative/cm [Drug Comparison]; *benzodiazepine derivative/iv [Intravenous Drug Administration]; *benzodiazepine derivative/pe [Pharmacoeconomics]; fentanyl/ae [Adverse Drug Reaction]; fentanyl/cb [Drug Combination]; fentanyl/cm [Drug Comparison]; fentanyl/iv [Intravenous Drug Administration]; fentanyl/pe [Pharmacoeconomics]; midazolam/ae [Adverse Drug Reaction]; midazolam/cb [Drug Combination]; midazolam/cm [Drug Comparison]; midazolam/iv [Intravenous Drug Administration]; midazolam/pe [Pharmacoeconomics]; *opiate/ae [Adverse Drug Reaction]; *opiate/cb [Drug Combination]; *opiate/cm [Drug Comparison]; *opiate/iv [Intravenous Drug Administration]; *opiate/pe [Pharmacoeconomics]
CC: SR-INJ
DOI: 10.1097/01.CCM.0000215454.50964.F8
AB: DESIGNA randomized, prospective, controlled trial.SETTINGA ten-bed medical intensive care unit at a university hospital.PATIENTSThirty patients with respiratory failure who were expected to require >48 hrs of mechanical ventilation and who were receiving a sedative regimen that did not include opiate pain control.INTERVENTIONSAn intravenous infusion of either midazolam alone or co-sedation was administered by a nurse-implemented protocol to achieve a target Ramsay Sedation Score set by the patient's physician. Study duration was 3 days, with a brief daily "wake-up."MEASUREMENTS AND MAIN RESULTSWe recorded the number of hours/day that patients were "off-target" with their Ramsay Sedation Scores, the number of dose titrations per day, the incidence of patient-ventilator asynchrony, and the time required to achieve adequate sedation as measures of sedative efficacy. We also recorded sedative cost in U.S. dollars and adverse events including hypotension, hypoventilation, ileus, and coma. Compared with the midazolam-only group, the co-sedation group had fewer hours per day with an "off-target" Ramsay Score (4.2 +/- 2.4 and 9.1 +/- 4.9, respectively, p < .002). Fewer episodes per day of patient-ventilator asynchrony were noted in the co-sedation group compared with midazolam-only (0.4 +/- 0.1 and 1.0 +/- 0.2, respectively, p < .05). Co-sedation also showed nonsignificant trends toward a shorter time to achieve sedation, a need for fewer dose titrations per day, and a lower total sedative drug cost. There was a trend toward more episodes of ileus with co-sedation compared with midazolam-only (2 vs. 0).CONCLUSIONSIn mechanically ventilated patients, co-sedation with midazolam and fentanyl by constant infusion provides more reliable sedation and is easier to titrate than midazolam alone, without significant difference in the rate of adverse events.OBJECTIVETo compare the efficacy of continuous intravenous sedation with midazolam alone vs. midazolam plus fentanyl ("co-sedation") during mechanical ventilation.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/349/CN-00563349/frame.html

Record #76 of 108
ID: CN-01246876
AU: Neven D
AU: Paulozzi L
AU: Howell D
AU: McPherson S
AU: Murphy SM
AU: Grohs B
AU: Marsh L
AU: Lederhos C
AU: Roll J
TI: A Randomized Controlled Trial of a Citywide Emergency Department Care Coordination Program to Reduce Prescription Opioid Related Emergency Department Visits
SO: Journal of emergency medicine
YR: 2016
VL: 51
NO: 5
PG: 498-507
XR: EMBASE 613220177
PT: Journal: Article
KY: confidence interval; control group; controlled clinical trial; controlled study; *coordination; doctor patient relation; driver; *emergency ward; human; information system; major clinical study; medical record review; *monitoring; odds ratio; *opiate addiction; pain; pill; *prescription; primary medical care; randomized controlled trial; controlled substance; morphine; *opiate; *prescription drug
DOI: 10.1016/j.jemermed.2016.06.057
AB: Background Increasing prescription overdose deaths have demonstrated the need for safer emergency department (ED) prescribing practices for patients who are frequent ED users. Objectives We hypothesized that the care of frequent ED users would improve using a citywide care coordination program combined with an ED care coordination information system, as measured by fewer ED visits by and decreased controlled substance prescribing to these patients. Methods We conducted a multisite randomized controlled trial (RCT) across all EDs in a metropolitan area; 165 patients with the most ED visits for complaints of pain were randomized. For the treatment arm, drivers of ED use were identified by medical record review. Patients and their primary care providers were contacted by phone. Each patient was discussed at a community multidisciplinary meeting where recommendations for ED care were formed. The ED care recommendations were stored in an ED information exchange system that faxed them to the treating ED provider when the patient presented to the ED. The control arm was subjected to treatment as usual. Results The intervention arm experienced a 34% decrease (incident rate ratios = 0.66, p < 0.001; 95% confidence interval 0.57-0.78) in ED visits and an 80% decrease (odds ratio = 0.21, p = 0.001) in the odds of receiving an opioid prescription from the ED relative to the control group. Declines of 43.7%, 53.1%, 52.9%, and 53.1% were observed in the treatment group for morphine milligram equivalents, controlled substance pills, prescriptions, and prescribers, respectively. Conclusion This RCT showed the effectiveness of a citywide ED care coordination program in reducing ED visits and controlled substance prescribing. Copyright © 2016 The Author(s)
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/876/CN-01246876/frame.html

Record #77 of 108
ID: CN-01245256
AU: Neven D
AU: Paulozzi L
AU: Howell D
AU: McPherson S
AU: Murphy SM
AU: Grohs B
AU: Marsh L
AU: Lederhos C
AU: Roll J
TI: A Randomized Controlled Trial of a Citywide Emergency Department Care Coordination Program to Reduce Prescription Opioid Related Emergency Department Visits
SO: Journal of emergency medicine
YR: 2016
VL: 51
NO: 5
PG: 498-507
XR: EMBASE 613220177
PT: Journal: Article
KY: adult; *ambulatory care; article; city; clinical effectiveness; controlled study; *emergency health service; *emergency ward; female; health care management; human; incidence; major clinical study; male; *medical information system; pain; prescription; priority journal; randomized controlled trial; morphine; *opiate; prescription drug; confidence interval; control group; controlled clinical trial; *coordination; doctor patient relation; driver; information system; medical record review; *monitoring; odds ratio; *opiate addiction; pill; *prescription; primary medical care; controlled substance; *prescription drug
DOI: 10.1016/j.jemermed.2016.06.057
AB: Background Increasing prescription overdose deaths have demonstrated the need for safer emergency department (ED) prescribing practices for patients who are frequent ED users. Objectives We hypothesized that the care of frequent ED users would improve using a citywide care coordination program combined with an ED care coordination information system, as measured by fewer ED visits by and decreased controlled substance prescribing to these patients. Methods We conducted a multisite randomized controlled trial (RCT) across all EDs in a metropolitan area; 165 patients with the most ED visits for complaints of pain were randomized. For the treatment arm, drivers of ED use were identified by medical record review. Patients and their primary care providers were contacted by phone. Each patient was discussed at a community multidisciplinary meeting where recommendations for ED care were formed. The ED care recommendations were stored in an ED information exchange system that faxed them to the treating ED provider when the patient presented to the ED. The control arm was subjected to treatment as usual. Results The intervention arm experienced a 34% decrease (incident rate ratios = 0.66, p < 0.001; 95% confidence interval 0.57-0.78) in ED visits and an 80% decrease (odds ratio = 0.21, p = 0.001) in the odds of receiving an opioid prescription from the ED relative to the control group. Declines of 43.7%, 53.1%, 52.9%, and 53.1% were observed in the treatment group for morphine milligram equivalents, controlled substance pills, prescriptions, and prescribers, respectively. Conclusion This RCT showed the effectiveness of a citywide ED care coordination program in reducing ED visits and controlled substance prescribing. Copyright © 2016 The Author(s)
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/256/CN-01245256/frame.html

Record #78 of 108
ID: CN-01065654
AU: Eaton K
AU: Kao M
AU: Barad M
TI: National trends of opioid treatment for adult and pediatric migraine headache patients in the emergency department
SO: Headache.
YR: 2014
VL: 54
PG: 15-16
XR: EMBASE 71558140
PT: Journal: Conference Abstract
KY: *headache; *human; *adult; *migraine; *patient; *emergency ward; *society; pain; diagnosis; sample size; brain infarction; migraine aura; therapy; ICD-9; transformed migraine; meta analysis; side effect; migraine with aura; monitoring; medication therapy management; population; menstrual migraine; drug therapy; prescription; child; hemiplegic migraine; model; migraine without aura; pathogenesis; controlled study; *opiate; placebo; caffeine; nicotinic agent; triptan derivative; receptor; tryptophan; tyrosine
DOI: 10.1111/head.12405
AB: Objectives: To determine the frequency and national trend of opioid use for treatment of headaches (including migraine headaches) in the Emergency Department from 2002 to 2009 Methods: Data on 288,199 ED visits in the National Ambulatory Medical Center Survey (NAMCS) between 2002 and 2009 are obtained. Variables extracted and investigated include reasons for visit, ICD9 diagnoses, demographics, and payer type. ICD-9 codes of Migraine/ Headache include Migraine with aura, Variants of migraine, no elsewhere classified, Hemiplegic migraine, Menstrual migraine, Persistent migraine aura w/o cerebral infarction, Persistent migraine aura with cerebral infarction, Chronic migraine without aura, Other forms of migraine, and Migraine unspecified. Weighted model estimation and inference was performed in SAS 9.4 (Cary, NC). Results: From 2002 to 2009, the number of visits to the Emergency Department (ED) for headache has been consistently at 5% of total ED visits in adults. In children (less than 16 years old), ED visits for headache has increased from 2.96% (SE 0.33%) in 2002 to 3.9% (SE 0.4%) in 2009. For adults with a diagnosis of migraine headaches in the ED, 64% (SE 3.8%) of patients received opioid prescriptions in 2002 compared with 53.0% (SE 6.0%) in 2009. For pediatric patients (less than 16 years old) who received a diagnosis of migraine headaches in the ED, about 10-20% received treatment with opioid medications. However, because this estimate is unstable due to sample size, we will not have the ability to look at the temporal trend. Conclusion: Though the trend of opioid management for migraine headaches in adult patients in the ED decreased by 11% from 2002 to 2009, it it still an abortive therapy being prescribed in over half of migraine patients presenting to the ED. Due to a smaller pediatric sample size, we are unable to accurately assess the temporal trend of opioid use for abortive therapy in this migraine population. However, this coding system may allow us to continue to follow trends of medication management for various RFV and ICD-9 codes in the ED in the future. 2) To assess the tolerability of Mycratine vs. placebo through the monitoring of adverse advents Background: While there are many therapeutic options for the treatment of acute migraine, limitations such as cost and unwanted side effects cause many patients to delay treatment or search for other treatment options. A meta-analysis of triptan efficacy demonstrated a 2-hour pain-free efficacy of approximately 35% when the treated headache had reached an intensity of moderate-to-severe. Thus, there are many attacks of acute migraine that are not being effectively treated with triptans. Mycratine is a homeopathic product containing Safe Nicotinic Receptor Agonist (SNRA), caffeine, L-Phenylalanice, L-Tyrosine , and L-Tryptophan. While the exact mechanism of action is unknown, Mycratine could modulate several receptors systems important in the pathogenesis of migraine. Methods: This was a five-center, randomized, double- blind, placebo-controlled study consisting of 50 screened subjects, 18 to 65 years of age, meeting ICHD-II criteria for migraine with or without aura. Subjects were instructed to treat their next four migraines at the onset of pain with 2 oz. of Mycratine or matching placebo. Subjects were randomized 1:1 and received study product (Mycratine) or placebo as treatment for the first 2 migraines. For the 3rd and 4th migraine, all subjects received active treatment. Subjects rated their migraine pain severity on a scale from0-3. Results: There was no difference in pain severity at headache onset (1.39 vs. 1.34, p = 0.71) or before treatment (1.54 vs. 1.59, p = 0.70) between groups. However, subj ects receiving Mycratine had a significant reduction in pain severity starting 1 hour after treatment (1.04 vs. 1.41, p = 0.04) when compared to placebo. These subjects continued to have a significant reduction in pain severity compared to placebo after two hours (0.96 vs. 1.45, p = 0.01) and 24 hours (0.25 vs. 0.61, p = 0.02) post treatment. Subjects receiving Mycratine also reported a significant decrease in pain (-0.17, p = 0.03) 10 minutes after treatment when compared to headache onset. Importantly there was no difference in the average incidence of adverse advents between the two groups (0.46 vs. 0.49, p = 0.88). Conclusion: Mycratine was a rapid, effective, and long lasting treatment option when used early during a migraine attack. Importantly, Mycratine significantly reduced migraine pain and was well tolerated in subjects. This study provides evidence for the use of Mycratine as a simple first-line therapeutic option for the treatment of migraine.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/654/CN-01065654/frame.html

Record #79 of 108
ID: CN-00707853
AU: Graham CA
AU: Baird K
AU: McGuffie AC
TI: A pilot randomised clinical trial of 3-in-1 femoral nerve block and intravenous morphine as primary analgesia for patients presenting to the emergency department with fractured hip
SO: Hong kong journal of emergency medicine
YR: 2008
VL: 15
NO: 4
PG: 205-211
XR: EMBASE 352685410
PT: Journal: Article
KY: absence of side effects/si [Side Effect]; aged; *analgesia; article; blood vessel injury; bolus injection; clinical article; clinical trial; controlled clinical trial; controlled study; drug efficacy; emergency ward; female; *femoral nerve; *femur neck fracture/di [Diagnosis]; general hospital; hip fracture/di [Diagnosis]; hip radiography; human; male; *nerve block; open study; outcome assessment; *pain/dt [Drug Therapy]; randomized controlled trial; scoring system; visual analog scale; bupivacaine/ct [Clinical Trial]; bupivacaine/cb [Drug Combination]; bupivacaine/dt [Drug Therapy]; diclofenac/ct [Clinical Trial]; diclofenac/do [Drug Dose]; diclofenac/dt [Drug Therapy]; dihydrocodeine/ct [Clinical Trial]; dihydrocodeine/do [Drug Dose]; dihydrocodeine/dt [Drug Therapy]; dihydrocodeine/po [Oral Drug Administration]; *morphine/ae [Adverse Drug Reaction]; *morphine/ct [Clinical Trial]; *morphine/cb [Drug Combination]; *morphine/do [Drug Dose]; *morphine/dt [Drug Therapy]; *morphine/iv [Intravenous Drug Administration]; naloxone; opiate derivative/dt [Drug Therapy]; opiate derivative/iv [Intravenous Drug Administration]; paracetamol/ct [Clinical Trial]; paracetamol/do [Drug Dose]; paracetamol/dt [Drug Therapy]; paracetamol/po [Oral Drug Administration]
CC: SR-ANAESTH: SR-MUSKINJ: SR-SYMPT
AB: Background: Fractured neck of femur (NOT) is a leading cause of morbidity and mortality in the elderly. Published clinical guidelines suggest early adequate analgesia as a key management aim. The femoral nerve '3-in-1 block' has previously been shown to provide effective analgesia for these patients in the peri- and post-operative phase of care. The aim of this study was to examine the use of the '3-in-1' femoral nerve block as primary analgesia for patients with a fractured NOT presenting to the emergency department. Methods: This was a single centre pragmatic randomised controlled open-label trial comparing femoral nerve block (using a '3-in-1' technique) with intravenous (IV) morphine. A convenience sample of patients presenting to the emergency department of a district general hospital with a clinically or radiologically suspected fractured NOT were recruited. They were randomised to receive either 0.1 mg/kg IV bolus of morphine or a '3-in-1' femoral nerve block with 30 mi of 0.5% plain bupivacaine. Visual analogue pain scores were noted prior to treatment and at 30 minutes, 2 hours, 6 hours and 12 hours after treatment. Immediate complications such as vascular puncture or the requirement for naloxone were noted. Results: Forty patients were recruited, 22 patients were randomised to IV morphine and 18 patients were randomised to '3-in-1' femoral nerve block. Complete data were available for 33 patients. There was no significant difference in initial median pain score (p=0.45). Analysis using the Wilcoxon test showed a significant decrease in pain score for the morphine group (p=0.01) and the nerve block group (p<0.01) at 30 minutes compared with baseline. Analysis using the Mann-Whitney U test between median pain scores at each time point showed a significant lower pain score in the nerve block group at 30 minutes (p=0.046). There were no immediate complications in either group. Conclusion: Our results suggest that a '3-in-1' femoral nerve block is at least as effective as IV morphine when used as primary analgesia for patients with fractured NOF Our results suggest that the femoral nerve block may provide better analgesia at 30 minutes. Further larger scale randomised trials are warranted.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/853/CN-00707853/frame.html

Record #80 of 108
ID: CN-01407013
AU: Klein L
AU: Cole J
AU: Driver B
AU: Martel M
TI: A randomized trial of intramuscular olatmnzapine versus oral clonidine for symptomatic treatment of opioid withdrawal in the emergency department
SO: Clinical toxicology. Conference: 2017 annual meeting of the north american congress of clinical toxicology, NACCT 2017. Canada
YR: 2017
VL: 55
NO: 7
PG: 692-693
XR: EMBASE 617812161
PT: Conference Abstract
KY: adult; adverse drug reaction; agonist; calculation; clinical trial; confidence interval; controlled clinical trial; controlled study; drug therapy; drug withdrawal; *emergency ward; female; human; human tissue; low drug dose; major clinical study; male; *palliative therapy; physician; *psychosis; randomized controlled trial; sample size; side effect; withdrawal syndrome; *clonidine; olanzapine; *opiate
CC: SR-ADDICTN
DOI: 10.1080/15563650.2017.1348043
AB: Background/Objectives: Patients experiencing withdrawal from opioids may present to the Emergency Department (ED) for symptoms associated with this clinical syndrome. Although outpatient programs can implement long-term opioid withdrawal treatment with agents such as methadone or buprenorphine, currently most EDs do not have the resources or infrastructure to initiate such treatments. Therefore, ED management of opioid withdrawal generally entails symptomatic control. The alpha-2 agonist clonidine is often considered the first-line agent for ED treatment of acute opioid withdrawal symptoms, but we hypothesized that intramuscular olanzapine would be superior to clonidine in this clinical scenario. Methods: This was a prospective, randomized clinical trial comparing 10mg of intramuscular olanzapine to 0.3mg of oral clonidine for the symptomatic treatment of acute opioid withdrawal in the ED. All adult ED patients reporting a history of ongoing opioid use with symptoms consistent with withdrawal necessitating medical treatment were screened for eligibility Patients were excluded if they had already received any treatment during the ED encounter. If enrolled, patients were randomized 1:1 to receive either olanzapine or clonidine for their initial medical treatment. A baseline Clinical Opiate Withdrawal Scale (COWS) score was calculated, and information regarding opioid use history was recorded. After 30 min post-study medication administration, the patient could receive any additional treatment at the ED physician's discretion. The primary efficacy outcome was need for any rescue medication within 1 h of study medication administration. Secondary outcomes included additional rescue medications needed after 1 h, change in COWS score from baseline, time in department, and any adverse reactions from the study medications. Results: We present preliminary data on the first 46 subjects enrolled. The target enrollment for adequate power is 56 patients based on a priori sample size calculations. Thus far, 28 patients were randomized to receive olanzapine and 18 patients were randomized to receive clonidine. All 46 enrolled subjects received study medications and were analyzed on an intention-to-treat basis. Baseline and demographic characteristics of the two groups are depicted in Table 1. Regarding the primary outcome, in the olanzapine group, 8/28 (29%) patients required rescue medication within 1 h of treatment, and in the clonidine group, 12/18 (67%) patients required rescue medication within 1 h of treatment, yielding a difference between the two groups of 38% (95% confidence interval of the difference 11-66%). Details of rescue medications administered as well as secondary outcomes are depicted in Table 2. Conclusions: The ED treatment of symptomatic acute opioid withdrawal with 10mg of intramuscular olanzapine results in a lower incidence of rescue medication administration and improved symptoms (utilizing the COWS scale) at 1 h when compared with 0.3mg of oral clonidine. Adverse events were uncommon, and occurred at a similar rate for both groups. Total time in the ED was similar for both groups (Table presented).
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/013/CN-01407013/frame.html

Record #81 of 108
ID: CN-01195221
TI: Emergency department patient perspectives on the risk of addiction to prescription opioids
SO: Pain medicine (united states)
YR: 2016
VL: 17
NO: 1
PG: 114-121
XR: EMBASE 605914651
PT: Journal: Article
KY: *addiction; analgesia; backache; content analysis; diagnosis; drug therapy; *emergency medicine; *emergency ward; fear; female; *human; injury; interview; *narcotic dependence; pain; *patient; *prescription; *qualitative research; randomized controlled trial; *risk; side effect; thematic analysis; hydrocodone; *narcotic analgesic agent; opiate; paracetamol
DOI: 10.1111/pme.12862
AB: Objective. To characterize emergency department (ED) patients' knowledge and beliefs about the addictive potential of opioids. Design. Mixed methods analysis of data from a randomized controlled trial. Setting. Urban academic ED (>88,000 visits). Subjects. One hundred and seventy four discharged ED patients prescribed hydrocodone-acetaminophen for acute pain. Methods. The study analyzed data collected from a randomized controlled trial investigating patients' knowledge of opioids. ED patients discharged with hydrocodone-acetaminophen completed an audio-recorded phone interview 4-7 days later. This analysis focuses on responses about addiction. Responses were categorized using content analysis; thematic analysis identified broad themes common across different categories. Results. Participants' mean age was 45.5 years (SD, 14.8), 58.6% female, 50.6% white, and the majority had an orthopedic diagnosis (24.1% back pain, 52.3% other injuries). Responses were categorized first based on whether the patient believed that opioids could be addictive (categorized as: yes, 58.7%; no, 19.5%; depends, 17.2%; or do not know, 4.6%), and second based on whether or not the patient discussed his/her own experience with the medication (categorized as: personalized, 35.6%; or not personalized, 64.4%). Cohen's Kappa was 0.84 for all categories. Three themes emerged in the thematic analysis: theme 1) patients expect to "feel" addicted if they are addicted, theme 2) patients fear addiction, and theme 3) side effects affected patient views of addiction. Conclusion. In this sample, patients had misconceptions about opioid addiction. Some patients did not know opioids could be addictive, others underestimated their personal risk of addiction, and others overtly feared addiction and, therefore, risked inadequate pain management. Despite limited data, we recommend providers discuss opioid addiction with their patients. Copyright © 2015 American Academy of Pain Medicine. All rights reserved.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/221/CN-01195221/frame.html

Record #82 of 108
ID: CN-01366130
AU: Murphy SM
AU: Howell D
AU: McPherson S
AU: Grohs R
AU: Roll J
AU: Neven D
TI: A Randomized Controlled Trial of a Citywide Emergency Department Care-Coordination Program to Reduce Prescription Opioid-Related Visits: an Economic Evaluation
SO: Journal of emergency medicine. (no pagination), 2017
YR: 2017
VL: Date of Publication: August 15
XR: EMBASE 615370943
PT: Article In Press
KY: clinical study; controlled clinical trial; *controlled study; *coordination; *economic evaluation; *emergency ward; human; investment; *prescription; randomized controlled trial; statistical significance; *opiate
DOI: 10.1016/j.jemermed.2017.02.014
AB: Background: Care provided in the emergency department (ED) can cost up to five times as much as care received for comparable diagnoses in alternative settings. Small groups of patients, many of whom suffer from an opioid use disorder, often account for a large proportion of total ED visits. We recently conducted, and demonstrated the effectiveness of, the first randomized controlled trial of a citywide ED care-coordination program intending to reduce prescription-opioid-related ED visits. All EDs in the metropolitan study area were connected to a Web-based information exchange system. Objective: The objective of this article was to perform an economic evaluation of the 12-month trial from a third-party-payer perspective. Methods: We modeled the person-period monthly for the 12-month observation period, and estimated total treatment costs and return on investment (ROI) with regard to cost offsets, over time, for all visits where the patient was admitted to and discharged from the ED. Results: By the end of month 4, the mean cumulative cost differential was significantly lower for intervention relative to treatment-as-usual participants (-$1370; p = 0.03); this figure climbed to -$3200 (p = 0.02) by the end of month 12. The ROI trended upward throughout the observation period, but failed to reach statistical significance by the end of month 12 (ROI = 3.39, p = 0.07). Conclusion: The intervention produced significant cost offsets by the end of month 4, which continued to accumulate throughout the trial; however, ROI was not significant. Because the per-patient administrative costs of the program are incurred at the time of enrollment, our results highlight the importance of future studies that are able to follow participants for a period beyond 12 months to more accurately estimate the program's ROI. Copyright © 2017 Elsevier Inc.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/130/CN-01366130/frame.html

Record #83 of 108
ID: CN-01010402
AU: Beaudoin FL
AU: Donaghy I
AU: Lin C
AU: Merchant RC
TI: Low-dose ketamine improves pain relief in patients receiving intravenous opioids for acute pain in the emergency department: results of a randomized, double-blind, clinical trial
SO: Academic emergency medicine.
YR: 2014
VL: 21
NO: 5 SUPPL. 1
PG: S6-S7
XR: EMBASE 71469308
PT: Journal: Conference Abstract
KY: *human; *analgesia; *patient; *low drug dose; *pain; *emergency ward; *double blind procedure; *society; *emergency medicine; arm; drug administration; analysis of variance; physician; rating scale; randomized controlled trial; rank sum test; ethnicity; Fisher exact test; *ketamine; morphine; placebo; sodium chloride; analgesic agent
DOI: 10.1111/acem.12365
AB: Background: Low-dose ketamine has been used peri-operatively for pain control and may be a useful adjunct to intravenous (IV) opioids in the control of acute pain in the emergency department (ED). Objectives: We aimed to determine the effectiveness of low-dose ketamine as an adjunct to morphine vs. standard care with morphine alone for the treatment of acute moderate to severe pain among ED patients. Methods: A double-blind, randomized, controlled trial with three study arms was conducted at a large, urban academic ED over a 10- month period. Eligible patients were 18-65 years old with acute moderate to severe pain (score of at least 5/10 numerical pain rating scale (NPRS) and pain duration <7 days) deemed by the ED physician to require IV opioids. The three study arms were: (1) standard care - morphine and normal saline placebo (SC), (2) morphine and 0.15 mg/ kg ketamine (LDK1), or (3) morphine and 0.3mg/kg ketamine (LDK2). Participants were assessed at 30, 60, and 120 minutes after study drug administration and received rescue analgesia as needed to target a 50% reduction in pain. The primary outcome measure of pain relief, or pain intensity reduction, was derived using the NPRS and calculated as the summed pain-intensity difference (SPID) over 2 hours. Continuous variables were compared between treatment groups using the Friedman analysis of variance and the Mann- Whitney U test; categorical variables were compared using the Fisher's exact test. Results: Sixty patients were enrolled (n=20 in each arm). There was no difference between study arms with respect to age, sex, ethnicity, pre-enrollment analgesia, or baseline NPRS. Over the 2-hour post-study drug administration period, the SPIDs were higher (greater pain relief) for the ketamine study arms than the control arm (SC=3.5, IQR 1.5-6; LDK1 6.3,IQR 2.5 - 12; and LDK2 7.8, IQR 4.8 - 12.8; p<0.02). The SPIDs for the two ketamine arms were similar (p=0.44). There was a trend towards more patients in the SC arm (9/20, 45%) receiving rescue analgesia compared to those in either the LDK1 (4/20, 20%) or LDK2 groups (4/20, 20%) (p=0.07). Conclusion: For treatment of acute moderate to severe pain, adjunctive doses of low doses of ketamine provided superior pain relief than morphine alone. Ketamine dosed at 0.3 mg/kg confers no additional benefit to treatment with 0.15 mg/kg. Ketamine is a viable adjunctive analgesic option in the ED.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/402/CN-01010402/frame.html

Record #84 of 108
ID: CN-01159244
AU: Bohnert ASB
AU: Bonar EE
AU: Cunningham R
AU: Greenwald MK
AU: Thomas L
AU: Chermack S
AU: Blow FC
AU: Walton M
TI: A pilot randomized clinical trial of an intervention to reduce overdose risk behaviors among emergency department patients at risk for prescription opioid overdose
SO: Drug and alcohol dependence
YR: 2016
VL: 163
PG: 40-47
XR: EMBASE 20160281001
PT: Journal: Article
KY: adult; article; behavior assessment; controlled study; drug misuse/th [Therapy]; *drug overdose/th [Therapy]; emergency ward; female; follow up; help seeking behavior; human; major clinical study; male; *motivational interviewing; patient assessment; patient education; prescription; priority journal; randomized controlled trial; risk assessment; risk factor; risk reduction; *social behavior; social interaction; treatment response; *narcotic analgesic agent
CC: SR-ADDICTN
DOI: 10.1016/j.drugalcdep.2016.03.018
AB: Background and aims: Prescription opioid overdose is a significant public health problem. Interventions to prevent overdose risk behaviors among high-risk patients are lacking. This study examined the impact of a motivational intervention to reduce opioid misuse and overdose risk behaviors. Methods: This study was a pilot randomized controlled trial set in a single emergency department (ED) in which, 204 adult, English-speaking patients seeking care who reported prescription opioid misuse during the prior 3 months were recruited. Patients were randomized to either the intervention, a 30-minute motivational interviewing-based session delivered by a therapist plus educational enhanced usual care (EUC), or EUC alone. Participants completed self-reported surveys at baseline and 6 months post-baseline (87% retention rate) to measure the primary outcomes of overdose risk behaviors and the secondary outcome of non-medical opioid use. Findings: Participants in the intervention condition reported significantly lower levels of overdose risk behaviors (incidence rate ratio [IRR] = 0.72, 95% CI: 0.59-0.87; 40.5% reduction in mean vs. 14.7%) and lower levels of non-medical opioid use (IRR = 0.81, 95% CI: 0.70-0.92; 50.0% reduction in mean vs. 39.5%) at follow-up compared to the EUC condition. Conclusions: This study represents the first clinical trial of a behavioral intervention to reduce overdose risk. Results indicate that this single motivational enhancement session reduced prescription opioid overdose risk behaviors, including opioid misuse, among adult patients in the ED.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/244/CN-01159244/frame.html

Record #85 of 108
ID: CN-00124110
AU: Jamali S
AU: Ravussin P
AU: Archer D
AU: Goutallier D
AU: Parker F
AU: Ecoffey C
TI: The effects of bolus administration of opioids on cerebrospinal fluid pressure in patients with supratentorial lesions
SO: Anesthesia and analgesia
YR: 1996
VL: 82
NO: 3
PG: 600-606
PM: PUBMED 8623968
XR: EMBASE 26072968
PT: Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial
KY: Anesthetics, Inhalation [administration & dosage];Anti-Arrhythmia Agents [administration & dosage];Atropine [administration & dosage];Blood Pressure [drug effects];Bradycardia [prevention & control];Cerebral Arteries [drug effects];Cerebrospinal Fluid Pressure [drug effects];Double-Blind Method;Fentanyl [pharmacology];Heart Rate [drug effects];Homeostasis [drug effects];Hypotension [prevention & control];Injections, Intravenous;Isoflurane [administration & dosage];Phenylephrine [administration & dosage];Placebos;Prospective Studies;Respiration, Artificial;Sufentanil [pharmacology];Supratentorial Neoplasms [surgery];Treatment Outcome;Vasoconstrictor Agents [administration & dosage];Vasodilation;Adult[checkword];Aged[checkword];Humans[checkword];Middle Aged[checkword];adult; aged; article; bradycardia; *brain injury; *cerebrospinal fluid pressure; clinical article; clinical protocol; clinical trial; controlled clinical trial; controlled study; double blind procedure; hemodynamics; human; hypotension; intravenous drug administration; mean arterial pressure; priority journal; randomized controlled trial; vasodilatation; atropine/ad [Drug Administration]; atropine/do [Drug Dose]; *fentanyl/ct [Clinical Trial]; *fentanyl/ad [Drug Administration]; *fentanyl/cm [Drug Comparison]; *fentanyl/do [Drug Dose]; isoflurane; midazolam; nitrous oxide; *opiate/ct [Clinical Trial]; *opiate/ad [Drug Administration]; *opiate/do [Drug Dose]; oxygen; *phenylephrine/ct [Clinical Trial]; *phenylephrine/ad [Drug Administration]; *phenylephrine/do [Drug Dose]; propofol; *sufentanil/ct [Clinical Trial]; *sufentanil/ad [Drug Administration]; *sufentanil/cm [Drug Comparison]; *sufentanil/do [Drug Dose]; vecuronium; anesthesia; artificial ventilation; bolus injection; brain injury; general anesthesia; heart rate; *hospital patient; hypothesis; injection; minimum lung alveolus concentration; patient; atropine; carbon dioxide; fentanyl; opiate; phenylephrine; sodium chloride; sufentanil
CC: SR-ANAESTH: SR-CANCER: SR-VASC
AB: In many studies reporting an increase in cerebrospinal fluid pressure (CSFP) after opioid administration, concomitant decreases in mean arterial pressure (MAP) have been observed. Autoregulatory cerebral vasodilation may therefore have been a factor in the CSFP increases. We tested the hypothesis that increases in CSFP after bolus injection of opioids could be minimized by modifying concomitant decreases in MAP with phenylephrine. Thirty-three patients with supratentorial mass lesions were studied in a randomized, prospective, double-blind, saline-controlled comparative trial. The principal outcome measures were lumbar CSFP, MAP, and heart rate (HR). Study drugs, sufentanil 0.8 micrograms/kg (n = 12), fentanyl 4.5 micrograms/kg (n = 11), or normal saline (n = 10), were injected intravenously (IV) during stable general anesthesia with 0.3-0.7 minimum alveolar anesthetic concentration (MAC) of isoflurane in oxygen and controlled ventilation (end-tidal carbon dioxide 32-35 mm Hg). Phenylephrine 50-100 micrograms was injected IV when MAP decreased by more than 15% of initial values, and atropine 0.5 mg IV when HR decreased to less than 45 bpm. Opioid administration was associated with significant decreases in MAP, 21 +/- 9 mm Hg (mean +/- SD) in the sufentanil group and 16 +/- 7 mm Hg in the fentanyl group; P < 0.001. These decreases in MAP were of short duration (i.e., corrected with 1-2 min). Patients in the sufentanil group needed more phenylephrine than patients in the fentanyl group (170 +/- 89 micrograms vs 100 +/- 47 micrograms; P < 0.05). No significant change in the CSFP was seen in either the sufentanil (1 +/- 6 mm Hg) or fentanyl-treated patients (O +/- 2 mm Hg). No significant changes in MAP or CSFP were observed in the saline-treated patients. HR decreased after injection of either study drug (P < 0.01) but remained unchanged in the saline group. In summary, during stable anesthesia with isoflurane in oxygen, bolus injections of fentanyl or sufentanil, despite producing rapidly corrected mean decreases in MAP of 18% and 25%, respectively, were not associated with any change in CSFP.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/110/CN-00124110/frame.html

Record #86 of 108
ID: CN-01432472
AU: Chang AK
AU: Bijur PE
AU: Esses D
AU: Barnaby DP
AU: Baer J
TI: Effect of a single dose of oral opioid and nonopioid analgesics on acute extremity pain in the emergency department: a randomized clinical trial
SO: JAMA - journal of the american medical association
YR: 2017
VL: 318
NO: 17
PG: 1661-1667
XR: EMBASE 619378130
PT: Article
KY: adult; adverse event; analysis of variance; controlled study; drug combination; drug therapy; *emergency ward; female; Hispanic; human; ingestion; *limb; major clinical study; male; New York; *numeric rating scale; outcome assessment; pain intensity; randomized controlled trial; codeine; hydrocodone; *hydrocodone bitartrate plus paracetamol; ibuprofen; *opiate; oxycodone; oxycodone plus paracetamol; paracetamol
DOI: 10.1001/jama.2017.16190
AB: IMPORTANCE: The choice of analgesic to treat acute pain in the emergency department (ED) lacks a clear evidence base. The combination of ibuprofen and acetaminophen (paracetamol) may represent a viable nonopioid alternative. OBJECTIVES: To compare the efficacy of 4 oral analgesics. DESIGN, SETTINGS, AND PARTICIPANTS: Randomized clinical trial conducted at 2 urban EDs in the Bronx, New York, that included 416 patients aged 21 to 64 years with moderate to severe acute extremity pain enrolled from July 2015 to August 2016. INTERVENTIONS: Participants (104 per each combination analgesic group) received 400 mg of ibuprofen and 1000 mg of acetaminophen; 5 mg of oxycodone and 325 mg of acetaminophen; 5 mg of hydrocodone and 300 mg of acetaminophen; or 30 mg of codeine and 300 mg of acetaminophen. MAIN OUTCOMES AND MEASURES: The primary outcome was the between-group difference in decline in pain 2 hours after ingestion. Pain intensity was assessed using an 11-point numerical rating scale (NRS), in which 0 indicates no pain and 10 indicates the worst possible pain. The predefined minimum clinically important difference was 1.3 on the NRS. Analysis of variance was used to test the overall between-group difference at P = .05 and 99.2% CIs adjusted for multiple pairwise comparisons. RESULTS: Of 416 patients randomized, 411 were analyzed (mean [SD] age, 37 [12] years; 199 [48%] women; 247 [60%] Latino). The baseline mean NRS pain score was 8.7 (SD, 1.3). At 2 hours, the mean NRS pain score decreased by 4.3 (95% CI, 3.6 to 4.9) in the ibuprofen and acetaminophen group; by 4.4 (95% CI, 3.7 to 5.0) in the oxycodone and acetaminophen group; by 3.5 (95% CI, 2.9 to 4.2) in the hydrocodone and acetaminophen group; and by 3.9 (95% CI, 3.2 to 4.5) in the codeine and acetaminophen group (P = .053). The largest difference in decline in the NRS pain score from baseline to 2 hours was between the oxycodone and acetaminophen group and the hydrocodone and acetaminophen group (0.9; 99.2% CI, -0.1 to 1.8), which was less than the minimum clinically important difference in NRS pain score of 1.3. Adverse events were not assessed. CONCLUSIONS AND RELEVANCE: For patients presenting to the ED with acute extremity pain, there were no statistically significant or clinically important differences in pain reduction at 2 hours among single-dose treatment with ibuprofen and acetaminophen or with 3 different opioid and acetaminophen combination analgesics. Further research to assess adverse events and other dosing may be warranted. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT02455518. Copyright © 2017 American Medical Association. All rights reserved.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/472/CN-01432472/frame.html

Record #87 of 108
ID: CN-00096348
AU: Marlow N
AU: Weindling M
AU: Shaw B
TI: Opiates, catecholamine concentrations, and ventilated preterm babies
SO: Lancet (london, england)
YR: 1993
VL: 342
NO: 8877
PG: 997-998
PM: PUBMED 8105252
PT: Clinical Trial; Comment; Letter; Randomized Controlled Trial
KY: Alfentanil [pharmacology];Catecholamines [metabolism];Infant, Newborn;Infant, Premature;Respiration, Artificial;Humans[checkword]
CC: SR-ANAESTH
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/348/CN-00096348/frame.html

Record #88 of 108
ID: CN-00522992
AU: White AG
AU: Birnbaum HG
AU: Mareva MN
AU: Daher M
AU: Vallow S
AU: Schein J
AU: Katz N
TI: Direct costs of opioid abuse in an insured population in the United States
SO: Journal of managed care pharmacy
YR: 2005
VL: 11
NO: 6
PG: 469-479
PM: PUBMED 15998164
PT: Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
KY: Adolescent;Cost of Illness;Demography;Insurance Claim Review;Insurance Coverage;Opioid-Related Disorders [economics] [epidemiology] [rehabilitation];Prevalence;United States [epidemiology];Adult[checkword];Child[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword]
CC: SR-CHILD
DOI: 10.18553/jmcp.2005.11.6.469
AB: METHODS: An administrative database of medical and pharmacy claims from 1998 to 2002 of 16 self-insured employer health plans with approximately 2 million lives was used to identify "opioid abusers"--patients with claims associated with ICD-9-CM (International Classification of Diseases, 9th Revision, Clinical Modification) codes for opioid abuse (304.0, 304.7, 305.5, and 965.0 [excluding 965.01]). A control group of nonabusers was selected using a matched sample (by age, gender, employment status, and census region) in a 3:1 ratio. Per-patient annual health care costs (mean total medical and drug costs) were measured in 2003 U.S. dollars. Multivariate regression techniques were also used to control for comorbidities and to compare costs with a benchmark of depressed patients.RESULTS: 740 patients were identified as opioid abusers, a prevalence of 8 in 10,000 persons aged 12 to 64 years continuously enrolled in health care plans for whom 12 months of data were available for calculating costs. Opioid abusers, compared with nonabusers, had significantly higher prevalence rates for a number of specific comorbidities, including nonopioid poisoning, hepatitis (A, B, or C), psychiatric illnesses, and pancreatitis, which were approximately 78, 36, 9, and 21 (P<0.01) times higher, respectively, compared with nonabusers. Opioid abusers also had higher levels of medical and prescription drug utilization. Almost 60% of opioid abusers had prescription drug claims for opioids compared with approximately 20% for nonabusers. Prevalence rates for hospital inpatient visits for opioid abusers were more than 12 times higher compared with nonabusers (P<0.01). Mean annual direct health care costs for opioid abusers were more than 8 times higher than for nonabusers ($15,884 versus $1,830, respectively, P < 0.01). Hospital inpatient and physician-outpatient costs accounted for 46% ($7,239) and 31% ($5,000) of opioid abusers. health care costs, compared with 17% ($310) and 50% ($906), respectively, for nonabusers. Mean drug costs for opioid abusers were more than 5 times higher than costs for nonabusers ($2,034 vs. $386, respectively, P<0.01), driven by higher drug utilization (including opioids) for opioid abusers. Even when controlling for comorbidities using a multivariate regression model of a matched control of depressed patients, the average health care costs of opioid abusers were 1.8 times higher than the average health care costs of depressed patients.CONCLUSION: The high costs of opioid abuse were driven primarily by high prevalence rates of costly comorbidites and high utilization rates of medical services and prescription drugs.OBJECTIVE: To (a) describe the demographics of opioid abusers; (b) compare the prevalence rates of selected comorbidities and the medical and drug utilization patterns of opioid abusers with patients from a control group, for the period from 1998 to 2002; and (c) calculate the mean annual per-patient total health care costs (e.g., inpatient, outpatient, emergency room, drug, other) from the perspective of a private payer.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/992/CN-00522992/frame.html

Record #89 of 108
ID: CN-01171943
AU: Onojighofia T
AU: Akindele B
AU: Schwarz D
AU: Meshkin B
TI: Study to comprehensively calculate risk of aberrant behavior to opioids by incorporating genetic and phenotypic risk factors in pain patients
SO: Regional anesthesia and pain medicine. Conference: 40th annual regional anesthesia and acute pain medicine meeting of the american society of regional anesthesia and pain medicine, ASRA 2015 las vegas, NV united states. Conference start: 20150514 conference end: 20150516. Conference publication: (var.pagings)
YR: 2015
VL: 40
NO: 5) (no pagination
XR: EMBASE 72215525
PT: Journal: Conference Abstract
KY: *pain; *regional anesthesia; *risk factor; *patient; *human; *American; *behavior disorder; *society; *risk; prescription; abuse; high risk population; algorithm; drug dependence; reward; neurochemistry; single nucleotide polymorphism; drug overdose; gold standard; addiction; technology; United States; genetics; assay; genotype; International Classification of Diseases; therapy; emergency ward; data analysis software; patient risk; opiate; prescription drug
AB: Introduction According to the CDC, nearly three out of four prescription drug overdoses are caused by prescription opioid pain relievers. The misuse and abuse of prescription opioid pain relievers was responsible for more than 475,000 emergency department visits in 2009, a number that nearly doubled in just five years. . A recent study estimated that in 2006 the total cost in the United States of nonmedical use of prescription opioids was $53.4 billion (Hansen et al. (2011). Thus, it has become extremely important to be able to effectively predict a patient's risk of aberrant behavior if given opioid pain relievers. The objective of this study is to determine the predictability of aberrant behavior to opioids (misuse, abuse, dependence and addiction) by using a comprehensive scoring algorithm that incorporates single nucleotide polymorphisms affecting neurochemistry of the mesolimbic reward system and phenotypic risk factors. Material and methods 162 pain subjects randomly selected from five clinical sites in the US. 80 diagnosed with Opioid drug dependence (ODD, ICD code 304.01) and 82 controls. Subjects were genotyped using TaqMan SNP genotyping assays (Life Technologies, Carlsbad, CA). A scoring algorithm, the Opioid Risk Index (ORI) score was calculated to predict risk of aberrant behavior to opioid pain relievers. The ORI is a scale of 0-52 that predicts risk of aberrant behavior to opioid pain relievers by incorporating both genetics and phenotypic risk factors. Results A cross tab analysis using IBM SPSS found a significant association between ODD and a NRI score of greater than or equal to 13. (Pearson Chi-Square = <0.05), Fishers Exact= <0.05, Sensitivity= 80.00 % (95% CI: 69.56 % to 88.11 %) Specificity= 93.90 % (95% CI: 86.33 % to 97.97 %), 92.75 % (95% CI: 83.88 % to 97.58 %), 82.80 % (95% CI: 73.57 % to 89.83 %), PLR =13.12 (95% CI: 5.57 to 30.89) NLR= 0.21 (95% CI: 0.14 to 0.33). Low (0-11), Moderate (12-23) and High risk (24 and greater) groups were calculated for the ORI by comparing it to the ORT (Opioid risk tool). The results of the low, moderate and high risk groups derived from the ORI were much better compared to same groups in the ORT. Discussion This study suggests that an ORI score of greater than or equal to 13 is a good cutoff to predict risk of aberrant behavior to opioid pain relievers. The ORI is also a useful tool to effectively stratify patients with risk of abusing opioids into low, moderate and high risk groups. In addition, the study showed that the ORI test may be a more robust test to help clinicians predict a patient's likelihood of aberrant behavior if given opioid pain relievers compared to the ORT test (current gold standard). It could therefore be employed before commencement or during therapy with opioid pain relievers to stem the tide of prescription opioid misuse/abuse.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/943/CN-01171943/frame.html

Record #90 of 108
ID: CN-01152733
AU: Bosch GE
AU: White T
AU: Marroun H
AU: Simons SH
AU: Lugt A
AU: Geest JN
AU: Tibboel D
AU: Dijk M
TI: Prematurity, Opioid Exposure and Neonatal Pain: do They Affect the Developing Brain?
SO: Neonatology
YR: 2015
VL: 108
NO: 1
PG: 8-15
PM: PUBMED 25871803
PT: Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
KY: Aging;Body Weight;Brain [drug effects];Chronic Pain [drug therapy];Follow-Up Studies;Gestational Age;Infant, Premature [growth & development];Magnetic Resonance Imaging;Morphine [adverse effects] [therapeutic use];Neuropsychological Tests;Rats;Respiration, Artificial [methods];Animals[checkword];Child[checkword];Female[checkword];Humans[checkword];Male[checkword]
DOI: 10.1159/000376566
AB: OBJECTIVESWe studied possible effects of prematurity, procedural pain and opioids in humans 10 years later. We hypothesized that these factors would negatively influence neurobiological, neuropsychological and sensory development later in life.METHODSWe included 19 children born preterm who as neonates participated in an RCT on the short-term effects of morphine administration and who previously participated in our follow-up studies at ages 5 and 8/9 years. We assessed associations between brain morphology (n = 11), neuropsychological functioning (n = 19) and thermal sensitivity (n = 17) and prematurity, opioid exposure and neonatal pain.RESULTSSignificant correlations (coefficients 0.60-0.85) of gestational age, number of painful procedures and morphine exposure with brain volumes were observed. Significant correlations between these factors and thermal sensitivity were not established. Neuropsychological outcome was significantly moderately correlated with morphine exposure in only two subtests, and children performed in general 'average' by Dutch norms.CONCLUSIONSAlthough prematurity, opioid exposure and neonatal pain were significantly associated with brain volume, no major associations with neuropsychological functioning or thermal sensitivity were detected. Our findings suggest that morphine administration during neonatal life does not affect neurocognitive performance or thermal sensitivity during childhood in children born preterm without brain damage during early life. Future studies with larger sample sizes are needed to confirm these findings.BACKGROUNDTraditionally, 10 years ago, children born preterm often routinely received morphine, especially during mechanical ventilation. Studies in neonatal rats, whose stage of brain development roughly corresponds to that of children born preterm, found negative long-term effects after pain and opioid exposure.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/733/CN-01152733/frame.html

Record #91 of 108
ID: CN-01449738
AU: Peckham M
AU: Fairman KA
AU: Sclar DA
TI: All-Cause and drug-related medical events associated with overuse of gabapentin and/or opioid medications in a commercially insured U.S. population: a retrospective cohort analysis Alyssa
SO: Pharmacotherapy. Conference: 2017 annual meeting of the american college of clinical pharmacy, ACCP 2017. United states
YR: 2017
VL: 37
NO: 12
PG: e188
XR: EMBASE 620235624
PT: Conference Abstract
KY: addiction; adult; anxiety; *cohort analysis; controlled study; diagnosis; drug combination; drug overdose; drug therapy; emergency ward; euphoria; follow up; health care utilization; hospital patient; human; mental health; outcome assessment; patient harm; randomized controlled trial; respiration depression; *retrospective study; controlled substance; *gabapentin; *opiate; sedative agent
DOI: 10.1002/phar.2052
AB: INTRODUCTION: Overuse of gabapentin and/or opioids occurs in a small percentage of patients at >3-fold labeled dosages. Gabapentin may potentiate opioid effects. RESEARCH QUESTION OR HYPOTHESIS: Assess patient harm, defined as use of inpatient hospital (IPH) or emergency department (ED) services, associated with overuse of gabapentin and/or opioids. STUDY DESIGN: Data source was Truven Health MarketScan Commercial Claims and Encounters database; years 2013-2015. Eligibility criteria was >2 claims and >120 days treatment with gabapentin and/or opioids. METHODS: Cohort identification was based on daily-dosage thresholds of 50 morphine-milligram equivalents and 3,600 milligrams gabapentin in 12-month follow-up: (1) no overuse; (2) mild overuse (>2 claims or <2 calendar quarters over-threshold); (3) sustained overuse (>3 over-threshold calendar quarters). IPH and ED use were measured for 6 months after first overuse date (cohorts 2 and 3), or a randomly assigned date (cohort 1). Logistic regression analyses controlled for pre-treatment IPH/ED utilization, indication, addiction diagnosis, concomitant sedative/hypnotic use, and demographics. RESULTS: All-cause and drug-related IPH/ED utilization increased monotonically with degree of overuse, particularly of >1 medication. Sustained overuse of gabapentin multiplied odds of all-cause IPH by 1.37, drug-related IPH by 1.44, and IPH/ED for altered mental status (e.g., euphoria, anxiety) by 1.86. Sustained overuse of both medications quadrupled odds of all-cause IPH, drug-related IPH, and IPH/ED for altered mental status or respiratory depression. CONCLUSION: Despite modest effects of gabapentin overuse alone, overuse of gabapentin with opioids may increase risk of harm and health-service utilization, supporting calls to make gabapentin a controlled substance in the U.S.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/738/CN-01449738/frame.html

Record #92 of 108
ID: CN-01423485
AU: Peckham AM
AU: Fairman KA
AU: Sclar DA
TI: All-Cause and Drug-Related Medical Events Associated with Overuse of Gabapentin and/or Opioid Medications: a Retrospective Cohort Analysis of a Commercially Insured US Population
SO: Drug safety
YR: 2017
PG: 1-16
XR: EMBASE 618503207
PT: Article In Press
KY: addiction; adult; anxiety; *cohort analysis; controlled study; diagnosis; drug combination; drug overdose; drug therapy; emergency ward; euphoria; follow up; health care utilization; hospital patient; human; mental health; outcome assessment; patient harm; randomized controlled trial; respiration depression; *retrospective study; controlled substance; *gabapentin; *opiate; sedative agent
DOI: 10.1007/s40264-017-0595-1
AB: Introduction: Overuse of gabapentin and/or opioids occurs in a small percentage of patients at > 3-fold labeled dosages. Gabapentin may potentiate opioid effects. Objective: The aim was to assess patient harm, defined as use of inpatient hospital (IPH) or emergency department (ED) services, associated with overuse of gabapentin with or without concomitant overuse of opioids. Data source: Data were sourced from the Truven Health MarketScan Commercial Claims and Encounters database, for the years 2013-2015. Eligibility criteria: The eligibility criteria were two or more claims (billed encounters) and >=120 days of treatment with gabapentin and/or opioids. Methods: Cohort identification was based on daily-dosage thresholds of 50 morphine-milligram equivalents and 3600 mg of gabapentin in a 12-month follow-up: (1) no overuse; (2) mild overuse (two or more claims or two or fewer calendar quarters over threshold); and (3) sustained overuse (three or more over-threshold calendar quarters). IPH and ED use were measured for 6 months after the first overuse date (cohorts 2 and 3) or a randomly assigned date (cohort 1). Logistic regression analyses controlled for pre-treatment IPH/ED utilization, indication, addiction diagnosis, concomitant sedative/hypnotic use, and demographics. Results: All-cause and drug-related IPH/ED utilization increased monotonically with degree of overuse, particularly of more than one medication. Sustained overuse of gabapentin multiplied odds of all-cause IPH by 1.366 [95% confidence interval (CI) 1.055-1.769], drug-related IPH by 1.440 (95% CI 1.010-2.053), and IPH/ED for altered mental status (e.g., euphoria, anxiety) by 1.864 (95% CI 1.324-2.624). Sustained overuse of both medications quadrupled odds of all-cause IPH, drug-related IPH, and IPH/ED for altered mental status or respiratory depression. Conclusion: Despite modest effects of gabapentin overuse alone, overuse of gabapentin with opioids may increase risk of harm and health-service utilization, supporting calls to make gabapentin a controlled substance in the USA. Copyright © 2017 Springer International Publishing AG
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/485/CN-01423485/frame.html

Record #93 of 108
ID: CN-00810830
AU: Wee MY
AU: Tuckey JP
AU: Thomas P
AU: Burnard S
TI: The IDvIP trial: a two-centre randomised double-blind controlled trial comparing intramuscular diamorphine and intramuscular pethidine for labour analgesia
SO: BMC pregnancy and childbirth
YR: 2011
VL: 11
PG: 51
PM: PUBMED 21740578
PT: Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
KY: Analgesia, Obstetrical;Analgesics, Opioid [administration & dosage] [adverse effects] [therapeutic use];Apgar Score;Cardiotocography;Double-Blind Method;Feeding Behavior;Heroin [administration & dosage] [adverse effects] [therapeutic use];Infant, Newborn;Injections, Intramuscular;Intensive Care, Neonatal;Labor Pain [drug therapy];Meperidine [administration & dosage] [adverse effects] [therapeutic use];Nausea [chemically induced];Oxygen [blood];Patient Satisfaction;Resuscitation;Vomiting [chemically induced];Female[checkword];Humans[checkword];Pregnancy[checkword]
DOI: 10.1186/1471-2393-11-51
AB: METHODS: The Intramuscular Diamorphine versus Intramuscular Pethidine (IDvIP) trial is a randomised double-blind two centre controlled trial comparing intramuscular diamorphine and pethidine regarding their analgesic efficacy in labour and their side effects in mother, fetus and neonate. Information about the trial will be provided to women in the antenatal period or in early labour. Consent and recruitment to the trial will be obtained when the mother requests opioid analgesia. The sample size requirement is 406 women with data on primary outcomes. The maternal primary outcomes are pain relief during the first 3 hours after trial analgesia and specifically pain relief after 60 minutes. The neonatal primary outcomes are need for resuscitation and Apgar Score <7 at 1 minute. The secondary outcomes are an additional measure of pain relief, maternal sedation, nausea and vomiting, maternal oxygen saturation, satisfaction with analgesia, whether method of analgesia would be used again, use of Entonox, umbilical arterial and venous pH, fetal heart rate, meconium staining, time from delivery to first breath, Apgar scores at 5 mins, naloxone requirement, transfer to neonatal intensive care unit, neonatal haemoglobin oxygen saturation at 30, 60, 90, and 120 mins after delivery, and neonatal sedation and feeding behaviour during first 2 hours.DISCUSSION: If the trial demonstrates that diamorphine provides better analgesia with fewer side effects in mother and neonate this could lead to a change in national practice and result in diamorphine becoming the preferred intramuscular opioid for analgesia in labour.TRIAL REGISTRATION: ISRCTN14898678Eudra No: 2006-003250-18, REC Reference No: 06/Q1702/95, MHRA Authorisation No: 1443/0001/001-0001, NIHR UKCRN reference 6895, RfPB grant PB-PG-0407-13170_IR5.BACKGROUND: Intramuscular pethidine is routinely used throughout the UK for labour analgesia. Studies have suggested that pethidine provides little pain relief in labour and has a number of side effects affecting mother and neonate. It can cause nausea, vomiting and dysphoria in mothers and can cause reduced fetal heart rate variability and accelerations. Neonatal effects include respiratory depression and impaired feeding. There are few large studies comparing the relative side effects and efficacy of different opioids in labour. A small trial comparing intramuscular pethidine with diamorphine, showed diamorphine to have some benefits over pethidine when used for labour analgesia but the study did not investigate the adverse effects of either opioid.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/830/CN-00810830/frame.html

Record #94 of 108
ID: CN-00724235
AU: Tamayo-Sarver JH
AU: Dawson NV
AU: Hinze SW
AU: Cydulka RK
AU: Wigton RS
AU: Albert JM
AU: Ibrahim SA
AU: Baker DW
TI: The effect of race/ethnicity and desirable social characteristics on physicians' decisions to prescribe opioid analgesics
SO: Academic emergency medicine
YR: 2004
VL: 10
NO: 11
PG: 1239-1248
CC: SR-ANAESTH: SR-SYMPT
AB: OBJECTIVE: Racial/ethnic disparities in physician treatment have been documented in multiple areas, including emergency department (ED) analgesia. The purpose of this study was to determine if physicians were predisposed to different treatment decisions based on patient race/ethnicity and if physicians' treatment predispositions changed when socially desirable information about the patient (occupation, socioeconomic status, and relationship with a primary care physician) was made explicit. METHODS: The authors developed three clinical vignettes designed to engage physicians' decision-making processes. The patient's race/ethnicity was included. Each vignette randomly included or omitted explicit socially desirable information. The authors mailed 5,750 practicing emergency physicians three clinical vignettes and a one-page questionnaire about demographic and practice characteristics. Chi-square tests of significance for bivariate analyses and multiple logistic regression were used for multivariate analyses. RESULTS: A total of 2,872 (53%) of the 5,398 potential physician subjects participated. Patient race/ethnicity had no effect on physician prescription of opioids at discharge for African Americans, Hispanics, and whites: absolute differences in rates of prescribing opioids at discharge were less than 2% for all three conditions presented. Making socially desirable information explicit increased the prescribing rates by 4% (95% CI = 0.1% to 8%) for the migraine vignette and 6% (95% CI = 3% to 8%) for the back pain vignette. CONCLUSIONS: Patient race/ethnicity did not influence physicians' predispositions to treatment plans in clinical vignettes. Even knowing that the patient had a high-prestige occupation and a primary care provider only minimally increased prescribing of opioid analgesics for conditions with few objective findings.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/235/CN-00724235/frame.html

Record #95 of 108
ID: CN-01211369
AU: Berthelot J-M
AU: Darrieutort-Lafitte C
AU: Goff B
AU: Maugars Y
TI: Strong opioids for noncancer pain due to musculoskeletal diseases: not more effective than acetaminophen or NSAIDs
SO: Joint, bone, spine
YR: 2015
VL: 82
NO: 6
PG: 397-401
PM: PUBMED 26453108
XR: EMBASE 609403397
PT: Journal: Short Survey
KY: acute limb pain/dt [Drug Therapy]; adverse drug reaction; chronic pain/dt [Drug Therapy]; drug efficacy; human; hyperalgesia; kidney colic/dt [Drug Therapy]; limb pain/dt [Drug Therapy]; low back pain/dt [Drug Therapy]; *musculoskeletal disease; *pain/co [Complication]; *pain/dt [Drug Therapy]; pain/dt [Drug Therapy]; randomized controlled trial (topic); sciatica; short survey; duloxetine/dt [Drug Therapy]; hydromorphone/dt [Drug Therapy]; morphine/cm [Drug Comparison]; morphine/do [Drug Dose]; morphine/dt [Drug Therapy]; nonsteroid antiinflammatory agent/dt [Drug Therapy]; *opiate/ct [Clinical Trial]; *opiate/do [Drug Dose]; *opiate/dt [Drug Therapy]; oxycodone/dt [Drug Therapy]; oxymorphone/dt [Drug Therapy]; paracetamol/ct [Clinical Trial]; paracetamol/dt [Drug Therapy]; placebo; analgesia; clinical trial; cold stress; controlled clinical trial; controlled study; death; double blind procedure; emergency ward; health care personnel; kidney colic; limb pain; low back pain; major clinical study; mortality; osteoarthritis; *pain; randomized controlled trial; morphine; nonsteroid antiinflammatory agent; opiate; *paracetamol
DOI: 10.1016/j.jbspin.2015.08.003
AB: The classification of morphine as a step III analgesic, based on pharmacological data, creates a strong bias toward a belief in the efficacy of this drug. However, double-blind emergency-room trials showed similar levels of pain relief with intravenous acetaminophen as with intravenous morphine in patients with renal colic, low back pain or acute limb pain. In patients with chronic noncancer low back pain, morphine and other strong opioids in dosages of up to 100 mg/day were only slightly more effective than their placebos, no more effective than acetaminophen, and somewhat less effective than nonsteroidal anti-inflammatory drugs (NSAIDs). In patients with osteoarthritis, strong opioids were not more effective than NSAIDs and, in some studies, than placebos. The only randomized controlled trial in patients with sciatica found no difference with the placebo. Chronic use of strong opioids can induce hyperalgesia in some patients. Hyperpathia with increased sensitivity to cold leading the patient to request higher dosages should suggest opioid-induced hyperalgesia. Pain specialists in the US have issued a petition asking that strong opioids be used in dosages no higher than 100 mg/day of morphine-equivalent, in an effort to decrease the high rate of mortality due to the misuse and abuse of strong opioids (10,000 deaths/year in the US). Healthcare providers often overestimate the efficacy of step III analgesics, despite pain score decreases of only 0.8 to 1.2 points. Copyright © 2015 Societe francaise de rhumatologie.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/369/CN-01211369/frame.html

Record #96 of 108
ID: CN-01302915
AU: Khemani D
AU: Camilleri M
AU: Roldan A
AU: Nelson AD
AU: Park S-Y
AU: Acosta A
AU: Zinsmeister AR
TI: Opioid analgesic use among patients presenting with acute abdominal pain and factors associated with surgical diagnoses
SO: Neurogastroenterology and motility
YR: 2016
VL: (no pagination)
XR: EMBASE 613920463
PT: Journal: Article In Press
KY: *acute abdomen; adult; adverse drug reaction; cohort analysis; computer assisted tomography; *constipation; controlled clinical trial; controlled study; diagnosis; electronic medical record; *emergency ward; human; major clinical study; neutrophil count; odds ratio; prevalence; randomized controlled trial; receiver operating characteristic; risk factor; side effect; statistical model; surgery; univariate analysis; validation process; *opiate
DOI: 10.1111/nmo.13000
AB: Background: The prevalence of chronic opioid use among non-cancer patients presenting with acute abdominal pain (AAP) is unknown. The aim was to characterize opioid use, constipation, diagnoses, and risk factors for surgical diagnoses among non-cancer patients presenting with AAP to an emergency department (ED). Methods: We performed a retrospective, observational cohort study of all (n=16,121) adult patients (88% from MN, IA and WI) presenting during 2014 with AAP. We used electronic medical records, and focused on 2352 adults with AAP who underwent abdominal CT scan within 24 hours of presentation. We determined odds ratios of association with constipation and features predicting conditions that may require surgery (surgical diagnosis). Key Results: There were 2352 eligible patients; 18.8% were opioid users. Constipation was more frequent in opioid (35.1%) compared to non-opioid users [OR 2.88 (95% CI 2.28, 3.62)]. Prevalence of surgical diagnosis in the opioid and non-opioid users was 35.3% and 41.7% respectively (P=.019). By univariate analysis, age and neutrophil count independently predicted increased risk, and chronic opioid use decreased risk of surgical diagnosis. Internal validation of logistic models using a randomly selected validation subset (25% of entire cohort, 587/2352) showed receiver operating characteristic (ROC) curves for the validation and full cohorts were similar. Conclusions and Inferences: Approximately 19% of adults presenting with AAP were opioid users; constipation is almost three times as likely in opioid users compared to non-opioid users presenting with AAP. Factors significantly associated with altered risk of surgical diagnoses were age, opioid use, and neutrophil count. Copyright © 2016 John Wiley & Sons Ltd.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/915/CN-01302915/frame.html

Record #97 of 108
ID: CN-01404126
AU: Mager A
AU: Pelot K
AU: Koch K
AU: Miller L
AU: Hubler C
AU: Ndifor A
AU: Coan C
AU: Leonard C
AU: Field JJ
TI: Opioid management strategy decreases admissions in high-utilizing adults with sickle cell disease
SO: Journal of opioid management
YR: 2017
VL: 13
NO: 3
PG: 143-156
XR: EMBASE 617550881
PT: Article
KY: adult; advance care planning; *analgesia; article; *chronic pain/dt [Drug Therapy]; chronic pain/dt [Drug Therapy]; clinical article; comparative study; controlled clinical trial; controlled study; daily life activity; drug dependence; drug efficacy; emergency care; female; *health care utilization; hemoglobin blood level; *hospital admission; hospital readmission; human; male; management; medical care; mental disease; middle aged; prospective study; psychologic assessment; psychosocial care; *sickle cell anemia; social care; social needs; social work; treatment planning; young adult; hemoglobin/ec [Endogenous Compound]; *morphine/ct [Clinical Trial]; *morphine/dt [Drug Therapy]; *morphine/iv [Intravenous Drug Administration]; *morphine/po [Oral Drug Administration]
DOI: 10.5055/jom.2017.0382
AB: Background: A subset of adults with sickle cell disease (SCD) heavily utilizes the emergency department (ED) and hospital. The objective of our study was to determine the efficacy of a multidisciplinary strategy to address unmet needs in highly utilizing adults with SCD. Methods: In a prospective study, adults with SCD with >=10 admissions per year were assessed by a multidisciplinary team for gaps in medical, social, and psychological care. Thereafter, the team decided upon the subject's predominant domain that drove admissions and instituted an interventional plan. All plans included an opioid management strategy. Preintervention and postintervention admission rate, as well as opioid use, was compared. Results: Twelve subjects were enrolled. Median rate of ED and hospital admissions preintervention was 25 per year. The predominant domains identified were social needs (n = 6), psychological disorder (n = 1), and substance use disorder (n = 5). Multifaceted interventional plans were developed to address a wide range of gaps in care, but an opioid management strategy was the only intervention successfully completed. Even so, when the preintervention versus postintervention admission rate was compared, regardless of the domain, there was a 40 percent decline in hospital admissions (p = 0.03). Consistent with the successful implementation of an opioid management plan, the decrease in admissions was accompanied by a 37 percent decrease in intravenous opioid use (p = 0.02) and 10 percent decrease in oral opioid use (p = 0.04). Conclusion: An opioid management strategy, as part of a larger effort to improve care for high-utilizing adults with SCD, decreased rate of admissions and opioid use. Copyright © 2017 Journal of Opioid Management, All Rights Reserved.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/126/CN-01404126/frame.html

Record #98 of 108
ID: CN-01362595
AU: Husain JM
AU: Larochelle M
AU: Keosaian J
AU: Gamble O
AU: Xuan Z
AU: Lasser KE
AU: Liebschutz JM
TI: Effects of discontinuing long-term opioid therapy in patients with chronic pain
SO: Journal of general internal medicine. Conference: 40th annual meeting of the society of general internal medicine, SGIM 2017. United states
YR: 2017
VL: 32
NO: 2 Supplement 1
PG: S175
XR: EMBASE 615581087
PT: Conference Abstract
KY: adverse drug reaction; analgesia; chi square test; *chronic pain; *clinical study; clinical trial; controlled clinical trial; controlled study; drug therapy; drug withdrawal; electronic health record; emergency ward; follow up; human; logistic regression analysis; medical record review; monitoring; normal human; nurse; odds ratio; prescription; primary medical care; randomized controlled trial; register; safety net hospital; side effect; *opiate
AB: BACKGROUND: Opioid prescribing guidelines for chronic pain recommend discontinuing opioid therapy if the risk-benefit ratio becomes unfavorable. However, reasons for discontinuing opioids and effects of discontinuation are largely unknown. Providers express concern for losing patients to follow-up, resulting in untreated pain or addiction and opioid-seeking from alternate sources. METHODS: The Transforming Opioid Prescribing in Primary Care (TOPCARE) study is a cluster-randomized controlled trial to improve opioid prescribing among patients on chronic opioid therapy for non-cancer pain. We analyzed data from an urban safety-net hospital primary care practice participating in the trial. Primary care providers (PCPs) randomized to the intervention were supported by a nurse care manger, electronic registry, academic detailing, and electronic tools; control PCPs received electronic tools only. We conducted a retrospective chart review of patients in both study arms whose PCPs discontinued opioids by the final 60 days of the 12 month intervention period, as noted in the electronic health record (EHR). Key outcomes from the EHR audit include: reason for discontinuation; >1 PCP visit and >1 pain-related emergency department (ED) visit within 6 months after discontinuation. We dichotomized discontinuation reasons as misuse/aberrant monitoring or other, which included pain resolved, inadequate analgesia, and adverse effects. We used chi-square tests to compare the frequency and reason for discontinuation between intervention and control patients. We used unadjusted logistic regression to determine if study arm or reason for discontinuation was associated with PCP follow-up or pain-related ED visits. RESULTS: Intervention patients discontinued opioids more frequently (60/ 331 [18%]) compared with control patients (28/233 [12%]; p = 0.049). Misuse/ aberrantmonitoring was the most common reason for discontinuation, and was more frequent among intervention (41/60 [68%]) vs. control patients (13/28 [46%]; p = 0.049). Similar proportions of patients discontinued due to other reasons in both trial arms. In the 6 months following opioid discontinuation, 70% of the patients returned for >1 PCP visit and 17% had a pain-related ED visit. Intervention patients were less likely to have PCP follow-up after discontinuation (odds ratio [OR] 0.3; 95% CI 0.1-0.9), and more likely to have pain-related ED visits (OR 8.2; 95% CI 1.0-66.0) than control patients. Discontinuation due to misuse/aberrant monitoring was not associated with PCP follow-up (OR 0.8; 95% CI 0.3-2.0) or pain-related ED visits (OR 1.9; 95% CI 0.6-6.6). CONCLUSIONS: The TOPCARE intervention led to higher rates of opioid discontinuation attributable to misuse or aberrant monitoring. However, intervention patients discontinued fromopioids were less likely to return for followup and more likely to seek care in the ED for pain. Future research should evaluate strategies to manage pain and keep patients engaged in care after opioid discontinuation.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/595/CN-01362595/frame.html

Record #99 of 108
ID: CN-01199317
AU: Bohnert AS
AU: Blow F
AU: Cunningham R
AU: Thomas L
AU: Greenwald MK
AU: Chermack S
AU: Bonar EE
AU: Walton M
TI: A randomized clinical trial of a behavioral intervention to reduce opioid overdose risk behavior
SO: Drug and alcohol dependence.
YR: 2015
VL: 156
PG: e22
XR: EMBASE 72176447
PT: Journal: Conference Abstract
KY: *human; *clinical trial; *intoxication; *risk; *college; *drug dependence; prescription; follow up; patient; computer; effect size; tablet; emergency ward; prevention; incidence; public health problem; *opiate
DOI: 10.1016/j.drugalcdep.2015.07.978
AB: Aims: Prescription opioid overdose represents a significant public health problem, but strategies to prevent overdose risk behavior have not been studied. This study compared a motivational enhancement-based brief intervention to an educational enhanced usual care condition in a clinical trial conducted in the emergency department (ED). Methods: Participants were approached and screened via tablet computer while waiting in the ED and were eligible if they reported prescription opioid misuse in the prior 3 months; individuals with a prior overdose experience were purposely over-sampled (76%). In total, 204 patients were randomized, and 86% were retained at 6 months follow-up. The intervention was delivered during the ED visit by master's-level therapists. The two primary outcomes were composite measures of prescription opioid misuse and overdose risk behaviors. Poisson regression was used to account for the outcome measure distributions. Results: Patients in the intervention condition reported lower levels of overdose risk behaviors at follow-up compared to controls; incidence rate ratio (IRR) = 0.78, 95% CI: 0.65-0.94. The intervention condition was also associated with significantly lower levels of prescription opioid misuse at follow-up compared to controls; IRR = 0.85, 95% CI: 0.74-0.99). Conclusions: This study represents the first clinical trial of a behavioral overdose prevention intervention and indicates that a motivational enhancement-based approach can reduce prescription opioid overdose risk behavior. Because the effect sizes were relatively modest, future research should explore methods to amplify the impact of the intervention.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/317/CN-01199317/frame.html

Record #100 of 108
ID: CN-00279419
AU: Chick JD
TI: Opioid mechanisms in alcohol dependence and its treatment
SO: Sixth world congress of biological psychiatry, nice, france. June 22-27, 1997.
YR: 1997
CC: HS-HANDSRCH
AB: Opioid antagonists reduce drinking in alcohol-dependent laboratory animals, and reduce the intensity of return to drinking after a period of abstinence when the animal is re-exposed to alcohol. Endogenous opioid peptides are believed to be important in the neural basis of reward and reinforcement. In human laboratory studies, the opioid antagonist, naltrexone, was found in some but not all studies to reduce rewarding effects of alcohol (Swift et al, 1994). This occurs without affecting psychomotor performance or ethanol pharmacokinetics. Naltrexone has also been found to decrease the urge to drink in non-dependent subjects taking part in a drinking experiment. Subjects at high risk of alcoholism (at least two generations of alcoholism in the family history) have been found in two separate studies to have an enhanced pituitary ?-endorphin release after drinking alcohol (Gianoulakis et al, 1996). A Spanish centre has reported that some abstinent alcoholics appear to have a deficiency of plasma endorphins, while alcoholics reporting to an emergency service when drinking appear to have an enhanced endorphin response to alcohol. In alcohol dependent patients receiving outpatient psychosocial treatments, two separate studies have shown that naltrexone reduces relapse rates now also published as combined data by O'Malley et al (1995). When naltrexone is discontinued, the beneficial effects experienced by the treated group only diminish slowly in the coming 6 months. In the UK Multi-Centre Study 90 patients were randomly allocated to receive naltrexone 50 mgs/day and 85 to receive a placebo for 12 weeks during outpatient care following detoxification from alcohol. In common with other alcoholism treatment outcome studies, many patients (58%) dropped out of attendance before completing the 12 week study period. The protocol specified analysis by compliance with treatment, which was defined as at least 80% correctly returned tablet counts and attendance at all appointments. The population completing the 3-month study, and reaching that definition of compliance, consisted of 35 placebo and 35 naltrexone patients. As found also in the Philadelphia naltrexone study, the benefits of naltrexone were only significant in compliant patients: for the 3 month period, the mean total of drinks reported by patients in the naltrexone group was 92.8 and by the placebo group, 185.9 (P < 0.05); the mean number of drinks consumed per day was 1.1 for naltrexone patients and 2.2 for placebo patients (P < 0.05); the mean total of non-abstinent days was 11.8 for naltrexone patients and 19.7 for placebo patients (P < 0.10); the median improvement from baseline in ?-glutamyl transferase was significantly greater for the naltrexone group than for the placebo group (P < 0.05); a measure of craving on the Obsessive Compulsive Drinking Scale showed a significantly (P < 0.05) greater improvement in the naltrexone group than placebo at multiple timepoints. The study confirmed the safety of naltrexone 50 mgs once daily for the treatment of alcohol dependence. It was well tolerated. No new safety concerns were identified. Reference: Gianoulakis C, Krishnan B, Thavundayil J. (1996) Enhanced sensitivity of pituitary ?-endorphin to ethanol in subjects at high risk of alcoholism Arch Gen Psychiat 53: 250-7 Reference: O'Malley, SS, Croup RS,, Wroblewski MS, Labriola DF, Volpicelli JR (1995) Naltrexone in the treatment of alcohol dependence: a combined analysis of two trials. Psychiatric Annals 25, 681-8. Reference: Swift RM, Whelihan W, Kuznetsov O, Buongiorno G, Hsuing H (1994) Naltrexone-induced alterations in human ethanol intoxication. Am J Psychiatry, 151: 1463-1467
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/419/CN-00279419/frame.html

Record #101 of 108
ID: CN-01199290
AU: D'Onofrio G
AU: O'Connor P
AU: Pantalon M
AU: Chawarski M
AU: Busch S
AU: Owens P
AU: Bernstein S
AU: Fiellin D
TI: A randomized clinical trial of emergency department initiated treatment for opioid dependence: two and six month outcomes
SO: Drug and alcohol dependence.
YR: 2015
VL: 156
PG: e53
XR: EMBASE 72176531
PT: Journal: Conference Abstract
KY: *human; *clinical trial; *emergency ward; *opiate addiction; *college; *drug dependence; patient; primary medical care; drug use; screening; analysis of variance; self report; substance abuse; interview; community; opiate; buprenorphine; illicit drug
DOI: 10.1016/j.drugalcdep.2015.07.1062
AB: Aims: Screening and Brief Intervention (SBIRT) followed by EDinitiated buprenorphine (Bup) with ongoing treatment in primary care (BupPC) is superior to referral to community-based treatment (RT) and SBIRT alone in engaging opioid dependent patients in treatment and decreasing drug use at 30-days. We evaluated the impact of these methods at 2 and 6 months. Methods: We conducted a randomized clinical trial in 329 opioid dependent ED patients that compared RT, SBIRT, and BupPC. RT patients (n = 104) received a referral to a substance use disorder (SUD) provider, SBIRT patients (n = 111) received a Brief Negotiation Interview and a facilitated referral to a SUD provider, BupPC patients (n = 114) received SBIRT and ED-initiated BUP with ongoing BUP in primary care for 10 weeks followed by transfer to ongoingSUDtreatment or taper as per patient request. Primary outcomes were self-report of current engagement in SUD treatment and illicit opioid use at 2 and 6 months. Analyses were conducted using chi-square and analysis of variance. Results: Patients in RT and SBIRT groups were less likely to be engaged in treatment compared with the BupPC group at 2 months, 53%, 47%, and 76%, respectively, p < 0.001. There was no difference in treatment engagement between groups at 6 months, 56%, 57%, 55%; p > 0.05. At 2 months, the mean number of days of illicit opioid use in the past week for RT, SBIRT and BupPC was 1.8, 2.0 and 1.1 days; p = 0.04 for comparison between SBIRT and BupPC. There was no difference in illicit opioid use between treatment groups at 6 months: 1.5, 2.0, 1.6 days; p = 0.54. Conclusions: BupPC was superior to RT and SBIRT for engaging opioid dependent patients in treatment and reducing illicit drug use during the period that primary care-based BUP was provided. While all treatments engaged patients and decreased illicit opioid use, BupPC offers the greatest benefit to opioid dependent ED patients.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/290/CN-01199290/frame.html

Record #102 of 108
ID: CN-00724213
AU: Tamayo-Sarver JH
AU: Dawson NV
AU: Cydulka RK
AU: Wigton RS
AU: Baker DW
TI: Variability in emergency physician decision making about prescribing opioid analgesics
SO: Annals of emergency medicine
YR: 2004
VL: 43
NO: 4
PG: 483-493
CC: SR-ANAESTH: SR-SYMPT
AB: STUDY OBJECTIVE: The purpose of this study is to determine what factors influence emergency physicians' decisions to prescribe an opioid analgesic for 3 common, painful conditions. METHODS: We developed items thought to influence the decision to prescribe an opioid analgesic through a review of the literature, expert consultation, and interviews with practicing emergency physicians. We developed a baseline vignette and items expected to influence the decision for each of the 3 conditions: migraine, back pain, and ankle fracture. We surveyed 650 physicians randomly selected from the American College of Emergency Physicians. The influence of individual items was explored through a univariate analysis of the response distribution. Patterns were assessed by analytically creating scales. RESULTS: We received responses from 398 (63%) of the 634 eligible physicians. Physicians' likelihoods of prescribing an opioid showed marked variability, with at least 10% of physicians saying they were unlikely and 10% of physicians saying they were likely to prescribe for each condition. Physician responses to individual pieces of clinical information, such as the patient requesting "something strong" for the pain, were also highly variable, with at least 10% of physicians saying they would be negatively influenced by this request and at least 10% saying they would be positively influenced by it. CONCLUSION: Even when faced with identical case scenarios, physicians' decisions to prescribe opioid analgesics are highly variable. Moreover, the same clinical information, such as a patient requesting a strong analgesic, changes the likelihood of prescribing opioids in opposite directions for different physicians
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/213/CN-00724213/frame.html

Record #103 of 108
ID: CN-00887948
AU: Deogaonkar A
AU: Khin M
AU: Samuel S
AU: Ebrahim ZY
AU: Mascha EJ
AU: Schubert A
TI: Gender rather than choice of intermediate duration opioids affects emergence after craniotomy for large intracranial tumors
SO: Ochsner journal
YR: 2011
VL: 11
NO: 1
PG: 22-28
XR: EMBASE 361537973
PT: Journal: Article
KY: adult; *anesthesia emergence; anesthesia induction; *anesthetic recovery; arousal; article; bolus injection; continuous infusion; controlled study; craniotomy; female; human; *intracranial tumor/su [Surgery]; major clinical study; male; minimum lung alveolus concentration; outcome assessment; prospective study; randomized controlled trial; sex difference; treatment duration; alfentanil/ct [Clinical Trial]; alfentanil/cb [Drug Combination]; fentanyl/ct [Clinical Trial]; fentanyl/cb [Drug Combination]; isoflurane/cb [Drug Combination]; *narcotic analgesic agent/cb [Drug Combination]; nitrous oxide/cb [Drug Combination]; sufentanil/ct [Clinical Trial]; sufentanil/cb [Drug Combination]; thiopental/cb [Drug Combination]; blood pressure; *craniotomy; *drug combination; extubation; *gender; incision; infusion; *intracranial tumor; laryngoscopy; neurologic examination; neurosurgery; patient; post hoc analysis; *surgery; survival; *alfentanil; *anesthetic agent; *fentanyl; isoflurane; nitrous oxide; opiate; *sufentanil
AB: Background: Opioid-based anesthetic techniques are commonly used during neurosurgical procedures. In the present randomized prospective study, we studied emergence after 4 anesthetic regimens combining intermediate duration opioids with isoflurane and nitrous oxide (N2O), in patients undergoing craniotomy for large (> 30 mm diameter with intracranial mass effect) intracranial tumors. Methods: One hundred seven patients were randomized into 4 groups: Group A: fentanyl (< 5 mug/kg) + isoflurane (< 1 minimum alveolar concentration [MAC]), Group B: sufentanil (1-2 mug/kg plus infusion) + isoflurane (< 0.5 MAC), Group C: sufentanil (2 mg/kg bolus only) + isoflurane (< 1 MAC), and Group D: alfentanil (100 mug/kg plus infusion) + isoflurane (< 0.5 MAC). Boluses were administered as divided doses during induction, laryngoscopy, head pinning, and incision. Blood pressure was controlled at +/-25% of baseline levels. All infusions were discontinued at the start of dural closure. Emergence was assessed using a mini-neurologic examination consisting of 7 questions. Groups were compared on time to emergence using survival analysis methods. Results: The groups did not differ regarding extubation time, which occurred at a median of 4 to 6 minutes across groups after discontinuing N2O. The median emergence time ranged from 15 to 22.5 minutes and did not differ among groups. However, across all groups more women had emerged by 30 minutes compared with men (83% vs 57%, P =.002). The median emergence time in women was found to be significantly shorter (0-15 minutes) than in men (15-30 minutes) (P =.012). Conclusions: No between-group differences in emergence time were observed; the study was stopped early because of evidence that no differences were likely to be found if the study were continued. However, in a post hoc analysis, female gender was associated with faster emergence. © Academic Division of Ochsner Clinic Foundation.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/948/CN-00887948/frame.html

Record #104 of 108
ID: CN-00080215
AU: McCrirrick A
AU: Ramage DT
TI: Caudal blockade for postoperative analgesia: a useful adjunct to intramuscular opiates following emergency lower leg orthopaedic surgery
SO: Anaesthesia and intensive care
YR: 1991
VL: 19
NO: 4
PG: 551-554
PM: PUBMED 1750637
PT: Clinical Trial; Journal Article; Randomized Controlled Trial
KY: Analgesia, Epidural;Ankle [surgery];Bupivacaine [administration & dosage] [therapeutic use];Double-Blind Method;Emergencies;Injections, Intramuscular;Injections, Intravenous;Leg [surgery];Nerve Block;Opium [administration & dosage] [therapeutic use];Pain Measurement;Pain, Postoperative [prevention & control];Sacrum;Time Factors;Adult[checkword];Female[checkword];Humans[checkword];Male[checkword]
CC: SR-ANAESTH: SR-SYMPT
AB: The efficacy of a single caudal epidural injection of bupivacaine 20 ml 0.5% following emergency orthopaedic surgery to the lower leg and ankle was investigated. Forty adult patients were studied, randomised to either the caudal or control group. The mean 24 hour postoperative papaveretum consumption was significantly reduced in the caudal group. Analogue pain scores as assessed in a double-blind manner were also significantly reduced in this group. The duration of analgesia after caudal blockade was approximately eight hours as estimated by the average time to the first dose of papaveretum. Our study demonstrates that caudal blockade represents an effective adjunct to intramuscular opiates following this type of surgery.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/215/CN-00080215/frame.html

Record #105 of 108
ID: CN-00877357
AU: Chang AK
AU: Bijur PE
AU: Lupow JB
AU: John Gallagher E
TI: Randomized clinical trial of efficacy and safety of a single 2-mg intravenous dose of hydromorphone versus usual care in the management of acute pain
SO: Academic emergency medicine
YR: 2013
VL: 20
NO: 2
PG: 185-192
PM: PUBMED 23406078
PT: Comparative Study; Journal Article; Randomized Controlled Trial
KY: Acute Pain [drug therapy];Analgesics, Opioid [administration & dosage] [adverse effects];Hydromorphone [administration & dosage] [adverse effects];Pain Management [methods];Pain Measurement;Treatment Outcome;Adult[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword];Young Adult[checkword]
DOI: 10.1111/acem.12071
AB: METHODSThis was a randomized clinical trial. Patients allocated to 2 mg of IV hydromorphone received their medication in a single dose. Those randomized to usual care received any IV opioid, with type, dose, and frequency chosen by the ED attending. All patients received 2 L/min. nasal cannula oxygen. The primary outcome was the difference in the proportion of patients who achieved clinically satisfactory analgesia by 30 minutes. This was defined as the patient declining additional analgesia when asked the question, "Do you want more pain medicine?" A 10% absolute difference was chosen a priori as the minimum difference considered clinically significant.RESULTSOf 175 subjects randomized to each group, 164 in the 2 mg hydromorphone group and 161 in the usual care group had sufficient data for analysis. Additional pain medication was declined by 77.4% of patients in the 2 mg hydromorphone group at 30 minutes, compared to 65.8% in the usual care group. This difference of 11.6% was statistically and clinically significant (95% confidence interval [CI] = 1.8% to 21.1%). Safety profiles were similar and no patient required naloxone. There was more pruritus in the hydromorphone group (18.3% vs. 8.7%; difference = 9.6%, 95% CI = 2.6% to 16.6%).CONCLUSIONSUsing a simple dichotomous patient-centered endpoint in which a difference of 10% in proportion obtaining adequate analgesia was considered clinically significant, 2 mg of hydromorphone in a single IV dose is clinically and statistically more efficacious when compared to usual care for acute pain management in the ED.OBJECTIVESThe objective was to test the efficacy and safety of 2 mg of intravenous (IV) hydromorphone (Dilaudid) against "usual care" in emergency department (ED) patients with acute severe pain.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/357/CN-00877357/frame.html

Record #106 of 108
ID: CN-01213918
AU: Darwish M
AU: Bond M
AU: Ma Y
AU: Tracewell W
AU: Robertson P
AU: Webster LR
TI: Evaluation of the abuse potential of a hydrocodone extended-release bitartrate tablet formulated with cima abuse-deterrence technology platform in nondependent, recreational opioid users
SO: Postgraduate medicine. Conference: 2016 pain week conference. United states. Conference start: 20160906. Conference end: 20160910
YR: 2016
VL: 128
PG: 12-13
XR: EMBASE 612036800
PT: Journal: Conference Abstract
KY: adult; beverage; clinical article; clinical trial; controlled clinical trial; controlled study; crossover procedure; double blind procedure; drug therapy; human; human tissue; oral drug administration; pharmacokinetic parameters; pharmacokinetics; plasma; powder; questionnaire; randomized controlled trial; safety; *tablet; visual analog scale; hydrocodone; *opiate; placebo; *tartaric acid
DOI: 10.1080/00325481.2016.1224633
AB: Purpose The increasing prevalence of recreational use of prescription pain relievers is evident in the rising number of emergency department visits and deaths related to misuse/abuse of these agents over the past 10 years. These observations have prompted development of abuse-deterrent formulations. This study assessed the abuse potential, pharmacokinetics, and safety of finely crushed and intact hydrocodone extendedrelease (ER) tablets formulated with a CIMA Abuse- Deterrence Technology platform vs. immediate-release (IR) hydrocodone. Method This randomized, double-blind, triple-dummy, placebocontrolled, crossover study was conducted in healthy adults with histories of nondependent, recreational opioid use. Subjects able to tolerate a dose of IR hydrocodone 45 mg and differentiate its effects from those of placebo were randomized to treatment. All subjects received finely crushed hydrocodone ER 45-mg tablet, intact hydrocodone ER 45-mg tablet, IR hydrocodone 45-mg powder in a noncarbonated beverage, and finely crushed placebo. The primary endpoint was maximum effect (Emax) of "at the moment" Drug Liking based on the Drug Liking and Effects Questionnaire (question 1), and a key secondary endpoint was Overall Drug Liking over 24 hours after study drug administration; both were scored on a 100-point visual analog scale (0=strong disliking, 50=neutral, and 100=strong liking). A subject's willingness or desire to take the drug again was assessed with the Take Drug Again Assessment (TDAA) score (0=definitely would not to 100=definitely would). Pharmacokinetic parameters and safety were also evaluated. Results In total, 45 subjects were evaluable for relative abuse potential. Significantly lower mean Emax for "at the moment" Drug Liking was observed after administration of finely crushed hydrocodone ER (66.9) compared with IR hydrocodone (85.2; P<0.001). Overall Drug Liking was also significantly lower for finely crushed hydrocodone ER (59.0) compared with IR hydrocodone (75.0; P<0.001). Findings were similar for comparisons of drug liking between intact hydrocodone ER and IR hydrocodone. "At the moment" Drug Liking was significantly lower for intact hydrocodone ER (53.9) compared with IR hydrocodone (85.2; P<0.001), and Overall Drug Liking was significantly lower for intact hydrocodone ER (49.2) compared with IR hydrocodone (75.0; P<0.001). Drug liking after administration of placebo was comparable to that after administration of intact hydrocodone ER ("at the moment" Drug Liking: 53.2 vs. 53.9; Overall Drug Liking: 51.1 vs. 49.2). TDAA scores were significantly lower for intact and finely crushed hydrocodone ER vs. IR hydrocodone (46.4 and 58.7 vs. 75.2; P<0.001), indicating that subjects were significantly less likely to want to take either hydrocodone ER formulation again compared with IR hydrocodone. TDAA scores were comparable in subjects administered intact hydrocodone ER and placebo (46.4 vs. 47.2; no statistical comparison was conducted). The 72-hour plasma concentration- time profile for each treatment paralleled its respective "at the moment" drug liking over time profile (ie, pharmacokinetic and pharmacodynamic profiles were qualitatively similar for each treatment). No unexpected safety signals were observed. Conclusions Assessments of "at the moment" Drug Liking and Overall Drug Liking over 24 hours showed that the abuse potential with oral use of hydrocodone ER, the most common route of abuse for hydrocodone products, is significantly lower for finely crushed and intact tablets developed with CIMA Abuse- Deterrence Technology platform compared with IR hydrocodone in nondependent, recreational opioid users. Hydrocodone ER administered orally intact had liking scores similar to those for placebo. Pharmacokinetic profiles are consistent with and supportive of the drug liking measures.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/918/CN-01213918/frame.html

Record #107 of 108
ID: CN-00309803
AU: Roosbroeck D
AU: Himpe D
AU: Borms S
AU: Theunissen W
AU: Vandermeersch E
TI: Hip surgery and effects of intra-operative opioids on emergence: remifentanil (R) vs. sufentanil (S)
SO: Br-j-anaesth
YR: 1999
VL: 82 Suppl 1
PG: 130-131
CC: HS-HANDSRCH
AB: European Society of Anaesthesiologists Annual Congress, Amsterdam, The Netherlands, 29 May-1 June 1999.
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/803/CN-00309803/frame.html

Record #108 of 108
ID: CN-00597760
AU: Hargreaves K
AU: Lenton S
AU: Phillips M
AU: Swensen G
TI: Potential impacts on the incidence of fatal heroin-related overdose in Western Australia: a time-series analysis
SO: Drug and alcohol review
YR: 2002
VL: 21
NO: 4
PG: 321-327
CC: SR-EPOC
AB: In response to the rising concerns about the rate of heroin-related fatalities, overdose prevention campaigns, run by both users' organizations and government agencies, have been implemented in a number of states across Australia. In Western Australia (WA) in mid-1997, various overdose prevention initiatives were implemented. These included the implementation of a protocol limiting police presence at overdose events; the commencement of naloxone administration by ambulance staff; and the establishment of the Opiate Overdose Prevention Strategy (OOPS) which provided follow-up for individuals treated for overdose in emergency departments. This paper reports the results of a multiple linear regression analysis of 60 months of time-series data, both prior to and following the implementation of these interventions, to determine their impact on the number of fatal heroin overdoses inWA. The model employed in the analysis controlled for changes over time in proxy indicators of use and community concerns about heroin, as well as market indicators. The results suggest that, although the interventions implemented have managed to reduce the expected number of fatalities, they have become less successful in doing so as time passes. This has implications for both existing and potential interventions to reduce fatal heroin-related overdose
US: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/760/CN-00597760/frame.html

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